New guidelines for peanut allergy prevention in high-risk infants recommend introducing peanut during infancy but do not address breastfeeding or maternal peanut consumption. We assessed the independent and combined association of these factors with peanut sensitization in the general population CHILD birth cohort (N = 2759 mother–child dyads). Mothers reported peanut consumption during pregnancy, timing of first infant peanut consumption, and length of breastfeeding duration. Child peanut sensitization was determined by skin prick testing at 1, 3, and 5 years. Overall, 69% of mothers regularly consumed peanuts and 36% of infants were fed peanut in the first year (20% while breastfeeding and 16% after breastfeeding cessation). Infants who were introduced to peanut early (before 1 year) after breastfeeding cessation had a 66% reduced risk of sensitization at 5 years compared to those who were not (1.9% vs. 5.8% sensitization; aOR 0.34, 95% CI 0.14–0.68). This risk was further reduced if mothers introduced peanut early while breastfeeding and regularly consumed peanut themselves (0.3% sensitization; aOR 0.07, 0.01–0.25). In longitudinal analyses, these associations were driven by a higher odds of outgrowing early sensitization and a lower odds of late-onset sensitization. There was no apparent benefit (or harm) from maternal peanut consumption without breastfeeding. Taken together, these results suggest the combination of maternal peanut consumption and breastfeeding at the time of peanut introduction during infancy may help to decrease the risk of peanut sensitization. Mechanistic and clinical intervention studies are needed to confirm and understand this “triple exposure” hypothesis.

The aim of the present study was to investigate the effect of a protein-free diet in the induction of food allergy and oral tolerance in BALB/c mice. The experimental model used was mice that were fed, since weaning up to adulthood, a balanced diet in which all dietary proteins were replaced by amino acid diet (Aa). The absence of dietary proteins did not prevent the development of food allergy to ovalbumin (OVA) in these mice. However, Aa-fed mice produced lower levels of IgE, secretory IgA and cytokines. In addition, when compared with mice from control group, Aa-fed mice had a milder aversive reaction to the allergen measured by consumption of OVA-containing solution and weight loss during food allergy development. In addition, mice that did not have dietary proteins in their diets were less susceptible to induction of oral tolerance. One single oral administration was not enough to suppress specific serum Ig and IgG1 levels in the Aa-fed group, although it was efficient to induce suppression in the control group. The present results indicate that the stimulation by dietary proteins alters both inflammatory reactivity and regulatory immune reactivity in mice probably due to their effect in the maturation of the immune system.

Epidemiological studies have shown an association between the consumption of raw farm milk and reduced incidence of allergy. In the present study, we fed untreated raw milk, gamma-sterilised milk, heat-treated milk or water to mice and compared their responses to allergen exposure and challenge treatment in a mouse model of gastrointestinal allergy. From weaning (3 weeks old), groups of BALB/c female mice (n 8) received raw milk, gamma-sterilised milk, heated milk or water via drink bottles, with the control group receiving water. All mice were fed a standard (dairy protein-free) rodent diet. At 6 and 8 weeks, groups were given intra-peritoneal injections with ovalbumin (OVA)/alum to sensitise them to the antigen. Controls were sham immunised. At week 10, mice were fasted and challenged four times on alternate days by intra-gastric administration with 50 mg OVA or saline. Levels of bacteria and milk proteins were assessed in milk samples. Mouse serum levels of specific IgE, IgG1 and IgG2a antibodies and mouse mast cell protease-1 (MMCP-1) were determined. Cytokine responses to 48 h activation with OVA were measured in cultured splenocytes from mice. Sterilised and heated milks contained no viable bacteria and reduced detectable levels of many milk proteins, in contrast to raw milk. Mice drinking raw milk had highest serum MMCP-1 and specific-OVA IgE responses. Cultured splenocytes from OVA-primed mice produced similar levels of IL-4 in response to the antigen; however, IL-10 levels were highest from mice drinking raw milk. Overall, the present study adds to the evidence that consuming different types of milk can affect allergic responses to a non-related dietary antigen.

Polyphenols are naturally derived bioactive compounds with numerous reported health benefits. We have previously reported on the beneficial effect of a polyphenol-enriched apple extract in a murine model of food allergy. The objectives of the present study were to elucidate the class of bioactive polyphenols that exhibit a beneficial anti-allergic effect and to assess whether the protective effect matches the in vivo bioavailable metabolite concentrations. Female BALB/c mice were sensitised to ovalbumin (OVA) following the protocol of a well-established murine model of food allergy. They were fed diets containing polyphenol-enriched extracts or purified epicatechin for 8 d after the last sensitisation. The sensitised mice were orally challenged with OVA after the intervention. The allergy symptoms, in addition to allergen-specific serum Ig concentrations and gene expression profiles in the intestine, of the control and treated mice were compared. Plasma samples were collected to compare the concentrations of bioavailable epicatechin metabolites in the treatment groups. Polyphenol-enriched fruit extracts containing epicatechin exhibited a significant anti-allergic effect in vivo. This effect was unambiguously attributed to epicatechin, as oral administration of this purified polyphenol to sensitised mice by inclusion in their diet modulated allergy symptoms in a dose-dependent manner. Immune parameters were also affected by the administration of epicatechin. Bioavailability measurements in plasma indicated that the attenuation of allergy symptoms could be due to the higher concentrations of bioavailable epicatechin metabolites. In conclusion, epicatechin is a key bioactive polyphenol that has the ability to modulate allergy outcomes in sensitised mice.

Food hypersensitivity (FHS) is the umbrella term used for food allergies that involve the immune system and food intolerances that do not involve the immune system. FHS has a huge impact on quality of life and any dietary advice given should aim to minimise this effect. Despite many advances made in diagnosing and managing patients with FHS, the cornerstone of management still remains avoidance of the relevant food. However, a commonly-presenting dilemma in clinical practice is deciding to what extent the food(s) should be avoided. The level of avoidance required is currently based on the type of FHS the patient has, characteristics of the particular food protein and the natural history of the particular FHS. In addition to management of other FHS, management of cow's milk allergy requires the healthcare professional to choose the appropriate formula. Information required by the patient also includes understanding food labels and issues surrounding cross-contamination. In order to ensure that the diet is nutritionally sound, advice should be given about suitable food choices and following a healthy balanced diet, whilst taking into account the dietary restrictions. Practical issues that need to be addressed include going on holiday, travelling and eating away from home. The dietitian plays a crucial role in this process. At present, there are no standardised documents or protocols for the management of FHS and practices differ within and between countries. If adrenaline auto-injectors are prescribed, correct administration should be demonstrated and reviewed on an ongoing basis.

Testing for food allergy/intolerance is a rapidly expanding market. We present an exploration of the efforts of one of the market leading companies in this sector to promote and justify their product in the face of considerable opposition from conventional medicine, as well as a range of alliances with patient groups, so-called ‘lifestyle gurus’ and their customers. In extracting the latent value of an immunoglobin called IgG, testing companies engage with and extend entrepreneurial patienthood and new forms of pastoral expertise in their efforts to identify and manage a group of low-level chronic conditions that resonate with contemporary social unease about the hazards of modernity. Rather than foregrounding novelty and hope, we found that a great deal of emphasis was placed upon establishing conventionality with business practice and scientific method, and relief from the past. We also found that the local circuits and networks of engagement, in which the company operated to secure their reputation and extend their market, were vitally important. We end by reflecting upon the implications of our analysis for contemporary scholarship on biocapitalism.

Anisakis simplex is a nematode parasite that can infect humans who have eaten raw or undercooked seafood. Larvae invading the gastrointestinal mucosa excrete/secrete proteins that are implicated in the pathogenesis of anisakiasis and can induce IgE-mediated symptoms. Since Ani s 1 is a potent secreted allergen with important clinical relevance, its measurement could assess the quality of allergenic products used in diagnosis/immunotherapy of Anisakis allergy and track the presence of A. simplex parasites in fish foodstuffs. An antibody-based ELISA for quantification of Ani s 1 has been developed based on monoclonal antibody 4F2 as capture antibody and biotin-labelled polyclonal antibodies against Ani s 1 as detection reagent. The dose-response standard curves, obtained with natural and recombinant antigens, ranged from 4 to 2000 ng/ml and were identical and parallel to that of the A. simplex extract. The linear portion of the dose-response curve with nAni s 1 was between 15 and 250 ng/ml with inter-assay and intra-assays coefficients of variation less than 20% and 10%, respectively. The assay was specific since there was no cross-reaction with other extracts (except Ascaris extracts) and was highly sensitive (detection limit of 1·8 ng/ml), being able to detect Ani s 1 in fish extracts from codfish and monkfish.

Currently, the only treatment for any food hypersensitivity (including food allergy) is the dietary avoidance of the causative allergen, using an elimination diet. In addition to being used for the management of food hypersensitivity, an elimination diet may also be used in the diagnosis of food allergy. Dietary exclusion should be managed by a dietitian or other health professional with nutritional expertise to ensure that the exclusion does not lead to a nutritionally-deficient diet. There are three main types of elimination diets: single-food exclusion; multiple-food exclusion; the ‘few-food’ diet, which requires the avoidance of a large number of allergens and therefore concentrates on the foods that can be included rather than the foods that need to be avoided. Any sort of elimination diet is hard to manage. Thus, as well as ensuring that the diet is nutritionally adequate, it is essential that families are given advice and support relevant to their circumstances to aid them in the day-to-day management of the diet, so that it remains varied and enjoyable for food-allergy sufferers. This approach involves advice about which alternative foods are available, provision of ‘free-from’ recipes and guidance on which nutritional supplements are needed to meet their nutritional needs.

There is considerable interest in the development and evaluation of approaches for the safety assessment of novel foods, and in particular in methods for characterisation of allergenic potential. One strategy that has found favour is a tiered approach in which the potential of novel proteins to induce allergic sensitisation is assessed based on considerations of stability of the protein in a simulated gastric juice and homology with, or structural similarity to, known allergens. Linked to such an approach may be evaluation of serological identity with proteins known to cause allergic disease. With the aim of supplementing such approaches with a more direct measurement of potential allergenic activity, attempts have been made to characterise the quality of immune responses elicited in BALB/c strain mice. Such evaluations comprise measurement of IgG and IgE antibody production and (to a lesser extent) of induced cytokine expression patterns. Investigations to date suggest that in mice proteins provoke variable immune responses, those with the potential to cause allergic sensitisation stimulating IgE (and IgG) antibody production. In contrast, non-allergenic, but nevertheless immunogenic, proteins are associated with IgG antibody responses in the absence of marked IgE production. Consistent with the selective activation of selective type 2 T lymphocyte responses, exposure of mice to allergenic protein is associated with preferential expression of IL-4, -5, -10 and -13. Collectively these data suggest that characterisation of the nature of immune response induced in mice by proteins may provide a useful adjunct or alternative to current strategies for the assessment of allergenic potential.

At present the only cure for food allergy is to avoid eating the food responsible for the allergy. Thus, food allergy or food hypersensitivity is a disease that is not only of concern to the individual who is affected but also to those involved directly and indirectly in supplying andpreparing food for the food-allergic individual, and its impact on society should be evaluated on this basis. It is generally assumed that questionnaire-based studies vastly overestimate the prevalence of food hypersensitivity. The reported perceived prevalence of food hypersensitivity varies from 3.24% to 34.9%, which may be explained partly by the difference in reporting lifetime prevalence compared with point prevalence. However, of more importance is the apparent inverse correlation between response rate and prevalence (the higher the response rate, the lower the perceived prevalence). The three most-recent prevalence studies on food hypersensitivity (one on perceived food hypersensitivity and two on confirmed food hypersensitivity) all report estimates for prevalence of approximately 3%, but their criteria for including subjects as being positive are not identical, although they do overlap. Furthermore, because of differences in methodology there is no definitive information to indicate whether the prevalence of food allergy is increasing. However, the high prevalence of pollen-related food allergy in younger adults in the population suggests that the increase in pollen allergy is also being accompanied by an increase in pollen-related food allergy.

IgE-mediated dietary hypersensitivity affects approximately 1% of the canine population. There are no breed associations and ≤50% of the patients are aged <1 year at presentation. The most common causative allergens are beef, chicken, milk, eggs, maize, wheat and soyabean. Affected dogs generally display cutaneous disease and 10–15% of the patients may have concurrent alimentary involvement. Diagnosis is currently based on dietary restriction followed by provocation. Procedures for the detection of serum allergen-specific IgE and IgG antibodies are widely available, but these tests correlate poorly with clinical presentation and dietary testing. Recent studies have demonstrated the allergen specificity of IgE antibodies by immunoblotting and have described blood lymphocyte proliferative responses to food allergens. In addition to investigations of spontaneously-arising dietary hypersensitivity, it has also proved possible to study this disorder experimentally. Small colonies of dogs sensitive to particular dietary proteins have been used to study clinical and serological responses to allergen challenge. Hypersensitivity has been experimentally induced in dogs of an atopic phenotype by repeated subcutaneous injection of alum-adjuvanted dietary allergen during neonatal life. These models have been used to trial a range of modified protein or hydrolysate diets. The dog provides a unique large-animal model for investigation of the immunopathogenesis of human dietary hypersensitivity. The dog is closely related genetically to man and shares environmental disease triggers with man. Spontaneously arising canine dietary hypersensitivity is a good clinical mimic of the human disease, and ability to therapeutically manipulate this adverse response in the dog might lead to benefits for human patients.

Re´sume´Les allergies alimentaires repre´sentent un sujet important pour la sante´. La pre´valence chez les adultes d'Europe Occidentale est estime´e entre 1 et 2 %, tandis que parmi les enfants elle est plus e´leve´e (autour de 5 %). La plupart des allergies confirme´es sont associe´es à une gamme de produits relativement re´duite, dont le lait de vache, les ufs, les noix, les cacahue´tes, le ble´, les poissons et les fruits de mer. Cependant, il est connu que la pre´valence des allergies aux aliments spe´cifiques varie selon la zone ge´ographique, en raison principalement des diffe´rences dans les habitudes alimentaires. Bien que nous n'en ayons pas la preuve formelle, on suppose que le nombre de cas d'allergie alimentaire, comme celui des autres formes de maladies atopiques, est en augmentation. Il n'y a aucun doute que la pre´disposition ge´ne´tique est un de´terminant important. Toutefois, il est connu que l'acquisition de la sensibilisation aux prote´ines alimentaires et par la suite au proble`me d'allergie est influence´e par un e´ventail de facteurs environnementaux, ainsi que par le moment, la dure´e et l'intensite´ de l'exposition. De plus, la nature de l'allerge`ne lui-meme peut avoir un rle tre`s important sur la se´ve´rite´ et la persistance de la maladie clinique. Notre objectif est ici de discuter de l'importance de quelques-unes de ces variables dans le contexte des re´ponses allergiques immunoglobuline E-dependant.

The skills and knowledge required to carry out food allergen avoidance are becoming increasingly sophisticated. It is not enough to know the names of a handful of dishes which contain a known allergen as an ingredient. Many lifestyles now depend on food prepared away from the home. New product development has introduced a wide range of ingredients and dishes which are labour saving, exciting and innovative. Product traceability now depends on advanced technological support as it struggles to keep up with foods manufactured, prepared and served in ever more complex circumstances. Consumers are now faced with ‘a jungle of choices’. However, those individuals who need to avoid a known allergen, particularly in trace quantities, often find that the food choice deemed suitable is poor, and the information available inadequate or even dangerously misleading. There are two important groups for whom this situation is a major concern. Thousands of families with young children are forced to live with the possibility that everyday foods may be contaminated by a known allergen which could kill in minutes. They live on their nerves, reading every packet and resorting to hyperprotective childcare and vigilance. In addition, the youngest independent consumers, teenagers and those in their twenties, may have little first-hand experience of food preparation. They may be ill-equipped in food-allergen risk assessment. Sadly, those who die from anaphylaxis or allergen-triggered asthma are often in this age-group. Current initiatives to support consumers at risk include a recognised standard for manufacturers seeking to eliminate an allergen from their production, and the integration of food allergy into training for caterers and food standards enforcement professionals.

The quantitative evaluation of the allergenicity of food proteins and the clinical tolerance towards antigens are problems the food industry and the clinicians have to face. The allergenicity of a protein depends on multiple factors, including the stability to digestion and the interaction with the intestinal environment. In addition to the possible reduction in allergenicity by technological treatments such as heat and enzymic hydrolysis, the complex interactions existing between the antigens, the intestinal epithelium and the underlying immune system, as well as the individual susceptibility to the sensitizing epitopes, have to be taken into account. Indeed, the intestinal cells are able to take up and process proteins, and possibly to present them directly to mucosal lymphocytes. On the other hand, pathophysiological conditions can modify the interactions between food antigens and the immune system. A large number of methods has been developed to assess the residual antigenicity of food proteins, based on the various immune responses leading to intestinal or extradigestive pathologies. Thus, the difficulty in measuring the residual allergenicity of hypoallergenic formulas is partly due to the physiology of the gastrointestinal tract, since an intricate network of interactions between enterocytes and immune cells governs the development of the immune response to food antigens. RésuméL’évaluation de l’allergénicité des aliments et leur bonne tolérance clinique est une question touchant à la fois les industriels de l’agro-alimentaire et les cliniciens. L’allergénicité d’une protéine dépend de multiples facteurs parmi lesquels la résistance à la digestion, les interactions avec le tractus digestif et les facteurs environnementaux. L’allergénicité d’un produit alimentaire peut être modifiée non seulement par les traitements technologiques industriels, mais aussi par le tractus gastrointestinal. La susceptibilité individuelle aux epitopes peptidiques formés est également un facteur primordial. En effet, les interactions complexes existant entre les antigènes, l’épithelium intestinal et le système immunitaire muqueux peuvent conduirent à des réponses immunitaires différentes selon les individus. De nombreuses méthodes existent pour mesurer l’antigénicité résiduelle des aliments, basées sur la nature des différentes réactions immunitaires anormales conduisant à une pathologie intestinale ou extradigestive. La difficulté de mesurer l’allergénicité résiduelle de formules hypoallergéniques repose donc sur les relations complexes entre les antigènes alimentaires, l’épithelium intestinal et le système immunitaire muqueux.

Allergic diseases are a common cause of illness in most industrialized countries. Diet during early childhood is an important determinant of the development of allergy, particularly in high-risk infants who have a parental history of atopy. Maternal avoidance of highly-allergenic foods during pregnancy and lactation, prolonged exclusive breast-feeding, the use of a hydrolysed milk formula, and delayed introduction of dairy products, eggs, fish, nuts and soyabean are associated with a lower incidence of allergic symptoms and signs. These beneficial effects are observed for as long as 18 years of age. Similarly, nutrition and physical growth are important factors that influence immunocompetence and morbidity due to infections. Small-for-gestational age low-birth-weight infants show prolonged impairment of cell-mediated immunity, antibody responses and phagocyte function. Recent studies indicate the beneficial effect of moderate amounts of Zn given in the first 6 months of life. Thus, diet and nutrition in early life are crucial for the development of allergic and infectious disease throughout childhood and into adulthood.

The intestinal epithelium is a selective barrier where incompletely-digested food antigens are transmitted to the immune system. Food antigens are often the starting point of intestinal diseases such as food allergy or coeliac disease. The intestinal epithelial cells (IEC) take up and process food antigens mainly by fluid-phase transcytosis involving two functional pathways, one minor direct pathway without degradation and another major lysosomal degradative pathway. Among the peptidic metabolites generated during transepithelial transport of luminal antigens, some have a molecular mass compatible with a binding to restriction (major histocompatibility complex; MHC) molecules; the latter can be up regulated on enterocytes, especially in inflammatory conditions. Indeed, interferon-γ not only increases the paracellular absorption of antigens, but also their transcytosis across epithelial cells. It has been reported that enterocytes may even directly present peptidic epitopes to underlying T-cells. As a new potential way of transmitting peptidic information to the local or systemic immune system, the secretion by IEC of antigen-presenting vesicles called exosomes and bearing MHC–peptide complexes has recently been proposed. Many other factors such as nutritional or environmental factors can also influence the properties of the epithelial barrier and the outcome of the immune response to lumen antigens.

Food allergy is often thought to be a cause of rhinitis by patients, whose views are frequently influenced by information obtained from the Internet. The incidence of food allergy in children is 2–8 per cent, although a vast majority will grow out of it, and food allergy is actually very rare in adults. Food allergy usually presents with multi-system involvement, most commonly cutaneous and gastrointestinal symptoms. Food allergy induced rhinitis is less common, and isolated rhinitis due to food allergy is extremely rare. Treatment for rhinitis due to food allergy is therefore rarely indicated.

This review summarises the literature related to the incidence, diagnosis and management of food allergy and food allergy induced rhinitis.

Dogs with food allergy are often treated by giving a diet with hydrolysed protein sources. Prebiotics might also be successful in prevention and treatment of allergic disease through their effect on the colonic microflora, analogous to studies on probiotics in allergic children. The present study was set up to investigate the effect of supplementing inulin (IN) to commercial hypoallergenic dog diets on apparent nutrient digestibility, faecal characteristics, haematology and Ig in dogs. Supplementation of 3 % IN did not affect faecal pH, food and water intake and urine production. Compared with the intact protein diet with a limited number of ingredients (L), the diet with a hydrolysed protein source (H) resulted in an increased water intake (P<0·001), which could be due to the osmotic effect of free amino acids. Faeces production was increased by IN due to increased faecal moisture content. Increased faeces production on the H diet was mainly due to a higher DM excretion. Subsequently, the apparent digestibility coefficient (ADC) of DM was lower in the H diet group. A similar result was noted for ADC of diethyl ether extract and crude ash. The ADC of crude protein was higher in the H diet group, whereas IN decreased the ADC of crude protein. Differences in the ADC of crude protein among the different diets disappeared after correction for a higher faecal biomass, except for the dogs fed the L + IN diet. Total faecal IgA concentrations were lower in the H group (P<0·05) because of lower antigenic stimulation of hydrolysed protein, which implies that hydrolysed protein is really hypoallergenic. The present study indicates that the use of hydrolysed protein diets for canine food allergy treatment can affect digestibility and that combination with IN affected apparent protein digestibility but not IgA response.