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Zhang Y, Shang M, Tian Y, Liu X, Sun X, Gao L. Allergen sensitization study in Dongying, China: An epidemiological study. Medicine (Baltimore) 2024; 103:e36862. [PMID: 38241586 PMCID: PMC10798692 DOI: 10.1097/md.0000000000036862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/14/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND To explore the relationship between specific immunoglobulin E levels in response to prevalent pollen and food allergens among patients suffering from localized allergic diseases in the Dongying area of China, and to analyze the interconnectivity among these factors. METHODS This research encompassed allergic patients who visited the Allergy Department of Shengli Oilfield Central Hospital from January 2022 to January 2023. We examined the specific immunoglobulin E levels in the blood of 230 patients utilizing the Fobock platform provided by Jiangsu Haoeubo Company. Statistical analysis was conducted with SPSS 25.0 statistical software. The chi-square test evaluated the relevance of differences in gender and age. A value of P < .05 was considered statistically significant. RESULTS In this study, eggs emerged as the allergen with the highest number of sensitized individuals, closely followed by dust mite. Conversely, the least sensitized allergen was the cypress tree, closely followed by mango. Notably, male patients exhibited higher sensitivities to cottonwood (P < .05) and egg (P < .001) compared to female patients. Children aged 0 to 10 years showed increased sensitivity to variety of allergens. A significant correlation was observed among different allergens. The top ten allergen pairs with the highest correlation included Birch Tree and Cottonwood (0.88, P < .001), Cottonwood and Pine Tree (0.86, P < .001), Birch Tree and Pine Tree (0.84, P < .001), Pine Tree and Paulownia (0.81, P < .001), Dust Mite and House Dust Mite (0.76, P < .001), Birch Tree and Paulownia (0.73, P < .001), Cashew and Pistachio (0.71, P < .001), Apple and Hazelnut (0.71, P < .001), Cottonwood and Paulownia (0.71, P < .001), and Pine Tree and Ordinary Ragweed (0.70, P < .001). CONCLUSION This research sheds light on the patterns of allergen sensitization in Dongying, Shandong, highlighting that egg is the most prevalent sensitizing allergen. A notably high correlation was observed between Birch Tree and Cottonwood. This study enhanced the understanding of allergic diseases, explored the causes and mechanisms of allergies, strengthened the management of allergic diseases. Furthermore, it offers valuable insights for the clinical diagnosis and prevention of allergic diseases.
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Affiliation(s)
- Yingying Zhang
- Department of Pediatrics, Shengli Oilfield Central Hospital, Dongying City, Shandong Province, China
| | - Mei Shang
- Department of Pediatrics, Shengli Oilfield Central Hospital, Dongying City, Shandong Province, China
| | - Ying Tian
- Department of Pediatrics, Shengli Oilfield Central Hospital, Dongying City, Shandong Province, China
| | - Xuwei Liu
- Department of Pediatrics, Shengli Oilfield Central Hospital, Dongying City, Shandong Province, China
| | - Xuhui Sun
- Department of Pediatrics, Shengli Oilfield Central Hospital, Dongying City, Shandong Province, China
| | - Lianjun Gao
- Department of Pediatrics, Shengli Oilfield Central Hospital, Dongying City, Shandong Province, China
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Matson RS. Well-Based Multiplex Food Allergen Colorimetric ELISA. Methods Mol Biol 2023; 2612:169-181. [PMID: 36795367 DOI: 10.1007/978-1-0716-2903-1_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Food allergy is a well-recognized and significant health hazard around the world. At least 160 food groups have been identified that present allergenic reactions or other sensitivities and intolerance in humans. Enzyme-linked immunosorbent assay (ELISA) is an accepted platform for identifying the nature of the food allergy and its severity. It is now possible to simultaneously screen patients for allergic sensitivity and intolerance to multiple allergens using multiplex immunoassays. This chapter describes the preparation and utility of a multiplex allergen ELISA for the assessment of food allergy and sensitivity in patients.
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Leonard SA, Ogawa Y, Jedrzejewski PT, Maleki SJ, Chapman MD, Tilles SA, Du Toit G, Mustafa SS, Vickery BP. Manufacturing processes of peanut ( Arachis hypogaea) allergen powder-dnfp. FRONTIERS IN ALLERGY 2022; 3:1004056. [PMID: 36304076 PMCID: PMC9592818 DOI: 10.3389/falgy.2022.1004056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022] Open
Abstract
Background Important components of drug safety, efficacy, and acceptability involve manufacturing and testing of the drug substance and drug product. Peanut flour sourcing/processing and manufacturing processes may affect final drug product allergen potency and contamination level, possibly impacting drug safety, quality, and efficacy. We describe key steps in the manufacturing processes of peanut (Arachis hypogaea) allergen powder-dnfp (PTAH; Palforzia®), a drug used in oral immunotherapy (OIT) for the treatment of peanut allergy. Methods Established criteria for source material must be met for manufacturing PTAH drug product. Degree of roasting was determined with a Hunter colorimeter. Protein/allergen content, identity, potency, safety, and quality of each batch of PTAH drug substance were assessed with a combustion analyzer, allergen-specific Western blot (immunoblotting), ELISA, and HPLC. Contaminants (ie, aflatoxin) were measured by UPLC. Results Roasting degree beyond "light roast" was associated with variable degrees of protein allergen degradation, or potentially aggregation. Relative potency and amounts of protein allergens showed variability due in part to seasonal/manufacturing variability. Proportion of lots not meeting aflatoxin limits has increased in recent years. Up to 60% of peanut flour source material failed to meet screening selection acceptance criteria for proceeding to drug substance testing, mostly because of failure to meet potency acceptance criteria. Other lots were rejected due to safety (ie, aflatoxin) and quality. Influence of potency variation, within specification parameters, on safety/tolerability observed in trials was considered low, in part due to stringent controls placed at each step of manufacturing. Conclusions Extensive variability in allergen potency is a critical issue during immunotherapy, particularly during OIT initial dose escalation and up-dosing, as it may result in lack of efficacy or avoidable adverse allergic reactions. Based on EU and US regulatory requirements, the production of PTAH includes manufacturing controls to ensure drug product safety, potency, and quality. For example, although PTAH contains all peanut allergens, each lot has met strict criteria ensuring consistent allergenic potency of Ara h 1, Ara h 2, and Ara h 6. The rigor of PTAH's manufacturing process ensures reliable dose consistency and stability throughout its shelf life.
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Affiliation(s)
- Stephanie A. Leonard
- Division of Pediatric Allergy / Immunology, University of California San Diego, Rady Children's Hospital, San Diego, CA, United States
| | - Yasushi Ogawa
- Medical Affairs, Aimmune Therapeutics, a Nestlé Health Science company, Brisbane, CA, United States
| | - Paul T. Jedrzejewski
- Medical Affairs, Aimmune Therapeutics, a Nestlé Health Science company, Brisbane, CA, United States
| | - Soheila J. Maleki
- United States Department of Agriculture, Agricultural Research Service, New Orleans, LA, United States
| | | | - Stephen A. Tilles
- Medical Affairs, Aimmune Therapeutics, a Nestlé Health Science company, Brisbane, CA, United States,Correspondence: Stephen A. Tilles
| | - George Du Toit
- Department of Pediatrics, Guy's and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - S. Shahzad Mustafa
- Rochester Regional Health, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Brian P. Vickery
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
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Terlouw S, van Boven FE, Borsboom-van Zonneveld M, de Graaf-in ‘t Veld C, van Splunter ME, van Daele PLA, van Maaren MS, Schreurs MWJ, de Jong NW. Homemade Food Allergen Extracts for Use in Skin Prick Tests in the Diagnosis of IgE-Mediated Food Allergy: A Good Alternative in the Absence of Commercially Available Extracts? Nutrients 2022; 14:nu14030475. [PMID: 35276832 PMCID: PMC8839075 DOI: 10.3390/nu14030475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The skin prick test (SPT) is the first step in the diagnosis of an immunoglobulin E (IgE)-mediated food allergy. The availability of commercial food allergen extracts is very limited, resulting in a need for alternative extraction methods of food allergens. The objective of this study was to compare the SPT results of homemade food allergen extracts with commercially available extracts. Methods: Adult patients with a suspected food allergy were included. Food allergen-specific symptoms were scored using a questionnaire. SPTs were performed with homemade and commercially available extracts (ALK-Abelló, Kopenhagen, Denmark) from almond, apple, hazelnut, peach, peanut, and walnut. Serum-specific IgE was measured with ISAC or ImmunoCAP™. Intra-class correlation coefficients (ICC) between the SPT results of both extract methods were calculated. The proportion of agreement with food allergen-specific symptoms was analyzed. Results: Fifty-four patients (mean age 36; range 19–69 years; female/male: 42/12) were included. The intra-class correlation coefficient (ICC) between the SPT results of both extract methods were strong for hazelnut 0.79 (n = 44) and walnut 0.78 (n = 31), moderate for apple 0.74 (n = 21) and peanut 0.66 (n = 28), and weak for almond 0.36 (n = 27) and peach 0.17 (n = 23). The proportion of agreement between SPT results and food allergen-specific symptoms was comparable for homemade and commercially available extracts, except for peach; 0.77 versus 0.36, respectively. Conclusion: In the diagnostic procedures to identify an IgE-mediated food allergy, homemade extracts from hazelnut and walnut appear to be a good alternative in the absence of commercially available food allergen extracts.
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Affiliation(s)
- Severina Terlouw
- Department of Allergology, Albert Schweitzer Hospital, 3331 LZ Zwijndrecht, The Netherlands; (M.B.-v.Z.); (C.d.G.-i.‘t.V.)
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
- Correspondence: ; Tel.: +31-640149222
| | - Frank E. van Boven
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
| | - Monika Borsboom-van Zonneveld
- Department of Allergology, Albert Schweitzer Hospital, 3331 LZ Zwijndrecht, The Netherlands; (M.B.-v.Z.); (C.d.G.-i.‘t.V.)
| | - Catharina de Graaf-in ‘t Veld
- Department of Allergology, Albert Schweitzer Hospital, 3331 LZ Zwijndrecht, The Netherlands; (M.B.-v.Z.); (C.d.G.-i.‘t.V.)
| | - Marloes E. van Splunter
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
| | - Paul L. A. van Daele
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
| | - Maurits S. van Maaren
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
| | - Marco W. J. Schreurs
- Laboratory Medical Immunology, Department of Immunology, Erasmus Medical Centre, 3015 GD Rotterdam, The Netherlands;
| | - Nicolette W. de Jong
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
- Department of Pediatric Allergology, Sophia Children Hospital, Erasmus Medical Centre, 3015 GD Rotterdam, The Netherlands
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Soares JRA, Pereira E Silva A, de Souza Oliveira AL, Guimarães IM, das Neves Faccini CRJ, de Aquino Mattos EB, Rodrigues SKPM, Marmello BO, Teixeira GAPB. Allergen extraction: Factors influencing immunogenicity and sensitivity of immunoassays. J Immunol Methods 2021; 498:113125. [PMID: 34450115 DOI: 10.1016/j.jim.2021.113125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
Food allergy prevalence is increasing worldwide, therefore there is a high demand for reliable tests to correctly diagnose this disease. Knowledge of proteins allergenicity and how they react both in the body and in diagnostic tests is necessary to adequately assess the potential immunogenicity of both natural foods and those produced through biotechnological processes. Thus, our aim was to analyze the factors that influence the protein extraction of foods in terms of, immunogenicity and immunoassays sensitivity. Peanut proteins were extracted using four distinct extraction buffers with different pH values (physiological saline, tris buffer, borate buffer with and without β-mercaptoethanol), the protein concentration was determined by the Lowry method and polyacrylamide electrophoresis (SDS-PAGE) was used to compare the protein profile of each extract. The immunogenicity of each extract was verified by sensitizing two mouse strains (Balb/c and C57Bl/6) with a solution containing 100 μg of the extracted proteins and was determined by ELISA. Results show that extraction with the distinct buffers resulted in protein solutions with different yields and profiles. The immunogenicity of the different extracts also demonstrated distinct patterns that varied depending on the extraction methods, mouse strain and in vitro test. Immunoreactivity varied in accordance with the protein extract used to coat the microtitration plates. In conclusion, the protein profile in the extracts is critically influenced by the salt composition and pH of the extraction buffers, this in turn influences both in vivo immunogenicity and in vitro immunoreactivity.
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Affiliation(s)
- João Ricardo Almeida Soares
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-150, Brazil; Graduate Program in Pathology, Medicine School, Antônio Pedro Hospital, Federal Fluminense University, Niterói, Rio de Janeiro 24033-900, Brazil
| | - Airton Pereira E Silva
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-150, Brazil; Graduate Program in Pathology, Medicine School, Antônio Pedro Hospital, Federal Fluminense University, Niterói, Rio de Janeiro 24033-900, Brazil
| | - Ana Luísa de Souza Oliveira
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-150, Brazil; Graduate Program in Pathology, Medicine School, Antônio Pedro Hospital, Federal Fluminense University, Niterói, Rio de Janeiro 24033-900, Brazil
| | - Isabelle Mazza Guimarães
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-150, Brazil; Graduate Program in Science and Biotechnology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-141, Brazil
| | - Claudia Regina Josetti das Neves Faccini
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-150, Brazil; Graduate Program in Pathology, Medicine School, Antônio Pedro Hospital, Federal Fluminense University, Niterói, Rio de Janeiro 24033-900, Brazil
| | - Erika Bertozzi de Aquino Mattos
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-150, Brazil; Graduate Program in Pathology, Medicine School, Antônio Pedro Hospital, Federal Fluminense University, Niterói, Rio de Janeiro 24033-900, Brazil
| | - Sónia Kristy Pinto Melo Rodrigues
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-150, Brazil; Graduate Program in Pathology, Medicine School, Antônio Pedro Hospital, Federal Fluminense University, Niterói, Rio de Janeiro 24033-900, Brazil
| | - Bárbara Oliveira Marmello
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-150, Brazil; Graduate Program in Science and Biotechnology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-141, Brazil
| | - Gerlinde Agate Platais Brasil Teixeira
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-150, Brazil; Graduate Program in Science and Biotechnology, Federal Fluminense University, Niterói, Rio de Janeiro 24020-141, Brazil; Graduate Program in Pathology, Medicine School, Antônio Pedro Hospital, Federal Fluminense University, Niterói, Rio de Janeiro 24033-900, Brazil.
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Regulatory Requirements for the Quality of Allergen Products for Allergen Immunotherapy of Food Allergy. Curr Allergy Asthma Rep 2021; 21:32. [PMID: 33970347 PMCID: PMC8110504 DOI: 10.1007/s11882-021-01008-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 11/13/2022]
Abstract
Purpose of Review Medicinal products for allergen immunotherapy (AIT) of food allergies have gained enormous momentum in recent years. With this new class of products entering marketing authorization procedures, compliance to regulatory requirements becomes a critical element. Here, an overview is provided on specific requirements and aspects concerning the quality control and manufacturing of these products. Recent Findings Recent developments in the field of AIT for food allergies are divers, including products for oral, epicutaneous, and subcutaneous application, most notably targeting egg, milk, and peanut allergy. As the source materials for food AIT product are typically produced for food consumption and not for medicinal purposes, unique challenges arise in the manufacturing processes and controls of these medicinal products. Individual approaches are needed to assure acceptable quality, including control of relevant quantitative and qualitative characteristics. Major characteristics for quality verification include determination of protein content, total allergenic activity, and major allergen content. The applied manufacturing processes need to be established such that relevant process parameters are kept within justified limits and consistency of produced batches is assured. Summary Allergen products for food AIT present specific challenges with respect to quality aspects that differentiate them from other commonly available AIT products. While established regulation is available and provides clear guidance for most aspects, other issues require consideration of new and individual settings relevant here. Consequently, as experience grows, respective amendments to currently available guidance may be needed.
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Manufacturing and quality assessment of allergenic extracts for immunotherapy: state of the art. Curr Opin Allergy Clin Immunol 2019; 19:640-645. [DOI: 10.1097/aci.0000000000000579] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Pucheu-Haston CM, Mougeot I. Serum IgE and IgG responses to dietary antigens in dogs with and without cutaneous adverse food reactions. Vet Dermatol 2019; 31:116-127. [PMID: 31749195 DOI: 10.1111/vde.12810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND It is suspected that many canine cutaneous adverse food reactions (CAFR) are true immunological hypersensitivities; however, few specific dietary allergens have been identified. OBJECTIVE To compare serum immunoglobulin (Ig)E and IgG reactivity to specific food antigens in privately owned dogs with and without CAFR. ANIMALS Eighteen adult dogs with nonseasonal pruritus recruited from a hospital population. METHODS AND MATERIALS Dogs were fed an extensively hydrolysed poultry-based diet exclusively for 12 weeks. Serum was collected at the beginning of the trial. Canine atopic dermatitis extent and severity index and pruritus Visual Analog Scale scoring were performed at the beginning and end of the trial. Immunoblotting was performed to identify IgE and/or IgG binding to specific proteins in beef, egg, milk, chicken, pork, soy and wheat extracts. RESULTS A CAFR (defined as an unequivocal relapse of pruritus after dietary challenge) was diagnosed in 10 dogs, with 60% relapsing when fed chicken-based diets. Binding of subjects' IgG to almost all proteins in all extracts was seen regardless of reported dietary history. Few proteins were exclusively or predominantly bound by IgE in CAFR dogs. Exceptions included a 42 kDa band (chicken), a 52 kDa band (beef), a 46 kDa band (beef and milk) and a poorly defined high molecular weight protein or proteins (beef and milk). CONCLUSION This study demonstrated three protein bands and a poorly defined band predominantly recognized by sera from dogs with CAFR relative to non-CAFR dog sera. Almost all proteins were bound by IgG in all dogs, suggesting prior exposure to unreported foods.
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Affiliation(s)
- Cherie M Pucheu-Haston
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Skip Bertman Drive, Baton Rouge, LA, 70803, USA
| | - Isabelle Mougeot
- CanCog Technologies, 120 Carlton Street, Toronto, Ontario, Canada, M5A 4K2
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Colombo F, Restani P, Novembre EM, Barni S, Di Lorenzo C, Orgiu F, Biella S, Mori F. Apovitellin identified as a novel major egg allergen in goose egg allergy. Pediatr Allergy Immunol 2019; 30:246-248. [PMID: 30346628 DOI: 10.1111/pai.12997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Francesca Colombo
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Patrizia Restani
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Elio Massimo Novembre
- Paediatric Allergy and Immunology Unit, Department of Paediatric, A. Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Simona Barni
- Paediatric Allergy and Immunology Unit, Department of Paediatric, A. Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Chiara Di Lorenzo
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Francesca Orgiu
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Simone Biella
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Francesca Mori
- Paediatric Allergy and Immunology Unit, Department of Paediatric, A. Meyer Children's Hospital, University of Florence, Florence, Italy
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