Alergia al cacahuete en niños: probable ventana de oportunidad para la desensibilización / Peanut allergy in children: probable window of opportunity for desensitization

Conclusiones de los autores del estudio: los niños menores de 4 años de edad alérgicos al cacahuete, que recibieron inmunoterapia oral al alérgeno, presentaron una mayor desensibilización y remisión frente al mismo. Por tanto, parece existir una ventana de oportunidad de desensibilizarse al cacahuete en esta franja etaria.Comentario de los revisores: la inmunoterapia se mostró eficaz para conseguir la desensibilización y remisión en niños alérgicos al cacahuete entre 1 y 4 años. Este efecto fue más evidente en el grupo de menor edad y con niveles más bajos de marcadores inmunológicos. (AU)

Authors’ conclusions: children under 4 years of age allergic to peanuts who received oral allergen immunotherapy exhibited greater desensitization and achieved remission more frequently. Thus, there seems to be a window of opportunity for desensitization to desensitized to peanuts in this age range.Reviewers’ commentary: immunotherapy proved effective in achieving desensitization and remission in children allergic to peanuts aged 1 to 4 years. This effect was more evident in the younger children and in children with lower levels of immunological markers. (AU)

Diagnostic capacity of commercial extracts vs prick-by-prick in the study of sensitization to peanut: which technique should we use?

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The signal transducer and activator of transcription 6 (STAT-6) mediates Th2 inflammation and tissue damage in a murine model of peanut-induced food allergy

Introduction: Food allergies are inflammatory conditions mediated by Th2 and probably STAT-6 dependent immune responses. Objective and design: Here we investigated the role of Signal Transducer and Activator of Transcription 6 (STAT-6) in development of inflammation in peanut allergy. Methods: To induce food allergy, wild-type (WT) and mice deficient for STAT-6 (Stat6-/-) were sensitized with peanut proteins and challenged with peanut seeds. Results: WT animals lost weight and refused the peanut diet, in contrast to Stat6-/- mice, which had a better maintenance of body weight and more regular seeds' consumption. The augmented peanut-specific IgG, IgG1 and IgE in the allergic WT was abolished in Stat6-/- animals that also presented increased IgG2a. There was an overall reduction in the gut mediators in the absence of STAT-6, including those related to inflammatory and Th2 responses, in contrast to a rising counter regulatory and Th1 reaction in Stat-6-/- mice. These animals had IFN-γ and IL-10 similar to WT after the four-week challenge. Most interestingly, Stat-6-/- mice had no intestinal damage, in contrast to WT animals, which had inflammatory infiltrate, tissue destruction, epithelial exulceration, edema, congestion and loss of villous architecture in the small gut segments. Conclusions: STAT-6 plays an important role in the establishment of the Th2 inflammatory responses and intestinal damage in peanut allergy

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Isotretinoin in severe peanut- and soy-allergic patients: is it safe or not?

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La introducción precoz del huevo y el cacahuete parece disminuir el riesgo de alergia / Early egg and peanut introduction appears to reduce allergy risk

Los autores de esta revisión sistemática concluyen que la introducción precoz del huevo o el cacahuete en la dieta infantil se asocia a una disminución del riesgo de alergia a dichos alimentos, aunque se deben tener en cuenta las limitaciones de los estudios primarios. Respecto a otros alimentos estudiados (pescado, leche de vaca, gluten) no se encontró evidencia de ningún efecto. Probablemente no haya justificación para retrasar la introducción de algunos alimentos como el huevo y el cacahuete con el fin de prevenir la alergia a los mismos e incluso esta recomendación sea perjudicial. Falta evidencia para hacer una recomendación sobre el momento más adecuado de introducirlos (AU)

The authors of this systematic review conclude that the early introduction of egg or peanut in the infant diet was associated with lower risk of developing egg or peanut allergy, although these findings should be considered in the context of limitations in the primary studies. Regarding other foods studied (fish, cow’s milk, gluten), no evidence of any effect was found. There is probably no justification for the delay in the introduction of some foods such as eggs and peanuts to prevent allergy to them. This recommendation can even be harmful. There is no evidence to make a recommendation on the most appropriate time to introduce them (AU)

Prevalence and factors associated to peanut allergy in Mexican school children

BACKGROUND: In our country, the prevalence and the factors associated to peanut allergy are unknown, a health problem that has been emerging worldwide. OBJECTIVE: To establish the prevalence and the factors that are associated to peanut allergy amongst school children. METHODS: This is a population-based cross-sectional study. We included 756 children aged 6-7 years. The children's parents were questioned about their peanut intake habits. A structured questionnaire was applied, it included questions regarding peanut intake; family and personal history of asthma; rhinitis; and atopic dermatitis. Allergic reactions to peanuts were registered as: probable, convincing and systematic. The statistical analyses included logistical regression models to look for associated factors. RESULTS: Males were 356/756 (47.1%). Peanut allergy prevalence: probable reaction: 14/756 (1.8%), convincing reaction: 8/756 (1.1%) and systemic reaction: 3/756 (0.4%). Through multivariate analysis, the presence of symptoms of allergic rhinitis (OR = 4.2 95% CI 1.3-13.2) and atopic dermatitis (OR = 5.2; 95% CI 1.4-19.5) during the previous year, showed significant association to probable peanut reaction. The former year, the presence of atopic dermatitis was the only variable that was substantially associated to a convincing reaction (OR = 7.5; 95% CI 1.4-38.4) and to a systematic reaction (OR = 45.1; 95% CI 4.0-510.0), respectively. CONCLUSIONS: The reported prevalence of peanut allergy was consistent with that found in previous studies; symptoms of allergic rhinitis and atopic dermatitis were identified as associated factors to peanut allergy

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Oral inmunotherapy for food allergy

Food allergy is a potentially life-threatening condition with no approved therapies apart from avoidance and injectable epinephrine for treatment of acute allergic reactions. Oral immunotherapy (OIT) is an experimental treatment in which patients consume gradually increasing quantities of the food to which they are allergic in an attempt to induce some level of desensitization. While desensitization is possible in most patients, OIT carries significant risks for allergic reactions, and the ability to induce longer-term tolerance has not yet been established. This review focuses on selected studies of OIT for the treatment of common food allergies such as cow’s milk, hen’s egg, and peanut (AU)

La alergia alimentaria es una condición potencialmente mortal para la que no existen tratamientos aprobados, excepto la evitación y la epinefrina para tratar reacciones alérgicas graves. La inmunoterapia oral (OIT) es un tratamiento experimental en el cual los pacientes ingieren cantidades gradualmente crecientes del alimento al que son alérgicos, con el fin de inducir algún nivel de desensibilización. Si bien la desensibilización es posible en la mayoría de los pacientes, OIT conlleva riesgos importantes de reacciones alérgicas y la capacidad de inducir tolerancia a más largo plazo todavía no ha sido establecida. Este artículo de revisión se centra en una selección de estudios de OIT para el tratamiento de alergias a alimentos comunes, como son la leche de vaca, huevos de gallina y cacahuete (AU)

IgE cross-reactivity of peanut with walnut and soybean in children with food allergy

BACKGROUND: Peanut allergies are common and can be life-threating for sensitised individuals. Peanut allergens share significant amino acid homology with those of other legumes and tree nuts, but their cross-reactivity still remains unclear. OBJECTIVE: We sought to determine the clinical significance of the cross-reactivity of peanut allergens with those of walnut and soybean. METHODS: Pooled sera from eight subjects with both peanut and walnut specific IgE were investigated in an inhibition test. After the sera were incubated with either peanut or walnut protein extracts, the quantity of IgE antibodies against the peanut and walnut was measured using an immunoCAP test. Likewise, pooled sera from 18 subjects with both peanut and soybean specific IgE antibodies were incubated with either peanut or soybean protein extracts and evaluated with a peanut and soybean immunoCAP test. SDS-PAGE and immunoblotting were also performed with peanut, walnut and soybean protein extracts and relevant sera. RESULTS: Peanut specific IgE was inhibited up to 20% and 26% by walnut and soybean protein extracts, respectively. In reverse, walnut and soybean specific IgE were inhibited up to 21% and 23% by peanut protein extracts, respectively. In the immunoblot analysis, pooled serum from the subjects with peanut specific IgE antibodies reacted with walnut protein extracts significantly. CONCLUSION: Although the clinical significance of the cross-reactivity of peanut specific IgE with walnut and soybean protein extracts has not been established, we believe that individuals who are allergic to peanuts need to be cautious about consuming walnuts and soybeans

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Is microarray analysis really useful and sufficient to diagnose nut allergy in the mediterranean area?

Background: Component-based diagnosis on multiplex platforms is widely used in food allergy but its clinical performance has not been evaluated in nut allergy. Objective: To assess the diagnostic performance of a commercial protein microarray in the determination of specific IgE (sIgE) in peanut, hazelnut, and walnut allergy. Methods: sIgE was measured in 36 peanut-allergic, 36 hazelnut-allergic, and 44 walnut-allergic patients by ISAC 112, and subsequently, sIgE against available components was determined by ImmunoCAP in patients with negative ISAC results. ImmunoCAP was also used to measure sIgE to Ara h 9, Cor a 8, and Jug r 3 in a subgroup of lipid transfer protein (LTP)-sensitized nut-allergic patients (positive skin prick test to LTP-enriched extract). sIgE levels by ImmunoCAP were compared with ISAC ranges. Results: Most peanut-, hazelnut-, and walnut-allergic patients were sensitized to the corresponding nut LTP (Ara h 9, 66.7%; Cor a 8, 80.5%; Jug r 3, 84% respectively). However, ISAC did not detect sIgE in 33.3% of peanut-allergic patients, 13.9% of hazelnut-allergic patients, or 13.6% of walnut-allergic patients. sIgE determination by ImmunoCAP detected sensitization to Ara h 9, Cor a 8, and Jug r 3 in, respectively, 61.5% of peanut-allergic patients, 60% of hazelnut-allergic patients, and 88.3% of walnut-allergic patients with negative ISAC results. In the subgroup of peach LTP-sensitized patients, Ara h 9 sIgE was detected in more cases by ImmunoCAP than by ISAC (94.4% vs 72.2%, P<.05). Similar rates of Cor a 8 and Jug r 3 sensitization were detected by both techniques. Conclusions: The diagnostic performance of ISAC was adequate for hazelnut and walnut allergy but not for peanut allergy. sIgE sensitivity against Ara h 9 in ISAC needs to be improved (AU)

Introducción: La utilidad clínica del diagnóstico por componentes no ha sido evaluada en el estudio de la alergia a frutos secos (FS). Objetivo: Evaluar la capacidad diagnóstica de una micromatriz comercial de proteínas alergénicas en la alergia a cacahuete, avellana y nuez. Métodos: Se determinó la sIgE en pacientes alérgicos a FS mediante la micromatriz ISAC 112, e ImmunoCAP en los pacientes con sIgE negativa frente a los componentes de ISAC. Además, se realizó ImmunoCAP frente a Ara h 9, Cor a 8 y Jug r 3 en un subgrupo de pacientes sensibilizados a LTP. La sIgE detectada por ImmunoCAP fue comparada con los rangos de ISAC. Resultados: La mayoría de los alérgicos a cacahuete (66,7%), avellana (80,5%) y nuez (84%) estaba sensibilizados a su LTP. Sin embargo, no se detectó sIgE frente a los componentes de ISAC en el 33,3% de alérgicos a cacahuete, 13,9% de alérgicos a avellana y 13,6% de los alérgicos a nuez. El ImmunoCAP permitió detectar sIgE a Ara h 9 en 61,5%, Cor a 8 en 60% y Jug r 3 en 83,3% de los ISAC negativo. En el subgrupo LTP, ImmunoCAP (94,4%) fue superior a ISAC (72,2%) en la detección de sIgE a Ara h 9 (p<0,05). La sIgE frente a Cor a 8 y Jug r 3 fue detectada de forma similar por ambas técnicas. Conclusiones: La micromatriz ISAC es adecuada para el diagnóstico de alergia a avellana y nuez. La sensibilidad del componente Ara h 9 de ISAC debe ser mejorada (AU)

Oral immunotherapy for management of peanut allergy in spanish children

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Allergic reactions to pine nut: a review

Pine nut is a nutrient-rich food with a beneficial impact on human health. The many bioactive constituents of pine nut interact synergistically to affect human physiology in a favorable way. However, pine nut can trigger dangerous allergic reactions. Severe anaphylactic reactions to pine nut accounted for most of the 45 cases reported in the scientific literature. Pine nut allergy seems to be characterized by low IgE cross-reactivity with other commonly consumed nuts and a high monosensitization rate. The present review provides updated information on allergic reactions to pine nut, molecular characterization of its allergens, and potential homologies with other nut allergens (AU)

El piñón es un alimento rico en nutrientes con un impacto beneficioso en la salud. Los componentes bioactivos del piñón interaccionan de forma sinérgica para influir en la fisiología humana de una forma favorable. Sin embargo el piñón puede producir reacciones alérgicas graves. Del total de los casos publicados, las reacciones anafilácticas severas representan la mayoría de las reacciones descritas. La alergia a piñón, además, parece estar caracterizada por una baja reactividad cruzada a nivel de anticuerpos IgE con otros frutos secos consumidos habitualmente y por un elevado porcentaje de monosensibilización. El propósito de esta revisión es dar una visión actualizada de las reacciones alérgicas a piñón, la caracterización de sus alérgenos a nivel molecular y sus homologías con otros alérgenos de frutos secos (AU)

Double-blind food challenges in children in general paediatric practice: Useful and safe, but not without pitfalls

OBJECTIVE: To describe results of double-blind placebo-controlled food challenges (DBPCFC) with cow's milk, hen's egg, soy, peanut and hazelnut in general paediatric practice. METHODS: Food challenges were performed between January 2006 and June 2011, in children 0-18 years of age, on two half-day hospital admissions with a one-week interval. Tests were performed in a double-blind fashion following a standardised protocol with validated recipes. RESULTS: Overall, 234 food challenges were performed in 209 children: 160 with cow's milk, 35 with peanut, 21 with hen's egg, 11 with hazelnuts, and 7 with soy. In two thirds of the cases, the DBPCFC was negative (cow's milk: 57.5%; peanut: 40.0%; hen's egg: 66.7%, hazelnut: 90.9%, soy: 100%). The only patient characteristic significantly associated with a positive DBPCFC was the presence of symptoms from three different organ systems (p = 0.007). Serious systemic allergic reactions with wheeze or anaphylaxis occurred in only two children (0.9%). Symptoms were recorded on 29.3% of placebo days. In 30/137 children with a negative test (22%), symptoms returned when reintroducing the allergen into the diet, mostly (66.7%) transient. Of the 85 tests regarded as positive by the attending physician, 19 (22.4%) did not meet predefined criteria for a positive test. This was particularly common with non-specific symptoms. CONCLUSION: A DBPCFC can be safely performed in a general hospital for a range of food allergens. The test result is negative in most cases except for peanut. Non-specific symptoms may hamper the interpretation of the DBPCFC, increasing the risk of a false-positive result

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Detección de alérgenos de cacahuete mediante un sensor de ADN / Detection of peanut allergens by a DNA sensor

En el presente trabajo se propone un genosensor electroquímico para la detección de un segmento de ADN que codifica parte de la proteína alergénica Ara h 2 del cacahuete. El genosensor se basa en un ensayo tipo sándwich, el analito hibrida con dos secuencias de bases, una de ellas inmovilizada sobre un electrodo de oro serigrafiado, formando una monocapa autoensamblada. La optimización del dispositivo se realizó utilizando la metodología de Superficies de Respuesta. La máxima respuesta se encontró para concentraciones de sonda de captura y agente bloqueante, 1 mM y 2,5 mM respectivamente

In the present work an electrochemical genosensor for detecting a DNA segment encoding part of the allergenic protein peanut Ara h 2 is proposed. Genosensors is based on a sandwich assay format, the analyte hybridized with two base sequences, one immobilized onto a screen printed gold electrode, forming a self-assembled monolayer. The optimization of the device was performed using Response Surface Methodology. The maximum response was found to be 1 µM of capture probe concentration and 2,5 mM of blocking agent concentration

La alergia alimentaria en el siglo XXI / Food allergy in the XXI century

La alergia alimentaria es una situación clínica de alta prevalencia y posible riesgo vital. En este artículo se revisan los alimentos más frecuentemente responsables de las reacciones graves, incluyendo datos de la Comunidad Autónoma de Navarra. Puesto que la dieta de eliminación constituye el punto primordial del tratamiento a largo plazo de la alergia alimentaria, se analizan sus dificultades, limitaciones y riesgos. Por último se exponen las nuevas perspectivas que ofrece la tecnología en el campo de la alergia a alimentos, tanto en la producción de alimentos hipoalergénicos como en el desarrollo de nuevas formas de inmunoterapia (AU)