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Katz Y.,Allergy and Immunology Institute | Katz Y.,Tel Aviv University | Gutierrez-Castrellon P.,National Institute of Perinatology | Gonzalez M.G.,University lle | And 3 more authors.
Clinical Reviews in Allergy and Immunology | Year: 2014

Since 1943, cases of sensitization or allergy to soy-based formulas (SBFs) have been described without any consensus on their real prevalence. We identified the adjusted prevalence of IgE-mediated soy allergies in children and performed a secondary analysis of the impact of age (less than and more than 6 months). We performed a systematic review with meta-analysis of studies published from 1909 to 2013 in PubMed, Embase, LILACS, ARTEMISA, Cochrane, Bandolier, DARE and the GRADE system for grading quality. Results are presented in tables and graphs using a forest plot. The 40 studies identified established weighted prevalence of soy allergies of 0 to 0.5 % (0.27) for the general population, 0.4 to 3.1 % (1.9) for the referred population, and 0 to 12.9 % (2.7) for allergic children. Prevalence of sensitization after the use of SBFs is 8.7 and 8.8 %, depending on the method used. The prevalence of allergies to soy and IgE sensitization to the use of SBFs is less than reported. Not enough evidence exists to show a higher risk of allergy in infants younger than 6 months. The concern about soy allergy is no reason to postpone the use of SBFs in IgE-mediated cow's milk allergy infants until the age of 6 months. © 2014 Springer Science+Business Media. Source


Levy M.B.,Allergy and Immunology Institute | Goldberg M.R.,Allergy and Immunology Institute | Nachshon L.,Allergy and Immunology Institute | Tabachnik E.,Kaplan Medical Center | And 2 more authors.
Israel Medical Association Journal | Year: 2012

Background: Most reports in the medical literature on food allergy mortality are related to peanut and tree nut. There is limited knowledge regarding these reactions and often only a partial medical history is described. Objective: To record and characterize all known cases of mortality due to food allergy in Israel occurring during the period 2004-2011. Methods: All cases of food allergy-related mortality that were known to medical personnel or were published in the Israeli national communications media were investigated. We interviewed the parents and, when feasible, physicians who treated the final event. Results: Four cases of food-related mortality were identified: three cases were due to cow's milk and one to hazelnut. All were exposed to a hidden/non-obvious allergen. All four had a history of asthma but were not on controller medications, and none had experienced previous non-life threatening accidental reactions. Three of the four patients had not been evaluated by an allergist, nor were they prescribed injectable epinephrine. The one patient who had been prescribed injectable epinephrine did not use it during her fatal anaphylactic attack. Conclusions: Fatal reactions to cow's milk and hazelnut but not to peanut are the only reported food mortality cases in Israel. Although these patients had previous reactions following accidental exposures, none had experienced a life-threatening reaction. Patients at risk are not adequately evaluated by allergists, nor are they prescribed and instructed on the proper use of injectable epinephrine. Cow's milk should be considered a potentially fatal allergen. Source


Elizur A.,Allergy and Immunology Institute | Elizur A.,Assaf Harofeh Medical Center | Rajuan N.,Allergy and Immunology Institute | Goldberg M.R.,Allergy and Immunology Institute | And 4 more authors.
Journal of Pediatrics | Year: 2012

Objective: To describe the natural course of IgE-mediated cow's milk allergy (IgE-CMA) and to determine risk factors for its persistence in a population-based cohort. Study design: In a prospective cohort study, 54 infants with IgE-CMA were identified from a population of 13 019 children followed from birth. Diagnosis of IgE-CMA was based on history, skin prick test (SPT), and an oral food challenge (OFC) when indicated. Allergic infants were followed for 48-60 months. Families were contacted by telephone every 6 months and asked about recent exposures to milk. OFC was repeated to evaluate for recovery. Clinical characteristics, SPT, and OFC outcomes were compared between infants with persistent IgE-CMA and infants who recovered. Results: Thirty-one infants (57.4%) recovered from IgE-CMA during the study period. Most infants (70.9%) recovered within the first 2 years. Risk factors for persistence on multivariate analysis included a reaction to <10 mL of milk on OFC (or on first exposure as estimated by the guardian, if OFC was not performed) (P = .01), a larger wheal size on SPT (P = .014), and age of ≤30 days at time of first reaction (P = .05). Conclusions: Resolution occurs in most infants with IgE-CMA. Infants reacting to <10 mL of milk or in the first month of life, and those with a larger wheal size on SPT, are at increased risk for persistence. © 2012 Mosby, Inc. Source


Elizur A.,Allergy and Immunology Institute | Elizur A.,Tel Aviv University | Katz Y.,Allergy and Immunology Institute | Katz Y.,Tel Aviv University
Current Opinion in Allergy and Clinical Immunology | Year: 2016

Purpose of review Until recently, nutritional guidelines did not support early introduction of allergenic foods into the diet of high-risk infants. Following recent studies, this approach is beginning to change, at least for peanuts. This review will examine the change in nutritional guidelines and the scientific data that led to these changes. Recent finding In a recent prospective controlled study, regular consumption of peanut protein in infants from 4-11 months of age with atopic dermatitis or egg allergy, was associated with lower prevalence of peanut allergy (1.9%) at 60 months of age compared with peanut avoidance (13.7%). Other studies demonstrated that earlier introduction of cow's milk protein and egg powder were also associated with decreased risk for milk and egg allergy, respectively. Summary Recent studies suggest that early rather than late introduction of allergenic foods reduces the risk of food allergy. The preferred timing of food introduction might be sooner than the current recommendation, and might apply not only to high-risk infants. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Source


Katz Y.,Allergy and Immunology Institute | Katz Y.,Tel Aviv University | Rajuan N.,Tel Aviv University | Goldberg M.R.,Allergy and Immunology Institute | And 4 more authors.
Journal of Allergy and Clinical Immunology | Year: 2010

Background: The diversity in the perceived prevalence, recovery, and risk factors for cow's milk allergy (CMA) necessitated a large-scale, population-based prospective study. Objective: We sought to determine the prevalence, cross-reactivity with soy allergy, and risk factors for the development of CMA. Methods: In a prospective study the feeding history of 13,019 infants was obtained by means of telephone interview (95.8%) or questionnaire (4.2%). Infants with probable adverse reactions to milk were examined, skin prick tested, and challenged orally. Results: Ninety-eight percent of the cohort participated in the study. The cumulative incidence for IgE-mediated CMA was 0.5% (66/13,019 patients). The mean age of cow's milk protein (CMP) introduction was significantly different (P < .001) between the healthy infants (61.6 ± 92.5 days) and those with IgE-mediated CMA (116.1 ± 64.9 days). Only 0.05% of the infants who were started on regular CMP formula within the first 14 days versus 1.75% who were started on formula between the ages of 105 and 194 days had IgE-mediated CMA (P < .001). The odds ratio was 19.3 (95% CI, 6.0-62.1) for development of IgE-mediated CMA among infants with exposure to CMP at the age of 15 days or more (P < .001). Sixty-four patients with IgE-mediated CMA tolerated soy, and none had a proved allergy to soy. Conclusions: IgE-mediated CMA is much less common than generally reported. Early exposure to CMP as a supplement to breast-feeding might promote tolerance. Finally, soy is a reasonable feeding alternative in patients with IgE-mediated CMA. © 2010 American Academy of Allergy, Asthma & Immunology. Source

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