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Pediatric food allergies (FA) are increasing in prevalence and have been associated with decreased quality of life (QOL) and impairment in physical, social, academic, and family functioning; however, little is known about the risk factors for psychological distress in this cohort. This was the first large-scale study to examine child, parent, and FA-related factors that may affect functioning in youth with FA. The sample consisted of 533 mothers of children with FA and 241 mothers of children with no chronic medical conditions, recruited through online forums. Mothers completed online questionnaires assessing their child's psychosocial health, physical health, and FA characteristics, as well as their own parenting behaviors and symptoms of psychological distress. It was hypothesized that (1) FA children would exhibit poorer functioning than healthy children; (2) mothers of FA children would exhibit higher levels of psychological distress than mothers of Healthy Control (HC) children; (3) higher FA severity would predict poorer child functioning; and (4) maternal psychological symptoms, overprotection, and gender would moderate the associations between presence of FA and child functioning, and between FA severity and child functioning. Results showed that (1) FA youth exhibited significantly better functioning than healthy children; (2) mothers of FA youth reported significantly less psychological distress than mothers of healthy children; (3) higher FA severity predicted poorer child functioning; and (4) these associations were moderated by maternal depression, anxiety, stress, and overprotection, but not by gender. Specifically, associations between presence of FA and child health-related QOL, child psychosocial health, and physical health were significantly stronger among children whose mothers were more depressed, anxious, and stressed. The associations between presence of FA and child psychosocial health were significantly weaker among highly overprotective mothers, indicating that in line with the anxiety disorder literature, overprotection in mothers of children with FA may serve a maladaptive function. These findings suggest that FA youth and their mothers are a particularly vulnerable population who may benefit from psychosocial interventions to address the psychological distress and interference associated with having FA.

No description available.

While food hypersensitivity can be a life-threatening problem, its scope is yet to be fully developed. More work is needed to further define its parameters but basic food hypersensitivity has been significantly clarified in the decade of the 80's to become standard practice for most updated allergists. Studies related to inhalation of food antigens remains within the purview of research centers as does other immunologic processes. The diagnosis of food hypersensitivity remains dependent on the medical history with test like elimination diets, skin testing, and RAST. Double-blind, placebo-controlled, food challenges (DBPCFC) provide the most definitive support for the association between certain symptoms and a specific food.

Indiana University-Purdue University Indianapolis (IUPUI) / Follicular T helper (TFH) and regulatory (TFR) cells are two key classes of CD4+ T cells found in germinal centers (GCs). The primary role of TFH cells is to help B cells form GCs to produce high-affinity antibodies during an infection while the role of TFR cells remains controversial. The transcriptional repressor Bcl6 is essential for the differentiation of TFH, TFR and GCB cells and understanding signaling pathways that induce Bcl6 and TFH cell differentiation are important. We observed that Bcl6 is highly up-regulated in activated CD4 T cells following glucose deprivation by a pathway involving the metabolic sensor AMP kinase. The transcription factor Blimp1 represses both TFH cell differentiation and Bcl6 expression, and we show the major role of Blimp1 on TFH cell differentiation is to repress Bcl6 expression and not other genes in the TFH differentiation pathway. We also found Bcl6 positively regulates expression of the key TFH cell receptor PD-1 by inhibiting the repression of PD-1 by the transcription factor Tbet. The roles of TFH and TFR cells in controlling allergen-specific IgE were investigated using a peanut allergy model and strains of mice with alterations in the TFH and TFR pathways. We found TFR cells unexpectedly play an essential role in promoting and maintaining IgE production and anaphylaxis, as well as the GC reaction. Compared to control mice, TFR-deficient mice lacked circulating peanut-specific IgE and anaphylactic responses were significantly weakened. Mechanistically, TFR cells require Blimp1 controlled IL-10 to promote GCB cell survival and IgE production. Blocking IL-10 signals mimicked the loss of IgE levels in TFR-deficient mice and rescued mice from anaphylaxis. Overall, these studies have defined novel roles of Bcl6, TFH and TFR cells in regulating antibody production by the GC reaction, and provide greater understanding of how allergic immune responses are controlled. / 2019-11-21

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[ES] Durante las últimas décadas, se han realizado importantes avances en el estudio de las causas genéticas de enfermedades raras y comunes, donde un gran número de variantes han sido identificadas y asociadas a múltiples enfermedades. Con las tecnologías de secuenciación de nueva generación, hoy en día somos capaces de investigar, con un alto rendimiento, la contribución de variantes de alta y baja frecuencia a distintos tipos de enfermedades, permitiéndonos así estudiar su importancia en el desarrollo de las mismas. En ésta tesis se ha utilizado la secuenciación del exoma como tecnología para el estudio de variantes raras en una enfermedad compleja, la alergia gastrointestinal inducida por múltiples alimentos. Para ello, se realizó la secuenciación del exoma completo de una cohorte de 31 individuos (ocho afectados y 23 no afectados) provenientes de siete familias diferentes. Se desarrolló un flujo de trabajo para procesar los datos generados a partir de diferentes librerías e instrumentos de secuenciación, así como un control de calidad exhaustivo con el fin de maximizar el número de variantes de alta calidad. Diferentes tipos de mutaciones fueron investigadas, incluyendo polimorfismos de nucleótido único, inserciones/deleciones, variantes del número de copia y haplotipos HLA, y se realizaron diferentes métodos de filtrado para su interpretación. Finalmente, se encontraron una serie de mutaciones que podrían estar asociadas con la enfermedad y se describe su posible papel en la patogénesis de las alergias gastrointestinales. Los resultados de esta tesis suponen importantes avances en el estudio de la compleja arquitectura genética de las alergias gastrointestinales y abren las puertas a futuras líneas de investigación, que serán necesarias para entender completamente las bases genéticas de esta enfermedad. / [CA] Durant les últimes dècades, s'han realitzat importants avanços en l'estudi de les causes genètiques de malalties rares i comunes, on un gran nombre de variants han sigut identificades i associades a múltiples malalties. Amb les tecnologies de seqüenciació de nova generació, avui en dia som capaços d'investigar, amb un alt rendiment, la contribució de variants d'alta i baixa freqüència a diferents tipus de malalties, permetent-nos així estudiar la seva importància en el desenvolupament de les mateixes. En aquesta tesis s'ha utilitzat la seqüenciació del exoma com a tecnologia per a l'estudi de variants rares en una malaltia complexa, l'al·lèrgia gastrointestinal induïda per múltiples aliments. Per això, es va realitzar la seqüenciació del exoma complet d'una cohort de 31 individus (vuit afectats i 23 no afectats) provinents de set famílies diferents. Es va desenvolupar un flux de treball per a processar les dades generades a partir de diferents llibreries e instruments de seqüenciació, així com un control de qualitat exhaustiu amb la fi de maximitzar el nombre de variants d'alta qualitat. Diferents tipus de mutacions foren investigades, incloïent polimorfismes de nucleòtid únic, insercions/delecions, variants del nombre de còpia i haplotips HLA, i es realitzaren diferent mètodes de filtrat per a la seva interpretació. Finalment, es trobaren una sèrie de mutacions que podrien estar associades amb la malaltia i es descriu el seu possible paper en la patogènesis de les al·lèrgies gastrointestinals. Els resultats d'aquesta tesis suposen importants avanços en l'estudi de la complexa arquitectura genètica de les al·lèrgies gastrointestinals i obrin les portes a futures línies d'investigació, que seran necessàries per entendre completament les bases genètiques d'aquesta malaltia. / [EN] The study of genetics has been making significant progress towards understanding the causes of rare and common disease during the past decades. Across a wide range of disorders, there have been hundreds of associated loci identified and associated with multiple disorders. Now, with the advent of next-generation sequencing technologies, we are able to interrogate the contribution of high and low frequency variation to disease in a high throughput manner. This provides an opportunity to investigate the role of rare variation in complex disease risk, potentially offering insights into disease pathogenesis and biological mechanisms. In this thesis, it has been assessed the use of whole-exome sequencing technology to investigate the role of rare variation in a complex disease, gastrointestinal food allergy induced by multiple food proteins. For that, a cohort of 31 individuals (eight affected and 23 non-affected) from seven different families was whole exome sequenced. Data obtained from multiple sequencing systems and libraries were analysed, and a workflow was developed, focusing on a comprehensive quality control to maximise the number of real positive calls. Different types of genome variations were investigated, including single nucleotide variants, insertions/deletions, copy number variants and HLA haplotypes. By approaching different methods of variant filtering, a set of rare variants that could be associated with the disease was identified. The possible role of these candidate variants in the pathogenesis of gastrointestinal food allergies was also discussed. These results reveal important insights into the genetic architecture of gastrointestinal food allergies and lead to additional lines of investigation that will be required in order to fully understand the genetic basis of this disease. / Sanchis Juan, A. (2019). Exome Sequencing in Gastrointestinal Food Allergy Induced by Multiple Food Protein [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/134361

L'allergie alimentaire peut avoir des effets significatifs sur la morbidité et la qualité de vie. Il existe donc un intérêt considérable à générer de nouvelles stratégies thérapeutiques capables de réduire le risque de développer une atopie. Des études cliniques et expérimentales ont montré que l’allergie était associée à une dysbiose intestinale. Une modulation du microbiote intestinal pourrait ainsi aider à prévenir et traiter les maladies allergiques, justifiant l’utilisation rationnelle de souches probiotiques. L’objectif de mon travail a été de sélectionner au sein d’un panel de 31 souches bactériennes une ou plusieurs souche(s) probiotique(s) possédant des propriétés préventives dans l'allergie, à l'aide d'une combinaison d’approches in vitro et in vivo. Les propriétés immunomodulatrices des souches bactériennes ont été étudiées sur cellules mononucléées sanguines humaines et sur splénocytes murins orientés Th2. Les six souches qui ont induit un fort rapport IL10/IL12p70 et une faible sécrétion d'IFN-γ dans ces deux modèles cellulaires ont été testées pour leur effet protecteur dans un modèle murin d’allergie alimentaire à la β-lactoglobuline (BLG). Trois de ces six souches ont montré un effet protecteur sur l'allergie avec une diminution de la dégranulation des mastocytes et sur la sensibilisation avec une diminution des IgE et des IgG1 spécifiques de la BLG. L’étude de l'impact de ces trois souches sur l'équilibre T helper a montré qu’elles possédaient différents mécanismes d’action. Au niveau systémique, la souche LA307 s’est révélée immunosuppressive, la souche LA308 a induit un profil pro-Th1 et la souche LA305 a induit une réponse à la fois pro-Th1 et régulatrice. Au niveau iléal, l’induction de tolérance pourrait être générée par anergie pour la souche LA305 et par suppression active des réponses Th2 pour les souches LA307 et LA308. L’étude de l’impact de ces trois souches sur le microbiote ne permet pas de conclure que leur effet protecteur est lié à une modulation de la composition du microbiote. Ces résultats montrent que le criblage in vitro, basé sur les propriétés immunomodulatrices des candidats probiotiques, permet une présélection efficace avec trois des six souches sélectionnées ayant un effet protecteur in vivo. / Food allergy can have significant effects on morbidity and quality of life. There, the generation of efficient approaches to reduce the risk of developing food allergy is of considerable interest. Clinical and experimental studies have shown the association of allergy with intestinal dysbiosis. Thus, a modulation of the gut microbiota may contribute to the prevention and management of allergic diseases. This notion supports the use of probiotics.The aim of my study was to select, among a panel of 31 bacterial strains, probiotic strains with preventive properties in allergy using a combination of in vitro and in vivo approaches. Immunomodulatory properties of strains were studied on human blood mononuclear cells and on Th2 skewed splenocytes. The six strains inducing a high IL10/IL12p70 ratio and a low secretion of IFN-γ on both cellular models were tested for their protective impact in a murine model of food allergy to β-lactoglobulin (BLG). Three out of six strains showed a protective impact on sensitization with a decrease in allergen specific IgE and on allergy with a decrease in mast cell degranulation. The study of the impact on the T-helper balance for these 3 strains showed that they had different mechanisms of action. At the systemic level, LA307 strain proved to be immunosuppressive, LA308 strain induced a pro-Th1 profile and LA305 strain induced both, a pro-Th1 and a regulatory profile. At the ileal level, tolerance induction resulted from anergy for LA305 strain and from active suppression of Th2 responses for LA307 and LA308 strains. This study does not enable to conclude about the relationship between the protective impact of these 3 strains and the modulation of the composition of microbiota. These results reveal that the in vitro screening, based on immunomodulatory properties of candidate probiotics, allow an efficient pre-selection with three out of the six selected strains showing an in vivo protective impact.