Allergies to fruits and vegetables

Allergic reactions to fruits and vegetables are frequently observed in older children and adolescents. They can result from a primary sensitization to food allergens or from a primary sensitization to inhalant allergens such as pollens or latex. In the case of fruit allergies, the stability of the allergens involved is crucial to the sensitization pathway and in the clinical presentation of the food allergy. Two patients allergic to fruits are presented and discussed in the light of the allergens involved. Patient 1 was a 14 yr-old girl with a grass and olive pollen allergy who developed oropharyngeal symptoms typical of the oral allergy syndrome (OAS) with multiple fruits from taxonomically unrelated families, and who was sensitized to profilin. Patient 2 was an 8 yr-old girl, with no pollen allergies, who developed systemic reactions to peach and apple, and who was sensitized to non-specific lipid transfer proteins (LTP). Profilins are labile allergens present in pollens and foods, and sensitization occurs through the respiratory route to pollen profilin. The cross-reactive IgE antibodies generated can elicit local reactions in the oropharyngeal mucosa (OAS) when exposed to fruit profilins. In contrast, LTPs are a family of stable allergens that resist thermal treatment and enzymatic digestion, and can thus behave as true food allergens inducing primary (non-pollen related) sensitizations and triggering systemic reactions. These two cases represent two distinct patterns of sensitization and clinical expression of fruit allergies that are determined by the panallergens involved (LTPs and profilins) and their intrinsic physicochemical properties. Additionally, these two cases also show the improved diagnostic value of Component Resolved Diagnosis, and strengthen its utility in the routine diagnosis and management of patients.     

Frequency of food allergy in a pediatric population from Spain

We evaluated the prevalence and characteristics of the principal foods implicated in 355 children diagnosed with IgE-mediated food allergy. Diagnosis was established on the basis of positive clinical history for the offending food, positive specific IgE by skin prick test and RAST, and open food challenge. Our results showed the principal foods involved in allergic reactions are: eggs, fish, and cow's milk. These are followed in frequency by fruits (peaches, hazelnuts and walnuts), legumes (lentils, peanuts and chick peas) and other vegetables (mainly sunflower seeds). The legumes demonstrated the highest degree of clinical cross-reactivity. Most patients with food allergy reacted to one or two foods (86.7%). Only 13.3% of patients reacted to 3 or more foods, mostly to legumes and fruits. We found that food allergy begins most frequently in the first (48.8%) and second (20.4%) years of life. Allergy to proteins of cow's milk, egg, and fish begins predominantly before the second year, demonstrating a clear relationship with the introduction of these foods into the child's diet. Allergy to foods of vegetable origin (fruits, legumes and other vegetables) begins predominantly after the second year.;     

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??Abdominal pain is a common symptom of food allergy. It may be the main symptom of some diseases of digestive system?? such as infant colic. It may be accompany symptom of some diseases?? such as eosinophilic gastroenteritis?? or it is a manifestation of systemic disease?? such as anaphylaxis. Oral tolerance development?? bacterial intestinal microflora?? intestinal barrier function?? transepithelial transport of food antigens?? eosinophil recruitment in the gastrointestinal tract?? and effect of food allergens on gastrointestinal motility are the contribution to pathophysiology of gastrointestinal food allergy.     

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??Abstract??Objective To investigate the diagnostic value of mean diameter of SPT in food allergic infants. Methods Totally 91 infants suspected with food allergy ??median age 7.35±2.94 months?? were selected??and all patients received family history inquiry??skin prick test and open food challenge.The mean diameter of SPT was measured??and OFC was performed to confirm food allergy.Diagnostic value of skin prick test, including the sensitivity and specificity, was calculated.In addition??receiver operating characteristic curve??ROC?? was plotted and area under the curve??AUC??was calculated to quantify the accuracy of the parameter.The SPSS software package version 13.0 for windows was used for all statistical analysis. Results A total of 128 babies received food challenge test?? in which there were 109 times of OFC positive and 19 times negative??totally 79 infants were diagnosed with FA.The induced symptoms of food challenge test included skin symptoms??70.6%??, gastrointestinal symptoms??20.2%??, rest with crying?? coughing?? rubbing eyes??etc.??9.2%??.When the rash MD was ≥3 mm??the sensitivity of SPT diagnosis milk??egg white and protein allergy was 19%??60.6% and 60.5% respectively??the area under ROC curve of rash MD in the milk??egg white??protein was 0.718??0.604 and 0.716 respectively?? the rates of three food SPT test results complying with the OFC were 44.4%??53.7% and 65.9%??the rates being 62.5%?? 58.3% and 31.3% in positive family history??when family history was negative??the area under the ROC curve of rash MD was 0.793. In the cases with positive family history??the area of ROC curve was 0.533.When rash MD of milk??egg white and protein was ≥2.2??5.0??4.7 mm or the rash MD was ≥3.25mm in children with a negative family history??SPT FA diagnostic specificity could be up to 100%. Conclusion SPT has some value in the diagnosis of FA. By finding the critical value of SPT FA and comprehensive analysis of family history??doctors can improve the diagnostic rate of FA. SPT can prevent some suspicious FA infants from food challenge test. It is very important to obtain rapid clinical diagnosis and to reduce the risk and burden to their families.     

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??Food allergy related digestive disease refers to damage of digestive tract mucosa caused by allergy??and digestive tract symptoms are the main manifestation. Including oral allergy syndrome??anaphylaxis??food protein-induced enteropathy??food protein-induced enterocolitis syndrome??food protein-induced proctocolitis??celiac disease??eosinophilic esophagitis??eosinophilic gastroenteritis. The diagnosis was based on history??manifestation??and food chanllenge. Skin prick test and specific serum IgE test are helpful for screening IgE mediated food allergy. Endoscopy should be based on different disease conditions. The management principles of these diseases include avoiding diet??choosing proper nutrition substitute??following up??carrying out nutrition monitoring and evaluation??and rationally using medicine.     

The effect of digestion and pH on the allergenicity of kiwifruit proteins

It is suggested that patients with oral allergy syndrome (OAS) respond to pepsin-sensitive allergens, and systemic reactors identify pepsin-resistant allergens. We sought to assess the digestibility of kiwifruit proteins in simulated gastric fluid (SGF), and to compare the immunogenicity of the digests in patients with isolated oral and systemic reactions to kiwifruit. In addition, the effect of pH on digestibility of kiwifruit proteins was investigated. The in vitro resistance of kiwifruit proteins to digestion was determined using SGF. G-immunoglobulin (IgE) binding to digested proteins was investigated by Western blotting using sera from children and adults (aged 5–72 yr) with systemic reactions and patients with isolated oral symptoms. To determine whether pH conditions influence digestion of kiwifruit extracts, digestion at pHs 1.5–7 were compared by SDS-PAGE. Patients with systemic reactions showed IgE binding to digestion-resistant allergens, but patients with oral symptoms reacted only to digestion-labile allergens. An increase in pH from 1.5 to 2.5 significantly reduced pepsin breakdown of kiwifruit allergens. Immunoreactive digested protein fragments were detectable by immunoblot but not Coomassie stain. This study confirms a difference in the lability of food allergens recognized by patients with systemic reactions and those with OAS. Pepsin digestion of kiwifruit proteins was impaired by hypoacidic conditions suggesting that patients with hypoacidic gastric conditions are at increased risk of systemic absorption of allergens. The data indicate that commonly used methods for predicting allergenicity of novel proteins using Coomassie stains may be flawed.     

Availability of,access to and consumption of fruits and vegetables in a peri‐urban area in KwaZulu‐Natal,South Africa

Availability and consumption of fruits and vegetables were assessed in peri‐urban households in KwaZulu‐Natal Province, South Africa. Caregivers of 400 randomly selected grade 6 and 7 learners were interviewed using a questionnaire that included unquantified food frequency questions. Using a repeated 24‐h dietary recall, dietary intake was quantified for learners, caregivers and 2‐ to 5‐year‐old children in the household. Usual household fruit and vegetable consumption was expressed over three Living Standard Measure (LSM) categories. Average per capita intake of fruit and/or vegetables was 99 g for 2‐ to 5‐year‐old children and 124 g for caregivers. For consumers, fruits and/or vegetables contributed towards total dietary intake of fibre (16–21%), calcium (13–21%), vitamin A (27–31%) and vitamin C (47–62%). For households not consuming fruits (n = 297) and vegetables (n = 178) daily, cost was the major constraint (≥75%). Of all households, 52% had fruit trees and 25% had a vegetable garden. Animals destroying vegetables was the major constraint to 59% of vegetable growers. Household consumption of fruits and vegetables increased over the LSM categories. Caregivers in the higher LSM group more likely used printed material for information on healthy eating, had fruit trees, were confident about vegetable gardening and sold some of their produce. To enable peri‐urban populations of low socio‐economic status to consume more frequently a bigger variety of fruits and vegetables, the cost of purchasing these food items needs to be addressed by government and business sector. Households should further receive support to overcome constraints which hamper the success of home gardens.     

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??About Helicobacter pylori??Hp?? infection??there is the view that Hp direct interference metabolism or indirect chronic inflammation may be associated with many diseases??and some even suggest that some of the protein composition of Hp or Hp be as a treatment for some diseases??such as asthma and obesity. However?? based on the studies on the data about gastroesophageal reflux disease and abnormal immune disease??such as asthma??food allergies??inflammatory bowel disease??IBD?? and obesity??there is no evidence showing that Hp is good for the human body. Therefore??for Hp infection- related diseases??pediatricians should give active treatment and strengthen research in order to cope with the rising Hp resistance and treatment failure rate.     

Correlation between skin prick test using commercial extract of cow''s milk protein and fresh milk and food challenges

The skin prick test (SPT) is regarded as an important diagnostic measure in the diagnostic work-up of cow's milk protein allergy. It is not known whether commercial extracts have any advantage over fresh milk. The aims of the study were to (i) compare the diagnostic capacity of SPTs for the three main cow's milk proteins (alpha-lactalbumin, casein and beta-lactoglobulin) with fresh milk and (ii) determine a cut-off that discriminates between allergic and tolerant children in a controlled food challenge. A study was carried out on 104 children consecutively attending two paediatric allergy clinics for suspected cow's milk allergy. A clinical history, SPTs with fresh cow's milk and commercial extracts of its three main proteins and a challenge test were performed on all the children. A study of the validity of the prick test was also performed by taking different cut-off points for fresh milk and its proteins. Twenty-eight of 104 challenge tests (26.9%) were positive. At a cut-off point of 3 mm, fresh milk showed the greatest negative predictive value (98%), whereas casein showed the greatest positive predictive value (PPV, 85%). Calculation of 95% predicted probabilities using logistic regression revealed predictive decision points of 12 mm for lactalbumin, 9 mm for casein, 10 mm for beta-lactoglobulin and 15 mm for fresh cow's milk. We found that the greater the number of positive SPTs for milk proteins, the more likely the positive response to challenge. Having a positive SPT for all three milk proteins had PPV of 92.3% and would seem more clinically useful than any cut-off. Both fresh milk and cow's milk extract of the three main proteins could be useful in the diagnostic work-up of cow's milk allergy. Finding positivity to all three cow's milk proteins seems to be a simpler and more useful way of avoiding oral food challenges.     

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??Objective To investigate the efficacy and safety of enteral nutritional powder ??AA-PA?? an amino acid-based formula?? therapy in treatment of the infants with food protein allergy.Methods The prospective?? blind?? controlled?? multi-center trial was performed.Two hundred and forty-eight infants with cow’s milk allergy or food protein allergy??with exclusion of positive diagnostic serum-specific IgE values to soy protein were randomized either to be treated with an amino acid-based formula ??n = 124?? or soy protein-based formula ??n = 124?? for 12 weeks. The weight?? height?? allergic clinical manifestations?? adverse events and adverse reactions were estimated in pre-treatment and 4th ??8th and12th week during treatment respectively. The serum total protein and albumin were measured in pre-treatment and 12th week during treatment respectively.Results The feeding of enteral nutritional powder satisfied the need of growth and improved significant clinical manifestations for food protein allergy in two groups. In amino acid-based formula group there was a significantly increase in the weight??compared with the soy protein-based formula group??the different value between week 4 and base weight??0.65kg ± 0.45 kg vs 0.61 kg ± 0.47 kg?? P = 0.6720?? between week 8 and base weight??1.22 kg ± 0.73 kg vs 1.02 kg ± 0.65 kg?? P = 0.0368?? between week 12 and base weight??1.74 kg ± 0.91 kg vs 1.39 kg ± 0.87 kg?? P = 0.0022. The height?? clinical manifestations?? serum total protein and albumin during observation were similar in both groups. The adverse event rate was 44.35% in amino acid-based formula group and 45.16% in soy protein-based formula group?? observed almost in respiratory and digestive system. No statistical significance was noticed in all safety parameters in amino acid-based formula group compared with soy protein-based formula group.Conclusion The amino acid-based formula proves to be an effective substitute formula for the infants with cow’s milk allergy or food protein allergy?? and it is superior to soy protein-based formula in weight gain and safety and is well tolerated.