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Background Peanut allergy is one of the most severe food allergies. Whether breastfeeding induces tolerance to peanuts or on the contrary, pre-disposes at risk-babies to occult allergic sensitization to peanuts is still a matter of discussion. We sought to investigate the transfer of the most potent peanut allergen Ara h 2 into human breast milk in a German breast milk study and to shed light on the time kinetics of Ara h 2 appearance. Methods We recruited 32 lactating, non-peanut-allergic women and collected breast milk samples at different time points after consumption of 100 g dry roasted peanuts. Breast milk samples were investigated for Ara h 2 with different immunological methods: by 2D immunoblotting with a patient's serum, by affinity enrichment using a monoclonal antibody against Ara h 2 followed by LC- MS/ MS-based detection and by a competitive inhibition ELISA for the detection of Ara h 2 and its digestion-resistant peptides ( DRP-Ara h 2). Results In a qualitative analysis, Ara h 2 could be identified in a breast milk sample by 2D immunoblot by means of a patient's serum and furthermore by immunoaffinity enrichment followed by LC- MS/ MS analysis. In a semi-quantitative analysis, Ara h 2 and its digestion-resistant peptides were detected in the breast milk of 9 of 32 subjects. Evidence suggests that Ara h 2 is excreted individually either rapidly (after 1, 2, 3 or 4 h) or delayed (after 8 or 12 h) and in different concentrations. Conclusions Time and concentration of secreted Ara h 2 in breast milk appears to be individually regulated. The identification of Ara h 2 in breast milk is the prerequisite for the investigation of its sensitizing or tolerogenic properties. [ABSTRACT FROM AUTHOR]

Background Risk factors of pediatric inflammatory bowel disease ( PIBD) are incompletely understood. Recently, we reported that among patients with PIBD, a previous diagnosis of cow's milk allergy ( CMA) and asthma occurred more frequently than among age- and sex-matched peers. We tested at a national level the hypothesis that CMA is associated with the risk of contracting PIBD. Methods A nationwide birth cohort (n = 225,041), including all Finnish children born between 1999 and 2002, was followed up until July 1, 2014. We identified all children with a diagnosis of CMA, asthma, and PIBD from a national register; the data were based on certificates, including diagnostic criteria. The 95% confidence intervals ( CI) for the incidence rates per 100,000 person-years were calculated assuming a Poisson distribution. Results We identified 7,910 infants with CMA yielding a cumulative incidence of 3.5% by 2 years of age. The cumulative incidence of PIBD was 0.14% (n = 316) and that of asthma 6.6% (14,807). Children with CMA were more likely to develop PIBD than non- CMA children, incidence ratio 2.6 (95% CI 1.7-3.8). Children with a diagnosis of CMA contracted PIBD at a younger age than the respective non- CMA group (9 vs. 11 years, p < 0.05). The risk was more evident for ulcerative colitis than for Crohn's disease. The association between CMA and asthma was stronger than that between CMA and PIBD. Conclusions CMA in infancy is associated with subsequent development of asthma and PIBD. This suggests that in a subgroup of patients, CMA may share underlying background with PIBD, warranting thorough follow-up. [ABSTRACT FROM AUTHOR]

Background Delivery by Cesarean section ( CS) may predispose to allergic disorders, presumably due to alterations in the establishment of normal gut microbiota in early infancy. In this study, we sought to investigate the association between CS and physician-diagnosed food allergy and atopic dermatitis during the first 3 years of life, using data from a homogeneous, population-based, birth cohort. Methods A total of 459 children born and cared for in the same tertiary maternity unit were examined at birth and followed up at 1, 6, 12, 18, 24, 30 and 36 months of age. Participants with symptoms suggestive of food allergy or atopic dermatitis were evaluated by a pediatric allergy specialist to confirm the diagnosis based on well-defined criteria. Results The rate of CS was 50.8% (n = 233). Food allergy was diagnosed in 24 participants (5.2%) while atopic dermatitis was diagnosed in 62 children (13.5%). Cesarean section ( OR 3.15; 95% CI 1.14-8.70), atopic dermatitis of the child ( OR 3.01; 95% CI 1.18-7.80), parental atopy ( OR 4.33; 95% CI 1.73-12.1), and gestational age ( OR 1.57; 95% CI 1.07-2.37) were significant and independent predictors of food allergy. Children with at least one allergic parent delivered by CS had higher probability of developing food allergy compared with vaginally delivered children of non-allergic parents ( OR 10.0; 95% CI 3.06-32.7). Conversely, the effect of CS on atopic dermatitis was not significant ( OR 1.35; 95% CI 0.74-2.47). Conclusions Delivery by CS predisposes to the development of food allergy but not atopic dermatitis in early childhood. Cesarean section delivery seems to upregulate the immune response to food allergens, especially in children with allergic predisposition. [ABSTRACT FROM AUTHOR]

Background: Over the past three decades, the prevalence of allergic diseases has markedly increased in developed countries. There has been a paucity of data on food allergy (FA) in developing countries such as China. We aimed to estimate the prevalence and the clinical features of FA in Chinese infants attending a routine well-baby clinic in Chongqing, China. Methods: From January 1st to February 28th, 2009, consecutive infants and young children aged 0-12 months attending routine well-baby checks at the Department of Primary Child Care, Children's Hospital of Chongqing Medical University, were invited to participate in the study. Parents completed questionnaires, and children were skin prick tested (SPT) to a panel of 10 foods (egg white, egg yolk, cow's milk, soybean, peanut, wheat, fish, shrimp, orange, and carrot) together of histamine and saline controls. Subjects with either a positive SPT or a positive medical history were invited to undergo an oral food challenge. Results: Of 497 children who consented to participate, 477 (96%) participated fully in the study. Of these, 56 subjects had a positive SPT (11.3%), with 45 positive to egg, 13 to cow's milk, 2 to peanut, 1 to fish, shrimp, and orange respectively. Eighty subjects (16.1%, 80/497) participated in food challenges. Conclusion: The overall prevalence of challenge-proven FA in 0- to 1-yr-old children in Chongqing, China, was 3.8% (18/477, 95% CI, 2.5-5.9%) with 2.5% (12/477) egg allergic and 1.3% (6/477) cow's milk allergic. [ABSTRACT FROM AUTHOR]

Observational studies have shown that allergic infants, irrespective of the type of diet, show various degrees of growth depression in the first year of life. We investigated whether the type of milk in the complementary feeding period (6–12 months of age) is associated with differences in the increase of standardized growth indices (weight-for-age, WA; length-for-age, LA; and weight-for-length, WL, z-scores) in infants with cow's milk allergy (CMA). Infants with immunoglobulin E-mediated CMA breastfed at least 4 months and progressively weaned in the 5- to 6-month period were randomly assigned to three special formulas, a soy formula (n = 32), a casein hydrolysate (n = 31), and a rice hydrolysate (n = 30). A fourth, non-randomized group was made up by allergic infants still breastfed up to 12 months (n = 32). Groups were compared for WA, LA, and WL z-scores at 6, 9 and 12 months of age. All groups showed low WA and LA z-scores at 6 months of age. Infants fed hydrolyzed products showed a trend toward higher WA z-score increments in the 6- to 12-month period. The use of casein- and rice-based hydrolyzed formulas resulted in higher changes in WA compared with soy formula. Further research should be aimed at optimizing the dietary needs and feeding regimens for infants with CMA. [ABSTRACT FROM AUTHOR]

Hill DJ, Hosking CS. Food allergy and atopic aermatitis in infancy: an epidemiologic study.Pediatr Allergy Immunol 2004: 15: 421–427.© 2004 Blackwell MunksgaardAtopic dermatitis is common in infancy. The role of food allergy in atopic dermatitis of infancy is unclear. We examined the relationship between atopic dermatitis and immunoglobulin E (IgE)-mediated food allergy in infancy. A birth cohort of 620 infants with a family history of eczema, asthma, hayfever or immediate food allergy in a parent or sibling: 487 children had complete data including skin prick tests (SPTs) to evaluate IgE-mediated food allergy to cow milk, egg and peanut. Participants were grouped as no atopic dermatitis (Gp 0) or in quartiles of increasing severity of atopic dermatitis (Gps 1–4) quantified by days of topical steroid use as reported monthly. Adverse reactions to foods were recorded. The cumulative prevalence of atopic dermatitis was 28.9% to 12 months (10.3% of the cohort of moderate severity). As atopic dermatitis severity increased so did the prevalence of IgE-mediated food allergy (Gp 0, 40/346 vs. Gp 1, 6/36 vs. Gp 2, 8/35 vs. Gp 3, 12/35 vs. Gp 4, 24/35;χ2 = 76; p < 10−6), and the frequency of reported adverse food allergy reactions (Gp 0, 43/346 vs. Gp 1, 4/36 vs. Gp 2, 8/35, vs. Gp 3, 5/35, vs. Gp 4, 13/35;χ2 = 17; p = 0.002). The relative risk of an infant with atopic dermatitis having IgE-mediated food allergy is 5.9 for the most severely affected group. Atopic dermatitis is common in infancy. There is a strong association between IgE-mediated food allergy and atopic dermatitis in this age group. [ABSTRACT FROM AUTHOR]

Cow’s milk‐based formulas used for infants with cow’s milk allergy are based on hydrolyzed proteins. The formulas that are successful in preventing allergic responses are extensively hydrolyzed. Nevertheless, reactions to such formulas are occasionally reported, and protein material of higher molecular weight than expected has been detected by binding immunoglobulin E (IgE) from patients’ sera. This paper presents the identification of high‐molecular‐weight material in the extensively hydrolyzed casein formula, Nutramigen. The material was concentrated by simple centrifugation. The proteins in the pellet were separated by sodium dodecyl sulfate‐polyacrylamide gel electrophoresis (SDS‐PAGE), and protein‐containing bands were analyzed by protein sequencing after electroblotting. The proteins were identified as maize zeins, which are water‐insoluble proteins of apparent Mr 20 000 and 23 000, presumably originating from the maize starch in Nutramigen. Rabbits immunized with this formula developed antibodies against zeins but not against milk proteins. The maize zeins are probably identical to the recently reported components in Nutramigen (), detected by binding of IgE from milk allergic patients, but not correlated to clinical allergic reactivity. The clinical relevance of maize proteins in Nutramigen remains to be established. [ABSTRACT FROM AUTHOR]

Assessment of activation of immune mechanisms is valuable in the early diagnosis of cow's milk allergy (CMA). The purpose of this study was to evaluate peripheral blood lymphocyte subclasses in children suspected of having CMA and healthy infants in order to detect an early marker for food allergy. Altogether 47 breast-fed infants, aged from 0.4 to 10 months were followed-up prospectively from birth because of atopic heredity. Twenty-three of the infants were healthy and 24 infants had a strong suspicion of and later challenge-proven cow's milk allergy. Leucocyte subsets were determined from peripheral blood mononuclear cells by flow cytometry. In response to a clinical cow's milk challenge, seven infants developed urticaria, 11 infants had eczema, three patients had loose stools, diarrhoea or vomiting and three infants had eczema and diarrhoea, loose stools or vomiting. The total percentage of B cells and also the proportion of B cells bearing a low-afftnity IgE receptor as a marker for activation were significantly higher, whereas the percentage of CD8+ T cells was significantly lower in infants with challenge-proven CMA than in healthy controls. These results imply that infants with active CMA have a defect in regulation of B-cell function. Further, they suggest that imbalance of the ratio of suppressor and helper T cells might be an important factor in the etiopathogenesis of CMA. Our results show that large numbers of activated CD19+ B cells and low numbers of CD8+ T cells could be considered as early markers for food allergy since they are already detectable in peripheral blood during the earliest symptoms of CMA. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the study of fecal eosinophil-derived neurotoxin in young infants with food protein-induced enterocolitis syndrome (FPIES).