The field of food allergy has seen tremendous change over the past 5-10 years with seminal studies redefining our approach to prevention and management and novel testing modalities in the horizon. Early introduction of allergenic foods is now recommended, challenging the previous paradigm of restrictive avoidance. The management of food allergy has shifted from a passive avoidance approach to active interventions that aim to provide protection from accidental exposures, decrease allergic reaction severity and improve the quality of life of food-allergic patients and their families. Additionally, novel diagnostic tools are making their way into the clinical practice with the goal to reduce the need for food challenges and assist physicians in the -- often complex -- diagnostic process. With all the new developments and available choices for diagnosis, prevention and therapy, shared decision-making has become a key part of the medical consultation, enabling patients to make the right choice for them, based on their values and preferences. Communication with patients has also become more complex over time, as patients are seeking advice online and through social media, but the information found online may be outdated, incorrect, or lacking in context. The role of the allergist has evolved to embrace all the above exciting developments and provide patients with the optimal care that fits their needs. In this review, we discuss recent developments, as well as the evolution of the field of food allergy in the next decade.

Rosan Meyer

and 11 more

Gastro-oesophageal reflux (GOR) and food allergy (FA) are common conditions, especially during the first 12 months of life. When GOR leads to troublesome symptoms, that affect daily functioning of the infant and family, it is referred to GOR disease (GORD). The role of food allergens as a cause of GORD remains controversial. This European Academy of Allergy and Clinical Immunology (EAACI) position paper aims to review the evidence for FA-associated GORD in young children and translate this into clinical practice that guides healthcare professionals through the diagnosis of suspected FA-associated GORD and the medical and dietary management. The Task Force (TF) on non-IgE mediated allergy consists of EAACI experts in paediatric gastroenterology, allergy, dietetics and psychology from Europe, United Kingdom, United States, Turkey and Brazil. Six clinical questions were formulated, amended and approved by the TF to guide this publication. A systematic literature search using PubMed, Cochrane and EMBASE databases (until June 2021) using a predefined inclusion criteria based on the 6 questions was used. The TF also gained access to the database from the European Society of Paediatric Gastroenterology and Hepatology working group, who published guidelines on GORD and ensured that all publications used within that position paper were included. For each of the 6 questions, practice points were formulated, followed by a modified Delphi method consisting of anonymous web-based voting that was repated with modified practice points where required, until at least 80% consensus for each practice point was achieved. This TF position paper shares the process, the discussion and consensus on all practice points on FA-associated GORD.

Daniil Lisik

and 15 more

Carina Venter

and 9 more

Background Two studies examining the association between maternal diet inflammatory indices (DII) during pregnancy and offspring asthma and/or wheeze have shown either no effect, or increased risk. Neither study investigated a biological pathway for the association. We examined the association between maternal DII and risk of offspring asthma and/or wheeze, and sought to determine whether cord sera cytokines/chemokines might connect maternal DII with offspring risk. Methods Analysis included 1228 dyads in Healthy Start, a prospective prebirth cohort from Colorado. DII scores were computed for each mother based on repeated 24-hour dietary recalls during pregnancy. Child diagnosis of asthma and/or wheeze up to four years was obtained from electronic medical records. For a subset of participants, cord sera was analyzed for five cytokines and two chemokines. Results Unadjusted analyses showed positive association between maternal DII scores and child asthma and/or wheeze by 4 years (OR = 1.17; 95% CI: 1.07, 1.27), but the association was attenuated and no longer significant in adjusted models (OR = 1.13; 95% CI: 0.99, 1.28). There were no significant associations between cord sera cytokines/chemokines and child asthma and/or wheeze. There were no significant assocations between DII scores and any cytokine or chemokine measured. Conclusion Our study showed that the inflammatory profile of the maternal diet was not significantly associated with offspring asthma and/or wheeze or cord sera cytokines and chemokines. Although the maternal diet in pregnancy seems an obvious biological target for asthma and/or wheeze prevention, factors other than the inflammatory profile need to be investigated.