PREVALENCE OF FOOD ALLERGY IN HELICOBACTER PYLORI-ASSOCIATED GASTRITIS IN CHILDREN

1. PREVALENCE OF FOOD ALLERGY IN HELICOBACTER PYLORI-ASSOCIATED GASTRITIS IN CHILDREN A. Ignat, M. Burlea, G. Paduraru, M. Moscalu, V. V. Lupu Pediatrics Department, “Gr. T. Popa” University of Medicine and Pharmacy, Iasi, Romania

2. Food allergy • Food allergy → immunologically mediated adverse reactions to foods. • Such allergies can result in disorders with: • acute onset of symptoms following ingestion of the triggering food allergen → anaphylaxis • chronic disorders → atopic dermatitis, eosinophilic esophagitis. • Symptoms observed in a food-induced anaphylactic reaction may involve: • the skin • gastrointestinal tract • respiratory tract

3. Food allergy Classification of food allergies

4. Food allergy • Most antigens reach the immune system through mucosae. • Gastrointestinal mucosa → a barrier for alimentary antigens. • Inflammatory processes (Helicobacter pylori - associated gastritis): • could alter the integrity of the gastric barrier • ↑ the mucosal permeability • enhance crossing of food antigens → stimulate allergic reactions.

5. A summary of studies which investigated the relationship between food allergy and Helicobacter pylori infection. Ma ZF, Majid NA, Yamaoka Y, Lee YY. Food Allergy and Helicobacter pyloriInfection: A Systematic Review. Frontiers in Microbiology. 2016;7:368.

6. Purpose • The aim of our work → to determine if there is a relationship between H. pylori and food allergy in children, given that this association remains unproven because of contradictory studies.

7. Material and methods • Retrospective study→ a group of 940 children with gastritis, admitted in a pediatric gastroenterology regional center in northeast Romania, were evaluated for the presence of H. pylori infection by upper digestive endoscopy with biopsies. Antral nodular congestion, chronic H. pylori infection

8. Results • Of the 940 patients, 86 (9.14%) also associated food allergy. • Children infected with H. pylori showed more frequent allergies (14.47%) than those non-infected (5.53%). • The distribution of age groups showed that there is no statistically significant difference in the results. • The association of allergic disease with H. pylori infection was 64.5%, and with gastritis without H. pylori was 35.5%.

9. Discussions • Helicobacter pylori  → a ubiquitous organism that is present in about 50% of the global population. • In 1983 → Warren (a biologist) and Marshall (a clinician) described H. pylori • Campylobacter pyloridis → Campylobacter pylori → H. pylori

10. Discussions • H. pylori infection is acquired during childhood, persisting as chronic gastritis if the organism is not eradicated. • With the progress of gastritis over the years, the gastric mucosa undergoes a series of changes that can lead to glandular atrophy, intestinal metaplasia, with increased risk of gastric dysplasia and carcinoma. • In the United States, the prevalence of gastritis with H. pylori in children appears to be age-dependent. Below the age of 5, few cases are reported, but prevalence increases with age, becoming the most common cause of gastritis in adolescents.

11. Discussions H. pylori has 2 types of strains: • some ulcerogenic (vacA)→producing vacuolated cytotoxin • others produce cytotoxic protein(cagA) and may generate atrophic gastritis → metaplasia→dysplasia → gastric cancer

12. Discussions • H. pylori → has certain properties than enable it to cross the gastric mucosa easily, stimulating the production of inflammatory cytokines due to the activity of urease → present in large quantities in the bacterial membrane. • The mucosal lesion is mediated by mucinase and phospholipase, which alter mucous secretion and the action of a vacuolizing cytosine. • H. pylori → produces factors that stimulate interleukin-8 secretion, production of platelet-activating factor → causes gastric acid hypersecretion + programmed cell death of epithelial cells. • EPITHELIAL LESION Murray PR, Rosenthal KS, Kobayashi GS, Pfaller MA. Medical Microbiology. 4.ª ed. 2002. Mosby, St. Louis, Miss. USA.

13. Discussions • Kolibasova et al. → achieved remission of chronic urticaria in H. pylori - infected patients through antibiotics against this infection. • After that, numerous studies have been published confirming or disconfirming this initial conclusion. Kolivasoba K, Cervenkova D, Hegyi E, Lengyelova J, Toth J. Helicobactder pylori: einmöglicherätiologischer factor del chronischen urticaria. Dermatosen 1994;42:235-6.

14. Discussions • Figura et al → found anti-CagA antibodies in 65% of a group of 38 H. pylori - infected adult patients with food allergy but in only 28% of H. pylori - infected controls without food allergy. The authors deduced that infection by CagA-positive H. pylori increases the risk of developing food allergy. • Corrado et al → found no differences in anti-CagA IgG titers between children with atopic dermatitis as the sole clinical manifestation of food allergy and children with allergic asthma and without food hypersensitivity. • In both studies, patients with food allergy showed IgG antibodies against H. pylori. Figura N, Perrone A, Gennari C, Orlandini G, Giannace R, Lenzi C et al. CagA-positive Helicobacter pylori infection may increase the risk of food allergy development. J PhysiolPharmacol 1999;50:827-31. Corrado G, Luzzi I, Pacchiarotti C, Lucarelli S, Frediani T, Cavaliere M et al. Helicobacter pylori seropositivity in children with atopic dermatitis as sole manifestation of food allergy. Pediatr Allergy Immunol 2000;11:101-5.

15. Discussions • The so-called ‘hygiene hypothesis’ has gained a big interest → according to which the increased prevalence of allergic diseases is related to the lower incidence of infectious diseases in the most developed countries. • This reduction is due to improved conditions of hygiene and the protection conferred by vaccines against numerous infections, which has shifted the balance in Th1 and Th2 responses in favor of Th2 responses → involved in allergic reactions. • Several recent studies demonstrate the lower prevalence of allergic disease in individuals with antibodies to bacteria transmitted through the oro-fecal route (H. pylori) than in those who tested negative. Cremonini F, Gasbarrini A. Atopy, Helicobacter pylori and hygiene hypothesis. Eur J Gastroenterol Hepatol 2003;15:635-6.

16. Conclusions • H. pylori represents a risk factor in the food allergy in children. • Identification of H. pylori infection (invasive or non-invasive methods) should be included in the diagnostic of food allergy to identify children who may benefit from eradication treatment of bacteria with disappearance of food allergy symptomatology.

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