Atopic Dermatitis With Coexisting Food Allergy in Early Life Is Associated With Childhood Asthma

PurposeAtopic dermatitis (AD) and food allergy (FA) are associated with respiratory comorbidities, in the concept of ‘atopic march.’ However, children with AD and a coexisting FA have various disease courses, and the mechanism of atopic march remains unclear. In this study, we investigated whether the phenotype of AD with coexisting FA in early life affected asthma or allergic rhinitis (AR) in school children.MethodsA total of 1,579 children from the Panel Study on Korean Children (PSKC) cohort were followed-up in 2013. The participants diagnosed with AD in this cohort were classified by the age of AD onset and persistence as well as FA history. We compared the presence of comorbidities—asthma and rhinitis—among different AD phenotypes.ResultsAsthma and AR with current symptoms within 12 months at age 6–8 years were associated with early-onset persistent AD phenotype, regardless of coexisting FA. AD with FA conferred a higher risk of recent wheezing at 8 years of age than AD without FA (adjusted odds ratio, 8.09; 95% confidence interval, 2.54–25.76). Children with early-onset persistent AD with FA manifested a distinctive trajectory with a higher prevalence of wheezing and AR at age 5–8 years than those without AD.ConclusionsAD with FA in early life is strongly associated with asthma and AR in school children, and the early-onset persistent AD with FA had a strong additive effect on the risk of asthma at school age. Classifying AD phenotypes regarding FA in early life will help predict and prevent asthma and AR in school children.     

Prevalence and cumulative incidence of food hypersensitivity in the first 3 years of life

Background:  Prevalence and incidence of food hypersensitivity (FHS) and its trends in early childhood are unclear.
Methods:  A birth cohort born on the Isle of Wight (UK) between 2001 and 2002 was followed-up prospectively. Children were clinically examined and skin prick tested at set times and invited for food challenges when indicated.
Results:  Nine hundred and sixty-nine children were recruited and 92.9%, 88.5% and 91.9% of them respectively were assessed at 1, 2 and 3 years of age. Prevalence of sensitization to foods was 2.2%, 3.8% and 4.5% respectively at these ages. Cumulatively, 5.3% [95% confidence interval (CI): 3.9–7.1] children were sensitized to a food. Using open food challenge and a good clinical history, the cumulative incidence of FHS was 6.0% (58/969, 95% CI: 4.6–7.7). Based on double-blinded, placebo-controlled, food challenge (DBPCFC) and a good clinical history, the cumulative incidence was 5.0% (48/969, 95% CI: 3.7–6.5). There is no evidence to suggest that the incidence of FHS has increased, comparing these results with previous studies. Overall, 33.7% of parents reported a food-related problem and of these, 16.1% were diagnosed with FHS by open challenge and history and 12.9% by DBPCFC and history. Main foods implicated were milk, egg and peanut.
Conclusions:  By the age of 3 years, 5–6% of children suffer from FHS based on food challenges and a good clinical history. There were large discrepancies between reported and diagnosed FHS. Comparing our data with a study performed in the USA more than 20 years ago, there were no significant differences in the cumulative incidence of FHS.     

Food Hypersensitivity in Patients with Pollen Allergy

Six hundred patients with pollen allergy answered a questionnaire about food hypersensitivity. Hypersensitivity to various nuts, fruits and roots was reported more often by patients with birch pollen allergy(70%) than be patients without birch pollen allergy (19%). The stronger the skin test reaction to birch pollen, the higher was the incidence of food hypersensitivity. A negative correlation was found between grass pollen allergy and food hypersensitivity.
In the diagnosis of springtime hayfever, the presence of hypersensitivity to nuts, fruits and roots supports a diagnosis of birch pollen allergy.     

Food allergy and non-allergic food hypersensitivity in children and adolescents

BACKGROUND: Previous studies have shown a 10-fold discrepancy of self-reported food-induced symptoms and physician-diagnosed food hypersensitivity. Little information is available on the prevalence of food hypersensitivity in unselected paediatric populations. No data were available for German children. OBJECTIVE: To study the perception of food-induced symptoms in the paediatric population, to investigate the allergens accused, to objectify patients' reports, and to identify subgroups at risk of having food-induced allergy (FA) or non-allergic food hypersensitivity (NAFH) reactions. METHODS: This paper presents the data of the paediatric group (0-17 years) of a representative, randomly sampled, cross-sectional population-based survey studying 13 300 inhabitants of the German capital city Berlin regarding food-related symptoms. Instruments included mailed questionnaires, structured telephone interviews, physical examination, skin-prick tests, specific serum IgE and standardized, controlled and blinded oral food challenges. RESULTS: Two thousand three hundred and fifty-four individuals were contacted by mailed questionnaire, 739 (31.4%) responses could be fully evaluated. Four hundred and fifty-five (61.5%) participants reported symptoms related to food ingestion, 284 (38.4%) affirmed reproducible symptoms in the standardized telephone interview. One hundred and eighty-four (24.8%) individuals were fully examined. Reproducible symptoms to food were found in 31 (4.2%) children and adolescents: 26 (3.5%) showed symptoms of FA and five (0.7%) of NAFH. The oral allergy syndrome was most often observed. Foods most commonly identified by oral challenges were apple, hazelnut, soy, kiwi, carrot and wheat. CONCLUSION: The perception of food-related symptoms is common among children and adolescents from the general population. Self-reports could be confirmed in around one out of 10 individuals, still resulting in 4.2% of proven clinical symptoms. However, most reactions were mild and mainly because of pollen-associated FA, while NAFH reactions were less common. Severe IgE-mediated FA was observed in individuals with pre-existing atopic disease, who should be fully investigated for clinically relevant FA.     

Prevalence and Clinical Impact of IgE-Mediated Food Allergy in School Children With Asthma: A Double-Blind Placebo-Controlled Food Challenge Study

Purpose

Recent studies indirectly suggest a possible link between food allergy (FA) and asthma. Most of them have evaluated the occurrence of FA in asthmatic children, especially in the first year of life, using questionnaire-based studies or specific IgE (sIgE) assay. The aim of this study was to evaluate the prevalence and clinical impact of IgE-mediated FA in school children with asthma using a double-blind placebo-controlled food challenge (DBPCFC).

Methods

The study group consisted of school children with atopic asthma who were admitted to the Department of Pediatric Allergology, Gastroenterology and Nutrition, Medical University of Lodz, for the evaluation of food hypersensitivity. The diagnosis of FA was established using questionnaires, sIgE analysis, and the DBPCFC. Asthma severity and asthma control state were also assessed.

Results

A relationship between consumed food and complaints was reported in 180 children (49.7%). Seventy children (19.3%) were sensitized to food allergens. IgE-mediated FA was confirmed in 24 children (6.6%), while 11 children (3%) demonstrated respiratory symptoms. Food-induced asthma exacerbations were observed in 9 patients (2.5%). Statistically significant differences in the prevalence of atopic dermatitis (P<0.002), urticaria (P<0.03), digestive symptoms (P<0.03), rhinitis (P<0.02), sIgE level (P<0.001), positive family history of atopy (P<0.001) and FA in history (P<0.001) were found between asthmatic children with FA and those without. Children with food-induced asthma exacerbations demonstrated significantly greater severity, poorer controls, and worse morbidity compared to those without.

Conclusions

Although food-induced respiratory reactions in children with asthma were rare, they were classified as severe and associated with worse morbidity, greater severity, and poorer control. As the most commonly observed symptoms were coughing and rhinitis, which can be easily misdiagnosed, a proper diagnosis is essential for improving the management of both clinical conditions.     

Allergy to foods in patients monosensitized to Artemisia pollen

It is known that patients with pollinosis may display clinical characteristics caused by allergy to certain fruits and vegetables, but subjects allergic to Artemisia seem to show particularly peculiar characteristics. The clinical features of 84 patients with rhinitis, asthma, urticaria, and/or anaphylaxis whose inhalant allergy was exclusively to Artemisia vulgaris were studied and compared with a control group of 50 patients monosensitized to grass pollen. The mean age for the beginning of symptoms was 30.2 years, and this was higher than in the control group ( P <0.05). We found the main incidence to be in women (70.2%). Some 42.3% had family history of atopia, lower than in the control group ( P <0.05), while the prevalence of asthma and urticaria was significantly higher ( P <0.05). Food hypersensitivity was reported by 23 patients (27.3%) allergic to Artemisia. The foods responsible (with respective numbers of cases) were honey (14), sunflower seeds (11), camomile (four), pistachio (three), hazelnut (two), lettuce (two), pollen (two), beer (two), almond (one), peanut (one), other nuts (one), carrot (one), and apple (one). None of the patients monosensitized to grass had food allergy. CAP inhibition experiments were carried out on a single patient. Results showed the existence of common antigenic epitopes in pistachio and Artemisia pollen for this patient. We concluded that mugwort hay fever can be associated with the Compositae family of foods, but that it is not normally associated with other foods.     

Disodium Cromoglycate and Food Allergy

In a food allergic patient challenge evoked a dual asthmatic response. These reactions could be partly or completely blocked by pretreatment with disodium cromoglycate (Intal, Lomudal) orally, depending on the doses given. Pretreatment with inhalations of disodium cromoglycate gave no protection.     

Prevalence of self-reported food allergy in American adults and use of food labels

BACKGROUND: Few population-based studies in the United States have determined the prevalence of food allergy in adults and the problems these individuals might have with reading food labels. OBJECTIVE: The objectives of this study are to report the prevalence of self-reported food allergy, to identify the characteristics of food allergy reactions, and to describe the use of labels among adults with food allergy. METHODS: Questions from the US Food and Drug Administration's 2001 Food Safety Survey were analyzed to determine the prevalence of food allergy and opinions about food labels in the management of food allergy. RESULTS: The prevalence of self-reported food allergy is 9.1% among all survey respondents, with 5.3% of all respondents reporting a doctor-diagnosed food allergy. The prevalence of food allergy to the 8 most common allergens (peanut, tree nuts, egg, milk, wheat, soybeans, fish, and crustacean shellfish) is self-reported as 2.7% among respondents with doctors' diagnoses. Several label issues, such as words on some ingredient lists being too technical or hard to understand and food labels not always alerting persons to new ingredients, were reported as serious or very serious obstacles for managing an allergy. CONCLUSION: The prevalence of self-reported doctor-diagnosed food allergy among US adults is 5.3%, and a large portion of adults with food allergy found certain label issues a serious problem for managing their food allergy. CLINICAL IMPLICATIONS: The findings provide a needed source of population-based prevalence data of food allergy among US adults. Label issues identified are useful in understanding the difficulties of managing a food allergy.     

Quality of Life in Food Allergy: Validation of the Korean Version of the Food Allergy Quality of Life Questionnaire Parent Form (K-FAQLQ-PF) and Risk Factor Analysis

PurposeThis study aimed to evaluate the reliability and validity of the Korean version of the Food Allergy Quality of Life Questionnaire-Parent Form (K-FAQLQ-PF) and to identify clinical characteristics related to low quality of life (QoL) in Korean children with food allergy (FA).MethodsParents of 0–12-year-old patients with FA were enrolled. The English version of FAQLQ-PF was translated into Korean. Construct validation was confirmed by the Food Allergy Independent Measure-Parent Form (FAIM-PF) and the Child Health Questionnaire Parent Form 28 (CHQ-PF28). Logistic regression analyses were used to evaluate associations between potential risk factors and QoL outcomes.ResultsA total of 182 patients with a median age of 5.0 years were enrolled in the study. Cronbach’s α coefficient values indicating internal consistency were higher than 0.8. Intraclass correlation coefficient values for test-retest reliability were good for all age groups (r > 0.6). Total K-FAQLQ-PF scores were positively correlated with the FAIM-PF (r = 0.56, P < 0.05) and were negatively correlated with the parental impact-emotional domain in the CHQ-PF28 (r = −0.44, P < 0.05). In multivariable logistic regression analysis, low QoL was significantly associated with female sex (adjusted odds ratio [aOR], 2.07; 95% confidence interval [CI], 1.03–4.18), age ≥ 5 years (aOR, 2.84; 95% CI, 1.31–6.16), FA diagnosis before the age of 3 years (aOR, 3.96; 95% CI, 1.13–13.93), the presence of atopic dermatitis (aOR, 2.21; 95% CI, 1.07–4.57), and residence in non-metropolitan areas (aOR, 3.44; 95% CI, 1.73–6.85).ConclusionsAccording to parental perceptions, the K-FAQLQ-PF is a valid and reliable tool to assess psychosocial QoL in Korean children with FAs. Age, sex, residential area, and comorbid AD can affect the QoL of pediatric patients with FA.     

Morphology of the Jejunum in Children with Eczema due to Food Allergy

We report the results of a morphometric study of jejunal biopsy specimens from 18 children wth eczema due to food allergy. The measurements were compared with those for 13 age-matched children without gastrointestinal or immunological diseases. The patients' ages ranged from 2 months to 4 years. In 14 the food responsible for the symptoms was cow's milk. During the challenge tests with suspected foods 10 children had skin symptoms only (group I) and eight had gastrointestinal symptoms in addition (group II). Both groups showed a significant decrease in the villus/crypt ratio, mostly due to an increase in crypt depth. The counts of lymphocytes and plasma cells in the lamina propria and of intraepithelial lymphocytes did not differ from those seen in the controls. Four patients had increased counts of jejunal eosinophils, but the mean count for the whole group was not significantly increased. Considering nine measurements only five of the patients had moderate changes in jejunal morphology.     

Food allergy is associated with an increased risk of asthma

Background The atopic march is well documented, but the interrelationship of food allergy (FA) and asthma is not well understood.
Objective The aim of this study was to examine the strength of the association and temporal relationships between FA and asthma.
Methods This analysis included 271 children 6 years (older group) and 296 children <6 years (younger group) from a family-based FA cohort in Chicago, IL. Asthma was determined by parental report of physician diagnosis. FA status was determined based on the type and timing of clinical symptoms after ingestion of a specific food, and results of prick skin test (Multi-Test II) and allergen-specific IgE (Phadia ImmunoCAP). Analyses were carried out using logistic regression accounting for important covariates and auto-correlations among siblings. Kaplan–Meier curves were used to compare the time to onset of asthma with the FA status.
Results Symptomatic FA was associated with asthma in both older [odds ratio (OR)=4.9, 95% confidence interval (CI): 2.5–9.5] and younger children (OR=5.3, 95% CI: 1.7–16.2). The association was stronger among children with multiple or severe food allergies, especially in older children. Children with FA developed asthma earlier and at higher prevalence than children without FA (Cox proportional hazard ratio=3.7, 95% CI: 2.2–6.3 for children 6 years, and hazard ratio=3.3, 95% CI: 1.1–10 for children <6 years of age). No associations were seen between asymptomatic food sensitization and asthma.
Conclusions Independent of markers of atopy such as aeroallergen sensitization and family history of asthma, there was a significant association between FA and asthma. This association was even stronger in subjects with multiple food allergies or severe FA.     

Nasal Smear as a Screening Test for Immediate-Type Nasal Allergy

From a previous sample of 634 students and school children, 115 subjects were selected for a thorough rhinological examination and allergy work-up in order to assess the value of nasal secretion eosinophilia in screening for immediate-type nasal allergy. Part of the subjects had, in the previous study, been found to have secretion eosinophilia and a history of chronic/allergic rhinitis, part of the subjects had either a secretion eosinophilia or a rhinitis history, and part of them had neither a secretion eosinophilia nor a rhinitis history. A significant correlation was obtained between secretion eosinophilia and allergy. Nasal provocation tests correlated with skin tests in 87%, whereas the correlation between nasal provocation tests and Ige determinations in the serum was poorer. Thickening of the maxillary sinus was, when present, usually attributable to infection and not to allergy. Reasons for "false positive or false negative" smears for eosinophils are discussed.     

Food Allergy Overview in Children

Food allergies have increased significantly in the past decade. An accurate history is crucial in approaching the management. At the outset, food intolerance must be distinguished from food allergies and, furthermore, these allergies should be classified into either an IgE, Non-IgE, or a mixed response. The clinical features vary from life-threatening anaphylaxis to milder IgE-mediated responses, atopic dermatitis, and gastrointestinal symptoms. The severity of the reaction and the potential risk for anaphylaxis on reexposure should be assessed. Milk, soy, egg, wheat, and peanut allergies are common in children, whereas peanut, tree nut, fish, shell fish allergies, and allergies to fruits and vegetables are common in adults. Structural proteins are important determinants of the severity of the reactions and may often predict the natural history and cross reactivity. Diagnostic work up must be guided by the clinical history. Skin testing and food-specific IgE done by standard methods are very useful, whereas oral challenges may be indicated in some situations. Majority of the patients outgrow their allergies to milk, soy, egg, and wheat, and some to peanut also, therefore, patients should be periodically reassessed. Novel diagnostic techniques which detect specific allergenic epitopes have been developed. Several newer therapies are promising.