Search Results (1,226)

Background: Food allergy is a growing public health concern, and oral immunotherapy (OIT) has emerged as a promising approach to induce desensitization and potentially sustained unresponsiveness to allergenic foods. Changes in humoral immunity, particularly in allergen-specific immunoglobulin levels, play a central role in the immunological mechanisms underlying OIT. This review aims to summarize the current evidence on how OIT modulates allergen-specific immunoglobulin E (IgE), G (IgG) and A (IgA) responses in individuals with food allergy. Methods: We conducted a review of original research articles reporting longitudinal data on allergen-specific IgE, IgG, and/or IgA in patients undergoing OIT for common food allergens. Results: OIT was consistently associated with a transient increase in allergen-specific IgE levels during early phases, followed by a gradual decline. In contrast, Allergen-specific IgG4 levels showed a robust and sustained increase, correlating with desensitization and proposed to function as blocking antibodies. Several studies also reported an increase in allergen-specific IgA, particularly secretory IgA at mucosal sites, suggesting a potential role in enhancing mucosal tolerance and immune exclusion of allergens. Conclusions: Humoral immune responses during OIT are characterized by distinct and dynamic changes in immunoglobulin patterns. In particular, the rise in IgG4 and, in some cases, IgA suggests a role in promoting tolerance. Monitoring these biomarkers may offer insights into treatment efficacy and support individualized approaches to OIT. Full article

Background: Diagnosing peanut allergy (PA) in children without known exposure remains challenging due to the need to distinguish true clinical allergy from asymptomatic sensitization. This study aimed to evaluate the diagnostic performance of individual and combined in vitro markers, particularly sIgE to Ara h 2, and to develop a multistage decision pathway that may reduce reliance on oral food challenge (OFC). Methods: Eighty children with suspected peanut allergy were prospectively enrolled. All participants, including healthy controls, underwent skin prick testing (SPT), measurement of sIgE to peanut and Ara h 2, and basophil activation testing (BAT). A multistage diagnostic algorithm incorporating these markers was constructed, and its performance was assessed using ROC analysis, predictive values, and likelihood ratios. A secondary analysis evaluated a simplified decision pathway excluding BAT. Results: sIgE to Ara h 2 demonstrated excellent individual performance (AUC 0.889), with 96.6% PPV at the optimal cut-off. The full multistage decision pathway (SPT + sIgE + BAT when interpretable) achieved 100% specificity and avoided OFC in 28.6% of children. However, BAT feasibility was limited; over 25% of results were uninterpretable. The simplified decision pathway (SPT + sIgE to Ara h 2) preserved 100% specificity and enabled the avoidance of OFC in 27.5% of cases, with slightly lower sensitivity. Conclusions: A structured in vitro diagnostic approach using sIgE to Ara h 2 and SPT can reliably identify peanut allergy in selected pediatric patients, particularly those without a reliable peanut exposure history. BAT enhances specificity but should be considered a confirmatory tool due to feasibility limitations. Full article

Background: Eosinophilic esophagitis (EoE) is a chronic, food antigen-driven disease of the esophagus that causes considerable morbidity. Elimination of allergenic foods from a patient’s diet is a highly effective treatment. However, existing allergen testing modalities are not effective at identifying EoE-causal foods. We sought to determine the extent to which positive results for two functional T-cell assays, the EoE Milk Test and EoE Soy Test, associated with the clinical outcomes of EoE milk allergy and EoE soy allergy, respectively. Methods: Subjects were enrolled into one of two study designs: a prospective observational study or a retrospective case/control study. Additional control samples were obtained from an institutional core. The EoE Milk and Soy Tests were performed on peripheral blood samples, and the association between positive tests and clinical outcomes was determined using Receiver Operating Characteristic curves and other performance measures. Results: The EoE Milk Test maintained reliability regardless of disease activity or recent milk consumption and had 87% sensitivity and 83% specificity for EoE milk allergy in all study subjects (control and EoE). The EoE Soy Test had 90% sensitivity and 93% specificity in all subjects. Conclusions: Our evaluation of the EoE Milk and Soy Tests demonstrates that these functional T-cell assays hold promise as a predictive tool for identifying causal allergens in eosinophilic esophagitis patients. Full article

Lefamulin, a new, first-in-class pleuromutilin antibiotic, was recently approved by the Food and Drug Administration (FDA) and European Medicines Agency (EMA) for the treatment of patients with community-acquired bacterial pneumonia (CABP). In this context, this review aimed to evaluate its activity against the most common pathogens causing this infection. A thorough search was performed in five databases (Embase, Scopus, Web of Science, PubMed, PubMed Central) from their inception to 14th of October 2025. Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) resistance breakpoints were applied. Out of a total of 224 articles identified, 11 were deemed eligible for inclusion. Resistance among Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus isolates was 0–2.6%, 0–2.4%, and 0–4.3%, respectively. Even among isolates with specific mechanisms of resistance, such as β-lactamase-producing H. influenzae and methicillin-resistant S. aureus, resistance was below 2.4% and 3.4%, respectively. Among isolates for which no breakpoints were available (Moraxella catarrhalis, atypical pathogens, Enterococcus spp., Streptococcus spp., Haemophilus spp., and Staphylococcus spp.), MIC₉₀ values were low. An exception were isolates belonging to Enterococcus spp., which displayed MIC₉₀ values ranging from 0.25 to >16 mg/L in the two studies with relevant data. Lefamulin demonstrated broad in vitro activity against key pathogens causing CABP, making it a considerable addition to the therapeutic options for such infections, especially in cases where first-line agents cannot be used for reasons such as allergy or previous failure. Full article

Food allergies represent a growing public health concern, requiring analytical methods capable of detecting trace levels of allergenic ingredients in increasingly complex and processed food matrices. In recent years, nucleic acid-based electrochemical sensors have emerged as a powerful alternative to protein-targeting assays, offering improved stability and sequence specificity, as well as compatibility with portable, low-cost sensing platforms. This review provides a comprehensive overview of nucleic acid-based sensing strategies developed for detecting either allergen proteins or nucleic acids related to allergenic species. Particular attention is given to the methodological approaches implemented, which for DNA detection include sandwich-type designs and DNA switches, while for protein detection rely on aptamer-based assays in a labelled or label-free setup. The review also discusses the impact of pre-analytical steps, such as nucleic acid extraction and PCR-based amplification, on assay reproducibility, cost and applicability at the point of need. Although significant improvements in analytical performance have been achieved, challenges remain in terms of simplifying workflows, standardizing methods, validating them on a large scale, and developing continuous monitoring schemes for timely intervention. The review highlights emerging opportunities, including multiplexed detection platforms, robust extraction protocols, and the harmonization of allergen thresholds, which are key to supporting the practical implementation of nucleic acid-based sensors. Full article

Background/Objectives: Food protein-induced allergic proctocolitis (FPIAP) is a non-IgE-mediated gastrointestinal food allergy. Although tolerance to the culprit food is usually achieved within the first year of life, late acquisition occurs and remains poorly predictable. This study aimed to analyze clinical characteristics and explore factors that may potentially function as predictors of late tolerance acquisition to cow’s milk (CM). Methods: We conducted a cross-sectional study at two Italian pediatric clinics (2020–2024), including infants diagnosed with FPIAP. Clinical, dietary, and immunological variables; onset and duration of rectal bleeding (visible blood in the stools); and time to CM tolerance were analyzed. Late tolerance was defined as acquisition after 19 months according to the distribution of tolerance achievement in our population. Statistical analyses included χ², Mann–Whitney U, Spearman’s correlation, and logistic regression. Results: Ninety-four infants were included (median age at onset 2.9 months [IQR 1.9–4.7]); 58 (62%) were exclusively breastfed and 18 (19%) were born preterm (<37 completed weeks of gestation). CM was the culprit food in all cases; tolerance was achieved in all infants at a median age of 12 months. Family history of atopy and atopic dermatitis were reported in 44% and 19% of infants, respectively. Late CM tolerance was associated with preterm birth, fortification of human milk, early antibiotic exposure, growth faltering, and recurrent infections. Logistic regression identified family history of atopy (OR 5.4 [95% CI 1.2–25.4]; p = 0.031), atopic dermatitis (OR 8.2 [1.7–40.7]; p = 0.010), rectal bleeding >18 days before elimination diet (OR 5.9 [1.3–27.7]; p = 0.023), and IgE sensitization (OR 6.4 [1.2–35.0]; p = 0.034) as factors that may potentially function as predictors of late tolerance acquisition to CM. Conclusions: Identification of factors that may potentially function as predictors of late tolerance acquisition to CM in infants with FPIAP may help providing a personalized clinical management for these patients. Full article

Background/Objectives: Recent reports on the co-occurrence of allergies and endometriosis have provided grounds for expanding research in this area, suggesting that diagnostics should be extended to women with endometriosis. However, numerous studies on nutrients and antioxidants do not specify the type of diet that supports the treatment process. In our review, we focus on the types of food elimination and dietary approaches that have been used. Methods: This systematic review was conducted according to the PRISMA guidelines. We searched the EMBASE, PUBMED and SCOPUS databases, as well as the bibliographies of research papers and reviews, including the latest reports from June 2025. The search keywords were “endometriosis” and “type of diet”, “nutrition”, “food products”, “nutrients”, “elimination diet”, and “allergies”. Results: Excluding coexisting allergies and introducing an anti-inflammatory diet low in animal products, limiting butter and margarine, and eliminating fried foods and refined simple sugars may be the best solution to help treat endometriosis. Conclusions: Personalised nutritional counselling for patients with endometriosis is particularly helpful and necessary, as there is no single elimination diet that can be recommended for all patients with endometriosis. The first step should be an anti-inflammatory diet, such as the Mediterranean diet or the MIND diet (Mediterranean-DASH diet intervention for neurological delay), followed by more in-depth allergy screening. The phenotypic diversity of this group of patients may require the use of a low-FODMAP (fermentable oligo-, di-, monosaccharides and polyols), low-nickel, gluten-free or other elimination diet. Full article

The prevalence of food allergy continues to rise worldwide. The allergen profile of affected individuals changes with age: milk, egg, wheat, and soy allergies are more common in early childhood and often resolve before adolescence, whereas peanut, tree nut, fish, and shellfish allergies tend to persist and become more apparent in teenagers. The aim of this narrative review is to discuss the impact of food allergy and elimination diets on the nutritional status, psychological functioning, and quality of life of adolescents. Although an elimination diet remains the main way of treatment, it may lead to the risk of vitamin D, calcium, iron, and protein deficiencies, and potentially to growth disorders. In adolescents, irregular eating habits and poor adherence to dietary recommendations pose additional challenges. The psychological burden of living with food allergy include fear of accidental contact with the allergen, difficulties in peer relationships, and reduced quality of life, particularly in terms of social and emotional functioning. Lack of training in using an adrenaline autoinjector and embarrassment about its use are further risk factors in this age group. Optimal care for adolescents with food allergies requires a multidisciplinary approach, including an allergist, dietitian, and psychologist. Education, psychological support, and gradual development of self-management skills are crucial to improving the safety and quality of life of adolescents with food allergies. Further efforts by medical societies are warranted to advance the development of alternative therapeutic approaches for food allergy, including immunotherapy and biologic therapies, as well as to strengthen public health strategies for individuals affected by food allergies. Full article

Food allergies in school-aged children are a growing public health concern, requiring coordinated strategies to ensure safety in educational settings. This study aimed to evaluate the safety conditions for children and young people with food allergies in public schools of the municipality of Matosinhos, Portugal. A descriptive, cross-sectional, quantitative study was conducted during the 2022/2023 academic year, targeting coordinating teachers from all public schools. Data were collected using a structured questionnaire based on national guidelines for managing food allergies in schools. Results revealed significant gaps in preparedness: 35.99% of respondents reported the absence of a formal document on food allergies, 66.01% indicated no school training plan on the topic, and bar and canteen staff were often excluded from training (50.00% and 42.00%, respectively). Furthermore, 83.02% stated that preventive measures were not consistently adopted, and 49.99% felt insufficiently trained to act in emergencies. Based on these findings, an intervention project with tailored training sessions for coordinating teachers was proposed to improve safety and inclusion for students with food allergies. The study highlights the urgent need for standardized protocols, inclusive training, and preventive measures in schools to mitigate risks and foster a safe learning environment for children with food allergies. Full article

The reduction in the immunoreactive properties of soy proteins is crucial, considering the widespread use of soy in food, including protein isolates. This study aimed to evaluate the effects of various culinary treatments on the immunoreactivity of whole soybeans and isolated 7S and 11S protein fractions. Soybean and the isolated 7S and 11S fractions were subjected to boiling (100 °C for 60 and 120 min), pressure cooking (120 °C, 202 kPa for 50 min), and microwave heating (360 W for 30 min). The immunoreactivity of the samples was assessed using ELISA and Western blotting. Culinary treatment of whole soybeans, regardless of the method, decreased the content of immunoreactive 7S and 11S fractions by approximately 30%. Culinary processing of the isolated 7S and 11S proteins, in the absence of the protective seed matrix, resulted in a more pronounced reduction in immunoreactivity. Pressure-cooking allowed for the reduction of the content of immunoreactive 7S and 11S proteins by 71 and 58%, respectively. Western blotting confirms a decrease in both 7S and 11S immunoreactive bands, with a more marked reduction observed for the 11S fraction. These findings indicate that such a reduction may be sufficient to lower the risk of allergic reactions in individuals with mild soy allergy. However, the persistence of immunoreactive bands even after intensive treatment suggests that culinary methods alone are unlikely to ensure safety for highly sensitized individuals. Full article

Associations between prenatal exposure to phthalates, bisphenols and their mixtures and early childhood allergic conditions and asthma were examined. Five hundred and fifty-six mother–child pairs from the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort participated. Urine samples collected from mothers during the second trimester of pregnancy were analyzed for phthalates and bisphenols. A child health questionnaire, completed by mothers when children were 12, 24, and 36 months, asked whether children had experienced allergic conditions (i.e., food allergies, eczema, rash) or asthma. In single-chemical models, associations varied with child age. Higher prenatal concentrations of mono-benzyl phthalate (MBzP) were associated with lower odds of eczema at 12 months. At 36 months, higher mono-methyl phthalate (MMP) was associated with increased odds of eczema, whereas higher mono-carboxy-octyl phthalate (MCOP) was associated with reduced odds. Higher prenatal MCOP was also associated with higher odds of rash at 12 months, and higher MMP was associated with higher odds of rash at 36 months. Higher bisphenol S (BPS) was associated with increased odds of asthma at 12 months but decreased odds of eczema and rash at 36 months. Sex-specific effects were also noted. In multi-chemical exposure least absolute shrinkage and selection operator (LASSO) models, several phthalate metabolites and BPS were selected as the best predictors of eczema and rash at 36 months of age. Bayesian kernel machine regression (BKMR) mixture models suggested that BPS was the most important chemical in predicting eczema in children at 36 months, while MMP and BPS were the most important chemicals in predicting rash at 36 months. Prenatal exposure to certain phthalate metabolites and BPS predicted allergic conditions and asthma in young children, with patterns varying by age and sex. Prenatal exposure to these chemicals may differentially influence immune development and contribute to the development of early-life allergic conditions, with potentially sex-specific susceptibility. Full article

Early-life respiratory syncytial virus (EL-RSV) infection has been implicated in long-term pulmonary disease in children. In these studies, neonatal BALB/c mice were infected at day 7 of life, leading to >35% losses in critical lung function, airway mucus metaplasia, and transcriptional hallmarks of mucus hypersecretion four weeks after RSV infection. While EL-RSV minimally reshaped the resident lung microbiota, it led to significant gut dysbiosis, including a long-term reduction of Proteobacteria that can be a source of protective metabolites related to barrier and immune function. Subsequent studies assessing whether a common infant antibiotic (ampicillin) could mitigate EL-RSV-induced lung alterations revealed further severe gut microbiome alterations and, on its own, later in life, recapitulated the full spectrum of RSV-associated alterations in lung function. Metagenomic inference showed that both RSV and ampicillin administered during early life reduced biosynthetic pathways for microbiome-derived metabolites, which are known to reinforce tight junctions, regulate inflammation, and preserve extracellular matrix elasticity. The shared loss of these metabolic programs provides a mechanistic bridge linking distinct early-life exposures to the microbiome changes and airway mechanical deficits later in life. Collectively, the data suggest that RSV and/or antibiotic-triggered gut dysbiosis is the primary insult that likely promotes improper lung maturation/repair through a metabolite-mediated mechanism and may suggest metabolite restoration as a strategy to promote proper developmental lung function. Full article

Allergen sensitization profiles are increasingly affected by environmental and climate changes. This study exemplifies fundamental differences in molecular IgE sensitization profiles in two nearby regions in Argentina with different climatic conditions (La Plata and Bahía Blanca). A cross-sectional study was conducted involving 155 patients with allergic symptoms from La Plata and Bahía Blanca (34.0 ± 11.2 years, female/male: 83/72). Serum samples were analyzed for IgE reactivity using a chip containing 101 micro-arrayed allergen molecules. Statistical analyses were performed to compare allergen-specific IgE levels, sensitization prevalences and reported symptoms. Patients from La Plata—with subtropical weather—showed a higher prevalence of IgE reactivity to house dust mite (HDM) allergens (Der p 23: 74%; Der p 1: 53% and Der p 2: 56%) and more frequently reported asthma (AS) symptoms (40% vs. 24%) than patients from Bahía Blanca. In contrast, patients from Bahía Blanca, with dry and windy weather, exhibited higher sensitization rates to pollen allergens, particularly Phl p 1 (49%) and Ole e 1 (22%) as well as to Alternaria alternata (Alt a 1, 35%) and reported a significantly higher prevalence of skin manifestations (54% vs. 31%) than those from La Plata. Cat allergen Fel d 1 was an equally important sensitizer in both regions (La Plata 30% and Bahía Blanca 37%). Sensitization to class 1 food allergens was rare in both groups (1–8%), including non-specific lipid transfer proteins (peanut Ara h 9 and peach Pru p 3) but IgE sensitizations to genuine peanut allergens were almost absent. Important regional differences in allergen sensitization profiles were observed between two geographically close regions with different climatic conditions. Our findings underscore the relevance of region-specific allergen profiling and highlight the clinical utility of molecular allergy diagnosis for a more precise allergen identification and improved management of allergic diseases. Full article

Honeybee products (HBPs), including honey, bee pollen, bee bread, royal jelly, propolis, beeswax, and bee brood, are increasingly used in food, nutraceutical, and cosmetic contexts. Because of their natural origin, HBPs can provoke allergic reactions ranging from localised dermatitis to life-threatening, systemic anaphylaxis. As the use of bee products for health purposes grows in apitherapy (a branch of alternative medicine), raising public awareness of their potential risks is essential. This narrative review synthesises the clinical manifestations of HBP allergy, culprit allergens present in each product, immunological mechanisms, diagnostic approaches, at-risk populations, and knowledge gaps. The analysis of the available literature suggests that, although relatively rarely, HPB may trigger allergic reactions, including anaphylactic shock. The sensitisation mechanism may be associated with both primary sensitisation and cross-reactivity and can be classified into type I (IgE-mediated) and type IV (T-cell-mediated). However, bee bread appears less allergenic than other HBPs, potentially due to lactic fermentation that can degrade allergenic proteins. Severe reactions following intake of bee bread have not been reported to date. Management of HBP allergic reactions centres on avoiding the products, educating about the risks, and providing more precise product labelling, specifying the allergen content. Individuals with atopy and beekeepers are at heightened risk of developing anaphylaxis; therefore, they should be particularly aware of the potential dangerous consequences of HPB use. Further research is needed to clarify the mechanisms of HBP allergies and improve safety for all users. Full article

Shellfish allergy is among the most common food allergies (FAs) worldwide and represents a severe immunoglobulin E (IgE)-mediated FA with tropomyosin functioning as the predominant pan-allergen. Current management of shellfish allergies is strictly palliative with allergen avoidance, underscoring the critical need for disease-modifying therapies. While conventional allergen-specific immunotherapy (AIT) approaches, namely oral and sublingual immunotherapies, demonstrate capacity for desensitization, more clinical applications are needed in the potential safety concerns and prolonged treatment durations. Innovative treatments, such as the design of modified shellfish allergens, DNA vaccine technologies, and nanoparticle-based delivery platforms such as virus-like particles (VLP), show efficacy and potential in inducing protective antibodies while promoting antigen-specific immune tolerance with reduced allergenic risks. These innovative approaches hint at a promising pathway in achieving safe, effective, and long-lasting clinical tolerance for shellfish allergy. This review describes the current perspectives on allergen immunotherapy regarding shellfish allergy and analyzes emerging therapeutic strategies poised to overcome these limitations. Full article