BACKGROUND: In recent decades, the number of patients experiencing food allergies and food anaphylaxis has been increasing worldwide. However, at present, epidemiological data on this problem are unclear. Anaphylaxis is an acute, potentially life-threatening pathological reaction of systemic hypersensitivity with various clinical symptoms, which can be coded under different diagnoses and conditions. Its acute onset and transient nature make it difficult to obtain prospective data. Thus, it appears realistic to conduct retrospective studies using a questionnaire analysis to identify children who have undergone such reactions for further examination and observation. AIM: This study aimed to investigate the prevalence of food hypersensitivity and food anaphylaxis in the pediatric population of Ekaterinburg. MATERIALS AND METHODS: A total of 5,000 parents with children aged 217 years were surveyed. The children attend preschool or school general educational institutions (childrens education institution (ChEI) of the city. ChEIs were randomized, and the parent survey was anonymous and voluntary. Respective parents were asked to complete the questionnaire, which asks them whether their children have skin lesions, wheezing, and clinical presentations of allergic rhinitis or food allergy. The developed questionnaire was based on the ISAC questionnaire translated into Russian. In the questionnaires, the parents gave only those symptoms that arose in children against the background of somatic health at normal body temperature. RESULTS: A total of 2,400 questionnaires were analyzed: 1,196 questionnaires were filled by parents of boys (49.9%) and 1,204 questionnaires by parents of girls (50.1%) aged 217 years (average age 10.31 0.30 years). Data collected from questionnaire revealed that skin rashes in 17% of the children were associated with products: most often, these were obligate allergens and histamine liberators. Additionally, 6.8% of the parents noted that persistent rhinitis in their children was associated with consumption of milk/fish/fruit/nuts. Symptoms of respiratory obstruction after eating fish/cows milk/nuts were described by parents of 2.7% of the children. Association of urticarial manifestations with food was noticed by parents of 194 (8.1%) children. Moreover, 0.96% of children experienced symptoms of anaphylaxis to food, 0.3% to cows milk, 0.12% to chicken eggs and fruit, and 0.08% to wheat, nuts, and fish. CONCLUSIONS: Epidemiological studies help understand the spread and nature of allergic diseases in a region. Moreover, identification of children who have had episodes of food-borne anaphylaxis helps prevent recurrent cases by conducting case follow-up of these patients.
Background: Immunoglobulin E (IgE)-mediated cow’s milk allergy (CMA) can be life-threatening and affects up to 3% of children. Hypoallergenic infant formulas based on hydrolyzed cow’s milk protein are increasingly considered for therapy and prevention of cow’s milk allergy. The aim of this study was to investigate the allergenic activity and ability to induce T cell and cytokine responses of an infant formula based on extensively hydrolyzed cow’s milk protein (whey) (eHF, extensively hydrolyzed formula) supplemented with Galactooligosaccharides (GOS) and Limosilactobacillus fermentum CECT5716 (LF) to determine its suitability for treatment and prevention of CMA. Methods: eHF and standard protein formula based on intact cow’s milk proteins (iPF) with or without Galactooligosaccharide (GOS) and Limosilactobacillus fermentum CECT5716 (LF) were investigated with allergen-specific antibodies and tested for IgE reactivity and allergenic activity in basophil degranulation assays with sera from cow’s milk (CM)-allergic infants/children. Their ability to stimulate T cell proliferation and cytokine secretion in cultured peripheral blood mononuclear cells (PBMC) from CM-allergic infants and children was studied with a FACS-based carboxyfluorescein diacetate succinimidyl ester (CFSE) dilution assay and xMAP Luminex fluorescent bead-based technology, respectively. Results: An eHF supplemented with GOS and LF exhibiting almost no IgE reactivity and allergenic activity was identified. This eHF induced significantly lower inflammatory cytokine secretion as compared to an intact protein-based infant formula but retained T cell reactivity. Conclusions: Due to strongly reduced allergenic activity and induction of inflammatory cytokine secretion but retained T cell reactivity, the identified eHF may be used for treatment and prevention of CMA by induction of specific T cell tolerance.
Anaphylaxis is an acute life-threatening condition affecting several body systems. It might have a rapid onset and lead to a lethal outcome. The major provoking factors for the development of anaphylactic reactions in childhood are food allergens. High hypersensitivity to one food allergen can make it difficult for a family to find a substitution for an allergenic product. Food-induced anaphylactic reaction to quite a number of food allergens is a serious problem for both the physician and the family of an allergic child necessitating organization of appropriate and safe nutrition. In real life, the standard recommendation for the patient – to strictly follow the rules of the elimination diet with exclusion of the causative allergen and all cross-reactive allergens – often becomes unrealizable. There is a serious risk of developing new allergic reactions due to accidental intake of the triggering allergens because of incorrect food labelling by manufacturers. The objective of the work is to present a clinical case report that demonstrates the importance of performing allergy component testing (ImmunoCAP ISAC-112,) for identification of the full spectrum of allergens with subsequent assessment of allergenic molecules as triggering allergens and shows serious difficulties in the elaboration of recommendations on a personalised diet that should be adequate and safe for a child with a history of recurrent episodes of food-induced anaphylaxis. Key words: children, life-threatening reactions, allergy component testing, food labelling, food-induced anaphylaxis, food allergens
Aim: to study the sensitization profile in patients with sensitivity to Bet v1 allergen who have clinically significant respiratory symptoms of pollinosis during the birch flowering season, oral allergy syndrome (OAS), and angioedema to nuts and stone fruits. Patients and Methods: a prospective open-label study included 40 children (average age 7.52±0.64), 26 (65%) boys and 14 (35%) girls. All children had sensitization to the birch major allergen (Bet v1), symptoms of respiratory allergy during the birch flowering season, manifestations of OAS with angioedema in combination with hives or without it after eating fruits of Rosaceae family/nuts/peanuts. Children underwent general clinical and allergy researches, determination of total IgE and eosinophil cationic protein. By the method of component-resolved diagnosis of allergy (ISAC-112, ImmunoCAP), a comprehensive allergology examination for 112 allergen molecules was performed for each child. Results: the children of the study group were found to have increased values of total IgE (256.66±40.45 IU/mL) and eosinophil cationic protein (67.22±8.67 ng/mL). It was found that 57.5% of children were sensitized to tree nut storage proteins (rJug r1, rJug r2, NCoR a9, rAna o2, rBer e1), and some patients (27.5%) had increased specific IgE to non-specific lipid-transfer proteins (npLTPs) (rPru p3, NCoR a8, rAra h9, rJug r3). Antibodies to peanut storage proteins (rAra h1, rAra h2, rAra h3, rAra h6) were in 22.5% of children in the study group. Conclusion: the component-resolved diagnosis of allergy allows to determine the sensitization profile of patients. Sensitization detection to storage proteins and/or nsLTPs of nuts, peanuts and fruits is a predictor of possible severe allergic reactions. The exclusion of these products, both raw and heat-treated, reduces the number of severe acute allergic reactions in patients and prevents possible fatal outcomes. KEYWORDS: oral allergy syndrome, angioedema, children, birch, sensitization to Bet v1 allergen, storage proteins, nsLTPs. FOR CITATION: Lepeshkova T.S., Beltyukov E.K., Tsarkova S.A., Naumova V.V. Oral allergy syndrome and angioedema in patients with birch allergen sensitization: are there any high risks? Russian Medical Inquiry. 2021;5(1):21–24. DOI: 10.32364/2587-6821-2021-5-1-21-24.
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