1
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Olivieri B, Skypala IJ. The Diagnosis of Allergy to Lipid Transfer Proteins. Curr Allergy Asthma Rep 2024; 24:509-518. [PMID: 38990405 DOI: 10.1007/s11882-024-01164-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE OF REVIEW To provide an update on the diagnosis of non-specific Lipid Transfer Protein (nsLTP) allergy. RECENT FINDINGS More publications report the presence of nsLTP allergy in Northern European countries and nsLTP sensitisation in children. Individuals are more likely to have severe reactions if there is recognition of increasing numbers of LTP components. Diagnosis is problematic; not all those with nsLTP allergy will have a positive test to a peach extract containing Pru p 3, the peach nsLTP. Sensitisation to nsLTP is being reported in more countries, including to the nsLTP in Cannabis Sativa in North America. Meals containing multiple nsLTP foods are more likely to be involved in co-factor reactions. Component-resolved diagnostics are superior to skin prick tests, to determine sensitisation to the individual nsLTP allergens causing symptoms and, in the future, the Basophil Activation test may best discriminate between sensitization and clinical allergy.
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Affiliation(s)
- Bianca Olivieri
- Department of Medicine, Asthma, Allergy and Clinical Immunology Section, University of Verona, Verona, Italy
| | - Isabel J Skypala
- Department of Allergy & Clinical Immunology, Royal Brompton & Harefield Hospitals, part of Guys and St Thomas NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK.
- Department of Inflammation and repair, Imperial College, London, UK.
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2
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Ebo DG, Toscano A, Rihs HP, Mertens C, Sabato V, Elst J, Beyens M, Hagendorens MM, Van Houdt M, Van Gasse AL. IgE-Mediated Cannabis Allergy and Cross-Reactivity Syndromes: A Roadmap for Correct Diagnosis and Management. Curr Allergy Asthma Rep 2024; 24:407-414. [PMID: 38990404 DOI: 10.1007/s11882-024-01159-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE OF THE REVIEW With increased access and decriminalization of cannabis use, cases of IgE-dependent cannabis allergy (CA) and cross-reactivity syndromes have been increasingly reported. However, the exact prevalence of cannabis allergy and associated cross-reactive food syndromes (CAFS) remains unknown and is likely to be underestimated due to a lack of awareness and insufficient knowledge of the subject among health care professionals. Therefore, this practical roadmap aims to familiarize the reader with the early recognition and correct management of IgE-dependent cannabis-related allergies. In order to understand the mechanisms underlying these cross-reactivity syndromes and to enable personalized diagnosis and management, special attention is given to the molecular diagnosis of cannabis-related allergies. RECENT FINDINGS The predominant signs and symptoms of CA are rhinoconjunctivitis and contact urticaria/angioedema. However, CA can also present as a life-threatening condition. In addition, many patients with CA also have distinct cross-reactivity syndromes, mainly involving fruits, vegetables, nuts and cereals. At present, five allergenic components of Cannabis sativa (Can s); Can s 2 (profilin), Can s 3 (a non-specific lipid protein), Can s 4 (oxygen-evolving enhancer protein 2 oxygen), Can s 5 (the Bet v 1 homologue) and Can s 7 (thaumatin-like protein) have been characterized and indexed in the WHO International Union of Immunological Sciences (IUIS) allergen database. However, neither of them is currently readily available for diagnosis, which generally starts by testing crude extracts of native allergens. The road to a clear understanding of CA and the associated cross-reactive food syndromes (CAFS) is still long and winding, but well worth further exploration.
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Affiliation(s)
- Didier G Ebo
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Campus Drie Eiken T5.95 Universiteitsplein 1, Antwerp, 2610, Belgium.
- Department of Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium.
- Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.
| | - Alessandro Toscano
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Campus Drie Eiken T5.95 Universiteitsplein 1, Antwerp, 2610, Belgium
- Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Hans-Peter Rihs
- PA-Institute for Prevention and Occupational Medicine, German Social Accident Insurance, Ruhr-University Bochum, Bochum, Germany
| | - Christel Mertens
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Campus Drie Eiken T5.95 Universiteitsplein 1, Antwerp, 2610, Belgium
- Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Vito Sabato
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Campus Drie Eiken T5.95 Universiteitsplein 1, Antwerp, 2610, Belgium
- Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Jessy Elst
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Campus Drie Eiken T5.95 Universiteitsplein 1, Antwerp, 2610, Belgium
- Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Michiel Beyens
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Campus Drie Eiken T5.95 Universiteitsplein 1, Antwerp, 2610, Belgium
- Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Margo M Hagendorens
- Department of Paediatrics and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of and Paediatrics, Antwerp University Hospital, Antwerp, Belgium
| | - Michel Van Houdt
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Campus Drie Eiken T5.95 Universiteitsplein 1, Antwerp, 2610, Belgium
- Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Athina L Van Gasse
- Department of Paediatrics and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of and Paediatrics, Antwerp University Hospital, Antwerp, Belgium
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3
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Eidem T, Nordgren T, Hernandez M. Bioaerosol Exposures and Respiratory Diseases in Cannabis Workers. Curr Allergy Asthma Rep 2024; 24:395-406. [PMID: 38878249 PMCID: PMC11233357 DOI: 10.1007/s11882-024-01157-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE OF REVIEW This review investigates occupational inhalation hazards associated with biologically derived airborne particles (bioaerosols) generated in indoor cannabis cultivation and manufacturing facilities. RECENT FINDINGS Indoor cannabis production is growing across the US as are recent reports of respiratory diseases among cannabis workers, including occupational asthma morbidity and mortality. More information is needed to understand how bioaerosol exposure in cannabis facilities impacts worker health and occupational disease risk. Preliminary studies demonstrate a significant fraction of airborne particles in cannabis facilities are comprised of fungal spores, bacteria, and plant material, which may also contain hazardous microbial metabolites and allergens. These bioaerosols may pose pathogenic, allergenic, toxigenic, and pro-inflammatory risks to workers. The absence of multi-level, holistic bioaerosol research in cannabis work environments necessitates further characterization of the potential respiratory hazards and effective risk prevention methods to safeguard occupational health as the cannabis industry continues to expand across the US and beyond.
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Affiliation(s)
- Tess Eidem
- Department of Civil, Environmental, and Architectural Engineering, University of Colorado Boulder, Boulder, CO, 80309-0428, US.
| | - Tara Nordgren
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, 80523-1601, US
| | - Mark Hernandez
- Department of Civil, Environmental, and Architectural Engineering, University of Colorado Boulder, Boulder, CO, 80309-0428, US
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4
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Wąsik J, Likońska A, Kurowski M. IgE-Mediated Allergy and Asymptomatic Sensitization to Cannabis Allergens-Review of Current Knowledge and Presentation of Six Cases. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:954. [PMID: 38929571 PMCID: PMC11205784 DOI: 10.3390/medicina60060954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
Cannabis allergy is a relatively new phenomenon described in the 1970s. Its increased frequency has been observed over the last years due to the increasing therapeutic and recreational use of cannabis-based products. Sensitization possibly leading to allergy symptoms can occur not only through the smoking of cannabis, but also through ingestion, the inhalation of pollen, or direct contact. The severity of symptoms varies from benign pruritus to anaphylaxis. There is scant information available to support clinicians throughout the entire therapeutic process, starting from diagnosis and ending in treatment. In this review, we present six cases of patients in whom molecular in vitro testing revealed sensitization to cannabis extract and/or cannabis-derived nsLTP molecules (Can s 3). Based on these cases, we raise important questions regarding this topic. The article discusses current proposals and highlights the importance of further research not only on cannabis allergy but also on asymptomatic sensitization to cannabis allergens, which may be ascertained in some percentage of the population.
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Affiliation(s)
- Jakub Wąsik
- Department of Immunology and Allergy, Medical University of Lodz, 90-419 Lodz, Poland; (J.W.); (A.L.)
- Student Scientific Association, Department of Immunology and Allergy, Medical University of Lodz, 90-419 Lodz, Poland
| | - Aleksandra Likońska
- Department of Immunology and Allergy, Medical University of Lodz, 90-419 Lodz, Poland; (J.W.); (A.L.)
| | - Marcin Kurowski
- Department of Immunology and Allergy, Medical University of Lodz, 90-419 Lodz, Poland; (J.W.); (A.L.)
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5
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Hassouneh A, Tambyraja AL. Cannabis-Related Disorders and Toxic Effects. N Engl J Med 2024; 390:867. [PMID: 38416441 DOI: 10.1056/nejmc2400805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
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6
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Conner JE, Steinberg JA. Approach to Idiopathic Anaphylaxis in Adolescents. Med Clin North Am 2024; 108:123-155. [PMID: 37951646 DOI: 10.1016/j.mcna.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Anaphylaxis is a potentially-life threatening condition. Adolescents are particularly vulnerable due to increased risk-taking behaviors, poor disease management, and minimized perception of risk. Although most anaphylaxis can be attributed to food, drug, or venom allergy via a detailed history and confirmatory studies, in nearly 1 in 5 cases, the cause may not be obvious. Clinical differentials including rare allergens, cofactors, mast-cell disorders, and mimic disorders can increase the likelihood of discovering of the cause of anaphylaxis.
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Affiliation(s)
- Jeanne E Conner
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Medical College of Wisconsin, 9000 West Wisconsin Avenue. B440, Milwaukee, WI 53226, USA
| | - Joshua A Steinberg
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Medical College of Wisconsin, 9000 West Wisconsin Avenue. B440, Milwaukee, WI 53226, USA; Section of Allergy, Department of Medicine, Clement J. Zablocki Veterans' Affairs Medical Center, 5000 West National Avenue, 1AN, Milwaukee, WI 53295, USA.
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7
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Beriziky P, Cherkaoui M, Linxe L, Perrin E, Rogniaux H, Denery-Papini S, Morisset M, Larré C, Dijk W. Hemp seed: An allergen source with potential cross-reactivity to hazelnut. Food Res Int 2023; 169:112932. [PMID: 37254358 DOI: 10.1016/j.foodres.2023.112932] [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: 10/03/2022] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 06/01/2023]
Abstract
The increasing exposure of the population to Cannabis sativa has revealed allergies to different parts of the plant, among which hemp seed. Nonetheless, the major hemp seed allergens remain to be identified. Several known families of allergens are present in hemp seed, including notably seed storage proteins. We therefore aimed to investigate the potential allergenicity of the hemp seed storage proteins and their potential cross-reactivity to different seeds and nuts. For this, we extracted hemp seed proteins sequentially using buffers with increasing levels of salinity (H2O, T2 and T3) to yield extracts differentially enriched in storage proteins. We used these extracts to perform immunoblots and ELISAs using sera of patients either sensitized to hemp seeds or sensitized/allergic to other seeds and nuts. Immunoblots and proteomics analyses identified vicilins and edestins as potential hemp seed allergens. Moreover, ELISA analyses revealed a correlation between sensitization to hazelnut and the hemp seed T3 extract (enriched in storage proteins). The possible cross-reactivity between hazelnut and hemp seed proteins was further strengthened by the results from inhibition ELISAs: the incubation of sera from hazelnut-sensitized individuals with increasing concentrations of the T3 extract inhibited serum IgE binding to the hazelnut extract by about 25-30%. Our study thus identifies vicilins and edestins as potential hemp seed allergens and highlights a possible cross-reactivity with hazelnut. The clinical relevance of this cross-reactivity between hemp seed and hazelnut needs to be further investigated in hazelnut-allergic individuals.
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Affiliation(s)
- Princy Beriziky
- INRAE, UR BIA, F-44316, Nantes, France; CHU d'Angers, unité d'allergologie, Angers, France
| | - Mehdi Cherkaoui
- INRAE, UR BIA, F-44316, Nantes, France; INRAE, PROBE research infrastructure, BIBS Facility, F-44316 Nantes, France
| | | | | | - Hélène Rogniaux
- INRAE, UR BIA, F-44316, Nantes, France; INRAE, PROBE research infrastructure, BIBS Facility, F-44316 Nantes, France
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8
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Sack C, Simpson C, Pacheco K. The Emerging Spectrum of Respiratory Diseases in the U.S. Cannabis Industry. Semin Respir Crit Care Med 2023; 44:405-414. [PMID: 37015286 PMCID: PMC10449032 DOI: 10.1055/s-0043-1766116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
While the cannabis industry is one of the fastest growing job markets in the United States and globally, relatively little is known about the occupational hazards that cannabis production workers face. Based on the closely related hemp industry and preliminary studies from recreational cannabis grow facilities, there is concern for significant respiratory exposures to bioaerosols containing microbial and plant allergens, chemicals such as pesticides, volatile organic compounds, and other irritant gases. Components of the cannabis plant have also recently been identified as allergenic and capable of inducing an immunoglobulin E-mediated response. Accumulating evidence indicates a spectrum of work-related respiratory diseases, particularly asthma and other allergic diseases. Disentangling causal relationships is difficult given the heterogeneity of mixed exposures, diagnostic challenges, and confounding by personal cannabis use. Despite and because of these uncertainties, better regulatory guidance and exposure controls need to be defined in order to reduce the risk of work-related disease.
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Affiliation(s)
- Coralynn Sack
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Christopher Simpson
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA
| | - Karin Pacheco
- Department of Environmental and Occupational Health Sciences, National Jewish Hospital, Denver, CO
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9
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Toscano A, Ebo DG, Abbas K, Brucker H, Decuyper II, Naimi D, Nanda A, Nayak AP, Skypala IJ, Sussman G, Zeiger JS, Silvers WS. A review of cannabis allergy in the early days of legalization. Ann Allergy Asthma Immunol 2023; 130:288-295. [PMID: 36384984 PMCID: PMC9991982 DOI: 10.1016/j.anai.2022.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022]
Abstract
Cannabis allergy is a burgeoning field; consequently, research is still in its infancy and allergists' knowledge surrounding this topic is limited. As cannabis legalization expands across the world, it is anticipated that there will be an increase in cannabis use. Thus, we hypothesize that a concomitant rise in the incidence of allergy to this plant can be expected. Initiatives aimed at properly educating health care professionals are therefore necessary. This review presents the most up-to-date information on a broad range of topics related to cannabis allergy. Although the clinical features of cannabis allergy are becoming more well described and recognized, the tools available to make a correct diagnosis are meager and often poorly accessible. In addition, research on cannabis allergy is still taking its first steps, and new and potentially groundbreaking findings in this field are expected to occur in the next few years. Finally, although therapeutic approaches are being developed, patient and physician education regarding cannabis allergy is certainly needed.
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Affiliation(s)
- Alessandro Toscano
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium; Post-Graduate School of Allergology and Clinical Immunology, University of Milan, Milan, Italy.
| | - Didier G Ebo
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium; Department of Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium
| | - Khaldon Abbas
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Ine I Decuyper
- Department of Pediatrics and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - David Naimi
- Naval Hospital Camp Pendleton, Oceanside, California
| | - Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, Dallas, Texas; Division of Allergy and Immunology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ajay P Nayak
- Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Isabel J Skypala
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Gordon Sussman
- Department of Medicine and Division of Clinical Immunology & Allergy, University of Toronto, Toronto, Ontario, Canada
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10
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Warren C, Nimmagadda SR, Gupta R, Levin M. The epidemiology of food allergy in adults. Ann Allergy Asthma Immunol 2023; 130:276-287. [PMID: 36509408 DOI: 10.1016/j.anai.2022.11.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/31/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022]
Abstract
The prevalence and awareness of food allergy (FA) among US adults is arguably at a historical high, both with respect to primary immunoglobulin E-mediated food hypersensitivity and other food-triggered conditions that operate through a variety of immunologic mechanisms (eg, pollen-FA syndrome, alpha-gal syndrome, food protein-induced enterocolitis syndrome, eosinophilic esophagitis). Worryingly, not only are many adults retaining childhood-onset food allergies as they age into adulthood, it seems that many adults are experiencing adult-onset allergies to previously tolerated foods, with correspondingly adverse physical, and psychological health impacts. Consequently, this review aims to summarize what is currently known about the epidemiology and population-level burden of FA among adult populations in North America and around the globe. This article also provides insights into the natural history of these conditions and what we need to know as we look to the future to support effective care and prevent FA.
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Affiliation(s)
- Christopher Warren
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois.
| | - Sai R Nimmagadda
- Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ruchi Gupta
- Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Chicago, Illinois
| | - Michael Levin
- Division Paediatric Allergology, University of Cape Town, Cape Town, South Africa
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11
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Dramburg S, Hilger C, Santos AF, de Las Vecillas L, Aalberse RC, Acevedo N, Aglas L, Altmann F, Arruda KL, Asero R, Ballmer-Weber B, Barber D, Beyer K, Biedermann T, Bilo MB, Blank S, Bosshard PP, Breiteneder H, Brough HA, Bublin M, Campbell D, Caraballo L, Caubet JC, Celi G, Chapman MD, Chruszcz M, Custovic A, Czolk R, Davies J, Douladiris N, Eberlein B, Ebisawa M, Ehlers A, Eigenmann P, Gadermaier G, Giovannini M, Gomez F, Grohman R, Guillet C, Hafner C, Hamilton RG, Hauser M, Hawranek T, Hoffmann HJ, Holzhauser T, Iizuka T, Jacquet A, Jakob T, Janssen-Weets B, Jappe U, Jutel M, Kalic T, Kamath S, Kespohl S, Kleine-Tebbe J, Knol E, Knulst A, Konradsen JR, Korošec P, Kuehn A, Lack G, Le TM, Lopata A, Luengo O, Mäkelä M, Marra AM, Mills C, Morisset M, Muraro A, Nowak-Wegrzyn A, Nugraha R, Ollert M, Palosuo K, Pastorello EA, Patil SU, Platts-Mills T, Pomés A, Poncet P, Potapova E, Poulsen LK, Radauer C, Radulovic S, Raulf M, Rougé P, Sastre J, Sato S, Scala E, Schmid JM, Schmid-Grendelmeier P, Schrama D, Sénéchal H, Traidl-Hoffmann C, Valverde-Monge M, van Hage M, van Ree R, Verhoeckx K, Vieths S, Wickman M, Zakzuk J, Matricardi PM, Hoffmann-Sommergruber K. EAACI Molecular Allergology User's Guide 2.0. Pediatr Allergy Immunol 2023; 34 Suppl 28:e13854. [PMID: 37186333 DOI: 10.1111/pai.13854] [Citation(s) in RCA: 63] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/05/2022] [Indexed: 05/17/2023]
Abstract
Since the discovery of immunoglobulin E (IgE) as a mediator of allergic diseases in 1967, our knowledge about the immunological mechanisms of IgE-mediated allergies has remarkably increased. In addition to understanding the immune response and clinical symptoms, allergy diagnosis and management depend strongly on the precise identification of the elicitors of the IgE-mediated allergic reaction. In the past four decades, innovations in bioscience and technology have facilitated the identification and production of well-defined, highly pure molecules for component-resolved diagnosis (CRD), allowing a personalized diagnosis and management of the allergic disease for individual patients. The first edition of the "EAACI Molecular Allergology User's Guide" (MAUG) in 2016 rapidly became a key reference for clinicians, scientists, and interested readers with a background in allergology, immunology, biology, and medicine. Nevertheless, the field of molecular allergology is moving fast, and after 6 years, a new EAACI Taskforce was established to provide an updated document. The Molecular Allergology User's Guide 2.0 summarizes state-of-the-art information on allergen molecules, their clinical relevance, and their application in diagnostic algorithms for clinical practice. It is designed for both, clinicians and scientists, guiding health care professionals through the overwhelming list of different allergen molecules available for testing. Further, it provides diagnostic algorithms on the clinical relevance of allergenic molecules and gives an overview of their biology, the basic mechanisms of test formats, and the application of tests to measure allergen exposure.
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Affiliation(s)
- Stephanie Dramburg
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christiane Hilger
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Alexandra F Santos
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
- Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | | | - Rob C Aalberse
- Sanquin Research, Dept Immunopathology, University of Amsterdam, Amsterdam, The Netherlands
- Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Nathalie Acevedo
- Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia, Colombia
| | - Lorenz Aglas
- Department of Biosciences and Medical Biology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Friedrich Altmann
- Department of Chemistry, University of Natural Resources and Life Sciences, Vienna, Austria
| | - Karla L Arruda
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Sao Paulo, Brasil, Brazil
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| | - Barbara Ballmer-Weber
- Klinik für Dermatologie und Allergologie, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Domingo Barber
- Institute of Applied Molecular Medicine Nemesio Diez (IMMAND), Department of Basic Medical Sciences, Facultad de Medicina, Universidad San Pablo CEU, CEU Universities, Madrid, Spain
- RETIC ARADyAL and RICORS Enfermedades Inflamatorias (REI), Madrid, Spain
| | - Kirsten Beyer
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University Munich, Munich, Germany
| | - Maria Beatrice Bilo
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
- Allergy Unit Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Torrette, Italy
| | - Simon Blank
- Center of Allergy and Environment (ZAUM), Technical University of Munich, School of Medicine and Helmholtz Center Munich, German Research Center for Environmental Health, Munich, Germany
| | - Philipp P Bosshard
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Heimo Breiteneder
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Helen A Brough
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Merima Bublin
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Dianne Campbell
- Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia, Colombia
| | - Jean Christoph Caubet
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - Giorgio Celi
- Centro DH Allergologia e Immunologia Clinica ASST- MANTOVA (MN), Mantova, Italy
| | | | - Maksymilian Chruszcz
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, South Carolina, USA
| | - Adnan Custovic
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Rebecca Czolk
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Janet Davies
- Queensland University of Technology, Centre for Immunology and Infection Control, School of Biomedical Sciences, Herston, Queensland, Australia
- Metro North Hospital and Health Service, Emergency Operations Centre, Herston, Queensland, Australia
| | - Nikolaos Douladiris
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Bernadette Eberlein
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University Munich, Munich, Germany
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
| | - Anna Ehlers
- Chemical Biology and Drug Discovery, Utrecht University, Utrecht, The Netherlands
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Philippe Eigenmann
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - Gabriele Gadermaier
- Department of Biosciences and Medical Biology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Francisca Gomez
- Allergy Unit IBIMA-Hospital Regional Universitario de Malaga, Malaga, Spain
- Spanish Network for Allergy research RETIC ARADyAL, Malaga, Spain
| | - Rebecca Grohman
- NYU Langone Health, Department of Internal Medicine, New York, New York, USA
| | - Carole Guillet
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Christine Hafner
- Department of Dermatology, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - Robert G Hamilton
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Hauser
- Department of Biosciences and Medical Biology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Thomas Hawranek
- Department of Dermatology and Allergology, Paracelsus Private Medical University, Salzburg, Austria
| | - Hans Jürgen Hoffmann
- Institute for Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Tomona Iizuka
- Laboratory of Protein Science, Graduate School of Life Science, Hokkaido University, Sapporo, Japan
| | - Alain Jacquet
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thilo Jakob
- Department of Dermatology and Allergology, University Medical Center, Justus Liebig University Gießen, Gießen, Germany
| | - Bente Janssen-Weets
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
| | - Uta Jappe
- Division of Clinical and Molecular Allergology, Priority Research Area Asthma and Allergy, Research Center Borstel, Borstel, Germany
- Leibniz Lung Center, Airway Research Center North (ARCN), Member of the German Center for Lung Research, Germany
- Interdisciplinary Allergy Outpatient Clinic, Dept. of Pneumology, University of Lübeck, Lübeck, Germany
| | - Marek Jutel
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
| | - Tanja Kalic
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
- Department of Dermatology, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - Sandip Kamath
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Sabine Kespohl
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr- Universität Bochum, Bochum, Germany
| | - Jörg Kleine-Tebbe
- Allergy & Asthma Center Westend, Outpatient Clinic and Clinical Research Center, Berlin, Germany
| | - Edward Knol
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - André Knulst
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jon R Konradsen
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Korošec
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Annette Kuehn
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Gideon Lack
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
- Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Thuy-My Le
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Andreas Lopata
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Olga Luengo
- RETIC ARADyAL and RICORS Enfermedades Inflamatorias (REI), Madrid, Spain
- Allergy Section, Internal Medicine Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mika Mäkelä
- Division of Allergy, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Pediatric Department, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Clare Mills
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Manchester Institute of Biotechnology, The University of Manchester, Manchester, UK
| | | | - Antonella Muraro
- Food Allergy Referral Centre, Department of Woman and Child Health, Padua University Hospital, Padua, Italy
| | - Anna Nowak-Wegrzyn
- Division of Pediatric Allergy and Immunology, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York, New York, USA
- Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Roni Nugraha
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- Department of Aquatic Product Technology, Faculty of Fisheries and Marine Science, IPB University, Bogor, Indonesia
| | - Markus Ollert
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
| | - Kati Palosuo
- Department of Allergology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Sarita Ulhas Patil
- Division of Rheumatology, Allergy and Immunology, Departments of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Allergy and Immunology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas Platts-Mills
- Division of Allergy and Clinical Immunology, University of Virginia, Charlottesville, Virginia, USA
| | | | - Pascal Poncet
- Institut Pasteur, Immunology Department, Paris, France
- Allergy & Environment Research Team Armand Trousseau Children Hospital, APHP, Paris, France
| | - Ekaterina Potapova
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lars K Poulsen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Christian Radauer
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Suzana Radulovic
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr- Universität Bochum, Bochum, Germany
| | - Pierre Rougé
- UMR 152 PharmaDev, IRD, Université Paul Sabatier, Faculté de Pharmacie, Toulouse, France
| | - Joaquin Sastre
- Allergy Service, Fundación Jiménez Díaz; CIBER de Enfermedades Respiratorias (CIBERES); Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Sakura Sato
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Enrico Scala
- Clinical and Laboratory Molecular Allergy Unit - IDI- IRCCS, Fondazione L M Monti Rome, Rome, Italy
| | - Johannes M Schmid
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Schmid-Grendelmeier
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
| | - Denise Schrama
- Centre of Marine Sciences (CCMAR), Universidade do Algarve, Faro, Portugal
| | - Hélène Sénéchal
- Allergy & Environment Research Team Armand Trousseau Children Hospital, APHP, Paris, France
| | - Claudia Traidl-Hoffmann
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Marcela Valverde-Monge
- Allergy Service, Fundación Jiménez Díaz; CIBER de Enfermedades Respiratorias (CIBERES); Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Marianne van Hage
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ronald van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Kitty Verhoeckx
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Stefan Vieths
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - Magnus Wickman
- Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Josefina Zakzuk
- Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia, Colombia
| | - Paolo M Matricardi
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
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12
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Nayak AP, Loblundo C, Bielory L. Immunomodulatory Actions of Cannabinoids: Clinical Correlates and Therapeutic Opportunities for Allergic Inflammation. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:449-457. [PMID: 36280137 PMCID: PMC9918686 DOI: 10.1016/j.jaip.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022]
Abstract
Endogenously produced cannabinoids as well as phytocannabinoids broadly exhibit anti-inflammatory actions. Recent emergence of cannabis for multiple medical issues combined with reports on potent immunomodulatory actions of distinct components has underscored the therapeutic potential of cannabis. Although synthetic cannabinoids that are based on structural similarities to the existing class of cannabinoids have been on the rise, their application in therapeutics have been limited owing to toxicity concerns. Herein, we review the current literature that details the immunomodulatory actions of cannabinoids. Further, we highlight the complexities of cannabinoid biology and examine the potential inflammatory risks associated with the use of cannabis including potential for toxic interactions between distinct constituents of cannabis.
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Affiliation(s)
- Ajay P Nayak
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pa; Center for Translational Medicine; Division of Pulmonary Allergy and Critical Care Medicine, Jane and Leonard Korman Lung Center, Thomas Jefferson University, Philadelphia, Pa.
| | - Cali Loblundo
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pa; Center for Translational Medicine; Division of Pulmonary Allergy and Critical Care Medicine, Jane and Leonard Korman Lung Center, Thomas Jefferson University, Philadelphia, Pa
| | - Leonard Bielory
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pa; Department of Medicine, Hackensack Meridian School of Medicine, Nutley, NJ; Rutgers University Center for Environmental Prediction, New Brunswick, NJ; Center for Aerobiological Research, Kean University, Union, NJ.
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13
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Toscano A, Elst J, van der Poorten ML, Beyens M, Heremans K, Decuyper II, Van Gasse AL, Mertens C, Van Houdt M, Hagendorens MM, Sabato V, Ebo DG. Establishing diagnostic strategies for cannabis allergy. Expert Rev Clin Immunol 2022; 18:1015-1022. [PMID: 35912836 DOI: 10.1080/1744666x.2022.2108791] [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: 11/04/2022]
Abstract
INTRODUCTION Cannabis is the most widely consumed illicit drug in the world and carries a risk of severe IgE-mediated allergic reactions, requiring appropriate diagnostic management. Currently available diagnostics are still relatively limited and require careful interpretation of results to avoid harmful over- and underdiagnosis. AREAS COVERED This review focuses on the most up-to-date understandings of cannabis allergy diagnosis, starting with the main clinical features of the disease and the allergenic characteristics of Cannabis sativa, and then providing insights into in vivo, in vitro, and ex vivo diagnostic tests. EXPERT OPINION At present, the diagnosis of IgE-mediated cannabis allergy is based on a three-step approach that starts with accurate history taking and ends with a confirmation of sensitization to the whole extract and, finally, molecular components. Although much has been discovered since its first description in 1971, the diagnosis of cannabis allergy still has many unmet needs. The lack of commercial standardized and validated extracts and in vitro assays makes a harmonized workup of cannabis allergy difficult. Furthermore, the epidemiological characteristics, and clinical implications of sensitization to different molecular components are not yet fully known. Future research will complete the picture and likely result in an individualized and standardized approach.
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Affiliation(s)
- Alessandro Toscano
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.,Post-Graduate School of Allergology and Clinical Immunology, University of Milan, Milan, Italy
| | - Jessy Elst
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Marie-Line van der Poorten
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.,Department of Pediatrics and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Michiel Beyens
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Kevin Heremans
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Ine I Decuyper
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.,Department of Pediatrics and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Athina L Van Gasse
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Christel Mertens
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Michel Van Houdt
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Margo M Hagendorens
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.,Department of Pediatrics and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vito Sabato
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.,Department of Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium
| | - Didier G Ebo
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.,Department of Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium
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14
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Skypala IJ, Jeimy S, Brucker H, Nayak AP, Decuyper II, Bernstein JA, Connors L, Kanani A, Klimek L, Lo SCR, Murphy KR, Nanda A, Poole JA, Walusiak-Skorupa J, Sussman G, Zeiger JS, Goodman RE, Ellis AK, Silvers WS, Ebo DG. Cannabis-related allergies: An international overview and consensus recommendations. Allergy 2022; 77:2038-2052. [PMID: 35102560 PMCID: PMC9871863 DOI: 10.1111/all.15237] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/10/2022] [Accepted: 01/23/2022] [Indexed: 01/26/2023]
Abstract
Cannabis is the most widely used recreational drug in the world. Cannabis sativa and Cannabis indica have been selectively bred to develop their psychoactive properties. The increasing use in many countries has been accelerated by the COVID-19 pandemic. Cannabis can provoke both type 1 and type 4 allergic reactions. Officially recognized allergens include a pathogenesis-related class 10 allergen, profilin, and a nonspecific lipid transfer protein. Other allergens may also be relevant, and recognition of allergens may vary between countries and continents. Cannabis also has the potential to provoke allergic cross-reactions to plant foods. Since cannabis is an illegal substance in many countries, research has been hampered, leading to challenges in diagnosis since no commercial extracts are available for testing. Even in countries such as Canada, where cannabis is legalized, diagnosis may rely solely on the purchase of cannabis for prick-to-prick skin tests. Management consists of avoidance, with legal issues hindering the development of other treatments such as immunotherapy. Education of healthcare professionals is similarly lacking. This review aimed to summarize the current status of cannabis allergy and proposes recommendations for the future management of this global issue.
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Affiliation(s)
- Isabel J. Skypala
- Department of Allergy & Clinical Immunology, Royal Brompton & Harefield Hospitals, and Imperial College, London, UK
| | - Samira Jeimy
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Ontario, Canada
| | | | - Ajay P. Nayak
- Center for Translational Medicine and Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ine I. Decuyper
- Department of Pediatrics, Faculty of Medicine and Health Sciences, University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium
| | - Jonathan A. Bernstein
- Division of Immunology/Allergy Section, Department of Internal Medicine, University of Cincinnati College of Medicine and Bernstein Allergy Group; Bernstein Clinical Research Center, Cincinnati, Ohio, USA
| | - Lori Connors
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amin Kanani
- Division of Allergy and Immunology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ludger Klimek
- Center for Rhinology and Allergy, Wiesbaden, Germany
| | - Shun Chi Ryan Lo
- Division of Allergy and Immunology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin R. Murphy
- Division of Allergy, Asthma and Pediatric Pulmonology, Department of Pediatrics, Boys Town National Research Hospital, Omaha, Nebraska, USA
| | - Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, Dallas, Texas, USA,Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jill. A. Poole
- Division of Allergy and Immunology, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jolanta Walusiak-Skorupa
- Department of Occupational Medicine and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Gordon Sussman
- Department of Medicine and Division of Clinical Immunology & Allergy, University of Toronto, Toronto, Ontario, Canada
| | | | - Richard E. Goodman
- Food Allergy Research and Resource Program, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Anne K. Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - William S. Silvers
- Division of Allergy Clinical Immunology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Didier G. Ebo
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium,Department of Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium,Department of Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium
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15
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Kicman A, Pędzińska-Betiuk A, Kozłowska H. The potential of cannabinoids and inhibitors of endocannabinoid degradation in respiratory diseases. Eur J Pharmacol 2021; 911:174560. [PMID: 34648805 DOI: 10.1016/j.ejphar.2021.174560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/01/2021] [Accepted: 10/06/2021] [Indexed: 12/21/2022]
Abstract
The global incidence of respiratory diseases and complications is increasing. Therefore, new methods of treatment, as well as prevention, need to be investigated. A group of compounds that should be considered for use in respiratory diseases is cannabinoids. There are three groups of cannabinoids - plant-derived phytocannabinoids, synthetic cannabinoids, and endogenous endocannabinoids including the enzymes responsible for their synthesis and degradation. All cannabinoids exert their biological effects through either type 1 cannabinoid receptors (CB1) and/or type 2 cannabinoid receptors (CB2). In numerous studies (in vitro and in vivo), cannabinoids and inhibitors of endocannabinoid degradation have shown beneficial anti-inflammatory, antioxidant, anti-cancer, and anti-fibrotic properties. Although in the respiratory system, most of the studies have focused on the positive properties of cannabinoids and inhibitors of endocannabinoid degradation. There are few research reports discussing the negative impact of these compounds. This review summarizes the properties and mechanisms of action of cannabinoids and inhibitors of endocannabinoid degradation in various models of respiratory diseases. A short description of the effects selected cannabinoids have on the human respiratory system and their possible use in the fight against COVID-19 is also presented. Additionally, a brief summary is provided of cannabinoid receptors properties and their expression in the respiratory system and cells of the immune system.
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Affiliation(s)
- Aleksandra Kicman
- Department of Experimental Physiology and Pathophysiology, Medical University of Białystok, 15-222, Białystok, Poland.
| | - Anna Pędzińska-Betiuk
- Department of Experimental Physiology and Pathophysiology, Medical University of Białystok, 15-222, Białystok, Poland.
| | - Hanna Kozłowska
- Department of Experimental Physiology and Pathophysiology, Medical University of Białystok, 15-222, Białystok, Poland.
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16
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Asero R, Pravettoni V, Scala E, Villalta D. Lipid transfer protein allergy: A review of current controversies. Clin Exp Allergy 2021; 52:222-230. [PMID: 34773669 DOI: 10.1111/cea.14049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 01/04/2023]
Abstract
Sensitization to lipid transfer protein (LTP), the most frequent cause of food allergy in southern Europe, still shows several controversial, but also intriguing, aspects. Some of these include the degree of cross-reactivity between LTPs from botanically distant sources, the definition of risk factors, the role of some cofactors, clinical outcomes, geographical differences and the identification of the primary sensitizer in different areas. This review article tries to analyse and comment on these aspects point by point suggesting some explanatory hypotheses with the final scope to stimulate critical thoughts and elicit the scientific discussion about this issue in the readership.
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Affiliation(s)
- Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Milan, Italy
| | - Valerio Pravettoni
- Department of General Medicine, Immunology and Allergy, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Scala
- Clinical and Laboratory Molecular Allergy Unit, IDI - IRCCS, Rome, Italy
| | - Danilo Villalta
- Immunologia e allergologia, Ospedale S. Maria degli Angeli, Pordenone, Italy
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Decuyper II, Rihs H, Mertens CH, Van Gasse AL, Elst J, Faber MA, Hagendorens MM, Sabato V, Ebo DG. In search of the golden ratio for cannabis allergy: Utility of specific allergen-to-total IgE ratios. Allergy 2021; 76:3522-3525. [PMID: 34324720 DOI: 10.1111/all.15028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/21/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Ine I. Decuyper
- Faculty of Medicine and Health Sciences Department of Immunology, Allergology Rheumatology and the Infla‐Med Centre of Excellence, and Immunology, Allergology, Rheumatology Antwerp University Hospital University of Antwerp Antwerp Belgium
- Faculty of Medicine and Health Sciences Department of Paediatrics and the Infla‐Med Centre of Excellence, and Paediatrics Antwerp University Hospital University of Antwerp Antwerp Belgium
| | - Hans‐Peter Rihs
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA) Institute of the Ruhr‐University Bochum Bochum Germany
| | - Christel H. Mertens
- Faculty of Medicine and Health Sciences Department of Immunology, Allergology Rheumatology and the Infla‐Med Centre of Excellence, and Immunology, Allergology, Rheumatology Antwerp University Hospital University of Antwerp Antwerp Belgium
| | - Athina Ludovica Van Gasse
- Faculty of Medicine and Health Sciences Department of Immunology, Allergology Rheumatology and the Infla‐Med Centre of Excellence, and Immunology, Allergology, Rheumatology Antwerp University Hospital University of Antwerp Antwerp Belgium
- Faculty of Medicine and Health Sciences Department of Paediatrics and the Infla‐Med Centre of Excellence, and Paediatrics Antwerp University Hospital University of Antwerp Antwerp Belgium
| | - Jessy Elst
- Faculty of Medicine and Health Sciences Department of Immunology, Allergology Rheumatology and the Infla‐Med Centre of Excellence, and Immunology, Allergology, Rheumatology Antwerp University Hospital University of Antwerp Antwerp Belgium
| | - Margaretha A. Faber
- Faculty of Medicine and Health Sciences Department of Immunology, Allergology Rheumatology and the Infla‐Med Centre of Excellence, and Immunology, Allergology, Rheumatology Antwerp University Hospital University of Antwerp Antwerp Belgium
| | - Margo M. Hagendorens
- Faculty of Medicine and Health Sciences Department of Immunology, Allergology Rheumatology and the Infla‐Med Centre of Excellence, and Immunology, Allergology, Rheumatology Antwerp University Hospital University of Antwerp Antwerp Belgium
- Faculty of Medicine and Health Sciences Department of Paediatrics and the Infla‐Med Centre of Excellence, and Paediatrics Antwerp University Hospital University of Antwerp Antwerp Belgium
| | - Vito Sabato
- Faculty of Medicine and Health Sciences Department of Immunology, Allergology Rheumatology and the Infla‐Med Centre of Excellence, and Immunology, Allergology, Rheumatology Antwerp University Hospital University of Antwerp Antwerp Belgium
- Department of Immunology and Allergology AZ Jan Palfijn Gent Ghent Belgium
| | - Didier G. Ebo
- Faculty of Medicine and Health Sciences Department of Immunology, Allergology Rheumatology and the Infla‐Med Centre of Excellence, and Immunology, Allergology, Rheumatology Antwerp University Hospital University of Antwerp Antwerp Belgium
- Department of Immunology and Allergology AZ Jan Palfijn Gent Ghent Belgium
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Skypala IJ, Bartra J, Ebo DG, Antje Faber M, Fernández‐Rivas M, Gomez F, Luengo O, Till SJ, Asero R, Barber D, Cecchi L, Diaz Perales A, Hoffmann‐Sommergruber K, Anna Pastorello E, Swoboda I, Konstantinopoulos AP, Ree R, Scala E. The diagnosis and management of allergic reactions in patients sensitized to non-specific lipid transfer proteins. Allergy 2021; 76:2433-2446. [PMID: 33655502 DOI: 10.1111/all.14797] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/29/2021] [Accepted: 02/24/2021] [Indexed: 12/12/2022]
Abstract
Sensitization to one or more non-specific lipid transfer proteins (nsLTPs), initially thought to exist mainly in southern Europe, is becoming accepted as a cause of allergic reactions to plant foods across Europe and beyond. The peach nsLTP allergen Pru p 3 is a dominant sensitizing allergen and peaches a common food trigger, although multiple foods can be involved. A frequent feature of reactions is the requirement for a cofactor (exercise, alcohol, non-steroidal anti-inflammatory drugs, Cannabis sativa) to be present for a food to elicit a reaction. The variability in the food and cofactor triggers makes it essential to include an allergy-focused diet and clinical history in the diagnostic workup. Testing on suspected food triggers should also establish whether sensitization to nsLTP is present, using purified or recombinant nsLTP allergens such as Pru p 3. The avoidance of known trigger foods and advice on cofactors is currently the main management for this condition. Studies on immunotherapy are promising, but it is unknown whether such treatments will be useful in populations where Pru p 3 is not the primary sensitizing allergen. Future research should focus on the mechanisms of cofactors, improving diagnostic accuracy and establishing the efficacy of immunotherapy.
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Affiliation(s)
- Isabel J. Skypala
- Royal Brompton & Harefield NHS Foundation Trust London UK
- Department of Allergy and Clinical Immunology Imperial College London UK
| | - Joan Bartra
- Hospital Clinic Barcelona Spain
- IDIBAPS Universitat de Barcelona ARADyAL, Barcelona Spain
| | - Didier G. Ebo
- Department of Immunology, Allergology, Rheumatology Faculty of Medicine and Health Sciences Infla‐Med Centre of Excellence Antwerp University Hospital University of Antwerp Antwerp Belgium
- Jan Palfijn Ziekenhuis Ghent Ghent Belgium
| | - Margaretha Antje Faber
- Faculty of Medicine and Health Sciences Department of Immunology, Allergology, Rheumatology Infla‐Med Centre of Excellence Antwerp University Hospital University of Antwerp Antwerp Belgium
| | - Montserrat Fernández‐Rivas
- Department of Allergy Hospital Clínico San Carlos Universidad Complutense de Madrid IdISSC ARADyAL Madrid Spain
| | - Francisca Gomez
- Allergy Unit IBIMA—Hospital Regional Universitario de Malaga Malaga Spain
- Spanish Network for Allergy ‐ RETICS de Asma Reaccionesadversas y Alérgicas (ARADyAL Madrid Spain
| | - Olga Luengo
- Allergy Unit Internal Medicine Department Vall d'Hebron University Hospital Universitat Autònoma de Barcelona ARADyAL Barcelona Spain
| | - Stephen J. Till
- Peter Gorer Department of Immunobiology King’s College London London UK
- Department of Allergy Guy’s & St Thomas’ NHS Foundation Trust London UK
| | - Riccardo Asero
- Ambulatorio di Allergologia Clinica San Carlo Paderno Dugnano Italy
| | - Domingo Barber
- IMMA School of Medicine Universidad San Pablo CEU, Universities Madrid Spain
- RETIC ARADYAL RD16/0006/0015 Instituto de Salud Carlos III Madrid Spain
| | - Lorenzo Cecchi
- SOS Allergy and Clinical Immunology USL Toscana Centro Prato Italy
| | - Araceli Diaz Perales
- Centro de Biotecnología y Genómica de Plantas Universidad Politecnica Madrid Spain
| | | | - Elide Anna Pastorello
- Unit of Allergology and Immunology ASST Grande Ospedale Metropolitano Niguarda University of Milan Milan Italy
| | - Ines Swoboda
- Biotechnology Section Campus Vienna Biocenter FH Campus Wien, University of Applied Sciences Vienna Austria
| | | | - Ronald Ree
- Department of Experimental Immunology Amsterdam University Medical Centers, location AMC Amsterdam The Netherlands
- Department of Otorhinolaryngology Amsterdam University Medical Centers, location AMC Amsterdam The Netherlands
| | - Enrico Scala
- Experimental Allergy Unit Istituto Dermopatico dell’Immacolata – IRCCS FLMM Rome Italy
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Defining pediatric asthma: phenotypes to endotypes and beyond. Pediatr Res 2021; 90:45-51. [PMID: 33173175 PMCID: PMC8107196 DOI: 10.1038/s41390-020-01231-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/26/2020] [Accepted: 10/03/2020] [Indexed: 01/19/2023]
Abstract
Asthma is the most common chronic pediatric lung disease that has traditionally been defined as a syndrome of airway inflammation characterized by clinical symptoms of cough and wheeze. Highlighting the complex and heterogeneous nature of asthma, this review summarizes recent advances in asthma classification that are based on pathobiology, and thereby directly addresses limitations of existent definitions of asthma. By reviewing and contrasting clinical and mechanistic features of adult and childhood asthma, the review summarizes key biomarkers that distinguish childhood asthma subtypes. While atopy and its severity are important features of childhood asthma, there is evidence to support the existence of a childhood asthma endotype distinct from the atopic endotype. Although biomarkers of non-atopic asthma are an area of future research, we summarize a clinical approach that includes existing measures of airway-specific and systemic measures of atopy, co-existing morbidities, and disease severity and control, in the definition of childhood asthma, to empower health care providers to better characterize asthma disease burden in children. Identification of biomarkers of non-atopic asthma and the contribution of genetics and epigenetics to pediatric asthma burden remains a research need, which can potentially allow delivery of precision medicine to pediatric asthma. IMPACT: This review highlights asthma as a complex and heterogeneous disease and discusses recent advances in the understanding of the pathobiology of asthma to demonstrate the need for a more nuanced definitions of asthma. We review current knowledge of asthma phenotypes and endotypes and put forth an approach to endotyping asthma that may be useful for defining asthma for clinical care as well as for future research studies in the realm of personalized medicine for asthma.
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Adverse Reactions to Illicit Drugs (Marijuana, Opioids, Cocaine) and Alcohol. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3006-3014. [PMID: 33965592 DOI: 10.1016/j.jaip.2021.04.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/19/2021] [Accepted: 04/25/2021] [Indexed: 12/28/2022]
Abstract
Drug allergy has been a research topic within the allergy field for decades. However, many drug reactions presumed to be of allergic nature are not and originate from different mechanisms. Drug-induced reactions can affect numerous organ systems, present with various symptoms, and have more than 1 mechanism of action. In this rostrum article, we want to give an overview of the different allergic and nonallergic reactions that can be expected with the (illicit) use of cannabis, cocaine, opioids, and alcohol. In addition, this article focuses on the different methods available to diagnose allergy related to these 4 drug types and highlight the pitfalls of nonallergic reactions or allergy "mimickers" complicating the diagnosis of true drug allergy. Finally, the impact on current medical practices and future research in support of the allergist in diagnosis and treatment of these medical problems is addressed.
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Ebo DG, Decuyper II, Rihs HP, Mertens C, Van Gasse AL, van der Poorten MLM, De Puysseleyr L, Faber MA, Hagendorens MM, Bridts CH, Sabato V, Elst J. IgE-binding and mast cell–activating capacity of the homologue of the major birch pollen allergen and profilin from Cannabis sativa. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2509-2512.e3. [DOI: 10.1016/j.jaip.2021.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 01/01/2023]
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Skypala IJ, Asero R, Barber D, Cecchi L, Diaz Perales A, Hoffmann-Sommergruber K, Pastorello EA, Swoboda I, Bartra J, Ebo DG, Faber MA, Fernández-Rivas M, Gomez F, Konstantinopoulos AP, Luengo O, van Ree R, Scala E, Till SJ. Non-specific lipid-transfer proteins: Allergen structure and function, cross-reactivity, sensitization, and epidemiology. Clin Transl Allergy 2021; 11:e12010. [PMID: 34025983 PMCID: PMC8129635 DOI: 10.1002/clt2.12010] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/08/2021] [Indexed: 12/27/2022] Open
Abstract
Background Discovered and described 40 years ago, non‐specific lipid transfer proteins (nsLTP) are present in many plant species and play an important role protecting plants from stressors such as heat or drought. In the last 20 years, sensitization to nsLTP and consequent reactions to plant foods has become an increasing concern. Aim The aim of this paper is to review the evidence for the structure and function of nsLTP allergens, and cross‐reactivity, sensitization, and epidemiology of nsLTP allergy. Materials and Methods A Task Force, supported by the European Academy of Allergy & Clinical Immunology (EAACI), reviewed current evidence and provide a signpost for future research. The search terms for this paper were “Non‐specific Lipid Transfer Proteins”, “LTP syndrome”, “Pru p 3”, “plant food allergy”, “pollen‐food syndrome”. Results Most nsLTP allergens have a highly conserved structure stabilised by 4‐disulphide bridges. Studies on the peach nsLTP, Pru p 3, demonstrate that nsLTPs are very cross‐reactive, with the four major IgE epitopes of Pru p 3 being shared by nsLTP from other botanically related fruits. These nsLTP allergens are to varying degrees resistant to heat and digestion, and sensitization may occur through the oral, inhaled or cutaneous routes. In some populations, Pru p 3 is the primary and sole sensitizing allergen, but many are poly‐sensitised both to botanically un‐related nsLTP in foods, and non‐food sources of nsLTP such as Cannabis sativa, Platanus acerifolia, (plane tree), Ambrosia artemisiifolia (ragweed) and Artemisia vulgaris (mugwort). Initially, nsLTP sensitization appeared to be limited to Mediterranean countries, however more recent studies suggest clinically relevant sensitization occurs in North Atlantic regions and also countries in Northern Europe, with nsLTP sensitisation profiles being broadly similar. Discussion These robust allergens have the potential to sensitize and provoke symptoms to a large number of plant foods, including those which are raw, cooked or processed. It is unknown why some sensitized individuals develop clinical symptoms to foods whereas others do not, or indeed what other allergens besides Pru p 3 may be primary sensitising allergens. It is clear that these allergens are also relevant in non‐Mediterranean populations and there needs to be more recognition of this. Conclusion Non‐specific LTP allergens, present in a wide variety of plant foods and pollens, are structurally robust and so may be present in both raw and cooked foods. More studies are needed to understand routes of sensitization and the world‐wide prevalence of clinical symptoms associated with sensitization to these complex allergens.
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Affiliation(s)
- Isabel J Skypala
- Department of Allergy & Clinical Immunology Royal Brompton & Harefield NHS Foundation Trust Imperial College London UK
| | - Ricardo Asero
- Ambulatorio di Allergologia Clinica San Carlo Milan Italy
| | - Domingo Barber
- IMMA School of Medicine Universidad San Pablo CEU CEU Universities Madrid Spain.,RETIC ARADYAL RD16/0006/0015 Instituto de Salud Carlos III Madrid Spain
| | - Lorenzo Cecchi
- SOS Allergy and Clinical Immunology USL Toscana Centro Prato Italy
| | - Arazeli Diaz Perales
- Departamento de Biotecnología-Biología Vegetal Centro de Biotecnología y Genómica de Plantas (CBGP, UPM-INIA) Universidad Politécnica de Madrid Madrid Spain
| | | | - Elide A Pastorello
- Unit of Allergology and Immunology ASST Grande Ospedale Metropolitano Niguarda University of Milan Milan Italy
| | - Ines Swoboda
- Biotechnology Section FH Campus Wien University of Applied Sciences Vienna Austria
| | - Joan Bartra
- Hospital Clinic de Barcelona IDIBAPS Universitat de Barcelona ARADyAL Barcelona Spain
| | - Didier G Ebo
- Department of Immunology, Allergology, Rheumatology and Infla-Med Centre of Excellence Faculty of Medicine and Health Sciences University of Antwerp and Antwerp University Hospital Ghent Belgium
| | - Margaretha A Faber
- Department of Immunology, Allergology, Rheumatology and Infla-Med Centre of Excellence Faculty of Medicine and Health Sciences University of Antwerp and Antwerp University Hospital Ghent Belgium
| | - Montserrat Fernández-Rivas
- Department of Allergy Hospital Clínico San Carlos Universidad Complutense de Madrid IdISSC, ARADyAL Madrid Spain
| | - Francesca Gomez
- Allergy Unit IBIMA- Hospital Regional Universitario de Malaga Malaga and Spanish Network for Allergy - RETICS de Asma, Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
| | | | - Olga Luengo
- Allergy Unit, Internal Medicine Department Vall d'Hebron University Hospital Universitat Autònoma de Barcelona ARADyAL Barcelona Spain
| | - Ronald van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology Amsterdam University Medical Centers location AMC Amsterdam The Netherlands
| | - Enrico Scala
- Experimental Allergy Unit Istituto Dermopatico Dell'immacolata IRCCS FLMM Rome Italy
| | - Stephen J Till
- Peter Gorer Department of Immunobiology King's College London London UK.,Department of Allergy Guy's & St Thomas' NHS Foundation Trust London UK
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Stepaniuk P, Kanani A. Selective cannabis strain allergy in a patient presenting with a local allergic reaction. Allergy Asthma Clin Immunol 2021; 17:49. [PMID: 34001257 PMCID: PMC8130344 DOI: 10.1186/s13223-021-00552-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/03/2021] [Indexed: 12/03/2022] Open
Abstract
Background Cannabis use is growing domestically due to recent legalization in many jurisdictions. There are two main species of cannabis, Cannabis sativa and Cannabis indica, and thousands of different commercially available cannabis strains. Although there are multiple reports of cannabis allergy in the literature, to our knowledge, there is no prior published report of selective cannabis strain allergy. Case presentation A 31-year-old male was referred for allergy assessment due to several episodes of localized pruritus and erythema after direct contact with various strains of cannabis. He had noted that the severity of his reaction appeared to be strain dependent. He developed a severe local reaction involving bilateral periorbital edema shortly after coming into direct contact with one particular strain of cannabis. He denied any adverse symptoms after inhalation of cannabis. Fresh skin prick testing was performed to various strains of cannabis and had positive testing to the three of the five tested strains. Conclusions We believe this is the first reported case of selective cannabis strain allergy based on patient history and skin prick testing. This case report outlines the variability in different strains of cannabis and stresses the importance of further research into cannabis allergen identification. Multiple cannabis allergens should be included and incorporated into commercial extracts when they become routinely available.
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Affiliation(s)
- Peter Stepaniuk
- Division of Allergy and Immunology, Department of Medicine, University of British Columbia, 905-750 Broadway W, Vancouver, BC, V5Z 1H8, Canada.
| | - Amin Kanani
- Division of Allergy and Immunology, Department of Medicine, University of British Columbia, 905-750 Broadway W, Vancouver, BC, V5Z 1H8, Canada
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Decuyper II, Green BJ, Sussman GL, Ebo DG, Silvers WS, Pacheco K, King BS, Cohn JR, Zeiger RS, Zeiger JS, Naimi DR, Beezhold DH, Nayak AP. Occupational Allergies to Cannabis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:3331-3338. [PMID: 33161961 DOI: 10.1016/j.jaip.2020.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
Within the last decade there has been a significant expansion in access to cannabis for medicinal and adult nonmedical use in the United States and abroad. This has resulted in a rapidly growing and diverse workforce that is involved with the growth, cultivation, handling, and dispensing of the cannabis plant and its products. The objective of this review was to educate physicians on the complexities associated with the health effects of cannabis exposure, the nature of these exposures, and the future practical challenges of managing these in the context of allergic disease. We will detail the biological hazards related to typical modern cannabis industry operations that may potentially drive allergic sensitization in workers. We will highlight the limitations that have hindered the development of objective diagnostic measures that are essential in separating "true" cannabis allergies from nonspecific reactions/irritations that "mimic" allergy-like symptoms. Finally, we will discuss recent advances in the basic and translational scientific research that will aid the development of diagnostic tools and therapeutic standards to serve optimal management of cannabis allergies across the occupational spectrum.
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Affiliation(s)
- Ine I Decuyper
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium; Infla-Med Centre of Excellence University of Antwerp, Antwerp, Belgium
| | - Brett J Green
- Office of the Director, Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, Wv
| | - Gordon L Sussman
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Didier G Ebo
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium; Infla-Med Centre of Excellence University of Antwerp, Antwerp, Belgium
| | | | - Karin Pacheco
- Division of Environmental and Occupational Health Sciences, Department of Medicine, National Jewish Health, Denver, Colo
| | - Bradley S King
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, Denver, Colo
| | - John R Cohn
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Philadelphia, Pa; Jane & Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pa
| | | | | | | | - Donald H Beezhold
- Office of the Director, Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, Wv
| | - Ajay P Nayak
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Philadelphia, Pa; Jane & Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pa; Center for Translational Medicine, Thomas Jefferson University, Philadelphia, Pa.
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Ebo DG, Bridts CH, Mertens CH, Sabato V. Principles, potential, and limitations of ex vivo basophil activation by flow cytometry in allergology: A narrative review. J Allergy Clin Immunol 2021; 147:1143-1153. [DOI: 10.1016/j.jaci.2020.10.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022]
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Scheurer S, van Ree R, Vieths S. The Role of Lipid Transfer Proteins as Food and Pollen Allergens Outside the Mediterranean Area. Curr Allergy Asthma Rep 2021; 21:7. [PMID: 33537877 PMCID: PMC7858557 DOI: 10.1007/s11882-020-00982-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW To provide an overview of the prevalence and clinical manifestation of non-specific lipid transfer proteins (LTP)-mediated allergies outside the Mediterranean area and to address potential reasons for the different geographical significance of LTP-driven allergies. RECENT FINDINGS LTPs are major allergens in the Mediterranean area, which frequently can elicit severe reactions. Pru p 3 the LTP from peach is reported as genuine allergen and is considered a prototypic marker for LTP-mediated allergies. However, both food and pollen LTP allergies exist outside the Mediterranean area, but with lower clinical significance, different immunogenicity, and less clarified role. Evidence has been reported that in areas with high exposure to pollen, in particular to mugwort, pollen-derived LTPs can act as a primary sensitizer to trigger secondary food allergies. Co-sensitization to unrelated allergens might be causative for less severe reactions in response to LTPs. However, the reason for the geographical different sensitization patterns to LTPs remains unclear.
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Affiliation(s)
- Stephan Scheurer
- Molecular Allergology, Paul-Ehrlich-Institut, Paul-Ehrlich Str. 51-59, 63225, Langen, Germany.
| | - Ronald van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Stefan Vieths
- Molecular Allergology, Paul-Ehrlich-Institut, Paul-Ehrlich Str. 51-59, 63225, Langen, Germany
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Üzülmez Ö, Kalic T, Breiteneder H. Advances and novel developments in molecular allergology. Allergy 2020; 75:3027-3038. [PMID: 32882057 PMCID: PMC7756543 DOI: 10.1111/all.14579] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 12/21/2022]
Abstract
The continuous search for new allergens and the design of allergen derivatives improves the understanding of their allergenicity and aids the design of novel diagnostic and immunotherapy approaches. This article discusses the recent developments in allergen and epitope discovery, allergy diagnostics and immunotherapy. Structural information is crucial for the elucidation of cross-reactivity of marker allergens such as the walnut Jug r 6 or that of nonhomologous allergens, as shown for the peanut allergens Ara h 1 and 2. High-throughput sequencing, liposomal nanoallergen display, bead-based assays, and protein chimeras have been used in epitope discovery. The binding of natural ligands by the birch pollen allergen Bet v 1 or the mold allergen Alt a 1 increased the stability of these allergens, which is directly linked to their allergenicity. We also report recent findings on the use of component-resolved approaches, basophil activation test, and novel technologies for improvement of diagnostics. New strategies in allergen-specific immunotherapy have also emerged, such as the use of virus-like particles, biologics or novel adjuvants. The identification of dectin-1 as a key player in allergy to tropomyosins and the formyl peptide receptor 3 in allergy to lipocalins are outstanding examples of research into the mechanism of allergic sensitization.
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Affiliation(s)
- Öykü Üzülmez
- Institute of Pathophysiology and Allergy Research Medical University of Vienna Vienna Austria
| | - Tanja Kalic
- Institute of Pathophysiology and Allergy Research Medical University of Vienna Vienna Austria
| | - Heimo Breiteneder
- Institute of Pathophysiology and Allergy Research Medical University of Vienna Vienna Austria
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Jackson B, Cleto E, Jeimy S. An emerging allergen: Cannabis sativa allergy in a climate of recent legalization. Allergy Asthma Clin Immunol 2020; 16:53. [PMID: 32834822 PMCID: PMC7371810 DOI: 10.1186/s13223-020-00447-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/04/2020] [Indexed: 11/13/2022] Open
Abstract
Considering its recent legalization in Canada, the health implications of Cannabis sativa exposure, including allergy, are coming to the forefront of medical study and interest. C. sativa allergy is an issue that affects recreational users of the substance, processors, agricultural workers, and contacts of Cannabis aeroallergens and secondhand product. Allergies to C. sativa are heterogenous and span the spectrum of hypersensitivity, from dermatitis to rhinoconjunctivitis to life-threatening anaphylaxis. Due to its recent legalization, sensitized individuals will have increasing exposure from direct contact to agricultural pollens. Diagnosis and treatment of Cannabis allergy are developing fields that are already showing promise in the identification of culprit antigens and the potential for immunotherapy; however, much responsibility still falls on clinical diagnosis and symptom management. Hopefully, given the current explosion of interest in and use of Cannabis, C. sativa allergy will continue to garner awareness and therapeutic strategies.
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Affiliation(s)
- Bradley Jackson
- Department of Paediatrics, Children's Hospital, London Health Sciences Centre, London, ON Canada
| | - Erica Cleto
- Schulich School of Medicine and Dentistry, Western University, London, ON Canada
| | - Samira Jeimy
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON Canada.,B3-112, St. Joseph's Healthcare London, 268 Grosvenor Street, London, ON N6A 4V2 Canada
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Ebo DG, Bridts CH, Rihs HP. Hevea latex-associated allergies: piecing together the puzzle of the latex IgE reactivity profile. Expert Rev Mol Diagn 2020; 20:367-373. [PMID: 32056456 DOI: 10.1080/14737159.2020.1730817] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: IgE-mediated Hevea latex allergy and associated food-allergies constitute a significant health issue with serious consequences of diagnostic error. Hence, there is a need for more reliable confirmatory diagnostics.Areas covered: Here, we summarize the major limitations of conventional tests using native extracts and describe how piecing together the IgE reactivity profile can benefit correct diagnosis in difficult cases in whom conventional tests yield equivocal or negative results. A diagnostic algorithm integrating traditional sIgE and component-resolved diagnosis (CRD) is presented.Expert opinion: Moreover, it is clear that the discoveries in the field of the Hevea latex proteome will contribute to our understandings and accurate approach of sometimes complex cross-reactivity phenomena that extend beyond the 'latex-fruit syndrome.'
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Affiliation(s)
- Didier G Ebo
- University of Antwerp - University Hospital of Antwerp, Immunology-Allergology-Rheumatology, Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.,Department of Immunology and Allergology, Jan Palfijn Ziekenhuis Gent, Ghent, Belgium
| | - Chris H Bridts
- University of Antwerp - University Hospital of Antwerp, Immunology-Allergology-Rheumatology, Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Hans-Peter Rihs
- Ruhr-University Bochum, IPA - Institute for Prevention and Occupational Medicine, Bochum, Germany
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