Merryn Netting

An Australian Consensus on Infant Feeding Guidelines to Prevent Food Allergy: Outcomes From the Australian Infant Feeding Summit

BACKGROUND Infant feeding in the first postnatal year of life has an important role in an infants risk of developing food allergy. Consumer infant feeding advice is diverse and lacks consistency. AIM The Australian Infant Feeding Summit was held with the aim of achieving national consensus on the wording of guidelines for infant feeding and allergy prevention. METHODS Two meetings were hosted by the Centre for Food and Allergy Research, the Australasian Society of Clinical Immunology and Allergy, and the Australian National Allergy Strategy. The first meeting of 30 allergy researchers, clinicians, and consumers assessed the evidence. The second consensus meeting involved 46 expert stakeholders including state and federal health care agencies, consumers, and experts in allergy, infant feeding, and population health. RESULTS Partner stakeholders agreed on consensus wording for infant feeding advice: CONCLUSIONS: Consensus was achieved in a context in which there is a high prevalence of food allergy. Guidelines for other countries are being updated. Provision of consistent wording related to infant feeding to reduce food allergy risk will ensure clear consumer advice.

Heated Allergens and Induction of Tolerance in Food Allergic Children

Food allergies are one of the first manifestations of allergic disease and have been shown to significantly impact on general health perception, parental emotional distress and family activities. It is estimated that in the Western world, almost one in ten children have an IgE-mediated allergy. Cow’s milk and egg allergy are common childhood allergies. Until recently, children with food allergy were advised to avoid all dietary exposure to the allergen to which they were sensitive, in the thought that consumption would exacerbate their allergy. However, recent publications indicate that up to 70% of children with egg allergy can tolerate egg baked in a cake or muffin without apparent reaction. Likewise, up to 75% of children can tolerate baked goods containing cow’s milk, and these children demonstrate IgE and IgG4 profiles indicative of tolerance development. This article will review the current literature regarding the use of heated food allergens as immunotherapy for children with cow’s milk and egg allergy.

Allergenicity of pasteurized whole raw Hen's egg compared with fresh whole raw Hen's egg

Oral food challenges for diagnosis and management of egg allergy using fresh egg are common; however, to limit the risk of foodborne infection, many allergy units use pasteurized raw egg. Pasteurization and drying processes have the potential to affect the structure of egg proteins in egg powder and thus the allergenicity when compared to fresh egg. Our aim was to compare the binding of serum IgE from egg‐allergic children to in vitro digested and undigested pasteurized whole raw egg powder with unpasteurized fresh whole raw egg.

Consensus of stakeholders on precautionary allergen labelling: A report from the Centre for Food and Allergy Research

Consensus of stakeholders on precautionary allergen labelling: A report from the Centre for Food and Allergy Research Giovanni A Zurzolo, Jennifer J Koplin, Anne-Louise Ponsonby, Vicki McWilliam, Shyamali Dharmage, Ralf G Heine, Mimi LK Tang, Susan Prescott, Dianne E Campbell, Richard Loh, Kristina Rueter, Merryn Netting, Katie Frith, Wendy Norton, Maria Said, Michael Gold, N Alicec Lee, Michael Mathai, Maximilian deCourten and Katrina J Allen Murdoch Children’s Research Institute, Centre for Food and Allergy Research, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, Department of Paediatrics and Melbourne School of Population and Global Health, University of Melbourne, Department of Allergy and Immunology, Royal Children’s Hospital, Melbourne, Victoria School of Paediatrics and Child Health, University of Western Australia, Princess Margaret Hospital for Children, Perth, Western Australia, The Children’s Hospital at Westmead, Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, Allergy and Anaphylaxis, ARC Training Centre for Advanced Technologies in FoodManufacture, The University of New SouthWales, Sydney, New SouthWales, Women’s and Children’s Health Research Institute and Discipline of Paediatrics, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia

Does providing written dietary advice improve the ingestion of non‐allergic nuts in children with existing nut allergies? – A randomized controlled trial

Allergy to one or more nuts is common in children and often complete nut avoidance is advised. More recently, introduction of non‐allergic nuts into the diet is advised by some allergists.

A patient-specific approach to develop an exclusion diet to manage food allergy in infants and children

Food allergy is becoming increasingly common in infants and young children. This article set out to explain the different factors that should be taken into account during an individualized allergy consultation: Foods to avoid and degree of avoidance, suitable alternatives, self‐management skills, co‐ and cross‐reactive allergens and novel allergens alongside the role of the industry in allergen avoidance, importance of nutritional aspects of the diet and the future directions that nutritional guidance make take. Allergy management advice should be individualized to provide a patient‐specific approach. Changes in the management of food allergies have in particular occurred in nut, milk and egg allergies over the past few years. There has also been a progressive increase in our understanding of cross‐reactivity between different foods and also food and aero‐allergens. A patient‐specific approach of allergen avoidance should consider factors relating to industry and the environment such as food and nutrition literacy, threshold levels, cross‐contact/contamination and safe eating away from home. Increasing migration and travel has also led to exposure of unfamiliar foods. As understanding improves on individual allergens and threshold levels, food labels and food labelling laws are affected. Allergy specialist dietitians should also keep up to date with the latest information on nutrition, the gut microbiome and the immune system to incorporate nutrition strategies in a dietetic consultation using an evidence‐based approach.

Advice about infant feeding for allergy prevention: A confusing picture for Australian consumers?

Early feeding plays an important role in programming the immune system, particularly the risk of food allergy. There are many infant feeding guides published for consumers available in Australia, with most based on the National Health and Medical Research Council (NHMRC) 2012 Infant Feeding Guidelines for Health Workers and the Australasian Society of Clinical Immunology and Allergy (ASCIA) Infant Feeding Advice for allergy prevention. We sought to compare allergy‐specific content of infant feeding educational material written for parents with these two documents.

Complementary Foods: Guidelines and Practices

Complementary feeding, the transition from a breast milk-based diet to inclusion of other sources of nutrition in an infants diet, is a major milestone in infant development. This transition period is important as it is a time when infants are vulnerable to developing nutritional deficiencies and occurs during a developmental stage when important food-related behavioral patterns are being established. As under- and overnutrition may coexist in children from the same country, it is important that advice provided by complementary feeding guidelines meets the needs of all children helping them to grow and develop into healthy adults. Many consistent and important themes emerge when comparing complementary feeding guidelines from different countries: complementary foods at or around 6 months of age; continued breastfeeding; nutrient-dense complementary foods; hygienic food practices; development of feeding skills that foster long-term healthy eating habits, and prevention of non-communicable diseases such as obesity. Complementary feeding guidelines that promote good eating during the first year and beyond recognize that nutrition, particularly during the first 1,000 days, has an important influence on immediate growth and development, but also an important role in setting up taste preferences and behavioral patterns which inform an infants susceptibility to development of disease later in life. However, guidelines in many countries are not always followed, particularly during the second year of life, and innovative methods are needed to increase compliance.

ASCIA-P18: ASCIA PRACTICAL INFORMATION ON HOW TO INTRODUCE SOLID FOODS TO INFANTS

Learning to eat  Learning to eat takes time, so be patient with your infant.  Offer your infant foods that are the right texture for their developmental stage.  Infants should move from smooth foods at around 6 months but not before 4 months to cut up foods at around 12 months.  Finger foods should be introduced around 8-9 months of age.  Aim for your child to be eating healthy family meals by 12 months of age where possible.  Infants with food allergies may take longer to get used to eating new foods and new textures of foods.  If your infant does not seem interested in eating or trying new foods, wait a few days and try again.  If your infant is having lots of feeding problems discuss this with your child health nurse, doctor or dietitian.

Allergenicity of pasteurised whole raw egg powder compared with fresh whole raw egg

Background: Antibodies of the IgE isotype and their recognition of allergens at the initiation of allergic response are crucial components of allergic reactions, with influence on the severity of the disease. Despite this, detailed information on the molecular nature of IgE-allergen interactions is still lacking for most important allergens. Method: IgE-derived antibody fragments specific for the major birch pollen allergen Bet v 1 were isolated from combinatorial libraries derived from the IgE-repertoires of nasal tissue of allergic donors. Their interactions with Bet v 1 were characterised using immunological assays. The structure of one of the IgE in single chain fragment variable (scFv) format was solved using X-ray crystallography. Results: We isolated four novel Bet v 1-specific IgE-derived antibody fragments with genetic origin in the IGHV5 germline gene, suggested to be overrepresented in some IgE repertoires. We show that that such antibodies, despite their limited diversity, are able to fulfill the basic criteria for FceRI cross-linkage by targeting two nonoverlapping epitopes. These previously undescribed IgE-reactive epitopes were further defined and a molecular basis for differential recognition of Bet v 1 isoforms and homologous allergens of the PR-10 family was identified by pinpointing important single amino acid residues within one of the epitopes. Further, we present the first highresolution structure of a human allergenspecific IgE in the scFv format, a structure that demonstrates that a human allergenspecific antigen binding site may display a protruding CDRH3. Conclusion: We here demonstrate the potential of local IgE repertoires with limited diversity in their genetic origin to fulfill the basic criteria for initiation of allergic responses. Further, the non-planar epitope targeted by MO418 and its protruding CDRH3 contrasts previous findings, suggesting IgE to favour planar epitopes, calling for further investigations of the nature of such epitopes.In recent times, allergy has become a financial, physical and psychological burden to the society as a whole. Allergic reactions can result in life-threatening situations causing morbidity and high economic cost. Therefore, more effective reagents are needed for allergy treatment. Omega-6 fatty acids have gained attention in allergic studies mainly due to their inflammatory properties. Literature suggests that a causal relationship exists between the intake of omega-6 fatty acids such as DPA and AA and atopic individuals suffering from allergies. In an allergic cascade, cytokines IL-4 and IL-13 bind to IL-4 receptor (IL-4R), which activates the STAT6 phosphorylation pathway leading to gene activation of allergen-specific IgE production by B cells. Consequently, IgE production leads to clinical symptoms of allergy. The overall aim of this study is to characterise DPA and AA and their effects on IgE production.Food allergy has continued to rise over the past few decades. Theincreasing occurrence of sensitivity to certain foods remains to be identified, and the allergen-epithelial interaction in particular remains elusive. Peanuts in particular are still one of the highest contributors of anaphylaxis after ingestion of a food allergen. Previous findings by our research group observed that peanut allergens were able to cross the Caco-2 cell culture model of the intestinal epithelium. Specifically, the major peanut allergens Ara h 1, Ara h 2 and Ara h 3, as well as Ara h 6. The direction of this research has deepened into identifying the mechanism by which the Caco-2 monolayers uptake peanut allergens, specifically by endocytosis. Here, we aim to further our understanding about the pathway from allergen to allergy.