Potential food allergens in wine: Double-blind, placebo-controlled trial and basophil activation analysis

Adverse Reactions to Illicit Drugs (Marijuana, Opioids, Cocaine) and Alcohol

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.

Application of soy protein isolate in the fining of red wine

Soy protein isolate was evaluated as a potential fining agent as an alternative to the predominant protein commercial fining agents (ovalbumin, porcine gelatin, and pea protein isolate). Two red wines (cv. ‘Merlot’ and cv. ‘Lambrusco Maestri’) were finned, bottled, and analyzed for phenolic content, color, turbidity, and sensory profile. Independent of the protein used, fining promoted a reduction in a majority of the phenolic compound, a slight (but significant) reduction of chromatic properties, and a decrease in the turbidity of the wines. A decrease in astringency, persistence, bitterness, and wine body, as well as an increase in brightness, clarity, and acidity, was also observed in all treatments. The application of soy protein isolates yielded similar results to those obtained with other commercial fining agents, both in the physicochemical and the sensory measures, which favors its usage as an alternative to the traditional fining agents of animal-protein origin.

Allergic and intolerance reactions to wine

Hypersensitivity reactions to alcoholic beverages (particularly red wine) are relatively frequent, affecting 10% of the general population. Hypersensitivity reactions due to alcoholic drinks, mainly in the form of airway reactions (rhinitis and asthma), occur significantly more frequently in persons with pre-existing rhinitis and asthma. In terms of pathogenesis, it has to be differentiated between immunologic, mainly IgE-mediated, hypersensitivity reactions (wine allergies), and intolerance reactions in which no causative allergen-specific immune mechanisms can be detected. Allergens responsible for wine allergy could be: grape (Vitis vinifera) proteins (particularly the major allergen lipid transfer protein Vit v1), proteins and ingredients used for the fining of wines such as fish gelatin or isinglass (swim bladder of the fish huso, family of sturgeons), ovalbumin, dairy (casein) products, gum arabic, enzymes (lysozyme, pectinase, glucanase, cellulase, glucosidase, urease, aromatic enzymes), molds (particularly Botrytis cinerea) responsible for the noble rot in wines, yeasts and proteins from insects that contaminated the mash. Type 1 allergic reactions (positive prick tests) have been described for inorganic components like ethanol, acetaldehyde, acetic acid and sulfites, but no specific IgE could be detected in the serum. Ethanol, acetaldehyde and acetic acid, flavonoids (anthocyanins and chatechines), sulfites, histamine and other biogenic amines are the main causative agents of intolerance reactions (pseudoallergic reactions) to wine. After a short historic review of viticulture and the importance of wine in classical antiquity, we go into the chemical processes of alcoholic fermentation and the genetically inherited “flush syndrome” caused by an acetaldehyde dehydrogenase 2 polymorphism, subsequently we focus on the different etiologic factors of allergies and intolerance reactions to wine. The most frequent intolerance reactions to sulfites occur particularly after the ingestion of white wine and in asthma patients. Intolerance reactions to histamine and other biogenic amines occur mainly after ingestion of red wine and in persons with diamine oxidase (DAO) deficiency.

Guidelines for the use and interpretation of diagnostic methods in adult food allergy

Food allergy has an increasing prevalence in the general population and in Italy concerns 8 % of people with allergies. The spectrum of its clinical manifestations ranges from mild symptoms up to potentially fatal anaphylactic shock. A number of patients can be diagnosed easily by the use of first- and second-level procedures (history, skin tests and allergen specific IgE). Patients with complex presentation, such as multiple sensitizations and pollen-food syndromes, frequently require a third-level approach including molecular diagnostics, which enables the design of a component-resolved sensitization profile for each patient. The use of such techniques involves specialists' and experts' skills on the issue to appropriately meet the diagnostic and therapeutic needs of patients. Particularly, educational programs for allergists on the use and interpretation of molecular diagnostics are needed.

Allergenic proteins in enology: a review on technological applications and safety aspects

Proteinaceous products are widely used as fining agents during winemaking to remove unwanted insoluble particles and undissolved microscopic particles (colloidal material) from the must or wine to improve stability. Some of them (egg white, caseinates, and fish gelatine) have allergenic potential and the presence of their residues in the final product could represent a risk for allergic individuals. Moreover, lysozyme (an egg allergen) is included among wine additives to control the fermentation processes and avoid spoiling during winemaking. The aim of this paper is to review the experimental/clinical data on the use of allergenic products in enology and the measurement of relative risk for sensitized subjects. In addition, methods developed specifically for the quantification of allergenic residues in must and wine are described.

Assessment of sensitization to grape and wine allergens as possible causes of adverse reactions to wine: a pilot study

BACKGROUND

In a recently performed survey with 4000 randomly selected persons, 68 (7.2 %) of 948 respondents reported intolerance and/or allergy-like symptoms to wine. The aim of this study was to analyze whether a real sensitization to wine proteins could be confirmed by diagnostic and/or immunological settings.

FINDINGS

For this purpose, 19 subjects with self-reported intolerance to wine of the invited subjects and 10 controls without a history of intolerance participated in an allergological examination (skin prick test, ImmunoCAP for determination of specific IgE antibodies, CAST for testing basophil activation, ImmunoBlot for testing specificity of IgE-antibodies). For the allergological work-up red and white grapes, selected wines, and the purified lipid transfer protein (LTP), a known grape allergen, were used. 7 subjects showed evidence of IgE sensitization to wine or grape extracts, including one control. One participant with symptoms of intolerance showed a positive skin prick test to red grape, a positive ImmunoCAP to grape, a positive cellular antigen stimulation test (CAST) and inhibition of Western blot by removal of cross-reactive carbohydrate determinants (CCD).

CONCLUSION

The presented study focused on the grape protein-related IgE-mediated cause of intolerance to wine (true allergy) and not on other wine components or fining agents (other forms of intolerance). A sensitization to grape and wine proteins was observed in our cohort. In one case, this reactivity could be explained by cross-reactivity to CCD. The results of this pilot study need to be validated in greater cohorts.

Fish allergy: in review

Globally, the rising consumption of fish and its derivatives, due to its nutritional value and divergence of international cuisines, has led to an increase in reports of adverse reactions to fish. Reactions to fish are not only mediated by the immune system causing allergies, but are often caused by various toxins and parasites including ciguatera and Anisakis. Allergic reactions to fish can be serious and life threatening and children usually do not outgrow this type of food allergy. The route of exposure is not only restricted to ingestion but include manual handling and inhalation of cooking vapors in the domestic and occupational environment. Prevalence rates of self-reported fish allergy range from 0.2 to 2.29 % in the general population, but can reach up to 8 % among fish processing workers. Fish allergy seems to vary with geographical eating habits, type of fish processing, and fish species exposure. The major fish allergen characterized is parvalbumin in addition to several less well-known allergens. This contemporary review discusses interesting and new findings in the area of fish allergy including demographics, novel allergens identified, immunological mechanisms of sensitization, and innovative approaches in diagnosing and managing this life-long disease.

Development of a sensitive ELISA for the detection of casein-containing fining agents in red and white wines

Fining of wine with proteinogenic fining agents such as casein from cow's milk is a traditional and commonly used technique all over the world. Casein and other proteins from cow's milk are well-known food allergens, which pose a risk for allergic consumers. Temporary regulations exempting the labeling of milk and products thereof in wine expired. Since July 1, 2012, these fining agents have to be declared on the wine label under Regulation (EU) No. 579/2012 in conjunction to article 120g of Regulation (EU) No. 1234/2007 if exceeding the threshold of 0.25 mg/L allergenic protein. The aim of the presented study was to develop sensitive ELISA methods for the detection of casein in white and red wines and to investigate the risk of allergenic residues in fined wines. In this context it was shown that the used substance for calibration is highly relevant. Casein wine fining agents of different commercial producers were investigated by LDS-PAGE and immunoblot. In addition to casein, they contain other milk proteins, which are potentially allergic and therefore have to be incorporated in the development of antibodies for an ELISA method to be set up. An indirect ELISA for the investigation of white wine was developed. The LOD is 0.1 mg/L. For red wine the LOD is 0.2 mg/L in an indirect sandwich ELISA setup. The LOD of the indirect sandwich ELISA for white wine depends on the calibration standard. It is 0.1 mg/L for the fining agent casein and 0.01 mg/L for casein from a chemical trader. It is also shown that the use of different technological procedures during winemaking leads to no detectable amounts of casein in various wine samples.

Wine, Food and Health

Wine has historically been associated with religious rights, used as a salubrious beverage, employed as a medication as well as a medicinal solvent, and consumed as a food accompaniment. It is the latter that is most intimately associated in the minds of most modern consumers. Despite this, there is little flavor commonality on which pairing could be based. The first section of the chapter examines this feature, and wine’s primary role as a palate cleanser and food condiment. The synergistic role of food and wine in suppressing each other’s least pleasant attributes is also explained. The final section deals with the latest evidence relating to the many beneficial health effects of moderate wine consumption, shortfalls in the data, headache induction, dental erosion, and conditions under which wine intake is contraindicated.

Risk of allergic reactions to wine, in milk, egg and fish-allergic patients

Background

European legislators and wine producers still debate on the requirement for labeling of wines fined with potentially allergenic food proteins (casein, egg white or fish-derived isinglass). We investigated whether wines fined with known concentrations of these proteins have the potential to provoke clinical allergic reactions in relevant patients.

Methods

In-house wines were produced for the study, fined with different concentrations of casein (n = 7), egg albumin (n = 1) and isinglass (n = 3). ELISA and PCR kits specific for the respective proteins were used to identify the fining agents. Skin prick tests and basophil activation tests were performed in patients with confirmed IgE-mediated relevant food allergies (n = 24). A wine consumption questionnaire and detailed history on possible reactions to wine was obtained in a multinational cohort of milk, egg or fish allergic patients (n = 53) and patients allergic to irrelevant foods as controls (n = 13).

Results

Fining agents were not detectable in wines with the available laboratory methods. Nevertheless, positive skin prick test reactions and basophil activation to the relevant wines were observed in the majority of patients with allergy to milk, egg or fish, correlating with the concentration of the fining agent. Among patients consuming wine, reported reactions were few and mild and similar with the ones reported from the control group.

Conclusion

Casein, isinglass or egg, remaining in traces in wine after fining, present a very low risk for the respective food allergic consumers. Physician and patient awareness campaigns may be more suitable than generalized labeling to address this issue, as the latter may have negative impact on both non-allergic and allergic consumers.

Effects of food processing on food allergens

Food allergies are on the rise in Western countries. With the food allergen labeling requirements in the US and EU, there is an interest in learning how food processing affects food allergens. Numerous foods are processed in different ways at home, in institutional settings, and in industry. Depending on the processing method and the food, partial or complete removal of the offending allergen may be possible as illustrated by reduction of peanut allergen in vitro IgE immunoreactivity upon soaking and blanching treatments. When the allergen is discretely located in a food, one may physically separate and remove it from the food. For example, lye peeling has been reported to produce hypoallergenic peach nectar. Protein denaturation and/or hydrolysis during food processing can be used to produce hypoallergenic products. This paper provides a short overview of basic principles of food processing followed by examples of their effects on food allergen stability. Reviewed literature suggests assessment of processing effects on clinically relevant reactivity of food allergens is warranted.

New insights into seafood allergy

PURPOSE OF REVIEW

Seafood plays an important role in human nutrition worldwide, sustained by international trade of a variety of new seafood products. Increased production and consumption have resulted in more frequent reports of adverse reactions, highlighting the need for more specific diagnosis and treatment of seafood allergy. This review discusses recent literature in this field.

RECENT FINDINGS

The most recent prevalence data from Asia highlight seafood as a significant sensitizer in up to 40% of children and 33% of adults. Furthermore, the demonstration of species-specific sensitization to salt-water and fresh-water prawns and processed prawn extract should improve diagnosis. Studies on humans demonstrated for the first time that biologically active fish allergens can be detected in serum samples as early as 10 min after ingestion. These studies highlight that minute amounts of ingested seafood allergens can quickly trigger allergic symptoms; also, inhaled airborne allergens seem to induce sensitization and reactions. In the past 2 years, over 10 additional seafood allergens have been characterized. Allergen-specific detection assays in food products are available for crustacean tropomyosin; however, many specific mollusk and some fish allergens are not readily identified.

SUMMARY

Although cross-reactivity between crustacean and mollusks as well as mites is demonstrated, the often poor correlation of IgE reactivity and clinical symptoms calls for more detailed investigations. The recent development of hypoallergenic parvalbumin from carp could form the basis for safer vaccination products for treatment of fish allergy. Molecular characterization of more universal marker allergens for the three major seafood groups will improve current component-resolved clinical diagnosis and have a significant impact on the management of allergic patients, on food labeling and on future immunotherapy for seafood allergy.

Development of animal models and sandwich-ELISA tests to detect the allergenicity and antigenicity of fining agent residues in wines

Food allergy can cause food-related anaphylaxis. Food allergen labeling is the principal means of protecting sensitized individuals. This motivated European Directive 2003/89 on the labeling of ingredients or additives that could trigger adverse reactions, which has been in effect since 2005. During this study, we developed animal models with allergy to ovalbumin, caseinate, and isinglass in order to be able to detect fining agent residues that could induce anaphylactic reactions in sensitized mice. The second aim of the study was to design sandwich ELISA tests specific to each fining agent in order to detect their residue antigenicity, both during wine processing and in commercially available bottled wines. Sensitized mice and sandwich ELISA methods were established to test a vast panel of wines. The results showed that although they were positive to our highly sensitive sandwich-ELISA tests, some commercially available wines are not allergenic in sensitized mice. Commercially available bottled wines made using standardized processes, fining, maturation, and filtration, do not therefore represent any risk of anaphylactic reactions in sensitized mice.

Adverse reactions to wine: think outside the bottle

PURPOSE OF REVIEW

Wine contains chemical and biological contaminants. Symptoms such as facial flushing, asthma and oral allergic swelling and burning (oral syndrome) have been attributed to these contaminants and food additives. Their clinical implications should be known.

RECENT FINDINGS

Recent studies have reported a high prevalence of hypersensitivity symptoms after intake of alcoholic drinks in the general population. Red wine was the most common beverage implicated. Wine contains many contaminants. Some of them come from Hymenoptera insects that fall into the wine when grapes are collected and pressed. We have found patients with allergic symptoms related to wine consumption who are sensitized to Hymenoptera venom without previous stings. The aim of this study is to assess the potential importance of their sensitization to Hymenoptera antigens as the cause of their symptoms and also to comment on other recent studies on wine hypersensitivity.

SUMMARY

We found patients with allergic symptoms related to wine consumption who are sensitized to Hymenoptera venoms. Challenges were negative with sulfites, other additives and aging wines, but positive with young wines. Sera from all the patients detected Hymenoptera venom antigens. We report the first cases of sensitization to venom antigens by the oral route.

Specific and sensitive enzyme-linked immunosorbent assays for analysis of residual allergenic food proteins in commercial bottled wine fined with egg white, milk, and nongrape-derived tannins

Regulations introduced by the Food Standards Australia New Zealand in December 2002 require all wine and wine product labels in Australia to identify the presence of a processing aid, additive or other ingredient, which is known to be a potential allergen. The objective of this study was to establish sensitive assays to detect and measure allergenic proteins from commonly used processing aids in final bottled wine. Sensitive and specific enzyme-linked immunosorbent assays (ELISA) were developed and established for the proteins casein, ovalbumin, and peanut. Lower limits of detection of these proteins were 8, 1, and 8 ng/mL, respectively. A panel of 153 commercially available bottled Australian wines were tested by these ELISA, and except for two red wines known to contain added whole eggs, residuals of these food allergens were not detected in any wine. These findings are consistent with a lack of residual potentially allergenic egg-, milk-, or nut-derived processing aids in final bottled wine produced in Australia according to good manufacturing practice at a concentration that could cause an adverse reaction in egg, milk, or peanut/tree-nut allergic adult consumers.

Investigation of the allergenic potential of wines fined with various proteinogenic fining agents by ELISA

Hidden allergens are a common problem in food safety that has been known for many years. This is why the European Parliament adopted Directive 2003/89/EC amending 2000/13/EC. In addition to specific ingredients, Directive 2003/89/EC also requests the declaration of specific products that were used in the production and could be a risk for allergic individuals. This also includes the declaration of fining agents and lysozyme used in wines. In fact, it could be assumed that fining agents would be almost completely removed during the manufacturing process; however, until now there has been no necessity to analyze wine for these fining agents. By applying enzyme-linked immunosorbent assay (ELISA), residuals of fining agent proteins and the stabilizer lysozyme were investigated in various German wines. The results showed no detectable amounts of fining agents in wines, except for dried egg white and lysozyme, both derived from hen's egg white. For those products, adverse reactions against treated wines could not be excluded.

Incomplete digestion of codfish represents a risk factor for anaphylaxis in patients with allergy

BACKGROUND

Fish represents one of the most important allergenic foods causing severe allergic reactions. Nevertheless, it has been shown that gastric digestion significantly reduces its allergenic capacity.

OBJECTIVE

In this study, we assessed the absorption kinetics of fish proteins and investigated the clinical reactivity of patients with fish allergy to codfish digested at physiological or elevated gastric pH.

METHODS

Healthy individuals were openly challenged with codfish and blood samples were evaluated by histamine release for absorbed fish allergens. Patients with allergy were recruited on the basis of previously diagnosed codfish allergy. Fish extracts were digested with gastric enzymes at pH 2.0 and 3.0 and used for histamine release, skin prick tests, and titrated double-blind placebo-controlled food challenges.

RESULTS

Ingestion experiments in subjects without allergy revealed absorption of biologically active fish allergens only 10 minutes after ingestion with maximal serum levels after 1 to 2 hours. Incubation of fish proteins with digestive enzymes at pH 2.0 resulted in a fragmentation of the proteins leading to a reduced biological activity evidenced by a significantly smaller wheal reaction and reduced histamine release. Fish digested at pH 3.0 revealed comparable reactivity patterns as undigested extracts. Moreover, these test materials triggered reactions at 10-fold to 30-fold lower cumulated challenge doses in patients with allergy.

CONCLUSION

Our data indicate the paramount importance of gastric digestion for fish allergens because the quantitatively significant absorption and elicitation of symptoms seemed to take place in the intestine.

CLINICAL IMPLICATIONS

Hindered digestion puts patients with fish allergy at risk to develop severe allergic reactions at minute amounts of allergens.