Search Results (147)

Background/Objectives: Food allergy prevention is no longer understood as the simple avoidance of allergenic foods. The first 1000 days (from conception to, approximately, 24 months of age) include prenatal, perinatal and postnatal windows in which diet, epithelial barrier integrity, microbial ecology, immune maturation and family-level implementation interact. This narrative review was developed as a Commission-proposed SIAIP-oriented clinical framework, rather than a formal guideline or consensus statement. Evidence from guidelines, systematic reviews, randomised trials, birth cohorts and mechanistic studies was organised by developmental window and interpreted according to endpoint validity, confounding, feasibility and clinical readiness. Prenatal factors include maternal allergen non-avoidance, whole-diet quality, micronutrient and fatty acid status, antibiotic exposure, environmental context and maternal microbiome. Perinatal factors include mode of delivery, intrapartum and neonatal antibiotics, gestational maturity, early colonisation, breastfeeding initiation and routine vaccination. Postnatal factors include eczema, skin barrier inflammation, the timing and regularity of allergen introduction, breastfeeding management, infant diet diversity, siblings, daycare, pets, smoke and pollution, physical activity and equitable implementation. The strongest actionable evidence remains eczema-linked risk recognition and timely, sustained oral exposure to peanut and well-cooked egg. Maternal and environmental factors are clinically important, but many are contextual rather than prescriptive; they should guide non-restrictive, non-blaming counselling rather than deterministic risk labelling. Full article

With the increasing consumption of plant-based foods, allergies to these foods are becoming more widespread and seriously affect human health. This review focuses on the properties of major plant-based food allergens, including those from soybeans, peanuts, wheat, sesame, and tree nuts. The composition, stability, structure, and IgE-binding epitopes of allergens from these major plant allergenic foods are summarized. For peanuts, the major allergens include Ara h 1, Ara h 2, Ara h 3, and Ara h 6, with Ara h 2 and Ara h 6 being notably heat- and protease-resistant. Gly m 4, Gly m 5, and Gly m 6 are the predominant allergens in soybeans. The primary sesame allergens are Ses i 1, Ses i 2, Ses i 3, Ses i 6, and Ses i 7, with Ses i 1 serving as a stable and highly specific diagnostic marker. Wheat allergens are categorized by exposure route, with ingestion of allergens such as gliadins and glutenins being particularly relevant for food-induced reactions. Major storage proteins and lipid transfer proteins are central to the allergenicity of nut varieties (such as almonds, hazelnuts, and walnuts). Understanding these molecular characteristics is crucial for developing hypoallergenic food products using targeted processing methods. Further studies are needed to comprehensively investigate these allergenic characteristics. Full article

Understanding how sensory preferences shape the acceptance of nutrient-dense foods is essential for improving prenatal nutrition. This exploratory study examined taste, smell, texture, appearance, and enjoyment factors influencing food acceptability among (n = 21) African American pregnant women, examining how determinants must be met for consumption. We administered surveys to identify preferred foods and analyzed the nutrient quantity of vitamin A, B vitamins, vitamin D, iodine, iron, calcium, magnesium, selenium, and omega-3 fatty acids in each food, given their influence on prenatal health. Nutrient-dense, anti-inflammatory foods were identified by ranking preferred foods by nutrients and selecting those that consistently ranked as top contributors. Focus groups further explored conditions that promote or hinder intake, and content analysis was conducted using NVivo. Preferred nutrient-dense, anti-inflammatory foods included cashews, peanuts, almonds, pistachios, black-eyed peas, pinto beans, salmon, carrots, red bell peppers, and spinach. Participants cited low acceptance due to allergies, undesirable textures (“dry” or “slimy”), unpleasant taste or appearance, a lack of cravings, preference for alternatives, unenjoyable preparation methods, and foods perceived as “display-only.” High acceptance was linked to appealing taste and texture, flexible preparation options, and perceived health benefits. These considerations suggest that taste, texture, appearance, and enjoyment are important considerations for prenatal food intake. 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

Food allergy is an increasingly prevalent global health condition characterized by immune-mediated reactions to dietary antigens and a substantial clinical burden. Growing understanding of IgE-mediated mechanisms has highlighted the central role of type 2 inflammation, effector-cell activation, and impaired immune regulation. These advances have prompted the development of disease-modifying therapies beyond allergen avoidance. This narrative review summarizes recent advances in the therapeutic management of IgE-mediated food allergy. A structured PubMed search was performed to identify clinical trials, randomized studies, and meta-analyses published within the last five years. Both allergen-specific and non-allergen-specific interventions were evaluated. Current evidence supports oral immunotherapy as the most effective strategy for increasing reaction thresholds and inducing desensitization in peanut, milk, and egg allergies. However, safety concerns remain, and sustained unresponsiveness after treatment discontinuation is achieved inconsistently. Sublingual and epicutaneous immunotherapy show improved safety but lower efficacy. Modified allergen approaches, including baked milk and processed peanut products, may improve tolerability and facilitate immune modulation in selected patients. Biologic therapies, particularly anti-IgE agents, demonstrate efficacy both alone and when combined with immunotherapy. Emerging approaches include peptide vaccines, DNA immunization, microbiome-targeted interventions, and early dietary modulation. These strategies may improve durable immune tolerance through personalized, mechanism-based therapeutic approaches. Future progress will depend on optimizing safety, identifying predictive biomarkers, and integrating multimodal approaches to achieve durable immune tolerance. Full article

Background/Objectives: Legume allergy is increasingly recognized as plant-based diets expand and legume proteins are widely used in processed foods. We aimed to characterize the clinical features, sensitization profiles, and management outcomes of IgE-mediated legume allergy in Italian children. Methods: This retrospective single-center study (January 2022–January 2024) included children (<18 years) allergic to ≥1 index legume (pea, lentil, chickpea, common bean, or soy). Diagnosis required a compatible clinical history and evidence of IgE sensitization. Clinical and allergy characteristics were analyzed. Results: Fifty-five children (63.6% male) were included; all had atopic comorbidities, and 96.4% had additional food allergies. Median age at first reaction was 18 months; anaphylaxis occurred at onset in 12.7%, most frequently triggered by pea. Pea (70.9%) and lentil (69.1%) were the most prevalent allergies, with pea causing 50% of index-legume anaphylaxis. Multi-legume allergy predominated (74.5%), with frequent co-allergy among pea, lentil, and chickpea (56–86%). Soy allergy was less frequent and mainly associated with Gly m 4 sensitization. Single-legume allergy (25.5%) was associated with later onset (54 vs. 15 months; p = 0.013) and liver transplantation (21% vs. 2%; p = 0.047). Peanut co-allergy occurred in 25.5%. Among 34 oral food challenges (OFCs), 23.5% were positive, including one case of pea-induced anaphylaxis. Of 16 oral immunotherapy (OIT) protocols initiated, 31.3% reached the full target maintenance dose, 37.5% remained on a lower, partial maintenance dose, and 31.3% were discontinued due to oral allergy syndrome (OAS). Conclusions: Pediatric legume allergy is characterized by early onset, frequent multi-legume involvement, and common co-allergies. In this cohort, pea allergy was associated with the highest proportion of severe reactions. Species-specific differences in severity, patterns of multi-legume involvement, and OIT outcomes should be interpreted cautiously given the limited sample size, while highlighting the need for tailored management and improved risk assessment across legume species. Full article

Although mango is not classified among the nine major allergenic foods reported by the Food and Drug Administration (FDA), the increasing global and domestic consumption of mango has been accompanied by a growing number of reported cases of mango allergy. Currently, reports on cross-reactive allergens and cross-reactive linear epitopes in mango are limited. This study employed BLASTp (version 2.11.0+) to predict potential allergens that may cross-react with mango protein allergens and other food protein allergens. Subsequently, cross-reactive allergens were identified using sera from mango-allergic patients. Furthermore, similar sequences of the identified cross-reactive allergens were predicted by BLAST. These similar sequences were then synthesized by the solid-phase peptide synthesis method. Finally, the cross-reactive linear epitopes were determined by assessing their IgE-binding capacity using serum IgE from the same patient cohort. The results demonstrated that the sera from mango-allergic patients exhibited IgE-binding cross-reactivity with those from peanut, wheat, cashew, pistachio, and hazelnut, particularly with IgE-binding cross-reactivity to wheat and hazelnut, which has not been previously reported. The following novel cross-reactive linear epitopes were identified: the AA80–88 sequence of mango chitinase with the AA37–45 sequence of wheat Tri a 27 and the AA15–22 sequence of mango profilin with the AA65–72 sequence of pistachio Pis v 1. Furthermore, multiple cross-reactive epitopes were mapped between mango profilin and peanut Ara h 5, corresponding to the sequences AA31–51/AA31–50, AA50–65/AA52–65, AA76–96/AA76–96, and AA103–117/AA104–117, respectively. Full article

Background/Objectives: The increasing use of pea protein in plant-based foods raises concerns about IgE-mediated reactions, particularly in individuals sensitized to peanut. Knowledge on clinically relevant pea allergens and the impact of heat processing remains limited. This study investigated how thermal treatment affects the IgE binding and functional allergenicity of pea proteins in children with a confirmed pea allergy, with or without a concomitant peanut allergy. Methods: Serum from 11 patients was analyzed using SDS-PAGE, Western blotting, and an indirect basophil activation test (iBAT). Results: All patients showed IgE binding to Pis s 1 and PA2a/b in raw pea extract, with variable sensitization to Pis s 2 and mitogenic lectin. Heating (120 °C, 5 min) markedly reduced IgE binding and eliminated detectable IgE to Legumin S and ML. Despite this reduction, basophil sensitivity did not decrease; in several patients, EC50 values significantly decreased, indicating increased basophil responsiveness to heated pea. Patients with IgE profiles dominated by Pis s 1 and PA2a/b were most likely to show enhanced basophil activation after heating. Conclusions: These findings demonstrate that heat-stable vicilin subunits and albumins can maintain functional allergenicity despite reduced IgE recognition, underscoring the need for diagnostic approaches that incorporate processed food allergens. Full article

Introduction: Peanut oral immunotherapy (P-OIT) is an emerging treatment strategy for peanut allergy (PA). Although a standardized pharmaceutical product, Peanut (Arachis hypogaea) Allergen Powder-dnfp, has been approved in several countries, it is not universally available. In such contexts, real-world protocols using readily utilizable peanut products may represent an alternative approach. This study aimed to describe the feasibility, safety, and clinical outcomes of P-OIT using toasted peanuts in a real-world effort in a pediatric population. Methods: This single-center retrospective cohort study enrolled children who initiated P-OIT at our tertiary pediatric hospital Allergy Unit between April 2015 and December 2024. Demographic and clinical features, allergy test results, and information about P-OIT were recorded. Desensitization was defined as tolerance of 630 mg of peanut protein (PP). Results: Sixty patients (51.7% male; median age 8.2 years) were included. 22/60 (36.7%) achieved desensitization within a median time of 22.7 months. 21/60 (35%) were still undergoing P-OIT at a median tolerated dose of 100 mg of PP, and 17/60 (28.3%) discontinued treatment, most commonly due to loss to follow-up (44%). At least one adverse reaction occurred in 43/60 (71.7%) patients, predominantly mild and self-limiting (68.3% resolved spontaneously, 39.5% occurred at home). However, 11/60 (18.3%) showed anaphylaxis, and 3/60 (5%) received adrenaline. A reduction in Ara h 2 serum-specific IgE levels compared to the baseline was observed in patients completing escalation (p = 0.03). Conclusions: In this real-world single-center cohort, P-OIT using toasted peanuts was feasible in a subset of patients and was associated predominantly with mild adverse reactions, although systemic reactions were also recorded. Treatment discontinuation and adherence remain relevant challenges. These findings highlight the need for prospective, controlled studies to better define the role, safety profile, and patient selection criteria for food-based P-OIT protocols in settings where standardized products are not available. Full article

Background: Food allergy (FA) is an increasing public health concern with significant implications for child health and quality of life. Early introduction of allergenic foods has been shown to reduce the risk of food allergy development; however, maternal awareness and adherence to these recommendations remain inconsistent. This study aimed to assess maternal awareness and practices regarding the timing of allergenic food introduction among mothers residing in Makkah, Saudi Arabia. Methods: A descriptive cross-sectional study was conducted between November 2023 and March 2024 involving parents of children aged younger than 48 monthsin the Makkah region. Data were collected via a self-administered electronic questionnaire distributed through social media platforms. Results: A total of 391 parents participated. Parent-reported food allergy was identified in 11.3% of children, while 14.6% had eczema. Early introduction (<12 months) was more common for egg (43.3%) and wheat (71.1%) compared to peanut (28.9%), tree nuts (30.9%), sesame (30.9%), and seafood (28.9%). A considerable proportion of children had not been introduced to key allergenic foods even after 36 months, particularly peanuts (45.3%) and sesame (42.2%). Children with eczema were significantly more likely to have early introduction of egg (p = 0.035), tree nuts (p = 0.046), and seafood (p = 0.031). Similarly, children with a family history of food allergy had higher early introduction rates of tree nuts (55.3% vs. 44.0%, p = 0.043) and seafood (62.3% vs. 49.1%, p = 0.019). Only 25.8% of mothers were aware that early introduction might prevent food allergies, and just 22% reported receiving professional advice to introduce allergenic foods early. Conclusions: Maternal awareness regarding the timely introduction of allergenic foods in Makkah remains limited, with delayed introduction persisting beyond 36 months for several high-risk allergens. These findings underscore the need for targeted educational interventions and improved counseling by healthcare providers. Full article

Food allergies arise when environmental factors, lifestyle choices, and genetic predispositions affect the integrity of the gut epithelial barrier. Under healthy conditions, gut microbiota supports intestinal tight junction integrity and promotes immune tolerance to dietary allergens. Disruption of this microbiota increases susceptibility to epithelial barrier leakage, thereby enabling food allergens to penetrate the bloodstream from the gut and leading to allergic sensitization. Restoring gut homeostasis through allergen-specific immunotherapy (AIT), executed via oral termed as oral immunotherapy (OIT), skin as subcutaneous immunotherapy (SCIT), or under the tongue in the form of sublingual immunotherapy (SLIT), remains a promising yet complex and multifaceted approach. In parallel, probiotics offer a simpler alternative to reinforce epithelial barrier function, restore cellular homeostasis, mitigate allergy symptoms, and represent the probiotics-based OIT. Recently, several bioengineering strategies have been developed toward enriching gut microbiota, such as using additives such as carbohydrates, polyphenols, and probiotics. While generic probiotics have shown efficacy, their undefined dosages and administration protocols pose challenges for clinical standardization in the form of OIT. Emerging developments include recombinant probiotics engineered to express the specific allergen in a controlled manner inside the gut. However, safety concerns regarding their clinical application remain under active discussion. This review highlights various bioengineering strategies to enhance the probiotic capacity, address safety considerations, and explore future prospects for managing food allergies. Full article

Background/Objectives: As an escalating global health challenge, food allergies impose substantial burdens on the physical and psychological well-being of pediatric populations, profoundly compromising their quality of life. Given the marked geographical heterogeneity in allergen distribution patterns, this epidemiological investigation systematically characterizes prevalent pediatric food allergens sensitization patterns in Southwest China, yielding critical region-specific data to inform targeted prevention strategies and clinical management protocols. Methods: A cohort of 36,399 pediatric participants (age <18 years) underwent hospital-based testing for allergen-specific immunoglobulin E (sIgE) reactivity against 10 regionally prevalent food allergens, utilizing a semi-quantitative, immunocapture-based, and enzyme-linked immunosorbent assay. Results: Of the 36,399 children whose food allergen sensitization profiles were analyzed, 48.12% (n = 17,514) demonstrated elevated sIgE reactivity in response to at least one tested allergen, with milk and eggs emerging as the predominant allergenic triggers. Age-stratified analyses identified preschool age (≤6 years) as the critical window for food sensitization, demonstrating peak IgE reactivity to major allergens, including milk, peanuts, soybeans, shrimp, eggs, wheat, and beef. Male subjects exhibited significantly higher sensitization rates to peanuts, soybeans, crustaceans and wheat compared to females (p < 0.05), underscoring the importance of sex-based considerations in allergy prevention strategies. Conclusions: Milk and eggs emerge as the dominant food allergens that cause sensitization in Chengdu’s pediatric population. Age- and sex-dependent vulnerabilities were identified, with younger children and male participants demonstrating higher sensitization rates than their counterparts. These age-stratified and male-predominant sensitization patterns provide a scientific foundation for public health initiatives. Full article

Peanut allergy (PA) remains a major diagnostic challenge in pediatric allergy, largely due to the frequent discrepancy between immunological sensitization and clinically relevant disease. This study aimed to develop a real-life diagnostic prediction model to distinguish true peanut allergy from asymptomatic peanut sensitization in children referred for evaluation of suspected PA. In this cross-sectional study, 80 children aged 1–18 years were assessed in a tertiary allergy center in Poland. Sixty-five children with peanut sensitization underwent detailed clinical history assessment, skin prick testing, measurement of serum specific IgE including component-resolved diagnostics, basophil activation testing, and oral food challenges where clinically indicated. Clinically confirmed peanut allergy was diagnosed in 42 sensitized children. In univariate analyses, several clinical and immunological factors were associated with PA, including atopic comorbidities, peanut component sensitization, and basophil activation. Multivariate analysis identified food-induced anaphylaxis and walnut sensitization as independent factors associated with PA. In addition, a penalized diagnostic prediction model was developed to support clinical risk stratification. A multivariable diagnostic prediction model integrating clinical history and laboratory parameters demonstrated good discriminative performance in internal validation (area under the ROC curve 0.83). In conclusion, peanut allergy in sensitized children is determined by a combination of clinical and immunological factors rather than a single biomarker. Integrative diagnostic models may support risk stratification and help optimize the use of oral food challenges in specialized clinical settings, although external validation is required before broader implementation. Full article

Food allergies are increasing worldwide, yet the early epithelial mechanisms that initiate allergic sensitization remain incompletely defined. As the intestinal epithelium governs both allergen translocation and epithelial–immune crosstalk, it constitutes a critical but underutilized model for predicting allergenicity. In this study, we used Caco-2 and T84 intestinal epithelial monolayers cultured on Transwell^® inserts to compare barrier properties and responses to peanut protein extract. Phenotypic characterization included biomarker profiling, transepithelial electrical resistance (TEER) measurements, tight junction integrity assessment, and analysis of cytokine levels as well as oxidative and nitrosative stress. Peanut exposure caused moderate TEER reductions without overt tight junction disruption while allowing translocation of the major allergen, Arachis hypogaea allergen 1 (Ara h 1), likely via transcellular pathways. Peanut protein extracts also induced epithelial stress responses, characterized by increased reactive oxygen species and nitric oxide production, alongside time-dependent secretion of innate and type 2-associated mediators, including IL-1β, TSLP, IL-25, and IL-33, indicating epithelial activation in the absence of complete barrier breakdown. Notably, basolateral supernatants from peanut-exposed epithelial monolayers activated THP-1-derived macrophages and enhanced IL-6 secretion, demonstrating that limited allergen passage across an otherwise intact epithelial barrier is sufficient to elicit early innate immune responses. Collectively, these findings indicate that peanut extract induce subtle functional perturbations in the intestinal epithelium while promoting downstream immune activation, highlighting Caco-2 and T84 cells as complementary in vitro platforms for studying barrier-dependent mechanisms of allergic sensitization. Full article

Background: Food allergy (FA) is an emerging problem in pediatrics, with tree nuts and peanuts being frequent causes of severe reactions. Oral food challenge (OFC) remains the gold standard for diagnosing FA. However, it is a stressful treatment and not always risk-free. Objectives: To identify potential biomarkers, using component-resolved diagnosis (CRD) associated with OFC outcome in children with tree nut (hazelnut, walnut, almond, and pistachio) and peanut allergy, who live in central and southern Italy. Methods: Eighty-eight (1–18 years) children followed at the Pediatric Allergy Clinic of Policlinico Umberto I in Rome were included in this study. All patients underwent skin prick tests (SPTs), prick-by-prick (PbP) tests, and serum-specific Immunoglobulin E (sIgE) measurement to allergenic components using CRDs. Results: In hazelnut allergy (n = 60 OFCs), OFC failure occurred in 41 children. Higher sIgE levels to Cor a 8 (OR 2.04, 95% CI 1.17–3.55), Cor a 9 (OR 2.61, 95% CI 1.37–5.00), and Cor a 14 (OR 1.65, 95% CI 1.14–2.38) were all significantly associated with an increased probability of a positive OFC outcome. In peanut allergy (n = 30 OFCs), OFC failure occurred in 16 children. Ara h 9 was the only statistically significant predictor of OFC failure, showing a very wide confidence interval (OR, 95% CI: 1.116–484). For walnut, almond, and pistachio, sample sizes were insufficient to support inferential modeling. Conclusions: CRD biomarkers can stratify the likelihood of OFC reactions in pediatric FA, enhancing clinical decision-making and reducing unnecessary challenges. Full article