Virtual Reality Reduces Pediatric Anxiety During Food Allergy Clinical Trials: A Pilot Randomized, Pragmatic Study

Phlebotomy procedures required in food allergy (FA) diagnosis and clinical trials often induce fear and anxiety for pediatric patients. The primary aim of this study was to determine whether virtual reality (VR) applications were effective in reducing anxiety for pediatric FA patients undergoing phlebotomy during FA clinical trials. Secondary aims assessed fear, pain, procedural compliance, and adverse events. Participants undergoing phlebotomy were enrolled and randomized to a VR group or standard of care (SOC) group for this prospective pilot randomized, pragmatic study. Participants in the VR group played interactive applications on a customized Samsung Gear VR headset and those in the SOC group received the standard of care. Participants' anxiety, fear, and pain were assessed with the Children's Anxiety Meter, Children's Fear Scale, and FACES pain scale pre, during, and post phlebotomy procedure. Compliance was assessed using the modified Induction Compliance Checklist during the procedure and compared between two groups. Forty-nine participants were randomized to VR (n = 26) and SOC (n = 23) groups. Although both the VR and SOC groups experienced a decrease in anxiety and fear from pre- to post-procedure, those in the VR group experienced less anxiety and fear during the procedure than SOC participants. Similarly, both groups experienced an increase in pain from pre- to post-procedure; however, the VR group reported less pain during the procedure than SOC. Fewer symptoms of procedural non-compliance were reported in the VR group. Interactive VR applications may be an effective tool for reducing fear, anxiety, and pain during phlebotomy for FA clinical trials.

Re-Print-Anaphylaxis Induced by Beer

The prevalence of cereal allergy is highly influenced by geographical area and consumption habits. According to data from Alergologica 2015 [1], cereal allergy accounts for 2.1% of all cases of food allergy in Spain. Beer is a barley-based alcoholic beverage that also contains hops, yeast, and other cereals (wheat, oats, corn, and even rye). Barley is also the basis of malt vinegar, whiskey, and gin. Several allergens of barley have been described, including lipid transfer protein (LTP), - and ß-amylase, gliadin, glutenin, peroxiredoxin, thionin, and trypsin inhibitor [2].

Association Between Breastmilk Microbiota and Food Allergy in Infants

Regulating the composition of human breastmilk has the potential to prevent allergic diseases early in life. The composition of breastmilk is complex, comprising varying levels of oligosaccharides, immunoactive molecules, vitamins, metabolites, and microbes. Although several studies have examined the relationship between different components of breastmilk and infant food allergies, few have investigated the relationship between microorganisms in breastmilk and infant food allergy. In the present study, we selected 135 healthy pregnant women and their full-term newborns from a cohort of 202 mother–infant pairs. Among them, 69 infants were exclusively breastfed until 6 mo after birth. At follow-up, 11 of the 69 infants developed a food allergy in infancy while 22 showed no signs of allergy. Thirty-three breastmilk samples were collected within 1 mo after delivery, and 123 infant fecal samples were collected at five time points following their birth. These samples were analyzed using microbial 16S rRNA gene sequencing. The abundance and evenness of the milk microbiota and the number of differential bacteria were higher in the breastmilk samples from the non-allergy group than in those from the food allergy group. The non-allergy group showed relatively high abundance of Bifidobacterium, Akkermansia, Clostridium IV, Clostridium XIVa, Veillonella, and butyrate-producing bacteria such as Fusobacterium, Lachnospiraceae incertae sedis, Roseburia, and Ruminococcus. In contrast, the abundance of Proteobacteria, Acinetobacter, and Pseudomonas in breastmilk was higher in the food allergy group. A comparison of the changes in dominant differential breastmilk microbiota in the intestinal flora of the two groups of infants over time revealed that the changes in Bifidobacterium abundance were consistent with those in the breastmilk flora. Functional pathway prediction of breastmilk microflora showed that the enhancement of the metabolic pathways of tyrosine, tryptophan, and fatty acids was significantly different between the groups. We suggest that changes in the breastmilk microbiota can influence the development of food allergies. Breastmilk contains several microbes that have protective effects against food allergies, both by influencing the colonization of intestinal microbiota and by producing butyrate. This study may provide new ideas for improving infant health through early intervention with probiotics.

Chemically Defined Formulas, Symbiotics and Cow’s Milk Protein Allergy

Cow’s milk protein (CMP) allergy (CMPA) is the earliest and most common food allergy in children [...]

Prevalence of Food Allergy among Schoolchildren in Lebanon

<b><i>Introduction:</i></b> Food allergy (FA) is a global health problem with an ongoing rise in prevalence, especially in developed countries. It has been reported to be most prevalent in children, although cases in adults have been increasing as well. FA may lead to life-threatening clinical manifestations. Data in Lebanon and the Middle East are limited. To our knowledge, few studies tackled its prevalence in children in this region. <b><i>Aim:</i></b> This study aims at determining self-reported prevalence of FA in schoolchildren (ages 3–17 years) in Lebanon and describes its characteristics. <b><i>Method:</i></b> Throughout this cross-sectional study, 5 schools from 3 different governorates in Lebanon (Beirut, Mt. Lebanon, and Beqaa) were contacted to participate and 5,312 questionnaires were sent out to be completed by the parents and sent back to the school during May 2019. <b><i>Results:</i></b> 2,610 questionnaires were collected (49.13%). A hundred and forty-eight (6%) children reported to have FA, 58% were males. 80% of them were breastfed, 51% were diagnosed between the ages of 2 and 14 years. Common allergens included cow’s milk and milk products (22.46%), fruits and vegetables (16.58%), eggs (8.02%), and nuts (5.88%). Allergic symptoms included skin reactions (45.08%), gastrointestinal (GI) symptoms (29.53%), respiratory symptoms (14.51%), and systemic symptoms (10.88%). 82% of the population with FA has sought professional advice, out of which 54% were confirmed by a physician. Common methods of diagnosis were IgE test (35.71%), food elimination (27.92%), and skin prick test (18.83%). χ² analysis has shown that a higher percentage of children with FA had skin reactions (58.8%, <i>p</i> = 0.033) and GI symptoms (30.41%, <i>p</i> = 0.047). A higher percentage of children with allergies were breastfed. No relation between the presence of FA and delivery mode was observed. <b><i>Conclusion:</i></b> This study has shown that the self-reported prevalence of FA among Lebanese schoolchildren is 6%, and it was correlated with skin and GI symptoms. The most common allergen was cow’s milk. A higher proportion of children with FA were breastfed. No association between the mode of delivery and FA was found. Larger studies are needed to confirm the above findings.

An Overview of Environmental Risk Factors for Food Allergy

IgE-mediated food allergy is an increasing public health concern in many regions around the world. Although genetics play a role in the development of food allergy, the reported increase has occurred largely within a single generation and therefore it is unlikely that this can be accounted for by changes in the human genome. Environmental factors must play a key role. While there is strong evidence to support the early introduction of allergenic solids to prevent food allergy, this is unlikely to be sufficient to prevent all food allergy. The purpose of this review is to summarize the evidence on risk factors for food allergy with a focus the outdoor physical environment. We discuss emerging evidence of mechanisms that could explain a role for vitamin D, air pollution, environmental greenness, and pollen exposure in the development of food allergy. We also describe the recent extension of the dual allergen exposure hypothesis to potentially include the respiratory epithelial barrier in addition to the skin. Few existing studies have examined the relationship between these environmental factors with objective measures of IgE-mediated food allergy and further research in this area is needed. Future research also needs to consider the complex interplay between multiple environmental factors.

Food allergy in early childhood increases the risk of pollen-food allergy syndrome

Background: The level of pollen in Korea has increased over recent decades. Research suggests that pollen-food allergy syndrome (PFAS) may be more frequent in childhood than previously recognized. We aimed to investigate the prevalence and characteristics of PFAS in children aged 6–10 years from a general population-based birth cohort. Methods: We analyzed 930 children from the COhort for Childhood Origin of Asthma and allergic diseases (COCOA) birth cohort. Allergic diseases were diagnosed annually by pediatric allergists. The skin prick tests were performed with 14 common inhalant allergens and four food allergens for children aged 3 and 7 years. Results: Of the 930 eligible children, 44 (4.7%) aged 6–10 years were diagnosed with. The mean age at onset was 6.74 years. PFAS prevalence was 7.2% among children with allergic rhinitis (AR) and 19.1% among those with pollinosis, depending on comorbidity. PFAS was more prevalent in schoolchildren with atopic dermatitis, food allergy, and sensitization to food allergens and grass pollen in early childhood. In schoolchildren with AR, only a history of food allergy before 3 years increased the risk of PFAS (aOR 2.971, 95% CI: 1.159–7.615). Conclusion: Food allergy and food sensitization in early childhood was associated with PFAS in schoolchildren with AR. Further study is required to elucidate the mechanism by which food allergy in early childhood affects the development of PFAS.