Update References Food Allergy

Update References Food Allergy 20121492922797717

Food allergy is an important public health problem that affects children and adults and may be increasing in prevalence. Allergic consumers must avoid eating foods that could provoke potentially life-threatening reactions, and successful avoidance depends on having complete and accurate information on food labels. Despite the risk of severe allergic reactions and even death, there is no current treatment for food allergy: the disease can only be managed by allergen avoidance or treatment of symptoms. The diagnosis and management of food allergy also may vary from one clinical practice setting to another. Finally, because patients frequently confuse nonallergic food reactions, such as food intolerance, with food allergies, there is an unfounded belief among the public that food allergy prevalence is higher than it truly is. In response to these concerns, the National Institute of Allergy and Infectious Diseases, working with 34 professional organizations, federal agencies, and patient advocacy groups, led the development of clinical guidelines for the diagnosis and management of food allergy. These Guidelines are intended for use by a wide variety of health care professionals, including family practice physicians, clinical specialists, and nurse practitioners. The Guidelines include a consensus definition for food allergy, discuss comorbid conditions often associated with food allergy, and focus on both IgE-mediated and non-IgE-mediated reactions to food. Topics addressed include the epidemiology, natural history, diagnosis, and management of food allergy, as well as the management of severe symptoms and anaphylaxis. These Guidelines provide 43 concise clinical recommendations and additional guidance on points of current controversy in patient management. They also identify gaps in the current scientific knowledge to be addressed through future research.

The optimal protocol, in terms of the route of administration of the food, target maintenance dose, and duration of maintenance therapy, and the optimal patient for these procedures are still being worked out. The mechanisms underlying successful food desensitization are also unclear, in part, because there is no standard immunotherapy protocol. The mechanisms involved, however, may include mast cell and basophil suppression, development of food-specific IgG4 antibodies, reduction in the food-specific IgE/IgG4 ratio, up-regulation and expansion of natural or inducible regulatory T cells, a skewing from a Th2 to a Th1 profile, and the development of anergy and/or deletion in antigen-specific cells. Additional studies are required to elucidate and understand these mechanisms by which desensitization and tolerance are achieved, which may reveal valuable biomarkers for evaluating and following food allergic patients on immunotherapy.

Update References Food Allergy 2012

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  • Diagnosed child, treated child: food challenge as the first step toward tolerance induction in cow’s milk protein allergy. Longo G, Berti I, Barbi E, Calligaris L, Matarazzo L, Radillo O, Ronfani L, Ventura A. Eur Ann Allergy Clin Immunol. 2012 Apr;44(2):54-60.
  • Characteristics of patients suffering from cow milk allergy. Liu LL, Yao H, Zhang XL, Zhang HL, Chao PL, Tong ML, Liu GL, Lin LR, Fan-Liu, Zhang ZY, Yang TC. Int Immunopharmacol. 2012 Sep;14(1):94-8. Epub 2012 Jun 18.
  • Chicken-based formula is better tolerated than extensively hydrolyzed casein formula for the management of cow milk protein allergy in infants. Jirapinyo P, Densupsoontorn N, Kangwanpornsiri C, Wongarn R. Asia Pac J Clin Nutr. 2012;21(2):209-14.
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  • Allergy to goat’s and sheep’s milk in a population of cow’s milk-allergic children treated with oral immunotherapy. Rodríguez del Río P, Sánchez-García S, Escudero C, Pastor-Vargas C, Sánchez Hernández JJ, Pérez-Rangel I, Ibáñez MD. Pediatr Allergy Immunol. 2012 Mar;23(2):128-32. doi: 10.1111/j.1399-3038.2012.01284.x.
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  • Measurement of Ara h 1-, 2-, and 3-specific IgE antibodies is useful in diagnosis of peanut allergy in Japanese children. Ebisawa M, Movérare R, Sato S, Maruyama N, Borres MP, Komata T. Pediatr Allergy Immunol. 2012 Jul 26.
  • A brief intervention to improve food allergy knowledge among US pediatricians: lessons learned. Springston EE, Lau CH, Patel P, Warrier MR, Sohn MW, Pongracic J, Gupta RS. Pediatr Allergy Immunol. 2012 Jul 26.
  • Peanut seed storage proteins are responsible for clinical reactivity in Spanish peanut-allergic children. Pedrosa M, Boyano-Martínez T, García-Ara MC, Caballero T, Quirce S. Pediatr Allergy Immunol. 2012 Jul 26.
  • Oral immunotherapy in hen’s egg-allergic children increases a hypo-proliferative subset of CD4+ T cells that could constitute a marker of tolerance achievement. Fuentes-Aparicio V, Alonso-Lebrero E, Zapatero L, Infante S, Lorente R, Angeles Muñoz-Fernández M, Correa-Rocha R. Pediatr Allergy Immunol. 2012 Jul 26.
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  • Tolerability of a Fully Maturated Cheese in Cow’s Milk Allergic Children: Biochemical, Immunochemical, and Clinical Aspects. Alessandri C, Sforza S, Palazzo P, Lambertini F, Paolella S, Zennaro D, Rafaiani C, Ferrara R, Bernardi ML, Santoro M, Zuzzi S, Giangrieco I, Dossena A, Mari A. PLoS One. 2012;7(7):e40945.
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  • Non-Celiac Wheat Sensitivity Diagnosed by Double-Blind Placebo-Controlled Challenge: Exploring a New Clinical Entity. Carroccio A, Mansueto P, Iacono G, Soresi M, D’Alcamo A, Cavataio F, Brusca I, Florena AM, Ambrosiano G, Seidita A, Pirrone G, Rini GB. Am J Gastroenterol. 2012 Jul 24. doi: 10.1038/ajg.2012.236.
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  • Prophylactic probiotics reduce cow’s milk protein intolerance in neonates after small intestine surgery and antibiotic treatment presenting symptoms that mimics postoperative infection. Ezaki S, Itoh K, Kunikata T, Suzuki K, Sobajima H, Tamura M. Allergol Int. 2012 Mar;61(1):107-13.
  • Changes in prevalence and characteristics of IgE-mediated food allergies in children referred to a tertiary care center in 2003 and 2008. Amin AJ, Davis CM. Allergy Asthma Proc. 2012 Jan-Feb;33(1):95-101.
  • Cost-effectiveness of using an extensively hydrolysed formula compared to an amino acid formula as first-line treatment for cow milk allergy in the UK. Taylor RR, Sladkevicius E, Panca M, Lack G, Guest JF. Pediatr Allergy Immunol. 2012 May;23(3):240-9.
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  • Tolerogenic effects of interferon-gamma with induction of allergen-specific interleukin-10-producing regulatory B cell (Br1) changes in non-IgE-mediated food allergy. Noh J, Noh G, Lee SJ, Lee JH, Kim A, Kim HS, Choi WS. Cell Immunol. 2012;273(2):140-9. Epub 2012 Jan 8.
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