Immune signatures predicting the clinical outcome of peanut oral immunotherapy: where we stand
Peanut allergy is a growing health concern that can cause mild to severe anaphylaxis as well as reduced quality of life in patients and their families. Oral immunotherapy is an important therapeutic intervention that aims to reshape the immune system toward a higher threshold dose reactivity and sustained unresponsiveness in some patients. From an immunological point of view, young patients, especially those under 3 years old, seem to have the best chance for therapy success. To date, surrogate markers for therapy duration and response are evasive. We provide a comprehensive overview of the current literature state regarding immune signatures evolving over the course of oral immunotherapy as well as baseline immune conditions prior to the initiation of treatment. Although research comparing clinical and immune traits in the first years of life vs. later stages across different age groups is limited, promising insights are available on immunological endotypes among peanut-allergic patients. The available data call for continued research to fill in gaps in knowledge, possibly in an integrated manner, to design novel precision health approaches for advanced therapeutic interventions in peanut allergy.
https://doi.org/10.3389/falgy.2023.1270344
Early Peanut Introduction in Infants: Improving Guideline Adherence With EMR Standardization
Objectives: Peanut allergy in children is a population health problem. Evidence suggests early peanut introduction (EPI) for infants can reduce the development of peanut allergy. Primary care settings have not widely adopted guidelines recommending EPI. Peanut allergy prevention depends on primary care providers incorporating EPI guidelines into well-child check (WCC) encounters. We aimed to improve guideline adherence in a primary care setting by implementing a bundle of clinical decision support (CDS) tools. Methods: Using quality improvement methodology, the team developed a standardized work protocol and CDS tools within an electronic medical record (EMR) at 4, 6, and 9-month WCC encounters. The team executed changes and modifications through plan-do-study-act cycles and analyzed results with statistical process control charts. Results: We collected data from 445 WCC encounters from baseline through sustainability. EMR documentation of EPI guidance at 4, 6, and 9-month WCCs shifted from 13.9% to 83.5% over 12 months. Provider adoption of smart lists and templates increased from 2% to 73%, the distribution of home peanut introduction handouts increased from 5.2% to 54.1%, and caregiver-reported peanut ingestion increased from 0% to 34.6%. Diphtheria-tetanus-acellular pertussis vaccination rates remained at 100% for 6-month visits, and patient in-room time remained at 65 minutes. Conclusions: Quality improvement methodology improved documentation of EPI guidance and increased reported peanut ingestion at routine WCC encounters without impacting other measures. Broader use of bundled CDS tools and EMR standardization could further improve guideline adherence and increase early peanut introduction to prevent peanut allergy in infants.
https://doi.org/10.1542/peds.2023-062371
Fast impedimetric immunosensing of IgGs associated with peanut and hazelnut allergens
Food allergies trigger a variety of clinical adverse symptoms and clinical evidence suggests that the presence of food allergy-related IgG can be helpful in the diagnosis when analyzed at the peptide-epitope level. To validate and select the peptides based on their specificity toward hazelnut or peanut epitopes, the authors of this study developed a silicon-based microchip coupled with click-chemistry bound peptides identified by the Fraunhofer Institute for Cell Therapy and Immunology. Peptides related to hazelnut and peanut allergies were identified and used to develop a silicon-based microchip. Peptides were coupled with click-chemistry to the sensor surface. The immunosensor was developed by electrografting diazotized amino phenylacetic acid and subsequently, dibenzocyclooctyne-amine (DBCO-NH2) was used as click-chemistry to allow coupling of the peptides with a C-terminal linker and azide structure. Energy-dispersive X-ray spectroscopy, electrochemical impedance spectroscopy (EIS), and fluorescence microscopy techniques have been used to analyze the bio-functionalization of the developed electrode. The peptide-epitope recognition was studied for seven allergen-derived peptides. The electrochemical responses were studied with sera from rabbits immunized with hazelnut and peanut powder. The microchips functionalized with the chosen peptides (peanut peptides T12 and EO13 and hazelnut peptides S4 and EO14 with an RSD of 4%, 3%, 9%, and 1% respectively) demonstrated their ability to specifically detect prevalent anti-nut related IgGs in rabbit sera in a range of dilutions from 1:500000 (0.0002%) until 1:50000 (0.002%). In addition, the other peptides showed promising differentiation abilities which can be further studied to perform multivariable detection fingerprint of anti-allergens in blood sera.
https://doi.org/10.1016/j.bios.2023.115612
EAACI guidelines on the diagnosis of IgE-mediated food allergy
This European Academy of Allergy and Clinical Immunology guideline provides recommendations for diagnosing IgE-mediated food allergy and was developed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Food allergy diagnosis starts with an allergy-focused clinical history followed by tests to determine IgE sensitization, such as serum allergen-specific IgE (sIgE) and skin prick test (SPT), and the basophil activation test (BAT), if available. Evidence for IgE sensitization should be sought for any suspected foods. The diagnosis of allergy to some foods, such as peanut and cashew nut, is well supported by SPT and serum sIgE, whereas there are less data and the performance of these tests is poorer for other foods, such as wheat and soya. The measurement of sIgE to allergen components such as Ara h 2 from peanut, Cor a 14 from hazelnut and Ana o 3 from cashew can be useful to further support the diagnosis, especially in pollen-sensitized individuals. BAT to peanut and sesame can be used additionally. The reference standard for food allergy diagnosis is the oral food challenge (OFC). OFC should be performed in equivocal cases. For practical reasons, open challenges are suitable in most cases. Reassessment of food allergic children with allergy tests and/or OFCs periodically over time will enable reintroduction of food into the diet in the case of spontaneous acquisition of oral tolerance.
https://doi.org/10.1111/all.15902
Prevalence of tree nut allergy in Europe: A systematic review and meta-analysis
In 2014, the European Academy of Allergy and Clinical Immunology (EAACI) published the first systematic review that summarized the prevalence of food allergy (FA) and food sensitization in Europe for studies published 2000-2012. However, only summary estimates for tree nut allergy (TNA) were feasible in that work. In the current update of that systematic review, we summarized the prevalence of tree nut allergy/sensitization to individual tree nuts. Six databases were searched for relevant papers published 2012-2021 and 17 eligible studies were added to the 15 studies already identified between 2000 and 2012, giving a total of 32 studies. Of the investigated tree nuts, meta-analysis was possible for hazelnut, walnut, almond, and in few cases, for cashew, and Brazil nut. The lifetime self-reported prevalence was 0.8% (95% CI 0.5-1.1) for hazelnut and 0.4% (0.2-0.9) for walnut. The point self-reported prevalence was 4.0% (2.9-5.2) for hazelnut, 3.4% (2.0-4.9) for Brazil nut, 2.0% (1.1-2.9) for almond, and 1.8% (1.1-2.5) for walnut. Point prevalence of food challenge-confirmed TNA was 0.04% (0.0-0.1) for hazelnut and 0.02% (0.01-0.1) for walnut. Due to paucity of data, we could not identify any meaningful and consistent differences across age groups and European regions.
https://doi.org/10.1111/all.15905
Revised Swedish infant feeding guidelines are associated with earlier introduction of allergenic foods.
Background: Randomized controlled trials have demonstrated that early introduction of allergenic foods, such as peanut and egg, can reduce food allergy in high-risk children. Many international guidelines recommend introduction in the first year of life and accordingly, the Swedish National Food agency released updated guidelines in June 2019. Objective: To examine if the age at introduction and consumption frequency of allergenic foods have changed since the release of revised national guidelines on the introduction of solid foods in Sweden. Methods: Children born between June 2016 and December 2018 (n=1925) were compared to children born between June 2019 and April 2021 (n=1761) using data from the NorthPop Birth Cohort study. Data on food introduction, eczema and food allergy were prospectively collected until age 18 months using web-based questionnaires. IgE sensitization was assessed at 18 months of age. Results: The proportion who had introduced egg, legume, soy protein, peanut, almond and cashew nut during the first year of life increased after the implementation of revised national guidelines. The most significant change was seen for legume (55.2% to 69.8% aOR 1.90 (95% CI: 1.62-2.24) and peanut (29.2% to 43.2% aOR 1.87 (95% CI: 1.55-2.24) and the consumption frequency had also increased. No differences in the prevalence of eczema, food allergy or sensitization to the foods of interest were found. Conclusion: Since the release of revised guidelines, infants in the general population introduce and consume a variety of allergenic foods earlier and more frequently, while early manifestations of allergic disease remained unchanged.
https://doi.org/10.1016/j.jaci.2023.08.037
Association Between Nut Consumption and Low Muscle Strength Among Korean Adults.
Nuts are an important component of a healthy diet, but little has been known about their effects on muscle health. Therefore, this study examined the association between nut consumption and low muscle strength among Korean adults. This cross-sectional analysis was conducted using single 24-hour recall and handgrip strength data from 3,962 younger adults 19-39y, 6,921 middle-aged adults 40-64y, and 3,961 older adults ≥65y participated in the seventh cycle (2016-2018) of the Korea National Health and Examination Survey (KNHANES). Low muscle strength was defined as handgrip strength <28 kg for men and <18 kg for women. Sex-specific odds ratios (ORs) were obtained for younger, middle-aged, and older adults using multivariable logistic regression analyses. About one in four Korean adults were consuming nuts (using a culinary definition) with peanut being the most frequently consumed type. After adjustment for age, body mass index, total energy intake, household income, alcohol consumption, smoking, resistance exercise, medical history, and dietary protein intake, nut consumption was associated with the lower risk of low muscle strength among older adults ≥65y (men: OR 0.55, 95% CI 0.38, 0.79; women: OR 0.69, 95% CI 0.51, 0.93); however, this association was not observed among younger adults 19-39y or middle-aged adults 40-64y. Our results suggest that consuming nuts might be beneficial in lowering the risk of low muscle strength among Korean older adults.
https://doi.org/10.1017/S0007114523002386
Combination of Walnut Peptide and Casein Peptide alleviates anxiety and improves memory in anxiety mices.
Introduction: Anxiety disorders continue to prevail as the most prevalent cluster of mental disorders following the COVID-19 pandemic, exhibiting substantial detrimental effects on individuals' overall well-being and functioning. Even after a search spanning over a decade for novel anxiolytic compounds, none have been approved, resulting in the current anxiolytic medications being effective only for a specific subset of patients. Consequently, researchers are investigating everyday nutrients as potential alternatives to conventional medicines. Our prior study analyzed the antianxiety and memory-enhancing properties of the combination of Walnut Peptide (WP) and Casein Peptide (CP) in zebrafish. Methods and results: Based on this work, our current research further validates their effects in mice models exhibiting elevated anxiety levels through a combination of gavage oral administration. Our results demonstrated that at 170 + 300 mg human dose, the WP + CP combination significantly improved performances in relevant behavioral assessments related to anxiety and memory. Furthermore, our analysis revealed that the combination restores neurotransmitter dysfunction observed while monitoring Serotonin, gamma-aminobutyric acid (GABA), dopamine (DA), and acetylcholine (ACh) levels. This supplementation also elevated the expression of brain-derived neurotrophic factor mRNA, indicating protective effects against the neurological stresses of anxiety. Additionally, there were strong correlations among behavioral indicators, BDNF (brain-derived neurotrophic factor), and numerous neurotransmitters. Conclusion: Hence, our findings propose that the WP + CP combination holds promise as a treatment for anxiety disorder. Besides, supplementary applications are feasible when produced as powdered dietary supplements or added to common foods like powder, yogurt, or milk.
https://doi.org/10.3389/fnut.2023.1273531
A Dietary Model of Partial Meat Replacement with Walnuts Demonstrates Changes in the Nutrient Profile and Quality of the United States Population’s Diet.
The purpose of the study is to assess the impact of partial meat replacement with walnuts using a dose–escalation approach on nutrient intake and diet quality in the usual US diet. Food modeling was implemented using the nationally representative 2015–2018 National Health and Examination Survey (NHANES), with a focus on non-nut consumers, which included 2707 children and adolescents and 5190 adults. Walnuts replaced meat in a dose-escalating manner (0.5, 1, 1.5, and 2 oz walnuts per day replaced 1, 2, 3, and 4 oz meat, respectively). Diet quality was estimated using the population ratio method of the 2015 Healthy Eating Index. The usual intake of nutrients was estimated using the National Cancer Institute method. Significant differences were determined using non-overlapping 95% confidence intervals. The partial replacement of meat with walnuts demonstrated significant increases in the mean intake of fiber, magnesium, and omega-3 fatty acids and significant decreases in cholesterol and vitamin B12 in the modeled diets for children, adolescents, and adults. Additionally, the partial replacement of meat with walnuts improved overall diet quality. Walnut consumption at 1–2 oz as a replacement for some meat may improve nutrient intake and diet quality across age groups.
http://dx.doi.org/10.3390/nu15214518
Tree Nut Consumption Associated with Decreased Prevalence of Cardiovascular Disease
Other benefits included lower cardiometabolic risk factors
A recent study published in Current Developments in Nutrition set out to estimate the usual tree nut intake of a nationally representative sample of US adults and examine the association between tree nut consumption and cardiometabolic health outcomes.
The study sample included 18,150 adults over 20 years of age who had participated in the 2011–2018 National Health and Nutrition Examination Survey (NHANES). Participants’ usual tree nut intake was estimated using the National Cancer Institute Method.
Approximately 8% of participants were found to be tree nut consumers (defined as those consuming at least ¼ ounce, or 7.09 grams, of tree nuts per day). Tree nut consumers were less likely than nonconsumers to have obesity (31% vs. 40%) and low high-density lipoprotein cholesterol (22% vs. 30%). Moreover, tree nut consumers had a lower mean waist circumference (97 vs. 101 cm) and lower levels of apolipoprotein B (88 vs. 92 mg/dL).
The researchers concluded that modest consumption of tree nuts was associated with decreased prevalence of cardiovascular disease and cardiometabolic risk factors, as well as improvement of some health outcome measures.
Lopez-Neyman, S. M., Zohoori, N., Broughton, K. S., & Miketinas, D. C. (2023). Association of Tree Nut Consumption with Cardiovascular Disease and Cardiometabolic Risk Factors and Health Outcomes in US Adults: NHANES 2011-2018. Current Developments in Nutrition, 7(10), 102007.