Christine Szychlinski

Naturally occurring tolerance acquisition to foods in previously allergic children is characterized by antigen specificity and associated with increased subsets of regulatory T cells.

Food allergy affects approximately 6–8% of children, and increasing in prevalence. Some children naturally outgrow their food allergy without intervention, but the mechanisms by which this occurs remain poorly understood. We sought to investigate the role of regulatory T cells in the development of naturally acquired tolerance.

Self-Perception and Family Functioning in Healthy School-Age Siblings of Children with Asthma and Diabetes, and Healthy Children

This study examined self-perception and family functioning in healthy school-age siblings of children with asthma and diabetes. The 135 siblings completed the Family APGAR for Children and the Self-Perception Profile for Children. Results indicated that siblings of children with diabetes were at risk for self-perception problems in the areas of scholastic competence and global self-worth. Male sibling pairs in the diabetes group had lower self-perception scores than male pairs in the asthma group; whereas, female sibling pairs in the diabetes group had lower family functioning scores than female pairs in the asthma or healthy groups. For the siblings in the diabetes group, physical appearance, athletic competence, behavioral conduct, scholastic competence, and global self-worth were significantly associated with family functioning. Results support inclusion of self-perception and family functioning as important indicators of healthy sibling adjustment.

Cytokine responses to egg protein in previously allergic children who developed tolerance naturally

Egg allergy is the second most common food allergy in childhood, characteristics are listed in eTable 1, available online). Patients with with 1% to 2% of Americans affected.1,2 Although approximately 70% of children outgrow this allergy,3 few studies have explored the mechanism by which children naturally outgrow the allergy (natural tolerance [NT]). Most studies have compared children with allergy with those who were never allergic, have not evaluated allergen-specific responses, or have only focused on treatment inducing desensitization (oral immunotherapy). Although not previously demonstrated in food allergy, tolerance to venom has been associated with elevation of interleukin (IL)-10.4 Our hypothesis was that peripheral blood mononuclear cells (PBMCs) stimulated with ovalbumin (OVA) in NT has increased allergenspecific IL-10 production. The objective was to determine the PBMC cytokine response to egg protein in previously allergic patients who developed NT and thus differentiate them from children with allergy. Food allergy was defined by an allergist-immunologist as a history of IgE-mediated reaction to egg (anaphylaxis, urticaria, or significant vomiting) within 2 hours of food ingestion and positive laboratory testing (skin prick mean wheal diameter 4 mm larger than saline wheal and/or specific IgE [sIgE] level 2 kU/L). Nonallergic (control) was defined as no history of clinical reactivity to egg. NT was defined as a clinical and laboratory history of egg allergy but passing an open food challenge to 1 scrambled egg within 6 months of recruitment. The PBMCs were stimulated with or without OVA or with anti-CD3 and anti-CD28. After 48 hours, the supernatant was collected and cytokines were analyzed using multiplex assays (eMethods). Patient characteristics, fold stimulation, and sIgE/sIgG4 ratio were compared using the Mann-Whitney or Kruskal-Wallis test. Cytokine data were logarithmically transformed, dose-dependent responses were analyzed with repeated-measures analysis of variance (ANOVA), and comparisons at specific doses were performed with ANOVA or t test. Data analysis was performed using SAS 9.3 (SAS Institute, Cary, North Carolina) and SPSS 14 (SPSS, Inc, Chicago, Illinois), with a 2-sided type I error rate of 5%. Forty children (11 with NT, 20 with allergy, and 9 without allergy; median age 6 years, range 2e18 years) were recruited from a cross-sectional, caseecontrol convenience sample (patient