1,721,235 research outputs found
Which advises for primary food allergy prevention in normal or high-risk infant?
No full textIn the last decades, international guidelines proposed different strategies of complementary foods introduction during weaning to prevent allergy. Avoidance measures, such as late introduction of allergenic foods, failed to show a significant preventive effect towards allergy. Recently, prospective randomized controlled studies suggested that the early introduction of solid foods - rather than the late introduction - could be a strategy to prevent allergic sensitization and food allergy. However, at today clear evidence of effectiveness and safety of early introduction are not yet available to recommend a radical change in the current clinical practice. A realistic advice for the general population could be to begin the weaning at 4-5 months with the progressive introduction of different foods. The advices for introduction of solid foods during weaning should also take in consideration the global development of child to chose the better timing of introduction of foods
Cow’s Milk Allergy: Management and Prevention.
Full text linkCow’s milk allergy (CMA) is one of the most frequent food allergies in childhood
with an estimated prevalence of 2% in infants. As observed in the natural course of
this disease, CMA has a good prognosis and more than half of the children reach
the tolerance before school age. Otherwise, many different factors can modulate the
natural history of CMA. Clinical and laboratory data suggest that many endotypes
and phenotypes can be individuated with different evolutions towards tolerance. For
these reasons physicians need to identify these different patterns to better choose the
therapeutic pathway for each patient. Another aspect is represented by the developing
strategies of primary prevention of CMA, such as dietary interventions both in
the mother (during pregnancy and/ or lactation), and, in absence of breast milk, also
in high risk infants, through the use of extensive or partial hydrolyzed milk formula.
Nevertheless many studies have been carried out, up today the available data are still
conflicting and more robust results should be reported. The aim of this review articleis
to give practical advices in the diagnosis, management and prevention of CMA
in childhood, according to the most recent guidelines and consensus documents
Evaluation of IgE Sensitization Profiles in a Pediatric Population with Wheat Allergy.
Full text linkIntroduction: IgE-mediated reactions to wheat can occur after ingestion, inhalation, contact or exercise. Among wheat allergens, Tri a14 and Tri a19 not only cause food allergy, but also baker's asthma (Tri a4) and exercise-induced anaphylaxis (Tri a19). Despite the prevalence of adverse reactions, few studies have been conducted in children.
Aim: To evaluate the pattern of sensitization to wheat allergenic components in a group of pediatric patients with sIgE to wheat referring to the Pediatric Allergy Unit of University of Bologna.
Materials and Methods: Patients were assessed by skin prick-test and serum specific IgE against pollens, wheat, gluten and the molecular allergens rTri a19 and rTri a14. The diagnosis was confirmed with open food challenges.
Results: The diagnosis of wheat allergy was confirmed in 7 patients (64%), of whom 2 (29%) suffered also from grass pollen allergy. The levels of specific IgE (geometric mean) to wheat and gluten were 5 times higher in allergic patients compared to tolerant ones. The comparison between the patterns of sensitization showed a higher prevalence of sensitization against gluten (100% vs. 75% in tolerant patients) and the molecular components rTri a14 (71% vs. 25%) and rTri a19 (71% vs. 0%) in the wheat-allergic group. Positive predictive value for rTria a19 was higher than rTri a14 (100% vs. 83%).
Conclusion: Patients with wheat allergy have different profiles of sensitization than the tolerant ones; in particular rTri a19 showed a higher positive predictive value than rTri a14. These findings need to be confirmed in a larger population
Recent advances in epidemiology and prevention of atopic eczema
No full textAtopic dermatitis (AD), named also atopic eczema, is a chronic relapsing inflammatory skin disease with a considerable social and economic burden. The primum movens of AD is in most cases a genetic and/or immune-supported defect of the skin barrier, facilitating penetration and sensitization to food or airborne allergens, as well as infections by Staphylococcus aureus, herpes simplex virus, or other microbes. New pathogenetic concepts have generated new approaches to prevention and therapy of AD. In particular, the daily use of emollients in newborns at high risk of AD has shown interesting results, with a reduction in the cumulative incidence of AD ranging from 32% to 50% of the treated infants. On the other hand, the AD preventive efficacy of food and/or inhalant allergen avoidance has been questioned, and supplementation strategies (vitamin D, probiotics, or other compounds) need to be further investigated
Immune Alterations in IgE and Non IgE-Associated Atopic Dermatitis.
Full text linkAtopic dermatitis is a complex disease in which a strong interaction between alterations of skin barrier and the adaptive immune system coexist. In the recent years, new findings have underlined the importance of skin proteins, especially filaggrin, which participate to the outmost layers of the skin. To strengthen this physical barrier, many factors are available, such as antimicrobial peptides, chemokines and cytokines produced by keratinocytes. Skin disruption can easily allow the allergen penetration and the local keratinocytes can promote the adaptive immune response toward a Th2 phenotype. On the other side, allergic Th2 cytokines may downregulate the production of skin barrier proteins, facilitating the penetration of allergens. Moreover, data on murine models show the absolute relevance of the systemic immune system to develop clinical skin reaction. Since the clinical aspect of patients with AD does not show different patterns whatever is the prevalent underlying mechanism, in clinical practice it is difficult to translate the different endotypes beside the IgE and non IgE associated forms. The aim of this review is to point out to the most recent knowledge in this field, which makes AD more difficult to frame in a unique clinical entity
Allergen-specific immunotherapy for inhalants allergens in children
No full textAllergen-specific immunotherapy (AIT) for aeroallergens consists of the administration of standardized allergen extracts to patients with respiratory IgE-mediated diseases to the same allergen in order to achieve immune tolerance to the allergen and prevent onset of symptoms. AIT is usually delivered by sublingual, subcutaneous route. Both sublingual immunotherapy (SLIT) and subcutaneous immunotherapy (SCIT) are given at increasing doses in the build-up phase and then at maintenance dose. The allergen dose is regularly administered throughout the year or pre/co-seasonally, depending on the causal allergen and the type of allergen extract. AIT with one or multiple allergens currently represents the only causal treatment able to change the natural history of allergic airways diseases (1). Significant progresses have been made in terms of AIT efficacy and safety since the first report of the treatment of hay-fever by SCIT using pollen extracts, described by Noon and Freeman in 1911 (2; 3). The first randomized study on SLIT dates back to 1986 (4). Several placebo-controlled studies on AIT in the subsequent years have allowed systematic reviews suggesting evidence for improvement of symptoms and reduction of medication use for both allergic rhinitis (AR) and asthma (5). However, AIT remains underused since interpretation of evidence remains challenging for heterogeneity among studied populations, selection of potential responders, outcomes, regimens and products for AIT. Moreover, the use of AIT is hampered by fluctuating availability of AIT products, different educational level of physicians and lack of consciousness of AIT in the general population (6)
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