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Special Issue "Eczema and Food Allergy in Children"

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A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Allergy and Immunology".

Deadline for manuscript submissions: 1 March 2024 | Viewed by 11011

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Special Issue Editors

Dr. Roxana Silvia Bumbãcea

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Guest Editor

1. Department of Allergology “Carol Davila”, University of Medicine and Pharmacy, 050474 Bucharest, Romania
2. Department of Allergy and Clinical Immunology, “Dr. Carol Davila” Nephrology Clinical Hospital, 010731 Bucharest, Romania
Interests: allergens; molecular diagnosis; atopic eczema; drug allergy; allergic rhinitis; asthma; anaphylaxis; urticaria; immunotherapy

Dr. Gavriela Maria Feketea

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Department of Pediatrics, Karamandaneio Children’s Hospital of Patra, Erithrou Stavrou 40, 26331 Patra, Greece
Interests: pediatric allergy; food allergy; asthma; allergic rhinitis; vitamin D
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Dr. Nicolaou Nicolaos

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Guest Editor

Department of Allergy and Pediatric Allergy, University of Nicosia Medical School, 2408 Nicosia, Cyprus
Interests: food allergy; molecular diagnosis; pediatric allergy

Dr. Emilia Vassilopoulou

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Guest Editor

1. Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
2. Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
Interests: food allergy/intolerance; immunomodulation and nutrition; gut–brain axis; nutritional psychiatry; inflammaging; food histamine; food proteins; diet; nutrition; eating disorders; immunity
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Eczema (atopic dermatitis, AD) and food allergy are two separate but strongly associated conditions. Once considered only a manifestation of food allergy, eczema is the first step in the chronological progression of allergic diseases, known as atopic march. The impaired skin barrier allows epicutaneous exposure to allergens, making AD a major risk factor for the development of food allergies. However, food allergens can also be responsible for eczema flare-ups. Although international guidelines offer clear instructions regarding the diagnosis and management of these disorders, some discrepancies still persist. While skin testing and sIgE have a clearly defined role in the evaluation of food-dependent reactions, placebo-controlled, double-blind oral provocation challenge is the gold standard, distinguishing between food sensitization and allergy. In some cases, dietary avoidance may be taken into consideration, but only after a careful assessment, as nutritional deficiencies and loss of tolerance to food allergens are undesirable consequences. Early introduction of allergenic food shows promising results in preventing food allergy in high-risk patients with AD, with further studies regarding the best approach and the ideal timing of reintroduction still underway.

This Special Issue will feature an update on recent data regarding the diagnosis, management and prevention of eczema and food allergies. We invite articles focusing on all aspects of the topic, especially those with a possible impact on the daily clinical practice in paediatric allergy.

Dr. Roxana Silvia Bumbãcea
Dr. Gavriela Maria Feketea
Dr. Nicolaou Nicolaos
Dr. Emilia Vassilopoulou
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

food allergy
eczema/ atopic dermatitis
atopy patch test
molecular diagnosis
elimination diet
preventive strategies

Published Papers (7 papers)

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Research

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Open AccessArticle

The Effect of Food Allergen Exclusion on the Growth of Saudi Children

Manar Abdulaziz Bin Obaid

Sahar Abdulaziz AlSedairy

and

Manal Abdulaziz Binobead

Children 2023, 10(9), 1468; https://doi.org/10.3390/children10091468 - 28 Aug 2023

Viewed by 330

Abstract

With a variety of symptoms that can impede children’s development, food allergies are an important public health concern. With the help of information from the King Fahad Medical City Hospital in Riyadh, we looked at how restricting certain foods affected the growth of Saudi children who had food allergies. An anonymous self-administered questionnaire asking about the individuals’ demographics and their restricted eating habits was completed by 72 children (48 boys and 24 girls) between the ages of 2 and 14. The sensitivity of six allergens (hen eggs, cow milk, fish, wheat, peanuts, and soybeans), anthropometric indices, specific Immunoglobulin E (IgE) levels, and sensitivity were examined. The Statistical Package for Social Science (SPSS), version 26, was used to analyze the data. Chi-square and t-tests were used to examine the relationships between various category variables. According to the findings, most of the mothers of the children were between the ages of 30 and 40 (80.6%), had a college degree (72.3%), were unemployed (59.7%), and had a monthly family income between 5000 and 15,000 SAR (69.4%). Both sexes had specific IgE antibodies for allergens in classes 2 and 3, with boys having noticeably (p ≤ 0.05) higher quantities than girls. While females were more sensitive to fish and peanuts, boys were more likely than girls to show specific IgE sensitivity to egg white, cow milk, wheat, and soybeans. Both sexes’ allergy levels were considerably (p ≤ 0.01) higher in children aged 5.01 to 10 than in other age groups. In terms of classifications of thinness, overweightness, and obesity, boys were slenderer than girls, and a greater percentage of boys than girls were overweight or obese. The exclusion of hen eggs, cow milk, wheat, and peanuts from the diet had a significant and detrimental effect on body mass index (BMI) and height-for-age ratio among children with impaired growth, in contrast to the demographic factors, which had a significant and favorable effect on the growth of other children. In conclusion, restrictions on food allergens impairs growth in Saudi children, particularly boys’ growth. Full article

(This article belongs to the Special Issue Eczema and Food Allergy in Children)

Open AccessArticle

Food Allergy Management Competence in Greek Schools

Gavriela Feketea

John Lakoumentas

Evangelia Papatriantafyllou

Nikolaos Douladiris

Dimitris Efthymiou

Luminita Aurelia Stanciu

and

Emilia Vassilopoulou

Children 2023, 10(3), 541; https://doi.org/10.3390/children10030541 - 11 Mar 2023

Viewed by 963

Abstract

Background: Schoolchildren are likely to consume meals and snacks at school, with a possibility of allergic food reactions and anaphylaxis in the school environment. The school personnel should be informed of the presence of schoolchildren with food allergy (FA) and need to be trained in the management of allergic reactions, as to prepare them to intervene appropriately when necessary. Limited knowledge of FA and its management is documented globally among school staff and there is no uniform protocol in schools. Methods: In this observational cross-sectional study, teachers at state schools throughout Greece completed an online anonymous questionnaire on their awareness of FA reactions and the plans for the management of medical emergencies in their schools of employment. Results: Among the 289 teachers who responded the online invitation, 203 (70.24%) were female and 157 (54%) were aged under 40 years. Females expressed a higher level of concern about the presence of school personnel trained to manage FA symptoms (p = 0.001), written instructions, and the availability of adrenaline (epinephrine) at school (p < 0.001). A younger age was associated with a higher level of both interest and knowledge on FA management in schools. School directors were more certain about the availability of a special record of children with FA at school (p = 0.01), the availability of adrenaline (p = 0.006), and written guidelines on the management of serious health incidents at school (p = 0.04). Written guidelines instructing children to avoid sharing cutlery, glasses, home-prepared meals, and snacks bought from the school canteen were more common in schools in urban areas (p = 0.015). Only 20% of respondents could confirm with certainty that adrenaline autoinjectors (AAIs) were available at their schools, for the purpose of administering to children in the case of a severe FA reaction. Approximately 3/4 of the participating teachers stated that completion of this questionnaire raised their awareness of the risk of FA reactions in children at school. Conclusions: This study, the first in Greece to explore the knowledge of teachers about FA in schoolchildren, revealed the following absences in many schools: a process for identifying children with FA, a written emergency treatment plan, and immediate access to emergency AAI. School FA guidelines are necessary in Greece, and training, which includes the use of AAIs, is required to prepare teachers to manage FA reactions in children at school. Full article

(This article belongs to the Special Issue Eczema and Food Allergy in Children)

Open AccessCommunication

Mediterranean Milk Ladder: Integrating a Healthy Eating Plan While Reintroducing Cow’s Milk

Emilia Vassilopoulou

Colleen McMilin

and

Carina Venter

Children 2023, 10(2), 234; https://doi.org/10.3390/children10020234 - 28 Jan 2023

Cited by 1 | Viewed by 3466

Abstract

The process of gradually reintroducing food allergens into an individual’s diet is referred to as a food allergen “ladder”, and the most recent edition of the original Milk Allergy in Primary (MAP) Care Guidelines, as well as the International Milk Allergy in Primary Care (IMAP), includes a shortened, improved, and international version with specific recipes, indicating the exact milk protein content, as well as the duration of heating and the temperature for each step of the ladder. Food allergen ladders are being used increasingly in clinical practice. The aim of this study was to develop a Mediterranean milk ladder based on the principles of the Mediterranean eating pattern. The protein content delivered in a portion of the final food product in each step of the ladder in the Mediterranean version corresponds to that provided in the IMAP ladder. Different recipes for the various steps were provided to increase acceptability and variety. Quantification of the total milk protein, casein content, and beta-lactoglobulin by Enzyme-linked immunosorbent assay (ELISA) could detect the gradual increase in concentrations, but the accuracy of the method was affected by the presence of the other ingredients in the mixtures. When developing the Mediterranean milk ladder, a key consideration was to reduce the amount of sugar by using limited amounts of brown sugar and substituting sugar with fresh fruit juice or honey for children aged older than one year. The proposed Mediterranean milk ladder includes principles of (a) healthy eating based on the Mediterranean diet and (b) the acceptability of foods across different age groups. Full article

(This article belongs to the Special Issue Eczema and Food Allergy in Children)

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Open AccessArticle

Parental Knowledge about Allergies and Problems with an Elimination Diet in Children Aged 3 to 6 Years

Malgorzata Kostecka

Joanna Kostecka-Jarecka

and

Children 2022, 9(11), 1693; https://doi.org/10.3390/children9111693 - 04 Nov 2022

Cited by 1 | Viewed by 1112

Abstract

Allergic diseases are highly prevalent, and they can exert a significant influence on the patients’ physical and mental well-being, thus affecting the quality of their lives and society as a whole. The aim of this study was to evaluate parental knowledge about allergens, allergy symptoms, and treatment of allergies, and to identify problems with adherence to an elimination diet and the underlying difficulties. Twelve kindergartens and the parents of 1350 preschoolers took part in the first stage of the study. In a screening trial, allergies were diagnosed in 197 children, and their parents participated in the second stage of the study. The child’s age at the onset of the first symptoms was significantly correlated with allergy type. Age was significantly correlated with selected symptoms of an allergic reaction, and skin allergies were more prevalent in younger children. Erythema, skin reddening, and urticaria occurred more frequently in children aged 3–4 years (OR 1.45; 95%CI 1.24–1.77, p < 0.05) and were diagnosed in skin tests (OR 1.36; 95%CI 1.22–1.59, p < 0.05). Allergies to numerous food items were associated with a long-term elimination diet (OR 1.89; 95%CI 1.33–2.19, p < 0.01), as well as problems with preparing safe meals, shopping for food, or dietary adherence when eating out. According to the respondents, lack of support from other family members and compliance with dietary restrictions in kindergartens and when eating out posed the greatest barriers to dietary adherence. Parents do not have sufficient knowledge about environmental allergens and effective strategies for coping with acute allergic reactions, including anaphylactic shock. Children with diagnosed food allergies should enjoy a similar quality of life to their healthy peers, which is why the parents should be educated about diet therapy, duration of treatment, and safe food substitutes. Full article

(This article belongs to the Special Issue Eczema and Food Allergy in Children)

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Review

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Open AccessReview

Food Allergy Education and Management in Early Learning and Childcare Centres: A Scoping Review on Current Practices and Gaps

Mae Jhelene L. Santos

and

Jennifer L. P. Protudjer

Children 2023, 10(7), 1175; https://doi.org/10.3390/children10071175 - 06 Jul 2023

Viewed by 723

Abstract

Anaphylaxis has occurred in preschools/schools yet there are no consistent food allergy (FA) management practices in early learning and childcare centres (ELCC) across jurisdictions. Presently, there are no reviews that have synthesized FA-related knowledge and management practices within ELCC. We aimed to perform a scoping review of FA management in ELCC, and report on perceived gaps or barriers. A PRISMA-ScR-guided search was conducted for North American, European and Australian articles in English/French in the OVID-MedLine, Scopus, and PsycInfo databases. Two independent reviewers screened the titles/abstracts of 2010 articles and full-text screened 77 articles; 15 of which were specifically related to ELCC. If the two reviewers could not agree to the relevance of a given study, a third reviewer provided guidance. This third reviewer also screened French articles. Thematic and descriptive reports of the studies were presented. We reported solely on pre-Coronavirus Disease pandemic ELCC studies. We included ten articles in this review, which provide evidence that ELCC staff have variable baseline knowledge, comprehension, experience, and practices in place to manage FA. ELCC staff also have limited FA-related training and experience regarding administration of epinephrine auto-injectors (EAI). Emergency Anaphylaxis Plans (EAP) were described in four studies. One study reported the parental influence on the site’s food purchasing and FA management. Three studies provided educational interventions, which demonstrated increased and sustained FA-related knowledge and confidence post-intervention. Participants deemed the training beneficial and desired annual training and more FA resources to be available. Across jurisdictions, ELCC staff have provided care and administered EAI in emergencies, but training remained variable. Communication and care planning amongst ELCC staff, and parents, is crucial. Annual education, available EAI and EAPs are tools necessary for effectively managing emergencies. Full article

(This article belongs to the Special Issue Eczema and Food Allergy in Children)

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Open AccessReview

Vitamin D and Omega-3 (Fatty Acid) Supplementation in Pregnancy for the Primary Prevention of Food Allergy in Children-Literature Review

Gavriela Feketea

Maria Kostara

Roxana Silvia Bumbacea

Emilia Vassilopoulou

and

Sophia Tsabouri

Children 2023, 10(3), 468; https://doi.org/10.3390/children10030468 - 27 Feb 2023

Cited by 1 | Viewed by 1793

Abstract

During the last decades the prevalence of food allergy (FA), an adverse immune response to a specific food antigen, has risen, with negative effects on the quality of life (QoL) of many children and their families. The pathogenesis of FA is complex, involving both genetic and environmental factors. SPINK5, STAT6, HLA and FOXP3 are some of the genes that are reported to be implicated in FA development. Regarding environmental factors, particular interest has been focused on modification of the dietary habits of pregnant women for the primary prevention of FA. Specifically, Vitamin D and omega-3 (Ω-3) fatty acid supplementation during pregnancy may influence the development of FA in the offspring. Vitamin D is a hormone with various actions, including mediation of the immune system, reducing the production of inflammatory cytokines and promoting tolerance. Vitamin D deficiency in pregnancy suppresses T-regulatory cells in the fetus, and Vitamin D supplementation might protect against FA development. Dietary Ω-3 fatty acids are found mainly in fish and vegetable oils. They are beneficial for human health, playing a role in the immune system as anti-inflammatory agents, and providing cell membrane stabilization with inhibition of antigen presentation. It is documented that maternal supplementation with Ω-3 during pregnancy may protect from allergic sensitization in the children. The aim of this literature review was to explore the potential preventive role of maternal supplementation during pregnancy with Vitamin D and Ω-3 in the development of FA in the offspring. With the prevalence of FA rising, all the possible protective mechanisms and measures for FA prevention need to be explored, starting with those that can be modified. Full article

(This article belongs to the Special Issue Eczema and Food Allergy in Children)

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Open AccessReview

Atopic Dermatitis and Water: Is There an Optimum Water Intake Level for Improving Atopic Skin?

Nikolaos Douladiris

Efstratios Vakirlis

and

Emilia Vassilopoulou

Children 2023, 10(2), 273; https://doi.org/10.3390/children10020273 - 31 Jan 2023

Cited by 2 | Viewed by 1749

Abstract

Water is a vital nutrient with innumerable functions for every living cell. The functions of human skin include protection against dehydration of the body. Atopic dermatitis (AD) is a chronic pruritic inflammatory skin disease that presents with dry skin, erythematous and eczematous lesions, and lichenification. This paper discusses the question of whether extra water intake in children with AD affects skin hydration and the skin barrier function. Among the methods used to treat dry skin, topical leave-on products are the first-line treatment, intended to improve hydration and the skin barrier function. The effectiveness of adequate water intake as a measure to treat dry skin is still under debate. Normal skin hydration increases with dietary water intake, particularly in those with prior lower water consumption. Skin dryness in AD is instrumental to the itch and inflammation cycle, contributing to barrier impairment and aggravating disease severity and flares. Certain emollients provide significant hydration to AD skin, with relief of dryness and reduction in barrier impairment, disease severity, and flares. Further investigations are needed to evaluate the optimum water intake levels in children with AD, as important questions remain unanswered, namely, does oral hydration provide relief of skin dryness and reduce barrier impairment, disease severity, and flares; is there any additional benefit from using mineral or thermal spring water; or is there a need to specifically study the fluid/water intake in children with AD and food allergy (FA) restrictions? Full article

(This article belongs to the Special Issue Eczema and Food Allergy in Children)

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