Establishment of a medical cooperation system for food allergy; the role of allergy specialists in outpatient clinics; a multi-occupational collaborative project on children's food allergies in Ehime Prefecture and results of oral food challenges in my outpatient clinic

2020 ◽  
Vol 34 (1) ◽  
pp. 52-58
Author(s):  
Keisuke Fukuoka
Keyword(s):  
Food Allergy ◽  
Outpatient Clinic ◽  
Outpatient Clinics ◽  
Food Allergies ◽  
Collaborative Project ◽  
Food Challenges ◽  
Cooperation System

Non-IgE Mediated Food Allergy

2020 ◽  
Vol 16 (2) ◽  
pp. 95-105
Author(s):  
Antonella Cianferoni
Keyword(s):  
Food Allergy ◽  
Eosinophilic Esophagitis ◽  
Allergic Diseases ◽  
Food Allergies ◽  
Food Protein ◽  
Ige Mediated ◽  
Food Challenges ◽  
Allergic Proctocolitis ◽  
Eosinophilic Disorders

Food allergies, defined as an immune response to food proteins, affect as many as 8% of young children and 2% of adults in western countries, and their prevalence appears to be rising like all allergic diseases. In addition to well-recognized urticaria and anaphylaxis triggered by IgE antibody– mediated immune responses, there is an increasing recognition of cell-mediated disorders, such as eosinophilic esophagitis and food protein–induced enterocolitis. Non-IgE-Mediated gastrointestinal food allergies are a heterogeneous group of food allergies in which there is an immune reaction against food but the primary pathogenesis is not a production of IgE and activation of mast cells and basophils. Those diseases tend to affect mainly the gastrointestinal tract and can present as acute (FPIES) or chronic reaction, such as Eosinophilic Esophagitis (EoE), Food Protein-Induced Allergic Proctocolitis (FPIAP). The role of food allergy in Non-EoE gastrointestinal Eosinophilic disorders (Non- EoE EGID) is poorly understood. In some diseases like EoE, T cell seems to play a major role in initiating the immunological reaction against food, however, in FPIES and FPIAP, the mechanism of sensitization is not clear. Diagnosis requires food challenges and/or endoscopies in most of the patients, as there are no validated biomarkers that can be used for monitoring or diagnosis of Non-IgE mediated food allergies. The treatment of Non-IgE food allergy is dependent on diet (FPIES, and EoE) and/or use of drugs (i.e. steroids, PPI) in EoE and Non-EoE EGID. Non-IgE mediated food allergies are being being investigated.

Non-IgE Mediated Food Allergy

2020 ◽  
Vol 16 (2) ◽  
pp. 95-105
Author(s):  
Antonella Cianferoni
Keyword(s):  
Food Allergy ◽  
Eosinophilic Esophagitis ◽  
Allergic Diseases ◽  
Food Allergies ◽  
Food Protein ◽  
Ige Mediated ◽  
Food Challenges ◽  
Allergic Proctocolitis ◽  
Eosinophilic Disorders

: Food allergies, defined as an immune response to food proteins, affect as many as 8% of young children and 2% of adults in western countries, and their prevalence appears to be rising like all allergic diseases. In addition to well-recognized urticaria and anaphylaxis triggered by IgE antibody– mediated immune responses, there is an increasing recognition of cell-mediated disorders, such as eosinophilic esophagitis and food protein–induced enterocolitis. Non-IgE-Mediated gastrointestinal food allergies are a heterogeneous group of food allergies in which there is an immune reaction against food but the primary pathogenesis is not a production of IgE and activation of mast cells and basophils. : Those diseases tend to affect mainly the gastrointestinal tract and can present as acute (FPIES) or chronic reaction, such as Eosinophilic Esophagitis (EoE), Food Protein-Induced Allergic Proctocolitis (FPIAP). The role of food allergy in Non-EoE gastrointestinal Eosinophilic disorders (Non- EoE EGID) is poorly understood. : In some diseases like EoE, T cell seems to play a major role in initiating the immunological reaction against food, however, in FPIES and FPIAP, the mechanism of sensitization is not clear. : Diagnosis requires food challenges and/or endoscopies in most of the patients, as there are no validated biomarkers that can be used for monitoring or diagnosis of Non-IgE mediated food allergies. : The treatment of Non-IgE food allergy is dependent on diet (FPIES, and EoE) and/or use of drugs (i.e. steroids, PPI) in EoE and Non-EoE EGID. : Non-IgE mediated food allergies are being being investigated.

scholarly journals Prevention of Food Allergy: The Significance of Early Introduction

Medicina ◽  
2019 ◽  
Vol 55 (7) ◽  
pp. 323 ◽  
Author(s):  
Pasquale Comberiati ◽  
Giorgio Costagliola ◽  
Sofia D’Elios ◽  
Diego Peroni
Keyword(s):  
Clinical Trials ◽  
Food Allergy ◽  
Total Duration ◽  
Food Allergies ◽  
Preventive Strategy ◽  
Food Allergens ◽  
High Quality ◽  
Early Introduction ◽  
Potential Food

Over the last two decades, the prevalence of food allergies has registered a significant increase in Westernized societies, potentially due to changes in environmental exposure and lifestyle. The pathogenesis of food allergies is complex and includes genetic, epigenetic and environmental factors. New evidence has highlighted the role of the intestinal microbiome in the maintenance of the immune tolerance to foods and the potential pathogenic role of early percutaneous exposure to allergens. The recent increase in food allergy rates has led to a reconsideration of prevention strategies for atopic diseases, mainly targeting the timing of the introduction of solid foods into infants’ diet. Early recommendation for high atopy risk infants to delay the introduction of potential food allergens, such as cow’s milk, egg, and peanut, until after the first year of life, has been rescinded, as emerging evidence has shown that these approaches are not effective in preventing food allergies. More recently, high-quality clinical trials have suggested an opposite approach, which promotes early introduction of potential food allergens into infants’ diet as a means to prevent food allergies. This evidence has led to the production of new guidelines recommending early introduction of peanut as a preventive strategy for peanut allergy. However, clinical trials investigating whether this preventive dietary approach could also apply to other types of food allergens have reported ambiguous results. This review focuses on the latest high-quality evidence from randomized controlled clinical trials examining the timing of solid food introduction as a strategy to prevent food allergies and also discusses the possible implications of early complementary feeding on both the benefits and the total duration of breastfeeding.

scholarly journals Primary Prevention of Food Allergy—Environmental Protection beyond Diet

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 2025
Author(s):  
Hanna Sikorska-Szaflik ◽  
Barbara Sozańska
Keyword(s):  
Food Allergy ◽  
Primary Prevention ◽  
Environmental Factors ◽  
Current Knowledge ◽  
Food Allergies ◽  
Allergy Prevention ◽  
Delivery Mode ◽  
Effective Prevention ◽  
Inhalant Allergens

A food allergy is a potentially life-threatening disease with a genetic and environmental background. As its prevalence has increased significantly in recent years, the need for its effective prevention has been emphasized. The role of diet modifications and nutrients in food allergy reduction has been extensively studied. Much less is known about the role of other environmental factors, which can influence the incidence of this disease. Changes in neonates gut microbiome by delivery mode, animal contact, inhalant allergens, oral and then cutaneous allergen exposure, air pollution, smoking, infections and vaccinations can be the potential modifiers of food allergy development. There is some data about their role as the risk or preventive factors, but yet the results are not entirely consistent. In this paper we present the current knowledge about their possible role in primary prevention of food allergies. We discuss the mechanisms of action, difficulties in designing accurate studies about food allergy and the potential biases in interpreting the connection between environmental factors and food allergy prevention. A better understanding of the role of environmental factors in food allergies development may help in implementing practical solutions for food allergy primary prevention in the future.

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

2021 ◽  
Vol 3 (1) ◽  
pp. 3-7 ◽  
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.

scholarly journals The Epidemiology of Food Allergy in the Global Context

2018 ◽  
Vol 15 (9) ◽  
pp. 2043 ◽  
Author(s):  
Wenyin Loh ◽  
Mimi Tang
Keyword(s):  
Developing Countries ◽  
Food Allergy ◽  
Immunoglobulin E ◽  
Clinical History ◽  
Food Allergies ◽  
Western Countries ◽  
Specific Immunoglobulin E ◽  
Food Challenges ◽  
Surrogate Measures ◽  
Allergy Prevalence

There is a lack of high-quality evidence based on the gold standard of oral food challenges to determine food allergy prevalence. Nevertheless, studies using surrogate measures of food allergy, such as health service utilization and clinical history, together with allergen-specific immunoglobulin E (sIgE), provide compelling data that the prevalence of food allergy is increasing in both Western and developing countries. In Western countries, challenge-diagnosed food allergy has been reported to be as high as 10%, with the greatest prevalence noted among younger children. There is also growing evidence of increasing prevalence in developing countries, with rates of challenge-diagnosed food allergy in China and Africa reported to be similar to that in Western countries. An interesting observation is that children of East Asian or African descent born in a Western environment are at higher risk of food allergy compared to Caucasian children; this intriguing finding emphasizes the importance of genome-environment interactions and forecasts future increases in food allergy in Asia and Africa as economic growth continues in these regions. While cow’s milk and egg allergy are two of the most common food allergies in most countries, diverse patterns of food allergy can be observed in individual geographic regions determined by each country’s feeding patterns. More robust studies investigating food allergy prevalence, particularly in Asia and the developing world, are necessary to understand the extent of the food allergy problem and identify preventive strategies to cope with the potential increase in these regions.

scholarly journals Role of PAR1 in Food Allergies

2020 ◽  
Vol 3 ◽  
Author(s):  
Jennifer Garcia ◽  
Lauren Buelow ◽  
Joan Cook-Mills
Keyword(s):  
Food Allergy ◽  
Skin Barrier ◽  
Food Allergies ◽  
Neonatal Mice ◽  
Signaling Mechanisms ◽  
Skin Keratinocytes ◽  
Potential Impact ◽  
Fungal Allergen ◽  
Deficient Mice

Background and Hypothesis:  The prevalence of food allergies continues to rise. In a mouse model, food allergy to peanuts develops in flaky tail mice with skin barrier mutations and exposure to peanut (PNE) and Alternaria Alternata (fungal allergen, Alt) on the skin. In the skin, keratinocytes respond to proteases in allergens through protease activating receptor 1 (PAR1). Blocking PAR1 decreased the severity of viral induced inflammation in mice. Whether PAR1 has a major role in food allergies has not been investigated. We tested the hypothesis that blocking PAR1 would halt the development of food allergy to peanuts in neonatal mice.    Project Methods:  In our studies, pups were injected intradermally (i.d.) with a PAR1 antagonist and then treated with PNE/Alt. In another group, pups received i.d. injections of a PAR1 agonist and then treated with PNE only. Control groups received allergens only. Pups were treated and skin sensitized 5 times every 3-4 days. Forty-eight hours after the last treatment, pups were challenged with PNE through oral gavage, and temperatures were recorded every 15-30 minutes for 3 hours. Skin, ileum, and jejunum samples were collected and used for qPCR to determine the expression of inflammatory mediators. Plasma serum was used for analysis of anti-PNE specific antibodies by ELISA.      Results:   PAR1 antagonist blocked anaphylaxis in allergic mice sensitized with PNE and Alt. PAR1 agonist is sufficient to induce anaphylaxis in mice sensitized with PNE only.     Conclusion and Potential Impact:  This study demonstrates that PAR1 is involved in the development of food allergies, where blocking the receptor blocked food allergies in neonatal mice. The signaling mechanisms and activators of PAR1 need further studies, using PAR1 deficient mice. This novel pathway may lead to therapies to stop the development of food allergies. 

scholarly journals Challenges in Diagnosis of Food Allergies via Oral Food Challenges: A Qualitative Analysis of the Caregiver Perspective

2020 ◽  
Author(s):  
Natasha Correa ◽  
Jennifer LP Protudjer ◽  
Elaine Hsu ◽  
Lianne Soller ◽  
Edmond S Chan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Food Allergy ◽  
Focus Group ◽  
Primary Care Physicians ◽  
Poor Quality ◽  
Standard Test ◽  
Food Allergies ◽  
Older Children ◽  
Food Challenges

Abstract Background: Food allergy disproportionately affects children and contributes to poor quality of life for families. As a result, accurate diagnosis of food allergy is important. Oral food challenges (OFC) are the gold standard test for diagnosis of food allergy. Yet, many children do not undergo OFCs. The purpose of this study was to understand the barriers to OFCs faced by parents of children with food allergies in Ontario, as well as solutions to increase their utilization.Methods: Three focus group discussions were carried out with a total of 24 parents of children with food allergies in Kitchener-Waterloo, Ontario. Focus group data were analyzed using constant comparative analysis.Results: Parents misperceived OFCs as management of food allergies. They were also unsure about whether OFCs take place in hospitals, clinics or in the home. Parents reported several barriers to OFCs including not being referred by their primary care physicians, wait times, and fear and anxiety. Additionally, parents with older children, children with multiple allergies and children who could only tolerate allergens in its baked form felt that OFCs would not improve their quality of life. Solutions offered by parents to increase uptake of OFCs included education of the public, physicians and policy makers to improve knowledge and training, and ensure timely access to OFCs. Parents also suggested a need for improved counselling about the risk of OFCs, psychological support, and sharing of patient success stories. Long-term follow-up after an OFC as well as support and guidance around food reintroduction was also suggested to ensure OFCs resulted in an improvement in quality of life.Conclusion: Interventions aimed at addressing barriers to OFCs identified by parents have the potential to increase utilization of OFCs, and thereby reduce the burden of food allergies in children and improve quality of life.

Respiratory Manifestations of Food Allergy

PEDIATRICS ◽  
2003 ◽  
Vol 111 (Supplement_3) ◽  
pp. 1625-1630
Author(s):  
John M. James
Keyword(s):  
Food Allergy ◽  
Respiratory Tract ◽  
Immunoglobulin E ◽  
Food Additives ◽  
Airway Hyperreactivity ◽  
Severe Atopic Dermatitis ◽  
Increased Risk ◽  
Food Particles ◽  
Food Challenges

Food allergy may present with a variety of respiratory tract symptoms that generally involve immunoglobulin E antibody-mediated responses. Exposure is typically through ingestion, but in some cases, inhalation of airborne food particles may trigger these reactions. Upper and lower respiratory tract reactions are often a significant component of multisystem, anaphylactic reactions. However, chronic or isolated asthma or rhinitis induced by food is unusual. It is important to recognize that food allergy in early childhood is a marker indicating an increased risk to develop respiratory allergy. The role of food allergy in otitis media is controversial and probably is extremely rare. Likewise, asthmatic responses to food additives can occur but are uncommon. Studies using blinded oral food challenges have demonstrated that foods can elicit airway hyperreactivity and asthmatic responses. Therefore, an evaluation for food allergy should be considered in patients who are at risk, including those with recalcitrant or otherwise unexplained acute, severe asthma exacerbations, asthma triggered after ingestion of particular foods, and asthma that is accompanied by other manifestations of food allergy (eg, anaphylaxis, moderate to severe atopic dermatitis).

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