No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Abstract
Little is known about late phase clinical reactions during oral food challenges and the value of specific IgE in terms of sensitivity and specificity.
We therefore analysed retrospectively the clinical outcome of 387 oral provocations during double-blind, placebo-controlled food challenge tests in 107 children with atopic dermatitis.
Eighty-seven (81%) children showed a positive clinical reaction to at least one challenge. The vast majority of children (94%) showed clinical symptoms to one or two allergens. One hundred and thirty-one of 259 (51%) of verum challenges and 1/128 (0.8%) placebo challenge were assessed as positive. Oral provocations with hen's egg showed the highest percentage of positive reactions (70%). Sensitivity of specific IgE to the four allergens tested was 90%, specificity 30%. Sensitivity of the parental history as a predictive factor was 48%, specificity 72%. Ninety-two of 131 (70%) children with positive verum provocations showed early reactions, 33 (25%) late and six (5%) combined early and late reactions. In 84/131 (64%) positive provocations one organ system was involved, while in 44 (34%) provocations two and in three (2%) challenges three organ systems were involved. Skin reactions were the most frequent clinical manifestation leading to positive reactions followed by gastro-intestinal and respiratory symptoms. There was no correlation between titration dose and specific IgE. The subgroup of non-sensitized children did not differ in terms of sex, age or titration dose from the total study population.
Double-blind, placebo-controlled oral food challenges are helpful in distinguishing children with clinically manifested symptoms from those with food sensitization. Accurately identifying children with a clinical relevant food allergy may help to prescribe specific diets on a scientific basis, avoiding dietary limitations which may be unnecessary or even harmful.
... Different studies have also reported that dermatological symptoms improved significantly in children with a food allergy after the elimination diet. 18,19 Our results show that the systematic questioning of associated symptoms by CoMiSS helps to select infants for the elimination diet. ...
... Allergy-focused family history and personal history of early atopic disease are very important for the diagnostic approach of CMPA. 2,4,[18][19][20] Among our CMPA(+) infants, family history of atopy was significantly more prevalent. Laboratory tests, including CM-sIgE and SPT, are accepted as useful for diagnosis, and positive results indicate IgE-mediated CMPA. ...
... Laboratory tests, including CM-sIgE and SPT, are accepted as useful for diagnosis, and positive results indicate IgE-mediated CMPA. 3,18 According to a report from Denmark, up to half of the children with CMPA are Ig E-mediated. 21 Of our CMPA(+) patients, 35.2% were IgE-mediated, and the CoMiSS score was significantly higher in these infants than non-IgE-mediated ones. ...
Background
The diagnosis of cows milk protein allergy (CMPA) is not always easy. Cow's Milk‐related Symptom Score (CoMiSS) has been developed to raise the awareness of CMPA among the primary health‐care providers. In this study, we aimed to evaluate the validity of CoMiSS as a diagnostic approach of CMPA in infants in our country.
Methods
Infants with a CoMiSS of more than 12 points were included. An elimination diet was implemented in these infants for 4 weeks, and CoMiSS was reapplied. Infants with a reduction of ≥3 points in CoMiSS were considered responsive to the elimination diet, and an open oral challenge test was performed. Infants with symptom recurrence were diagnosed with CMPA.
Results
The study included 168 infants. When they were included in the study, the first CoMiSS score was 13.6 ± 1.9. After the elimination diet, the number of responsive infants was 154 (91.7%). Of the infants, 91 (54.2%) were diagnosed with CMPA with positive challenge. The majority of the patients diagnosed with CMPA presented with gastrointestinal and/or dermatological symptoms (80.3%). Positive family history of allergy was more prevalent in CMPA(+) infants (P < 0.001). The mean atopic dermatitis score was higher in CMPA(+) infants (P = 0.001). Eosinophilia and cows milk‐specific IgE (CM‐sIgE) positivity were more prevalent in infants with CMPA (P = 0.01 and P < 0.001, respectively).
Conclusions
CoMiSS is a valuable tool to evaluate CMPA in primary care. The presence of multiple symptoms, especially skin involvement, helps to recognise infants with CMPA. Family history and eosinophilia also support the diagnosis of CMPA.
... Statistical analysis was performed using IBM SPSS Statistics for Windows v. 22.0 (IBM Corp., Armonk, NY, USA). Descriptive analysis was used to characterize the patients. ...
... Hence in previous studies, most frequently evaluated foods with OFC were cow's milk and hen's egg. 21,22 The prevalence of IgE-mediated food sensitization/ allergy is higher in the first 2 years of life 23,24 and some of these can be tolerated or become tolerated within few years. [25][26][27] This explains why our study population is young (median age 2 years) and why almost half of OFCs are performed at the age of 2 years or below. ...
Background:
The oral food challenge (OFC) in IgE mediated food allergy causes anxiety both in parents and in patients due to its inherent risks.
Objective:
Documentation of the rate, spectrum, and predictors of positive reactions is instructive.
Methods:
Children, who underwent OFC between January 1, 2017 and December 31, 2019 were analyzed.
Results:
A total of 1361 OFCs in 613 cases were reviewed. Most of them were performed in preschool children (≤2 years 50%) and 55% of them had more than one OFC. Mainly considered food groups were cow's milk (31.8%), hen's egg (28.5%), tree nuts (20%), legumes (7%), seeds (4.9%), and wheat (2.7%). The overall OFC positivity was 9.6%, whereas 6.7% with cow's milk, 4.9% with hen's egg, 16.1% with tree nuts, 21.6% with wheat, and 32.8% with seeds. The severity scoring revealed grade I (24.4%), II (45.8%), and III (29.7%) reactions. Fifty (38%) cases required epinephrine and four cases required hospitalization. OFCs with sesame seeds (odds ratio [OR]: 7.747, [confidence interval (CI) 95%: 4.03-14.90]), wheat (OR: 3.80, [CI: 1.64-8.84]), and tree nuts (OR: 2.78, [CI: 1.83-4.23]) predicted a positive OFC while a concomitant asthma (OR: 3.61 [CI: 1.27-10.28]) was more likely to elicit anaphylaxis.
Conclusion:
In OFC practice, priority is given to basic nutritional sources and the most frequent food allergens, where preschool children with multiple sensitizations are the primary subjects. Increased risks of positive reactions with sesame, tree nut, and wheat and increased risk of anaphylaxis with concomitant asthma should be considered while performing OFC.
... 77 The protocol is stopped when a reaction is observed. 78 When and for how long to challenge Celiac disease. In the past, a GC was mandatory for celiac patients to demonstrate their clinical and histological remission after a GFD and, later, a third biopsy would have to demonstrate histological damage relapse after gluten reintroduction. ...
... Increasing doses of wheat can be administered with 30-minute intervals between doses until the onset of symptoms. 78 ...
Gluten-related disorders (GRDs) are gradually emerging as epidemiologically relevant diseases, with a global prevalence estimated to be approximately 5% in the population. Conditions related to gluten ingestion include celiac disease (CD), wheat allergy (WA), and nonceliac gluten sensitivity (NCGS). Although mediated by different pathogenic pathways, these 3 conditions share similar clinical manifestations and can present a difficult differential diagnosis. The gluten challenge (GC) is an important diagnostic tool for GRDs, but there is great variability in regards to deciding which patients should be challenged, what amount of gluten should be used, what the GC duration should be, when and where the GC should occur, and, sometimes, why to conduct a GC. This review summarizes the current knowledge about the desirable characteristics of GCs in the 3 main GRDs following a 5 Ws approach-that is, the 5 main journalistic questions: who, what, when, where, why. The answers will help to determine the correct use of the GC in diagnosing GRDs.
... Atopic dermatitis: Milk allergy, after egg allergy, is the second most common allergy reported in infants and young children with moderate to severe atopic dermatitis (14,15) ...
... Non-IgE mediated reactions usually start two hours after the ingestion (15) Food protein-induced enterocolitis syndrome, allergic eosinophilic gastrointestinal disorders, infantile colic, constipation, food protein-induced enterocolitis syndrome, gastroesophageal reflux, Heiner syndrome, protein-induced proctitis/proctocolitis are non-IgE-mediated reactions. ...
Background: Cow milk allergy is one of the most common food allergies in young children causing a wide range of clinical syndromes due to immunologic responses to cow milk proteins. In this report we introduce an infant with dietary protein proctitis due to a cow’s milk referred with hematuria and bloody stool. Case Presentation: Our case was a 10-month old male infant with hematuria and bloody stool following consumption of yogurt. The infant had prior history of blood in stool at 20th day and 2nd month of life while exclusively breastfed. The episodes of bloody stool had been resolved at the time with elimination of cow milk dairy products form the mother’s diet. All physical examinations and laboratory tests were normal and with stopping Bovine products, the symptoms were disappeared. Conclusion: Allergy should be considered as a probable diagnosis in children with otherwise unexplained hematuria. © 2017, Kerman University of Medical Sciences. All rights reserved.
... The link between AD and food allergy (FA), including FA's possible role in causing AD, remains controversial [170]. Support for the causal link comes from the observation of immediate-type allergic reactions in children with AD after the elimination and subsequent reintroduction of certain foods, especially cow's milk (CM) and hen's egg [171][172][173][174][175][176]. Additionally, many studies have shown that the more severe the AD [176][177][178][179] and earlier its first appearance [180], the greater the association with IgE-mediated FA comorbidity. ...
... Rowlands et al. [187] were able to demonstrate a link between reintroduction of previously eliminated foods and late recrudescence of AD only in one out of 17 children hospitalized with severe AD. Other studies showing the onset of late eczematous-type reactions not preceded by immediate allergic reactions are scarce and of variable quality [175,188]. The key question is whether food allergy in the context of IgE-associated AD is an unrelated condition or whether it can trigger or worsen AD. ...
The Italian Consensus Conference on clinical management of atopic dermatitis in children reflects the best and most recent scientific evidence, with the aim to provide specialists with a useful tool for managing this common, but complex clinical condition. Thanks to the contribution of experts in the field and members of the Italian Society of Pediatric Allergology and Immunology (SIAIP) and the Italian Society of Pediatric Dermatology (SIDerP), this Consensus statement integrates the basic principles of the most recent guidelines for the management of atopic dermatitis to facilitate a practical approach to the disease. The therapeutical approach should be adapted to the clinical severity and requires a tailored strategy to ensure good compliance by children and their parents. In this Consensus, levels and models of intervention are also enriched by the Italian experience to facilitate a practical approach to the disease.
... Food allergies are also present in up to 37% of infants with AD, whereas they are present in approximately 10% of adults with AD (10) . There is some debate about the role of food allergies in AD (11)(12)(13) . In assessing allergen triggers in AD patients, doctors typically perform a range of tests, including tests for food allergens. ...
Previous studies have revealed an association between dietary factors and atopic dermatitis (AD). To explore whether there was a causal relationship between diet and AD, we performed Mendelian randomization (MR) analysis. The dataset of 21 dietary factors was obtained from UK Biobank. The dataset for AD was obtained from the publicly available FinnGen consortium. The main research method was the inverse-variance weighting method, which was supplemented by MR‒Egger, weighted median and weighted mode. In addition, sensitivity analysis was performed to ensure the accuracy of the results. The study revealed that beef intake (OR=0.351; 95% CI:0.145-0.847; p=0.020) and white bread intake (OR=0.141; 95% CI:0.030-0.656; p=0.012) may be protective factors against AD. There were no causal relationships between AD and any other dietary intake factors. Sensitivity analysis showed that our results were reliable, and no heterogeneity or pleiotropy was found. Therefore, we believe that beef intake may be associated with a reduced risk of AD. Although white bread was significant in the IVW analysis, there was large uncertainty in the results given the wide 95% CI. Other factors were not associated with AD in this study.
... In addition, the fact that our study group consisted of patients in the first 2 years of age, which is the age group in which AD symptoms and food allergy are most common, may have contributed to this result. [34] Consistent with our findings in studies conducted in our and the other countries, the frequency of food allergy was found to be high, ranging from 33% to 39%, especially in patients with severe AD. [24,[35][36][37] In our study, sensitivity to egg white/yolk, cow's milk, wheat, and chicken meat was found most frequently. In addition, while food allergy was confirmed in half of the patients with egg and cow's milk sensitivity, food allergy was not confirmed in any of the patients with wheat and chicken meat sensitivities. ...
Objectives
In this study, it was aimed to examine food sensitivity in patients with atopic dermatitis (AD) and to investigate the frequency of food allergy in patients with food sensitivity.
Methods
Patients aged 0–2 years who were followed up with the diagnosis of AD were included in the study. The characteristics of demographic and clinical and laboratory findings of the patients were recorded retrospectively. Patients were classified as mild, moderate, and severe using the SCORing AD index according to the severity of AD. The presence of food sensitivity was evaluated by skin prick test and serum-specific immunoglobulin (Ig)E results. Food allergy was diagnosed by oral food challenge (OFC) test.
Results
Of the 72 patients included in the study, 62.5% (n=45) were male, and the mean age was 9±4.8 months. When the disease severity was evaluated, it was mild in 40 patients (55.6%); moderate/severe AD was present in 32 patients (44.4%). The frequency of moderate/severe AD was higher in patients who were younger (p=0.01), whose symptoms started in the first 6 months (p=0.03), who had a family history of allergic disease (p=0.001), who breastfed for <6 months (p=0.01), who had a higher median serum total IgE level, and a higher percentage of serum eosinophils (p=0.005 and p=0.01, respectively). Food sensitivity in 45.8% of patients; food allergy was detected in 41.7% of them. The most common sensitivities and allergies were eggs white/yolk and cow’s milk, respectively. The rate of food sensitivity was found to be higher in male gender (p=0.03) and breastfed patients (p=0.03), whereas it was similar in patients with mild and moderate/severe AD.
Conclusion
In the investigation of food sensitivity in patients with AD, it is important to evaluate other demographic and clinical characteristics such as gender and breastfeeding, apart from the severity of disease. The OFC test should be performed to confirm the food allergy in patients with food sensitivity before the recommendation of an elimination diet.
... 49,50 Atopik dermatit ve besin alerjisi beraberli inin yanı sıra, çocuklarda besin alımı ile deri lezyonlarının tetiklenebilece i ve hastalık iddetinin arta-bilece i bildirilmi tir. 51,52 Eri kinlerde yapılan sınırlı sayıda çalı manın sonuçları farklılıklar göstermekle beraber besin alerjisinin hastalık iddetini arttırdı ını kuvvetle destekleyen bir veri bulunmamaktadır. [53][54][55][56] Besinlerle hastalık alevlenmesi hikayesi olan hastalarda deri delme testi, spesifik IgE düzeyi ölçümü, oral provokasyon testi ve eliminasyon diyetleri yapılarak olası ili ki ve tanı dorulanmalıdır. ...
Food Allergy and Skin Findings
Food allergies, which are increasing in frequency all over the world, affect all ages, geo-graphical/ethnic groups and socioeconomic levels. Although the prevalence of food-related allergic reactions is not clearly reported, food is one of the most researched and questioned triggers among the causative factors of various diseases. It is reported that patients who apply to the emergency department due to food allergy most frequently present with skin findings. Dermatological symptoms and features such as itching, flushing, morbilliform rash, urticaria, angioedema and eczema may occur in food allergies. The duration and form of clinical findings vary according to the pathophysiology of the allergic reaction. Food-induced reactions can be classified as IgE-mediated, cell-mediated and mixed reactions. These allergic reactions can develop after oral intake, inhalation or contact with the food via skin and mucous membranes.
Besin Alerjisi ve Deri Bulguları
ÖZET Tüm dünyada sıklı ı giderek artan besin alerjileri her yaş , coğrafik/etnik grup ve sosyoekonomik seviyeyi etkilemektedir. Besin ili kili alerjik reaksiyonların prevalansı tam olarak bilinmese de besinler hastalı ın nedensel faktörleri arasında en çok ara tırılan ve hastalar tarafından sorgulanan tetikleyicilerdendir. Besin alerjisi nedeniyle acil servise ba vuran hastaların en sık deri bulgularıyla geldikleri bildirilmektedir. Besin alerjilerine kaşıntı, flushing, morbiliform döküntü, ürtiker, anjioödem ve egzama gibi birçok dermatolojik semptom ve bulgu eşlik edebilir. Klinik bulguların ortaya çıkı süresi ve şekli, alerjik reaksiyonun patofizyolojisine göre değişmektedir. Besinlerle tetiklenen reaksiyonlar IgE aracılı, hücre aracılı ve mikst reaksiyonlar olarak sınıflandırılabilir. Bu alerjik reaksiyonlar besinlerin oral alımı, inhalasyonu veya deri ve mukozalara teması sonrasında ortaya çıkabilmektedir.
... 7 Among children with moderate-to-severe AD, FA confirmed by double-blind, placebo-controlled, food challenges or open food challenges was identified in 33% to 81%. [8][9][10][11][12] Numerous population-based studies have found associations between AD and food allergen sensitization (ie, the presence of foodspecific IgE). Food sensitization in infants with AD is up to 6 times higher than that in healthy controls at the age of 3 months. ...
Food allergy and food-related worsening of dermatitis can occur in patients with atopic dermatitis (AD). We reviewed the relationship of AD with food allergen hypersensitivity, and the risks and benefits of food-allergen testing and avoidance in AD patients. Skin prick testing and specific Immunoglobulin E to aeroallergens may identify patients with immediate hypersensitivity. Atopy patch tests may detect non-Immunoglobulin E-mediated reactions, but are not standardized or routinely used. Younger children with more severe AD who failed optimal management may have food-triggered AD. Egg, milk, and peanut account for most food allergens. Elimination of relevant food allergens should improve the AD, but must be guided by appropriate allergy testing and establishing clinical relevance. Serum immunoglobulin E panels for food allergens are discouraged in the primary care setting due to their difficulty of interpretation. Empiric avoidance of foods is entirely discouraged in AD due to their risk of causing nutritional issues, food allergy and other problems.
... Numerous studies support that more severe phenotypes of AD are associated with more frequent diagnosis of food allergy, ranging between 33% to 39%, with occasional studies reporting higher rates up to 80% [40][41][42][43], while food allergy prevalence in the general population is estimated about 0.1-6% [44]. Hence, atopic dermatitis is proposed as a major risk factor for food sensitization and IgE-mediated food allergy [23,45]. ...
Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by intense pruritus, eczematous lesions, and relapsing course. It presents with great clinical heterogeneity, while underlying pathogenetic mechanisms involve a complex interplay between a dysfunctional skin barrier, immune dysregulation, microbiome dysbiosis, genetic and environmental factors. All these interactions are shaping the landscape of AD endotypes and phenotypes. In the “era of allergy epidemic”, the role of food allergy (FA) in the prevention and management of AD is a recently explored “era”. Increasing evidence supports that AD predisposes to FA and not vice versa, while food allergens are presumed as one of the triggers of AD exacerbations. AD management should focus on skin care combined with topical and/or systemic treatments; however, in the presence of suspected food allergy, a thorough allergy evaluation should be performed. Food-elimination diets in food-allergic cases may have a beneficial effect on AD morbidity; however, prolonged, unnecessary diets are highly discouraged since they can lead to loss of tolerance and potentially increase the risk of IgE-mediated food allergy. Preventive AD strategies with the use of topical emollients and anti-inflammatory agents as well as early introduction of food allergens in high-risk infants seem promising in managing and preventing food allergy in AD patients. The current review aims to overview data on the complex AD/FA relationship and provide the most recent developments on whether food allergy interventions change the AD course and vice versa.
... There are four principal allergens that account for the majority of cases of food allergy (FA) in young children 98,99 : milk from cows, chicken eggs, wheat and soya. A rise in cases of groundnut allergy has newly been reported, especially in the UK and US, where rates are estimated at 0.5% and 0.6% 100,101 . ...
OBJECTIVES. We reviewed the literature on allergic disorders during adolescence.
MATERIAL AND METHODS. The Pubmed, Google, Google Scholar and Proquest Central databases were used with search terms: adolescent, teenager, allergic rhinitis, asthma, atopic dermatitis and food allergy.
RESULTS. Children with a proven allergy have a risk for developing another allergic disorder that is 8-fold higher compared to normal and approaching 7-fold for asthma. The age at which allergy is diagnosed in childhood has a powerful bearing on whether allergic disorders or asthma develop in adolescence. Atopic response severity in a patient during childhood predicts the severity of allergic asthma as an adult. Patients may become asthmatic as adolescents, probably due to a late presentation of allergic disease, or as the presenting complaint for the triad of intrinsic asthma, nasal polyp formation and aspirin intolerance (so-called Samter triad). Allergic eczema (Atopic dermatitis) carries on into their adolescent years in between 10 and 20% of children. Food allergy (FA) is more frequently noted in childhood and adolescence than in adulthood. For the most part, symptoms were attributable to pollen-associated FA and of mild severity. Being hypersensitive to food for non-allergic reasons was rarer.
CONCLUSION. Allergic rhinitis represents a significant risk factor for becoming asthmatic, whether in childhood, adolescence or adulthood. Atopic dermatitis and food allergy are also frequent conditions during adolescence. Pollen-associated FA constitutes an important part of the food allergy. Furthermore, food allergy may be the leading trigger for anaphylaxis. Common associations/comorbidities of atopic dermatitis reported are other atopic conditions such as food allergies, asthma and allergic rhinitis/rhinoconjunctivitis.
... In een Deens populatieonderzoek had 15% van de kinderen met CE ook een voedselallergie [Eller 2009]. In onderzoeken in ziekenhuizen hebben kinderen met matig tot ernstig CE in een tot twee derde van de gevallen ook een voedselallergie (meestal voor ei of koemelk) [Eigenmann 2000;Niggemann 1999;Werfel 2007]. Kinderen met licht CE zijn niet vaker of hoger gesensibiliseerd voor voedsel dan kinderen zonder CE [Eller 2009;Guillet 1992]. ...
... [27] çalışmasında alerjen duyarlılaşma %37,8 olarak bildirilmiştir; bizim çalışmamızda ise %65,4 olarak yüksek saptanmış, ancak besin alerjisi varlığı ise hastaların %38,5 (n=50)'sinde gösterilmiştir. Literatürde atopik dermatitli infantlarda besin alerjisi sıklığı çeşitli çalışmalarda ise %33-66 olarak bildirilmektedir [28][29][30][31]. İnek sütü, yumurta, buğday, soya, kuruyemişler, balık, kabuklu deniz ürünleri en sık suçlanan besinlerdir [10,32]. ...
... alimentari. Alcuni studi avevano mostrato un miglioramento della DA dopo dieta di esclusione di latte vaccino e uovo [137][138][139] . Lavori più recenti hanno dimostrato, al contrario, che una cute con un deficit di barriera ed esposta al cibo sarebbe la responsabile dapprima di una sensibilizzazione e in seguito di una allergia alimentare IgE mediata [140][141][142][143] . ...
... Breuer et al. investigated children aged between 1 and 10 years, and they diagnosed food allergy in 64% of these children (23). In another study conducted by Niggemann et al., 51% of all challenge tests resulted in allergic reactions, and 81% of all patients reacted to at least one allergen (24). Sampson et al. found that food allergy was present in more than 60% of children with AD (25). ...
Background
Food and inhalant allergens have also been identified as potential trigger factors of
atopic dermatitis symptoms. Here we aimed to investigate relationships between
atopic dermatitis and inhalant–food allergen sensitization in Turkish children with
atopic dermatitis.
Materials and methods
We included 70 patients (42 male, 28 female) with atopic dermatitis and 45 controls
(30 male, 15 female) with no atopy, no atopy familial history, no atopy clinical
findings no atopic dermatitis. We noted patients’ and controls’ age, gender, passive
smoking exposure, atopy, xerosis, bath water temperature, shower gel type, clothes
detergent type, blood hemoglobin, blood eosinophil count, blood eosinophil percent,
values of serum immunoglobulin E, serum immunoglobulin A, serum immunoglobulin
G, serum immunoglobulin M, results of inhalant allergen and food allergen testing.
Results
We found that nine cases had inhalant allergen sensitization and 21 cases had food
allergen sensitization. There were significant relationships between cases and
controls in terms of count of eosinophil and percent of eosinophil (p=0.008, p=0.009
respectively).
Conclusion
Humoral and cellular allergen-specific immune responses to food and inhalant
allergens can be detected in patients with atopic dermatitis. Accordingly, we believe
that blood eosinophil count and percent are more valuable laboratory parameters
than serum total IgE for following patients with atopic dermatitis.
... Hızla ortaya çıkan semptomlar için verilen klinik anamnezin tek başına veya deri prik testi (DPT) veya ssIgE testleriyle birlikte tanıyı %50'den %100'e değişen oranlarda koyduğu birkaç literatür tarafından belirtilmiştir. 10,[30][31][32] Klinik değerlendirme eşlik eden atopik hastalıkların (atopik egzema/dermatit, allerjik rinit, astım) yanı sıra özellikle çocuk yaş grubunda nutrisyonel durum ve büyümeyi de içermelidir. 10 Öyküde şüphenilen gıda, gıda alınması ile reaksiyon oluşması arasında geçen süre, reaksiyona neden olan gıda miktarı, hastanın şikayeti ve klinik bulgular, gıdanın çiğ mi pişmiş mi olduğu, çapraz reaksiyona neden olabilecekbaşka maddenin varlığı, reaksiyonun lokalizasyonu ve yoğunluğuna mutlaka dikkat edilmelidir. ...
Food allergy (FA) is a hypersensitivity reaction to food proteins which is caused by immunological mechanisms. FA is a distinct entity which differs from food intolerance. Clinical symptoms may affect skin, gastrointestinal system, respiratory system or it can be presented as anaphylaxis. FA frequency is increased during last 10-20 years but its prevalance differs between countries. Diagnosis is challenging and double blinded placebo controlled food challenge is the golden standart test for diagnosis. Mainstay of treatment and long-term disease management depends on elimination diet. Immunotherapy is a promising novel treatment approach for FA.
... Patients diagnosed with atopic dermatitis have a more frequent allergy to the egg, which suggests that they produce AD, but these children are usually diagnosed when they are breastfeeding, with no relation to the egg intake, although there are some which worsen eczema in a delayed manner, making it difficult to establish causality [16,17]. There are children with AD who tolerate the egg and present positive tests, this may be an epiphenomenon associated with the increase of total IgE. ...
... The eight foods commonly known as the BBig Eight^account for about 90% of documented food allergy and includes peanuts, soybeans, cow's milk, hen's egg, fish, crustacean, wheat, and tree nuts. Out of these foods, cow's milk, eggs, wheat, soy, peanut, and fish are the main causes of food allergy in infancy and early childhood [8][9][10]; whereas peanut, tree nuts, and seafood are reported to be causative factors in 85% of severe reactions in grown-up children and adults [11,12]. In addition to these common and potential allergens, few uncommon or unusual foods may also cause allergic reactions in sensitive individuals; these include mustard [13], sesame seeds [14], mango [15], red meat [16], avocados [17], kiwis [18], spices and condiments [19], banana [20], cereals [21], eggplant [22], and many others. ...
Mustard is widely used in a variety of foods/food products to enhance the flavor and nutritional value that subsequently raise the risk of hypersensitivity reactions. Mustard allergy has been reported for many years and is increasing gradually especially in the areas where its consumption is comparatively higher, and it may be considered among the most important food allergies. A number of relevant clinical studies focused on mustard-induced allergic manifestations are summarized in the current review. In addition, the knowledge regarding the immunological as well as biochemical characteristics of mustard allergens that have been known till date and their cross-reactivity with other food allergens have also been discussed here. Notably, mustard may also be present as a hidden allergen in foods; therefore, it is important to recognize food products that may contain mustard as it may pose potential risk for the allergic individuals. Additionally, the better understanding of the underlying mechanism in mustard allergy is a prerequisite for the development of specific therapeutic procedures. Conclusively, mustard sensitivity should be routinely tested in patients with idiopathic anaphylaxis for the safety of the allergic patients.
... The second possible allergic reaction to wheat proteins is a delayed antibody-independent T-cell response which is a non-IgE-mediated reaction to different wheat protein fractions [68]. Atopic eczema/dermatitis is a form of non-IgE-mediated WA, which can be investigated with an oral double-blind food challenge [83]. Mixed IgE-and non-IgEmediated food allergic reactions have been described as eosinophilic, esophagitis and gastroenteritis; a chronic inflammatory disease of the digestive system [84]. ...
In the last decade, the ingestion of gluten, a heterogeneous complex of proteins present in wheat, rice, barley and probably in oats, has been associated with clinical disorders, such as celiac disease, wheat allergy and recently to non-celiac gluten sensitivity or wheat intolerance syndrome. Gluten-related disorders, which are becoming epidemiologically relevant with an estimated global prevalence of about 5%, require the exclusion of gluten from the diet. For the past 5 years, an important shift in the availability of gluten-free products, together with increased consumption in the general population, has been recorded and is estimated to be about 12–25%. Many people follow a self-prescribed gluten-free diet, despite the fact that the majority have not first been previously excluded, or confirmed, as having gluten disorders. They rely on claims that a gluten-free diet improves general health. In this review, we provide an overview of the clinical disorders related to gluten or wheat ingestion, pointing out the current certainties, open questions, possible answers and several doubts in the management of these conditions.
• KEY MESSAGE
• Incidence of gluten-related disorders is increased in the last decade and self-diagnosis is frequent with inappropriate starting of a gluten-free diet.
• Gluten and wheat are considered as the most important triggers to coeliac disease, wheat allergy and non-celiac gluten sensitivity.
• Pediatricians, allergologist and gastroenterologist are involved in the management of these conditions and appropriate diagnostic protocols are required.
... Eliminasi diit pada bayi di bawah usia 3 bulan ialah dengan substitusi susu dan eliminasi diit ibu; bayi umur 3-6 bulan dengan substitusi susu dan sereal / beras; bayi umur 6 bulan Telur -2 4 1 1 8 Ikan -3 3 3 1 10 Udang --3 4 1 8 Ketam --2 2 -4 Telur dan ikan 1 1 ---2 Ayam --1 --1 sampai usia 2 tahun dengan substitusi susu, sereal, buah-buahan tertentu, telur, coklat dan kacang. Gejala yang tetap mucul pada pasien yang sudah menjalani eliminasi diit menunjukkan bahwa gejala tersebut tidak disebabkan oleh makanan [19][20][21] Jika gejala berkurang dengan eliminasi diit, uji provokasi dapat dimulai 3 minggu kemudian. Meskipun prosedur ini tampaknya rumit dan lama, cara ini merupakan uji yang langsung. ...
Patogenesis hipersensitivitas makanan terhadap dermatitis atopik telah mengalami
perubahan pada akhir abad ini. Peran hipersensitivitas tipe I yang diperantarai oleh Ig E
dalam patogenesis dermatitis atopik telah banyak diperdebatkan. Tujuan penelitian ini
ialah untuk mengetahui peran hipersensitivitas makanan pada kasus dermatitis atopik
dan untuk mengetahui apakah uji tusuk kulit bermanfaat untuk diagnosis reaksi
hipersensitivitas. Telah dilakukan penelitian prospektif pada seluruh pasien dermatitis
atopik yang dirawat di RSUP Manado selama periode Januari 1998 sampai Desember
1999. Subyek penelitian ini ialah pasien dermatitis atopik yang berusia 4 bulan – 12
tahun yang bersedia untuk melakukan uji tantangan. Data yang dikumpulkan meliputi
anamnesis, uji tusuk kulit (skin prick test), dan eliminasi makanan yang dicurigai. Analisis
data menggunakan distribusi frekuensi. Tiga puluh pasien memenuhi kriteria inklusi
terdiri dari 15 laki-laki dan 15 perempuan. Enam belas pasien mempunyai riwayat alergi
terhadap makanan yang dicurigai dan 16 penderita disertai penyakit alergi lain. Lima
belas pasien mempunyai riwayat atopi pada salah satu orang tua, 3 pasien lainnya riwayat
atopi ditemukan pada kedua orang tua. Pada uji tantangan makanan ditemukan 19
pasien mempunyai manifestasi alergi yang dicetuskan oleh makanan, yaitu berturutturut
40%, 53% dan 40% oleh telur, ikan dan udang. Uji tusuk kulit yang terdiri atas
20 jenis alergen makanan dilakukan pada semua pasien yang berumur diatas 2 tahun
dengan hasil 12 anak di antaranya memberikan hasil positif. Penelitian ini menyimpulkan
bahwa hipersensitivitas makanan berperan dalam patogenesis dermatitis atopik pada
beberapa anak. Diagnosis dan pengaturan diit yang tepat dapat memperbaiki gejala
klinik yang timbul.
... Prevalensi alergi makanan paling tinggi pada usia tahun pertama kehidupan, yaitu sekitar 6% untuk usia di bawah 3 tahun sedangkan untuk bayi sekitar 10-12% 13,14 . Prevalensi alergi makanan terdapat pada 40% kasus DA. 22,23 Anak dengan penyakit atopik akan mempunyai alergi makanan lebih tinggi dari anak normal. ...
Sensitisasi makanan dan aeroalergen memegang peran pada patogenesis penyakit atopik
seperti dermatitis atopik (DA), rinitis alergik dan asma. Dermatitis atopik merupakan
suatu penyakit kronik yang tidak dapat disembuhkan 100% dan sering mengalami
eksaserbasi, serta menimbulkan masalah pada orang tua dan dokter. Banyak faktor yang
berperan pada DA, baik faktor eksogen atau endogen maupun kombinasi keduanya.
Faktor genetik merupakan salah satu faktor yang berperan pada DA. Faktor eksogen
seperti makanan aeroalergen banyak dilaporkan sebagai pencetus timbulnya DA. Masih
terdapat perbedaan pendapat mengenai makanan sebagai penyebab tetapi terdapat bukti
bahwa bila makanan dihindarkan gejala dermatitis membaik. Susu sapi memprovokasi
gejala DA pada usia bayi1 dan 30% DA disebabkan alergi susu sapi2.
Alergen hirup seperti tungau debu rumah berperan pada patogenesis DA, terutama
pada anak; hal ini berdasarkan beberapa pengamatan klinis, uji kulit dan IgE spesifik
yang tinggi serta terdapat perbaikan gejala klinis DA setelah penghindaran tungau debu
rumah.3 Alergen makanan lebih berpengaruh pada usia bayi kurang dari 1 tahun
sedangkan aeroalergen pada usia di atas 2 tahun.4 H asil penelitian di Departemen IKA
RSCM menunjukkan bahwa DA pada anak dengan onset kurang dari 1 tahun yang
telah tersensitisasi telur dan aeroalergen akan meningkatkan risiko alergi saluran napas
di kemudian hari sampai sepuluh kali lipat
... In the same trial, children were given exclusion diet of egg and milk and AD improved significantly. [26] In an Indian study by Dhar and Saxena, SPT positivity to common food allergens were egg white, fish, milk, brinjal, dal, groundnut, and banana. [27] Different studies have shown variation in positive predictive value for atopic patch testing, hence not routinely performed. ...
Food allergy in atopic dermatitis (AD) is debatable from decades. Role of diet in the cause and treatment of AD is controversial and is not well-defined. Allergists and pediatricians are convinced about the food allergy in AD whereas many dermatologists are contrary for this. However, there are studies in the Indian and western literature supporting the evidence that elimination diet may improve the severe type of AD. There is increasing awareness and lot of misconception among caregivers about food allergy and hence careful understanding about this concept is necessary to counsel parents. Recent evidence-based literature suggests avoidance of proven food allergens in AD could be beneficial in moderate to severe type of AD.
... A study from Germany looking retrospectively at 106 DBPCFCs to cow's milk, hen's egg, wheat, and soy in 64 children with AD found isolated late eczematous reactions in 12% of all positive challenges. 72 Similarly, Niggemann and colleagues 73 found that late eczematous reactions (after 2 hours) occurred in 18.9% of positive reactions. In a recent study looking at outcomes of 1186 DBPCFCs performed for suspicion of food allergy, 54.9% of those challenges had a current history of AD and on challenge, late eczematous reactions were unlikely to occur without other immediate symptoms preceding. ...
Hypersensitivity reactions to foods can have diverse and highly variable manifestations. Cutaneous reactions, such as acute urticaria and angioedema, are among the most common manifestations of food allergy. However, cutaneous manifestations of food allergy encompass more than just IgE-mediated processes and include atopic dermatitis, contact dermatitis, and even dermatitis herpetiformis. These cutaneous manifestations provide an opportunity to better understand the diversity of adverse immunologic responses to food and the interconnected pathways that produce them.
... Glycinin is made up of five subunits, and each subunit contains an acidic and a basic polypeptide linked by a disulphide bond (Hou & Chang 2004). Glycinin may cause allergic reactions in young children (Niggemann et al. 1999), piglets (Li et al. 1990(Li et al. ,1991aSun et al. 2008a), calves (Lallè s et al. 1996) and lambs (Ouedraogo et al. 1998). ...
Glycinin, an antigenic glycoprotein found in soybeans, is the major cause of allergic reactions in young animals. The objective of this study was to evaluate the effects of a prior immunisation of sucking piglets with glycinin on their post-weaning growth performance, serum immunoglobulin contents, small intestinal histamine release and mucosal histology. Forty piglets (7 d of age) were randomly divided into four groups of 10 piglets each. Piglets of Group C (Control) received a physiological saline solution, Groups Im (Immunised) and ImþS (Sensitised) were immunised twice with 500µg/kg of glycinin at 7 and 21-d-old. All piglets were weaned at 23 d; Groups ImþS and S were sensitised with 2500µg/kg of glycinin at weaning. Compared with Group C, in Group S the average daily gain (ADG), average daily feed intake and gain:feed ratio were decreased, and serum levels of IgG and IgE were increased. Furthermore, in this group, the histamine levels in the duodenum and ileum were significantly decreased, and the structure of duodenal and ileal mucosa was severely damaged. On the contrary, in Groups Im and Im+S the ADG was increased, serum IgE levels were decreased, intestinal histamine levels were increased and the intestinal mucosa was not damaged. These findings suggest that prior immunisation with glycinin can protect the structural integrity of the intestinal mucosal epithelia and alleviate allergic reactions in piglets.
... As in many other plant food species, soybeans contain numerous proteins that are potentially allergenic. Soy allergy affects mainly young children (Sampson et al., 1997; Niggemann et al., 1999), although the onset of soy allergy in adults has been reported (). Allergic reactions to soy proteins are variable and typically involve mild skin and digestive reactions (). ...
Allergic reactions to legumes range from mild skin rashes to life-threatening systemic anaphylaxis. These reactions are caused by naturally occurring proteins in the plant that upon interaction with the immune system of allergic patients, trigger the production allergen specific IgE antibodies. Soybean is considered one of the eight most allergenic foods and, along with peanut, are the most important legumes associated with food allergies. Currently, the only method to manage soybean allergy is to remove it from the diet. However, this has proven virtually impossible for the majority of soy-allergic patients because soy products are “hidden” in many processed foods. Despite the fact that several soybean allergens have already been characterized, the goal of this investigation was to identify and characterize novel soy allergens, since these data might be used in the development of therapeutic agents to treat soy-allergic patients. Further, because recent investigations have demonstrated the potential use of soybean protein to desensitize people with more severe allergy to foods such
as peanut, the identification of novel soy allergens could also advance the development of this desensitization strategy. Because plant food allergens belong to a small number of protein families present in a wide array of species, we hypothesized that soy proteins that are orthologs of proteins known to be allergenic in other crop species could also be allergens in soy. In this investigation we constructed a cDNA library from developing soy seeds and isolated four full length cDNAs encoding novel candidate allergens. The proteins these cDNA encoded were expressed in a bacterial system and were analyzed by a combination of genomic, proteomic and immunological techniques. The results presented here demonstrate that we have characterized a novel soybean allergen, the seed specific biotinylated protein (SBP). Our results also indicate that SBP is potentially a major allergen because it exhibits reactivity with the majority of soy-allergic patient sera tested in the study. Further characterization of this protein has led us to hypothesize that the peanut ortholog of soy SBP is also allergenic. The soybean SBP is thus an important allergen and should be considered in the diagnosis and treatment of soybean allergy.
This European Academy of Allergy and Clinical Immunology guideline provides recommendations for diagnosing IgE‐mediated food allergy and was developed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Food allergy diagnosis starts with an allergy‐focused clinical history followed by tests to determine IgE sensitization, such as serum allergen‐specific IgE (sIgE) and skin prick test (SPT), and the basophil activation test (BAT), if available. Evidence for IgE sensitization should be sought for any suspected foods. The diagnosis of allergy to some foods, such as peanut and cashew nut, is well supported by SPT and serum sIgE, whereas there are less data and the performance of these tests is poorer for other foods, such as wheat and soya. The measurement of sIgE to allergen components such as Ara h 2 from peanut, Cor a 14 from hazelnut and Ana o 3 from cashew can be useful to further support the diagnosis, especially in pollen‐sensitized individuals. BAT to peanut and sesame can be used additionally. The reference standard for food allergy diagnosis is the oral food challenge (OFC). OFC should be performed in equivocal cases. For practical reasons, open challenges are suitable in most cases. Reassessment of food allergic children with allergy tests and/or OFCs periodically over time will enable reintroduction of food into the diet in the case of spontaneous acquisition of oral tolerance.
Zoonotik Enfeksiyonların Retrospektif İncelenmesi: Çukurova Üniversitesi Örneği
BACKGROUND
The influence of diet on atopic dermatitis (AD) is complex, and the use of dietary elimination as a treatment has conflicting views.
OBJECTIVE
To systematically review the benefits and harms of dietary elimination for the treatment of AD.
METHODS
We searched MEDLINE, EMBASE, AMED, PsycINFO and CENTRAL from inception to Jan 18, 2022, without language restrictions, for RCTs and observational studies comparing dietary elimination versus no dietary elimination for treatment of AD. We conducted random-effects meta-analysis of eczema outcomes. We used the GRADE approach to assess certainty of evidence (CRD42021237953).
RESULTS
Ten RCT (n = 599, baseline median of study mean ages 1.5 years, median of study mean SCORAD 20.7, range 3.5-37.6) were included in the meta-analysis. Compared to no dietary elimination, low certainty evidence showed that dietary elimination may slightly improve eczema severity (50% with versus 41% without dietary elimination improved SCORAD by a minimally important difference of 8.7 points, risk difference [RD], 9% [95%CI 0 to 17]), pruritus (daytime itch score [range 0-3], mean difference [MD] -0.21 [95%CI -0.57 to 0.15]) and sleeplessness (sleeplessness score [range 0-3], MD -0.47 [95%CI -0.80 to -0.13]). There were no credible subgroup differences based on elimination strategy (empiric versus guided by testing) or food-specific sensitization. Insufficient data addressed harms of elimination diets among included RCTs, although indirect evidence suggests elimination diets may increase the risk of developing IgE-mediated food allergy.
CONCLUSION
Dietary elimination may lead to a slight, potentially unimportant, improvement in eczema severity, pruritus and sleeplessness in patients with mild-moderate AD. This must be balanced against potential risks of indiscriminate elimination diets including developing IgE-mediated food allergy and withholding more effective treatment options for AD.
p> Introduction: It is unclear at present which type of food challenge (open vs. double blind) is best suited for the diagnosis of food hypersensitivity (FHS) in children.
This research aimed to assess 1) what is the best approach for the diagnosis of FHS; 2) how maternal dietary and infant feeding and weaning practices influence the development of FHS; 3) the role of a personal or family history of atopy in dietary practices.
Methods: A birth cohort of children born during 2001 - 2002 was recruited at the ante-natal clinic and followed prospectively for two years. In addition, three sets of school cohorts were approached to participate in the study. To address the first aim, all cohorts were utilised and the use of open food challenges (OFC) and double blind placebo controlled food challenges (DBPCFC) were assessed in the diagnosis of FHS. To address the second aim the birth cohort was used. A food frequency questionnaire (FFQ) was developed and validated to obtain the information on the maternal diet. Standardised questionnaires were developed and used prospectively to assess feeding and weaning practices and their influence on the infant’s FHS. To address the third aim the family history of atopy was obtained during recruitment of the birth cohort.
Results: We found that the positive predictive value of the one-day OFC challenges was higher than the one-week OFC. The data therefore suggest that OFC may be suitable for diagnosing immediate (objective) symptoms, whereas a DBPCFC may be needed for the diagnosis of delayed (subjective) symptoms.
Fruit and vegetable intake during pregnancy, food avoidance during lactation and weaning age of the infant affected the development of FHS.
A family history of atopy positively affected exclusive breast feeding at three months and delayed introduction of peanuts into the infant’s diet by six months. </p
The relationship between diet and atopic dermatitis (AD) is complex and involves many factors. Various nutrients can play a role in immune modulation, and some nutrients may have beneficial effects on the disease process while others may be detrimental. Consumption of foods high in fat and refined carbohydrates has been associated with an increased risk of severe eczema whereas consumption of fresh fruits, vegetables, and fish have been associated with a decreased risk of AD. AD is frequently associated with food allergies, and allergy testing may be advised for some patients. While evidence is conflicting, some studies indicated that supplementation of zinc and vitamins C, D and E may be beneficial in AD. Though much remains uncertain about the appropriate diet for AD patients, a well-balanced diet that incorporates anti-inflammatory foods such as fruits, vegetables, and fish is recommended.
Atopic dermatitis (AD) — a chronic inflammatory skin disease with a broad spectrum of clinical symptoms. It is diagnosed mainly clinically. Sensitization to inhalled and food allergens may play a role in the development of AD. Thus, it is important to determine the presence of sensitization for environmental control and allergen avoidance, pharmacotherapy, and immunotherapy.
Aim: To evaluate the occurrence of egg allergy in atopic dermatitis patients, to analyse the results of specific IgE. We show the occurrence of bird-egg syndrome and the relation between the sensitisation to some molecular components and egg allergy. Methods: Egg allergy was confirmed according to the results of the challenge test (history) together with positive results of specific IgE to molecular components of egg and/or extract specific IgE to egg. Results and conclusion: Altogether 100 atopic dermatitis patients were examined – 48 men, 52 women, the average age 40.9 years. Reaction to egg was confirmed in 23 patients (23%); egg allergy was confirmed in 18 patients (18%). In these patients we recorded the significantly higher sensitisation to molecular components Der f 2, Der p 2, Equ c 1 and Phl p 7. The bird – egg syndrome was confirmed in 3 patients (3%).
The diagnosis of food allergy in clinical practice has not been standardized, and food allergy is overdiagnosed in patients with atopic dermatitis (AD). This overdiagnosis of food allergy leads to unnecessary elimination diets that may exert potential adverse effects on the health of children with AD. Unlike classic IgE-mediated food allergy, food allergy in patients with AD may manifest as non-eczematous reactions, isolated eczematous reactions, or a combination of these reactions. The diagnosis of food allergy in children with AD should be made based on a thorough clinical history (detailed allergic history and feeding history), clinical manifestations, and laboratory workup including skin prick testing, serum specific IgE measurement, atopy patch testing, and oral food challenges. Once an underlying food allergy is confirmed in a patient with AD, comprehensive management is generally recommended. Avoidance of the food allergen is the main treatment approach, but there is a need for regular clinical follow-up, including evaluation of the nutritional status and supervision of growth and development. Multidisciplinary cooperation between dermatologists, nutritionists, and pediatricians is required.
Eczema, including atopic dermatitis (AD), is the most common chronic inflammatory disorder of the skin in children, regularly associated with other allergic diseases and often cited as one of the earliest components of the “atopic march.” While food allergy (FA) is often implicated in the underlying etiology, AD caused by a food trigger is relatively rare, with age of onset being an important clinical factor. Still, FA is more common in patients with AD and so understanding the capacity of FA testing as well as limitations is paramount for both the practicing allergist and primary care clinician. In addition to contributing to the basic understanding of AD, this chapter seeks to specifically discuss FA as it is related to AD in children and adults along with practical considerations in clinical care.
Purpose of review:
To present the most recent evidence on atopic dermatitis and its relation to food allergy.
Recent findings:
Atopic dermatitis is a chronic inflammatory disorder of the skin characterized by impaired skin barrier because of multifactorial causes including genetic factors, immune dysregulation, and skin microbiome dysbiosis. Infants with temporary skin barrier disruption and/or persistent atopic dermatitis are particularly at risk of developing food allergy (during the so-called atopic march), with up to half of patients demonstrating positive food-specific IgE and one-third of severe cases of atopic dermatitis having positive symptoms on oral food challenge. A high proportion of children with atopic dermatitis exhibit asymptomatic sensitization to foods, and skin testing to identify potential food triggers is not recommended unless the patient has a history suggestive of food allergy and/or moderate-to-severe atopic dermatitis unresponsive to optimal topical care. Indeed, indiscriminate testing can lead to a high proportion of false-positive tests and harmful dietary evictions. Promising strategies to prevent food allergy in children with atopic dermatitis include early skincare with emollients and treatment with topical steroid, and early introduction of highly allergenic foods.
Summary:
Further studies are required to identify risk factors for atopic dermatitis to help prevent the development of food allergy in this high-risk population.
Food allergy is an important public health problem that affects children and adults, and it has been increasing in prevalence in the last 2 to 3 decades. The symptoms can vary from mild to severe, and in extreme cases food allergy can lead to anaphylaxis, which is a life-threatening allergic reaction. Currently, there is no cure for food allergy. Management of food allergy includes allergen avoidance or emergency treatment. The eight most common food allergens are eggs, milk, peanuts, tree nuts, soy, wheat, crustacean shellfish, and fish, all of which are frequently consumed in the US. Thus, patients and their families must remain constantly vigilant, which can often be stressful. Moreover, nonallergic food reactions, such as food intolerance, are commonly mistaken as food allergies. This article highlights risk factors, natural history, diagnosis, and management of food allergy. [Pediatr Ann. 2020;49(1):e50-e58.].
The objective of this study was conducted to research the effects of β‐conglycinin in the diets on the growth performance, immunity function, antioxidant capacity and intestinal health of juvenile golden crucian carp (Carassius auratus). Five diets contained respectively (0, 20, 40, 60 and 80 g/kg) β‐conglycinin, and were used to feed juvenile golden crucian carp for 56 days. Final weight, weight gain and specific growth rate were significantly reduced by dietary β‐conglycinin (20–80 g/kg). Feed efficiency and protein efficiency were significantly reduced by dietary β‐conglycinin (40–80 g/kg). In hepatopancreas, the activities of T‐SOD, ACP, ALT and T‐AOC were significantly suppressed by dietary β‐conglycinin (20–80 g/kg). The activities of LZM, AKP, CAT and GPx were significantly reduced by dietary β‐conglycinin (40–80 g/kg). The activities of protease were significantly reduced and the content of MDA was significantly increased by dietary β‐conglycinin (60–80 g/kg). In proximal intestines, the activities of protease and CAT were significantly decreased by dietary β‐conglycinin (40–80 g/kg). In mid and distal intestines, the activities of protease and CAT were significantly inhibited by dietary β‐conglycinin (20–80 g/kg). In intestines, T‐AOC and GPx were significantly declined by dietary β‐conglycinin (20–80 g/kg). In proximal and mid intestines, the content of MDA were significantly increased by dietary β‐conglycinin (40–80 g/kg). In distal intestines, the content of MDA was significantly increased by dietary β‐conglycinin (20–80 g/kg). The expression of IGF‐I was significantly decreased and the expression of IL‐1β and TNF‐α was significantly increased by dietary β‐conglycinin (20–80 g/kg). The structural integrity of intestinal tissues were damaged by dietary β‐conglycinin (20–80 g/kg), the part of intestinal villus were shed, the part of epithelial cells were separated from lamina propria. Ultimately, these results suggested dietary β‐conglycinin should be <20 g/kg in formula feed of golden crucian carp.
Background
Early-onset eczema is associated with food allergy, and allergic reactions to foods can cause acute exacerbations of eczema. Parents often pursue dietary restrictions as a way of managing eczema and seek allergy testing for their children to guide dietary management. However, it is unclear whether test-guided dietary management improves eczema symptoms, and whether the practice causes harm through reduced use of conventional eczema treatment or unnecessary dietary restrictions. The aim of the TEST (Trial of Eczema allergy Screening Tests) study is to determine the feasibility of conducting a trial comparing food allergy testing and dietary advice versus usual care, for the management of eczema in children.
Methods and analysis
Design: a single centre, two-group, individually randomised, feasibility RCT with economic scoping and a nested qualitative study. Setting: GP surgeries in the West of England. Participants: children aged over 3 months and less than 5 years with mild to severe eczema. Interventions: allergy testing (structured allergy history and skin prick tests) or usual care. Sample size and outcome measures: we aim to recruit 80 participants and follow them up using 4-weekly questionnaires for 24 weeks. Nested qualitative study: We will conduct ~20 interviews with parents of participating children, 5-8 interviews with parents who decline or withdraw from the trial and ~10 interviews with participating GPs. Economic scoping: We will gather data on key costs and outcomes to assess the feasibility of carrying out a cost-effectiveness analysis in a future definitive trial.
Ethics and dissemination
The study has been reviewed by the Health Research Authority and given a favourable opinion by the NHS REC (West Midlands – South Birmingham Research Ethics Committee, Reference Number 18/WM/0124). Findings will be submitted for presentation at conferences and written up for publication in peer-reviewed journals.<br/
A wide variety of foods may cause or aggravate skin diseases such as contact dermatitis, contact urticaria, or atopic dermatitis (AD), both in occupational and private settings. The mechanism of action underlying allergic disease to food, food additives, and spices may be immunologic and non-immunologic. The classification and understanding of these reactions is a complex field, and knowledge of the possible reaction patterns and appropriate diagnostic test methods is essential. In addition, certain foods may cause worsening of atopic dermatitis lesions in children. The atopy patch test (APT) is a well-established, clinically useful tool for assessing delayed type reactions to protein allergens in patients and may be useful to detect protein allergens relevant for certain skin diseases. The APT may even detect sensitization against allergens in intrinsic atopic dermatitis patients, who show negative skin prick test and negative in vitro IgE test results against these allergens. Native foods, SPT solutions on filter paper, and purified allergens in petrolatum have been used for APT. The European Task Force on Atopic Dermatitis (ETFAD) has worked on standardizing this test in the context of AD patients, who are allergic to aeroallergens and food. This recommended, standardized technique involves test application at the upper back of children and adults; use of large, 12-mm Finn chambers; avoidance of any pre-treatment such as tape stripping or delipidation; standardized amounts of purified allergens in petrolatum; and use of the standardized ETFAD reading key. The APT may not be the best working or best standardized of all possible skin tests, but it is the best test that we currently have available in this niche.
Background:
Infant feeding in the first postnatal year of life has an important role in an infant's risk of developing food allergy. Consumer infant feeding advice is diverse and lacks consistency.
Aim:
The Australian Infant Feeding Summit was held with the aim of achieving national consensus on the wording of guidelines for infant feeding and allergy prevention.
Methods:
Two meetings were hosted by the Centre for Food and Allergy Research, the Australasian Society of Clinical Immunology and Allergy, and the Australian National Allergy Strategy. The first meeting of 30 allergy researchers, clinicians, and consumers assessed the evidence. The second consensus meeting involved 46 expert stakeholders including state and federal health care agencies, consumers, and experts in allergy, infant feeding, and population health.
Results:
Partner stakeholders agreed on consensus wording for infant feeding advice: CONCLUSIONS: Consensus was achieved in a context in which there is a high prevalence of food allergy. Guidelines for other countries are being updated. Provision of consistent wording related to infant feeding to reduce food allergy risk will ensure clear consumer advice.
Allergische Erkrankungen gehören heute zu den häufigsten chronischen Erkrankungen des Kindesalters (ISAAC 1998). In Deutschland sind mehr als 25% aller Kinder im Schulalter davon betroffen, die Tendenz ist steigend. Da in den letzten Jahrzehnten auch in anderen, insbesondere in den industrialisierten Ländern eine deutliche Zunahme der Allergieprävalenz beobachtet wurde, ist nicht abzusehen, ob bereits der Gipfel der Erkrankungshäufigkeit erreicht wurde.
Zur Abklärung von vermuteten Nahrungsmittelallergien steht eine Reihe von diagnostischen Möglichkeiten zur Verfügung. Dazu zählen – neben einer genauen Anamnese und evtl. Symptom-Nahrungsmittel-Protokollen – v. a. die Bestimmung des spezifischen IgE im Serum (inklusive der Komponentendiagnostik, s. auch Kap. 51, In-vitro-Serumdiagnostik), der Hautpricktest (s. auch Kap. 43, Hauttestung: Typ-I- und Typ-IV-Testung) sowie orale Provokationstests. Eine untergeordnete Rolle spielen der Atopie-Patch- Test, Basophilenaktivierungstest und der Histamin-Release- Test oder andere Verfahren. Abzulehnen sind alternative Verfahren ohne Evidenz, zu denen auch die Bestimmung des spezifischen IgG im Serum gehört (Kleine- Tebbe et al. 2009).
Ovalbumin (OVA), an (hen) egg allergen, is one of the most abundant glycoprotein allergens associated with IgE-mediated hypersensitivity through the T-helper type 2 immune response. The effect of deglycosylation of the N-terminal glycan in OVA on allergenicity and antigenicity after N-acetylglucosaminidase treatment was studied. N-acetylglucosaminidase-treated OVA (N-OVA) evaluated using an enzyme-linked immunosorbent assay, respectively. N-OVA significantly (p < 0.05) OVA-specific IgE and histamine levels. In addition, N-OVA decreased the antigenicity of OVA 1000-fold. These results suggest that the degree of allergenicity and antigenicity reduced with deglycosylation of N-terminal glycan in OVA.
In contrast to respiratory allergies, the epidemiology of food allergy has been little studied, and there is no strong evidence for an increasing incidence, either among infants and children or in adults. Neither are there any studies showing regional differences in prevalence. On the contrary, studies in Estonia, Iceland and Sweden indicate a similar prevalence during the first 2 years of life, both in verified food allergy and reported food intolerance. This is despite a low prevalence of respiratory allergies in the two former countries and a high prevalence in Sweden. The major problem with such epidemiological studies lies in the fact that there are no simple diagnostic criteria to verify the diagnosis. So far IgE determinations have been the only available diagnostic test, and their value is limited by poor sensitivity and the fact that at best they would only verify a small proportion of food intolerance, i.e. that caused by IgE-mediated reactions. A diagnosis of food allergy/intolerance must be based on a double-blind placebo-controlled food challenge, and not on the patient's or doctor's impression. More studies are required from different regions in order to identify similarities and differences in the patterns of food allergy. In particular, there is a need for properly conducted epidemiological studies in adults. Such studies should be interdisciplinary, as the cultural and social perceptions of food allergy and food intolerance would be expected to have a major impact on prevalence, perhaps even more than medical factors.
Background:
Egg allergy is the most common food allergy in children with atopic dermatitis (AD). This study aimed to determine the prevalence of, component patterns and predictive values of screening tests in egg allergy in South African children with AD.
Methodology:
This was a prospective, observational study in a paediatric university hospital in Cape Town. Children with AD, aged 6 months to 10 years, were recruited randomly. They were assessed for sensitisation and allergy to egg by questionnaire, skin prick tests (SPT), Immuno Solid Phase Allergen Chip (ISAC 103) test, ImmunoCAP component tests to egg and ovomucoid (Gal d 1); and incremental food challenges.
Results:
100 participants (59 black Africans and 41 of mixed ethnicity) were enrolled, median age 42 months. There was a high rate of egg sensitisation of 54% and prevalence of confirmed egg allergy of 25%. History and screening laboratory tests overestimated egg allergy significantly. SPT to fresh egg white was significantly more sensitive in diagnosing egg allergy than SPT to the commercial egg white extract, and produced the highest area under the receiver operator characteristics (ROC) curve of all the screening tests in predicting true egg allergy. In those participants sensitised to egg, the component ovomucoid was best at differentiating true egg allergy from tolerance. Commonly used 95% Positive Predictive Values (PPV) for SPT to egg and ImmunoCAP egg white produced low PPV of 57% and 74% respectively in this population overall, with generally poorer predictive values amongst the black Africans than the mixed ethnicity participants. A SPT to fresh egg of 17 mm and ImmunoCAP egg white of 13 kU/L produced the best PPV for egg allergy in this population.
Conclusion:
The prevalence of egg allergy is high in African children with AD, but history of egg allergy and sensitisation to egg significantly overestimate the true egg allergy rate. SPT to fresh egg white was more sensitive than that to commercial egg white extract, hence fresh egg white should be recommended in an egg allergy screening panel. The component ovomucoid was useful for differentiating allergy from tolerance in egg-sensitised participants. Population specific 95% PPV for egg allergy tests may need to be established in developing world populations. This article is protected by copyright. All rights reserved.
Allergische Erkrankungen gehören heute zu den häufigsten chronischen Erkrankungen des Kindesalters (ISAAC 1998). In Deutschland sind mehr als 25% aller Kinder im Schulalter davon betroffen, die Tendenz ist steigend. Da in den letzten Jahrzehnten auch in anderen, insbesondere in den industrialisierten Ländern eine deutliche Zunahme der Allergieprävalenz beobachtet wurde, ist nicht abzusehen, ob bereits der Gipfel der Erkrankungshäufigkeit erreicht wurde.
Das atopische Ekzem (AE) (syn. Neurodermitis, endogenes Ekzem, atopische Dermatitis) ist die häufigste entzündliche Hauterkrankung im Kindesalter (Ring et al., 2006). Die Prävalenz liegt in Deutschland bei Erwachsenen bei etwa 3 %, bei Vorschulkindern bei über 10 % (Schäfer et al., 2003; Williams et al., 1999). Epidemiologische Studien zeigen, dass eine positive mütterliche Atopieanamnese und eine positive Familienanamnese für Neurodermitis besonders hohe Risikofaktoren darstellen. Das Risiko für ein Kind an AE zu erkranken verdoppelt sich, wenn eines der Elternteile an AE erkrankt ist, und verdreifacht sich, wenn beide Eltern betroffen sind (Aberg 1993; Schäfer et al., 2003; Schäfer et al., 1999).
Ungefähr 3–4% aller Kinder leiden unter einer Nahrungsmittelallergie
(Röhr et al. 2004). Die Prävalenz bei Kindern mit einer atopischen Dermatitis
liegt deutlich höher: ungefähr ein Drittel aller Säuglinge und Kinder mit einer atopischen Dermatitis haben gleichzeitig eine Nahrungsmittelallergie (Sampson 1999). Je früher und je stärker ausgeprägt ein atopisches Ekzem ist, desto wahrscheinlicher liegt eine Nahrungsmittelallergie
vor. Die ersten diagnostischen und therapeutischen Ansätze werden daher meist schon im Säuglingsalter gestellt. Bei jungen Kindern mit frühkindlichen Nahrungsmittelallergien sind die Chancen groß, dass sich diese bis zum Schulalter wieder verlieren (Burks et al. 1988). Ungefähr 80% der Nahrungsmittelallergien verschwinden im Laufe der ersten 4–5 Lebensjahre wieder. Deutlich schlechter ist die Prognose bei Erdnuss
- und Baumnussallergien
.
The intake of nutrients over a five day period was studied in 23 children whose atopic eczema was being treated by the avoidance of multiple foods. The results were compared with those from 23 healthy control children not on a diet. Significantly low intakes of calcium were discovered in 13 patients but not in controls. Avoidance of multiple foods is potentially hazardous and requires continued paediatric and dietetic supervision.
The double-blind, placebo-controlled food challenge (DBPCFC) is the "gold standard" for diagnosis of food hypersensitivity. Skin prick tests and RASTs are sensitive indicators of food-specific IgE antibodies but poor predictors of clinical reactivity. Previous studies suggested that high concentrations of food-specific IgE antibody were predictive of food-induced clinical symptoms. Because the CAP System FEIA (Pharmacia Diagnostics, Uppsala, Sweden) provides a quantitative assessment of allergen-specific IgE antibody, this study was undertaken to determine the potential utility of the CAP System FEIA in diagnosis of IgE-mediated food hypersensitivity.
Sera from 196 patients with food allergy were analyzed for specific IgE antibodies to egg, milk, peanut, soy, wheat, and fish by CAP System FEIA. Sera were randomly selected from 300 stored samples of children and adolescents who had been evaluated by history, skin prick tests, and DBPCFCs. The study population was highly atopic; all patients had atopic dermatitis, and approximately 50% had asthma and allergic rhinitis at the time of initial evaluation. The performance characteristics of the CAP System FEIA were compared with those of skin prick tests and the outcome of DBPCFCs or "convincing" histories of anaphylactic reactions.
The prevalence of specific food allergies in the study population varied from 22% for wheat to 73% for egg. Allergy to egg, milk, peanut, and soy accounted for 87% of confirmed reactions. The performance characteristics of skin prick tests and CAP System FEIA (egg, milk, peanut, fish) were comparable, with excellent sensitivity and negative predictive accuracy but poor specificity and positive predictive accuracy. The performance characteristics of the CAP System FEIA for soy and wheat were poor. For egg, milk, peanut, and fish allergy, diagnostic levels of IgE, which could predict clinical reactivity in this population with greater than 95% certainty, were identified: egg, 6 kilounits of allergen-specific IgE per liter (kU[A]/L); milk, 32 kU(A)/L; peanut, 15 kU(A)/L; and fish, 20 kU(A)/L.
When compared with the outcome of DBPCFCs, results of CAP System FEIA are generally comparable to those of skin prick tests in predicting symptomatic food hypersensitivity. Furthermore, by measuring the concentrations of food-specific IgE antibodies with the CAP System FEIA, it is possible to identify a subset of patients who are highly likely (>95%) to experience clinical reactions to egg, milk, peanut, or fish. This could eliminate the need to perform DBPCFCs in a significant number of patients suspected of having IgE-mediated food allergy.
Background:
Early recognition of dietary allergies in infants with atopic dermatitis is essential for avoidance of unnecessary elimination diets, amelioration of the skin disease, and secondary prevention of the development of multiple food allergies. Simple and accurate methods of identifying provocative foods are urgently needed.
Methods:
The usefulness of skin prick and patch tests as indicators of cow milk allergy was evaluated in 183 patients ranging in age from 2 to 36 months with double-blind, placebo-controlled (n = 118) or open (n = 65) cow milk challenges.
Results:
The oral cow milk challenges were interpreted as positive in 54% of both challenge types. Positive challenge rapidly elicited pruritus, urticaria, and/or exanthema in 49% of cases and delayed-onset eczematous lesions in 51%. The skin prick and patch tests gave markedly discrepant results; prick tests were positive in 67% of the cases with acute-onset reactions to milk challenge, whereas patch tests tended to be negative. Patch tests were positive in 89% of those with delayed-onset reactions, although prick tests were frequently negative.
Conclusions:
The observations indicate that IgE and T cell-mediated responses to cow milk can be distinguished in atopic dermatitis. Parallel skin testing with combined prick and patch tests can significantly enhance the accuracy in diagnosis of specific dietary allergies in patients with atopic dermatitis.
• Background and Design.—
The aim of the study was to define the natural history of sensitization in atopic dermatitis (AD) through cross-sectional (comparison of three age classes) and longitudinal study: 250 children with minor (32.5%), moderate (32.5%), and severe (35%) AD were examined for aeroallergen and food hypersensitivity (skin tests, clinical scoring after allergen elimination, and food challenges).Results.—
The allergic screening was negative in minor AD and positive in 33% of cases of moderate AD that were concerned with aeroallergen sensitizations with only limited respiratory involvement. This suggests that nonspecific cutaneous hyperreactivity remains an almost exclusive precipitating factor in moderate or minor AD. Severe AD was characterized by a positive allergologic assessment in 100% of patients: food allergens were incriminated as flare factors in 96% of patients, with associated aeroallergen sensitization in 36%. Even at a young age (2 years), the severe AD group is marked by an extreme frequency of food sensitization (93%) that persists in 73% of children younger than 7 years and 67% younger than 16 years. From the comparison of three age classes, the sequence of food and respiratory sensitization seems to be part of the natural course of AD. Prospective study in 29 children of group 1 (<2 years) with a 3-year follow-up confirms the data of the cross-sectional study since 27 had development of aeroallergen sensitization, with respiratory symptoms as early as age 3 years in 23 of these children.Conclusion.—
The detection of food allergy in a child presenting with AD is likely to indicate a prognosis of severe AD and should be considered by dermatologists as a potentially important predictor of further respiratory symptoms.(Arch Dermatol. 1992;128:187-192)
Early recognition of dietary allergies in infants with atopic dermatitis is essential for avoidance of unnecessary elimination diets, amelioration of the skin disease, and secondary prevention of the development of multiple food allergies. Simple and accurate methods of identifying provocative foods are urgently needed.
The usefulness of skin prick and patch tests as indicators of cow milk allergy was evaluated in 183 patients ranging in age from 2 to 36 months with double-blind, placebo-controlled (n = 118) or open (n = 65) cow milk challenges.
The oral cow milk challenges were interpreted as positive in 54% of both challenge types. Positive challenge rapidly elicited pruritus, urticaria, and/or exanthema in 49% of cases and delayed-onset eczematous lesions in 51%. The skin prick and patch tests gave markedly discrepant results; prick tests were positive in 67% of the cases with acute-onset reactions to milk challenge, whereas patch tests tended to be negative. Patch tests were positive in 89% of those with delayed-onset reactions, although prick tests were frequently negative.
The observations indicate that IgE and T cell-mediated responses to cow milk can be distinguished in atopic dermatitis. Parallel skin testing with combined prick and patch tests can significantly enhance the accuracy in diagnosis of specific dietary allergies in patients with atopic dermatitis.
Adverse food reactions may be secondary to food allergy (hypersensitivity) or food intolerance. The clinical manifestations of food allergies depend on the target organ affected. Gastrointestinal, respiratory, and cutaneous symptoms are the most common of the clinical responses. The medical history, physical examination, and various in vivo or in vitro tests are useful in the diagnostic evaluation. Double-blind, placebo-controlled food challenges are the standard for diagnosis of food allergies. Presumptive diagnosis of food allergy based on patient history and on results of skin test or radioallergosorbent test is no longer acceptable, except in cases of severe anaphylaxis after an isolated ingestion of a specific food. Uniess the physician provides an unequivocal diagnosis of food allergy, people will continue to alter their eating habits on the basis of misconceptions of food allergy.
20 out of 36 children (aged two to eight years) with atopic eczema completed a twelve-week, double-blind, controlled, crossover trial of an egg and cows' milk exclusion diet. During the first and third four-week periods, patients on an egg and cows' milk exclusion diet received a soya-based milk substitute (trial period) or an egg and cows' milk preparation (control period). Response was assessed in terms of eczema activity, number of areas affected, pruritus, sleeplessness, and antihistamine usage while on the two diets. During the middle period patients resumed their normal diet to minimise any carry-over effect. 14 patients responded more favourably to the antigen-avoidance diet than to the control diet, whereas only 1 responded more favourably to the control diet than the trial diet. Patients experienced more benefit during the first diet period than the second, whatever the nature of the diet. There was no correlation between a positive prick test to egg and cows' milk antigen and response to the trial diet.
Reports of fatal or near-fatal anaphylactic reactions to foods in children and adolescents are rare. We identified six children and adolescents who died of anaphylactic reactions to foods and seven others who nearly died and required intubation. All the cases but one occurred in one of three metropolitan areas over a period of 14 months. Our investigations included a review of emergency medical care reports, medical records, and depositions by witnesses to the events, as well as interviews with parents (and some patients).
Of the 13 children and adolescents (age range, 2 to 17 years), 12 had asthma that was well controlled. All had known food allergies, but had unknowingly ingested the foods responsible for the reactions. The reactions were to peanuts (four patients), nuts (six patients), eggs (one patient), and milk (two patients), all of which were contained in foods such as candy, cookies, and pastry. The six patients who died had symptoms within 3 to 30 minutes of the ingestion of the allergen, but only two received epinephrine in the first hour. All the patients who survived had symptoms within 5 minutes of allergen ingestion, and all but one received epinephrine within 30 minutes. The course of anaphylaxis was rapidly progressive and uniphasic in seven patients; biphasic, with a relatively symptom-free interval in three; and protracted in three, requiring intubation for 3 to 21 days.
Dangerous anaphylactic reactions to food occur in children and adolescents. The failure to recognize the severity of these reactions and to administer epinephrine promptly increases the risk of a fatal outcome.
The aim of the study was to define the natural history of sensitization in atopic dermatitis (AD) through cross-sectional (comparison of three age classes) and longitudinal study: 250 children with minor (32.5%), moderate (32.5%), and severe (35%) AD were examined for aeroallergen and food hypersensitivity (skin tests, clinical scoring after allergen elimination, and food challenges).
The allergic screening was negative in minor AD and positive in 33% of cases of moderate AD that were concerned with aeroallergen sensitizations with only limited respiratory involvement. This suggests that nonspecific cutaneous hyperreactivity remains an almost exclusive precipitating factor in moderate or minor AD. Severe AD was characterized by a positive allergologic assessment in 100% of patients: food allergens were incriminated as flare factors in 96% of patients, with associated aeroallergen sensitization in 36%. Even at a young age (less than or equal to 2 years), the severe AD group is marked by an extreme frequency of food sensitization (93%) that persists in 73% of children younger than 7 years and 67% younger than 16 years. From the comparison of three age classes, the sequence of food and respiratory sensitization seems to be part of the natural course of AD. Prospective study in 29 children of group 1 (less than 2 years) with a 3-year follow-up confirms the data of the cross-sectional study since 27 had development of aeroallergen sensitization, with respiratory symptoms as early as age 3 years in 23 of these children.
The detection of food allergy in a child presenting with AD is likely to indicate a prognosis of severe AD and should be considered by dermatologists as a potentially important predictor of further respiratory symptoms.
For 16 years the double-blind, placebo-controlled food challenge (DBPCFC) has been used at the National Jewish Center for Immunology and Respiratory Medicine to determine whether adverse reactions to foods do occur in children. The objective of these studies was to explore these reproducible adverse reactions and to characterize them. Although skin testing was performed on all subjects, a history of an adverse reaction to food and to subsequent DBPCFC were the only criteria for entry into this study. Of 480 children studied, 185 (39%) have had positive DBPCFC results. In these 480 children, 245 (24%) of 1014 DBPCFCs showed positive results. Egg, peanut, and cow milk accounted for 73% of the positive DBPCFC reactions, but many foods produced reactions. Skin test results were positive in most children with a positive DBPCFC reaction, but the large number of patients with asymptomatic hypersensitivity limited the accuracy of a positive skin test result alone as a predictor of clinical symptoms during food ingestion. Evaluation of results in this large number of children for a prolonged period revealed reproducible patterns of symptoms, timing, and incriminated foods. Placebo reactions were rare. The procedure was safe. Twelve youngsters with a negative DBPCFC result subsequently had positive reactions to open challenges when large amounts of the challenge food were used. In each of these cases the reactions were limited to areas of direct contact with the food or could be explained by the larger amount of food ingested during the open challenge. Multiple food hypersensitivity has been a rare finding. The DBPCFC should be the "gold standard" for both research and clinical diagnostic evaluations until it is superseded by methods that have yet to be developed.
The proliferative responses of peripheral blood mononuclear cells (PBMCs) to ovalbumin or bovine serum albumin in children with atopic dermatitis (AD) who are sensitive to hen's egg or cow's milk were significantly higher than responses of PBMCs of healthy children and hen's egg- or cow's milk-sensitive children with immediate symptoms. However, the percentages of positive RAST for hen's egg or cow's milk in the patients with AD were lower than percentages in the patients with immediate symptoms. In the patients with AD, there were no significant correlations between the proliferative responses of PBMCs and the RAST values. There were no significant differences of RAST scores among groups of patients having different degrees of severity of AD. The proliferative responses of PBMCs to ovalbumin or bovine serum albumin in patients with severe AD or moderate AD who were sensitive to hen's egg or cow's milk tended to be higher than responses of patients with mild AD, respectively, but there were no significant differences in those results. Taken together, the combination of RAST and the detection of proliferative responses of PBMCs to each food antigen is very useful in the diagnosis of hypersensitivity in children with AD who are sensitive to food allergens.
Patients with atopic dermatitis and food hypersensitivity who were adhering to an elimination diet underwent repeat double-blind, placebo-controlled oral food challenges annually for follow-up of their food allergy. After 1 year, 19 of 75 patients lost all signs of clinical food hypersensitivity (15 of 45 patients allergic to one food, and 4 of 21 allergic to two foods). Of the individual foods, 38 of 121 no longer elicited symptomatic responses. After 2 years, patients underwent a second rechallenge; 4 of 44 patients tested lost their clinical food hypersensitivity. In 20 patients undergoing a third rechallenge, no food hypersensitivity was lost. Loss rate of food hypersensitivity varied among foods; after 1 year, there was a 26% loss of symptomatic food allergy to five major allergens (egg, milk, soy, wheat, and peanut) compared with a 66% loss rate to other food allergens. Loss of symptomatic allergy was not affected by the patient's age at diagnosis, except with milk allergy, for which older patients were more likely to lose clinical food hypersensitivity (p less than 0.05). Total serum IgE and prick skin tests were not useful for predicting loss of symptomatic food hypersensitivity. There was no significant decrease in skin test wheal size corresponding to loss of clinical food hypersensitivity. Patients developing only skin symptoms during the initial challenge were most likely to lose symptomatic food hypersensitivity.
There is now enough experience with the use of double-blind, placebo-controlled, food challenge (DBPCFC) to recommend its use as an office procedure for most patients complaining of adverse reactions to foods. This manual discusses the practical methods required for the allergist to undertake DBPCFC in the office. Thorough histories supplemented by food allergen skin testing are used to design a DBPCFC that carefully attempts to reproduce the history of food-induced symptoms described by the patient. Precautions that must be taken are delineated before challenge, as is treatment that may be required if a reaction occurs. For those foods to which challenges are positive, longitudinal evaluation with repeated challenge at appropriate intervals help to determine whether or not the problem will resolve over a period of time.
Cloth diapers, cellulose core diapers (conventional disposable diapers), and cellulose core diapers containing absorbent gelling material were examined for their effects on diaper rash and skin microbiology of normal infants and infants with atopic dermatitis in a 26-week double-blind clinical trial. Infants with atopic dermatitis wearing the diapers containing absorbent gelling material had significantly lower diaper rash grades than infants with atopic dermatitis wearing cloth diapers at five of eight grading visits. Infants with atopic dermatitis wearing conventional cellulose core diapers had statistically less rash at one of eight visits. There was no statistically significant difference between diaper types at three of the eight visits. At no time did the cloth group have less diaper rash than the conventional cellulose or absorbent gelling material disposable diaper group. A statistical correlation between the severity of general atopic dermatitis outside the diaper area and the diaper rash condition under the diaper occurred only in the atopic dermatitis group wearing cloth diapers. Isolation of microorganisms from the intact, uninvolved skin surface both inside and outside the diaper showed no biologically significant changes in the presence or numbers of selected skin organisms. Repeated isolation, at multiple grading visits of Staphylococcus aureus from uncompromised skin inside the diaper area was infrequent but correlated with the diagnosis of atopic dermatitis when observed.
Forty-six patients with atopic dermatitis ranging from mild to severe were evaluated for food hypersensitivity with double-blind placebo-controlled food challenges. Twenty-eight (61%) patients had a positive prick skin reaction to one of the foods tested. Sixty-five food challenges were performed; 27 (42%) were interpreted as positive in 15 (33%) patients. Egg, milk, and peanut accounted for 78% of the positive reactions. As in previous studies, patients developed skin (96%), respiratory (52%), or gastrointestinal (30%) symptoms during the challenge. These studies indicate that children who have atopic dermatitis unresponsive to routine therapy or who continue to need daily treatment after several months would benefit from evaluation for food hypersensitivity.
One hundred thirteen patients with severe atopic dermatitis were evaluated for food hypersensitivity with double-blind placebo-controlled oral food challenges. Sixty-three (56%) children experienced 101 positive food challenges; skin symptoms developed in 85 (84%) challenges, gastrointestinal symptoms in 53 (52%), and respiratory symptoms in 32 (32%). Egg, peanut, and milk accounted for 72% of the hypersensitivity reactions induced. History and laboratory data were of marginal value in predicting which patients were likely to have food allergy. When patients were given appropriate restrictive diets based on oral food challenge results, approximately 40% of the 40 patients re-evaluated lost their hypersensitivity after 1 or 2 years, and most showed significant improvement in their clinical course compared with patients in whom no food allergy was documented. These studies demonstrate that food hypersensitivity plays a pathogenic role in some children with atopic dermatitis and that appropriate diagnosis and exclusionary diets can lead to significant improvement in their skin symptoms.
Forty children with atopic dermatitis were evaluated for clinical evidence of hypersensitivity to foods by double-blind, placebo-controlled food challenges. Twenty-four children (60%) experienced 33 positive challenges, manifested by cutaneous symptoms in 31 (94%), gastrointestinal symptoms in 14 (42%), nasal symptoms in nine (27%), and respiratory in six (18%). Results of prick skin tests (STs) and RASTs to eight food antigens frequently eliciting hypersensitivity reactions were compared with those from food challenges to determine the diagnostic accuracy in children with atopic dermatitis. Defining a positive ST as a wheal 3 mm larger than the negative control wheal and a positive RAST as a Phadebas RAST score of 3 or 4, the sensitivity, specificity, and predictive accuracies of these tests were found to be comparable except in the case of wheat antigen where the ST was clearly superior to the RAST. Accepting a RAST score of 2 or more as a positive slightly improved sensitivity in some cases but dramatically decreased specificity. Combining results of STs and RASTs did not improve significantly the diagnostic accuracy over results of the tests used individually. These studies demonstrate no advantage of RAST alone or in combination with prick skin testing over prick skin testing alone in the evaluation of food hypersensitivity in children with atopic dermatitis. Furthermore, skin testing should be considered a good test for excluding immediate food hypersensitivity but only a suggestive positive indicator of hypersensitivity due to the high rate of clinically insignificant positive STs.
We evaluated the prevalence and characteristics of the principal foods implicated in 355 children diagnosed with IgE-mediated food allergy. Diagnosis was established on the basis of positive clinical history for the offending food, positive specific IgE by skin prick test and RAST, and open food challenge. Our results showed the principal foods involved in allergic reactions are: eggs, fish, and cow's milk. These are followed in frequency by fruits (peaches, hazelnuts and walnuts), legumes (lentils, peanuts and chick peas) and other vegetables (mainly sunflower seeds). The legumes demonstrated the highest degree of clinical cross-reactivity. Most patients with food allergy reacted to one or two foods (86.7%). Only 13.3% of patients reacted to 3 or more foods, mostly to legumes and fruits. We found that food allergy begins most frequently in the first (48.8%) and second (20.4%) years of life. Allergy to proteins of cow's milk, egg, and fish begins predominantly before the second year, demonstrating a clear relationship with the introduction of these foods into the child's diet. Allergy to foods of vegetable origin (fruits, legumes and other vegetables) begins predominantly after the second year.
Positive skin prick test (SPT) and RAST reactions to egg that had never previously been ingested have been observed in infants with food allergy. The likelihood of having clinical hypersensitivity reactions when egg is first ingested and the predictive value of SPT and RAST remain to be elucidated.
We investigated the relationship between egg-specific IgE antibodies and positive SPT reaction to egg, and the development of clinical hypersensitivity on the first exposure, in infants with food allergy.
The patient group consisted of 21 infants with food allergy and positive SPT and/or RAST reaction to egg, which they had never previously ingested; the control group of 12 infants had food allergy and negative test results. All subjects underwent double-blind placebo-controlled food challenges with egg.
Thirteen of 21 patients (61%) and one of 12 control subjects (8%) had positive reactions to challenges (p < 0.01). Thirteen positive reactions to challenges (93%) elicited immediate symptoms. Late-onset eczema occurred in two children. SPT results showed a high sensitivity (0.92) and negative predictive accuracy (0.92), whereas specificity (0.57) and positive predictive accuracy (0.61) were poor. RAST did not have any diagnostic advantage over SPT.
In infants with food allergy SPT with egg may be helpful in predicting which patients will react to the first exposure.
The clinical manifestations of cow's milk allergy (CMA) are highly variable, and challenges usually identify only immediate, IgE mediated reactions.
To clearly identify CMA of immediate and delayed types using a two-stage, double-blind, placebo-controlled food challenge (DBPCFC), and to prospectively compare the clinical history and analyses of specific IgE antibodies to milk in predicting outcome of DBPCFC.
A total of 69 patients (33 girls, 36 boys) were recruited for study based on a history highly suggestive of CMA and resolution of symptoms on a bovine protein-free diet. After skin-prick tests (SPTs) and search for allergen-specific serum IgE antibodies by enzyme allergosorbent test (EAST), a two-stage DBPCFC was performed over several days.
Of 16 patients (mean age 36.9 months) classified as probable immediate reactors based on the history, 10 (62.5%) had a positive DBPCFC with similar patterns to historical adverse reactions (< or = 2 h after milk exposure). The other 53 (77%) patients (17.3 months) had a history of probable delayed type CMA presenting with predominantly gastrointestimal symptoms from 2 h and up to 6 days after milk exposure. Of these, 15 (28.8%) had a positive DBPCFC, again with a symptom pattern similar to the history. Sensitivity/specificity of SPT was similar to that of EAST for both immediate (70/83% and 62/83% respectively, NS) or delayed (0/97% and 0/97%) CMA confirmed by DBPCFC.
Using our two-stage, prolonged DBPCFC, we clearly identified two groups of children with CMA, reflecting different pathogenesis of either immediate-type IgE-dependent, or delayed-type IgE-independent allergy. Although useful in immediate reactors, IgE antibody determination cannot predict the outcome of DBPCFC in delayed reactors. A thorough clinical history was the most helpful tool to predict the type of response in challenge positive patients.
To determine the role of food hypersensitivity in atopic dermatitis and to determine whether patients with atopic dermatitis who had food hypersensitivity could be identified by screening prick skin tests using a limited number of food allergens.
Patients with atopic dermatitis attending the Arkansas Children's Hospital Pediatric Allergy Clinic underwent allergy prick skin testing to a battery of food antigens. Patients with positive prick skin tests underwent double-blind, placebo-controlled food challenges.
One-hundred sixty-five patients were enrolled and completed the study. Patients ranged in age from 4 months to 21.9 years (mean 48.9 months). Ninety-eight (60%) patients had at least one positive prick skin test. A total of 266 double-blind, placebo-controlled food challenges were performed. Sixty-four patients (38.7% of total) were interpreted as having a positive challenge. Seven foods (milk, egg, peanut, soy, wheat, cod/catfish, cashew) accounted for 89% of the positive challenges. By use of screening prick skin tests for these seven foods we could identify 99% of the food allergic patients correctly.
This study confirms that most children with atopic dermatitis have food allergy that can be diagnosed by a prick skin test for the seven foods.