Archive for month: November, 2024

In a mouse model, offspring of mothers fed a diet containing 2′-FL displayed no allergy symptoms and exhibited reduced levels of allergy biomarkers. The analysis emphasized the potential benefits of 2′-FL in reducing allergy risk in offspring, as highlighted by the investigators.

Recent findings highlight the potential of gestational supplementation with 2′-Fucosyllactose (2′-FL) to prevent food allergies in offspring. The research, led in part by A. Rousseaux from the Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement in Nantes, France, builds on previous studies linking 2′-FL in breast milk to reduced allergy risk in infants.

Rousseaux and colleagues noted that effective strategies to prevent food allergies have been lacking. Allergies often emerge in the first months of life and involve dysfunctions in multiple biological systems. Human milk oligosaccharides (HMOs), including 2′-FL, are known to influence immune function, strengthen the gut barrier, and shape the infant gut microbiota. These HMOs are not only present in breast milk but also in pregnant women’s blood, urine, and amniotic fluid, suggesting their role in early immune programming. Based on this, the team hypothesized that supplementing pregnant mothers with 2′-FL could create a protective microbial and immune imprint in their offspring.

To test this, the researchers used a mouse model of wheat allergy. Pregnant mice were given either a standard diet or a diet supplemented with 2′-FL from conception to birth. After weaning, the offspring were exposed to wheat allergens, while non-allergic pups served as controls. The offspring of mothers on the 2′-FL diet showed no allergy symptoms, lower allergy scores, and stable body temperatures compared to the control group. Blood tests revealed reduced levels of allergy-related biomarkers, such as wheat-specific immunoglobulins and mMCP-1, in the 2′-FL group. Additionally, these offspring had higher levels of IgG2a, a protective antibody.

The researchers also examined the effects of 2′-FL on gut microbiota. Significant differences in microbial diversity were observed between the 2′-FL and control groups during pregnancy, though these differences diminished during lactation. Among offspring, variations in gut microbiota diversity persisted and were linked to maternal diet and allergy status, suggesting that 2′-FL supplementation created a distinct microbial imprint associated with allergy protection.

The study concluded that maternal nutrition can influence HMO levels in breast milk and amniotic fluid, with 2′-FL supplementation offering full protection against food allergies in offspring. These findings align with previous reports linking 2′-FL in breast milk to a lower allergy risk in infants and underscore the potential of maternal dietary strategies to support early-life health.

Reference:

Rousseaux, A., Misme-Aucouturier, B., Romancer, M. L., Villette, R., Larsen, M., Carvalho, M. D., Bouchaud, G., Perrin, E., Barbarot, S., Brosseau, C., & Bodinier, M. A Gestational Supplementation With 2′-Fucosyllactose Is an Effective Strategy to Prevent Food Allergy. Allergy. https://doi.org/10.1111/all.16396

These findings highlight the potential importance of measuring specific IgE (sIgE) levels for tree nuts in peanut-sensitized children who have not yet consumed tree nuts. This research, led by Lara Meixner, MSc, from the Department of Pediatric Respiratory Medicine at Universitätsmedizin Berlin in Germany, sheds light on the need for careful allergy assessment in these young patients.

Infants with eczema are at high risk for food allergies due to impaired skin barriers. High household peanut consumption may increase peanut allergy risk. German guidelines recommend ruling out peanut allergy in atopic infants before dietary introduction. Rising plant-based diets may heighten tree nut allergen exposure, increasing allergy risks. Therefore, the researchers aimed to examine the frequency of sensitization to cashews, hazelnuts, and walnuts, along with their seed storage proteins, in peanut-sensitized infants and toddlers, as these may be linked to a high risk of clinical reactivity.

The study included infants and toddlers (≤2 years) referred to Charité—Universitätsmedizin Berlin, with specific IgE (sIgE) to peanut ≥0.1 kU/l. Blood and clinical data were collected during routine diagnostics, including oral food challenges (OFC) between 2007 and 2020. Sensitization to peanut, hazelnut, walnut, cashew, and their proteins (e.g., Ara h 2, Cor a 14, Ana o 3) was assessed using the NOVEOSTM immunoanalyzer, with sIgE ≥0.1 kU/l indicating sensitization. OFC risk for hazelnut and cashew was calculated using established probability curves. Among 101 peanut-sensitized patients (median age 16 months), 98% had eczema.

The findings of the study were as follows:

• 96% of patients (n = 97) had specific IgE ≥0.1 kU/l to at least one tree nut.
• Sensitization rates were highest for hazelnut (94.1%), followed by walnut (87.1%) and cashew (84.2%).
• 58.4% were sensitized to at least one 2S albumin, with 41.6% (n = 42) sensitized to Cor a 14 and Jug r 1, and 39.6% to Ana o 3.
• 80.2% were sensitized to all three tree nuts, and 26.7% to all corresponding 2S albumins.
• Peanut-sensitized infants ≤12 months old (n = 26) had high sensitization rates to tree nuts (88.5%) and 2S albumins (46.2%).
• 15.8% had a ≥90% predicted probability of allergy to hazelnuts and/or cashews.
• Almost all participants (98%) had eczema, a significant risk factor for sensitization and food allergies.

Our study at a tertiary care clinic reveals that most peanut-sensitized infants and toddlers with eczema are co-sensitized to tree nuts, with many at significant risk for allergic reactions.

“Measuring sIgE to tree nuts in peanut-sensitized children who have not yet consumed them should be considered. If sensitization is detected, an oral food challenge is recommended to assess clinical relevance,” the researchers concluded.

Reference:

Meixner, L., Heller, S., Bluhme, F., Trendelenburg, V., Beyer, K., & Kalb, B. (2024). Infants and toddlers with sensitization to peanuts are often co-sensitized to tree nuts. Clinical and Translational Allergy, 14(11), e70008. https://doi.org/10.1002/clt2.70008

“Women with unintended pregnancies were more likely to experience mycophenolate exposure and allograft loss within two years postpartum. However, unintended pregnancy was not associated with acute kidney rejection or overall allograft survival,” the researchers wrote in O&G Open.

Unintended pregnancies, which account for about 45% of all pregnancies in the U.S., can lead to significant medical and social challenges, including delays in prenatal care, substance use, and financial burdens. For kidney transplant recipients, unintended pregnancies may pose additional risks for maternal, neonatal, and graft outcomes.

Against the above background, Yalda Afshar, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, and colleagues aimed to identify risk factors, obstetric complications, and allograft outcomes linked to unintended pregnancy following a kidney transplant.

For this purpose, the researchers conducted a retrospective cohort study of pregnancies in women who had undergone kidney transplantation and were enrolled in the Transplant Pregnancy Registry International, with births between 1967 and 2019. The pregnancies were categorized into intended and unintended groups.

The primary outcome was acute kidney rejection during pregnancy or within 6 weeks postpartum. Secondary outcomes included allograft loss, severe maternal morbidity, and neonatal composite morbidity. The study used multivariable logistic regression, Kaplan–Meier curves, and Cox proportional hazards regression models, adjusting for covariates relevant to the allograft function.

Based on the study, the following findings were made:

• Among 1,723 pregnancies in kidney transplant recipients, 1,081 (62.7%) were intended, and 642 (37.3%) were unintended.
• Risk factors for unintended pregnancy included younger age, Black race, nulliparity, chronic hypertension, and transplant from a deceased donor.
• Exposure to mycophenolate products (16.0% versus 5.7%) and termination (4.7% versus 0.4%) were more common in unintended pregnancies.
• Unintended pregnancy was not associated with acute kidney rejection (2.3% versus 0.9%, adjusted odds ratio [AOR] 2.38).
• Unintended pregnancy was independently associated with allograft loss at 2 years from the end of pregnancy (8.1% versus 3.5%, AOR 2.27), but not allograft survival (adjusted hazard ratio 1.22).
• No differences were found in severe maternal morbidity (3.3% versus 3.6%) or neonatal composite morbidity (12.9% versus 14.3%) between intended and unintended pregnancies.

The findings showed that unintended pregnancy was not linked to acute kidney allograft rejection during the peripartum period but was associated with mycophenolate exposure and allograft loss at 2 years postpartum. Social factors contributing to challenges in accessing reproductive care may also affect transplant health.

“Prepregnancy counseling and continuous follow-up for transplant recipients are recommended to reduce unintended pregnancies and improve long-term transplant outcomes,” the researchers concluded.

Reference:

Yin, Ophelia MD; Gliwa, Catherine MD; Walia, Anjali BS; Coscia, Lisa RN, BSN; Constantinescu, Serban MD, PhD; Moritz, Michael MD; Sarkar, Monika MD; Irani, Roxanna MD, PhD; Afshar, Yalda MD, PhD. Unintended Pregnancy After Kidney Transplantation: Risk Factors and Associated Obstetric and Allograft Outcomes. O&G Open 1(4):p 040, December 2024. | DOI: 10.1097/og9.0000000000000040

Although prior research has shown that tear film
hyperosmolarity can compromise pre-surgical measurements and impact
post-surgical outcomes, it is not currently known whether hyperosmolarity is
directly associated with aberrant visual sequelae. Therefore, author’s current
hypothesis was that hyperosmolarity is associated with increased variation in
light scatter between blinks, and specifically, that this effect is not
observable under a slit lamp. If this hypothesis is correct, it would likely
help to explain a portion of the phenomenon of a post-operative patient that
achieves target refraction, hasan unremarkable ocular surface, but is
dissatisfied with the overall quality of vision – colloquially known as the
20/20 unhappy patient.

Contiguous, 20-second objective scatter index (OSI) scans
were recorded in hyperosmolar (≥320 mOsm/L) and normal subjects (<308
mOsm/L) with cataract nuclear opacity ≥3. OSI was measured at screening,
baseline and 90 days following surgery. Along with symptoms of ocular surface
disease, slit-lamp examination included corneal staining (0–3), tear film
breakup time (TBUT) and evaluation of meibomian gland disease (MGD). An
additional cohort of hyperosmolar subjects were measured for OSI at screening,
baseline, and 5, 10, 15 and 30 minutes following instillation of 0.18% sodium
hyaluronate (HA).

Thirty-one eyes of 31 patients were included. There was a
significant difference in post-operative OSI variation when comparing
hyperosmolar (0.65±0.30, N=11) to normal subjects (0.33±0.11, N=10, p=0.005).
Of note, there were no significant differences in OSI variation when subjects
were sorted by staining (p=0.9), TBUT (p=0.7), symptoms (p=0.7), or MGD status
(p=0.9). Instillation of 0.18% HA (N=10) did not alter OSI at 5 minutes, but
significant reductions in OSI of 28.8%, 38.5% and 36.7% (all p < 0.001) were
observed at 10, 15 and 30 minutes.

Subjects with tear film hyperosmolarity exhibited
significantly increased variation in light scatter following cataract surgery
that was undifferentiated by staining or TBUT. Addition of artificial tears can
acutely eliminate much of the light scatter associated with hyperosmolarity,
but requires at least 15 minutes to stabilize in a hyperosmolar cohort.
Elevated osmolarity may be indicative of light scatter equivalent to that of a
grade 2–3 cataract.

Source: Sullivan et al; Clinical Ophthalmology 2024:18

https://doi.org/10.2147/OPTH.S484840