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ABSTRACT Introduction Methods Results Discussion Patients with food allergies need personalized information on their risk of reaction in “real‐life” situations. This multicentric study aimed to investigate the link during accidental reactions between the nature and amount of food allergens consumed in “real‐life situation” and the severity of the symptoms.Patients were prospectively recruited from December 1, 2020, to December 31, 2021, at the emergency departments in the Geneva University Hospitals and local pediatric emergency facilities, through an allergy outpatient clinic, at school and daycare facilities and trough their primary care physicians. Medical history of patients presenting reactions suggestive with immediate food allergy and suspected food samples were collected. Allergy diagnostic tests were retrospectively and prospectively collected. The samples were analyzed for their allergen content.We recruited 147 subjects with an accidental immediate‐type allergic reaction to a food. We were able to collect 115 reaction‐eliciting food samples allowing to quantify the allergen amount causing the reaction, as well as correlating this amount to the severity of the reaction. Children represented a large part of the reactors, and most reactions were to common food allergens such as tree nuts, cow's milk as well as peanuts and hen's egg. Reactions were mostly to prepackaged foods and seven reactions were to products with precautionary allergy labeling, or without labelling to the eliciting allergen. Reactions were of various degrees of severity, and independent to the amount of allergen ingested.The severity of reactions did not show a direct correlation with allergen quantity, emphasizing individual sensitivity. Some reactions occurred with allergen amounts significantly below the legal limit for mandatory labelling of 1 g/kg (1000 ppm) in Switzerland. The study also highlighted considerable variability in allergen concentrations in foods labeled with possible “contaminations” or “traces”. These findings raise questions about the accuracy of allergen labeling and regulations in Switzerland. [ABSTRACT FROM AUTHOR]

The article discusses a study on the effectiveness of gestational supplementation with 2'-Fucosyllactose (2'-FL) in preventing food allergies in offspring. The study found that maternal diet during pregnancy and breastfeeding can impact the immune system, gut microbiota, and epithelial barriers, leading to allergies. The research showed that gestational supplementation with 2'-FL protected offspring from food allergies by creating a specific microbial and immune imprint. This study highlights the potential benefits of maternal nutrition and supplementation in preventing allergies in children, suggesting further research in high-risk populations. [Extracted from the article]

The article discusses alpha-Gal syndrome, a unique red meat allergy caused by specific IgE antibodies to alpha-Gal. It is mainly associated with delayed anaphylaxis and is not correlated with tick-borne infections. Diagnosis involves history, sensitization, and oral challenge tests, with management focusing on avoidance and potential oral immunotherapy. The authors recommend further studies to evaluate the effectiveness and risks of oral immunotherapy for alpha-Gal syndrome. [Extracted from the article]

This European Academy of Allergy and Clinical Immunology (EAACI) guideline provides recommendations for the management of IgE‐mediated food allergy and was developed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Following the confirmation of IgE‐mediated food allergy diagnosis, allergen avoidance and dietary advice (with support of a specialised dietitian, if possible) together with the provision of a written treatment plan, education on the recognition of allergic symptoms and prescription of medication including adrenaline using an auto‐injector are essential. Patients with significant anxiety and requirement for coping strategies may benefit from support from a clinical psychologist. As immunomodulatory interventions, omalizumab is suggested for treatment of IgE‐mediated food allergy in children from the age of 1 and adults; and oral allergen‐specific immunotherapy is recommended for children and adolescents with peanut allergy and suggested for milk and egg allergies (generally after 4 years of age for milk and egg). Sublingual and epicutaneous immunotherapy are suggested for peanut allergy but are not yet available at the point of care. Future research into disease modifying treatments for IgE‐mediated food allergy are highly needed, with standardised and patient‐focused protocols and outcomes. [ABSTRACT FROM AUTHOR]

The article discusses the benefits of a baked milk diet for children with cow's milk allergy (CMA). The study found that introducing baked milk products into the regular diet of milk-allergic children improved their quality of life and growth parameters. The research showed that both fast and slow escalation regimes of baked milk consumption significantly improved quality of life. The study also highlighted the association between CMA and decreased growth, emphasizing the importance of proactive management through regular ingestion of tolerated milk products. [Extracted from the article]

This article explores the use of biologic therapies such as dupilumab, mepolizumab, and benralizumab in treating severe asthma, emphasizing their efficacy and safety in improving symptoms and disease control. The studies underscore the benefits of personalized treatment approaches and combining different biologic therapies for optimal outcomes. Additionally, the article discusses the immunogenic properties of Bet v 1 conjugated with the TLR7-agonist TL7-887, suggesting a potential for enhanced allergy vaccines. The study on hereditary angioedema in Belarus sheds light on the challenges faced by patients in accessing effective treatments, while a case report highlights the efficacy of targeted therapy in managing mastocytosis. Lastly, the article emphasizes the importance of recognizing emerging allergens like fenugreek and managing drug-induced skin reactions like acute generalized exanthematous pustulosis. [Extracted from the article]

The study explored the impact of purified free mannan and Toll-like receptor ligands on dendritic cells in response to peanut allergens, suggesting that mannan may promote tolerogenic responses. Butyrate treatment was found to induce Sin a 1 nuclear translocation, potentially influencing food allergy development, while also showing a protective effect against allergic responses. The ITACA Registry provided real-life data on hereditary angioedema patients, and the ENABLE study demonstrated the effectiveness of lanadelumab in reducing HAE attacks. BMK treatment improved symptoms in allergic rhinitis patients with multiple pollen sensitivities, highlighting its potential as a therapeutic option. The study on indoor allergen exposure emphasized the need for monitoring and management strategies to reduce allergic reactions in various settings. Dupilumab was effective in treating eosinophilic esophagitis in children, reducing eosinophil counts and improving symptoms. The SQ HDM SLIT-tablet was found to be effective and well-tolerated in children with house dust mite allergic rhinitis/rhinoconjunctivitis. Patients with moderate-to-severe asthma treated with dupilumab were more likely to achieve clinical remission criteria, indicating significant patient benefit. Dymista showed rapid symptom reduction in allergic rhinitis patients, providing clinically meaningful relief. [Extracted from the article]

This article provides a comprehensive overview of an algorithm for diagnosing betalactam (BL) allergy. The diagnostic process involves a clinical history, skin tests, in vitro tests, lymphocyte transformation tests, and drug provocation tests. The sensitivity and specificity of these tests vary, with skin tests and in vitro tests showing lower sensitivity but higher specificity. The article also discusses risk stratification, the development of assessment tools, and the use of alternative drugs for allergic patients. It includes a list of various antibiotics categorized by generation, along with recommendations for administration and testing based on structural similarities. The document is authored by a group of researchers and clinicians from Spain and provides references for further exploration. [Extracted from the article]

The European Academy of Allergy and Clinical Immunology (EAACI) has released updated clinical guidelines for the diagnosis and management of IgE-mediated food allergy. The guidelines provide evidence-based recommendations for clinicians treating patients with suspected food allergies. The guidelines emphasize the importance of a detailed clinical history, including dietary history, in reaching an accurate diagnosis. They also outline various diagnostic tests, such as skin prick tests and specific IgE tests, and recommend oral food challenges when necessary. The guidelines also address management strategies, including dietary advice, treatment plans for allergic reactions, and the potential use of immunomodulatory treatments. [Extracted from the article]

This document is a research paper discussing the diagnosis of hypersensitivity to amoxicillin, a type of beta-lactam antibiotic. The authors conducted a study using a test called hMC-pMAT to evaluate its effectiveness in diagnosing amoxicillin hypersensitivity. The results showed that hMC-pMAT was comparable to other diagnostic tests, such as the basophil activation test (BAT), in clear cases of hypersensitivity. However, in more difficult cases and in patients with non-responsive basophils, hMC-pMAT did not provide additional value. The authors suggest that further research is needed to validate and generalize these findings, especially for patients with non-responsive basophils. [Extracted from the article]

This article explores the differences in mast cell activation between anaphylaxis and desensitization in human peanut allergy. The study used human mast cells and sera from peanut-allergic individuals to investigate the functional differences in mast cell activation after anaphylaxis and desensitization. The findings suggest that desensitization reduces the overall activation and release of interleukin 8 (IL-8) compared to anaphylaxis. The study also found that refractoriness, or temporary antigen-specific resistance, occurs independently of the initial activation modality. Further research is needed to understand the immune response to allergen-specific immunotherapy in vivo. [Extracted from the article]

Food allergy (FA) is a potentially life‐threatening chronic condition that is becoming an increasing public health problem worldwide. This systematic review (SR) was carried out to inform the development of clinical recommendations on the treatment of IgE‐mediated FA with biologics and/or IT for the update of the EAACI guidelines. A SR of randomized‐controlled trials or quasi‐controlled trials was carried out. Studies were identified via comprehensive search strategies in Medline, Embase, and Cochrane Library, up to April 2022. Population: Human adults, children, and adolescents with IgE‐mediated FA. Intervention: IT and/or biologics. Comparator: Placebo or standard‐of‐care (allergen avoidance). Outcome: Efficacy (desensitization, sustained unresponsiveness (SU), remission), quality of life, and safety (systemic and local adverse reactions (AR)). The Cochrane RoB tool was used to assess the risk of bias. It was reported according to PRISMA and registered in PROSPERO CRD4202229828. After screening, 121 studies were included (111 for IT and 10 for biologics). Most studies had a high risk of bias and showed high heterogeneity in design and results. Metanalysis showed a positive effect of biologics and IT in terms of relative risk (RR) for achieving tolerance to the culprit food compared to avoidance or placebo. Omalizumab for any FA showed a RR of 2.17 [95% confidence interval: 1.22, 3.85]. For peanut allergy, oral IT (OIT) had a RR of 11.94 [1.76, 80.84] versus avoidance or placebo, sublingual IT (SLIT) had a RR of 3.00 [1.04, 8.66], and epicutaneous IT (EPIT) of 2.16 [1.56, 3.00]. OIT had a RR of 5.88 [2.27, 15.18] for cow's milk allergy, and of 3.43 [2.24, 5.27] for egg allergy. There was insufficient data on SLIT or EPIT for the treatment of egg and milk allergies. Most ARs reported were mild. For OIT the most common AR involved the gastrointestinal system and for EPIT, AR's most commonly affected the skin. There was limited data on severe or life‐threatening ARs. There was limited evidence for long term efficacy and quality of life. In conclusion, biologics and IT, alone or in combination, are effective in achieving desensitization while on active treatment but more evidence is needed on long‐term tolerance as current evidence is not of high quality. Adverse events while on therapy are generally mild to moderate but a long‐term comprehensive safety profile is missing. There is a critical need to optimize and standardize desensitization protocols and outcome measures to facilitate our understanding of the efficacy and safety as well as to allow for comparison between interventions. [ABSTRACT FROM AUTHOR]

The article discusses the evaluation of oral immunotherapy in hazelnut allergy among pediatric patients in Toulouse, France. The study aimed to desensitize patients through a hazelnut OIT protocol, with 52.2% of patients considered desensitized after a year. Adverse events during home OIT were mostly mild, but there was a high discontinuation rate. Lower IgE levels were associated with a higher likelihood of desensitization, and predictive thresholds for desensitization were established. Further studies with larger sample sizes are recommended to confirm these results. [Extracted from the article]

The article discusses the link between mammalian meat allergy and tick bites, known as alpha-gal syndrome (AGS), which has been reported globally. The research highlights the allergenic potency of mammalian meat sources and the clinical spectrum of reactions, emphasizing the importance of understanding co-factors that modulate reactions. The study also quantifies the allergenic potency of different mammalian meat sources, noting that innards and game lean meat pose the greatest risk, while cow's milk products have the lowest risk. This information aims to guide healthcare providers and patients in managing mammalian meat allergy after tick bites effectively. [Extracted from the article]

Background Methods Results Conclusions The α‐Gal syndrome (AGS) is an emerging allergy to mammalian food caused by IgE‐mediated reactions to the carbohydrate galactose‐α‐1,3‐galactose (α‐Gal). Mammalian food sources contain α‐Gal, but the amount differs. The objective of this study was to investigate the allergenic potency of various foods of mammalian origin among AGS patients.Twenty‐six AGS patients were included. Food extracts from innards, lean meats, processed meat products, milk, and whey were analyzed. Immunoblot, ELISA, immunofluorescence, and basophil activation test were used to determine the α‐Gal content, characterize IgE binding, and assess foods' allergenicity.The determined amount of α‐Gal, IgE reactivity to food extracts, and food extract potencies to activate patients' basophils correlated well with each other. Pork and beef kidney showed the highest allergenicity. Beef liver and bacon showed allergenicity comparable to that of lean meats. Game meat seemed to have a higher allergenic potency than meats from farm‐raised animals. The processed meat products liver pâté and black pudding, despite lower α‐Gal content, demonstrated moderate allergenicity. Milk showed the lowest allergenicity. IgE reactivity to food extracts was highly similar for all patients and strongly dominated by the α‐Gal epitope.The allergenic potency of mammalian meat depends on the origin of the meat, the different cuts, and type of processing, with innards posing the greatest risk to AGS patients. Even processed mammalian meat constitutes a risk. Dairy products show the lowest risk. This study highlights the importance of analyzing even more foods to improve the management of AGS. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Antigen‐specific memory B cells play a key role in the induction of desensitization and remission to food allergens in oral immunotherapy and in the development of natural tolerance (NT). Here, we characterized milk allergen Bos d 9‐specific B cells in oral allergen‐specific immunotherapy (OIT) and in children spontaneously outgrowing cow's milk allergy (CMA) due to NT.Samples from children with CMA who received oral OIT (before, during, and after), children who naturally outgrew CMA (NT), and healthy individuals were received from Stanford biobank. Bos d 9‐specific B cells were isolated by flow cytometry and RNA‐sequencing was performed. Protein profile of Bos d 9‐specific B cells was analyzed by proximity extension assay.Increased frequencies of circulating milk allergen Bos d 9‐specific B cells were observed after OIT and NT. Milk‐desensitized subjects showed the partial acquisition of phenotypic features of remission, suggesting that desensitization is an earlier stage of remission. Within these most significantly expressed genes, IL10RA and TGFB3 were highly expressed in desensitized OIT patients. In both the remission and desensitized groups, B cell activation‐, Breg cells‐, BCR‐signaling‐, and differentiation‐related genes were upregulated. In NT, pathways associated with innate immunity characteristics, development of marginal zone B cells, and a more established suppressor function of B cells prevail that may play a role in long‐term tolerance. The analyses of immunoglobulin heavy chain genes in specific B cells demonstrated that IgG2 in desensitization, IgG1, IgA1, IgA2, IgG4, and IgD in remission, and IgD in NT were predominating. Secreted proteins from allergen‐specific B cells revealed higher levels of regulatory cytokines, IL‐10, and TGF‐β after OIT and NT.Allergen‐specific B cells are essential elements in regulating food allergy towards remission in OIT‐received and naturally resolved individuals. [ABSTRACT FROM AUTHOR]

This systematic review and meta‐analysis aimed to consolidate evidence on dietary interventions for atopic eczema/dermatitis (AD) skin symptoms in children without food allergies, following PRISMA 2020 guidelines. Systematic review updates were conducted in May 2022 and June 2023, focusing on randomized placebo‐controlled trials (RCTs) involving children with AD but without food allergies. Specific diets or supplements, such as vitamins, minerals, probiotics, prebiotics, symbiotics, or postbiotics, were explored in these trials. Exclusions comprised descriptive studies, systematic reviews, meta‐analyses, letters, case reports, studies involving elimination diets, and those reporting on food allergens in children and adolescents. Additionally, studies assessing exacerbation of AD due to food allergy/sensitization and those evaluating elimination diets' effects on AD were excluded. Nutritional supplementation studies were eligible regardless of sensitization profile. Evaluation of their impact on AD clinical expression was performed using SCORAD scores, and a meta‐analysis of SCORAD outcomes was conducted using random‐effect models (CRD42022328702). The review encompassed 27 RCTs examining prebiotics, Vitamin D, evening primrose oil, and substituting cow's milk formula with partially hydrolyzed whey milk formula. A meta‐analysis of 20 RCTs assessing probiotics, alone or combined with prebiotics, revealed a significant reduction in SCORAD scores, suggesting a consistent trend in alleviating AD symptoms in children without food allergies. Nonetheless, evidence for other dietary interventions remains limited, underscoring the necessity for well‐designed intervention studies targeting multiple factors to understand etiological interactions and propose reliable manipulation strategies. [ABSTRACT FROM AUTHOR]

This article discusses the potential use of butyrate dietary supplementation as a treatment for plant-food allergies, specifically focusing on the allergen Pru p 3 found in peaches. The study conducted experiments on mice and found that butyrate supplementation promoted a tolerogenic environment by increasing the percentage of tolerogenic dendritic cells and regulatory T cells. These findings suggest that butyrate supplementation may be a promising alternative therapy for food allergies. However, further research is needed to determine the long-term effects and efficacy of butyrate supplementation in promoting tolerance. [Extracted from the article]

This document summarizes a study on the presence of food allergens in blood and its potential impact on adverse transfusion reactions (ATRs). The study found that the reactivity of basophil activation test (BAT) varied depending on the time between ingestion and blood collection, as well as the type of donor and food ingested. Patients with high levels of food-specific IgE were more likely to have a higher BAT response. However, the study did not verify the identification and concentration of allergens in donor blood, and future studies should further investigate the relationship between allergen content in blood products and the risk of developing ATRs. [Extracted from the article]

The article discusses the use of precautionary allergen labeling (PAL) in the food industry and the need for a regulated approach to assessing unintended allergen presence (UAP). It emphasizes the importance of accurate risk assessment and the need for further research in this area. The article also discusses the interpretation and implications of data on allergen thresholds for individuals with food allergies, cautioning that estimates for the proportion of allergic individuals who may react to very low doses of allergens should be interpreted with caution due to limited data at these levels. The text suggests alternative approaches, such as single-dose oral food challenges, to validate these estimates and highlights the potential benefits of individualized allergen management based on a patient's threshold. It addresses concerns about the applicability of oral food challenge data to real-world exposures and the impact of food processing on allergenicity. The article concludes by calling for the sharing of standardized oral food challenge datasets to inform allergen risk management. [Extracted from the article]

Background: The epidemiology and management of anaphylaxis are not well‐reported in Asia. Methods: A regional pediatric anaphylaxis registry was established by the Asia‐Pacific Research Network for Anaphylaxis (APRA), using standardized protocols for prospective data collection, to evaluate the triggers and management of anaphylaxis in the Asia‐Pacific region. Pediatric patients below 18 years presenting with anaphylaxis across four Asian countries/cities (Thailand, Singapore, Hong Kong (HK), and Qingdao) were included. Allergen triggers, symptoms, anaphylaxis severity, and management were compared. Results: Between 2019 and 2022, 721 anaphylaxis episodes in 689 patients from 16 centers were identified. The mean age at anaphylaxis presentation was 7.0 years (SD = 5.2) and 60% were male. Food was the most common trigger (62%), particularly eggs and cow's milk in children aged 3 years and below. In school‐age children, nut anaphylaxis was most common in HK and Singapore, but was rare in the other countries, and wheat was the top allergen in Bangkok. Shellfish anaphylaxis was most common in children aged 7–17. Adrenaline was administered in 60% of cases, with 9% given adrenaline before hospital arrival. Adrenaline devices were prescribed in up to 82% of cases in Thailand but none in Qingdao. Conclusions: The APRA identified food as the main trigger of anaphylaxis in children, but causative allergens differed even across Asian countries. Fewer than two‐thirds of cases received adrenaline treatment, pre‐hospital adrenaline usage was low, and adrenaline device prescription remained suboptimal. The registry recognizes an unmet need to strengthen anaphylaxis care and research in Asia‐Pacific. [ABSTRACT FROM AUTHOR]

Background: p‐Phenylenediamine (PPD) is a potent contact allergen found in many hair colour products. However, not all individuals develop allergic contact dermatitis (ACD) although they are regularly exposed to PPD. It is unclear whether these asymptomatic individuals are true non‐responders to PPD or whether they mount a response to PPD without showing any symptoms. Methods: Skin biopsies were collected from 11 asymptomatic hairdressers regularly exposed to PPD and from 10 individuals with known ACD on day 4 after patch testing with 1% PPD in petrolatum and petrolatum exclusively as control. RNA sequencing and confocal microscopy were performed. Results: T cell activation, inflammation and apoptosis pathways were up‐regulated by PPD in both asymptomatic and allergic individuals. Compared to asymptomatic individuals with a negative patch test, individuals with a strong reaction to PPD strongly up‐regulated both pro‐ and anti‐inflammatory cytokines genes. Interestingly, PPD treatment induced significant up‐regulation of several genes for chemokines, classical type 2 dendritic cell markers and regulatory T cell markers in both asymptomatic and allergic individuals. In addition, apoptosis signalling pathway was activated in both non‐responders and allergic individuals. Conclusion: This study demonstrates that there are no true non‐responders to PPD but that the immune response elicited by PPD differs between individuals and can lead to either tolerance, subclinical inflammation or allergy. [ABSTRACT FROM AUTHOR]

Background: Food allergy is common in childhood with some children having a low threshold and being difficult to protect from accidental ingestion of the offending food. Therapies for this potentially life‐threatening condition are highly needed. The aim of this study was to evaluate the efficacy of Omalizumab in food‐allergic children. Methods: This is a single‐center, double‐blind, placebo‐controlled study. Food allergic children with a cumulative threshold ≤443 mg food protein at DBPCFC were randomized to Omalizumab (asthma dose) or placebo (3:1). After 3 months, a second DBPCFC was performed (steps 3, 10, 30, 100, 300, 1000, and 3000 mg food protein), followed by a separate open challenge up to 10,000 and 30,000 mg food protein if negative. Responders were defined as ≥2‐step increases in threshold. Non‐responders received high‐dose Omalizumab. A third DBPCFC was performed after 6 months. Skin testing, blood samples, and the severity of atopic co‐morbidity were registered during the study and 3 months after treatment. Results: In total, 20 children were evaluated at 3 months (14 Omalizumab, 6 placebo). All treated with Omalizumab increased their threshold at least two steps and with a significant difference between the Omalizumab and the placebo group (p =.003), although the intended number of included children was not reached. The threshold before Omalizumab treatment was 13–443 mg food protein while the threshold after 3 months of treatment increased up to 44,000 mg (1143–44,000). In the placebo group, two children improved threshold during the study. Conclusion: An increase in the threshold level during Omalizumab treatment significantly improve patient safety and protected all children against small amount of allergen. [ABSTRACT FROM AUTHOR]

Background: IgE‐mediated cow's milk allergy (IgE‐CMA) is one of the first allergies to arise in early childhood and may result from exposure to various milk allergens, of which β‐lactoglobulin (BLG) and casein are the most important. Understanding the underlying mechanisms behind IgE‐CMA is imperative for the discovery of novel biomarkers and the design of innovative treatment and prevention strategies. Methods: We report a longitudinal in vivo murine model, in which two mice strains (BALB/c and C57Bl/6) were sensitized to BLG using either cholera toxin or an oil emulsion (n = 6 per group). After sensitization, mice were challenged orally, their clinical signs monitored, antibody (IgE and IgG1) and cytokine levels (IL‐4 and IFN‐γ) measured, and fecal samples subjected to metabolomics. The results of the murine models were further extrapolated to fecal microbiome‐metabolome data from our population of IgE‐CMA (n = 22) and healthy (n = 23) children (Trial: NCT04249973), on which polar metabolomics, lipidomics and 16S rRNA metasequencing were performed. In vitro gastrointestinal digestions and multi‐omics corroborated the microbial origin of proposed metabolic changes. Results: During mice sensitization, we observed multiple microbially derived metabolic alterations, most importantly bile acid, energy and tryptophan metabolites, that preceded allergic inflammation. We confirmed microbial dysbiosis, and its associated effect on metabolic alterations in our patient cohort, through in vitro digestions and multi‐omics, which was accompanied by metabolic signatures of low‐grade inflammation. Conclusion: Our results indicate that gut dysbiosis precedes allergic inflammation and nurtures a chronic low‐grade inflammation in children on elimination diets, opening important new opportunities for future prevention and treatment strategies. [ABSTRACT FROM AUTHOR]

Background: IgE‐mediated food allergy (FA) is a global health concern with substantial individual and societal implications. While diverse intervention strategies have been researched, inconsistencies in reported outcomes limit evaluations of FA treatments. To streamline evaluations and promote consistent reporting, the Core Outcome Measures for Food Allergy (COMFA) initiative aimed to establish a Core Outcome Set (COS) for FA clinical trials and observational studies of interventions. Methods: The project involved a review of published clinical trials, trial protocols and qualitative literature. Outcomes found as a result of review were categorized and classified, informing a two‐round online‐modified Delphi process followed by hybrid consensus meeting to finalize the COS. Results: The literature review, taxonomy mapping and iterative discussions with diverse COMFA group yielded an initial list of 39 outcomes. The iterative online and in‐person meetings reduced the list to 13 outcomes for voting in the formal Delphi process. One more outcome was added based on participant suggestions after the first Delphi round. A total of 778 participants from 52 countries participated, with 442 participating in both Delphi rounds. No outcome met a priori criteria for inclusion, and one was excluded as a result of the Delphi. Thirteen outcomes were brought to the hybrid consensus meeting as a result of Delphi and two outcomes, 'allergic symptoms' and 'quality of life' achieved consensus for inclusion as 'core' outcomes. Conclusion: In addition to the mandatory reporting of adverse events for FA clinical trials or observational studies of interventions, allergic symptoms and quality of life should be measured as core outcomes. Future work by COMFA will define how best to measure these core outcomes. [ABSTRACT FROM AUTHOR]

This article discusses the immunological effects of allergen immunotherapy (AIT) in allergic rhinitis (AR) and allergic asthma (AA) subjects. The study found that AR subjects displayed increased allergen-responsive LAP+ B-regulatory (Breg) cells during AIT, while AA subjects did not show this increase. Additionally, changes in gene expression and Ig-related transcripts were observed in AR subjects but not in AA subjects. These findings suggest that there may be differences in the immunological mechanisms and clinical efficacy of AIT between AR and AA. Further research is needed to understand the consequences of these differences on the outcome of AIT. [Extracted from the article]

Background: IgE cross‐sensitization to major birch pollen allergen Bet v 1 and pathogenesis‐related (PR10) plant food allergens is responsible for the pollen‐food allergy syndrome. Methods: We designed a recombinant protein, AB‐PreS, consisting of non‐allergenic peptides derived from the IgE‐binding sites of Bet v 1 and the cross‐reactive apple allergen, Mal d 1, fused to the PreS domain of HBV surface protein as immunological carrier. AB‐PreS was expressed in E. coli and purified by chromatography. The allergenic and inflammatory activity of AB‐PreS was tested using basophils and PBMCs from birch pollen allergic patients. The ability of antibodies induced by immunization of rabbits with AB‐PreS and birch pollen extract‐based vaccines to inhibit allergic patients IgE binding to Bet v 1 and Mal d 1 was assessed by ELISA. Results: IgE‐binding experiments and basophil activation test revealed the hypoallergenic nature of AB‐PreS. AB‐PreS induced lower T‐cell activation and inflammatory cytokine production in cultured PBMCs from allergic patients. IgG antibodies induced by five injections with AB‐PreS inhibited allergic patients' IgE binding to Bet v 1 and Mal d 1 better than did IgG induced by up to 30 injections of six licensed birch pollen allergen extract‐based vaccines. Additionally, immunization with AB‐PreS induced HBV‐specific antibodies potentially protecting from infection with HBV. Conclusion: The recombinant AB‐PreS‐based vaccine is hypoallergenic and superior over currently registered allergen extract‐based vaccines regarding the induction of blocking antibodies to Bet v 1 and Mal d 1 in animals. [ABSTRACT FROM AUTHOR]

The European Academy of Allergy and Clinical Immunology (EAACI) is updating the Guidelines on Food Allergy Diagnosis. We aimed to undertake a systematic review of the literature with meta‐analyses to assess the accuracy of diagnostic tests for IgE‐mediated food allergy. We searched three databases (Cochrane CENTRAL (Trials), MEDLINE (OVID) and Embase (OVID)) for diagnostic test accuracy studies published between 1 October 2012 and 30 June 2021 according to a previously published protocol (CRD42021259186). We independently screened abstracts, extracted data from full texts and assessed risk of bias with QUADRAS 2 tool in duplicate. Meta‐analyses were undertaken for food‐test combinations for which three or more studies were available. A total of 149 studies comprising 24,489 patients met the inclusion criteria and they were generally heterogeneous. 60.4% of studies were in children ≤12 years of age, 54.3% were undertaken in Europe, ≥95% were conducted in a specialized paediatric or allergy clinical setting and all included oral food challenge in at least a percentage of enrolled patients, in 21.5% double‐blind placebo‐controlled food challenges. Skin prick test (SPT) with fresh cow's milk and raw egg had high sensitivity (90% and 94%) for milk and cooked egg allergies. Specific IgE (sIgE) to individual components had high specificity: Ara h 2‐sIgE had 92%, Cor a 14‐sIgE 95%, Ana o 3‐sIgE 94%, casein‐sIgE 93%, ovomucoid‐sIgE 92/91% for the diagnosis of peanut, hazelnut, cashew, cow's milk and raw/cooked egg allergies, respectively. The basophil activation test (BAT) was highly specific for the diagnosis of peanut (90%) and sesame (93%) allergies. In conclusion, SPT and specific IgE to extracts had high sensitivity whereas specific IgE to components and BAT had high specificity to support the diagnosis of individual food allergies. [ABSTRACT FROM AUTHOR]

This document contains summaries of several research studies related to allergies. The studies cover a range of topics, including the introduction of allergenic foods, the use of baked milk products for milk allergies, the impact of breastfeeding and pet exposure on food allergies, and the efficacy of oral immunotherapy for peanut allergy. These studies provide valuable insights into the prevention and treatment of allergies, highlighting the importance of personalized approaches and patient-reported outcomes. Library patrons conducting research on allergies will find these summaries helpful in understanding the latest findings in the field. [Extracted from the article]

Background: Oral immunotherapy (OIT) is a promising treatment for food allergies. Our aim was to establish the long‐term safety and efficacy of a novel red meat (RM) OIT in galactose‐alpha‐1,3‐galactose (alpha‐gal) allergy in adults. Methods: Out of 20 patients with confirmed RM allergy, five (41.66%) underwent an early OIT, seven (58.33%) underwent a delayed protocol and eight patients who were not desensitized formed the patient control group. 15 and 27 day RM OIT for early‐onset and delayed‐onset alpha‐gal allergy were administered, respectively. Desensitized patients were recommended to continue eating at least 100 g RM every day for 6 months and every other day in the following 6 months. After a year, the consumption was recommended 2/3 times in a week. Patients were followed up with skin tests with commercial beef and lamb extracts, fresh raw/cooked beef and lamb and cetuximab and also with serum alpha‐gal specific Immunoglobulin‐E (sIgE) in the first and fifth years. Results: All patients who underwent OIT became tolerant to RM. During the 5 year follow‐up, the median alpha‐gal sIgE concentration gradually decreased in nine patients who consumed RM uneventfully while remained unchanged in the control group (p =.016). In two patients, rare tick bites acted as inducers of hypersensitivity reactions with concomitant elevation of alpha‐gal sIgE concentrations whereas one patient with low follow‐up alpha‐gal sIgE concentrations consumed RM uneventfully after frequent tick bites. Conclusions: Our study showed the long‐term safety and efficacy of alpha‐gal OIT. Additionally, alpha‐gal sIgE seems to be a potential biomarker to monitor OIT. [ABSTRACT FROM AUTHOR]

The article discusses allergen-specific B cell responses in individuals undergoing desensitization and natural tolerance to cow's milk allergy. It highlights the challenges and benefits of oral immunotherapy (OIT) in inducing desensitization and remission, as well as the differences in gene signatures between desensitized and remission groups. The study also compares the trajectory of allergen-specific B cells in OIT patients, those who naturally outgrew the allergy, and healthy controls, shedding light on the mechanisms of food allergen tolerance. The findings suggest that OIT modulates gene signatures to mimic profiles seen in natural tolerance, raising questions about the long-term effectiveness and potential interference with natural tolerance. [Extracted from the article]

Trait profiles in difficult-to-treat asthma: clinical impact and response to systematic assessment - P.2418 Tiffany Lin, Jonathan Pham, Eve Denton, Joy Lee, Fiona Hore-Lacy, Asger Sverrild, Stephanie Stojanovic, Tunn Ren Tay, Kavitha Garuna Murthee, Naghmeh Radhakrishna, Monique Dols, Janet Bondarenko, Janine Mahoney, Robyn E. O'Hehir, Eli Dabscheck, Mark Hew We performed latent class analysis on 241 difficult-to-treat asthma patients undergoing systematic assessment at Alfred Health in Melbourne, Australia. Month 12 peanut-specific IgG4/IgE ratio as well as month 12 peanut-specific Ara h 2 levels had moderate predictability for an eliciting dose >=300 mg peanut protein. Abbreviations: CRD, component-resolved diagnostic; IgE, immunoglobulin E; kUA/L, kilounits of allergen-specific IgE per liter; LTP, lipid transfer protein. [Extracted from the article]

Keywords: food allergy; oral food challenge; may contain traces; precautionary allergen labeling EN food allergy oral food challenge may contain traces precautionary allergen labeling 2558 2561 4 09/05/23 20230901 NES 230901 DATA AVAILABILITY STATEMENT The data that support the findings of this study are available from the corresponding author upon reasonable request. All in all, our study demonstrates a reassuring safety profile of PAL food ingestion in a real-world setting and supports the possible introduction of foods with PAL in certain patients with confirmed IgE-mediated food allergy and high reactivity thresholds. Real-life evaluation of tolerance to foods with precautionary allergen labeling in children with IgE-mediated food allergy. [Extracted from the article]

Background: Pru p 3 and Pru p 7 have been implicated as risk factors for severe peach allergy. This study aimed to establish sensitization patterns to five peach components across Europe and in Japan, to explore their relation to pollen and foods and to predict symptom severity. Methods: In twelve European (EuroPrevall project) and one Japanese outpatient clinic, a standardized clinical evaluation was conducted in 1231 patients who reported symptoms to peach and/or were sensitized to peach. Specific IgE against Pru p 1, 2, 3, 4 and 7 and against Cup s 7 was measured in 474 of them. Univariable and multivariable Lasso regression was applied to identify combinations of parameters predicting severity. Results: Sensitization to Pru p 3 dominated in Southern Europe but was also quite common in Northern and Central Europe. Sensitization to Pru p 7 was low and variable in the European centers but very dominant in Japan. Severity could be predicted by a model combining age of onset of peach allergy, probable mugwort, Parietaria pollen and latex allergy, and sensitization to Japanese cedar pollen, Pru p 4 and Pru p 7 which resulted in an AUC of 0.73 (95% CI 0.73–0.74). Pru p 3 tended to be a risk factor in South Europe only. Conclusions: Pru p 7 was confirmed as a significant risk factor for severe peach allergy in Europe and Japan. Combining outcomes from clinical and demographic background with serology resulted in a model that could better predict severity than CRD alone. [ABSTRACT FROM AUTHOR]

Background: The Step‐Down Approach for Cow's Milk Allergy (SDACMA) trial evaluated the tolerability and the rate of immune tolerance acquisition in CMA children starting dietary treatment with amino acid‐based formula (AAF) and then switching to EHCF containing the probiotic Lacticaseibacillus rhamnosus GG (EHCF + LGG). Methods: Randomized controlled trial involving IgE‐mediated CMA children receiving AAF from at least 4 weeks. EHCF + LGG tolerance was evaluated by the results of double‐blind placebo‐controlled food challenge (DBPCFC). Subjects tolerating EHCF + LGG were randomly allocated to remain on AAF, or to switch to EHCF + LGG. Immune tolerance acquisition to cow's milk proteins was evaluated with DBPCFC after 12 months of treatment. Allergy screening tests and body growth were also monitored. Results: Sixty IgE‐mediated CMA children were enrolled. The proportion of children treated with AAF who resulted tolerant to the first exposure of EHCF + LGG was 0.98 (exact 95% CI 0.91–0.99). The rate of the immune tolerance acquisition to cow milk proteins after 12 months treatment was higher in the EHCF + LGG (0.48, 95% exact CI 0.29–0.67, n/N = 14/29) than in the AAF group (0.03, 95% exact CI 0.001–0.17, n/N = 1/30). There was an absolute benefit increase (ABI) of tolerance rate equal to 0.45 (95% CI 0.23–0.63, Newcombe method 10) for EHCF + LGG versus AAF, corresponding to a NNT of 2 (2–4, Bender's method). A normal body growth pattern was observed in the two study groups. Conclusion: In IgE‐mediated CMA children the step‐down from AAF to EHCF + LGG is well tolerated and could facilitate the immune tolerance acquisition. [ABSTRACT FROM AUTHOR]

However, children with FA and atopic dermatitis (AD) had lower hip BMD compared to children without AD (Figure 2A), and FN and hip BMD also trended lower in those with comorbid allergic rhinitis (Figure 2B). BMI, body mass index; Med, Median. gl Of the 35 children with CMA, 54.3% had BMD z-score(s) between -1 and -2, and 17.1% had BMD z-score <= -2 at one or more sites (Table S1). Abbreviations AD atopic dermatitis AR allergic rhinitis BMD bone mineral density BMI body mass index CMA cow's milk allergy DXA dual-energy X-ray absorptiometry FA food allergy FN femoral neck hip total hip RDI recommended dietary intake WB (subtotal) whole body (subtotal) Food allergy (FA) is a worldwide public health problem. [Extracted from the article]

Of the 73 patients, 53 (72.6%) were positive for at least one of the four allergen components; only 30 (41.1%) were positive for mango extract in ImmunoCAP, suggesting low or lacking presence of relevant allergens in the mango extract. Mango allergy is frequently associated with pollinosis by I Artemisia i and I Betula i pollens.[[1]] Immunoglobulin E (IgE)-mediated mango allergy is the leading cause of fruit allergies in China.[3] Although several mango allergens have been identified with IgE-binding bands around 14, 17, 30, 40, 50, 60, and 67 kDa,[[2], [4], [6]] their molecular characterization is absent from the International Union of Immunological Societies (IUIS) allergen database. Specific IgE positivity against mango extract and allergen components was higher in children and teenagers than in adults (Figure 1G), indicating the increasing trend of mango allergy in younger people. [Extracted from the article]

Background: The microbiome associations of food protein‐induced enterocolitis syndrome (FPIES) are understudied. We sought to prospectively define the clinical features of FPIES in a birth cohort, and investigate for the evidence of gut dysbiosis. Methods: We identified children diagnosed with FPIES in the Gastrointestinal Microbiome and Allergic Proctocolitis Study, a healthy infant cohort. Children were assessed and stools were collected at each well child visit. The clinical features of the children with FPIES were summarized. Stool microbiome was analyzed using 16S rRNA sequencing comparing children with and without FPIES. Results: Of the 874 children followed up for 3 years, 8 FPIES cases (4 male) were identified, yielding a cumulative incidence of 0.92%. The most common triggers were oat and rice (n = 3, each) followed by milk (n = 2). The children with FPIES were more likely to have family history of food allergy (50% vs. 15.9% among unaffected, p =.03). The average age of disease presentation was 6 months old. During the first 6 months of life, stool from children with FPIES contained significantly less Bifidobacterium adolescentis, but more pathobionts, including Bacteroides spp. (especially Bacteroides fragilis), Holdemania spp., Lachnobacterium spp., and Acinetobacter lwoffii. The short‐chain fatty acid (SCFA)‐producing Bifidobacterium shunt was expressed significantly less in the stool from FPIES children. Conclusions: In this cohort, the cumulative incidence over the 3‐year study period was 0.92%. During the first 6 months of life, children with FPIES had evidence of dysbiosis and SCFA production pathway was expressed less in their stool, which may play an important role in the pathogenesis of FPIES. [ABSTRACT FROM AUTHOR]

Background: Having a better understanding of the risk factors of severe anaphylaxis is a crucial challenge for physicians. Methods: To retrospectively analyse fatal/near‐fatal anaphylaxis cases recorded by the Allergy‐Vigilance® Network (2002–2020) and evaluate the characteristics associated with survival, age and allergens. Results: Among the 3510 anaphylaxis cases documented in the network, 70 (2%) patients (males: 57%; mean age: 35.4 y) presented grade 4 (Ring‐Messmer) anaphylaxis and 25 died (19 food‐related); 33% had a history of asthma. The main allergens were food (60%; peanut, 20%; milks, 11%) involved in 25/26 cases in children and in 17/44 (39%) cases in adults. Non‐food anaphylaxis was related to drugs/latex (24%; neuromuscular blocking agents, 10%; betalactamins, 6%), Hymenoptera (16%). Three food‐related cases (one death) occurred during oral food challenge in children. Patients with a food allergy were younger (22.2 years vs. 55 years, p <.001), had more likely a history of asthma (50% vs. 7%; p <.001), a pre‐existing allergy (62% vs. 18%; p <.001) compared with other allergies. A cofactor was identified in 35 cases (50%) but predominantly in adults as opposed to children (64% vs. 27%; p =.01). The patients who died were younger (25.6 vs. 40.8 years; p =.01) than the survivors and mostly presented bronchospasm (56% vs. 29%; p =.05). Gaps in the prevention and management of anaphylaxis were noted in 15 cases (21%). Conclusions: Severe food anaphylaxis has specific features compared with other causes such as young age, asthma history and exercise. Food is also involved in severe anaphylaxis in adults that should not be underestimated. [ABSTRACT FROM AUTHOR]

The article discusses the new guidelines on the management of IgE-mediated food allergy issued by the European Academy of Allergy, Asthma, and Clinical Immunology (EAACI). These guidelines provide recommendations for the treatment of food allergies, including allergen-specific immunotherapy and the inclusion of tolerated foods in the diet. The guidelines also emphasize the importance of addressing economic issues, health disparities, and mental health needs in food allergy management. The article acknowledges the gaps in evidence and the need for further research to personalize care and optimize treatment options. [Extracted from the article]

To the Editor, Globally, the prevalence of food allergy (FA) in children is increasing, and FA can induce fatal anaphylaxis, which affects morbidity and mortality.[[1]] Children with FAs are more likely to have food neophobia, which may lead to severe vitamin D deficiency and osteoporosis. The earlier the development of FA, the higher the risk of fractures (aHR for the first FA diagnosis at <2 years, 1.19 [95% CI: 1.08-1.31]; aHR for the first FA diagnosis at 2-4 years, 1.09 [95% CI: 1.01-1.19]; and aHR for the first FA diagnosis at >=5 years, 1.14 [95% CI: 1.04-1.26]). The risk of fracture increased with increasing FA severity (fracture incidence rate [1000 person-years]: 36.60 for control vs. 40.63 for mild FA vs. 48.61 for moderate-to-severe FA). [Extracted from the article]

Dupilumab has a profound effect on specific-IgE levels of several food allergens in atopic dermatitis patients Error bars indicate the 95% confidence interval. gl This is the first study that showed a profound decrease in sIgE levels of food allergens during dupilumab treatment (up to 3.5 years) in a large population of food-allergic AD patients. In our study, 33 of 40 patients, who accidentally ingested foods during dupilmab treatment, reported a decrease in severity of food-allergic symptoms (Table S2). [Extracted from the article]

Data collected included demographics, medication chart and inpatient note drug allergy documentation, culprit drug prescribing, consistency of drug allergy documentation throughout admissions and Adverse Drug Reaction (ADR) alerts. When evaluated in terms of treatment results, 15 (60%) patients successfully completed the treatment; 1 (4%) patient was excluded from follow-up; 3 (12%) patients were transferred abroad, 6 (24%) patients are still under treatment. MicroRNA expression in patients with allergic rhinitis during grass pollen immunotherapy K. Specjalski*; A. Maciejewska; J. Romantowski; R. Pawlowski; E. Jassem; M. Niedoszytko Medical University of Gda'nsk, Gda'nsk, Poland B Background: b Subcutaneous immunotherapy (SCIT) is a well-established method of treatment of allergic rhinitis (AR) resulting in symptoms and pharmacotherapy reduction, and better quality of life. B Results: b 2677 patient treated for tuberculosis; 210 patients were consulted to the Allergy; 25 drug-resistant patients seen by the authors.12 (48%) of the cases were women; mean age 37.24 ± 14.44 years; type 1 hypersensitivity reaction in 13 (52%) cases; 16 (64%) of them are citizens of the Republic of Turkey; 24 (96%) of them were diagnosed bacteriologically; 21 (84%) had pulmonary tuberculosis; 5 (20%) of them had previously received antituberculosis treatment. Drug allergy was ruled out in 83% of the patients and confirmed in the remaining 17%, with positive skin tests in 1 patient (with immediate reaction) and requiring a controlled oral exposure test in the remaining cases. [Extracted from the article]

Scientific Flash Talks on allergen immunotherapy in the clinic 09:00 - 10:30 Room D6 Flash Talks I Chair i : D. Silva (Porto, Portugal), M. Jesenak (Martin, Slovakia) • B Exposure to allergen-specific immunotherapy in pregnancy and risk of congenital malformations and other adverse pregnancy outcomes b 09:00 - 000122 I Speaker(s): i N. Mitselou (Örebro, Sweden) I Author(s): i N. Mitselou (Örebro, Sweden), O. Stephansson (Stockholm, Sweden), E. Melén (Stockholm, Sweden), J. Ludvigsson (Örebro, Sweden) • B Consistent reduction of nasal and ocular symptoms in children treated with SQ grass or ragweed SLIT-tablet in randomised controlled trials b 09:10 - 000443 I Speaker(s): i M. Jesenak (Martin, Slovakia) I Author(s): i M. Jesenak (Martin, Slovakia), R. Gronskyte Juhl (Hørsholm, Denmark), H. Nolte (Bedminster, United States of America), P. Creticos (Baltimore, United States of America) • B Retrospective cohort study demonstrates the effects of allergen immunotherapy under real life conditions in house dust mite induced allergic rhinitis and asthma b 09:20 - 000453 I Speaker(s): i R. Mösges (Köln, Germany) I Author(s): i A. Sager (Witten, Germany), R. Mösges (Cologne, Germany), T. Müller (Ismaning, Germany), H. Richter (Frankfurt am Main, Germany) • B A first-in-human phase 2 dose-finding trial with grass pollen allergoids coupled to mannan in subcutaneous and sublingual immunotherapy. [Extracted from the article]

B Method: b In order to evaluate its effect on NP, we compared the expression levels of mRNA and protein by real-time PCR and Western blot analysis, respectively, among 4 tissue types (uncinate tissues (UT) from normal control, chronic rhinosinusitis (CRS) without NP (CRSsNP) patient, and CRS with NP (CRSwNP) patient, and NP tissue from CRSwNP patient). In subjects without asthma at baseline, the 5-year SQ grass SLIT-tablet asthma prevention trial ( I n i = 812) showed sustained risk reduction in asthma symptoms and asthma medication use throughout a 3-year treatment period and 2 years follow-up compared to placebo-treated subjects (OR = 0.66, I p i = 0.036 across 5 grass pollen seasons). Over 52 weeks, a higher proportion of tezepelumab recipients than placebo recipients had well-controlled or partially controlled asthma symptoms (Figure 1). B Conclusion: b Tezepelumab treatment resulted in a greater proportion of patients achieving early and sustained clinically meaningful improvements in PRO measures of asthma control, asthma symptoms and HRQoL, further demonstrating the efficacy of tezepelumab in patients with severe, uncontrolled asthma. B Method: b Patients with asthma with or without CRS/NP received 200 or 300 mg dupilumab or placebo either every 2 weeks (q2w) or q4w during phase 2b (parent study); all patients received dupilumab 300 mg q2w for up to 96 weeks during TRAVERSE (DPL/DPL and PBO/DPL patients, respectively). 000575 The proportions of tezepelumab-treated patients with severe, uncontrolled asthma who achieved... Jackson D. 1,2, Cook B. 3, Martin N. 4,5, Clarke N. 6, Hunter G. 7, Llanos-Ackert J. P.... 1 Guy "s and St Thomas" NHS Foundation Trust, London, UK, London, UK; 2 King 's College Londo... B Background: b Patients with severe, uncontrolled asthma experience poor symptom control and health-related quality of life (HRQoL). [Extracted from the article]

The furan fatty acid metabolite CMPF was identified as top biomarker of the fish-oil supplementation. GRAPH Abbreviations: OIT, oral immunotherapy; Ig, immunoglobulin; sIg, specific immunoglobulin; kUA/L, kilounits of allergen-specific IgE per liter; T, time point. Fecal metabolites including bile acids, sphingolipids, and caffeine metabolites are associated with food allergy/sensitization. [Extracted from the article]

Although the sample size was very small, none of the peanut allergic avoiders without eczema ( I n i = 3) had ses-IgE to those epitopes at a 2.5-year timepoint but did develop ses-IgE to some of the epitopes of the eczema group by 5 years. In children with eczema, expansion of epitope-specific IgE is associated with peanut allergy at 5 years of age A well-known risk factor for food allergies is childhood eczema or atopic dermatitis (AD).[1] Even the non-lesional skin of AD subjects with food allergies has morphologic changes characteristic of a distinct endotype.[2] Allergen exposure from house dust and/or contamination on caregivers hands on inflamed skin may provoke the release of alarmins resulting in inflammatory Th2-skewing.[3] In a recent study, we followed the evolution of serum epitope-specific (ses-)IgE and ses-IgG SB 4 sb antibodies in a subset of 341 infants at risk for peanut allergy (LEAP trial). [Extracted from the article]

Background: Alpha‐gal syndrome (AGS) is an IgE‐mediated allergy to galactose‐alpha‐1,3‐galactose. Clinical presentation ranges from hives to anaphylaxis; episodes typically occur 2–6 h after exposure to alpha‐gal‐containing products. In the United States, lone star tick bites are associated with the development of AGS. To characterize features of AGS, we evaluated a cohort of patients presenting for care at the University of North Carolina, focusing on symptoms, severity, and identifying features unique to specific alpha‐gal‐containing product exposures. Methods: We performed a chart review and descriptive analysis of 100 randomly selected patients with AGS during 2010–2019. Results: Median age at onset was 53 years, 56% were female, 95% reported White race, 86% reported a history of tick bite, and 75% met the criteria for anaphylaxis based on the involvement of ≥2 organ systems. Those reporting dairy reactions were significantly less likely to report isolated mucocutaneous symptoms (3% vs. 24%; ratio [95% CI]: 0.1 [0.1, 0.3]) than those who tolerated dairy, and were more likely to report gastrointestinal symptoms (79% vs. 59%; ratio [95% CI]: 1.3 [0.7, 2.6]), although this difference was not statistically significant. Dairy‐tolerant patients demonstrated higher alpha‐gal sIgE titers (as a percentage of total IgE) than dairy‐reactive patients (GM 4.1 [95% CI: 2.7, 6.1] vs. GM 2.5 [95% CI: 1.3, 4.8], respectively; ratio −1.6 [95% CI: −1.0, 3.9]). Conclusion: While tick exposure is common in the southern United States, nearly all AGS patients reported a tick bite. Gastrointestinal symptoms were prominent among those reporting reactions to dairy. Anaphylaxis was common, underscoring the severity and need to raise awareness of AGS among patients and providers. [ABSTRACT FROM AUTHOR]

Background: Milk oral immunotherapy (OIT) may increase the amount of milk protein that can be ingested without triggering an allergic reaction. It is important to understand why some patients benefit from the treatment while others do not. Objective: The aim was to define the differences in the milk allergen component‐specific (casein, α‐lactalbumin, ß‐lactoglobulin) immunoglobulin (sIg [sIgE, sIgG4, and sIgA]) levels relative to the long‐term outcomes of milk OIT. Methods: In this long‐term, open‐label follow‐up study, 286 children started milk OIT between 2005 and 2015. Follow‐up data were collected at two points: the post‐buildup phase and long term (range 1–11 years, median 6 years). Comparisons of sIg levels were made among three outcome groups of self‐reported long‐term milk consumption (high‐milk dose, low‐milk dose, and avoidance). Results: A total of 168 (59%) of the 286 patients on OIT participated. Most patients (57%) were in the high‐dose group; here, 80% of these patients had a baseline casein sIgE value less than 28 kUA/L, they had the lowest casein sIgE levels at all time (p <.001), their casein sIgG4/IgE levels increased, and long‐term casein sIgA was highest compared with the low‐dose and avoidance groups (p =.02). Low‐milk dose group had the highest casein sIgG4/IgE levels in long term (p =.002). Conclusion: The baseline Ig profiles and responses to milk OIT differed depending on long‐term milk consumption. Lower casein sIgE levels were associated with better outcome. Milk casein sIgA differed in the long term among high‐milk consumers. [ABSTRACT FROM AUTHOR]