Allergens can change depending on the Food you Eat

https://news.yahoo.com/study-finds-mennonite-moms-breast-161448515.html

Do you have allergies? Are there certain triggers that can make your allergy symptoms worse? One of the things to consider when it comes to managing your allergies is what you’re eating. From dairy products, to legumes and nuts, and even some vegetables – all these foods can cause allergic reactions in many people. Every person will react differently so it’s important to keep track of how specific items affect you. In this blog post, we’ll explore how different types of food can trigger or reduce allergic reactions in individuals with allergies.

It turns out one way to protect babies from developing bad allergies in life is to give them breast milk from Mennonite mothers who grew up on farms. Yes, that’s for real: a new (peer reviewed!) study published in Frontiers in Immunology found that breast milk from Mennonite moms has a greater abundance in the type of antibodies and other immune systems components that protect babies from common allergies.

“Our findings indicate that that breast milk from old order Mennonite mothers contains higher levels of beneficial antibodies, microbes and metabolites that help to ‘program’ the developing gut microbiota and immune system of their babies,” study coauthor Antti Seppo from the University of Rochester said in a statement. “These may protect infants against developing allergic diseases.”

What prompted the study? Allergy rates in Western societies have exploded in the early 20th century. One theory explaining this phenomenon argues that lately people have adopted cleaner and more sedentary lives that leave them less exposed to the outside world, which means the immune system is unable to prime itself to co-exist with a lot of foreign substances. A lot of immunity during infancy is passed down from mother to child via breast milk—so over several generations, that breast milk would contain fewer antibodies that tell the body certain airborne dust and certain foods are actually safe.

Mennonite mothers, on the other hand, live very traditional one-family farming lives with little modern technology. They are constantly exposed to pollen and animal dander, unpasteurized milk and other dairy products, and livestock. The research team compared the breast milk of 52 Mennonite women living in Western New York to 29 urban and suburban women living around the city of Rochester. Not only did Mennonite breast milk contain more allergy-associated antibodies, but it also contained a greater diversity of milk microbes that bolster the developing gut microbiota of babies.

The main takeaway here is that it might be good to get outside and touch some grass, at least for your future children’s sake. It is not suggesting you go out and find some Mennonite breast milk.

Seppo AE, Bu K, Jumabaeva M, Thakar J, Choudhury RA, Yonemitsu C, Bode L, Martina CA, Allen M, Tamburini S, Piras E, Wallach DS, Looney RJ, Clemente JC, Järvinen KM. Infant gut microbiome is enriched with Bifidobacterium longum ssp. infantis in Old Order Mennonites with traditional farming lifestyle. Allergy. 2021 Nov;76(11):3489-3503. doi: 10.1111/all.14877. Epub 2021 May 14. PMID: 33905556.

The prevalence of allergic diseases and asthma is increasing rapidly worldwide, with environmental and lifestyle behaviors implicated as a reason. Epidemiological studies have shown that children who grow up on farms are at lower risk of developing childhood atopic disease, indicating the presence of a protective “farm effect”. The Old Order Mennonite (OOM) community in Upstate New York have traditional, agrarian lifestyles, a low rate of atopic disease, and long periods of exclusive breastfeeding. Human milk proteins are heavily glycosylated, although there is a paucity of studies investigating the milk glycoproteome. In this study, we have used quantitative glycoproteomics to compare the N-glycoprotein profiles of 54 milk samples from Rochester urban/suburban and OOM mothers, two populations with different lifestyles, exposures, and risk of atopic disease. We also compared N-glycoprotein profiles according to the presence or absence of atopic disease in the mothers and, separately, the children. We identified 79 N-glycopeptides from 15 different proteins and found that proteins including immunoglobulin A1, polymeric immunoglobulin receptor, and lactotransferrin displayed significant glycan heterogeneity. We found that the abundances of 38 glycopeptides differed significantly between Rochester and OOM mothers and also identified four glycopeptides with significantly different abundances between all comparisons. These four glycopeptides may be associated with the development of atopic disease. The findings of this study suggest that the differential glycosylation of milk proteins could be linked to atopic disease.

Holm M, Saraswat M, Joenväärä S, Seppo A, Looney RJ, Tohmola T, Renkonen J, Renkonen R, Järvinen KM. Quantitative glycoproteomics of human milk and association with atopic disease. PLoS One. 2022 May 13;17(5):e0267967. doi: 10.1371/journal.pone.0267967. PMID: 35559953; PMCID: PMC9106177.

Background: Growing up on traditional, single-family farms is associated with protection against asthma in school age, but the mechanisms against early manifestations of atopic disease are largely unknown. We sought determine the gut microbiome and metabolome composition in rural Old Order Mennonite (OOM) infants at low risk and Rochester, NY urban/suburban infants at high risk for atopic diseases.

Methods: In a cohort of 65 OOM and 39 Rochester mother-infant pairs, 101 infant stool and 61 human milk samples were assessed by 16S rRNA gene sequencing for microbiome composition and qPCR to quantify Bifidobacterium spp. and B. longum ssp. infantis (B. infantis), a consumer of human milk oligosaccharides (HMOs). Fatty acids (FAs) were analyzed in 34 stool and human 24 milk samples. Diagnoses and symptoms of atopic diseases by 3 years of age were assessed by telephone.

Results: At a median age of 2 months, stool was enriched with Bifidobacteriaceae, Clostridiaceae, and Aerococcaceae in the OOM compared with Rochester infants. B. infantis was more abundant (p < .001) and prevalent, detected in 70% of OOM compared with 21% of Rochester infants (p < .001). Stool colonized with B. infantis had higher levels of lactate and several medium- to long/odd-chain FAs. In contrast, paired human milk was enriched with a distinct set of FAs including butyrate. Atopic diseases were reported in 6.5% of OOM and 35% of Rochester children (p < .001).

Conclusion: A high rate of B. infantis colonization, similar to that seen in developing countries, is found in the OOM at low risk for atopic diseases.

Seppo AE, Choudhury R, Pizzarello C, Palli R, Fridy S, Rajani PS, Stern J, Martina C, Yonemitsu C, Bode L, Bu K, Tamburini S, Piras E, Wallach DS, Allen M, Looney RJ, Clemente JC, Thakar J, Järvinen KM. Traditional Farming Lifestyle in Old Older Mennonites Modulates Human Milk Composition. Front Immunol. 2021 Oct 11;12:741513. doi: 10.3389/fimmu.2021.741513. PMID: 34707611; PMCID: PMC8545059.

Background: In addition to farming exposures in childhood, maternal farming exposures provide strong protection against allergic disease in their children; however, the effect of farming lifestyle on human milk (HM) composition is unknown.

Objective: This study aims to characterize the maternal immune effects of Old Order Mennonite (OOM) traditional farming lifestyle when compared with Rochester (ROC) families at higher risk for asthma and allergic diseases using HM as a proxy.

Methods: HM samples collected at median 2 months of lactation from 52 OOM and 29 ROC mothers were assayed for IgA1 and IgA2 antibodies, cytokines, endotoxin, HM oligosaccharides (HMOs), and targeted fatty acid (FA) metabolites. Development of early childhood atopic diseases in children by 3 years of age was assessed. In addition to group comparisons, systems level network analysis was performed to identify communities of multiple HM factors in ROC and OOM lifestyle.

Results: HM contains IgA1 and IgA2 antibodies broadly recognizing food, inhalant, and bacterial antigens. OOM HM has significantly higher levels of IgA to peanut, ovalbumin, dust mites, and Streptococcus equii as well TGF-β2, and IFN-λ3. A strong correlation occurred between maternal antibiotic use and levels of several HMOs. Path-based analysis of HMOs shows lower activity in the path involving lactoneohexaose (LNH) in the OOM as well as higher levels of lacto-N-neotetraose (LNnT) and two long-chain FAs C-18OH (stearic acid) and C-23OH (tricosanoic acid) compared with Rochester HM. OOM and Rochester milk formed five different clusters, e.g., butyrate production was associated with Prevotellaceae, Veillonellaceae, and Micrococcaceae cluster. Development of atopic disease in early childhood was more common in Rochester and associated with lower levels of total IgA, IgA2 to dust mite, as well as of TSLP.

Conclusion: Traditional, agrarian lifestyle, and antibiotic use are strong regulators of maternally derived immune and metabolic factors, which may have downstream implications for postnatal developmental programming of infant’s gut microbiome and immune system.

The food we eat can change the way our body reacts to form allergies. Our western culture is almost too clean, and this leads to changes in our microbiome that favors the development of allergies. There is research demonstrating that subcultures within the United States have very different breast feeding habits during infancy that actually decrease the incidence of allergy in that population. You can remember that probiotics are a good way to prevent allergies and please pay attention to your food–you are what you eat!

#allergy, #food

Lips Like Strawberry Wine…

 

Sometimes even I get surprised by a clinical problem that may not be due to allergy. Every 2-3 months, a patient will come in to the office wondering what has caused the redness, swelling, and cracking of their lips, a condition called chelitis. Of course we many times think this is due to #food allergy, but think again. I wish it were as easy as food allergy. 

Yes, it’s true that foods go past your lips in order to be swallowed, but that may not have anything to do with food allergy or fixing your problem. 

Let’s get it on with those not so strawberry lips….

Background

Evaluation

  • Patients with irritant or allergic cheilitis may present with dryness, scaliness and/or fissuring, with or without erythema or edema of the vermillion border.
    • Ask about common allergens, such as lipsticks, cosmetics, nail polishes, and oral hygiene products; and common irritants, such as wind or cold weather exposure, irritative topicals (lip cosmetics, antiseptics), repeated lip-licking behaviors, and musical instrument contact.
    • For allergic contact cheilitis, consider patch testing if the culprit allergen is not identified by history.
  • Angular cheilitis (also called perleche) may occur in young children or in adults with dentures or dental appliances. Erythema, scaling, fissuring, bleeding, or ulceration is seen at the angle (corner) of the lip, and may be unilateral or bilateral.
  • Actinic cheilitis (also called solar cheilosis) typically presents in older adults (aged > 40 years), more commonly in fair-skinned individuals, and is more common in men. Actinic cheilitis may be seen as dryness, scaliness, color variation on lip, atrophy, leukoplakia, erythema, solitary papule or nodule, and/or with blurring of the vermilion border. Consider biopsy to rule out cutaneous squamous cell carcinoma.
  • Consider other differential diagnoses of lip lesions, such as cutaneous squamous cell carcinoma, basal cell carcinoma, melanoma, salivary gland tumors and metastatic tumors of the lip.

Management

  • Management for any identified infection should follow usual, advised treatment.
  • Management for any identified generalized or systemic causes of cheilitis, such as atopic dermatitis or lichen planus should follow usual, advised treatment.
  • For allergic or irritant cheilitis, advise patients to avoid the culprit agent or exposure. Consider short-term topical steroids for symptoms of pain or pruritus.
  • Management of actinic cheilitis may depend on the type of lesion.
    • For lesions with suspicious features of cutaneous squamous cell carcinoma, obtain biopsy.
    • For well-circumscribed nodules or papules, consider surgical excision.
    • For larger focal lesions, prolonged ulceration, and areas of atrophy, consider topical 5-fluorouracil or imiquimod, or ablation with cryotherapy or electrosurgery.
    • For diffuse disease, particularly if the vermilion border is involved, consider topical 5-fluorouracil or imiquimod, photodynamic therapy, vermilionectomy, or laser treatment.
  • Management of angular cheilitis (perleche) depends on the cause.
    • For idiopathic angular cheilitis, consider application of an emollient barrier such as petroleum jelly.
    • Advise correction or elimination of any sources of irritation, such as ill-fitting dentures.
    • For Staphylococcal infection, use topical mupirocin or fusidic acid.
    • For Candidal infection, use a topical antifungal, such as ketoconazole 2% cream.
    • Replete nutritional deficiencies if present.
  • For cheilitis glandularis, consider intralesional steroid injection, topical tacrolimus or pimecrolimus, or vermilionectomy.
  • For plasma cell cheilitis, consider topical fusidic acid, topical pimecrolimus, or tacrolimus.

The Government Gets It Right!

Supersize Me!

Supersize Me!

Food allergy is a constant source of anxiety to parents of children who could in fact die or suffer a severe reaction to foods.  Believe it or not, the government has done a nice job with information pertaining to public safety, in this case, food allergy in schools.  In case you think I’m kidding about the severity of food allergy, the YouTube link below should change your mind.  The second link from the CDC is the “official word” on food allergy in schools. 

 

http://www.cdc.gov/healthyyouth/foodallergies/index.htm

#center-for-disease-control-and-prevention, #food, #food-allergy

Contradictory skin test and ImmunoCAP results–which is better?

This question comes up in my office almost everyday….should I do skin testing or blood work?  As you can see from the response of national experts, it depends.  There is NO test that can boast 100% accuracy to predict whether or not you will react to a food.  In fact, the gold standard if you will, is still the oral food challenge.  Here is some food for thought (really, do you have to pun)

  1. Clinical history is very important in determining food allergy.  If you can eat a food without difficulty breathing, rash, or hives, you are most likely not allergic.  You may have a positive test, but that only means you’ve had previous exposure to the food.
  2. I will often obtain both skin testing and ImmunoCap (blood work) to clarify the presence of IgE-mediated allergy. If both tests are negative, you may have an adverse reaction to a food, not the severe life-threatening anaphylaxis.  Very important distinction!
  3. If in doubt, a food challenge is always a procedure to consider.  Here’s why.
  4. Sometimes the food in question just isn’t worth the trouble to challenge.  No one says you have to eat strawberries!
  5. If you challenge peanuts for example, in the doctor’s office and experience anaphylaxis, better there than at home.  Epinephrine is more readily available and in many cases, IV access and full resuscitation is available within minutes of your reaction. 
  6. This is another reason why a single test or treating allergy without experience is not a good idea.  Read the link below and tell me just how complicated things can become!

Contradictory skin test and ImmunoCAP results.

#allergy, #anaphylaxis, #food, #immunocap, #immunoglobulin-e

5 Tips for Dodging Frightful Food Allergies this Halloween

From the College of Allergy, Asthma, and Immunology–always a great source of support for allergy treatment.  Click on the link below BEFORE Halloween!Trick or Treat? (safely)

5 Tips for Dodging Frightful Food Allergies this Halloween.

#allergy, #food, #halloween

Why Doctors Order Too Many Tests

A good lab test will solve everything!

A good lab test will solve everything!

You blurt out an insult to your girlfriend, the quarterback throws for an interception, I bought a stock that tanked….if only I could take back decisions I’ve made.  We all feel that way at times, but how can a lab test be a bad decision? Continue reading

#food, #immunoglobulin-a

Have We Lost our CommonSense?

Schools are quite paranoid about giving any medication on their watch.  The liability for giving sunscreen when you don’t need it?  Zero.  This is very similar to the use of epinephrine in a school aged child with food allergy.  You certainly don’t want to withhold epi and risk anaphylaxis or death, when the risk of giving the EpiPen is negligible even if you don’t need the drug.  Maybe our policies in schools will change after a large malpractice case gets media attention for NOT giving epinephrine at the appropriate time for peanut allergy. 

http://www.usatoday.com/news/health/story/2012-06-27/sunscreen-policies/55877080/1

#allergies, #allergy, #epinephrine, #epinephrine-autoinjector, #food, #food-allergy, #health, #new-york-city

Are We Beating a Dead Horse?

Ok, another study about the dangers of food allergy (yesterday in USA Today).  You would think the occurrence of food allergy to KNOWN allergens (peanut & milk) would decrease given all the attention given to accidental ingestion.  Evidently, this is not the case.  Explanations?  Maybe we’re afraid of giving epinephrine.  In my personal experience, giving epinephrine is analogous to “waving the white flag.”  It doesn’t have to be nor should it be when treating children with suspected food allergy.  As I tell my nurses, “give the epi, then call the doctor!” 

http://www.usatoday.com/news/health/story/2012-06-25/kids-food-allergies/55797696/1

#allergen, #allergies, #allergy, #epinephrine, #food, #food-allergy, #health, #usa-today

A Cultural and Historical Examination of the Cough Drop

What’s medicine and what’s just candy!  Read on to find out.  My own personal thought is many patients with vocal cord dysfunction (VCD) respond to vocal hydration which can occur while sucking on a cough drop/candy.  Maybe we’ve been treating VCD all along with HALLs!  Stranger things have happened.

A Cultural and Historical Examination of the Cough Drop.

#cough, #food, #mens-health, #shopping, #throat-lozenge, #vicks, #video-cd, #vocal-cord-dysfunction

Celiac disease & gluten-free diets–now I can have pizza!

Finally, the voice of consumers is being heard!  That is gluten-sensitive patients. 

http://www.usatoday.com/money/industries/food/story/2012-05-04/gluten-free-food-pizza/54793108/1

#coeliac-disease, #food, #gluten, #gluten-free, #gluten-free-diet