Signals from the various immune cells in promoting food allergy-induced eosinophilic esophagitis like disease

Eosinophilic esophagitis (EoE) is a recently recognized esophageal inflammatory disease with clinical manifestations arising from esophageal dysfunction. The etiology of EoE is currently being clarified and food allergy is evolving as the central cornerstone of EoE disease pathogenesis. Given the large number of eosinophils in the esophagus of people with EoE verified by data from murine models EoE is widely considered as the hallmark T-helper type 2 (Th2) disease of the esophagus. It is also known that some eosinophilic inflammation is controlled by other subsets of T cells such as Th9 or Th17 and control is also exerted by type 2 innate lymphoid cells acting together with basophils. In this paper we review results from molecular studies of mouse models in light of the results from the first clinical trials targeting key cytokines in humans and present in-depth molecular understanding of EoE.

Determination of the Effect of the Elimination Diet Applied for Overweight and Obese People with Food Intolerance on Body Composition and Biochemical Parameters

ABSTRACT Food Intolerance, is a reaction against food, but not immunological manner, and may be confused with real food allergies. In this study, effects of special weight-loss diet together with an elimination diet on body composition and biochemical parameters of overweight and obese people who were diagnosed with food intolerance were investigated. The study group consists of 20 patients in total who were followed-up and treated in Yorktest Turkey Laboratory; who were diagnosed with food intolerance, and whose BMI was > 26kg/m2. Bloodletting for these patients was executed with Lancet from their fingertips, and the blood drawn from these patients was assessed via enzyme-linked immunosorbent assay (ELİSA) method, and food reactions of patients were determined for each food. Biochemical parameters of these patients are routine tests, which are necessary for food intolerance tests, and they are analyzed at Yorktest Turkey Laboratory for two times: before and after elimination diet plus special weight-loss diet. It has been determined that, the most common sensivity is obtained against yeast, egg yolk and white, cranberry, cow's milk, chicken, lentils and parsley. Anthropometric measurements and biochemical parameters before and after elimination diet plus special weight-loss diet applied to participants, were significantly improved in statistical manner. Due to positive changes in body composition and biochemical parameters obtained through application of special weight-loss diets together with elimination diet applied to fat and obese people, we think that this diet might be used for medical nutrition treatment of obesity as a treatment option.

Determination of the Effect of the Elimination Diet Applied for Overweight and Obese People with Food Intolerance on Body Composition and Biochemical Parameters

ABSTRACT Food Intolerance, is a reaction against food, but not immunological manner, and may be confused with real food allergies. In this study, effects of special weight-loss diet together with an elimination diet on body composition and biochemical parameters of overweight and obese people who were diagnosed with food intolerance were investigated. The study group consists of 20 patients in total who were followed-up and treated in Yorktest Turkey Laboratory; who were diagnosed with food intolerance, and whose BMI was > 26kg/m2. Bloodletting for these patients was executed with Lancet from their fingertips, and the blood drawn from these patients was assessed via enzyme-linked immunosorbent assay (ELİSA) method, and food reactions of patients were determined for each food. Biochemical parameters of these patients are routine tests, which are necessary for food intolerance tests, and they are analyzed at Yorktest Turkey Laboratory for two times: before and after elimination diet plus special weight-loss diet. It has been determined that, the most common sensivity is obtained against yeast, egg yolk and white, cranberry, cow's milk, chicken, lentils and parsley. Anthropometric measurements and biochemical parameters before and after elimination diet plus special weight-loss diet applied to participants, were significantly improved in statistical manner. Due to positive changes in body composition and biochemical parameters obtained through application of special weight-loss diets together with elimination diet applied to fat and obese people, we think that this diet might be used for medical nutrition treatment of obesity as a treatment option.

Relación entre dermatitis atópica y alergia alimentaria / Relationship between atopic dermatitis and food allergy

La denominada "marcha alérgica" se caracteriza por diferentes manifestaciones atópicas relacionadas y sucesivas a lo largo de la vida del individuo. Los niños que presentan alergia alimentaria (AA) tienen mayor predisposición al desarrollo de otras enfermedades alérgicas entre las cuales destacan dermatitis atópica (DA), asma y rinitis alérgica. La DA y AA coexisten en mayor medida en los pacientes que presentan DA de comienzo precoz, agresiva y persistente. Por su parte, la AlA es un factor precipitante de DA en un subgrupo de pacientes especialmente aquellos con AA mediadas por IgE, y también existiría correlación con las manifestaciones de AA de tipo retardadas. La disfunción en la barrera epitelial principalmente atribuida a mutaciones en el gen de la filagrina se ha descrito como posible desencadenante de la sensibilización a alérgenos por aumento de la permeabilidad cutánea. Se describen las características generales de la DA y evidencias de investigaciones actuales con respecto al rol de la AA sobre el desarrollo de la DA, su manejo y estrategias de prevención. Se discute la utilidad de los exámenes para el diagnóstico y las indicaciones de tratamiento y prevención en el manejo de niños con DA y AA. La restauración de las alteraciones de la barrera cutánea para prevenir la sensibilización antigénica tendría un rol importante para evitar el desarrollo de enfermedades alérgicas especialmente respiratorias.

The term "allergic march" refers to the history of different atopic manifestations throughout the patient's life. Children with food allergy (FA) are more predisposed to the development of other allergic diseases such as atopic dermatitis (AD), asthma and allergic rhinitis. AlD and FA coexist to a greater extent in patients with early signs of AD, aggressive and persistent symptoms. Meanwhile, FA is a precipitating factor to AlD especially in patients with IgE-mediated FA. Correlation to delayed manifestations of FA may also be found. Epithelial barrier dysfunction, mainly attributed to mutations in the filaggrin gene, has been described as a possible trigger for allergen sensitization by increasing skin permeability. This study describes general characteristics of DA and current research evidence regarding the role of FA in the DA development, management and prevention strategies. Also, the utility of diagnostic tests, treatment and prevention in children with DA and FA are discussed. The restoration of impaired skin barrier to prevent sensitization to antigens may have an important role to prevent the development of allergic diseases, especially respiratory diseases.

Tratamientos biológicos del autismo y dietas de eliminación / Biological treatments of autism, elimination diets: a critical review

This paper presents some critical considerations regarding the growing adoption, by families, of alternative treatments and diets for the treatment of various disorders like autism in children. Research does not seem to support such practices, with the exception of the relationship between timesoral and vaccines, neurological and cardiac disorders. Issues to consider are pointed out in the need to opt for biological treatments, and the need for families and research teams to work together for the purpose of clarifying such procedures.

El objetivo de este trabajo es presentar consideraciones críticas en relación a la creciente adopción, por parte de las familias de niños con trastornos del desarrollo, de tratamientos alternativos y dietas para reducir los síntomas de diversas alteraciones tales como el autismo, SDAH y otros. Las investigaciones no parecen apoyar tales prácticas, a excepción de la creciente evidencia de la relación entre el timerosal de las vacunas y afecciones cardíacas y neurológicas. Se señalan los elementos a tener en cuenta para optar por los tratamientos biológicos y dietas, junto con insistir en la necesidad de mancomunar esfuerzos entre familias y equipos de investigación para desarrollar estudios que clarifiquen los efectos de tales procedimientos.

Food Allergy in Children

Food allergy has increased in developed countries over the past 20 years and it has been estimated that food allergic reactions affect some 6~8% of children. Food allergy is common and potentially serious problem in childhood. Adverse reaction to food could be classified into four groups: IgE-mediated food allergy; non-IgE mediated food allergy; non-allergic food hypersensitivity; and symptoms falsely assumed to be due to foods. Allergic testing is moving towards established thresholds levels of specific IgE that predict a probability of a clinical reaction and reduce the need of oral food challenge. 1) Diagnosing and managing food allergy in children largely depends upon a thorough medical history with questions targeted to differentiate the character of the reaction for each suspected food. 2) Investigations such as skin prick testing and specific IgE are helpful only in IgE-mediated reactions. 3) The mainstay of management is to avoid the offending allergen. 4) An anaphylactic reaction is an indication for self-injectable epinephrine for emergency use. Studies of allergen characterization and immunologic mechanisms are needed and should provide a better understanding of the immunopathology of food allergy and new, more specific forms of diagnosis and therapy. It is important to identify children with potentially life-threatening food allergy as life-threatening reaction can occur. A clear understanding of the manifestations of food allergy caused by both IgE- and non-IgE-related mechanisms will help the practitioner to identify children who likely have food allergy so that additional diagnostic evaluation can be performed and appropriate avoidance can be instituted.

Clinical Features and the Natural History of Dietary Protein Induced Proctocolitis: a Study on the Elimination of Offending Foods from the Maternal Diet / 대한소아소화기영양학회지

PURPOSE: The aim of this study was to identify the clinical features and natural history of dietary protein induced proctocolitis (DPIPC) and to detect the causative foods of DPIPC, and to evaluate the effect of elimination of the foods on the course of the disease. METHODS: Between March 2003 and July 2004, data from 30 consecutive patients with DPIPC who were followed for over 6 months, was reviewed. The diagnostic criterion used for DPIPC was an increase in the number of eosinophils in the lamina propria (> or =60 per 10 high-power fields). In breast feeding mothers, 5 highly allergenic foods were eliminated from the maternal diet for 7 days, namely, allergenic food groups such as dairy products, eggs, nuts and soybean, fish and shellfish, and wheat and buckwheat. We observed the disappearance or appearance of hematochezia after elimination or challenge with the offending foods. RESULTS: Before diagnosis infants were breast-fed (93.3%) or formula-fed (6.7%). Mean age at symptom onset was 11.5+/-5.1 (5~24) weeks, and mean age at diagnosis was 17.8+/-9.5 (8~56) weeks. Duration from symptom onset to diagnosis was 6.3+/-6.7 (0~36) weeks. Mean peripheral blood eosinophil count was 478+/-320 (40~1,790)/mm3 and eosinophilia (>250/mm3) was observedin 90.0% of patients. None of patients were found to have an increased serum IgE level. Of 15 patients that received sigmoidoscopy, nodular hyperplasia with erosion was observed in 93.3%. Of 27 patients whose mother ate the diet eliminated the 5 food groups, hematochezia diappeared in 74.1% of patients. Offending foods were identified as dairy products (37.5%), wheat and buckwheat (27.5%), fish and shellfish (20.0%), nuts and soybean (7.5%) and eggs (7.5%). A free maternal diet without patient's clinical symptoms was achieved at 29.4+/-8.7 (9~44) weeks of patient's age, and a free baby diet without blood in stools was achieved at 37.5+/-9.7 (12~56) weeks of age. CONCLUSION: DPIPC commonly occurs in exclusively breast-fed babies. Elimination of the above-mentioned 5 hyper-allergenic food groups from the maternal diet for 7days enables the detection of the offending foods. DPIPC is a transient disorder and 96.0% of patients can tolerate the offending foods at 12 months of age.

Effect of Egg White Elimination Diet on Clinical Progress and Specific IgE Levels in Egg White Sensitized Children with Atopic Dermatitis / 소아알레르기및호흡기학회지

PURPOSE: Food allergies play a major role in childhood atopic dermatitis. Egg white is the most common causative allergen in IgE mediated food allergies, and the only treatment is complete elimination of egg white from diet. The purpose of this study is to evaluate the effect of an egg white elimination diet on clinical progress and egg white-specific IgE concentration in childhood atopic dermatitis. METHOD: In 20 children with mild to severe atopic dermatitis, clinical progress was monitored by Jakob's atopic dermatitis grading system, and serum specific-IgE levels to six common food allergens and two house dust mites were measured by CAP-FEIA. RESULTS: In the study subjects, eight patients had been exposed to egg before diagnosis. During the six to 48 months of egg white elimination diet, clinical symptoms and signs were improved in 15 out of 20 patients. However, egg white-specific IgE levels were reduced by less than 1.20 kU/L (the cut off level suggesting immunological tolerance) in only seven patients. In the five patients with clinically persistent atopic dermatitis, egg white-specific IgE levels were 10.6-100 kU/L and house dust mite-specific IgE levels were 25.9-100 kU/L at the time of final examination. CONCLUSION: After 6-48 months of the egg white elimination diet, 75% of egg allergic infants and children with atopic dermatitis showed clinical improvement of atopic dermatitis. However, it is suggested that the patients need more than 1-3 years of a complete elimination diet to obtain immunological tolerance determined by egg white-specific IgE levels.

Follow-up Study of Children with Egg Allergy: Comorbidity of Allergic Diseases and Factors Affecting Prognosis / 소아알레르기및호흡기학회지

PURPOSE: Sensitization to eggs in infancy has been reported to be associated with increasing the risk of respiratory allergic diseases during childhood. So our study was designed to follow up children who have had atopic dermatitis with egg allergy and to evaluate the prognosis according to family history, early egg elimination diet, house dust mite sensitization, egg/histamine wheel ratio of skin prick test, RAST class and age tolerance to find the risk factors which might be helpful for applying some preventable measures. METHODS: Twenty three children diagnosed with egg allergy at Kangnam General Hospital between March 1988 and March 2000 were studied retrospectively. At the time of the first visit, we interviewed an feeding methods, past medical history, atopic family histories and performed skin prick tests, and total IgE and egg-white specific IgE tests (RAST). At the time of the last visit, we evaluated whether the children had allergic diseases or not, as well as prognosis and other allergen sensitization. RESULTS: Four (17.4%) children resolved allergic symptoms, Fifteen (65.2%) children had atopic dermatitis, 11 (47.8%) children had asthma, and 12 children (52.2%) had allergic rhinitis. Prognosis was good in children with early tolerance and no sensitization to house dust mites. There was no relationship between prognosis and atopic family history, early egg elimination diet, infant feeding methods, or RAST class. CONCLUSION: Because 19 (82.6%) of 23 children with egg allergy have persistent allergic diseases and related to sensitization of house dust mites, early environment intervention for house dust mites must be evaluated to prevent other allergic diseases.

The necessity of diet therapy for successful interferon-gamma therapy in atopic dermatitis

The avoidance of incriminated foods is one of the principal therapies for atopic dermatitis (AD). Recently, interferon (IFN)-gamma therapy has been tried in AD with limited success. The necessity of diet therapy for the success of IFN-gamma therapy in AD was evaluated. A total of 524 AD patients participated in this study and 316 patients among them were entered into open food challenge tests. As the first step, an elimination diet was administered to 43 AD patients and 30 AD patients were enrolled as an untreated control group. As the second step, 45 AD patients were treated by both IFN-gamma therapy and elimination diet alone, 30 AD patients by elimination diet alone, 50 AD patients by IFN-gamma therapy, and 43 AD patients as controls. Clinical severity reduced significantly by using only the elimination diet in 58.1% patients with varying degrees of AD. Elimination diet improved the clinical results of IFN-gamma therapy in AD. In regard to the food challenge test, 77.8% of AD patients showed an adverse reaction to at least one food. Diet therapy itself had therapeutic effects on AD and an elimination diet might be essential for the success of IFN-gamma therapy in AD.