Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel.

Food allergy is an important public health problem that affects children and adults and may be increasing in prevalence. Despite the risk of severe allergic reactions and even death, there is no current treatment for food allergy: the disease can only be managed by allergen avoidance or treatment of symptoms. The diagnosis and management of food allergy also may vary from one clinical practice setting to another.

Peanut allergy: Clinical and immunologic differences among patients from 3 different geographic regions.

Background: Peanut allergy affects persons from various geographic regions where populations are exposed to different dietary habits and environmental pollens.

Objective: We sought to describe the clinical and immunologic characteristics of patients with peanut allergy from 3 countries (Spain, the United States, and Sweden) using a molecular component diagnostic approach.

Methods: Patients with peanut allergy from Madrid (Spain, n = 50), New York (United States, n = 30), Gothenburg, and Stockholm (both Sweden, n = 35) were enrolled.

Maternal consumption of peanut during pregnancy is associated with peanut sensitization in atopic infants.

Background: Peanut allergy is typically severe, lifelong, and prevalent.

Objective: To identify factors associated with peanut sensitization.

Methods: We evaluated 503 infants 3 to 15 months of age (mean, 9.

Identification of IgE sequential epitopes of lentil (Len c 1) by means of peptide microarray immunoassay.

Background: Lentils are often responsible for allergic reactions to legumes in Mediterranean children. Although the primary sequence of the major allergen Len c 1 is known, the location of the IgE-binding epitopes remains undefined.

Objective: We sought to identify IgE-binding epitopes of Len c 1 and relate epitope binding to clinical characteristics.

Perennial allergen-specific immunoglobulin E levels among inner-city elderly asthmatics.

Background: The role of allergen sensitization has been well established among children and young adults with asthma. Some studies have suggested that allergens play a less important role among older patients with asthma. However, whether older asthmatics have a lower prevalence of allergen sensitization than younger adults remains controversial.

Safety, tolerability, and immunologic effects of a food allergy herbal formula in food allergic individuals: a randomized, double-blinded, placebo-controlled, dose escalation, phase 1 study.

Background: Food allergy is a common and serious health problem. A new herbal product, called food allergy herbal formula 2 (FAHF-2), has been demonstrated to have a high safety profile and potent long-term efficacy in a murine model of peanut-induced anaphylaxis.

Objective: To evaluate the safety and tolerability of FAHF-2 in patients with food allergy.

Oral peanut immunotherapy in children with peanut anaphylaxis.

Background: The only treatment option for peanut allergy is strict avoidance.

Objective: To investigate efficacy and safety of oral immunotherapy (OIT) in peanut allergy.

Methods: Twenty-three children (age, 3.

Targeting Toll-like receptors on dendritic cells modifies the T(H)2 response to peanut allergens in vitro.

Background: Delivery of allergens with bacterial adjuvants has been shown to be a successful immunotherapeutic strategy for food allergy treatment in animal models. How microbial signals, acting through the innate immune system, reshape ongoing allergic responses is poorly understood.

Objective: To investigate the contribution of Toll-like receptors (TLRs) in the response to bacterial adjuvants, we designed an in vitro system to characterize the effect of heat-killed Escherichia coli vector (HKE) on peanut-induced responses of dendritic cells (DCs) and T cells.

Greater epitope recognition of shrimp allergens by children than by adults suggests that shrimp sensitization decreases with age.

Background: Shellfish allergy is a long-lasting disorder typically affecting adults. Despite its high prevalence, there is limited information about allergenic shrimp proteins and the epitopes implicated in such allergic reactions.

Objective: We sought to identify the IgE-binding epitopes of the 4 shrimp allergens and to characterize epitope recognition profiles of children and adults with shrimp allergy.

US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up.

Background: Allergy to peanuts and tree nuts (TNs) is the leading cause of fatal allergic reactions in the United States, and the prevalence appears to be increasing.

Objectives: We sought to determine the US prevalence of self-reported peanut, TN, and sesame allergy in 2008 and compare results with comparable surveys conducted in 1997 and 2002.

Methods: A nationwide, cross-sectional, random telephone survey for peanut and TN allergy was conducted with a previously used questionnaire, with additional questions about sesame.

Early recovery from cow's milk allergy is associated with decreasing IgE and increasing IgG4 binding to cow's milk epitopes.

Background: The dynamics and balance of allergen-specific IgE, IgG4, and IgA binding might contribute to the development of tolerance in patients with cow's milk allergy (CMA). Profiling of antibody binding to cow's milk (CM) protein epitopes might help in predicting the natural history of allergy.

Objective: We sought to investigate differences in IgE, IgG4, and IgA binding to CM epitopes over time between patients with early recovery or with persisting CMA.

Immunologic features of infants with milk or egg allergy enrolled in an observational study (Consortium of Food Allergy Research) of food allergy.

Background: Immune features of infants with food allergy have not been delineated.

Objectives: We sought to explore the basic mechanisms responsible for food allergy and identify biomarkers, such as skin prick test (SPT) responses, food-specific IgE levels, and mononuclear cell responses, in a cohort of infants with likely milk/egg allergy at increased risk of peanut allergy.

Methods: Infants aged 3 to 15 months were enrolled with a positive SPT response to milk or egg and either a corresponding convincing clinical history of allergy to milk or egg or moderate-to-severe atopic dermatitis.

Correlation of IgE/IgG4 milk epitopes and affinity of milk-specific IgE antibodies with different phenotypes of clinical milk allergy.

Background: Results from large-scale epitope mapping with a peptide microarray have been shown to correlate with clinical features of milk allergy.

Objectives: We sought to assess IgE and IgG4 epitope diversity and IgE affinity in different clinical phenotypes of milk allergy and identify informative epitopes that might be predictive of clinical outcomes of milk allergy.

Methods: Forty-one subjects were recruited from a larger study on the effects of ingesting heat-denatured milk proteins in subjects with milk allergy.

Food allergy: recent advances in pathophysiology and treatment.

Food allergies are adverse immune reactions to food proteins that affect up to 6% of children and 3-4% of adults. A wide range of symptoms can occur depending on whether IgE or non-IgE mediated mechanism are involved. Many factors influence the development of oral tolerance, including route of exposure, genetics, age of the host, and allergen factors.

Food allergy.

Adverse immune responses to foods affect approximately 5% of young children and 3% to 4% of adults in westernized countries and appear to have increased in prevalence. Food-induced allergic reactions are responsible for a variety of symptoms and disorders involving the skin and gastrointestinal and respiratory tracts and can be attributed to IgE-mediated and non-IgE-mediated (cellular) mechanisms. Genetic disposition and environmental factors might abrogate oral tolerance, leading to food allergy.

Epinephrine treatment is infrequent and biphasic reactions are rare in food-induced reactions during oral food challenges in children.

Background: Data about epinephrine use and biphasic reactions in childhood food-induced anaphylaxis during oral food challenges are scarce.

Objective: To determine the prevalence and risk factors of reactions requiring epinephrine and the rate of biphasic reactions during oral food challenges (OFCs) in children.

Methods: Reaction details of positive OFCs in children between 1999 and 2007 were collected by using a computerized database.

Linear IgE-epitope mapping and comparative structural homology modeling of hazelnut and English walnut 11S globulins.

Allergic reactions to walnuts and hazelnuts can be serious. The 11S globulins (legumins) have been identified as important allergens in these and other nuts and seeds. Here we identify the linear IgE-binding epitopes of walnut and hazelnut 11S globulins, and generate 3D 11S globulin models to map the locations of the epitopes for comparison to other allergenic homologues.

Asthma morbidity among inner-city adolescents receiving guidelines-based therapy: role of predictors in the setting of high adherence.

Background: With the expanding effort to provide guidelines-based therapy to adolescents with asthma, attention must be directed to evaluating which factors predict future asthma control when guidelines-based management is applied.

Objective: We evaluated the role of fraction of exhaled nitric oxide in parts per billion, markers of allergic sensitization, airway inflammation, and measures of asthma severity in determining future risk of asthma symptoms and exacerbations in adolescents and young adults participating in the Asthma Control Evaluation study.

Methods: Five hundred forty-six inner-city residents, ages 12 through 20 years, with persistent asthma were extensively evaluated at study entry for predictors of future symptoms and exacerbations over the subsequent 46 weeks, during which guidelines-based, optimal asthma management was offered.

Development of a novel peptide microarray for large-scale epitope mapping of food allergens.

Background: The peptide microarray is a novel assay that facilitates high-throughput screening of peptides with a small quantity of sample.

Objective: We sought to use overlapping peptides of milk allergenic proteins as a model system to establish a reliable and sensitive peptide microarray-based immunoassay for large-scale epitope mapping of food allergens.

Methods: A milk peptide microarray was developed by using commercially synthesized peptides (20-mers, 3 offset) covering the primary sequences of alpha(s1)-casein, alpha(s2)-casein, beta-casein, kappa-casein, and beta-lactoglobulin.

The role of immunoglobulin E-binding epitopes in the characterization of food allergy.

Purpose Of Review: Allergen-specific immunoglobulin E (IgE) antibodies play a central role in food allergic reactions. IgE epitope mapping of food allergens may provide information regarding patient's clinical history and contribute to food allergy diagnosis/prognosis. The goal of this article is to review recent developments in the methods for IgE epitope mapping and the role of IgE-binding epitopes in the characterization of food allergy.

Sarcoplasmic calcium-binding protein is an EF-hand-type protein identified as a new shrimp allergen.

Background: Shellfish allergy is a long-lasting disorder usually persisting throughout life. Despite its high prevalence, there is limited information about allergenic shrimp proteins.

Objective: Characterization of shrimp allergens.

The Urban Environment and Childhood Asthma (URECA) birth cohort study: design, methods, and study population.

Background: The incidence and morbidity of wheezing illnesses and childhood asthma is especially high in poor urban areas. This paper describes the study design, methods, and population of the Urban Environment and Childhood Asthma (URECA) study, which was established to investigate the immunologic causes of asthma among inner-city children.

Methods And Results: URECA is an observational prospective study that enrolled pregnant women in central urban areas of Baltimore, Boston, New York City, and St.