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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 38139

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Dr. Carla Mastrorilli

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Guest Editor

Department of Pediatrics and Emergency, Pediatric Allergy and Pulmonology Unit, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Pediatric Hospital Giovanni XXIII, 70126 Bari, Italy
Interests: allergy; allergy diagnosis; allergens; allergic sensitization; children; diabetes mellitus; eczema; food allergy; nutrition; pediatrics

Special Issue Information

Dear Colleagues,

I would like to invite you to contribute to this Special Issue of Nutrients, addressing the topic‘Nutrition, Diet and Food Allergy’. Globally, food allergy affects 1.5% of adults and 5% of children and this prevalence is increasing in recent decades, representing a public health problem.

Different mechanisms are involved in food allergic diseases with distinctive clinical characteristics: IgE-mediated and non-IgE-mediated phenotypes will be distinguished in the Issue, considering the early recent literature on the prevalence, age of onset, follow-up recommendations and duration of food allergies.

Moreover, the management of these fascinating diseases will be discussed with particular attention on nutritional hazards, risks of allergic reactions to new allergens, problems with missed labelling (precautionary allergen labelling (PAL)). Especially, the dietary restrictions and the re-introduction of allergens lead to a significant burden for affected patients, fear of accidental ingestions and related risk of severe reactions, resulting in a reduced quality of life among patients with food allergies.

This Special Issue of Nutrients aims to collect an overview of the current body of evidence on the latest epidemiological, pathogenetic, and diagnostic findings on food allergies and the role of nutrition on the disease, in particular at pediatric age.

This information will provide novelties to health care professionals with a widespread, clear and update evidences in pediatric care.

I remain at your disposal for any further question.

Dr. Carla Mastrorilli
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Allergy
Breastfeeding
Children
Food labelling
Food allergy
Maternal diet
Nutrition
Non-IgE mediated
Rare allergic disorders
Tolerance

Published Papers (10 papers)

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Research

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21 pages, 2667 KiB

Open AccessArticle

The Risk of Undeclared Allergens on Food Labels for Pediatric Patients in the European Union

by Montserrat Martínez-Pineda and Cristina Yagüe-Ruiz

Nutrients 2022, 14(8), 1571; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14081571 - 10 Apr 2022

Cited by 11 | Viewed by 2984

Abstract

The dietary avoidance of allergens has been widely recognized as the key intervention in the management of food allergies, but the presence of undeclared allergens makes compliance difficult. The aim of this study was to analyze the presence of undeclared allergens in food labeling through RASFF notifications in the European Union, focusing on those allergens that frequently affect the pediatric population and the implicated products, so as to provide useful information for its risk evaluation and the development of educational materials for patients. The results showed milk (20.5%), gluten (14.8%), and nuts (10.9%) to be the pediatric allergens with higher presences. In 80% of the notifications concerning milk and milk derivatives, the specific compound present (lactose or lactoprotein) was not identified. They were mainly present in cereal and bakery products, prepared dishes and snacks, and cacao and confectionery products, all of which are frequently consumed by the pediatric population. The large quantity (7.6%) of undeclared allergens in “free-from-allergen” products was also remarkable, especially in regard to the supposedly not-present allergens. Undeclared allergens in food products pose an evident risk for allergic patients and knowledge of them should take a relevant role in a patient’s nutritional education. It is also necessary to raise awareness among manufacturers and safety authorities. Full article

(This article belongs to the Special Issue Nutrition, Diet and Food Allergy)

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9 pages, 479 KiB

Open AccessArticle

Food Protein-Induced Enterocolitis Syndrome in Children with Down Syndrome: A Pilot Case-Control Study

by Fumiko Okazaki, Hiroyuki Wakiguchi, Yuno Korenaga, Kazumasa Takahashi, Hiroki Yasudo, Ken Fukuda, Mototsugu Shimokawa and Shunji Hasegawa

Nutrients 2022, 14(2), 388; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14020388 - 17 Jan 2022

Cited by 3 | Viewed by 2558

Abstract

Food protein-induced enterocolitis syndrome (FPIES) is a non-immunoglobin E-mediated food hypersensitivity disorder. However, little is known about the clinical features of FPIES in patients with Down syndrome (DS). Medical records of children with DS diagnosed at our hospital between 2000 and 2019 were retrospectively reviewed. Among the 43 children with DS, five (11.6%) were diagnosed with FPIES; all cases were severe. In the FPIES group, the median age at onset and tolerance was 84 days and 37.5 months, respectively. Causative foods were cow’s milk formula and wheat. The surgical history of colostomy was significantly higher in the FPIES group than in the non-FPIES group. A colostomy was performed in two children in the FPIES group, both of whom had the most severe symptoms of FPIES, including severe dehydration and metabolic acidosis. The surgical history of colostomy and postoperative nutrition of formula milk feeding may have led to the onset of FPIES. Therefore, an amino acid-based formula should be considered for children who undergo gastrointestinal surgeries, especially colostomy in neonates or early infants. When an acute gastrointestinal disease is suspected in children with DS, FPIES should be considered. This may prevent unnecessary tests and invasive treatments. Full article

(This article belongs to the Special Issue Nutrition, Diet and Food Allergy)

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14 pages, 1068 KiB

Open AccessArticle

Threshold of Reactivity and Tolerance to Precautionary Allergen-Labelled Biscuits of Baked Milk- and Egg-Allergic Children

by Vincenzo Fierro, Valeria Marzano, Linda Monaci, Pamela Vernocchi, Maurizio Mennini, Rocco Valluzzi, Stefano Levi Mortera, Rosa Pilolli, Lamia Dahdah, Veronica Calandrelli, Giorgia Bracaglia, Stefania Arasi, Carla Riccardi, Alessandro Fiocchi and Lorenza Putignani

Nutrients 2021, 13(12), 4540; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13124540 - 18 Dec 2021

Cited by 7 | Viewed by 3231

Abstract

Extremely sensitive food-allergic patients may react to very small amounts of allergenic foods. Precautionary allergen labelling (PAL) warns from possible allergenic contaminations. We evaluated by oral food challenge the reactivity to a brand of PAL-labelled milk- and egg-free biscuits of children with severe milk and egg allergy. We explored the ability of proteomic methods to identify minute amounts of milk/egg allergens in such biscuits. Traces of milk and/or egg allergens in biscuits were measured by two different liquid-chromatography-mass spectrometry methods. The binding of patient’s serum with egg/milk proteins was assessed using immunoblotting. None of the patients reacted to biscuits. Egg and milk proteins were undetectable with a limit of detection of 0.6 µg/g for milk and egg (method A), and of 0.1 and 0.3 µg /g for milk and egg, respectively (method B). The immunoblots did not show milk/egg proteins in the studied biscuits. Milk/egg content of the biscuits is far lower than 4 µg of milk or egg protein per gram of product, the minimal doses considered theoretically capable of causing reactions. With high sensitivity, proteomic assessments predict the harmlessness of very small amount of allergens in foods, and can be used to help avoiding unnecessary PAL. Full article

(This article belongs to the Special Issue Nutrition, Diet and Food Allergy)

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14 pages, 738 KiB

Open AccessArticle

Chronic Milk-Dependent Food Protein-Induced Enterocolitis Syndrome in Children from West Pomerania Region

by Karolina Bulsa, Małgorzata Standowicz, Elżbieta Baryła-Pankiewicz and Grażyna Czaja-Bulsa

Nutrients 2021, 13(11), 4137; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13114137 - 19 Nov 2021

Cited by 2 | Viewed by 2211

Abstract

Characteristics of chronic milk-dependent food protein-induced enterocolitis syndrome (FPIES) in children from the region of Western Pomerania were studied. Prospectively, 55 children were diagnosed at a median of 2.2 months. The open food challenges (OFC), morphologies, milk-specific IgE (sIgE) (FEIA method, CAP system), and skin prick tests (SPTs) were examined. Vomiting and diarrhea escalated gradually but quickly led to growth retardation. Of the infants, 49% had BMI < 10 c, 20% BMI < 3 c; 25% had anemia, and 15% had hypoalbuminemia. During the OFCs we observed acute symptoms that appeared after 2–3 h: vomiting diarrhea and pallor. A total of 42% children required intravenous hydration. Casein hydrolysates or amino acids formulae (20%) were used in treatment. In 25% of children, SPT and milk sIgE were found, in 18%—other food SPTs, and in 14% allergy to other foods. A transition to IgE-dependent milk allergy was seen in 3 children. In the twelfth month of life, 62% of children had tolerance to milk, and in the twenty-fifth month—87%. Conclusions. Chronic milk-dependent FPIES resolves in most children. By the age of 2 children are at risk of multiple food sensitization, and those who have milk sIgE are at risk to transition to IgE-mediated milk allergy. Every OFC needs to be supervised due to possible severe reactions. Full article

(This article belongs to the Special Issue Nutrition, Diet and Food Allergy)

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12 pages, 712 KiB

Open AccessArticle

Nut Allergy: Clinical and Allergological Features in Italian Children

by Sylvie Tagliati, Simona Barni, Mattia Giovannini, Giulia Liccioli, Lucrezia Sarti, Tatiana Alicandro, Erika Paladini, Giancarlo Perferi, Chiara Azzari, Elio Novembre and Francesca Mori

Nutrients 2021, 13(11), 4076; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13114076 - 15 Nov 2021

Cited by 5 | Viewed by 2300

Abstract

Background: Nut allergies are an increasingly frequent health issue in the pediatric population. Tree nuts (TN) and peanuts are the second cause of food anaphylaxis in Italy. Unfortunately, knowledge of the clinical characteristics of a TN allergy in Italian children is limited. Our study aimed to identify the clinical and allergological characteristics of Italian children with a nut allergy (TN and peanut). Methods: A retrospective observational analysis was performed on the clinical charts of children with a history of nut reaction referred to the allergy unit of the hospital from 2015 to 2019. The studied population was represented by children with a confirmed nut allergy based on positive prick by prick and/or serum-specific IgE to nut plus a positive nut oral food challenge. Demographic, clinical, and allergological features were studied and compared among different nuts. Results: In total, 318 clinical charts were reviewed. Nut allergy was confirmed in 113 patients. Most patients (85/113, 75%) had a familial history of allergy and/or a concomitant allergic disorder (77/113, 68%). Hazelnut and walnut were the more common culprit nuts observed in allergic children. Anaphylaxis was the first clinical manifestation of nut allergy in a high percentage of children (54/113, 48%). The mean age of the first nut reaction was statistically higher with pine nuts. Over 75% of children reported a single nut reaction. During the OFCs, the signs and symptoms involved mainly the gastrointestinal system (82/113, 73%) and resolved spontaneously in most cases. Severe reactions were not frequent (22/113, 19%). Conclusion: To our knowledge, this is the first Italian study that provided a comprehensive characterization of children with a nut allergy. These results are important for clinicians treating children with a nut allergy. Full article

(This article belongs to the Special Issue Nutrition, Diet and Food Allergy)

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20 pages, 1967 KiB

Open AccessArticle

A Combined Analysis of Gut and Skin Microbiota in Infants with Food Allergy and Atopic Dermatitis: A Pilot Study

by Ewa Łoś-Rycharska, Marcin Gołębiewski, Marcin Sikora, Tomasz Grzybowski, Marta Gorzkiewicz, Maria Popielarz, Julia Gawryjołek and Aneta Krogulska

Nutrients 2021, 13(5), 1682; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13051682 - 15 May 2021

Cited by 25 | Viewed by 4255

Abstract

The gut microbiota in patients with food allergy, and the skin microbiota in atopic dermatitis patients differ from those of healthy people. We hypothesize that relationships may exist between gut and skin microbiota in patients with allergies. The aim of this study was to determine the possible relationship between gut and skin microbiota in patients with allergies, hence simultaneous analysis of the two compartments of microbiota was performed in infants with and without allergic symptoms. Fifty-nine infants with food allergy and/or atopic dermatitis and 28 healthy children were enrolled in the study. The skin and gut microbiota were evaluated using 16S rRNA gene amplicon sequencing. No significant differences in the α-diversity of dermal or fecal microbiota were observed between allergic and non-allergic infants; however, a significant relationship was found between bacterial community structure and allergy phenotypes, especially in the fecal samples. Certain clinical conditions were associated with characteristic bacterial taxa in the skin and gut microbiota. Positive correlations were found between skin and fecal samples in the abundance of Gemella among allergic infants, and Lactobacillus and Bacteroides among healthy infants. Although infants with allergies and healthy infants demonstrate microbiota with similar α-diversity, some differences in β-diversity and bacterial species abundance can be seen, which may depend on the phenotype of the allergy. For some organisms, their abundance in skin and feces samples may be correlated, and these correlations might serve as indicators of the host’s allergic state. Full article

(This article belongs to the Special Issue Nutrition, Diet and Food Allergy)

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12 pages, 1376 KiB

Open AccessArticle

Maternal Vegetable and Fruit Consumption during Pregnancy and Its Effects on Infant Gut Microbiome

by Hsien-Yu Fan, Yu-Tang Tung, Yu-Chen S. H. Yang, Justin BoKai Hsu, Cheng-Yang Lee, Tzu-Hao Chang, Emily Chia-Yu Su, Rong-Hong Hsieh and Yang-Ching Chen

Nutrients 2021, 13(5), 1559; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13051559 - 05 May 2021

Cited by 20 | Viewed by 4993

Abstract

Maternal nutrition intake during pregnancy may affect the mother-to-child transmission of bacteria, resulting in gut microflora changes in the offspring, with long-term health consequences in later life. Longitudinal human studies are lacking, as only a small amount of studies showing the effect of nutrition intake during pregnancy on the gut microbiome of infants have been performed, and these studies have been mainly conducted on animals. This pilot study explores the effects of high or low fruit and vegetable gestational intake on the infant microbiome. We enrolled pregnant women with a complete 3-day dietary record and received postpartum follow-up. The 16S rRNA gene sequence was used to characterize the infant gut microbiome at 2 months (n = 39). Principal coordinate analysis ordination revealed that the infant gut microbiome clustered differently for high and low maternal fruit and vegetable consumption (p < 0.001). The linear discriminant analysis effect size and feature selection identified 6 and 17 taxa from both the high and low fruit and vegetable consumption groups. Among the 23 abundant taxa, we observed that six maternal intake nutrients were associated with nine taxa (e.g., Erysipelatoclostridium, Isobaculum, Lachnospiraceae, Betaproteobacteria, Burkholderiaceae, Sutterella, Clostridia, Clostridiales, and Lachnoclostridium). The amount of gestational fruit and vegetable consumption is associated with distinct changes in the infant gut microbiome at 2 months of age. Therefore, strategies involving increased fruit and vegetable consumption during pregnancy should be employed for modifying the gut microbiome early in life. Full article

(This article belongs to the Special Issue Nutrition, Diet and Food Allergy)

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Review

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14 pages, 458 KiB

Open AccessReview

Phenotypes and Endotypes of Peach Allergy: What Is New?

by Simona Barni, Davide Caimmi, Fernanda Chiera, Pasquale Comberiati, Carla Mastrorilli, Umberto Pelosi, Francesco Paravati, Gian Luigi Marseglia and Stefania Arasi

Nutrients 2022, 14(5), 998; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14050998 - 26 Feb 2022

Cited by 5 | Viewed by 4288

Abstract

Peach allergy is emerging as a common type of fresh-fruit allergy in Europe, especially in the Mediterranean area. The clinical manifestations of peach allergy tend to have a peculiar geographical distribution and can range from mild oral symptoms to anaphylaxis, depending on the allergic sensitization profile. The peach allergen Pru p 7, also known as peamaclein, has recently been identified as a marker of peach allergy severity and as being responsible for peculiar clinical features in areas with high exposure to cypress pollen. This review addresses the latest findings on molecular allergens for the diagnosis of peach allergy, the clinical phenotypes and endotypes of peach allergy in adults and children, and management strategies, including immunotherapy, for peach allergy. Full article

(This article belongs to the Special Issue Nutrition, Diet and Food Allergy)

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16 pages, 1818 KiB

Open AccessReview

Food Allergy Education and Management in Schools: A Scoping Review on Current Practices and Gaps

by Mae Jhelene L. Santos, Kaitlyn A. Merrill, Jennifer D. Gerdts, Moshe Ben-Shoshan and Jennifer L. P. Protudjer

Nutrients 2022, 14(4), 732; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14040732 - 09 Feb 2022

Cited by 17 | Viewed by 4326

Abstract

Currently, no synthesis of in-school policies, practices and teachers and school staff’s food allergy-related knowledge exists. We aimed to conduct a scoping review on in-school food allergy management, and perceived gaps or barriers in these systems. We conducted a PRISMA-ScR-guided search for eligible English or French language articles from North America, Europe, or Australia published in OVID-MedLine, Scopus, and PsycINFO databases. Two reviewers screened 2010 articles’ titles/abstracts, with 77 full-text screened. Reviewers differed by language. Results were reported descriptively and thematically. We included 12 studies. Among teachers and school staff, food allergy experiences, training, and knowledge varied widely. Food allergy experience was reported in 10/12 studies (83.4%); 20.0–88.0% had received previous training (4/10 studies; 40.0%) and 43.0–72.2% never had training (2/10 studies; 20.0%). In-school policies including epinephrine auto-injector (EAI) and emergency anaphylaxis plans (EAP) were described in 5/12 studies (41.7%). Educational interventions (8/12 studies; 66.7%) increased participants’ knowledge, attitudes, beliefs, and confidence to manage food allergy and anaphylaxis vs. baseline. Teachers and school staff have more food allergy-related experiences than training and knowledge to manage emergencies. Mandatory, standardized training including EAI use and evaluation, and the provision of available EAI and EAPs may increase school staff emergency preparedness. Full article

(This article belongs to the Special Issue Nutrition, Diet and Food Allergy)

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12 pages, 543 KiB

Open AccessReview

Heiner Syndrome and Milk Hypersensitivity: An Updated Overview on the Current Evidence

by Stefania Arasi, Carla Mastrorilli, Luca Pecoraro, Mattia Giovannini, Francesca Mori, Simona Barni, Lucia Caminiti, Riccardo Castagnoli, Lucia Liotti, Francesca Saretta, Gian Luigi Marseglia and Elio Novembre

Nutrients 2021, 13(5), 1710; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13051710 - 18 May 2021

Cited by 8 | Viewed by 5511

Abstract

Infants affected by Heiner syndrome (HS) display chronic upper or lower respiratory tract infections, including otitis media or pneumonia. Clinically, gastrointestinal signs and symptoms, anemia, recurrent fever and failure to thrive can be also present. Chest X-rays can show patchy infiltrates miming pneumonia. Clinical manifestations usually disappear after a milk-free diet. The pathogenetic mechanism underlying HS remains unexplained, but the formation of immune complexes and the cell-mediated reaction have been proposed. Patients usually outgrow this hypersensitivity within a few years. The aim of this review is to provide an updated overview on the current evidence on HS in children, with a critical approach on the still undefined points of this interesting disease. Finally, we propose the first structured diagnostic approach for HS. Full article

(This article belongs to the Special Issue Nutrition, Diet and Food Allergy)

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