Food Allergy Abstracts 8

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The role of food allergy in children's bronchial asthma.
            (Basomba, 1967) Download
There are tl great many factors which play an important role in the etiology of infantile asthma. The bacterial and the inhalant factors are often taken into consideration, but the possibility that the process might be due to the action of certain foods is largely disregarded. We have demonstrated the high percentage (45%) of intestinal parasitosis which is to be found in asthmatic children, and the importance of this condition particularly with regard to food sensitizations, not only in skin allergies but also in infantile asthma.

Co-factor-enhanced food allergy.
            (Cardona et al., 2012)  Download
BACKGROUND:  Alcohol, exercise or non-steroidal anti-inflamatory drugs (NSAID) are frequently mentioned as amplifiers of food allergic reactions but only individual cases or small series have been previously published. METHODS:  Descriptive study including 74 cases of suspected co-factor enhanced food allergy, assessed by skin-prick tests, specific IgE and oral challenges. RESULTS:  Anaphylaxis accounted for 85.1% of reactions. In 99% of cases culprit food allergens were plant-derived, mainly vegetables and cereals. NSAID were involved in 58%, exercise in 52.7% and alcohol in 12.2%. Lipid transfer protein was the most frequently involved allergen. CONCLUSIONS:  Co-factor enhanced food allergy should be considered when assessing food, alcohol, exercise and NSAID allergic reactions.

Food Allergies and Ageing.
            (De Martinis et al., 2019)  Download
All over the world, there is an increase in the overall survival of the population and the number of elderly people. The incidence of allergic reactions is also rising worldwide. Until recently, allergies, and in particular food allergies (FAs), was regarded as a pediatric problem, since some of them start in early childhood and may spontaneously disappear in adulthood. It is being discovered that, on the contrary, these problems are increasingly affecting even the elderly. Along with other diseases that are considered characteristics of advanced age, such as cardiovascular, dysmetabolic, autoimmune, neurodegenerative, and oncological diseases, even FAs are increasingly frequent in the elderly. An FA is a pleiomorphic and multifactorial disease, characterized by an abnormal immune response and an impaired gut barrier function. The elderly exhibit distinct FA phenotypes, and diagnosis is difficult due to frequent co-morbidities and uncertainty in the interpretation of in vitro and in vivo tests. Several factors render the elderly susceptible to FAs, including the physiological changes of aging, a decline in gut barrier function, the skewing of adaptive immunity to a Th2 response, dysregulation of innate immune cells, and age-related changes of gut microbiota. Aging is accompanied by a progressive remodeling of immune system functions, leading to an increased pro-inflammatory status where type 1 cytokines are quantitatively dominant. However, serum Immunoglobulin E (IgE) levels and T helper type 2 (Th2 cytokine production have also been found to be increased in the elderly, suggesting that the type 2 cytokine pattern is not necessarily defective in older age. Dysfunctional dendritic cells in the gut, defects in secretory IgA, and decreased T regulatory function in the elderly also play important roles in FA development. We address herein the main immunologic aspects of aging according to the presence of FAs.

Food-Dependent, Exercise-Induced Anaphylaxis: Diagnosis and Management in the Outpatient Setting.
            (Feldweg, 2017)  Download
Food-dependent, exercise-induced anaphylaxis is a disorder in which anaphylaxis develops most predictably during exercise, when exercise takes place within a few hours of ingesting a specific food. IgE to that food should be demonstrable. It is the combination of the food and exercise that precipitates attacks, whereas the food and exercise are each tolerated independently. Recently, it was demonstrated that exercise is not essential for the development of symptoms, and that if enough of the culprit food is ingested, often with additional augmentation factors, such as alcohol or acetylsalicylic acid, symptoms can be induced at rest in the challenge setting. Thus, food-dependent, exercise-induced anaphylaxis appears to be more correctly characterized as a food allergy syndrome in which symptoms develop only in the presence of various augmentation factors, with exercise being the primary one. However, additional factors are not usually present when the patient exercises normally, so ongoing investigation is needed into the physiologic and cellular changes that occur during exercise to facilitate food-induced anaphylaxis.

Prevalence and characteristics of adult-onset food allergy.
            (Kamdar et al., 2015) Download
Although it is common for childhood food allergies to milk, egg, soy, or wheat to be outgrown, those to fish or shellfish have been suggested to develop in adulthood and/or to persist. Here, our primary objective was to determine the prevalence of adult-onset food allergy, with secondary objectives of examining the characteristics of these patients further, including the assessment of additional common allergens. By using the Northwestern Medicine Enterprise Data Warehouse, medical records of patients who were seen by allergy physicians at the Northwestern University adult allergy clinics and who received a diagnosis of food allergy underwent retrospective chart review. From 1111 charts assessed, 171 cases were determined to meet the age-restricted inclusion criteria, which suggests that at least 15% of patients with an initial food allergy diagnosis code were adult-onset food allergy.

Should wheat, barley, rye, and/or gluten be avoided in a 6-food elimination diet
            (Kliewer et al., 2016) Download
Eosinophilic esophagitis (EoE), a food antigen-mediated disease, is effectively treated with the dietary elimination of 6 foods commonly associated with food allergies (milk, wheat, egg, soy, tree nuts/peanuts, and fish/shellfish). Because wheat shares homologous proteins (including gluten) with barley and rye and can also be processed with these grains, some clinicians have suggested that barley and rye might also trigger EoE as a result of cross-reaction and/or cross-contamination with wheat. In this article, we discuss the theoretical risks of cross-reactivity and cross-contamination among wheat, barley, and rye proteins (including gluten); assess common practices at EoE treatment centers; and provide recommendations for dietary treatment and future studies of EoE.

Impaired gastric function in children with cow's milk intolerance.
            (Kokkonen et al., 1979) Download
Eight infants with cow's milk intolerance (CMI) were studied for basal and maximal gastric acid secretion and the fasting serum gastrin level. All these patients had clinical malabsorption. Jejunal biopsies revealed subtotal villous atrophy in six children and slight changes in the remaining two. The mean maximal acid secretion in the infants with CMI was significantly decreased being 85 +/- 78 mumol/h/kg (mean +/- SD), as compared with a control group of the same age with a corresponding value of 233 +/- 66 mumol/h/kg. The fasting serum gastrin level was elevated, being 104 +/- 116 pmol/l in the study group and 37 +/- 10 in the controls. Three infants with CMI underwent gastric biopsy. Marked changes with epithelial degeneration and prominent cellularity in the lamina propria were seen in two patients. The injury was most severe in the antrum of the stomach. When these patients with CMI were treated with human or soy milk, the maximal acid secretion returned normal in six months.


 

Prevalence of fish and shellfish allergy: A systematic review.
            (Moonesinghe et al., 2016) Download
BACKGROUND:  Accurate information on the prevalence of food allergy facilitates a more evidence-based approach to planning of allergy services and can identify important geographic variations. OBJECTIVE:  To conduct a systematic review to assess the age-specific prevalence of fish and shellfish allergy worldwide. METHODS:  Searches were conducted using Web of Science and PubMed. Population-based cross-sectional studies and cohort studies that examined the prevalence of fish and shellfish allergy (IgE mediated and non-IgE mediated) at an identifiable point in time were eligible for inclusion in the study. Reviewers extracted general study information and study design, type of food allergy considered, food(s) assessed, method of diagnosis, sampling strategy, and sample characteristics. Raw data were extracted and percentage prevalence and 95% confidence intervals calculated. RESULTS:  A total of 7,333 articles were identified of which 61 studies met the inclusion criteria and were included in this review. The prevalence of fish allergy ranged from 0% to 7% and the prevalence of shellfish allergy from 0% to 10.3%, depending on the method of diagnosis. Where food challenges were used, the prevalence for fish allergy was found to be 0% to 0.3% and for shellfish allergy was 0% to 0.9%. CONCLUSION:  Few studies have established the prevalence of fish or shellfish allergy using the gold standard double-blind, placebo-controlled challenge criteria, with most instead relying on self-reported questionnaire-based methods. The limited data available suggest that fish allergy prevalence is similar worldwide; however, shellfish allergy prevalence may be higher in the Southeast Asia region.

Anti-acid medication as a risk factor for food allergy.
            (Pali-Schöll and Jensen-Jarolim, 2011) Download
An important feature for oral allergens is their digestion-resistance during gastrointestinal transit. For some oral allergens, digestion stability is an innate feature, whereas digestion-labile antigens may only persist in times of impairment of the digestive system. In this review, we collect evidence from mouse and human studies that besides the inherent molecular characteristics of a food protein, the stomach function is decisive for the allergenic potential. Gastric acid levels determine the activation of gastric pepsin and also the release of pancreatic enzymes. When anti-ulcer drugs inhibit or neutralize gastric acid, they allow persistence of intact food allergens and protein-bound oral drugs with enhanced capacity to sensitize and elicit allergic reactions via the oral route. Mouse studies further suggest that maternal food allergy arising from co-application of a food protein with anti-acid drugs results in a Th2-biased immune response in the offspring. Especially, anti-ulcer drugs containing aluminum compounds act as Th2 adjuvants. Proton pump inhibitors act on proton secretion but also on expression of the morphogen Sonic hedgehog, which has been related to the development of atrophic gastritis. On the other hand, atrophic gastritis and resulting hypoacidity have previously been correlated with enhanced sensitization risk to food allergens in elderly patients. In summary, impairment of gastric function is a documented risk factor for sensitization against oral proteins and drugs.

The Effect of Digestion and Digestibility on Allergenicity of Food.
            (Pali-Schöll et al., 2018)  Download
Food allergy prevalence numbers are still on the rise. Apart from environmental influences, dietary habits, food availability and life-style factors, medication could also play a role. For immune tolerance of food, several contributing factors ensure that dietary compounds are immunologically ignored and serve only as source for energy and nutrient supply. Functional digestion along the gastrointestinal tract is essential for the molecular breakdown and a prerequisite for appropriate uptake in the intestine. Digestion and digestibility of carbohydrates and proteins thus critically affect the risk of food allergy development. In this review, we highlight the influence of amylases, gastric acid- and trypsin-inhibitors, as well as of food processing in the context of food allergenicity.

Which cereal is a suitable substitute for wheat in children with wheat allergy
            (Pourpak et al., 2005) Download
Wheat is one of the main food allergens. It is among widely used cereals and there is an extensive cross-reaction between cereals. The aim of this study is to evaluate the extent to which cereals cross-react and to find the best substitute for wheat. Eighteen patients with definite diagnosis of type I hypersensitivity reactions to wheat enrolled in this study. Measurement of serum-specific IgE and skin prick test (SPT) for cereals flour (wheat, barley, oat, rye, rice and corn) and wheat bran was carried out. Also, open food challenge tests with available and conventional cereals in Iranian food culture (wheat, corn, rice and barley) were carried out. The SPTs were positive in 44.4% of patients for barley, 94.5% for wheat and 44-77% for other cereals. Positive serum-specific IgE was remarkable for wheat and barley and there was correlation between wheat and barley-specific IgE concentrations (r = 0.773 and p < 0.01). Corn serum-specific IgE was measured in 10 patients, which were positive in six of them. Of the patients, 55.5% had positive barley challenge tests, but all corn and rice challenge tests were negative. The best substitutes for wheat in wheat allergic patients are rice and corn. Regarding the correlation of wheat and barley serum-specific IgEs, there might be a high antigenic cross-reaction, therefore barley is not a good substitute for wheat and consuming barley needs a careful challenge test. Considering concordance of positive SPT to wheat flour and wheat bran, avoiding both of them is necessary in patients with wheat allergy.


 

Adult-onset food allergies.
            (Ramesh and Lieberman, 2017) Download
Prevalence of food sensitization among adults is high. In the United States, it was reported to be 14.9% in 2010. At the same time, physician-diagnosed food allergy was reported to be 6.5%. In Europe, the rates of sensitization to any food range from 11% to 24% as estimated by the European Community Respiratory Health Survey. Seafood allergy is one of the more frequent causes of food allergy in adults. Some patients who react to most fish are able to tolerate extensively cooked tuna and salmon in canned form.

Bronchial asthma due to food allergy alone in ninety-five patients.
            (Rowe et al., 1959) Download
Bronchial asthma due to food allergy alone or associated with inhalant allergy is too frequently overlooked. Recognition of the importance of food allergy in a given patient is usually impossible unless one begins with a cereal-free elimination diet which assumes allergy to cereal grains as well as to milk, eggs, and other less common allergenic foods. This was clearly demonstrated in 50 children and 45 adults, whose bronchial asthma was relieved without use of antigens, vaccines, corticosteroids, or ACTH. Strict adherence to the diet was necessary at first, especially in the winter, but in many cases it was found that tolerance to some foods developed in one to four years and that a more liberal diet could be allowed in the summer.

Food allergy: is prevalence increasing
            (Tang and Mullins, 2017)  Download
It is generally accepted that the prevalence of food allergy has been increasing in recent decades, particularly in westernised countries, yet high-quality evidence that is based on challenge confirmed diagnosis of food allergy to support this assumption is lacking because of the high cost and potential risks associated with conducting food challenges in large populations. Accepting this caveat, the use of surrogate markers for diagnosis of food allergy (such as nationwide data on hospital admissions for food anaphylaxis or clinical history in combination with allergen-specific IgE (sIgE) measurement in population-based cohorts) has provided consistent evidence for increasing prevalence of food allergy at least in western countries, such as the UK, United States and Australia. Recent reports that children of East Asian or African ethnicity who are raised in a western environment (Australia and United States respectively) have an increased risk of developing food allergy compared with resident Caucasian children suggest that food allergy might also increase across Asian and African countries as their economies grow and populations adopt a more westernised lifestyle. Given that many cases of food allergy persist, mathematical principles would predict a continued increase in food allergy prevalence in the short to medium term until such time as an effective treatment is identified to allow the rate of disease resolution to be equal to or greater than the rate of new cases.

Anti-ulcer drugs promote IgE formation toward dietary antigens in adult patients.
            (Untersmayr et al., 2005) Download
Recently, we have demonstrated that anti-ulcer drugs, such as H2-receptor blockers and proton pump inhibitors, promote the development of immediate type food allergy toward digestion-labile proteins in mice. The aim of this study was to examine the allergological relevance of these findings in humans. In an observational cohort study, we screened 152 adult patients from a gastroenterological outpatient clinic with negative case histories for atopy or allergy, who were medicated with H2-receptor blockers or proton pump inhibitors for 3 months. IgE reactivities to food allergens before and after 3 months of anti-acid treatment were compared serologically. Ten percent of the patients showed a boost of preexisting IgE antibodies and 15% de novo IgE formation toward numerous digestion-labile dietary compounds, like milk, potato, celery, carrots, apple, orange, wheat, and rye flour. Thus, the relative risk to develop food-specific IgE after anti-acid therapy was 10.5 (95% confidence interval: 1.44-76.48). The long-term effect was evaluated 5 months after therapy. Food-specific IgE could still be measured in 6% of the patients, as well as significantly elevated serum concentrations of ST2, a Th2-specific marker. An unspecific boost during the pollen season could be excluded, as 50 untreated control patients revealed no changes in their IgE pattern. In line with our previous animal experiments, our data strongly suggest that anti-ulcer treatment primes the development of IgE toward dietary compounds in long-term acid-suppressed patients.

The effect of gastric digestion on food allergy.
            (Untersmayr and Jensen-Jarolim, 2006) Download
PURPOSE OF REVIEW:  The role of the stomach as the primary location of protein digestion is very well recognized, leading to classification of proteins as digestion-resistant or digestion-labile. This review analyses the role of gastric digestion in food allergy. RECENT FINDINGS:  Hindrance of gastric digestion by elevation of the gastric pH, the therapeutic goal of anti-ulcer medication, was recently shown to trigger food allergy via oral sensitization in a murine food allergy model. The relevance in humans was assessed in an observational study of 152 gastroenterological patients who were medicated with anti-ulcer drugs due to dyspeptic disorders. Twenty-five percent of all patients developed a boost or de-novo IgE formation towards regular constituents of the daily diet. The clinical relevance of the induced antibodies was confirmed by positive skin and oral-provocation tests. Moreover, the importance of gastric digestion was also proven for food-allergic patients, as the allergenicity of allergens were reduced up to a 10,000-fold by gastric digestion. SUMMARY:  These recent studies indicate for the first time the important gate-keeping function of gastric digestion, both in the sensitization and the effector phases of food allergy.

Prevalence of self-reported food allergy in U.S. adults: 2001, 2006, and 2010.
            (Verrill et al., 2015) Download
BACKGROUND:  Epidemiologic evidence indicates that food allergies are increasing in the population. Information on a change in self-reported food allergy (srFA) in adults over time is lacking. OBJECTIVE:  To report the prevalence of srFA and compare differences at three time points over a decade. METHODS:  We analyzed srFA and reported physician-diagnosed food allergy in >4000 U.S. adults who participated in the 2010 U.S. Food and Drug Administration Food Safety Survey. Information on causative food(s), reaction severity characteristics, and various diagnostic factors was also analyzed. We compared 2010 Food Safety Survey data with 2006 and 2001 data, and highlighted relevant differences. RESULTS:  SrFA prevalence increased significantly, to 13% in 2010 and 14.9% in 2006 compared with 9.1% in 2001 (p < 0.001). Physician diagnosed food allergy was 6.5% in 2010, which was not significantly different compared with 7.6% in 2006 and 5.3% in 2001. SrFA increased in both men and women, non-Hispanic white and black adults, 50-59 year olds, and in adults with a high school or lower education. In 2010, milk, shellfish, and fruits were the most commonly reported food allergens, similar to 2001. Also, in 2010, 15% of reactions reportedly required a hospital visit and 8.4% were treated with epinephrine. Minor differences in reaction severity characteristics were noted among the surveys. CONCLUSIONS:  Analysis of survey results indicates that the prevalence of srFA increased among U.S. adults from 2001 to 2010 and that adults are increasingly self-reporting FAs without obtaining medical diagnosis. Improved education about food allergies is needed for this risk group.

Boiling and roasting treatment affecting the peanut allergenicity.
            (Zhang et al., 2018)  Download
Background:  Peanut allergy appears to be less prevalent in other parts of the world than North America and several European countries, and it has been proposed difference in cooking practices may be responsible. In this study, the boiling and roasting processes were investigated to find a potential method to enhanced or reduce the allergenicity. Methods:  The allergenicity of different peanut products, as reflected by changes in ethology (diarrhea and weight loss) and pathology (splenomegaly and jejunum breakage) were observed, and relevant serological indexes were determined after feeding different peanut products. Different peanut proteins were used to analyze the ability to resistance digestion in simulated gastric fluid (SGF). Ultraviolet spectrum and CD spectra were used to analyze structure changes of Ara h 2 in roasting and boiling treatment. Results:  In the detection of the corresponding serological indicators, boiled peanuts show a lower sensitization than roasted and raw peanuts. SGF experiments demonstrated an increased resistance of roasted peanut protein to digestion. The results of ultraviolet spectrum and CD spectra showed that the roasting and boiling causes altered structures of the Ara h 2 peanut allergens. Conclusions:  The summary show that different thermal processing may affect the structure and immunoreactivity, and the sensitization of roasted or boiled peanuts will be enhanced or reduced.

 


 

References

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Cardona, V, et al. (2012), ‘Co-factor-enhanced food allergy.’, Allergy, 67 (10), 1316-18. PubMed: 22845005
De Martinis, M, et al. (2019), ‘Food Allergies and Ageing.’, Int J Mol Sci, 20 (22), PubMed: 31717303
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Zhang, T, et al. (2018), ‘Boiling and roasting treatment affecting the peanut allergenicity.’, Ann Transl Med, 6 (18), 357. PubMed: 30370284