Exploration of parent-reported food allergy symptoms via breastmilk exposures and likelihood to develop tolerance

Abstract Background Knowledge is limited about the relationship between clinical reactivity to foods through breastfeeding and long-term food allergy outcomes. We explored parent-perceived symptoms of food allergy via breastfeeding and the association with future tolerance. Methods Subjects identified from the Chicago Food Allergy Study (2005–2011) were categorized by parent-reported reactions to maternally ingested foods via breastfeeding (50/898 peanut-allergic, 69/620 egg-allergic, and 153/589 milk-allergic). The primary outcome was tolerance [passed oral food challenge (OFC) or consumption of previously implicated food]. Secondary outcomes included severe reactions (anaphylaxis and/or cardiovascular/respiratory symptoms) and additional concomitant food allergies. Univariate chi-square analyses were performed to assess for association between variables, followed by logistic regression models. Results Of the 50 subjects with parent-reported peanut-associated symptoms with breastfeeding, none gained tolerance. There were no significant associations between parent-reported breastfeeding symptoms and development of tolerance for egg and milk (egg: OR 0.46, 95% CI 0.21–1.01, p = 0.053; milk: OR 1.13, 95% CI 0.70–1.81, p = 0.614). All egg-allergic subjects with parent-perceived symptoms while breastfeeding also reported multiple food allergies (n = 69), but milk- and peanut-allergic subjects were not more likely to have multiple allergies (milk: OR 1.89, 95% CI 0.88–4.02, p = 0.10; peanut: OR 2.36, 95% CI 0.72–7.76, p = 0.16). There were no significant associations between parent-reported breastfeeding symptoms and subsequent reaction severity. Conclusions A significant proportion of parents perceive symptoms of food allergy attributable to indirect breastfeeding exposures. Our exploratory analysis suggests that infants with parent-perceived clinical reactivity to peanut via breastmilk may be less likely to gain tolerance. Infants with parent-reported reactivity to egg via breastmilk exposure were more likely to report multiple food allergies. Further rigorous prospective studies are needed to clarify the true prevalence of IgE-mediated food allergy symptoms attributable to indirect breastfeeding exposures and the association with development of tolerance.

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Using oral food challenges to provide clarity and confidence when diagnosing food allergies

Journal of Food Allergy ◽

10.2500/jfa.2021.3.210002 ◽

2021 ◽

Vol 3 (1) ◽

pp. 3-7 ◽

Cited By ~ 1

Author(s):

Justin Greiwe

Keyword(s):

Food Allergy ◽

Immunoglobulin E ◽

Food Challenge ◽

Clinical History ◽

The United States ◽

Oral Immunotherapy ◽

Food Allergies ◽

Ige Mediated ◽

Challenge Education ◽

Food Challenges

A verified food allergy can be an impactful life event that leads to increased anxiety and measurable effects on quality of life. Allergists play a key role in framing this discussion and can help alleviate underlying fears by promoting confidence and clarifying safety concerns. Correctly diagnosing a patient with an immunoglobulin E (IgE) mediated food allergy remains a nuanced process fraught with the potential for error and confusion. This is especially true in situations in which the clinical history is not classic, and allergists rely too heavily on food allergy testing to provide a confirmatory diagnosis. A comprehensive medical history is critical in the diagnosis of food allergy and should be used to determine subsequent testing and interpretation of the results. Oral food challenge (OFC) is a critical procedure to identify patients with an IgE-mediated food allergy when the history and testing are not specific enough to confirm the diagnosis and can be a powerful teaching tool regardless of outcome. Although the safety and feasibility of performing OFC in a busy allergy office have always been a concern, in the hands of an experienced and trained provider, OFC is a safe and reliable procedure for patients of any age. With food allergy rates increasing and analysis of recent data that suggests that allergists across the United States are not providing this resource consistently to their patients, more emphasis needs to be placed on food challenge education and hands-on experience. The demand for OFCs will only continue to increase, especially with the growing popularity of oral immunotherapy programs; therefore, it is essential that allergists become familiar with the merits and limitations of current testing modalities and open their doors to using OFCs in the office.

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Timing of Food Introduction and the Risk of Food Allergy

Nutrients ◽

10.3390/nu11051131 ◽

2019 ◽

Vol 11 (5) ◽

pp. 1131 ◽

Cited By ~ 4

Author(s):

Valentina Ferraro ◽

Stefania Zanconato ◽

Silvia Carraro

Keyword(s):

Food Allergy ◽

Milk Protein ◽

Scientific Evidence ◽

Low Risk ◽

Food Allergies ◽

Solid Foods ◽

Ige Mediated ◽

Research Challenge ◽

The Relationship ◽

Delayed Exposure

Given that the prevalence of pediatric IgE-mediated food allergies (FA) has followed a substantive increase in recent decades, nowadays, a research challenge is to establish whether the weaning strategy can have a role in FA prevention. In recent decades, several studies have demonstrated that delayed exposure to allergenic foods did not reduce the risk of FA, leading to the publication of recent guidelines which recommend against delaying the introduction of solid foods after 4–6 months of age, both in high- and low-risk infants, in order to prevent food allergy. In the present review, focusing on cow’s milk protein, hen’s eggs, peanuts, soy, wheat and fish, we describe the current scientific evidence on the relationship between timing of these foods’ introduction in infants’ diet and allergy development.

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Oral Food Challenge

Medicina ◽

10.3390/medicina55100651 ◽

2019 ◽

Vol 55 (10) ◽

pp. 651

Author(s):

Calvani ◽

Bianchi ◽

Reginelli ◽

Peresso ◽

Testa

Keyword(s):

Food Allergy ◽

Food Challenge ◽

Clinical History ◽

Specific Ige ◽

Oral Food Challenge ◽

Food Allergies ◽

Pediatric Allergy ◽

Expert Review ◽

Ige Mediated ◽

Food Specific Ige

: Oral food challenge (OFC) is the gold standard for diagnosis of IgE-mediated and non-IgE mediated food allergy. It is usually conducted to make diagnosis, to monitor for resolution of a food allergy, or to identify the threshold of responsiveness. Clinical history and lab tests have poor diagnostic accuracy and they are not sufficient to make a strict diagnosis of food allergy. Higher concentrations of food-specific IgE or larger allergy prick skin test wheal sizes correlate with an increased likelihood of a reaction upon ingestion. Several cut-off values, to make a diagnosis of some food allergies (e.g., milk, egg, peanut, etc.) without performing an OFC, have been suggested, but their use is still debated. The oral food challenge should be carried out by experienced physicians in a proper environment equipped for emergency, in order to carefully assess symptoms and signs and correctly manage any possible allergic reaction. This review does not intend to analyse comprehensively all the issues related to the diagnosis of food allergies, but to summarize some practical information on the OFC procedure, as reported in a recent issue by The Expert Review of Food Allergy Committee of Italian Society of Pediatric Allergy and Immunology (SIAIP)

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Sex Disparity in Food Allergy: Evidence from the PubMed Database

Journal of Allergy ◽

10.1155/2009/159845 ◽

2009 ◽

Vol 2009 ◽

pp. 1-7 ◽

Cited By ~ 19

Author(s):

Caleb Kelly ◽

Venu Gangur

Keyword(s):

Food Allergy ◽

Food Allergies ◽

Female Ratio ◽

Immune Mediated ◽

Pubmed Database ◽

Male Female Ratio ◽

Ige Mediated ◽

Sex Disparity ◽

The Relationship

Food allergies are potentially fatal immune-mediated disorders that are growing globally. The relationship between sex and food allergy remains incompletely understood. Here we tested the hypothesis that, should sex influence the clinical response to food allergens, this would be reflected by a sex disparity in published studies of food allergy. We performed a systematic search of the PubMed literature for IgE-mediated allergy to 11 allergenic foods of international regulatory importance. No date restriction was used and only articles in English were considered. Of the 4744 articles retrieved, 591 met the inclusion criteria representing 17528 subjects with food allergies. Whereas among children with food allergies, 64.35% were males and 35.65% were females (male/female ratio, 1.80), among adults 34.82% were males and 65.18% were females (male/female ratio, 0.53). Consequently, these data argue that there is need for further investigation to define the role of sex in the pathogenesis of food allergy.

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Food allergy in infants assessed in two German birth cohorts 10 years after the EuroPrevall Study

10.22541/au.162209127.71220327/v1 ◽

2021 ◽

Author(s):

Daniela Roehrl ◽

Susanne Brandstetter ◽

Linda Siziba ◽

Dietrich Rothenbacher ◽

Vincent Gaertner ◽

...

Keyword(s):

Food Allergy ◽

Food Challenge ◽

Turn Of The Century ◽

Food Allergies ◽

Birth Cohorts ◽

High Prevalence ◽

The Status ◽

Health Studies ◽

Exposure During Pregnancy ◽

Personalized Health

Background: The prevalence of food allergies (FA) in children increased rapidly at the turn of the century. The EuroPrevall study identified Germany as a country with very high prevalence of FA at that time. Using two large German birth cohorts we provide an update of the status quo ten years later. Methods: KUNO Kids and Ulm SPATZ Health studies are two ongoing prospective birth cohorts. Information on FA was obtained by questionnaires at birth and after 6, 12 and 24 months. Univariate logistic regression analyses were performed to investigate risk factors during pregnancy, birth and early childhood. Results: In 1139 and 1006 children from KUNO Kids and SPATZ the point prevalence of parent-reported FA symptoms at the ages of 1 and 2 years was 13.2% and 13.9 % in KUNO Kids. Doctor’s diagnosed FA at 1 and 2 years was 2.4% and 2.7% in KUNO Kids and 2.3% and 3% in SPATZ. Cow’s milk and citrus fruits were most frequently suspected by parents to cause FA symptoms. Atopy in the child was associated with a higher frequency of FA at any time, whereas atopy in first degree relatives was only associated with FA at year 1. Smoke exposure during pregnancy was a risk for FA at age 2. Conclusion: The prevalence of food allergy seems to have plateaued in the last 10 years in Germany. FA is often suspected by parents but only rarely diagnosed by oral food challenge. Risk factor analysis may help to establish personalized health approaches.

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HUBUNGAN PENGGUNAAN DIAPERS DENGAN KEMAMPUAN TOILETING PADA ANAK

Health Sciences Journal ◽

10.24269/hsj.v2i1.82 ◽

2018 ◽

Vol 2 (1) ◽

pp. 117

Author(s):

Rendika Baharudin Abror ◽

Cholik Harun Rosjidi ◽

Rika Maya Sari

Keyword(s):

Data Collection ◽

Toilet Training ◽

P Value ◽

Developmental Tasks ◽

Chi Square ◽

Cross Sectional ◽

Large Sample ◽

Relationship Of ◽

The Relationship

AbstractEach child has a task that must be passed well, especially at the age of the child (12-36 months). One of the developmental tasks in toddlers is toilet training. Long-term use of diapers can cause toilet effects. This study aims to determine the relationship between diapers with the ability of toileting in children.The design of this research is Correlation with cross sectional approach. Large sample of 70 respondents. Sampling of the study using total sampling, data collection using questionnaires and calculations using Chi-square Correlation test using SPSS 16.0 error α 0.05.The results of the research variables The use of diapers in children interpreted most of the 47 children of respondents (67.1%) Did not use and almost half of the 23 respondents (32.9%) use. The ability of toileting in children is interpreted by most of the 42 respondents (60.0%) fulfilled, and almost half of 28 respondents (40.0%) are not met.Based on the calculation of Chi-square SPSS statistic shows that p value 0,000 <0,05) means that there is relationship of diaper usage with the ability of toileting in children with the closeness of cc relationship of 0.479 enough category.The results of this study concluded that almost half of them use diapers, and almost half of them do not meet the ability of toileting, the researcher suggests in the research place to put a picture or leaflet about the effect of Diaper Usage on Toileting Ability so that the wise mother in using Diapers.Keywords: diapers, toileting, children AbstrakSetiap anak mempunyai tugas perkembangan yang harus dilewati dengan baik, terlebih pada usia toddler (12-36 bulan). Salah satu tugas perkembangan pada anak usia toddler adalah toilet training. Pemakaian diapers dalam jangka panjang dapat menimbulkan efek yang berbahaya serta bisa menghambat kemampuan toilet training anak. Penelitian ini bertujuan untuk mengetahui Hubungan Penggunaan diapers dengan kemampuan toileting pada anakDesain penelitian ini adalah Korelasi dengan pendekatan cross sectional. Besar sampel 70 responden. Sampling penelitian menggunakan Total sampling, pengumpulan data menggunakan kuesioner dan perhitungan menggunakan uji Korelasi Chi-square dengan menggunakan SPSS 16.0 kesalahan α 0,05.Hasil penelitian variabel Penggunaan diapers pada anak diinterpretasikan sebagian besar 47 anak responden (67,1%) Tidak menggunakan dan hampir setengahnya 23 responden (32,9%) menggunakan. Pada kemampuan toileting pada anak diinterpretasikan sebagian besar 42 responden (60,0%) tercapai, dan hampir setengahnya 28 responden (40,0%) belum tercapai.Berdasarkan perhitungan uji statistik Chi-square SPSS menunjukkan p value 0,000< 0,05) artinya ada hubungan penggunaan diapers dengan kemampuan toileting pada anak dengan keeratan hubungan cc sebesar 0,479 kategori cukupHasil penelitian disimpulkan hampir setengahnya menggunakan diapers, dan hampir setengahnya belum tercapai kemampuan toileting maka peneliti menyarankan pada tempat penelitian untuk memasang gambar atau leaflet tentang dampak Penggunaan Diapers Terhadap Kemampuan Toileting, sehingga ibu bijak dalam menggunakan Diapers.Kata kunci: Diapers, Toileting, Anak.

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Food Allergies

10.2310/tywc.4077 ◽

2018 ◽

Author(s):

Edmond A. Hooker ◽

Charles Kircher

Keyword(s):

Food Allergy ◽

Action Plan ◽

The United States ◽

Emergency Department Visits ◽

Food Allergies ◽

Cell Mediated Immunity ◽

Clinical Criteria ◽

Rome Iii ◽

Ige Mediated ◽

Irritable Bowel

Food allergies are responsible for a considerable number of emergency department visits. Food allergy can be divided into classic (i.e., IgE-mediated) reactions to specific allergens after exposure via skin or mucosal membrane and non–IgE-mediated food allergies, which include T cell–mediated immunity, enteropathies to specific proteins, and mixed disorders (e.g., eosinophilic esophagitis). Food-induced anaphylaxis can be life threatening and requires immediate treatment with epinephrine, even if the causative agent has not been identified. This review describes the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes for patients with food allergies. Figures show IgE-mediated allergic reactions to food and other allergens, classification of adverse reactions to foods, commercially available epinephrine autoinjectors, a sample anaphylaxis action plan, and a map showing school access to epinephrine in the United States as of September 4, 2014. Tables list potential food allergies with estimated self-reported prevalence, National Institute of Allergy and Infectious Disease clinical criteria of anaphylaxis, non–IgE-mediated food intolerance disorders, Rome III diagnostic criteria for irritable bowel syndrome, food allergy mimickers, and potential criteria for prolonged observation. This review contains 5 highly rendered figures, 6 tables, and 54 references.

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Oral immunotherapy for treatment of peanut allergy

Journal of Investigative Medicine ◽

10.1136/jim-2020-001422 ◽

2020 ◽

Vol 68 (6) ◽

pp. 1152-1155

Author(s):

Joan H Dunlop

Keyword(s):

Food Allergy ◽

Peanut Allergy ◽

Food Challenge ◽

Oral Immunotherapy ◽

Peanut Protein ◽

Subcutaneous Immunotherapy ◽

Double Blind ◽

The Us ◽

Allergy Prevalence

The US Food and Drug Administration’s approval of a peanut oral immunotherapy product in January 2020 is a landmark development in the field of food allergy therapy. While food allergy prevalence has been increasing, this product is the first approved therapy for food allergy. Oral immunotherapy has many similarities to subcutaneous immunotherapy and drug desensitization protocols, but does not lead to sustained unresponsiveness. The studies leading to approval of the Palforzia product demonstrated increase in the amount of peanut protein able to be consumed, with 67% of subjects randomized to the treatment arm able to consume 600 mg of peanut protein in double-blind placebo-controlled food challenge at study exit. However, side effects are an important consideration, and dropout rates in studies of Palforzia ranged from 11% to 21%. Postmarketing surveillance of this product will be critical in assessing its long-term risks and benefits.

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Relationship Between Atopic Dermatitis and Food Allergy

Current Pediatric Reviews ◽

10.2174/1573396315666191111122436 ◽

2020 ◽

Vol 16 (2) ◽

pp. 115-122

Author(s):

Olga Domínguez ◽

Ana María Plaza ◽

Montserrat Alvaro

Keyword(s):

Atopic Dermatitis ◽

Food Allergy ◽

Challenge Test ◽

Food Challenge ◽

House Dust Mites ◽

Main Role ◽

Early Introduction ◽

Animal Dander ◽

Restrictive Diet ◽

The Relationship

Consistent evidence has been found on the relationship between food allergy (FA) and atopic dermatitis (AD) in some children. Food sensitization can be often found in these patients. Allergy should be confirmed, though, with a food challenge test (FC) before advising a restrictive diet which could be harmful for the patient. Younger children with AD frequently show sensitization to egg, milk or peanut, while older ones and adults are more often sensitized to environmental allergens such as house dust mites, moulds, animal dander or pollens. It is well known that a barrier disturbance plays a main role in the development of sensitization and allergy. Therefore, due to the early appearance of AD, preventive newborn skincare with emollients and early introduction of food appear to be very important to determine food tolerance.

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Microbial signature in IgE-mediated food allergies

Genome Medicine ◽

10.1186/s13073-020-00789-4 ◽

2020 ◽

Vol 12 (1) ◽

Cited By ~ 1

Author(s):

Michael R. Goldberg ◽

Hadar Mor ◽

Dafna Magid Neriya ◽

Faiga Magzal ◽

Efrat Muller ◽

...

Keyword(s):

Food Allergy ◽

Gut Microbiota ◽

Learning Algorithm ◽

Area Under The Curve ◽

Food Allergies ◽

Rrna Gene ◽

Microbiota Composition ◽

Α Diversity ◽

Ige Mediated ◽

Gut Microbiota Composition

Abstract Background Multiple studies suggest a key role for gut microbiota in IgE-mediated food allergy (FA) development, but to date, none has studied it in the persistent state. Methods To characterize the gut microbiota composition and short-chain fatty acid (SCFAs) profiles associated with major food allergy groups, we recruited 233 patients with FA including milk (N = 66), sesame (N = 38), peanut (N = 71), and tree nuts (N = 58), and non-allergic controls (N = 58). DNA was isolated from fecal samples, and 16S rRNA gene sequences were analyzed. SCFAs in stool were analyzed from patients with a single allergy (N = 84) and controls (N = 31). Results The gut microbiota composition of allergic patients was significantly different compared to age-matched controls both in α-diversity and β-diversity. Distinct microbial signatures were noted for FA to different foods. Prevotella copri (P. copri) was the most overrepresented species in non-allergic controls. SCFAs levels were significantly higher in the non-allergic compared to the FA groups, whereas P. copri significantly correlated with all three SCFAs. We used these microbial differences to distinguish between FA patients and non-allergic healthy controls with an area under the curve of 0.90, and for the classification of FA patients according to their FA types using a supervised learning algorithm. Bacteroides and P. copri were identified as taxa potentially contributing to KEGG acetate-related pathways enriched in non-allergic compared to FA. In addition, overall pathway dissimilarities were found among different FAs. Conclusions Our results demonstrate a link between IgE-mediated FA and the composition and metabolic activity of the gut microbiota.

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