scholarly journals From Allergen Molecules to Molecular Immunotherapy of Nut Allergy: A Hard Nut to Crack

2021 ◽  
Vol 12 ◽  
Author(s):  
Verena Fuhrmann ◽  
Huey-Jy Huang ◽  
Aysegul Akarsu ◽  
Igor Shilovskiy ◽  
Olga Elisyutina ◽  
...  
Keyword(s):  
Food Allergy ◽  
Immunoglobulin E ◽  
Class I ◽  
Food Allergens ◽  
Allergy Diagnosis ◽  
Allergen Specific Immunotherapy ◽  
Tree Nuts ◽  
Carbohydrate Epitopes ◽  
Molecular Allergy ◽  
Life Threatening

Peanuts and tree nuts are two of the most common elicitors of immunoglobulin E (IgE)-mediated food allergy. Nut allergy is frequently associated with systemic reactions and can lead to potentially life-threatening respiratory and circulatory symptoms. Furthermore, nut allergy usually persists throughout life. Whether sensitized patients exhibit severe and life-threatening reactions (e.g., anaphylaxis), mild and/or local reactions (e.g., pollen-food allergy syndrome) or no relevant symptoms depends much on IgE recognition of digestion-resistant class I food allergens, IgE cross-reactivity of class II food allergens with respiratory allergens and clinically not relevant plant-derived carbohydrate epitopes, respectively. Accordingly, molecular allergy diagnosis based on the measurement of allergen-specific IgE levels to allergen molecules provides important information in addition to provocation testing in the diagnosis of food allergy. Molecular allergy diagnosis helps identifying the genuinely sensitizing nuts, it determines IgE sensitization to class I and II food allergen molecules and hence provides a basis for personalized forms of treatment such as precise prescription of diet and allergen-specific immunotherapy (AIT). Currently available forms of nut-specific AIT are based only on allergen extracts, have been mainly developed for peanut but not for other nuts and, unlike AIT for respiratory allergies which utilize often subcutaneous administration, are given preferentially by the oral route. Here we review prevalence of allergy to peanut and tree nuts in different populations of the world, summarize knowledge regarding the involved nut allergen molecules and current AIT approaches for nut allergy. We argue that nut-specific AIT may benefit from molecular subcutaneous AIT (SCIT) approaches but identify also possible hurdles for such an approach and explain why molecular SCIT may be a hard nut to crack.

Food allergy: Diagnosis and treatment

2019 ◽  
Vol 40 (6) ◽  
pp. 446-449
Author(s):  
Elisa N. Ochfeld ◽  
Jacqueline A. Pongracic
Keyword(s):  
Food Allergy ◽  
Immunoglobulin E ◽  
Water Soluble ◽  
Adolescent And Young Adult ◽  
Cow’S Milk ◽  
Food Allergens ◽  
Early Introduction ◽  
Adult Age ◽  
Cow's Milk ◽  
Tree Nuts

Immunoglobulin E‐mediated food reactions usually develop within minutes of food ingestion. Although most reactions are not life-threatening, fatalities do occur. Risk factors for fatal food-induced anaphylaxis include the presence of asthma (a risk factor for anaphylaxis in general), failure to use epinephrine autoinjectors promptly, a history of severe reactions, known food allergy, denial of symptoms, and adolescent and young adult age. The most commonly implicated foods are cow's milk, egg, peanut, soy, tree nuts, fish, shellfish, and wheat. Peanut, tree nuts, and seafood are the most common food allergens in adults, whereas cow's milk, peanut, egg, soy, and wheat are more common in children. The major food allergens are glycoproteins, which are generally water soluble and stable to the effects of heat, proteases, and acids. Recent studies showed that natural tolerance can be acquired at a later age than previously thought, even during adolescence. Allergies to peanut, tree nuts, and seafood are frequently life-long. Patients and their caregivers should be taught when and how to administer injectable epinephrine. In terms of primary prevention, there is evidence that early introduction, followed by ongoing regular consumption of peanut has a protective effect on the development of peanut allergy.

Anaphylaxis and Emergency Treatment

PEDIATRICS ◽  
2003 ◽  
Vol 111 (Supplement_3) ◽  
pp. 1601-1608 ◽  
Author(s):  
Hugh A. Sampson
Keyword(s):  
Emergency Departments ◽  
Emergency Treatment ◽  
Immunoglobulin E ◽  
Antibody Therapy ◽  
The United States ◽  
Food Allergens ◽  
Tree Nuts ◽  
Immunomodulatory Therapies ◽  
Fish And Shellfish ◽  
Food Anaphylaxis

Food anaphylaxis is now the leading known cause of anaphylactic reactions treated in emergency departments in the United States. It is estimated that there are 30 000 anaphylactic reactions to foods treated in emergency departments and 150 to 200 deaths each year. Peanuts, tree nuts, fish, and shellfish account for most severe food anaphylactic reactions. Although clearly a form of immunoglobulin E-mediated hypersensitivity, the mechanistic details responsible for symptoms of food-induced anaphylaxis are not completely understood, and in some cases, symptoms are not seen unless the patient exercises within a few hours of the ingestion. At the present time, the mainstays of therapy include educating patients and their caregivers to strictly avoid food allergens, to recognize early symptoms of anaphylaxis, and to self-administer injectable epinephrine. However, clinical trials are now under way for the treatment of patients with peanut anaphylaxis using recombinant humanized anti-immunoglobulin E antibody therapy, and novel immunomodulatory therapies are being tested in animal models of peanut-induced anaphylaxis.

A Review on Identified Major Food Allergens: Characteristics and Role in Food Allergy

2017 ◽  
Vol 54 (3) ◽  
pp. 346
Author(s):  
Chhavi Arya ◽  
Chetna Jantwal
Keyword(s):  
Food Allergy ◽  
Food Allergies ◽  
Allergic Reactions ◽  
Food Allergens ◽  
Food Groups ◽  
Consumer Protection Act ◽  
Major Food ◽  
Life Threatening ◽  
Major Allergens ◽  
Allergen Labeling

Food allergens are the substances present in food that cause food allergy. Human body reactions to food allergens range from mild to severe life threatening anaphylactic shock. At least seventy different foods have been reported to cause allergic reactions and several other foods have been identified which have the potential to provoke allergic reactions. Majority of the identified food allergens are proteins. The Food Allergen Labeling and Consumer Protection Act (FALCPA) identifies eight major food groups i.e. milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, and soybeans as major allergy causing foods. These eight foods are believed to account for 90 per cent of food allergies and are responsible for most serious reactions to foods. Several studies have been done which identify the major allergens in various foods. The present paper attempts to review the major allergens present in various food.

scholarly journals Common food allergens and cross-reactivity

2020 ◽  
Vol 2 (1) ◽  
pp. 17-21
Author(s):  
Olivia L. Francis ◽  
Kathleen Y. Wang ◽  
Edwin H. Kim ◽  
Timothy P. Moran
Keyword(s):  
Food Allergy ◽  
Protein Stability ◽  
Cross Reactivity ◽  
Molecular Characteristics ◽  
Food Allergens ◽  
Tree Nuts ◽  
Heat Stable ◽  
Systemic Reactions ◽  
Hen’S Egg ◽  
Fish And Shellfish

The most clinically relevant food allergens are cow’s milk, hen’s egg, peanut, tree nuts, wheat, soy, fish, shellfish, and seeds. Heat-stable food allergens have molecular characteristics that enhance protein stability and gastrointestinal absorption and thus are more likely to cause systemic reactions on ingestion. In contrast, heat-labile food allergens lack these characteristics and do not typically elicit reactions if sufficiently altered by heat or acid. Immunologic cross-sensitization between food allergens is more common than clinical cross-reactivity. However, certain groups of food allergens, such as tree nuts, fish, and shellfish, are associated with high rates of clinical cross-reactivity. Knowing the rates of clinical cross-reactivity is important when providing guidance to patients with food allergy and families on what foods can be safely added to the diet and what foods should be avoided.

Oral food challenges in clinical practice: a missing element of food allergy diagnosis in Russia

2021 ◽  
Vol 17 (4) ◽  
pp. 19-29
Author(s):  
Daria M. Levina ◽  
Ilya A. Korsunskiy ◽  
Daniel B. Munblit
Keyword(s):  
Food Allergy ◽  
Russian Federation ◽  
Food Challenge ◽  
Clinical History ◽  
Allergy Diagnosis ◽  
Laboratory Test Results ◽  
The World ◽  
Life Threatening ◽  
Food Challenges ◽  
Food Allergy Diagnosis

Food allergy is one of the most prevalent allergic conditions, causing reduction in patient quality of life. It is linked with high levels of anxiety due to potential life-threatening reactions, and high economic burden for a healthcare system. Food allergy affects approximately 5 to 10% of children around the world. In Russian Federation the diagnosis of food allergy is primarily based on clinical history, laboratory test results, examination and elimination of suspected food. Meanwhile oral food challenge (OFC) is considered a gold standard of food allergy diagnosis by most of professional bodies nationally and internationally. OFC is a diagnostic procedure involving administration of a causative allergen in gradually increasing amount under a close medical supervision. The method is safe, highly specific and sensitive and is widely used around the world for more than 45 years. The main goals of OFC include food allergy diagnosis and presence of tolerance evaluation, which may result in diet expansion. OFC may also help establishing both, reaction severity and dose needed to elicit reaction, which may further assist with alleviation of patients anxiety. In this paper we discuss existing approaches to the diagnosis of food allergy in Russian Federation and review available recommendations on OFC outlined in international guidelines.

scholarly journals Review of statutory and voluntary labelling of food allergens

2005 ◽  
Vol 64 (4) ◽  
pp. 475-480 ◽  
Author(s):  
Mark Boden ◽  
Ruth Dadswell ◽  
Sue Hattersley
Keyword(s):  
Food Allergy ◽  
Western Europe ◽  
Adult Population ◽  
Food Allergies ◽  
Food Allergens ◽  
Arachis Hypogea ◽  
Important Health ◽  
Life Threatening ◽  
The Uk ◽  
Specific Symptoms

Food allergy represents an increasingly important health problem, with prevalence in Western Europe continuing to rise. While some reactions are mild, others can include life-threatening anaphylactic shock. It is estimated that food allergies affect 1–2% of the adult population and ≤8% of children. Relatively few foods are to blame for a large majority of allergic reactions to food in the UK, with most reactions being to milk, eggs, peanuts (Arachis hypogea), nuts, fish, shellfish, soyabean, sesame (Sesamum indicum L.) and wheat. There is currently no cure for food allergy and the few available treatments are focused on relieving the specific symptoms. Consumers with food allergies and food intolerances rely on food labelling to enable them to make informed choices about the foods they eat. Whilst there have recently been important advances in the labelling of food allergens, these advances relate only to requirements for the labelling of the deliberate use of specified food allergens in foods sold pre-packed. In other areas the development of guidance for food manufacturers and retailers on how to assess the risks of possible allergen cross-contamination during food production and manufacture, and then to determine appropriate advisory labelling, is well advanced. Work to address the issue of how to provide appropriate allergen information for foods sold loose, or in catering establishments, is also in progress.

scholarly journals Food allergy: Epicutaneous immunotherapy

2020 ◽  
Vol 2 (1) ◽  
pp. 81-85
Author(s):  
Timothy G. Chow ◽  
Christopher Parrish ◽  
J. Andrew Bird
Keyword(s):  
Food Allergy ◽  
Peanut Allergy ◽  
Immunoglobulin E ◽  
Treatment Options ◽  
Allergen Exposure ◽  
Application Site ◽  
Regional Lymph Nodes ◽  
Antigen Uptake ◽  
Allergen Specific Immunotherapy ◽  
Epicutaneous Immunotherapy

The goal of allergen-specific immunotherapy for treatment of immunoglobulin E (IgE) mediated food allergy is to safely and effectively modify the allergic response, providing protection against anaphylaxis via ongoing exposure to the triggering allergen. Targeted allergen exposure via application of allergen to the epidermis has emerged as a potentially promising approach to desensitization. Epicutaneous immunotherapy (EPIT) uses allergen embedded on an adhesive patch secured to the skin. This allows for long-lasting allergen exposure, with subsequent antigen uptake and trafficking by skin antigen‐presenting cells to regional lymph nodes, which produce immunomodulatory effects in a manner that is noninvasive and limits exposure of allergen to the systemic circulation when applied to intact skin. As such, EPIT is overall well tolerated; local application site reactions are common, but systemic adverse effects are infrequent compared with other forms of immunotherapy. For peanut allergy, EPIT may increase the dose-triggering threshold in some individuals with peanut-allergy, especially younger children, but induction of remission has not been closely studied, and reliable predictors of clinical response are lacking. With U.S. Food and Drug Administration approved treatment for peanut allergy now available, the precepts of shared decision-making will be crucial in discussions with patients and their families with regard to treatment options.

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.

Criteria to Determine Food Allergen Priority

2000 ◽  
Vol 63 (7) ◽  
pp. 982-986 ◽  
Author(s):  
JUPITER M. YEUNG ◽  
RHONA S. APPLEBAUM ◽  
REGINA HILDWINE
Keyword(s):  
Food Allergen ◽  
Food Industry ◽  
Scientific Literature ◽  
Immunoglobulin E ◽  
Allergic Reactions ◽  
Food Allergens ◽  
Important Challenge ◽  
Life Threatening ◽  
Allergen Labeling ◽  
Food Anaphylaxis

The emergent health issue of food allergens presents an important challenge to the food industry. More than 170 foods have been reported in the scientific literature as causing allergic reactions. Clearly, it would be impossible to deal with the presence of trace amounts of all these in the context of food labeling. If the decision to classify major allergens is based solely on the knowledge and experience of allergists and food scientists in the field, without scientifically defined criteria, it is likely to lead to a proliferation of lists. Such practices may lead to an unnecessary elimination of foods containing important nutrients. This paper defines food allergy, food intolerance, and food anaphylaxis and identifies criteria for classifying food allergens associated with frequent allergic reactions. A practical list of food allergens that may result in potentially life-threatening allergic reactions is provided. A mechanism-based (i.e., immunoglobulin E mediated), acute life-threatening anaphylaxis that is standardized and measurable and reflects the severity of health risk is proposed as the principal inclusion criterion for food allergen labeling. Where available, prevalence in the population and threshold levels of allergens should be used as an additional guide to identify possible future labeling needs.

Alimentos alérgenos más frecuentes en escolares y prevalencia de alergia alimentaria mediada por IgE por reporte parental

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
María de los Ángeles Sabaté ◽  
◽  
Gimena Valeria A. Dezar ◽  
Keyword(s):  
Food Allergy ◽  
Latin American ◽  
Immunoglobulin E ◽  
Developed Countries ◽  
Correct Identification ◽  
Food Allergens ◽  
Parental Report ◽  
Questionnaire Response ◽  
Immune Disorder ◽  
Ige Mediated

Introduction: food allergy (FA) is an immune disorder triggered by the ingestion of an allergen food, whose symptoms are specific and reproducible. Although in developed countries the prevalence of FA has been documented in 6-8% of the child population, data from the most of Latin American countries remain unknown. Objectives: to evaluate the prevalence of FA immunoglobulin E (IgE) mediated by parental report and to determine the most frequent food allergens in schoolchildren from 5 to 14 years of the city of Santa Fe, Argentina, in 2018. Materials and methods: a cross-section quantitative, descriptive, observational, retrospective study was performed collecting data by using a validated survey in Argentine Spanish to determine the most frequent food allergens and FA prevalence among schoolchildren. The sample consisted of 4,059 schoolchildren from nine schools; 1,493 schoolchildren returned the questionnaire (response rate of 36.78%) and 1,431 were considered as valid. Results: the prevalence of FA IgE mediated by parental report in schoolchildren from 5 to 14 years of age was 5.03%. The most frequently reported allergenic foods in this population were chocolate (23.58%), chilli and milk (both 16.04%). Conclusions: the prevalence of FA IgE mediated by parental report in schoolchildren was 5.03%. The most frequently reported allergenic foods in schoolchildren were chocolate, chilli and milk. Correct identification of FAs is important to avoid unnecessary exclusion of foods that can harm the growth and development of children, especially during the first years old. Key words: food allergy; schoolchildren; parental report.

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