Background Infant feeding guidelines have long recommended delaying introduction of solids and allergenic foods to prevent allergy in high-risk infants, despite a paucity of evidence. Objective We ...aimed to determine whether confirmed egg allergy in 12-month-old infants is associated with (1) duration of breast-feeding and (2) ages of introducing egg and solids. Methods In a population-based cross-sectional study (HealthNuts) parents reported on infant feeding and potential confounding factors before skin prick testing for egg white. Egg-sensitized infants were then offered an egg oral food challenge. Multiple logistic regression was used to investigate associations between diet and egg allergy adjusted for possible confounding factors. Results A total of 2589 infants (73% response) participated. Compared with introduction at 4 to 6 months, introducing egg into the diet later was associated with higher risks of egg allergy (adjusted odds ratios ORs, 1.6 95% CI, 1.0-2.6 and 3.4 95% CI, 1.8-6.5 for introduction at 10-12 and after 12 months, respectively). These findings persisted even in children without risk factors (OR, 3.3 95% CI, 1.1-9.9; 10-12 months). At age 4 to 6 months, first exposure as cooked egg reduced the risk of egg allergy compared with first exposure as egg in baked goods (OR, 0.2 95% CI, 0.06-0.71). Duration of breast-feeding and age at introduction of solids were not associated with egg allergy. Conclusions Introduction of cooked egg at 4 to 6 months of age might protect against egg allergy. Changes in infant feeding guidelines could have a significant effect on childhood egg allergy and possibly food allergy more generally.
Background There is a paucity of data examining the natural history of and risk factors for egg allergy persistence, the most common IgE-mediated food allergy in infants. Objective We aimed to assess ...the natural history of egg allergy and identify clinical predictors for persistent egg allergy in a population-based cohort. Methods The HealthNuts study is a prospective, population-based cohort study of 5276 infants who underwent skin prick tests to 4 allergens, including egg. Infants with a detectable wheal were offered hospital-based oral food challenges (OFCs) to egg, irrespective of skin prick test wheal sizes. Infants with challenge-confirmed raw egg allergy were offered baked egg OFCs at age 1 year and follow-up at age 2 years, with repeat OFCs to raw egg. Results One hundred forty infants with challenge-confirmed egg allergy at age 1 year participated in the follow-up. Egg allergy resolved in 66 (47%) infants (95% CI, 37% to 56%) by 2 years of age; however, resolution was lower in children with baked egg allergy at age 1 year compared with baked egg tolerance (13% and 56%, respectively; adjusted odds ratio, 5.27; 95% CI, 1.36-20.50; P = .02). In the subgroup of infants who were tolerant to baked egg at age 1 year, frequent ingestion of baked egg (≥5 times per month) compared with infrequent ingestion (0-4 times per month) increased the likelihood of tolerance (adjusted odds ratio, 3.52; 95% CI, 1.38-8.98; P = .009). Mutation in the filaggrin gene was not associated with the resolution of either egg allergy or egg sensitization at age 2 years. Conclusion Phenotyping of egg allergy (baked egg tolerant vs allergic) should be considered in the management of this allergy because it has prognostic implications and eases dietary restrictions. Randomized controlled trials for egg oral immunotherapy should consider stratifying at baseline by the baked egg subphenotype to account for the differential rate of tolerance development.
To the Editor: Oral food challenges (OFCs) remain the gold standard for diagnosing food allergy.1 However, to date, most studies describing the use of OFCs for the purposes of diagnosing food allergy ...have been retrospective clinical audits that have not clearly described crucial methodological characteristics, such as eligibility for challenge and exclusion and inclusion criteria.2,3 Study outcomes from these retrospective audits are difficult to generalize to other clinic or population cohorts because undeclared physician and parent selection bias is likely to significantly affect the inclusion or exclusion of, for instance, a child with a history of anaphylaxis. ...we thank ALK-Abelló, Spain, for donating food allergens for skin prick tests.
Background Epidemiological evidence has shown that pediatric food allergy is more prevalent in regions further from the equator, suggesting that vitamin D insufficiency may play a role in this ...disease. Objective To investigate the role of vitamin D status in infantile food allergy. Methods A population sample of 5276 one-year-old infants underwent skin prick testing to peanut, egg, sesame, and cow’s milk or shrimp. All those with a detectable wheal and a random sample of participants with negative skin prick test results attended a hospital-based food challenge clinic. Blood samples were available for 577 infants (344 with challenge-proven food allergy, 74 sensitized but tolerant to food challenge, 159 negative on skin prick test and food challenge). Serum 25-hydroxyvitamin D levels were measured by using liquid chromatography tandem mass spectrometry. Associations between serum 25-hydroxyvitamin D and food allergy were examined by using multiple logistic regression, adjusting for potential risk and confounding factors. Results Infants of Australian-born parents, but not of parents born overseas, with vitamin D insufficiency (≤50 nmol/L) were more likely to be peanut (adjusted odds ratio aOR, 11.51; 95% CI, 2.01-65.79; P = .006) and/or egg (aOR, 3.79; 95% CI, 1.19-12.08; P = .025) allergic than were those with adequate vitamin D levels independent of eczema status. Among those with Australian-born parents, infants with vitamin D insufficiency were more likely to have multiple food allergies (≥2) rather than a single food allergy (aOR, 10.48; 95% CI, 1.60-68.61 vs aOR, 1.82; 95% CI, 0.38-8.77, respectively). Conclusions These results provide the first direct evidence that vitamin D sufficiency may be an important protective factor for food allergy in the first year of life.
Background Ninety-five percent positive predictive values (PPVs) provide an invaluable tool for clinicians to avoid unnecessary oral food challenges. However, 95% PPVs specific to infants, the age ...group most likely to present for diagnosis of food allergy, are limited. Objective We sought to develop skin prick test (SPT) and allergen-specific IgE (sIgE) thresholds with 95% PPVs for challenge-confirmed food allergy in a large population-based cohort of 1-year-old infants with challenges undertaken irrespective of SPT wheal size or previous history of ingestion. Methods HealthNuts is a population-based, longitudinal food allergy study with baseline recruitment of 1-year-old infants. Infants were recruited from council-run immunization sessions during which they underwent SPTs to 4 allergens: egg, peanut, sesame, and cow’s milk/shrimp. Any infant with a detectable SPT response was invited to undergo oral food challenge and sIgE testing. Results Five thousand two hundred seventy-six infants participated in the study. Peanut SPT responses of 8 mm or greater (95% CI, 7-9 mm), egg SPT responses of 4 mm or greater (95% CI, 3-5 mm), and sesame SPT responses of 8 mm or greater (95% CI, 5-9 mm) had 95% PPVs for challenge-proved food allergy. Peanut sIgE levels of 34 kUA /L or greater (95% CI, 14-48 kUA /L) and egg sIgE levels of 1.7 kUA /L or greater (95% CI, 1-3 kUA /L) had 95% PPVs for challenge-proved food allergy. Results were robust when stratified on established risk factors for food allergy. Egg SPT responses and sIgE levels were poor predictors of allergy to egg in baked goods. Conclusion These 95% PPVs, which were generated from a unique dataset, are valuable for the diagnosis of food allergy in young infants and were robust when stratified across a number of different risk factors.
Background Identification of children at risk of developing asthma provides a window of opportunity for risk-reducing interventions. Allergen sensitization might identify high-risk children. ...Objective We sought to determine whether skin prick tests (SPTs) to individual allergens up to age 2 years predict wheeze at age 12 years. Methods In a birth cohort of 620 children oversampled for familial allergy, sensitization was assessed by using SPTs (monosensitized, polysensitized, or either) to 6 allergens at ages 6, 12, and 24 months. Wheeze and eczema were recorded 18 times during the first 2 years. Current wheeze was recorded at age 12 years. Adjusted associations were evaluated by multiple logistic regression. Results A positive SPT to house dust mite (HDM) at age 1 or 2 years predicted wheeze at age 12 years (adjusted odds ratio: 1 year, 3.31 95% CI 1.59-6.91; 2 years, 6.37 95% CI, 3.48-11.66). Among wheezy 1-year-olds, those who were HDM sensitized had a 75% (95% CI, 51% to 91%) probability of wheeze at age 12 years compared with a 36% (95% CI, 23% to 50%) probability among those not sensitized. Among eczematous 1-year-olds, those who were HDM sensitized had a 67% (95% CI, 45% to 84%) probability of wheeze at age 12 years compared with a 35% (95% CI, 25% to 45%) probability among those not sensitized. Among 1-year-old children with both eczema and wheeze, the probability of wheeze at age 12 years was 64% (95% CI, 35% to 87%) if HDM sensitized and 50% (95% CI, 26% to 74%) if not. Conclusion HDM sensitization at age 1 or 2 years in wheezing and eczematous children at increased familial allergy risk predicts asthma and may inform management of these high-risk groups.
Soy consumption is not a risk factor for peanut sensitization Koplin, Jennifer, BSc (Hons); Dharmage, Shyamali C., MBBS, MD, PhD; Gurrin, Lyle, PhD ...
Journal of allergy and clinical immunology,
06/2008, Letnik:
121, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Background A recent cohort study suggested that intake of soy milk or soy formula was associated with peanut allergy. If this finding is confirmed, it suggests an avenue for modification of diet as a ...peanut allergy prevention strategy. Objective To investigate the relationship between soy consumption and peanut sensitization in a prospective cohort study of children. Methods A total of 620 babies with a family history of allergic disease were recruited. Dietary information was obtained from telephone interviews every 4 weeks from birth until 15 months and then again at 18 months and 2 years. Skin prick tests to peanut, milk, and egg were performed at 6, 12, and 24 months. A wheal size ≥3 mm was considered positive for sensitization. Results Children whose parents elected to introduce soy formula or soy milk into their children's diet were more likely to be sensitized to peanuts at 2 years (odds ratio, 2.02; 95% CI, 1.04-3.92; P = .039). However, this relationship was explained by feeding of soy to children who had siblings with milk allergy or were themselves sensitized to milk. After adjusting for these factors, there was no evidence of an association between soy consumption and peanut sensitization (odds ratio, 1.34; 95% CI, 0.64-2.79; P = .434). Conclusion The association between soy consumption and peanut sensitization is not causal but merely a result of preferential use of soy milk in infants with a personal or family history of cow's milk allergy. Future studies should take the confounding effects related to dietary modifications by parents into account when investigating the association between diet and childhood allergic diseases.
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