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  • 1. WHAT YOU SHOULD HAVE READ BUT….2010
    • food allergy
    University of Verona, Italy Attilio Boner
  • 2.
    • Prevalence
    • Time trends
  • 3. Food Allergy Among Children in the United States Branum Pediatrics 2009;124:1549
    • A cross-sectional survey of data on food allergy among children <18 yrs
    • in the 1997–2007
    % INCREASE IN REPORTED FOOD ALLERGY FROM 1997 TO 2007 18% 30 – 20 – 10 – 0 P< 0.01
  • 4. Time trends in the prevalence of peanut allergy: three cohorts of children from the same geographical location in the UK. Venter Allergy 2010:65:103
    • Prevalence of peanut allergy in 3 cohorts of children born in the same geographical location, Isle of Wight.
    • Reviewed between 3 and 4 years of age
    1989-1990 1.3% 4.0 – 3.5 – 3.0 – 2.5 – 2.0 – 1.5 – 1.0 – 0.5 – 0 Peanut Sensitization Rate 1994-1996 2001-2002 3.3% 2.0% ns BORN p=0.03
  • 5.
    • Food allergy natural history
  • 6. The natural history of wheat allergy Keet Ann Allergy Asthma Immunol 2009;102:410
    • 103 p atients with symptomatic reaction to wheat and a positive wheat IgE test result.
    4 8 12 29% Rates of Resolution 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 56% 65% AGE (YEARS)
  • 7. The natural history of wheat allergy Keet Ann Allergy Asthma Immunol 2009;102:410
    • 103 p atients with symptomatic reaction to wheat and a positive wheat IgE test result.
    4 8 12 29% Rates of Resolution 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 56% 65% The median age of resolution of wheat allergy is approximately 6½ years in this population. In a significant minority of patients, wheat allergy persists into adolescence. AGE (YEARS)
  • 8. The natural history of wheat allergy Keet Ann Allergy Asthma Immunol 2009;102:410
    • 103 p atients with symptomatic reaction to wheat and a positive wheat IgE test result.
    4 8 12 29% Rates of Resolution 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 56% 65% Higher wheat IgE levels were associated with poorer outcomes. Although many children outgrew wheat allergy with even the highest levels of wheat IgE. AGE (YEARS)
  • 9. The natural history of wheat allergy Keet Ann Allergy Asthma Immunol 2009;102:410
    • 103 p atients with symptomatic reaction to wheat and a positive wheat IgE test result.
    Relationship of peak wheat IgE level to persistence of wheat allergy during the first 14 years of life.
  • 10. The natural history of soy allergy Savage JACI 2010;125:683
    • Background:
    • Soy allergy is very common, affecting approximately 0.4% of children .
    • It is generally thought that the majority of children with soy allergy develop tolerance in early childhood; however, this has not been examined in a large cohort with soy allergy.
  • 11. % patients with
    • Soy-specific IgE levels, peanut-specific IgE levels, and food challenge results.
    • 133 patients with soy allergy.
    • Median duration of follow-up.
    asthma 64% The natural history of soy allergy Savage JACI 2010;125:683 100 – 80 – 60 – 40 – 20 – 0 71% 85% 88% Concomitant peanut allergy Atopic dermatits Allergic Rhinitis
  • 12.
    • Soy-specific IgE levels, peanut-specific IgE levels, and food challenge results.
    • 133 patients with soy allergy.
    • Median duration of follow-up.
    The natural history of soy allergy Savage JACI 2010;125:683 Soy allergy resolution over time (95% CI)
  • 13.
    • Soy-specific IgE levels, peanut-specific IgE levels, and food challenge results.
    • 133 patients with soy allergy.
    • Median duration of follow-up.
    The natural history of soy allergy Savage JACI 2010;125:683 Kaplan-Meier analysis predicted resolution of soy allergy in: 25% by age 4 yrs, 45% by age 6 yrs, 69% by age 10 yrs. Soy allergy resolution over time (95% CI)
  • 14.
    • Survival curves for
    • each stratum of peak
    • soy IgE level
    • Number of patients in
    • each stratum:
    • ≥ 50 kU/L (n = 27),
    • 10 to 49.9 kU/L (n= 37)
    • 5 to 9.9 kU/L (n = 20),
    • < 5 kU/L (n = 38),
    The natural history of soy allergy Savage JACI 2010;125:683 Relationship of peak soy IgE level and resolution of soy allergy
  • 15. The natural history of soy allergy Savage JACI 2010;125:683
    • Conclusions:
    • In this referral population approximately 50% of children with soy allergy outgrew their allergy by age 7 years.
    • Absolute soy IgE levels were useful predictors of outgrowing soy allergy.
  • 16. Shellfish allergy in children Kandyil Pediatr Allergy Immunol 2009:20:408
    • Over 90% of food allergies in childhood are caused by 8 foods: cow's milk, hen's egg, soy, peanuts, tree nuts, wheat, fish, and shellfish .
    • Shellfish allergy is known to be common and persistent in adults, and is an important cause of food induced anaphylaxis for both children and adults.
    • Most shellfish-allergic children have sensitivity to dust mite and cockroach allergens .
    • All patients with symptoms of IgE-mediated reactions to shellfish should receive epinephrine autoinjectors , even if the initial symptoms are mild.
  • 17. Expression levels of parvalbumins determine allergenicity of fish species. Griesmeier Allergy 2010:65:184
    • Parvalbumins are the most important fish allergens.
    • Polysensitization to various fish species is frequently reported and linked to the cross-reactivity of their parvalbumins.
    • Parvalbumins from cod, whiff, and swordfish.
    Amounts of Parvalbumins Compared to Swordfish 20 30 COD WHIFF 30 – 25 – 20 – 15 – 10 – 0 5 – 0 0 TIMES HIGHER TIMES HIGHER
  • 18. Expression levels of parvalbumins determine allergenicity of fish species. Griesmeier Allergy 2010:65:184
    • Parvalbumins are the most important fish allergens.
    • Polysensitization to various fish species is frequently reported and linked to the cross-reactivity of their parvalbumins.
    • Parvalbumins from cod, whiff, and swordfish.
    Amounts of Parvalbumins Compared to Swordfish 20 30 COD WHIFF 30 – 25 – 20 – 15 – 10 – 0 5 – 0 0 TIMES HIGHER TIMES HIGHER The low allergenicity of swordfish is due to the low expression levels of its parvalbumin.
  • 19. Fish muscles express parvalbumin Bony fish have fast twitching white muscle for rapid movements and dark muscle for continuous swimming. Active fish, such as tuna, skipjack, and swordfish have a higher proportion of dark muscles than bottom dwelling fish, such as cod, flounder, or whiff. Dark muscle contains lower levels of parvalbumins , thus these fish species are expected to be of lower allergenicity. Expression levels of parvalbumins determine allergenicity of fish species. Griesmeier Allergy 2010:65:184
  • 20.
    • Infantile FPIES manifests as profuse vomiting and/or diarrhoea in neonates or young infants before 2 months of age, and is most commonly caused by cow’s milk and/or soy protein. FPIES is typically negative in traditional food specific IgE tests.
    • An initial positive OFC is needed to confirm a diagnosis of FPIES and a follow-up oral food challenge (FU-OFC) is necessary to evaluate food tolerance in patients previously diagnosed with FPIES.
    PROSPECTIVE FOLLOW-UP ORAL FOOD CHALLENGE IN FOOD PROTEIN-INDUCED ENTEROCOLITIS SYNDROME Hwang Arch Dis Child 2009;94:425
  • 21.
    • 23 patients with infantile FPIES
    • two or more FU-OFCs and were followed up until over 2 years of age
    TOLERANCE RATE AT 6 MONTHS 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 27.3% Cow’s milk Soy 75.0% PROSPECTIVE FOLLOW-UP ORAL FOOD CHALLENGE IN FOOD PROTEIN-INDUCED ENTEROCOLITIS SYNDROME Hwang Arch Dis Child 2009;94:425
  • 22. PROSPECTIVE FOLLOW-UP ORAL FOOD CHALLENGE IN FOOD PROTEIN-INDUCED ENTEROCOLITIS SYNDROME Hwang Arch Dis Child 2009;94:425 100 – 90 – 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 63.6% 91.7% TOLERANCE RATE AT 10 MONTHS Cow’s milk Soy 100 – 90 – 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 41.7% 90.9% TOLERANCE RATE AT 8 MONTHS Cow’s milk Soy
  • 23. PROSPECTIVE FOLLOW-UP ORAL FOOD CHALLENGE IN FOOD PROTEIN-INDUCED ENTEROCOLITIS SYNDROME Hwang Arch Dis Child 2009;94:425 100 – 90 – 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 63.6% 91.7% TOLERANCE RATE AT 10 MONTHS Cow’s milk Soy 100 – 90 – 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 41.7% 90.9% TOLERANCE RATE AT 8 MONTHS Cow’s milk Soy In infantile FPIES, the first FU-OFC should be performed with soy at 6–8 months of age and cow’s milk FU-OFC should be conducted at over 12 months of age
  • 24.
    • Food allergy patogenesi
  • 25. Svezzamento
  • 26. Age at the Introduction of Solid Foods During the First Year and Allergic Sensitization at Age 5 Years Nwaru Pediatrics 2010;125:50
    • 994 children
    • age at the introduction of solid foods
    • allergen-sIgE at 5 years
    Late introduction of: - potatoes (4>months), - oats (5>months), - rye (7>months), - wheat (6>months), - meat (5.5>months), - fish (8.2>months), - eggs (10.5>months) was significantly directly associated with sensitization to food allergens.
  • 27. Age at the Introduction of Solid Foods During the First Year and Allergic Sensitization at Age 5 Years Nwaru Pediatrics 2010;125:50
    • 994 children
    • age at the introduction of solid foods
    • allergen-sIgE at 5 years
    Late introduction of: - potatoes (4>months), - oats (5>months), - rye (7>months), - wheat (6>months), - meat (5.5>months), - fish (8.2>months), - eggs (10.5>months) was significantly directly associated with sensitization to food allergens. Late introduction of potatoes , rye , meat , and fish was also significantly associated with sensitization to any inhalant allergen .
  • 28. OR for sentitization 3 – 2 – 1 – 0 Age at the Introduction of Solid Foods During the First Year and Allergic Sensitization at Age 5 Years Nwaru Pediatrics 2010;125:50 Potatoes >4 mo Milk >4 mo Fruits >4 mo Wheat >6 mo Rye >7 mo Meat >6 mo Fish >8 mo Egg >10 mo 2.56 1.51 2.2 2.42 1.65 2.30 1.49 1.70
  • 29. Factors associated with maternal dietary intake, feeding and weaning practices, and the development of food hypersensitivity in the infant Venter Pediatr Allergy Immunol 2009:20:320
    • 969 pregnant women recruited at 12 wk pregnancy.
    • Food frequency questionnaire completed at 36 wk gestation.
    • Feeding practices and reported symptoms of atopy during the infants' first 3 yr of life .
    OR FOR FOOD HYPERSENSITIVITY AT 0.26 WEANING BEFORE 16 WKS 0.51 p=0.03 p=0.02 1.0 – 0.9 – 0.8 – 0.7 – 0.6 – 0.5 – 0.4 – 0.3 – 0.2 – 0.1 – 0 1 YEAR 3 YEARS
  • 30. Factors associated with maternal dietary intake, feeding and weaning practices, and the development of food hypersensitivity in the infant Venter Pediatr Allergy Immunol 2009:20:320
    • Maternal dietary intake during pregnancy and breast-feeding duration did not appear to influence the development of sensitization to food allergens or FHS.
    • Children weaned at or after 16 wk were more likely to develop food hypersensitivity (FHS) and sensitization to foods .
    • In contrast, the data regarding exposure to food allergens and age of weaning on to food allergens showed that children who were exposed to a certain food ( egg, wheath, peanut, cod, sesame ) allergen before the age of 3–6 months were more likely to become sensitized or develop FHS to the particular food at age 1 and 3 yr .
  • 31. Factors associated with maternal dietary intake, feeding and weaning practices, and the development of food hypersensitivity in the infant Venter Pediatr Allergy Immunol 2009:20:320
    • Maternal dietary intake during pregnancy and breast-feeding duration did not appear to influence the development of sensitization to food allergens or FHS.
    • Children weaned at or after 16 wk were more likely to develop food hypersensitivity (FHS) and sensitization to foods .
    • In contrast, the data regarding exposure to food allergens and age of weaning on to food allergens showed that children who were exposed to a certain food (egg, wheath, peanut, cod, sesame) allergen before the age of 3–6 months were more likely to become sensitized or develop FHS to the particular food at age 1 and 3 yr .
    This may indicate that although early weaning could lead to tolerization in general, the main allergenic food proteins may behave differently and that age of introduction to these needs special investigation .
  • 32. Factors associated with maternal dietary intake, feeding and weaning practices, and the development of food hypersensitivity in the infant Venter Pediatr Allergy Immunol 2009:20:320
    • Maternal dietary intake during pregnancy and breast-feeding duration did not appear to influence the development of sensitization to food allergens or FHS.
    • Children weaned at or after 16 wk were more likely to develop food hypersensitivity (FHS) and sensitization to foods .
    • In contrast, the data regarding exposure to food allergens and age of weaning on to food allergens showed that children who were exposed to a certain food (egg, wheath, peanut, cod, sesame) allergen before the age of 3–6 months were more likely to become sensitized or develop FHS to the particular food at age 1 and 3 yr .
    Allergenic foods should probably be introduced between the 7° and 8° month.
  • 33. Infant feeding and allergy prevention: a review of current knowledge and recommendations. A EuroPrevall state of the art paper. Grimshaw Allergy 2009:64:1407
    • Although all authorities agree that breast milk is the food of choice for infants, the evidence that it prevents allergic outcomes is contradictory, with different studies showing, protection , no effect and even increased risk .
    • This may be due to variations in breast milk composition or differences in maternal diet.
    1) Evidence related to the duration of exclusive breastfeeding
  • 34. Infant feeding and allergy prevention: a review of current knowledge and recommendations. A EuroPrevall state of the art paper. Grimshaw Allergy 2009:64:1407
    • Due to inconsistency of findings, there is no clear-cut evidence that the early use of cow's milk hydrolysate exerts a preventive effect on allergic diseases generally or cow's milk allergy in particular.
    • Further carefully designed and correctly powered randomized double-blind placebo-controlled studies are needed before clear recommendations can be made.
    2) Evidence related to infant cow's milk based formulas
  • 35. Infant feeding and allergy prevention: a review of current knowledge and recommendations. A EuroPrevall state of the art paper. Grimshaw Allergy 2009:64:1407 3) Evidence related to the timing of introduction of complementary foods Studies have raised the possibility that delaying the introduction of foods into an infant's diet (particularly of allergenic foods) is not beneficial and may actually increase the risk of the child developing allergic diseases Zutavern A, Arch Dis Child 2004;89:303–308.   Zutavern A, Pediatrics 2008;121:e44–e52.   Snijders BE, Pediatrics 2008;122:e115–e122.   Filipiak B, J Pediatr 2007;151:352–358.   Poole JA, Pediatrics 2006;117:2175–2182.   Grimshaw KE, J Allergy Clin Immunol 2004;113:S145
  • 36. Infant feeding and allergy prevention: a review of current knowledge and recommendations. A EuroPrevall state of the art paper. Grimshaw Allergy 2009:64:1407 4) Evidence related to the use of pro-and/or prebiotic supplements Although pro-, pre- and synbiotics are theoretically promising candidates to prevent allergic diseases, results of clinical trials are not conclusive . Some trials show favourable results with regard to AD , but there is currently not enough evidence to support the use of pro-, pre- or synbiotics for prevention of allergic disease in clinical practice.
  • 37. Infant feeding and allergy prevention: a review of current knowledge and recommendations. A EuroPrevall state of the art paper. Grimshaw Allergy 2009:64:1407 5) Recommendations on the duration of exclusive breastfeeding ESPACI and ESPGHAN recommend that high-risk infants should be fed with a formula of confirmed reduced allergenicity if they are not breast fed . 6) Recommendations on infant cow's milk based formulas ESPACI and ESPGHAN jointly recommended exclusive breastfeeding for 4–6 months for allergy prevention. The WHO recommends exclusive breastfeeding for 6 mo.
  • 38. Infant feeding and allergy prevention: a review of current knowledge and recommendations. A EuroPrevall state of the art paper. Grimshaw Allergy 2009:64:1407 7) Recommendations on the timing of introduction of complementary foods
    • The AAP no longer recommend delaying the introduction of allergenic foods beyond 4–6 months .
    • A joint statement of ESPACI Committee and the ESPGHAN Committee advised simply that no solids be given before the fifth month (i.e. 17 weeks).
    • ESPGHAN recommend the avoidance of early (<4 months of age) and late (>7 months of age) introduction of gluten to reduce the risk of wheat allergy.
  • 39. Aluminium per se and in the anti-acid drug sucralfate promotes sensitization via the oral route Brunner Allergy 2009:64:890 Background:   Aluminium (ALUM) is used as experimental and clinical adjuvant for parenteral vaccine formulation. It is also contained in anti-acid drugs like sucralfate (SUC). These anti-acids have been shown to cause sensitization to food proteins via elevation of the gastric pH. The aim of this study was to assess the oral adjuvant properties of ALUM, alone or contained in SUC, in a BALB/c mouse model.
  • 40. Aluminium per se and in the anti-acid drug sucralfate promotes sensitization via the oral route Brunner Allergy 2009:64:890 The highest OVA-specific immunoglobulin G1 (IgG1) and IgE antibody levels were found in mice fed with OVA/SUC, followed by OVA/ALUM-treated animals, indicating a T helper 2 (Th2) shift in both groups. Antibody levels in other groups revealed lower (OVA/PPI-group) or baseline levels (control groups). Orally applied SUC leads to an enhanced risk for food allergy, not only by inhibiting peptic digestion but also by acting as a Th2-adjuvant by its ALUM content. 1) Ovalbumin + Sucralfate 2) Ovalbumin + Allum or 3) Ovalbumin + proton pump inhibitor or
  • 41. Aluminium per se and in the anti-acid drug sucralfate promotes sensitization via the oral route Brunner Allergy 2009:64:890 Alum is a ubiquitous element in western regions. It is present in drinking water – especially in urban areas – as well as in food such as soy-based milk products, baking powder, frozen products ALUM is used in water purification, sugar refining and brewing. Many drugs use ALUM either as an additive (antacids, analgesics, antidiabetic drugs, etc.)
  • 42.
    • Tra i 6 e i 10 anni si può sviluppare tolleranza al frumento e alla soia,
    • Lo sviluppo di tolleranza è più probabile nei soggetti con livelli inferiori di IgE specifiche, ma è possibile anche con IgE elevate,
    Take home
    • L’allergia ai molluschi è persistente… ..prescrivi adrenalina in questi soggetti,
    • Nell’allergico al pesce prova il pesce spada ed il tonno, ma se reagisce a questi è poco probabile che tolleri altri pesci,
    • Nelle FPIES la prognosi è nettamente migliore soprattutto per la soia.
  • 43.
    • Divezzamento? I nuovi dati sono sicuramente interessanti,
    • L’allattamento al seno non si discute,
    • Cibi semisolidi nel 4° mese,
    • Per i prematuri età cronologica o gestazionale?
    • Gli alimenti sono tutti uguali oppure …pesce, uovo, kiwi…?
    • I bambini sono tutti uguali oppure chi ha la mamma allergica…?
    È necessario uno studio randomizzato per tipo di paziente e per tipo di alimento Reduced risk of long-lasting atopy. Siltanen,JACI 2001;107:229
  • 44.
    • Divezzamento? I nuovi dati sono sicuramente interessanti,
    • L’allattamento al seno non si discute,
    • Cibi semisolidi nel 4° mese,
    • Per i prematuri età cronologica o gestazionale?
    • Gli alimenti sono tutti uguali oppure …pesce, uovo, kiwi…?
    • I bambini sono tutti uguali oppure chi ha la mamma allergica…?
    È necessario uno studio randomizzato per tipo di paziente e per tipo di alimento Reduced risk of long-lasting atopy. Siltanen,JACI 2001;107:229 In the subgroup of infants with a family history of atopy, however, those who received preterm formula rather than human milk as supplement had a significantly greater risk of developing eczema by 18 months (odds ratio 3.6) Lukas BMJ 1990;300:837
  • 45.
    • Food allergy burden
  • 46. Parents' attitudes when purchasing products for children with nut allergy: A UK perspective Noimark Pediatr Allergy Immunol 2009:20:500
    • Questionnaire was filled out by parents of children with nut allergy attending a tertiary paediatric allergy clinic.
    % Parents Who Would Not Purchase a Product Labelled 80% ‘ Not suitable for nut allergy sufferers' or 'may contain nuts' 50% ‘ This product does not contain any nuts but is made in a factory that uses nuts', 'cannot guarantee is nut free' and 'may contain traces of nuts' 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0
  • 47. Parents' attitudes when purchasing products for children with nut allergy: A UK perspective Noimark Pediatr Allergy Immunol 2009:20:500
    • Questionnaire was filled out by parents of children with nut allergy attending a tertiary paediatric allergy clinic.
    80% ‘ Not suitable for nut allergy sufferers' or 'may contain nuts' 50% ‘ This product does not contain any nuts but is made in a factory that uses nuts', 'cannot guarantee is nut free' and 'may contain traces of nuts' 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 Further tightening of labelling legislation and improved education would help to decrease the risk of anaphylaxis. % Parents Who Would Not Purchase a Product Labelled
  • 48. Parents' attitudes when purchasing products for children with nut allergy: A UK perspective Noimark Pediatr Allergy Immunol 2009:20:500 Percentage of parents who checked product labels for content of nut derived additives
    • Questionnaire was filled out by parents of children with nut allergy attending a tertiary paediatric allergy clinic.
  • 49. % SUBJECTS WITH ANAPHYLAXIS 36.2% 40 – 35 – 30 – 25 – 20 – 15 – 10 – 5 – 0
    • O nline survey to university students.
    • 513 individuals.
    Food allergy and food allergy attitudes among college students. Greenhawt JACI 2009;124:323
  • 50. Food allergy and food allergy attitudes among college students. Greenhawt JACI 2009;124:323 Avoiding Allergenic Foods 40 – 30 – 20 – 10 – 0 % SUBJECTS WITH FOOD ALLERGY Having Self-injectable Epinephrine Always Carrying Self-injectable Epinephrine 6% ONLY! 21% 39.7%
    • O nline survey to university students.
    • 513 individuals.
  • 51. Food allergy and food allergy attitudes among college students. Greenhawt JACI 2009;124:323 Avoiding Allergenic Foods 39.7% 40 – 30 – 20 – 10 – 0 % SUBJECTS WITH FOOD ALLERGY Having Self-injectable Epinephrine Always Carrying Self-injectable Epinephrine 21% 6% ONLY!
  • 52. Food allergy and food allergy attitudes among college students. Greenhawt JACI 2009;124:323
    • O nline survey to university students.
    • 513 individuals.
    Reaction locations of a food allergy. Students were allowed to select multiple venues.
  • 53. Reasons justifying food allergy risk-taking behavior among university students Food allergy and food allergy attitudes among college students. Greenhawt JACI 2009;124:323 Reasons given ∗ Percentage (n = 173) No history of severe reaction 37.6 (n = 65) Do not have consistent symptoms 21.9 (n = 38) Do not perceive this to be a risky action 20.8 (n = 36) Belief that item does not contain enough allergen to trigger a reaction 18.5 (n = 32) Belief that I could treat any reaction that occurred 17.9 (n = 31) Belief that I can eat around the allergen 14.5 (n = 25) Indifference 12.1 (n = 21) Last reaction was in the distant past 10.4 (n = 1) ∗ Students were allowed to select multiple reasons.
  • 54. Allergic status of schoolchildren with food allergy to eggs, milk or wheat in infancy Kusunoki Pediatr Allergy Immunol 2009:20:642
    • Questionnaire to the parents of 14,669 schoolchildren aged 7 to 15 yr in 30 schools in Kyoto, Japan.
    5.4% Rate of 7-yr-old Children Who Avoided Eggs, Milk Or Wheat in Infancy 6 – 5 – 4 – 3 – 2 – 1 – 0
  • 55. Allergic status of schoolchildren with food allergy to eggs, milk or wheat in infancy Kusunoki Pediatr Allergy Immunol 2009:20:642
    • Questionnaire to the parents of 14,669 schoolchildren aged 7 to 15 yr in 30 schools in Kyoto, Japan.
    5.4% Rate of 7-yr-old Children Who Avoided Eggs, Milk Or Wheat in Infancy 6 – 5 – 4 – 3 – 2 – 1 – 0 More than 80% became tolerant to these foods by school age.
  • 56. Allergic status of schoolchildren with food allergy to eggs, milk or wheat in infancy Kusunoki Pediatr Allergy Immunol 2009:20:642
    • Questionnaire to the parents of 14,669 schoolchildren aged 7 to 15 yr in 30 schools in Kyoto, Japan.
    7.7 OR for Avoidance of Other Foods ( Buckwheat, Shellfish, Fruits and Others) at School Age 8 – 7 – 6 – 5 – 4 – 3 – 2 – 1 – 0 In children avoiding eggs, milk or wheat in infancy versus non avoiders
  • 57. Allergic status of schoolchildren with food allergy to eggs, milk or wheat in infancy Kusunoki Pediatr Allergy Immunol 2009:20:642
    • Questionnaire to the parents of 14,669 schoolchildren aged 7 to 15 yr in 30 schools in Kyoto, Japan.
    7.7 OR for Avoidance of Other Foods ( Buckwheat, Shellfish, Fruits and Others) at School Age 8 – 7 – 6 – 5 – 4 – 3 – 2 – 1 – 0 In children avoiding eggs, milk or wheat in infancy versus non avoiders Food avoiders in infancy appear to have a higher risk of not only other allergic diseases ('atopic march') but also allergy to other foods ('food allergen march') at school age, indicating the need for continuous attention to food allergy.
  • 58.
    • Questionnaire to parents of 167 children.
    • Parental perceptions of those children who had not had an egg challenge (n = 83) were compared with those whose children had a positive (n = 27) and those with a negative (n = 57) egg challenge .
    • For 6/10 parameters, expectations concerning egg allergy in children who had been challenged were significantly better than those who had never been challenged irrespective of the challenge outcome.
    • The greater certainty provided by the performance of a food challenge may be a positive outcome in both CP and CN children.
    Parental perceptions in egg allergy: Does egg challenge make a difference? Kemp Pediatr Allergy Immunol 2009:20:648
  • 59. Parental perceptions in egg allergy: Does egg challenge make a difference? Kemp Pediatr Allergy Immunol 2009:20:648
    • Does your child's egg allergy affect your out-of-home care arrangements for your child? e.g. childcare, preschool or babysitting?
    • How severe do you feel your child's egg allergy is in comparison to other common childhood illnesses such as fever, otitis media (middle ear infections), bronchitis, diarrhoea?
    • How difficult is it to manage your child's egg allergy?
    • How much control do you feel you have over your child's egg allergy?
    • How stressful do you find your child's egg allergy?
    PARENTAL PERCEPTIONS Questionnaire Possible responses Yes/no Less severe/same severity/more severe Not difficult/little bit difficult/difficult/ very difficult None/a little/some/a lot Not at all stressful/a little stressful/ moderately stressful/very stressful
  • 60. Parental perceptions in egg allergy: Does egg challenge make a difference? Kemp Pediatr Allergy Immunol 2009:20:648
    • How much time do you spend worrying about your child's egg allergy on a weekly basis?
    • Has you and your families' lifestyle changed because of your child's egg allergy?
    • In the future, how much inconvenience do you anticipate your child will have due to egg allergy?
    • Do you find that people treat your child with egg allergy differently than other children because he/she has egg allergy?
    • Do you think other people understand what is needed to care for a child with egg allergy?
    PARENTAL PERCEPTIONS Questionnaire Possible responses Once a week or less/every 2 nd or 3 rd day/once a day/more than once/day Yes/no Not at all/a little bit/somewhat/a lot Yes/no Yes/no
  • 61. Longitudinal validity and responsiveness of the Food Allergy Quality of Life Questionnaire – Parent Form in children 0–12 years following positive and negative food challenges DunnGalvin, CEA 2010;40:476 Background: There are no published studies of longitudinal health-related quality of life (HRQL) assessments of food-allergic children using a disease-specific measure. Objective: This study assessed the longitudinal measurement properties of the Food Allergy Quality of Life Questionnaire – Parent Form (FAQLQ-PF) in a sample of children undergoing food challenge.
  • 62. Longitudinal validity and responsiveness of the Food Allergy Quality of Life Questionnaire – Parent Form in children 0–12 years following positive and negative food challenges DunnGalvin, CEA 2010;40:476
    • Parents of children 0–12 years completed the FAQLQ-PF and the Food Allergy Independent Measure (FAIM) pre-challenge and at 2 and 6 months post food challenge.
    The decreasing impact of food allergy on health-related quality of life from baseline, to 2 months, and to 6 months for positive and negative groups (P < 0.05).
  • 63. Longitudinal validity and responsiveness of the Food Allergy Quality of Life Questionnaire – Parent Form in children 0–12 years following positive and negative food challenges DunnGalvin, CEA 2010;40:476
    • Parents of children 0–12 years completed the FAQLQ-PF and the Food Allergy Independent Measure (FAIM) pre-challenge and at 2 and 6 months post food challenge.
    Domains and total score improved significantly at post-challenge time-points for both groups (all P<0.05). The identification of the offending food as well as knowing that foods are not involved improves QoL of parents. The decreasing impact of food allergy on health-related quality of life from baseline, to 2 months, and to 6 months for positive and negative groups (P < 0.05).
  • 64. Management of food allergies in schools: A perspective for allergists Young JACI 2009;124:175
    • Food allergy and anaphylaxis have been increasing in school-aged children.
    • Food allergy is a common trigger of anaphylaxis for school-aged children.
    % Children with Food Allergy Experiencing a Reaction at School 16% Arch Ped Ad Med 2001 J Ped 2001 20 – 15 – 10 – 5 – 0 18%
  • 65. Management of food allergies in schools: A perspective for allergists Young JACI 2009;124:175
    • Food allergy and anaphylaxis have been increasing in school-aged children.
    • Food allergy is a common trigger of anaphylaxis for school-aged children.
    % Children with Food Allergy Experiencing a Reaction at School 16% Arch Ped Ad Med 2001 J Ped 2001 20 – 15 – 10 – 5 – 0 18% Nearly 25% of peanut/nut induced alleric reactions in school/day care were reported to be before diagnosis
  • 66. Food allergy Diagnostic aspects
  • 67. Prospective association between food sensitization and food allergy: results of the LISA birth cohort study Schnabel, CEA 2010;40:450 Background: Food allergy is common, especially in childhood, where 6–8% of children are affected. Identification of early and efficient markers for later development of food allergy is very important. Objective: We examined the ability of repeated measurements of food sensitization in early childhood to predict doctor-diagnosed food allergy (DDFA) at the age of 6 years.
  • 68. No sensitization: no IgE at 2 and 6 years.   Early onset sensitization: IgE only at 2 years.   Late onset sensitization: IgE only at 6 years.   Persistent sensitization: IgE at 2 and 6 years. Prospective association between food sensitization and food allergy: results of the LISA birth cohort study Schnabel, CEA 2010;40:450
    • Birth cohort study (n=3097).
    • Parental questionnaires, blood samples at 2 and 6 years.
    • Sensitization phenotypes: no , early onset , late onset and persistent sensitization .
  • 69.
    • Birth cohort study (n=3097).
    • Parental questionnaires, blood samples at 2 and 6 years.
    • Sensitization phenotypes: no , early onset , late onset and persistent sensitization .
    7 – 6 – 5 – 4 – 3 – 2 – 1 – 0 OR for Doctor Diagnosed Food Allergy at age 6 yrs 4.7 6.1 EARLY PERSISTENT Prospective association between food sensitization and food allergy: results of the LISA birth cohort study Schnabel, CEA 2010;40:450 FOOD SENSITIZATION
  • 70. Utility of diagnostic tests in the follow-up of egg-allergic children Diéguez Clinical & Experimental Allergy 2009;39:1575 % CHILDREN WITH A (+) ORAL FOOD CHALLENGE 80.7%
    • Skin prick test and specific IgE
    • 157 children
    63.7 % (100/157) 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0
  • 71. Utility of diagnostic tests in the follow-up of egg-allergic children Diéguez Clinical & Experimental Allergy 2009;39:1575 80.7% A 7 mm egg white prick test Positive likelihood ratio of 6.7 Level of 1.3 KU/L egg white-sIgE Measuring the SPT and sIgE levels is useful to predict persistent allergy in these children, especially with the egg white complete extract. Positive likelihood ratio of 5.1
  • 72. in patients who developed tolerance Duration of clinical reactivity in cow’s milk allergy (CMA) is associated with levels of specific immunoglobulin G4 and immunoglobulin A antibodies to β -lactoglobulin Savilahti CEA 2010;40:251
    • 83 patients with IgE-mediated CMA.
    • Serum samples were available: -at diagnosis (median age 7 months), -1 year later (median 19 months) and -at follow-up (median 8.5 years).
    diagnosis 1 year 8.5 years sIgE sIgG4 sIgA
  • 73. Oropharyngeal symptoms predict objective symptoms in double-blind,placebo-controlled food challenges to cow's milk Kok Allergy 2009:64:1226
    • Subjective symptoms during food challenges are a source of confusion and sometimes difficult to interpret.
    • Oropharyngeal symptoms (OS) might be an exception, as these symptoms are usually very typical.
    • Oropharyngeal symptoms are the most common food allergy-related manifestation and define a complex of symptoms induced by exposure of the oral and pharyngeal mucosa to food allergens.
    •   Mari A, Curr Opin Allergy Clin Immunol 2005;5:267–273
  • 74. Oropharyngeal symptoms predict objective symptoms in double-blind,placebo-controlled food challenges to cow's milk Kok Allergy 2009:64:1226
    • 52 children with a positive DBPCFC to cow's milk
    • Oropharyngeal symptoms (OS)
    19.2% NO YES OROPHARYNGEAL SYMPTOMS 80.8% % Children that During the Challenge Presented 90 – 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 100 –
  • 75. Oropharyngeal symptoms predict objective symptoms in double-blind,placebo-controlled food challenges to cow's milk Kok Allergy 2009:64:1226
    • 52 children with a positive DBPCFC to cow's milk
    • Oropharyngeal symptoms (OS)
    19.2% NO YES OROPHARYNGEAL SYMPTOMS 80.8% Nine children (9/10 = 90%) developed objective symptoms after the occurrence of OS, including generalized pruritus with scratching, sneezing, wheezing, (rhino)conjunctivitis, rhinorrhoea, dyspnoea and repetitive vomiting. % Children that During the Challenge Presented 90 – 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 100 –
  • 76. Oropharyngeal symptoms predict objective symptoms in double-blind,placebo-controlled food challenges to cow's milk Kok Allergy 2009:64:1226 Subjective and objective symptoms during DBPCFC to cow's milk No. Subjective symptom(s) (Objective) symptom(s) preceded by OS 1 Transient localized erythema, sensation of pain in throat and mouth (OS) 2 Oral pruritus tongue and throat (OS), nausea 3 Oral pruritus/tingling (OS) 4 Transient localized pruritus face, pain in palate (OS), abdominal pain, nausea 5 Transient localized flushing, oral pruritus (OS) Generalized pruritus with erythema and scratching, sneezing, rhinoconjunctivitis, dyspnoea Repetitive vomiting, wheezing, dyspnoea Generalized urticaria Rhinorrhoea, conjunctivitis Sensation of throat tightness, mild dyspnoea
  • 77. Oropharyngeal symptoms predict objective symptoms in double-blind,placebo-controlled food challenges to cow's milk Kok Allergy 2009:64:1226 Subjective and objective symptoms during DBPCFC to cow's milk No. Subjective symptom(s) (Objective) symptom(s) preceded by OS 6 Sensation of swelling lip, sensation of pruritus throat (OS), abdominal pain 7 Oral pruritus tongue (OS) 8 Pruritus throat (OS), abdominal pain 9 Transient localized erythema, sensation of pain in mouth (OS) Repetitive vomiting, rhinorrhoea Change in activity level (fatigue), malaise, pale skin Conjunctivitis, generalized urticaria Repetitive vomiting, generalized urticaria
  • 78. Predicting outcome of repeat milk, egg, or peanut oral food challenges Mudd JACI 2009;124:1115
    • 101 patients who failed initial OFCs to milk, egg, and/or peanut and went on to have a repeat OFC.
    % Patients Who Failed Also the Second Challenge 57.9% 60 – 50 – 40 – 30 – 20 – 10 – 0
  • 79.
    • The severity of the reaction at the initial OFC may be a predictor of the outcome of the repeat OFC, but it was significant only for milk .
    • Severity did not appear to be a predictor of repeat OFC outcome for egg or peanut .
    • Food-specific IgE measurements at the initial OFC did not predict the outcome of the repeat OFC .
    • Patients who passed their repeat milk OFC did have a significantly lower milk-specific IgE level at the time of the repeat OFC than those who failed their repeat milk OFC.
    • This suggests patients who have not had known reactions in the interim should be considered candidates for a repeat OFC, regardless of the circumstances of the initial OFC.
    Predicting outcome of repeat milk, egg, or peanut oral food challenges Mudd JACI 2009;124:1115
  • 80. Predicting the outcome of oral food challenges with hen's egg through skin test end-point titration Tripodi C EA 2010;39:1225 Background: Oral food challenge (OFC) is the diagnostic 'gold standard' of food allergies but it is laborious and time consuming. Attempts to predict a positive OFC through specific IgE assays or conventional skin tests so far gave suboptimal results. Objective: To test whether skin test with titration curves predict with enough confidence the outcome of an oral food challenge.
  • 81. Predicting the outcome of oral food challenges with hen's egg through skin test end-point titration Tripodi C EA 2010;39:1225
    • Children (n=47; mean age 6.2 ± 4.2 years) with suspected and diagnosed allergic reactions to hen's egg (HE).
    • Serial twofold dilutions of the HE white extract in sterile saline solution (1:1, 1:4, 1:16, 1:64, 1:256, 1:1024, 1:4096).
    42.5% % Children with OFC was Positive (Sampson's score ≥3) 50 – 40 – 30 – 20 – 10 – 0
  • 82. Predicting the outcome of oral food challenges with hen's egg through skin test end-point titration Tripodi C EA 2010;39:1225 Sampson HA. Anaphylaxis and emergency treatment. Pediatrics 2003; 111 (Part 3):1601–8. Grading of food-induced anaphylaxis according to severity of clinical symptoms
  • 83. Predicting the outcome of oral food challenges with hen's egg through skin test end-point titration Tripodi C EA 2010;39:1225
  • 84. Predicting the outcome of oral food challenges with hen's egg through skin test end-point titration Tripodi C EA 2010;39:1225 * Established with ROC analysis. † n=31.  ROC, receiver operating characteristic; SPT, skin prick test. Best prediction (%) of a positive oral provocation test with hen's egg white skin prick tests (undiluted and titrated) and IgE assays
  • 85. Predicting the outcome of oral food challenges with hen's egg through skin test end-point titration Tripodi C EA 2010;39:1225 Best prediction (%) of a positive oral provocation test with hen's egg white skin prick tests (undiluted and titrated) and IgE assays * Established with ROC analysis. † n=31.  ROC, receiver operating characteristic; SPT, skin prick test.
  • 86. Predicting the outcome of oral food challenges with hen's egg through skin test end-point titration Tripodi C EA 2010;39:1225 Best prediction (%) of a positive oral provocation test with hen's egg white skin prick tests (undiluted and titrated) and IgE assays * Established with ROC analysis. † n=31.  ROC, receiver operating characteristic; SPT, skin prick test. The extract's dilution that successfully discriminated a positive from a negative OFC (sensitivity 95%, specificity 100%) was 1:256
  • 87. Mammalian meat–induced anaphylaxis: Clinical relevance of anti–galactose-α-1,3-galactose IgE confirmed by means of skin tests to cetuximab   Jacquenet JACI 2009;124:603
    • Specific IgE to galactose-α-1,3-galactose (α-gal) was shown to be linked with anaphylaxis or angioedema reactions to mammalian meats.
    2 cases of anaphylaxis to mammalian meats, which were evaluated by using novel intradermal tests (IDTs) to cetuximab. Cetuximab is an mAb presenting the α-gal oligosaccharide in the Fab portion of the heavy chain.
  • 88. Mammalian meat–induced anaphylaxis: Clinical relevance of anti–galactose-α-1,3-galactose IgE confirmed by means of skin tests to cetuximab   Jacquenet JACI 2009;124:603
    • Patient 1 was a 53-year-old man who had an anaphylactic shock in 2006 ninety minutes after consuming pork offal. He experienced recurrent episodes of delayed urticaria 4 hours after ingesting pork, beef, and horse, lamb, and rabbit meats. Consumption of milk and poultry did not result in allergic reactions.
    • Patient 2 was a 48-year-old woman who experienced an anaphylactic shock in 2004 two hours after eating a meal that included pork offal (kidney) and 7 episodes of urticaria that occurred at night. Retrospectively, the anamnesis indicated that she had consumed mammalian meat 6 hours before the allergic reaction. She consumed milk and poultry without incident.
  • 89. Mammalian meat–induced anaphylaxis: Clinical relevance of anti–galactose-α-1,3-galactose IgE confirmed by means of skin tests to cetuximab   Jacquenet JACI 2009;124:603
    • IDTs to cetuximab (Erbitux; Merck Serono, Geneva, Switzerland) were conducted at concentrations of 5, 50, and 500 μg/mL. For both patients, the IDT results were positive at the lowest concentration (5 μg/mL) and produced a mean wheal diameter of 9 mm (ie, the reaction was 3 times larger than the wheal of injection.
  • 90. Mammalian meat–induced anaphylaxis: Clinical relevance of anti–galactose-α-1,3-galactose IgE confirmed by means of skin tests to cetuximab   Jacquenet JACI 2009;124:603
    • IDTs to cetuximab (Erbitux; Merck Serono, Geneva, Switzerland) were conducted at concentrations of 5, 50, and 500 μg/mL. For both patients, the IDT results were positive at the lowest concentration (5 μg/mL) and produced a mean wheal diameter of 9 mm (ie, the reaction was 3 times larger than the wheal of injection.
    This diagnostic tool could be used to accurately identify mammalian meat allergies in patients given diagnoses of idiopathic anaphylaxis and eosinophilic esophagitis, gastroenteritis, or colitis.
  • 91. Assessment of the tolerance to lupine-enriched pasta in peanut-allergic children Fiocchi CEA 2010;39:1045 Lupine flour is increasingly used in the food industry because of its protein-rich composition and good technological characteristics. Lupine ( Lupinus spp.) is a member of the Fabaceae (ex Leguminosae ) family which includes the well-known allergen peanut ( Arachis hypogaea ). Used to add protein and fibre and to improve texture, lupine is also an useful alternative to soybean when non-genetically modified food ingredients are sought (e.g. in baby foods).
  • 92. Assessment of the tolerance to lupine-enriched pasta in peanut-allergic children Fiocchi CEA 2010;39:1045 Lupine flour is increasingly used in the food industry because of its protein-rich composition and good technological characteristics. Lupine ( Lupinus spp.) is a member of the Fabaceae (ex Leguminosae ) family which includes the well-known allergen peanut ( Arachis hypogaea ). Used to add protein and fibre and to improve texture, lupine is also an useful alternative to soybean when non-genetically modified food ingredients are sought (e.g. in baby foods). 30–68% of patients allergic to peanuts show positive reactions to lupine flour.
  • 93. In Italy, lupine flour and lupine protein concentrate are being increasingly used in bakery and pasta formulations, in particular in gluten-free products, where lupine derivatives produce better elasticity, texture, and flavour than soybean substitutes Spaghetti fortified with 5% of lupine protein isolate had a colour and rheological features comparable with pasta produced with gluten, and also had good cooking qualities. Assessment of the tolerance to lupine-enriched pasta in peanut-allergic children Fiocchi CEA 2010;39:1045
  • 94.
    • 12 patients with a history of clinical allergic reactions to peanut.
    • Lupine-enriched pasta and placebo pasta were administered in a DBPCFC protocol.
    • Positive clinical reactions were observed in 2 children, the eliciting doses (EDs) being 0.2 and 6.4 g of pasta, corresponding to 50 mg and 1.6 g of lupine proteins, respectively.
    • β-conglutin was the protein most involved in SPT positivity.
    Assessment of the tolerance to lupine-enriched pasta in peanut-allergic children Fiocchi CEA 2010;39:1045
  • 95.
    • Food allergy transgenic foods
  • 96.
    • Hidden foods
  • 97.
    • The prevalence of latex sensitization among Western health care workers is estimated at 3–18%, versus <1% in the general population;
    • A 47-year old surgeon occupationally sensitized to NRL for 5 yrs;
    • On several occasions, the patient suffered from severe oedema of his uvula, resulting in impaired swallowing, breathing and speaking, without skin reactions or oral itching. This occurred after consumption of peeled shrimps, fish and some types of salad or bread ;
    • He tolerated unpeeled king-size shrimps;
    • It appeared that the reactions could always be attributed to latex contamination of the food product.
    Pseudo-food allergy caused by carry-over of latex proteins from gloves to food: need for prevention? A. M. Van Drooge, Allergy 2010;65;532
  • 98. Lupin allergy and lupin sensitization among patients with suspected food allergy Hieta Ann Allergy Asthma Immunol 2009;103:233
    • Occurrence of (+) SPTs to lupin seed flour.
    • 1,522 patients with suspected food allergy.
    1.6% % Patients with (+) SPTs to Lupin 3.0 – 2.5 – 2.0 – 1.5 – 1.0 – 0.5 – 0 25/1.522
  • 99. Lupin allergy and lupin sensitization among patients with suspected food allergy Hieta Ann Allergy Asthma Immunol 2009;103:233
    • Occurrence of (+) SPTs to lupin seed flour.
    • 1,522 patients with suspected food allergy.
    1.6% % Patients with (+) SPTs to Lupin 3.0 – 2.5 – 2.0 – 1.5 – 1.0 – 0.5 – 0 25/1.522 Cross-reactions or concurrent reactions to other legumes were seen in 18 of 25 patients.
  • 100. Lupin allergy and lupin sensitization among patients with suspected food allergy Hieta Ann Allergy Asthma Immunol 2009;103:233
    • Occurrence of (+) SPTs to lupin seed flour.
    • 1,522 patients with suspected food allergy.
    1.6% % Patients with (+) SPTs to Lupin 3.0 – 2.5 – 2.0 – 1.5 – 1.0 – 0.5 – 0 25/1.522 Half the lupin-sensitized patients were also sensitized to peanut.
  • 101. Bovine and porcine gelatin sensitivity in children sensitized to milk and meat Bogdanovic JACI 2009;124:1108
    • Gelatin is a protein derived from collagen, and it is obtained principally from cow and pig bones, hides, and fish skin.
    • It is a common ingredient in foods such as jellies , sweets , yogurt , and frozen desserts .
    • It is also found in lunch meats , and it is used extensively as clarifying agents in wine , juices , and other beverages.
    • Bovine and porcine gelatins, in particular, also have numerous applications throughout the pharmaceutical industry as integral components in drug capsules, plasma expanders, and stabilizers in vaccines , including measles, mumps and rubella ( MMR ), varicella, yellow fever, rabies, and some influenza vaccines.
  • 102.
    • Postvaccination allergic reactions to MMR and varicella vaccines have been linked to the gelatin excipient .
    • Systemic allergic reactions have also been observed with the ingestion of gelatin-containing foods and administration of gelatin-containing medical products (eg, suppositories ). These gelatin exposures have been associated with sensitization as evidenced by the induction of gelatin-specific IgE antibodies. Kelso JM. J Allergy Clin Immunol 1993;91:867–872
    • Sakaguchi M. J Allergy Clin Immunol 1997;99:263–264
    • Wang J. Ann Allergy Asthma Immunol 2005;94:530–533
    • Yamada A. Pediatr Int 2002;44:87–89
    Bovine and porcine gelatin sensitivity in children sensitized to milk and meat Bogdanovic JACI 2009;124:1108
  • 103.
    • Postvaccination allergic reactions to MMR and varicella vaccines have been linked to the gelatin excipient .
    • Systemic allergic reactions have also been observed with the ingestion of gelatin-containing foods and administration of gelatin-containing medical products (eg, suppositories ). These gelatin exposures have been associated with sensitization as evidenced by the induction of gelatin-specific IgE antibodies. Kelso JM. J Allergy Clin Immunol 1993;91:867–872
    • Sakaguchi M. J Allergy Clin Immunol 1997;99:263–264
    • Wang J. Ann Allergy Asthma Immunol 2005;94:530–533
    • Yamada A. Pediatr Int 2002;44:87–89
    Bovine and porcine gelatin sensitivity in children sensitized to milk and meat Bogdanovic JACI 2009;124:1108 Gelatins used in medical applications are almost exclusively bovine and porcine.
  • 104. % CHILDREN SENSITIVE ALSO TO MILK 97% Bovine and porcine gelatin sensitivity in children sensitized to milk and meat Bogdanovic JACI 2009;124:1108 90 – 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 100 –
    • 141 children with sIgE to beef and/or pork meat.
  • 105. % CHILDREN WITH sIgE TO GELATIN 16% BEEF SENSITIVE 38% PORK SENSITIVE 40 – 35 – 30 – 25 – 20 – 15 – 10 – 5 – 0 Bovine and porcine gelatin sensitivity in children sensitized to milk and meat Bogdanovic JACI 2009;124:1108
    • 141 children with sIgE to beef and/or pork meat.
  • 106. % CHILDREN WITH sIgE TO GELATIN 16% BEEF SENSITIVE 38% PORK SENSITIVE 40 – 35 – 30 – 25 – 20 – 15 – 10 – 5 – 0 Bovine and porcine gelatin sensitivity in children sensitized to milk and meat Bogdanovic JACI 2009;124:1108 The presence of IgE antigelatin may place them at risk for potential allergic reactions after exposure to gelatin-containing foods, vaccines, or other medical products.
    • 141 children with sIgE to beef and/or pork meat.
  • 107.
    • labelling
  • 108. Audit of manufactured products: Use of allergen advisory labels and identification of labeling ambiguities Pieretti JACI 2009;124:337
    • Trained surveyors performed a supermarket survey of 20,241 unique manufactured food products.
    Products Surveyed Containing Advisory Labels 17% 20 – 15 – 10 – 5 – 0
  • 109. Audit of manufactured products: Use of allergen advisory labels and identification of labeling ambiguities Pieretti JACI 2009;124:337
    • Trained surveyors performed a supermarket survey of 20,241 unique manufactured food products.
    % Categorically, Advisory Warnings 38% 40 – 35 – 30 – 25 – 20 – 15 – 10 – 5 – 0 “ MAY CONTAIN” “ SHARED EQUIPMENT” 33%
  • 110. Audit of manufactured products: Use of allergen advisory labels and identification of labeling ambiguities Pieretti JACI 2009;124:337
    • Trained surveyors performed a supermarket survey of 20,241 unique manufactured food products.
    % Products with Non Specific Terms such as “Natural Flavors” and “Spices” 65% 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0
  • 111. Audit of manufactured products: Use of allergen advisory labels and identification of labeling ambiguities Pieretti JACI 2009;124:337 Examples of labeling ambiguities and FALCPA * limitations
    • Mollusks, such as squid, clams, mussels, and oysters, are excluded from regulatory labeling.
    • Nonspecific terms (such as spices, natural flavors and flavors) are frequently used and are frequently not linked to an allergen or to an ingredient.
    • Flour is listed as an ingredient, but the type of flour (eg, soy, wheat, rice) is not identified.
    • Product contains fish gelatin, yet the type of fish is not disclosed.
    • Products with advisory labels to tree nuts often do not disclose the type of tree nut the product may contain.
    • Soy lecithin is the only soy ingredient, yet product states “contains soy.”
    • Soy oil is the only soy ingredient, yet the product lists a separate warning stating,“contains soy.”
    • Lecithin is an ingredient, without the source disclosed.
    * Food Allergy Labeling and Consumer Protection Act
  • 112.  
  • 113.  
  • 114.
    • Food allergy
    • APTs
  • 115.
    • Food allergy clinical manifestations
  • 116. The Prevalence of food hypersensitivity in young adults Osterballe Pediatr Allergy Immunol 2009:20:686
    • 1272 young adults 22 yrs of age
    • questionnaire,
    • SPTs
    • histamin release (HR)
    • oral challenge to the most common allergenic foods.
    19.6% % Subjects Reporting Food Hypersensitivity Independent of Pollen Sensitization 20 – 15 – 10 – 5 – 0
  • 117. The Prevalence of food hypersensitivity in young adults Osterballe Pediatr Allergy Immunol 2009:20:686
    • 1272 young adults 22 yrs of age by
    • questionnaire,
    • SPTs
    • histamin release (HR)
    • oral challenge to the most common allergenic foods.
    19.6% % Subjects Reporting Food Hypersensitivity Independent of Pollen Sensitization 20 – 15 – 10 – 5 – 0 1.7% subjects were confirmed (+) by oral food challenge.
  • 118. The Prevalence of food hypersensitivity in young adults Osterballe Pediatr Allergy Immunol 2009:20:686 16.7% % Subjects Reporting Food Hypersensitivity to Pollen Related Fruits and Vegetables 20 – 15 – 10 – 5 – 0
    • 1272 young adults 22 yrs of age
    • questionnaire,
    • SPTs
    • histamin release (HR)
    • oral challenge to the most common allergenic foods.
  • 119. The Prevalence of food hypersensitivity in young adults Osterballe Pediatr Allergy Immunol 2009:20:686 KIWI HAZELNUT PINEAPPLE APPLE ORANGE % foods responsible of hypersensitivity in pollen allergic sub-group 7.8% 10 – 9 – 8 – 7 – 6 – 5 – 4 – 3 – 2 – 1 – 0 4.4% 4.3% 4.2% 6.6%
  • 120. The Prevalence of food hypersensitivity in young adults Osterballe Pediatr Allergy Immunol 2009:20:686 KIWI HAZELNUT PINEAPPLE APPLE ORANGE % foods responsible of hypersensitivity in pollen allergic sub-group 7.8% 10 – 9 – 8 – 7 – 6 – 5 – 4 – 3 – 2 – 1 – 0 4.4% 4.3% 4.2% 6.6% Tomato (3.8%), peach (3.0%), and brazil nuts (2.7%).
  • 121.
    • sIgE against 5 pollens
    • 622 outpatients with atopic dermatitis, urticaria, angioedema, and food allergy
    Correlation of oral allergy syndrome due to plant-derived foods with pollen sensitization in Japan Maeda Ann Allergy Asthma Immunol. 2010;104:205–210. % patients with oral allergy syndrome 4.1% 5 - 4 - 3 – 2 – 1 – 0
  • 122.
    • sIgE against 5 pollens
    • 622 outpatients with atopic dermatitis, urticaria, angioedema, and food allergy
    Foods That Caused Oral Allergy Syndrome in 18 Patients Correlation of oral allergy syndrome due to plant-derived foods with pollen sensitization in Japan Maeda Ann Allergy Asthma Immunol. 2010;104:205–210.
  • 123.
    • sIgE against 5 pollens
    • 622 outpatients with atopic dermatitis, urticaria, angioedema, and food allergy
    Foods That Caused Oral Allergy Syndrome in 18 Patients The prevalence of OAS showed a significant positive correlation with sensitization to alder ( P <.001). Correlation of oral allergy syndrome due to plant-derived foods with pollen sensitization in Japan Maeda Ann Allergy Asthma Immunol. 2010;104:205–210.
  • 124.
    • sIgE against 5 pollens
    • 622 outpatients with atopic dermatitis, urticaria, angioedema, and food allergy
    Foods That Caused Oral Allergy Syndrome in 18 Patients The prevalence of OAS showed a significant positive correlation with sensitization to alder ( P <.001). Correlation of oral allergy syndrome due to plant-derived foods with pollen sensitization in Japan Maeda Ann Allergy Asthma Immunol. 2010;104:205–210. ontano
  • 125.
    • sIgE against 5 pollens
    • 622 outpatients with atopic dermatitis, urticaria, angioedema, and food allergy
    Foods That Caused Oral Allergy Syndrome in 18 Patients The most frequent causative foods were found to be apple, peach, and melon. Correlation of oral allergy syndrome due to plant-derived foods with pollen sensitization in Japan Maeda Ann Allergy Asthma Immunol. 2010;104:205–210.
  • 126.  
  • 127. Food Proteins Induced Enterocolitis
  • 128.
    • Infantile FPIES manifests as profuse vomiting and/or diarrhoea in neonates or young infants before 2 months of age, and is most commonly caused by cow’s milk and/or soy protein. FPIES is typically negative in traditional food specific IgE tests.
    • An initial positive OFC is needed to confirm a diagnosis of FPIES and a follow-up oral food challenge (FU-OFC) is necessary to evaluate food tolerance in patients previously diagnosed with FPIES.
    PROSPECTIVE FOLLOW-UP ORAL FOOD CHALLENGE IN FOOD PROTEIN-INDUCED ENTEROCOLITIS SYNDROME Hwang Arch Dis Child 2009;94:425
  • 129.
    • 23 patients with infantile FPIES
    • two or more FU-OFCs and were followed up until over 2 years of age
    TOLERANCE RATE AT 6 MONTHS 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 27.3% Cow’s milk Soy 75.0% PROSPECTIVE FOLLOW-UP ORAL FOOD CHALLENGE IN FOOD PROTEIN-INDUCED ENTEROCOLITIS SYNDROME Hwang Arch Dis Child 2009;94:425
  • 130. PROSPECTIVE FOLLOW-UP ORAL FOOD CHALLENGE IN FOOD PROTEIN-INDUCED ENTEROCOLITIS SYNDROME Hwang Arch Dis Child 2009;94:425 100 – 90 – 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 63.6% 91.7% TOLERANCE RATE AT 10 MONTHS Cow’s milk Soy 100 – 90 – 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 41.7% 90.9% TOLERANCE RATE AT 8 MONTHS Cow’s milk Soy
  • 131. PROSPECTIVE FOLLOW-UP ORAL FOOD CHALLENGE IN FOOD PROTEIN-INDUCED ENTEROCOLITIS SYNDROME Hwang Arch Dis Child 2009;94:425 100 – 90 – 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 63.6% 91.7% TOLERANCE RATE AT 10 MONTHS Cow’s milk Soy 100 – 90 – 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 41.7% 90.9% TOLERANCE RATE AT 8 MONTHS Cow’s milk Soy In infantile FPIES, the first FU-OFC should be performed with soy at 6–8 months of age and cow’s milk FU-OFC should be conducted at over 12 months of age
  • 132. Eosinophilic esophagitis eosinophilic gastritis
  • 133. A symptom scoring tool for identifying pediatric patients with eosinophilic esophagitis and correlating symptoms with inflammation Aceves Ann Allergy Asthma Immunol 2009;103:401
    • A symptom scoring tool's ability to distinguish pediatric patients with EE from those with GERD and from control patients with and without allergies and to correlate symptoms with tissue inflammation.
    Answers were scored on a scale of 0 (not at all), 1 (mild; no problem with daily activities, medicines as needed), or 2 (severe; regularly interferes with daily activities or requires daily medicines).
    • Does your child ever have a burning sensation in che chest (heartburn)?
    • Does your child complain about stomach pains? Is your child often irritable for no apparent reason (your suspect belly pain)?
    • How often does your child complain about like throwing up? How often does your child throw up?
    • How often does your child eat too little or get full before finishing his or her meal?
    • How often does your child wake up during the night from belly pain?
    • How often has your child noticed blood in his or her stool during the last 3 months?
    • Does your child have difficulties swallowing? Does swallowing feel painful to your child? Please distinguish between problems swallowing liquids and solids.
  • 134. A symptom scoring tool for identifying pediatric patients with eosinophilic esophagitis and correlating symptoms with inflammation Aceves Ann Allergy Asthma Immunol 2009;103:401 6.51 Total Symptom score values Eosinophilic Esophagitis (N=35) GERD (n=27) Allergic (n=24) Non-allergic (n=14) 7.0 – 6.0 – 5.0 – 4.0 – 3.0 – 2.0 – 1.0 – 0 5.44 0.92 1.0 Patients with
  • 135. Distinguishing symptoms in patients with eosinophilic esophagitis (EE) * P < .05 for patients with GERD or EE compared with control patients. ** P < .05 for patients with GERD compared with patients with EE. ANE indicates anorexia/early satiety; AP, abdominal pain; HB/R, heartburn/regurgitation; NA, nocturnal awakening; N/V, nausea/vomiting. A symptom scoring tool for identifying pediatric patients with eosinophilic esophagitis and correlating symptoms with inflammation Aceves Ann Allergy Asthma Immunol 2009;103:401
  • 136. Distinguishing symptoms in patients with eosinophilic esophagitis (EE) * P < .05 for patients with GERD or EE compared with control patients. ** P < .05 for patients with GERD compared with patients with EE. ANE indicates anorexia/early satiety; AP, abdominal pain; HB/R, heartburn/regurgitation; NA, nocturnal awakening; N/V, nausea/vomiting. A symptom scoring tool for identifying pediatric patients with eosinophilic esophagitis and correlating symptoms with inflammation Aceves Ann Allergy Asthma Immunol 2009;103:401 Dysphagia and anorexia/early satiety identify pediatric patients with EE and correlate symptoms with tissue inflammation.
  • 137.  
  • 138.
    • Induction of tolerance
  • 139. Safety of a peanut oral immunotherapy protocol in children with peanut allergy Hofmann JACI 2009;124:286 OIT protocol   The OIT protocol consisted of 3 phases: - an initial escalation day , - a buildup phase , and - a home dosing phase . The goal of OIT was to achieve ingestion of a daily maintenance dose of 300 mg of peanut protein , which is the equivalent of 1 peanut and is greater than the amount that might cause an accidental allergic reaction.
  • 140. Safety of a peanut oral immunotherapy protocol in children with peanut allergy Hofmann JACI 2009;124:286 Initial escalation day  On the initial escalation day, subjects were admitted to the Duke Clinical Research Unit, an intravenous catheter was inserted, and diphenhydramine, epinephrine, and albuterol were made immediately available. Each subject first ingested 0.1 mg of peanut protein (Golden Peanut Co, Alpharetta, Ga) mixed in a food vehicle. The dose was doubled every 30 minutes until a maximum dose of 50 mg of peanut protein (cumulative peanut protein, 99 mg) was ingested. If the subject had a mild reaction to a dose, the next dose was determined at the discretion of the investigator: the investigator administered the last previously tolerated dose, waited an additional amount of time between doses, or repeated the current dose. If the subject tolerated this dose, the desensitization process resumed.
  • 141. Safety of a peanut oral immunotherapy protocol in children with peanut allergy Hofmann JACI 2009;124:286 Initial escalation day  If the subject continued to have symptoms or if the symptoms were moderate or severe, the desensitization process was discontinued and the highest tolerated dose was recorded. On completion of the initial escalation day, the patient was observed for a minimum of 2 hours. The subject was then discharged home with self-injectable epinephrine after instructions were given to the parents regarding its use. The subject returned to the DCRU the following day for an observed ingestion of the maximum tolerated dose of peanut protein. This dose became the starting dose for home dosing.
  • 142. Safety of a peanut oral immunotherapy protocol in children with peanut allergy Hofmann JACI 2009;124:286 Buildup phase and home dosing phase  The subject ingested the daily dose every day at home for a minimum of 2 weeks. If the home doses were well tolerated, the subject underwent an observed dosage escalation schedule whereby the daily dose was increased by 25 mg every 2 weeks at the DCRU until a 300-mg dose was reached. The 300-mg dose was ingested daily for 4-24 months.
  • 143. Safety of a peanut oral immunotherapy protocol in children with peanut allergy Hofmann JACI 2009;124:286 % Children Experiencing Symptoms During Initial Escalation Day UPPER RESPIRATORY TRACT ABDOMINAL WHEEZING 79% 68% 18%
    • Twenty of 28 pts completed all phases of the study.
    80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0
  • 144. Safety of a peanut oral immunotherapy protocol in children with peanut allergy Hofmann JACI 2009;124:286 % Children Experiencing Symptoms During The Buildup Phase ANY SYMPTOMS SKIN 46% 29% 24%
    • Twenty of 28 pts completed all phases of the study.
    50 – 40 – 30 – 20 – 10 – 0 UPPER RESPIRATORY TRACT
  • 145. Safety of a peanut oral immunotherapy protocol in children with peanut allergy Hofmann JACI 2009;124:286 ANY SYMPTOMS SKIN 46% 29% 24%
    • Twenty of 28 pts completed all phases of the study.
    50 – 40 – 30 – 20 – 10 – 0 UPPER RESPIRATORY TRACT The risk of reaction with any home dose was 3.5%. % Children Experiencing Symptoms During The Buildup Phase
  • 146. Safety of a peanut oral immunotherapy protocol in children with peanut allergy Hofmann JACI 2009;124:286 ANY SYMPTOMS SKIN 46% 29% 24%
    • Twenty of 28 pts completed all phases of the study.
    50 – 40 – 30 – 20 – 10 – 0 UPPER RESPIRATORY TRACT Subjects were more likely to have significant allergic symptoms during the initial escalation day when they were in a closely monitored setting. % Children Experiencing Symptoms During The Buildup Phase
  • 147. Safety of a peanut oral immunotherapy protocol in children with peanut allergy Hofmann JACI 2009;124:286 Frequency of treatment Treatment Initial escalation Any 71% (20/28) Diphenhydramine alone 50% (14/28) Albuterol alone 0% Diphenhydramine + albuterol 7% (2/28) Diphenhydramine + epinephrine 11% (3/28) Diphenhydramine + albuterol + epinephrine 4% (1/28)
  • 148. Safety of a peanut oral immunotherapy protocol in children with peanut allergy Hofmann JACI 2009;124:286 Frequency of treatment Treatment Buildup doses Any 1.7% (5/301) Diphenhydramine alone 1% (3/301) Albuterol alone 0% Diphenhydramine + albuterol 0.7% (2/301) Diphenhydramine + epinephrine 0% Diphenhydramine + albuterol + epinephrine 0%
  • 149. Safety of a peanut oral immunotherapy protocol in children with peanut allergy Hofmann JACI 2009;124:286 Frequency of treatment Treatment Home doses Any 0.7% (67/10,184) Diphenhydramine alone 0.4% (45/10,184) Albuterol alone 0.04% (4/10,184) Diphenhydramine + albuterol 0.2% (18/10,184) Diphenhydramine + epinephrine 0% Diphenhydramine + albuterol + epinephrine 0.02% (2/10,184)
  • 150.
    • Peanut oral immunotherapy (OIT) in 4 peanut-allergic children.
    • OIT was then administered as daily doses of peanut flour increasing from 5 to 800 mg of protein with 2-weekly dose increases.
    Successful oral tolerance induction in severe peanut allergy Clark Allergy 2009:64:1218 Oral immunotherapy was administered as daily oral doses of peanut flour (50% protein, light roast; Golden Peanut Company, Alpharetta, GA, USA) mixed with yoghurt.
  • 151. Successful oral tolerance induction in severe peanut allergy Clark Allergy 2009:64:1218
    • Preintervention challenges confirmed peanut allergy and revealed dose thresholds of 5–50 mg (1/40–1/4 of a whole peanut).
    • All subjects tolerated immunotherapy updosing to 800 mg protein and i.m. adrenaline was not required.
    • Each subject tolerated at least 10 whole peanuts (approximately 2.38 g protein) in postintervention challenges, an increase in dose threshold of at least 48-, 49-, 55- and 478-fold for the four subjects.
  • 152. Dietary advice, dietary adherence and the acquisition of tolerance in egg-allergic children: a 5-yr follow-up Allen Pediatr Allergy Immunol 2009:20:213
    • Questionnaire.
    • 261 parents of children seen in a tertiary paediatric allergy clinic.
    • 5.5 yr of follow-up.
    47% % CHILDREN ACCIDENTALLY EXPOSED TO EGG 50 – 40 – 30 – 20 – 10 – 0
  • 153. Dietary advice, dietary adherence and the acquisition of tolerance in egg-allergic children: a 5-yr follow-up Allen Pediatr Allergy Immunol 2009:20:213
    • Questionnaire.
    • 261 parents of children seen in a tertiary paediatric allergy clinic.
    • 5.5 yr of follow-up.
    68% % CHILDREN HAVING OUTGROWN THEIR EGG ALLERGY 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0
  • 154. Dietary advice, dietary adherence and the acquisition of tolerance in egg-allergic children: a 5-yr follow-up Allen Pediatr Allergy Immunol 2009:20:213
    • Questionnaire.
    • 261 parents of children seen in a tertiary paediatric allergy clinic.
    • 5.5 yr of follow-up.
    68% % CHILDREN HAVING OUTGROWN THEIR EGG ALLERGY 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 Children who had outgrown their egg allergy did not differ from those who remained egg-allergic on in-hospital challenge in terms of either the frequency of accidental ingestion or the severity of initial reaction
  • 155. Dietary advice, dietary adherence and the acquisition of tolerance in egg-allergic children: a 5-yr follow-up Allen Pediatr Allergy Immunol 2009:20:213
    • Questionnaire.
    • 261 parents of children seen in a tertiary paediatric allergy clinic.
    • 5.5 yr of follow-up.
    68% % CHILDREN HAVING OUTGROWN THEIR EGG ALLERGY 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 Strict avoidance of egg and accidental ingestion of egg did not appear to influence the acquisition of tolerance.
  • 156. Impact of dietary regimen on the duration of cow's milk allergy: a random allocation study Terracciano C EA 2010; 40:637
    • 72 children aged a mean of 14.1±8.6 months at diagnosis of cow’s milk allergy.
    • Rice hydrolysate formula.
    • Extensively hydrolysed cow's milk formula.
    • Soy-based formula.
    51 reached tolerance at a mean of 34.1±15.2 months.
  • 157. Milk Hydrolysate Impact of dietary regimen on the duration of cow's milk allergy: a random allocation study Terracciano C EA 2010; 40:637 Mean Duration of Cow’s Milk Allergy (Months) 50 – 40 – 30 – 20 – 10 – 0 40.2 months Soy Rice 24.3 months 24.3 months
    • 72 children aged a mean of 14.1±8.6 months at diagnosis of cow’s milk allergy.
    • Rice hydrolysate formula.
    • Extensively hydrolysed cow's milk formula.
    • Soy-based formula.
  • 158. Milk Hydrolysate Impact of dietary regimen on the duration of cow's milk allergy: a random allocation study Terracciano C EA 2010; 40:637 Mean Duration of Cow’s Milk Allergy (Months) 50 – 40 – 30 – 20 – 10 – 0 40.2 months Soy Rice 24.3 months 24.3 months
    • 72 children aged a mean of 14.1±8.6 months at diagnosis of cow’s milk allergy.
    • Rice hydrolysate formula.
    • Extensively hydrolysed cow's milk formula.
    • Soy-based formula.
    Dietary choice independently predicted shorter duration of disease [adjusted HRs 3.09 ( P=0.007 ) for rice, 2.54 ( P=0.02 ) for soy, both against milk hydrolysate].
  • 159.
    • Human basophils were passively sensitized using sera from 10 patients with allergies to cow's milk. All the patients experienced symptoms immediately after ingesting milk.
    • Cells were stimulated with untreated, heat-treated, or heat-treated and pepsin-and-trypsin-digested β-lactoglobulin or α -casein for 1 h.
    • Heat treated β -lactoglobulin and α-casein solutions were prepared by placing the same solutions in 15 mL conical tubes with lids to eliminate evaporation and placing them in a hot water bath at 80 °C or 100 °C for 15, 60, or 120 min.
    Effect of heat treatment and enzymatic digestion on the B cell epitopes of cow's milk proteins Morisawa CEA 2010;39:918
  • 160. Effect of heat treatment on the susceptibility of β-lactoglobulin to digestion by trypsin Effect of heat treatment and enzymatic digestion on the B cell epitopes of cow's milk proteins Morisawa CEA 2010;39:918
  • 161. Histamine release from passively sensitized cultured basophils after stimulation with β-lactoglobulin. Untreated (UT), heat-treated (HT), heat-treated and enzymatically digested (ED) for 1 h. Histamine release from passively sensitized cultured basophils after stimulation with α -casein. Untreated (UT), heat-treated (HT), heat-treated and enzymatically digested (ED) for 1 h. Effect of heat treatment and enzymatic digestion on the B cell epitopes of cow's milk proteins Morisawa CEA 2010;39:918
  • 162. Histamine release from passively sensitized cultured basophils after stimulation with β-lactoglobulin. Untreated (UT), heat-treated (HT), heat-treated and enzymatically digested (ED) for 1 h. Histamine release from passively sensitized cultured basophils after stimulation with α -casein. Untreated (UT), heat-treated (HT), heat-treated and enzymatically digested (ED) for 1 h. Heat treatment reduced the allergenicity of β -lactoglobulin by inducing conformational changes and by increasing its susceptibility to enzymatic digestion, both of which disrupted B cell epitopes, whereas heat treatment alone did not alter the allergenicity of α -casein. Effect of heat treatment and enzymatic digestion on the B cell epitopes of cow's milk proteins Morisawa CEA 2010;39:918
  • 163. Food allergy treatment
  • 164. Objectives: To determine the benefits of Lactobacillus rhamnosus GG (LGG) in an extensively hydrolyzed casein formula (EHCF) in improving hematochezia and fecal calprotectin over EHCF alone. Study design: Fecal calprotectin was compared in 30 infants with hematochezia and 4 weeks after milk elimination with that of a healthy group. We also compared fecal calprotectin and hematochezia on 26 formula-fed infants randomly assigned to EHCF with LGG (Nutramigen LGG) (EHCF + LGG) or without (Nutramigen) (EHCF - LGG) and on 4 breastfed infants whose mothers eliminated dairy. Lactobacillus GG Improves Recovery in Infants with Blood in the Stools and Presumptive Allergic Colitis Compared with Extensively Hydrolyzed Formula Alone Baldassarre J Pediatr 2010;156:397
  • 165. Fecal calprotectin µg/g stool 326 Hematochezia 38 Control
    • 30 infants with hematochezia.
    • 32 control infant.
    p<0.0001 Lactobacillus GG Improves Recovery in Infants with Blood in the Stools and Presumptive Allergic Colitis Compared with Extensively Hydrolyzed Formula Alone Baldassarre J Pediatr 2010;156:397 350 – 300 – 250 – 200 – 150 – 100 – 50 – 0
  • 166. Lactobacillus GG Improves Recovery in Infants with Blood in the Stools and Presumptive Allergic Colitis Compared with Extensively Hydrolyzed Formula Alone Baldassarre J Pediatr 2010;156:397
  • 167. Decrease in fecal calprotectin µg/g stool in infants with hematochezia after 4 week of -225 BREAST FEEDING NUTRAMIGEN
    • 30 infants with hematochezia.
    • 32 control infant.
    Lactobacillus GG Improves Recovery in Infants with Blood in the Stools and Presumptive Allergic Colitis Compared with Extensively Hydrolyzed Formula Alone Baldassarre J Pediatr 2010;156:397 0 – -50 – -100 – -200 – -250 – -112 -214 NUTRAMIGEN + Lactobacillus GG p<0.0001
  • 168. Decrease in fecal calprotectin µg/g stool in infants with hematochezia after 4 week of -225 BREAST FEEDING NUTRAMIGEN
    • 30 infants with hematochezia.
    • 32 control infant.
    Lactobacillus GG Improves Recovery in Infants with Blood in the Stools and Presumptive Allergic Colitis Compared with Extensively Hydrolyzed Formula Alone Baldassarre J Pediatr 2010;156:397 0 – -50 – -100 – -200 – -250 – -112 -214 NUTRAMIGEN + Lactobacillus GG p<0.0001 EHCF + LGG resulted in significant improvement of hematochezia and fecal calprotectin compared with the EHCF alone.
  • 169.
    • Chi è allergico ad un alimento è facile che eviti, a torto o a ragione, anche altri alimenti,
    • Il test di scatenamento migliora omunque la QoL,
    • Durante il test di scatenamento fa attenzione ai sintomi orofaringei,
    • Una reazione grave ad un primo test di scatenamento non controindica un secondo tentativo, ma attenzione al latte,
    • Quando vaccini per il morbillo non preoccuparti dell’uovo ma della carne di maiale e bovina,
    • I probiotici possono aiutare.
    take home
  • 170.  
  • 171. Food allergy guidelines
  • 172.