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Prenatal Exposure to Nut Allergens and Risk of Childhood Nut Sensitization
Abstracts AB173
J ALLERGY CLIN IMMUNOL VOLUME 129, NUMBER 2
Prenatal Exposure to Nut Allergens and Risk of Childhood Nut Sensitization J. T. Hsu1, S. A. Missmer2, M. C. Young1, K. F. Berry2, F. J. Twarog1, I. Borras1, M. D. Hornstein2, L. C. Schneider1; 1Children’s Hospital Boston, Boston, MA, 2Brigham and Women’s Hospital, Boston, MA. RATIONALE: Allergic diseases have increased four-fold in the last ten years. Prenatal exposures, including maternal diet and medications, may account for some of this increase. In the US, progesterone for fetal support in assisted reproduction is commonly formulated in peanut or sesame oil; it is unknown whether this increases the child’s risk of peanut or tree nut allergy. METHODS: Parents of children seen in the Allergy Program at Children’s Hospital Boston and two affiliated practices between May 2005 and October 2009 completed questionnaires on reproductive methods, prenatal exposures, and child’s dietary and allergic history. 1272 completed questionnaires were returned. Child’s medical record, allergy skin-prick, and blood test results were reviewed. Odds ratios (OR) and 95% confidence intervals (CI) are from adjusted logistic regression models. RESULTS: There was no increased risk of peanut or tree nut sensitization in the children of mothers with history of infertility, in vitro fertilization, or use of progesterone-in-oil. First trimester maternal consumption of tree nuts was associated with a 60% higher odds of having a nut-sensitized child (95%CI51.01- 2.51). A similarly increased odds was seen with first trimester maternal sesame seed ingestion (OR51.78; 95%CI51.08-2.92). The odds of nut sensitization were twice as high among children with asthma and environmental allergies. CONCLUSIONS: Neither maternal infertility nor exposure to nut oils via progesterone support during assisted reproduction increased the odds of peanut or tree nut sensitization in the child. First trimester maternal ingestion of tree nuts and sesame seeds during pregnancy was associated with increased odds of nut sensitization in the child.
654
Maternal Dietary Intake and Subsequent Allergy Development K. E. C. Grimshaw1, E. M. Oliver1, T. Kemp2, E. N. C. Mills3, K. Beyer4, K. Foote2, G. Roberts1; 1Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UNITED KINGDOM, 2Department of Paediatric and Child Health, Royal Hampshire County Hospital, Winchester, UNITED KINGDOM, 3Institute of Food Research, Norwich, UNITED KINGDOM, 4Department of Paediatric Pneumology and Immunology, Charit University Medical Centre, Berlin, GERMANY. RATIONALE: Numerous allergy prevention studies have advocated different maternal dietary intakes during pregnancy and lactation but there is currently insufficient evidence to suggest the ideal maternal diet for allergy prevention (1). METHODS: Questionnaire data detailing foods mothers ate or avoided during pregnancy and lactation were collected at recruitment of the UK cohort of the EuroPrevall birth cohort study between 2006 and 2008 (2). Chi-square was used to compare maternal dietary intake of infants who subsequently developed a food allergy by the age of two years (diagnosed by Double Blind Placebo Controlled Food Challenge) with their 2 agematched controls. Additionally, nutritional supplement intake between the groups was compared. RESULTS: For this UK cohort, 41 infants were diagnosed as having a food allergy by the age of 2 years. Infants of mothers who reported avoiding allergenic foods (such as peanuts, tree nuts, eggs, seeds and shellfish) from their diet during pregnancy were more likely to develop a food allergy than those infants whose mothers reported a full diet (p50.032).However, similar dietary avoidance during lactation was not associated with food allergy.. Additionally, maternal dietary supplementation of multivitamins, folic acid, Vitamin D and fish oils during either pregnancy (p50.820; 0.144; 0.293; and 0.591 respectively) or lactation
(p50.731; 0.695; 0.397; 0.762; and 0.114 respectively) had no apparent effect. CONCLUSIONS: This data does not support allergen avoidance during pregnancy or lactation as an allergy prevention strategy.
655
Maternal Cow's Milk Avoidance During Lactation Suppresses IgA Levels in Breast Milk and Serum IgG Levels in Infants K. M. Jarvinen, M. S. Seppo, A. James, A. Tsuang, M. C. Berin, H. A. Sampson; Mount Sinai School of Medicine, New York, NY. RATIONALE: The effect of maternal avoidance diets during breastfeeding on development of food allergies in infants is currently under debate. We sought to assess the effect of maternal cow’s milk avoidance during breastfeeding on cow’s milk-specific IgA levels in breast milk and specific IgG levels in their infants. METHODS: We utilized historical human milk and serum samples from a prospective birth cohort, which assessed the association between human milk factors and development of food allergies in breastfed infants. A total of 160 paired maternal serum and breast milk samples were assessed for ß-lactoglobulin (BLG)-specific IgA by ELISA; 71 of them were taken during maternal milk avoidance due to family history of cow’s milk allergy. Infants’ serum samples were assessed for BLG- and casein-specific IgG at a median 6 months of age. RESULTS: BLG- and casein-specific IgA levels were lower in milk from mothers avoiding cow’s milk (median <7.7 and 31 pg/mL) than in milk from those not avoiding milk (37 and 99 pg/ml, p50.01 and 0.002, respectively). Specific IgA levels in serum were not affected by diet. The infants of mothers who were avoiding milk during lactation had lower levels of casein-specific IgG than those not avoiding milk (6.6 and 10.7 pg/ ml, p50.03). CONCLUSIONS: Maternal milk avoidance results in down-regulation of mucosal cow’s milk-specific IgA levels. This was associated with an impairment of specific IgG responses in the infants. Since human milk IgA may protect against food allergies, prophylactic maternal elimination diets may be counterproductive in preventing food allergies.
656
Detection Of Peanut Allergens In Breast Milk K. Rose1, H. Cheng2, S. A. Jortani1, S. J. Maleki2; 1University of Louisville, Louisville, KY, 2U.S. Department of Agriculture-ARS, New Orleans, LA. RATIONALE: Infants have been reported to react to peanut upon their first known exposure and peanut proteins have been detected in breast milk. Methods to identify the peanut proteins secreted in breast milk were tested here. Identification of the allergens or fragments thereof in breast milk may allow us to determine if they are sensitizing or tolerizing. METHODS: Various immunoassays were optimized and utilized to analyze for the presence of peanut proteins in breast milk. Breast milk samples from healthy lactating mothers were collected following a 48 hour peanut fast and spiked with known amounts of peanut and subjected to SDS-PAGE, 2-dimensional gel electrophoresis (2DGE), and western blot with anti-raw and roasted peanut, anti-Ara h 1 and 2 antibodies and pooled serum IgE from peanut allergic individuals. RESULTS: We found that we were able to detect peanut protein at 20 ng/ ml, Ara h 1 at 1 ng/ml, Ara h 2 at 50 ng/ml and with serum IgE at 50 ng/ml, in peanut-spiked breast milk. It was also found that the mobility of peanut proteins and individual allergens were altered in both SDS-PAGE and 2DGE when in breast milk. CONCLUSIONS: The allergic proteins or peptides that survive digestive enzymes, and are liable to be secreted in biological fluids, are most likely the sensitizing or tolerizing agents within an allergic food. Developing methods to detect these allergens in breast milk is a preliminary step in identification of allergens or fragments thereof that are secreted and may contribute to the original development of allergic disease.
MONDAY
653
J ALLERGY CLIN IMMUNOL VOLUME 129, NUMBER 2
Prenatal Exposure to Nut Allergens and Risk of Childhood Nut Sensitization J. T. Hsu1, S. A. Missmer2, M. C. Young1, K. F. Berry2, F. J. Twarog1, I. Borras1, M. D. Hornstein2, L. C. Schneider1; 1Children’s Hospital Boston, Boston, MA, 2Brigham and Women’s Hospital, Boston, MA. RATIONALE: Allergic diseases have increased four-fold in the last ten years. Prenatal exposures, including maternal diet and medications, may account for some of this increase. In the US, progesterone for fetal support in assisted reproduction is commonly formulated in peanut or sesame oil; it is unknown whether this increases the child’s risk of peanut or tree nut allergy. METHODS: Parents of children seen in the Allergy Program at Children’s Hospital Boston and two affiliated practices between May 2005 and October 2009 completed questionnaires on reproductive methods, prenatal exposures, and child’s dietary and allergic history. 1272 completed questionnaires were returned. Child’s medical record, allergy skin-prick, and blood test results were reviewed. Odds ratios (OR) and 95% confidence intervals (CI) are from adjusted logistic regression models. RESULTS: There was no increased risk of peanut or tree nut sensitization in the children of mothers with history of infertility, in vitro fertilization, or use of progesterone-in-oil. First trimester maternal consumption of tree nuts was associated with a 60% higher odds of having a nut-sensitized child (95%CI51.01- 2.51). A similarly increased odds was seen with first trimester maternal sesame seed ingestion (OR51.78; 95%CI51.08-2.92). The odds of nut sensitization were twice as high among children with asthma and environmental allergies. CONCLUSIONS: Neither maternal infertility nor exposure to nut oils via progesterone support during assisted reproduction increased the odds of peanut or tree nut sensitization in the child. First trimester maternal ingestion of tree nuts and sesame seeds during pregnancy was associated with increased odds of nut sensitization in the child.
654
Maternal Dietary Intake and Subsequent Allergy Development K. E. C. Grimshaw1, E. M. Oliver1, T. Kemp2, E. N. C. Mills3, K. Beyer4, K. Foote2, G. Roberts1; 1Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UNITED KINGDOM, 2Department of Paediatric and Child Health, Royal Hampshire County Hospital, Winchester, UNITED KINGDOM, 3Institute of Food Research, Norwich, UNITED KINGDOM, 4Department of Paediatric Pneumology and Immunology, Charit University Medical Centre, Berlin, GERMANY. RATIONALE: Numerous allergy prevention studies have advocated different maternal dietary intakes during pregnancy and lactation but there is currently insufficient evidence to suggest the ideal maternal diet for allergy prevention (1). METHODS: Questionnaire data detailing foods mothers ate or avoided during pregnancy and lactation were collected at recruitment of the UK cohort of the EuroPrevall birth cohort study between 2006 and 2008 (2). Chi-square was used to compare maternal dietary intake of infants who subsequently developed a food allergy by the age of two years (diagnosed by Double Blind Placebo Controlled Food Challenge) with their 2 agematched controls. Additionally, nutritional supplement intake between the groups was compared. RESULTS: For this UK cohort, 41 infants were diagnosed as having a food allergy by the age of 2 years. Infants of mothers who reported avoiding allergenic foods (such as peanuts, tree nuts, eggs, seeds and shellfish) from their diet during pregnancy were more likely to develop a food allergy than those infants whose mothers reported a full diet (p50.032).However, similar dietary avoidance during lactation was not associated with food allergy.. Additionally, maternal dietary supplementation of multivitamins, folic acid, Vitamin D and fish oils during either pregnancy (p50.820; 0.144; 0.293; and 0.591 respectively) or lactation
(p50.731; 0.695; 0.397; 0.762; and 0.114 respectively) had no apparent effect. CONCLUSIONS: This data does not support allergen avoidance during pregnancy or lactation as an allergy prevention strategy.
655
Maternal Cow's Milk Avoidance During Lactation Suppresses IgA Levels in Breast Milk and Serum IgG Levels in Infants K. M. Jarvinen, M. S. Seppo, A. James, A. Tsuang, M. C. Berin, H. A. Sampson; Mount Sinai School of Medicine, New York, NY. RATIONALE: The effect of maternal avoidance diets during breastfeeding on development of food allergies in infants is currently under debate. We sought to assess the effect of maternal cow’s milk avoidance during breastfeeding on cow’s milk-specific IgA levels in breast milk and specific IgG levels in their infants. METHODS: We utilized historical human milk and serum samples from a prospective birth cohort, which assessed the association between human milk factors and development of food allergies in breastfed infants. A total of 160 paired maternal serum and breast milk samples were assessed for ß-lactoglobulin (BLG)-specific IgA by ELISA; 71 of them were taken during maternal milk avoidance due to family history of cow’s milk allergy. Infants’ serum samples were assessed for BLG- and casein-specific IgG at a median 6 months of age. RESULTS: BLG- and casein-specific IgA levels were lower in milk from mothers avoiding cow’s milk (median <7.7 and 31 pg/mL) than in milk from those not avoiding milk (37 and 99 pg/ml, p50.01 and 0.002, respectively). Specific IgA levels in serum were not affected by diet. The infants of mothers who were avoiding milk during lactation had lower levels of casein-specific IgG than those not avoiding milk (6.6 and 10.7 pg/ ml, p50.03). CONCLUSIONS: Maternal milk avoidance results in down-regulation of mucosal cow’s milk-specific IgA levels. This was associated with an impairment of specific IgG responses in the infants. Since human milk IgA may protect against food allergies, prophylactic maternal elimination diets may be counterproductive in preventing food allergies.
656
Detection Of Peanut Allergens In Breast Milk K. Rose1, H. Cheng2, S. A. Jortani1, S. J. Maleki2; 1University of Louisville, Louisville, KY, 2U.S. Department of Agriculture-ARS, New Orleans, LA. RATIONALE: Infants have been reported to react to peanut upon their first known exposure and peanut proteins have been detected in breast milk. Methods to identify the peanut proteins secreted in breast milk were tested here. Identification of the allergens or fragments thereof in breast milk may allow us to determine if they are sensitizing or tolerizing. METHODS: Various immunoassays were optimized and utilized to analyze for the presence of peanut proteins in breast milk. Breast milk samples from healthy lactating mothers were collected following a 48 hour peanut fast and spiked with known amounts of peanut and subjected to SDS-PAGE, 2-dimensional gel electrophoresis (2DGE), and western blot with anti-raw and roasted peanut, anti-Ara h 1 and 2 antibodies and pooled serum IgE from peanut allergic individuals. RESULTS: We found that we were able to detect peanut protein at 20 ng/ ml, Ara h 1 at 1 ng/ml, Ara h 2 at 50 ng/ml and with serum IgE at 50 ng/ml, in peanut-spiked breast milk. It was also found that the mobility of peanut proteins and individual allergens were altered in both SDS-PAGE and 2DGE when in breast milk. CONCLUSIONS: The allergic proteins or peptides that survive digestive enzymes, and are liable to be secreted in biological fluids, are most likely the sensitizing or tolerizing agents within an allergic food. Developing methods to detect these allergens in breast milk is a preliminary step in identification of allergens or fragments thereof that are secreted and may contribute to the original development of allergic disease.
MONDAY
653