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Sugars can bind non-enzymatically to proteins, nucleic acids or lipids and form compounds called Advanced Glycation End Products (AGEs). Although AGEs can form in vivo, factors in the Western diet such as high amounts of added sugars, processing methods such as dehydration of proteins, high temperature sterilisation to extend shelf life, and cooking methods such as frying and microwaving (and reheating), can lead to inordinate levels of dietary AGEs. Dietary AGEs (dAGEs) have the capacity to bind to the Receptor for Advanced Glycation End Products (RAGE) which is part of the endogenous threat detection network. There are persuasive epidemiological and biochemical arguments that correlate the rise in food allergy in several Western countries with increases in dAGEs. The increased consumption of dAGEs is enmeshed in current theories of the aetiology of food allergy which will be discussed.
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Since 2007, the Oncofertility Consortium Annual Conference has brought together a diverse network of individuals from a wide range of backgrounds and professional levels to disseminate emerging basic and clinical research findings in fertility preservation. This network also developed enduring educational materials to accelerate the pace and quality of field-wide scientific communication. Between 2007 and 2019, the Oncofertility Consortium Annual Conference was held as an in-person event in Chicago, IL. The conference attracted approximately 250 attendees each year representing 20 countries around the world. In 2020, however, the COVID-19 pandemic disrupted this paradigm and precluded an in-person meeting. Nevertheless, there remained an undeniable demand for the oncofertility community to convene. To maintain the momentum of the field, the Oncofertility Consortium hosted a day-long virtual meeting on March 5, 2021, with the theme of "Oncofertility Around the Globe" to highlight the diversity of clinical care and translational research that is ongoing around the world in this discipline. This virtual meeting was hosted using the vFairs ® conference platform and allowed over 700 people to participate, many of whom were first-time conference attendees. The agenda featured concurrent sessions from presenters in six continents which provided attendees a complete overview of the field and furthered our mission to create a global community of oncofertility practice. This paper provides a synopsis of talks delivered at this event and highlights the new advances and frontiers in the fields of oncofertility and fertility preservation around the globe from clinical practice and patient-centered efforts to translational research.
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COVID-19 , Preservación de la Fertilidad , Neoplasias , COVID-19/epidemiología , Humanos , PandemiasRESUMEN
ETHNOPHARMACOLOGICAL RELEVANCE: Tarchonanthus camphoratus L. complex has numerous medicinal uses amongst the sub-Saharan African populace, including treatment for bronchospasm. This study focused on providing scientific rationale for the traditional use of the extracts of T. camphoratus and T. parvicapitulatus. T. camphoratus L. complex has been published under diverse names by various taxonomists. Tarchonanthus parvicapitulatus was one of the newly described taxa, leaving Tarchonanthus camphoratus L. sens. strict. as a homogenous taxon. However, some of the morphological characters used tend to overlap, making it difficult to identify the different taxa. AIMS: The aim of this study was to evaluate the bronchodilatory, antioxidant and toxicological properties of the leaves of T. camphoratus L. and T. parvicapitulatus. This study also aimed to use scanning electron microscopy (SEM) to assess the differences between T. camphoratus L. and T. parvicapitulatus. MATERIALS AND METHODS: Thin layer chromatography (TLC) with vanillin as visualizing agent was used to qualitatively compare the phytoconstituents of the plant acetone extracts. The free radical scavenging antioxidant qualitative assay was done by spraying TLC plates with DPPH free radical. The bronchodilatory effects of the aqueous extracts were assessed using pre-contracted guinea pig trachea. The effects of the extracts of T. camphoratus L. and T. parvicapitulatus on superoxide and ATP production was also investigated on isolated human neutrophils. A micromorphology study was done using scanning electron microscopy to study the leaves. RESULTS: Different compounds were visualized on the TLC plates with more than 40 compounds of intermediate polarity. The TLC plates sprayed with DPPH revealed the presence of 20 and 23 antioxidant compounds for T. camphoratus and T. parvicapitulatus respectively. Upon pre-contraction of the tracheal smooth muscles, the aqueous extracts of T. parvicapitulatus significantly relaxed the trachea while the relaxation observed for T. camphoratus was not significant. All the tested concentrations had a dose dependent inhibitory effect on superoxide production. The crude extract of T. parvicapitulatus at the highest concentration (10 mg/ml) significantly decreased ATP production while a non-significant increase in ATP production was observed for T. camphoratus at the highest concentration (10 mg/ml) when compared with the control. The micromorphology study was useful in revealing the presence of trichomes on the upper leaf surface of the studied taxa. CONCLUSIONS: The results obtained from this study showed that the studied plant extracts had bronchodilatory effects on contracted guinea pig trachea and could also inhibit the production of free radicals including superoxide anions. To the best of our knowledge, this is the first report on the bronchodilatory activity of T. camphoratus and T. parvicapitulatus. The micromorphological studies were useful in distinguishing between the two species, confirming that T. camphoratus L. and T. parvicapitulatus are different taxa. This study provides evidence to support the traditional use of T. camphoratus and T. parvicapitulatus in managing bronchospasm.
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Asteraceae , Broncodilatadores/farmacología , Depuradores de Radicales Libres/farmacología , Microscopía Electrónica de Rastreo , Contracción Muscular/efectos de los fármacos , Neutrófilos/efectos de los fármacos , Estrés Oxidativo/efectos de los fármacos , Extractos Vegetales/farmacología , Hojas de la Planta , Tráquea/efectos de los fármacos , Adenosina Trifosfato/metabolismo , Animales , Asteraceae/química , Asteraceae/clasificación , Asteraceae/ultraestructura , Broncodilatadores/aislamiento & purificación , Depuradores de Radicales Libres/aislamiento & purificación , Cobayas , Humanos , Técnicas In Vitro , Masculino , Neutrófilos/metabolismo , Extractos Vegetales/aislamiento & purificación , Hojas de la Planta/química , Hojas de la Planta/ultraestructura , Superóxidos/metabolismoRESUMEN
The distribution of metals across the environment is increasingly becoming a major concern as they not only pollute the environment but also pose a danger to humans and animals. Human exposure to heavy metals often occurs as a combination of metals the synergistic effects of which can be more toxic than a single metal. The aim of this study was to investigate the effects that the metals mercury (Hg), nickel (Ni) and manganese (Mn) alone and in combination have on erythrocyte morphology and other components of the coagulation system using the haemolysis assay, scanning electron microscopy (SEM), and confocal laser scanning microscopy. Human blood was exposed to the heavy metals ex vivo, and percentage haemolysis was determined. Ultrastructural analysis of erythrocytes, platelets and fibrin networks was performed using SEM. Analysis of phosphatidylserine (PS) flip-flop was determined using confocal laser scanning microscopy. At the highest concentration of 10,000× the World Health Organization safety limit, all the metals caused haemolysis. The results showed that the exposure of erythrocytes to Hg alone and in combination with other metals displayed more haemolysis compared to Ni and Mn alone and in combination. Components of the coagulation system showed ultrastructural changes, including the formation of echinocytes and the activation of platelets with all single metals as well as the combinations. Confocal laser scanning microscopy analysis showed the presence of PS on the outer surface of the echinocytes that were exposed to metals alone and in combination. It can, therefore, be concluded that these heavy metals have a negative impact on erythrocytes and the coagulation system.
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Plaquetas/efectos de los fármacos , Eritrocitos/efectos de los fármacos , Metales Pesados/toxicidad , Plaquetas/citología , Plaquetas/metabolismo , Eritrocitos/citología , Eritrocitos/metabolismo , Fibrina/metabolismo , Hemólisis/efectos de los fármacos , Humanos , MasculinoRESUMEN
This study correlates the readiness survey scores of bona fide first year university students with their success in a mathematically based first year module. It follows on the need for skilled individuals in the fields of Science and Technology that exists across the globe and is continually becoming the focus of educational institutions world-wide. Similarly, in South Africa, universities were instructed to increase their intake of students in the fields of Science and Technology so as to provide for the technology orientated needs of the country, as well as to increase participation of previously disadvantaged race groups in these fields. In response to this instruction, universities increased the number of students enrolled in Science and Technology fields by 23% in recent years. The challenge is now to ensure that these students exit the university with a suitable degree in the shortest possible time. Statistics published by the South African Council of Higher Education affirms the extent of this challenge faced by universities-only 51% of students enrolled in the fields of Science and Technology complete their 3-year undergraduate degrees, and some of them took as long as 6 years to complete the 3-year degrees. This still leaves 49% of students that either took more than 6 years to complete their degrees, or did not complete their degrees at all. The underlying cause(s) for these failures must be identified and addressed. As a starting point in this discussion, the questions that this study aim to answer are whether first year students are in fact as prepared for the challenges at university as they perceive themselves to be; and whether student readiness (or lack thereof) can be a root cause for the low throughput rates. This study determines how prepared first year students, at a leading South African university, perceive themselves to be for the demands of university and, specifically, how their perceptions of their readiness in different areas correlate with their academic success in a mathematically based module. The correlation is determined by analysing data gathered through a readiness survey that is completed by first year students at the beginning of the academic year, and their final mark in the mathematics based first year module. The survey is a standardised, self-evaluation tool originally developed by the University of Pretoria. It is also applied at the university where this study is conducted. The survey measures the preparedness of students in different areas and the empirical study shows that there is a statistically significant correlation between the perception of the students regarding their planning ability and the final mark obtained in the mathematics based module.
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PURPOSE: The state of limited resource settings that Coronavirus (COVID-19) pandemic has created globally should be taken seriously into account especially in healthcare sector. In oncofertility, patients should receive their fertility preservation treatments urgently even in limited resource settings before initiation of anticancer therapy. Therefore, it is very crucial to learn more about oncofertility practice in limited resource settings such as in developing countries that suffer often from shortage of healthcare services provided to young patients with cancer. METHODS: As an extrapolation during the global crisis of COVID-19 pandemic, we surveyed oncofertility centers from 14 developing countries (Egypt, Tunisia, Brazil, Peru, Panama, Mexico, Colombia, Guatemala, Argentina, Chile, Nigeria, South Africa, Saudi Arabia, and India). Survey questionnaire included questions on the availability and degree of utilization of fertility preservation options in case of childhood cancer, breast cancer, and blood cancer. RESULTS: All surveyed centers responded to all questions. Responses and their calculated oncofertility scores showed different domestic standards for oncofertility practice in case of childhood cancer, breast cancer, and blood cancer in the developing countries under limited resource settings. CONCLUSIONS: Medical practice in limited resource settings has become a critical topic especially after the global crisis of COVID-19 pandemic. Understanding the resources necessary to provide oncofertility treatments is important until the current COVID-19 pandemic resolves. Lessons learned will be valuable to future potential worldwide disruptions due to infectious diseases or other global crises.
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Betacoronavirus/patogenicidad , Infecciones por Coronavirus/prevención & control , Atención a la Salud/normas , Preservación de la Fertilidad/métodos , Neoplasias/terapia , Pandemias/prevención & control , Neumonía Viral/prevención & control , Betacoronavirus/aislamiento & purificación , COVID-19 , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Atención a la Salud/economía , Países en Desarrollo , Femenino , Preservación de la Fertilidad/economía , Preservación de la Fertilidad/estadística & datos numéricos , Humanos , Neoplasias/virología , Neumonía Viral/transmisión , Neumonía Viral/virología , SARS-CoV-2 , Encuestas y CuestionariosRESUMEN
Cellular proliferation and migration are crucial during development, regeneration and disease. Methods to quantify these processes are available; however, many are time consuming and require specialized equipment and costly reagents. Simple cell counts (proliferation analysis) and the scratch assay (migration analysis) are favorable methods due to their simplicity and cost-effectiveness; however, they rely on subjective and labor-intensive manual analysis, resulting in low throughput. We have developed optimized protocols to rapidly and accurately quantify adherent cell number and wound area using ImageJ, an open-source image processing program. Notably, these adaptable protocols facilitate quantification with significantly greater accuracy than manual identification.
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Recuento de Células/métodos , Movimiento Celular/genética , Proliferación Celular/genética , Imagen Molecular/métodos , Humanos , Procesamiento de Imagen Asistido por ComputadorRESUMEN
Water contamination with metals due to anthropogenic activity is increasing and subsequent exposure increases the risk of associated toxicity. Exposure is not limited to a single metal but usually involves mixtures of different metals at different concentrations. Little is known about the contribution of this type of exposure, in humans, to the development of non-communicable diseases such as cardiovascular disease, and an increased risk to thrombosis. The World Health Organization has established limits for metal levels in drinking water and this includes levels for copper (Cu), manganese (Mn) and mercury (Hg). In this study, at 100X these limits, the ability of the metals' oxidative effects as catalysts of the Fenton reaction and/or ability to bind glutathione (GSH) were determined. The haemostatic effects of these metals, alone and in combination, at the World Health Organization limit were then evaluated. The ultrastructural and viscoelastic alterations of exposed ex vivo whole blood were also evaluated using scanning electron microscopy and thromboelastography® (TEG), respectively. Cu, alone and in combination with Mn and/or Hg, induced hydroxyl radical formation and reduced GSH levels. Ex vivo exposure caused deformation of erythrocytes and accelerated platelet activation especially for Cu, alone and in combination, with Mn. Reduction in the lysis potential of the clot was also observed for all combinations, especially Cu in combination with Hg as well as Mn alone. Although the TEG findings were not statistically significant, the trends indicate that the exposure to these metals, alone and in combination, adversely affects thrombus formation in ex vivo blood, thereby potentially increasing the risk in exposed individuals for thrombosis.
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Cobre/toxicidad , Hemostáticos/toxicidad , Manganeso/toxicidad , Mercurio/toxicidad , Contaminantes Químicos del Agua/toxicidad , Plaquetas/efectos de los fármacos , Plaquetas/fisiología , Interacciones Farmacológicas , Eritrocitos/efectos de los fármacos , Eritrocitos/fisiología , Glutatión/metabolismo , Humanos , Radical Hidroxilo/metabolismo , Masculino , Estrés Oxidativo/efectos de los fármacos , TromboelastografíaRESUMEN
BACKGROUND: Elimination diets required for the management of food allergies increase the risk for poor growth in children. Currently, no worldwide data exist on this topic and limited published data exist on the impact of atopic comorbidity, type of allergy and foods eliminated on growth. We therefore set out to perform a worldwide survey on growth and impacting factors in food allergic children. METHODS: A prospective growth survey was performed of children (aged 0-16 years) on an elimination diet with confirmed immunoglobulin (Ig)E and non-IgE mediated food allergies. Data collected included: weight-for-age, weight-for-height, height-for-age, head circumference, body mass index, type of food allergy and eliminated foods, allergic comorbidities and replacement milk/breast milk. Multivariable regression analysis was used to establish factors that affected growth. RESULTS: Data from 430 patients from twelve allergy centres were analysed: median age at diagnosis and data collection was 8 months and 23 months, respectively. Pooled data indicated that 6% were underweight, 9% were stunted, 5% were undernourished and 8% were overweight. Cow's milk elimination lead to a lower weight-for-height Z-scores than other food eliminations and mixed IgE and non-IgE mediated allergy had lower height-for-age Z-scores than IgE mediated allergy. Children with only non-IgE mediated allergies had lower weight-for-height and body mass index. Atopic comorbidities did not impact on growth. CONCLUSIONS: Stunting is more common in children with food allergies than low weight. Children particularly at risk of poor growth are those with non-IgE and mixed IgE and non-IgE mediated allergies, as well as those with cow's milk allergy.
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Estatura/fisiología , Peso Corporal/fisiología , Hipersensibilidad a los Alimentos/fisiopatología , Trastornos del Crecimiento/etiología , Delgadez/etiología , Adolescente , Niño , Desarrollo Infantil/fisiología , Preescolar , Femenino , Hipersensibilidad a los Alimentos/complicaciones , Gráficos de Crecimiento , Humanos , Lactante , Recién Nacido , Masculino , Estudios Prospectivos , Análisis de Regresión , Encuestas y CuestionariosRESUMEN
The multi-disciplinary team approach is an effective model for patient care. Allied health professionals (AHPs) are an important part of such teams, bringing specific knowledge and skills related to the target patient population. The AHPs most often involved in allergy care are nurses and dietitians. Nurses are often involved in the care of patients with all types of allergy and also with asthma, whilst allergy-specialist dietitians provide vital nutritional and dietary support for the diagnosis and management of food allergy. There are many other AHPs who have a role to play in allergy care, including physiotherapists, psychologists, pharmacists and speech therapists, and their involvement is likely to develop as allergy care becomes more rooted in the community. With the development of multi-professional teams comes the requirement for disease-specific knowledge and skill sets, with all allergy team members required to have baseline knowledge and competency of the condition being managed. Whilst some competencies for AHPs practising in other disease states have been published, none are available for allergic disease against which AHPs can be benchmarked. The European Academy of Allergy & Clinical Immunology (EAACI) recognised this need, and supported the establishment of a Task Force to develop allergy-focussed competencies for AHPs. The varied skills, expertise and professional background of the Task Force members enabled the creation of a set of allergy competencies relevant to all AHPs working in allergy. It is recognised that the training and allergy expertise of AHPs, and their role within the allergy setting, will vary considerably depending on the country. However, it is important for patient care, that all AHP involved in allergy services have access to training, of a sufficiently high enough level to be aspirational and enable the continued growth and development of a wide range of allergy services, given the increasing need. The EAACI competencies will provide an important benchmark for allergy knowledge and skills against which education and training can be designed and health care professionals can subsequently be measured. However, more importantly, the EAACI AHP allergy competencies will enable the development and reach of specialist allergy services, with allergy-specialist AHPs undertaking key roles, especially in the community care setting.
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Successful skeletal muscle wound repair requires the alignment and fusion of myoblasts to generate multinucleated myofibers. In vitro, the accurate quantification of cellular alignment remains a challenge. Here we present the application of ImageJ and ct-FIRE to quantify muscle cell orientation by means of an alignment index (AI). Our optimised method, which does not require programming skills, allows the alignment of myoblasts in vitro to be determined independently of a predefined reference point. Using this method, we demonstrate that co-culture of myoblasts with macrophages, but not fibroblasts, promotes myoblast alignment in a cell density-dependent manner. Interestingly, myoblast fusion was significantly decreased in response to co-culture with macrophages, while the effect of fibroblasts on fusion was density-dependent. At lower numbers, fibroblasts significantly increased myoblast fusion, whereas at higher numbers a significant decrease was observed. Finally, triple co-culture revealed that the effect of macrophages on myoblast alignment and fusion is unaltered by the additional presence of fibroblasts. Application of our optimised method has therefore revealed quantitative differences in the roles of macrophages versus fibroblasts during alignment and fusion: while successful myoblast alignment is promoted by increasing macrophage numbers, regenerative fusion coincides with a decreasing macrophage population and initial rise in fibroblast numbers.
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Diferenciación Celular/fisiología , Fibroblastos/citología , Fibras Musculares Esqueléticas/citología , Mioblastos/citología , Animales , Comunicación Celular/fisiología , Técnicas de Cocultivo , Macrófagos/citología , Ratones , Músculo Esquelético/citología , Cicatrización de Heridas/fisiologíaRESUMEN
Food allergy is becoming increasingly common in infants and young children. This article set out to explain the different factors that should be taken into account during an individualized allergy consultation: Foods to avoid and degree of avoidance, suitable alternatives, self-management skills, co- and cross-reactive allergens and novel allergens alongside the role of the industry in allergen avoidance, importance of nutritional aspects of the diet and the future directions that nutritional guidance make take. Allergy management advice should be individualized to provide a patient-specific approach. Changes in the management of food allergies have in particular occurred in nut, milk and egg allergies over the past few years. There has also been a progressive increase in our understanding of cross-reactivity between different foods and also food and aero-allergens. A patient-specific approach of allergen avoidance should consider factors relating to industry and the environment such as food and nutrition literacy, threshold levels, cross-contact/contamination and safe eating away from home. Increasing migration and travel has also led to exposure of unfamiliar foods. As understanding improves on individual allergens and threshold levels, food labels and food labelling laws are affected. Allergy specialist dietitians should also keep up to date with the latest information on nutrition, the gut microbiome and the immune system to incorporate nutrition strategies in a dietetic consultation using an evidence-based approach.
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Alérgenos/inmunología , Hipersensibilidad a los Alimentos/dietoterapia , Hipersensibilidad a los Alimentos/inmunología , Alimentos/efectos adversos , Factores de Edad , Animales , Niño , Preescolar , Reacciones Cruzadas/inmunología , Dieta , Manejo de la Enfermedad , Ambiente , Exposición a Riesgos Ambientales , Métodos de Alimentación , Humanos , Lactante , Estado Nutricional , Apoyo Nutricional , Factores de RiesgoRESUMEN
BACKGROUND: Exclusion diets for the management of food allergy pose a risk of nutritional deficiencies and inadequate growth in children, yet less is known about their effect in adolescents and adults. The present study aimed to compare the dietary intake of adolescents and adults with food allergies with that of a control group. METHODS: A food allergic and a control group were recruited from Portsmouth and the Isle of Wight in the UK. Participants were recruited from a food allergy charity, allergy clinics, a local school and university, and previous research studies. Macro and micronutrient intake data were obtained using a 4-day estimated food diary. Sociodemographic and anthropometric data was collected via a constructed questionnaire. RESULTS: This cross-sectional study included 81 adolescents (48 food allergic and 33 controls) aged 11-18 years and 70 adults aged 19-65 years (23 food allergic and 47 controls). Overall, 19 (22.8%) adolescents and 19 (27.1%) adults took dietary supplements, with no difference according to food allergic status. Adolescents with food allergy had higher intakes of niacin and selenium than adolescents without (P < 0.05). This difference persisted when dietary supplements were removed from the analysis. Adults with food allergies had higher intakes of folate and zinc than those without (P < 0.05); however, this difference did not persist when dietary supplements were removed from the analysis. Across all participants, the intake of several micronutrients was suboptimal. There was no difference in protein or energy intake, or body mass index, according to food allergic status. CONCLUSIONS: The dietary intake of food allergic participants was broadly similar and, in some cases, better than that of control participants. However, suboptimal intakes of several micronutrients were observed across all participants, suggesting poor food choices.
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Conducta del Adolescente , Enfermedades Carenciales , Dieta , Conducta Alimentaria , Hipersensibilidad a los Alimentos , Micronutrientes/administración & dosificación , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Niño , Estudios Transversales , Enfermedades Carenciales/etiología , Registros de Dieta , Suplementos Dietéticos , Ingestión de Energía , Femenino , Hipersensibilidad a los Alimentos/complicaciones , Hipersensibilidad a los Alimentos/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Estado Nutricional , Reino Unido , Adulto JovenRESUMEN
BACKGROUND: The prevalent use of African traditional medicine by the general public has been reported. With commercialisation and marketing, some of the herbal medicines (HMs) used are readily available over the counter, most of them promoted as immune boosters. These commercial HMs have not been taken through clinical trials and other tests that would validate their composition and safety, and other properties such as their effect on laboratory diagnostic tests. OBJECTIVE: To investigate the cross-reactivity of selected HMs with commonly tested drugs of abuse (DoA) using a qualitative rapid urinalysis assay. METHODS: The six HMs selected were bought from local pharmacies. A rapid urinalysis screening test was performed with the Instant View Multi-Drug of Abuse Test kit from Labstix Diagnostics. Drug-free urine (DFU) was pooled from samples donated by healthy volunteers. Urine samples that had tested positive for DoA were obtained from a pharmacology laboratory. Aliquots of the urine samples were spiked with the HMs in neat and diluted form, and tested at various time intervals. RESULTS: The results for the DFU samples spiked with the HMs remained negative. There were no significant changes in pH or specific gravity of the samples. The results of samples that had tested positive for tetrahydrocannabinol (THC) were not altered by five of the HMs when spiked at 40% v/v. The HM Ngoma Herbal Tonic Immune Booster caused false-negative results for the THC test. CONCLUSION: An important finding is that the herbal mixture Ngoma Herbal Tonic Immune Booster caused false-negative results for the cannabinoid screening test. It adds to the list of substances that may be potential adulterants of urine for screening tests.
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Medicinas Tradicionales Africanas , Preparaciones de Plantas/orina , Detección de Abuso de Sustancias , Anfetamina/orina , Cocaína/orina , Dronabinol/orina , Reacciones Falso Negativas , Reacciones Falso Positivas , Humanos , Metanfetamina/orina , Morfina/orina , N-Metil-3,4-metilenodioxianfetamina/orinaRESUMEN
Peanut nut and tree nut allergy are characterised by IgE mediated reactions to nut proteins. Nut allergy is a global disease. Limited epidemiological data suggest varying prevalence in different geographical areas. Primary nut allergy affects over 2% of children and 0.5% of adults in the UK. Infants with severe eczema and/or egg allergy have a higher risk of peanut allergy. Primary nut allergy presents most commonly in the first five years of life, often after the first known ingestion with typical rapid onset IgE-mediated symptoms. The clinical diagnosis of primary nut allergy can be made by the combination of a typical clinical presentation and evidence of nut specifc IgE shown by a positive skin prick test (SPT) or specific IgE (sIgE) test. Pollen food syndrome is a distinct disorder, usually mild, with oral/pharyngeal symptoms, in the context of hay fever or pollen sensitisation, which can be triggered by nuts. It can usually be distinguish clinically from primary nut allergy. The magnitude of a SPT or sIgE relates to the probability of clinical allergy, but does not relate to clinical severity. SPT of ≥ 8 mm or sIgE ≥ 15 KU/L to peanut is highly predictive of clinical allergy. Cut off values are not available for tree nuts. Test results must be interpreted in the context of the clinical history. Diagnostic food challenges are usually not necessary but may be used to confirm or refute a conflicting history and test result. As nut allergy is likely to be a long-lived disease, nut avoidance advice is the cornerstone of management. Patients should be provided with a comprehensive management plan including avoidance advice, patient specific emergency medication and an emergency treatment plan and training in administration of emergency medication. Regular re-training is required.
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Arachis/efectos adversos , Hipersensibilidad a la Nuez/diagnóstico , Hipersensibilidad a la Nuez/terapia , Nueces/efectos adversos , Hipersensibilidad al Cacahuete/diagnóstico , Hipersensibilidad al Cacahuete/terapia , Alérgenos/inmunología , Antialérgicos/administración & dosificación , Antialérgicos/uso terapéutico , Especificidad de Anticuerpos/inmunología , Costo de Enfermedad , Dietoterapia/métodos , Manejo de la Enfermedad , Servicios Médicos de Urgencia , Humanos , Inmunoglobulina E/inmunología , Inmunoterapia/métodos , Hipersensibilidad a la Nuez/epidemiología , Hipersensibilidad a la Nuez/prevención & control , Educación del Paciente como Asunto , Hipersensibilidad al Cacahuete/epidemiología , Hipersensibilidad al Cacahuete/prevención & control , Prevalencia , Calidad de Vida , Factores de Riesgo , Pruebas Cutáneas/métodos , Evaluación de SíntomasRESUMEN
BACKGROUND: In the Learning Early About Peanut Allergy (LEAP) study, early peanut introduction in high-risk 4- to 11-month-olds was associated with a significantly decreased risk of developing peanut allergy. However, the influences of key baseline high-risk factors on peanut tolerance are poorly understood. METHODS: Secondary analysis was conducted on the publically available LEAP dataset, exploring relationships between peanut tolerance, baseline peanut/egg sensitization, eczema severity/duration, age of introduction, gender, and race. RESULTS: A multiple logistic regression model predicting odds of successful oral food challenge (OFC) at 60 months noted higher odds with early introduction (OR 9.2, P < 0.001, 95% CI 4.2-20.3), white race (OR 2.1, P = 0.04, 95% CI 1.1-3.9), and advancing age (OR 4.8, P = 0.04, 95% CI 1.1-20.8). Odds of peanut tolerance were lower with increasing peanut wheal size (OR 0.58, P < 0.001, 95% CI 0.46-0.74), increased baseline SCORAD score (OR 0.98, P = 0.04, 95% CI 0.97-1), and increased kUA /l of egg serum IgE (sIgE) (OR 0.99, P = 0.04, 95% CI 0.98-1). The probability of peanut tolerance in the early introduction group was 83% vs 43% in the avoidance group with SPT wheal of <4 mm. The probability of a successful OFC was significantly higher with peanut introduction between 6 and 11 months than at 4-6 months. Increasing eczema severity had limited impact on the probability of peanut tolerance in the early introduction arm. CONCLUSION: Increasing peanut wheal size predicted peanut tolerance only in the avoidance arm. Peanut introduction between 6 and 11 months of age was associated with the highest rates of peanut tolerance, questioning the 'urgency' of introduction before 6 months.
Asunto(s)
Alérgenos/inmunología , Arachis/inmunología , Tolerancia Inmunológica , Hipersensibilidad al Cacahuete/epidemiología , Hipersensibilidad al Cacahuete/inmunología , Factores de Edad , Alérgenos/administración & dosificación , Eccema/diagnóstico , Eccema/epidemiología , Eccema/inmunología , Femenino , Humanos , Inmunización , Inmunoglobulina E/sangre , Inmunoglobulina E/inmunología , Masculino , Hipersensibilidad al Cacahuete/diagnóstico , Hipersensibilidad al Cacahuete/prevención & control , Vigilancia de la Población , Probabilidad , Factores de Riesgo , Pruebas CutáneasRESUMEN
BACKGROUND: Taste exposure in infancy is known to predict food preferences later in childhood. This is particularly relevant in children with cows' milk allergy who consume a substitute formula and/or a cows' milk exclusion (CME) diet early in life. This prospective study aimed to show whether there is a long-term effect of consuming a substitute formula and CME diet on taste preferences and dietary intake. METHODS: Children were predominantly recruited from two large birth cohort studies in the UK. Two groups were recruited: an experimental group of children who had consumed a CME diet during infancy and a control group who had consumed an unrestricted diet during infancy. Parents completed a food neophobia questionnaire and an estimated prospective food diary. Children completed a taste preference test and their growth was assessed. RESULTS: One hundred and one children with a mean age of 11.5 years were recruited (28 CME and 73 controls). Children in the CME group had a significantly higher preference for bitter taste than those in the control group (P < 0.05). There were significant differences between the groups with respect to the intake of some micronutrients, including riboflavin, iodine, sodium and selenium. Food neophobia did not differ between groups. Some 28% of the CME group were overweight/obese compared to 15% of the control group; however, this difference was not statistically significant. CONCLUSIONS: Consuming a substitute formula and/or a CME diet in infancy has a long-term effect on the preference for bitter taste. Differences exist with respect to the intake of some micronutrients, but not macronutrients. There was a nonsignificant trend towards being overweight and obese in children in the CME group.