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Cow's milk protein allergy (CMPA) affects 2% to 3% of infants and is managed with hypoallergenic formulas. The 2022 recalls of infant formulas due to factors including contamination led to specialty formula shortages, highlighting CMPA management challenges. Understanding health care providers' (HCPs) decision-making in transitioning to alternative formulas during shortages is crucial. Limited attention has been given to how pediatric physicians make these choices. This study utilized US HCPs' de-identified survey data to assess driving factors when switching extensively hydrolyzed formulas during shortages. A total of 104 eligible HCPs participated, including general pediatrics, pediatric allergy/immunology, and pediatric gastroenterology specialists. Safety, tolerability, and efficacy were identified as top factors for switching formulas. Formula 1 was considered well-tolerated, patient-accepted, and safe by all HCPs. Most expressed strong belief in Formula 1's safety and effectiveness. Findings inform CMPA management during shortages, offering guidance to HCPs for suitable formula selection and enhanced infant care. [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]

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]

Summary This manuscript sheds light on the impact of maternal breast milk antibodies on infant health. Milk antibodies prepare and protect the newborn against environmental exposure, guide and regulate the offspring's immune system, and promote transgenerational adaptation of the immune system to its environment. While the transfer of IgG across the placenta ceases at birth, milk antibodies are continuously replenished by the maternal immune system. They reflect the mother's real‐time adaptation to the environment to which the infant is exposed. They cover the infant's upper respiratory and digestive mucosa and are perfectly positioned to control responses to environmental antigens and might also reach their circulation. Maternal antibodies in breast milk play a key role in the immune defense of the developing child, with a major impact on infectious disease susceptibility in both HIC and LMIC. They also influence the development of another major health burden in children—allergies. Finally, emerging evidence shows that milk antibodies also actively shape immune development. Much of this is likely to be mediated by their effect on the seeding, composition and function of the microbiota, but not only. Further understanding of the bridge that maternal antibodies provide between the child and its environment should enable the best interventions to promote healthy development. [ABSTRACT FROM AUTHOR]

\nIntroduction: Stepwise oral food challenge (OFC) tests begin with low doses of allergens and progress to full doses. We previously reported the safety and efficacy of stepwise OFC for reintroducing hen eggs. In this study, we discuss its application for cow’s milk (CM) allergy. Methods: We included 927 children (median age, 3.2 years) who underwent CM-OFC between 2017 and 2021. The target challenge dose was classified as low (<10 mL), middle (≥10 mL but <100 mL), or full. When participants reacted to the low dose, they underwent a very low-dose OFC using baked milk or <1 mL of CM. Results: Positive reactions occurred in 210 cases (22.7%), including 69 anaphylactic reactions (7.4%). A lower target dose resulted in more positive OFC results (p < 0.001) and anaphylaxis (p = 0.001). The lower dose group included more children with complete elimination of CM (p < 0.001), with numerous histories of anaphylaxis induced by CM (p < 0.001), and higher levels of total IgE (p = 0.033) and CM-sIgE (p < 0.001). A multivariate analysis indicated that in the low-dose-OFC group, higher CM-sIgE levels (p = 0.034), younger age (p = 0.005), and complete elimination of CM (p = 0.002) were associated with positive OFC results. Conclusion: The stepwise OFC could reintroduce small amounts of CM, even in cases with high CM-sIgE levels or a history of anaphylaxis. Performing CM-OFC at younger ages, specifically from infancy, with very low doses, might facilitate the safe reintroduction of CM. Stepwise oral food challenge (OFC) tests begin with low doses of allergens, progressing to full doses. This is one of the strategies used to avoid anaphylactic reactions to the reintroduction of allergens. We previously reported the safety and efficacy of hen egg OFC. In this study, we discuss it for cow’s milk (CM) allergy. We included 927 children (median age, 3.2 years) who underwent CM-OFC between 2017 and 2021. The target challenge dose was classified as low (<10 mL), middle (≥10 mL but <100 mL), or full. When the participants reacted to low doses, they underwent very low-dose OFC using baked milk or <1 mL of CM. Positive reactions developed in 210 cases (22.7%), including 69 anaphylactic reactions (7.4%). A lower target dose resulted in more positive OFC results and anaphylaxis. Multivariate analysis indicated that only in low-dose OFCs, higher CM-specific IgE (CM-sIgE) levels, younger age, and complete CM elimination were associated with positive OFC results. Food ladders, an approach to reintroduce allergens, are becoming increasingly popular. Although we believe that OFC is a safer strategy to reintroduce CM to children with CM allergy, our CM-OFCs appeared to develop more anaphylactic reactions than milk ladders. The stepwise OFC reintroduced small amounts of CM, even in cases with high CM-sIgE levels or a history of anaphylaxis. Performing CM-OFC at a younger age, preferably from infancy, with very low doses, similar to milk ladders, may facilitate the safe reintroduction of CM. [ABSTRACT FROM AUTHOR]

Milk protein sensitivity is a major challenge in infant feeding, especially for infants who cannot receive adequate breastfeeding. Hydrolyzed milk protein is a mainstream way to address this difficulty. The aim of this study was to assess the effect of differences in whey protein concentrate (WPC) source and the degree of hydrolysis on blocking allergy and to analyze the possible mechanisms by which hydrolyzed infant formula (IF) blocks allergy through colony‐metabolism–immunity response. First, we prepared six groups of goat's milk IF with unhydrolyzed, partially, and extensively hydrolyzed WPC, which come from cow's milk WPC and goat's milk WPC. Subsequently, we evaluated their effects on allergy. The results showed that the hydrolyzed IF improved the allergic characteristics of mice, including low levels of total immunoglobulin E (IgE), specific IgE, histamine, and mucosal mast cell protease‐1 (mMCP‐1). Furthermore, the hydrolyzed IF promoted the immune response of T helper 1 (Th1) and regulatory T (Treg) cells by enhancing the messenger RNA (mRNA) expression of T‐box transcription factor 21 (T‐bet) and forkhead box protein P3 (Foxp3), which in turn suppressed the T helper 2 (Th2) overexpressed immune response in allergy (GATA‐binding protein 3 (GATA‐3) and retinoic‐acid‐receptor‐related orphan receptor gamma t (RORγt) mRNA expression, as well as interleukin 4 (IL‐4) and interleukin 5 (IL‐5) levels). Hydrolyzed IF promoted an increase in beneficial gut microbe Lactobacillus and Alistipes, which in turn promoted an increase in intestinal butyrate levels. The beneficial bacteria and their metabolized butyrate may have suppressed the abundance of the allergy‐characterizing bacterium Rikenellaceae‐RC9‐gut‐group. The final result we obtained was that for both cow's milk WPC and goat's milk WPC, at similar levels of hydrolysis, they did not bring about a significant effect on allergy symptoms. The hydrolyzed IF improved the allergic characteristics of mice, the deeper the degree of hydrolysis of WPC, the more obvious the effect of reducing allergic symptoms in model mice. [ABSTRACT FROM AUTHOR]

Simple Summary: In recent decades, interest in the use of donkey milk for human nutrition has increased, since it may represent a natural substitute for cow's milk for children affected by milk protein allergies. The functional peculiarities of donkey milk are mainly linked to its casein content comparable to that of human milk. This study provides a thorough analysis of transcript isoforms generated by two αs2-casein-encoding genes (CSN1S2 I and CSN1S2 II) in donkeys and a detection of significant genetic diversity at both loci along with sequence comparisons across species. In particular, a key mutation affecting exon 17 splicing in CSN1S2 I was identified, and a genotyping method was developed. These data represent an important step in the understanding of the expression regulation of these genes in donkeys and a useful tool for the genetic improvement of donkey milk production that fulfils special consumer requirements. The αs2-casein is a phosphoprotein secreted in the milk of most mammals, and it is the most hydrophilic of all caseins. Contrary to genes found in ruminants, in donkeys two different encoding genes for donkey αs2-casein (CSN1S2 I and CSN1S2 II) have been identified. However, unlike in ruminants, the variability at these loci has not been characterized in detail in donkeys until now. In this study, we analyze the transcript profile of the donkey CSN1S2 I and CSN1S2 II genes, and we identify and describe the variability of these loci in the Ragusana and Amiatina breeds reared in Italy. The analysis of the CSN1S2 I Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) products and subsequent sequencing showed, in addition to correctly spliced mRNA, seven other minor mRNAs resulting from differential splicing events involving, in various combinations, entire exons (4, 5, 6, and 11), parts of exons (5′ or 3′ end of exon 17), or the recognition of intronic sequences as an exon (exon 12′). Similarly, the transcription analysis of the CSN1S2 II gene revealed a remarkable variability in splicing events, mainly concerning the alternative insertion of an extra exon 7 (named 7′); the first 33 bp of exon 13; or the alternative skipping of exons 9, 10, 11, 12, and 15, and their combinations. At the mRNA level for CSN1S2 I, seven SNPs were observed, five of which led to amino acid changes: p.T73>A, p.I109>V, p.I130>V, p.I146>T, and p.D217>Y. Similarly, nine SNPs were observed at the CSN1S2 II locus, seven of which are non-synonymous: p.L63>F, p.H70>Q, p.D90>N, p.129A>T, p.H131>Y, p.E144>G, and p.F157>S. In addition, the DNA sequencing of exon 17 and flanking introns of the CSN1S2 I gene revealed a G>A transition at the splice acceptor site of CSN1S2 I exon 17 (FM946022.1:c.375-1G>A), resulting in an allele-specific skipping of the first 15 nucleotides of this exon, which encode the peptide 176NKINQ180, and the recognition of an in-frame cryptic splicing acceptor site: arAACAAAATCAACCAG. A genotyping method based on restriction fragment length polymorphism (XbaI PCR-RFLP) was set up for this SNP. In the total population studied (105 Ragusana and 14 Amiatina donkeys), the A allele had a frequency of 0.2437 with no evidence of deviation from the Hardy–Weinberg equilibrium. This study adds new knowledge regarding the genetic variability of αs2-caseins in donkeys and may contribute significantly to the genetic improvement of milk production for this species. [ABSTRACT FROM AUTHOR]

ABSTRACT Fat and protein derived from milk are prime ingredients in a frozen dessert such as ice cream conferring multiple desirable functionalities. However, this frozen dairy dessert is not suitable for individuals having lactose intolerance, cow milk allergy, or vegans. Hence, the study aimed to formulate dairy‐free frozen desserts using plant oils and plant proteins and compare their physicochemical characteristics and sensory acceptance against an ice cream containing milk fat and milk protein. Results indicated that the types of protein significantly influenced the physicochemical properties and sensory acceptance of the frozen dessert samples. Frozen desserts containing brown rice, pea, and soy protein showed greater resistance to melting (0.29, 0.12, and 0.19%/min vs. 1.95%/min), but they scored lower in sensory quality than ice cream made with milk protein; although they remained at an acceptable level. When compared among the plant proteins, the physicochemical characteristics of frozen desserts containing brown rice, pea, and soy protein varied because of the differences in the respective protein composition. Frozen dessert with brown rice protein showed higher overrun (47.50% vs. 40.78% and 37.8%), lower hardness (20.02 N vs. 22.24 and 26.37 N), and higher melting rate (0.29%/min vs. 0.19 and 0.12%/min) than frozen desserts containing soy and pea protein. Additionally, the brown rice protein frozen dessert received lower sensory acceptance than soy and pea protein frozen desserts. In summary, brown rice, pea, and soy proteins showed potential to be used as viable alternatives to milk protein for dairy‐free frozen dessert applications. [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]

This article provides a comprehensive overview of an algorithm for diagnosing betalactam (BL) allergy. The diagnostic process involves a clinical history, skin tests, in vitro tests, lymphocyte transformation tests, and drug provocation tests. The sensitivity and specificity of these tests vary, with skin tests and in vitro tests showing lower sensitivity but higher specificity. The article also discusses risk stratification, the development of assessment tools, and the use of alternative drugs for allergic patients. It includes a list of various antibiotics categorized by generation, along with recommendations for administration and testing based on structural similarities. The document is authored by a group of researchers and clinicians from Spain and provides references for further exploration. [Extracted from the article]

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]

This article explores the use of biologic therapies such as dupilumab, mepolizumab, and benralizumab in treating severe asthma, emphasizing their efficacy and safety in improving symptoms and disease control. The studies underscore the benefits of personalized treatment approaches and combining different biologic therapies for optimal outcomes. Additionally, the article discusses the immunogenic properties of Bet v 1 conjugated with the TLR7-agonist TL7-887, suggesting a potential for enhanced allergy vaccines. The study on hereditary angioedema in Belarus sheds light on the challenges faced by patients in accessing effective treatments, while a case report highlights the efficacy of targeted therapy in managing mastocytosis. Lastly, the article emphasizes the importance of recognizing emerging allergens like fenugreek and managing drug-induced skin reactions like acute generalized exanthematous pustulosis. [Extracted from the article]

The study explored the impact of purified free mannan and Toll-like receptor ligands on dendritic cells in response to peanut allergens, suggesting that mannan may promote tolerogenic responses. Butyrate treatment was found to induce Sin a 1 nuclear translocation, potentially influencing food allergy development, while also showing a protective effect against allergic responses. The ITACA Registry provided real-life data on hereditary angioedema patients, and the ENABLE study demonstrated the effectiveness of lanadelumab in reducing HAE attacks. BMK treatment improved symptoms in allergic rhinitis patients with multiple pollen sensitivities, highlighting its potential as a therapeutic option. The study on indoor allergen exposure emphasized the need for monitoring and management strategies to reduce allergic reactions in various settings. Dupilumab was effective in treating eosinophilic esophagitis in children, reducing eosinophil counts and improving symptoms. The SQ HDM SLIT-tablet was found to be effective and well-tolerated in children with house dust mite allergic rhinitis/rhinoconjunctivitis. Patients with moderate-to-severe asthma treated with dupilumab were more likely to achieve clinical remission criteria, indicating significant patient benefit. Dymista showed rapid symptom reduction in allergic rhinitis patients, providing clinically meaningful relief. [Extracted from the article]

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 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]

Practical Application Plant‐based yogurt alternatives (YAs) are in demand due to the societal prevalence of milk sensitivities and allergies and some consumers abstaining from animal‐derived products. Producing rice flour YAs has considerable potential because rice flour is hypoallergenic, more economical compared to plant milks, and there are no commercial rice‐based YAs. A new higher protein variety of rice was developed, Frontière, which is sold as both brown and white rice. Therefore, the overall goals of this study were (1) to compare physicochemical properties of YAs from Frontière brown (Frontière brown rice flour [FBRF]) and white (Frontière white rice flour [FWRF]) high‐protein rice flours to regular protein level rice flours and (2) to evaluate the sensory quality of Frontière YAs compared to commercial plant‐based oat yogurt. Rice flours were fermented with Streptococcus thermophilus, Lactobacillus delbrueckii subsp. bulgaricus, and Lacticaseibacillus rhamnosus (a probiotic) to produce FBRF‐ and FWRF‐YAs. A consumer study was conducted to compare FBRF‐ and FWRF‐YAs to a commercially available oat‐based YA. Consumers rated the YAs using 9‐point hedonic and just‐about‐right (JAR) scales. Protein, fat, and ash levels were greater, whereas starch levels and peak viscosities were lower for BRFs than for WRFs. The use of BRF resulted in longer fermentation times but higher bacteria counts for YAs. FWRF‐YA was preferred in terms of overall flavor and liking, sweetness, and tartness. Purchase intent (PI) for FWRF‐YA increased 2.6 times after providing a health claim. This research showed that rice flour can be used to produce YAs with probiotic counts above the minimum recommended, which provides added health benefits for consumers.This research provides a possible new use of Frontière high‐protein rice flour to produce plant‐based yogurts. This will help the rice industry by adding value, and those who are vegan, allergic to casein, or lactose‐intolerant will have another option for a plant‐based yogurt. Moreover, the greater levels of probiotic bacteria found in the brown rice flour YAs can potentially provide greater health benefits, making brown rice flour a better choice for making rice‐based YAs. [ABSTRACT FROM AUTHOR]

Background/Objectives: Milk is an important source of dietary calcium and, if fortified, vitamin D. Cow's milk allergy (CMA) is treated with a milk elimination diet. Although most children become tolerant by age 3 years, some continue dairy avoidance. It remains unclear whether adolescents with a history of CMA adopt similar milk consumption as their peers. We assessed dairy consumption and concentration of serum 25-hydroxyvitamin D (25(OH)D) in adolescents with either confirmed CMA or a negative CMA challenge in infancy (CMA-refuted group) and age-matched controls. Subjects/Methods: This study is based on a previously reported randomized controlled trial from 1999 to 2002 on the treatment effect of probiotics on atopic eczema in participants aged <12 months (n = 230) with data on CMA status. We followed up these participants, aged 15–18 years, in 2017 (n = 104). A 20-item food frequency questionnaire assessed dairy consumption. An automated immunoassay measured 25(OH)D concentration. Results: Median dairy product consumption did not differ between adolescents with CMA (449 g/d, n = 40), the CMA-refuted group (566 g/d, n = 36), and controls (235 g/d, n = 51) (P = 0.117). Median 25(OH)D concentrations were 76.0, 79.3, and 80.8 nmol/l, respectively (P = 0.844). Among participants, 93% were vitamin D sufficient (25(OH)D ≥ 50 nmol/l), with no differences between groups (P = 0.914). Conclusion: Among adolescents with a history of CMA during infancy, our study found no reintroduction failure of milk and no difference in vitamin D insufficiency rate compared with peers. Current management of CMA seems to adequately minimize later nutritional disadvantages associated with a cow's milk elimination diet. [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]

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]

ABSTRACT Background Methods Results Conclusions Food protein‐induced enterocolitis syndrome (FPIES) is a food allergy primarily affecting infants, often leading to vomiting and shock. Due to its poorly understood pathophysiology and lack of specific biomarkers, diagnosis is frequently delayed. Understanding FPIES genetics can shed light on disease susceptibility and pathophysiology—key to developing diagnostic, prognostic, preventive and therapeutic strategies. Using a well‐characterised cohort of patients we explored the potential genome‐wide susceptibility factors underlying FPIES.Blood samples from 41 patients with oral food challenge‐proven FPIES were collected for a comprehensive whole exome sequencing association study.Notable genetic variants, including rs872786 (RBM8A), rs2241880 (ATG16L1) and rs2289477 (ATG16L1), were identified as significant findings in FPIES. A weighted SKAT model identified six other associated genes including DGKZ and SIRPA. DGKZ induces TGF‐β signalling, crucial for epithelial barrier integrity and IgA production; RBM8A is associated with thrombocytopenia absent radius syndrome, frequently associated with cow's milk allergy; SIRPA is associated with increased neutrophils/monocytes in inflamed tissues as often observed in FPIES; ATG16L1 is associated with inflammatory bowel disease. Coexpression correlation analysis revealed a functional correlation between RBM8A and filaggrin gene (FLG) in stomach and intestine tissue, with filaggrin being a known key pathogenic and risk factor for IgE‐mediated food allergy. A transcriptome‐wide association study suggested genetic variability in patients impacted gene expression of RBM8A (stomach and pancreas) and ATG16L1 (transverse colon).This study represents the first case–control exome association study of FPIES patients and marks a crucial step towards unravelling genetic susceptibility factors underpinning the syndrome. Our findings highlight potential factors and pathways contributing to FPIES, including epithelial barrier dysfunction and immune dysregulation. While these results are novel, they are preliminary and need further validation in a second cohort of patients. [ABSTRACT FROM AUTHOR]

What infants eat early in life may shape the immune system and have long‐standing consequences on the health of the host during later life. In the early months post‐birth, breast milk serves as the exclusive and optimal nourishment for infants, facilitating crucial molecular exchanges between mother and infant. Recent advances have uncovered that some maternal factors influence breastfed infant outcomes, including the risk of food allergy (FA). To date, accumulated data show that breastfed infants have a lower risk of FA. However, the issue remains disputed, some reported preventive allergy effects, while others did not confirm such effects, or if identified, protective effects were limited to early childhood. The disputed outcomes may be attributed to the maternal status, as it determines the compounds of the breast milk that breastfed infants are exposed to. In this review, we first detail the compounds in breast milk and their roles in infant FA. Then, we present maternal factors resulting in alterations in breast milk compounds, such as maternal health status, maternal diet intake, and maternal food allergen intake, which subsequently impact FA in breastfed infants. Finally, we analyze how these compounds in breast milk alleviated the infant FA by mother‐to‐infant transmission. Altogether, the mechanisms are primarily linked to the synergetic and direct effects of compounds in breast milk, via promoting the colonization of gut microbiota and the development of the immune system in infants. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusions Cow's milk allergy (CMA) overdiagnosis appears to be increasing and is associated with excessive low‐allergy formula prescription. We evaluated recent trends and regional variation in low‐allergy formula prescribing for CMA in England, and assessed potential risk factors for higher prescribing rates.Data on national and regional prescribing of low‐allergy formulas were extracted from England's electronic prescription database using R. Region‐level factors were evaluated for potential associations with regional low‐allergy formula prescription rates using multivariate linear regression. Analysis of national prescribing trends covered 2007–2023, analysis of regional variation and region‐level factors examined 2017–2019, prior to a re‐organisation of the regional healthcare structure in England.Low‐allergy formula prescribing increased from 6.1 to 23.3 L per birth nationally, between 2007 and 2023. Regional prescribing rate varied from 0.8 to 47.6 L per birth in 2017–2019. We found significant associations between regional low‐allergy formula prescribing rate and regional prescribing rates for milk feed thickeners Gaviscon Infant and Carobel Instant (β = 0.10, p < 0.01), and for other anti‐reflux medications used in young children (β = 0.89 p < 0.01). Inconsistent associations were seen with prescribing junior adrenaline auto‐injectors and oral antibiotics. A model including these four variables accounted for 37% of regional variation in low‐allergy formula prescribing rate. Region‐level socio‐economic deprivation, CMA guideline recommendations and paediatric allergy service provision were not associated with low‐allergy formula prescribing.Low‐allergy formula prescribing in England is increasing, varies significantly by region and is consistently associated with prescribing rates for milk feed thickeners and other anti‐reflux medication for young children. Community prescribing behaviours may be important determinants of CMA overdiagnosis. [ABSTRACT FROM AUTHOR]

Practical Application Cow milk (CM) is an important food source for humans, and food allergy caused by CM has attracted attention worldwide. To our knowledge, systematic studies about the effects of Lactobacillus paracasei, Lactobacillus plantarum, and Pediococcus pentosaceus on the IgE‐/IgG‐binding ability and nutritional properties of CM are very rare. In this study, L. paracasei, L. plantarum, and P. pentosaceus fermentation on the IgE‐/IgG‐binding ability was determined by Enzyme‐Linked Immunosorbent Assay (ELISA), and the protein quality, amino acid profile, and color were systematically evaluated. The results showed that these LAB strains exhibited higher protein degradation ability, and the IgE reactivity reduction rate was 41.03%–60.00% and the IgG reduction rate was 29.86%–67.20%, respectively. Additionally, the nutritional value was improved obviously, and the color was altered significantly, which was conductive to develop dairy products. These findings provided a theoretical foundation for the development of hypoallergenic dairy products.In this study, L. paracasei, L. plantarum and P. pentosaceus could be considered as good potential candidates for solving cow milk allergy owing to their decreased IgE/IgG binding ability andimproved nutritional and sensory properties, which provide a promising strategy to develop hypoallergenic dairy products. [ABSTRACT FROM AUTHOR]

The European Academy of Allergy and Clinical Immunology (EAACI) has released updated clinical guidelines for the diagnosis and management of IgE-mediated food allergy. The guidelines provide evidence-based recommendations for clinicians treating patients with suspected food allergies. The guidelines emphasize the importance of a detailed clinical history, including dietary history, in reaching an accurate diagnosis. They also outline various diagnostic tests, such as skin prick tests and specific IgE tests, and recommend oral food challenges when necessary. The guidelines also address management strategies, including dietary advice, treatment plans for allergic reactions, and the potential use of immunomodulatory treatments. [Extracted from the article]

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Milk is a good source of nutrition but is also a source of allergenic proteins such as α-lactalbumin, β-lactoglobulin (BLG), casein, and immunoglobulins. The Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)/Cas technology has the potential to edit any gene, including milk allergens. Previously, CRISPR/Cas has been successfully employed in dairy cows and goats, but buffaloes remain unexplored for any milk trait. In this study, we utilized the CRISPR/Cas9 system to edit the major milk allergen BLG gene in buffaloes. First, the editing efficiency of designed sgRNAs was tested in fibroblast cells using the T7E assay and Sanger sequencing. The most effective sgRNA was selected to generate clonal lines of BLG-edited cells. Analysis of 15 single-cell clones, through TA cloning and Sanger sequencing, revealed that 7 clones exhibited bi-allelic (−/−) heterozygous, bi-allelic (−/−) homozygous, and mono-allelic (−/+) disruptions in BLG. Bioinformatics prediction analysis confirmed that non-multiple-of-3 edited nucleotide cell clones have frame shifts and early truncation of BLG protein, while multiple-of-3 edited nucleotides resulted in slightly disoriented protein structures. Somatic cell nuclear transfer (SCNT) method was used to produce blastocyst-stage embryos that have similar developmental rates and quality with wild-type embryos. This study demonstrated the successful bi-allelic editing (−/−) of BLG in buffalo cells through CRISPR/Cas, followed by the production of BLG-edited blastocyst stage embryos using SCNT. With CRISPR and SCNT methods described herein, our long-term goal is to generate gene-edited buffaloes with BLG-free milk. [ABSTRACT FROM AUTHOR]

Introduction: When infants cannot consume breast milk, the most commonly available alternative milk formula is cow milk-based. Due to a rise in the prevalence of cow milk protein allergy (CMPA) among children, this study aimed to assess the biofilm formation and acidogenicity of cow milk-based formulas as well as milk formulas suggested for children with CMPA. Methods: Cow milk-based formulas with 0%, 10%, or 18% sucrose added, partially hydrolyzed formula (pHF), extensively hydrolyzed formula (eHF), amino acid-based formula (AAF), and soy-based formulas with 0%, or 11% sucrose added were evaluated. Streptococcus mutans was used as a representative microorganism associated with caries. The acidogenicity after 24-h incubation was assessed by the pH of the formed biofilm and lactic acid formation. Biofilm formation was quantified using crystal violet staining. Additionally, the biofilm characteristics were determined using confocal laser scanning microscopy (CLSM). Comparisons were made among formulas without added sucrose to observe protein-based differences. Furthermore, formulas with different sucrose percentages were compared to explore the impact of sucrose content. Results: When comparing the formulas without added sucrose, the biofilm formation in the cow milk-based formula and pHF were significantly greater than the soy-based formula, eHF, and AAF. In the presence of S. mutans, all formulas reduced the biofilm pH below the critical enamel pH. The cow milk-based formula and AAF showed a significantly lower biofilm pH than the pHF, soy-based, and eHF groups, while the lactic acid production was markedly higher in the cow milk-based formula, pHF and AAF, compared with the eHF and soy-based formula. Adding sucrose into the cow milk-based and soy-based formulas substantially increased biofilm mass. The biofilm pH of the cow milk-based formulas, with or without sucrose, was significantly lower than that of the soy-based formulas. The CLSM indicated distinct biofilm characteristics among the different protein-based formulas, with sucrose supplementation promoting S. mutans aggregation in cow milk-based formula biofilm and increased density and intact biofilm in the soy-based formula. Conclusion: All assessed milk formulas had caries-inducing factors, including those without supplemental sucrose. Among them, the eHF demonstrated the least caries-inducing factors, attributed to its minimal biofilm formation and the highest biofilm pH. [ABSTRACT FROM AUTHOR]

Kefiran is a heteropolysaccharide that is considered a postbiotic and is obtained by kefir grains fermented in cow's milk, while little is known about the donkey milk (DM) variety. Postbiotics are recognised as having important human health benefits that are very similar to probiotics but without the negative effects associated with their ingestion. Donkey is a monogastric animal, as are humans, and when used as an alternative food for infants who suffer from cow milk protein allergies, DM could therefore display more biocompatibility. In this study, the DM kefiran was extracted by ultrasound from kefir grains cultured in donkey milk and fully characterized for its structural and physicochemical properties by Fourier-transform infrared spectroscopy (FT-IR), High-Performance Liquid Chromatography- Refractive Index (HPLC-RI), Scanning electron microscope (SEM), Differential Scanning Calorimeters (DSC) and rheological analyses. In addition, tests were conducted on keratinocytes cell lines and human red blood cells to assess the nontoxicity and haemolysis degree of the polymer. The extraction yield of the DM kefiran was 6.5 ± 0.15%. The FT-IR analysis confirmed the structure of the polysaccharide by showing that the stretching of the C-O-C and C-O bonds in the ring, which formed two bands at 1157 and 1071 cm−1, respectively, and the anomeric band at 896 cm−1 indicates the β configuration and vibrational modes of glucose and galactose. Results were confirmed by HPLC-RI analysis indicating that the ratio glucose/galactose was 1:0.87. Furthermore, the SEM analysis showed a porous and homogeneous structure. The rheological analysis confirmed the pseudoplastic nature of the polymer, while the DSC analysis highlighted excellent thermal resistance (324 °C). Finally, DM kefiran was revealed to have biologically acceptable toxicity, showing a haemolytic activity of less than 2% when using fresh human red blood cells and showing no cytotoxicity on human keratinocytes. Therefore, kefiran obtained by DM shows an excellent biocompatibility, establishing it as a promising polymer for bioengineering human tissue for regenerative applications. [ABSTRACT FROM AUTHOR]

Summary: Cow milk protein allergy (CMPA) is one of the most common food allergies in the pediatric age worldwide. Prevalence, persistence, and severity of this condition are on the rise, with a negative impact on the health‐related quality of life of the patients and families and on the costs related to its management. Another relevant issue is that CMPA in early life may be the first stage of the "allergic march," leading to the occurrence of other atopic manifestations later in life, especially asthma, atopic eczema, urticaria, and rhinoconjunctivitis. Thus, "disease modification" options that are able to modulate the disease course of pediatric patients affected by CMPA would be very welcomed by affected families and healthcare systems. In this review, we report the most relevant progress on this topic. [ABSTRACT FROM AUTHOR]

Summary: The prevalence of allergies has been globally escalating. While allergies could appear at any age, they often develop in early life. However, the significant knowledge gap in the field is the mechanisms by which allergies affect certain people but not others. Investigating early factors and events in neonatal life that have a lasting impact on determining the susceptibilities of children to develop allergies is a significant area of the investigation as it promotes the understanding of neonatal immune system that mediates tolerance versus allergies. This review focuses on the research over the recent 10 years regarding the potential maternal factors that influence offspring allergies with a view to food allergy, a potentially life‐threatening cause of anaphylaxis. The role of breast milk, maternal diet, maternal antibodies, and microbiota that have been suggested as key maternal factors regulating offspring allergies are discussed here. We also suggest future research area to expand our knowledge of maternal–offspring interactions on the pathogenesis of food allergy. [ABSTRACT FROM AUTHOR]

Background: One of the most common food allergies in the pediatric population is allergy to cow's milk protein (CMPA). Treatment consists of avoiding cow's milk proteins in lactating mothers and/or using therapeutic formulas based on hydrolysates or vegetable formulas. In infants with CMPA at diagnosis, a different gut microbial profile has been found compared to healthy children, with a reduction in beneficial bacteria. The aim of this study was to evaluate changes in the gut microbiota profile and its metabolites, dietary patterns and anthropometric variables in a pediatric cohort with CMPA after six months on a restrictive diet compared to healthy controls. Methods: In total, 21 patients diagnosed with CMPA and a control group of 24 healthy infants participated in this study. The fecal microbiota of all participants were investigated by metataxonomic analysis of 16S rDNA amplicons, and fecal short-chain fatty acids were measured by gas chromatography. Epidemiological assessment and dietary questionnaires were carried out for both groups. Results: Regarding growth, no significant differences were found, but differences in dietary intake of some macro- and micronutrients were observed. Patients who were breastfed at six months had higher bifidobacteria and lipid intakes than patients fed with hydrolyzed formulas. Conclusions: Although the growth of CMPA infants fed with therapeutic formula is similar to breastfed CMPA infants, there are differences in microbiota composition and macronutrient intake that underline the importance of continued breastfeeding in CMPA cases. [ABSTRACT FROM AUTHOR]

Abstract Milk is a good source of nutrition but is also a source of allergenic proteins such as α-lactalbumin, β-lactoglobulin (BLG), casein, and immunoglobulins. The Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)/Cas technology has the potential to edit any gene, including milk allergens. Previously, CRISPR/Cas has been successfully employed in dairy cows and goats, but buffaloes remain unexplored for any milk trait. In this study, we utilized the CRISPR/Cas9 system to edit the major milk allergen BLG gene in buffaloes. First, the editing efficiency of designed sgRNAs was tested in fibroblast cells using the T7E assay and Sanger sequencing. The most effective sgRNA was selected to generate clonal lines of BLG-edited cells. Analysis of 15 single-cell clones, through TA cloning and Sanger sequencing, revealed that 7 clones exhibited bi-allelic (−/−) heterozygous, bi-allelic (−/−) homozygous, and mono-allelic (−/+) disruptions in BLG. Bioinformatics prediction analysis confirmed that non-multiple-of-3 edited nucleotide cell clones have frame shifts and early truncation of BLG protein, while multiple-of-3 edited nucleotides resulted in slightly disoriented protein structures. Somatic cell nuclear transfer (SCNT) method was used to produce blastocyst-stage embryos that have similar developmental rates and quality with wild-type embryos. This study demonstrated the successful bi-allelic editing (−/−) of BLG in buffalo cells through CRISPR/Cas, followed by the production of BLG-edited blastocyst stage embryos using SCNT. With CRISPR and SCNT methods described herein, our long-term goal is to generate gene-edited buffaloes with BLG-free milk.

This document is a research paper discussing the diagnosis of hypersensitivity to amoxicillin, a type of beta-lactam antibiotic. The authors conducted a study using a test called hMC-pMAT to evaluate its effectiveness in diagnosing amoxicillin hypersensitivity. The results showed that hMC-pMAT was comparable to other diagnostic tests, such as the basophil activation test (BAT), in clear cases of hypersensitivity. However, in more difficult cases and in patients with non-responsive basophils, hMC-pMAT did not provide additional value. The authors suggest that further research is needed to validate and generalize these findings, especially for patients with non-responsive basophils. [Extracted from the article]

The article provides an update on the diagnosis and treatment of alpha-Gal syndrome, a red meat allergy caused by specific antibodies. The syndrome is severe and associated with delayed anaphylaxis, and it is not directly linked to tick-borne infections. Diagnosis involves a combination of history, sensitization tests, and oral challenges. Management includes avoiding alpha-Gal exposure, but serious reactions can still occur. Oral immunotherapy shows promise but requires further study. The document itself is a list of authors, affiliations, and references related to alpha-gal syndrome and meat allergy. [Extracted from the article]

This article compares the efficacy and safety of two methods, the Milk Ladder (ML) and early oral immunotherapy (E-OIT), for managing cow's milk protein allergy (CMPA) in infants. The ML method involves stepwise exposure to milk-containing foods, while E-OIT gradually increases the use of pure cow's milk protein. The study found that both methods were equally effective in improving CMP tolerance, but the ML method facilitated the intake of processed foods better than E-OIT. Adverse event rates were similar in both groups, but careful monitoring is necessary to prevent anaphylaxis. The study acknowledges its limitations, such as a small sample size and lack of blinding, and suggests the need for further research. [Extracted from the article]

In pursuit of expanding dietary options for those with allergies, we aimed to develop a low‐allergenic fermented milk beverage. We adopted a combination fermentation strategy to enhance the allergy mitigation efficacy of 4 strains of lactic acid bacteria. Our fermentation conditions were optimised with an equal ratio (1:1:1:1) of strains, a total 5% inoculation rate and fermentation at 40°C for 6.5 h. Under conditions, the antigen reduction rates for α‐lactalbumin (α‐LA), β‐lactoglobulin (β‐LG), α‐casein and β‐casein were impressive, ranging from 43.54 to 70.51%. A 28‐day storage assessment showed that the reduction rates of the 4 antigens ranged from 38.98% to 78.06%. Most importantly, it was found through indirect competitive ELISA that the binding ability of immunoglobulin E to α‐LA and β‐LG, which we are concerned about, was significantly reduced compared to the unfermented sample. Notable, the beverage maintained favorable physicochemical properties throughout the storage period. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess the quality and consistency of recommendations in clinical practice guidelines (CPGs) and expert consensus on paediatric cow's milk protein allergy (CMPA) to serve as a foundation for future revisions and enhancements of clinical guidelines and consensus documents. We conducted a comprehensive literature search across several databases, including the Chinese Biomedical Literature Database (CBM), PubMed, Embase, Web of Science, UpToDate, ClinicalKey, DynaMed Plus and BMJ Best Practice. We spanned the search period from the inception of each database through October 1, 2023. We integrated subject headings (MeSH/Emtree) and keywords into the search strategy, used the search methodologies of existing literature and developed it in collaboration with a librarian. Two trained researchers independently conducted the literature screening and data extraction. We evaluated methodological quality and recommendations by using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) and AGREE-Recommendations for Excellence (AGREE-REX) tools. Moreover, we compared and summarized key recommendations from high-quality CPGs. Our study included 27 CPGs and expert consensus documents on CMPA. Only four CPGs (14.8%) achieved a high-quality AGREE II rating. The four high-quality CPGs consistently provided recommendations for CMPA. The highest scoring domains for AGREE II were 'scope and purpose' (77 ± 12%) and 'clarity of presentation' (75 ± 22%). The lowest scoring domains were 'stakeholder involvement' (49 ± 21%), 'rigor of development' (34 ± 20%) and 'applicability' (12 ± 20%). Evaluation with AGREE-REX generally demonstrated low scores across its domains. Conclusion: Recommendations within high-quality CPGs for the paediatric CMPA showed fundamental consistency. Nevertheless, the methodology and recommendation content of CPGs and the expert consensus exhibited low quality, thus indicating a substantial scope for enhancement. Guideline developers should rigorously follow the AGREE II and AGREE-REX standards in creating CPGs or expert consensuses to guarantee their clinical efficacy in managing paediatric CMPA. What is Known: • The quality of clinical practice guidelines and expert consensus on paediatric cow's milk protein allergy (CMPA) remains uncertain. • There is a lack of clarity regarding the consistency of crucial recommendations for CMPA management. What is New: • Improving the methodological quality of guidelines and consensus on CMPA requires greater emphasis on stakeholder engagement, rigorous development processes, and practical applicability. • The recommendations from four high-quality guidelines align. However, addressing clinical applicability, integrating values and preferences, and ensuring actionable implementation are critical to improving the quality of all guidelines. [ABSTRACT FROM AUTHOR]

This article explores the differences in mast cell activation between anaphylaxis and desensitization in human peanut allergy. The study used human mast cells and sera from peanut-allergic individuals to investigate the functional differences in mast cell activation after anaphylaxis and desensitization. The findings suggest that desensitization reduces the overall activation and release of interleukin 8 (IL-8) compared to anaphylaxis. The study also found that refractoriness, or temporary antigen-specific resistance, occurs independently of the initial activation modality. Further research is needed to understand the immune response to allergen-specific immunotherapy in vivo. [Extracted from the article]

Food allergy (FA) is a potentially life‐threatening chronic condition that is becoming an increasing public health problem worldwide. This systematic review (SR) was carried out to inform the development of clinical recommendations on the treatment of IgE‐mediated FA with biologics and/or IT for the update of the EAACI guidelines. A SR of randomized‐controlled trials or quasi‐controlled trials was carried out. Studies were identified via comprehensive search strategies in Medline, Embase, and Cochrane Library, up to April 2022. Population: Human adults, children, and adolescents with IgE‐mediated FA. Intervention: IT and/or biologics. Comparator: Placebo or standard‐of‐care (allergen avoidance). Outcome: Efficacy (desensitization, sustained unresponsiveness (SU), remission), quality of life, and safety (systemic and local adverse reactions (AR)). The Cochrane RoB tool was used to assess the risk of bias. It was reported according to PRISMA and registered in PROSPERO CRD4202229828. After screening, 121 studies were included (111 for IT and 10 for biologics). Most studies had a high risk of bias and showed high heterogeneity in design and results. Metanalysis showed a positive effect of biologics and IT in terms of relative risk (RR) for achieving tolerance to the culprit food compared to avoidance or placebo. Omalizumab for any FA showed a RR of 2.17 [95% confidence interval: 1.22, 3.85]. For peanut allergy, oral IT (OIT) had a RR of 11.94 [1.76, 80.84] versus avoidance or placebo, sublingual IT (SLIT) had a RR of 3.00 [1.04, 8.66], and epicutaneous IT (EPIT) of 2.16 [1.56, 3.00]. OIT had a RR of 5.88 [2.27, 15.18] for cow's milk allergy, and of 3.43 [2.24, 5.27] for egg allergy. There was insufficient data on SLIT or EPIT for the treatment of egg and milk allergies. Most ARs reported were mild. For OIT the most common AR involved the gastrointestinal system and for EPIT, AR's most commonly affected the skin. There was limited data on severe or life‐threatening ARs. There was limited evidence for long term efficacy and quality of life. In conclusion, biologics and IT, alone or in combination, are effective in achieving desensitization while on active treatment but more evidence is needed on long‐term tolerance as current evidence is not of high quality. Adverse events while on therapy are generally mild to moderate but a long‐term comprehensive safety profile is missing. There is a critical need to optimize and standardize desensitization protocols and outcome measures to facilitate our understanding of the efficacy and safety as well as to allow for comparison between interventions. [ABSTRACT FROM AUTHOR]

This document summarizes a study on the relationship between atopic dermatitis (AD) and IgE-mediated food allergy (FA) in children. The study found that children with AD were more likely to develop FA, and vice versa. However, the study had limitations, such as not assessing the severity of AD and having a small sample size for cases of FA. The findings suggest that AD and FA may be related and further research is needed to understand and address these conditions. [Extracted from the article]

This article provides information on the characteristics and diagnosis of Wiskott-Aldrich syndrome (WAS), a primary immunodeficiency disorder. It highlights that while low mean platelet volume (MPV) is typical for WAS, normal MPV values can be observed in some patients at the time of diagnosis. The article presents case reports of infants with thrombocytopenia and normal MPV values, emphasizing the importance of accurate diagnosis and distinguishing WAS from other conditions. It also discusses the potential misdiagnosis of WAS in infants with rectal bleeding and eczema, particularly when cow's milk protein allergy (CMPA) is considered. The article concludes by emphasizing the need for further research and awareness of WAS to improve diagnosis and treatment outcomes. [Extracted from the article]

BACKGROUND. The use of high-throughput technologies has enabled rapid advancement in the knowledge of host immune responses to pathogens. Our objective was to compare the repertoire, protection, and maternal factors associated with human milk antibodies to infectious pathogens in different economic and geographic locations. METHODS. Using multipathogen protein microarrays, 878 milk and 94 paired serum samples collected from 695 women in 5 high and low-to-middle income countries (Bangladesh, Finland, Peru, Pakistan, and the United States) were assessed for specific IgA and IgG antibodies to 1,607 proteins from 30 enteric, respiratory, and bloodborne pathogens. RESULTS. The antibody coverage across enteric and respiratory pathogens was highest in Bangladeshi and Pakistani cohorts and lowest in the U.S. and Finland. While some pathogens induced a dominant IgA response (Campylobacter, Klebsiella, Acinetobacter, Cryptosporidium, and pertussis), others elicited both IgA and IgG antibodies in milk and serum, possibly related to the invasiveness of the infection (Shigella, enteropathogenic E. coli "EPEC", Streptococcus pneumoniae, Staphylococcus aureus, and Group B Streptococcus). Besides the differences between economic regions and decreases in concentrations over time, human milk IgA and IgG antibody concentrations were lower in mothers with high BMI and higher parity, respectively. In Bangladeshi infants, a higher specific IgA concentration in human milk was associated with delayed time to rotavirus infection, implying protective properties of antirotavirus antibodies, whereas a higher IgA antibody concentration was associated with greater incidence of Campylobacter infection. CONCLUSION. This comprehensive assessment of human milk antibody profiles may be used to guide the development of passive protection strategies against infant morbidity and mortality. FUNDING. Bill and Melinda Gates Foundation grant OPP1172222 (to KMJ); Bill and Melinda Gates Foundation grant OPP1066764 funded the MDIG trial (to DER); University of Rochester CTSI and Environmental Health Sciences Center funded the Rochester Lifestyle study (to RJL); and R01 AI043596 funded PROVIDE (to WAP). [ABSTRACT FROM AUTHOR]

The demand for plant-based milk alternatives (PMAs) has increased significantly in recent years, whether for health, sustainability, ethical or environmental motives. On the other hand, the dairy industry is under pressure due to factory farming and environmental impact. Furthermore, various reasons such as lactose intolerance or cow's milk allergy are also leading to a larger and broader market for PMA products derived from different plants. This growing interest is accompanied by appropriate marketing strategies for selling the products in the best possible way. Suitable methods for this are placing the product in the supermarket near the cow's milk and labelling that is recognizable and easy for the customer to understand. Nevertheless, the labelling of PMA products with dairy-associated terms should meet different legal basis in the world, so that there is a uniform naming of PMAs. PMAs have different nutritional composition from cow's milk and from each other, which, in combination with the legal situation, has led to a great deal of discussion about the labelling of PMAs. This study presents a review of published data regarding the legalization of these lactate-free plant-based products as well as the naming of these products, with consequences of naming PMAs as milk. [ABSTRACT FROM AUTHOR]

Background: Although rare, allergic reactions to metal implants represent a diagnostic challenge in view of missing guidelines. Objectives: To develop an European expert consensus on characteristics of metal allergy reactions and the utility of various diagnostic tools in suspected metal implant allergy. Methods: A nominal group technique (NGT) was applied to develop consensus statements. Initially an online literature database was created on a secure server to enable a comprehensive information. Twenty‐three statements were formulated on potential aspects of metal implant allergy with a focus on diagnostics and grouped into five domains. For the consensus development, the panel of 12 experts initially did refine and reformulate those statements that were ambiguous or had unclear wording. By face‐to‐face (9/12) or virtual participation (3/12), an anonymous online voting was performed. Results: Consensus (≥80% of agreement) was reached in 20/23 statements. The panel agreed that implant allergy despite being rare should be considered in case of persistent unexplained symptoms. It was, however, recommended to allow adequate time for resolution of symptoms associated with healing and integration of an implant. Obtaining questionnaire‐aided standardized medical history and standardized scoring of patient outcomes was also considered an important step by all experts There was broad consensus regarding the utility/performance of patch testing with additional late reading. It was recognized that the lymphocyte transformation test (LTT) has to many limitations to be generally recommended. Prior to orthopaedic implant, allergy screening of patients without a history of potential allergy to implant components was not recommended. Conclusions: Using an expert consensus process, statements concerning allergy diagnostics in suspected metal implant allergy were created. Areas of nonconsensus were identified, stressing uncertainty among the experts around topics such as preoperative testing in assumed allergy, histological correlate of periimplant allergy and in vitro testing, which underscores the need for further research. [ABSTRACT FROM AUTHOR]

Infant formulas and their quality are an extremely important factor for proper growth and development and their composition and nutritional quality are extremely important. Fast, green, and cheap quality analysis methods are definitely desirable. Therefore, the aim of this work was to examine the potential of applying near-infrared (NIR) spectroscopy using two devices: a (i) laboratory NIR analyzer and (ii) portable NIR device. Both devices record the vibrations of molecules in the NIR region of 900–1699 nm. Infant formulas intended for children up to 6 months (n = 6) and for infants with a sensitive digestive system or confirmed allergy to cow's milk proteins (n = 5) were tested. Each infant formula was recorded in the form of powder and in the form of prepared samples corresponding to different ages, according to the instructions on the product declaration. The parameters of color, conductivity, and total dissolved solids (TDS) were also measured. The measured parameters and the chemical composition of infant formulas were associated with NIR spectra and with the application of chemometric tools (principal component analysis (PCA) and partial least squares regression (PLSR)), the similarity and/or difference between the samples was determined and the qualitative/quantitative potential was determined through applications of both devices. Characteristic peaks at certain wavelengths indicate the presence of carbohydrates, proteins, and water were identified and are specific for regular and specific purpose infant formulas. It is precisely these specificities in the composition, which are visible in the NIR spectrum, that make it possible to distinguish samples on a qualitative level. The connection of NIR spectra as input variables and 22 parameters (color, TDS, conductivity, and energy–nutrient composition) as output variables, using PLSR, gave an insight into the quantitative potential, i.e., the possibility of predicting the observed parameters on the basis of NIR spectra (recorded using two devices). The quantitative potential was confirmed on the basis of model parameters that resulted in acceptable values for both NIR devices: the coefficient of determination for the calibration, Rc2 > 0.9, and Range Error Ratio, RER > 6. [ABSTRACT FROM AUTHOR]

Consumer health concerns in recent years have spurred a shift from dairy consumption to dairy‐free or plant‐based diets. Factors such as lactose intolerance, milk allergies, ethical concerns, environmental sustainability, and personal health preferences drive this trend. Millet milk offers a viable alternative for cattle milk like any other plant‐based milk. Compared to other plant‐based milk alternatives, millet milk has a better nutritional profile. Moreover, the extracted millet milk can be used for the development of various value‐added products. Millet, being a potential source of antinutritional factors, requires pretreatments before milk extraction. This review discusses in detail the nutritional profile of millets along with the pretreatments to reduce the antinutritional factors in millets, followed by the extraction of millet milk. The comparative study of millet milk versus other plant‐based milks has also been explored. The potential usage of millet milk for further value addition has also been highlighted in the present article. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions The α‐Gal syndrome (AGS) is an emerging allergy to mammalian food caused by IgE‐mediated reactions to the carbohydrate galactose‐α‐1,3‐galactose (α‐Gal). Mammalian food sources contain α‐Gal, but the amount differs. The objective of this study was to investigate the allergenic potency of various foods of mammalian origin among AGS patients.Twenty‐six AGS patients were included. Food extracts from innards, lean meats, processed meat products, milk, and whey were analyzed. Immunoblot, ELISA, immunofluorescence, and basophil activation test were used to determine the α‐Gal content, characterize IgE binding, and assess foods' allergenicity.The determined amount of α‐Gal, IgE reactivity to food extracts, and food extract potencies to activate patients' basophils correlated well with each other. Pork and beef kidney showed the highest allergenicity. Beef liver and bacon showed allergenicity comparable to that of lean meats. Game meat seemed to have a higher allergenic potency than meats from farm‐raised animals. The processed meat products liver pâté and black pudding, despite lower α‐Gal content, demonstrated moderate allergenicity. Milk showed the lowest allergenicity. IgE reactivity to food extracts was highly similar for all patients and strongly dominated by the α‐Gal epitope.The allergenic potency of mammalian meat depends on the origin of the meat, the different cuts, and type of processing, with innards posing the greatest risk to AGS patients. Even processed mammalian meat constitutes a risk. Dairy products show the lowest risk. This study highlights the importance of analyzing even more foods to improve the management of AGS. [ABSTRACT FROM AUTHOR]