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Dietary Intake and Nutrition for Pediatric Allergic Diseases

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutritional Immunology".

Deadline for manuscript submissions: closed (31 July 2021) | Viewed by 31984

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Special Issue Editors

Dr. Enza D'Auria

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Guest Editor

Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Via Lodovico Castelvetro, 32, 20154 Milano MI, Italy
Interests: food allergy; dietary intake, allergy and nutrition; immune - nutrition; precision medicine
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Roberto Berni Canani

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Co-Guest Editor

Chief, Food Allergy Unit, Department of Translational Medical Science-Pediatric Section, European Laboratory for the Investigation of Food Induced Diseases, CEINGE-Advanced Biotechnologies, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
Interests: pediatric nutrition; pediatric gastroenterology; food allergy; gut microbiome; epigenetics; immunenutrition; immune tolerance

Prof. Dr. Gianvincenzo Zuccotti

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Co-Guest Editor

1. Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy
2. Department of Pediatrics, Buzzi Children’s Hospital, 20157 Milano, Italy
Interests: pediatric infectious diseases; pediatric nutrition; children; malnutrition; obesity; global health; telemedicine; digital health; preventive medicine; translational research
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The prevalence of food allergies appears to be increasing worldwide. Likewise, the prevalence of allergic rhinitis and atopic dermatitis is also increasing and asthma epidemics continue, especially in transitional countries. Allergic diseases are an important cause of burden to patients and their families, and currently represent a major public health concern. For these reasons, considerable efforts have been devoted to reverse this epidemiologic trend in recent years.

Besides genetic causes, environmental factors may have also played an important role in this increase. Recent evidence suggests the pivotal role of nutrition in both preventing and managing allergic diseases. Nutrients are essential in the development and functionality of the immune system. The term immunonutrition, which is the study of the effects of nutrients, bioactive compounds, and both conventional and functional foods on the immune system, highlights, at its core, the centrality of diet in human health/diseases. Nutritional prevention strategies are focused on both pre- and postnatal factors. Maternal diet during pregnancy and lactation may have a role in the development of allergic diseases, in part due to epigenetic mechanisms through the modulation of maternal gut microbiota, mammalian gland microbiota, and breast milk components. In recent years, the importance of a varied diet and dietary patterns in immunomodulation has become more evident. A more varied diet in early life may increase exposure to food allergens, thereby promoting tolerance development and also shaping gut microbiota. The first 1000 days of life are considered a window of opportunity to modulate gut microbiota, which are responsible for the production of a myriad of specific metabolites that finally impact the immune system.

A nutritional approach represents an important step in food allergy management, with the aim of satisfying the needs of macro- and micronutrients, while maintaining a well-balanced diet. Besides the traditional approach, which involves avoiding the offending foods, a novel paradigm shift is currently under way with the spread of oral tolerance induction as a concept in allergy therapy. In recent years, the dietary management of allergic diseases has thus moved from a passive approach, consisting of an elimination diet to relieve symptoms, to a “proactive” one, meaning the possibility to also actively modulate the immune system by dietary intervention.

The purpose of this Special Issue of Nutrients is to provide an overview of how nutrition may impact allergic diseases. More specifically, the Special Issue addresses how dietary factors, a varied diet, and dietary patterns may affect allergic outcomes. The importance of supplying adequate dietary intake in managing food allergies is also highlighted. Furthermore, the recent developments in actively managing and treating food allergies are summarized.

Dr. Enza D'Auria
Prof. Dr. Roberto Berni Canani
Prof. Dr. Gian Vincenzo Zuccotti
Guest Editors

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Keywords

food allergy; pediatric allergy; pediatric nutrition; immune nutrition; dietary intake; gut microbiota

Published Papers (8 papers)

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Research

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9 pages, 630 KiB

Open AccessArticle

Analysis of Serum Th2 Cytokines in Infants with Non-IgE Mediated Food Allergy Compared to Healthy Infants

by Francesco Savino, Francesca Giuliani, Stefano Giraudi, Ilaria Galliano, Paola Montanari, Valentina Daprà and Massimiliano Bergallo

Nutrients 2022, 14(8), 1565; https://doi.org/10.3390/nu14081565 - 9 Apr 2022

Cited by 1 | Viewed by 1756

Abstract

Background: The aim of this study is to assess the serum values of IL-4, IL-5, IL-10, and IL-13 in a group of infants with non-IgE mediated food allergies treated with a hydrolyzed formula and compare them with a group of healthy peers. Methods: A total of 53 infants aged 1 to 4 months, of which 34 with non-IgE mediated food allergies and 19 healthy infants were enrolled in this study. Infants were eligible if they had gastrointestinal symptoms of food allergy and needed to switch from their initial formula to hydrolyzed formulas with an improvement of symptoms. Controls were fed with either breastmilk or standard formula. Blood samples were taken within one week of a special diet for cases. Interleukinsin in peripheral blood was detected and analyzed using the real-time PCR MAMA method. Fecal calprotectin was evaluated using a quantitative assay. Results: Values of IL-4 and IL-13 were significantly higher in the non-IgE food allergy group compared to the control group (p < 0.05), while IL-5 and IL-10 were significantly lower than the control group (p < 0.05). Fecal calprotectin in the non-IgE food allergy group was significantly higher compared to the control group (p < 0.05). Conclusion: This study provides a theoretical basis that Th2 cytokine expression in infants with a non-IgE mediated food allergy is significantly different than in healthy infants; this finding supports the use of early dietetic treatment with hydrolyzed formulas. Full article

(This article belongs to the Special Issue Dietary Intake and Nutrition for Pediatric Allergic Diseases)

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13 pages, 283 KiB

Open AccessArticle

A Survey to Identify the Current Management of Cow’s Milk Disorders and the Role of Goat Milk-Based Formulas in the Middle East and North Africa Region

by Wael A. Bahbah, Mostafa ElHodhod, Mohamed Salah, Fawaz AlRefaee, Muath AlTuraiki, Samira Mousa, Ali Al Mehaidib, Wafaa Helmi Ayesh, Ahmed N. El-Bazzar, Joseph El Haddad, Heba Y. El Khashab, Amr El Zawahry, Mohammed Hasosah, Sanaa Youssef Shaaban and Yvan Vandenplas

Nutrients 2022, 14(5), 1067; https://doi.org/10.3390/nu14051067 - 3 Mar 2022

Cited by 3 | Viewed by 2715

Abstract

Background: Cow’s milk allergy (CMA) and cow’s milk intolerance (CMI) are the major cow’s milk disorders observed in infants and young children. This study investigates, for the first time, physician knowledge regarding CMA and CMI prevalence, diagnosis, and management in the Middle East and North Africa (MENA) region. In addition, we explore the role of goat milk-based formula as an alternative in infants suffering from CMI. Method: This cross-sectional survey was conducted from December 2020 to February 2021. A convenience sample of 2500 MENA-based physicians received the questionnaire, developed by a working group of pediatric experts. Results: 1868 physicians completed the questionnaire, including pediatric specialists (80.8%), training physicians (0.2%), dermatologists (0.1%), family/general physicians (12.9%), neonatologists (3.6%), neurosurgeons (0.2%), allergy nurse specialists (0.3%), pharmacists (2.1%), and public health workers (0.1%). Differentiation between CMA and CMI was recognized by the majority of respondents (80.7%), for which the majority of respondents (35.4%) identified that the elimination and challenge test was the best test to differentiate CMA from CMI, whereas 30.7% and 5.4% preferred the immunoglobulin E (IgE) test and skin prick test, respectively. In addition, 28.5% of respondents reported that there is no confirmatory test to differentiate CMA from CMI. The majority of respondents (47.3%) reported that amino acid-based formula (AAF)/ extensively hydrolyzed formula (EHF) is the cornerstone for the management of CMA. However, most respondents (33.7%) reported that lactose avoidance was best for the management of CMI. Overall, 65% of the respondents were aware of nutritionally adapted goat’s milk formula as an alternative to cow’s milk products and 37% would recommend its routine use in infants (≤2 years of age). Conclusion: The results of this survey demonstrate that the majority of physicians are aware of the underlying pathophysiology and management of CMA and CMI. However, a significant proportion of physicians do not follow the clinical guidelines concerning CMA/CMI diagnosis and management. Notably, this survey identified that goat’s milk formulas may offer a suitable alternative to AAF/EHF in infants with CMI as they contain β-casein protein which is easily digestible. In addition, goat’s milk formulas contain higher levels of oligosaccharides and medium-chained fatty acids compared with standard cow’s milk formulas, yet further clinical trials are warranted to support the inclusion of goat’s milk formulas in clinical guidelines. Full article

(This article belongs to the Special Issue Dietary Intake and Nutrition for Pediatric Allergic Diseases)

14 pages, 1081 KiB

Open AccessArticle

Partially Hydrolysed Whey-Based Infant Formula Improves Skin Barrier Function

by Sébastien Holvoet, Sophie Nutten, Lénaïck Dupuis, Dominique Donnicola, Tristan Bourdeau, Betsy Hughes-Formella, Dagmar Simon, Hans-Uwe Simon, Ryan S. Carvalho, Jonathan M. Spergel, Sibylle Koletzko and Carine Blanchard

Nutrients 2021, 13(9), 3113; https://doi.org/10.3390/nu13093113 - 4 Sep 2021

Cited by 6 | Viewed by 3504

Abstract

Specific partially hydrolysed whey-based infant formulas (pHF-W) have been shown to decrease the risk of atopic dermatitis (AD) in infants. Historically, AD has been associated primarily with milk allergy; however, defective skin barrier function can be a primary cause of AD. We aimed to ascertain whether oral supplementation with pHF-W can improve skin barrier function. The effect of pHF-W was assessed on transepidermal water loss (TEWL) and antibody productions in mice epicutaneously exposed to Aspergillus fumigatus. Human primary keratinocytes were stimulated in vitro, and the expression of genes related to skin barrier function was measured. Supplementation with pHF-W in neonatal mice led to a significant decrease in TEWL and total IgE, but not in allergen-specific antibody levels. The whey hydrolysate was sufficient to decrease both TEWL and total IgE. Aquaporin-3 gene expression, linked with skin hydration, was modulated in the skin of mice and human primary keratinocytes following protein hydrolysate exposure. Skin barrier improvement may be an additional mechanism by which pHF-W may potentially reduce the risk of AD development in infants. Further human studies are warranted to confirm the clinical efficacy of these observations. Full article

(This article belongs to the Special Issue Dietary Intake and Nutrition for Pediatric Allergic Diseases)

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12 pages, 1103 KiB

Open AccessArticle

Peptide Characterization and Functional Stability of a Partially Hydrolyzed Whey-Based Formula over Time

by Tristan Bourdeau, Michael Affolter, Lénaïck Dupuis, Alexandre Panchaud, Sabine Lahrichi, Loraine Merminod, Christine Martin-Paschoud, Rachel Adams, Sophie Nutten and Carine Blanchard

Nutrients 2021, 13(9), 3011; https://doi.org/10.3390/nu13093011 - 28 Aug 2021

Cited by 7 | Viewed by 3870

Abstract

Human clinical trials have shown that a specific partially hydrolyzed 100% whey-based infant formula (pHF-W) reduces AD risk in the first yeast of life. Meta-analyses with a specific pHF-W (pHF-W1) confirm a protective effect while other meta-analyses pooling different pHF-W show conflicting results. Here we investigated the molecular composition and functional properties of the specific pHF-W1 as well as the stability of its manufacturing process over time. This specific pHF-W1 was compared with other pHF-Ws. We used size exclusion chromatography to characterize the peptide molecular weight (MW), a rat basophil degranulation assay to assess the relative level of beta-lactoglobulin (BLG) allergenicity and a preclinical model of oral tolerance induction to test prevention of allergic sensitization. To analyze the exact peptide sequences before and after an HLA binding assay, a mass cytometry approach was used. Peptide size allergenicity and oral tolerance induction were conserved across pHF-W1 batches of production and time. The median MW of the 37 samples of pHF-W1 tested was 800 ± 400 Da. Further oral tolerance induction was observed using 10 different batches of the pHF-W1 with a mean reduction of BLG-specific IgE levels of 0.76 log (95% CI = −0.95; −0.57). When comparing pHF-W1 with three other formulas (pHF-W2 3 and 4), peptide size was not necessarily associated with allergenicity reduction in vitro nor oral tolerance induction in vivo as measured by specific IgE level (p < 0.05 for pHF-W1 and 2 and p = 0.271 and p = 0.189 for pHF-W3 and 4 respectively). Peptide composition showed a limited overlap between the formulas tested ranging from 11.7% to 24.2%. Furthermore nine regions in the BLG sequence were identified as binding HLA-DR. In conclusion, not all pHF-Ws tested have the same peptide size distribution decreased allergenicity and ability to induce oral tolerance. Specific peptides are released during the different processes used by different infant formula producers. Full article

(This article belongs to the Special Issue Dietary Intake and Nutrition for Pediatric Allergic Diseases)

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Review

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14 pages, 752 KiB

Open AccessReview

Nutrition during Pregnancy and Lactation: Epigenetic Effects on Infants’ Immune System in Food Allergy

by Margherita Di Costanzo, Nicoletta De Paulis, Maria Elena Capra and Giacomo Biasucci

Nutrients 2022, 14(9), 1766; https://doi.org/10.3390/nu14091766 - 23 Apr 2022

Cited by 13 | Viewed by 4970

Abstract

Food allergies are an increasing health problem worldwide. They are multifactorial diseases, in which the genome alone does not explain the development of the disease, but a genetic predisposition and various environmental factors contribute to their onset. Environmental factors, in particular nutritional factors, in the early stages of life are recognized as key elements in the etiology of food allergies. There is growing evidence advising that nutrition can affect the risk of developing food allergies through epigenetic mechanisms elicited by the nutritional factors themselves or by modulating the gut microbiota and its functional products. Gut microbiota and postbiotics can in turn influence the risk of food allergy development through epigenetic mechanisms. Epigenetic programming accounts not only for the short-term effects on the individual’s health status, but also for those observed in adulthood. The first thousand days of life represent an important window of susceptibility in which environmental factors, including nutritional ones, can influence the risk of developing allergies through epigenetic mechanisms. From this point of view, it represents an interesting window of opportunity and intervention. This review reports the main nutritional factors that in the early stages of life can influence immune oral tolerance through the modulation of epigenetic mechanisms. Full article

(This article belongs to the Special Issue Dietary Intake and Nutrition for Pediatric Allergic Diseases)

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13 pages, 309 KiB

Open AccessReview

Potential Role of Omega-3 Polyunsaturated Fatty Acids in Pediatric Food Allergy

by Marco Ugo Andrea Sartorio, Erica Pendezza, Serena Coppola, Lorella Paparo, Enza D’Auria, Gian Vincenzo Zuccotti and Roberto Berni Canani

Nutrients 2022, 14(1), 152; https://doi.org/10.3390/nu14010152 - 29 Dec 2021

Cited by 20 | Viewed by 3779

Abstract

Polyunsaturated fatty acids (PUFAs) are involved both in immune system regulation and inflammation. In particular, within the PUFAs category, omega-3 (ω-3) may reduce inflammation, whereas omega-6 (ω-6) PUFAs are generally considered to have a proinflammatory effect. Recent evidence highlights an imbalance in the ω-3:ω-6 ratio with an increased intake of ω-6, as a consequence of the shift towards a westernized diet. In critical age groups such as infants, toddlers and young children, as well as pregnant and lactating women or fish allergic patients, ω-3 intake may be inadequate. This review aims to discuss the potential beneficial effects of PUFAs on pediatric food allergy prevention and treatment, both at prenatal and postnatal ages. Data from preclinical studies with PUFAs supplementation show encouraging effects in suppressing allergic response. Clinical studies results are still conflicting about the best timing and dosages of supplementation and which individuals are most likely to benefit; therefore, it is still not possible to draw firm conclusions. With regard to food-allergic children, it is still debated whether PUFAs could slow disease progression or not, since consistent data are lacking. In conclusion, more data on the effects of ω-3 PUFAs supplementation alone or in combination with other nutrients are warranted, both in the general and food allergic population. Full article

(This article belongs to the Special Issue Dietary Intake and Nutrition for Pediatric Allergic Diseases)

14 pages, 654 KiB

Open AccessReview

Semi-Elemental and Elemental Formulas for Enteral Nutrition in Infants and Children with Medical Complexity—Thinking about Cow’s Milk Allergy and Beyond

by Elvira Verduci, Silvia Salvatore, Ilia Bresesti, Elisabetta Di Profio, Erica Pendezza, Alessandra Bosetti, Massimo Agosti, Gian Vincenzo Zuccotti and Enza D’Auria

Nutrients 2021, 13(12), 4230; https://doi.org/10.3390/nu13124230 - 25 Nov 2021

Cited by 7 | Viewed by 4595

Abstract

Children with medical complexities, such as multi-system disorders and/or neurological impairments, often experience feeding difficulties and need enteral nutrition. They frequently have impaired motility and digestive–absorbing functions related to their underlying condition. If a cow’s milk allergy (CMA) occurs as a comorbidity, it is often misdiagnosed, due to the symptoms’ overlap. Many of the commercialized mixtures intended for enteral nutrition are composed of partially hydrolyzed cow’s milk proteins, which are not suitable for the treatment of CMA; thus, the exclusion of a concomitant CMA is mandatory in these patients for obtaining symptoms relief. In this review, we focus on the use of elemental and semi-elemental formulas in children with neurological diseases and in preterm infants as clinical “models” of medical complexity. In children with neurodisabilities, when gastrointestinal symptoms persist despite the use of specific enteral formula, or in cases of respiratory and/or dermatological symptoms, CMA should always be considered. If diagnosis is confirmed, only an extensively hydrolyzed or amino-acid based formula, or, as an alternative, extensively hydrolyzed nutritionally adequate formulas derived from rice or soy, should be used. Currently, enteral formulas tailored to the specific needs of preterm infants and children with neurological impairment presenting concomitant CMA have not been marketed yet. For the proper monitoring of the health status of patients with medical complexity, multidisciplinary evaluation and involvement of the nutritional team should be promoted. Full article

(This article belongs to the Special Issue Dietary Intake and Nutrition for Pediatric Allergic Diseases)

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35 pages, 2087 KiB

Open AccessReview

Pediatric Obesity-Related Asthma: The Role of Nutrition and Nutrients in Prevention and Treatment

by Valeria Calcaterra, Elvira Verduci, Michele Ghezzi, Hellas Cena, Martina Chiara Pascuzzi, Corrado Regalbuto, Rossella Lamberti, Virginia Rossi, Matteo Manuelli, Alessandra Bosetti and Gian Vincenzo Zuccotti

Nutrients 2021, 13(11), 3708; https://doi.org/10.3390/nu13113708 - 21 Oct 2021

Cited by 17 | Viewed by 5781

Abstract

Childhood obesity rates have dramatically risen in numerous countries worldwide. Obesity is likely a factor in increased asthma risk, which is already one of the most widespread chronic respiratory pathologies. The pathogenic mechanism of asthma risk has still not yet been fully elucidated. Moreover, the role of obesity-related inflammation and pulmonary overreaction to environmental triggers, which ultimately result in asthma-like symptoms, and the importance of dietary characteristics is well recognized. Diet is an important adjustable element in the asthma development. Food-specific composition of the diet, in particular fat, sugar, and low-quality nutrients, is likely to promote the chronic inflammatory state seen in asthmatic patients with obesity. An unbalanced diet or supplementation as a way to control asthma more efficiently has been described. A personalized dietary intervention may improve respiratory symptoms and signs and therapeutic response. In this narrative review, we presented and discussed more recent literature on asthma associated with obesity among children, focusing on the risk of asthma among children with obesity, asthma as a result of obesity focusing on the role of adipose tissue as a mediator of systemic and local airway inflammation implicated in asthma regulation, and the impact of nutrition and nutrients in the development and treatment of asthma. Appropriate early nutritional intervention could possibly be critical in preventing and managing asthma associated with obesity among children. Full article

(This article belongs to the Special Issue Dietary Intake and Nutrition for Pediatric Allergic Diseases)

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