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Goldberg M.,Allergy and Immunology Institute | Goldberg M.,Institute of Allergy and Immunology | Eisenberg E.,Tel Aviv University | Elizur A.,Allergy and Immunology Institute | And 8 more authors.
Annals of Allergy, Asthma and Immunology | Year: 2013

Background: A family history of atopy has been considered an independent risk factor for atopic diseases in children. Objective: To relate the risk of an infant developing IgE-mediated cow's milk allergy (IgE-CMA) to the atopic status of parents. Methods: Assessment of the parental atopic status of children with IgE-CMA (n = 66) previously identified in a large-scale prospective study was compared with the parental atopic status of a control group of healthy infants (n = 156). The atopic status was identified both by self-reporting and skin prick tests (SPTs). Results: Analysis for the risk for infants to develop IgE-CMA depended on the assessment method used. No significant differences were noted in self-reported parental atopic status between the IgE-CMA patients and the control group. However, among the subgroup of infants with persistent IgE-CMA (n = 25), maternal but not paternal self-reporting for atopy was more likely compared with parents of the control group (P =.04). In contrast, when analyzed by SPT, in both this persistent subgroup and the total allergic cohort, no significant differences were noted whether analyzed by single parent or both parents and whether the parent tested singly or multiply positive on the SPT. Conclusion: In families with children with persistent IgE-CMA, self-reporting of atopy by parents may be biased. Furthermore, the demonstration of IgE-mediated responses to allergens in parents is insufficient by itself, in a general population cohort, to predict which infants are at greatest risk of developing IgE-CMA. © 2013 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved. Source

Katz Y.,Institute of Allergy and Immunology | Katz Y.,Tel Aviv University | Goldberg M.R.,Institute of Allergy and Immunology
Current Opinion in Allergy and Clinical Immunology | Year: 2014

Purpose of review: Because of the paucity of reports and variability in the diagnostic criteria utilized, little is known regarding the natural outcome of patients with food protein-induced enterocolitis syndrome (FPIES). Data extracted from referenced manuscripts, as well as allergists' unpublished observations from across the globe, were used to form a cohesive opinion regarding its natural outcome. Recent findings: All authors concur that there is a generally high rate of recovery for FPIES. The most common foods causing FPIES are milk and soy. Depending upon which study is analyzed, by the age of 3-5 years, approximately 90% of patients recover from their disease. Recovery from FPIES to solid foods, occurs at a later age, but may reflect a later stage of introduction of the food into the diet. An important clinical outcome, although not common, is a shift from FPIES food hypersensitivity to an IgE-mediated food allergy. This necessitates a change in the oral food challenge protocol, if IgE-mediated sensitization is detected. Summary: Over the past several years, there has been an increasing awareness of FPIES. This knowledge should lead to a more timely diagnosis and should reassure parents and practitioners alike regarding its favorable course. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Nachshon L.,Institute of Allergy and Immunology | Goldberg M.R.,Institute of Allergy and Immunology | Elizur A.,Institute of Allergy and Immunology | Elizur A.,Tel Aviv University | And 4 more authors.
Annals of Allergy, Asthma and Immunology | Year: 2015

Background Reactions during the home treatment phase of oral immunotherapy (OIT) are not uncommon. An ongoing accurate reporting of home treatment outcomes is crucial for the safety and success of OIT. Previous reports have shown that as few as 20% of patients are truly compliant with paper-based diaries. Objective To develop a Web site-based electronic reporting system (web-RS) for monitoring home treatment during OIT for food allergy. Methods A web-RS was developed and incorporated a thorough questionnaire querying for pertinent data including the dose(s) consumed, occurrence and details of adverse reactions, treatment(s), and relevant potential exacerbating factors. All patients enrolled in milk, peanut, or egg OIT programs for at least 4 weeks from November 2012 through January 2014 were introduced to web-RS (n = 157). Successful reporting through web-RS was defined by consecutive reporting during the first home treatment phase (24 days) after its introduction. Comparisons were made with a previous group of OIT-treated patients (n = 100) who reported by E-mail. Results Successful reporting was achieved by 142 of 157 patients (90.44%) in contrast to a 75% success rate with E-mail (P =.0009). The odds for successful reporting using web-RS were 3.1 (95% confidence interval 1.6-6.3) times higher compared with using E-mail. Mild reactions were reported more frequently with web-RS (P =.0032). Patient reports were constantly available in real time for medical staff review. No complaints regarding web-RS feasibility were reported. One risk factor for failure to use web-RS was a patient's prior successful OIT experience without using web-RS (P =.012). Conclusion A web-RS can be a powerful tool for improving OIT safety by achieving a high level of patient cooperation in reporting home treatment results. © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved. Source

Nachshon L.,Institute of Allergy and Immunology | Goldberg M.R.,Institute of Allergy and Immunology | Schwartz N.,Haifa University | Sinai T.,Hebrew University of Jerusalem | And 5 more authors.
Journal of Allergy and Clinical Immunology | Year: 2014

Background IgE-mediated cow's milk-allergic (IgE-CMA) patients provide a valuable model for studying the relationship between dairy intake and bone mineral density (BMD) because they are unable to consume even minor amounts of dairy foods. Objective To determine the effects of dairy restriction on BMD in young adult IgE-CMA patients. Methods A prospective observational study was conducted from July 2012 to June 2013 at the Allergy unit of the Assaf-Harofeh Medical Center. Densitometric measurements of postpubertal patients diagnosed with IgE-CMA (group I, n = 33) were compared with those of volunteers matched for age and sex without IgE-CMA (control group II, n = 24). In a second analysis, group I and II patients were compared with IgE-CMA patients who after desensitization consumed milk for 12 to 39 months before analysis (group III, n = 12). Results Densitometric measurements (average T scores and Z scores) of the hip, femoral neck, and lumbar spine of IgE-CMA patients were significantly lower than of those in the control group (P <.0001). A T score below -2.5 SD, identifying a risk for osteoporosis, was found in 27% of IgE-CMA patients but in none of the controls (P =.0071). Calcium intake was severely reduced in allergic patients than in controls (P <.0001). BMD measurements in group III were significantly greater than in group I (P <.0001) and unchanged from the control group. Conclusions Patients with IgE-CMA have a significant risk of reduced BMD and early osteoporosis, which appears to be reversible on milk desensitization. Adequate calcium intake is not achieved while on a nondairy diet, requiring investigation into optimal nutritional protocols for these patients. © 2014 American Academy of Allergy, Asthma & Immunology. Source

Goldberg M.R.,Institute of Allergy and Immunology | Goldberg M.R.,Tel Aviv University | Elizur A.,Institute of Allergy and Immunology | Elizur A.,Tel Aviv University | And 5 more authors.
Pediatric Research | Year: 2013

Background: We previously demonstrated that the proliferative response to lipopolysaccharide (LPS) in cord blood mononuclear cells (CBMCs) is negatively correlated with the induced expression of interleukin (IL)-4. Our aim, therefore, was to examine whether an impaired cellular response to LPS in infancy is associated with the risk for asthma.Methods: In a prospective cohort study, the relationship between the CBMC response to LPS and the risk of atopy and wheezing after the age of 4 y was evaluated.Results: LPS-induced CBMC proliferative responses varied markedly among the 102 infants studied (range, one-to fivefold increase over cells with diluent alone). Ninety-five infants (93%) were followed longitudinally. A higher CBMC proliferative response to LPS was noted in offspring born to nonatopic parents compared with those with at least one atopic parent (P = 0.008). Using a proliferative index cutoff of 2 separated patients into high and low induced IL-4 mRNA responders (P = 0.001). Significantly more children who never wheezed had a greater than twofold LPS-induced CBMC proliferative response compared to those with persistent atopic wheezing (P = 0.046).Conclusion: These results demonstrate that CBMC proliferative responses to LPS is impaired in infants born to atopic parents and may be a risk factor for asthma later in life. © 2013 International Pediatric Research Foundation, Inc. Source

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