scholarly journals Food allergy and breast-feeding

2020 ◽  
Vol 2 (1) ◽  
pp. 99-103
Author(s):  
Jennifer Pier ◽  
Kirsi M. Järvinen
Keyword(s):  
Food Allergy ◽  
Breast Feeding ◽  
Immunoglobulin E ◽  
Gastrointestinal Symptoms ◽  
Allergic Reactions ◽  
Unique Challenge ◽  
Food Avoidance ◽  
Food Antigens ◽  
Ige Mediated ◽  
Breast Fed

Breast-feeding is currently recommended as the optimal source of nutrition for infants; however, it is known that some individuals can excrete enough food antigens in breast milk to result in allergic reactions in infants, especially those already highly sensitized. These reactions can include non‐immunoglobulin E (IgE) mediated reactions, such as atopic dermatitis or gastrointestinal symptoms, and IgE-mediated reactions, such as anaphylaxis, although rare. Food reactions in infants who are breast-fed is a unique challenge because identifying the culprit foods may be more difficult and special consideration must be taken in ensuring proper nutrition during periods of food avoidance for both the infant and mother. This article reviews what is currently known about food allergy in infants who are breast-fed as well as offers insights into a proposed evaluation.

scholarly journals Clinical manifestations of immunoglobulin E‐mediated food allergy, including pollen‐food allergy syndrome

2020 ◽  
Vol 2 (1) ◽  
pp. 22-25
Author(s):  
Pooja Varshney ◽  
Jacqueline A. Pongracic
Keyword(s):  
Food Allergy ◽  
Immunoglobulin E ◽  
Acute Infection ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Physical Exertion ◽  
Allergic Reactions ◽  
Cutaneous Manifestations ◽  
Ige Mediated ◽  
Inflammatory Drugs

Immunoglobulin E-(IgE) mediated food allergy affects people of all ages but does not have a consistent presentation and may result in various manifestations, even for an individual. The onset of symptoms is usually quite rapid, minutes to a few hours after consumption of the allergen, although exceptions exist. Cutaneous and gastrointestinal symptoms are the most common clinical manifestations; however, they are not present in all allergic reactions. Clinicians, particularly those in emergency care settings, need to be aware that the lack of cutaneous manifestations does not exclude the possibility of anaphylaxis. It is extremely unusual for food allergy reactions to present with isolated upper or lower respiratory symptoms, nor is chronic urticaria a manifestation of food allergy. Clinical manifestations of IgE-mediated food allergy range from mild to severe and, in rare cases, can be fatal. Mild, localized reactions, such as those that occur in pollen‐food allergy syndrome, occur in individuals with sensitization to pollens. A small proportion of patients with this syndrome develop anaphylaxis. Alcohol, medications (nonsteroidal anti-inflammatory drugs, antacids), physical exertion, increased body temperature, acute infection, and menstruation are factors that are known to augment the severity of food-induced allergic reactions.

Studies of mitochondrial and nuclear DNA released from food allergen‐activated neutrophils. Implications for non‐IgE food allergy

2021 ◽  
Vol 42 (3) ◽  
pp. e59-e70
Author(s):  
Brigitte König ◽  
Anja N. Koch ◽  
Joseph A. Bellanti
Keyword(s):  
Mitochondrial Dna ◽  
Food Allergy ◽  
Calcium Binding ◽  
Inflammatory Responses ◽  
Immunoglobulin E ◽  
Innate Immune ◽  
Extracellular Dna ◽  
Test Results ◽  
Food Antigens ◽  
Ige Mediated

Background: Although adverse food reactions are commonly divided into immunoglobulin E (IgE) mediated food allergy (FA), and non-IgE FA, the current literature is providing support for the role of innate immune responses as an important component of non-IgE FA. Using a commercially available leukocyte activation (LA) assay, a recent quantitative study of total extracellular DNA released in cellular supernatants of human peripheral blood mononuclear cells exposed either to positive or negative tested foods demonstrated that leukocytes exposed to foods with positive LA test results showed higher DNA content than those exposed to foods with negative LA test results. In humans, the origin of DNA might be either the nucleus or the mitochondria. Analysis of emerging data from several laboratories, including our own, suggests that mitochondrial DNA induces inflammatory responses through induction of proinflammatory cytokines. Objective: This pilot study was designed primarily to convey the finding, and relevance of, mitochondrial DNA in the form of neutrophil extracellular traps (NET) as a new pathogenetic mechanism for innate immune-mediated non-IgE FA. Methods: The study population consisted of a total of six subjects, four in a major FA study group and two in a subgroup. Neutrophils were isolated and treated with food antigens that elicited positive and negative LA responses, and the released free DNA was analyzed for the cellular site of origin by using real-time polymerase chain reaction and for leukocyte calprotectin and S100 calcium-binding protein A12 (S100A12) proteins as markers of NETs. Results: We showed that cellular supernatants from neutrophils treated with foods that elicit positive LA responses can contain increased DNA levels of nuclear as well as mitochondrial origin. Supernatants from neutrophils treated with negative tested food (LA) responses did not induce the release of nuclear or mitochondrial DNA. Conclusion: Analysis of our data suggested that the induction of NETs that contain proinflammatory mitochondrial DNA may provide the critical link necessary for a better understanding of the pathogenesis of non‐IgE-mediated FA. These discoveries may not only facilitate better diagnostic tests of FA but should also improve clinical management of allergic and other inflammatory diseases.

scholarly journals Developing food allergy: a potential immunologic pathway linking skin barrier to gut

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2660 ◽  
Author(s):  
Yui-Hsi Wang
Keyword(s):  
Food Allergy ◽  
Mast Cells ◽  
Immunoglobulin E ◽  
Lymphoid Cells ◽  
Th2 Cells ◽  
Allergic Reactions ◽  
Mucosal Mast Cells ◽  
Life Threatening ◽  
Ige Mediated

Immunoglobulin E (IgE)-mediated food allergy is an adverse reaction to foods and is driven by uncontrolled type-2 immune responses. Current knowledge cannot explain why only some individuals among those with food allergy are prone to develop life-threatening anaphylaxis. It is increasingly evident that the immunologic mechanisms involved in developing IgE-mediated food allergy are far more complex than allergic sensitization. Clinical observations suggest that patients who develop severe allergic reactions to food are often sensitized through the skin in early infancy. Environmental insults trigger epidermal thymic stromal lymphopoietin and interleukin-33 (IL-33) production, which endows dendritic cells with the ability to induce CD4+TH2 cell-mediated allergic inflammation. Intestinal IL-25 propagates the allergic immune response by enhancing collaborative interactions between resident type-2 innate lymphoid cells and CD4+TH2 cells expanded by ingested antigens in the gastrointestinal tract. IL-4 signaling provided by CD4+TH2 cells induces emigrated mast cell progenitors to become multi-functional IL-9-producing mucosal mast cells, which then expand greatly after repeated food ingestions. Inflammatory cytokine IL-33 promotes the function and maturation of IL-9-producing mucosal mast cells, which amplify intestinal mastocytosis, resulting in increased clinical reactivity to ingested food allergens. These findings provide the plausible view that the combinatorial signals from atopic status, dietary allergen ingestions, and inflammatory cues may govern the perpetuation of allergic reactions from the skin to the gut and promote susceptibility to life-threatening anaphylaxis. Future in-depth studies of the molecular and cellular factors composing these stepwise pathways may facilitate the discovery of biomarkers and therapeutic targets for diagnosing, preventing, and treating food allergy.

scholarly journals Testing the Cow’s Milk-Related Symptom Score (CoMiSSTM) for the Response to a Cow’s Milk-Free Diet in Infants: A Prospective Study

Nutrients ◽  
2019 ◽  
Vol 11 (10) ◽  
pp. 2402 ◽  
Author(s):  
Silvia Salvatore ◽  
Elisabetta Bertoni ◽  
Federica Bogni ◽  
Valentina Bonaita ◽  
Chiara Armano ◽  
...  
Keyword(s):  
Symptom Score ◽  
Immunoglobulin E ◽  
Gastrointestinal Symptoms ◽  
Cow’S Milk ◽  
P Value ◽  
Cow's Milk ◽  
Related Symptom ◽  
Receiver Operation Characteristic ◽  
Ige Mediated ◽  
A Prospective Study

The diagnosis of cow’s milk allergy (CMA) is particularly challenging in infants, especially with non-Immunoglobulin E (IgE)-mediated manifestations, and inaccurate diagnosis may lead to unnecessary dietary restrictions. The aim of this study was to assess the accuracy of the cow’s milk-related symptom score (CoMiSSTM) in response to a cow’s milk-free diet (CMFD). We prospectively recruited 47 infants (median age three months) who had been placed on a CMFD due to persisting unexplained gastrointestinal symptoms. We compared data with 94 healthy controls (median age three months). The CoMiSSTM score was completed at recruitment and while on the exclusion diet. In 19/47 (40%) cases a response to the diet occurred. At recruitment CoMiSSTM was significantly higher in cases compared to controls (median score 8 vs. 3; p-value: <0.05), 9 cases had a score ≥12 and 8/9 normalized on CMFD. An oral milk challenge was performed in all 19 responders and six of these had a positive reaction to cow’s milk (CM). In eight infants IgE allergy tests were positive. The receiver operation characteristic (ROC) curve identified a CoMISSTM score of 9 to be the best cut-off value (84% sensitivity, 85% specificity, 80% positive (PPV) and 88% negative predictive value (NPV)) for the response to CMFD. We found CoMiSSTM to be a useful tool to help identify infants with persisting gastrointestinal symptoms and suspected CMA that would benefit from CMFD.

scholarly journals Antigen-Presenting Cells in Food Tolerance and Allergy

2021 ◽  
Vol 11 ◽  
Author(s):  
Elise G. Liu ◽  
Xiangyun Yin ◽  
Anush Swaminathan ◽  
Stephanie C. Eisenbarth
Keyword(s):  
Food Allergy ◽  
T Cell ◽  
Oral Tolerance ◽  
Immunoglobulin E ◽  
Antigen Presenting Cells ◽  
Western World ◽  
Dominant Form ◽  
Food Antigens ◽  
Different Types ◽  
Antigen Presenting

Food allergy now affects 6%–8% of children in the Western world; despite this, we understand little about why certain people become sensitized to food allergens. The dominant form of food allergy is mediated by food-specific immunoglobulin E (IgE) antibodies, which can cause a variety of symptoms, including life-threatening anaphylaxis. A central step in this immune response to food antigens that differentiates tolerance from allergy is the initial priming of T cells by antigen-presenting cells (APCs), primarily different types of dendritic cells (DCs). DCs, along with monocyte and macrophage populations, dictate oral tolerance versus allergy by shaping the T cell and subsequent B cell antibody response. A growing body of literature has shed light on the conditions under which antigen presentation occurs and how different types of T cell responses are induced by different APCs. We will review APC subsets in the gut and discuss mechanisms of APC-induced oral tolerance versus allergy to food identified using mouse models and patient samples.

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 Adults with possible food protein-induced enterocolitis syndrome with crustacean ingestion

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Daniel H. Li ◽  
Andrew Wong-Pack ◽  
Andrea Leilani Macikunas ◽  
Harold Kim
Keyword(s):  
Time Course ◽  
Immunoglobulin E ◽  
Gastrointestinal Symptoms ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Food Protein ◽  
Female Predominance ◽  
Adolescents And Adults ◽  
History Of ◽  
Ige Mediated

Abstract Background Food protein-induced enterocolitis (FPIES), an entity previously thought to only affect children, has been increasingly described in adults. In this study, we report a Canadian cohort of 19 adolescents and adults with recurrent non-immunoglobulin E (IgE)-mediated gastrointestinal symptoms after crustacean ingestion, consistent with FPIES. Methods We conducted a retrospective chart review of patients in an outpatient allergy clinic from January 2005 to May 2020. Electronic records were searched using keywords for crustaceans and for symptoms consistent with FPIES. We included patients with gastrointestinal symptoms specifically to crustaceans on more than one occasion, who were 14 years or older at the time of index reaction. Exclusion criteria included symptoms suggestive of an IgE-mediated anaphylactic reaction or a likely alternative diagnosis. We identified 19 patients for our cohort who met the criteria. Results Our cohort was 68.4% female (13) and 32.6% (6) male. The average age at first reaction to crustaceans was 34 years old with a range of 14–68 years (median = 28 years; IQR = 32 years). Time from ingestion to beginning of symptoms ranged from 3 min to 6.5 h, with an average of 2.8 h (median = 2 h; IQR = 3.25 h). Duration of reaction ranged from less than a minute to over 48 h, with a mean of 9.4 h (median = 4 h; IQR = 7.75 h). Patients had 4.8 reactions on average; however, number of reactions ranged from 2 to 12.5 (median = 3, IQR = 3). All patients identified a “trigger” food in the crustacean group, and 12 subjects identified additional reactions to other seafood. Conclusions This case series will better characterize and advance our understanding of this disease entity in adults. There are key differences in the presentation of FPIES in adults compared to children, namely female predominance, difference in solid food trigger, and unpredictable time course. Future studies are needed to examine the pathophysiology and natural history of adult FPIES. Specific guidelines should be developed for the diagnosis and management in adults. Trial registration: retrospectively registered.

Breast-Feeding: Second Thoughts

PEDIATRICS ◽  
1974 ◽  
Vol 54 (6) ◽  
pp. 757-764
Author(s):  
John W. Gerrard
Keyword(s):  
Breast Milk ◽  
Breast Feeding ◽  
Cow’S Milk ◽  
Allergic Reactions ◽  
Gastrointestinal Infections ◽  
Cow's Milk ◽  
Medical Facilities ◽  
Protection Against Infection ◽  
Breast Fed

A number of studies have shown that breast-feeding not only supplies the infant with nourishment but gives him immunologic protection against infection as well. Breast-fed infants are less likely to develop respiratory and gastrointestinal infections and allergic reactions. Infants slowly develop their own immunologic defenses in the months after birth, and breast-feeding is a hygienic, gradual method of protection during the transition to immunologic independence. Best protection is achieved when the infant receives breast milk alone for, at least, the first six months of life. Pediatricians should be aware that this is particularly important in areas where contamination of cow's milk and other foods is likely and where medical facilities are inadequate.

scholarly journals Mechanisms Underlying the Skin-Gut Cross Talk in the Development of IgE-Mediated Food Allergy

Nutrients ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3830
Author(s):  
Marloes van Splunter ◽  
Liu Liu ◽  
R.J. Joost van Neerven ◽  
Harry J. Wichers ◽  
Kasper A. Hettinga ◽  
...  
Keyword(s):  
Food Allergy ◽  
Gastrointestinal Tract ◽  
Immune Tolerance ◽  
Allergic Sensitization ◽  
Therapeutic Strategies ◽  
Dietary Proteins ◽  
Oral Ingestion ◽  
Food Antigens ◽  
Ige Mediated ◽  
Gastrointestinal Inflammation

Immune-globulin E (IgE)-mediated food allergy is characterized by a variety of clinical entities within the gastrointestinal tract, skin and lungs, and systemically as anaphylaxis. The default response to food antigens, which is antigen specific immune tolerance, requires exposure to the antigen and is already initiated during pregnancy. After birth, tolerance is mostly acquired in the gut after oral ingestion of dietary proteins, whilst exposure to these same proteins via the skin, especially when it is inflamed and has a disrupted barrier, can lead to allergic sensitization. The crosstalk between the skin and the gut, which is involved in the induction of food allergy, is still incompletely understood. In this review, we will focus on mechanisms underlying allergic sensitization (to food antigens) via the skin, leading to gastrointestinal inflammation, and the development of IgE-mediated food allergy. Better understanding of these processes will eventually help to develop new preventive and therapeutic strategies in children.

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