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1.
Component-Resolved Diagnosis of Hazelnut Allergy in Children.
Caffarelli, C, Mastrorilli, C, Santoro, A, Criscione, M, Procaccianti, M
Nutrients. 2021;(2)
Abstract
Hazelnuts commonly elicit allergic reactions starting from childhood and adolescence, with a rare resolution over time. The definite diagnosis of a hazelnut allergy relies on an oral food challenge. The role of component resolved diagnostics in reducing the need for oral food challenges in the diagnosis of hazelnut allergies is still debated. Therefore, three electronic databases were systematically searched for studies on the diagnostic accuracy of specific-IgE (sIgE) on hazelnut proteins for identifying children with a hazelnut allergy. Studies regarding IgE testing on at least one hazelnut allergen component in children whose final diagnosis was determined by oral food challenges or a suggestive history of serious symptoms due to a hazelnut allergy were included. Study quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Eight studies enrolling 757 children, were identified. Overall, sensitivity, specificity, area under the curve and diagnostic odd ratio of Cor a 1 sIgE were lower than those of Cor a 9 and Cor a 14 sIge. When the test results were positive, the post-test probability of a hazelnut allergy was 34% for Cor a 1 sIgE, 60% for Cor a9 sIgE and 73% for Cor a 14 sIgE. When the test results were negative, the post-test probability of a hazelnut allergy was 55% for Cor a 1 sIgE, 16% for Cor a9 sIgE and 14% for Cor a 14 sIgE. Measurement of IgE levels to Cor a 9 and Cor a 14 might have the potential to improve specificity in detecting clinically tolerant children among hazelnut-sensitized ones, reducing the need to perform oral food challenges.
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2.
Immunoglobulin E (IgE)-Mediated Food Allergy in Children: Epidemiology, Pathogenesis, Diagnosis, Prevention, and Management.
Barni, S, Liccioli, G, Sarti, L, Giovannini, M, Novembre, E, Mori, F
Medicina (Kaunas, Lithuania). 2020;(3)
Abstract
A food allergy is an immunoglobulin E (IgE)-mediated hypersensitive reaction to food, which consists in the appearance of allergic symptoms; it can vary from common urticaria to even fatal anaphylaxis. The prevalence of food allergies has been increasing in the past twenty years and it represents a major public health problem in industrialized countries. The mechanism that leads to food allergies is the lack of immunologic and clinical tolerance to food allergens. The diagnosis of IgE-mediated food allergies is based on the combined use of a detailed medical history, in-vivo, and in-vitro research of specific IgE, the elimination diet, and the double-blind placebo-controlled food challenge. The only currently available treatment for allergies is the strict elimination diet. This type of attitude, which we could define as "passive", does not overcome the risk of accidental reactions due to involuntary intake of the culprit food. For food allergy management, an "active" approach is urgently needed, such as specific allergen immunotherapy, which is currently under development and only used for research purposes. This article aims to give an updated review of IgE-mediated food allergies in pediatric populations in terms of epidemiology, pathogenesis, prevention, diagnosis, and management.
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3.
Molecular Approaches for Diagnosis, Therapy and Prevention of Cow´s Milk Allergy.
Linhart, B, Freidl, R, Elisyutina, O, Khaitov, M, Karaulov, A, Valenta, R
Nutrients. 2019;(7)
Abstract
Cow´s milk is one of the most important and basic nutrients introduced early in life in our diet but can induce IgE-associated allergy. IgE-associated allergy to cow´s milk can cause severe allergic manifestations in the gut, skin and even in the respiratory tract and may lead to life-threatening anaphylactic shock due to the stability of certain cow´s milk allergens. Here, we provide an overview about the allergen molecules in cow´s milk and the advantages of the molecular diagnosis of IgE sensitization to cow´s milk by serology. In addition, we review current strategies for prevention and treatment of cow´s milk allergy and discuss how they could be improved in the future by innovative molecular approaches that are based on defined recombinant allergens, recombinant hypoallergenic allergen derivatives and synthetic peptides.
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4.
What Do We Know Now about IgE-Mediated Wheat Allergy in Children?
Czaja-Bulsa, G, Bulsa, M
Nutrients. 2017;(1)
Abstract
IgE-mediated wheat allergy is a gluten-related disorder. Wheat is one of the five most common food allergens in children. However, the natural history of IgE-mediated wheat allergy has seldom been described in the research literature. This study presents the current state of knowledge about the IgE-mediated wheat allergy in children.
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5.
Allergic Reactions to Pine Nut: A Review.
Cabanillas, B, Novak, N
Journal of investigational allergology & clinical immunology. 2015;(5):329-33
Abstract
Pine nut is a nutrient-rich food with a beneficial impact on human health. The many bioactive constituents of pine nut interact synergistically to affect human physiology in a favorable way. However, pine nut can trigger dangerous allergic reactions. Severe anaphylactic reactions to pine nut accounted for most of the 45 cases reported in the scientific literature. Pine nut allergy seems to be characterized by low IgE cross-reactivity with other commonly consumed nuts and a high monosensitization rate. The present review provides updated information on allergic reactions to pine nut, molecular characterization of its allergens, and potential homologies with other nut allergens.
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6.
Comprehensive Review of Current Knowledge on Egg Oral Immunotherapy.
Ibáñez, MD, Escudero, C, Sánchez-García, S, Rodríguez del Río, P
Journal of investigational allergology & clinical immunology. 2015;(5):316-28; quiz 2 p following 328
Abstract
Oral immunotherapy (OIT) is an attractive strategy for active treatment of IgE-mediated food allergy. Multiple egg OIT studies have been published to date, but many are uncontrolled. Furthermore, interpretation of the results is difficult because of significant heterogeneity in design, aims, and population. Most studies have demonstrated the potential of egg OIT to induce desensitization, albeit to different extents (0%-100% of patients). However, few studies have explored the capacity of OIT to maintain tolerance, that is, enabling the patient to continue consuming egg after suspension of therapy. Nowadays, 28% to 75% of patients maintain tolerance after 1 to 3 months of their elimination diet. Adverse effects are the main drawback of this treatment, which is still not recommended in routine practice. Adverse reactions are not reported homogeneously, with the result that it is difficult to properly assess outcomes. The overall impression is that adverse reactions affect most patients and tend to be frequent, although of mild to moderate severity. Nevertheless, severe events such as anaphylaxis or eosinophilic esophagitis may also occur. Immunological changes resulting from egg OIT, for example, the decrease in the size of the skin prick test wheal and the levels of egg white sIgE and a significant early increase in egg white sIgG4, have been reported. Several areas of egg OIT remain unclear, including patient selection, materials used, dosing schedule, treatment duration, long-term maintained effectiveness, requirements for implementation in clinical practice, influence on quality of life, and cost-effectiveness of treatment. In this review, we provide an in-depth examination of methodological differences between studies in order to understand the diversity in the efficacy and safety results of the procedures used in egg OIT.
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7.
Cow's milk protein allergy in children: a practical guide.
Caffarelli, C, Baldi, F, Bendandi, B, Calzone, L, Marani, M, Pasquinelli, P, ,
Italian journal of pediatrics. 2010;:5
Abstract
A joint study group on cow's milk allergy was convened by the Emilia-Romagna Working Group for Paediatric Allergy and by the Emilia-Romagna Working Group for Paediatric Gastroenterology to focus best practice for diagnosis, management and follow-up of cow's milk allergy in children and to offer a common approach for allergologists, gastroenterologists, general paediatricians and primary care physicians.The report prepared by the study group was discussed by members of Working Groups who met three times in Italy. This guide is the result of a consensus reached in the following areas. Cow's milk allergy should be suspected in children who have immediate symptoms such as acute urticaria/angioedema, wheezing, rhinitis, dry cough, vomiting, laryngeal edema, acute asthma with severe respiratory distress, anaphylaxis. Late reactions due to cow's milk allergy are atopic dermatitis, chronic diarrhoea, blood in the stools, iron deficiency anaemia, gastroesophageal reflux disease, constipation, chronic vomiting, colic, poor growth (food refusal), enterocolitis syndrome, protein-losing enteropathy with hypoalbuminemia, eosinophilic oesophagogastroenteropathy. An overview of acceptable means for diagnosis is included. According to symptoms and infant diet, three different algorithms for diagnosis and follow-up have been suggested.
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8.
Immunoglobulin-E-mediated reactivity to self antigens: a controversial issue.
Zeller, S, Glaser, AG, Vilhelmsson, M, Rhyner, C, Crameri, R
International archives of allergy and immunology. 2008;(2):87-93
Abstract
Immunoglobulin E (IgE) reactivity to self antigens is well established in vitro by ELISA, inhibition ELISA, Western blot analyses and T cell proliferation experiments. In vivo, IgE-binding self antigens are able to elicit strong type I reactions in sensitized individuals and, in the case of human manganese superoxide dismutase, to elicit eczematous reactions on healthy skin areas of patients suffering from atopic eczema. The reactions against self antigens sharing structural homology with environmental allergens can be plausibly explained by molecular mimicry between common B cell epitopes. For the second class of IgE-binding self antigens without sequence homology to known allergens, it is still unclear if the structures are able to induce a B cell switch to IgE production, or if the reactivity is due to sequence similarity shared with not yet detected environmental allergens. However, in all cases, cross-reactivity is never complete, indicating either a lower affinity of IgE antibodies to self allergens than to the homologous environmental allergens or the presence of additional B cell epitopes on the surface of the environmental allergens, or both. Increasing evidence shows that self allergens could play a decisive role in the exacerbation of long-lasting atopic diseases. However, the only observation supporting a clinical role of IgE-mediated autoreactivity is confined to the fact that IgE levels against self antigens correlate with disease severity.
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9.
Food allergy: an overview.
Kagan, RS
Environmental health perspectives. 2003;(2):223-5
Abstract
Food allergy affects between 5% and 7.5% of children and between 1% and 2% of adults. The greater prevalence of food allergy in children reflects both the increased predisposition of children to develop food allergies and the development of immunologic tolerance to certain foods over time. Immunoglobulin (Ig) E-mediated food allergies can be classified as those that persist indefinitely and those that are predominantly transient. Although there is overlap between the two groups, certain foods are more likely than others to be tolerated in late childhood and adulthood. The diagnosis of food allergy rests with the detection of food-specific IgE in the context of a convincing history of type I hypersensitivity-mediated symptoms after ingestion of the suspected food or by eliciting IgE-mediated symptoms after controlled administration of the suspected food. Presently, the only available treatment of food allergies is dietary vigilance and administration of self-injectable epinephrine.