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BACKGROUND: Worldwide, vegan and vegetarian lifestyles, as well as food allergies and intolerance (e.g. lactose intolerance and milk protein allergy) demand the development of alternatives to dairy‐based probiotic foods. In the present study, probiotic Lacticaseibacillus casei CECT 9104 was added to alginate‐based edible coatings enriched with inulin and oligofructose and applied to fresh‐cut apple. Microbiological, physicochemical and sensory quality parameters of the apple cubes were monitored during 8 days of refrigerated storage. Lacticaseibacillus casei was tested for its antagonistic effect against inoculated Listeria innocua and Escherichia coli O157:H7. The viability of the probiotic strain during refrigerated storage and after simulated gastrointestinal digestion (GID) was evaluated. RESULTS: After 8 days of storage, 9.52–9.64 log colony‐forming units (CFU) g−1 of L. casei were detected in apple samples. The functional apple cubes retained 8.31–8.43 log CFU g−1 of the probiotic after GID, without a significant effect of prebiotic addition. The microbiological quality and nutritional properties were maintained by the use of active coatings, whereas the sensory quality decreased after 8 days of storage. A bactericidal effect was exerted by the probiotic strain loaded in the coating against L. innocua artificially inoculated on apple cubes. Escherichia coli O157:H7 counts were reduced by 2.5 log after 8 days. CONCLUSION: This study has demonstrated the suitability of apple cubes as an alternative matrix to milk for carrying probiotic L. casei CECT 9104 and prebiotics, offering a promising alternative for the development of plant‐based functional foods. © 2024 Society of Chemical Industry. [ABSTRACT FROM AUTHOR]

What infants eat early in life may shape the immune system and have long‐standing consequences on the health of the host during later life. In the early months post‐birth, breast milk serves as the exclusive and optimal nourishment for infants, facilitating crucial molecular exchanges between mother and infant. Recent advances have uncovered that some maternal factors influence breastfed infant outcomes, including the risk of food allergy (FA). To date, accumulated data show that breastfed infants have a lower risk of FA. However, the issue remains disputed, some reported preventive allergy effects, while others did not confirm such effects, or if identified, protective effects were limited to early childhood. The disputed outcomes may be attributed to the maternal status, as it determines the compounds of the breast milk that breastfed infants are exposed to. In this review, we first detail the compounds in breast milk and their roles in infant FA. Then, we present maternal factors resulting in alterations in breast milk compounds, such as maternal health status, maternal diet intake, and maternal food allergen intake, which subsequently impact FA in breastfed infants. Finally, we analyze how these compounds in breast milk alleviated the infant FA by mother‐to‐infant transmission. Altogether, the mechanisms are primarily linked to the synergetic and direct effects of compounds in breast milk, via promoting the colonization of gut microbiota and the development of the immune system in infants. [ABSTRACT FROM AUTHOR]

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]

Plant‐based milk is becoming an increasingly important component in developing new food items. Hemp seed has anti‐inflammatory effects and a high protein content, which gives health advantages. Hemp milk is a suitable alternative for those with allergies to milk protein and lactose or concerns about cholesterol. However, optimal extraction conditions for hemp milk are not well documented. This study utilized a response surface methodology (RSM) based on a Central composite rotatable design (CCRD) to optimize the variables of soaking time (A), heating time (B), and temperature (C) for hemp milk production. The study measured levels of antinutrients such as phytic acid, tannins, and saponins, as well as nutrients like fat and protein. Regression models were developed to analyze these factors, and their effectiveness was evaluated using a lack of fit test and the coefficient of variation (R2). The study found that soaking duration, extraction time, and temperature had a substantial (p < 0.05) influence on responses. The optimal soaking period, extraction time, and temperature for best hemp seed milk production are as follows: soaking period of approximately 9 h, heating time in a water bath for almost 60 min, and heating temperature of 48°C. The experimental findings confirmed the accuracy of the predicted models within a satisfactory response range. Additionally, the results suggest that the formulated model is effective for enhancing milk production and achieving consistent quality. [ABSTRACT FROM AUTHOR]

The article "Linking Macronutrient Composition of Common Allergenic Foods to European and North American Food Allergy Prevalence" explores the relationship between macronutrient profiles of common allergenic foods and food allergy prevalence in Europe and North America. The study found that higher protein and glycine contents in allergenic foods were negatively correlated with food allergy prevalence, while carbohydrate and fat contents showed no association. The research suggests that total protein and glycine contents in common allergenic foods may influence food allergy development, prompting further investigation into the role of macronutrients in food allergies. [Extracted from the article]

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]

Summary: This manuscript sheds light on the impact of maternal breast milk antibodies on infant health. Milk antibodies prepare and protect the newborn against environmental exposure, guide and regulate the offspring's immune system, and promote transgenerational adaptation of the immune system to its environment. While the transfer of IgG across the placenta ceases at birth, milk antibodies are continuously replenished by the maternal immune system. They reflect the mother's real‐time adaptation to the environment to which the infant is exposed. They cover the infant's upper respiratory and digestive mucosa and are perfectly positioned to control responses to environmental antigens and might also reach their circulation. Maternal antibodies in breast milk play a key role in the immune defense of the developing child, with a major impact on infectious disease susceptibility in both HIC and LMIC. They also influence the development of another major health burden in children—allergies. Finally, emerging evidence shows that milk antibodies also actively shape immune development. Much of this is likely to be mediated by their effect on the seeding, composition and function of the microbiota, but not only. Further understanding of the bridge that maternal antibodies provide between the child and its environment should enable the best interventions to promote healthy development. [ABSTRACT FROM AUTHOR]

Diagnosis of infant feeding problems can be challenging due to limited examination findings, few options of diagnostic tests and overlying symptoms. While contrasting colic, CMPA and reflux, this article highlights the overlapping symptoms of each condition and seeks to analyse the differences to provide a framework for diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Fat and protein derived from milk are prime ingredients in a frozen dessert such as ice cream conferring multiple desirable functionalities. However, this frozen dairy dessert is not suitable for individuals having lactose intolerance, cow milk allergy, or vegans. Hence, the study aimed to formulate dairy‐free frozen desserts using plant oils and plant proteins and compare their physicochemical characteristics and sensory acceptance against an ice cream containing milk fat and milk protein. Results indicated that the types of protein significantly influenced the physicochemical properties and sensory acceptance of the frozen dessert samples. Frozen desserts containing brown rice, pea, and soy protein showed greater resistance to melting (0.29, 0.12, and 0.19%/min vs. 1.95%/min), but they scored lower in sensory quality than ice cream made with milk protein; although they remained at an acceptable level. When compared among the plant proteins, the physicochemical characteristics of frozen desserts containing brown rice, pea, and soy protein varied because of the differences in the respective protein composition. Frozen dessert with brown rice protein showed higher overrun (47.50% vs. 40.78% and 37.8%), lower hardness (20.02 N vs. 22.24 and 26.37 N), and higher melting rate (0.29%/min vs. 0.19 and 0.12%/min) than frozen desserts containing soy and pea protein. Additionally, the brown rice protein frozen dessert received lower sensory acceptance than soy and pea protein frozen desserts. In summary, brown rice, pea, and soy proteins showed potential to be used as viable alternatives to milk protein for dairy‐free frozen dessert applications. [ABSTRACT FROM AUTHOR]

Milk protein sensitivity is a major challenge in infant feeding, especially for infants who cannot receive adequate breastfeeding. Hydrolyzed milk protein is a mainstream way to address this difficulty. The aim of this study was to assess the effect of differences in whey protein concentrate (WPC) source and the degree of hydrolysis on blocking allergy and to analyze the possible mechanisms by which hydrolyzed infant formula (IF) blocks allergy through colony‐metabolism–immunity response. First, we prepared six groups of goat's milk IF with unhydrolyzed, partially, and extensively hydrolyzed WPC, which come from cow's milk WPC and goat's milk WPC. Subsequently, we evaluated their effects on allergy. The results showed that the hydrolyzed IF improved the allergic characteristics of mice, including low levels of total immunoglobulin E (IgE), specific IgE, histamine, and mucosal mast cell protease‐1 (mMCP‐1). Furthermore, the hydrolyzed IF promoted the immune response of T helper 1 (Th1) and regulatory T (Treg) cells by enhancing the messenger RNA (mRNA) expression of T‐box transcription factor 21 (T‐bet) and forkhead box protein P3 (Foxp3), which in turn suppressed the T helper 2 (Th2) overexpressed immune response in allergy (GATA‐binding protein 3 (GATA‐3) and retinoic‐acid‐receptor‐related orphan receptor gamma t (RORγt) mRNA expression, as well as interleukin 4 (IL‐4) and interleukin 5 (IL‐5) levels). Hydrolyzed IF promoted an increase in beneficial gut microbe Lactobacillus and Alistipes, which in turn promoted an increase in intestinal butyrate levels. The beneficial bacteria and their metabolized butyrate may have suppressed the abundance of the allergy‐characterizing bacterium Rikenellaceae‐RC9‐gut‐group. The final result we obtained was that for both cow's milk WPC and goat's milk WPC, at similar levels of hydrolysis, they did not bring about a significant effect on allergy symptoms. The hydrolyzed IF improved the allergic characteristics of mice, the deeper the degree of hydrolysis of WPC, the more obvious the effect of reducing allergic symptoms in model mice. [ABSTRACT FROM AUTHOR]

The article discusses the management of mild hematochezia in infants under 6 months, focusing on the potential causes and treatment options. It introduces a new approach called the Rapid Elimination Diet (RED) that involves eliminating seven suspect foods from the mother's diet simultaneously for one week. The article also highlights the debate surrounding the necessity of an elimination diet for infants with hematochezia and suggests alternative management options. Additionally, it emphasizes the need for further research to determine the prevalence of food allergies as a cause of rectal bleeding in infants. [Extracted from the article]

Background: Cow's milk allergy (CMA) overdiagnosis appears to be increasing and is associated with excessive low‐allergy formula prescription. We evaluated recent trends and regional variation in low‐allergy formula prescribing for CMA in England, and assessed potential risk factors for higher prescribing rates. Methods: Data on national and regional prescribing of low‐allergy formulas were extracted from England's electronic prescription database using R. Region‐level factors were evaluated for potential associations with regional low‐allergy formula prescription rates using multivariate linear regression. Analysis of national prescribing trends covered 2007–2023, analysis of regional variation and region‐level factors examined 2017–2019, prior to a re‐organisation of the regional healthcare structure in England. Results: Low‐allergy formula prescribing increased from 6.1 to 23.3 L per birth nationally, between 2007 and 2023. Regional prescribing rate varied from 0.8 to 47.6 L per birth in 2017–2019. We found significant associations between regional low‐allergy formula prescribing rate and regional prescribing rates for milk feed thickeners Gaviscon Infant and Carobel Instant (β = 0.10, p < 0.01), and for other anti‐reflux medications used in young children (β = 0.89 p < 0.01). Inconsistent associations were seen with prescribing junior adrenaline auto‐injectors and oral antibiotics. A model including these four variables accounted for 37% of regional variation in low‐allergy formula prescribing rate. Region‐level socio‐economic deprivation, CMA guideline recommendations and paediatric allergy service provision were not associated with low‐allergy formula prescribing. Conclusions: Low‐allergy formula prescribing in England is increasing, varies significantly by region and is consistently associated with prescribing rates for milk feed thickeners and other anti‐reflux medication for young children. Community prescribing behaviours may be important determinants of CMA overdiagnosis. [ABSTRACT FROM AUTHOR]

Background: Food protein‐induced enterocolitis syndrome (FPIES) is a food allergy primarily affecting infants, often leading to vomiting and shock. Due to its poorly understood pathophysiology and lack of specific biomarkers, diagnosis is frequently delayed. Understanding FPIES genetics can shed light on disease susceptibility and pathophysiology—key to developing diagnostic, prognostic, preventive and therapeutic strategies. Using a well‐characterised cohort of patients we explored the potential genome‐wide susceptibility factors underlying FPIES. Methods: Blood samples from 41 patients with oral food challenge‐proven FPIES were collected for a comprehensive whole exome sequencing association study. Results: Notable genetic variants, including rs872786 (RBM8A), rs2241880 (ATG16L1) and rs2289477 (ATG16L1), were identified as significant findings in FPIES. A weighted SKAT model identified six other associated genes including DGKZ and SIRPA. DGKZ induces TGF‐β signalling, crucial for epithelial barrier integrity and IgA production; RBM8A is associated with thrombocytopenia absent radius syndrome, frequently associated with cow's milk allergy; SIRPA is associated with increased neutrophils/monocytes in inflamed tissues as often observed in FPIES; ATG16L1 is associated with inflammatory bowel disease. Coexpression correlation analysis revealed a functional correlation between RBM8A and filaggrin gene (FLG) in stomach and intestine tissue, with filaggrin being a known key pathogenic and risk factor for IgE‐mediated food allergy. A transcriptome‐wide association study suggested genetic variability in patients impacted gene expression of RBM8A (stomach and pancreas) and ATG16L1 (transverse colon). Conclusions: This study represents the first case–control exome association study of FPIES patients and marks a crucial step towards unravelling genetic susceptibility factors underpinning the syndrome. Our findings highlight potential factors and pathways contributing to FPIES, including epithelial barrier dysfunction and immune dysregulation. While these results are novel, they are preliminary and need further validation in a second cohort of patients. [ABSTRACT FROM AUTHOR]

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 article discusses a case of allergic contact dermatitis in an adoptive mother who developed eczema on her nipples, areolas, and fingers after using a supplemental nursing system (SNS) with infant formula to breastfeed her adopted baby. Patch testing revealed a positive reaction to the formula and nickel, with suspicions raised about metal contamination during formula preparation. The patient's eczema healed with corticosteroid treatment, and she remained lesion-free during a 14-month follow-up. This case underscores the importance of considering ACD from infant formula as a potential cause of nipple eczema in breastfeeding mothers, especially those using SNS. [Extracted from the article]

Background: Infants aged <1 year with confirmed food allergies generally need to avoid causative foods completely for a certain period. Low‐dose oral food challenges (LD‐OFCs) may be an effective strategy for safely introducing small amounts of causative foods to individuals with food allergies. This study clarified the safety of LD‐OFCs in infants aged <1 year with food allergies. Methods: We retrospectively analyzed the clinical records of LD‐OFCs performed in infants aged <1 year allergic to hen's egg, cow's milk, or wheat between April 2014 and October 2017. Approximately 1/25th–1/20th of the egg white from a heated whole hen's egg, 3 mL heated cow's milk, and 2 g wheat noodles (udon) were used as challenge foods. We examined the LD‐OFC results, including the induced symptoms and treatment required for positive LD‐OFC results. Results: The LD‐Egg, LD‐Milk, and LD‐Wheat OFC groups comprised 68, 42, and 13 participants, respectively. The positivity rates for the LD‐Egg, LD‐Milk, and LD‐Wheat OFC groups were 7%, 24%, and 0%, respectively. Patients predominantly exhibited skin symptoms, and most were treated with oral antihistamines alone. None of the patients experienced anaphylaxis or required adrenaline injections. Conclusions: Infants aged <1 year with food allergies can safely undergo LD‐OFCs by consuming low doses of causative foods. Avoiding the complete elimination of causative foods is an important strategy for managing infants with food allergies when initially introducing causative foods. [ABSTRACT FROM AUTHOR]

Background: Consumption of raw cow's milk has repeatedly been shown to protect from asthma, allergies, and respiratory infections. As raw milk bears potential health hazards, it cannot be recommended for prevention. Therefore, we performed an intervention study with microbially safe but otherwise minimally processed cow's milk. Here we describe feasibility and safety of the trial. Methods: The MARTHA trial (DRKS00014781) was set up as a double‐blind randomized intervention in a population residing in Bavaria. Infants from 6 to 36 months of age consumed minimally processed cow's milk (intervention arm) or ultra‐heat‐treated (UHT) semi‐skimmed milk (comparator arm). Results: At the age of 6 to 12 months, 260 infants were enrolled, with 72% having a family history of atopy. The extensive screening system for milk consumption and symptoms suggestive of adverse events was well accepted with 22,988 completed weekly surveys and an average completion of 82% surveys sent out. The children consumed the study milk on average on 457 days (61% of intervention days). The intervention proved to be safe without any case of milk allergy or milk intolerance under the intervention in both arms. All 6 cases of serious adverse events were unrelated to milk. The most common reason was unscheduled hospitalization of more than 3 days. Conclusions: The intervention with minimally processed milk and the study instruments proved feasible. During the age of 6 to 36 months, there was no increased risk of milk allergy in a population with a substantial proportion of family history of atopy. [ABSTRACT FROM AUTHOR]

The study conducted at a UK allergy clinic focused on patch testing in cutaneous adverse drug reactions to evaluate its effectiveness in diagnosing these reactions. The British Registry of Immunotherapy (BRIT) was used to monitor patient outcomes and safety in venom immunotherapy (VIT) protocols, with high patient engagement and excellent compliance observed. A dietitian-led rapid access clinic for non-IgE-mediated cow's milk allergy (CMA) successfully confirmed diagnoses, reduced unnecessary hydrolyzed formula (HF) prescribing, and improved patient outcomes. The importance of thorough testing, diagnosis, and individualized care in managing allergies, such as salmon roe and shellfish allergy, was highlighted in a case study on refractory severe asthma in children. [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]

Summary: Cow milk protein allergy (CMPA) is one of the most common food allergies in the pediatric age worldwide. Prevalence, persistence, and severity of this condition are on the rise, with a negative impact on the health‐related quality of life of the patients and families and on the costs related to its management. Another relevant issue is that CMPA in early life may be the first stage of the "allergic march," leading to the occurrence of other atopic manifestations later in life, especially asthma, atopic eczema, urticaria, and rhinoconjunctivitis. Thus, "disease modification" options that are able to modulate the disease course of pediatric patients affected by CMPA would be very welcomed by affected families and healthcare systems. In this review, we report the most relevant progress on this topic. [ABSTRACT FROM AUTHOR]

Summary: The prevalence of allergies has been globally escalating. While allergies could appear at any age, they often develop in early life. However, the significant knowledge gap in the field is the mechanisms by which allergies affect certain people but not others. Investigating early factors and events in neonatal life that have a lasting impact on determining the susceptibilities of children to develop allergies is a significant area of the investigation as it promotes the understanding of neonatal immune system that mediates tolerance versus allergies. This review focuses on the research over the recent 10 years regarding the potential maternal factors that influence offspring allergies with a view to food allergy, a potentially life‐threatening cause of anaphylaxis. The role of breast milk, maternal diet, maternal antibodies, and microbiota that have been suggested as key maternal factors regulating offspring allergies are discussed here. We also suggest future research area to expand our knowledge of maternal–offspring interactions on the pathogenesis of food allergy. [ABSTRACT FROM AUTHOR]

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 compares the efficacy and safety of two methods, the Milk Ladder (ML) and early oral immunotherapy (E-OIT), for managing cow's milk protein allergy (CMPA) in infants. The ML method involves stepwise exposure to milk-containing foods, while E-OIT gradually increases the use of pure cow's milk protein. The study found that both methods were equally effective in improving CMP tolerance, but the ML method facilitated the intake of processed foods better than E-OIT. Adverse event rates were similar in both groups, but careful monitoring is necessary to prevent anaphylaxis. The study acknowledges its limitations, such as a small sample size and lack of blinding, and suggests the need for further research. [Extracted from the article]

In pursuit of expanding dietary options for those with allergies, we aimed to develop a low‐allergenic fermented milk beverage. We adopted a combination fermentation strategy to enhance the allergy mitigation efficacy of 4 strains of lactic acid bacteria. Our fermentation conditions were optimised with an equal ratio (1:1:1:1) of strains, a total 5% inoculation rate and fermentation at 40°C for 6.5 h. Under conditions, the antigen reduction rates for α‐lactalbumin (α‐LA), β‐lactoglobulin (β‐LG), α‐casein and β‐casein were impressive, ranging from 43.54 to 70.51%. A 28‐day storage assessment showed that the reduction rates of the 4 antigens ranged from 38.98% to 78.06%. Most importantly, it was found through indirect competitive ELISA that the binding ability of immunoglobulin E to α‐LA and β‐LG, which we are concerned about, was significantly reduced compared to the unfermented sample. Notable, the beverage maintained favorable physicochemical properties throughout the storage period. [ABSTRACT FROM AUTHOR]

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]

This document summarizes a study on the relationship between atopic dermatitis (AD) and IgE-mediated food allergy (FA) in children. The study found that children with AD were more likely to develop FA, and vice versa. However, the study had limitations, such as not assessing the severity of AD and having a small sample size for cases of FA. The findings suggest that AD and FA may be related and further research is needed to understand and address these conditions. [Extracted from the article]

This article provides information on the characteristics and diagnosis of Wiskott-Aldrich syndrome (WAS), a primary immunodeficiency disorder. It highlights that while low mean platelet volume (MPV) is typical for WAS, normal MPV values can be observed in some patients at the time of diagnosis. The article presents case reports of infants with thrombocytopenia and normal MPV values, emphasizing the importance of accurate diagnosis and distinguishing WAS from other conditions. It also discusses the potential misdiagnosis of WAS in infants with rectal bleeding and eczema, particularly when cow's milk protein allergy (CMPA) is considered. The article concludes by emphasizing the need for further research and awareness of WAS to improve diagnosis and treatment outcomes. [Extracted from the article]

Background: Although rare, allergic reactions to metal implants represent a diagnostic challenge in view of missing guidelines. Objectives: To develop an European expert consensus on characteristics of metal allergy reactions and the utility of various diagnostic tools in suspected metal implant allergy. Methods: A nominal group technique (NGT) was applied to develop consensus statements. Initially an online literature database was created on a secure server to enable a comprehensive information. Twenty‐three statements were formulated on potential aspects of metal implant allergy with a focus on diagnostics and grouped into five domains. For the consensus development, the panel of 12 experts initially did refine and reformulate those statements that were ambiguous or had unclear wording. By face‐to‐face (9/12) or virtual participation (3/12), an anonymous online voting was performed. Results: Consensus (≥80% of agreement) was reached in 20/23 statements. The panel agreed that implant allergy despite being rare should be considered in case of persistent unexplained symptoms. It was, however, recommended to allow adequate time for resolution of symptoms associated with healing and integration of an implant. Obtaining questionnaire‐aided standardized medical history and standardized scoring of patient outcomes was also considered an important step by all experts There was broad consensus regarding the utility/performance of patch testing with additional late reading. It was recognized that the lymphocyte transformation test (LTT) has to many limitations to be generally recommended. Prior to orthopaedic implant, allergy screening of patients without a history of potential allergy to implant components was not recommended. Conclusions: Using an expert consensus process, statements concerning allergy diagnostics in suspected metal implant allergy were created. Areas of nonconsensus were identified, stressing uncertainty among the experts around topics such as preoperative testing in assumed allergy, histological correlate of periimplant allergy and in vitro testing, which underscores the need for further research. [ABSTRACT FROM AUTHOR]

The document outlines the KITY Study Protocol, a randomized controlled trial focusing on preventing eczema in high-risk neonates by ingesting kestose. The study aims to investigate the impact of kestose versus maltose supplementation in the first five months of life. By addressing the skin-gut axis, gut microbiota, and prebiotics like kestose, the study seeks to provide insights into preventive measures for eczema. The research emphasizes the importance of a balanced gut microbiota in preventing the development of eczema, highlighting the potential role of kestose in modulating microbiomes to manage allergic diseases. [Extracted from the article]

The article highlights the research findings presented at the British Society of Allergy and Clinical Immunology (BSACI) conference in 2024. The winners in various categories presented their research, including understanding allergen content in immunotherapy, exploring parents' perspectives on education models for allergic reactions, diagnosing cow's milk allergy in infants, patch testing for cutaneous adverse drug reactions, and investigating the impact of gas flaring on lung function in children in Nigeria. The research covers a wide range of topics related to allergy and asthma, emphasizing the importance of tailored treatments, effective education models, accurate diagnostics, and environmental factors affecting health. [Extracted from the article]

The article discusses a study on the diagnostic accuracy of milk component IgE/IgG4 levels in diagnosing cow milk protein allergy in sensitized children. The study found that milk protein and component IgE/IgG4 ratios were more clinically relevant than IgE or IgG4 alone, with casein IgE/IgG4 ratio showing the best diagnostic value. The research suggests that these ratios could be potential markers for cow milk protein allergy, but further studies are needed to validate their role. [Extracted from the article]

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]

The article discusses the health hazards associated with plant-based and dairy-free drinks marketed as 'growing up' or 'toddler' milks for young children. These products, high in free sugars, are advised against due to their potential contribution to dental decay, overweight, and obesity. The lack of regulations on marketing these products raises concerns, especially with the increasing popularity of plant-based alternatives. The authors recommend clear information dissemination and product reformulation to limit free sugars content to align with public health recommendations. [Extracted from the article]

Consumer health concerns in recent years have spurred a shift from dairy consumption to dairy‐free or plant‐based diets. Factors such as lactose intolerance, milk allergies, ethical concerns, environmental sustainability, and personal health preferences drive this trend. Millet milk offers a viable alternative for cattle milk like any other plant‐based milk. Compared to other plant‐based milk alternatives, millet milk has a better nutritional profile. Moreover, the extracted millet milk can be used for the development of various value‐added products. Millet, being a potential source of antinutritional factors, requires pretreatments before milk extraction. This review discusses in detail the nutritional profile of millets along with the pretreatments to reduce the antinutritional factors in millets, followed by the extraction of millet milk. The comparative study of millet milk versus other plant‐based milks has also been explored. The potential usage of millet milk for further value addition has also been highlighted in the present article. [ABSTRACT FROM AUTHOR]

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]

Summary: Casein causes allergic reactions in cow's milk protein allergy (CMPA) individuals. Casein can cross‐react with cows and goats. Hence, a rapid and highly specific technique is required for its detection. The study aims to evaluate and optimise multiple Enzyme‐Linked Immunosorbent Assay (ELISA) approaches for the detection of casein isolated from goat's milk. The study utilised and optimised various ELISA approaches, including direct, indirect and sandwich with various antibodies. Several parameters of ELISA including pre‐treatments of casein, blocking reagent, concentrations of antibodies and background signal were evaluated. The results showed that sandwich ELISA revealed a good signal‐to‐noise ratio at 1 mg mL−1. Indirect ELISA showed a higher signal‐to‐noise ratio without any heat treatment in comparison to the direct ELISA despite utilising an equivalent concentration (i.e., 10 μg mL−1) of goat's milk casein. The findings provide a theoretical foundation for obtaining a high signal‐to‐noise ratio for antigenicity studies of goat's milk casein to minimise its immunological response. [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]

Background: The impact of alternative milk substitutes on the nutritional status of children with cow's milk allergy (CMA), the prevailing cause of food allergies, is unresolved. Methods: A cross‐sectional study was performed in children older than 2 years with IgE‐mediated CMA. Patients' clinical characteristics, anthropometric measurements, dietary intake (by 3‐day food diary), and biochemical markers of nutritional status were assessed. Results: One hundred two children with CMA (68.6% boys; median age, 3.7 years; 51% multiple food allergies) were evaluated. 44.1% of the children consumed plant‐based beverages (PBB), 19.6% therapeutic formula and 36.3% did not consume any milk substitutes. In all age groups, dietary calcium, riboflavin, and vitamin D intake of those who did not use milk substitutes were lower than those who consumed formula or PBB (p <.01). Also in the 2–3 years old age group, dietary zinc (p =.011) and iron intake (p =.004) of the formula‐fed group was higher. Formula‐fed patients had higher levels of 25‐OH vitamin D (μg/L) and serum vitamin B12 (ng/L) than PBB‐fed patients (respectively; p <.001, p =.005) and those who did not consume any milk substitute (p <.001). Patients of all ages who did not utilize a milk substitute failed to obtain an adequate amount of dietary calcium. Conclusion: The use of milk substitutes positively affects dietary calcium, riboflavin, and vitamin D intake in CMA, but their contribution is variable. Those who do not use milk substitutes are at greater risk inadequate of dietary calcium intake. Personalized nutritional advice, given the clinical diversity and the impact of individual differences, is required. [ABSTRACT FROM AUTHOR]

This article examines the occurrence of anaphylaxis in children undergoing oral immunotherapy (OIT) for cow's milk and egg allergies. The study found that 38.1% of patients experienced anaphylaxis during OIT, with a higher rate in cow's milk OIT compared to egg OIT. Most cases of anaphylaxis were mild or moderate and successfully treated with medication. Only one patient had severe anaphylaxis but recovered with prompt treatment. A significant number of patients who experienced anaphylaxis discontinued the treatment, but the achievement of desensitization was similar between those with and without anaphylactic reactions. The study emphasizes the importance of education and additional therapies to improve adherence and outcomes in OIT. [Extracted from the article]

Background: Complete avoidance of milk is the usual management for IgE‐mediated cow's milk protein allergy (CMPA). A baked milk ladder is a method of dietary advancement therapy in IgE‐mediated CMPA in Ireland, while in Spain, avoidance of milk awaiting natural tolerance acquisition through an oral food challenge (OFC) is employed. The aim of this study was to evaluate the use of dietary advancement therapy using a milk ladder compared with complete avoidance of milk for managing IgE‐mediated CMPA. Methods: This is a retrospective chart review of 371 pediatric patients from the population who have been treated for IgE‐mediated CMPA between 2011 and 2020, with the milk ladder (Ireland) or complete avoidance followed by an OFC (Spain). The main outcome was the introduction of cow's milk. Results: Milk ladder patients were 3.67 times more likely to succeed in comparison with milk avoidance (p <.001). Anaphylaxis during the treatment period occurred in 34 patients in the milk avoidance groups, while three patients in the milk ladder group experienced anaphylaxis due to accidental exposure to milk (p <.001). Failure to complete treatment was associated with a higher skin prick test in the milk avoidance group and a raised specific IgE in the milk ladder group. Conclusion: This is the first study that compares outcomes of dietary advancement therapy to complete avoidance for CMPA management, demonstrating that cow's milk can be successfully and safely reintroduced using dietary advancement therapy using a milk ladder. [ABSTRACT FROM AUTHOR]

This article discusses a study on children with severe cow's milk allergy who also have esophageal eosinophilia (EE). The study found that 45.4% of patients had EE, with 21.2% diagnosed with eosinophilic esophagitis (EoE) and 24.2% with asymptomatic esophageal eosinophilia (aEE). The article provides detailed information on the characteristics and outcomes of the patients in the study, including a table showing follow-up information for 15 patients. The study highlights the importance of screening for EE in patients with cow's milk allergy, but notes the challenges in diagnosing and treating the condition. Further research is needed to better understand EE in these patients. [Extracted from the article]

During the last decade, consumers pay much attention to the food they eat. They try to choose functional products that have a beneficial effect on health and well‐being, beyond their typical nutritional function. For this reason, the primary aim of the study was to create a gluten‐free and dairy‐free cereal product with increased polyphenol and fiber content. Microencapsulation technology using freeze‐drying method and trehalose as matrix material was used in order to protect the polyphenols from the degradation during processing. The effect of the content of beta‐glucan concentrate, polyphenol microencapsulation and acai oil on the physicochemical properties of pastry products was studied. Response surface methodology was used to optimize the product formulation. The scope of work included analysis of process efficiency, instrumental analysis of color and texture, analysis of total antioxidant capacity, assessment of the content of polyphenols, flavonoids, and beta‐glucan, volume testing, analysis of the profile of fatty acids and volatile compounds, and assessment of sensory acceptability. Based on the obtained data, a response surface model was developed to determine the optimal recipe for the final product. The predicted data were verified using empirical methods. It was found that the optimal formulation of the product involves incorporating 6.48% polyphenol microcapsules, 7.60% beta‐glucan concentrate and 3.71% acai oil. The final product had higher content of polyphenols and beta‐glucan, as well as higher antioxidant activity compare to conventional product. Moreover, it was characterized by physical characteristics similar to the standard product and high sensory acceptability. Practical applications: Consumers are currently eager to purchase fortified products with beneficial effects on health and well‐being. The developed functional product with increased polyphenol and beta‐glucan content, high antioxidant activity, is anticipated to garner significant consumer acceptance. The product, with its significant health‐promoting and well‐being enhancing properties, along with characteristics similar to conventional products, is poised to effectively meet consumers' needs and expectations. Additionally, it addresses a market void for bakery items tailored specifically for individuals with gluten intolerance, celiac disease, or cow's milk protein allergy. It provides a safe consumption option for these groups, offering a product similar to conventional items found on shelves that they are unable to consume. [ABSTRACT FROM AUTHOR]