Faculty Bibliography

Professor Hugh A. Sampson, MD is a Canadian- born American clinician and translational researcher, whose evidence-based approach validated food allergy as a legitimate allergic disorder. He single-handedly transformed the management of patients with food allergies and initiated investigations that led to novel diagnostic tests and therapies giving hope to millions of individuals and their families worldwide. Hugh Sampson's immense impact on the rapidly developing field of food allergy makes him a true legend in allergy/immunology.

Eosinophilic esophagitis (EoE) is an atopic disease characterized by eosinophilic inflammation in the esophagus.

BACKGROUND:Sesame is an allergen of increasing importance. OBJECTIVE:We sought to characterize the outcomes of oral food challenges (OFCs) to sesame and evaluate the diagnostic accuracy of skin prick testing (SPT), sesame, and Ses i 1-specific IgE (sIgE). METHODS:We reviewed sesame OFCs performed at the Mount Sinai pediatric allergy clinic between January 2010 and April 2018. We assessed the accuracy of diagnostic tests by calculating the area under the curve (AUC) of the receiver operating characteristic curves. The association between OFC outcome and sesame sensitization was analyzed using a logistic regression, which was then used to estimate the 95% positive predictive value (PPV) of these tests. RESULTS:We identified 341 patients (69% male, mean age 7.7 years) who underwent sesame OFC. Among 106 (31%) positive OFCs, the median cumulative eliciting dose was 500 mg sesame protein (1/2 teaspoon tahini). Sesame SPT wheal ≥6 mm had sensitivity 54.1% and specificity 87.8%; AUC 0.756 (95% confidence interval [CI], 0.699-0.814). SPT wheal size ≥14 mm had 95% PPV. Sesame-sIgE level did not correlate with OFC outcome. Ses i-sIgE levels were analyzed in 30 patients using the Immuno Solid-phase Allergen Chip (ISAC) microarray and were significantly associated with OFC outcome (AUC: 0.715 [95% CI, 0.541-0.890]). Ses i 1-sIgE ≥0.3 ISAC Standardized Units had sensitivity 58.3% and specificity 83.3%. CONCLUSIONS:This is the largest study of sesame allergy to date. Sesame SPT is a more accurate predictor of sesame allergy compared with sesame sIgE. Ses i 1-sIgE appears promising but requires further study regarding diagnostic accuracy.

PURPOSE OF REVIEW/OBJECTIVE:The aim of the article is to critically appraise the most relevant studies in the rapidly advancing field of food allergy prevention. RECENT FINDINGS/RESULTS:Epidemiologic studies identified atopic dermatitis as a strong risk factor for food allergy, with mounting evidence for impaired skin barrier and cutaneous inflammation in the pathogenesis. Additional risk factors include a family history of atopy, the timing of allergenic food introduction into the infant's diet, dietary diversity, vitamin D, and environmental factors, such as dog ownership. Early introduction of allergenic foods (such as peanut) into the infant diet was shown to significantly reduce the risk of food allergy in infants with risk factors, whereas studies targeting skin barrier function have produced conflicting results. Cumulative evidence supports dietary diversity during pregnancy, breastfeeding, infancy, and early childhood. SUMMARY/CONCLUSIONS:A variety of interventions have been evaluated for the prevention of atopic dermatitis and food allergy, often producing conflicting results. At present, official guidelines encourage breastfeeding and early allergenic food introduction for infants at risk for food allergy, with an emphasis on dietary diversity, fruits, vegetables, fish, and food sources of vitamin D during pregnancy, lactation, and early life for all infants.

PURPOSE OF REVIEW/OBJECTIVE:First described in the mid 20th century, it was just in the last decade that diagnostic and treatment guidelines for food protein-induced enterocolitis syndrome (FPIES) were established. Awareness of the diagnosis is improving, and epidemiologic data are emerging. RECENT FINDINGS/RESULTS:Recent studies suggest that FPIES may affect as many as 0.5% of children worldwide. FPIES in adults is usually triggered by seafood and may be more common than previously thought. Many patients with FPIES have other allergic disorders. SUMMARY/CONCLUSIONS:With refined diagnostic criteria and improved awareness, FPIES is now diagnosed with increasing frequency, and epidemiologic data are emerging. FPIES appears to be increasing in prevalence, and the frequent association with other allergic disorders suggests a shared predisposition or immune mechanism that remains to be elucidated.

Rationale: Oral food challenges (OFC) are recommended for introducing peanut to infants at high risk of developing peanut allergy. We examined peanut-OFC safety, utility of pre-challenge risk assessment and rates of peanut tolerance at follow-up.
Method(s): his is a single-center, retrospective review of infant peanut-OFC per LEAP protocol performed between 01/2015-01/2019. Pre-challenge skin prick test (SPT) wheal size, serum whole and component peanut-sIgE were analyzed via area under the ROC curve (MedCalc Statistical Software).
Result(s): We analyzed 87 peanut-OFCs; 55.8% were male infants, median age at OFC 8 months (IQR 7-10). Indications for OFC were: eczema, egg allergy or both (n=71); sibling with food allergy (n=7); adverse reaction to peanut-containing food (n=6) or adverse reaction to other food (n=3). OFC outcome was negative in 70 (80.5%), positive in 17 (19.5%). Of those who reacted, 16 (94.1%) received oral antihistamine therapy alone; one (5.9%) received epinephrine. Post-OFC follow up was available in 45 who passed peanut-OFC. Of those, 35 (77.7%) consumed peanut regularly, whereas 10 (22.3%) avoided peanut, including 6 (13.3%) who reported allergic symptoms attributed to peanut. Arah2-sIgE testing outperformed whole peanut-sIgE and SPT in predicting positive challenge outcome by ROC analysis (cutoff >0.56 kU/L, AUC 0.78; p=0.003 vs. sIgE AUC 0.63; p=0.23 and SPT AUC 0.69; p=0.007).
Conclusion(s): Infant peanut-OFC and early introduction are safe in select patients. The majority of infants passing peanut-OFC continue to consume peanut, however a subset avoids peanuts due to potential mild allergic reactions at home. Arah2-sIgE testing has superior diagnostic capacity in our cohort.
Copyright

Rationale: Peanut OIT induces desensitization in peanut-allergic participants after 1-3 years of treatment; tolerance induction has not been evaluated in young children.
Method(s): A multi-center study was conducted in peanut-allergic children (ages 1-3 years), reactive to <500mg peanut protein during baseline double-blind, placebo-controlled food challenge (