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The Editor recommends this issue's articles to the reader

The Editor recommends this issue's articles to the reader No effect of probiotics on respiratory allergies: A seven‐year follow up of a randomized controlled trial in infancy Thomas R. Abrahammsson There are only a few long‐term follow‐up studies, despite over 15 randomized trials, using probiotics for primary allergy prevention. Most studies have revealed an effect on eczema until two years of age. According to the atopic march theory, eczema is typically outgrown and replaced in school age by allergic asthma and rhinoconjunctivitis. Consequently, it is expected that children treated with probiotics in infancy would have less respiratory allergic disease at school age. The results of a first seven–year follow‐up study, however, were discouraging. Despite a lower eczema incidence at two years of age in the probiotic‐ than the placebo‐treated infants, there was no effect on respiratory disease. In contrast to the other probiotic prevention studies, the original allergy prevention study with Lactobacillus reuteri also revealed an effect on sensitization. Since sensitization is considered to be a stronger predictor than eczema for subsequent asthma, the L. reuteri‐ treated infants might run a reduced risk to develop respiratory allergic disease in school age. In the current issue of Pediatric Allergy and immunology , Abrahamsson et al (1) report the seven‐year follow up of the original randomized controlled trial with L. reuteri . In this study the prevalence of respiratory allergies was similar both in the probiotic and placebo groups. The difference in sensitization between the probiotic and placebo groups at two years was also absent at seven years of age. Thus, the effect of L. reuteri on the immune system in infancy was transient. Possibly, interventions that are given for a prolonged period prenatally as well as postnatally may induce more long‐lasting immune modulation. Importantly, there were no signs of any long‐term side effects in this seven‐year follow up, providing a response to concerns about treatment of susceptible newborns. Intestinal permeability in children with food allergy on specific elimination diets Kirsi M. Järvinen Alteration of intestinal permeability (IP) is hypothesized to play a key role in the pathophysiologic mechanisms of many chronic diseases. Elevated IP has also been reported in food hypersensitivity following ingestion of the offending food as well as during elimination diets. It is unclear whether elevated IP is a consequence of an allergic insult to the gut mucosa (i.e. damage), or whether it predisposes certain individuals for development of food allergy. In order to address this question Jarvinen et al (2) designed the current study to measure IP in 131 asymptomatic cow's‐milk and egg‐allergic children treated with a specific allergen elimination diet. The authors found that elevated IP was present in about one‐third of asymptomatic food‐allergic children on elimination diets and was associated with shorter stature, independently of age. Furthermore, repeated measures showing stable IP over time suggest an intrinsic problem rather than a defect secondary to an allergen insult. IP was not correlated with any other clinical parameter, including family history, other atopic manifestations, environmental sensitizations nor symptoms during OFC. The authors concluded that increased IP may be an intrinsic trait in a subset of food allergic children. Large prospective studies are necessary now to determine the role of impaired intestinal barrier in food allergy. Maternal allergy is associated with surface‐bound IgE on cord blood basophils Adam P. Matson Efforts to reduce allergy in children have been largely ineffective. One possible explanation is that many preventative strategies have been implemented after the tendency for skewing towards Th2‐type immune responses has already been established. Furthermore, it is known that maternal allergy is a risk factor for the development of allergic disease in children; however, the cell types mediating this maternal influence remain poorly understood. In this issue of Pediatric Allergy and Immunology , Matson et al (3) demonstrate that despite there being similar frequencies of basophils in the cord blood of infants born to mothers with or without a history of allergy, the percentages of basophils with surface‐bound IgE were significantly greater in infants of allergic mothers. Interestingly, there was no difference in cord blood serum IgE levels between the allergic and non‐allergic groups, suggesting that cell‐bound IgE may be a more sensitive indicator of total IgE located in the fetal compartment. FcεRI expression on cord blood basophils did not correlate with cord blood serum IgE levels, which at first glance is surprising, yet consistent with the overall low serum IgE levels in the majority of cord blood specimens, and the amount of IgE required to double FcεRI expression. It remains to be determined whether the basophil‐bound IgE is maternal or fetal in origin, or if IgE loading of fetal basophils has any impact on allergy development. Nonetheless, this study provides insight into an additional pool of IgE localized to FcεRI‐expressing fetal cells that appears associated with maternal allergy. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Pediatric Allergy and Immunology Wiley

The Editor recommends this issue's articles to the reader

Pediatric Allergy and Immunology , Volume 24 (6) – Sep 1, 2013

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References (4)

Publisher
Wiley
Copyright
Copyright © 2013 John Wiley & Sons A/S
ISSN
0905-6157
eISSN
1399-3038
DOI
10.1111/pai.12128
Publisher site
See Article on Publisher Site

Abstract

No effect of probiotics on respiratory allergies: A seven‐year follow up of a randomized controlled trial in infancy Thomas R. Abrahammsson There are only a few long‐term follow‐up studies, despite over 15 randomized trials, using probiotics for primary allergy prevention. Most studies have revealed an effect on eczema until two years of age. According to the atopic march theory, eczema is typically outgrown and replaced in school age by allergic asthma and rhinoconjunctivitis. Consequently, it is expected that children treated with probiotics in infancy would have less respiratory allergic disease at school age. The results of a first seven–year follow‐up study, however, were discouraging. Despite a lower eczema incidence at two years of age in the probiotic‐ than the placebo‐treated infants, there was no effect on respiratory disease. In contrast to the other probiotic prevention studies, the original allergy prevention study with Lactobacillus reuteri also revealed an effect on sensitization. Since sensitization is considered to be a stronger predictor than eczema for subsequent asthma, the L. reuteri‐ treated infants might run a reduced risk to develop respiratory allergic disease in school age. In the current issue of Pediatric Allergy and immunology , Abrahamsson et al (1) report the seven‐year follow up of the original randomized controlled trial with L. reuteri . In this study the prevalence of respiratory allergies was similar both in the probiotic and placebo groups. The difference in sensitization between the probiotic and placebo groups at two years was also absent at seven years of age. Thus, the effect of L. reuteri on the immune system in infancy was transient. Possibly, interventions that are given for a prolonged period prenatally as well as postnatally may induce more long‐lasting immune modulation. Importantly, there were no signs of any long‐term side effects in this seven‐year follow up, providing a response to concerns about treatment of susceptible newborns. Intestinal permeability in children with food allergy on specific elimination diets Kirsi M. Järvinen Alteration of intestinal permeability (IP) is hypothesized to play a key role in the pathophysiologic mechanisms of many chronic diseases. Elevated IP has also been reported in food hypersensitivity following ingestion of the offending food as well as during elimination diets. It is unclear whether elevated IP is a consequence of an allergic insult to the gut mucosa (i.e. damage), or whether it predisposes certain individuals for development of food allergy. In order to address this question Jarvinen et al (2) designed the current study to measure IP in 131 asymptomatic cow's‐milk and egg‐allergic children treated with a specific allergen elimination diet. The authors found that elevated IP was present in about one‐third of asymptomatic food‐allergic children on elimination diets and was associated with shorter stature, independently of age. Furthermore, repeated measures showing stable IP over time suggest an intrinsic problem rather than a defect secondary to an allergen insult. IP was not correlated with any other clinical parameter, including family history, other atopic manifestations, environmental sensitizations nor symptoms during OFC. The authors concluded that increased IP may be an intrinsic trait in a subset of food allergic children. Large prospective studies are necessary now to determine the role of impaired intestinal barrier in food allergy. Maternal allergy is associated with surface‐bound IgE on cord blood basophils Adam P. Matson Efforts to reduce allergy in children have been largely ineffective. One possible explanation is that many preventative strategies have been implemented after the tendency for skewing towards Th2‐type immune responses has already been established. Furthermore, it is known that maternal allergy is a risk factor for the development of allergic disease in children; however, the cell types mediating this maternal influence remain poorly understood. In this issue of Pediatric Allergy and Immunology , Matson et al (3) demonstrate that despite there being similar frequencies of basophils in the cord blood of infants born to mothers with or without a history of allergy, the percentages of basophils with surface‐bound IgE were significantly greater in infants of allergic mothers. Interestingly, there was no difference in cord blood serum IgE levels between the allergic and non‐allergic groups, suggesting that cell‐bound IgE may be a more sensitive indicator of total IgE located in the fetal compartment. FcεRI expression on cord blood basophils did not correlate with cord blood serum IgE levels, which at first glance is surprising, yet consistent with the overall low serum IgE levels in the majority of cord blood specimens, and the amount of IgE required to double FcεRI expression. It remains to be determined whether the basophil‐bound IgE is maternal or fetal in origin, or if IgE loading of fetal basophils has any impact on allergy development. Nonetheless, this study provides insight into an additional pool of IgE localized to FcεRI‐expressing fetal cells that appears associated with maternal allergy.

Journal

Pediatric Allergy and ImmunologyWiley

Published: Sep 1, 2013

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