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 Atypical Food protein-induced enterocolitis syndrome in children: Is IgE sensitization an issue longitudinally?

2021 ◽  
Vol 49 (3) ◽  
pp. 73-82
Author(s):  
Athina Papadopoulou ◽  
Theano Lagousi ◽  
Elpiniki Hatzopoulou ◽  
Paraskevi Korovessi ◽  
Stavroula Kostaridou ◽  
...  
Keyword(s):  
Immunoglobulin E ◽  
Allergic Diseases ◽  
Cow’S Milk ◽  
Food Protein ◽  
Cow's Milk ◽  
T Helper 2 ◽  
Term Evaluation ◽  
Ige Mediated ◽  
Trigger Mechanisms

Background: Food Protein-Induced Enterocolitis Syndrome (FPIES) is a clinically well-characterised, non-Immunoglobulin E (IgE)-mediated food allergy syndrome, yet its rare atypical presen-tation remains poorly understood.Objective: Aim of this study was to present the 10-year experience of a referral centre high-lighting the atypical FPIES cases and their long-term outcome.Methods: FPIES cases were prospectively evaluated longitudinally in respect of food outgrowth and developing other allergic diseases with or without concomitant IgE sensitisation.Results: One hundred subjects out of a total of 14,188 referrals (0.7%) were identified. At pre-sentation, 15 patients were found sensitised to the offending food. Fish was the most frequent eliciting food, followed by cow’s milk and egg. Tolerance acquisition was earlier for cow’s milk, followed by egg and fish, while found not to be protracted in atypical cases. Resolution was not achieved in half of the fish subjects during the 10-year follow-up time. Sensitisation to food was not related to infantile eczema or culprit food, but was related to sensitisation to aeroallergens. In the long-term evaluation, persistence of the FPIES or aeroallergen sensitisation was significantly associated with an increased hazard risk of developing early asthma symptoms. Conclusion: Sensitisation to food was related neither to eczema or culprit food nor to tolerance acquisition but rather to the development of allergic asthma through aeroallergen sen-sitisation. In addition to an IgE profile at an early age, FPIES persistence may also trigger mechanisms switching FPIES cases to a T-helper 2 cells immune response later in life, predis-posing to atopic respiratory symptoms; albeit further research is required.

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 Assessment of IgE-Mediated and Non-IgE-Mediated Cow’s Milk Protein Allergy in Children

2019 ◽  
Vol 25 (3) ◽  
pp. 129-131
Author(s):  
Balasa Adriana ◽  
Mihai Cristina ◽  
Pruna Irina ◽  
Chisnoiu Tatiana ◽  
Daineanu Diana ◽  
...  
Keyword(s):  
Primary Care Physicians ◽  
Milk Protein ◽  
Immunoglobulin E ◽  
Clinical Manifestations ◽  
Specific Ige ◽  
Cow Milk ◽  
Cow’S Milk ◽  
Cow's Milk ◽  
Ige Mediated ◽  
Cow’S Milk Protein

Abstract Cow’s milk protein allergy (CMPA) is the most common food allergy found in children under 3 years of age. In most cases, it occurs in infancy. Early diagnosis and appropriate treatment can decrease the risk of impaired growth. In our study, we evaluated 40 children, with ages between 1 month and 3 years, diagnosed with IgE-mediated or non-IgE-mediated CMPA, from january to december 2017, in the Department of Pediatrics of the Clinical Emergency County Hospital of Constanta. The inclusion criteria consisted of: age, natural or artificial feeding, specific IgE levels, CoMiSS score, and clinical manifestations. The Cow’s Milk-related-Symptom-Score (CoMiSS) was developed as a screening and diagnostic tool for CMPA prediction, and can guide pediatricians and primary care physicians to make an early diagnostic, as it can be easily missed. We observed a higher number of cases of CMPA registered among children who were artificially fed (57,5%), followed by those with mixed nutrition (25%), the remaining (17,5%) being represented by exclusively breastfed infants. The most frequent clinical manifestations were rashes (87,5%), failure to thrive (82,5%), regurgitation (50%) and diarrhea (35%). Further data should be collected to prove if the association between a CoMiSS score higher than 12 and specific IgE-mediated CMPA is clinically relevant, and can predict, based on clinical examination and anamnesis, high serum levels of specific immunoglobulin E. The prognosis can depend on the titre of specific IgE at the time of diagnosis, as they are more likely to develop several crossed allergies and less prone to become tolerant to cow milk proteins than those with non-IgE-mediated CMPA.

Shift from IgE-mediated cow's milk allergy to food protein-induced enterocolitis syndrome in 2 infants

2018 ◽  
Vol 29 (4) ◽  
pp. 446-447 ◽  
Author(s):  
Simona Barni ◽  
Francesca Mori ◽  
Annamaria Bianchi ◽  
Neri Pucci ◽  
Elio Novembre
Keyword(s):  
Cow’S Milk Allergy ◽  
Cow’S Milk ◽  
Food Protein ◽  
Milk Allergy ◽  
Cow's Milk ◽  
Cow's Milk Allergy ◽  
Ige Mediated

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 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.

scholarly journals Immunological biomarkers changes during diet therapy in children with food allergy

2015 ◽  
Vol 12 (1) ◽  
pp. 73-78
Author(s):  
I V Vorozhko ◽  
T B Sentsova ◽  
V A Revyakina ◽  
O O Chernyak ◽  
S N Denisova
Keyword(s):  
Food Allergy ◽  
Milk Protein ◽  
Goat Milk ◽  
Specific Ige ◽  
Diet Therapy ◽  
Cow’S Milk ◽  
Igg Antibodies ◽  
Cow's Milk ◽  
Cow’S Milk Protein ◽  
Different Sources

Immunological estimating of different diet therapy types became currently very important. The aim of this work was to study the changes of immunological biomarkers during usage of formulas based on different sources of protein in children with food allergy and to assess and predict the effectiveness of diet therapy. The study included 66 children with food allergy in age from 1,5 months to 1,5 years. Observed children were divided into three groups depending on the type of formulas used. The dynamics of immunoregulatory substances (IL-5, TGF β 1, IL-10, IL-4, IL-2, IL-13, Eotaxin3), and allergenspecific IgE and IgG antibodies to cow’s milk protein, α-lactoglobulin, β-laktoglobulin, casein, soy and goat’s milk during diet therapy were evaluated. Observation duration was 28-30 days. The differences in the dynamics of the investigated parameters depending on the type of formula were revealed. Thus, the use of formula based on cow’s milk hydrolysates revealed their primarily effect on cytokines IL-2, IL-5 and growth factor TGF β ; the use of formula based on soy protein revealed combined effect on humoral immunity (allergen specific IgE and IgG antibodies) and IL-5; the use of formula based on goat milk characterized decreased levels of allergenspecific IgG antibodies to the cow’s milk protein and its fractions, reduced allergen specific IgE antibody concentrations to cow’s milk protein and α-lactoglobulin, decreased levels of IL-5, and, exclusive for this formula - reduction of IL-4 level. Accordingly, the assessment of immunological biomarkers can be used to personalize diet therapy in children with food allergy.

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