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Oral birch pollen immunotherapy with apples: Results of a phase II clinical pilot study.
Nothegger, B, Reider, N, Covaciu, CE, Cova, V, Ahammer, L, Eidelpes, R, Unterhauser, J, Platzgummer, S, Raffeiner, E, Tollinger, M, et al
Immunity, inflammation and disease. 2021;9(2):503-511
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The prevalence of birch pollen allergy (BPA) has increased in recent years and has led to a rise in birch pollen-related food allergy (prFA). The current immunotherapy approach for BPA is to use birch pollen extract to attenuate the allergic response. While it has been successful for BPA, it has shown little to no effect on prFA, illuminating a current gap in the research. The aim of this pilot study was to assess the clinical efficacy of immunotherapy by daily apple consumption in developing permanent oral tolerance to apples and simultaneously to birch‐pollen. Sixteen participants consumed apples daily over an eight month period. Various allergy responses were measured during the peak birch pollen season. The results demonstrated continuous consumption of apples by BPA patients with prFA to apples could both improve prFA and birch-pollen induced allergic reactions. Based on these results, the authors conclude that oral immunotherapy with fresh apples is feasible and safe for the treatment of both BPA and birch prFA. As this was a small pilot study, a larger controlled trial is needed to confirm the potential of this treatment option in the clinical setting.
Abstract
BACKGROUND Seventy percent of patients suffering from birch pollen allergy (BPA) develop a pollen-related food allergy (prFA), especially to apples, due to a clinically relevant cross-reactivity between the major allergen in birch Bet v 1 and Mal d 1 in apples. Therefore allergen-specific immunotherapy with fresh apples (AITA) could be a promising natural treatment of both BPA and prFA. OBJECTIVE To assess the clinical efficacy of immunotherapy by daily apple consumption for patients with BPA and prFA. METHODS A daily defined increasing amount of selected cultivars (Red Moon®, Pink Lady®, Topaz, Golden Delicious) was continuously consumed by 16 patients (12 female; median age; 50; range, 23-68 years), leading to increased intake of allergen over a period of at least 8 months. Specific IgE and IgG4 to Bet v 1 and Mal d 1, conjunctival and oral provocation tests, skin reactivity, and the average daily rhinoconjunctivitis combined symptom and medication score (CSMS) were measured during the peak birch pollen season. RESULTS After 8 months of therapy, patients showed increased tolerance to apples (p < .001) and a decreased skin reactivity to apples. Oral allergy syndrome to other birch prFA than apple also decreased (p < .05). Moreover, daily rhinoconjunctivitis CSMS declined by 34% (p < .001), as did conjunctival reactivity to birch pollen extract by 27% (p < .01), while specific IgG4 to Mal d 1 and Bet v 1 increased (p < .01).
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Ratios of specific IgG4 over IgE antibodies do not improve prediction of peanut allergy nor of its severity compared to specific IgE alone.
Datema, MR, Eller, E, Zwinderman, AH, Poulsen, LK, Versteeg, SA, van Ree, R, Bindslev-Jensen, C
Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology. 2019;49(2):216-226
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Ara h 1, 2, 3 and 6 are major peanut allergens. Peanut allergy sufferers are sensitized to at least one of these allergens, which can increase their risk of allergy symptoms and anaphylactic reactions. A component-resolved diagnosis using IgE has become an indispensable tool for distinguishing between tolerance, allergy, and risk of severe reactions. The blocking antibodies IgG4, IgG, and IgA may counteract IgE antibodies. This clinical trial, therefore, investigated the associations between component-specific IgG, IgE, IgG4, IgA antibodies and whole peanut extract by analysing the severity of the outcome and assessing the diagnostic accuracy of antibody levels and ratios to determine the severity level of peanut allergy. One hundred and sixty-two peanut sensitised tolerant and allergic subjects were examined using immunoCAP for specific antibody isotypes against peanut extract, Ara h1, 2, 3, 8 and 9. According to the study, specific IgE against Ara h 2 is the best biomarker to diagnose peanut allergy, distinguish peanut-allergic subjects from tolerant sensitised subjects, and estimate the severity of the reaction. Additionally, the ratio of IgG and IgG4 antibodies over IgE did not improve predictive accuracy. This study provides healthcare professionals with insight into the role of different antibody isotypes in testing and diagnosing peanut allergies.
Abstract
BACKGROUND IgG4 antibodies have been suggested to play a protective role in the translation of peanut sensitization into peanut allergy. Whether they have added value as diagnostic read-out has not yet been reported. OBJECTIVE To evaluate whether (a) peanut-specific IgG, IgG4 and/or IgA antibodies are associated with tolerance and/or less severe reactions and (b) they can improve IgE-based diagnostic tests. METHODS Sera of 137 patients with challenge-proven peanut allergy and of 25 subjects that tolerated peanut, both with known IgE profiles to peanut extract and five individual peanut allergens, were analyzed for specific IgG and IgG4 . Antibody levels and ratios thereof were associated with challenge outcome including symptom severity grades. For comparison of the discriminative performance, receiver operating characteristic curve (ROC) analysis was used. RESULTS IgE against Ara h 2 was significantly higher in allergic than in tolerant patients and associated with severity of reactions (P < 0.001) with substantial diagnostic capability (AUC 0.91, 95%CI 0.87-0.96 and 0.80, 95%CI 0.73-0.87, respectively). IgG and IgG4 were also positively associated albeit significantly weaker (AUCs from 0.65 to 0.72). On the other hand, ratios of IgG and IgG4 over IgE were greater in patients that were tolerant or had mild symptoms as compared to severe patients but they did not predict challenge outcomes better than IgE alone (AUCs from 0.54 to 0.89). CONCLUSION IgE against Ara h 2 is the best biomarker for predicting peanut challenge outcomes including severity and IgG and IgG4 antibody ratios over IgE do not improve these outcomes.
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Serological investigation of IgG and IgE antibodies against food antigens in patients with inflammatory bowel disease.
Wang, HY, Li, Y, Li, JJ, Jiao, CH, Zhao, XJ, Li, XT, Lu, MJ, Mao, XQ, Zhang, HJ
World journal of clinical cases. 2019;7(16):2189-2203
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Crohn's disease and ulcerative colitis are relapsing gut inflammatory diseases that are usually referred to as Inflammatory Bowel Disease (IBD). It may be triggered by an imbalance in immune response in response to environmental factors such as diet. The aim of this retrospective study was to evaluate the presence of IgG and IgE mediated antibodies to food antigens in IBD patients. There were one hundred and thirty-seven IBD patients participating in this study, including forty Ulcerative colitis patients and ninety-seven Crohn's disease patients against fifty healthy controls to test serum IgG antibodies to fourteen specific food antigens and serum IgE antibodies to fourteen specific food antigens. There were significantly higher IgG antibodies in response to food antigens in Crohn's disease patients than in Ulcerative colitis patients and healthy controls. Food antigens such as tomato, corn, egg, rice, and soybean exhibited varying levels of IgG antibody responses in Crohn's disease patients and ulcerative colitis patients. Smokers were more likely to develop IgG reactions. Further robust research is needed to examine more IgG-specific food antigens to help manage IBD with an elimination rotation diet. The results of this study can help healthcare professionals understand the importance of diagnosing food intolerances when treating IBD.
Abstract
BACKGROUND Food antigens have been shown to participate in the etiopathogenesis of inflammatory bowel disease (IBD), but their clinical value in IBD is still unclear. AIM: To analyze the levels of specific immunoglobulin G (IgG) and E (IgE) antibodies against food antigens in IBD patients and to determine their clinical value in the pathogenesis of IBD. METHODS We performed a retrospective study based on patients who visited the First Affiliated Hospital of Nanjing Medical University between August 2016 and January 2018. A total of 137 IBD patients, including 40 patients with ulcerative colitis (UC) and 97 patients with Crohn's disease (CD), and 50 healthy controls (HCs), were recruited. Serum food-specific IgG antibodies were detected by semi-quantitative enzyme-linked immunosorbent assay, and serum food-specific IgE antibodies were measured by Western blot. The value of food-specific IgG antibodies was compared among different groups, and potent factors related to these antibodies were explored by binary logistic regression. RESULTS Food-specific IgG antibodies were detected in 57.5% of UC patients, in 90.72% of CD patients and in 42% of HCs. A significantly high prevalence and titer of food-specific IgG antibodies were observed in CD patients compared to UC patients and HCs. The number of IgG-positive foods was greater in CD and UC patients than in HCs (CD vs HCs, P = 0.000; UC vs HCs, P = 0.029). The top five food antigens that caused positive specific IgG antibodies in CD patients were tomato (80.68%), corn (69.32%), egg (63.64%), rice (61.36%), and soybean (46.59%). The foods that caused positive specific IgG antibodies in UC patients were egg (60.87%), corn (47.83%), tomato (47.83%), rice (26.09%), and soybean (21.74%). Significantly higher levels of total food-specific IgG were detected in IBD patients treated with anti-TNFα therapy compared to patients receiving steroids and immunosuppressants (anti-TNFα vs steroids, P = 0.000; anti-TNFα vs immunosuppressants, P = 0.000; anti-TNFα vs steroids + immunosuppressants, P = 0.003). A decrease in food-specific IgG levels was detected in IBD patients after receiving anti-TNFα therapy (P = 0.007). Patients who smoked and CD patients were prone to developing serum food-specific IgG antibodies [Smoke: OR (95%CI): 17.6 (1.91-162.26), P = 0.011; CD patients: OR (95%CI): 12.48 (3.45-45.09), P = 0.000]. There was no difference in the prevalence of food-specific IgE antibodies among CD patients (57.1%), UC patients (65.2%) and HCs (60%) (P = 0.831). CONCLUSION CD patients have a higher prevalence of food-specific IgG antibodies than UC patients and HCs. IBD patients are prone to rice, corn, tomato and soybean intolerance. Smoking may be a risk factor in the occurrence of food-specific IgG antibodies. Food-specific IgG antibodies may be a potential method in the diagnosis and management of food intolerance in IBD.
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Chronic Food Antigen-specific IgG-mediated Hypersensitivity Reaction as A Risk Factor for Adolescent Depressive Disorder.
Tao, R, Fu, Z, Xiao, L
Genomics, proteomics & bioinformatics. 2019;17(2):183-189
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The prevalence of major depressive disorder (MDD) among adolescents has been on the rise recently. A high level of systemic low-grade inflammation is found in the serum of MDD adults, which is believed to interfere with neurotransmitter metabolism, resulting in symptoms of depression. Furthermore, disruption of the blood-brain barrier may inhibit neurotransmitter metabolism. One hundred and eighty-four adolescents with moderate MDD were evaluated against the same number of healthy controls to determine their serum levels of markers of inflammation, homocysteine, food sensitivity, histamine, and histamine metabolism. The study found that histamine levels and food antigen-specific antibodies in MDD adolescent patients were significantly higher than those in the control group. Increasing histamine levels, food-specific IgG levels, and S100 calcium-binding protein B levels suggest blood-brain barrier leakage may contribute to adolescent depression. There is still much to be learned about the pathophysiology of MDD, and further studies are needed to elucidate the mechanisms involved. The results of this study can be used by healthcare professionals to understand the role of histamine and food sensitivities in the development of adolescent depression rather than low-grade inflammation.
Abstract
Major depressive disorder (MDD) is the most common nonfatal disease burden worldwide. Systemic chronic low-grade inflammation has been reported to be associated with MDD progression by affecting monoaminergic and glutamatergic neurotransmission. However, whether various proinflammatory cytokines are abnormally elevated before the first episode of depression is still largely unclear. Here, we evaluated 184 adolescent patients who were experiencing their first episode of depressive disorder, and the same number of healthy individuals was included as controls. We tested the serum levels of high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), IgE, 14 different types of food antigen-specific IgG, histamine, homocysteine, S100 calcium-binding protein B, and diamine oxidase. We were not able to find any significant differences in the serum levels of hs-CRP or TNF-α between the two groups. However, the histamine level of the patients (12.35 μM) was significantly higher than that of the controls (9.73 μM, P < 0.001, Mann-Whitney U test). Moreover, significantly higher serum food antigen-specific IgG positive rates were also found in the patient group. Furthermore, over 80% of patients exhibited prolonged food intolerance with elevated levels of serum histamine, leading to hyperpermeability of the blood-brain barrier, which has previously been implicated in the pathogenesis of MDD. Hence, prolonged high levels of serum histamine could be a risk factor for depressive disorders, and antihistamine release might represent a novel therapeutic strategy for depression treatment.
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Extensively hydrolyzed casein formula containing Lactobacillus rhamnosus GG reduces the occurrence of other allergic manifestations in children with cow's milk allergy: 3-year randomized controlled trial.
Berni Canani, R, Di Costanzo, M, Bedogni, G, Amoroso, A, Cosenza, L, Di Scala, C, Granata, V, Nocerino, R
The Journal of allergy and clinical immunology. 2017;139(6):1906-1913.e4
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Food allergies in children are becoming increasingly more common, and make a child more at risk of developing other conditions including asthma, eczema and respiratory allergies. The aim of this study was to investigate whether an extensively hydrolysed casein formula (EHCF) containing Lactobacillus rhamnosus (LGG) had an impact on risk of developing additional allergies in children with an allergy to cow's milk (IgE). It was a randomised controlled trial including 220 children aged 1-12 months in Italy who were randomly assigned to one of two groups. Group one consumed EHCF and group two consumed EHCF + LGG. The authors concluded that the addition of LGG reduced the incidence of additionally allergies in these children.
Abstract
BACKGROUND Children with cow's milk allergy (CMA) have an increased risk of other allergic manifestations (AMs). OBJECTIVE We performed a parallel-arm randomized controlled trial to test whether administration of an extensively hydrolyzed casein formula (EHCF) containing the probiotic Lactobacillus rhamnosus GG (LGG) can reduce the occurrence of other AMs in children with CMA. METHODS Children with IgE-mediated CMA were randomly allocated to the EHCF or EHCF+LGG groups and followed for 36 months. The main outcome was occurrence of at least 1 AM (eczema, urticaria, asthma, and rhinoconjunctivitis). The secondary outcome was tolerance acquisition, which was defined as the negativization of a double-blind food challenge results at 12, 24, and 36 months. AMs were diagnosed according to standardized criteria. Tolerance acquisition was evaluated every 12 months. RESULTS A total of 220 children (147 boys [67%]) with a median age of 5.0 months (interquartile range, 3.0-8.0 months) were randomized; 110 children were placed in the EHCF group, and 110 children were placed in the EHCF+LGG group. In the complete case analysis the absolute risk difference for the occurrence of at least 1 AM over 36 months was -0.23 (95% CI, -0.36 to -0.10; P < .001), and the absolute risk difference for the acquisition of cow's milk tolerance was 0.20 (95% CI, 0.05-0.35; P < .01) at 12 months, 0.24 (95% CI, 0.08-0.41; P < .01) at 24 months, and 0.27 (95% CI, 0.11-0.43; P < .001) at 36 months. In the sensitivity analysis the effect size of the main outcome was virtually unchanged when the occurrence of AMs was assigned to all 27 missing children. CONCLUSIONS EHCF+LGG reduces the incidence of other AMs and hastens the development of oral tolerance in children with IgE-mediated CMA.
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A randomized trial of egg introduction from 4 months of age in infants at risk for egg allergy.
Wei-Liang Tan, J, Valerio, C, Barnes, EH, Turner, PJ, Van Asperen, PA, Kakakios, AM, Campbell, DE
The Journal of allergy and clinical immunology. 2017;139(5):1621-1628.e8
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The egg allergy is a common allergy mediated by IgE antibodies. Randomised, double-blind, single-site, parallel-arm, controlled study investigated whether early egg introduction could help to prevent or reduce the risk of developing egg allergy. Three hundred and nineteen infants of four months of age with atopic diseases were randomised to receive either 350 mg of freeze-dried egg protein (pasteurized whole egg powder) or rice powder as a placebo daily for four months of intervention. At twelve months, sensitisation to egg white was lower in infants who were randomised to egg (11%) than the infants who were randomised to receive rice powder (20%). The high-risk infants who received the egg white showed significant induction of egg specific IgG4 antibody levels and two major egg protein components such as ovalbumin and ovomucoid at the age of twelve months. There is a need for further robust research using a generalised population in order to confirm the generalisability of the results of this study. Healthcare professionals can use the findings of this study to plan infant weaning strategies.
Abstract
BACKGROUND Epidemiologic evidence suggests delayed introduction of egg might not protect against egg allergy in infants at risk of allergic disease. OBJECTIVE We sought to assess whether dietary introduction of egg between 4 and 6 months in infants at risk of allergy would reduce sensitization to egg. METHODS We conducted a randomized controlled trial in infants with at least 1 first-degree relative with allergic disease. Infants with a skin prick test (SPT) response to egg white (EW) of less than 2 mm were randomized at age 4 months to receive whole-egg powder or placebo (rice powder) until 8 months of age, with all other dietary egg excluded. Diets were liberalized at 8 months in both groups. The primary outcome was an EW SPT response of 3 mm or greater at age 12 months. RESULTS Three hundred nineteen infants were randomized: 165 to egg and 154 to placebo. Fourteen infants reacted to egg within 1 week of introduction (despite an EW SPT response <2 mm at entry) and were unsuitable for intervention. Two hundred fifty-four (83%) infants were assessed at 12 months of age. Loss to follow-up was similar between groups. Sensitization to EW at 12 months was 20% and 11% in infants randomized to placebo and egg, respectively (odds ratio, 0.46; 95% CI, 0.22-0.95; P = .03, χ2 test). The absolute risk reduction was 9.8% (95% CI, 8.2% to 18.9%), with a number needed to treat of 11 (95% CI, 6-122). Levels of IgG4 to egg proteins and IgG4/IgE ratios were higher in those randomized to egg (P < .0001 for each) at 12 months. There was no effect on the proportion of children with probable egg allergy (placebo, 13; egg, 8). CONCLUSIONS Introduction of whole-egg powder into the diets of high-risk infants reduced sensitization to EW and induced egg-specific IgG4 levels. However, 8.5% of infants randomized to egg were not amenable to this primary prevention.
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Randomized trial of peanut consumption in infants at risk for peanut allergy.
Du Toit, G, Roberts, G, Sayre, PH, Bahnson, HT, Radulovic, S, Santos, AF, Brough, HA, Phippard, D, Basting, M, Feeney, M, et al
The New England journal of medicine. 2015;372(9):803-13
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Children with peanut allergies are at a higher risk of death and anaphylaxis. This randomised, open-label, controlled study investigated whether reducing peanut exposure or eliminating peanuts is a better strategy to prevent peanut allergy development. Six hundred and forty infants between the ages of four months and eleven months old were randomly assigned to different cohorts depending on whether they had a pre-existing sensitivity to peanut extract. The study also assessed the proportion of infants with peanut allergies at 60 months. The introduction of peanuts at an early age significantly reduced peanut allergies in infants at high risk. Those who consumed peanuts had elevated peanut-specific IgG4 antibody levels whereas those who avoided peanuts had elevated peanut-specific IgE antibody levels. At the age of sixty months, the proportion of infants in the intention-to-treat group that developed peanut allergy was higher in the infants who avoided peanuts than in those who consumed them. As this study only included low-risk infants, future robust studies will be required to prove the benefits of peanuts’ early introduction. These results can be used by healthcare professionals to develop potential strategies to reduce the prevalence of peanut allergy in children.
Abstract
BACKGROUND The prevalence of peanut allergy among children in Western countries has doubled in the past 10 years, and peanut allergy is becoming apparent in Africa and Asia. We evaluated strategies of peanut consumption and avoidance to determine which strategy is most effective in preventing the development of peanut allergy in infants at high risk for the allergy. METHODS We randomly assigned 640 infants with severe eczema, egg allergy, or both to consume or avoid peanuts until 60 months of age. Participants, who were at least 4 months but younger than 11 months of age at randomization, were assigned to separate study cohorts on the basis of preexisting sensitivity to peanut extract, which was determined with the use of a skin-prick test--one consisting of participants with no measurable wheal after testing and the other consisting of those with a wheal measuring 1 to 4 mm in diameter. The primary outcome, which was assessed independently in each cohort, was the proportion of participants with peanut allergy at 60 months of age. RESULTS Among the 530 infants in the intention-to-treat population who initially had negative results on the skin-prick test, the prevalence of peanut allergy at 60 months of age was 13.7% in the avoidance group and 1.9% in the consumption group (P<0.001). Among the 98 participants in the intention-to-treat population who initially had positive test results, the prevalence of peanut allergy was 35.3% in the avoidance group and 10.6% in the consumption group (P=0.004). There was no significant between-group difference in the incidence of serious adverse events. Increases in levels of peanut-specific IgG4 antibody occurred predominantly in the consumption group; a greater percentage of participants in the avoidance group had elevated titers of peanut-specific IgE antibody. A larger wheal on the skin-prick test and a lower ratio of peanut-specific IgG4:IgE were associated with peanut allergy. CONCLUSIONS The early introduction of peanuts significantly decreased the frequency of the development of peanut allergy among children at high risk for this allergy and modulated immune responses to peanuts. (Funded by the National Institute of Allergy and Infectious Diseases and others; ClinicalTrials.gov number, NCT00329784.).
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Associations between maternal antioxidant intakes in pregnancy and infant allergic outcomes.
West, CE, Dunstan, J, McCarthy, S, Metcalfe, J, D'Vaz, N, Meldrum, S, Oddy, WH, Tulic, MK, Prescott, SL
Nutrients. 2012;4(11):1747-58
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This research studied the maternal intake of antioxidants (carotene, vitamin C, vitamin E, copper and zinc) during pregnancy and the effect on allergic outcomes during early infancy (eczema, food allergies, allergic sensitisation and wheeze) at 1 year of age. The study included 300 mother and child pairs from a pregnancy cohort in Western Australia from 2005 to 2008. The pregnant women had a family history of allergic rhinitis, asthma, eczema, food or other allergy. A post-natal randomised trial allocated either 650mg fish oil (280mg docosahexaenoic acid (DHA) and 110mg eicosapentaenoic acid (EPA)) or a placebo of olive oil for the first 6 months of life. The study also examined the effect of maternal diet during pregnancy. Demographic information was collected, and a semi quantitative food frequency questionnaire covering 212 foods was completed during the final trimester of pregnancy. Clinical outcome measures of the infants were taken at 12 months of age via a detailed history and examination. Eczema, IgE mediated food allergies and allergic sensitisation were the most common clinical outcomes of the study. The majority of pregnant women met the recommended daily intakes of antioxidants apart from vitamin E and zinc. At 12 months of age there was no difference in the occurrence of clinical outcomes between the fish oil and placebo groups. Higher dietary vitamin C in the mothers was associated with reduced risk of any diagnosed allergic disease when children were a year old, and also a reduced risk of wheeze. Higher copper intake was related to reduced risk of wheeze and development of early allergic disease. However, this was only seen in relation to nutrients from food rather than supplements. It was noted that there were no significant associations between early allergic responses/disease and dietary intake of carotene, vitamin E and zinc. In the group studied, the majority of mothers used some vitamin/mineral supplementation during pregnancy. There was no statistically significant association between carotene, vitamin E and zinc intake in pregnancy and risk of developing any allergic disease. Women reported intakes of dietary vitamin C were above the daily recommended intake of 60mg, and authors noted that allergic outcomes were not affected by vitamin supplementation.
Abstract
Antioxidant intakes in pregnancy may influence fetal immune programming and the risk of allergic disease. We investigated associations between maternal intakes of β-carotene, vitamin C, vitamin E, copper and zinc, and infant allergic outcomes. Antioxidant intakes of pregnant women (n = 420) assessed prospectively by a food frequency questionnaire, were examined in relation to allergic outcomes at 1 year of age (n = 300). The main relationships with allergic outcomes were seen with dietary vitamin C and copper. Specifically, higher maternal dietary vitamin C intake was associated with a reduced risk of any diagnosed infant allergic disease and wheeze. After adjustment for potential confounders the relationship with wheeze remained statistically significant. There was also an inverse linear relationship between vitamin C and food allergy. Higher dietary copper intake was associated with reduced risk of eczema, wheeze and any allergic disease. The relationship with wheeze and any allergic disease remained statistically significant in multivariate analysis, and there was also an inverse linear relationship between copper and food allergy. However, these relationships were only seen for nutrients present in food. There were no relationships between β-carotene, vitamin E or zinc and any allergic outcomes. In summary, this study suggests that maternal diet of fresh foods rich in vitamin C is associated with reduced risk of infant wheeze, and that copper intake is associated with reduced risk of several allergic outcomes.
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Diet restriction in migraine, based on IgG against foods: a clinical double-blind, randomised, cross-over trial.
Alpay, K, Ertas, M, Orhan, EK, Ustay, DK, Lieners, C, Baykan, B
Cephalalgia : an international journal of headache. 2010;30(7):829-37
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Migraine is a chronic neurological condition characterised by a multifactorial aetiology, with genetic susceptibility playing a significant role in its development. Some researchers believe the development of migraine may also be related to IgG-mediated food intolerances and IgE-mediated food allergies. This randomised, controlled, double-blinded, cross-over clinical trial assessed the effect of an IgG antibody-based elimination diet against two hundred and sixty-six food antigens in thirty migraineurs. During the baseline, each participant was tested for IgG antibody levels in response to specific food antigens in order to receive a tailored elimination diet. The results of this study showed a statistically significant reduction in the number of headache days and the number of migraine attacks during the elimination diet phase, in comparison to the baseline in migraineurs. However, additional larger scale, robust studies are required in order to confirm the efficacy of the IgG-specific elimination diets in the treatment of migraine. In terms of migraine management, the results of this study can be of assistance to health care professionals who would like to understand the potential of diet restrictions based on IgG antibodies.
Abstract
INTRODUCTION It is well-known that specific foods trigger migraine attacks in some patients. We aimed to investigate the effect of diet restriction, based on IgG antibodies against food antigens on the course of migraine attacks in this randomised, double blind, cross-over, headache-diary based trial on 30 patients diagnosed with migraine without aura. METHODS Following a 6-week baseline, IgG antibodies against 266 food antigens were detected by ELISA. Then, the patients were randomised to a 6-week diet either excluding or including specific foods with raised IgG antibodies, individually. Following a 2-week diet-free interval after the first diet period, the same patients were given the opposite 6-week diet (provocation diet following elimination diet or vice versa). Patients and their physicians were blinded to IgG test results and the type of diet (provocation or elimination). Primary parameters were number of headache days and migraine attack count. Of 30 patients, 28 were female and 2 were male, aged 19-52 years (mean, 35 +/- 10 years). RESULTS The average count of reactions with abnormally high titre was 24 +/- 11 against 266 foods. Compared to baseline, there was a statistically significant reduction in the number of headache days (from 10.5 +/- 4.4 to 7.5 +/- 3.7; P < 0.001) and number of migraine attacks (from 9.0 +/- 4.4 to 6.2 +/- 3.8; P < 0.001) in the elimination diet period. CONCLUSION This is the first randomised, cross-over study in migraineurs, showing that diet restriction based on IgG antibodies is an effective strategy in reducing the frequency of migraine attacks.
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Fish consumption during the first year of life and development of allergic diseases during childhood.
Kull, I, Bergström, A, Lilja, G, Pershagen, G, Wickman, M
Allergy. 2006;61(8):1009-15
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This study aimed to investigate the association of eating fish in the first year of human life, and the development of allergic diseases by the age of four. A group of 4089 new born babies was followed for a period of four years, and information about fish consumption and time of introduction was collected via a simple parental questionnaire when the infants were 2 months, 1, 2 and 4 years old. Five predefined categories – never, once a month, 2-3 times a month, once a week and more than once a week – were used to identify how much fish was eaten. There was a 90% response rate at 4 years. Clinical investigations of 2614 children aged four were undertaken, including blood sampling to analyse IgE responses to common foods and allergens, such as cat, dog, horse, birch, milk, egg, fish, soy, peanut and wheat. It was found that those children who ate fish in the first year of their life had a reduced risk of developing an allergic disease at age 4 (asthma, eczema, allergic rhinitis or sensitisation) when compared with those children who began to eat fish at 9 months or older. In addition, a reduced risk was seen when children ate fish more than twice a month compared with those who ate fish less than once a month, and this was more noticeable when measured as persistent allergic disease (those children who had allergic responses at 2 years and 4 years). In this study, there was no clear difference in risk between children with or without parental allergic diseases. However, reduced risk of sensitisation, alongside regular fish in the diet, was only seen in children without parental allergic disease. Risk reduction was most noticeable for allergic rhinitis. The authors conclude that eating fish early and regularly in life was associated with a reduced risk of developing allergic disease, in particular eczema and allergic rhinitis.
Abstract
BACKGROUND Fish consumption during infancy has been regarded as a risk factor for allergic disease but later evidence suggests a protective role. However, methodological limitations in the studies make conclusions uncertain. The aim of this study was to assess the association between fish consumption during the first year of life and development of allergic diseases by age 4. METHODS A prospective birth cohort of 4089 new-born infants was followed for 4 years using parental questionnaires at ages 2 months, 1, 2 and 4 years to collect information on exposure and health effects. The response rate at 4 years was 90%. A clinical investigation was performed at age 4 years, which included blood sampling for analysis of specific IgE to common food and airborne allergens. RESULTS Parental allergic disease and onset of eczema or wheeze during the first year of life delayed introduction of fish in the child's diet. After exclusion of such children to avoid disease-related modification of exposure, regular fish consumption during the first year of life was associated with a reduced risk for allergic disease by age 4, OR(adj) 0.76 (95% CI 0.61-0.94) and sensitization, OR(adj) 0.76 (0.58-1.0). The reduced risk appeared most pronounced for multiple disease, OR(adj) 0.56 (0.35-0.89). IgE-sensitization to fish was only present among 18 of the 2614 children. CONCLUSION Regular fish consumption before age 1 appears to be associated with a reduced risk of allergic disease and sensitization to food and inhalant allergens during the first 4 years of life.