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Marenholz I, Nickel R, Rüschendorf F, et al. J Allergy Clin Immunol. 2006;118:866–871 PURPOSE OF THE STUDY. To assess the importance of filaggrin loss-of-function mutations in the susceptibility to eczema and associated clinical phenotypes. STUDY POPULATION. Two large European populations including 1092 children with eczema. METHODS. The filaggrin mutations were genotyped and tested for association with allergic disorders. RESULTS. A highly significant association of the filaggrin null mutations with eczema and concomitant asthma was found. These mutations predisposed to asthma, allergic rhinitis, and allergic sensitization only in the presence of eczema. The presence of 2 filaggrin null alleles was an independent risk factor for asthma in children with eczema, and the 2 investigated mutations accounted for ∼11% of eczema cases in the German population. CONCLUSIONS. These results support the role of filaggrin in the pathogenesis of eczema and in the subsequent progression along the atopic march. The fact that previous expression of eczema is a prerequisite for the manifestation of allergic airways disease and specific sensitization in a large subset of patients highlights the importance of the epidermal barrier in the pathogenesis of these disorders. REVIEWER COMMENTS. The filaggrin gene encodes a structural protein that is essential for skin-barrier formation. Infants and children with atopic dermatitis are at high risk for developing additional atopic disorders, including food allergy, allergic rhinitis, and asthma. A disrupted skin barrier may be an important portal of entry for environmental and food allergens. In animal models, exposure through the skin predisposes to development of immunoglobulin E sensitization. Early intensive efforts to maintain and restore skin-barrier function may prevent subsequent development of allergic diseases and stop the progression of the atopic march.

R Peters, K Allen, S Dharmage. J Allergy Clin Immunol. 2015;135(5):1257–1266 Using prospectively collected data, this study sought to describe the natural history of peanut allergy in childhood and to provide thresholds for skin prick test (SPT) results and specific immunoglobulin E (sIgE) levels that predict probability of tolerance or persistence of peanut allergy. This study included 1-year old infants with peanut allergy from the population-based, longitudinal HealthNuts study conducted in Australia. Infants with challenge-confirmed peanut allergy ( n = 156) were enrolled at …

YH Chiu, BA Coull, MJ Sternthal. J Allergy Clin Immunol. 2014;133(3):713–722.e4 Prenatal exposures to maternal stress and physical toxins can affect children’s respiratory development and health. This study sought to examine the effects of prenatal psychosocial stressors (exposure to community violence [ECV]) and physical (traffic-related air pollution) stressors on childhood wheeze concurrently in an urban population. The study enrolled 989 women (≥18 years old) in mid- to late pregnancy (28.4 ± 7.9 weeks) receiving care at Brigham & Women’s Hospital in Boston, Massachusetts, between August 2002 and December 2009. Of these, 708 mother–child pairs completed the study and were …

T Jartti, R Nieminen, T Vuorinen. J Allergy Clin Immunol. 2015;135(3):691–698 Rhinovirus is prevalent in children during the first 2 years of life. Rhinovirus-related cause of early wheezing is strongly associated with recurrent wheezing and asthma. This study hypothesized that prednisolone decreases the risk of relapse in children with their first rhinovirus-induced wheezing episode. The study included children aged 3 to 23 months, gestational age ≥36 weeks, without previous corticosteroid use who were diagnosed with rhinovirus as detected by polymerase chain reaction and were experiencing their first wheezing episode. A double-blind randomized …

KM Donohue, RL Miller, MS Perzanowski. J Allergy Clin Immunol. 2013;131(3):736–742 Mouse models suggest that bisphenol A (BPA), which is widely used in manufacturing of food container linings, may increase allergic inflammation. Authors of this study sought to investigate whether BPA exposure would be associated with increased odds of developing wheeze and asthma. Between 1998 and 2006, 568 pregnant women were recruited from prenatal clinics. The women were of African American and Dominican ethnicity, aged between 18 and 35 years, and had lived in northern Manhattan or the South Bronx for at least 1 year. Urine BPA concentrations were …

KJ Allen, JJ Koplin, AL Ponsonby. J Allergy Clin Immunol. 2013;131(4):1109–1116, e1–e6 In light of epidemiologic studies that show increased prevalence of food allergy in populations who reside farther from the equator, investigators sought to determine the association between vitamin D and food allergy. From 2007 to August 2011, a total of 7134 infants between 11 and 15 months of age (inclusive) were approached during immunization visits at 120 locations throughout Australia. A total of 5120 infants underwent skin-prick testing (SPT) to peanut, egg, sesame, and cow’s milk or shrimp. Infants with a detectable wheal ≥1 mm as well as a random sample of infants with negative SPT were referred to a food allergy center …

H Bisgaard, N Li, K Donnelykke. J Allergy Clin Immunol. 2011;128(3):646–652 To investigate the potential association between the diversity of neonatal intestinal microbiota and the development of atopic disorders in childhood. Four hundred eleven infants born in Copenhagen to mothers with a history of asthma were enrolled from the years 1998 to 2001. Infants had an initial visit at 1 month of age and were subsequently seen for a scheduled visit every 6 months until the age of 6 years. Atopic disease was assessed through examination by doctors at the clinical research unit with support from symptom diaries kept by the parents. Investigators conducted interval testing of peripheral blood eosinophil count, skin prick tests, …

S Keles, E Karakos-Aydiner, A Ozen. J Allergy Clin Immunol. 2011;128(4):808–815 To compare the efficacy and safety of a novel combination of subcutaneous immunotherapy (SCIT) for induction and sublingual immunotherapy (SLIT) for maintenance, to immunotherapy via a single method (either SCIT or SLIT) for both induction and maintenance. Investigators enrolled 60 children, aged 5 to 12 years, monosensitized to house dust mite (HDM), who had been followed at a pediatric allergy immunology clinic in Istanbul for mild persistent to moderate asthma or rhinitis, with persistent symptoms despite inhaled or intranasal steroids for 2 years. After an 8-week evaluation to assess baseline symptoms, patients were randomized to 1 of 4 parallel treatment groups. One group was treated with pharmacotherapy, while the other 3 received immunotherapy administered in 1 of …

C Gruber, M van Stuijvenberg, F Mosca; MIPS 1 Working Group. J Allergy Clin Immunol. 2010;126(4):791–797 To determine whether the supplementation of prebiotics and immunoactive oligosaccharides can prevent the development of atopic dermatitis in infants. Term weaned infants younger than 8 weeks without a family history of atopy in a parent or sibling were recruited from several northern European study centers. This was a double-blind, placebo-controlled, randomized, prospective study. Infants were randomly assigned to the prebiotics group (PG), control group (CG), or exclusively breastfed group (BG). Infants in the PG received a nonhydrolyzed cow's milk–based formula with a specific mixture of short- and long-chain oligosaccharides (ratio 9:1, 85% of mixture) and pectin-derived acidic oligosaccharides (15% …

AH Liu, R Jaramillo, SH Sicherer. J Allergy Clin Immunol. 2010;126(4):798–806 To investigate the prevalence and demographic risk factors of food allergy (FA) and its association with other atopic diseases in a population sample. Data were collected from 10 348 adult and children older than 1 year, who represented the national population from 30 sites across the continental United States. Blood was collected and specific immunoglobulin E (IgE) panels were run for 79.3% of the subjects. Specific IgE levels to peanut, cow's milk, egg white, and shrimp were collected from subjects aged 6 years and older. Shrimp-specific IgE was not tested for subjects younger than 6 years. Food sensitization was defined as having at least 1 food-specific serum IgE level at ≥0.35 kU/L. FA risk categories included unlikely FA (between ≥0.35 …

Pfefferle PI, Sel S, Ege MJ, et al; PASTURE Study Group. J Allergy Clin Immunol . 2008;122(4):711–716 PURPOSE OF THE STUDY. To investigate the relationship between allergen-specific cord blood (CB) immunoglobulin E (IgE) levels, parental allergen sensitization, CB cytokine production, and environmental influences. STUDY POPULATION. This study included families recruited for the multicenter Protection Against Allergy–Study in Rural Environments (PASTURE) study, an ongoing longitudinal birth cohort study designed to evaluate risk factors and preventative factors for atopic disease. Pregnant women in their third trimester were recruited for participation from Finland, Germany, France, Switzerland, and Austria. METHODS. CB samples were collected from umbilical cord veins, and parental blood …

Du Toit G, Katz Y, Sasieni P, et al. J Allergy Clin Immunol . 2008;122(5):984–991 PURPOSE OF THE STUDY. To determine the prevalence of peanut allergy (PA) among Israeli and United Kingdom Jewish children and to evaluate the relationship of PA to peanut consumption by infants and mothers. STUDY POPULATION. The study included Jewish children between the ages of 4 and 19 years who attended targeted primary and high schools. Eligible Jewish schools in greater London, United Kingdom, and Israeli schools in the Mehoz Merkaz region of Tel Aviv were selected because they were thought to represent comparable residential environments. The mothers of Jewish infants 4 to 24 months of age in general practitioner clinics in the United Kingdom and Tipat Halav clinics in Israel were also surveyed about the timing of ingestion of peanut. METHODS. Two validated questionnaires were used. The Food Allergy Questionnaire was completed by high school pupils …

Kusel MMH, de Klerk N, Holt PG, Sly PD. Clin Exp Allergy. 2008;38(12):1921–1928 PURPOSE OF THE STUDY. To investigate an association with antibiotic use in the first year of life and subsequent development of atopic disease in the first 5 years of life. STUDY POPULATION. A prospective birth cohort of 198 children considered to be at high atopic risk was recruited prenatally and monitored for 5 years. Risk was based on ≥1 parent with a doctor's diagnosis of asthma, hay fever, or eczema. METHODS. Parents kept a daily …

Schulmeister U, Swoboda I, Quirce S, et al. Clin Exp Allergy. 2008;38(1):60–68 PURPOSE OF THE STUDY. To analyze the specificity and possible biological relevance of immunoglobulin E (IgE) reactivity to human milk antigens in milk-allergic patients. STUDY POPULATION. Milk-allergic children and adults from different European countries with a positive case history, positive skin-prick reactions, and specific IgE to cow's milk extract were selected. METHODS. The specificity of IgE reactivity to cow's milk and human milk antigens was analyzed with sera from milk-allergic children and adults by immunoblotting. IgE cross-reactivity between milk antigens was studied by immunoblot inhibition experiments. To demonstrate that IgE reactivity to human milk antigens is not caused by alloreactivity or transmission of foreign antigens, genetically unrelated mothers’ milk samples were analyzed before and after intake of dietary milk products. Skin-prick tests were performed with cow's, sheep's, mare's, and human milk samples. RESULTS. IgE antibodies to human milk were found in >80% of the tested milk-allergic patients (n = 17). Cross-reactive IgE-reactive human antigens such as α-lactalbumin and non–cross-reactive human milk antigens were identified. Immunoblots showed IgE reactivity to antigens of the same molecular weights in each of the 4 milk samples from unrelated mothers. An immediate-type skin reaction could be elicited with human milk samples in 2 tested patients with IgE reactivity to human milk. CONCLUSIONS. IgE reactivity to human milk in milk-allergic patients may be caused by cross-sensitization and genuine sensitization, causing allergic symptoms. Sensitization to human milk is common in milk-allergic patients and may require diagnostic testing and clinical monitoring. REVIEWER COMMENTS. This is one of the first studies to have addressed the nature and biological relevance of IgE reactivity to human milk. The study demonstrated that sensitization to human milk is common in milk-allergic patients, but additional research is necessary, because it is unclear if patients with positive skin reactions suffered from clinically significant reactions to human milk. One may consider searching for the presence of IgE antibodies to human milk in children who have signs of allergy after breastfeeding. However, the benefits of breastfeeding, including its protective effect against early atopic diseases, must also be considered before advising dietary changes.

Szefler SJ, Baker JW, Uryniak T, Goldman M, Silkoff PE. J Allergy Clin Immunol. 2007;120(5):1043–1050 PURPOSE OF THE STUDY. To evaluate the efficacy of budesonide inhalation suspension (Pulmicort respules) compared with montelukast (Singulair) for controlling asthma symptoms in young children with mild persistent asthma. STUDY POPULATION. This was a prospective study of 395 children, aged 2 to 8 years, diagnosed with mild persistent asthma recruited from 55 US centers. Approximately 12% of the subjects had previous histories of inhaled corticosteroid (ICS) use. METHODS. Subjects were randomly assigned to receive either budesonide 0.5 mg or montelukast 4 to 5 mg daily and were followed for 52 weeks. Compliance was assessed by daily electronic diary review. For mild asthma exacerbations, step-up therapy consisted of the addition of a morning dose of budesonide 0.5 mg in both arms. For severe asthma exacerbations, subjects received a 3- to 10-day standardized course of oral steroids. The primary end point was evaluated by using the intention-to-treat population and was defined as time to first additional medication for asthma worsening at 52 weeks. Secondary end points included the time to additional asthma medication and rates of occurrence of mild and severe asthma exacerbations. Changes in symptom scores, peak flows, rescue-medication use, and pulmonary-function test results were also evaluated. RESULTS. Kaplan-Meier probability curves showed that the primary outcome measurement, time to the first additional asthma medication, was not significantly different between the 2 groups at 52 weeks (P = .3). There was a significant increase in the time to first additional asthma medication in the budesonide group compared with the montelukast group at 12 weeks (P = .05). The percentage of subjects requiring step-up therapy in the budesonide group versus the montelukast group at 12 weeks was 29.1% versus 38.6% (not significant [NS]), at 26 weeks was 41.3% versus 48.2% (NS), and at 52 weeks was 52% versus 56.9% (NS), respectively. The budesonide group achieved significantly improved morning and evening peak flow values compared with the montelukast group at 12 weeks (P = .005–.007). The rate of mild and severe asthma exacerbations per subject per year in the budesonide and montelukast groups was 1.23 and 1.63, respectively (P = .034). There was no significant difference in the number of severe asthma exacerbations between the 2 groups. Both treatment groups showed nonsignificant improvements in changes from baseline asthma scores, 24-hour rescue-medication use, and medication- and asthma-free days. CONCLUSIONS. Both budesonide and montelukast are effective and well-tolerated as controller medications in children aged 2 to 8 years with mild persistent asthma. Results favored budesonide for several secondary outcome measures. REVIEWER COMMENTS. Previous studies have shown that ICSs are more effective asthma-controller medications compared with montelukast in children older than 6 years. Although this study failed to show statistical significance in the primary outcome, it provides data supporting certain treatment benefits of ICSs in children younger than 6 years (257 of 395 children were

Mehl A, Rolinck-Werninghaus C, Staden U, et al. J Allergy Clin Immunol. 2006;118:923–929 PURPOSE OF THE STUDY. To determine the utility of atopy patch tests (APTs) in the diagnostic evaluation of food allergy. STUDY POPULATION. A cohort of 437 children (median age: 13 months; 90% with atopic dermatitis) who were referred for evaluation of suspected food allergy. METHODS. Specific serum immunoglobulin E (sIgE) measurements, skin-prick tests (SPTs), APTs, and controlled oral food challenges were performed. RESULTS. The outcomes of 873 oral challenges with cow's milk, hen's egg, wheat, and/or soy were analyzed. One thousand seven hundred single APTs were performed. As a single parameter, the APTs showed the best specificity compared with sIgE measurements, SPTs, or both. Combining the APT with either the SPT or sIgE measurement resulted in improved sensitivity and specificity. Decision points for sIgE measurement and for the SPT showed lower values when combined with a positive APT result. By including the APT in the evaluation, only between 0.5% and 7.0% (99% predicted probability) and between 6% and 14% (using 95% predicted probability) of children would fulfill the criteria for avoiding an oral food challenge. CONCLUSIONS. Although the predictive capacity of the APT is improved when combined with sIgE measurement or the SPT, oral food challenges become superfluous in only 0.5% to 14.0% of study patients. In addition, the APT is time-consuming and demands a highly experienced test evaluator. For daily clinical practice, the APT adds only a small predictive value to the standard SPT and sIgE measurement in the diagnostic workup of suspected food-related symptoms in children with atopic dermatitis. REVIEWER COMMENTS. The APT is presumed to reflect late-phase clinical reactions. However, even with late onset of symptoms (>2 hours after food ingestion), the performance of the APT was not consistent in the children with atopic dermatitis. The question that remains unanswered is whether the APT could be used to diagnose non–IgE-mediated gastrointestinal reactions to foods, such as allergic eosinophilic esophagitis/gastroenteritis or food protein–induced enterocolitis syndrome.

Purpose of the Study. To estimate the proportion of children who outgrow tree nut (TN) allergy and examine predictors of outgrowing it. Study Population. All children with TN allergy followed at the authors’ pediatric allergy clinic. Methods. Patients with TN allergy, defined as a history of reaction on ingestion and evidence of TN-specific immunoglobulin E (TN-IgE) or positive TN-specific IgE level but no history of ingestion, were evaluated. If all current TN-IgE levels were Results. Two hundred seventy-eight patients with TN allergy were identified. One hundred one (36%) had a history of acute reactions, 12 (12%) of whom had reactions to multiple TNs and 73 (63%) of whom had a history of moderate-to-severe reactions. Nine of 20 patients who had previously reacted to a TN passed challenges, so that 9 (8.9%; 95% confidence interval: 4%–16%) of 101 patients with a history of previous TN reactions outgrew TN allergy. Of 19 patients who had never ingested TNs but had detectable TN-specific IgE levels, 14 passed challenges. One hundred sixty-one did not meet the challenge criteria, and 78 met the criteria but declined challenges. Looking at specific TN-IgE values, 58% with TN-IgE levels of ≤5 kUA/L and 63% with TN-IgE levels of ≤2 kUA/L passed challenges. Conclusions. Approximately 9% of patients outgrow TN allergy, including some who had previous severe reactions. Although ideal cutoffs for challenge cannot be firmly recommended on the basis of these data, patients aged 4 years or older with all TN-IgE levels of ≤5 kUA/L should be considered for physician-supervised oral food challenges. Reviewer Comments. This is the first study to comprehensively address the natural history of TN allergy. Although the 9% chance of outgrowing TN allergy may seem low, it may be an underestimate of the actual resolution rate, because a large number of eligible patients declined diagnostic food challenges. The results of this study should encourage regular follow-up of children with TN allergy and consideration, when clinically indicated, for physician-supervised oral food challenges to determine the possibility of resolution. Because these oral food challenges can trigger anaphylaxis, they are generally undertaken under the supervision of an allergist and with immediate access to medications and equipment to treat a significant allergic reaction.

Purpose of the Study. To investigate the effect of breastfeeding in various phenotypes of eczema. Study Population. A birth cohort of 4089 children followed up to 4 years of age. Methods. Data on breastfeeding, allergic symptoms, and potential confounders were obtained from questionnaires when the children were 2 months and 1, 2, and 4 years old. At 4 years, blood allergen-specific immunoglobulin E was analyzed. Children with symptoms of eczema and asthma during the period of breastfeeding were excluded in most analyses on risk assessment of eczema and asthma, respectively, to avoid disease-related modification of exposure. Results. Exclusive breastfeeding for ≥4 months reduced the risk for eczema at the age of 4 years (odds ratio [OR]: 0.78; 95% confidence interval [CI]: 0.63–0.96) irrespective of combination with asthma, sensitization to common allergens, or parental allergic disease. This decreased risk was most evident for children with onset of eczema during the first 2 years persisting to 4 years (OR: 0.59; 95% CI: 0.45–0.77). Among children with early-onset eczema, irrespective of persistency, followed by late onset of asthma or early-onset asthma, irrespective of persistency, followed by late-onset eczema to 4 years, a protective effect of breastfeeding was also seen (OR: 0.48; 95% CI: 0.30–0.76). Conclusions. Breastfeeding ≥4 months reduces the risk for eczema and asthma to 4 years of age. Reviewer Comments. Many studies to date have shown that breastfeeding confers a protective effect against early atopic diseases including eczema. This is yet another argument to support breastfeeding.

Nguyen LHP, Manoukian JJ, Sobol SE, et al. J Allergy Clin Immunol . 2004;114:1110–1115 To determine if the middle-ear compartment may be a component of the united airways in allergic disease by comparing the inflammatory profiles of the middle ear to the upper airway. Children (aged 2–18 years) undergoing myringotomy, tympanostomy tube placement, and adenoidectomy were recruited prospectively and consecutively for the study. All children had documented conductive hearing loss, flat tympanograms, and middle-ear effusions that persisted for >3 months and were …

RA Wood, SH Sicherer, BP Vickery; for the Consortium of Food Allergy Research. J Allergy Clin Immunol. 2013;131(3):805–812 Previous studies on the natural history of milk allergy have been limited in duration and in geographic area. Through this multisite, longitudinal study, the authors provide a natural history of milk allergy and identify means for early prediction of likelihood of resolution. Children aged 3 to 15 months were recruited from 5 food allergy referral centers, using the following inclusion criteria: history of immediate allergic reaction to cow’s milk or egg with positive skin-prick test (SPT) to the inciting food; or moderate-to-severe atopic dermatitis (AD) with positive SPT to …

Mullins RJ. Clin Exp Allergy . 2003;33:1033–1040 To determine the incidence of anaphylaxis and risk factors for recurrence. Four hundred thirty-two patients with anaphylaxis who were referred to a community-based specialist practice in the Australian Capital Territory were studied. Twenty-seven percent were of school age (5–18 years of age). Patients referred to an allergist for evaluation of anaphylaxis were enrolled during a 5.5-year period and evaluated prospectively. Medical record review, patient questionnaires, allergy skin testing, and challenge testing (for a small subset …

Rebelo Gomes E, Fonseca J, Araujo L, Demoly P. Clin Exp Allergy. 2008;38(1):191–198 PURPOSE OF THE STUDY. To assess the prevalence of self-reported adverse drug reactions and drug allergy in a pediatric population and confirm the diagnosis in children with suspected drug allergy. STUDY POPULATION. Patients (n = 1426) responded to an initial cross-sectional survey. A total of 60 of 67 patients with reported drug allergy were evaluated at an allergy clinic. METHODS. The first phase included a cross-sectional survey that assessed the life occurrence of adverse drug reactions and self-reported drug allergy in the outpatient clinic of a pediatric hospital. The second phase involved a diagnostic workup in children with parent-reported drug allergy, including detailed clinical history and in vitro and in vivo investigations. Specific immunoglobulin E (IgE) level determination for β-lactams, prick and intradermal skin testing for β-lactams, local anesthetics and sulfonamides, and patch tests (if a delayed reaction was reported) were performed. If all other investigations were inconclusive and a provocation test was not contraindicated, this test was performed. RESULTS. The prevalence of self-reported adverse drug reactions and drug allergy were 10.2% and 6.0%, respectively. The frequency of a medical diagnosis of drug allergy was 3.9%. The majority of the suspected allergic reactions were nonimmediate cutaneous events attributed to β-lactam antibiotics in younger children. Of 60 patients evaluated in the allergy clinic, 39 patients had a plausible clinical history, and additional investigation including a skin test, IgE-level measurement, and possible provocation tests were conducted. Drug allergy was diagnosed in 3 children on the basis of positive responses in skin (n = 1) and oral provocation (n = 2) tests. CONCLUSIONS. Although adverse drug reactions and suspected drug allergy are frequently reported in children, after a complete evaluation, only a few of these reactions can be attributed to immediate and nonimmediate drug allergy. Overall, 94% of the patients could tolerate the initially suspected drug. REVIEWER COMMENTS. This study underscores a serious problem: patients who experience or perceive a drug reaction are often classified as being truly allergic when this may not be the case. Such overdiagnosis and misdiagnosis may result in suboptimal medication choices. These results show that only 6% of the patients with initially suspected drug allergy were truly allergic. This study demonstrates the importance of a complete and detailed history, with consideration of additional testing including skin-prick tests, specific IgE-level determination, and provocation tests. It should be noted that for nonimmediate drug allergy, an oral provocation test may require prolonged treatment to observe for symptoms. Such provocation tests would not be undertaken for severe previous reactions (eg, toxic epidermal necrolysis).

Maloney JM, Chapman MD, Sicherer SH. J Allergy Clin Immunol. 2006;118:719–724 PURPOSE OF THE STUDY. To determine the time course of major peanut allergen (Arah1) persistence in saliva after ingestion of peanut butter and to evaluate mouth-cleansing interventions to reduce salivary peanut allergen. STUDY POPULATION. A convenient sample of adults without peanut allergy. METHODS. Thirty-eight individuals ingested 2 tablespoons of peanut butter, and saliva was collected at various time points. At another time, samples were collected after 5 interventions (brushing teeth, brushing and rinsing, rinsing, waiting then brushing, waiting then chewing gum). Detection of Arah1 was performed by a monoclonal-based enzyme-linked immunosorbent assay (detection limit: 15–20 ng/mL). RESULTS. Salivary peanut allergen Arah1 varied considerably immediately after ingestion but included levels expected to invoke reactions (as much as 40 μg/mL). Most (87%) subjects with detectable peanut after a meal had undetectable levels by 1 hour with no interventions. None had detectable levels several hours later after a peanut-free lunch. This result indicates (with 95% confidence) that 90% would have undetectable Arah1 in saliva under these circumstances. All of the immediate interventions reduced salivary Arah1, in some cases by >95%, but Arah1 remained detectable in ∼40% of the samples (although typically below thresholds reported to induce reactions). CONCLUSIONS. Patients with peanut allergy require counseling regarding the risks of kissing or sharing utensils, even if their partners have brushed their teeth or chewed gum. Advice to reduce risks, although not as ideal as total avoidance, includes waiting a few hours plus eating a peanut-free meal. REVIEWER COMMENTS. Passionate kissing was reported to cause allergic reactions to foods, including anaphylaxis. Waiting several hours and ingesting a peanut-free meal were more effective at reducing salivary peanut protein concentration than simple, immediate interventions. Teenagers with peanut and other food allergies need to be reminded that to stay safe, restraint and patience are necessary even in the most intimate situations.

Fleischer DM, Conover-Walker MK, Christie L, Burks AW, Wood RA. J Allergy Clin Immunol . 2004;114:1195–1201 To determine the rate of peanut allergy recurrence, identify risk factors for recurrent peanut allergy, and develop specific recommendations for the treatment of patients with resolved peanut allergy. Children >4 years old with prior diagnosis of peanut allergy who had undergone and passed an oral peanut challenge. Children were evaluated by using questionnaires, skin tests, and peanut-specific IgE levels. Patients were invited to undergo …

Peat JK, Mihrshahi S, Kemp AS, et al. J Allergy Clin Immunol . 2004;114:807–813 To measure the effects of dietary supplementation with ω-3 fatty acids and house d-e (HDM) allergen avoidance in children with a family history of asthma. Children at high risk for asthma, defined by having at least 1 parent or sibling with current asthma or frequent wheeze. A total of 616 children at high risk for asthma were enrolled antenatally, …

Oddy WH, Halonen M, Martinez FD, et al. J Allergy Clin Immunol. 2003;112:723–728 To determine whether the cytokines in breast milk could account for some of the apparent protective effects of breastfeeding against wheeze in the first 1 year of life. Mothers and their infants participating in the Infant Immune Study in Tucson, Arizona, were studied. Data on breastfeeding and infant wheeze, from birth to 1 year, were collected prospectively from 243 mothers. Breast milk samples obtained at a mean postpartum age of …

Perry T, Matsui E, Merriman B, Duong T, Eggleston P. J Allergy Clin Immunol . 2003;112:346–352 To determine the prevalence of rat allergen in the homes of inner-city children with asthma and to examine the relationship between rat allergen exposure, sensitization, and asthma morbidity Children enrolled in the National Cooperative Inner-City Asthma Study were studied. Dust samples collected from the homes of 1528 asthmatic children from 8 major inner-city …

Purpose of the Study. Numerous studies have demonstrated that the prevalence of atopic diseases is lower in the Central and Eastern European countries as compared with Western European countries. The intestinal microflora is a likely source for the induction of immune deviation in infancy. The purpose of this study was to prospectively relate the intestinal microflora to allergy development in 2 countries differing with respect to the prevalence of atopic disease. Study Population. A cohort of 24 infants in Estonia and 20 infants in Sweden followed prospectively through …

Purpose of the Study. Prevalence of atopic diseases has increased in westernized countries despite current prevention strategies. The objective of this study was to determine whether specific immunotherapy (IT) can stop progression of sensitization to additional environmental allergens in children monosensitized to house dust mites. Study Population. One hundred thirty-four children ages 5 to 8 years, …

1. Iacono G, 2. Cavataio F, 3. Montalto G, 4. Soresi M, 5. Notarnartolo A, 6. Carroccio A (1998) Clin Exp Allergy. 28:817–823. [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] #### Purpose of the Study To investigate the natural history of cow milk protein intolerance (CMPI) in infants. ##### Study Population Twelve infants (6 boys and 6 girls) with persistent CMPI were followed from birth until a median age of 5 years. Controls were 26 children (12 boys, 14 girls), median age 6 years, with CMPI that resolved within 1 to 2 years. ##### Methods A retrospective chart review of patients with CMPI followed over a period of 7 years. Clinical suspicion of CMPI was confirmed by a double-blinded, placebo-controlled, food challenge (DBPCFC), within 4 to 6 weeks after onset of symptoms, after the patients had followed a CMP-free diet. The immunologic status of the study subjects was evaluated at baseline, including total serum immunoglobulin E, … [1]: {openurl}?query=rft.jtitle%253DClinical%2Band%2Bexperimental%2Ballergy%2B%253A%2B%2Bjournal%2Bof%2Bthe%2BBritish%2BSociety%2Bfor%2BAllergy%2Band%2BClinical%2BImmunology%26rft.stitle%253DClin%2BExp%2BAllergy%26rft.aulast%253DIacono%26rft.auinit1%253DG.%26rft.volume%253D28%26rft.issue%253D7%26rft.spage%253D817%26rft.epage%253D823%26rft.atitle%253DPersistent%2Bcow%2527s%2Bmilk%2Bprotein%2Bintolerance%2Bin%2Binfants%253A%2Bthe%2Bchanging%2Bfaces%2Bof%2Bthe%2Bsame%2Bdisease.%26rft_id%253Dinfo%253Adoi%252F10.1046%252Fj.1365-2222.1998.00334.x%26rft_id%253Dinfo%253Apmid%252F9720815%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1046/j.1365-2222.1998.00334.x&link_type=DOI [3]: /lookup/external-ref?access_num=9720815&link_type=MED&atom=%2Fpediatrics%2F104%2FSupplement_2%2F362.1.atom [4]: /lookup/external-ref?access_num=000075104800007&link_type=ISI

1. Eggleston PA, 2. Rosenstreich D, 3. Lynn H, 4. et al. (1998) J Allergy Clin Immunol. 102:563–569. [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] #### Purpose of the Study To determine whether there was a dose response between exposure to dust mite, cockroach and cat and sensitization to these allergens in inner-city children. ##### Study Population Five hundred children participating in the National Cooperative Inner City Asthma Study. ##### Methods Children were prick skin-tested with a Multi Test device. Samples of home dust were collected from the floor and furniture in the kitchen, bedroom and living room, and the levels of major allergens for dust mite ( Der p 1, Der f 1 ), cockroach ( Bla g 1 ) and … [1]: {openurl}?query=rft.jtitle%253DJournal%2Bof%2BAllergy%2Band%2BClinical%2BImmunology%26rft.stitle%253DJournal%2Bof%2BAllergy%2Band%2BClinical%2BImmunology%26rft.aulast%253DEggleston%26rft.auinit1%253DP.%2BA.%26rft.volume%253D102%26rft.issue%253D4%2BPt%2B1%26rft.spage%253D563%26rft.epage%253D570%26rft.atitle%253DRelationship%2Bof%2Bindoor%2Ballergen%2Bexposure%2Bto%2Bskin%2Btest%2Bsensitivity%2Bin%2Binner-city%2Bchildren%2Bwith%2Basthma.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0091-6749%252898%252970272-6%26rft_id%253Dinfo%253Apmid%252F9802363%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1016/S0091-6749(98)70272-6&link_type=DOI [3]: /lookup/external-ref?access_num=9802363&link_type=MED&atom=%2Fpediatrics%2F104%2FSupplement_2%2F382.2.atom [4]: /lookup/external-ref?access_num=000076600400005&link_type=ISI