Adult-onset asthma, allergy, and aspirin hypersensitivity associate with self-reported food avoidance.

Background: The adoption of avoidance diets by adult-onset asthmatics has not previously been studied. We hypothesized that avoidance diets would associate with adult-onset asthma, allergy, and aspirin-exacerbated respiratory disease (AERD). Methods: A total of 1247 subjects with adult-onset asthma (age range: 31-91) from the Finnish national registry, and age- and sex-matched controls (n = 1970) participated in a questionnaire study in 1997. We estimated the association between asthma/allergy/AERD and avoidance diets, adjusting for potential confounding factors and validated the results in two retrospective cohorts of 5080 rhinitis/rhinosinusitis patients and 167 AERD patients from 2019 to 2020. Results: The presence of asthma positively associated with adoption of any avoidance diet (adjusted OR [CI95%] 1.24 [1.02-1.51], p = 0.029) as did allergic disease and self-reported AERD within the asthmatic group (1.79 [1.29-2.48], p = 0.001 and 1.69 [1.15-2.49], p = 0.007, respectively). Asthmatics and allergic asthmatics were more likely to report avoidance of fish, fruits and vegetables, and spices (p ≤ 0.03) compared to controls and non-allergic asthmatics. The adjusted OR for multiple diets among AERD patients was 2.57 [1.34-4.95] p = 0.005. In the validation, 26.2% of the allergic asthmatics and 10.8% of AERD patients had documented avoidance diets. Conclusions: Our study shows a positive association between avoidance diets and adult-onset asthma, and with allergic disease or AERD within asthmatic patients. Although we lack information on the reason patients chose to observe a specific diet, our results reinforce the importance of asking patients about their diet and if needed, giving dietary advice for adult asthma patients to help them avoid the adoption of unnecessarily restrictive diets.

The effect of oral immunotherapy treatment in severe IgE mediated milk, peanut, and egg allergy in adults.

INTRODUCTION: The standard care of severe food allergy in both adults and children means avoidance of allergens. In recent years promising results of oral immunotherapy (OIT) have been reported in children. In adults, information on OIT in severe food allergy is very limited. OBJECTIVE: We aimed to study if OIT is possible in adults. METHODS: We report OIT results in 10 adult patients with milk OIT, nine adult patients with peanut OIT, and four adult patients with egg OIT. The allergy was confirmed with allergen specific IgE tests and oral food challenges (open in milk allergy and double-blind in peanut and egg allergy). The OIT was performed as open. RESULTS: The median dose of protein that led to discontinuation of allergen challenge because of symptoms was 7.5 mg in milk allergy, 25 mg in peanut allergy, and 15 mg in egg allergy. The median period of OIT was 515 days. Currently on OIT are 6/10 milk allergic patients, 4/9 peanut allergic patients and 3/4 egg allergic patients. The median dose of milk protein increased by 60-fold during OIT compared to the allergen challenge dose. In peanut OIT the median dose increased by eightfold and in egg allergy the dose increased with OIT by 35-fold. Local itching was the most common side effect of OIT (73.9% of the patients), four patients reported having used epinephrine autoinjector and three patients having needed emergency room treatment. CONCLUSIONS AND CLINICAL RELEVANCE: OIT can be given in adult patients with severe milk, peanut, or egg allergy only in selected cases. OIT leads into desensitization but it is not clear whether persistent tolerance can be achieved. Mild adverse events during OIT are common.

[Update on Current Care Guideline: Food allergy (children)]. / Ruoka-allergia (lapset).

This guideline, targeted to healthcare workers dealing with food-allergic children, provides a review on the clinical aspects of pediatric food allergy. The main updates include: elimination diets are not recommended for breast-feeding mothers; probiotics are not recommended for allergy prevention or treatment; food challenges are the basis of the diagnosis, but it can be improved by IgE component diagnostics. The treatment for severe symptoms is specific food avoidance, mildly symptomatic children should continue with versatile diet. Specific oral tolerance induction is a safe and effective treatment in most of the pediatric patients.

Impact of elimination diets on growth and nutritional status in children with multiple food allergies.

BACKGROUND: Impairment of growth has been reported in food-allergic children. It is not known whether this is related to the extent of food allergies. We sought to compare growth, nutritional status, and nutrient intake in children with food allergy either avoiding cow's milk or avoiding cow's milk and wheat, which are staples of the diet in young children. METHODS: Infants and young children with challenge-proven allergy were recruited to this prospective study. They were strictly avoiding their allergic food triggers, either cow's milk, or cow's milk and wheat. They were counseled by a dietitian specialized in food allergies on food avoidance diets and nutritionally adequate supplementation at regular intervals. A 3-day food diary was kept. Children's height, weight, and laboratory data for nutritional parameters were monitored at 8-month intervals. RESULTS: A total of 18 patients avoiding milk and 28 patients avoiding milk and wheat were evaluated at an average of 12, 21, and 28 months of age. During the follow-up, the markers of nutritional status, nutrient intake or height for age, and weight for height were comparable between the two groups, although the means for anthropometric measures were below the average for age in both groups. CONCLUSIONS: The extent of food elimination diet has no impact on growth or nutritional status of food-allergic children, when diet is adequately supplemented. Close physician and dietitian follow-up are essential for food-allergic children when avoiding one or more foods, which are staples of the diet.