Maternal Late-Pregnancy Serum Unmetabolized Folic Acid Concentrations Are Not Associated with Infant Allergic Disease: A Prospective Cohort Study

ABSTRACT Background The increase in childhood allergic disease in recent decades has coincided with increased folic acid intakes during pregnancy. Circulating unmetabolized folic acid (UMFA) has been proposed as a biomarker of excessive folic acid intake. Objective We aimed to determine if late-pregnancy serum UMFA and total folate concentrations were associated with allergic disease risk in the offspring at 1 y of age in a population at high risk of allergy. Methods The cohort consisted of 561 mother–infant pairs from Western Australia. To be eligible the infant had to have a first-degree relative (mother, father, or sibling) with a history of medically diagnosed allergic disease. Maternal venous blood was collected between 36 and 40 wk of gestation. Serum UMFA was measured by LC–tandem MS. Serum total folate was determined using a microbiological method with chloramphenicol-resistant Lactobacillus rhamnosus as the test organism, and was collected between 36 and 40 wk of gestation. UMFA concentrations were measured by tandem MS using stable isotope dilution; folate concentrations were determined using the microbiological method with standardized kits. Infant allergic disease outcomes of medically diagnosed eczema, steroid-treated eczema, atopic eczema, IgE-mediated food allergy, allergen sensitization, and medically diagnosed wheeze were assessed at 1 y of age. Results Median (IQR) concentrations for UMFA and serum folate were 1.6 (0.6–4.7) and 53.2 (32.6–74.5) nmol/L, respectively. Of the infants, 34.6% had medically diagnosed eczema, 26.4% allergen sensitization, and 14.9% had an IgE-mediated food allergy. In both adjusted and unadjusted models there was little evidence of association between UMFA or serum folate and any of the infant allergy outcomes. Conclusions In this cohort of children at high risk of allergic disease there was no association between maternal UMFA or serum folate concentrations measured in late pregnancy and allergic disease outcomes at 1 y of age.

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Maternal late-pregnancy serum unmetabolized folic acid concentrations are not associated with infant allergic disease - A prospective cohort study

10.1101/2020.10.29.20222588 ◽

2020 ◽

Author(s):

Karen P Best ◽

Tim J Green ◽

Dian Sulistyoningrum ◽

Thomas R Sullivan ◽

Susanne Aufreiter ◽

...

Keyword(s):

Food Allergy ◽

Folic Acid ◽

High Risk ◽

Allergic Disease ◽

Disease Risk ◽

Late Pregnancy ◽

Serum Folate ◽

Allergen Sensitization ◽

Disease Outcomes ◽

Ige Mediated

AbstractBackgroundThe increase in childhood allergic disease in recent decades has coincided with increased folic acid intakes during pregnancy. Circulating unmetabolized folic acid (UMFA) has been proposed as a biomarker of excessive folic acid intake.ObjectiveWe aimed to determine if late-pregnancy serum UMFA and total folate concentrations were associated with allergic disease risk in the offspring at one year of age in a population at high risk of allergy.MethodsThe cohort consisted of 561 mother-infant pairs from Western Australia. To be eligible the infant had a first-degree relative (mother, father or sibling) with a history of medically diagnosed allergic disease. Maternal serum was collected between 36 and 40 weeks of gestation. UMFA concentrations were measured by tandem mass spectrometry using stable isotope dilution, folate concentrations were determined using the microbiological method with standardized kits. Infant allergic disease outcomes of medically diagnosed eczema, steroid treated eczema, atopic eczema, IgE-mediated food allergy, allergen sensitization and medically diagnosed wheeze were assessed at 1 year of age.ResultsMedian (IQR) for UMFA and serum folate was 1.6 (0.6-4.7) and 53.2 (32.6-74.5) nmol/L, respectively. Of the infants, 34.6% had medically diagnosed eczema, 26.4% allergen sensitization and 14.9% had an IgE-mediated food allergy. In both adjusted and unadjusted models there was little evidence of association between UMFA or serum folate and any of the infant allergy outcomes.ConclusionIn this cohort of children at high risk for allergic disease there was no association between maternal UMFA or serum folate measured in late pregnancy and allergic disease outcomes at 1 year of age.

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Maternal Folic Acid Supplementation during Pregnancy and Childhood Allergic Disease Outcomes: A Question of Timing?

Nutrients ◽

10.3390/nu9020123 ◽

2017 ◽

Vol 9 (2) ◽

pp. 123 ◽

Cited By ~ 28

Author(s):

Catrina McStay ◽

Susan Prescott ◽

Carol Bower ◽

Debra Palmer

Keyword(s):

Folic Acid ◽

Allergic Disease ◽

Folic Acid Supplementation ◽

Acid Supplementation ◽

Disease Outcomes

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Adult-onset IgE-mediated food allergy at a Winnipeg allergy clinic: a case series

Allergy Asthma & Clinical Immunology ◽

10.1186/s13223-020-00483-5 ◽

2020 ◽

Vol 16 (1) ◽

Author(s):

Graham Walter ◽

Chrystyna Kalicinsky

Keyword(s):

Food Allergy ◽

Allergic Disease ◽

Adult Population ◽

Case Series ◽

Atopic Disease ◽

Adult Onset ◽

Allergy And Immunology ◽

Canadian Population ◽

Ige Mediated ◽

Exercise Induced

Abstract Background It is a putatively understood phenomenon that the overall prevalence of allergic disease has been increasing in recent decades—particularly in industrialized nations. Despite this, there is a relative scarcity of data concerning the development of food-related allergic disease in the adult population. In addition, the paucity of data as it pertains to the Canadian population is particularly marked when compared to other nations. We sought to determine common culprit foods and the reactions they elicited in a series of 14 patients seen in the Winnipeg allergy and immunology clinic. Methods We conducted a retrospective review of patients identified by academic allergists in Winnipeg, Manitoba as fitting criteria for adult-onset IgE-mediated food allergy from May 2018–July 2020. We included patients with IgE-mediated symptoms, including the pollen-food syndrome which developed at the age of 16 or later. We collected data regarding the food which induced the reaction, what the reaction was, and any concomitant atopic disease. Results The most common culprit food identified was shellfish, followed by finfish, pollen-food syndrome, and wheat/flour. The most common reaction experienced was anaphylaxis, followed by food-dependent exercise-induced anaphylaxis and isolated (muco)cutaneous symptoms. With regard to concomitant atopic disease, allergic rhinitis/rhinoconjunctivitis stood out as the most prevalent. Conclusions Adult-onset food allergy—particularly with resultant anaphylaxis—is an important phenomenon to recognize, even when patients have previously tolerated the food in question.

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Allergic disease and risk of stress in pregnant women: a PreventADALL study

ERJ Open Research ◽

10.1183/23120541.00175-2020 ◽

2020 ◽

Vol 6 (4) ◽

pp. 00175-2020

Author(s):

Caroline-Aleksi Olsson Mägi ◽

Anders Bjerg Bäcklund ◽

Karin Lødrup Carlsen ◽

Catarina Almqvist ◽

Kai-Håkon Carlsen ◽

...

Keyword(s):

Allergic Rhinitis ◽

Atopic Dermatitis ◽

Food Allergy ◽

Linear Regression ◽

Pregnant Women ◽

Allergic Disease ◽

Maternal Stress ◽

High Stress ◽

Late Pregnancy ◽

In Pregnancy

BackgroundMaternal stress during pregnancy may negatively affect the health of mother and child. We therefore aimed to identify the proportion of women reporting high maternal stress in mid and late pregnancy and explore whether symptoms of maternal allergic disease are associated with perceived maternal stress in late pregnancy.MethodThe population-based Preventing Atopic Dermatitis and Allergy in Children (PreventADALL) study enrolled 2697 pregnant women at their 18-week routine ultrasound examination in Norway and Sweden. Information about sociodemographic factors, symptoms and doctor-diagnosed asthma, allergic rhinitis, atopic dermatitis, food allergy, and anaphylaxis and stress using the 14-item perceived stress scale (PSS) was collected at 18 weeks (mid) and 34 weeks (late) pregnancy. High stress was defined as a PSS score ≥29. Scores were analysed using multivariate logistic and linear regression.ResultsAmong the 2164 women with complete PSS data, 17% reported asthma, 20% atopic dermatitis, 23% allergic rhinitis, 12% food allergy and 2% anaphylaxis. The proportion of women reporting high stress decreased from 15% at mid to 13% at late pregnancy (p<0.01). The adjusted odds ratio for high stress in late pregnancy was 2.25 (95% CI 1.41–3.58) for self-reported symptoms of asthma, 1.46 (95% CI 1.02–2.10) for allergic rhinitis and 2.25 (95% CI 1.32–3.82) for food allergy. A multivariate linear regression model confirmed that symptoms of asthma (β coefficient 2.11; 0.71–3.51), atopic dermatitis (β coefficient 1.76; 0.62–2.89) and food allergy (β coefficient 2.24; 0.63–3.84) were independently associated with increased PSS score.ConclusionAllergic disease symptoms in pregnancy were associated with increased stress, highlighting the importance of optimal disease control in pregnancy.

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In “High-Risk” Infants with Sufficient Vitamin D Status at Birth, Infant Vitamin D Supplementation Had No Effect on Allergy Outcomes: A Randomized Controlled Trial

Nutrients ◽

10.3390/nu12061747 ◽

2020 ◽

Vol 12 (6) ◽

pp. 1747 ◽

Cited By ~ 1

Author(s):

Kristina Rueter ◽

Anderson P. Jones ◽

Aris Siafarikas ◽

Ee-Mun Lim ◽

Susan L. Prescott ◽

...

Keyword(s):

Vitamin D ◽

High Risk ◽

Allergic Disease ◽

Controlled Trial ◽

Vitamin D Supplementation ◽

Vitamin D Status ◽

Disease Outcomes ◽

Vitamin D Levels ◽

High Risk Infants ◽

Sufficient Vitamin

Lower vitamin D status at birth and during infancy has been associated with increased incidence of eczema and food allergies. The aim of this study was to investigate the effect of early infancy vitamin D supplementation on allergic disease outcomes in infants at “hereditary risk” of allergic disease, but who had sufficient vitamin D levels at birth. Here, we report the early childhood follow-up to 2.5 years of age of “high-risk” infants who participated in a double-blinded, randomized controlled trial. For inclusion in this trial, late gestation (36–40 weeks) maternal 25-hydroxyvitamin D levels needed to be ≥50 nmol/L. Infants were randomized to either oral vitamin D supplementation of 400 IU/day (n = 97) or a placebo (n = 98) for the first six months of life. Vitamin D levels and allergic disease outcomes were followed up. There were no statistically significant differences in incidence of any medically diagnosed allergic disease outcomes or allergen sensitization rates between the vitamin D-supplemented and placebo groups at either 1 year or at 2.5 years of age. In conclusion, for “allergy high-risk” infants who had sufficient vitamin D status at birth, early infancy oral vitamin D supplementation does not appear to reduce the development of early childhood allergic disease.

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Adult-onset IgE-mediated food allergy at a Winnipeg allergy clinic – a case series

10.21203/rs.3.rs-51706/v2 ◽

2020 ◽

Author(s):

Graham Walter ◽

Chrystyna Kalicinsky

Keyword(s):

Food Allergy ◽

Allergic Disease ◽

Adult Population ◽

Case Series ◽

Atopic Disease ◽

Adult Onset ◽

Allergy And Immunology ◽

Canadian Population ◽

Ige Mediated ◽

Exercise Induced

Abstract Background It is a putatively understood phenomenon that the overall prevalence of allergic disease has been increasing in recent decades – particularly in industrialized nations. Despite this, there is a relative scarcity of data concerning the development of food-related allergic disease in the adult population. In addition, the paucity of data as it pertains to the Canadian population is particularly marked when compared to other nations. We sought to determine common culprit foods and the reactions they elicited in a series of 14 patients seen in the Winnipeg allergy and immunology clinic.Methods We conducted a retrospective review of patients identified by academic allergists in Winnipeg, Manitoba as fitting criteria for adult-onset IgE-mediated food allergy from May 2018 – July 2020. We included patients with IgE-mediated symptoms, including the pollen-food syndrome which developed at the age of 16 or later. We collected data regarding the food which induced the reaction, what the reaction was, and any concomitant atopic disease.ResultsThe most common culprit food identified was shellfish, followed by finfish, pollen-food syndrome, and wheat/flour. The most common reaction experienced was anaphylaxis, followed by food-dependent exercise-induced anaphylaxis and isolated (muco)cutaneous symptoms. With regard to concomitant atopic disease, allergic rhinitis/rhinoconjunctivitis stood out as the most prevalent.Conclusions Adult-onset food allergy – particularly with resultant anaphylaxis – is an important phenomenon to recognize, even when patients have previously tolerated the food in question.

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Adult-Onset IgE-Mediated Food Allergy in Manitoba

10.21203/rs.3.rs-51706/v1 ◽

2020 ◽

Author(s):

Graham Walter ◽

Chrystyna Kalicinsky

Keyword(s):

Food Allergy ◽

Allergic Disease ◽

Adult Population ◽

Atopic Disease ◽

Adult Onset ◽

Allergy And Immunology ◽

Canadian Population ◽

Industrialized Nations ◽

Ige Mediated ◽

Exercise Induced

Abstract BackgroundIt is a putatively understood phenomenon that the overall prevalence of allergic disease has been increasing in recent decades – particularly in industrialized nations. Despite this, there is a relative scarcity of data concerning the development of food-related allergic disease in the adult population. In addition, the paucity of data as it pertains to the Canadian population is particularly marked when compared to other nations. We sought to determine common culprit foods and the reactions they elicited in a series of 14 patients seen in the Winnipeg allergy and immunology clinic. MethodsWe conducted a retrospective review of patients identified by academic allergists in Winnipeg, Manitoba as fitting criteria for adult-onset IgE-mediated food allergy from May 2018 – July 2020. We included patients with IgE-mediated symptoms, including the food pollen syndrome which developed at the age of 16 or later. We collected data regarding the food which induced the reaction, what the reaction was, and any concomitant atopic disease.ResultsThe most common culprit food identified was shellfish, followed by finfish, food pollen syndrome, and wheat/flour. The most common reaction experienced was anaphylaxis, followed by food-dependent exercise-induced anaphylaxis and isolated (muco)cutaneous symptoms. With regard to concomitant atopic disease, allergic rhinitis/rhinoconjunctivitis stood out as the most prevalent.ConclusionsAdult-onset food allergy – particularly with resultant anaphylaxis – is an important phenomenon to recognize, even when patients have previously tolerated the food in question.

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Introduction of Complementary Foods to Infants

Annals of Nutrition and Metabolism ◽

10.1159/000457928 ◽

2017 ◽

Vol 70 (Suppl. 2) ◽

pp. 47-54 ◽

Cited By ~ 5

Author(s):

Christina West

Keyword(s):

Food Allergy ◽

High Risk ◽

Infant Feeding ◽

Allergic Disease ◽

Peanut Allergy ◽

Future Research ◽

Optimal Timing ◽

Controlled Trials ◽

Allergy Prevention ◽

Complementary Foods

While earlier food allergy prevention strategies implemented avoidance of allergenic foods in infancy, the current paradigm is shifting from avoidance to controlled exposure. This review focuses on the outcome of recent randomized controlled trials, which have examined the early introduction of allergenic foods for allergy prevention, and discusses the implementation of results in clinical practice. In infants at high risk of allergic disease, there is now direct evidence that regular early peanut consumption will reduce the prevalence of peanut allergy, compared to avoidance. Many international infant feeding guidelines already recommend complementary foods, including allergenic foods, to be introduced from 4 to 6 months of age irrespective of family history risk. Interim guidelines from 10 International Pediatric Allergy Associations state that healthcare providers should recommend the introduction of peanut-containing products into the diets of infants at high risk of allergic disease in countries where peanut allergy is prevalent. Direct translation of the results obtained from a cohort of high-risk infants to the general population has proved difficult, and issues regarding feasibility, safety, and cost-effectiveness have been raised. Five randomized placebo-controlled trials have assessed the effects of early egg exposure in infancy with varying results. In a recent comprehensive meta-analysis, there was moderate-certainty evidence that early versus late introduction of egg was associated with a reduced egg allergy risk. Although promising, optimal timing, doses, and if the feeding regimen should be stratified according to infant allergy risk remain to be determined. The single study that assessed introduction of multiple foods from 3 months whilst breastfeeding compared with exclusive breastfeeding until 6 months of age showed no reduction in food allergy prevalence. Future research should aim at optimizing infant feeding regimens and support a tolerogenic gastrointestinal microenvironment during the period of food allergen introduction.

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