Anna Nowak-Węgrzyn

Icahn School of Medicine at Mount Sinai, Borough of Manhattan, New York, United States

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Publications (77)

  • Anna Nowak-Węgrzyn · A. Wesley Burks · Hugh A. Sampson
    [Show abstract] [Hide abstract] ABSTRACT: Food allergy affects 6% of US children younger than 5 years and 3.5-4% of the general population. Incidence of peanut allergy has quadrupled over the past decade in the USA. Pathophysiology of food reactions may be IgE-mediated, non-IgE-mediated, or mixed, IgE- and non-IgE-mediated, affecting the skin, gastrointestinal tract, respiratory tract, and/or cardiovascular system. Foods are major triggers of anaphylaxis in all ages. Increasing levels of serum food-specific IgE or skin-prick wheal diameters correlate with increasing probabilities of reactions. The double-blind, placebo-controlled food challenge remains the diagnostic gold standard. Food allergen avoidance requires education about reading ingredient labels, avoiding cross-contact, and obtaining safe meals. Managing food-induced anaphylaxis requires education about recognizing symptoms and prompt treatment with epinephrine. Early exposure to food through a disrupted skin barrier leads to allergic sensitization, whereas early oral exposure to peanut may induce tolerance. Novel therapies utilize both allergen-specific and allergen-non-specific approaches, with great potential for effective desensitization. Because of safety concerns and ongoing evaluation of long-term efficacy parameters, immunotherapy for food allergy remains investigational.
    Chapter · Jan 2017
  • Scott H. Sicherer · Anna Nowak-Węgrzyn
    Chapter · Dec 2016
  • Jean-Christoph Caubet · Hania Szajewska · Raanan Shamir · Anna Nowak-Węgrzyn
    [Show abstract] [Hide abstract] ABSTRACT: Non-IgE-mediated gastrointestinal food allergic disorders (non-IgE-GI-FA) including food protein-induced enterocolitis syndrome (FPIES), food protein-induced enteropathy (FPE) and food protein-induced allergic proctocolitis (FPIAP) are relatively uncommon in infants and young children, but are likely under-diagnosed. Non-IgE-GI-FA have a favorable prognosis, with majority resolving by age 3-5 years. Diagnosis relies on the recognition of symptoms pattern in FPIAP and FPIES and biopsy in FPE. Further studies are needed for a better understanding of the pathomechanism, which will lead eventually to the development of diagnostic tests and treatments. Limited evidence supports the role of food allergens in subsets of constipation, gastroesophageal reflux disease, irritable bowel syndrome, and colic. The immunologic pathomechanism is not fully understood and empiric prolonged avoidance of food allergens should be limited to minimize nutrient deficiency and feeding disorders/food aversions in infants. This article is protected by copyright. All rights reserved.
    Article · Sep 2016 · Pediatric Allergy and Immunology
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    [Show abstract] [Hide abstract] ABSTRACT: Delayed type hypersensitivity; Food patch test; Th17; Peanut; IL-33.T
    Full-text available · Article · Aug 2016 · Experimental Dermatology
  • Giovanni Passalacqua · Anna Nowak-Węgrzyn · Giorgio Walter Canonica
    [Show abstract] [Hide abstract] ABSTRACT: Sublingual immunotherapy (SLIT) is increasingly used worldwide, and several products have been recently registered as drugs for respiratory allergy by the European Medicine Agency and the Food and Drug Administration. Concerning inhalant allergens, the safety of SLIT is overall superior to that of subcutaneous immunotherapy in terms of systemic adverse events. No fatality has been ever reported, and episodes of anaphylaxis were described only exceptionally. Looking at the historical and recent trials, most (>90%) adverse events are "local" and confined to the site of administration. For this reason, a specific grading system has been developed by the World Allergy Organization to classify and describe local adverse events. There is an increasing amount of literature concerning oral desensitization for food allergens, referred to as oral immunotherapy. Also, in this case, local side effects are predominant, although systemic adverse events are more frequent than with inhalant allergens. We review herein the description of local side effects due to SLIT, with a special focus on large trials having a declared sample size calculation. The use of the Medical Dictionary for Regulatory Activities nomenclature for adverse events is mentioned in this context, as recommended by regulatory agencies. It is expected that a uniform classification/grading of local adverse events will improve and harmonize the surveillance and reporting on the safety of SLIT.
    Article · Aug 2016
  • Jean Christoph Caubet · Ramon Bencharitiwong · Andrew Ross · [...] · Anna Nowak-Węgrzyn
    [Show abstract] [Hide abstract] ABSTRACT: Background: Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy manifesting within 1 to 4 hours of food ingestion with repetitive emesis and lethargy. Objective: We sought to characterize immune responses to casein in children with FPIES caused by cow's milk (CM). Methods: Total IgE and IgM, CM-specific IgG, and casein-specific IgE, IgG, IgG4, and IgM levels, as well as immunoglobulin free light chains, were measured in both patients with active and those with resolved CM-FPIES. Proliferating casein/T-effector cell counts were measured in children with CM-FPIES, children with IgE-mediated CM allergy, and those tolerating CM. Cytokine concentrations in the supernatants were quantified. Serum cytokine and tryptase levels were measured before and after a positive oral food challenge (OFC) result and compared with levels in those with a negative OFC result. Results: We found low levels of CM and casein-specific IgG and casein-specific IgG4 in patients with CM-FPIES versus those tolerating CM (P < .05). Although we found both a high CD4(+) T cell-proliferative response and TH2 cytokines production after casein stimulation in children with CM-FPIES, results were similar to those in control subjects. Significantly lower secretion of IL-10 and higher secretion of IL-9 by casein-stimulated T cells were found in patients with CM-FPIES versus those with IgE-mediated CM allergy. Lower baseline serum levels of IL-10 and higher tryptase levels were found in active CM-FPIES versus resolved CM-FPIES. We found a significant increase in serum IL-10 and IL-8 levels after a positive OFC result. Conclusions: We confirm the paucity of humoral response in patients with CM-FPIES. IL-10 might play a key role in acquisition of tolerance in patients with CM-FPIES. Increased serum IL-8 levels in patients with active FPIES suggest neutrophil involvement. Elevated baseline serum tryptase levels in patients with active FPIES suggest low-grade intestinal mast cell activation or increased mast cell load.
    Article · Jul 2016 · The Journal of allergy and clinical immunology
  • Elizabeth Feuille · Anna Nowak-Węgrzyn
    [Show abstract] [Hide abstract] ABSTRACT: Oral immunotherapy (OIT) is a promising investigational therapy for food allergy. Clinical trials in peanut, milk, egg, and wheat allergy provide evidence that OIT can effectively desensitize a majority of individuals to a food allergen. While a portion of subjects demonstrate sustained unresponsiveness, the majority regain sensitivity with allergen avoidance. The safety and tolerability of OIT continue to limit its use in some patients. Virtually all studies report adverse reactions that are more frequent during dose escalation but may also occur during maintenance therapy. Recent studies have identified adjunctive therapies (such as omalizumab) which may mitigate adverse effects. There is a paucity of data on the long-term safety and efficacy of OIT. Further study is required before OIT is ready for routine clinical practice. This review is intended to provide the reader with an up-to-date understanding of OIT, including its mechanisms, efficacy, safety profile, and potential utility in clinical practice.
    Article · Jun 2016 · Annals of Nutrition and Metabolism
  • George N. Konstantinou · Christina M. Cherny · Anna Nowak-Węgrzyn
    [Show abstract] [Hide abstract] ABSTRACT: We examined the use of surgical eye spears for saliva collection and recovery of secretory immunoglobulin A (s-IgA). We established a protocol for recovering s-IgA at concentrations equivalent to those present in the control samples (untreated by surgical eye spears). Four different types of eye spears were submerged in the salivary fluid. Saliva was recovered from each spear by centrifugation. Novel ultra-sensitive enzyme-linked immunosorbent assay was used to determine s-IgA concentration in each sample. The results revealed that Weck-Cel eye spears recovered s-IgA at concentrations not significantly different from s-IgA concentrations in control samples as long as the appropriate protocol was followed. We demonstrated that the use of surgical eye spears for saliva collection is a viable method for recovering s-IgA. (J Oral Sci 58, 205-210, 2016)
    Article · Jun 2016 · Journal of Oral Science
  • Joanna Lange · Ewa Cichocka-Jarosz · Honorata Marczak · [...] · Anna Nowak-Węgrzyn
    [Show abstract] [Hide abstract] ABSTRACT: Background Differences in treatment approach still exist for children after systemic sting reactions. In addition, there are still some doubts about when systemic reactors should be treated with venom immunotherapy (VIT). Objective To determine the rate of sting recurrence and natural history of Hymenoptera venom allergy (HVA) in children not treated with VIT. Methods A total of 219 children diagnosed as having HVA who were not treated with VIT were identified in 3 pediatric allergology centers. Survey by telephone or mail with the use of a standardized questionnaire was conducted. The number of field re-stings, subsequent symptoms, and provided treatment were analyzed. Results A total of 130 of the 219 patients responded to the survey, for a response rate of 59.4%. During the median follow-up period of 72 months (interquartile range, 52-85 months), 44 children (77% boys) were stung 62 times. Normal reactions were most common, occurring in 27 patients (62%). Severe systemic reactions (SSRs) occurred in 8 (18%) of those who were re-stung. The subsequent reaction was significantly milder (P < 0.001), especially in the case of patients re-stung by the same insect (P <.001). None of the children with prediagnostic large local reactions and negative test results for venom specific IgE developed SSRs after re-sting by the culprit insect (P =.03). In children with SSRs, median time from diagnosis to re-sting was 2 times longer than that in those with large local reactions and normal reactions (P =.007). Conclusions Most children with HVA not treated with VIT reported milder reactions after a re-sting. Probability of SSR to re-sting increases along with the severity of initial reaction.
    Article · Mar 2016
  • Marion E. Groetch · Zara Atal · Anna H. Nowak-Wegrzyn
    Article · Feb 2016
  • Stephanie A. Leonard · Anna H. Nowak-Węgrzyn
    [Show abstract] [Hide abstract] ABSTRACT: In baked form, cow's milk and egg are less allergenic and tolerated by a majority of milk- and egg-allergic children. Not only may including baked milk and egg in the diets of children who are tolerant improve nutrition and promote more social inclusion but there is also evidence that inclusion may accelerate the resolution of unheated milk and egg allergy. Further research is needed to identify biomarkers that can predict baked milk or egg reactivity; however, data suggest casein- and ovomucoid-specific immunoglobulin E levels may be useful. Physician-supervised introduction of baked milk and egg is recommended since anaphylaxis has occurred.
    Article · Feb 2016 · Immunology and Allergy Clinics of North America
  • Anna H. Nowak-Wegrzyn · Zara Atal
    Article · Feb 2016
  • Anna H. Nowak-Węgrzyn · Linda S. Cox
    Article · Feb 2016
  • Jeanifer Poon · Elizabeth Feuille · Zara Atal · [...] · Anna H. Nowak-Wegrzyn
    Article · Feb 2016
  • Linda S. Cox · Anna H. Nowak-węgrzyn
    Article · Feb 2016
  • [Show abstract] [Hide abstract] ABSTRACT: SLIT (sublingual immunotherapy,) induces allergen-specific immune tolerance by sublingual administration of a gradually increasing dose of an allergen. The mechanism of SLIT is comparable to those during SCIT (subcutaneous immunotherapy), with the exception of local oral dendritic cells, pre-programmed to elicit tolerance. In the SLIT dose, to achieve the same efficacy as in SCIT, it should be 50-100 times higher with better safety profile. The highest quality evidence supporting the efficacy of SLIT lasting 1-3 years has been provided by the large scale double-blind, placebo-controlled (DBPC) trials for grass pollen extracts, both in children and adults with allergic rhinitis. Current indications for SLIT are allergic rhinitis (and conjunctivitis) in both children and adults sensitized to pollen allergens (trees, grass, Parietaria), house dust mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae), cat fur, as well as mild to moderate controlled atopic asthma in children sensitized to house dust mites. There are positive findings for both asthma and new sensitization prevention. Severe adverse events, including anaphylaxis, are very rare, and no fatalities have been reported. Local adverse reactions develop in up to 70-80% of patients. Risk factors for SLIT adverse events have not been clearly identified. Risk factors of non-adherence to treatment might be dependent on the patient, disease treatment, physician-patient relationship, and variables in the health care system organization. © 2016, Institute of Agricultural Medicine. All rights reserved.
    Article · Jan 2016
  • Stephanie A. Leonard · Anna Nowak-Wegrzyn
    [Show abstract] [Hide abstract] ABSTRACT: Food protein-induced enterocolitis syndrome (FPIES) is a rare, non-immunoglobulin E-mediated gastrointestinal food allergy primarily diagnosed in infancy, but has also been reported in older children and adults. Acute FPIES reactions typically present with delayed, repetitive vomiting, lethargy, and pallor within 1 to 4 hours of food ingestion. Chronic FPIES typically presents with protracted vomiting and/or diarrhea, and weight loss or poor growth. Common foods triggering FPIES include cow's milk, soy, rice, oats, fish, and egg. More detailed diagnostic criteria may help in increasing awareness of FPIES and reducing delayed diagnoses or misdiagnoses.
    Article · Dec 2015 · Pediatric Clinics of North America
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    Yitzhak Katz · Anna Nowak-Węgrzyn · Jonathan M. Spergel
    Full-text available · Article · Oct 2015 · Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology
  • Elizabeth Feuille · Anna Nowak-Węgrzyn
    [Show abstract] [Hide abstract] ABSTRACT: Food protein-induced enterocolitis (FPIES), allergic proctocolitis (FPIAP), and enteropathy (FPE) are among a number of immune-mediated reactions to food that are thought to occur primarily via non-IgE-mediated pathways. All three are typically present in infancy and are triggered most commonly by cow's milk protein. The usual presenting features are vomiting with lethargy and dehydration in FPIES; bloody and mucous stools in FPIAP; and diarrhea with malabsorption and failure to thrive in FPE. Diagnosis is based on convincing history and resolution of symptoms with food avoidance; confirmatory diagnostic testing other than food challenge is lacking. The mainstay of management is avoidance of the suspected inciting food, with interval challenge to assess for resolution, which usually occurs in the first years of life. Studies published in the past few years clarify common presenting features, report additional culprit foods, address potential biomarkers, and suggest new management strategies.
    Article · Aug 2015 · Current Allergy and Asthma Reports
  • Anna Nowak-Węgrzyn · Marion Groetch
    [Show abstract] [Hide abstract] ABSTRACT: Dietary intervention is a crucial component of food allergy management but can negatively impact nutrient intake. A comprehensive nutrition assessment with appropriate intervention is warranted in all children with food allergies to meet nutrient needs and optimize growth. Nutrition assessment may also be indicated in adults with food allergy. Frequently, an elimination diet is absolutely necessary to prevent potentially life-threatening anaphylaxis. Allergen elimination can also improve chronic symptoms, such as atopic dermatitis, when a food is proven to trigger symptoms. Allergen elimination goals are to prevent acute and chronic food-allergic reactions in the safest and least restrictive environment to supply a balanced diet that promotes health in children and adults. © 2015 S. Karger AG, Basel.
    Article · May 2015 · Progress in allergy