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Tropomyosin has been identified as the major cross-reactive shellfish allergen, but recent studies showed the presence of other clinically relevant allergens. This study aims at determining the allergic immune responses of mice sensitized with raw and boiled shrimp extracts in comparison to recombinant tropomyosin (rTM). Female Balb/c mice were intragastrically sensitized and challenged with raw, boiled shrimp or rTM. Systemic, cellular and humoral allergic responses were compared, while allergenicity of the extracts was also compared by skin prick test (SPT) and immunoblot on shrimp allergic subjects. We showed that rTM and shrimp extracts induced IgE- and Th2-mediated allergic responses in mice, distinguished by remarkable intestinal inflammation in small intestine across all regimens. Notably, boiled shrimp extract exhibited the highest sensitization rate (73.7% of mice developed positive TM-specific IgE response) when compared with raw extract (47.8%) and rTM (34.8%). Mice sensitized with boiled extract manifested the highest allergen-specific IgE and Th2 cytokine responses than the others. Immunoblot results indicated that tropomyosin remained the major allergen in extract-based sensitization and had stronger allergenicity in a heat-treated form comparing to untreated TM, which was in line with the SPT results that boiled extract induced larger wheal size in patients. Hemocyanin and glycogen phosphorylase were also identified as minor allergens associated with manifestation of shrimp allergy. This study shows that boiled extract enhanced sensitization and Th2 responses in agreement with the higher allergenicity of heat-treated TM. This study thus presents three shrimp allergy murine models suitable for mechanistic and intervention studies, and in vivo evidence implies higher effectiveness of boiled extract for the clinical diagnosis of shellfish allergy.

PURPOSE OF REVIEW: The aim of this review is to highlight key published oral immunotherapy (OIT) protocols and post-desensitization strategies for the major food allergens and to cover important concepts to consider when evaluating OIT for food-allergic patients. Shared decision-making should help identify patient and family values which will help influence the type of evidence-based protocol and maintenance strategy to use. RECENT FINDINGS: With food OIT emerging as a treatment option, there is a pressing need for patients, physicians, and other providers to have a nuanced understanding of the management choices available to them. There are now randomized controlled trials (RCT) of OIT for peanut, egg, milk, and wheat, and reports of cohorts of patients who have undergone OIT for tree nuts and sesame clinically. The current published protocols contain significant diversity in terms of starting dose, build-up schedule, maintenance dose, and even the product used for desensitization. Emerging data can help direct the long-term maintenance strategy for patients on OIT. Based on patient and family values elicited through the shared decision-making process, an OIT protocol may be selected that balances the level of desensitization, potential side effects, frequency of clinic visits, and potential to induce sustained unresponsiveness, among other factors. Once maintenance dosing is reached, most patients will need to maintain regular exposure to the food allergen to remain desensitized. The option to transition to commercial food products with equivalent amounts of food protein as the OIT maintenance dose would simplify the dosing process and perhaps improve palatability as well. Less frequent or decreased OIT dosing can provide practical benefits but may affect the level of desensitization and safety for some patients.

Food allergies have emerged as a pressing health concern in recent years, largely due to food resources and environmental changes. Dairy products fermented by lactic acid bacteria play an essential role in mitigating allergic diseases. Lactic acid bacteria have been found to possess a distinctive proteolytic system comprising a cell envelope protease (CEP), transporter system, and intracellular peptidase. Studying the impact of different Lactobacillus proteolytic systems on the destruction of milk allergen epitopes and their potential to alleviate allergy symptoms by releasing peptides containing immune regulatory properties is a valuable and auspicious research approach. This paper summarizes the proteolytic systems of different species of lactic acid bacteria, especially the correlation between CEPs and the epitopes from milk allergens. Furthermore, the mechanism of immunomodulatory peptide release was also concluded. Finally, further research on the proteolytic system of lactic acid bacteria will provide additional clinical evidence for the possible treatment and/or prevention of allergic diseases with specific fermented milk/dairy products in the future. [ABSTRACT FROM AUTHOR]

Edible insect products contain high-quality protein and other nutrients, including minerals and fatty acids. The consumption of insect food products is considered a future trend and a potential strategy that could greatly contribute to meeting food needs worldwide. However, insect proteins have the potential to be allergenic to insect consumers. In this review, the nutritional value and allergy risk of insect-derived foods, and the immune responses elicited by insect allergens are summarized and discussed. Tropomyosin and arginine kinase are the most important and widely known insect allergens, which induce Th2-biased immune responses and reduced the activity of CD4+T regulatory cells. Besides, food processing methods have been effectively improving the nutrients and characteristics of insect products. However, limited reviews systematically address the immune reactions to allergens present in edible insect proteins following treatment with food processing technologies. The conventional/novel food processing techniques and recent advances in reducing the allergenicity of insect proteins are discussed in this review, focusing on the structural changes of allergens and immune regulation. [ABSTRACT FROM AUTHOR]

The goal of food allergy (FA) prevention and treatment is to induce oral tolerance (OT). Appropriate nutritional interventions are essential to induce OT to food allergens. This review introduces the mechanism of OT and the importance of early nutritional interventions, and then firstly summarizes specific nutritional factors to induce the development of OT of FA, including proteins, vitamins, fatty acids, saccharides and probiotics. The regulatory mechanism mainly induces the development of tolerance by increasing local or systemic protective regulatory T cells (Tregs) to suppress FA, while the gut microbiota may also be changed to maintain intestinal homeostasis. For allergens-specific OT, the disruption to the structure of proteins and epitopes is critical for the induction of tolerance by hydrolyzed and heated proteins. Vitamins (vitamin A, D), fatty acids, saccharides and probiotics as allergens nonspecific OT also induce the development of OT through immunomodulatory effects. This review contributes to our understanding of OT in FA through nutritional interventions. Nutritional interventions play an important role in the induction of OT, and offer promising approaches to reduce allergy risk and alleviate FA. Moreover, due to the importance and diversity of nutrition, it must be the future trend of induction of OT in FA. [ABSTRACT FROM AUTHOR]

Atopic diseases, including atopic dermatitis (AD), food allergy (FA), asthma, and allergic rhinitis (AR) are closely related to inflammatory diseases involving different body sites (i.e. the skin, airway, and digestive tract) with characteristic features including specific IgE to allergens (so-called "atopy") and Th2 cell-mediated inflammation. It has been recognized that AD often precedes the development of other atopic diseases. The progression from AD during infancy to FA or asthma/AR in later childhood is referred to as the "atopic march" (AM). Clinical, genetic, and experimental studies have provided evidence that allergen sensitization occurring through AD skin could be the origin of the AM. Here, we provide an updated review focusing on the role of the skin in the AM, from genetic mutations and environmental factors associated with epidermal barrier dysfunction in AD and the AM to immunological mechanisms for skin sensitization, particularly recent progress on the function of key cytokines produced by epidermal keratinocytes or by immune cells infiltrating the skin during AD. We also highlight the importance of developing strategies that target AD skin to prevent and attenuate the AM. [ABSTRACT FROM AUTHOR]

Existing therapeutic strategies are challenged by long times to achieve effect and often require frequent administration. Peanut-allergic individuals would benefit from a therapeutic that provides rapid protection against accidental exposure within days of administration while carrying little risk of adverse reactions. Guided by the repertoire of human IgE mAbs from allergic individuals, we sought to develop a treatment approach leveraging the known protective effects of allergen-specific IgG4 antibodies. We applied our single-cell RNA-sequencing SEQ SIFTER platform (IgGenix, Inc, South San Francisco, Calif) to whole blood samples from peanut-allergic individuals to discover IgE mAbs. These were then class-switched by replacing the IgE constant region with IgG4 while retaining the allergen-specific variable regions. In vitro mast cell activation tests, basophil activation tests, ELISAs, and an in vivo peanut allergy mouse model were used to evaluate the specificity, affinity, and activity of these recombinant IgG4 mAbs. We determined that human peanut-specific IgE mAbs predominantly target immunodominant epitopes on Ara h 2 and Ara h 6 and that recombinant IgG4 mAbs effectively block these epitopes. IGNX001, a mixture of 2 such high-affinity IgG4 mAbs, provided robust protection against peanut-mediated mast cell activation in vitro as well as against anaphylaxis upon intragastric peanut challenge in a peanut allergy mouse model. We developed a peanut-specific IgG4 antibody therapeutic with convincing preclinical efficacy starting from a large repertoire of human IgE mAbs from demographically and geographically diverse individuals. These results warrant further clinical investigation of IGNX001 and underscore the opportunity for the application of this therapeutic development strategy in other food and environmental allergies. [ABSTRACT FROM AUTHOR]

Because young children cannot self-report symptoms, there is a need for parent surrogate reports. Although early work suggested parent-child alignment for eosinophil esophagitis (EoE) patient-reported outcomes (PROs), the longitudinal alignment is unclear. We sought to assess the agreement and longitudinal stability of PROs between children with EoE and their parents. A total of 292 parent-child respondents completed 723 questionnaires over 5 years in an observational trial in the Consortium of Eosinophilic Gastrointestinal Disease Researchers. The change in and agreement between parent and child Pediatric Eosinophilic Esophagitis Symptom Score version 2 (PEESSv2.0) and Pediatric Quality of Life Eosinophilic Esophagitis Module (PedsQL-EoE) PROs over time were assessed using Pearson correlation and Bland-Altman analyses. Clinical factors influencing PROs and their agreement were evaluated using linear mixed models. The cohort had a median disease duration equaling 3.7 years and was predominantly male (73.6%) and White (85.3%). Child and parent PEESSv2.0 response groups were identified and were stable over time. There was strong correlation between child and parent reports (PEESSv2.0, 0.83;PedsQL-EoE, 0.74), with minimal pairwise differences for symptoms. Longitudinally, parent-reported PedsQL-EoE scores were stable (P ≥.32), whereas child-reported PedsQL-EoE scores improved (P =.026). A larger difference in parent and child PedsQL-EoE reports was associated with younger age (P <.001), and differences were driven by psychosocial PRO domains. There is strong longitudinal alignment between child and parent reports using EoE PROs. These data provide evidence that parent report is a stable proxy for objective EoE symptoms in their children. [ABSTRACT FROM AUTHOR]

Introduction: The basophil activation test (BAT) has shown evidence of high sensitivity and high specificity to support the diagnosis of IgE-mediated allergy. It is a functional test that uses live cells analyzed by flow cytometry and thus needs to be performed within 24h of blood collection. BAT has shown to be reproducible and reliable when tested in a clinical diagnostic laboratory with standardized protocols and flow cytometry settings. Areas covered: In this review, we summarize the evidence to support clinical use of BAT and the next steps required for clinical implementation for an improve clinical care for patients with suspected IgE-mediated food allergy. Expert opinion: BAT has recently been included in Clinical Guidelines of Food Allergy Diagnosis and its implementation in clinical practice depends largely on availability. Proposed clinical applications of the BAT include: distinction between food allergy and asymptomatic IgE sensitization; determination of food allergic status to peanut, tree nuts and seeds in polysensitized children; evaluation of tolerance to baked egg and baked milk in egg and milk allergic children; identification of patients at high-risk of severe allergic reactions; monitoring for spontaneous resolution of food allergy; confirmation of eligibility for specific treatments of food allergy; prediction and monitoring of response to immunomodulatory treatments. [ABSTRACT FROM AUTHOR]

Introduction: Gingival darkening, known as smokers' gingival melanosis or smoker's melanosis, is a benign symptom attributed to excessive deposition of melanin pigment. Melanin, responsible for skin, hair, and eye coloration, accumulates excessively, resulting in darkened gums. While not typically a severe health concern, smokers and former smokers may worry about this aesthetic change. This study aims to differentiate and categorize gingival pigmentation in smokers compared to non‐smokers using a deep learning‐based SqueezeNet. This innovative diagnostic tool holds significant promise in the medical and dental fields for assessing the presence and prognosis of such gingival pigmentations. Methods: The research utilized intraoral images obtained from patients at Saveetha Dental College. Two hundred patients exhibiting oral and gingival pigmentation were enrolled, specifically targeting those with a smoking history and excluding cases of amalgam, metallic, physiological pigmentation, intestinal polyposis, and pigmentation from food allergies. After applying inclusion and exclusion criteria, 102 subjects were selected from the initial pool for further analysis. These subjects were classified into healthy and pigmented gingiva, displaying brownish‐black pigmentation. Intraoral photographs were captured and subjected to segmentation and annotation using a SqueezeNet for subsequent analysis. Machine learning techniques were employed for further evaluation, including random forest, logistic Regression, and naive Bayes. Results: The accuracy results indicate the performance of three different machine learning algorithms, namely random forest, logistic regression, and Naive Bayes, on predicting the presence of pigmented gingiva in smokers and non‐smokers. Using random forest, logistic regression, and Naive Bayes, respectively, it was discovered that the accuracy of pigmented gingiva in smokers and non‐smokers was 88.8% and 92.6%, 93.3% and 95.2%, 95.1%, and 95.6%. A confusion matrix and a Roc graph were produced. Conclusions: The results suggest that machine learning algorithms can be effective in predicting the presence of pigmented gingiva in different populations. The confusion matrix and ROC graph can provide further insights into the model's performance and can be used to optimize the classifier's threshold for prediction. Thus, it allows patients to self‐diagnose and doctors to diagnose in their hectic clinical routines. [ABSTRACT FROM AUTHOR]

This European Academy of Allergy and Clinical Immunology (EAACI) guideline provides recommendations for the management of IgE‐mediated food allergy and was developed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Following the confirmation of IgE‐mediated food allergy diagnosis, allergen avoidance and dietary advice (with support of a specialised dietitian, if possible) together with the provision of a written treatment plan, education on the recognition of allergic symptoms and prescription of medication including adrenaline using an auto‐injector are essential. Patients with significant anxiety and requirement for coping strategies may benefit from support from a clinical psychologist. As immunomodulatory interventions, omalizumab is suggested for treatment of IgE‐mediated food allergy in children from the age of 1 and adults; and oral allergen‐specific immunotherapy is recommended for children and adolescents with peanut allergy and suggested for milk and egg allergies (generally after 4 years of age for milk and egg). Sublingual and epicutaneous immunotherapy are suggested for peanut allergy but are not yet available at the point of care. Future research into disease modifying treatments for IgE‐mediated food allergy are highly needed, with standardised and patient‐focused protocols and outcomes. [ABSTRACT FROM AUTHOR]

Immunoglobulin E (IgE)‐mediated food allergies are reported to affect around 3.5% of children and 2.4% of adults, with symptoms varying in range and severity. While being the gold standard for diagnosis, oral food challenges are burdensome, and diagnostic tools based on specific IgE can be flawed. Furthering our understanding of the mechanisms behind food allergy onset, severity and persistence could help reveal immune profiles associated with the disease, to ultimately aid in diagnosis. Alterations to cytokine levels and immune cell ratios have been identified, though further research is needed to fully capture the heterogenous nature of food allergy. Moreover, the existence of such immune alterations also raises the question of potential wider systemic effects. For example, recent research has emphasised the existence and impact of neuro‐immune interactions and implicated behavioural and neurological changes associated with food allergy. This review will provide an overview of such food allergy‐driven neuro‐immune interactions, with the aim of emphasising the importance of furthering our understanding of the immune mechanisms underlying IgE‐mediated food allergy. [ABSTRACT FROM AUTHOR]

Food allergies, often triggered by minute amounts of certain foods, affect people of all ages and frequently occur in dining-out settings. Previous research in Saudi Arabia has not investigated the extent of restaurant workers' knowledge of food allergies and their role in protecting patrons from allergic reactions. This descriptive study assessed the knowledge, attitudes, and practices of restaurant staff regarding food allergies in Qassim, Saudi Arabia between January and March 2023. Interviews and observations were conducted in four stages, and data were analyzed using the Environmental Health Specialists Network Food Allergen Study Protocol. Results showed that most restaurant staff had limited knowledge of food allergens and their symptoms, and a small proportion had received specific training on food allergies. Moreover, only 14% of restaurants provided allergen information on their menus. Despite these knowledge gaps, most staff exhibited positive attitudes toward managing food allergies. Findings also indicated that factors such as experience, training, and restaurant policies were associated with higher levels of knowledge and more positive attitudes. These results highlight the urgent need for the restaurant sector to implement food allergy measures, including clear policies and comprehensive training, to prevent potentially life-threatening incidents. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Alpha‐gal syndrome is a novel food allergy to the oligosaccharide galactose‐α‐1,3‐galactose (alpha‐gal) present in mammalian meat. Tick bites are considered an important route of sensitization to alpha‐gal. Data on alpha‐gal sensitization in the general population is scant. We utilized a unique data source of repeated population‐based health examination studies to assess prevalence, time trends, risk factors, and characteristics of alpha‐gal sensitization.Alpha‐gal sensitization was assessed in >11.000 adults from four health examination studies of randomly invited residents in the Copenhagen region conducted in 1990–1991, 2011–2012, 2012–2015, and 2016–2017. Alpha‐gal sensitization was defined as serum specific IgE (sIgE) to alpha‐gal ≥0.1 kUA/L; ≥0.35 kUA/L; ≥0.7 kUA/L; ≥3.5 kUA/L. The population was characterized according to genetically determined ABO blood group, aeroallergen sensitization, and pets at home.The prevalence of sIgE to alpha‐gal ≥0.1 kUA/L was 1.3% in 1990–1991, 3.7% in 2012–2015 and 3.2% in 2016–2017. Of those sensitized to alpha‐gal >97% reported to consume red meat at least once a week, even for sIgE to alpha‐gal ≥3.5 kUA/L. Male sex, older age, aeroallergen sensitization, cat at home, and blood group A were associated with increased odds of alpha‐gal sensitization. The known protective effect of blood group B was confirmed.In this general adult population, the prevalence of alpha‐gal sensitization had doubled from 1990–1991 to 2016–2017. This could potentially be due to increased tick exposure and an increased atopic predisposition. [ABSTRACT FROM AUTHOR]

The article "Whole Blood Transcriptomics Identifies Differences in Innate Immune Pathway Expression in Infants at Risk for Peanut Allergy" explores the differential gene expression in infants at risk for peanut allergy. The study aims to analyze the transcriptomic signature of infants at risk for peanut allergy using whole blood RNA sequencing. Results suggest that disruption of the innate immune response may play a role in peanut allergy development, highlighting the importance of understanding immune developmental defects associated with food allergies. Further investigation into the innate immune response in infants at high risk of peanut allergy may have implications for the development of clinical reactivity in sensitized individuals. [Extracted from the article]

Background: Food allergy affects 1%–10% of children under five worldwide, with genetic and early‐life factors playing a primary role. Reported factors include a family history of allergic diseases, personal atopic dermatitis, cesarean section, dietary restrictions during pregnancy and lactation, and the timing of introducing solid foods. This study was aimed at identifying various factors associated with food allergy and evaluate each food allergy's clinical features. Methods: We conducted a case–control study with a participant ratio of 1:2 between cases and controls. Data were gathered from both groups of participants, and questionnaires included living area, sex, and natal history (birth details, maternal diet during pregnancy and breastfeeding, feeding history during infancy, family history of atopic diseases, and household smoking). Results: All 72 cases with food allergy and 145 controls were included in the study. Term birth comprised a protective factor for developing food allergy (adjusted odds ratio [aOR] 0.213, p value 0.022). In contrast, personal atopic dermatitis (aOR 20.097, p value 0.001) and a family history of allergic disease constituted risks (aOR 3.183, p value 0.002). Food allergy was unrelated to cesarean section, low birth weight, dietary restrictions during lactation and pregnancy, exclusive breastfeeding, or the early introduction of complementary foods. The three most common food allergens were egg white (40.2%), wheat (34.7%), and cow's milk (30.5%), respectively. Conclusions: In this study, risk factors associated with food allergy comprised a personal history of atopic dermatitis and a family allergic disease, which may be used as predictive factors for developing food allergy among Thai children. [ABSTRACT FROM AUTHOR]

Background: Oral immunotherapy (OIT) is an increasingly utilized management strategy for IgE-mediated food allergy. Despite promising efficacy and effectiveness, there is still a lack of data surrounding the reasons for discontinuation of OIT. The primary reason stated in the literature for discontinuation is adverse gastrointestinal effects. Social factors contributing to OIT discontinuation have not been well reported. We hypothesize that social considerations are significant contributors to treatment discontinuation. Methods: We completed a retrospective chart review of 50 patients treated in community pediatric allergy practices who discontinued OIT out of 507 patients who were started on OIT between October 1, 2017-October 27, 2022. Reasons for discontinuation were identified and classified into five main categories: unsafe care decisions, anxiety, adverse effects of OIT, uncontrolled comorbidity and social factors. Categories were not exclusive. Results: 507 patients were started on OIT, with data available for 50 patients who discontinued OIT, aged 10 months to 18 years and 2 months. The overall discontinuation rate was 9.8%, of which 40 patients (80%) discontinued during buildup, 9 patients (18%) discontinued during maintenance and one patient on two food OIT discontinued one food during buildup and one during maintenance (2%). Thirty-four patients (68%) had multiple reasons for discontinuing OIT. Social factors were the most common reason for discontinuation and were identified in 32 patients (64%). Twenty-four patients (48%) discontinued OIT due to adverse effects. Gastrointestinal symptoms were the most prevalent, while anaphylaxis contributed to discontinuation in 15 patients (30%). Anxiety led to discontinuation in 17 patients (34%). Conclusions: Our data highlights the importance of social factors and anxiety in the success of OIT completion. Our results support the need to consider not only the patient's medical history, but also their social history and support networks when selecting patients who are good candidates for OIT to optimize the successful completion of OIT. [ABSTRACT FROM AUTHOR]

Background: Oral immunotherapy (OIT) has become the standard of care for children with food allergy (FA) and has substantially improved their quality of life. The effect of OIT on the quality of life in adults, however, has been studied to a much lesser degree. Methods: Patients with food allergy aged ≥ 18 years who underwent OIT at Shamir Medical Center completed the Food Allergy Quality of Life Questionnaire-Adult Form (FAQLQ-AF) before and at the end of treatment. Adults with FA not undergoing OIT who completed the FAQLQ-AF at 2 time points, served as controls. Results: A total of 44 adults, median age 23.4 years, who underwent OIT for milk (n = 19), egg (n = 2), peanut (n = 9), sesame (n = 6), and tree nuts (n = 8), and 11 controls were studied. The median OIT starting dose was 23.8 mg protein. 33 patients (75%) reached full desensitization within a median of 10.3 months. The FAQLQ-AF baseline scores were comparable between the study and control groups for all items except for Food Allergy related Health (FAH) item in which the study group had a significantly better score (p = 0.02). At the second time point, the study group had significantly better scores in all items (Allergen Avoidance and Dietary Restrictions (AADR), p = 0.02; and Emotional Impact (EI), Risk of Allergen Exposure (RAE), FAH and the Total Score, p < 0.01). The change in scores for the study group was significantly better, statistically and clinically, in AADR, p = 0.04; EI, p < 0.01; RAE, p = 0.01, and in the total score, p = 0.01. Conclusions: OIT significantly improves quality of life of adults with FA. This finding adds important support for providing OIT in this population. [ABSTRACT FROM AUTHOR]

In the past decades, food allergies became increasingly dominant since early childhood, leading to a lower quality of life and to increasing costs addressed by the health care system. Beside standard avoidance of specific allergens and drug treatments following allergen exposure, a great deal of research has lately focused on Food Allergy Allergen Immunotherapy (FA‐AIT). SCIT and EPIT (Subcutaneous and Epicutaneous Immunotherapy), OIT (Oral Immunotherapy), and SLIT (Sublingual Immunotherapy) consist in gradual exposure to allergens to desensitize and achieve tolerance once therapy has ended. Although promising, FA‐AIT may bring acute local and systemic adverse reactions. To enhance efficacy, safety and convenience of AIT, the quest of potential adjuvants to mitigate the adverse reactions becomes crucial. Immunomodulatory activities, such as that of increasing the regulatory T cells and decreasing the IgE, have been observed in specific probiotics' strains and multiple studies elucidated the role of gut microbiota as a major interplayer among the host and its immune system. In this review, the microbiome modulation is shown as potential AIT adjuvant, nevertheless the need of more clinical studies in the near future is pivotal to assess the efficacy of targeted bacterial therapies and faecal microbiota transplantation. [ABSTRACT FROM AUTHOR]

This document provides an update on a medical algorithm for diagnosing and treating drug hypersensitivity reactions to biologicals. Biologicals now include drugs made from organic molecules produced by living organisms that target genes or proteins for therapy. Hypersensitivity reactions to biologicals can be categorized beyond traditional classifications and are best defined by their clinical presentation and underlying mechanism. Risk stratification is important in determining eligibility for rapid drug desensitization, and alternative therapies should be considered for certain reaction types. The document also discusses the use of basophil activation testing and skin testing for diagnosing drug allergies, as well as the importance of delabeling patients who do not have a drug allergy to save resources. Rapid drug desensitization is a personalized approach that requires a multidisciplinary team and premedication based on the initial reaction. Different protocols exist for desensitization based on the level of risk, and breakthrough reactions are treated symptomatically. The document also highlights specific considerations for managing hypersensitivity reactions in children and the need for standardization of protocols. Phenotype switching, where the type of reaction to a biological drug changes, is also discussed, along with the management of hypersensitivity reactions to specific monoclonal antibodies. The document includes a list of references for further research on drug reactions, hypersensitivity, and desensitization, providing valuable information for researchers and healthcare professionals in the field of allergy and clinical immunology. [Extracted from the article]

Background Methods Results Conclusions Food allergies are increasingly common and so hospitals must promptly identify and manage these to maintain patient safety. The present study explored patient understanding and expectations of food allergy management in hospital food services.This exploratory descriptive study used mixed methods, including semi‐structured interviews and surveys with hospital inpatients declaring food allergies, aiming to explore understanding, expectations and preferences for food allergy management in the hospital setting.Twenty‐four participants were interviewed, reporting between one and six food allergies across 25 different allergens. Three main themes were identified: “Shared responsibility for declaring and managing allergens in hospital”, “Varied understanding and trust in hospital food service processes” and “Satisfactory hospital food service experience”. In the latter, participants identified 13 key factors valued for hospital food, including appearance, food quality and flavour. Remarkably, being “free from” the food allergen was not amongst the most common factors. Generally, participants felt that declaring a food allergy had not negatively impacted their hospital admission, and overall satisfaction with food services did not differ between the food allergic study participants and the general hospital population.Overall, the declaration of a food allergy did not negatively impact on hospital experience. However, further investigations are required to identify the most valued factors for hospital meals, aiming to enable a more targeted approach to better meet patient expectations. [ABSTRACT FROM AUTHOR]

Background: Fenugreek, or Trigonella foenum greacum, is an ancient medicinal plant native to the eastern Mediterranean that later spread to Asia; it is used as a medicinal herb, spice, or food. It is a component of spice mixes, such as curry, and it is also used as a supplement in wheat and corn flour for bread making. Fenugreek appears to have many health benefits and potential medicinal properties; for this reason, it is increasingly being used in nutraceutical formulations. This study aimed to describe patients who visited our operative unit for a suspected adverse reaction after ingestion of fenugreek and to highlight possible cross-reactivity between fenugreek and other legumes or other foods. Methods: A total of 13 patients (5 males and 8 females; mean age: 30.6; range: 20–42 years) visited our outpatient clinic with a clinical history suggestive of an allergic reaction to spices or legumes. They underwent a skin prick test for fenugreek, fresh foods, and food extracts. Results: A total of 6 out of 13 patients positive for fenugreek had experienced allergic symptoms after ingesting foods containing spices, and 10 patients presented polysensitization with other legumes, of which 8 also presented sensitization to pistachios. Conclusions: Given the increasing use of novel spices in Mediterranean cuisine and the possible spread of fenugreek-based nutraceuticals, it is relevant to draw attention to possible allergic reactions. Further studies are also needed to be able to establish its cross-reactivity pattern. [ABSTRACT FROM AUTHOR]

ABSTRACT Dysfunctional immune regulation contributes to the pathogenesis of food allergy (FA). The mechanism behind regulatory B‐cell dysfunction is unclear. CpG has immune regulatory functions. The purpose of this study is to use CpG to recover the immune suppressive functions of B cells in mice with FA. An FA mouse model was created using ovalbumin as the specific antigen. Flow cytometry was used to isolate B cells from the intestinal tissues. The immune regulatory functions of B cells were assessed using immunological approaches. The results showed that the FA response was linked to low IL‐10 levels in gut lavage fluids of FA mice. FA mouse intestinal B cells produced lower amounts of IL‐10 as compared with B cells isolated from naïve control mice. Impaired immune suppressive functions were observed in B cells isolated from the FA mouse intestine. The inducibility of the Il10 expression in naïve B cells of the intestine of FA mice was defective. The induction of Il10 expression in FA B cells could be restored by CpG through regulating the methylation status of the Cmip promoter. CpG promoted the therapeutic efficacy of allergen specific immunotherapy by restoring the induction of IL‐10+ B cells in the intestine. The expression of Il10 in B cells of the FA mouse intestine was impaired. Administration of CpG could restore the expression of Il10 in B cells in the intestine and promote immunotherapy for FA. [ABSTRACT FROM AUTHOR]

The article discusses the benefits of a baked milk diet for children with cow's milk allergy (CMA). The study found that introducing baked milk products into the regular diet of milk-allergic children improved their quality of life and growth parameters. The research showed that both fast and slow escalation regimes of baked milk consumption significantly improved quality of life. The study also highlighted the association between CMA and decreased growth, emphasizing the importance of proactive management through regular ingestion of tolerated milk products. [Extracted from the article]

ABSTRACT Anaphylaxis affects up to 5% of people during their lifetime. Although anaphylaxis usually resolves without long‐term physical consequences, it can result in anxiety and quality of life impairment. Rarely and unpredictably, community anaphylaxis can cause rapid physiological decompensation and death. Adrenaline (epinephrine) is the cornerstone of anaphylaxis treatment, and provision of adrenaline autoinjectors (AAI) has become a standard of care for people at risk of anaphylaxis in the community. In this article, we explore the effectiveness of AAIs for preventing fatal outcomes in anaphylaxis, using information drawn from animal and human in vivo studies and epidemiology. We find that data support the effectiveness of intravenous adrenaline infusions for reversing physiological features of anaphylaxis, typically at doses from 0.05 to 0.5 μg/kg/min for 1–2 h, or ~ 10 μg/kg total dose. Intramuscular injection of doses approximating 10 μg/kg in humans can result in similar peak plasma adrenaline levels to intravenous infusions, at 100–500 pg/mL. However, these levels are typically short‐lived following intramuscular adrenaline, and pharmacokinetic and pharmacodynamic outcomes can be unpredictable. Epidemiological data do not support an association between increasing AAI prescriptions and reduced fatal anaphylaxis, although carriage and activation rates remain low. Taken together, these data suggest that current AAIs have little impact on rates of fatal anaphylaxis, perhaps due to a lack of sustained and sufficient plasma adrenaline concentration. Effects of AAI prescription on quality of life may be variable. There is a need to consider alternatives, which can safely deliver a sustained adrenaline infusion via an appropriate route. [ABSTRACT FROM AUTHOR]

The immune system recognizes a multitude of innocuous antigens from food and intestinal commensal microbes toward which it orchestrates appropriate, non-inflammatory responses. This process requires antigen-presenting cells (APCs) that induce T cells with either regulatory or effector functions. Compromised APC function disrupts the T cell balance, leading to inflammation and dysbiosis. Although their precise identities continue to be debated, it has become clear that multiple APC lineages direct the differentiation of distinct microbiota-specific CD4+ T cell programs. Here, we review how unique APC subsets instruct T cell differentiation and function in response to microbiota and dietary antigens. These discoveries provide new opportunities to investigate T cell-APC regulatory networks controlling immune homeostasis and perturbations associated with inflammatory and allergic diseases. Although the precise identities of the APCs that induce peripheral Treg cells and most effector T cell subsets continue to be debated, what is clear is that the microbiota direct the differentiation of distinct CD4+ T cell programs by delivering antigens to multiple APCs that are dedicated to unique functions in their instruction of T cells and may participate in regulatory networks to achieve homeostasis. [ABSTRACT FROM AUTHOR]

Background: Infants aged <1 year with confirmed food allergies generally need to avoid causative foods completely for a certain period. Low‐dose oral food challenges (LD‐OFCs) may be an effective strategy for safely introducing small amounts of causative foods to individuals with food allergies. This study clarified the safety of LD‐OFCs in infants aged <1 year with food allergies. Methods: We retrospectively analyzed the clinical records of LD‐OFCs performed in infants aged <1 year allergic to hen's egg, cow's milk, or wheat between April 2014 and October 2017. Approximately 1/25th–1/20th of the egg white from a heated whole hen's egg, 3 mL heated cow's milk, and 2 g wheat noodles (udon) were used as challenge foods. We examined the LD‐OFC results, including the induced symptoms and treatment required for positive LD‐OFC results. Results: The LD‐Egg, LD‐Milk, and LD‐Wheat OFC groups comprised 68, 42, and 13 participants, respectively. The positivity rates for the LD‐Egg, LD‐Milk, and LD‐Wheat OFC groups were 7%, 24%, and 0%, respectively. Patients predominantly exhibited skin symptoms, and most were treated with oral antihistamines alone. None of the patients experienced anaphylaxis or required adrenaline injections. Conclusions: Infants aged <1 year with food allergies can safely undergo LD‐OFCs by consuming low doses of causative foods. Avoiding the complete elimination of causative foods is an important strategy for managing infants with food allergies when initially introducing causative foods. [ABSTRACT FROM AUTHOR]

Background: Consumption of raw cow's milk has repeatedly been shown to protect from asthma, allergies, and respiratory infections. As raw milk bears potential health hazards, it cannot be recommended for prevention. Therefore, we performed an intervention study with microbially safe but otherwise minimally processed cow's milk. Here we describe feasibility and safety of the trial. Methods: The MARTHA trial (DRKS00014781) was set up as a double‐blind randomized intervention in a population residing in Bavaria. Infants from 6 to 36 months of age consumed minimally processed cow's milk (intervention arm) or ultra‐heat‐treated (UHT) semi‐skimmed milk (comparator arm). Results: At the age of 6 to 12 months, 260 infants were enrolled, with 72% having a family history of atopy. The extensive screening system for milk consumption and symptoms suggestive of adverse events was well accepted with 22,988 completed weekly surveys and an average completion of 82% surveys sent out. The children consumed the study milk on average on 457 days (61% of intervention days). The intervention proved to be safe without any case of milk allergy or milk intolerance under the intervention in both arms. All 6 cases of serious adverse events were unrelated to milk. The most common reason was unscheduled hospitalization of more than 3 days. Conclusions: The intervention with minimally processed milk and the study instruments proved feasible. During the age of 6 to 36 months, there was no increased risk of milk allergy in a population with a substantial proportion of family history of atopy. [ABSTRACT FROM AUTHOR]

M2 macrophages play an important role in food allergy. Several studies have reported that lactic acid bacteria isolated from pickles exert antiallergic effects. We investigated the effects of several strains of lactic acid bacteria on the immune function of M2 macrophages. M2 macrophages differentiated from THP‐1 cell line by interleukin‐4 (IL‐4) and IL‐13 strongly expressed CD163, CD206, and HMOX1 mRNA. Levilactobacillus brevis IBARAKI‐TS3 (IBARAKI‐TS3) isolated from pickles was identified as a lactic acid bacterium that enhances the expressions of IL‐10 and EBI3 mRNA in M2 macrophages. IBARAKI‐TS3 induced the expression of genes involved in Toll‐like receptor (TLR) signaling, such as IRAK, mitogen‐activated protein kinases (MAPKs), and NF‐κB mRNA. IBARAKI‐TS3–induced IL‐10 production was suppressed by anti‐TLR2–neutralizing antibodies. Furthermore, the IBARAKI‐TS3–induced increase in IL‐10 levels was significantly reduced in TLR2–knockdown M2 macrophages compared to M2 macrophages. These results suggest that IBARAKI‐TS3 promotes of IL‐10 production via TLR2 in M2 macrophages. Significance Statement: M2 macrophages play an important role in food allergies. The effects of lactic acid bacteria have been reported; however, their effects on M2 macrophages remain unclear. Our results revealed that when cultured with lactic acid bacteria, M2 macrophages increased IL‐10 production compared with when they were not. Culture with IBARAKI‐TS3, a strain of Levilactobacillus brevis, resulted in the highest levels of IL‐10 production. Based on the decrease in IL‐10 production following TLR2–knockdown and culture with TLR2–neutralizing antibodies, our results revealed that the anti‐inflammatory effects of M2 macrophages are enhanced by IBARAKI‐TS3 via TLR2. These suggest that IBARAKI‐TS3 may attenuate food allergies by enhancing the anti‐inflammatory effects of M2 macrophages. [ABSTRACT FROM AUTHOR]

The study conducted at a UK allergy clinic focused on patch testing in cutaneous adverse drug reactions to evaluate its effectiveness in diagnosing these reactions. The British Registry of Immunotherapy (BRIT) was used to monitor patient outcomes and safety in venom immunotherapy (VIT) protocols, with high patient engagement and excellent compliance observed. A dietitian-led rapid access clinic for non-IgE-mediated cow's milk allergy (CMA) successfully confirmed diagnoses, reduced unnecessary hydrolyzed formula (HF) prescribing, and improved patient outcomes. The importance of thorough testing, diagnosis, and individualized care in managing allergies, such as salmon roe and shellfish allergy, was highlighted in a case study on refractory severe asthma in children. [Extracted from the article]

The article in Clinical & Experimental Allergy explores how exposure to house dust mite (HDM) can promote the development of allergy to egg white in mice. The study found that inhalation of egg white and HDM led to systemic Th2 responses in mice, indicating a potential link between respiratory exposure to food allergens and systemic sensitization. The research suggests that prior sensitization to egg proteins through the respiratory tract, facilitated by HDM components, could lead to food allergies when egg is later ingested. The study highlights the adjuvant activity of HDM in enhancing the development of a Th2-driven immune response to egg white through the airways, with protease activity playing a modest role in this context. [Extracted from the article]

Simple Summary: Food allergy in dogs, primarily triggered by proteins, results in symptoms in the skin and gastrointestinal system. This case study focused on a 5-year-old female beagle weighing 12.4 kg, diagnosed with a food allergy with gastrointestinal manifestations, to assess the efficacy of black soldier fly larva (BSFL) meal in controlling the condition. The protocol included two nutritionally very similar diets: the control diet, with poultry by-product meal; and the BSFL diet, completely substituting the poultry by-product meal with BSFL meal. After a 12-day adaptation period to the BSFL diet, the dog maintained an adequate fecal score and showed no gastrointestinal changes. A food challenge test with the control diet induced gastrointestinal manifestations, which were reversed within two days by reintroducing the BSFL diet. The BSFL meal may be a promising option, offering improvement in gastrointestinal symptoms in dogs with food allergies. It represents a viable, cost-effective, and beneficial alternative for dogs diagnosed with food allergies. Food allergy triggers an immune response to dietary proteins, resulting in food rejection and dermatological and gastrointestinal manifestations. The preferred therapies include diets with hydrolyzed proteins or unusual single-source proteins, with insect protein emerging as a promising option, with no reported allergic reactions in dogs with a food allergy. In this case study, the effects of including black soldier fly larva (BSFL) meal were observed in a 5-year-old spayed beagle previously diagnosed with a food allergy. The objective was to assess the potential of BSFL meal as an adjunct in treating a food allergy. As part of the protocol, two nutritionally very similar diets were used, differing only in the protein source: the control diet, with poultry by-product meal; and the BSFL diet, which completely replaced the poultry by-product meal. After a 12-day adaptation period to the BSFL diet, the dog showed no gastrointestinal changes, maintaining an adequate fecal score and no clinical signs of the disease. A challenge test with the control diet resulted in episodic gastrointestinal symptoms, which were reversed within two days by reintroducing the BSFL diet. The BSFL protein-based diet was effective in controlling the dog's clinical signs. [ABSTRACT FROM AUTHOR]

The editorial "Food Allergy: Epidemiology, Pathogenesis, Diagnosis, and Treatment" discusses the complexities of food allergies, including different immune responses and their impact on quality of life. The issue highlights research on prevalence, pediatric populations, pathophysiological mechanisms, quality of life, and nutritional therapeutic strategies related to food allergies. Studies in the issue focus on topics such as the prevalence of food allergies in Mexican preschoolers, latex allergies in children, and the impact of food allergies on quality of life at different ages. The research emphasizes the importance of understanding the underlying mechanisms of food allergies for developing effective therapeutic strategies. [Extracted from the article]

Microorganisms colonize all barrier tissues and are present on the skin and all mucous membranes from birth. Bacteria have many ways of influencing the host organism, including activation of innate immunity receptors by pathogen-associated molecular patterns and synthesis of various chemical compounds, such as vitamins, short-chain fatty acids, bacteriocins, toxins. Bacteria, using extracellular vesicles, can also introduce high-molecular compounds, such as proteins and nucleic acids, into the cell, regulating the metabolic pathways of the host cells. Epithelial cells and immune cells recognize bacterial bioregulators and, depending on the microenvironment and context, determine the direction and intensity of the immune response. A large number of factors influence the maintenance of symbiotic microflora, the diversity of which protects hosts against pathogen colonization. Reduced bacterial diversity is associated with pathogen dominance and allergic diseases of the skin, gastrointestinal tract, and upper and lower respiratory tract, as seen in atopic dermatitis, allergic rhinitis, chronic rhinosinusitis, food allergies, and asthma. Understanding the multifactorial influence of microflora on maintaining health and disease determines the effectiveness of therapy and disease prevention and changes our food preferences and lifestyle to maintain health and active longevity. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease (IBD) and food allergy (FA) increase in tandem, but the potential impact of IBD on FA remains unclear. We sought to determine the role of IBD on FA. We first assessed the changes of FA‐related risk factors in dextran sulphate sodium salt (DSS) induced colitis mice model. Then, we evaluated the role of IBD on FA in mice. FA responses were determined using a clinical allergy score, body temperature change, serum antibody levels, cytokines level and mouse mast cell protease 1 (MMCP‐1) concentration. Accumulation of regulatory T cells was tested using flow cytometry. Intestinal changes were identified by histology, immunohistochemistry, gene expression and gut microbial community structure. In DSS‐induced colitis mice model, we found the intestinal damage, colonic neutrophil infiltration, and downregulation of splenic Th2 cytokines and Tregs in mesenteric lymph nodes (MLN). Moreover, we also found that IBD can alleviate the FA symptoms and lead to the significant downregulation of Th2 cytokines, serum IgE and MMCP‐1. However, IBD exacerbates intestinal injury and promotes the gene expression levels of IL‐33 and IL‐5 in the small intestine, damages the intestinal tissue structure and aggravates intestinal dysbiosis in FA. IBD functions as a double‐edged sword in FA. From the perspective of clinical symptoms and humoral immune responses, IBD can reduce FA response by downregulating Th2 cytokines. But from the perspective of the intestinal immune system, IBD potentially disrupts intestinal tolerance to food antigens by damaging intestinal tissue structure and causing intestinal dysbiosis. [ABSTRACT FROM AUTHOR]

Background: Approximately 70% of individuals allergic to birch pollen (Bet v 1.01 [Bet]) develop a secondary food allergy (e.g., hazelnut: Cor a 1.04 [Cor]), due to allergen cross‐reactivity. However, standard immunotherapy for type I allergies often does not improve the food allergy sufficiently. We analyzed the allergen‐specific and cross‐reactive suppressive capacity of primary human regulatory T cells (Treg) induced by autologous IL‐10‐modulated dendritic cells (IL‐10 DC) in vitro and in vivo. Methods: CD4+ T cells of patients with birch pollen and associated hazelnut allergies were differentiated into Bet‐specific or non‐specific induced Treg (iTreg). After Bet‐ or Cor‐specific restimulation the phenotype, proliferation, and suppressive capacity of iTreg subsets were analyzed. iTreg function was further investigated in humanized mouse models of airway and intestinal allergy, generated by engraftment of peripheral blood mononuclear cells from allergic donors into immunodeficient animals. Results: After IL‐10 DC priming and allergen‐specific restimulation (Bet or Cor), non‐specific control iTreg remained anergic, whereas Bet‐specific iTreg proliferated extensively and exhibited a regulatory phenotype (enhanced expression of CTLA‐4, PD‐1, TNFR2, IL‐10). Accordingly, activated Bet‐specific iTreg displayed a high capacity to suppress Bet‐ and Cor‐induced responder Th2 cell responses in vitro, indicating induction of both allergen‐specific (birch) and cross‐reactive tolerance (hazelnut). In vivo, the beneficial effect of Bet‐specific iTreg was verified in humanized mouse models of allergic airway and intestinal inflammation, resulting in reduced allergen‐induced clinical symptoms, and immune responses. Conclusion: Human IL‐10 DC‐induced iTreg facilitate allergen‐specific and cross‐reactive tolerance. Therefore, they are potential candidates for regulatory cell therapy in allergic and autoimmune diseases. [ABSTRACT FROM AUTHOR]

Background: While food allergy (FA) can be fatal, the greatest public health impact of FA arguably lies in its detrimental effect on quality of life (FAQOL). Understanding the factors that contribute to FAQOL at different ages is essential to develop personalized interventions that will improve FAQOL. Objective: To determine the most influential factors that impact FAQOL across ages in well‐phenotyped participants with confirmed FA. Methods: One hundred and twenty‐five individuals aged 2–28 years with IgE‐mediated FA completed validated age‐specific FAQOL questionnaires. The relationship between demographic/clinical variables and scores were analyzed to identify key predictors of FAQOL. Results: Poor FAQOL was associated with increasing age, strict avoidance practices, reactions to trace exposures, and more severe reactions as assessed by epinephrine use, anaphylaxis, and/or treatment in the emergency department; FAQOL improved with time from the event. FAQOL was worse in subjects avoiding >2 versus ≤2 foods and in those avoiding milk, egg, soy, sesame, or wheat. Number of foods avoided had greatest impact on children ages 2–7 years, while total number of allergic reactions strongly impacted FAQOL in teens and adults; FAQOL of subjects ages 8–12 years appeared less affected by these variables compared to other age groups. A decision tree analysis identified key predictors of overall FAQOL (age, number of food avoidances, and time since epinephrine use) that can be used to guide intervention strategies to improve FAQOL. Conclusion: We directly compared FAQOL in extensively phenotyped children, teenagers, and adults with confirmed IgE‐mediated FA. Age; timing, number, and severity of reactions; type and number of FA; and food avoidance practices influence FAQOL and should guide intervention strategies. [ABSTRACT FROM AUTHOR]

Background: Food allergy (FA) is associated with poor health‐related quality of life and high levels of psychological distress. Psychological support is extremely important but not always available. As part of the Global Access to Psychological Services for Food Allergy (GAPS) study, we aimed to assess psychological distress and service use among adults, caregivers and children with FA in a global survey. Methods: Participants (n = 1329 adults with FA; n = 1907 caregivers of children with FA) from >20 countries were recruited through patient organisations, social media advertisements and online survey panels to complete an online survey. Surveys were available in six languages. Results: A total of 67.7% of adults and 77.2% of caregivers reported direct experience, and 51.6% of caregivers said their child had experienced FA‐related psychological distress. The most commonly reported issue was anxiety about having an allergic reaction. Less than 20% had been assessed for FA‐related psychological distress. There were significant differences across countries for levels of distress, screening for distress, seeing a mental health professional and being diagnosed with a FA‐related mental health disorder (all p <.001). The United Kingdom, Australia and Brazil had the highest number of participants reporting distress. The most commonly reported barrier to seeing a mental health professional was cost. Conclusions: FA‐related distress is common across countries, but with substantial country‐to‐country variability. Allergy providers are encouraged to routinely assess families for psychological distress and provide access to appropriate mental health resources. Development and implementation of evidence‐based, patient‐informed accessible, affordable FA interventions in multiple languages is urgently needed. [ABSTRACT FROM AUTHOR]

Background: Various biomarkers are used to define peanut allergy (PA). We aimed to observe changes in PA resolution and persistence over time comparing biomarkers in PA and peanut sensitised but tolerant (PS) children in a population‐based cohort. Methods: Participants were recruited from the EAT and EAT‐On studies, conducted across England and Wales, and were exclusively breastfeed babies recruited at 3 months old and followed up until 7–12 years old. Clinical characteristics, skin prick test (SPT), sIgE to peanut and peanut components and mast cell activation tests (MAT) were assessed at 12 months, 36 months and 7–12 years. PA status was determined at the 7–12 year time point. Results: The prevalence of PA was 2.1% at 7–12 years. Between 3 and 7–12 year, two children developed PA and one outgrew PA. PA children had larger SPT, higher peanut‐sIgE, Ara h 2‐sIgE and MAT (all p <.001) compared to PS children from 12 months onwards. SPT, peanut‐sIgE, Ara h 2‐sIgE and MAT between children with persistent PA, new PA, outgrown PA and PS were statistically significant from 12 months onwards (p <.001). Those with persistent PA had SPT, peanut‐sIgE and Ara h 2‐sIgE that increased over time and MAT which was highest at 36 months. New PA children had increased SPT and peanut‐sIgE from 36 months to 7–12 years, but MAT remained low. PS children had low biomarkers across time. Conclusions: In this cohort, few children outgrow or develop new PA between 36 months and 7–12 years. Children with persistent PA have raised SPT, peanut‐sIgE, Ara h 2‐sIgE and MAT evident from infancy that consistently increase over time. [ABSTRACT FROM AUTHOR]

Background: Allergen immunotherapy (AIT) is the only known causative treatment for Alternaria allergy, but the difficulty in standardizing Alternaria extracts hampers its effectiveness and safety. Summary:Alternaria, a potent airborne allergen, has a high sensitization rate and is known to trigger the onset and exacerbation of respiratory allergies, even inducing fungal food allergy syndrome in some cases. It can trigger a type 2 inflammatory response, leading to an increase in the secretion of type 2 inflammatory cytokines and eosinophils, which are the culprits behind allergic symptoms. Diagnosing Alternaria allergy is a multistep process, involving a careful examination of clinical symptoms, medical history, skin prick tests, serum-specific IgE detection, or provocation tests. Alt a1, the major component of Alternaria, is a vital player in diagnosing Alternaria allergy through component-resolved diagnosis. Interestingly, Alternaria can reduce the protein activity of other allergens like pollen and cat dander when mixed with them. In order to solve the problems of standardization, efficacy and safety of traditional Alternaria AIT, novel AIT methods targeting Alt a1 and innovative vaccines such as epitope, DNA, and mRNA vaccines seem promising in bypassing the standardization issue of Alternaria extracts. But these studies are in early stages, and most researches are still focused on animal models, calling for more evidence to validate their use in humans. Key Messages: This review delves into the various aspects of Alternaria allergy, including characteristics, epidemiology, immune mechanisms, diagnosis, clinical manifestations, and the application and limitations of Alternaria AIT, aiming to provide a foundation for the management of patients with Alternaria allergy. [ABSTRACT FROM AUTHOR]

Introduction: Despite the increasing prevalence of fruit and vegetable allergies in childhood over the past decades, the clinical course of reaction types and tolerance remain unclear. Our aim was to evaluate the clinical course, demographic characteristics, and tolerance rate of allergic reactions induced by fruits or vegetables. Methods: We conducted a retrospective, descriptive, cross-sectional study on patients who presented with suspected allergic reactions to fruit or vegetables. We used patient records to identify demographic data, skin prick test, prick-to-prick test, and oral food challenge test results and laboratory findings. Results: The study included 78 children with a median age of 61.5 months. Class 1 and 2 allergies were found in 65 and 13 cases, respectively. The most common allergens were potato (21.8%), banana (15.4%), peach (14.1%), and tomato (12.8%). Clinical symptoms included urticaria (75.6%), oral allergy syndrome (15.4%), angioedema (7.7%), and anaphylaxis (1.3%). Thirteen children achieved tolerance, while 61.7% did not. The median time to tolerance was 13.5 months after diagnosis, with a minimum of 9 months. Significant differences in reaction type, clinical presentation, pan-allergy to aeroallergens, and serum total IgE levels were found between the tolerant and non-tolerant groups (p = 0.006, 0.009, 0.005, and 0.001, respectively). Conclusion: This is the first study to provide guidance on the tolerance rate and resolution time of fruit and vegetable allergies based on demographic and diagnostic parameters. Further research is needed to deepen our understanding of fruit and vegetable allergy. [ABSTRACT FROM AUTHOR]

Introduction: Diagnostic of aspirin (ASA) hypersensitivity is largely based on provocation tests. However, they have significant limitations including influence of medications, necessity of hospitalization, and safety issues. Basophil activation test (BAT) seems to be a promising in vitro alternative. It has already proven to be a useful tool for diagnosing IgE-mediated allergy to certain food and airborne allergens as well as insects venoms. The aim of the study was to assess performance of BAT in diagnosing aspirin hypersensitivity in comparison with current golden standard (oral provocation test, OPT). Methods: The study group comprised 148 adult patients with suspicion of aspirin hypersensitivity, including 51 (36%) with chronic urticaria, 73 (51%) with asthma, and 55 (39%) with chronic sinusitis. The control group was 10 healthy adult patients who used NSAIDs during preceding year with good tolerance. BAT with ASA was conducted in all the participants. Additionally, in the study group, OPT was performed with cumulative dose of 1,000 mg of ASA. Results: Out of 148 study group participants, 114 underwent BAT and ASA provocation with conclusive results acquired in both tests. In this group, the threshold for positive BAT was 4.9%. Sensitivity and specificity of BAT were found to be 55.9% and 75%, respectively, with a positive predictive value of 77% and a negative predictive value of 54%. The highest sensitivity (78%) was found in subgroup patients with chronic urticaria, while specificity was highest in the subgroup with chronic respiratory diseases (87%). Conclusion: Despite significant advantages of BAT such as safety, no influence of drugs, and objectivity, its performance makes it inferior to current standard in ASA hypersensitivity. [ABSTRACT FROM AUTHOR]

Preparing and serving allergen-free meals continue to be challenging for food service establishments due to the associated costs and complexity of menu items. Our study assessed food allergy policies and procedures in independently owned restaurants (n = 103) within the Orlando metropolitan area in Florida. The Florida Department of Business and Professional Regulation HR 5030-038 from the Division of Hotels and Restaurants requires all food service managers and employees to know and name the top 8 major allergens and describe common food allergy symptoms. In total, 71 restaurants accommodated customers who have food allergies. Further, 25 restaurants reported having written food allergy policies and procedures, 63 did not, and 5 did not know. Approximately one half (49) of the owners, operators, and managers did not receive food allergy training. Of the training provided, 27 restaurants offered training in English and 20 restaurants offered training also in Spanish. Food service establishments will benefit from developing and implementing food allergy policies and procedures to serve food safely to customers who have food allergies. [ABSTRACT FROM AUTHOR]

Food allergies are an increasing global problem and societal issue. In addition to the potential for severe allergic reactions from accidental ingestion, food allergies impose a significant burden on the quality of life, nutrition, cost of living, and social activities of both those afflicted and their caregivers. Strict avoidance of allergens and use of emergency medications to treat allergic reactions are the traditional management and treatment strategies; however, significant progress has been made in recent years toward better treatment of food allergies. Many clinical trials on food allergen immunotherapy (oral, epicutaneous, and sublingual) have revealed its efficacy in increasing reaction thresholds and desensitization. These positive results led to the first FDA approval of peanut oral immunotherapy (OIT). However, safer and more effective approaches are required, and adjunct treatments and allergen modifications are being considered. More than 100 facilities in Japan conduct OIT, and numerous studies on it have been reported. Unlike in Europe and the US, stepwise oral food challenges with dietary guidance are conducted separately from the OIT. This review describes the current perspectives on allergen immunotherapy for the treatment of food allergies, focusing on evidence from Japan. [ABSTRACT FROM AUTHOR]

To avoid complete elimination of hen eggs (HE) from diet, we introduced a very-low-dose (VLD) oral food challenge (OFC) in patients with severe HE allergy in 2019. Herein, we investigated the efficacy of VLD HE OFC for achieving the full dose OFC. Patients with an overt allergic reaction to LD (1/32 HE [≤100 mg]) or less, egg white (EW) protein within 6 months were included. In the VLD group, patients not achieving full-dose OFC (1/2 HE: 1600 mg EW protein) within 2 years were excluded. We retrospectively compared the rate of passing a full-dose OFC between patients who underwent a LD OFC before 2019 (LD group) and those who underwent a VLD OFC (1/100 HE: 32 mg EW protein) after 2019 (VLD group). The period for passing the full-dose OFC was evaluated using Kaplan–Meier survival analysis. We enrolled 411 and 111 patients in the LD and VLD groups, respectively. The median age at OFC initiation was 2.2 [1.5–3.6] and 2.1 [1.4–3.2] years in the LD and VLD groups, respectively. EW- and ovomucoid-specific IgE levels were 38.3 (12.5–72.9) and 21.0 (8.3–46.2) kU A /L in the LD group and 49.8 [18.8–83.9] and 32.1 [15.6–67.8] kU A /L in the VLD group, respectively. Over 4 years, the LD and VLD groups passed the full-dose OFC at rates of 70 and 95%, respectively, with significant differences (log-rank test, P < 0.001). VLD HE OFC may contribute to passing a full-dose OFC in patients with severe HE allergies. [ABSTRACT FROM AUTHOR]

Intestinal bacteria may play a role in the development of food allergies. This study aimed to analyze and compare the gut microbiota of food-allergic children with that of healthy children of the same age. Stool samples were collected from one-and-a-half-year-old food-allergic (FA group, n = 29) and healthy controls (HC group, n = 19). A questionnaire was provided to examine the children's birth, dietary, medical, and social histories. The gut microbiota was profiled by 16S rRNA sequencing. Differences in taxonomic composition were assessed using linear discriminant analysis effect size (LEfSe), and microbial functional profiles were predicted with Tax4Fun2. No significant difference in the alpha diversity index between the two groups; however, a negative correlation was observed between the Shannon diversity index and the relative abundance of Bacteroides. A significant difference was observed in beta diversity (permutational multivariate analysis of variance) in the bacterial composition between the FA and HC groups (P < 0.05). The FA group had a higher abundance of Escherichia and Anaeromassilibacillus and a lower abundance of Bacteroides , Oscillibacter , Ruminococcus, Hungateiclostridium and Anaerotaenia than the HC group (LEfSe: linear discriminant analysis score >2). The FA group showed a predicted increase in the expression levels of genes associated with intestinal pathogenicity compared with that in the HC group. The gut microbiota of food-allergic children has a higher abundance of bacteria involved in intestinal inflammation and a lower abundance of bacteria involved in immune tolerance than that of healthy children. This dysbiosis may also be associated with food allergies. [ABSTRACT FROM AUTHOR]

Translating evidence-based practice (EBP) into real-world clinical settings often takes a considerable amount of time and resources. In allergy and immunology, the dissemination and implementation (D&I) sciences facilitate the study of how variations in knowledge, resources, patient populations, and staffing models lead to differences in the clinical care of asthma, allergic disease, and primary immunodeficiency. Despite the need for validated approaches to study how to best apply EBP in the real world, the D&I sciences are underutilized. To address this gap, an American Academy of Allergy, Asthma & Immunology (AAAAI) work group was convened to provide an overview for the role of the D&I sciences in clinical care and future research within the field. For the D&I sciences to be leveraged effectively, teams should be multidisciplinary and inclusive of community and clinical partners, and multimethods approaches to data collection and analyses should be used. Used appropriately, the D&I sciences provide important tools to promote EBP and health equity as well as optimization of clinical practice in allergy and immunology. [ABSTRACT FROM AUTHOR]

The Proprotein Convertase Subtilisin Kexin of type 9 (PCSK9) has been identified in 2003 as the third gene involved in familial hypercholesterolemia. PCSK9 binds to the membrane low-density lipoprotein receptor (LDLR) and promotes its cellular internalization and lysosomal degradation. Beyond this canonical role, PCSK9 was recently described to be involved in several immune responses. However, to date, the contribution of PCSK9 in food allergy remains unknown. Here, we showed that Pcsk9 deficiency or pharmacological inhibition of circulating PCSK9 with a specific monoclonal antibody (m-Ab) protected mice against symptoms of gliadin-induced-food allergy, such as increased intestinal transit time and ear oedema. Furthermore, specific PCSK9 inhibition during the elicitation steps of allergic process was sufficient to ensure anti-allergic effects in mice. Interestingly, the protective effect of PCSK9 inhibition against food allergy symptoms was independent of the LDLR as PCSK9 inhibitors remained effective in Ldlr deficient mice. In vitro , we showed that recombinant gain of function PCSK9 (PCSK9 D374Y) increased the percentage of mature bone marrow derived dendritic cells (BMDCs), promoted naïve T cell proliferation and potentiated the gliadin induced basophils degranulation. Altogether, our data demonstrate that PCSK9 inhibition is protective against gliadin induced food allergy in a LDLR-independent manner. [ABSTRACT FROM AUTHOR]

This study reports on the interactions of egg proteins, which represent a major health concern in food allergy, with polyphenols obtained from orange and lemon peels. The antioxidant properties of such citrus peel extracts prior to protein binding were evaluated. The resulting edible, and therefore inherently safe, matrices exhibit reduced IgE binding compared to pure proteins in indirect immunological assays (ELISA) using individual sera from patients allergic to ovalbumin and lysozyme. The reduced allergenicity could arise from the interactions with polyphenols, which alter the structure and functionality of the native proteins. It is hypothesized that the anti-inflammatory and antioxidant properties of the polyphenols, described as inhibitors of the allergic response, could add immunomodulatory features to the hypoallergenic complexes. A docking analysis using lysozyme was conducted to scrutinize the nature of the protein–polyphenol interactions. An in silico study unravelled the complexity of binding modes depending on the isoforms considered. Altogether, the presented results validate the antioxidant properties and reduced allergenicity of polyphenol-fortified proteins. Lastly, this study highlights the upgrading of vegetable wastes as a source of natural antioxidants, thus showing the benefits of a circular economy in agri-food science. [ABSTRACT FROM AUTHOR]