Mechanisms of allergic sensitization to foods: bypassing immune tolerance pathways.
Immunol Allergy Clin North Am. 2012 Feb;32(1):1-10
Authors: Berin MC
Abstract
The default response of the mucosal immune system to antigens derived from food is one of active immune tolerance carried out by regulatory T cells and induced by dendritic cells residing in the intestinal mucosa. This tolerance response must be inhibited or bypassed to generate allergic sensitization in experimental food allergy and this has been achieved by 3 main approaches: genetic modifications, experimental adjuvants, and bypassing oral tolerance by administering the antigen through alternative routes. This article discusses the implications of these approaches for understanding the mechanisms of sensitization to food allergens in human disease.
Immunol Allergy Clin North Am. 2012 Feb;32(1):11-33
Authors: Masilamani M, Commins S, Shreffler W
Abstract
Food allergy is an emerging epidemic in the United States and the Western world. The determination of factors that make certain foods allergenic is still not clearly understood. Only a tiny fraction of thousands of proteins and other molecules is responsible for inducing food allergy. In this review, the authors present 3 examples of food allergies with disparate clinical presentations: peanut, soy, and mammalian meat. The potential relationships between allergen structure and function, emphasizing the importance of cross-reactive determinants, immunoglobulin E antibodies to the oligosaccharides, and the immune responses induced in humans are discussed.
The Epidemiology of IgE-Mediated Food Allergy and Anaphylaxis.
Immunol Allergy Clin North Am. 2012 Feb;32(1):35-50
Authors: Allen KJ, Koplin JJ
Abstract
The rise in food allergy prevalence in developed countries is evident from anecdotal reports but has been difficult to document and until recently good quality prevalence data were lacking. Although most emerging risk factors seem related to the “modern lifestyle” the reasons for the rise in food allergy prevalence remain poorly understood. The incidence of food allergy-related anaphylaxis is rising particularly in children younger than 5 years of age. Emerging studies are better designed to assess the true prevalence of IgE-mediated food allergy using formal population sampling frames, standardized and objective outcome data including use of the gold standard oral food challenge, and the capacity to adjust for potential selection bias.
Can we prevent food allergy by manipulating the timing of food exposure?
Immunol Allergy Clin North Am. 2012 Feb;32(1):51-65
Authors: Järvinen KM, Fleischer DM
Abstract
Prevention of food allergies by maternal and infant feeding practices serves as a simple, inexpensive approach to address the growing number of subjects with food allergies in comparison with any emerging interventional therapies for existing food allergies, such as oral immunotherapy. This article provides a careful evaluation of the rationale and existing data on the effect of timing of the introduction of food allergens (during pregnancy, lactation, and early childhood) on the development of specific food allergies.
Eosinophilic esophagitis: diagnosis and management.
Immunol Allergy Clin North Am. 2012 Feb;32(1):67-81
Authors: Lieberman JA, Chehade M
Abstract
Eosinophilic esophagitis is a clinicopathologic disease that can present with a constellation of upper gastrointestinal symptoms and endoscopic findings in conjunction with significant infiltration of the esophageal tissue with eosinophils. Clinical and histologic resolution of the disease can be seen with dietary restriction therapies and systemic and topical corticosteroids. Because most patients have an atopic background and the disease seems to have an underlying T-helper type 2 pathogenesis, allergists and gastroenterologists need to be familiar with the diagnosis and management of this disease. In this review, clinical characteristics, endoscopic and histologic findings, and available therapy options are discussed.
Mental Health and Quality-of-Life Concerns Related to the Burden of Food Allergy.
Immunol Allergy Clin North Am. 2012 Feb;32(1):83-95
Authors: Ravid NL, Annunziato RA, Ambrose MA, Chuang K, Mullarkey C, Sicherer SH, Shemesh E, Cox AL
Abstract
As food allergy increases, more research is devoted to its influence on patient and family mental health and quality of life (QoL). This article discusses the effects on parent and child QoL, as well as distress, while appraising the limitations of knowledge given the methods used. Topics include whether QoL and distress are affected compared with other illnesses, assessment of distress and QoL in parents compared with children, concerns about food allergy-related bullying, and the necessity for evidence-based interventions. Suggestions are offered for how to improve QoL and reduce distress on the way to better coping with food allergy.
Beyond skin testing: state of the art and new horizons in food allergy diagnostic testing.
Immunol Allergy Clin North Am. 2012 Feb;32(1):97-109
Authors: Caubet JC, Sampson HA
Abstract
Food allergy affects approximately 1% to 10.8% of the general population, and its prevalence seems to be increasing. An accurate diagnosis is particularly important because a misdiagnosis could lead to life-threatening reactions or to unnecessary restrictive diets. However, allergy tests currently used in clinical practice have limited accuracy, and an oral food challenge, considered as the gold standard, is often required to confirm or exclude a food allergy. This article reviews several promising novel approaches for the diagnosis of food allergy, such as new molecular diagnostic technologies and functional assays, along with their potential clinical applications.
One of the most promising therapies for food allergy is oral immunotherapy (OIT), in which small amounts of allergen are administered in increasing amounts, with the immediate goal of desensitization and the long-term goal of tolerance. However, safety and standardization concerns prevent its widespread use, and a subgroup of patients may experience severe allergic reactions. These concerns might be addressed by another promising therapy involving anti-IgE monoclonal antibodies (mAb), which can reduce allergic reactions associated with food administration. A recent pilot study combining anti-IgE mAb with OIT suggests that anti-IgE mAb might improve the safety, rapidity, and efficacy of OIT.
Alternative and complementary treatment for food allergy.
Immunol Allergy Clin North Am. 2012 Feb;32(1):135-50
Authors: Wisniewski JA, Li XM
Abstract
Despite increased consumer interest in complementary and alternative medicine (CAM) for the treatment of food allergy, there remains a relative paucity of knowledge regarding the clinical efficacy, mechanisms of action, and safety of most CAM treatments available to consumers. This article focuses on recent advances in CAM for food allergy, including acupuncture, herbal medicine, probiotics, and alternative approaches to allergen immunotherapy. The mechanism of action of several novel approaches to treatment of food allergy is reviewed, but FAHF-2 is the only investigational herbal formulation currently validated for use in human clinical trials.
Paradigm shift in the management of milk and egg allergy: baked milk and egg diet.
Immunol Allergy Clin North Am. 2012 Feb;32(1):151-64
Authors: Konstantinou GN, Kim JS
Abstract
Heat treatment of several foods, including all types of cooking, has been mainly used to minimize the number of viable microbes, reduce pathogenicity, and destroy the undesirable enzymes, maintaining food quality. In addition, food processing improves sensory, nutritional, and physical properties of the foods, due to food protein denaturation. Heat-induced alterations of food proteins can attenuate allergenicity. In this article, the authors review the important role of thermal processing on milk and egg proteins, which comprise the commonest food allergies in infancy and early childhood.
PMID: 22244238 [PubMed - in process]
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