Sensitization and allergy to wheat in a paediatric population: evaluation of IgE reactivity profiles and cross-reactivity with grass pollens.

Introduzione: L'allergia al grano si verifica tramite ingestione, inalazione, contatto o esercizio fisico dopo avere assunto alimenti contenenti grano. Tra i 21 allergeni del grano, l' ω-5 gliadina (Tri a19) è un allergene rilevante nei bambini, implicato in reazioni immediate dopo l'ingestione, mentre la non-specific lipid transfer protein (nsLTP) Tri a14 è un allergene rilevante nella popolazione dell'area del Mediterraneo ed è anche implicato nell'asma del panettiere. Scopo del presente studio è valutare i diversi profili di sensibilizzazione al grano in una popolazione pediatrica e determinare l'accuratezza diagnostica delle componenti molecolari del grano nel predire l'esito del Test di Provocazione Orale (TPO). Metodi: Sono stati arruolati 21 bambini(16 M, età media 7.9 anni) sensibilizzati al grano presso l'Ambulatorio di Allergologia Pediatrica-Policlinico S. Orsola- Malpighi Università di Bologna. I pazienti sono stati valutati tramite SPT e dosaggio di IgEs per pollini, grano, glutine, Tri a19 e Tri a14.La diagnosi di allergia al grano è stata confermata tramite TPO. Risultati: 6 pazienti (28.6%) sono risultati allergici al grano. I livelli di IgEs verso grano e glutine sono risultati significativamente più elevati nei soggetti allergici rispetto ai tolleranti. Il confronto tra i profili di sensibilizzazione ha mostrato una maggiore prevalenza di sensibilizzazione verso il glutine (100% vs. 46.6%) e Tri a19 (83.3% vs. 0%) nel gruppo degli allergici. L'area sotto la curva ROC(AUC) per le IgEs verso omega-5 gliadina era 0.917 per un cut-off di 0.34 kU/L mentre l'AUC per le IgEs verso la nsLTP non era rilevante (AUC=0.525). Conclusione: I pazienti con allergia al grano hanno diversi profili di sensibilizzazione rispetto ai tolleranti; Tri a19 si è mostrato utile come strumento diagnostico nella diagnosi di allergia al grano nella nostra popolazione dell'area del Mediterraneo.Introduction: Wheat allergy (WA) can occur after ingestion, inhalation, contact or physical exercise after eating wheat-based foods. Up to now, 21 allergenic components have been identified in wheat grain: in particular ω-5 gliadin (Tri a 19) is a significant allergen in young children with immediate reactions to ingested wheat, while the non-specific lipid transfer protein (nsLTP) Tri a 14 is a relevant allergen in patients from the Mediterranean area and is also associated with baker’s asthma. The aim of this study is to investigate the molecular patterns of wheat sensitization in a pediatric population and to assess the diagnostic accuracy of each wheat component in predicting IgE-mediated adverse reactions to wheat. Methods: We consecutively enrolled 21 pediatric patients (16 M, mean age 7.9 years) with sensitization to wheat grain referring to the Pediatric Allergy Outpatient Unit of S. Orsola- Malpighi Hospital - University of Bologna (Italy). Patients were assessed by SPT and serum sIgE against pollens, wheat, gluten and Tri a19 and Tri a14. The diagnosis of WA was confirmed with open food challenges (OFC). Results: The diagnosis of WA was confirmed in 6 patients (28.6%). The levels of sIgE to wheat and gluten were statistically significant higher in allergic patients compared to tolerant ones. The comparison between the patterns of sensitization showed a higher prevalence of sIgE against gluten (100% vs. 46.6%) and rTri a19 (83.3% vs. 0%) in the wheat-allergic group. The area under the ROC curve (AUC) for sIgE to omega-5 gliadin was 0.917 for a cut-off value of 0.34 kU/L while the AUC for sIgE to the wheat nsLTP was not relevant (AUC=0.525). Conclusion: Patients with WA have different profiles of sensitization than the tolerant ones; in particular Tri a19 was useful as a diagnostic tool in WA in patients from the Mediterranean area

Peanut Sensitization Profiles in Italian Children and Adolescents with Specific IgE to Peanuts

Peanuts are one of the most relevant foods implicated in IgE-mediated adverse reactions in pediatric population. This study aimed to evaluate the pattern of sensitization towards five peanut allergenic components (rAra h 1, 2, 3, 8 and 9) in a population of Italian children and adolescents with specific IgE (sIgE) to peanut. rAra h 9 was the main allergen implicated in peanut sensitization (58%), followed by rAra h 8 (35%), rAra h 2 (27%), rAra h 3 (23%) and rAra h 1 (12.5%). rAra h 1, 2, and 3 were the main allergenic components in young children: 8/13 (62%) between 2 and 5 years, 8/23 (35%) between 6 and 11 years, and 3/12 (25%) between 1 and 16 years. No differences were found among the levels of sIgE towards rAra h 1, 2, 3, and 9 in the three groups; in contrast, the levels of sIgE against rAra h 8 showed an increasing trend according to age. In conclusion rAra h 1, 2, and 3 were the prevalent sensitizing allergens during the first years of life in Italian patients with sIgE to peanuts (“genuine” allergy); in contrast rAra h 9 and 8 were mainly involved in school-age children and adolescents with pollen allergy (“secondary” sensitization)

Allergen Avoidance in Allergic Asthma

Allergic asthma is the most frequent disease among the chronic respiratory disorders in pediatric age with an important social impact. In the last years, many efforts have been made to identify effective preventive approaches to get a better control of symptoms and to obtain the best future outcomes for the patients. In patients with allergic asthma triggered by the exposure to indoor allergens, the avoidance is the first intervention to prevent the appearance or the worsening of bronchial symptoms. This review article summarized the most recent evidence from literature about the efficacy of specific control interventions for the most important allergens. Even if a wide spectrum of interventions has been suggested and may help to reduce exposure to trigger allergy for sensitized patients suffering from respiratory allergy, evidence supporting the efficacy of these approaches is still weak and subject of controversy. However, the exposure control to specific airborne allergens is still widely recommended and may be effective as part of a holistic approach to reduce the severity of allergic respiratory symptoms in sensitized individuals

Wheat allergy in a pediatric population from the Mediterranean area

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Cow\u2019s Milk Allergy: Management and Prevention.

Cow\u2019s milk allergy (CMA) is one of the most frequent food allergies in childhood with an estimated prevalence of 2% in infants. As observed in the natural course of this disease, CMA has a good prognosis and more than half of the children reach the tolerance before school age. Otherwise, many different factors can modulate the natural history of CMA. Clinical and laboratory data suggest that many endotypes and phenotypes can be individuated with different evolutions towards tolerance. For these reasons physicians need to identify these different patterns to better choose the therapeutic pathway for each patient. Another aspect is represented by the developing strategies of primary prevention of CMA, such as dietary interventions both in the mother (during pregnancy and/ or lactation), and, in absence of breast milk, also in high risk infants, through the use of extensive or partial hydrolyzed milk formula. Nevertheless many studies have been carried out, up today the available data are still conflicting and more robust results should be reported. The aim of this review articleis to give practical advices in the diagnosis, management and prevention of CMA in childhood, according to the most recent guidelines and consensus documents

Update on interventions in prevention and treatment of pediatric asthma

BACKGROUND: Asthma represents a worldwide health problem with a strong morbidity and a major impact on the health care system. Multiple efforts have been made towards the development of new strategies of prevention and treatment of this disorder. In the light of this the present review of the literature aimed at summarizing the latest advances in prevention and treatment of pediatric asthma with a focus on the most effective options of interventions during the first stages of life. METHODS: References were identified by searches of PubMed. Search terms used in the search were "pediatric asthma", "treatment" and "prevention" . We included only meta-analysis, randomized controlled trials, reviews and systematic review articles pertaining to humans and subjects aged 0-18 years. All the interventions have been classified as "non-pharmacological" and pharmacological". RESULTS: Non-pharmacological interventions have been focused in identifying the genetic and environmental factors underlying the pathogenesis of this disease, including the individual genetic susceptibility, the early allergic sensitization, the role of the environmental microbiome and the exposure to infections and to pollutants. Moreover the optimization of the existing pharmacological strategies and the development of new treatment options have improved markedly the management of this disease, thereby reducing the health care costs and ameliorating the quality of life of patients. CONCLUSIONS: Childhood asthma prevention and treatment still represents a worldwide challenge. Future efforts should be aimed at identifying high risk target populations, minimizing the costs of each policy of intervention and increasing adherence to treatment strategies

Peanut Sensitization Profiles in Italian Children and Adolescents with Specific IgE to Peanuts

Peanuts are one of the most relevant foods implicated in IgE-mediated adverse reactions in pediatric population.This study aimed to evaluate the pattern of sensitization towards five peanut allergenic components (rAra h 1, 2, 3, 8 and 9) in a population of Italian children and adolescents with specific IgE (sIgE) to peanut. rAra h 9 was the main allergen implicated in peanut sensitization (58%), followed by rAra h 8 (35%), rAra h 2 (27%), rAra h 3 (23%) and rAra h 1 (12.5%). rAra h 1, 2, and 3 were the main allergenic components in young children: 8/13 (62%) between 2 and 5 years, 8/23 (35%) between 6 and 11 years, and 3/12 (25%) between 1 and 16 years. No differences were found among the levels of sIgE towards rAra h 1, 2, 3, and 9 in the three groups; in contrast, the levels of sIgE against rAra h 8 showed an increasing trend according to age. In conclusion rAra h 1, 2, and 3 were the prevalent sensitizing allergens during the first years of life in Italian patients with sIgE to peanuts (\u201cgenuine\u201d allergy); in contrast rAra h 9 and 8 were mainly involved in school-age children and adolescents with pollen allergy (\u201csecondary\u201d sensitization)