Up to 5% of young children suffer from food allergy. Children with food allergy may present with a variety of symptoms that parents have attributed to constituents of the diet. The diagnosis and management of adverse food reactions is a challenge for physicians. Diagnostic approaches are composed of a detailed history, in vitro tests and in vivo tests. Improved diagnostic methods include more precise in vitro and in vivo tests for immunoglobulin E-mediated food allergies, in vitro assays for predicting development of oral tolerance, and novel non-invasive tests for cell-mediated food allergies such as patch testing, cytokine assays, and detection of eosinophil activation markers. The conventional diet therapy, pharmacotherapy and new immunomodulatory approaches to food allergy are also discussed. Rapidly evolving findings might provide hope for a cure of food allergy in the near future.
Child ; Diagnosis* ; Diet ; Diet Therapy ; Drug Therapy ; Eosinophils ; Food Hypersensitivity* ; Hope ; Humans ; Immunoglobulins ; Parents ; Patch Tests

BACKGROUND: In adult patients with chronic urticaria (CU), the prevalence of food allergy is low compared to childhood patients. However, there are many patients who report food-related aggravation of CU, and some of them may have histamine intolerance. OBJECTIVE: The aim of this study was to evaluate the role of ingested histamine and to investigate the effect of a histamine-free diet in adult patients with CU. METHODS: Twenty-two adult patients with CU were enrolled. Foods with high amounts of histamine were prohibited to all patients for four weeks. The degree of severity of the urticaria was evaluated using the urticaria severity score (USS) and urticaria activity score (UAS). Plasma histamine levels and diamine oxidase (DAO) activity were determined and compared before (baseline) and after the histamine-free diet. RESULTS: Twenty-two adult patients were recruited and completed four weeks of histamine-free diet. The USS and UAS scores each showed significant differences before and after the histamine-free diet (p=0.010, p=0.006). There was a significant reduction in plasma histamine level after the histamine free-diet, compared with baseline (p=0.010). However, DAO activity did not change after the histamine-free diet (p=0.165). CONCLUSION: Our study suggested that ingested histamine might be related to CU severity and that a histamine-free diet is helpful for treatment of adult patients with CU.
Adult* ; Amine Oxidase (Copper-Containing) ; Diet Therapy ; Diet* ; Food Hypersensitivity ; Histamine ; Humans ; Plasma ; Prevalence ; Urticaria*

The avoidance of incriminated foods is one of the principal therapies for atopic dermatitis (AD). Recently, interferon (IFN)-gamma therapy has been tried in AD with limited success. The necessity of diet therapy for the success of IFN-gamma therapy in AD was evaluated. A total of 524 AD patients participated in this study and 316 patients among them were entered into open food challenge tests. As the first step, an elimination diet was administered to 43 AD patients and 30 AD patients were enrolled as an untreated control group. As the second step, 45 AD patients were treated by both IFN-gamma therapy and elimination diet alone, 30 AD patients by elimination diet alone, 50 AD patients by IFN-gamma therapy, and 43 AD patients as controls. Clinical severity reduced significantly by using only the elimination diet in 58.1% patients with varying degrees of AD. Elimination diet improved the clinical results of IFN-gamma therapy in AD. In regard to the food challenge test, 77.8% of AD patients showed an adverse reaction to at least one food. Diet therapy itself had therapeutic effects on AD and an elimination diet might be essential for the success of IFN-gamma therapy in AD.
Adolescence ; Adult ; Child ; Child, Preschool ; Dermatitis, Atopic/drug therapy* ; Dermatitis, Atopic/diet therapy* ; Female ; Food Hypersensitivity/diet therapy ; Human ; Interferon Type II/therapeutic use* ; Male ; Treatment Outcome

Atopic dermatitis (AD) is one of the major public health problem. It has been reported that the prevalence of AD in children and adults are 10-20% and 1-3%, respectively. Westernization of food habits, urbanization, and environmental pollution are contributing factors toward the recent rise in prevalence. Excessive dietary restriction leads to chronic malnutrition in atopic dermatitis patients. The purpose of this study was to investigate the effects of medical nutrition therapy (MNT) on quality of diet and blood immune parameters in atopic dermatitis patients. The 19 atopic dermatitis patients (7 men and 12 women) admitted to K University Medical Center were studied. During the 12 weeks of intervention, the subjects were given MNT by a dietitian for 30-45 minutes every other week. MNT was comprised with general dietary therapy, intake of balanced meals, emphasis on n-3 fatty acid contents in foods, and food allergies. Anthropometric and dietary assessment and blood analysis were taken at baseline and after 12 weeks of MNT. After 12 weeks of MNT, the subjects' dietary qualities, including dietary diversity score (DDS), meal balance score (MBS) and dietary variety score (DVS) were significantly increased (p < 0.05). According to significantly increased intake of EPA and DHA, dietary n-6/n-3 fatty acid ratio decreased to the recommended level for the atopic dermatitis patients (p < 0.05). These changes of dietary fatty acid consumption were reflected rythrocyte fatty acid composition. After 12 weeks of MNT, serum levels of IgE and IL-4 levels were significantly decreased, however, the levers of INF-gamma, WBC, lymphocyte and TLC were not changed. As a conclusion, the individualized MNT improved the quality of diet in atopic dermatitis patients thereby influenced RBC fatty acid composition and IgE and IL-4 levels.
Academic Medical Centers ; Adult ; Child ; Dermatitis ; Dermatitis, Atopic ; Diet ; Environmental Pollution ; Food Habits ; Food Hypersensitivity ; Humans ; Immunoglobulin E ; Interleukin-4 ; Lymphocytes ; Male ; Malnutrition ; Meals ; Nutrition Therapy ; Plasma ; Prevalence ; Public Health ; Urbanization

OBJECTIVETo assess the preventive effects of different dietary regimens on development of eczema and food allergy in infants at high-risk for allergy.

METHODSForty-six infants whose parents were atopic and umbilical cord IgE > 0.35 kU/L were enrolled in the study. The infants were randomly assigned at birth to one of 2 dietary regimen protocols: those in intervention group (23 cases) were breast fed till more than 4 months of age, then followed by feeding with partially hydrolyzed formula (pHF), combined solid foods avoidance until 4-month of age, egg, fish, shrimp avoidance until 12-month of age. The other 23 cases in non-intervention group were breast fed for less than 4 months, or bottle fed with cow's milk-based formula, egg yolk was introduced at 4-month of age, and egg white at 6-month of age, besides, no any other dietary avoidance was applied. All the infants were followed-up for 18 months. The primary end point was the presence of atopic eczema. Food allergy was detected by fresh food prick-to-prick tests or in vitro sIgE or Fx5E.

RESULTSAt 6 months, 12 months and 18 months, the incidence of eczema in intervention group was 4.3% (1/23), 8.7% (2/23), and 17.4% (4/23), respectively, which was significantly reduced as compared to that of the non-intervention group, which was 26.1% (6/23), 34.8% (8/23), and 39.1% (9/23), respectively. Food allergy was found in 13.0% (3/23) of intervention group and 34.8% (9/23) of non-intervention group by skin prick tests or sIgE. Egg white was the most common offending food.

CONCLUSIONEarly life dietary interventions which included breastfeeding, delayed solid food introducing, pHF feeding, and high risk food avoidance could reduce the risk of atopic eczema and food allergy development, and was probably an effective primary intervention method for infants at high risk for atopy.

Breast Feeding ; Dermatitis, Atopic ; diet therapy ; epidemiology ; etiology ; prevention & control ; Female ; Fetal Blood ; immunology ; Follow-Up Studies ; Food Hypersensitivity ; complications ; diet therapy ; epidemiology ; Humans ; Immunoglobulin E ; blood ; Infant ; Infant Formula ; methods ; Infant, Newborn ; Male ; Mothers ; Prevalence ; Risk Factors ; Time Factors ; Treatment Outcome