Can early life interventions prevent food allergies?

BACKGROUND: The incidence of food allergies is increasing all over the world. Prevention strategies intend to reduce food sensitization risk and subsequent allergies. In this review, we will discuss the recent data concerning different geographic regions for the prevention of food allergies in children. METHODS: This review provides recommendations for the prevention of food allergies based on the recent data available in the PUBMED database in English (up to December 2022). RESULTS: The best strategy to prevent food allergies is regarded as the early introduction of allergenic foods to an infant`s diet. A healthy and diverse diet is recommended for infants and their mothers, in accordance with the family`s eating habits and regional food culture, rather than avoiding certain foods or using supplements. Avoiding common food allergens in the maternal diet during pregnancy and/or breastfeeding is not recommended. Exclusive breastfeeding is generally recommended for all mothers for at least 6 months. There is no specific association between exclusive breastfeeding and the primary prevention of any specific food allergy. Where a breastmilk substitute is needed, the best alternative should be chosen according to the infant`s nutritional needs. There is no substantial evidence to support the use of hydrolyzed or soy formula in infancy against food allergies or sensitization. CONCLUSIONS: Feeding patterns in infancy play an important role in the risk of developing food allergies. Existing strategies to prevent allergies are relatively ineffective and further research is needed to figure out strategies for food allergy prevention, particularly in high-risk infants.

Habits and Perspectives on Reading Allergy Food Labels of Parents of Children with Food Allergies.

Study Objective: Food allergy is an essential growing public health concern that affects the quality of life of children and their parents. This study aimed to identify the parents' awareness and daily practice about food labels and allergy warnings on packaged foods. Materials and Methods: The study investigated the parents of children with food allergies who applied to the pediatric allergy outpatient clinic between October 01, 2020 and March 30, 2021. A total of 106 questionnaires were collected and statistically analyzed. Results: One hundred six parents with an average age of 31.6 ± 5.17 years were questioned. Most of the participants were mothers (88.7%). The most common food allergens observed in children were hen's egg (75%), cow's milk (56%), nuts (24.5%), peanuts (19.8%), walnuts (11.3%), and wheat (10.4%). Of the children, 39.6% rarely consumed packaged products, and the proportion of children who did not consume packaged products at all was 32.1%. All parents reported that they read the labels. Of them, 65.1% stated that allergy food labels were inadequate and it could be more noticeable if symbols (53.6%) or bold text (39.1%) were used for labeling. Conclusion: This study shows that parents with a diagnosis of food allergy in their child were highly aware of labels that indicate the content of the product. However, they thought that food labels are insufficient in scope and shape and needed to be improved. Parents preferred allergen labels with both symbols and bold text.

Evaluation of Children with Cow's Milk Allergy Who Received Measles or Measles, Mumps, and Rubella Vaccines Containing Alpha-Lactalbumin.

Objective: Cases of cow's milk allergy (CMA) who reacted to measles or measles, mumps, and rubella (MMR) vaccines containing alpha-lactalbumin have been reported. The purpose of this study was to assess patients with CMA who received measles or MMR vaccines containing alpha-lactalbumin, as well as the characteristics of those who developed reactions to these vaccines. Study Design: Patients followed up in the allergy clinic for CMA and who received measles or MMR vaccines containing alpha-lactalbumin at 9 or 12 months of age were included in the study, and their characteristics were analyzed retrospectively from the hospital registry system. Results: Forty-nine patients were included in the study. Six patients received the measles vaccine, whereas 43 patients received the MMR vaccine containing alpha-lactalbumin. Vaccine skin tests were performed on these 6 patients. One patient had a positive intradermal test, so an alternative vaccine not containing alpha-lactalbumin was administered. The other 5 patients were vaccinated, and no reaction was observed. Anaphylaxis was observed in 3 of 43 patients who received the MMR vaccine containing alpha-lactalbumin. In all of these patients, the first reaction to dairy products was anaphylaxis. In 2 of those patients, cow's milk-specific IgE (spIgE) levels were >100 kU/L, and alpha-lactalbumin-spIgE levels were also high at 97 and 90 kU/L. The third patient's cow's milk-spIgE level was 15.9 kU/L, whereas the alpha-lactalbumin-spIgE level was 0.04 kU/L. Conclusion: Especially in patients with an initial reaction of anaphylaxis to dairy products and high cow's milk-spIgE levels, the risk of reaction is high with the MMR vaccine.

Different age groups present different clinics in anaphylaxis with children: one size does not fit all children.

BACKGROUND: Childhood anaphylaxis presents with a heterogeneous clinic. Elicitors and epidemiologic factors associated with anaphylaxis differ with age, geographic location and lifestyle. This study aimed to determine the clinical features and age-specific patterns of childhood anaphylaxis in a single referral center in Turkey. METHODS: We conducted a retrospective study of anaphylaxis in children aged between 0 and 18 years of age, attending an allergy department in a children's hospital. RESULTS: A total of 95 children diagnosed with anaphylaxis were analyzed. Among all, 35.8% of the first anaphylaxis episodes occurred ininfancy and 57.9% in preschool age. Foods were the most common culprits (57.9%) and followed by drugs (15.8%). Patients with foodinduced anaphylaxis were younger in age (p < 0.001). Food-related anaphylaxis was most common with cow's milk (36.4%) and followed by tree nuts (20%). Cow's milk played a significant role as a trigger in infancy, and tree nuts as a trigger in preschoolers and school-age children. Mucocutaneous manifestations were almost universally present (94.7%), followed by respiratory compromise (56.8%), with gastrointestinal (55.8%), cardiovascular (9.5%), and neurologic (4.2%) symptoms being less common. Respiratory and cardiovascular system-related symptoms were found more frequently in school-age children (p = 0.02 and p = 0.014, respectively). The severity of anaphylaxis was higher in school-age children (p = 0.015). DISCUSSION: Findings reveal that children diagnosed with anaphylaxis differ in terms of etiological and clinical findings according to age groups. This difference shows the dynamically changing clinic of anaphylaxis over time and the importance of evaluating childhood anaphylaxis according to age groups.

COVID-19 Vaccines Are Safely Tolerated in Adolescents with Cutaneous Mastocytosis.

INTRODUCTION: The management of the COVID-19 vaccine in children with mastocytosis is unclear due to a lack of data. In the current study, we aimed to evaluate the adverse reactions following COVID-19 vaccination in adolescents with cutaneous mastocytosis (CM). METHODS: This study included 27 paediatric patients who were diagnosed with CM and were followed up in the paediatric allergy department of a tertiary care children's hospital. RESULTS: The median (IQR) age of the patients at the time of COVID-19 vaccination was 180 (156-203) months. Forty-four per cent of patients were vaccinated with the COVID-19 vaccine. Among all participants, the vaccination rate was found to be higher in older children, those who had been diagnosed with MPCM, and those who had not been infected with COVID-19 (p = 0.019, p = 0.009, p = 0.002, respectively). A total of 23 doses of the COVID-19 vaccine, including two doses of Sinovac/CoronaVac and 21 doses of Pfizer/BioNTech, were administered to 12 paediatric patients with CM. One of the patients had a history of intense itch, erythematous urticarial plaques, and had an exacerbation of existing skin lesions within 24-48 h after both doses of Pfizer/BioNTech vaccination. CONCLUSION: The COVID-19 vaccination of patients with CM in this series seems to be safe, and the rate of adverse events was comparable to that in the general population. These results found in adolescents with CM are in line with the existing evidence that CM does not preclude vaccination in children.

Characteristics of children with cat sensitivity: a prospective cross-sectional study.

BACKGROUND: Animal dander is one of the most common respiratory allergens in children, and there is evidence that cat sensitivity is a risk factor for asthma and allergic rhinitis. In this study, it was aimed to evaluate children with cat sensitivity and to identify their demographic and clinical characteristics. METHODS: Patients who were found to be sensitive to cats following skin prick tests performed in our allergy clinic over a period of one year (and two control groups), were included in the study. Patients in the study and control groups filled in a questionnaire including demographic and clinical characteristics. RESULTS: The prevalence of cat sensitivity in our allergy clinic was 6% (182/3033). The most common diagnoses in patients were 41.8% allergic rhinitis, 25.8% asthma, and 13.2% allergic rhinitis + asthma. Allergic rhinitis symptoms were the most prevalent symptom associated with cat contact (29.4%), whereas 28% of the patients were asymptomatic. Only 17.3% had a cat at home and 13.4% had cat exposure apart from home but having a cat at home was significantly higher than the control groups (p < 0.05). Eosinophilia was present in 54.6% of the patients, and 17.3% had blood tIgE levels of >1000 IU/mL. Eosinophilia and tIgE levels were significantly higher than both control groups (p < 0.05). DISCUSSION: Cat ownership can affect the development of cat sensitivity but the majority of patients with cat sensitivity are not cat owners. Elevated tIgE levels (> 1000 IU/mL) may be associated with cat sensitivity, these patients should be evaluated for cat sensitivity, even if they do not report symptoms with cat contact.

Evaluation of emotional, Behavioral, and clinical characteristics of children aged 1-5 with a history of food-related anaphylaxis.

BACKGROUND: Our study aimed to investigate emotional, behavioral, and social characteristics assessed with internationally validated psychometric scales and their relationship with demographic, clinical, and laboratory data in children with a history of food-related anaphylaxis. METHOD: The study included patients aged 1-5 who were followed up in the pediatric allergy outpatient clinic with a diagnosis of food-related anaphylaxis. All participants were evaluated during admission to the clinic using a study questionnaire, which was prepared by the authors, consisting of three parts: a sociodemographic information form, a clinical evaluation form, and the Aberrant Behavior Checklist (ABC) for psychiatric evaluation. Parents answered the questionnaires regarding the patients' emotional and behavioral health. RESULTS: Thirty patients aged between 12 and 62 months were included in the study. The data were compared with 30 healthy controls with similar age and gender distribution. The total ABC score (p = 0.015), and the stereotypic behavior (p = 0.003) and hyperactivity (p = 0.002) subscale scores were significantly higher in patients with anaphylaxis history compared to the controls. CONCLUSION: Emotional and behavioral status assessments and the clinical follow-up of food allergies of patients who experienced anaphylaxis in early childhood are useful for the holistic management and early recognition of possible pathologies.

Knowledge and Attitudes of Pediatric Residents to Smoking Intervention in Adolescents.

OBJECTIVE: Tobacco use is an important, preventable public health problem, and its use usually begins in adolescence. For this reason, smoking intervention for tobacco control is considered one of the fields of pediatrics. This study aims to examine the knowledge and attitudes of pediatric residents toward tobacco control and smoking intervention. MATERIALS AND METHODS: In this multicenter study, pediatric residents were asked about their knowledge and attitudes toward adolescent smoking intervention and tobacco control through an online questionnaire. RESULTS: A total of 271 pediatric residents participated in the study, and 56% of the residents stated that they asked adolescents with respiratory tract symptoms whether they smoked or not. However, 22% of pediatric residents stated that they asked the same question to adolescents regardless of their symptoms, 92% of residents were unaware of the International Diagnostic Code for tobacco use, and 86% of the participants reported that they did not receive any training on tobacco control. It was determined that the residents, who knew the national smoking cessation hotline, were female, smokers, and seniors. They asked the adolescents whether they smoked or not and the results were statistically significant (P < .05). CONCLUSION: The results show that pediatric residents have insufficient knowledge about tobacco control and cannot guide adolescents in smoking intervention. This research reveals that pediatric residents need a training program for adolescent smoking intervention in the pediatric resident curriculum. Pediatricians who are well trained in adolescent tobacco control can make important contributions to the prevention of tobacco use in adults.

Clinical Features and Clinical Course of Food Protein-Induced Allergic Proctocolitis: 10-Year Experience of a Tertiary Medical Center.

BACKGROUND: Food protein-induced allergic proctocolitis (FPIAP) is a food allergy characterized by bloody stools in well-appearing breast-fed infants. OBJECTIVE: To determine the clinical course of FPIAP and the factors affecting the development of tolerance. METHODS: Over a 10-year period, patients with a diagnosis of FPIAP who were followed at the outpatient Allergy-Immunology clinic in a tertiary care children's hospital in Turkey were retrospectively analyzed. RESULTS: The frequency of FPIAP was 0.18% among 64,549 patients. The median age of symptom onset was 2 months (interquartile range, 1.0-3.5 months), and the median age of tolerance development was 12 months (interquartile range, 8.0-17.21 months). The occurrence of symptoms in the neonatal period was associated with a history of premature birth (odds ratio, 3.75; 95% CI, 1.33-10.59; P = .031) and neonatal intensive care unit hospitalization (odds ratio, 4.72; 95% CI, 1.78-12.53; P = .002). Use of a cow's milk-based formula was associated with a higher risk of the onset of symptoms after 1 month (odds ratio, 2.69; 95% CI, 1.19-6.07; P = .016). The use of an amino acid-based formula and the presence of diarrhea at admission were associated with later development of tolerance (P = .023 and P < .001, respectively). An IgE-mediated reaction was observed during oral food challenge testing in 6% of the patients. CONCLUSIONS: The manifestations of FPIAP appeared earlier in premature infants and later in infants using formula. The use of amino acid-based formula and having had diarrhea were associated with delayed tolerance.

Anaphylaxis and epinephrine autoinjector use in pediatric patients with cutaneous mastocytosis.

BACKGROUND/OBJECTIVES: Mastocytosis is a complex disorder presenting with a broad clinical spectrum. In this study, we aimed to evaluate the frequency of systemic symptoms, necessity of the usage of epinephrine autoinjectors (EAI), and factors affecting the use of EAI among pediatric patients with cutaneous mastocytosis (CM). METHODS: The study population was composed of 53 patients with CM. The clinical data were collected from the medical files. A questionnaire about the patient's anaphylaxis experiences and treatment attitudes toward EAI was performed. RESULTS: Thirty-three of 53 patients were male (62.3%), and the median age of the study participants was 80 months. Anaphylaxis was reported in two patients (3.7%). One of the patients had drug-induced anaphylaxis, and the other had venom-induced anaphylaxis. Three patients (5.6%) reported a personal history of EAI use due to systemic symptoms. Patients with higher serum tryptase level and cases of familial mastocytosis had more systemic symptoms (P = .012 and P = .010, respectively). The patient rate of compliance with EAI for prescription filling and carrying the EAI was 88.7% and 79.2% respectively. 41.5% of parents were hesitant to use EAI when necessary, although they were trained for the use of it by medical staff. CONCLUSIONS: The rate of anaphylaxis in patients with CM in the current study wassignificant and justifies prescribing EAI. Detailed education and counseling on EAI usage are needed to reduce parental hesitancy.

Is Oral Food Challenge as Safe Enough as It Seems?

BACKGROUND: Oral food challenges (OFCs) assist in the diagnosis of food allergies and are essential to determine whether an allergy has been outgrown. During the OFC, a medical procedure e introduces foods suspected to be allergenic orally in increasing doses. Mild skin reactions such as urticaria or rarely serious life-threatening reactions such as anaphylaxis may develop. OBJECTIVE: In this study, we aimed to retrospectively evaluate the clinical and laboratory characteristics of patients who experienced anaphylaxis during open OFCs in a tertiary care children's hospital. METHODS: Patients who underwent OFCs to confirm the presence of a food allergy or to assess tolerance status at the University of Health Sciences, Ankara, Dr. Sami Ulus Maternity and Children Training and Research Hospital, Pediatric Allergy and Immunology Outpatient Clinic between 1 January 2013 and 1 February 2016, were included in the study. Patients' data were obtained retrospectively from electronic medical records and challenge chart reviews. RESULTS: A total of 623 OFCs were performed during the period studied. Nine patients (1.4%) between 13 and 67 months of age (mean age: 38.3 months) developed anaphylaxis during their OFC. CONCLUSION: OFCs should be performed in a hospital or outpatient office under medical supervision that is adequate for anaphylaxis intervention by an allergy specialist. Close observation of objective and subjective symptoms is essential during the challenge because there are no laboratory tests that can predict an anaphylactic diagnosis or the severity of the reaction.

A remarkable food allergy in children: cashew nut allergy.

OBJECTIVE: The prevalence of cashew nut allergy is increasing. Clinical reaction to cashew nuts may be severe, including anaphylaxis. In this study, we aimed to evaluate the frequency of cashew nut sensitivity in a group of children with food allergy and the clinical features and course of cashew nut allergy. MATERIAL AND METHODS: A retrospective chart review was performed on 516 children who presented with food allergy at a pediatric allergy department. Individuals sensitized to cashew nuts were examined. RESULTS: Cashew nut sensitization was detected in 17 (64.7% male; mean age of symptom onset, 14 months) of 516 patients with food allergy. Skin symptoms were the most frequent clinical presentation, followed by gastrointestinal symptoms. Overall, 29.4% of the patients presented with anaphylaxis. All anaphylactic reactions were developed after the first consumption of cashew nuts. Of the cashew nut-sensitized patients, 82.3% were diagnosed with moderate-to-severe atopic dermatitis, and all of them had multiple food allergies. During the follow-up, 90% of the patients who had cashew nut sensitization and co-existing food allergies to cow's milk and/or hen's egg developed tolerance to cow's milk and/or hen's egg, but none of the patients could tolerate cashew nut ingestion. CONCLUSION: Cashew nut is a potent allergen, causing severe allergic reactions that persist long term compared with other food allergies. Early onset of moderate-to-severe atopic dermatitis and multiple food allergies are remarkable co-existing conditions in children who have been diagnosed with cashew nut allergy. Pediatricians should be aware of this emerging food allergy.

Revaccination following suspected vaccine-triggered hypersensitivity reactions: experience of a tertiary care centre.

INTRODUCTION AND OBJECTIVES: Suspected hypersensitivity reactions (HRs) associated with vaccines are frequently reported, but confirmed cases of vaccine-triggered HRs are rare. Suspected HRs should be distinguished from actual HRs. The aims of this study are to identify the rate of actual vaccine-triggered hypersensitivity in patients who were referred to the paediatric allergy clinic due to a suspected HR and to explore the rate of revaccination in a real clinical setting. MATERIALS AND METHODS: A retrospective study was performed with a group of preschool children who were evaluated by skin and/or provocation tests (PTs) for the suspected HRs following vaccination. RESULTS: A total of 26 paediatric patients (61.5% male; median age 9 months) with a previous history of suspected vaccine-triggered HR were included. In this group, 69.2% and 38.5% of the patients had a pre-existing atopic disease and an immediate reaction (emerging <1 hour after vaccine administration), respectively. Skin rash was the most frequent clinical presentation (96.1%). Vaccine-triggered anaphylaxis was reported in six patients (23.1%). Measles-mumps-rubella was the most frequently suspected vaccine causing HRs. The skin test positivity with the suspected vaccine was 4%, whereas PTs revealed no reaction after reimmunisation in 76.9% (20/26) of the study participants tested. CONCLUSIONS: Most incidents of skin rashes after immunisation are not suggestive of actual HRs. The results in the current study showed that the majority of the patients presenting with suspected HRs tolerated revaccination, including those with a previous history of suspected anaphylaxis. Revaccination of these patients is safe with adequate precautions. It is absolutely essential to be equipped for the management of anaphylaxis.

Revaccination following suspected vaccine triggered hypersensitivity reactions: experience of a tertiary care centre

INTRODUCTION AND OBJECTIVES: Suspected hypersensitivity reactions (HRs) associated with vaccines are frequently reported, but confirmed cases of vaccine-triggered HRs are rare. Suspected HRs should be distinguished from actual HRs. The aims of this study are to identify the rate of actual vaccine-triggered hypersensitivity in patients who were referred to the pae­diatric allergy clinic due to a suspected HR and to explore the rate of revaccination in a real clinical setting. MATERIALS AND METHODS: A retrospective study was performed with a group of preschool chil­dren who were evaluated by skin and/or provocation tests (PTs) for the suspected HRs follow­ing vaccination. RESULTS: A total of 26 paediatric patients (61.5% male; median age 9 months) with a previous history of suspected vaccine-triggered HR were included. In this group, 69.2% and 38.5% of the patients had a pre-existing atopic disease and an immediate reaction (emerging < 1 hour after vaccine administration), respectively. Skin rash was the most frequent clinical presentation (96.1%). Vaccine-triggered anaphylaxis was reported in six patients (23.1%). Measles-mumps-rubella was the most frequently suspected vaccine causing HRs. The skin test positivity with the suspected vaccine was 4%, whereas PTs revealed no reaction after reimmunisation in 76.9% (20/26) of the study participants tested. CONCLUSIONS: Most incidents of skin rashes after immunisation are not suggestive of actual HRs. The results in the current study showed that the majority of the patients presenting with suspected HRs tolerated revaccination, including those with a previous history of suspected anaphylaxis. Revaccination of these patients is safe with adequate precautions. It is absolutely essential to be equipped for the management of anaphylaxis

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Why are influenza vaccination coverage rates still too low among health care workers in a tertiary care children's hospital in Turkey?

Annual influenza vaccination offers the best means to control and prevent influenza-associated illnesses. Vaccination of health care workers (HCWs) is crucial for reducing influenza-related morbidity and mortality, and health authorities recommend universal vaccination of this population. We evaluate the rates of influenza vaccination among HCWs and factors influencing uptake among health care professional groups in a children's hospital in Ankara, Turkey. We surveyed 108 HCWs using a self-administered questionnaire. Influenza vaccination coverage rates (VCR) among HCWs for at least one dose in their lifetimes was 60.2%. In the 2016-2017 influenza season, VCR of HCWs was 14.8%. We found a significantly higher rate of vaccinated participants among physicians (83.3%), older HCWs (mean age ± SD, 36.2 ± 7.7 year), HCWs who believed in the necessity for vaccination (79.5%), and HCWs who have worked for a longer time (> 5 years) in the health care profession (71.2%) (p = 0.023, p = 0.002, p = 0.001, p = 0.003 respectively). For those who refused vaccination, the most common reason was doubts about its effectiveness. The most used source for information about the influenza vaccine among HCWs was the Ministry of Health (MoH). The MoH's policies should prioritize HCWs to improve VCRs.

Sleep Patterns and Development of Children with Atopic Dermatitis.

INTRODUCTION: Atopic dermatitis (AD) is a chronic inflammatory disease that begins in early childhood. Sleep problems have increased in children with AD. The aim of this study was to evaluate sleep patterns and the development of children with AD at an early age. METHODS: This is a cross-sectional study consisting of a total of 80 children aged 0-36 months with AD. Patients were evaluated by the Brief Infant Sleep Questionnaire and International Guide for Monitoring Child Development. RESULTS: The median age (IQR) of the patients was 6 (4.25-9) months, 63.7% of them were male and 50% of them had sleep problems. Male sex (OR: 3.78, p = 0.024, 95% CI, 0.083-0.837), patients with AD who were in the first 3 months after diagnosis (OR: 3.56; 95% CI, 1.220-10.43, p = 0.020), and moderate-severe AD (OR: 5.09; 95% CI, 1.649-15.748, p = 0.005) were determined as risk factors for sleep problems. In all, 12.5% of the patients needed support for one or more developmental areas (gross motor skills, expressive language and communication, receptive language, fine motor skills, relationship, and play). Developmental delay was higher in patients with sleep problems (p = 0.037). Multiple siblings (OR: 14.381; 95% CI, 1.557-132.871, p = 0.019) and the presence of sleep problems (OR: 8.011; 95% CI, 1.764-36.387, p = 0.024) were found to be risk factors for developmental delay. CONCLUSION: Boys with moderate-severe AD within the first 3 months of diagnosis were at increased risk for sleep problems. Children with AD who have multiple siblings and sleep problems should be evaluated for developmental delay and monitored closely.

Eczema herpeticum emerging during atopic dermatitis in infancy.

BACKGROUND: Eczema herpeticum (EH) is an acute disseminated viral infection that develops in the presence of an existing skin lesion, often on the ground of atopic dermatitis (AD). Morbidity and mortality of EH can be minimized by starting antiviral therapy at the earliest time in diagnosis. CASE: Herein we report five infants diagnosed with EH in the course of AD treatment. All patients had early onset, moderate to severe AD and needed intermittent topical corticosteroid (TCS) therapy. In physical examination, newly formed, TCS-resistant vesiculo-papular skin lesions were recognised on the present dermatitis. The presence of AD with food allergy and moderate to severe eosinophilia were other prominent findings. CONCLUSION: All patients were misdiagnosed as AD exacerbation. Therefore, EH should be considered in the differential diagnosis of AD exacerbation especially in the infants with moderate to severe AD.

Bacitracin: A Causative Agent of Purpuric Allergic Contact Dermatitis.

Background: Purpuric contact dermatitis (CD) is an unusual presentation of CD. Case: We present a case of purpuric CD occurring after topical usage of bacitracin. We want to emphasize the clinical presentation, besides the classic eczematous form of allergic CD. Conclusion: Purpuric CD may be suspected when there are purple rashes located in areas related to contact with topical medications.