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BACKGROUND: Worldwide, vegan and vegetarian lifestyles, as well as food allergies and intolerance (e.g. lactose intolerance and milk protein allergy) demand the development of alternatives to dairy‐based probiotic foods. In the present study, probiotic Lacticaseibacillus casei CECT 9104 was added to alginate‐based edible coatings enriched with inulin and oligofructose and applied to fresh‐cut apple. Microbiological, physicochemical and sensory quality parameters of the apple cubes were monitored during 8 days of refrigerated storage. Lacticaseibacillus casei was tested for its antagonistic effect against inoculated Listeria innocua and Escherichia coli O157:H7. The viability of the probiotic strain during refrigerated storage and after simulated gastrointestinal digestion (GID) was evaluated. RESULTS: After 8 days of storage, 9.52–9.64 log colony‐forming units (CFU) g−1 of L. casei were detected in apple samples. The functional apple cubes retained 8.31–8.43 log CFU g−1 of the probiotic after GID, without a significant effect of prebiotic addition. The microbiological quality and nutritional properties were maintained by the use of active coatings, whereas the sensory quality decreased after 8 days of storage. A bactericidal effect was exerted by the probiotic strain loaded in the coating against L. innocua artificially inoculated on apple cubes. Escherichia coli O157:H7 counts were reduced by 2.5 log after 8 days. CONCLUSION: This study has demonstrated the suitability of apple cubes as an alternative matrix to milk for carrying probiotic L. casei CECT 9104 and prebiotics, offering a promising alternative for the development of plant‐based functional foods. © 2024 Society of Chemical Industry. [ABSTRACT FROM AUTHOR]

Background: There is ongoing debate about the safety and efficacy of epicutaneous immunotherapy (EPIT) in treating food allergies. The systematic review and meta-analysis aimed to evaluate the safety and efficacy of EPIT. Methods: We systematically searched international trial registers (ClinicalTrials.gov), PubMed, Embase, the Cochrane Central of Controlled Trials (CENTRAL), and Web of Science from the inception of the database until June 25, 2023. Two authors independently screened potential studies based on the following criteria: food allergy, epidermal immunotherapy, and randomized controlled trials(RCTs). The risk-of-bias assessment was performed using the Cochrane risk-of-bias 2 (ROB 2) tool. The primary outcomes included desensitization, local adverse events, systemic adverse events, and quality of life. Secondary outcomes included epinephrine utilization, topical medication utilization, and severe adverse events. We assessed certainty of evidence by the GRADE approach. Results: Ten studies involving 1970 participants were included. Ten high-quality RCTs focusing on peanut allergy and cow's milk allergy were included in the analysis. The meta-analysis revealed that EPIT promoted desensitization in patients with food allergy (RR 2.11, 95% CI 1.72–2.58; I2 = 0%, high certainty), particularly in aged ≤ 11 years (RR 3.84, 95% CI 2.39–6.26; I2 = 34%). Additionally, treatment duration ≥ 52 weeks was found to increase immune tolerance (RR 3.37, 95% CI 2.39–4.75; I2 = 13%). Patients who undergo EPIT treatment not only raised the local adverse reactions (RR 1.63, 95% CI 1.10–2.41; I2 = 82%, low certainty) but also raised systemic adverse reactions (RR 1.52, 95% CI 1.01–2.28; I2 = 0%, high certainty). Conclusion: After EPIT treatment, patients with food allergy can effectively increase their immune tolerance to food. However, it also significantly increases mild-to-moderate anaphylaxis. There is limited data on the impact of EPIT on quality of life and other food allergic diseases, indicating a need for further research. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion Adverse food reactions include food allergy (FA; immune‐mediated) and food intolerances (non‐immune‐mediated). FA are classified into IgE‐ and non‐IgE‐mediated FA. There is limited information available about changes in FA prevalence over time.Two cohorts of children were evaluated, born on the Isle of Wight (IOW) 12 years apart, the IOW birth cohort (IOWBC; 1989–1990) and the FA and Intolerance Research birth cohort (FAIRBC; 2001–2002). We compared the prevalence of parental reported reactions to foods (adverse food reactions), allergic sensitisation to foods and FA between the IOWBC and FAIRBC, at ages 1, 2, 3–4 and 10 years. FA included both IgE‐ and non‐IgE‐mediated FA.Reported adverse reactions to food and sensitisation rates remained stable between the two cohorts. For example, FA at age 3–4 years was reported in 9.1% (95% CI: 7.5, 10.7) in IOWBC and 8.3% (95% CI: 6.5, 10.1) in FAIRBC (p = 0.57) and food sensitisation by skin prick test at age 3–4 years was found in 3.2% (95% CI: 2.1, 4.3) in IOWBC and 4.5% (95% CI: 2.9, 6.1) in FAIRBC (p = 0.20). Confirmed FA prevalence was lower in FAIRBC than IOWBC at ages 1, 2 and 3–4, but these differences were not significant after adjustment for multiple comparisons. For example, FA at age 3–4 years was confirmed in 5.0% (95% CI: 3.8, 6.2) in IOWBC and 3.0% (95% CI: 1.9, 4.2) in FAIRBC (p = 0.03, significance threshold after Bonferroni correction p < 0.004). Confirmed cow's milk allergy rate was higher in IOWBC than FAIRBC at 3 years (< 0.001) but not at other time points.Our data show no evidence of changes in rates of adverse reactions to foods, food sensitisation or food allergy during the first 10 years of life between two cohorts born in England in 1989–1990 and 2001–2002. [ABSTRACT FROM AUTHOR]

The list of standard abbreviations for JDS is available at adsa.org/jds-abbreviations-24. Nonstandard abbreviations are available in the Notes. Cow milk protein allergy (CMPA) is a significant health concern characterized by adverse immune reactions to cow milk proteins. Biomarkers for the accurate diagnosis and prognosis of CMPA are lacking. This study analyzed the clinical features of CMPA, and 16S RNA sequencing was used to investigate potential biomarkers through fecal microbiota profiling. Children with CMPA exhibit a range of clinical symptoms, including gastrointestinal (83% of patients), skin (53% of patients), and respiratory manifestations (26% of patients), highlighting the complexity of this condition. Laboratory analysis revealed significant differences in red cell distribution width and inflammatory markers between the CMPA and control groups, suggesting immune activation and inflammatory responses in CMPA. Microbial diversity analysis revealed higher specific diversity indices in the CMPA group compared with those in control group, with significant differences at the genus and species levels. Bacteroides were more abundant in the CMPA group, whereas Bifidobacterium , Ruminococcus , Faecalibacterium , and Parabacteroides were less abundant. The control group exhibited a balanced microbial profile, with a predominant presence of Bifidobacterium bifidum and Akkermansia muciniphila. The significant abundance of Bifidobacterium in the control group (23.19% vs. 9.89% in CMPA) was associated with improved growth metrics such as height and weight, suggesting its potential as a probiotic to prevent CMPA and enhance gut health. Correlation analysis linked specific microbial taxa such as Coprococcus and Bifidobacterium to clinical parameters such as family allergy history, weight, and height, providing insights into CMPA pathogenesis. Significant differences in bacterial abundance suggested diagnostic potential, with a panel of 6 bacteria achieving high predictive accuracy (area under curve = 0.8708). This study emphasizes the complex relationship between the gut microbiota and CMPA, offering valuable insights into disease mechanisms and diagnostic strategies. [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]

Food allergy typically begins early in life and persists as a lifelong condition. Delayed introduction of allergenic foods followed by years of hesitancy to introduce these foods early may have contributed to the increase in food allergy prevalence in recent decades. Most infant feeding guidelines focus on the importance of early introduction of allergenic foods in infants at around age 4–6 months. However, regular, ongoing ingestion of allergenic foods is also critical for the primary prevention of food allergy. Similarly, intermittent exposure to cow's milk formula (CMF) in early infancy increases the risk of cow's milk allergy (CMA), while regular exposure (if it is introduced) prevents it. Families hesitant to introduce allergenic foods to their infant at home (despite education) should be offered introduction in a primary care clinic. Infants who have failed primary prevention should be referred to an allergist for consideration of early infant oral immunotherapy (OIT). [ABSTRACT FROM AUTHOR]

A large portion of the world's population has lactose intolerance. Fundamentally, this condition occurs when the small intestine does not produce enough of the lactase enzyme, which digests the disaccharide lactose in milk. Lactose avoiders might unconsciously decide to limit or exclude milk and dairy products from their diets. This group includes people with lactose intolerance, people with an allergy to milk protein, vegans, and those expressing personal preferences. Lactose avoiders are often self-reported as being milk intolerant. In this review, specific amounts of lactose in different types of milk and milk products are presented. The amounts of micro- and macronutrients in them are compared with the daily requirements established by accepted sources. Foods are suggested that can play vital roles in permanently avoiding lactose-containing dairy products, for example, brussels sprouts, as a good source of vitamin B1; kale, as a source of vitamin K; and cereals at breakfast for vitamin B6. Attention is paid to mature cheeses as they are extremely beneficial for health due to their rich vitamin and elemental compositions, and they are also suitable for people with lactose intolerance due to their low lactose content. This information is rarely provided on packaging. In addition, the current state of labeling for the presence of lactose in food and pharmaceutical products is discussed. The term "hidden lactose" is introduced to include added lactose in unexpected foods, drinks, and even medicines. [ABSTRACT FROM AUTHOR]

Human Milk Oligosaccharides (HMOs) have been proposed to be instrumental in building immune competence. To explore the role of HMOs in allergy prevention, twenty-one HMOs were quantified in breast milk samples and associated with sensitisation in infants. 2′-fucosyllactose (2′-FL) levels were positively associated with an increased risk of sensitisation, atopic dermatitis and recurrent skin rash. Interestingly, 2′-FL levels, ranging from 1.35 to 1.95 g/L, were associated with a higher prevalence of non-allergic and non-sensitised infants. The role of 2′-FL and lacto-N-neotetraose (LNnT) was further investigated in allergic sensitisation models in vivo. Oral administration of HMOs decreased allergic sensitisation. This was associated with gut microbiota and short-chain fatty acid (SCFA) production changes. Aligned with the clinical associations, the decreased sensitisation was not observed with lower and higher tested doses of the HMOs supporting a U-shape association between 2′-FL and LNnT levels and allergic sensitisation risk reduction in humans and mice. Trial registration: ClinicalTrials.gov identifier: NCT02550236. [ABSTRACT FROM AUTHOR]

The list of standard abbreviations for JDS is available at adsa.org/jds-abbreviations-24. Nonstandard abbreviations are available in the Notes. Cow milk, although rich in essential nutrients, is a well-known food allergen that can cause allergic reactions in infants and young children. β-Lactoglobulin accounts for 10% of the total protein in milk and 50% of the whey protein, which has high nutritional value and excellent functional properties but is also the main allergen leading to milk protein allergy. Exploring the mechanism of milk allergy and selecting suitable separation and purification methods to obtain high-purity β-LG is the premise of research on reducing allergenicity. In this review, the research progress in membrane technology, gel filtration chromatography, ion exchange chromatography, affinity chromatography, precipitation, and aqueous 2-phase system separation for the separation and purification of milk β-LG is reviewed in detail to promote the further development of milk β-LG separation and purification methods and provide a new method for the development of hypoallergenic dairy products in the future. Among these methods, ion exchange chromatography and gel chromatography are widely used, precipitation is generally used as a crude purification step, and HPLC and membrane technology are used for further purification to improve the purity of allergens. [ABSTRACT FROM AUTHOR]

Adoption of allergen avoidance diets may increase the risk of nutritional deficiencies and affect growth in children with food allergy (FA). How these dietary restrictions have an impact on diet diversity, a health-promoting eating behavior, remains unclear. To evaluate diet diversity, dietary intake, and weight status of children with FA. Observational study. One hundred children with immunoglobulin E (IgE)-mediated milk, egg, or nut FA or multiple FAs and 60 children with perennial respiratory allergies (RA) matched as controls, aged 3 to 18 years, were consecutively recruited into the study. Dietary intake and diet diversity (number of different foods consumed/day) were assessed through 4 24-hour recalls. Weight status (underweight, healthy weight, overweight, or obesity) was also evaluated. Chi-squared test and 2-sample independent t test were used to test differences between groups. Adjustment for sex, age, and energy intake was made using linear regression. The percentage of underweight was higher in children with FA (19.6%) compared with children in the control group (5.1%). Children with FA compared with children in the control group consumed more servings of meat (1.7, 95% CI, 1.6, 1.9 vs. 1.5, 95% CI, 1.3, 1.7 servings/day [ P adj = 0.031]). No difference was observed in the diet diversity between the 2 groups (11–12 different foods/day). Within the FA group, children with allergy to milk proteins had lower energy intake from protein, lower intake of calcium, lower consumption of commercially prepared sweets, and higher consumption of eggs, compared with children with nut or egg allergy, but no difference in diet diversity was observed. Diet diversity did not differ between children with FA and children with no FA, despite some differences in the intake from specific food groups. However, the higher percentage of underweight in children with FA suggests the need for targeted nutrition intervention as early as possible after FA diagnosis. [ABSTRACT FROM AUTHOR]

The article from the Singapore Medical Journal discusses an approach to feeding problems in infants and toddlers, covering a wide range of issues from mild picky eating to severe food refusal. It emphasizes the importance of addressing feeding difficulties early on, as they can impact long-term nutrition and cognitive development. The article also highlights the role of family physicians in detecting, managing, and educating parents about feeding issues, with a focus on a structured medical approach and the need for a multidisciplinary team in complex cases. Additionally, it provides practical tips and strategies for managing various feeding problems in infants and toddlers, emphasizing the importance of reassurance, education, and behavioral interventions. [Extracted from the article]

ABSTRACT Introduction Methods Results Discussion Patients with food allergies need personalized information on their risk of reaction in “real‐life” situations. This multicentric study aimed to investigate the link during accidental reactions between the nature and amount of food allergens consumed in “real‐life situation” and the severity of the symptoms.Patients were prospectively recruited from December 1, 2020, to December 31, 2021, at the emergency departments in the Geneva University Hospitals and local pediatric emergency facilities, through an allergy outpatient clinic, at school and daycare facilities and trough their primary care physicians. Medical history of patients presenting reactions suggestive with immediate food allergy and suspected food samples were collected. Allergy diagnostic tests were retrospectively and prospectively collected. The samples were analyzed for their allergen content.We recruited 147 subjects with an accidental immediate‐type allergic reaction to a food. We were able to collect 115 reaction‐eliciting food samples allowing to quantify the allergen amount causing the reaction, as well as correlating this amount to the severity of the reaction. Children represented a large part of the reactors, and most reactions were to common food allergens such as tree nuts, cow's milk as well as peanuts and hen's egg. Reactions were mostly to prepackaged foods and seven reactions were to products with precautionary allergy labeling, or without labelling to the eliciting allergen. Reactions were of various degrees of severity, and independent to the amount of allergen ingested.The severity of reactions did not show a direct correlation with allergen quantity, emphasizing individual sensitivity. Some reactions occurred with allergen amounts significantly below the legal limit for mandatory labelling of 1 g/kg (1000 ppm) in Switzerland. The study also highlighted considerable variability in allergen concentrations in foods labeled with possible “contaminations” or “traces”. These findings raise questions about the accuracy of allergen labeling and regulations in Switzerland. [ABSTRACT FROM AUTHOR]

Plant‐based milk is becoming an increasingly important component in developing new food items. Hemp seed has anti‐inflammatory effects and a high protein content, which gives health advantages. Hemp milk is a suitable alternative for those with allergies to milk protein and lactose or concerns about cholesterol. However, optimal extraction conditions for hemp milk are not well documented. This study utilized a response surface methodology (RSM) based on a Central composite rotatable design (CCRD) to optimize the variables of soaking time (A), heating time (B), and temperature (C) for hemp milk production. The study measured levels of antinutrients such as phytic acid, tannins, and saponins, as well as nutrients like fat and protein. Regression models were developed to analyze these factors, and their effectiveness was evaluated using a lack of fit test and the coefficient of variation (R2). The study found that soaking duration, extraction time, and temperature had a substantial (p < 0.05) influence on responses. The optimal soaking period, extraction time, and temperature for best hemp seed milk production are as follows: soaking period of approximately 9 h, heating time in a water bath for almost 60 min, and heating temperature of 48°C. The experimental findings confirmed the accuracy of the predicted models within a satisfactory response range. Additionally, the results suggest that the formulated model is effective for enhancing milk production and achieving consistent quality. [ABSTRACT FROM AUTHOR]

Background: Milk allergy commonly occurs in children, mainly caused by bovine-derived casein (CAS) protein. Neutrophil-activating protein (NAP) of Helicobacter pylori plays an immunomodulatory role with potential to suppress Th2-type immune responses. Bacillus subtilis (B. subtilis) spores are commonly used as oral vectors for drug delivery. Objective: To investigate whether recombinantly expressed NAP on B. subtilis spores could be an effective treatment for CAS allergy in mouse. Methods: After CAS sensitization, mice were orally administered B. subtilis spores expressing recombinant NAP for 6 weeks. Allergic symptoms and parameters were evaluated after CAS challenge oral gavage, including allergic inflammation, splenic cytokines, and serum-specific antibodies. Protein levels of Toll-like receptor 2 (TLR2) and c-JUN in the jejunum tissue were measured by western blot. Bone marrow-derived macrophages (BMDMs) were stimulated with inactivated NAP spores to measure the influence on cytokine profiles in vitro. Results: NAP recombinant spore treatment significantly reduced allergic symptoms and intestinal inflammation. Interleukin-12 and interferon-gamma levels increased, whereas serum CAS-specific IgG1 and IgE levels decreased. TLR2 and c-JUN expression levels were elevated in the jejunal tissue. Inactivated NAP spores polarized BMDMs to the M1 phenotype and enhanced cytokine expression, which were inhibited by a TLR2 neutralizing antibody. Conclusion: NAP offers a new strategy in the treatment of CAS allergy by inhibiting the Th2 response, while eliciting macrophages to promote Th1 immune responses. Oral treatment of recombinant Bacillus subtilis spore was found effective against casein allergy, which delivered neutrophil-activating protein (NAP) of Helicobacter pylori. We explored that recombinant CotC-NAP spores could elicit macrophages M1 polarization through TLR2-dependent signaling pathway, which activate phosphorylation of NF-κB and c-JUN, further release cytokines like interleukin-12 and interferon-gamma to rectify the balance of Th1/Th2 and regulate the level of Tregs. [ABSTRACT FROM AUTHOR]

The article "Linking Macronutrient Composition of Common Allergenic Foods to European and North American Food Allergy Prevalence" explores the relationship between macronutrient profiles of common allergenic foods and food allergy prevalence in Europe and North America. The study found that higher protein and glycine contents in allergenic foods were negatively correlated with food allergy prevalence, while carbohydrate and fat contents showed no association. The research suggests that total protein and glycine contents in common allergenic foods may influence food allergy development, prompting further investigation into the role of macronutrients in food allergies. [Extracted from the article]

The article "Evaluation and Management of Anaphylaxis in the Emergency Department" discusses the challenges faced by emergency physicians in diagnosing and treating anaphylaxis. Anaphylaxis is a potentially life-threatening hypersensitivity reaction with diverse presentations. The incidence of anaphylaxis is increasing globally, with food being the most common trigger. Prompt administration of epinephrine is crucial in treating anaphylaxis, and delayed administration is associated with increased mortality. Patients with anaphylaxis may not always present with a chief complaint of an allergic reaction. Further research is needed to establish diagnostic criteria and treatment guidelines for anaphylaxis. [Extracted from the article]

The article discusses a study on the effectiveness of gestational supplementation with 2'-Fucosyllactose (2'-FL) in preventing food allergies in offspring. The study found that maternal diet during pregnancy and breastfeeding can impact the immune system, gut microbiota, and epithelial barriers, leading to allergies. The research showed that gestational supplementation with 2'-FL protected offspring from food allergies by creating a specific microbial and immune imprint. This study highlights the potential benefits of maternal nutrition and supplementation in preventing allergies in children, suggesting further research in high-risk populations. [Extracted from the article]

Background: Infantile Colic (IC) poses a significant challenge for parents as it manifests through repeated and extended episodes of fussiness, crying, or irritability occurring before the age of 5 months. The precise cause of IC is currently unknown. The association between IC, a family history of atopy, and the development of individual atopy in the future remains uncertain, given conflicting findings from prior studies. Objectives: This study aimed to investigate the impact of parental atopy on IC severity and the effectiveness of the mother's hypoallergenic Dairy-Free Diet in alleviating pain in infants with colic. Methods: This non-randomized trial conducted at Amirkabir Hospital in Arak, Iran, from January 2023 to October 2023, involving 206 eligible IC patients non-randomly assigned to two groups based on parental atopy history. Breastfed infants were prescribed a dairy-free diet, involving the removal of dairy products from the mother's diet. Pain severity was assessed using the FLACC scale at baseline and after one-month of intervention. Results: The research initially involved 206 subjects with an average age of 28.77 ± 9.99 days, evenly distributed based on parental atopy history. However, there was a 28.6% loss to follow-up, resulting in a final analyzed population of 147 individuals. The intervention, a maternal dairy-free diet, demonstrated a significant reduction in pain symptoms within both groups and overall (P = 0.001), with no significant difference in efficacy between infants with and without parental atopy history (P = 0.219). Parental history of atopy did not exhibit a significant association with colic pain severity (P = 0.404). The study revealed that the impact of the diet on colic severity varied, with more pronounced effects observed in cases of severe and moderate colic compared to mild cases. Conclusions: Adopting a Dairy-Free Diet significantly reduced colic symptoms, irrespective of parental atopy history. The severity of colic appears unrelated to parental atopy, and the observed improvement with a Dairy-Free diet is potentially attributed to milk intolerance rather than milk allergy. [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]

Diagnosis of infant feeding problems can be challenging due to limited examination findings, few options of diagnostic tests and overlying symptoms. While contrasting colic, CMPA and reflux, this article highlights the overlapping symptoms of each condition and seeks to analyse the differences to provide a framework for diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Background: Various guidelines for the diagnosis and management of cow's milk allergy (CMA) have been published. Purpose: This study aimed to compare voting outcomes of experts from Mexico, the Middle East, and the European Society of Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) on statements regarding CMA Methods: The 3 expert groups voted on the same 10 statements. Each participant voted anonymously using a score of 0-9 (≥6 meant agreement; <5 reflected disagreement). If <75% of the participants agreed with the statement, it was rejected. None of the groups was aware of the voting outcomes of another group. Results: There was broad consensus amongst the 3 groups. Agreement was reached that infant colic as a single manifestation is not suggestive of CMA. All groups confirmed that an extensively hydrolysed formula is the preferred elimination diet in mild/moderate CMA cases; however, hydrolysed rice formula is an alternative. Amino acid-based formulas should be reserved for infants with severe symptoms. The discrepancy in voting outcomes regarding soy formulas highlights the differences in opinions. Two of 13 ESPGHAN experts (15%), 1 of 14 Middle East experts (7%), and 6 of 26 Mexican experts (23%) disagreed with the statement that soy formula should not be the first choice for the diagnostic elimination diet but can be considered in some cases for economic, cultural, and palatability reasons. All of the ESPGHAN and Mexican experts agreed that there was no added value of probiotics, prebiotics, or synbiotics to the efficacy of elimination diets on CMA, whereas 3 of 14 Middle East experts (21%) determined that there was sufficient evidence. Conclusion: Although all statements were accepted by the 3 groups, there were relevant differences illustrating variations according to geography, culture, cost, and formula availability. These findings emphasize the need for region-specific guidelines. [ABSTRACT FROM AUTHOR]

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]

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]

The beneficial effect of milk kefir on respiratory heath has been previously demonstrated; however, water kefir and kefiran in the context of respiratory viral infections have not been investigated. Water kefir and kefiran could be alternatives to milk kefir for their application in persons with lactose intolerance or milk allergy and could be incorporated into vegan diets. Using mice models, this work demonstrated that the oral administration of water kefir or kefiran can modulate the respiratory Toll-like receptor (TLR3)-mediated innate antiviral immunity and improve the resistance to respiratory syncytial virus (RSV) infection. The treatment of mice with water kefir or kefiran for 6 days improved the production of interferons (IFN-β and IFN-γ) and antiviral factors (Mx2, OAS1, RNAseL, and IFITM3) in the respiratory tract after the activation of the TLR3 signaling pathway, differentially modulated the balance of pro- and anti-inflammatory cytokines, reduced RSV replication, and diminished lung tissue damage. Maintaining a proper balance between anti-inflammatory and pro-inflammatory mediators is vital for ensuring an effective and safe antiviral immune response, and the results of this work show that water kefir and kefiran would help to maintain that balance promoting a controlled inflammatory response that defends against infection while minimizing tissue damage. [ABSTRACT FROM AUTHOR]

The article discusses the management of mild hematochezia in infants under 6 months, focusing on the potential causes and treatment options. It introduces a new approach called the Rapid Elimination Diet (RED) that involves eliminating seven suspect foods from the mother's diet simultaneously for one week. The article also highlights the debate surrounding the necessity of an elimination diet for infants with hematochezia and suggests alternative management options. Additionally, it emphasizes the need for further research to determine the prevalence of food allergies as a cause of rectal bleeding in infants. [Extracted from the article]

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. Practical Application: 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]

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. Practical Application: 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: 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. Methods: 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. Results: 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. Conclusions: 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]

Background: 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. Methods: Blood samples from 41 patients with oral food challenge‐proven FPIES were collected for a comprehensive whole exome sequencing association study. Results: 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). Conclusions: 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]

The article discusses alpha-Gal syndrome, a unique red meat allergy caused by specific IgE antibodies to alpha-Gal. It is mainly associated with delayed anaphylaxis and is not correlated with tick-borne infections. Diagnosis involves history, sensitization, and oral challenge tests, with management focusing on avoidance and potential oral immunotherapy. The authors recommend further studies to evaluate the effectiveness and risks of oral immunotherapy for alpha-Gal syndrome. [Extracted from the article]

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]

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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]

ABSTRACT: Cow milk, although rich in essential nutrients, is a well-known food allergen that can cause allergic reactions in infants and young children. β-Lactoglobulin accounts for 10% of the total protein in milk and 50% of the whey protein, which has high nutritional value and excellent functional properties but is also the main allergen leading to milk protein allergy. Exploring the mechanism of milk allergy and selecting suitable separation and purification methods to obtain high-purity β-LG is the premise of research on reducing allergenicity. In this review, the research progress in membrane technology, gel filtration chromatography, ion exchange chromatography, affinity chromatography, precipitation, and aqueous 2-phase system separation for the separation and purification of milk β-LG is reviewed in detail to promote the further development of milk β-LG separation and purification methods and provide a new method for the development of hypoallergenic dairy products in the future. Among these methods, ion exchange chromatography and gel chromatography are widely used, precipitation is generally used as a crude purification step, and HPLC and membrane technology are used for further purification to improve the purity of allergens.

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]

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]

\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]

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 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]

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]

The article discusses a case of allergic contact dermatitis in an adoptive mother who developed eczema on her nipples, areolas, and fingers after using a supplemental nursing system (SNS) with infant formula to breastfeed her adopted baby. Patch testing revealed a positive reaction to the formula and nickel, with suspicions raised about metal contamination during formula preparation. The patient's eczema healed with corticosteroid treatment, and she remained lesion-free during a 14-month follow-up. This case underscores the importance of considering ACD from infant formula as a potential cause of nipple eczema in breastfeeding mothers, especially those using SNS. [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]

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]

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]