19. Fish muscles express parvalbumin Bony fish have fast twitching white muscle for rapid movements and dark muscle for continuous swimming. Active fish, such as tuna, skipjack, and swordfish have a higher proportion of dark muscles than bottom dwelling fish, such as cod, flounder, or whiff. Dark muscle contains lower levels of parvalbumins , thus these fish species are expected to be of lower allergenicity. Expression levels of parvalbumins determine allergenicity of fish species. Griesmeier Allergy 2010:65:184

22. PROSPECTIVE FOLLOW-UP ORAL FOOD CHALLENGE IN FOOD PROTEIN-INDUCED ENTEROCOLITIS SYNDROME Hwang Arch Dis Child 2009;94:425 100 – 90 – 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 63.6% 91.7% TOLERANCE RATE AT 10 MONTHS Cow’s milk Soy 100 – 90 – 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 41.7% 90.9% TOLERANCE RATE AT 8 MONTHS Cow’s milk Soy

23. PROSPECTIVE FOLLOW-UP ORAL FOOD CHALLENGE IN FOOD PROTEIN-INDUCED ENTEROCOLITIS SYNDROME Hwang Arch Dis Child 2009;94:425 100 – 90 – 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 63.6% 91.7% TOLERANCE RATE AT 10 MONTHS Cow’s milk Soy 100 – 90 – 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 41.7% 90.9% TOLERANCE RATE AT 8 MONTHS Cow’s milk Soy In infantile FPIES, the first FU-OFC should be performed with soy at 6–8 months of age and cow’s milk FU-OFC should be conducted at over 12 months of age

25. Svezzamento

28. OR for sentitization 3 – 2 – 1 – 0 Age at the Introduction of Solid Foods During the First Year and Allergic Sensitization at Age 5 Years Nwaru Pediatrics 2010;125:50 Potatoes >4 mo Milk >4 mo Fruits >4 mo Wheat >6 mo Rye >7 mo Meat >6 mo Fish >8 mo Egg >10 mo 2.56 1.51 2.2 2.42 1.65 2.30 1.49 1.70

35. Infant feeding and allergy prevention: a review of current knowledge and recommendations. A EuroPrevall state of the art paper. Grimshaw Allergy 2009:64:1407 3) Evidence related to the timing of introduction of complementary foods Studies have raised the possibility that delaying the introduction of foods into an infant's diet (particularly of allergenic foods) is not beneficial and may actually increase the risk of the child developing allergic diseases Zutavern A, Arch Dis Child 2004;89:303–308. Zutavern A, Pediatrics 2008;121:e44–e52. Snijders BE, Pediatrics 2008;122:e115–e122. Filipiak B, J Pediatr 2007;151:352–358. Poole JA, Pediatrics 2006;117:2175–2182. Grimshaw KE, J Allergy Clin Immunol 2004;113:S145

36. Infant feeding and allergy prevention: a review of current knowledge and recommendations. A EuroPrevall state of the art paper. Grimshaw Allergy 2009:64:1407 4) Evidence related to the use of pro-and/or prebiotic supplements Although pro-, pre- and synbiotics are theoretically promising candidates to prevent allergic diseases, results of clinical trials are not conclusive . Some trials show favourable results with regard to AD , but there is currently not enough evidence to support the use of pro-, pre- or synbiotics for prevention of allergic disease in clinical practice.

37. Infant feeding and allergy prevention: a review of current knowledge and recommendations. A EuroPrevall state of the art paper. Grimshaw Allergy 2009:64:1407 5) Recommendations on the duration of exclusive breastfeeding ESPACI and ESPGHAN recommend that high-risk infants should be fed with a formula of confirmed reduced allergenicity if they are not breast fed . 6) Recommendations on infant cow's milk based formulas ESPACI and ESPGHAN jointly recommended exclusive breastfeeding for 4–6 months for allergy prevention. The WHO recommends exclusive breastfeeding for 6 mo.

39. Aluminium per se and in the anti-acid drug sucralfate promotes sensitization via the oral route Brunner Allergy 2009:64:890 Background: Aluminium (ALUM) is used as experimental and clinical adjuvant for parenteral vaccine formulation. It is also contained in anti-acid drugs like sucralfate (SUC). These anti-acids have been shown to cause sensitization to food proteins via elevation of the gastric pH. The aim of this study was to assess the oral adjuvant properties of ALUM, alone or contained in SUC, in a BALB/c mouse model.

40. Aluminium per se and in the anti-acid drug sucralfate promotes sensitization via the oral route Brunner Allergy 2009:64:890 The highest OVA-specific immunoglobulin G1 (IgG1) and IgE antibody levels were found in mice fed with OVA/SUC, followed by OVA/ALUM-treated animals, indicating a T helper 2 (Th2) shift in both groups. Antibody levels in other groups revealed lower (OVA/PPI-group) or baseline levels (control groups). Orally applied SUC leads to an enhanced risk for food allergy, not only by inhibiting peptic digestion but also by acting as a Th2-adjuvant by its ALUM content. 1) Ovalbumin + Sucralfate 2) Ovalbumin + Allum or 3) Ovalbumin + proton pump inhibitor or

41. Aluminium per se and in the anti-acid drug sucralfate promotes sensitization via the oral route Brunner Allergy 2009:64:890 Alum is a ubiquitous element in western regions. It is present in drinking water – especially in urban areas – as well as in food such as soy-based milk products, baking powder, frozen products ALUM is used in water purification, sugar refining and brewing. Many drugs use ALUM either as an additive (antacids, analgesics, antidiabetic drugs, etc.)

51. Food allergy and food allergy attitudes among college students. Greenhawt JACI 2009;124:323 Avoiding Allergenic Foods 39.7% 40 – 30 – 20 – 10 – 0 % SUBJECTS WITH FOOD ALLERGY Having Self-injectable Epinephrine Always Carrying Self-injectable Epinephrine 21% 6% ONLY!

53. Reasons justifying food allergy risk-taking behavior among university students Food allergy and food allergy attitudes among college students. Greenhawt JACI 2009;124:323 Reasons given ∗ Percentage (n = 173) No history of severe reaction 37.6 (n = 65) Do not have consistent symptoms 21.9 (n = 38) Do not perceive this to be a risky action 20.8 (n = 36) Belief that item does not contain enough allergen to trigger a reaction 18.5 (n = 32) Belief that I could treat any reaction that occurred 17.9 (n = 31) Belief that I can eat around the allergen 14.5 (n = 25) Indifference 12.1 (n = 21) Last reaction was in the distant past 10.4 (n = 1) ∗ Students were allowed to select multiple reasons.

61. Longitudinal validity and responsiveness of the Food Allergy Quality of Life Questionnaire – Parent Form in children 0–12 years following positive and negative food challenges DunnGalvin, CEA 2010;40:476 Background: There are no published studies of longitudinal health-related quality of life (HRQL) assessments of food-allergic children using a disease-specific measure. Objective: This study assessed the longitudinal measurement properties of the Food Allergy Quality of Life Questionnaire – Parent Form (FAQLQ-PF) in a sample of children undergoing food challenge.

66. Food allergy Diagnostic aspects

67. Prospective association between food sensitization and food allergy: results of the LISA birth cohort study Schnabel, CEA 2010;40:450 Background: Food allergy is common, especially in childhood, where 6–8% of children are affected. Identification of early and efficient markers for later development of food allergy is very important. Objective: We examined the ability of repeated measurements of food sensitization in early childhood to predict doctor-diagnosed food allergy (DDFA) at the age of 6 years.

71. Utility of diagnostic tests in the follow-up of egg-allergic children Diéguez Clinical & Experimental Allergy 2009;39:1575 80.7% A 7 mm egg white prick test Positive likelihood ratio of 6.7 Level of 1.3 KU/L egg white-sIgE Measuring the SPT and sIgE levels is useful to predict persistent allergy in these children, especially with the egg white complete extract. Positive likelihood ratio of 5.1

76. Oropharyngeal symptoms predict objective symptoms in double-blind,placebo-controlled food challenges to cow's milk Kok Allergy 2009:64:1226 Subjective and objective symptoms during DBPCFC to cow's milk No. Subjective symptom(s) (Objective) symptom(s) preceded by OS 1 Transient localized erythema, sensation of pain in throat and mouth (OS) 2 Oral pruritus tongue and throat (OS), nausea 3 Oral pruritus/tingling (OS) 4 Transient localized pruritus face, pain in palate (OS), abdominal pain, nausea 5 Transient localized flushing, oral pruritus (OS) Generalized pruritus with erythema and scratching, sneezing, rhinoconjunctivitis, dyspnoea Repetitive vomiting, wheezing, dyspnoea Generalized urticaria Rhinorrhoea, conjunctivitis Sensation of throat tightness, mild dyspnoea

77. Oropharyngeal symptoms predict objective symptoms in double-blind,placebo-controlled food challenges to cow's milk Kok Allergy 2009:64:1226 Subjective and objective symptoms during DBPCFC to cow's milk No. Subjective symptom(s) (Objective) symptom(s) preceded by OS 6 Sensation of swelling lip, sensation of pruritus throat (OS), abdominal pain 7 Oral pruritus tongue (OS) 8 Pruritus throat (OS), abdominal pain 9 Transient localized erythema, sensation of pain in mouth (OS) Repetitive vomiting, rhinorrhoea Change in activity level (fatigue), malaise, pale skin Conjunctivitis, generalized urticaria Repetitive vomiting, generalized urticaria

80. Predicting the outcome of oral food challenges with hen's egg through skin test end-point titration Tripodi C EA 2010;39:1225 Background: Oral food challenge (OFC) is the diagnostic 'gold standard' of food allergies but it is laborious and time consuming. Attempts to predict a positive OFC through specific IgE assays or conventional skin tests so far gave suboptimal results. Objective: To test whether skin test with titration curves predict with enough confidence the outcome of an oral food challenge.

82. Predicting the outcome of oral food challenges with hen's egg through skin test end-point titration Tripodi C EA 2010;39:1225 Sampson HA. Anaphylaxis and emergency treatment. Pediatrics 2003; 111 (Part 3):1601–8. Grading of food-induced anaphylaxis according to severity of clinical symptoms

83. Predicting the outcome of oral food challenges with hen's egg through skin test end-point titration Tripodi C EA 2010;39:1225

84. Predicting the outcome of oral food challenges with hen's egg through skin test end-point titration Tripodi C EA 2010;39:1225 * Established with ROC analysis. † n=31. ROC, receiver operating characteristic; SPT, skin prick test. Best prediction (%) of a positive oral provocation test with hen's egg white skin prick tests (undiluted and titrated) and IgE assays

85. Predicting the outcome of oral food challenges with hen's egg through skin test end-point titration Tripodi C EA 2010;39:1225 Best prediction (%) of a positive oral provocation test with hen's egg white skin prick tests (undiluted and titrated) and IgE assays * Established with ROC analysis. † n=31. ROC, receiver operating characteristic; SPT, skin prick test.

86. Predicting the outcome of oral food challenges with hen's egg through skin test end-point titration Tripodi C EA 2010;39:1225 Best prediction (%) of a positive oral provocation test with hen's egg white skin prick tests (undiluted and titrated) and IgE assays * Established with ROC analysis. † n=31. ROC, receiver operating characteristic; SPT, skin prick test. The extract's dilution that successfully discriminated a positive from a negative OFC (sensitivity 95%, specificity 100%) was 1:256

91. Assessment of the tolerance to lupine-enriched pasta in peanut-allergic children Fiocchi CEA 2010;39:1045 Lupine flour is increasingly used in the food industry because of its protein-rich composition and good technological characteristics. Lupine ( Lupinus spp.) is a member of the Fabaceae (ex Leguminosae ) family which includes the well-known allergen peanut ( Arachis hypogaea ). Used to add protein and fibre and to improve texture, lupine is also an useful alternative to soybean when non-genetically modified food ingredients are sought (e.g. in baby foods).

92. Assessment of the tolerance to lupine-enriched pasta in peanut-allergic children Fiocchi CEA 2010;39:1045 Lupine flour is increasingly used in the food industry because of its protein-rich composition and good technological characteristics. Lupine ( Lupinus spp.) is a member of the Fabaceae (ex Leguminosae ) family which includes the well-known allergen peanut ( Arachis hypogaea ). Used to add protein and fibre and to improve texture, lupine is also an useful alternative to soybean when non-genetically modified food ingredients are sought (e.g. in baby foods). 30–68% of patients allergic to peanuts show positive reactions to lupine flour.

93. In Italy, lupine flour and lupine protein concentrate are being increasingly used in bakery and pasta formulations, in particular in gluten-free products, where lupine derivatives produce better elasticity, texture, and flavour than soybean substitutes Spaghetti fortified with 5% of lupine protein isolate had a colour and rheological features comparable with pasta produced with gluten, and also had good cooking qualities. Assessment of the tolerance to lupine-enriched pasta in peanut-allergic children Fiocchi CEA 2010;39:1045

119. The Prevalence of food hypersensitivity in young adults Osterballe Pediatr Allergy Immunol 2009:20:686 KIWI HAZELNUT PINEAPPLE APPLE ORANGE % foods responsible of hypersensitivity in pollen allergic sub-group 7.8% 10 – 9 – 8 – 7 – 6 – 5 – 4 – 3 – 2 – 1 – 0 4.4% 4.3% 4.2% 6.6%

120. The Prevalence of food hypersensitivity in young adults Osterballe Pediatr Allergy Immunol 2009:20:686 KIWI HAZELNUT PINEAPPLE APPLE ORANGE % foods responsible of hypersensitivity in pollen allergic sub-group 7.8% 10 – 9 – 8 – 7 – 6 – 5 – 4 – 3 – 2 – 1 – 0 4.4% 4.3% 4.2% 6.6% Tomato (3.8%), peach (3.0%), and brazil nuts (2.7%).

127. Food Proteins Induced Enterocolitis

130. PROSPECTIVE FOLLOW-UP ORAL FOOD CHALLENGE IN FOOD PROTEIN-INDUCED ENTEROCOLITIS SYNDROME Hwang Arch Dis Child 2009;94:425 100 – 90 – 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 63.6% 91.7% TOLERANCE RATE AT 10 MONTHS Cow’s milk Soy 100 – 90 – 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 41.7% 90.9% TOLERANCE RATE AT 8 MONTHS Cow’s milk Soy

131. PROSPECTIVE FOLLOW-UP ORAL FOOD CHALLENGE IN FOOD PROTEIN-INDUCED ENTEROCOLITIS SYNDROME Hwang Arch Dis Child 2009;94:425 100 – 90 – 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 63.6% 91.7% TOLERANCE RATE AT 10 MONTHS Cow’s milk Soy 100 – 90 – 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 41.7% 90.9% TOLERANCE RATE AT 8 MONTHS Cow’s milk Soy In infantile FPIES, the first FU-OFC should be performed with soy at 6–8 months of age and cow’s milk FU-OFC should be conducted at over 12 months of age

132. Eosinophilic esophagitis eosinophilic gastritis

134. A symptom scoring tool for identifying pediatric patients with eosinophilic esophagitis and correlating symptoms with inflammation Aceves Ann Allergy Asthma Immunol 2009;103:401 6.51 Total Symptom score values Eosinophilic Esophagitis (N=35) GERD (n=27) Allergic (n=24) Non-allergic (n=14) 7.0 – 6.0 – 5.0 – 4.0 – 3.0 – 2.0 – 1.0 – 0 5.44 0.92 1.0 Patients with

135. Distinguishing symptoms in patients with eosinophilic esophagitis (EE) * P < .05 for patients with GERD or EE compared with control patients. ** P < .05 for patients with GERD compared with patients with EE. ANE indicates anorexia/early satiety; AP, abdominal pain; HB/R, heartburn/regurgitation; NA, nocturnal awakening; N/V, nausea/vomiting. A symptom scoring tool for identifying pediatric patients with eosinophilic esophagitis and correlating symptoms with inflammation Aceves Ann Allergy Asthma Immunol 2009;103:401

136. Distinguishing symptoms in patients with eosinophilic esophagitis (EE) * P < .05 for patients with GERD or EE compared with control patients. ** P < .05 for patients with GERD compared with patients with EE. ANE indicates anorexia/early satiety; AP, abdominal pain; HB/R, heartburn/regurgitation; NA, nocturnal awakening; N/V, nausea/vomiting. A symptom scoring tool for identifying pediatric patients with eosinophilic esophagitis and correlating symptoms with inflammation Aceves Ann Allergy Asthma Immunol 2009;103:401 Dysphagia and anorexia/early satiety identify pediatric patients with EE and correlate symptoms with tissue inflammation.

139. Safety of a peanut oral immunotherapy protocol in children with peanut allergy Hofmann JACI 2009;124:286 OIT protocol The OIT protocol consisted of 3 phases: - an initial escalation day , - a buildup phase , and - a home dosing phase . The goal of OIT was to achieve ingestion of a daily maintenance dose of 300 mg of peanut protein , which is the equivalent of 1 peanut and is greater than the amount that might cause an accidental allergic reaction.

140. Safety of a peanut oral immunotherapy protocol in children with peanut allergy Hofmann JACI 2009;124:286 Initial escalation day On the initial escalation day, subjects were admitted to the Duke Clinical Research Unit, an intravenous catheter was inserted, and diphenhydramine, epinephrine, and albuterol were made immediately available. Each subject first ingested 0.1 mg of peanut protein (Golden Peanut Co, Alpharetta, Ga) mixed in a food vehicle. The dose was doubled every 30 minutes until a maximum dose of 50 mg of peanut protein (cumulative peanut protein, 99 mg) was ingested. If the subject had a mild reaction to a dose, the next dose was determined at the discretion of the investigator: the investigator administered the last previously tolerated dose, waited an additional amount of time between doses, or repeated the current dose. If the subject tolerated this dose, the desensitization process resumed.

141. Safety of a peanut oral immunotherapy protocol in children with peanut allergy Hofmann JACI 2009;124:286 Initial escalation day If the subject continued to have symptoms or if the symptoms were moderate or severe, the desensitization process was discontinued and the highest tolerated dose was recorded. On completion of the initial escalation day, the patient was observed for a minimum of 2 hours. The subject was then discharged home with self-injectable epinephrine after instructions were given to the parents regarding its use. The subject returned to the DCRU the following day for an observed ingestion of the maximum tolerated dose of peanut protein. This dose became the starting dose for home dosing.

142. Safety of a peanut oral immunotherapy protocol in children with peanut allergy Hofmann JACI 2009;124:286 Buildup phase and home dosing phase The subject ingested the daily dose every day at home for a minimum of 2 weeks. If the home doses were well tolerated, the subject underwent an observed dosage escalation schedule whereby the daily dose was increased by 25 mg every 2 weeks at the DCRU until a 300-mg dose was reached. The 300-mg dose was ingested daily for 4-24 months.

147. Safety of a peanut oral immunotherapy protocol in children with peanut allergy Hofmann JACI 2009;124:286 Frequency of treatment Treatment Initial escalation Any 71% (20/28) Diphenhydramine alone 50% (14/28) Albuterol alone 0% Diphenhydramine + albuterol 7% (2/28) Diphenhydramine + epinephrine 11% (3/28) Diphenhydramine + albuterol + epinephrine 4% (1/28)

148. Safety of a peanut oral immunotherapy protocol in children with peanut allergy Hofmann JACI 2009;124:286 Frequency of treatment Treatment Buildup doses Any 1.7% (5/301) Diphenhydramine alone 1% (3/301) Albuterol alone 0% Diphenhydramine + albuterol 0.7% (2/301) Diphenhydramine + epinephrine 0% Diphenhydramine + albuterol + epinephrine 0%

149. Safety of a peanut oral immunotherapy protocol in children with peanut allergy Hofmann JACI 2009;124:286 Frequency of treatment Treatment Home doses Any 0.7% (67/10,184) Diphenhydramine alone 0.4% (45/10,184) Albuterol alone 0.04% (4/10,184) Diphenhydramine + albuterol 0.2% (18/10,184) Diphenhydramine + epinephrine 0% Diphenhydramine + albuterol + epinephrine 0.02% (2/10,184)

160. Effect of heat treatment on the susceptibility of β-lactoglobulin to digestion by trypsin Effect of heat treatment and enzymatic digestion on the B cell epitopes of cow's milk proteins Morisawa CEA 2010;39:918

161. Histamine release from passively sensitized cultured basophils after stimulation with β-lactoglobulin. Untreated (UT), heat-treated (HT), heat-treated and enzymatically digested (ED) for 1 h. Histamine release from passively sensitized cultured basophils after stimulation with α -casein. Untreated (UT), heat-treated (HT), heat-treated and enzymatically digested (ED) for 1 h. Effect of heat treatment and enzymatic digestion on the B cell epitopes of cow's milk proteins Morisawa CEA 2010;39:918

162. Histamine release from passively sensitized cultured basophils after stimulation with β-lactoglobulin. Untreated (UT), heat-treated (HT), heat-treated and enzymatically digested (ED) for 1 h. Histamine release from passively sensitized cultured basophils after stimulation with α -casein. Untreated (UT), heat-treated (HT), heat-treated and enzymatically digested (ED) for 1 h. Heat treatment reduced the allergenicity of β -lactoglobulin by inducing conformational changes and by increasing its susceptibility to enzymatic digestion, both of which disrupted B cell epitopes, whereas heat treatment alone did not alter the allergenicity of α -casein. Effect of heat treatment and enzymatic digestion on the B cell epitopes of cow's milk proteins Morisawa CEA 2010;39:918

163. Food allergy treatment

164. Objectives: To determine the benefits of Lactobacillus rhamnosus GG (LGG) in an extensively hydrolyzed casein formula (EHCF) in improving hematochezia and fecal calprotectin over EHCF alone. Study design: Fecal calprotectin was compared in 30 infants with hematochezia and 4 weeks after milk elimination with that of a healthy group. We also compared fecal calprotectin and hematochezia on 26 formula-fed infants randomly assigned to EHCF with LGG (Nutramigen LGG) (EHCF + LGG) or without (Nutramigen) (EHCF - LGG) and on 4 breastfed infants whose mothers eliminated dairy. Lactobacillus GG Improves Recovery in Infants with Blood in the Stools and Presumptive Allergic Colitis Compared with Extensively Hydrolyzed Formula Alone Baldassarre J Pediatr 2010;156:397

166. Lactobacillus GG Improves Recovery in Infants with Blood in the Stools and Presumptive Allergic Colitis Compared with Extensively Hydrolyzed Formula Alone Baldassarre J Pediatr 2010;156:397

171. Food allergy guidelines