Published online: October 25, 2019
Food allergies (FA) affect an increasing proportion of children both in the US and worldwide. Despite this ongoing epidemic, it is still challenging for physicians to accurately diagnose FA due to the lack of accurate disease biomarkers. Moreover, no prevention strategies or curative treatments are available for FA and patients are left at risk of potentially severe anaphylactic reactions resulting from accidental exposures to food allergens. These gaps in patient care are largely the result of the still incomplete understanding of the pathogenic mechanisms underlying the development and resolution of FA.
In an article recently published in The Journal of Allergy and Clinical Immunology (JACI), Crestani and coauthors applied a novel approach called untargeted metabolomic profiling to the study of patients with FA. This technique detects changes in the levels of blood metabolites that reflect disease-driven alterations in key metabolic processes and may thus provide a glimpse into the pathogenesis of FA. Since metabolomic changes are driven both by genetic and environmental components, metabolomic profiling has been successfully employed in the study of other multifactorial conditions and can be particularly useful in investigating FA, in which both genetic and environmental influences are thought to be driving forces.
By recruiting children with either FA or asthma, children with both conditions and children with no allergies, the authors were able to compare metabolomic alterations attributable to the presence of either FA or asthma. Their results showed that FA is associated with unique alterations in sphingolipids and other complex lipids, suggesting a key role for lipid metabolism in FA. The severity of FA, gauged by a history of multiple FA and/or anaphylactic reactions treated with intramuscular epinephrine, was further associated with changes in metabolites, including secondary bile acids and aromatic amino acids, that are processed by the gut bacteria. These findings are in line with recent evidence that changes in the microbiome play a key role in allergic disorders including FA. Finally, the authors observed that children with both FA and asthma displayed metabolomic changes resembling those of children with FA alone, suggesting that FA pathogenic mechanisms are independent and possibly prevalent when multiple allergic conditions coexist.
The study provides important leads for further investigations into mechanisms causing FA and suggests a novel approach to identify much needed disease biomarkers in FA. Future studies on larger patient populations across different age groups will aim to expand on these findings to identify the role of metabolomic pathways in FA and the potential for novel precision therapeutic approaches that target those pathways.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.