Search

This document contains abstracts from the journal "Pediatric Allergy & Immunology" covering a range of topics related to pediatric allergies. The abstracts discuss studies on early introduction of peanuts to prevent peanut allergy, the indirect costs of food allergy management, the effectiveness of dupilumab in treating eosinophilic esophagitis, the safety of oral immunotherapy in preschool-aged children, the association between diverse diet in infancy and reduced risk of food allergies, the burden of allergic rhinitis in children, the use of omalizumab in severe allergic asthma, and various other studies on different aspects of pediatric allergies. The abstracts provide valuable insights into the diagnosis, management, and treatment of pediatric allergies. [Extracted from the article]

This letter to the editor discusses the diagnosis and potential role of gut-originating immunoglobulin E (IgE) in non-IgE-mediated cow's milk protein allergy (CMA). The study measured fecal IgE levels in infants with suspected non-IgE CMA before and after an oral food challenge (OFC) with cow's milk protein. The results showed a transient increase in fecal IgE levels in confirmed non-IgE CMA cases, which decreased when dairy products were removed from the diet. These findings suggest a possible involvement of gut-originating IgE in the pathogenesis of non-IgE CMA. Further research is needed to confirm these preliminary findings and explore the mechanisms involved. [Extracted from the article]

Background/aim: Data on the prevalence of allergic diseases in children with proven drug allergies are limited. We aim to evaluate the frequency of allergic comorbidity in children with proven common drug allergies. Materials and methods: Children with drug hypersensitivity confirmed by diagnostic allergy tests at our center between January 2010 and December 2020 were screened retrospectively. Patients with the most common drug allergies (due to antibiotics, nonsteroidal antiinflammatory drugs [NSAIDs], and antiepileptic drugs) were selected for analysis. Age, sex, the culprit drug, initial reaction characteristics, diagnostic test results, and the study physician who diagnosed concomitant allergic diseases were noted. Results: A total of 168 patients (boys, 51.2%) with a median age of 12 years (IQR = 8-16.3) were included in the study. The culprit drug was an antibiotic in 63% (n = 106), NSAID in 25% (n = 42) and anticonvulsant in 11.9 % (n = 20) of the patients. Drug hypersensitivity reactions were immediate in 74.4 % (n = 125) and delayed in 25.6 % (n = 43) of the patients. Seventy-five patients (44.6 %) had at least one allergic disease, most commonly rhinitis (27.3 %, n = 46) or asthma (25 %, n = 42). Fifty-five patients underwent skin prick tests with aeroallergens, producing a positive result in 60% (n = 31). The prevalence of allergic disease was not differing according to the culprit drug. The frequency of developing at least one concomitant allergic disease was 47.2% (n = 50/106) for antibiotic hypersensitivity, 52.4% (n = 22/42) for NSAID hypersensitivity, and 15% (n = 3/20) for anticonvulsant hypersensitivity (p < 0.00). Immediate drug hypersensitivity reactions were more frequent in children who had allergic diseases (80 % vs. 64.5 %; p = 0.027). Conclusion: Nearly half (44.6%) of the children with proven drug hypersensitivity had concomitant allergic diseases and immediate reactions were more common in this group. Children evaluated for drug hypersensitivity should be assessed for other allergic diseases. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal symptoms after drinking milk are often attributed to lactose intolerance or cow's milk allergy. However, some individuals without either condition still report gastrointestinal symptoms after drinking milk. This may be caused by gastric emptying (GE) rate or gastric protein coagulation. This study aimed to compare GE rate and protein coagulation after milk consumption between individuals reporting gastrointestinal symptoms and those without symptoms using a novel gastric MRI approach. Methods: Thirty women were included in this case–control study, of whom 15 reported gastrointestinal symptoms after drinking milk and 15 were controls. Participants underwent gastric MRI before and up to 90 min after consumption of 250 mL cow's milk. Gastric content volume and image texture of the stomach contents were used to determine GE and changes in the degree of coagulation. Key Results: GE half‐time did not differ between the groups (gastrointestinal symptom group 66 ± 18 min; control group 61 ± 14 min, p = 0.845). The gastrointestinal symptom group reported symptoms from 30 min onwards and rated pain highest at 90 min. The control group reported no symptoms. Image texture analyses showed a significantly higher percentage of coagulum and lower percentage of liquid in the group in the GI symptom group (MD 11%, 95% CI [3.9, 17], p = 0.003). In vitro data suggests that pH and proteolytic enzyme activity influence the coagulum structure. Conclusions and Inferences: Gastric milk coagulation and emptied fraction of stomach content may differ between individuals experiencing symptoms after milk consumption, possibly due to differences in pH and proteolytic enzyme activity. [ABSTRACT FROM AUTHOR]

As a potential link between genetic predisposition, environmental exposures, and food allergy outcomes, epigenetics has been a molecular variable of interest in ongoing efforts to understand food allergy mechanisms and outcomes. Here we review population‐based investigations of epigenetic loci associated with food allergy, focusing on established clinical food allergy. We first provide an overview of epigenetic mechanisms that have been studied in cohorts with food allergy, predominantly DNA methylation but also microRNA. We then discuss investigations that have implemented epigenome‐wide approaches aimed at genome‐wide profiling and discovery. Such epigenome‐wide studies have collectively identified differentially methylated and differentially regulated loci associated with T cell development, antigen presentation, reaction severity, and causal mediation in food allergy. We then discuss candidate‐gene investigations that have honed in on Th1, Th2, T regulatory, and innate genes of a priori interest in food allergy. These studies have highlighted methylation changes in specific candidate genes as associated with T regulatory cell activity as well as differential methylation of Type 1 and Type 2 cytokine genes associated with various food allergies. Intriguingly, epigenetic loci associated with food allergy have also been explored as potential biomarkers for the clinical management of food allergy. We conclude by highlighting several priority directions for advancing population‐based epigenomic and epigenetic understandings of food allergy. [ABSTRACT FROM AUTHOR]

Oral immunotherapy (OIT) can ameliorate cow's milk allergy (CMA); however, the achievement of sustained unresponsiveness (SU) is challenging. Regarding the pathogenesis of CMA, recent studies have shown the importance of gut microbiota (Mb) and fecal water-soluble metabolites (WSMs), which prompted us to determine the change in clinical and gut environmental factors important for acquiring SU after OIT for CMA. We conducted an ancillary cohort study of a multicenter randomized, parallel-group, delayed-start design study on 32 school-age children with IgE-mediated CMA who underwent OIT for 13 months. We defined SU as the ability to consume cow's milk exceeding the target dose in a double-blind placebo-controlled food challenge after OIT followed by a 2-week-avoidance. We longitudinally collected 175 fecal specimens and clustered the microbiome and metabolome data into 29 Mb- and 12 WSM-modules. During OIT, immunological factors improved in all participants. However, of the 32 participants, 4 withdrew because of adverse events, and only 7 were judged SU. Gut environmental factors shifted during OIT, but only in the beginning, and returned to the baseline at the end. Of these factors, milk- and casein-specific IgE and the Bifidobacterium -dominant module were associated with SU (milk- and casein-specific IgE; OR for 10 kU A /L increments, 0.67 and 0.66; 95%CI, 0.41–0.93 and 0.42–0.90; Bifidobacterium -dominant module; OR for 0.01 increments, 1.40; 95%CI, 1.10–2.03), and these associations were observed until the end of OIT. In this study, we identified the clinical and gut environmental factors associated with SU acquisition in CM-OIT. [ABSTRACT FROM AUTHOR]

Atopic dermatitis, a multifactorial, relapsing, and inflammatory condition, can affect the patient’s quality of life to a great extent. Simultaneous food allergy has also been noted in many patients with atopic dermatitis. Cow milk protein allergy is a commonly reported issue in children. Here, we presented a case of allergic reaction in a 2-month-old boy diagnosed with cow’s milk allergy based on mild atopic dermatitis despite the absence of immediate symptoms after milk ingestion. Dietary modifications (feeding of the exclusive hydrolyzed formula; elimination diet) were suggested; however, as there was no apparent improvement in the child’s symptoms, the parents reintroduced regular formula to his diet. The first re-exposure led to immediate reactions in the form of hives and irritability. The condition was diagnosed with an allergic reaction on presentation to the emergency room and was managed successfully. The follow‑up visit confirmed the diagnosis of IgE‑mediated cow’s milk allergy based on the history and the positive allergy testing to cow’s milk. Putting the child suffering from atopic dermatitis on a strict elimination diet might not be prudent as it increases the financial burden and the risk of developing severe life‑threatening allergic reactions following accidental exposure to the allergen, as repeated oral exposure to allergens is very important for the development of tolerance. [ABSTRACT FROM AUTHOR]

Introduction: During an oral food challenge (OFC), there is a risk of adverse reactions, including anaphylaxis. Therefore, the physician should carefully conduct the OFC. This study aimed to evaluate the OFC results in individuals with low levels of egg white (EW)- and ovomucoid (OVM)-specific immunoglobulin E (sIgE) and the safety of a hen's egg (HE) OFC in these individuals. Methods: A total of 2,058 individuals with low EW- or OVM-sIgE underwent HE-OFC at two institutions in Kumamoto prefecture, located in the western area of Japan, between January 1, 2017, and December 31, 2021, within 1 year of recorded sIgE measurements. The ImmunoCAP systems were used to measure sIgEs. The HE-OFC test was performed according to the 2017 Food Allergy Guidelines in an open and unblinded method. Results: Five hundred and one individuals (24.3%) had low EW-sIgE levels (class 2 or lower), and 926 (45.0%) had low OVM-sIgE levels (class 2 or lower). Individuals with low EW-sIgE had lower total IgE and OVM-sIgE than did those with high EW-sIgE (greater than class 2). Those with low OVM-sIgE had lower total IgE and EW-sIgE than did those with high OVM-sIgE (greater than class 2). Among the individuals with low EW-sIgE, 86.4% (433/501 cases) passed the OFC without symptoms. Among the individuals with low OVF-sIgE, 82.6% (765/926 cases) passed the OFC without symptoms. Conclusion: More than 80% of individuals with suspected IgE-dependent HE allergy and low levels of EW- or OVM-specific IgE were able to consume at least a small amount of HE. As the OFC results are independent of the loading dose in cases with low EW- or OVM-sIgE, a medium-dose HE-OFC may be performed safely in individuals with no history of anaphylaxis. [ABSTRACT FROM AUTHOR]

Introduction: Atopic dermatitis (AD) is characterized by an impaired epidermal barrier, which could be associated with sensitization to food allergens (FAs) and/or inhaled allergens and contribute to the severity of AD. However, no clinical guidance has been established for evaluations of food sensitization (FS) in AD patients. This study investigated how AD severity and epidermal barrier impairment are associated with FS and factors that can predict FS in children with AD. Methods: This cross-sectional study included 100 children (12–60 months) diagnosed with AD. AD severity was determined using the Scoring Atopic Dermatitis (SCORAD) index. FS was evaluated by measuring serum-specific IgE antibodies against 31 FAs using an immunoblotting method. Epidermal barrier impairment was assessed by measuring transepidermal water loss (TEWL) and stratum corneum hydration (SCH) levels. Results: 90% of participants were sensitized to at least one tested FA, with cow's milk, egg white, beef, almond, egg yolk, and peanut being the most common. Children with moderate-severe AD had lower SCH levels than those with mild AD. Children with AD who were sensitized to >10 FAs had significantly higher TEWL and lower SCH levels, compared with those sensitized to 1–4 FAs and 5–10 FAs. The SCORAD score and SCH level in lesional skin provided moderately predictive value for sensitization to FAs in children with AD. Conclusion: FS is common in children with AD and closely associate with AD severity as well as epidermal barrier impairment. Evaluations of FS should be considered for children with moderate to severe AD and/or low SCH levels. [ABSTRACT FROM AUTHOR]

We describe a series of 7 toddler-aged children with iron deficiency anemia from excessive cow's milk consumption who presented with cerebral venous sinus thrombosis and no other identifiable risk factors for thrombosis. The deep venous system was involved in 6 patients, 6 had venous infarcts, and 5 have significant neurocognitive sequelae. [ABSTRACT FROM AUTHOR]

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE cell mediated food allergy triggered by the ingestion of specific food proteins that may manifest in an acute or chronic form. We report a case of an infant with severe chronic FPIES presenting in the neonatal period that failed to respond to amino acid-based formulas. The patient remained on total parenteral nutrition for 4 weeks and after that he could tolerate amino acid formula. Our case suggests that bowel rest for extended periods may be necessary for severe cases of FPIES, while endoscopy may be helpful in the differential diagnosis and the therapeutic management of these cases. [ABSTRACT FROM AUTHOR]

This article discusses the efficacy of skin care interventions in preventing eczema and food allergy in infants. The study found that emollients, such as moisturizers, during infancy do not significantly impact the risk of developing eczema. However, they may increase the chance of developing mild local skin infections. The study also highlights a lack of trials studying other approaches to infant skincare for preventing eczema. Further research is needed to understand whether different approaches to infant skin care might prevent eczema or food allergy. [Extracted from the article]

Cow milk is a major allergenic food. The potential prevention and treatment effects of lactic acid bacteria (LAB)-fermented dairy products on allergic symptoms have garnered considerable attention. Cow milk allergy (CMA) is mainly attributed to extracellular and/or cell envelope proteolytic enzymes with hydrolysis specificity. Numerous studies have demonstrated that LAB prevents the risk of allergies by modulating the development and regulation of the host immune system. Specifically, LAB and its effectors can enhance intestinal barrier function and affect immune cells by interfering with humoral and cellular immunity. Fermentation hydrolysis of allergenic epitopes is considered the main mechanism of reducing CMA. This article reviews the linear epitopes of allergens in cow milk and the effect of LAB on these allergens and provides insight into the means of predicting allergenic epitopes by conventional laboratory analysis methods combined with molecular simulation. Although LAB can reduceCMAin several ways, the mechanism of action remains partially clarified. Therefore, this review additionally attempts to summarize the main mechanism of LAB fermentation to provide guidance for establishing an effective preventive and treatment method for CMA and serve as a reference for the screening, research, and application of LAB-based intervention. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate outcomes of oral food challenge (OFC) test to assess tolerance in infants with non-IgE-mediated cow's milk allergy (CMA) with gastrointestinal manifestations and explore clinical data predictive of these outcomes. Methods: Single-center retrospective study including infants (age < 12 months) who were referred for CMA between 2000 and 2018 and underwent OFC on follow-up. A univariate logistic regression test was performed to evaluate variables associated with the outcomes of the follow-up OFC test. Results: Eighty-two patients were included, 50% were male. Eighteen patients had a positive OFC test (22%). Most patients had presented with hematochezia (77%). The median age of symptom onset was 30 days. Two-thirds of the patients were on appropriate infant formula (extensively hydrolyzed or amino acid-based formula), exclusively or in association with breastfeeding. The median time on an elimination diet before the OFC test was 8 months (Q1 6 - Q3 11 months). All cases with positive follow-up OFC tests (n = 18) had been exposed to cow's milkbased formula before the first clinical manifestation of CMA. Five out of eight cases with Food Protein-Induced Enterocolitis Syndrome (FPIES) had positive OFC tests. Exposure to cow's milkbased formula before diagnosis, a history of other food allergies, hematochezia and diarrhea were predictors of a positive OFC test. Conclusions: In infants with non-IgE-mediated CMPA with gastrointestinal manifestations, the use of cow's milk-based formula, a history of other food allergies, and hematochezia and diarrhea upon initial presentation were associated factors for the later achievement of tolerance. [ABSTRACT FROM AUTHOR]

This document contains summaries of several research studies related to allergies. The studies cover a range of topics, including the introduction of allergenic foods, the use of baked milk products for milk allergies, the impact of breastfeeding and pet exposure on food allergies, and the efficacy of oral immunotherapy for peanut allergy. These studies provide valuable insights into the prevention and treatment of allergies, highlighting the importance of personalized approaches and patient-reported outcomes. Library patrons conducting research on allergies will find these summaries helpful in understanding the latest findings in the field. [Extracted from the article]

Background: In Spain, IgE-mediated cow's milk protein allergy (CMPA) affects approximately 0.69% of infants. Molecular diagnosis may be useful for monitoring natural spontaneous tolerance development in CMPA. The aim of this study was to retrospectively analyse a cohort of paediatric patients with IgE-mediated CMPA who were avoiding milk products awaiting natural tolerance and determine the relationship between disease persistence and major cow's milk allergens. Methods: A retrospective chart review of 200 patients diagnosed with IgE-mediated CMPA between 2011 and 2020 was conducted. Patients strictly avoided milk products until an oral food challenge was performed. The main outcome was the introduction of liquid milk following a negative oral food challenge and its correlation with IgE and SPT measurements of milk components at diagnosis. Secondary outcomes included the rate of allergic reactions and anaphylaxis during the treatment period and its correlation with IgE and SPT measurements. Results: Of the 200 charts analysed, 122 patients had a negative oral food challenge to milk (61.0%) (95% confidence interval (CI): 54.1–67.5) following a period of strict avoidance of milk. Higher levels of component-specific IgE, especially casein, were associated with failure in the oral food challenge (p = 0.02). Allergic reactions were experienced by 106 children (53%), of which 34 (17%; 95% CI: 12.4–22.8) had anaphylactic reactions. The risk of anaphylaxis was not predicted by raised IgE levels. Conclusions: While a large proportion of children acquired natural tolerance to cow's milk following a period of strict avoidance, IgE-mediated CMPA persisted in many children. Casein IgE levels at diagnosis were raised in those who failed to achieve natural tolerance. Allergic reactions to milk, including anaphylaxis, occurred commonly, but this was not predicted by raised IgE levels or SPT measurements. [ABSTRACT FROM AUTHOR]

This article examines the public's interest and information-seeking behavior regarding food allergies. Using Google Trends, the study analyzed search trends and interest in 10 countries from 2012 to 2022. The study found a significant increase in interest in searching for information about food allergies, with milk allergy being the most searched topic in six out of the 10 countries. The study also identified spikes in interest related to specific events, such as a study linking cow's milk allergy to allergic symptoms in newborns and incidents of contaminated baby formula. The study concludes that Google Trends is a valuable tool for understanding public interest in food allergies and can inform policymakers and guideline developers. [Extracted from the article]

Background: Oral immunotherapy (OIT) is a promising treatment for food allergies. Our aim was to establish the long‐term safety and efficacy of a novel red meat (RM) OIT in galactose‐alpha‐1,3‐galactose (alpha‐gal) allergy in adults. Methods: Out of 20 patients with confirmed RM allergy, five (41.66%) underwent an early OIT, seven (58.33%) underwent a delayed protocol and eight patients who were not desensitized formed the patient control group. 15 and 27 day RM OIT for early‐onset and delayed‐onset alpha‐gal allergy were administered, respectively. Desensitized patients were recommended to continue eating at least 100 g RM every day for 6 months and every other day in the following 6 months. After a year, the consumption was recommended 2/3 times in a week. Patients were followed up with skin tests with commercial beef and lamb extracts, fresh raw/cooked beef and lamb and cetuximab and also with serum alpha‐gal specific Immunoglobulin‐E (sIgE) in the first and fifth years. Results: All patients who underwent OIT became tolerant to RM. During the 5 year follow‐up, the median alpha‐gal sIgE concentration gradually decreased in nine patients who consumed RM uneventfully while remained unchanged in the control group (p =.016). In two patients, rare tick bites acted as inducers of hypersensitivity reactions with concomitant elevation of alpha‐gal sIgE concentrations whereas one patient with low follow‐up alpha‐gal sIgE concentrations consumed RM uneventfully after frequent tick bites. Conclusions: Our study showed the long‐term safety and efficacy of alpha‐gal OIT. Additionally, alpha‐gal sIgE seems to be a potential biomarker to monitor OIT. [ABSTRACT FROM AUTHOR]

This document is a correction notice for the journal "Annals of Medicine." It provides a list of articles and their corrected page numbers that were published with incorrect information. The articles cover a range of topics including aging, forensic human identification, stroke recovery, synthetic cannabinoids, respiratory insufficiency, nursing communication, and more. The correction notice ensures that library patrons conducting research on these specific topics have accurate information to reference. Additionally, the document provides lists of research articles in various fields, including Dental Prosthesis, Environmental Sciences, Forensic Sciences, Health Sciences, Medicine, Microbiology, Nursing, Nutrition, Pharmacy, Psychology (Clinical and Forensic), Physiotherapy, Public Health, and Sociology and Social Sciences. Each article is accompanied by a title, a DOI number, and a corresponding code. These articles cover a range of topics within their respective fields, offering valuable insights and research findings. They can be valuable resources for library patrons conducting research in these specific areas. [Extracted from the article]

The probiotic bacteria, Lactiplantibacillus plantarum (L. plantarum) MCC5231, used in the present study has previously been characterized for several in vitro probiotic and functional properties such as antimicrobial compound production, tolerance to gastrointestinal tract conditions, adherence of mucin and fibronectin, antioxidant activity, cholesterol reduction, etc. Additionally, L. plantarum MCC5231 is a potential probiotic for regulating lipid metabolism under iv vivo conditions. Delivery of the probiotics through a non-dairy-based food system is a favorable option due to the several problems associated with dairy-based products, such as lactose intolerance, milk allergies, etc. Hence, in the present study, vegetable-based probiotic carrot nectar was developed by incorporating the probiotic bacterium L. plantarum MCC5231 in carrot nectar. The probiotic carrot nectar, under refrigerated conditions, maintained a viability of 6.4 log CFU/mL for 75 days with a percent viability of 53.02 without the growth of coliforms, yeasts, and molds. Probiotic bacteria have also been found to thrive in simulated gastric and intestinal conditions with a percent viability of 94.28% and 90.01%, respectively, indicating the protective effect of carrot matrix on the viability of probiotic bacteria. L. plantarum MCC5231 significantly contributed to the overall Vitamin A content of carrot nectar and, finally, estimated as 509 µg/100ml of carrot nectar, representing more than half of the daily need for vitamin A (840–1000 µg). Polyphenols, minerals, proximate properties, and sensory quality of probiotic carrot nectar were also studied. As a result, the symbiotic relationship between L. plantarum MCC5231 and carrot nectar provides a value-added probiotic product with several health benefits. [ABSTRACT FROM AUTHOR]

Signs and symptoms attributed to adverse reactions to foodstuffs (ARFS) need tools for research and evaluation in clinical practice. The objectives of this study were (a) to evaluate the most frequent self-reported signs and symptoms attributed to ARFS in Spanish adults, (b) to determine the prevalence of food-specific IgG4 antibody reactions (AbRs), and (c) to investigate the association between self-reported ARFS symptomatology and food-specific IgG4 AbRs. Food-specific IgG4 AbRs against 57 common food and beverages (AESKUCARE-T2FA® in vitro point-of-care test kit, Aesku.Diagnostics GmbH, Germany) were determined in capillary blood samples of 205 volunteers living in the Region of Madrid (Spain). The most frequent self-reported signs and symptoms were related to skin (43%), digestive (41%), and nervous system (NS, 33%) problems. The prevalence of food-specific IgG4 AbRs was cow's milk (73%), sheep's milk (70%), casein (66%), and goat's milk (56.10%). Positive IgG4 AbRs against tomato had a profile consisting of 3/4 of skin problems, more than half of digestive, and 2/5 of NS self-reported signs and symptoms. In conclusion, at least 1/3 of the studied sample reported skin, digestive, and NS signs and symptoms. The most frequent food-specific IgG4 AbRs were related to dairy. Skin problems were more frequent in positive tomato IgG4 AbRs. [ABSTRACT FROM AUTHOR]

Currently, the presence or absence of an asthma diagnosis is recorded in most food allergy action plans with the advice to administer epinephrine, followed by a b-agonist inhaler to further relieve respiratory symptoms, such as wheeze, if they occur as part of an allergic reaction [[11]]. Keywords: Accidental exposure; food allergy; allergic reaction; severity; anaphylaxis; asthma; biomarkers; epinephrine; oral immunotherapy; risk factor EN Accidental exposure food allergy allergic reaction severity anaphylaxis asthma biomarkers epinephrine oral immunotherapy risk factor 1427 1430 4 11/10/23 20231201 NES 231201 1. Allergy: Eur J Allergy Clin Immunol. 2018; 73 (9): 1792 - 1800. doi: 10.1111/all.13408 • Key study discussing the need for a universal severity scoring system for allergic reactions. Accidental exposure, allergic reaction, food allergy, severity, anaphylaxis, biomarkers, asthma, epinephrine, oral immunotherapy, risk factor. [Extracted from the article]

Background: Clinician's choice of hypoallergenic formulas in the first-line management of cow's milk protein allergy (CMPA) should be informed by evidence on clinical efficacy and costeffectiveness. Objective: We compare the cost-effectiveness of amino acid-based formula (AAF), extensively hydrolyzed casein formula with Lactobacillus rhamnosus Gorbach Goldin (EHCF+LGG), extensively hydrolyzed whey formula (EHWF), and rice hydrolyzed formula (RHF) in non-breastfed children in France. Methods: Immunotolerance and atopic manifestations' prevalence were based on a prospective non-randomized study with a 36-month follow-up. Resource utilization was sourced from a survey of French clinicians, and unit costs were based on national data. Costs and health consequences were discounted at 2.5% annually. Results were reported using the Collective and French National Health Insurance perspectives. Results: Children receiving EHCF+LGG were predicted to require less healthcare resources, given their reduced prevalence of CMPA symptoms at 3 years. In the base case, EHCF+LGG led to savings of at least €674 per child compared to AAF, EHWF, and RHF at 3 years, from both perspectives. Nutrition had the highest economic burden in CMPA, driven by hypoallergenic formulas and dietetic replacements costs. Results were robust to one-way and probabilistic sensitivity analyses. Conclusions: EHCF+LGG was associated with more symptom-free time, higher immune tolerance, and lower costs. [ABSTRACT FROM AUTHOR]

Abstract Background The effect of the amount of transient cow's milk formula (CMF) consumed during the first days of life on IgE‐cow's milk allergy (IgE‐CMA) is unknown. Methods A cohort of 58 patients with IgE‐CMA was identified from a large scale population‐based study of 13,019 infants followed from birth. A group of 116 infants matched for sex and breastfeeding only duration (beyond the nursery period), and another random group of 259 healthy infants were used as controls. Parents were interviewed and the infants' medical records were searched to assess CMF consumption in the nursery. Results While 96% of the mothers of the 174 infants (58 with Cow's milk allergy and 116 controls) reported on exclusive breastfeeding during the stay in the nursery, CMF consumption was documented in 96 (55%) of the infants. Of those, most (57; 59%) received one to three feedings, 20 (21%) received four to nine feedings, and 19 (20%) received ≥10 feedings. Fewer formula feeds (1–3) were significantly more common in the allergic group than ≥4 feeds (p = 0.0003) and no feeds at all (p = 0.02) compared to controls (n = 116). Of those exclusively breastfed in the nursery, 13/23 allergic infants (57%) introduced CMF at age 105–194 days (the period with highest‐risk for IgE‐CMA) compared to 33/98 (34%) from the random control group (n = 259) (p = 0.04). Conclusions Most infants end up receiving few CMF feeds in the nursery. Transient CMF in the nursery is associated with increased risk of IgE‐CMA.

Background: Cow's milk allergy (CMA) is the most common food allergy in infants. The replacement with specialized formulas is an established clinical approach to ensure adequate growth and minimize the risk of severe allergic reactions when breastfeeding is not possible. Still, given the availability of multiple options, such as extensively hydrolyzed cow's milk protein formula (eHF-CM), amino acid formula (AAF), hydrolyzed rice formula (HRF) and soy formulas (SF), there is some uncertainty as to the most suitable choice with respect to health outcomes. Furthermore, the addition of probiotics to a formula has been proposed as a potential approach to maximize benefit. Objective: These evidence-based guidelines from the World Allergy Organization (WAO) intend to support patients, clinicians, and others in decisions about the use of milk specialized formulas, with and without probiotics, for individuals with CMA. Methods: WAO formed a multidisciplinary guideline panel balanced to include the views of all stakeholders and to minimize potential biases from competing interests. The McMaster University GRADE Centre supported the guideline-development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used, including GRADE Evidence-to-Decision frameworks, which were subject to review by stakeholders. Results: After reviewing the summarized evidence and thoroughly discussing the different management options, the WAO guideline panel suggests: a) using an extensively hydrolyzed (cow's milk) formula or a hydrolyzed rice formula as the first option for managing infants with immunoglobulin E (IgE) and non-IgE-mediated CMA who are not being breastfed. An amino-acid formula or a soy formula could be regarded as second and third options respectively; b) using either a formula without a probiotic or a casein-based extensively hydrolyzed formula containing Lacticaseibacillus rhamnosus GG (LGG) for infants with either IgE or non-IgE-mediated CMA.The issued recommendations are labeled as “conditional” following the GRADE approach due to the very low certainty about the health effects based on the available evidence. Conclusions: If breastfeeding is not available, clinicians, patients, and their family members might want to discuss all the potential desirable and undesirable consequences of each formula in infants with CMA, integrating them with the patients' and caregivers’ values and preferences, local availability, and cost, before deciding on a treatment option. We also suggest what research is needed to determine with greater certainty which formulas are likely to be the most beneficial, cost-effective, and equitable.

Objective αS1-Casein is more closely associated with milk allergic reaction than other milk protein components. microRNA (miRNA) is a class of small non-coding RNAs that modulate multiple biological progresses by the target gene. However, the post-transcriptional regulation of αS1-casein expression by miRNA in ruminants remains unclear. This study aims to explore the regulatory roles of miR-380-3p on αS1-casein synthesis in goat mammary epithelial cells (GMEC). Methods αS1-Casein gene and miR-380-3p expression was measured in dairy goat mammary gland by quantitative real-time polymerase chain reaction (qRT-PCR). miR-380-3p overexpression and knockdown were performed by miR-380-3p mimic or inhibitor in GMEC. The effect of miR-380-3p on αS1-casein synthesis was detected by qRT-PCR, western blot, luciferase and chromatin immunoprecipitation assays in GMEC. Results Compared with middle-lactation period, αS1-casein gene expression is increased, while miR-380-3p expression is decreased during peak-lactation of dairy goats. miR-380-3p reduces αS1-casein abundance by targeting the 3′-untranslated region (3′UTR) of αS1-casein mRNA in GMEC. miR-380-3p enhances β-casein expression and signal transducer and activator of transcription 5a (STAT5a) activity. Moreover, miR-380-3p promotes β-casein abundance through target gene αS1-casein, and activates β-casein transcription by enhancing the binding of STAT5 to β-casein gene promoter region. Conclusion miR-380-3p decreases αS1-casein expression and increases β-casein expression by targeting αS1-casein in GMEC, which supplies a novel strategy for reducing milk allergic potential and building up milk quality in ruminants.

This article discusses the role of epigenetics in food allergies. Epigenetic modifications, which impact gene expression without altering the DNA sequence, have been found to play a significant role in the development and manifestation of food allergies. The article reviews various studies that have investigated epigenetic patterns associated with food allergies, including DNA methylation and microRNA studies. These studies have identified dysregulation of immune pathways and specific gene changes associated with food allergies. The findings suggest that epigenetic modifications could be used as biomarkers for monitoring and predicting the course of food allergies, and may lead to advancements in personalized medicine for diagnosis, management, and prevention of food allergies. [Extracted from the article]

Food allergy is a significant public health issue, particularly affecting children, but the underlying mechanisms are not well understood. The emergence of "omics" sciences, such as genomics and metabolomics, is revolutionizing research in this field by allowing for the comprehensive study of biological processes. This special issue focuses on the application of omics sciences to food allergy research, including epigenetic mechanisms, metabolomics, and the role of the gut microbiome. The goal is to gain a better understanding of the biological determinants of food allergy and improve approaches to precision medicine. [Extracted from the article]

This article discusses a case of infantile bullous pemphigoid (IBP), a rare autoimmune bullous disease that typically affects individuals over 60 years old. The case involves a 6-month-old male who presented with erythema and blisters on the skin. The diagnosis was confirmed through histopathologic examination and direct immunofluorescence. The patient was treated with methyprednisolone and topical mupirocin ointment, and showed no recurrence or scarring after 12 years of follow-up. The article also explores the etiology, treatment options, and prognosis of IBP, as well as genetic and cultural factors that may contribute to its development. [Extracted from the article]

The prevalence of allergic disorders in China has increased significantly due to economic development and urbanization. Factors such as changes in diet, improved hygiene, and rapid urbanization have contributed to the rise in allergic diseases. Asthma, food allergies, allergic rhinitis, chronic rhinosinusitis, and atopic dermatitis are among the most common allergic conditions in China. However, there are challenges in research, training, and clinical practice in the field of allergy in China, including the need for more training programs, standardized allergen vaccines, and improved diagnosis and treatment practices. Efforts are being made to address these challenges and develop preventive and treatment strategies for allergic diseases in China. [Extracted from the article]

The article discusses the Ukrainian Milk Ladder, which is a modified version of the milk ladder used to reintroduce cow's milk into the diets of children with cow's milk allergy (CMA). The Ukrainian Milk Ladder is specifically adapted to suit Ukrainian cuisine and addresses the challenge of maintaining a balanced diet for children with restricted cow's milk intake. The ladder consists of five steps, gradually increasing the amount of cow's milk protein and reducing the degree of heat treatment. The article provides recommendations for using the Ukrainian Milk Ladder and emphasizes the importance of consulting an allergist and recognizing and managing allergic reactions. However, further research is needed to determine the long-term effects and efficacy of milk ladders in promoting sustained tolerance to cow's milk proteins. [Extracted from the article]

Abstract The market share of foods carrying labels suggesting absence of animal ingredients has significantly increased in recent years. The purpose of this study was to document the purchasing behaviour of egg- or milk-allergic consumers vis-à-vis food marketed as “vegan” and “plant-based”, and to evaluate the associated allergenic risk. A survey was conducted among egg- and milk-allergic consumers and revealed that 86% (margin of error 5.4%; confidence level 95%) would buy “vegan” products, indicating this label may be perceived as a substitute for “free from milk and eggs”. To assess the risk posed by these products, 87 prepackaged foods with “vegan” and/or “plant-based” claims purchased in Quebec were tested for milk proteins, and 64 for egg proteins. Overall, 5.7% and 0% occurrence of milk and egg proteins, respectively, were observed, suggesting that the analysed prepackaged foods carrying “vegan” and/or “plant-based” labels pose little risk to egg- or milk-allergic consumers. However, this is likely due to allergen management practices applied by the Canadian manufacturers of the products tested, and should not be attributed to the use of “vegan” or similar labels. Enhanced regulatory requirements for the use of these labels, and an education campaign on their meaning with respect to allergy-related risks, are necessary to better inform and protect egg- and milk-allergic consumers.

Background: Oral food challenge (OFC) is the criterion standard for diagnosing food allergy (FA). It is important to have parameters to aid in selecting ideal OFC candidates. Objective: We sought to characterize outcomes and predictors of OFCs for common food allergens. Methods: We completed a retrospective chart review of all OFCs for IgE-mediated FA performed at Duke University pediatric allergy clinics from June 2017 through May 2022. Patients were deemed eligible for milk, egg, and nut OFC if testing revealed a specific IgE level not exceeding 2 kU/L and a skin prick test (SPT) resulting in a wheal size not exceeding 5 mm. Different parameters were followed for selecting candidates for baked challenge. Results: A total of 663 OFCs were conducted on 510 patients (59% male). The most common foods challenged were peanut (26%), plain egg (23%), baked egg (8%), and milk (8%), with pass rates of 84%, 88%, 62%, and 84%, respectively. Of the patients who failed OFC, 84% had objective symptoms, 23% had multisystemic reactions, and 15% required epinephrine. Although the presence of a personal or family history of atopy or prior failed OFC was not associated with outcomes, a history of anaphylaxis (regardless of the trigger) was associated with increased risk of failure. Conclusion: Although there are no established consensus guidelines, our study provides a benchmark illustrating that cutoffs of a specific IgE level not exceeding 2 kU/L and SPT finding not exceeding 5 mm result in a failure rate of approximately 13% for nonbaked milk, nonbaked egg, and nuts. The high rate of failed baked egg OFCs is likely related to selection bias, but our results illustrate the low negative predictive value of ovomucoid.

ABSTRACTBovine αS1-casein (αS1-CN) is the main allergen in cow's milk, and immunoglobulin E (IgE) epitopes are the material basis to trigger allergic reactions. Thus, IgE epitopes could be as key targets for precise αS1-CN detection and allergenicity assessment. Here, we designed a tandem containing nine IgE linear epitopes of αS1-CN (tαS1-CN), expressed the recombinant tαS1-CN in Escherichia coli, and prepared the rabbit polyclonal antibody against recombinant tαS1-CN (pAb-tαS1-CN). The obtained recombinant tαS1-CN had a purity of 94.43% and retained the antigenicity and potential allergenicity of IgE epitopes. The pAb-tαS1-CN could recognize the nine IgE epitopes of αS1-CN, and also showed high specificity. The ability of pAb-tαS1-CN to evaluate the potential allergenicity of milk in foods was validated by sera from cow's milk allergy patients. These findings indicate that our prepared pAb-tαS1-CN may represents a valuable tool for the evaluation of milk allergenicity in processed foods.

Background. Cow's milk protein allergy (CMPA) is a common food allergy in infants and young children and may be a risk factor for feeding difficulties. Studies exploring feeding difficulties and feeding behaviors in Thai children with CMPA are scarce. Objectives. To determine the prevalence of feeding difficulties and feeding behaviors in Thai children with CMPA compared to healthy controls. Methods. A cross-sectional study was performed comparing children aged 1-6 years old diagnosed with CMPA and had eliminated cow's milk for at least 4 months with age-matched healthy children. Feeding difficulties were evaluated using the Montreal Children's Hospital Feeding Scale questionnaire, and feeding behaviors were measured using the Child Eating Behavior Questionnaire (CEBQ). Results. One hundred and twenty-two participants were recruited (30 children with CMPA and 92 controls). The median age of the CMPA and control groups was 31.0 (14.0, 43.3) and 40.0 (28.0, 53.8) months, respectively (p value = 0.01). The CMPA group had lower calcium, phosphorus, and zinc intake than the healthy controls. The prevalence of feeding difficulties between the two groups did not show a significant difference (36.7 vs. 43.5%, p value = 0.70). The slowness in the eating subscale of feeding behaviors exhibited a lower score in the CMPA group than in the healthy group. Feeding difficulties was positively correlated with the desire to drink (β 3.079, p value = 0.011) but negatively correlated with the enjoyment of food subscale of CEBQ among the CMPA children (β -10.684, p value < 0.001). Conclusion. Despite a similar prevalence of feeding difficulties between CMPA and healthy children, the CMPA group demonstrated some differences in feeding behaviors. The lower score of enjoyment of food and a higher score of desire to drink correlated with a higher degree of feeding difficulties in the CMPA children. The provision of appropriate nutrition for this group of children should be prioritized. [ABSTRACT FROM AUTHOR]

Background: Food ladders are tools designed to facilitate home-based dietary advancement in children with food allergies through stepwise exposures to increasingly allergenic forms of milk and egg. Several studies have now documented safety and efficacy of food ladders. In 2021, we published a Canadian adaptation of the previously existing milk and egg ladders originating in Europe using foods more readily available/consumed in Canada. Our study adds to the growing body of evidence supporting food ladder use and provides safety and effectiveness data for our Canadian adaptation of the milk and egg ladders. Methods: Surveys were distributed to families of children using the Canadian Milk Ladder and/or the Canadian Egg Ladder at baseline, with follow up surveys at 3 months, 6 months, and 12 months. Data were analyzed using REDCap and descriptive and inferential statistics are presented. Results: One hundred and nine participants were started on milk/egg ladders between September 2020 and June 2022. 53 participants responded to follow up surveys. Only 2 of 53 (3.8%) participants reported receiving epinephrine during the study. Severe grade 4 reactions (defined according to the modified World Allergy Organization grading system) were not reported by any participants. Minor cutaneous adverse reactions were common, with about 71% (n = 10/14) of respondents reporting cutaneous adverse reactions by 1 year of food ladder use. An increasing proportion of participants could tolerate most foods from steps 2–4 foods after 3, 6, and 12 months of the food ladder compared to baseline. Conclusion: The Canadian food ladders are safe tools for children with cow's milk and/or egg allergies, and participants tolerated a larger range of foods with food ladder use compared to baseline. [ABSTRACT FROM AUTHOR]

The role of nutritional interventions for the primary prevention of cow's milk allergy (CMA) remains debated as well as the role of early introduction of allergenic foods, which is largely encouraged from the beginning of complementary feeding. Considering the introduction of cow's milk protein (CMP), current recommendations suggest avoidance of any cow's milk formula (CMF) supplements in breastfed infants in the maternity ward. By contrast, based on poor evidence, some authors support systematic supplements of CMP in breastfed children at risk of allergy from the first week of life. The Committee on Nutrition of the French Society of Pediatrics considers that such a proposal requires more clinical studies and mainly randomized and placebo-controlled clinical trials before becoming a recommendation. [ABSTRACT FROM AUTHOR]

The etiology of Ménière's disease (MD) remains controversial. Allergies are potential extrinsic factors that, in conjunction with underlying intrinsic factors, may cause MD. The link between allergies and MD was first described in 1923. For nearly a century, studies have demonstrated a possible link between allergies and MD, even though a causal relationship has not been definitively determined. Previous reviews have mainly focused on clinical epidemiology studies of patients. In this review, we shed light on the association between allergies and MD not only in terms of its epidemiology, but also from an immunology, pathophysiology, and immunotherapy perspective in both patients and animal models. Patients with MD tend to have a high risk of comorbid allergies or an allergy history, showing positive allergy immunology characteristics. Other MD-related diseases, such as migraine, may also interact with allergies. Allergy mediators such as IgE may worsen the symptoms of MD. Deposits of IgE in the vestibular end organs indicate the ability of the inner ear to participate in immune reactions. Allergic challenges can induce vertigo in animals and humans. Anti-allergy therapy plays a positive role in patients with MD and animal models of endolymphatic hydrops. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to describe the growth, body protein status, and micronutrient biomarkers of Brazilian infants with cow's milk allergy (CMPA) at baseline and at 18 months of follow-up in comparison with their healthy peers. Methods: Thirty infants with CMPA younger than six months of age were included in this longitudinal study, and their nutritional status was compared with that of 24 non-allergic age-matched children. Anthropometric measurements were used to assess growth, and blood and urine samples were analyzed for protein and micronutrient status. Mixed linear models adjusted for birth weight, socioeconomic status, infant feeding at baseline, weightfor-age, C-reactive protein, serum albumin, micronutrient dietary supplementation, and salt consumption were employed to evaluate the evolution of nutritional parameters throughout the follow-up period. Results: Overall, the mean age of the children at enrolment was 2.9 (standard deviation 1.7) months, and 29 children (53.7%) were male. Infants with CMPA showed a higher prevalence of functional iron depletion (transferrin saturation <20) (p=0.027), lower serum ferritin (p=0.009), and lower urinary iodine (p=0.034) levels than non-allergic children at baseline. Patients with CMPA showed a higher increment in weight-for-age and length-for-age over time than those in the control group (p<0.01). Mixed linear analyses showed a significantly lower increase in serum vitamin B12 (s-B12) (p=0.001) and urinary iodine (p<0.001) concentrations over time compared to the control group. Conclusion: Infants with CMPA on a cow's milk elimination diet had a higher weight and length at 18 months of follow-up but showed signs of inadequate iron, iodine, and B-12 vitamin status. [ABSTRACT FROM AUTHOR]

Background: Cow's milk protein allergy (CMPA) is one of the most common types of food allergy in infants. Faecal pathogen cultures showed that the positive rate of Clostridium perfringens was more than 30%, which was significantly higher than that for other bacteria. Therefore, it is speculated that Clostridium perfringens colonization may be one of the pathogenetic factors for CMPA in infants. We conducted a real-world evidence study. Infants aged 0–6 months with diarrhoea and mucoid and/or bloody stools were recruited from a large tertiary hospital in China. Faecal pathogen cultures for the detection of Clostridium perfringens were confirmed by flight mass spectrometry, and potential toxin genes were identified using PCR. After 12 months of follow-up, the diagnoses of CMPA and food allergy were recorded. The correlation was assessed by Pearson correlation analysis. Results: In this study, 358 infants aged 0–6 months with gastrointestinal symptoms and faecal pathogen cultures were recruited. A total of 270 (44.07% girls; mean age, 2.78 ± 2.84 months) infants were followed up for 12 months. Overall, the rate of positivity for Clostridium perfringens in faecal pathogen cultures was 35.75% (128/358) in infants aged ≤ 6 months. The earliest Clostridium perfringens colonization was detected within 2 days after birth. The majority of Clostridium perfringens isolates were classified as type C in 85 stool samples. In the Clostridium perfringens-positive group, 48.21% (54/112) of infants were clinically diagnosed with food allergies after 12 months, including 37.5% (42/112) with CMPA, which was significantly higher than that of the negative group, with 7.59% (12/158) exhibiting food allergies and 5.06% (8/158) presenting CMPA (P < 0.0001). Faecal Clostridium perfringens positivity was significantly correlated with CMPA, food allergy, faecal occult blood, faecal white blood cells, antibiotic use, increased peripheral blood platelet counts, and decreased haemoglobin levels (P < 0.0001). Conclusions: This study demonstrates that intestinal colonization by Clostridium perfringens is common in infants. The majority of Clostridium perfringens isolates are classified as type C. Colonization of the intestine by Clostridium perfringens is associated with the development of CMPA and food allergy in infants. [ABSTRACT FROM AUTHOR]

Objective: αS1-Casein is more closely associated with milk allergic reaction than other milk protein components. microRNA (miRNA) is a class of small non-coding RNAs that modulate multiple biological progresses by the target gene. However, the post-transcriptional regulation of αS1-casein expression by miRNA in ruminants remains unclear. This study aims to explore the regulatory roles of miR-380-3p on αS1-casein synthesis in goat mammary epithelial cells (GMEC). Methods: αS1-Casein gene and miR-380-3p expression was measured in dairy goat mammary gland by quantitative real-time polymerase chain reaction (qRT-PCR). miR-380-3p overexpression and knockdown were performed by miR-380-3p mimic or inhibitor in GMEC. The effect of miR-380-3p on αS1-casein synthesis was detected by qRT-PCR, western blot, luciferase and chromatin immunoprecipitation assays in GMEC. Results: Compared with middle-lactation period, αS1-casein gene expression is increased, while miR-380-3p expression is decreased during peak-lactation of dairy goats. miR-380-3p reduces αS1-casein abundance by targeting the 3'-untranslated region (3'UTR) of αS1-casein mRNA in GMEC. miR-380-3p enhances β-casein expression and signal transducer and activator of transcription 5a (STAT5a) activity. Moreover, miR-380-3p promotes β-casein abundance through target gene αS1-casein, and activates β-casein transcription by enhancing the binding of STAT5 to β-casein gene promoter region. Conclusion: miR-380-3p decreases αS1-casein expression and increases β-casein expression by targeting αS1-casein in GMEC, which supplies a novel strategy for reducing milk allergic potential and building up milk quality in ruminants. [ABSTRACT FROM AUTHOR]

Atopic dermatitis represents a non-infectious, multifactorial inflammatory and chronic dermatosis. Pruritus is the main symptom. The pathophysiology of atopic dermatitis is very complex and includes genetic disorders, a defect in the epidermal barrier, an altered immune response and a disruption of the skin's microbial balance, all of which damage the epidermis, causing itchy skin lesions. The prevalence varies, but it is generally present in 30% of children, and 85% of cases manifest before the age of 5. The triad of atopic diseases consists of atopic dermatitis, allergic rhinitis and asthma. A retrospective analysis of the documentation of the children who were treated at the Pediatric Clinic of the University Clinical Center Niš from 2018 to 2019 focused on anamnestic data, clinical manifestations, and laboratory parameters obtained from the medical records of the subjects. The total number of examined children was 40, among them, 21 were male and 19 female. They were divided into 3 age groups, from 2 months to 7 years. Anamnestic data indicate a connection between AD and other disorders of atopic diseases, allergic rhinitis, asthma, respiratory infections, and milk allergies. [ABSTRACT FROM AUTHOR]

The article aims to highlight the diagnosis and management of gastrointestinal cow's milk protein allergy (GI-CMPA) in infants. GI-CMPA, a non-IgE-mediated allergic condition, can lead to symptoms such as frequent loose stools with mucus or blood, poor feeding, irritability and poor weight gain in infants. Management involves an exclusion diet, either for the breastfeeding mother or the infant, with guidance from an experienced pediatric dietitian.

Pollen-food allergy syndrome (PFAS) is an immunoglobulin E (IgE)-mediated allergic reaction caused when patients with pollen allergy ingest food having cross-reactivity with pollen. To date, no effective treatment method for this has been established. Here we report the case of a patient with PFAS who experienced lip edema, causing difficulties in treatment. This report describes the case of a 12-year-old boy with perennial allergic rhinitis since the age of 8 years. After ingesting fresh fruits and raw vegetables at the age of 11 years, he started to experience lip edema repeatedly. Thus, the patient was referred to our department. Based on the results of serum antigen-specific IgE, prick-to-prick, and allergen component tests, he was diagnosed with PFAS. He has been instructed to avoid causative food. Furthermore, the treatment using an antihistamine and antileukotriene receptor antagonist was initiated for pollen allergy. Sublingual immunotherapy (SLIT) for Japanese cedar pollen was initiated because the patient experienced severe nasal allergy symptoms during the dispersal season of this pollen. These treatments alleviated the nasal symptoms; however, the lip edema persisted. Omalizumab administration improved the lip edema. The combination of SLIT and omalizumab may be an effective treatment option for patients with PFAS. [ABSTRACT FROM AUTHOR]

A152 Patient-responsive paediatric allergy care pathways: Creating safe and efficient acceptance,... Serena Braccio 1; Penny Salt 1; Natalie Bishop 2; Louise Long 1; Sean Harrison 1; Dalbir... 1 University College London Hospital, London, UK; 2 University College London, London, UK B Objectives: b Due to our long waiting list, we have lost our ability to be responsive to patients who are at risk of severe allergic reactions due to delay in diagnosis or those with multi-allergic disease affecting their quality of life. A043 Development of a regional paediatric egg allergy management pathway Anna Rucker 1; Cherry Alviani 2; Penny Barnard 3; Isabelle Brady 2; Rachel Freer 4; Lucy... 1 Royal Surrey County Hospital, Guildford, UK; 2 University Hospital Southampton, Southampton... B Objectives: b I Aims i : The BSACI 2021 guideline for the management of egg allergy recommends managing mild egg allergy in infants with education and gradual egg reintroduction at home, without prior allergy tests or referral to secondary care. A055 Using electronic patient records to identify IgE-mediated milk allergy patients who have not... William Tan 1,2; Andrew Clark 2; Amruta Fulmali 2; Zaraquiza Zolkipli 2; Rebecca Tibbott... 1 University of Cambridge, Cambridge, UK; 2 Cambridge University Hospitals, Cambridge, UK B Objectives: b Early-life milk reintroduction, following diagnosis of IgE-mediated milk allergy, may protect against persistent milk allergy and thereby reduce risk and improve quality of life. A084 Two cases of lipid transfer protein allergy in a tertiary paediatric allergy centre Felicity Norris; Briony Stone; David Luyt; Gary Stiefel Leicester Children's Hospital, Leicester, UK B Objectives: b I Background i : LTP allergy is anecdotally increasingly common within paediatric allergy clinics which presents clinical challenges particularly for management. [Extracted from the article]

Introduction: Cow's milk allergy (CMA) is a common complication and one of the most common food allergies in infants, and it is estimated that this disease affects 2-3% of children under five years old. Objectives: This study investigated the factors associated with developing immune tolerance in children with CMA in Gorgan. Patients and Methods: In this cross-sectional study, 50 children with CMA referred to the asthma and allergy clinic of Taleghani Hospital in Gorgan during 2019-2020 were investigated. Multiple logistic regression was applied to measure odds ratios (ORs) and 95% confidence intervals (CIs) of the associations between the selected factors and tolerance to cow's milk. Results: The results suggested that factors including standard delivery (P = 0.024, OR=4.03, 95% CI: 1.20-13.53) and breastfeeding in the first month of birth (P = 0.003, OR=6.73, 95% CI:1.94-23.36), and gastrointestinal symptoms (P = 0.026, OR=3.78, 95% CI: 1.17-12.19) were associated with immune tolerance to CMA. Younger age of starting complementary feeding (P < 0.001, OR=0.070, 95% CI:0.02-0.30), younger age of starting cow's milk feeding (P = 0.003, OR=0.520, 95% CI: 0.32-0.83), skin symptoms (P = 0.012, OR=0.211, 95% CI: 0.06-0.71) and respiratory symptoms (P = 0.013, OR=0.219, 95% CI:0.07-0.72) were associated with allergy persistence. Conclusion: The findings of our study demonstrated natural childbirth, breastfeeding, and gastrointestinal symptoms, including bloody stools, are factors related to immune tolerance in children with CMA. The findings showed that decreasing the onset of complementary feeding, reducing the age of cow's milk feeding, and clinical manifestations of respiratory and skin are associated with persistent CMA in children. [ABSTRACT FROM AUTHOR]

Allergic conditions are associated with canonical and noncanonical activation of the complement system leading to the release of several bioactive mediators with inflammatory and immunoregulatory properties that regulate the immune response in response to allergens during the sensitization and/or the effector phase of allergic diseases. Further, immune sensors of complement and regulator proteins of the cascade impact on the development of allergies. These bioactive mediators comprise the small and large cleavage fragments of C3 and C5. Here, we provide an update on the multiple roles of immune sensors, regulators, and bioactive mediators of complement in allergic airway diseases, food allergies, and anaphylaxis. A particular emphasis is on the anaphylatoxins C3a and C5a and their receptors, which are expressed on many of the effector cells in allergy such as mast cells, eosinophils, basophils, macrophages, and neutrophils. Also, we will discuss the multiple pathways, by which the anaphylatoxins initiate and control the development of maladaptive type 2 immunity including their impact on innate lymphoid cell recruitment and activation. Finally, we briefly comment on the potential to therapeutically target the complement system in different allergic conditions. [ABSTRACT FROM AUTHOR]