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Food Allergies in Modern Life

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutritional Immunology".

Deadline for manuscript submissions: closed (15 May 2021) | Viewed by 55955

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Special Issue Editors

Dr. Sara Manti

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Guest Editor

Department of Clinical and Experimental Medicine, Neonatal Intensive Care Unit, University of Messina, 98125 Messina, Italy
Interests: pediatrics; pulmonology; allergy
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Gian Luigi Marseglia

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Guest Editor

Pediatric Clinic, Pediatrics Department, Policlinico San Matteo, University of Pavia, Pavia, Italy
Interests: pediatrics; allergology; immunology; pulmonology
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Dr. Salvatore Leonardi

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Department of Clinical and Experimental Medicine, Pediatric Respiratory Unit, University of Catania, 95124 Catania, Italy
Interests: clinical investigation; translational research; pulmonology; allergology; cystic fibrosis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Food allergy, a specific immune response that occurs reproducibly upon exposure to a food allergen, is an increasing public health problem, causing a significant burden for affected patients, resulting in dietary restrictions, fear of accidental ingestions and related risk of severe reactions, and reduced quality of life. Clinical presentation ranges from mild to life-threatening symptoms. Component-resolved diagnosis with recombinant allergens has improved the diagnosis and, consequently, clinical management. Currently, there is no specific treatment for food allergy, so the only available management is limited to strict dietary avoidance, education on prompt recognition of symptoms, and emergency treatment of adverse reaction. In parallel, novel knowledge on the pathogenesis of food allergy is opening the way to new trials investigating several allergen-specific and allergen non-specific therapies, aiming to prevent the development of food allergy and acquire a persistent food tolerance.

The aim of this Special Issue is to update knowledge on the pathogenesis, clinical presentation, diagnosis, and treatment of food allergies, especially related to the pediatric population.

We remain at your disposal for additional questions.

Dr. Sara Manti
Prof. Gian Luigi Marseglia
Prof. Salvatore Leonardi
Guest Editors

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Keywords

allergen
food allergy
children
adolescent
clinical manifestation
diagnosis
treatment

Published Papers (11 papers)

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11 pages, 667 KiB

Open AccessArticle

LTP Allergy Follow-Up Study: Development of Allergy to New Plant Foods 10 Years Later

by Diana Betancor, Alicia Gomez-Lopez, Carlos Villalobos-Vilda, Emilio Nuñez-Borque, Sergio Fernández-Bravo, Manuel De las Heras Gozalo, Carlos Pastor-Vargas, Vanesa Esteban and Javier Cuesta-Herranz

Nutrients 2021, 13(7), 2165; https://doi.org/10.3390/nu13072165 - 24 Jun 2021

Cited by 12 | Viewed by 3265

Abstract

Introduction: Allergy to nonspecific lipid transfer protein (nsLTP) is the main cause of plant-food allergy in Spain. nsLTPs are widely distributed in the plant kingdom and have high cross-reactivity but extremely variable clinical expression. Little is known about the natural evolution of this allergy, which complicates management. The objective of this study was to assess the development of allergy to new plant foods in nsLTP-sensitized patients 10 years after diagnosis. Methods: One hundred fifty-one patients showing specific IgE to nsLTP determined by ISAC (Thermofisher) were included. After clinical workup (i.e., anamnesis, skin test, and challenge when needed), these patients were divided into two groups: 113 patients allergic to one or more plant food (74.5%) and 38 patients not allergic to any plant food (25.1%). Ten years later, a telephone interview was conducted to check whether patients had developed additional allergic reactions to plant foods. Results: Ten years after diagnosis, 35 of the 113 (31%) plant-food-allergic patients sensitized to nsLTP reported reactions to new, previously tolerated plant foods, mainly Rosaceae/Prunoideae fruits and nuts followed by vegetables, Rosacea/Pomoideae fruits, legumes, and cereals. Five out of 38 (13.2%) patients previously sensitized to nsLTP but without allergy to any plant food had experienced allergic reactions to some plant food: two to Rosaceae/Prunoideae fruits, two to Rosaceae/Prunoideae fruit and nuts, and one to legumes. Conclusion: Patients sensitized to nsLTP developed allergic reactions to other plant foods, mainly Rosaceae-Prunoideae fruits and nuts. This was more frequent among plant-food-allergic patients than among those who had never had plant-food allergy. Full article

(This article belongs to the Special Issue Food Allergies in Modern Life)

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19 pages, 15110 KiB

Open AccessArticle

Investigation of Sensitization Potential of the Soybean Allergen Gly m 4 by Using Caco-2/Immune Cells Co-Culture Model

by Ivan V. Bogdanov, Ekaterina I. Finkina, Daria N. Melnikova, Rustam H. Ziganshin and Tatiana V. Ovchinnikova

Nutrients 2021, 13(6), 2058; https://doi.org/10.3390/nu13062058 - 16 Jun 2021

Cited by 7 | Viewed by 3225

Abstract

The soybean allergen Gly m 4 is known to cause severe allergic reactions including anaphylaxis, unlike other Bet v 1 homologues, which induce mainly local allergic reactions. In the present study, we aimed to investigate whether the food Bet v 1 homologue Gly m 4 can be a sensitizer of the immune system. Susceptibility to gastrointestinal digestion was assessed in vitro. Transport through intestinal epithelium was estimated using the Caco-2 monolayer. Cytokine response of different immunocompetent cells was evaluated by using Caco-2/Immune cells co-culture model. Absolute levels of 48 cytokines were measured by multiplex xMAP technology. It was shown that Gly m 4 can cross the epithelial barrier with a moderate rate and then induce production of IL-4 by mature dendritic cells in vitro. Although Gly m 4 was shown to be susceptible to gastrointestinal enzymes, some of its proteolytic fragments can selectively cross the epithelial barrier and induce production of Th2-polarizing IL-5, IL-10, and IL-13, which may point at the presence of the T-cell epitope among the crossed fragments. Our current data indicate that Gly m 4 can potentially be a sensitizer of the immune system, and intercommunication between immunocompetent and epithelial cells may play a key role in the sensitization process. Full article

(This article belongs to the Special Issue Food Allergies in Modern Life)

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21 pages, 2766 KiB

Open AccessFeature PaperArticle

Identification and Purification of Novel Low-Molecular-Weight Lupine Allergens as Components for Personalized Diagnostics

by Uta Jappe, Arabella Karstedt, Daniela Warneke, Saskia Hellmig, Marisa Böttger, Friedrich W. Riffelmann, Regina Treudler, Lars Lange, Susanne Abraham, Sabine Dölle-Bierke, Margitta Worm, Nicola Wagner, Franziska Ruëff, Gerald Reese, André C. Knulst and Wolf-Meinhard Becker

Nutrients 2021, 13(2), 409; https://doi.org/10.3390/nu13020409 - 28 Jan 2021

Cited by 17 | Viewed by 2739

Abstract

Lupine flour is a valuable food due to its favorable nutritional properties. In spite of its allergenic potential, its use is increasing. Three lupine species, Lupinus angustifolius, L. luteus, and L. albus are relevant for human nutrition. The aim of this study is to clarify whether the species differ with regard to their allergen composition and whether anaphylaxis marker allergens could be identified in lupine. Patients with the following characteristics were included: lupine allergy, suspected lupine allergy, lupine sensitization only, and peanut allergy. Lupine sensitization was detected via CAP-FEIA (ImmunoCAP) and skin prick test. Protein, DNA and expressed sequence tag (EST) databases were queried for lupine proteins homologous to already known legume allergens. Different extraction methods applied on seeds from all species were examined by SDS-PAGE and screened by immunoblotting for IgE-binding proteins. The extracts underwent different and successive chromatography methods. Low-molecular-weight components were purified and investigated for IgE-reactivity. Proteomics revealed a molecular diversity of the three species, which was confirmed when investigated for IgE-reactivity. Three new allergens, L. albus profilin, L. angustifolius and L. luteus lipid transfer protein (LTP), were identified. LTP as a potential marker allergen for severity is a valuable additional candidate for molecular allergy diagnostic tests. Full article

(This article belongs to the Special Issue Food Allergies in Modern Life)

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Review

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19 pages, 1005 KiB

Open AccessReview

An Updated Overview of Almond Allergens

by Mário Bezerra, Miguel Ribeiro and Gilberto Igrejas

Nutrients 2021, 13(8), 2578; https://doi.org/10.3390/nu13082578 - 27 Jul 2021

Cited by 9 | Viewed by 4520

Abstract

Tree nuts are considered an important food in healthy diets. However, for part of the world’s population, they are one of the most common sources of food allergens causing acute allergic reactions that can become life-threatening. They are part of the Big Eight food groups which are responsible for more than 90% of food allergy cases in the United States, and within this group, almond allergies are persistent and normally severe and life-threatening. Almond is generally consumed raw, toasted or as an integral part of other foods. Its dietary consumption is generally associated with a reduced risk of cardiovascular diseases. Several almond proteins have been recognized as allergens. Six of them, namely Pru du 3, Pru du 4, Pru du 5, Pru du 6, Pru du 8 and Pru du 10, have been included in the WHO-IUIS list of allergens. Nevertheless, further studies are needed in relation to the accurate characterization of the already known almond allergens or putative ones and in relation to the IgE-binding properties of these allergens to avoid misidentifications. In this context, this work aims to critically review the almond allergy problematic and, specifically, to perform an extensive overview regarding known and novel putative almond allergens. Full article

(This article belongs to the Special Issue Food Allergies in Modern Life)

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13 pages, 455 KiB

Open AccessReview

Monoclonal Antibodies in Treating Food Allergy: A New Therapeutic Horizon

by Sara Manti, Giulia Pecora, Francesca Patanè, Alessandro Giallongo, Giuseppe Fabio Parisi, Maria Papale, Amelia Licari, Gian Luigi Marseglia and Salvatore Leonardi

Nutrients 2021, 13(7), 2314; https://doi.org/10.3390/nu13072314 - 5 Jul 2021

Cited by 4 | Viewed by 2780

Abstract

Food allergy (FA) is a pathological immune response, potentially deadly, induced by exposure to an innocuous and specific food allergen. To date, there is no specific treatment for FAs; thus, dietary avoidance and symptomatic medications represent the standard treatment for managing them. Recently, several therapeutic strategies for FAs, such as sublingual and epicutaneous immunotherapy and monoclonal antibodies, have shown long-term safety and benefits in clinical practice. This review summarizes the current evidence on changes in treating FA, focusing on monoclonal antibodies, which have recently provided encouraging data as therapeutic weapons modifying the disease course. Full article

(This article belongs to the Special Issue Food Allergies in Modern Life)

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15 pages, 1282 KiB

Open AccessReview

Update on the Role of Allergy in Pediatric Functional Abdominal Pain Disorders: A Clinical Perspective

by Craig Friesen, Jennifer Colombo and Jennifer Schurman

Nutrients 2021, 13(6), 2056; https://doi.org/10.3390/nu13062056 - 16 Jun 2021

Cited by 5 | Viewed by 3327

Abstract

Both functional abdominal pain disorders (FAPDs) and food allergies are relatively common in children and adolescents, and most studies report an association between FAPDs and allergic conditions. FAPDs share pathophysiologic processes with allergies, including both immune and psychological processes interacting with the microbiome. No conclusive data are implicating IgE-mediated reactions to foods in FAPDs; however, there may be patients who have IgE reactions localized to the gastrointestinal mucosa without systemic symptoms that are not identified by common tests. In FAPDs, the data appears stronger for aeroallergens than for foods. It also remains possible that food antigens initiate an IgG reaction that promotes mast cell activation. If a food allergen is identified, the management involves eliminating the specific food from the diet. In the absence of systemic allergic symptoms or oral allergy syndrome, it appears unlikely that allergic triggers for FAPDs can be reliably identified by standard testing. Medications used to blunt allergic reactions or symptomatically treat allergic reactions may be useful in FAPDs. The purpose of the current manuscript is to review the current literature regarding the role of allergy in FAPDs from a clinical perspective, including how allergy may fit in the current model of FAPDs. Full article

(This article belongs to the Special Issue Food Allergies in Modern Life)

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12 pages, 388 KiB

Open AccessReview

Primary Prevention of Food Allergy—Environmental Protection beyond Diet

by Hanna Sikorska-Szaflik and Barbara Sozańska

Nutrients 2021, 13(6), 2025; https://doi.org/10.3390/nu13062025 - 12 Jun 2021

Cited by 10 | Viewed by 6708

Abstract

A food allergy is a potentially life-threatening disease with a genetic and environmental background. As its prevalence has increased significantly in recent years, the need for its effective prevention has been emphasized. The role of diet modifications and nutrients in food allergy reduction has been extensively studied. Much less is known about the role of other environmental factors, which can influence the incidence of this disease. Changes in neonates gut microbiome by delivery mode, animal contact, inhalant allergens, oral and then cutaneous allergen exposure, air pollution, smoking, infections and vaccinations can be the potential modifiers of food allergy development. There is some data about their role as the risk or preventive factors, but yet the results are not entirely consistent. In this paper we present the current knowledge about their possible role in primary prevention of food allergies. We discuss the mechanisms of action, difficulties in designing accurate studies about food allergy and the potential biases in interpreting the connection between environmental factors and food allergy prevention. A better understanding of the role of environmental factors in food allergies development may help in implementing practical solutions for food allergy primary prevention in the future. Full article

(This article belongs to the Special Issue Food Allergies in Modern Life)

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12 pages, 987 KiB

Open AccessReview

Component-Resolved Diagnosis of Hazelnut Allergy in Children

by Carlo Caffarelli, Carla Mastrorilli, Angelica Santoro, Massimo Criscione and Michela Procaccianti

Nutrients 2021, 13(2), 640; https://doi.org/10.3390/nu13020640 - 16 Feb 2021

Cited by 8 | Viewed by 2497

Abstract

Hazelnuts commonly elicit allergic reactions starting from childhood and adolescence, with a rare resolution over time. The definite diagnosis of a hazelnut allergy relies on an oral food challenge. The role of component resolved diagnostics in reducing the need for oral food challenges in the diagnosis of hazelnut allergies is still debated. Therefore, three electronic databases were systematically searched for studies on the diagnostic accuracy of specific-IgE (sIgE) on hazelnut proteins for identifying children with a hazelnut allergy. Studies regarding IgE testing on at least one hazelnut allergen component in children whose final diagnosis was determined by oral food challenges or a suggestive history of serious symptoms due to a hazelnut allergy were included. Study quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Eight studies enrolling 757 children, were identified. Overall, sensitivity, specificity, area under the curve and diagnostic odd ratio of Cor a 1 sIgE were lower than those of Cor a 9 and Cor a 14 sIge. When the test results were positive, the post-test probability of a hazelnut allergy was 34% for Cor a 1 sIgE, 60% for Cor a9 sIgE and 73% for Cor a 14 sIgE. When the test results were negative, the post-test probability of a hazelnut allergy was 55% for Cor a 1 sIgE, 16% for Cor a9 sIgE and 14% for Cor a 14 sIgE. Measurement of IgE levels to Cor a 9 and Cor a 14 might have the potential to improve specificity in detecting clinically tolerant children among hazelnut-sensitized ones, reducing the need to perform oral food challenges. Full article

(This article belongs to the Special Issue Food Allergies in Modern Life)

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17 pages, 706 KiB

Open AccessReview

Cow’s Milk Allergy or Gastroesophageal Reflux Disease—Can We Solve the Dilemma in Infants?

by Silvia Salvatore, Massimo Agosti, Maria Elisabetta Baldassarre, Enza D’Auria, Licia Pensabene, Luana Nosetti and Yvan Vandenplas

Nutrients 2021, 13(2), 297; https://doi.org/10.3390/nu13020297 - 21 Jan 2021

Cited by 32 | Viewed by 11724

Abstract

Cow’s milk allergy (CMA) and gastro-esophageal reflux disease (GERD) may manifest with similar symptoms in infants making the diagnosis challenging. While immediate reaction to cow’s milk protein indicate CMA, regurgitation, vomiting, crying, fussiness, poor appetite, sleep disturbances have been reported in both CMA and GERD and in other conditions such as functional gastrointestinal disorders, eosinophilic esophagitis, anatomic abnormalities, metabolic and neurological diseases. Gastrointestinal manifestations of CMA are often non-IgE mediated and clinical response to cow’s milk free diet is not a proof of immune system involvement. Neither for non-IgE CMA nor for GERD there is a specific symptom or diagnostic test. Oral food challenge, esophageal pH impedance and endoscopy are recommended investigations for a correct clinical classification but they are not always feasible in all infants. As a consequence of the diagnostic difficulty, both over- and under- diagnosis of CMA or GERD may occur. Quite frequently acid inhibitors are empirically started. The aim of this review is to critically update the current knowledge of both conditions during infancy. A practical stepwise approach is proposed to help health care providers to manage infants presenting with persistent regurgitation, vomiting, crying or distress and to solve the clinical dilemma between GERD or CMA. Full article

(This article belongs to the Special Issue Food Allergies in Modern Life)

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31 pages, 479 KiB

Open AccessFeature PaperReview

Non–IgE- or Mixed IgE/Non–IgE-Mediated Gastrointestinal Food Allergies in the First Years of Life: Old and New Tools for Diagnosis

by Mauro Calvani, Caterina Anania, Barbara Cuomo, Enza D’Auria, Fabio Decimo, Giovanni Cosimo Indirli, Gianluigi Marseglia, Violetta Mastrorilli, Marco Ugo Andrea Sartorio, Angelica Santoro and Elisabetta Veronelli

Nutrients 2021, 13(1), 226; https://doi.org/10.3390/nu13010226 - 14 Jan 2021

Cited by 47 | Viewed by 9672

Abstract

non-IgE and mixed gastrointestinal food allergies present various specific, well-characterized clinical pictures such as food protein-induced allergic proctocolitis, food protein-induced enterocolitis and food protein-induced enteropathy syndrome as well as eosinophilic gastrointestinal disorders such as eosinophilic esophagitis, allergic eosinophilic gastroenteritis and eosinophilic colitis. The aim of this article is to provide an updated review of their different clinical presentations, to suggest a correct approach to their diagnosis and to discuss the usefulness of both old and new diagnostic tools, including fecal biomarkers, atopy patch tests, endoscopy, specific IgG and IgG4 testing, allergen-specific lymphocyte stimulation test (ALST) and clinical score (CoMiss). Full article

(This article belongs to the Special Issue Food Allergies in Modern Life)

12 pages, 1010 KiB

Open AccessReview

Malnutrition in Eosinophilic Gastrointestinal Disorders

by Martina Votto, Maria De Filippo, Francesca Olivero, Alessandro Raffaele, Emanuele Cereda, Mara De Amici, Giorgia Testa, Gian Luigi Marseglia and Amelia Licari

Nutrients 2021, 13(1), 128; https://doi.org/10.3390/nu13010128 - 31 Dec 2020

Cited by 18 | Viewed by 4142

Abstract

Primary eosinophilic gastrointestinal disorders (EGIDs) are emerging chronic/remittent inflammatory diseases of unknown etiology, which may involve any part of the gastrointestinal (GI) tract, in the absence of secondary causes of GI eosinophilia. Eosinophilic esophagitis is the prototype of eosinophilic gastrointestinal disorders and is clinically characterized by symptoms related to esophageal inflammation and dysfunction. A few studies have assessed the nutritional status of patients with eosinophilic gastrointestinal disorders, showing conflicting results. This review summarizes the current evidence on the nutritional status of patients with EGIDs, focusing on the pediatric point of view and also speculating potential etiological mechanisms. Full article

(This article belongs to the Special Issue Food Allergies in Modern Life)

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