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Current Trends in Tolerance Induction in Cow's Milk Allergy: From Passive to Proactive Strategies
(FRONTIERS MEDIA SA, 2019-01-01) Sackesen, Cansin; Altintas, Derya Ufuk; Bingol, Aysen; Bingol, Gulbin; Buyuktiryaki, Betul; Demir, Esen; Kansu, Aydan; Kuloglu, Zarife; Tamay, Zeynep; Sekerel, Bulent Enis
This review addresses the current strategies of inducing tolerance development in infant and childhood cow's milk protein allergy (CMPA). The change in prevention strategies for CMPA has been emphasized based on the lack of evidence to support the efficacy of food allergen avoidance in infancy and the concept of the dual-allergen-exposure hypothesis, which suggests that allergen exposure through the skin leads to sensitization, whereas early oral consumption of allergenic food protein induces oral tolerance. The new approach is based on the likelihood of early introduction of allergenic foods to the infant's diet to reduce the development of food allergies through oral tolerance induction. The latest treatment guidelines recommend the continuation of breast feeding and the elimination of cow's milk and products from the maternal diet in exclusively breast-fed infants with CMPA, the use of an extensively hydrolyzed infant formula (eHF) with proven efficacy in CMPA as the first elimination diet in formula-fed infants with CMPA and the use of amino acid-based formula (AAF) in severe cases, such as anaphylaxis, enteropathy, eosinophilic esophagitis, and food protein-induced enterocolitis syndrome (FPIES), as well as cases of multiple system involvement, multiple food allergies, and intolerance to extensively hydrolyzed formula (eHF). In conclusion, this paper presents the current knowledge on tolerance development in infants and children with CMPA to increase the awareness of the clinicians concerning the new approaches in CMPA treatment Tolerance development is considered a relatively new concept in CMPA, inducing a shift in interventions in CMPA from a passive (avoidance of responsible allergen) toward a proactive (tolerance induction) strategy.
An Expert Panel Statement on the Beneficial Effects of Human Milk Oligosaccharides (HMOs) in Early Life and Potential Utility of HMO-Supplemented Infant Formula in Cow's Milk Protein Allergy
(DOVE MEDICAL PRESS LTD, 2021-01-01) Sekerel, Bulent Enis; Bingol, Gulbin; Cokugras, Fugen Cullu; Cokugras, Haluk; Kansu, Aydan; Ozen, Hasan; Tamay, Zeynep
This review by pediatric gastroenterology and allergy-immunology experts aimed to address the biological roles of human milk oligosaccharides (HMOs) and the potential utility of HMOs in prevention of allergy with particular emphasis on cow's milk protein allergy (CMPA). The participating experts consider HMOs amongst the most critical bioactive components of human milk, which act as antimicrobials and antivirals by preventing pathogen adhesion to epithelial cells, as intestinal epithelial cell modulators by enhancing maturation of intestinal mucosa and intestinal epithelial barrier function, as prebiotics by promoting healthy microbiota composition and as immunomodulators by modulating immune cells indirectly and directly. Accordingly, the participating experts consider the proposed link between HMOs and prevention of allergy to be primarily based on the impact of HMO on gut microbiota, intestinal mucosal barrier, immunomodulation and immune maturation. Along with the lower risk of respiratory and gastrointestinal infections, HMO supplemented formulas seem to be promising alternatives in the management of CMPA. Nonetheless, the effects of individual as well as complex mixtures of HMO in terms of clear clinical and immunological effects and tolerance development need to be further explored to fully realize the immunomodulatory mechanisms and the potential for HMOs in prevention of allergic diseases and CMPA.
Distribution of Allergen Sensitization in Childhood with the Skin Test
(BILIMSEL TIP YAYINEVI, 2017-01-01) Sasihuseyinoglu, Ayse Senay; Kont Ozhan, Aylin; Serbes, Mahir; Duyuler, Gulsah Aycin; Bingol, Gulbin; Yilmaz, Mustafa; Altintas, Derya Ufuk
Objective: Skin prick testing (SPT) is widely used for assessing the clinical reactivity to aeroallergens, foods, and drugs. The aim of our study was to investigate the prevalence of allergic sensitivity in the patients presenting to our clinic. Materials and Methods: The retrospective study included 2,512 patients who presented to our clinic and underwent SPT due to suspected atopy between January and December 2014. SPT was based on sensitivity against house dust mites, molds, pollens, and foods including milk, egg, wheat, chestnut, and latex. Based on their ages, the patients were divided into four groups: Group I

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