scholarly journals Additives and preservatives: Role in food allergy

2020 ◽  
Vol 2 (1) ◽  
pp. 119-123
Author(s):  
Amber N. Pepper ◽  
Panida Sriaroon ◽  
Mark C. Glaum
Keyword(s):  
Food Allergy ◽  
Immunoglobulin E ◽  
Skin Prick Testing ◽  
Food Additives ◽  
Specific Ige ◽  
Food Additive ◽  
Blood Testing ◽  
Commercial Products ◽  
Natural Substances ◽  
Ige Mediated

Food additives are natural or synthetic substances added to foods at any stage of production to enhance flavor, texture, appearance, preservation, safety, or other qualities. Common categories include preservatives and antimicrobials, colorings and dyes, flavorings, antioxidants, stabilizers, and emulsifiers. Natural substances rather than synthetics are more likely to cause hypersensitivity. Although rare, food additive hypersensitivity should be suspected in patients with immunoglobulin E (IgE)-mediated reactions to multiple, unrelated foods, especially if the foods are prepared outside of the home or when using commercial products. A complete and thorough history is vital. Skin prick testing and/or specific IgE blood testing to food additives, if available, additive avoidance diets, and blind oral challenges can help establish the diagnosis. Once an allergy to a food additive is confirmed, management involves avoidance and, if necessary, carrying self-injectable epinephrine.

scholarly journals Food Allergy: Unproven diagnostics and therapeutics

2020 ◽  
Vol 2 (1) ◽  
pp. 91-94
Author(s):  
Megan F. Patterson ◽  
Stacy L. Dorris
Keyword(s):  
Food Allergy ◽  
Adverse Reactions ◽  
Immunoglobulin E ◽  
Skin Prick Testing ◽  
Scientific Evidence ◽  
Food Challenge ◽  
Clinical History ◽  
Specific Ige ◽  
Therapeutic Modalities ◽  
Diagnostic Modalities

Food allergy or intolerance is often attributed by patients as the cause of many symptoms unknown to be directly related to food ingestion. For immunoglobulin E (IgE) mediated food allergy, diagnostic modalities are currently limited to the combination of clinical history, evidence of sensitization with food-specific IgE testing and skin-prick testing, and oral food challenge. Many patients find an appeal in the promise of identification of the etiology of their symptoms through alternative food allergy or intolerance diagnostic modalities. These patients may seek guidance from allergists or their general providers as to the legitimacy of these tests or interpretation of results. These tests include food-specific serum IgG or IgG4 testing, flow cytometry to measure the change in leukocyte volume after exposure to food, intradermal or sublingual provocation-neutralization, electrodermal testing, applied kinesiology, hair analysis, and iridology. In addition, there are some unconventional therapeutic modalities for adverse reactions to foods, including rotary diets. None of these have been supported by scientific evidence, and some even carry the risk of severe adverse reactions. It is important that we offer our patients evidence-based, accurate counseling of these unproven modalities by understanding their methods, their paucity of credible scientific support, and their associated risks.

scholarly journals The Challenge of Home Allergen Re-introductions Using the Ladder Approach in Children With Non-IgE Mediated Gastrointestinal Food Allergy

2021 ◽  
Vol 2 ◽  
Author(s):  
Rosan Meyer ◽  
Claire De Koker ◽  
Robert Dziubak ◽  
Heather Godwin ◽  
Kate Reeve ◽  
...  
Keyword(s):  
Food Allergy ◽  
Immunoglobulin E ◽  
Specific Ige ◽  
Cow’S Milk ◽  
Symptom Improvement ◽  
Food Protein ◽  
Nutrition Survey ◽  
Cow's Milk ◽  
Ige Mediated ◽  
Gastrointestinal Food Allergy

Background: Oral food challenges remain the most reliable method for allergy confirmation. Although consensus guidelines have been published to unify Immunoglobulin E (IgE)-mediated challenges, this does not exist for non-IgE mediated gastrointestinal allergies outside of Food Protein Induced Enterocolitis Syndrome. We therefore set out to establish the use of home introduction protocols (HIP) for confirmation of food allergy for milk, soya, egg and wheat using a ladder approach in children with non-IgE mediated allergy.Materials and Methods: Patients with suspected non-IgE mediated gastrointestinal allergies (0–16 years) were recruited following symptom improvement on an elimination diet. All children had skin prick or specific IgE tests to rule out IgE-mediated allergies prior to suggestion the HIP. Number of trials and outcome was documented. HIPs were developed using a published ladder approach for cow's milk as baseline and final dose was calculated based on guidelines for food protein induced enterocolitis syndrome and portions for age from the National Diet and Nutrition Survey. First foods were baked/highly processed and every 4th day patients moved to a more unprocessed/unheated food.Results: From 131 recruited patients, 117 (89.3%) followed the HIP for food allergens. No adverse events were documented. In more than 50% of cases one attempt at the HIP was sufficient to establish allergy status, but many required 2–5 attempts before the outcome was clear. About half of the children were fully tolerant to foods they initially eliminated: 36, 26 and 30% were partially tolerant to milk, soya, and egg and only 15% achieved partial tolerance to wheat. Wheat was the allergen introduced earliest, followed by soya, cow's milk and egg.Conclusions: This study indicates that home HIPs are safe in non-IgE mediated gastrointestinal food allergy and that the ladder approach may be useful in re-introducing allergens in children at home with non-IgE mediated gastrointestinal allergies. From this study we can also conclude that tolerance to processed/baked allergens was observed in many children. Further studies should be performed on the HIP and ideally reintroduction should occur pre-defined time intervals.

scholarly journals Adverse reactions to food additives

2021 ◽  
Vol 3 (1) ◽  
pp. 8-23
Author(s):  
Justin Babbel ◽  
Courtney Ramos ◽  
Hannah Wangberg ◽  
Kate Luskin ◽  
Ronald Simon
Keyword(s):  
Adverse Reactions ◽  
Immunoglobulin E ◽  
Food Additives ◽  
Daily Basis ◽  
Food Additive ◽  
Double Blind ◽  
Naturally Occurring ◽  
Different Types ◽  
Ige Mediated ◽  
The Subject

Food additives are naturally occurring or synthetic substances that are added to food to modify the color, taste, texture, stability, or other characteristics of foods. These additives are ubiquitous in the food that we consume on a daily basis and, therefore, have been the subject of much scrutiny about possible reactions. Despite these concerns, the overall prevalence of food additive reactions is 1‐2%, with a minority of the wide variety of symptoms attributed to food-additive exposure being reproduced by double-blind placebo controlled challenges. Reactions can be broadly classified into either immunoglobulin E (IgE)- and non‐IgE-mediated reactions, with natural additives accounting for most IgE-mediated reactions, and both natural and synthetic additives being implicated in the non‐IgE-mediated reactions. Reactions that include asthma exacerbations, urticaria and/or angioedema, or anaphylaxis with ingestion of a food additive are most deserving of further allergy evaluation. In this article, we discussed the different types of adverse reactions that have been described to various food additives. We also reviewed the specifics of how to evaluate and diagnose a food additive allergy in a clinic setting.

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

Allergic Response

2019 ◽  
Author(s):  
Joud Hajjar ◽  
Lawrence B Schwartz
Keyword(s):  
Mast Cell ◽  
Immunoglobulin E ◽  
Signs And Symptoms ◽  
Specific Ige ◽  
Consensus Conference ◽  
Allergic Response ◽  
Working Definition ◽  
Keywords Allergy ◽  
Ige Mediated ◽  
Definition Of

The term hypersensitivity refers to diseases caused by an immune response, regardless of whether the response is against a pathogen, nonpathogen, or self and regardless of whether the response is directed by antibodies, lymphocytes, or innate pathways. The term anaphylaxis was coined in 1902 by Charles Richet, who received the Nobel Prize in 1913; this systemic allergic response is now known to be an immediate hypersensitivity reaction, initiated by allergen delivered to a host having allergen-specific IgE, thereby causing an IgE-mediated immunologic response and activating mast cells and basophils to secrete bioactive mediators. In 2005, the National Institutes of Health organized a consensus conference to develop a working definition of anaphylaxis, designed to be used by physicians at the bedside, as a serious allergic reaction that is rapid in onset, typically eliciting various combinations of cutaneous, cardiovascular, respiratory, and gastrointestinal manifestations, and may cause death.1,2 This facilitated the early treatment of such patients with epinephrine. Confusion arises over the misapplication of the term allergy or hypersensitivity to describe any untoward reaction to food, medications, or environmental exposures. Furthermore, non–IgE-mediated forms of local and systemic mast cell or basophil activation events can occur, causing signs and symptoms similar to those mediated by IgE.  This review contains 3 figures, 9 tables, and 62 references. Keywords: allergy, hypersensitivity, anaphylaxis, interleukin, chemokines, immunoglobulin E, mast cell, eosinophil

scholarly journals Decreased Histone Acetylation Levels at Th1 and Regulatory Loci after Induction of Food Allergy

Nutrients ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 3193
Author(s):  
Bilal Alashkar Alhamwe ◽  
Laura A. P. M. Meulenbroek ◽  
Désirée H. Veening-Griffioen ◽  
Tjalling M. D. Wehkamp ◽  
Fahd Alhamdan ◽  
...  
Keyword(s):  
Gene Expression ◽  
Food Allergy ◽  
Histone Acetylation ◽  
Specific Ige ◽  
Allergic Response ◽  
Cow’S Milk ◽  
Milk Allergy ◽  
T Helper ◽  
Cow's Milk ◽  
Ige Mediated

Immunoglobulin E (IgE)-mediated allergy against cow’s milk protein fractions such as whey is one of the most common food-related allergic disorders of early childhood. Histone acetylation is an important epigenetic mechanism, shown to be involved in the pathogenesis of allergies. However, its role in food allergy remains unknown. IgE-mediated cow’s milk allergy was successfully induced in a mouse model, as demonstrated by acute allergic symptoms, whey-specific IgE in serum, and the activation of mast cells upon a challenge with whey protein. The elicited allergic response coincided with reduced percentages of regulatory T (Treg) and T helper 17 (Th17) cells, matching decreased levels of H3 and/or H4 histone acetylation at pivotal Treg and Th17 loci, an epigenetic status favoring lower gene expression. In addition, histone acetylation levels at the crucial T helper 1 (Th1) loci were decreased, most probably preceding the expected reduction in Th1 cells after inducing an allergic response. No changes were observed for T helper 2 cells. However, increased histone acetylation levels, promoting gene expression, were observed at the signal transducer and activator of transcription 6 (Stat6) gene, a proallergic B cell locus, which was in line with the presence of whey-specific IgE. In conclusion, the observed histone acetylation changes are pathobiologically in line with the successful induction of cow’s milk allergy, to which they might have also contributed mechanistically.

scholarly journals IgE-Mediated Peanut Allergy: Current and Novel Predictive Biomarkers for Clinical Phenotypes Using Multi-Omics Approaches

2021 ◽  
Vol 11 ◽  
Author(s):  
Rebecca Czolk ◽  
Julia Klueber ◽  
Martin Sørensen ◽  
Paul Wilmes ◽  
Françoise Codreanu-Morel ◽  
...  
Keyword(s):  
Food Allergy ◽  
Peanut Allergy ◽  
Biomarker Discovery ◽  
Disease Model ◽  
Predictive Biomarkers ◽  
Immunological Response ◽  
Specific Ige ◽  
Clinical Phenotypes ◽  
Ige Mediated

Food allergy is a collective term for several immune-mediated responses to food. IgE-mediated food allergy is the best-known subtype. The patients present with a marked diversity of clinical profiles including symptomatic manifestations, threshold reactivity and reaction kinetics. In-vitro predictors of these clinical phenotypes are evasive and considered as knowledge gaps in food allergy diagnosis and risk management. Peanut allergy is a relevant disease model where pioneer discoveries were made in diagnosis, immunotherapy and prevention. This review provides an overview on the immune basis for phenotype variations in peanut-allergic individuals, in the light of future patient stratification along emerging omic-areas. Beyond specific IgE-signatures and basophil reactivity profiles with established correlation to clinical outcome, allergenomics, mass spectrometric resolution of peripheral allergen tracing, might be a fundamental approach to understand disease pathophysiology underlying biomarker discovery. Deep immune phenotyping is thought to reveal differential cell responses but also, gene expression and gene methylation profiles (eg, peanut severity genes) are promising areas for biomarker research. Finally, the study of microbiome-host interactions with a focus on the immune system modulation might hold the key to understand tissue-specific responses and symptoms. The immune mechanism underlying acute food-allergic events remains elusive until today. Deciphering this immunological response shall enable to identify novel biomarker for stratification of patients into reaction endotypes. The availability of powerful multi-omics technologies, together with integrated data analysis, network-based approaches and unbiased machine learning holds out the prospect of providing clinically useful biomarkers or biomarker signatures being predictive for reaction phenotypes.

Allergic Response

2019 ◽  
Author(s):  
Joud Hajjar ◽  
Lawrence B Schwartz
Keyword(s):  
Mast Cell ◽  
Immunoglobulin E ◽  
Signs And Symptoms ◽  
Specific Ige ◽  
Consensus Conference ◽  
Allergic Response ◽  
Working Definition ◽  
Keywords Allergy ◽  
Ige Mediated ◽  
Definition Of

The term hypersensitivity refers to diseases caused by an immune response, regardless of whether the response is against a pathogen, nonpathogen, or self and regardless of whether the response is directed by antibodies, lymphocytes, or innate pathways. The term anaphylaxis was coined in 1902 by Charles Richet, who received the Nobel Prize in 1913; this systemic allergic response is now known to be an immediate hypersensitivity reaction, initiated by allergen delivered to a host having allergen-specific IgE, thereby causing an IgE-mediated immunologic response and activating mast cells and basophils to secrete bioactive mediators. In 2005, the National Institutes of Health organized a consensus conference to develop a working definition of anaphylaxis, designed to be used by physicians at the bedside, as a serious allergic reaction that is rapid in onset, typically eliciting various combinations of cutaneous, cardiovascular, respiratory, and gastrointestinal manifestations, and may cause death.1,2 This facilitated the early treatment of such patients with epinephrine. Confusion arises over the misapplication of the term allergy or hypersensitivity to describe any untoward reaction to food, medications, or environmental exposures. Furthermore, non–IgE-mediated forms of local and systemic mast cell or basophil activation events can occur, causing signs and symptoms similar to those mediated by IgE.  This review contains 3 figures, 9 tables, and 62 references. Keywords: allergy, hypersensitivity, anaphylaxis, interleukin, chemokines, immunoglobulin E, mast cell, eosinophil

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