Food reactions during avoidance: focus on peanut.
Objective: Peanut allergy has historically been difficult to manage, with most cases persisting into adulthood. Novel therapies for peanut allergy treatment are on the horizon, yet allergists must maintain a robust understanding of the risks and benefits of the current standard of therapy, avoidance diet. Data sources: A comprehensive literature search using PubMed of reviews and clinical articles was performed. Study selections: Articles discussing peanut or other food-related allergic reactions, accidental exposures or anaphylaxis pertinent to avoidance diet or comparative to oral immunotherapy trials were selected. Results: Peanut remains a leading allergen associated with accidental ingestions responsible for food-related reactions, both mild and severe. Fatal reactions, however, are rare and measures such as anaphylaxis plans can significantly decrease the risk of accidental anaphylaxis. Patients may over estimate situations thought to increase risk for reactions to peanut, such as inhalation or contact through skin. In oral immunotherapy trials, the rate of anaphylaxis secondary to treatment was significantly higher than avoidance practices. Conclusion: Clinicians should continue to discuss avoidance as a viable option for long-term peanut allergy management and empower patients to differentiate relevant situations in which accidental reactions might occur.
Unmet needs of children with peanut allergy: aligning the risks and the evidence.
Background: Peanut allergy is a potentially severe and lifelong allergy, with few effective treatments or preventative measures. Objective: To convene an expert panel of allergists, pediatricians, and advocates to discuss and highlight unmet needs in the prevention and management of peanut allergies. Methods: Literature searches of PubMed were performed. The panel evaluated published data on the prevention of peanut allergy, treatment of existing peanut allergy, and management of reactions following unintentional peanut exposures. Results: Key unmet needs in the prevention and management of peanut allergy were identified, including: 1) enhancing and optimizing implementation of early peanut introduction as a means of preventing the development of peanut allergy; 2) developing knowledge translation strategies regarding the safety and efficacy data for current and emerging immunotherapies for peanut-allergic children to support their use in clinical practice; and 3) promoting understanding of true exposure risk in allergic individuals and ensuring access to epinephrine for accidental exposures that provoke severe reactions. Clinicians should help educate caregivers about the actual risks associated with peanut allergy, and its prevention and management so that treatment decisions can be evidence based rather than fear based. Support tools are needed to help address caregiver goals, expectations, and psychological barriers, as well as identify facilitators for prevention and treatment strategies. Conclusion: There are significant unmet needs in our understanding of peanut allergy; addressing these needs will help to enhance understanding of how to most effectively prevent and treat peanut allergy, as well as educate the food-allergic and nonallergic community regarding current evidence-based practices.
Food allergy immunotherapy: OIT and EPIT.
IgE mediated food allergy remains a significant and growing problem across the globe. Of the various treatment modalities, oral immunotherapy (OIT) and epicutaneous immunotherapy (EPIT) have been the best studied. Across various studies of OIT for egg, milk and peanut allergy, strong levels of desensitization have been shown. With egg and peanut OIT, a limited remission, or sustained unresponsiveness (SU), has further been demonstrated. These advances have been further validated by successful phase 2 and phase 3 studies of peanut OIT. EPIT, using daily administrations of a proprietary patch, demonstrated efficacy as well as safety and tolerability in parallel phase 2 studies, however its phase 3 study did not meet its primary efficacy outcome. Despite its good track record of desensitization, the safety and tolerability of OIT has remained a question. EPIT, on the other hand, has proven safe and tolerable, however the adequacy of its desensitization has remained to be determined. As OIT and EPIT continue their march towards regulatory review, optimizations for immunotherapy and novel therapies continue to be developed providing hope for food allergy patients everywhere.
Development and Acceptability of a Shared Decision-Making Tool for Commercial Peanut Allergy Therapies.
Background: Shared decision making (SDM) is the process through which patients and their medical provider mutually explore therapy goals, risks/benefits, and treatment options regarding medical care. Decision-aids are tools to help with the values clarification process and assess decisional needs and potential decisional conflicts. Objective: To develop and assess acceptability of a decision-aid for commercial peanut allergy therapies. Methods: The creation of this decision-aid occurred in three stages, including a qualitative study to assess decisional needs, development of a draft decision-aid through multiple iterations in accordance with international guidelines and decision-aid experts, and assessment of decisional acceptability, decisional conflict, and decisional self-efficacy related to using the decision-aid. Results: The decision-aid went through 9 iterations, resulting in a 4-page aid with 7 parts, explaining the therapies, the key risks and benefits of the therapy choices, the relative importance of key attributes of the therapies, and a self-check assessment regarding informational adequacy and how to take the next steps. Twenty-four subjects assessed the decision-aid, noting it had good acceptability, high decisional self-efficacy (mean score 91.9/100) and low decisional conflict (mean score 20.2/100). Respondents rated the information content as adequate and sufficient, and the information regarding the therapy choices as fair and balanced without a clear bias or presenting a "best choice". Conclusion: We have developed this decision-aid as a tool to help caregivers navigate the complexity of decision-making for peanut allergy treatment options. The decision-aid was noted to have good acceptability, with scores reflective of the instrument enhancing decisional self-efficacy and reducing decisional conflict.
A label-free shotgun proteomics analysis of macadamia nut.
In this study, we present a systematic proteomic overview of macadamia nut using a label-free shotgun proteomic approach. We identified 947 proteins in 723 clusters and gene ontology analysis revealed proteins across 46 functional categories including carbohydrate metabolism (10%), protein metabolic processes (5%), amino acid metabolism (4%), transport (4%), stress response (3%), lipid metabolism (3%), protein folding (3%) and defense response (1.4%). The defense response proteins accounted for 24% of the total peptide abundance. The vicilin-like macadamia antimicrobial peptides 2-3 (MiAMP2) was the most abundant protein, followed by glyceraldehyde-3-phosphate dehydrogenase 3, 11S legumin-like protein, 2-phospho-D-glycerate hydrolase and heat shock 70 kDa protein among others. The cascading of amino acid and carbohydrate metabolic pathways in macadamia nut were constructed against reference maps from KEGG and proposed for the first time. Results were also indicative of useful protein candidates with possible allergenic potential and cross-reactivity in macadamia nut. The in-silico analysis revealed homology and linear epitope similarities to known allergens such as conglutin β allergen from lupin, Jug r2 vicilin allergens from walnut, Ara h3 11S globulin from peanut, small rubber particle protein Hev b3, hevein, enolase 2, HSP 70kDa Cla h4, Der f28 allergen, and methylglyoxalases. Label-free shotgun proteomics reveal valuable insights into the genetic and biological makeup of macadamia nut proteome and provide guidance on protein candidates with allergenic potential for further immunological investigation. Data are available via ProteomeXchange with identifier PXD015364.
Prevalence and natural history of tree nut allergy.
Objective: Tree nuts are common causes of food related allergic reactions and anaphylaxis. Resolution of tree nut allergy is thought to be low yet studies of the natural history of tree nut allergy are limited. This review summarizes the available literature regarding tree nut allergy prevalence and natural history, and discusses emerging diagnostic and prognostic developments that will inform clinical management of tree nut allergy. Data sources: A comprehensive literature search using PubMed was performed. Study selections: Peer-reviewed publications relating to tree nut allergy prevalence, resolution and diagnosis were selected, and findings summarised using a narrative approach. Results: Tree nut allergy prevalence varies by age, region and food allergy definition, and ranges from less than 1% to around 3% worldwide. Reports on the natural history of tree nut allergy data are limited to retrospective clinical data or cross-sectional survey data of self-reported food allergy with reported resolution ranging from 9-14%. Component resolved diagnostics and basophil activation testing offer the potential to improve the diagnostic accuracy and predicted prognosis of specific tree nut allergy but studies are limited to date. Conclusion: Tree nut allergy remains an understudied area of food allergy research with limited region specific studies based on robust food allergy measures in population cohorts with longitudinal follow up. This currently limits our understanding of tree nut allergy prognosis.
Beneficial Effects of Walnuts on Cognition and Brain Health
Also, evidence from animal and human studies suggests that dietary consumption of walnuts may help improve cognitive function (brain health) and may also reduce the risk of other diseases, such as cardiovascular disease, depression and type 2 diabetes, which are risk factors for the development of dementia.
Chauhan, A., & Chauhan, V. (2020). Beneficial Effects of Walnuts on Cognition and Brain Health. Nutrients, 12(2), E550. https://doi.org/10.3390/nu12020550
Gulfood 2021
Gulfood is the world’s biggest annual food & hospitality show. Established over 26 years, Gulfood has a well deserved reputation amongst exporters for delivering spectacular return on investment. For the exporter seeking new sales from the Middle East, Africa and South Asia, Gulfood provides a trade and sourcing platform without equal, where international flavors find world-class business. Benefit from the region’s premier knowledge exchange from education, training, competitions & live events. Gulfood strives to inspire and inform.
The INC Nuts and Dried Fruits Pavilion will participate in the event. Click HERE for more information.
THE ALMOND CONFERENCE 2020 - VIRTUAL
We invite your company to be an integral part of the largest almond conference in the world. This premier almond event gives exhibitors and sponsors access to nearly 4,000 delegates. The Almond Conference, now in its 48th year, provides an unsurpassed platform for your company to showcase its products, services and offerings to a targeted audience of growers, handlers, suppliers, distributors, marketers, and researchers from around the globe.
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