Long-term outcome of oral immunotherapy Nagakura, Ken-ichi; Sato, Sakura; Yanagida, Noriyuki ...
Nihon Shoni Arerugi Gakkaishi. The Japanese Journal of Pediatric Allergy and Clinical Immunology,
2019, Letnik:
33, Številka:
1
Journal Article
Oral immunotherapy (OIT) induces desensitization in a majority of patients. However, adverse reactions occur due to full-dose OIT. These reactions are mainly mild or moderate, but at times can be ...severe. In addition, efficacy and continuation of therapy have been problematic. In recent years, some studies on omalizumab combined with OIT, low-dose OIT, sublingual immunotherapy (SLIT) and epicutaneous immunotherapy (EPIT) were performed. Combining omalizumab with OIT was reported to improve safety but not the outcome and long-term efficacy. We performed low-dose OIT (target dose : 1/32 of heated whole hen's egg, 3 mL of cow's milk, 2 g of Udon noodle or 0.5 g of peanut) for children with severe food allergy with low thresholds. Low-dose OIT seems to be relatively safer compared with full-dose OIT and it would be appropriate approach for severe food allergies. Further studies are needed to assess the long-term efficacy and safety of omalizumab combined with OIT or low-dose OIT.
The topic of oral food challenge (OFC) has been addressed in Chapter 7 of the Japanese Pediatric Guideline of Food Allergy 2016. In addition to detailing the guidelines, Chapter 7 defines and ...highlights the purpose of OFC, risk assessment, and establishment of an OFC system based on evidence. As shown in the summary, there are 5 major changes. First, the definition of OFC was updated to “OFC is a test to diagnose food allergy in suspected cases and confirm the tolerance of certain foods previously determined to be allergens by ingesting them multiple times or in a single dose”. Second, the purpose of OFC was divided into two main aspects, namely, diagnosis and confirmation of tolerance. Third, risk assessment prior to OFC was also established. Fourth, the reproducibility of the OFC results and the target dose of OFC were examined. It is also recommended that stepwise OFCs be performed regularly to ensure safety during OFC. Finally, a system for implementing OFC safely was also discussed. We will explain these changes and the reasons underlying them in detail.
Chapter 1 definition, classification and symptoms Ito, Komei; Ebisawa, Motohiro; Fujisawa, Takao
Nihon Shoni Arerugi Gakkaishi. The Japanese Journal of Pediatric Allergy and Clinical Immunology,
2017, 2017-00-00, Letnik:
31, Številka:
2
Journal Article
1. A food allergy is defined as “a phenomenon in which adverse reactions are caused through antigen-specific immunological mechanisms after exposure to a given food”.2. When food or its components ...cause the allergic symptoms, the term “food allergy” is applied regardless the route of allergen exposure.3. Food allergies are immunologically classified into IgE-mediated reactions and non-IgE-mediated reactions. Based on the time course, it is divided into immediate reactions and non-immediate reactions. Most of the IgE-mediated reactions cause immediate reaction, but it is not always the case.4. Symptoms provoked by food allergy include skin, mucosal, respiratory, gastrointestinal, nervous and cardiac organs.5. Anaphylaxis is defined as “severe hypersensitivity reaction that may cause a life-threatening risk with systemic symptoms induced at several organs”. Anaphylaxis shock is that accompanied by reduced blood pressure or incontinence.
Background: TH1 and TH2 cytokines are thought to regulate allergic inflammation. Objective: Two key regulatory cytokines, IL-4 and IFN-γ, were examined for their effects on cytokine production by ...cultured human mast cells (CHMCs). Methods: CHMCs were obtained by culturing cord blood–derived CD34+ cells in the presence of stem cell factor and IL-6 for 14 to 16 weeks. CHMCs were passively sensitized with human myeloma IgE and supplemented with or without IL-4 or IFN-γ. After the sensitization, CHMCs were stimulated with anti-FcϵRIα mAb. Concentrations of secreted cytokines were measured by using ELISA, and cytokine messenger RNA was analyzed by using quantitative competitive RT-PCR. Results: IL-4 profoundly enhanced FcϵRI-mediated production of macrophage inflammatory protein (MIP) 1α, IL-8, and GM-CSF. For example, the enhancement by IL-4 (10 ng/mL) of the production of MIP-1α, IL-8, and GM-CSF was 25-, 7-, and 90-fold, respectively, after 6 hours. IL-4 also enhanced levels of FcϵRI-induced cytokine messenger RNA but to a lesser degree. In contrast, IFN-γ inhibited FcϵRI-induced production of MIP-1α, IL-8, and GM-CSF. For example, the inhibition by IFN-γ (10 ng/mL) of FcϵRI-mediated production of MIP-1α, IL-8, and GM-CSF was 80%, 75%, and 95%, respectively. IFN-γ also suppressed FcϵRI-induced messenger RNA expression of these cytokines. Neither IL-4 nor IFN-γ affected the kinetics of cytokine production by CHMCs. Conclusion: These data suggest that IL-4 and IFN-γ may influence allergic reactions by modulating human mast cell cytokine production. (J Allergy Clin Immunol 2000;106:141-9.)
Most of food allergy (FA) cases during childhood start as infantile atopic dermatitis (AD) at the ages of a few months old. We tried to clarify the association between infantile AD and FA during ...infancy.
We analyzed relationship between AD and FA during infancy among patients with 208 cases, who had visited our outpatient clinic with chief complaint of "eczema" from 1998 to 2000.
Among 208 cases, 148 cases (71%) were diagnosed as infantile AD, moreover 109 cases (74%) were diagnosed as FA among infantile AD. The most frequent food antigens among infantile AD were egg (72.3%), cow's milk (39.9%), wheat (12.2%) and soybean (7.4%), respectively, in addition to these food antigens, food allergy was widely recognized against peanuts, sesame, meats, buckwheat, fishes and potato. In terms of food antigen, 44 cases with single food allergy against egg were seen out of 46 single allergy cases, whereas 36 cases with double food allergy against both egg and cow's milk were seen in 63 multiple food allergy cases. Although the value of antigen specific IgE against egg and cow's milk was recognized for the diagnosis of food allergy during infancy, even cases with negative IgE against those foods were proved to be food allergy by food elimination and provocation tests. In contrast to egg and cow's milk, positive IgE against rice, soybean, and wheat did not always correlate with the results of the diagnosis of food allergy. Concerning risk factors of AD, family history of any allergy diseases and passive smoking were recognized in comparison with infantile eczema. Neither the nutrition method nor incomplete elimination of diet during pregnancy and lactation had anything to do with the development of AD.
When infantile AD cases were not improved by environmental control, skin care and application of steroid ointment, it would be important for doctors to think of the possibility of FA.
