Provider Recommendations and Maternal Practices When Providing Breast Milk to Children With Immunoglobulin E-Mediated Food Allergy

PEDIATRICS ◽  
2021 ◽  
Vol 148 (Supplement 3) ◽  
pp. S30-S31
Author(s):  
Gaytri Patel ◽  
Jeffrey Chambliss
Keyword(s):  
Food Allergy ◽  
Breast Milk ◽  
Immunoglobulin E

Prevention of food allergy

2019 ◽  
Vol 40 (6) ◽  
pp. 450-452 ◽  
Author(s):  
Ashley L. Devonshire ◽  
Rachel Glick Robison
Keyword(s):  
Food Allergy ◽  
Peanut Allergy ◽  
Immunoglobulin E ◽  
Skin Prick Testing ◽  
Clinical Manifestations ◽  
Conclusive Evidence ◽  
Severe Atopic Dermatitis ◽  
Early Introduction ◽  
Infant Diet ◽  
Specific Immunoglobulin E

Primary prevention and secondary prevention in the context of food allergy refer to prevention of the development of sensitization (i.e., the presence of food-specific immunoglobulin E (IgE) as measured by skin-prick testing and/or laboratory testing) and sensitization plus the clinical manifestations of food allergy, respectively. Until recently, interventions that target the prevention of food allergy have been limited. Although exclusive breast-feeding for the first 6 months of life has been a long-standing recommendation due to associated health benefits, recommendations regarding complementary feeding in infancy have significantly changed over the past 20 years. There now is evidence to support early introduction of peanut into the diet of infants with egg allergy, severe atopic dermatitis, or both diagnoses, defined as high risk for peanut allergy, to try to prevent development of peanut allergy. Although guideline-based recommendations are not available for early introduction of additional allergenic foods, this topic is being actively studied. There is no evidence to support additional dietary modification of the maternal or infant diet for the prevention of food allergy. Similarly, there is no conclusive evidence to support maternal avoidance diets for the prevention of food allergy.

Diagnostic and Therapeutic Principles In Allergy

2018 ◽  
Author(s):  
Mitchell H. Grayson ◽  
Peter Mustillo
Keyword(s):  
Food Allergy ◽  
Immunoglobulin E ◽  
Skin Testing ◽  
Allergic Sensitization ◽  
Allergic Diseases ◽  
Specific Ige ◽  
Severe Form ◽  
Therapeutic Principles ◽  
Anticytokine Therapy ◽  
Release Assay

The incidence of allergic diseases, like asthma, allergic rhinitis, and food allergy, is increasing in Westernized countries. This chapter discusses the importance of taking a careful and focused history and physical examination, as well as the laboratory studies that can be used to demonstrate the presence of allergic sensitization. Treatment for allergic disease is discussed, with an emphasis on new biologic therapies that have been developed. Finally, the chapter explores relatively new studies on the potential for interventions to prevent food allergy.  Allergy is defined as an untoward physiologic event mediated by immune mechanisms, usually involving the interaction between an allergen and the allergic antibody, immunoglobulin E (IgE). Allergic reactions typically occur due to exposure to either airborne allergens, foods, drugs, chemicals, or Hymenoptera (such as wasps, bees and fire ants). Allergies manifest in numerous ways, including allergic asthma, allergic rhinoconjunctivitis, urticaria, eczema, and in its most severe form, anaphylaxis. This review contains 4 videos, 5 figures, 4 tables and 42 references Key Words: Delayed allergic reaction (Alpha-gal), Allergy diagnosis, Measurement of specific IgE, Allergy and asthma therapies, Anticytokine therapy (dupilumab, mepolizumab, reslizumab), AntiIgE therapy (omalizumab), Allergy skin testing, Basophil histamine release assay

Idiopathic anaphylaxis: Diagnosis and management

2021 ◽  
Vol 42 (6) ◽  
pp. 481-488 ◽  
Author(s):  
Alyssa G. Burrows ◽  
Anne K. Ellis
Keyword(s):  
Food Allergy ◽  
Immunoglobulin E ◽  
Treatment Options ◽  
Serum Tryptase ◽  
Genetic Trait ◽  
Baseline Serum ◽  
Diagnostic Technologies ◽  
Term Management ◽  
Idiopathic Anaphylaxis

Introduction: Idiopathic anaphylaxis (IA) is a diagnosis of exclusion and is based on the inability to identify a causal relationship between a trigger and an anaphylactic event, despite a detailed patient history and careful diagnostic assessment. The prevalence of IA among the subset of people who experienced anaphylaxis is challenging to estimate and varies widely, from 10 to 60%; most commonly noted is ∼20% in the adult anaphylactic population. Comorbid atopic conditions, such as food allergy, allergic rhinitis, and asthma, are present in up to 48% of patients with IA. Improved diagnostic technologies and an increased understanding of conditions that manifest with symptoms associated with anaphylaxis have improved the ability to determine a more accurate diagnosis for patients who may have been initially diagnosed with IA. Methods: Literature search was conducted on PubMed, Google Scholar and Embase. Results: Galactose-α-1,3-galactose (α-gal) allergy, mast cell disorders, and hereditary a-tryptasemia are a few differential diagnoses that should be considered in patients with IA. Unlike food allergy, when anaphylaxis occurs within minutes to 2 hours after allergen consumption, α-gal allergy is a 3‐6-hour delayed immunoglobulin E‐mediated anaphylactic reaction to a carbohydrate epitope found in red meat (e.g., beef, lamb, pork). The more recently described hereditary α-tryptasemia is an inherited autosomal dominant genetic trait caused by increased germline copies of tryptase human gene alpha-beta 1 (TPSAB1), which encodes α tryptase and is associated with elevated baseline serum tryptase. Acute management of IA consists of carrying an epinephrine autoinjector to be administered immediately at the first signs of anaphylaxis. Long-term management for IA with antihistamines and other agents aims to potentially reduce the frequency and severity of the anaphylactic reactions, although the evidence is limited. Biologics are potentially steroid-sparing for patients with IA; however, more research on IA therapies is needed. Conclusion: The lack of diagnostic criteria, finite treatment options, and intricacies of making a differential diagnosis make IA challenging for patients and clinicians to manage.

scholarly journals Maternal Intake of Cow’s Milk during Lactation Is Associated with Lower Prevalence of Food Allergy in Offspring

Nutrients ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3680
Author(s):  
Mia Stråvik ◽  
Malin Barman ◽  
Bill Hesselmar ◽  
Anna Sandin ◽  
Agnes E. Wold ◽  
...  
Keyword(s):  
Food Allergy ◽  
Breast Milk ◽  
Maternal Diet ◽  
Maternal Blood ◽  
Cow’S Milk ◽  
Lower Prevalence ◽  
Food Frequency ◽  
Lactating Women ◽  
Cow's Milk ◽  
Pregnancy And Lactation

Maternal diet during pregnancy and lactation may affect the propensity of the child to develop an allergy. The aim was to assess and compare the dietary intake of pregnant and lactating women, validate it with biomarkers, and to relate these data to physician-diagnosed allergy in the offspring at 12 months of age. Maternal diet during pregnancy and lactation was assessed by repeated semi-quantitative food frequency questionnaires in a prospective Swedish birth cohort (n = 508). Fatty acid proportions were measured in maternal breast milk and erythrocytes. Allergy was diagnosed at 12 months of age by a pediatrician specialized in allergy. An increased maternal intake of cow’s milk during lactation, confirmed with biomarkers (fatty acids C15:0 and C17:0) in the maternal blood and breast milk, was associated with a lower prevalence of physician-diagnosed food allergy by 12 months of age. Intake of fruit and berries during lactation was associated with a higher prevalence of atopic eczema at 12 months of age. Our results suggest that maternal diet modulates the infant’s immune system, thereby influencing subsequent allergy development.

Breast milk butyrate as protective factor against food allergy

2015 ◽  
Vol 47 ◽  
pp. e274 ◽  
Author(s):  
R. Aitoro ◽  
L. Paparo ◽  
M. Di Costanzo ◽  
R. Nocerino ◽  
A. Amoroso ◽  
...  
Keyword(s):  
Food Allergy ◽  
Breast Milk ◽  
Protective Factor

scholarly journals Oral Tolerance Induced by Transfer of Food Antigens via Breast Milk of Allergic Mothers Prevents Offspring from Developing Allergic Symptoms in a Mouse Food Allergy Model

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Takeshi Yamamoto ◽  
Yuma Tsubota ◽  
Toshihisa Kodama ◽  
Natsuko Kageyama-Yahara ◽  
Makoto Kadowaki
Keyword(s):  
Food Allergy ◽  
Breast Milk ◽  
Oral Tolerance ◽  
Maternal Exposure ◽  
Oral Intubation ◽  
Female Mice ◽  
Allergic Symptoms ◽  
Dietary Antigens ◽  
Food Antigens

We examined whether maternal exposure to food antigens during lactation and maternal allergic status would affect the development of food allergy in offspring. OVA-sensitized or OVA-nonsensitized BALB/c female mice were exposed or unexposed to OVA during lactation. After weaning, their offspring were systemically sensitized twice with OVA and repeatedly given OVA by oral intubation. While 97.1% of the mice breastfed by OVA-nonsensitized and OVA-unexposed mothers developed allergic diarrhea, 59.7% of the mice breastfed by OVA-exposed nonallergic mothers during lactation and 24.6% of the mice breastfed by OVA-exposed allergic mothers during lactation developed food allergy. Furthermore, OVA was detected in breast-milk from OVA-exposed nonallergic mothers during lactation (4.6±0.5 μg/mL). In addition, OVA-specific IgG1 titers were markedly increased in breast milk from allergic mothers (OVA-sensitized and OVA-unexposed mother:11.0±0.5, OVA-sensitized and OVA-exposed mother:12.3±0.3). Our results suggest that oral tolerance induced by breast milk-mediated transfer of dietary antigens along with their specific immunoglobulins to offspring leads to antigen-specific protection from food allergy.

In vitro testing for immunoglobulin E-mediated food allergies

1996 ◽  
Vol 115 (4) ◽  
pp. 312-318 ◽  
Author(s):  
Jacquelynne P. Corey ◽  
Anil Gungor
Keyword(s):  
Food Allergy ◽  
Immunoglobulin E ◽  
Diagnostic Methods ◽  
Food Allergies ◽  
Vitro Assay ◽  
Positive Screen ◽  
Specific Immunoglobulin E ◽  
Radioallergosorbent Test ◽  
Specific Immunoglobulin

The role of immunoglobulin E-mediated food allergy in subjects with allergic disorders, especially in patients with rhinitis and sinusitis, is underestimated by clinicians because of the initial attribution of these disorders to immediate-type hypersensitivity reactions. The difficulties of diagnosing food-related reactions have caused further delay in their recognition and incorporation into the daily practice of diagnosing food allergy. Two of the diagnostic methods for food allergy are the in vitro assay of total immunoglobulin E and the measurement of food-specific immunoglobulin E levels in serum with the radioallergosorbent test. Measurement of specific immunoglobulin E level is the most commonly used but also one of the most controversial techniques. We examined 123 patients with rhinitis who were referred to our otolaryngology/allergy clinic between January and April 1995. All patients received an initial radioallergosorbent test screen, which included milk. We determined the positive predictive value of this positive screen and, in particular, of a positive test for milk in the diagnosis of immunoglobulin E-mediated food allergies in these patients. Conclusions were based on comparison with the result of an additional radioallergosorbent test food panel consisting of eight common and two investigational food allergens. (Otolaryngol Head Neck Surg 1996;115:312-8.)

scholarly journals Prevalence, Risk Factors, Clinical Manifestation, Diagnosis Aspects and Nutrition Therapy in Relation to both IgE and IgG Cow’s Milk Protein Allergies among a Population of Saudi Arabia: A Literature Review

2021 ◽  
Vol 9 (2) ◽  
pp. 375-389
Author(s):  
Mashail A Baghlaf ◽  
Noura M S Eid
Keyword(s):  
Risk Factors ◽  
Saudi Arabia ◽  
Food Allergy ◽  
Clinical Manifestation ◽  
Milk Protein ◽  
Immunoglobulin E ◽  
Cow Milk ◽  
Cow’S Milk ◽  
Cow's Milk ◽  
Cow’S Milk Protein

Cow milk protein allergy (CMPA) becoming a major public health issue that has attracted the attention of health professionals and researchers. This paper aimed to review the important aspects of both IgE and IgG types of cow’s milk protein allergy in terms of prevalence, clinical manifestation, risk factors, other health-related issues and nutritional therapy proposed for such allergies in the adult and pediatric population in Saudi Arabia. A search on “cow’s milk allergy” was done using PubMed, Google Scholar and Scopus Engine for published papers between 1993 and 2020 to find studies yielding knowledge on that context. The prevalence of cow’s milk protein allergy (CMPA) among infants is now in the range of 2–3%. This type of allergy is also detected in adulthood but less frequently. CMPA is defined as an immunological reaction to specific proteins in milk. CMPA is classified based on its type as an immunoglobulin E (IgE)-mediated form and an immunoglobulin G (IgG)-mediated form, each type representing different immunological pathways. The presence of Genetic aspects, family history and short duration of breastfeeding in the infant are among the risk factors contributing to this form of allergy. Its manifestations mainly present as skin presentation, followed by the gastrointestinal and respiratory presentation in most cases in addition to a life-threatening anaphylactic reaction that may occur in 12% of cases. food allergy committees have developed strict diagnosis criteria, including blood testing for food-specific immunoglobulin E (sIgE), a skin prick test and double-blind placebo-controlled food challenges (DBPCFC) as the gold standard. A diet free of cow’s milk protein (CMP) allergen and including the appropriate alternative milk formula is the first line of prevention recommended by many organizations and food allergy experts. As for Saudi Arabia, more research and clinical trials are required to discuss the various aspects of adult and pediatric CMPA and to provide a better understanding along with good control strategies implementation.

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