Cansin Sackesen

Allergen immunotherapy for IgE-mediated food allergy: a systematic review and meta-analysis.

The European Academy of Allergy and Clinical Immunology (EAACI) is developing Guidelines for Allergen Immunotherapy (AIT) for IgE‐mediated Food Allergy. To inform the development of clinical recommendations, we sought to critically assess evidence on the effectiveness, safety and cost‐effectiveness of AIT in the management of food allergy.

EAACI Guidelines on allergen immunotherapy: IgE-mediated food allergy.

Food allergy can result in considerable morbidity, impairment of quality of life, and healthcare expenditure. There is therefore interest in novel strategies for its treatment, particularly food allergen immunotherapy (FA‐AIT) through the oral (OIT), sublingual (SLIT), or epicutaneous (EPIT) routes. This Guideline, prepared by the European Academy of Allergy and Clinical Immunology (EAACI) Task Force on Allergen Immunotherapy for IgE‐mediated Food Allergy, aims to provide evidence‐based recommendations for active treatment of IgE‐mediated food allergy with FA‐AIT. Immunotherapy relies on the delivery of gradually increasing doses of specific allergen to increase the threshold of reaction while on therapy (also known as desensitization) and ultimately to achieve post‐discontinuation effectiveness (also known as tolerance or sustained unresponsiveness). Oral FA‐AIT has most frequently been assessed: here, the allergen is either immediately swallowed (OIT) or held under the tongue for a period of time (SLIT). Overall, trials have found substantial benefit for patients undergoing either OIT or SLIT with respect to efficacy during treatment, particularly for cows milk, hens egg, and peanut allergies. A benefit post‐discontinuation is also suggested, but not confirmed. Adverse events during FA‐AIT have been frequently reported, but few subjects discontinue FA‐AIT as a result of these. Taking into account the current evidence, FA‐AIT should only be performed in research centers or in clinical centers with an extensive experience in FA‐AIT. Patients and their families should be provided with information about the use of FA‐AIT for IgE‐mediated food allergy to allow them to make an informed decision about the therapy.

Phenotypes of IgE-mediated food allergy in Turkish children.

Data on food allergy-related comorbid diseases and the knowledge on factors associating specific food types with specific allergic outcomes are limited. The aim of this study was to determine the clinical spectrum of IgE-dependent food allergy and the specific food-related phenotypes in a group of children with IgE-mediated food allergy. Children diagnosed with IgE-mediated food allergy were included in a cross-sectional study. IgE-mediated food allergy was diagnosed in the presence of specific IgE or skin-prick test and a consistent and clear-cut history of food-related symptoms or positive open provocation test. Egg (57.8%), cows milk (55.9%), hazelnut (21.9%), peanut (11.7%), walnut (7.6%), lentil (7.0%), wheat (5.7%), and beef (5.7%) were the most common food allergies in children with food allergy. The respiratory symptoms and pollen sensitization were more frequent in children with isolated tree nuts-peanut allergy compared with those with egg or milk allergy (p < 0.001); whereas atopic dermatitis was more frequent in children with isolated egg allergy compared with those with isolated cows milk and tree nuts-peanut allergy (p < 0.001). Children with food allergy were 3.1 (p = 0.003) and 2.3 (p = 0.003) times more likely to have asthma in the presence of allergic rhinitis and tree nuts-peanut allergy, respectively. Interestingly, children with atopic dermatitis were 0.5 (p = 0.005) times less likely to have asthma. Asthma (odds ratio [OR], 2.3; p = 0.002) and having multiple food allergies (OR, 5.4; p < 0.001) were significant risk factors for anaphylaxis. The phenotypes of IgE-mediated food allergy are highly heterogeneous and some clinical phenotypes may be associated with the specific type of food and the number of food allergies.

Cor a 14, Hazelnut-Specific IgE, and SPT as a Reliable Tool in Hazelnut Allergy Diagnosis in Eastern Mediterranean Children

BACKGROUNDnImproving the diagnostic efficacy of laboratory tests might reduce the need for oral food challenges and facilitate our daily practice.nnnOBJECTIVEnWe aimed to determine cutoff values and probability curves, as well as to investigate the role of component-resolved diagnosis in predicting clinical reactivity in children with hazelnut allergy and to evaluate the association with pollen sensitivity.nnnMETHODSnA total of 56 children with hazelnut allergy who underwent double-blind placebo-controlled food challenge and 8 children who experienced anaphylaxis after accidental hazelnut intake were included. Serum IgE levels to hazelnut extract, Cor a 1, Cor a 8, Cor a 9, Cor a 14, and Bet v 1 were measured with the ImmunoCAP system. Skin prick tests (SPT) with hazelnut, other implicated foods, and aeroallergens were performed.nnnRESULTSnThe optimal cutoff levels for hazelnut sIgE and SPT wheal diameter that predicted clinical reactivity with the highest sensitivity and specificity were 3.15 kU/L and 7.5 mm, respectively. Among the components, only Cor a 14 discriminated between reactive and nonreactive children. The area under curve (AUC) at the optimal cutoff point of 0.63 kU/L for Cor a 14 (0.936) was higher than the AUC of hazelnut sIgE (0.818) and SPT wheal diameter (0.803). For the first time, a 95% probability for clinical reactivity was estimated for SPT wheal diameter, IgE to hazelnut extract, and to Cor a 14 at 12 mm, 10.2 kU/L, and 1.0 kU/L, respectively.nnnCONCLUSIONnCor a 14 was found to be a useful and reliable tool for predicting clinical reactivity in children with hazelnut allergy in the Eastern Mediterranean area.

Allergen immunotherapy for IgE-mediated food allergy: protocol for a systematic review

Background The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing the EAACI Guidelines for Allergen Immunotherapy (AIT) for IgE-mediated food allergy. We seek to critically assess the effectiveness, cost-effectiveness and safety of AIT in IgE-mediated food allergy.MethodsWe will undertake a systematic review, which will involve searching international biomedical databases for published, in progress and unpublished evidence. Studies will be independently screened against pre-defined eligibility criteria and critically appraised using established instruments. Data will be descriptively and, if possible and appropriate, quantitatively synthesised.DiscussionThe findings from this review will be used to inform the development of recommendations for EAACI’s Guidelines on AIT.

Low indoleamine 2,3-dioxygenase activity in persistent food allergy in children.

Indoleamine 2,3‐dioxygenase (IDO), which degrades tryptophan (Trp) to kynurenine (Kyn), has been demonstrated to contribute to modulation of allergic responses. However, the role of IDO in food allergy has not yet been elucidated.

Features of asthma which provide meaningful insights for understanding the disease heterogeneity

Data‐driven methods such as hierarchical clustering (HC) and principal component analysis (PCA) have been used to identify asthma subtypes, with inconsistent results.

Basal serum tryptase is not a risk factor for immediate-type drug hypersensitivity during childhood.

High serum basal tryptase (sBT) levels have been identified as a risk factor for both venom‐ and food‐induced severe allergic reactions. The aim of this study was to compare sBT levels in children with different severity of actual drug hypersensitivity reactions (DHRs) with those of age‐ and sex‐matched controls without any history of DHRs.

Factors associated with the course of egg allergy in children

BACKGROUNDnThe risk factors that affect persistence of egg allergy are under investigation.nnnOBJECTIVEnTo investigate the factors associated with the course of egg allergy and anaphylaxis in children.nnnMETHODSnChildren who had been diagnosed as having an IgE-mediated egg allergy and followed up until 6xa0years of age were enrolled. IgE-mediated egg allergy was diagnosed by a positive skin prick test result, specific IgE (sIgE) level of 0.35 kU/L or greater, and clear-cut history of egg-related symptoms or positive challenge test results.nnnRESULTSnA total of 203 (56%) of 363 egg allergic children were followed up until 6 years of age. Egg allergy resolved in 92 children (45%) at 2 years of age, 134 children (66%) at 4 years of age, and 145 children (71%) at 6 years of age. The resolution of egg allergy was associated with baseline egg sIgE level of 6.2 kU/L or less and the absence of anaphylaxis (hazard ratio, 0.32; 95% CI, 0.21-0.49; P < .001; and hazard ratio, 0.38; 95% CI, 0.21-0.69; Pxa0= .001, respectively). Baseline factors, including cut-off level of egg sIgE level greater than 6.2 kU/L, egg sIgE level, gastrointestinal symptoms after egg exposure, anaphylaxis with egg, and concomitant cows milk allergy, were significantly associated with later resolution of egg allergy. The multivariate logistic regression determined that the natural logarithm for egg-white sIgE (odds ratio, 1.44; 95% CI, 1.09-1.91; Pxa0=xa0.01) and the baseline gastrointestinal symptoms with egg (odds ratio, 6.86; 95% CI, 2.93-16.06; P < .001) were significantly related to a higher risk of anaphylaxis with egg.nnnCONCLUSIONnBaseline egg white sIgE levels, baseline gastrointestinal system involvement, concomitant cows milk allergy, and anaphylaxis with egg may predict a more severe course of egg allergy with late resolution. Moreover, egg white sIgE levels and gastrointestinal symptoms after egg exposure seem to increase the risk of anaphylaxis with egg.

Characteristics of children with food protein-induced enterocolitis and allergic proctocolitis.

BACKGROUNDnThe aim of this study was to determine and compare the clinical and laboratory features of food protein-induced enterocolitis syndrome (FPIES) and food protein-induced allergic proctocolitis (FPIAP), and to provide information about the short-term prognoses.nnnMETHODnChildren diagnosed with FPIES or FPIAP between 2010 and 2015 were enrolled in this study.nnnRESULTSnOverall, 64 infants (37 FPIAP, 27 FPIES) were evaluated, with the average age at the onset of symptoms being significantly lower in the patients with FPIAP than in the patients with FPIES (2 months [1-3 months] versus 4 months [1.5-6 months]; p = 0.043). Fifteen of the patients with FPIAP (40.5%) and six of the patients with FPIES (22.2%) were exclusively breast-fed at the time of the onset of symptoms. Cows milk was the most frequent trigger (100% FPIAP, 74% FPIES); solid foods caused FPIES more frequently. Forty-eight of the 64 patients were followed up until at least 2 years of age, with the resolution rates being 91.3% for FPIAP and 60% for FPIES. The solid food-induced cases of FPIES (27.3%) had a significantly lower rate of resolution than the liquid food-induced FPIES (83.3%) (p = 0.003).nnnCONCLUSIONnCows milk is the most common trigger of both FPIAP and FPIES. The symptom onset age seemed to be earlier in FPIAP. The resolution age was similar, however, the recovery in FPIES may be later if the trigger food is solid. To our knowledge, this was the first clinical study to compare the clinical and laboratory characteristics of patients with FPIAP and FPIES.