Association of tree nut and coconut sensitizations Polk, Brooke I; Dinakarpandian, Deendayal; Nanda, Maya ...
Annals of allergy, asthma, & immunology,
10/2016, Letnik:
117, Številka:
4
Journal Article
Recenzirano
Coconut (Cocos nucifera), despite being a drupe, was added to the US Food and Drug Administration list of tree nuts in 2006, causing potential confusion regarding the prevalence of coconut allergy ...among tree nut allergic patients.
To determine whether sensitization to tree nuts is associated with increased odds of coconut sensitization.
A single-center retrospective analysis of serum specific IgE levels to coconut, tree nuts (almond, Brazil nut, cashew, chestnut, hazelnut, macadamia, pecan, pistachio, and walnut), and controls (milk and peanut) was performed using deidentified data from January 2000 to August 2012. Spearman correlation (ρ) between coconut and each tree nut was determined, followed by hierarchical clustering. Sensitization was defined as a nut specific IgE level of 0.35 kU/L or higher. Unadjusted and adjusted associations between coconut and tree nut sensitization were tested by logistic regression.
Of 298 coconut IgE values, 90 (30%) were considered positive results, with a mean (SD) of 1.70 (8.28) kU/L. Macadamia had the strongest correlation (ρ = 0.77), whereas most other tree nuts had significant (P < .05) but low correlation (ρ < 0.5) with coconut. The adjusted odds ratio between coconut and macadamia was 7.39 (95% confidence interval, 2.60-21.02; P < .001) and 5.32 (95% confidence interval, 2.18-12.95; P < .001) between coconut and almond, with other nuts not being statistically significant.
Our findings suggest that although sensitization to most tree nuts appears to correlate with coconut, this is largely explained by sensitization to almond and macadamia. This finding has not previously been reported in the literature. Further study correlating these results with clinical symptoms is planned.
Asthma is the most common chronic disease of childhood in developed countries, with a continually increasing prevalence. The paradigm of asthma control is shifting from disease management to primary ...prevention, and the modification of numerous host and external factors have been proposed as methods to prevent recurrent wheeze and asthma in children, some with promising preliminary results. This article reviews potential asthma prevention strategies and identifies future areas of research.
There are sparse data regarding the predictors of positive oral food challenges and reaction severity for seafood in children.
Identify clinical characteristics in children with seafood allergy who ...were most likely to experience a negative oral food challenge (OFC).
A retrospective chart review was performed for children who had a graded OFC to seafood at a pediatric tertiary care center from 2008 through 2019.
Sixty-three (60% male; average age 8 years; range 1–21 years) OFCs were performed, of which 21 were fish and 42 were shellfish. There were 10 (16%) positive OFCs and positive OFC rate was similar between fish (19%) and shellfish (14%). Forty-three children who underwent OFC had a reported history of IgE-mediated symptoms. Five of six children who had a history of anaphylaxis had a negative OFC. There was no difference in positive OFCs due to age, history of atopy, or initial allergic reaction history. The clinical characteristics of the positive OFCs were similar between fish and shellfish. A positive skin prick test to fish or shellfish did not increase the risk of a positive OFC. While the positive OFC rate did not differ for the shellfish food-specific IgE (FSIgE) level, there was a significant difference for fish (median <0.34 kUA/L vs. 1.63 kUA/L for pass and fail, respectively; P = 0.023).
A retrospective study of OFCs to seafood showed that the rate of a positive OFC was low. While seafood allergy is thought to be rarely outgrown, children who have a low FsIgE and/or skin testing can successfully tolerate seafood.
Immediate type I, type III, and delayed type IV hypersensitivity reactions to insulin are rare, but potentially serious complications of exogenous insulin administration required for the treatment of ...type 1 diabetes (T1D).
We present four cases of insulin hypersensitivity reactions occurring in youth with T1D and a literature review of this topic.
Insulin hypersensitivity reactions included types I, III, and IV with presentations ranging from localized urticaria, erythematous nodules, and eczematous plaques to anaphylaxis with respiratory distress. Reactions occurred in youth with newly diagnosed T1D and in those with long-standing T1D who were using both injection and insulin pump therapy. Multidisciplinary care involving pediatric endocrinology and allergy/immunology utilizing trials of many adjunct therapies yielded minimal improvement. Despite the use of various treatments, including antihistamines, topical therapies, immunosuppressant medications, desensitization trials, and intravenous immune globulin, cutaneous reactions, elevated hemoglobin A1c levels, and negative effects on quality of life remain persistent challenges. One patient became one of the youngest pancreas transplant recipients in the world at age 12 years due to uncontrollable symptoms and intolerable adverse effects of attempted therapies.
Although rare, insulin hypersensitivity reactions negatively affect glycemic control and quality of life. These cases demonstrate the varying severity and presentation of insulin hypersensitivity reactions along with the limited success of various treatment approaches. Given the life-sustaining nature of insulin therapy, further studies are needed to better understand the underlying pathophysiology of insulin hypersensitivity and to develop targeted treatment approaches.
PURPOSE OF THE STUDY. To investigate the efficacy and safety of the novel oral biologic peanut oral immunotherapy (OIT) drug product, AR101, in a phase II multicenter study. STUDY POPULATION. ...Subjects aged 4 to 26 years meeting the following criteria were included: a clinical history of peanut allergy, positive skin or blood peanut immunoglobulin E test result, and reaction to <143 mg of peanut protein in the screening double-blind, placebo-controlled food challenge (DBPCFC). Subjects with a history of life-threatening anaphylaxis or poorly controlled asthma were excluded. METHODS. In this randomized controlled trial, subjects were randomly assigned 1:1 to receive either AR101 (a defatted peanut flour capsule) or a placebo, with gradual updosing from 0.5 to 300 mg daily over 20 to 34 weeks. After 2 weeks on a 300 mg maintenance dose, repeat DBPCFC was performed. The primary end point was successful consumption of ≥443 mg of cumulative peanut protein, a level exceeding the amount of peanut typically required to trigger a reaction with accidental ingestion. The number of subjects tolerating 1043 mg of cumulative peanut protein was also recorded. RESULTS. Fifty-five subjects (29 AR101 and 26 placebo) were enrolled. Six subjects who were randomly assigned to AR101 withdrew, primarily because of adverse gastrointestinal side effects. In intention-to-treat analysis, 23 of 29 (79%) and 18 of 29 (62%) AR101 subjects tolerated 443 mg and 1043 mg at exit DBPCFC, respectively, versus 5 of 26 (19%) and 0 of 26 (0%) subjects on a placebo. AR101 increased the maximum tolerated dose of peanut by 18-fold. Most treatment-emergent adverse events were graded as mild, and no severe treatment-emergent adverse events occurred in either group. CONCLUSIONS. Compared with a placebo, AR101 significantly increased the ability to tolerate peanut protein in subjects with a peanut allergy and was safe and well tolerated. REVIEWER COMMENTS. In this phase 2 randomized controlled trial of peanut OIT with exit and entry DBPCFCs using a Current Good Manufacturing Practice drug product, we provide proof of concept of the effectiveness of AR101. Resoundingly, all the 26 subjects who completed treatment were able to tolerate 443 mg of peanut. Notably, all 6 who withdrew from the study had initial peanut serum immunoglobulin E >100 killiunits/L, and all gastrointestinal complaints resolved within 3 weeks of discontinuation. A case of new-onset eosinophilic esophagitis noted in a treatment group participant is consistent with previous OIT studies. Eosinophilic esophagitis should be suspected in future patients receiving peanut OIT who complain of chronic, recurrent gastrointestinal symptoms. Overall, in this phase 2 study, AR101 demonstrated the clinical and safety characteristics of a feasible immunomodulatory treatment option in individuals with a peanut allergy 4 to 26 years of age. An active phase 3 study (identifier NCT02635776) has shown similar results, and Aimmune Therapeutics is widely expected to file a biologic license application for AR101 late this year. Although not a cure for peanut allergy, AR101 could be a viable option for patients wishing to reduce the risk of anaphylaxis from accidental peanut protein consumption.
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disease with incompletely understood pathogenesis. Though disease manifestations were initially ascribed to a delayed ...reaction to food allergens, emerging evidence suggests that modifiable host factors and environmental allergen exposure may also play critical roles in the pathogenesis and ongoing manifestations of EoE. As with other atopic diseases, lack of early-life exposure to microbial pathogens leads to an immune tolerance defect and reprograms the commensal gut microflora toward a type 2 T helper (Th2) phenotype; the esophageal microbiota, a rich environment consisting of diverse bacterial species, is greatly altered by inflammation. Although multiple early life microbiome-altering factors are associated with EoE development, no causative, direct relationships have been identified. Interestingly, large, cross-sectional analyses of several populations identify an inverse relationship between
Helicobacter pylori
presence and EoE, likely via virulence factors that downregulate Th2 inflammation, though causality has not been proven. In regard to environmental allergens, some studies support seasonal variation in EoE diagnosis and flares, and EoE can be generated after a large, identifiable aeroallergen exposure. Examples include mouse models of intranasal Aspergillus dosing and following initiation of oral immunotherapy to foods or environmental allergens. Conversely, treatment of allergic rhinoconjunctivitis may improve EoE symptoms, though data is limited to case reports and small series. Unfortunately, biologic therapies for atopic conditions have failed to improve EoE symptoms despite improvement in esophageal eosinophil count, though dupilumab shows promise in ongoing studies. Overall, this chapter shows that EoE pathogenesis is likely multifactorial, and the environment is a key component in our understanding of EoE.
PURPOSE OF THE STUDY. To calculate the clinical benefit (risk reduction of allergic reactions) of increased peanut tolerance threshold in patients who are allergic, such as those who undergo peanut ...immunotherapy. STUDY POPULATION. Included in this study is a projected model of individuals with peanut allergy who consume food products with precautionary allergen labels (eg, “may contain peanut”). METHODS. The authors performed quantitative risk assessment to predict the allergenic risk associated with exposure to residual peanut protein in food products. NHANES food consumption data were paired with reported residual peanut protein levels in food products with precautionary allergen labels. The modeled exposure was matched to clinical threshold levels in individuals who were peanut allergic. The clinical benefit of the increased threshold dose attained by peanut immunotherapy was then assessed. RESULTS. An increase in tolerance of peanut protein (from <100 mg to >300 mg) after peanut immunotherapy reduces the risk of allergic reaction by >95% for all 4 food categories evaluated (snack chips, cookies, snack cakes, and ice cream). CONCLUSIONS. Threshold doses (ie, 300 mg and 1000 mg) achieved by peanut immunotherapy are clinically relevant and meaningful. REVIEWER COMMENTS. In the results of current studies, it is suggested that peanut immunotherapy increases the threshold of peanut protein dose needed to trigger an allergic reaction in responsive patients. In this novel study, researchers attempt to assess the real-life implications of this altered reactivity using a quantitative risk assessment model. With their findings, they suggest that peanut immunotherapy can reduce the risk associated with accidental ingestion of foods that contain precautionary peanut labels. Although 300 mg (equivalent to 1 large kernel peanut) may not seem striking, the reduced anxiety surrounding accidental consumption of an allergen that can potentially trigger anaphylaxis can be substantial to patients and families. The perceived benefit of that risk reduction may persuade some patients to discuss the option of peanut immunotherapy with their allergists.
PURPOSE OF THE STUDY. To assess the impact of asthma triggers and exacerbations on asthma-specific quality of life in children. STUDY POPULATION. A 3-year observational study, The Epidemiology and ...Natural History of Asthma Outcomes and Treatment Regimens, included a cohort of 438 children aged 6 to 12 years with severe or difficult-to-treat asthma recruited from 283 sites in the United States. METHODS. Patients were seen at 6-month intervals, and data on health care use, asthma exacerbations, and number of recent asthma triggers were obtained. Patients and parents completed the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and the Asthma Therapy Assessment Questionnaire. Multivariable linear regression was used to model the PAQLQ score as a function of common asthma triggers. RESULTS. Greater asthma exacerbation severity and number were associated with lower PAQLQ scores (P < .001), indicating poorer quality of life. PAQLQ was significantly lower in patients with more baseline triggers, and greater trigger number was associated with both severity and number of asthma exacerbations. CONCLUSIONS. The number of baseline asthma triggers affects quality of life, exacerbation severity, and frequency of exacerbations in children aged 6 to 12 with severe or difficult-to-control asthma. REVIEWER COMMENTS. Asthma is the most common childhood chronic disease in the United States, accounting for many missed school days and a significant social and economic burden for patients and families. The authors of this study emphasize the need to identify asthma triggers and to counsel patients on trigger avoidance as a way to reduce the number and severity of asthma exacerbations in children with severe and difficult-to-treat asthma. Addressing the psychosocial aspects of asthma via identification of baseline disease characteristics that negatively affect asthma-related quality of life can help lead to a patient-centered care approach.
A 2-Month-Old Child With Hypovolemic Shock Polk, Brooke I; Nowak-Wegrzyn, Anna
The journal of allergy and clinical immunology in practice (Cambridge, MA),
12/2022, Letnik:
10, Številka:
12
Journal Article
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