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Allergic reactions during travel among individuals with IgE-mediated food allergy

Brady, Kathryn; Martinez-Flores, Beatriz; Trogen, Brit; Cruz-Vasquez, Joseline; Nowak-Wegrzyn, Anna
PMID: 37925073
ISSN: 2213-2201
CID: 5607202

Food allergy ladders: when to use them?

Meyer, Rosan; Nowak-Wegrzyn, Anna
PMID: 38056525
ISSN: 1534-4436
CID: 5595792

For allergists, the solution is never violence! [Editorial]

Spergel, Jonathan; Borish, Larry; Grayson, Mitchell H; Greenhawt, Matthew J; Leung, Donald Y M; Levi-Schaffer, Francesca; Lieberman, Jay A; Moore-Clingenpeel, Melissa; Nowak-Wegrzyn, Anna; Oppenheimer, John; Shaker, Marcus S; Shulenberger, Kurt; Stukus, David R
PMID: 37863191
ISSN: 1534-4436
CID: 5614252

Reply [Letter]

Casale, Thomas B; Ellis, Anne K; Nowak-Wegrzyn, Anna; Kaliner, Michael; Lowenthal, Richard; Tanimoto, Sarina
PMID: 38069978
ISSN: 1097-6825
CID: 5589762

Evaluation of clinical outcomes of efficacy in food allergen immunotherapy trials, COFAITH EAACI task force

Rodriguez del Rio, Pablo; Álvaro-Lozano, Montserrat; Arasi, Stefania; Bazire, Raphaëlle; Escudero, Carmelo; Patel, Nandinee; Sandoval-Ruballos, Monica; Vazquez-Ortiz, Marta; Nowak-Wegrzyn, Anna; Blümchen, Katharina; Dunn Galvin, Audrey; Deschildre, Antoine; Greenhawt, Matthew; Schnadt, Sabine; Riggioni, Carmen; Remington, Benjamin C.; Turner, Paul; Fernandez Rivas, Montserrat
Food allergy is a global public health problem that until recent years lacked any aetiological treatment supported by academy, industry and regulators. Food immunotherapy (AIT) is an evolving treatment option, supported by clinical practice and industry trial data. Recent AIT meta-analyses have highlighted the difficulty in pooling safety and efficacy data from AIT trials, due to secondary heterogeneity in the study. An EAACI task force (CO-FAITH) initiated by the Paediatric Section was created to focus on AIT efficacy outcomes for milk, egg and peanut allergy rather than in trial results. A systematic search and a narrative review of AIT controlled clinical trials and large case series was conducted. A total of 63 manuscripts met inclusion criteria, corresponding to 23, 21 and 22 studies of milk, egg and peanut AIT, respectively. The most common AIT efficacy outcome was desensitization, mostly defined as tolerating a maintenance phase dose, or reaching a particular dose upon successful exit oral food challenge (OFC). However, a large degree of heterogeneity was identified regarding the dose quantity defining this outcome. Sustained unresponsiveness and patient-reported outcomes (e.g. quality of life) were explored less frequently, and to date have been most rigorously described for peanut AIT versus other allergens. Change in allergen threshold assessed by OFC remains the most common efficacy measure, but OFC methods suffer from heterogeneity and methodological disparity. This review has identified multiple heterogeneous outcomes related to measuring the efficacy of AIT. Efforts to better standardize and harmonize which outcomes, and how to measure them must be carried out to help in the clinical development of safe and efficacious food allergy treatments.
ISSN: 0105-4538
CID: 5629342

Sustained silencing peanut allergy by xanthopurpurin is associated with suppression of peripheral and bone marrow IgE-producing B cell

Yang, Nan; Srivastava, Kamal; Chen, Yujuan; Li, Hang; Maskey, Anish; Yoo, Patrick; Liu, Xiaohong; Tiwari, Raj K; Geliebter, Jan; Nowak-Wegrzyn, Anna; Zhan, Jixun; Li, Xiu-Min
INTRODUCTION/UNASSIGNED:models. METHODS/UNASSIGNED:B cells were analyzed by flow cytometry. Acute and sub-chronic toxicity were evaluated. IL-4 promoter DNA methylation, RNA-Seq, and qPCR analysis were performed to determine the regulatory mechanisms of XPP. RESULTS/UNASSIGNED:B cells compared to the untreated group. XPP increased IL-4 promoter methylation. RNA-Seq and RT-PCR experiments revealed that XPP regulated the gene expression of CCND1, DUSP4, SDC1, ETS1, PTPRC, and IL6R, which are related to plasma cell IgE production. All safety testing results were in the normal range. CONCLUSIONS/UNASSIGNED:XPP successfully protected peanut-allergic mice against peanut anaphylaxis by suppressing IgE production. XPP suppresses murine IgE-producing B cell numbers and inhibits IgE production and associated genes in human plasma cells. XPP may be a potential therapy for IgE-mediated food allergy.
PMID: 38380329
ISSN: 1664-3224
CID: 5634272

Pharmacokinetics/pharmacodynamics of epinephrine after single and repeat administration of neffy, EpiPen, and manual intramuscular injection

Casale, Thomas B; Ellis, Anne K; Nowak-Wegrzyn, Anna; Kaliner, Michael; Lowenthal, Richard; Tanimoto, Sarina
BACKGROUND:Epinephrine is the first-line treatment for severe allergic reactions, and rapid treatment is associated with lower rates of hospitalization and death. Current treatment options (epinephrine auto-injectors and manual intramuscular injection) are considered cumbersome, and most patients/caregivers fail to use them, even during severe reactions. An intranasal epinephrine delivery device, neffy, has been designed to provide an additional option for patients/caregivers. OBJECTIVE:We sought to assess the comparative pharmacokinetics and pharmacodynamics of neffy 2.0 mg, EpiPen 0.3 mg, and manual intramuscular injection 0.3 mg. METHODS:This was a phase 1, randomized, 6-treatment, 6-period, 2-part crossover study in 59 healthy subjects. Pharmacokinetic and pharmacodynamic parameters following single and repeat doses of epinephrine were assessed before dosing and at various postdose intervals. RESULTS:The pharmacokinetic profile of neffy was bracketed by approved injection products, with a mean peak plasma level of 481 pg/mL, which fell between EpiPen (753 pg/mL) and epinephrine manual intramuscular injection (339 pg/mL). When dosed both once and twice, neffy resulted in more pronounced increases in pharmacodynamic parameters relative to EpiPen or manual injection. CONCLUSIONS:neffy's pharmacokinetic profile was bracketed by approved injection products, with pharmacodynamic responses that were comparable to or better than approved injection products. neffy is expected to be a safe and effective option, particularly for patients/caregivers who are reluctant to carry and use injection devices.
PMID: 37604314
ISSN: 1097-6825
CID: 5613442

Citrin: a novel food allergen in citrus seeds and citrus-derived pectin that shows cross-reactivity with cashew and pistachio

Konstantinou, George N; Baker, Mary Grace; Yu, Joyce; Ford, Lara S; Bencharitiwong, Ramon; Grishina, Galina; Sampson, Hugh A; Sicherer, Scott; Nowak-Wegrzyn, Anna
BACKGROUND:Patients exquisitely sensitive to cashew/pistachio are at risk for allergic reactions to citrus seeds and pectin. OBJECTIVE:In this study, we sought to evaluate whether pectin is contaminated with citrus seeds, to identify a culprit antigen in citrus seeds, and to assess for cross-reactivity among allergens in citrus seeds, citrus pectin, and cashew or pistachio. METHODS:Proteins from orange seed coats, orange seed endosperms, lemon seeds, grapefruit seeds, citrus pectin, apple pectin, and grapefruit pectin were extracted. Protein concentrations in all extracts were determined and visualized using sodium dodecyl sulfate-polyacrylamide gel electrophoresis technique. Immunoglobulin E-binding capacity was determined with Western blot analyses and tandem mass spectrometry for the identification of the culprit allergen in citrus seeds and pectin. RESULTS:In subjects with citrus seed, pectin, and cashew allergies, there was strong immunoglobulin E-reactivity to bands between 17 to 28 kDa and 28 to 38 kDa. The tandem mass spectrometry analysis of these bands indicated the presence of citrin as the culprit allergen. Citrin and Ana o 2 are both 11S globulins belonging to the cupin superfamily, and significant homology was found between these proteins. CONCLUSION/CONCLUSIONS:Citrus pectin may be contaminated with citrus seeds. Citrin, a newly identified allergen in citrus seeds, seems to be the culprit antigen in citrus seeds and contaminated citrus pectin. Citrin is highly homologous with Ana o 2 in cashew and Pis v 2 in pistachio, suggesting potential for cross-reactivity and providing an explanation for co-allergenicity of cashew or pistachio, citrus seeds, and citrus pectin.
PMID: 37659472
ISSN: 1534-4436
CID: 5590112

The Remaining Challenge to Diagnose and Manage Cow's Milk Allergy: An Opinion Paper to Daily Clinical Practice

Vandenplas, Yvan; Meyer, Rosan; Nowak-Wegrzyn, Anna; Salvatore, Silvia; Venter, Carina; Vieira, Mario C
Guidelines and recommendations for the diagnosis and management of cow's milk allergy (CMA) in childhood are based on scientific review of the available evidence. While this approach is the most rigorous, guidelines may not fully address all scenarios encountered by clinicians. Many symptoms of CMA overlap with other common childhood illnesses and are subjectively reported by the caregivers of the infant, as is the interpretation of the dietary interventions. Additionally, many healthcare professionals and caregivers do not follow the recommendations to perform an oral food challenge or reintroduction of cow's milk after a diagnostic elimination diet because (1) the infant is doing well and (2) the carer's fear of symptoms relapsing with this procedure. As a result, CMA in infants may be either under-diagnosed leading to reduced quality of life for families or over-diagnosed, resulting in unnecessary long-term elimination diets and increasing the risk for nutritional deficiencies. This paper discusses some of these controversial topics, focusing on misdiagnosis and mismanagement in clinical practice. The lack of objective diagnostic criteria can hamper the diagnosis and management of CMA in daily practice.
PMID: 38004156
ISSN: 2072-6643
CID: 5609082

Feeding difficulties in children with food protein-induced enterocolitis syndrome

Flom, Julie D; Groetch, Marion; Kovtun, Kyle; Westcott-Chavez, Amity; Schultz, Fallon; Nowak-Wegrzyn, Anna
PMID: 37263350
ISSN: 2213-2201
CID: 5543412