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Allergic disorders have now become a major worldwide public health issue, but the effective treatment options remain limited. We report a novel approach to block allergic reactivity by targeting the surface-bound IgE of the allergic effector cells via low-affinity anti-human IgE Abs with dissociation constants in the 10-6 to 10-8 M range. We demonstrated that these low-affinity anti-IgE mAbs bind to the cell surface-bound IgE without triggering anaphylactic degranulation even at high concentration, albeit they would weakly upregulate CD203c expression on basophils. This is in contrast to the high-affinity anti-IgE mAbs that trigger anaphylactic degranulation at low concentration. Instead, the low-affinity anti-IgE mAbs profoundly block human peanut- and cat-allergic IgE-mediated basophil CD63 induction indicative of anaphylactic degranulation; suppress peanut-, cat-, and dansyl-specific IgE-mediated passive cutaneous anaphylaxis; and attenuate dansyl IgE-mediated systemic anaphylaxis in human FcεRIα transgenic mouse model. Mechanistic studies reveal that the ability of allergic reaction blockade by the low-affinity anti-IgE mAbs was correlated with their capacity to downregulate the surface IgE and FcεRI level on human basophils and the human FcεRIα transgenic mouse bone marrow-derived mast cells via driving internalization of the IgE/FcεRI complex. Our studies demonstrate that targeting surface-bound IgE with low-affinity anti-IgE Abs is capable of suppressing allergic reactivity while displaying an excellent safety profile, indicating that use of low-affinity anti-IgE mAbs holds promise as a novel therapeutic approach for IgE-mediated allergic diseases.

The dynamically growing incidence of food allergies forces the scientific community to develop new methods for their diagnosis, differentiation, and effective treatment. Parasitoses appear much less frequently in the scientific literature, as well as among the presumed causes of numerous conditions. The similarity of inflammatory mechanisms in allergies and parasitosis necessitates a revision of current diagnostic standards. A lack of specificity and the coincidence of symptoms at an early stage of disease can lead to misdiagnosis. In this paper, we attempted to perform a comparative analysis of the similarities and differences in symptoms for these two types of diseases. We described the molecular mechanisms and metabolic pathways of food allergy and parasitosis. We presented the available research methods and directions of ongoing studies aimed at implementing precise medical techniques for differential diagnosis. We discussed the allergenic properties of certain parasite proteins, using the example of myofibrillar tropomyosins from the nematode Anisakis simplex. The literature in the fields of allergology and parasitology leads to the conclusion that it is reasonable to run parallel allergological and parasitological diagnostics in patients with non-specific symptoms. This approach will facilitate accurate and early diagnosis and implementation of effective therapy.

BACKGROUND: Researchers have found a relationship between having food allergies and anxiety in children. Anxiety may relate to others' lack of food allergy knowledge. This study investigated the relationship between having a food allergy and self‐reported anxiety among children. Furthermore, knowledge of food allergies among children without food allergies and teachers was explored. METHODS: Children with food allergies and their parents each completed a perceived food allergy severity questionnaire. Children without food allergies completed a food allergy knowledge measure. All children completed a self‐reported anxiety measure. Teachers completed a questionnaire investigating knowledge, attitudes, and beliefs about food allergies. Correlational analyses and analyses of variance were conducted. RESULTS: Overall anxiety was significantly higher in children with food allergies than in children without food allergies. When controlling for the effects of sex and age, children with food allergies had significantly higher social phobia and school phobia. Teachers correctly answered 69.7% of knowledge‐based questions about food allergies; children without food allergies correctly answered 62.7%. CONCLUSIONS: Findings highlight the need for an integrated approach in which families, school personnel, psychologists and other mental health professionals, and medical professionals work together to increase awareness about the multifaceted needs of children with food allergies. [ABSTRACT FROM AUTHOR]

Eosinophilic gastroenteritis (EGE) is a subgroup of the eosinophilic gastro-intestinal disorders (EGIDs), characterized by eosinophilic infiltration and chronic inflammation of the gastrointestinal tract. These are rare diseases with still incompletely elucidated causes and mechanisms, with frequently delayed diagnosis and variable outcome. Despite increased interest in eosinophilic diseases in recent years, fewer data have been published on EGE and no standardized diagnostic and therapeutic approach exists. This paper reports the case of a young male patient diagnosed with EGE in 2017 based on clinical and histopathological criteria and constantly monitored during five years. Besides gastrointestinal eosinophilic infiltration, biopsies also revealed eosinophilic infiltration of the oesophagus, despite no declared characteristic oesophageal symptoms. We found increased specific IgE to multiple foods and progressive blood hypereosinophilia which preceded EGE diagnosis by three years. The EGE management included selective dietary restrictions and pharmacologic therapy based on daily budesonide non-enteric coated tablets, proton pumps inhibitors, antihistamines, cromoglycate, correction of iron, calcium and vitamin D deficiencies. The clinical outcome was good, while blood eosinophilia and endoscopic appearance remained almost unchanged. After one year the patient complained of respiratory symptoms suggesting asthma, needing continuous combined inhaled therapy. The reported case is illustrative for complex presentation, diagnosis and outcome of a rare case of mucosal chronic EGE associated with oesophageal involvement, peripheral eosinophilia, multiple food allergies and asthma. [ABSTRACT FROM AUTHOR]

Unhealthy diets represent a major risk for the pathogenesis of metabolic and chronic inflammatory diseases. Improving the quality of diet is important to prevent chronic diseases, and diet-induced modifications of the gut microbiota (GM) community likely play an important role. The EU-funded Stance4Health project aims at performing a randomized clinical trial based on a nutritional intervention program in the context of normal weight and overweight adults as well as children with obesity and gluten-related disorders or allergy/intolerance to cow's milk. The trial will evaluate the efficacy of a Smart Personalised Nutrition (SPN) service in modifying GM composition and metabolic function and improving consumer empowerment through technology adoption. [ABSTRACT FROM AUTHOR]

Cow's milk allergy (CMA) remains one of the most common and complex paediatric food allergies. In the last decade, our understanding has advanced in terms of immunoglobulin E (IgE)-mediated CMA and focus is now also paid to non-IgE-mediated CMA, particularly in some Western countries where incidence rates are high. We have had significant progress in the last 10 years in relation to our understanding of existing supportive tests for IgE-mediated CMA, with the advancement of newer tests, such as the basophil activation test (BAT), which have shown great promise. However, little advancement has been made in terms of tests for non-IgE-mediated CMA, and controversy still exists around symptoms. Our understanding of the natural history of CMA has also advanced with more awareness of different phenotypes. While the mainstay of management remains cow's milk elimination, the importance of supporting breastfeeding and avoidance of unwarranted cow's milk elimination diets in breastfeeding mothers has been highlighted. For non-breastfed children, there has been some advancement in the formulas offered for the management of CMA, including the recognition of hydrolysed rice-based formulas and increased demand for nutritionally complete plant-based options, some of which are currently being assessed. The addition of pro, pre and synbiotics is considered safe to use, although research and guidance on routine use remain absent. Knowledge of tolerance induction from studies on the early introduction of peanuts has also highlighted the importance of a more active approach to managing CMA with the use of milk ladders, primarily in non-IgE-mediated CMA and baked milk (BM) introduction in IgE-mediated CMA. In addition, modulation of the microbiome and diet diversity during complementary feeding has been a major advancement in the last 10 years. While data on poor growth and feeding difficulties in children with CMA has not changed much, increased rates of obesity are now also reported. Finally, novel approaches, including oral immunotherapy, the use of milk ladders and earlier consideration of BM, have advanced somewhat in the last decade, although the risks and benefits of these novel approaches require further research. While CMA remains a complicated allergy to diagnose and manage, the evolution of science has advanced our knowledge and brought some novel innovations, which combined have enhanced our practice., (© 2024 The Author(s). Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association.)

Chronic eosinophilic inflammation is associated with tissue remodeling and fibrosis in a number of chronic T-helper 2 (Th2)-mediated diseases including eosinophilic esophagitis (EoE) and asthma. Chronic inflammation results in dysregulated tissue healing, leading to fibrosis and end organ dysfunction, manifesting clinically as irreversible airway obstruction in asthma and as esophageal rigidity, strictures, narrowing, dysmotility, dysphagia, and food impactions in EoE. Current therapies for EoE and asthma center on reducing inflammation-driven tissue remodeling and fibrosis with corticosteroids, coupled with symptomatic control and allergen avoidance. Additional control of Th2 inflammation can be achieved in select asthma patients with biologic therapies such as anti-IL-5 and anti-IL-13 antibodies, which have also been trialed in EoE. Recent molecular analysis suggests an emerging role for structural cell dysfunction, either inherited or acquired, in the pathogenesis and progression of EoE and asthma tissue remodeling. In addition, new data suggest that inflammation-independent end organ rigidity can alter structural cell function. Herein, we review emerging data and concepts for the pathogenesis of tissue remodeling and fibrosis primarily in EoE and relevant pathogenetic parallels in asthma, focusing additionally on emerging disease-specific therapies and the ability of these therapies to reduce tissue remodeling in subsets of patients.

BackgroundFood allergy is an important public health problem because it affects children and adults, can be severe and even life-threatening, and may be increasing in prevalence. Beginning in 2008, the National Institute of Allergy and Infectious Diseases, working with other organizations and advocacy groups, led the development of the first clinical guidelines for the diagnosis and management of food allergy. A recent landmark clinical trial and other emerging data suggest that peanut allergy can be prevented through introduction of peanut-containing foods beginning in infancy.ObjectivesPrompted by these findings, along with 25 professional organizations, federal agencies, and patient advocacy groups, the National Institute of Allergy and Infectious Diseases facilitated development of addendum guidelines to specifically address the prevention of peanut allergy.ResultsThe addendum provides 3 separate guidelines for infants at various risk levels for the development of peanut allergy and is intended for use by a wide variety of health care providers. Topics addressed include the definition of risk categories, appropriate use of testing (specific IgE measurement, skin prick tests, and oral food challenges), and the timing and approaches for introduction of peanut-containing foods in the health care provider's office or at home. The addendum guidelines provide the background, rationale, and strength of evidence for each recommendation.ConclusionsGuidelines have been developed for early introduction of peanut-containing foods into the diets of infants at various risk levels for peanut allergy.

Peanut allergy is an IgE-mediated adverse reaction to a subset of proteins found in peanuts. Immunotherapy aims to desensitize allergic patients through repeated and escalating exposures for several months to years using extracts or flours. The complex mix of proteins and variability between preparations complicates immunotherapy studies. Moreover, peanut immunotherapy is associated with frequent negative side effects and patients are often at risk of allergic reactions once immunotherapy is discontinued. Allergen-specific approaches using recombinant proteins are an attractive alternative because they allow more precise dosing and the opportunity to engineer proteins with improved safety profiles. We tested whether Ara h 1 and Ara h 2, two major peanut allergens, could be produced using chloroplast of the unicellular eukaryotic alga, Chlamydomonas reinhardtii. C. reinhardtii is novel host for producing allergens that is genetically tractable, inexpensive and easy to grow, and is able to produce more complex proteins than bacterial hosts. Compared to the native proteins, algal-produced Ara h 1 core domain and Ara h 2 have a reduced affinity for IgE from peanut-allergic patients. We further found that immunotherapy using algal-produced Ara h 1 core domain confers protection from peanut-induced anaphylaxis in a murine model of peanut allergy.

BackgroundAtopic dermatitis (AD) is often the first step in the atopic march leading to the development of asthma or allergic rhinitis. The goal of this study was to determine whether early intervention with pimecrolimus limits the atopic march in infants with AD and to evaluate its efficacy and safety.MethodsThis was a 3-year double-blind study in which patients were randomized to pimecrolimus or vehicle and then open-label pimecrolimus for a planned further 3 years. Rescue topical corticosteroid was permitted if 3 days of study medication led to no improvement; investigators made decisions on rescue medication until week 14 and caregivers thereafter. Efficacy assessments included disease-free days, Eczema Area and Severity Index, and body surface area affected.ResultsInfants ages 3 to 18 months with recent-onset AD (≤3 months) were observed for a mean of 2.8 years (N = 1,091). No significant differences between pimecrolimus- and placebo-treated groups were found in the percentage of patients with AD who developed asthma (10.7%) or other allergic conditions (allergic rhinitis, 22.4%; food allergy, 15.9%; allergic conjunctivitis, 14.1%; one or more atopic comorbidities, 37.0%) by study end. Allergic rhinitis, food allergy, and having one or more atopic comorbidities (but not asthma or allergic conjunctivitis alone) developed significantly more often in infants with greater AD severity at baseline. Pimecrolimus was significantly more effective than vehicle for AD treatment at week 14. Adverse event incidences were similar.ConclusionsThis longitudinal observation of infants with AD provides evidence of the atopic march. Pimecrolimus was safe and effective in infants with mild to moderate AD.

Eosinophilic esophagitis (EoE), a food antigen-mediated disease, is effectively treated with the dietary elimination of 6 foods commonly associated with food allergies (milk, wheat, egg, soy, tree nuts/peanuts, and fish/shellfish). Because wheat shares homologous proteins (including gluten) with barley and rye and can also be processed with these grains, some clinicians have suggested that barley and rye might also trigger EoE as a result of cross-reaction and/or cross-contamination with wheat. In this article, we discuss the theoretical risks of cross-reactivity and cross-contamination among wheat, barley, and rye proteins (including gluten); assess common practices at EoE treatment centers; and provide recommendations for dietary treatment and future studies of EoE.

The dietary avoidance of allergens has been widely recognized as the key intervention in the management of food allergies, but the presence of undeclared allergens makes compliance difficult. The aim of this study was to analyze the presence of undeclared allergens in food labeling through RASFF notifications in the European Union, focusing on those allergens that frequently affect the pediatric population and the implicated products, so as to provide useful information for its risk evaluation and the development of educational materials for patients. The results showed milk (20.5%), gluten (14.8%), and nuts (10.9%) to be the pediatric allergens with higher presences. In 80% of the notifications concerning milk and milk derivatives, the specific compound present (lactose or lactoprotein) was not identified. They were mainly present in cereal and bakery products, prepared dishes and snacks, and cacao and confectionery products, all of which are frequently consumed by the pediatric population. The large quantity (7.6%) of undeclared allergens in "free-from-allergen" products was also remarkable, especially in regard to the supposedly not-present allergens. Undeclared allergens in food products pose an evident risk for allergic patients and knowledge of them should take a relevant role in a patient's nutritional education. It is also necessary to raise awareness among manufacturers and safety authorities. [ABSTRACT FROM AUTHOR]

Background: Early life body mass index (BMI) trajectories influence the risk of asthma at 18 years of age. However, it is unclear if these are also associated with other allergic diseases. Objectives: We investigated the associations between BMI trajectories and subsequent allergic rhinitis, eczema and food sensitisation/allergies. Methods: Parent‐reported anthropometric data were collected 18 times in the first two years of life from a cohort of 620 participants in a high‐risk cohort. Group‐based trajectory modelling was applied to develop BMI trajectories. Associations between trajectories and allergic rhinitis, eczema and food sensitisation at 6, 12 and 18 years of age were assessed using logistic regression models. Potential effect modifications by parental allergic disease, sex and allocated infant formula were assessed. Results: We identified five BMI trajectories: average, below average, persistently low, early low and catch up, and persistently high. None showed an association with allergic rhinitis. In participants with maternal allergic rhinitis, 'early‐low and catch‐up' (OR = 2.83;95%CI 1.34‐5.96, Pint = 0.05) and 'below average' trajectories (OR = 2.39; 1.18‐7.23, Pint = 0.02) were associated with allergic rhinitis at 18 years of age compared with the average trajectory. No associations were observed with eczema or food sensitisation. Conclusion: Infants with early‐low and catch‐up, or below average BMI growth, were at increased risk of allergic rhinitis at 18 years if they had a mother with allergic rhinitis. These results require replication, but suggest that interactions between poor intrauterine growth, failure to thrive and maternal allergies may influence the risk of allergic rhinitis. [ABSTRACT FROM AUTHOR]

Patients with atopic dermatitis (AD) are at increased risk of atopic and non-atopic comorbidities. In fact, the Hanifin and Rajka criteria include allergic and infectious comorbidities as a minor criterion. Despite the well-recognized list of comorbidities, the past 15 years greatly expanded the list of recognized comorbidities of AD. This narrative review focuses on comorbidities of AD using a mnemonic, VINDICATE-P: vascular/cardiovascular, infectious, neoplastic and neurologic, degenerative, iatrogenic, congenital, atopic and autoimmune, traumatic, endocrine/metabolic, and psychiatric. The comorbidities of AD vary by age. More research is needed into the mechanisms of comorbidities and optimal screening strategies in AD patients., Competing Interests: Disclosure J.I. Silverberg has received honoraria as a consultant and/or advisory board member for Abbvie, Alamar, Aldena, Amgen, AObiome, Apollo, Arcutis, Arena, Asana, Aslan, Attovia, BioMX, Biosion, Bodewell, Boehringer-Ingelheim, Bristell-Meyers Squibb, Cara, Castle Biosciences, Celgene, Connect Biopharma, Corevitas, Dermavant, Eli Lilly, FIDE, Galderma, GlaxoSmithKline, Incyte, Inmagene, Invea, Kiniksa, Leo Pharma, Merck, My-Or Diagnostics, Nektar, Novartis, Optum, Pfizer, RAPT, Recludix, Regeneron, Sandoz, Sanofi-Genzyme, Shaperon, TARGET-RWE, Teva, Union, UpToDate; speaker for Abbvie, Eli Lilly, Leo Pharma, Pfizer, Regeneron, Sanofi-Genzyme; institution received grants from Galderma, Incyte, Pfizer. Nanette Silverberg has received honoraria as a consultant, speaker, and/ or advisory board member for Incyte, Leo. Novan, Pfizer, Regeneron, Sanofi-Genzyme, and Verrica Pharmaceuticals., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Despite recent improvements, infant and young child feeding (IYCF) remains a challenge in Basra, Iraq., Aim: To describe the predictors of IYCF knowledge among new mothers in Basra City, Iraq., Methods: This cross-sectional study collected data on infant nutrition knowledge from 400 new mothers attending 12 primary health care centres in Basra, Iraq, between February and June 2023. Jamovi version 2.3 was used for statistical analyses. Predictive analysis was performed with univariable and multivariable ordinal logistic regression, and the results were reported as crude and adjusted odds ratios with 95% confidence interval. P < 0.05 was considered significant., Results: Most (60%) of the women interviewed were younger than 19 years, married (98%), living in an extended family setting (93%), and in the lowest income level (76%). Age ≤19 was a significant predictor of knowledge about breastfeeding, formula feeding, complementary feeding, water and supplements, and food allergies (adjusted odds ratio range 2.24-5.30). Unemployment and low education status predicted lower knowledge about breastfeeding, complementary feeding, water and supplements, and food allergies, but neither unemployment nor low education status predicted lower knowledge about formula feeding. Receiving information from doctors or healthcare workers and social media or the internet was associated with better maternal IYCF knowledge while receiving information from family and friends predicted poorer knowledge about food allergy and water and supplements., Conclusion: IYCF education in Basra should be improved, with particular attention to healthcare worker-mediated and social media- and family systems-based approaches. Priority should be given to the less educated, younger and unemployed women and those in the lower income group., (Copyright: © Authors 2024; Licensee: World Health Organization. EMHJ is an open access journal. All papers published in EMHJ are available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Atopic dermatitis (AD) is a common chronic skin condition in children that has a proven association with other atopic conditions and allergies. These associations, like the general pathophysiology of AD, are complex and not fully understood. While there is evidence for the efficacy of specific immunotherapy (SIT) in pediatric asthma and allergic rhinitis (AR), there is a lack of strong data to support its use in AD. IgE has been shown to be elevated in many patients with AD, but it is an unreliable biomarker due to variability and great fluctuation over time, poor positive predictive value for clinically relevant allergy, and poor correlation with disease state. In spite of this, almost all studies of SIT use either positive skin prick testing (SPT) or serum specific IgE levels to guide therapy. Allergen avoidance, with some exceptions, is generally not effective at controlling AD in children. The few studies that have investigated the efficacy of SIT in children with AD have produced conflicting results, and a lack of reproducibility with a standard treatment protocol. Limited studies have shown clinical improvement in mild to moderate AD cases, but no effect on more severe patients. Uncontrolled studies are difficult to interpret, due to the natural history of remission or "outgrowing" of AD over time in many patients without specific interventions. Drawbacks to SIT include the length of treatment, poor compliance, cost, and potential side effect profile. The potential for misdirection of time and energy away from skin directed therapy could negatively impact on AD outcomes.

BackgroundAccurate diagnosis of mosquito allergy has been hampered by the laborious task of obtaining mosquito salivary allergens. We have previously studied 3 recombinant (r) Aedes aegypti mosquito salivary allergens: rAed a 1, rAed a 2 and rAed a 3. Here, we report the expression, purification, identification and evaluation of rAed a 4, a 67-kDa α-glucosidase.MethodsrAed a 4 was expressed using a baculovirus/insect cell system, purified by a combination of anion- and cation-exchange chromatography, and identified by immunoblotting. A. aegypti saliva extract was prepared in our laboratory. An indirect enzyme-linked immunosorbent assay (ELISA) was developed to measure rAed a 4-specific immunoglobulin E (IgE) and IgG antibodies in sera from 13 individuals with a positive mosquito-bite test from a laboratory-reared mosquito. Sera from 18 individuals with a negative bite test served as controls.ResultsPurified rAed a 4 bound to the IgE in mosquito-allergic sera, as detected by ELISA and immunoblotting. The binding of rAed a 4 to IgE could be inhibited in a dose-dependent manner by the addition of an A. aegypti extract. Mosquito-allergic individuals had significantly higher mean levels of rAed a 4-specific IgE and IgG than controls. Using the mean of the controls ± 2 SD as a cut-off level, 46% of the 13 allergic individuals had a positive IgE, while none of the controls was positive (p < 0.001).ConclusionsAed a 4 is a major allergen in mosquito saliva. Its recombinant form has the hydrolase function and can be used for the diagnosis of mosquito allergy.

There has been concern that patients with asthma may develop more severe disease as a result of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Recent studies towards the exploration of the clinical aspects of COVID-19 have opened up a new postulation citing that people with minor allergies particularly food allergies have reported to possess lower chances of being infected. This postulation is cited more specifically for food allergies and asthma. However, the research on the validity of the postulation has not been done significantly and therefore the currently available literature does not provide a vivid elucidation of this association. Thus, this article highlights the current gaps and loopholes present in the current literature to give an impetus to the future researches considering to establish the possible connection between the pathobiology of COVID with allergic problems. It also discusses the possible interventions of the postulation in detail in coordination with the currently available confirmations. It will help in understanding the susceptibility and risk factors associated with the SARS-Cov2 virus disease which would eventually lead to the development of novel treatments and therapeutics for allergic conditions and COVID-19 disease. [ABSTRACT FROM AUTHOR]

Regulating the composition of human breastmilk has the potential to prevent allergic diseases early in life. The composition of breastmilk is complex, comprising varying levels of oligosaccharides, immunoactive molecules, vitamins, metabolites, and microbes. Although several studies have examined the relationship between different components of breastmilk and infant food allergies, few have investigated the relationship between microorganisms in breastmilk and infant food allergy. In the present study, we selected 135 healthy pregnant women and their full-term newborns from a cohort of 202 mother–infant pairs. Among them, 69 infants were exclusively breastfed until 6 mo after birth. At follow-up, 11 of the 69 infants developed a food allergy in infancy while 22 showed no signs of allergy. Thirty-three breastmilk samples were collected within 1 mo after delivery, and 123 infant fecal samples were collected at five time points following their birth. These samples were analyzed using microbial 16S rRNA gene sequencing. The abundance and evenness of the milk microbiota and the number of differential bacteria were higher in the breastmilk samples from the non-allergy group than in those from the food allergy group. The non-allergy group showed relatively high abundance of Bifidobacterium, Akkermansia, Clostridium IV, Clostridium XIVa, Veillonella, and butyrate-producing bacteria such as Fusobacterium, Lachnospiraceae incertae sedis, Roseburia, and Ruminococcus. In contrast, the abundance of Proteobacteria, Acinetobacter, and Pseudomonas in breastmilk was higher in the food allergy group. A comparison of the changes in dominant differential breastmilk microbiota in the intestinal flora of the two groups of infants over time revealed that the changes in Bifidobacterium abundance were consistent with those in the breastmilk flora. Functional pathway prediction of breastmilk microflora showed that the enhancement of the metabolic pathways of tyrosine, tryptophan, and fatty acids was significantly different between the groups. We suggest that changes in the breastmilk microbiota can influence the development of food allergies. Breastmilk contains several microbes that have protective effects against food allergies, both by influencing the colonization of intestinal microbiota and by producing butyrate. This study may provide new ideas for improving infant health through early intervention with probiotics.

Regulating the composition of human breastmilk has the potential to prevent allergic diseases early in life. The composition of breastmilk is complex, comprising varying levels of oligosaccharides, immunoactive molecules, vitamins, metabolites, and microbes. Although several studies have examined the relationship between different components of breastmilk and infant food allergies, few have investigated the relationship between microorganisms in breastmilk and infant food allergy. In the present study, we selected 135 healthy pregnant women and their full-term newborns from a cohort of 202 mother–infant pairs. Among them, 69 infants were exclusively breastfed until 6 mo after birth. At follow-up, 11 of the 69 infants developed a food allergy in infancy while 22 showed no signs of allergy. Thirty-three breastmilk samples were collected within 1 mo after delivery, and 123 infant fecal samples were collected at five time points following their birth. These samples were analyzed using microbial 16S rRNA gene sequencing. The abundance and evenness of the milk microbiota and the number of differential bacteria were higher in the breastmilk samples from the non-allergy group than in those from the food allergy group. The non-allergy group showed relatively high abundance of Bifidobacterium , Akkermansia , Clostridium IV, Clostridium XIVa, Veillonella , and butyrate-producing bacteria such as Fusobacterium , Lachnospiraceae incertae sedis , Roseburia , and Ruminococcus. In contrast, the abundance of Proteobacteria , Acinetobacter , and Pseudomonas in breastmilk was higher in the food allergy group. A comparison of the changes in dominant differential breastmilk microbiota in the intestinal flora of the two groups of infants over time revealed that the changes in Bifidobacterium abundance were consistent with those in the breastmilk flora. Functional pathway prediction of breastmilk microflora showed that the enhancement of the metabolic pathways of tyrosine, tryptophan, and fatty acids was significantly different between the groups. We suggest that changes in the breastmilk microbiota can influence the development of food allergies. Breastmilk contains several microbes that have protective effects against food allergies, both by influencing the colonization of intestinal microbiota and by producing butyrate. This study may provide new ideas for improving infant health through early intervention with probiotics. [ABSTRACT FROM AUTHOR]

Background: The prevalence of precautionary allergen labelling (PAL) on food products is estimated at 65%, but PAL is inconsistently applied. Consumers believe that PAL is well regulated, but their knowledge and practice of PAL is unsound, which is inconsistent with their apparent lack of trust in PAL statements. PAL should be clearly visible, easily understandable, reliable and precise in indicating 'real risk'. Objectives: The primary objective was to determine the knowledge and practice (including adherence) of South African parents and/or caregivers regarding PAL in managing immune-mediated food allergies in children. Methods: This study was a descriptive cross-sectional investigation with an analytical component. The study population consisted of parents and/or caregivers of children (birth to ten years) with an immune-mediated food allergy in South Africa. An online self-administered questionnaire was the instrument used for data collection. Results: Of the 140 participants included in the study, 98% were aware that there is a special statement on food labels indicating food allergens. The majority (84%) considered the phrase 'contains' to indicate a real risk of allergen contamination, 64% for 'may contain', 56% for 'made with the same equipment' and 40% for 'made in the same factory'. Only 29% indicated that they would read the food label every time before using a food product. Non-adherence to the PAL statement 'made with the same equipment as (the allergen-containing food)' was associated with a life-threatening reaction (p = 0.007) or a visit to an emergency unit (p = 0.033). Conclusion: This research shows that parents of children with food allergies either do not understand PAL fully or do not implement PAL statements effectively. It is vital to standardise PAL locally and globally to indicate 'real risk' or 'no risk' in order for consumers to recognise best practice in eliminating the risk of being exposed to allergen-containing food products. [ABSTRACT FROM AUTHOR]

"Food is relationships isn't it," Yamada san stated in 2017, neatly capturing the importance of food in social life. This article, drawing on the experiences of people with severe food allergies in Japan, illustrates the complexities of safely managing allergies when food—and the importance of sharing the same food—is so important to social life. In particular, I argue that individuals develop and practice skills of vigilance and situational awareness to mitigate physical and social risk which emerge through an affective imagination of what they feel could happen in the future, built on embodied memories of what has been experienced prior (e.g., severe allergic reactions and difficult social experiences with food). The development and enactment of these skills of vigilance happen through an 'education of attention' (Gibson in The ecological approach to visual perception, Psychology Press, New York, 1979; Ingold in The perception of the environment: essays on livelihood, dwelling and skill, Routledge, London, 2000) developed over time and in different social settings and constitute a somatic mode of attention (Csordas in Cult Anthropol 8:135–156, 1993) which shapes social interactions and aims to mitigate against any potential perceived social costs for not being able to eat everything. [ABSTRACT FROM AUTHOR]

Internists are front-line health care providers that commonly provide the first encounter to patients for dermatological conditions, especially atopic dermatitis (AD). Internists need to be comfortable with managing mild-moderate AD in their practices. Criteria and guidelines established in dermatology literature are available to help the general practitioner diagnose and treat AD. AD is a systemic disease associated with multiple cutaneous and extra-cutaneous comorbidities that warrant screening by internists, especially mental health conditions. Environmental factors may play a role in the development or worsening of AD; however, there is currently no strong evidence to guide specific population- or clinic-based interventions for their avoidance. While food allergies are common in AD patients, the role of food allergens as an exacerbating factor for AD is controversial. Before starting any dietary modifications, careful evaluation should be performed by an allergist. If the patient is not well-controlled despite adequate topical therapies or is experiencing severe/worsening disease, early referral to dermatology is warranted to rule out confounding diagnoses and/or escalation to systemic therapies. Finally, it is important to recognise the racial disparities present in AD and address these when formulating treatment plans. Confounding dermatoses, either instead of or in addition to AD, should be considered in treatment-refractory AD, and the appropriate workup may be initiated while awaiting dermatology referral. AD patients have multiple cutaneous and extra-cutaneous comorbidities that warrant screening by internists, especially mental health conditions. [ABSTRACT FROM AUTHOR]