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Food allergy in children

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Food allergy in children Hugo Van Bever Department of Pediatrics National University Singapore APAPARI Workshop, Hanoi, May 2008 Food Allergy Fact or Fiction? – PowerPoint PPT presentation

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Title: Food allergy in children


1
Food allergy in children
  • Hugo Van Bever
  • Department of Pediatrics
  • National University Singapore

APAPARI Workshop, Hanoi, May 2008
2
Food AllergyFact or Fiction?
1. Difficult problem group
of diseases 2. Lot of non-scientific data
opinions truths tradition stories. 3.
Food other types of reaction
(intolerance, intoxication, etc) 4. Too
many children are labeled as being food-allergic
3
Food allergy an immunologically-mediated
reaction against food
  • 1. IgE-mediated
  • 2. Cell-mediated reactions
  • (T lymphocytes -
    delayed onset)
  • 3. Mixed types (atopic dermatitis)
  • 4. Other mechanisms
  • ( unknown - CIC complement etc)

4
Prevalence of food allergy
  • 1. General population 2
  • 2. Young children (lt 3 yrs) 8
  • 3. Singapore children 4 5
  • SPECIFIC GROUPS
  • 4. Young children with severe eczema 90
  • 5. Children with asthma lt 10

5
Manifestations of food allergy
  • 1. SKIN urticaria angioedema gt eczema
  • 2. RESPIRATORY rhinitis asthma
  • 3. GI TRACT diarrhea vomiting FTT
  • - eosinophilic
    gastroenteritis
  • - enterocolitis
  • 4. GENERAL anaphylactic shock
  • 5. OTHER migraine, hyperactivity,
  • sleep disturbances etc ?

6
Foods triggering anaphylaxis in Singaporean
children (1992 1996)
  • 124 children with acute anaphylaxis at NUH
  • mean age (yrs)
  • 1. Egg and milk 11 0.7
  • 2. Birds nest 27 4.5
  • 3. Chinese herbs 7 5.0
  • 4. Crustacean seafood 24 11.0
  • 5. Others 30 7.0

Chicken, duck, ham, fruits (banana, rambutan),
cereals, gelatin and spices
Goh et al. Allergy 54, 1999, 78-92.
7
Every food has its own story
cows milk hens egg peanuts, fish, seafood,
prevalence
age
3 yrs 5 yrs
6 months
8
Sensitization to foodsensitization to
allergens
  • 1. prenatal sensitization
  • 2. postnatal sensitization

9
Sensitization to food eating, touching
and smelling
peanuts fish hen's egg
10
Allergy to cows milk proteins in mothers milk
or in hydrolyzed cows milk infant formulas
assessed by intestinal permeability measurements.
mothers milk
ovalbumin peanut protein cows milk protein
11
Prenatal sensitization to allergensdoes it exist?
  • 1. clinical evidence
  • (peanuts ovalbumine pollen house
  • dust mite cat - dog)
  • 2. allergens in amniotic fluid cord blood
  • 3. active transport through placenta

12
Exposure to peanuts in utero and in infancy and
the development of sensitization to peanut
allergens in young children. Frank L, Marian A,
Visser M, Weinberg E, Potter PC. Pediatr Allergy
Immunol 1999, 10, 27-32.
mothers who consumed peanuts more than once a
week during pregnancy were more likely to have a
peanut-allergic child than mothers who consumed
peanuts less than once a week (odds ratio3.97,
98 confidence interval 0.73-24).
13
Allergic sensitization during pregnancy
influences the offsprings immune reactions. A
study in a mouse model (H. Renz, 1999).
study group
Ovalbumin challenge (every second day)
decreased INF-g
( x 8 9 )
control group
PREGNANCY BIRTH
14
Direct evidence for transplacental allergen
transfer. Szépfalusi et al. Pediatr Res 2000,
48, 404-7.
maternal side fetal side
BLG 8
8
Bet v1 10 2
Human IgG increase
Ig receptor involvement
15
Diagnosis of food allergy
  • 1. IgE-mediated food allergy
  • - SPT IgE
  • 2. Non-IgE-mediated food allergy
  • - patch test
  • - in vitro LTT (cytokine profile?)

research
GOLDEN STANDARD DBPCFC
16
Utility of food-specific IgE concentrations in
predicting symptomatic food allergy. Hugh A.
Sampson. JACI 2001, 107, 891.
  • Diagnostic decision points of 95
  • - cows milk 15 kU/L
  • - egg 7 kU/L
  • - peanut 14 kU/L
  • - fish 20 kU/L

n 100, mean age 3.8 yrs
17
Future immunomodulatory therapies for food allergy
  • 1. Humanized monoclonal anti-IgE
  • 2. Mutated allergen protein immunotherapy
  • 3. Peptide immunotherapy
  • 4. Immuno-stimulatory sequences
  • 5. Probiotics (?) no effect on allergic
    reactions

18
Alternative feedings in case of CMA
  • 1. Breast milk
  • 2. Soy formulas (?)
  • 3. Goat formulas (?)
  • 4. Hypoallergenic formulas
  • ( partial hydrolysate formulas)
  • 5. Amino acid-based formulas
  • (complete hydrolysate formulas

19
Primary prevention of atopy food allergen
avoidance
  • -- BREAST FEEDING
  • Saarinen AM, Kajosaari M. Breastfeeding as
    prophylaxis against atopic disease prospective
    follow-up study until 17 years old. Lancet 1995
    346 1065 - 1069.
  • -- HYPO-ALLERGENIC MILK
  • Vandenplas Y et al. The long-term effect of a
    partial whey hydrolysate formula on the
    prophylaxis of atopic disease. Eur J Pediatr
    1995 154 488 - 494.

20
The long-term effect of a partial whey
hydrolysate formula on the prophylaxis of atopic
disease.Vandenplas et al. Eur J Ped 1995, 154,
488.
prevalence of CMP sensitivity
21
Conclusion Food AllergyFact or Fiction?
A fact surrounded with lots of fiction
a lot of non-scientific data opinions
truths tradition stories etc
scientific data
22
Conclusion
  • Still breast is best
  • but impossible to study
  • no contra-indications
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