Top

Published in:

Open Access 01-12-2022 | Lactose Intolerance | Review

Diagnostic therapeutic care pathway for pediatric food allergies and intolerances in Italy: a joint position paper by the Italian Society for Pediatric Gastroenterology Hepatology and Nutrition (SIGENP) and the Italian Society for Pediatric Allergy and Immunology (SIAIP)

Authors: Roberto Berni Canani, Carlo Caffarelli, Mauro Calvani, Alberto Martelli, Laura Carucci, Tommaso Cozzolino, Patrizia Alvisi, Carlo Agostoni, Paolo Lionetti, Gian Luigi Marseglia

Published in: Italian Journal of Pediatrics | Issue 1/2022

Abstract

Epidemiologic data suggest an increased prevalence of pediatric food allergies and intolerances (FAIs) during the last decades. This changing scenario has led to an increase in the overall healthcare costs, due to a growing demand for diagnostic and treatment services. There is the need to establish Evidence-based practices for diagnostic and therapeutic intervention that could be adopted in the context of public health policies for FAIs are needed.

This joint position paper has been prepared by a group of experts in pediatric gastroenterology, allergy and nutrition from the Italian Society for Pediatric Gastroenterology Hepatology and Nutrition (SIGENP) and the Italian Society for Pediatric Allergy and Immunology (SIAIP). The paper is focused on the Diagnostic Therapeutic Care Pathway (DTCP) for pediatric FAIs in Italy.

Sicherer SH, Sampson HA. Food allergy: a review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol. 2018;141:41–58.PubMedCrossRef

Branum AM, Lukacs SL. Food allergy among children in the United States. Pediatrics. 2009;124:1549–55.PubMedCrossRef

Gupta RS, Springston EE, Warrier MR, et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. 2011;128:e9–e17.PubMedCrossRef

Johansson SG, Hourihane JO, Bousquet J, Bruijnzeel-Koomen C, Dreborg S, Haahtela T, et al. EAACI (the European academy of Allergology and ClinicalImmunology) nomenclature task force. A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy. 2001;56:813–24.PubMedCrossRef

American Gastroenterological Association medical position statement: guidelines for the evaluation of food allergies. Gastroenterology. 200;120:1023–5.

Boyce J, Assa’ad A, Burks AW, Jones SM, Sampson HA, Wood RA, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126:1–58.CrossRef

Cianferoni A. Non-IgE mediated food allergy. Curr Pediatr Rev. 2020;16:95–105.PubMed

Onyimba F, Crowe SE, Johnson S, Leung J. Food allergies and intolerances: a clinical approach to the diagnosis and Management of Adverse Reactions to food. Clin Gastroenterol Hepatol. 2021;19:2230–2240.e1.PubMedCrossRef

Nocerino R, Leone L, Cosenza L, Berni CR. Increasing rate of hospitalizations for food-induced anaphylaxis in Italian children: an analysis of the Italian Ministry of Health database. J Allergy Clin Immunol. 2015;135:833–5.PubMedCrossRef

10.

Grimshaw KE, Bryant T, Oliver EM, et al. Incidence and risk factors for food hypersensitivity in UK infants: results from a birth cohort study. ClinTransl Allergy. 2016;6:1.

11.

Italian National Institute of Statistics (ISTAT) Rome, Italy: ISTAT; 2018 Available from: http://demo.istat. it/bil2018/index_e.html. Accesso in data 13.12.2019.

12.

Calvani M, Anania C, Cuomo B, D’Auria E, Decimo F, Indirli GC, et al. Non–IgE- or mixed IgE/non–IgE-mediated gastrointestinal food allergies in the first years of life: old and new tools for diagnosis. Nutrients. 2020;13:226.CrossRef

13.

Renz H, Allen KJ, Sicherer SH, Sampson HA, Lack G, Beyer K, et al. Food allergy Nat Rev Dis Primers. 2018;4:17098.PubMedCrossRef

14.

Nowak-Węgrzyn A, Chehade M, Groetch ME, et al. International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome: executive summary- workgroup report of the adverse reactions to foods committee, American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2017;139:1111–26.PubMedCrossRef

15.

Feuille E, Nowak-Wegrzyn A. Medical algorithms: recognizing and treating food protein-induced enterocolitis syndrome. Allergy. 2019;74:2019–22.PubMedCrossRef

16.

Zeevenhooven J, Koppen IJ, Benninga MA. The new Rome IV criteria for functional gastrointestinal disorders in infants and toddlers. Pediatr Gastroenterol Hepatol Nutr. 2017;20(1):1–13. https://doi.org/10.5223/pghn.2017.20.1.1.CrossRefPubMedPubMedCentral

17.

Muraro A, Werfel T, Hoffmann-Sommergruber K, et al. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allegy. Allergy. 2014;69:1008–25.PubMedCrossRef

18.

Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, et al. Joint task force on practice parameters. Food allergy: a practice parameter update—2014. J Allergy Clin Immunol. 2014;134:1016–25.PubMedCrossRef

19.

Bernstein IL, Li JT, Bernstein DI, Hamilton R, Spector SL, Tan R, et al. Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol. 2008;100(suppl 3):S1–148.PubMed

20.

Nowak-Wegrzyn A, Fiocchi A. Rare, medium, or well done? The effect of heating and food matrix on food protein allergenicity. Curr Opin Allergy Clin Immunol. 2009;3:234–7.CrossRef

21.

Peters RL, Gurrin LC, Allen KJ. The predictive value of skin prick testing for challenge-proven food allergy: a systematic review. Pediatr Allergy Immunol. 2012;23:347–52.PubMedCrossRef

22.

Henzgen M, Ballmer-Weber BK, Erdmann S, Fuchs T, Kleine-Tebbe J, Lepp U, et al. Skin testing with food allergens guideline of the German Society of Allergology and Clinical Immunology (DGAKI), the physicians’ Association of German Allergologists (ÄDA) and the Society of Pediatric Allergology (GPA) together with the Swiss Society of Allergology. J Dtsch Dermatol Ges. 2008;6(11):983–8.PubMedCrossRef

23.

Calvani M, Paravati S, Arasi S, Barni S, Bianchi A, et al. Il test di provocazione orale per alimenti nella pratica clinica. Rivista di Immunologia e Allergologia Pediatrica. 2018;1:1–51.

24.

Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, Valenta R, Hilger C, Hofmaier S, et. al. EAACI MolecularAllergologyUser's guide. Pediatr Allergy Immunol 2016;27Suppl 23:1–250.

25.

McKenna OE, Asam C, Araujo GR, Roulias A, Goulart LR, Ferreira F. How relevant is panallergen sensitization in the development of allergies? Pediatr Allergy Immunol. 2016;27(6):560–8.PubMedPubMedCentralCrossRef

26.

Hemmer W, Altmann F, Holzweber F, Gruber C, Wantke F, Wöhrl S. ImmunoCAP cellulose displays cross-reactive carbohydrate determinant (CCD) epitopes and can cause false-positive test results in patients with high anti-CCD IgE antibody levels. J Allergy ClinImmunol. 2018;141:372–381.e3.CrossRef

27.

Rodríguez Del Río P, Díaz-Perales A, Sánchez-García S, Escudero C, Ibáñez MD, Méndez-Brea P, et al. Profilin, a change in the paradigm. J Investig Allergol Clin Immunol. 2018;28(1):1–12.PubMedCrossRef

28.

Berneder M, Bublin M, Hoffmann-Sommergruber K, Hawranek T, Lang R. Allergen chip diagnosis for soy-allergic patients: Gly m 4 as a marker for severe food-allergic reactions to soy. Int Arch Allergy mmunol. 2013;161:229–33.CrossRef

29.

Asero R, Piantanida M, Pravettoni V. Allergy to LTP: to eat or not to eat sensitizing foods? A follow-up study. Eur Ann Allergy ClinImmunol. 2018;50(4):156–62.CrossRef

30.

Villalta D, Scala E, Mistrello G, Amato S, Asero R. Evidence of cross-reactivity between different seed storage proteins from hazelnut (Corylusavellana) and walnut (Juglansregia) using recombinant allergen proteins. Int Arch Allergy Immunol. 2019;178(1):89–92.PubMedCrossRef

31.

Posthumus J, James HR, Lane CJ, Matos LA, Platts-Mills TA, Commins SP. Initial description of pork-cat syndrome in the United States. J Allergy Clin Immunol. 2013;131(3):923–5.PubMedPubMedCentralCrossRef

32.

Martelli A, De Chiara A, Corvo M, Restani P, Fiocchi A. Beef allergy in children with cow's milk allergy; cow's milk allergy in children with beef allergy. Ann Allergy Asthma Immunol. 2002;89(6 Suppl 1):38–43.PubMedCrossRef

33.

Carvalho S, Marcelino J, CabralDuarte M, Costa C, Barbosa M. Pereira dos Santos MC. Contribution of recombinant Parvalbumin gad c 1 in the diagnosis and prognosis of fish allergy. J Investig Allergol Clin Immunol. 2020;30(5):340–5.PubMedCrossRef

34.

Celi G, Brusca I, Scala E, et al. House dust mite allergy in Italy-diagnostic and clinicalrelevance of Der p 23 (and of minor allergens): a real-life, multicenterstudy. Allergy. 2019;74(9):1787–9.PubMedCrossRef

35.

Platts-Mills TAE, Li RC, Keshavarz B, Smith AR, Wilson JM. Diagnosis and Management of Patients with the α-gal syndrome. J Allergy Clin Immunol Pract. 2020;8:15–23.e1.PubMedCrossRef

36.

Inomata N. Gibberellin-regulated protein allergy: clinical features and cross-reactivity. Allergol Int. 2020;69:11–8.PubMedCrossRef

37.

Takahashi K, Yanagida N, Sato S, Ebisawa M. Predictive power of ovomucoid and egg white specific IgE in heated egg oral food challenges. J Allergy Clin Immunol Pract. 2018;6(6):2115–2117.e6.PubMedCrossRef

38.

BoyanoMartínez T, García-Ara C, Díaz-Pena JM, Muñoz FM, García Sánchez G, Esteban MM. Validity of specific IgE antibodies in children with egg allergy. Clin Exp Allergy. 2001;31(9):1464–9.CrossRef

39.

Dang TD, Mills CE, Allen KJ. Determination of the clinical egg allergy phenotypes using component-resolved diagnostics. Pediatr Allergy Immunol. 2014;25:639–43.PubMedCrossRef

40.

Infante S, López-Matas MÁ, Carnés J, Fuentes V, Alonso E, Zapatero L. Allergy reaction mediated by gal d 4 (lysozyme) after the induction of tolerance with egg. Ann Allergy Asthma Immunol. 2014;113(4):491–2.PubMedCrossRef

41.

Inomata N, Kawano K, Aihara M. Bird-egg syndrome induced by α-livetin sensitization in a budgerigar keeper: successful induction of tolerance by avoiding exposure to avians. Allergol Int. 2019;68(2):282–4.PubMedCrossRef

42.

Amo A, Rodríguez-Pérez R, Blanco J, Villota J, Juste S, Moneo I, et al. Gal d 6 is the second allergen characterized from egg yolk. J Agric Food Chem. 2010;58:7453–7.PubMedCrossRef

43.

Tsabouri S, Douros K, Priftis KN. Cow's milk allergenicity. Endocr Metab Immune Disord Drug Targets. 2014;14:16–26.PubMedCrossRef

44.

Fox A, Brown T, Walsh J, Venter C, Meyer R, Nowak-Wegrzyn A, et al. An update to the Milk allergy in primary care guideline. Clin Transl Allergy. 2019;12(9):40.CrossRef

45.

Mastrorilli C, Tripodi S, Caffarelli C, Perna S, Di Rienzo-Businco A, et al. For the Italian pediatric allergy network (I-PAN). Endotypes of pollen-food syndrome in children with seasonal allergic rhinoconjunctivitis: a molecular classification. Allergy. 2016;71:1181–91.PubMedCrossRef

46.

Jacob T, Forstenlechner P, Matricardi P, Kleine TJ. Molecular allergy diagnostics using multiplex assays: methodological and practical considerations for use in research and clinical routine. Part 21 of the series molecular Allergology. Allergo J Int. 2015;24:320–32.CrossRef

47.

Luo Y, Zhang GQ, Li ZY. The diagnostic value of APT for food allergy in children: a systematic review and meta-analysis. Pediatr Allergy Immunol. 2019;30(4):451–61.PubMedCrossRef

48.

Sundquist BK, Yang B, Pasha MA. Experience in patch testing: a 6-year retrospective review from a single academic allergy practice. Ann Allergy Asthma Immunol. 2019;122(5):502–7.PubMedCrossRef

49.

Rancé F, Deschildre A, Villard-Truc F, Gomez SA, Paty E, Santos C, et al. Oral food challenge in children: an expert review. Eur Ann Allergy ClinImmunol. 2009;41:35–49.

50.

Nowak-Wegrzyn A, Assa’ad AH, Bahna SL, Bock SA, Sicherer SH, Teuber SS. Adverse reactions to food Committee of American Academy of allergy, Asthma & Immunology. Work group report: Oral food challenge testing. J Allergy Clin Immunol. 2009;123:S365–83.PubMedCrossRef

51.

Nowak-Węgrzyn A, et al. Non-IgE-mediated gastrointestinal food allergy J Allergy ClinImmunol. 2015;135:1114–24.

52.

Collins MH, et al. Eosinophilic Gastrointestinal Disorders Pathology Front Med. 2018;4:261.

53.

Berni Canani R, Di Costanzo M, Troncone R. The optimal diagnostic workup for children with suspected food allergy. Nutrition. 2011;27:983–7.PubMedCrossRef

54.

Mehr S, Campbell DE. Food protein-induced enterocolitis syndrome: guidelines summary and practice recommendations. Med J Aust. 2019;210(2):94–9.PubMedCrossRef

55.

Berni Canani R, Pezzella V, Amoroso A, Cozzolino T, Di Scala C, Passariello A. Diagnosing and treating intolerance to carbohydrates in children. Nutrients. 2016;8:157.PubMedPubMedCentralCrossRef

56.

Francavilla R, Cristofori F, Castellaneta S, et al. Clinical, serologic and histologic features of gluten sensitivity in children. J Pediatr. 2014;164:463–7.PubMedCrossRef

57.

Catassi C, Elli L, Bonaz B, et al. Diagnosis of on-celiac gluten Sensitvity (NCGS): the Salerno Experts’Criteria. Nutrients. 2015;7:4966–77.PubMedPubMedCentralCrossRef

Title: Diagnostic therapeutic care pathway for pediatric food allergies and intolerances in Italy: a joint position paper by the Italian Society for Pediatric Gastroenterology Hepatology and Nutrition (SIGENP) and the Italian Society for Pediatric Allergy and Immunology (SIAIP)
Authors: Roberto Berni Canani
Carlo Caffarelli
Mauro Calvani
Alberto Martelli
Laura Carucci
Tommaso Cozzolino
Patrizia Alvisi
Carlo Agostoni
Paolo Lionetti
Gian Luigi Marseglia
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Lactose Intolerance
Anaphylaxis
Nutrition
Care
Pediatric Gastroenterology
Food Allergy
Anaphylaxis
Published in: Italian Journal of Pediatrics / Issue 1/2022
Electronic ISSN: 1824-7288
DOI: https://doi.org/10.1186/s13052-022-01277-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Diagnostic therapeutic care pathway for pediatric food allergies and intolerances in Italy: a joint position paper by the Italian Society for Pediatric Gastroenterology Hepatology and Nutrition (SIGENP) and the Italian Society for Pediatric Allergy and Immunology (SIAIP)

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2022

A dangerous food binge: a case report of hypokalemic periodic paralysis and review of current literature

Different AHO phenotype in a Chinese family with a novel GNAS missense variant: a case report

Hypertrophic pyloric stenosis masked by kidney failure in a male infant with a contiguous gene deletion syndrome at Xp22.31 involving the steroid sulfatase gene: case report

Multidisciplinary care for patients with epidermolysis bullosa from birth to adolescence: experience of one Italian reference center

Factors associated with children’s HIV- positive status disclosure in Wolaita Zone, Southern Ethiopia: a cross-sectional study

Assessment of selected interleukins (IL-6, IL-17A, IL-18, IL-23) and chemokines (RANTES, IP-10) in children with acute and chronic urticaria