Search Results (1,325)

Background: Children with food allergy (FA) may develop eating difficulties that extend beyond medically required allergen avoidance, including food neophobia, selective eating, and avoidant/restrictive food intake disorder (ARFID)-related symptoms. This mixed-methods study aimed to assess ARFID symptoms, food neophobia, diet quality, and food-related psychological experiences in children with FA. Methods: Seventy children with confirmed FA were enrolled in an observational cross-sectional mixed-methods study conducted at a tertiary pediatric allergy center. Quantitative assessment included the Eating Disorders in Youth-Questionnaire (EDY-Q), the Italian Child Food Neophobia Scale (ICFNS), and the Mediterranean Diet Quality Index for Children and Adolescents (KIDMED). Qualitative data were collected from a purposive subsample of 26 children through semi-structured child-friendly interviews and drawing-based elicitation activities and were analyzed using inductive thematic analysis. Results: A positive EDY-Q screening result for ARFID-related symptoms was observed in 3 children (4.3%). Selective Eating showed the highest median EDY-Q domain score (median 1.50, IQR 0.67–4.00), followed by Food Avoidance Emotional Disorder (median 1.00, IQR 0.00–2.00) and Functional Dysphagia (median 0.00, IQR 0.00–2.00). Moderate food neophobia was observed in 45 children (64.3%), while 24 children (34.3%) were classified within the high food-neophobia category. KIDMED score was negatively correlated with EDY-Q total score (Spearman’s ρ = −0.302; p = 0.011), Selective Eating (ρ = −0.356; p = 0.002), and Functional Dysphagia (ρ = −0.238; p = 0.048). In an exploratory hierarchical regression, Selective Eating remained inversely associated with KIDMED after adjustment for demographic and FA-related covariates (β = −0.386; p = 0.002); however, the overall model did not reach statistical significance (p = 0.081), and the additional clinical covariates did not significantly improve model fit. Accordingly, the fully adjusted findings should be interpreted as exploratory. Qualitative analysis identified five themes: anticipatory fear of food and tasting, emotional memory of allergic reactions and generalization of risk, selective avoidance and food rigidity, reassurance-seeking and decision-making dependence, and ambivalent parental dynamics. Conclusions: Within this tertiary-care sample, positive EDY-Q screening results were uncommon, whereas broader food-related difficulties were identified. Pediatric FA assessment may benefit from attention to eating behavior, diet quality, and avoidance extending beyond confirmed allergens. Full article

Background/Objective: Non-IgE-mediated food allergies (non-IgE-FAs) are increasingly recognized in infancy as causes of delayed gastrointestinal symptoms, nutritional compromise, and impaired growth. This retrospective study aimed to evaluate longitudinal growth outcomes in children with non-IgE-FAs managed with different dietary interventions and to explore phenotype-specific differences and clinical correlations. Methods: Children diagnosed with non-IgE-FAs at the Pediatric Clinic Unit of Salesi Hospital (Ancona, Italy) between July 2022 and June 2025 were included. Anthropometric, clinical, and laboratory data were collected at baseline (T0) and follow-up visits at 6, 12, and 18 months. Weight-, length-, and BMI-for-age z-scores were calculated using Growth Calculator 4.0. Longitudinal growth trends were assessed through individual linear regression slopes, and dietary intervention effects were evaluated with ANOVA models. Results: Thirty-seven children were included (57% male), 95% of whom were diagnosed with CMA. Slope analyses demonstrated significant positive trends for BMI z-scores (median 0.340, IQR −0.171 to 1.130; p = 0.013). BMI slope differed according to phenotype when comparing children with FPE and those with FPIAP (mean slope = 0.068 ± 0.795 vs. 0.782 ± 0.873, respectively; p = 0.048). No significant differences in BMI improvement were observed between children on an elimination diet, breastfed children whose mothers followed an elimination diet, and those on a free diet. Conclusion: Dietary management in children with non-IgE-FAs was associated with improved growth trajectories, particularly in BMI-for-age z-scores. Children with FPE showed a less favorable BMI trajectory than those with FPIAP. Although the choice of dietary strategy did not significantly affect growth outcomes in this cohort, individualized nutritional assessment and judicious use of elimination diets remain essential. Larger prospective studies are needed to refine phenotype-specific nutritional strategies and optimize long-term outcomes. Full article

Food allergy (FA) is a chronic condition that can affect adolescents’ emotional well-being, daily functioning, and psychosocial adjustment. Digital interventions based on serious games may support the development of socioemotional competencies in this population, although evidence remains limited. This study explored the psychological outcomes derived from emoTIChealth, a serious game designed to promote psychological adjustment and emotional competencies in adolescents with FA. A quasi-experimental longitudinal design with repeated measures and no parallel control group was conducted in 23 adolescents aged 11–17 years diagnosed with FA. Participants completed assessments at two pre-intervention time points and one post-intervention assessment. Outcomes included health-related quality of life, emotional competencies, socioemotional skills, self-concept, healthy habits, psychopathological symptoms, and perceived disease threat. A significant decrease in emotional awareness-related dimensions was observed, particularly in attention to others’ emotions and global emotional awareness. A significant decrease in Global Difficulties and the presence of psychopathology post-intervention was also observed. The participants’ emotional state and perceived difficulties during the intervention were associated with changes in some psychological outcomes. These findings provide preliminary evidence that emoTIChealth may influence specific emotional processes in adolescents with FA, although its impact on broader psychosocial and health-related outcomes appears limited. Further controlled studies with larger samples are warranted. Full article

Introduction: It is estimated that about 20–35% of the Western population reports symptoms of food intolerances, which is a growing trend. Intolerance to histamine, a dose-dependent, non-allergic food hypersensitivity reaction, despite similar clinical manifestations, has mechanisms distinct from food allergies. Objectives: This narrative review aims to ascertain and synthesize the evidence on the role of nutrition, microbiota modulation, and food supplementation in histamine intolerance. Methods: The search was conducted between September and October 2025 in the PubMed and ScienceDirect databases, using terms related to “histamine intolerance” and considering the last 10 years. 43 scientific articles and 5 additional regulatory and guidance documents were included. Results: The clinical manifestations of histamine intolerance are heterogeneous and complex, and different responses may occur in the same individual with equal doses of histamine. In the literature, intestinal dysbiosis promotes a local and systemic increase in histamine, triggering symptoms in predisposed individuals. The low-histamine diet induced a significant reduction in cutaneous and gastrointestinal symptoms. The literature also shows that diamine oxidase enzyme supplementation is promising in the treatment of migraines and chronic urticaria, contributing to a reduction in the dose and frequency of drugs. In addition, vitamins C and B6, S-adenosylmethionine, and magnesium have been studied in therapy. Conclusions: Histamine intolerance represents a challenge in clinical practice due to its complexity, symptomatologic diversity, and the lack of consensus regarding diagnosis and treatment. Full article

Background: Food allergy is a heterogeneous pediatric disease involving IgE-mediated, non-IgE-mediated, and mixed immune mechanisms, with manifestations ranging from mild symptoms to life-threatening anaphylaxis. Current diagnostic tools, including clinical history, skin prick testing, serum-specific IgE measurement, and oral food challenge, have limitations in specificity, invasiveness, prognostic value, and ability to guide personalized management. Methods: This narrative review summarizes emerging biomarkers in pediatric food allergy and evaluates their diagnostic, prognostic, predictive, and therapeutic potential. A literature search was conducted in PubMed/MEDLINE and Cochrane Central for English-language studies published between December 2015 and March 2026. Eligible studies included original clinical or translational research involving children aged 0–18 years and assessing functional cellular assays, epithelial barrier markers, intestinal permeability, gut microbiota, metabolomics, transcriptomics, proteomics, epigenetics, and immune biomarkers. Findings were synthesized qualitatively according to biomarker category and biological function. Results: Functional cellular biomarkers, particularly the basophil activation test, show the greatest translational readiness, with high diagnostic specificity, utility in reaction threshold and severity assessment, and potential value for monitoring oral immunotherapy. Biomarkers of epithelial barrier dysfunction, including zonulin, tight junction proteins, epithelial injury markers, filaggrin variants, and epithelial-derived cytokines, provide mechanistic insight into allergic sensitization and gastrointestinal phenotypes but remain insufficiently validated. Microbiota-derived, metabolomic, transcriptomic, proteomic, epigenetic, and integrated multi-omics approaches offer promising tools for risk prediction, tolerance monitoring, endotype identification, and precision medicine. Conclusions: Emerging biomarkers may improve diagnosis, risk stratification, therapeutic monitoring, and personalized care in pediatric food allergy. However, standardized assays, large longitudinal pediatric studies, and external validation are required before routine clinical implementation. Full article

Plant-based “milks” have gained increasing attention as functional beverages due to their nutritional properties, consumer acceptance, and potential for probiotic fermentation. Lactose intolerance, milk allergies, and growing interest in sustainable plant-based diets have contributed to the rapid expansion of nut-based beverage (NBBs) markets. This review summarizes recent advances in processing and nutritional characteristics of NBBs as dairy alternatives. Although rich in bioactive compounds, including antioxidants, minerals, unsaturated fatty acids, and vitamins, NBBs generally exhibit lower nutritional density than bovine milk, particularly in protein content and mineral bioaccessibility due to antinutritional compounds present in plant matrices. Fermentation with lactic acid bacteria (LAB) can confer probiotic properties, increase the bioaccessibility of bioactive compounds, and improve sensory properties by reducing off-flavors and promoting the formation of desirable aromas. Pistachio- and almond-based beverages generally exhibit more consistent fermentation performance, favoring probiotic growth and sensory improvement, whereas coconut- and walnut-based milks often require additional stabilization strategies due to limited emulsifying capacity or oxidative instability. Overall, fermented NBBs represent a promising category of functional foods with increasing technological and nutritional relevance. Future research should focus on optimizing starter cultures and processing conditions, improving scalability and industrial feasibility, and elucidating microbial/matrix interactions through integrated omics approaches. Full article

Background: Infants born small for gestational age (SGA) are at increased risk of altered postnatal growth and early metabolic vulnerability. Early feeding practices may modulate these outcomes, but evidence from Eastern Europe remains limited. Objective: To evaluate the influence of birth weight and early nutrition on anthropometric outcomes at 2–3 years of age in former SGA infants in Romania, and to examine associations with allergies, respiratory infections, and food intolerances. Methods: We conducted a retrospective comparative study including two cohorts of term SGA infants born in a Romanian tertiary hospital in 2010–2011 (n = 600) and 2020–2021 (n = 508). Perinatal data were extracted from medical records; anthropometrics and feeding practices at 2–3 years were obtained via parental telephone interviews. BMI z-scores were calculated using WHO standards. Logistic regression models were used to identify predictors of overweight/obesity and selected health outcomes. Results: Breastfeeding increased markedly over one decade (59.1% vs. 35.5%, p < 0.001), as did appropriate complementary feeding (74.2% vs. 66.3%, p = 0.005). Obesity prevalence decreased from 29.5% to 22.4% at 2 years and from 32.7% to 20.7% at 3 years (both p < 0.001), while overweight prevalence increased slightly. In the historical cohort, mixed feeding (vs. formula) predicted overweight/obesity at 2 years (aOR 2.55, 95% CI 1.52–4.43, p < 0.001); the association was directionally similar but not significant in the contemporary cohort (aOR 1.62, 95% CI 0.75–3.47, p = 0.215). Breastfeeding was protective in both cohorts. Appropriate complementary feeding was associated with lower allergy prevalence in the historical cohort (14.8% vs. 24.8%, p = 0.004). Food intolerances increased over time (16.3% to 27.6%, p < 0.001), while respiratory infections showed no significant differences. Conclusions: In this Romanian SGA population, early feeding practices improved substantially over one decade and were associated with more favorable weight outcomes, including a notable reduction in obesity. Mixed feeding emerged as a potential risk factor for early overweight, whereas breastfeeding remained protective. Despite these improvements, former SGA infants continue to exhibit elevated risk for early-onset overweight and obesity, underscoring the need for targeted nutritional counseling and longitudinal monitoring. Full article

Background: Food hypersensitivity is frequently associated with gastrointestinal and systemic manifestations. This study aimed to evaluate the clinical, nutritional, biochemical, lifestyle characteristics, and stress levels of Lebanese adults with food hypersensitivity (cases) (n = 378) compared with controls (n = 397) (absence of food hypersensitivity). Methods: A case–control study was conducted among 775 Lebanese adults, including participants with self-reported food allergies and/or food intolerance and controls. Sociodemographic, clinical, and lifestyle data were collected. Dietary intake was assessed using validated dietary assessment tools. Biochemical parameters (n = 775), stool analyses (n = 297), and fecal calprotectin were evaluated. Results: Overall, 378 participants (48.8%) were classified as having food hypersensitivity. Dermatological, nasal, respiratory, and gastrointestinal symptoms were significantly more frequent among cases than controls (p < 0.05). Autoimmune diseases were more prevalent among cases. Daily energy and nutrient intake differed significantly between groups, with cases generally reporting lower intakes than controls. Cases exhibited substantially lower serum vitamin D, vitamin B12, and hematocrit levels. In binary logistic regression models, significant correlations were observed alongside key antioxidant and immunomodulatory micronutrients: vitamin C (OR = 0.604; 95% CI: 0.390–0.937), dietary vitamin D (OR = 0.079; 95% CI: 0.011–0.565), vitamin E (OR = 0.085; 95% CI: 0.013–0.568), and iron (OR = 0.025; 95% CI: 0.002–0.291). Conclusions: Biochemical and nutritional differences were observed despite generally adequate dietary intake. Reduced intakes of essential micronutrients, including antioxidant vitamins (vitamins C and E), vitamin D, and the essential mineral iron, emerged as primary independent predictors of food hypersensitivity. These findings highlight the core role of localized intestinal inflammation, specific dietary avoidance behaviors, and systemic immune modulation. Full article

Background/Objectives: Cow’s milk allergy (CMA) is one of the most frequent food allergies in early childhood, yet its diagnosis remains a challenge. The Parent-Specific Cow’s Milk-Related Symptom Score (Pre-CoMiSS™) was developed in 2024 to assist parents in tracking possible cow’s milk-related symptoms in their infants. The aim of this qualitative study was to explore users’ experience with the Pre-CoMiSS™ tool, learn from their experience and identify areas for improvement. Methods: Participants were parents of infants aged up to 12 months who felt that their babies were experiencing possible feeding-related symptoms. Participants were selected from a local panel of potential parents in the UK and Sweden. Forty-five-minute interviews, led by experienced qualitative research moderators, were conducted using dedicated discussion guides and a frame-by-frame PDF version of the Pre-CoMiSS™ tool. Thematic analysis of the data was undertaken. Results: A total of 20 parents participated, 10 from the UK and 10 from Sweden. The Pre-CoMiSS™ tool was well received by parents from both countries. Parents found the tool’s results clear, useful, and easy to understand. However, some parents, especially from Sweden, expressed the need for additional guidance on next steps. Conclusions: Parents found the Pre-CoMiSS™ tool acceptable and easy to use, although some requested clearer guidance on next steps. These findings support further refinement and formal validation before clinical implementation. Full article

Peanut allergy is a major food allergy associated with severe IgE-mediated hypersensitivity reactions and strong T-cell responses to peanut-derived epitopes. In this study, complementary computational approaches were developed to identify digestion-stable peanut peptides binding to HLA-DRB5*01:01, an HLA class II molecule associated with peanut allergy. A dataset of experimentally validated binders and non-binders was used to construct one sequence logo model and three machine learning (ML) models based on Random Forest (RF), Support Vector Machine (SVM), and Gradient Boosting (GB) algorithms. Peptide sequences were encoded using Wold’s z-scale descriptors representing hydrophobic, steric, and electronic amino acid properties. All ML models showed excellent predictive performance, with ROC AUC values between 0.978 and 0.980, while the SVM model achieved the best overall accuracy (95.8%). Permutation-importance analysis identified the dominant peptide properties for HLA-DRB5 binding. The developed models were applied to major peanut allergens Ara h 1, Ara h 2, Ara h 3, and Ara h 6 following simulated gastrointestinal digestion. Multiple consensus HLA-DRB5-binding peptides were identified, including several experimentally reported allergenic epitopes. The identified peptides should be regarded as candidate HLA-DRB5*01:01-restricted CD4+ T-cell epitopes that warrant further experimental validation using peptide–HLA binding assays and T-cell functional studies. Full article

Pollen–food allergy syndrome is an IgE-mediated allergic condition resulting from cross-reactivity between pollen allergens and homologous proteins present in plant-derived foods. PFAS typically presents with rapid-onset itching, burning, swelling, and erythema of the oral cavity and pharynx, with symptoms usually limited to the oropharyngeal region, although systemic reactions, including respiratory or gastrointestinal symptoms and, rarely, anaphylaxis, may occur. PFAS is strongly associated with the atopic phenotype and frequently coexists with allergic rhinitis, atopic dermatitis, and asthma. Available studies show marked variability in prevalence, from a few percent in general pediatric populations to 50–80% among atopic children, especially those with allergic rhinitis, with regional differences likely reflecting pollen sensitization patterns and dietary habits. The aim of this review was to summarize current knowledge regarding the epidemiology, clinical characteristics, molecular determinants, and food-related aspects of PFAS in children across different regions of the world. PFAS is a common but still insufficiently studied condition in children. Standardized diagnostic criteria and large population-based studies incorporating molecular diagnostic approaches are needed to better define the true burden, risk factors, and clinical spectrum of PFAS in childhood. Full article

The basophil activation test (BAT) is a modern in vitro functional assay used for the diagnosis of immunoglobulin E-mediated allergic reactions. The method is based on flow cytometric assessment of activation marker expression on peripheral blood basophils after stimulation with specific allergens. BAT has gained increasing clinical relevance in allergology, particularly in patients with anaphylaxis risk, polysensitization, drug hypersensitivity, and inconclusive skin or serological test results. This narrative review summarizes current evidence on the diagnostic performance and clinical applications of BAT in food allergy, drug hypersensitivity, Hymenoptera venom allergy, latex sensitization, and allergen immunotherapy monitoring. The review discusses the immunological mechanisms of basophil activation, the role of CD63 and CD203c, methodological aspects of the assay, sensitivity and specificity data, and advantages and limitations compared with conventional diagnostic approaches. Particular attention is given to protocol standardization, interpretation criteria, and the problem of non-responder patients. Current evidence indicates that BAT demonstrates high specificity and provides functional assessment of clinically relevant allergic reactions. In addition, this review proposes practical clinical frameworks for integrating BAT into allergy diagnostic pathways and for managing inconclusive or non-responder BAT results. Further standardization, multiplex formats, and automated analytical approaches may expand its role in personalized allergy diagnostics. Full article

Background/Objectives: Although cow’s milk allergy is the most common food allergy in infants, its diagnosis remains challenging. Conventional allergy tests, including skin-prick testing and serum-specific IgE, can support the diagnosis in cases with a clear clinical history; however, neither positive nor negative results are sufficient for a definitive diagnosis without confirmation via an oral food challenge or reintroduction. The basophil activation test has emerged as a promising adjunctive tool in the diagnosis of cow’s milk allergy. Methods: We searched in the electronic databases PubMed/MEDLINE and Google Scholar for English articles published up to March 2026, using combinations of the following keywords: “cow’s milk allergy,” “basophil activation test, “BAT”, “food allergy,” “oral food challenge,” “IgE-mediated,” “children,” and “pediatric.” Results: While its widespread use is currently limited by the lack of standardized protocols, the need for fresh blood samples, and restricted availability outside specialized centers, the basophil activation test has the potential to improve diagnostic accuracy and support clinical decision-making in IgE-mediated cow’s milk allergy. Importantly, basophil activation test may also reduce the number of oral food challenges by providing a safe, functional assessment of allergen reactivity, thereby minimizing patient risk and the burden of invasive testing. Conclusions: Further studies and validation are needed before the basophil activation test can be implemented as a routine diagnostic tool. Full article

Allergic diseases are increasing globally, particularly among children, who are highly vulnerable due to critical windows of immune development. This review examines climate change as a key environmental determinant driving the rising burden of pediatric allergic diseases, including asthma, allergic rhinitis (AR), atopic dermatitis (AD), and food allergy (FA). Climate change influences disease risk through interconnected pathways, such as increased air pollution, altered aeroallergen patterns, and more frequent extreme weather events. Elevated carbon dioxide (CO₂) levels and rising temperatures prolong pollen seasons and enhance allergenicity, while pollutants such as ozone (O₃) and particulate matter (PM) exacerbate airway inflammation and immune dysregulation. Emerging evidence emphasizes the role of early-life exposure, particularly during prenatal and early postnatal periods, when environmental insults can induce long-term effects via epigenetic modifications and immune reprogramming. These mechanisms may increase susceptibility to allergic sensitization and subsequent disease development. Epidemiological studies consistently link exposure to air pollution, including PM_2.5 (PM with aerodynamic diameter < 2.5 μm) and nitrogen dioxide (NO₂), with increased risk of allergic diseases in children. Additionally, climate change-related events such as wildfires, sand and dust storms, and thunderstorms further elevate exposure to allergens and pollutants, contributing to acute exacerbations and disease progression. Climate change may also contribute to allergic diseases through microbiome dysbiosis, as altered environmental microbial exposures, biodiversity loss, air pollution, and antibiotic-associated microbial disruption may impair immune tolerance and promote allergic sensitization in children. Addressing this growing public health challenge requires integrated mitigation strategies to reduce greenhouse gas (GHG) emissions and improve air quality, alongside adaptive interventions to enhance resilience and reduce exposure. Understanding these mechanisms is essential for developing targeted prevention strategies and protecting child health in a changing climate. Full article

Background: To investigate the diagnostic value of the SPT-to-histamine ratio, casein-specific immunoglobulin E (IgE), and cow’s milk-specific IgE in predicting oral food challenge (OFC) positivity in children with suspected cow’s milk allergy. Methods: In this single-center retrospective observational study, 126 children evaluated for suspected cow’s milk allergy who underwent OFC between January 2019 and July 2024 at a tertiary pediatric allergy and immunology center were included. Demographic and clinical characteristics, SPT parameters, and laboratory biomarkers were analyzed. Discriminatory performance was assessed using receiver operating characteristic (ROC) analysis, and independent predictors were identified using multivariable logistic regression. Results: OFC was positive in 66 patients (52.4%). Casein-specific IgE demonstrated strong discriminatory performance (AUC = 0.878), with 80.3% sensitivity and 85.0% specificity at a cutoff value of ≥2.55 kUA/L. The SPT-to-histamine ratio showed moderate discriminatory performance (AUC = 0.758). In multivariable analysis, only casein-specific IgE remained an independent predictor of OFC positivity (adjusted OR = 1.317, p < 0.001). Conclusions: Casein-specific IgE is a strong independent predictor of OFC positivity. Although SPT-derived ratios may provide complementary diagnostic information, their independent predictive contribution appears limited. These findings support the role of component-resolved diagnostics in pre-challenge risk stratification. Full article