Significance of fecal calprotectin and eosinophil-derived neurotoxin in non-IgE-mediated food allergy / 国际儿科学杂志

Non-IgE-mediated food allergy most often presents with gastrointestinal symptoms such as diarrhoea, mucus stools, bloody stools, reflux and vomiting a few hours to days after exposure to the allergenic food.The pathogenesis may be related to the activation of intestinal T lymphocytes to secrete pro-inflammatory cytokines such as TNF-α and IL-4 by food allergens, leading to migration of neutrophils and eosinophils into the intestinal lumen, causing an intestinal inflammatory response and increased intestinal permeability.There is no rapid and specific diagnostic method.The diagnosis is mainly based on clinical manifestations combined with food avoidance and oral food challenge.In recent years, fecal biomarkers have been widely used as specific indicators for determining intestinal inflammation as an aid to diagnosis and condition assessment of intestinal infections and inflammatory bowel diseases, but their application in gastrointestinal allergic diseases is rarely reported.In this paper, we will focus on the significance of fecal calprotectin, fecal eosinophil-derived neurotoxin in non-IgE-mediated food allergy.

Guidelines for diagnosis and nutritional intervention of mild to moderate non-IgE mediated cow′s milk protein allergy in Chinese infants / 中华实用儿科临床杂志

Cow′s milk protein allergy (CMPA) is one of the most common presentations of food allergy seen in early childhood.It is an abnormal immune response caused by cow′s milk protein.CMPA can be clinically subdivided into either immediate-onset IgE mediated or delayed onset non-IgE mediated, or both.At present, concerns regarding the early and timely diagnosis of CMPA have been high-lighted over the years and there are many expert consensus on CMPA in China, but these consensus did not distinguish IgE mediated or non-IgE mediated CMPA.In view of the obvious clinical differences between the two type of CMPA and non-IgE mediated CMPA is more common in infancy, experts focus on pediatric gastroenterology, allergy/immunology, dermatology, nutrition and child healthcare convened by the Allergy Prevention and Control Professional Committee of Chinese Preventive Medicine Association present this guideline to help practitioners in primary care settings to early recognize and make suitable management of non-IgE mediated CMPA in China.The guideline incorporates the cutting-edge international guidance and the actual situation of Chinese children describing in detail the types, clinical features, diagnosis and nutritional intervention of non-IgE mediated CMPA.There are 42 recommendations in 7 categories in total referring to the common questions related to non-IgE mediated CMPA.

Research advances in the diagnosis and treatment of food protein-induced enterocolitis / 中华实用儿科临床杂志

Food protein-induced enterocolitis (FPIES) is a non-IgE mediated food allergy that occurs primarily in infants and children.Although the hypotension or even shock occurs and might need to go to emergency department in severe patient with FPIES,there is an overall lack of knowledge about FPIES.Misdiagnosed or delayed diagnosis might be due to the absence of non-invasive diagnostic biomarker or diagnostic program specifically for FPIES,an overall lack of understanding of FPIES,and a combination of nonspecific symptoms.A clinical history and oral food challenges are the main diagnostic tools.Take care to exclude other potential causes before diagnosis established in the case of the history unclear.Avoidance of trigger food is the main treatment.During a acute episode,intravenous fluids may be required,and the complications need to be treated as well.

Progresses in diagnosis and treatment of food protein-induced enteropathy / 国际儿科学杂志

Food protein-induced enteropathy (FPE)is a series symptom of chronic diarrhea, malabsorption, hypoproteinemia, malnutrition caused by non-IgE mediated food allergy.The pathogenesis of FPE remains unclear, and may be related to gut mucosal barrier, intestinal bacteria, gastrointestinal immunity, oral tolerance and genetic, etc.Histology performance of FPE is characterized by flat atrophy of the small intestine.Diagnosis of PFE relies on history, mucosal histological changes, and oral food challenges.Food eliminate is the mainstay of FPE management.The paper reviews the pathogenesis, clinical manifestation, diagnosis and treatment of FPE to improve the recognition of clinicians.

Non-IgE mediated food allergy: diagnosis and treatment / 国际儿科学杂志

Food allergy(FA) seems to be increasing world wide which is roughly divided into IgE mediated or non-IgE mediated FA(NFA).NFA primarily affects the gastrointestinal mucosa which is far less understanding the immunological mechanisms than IgE-mediated FA.Clinicians sometimes experienced confusion due to delayed onset of symptoms and subsequent difficulty in making the clinical association between offending food and clinical symptoms.The lack of easily accessible diagnostic measures also contributes to the problem.The diagnosis of NFA usually is established in the eliminated of food allergen and food challenge test.In this paper,the diagnosis and treatment of NFA is introduced combined with our clinical practice experience.

In Vitro Induction of Allergen-Specific Interleukin-10-Producing Regulatory B Cell Responses by Interferon-gamma in Non-Immunoglobulin E-Mediated Milk Allergy

PURPOSE: Specific oral immunotherapy (SOIT) using interferon-gamma (IFN-gamma) has been successful as a food allergy treatment. Interleukin-10 (IL-10)-producing regulatory B cells (Br1s) play a role in immune tolerance to food allergens. In addition, IFN-gamma shows tolerogenic effects on allergen-induced Br1 responses. METHODS: Eleven patients that were allergic to cow's milk and 12 milk-tolerant subjects were selected by double-blind placebo-controlled food challenge (DBPCFC) and clinical characteristics. The immunomodulatory effects of IFN-gamma on allergen-specific Br1 responses were evaluated in 6 milk allergy patients and 8 milk-tolerant subjects. Peripheral blood mononuclear cells (PBMCs) from subjects were stimulated with casein and/or IFN-gamma and analyzed by flow cytometry. RESULTS: IFN-gamma had no effect on total cell counts or the proportion of Br1 cells in PBMCs. IFN-gamma stimulation did not change total Br1 cell counts or the percentage of Br1s among CD5(+) B cells in the milk allergy or the milk-tolerant groups. In the milk allergy group, Br1 counts were not different between the control and the casein stimulation but significantly increased in the IFN-gamma + casein stimulated cells, and the Br1 fractions were decreased after casein stimulation and recovered in the addition of IFN-gamma for stimulation. In the milk-tolerant group, Br1 counts increased in the casein stimulated cells and in the IFN-gamma + casein stimulated cells, but the increase was significantly less when IFN-gamma was added, and the Br1 fractions were increased after casein stimulation and IFN-gamma + casein stimulation, that was not significant when IFN-gamma was added. CONCLUSIONS: IFN-gamma-induced allergen-specific Br1 responses in the PBMCs of milk allergy patients play a role in milk allergen-specific tolerance induction in vitro. Further investigations into the molecular immunological mechanisms underlying the induction of allergen-specific Br1 responses are needed.

Characterization of food allergies in patients with atopic dermatitis

We examined the characteristics of food allergy prevalence and suggested the basis of dietary guidelines for patients with food allergies and atopic dermatitis. A total of 2,417 patients were enrolled in this study. Each subject underwent a skin prick test as well as serum immunoglobulin E (IgE) measurement. A double-blind, placebo-controlled food challenge was conducted using milk, eggs, wheat, and soybeans, and an oral food challenge was performed using beef, pork, and chicken. Food allergy prevalence was found among 50.7% in patients with atopic dermatitis. Among patients with food allergies (n = 1,225), the prevalence of non-IgE-mediated food allergies, IgE-mediated food allergies, and mixed allergies was discovered in 94.9%, 2.2%, and 2.9% of the patients, respectively. Food allergy prevalence, according to food item, was as follows: eggs = 21.6%, milk = 20.9%, wheat = 11.8%, soybeans = 11.7%, chicken = 11.7%, pork = 8.9% and beef = 9.2%. The total number of reactions to different food items in each patient was also variable at 45.1%, 30.6%, 15.3%, 5.8%, 2.2%, and 1.0% for 1 to 6 reactions, respectively. The most commonly seen combination in patients with two food allergies was eggs and milk. The clinical severity of the reactions observed in the challenge test, in the order of most to least severe, were wheat, beef, soybeans, milk, pork, eggs, and chicken. The minimum and maximum onset times of food allergy reactions were 0.2-24 hrs for wheat, 0.5-48 hrs for beef, 1.0-24 hrs for soybeans, 0.7-24 hrs for milk, 3.0-24 hrs for pork, 0.01-72 hrs for eggs, and 3.0-72 hrs for chicken. In our study, we examined the characteristics of seven popular foods. It will be necessary, however, to study a broader range of foods for the establishment of a dietary guideline. Our results suggest that it may be helpful to identify food allergies in order to improve symptoms in patients with atopic dermatitis.

A Case of Non-IgE-mediated Eosinophilic Gastroenteritis Presenting as Ascites / 대한소아소화기영양학회지

Eosinophilic gastroenteritis is a rare disease occurring especially in children, and shows various non-specific presentations with infiltration of eosinophils in the gastrointestinal organs. The pathophysiology of eosinophilic gastroenteritis is not yet clearly known, but allergic reactions are suspected to be related with the disease. Eosinophilic gastroenteritis is categorized into the mucosal, muscularis and subserosal types based on which layer of the intestinal wall is involved. There are different clinical manifestations according to the involved layer. Most cases to date have responded well to steroid therapy. In this study, we diagnosed and treated a case of non-IgE-mediated, subserosal eosinophilic gastroenteritis in a child with abdominal pain, diarrhea and ascites.

The Diagnosis of Food Allergy in a Pediatric Gastroenterology: Focusing on Non-IgE-mediated Allergic Diseases / 대한소아소화기영양학회지

Food allergy is an adverse immune response to foods. The prevalence of food allergy vary by age, diet, and many other factors. Based on the immunological mechanism, food allergies may be classified in a IgE-mediated diseases, which are the best-characterized food allergy reactions, non-IgE-medicated diseases, and mixed type diseases. In children, the GI tract seems to be the most common target organ. Generally, IgE-mediated reactions have an acute onset, whereas non-IgE-mediated reactions have a late onset. The most food allergy with GI manifestation involve non-IgE-mediated reactions. The evaluation of a child with suspected food allergy includes medical history, physical examination, screening test and the response to elimination diet and to oral food challenge. The diagnosis of non-IgE-mediated food allergies using a screening test is difficult. In this review, investigate the diagnostic criteria and manifestations of several non-IgE-mediated allergic diseases and the diagnostic method in the field of a pediatric gastroenterology.

Food allergy: a practical update from the gastroenterological viewpoint / Food allergy: a practical update from the gastroenterological viewpoint

OBJETIVOS: Apresentar uma revisão atualizada e crítica sobre alergias alimentares, focando principalmente em tratamento e prevenção. FONTES DOS DADOS: Revisão da literatura publicada obtida através do banco de dados MEDLINE, sendo selecionados os mais atuais e representativos do tema (2000-2006). A pesquisa incluiu os sites da European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) e American Academy of Pediatrics (AAP). SíNTESE DOS DADOS: A prevalência de doenças alérgicas tem aumentado nas últimas décadas e alergia alimentar parece fazer parte desse aumento. Alergia alimentar é muito mais comum em pediatria e apresenta impacto médico, financeiro e social significativos em crianças menores e suas famílias. Tratamento e prevenção da alergia alimentar são desafios maiores do ponto de vista da saúde pública e para as comunidades médica e científica. Há muita informação incorreta e condutas médicas discutíveis nessa área. Apresentamos e discutimos as recomendações publicadas pelos Comitês de Nutrição da ESPGHAN juntamente com a Sociedade Européia Pediátrica de Alergologia e Imunologia Clínica (ESPACI) e AAP. CONCLUSÃO: Excesso de diagnósticos de alergia alimentar é bastante prevalente. Há necessidade de uniformização de definições e procedimentos diagnósticos. O objetivo primário do manejo deve ser o de instituir medidas efetivas de prevenção das alergias alimentares. Há necessidade de métodos precisos para confirmar ou excluir o diagnóstico. Os pacientes necessitam tratamento apropriado através da eliminação de alimentos que causam sintomas, ao mesmo tempo evitando os efeitos adversos nutricionais e o custo de dietas inadequadas.

OBJECTIVE: To present an up-to-date and critical review regarding food allergies, focusing mainly on treatment and prevention. SOURCES: Review of published literature searched on MEDLINE database; those data which were the most up-to-date and representative were selected (2000-2006). The search included the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the American Academy of Pediatrics (AAP). SUMMARY OF THE FINDINGS: The prevalence of allergic diseases has increased over the last decades, and food allergy seems to be part of this increase. Food allergy is much more common in pediatrics and has a significant medical, financial and social impact on young children and their families. Treatment and prevention of food allergy is a major challenge for public health, scientific and medical communities. There is a lot of misinformation and the medical management of this condition is still discussable. We present and discuss the guidelines regarding criteria for the prevention of food allergy and atopic diseases published by the Nutrition Committees of ESPGHAN jointly with the European Society for Pediatric Allergy and Clinical Immunology (ESPACI) and AAP. CONCLUSION: The overdiagnosis of food allergy is quite prevalent. There is a need for standardization of definitions and diagnostic procedures. The primary goal of therapy should be to first establish effective means of preventing food allergies. There is a need for accurate diagnostic methods to confirm or rule out the diagnosis. Patients need appropriate treatment by eliminating foods that cause symptoms, while avoiding the nutritional side effects and the cost of inappropriate diets.

Increased Serum Thymus and Activation-regulated Chemokine (TARC) Levels in Children with Atopic Dermatitis / 소아알레르기및호흡기학회지

PURPOSE: Thymus and activation-regulated chemokine (TARC) is responsible for the trafficking of Th2 lymphocytes into sites of allergic inflammation. We tested whether TARC is a useful marker for childhood atopic dermatitis (AD) and we evaluated age-related differences in the level of TARC. METHODS: Serum TARC level, serum total IgE level, total eosinophil count and specific IgE level were measured in 401 children. They were characterized as having IgE-mediated atopic dermatitis (n=157), non-IgE mediated atopic dermatitis (n=107), or as healthy control subjects (n=137). RESULTS: TARC levels in AD significantly were higher than those in healthy control subjects. (152.9+/-11.6 vs 56.7+/-5.2 pg/mL, P< 0.05) Serum TARC levels significantly correlated with disease severity (SCORAD index) both in children with IgE mediated AD (r=0.670, P< 0.05) and children with non-IgE mediated AD. (r=0.605, P< 0.05) Serum TARC levels in control subjects decreased in accordance with age. (r=-0.201, P< 0.05) CONCLUSION: Serum TARC might be a useful marker for disease severity both in children with IgE mediated AD and children with non-IgE mediated AD. Serum TARC levels in control subjects decreased in accordance with ages.

A Case of Eosinophilic Colitis in a 11-year-old Boy / 대한소아소화기영양학회지

Eosinophilic gastroenteritis, which shows characteristic eosinophilic inflammation, involves any part of the intestine from esophagus to colon. The immunopathogenesis is expected to be associated with IgE-mediated or non-IgE-mediated reaction, but the precise mechanism is not revealed yet. The clinical manifestation is variably dependent on the extent of eosinophilic infiltration. Usually the symptoms, such as abdominal pain, diarrhea, vomiting, wax and wane for a few months result in failure to thrive, which implicates the importance of early detection. Although the diagnosis is made through clinical and histopathologic evidences, we should suspect the illness in a case of anemia, hypoalbuminemia, and peripheral eosinophilia. Recently, we experienced a case of non- IgE-mediated eosinophilic colitis in a 11-year-old male who complained of diarrhea, right lower abdominal pain, body weight loss, was diagnosed with peculiar histopathologic finding of sigmoid colon specimens obtained by sigmoidoscopy.