Food Allergy Abstracts 2

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Allergic cystitis: the cause of nocturnal enuresis.
            (Breneman, 1959)  Download
More than 5 million children are plagued by nocturnal enuresis. The author concludes that there is strong evidence relating to causative food allergies. He stresses the need for further urologic and neurologic investigations.

Nocturnal Enuresis, A Treatment Regimen For General Use.
            (Breneman, 1965)  Download
Enuresis is not a disease but a symptom. The treatment of enuresis therefore  must be directed at eliminating the causes. This study fortifies previous statements that food allergy is one of the major causes of enuresis. The removal of food allegens from the diet is the specific treatment for this group of enuretics.

Allergy elimination diet as the most effective gallbladder diet.
            (Breneman, 1968)  Download
Since many people have individual tolerances and intolerances to various foods, an allergy elimination diet may be a very effective gallbladder diet in gallbladder disease. Each patient was placed on a basic allergy elimination diet, which in this case consisted of beef, rye, soybean, rice, cherry, peach, apricot, beet and spinach. A long-acting antihistamine capsule twice a day during the first week was given. The capsule used contained pyrilamine maleate 30 mg, methapyrilene hydrochloride 20 mg, prophenpyridamine maleate 10 mg in time released form. Sixty-three of the 69 patients could not tolerate egg.


Food allergy - the great masquerader.
(Crook, 1975)   Download
Common allergy masquerades: The Allergic Tension-Fatigue Syndrome; Recurrent Abdominal Pain; Headaches; Leg Ache and Other Musculoskeletal Symptoms; Bedwetting and Other Urinary Disturbances; Respiratory Tract Disorders; False Anemia; Learning Problems; Miscellaneous (pseudomononucleosis). To make a diagnosis of nonreaginic food allergy, you must first think of it when you see a pale, tired, nervous child with circles under his eyes and a variety of other systemic complaints. You need not do allergy skin tests for foods, since such skin tests do not help in the diagnosis of non-IgE mediated food allergy. Ask  "What's your favorite food?"

Effect of diet treatment on enuresis in children with migraine or hyperkinetic behavior.
            (Egger et al., 1992)  Download
Twenty-one children with migraine and/or hyperkinetic behavior disorder which was successfully treated with an oligoantigenic (few-foods) diet also suffered from nocturnal and/or diurnal enuresis. On diet, the enuresis stopped in 12 of these children and improved in an additional four. Identification of provoking foods was by sequential reintroduction of the foods that were avoided on the oligoantigenic diet. In eight of the 12 children who recovered on the oligoantigenic diet and in the four who improved, reintroduction of one or more foods provoked a reproducible relapse of the enuresis. Nine children were subjected to a placebo-controlled, double-blind reintroduction of provoking foods. Six children relapsed during testing with incriminated foods; none reacted to placebo. Enuresis in food-induced migraine and/or behavior disorder seems to respond, in some patients, to avoidance of provoking foods.

Evaluating the clinical relevance of food sensitivity tests: a single subject experiment
            (Herman and Drost, 2004) Download
A number of tests are available to identify food sensitivities. This article presents an analysis of the diagnostic value of nine different food sensitivity tests run concurrently on a healthy 33-year-old female with a previous diagnosis of environmental allergies. This case study evaluated conventional allergy tests (skin prick and serum IgE), tests of other immune-mediated reactions (serum IgG and salivary IgA), and tests that claim to measure the energetic reaction of the whole person to particular foods (kinesiology, Vega, and Carroll testing). The results of an elimination/challenge test were used as indicators of true food reactions in order to calculate the sensitivity, specificity, and positive predictive value (PPV) of each test. In a separate evaluation, the variability of results across the four tests measuring IgG was determined. Results show several tests (one of the two serum tests of IgG alone, both serum tests of IgE and IgG, skin prick testing, and Carroll testing) may have very high (100 percent) specificity and PPV when test results are compared to the results of an elimination/challenge test. Sensitivity, however, is low across tests (50-60 percent), likely because different tests measure different mechanisms of food reactions and because food sensitivities can be the result of a number of different mechanisms. Very little consistency was found among the results of the four tests measuring IgG - 79-83 percent disagreement. This study shows a number of tests may be useful in identifying foods to which a patient is reactive; however, no one test is likely to identify all reactive foods.

Letter: Hyperactivity, allergy and megavitamins.
            (Hoffer, 1974)  Download
To the Editor: During the past year there have been several exchanges of information in the Correspondence section of the Journal about children with learning and behavioural disabilities and enuresis. Like many other physicians I have come to the conclusion that vitamin dependancy and cerebral allergy may cause these disorders. A case At that time his parents had started him on nicotinamide 0.50 g three times a day and pyridoxine hydrochloride 0.25 g once a day. On this medication he was also able to sleep better. The dose of the vitamins was doubled and the child was started on a low-sugar diet. A month later he showed signs of improvement. On one occasion he ate a small quantity of butter in his food without knowing it and that night he wet the bed. It is obvious to me that this child's problem arose from a milk allergy which first expressed itself in prolonged colic. If vitamin therapy in children with similar conditions were investigated by the double-blind technique only the vitamin-dependent group would respond. adequately.

Prevalence of food allergy: an overview.
            (Madsen, 2005)  Download
At present the only cure for food allergy is to avoid eating the food responsible for the allergy. Thus, food allergy or food hypersensitivity is a disease that is not only of concern to the individual who is affected but also to those involved directly and indirectly in supplying and preparing food for the food-allergic individual, and its impact on society should be evaluated on this basis. It is generally assumed that questionnaire-based studies vastly overestimate the prevalence of food hypersensitivity. The reported perceived prevalence of food hypersensitivity varies from 3.24% to 34.9%, which may be explained partly by the difference in reporting lifetime prevalence compared with point prevalence. However, of more importance is the apparent inverse correlation between response rate and prevalence (the higher the response rate, the lower the perceived prevalence). The three most-recent prevalence studies on food hypersensitivity (one on perceived food hypersensitivity and two on confirmed food hypersensitivity) all report estimates for prevalence of approximately 3%, but their criteria for including subjects as being positive are not identical, although they do overlap. Furthermore, because of differences in methodology there is no definitive information to indicate whether the prevalence of food allergy is increasing. However, the high prevalence of pollen-related food allergy in younger adults in the population suggests that the increase in pollen allergy is also being accompanied by an increase in pollen-related food allergy.

Plasma levels of vitamins A and E, coenzyme Q10, and anti-ox-LDL antibody titer in children treated with an elimination diet due to food hypersensitivity
            (Mikoluc et al., 2009)  Download
AIM: Has elimination diet applied in children with food hypersensitivity in infancy any effect on plasma levels of anti-oxidative vitamins and antibodies to oxidized low-density lipoprotein (anti-ox-LDL antibody) titer in these children at their pre-school age?" MATERIAL: The study involved 92 children (3 to 7 years of age) with food hypersensitivity treated in their infancy and early childhood with soy formula or casein hydrolysate, as a milk substitute for at least 12 months. Control group comprised 62 children, who had never been treated with an elimination diet. METHODS: The status of the anti-oxidative system was evaluated by determination of retinol, alpha-tocopherol, and coenzyme Q10 plasma levels by high-performance liquid chromatography (HPLC). The titer of antibodies to oxidized LDL lipoproteins was specified by immunoenzymatic assay. On the basis of the RESULTS, the following CONCLUSIONS have been reached: 1. It was shown that alpha-tocopherol and retinol levels in pre-school children who had received dietary treatment in their infancy, were higher than in the control group. No deficiencies in anti-oxidative vitamins within the control group were found. 2. A type of milk-substitute formula applied in the elimination diet had no effect on the status of the anti-oxidative system in the children examined.

Nocturnal enuresis and allergy.
            (Mungan et al., 2005)  Download
OBJECTIVE:  To investigate whether an interaction exists between nocturnal enuresis and allergy. MATERIAL AND METHODS:  Thirty-seven (20 boys, 17 girls) children with monosymptomatic nocturnal enuresis were recruited. We studied an allergy panel that included total IgE, 10 examples of inhalant-specific IgE, 10 examples of food-specific IgE, eosinophilic cationic protein (ECP) and Phadiotop. The same panel was studied in a control group of 18 children without monosymptomatic nocturnal enuresis. RESULTS:  We did not determine statistically significant differences between the enuretic group and the control group in terms of levels of total IgE, the 10 examples of inhalant-specific IgE and Phadiotop. However, two (soybean and hazelnut) of the 10 food-specific IgE and ECP levels did differ significantly between the two groups. CONCLUSIONS:  This first specific IgE study showed that there may be a relationship between nocturnal enuresis and soybean and hazelnut food allergens. Our findings may explain some cases of nocturnal enuresis. However, further studies are necessary to explain the underlying mechanisms and management of this disorder.

Heated allergens and induction of tolerance in food allergic children.
            (Netting et al., 2013)  Download
Food allergies are one of the first manifestations of allergic disease and have been shown to significantly impact on general health perception, parental emotional distress and family activities. It is estimated that in the Western world, almost one in ten children have an IgE-mediated allergy. Cow's milk and egg allergy are common childhood allergies. Until recently, children with food allergy were advised to avoid all dietary exposure to the allergen to which they were sensitive, in the thought that consumption would exacerbate their allergy. However, recent publications indicate that up to 70% of children with egg allergy can tolerate egg baked in a cake or muffin without apparent reaction. Likewise, up to 75% of children can tolerate baked goods containing cow's milk, and these children demonstrate IgE and IgG4 profiles indicative of tolerance development. This article will review the current literature regarding the use of heated food allergens as immunotherapy for children with cow's milk and egg allergy.

Allergy as a causative factor of fatigue, irritability, and behavior problems of children.
            (Randolph, 1947)  Download
The tired, listless, irritable child has long been a difficult problem for the physician, particularly the one with associated abnormalities of behavior but without obvious physical findings. Among the various causes of this condition, allergic disease has not had the recognition or emphasis that it deserves in view of its frequency as an etiologic mechanism. In this respect, allergic children are commonly misunderstood by their parents and teachers as well as by their physicians. The manifestations of fatigue and irritability in children with chronic allergic disease are similar to those occurring in adults. The fatigue syndrome of allergic origin is a common cause of irritability and abnormalities of behavior in children. It usually results from chronic food allerg:y involving sensitivity to more than one food. Although any food ingested in oft-repeated feedings may be the cause of suck chronic symptoms, sensitivity to wheat and corn is encountered most frequently.


Abdominal Food Allergy: Its History, Symptomatology, Diagnosis And Treatment.
            (Rowe, 1928b)  Download
Food allergy is a frequent cause of mild or severe abdominal symptoms. Skin tests are frequently negative.

Food allergy: its manifestations, diagnosis and treatment (JAMA)
            (Rowe, 1928a)  Download
Food allergy as a frequent cause of symptoms in adults as in children should receive greater recognition. It has been emphasized by Schloss 1 as a frequent cause of disturbances in childhood. In adults, however, outside of the articles of Duke, 2 food allergy has received little consideration. It is felt that with the method of analysis of the patient's history, the interpretation of the skin tests and the use of" elimination diets" advocated and outlined in this paper, many of the manifestations of food allergy described here will be discovered.

Food allergy. Its manifestations, diagnosis and treatment with a general discussion of bronchial asthma
            (Rowe, 1931)  Download
Food allergy as a common cause of human symptomatology is gaining increasing recognition. Food sensitization is one of the most important etiological agents known. Of the two methods of diagnosis, I place diet trial ahead of testing.

Stress and food allergy: mechanistic considerations.
            (Schreier and Wright, 2014)  Download
Recent years have seen a marked increase in food allergy prevalence among children, particularly in Western countries, that cannot be explained by genetic factors alone. This has resulted in an increased effort to identify environmental risk factors underlying food allergies and to understand how these factors may be modified through interventions. Food allergy is an immune-mediated adverse reaction to food. Consequently, considerations of candidate risk factors have begun to focus on environmental influences that perturb the healthy development of the emerging immune system during critical periods of development (eg, prenatally and during early childhood), particularly in the gut. Given that psychosocial stress is known to play an important role in other allergic and inflammatory diseases, such as asthma, its potential role in food allergy is a growing area of research. However, research to date has largely focused on animal studies. This review synthesizes relevant animal research and epidemiological data, providing proof of concept for moderating influences of psychological stress on food allergy outcomes in humans. Pathways that may underlie associations between psychosocial stress and the expression of food allergy are discussed.

Statistical validation of the shorter-moldwin food sensitivity questionnaire for patients with interstitial cystitis/bladder pain syndrome.
            (Shorter et al., 2014)  Download
PURPOSE:  American Urological Association guidelines suggest dietary changes as first line treatment for interstitial cystitis/bladder pain syndrome. We previously developed a validated survey instrument to determine which foods, beverages and supplements exacerbate the symptoms of this condition. In this study we developed a shortened questionnaire that would provide an easily self-administered food symptom history useful for clinical practice and future research. MATERIALS AND METHODS:  Using data from our previously validated food sensitivity questionnaire we remodeled the original lengthy survey to an abbreviated list including the 35 most problematic comestibles. The instrument was reviewed by a panel of experts for face and content validity, and tested for internal consistency, readability and clarity, and test-retest reliability. RESULTS:  Of the 124 patients who completed a baseline questionnaire 52 (42%) returned the second instrument 1 week after completing the first instrument. Internal consistency was high (α=0.96). A total of 47 patients (90.4%) indicated that they were food sensitive. Questionnaire test-retest reliability assessed by the Spearman correlation coefficient ranged from moderate (ρ=0.48 for Equal®) to very strong (ρ=0.90 for beer). Discrepancies between the survey instruments in individual comestibles occurred only 1% of the time. CONCLUSIONS:  Our short form diet history questionnaire based on a previously validated long form is a reliable, newly validated instrument that will help identify comestibles associated with interstitial cystitis/bladder pain syndrome symptoms. Its brevity makes it simple to administer and useful for dietary management in this population.

Safety, tolerability, and immunologic effects of a food allergy herbal formula in food allergic individuals: a randomized, double-blinded, placebo-controlled, dose escalation, phase 1 study.
            (Wang et al., 2010)  Download
BACKGROUND:  Food allergy is a common and serious health problem. A new herbal product, called food allergy herbal formula 2 (FAHF-2), has been demonstrated to have a high safety profile and potent long-term efficacy in a murine model of peanut-induced anaphylaxis. OBJECTIVE:  To evaluate the safety and tolerability of FAHF-2 in patients with food allergy. METHODS:  In this randomized, double-blinded, placebo-controlled, dose escalation, phase 1 trial, patients received 1 of 3 doses of FAHF-2 or placebo: 2.2 g (4 tablets), 3.3 g (6 tablets), or 6.6 g (12 tablets) 3 times a day for 7 days. Four active and 2 placebo patients were treated at each dose level. Vital signs, physical examination results, laboratory data, pulmonary function test results, and electrocardiogram data were monitored. Immunomodulatory studies were also performed. RESULTS:  Nineteen food allergic participants were included in the study. Two patients (1 in the FAHF-2 group and 1 in the placebo group) reported mild gastrointestinal symptoms. One patient withdrew from the study because of an allergic reaction that was unlikely related to the study medication. No significant differences were found in vital signs, physical examination results, laboratory data, pulmonary function test results, and electrocardiogram data obtained before and after treatment visits. Significantly decreased interleukin (IL) 5 levels were found in the active treatment group after 7 days. In vitro studies of peripheral blood mononuclear cells cultured with FAHF-2 also demonstrated a significant decrease in IL-5 and an increase in culture supernatant interferon gamma and IL-10 levels. CONCLUSIONS:  FAHF-2 appeared to be safe and well tolerated in patients with food allergy.

Histamine, mast cells, and the enteric nervous system in the irritable bowel syndrome, enteritis, and food allergies
            (Wood, 2006)  Download
There is altered expression of histamine H and H receptor 12subtypes in mucosal biopsies from the terminal ileum and large intestine of patients with symptoms of food allergy and/or irritable bowel syndrome

The prevalence of plant food allergies: a systematic review
            (Zuidmeer et al., 2008)  Download
BACKGROUND: There is uncertainty regarding the prevalence of allergies to plant food. OBJECTIVE: To assess the prevalence of allergies to plant food according to the different subjective and objective assessment methods. METHODS: Our systematic search of population-based studies (since 1990) in the literature database MEDLINE focused on fruits, vegetables/legumes, tree nuts, wheat, soy, cereals, and seeds. Prevalence estimates were categorized by food item and method used (food challenges, skin prick test, serum IgE, parent/self-reported symptoms), complemented by appropriate meta-analyses. RESULTS: We included 36 studies with data from a total of over 250,000 children and adults. Only 6 studies included food challenge tests with prevalences ranging from 0.1% to 4.3% each for fruits and tree nuts, 0.1% to 1.4% for vegetables, and < 1% each for wheat, soy, and sesame. The prevalence of sensitization against any specific plant food item assessed by skin prick test was usually < 1%, whereas sensitization assessed by IgE against wheat ranged as high as 3.6% and against soy as high as 2.9%. For fruit and vegetables, prevalences based on perception were generally higher than those based on sensitization, but for wheat and soy in adults, sensitization was higher. Meta-analyses showed significant heterogeneity between studies regardless of food item or age group. CONCLUSION: Population-based prevalence estimates for allergies to plant products determined by the diagnostic gold standard are scarce. There was considerable heterogeneity in the prevalence estimates of sensitization or perceived allergic reactions to plant food.

 


References

Breneman, JC (1959), ‘Allergic cystitis: the cause of nocturnal enuresis.’, GP, 20 84-98. PubMed: 13804175
——— (1965), ‘Nocturnal Enuresis, A Treatment Regimen For General Use.’, Ann Allergy, 23 185-91. PubMed: 14283374
——— (1968), ‘Allergy elimination diet as the most effective gallbladder diet.’, Ann Allergy, 26 (2), 83-87. PubMed: 5638514
Crook, WG (1975), ‘Food allergy - the great masquerader.’, Pediatr Clin North Am, 22 (1), 227-38. PubMed: 1096052
Egger, J, et al. (1992), ‘Effect of diet treatment on enuresis in children with migraine or hyperkinetic behavior.’, Clin Pediatr (Phila), 31 (5), 302-7. PubMed: 1582098
Herman, P. M. and L. M. Drost (2004), ‘Evaluating the clinical relevance of food sensitivity tests: a single subject experiment’, Altern Med Rev, 9 (2), 198-207. PubMed: 15253678
Hoffer, A (1974), ‘Letter: Hyperactivity, allergy and megavitamins.’, Can Med Assoc J, 111 (9), 905, 907. PubMed: 4608049
Madsen, C (2005), ‘Prevalence of food allergy: an overview.’, Proc Nutr Soc, 64 (4), 413-17. PubMed: 16313682
Mikoluc, B., et al. (2009), ‘Plasma levels of vitamins A and E, coenzyme Q10, and anti-ox-LDL antibody titer in children treated with an elimination diet due to food hypersensitivity’, Int J Vitam Nutr Res, 79 (5-6), 328-36. PubMed: 20533219
Mungan, NA, et al. (2005), ‘Nocturnal enuresis and allergy.’, Scand J Urol Nephrol, 39 (3), 237-41. PubMed: 16118098
Netting, M, et al. (2013), ‘Heated allergens and induction of tolerance in food allergic children.’, Nutrients, 5 (6), 2028-46. PubMed: 23739144
Randolph, TG (1947), ‘Allergy as a causative factor of fatigue, irritability, and behavior problems of children.’, J Pediatr, 31 (5), 560-72. PubMed: 20268816
Rowe, AH (1928a), ‘Food allergy: its manifestations, diagnosis and treatment’, JAMA, 91 (21), 1623. PubMed:
——— (1928b), ‘Abdominal Food Allergy: Its History, Symptomatology, Diagnosis And Treatment.’, Cal West Med, 29 (5), 317-22. PubMed: 18740859
——— (1931), Food allergy. Its manifestations, diagnosis and treatment with a general discussion of bronchial asthma, (Lea & Febiger).
Schreier, HM and RJ Wright (2014), ‘Stress and food allergy: mechanistic considerations.’, Ann Allergy Asthma Immunol, 112 (4), 296-301. PubMed: 24428964
Shorter, B, et al. (2014), ‘Statistical validation of the shorter-moldwin food sensitivity questionnaire for patients with interstitial cystitis/bladder pain syndrome.’, J Urol, 191 (6), 1793-801. PubMed: 24316093
Wang, J, et al. (2010), ‘Safety, tolerability, and immunologic effects of a food allergy herbal formula in food allergic individuals: a randomized, double-blinded, placebo-controlled, dose escalation, phase 1 study.’, Ann Allergy Asthma Immunol, 105 (1), 75-84. PubMed: 20642207
Wood, J. D. (2006), ‘Histamine, mast cells, and the enteric nervous system in the irritable bowel syndrome, enteritis, and food allergies’, Gut, 55 (4), 445-47. PubMed: 16531524
Zuidmeer, L., et al. (2008), ‘The prevalence of plant food allergies: a systematic review’, J Allergy Clin Immunol, 121 (5), 1210-1218 e4. PubMed: 18378288