Vassilopoulou E, Karastogiannidou C, Comotti A, Agostoni C, Maragkou MK, et al.
Allergy •
Prevention is a key strategy for reducing the burden of food allergies (FA). The maternal diet during pregnancy and breastfeeding is increasingly recognized as a factor contributing to FA risk. We analyzed data from a sub-cohort of the MEDALLION study to evaluate the association between maternal adherence to the Mediterranean Diet (MedDiet) and the development of FA in offsprings. Maternal dietary intake during pregnancy and lactation was assessed using a validated scale, i.e., the MedDiet Score, along with individual food group consumption. Multiple logistic regression models were performed. A total of 430 mother-offspring dyads were included in the analysis. Higher maternal adherence to the MedDiet was associated with reduced odds of FA in offspring during both pregnancy (adjusted OR 0.94, 95% CI 0.89-1.00) and lactation (adjusted OR 0.94, 95% CI 0.88-1.00). Increased weekly consumption of fruits and full-fat dairy products during pregnancy, and vegetables during breastfeeding, was associated with reduced likelihood of FA in the offspring. Conversely, higher intake of poultry and red meat (> 3 servings/week) during both periods, and fish consumption during pregnancy (> 1 serving/week), were associated with increased odds of FA. This study points out that the MedDiet and, especially, some specific components, such as fruits, vegetables, and full-fat dairy products, may contribute to lowering the risk of FA in infants, whereas a higher intake of poultry, red meat, and fish may increase it. These findings support the potential of maternal nutrition to reduce childhood FA.
European annals of allergy and clinical immunology •
Epithelial barriers are crucial defenses against pathogens and allergens, and recent theories suggest that environmental factors may compromise them, leading to type 2 inflammation and conditions such as asthma, atopic dermatitis, food allergy, and rhinitis. While skin and respiratory barriers show clear dysfunctions in allergies, the role of the gut epithelium is less defined, particularly in view of its ability to absorb nutrients and maintain immune tolerance under normal conditions. Research indicates that gastrointestinal barrier integrity typically remains preserved in food allergies, allowing for the development of immune tolerance to ingested food antigens through mechanisms like Treg cells and IgA. Allergies to cow's milk or hen's egg proteins most often resolve with age, highlighting the gut's evolving role in allergen sensitization. Studies like the LEAP (Learning Early About Peanut Allergy) trial demonstrate the preventive benefits of early allergen exposure against peanut allergy, supporting the dual allergen exposure hypothesis. New allergens such as alpha-Gal and gibberellin-regulated proteins (GRP) reveal distinct sensitization pathways beyond traditional ingestion routes, implicating non-dietary sources in allergen introduction. Altogether, there is lack of evidence suggesting that the intestinal epithelium is disrupted in food allergy.
Villalta D, Cecchi L, Farsi A, Chiarini F, Minale P, et al.
European annals of allergy and clinical immunology •
The term of α-Gal syndrome, which includes the delayed allergy to red meat and the allergic reactions following the administration of cetuximab, is associated to the presence of specific IgE to α-Gal. In Italy, only anecdotal cases were reported so far. The Association of Italian Allergists (AAITO) carried out a survey with the aim of evaluating presence, characteristics, clinical features, and distribution of the syndrome in Italy. A web structured questionnaire was made available on the website of AAIITO from July 2016 to January 2017. It included 31 multiple-choice questions concerning different items, including the site of physicians, the number of patients diagnosed as having cetuximab allergy and/or delayed red meat allergy, recall of tick bites, symptoms, time to reactions, elicitor foods, reactions with foods other than meat, and in-vivo and in-vitro tests used for the diagnosis. Seventy-nine physicians completed the questionnaire. Nine cases of allergy to cetuximab and 40 cases of delayed red meat allergy were recorded across Italy. 22.5% of patients with cetuximab allergy and 62.5% of those with delayed red meat allergy recalled a tick bite. 75% of patients with delayed red meat allergy experienced symptoms after eating beef (butcher's cut in 72.5%). Urticaria was the most frequent clinical manifestation (65% of cases). In 60.6% of cases symptoms appeared 2 - 4 hours after meat ingestion, while in 7.9% symptoms appeared after > 4 hours. The most used diagnostic methods were the intradermal test for cetuximab allergy (88.9%) and the detection of IgE to α-Gal (55.5%) for red meat allergy. Most case reports came from Northern Italy. α-Gal syndrome is present in Italy and beef is the most frequent offending food. In most cases symptoms were not severe.
European annals of allergy and clinical immunology •
We report the case of a 55-year-old man who went into anaphylactic shock six hours after eating a meal containing meat. He reported having had several tick bites in months before the reaction. The serum specific IgE showed strong positivity to alpha-gal. This is clearly alpha-gal anaphylaxis with delayed onset after meat ingestion caused by tick bite, confirmed by alpha-gal IgE positivity.
