Assuntos
Hipersensibilidade Alimentar , Hipersensibilidade a Noz , Hipersensibilidade a Amendoim , Criança , Humanos , Nozes/efeitos adversos , Arachis/efeitos adversos , Hipersensibilidade Alimentar/diagnóstico , Hipersensibilidade a Noz/diagnóstico , Hipersensibilidade a Amendoim/diagnóstico , Hipersensibilidade a Amendoim/prevenção & controle , AlérgenosRESUMO
BACKGROUND: Atopic dermatitis (AD) affects children of all skin types. Most research has focused on light skin types. Studies investigating biomarkers in people with AD with dark skin types are lacking. OBJECTIVES: To explore skin barrier and immune response biomarkers in stratum corneum (SC) tape strips from children with AD with different skin types. METHODS: Tape strips were collected from lesional and nonlesional forearm skin of 53 children with AD and 50 controls. We analysed 28 immunomodulatory mediators, and natural moisturizing factors (NMF) and corneocyte morphology. RESULTS: Interleukin (IL)-1ß, IL-18, C-X-C motif chemokine (CXCL) 8 (CXCL8), C-C motif chemokine ligand (CCL) 22 (CCL22), CCL17, CXCL10 and CCL2 were significantly higher (P < 0·05) in lesional AD skin compared with nonlesional AD skin; the opposite trend was seen for IL-1α. CXCL8, CCL2 and CCL17 showed an association with objective SCORing Atopic Dermatitis score. NMF levels showed a gradual decrease from healthy skin to nonlesional and lesional AD skin. This gradual decreasing pattern was observed in skin type II but not in skin type VI. Skin type VI showed higher NMF levels in both nonlesional and lesional AD skin than skin type II. Corneocyte morphology was significantly different in lesional AD skin compared with nonlesional AD and healthy skin. CONCLUSIONS: Minimally invasive tape-stripping is suitable for the determination of many inflammatory mediators and skin barrier biomarkers in children with AD. This study shows differences between children with AD with skin type II and skin type VI in NMF levels, suggesting that some aspects of pathophysiological mechanisms may differ in AD children with light versus dark skin types.
Assuntos
Quimiocinas/análise , Dermatite Atópica/diagnóstico , Epiderme/patologia , Biomarcadores/análise , Estudos de Casos e Controles , Quimiocinas/imunologia , Quimiocinas/metabolismo , Criança , Pré-Escolar , Dermatite Atópica/imunologia , Dermatite Atópica/patologia , Epiderme/imunologia , Epiderme/metabolismo , Estudos de Viabilidade , Feminino , Proteínas Filagrinas , Humanos , Lactente , Masculino , Mutação , Permeabilidade , Proteínas S100/genética , Pigmentação da Pele/imunologiaRESUMO
BACKGROUND: The conduct of oral food challenges as the preferred diagnostic standard for food allergy (FA) was harmonized over the last years. However, documentation and interpretation of challenge results, particularly in research settings, are not sufficiently standardized to allow valid comparisons between studies. Our aim was to develop a diagnostic toolbox to capture and report clinical observations in double-blind placebo-controlled food challenges (DBPCFC). METHODS: A group of experienced allergists, paediatricians, dieticians, epidemiologists and data managers developed generic case report forms and standard operating procedures for DBPCFCs and piloted them in three clinical centres. The follow-up of the EuroPrevall/iFAAM birth cohort and other iFAAM work packages applied these methods. RECOMMENDATIONS: A set of newly developed questionnaire or interview items capture the history of FA. Together with sensitization status, this forms the basis for the decision to perform a DBPCFC, following a standardized decision algorithm. A generic form including details about severity and timing captures signs and symptoms observed during or after the procedures. In contrast to the commonly used dichotomous outcome FA vs no FA, the allergy status is interpreted in multiple categories to reflect the complexity of clinical decision-making. CONCLUSION: The proposed toolbox sets a standard for improved documentation and harmonized interpretation of DBPCFCs. By a detailed documentation and common terminology for communicating outcomes, these tools hope to reduce the influence of subjective judgment of supervising physicians. All forms are publicly available for further evolution and free use in clinical and research settings.
Assuntos
Alérgenos/imunologia , Pesquisa Biomédica , Estudos Clínicos como Assunto , Hipersensibilidade Alimentar/diagnóstico , Hipersensibilidade Alimentar/imunologia , Alimentos/efeitos adversos , Administração Oral , Alérgenos/administração & dosagem , Pesquisa Biomédica/métodos , Pesquisa Biomédica/normas , Tomada de Decisão Clínica , Estudos Clínicos como Assunto/métodos , Estudos Clínicos como Assunto/normas , Reações Cruzadas/imunologia , Documentação , Hipersensibilidade Alimentar/epidemiologia , Humanos , Imunoglobulina E/sangue , Imunoglobulina E/imunologia , Autorrelato , Testes Cutâneos/métodos , Testes Cutâneos/normas , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Parents and health staff perceive hen's egg allergy (HEA) as a common food allergy in early childhood, but the true incidence is unclear because population-based studies with gold-standard diagnostic criteria are lacking. OBJECTIVE: To establish the incidence and course of challenge-confirmed HEA in children, from birth until the age of 24 months, in different European regions. METHODS: In the EuroPrevall birth cohort study, children with a suspected HEA and their age-matched controls were evaluated in 9 countries, using a standardized protocol including measurement of HE-specific immunoglobulin E-antibodies in serum, skin prick tests, and double-blind, placebo-controlled food challenges (DBPCFC). RESULTS: Across Europe, 12 049 newborns were enrolled, and 9336 (77.5%) were followed up to 2 years of age. In 298 children, HEA was suspected and DBPCFC was offered. HEA by age two was confirmed in 86 of 172 challenged children (mean raw incidence 0.84%, 95% confidence interval (95% CI) 0.67-1.03). Adjusted mean incidence of HEA was 1.23% (95% CI 0.98-1.51) considering possible cases among eligible children who were not challenged. Centre-specific incidence ranged from United Kingdom (2.18%, 95% CI 1.27-3.47) to Greece (0.07%). Half of the HE-allergic children became tolerant to HE within 1 year after the initial diagnosis. CONCLUSIONS: The largest multinational European birth cohort study on food allergy with gold-standard diagnostic methods showed that the mean adjusted incidence of HEA was considerably lower than previously documented, although differences in incidence rates among countries were noted. Half of the children with documented HEA gained tolerance within 1 year postdiagnosis.
Assuntos
Alérgenos/imunologia , Hipersensibilidade a Ovo/epidemiologia , Ovos/efeitos adversos , Animais , Galinhas , Estudos de Coortes , Hipersensibilidade a Ovo/diagnóstico , Hipersensibilidade a Ovo/imunologia , Feminino , Humanos , Imunoglobulina E/imunologia , Incidência , Masculino , Vigilância da População , Testes CutâneosRESUMO
BACKGROUND: Cow's milk allergy (CMA) is one of the most commonly reported childhood food problems. Community-based incidence and prevalence estimates vary widely, due to possible misinterpretations of presumed reactions to milk and differences in study design, particularly diagnostic criteria. METHODS: Children from the EuroPrevall birth cohort in 9 European countries with symptoms possibly related to CMA were invited for clinical evaluation including cows' milk-specific IgE antibodies (IgE), skin prick test (SPT) reactivity and double-blind, placebo-controlled food challenge. RESULTS: Across Europe, 12 049 children were enrolled, and 9336 (77.5%) were followed up to 2 years of age. CMA was suspected in 358 children and confirmed in 55 resulting in an overall incidence of challenge-proven CMA of 0.54% (95% CI 0.41-0.70). National incidences ranged from 1% (in the Netherlands and UK) to <0.3% (in Lithuania, Germany and Greece). Of all children with CMA, 23.6% had no cow's milk-specific IgE in serum, especially those from UK, the Netherlands, Poland and Italy. Of children with CMA who were re-evaluated one year after diagnosis, 69% (22/32) tolerated cow's milk, including all children with non-IgE-associated CMA and 57% of those children with IgE-associated CMA. CONCLUSIONS: This unique pan-European birth cohort study using the gold standard diagnostic procedure for food allergies confirmed challenge-proven CMA in <1% of children up to age 2. Affected infants without detectable specific antibodies to cow's milk were very likely to tolerate cow's milk one year after diagnosis, whereas only half of those with specific antibodies in serum 'outgrew' their disease so soon.
Assuntos
Imunoglobulina E/imunologia , Hipersensibilidade a Leite/diagnóstico , Hipersensibilidade a Leite/epidemiologia , Proteínas do Leite/efeitos adversos , Distribuição por Idade , Alérgenos/imunologia , Animais , Bovinos , Criança , Pré-Escolar , Estudos de Coortes , Método Duplo-Cego , Europa (Continente)/epidemiologia , Feminino , Humanos , Incidência , Lactente , Masculino , Proteínas do Leite/imunologia , Índice de Gravidade de Doença , Distribuição por Sexo , Testes Cutâneos/métodosRESUMO
Cow's milk allergy is the most common food allergy among children. Patients with cow's milk allergy may present a wide range of complaints. Complaints can occur in multiple organ systems. The gold standard to confirm a diagnosis of cow's milk allergy is the double-blind placebo-controlled food challenge. The treatment consists of the elimination of cow's milk from a child's diet.It is estimated that at the age of 1 year, 75% of children with cow's milkallergy have become tolerant to cow's milk, and 90% at the age of 4 years. It is recommended to expose all infants with cow's milk allergy to cow's milk at the age of 1 year to see if they have become tolerant.
Assuntos
Hipersensibilidade a Leite , Leite/imunologia , Animais , Bovinos , Pré-Escolar , Diagnóstico Diferencial , Método Duplo-Cego , Humanos , Lactente , Hipersensibilidade a Leite/diagnóstico , Hipersensibilidade a Leite/epidemiologia , Hipersensibilidade a Leite/imunologiaRESUMO
Assessing maternal dietary habits across Europe during pregnancy in relation to their national pregnancy recommendations. A collaborative, multi-centre, birth cohort study in nine European countries was conducted as part of European Union funded EuroPrevall project. Standardised baseline questionnaire data included details of food intake, nutritional supplement use, exposure to cigarette smoke during pregnancy and socio-demographic data. Pregnancy recommendations were collected from all nine countries from the appropriate national organisations. The most commonly taken supplement in pregnancy was folic acid (55.6 % Lithuania-97.8 % Spain) and was favoured by older, well-educated mothers. Vitamin D supplementation across the cohort was very poor (0.3 % Spain-5.1 % Lithuania). There were significant differences in foods consumed in different countries during pregnancy e.g. only 2.7 % Dutch mothers avoided eating peanut, while 44.4 % of British mothers avoided it. Some countries have minimal pregnancy recommendations i.e. Lithuania, Poland and Spain while others have similar, very specific recommendations i.e. UK, the Netherlands, Iceland, Greece. Allergy specific recommendations were associated with food avoidance during pregnancy [relative rate (RR) 1.18 95 % CI 0.02-1.37]. Nutritional supplement recommendations were also associated with avoidance (RR 1.08, 1.00-1.16). Maternal dietary habits and the use of dietary supplements during pregnancy vary significantly across Europe and in some instances may be influenced by national recommendations.
Assuntos
Anormalidades Congênitas/prevenção & controle , Suplementos Nutricionais , Comportamento Alimentar , Ácido Fólico/administração & dosagem , Guias de Prática Clínica como Assunto , Vitamina D/administração & dosagem , Adolescente , Adulto , Estudos de Coortes , Comparação Transcultural , Europa (Continente) , Feminino , Humanos , Política Nutricional , Necessidades Nutricionais , Cuidado Pré-Concepcional , Gravidez , Saúde da MulherRESUMO
The double blind placebo controlled food challenge (DBPCFC) is the gold standard for diagnosing cow's milk allergy (CMA). However, false-negative DBPCFC have been reported. We present 2 cases with a false negative DBPCFC in exclusively breastfed infants suspected of CMA. These cases highlight the occurrence of severe allergic reactions of infants who were exclusively breastfed. Several reported causes of a false negative DBPCFC will be discussed. However, there is currently no clear understanding of the cause of a false negative DBPCFC. This paper highlights that a negative outcome of a DBFCFC must be interpreted with caution, because a severe allergic reaction might occur upon re-introduction of cow's milk. Therefore, an additional open food challenge under medical supervision is recommended in exclusively breastfed infants with a negative DBPCFC.
Assuntos
Aleitamento Materno , Hipersensibilidade a Leite/diagnóstico , Método Duplo-Cego , Reações Falso-Negativas , Feminino , Humanos , Recém-Nascido , Masculino , Placebos , RiscoRESUMO
EoE patients show variable sensitization patterns to food and aeroallergens. The value of allergy testing in adult EoE patients is unclear. Component-resolved diagnosis (CRD) may offer additional insights into sensitization patterns. The aim of this study was to characterize sensitization patterns in adult EoE patients using CRD. Serum from 76 patients (17 female), age 38.6 ± 1.5 years, was analyzed for reactivity to 112 different allergen components using an immuno-solid-phase allergen chip (ISAC). We observed any sensitization in 59 patients (78%), of which 54 patients were polysensitized. Aeroallergen sensitization, mostly against components of grass or tree pollen, or house dust mite, was observed in 74% of the patients. Birch pollen (rBet v 1) sensitization with cross-reactivity to food allergen components was observed in 30 patients (39%). In conclusion, food sensitizations in EoE patients are mainly caused by cross-reactivity to food allergens after primary birch pollen sensitization. Pollen and food sensitizations may cause or maintain esophageal inflammation in EoE patients. CRD provides more insight into sensitization patterns, identifies additional food allergen sensitizations and might be useful to direct dietary therapy in EoE.
Assuntos
Betula/imunologia , Esofagite Eosinofílica/imunologia , Hipersensibilidade Alimentar/imunologia , Pólen/imunologia , Hipersensibilidade Respiratória/imunologia , Adulto , Alérgenos/imunologia , Animais , Reações Cruzadas/imunologia , Cynodon/imunologia , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/dietoterapia , Feminino , Hipersensibilidade Alimentar/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Pyroglyphidae/imunologia , Hipersensibilidade Respiratória/diagnóstico , Adulto JovemRESUMO
BACKGROUND: In a murine model of allergic inflammation, Bifidobacterium breve M-16V has been shown to reduce IL-4 and IgE by inducing IL-10 and IFN-γ. However, it remains unknown whether this strain has the same effect in humans with allergic disease. OBJECTIVE: To determine the effects of Bifidobacterium breve M-16V combined with a prebiotic oligosaccharide mixture (synbiotic) on atopic markers, ex vivo cytokine production by peripheral blood mononuclear cells (PBMCs) and circulating regulatory T cell percentage in infants with atopic dermatitis. METHODS: In a double-blind, placebo-controlled multi-centre trial, 90 infants with atopic dermatitis, age <7 months, were randomized to receive an infant formula with Bifidobacterium breve M-16V and a mixture of short chain galactooligosaccharides and long chain fructooligosaccharides (Immunofortis(®) ), or the same formula without synbiotics during 12 weeks. At week 0 and 12, plasma levels of IL-5, IgG1, IgG4, CTACK and TARC, ex vivo cytokine responses by PBMCs and percentage of regulatory T cells, were determined. RESULTS: There were no significant differences between the synbiotic and the placebo group in IL-5, IgG1, IgG4, CTACK and TARC levels and ex vivo cytokine production by anti-CD3/anti-CD28-stimulated PBMCs. With allergen-specific stimuli, we found a decreased IL-12p40/70 and IL-12p70 production in response to egg allergen (P = 0.04 and P = 0.01, respectively) and decreased IL-12p70 production in response to peanut allergen (P = 0.003) in the synbiotic compared with the placebo group. Circulating regulatory T cell percentage did not significantly differ between the groups. CONCLUSIONS AND CLINICAL RELEVANCE: This synbiotic mixture has no detectable effect on plasma levels of the analysed atopic disease markers, ex vivo cytokine production and circulating regulatory T cell percentage in infants with atopic dermatitis, besides down-regulation of IL-12 production in egg- and peanut-stimulated PBMCs. These results do not support the use of this synbiotic in clinical practice.
Assuntos
Dermatite Atópica/tratamento farmacológico , Fatores Imunológicos/farmacologia , Imunomodulação/imunologia , Simbióticos , Bifidobacterium/imunologia , Quimiocina CCL17/sangue , Quimiocina CCL27/sangue , Citocinas/biossíntese , Dermatite Atópica/sangue , Dermatite Atópica/imunologia , Método Duplo-Cego , Feminino , Humanos , Imunoglobulina G/sangue , Lactente , Fórmulas Infantis/química , Recém-Nascido , Interleucina-5/sangue , Masculino , Probióticos/uso terapêutico , Linfócitos T Reguladores/efeitos dos fármacos , Linfócitos T Reguladores/imunologiaRESUMO
BACKGROUND: Prebiotic galacto- and fructo-oligosaccharides (scGOS/lcFOS) resembling non-digestible oligosaccharides in human milk reduce the development of atopic disorders. However, the underlying mechanisms are still unclear. Galectins are soluble-type lectins recognizing ß-galactoside containing glycans. Galectin-9 has been shown to regulate mast cell degranulation and T-cell differentiation. In this study, the involvement of galectin-9 as a mechanism by which scGOS/lcFOS in combination with Bifidobacterium breve M-16V protects against acute allergic symptoms was investigated. METHODS: Mice were sensitized orally to whey, while being fed with a diet containing scGOS/lcFOS and Bifidobacterium breve M-16V (GF/Bb) or a control diet. Galectin-9 expression was determined by immunohistochemistry in the intestine and measured in the serum by ELISA. T-cell differentiation was investigated in the mesenteric lymph nodes (MLN) as well as in galectin-9-exposed peripheral blood mononuclear cells (PBMC) cultures. Sera of the mice were evaluated for the capacity to suppress mast cell degranulation using a RBL-2H3 degranulation assay. In addition, in a double-blind, placebo-controlled multicenter trial, galectin-9 levels were measured in the sera of 90 infants with atopic dermatitis who received hydrolyzed formulae with or without GF/Bb. RESULTS: Galectin-9 expression by intestinal epithelial cells and serum galectin-9 levels were increased in mice and humans following dietary intervention with GF/Bb and correlated with reduced acute allergic skin reaction and mast cell degranulation. In addition, GF/Bb enhanced T(h)1- and T(reg)-cell differentiation in MLN and in PBMC cultures exposed to galectin-9. CONCLUSIONS: Dietary supplementation with GF/Bb enhances serum galectin-9 levels, which associates with the prevention of allergic symptoms.
Assuntos
Dermatite Atópica/terapia , Galectinas/metabolismo , Fórmulas Infantis/administração & dosagem , Oligossacarídeos/administração & dosagem , Probióticos/administração & dosagem , Simbióticos , Animais , Bifidobacterium , Degranulação Celular , Diferenciação Celular , Dermatite Atópica/imunologia , Dermatite Atópica/prevenção & controle , Suplementos Nutricionais , Método Duplo-Cego , Células Epiteliais/metabolismo , Galectinas/sangue , Galectinas/uso terapêutico , Humanos , Fórmulas Infantis/química , Intestinos/citologia , Mastócitos/fisiologia , Camundongos , Oligossacarídeos/química , Prebióticos , Linfócitos T/imunologia , Resultado do TratamentoRESUMO
It is unclear why some children develop food allergy. The EuroPrevall birth cohort was established to examine regional differences in the prevalence and risk factors of food allergy in European children using gold-standard diagnostic criteria. The aim of this report was to describe pre-, post-natal and environmental characteristics among the participating countries. In nine countries across four major European climatic regions, mothers and their newborns were enrolled from October 2005 through February 2010. Using standardized questionnaires, we assessed allergic diseases and self-reported food hypersensitivity of parents and siblings, nutrition during pregnancy, nutritional supplements, medications, mode of delivery, socio-demographic data and home environmental exposures. A total of 12,049 babies and their families were recruited. Self-reported adverse reactions to food ever were considerably more common in mothers from Germany (30%), Iceland, United Kingdom, and the Netherlands (all 20-22%) compared with those from Italy (11%), Lithuania, Greece, Poland, and Spain (all 5-8%). Prevalence estimates of parental asthma, allergic rhinitis and eczema were highest in north-west (Iceland, UK), followed by west (Germany, the Netherlands), south (Greece, Italy, Spain) and lowest in central and east Europe (Poland, Lithuania). Over 17% of Spanish and Greek children were exposed to tobacco smoke in utero compared with only 8-11% in other countries. Caesarean section rate was highest in Greece (44%) and lowest in Spain (<3%). We found country-specific differences in antibiotic use, pet ownership, type of flooring and baby's mattress. In the EuroPrevall birth cohort study, the largest study using gold-standard diagnostic criteria for food allergy in children worldwide, we found considerable country-specific baseline differences regarding a wide range of factors that are hypothesized to play a role in the development of food allergy including allergic family history, obstetrical practices, pre- and post-natal environmental exposures.
Assuntos
Família , Hipersensibilidade Alimentar/epidemiologia , Adulto , Alérgenos/imunologia , Estudos de Coortes , Exposição Ambiental , Europa (Continente)/epidemiologia , Feminino , Hipersensibilidade Alimentar/complicações , Hipersensibilidade Alimentar/imunologia , Humanos , Hipersensibilidade/epidemiologia , Hipersensibilidade/etiologia , Hipersensibilidade/imunologia , Recém-Nascido , Masculino , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/imunologia , Prevalência , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Infants with atopic dermatitis (AD) have a high risk of developing asthma. We investigated the effect of early intervention with synbiotics, a combination of probiotics and prebiotics, on the prevalence of asthma-like symptoms in infants with AD. METHODS: In a double-blind, placebo-controlled multicentre trial, ninety infants with AD, age <7\ months, were randomized to receive an extensively hydrolyzed formula with Bifidobacterium breve M-16V and a galacto/fructooligosaccharide mixture (Immunofortis(®) ), or the same formula without synbiotics during 12 weeks. After 1 year, the prevalence of respiratory symptoms and asthma medication use was evaluated, using a validated questionnaire. Also, total serum IgE and specific IgE against aeroallergens were determined. FINDINGS: Seventy-five children (70.7% male, mean age 17.3 months) completed the 1-year follow-up evaluation. The prevalence of 'frequent wheezing' and 'wheezing and/or noisy breathing apart from colds' was significantly lower in the synbiotic than in the placebo group (13.9%vs 34.2%, absolute risk reduction (ARR) -20.3%, 95% CI -39.2% to -1.5%, and 2.8%vs 30.8%, ARR -28.0%, 95% CI -43.3% to -12.5%, respectively). Significantly less children in the synbiotic than in the placebo group had started to use asthma medication after baseline (5.6%vs 25.6%, ARR -20.1%, 95% CI -35.7% to -4.5%). Total IgE levels did not differ between the two groups. No children in the synbiotic and five children (15.2%) in the placebo group developed elevated IgE levels against cat (ARR -15.2%, 95% CI -27.4% to -2.9%). CONCLUSION: These results suggest that this synbiotic mixture prevents asthma-like symptoms in infants with AD.
Assuntos
Asma/prevenção & controle , Dermatite Atópica/terapia , Simbióticos , Animais , Asma/patologia , Bifidobacterium , Gatos/imunologia , Método Duplo-Cego , Quimioterapia Combinada/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Oligossacarídeos , Inquéritos e Questionários , Resultado do TratamentoRESUMO
BACKGROUND: Clinical trials investigating the therapeutic effect of probiotics on atopic dermatitis (AD) show inconsistent results. Better results can possibly be achieved by combining probiotics with prebiotics, i.e. synbiotics. OBJECTIVE: To investigate the therapeutic effect of a synbiotic mixture on the severity of AD in infants. METHODS: In a double-blind, placebo-controlled multi-centre trial, 90 infants with AD [SCORing Atopic Dermatitis (SCORAD) score > or =15], aged < 7 months and exclusively formula fed, were randomly assigned to receive either an extensively hydrolysed formula with Bifidobacterium breve M-16V and a galacto-/fructooligosaccharide mixture (Immunofortis), or the same formula without synbiotics for 12 weeks. The primary outcome was severity of AD, assessed using the SCORAD index. A secondary outcome measure was intestinal microbiota composition. RESULTS: There was no difference in SCORAD score improvement between the synbiotic and the placebo group. The synbiotic group did have a significantly higher percentage of bifidobacteria (54.7% vs. 30.1%, P<0.001) and significantly lower percentages of Clostridium lituseburense/Clostridium histolyticum (0.5 vs. 1.8, P=0.02) and Eubacterium rectale/Clostridium coccoides (7.5 vs. 38.1, P<0.001) after intervention than the placebo group. In the subgroup of infants with IgE-associated AD (n=48), SCORAD score improvement was significantly greater in the synbiotic than in the placebo group at week 12 (-18.1 vs. -13.5 points, P=0.04). CONCLUSIONS: This synbiotic mixture does not have a beneficial effect on AD severity in infants, although it does successfully modulate their intestinal microbiota. Further randomized-controlled trials should explore a possible beneficial effect in IgE-associated AD.
Assuntos
Dermatite Atópica/terapia , Fórmulas Infantis/administração & dosagem , Probióticos/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Países Baixos , Resultado do TratamentoRESUMO
BACKGROUND/AIM: The true prevalence and risk factors of food allergies in children are not known because estimates were based predominantly on subjective assessments and skin or serum tests of allergic sensitization to food. The diagnostic gold standard, a double-blind placebo-controlled food provocation test, was not performed consistently to confirm suspected allergic reactions in previous population studies in children. This protocol describes the specific aims and diagnostic protocol of a birth cohort study examining prevalence patterns and influential factors of confirmed food allergies in European children from different regions. METHODS: Within the collaborative translational research project EuroPrevall, we started a multi-center birth cohort study, recruiting a total of over 12 000 newborns in nine countries across Europe in 2005-2009. In addition to three telephone interviews during the first 30 months, parents were asked to immediately inform the centers about possible allergic reactions to food at any time during the follow-up period. RESULTS: All children with suspected food allergy symptoms were clinically evaluated including double-blind placebo-controlled food challenge tests. We assessed sensitization to different food allergens by measurements of specific serum immunoglobulin E and skin prick tests, collect blood, saliva or buccal swabs for genetic tests, breast milk for measurement of food proteins/cytokines, and evaluate quality-of-life and economic burden of families with food allergic children. CONCLUSIONS: This birth cohort provides unique data on prevalence, risk factors, quality-of-life, and costs of food allergies in Europe, leading to the development of more informed and integrated preventative and treatment strategies for children with food allergies.
Assuntos
Hipersensibilidade Alimentar/epidemiologia , Pré-Escolar , Estudos de Coortes , Método Duplo-Cego , Europa (Continente)/epidemiologia , Hipersensibilidade Alimentar/diagnóstico , Humanos , Testes Imunológicos , Lactente , Recém-Nascido , PrevalênciaAssuntos
Antagonistas dos Receptores Histamínicos/efeitos adversos , Hipersensibilidade/epidemiologia , Hipersensibilidade/etiologia , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Inibidores da Bomba de Prótons/efeitos adversos , Feminino , Humanos , Masculino , GravidezRESUMO
BACKGROUND: Tolerance development rates differ between food allergies. Almost all previous studies have not used the gold standard method, the double-blind, placebo-controlled food challenge (DBPCFC), which may affect the reported prevalence rates. Little is known about the association of the eliciting dose (ED) obtained during the initial DBPCFC with later tolerance development. METHODS: This was a retrospective, tertiary care study of children who had a positive DBPCFC to either peanut, milk or egg, and at least one follow-up food challenge (open or DBPCFC) with the same food. The association between ED and negative (tolerant) follow-up food challenge outcome was analyzed by logistic regression, with adjustment for confounders. Suspected confounders were initial DBPCFC test characteristics, atopic comorbidities and serum specific IgE (sIgE) levels. RESULTS: In 47 peanut allergic children, tolerance developed in 27.7% (median follow-up duration of 43 months). In 80 milk (follow-up 23 months) and 55 egg (follow-up 37 months) allergic children, tolerance developed in 55.0% and 65.5%. The ED obtained during the initial DBPCFC was significantly associated with tolerance development in peanut and milk allergy, but not in egg allergy. CONCLUSION: Approximately 1 out of 4 children with DBPCFC confirmed peanut allergy developed tolerance, compared to more than half of the children with milk or egg allergy, respectively. Tolerance development in peanut and milk allergy is significantly associated with ED at initial DBPCFC.