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Yamamoto R, Izawa K, Ando T, Kaitani A, Tanabe A, Yamada H, Uchida S, Yoshikawa A, Kume Y, Toriumi S, Maehara A, Wang H, Nagamine M, Negishi N, Nakano N, Ebihara N, Shimizu T, Ogawa H, Okumura K, Kitaura J. Murine model identifies tropomyosin as IgE cross-reactive protein between house dust mite and coho salmon that possibly contributes to the development of salmon allergy. Front Immunol 2023; 14:1238297. [PMID: 37711608 PMCID: PMC10498769 DOI: 10.3389/fimmu.2023.1238297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
Background Recently, we have developed a method to identify IgE cross-reactive allergens. However, the mechanism by which IgE cross-reactive allergens cause food allergy is not yet fully understood how. In this study, we aimed to understand the underlying pathogenesis by identifying food allergens that cross-react with house dust mite allergens in a murine model. Material and methods Allergenic protein microarray analysis was conducted using serum from mice intraperitoneally injected with Dermatophagoides pteronyssinus (Der p) extract plus alum or alum alone as controls. Der p, Dermatophagoides farinae (Der f), coho salmon extract-sensitized and control mice were analyzed. Serum levels of IgE against Der p, Der f, coho salmon extract, protein fractions of coho salmon extract separated by ammonium sulfate precipitation and anion exchange chromatography, and recombinant coho salmon tropomyosin or actin were measured by an enzyme-linked immunosorbent assay. A murine model of cutaneous anaphylaxis or oral allergy syndrome (OAS) was established in Der p extract-sensitized mice stimulated with coho salmon extract, tropomyosin, or actin. Results Protein microarray analysis showed that coho salmon-derived proteins were highly bound to serum IgE in Der p extract-sensitized mice. Serum IgE from Der p or Der f extract-sensitized mice was bound to coho salmon extract, whereas serum IgE from coho salmon extract-sensitized mice was bound to Der p or Der f extract. Analysis of the murine model showed that cutaneous anaphylaxis and oral allergic reaction were evident in Der p extract-sensitized mice stimulated by coho salmon extract. Serum IgE from Der p or Der f extract-sensitized mice was bound strongly to protein fractions separated by anion exchange chromatography of coho salmon proteins precipitated with 50% ammonium sulfate, which massively contained the approximately 38 kDa protein. We found that serum IgE from Der p extract-sensitized mice was bound to recombinant coho salmon tropomyosin. Der p extract-sensitized mice exhibited cutaneous anaphylaxis in response to coho salmon tropomyosin. Conclusion Our results showed IgE cross-reactivity of tropomyosin between Dermatophagoides and coho salmon which illustrates salmon allergy following sensitization with the house dust mite Dermatophagoides. Our method for identifying IgE cross-reactive allergens will help understand the underlying mechanisms of food allergies.
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Affiliation(s)
- Risa Yamamoto
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kumi Izawa
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomoaki Ando
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ayako Kaitani
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Tanabe
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiromichi Yamada
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shino Uchida
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akihisa Yoshikawa
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Otorhinolaryngology, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - Yasuharu Kume
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Shun Toriumi
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akie Maehara
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hexing Wang
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Science of Allergy and Inflammation, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - Masakazu Nagamine
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Naoko Negishi
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobuhiro Nakano
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobuyuki Ebihara
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Toshiaki Shimizu
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hideoki Ogawa
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ko Okumura
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Jiro Kitaura
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Science of Allergy and Inflammation, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan
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Briceno Noriega D, Savelkoul HFJ, Jansen A, Teodorowicz M, Ruinemans-Koerts J. Pollen Sensitization Can Increase the Allergic Reaction to Non-Cross-Reactive Allergens in a Soy-Allergic Patient. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6045. [PMID: 37297649 PMCID: PMC10252215 DOI: 10.3390/ijerph20116045] [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: 03/16/2023] [Revised: 04/28/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
During and after the pollen season, an increase in food-triggered allergic symptoms has been observed in pollen-food syndrome patients, possibly due to seasonal boosting of pollen-IgE levels. It has been suggested that consumption of birch-pollen-related foods plays a role in seasonal allergenic inflammation. However, whether this increased pollen sensitization during the pollen season can also affect the allergenicity of allergens that are non-cross-reactive with birch pollen remains in question. This study presents the case of a patient with soy allergy and pollinosis, who experiences worsening of gastrointestinal (GI) symptoms during the birch pollen season even though the eliciting food factor does not cross-react with birch pollen allergens and their homologs (e.g., Bet v 1 and Gly m 4). The results showed a notable increase in sIgE for Gly m 4 (3.3 fold) and Bet v 1 (2.6 fold) during the birch pollen season compared to outside the birch pollen season, while Gly m 5 and Gly m 6 showed only a slight increase (1.5 fold). The basophil activation test (BAT) showed that in this patient Gly m 5 and Gly m 6 are clinically relevant soy allergens, which correlates with the reported clinical symptoms to processed soy. Moreover, the BAT against raw soy shows an increase in basophil activation during the birch pollen season and a negative basophil activation result outside the birch pollen season. Thus, the worsening of GI symptoms could possibly be due to an increase in IgE receptors, an over-reactive immune system, and/or significant intestinal allergic inflammation. This case highlights the importance of including allergens that do not cross-react with birch pollen and using a functional assay such as the BAT to evaluate clinical relevance when assessing birch pollen seasonal influence on soy allergenicity.
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Affiliation(s)
- Daniela Briceno Noriega
- Cell Biology and Immunology Group, Wageningen University and Research Centre, 6708 WD Wageningen, The Netherlands
| | - Huub F. J. Savelkoul
- Cell Biology and Immunology Group, Wageningen University and Research Centre, 6708 WD Wageningen, The Netherlands
| | - Ad Jansen
- Department of Otorhinolaryngology, Radboud University Nijmegen Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Malgorzata Teodorowicz
- Cell Biology and Immunology Group, Wageningen University and Research Centre, 6708 WD Wageningen, The Netherlands
| | - Janneke Ruinemans-Koerts
- Cell Biology and Immunology Group, Wageningen University and Research Centre, 6708 WD Wageningen, The Netherlands
- Department of Clinical Chemistry and Hematology, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands
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3
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Wise SK, Damask C, Roland LT, Ebert C, Levy JM, Lin S, Luong A, Rodriguez K, Sedaghat AR, Toskala E, Villwock J, Abdullah B, Akdis C, Alt JA, Ansotegui IJ, Azar A, Baroody F, Benninger MS, Bernstein J, Brook C, Campbell R, Casale T, Chaaban MR, Chew FT, Chambliss J, Cianferoni A, Custovic A, Davis EM, DelGaudio JM, Ellis AK, Flanagan C, Fokkens WJ, Franzese C, Greenhawt M, Gill A, Halderman A, Hohlfeld JM, Incorvaia C, Joe SA, Joshi S, Kuruvilla ME, Kim J, Klein AM, Krouse HJ, Kuan EC, Lang D, Larenas-Linnemann D, Laury AM, Lechner M, Lee SE, Lee VS, Loftus P, Marcus S, Marzouk H, Mattos J, McCoul E, Melen E, Mims JW, Mullol J, Nayak JV, Oppenheimer J, Orlandi RR, Phillips K, Platt M, Ramanathan M, Raymond M, Rhee CS, Reitsma S, Ryan M, Sastre J, Schlosser RJ, Schuman TA, Shaker MS, Sheikh A, Smith KA, Soyka MB, Takashima M, Tang M, Tantilipikorn P, Taw MB, Tversky J, Tyler MA, Veling MC, Wallace D, Wang DY, White A, Zhang L. International consensus statement on allergy and rhinology: Allergic rhinitis - 2023. Int Forum Allergy Rhinol 2023; 13:293-859. [PMID: 36878860 DOI: 10.1002/alr.23090] [Citation(s) in RCA: 65] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/11/2022] [Accepted: 09/13/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document. METHODS ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. RESULTS ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. CONCLUSION The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.
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Affiliation(s)
- Sarah K Wise
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Cecelia Damask
- Otolaryngology-HNS, Private Practice, University of Central Florida, Lake Mary, Florida, USA
| | - Lauren T Roland
- Otolaryngology-HNS, Washington University, St. Louis, Missouri, USA
| | - Charles Ebert
- Otolaryngology-HNS, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joshua M Levy
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Sandra Lin
- Otolaryngology-HNS, University of Wisconsin, Madison, Wisconsin, USA
| | - Amber Luong
- Otolaryngology-HNS, McGovern Medical School of the University of Texas, Houston, Texas, USA
| | - Kenneth Rodriguez
- Otolaryngology-HNS, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ahmad R Sedaghat
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Elina Toskala
- Otolaryngology-HNS, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Baharudin Abdullah
- Otolaryngology-HNS, Universiti Sains Malaysia, Kubang, Kerian, Kelantan, Malaysia
| | - Cezmi Akdis
- Immunology, Infectious Diseases, Swiss Institute of Allergy and Asthma Research, Davos, Switzerland
| | - Jeremiah A Alt
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fuad Baroody
- Otolaryngology-HNS, University of Chicago, Chicago, Illinois, USA
| | | | | | - Christopher Brook
- Otolaryngology-HNS, Harvard University, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Raewyn Campbell
- Otolaryngology-HNS, Macquarie University, Sydney, NSW, Australia
| | - Thomas Casale
- Allergy/Immunology, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Mohamad R Chaaban
- Otolaryngology-HNS, Cleveland Clinic, Case Western Reserve University, Cleveland, Ohio, USA
| | - Fook Tim Chew
- Allergy/Immunology, Genetics, National University of Singapore, Singapore, Singapore
| | - Jeffrey Chambliss
- Allergy/Immunology, University of Texas Southwestern, Dallas, Texas, USA
| | - Antonella Cianferoni
- Allergy/Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | - Anne K Ellis
- Allergy/Immunology, Queens University, Kingston, ON, Canada
| | | | - Wytske J Fokkens
- Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | | | - Matthew Greenhawt
- Allergy/Immunology, Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Amarbir Gill
- Otolaryngology-HNS, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashleigh Halderman
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Jens M Hohlfeld
- Respiratory Medicine, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover Medical School, German Center for Lung Research, Hannover, Germany
| | | | - Stephanie A Joe
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Shyam Joshi
- Allergy/Immunology, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Jean Kim
- Otolaryngology-HNS, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adam M Klein
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Helene J Krouse
- Otorhinolaryngology Nursing, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Edward C Kuan
- Otolaryngology-HNS, University of California Irvine, Orange, California, USA
| | - David Lang
- Allergy/Immunology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Matt Lechner
- Otolaryngology-HNS, University College London, Barts Health NHS Trust, London, UK
| | - Stella E Lee
- Otolaryngology-HNS, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Victoria S Lee
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Patricia Loftus
- Otolaryngology-HNS, University of California San Francisco, San Francisco, California, USA
| | - Sonya Marcus
- Otolaryngology-HNS, Stony Brook University, Stony Brook, New York, USA
| | - Haidy Marzouk
- Otolaryngology-HNS, State University of New York Upstate, Syracuse, New York, USA
| | - Jose Mattos
- Otolaryngology-HNS, University of Virginia, Charlottesville, Virginia, USA
| | - Edward McCoul
- Otolaryngology-HNS, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Erik Melen
- Pediatric Allergy, Karolinska Institutet, Stockholm, Sweden
| | - James W Mims
- Otolaryngology-HNS, Wake Forest University, Winston Salem, North Carolina, USA
| | - Joaquim Mullol
- Otorhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Jayakar V Nayak
- Otolaryngology-HNS, Stanford University, Palo Alto, California, USA
| | - John Oppenheimer
- Allergy/Immunology, Rutgers, State University of New Jersey, Newark, New Jersey, USA
| | | | - Katie Phillips
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael Platt
- Otolaryngology-HNS, Boston University, Boston, Massachusetts, USA
| | | | | | - Chae-Seo Rhee
- Rhinology/Allergy, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Sietze Reitsma
- Otolaryngology-HNS, University of Amsterdam, Amsterdam, Netherlands
| | - Matthew Ryan
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Joaquin Sastre
- Allergy, Fundacion Jiminez Diaz, University Autonoma de Madrid, Madrid, Spain
| | - Rodney J Schlosser
- Otolaryngology-HNS, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore A Schuman
- Otolaryngology-HNS, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marcus S Shaker
- Allergy/Immunology, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Aziz Sheikh
- Primary Care, University of Edinburgh, Edinburgh, Scotland
| | - Kristine A Smith
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | - Michael B Soyka
- Otolaryngology-HNS, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Masayoshi Takashima
- Otolaryngology-HNS, Houston Methodist Academic Institute, Houston, Texas, USA
| | - Monica Tang
- Allergy/Immunology, University of California San Francisco, San Francisco, California, USA
| | | | - Malcolm B Taw
- Integrative East-West Medicine, University of California Los Angeles, Westlake Village, California, USA
| | - Jody Tversky
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Matthew A Tyler
- Otolaryngology-HNS, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maria C Veling
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Dana Wallace
- Allergy/Immunology, Nova Southeastern University, Ft. Lauderdale, Florida, USA
| | - De Yun Wang
- Otolaryngology-HNS, National University of Singapore, Singapore, Singapore
| | - Andrew White
- Allergy/Immunology, Scripps Clinic, San Diego, California, USA
| | - Luo Zhang
- Otolaryngology-HNS, Beijing Tongren Hospital, Beijing, China
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4
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Kamei A, Izawa K, Ando T, Kaitani A, Yamamoto R, Maehara A, Ide T, Yamada H, Kojima M, Wang H, Tokushige K, Nakano N, Shimizu T, Ogawa H, Okumura K, Kitaura J. Development of mouse model for oral allergy syndrome to identify IgE cross-reactive pollen and food allergens: ragweed pollen cross-reacts with fennel and black pepper. Front Immunol 2022; 13:945222. [PMID: 35958602 PMCID: PMC9358994 DOI: 10.3389/fimmu.2022.945222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/27/2022] [Indexed: 11/27/2022] Open
Abstract
Oral allergy syndrome (OAS) is an IgE-mediated immediate food allergy that is localized to the oral mucosa. Pollen food allergy syndrome (PFAS), a pollinosis-associated OAS, is caused by cross-reactivity between food and pollen allergens. However, we need to more precisely understand the underlying pathogenesis of OAS/PFAS. In the present study, we developed a method to comprehensively identify cross-reactive allergens by using murine model of OAS and protein microarray technology. We focused on lip angioedema, which is one of the most common symptoms of OAS, and confirmed that mast cells reside in the tissues inside the lower lip of the mice. Interestingly, when the food allergen ovalbumin (OVA) was injected inside the lower lip of mice with high levels of OVA-specific IgE followed by an intravenous injection of the Evans blue dye, we found immediate dye extravasation in the skin of the neck in a mast cell-dependent manner. In addition, the degree of mast cell degranulation in the oral cavity, reflecting the severity of oral allergic responses, can be estimated by measuring the amount of extravasated dye in the skin. Therefore, we used this model of OAS to examine IgE cross-reactive allergens in vivo. Protein microarray analysis showed that serum IgE from mice intraperitoneally sensitized with ragweed pollen, one of the major pollens causing pollinosis, bound highly to protein extracts from several edible plants including black peppercorn and fennel. We confirmed that the levels of black pepper-specific IgE and fennel-specific IgE were significantly higher in the serum from ragweed pollen-sensitized mice than in the serum from non-sensitized control mice. Importantly, analysis of murine model of OAS showed that the injection of black pepper or fennel extract induced apparent oral allergic responses in ragweed pollen-sensitized mice. These results indicate IgE cross-reactivity of ragweed pollen with black pepper and fennel. In conclusion, we developed mouse model of OAS to identify IgE cross-reactive pollen and food allergens, which will help understand the pathogenesis of OAS/PFAS.
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Affiliation(s)
- Anna Kamei
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Science of Allergy and Inflammation, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kumi Izawa
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- *Correspondence: Kumi Izawa, ; Jiro Kitaura,
| | - Tomoaki Ando
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ayako Kaitani
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Risa Yamamoto
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akie Maehara
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takuma Ide
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Otorhinolaryngology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiromichi Yamada
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mayuki Kojima
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hexing Wang
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Science of Allergy and Inflammation, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Koji Tokushige
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Science of Allergy and Inflammation, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobuhiro Nakano
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshiaki Shimizu
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hideoki Ogawa
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ko Okumura
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Jiro Kitaura
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- *Correspondence: Kumi Izawa, ; Jiro Kitaura,
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5
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Juel-Berg N, Larsen LF, Küchen N, Norgil I, Hansen KS, Poulsen LK. Patterns of Clinical Reactivity in a Danish Cohort of Tree Nut Allergic Children, Adolescents, and Young Adults. FRONTIERS IN ALLERGY 2022; 3:824660. [PMID: 35958942 PMCID: PMC9361471 DOI: 10.3389/falgy.2022.824660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Tree nut allergy is associated with severe reactions and poly-sensitization to other nuts and peanuts often occurs. There are regional differences in sensitization profiles that result in differences in clinical presentation. Denmark is located in a birch pollen endemic area, which could influence the allergy patterns due to pollen cross-sensitization. Objective This study aimed to investigate patterns of sensitization and clinical reactivity to tree nuts and peanuts and threshold levels for oral food challenges (OFCs) in a Danish cohort of tree nut allergic children, adolescents, and young adults. Methods Forty tree nut allergic subjects were assessed for clinical reactivity to six nuts, i.e., hazelnut, walnut, pistachio, cashew, almond, and peanut, by OFCs or convincing medical history of an immediate allergic reaction or tolerance. Clinical presentation and allergen-specific immunoglobulin E (sIgE) levels together with eliciting dose and rescue medication in OFCs were furthermore assessed. Results Allergy to two or more tree nuts was observed in most cases. Hazelnut-walnut dual allergy was common but not exclusively observed as concomitant allergies. Allergy to cashew was coincided in all but one of the assessed subjects with pistachio allergy. Half of all assessed subjects were allergic to peanuts. Oral symptoms followed by a skin reaction were the most common symptomatology that lead to OFC cessation and subjects often presented with symptoms from two or more organ systems. OFC threshold levels were within the same range, but cashew was distinguished from other nuts by causing allergic symptoms at the lowest dose. Clinical reactivity and the allergy patterns were to some extent reflected by sIgE levels and by correlations in sIgE between the nuts. Conclusions In this Northern European cohort, subjects with clinically relevant tree nut allergy were generally allergic to two or more tree nuts and close to half of them also to peanuts. There were two distinct and independent allergic phenotypes; the majority of hazelnut allergic subjects were also allergic to walnut, and all but one subject with cashew allergy were dual allergic to pistachio. These findings are consistent with a strong sIgE correlation between hazelnut and walnut and a close to total sIgE correlation between cashew and pistachio.
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Affiliation(s)
- Nanna Juel-Berg
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
- Department of Pediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Lau Fabricius Larsen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
| | - Niels Küchen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
- Department of Pediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Ida Norgil
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
- Department of Pediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Kirsten Skamstrup Hansen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
- Department of Pediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Lars K. Poulsen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
- *Correspondence: Lars K. Poulsen
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Vassilopoulou E, Skypala I, Feketea G, Gawlik R, Dunn Galvin A, Meyer R, Pitsios C, Maria Pop R, Ryan D, Said M, Schiere S, Vlieg-Boerstra B, Kull I. A multi-disciplinary approach to the diagnosis and management of allergic diseases: An EAACI Task Force. Pediatr Allergy Immunol 2022; 33:e13692. [PMID: 34724234 DOI: 10.1111/pai.13692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Guidelines for management of patients with allergic conditions are available, but the added value of nurses, allied healthcare professionals (AHPs), and general practitioners (GPs), in the management of allergic disease, has not been fully clarified. The European Academy of Allergy and Clinical Immunology (EAACI) appointed a task force to explore this issue. AIM To investigate the added value of nurses, AHPs, and GPs in management of allergic diseases, in an integrated model of care. METHODS A search was made of peer-reviewed literature published between 2010 and December 2020 (Cochrane Library, PubMed, and CINAHL) on the involvement of the various specific healthcare providers (HCPs) in the management of allergic diseases. RESULTS Facilitative models of care for patients with allergies can be achieved if HCP collaborates in the diagnosis and management. Working in multi-disciplinary teams (MDT) can increase patients' understanding of the disease, adherence to treatment, self-care capabilities, and ultimately improve quality of life. The MDT competencies and procedures can be improved and enhanced in a climate of mutual respect and shared values, and with inclusion of patients in the planning of care. Patient-centered communication among HCPs and emphasis on the added value of each profession can create an effective integrated model of care for patients with allergic diseases. CONCLUSION Nurses, AHPs, and GPs, both individually and in collaboration, can contribute to the improvement of the management of patients with allergic disease. The interaction between the HCPs and the patients themselves can ensure maximum support for people with allergies.
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Affiliation(s)
- Emilia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Isabel Skypala
- Department of Allergy & Clinical Immunology, Royal Brompton & Harefield NHS Foundation Trust, London, and Imperial College, London, UK
| | - Gavriela Feketea
- Iuliu Hatieganu, University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Pediatrics, Pediatric Allergy Outpatient Clinic, "Karamandaneio", Children Hospital, Patras, Greece
| | | | | | - Rosan Meyer
- Department of Paediatrics, Imperial College London, London, UK
| | | | - Raluca Maria Pop
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dermot Ryan
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Maria Said
- Allergy & Anaphylaxis Australia, Sydney, Australia.,EAACI Patient Organisation Committee, Zurich, Switzerland
| | - Sophie Schiere
- Department of Pharmacology, Gent University, Gent, Belgium
| | | | - Inger Kull
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden
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Birch Pollen Related Pear Allergy: A Single-Blind Oral Challenge TRIAL with 2 Pear Cultivars. Nutrients 2021; 13:nu13041355. [PMID: 33919631 PMCID: PMC8073155 DOI: 10.3390/nu13041355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 01/06/2023] Open
Abstract
Approximately 70% of birch pollen allergic patients in Europe experience hypersensitivity reactions to Immunoglobulin E (IgE) cross-reactive food sources. This so-called pollen-food syndrome (PFS) is defined by allergic symptoms elicited promptly by the ingestion of fruits, nuts, or vegetables in these patients. So far, in the literature, less attention has been given to Bet v 1 cross-reactive symptoms caused by pear (Pyrus communis). In the Netherlands, pears are widely consumed. The primary objective of this study was to measure the type and severity of allergic symptoms during pear challenges in birch pollen allergic patients, with a positive history of pear allergy, using two different pear varieties. Fifteen patients were included, skin prick test (SPT), prick-to-prick test (PTP), specific Immunoglobulin E (sIgE), and single-blind oral challenges were performed with two pear (Pyrus communis) varieties: the ‘Cepuna’ (brand name Migo®) and the ‘Conference’ pears. All patients were sensitized to one or both pear varieties. A total of 12 out of 15 participants developed symptoms during the ‘Cepuna’ food challenge and 14/15 reacted during the ‘Conference’ challenge. Challenges with the ‘Cepuna’ pears resulted in less objective symptoms (n = 2) in comparison with challenges with ‘Conference’ pears (n = 7). Although we did not find significance between both varieties in our study, we found a high likelihood of fewer and less severe symptoms during the ‘Cepuna’ challenges. Consequently selected pear sensitized patients can try to consume small doses of the ‘Cepuna’ pear outside the birch pollen season.
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8
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Gao J, Cai R, Zhou N. Development of a sensitive and stable chemiluminescent immunoassay for detection of birch pollen allergic specific IgE based on recombinant Bet v1 protein. J Immunol Methods 2021; 493:113040. [PMID: 33741388 DOI: 10.1016/j.jim.2021.113040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/04/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
Background Quantitative detection of allergens is of great significance for clarifying the cause, treatment, and prevention of allergy disease. Birch pollen is one of the most common inhalational allergens and Bet v1 is the major component allergen of birch allergen. This study aims to develop a stable and sensitive chemiluminescence immunoassay (CLIA) for the detection of birch pollen allergic specific IgE (sIgE) based on recombinant Bet v1 (rBet v1) protein. Methods rBet v1 protein was expressed in Escherichia coli and purified. Then rBet v1 was applied to detect sIgE in human serum. The performance of the established CLIA was evaluated and compared with Phadia rBet v1 fluorescence enzyme immunoassay (FEIA) system. Results The developed CLIA for sIgE to rBet v1 detection shows excellent performance. The assay showed a linear range from 0.1 to 100 IU/mL, with a low detection limit of 0.06 IU/mL. A total of 164 samples were evaluated by CLIA and compared with the results of FEIA. The positive, negative, and total coincidence rate was 90.6% (87/96), 91.2% (62/68), and 90.9% (149/164), respectively. The r-value of Spearman's rank correlation analysis was 0.935 (P < 0.001). The use of high levels of bilirubin (50 mg/dL), hemoglobin (400 mg/dL) and lipid (2000 mg/dL) didn't interfere with the results. Conclusions The proposed CLIA exhibits excellent performance for the detection of rBet v1 specific IgE. It can be a reliable tool for the early diagnosis of hypersensitivity.
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Affiliation(s)
- Jinyan Gao
- The Key Laboratory of Carbohydrate Chemistry and Biotechnology, Ministry of Education, School of Biotechnology, Jiangnan University, Wuxi 214122, China
| | - Rongfeng Cai
- The Key Laboratory of Carbohydrate Chemistry and Biotechnology, Ministry of Education, School of Biotechnology, Jiangnan University, Wuxi 214122, China
| | - Nandi Zhou
- The Key Laboratory of Carbohydrate Chemistry and Biotechnology, Ministry of Education, School of Biotechnology, Jiangnan University, Wuxi 214122, China.
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9
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Cudowska B, Pawłowicz M, Lebensztejn DM. Pollen-related food allergy in children with seasonal allergic rhinitis. Postepy Dermatol Alergol 2021; 38:96-101. [PMID: 34408574 PMCID: PMC8362771 DOI: 10.5114/ada.2021.104284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 07/20/2019] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Seasonal allergic rhinitis (SAR) and bronchial asthma are typical manifestations of pollen-food sensitization in adults. There is limited information regarding the sensitization patterns of pollen-food allergy in children. AIM To evaluate the prevalence of SAR in children with pollen-food sensitization and assess the impact of food allergens on nasal symptoms. MATERIAL AND METHODS Forty-three children with pollen-food sensitization aged 2-14 years were evaluated for evidence of SAR. The inclusion criteria was IgE-mediated sensitization to pollen and homologous food allergens. The control group consisted of 19 children with SAR caused by pollen without sensitization to homologous food allergens. RESULTS Allergic rhinitis was the main symptom in 65.1% of children; in 25.6% an association between ingestion of pollen-related foods and nasal symptoms was observed. The simultaneous sensitization to animal origin food allergens was stated in 63.3% of children with SAR. In 25.6% anaphylactic reactions to foods were registered. 37.2% of children were asymptomatic to pollen origin foods despite pollen-food sensitization. The statistically significant differences between values were noticed in comparison to the control group. CONCLUSIONS Allergic rhinitis is a common manifestation of pollen-food sensitization in children and this type of immunological hyperreactivity should be taken into account regardless of age. The lack of association of symptoms with plant origin foods in the majority of cases and the asymptomatic course of food sensitization in more than one third of patients indicates the need for follow-up and being careful in routine recommending the avoidance diet.
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Affiliation(s)
- Beata Cudowska
- Department of Paediatrics, Gastroenterology, Hepatology, Nutrition and Allergology, Medical University of Bialystok, Bialystok, Poland
| | - Magdalena Pawłowicz
- Department of Paediatrics, Gastroenterology, Hepatology, Nutrition and Allergology, Medical University of Bialystok, Bialystok, Poland
| | - Dariusz M Lebensztejn
- Department of Paediatrics, Gastroenterology, Hepatology, Nutrition and Allergology, Medical University of Bialystok, Bialystok, Poland
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10
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Walter G, Kalicinsky C. Adult-onset IgE-mediated food allergy at a Winnipeg allergy clinic: a case series. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2020; 16:85. [PMID: 33014083 PMCID: PMC7526386 DOI: 10.1186/s13223-020-00483-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/17/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND It is a putatively understood phenomenon that the overall prevalence of allergic disease has been increasing in recent decades-particularly in industrialized nations. Despite this, there is a relative scarcity of data concerning the development of food-related allergic disease in the adult population. In addition, the paucity of data as it pertains to the Canadian population is particularly marked when compared to other nations. We sought to determine common culprit foods and the reactions they elicited in a series of 14 patients seen in the Winnipeg allergy and immunology clinic. METHODS We conducted a retrospective review of patients identified by academic allergists in Winnipeg, Manitoba as fitting criteria for adult-onset IgE-mediated food allergy from May 2018-July 2020. We included patients with IgE-mediated symptoms, including the pollen-food syndrome which developed at the age of 16 or later. We collected data regarding the food which induced the reaction, what the reaction was, and any concomitant atopic disease. RESULTS The most common culprit food identified was shellfish, followed by finfish, pollen-food syndrome, and wheat/flour. The most common reaction experienced was anaphylaxis, followed by food-dependent exercise-induced anaphylaxis and isolated (muco)cutaneous symptoms. With regard to concomitant atopic disease, allergic rhinitis/rhinoconjunctivitis stood out as the most prevalent. CONCLUSIONS Adult-onset food allergy-particularly with resultant anaphylaxis-is an important phenomenon to recognize, even when patients have previously tolerated the food in question.
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Affiliation(s)
- Graham Walter
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Chrystyna Kalicinsky
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
- Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada
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11
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Monaci L, Pilolli R, De Angelis E, Crespo JF, Novak N, Cabanillas B. Food allergens: Classification, molecular properties, characterization, and detection in food sources. ADVANCES IN FOOD AND NUTRITION RESEARCH 2020; 93:113-146. [PMID: 32711861 DOI: 10.1016/bs.afnr.2020.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Food allergy is a large and growing public health problem in many areas of the world. The prevalence of food allergy has increased in the last decades in a very significant way in many world regions, particularly in developed countries. In that respect, the research field of food allergy has experienced an extensive growth and very relevant progress has been made in recent years regarding the characterization of food allergens, the study of their immunological properties, and their detection in food sources. Furthermore, food labeling policies have also been improved decidedly in recent years. For that immense progress made, it is about time to review the latest progress in the field of food allergy. In this review, we intend to carry out an extensive and profound overview regarding the latest scientific advances and knowledge in the field of food allergen detection, characterization, and in the study of the effects of food processing on the physico-chemical properties of food allergens. The advances in food labeling policies, and methodologies for the characterization of food allergens are also thoroughly reviewed in the present overview.
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Affiliation(s)
- Linda Monaci
- Institute of Sciences of Food Production, CNR-ISPA, Bari, Italy
| | - Rosa Pilolli
- Institute of Sciences of Food Production, CNR-ISPA, Bari, Italy
| | | | - Jesus F Crespo
- Department of Allergy, Research Institute Hospital 12 de Octubre de Madrid, Madrid, Spain
| | - Natalija Novak
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
| | - Beatriz Cabanillas
- Department of Allergy, Research Institute Hospital 12 de Octubre de Madrid, Madrid, Spain.
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12
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Chong KW, Ruiz-Garcia M, Patel N, Boyle RJ, Turner PJ. Reaction phenotypes in IgE-mediated food allergy and anaphylaxis. Ann Allergy Asthma Immunol 2020; 124:473-478. [PMID: 31923546 PMCID: PMC7251627 DOI: 10.1016/j.anai.2019.12.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/07/2019] [Accepted: 12/27/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Food allergy encompasses a range of food hypersensitivities. Different clinical phenotypes for food allergy likely exist in much the same way as endotype discovery is now a major research theme in asthma. We discuss the emerging evidence for different reaction phenotypes (ie, symptoms experienced after allergen exposure in food allergic individuals) and their relevance for clinical practice. DATA SOURCES Published and unpublished literature relating to reaction phenotypes in food allergy. STUDY SELECTIONS Authors assessment of the available data. RESULTS Food anaphylaxis may be pathophysiologically different than anaphylaxis caused by nonfood triggers. Currently, there are no robust, clinically useful predictors of severity in food allergy. It is likely that patient-specific reaction phenotypes exist in food allergy, which may affect the risk of severe anaphylaxis. Allergen immunotherapy may modulate these phenotypes. CONCLUSION Data are emerging to confirm our clinical experience that many food allergic patients experience stereotypical symptoms after allergen exposure, both in the community and at supervised oral food challenge, in a manner that varies among patients. Integrating data sets from different cohorts and applying unbiased machine-based learning analyses may demonstrate specific food allergy endotypes in a similar way to asthma. Whether this results in improvements in patient management (eg, through facilitating risk stratification or affecting the decision to prescribe an epinephrine autoinjector and, perhaps, the number of devices) remains to be determined, but given our current inability to predict which patients are most at risk of severe food allergic reactions, this will clearly be an important area of research in the future.
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Affiliation(s)
- Kok Wee Chong
- Section of Inflammation, Repair, and Development, National Heart and Lung Institute, Imperial College London, London, United Kingdom; Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Monica Ruiz-Garcia
- Section of Inflammation, Repair, and Development, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Nandinee Patel
- Section of Inflammation, Repair, and Development, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Robert J Boyle
- Section of Inflammation, Repair, and Development, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Paul J Turner
- Section of Inflammation, Repair, and Development, National Heart and Lung Institute, Imperial College London, London, United Kingdom; Discipline of Paediatrics and Child Health, School of Medicine, University of Sydney, Sydney, Australia.
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13
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Guvenir H, Dibek Misirlioglu E, Buyuktiryaki B, Zabun M, Capanoglu M, Toyran M, Civelek E, Kocabas C. Frequency and clinical features of pollen-food syndrome in children. Allergol Immunopathol (Madr) 2020; 48:78-83. [PMID: 31601505 DOI: 10.1016/j.aller.2019.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/09/2019] [Accepted: 07/26/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pollen-food syndrome (PFS) is an allergic reaction to fresh fruits, vegetables and/or nuts that can occur in patients who are allergic to pollen. The prevalence of PFS in children is not clearly known. OBJECTIVE The objective of this study was to determine the frequency and clinical features of PFS in pediatric patients with pollen-induced allergic rhinitis (AR). METHOD This study was conducted in the pediatric allergy outpatient clinic of our hospital. Pollen-induced seasonal AR patients who were evaluated for any symptoms appearing after consuming any fresh fruits and vegetables. RESULTS Six hundred and seventy-two pollen-sensitized patients were included in this study. The symptoms related to PFS were reported in 22 (3.3%) patients. The median age of the patients was 12.3 years and 59% (n=13) were female. Peach was the most common culprit (22%). There were isolated oropharyngeal symptoms in 20 (91%) patients and anaphylaxis in two (9%) patients with the suspected food. The multiple logistic regression analysis revealed that female gender, history of atopic dermatitis and allergic diseases in the family were the potential risk factors for PFS [Odds ratio 95%CI: 3.367 (1.344-8.435), 5.120 (1.935-13.550), 3.046 (1.239-7.492), respectively]. CONCLUSION PFS can be seen in children who are followed up for pollen-induced AR. The symptoms of PFS are usually mild and transient. However, comprehensive evaluation of patients is important since serious systemic reactions such as anaphylaxis can also be observed.
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14
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Abstract
Although the gold standard for diagnosis of immunoglobulin E (IgE)-mediated food allergy is an oral food challenge, clinically relevant biomarkers of IgE sensitization, including serum-specific IgE and skin prick testing, can aid in diagnosis. Clinically useful values have been defined for individual foods. More recently, specific IgE to particular protein components has provided additional diagnostic value. In summary, food allergy diagnostics to evaluate IgE sensitization are clinically useful and continue to evolve to improve evaluation of IgE-mediated food allergies.
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Affiliation(s)
- Nicole A LaHood
- Allergy and Immunology, Department of Medicine, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, 55 Fruit Street, Cox 201, Boston, MA, USA
| | - Sarita U Patil
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, 55 Fruit Street, Cox 201, Boston, MA, USA; Food Allergy Center, Massachusetts General Hospital for Children, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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15
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Kim M, Ahn Y, Yoo Y, Kim DK, Yang HJ, Park HS, Lee HJ, Kim MA, Jeong YY, Kim BS, Bae WY, Jang AS, Park Y, Koh YI, Lee J, Lim DH, Kim JH, Lee SM, Kim YM, Jun YJ, Kim HY, Kim Y, Choi JH. Clinical Manifestations and Risk Factors of Anaphylaxis in Pollen-Food Allergy Syndrome. Yonsei Med J 2019; 60:960-968. [PMID: 31538431 PMCID: PMC6753338 DOI: 10.3349/ymj.2019.60.10.960] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/27/2019] [Accepted: 08/09/2019] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Many studies have reported that pollen-food allergy syndrome (PFAS) can cause anaphylaxis. No comprehensive investigations into anaphylaxis in PFAS have been conducted, however. In this study, we investigated the clinical manifestations and risk factors for anaphylaxis in PFAS in Korean patients with pollinosis. MATERIALS AND METHODS Data were obtained from a nationwide cross-sectional study that previously reported on PFAS in Korean patients with pollinosis. Data from 273 patients with PFAS were collected, including demographics, list of culprit fruits and vegetables, and clinical manifestations of food allergy. We analyzed 27 anaphylaxis patients and compared them with patients with PFAS with oropharyngeal symptoms only (n=130). RESULTS The most common cause of anaphylaxis in PFAS was peanut (33.3%), apple (22.2%), walnut (22.2%), pine nut (18.5%), peach (14.8%), and ginseng (14.8%). Anaphylaxis was significantly associated with the strength of sensitization to alder, hazel, willow, poplar, timothy, and ragweed (p<0.05, respectively). Multivariable analysis revealed that the presence of atopic dermatitis [odds ratio (OR), 3.58; 95% confidence interval (CI), 1.25-10.23; p=0.017]; sensitization to hazel (OR, 5.27; 95% CI, 1.79-15.53; p=0.003), timothy (OR, 11.8; 95% CI, 2.70-51.64; p=0.001), or ragweed (OR, 3.18; 95% CI, 1.03-9.87; p=0.045); and the number of culprit foods (OR, 1.25; 95% CI, 1.15-1.37; p<0.001) were related to the development of anaphylaxis in PFAS. CONCLUSION The most common culprit foods causing anaphylaxis in PFAS were peanut and apple. The presence of atopic dermatitis; sensitization to hazel, timothy, or ragweed; and a greater number of culprit foods were risk factors for anaphylaxis in PFAS.
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Affiliation(s)
- Minji Kim
- Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
- Allergy and Clinical Immunology Research Center, Hallym University College of Medicine, Chuncheon, Korea
| | - Youngmin Ahn
- Department of Pediatrics, Eulji Hospital, Eulji University, Seoul, Korea
| | - Young Yoo
- Department of Pediatrics, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
| | - Dong Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Chuncheon Sacred Heart Hospital and Nano-Bio Regenerative Medical Institute, Hallym University College of Medicine, Chuncheon, Korea
| | - Hyeon Jong Yang
- Department of Pediatrics, Pediatric Allergy and Respiratory Center, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Jong Lee
- Lee & Hong ENT, Sleep and Cosmetic Center, Seongnam, Korea
| | - Mi Ae Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Yi Yeong Jeong
- Department of Internal Medicine, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Bong Seong Kim
- Department of Pediatrics, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Woo Yong Bae
- Department of Otorhinolaryngology, Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - An Soo Jang
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Yang Park
- Department of Pediatrics, Wonkwang University Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea
| | - Young Il Koh
- Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jaechun Lee
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Dae Hyun Lim
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Jeong Hee Kim
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Sang Min Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Yong Min Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Korea
| | - Young Joon Jun
- Department of Otorhinolaryngology-Head & Neck Surgery, Soonchunhyang University Gumi Hospital, Soonchunhyang University College of Medicine, Gumi, Korea
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Yunsun Kim
- SCH Biomedical Informatics Research Unit, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jeong Hee Choi
- Allergy and Clinical Immunology Research Center, Hallym University College of Medicine, Chuncheon, Korea
- Department of Pulmonology, Allergy and Critical Care Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
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Mastrorilli C, Cardinale F, Giannetti A, Caffarelli C. Pollen-Food Allergy Syndrome: A not so Rare Disease in Childhood. ACTA ACUST UNITED AC 2019; 55:medicina55100641. [PMID: 31561411 PMCID: PMC6843262 DOI: 10.3390/medicina55100641] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/18/2019] [Accepted: 09/20/2019] [Indexed: 12/12/2022]
Abstract
Seasonal allergic rhinoconjunctivitis (SAR) affects millions of people worldwide, particularly in childhood and adolescence. Pollen food allergy syndrome (PFAS) is a common adverse reaction occurring few minutes after the consumption of vegetable foods in patients with pollen-induced SAR. PFAS has rarely been investigated in the pediatric population, as it has been mainly examined as an adult disease. Recent studies suggested that PFAS might be more frequent in childhood than previously recognized. The present review aims to give an overview of the epidemiology, pathophysiology, diagnosis, management and prognosis of PFAS in children with SAR-induced by pollens.
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Affiliation(s)
- Carla Mastrorilli
- Pediatric and Emergency Operative Unit, Policlinic Consortium University Hospital-Pediatric Hospital "Giovanni XXIII", 70126 Bari, Italy.
- Pediatric Clinic, University Children's Hospital, Medicine and Surgery Department, University of Parma, 43100 Parma, Italy.
| | - Fabio Cardinale
- Pediatric and Emergency Operative Unit, Policlinic Consortium University Hospital-Pediatric Hospital "Giovanni XXIII", 70126 Bari, Italy.
| | - Arianna Giannetti
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy.
| | - Carlo Caffarelli
- Pediatric Clinic, University Children's Hospital, Medicine and Surgery Department, University of Parma, 43100 Parma, Italy.
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17
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Carlson G, Coop C. Pollen food allergy syndrome (PFAS): A review of current available literature. Ann Allergy Asthma Immunol 2019; 123:359-365. [PMID: 31376490 DOI: 10.1016/j.anai.2019.07.022] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/16/2019] [Accepted: 07/24/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Pollen food allergy syndrome (PFAS) is a complex syndrome posing a diagnostic and therapeutic challenge. Our objective was to summarize the available literature regarding its prevalence, pathogenesis, diagnosis, and treatment. DATA SOURCES A PubMed search was performed to include English language articles with the following search terms: pollen food syndrome, pollen food allergy syndrome, PFAS, oral allergy syndrome, OAS, food anaphylaxis, food components. STUDY SELECTIONS Human articles discussing PFAS. RESULTS Varying reports have been made of the prevalence of PFAS, ranging from 4.7% to greater than 20% in children and 13% to 58% in adults. Prevalence varies widely by geographic region. PFAS is typically the results of class II food allergens (e.g. sensitized to anaeroallergen, but reaction occurs due to cross reactivity from a food allergen). Commonly these reactions are limited to the oropharynx due to the lability of the proteins causing the reaction. As multiple families of proteins with varying stability cause PFAS, severe systemic reactions are also possible, as anaphylactic shock has been documented in up to 1.7% of reactions. CONCLUSION Pollen food allergy syndrome therefore cannot be dismissed as a benign food allergy, but it needs to be approached individually based on known risk factors.
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Affiliation(s)
- Geoffrey Carlson
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland AFB, Texas.
| | - Christopher Coop
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland AFB, Texas
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Fiocchi A, Ebisawa M. Editorial: Adults are not big children. Curr Opin Allergy Clin Immunol 2019; 19:216-217. [PMID: 31033604 DOI: 10.1097/aci.0000000000000527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
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Kim KI, Lee B, Min TK, Lee J, Pyun BY, Jeon YH. Clinical Characteristics of Oral Allergy Syndrome in Children with Atopic Dermatitis and Birch Sensitization: a Single Center Study. J Korean Med Sci 2019; 34:e11. [PMID: 30636944 PMCID: PMC6327088 DOI: 10.3346/jkms.2019.34.e11] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/17/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Oral allergy syndrome (OAS) is an immunoglobulin E (IgE)-mediated hypersensitivity that occurs frequently in older children with pollen sensitization. This study focused on the clinical characteristics of OAS in children with atopic dermatitis (AD) and birch sensitization. METHOD s: A total of 186 patients aged 2-18 years with AD and birch sensitization were enrolled in this study between January 2016 and March 2017. Their levels of serum total IgE and birch- and ragweed-specific IgE (sIgE) were measured using ImmunoCAP (Thermo Fisher Scientific, Uppsala, Sweden). Information regarding causative foods and symptoms were obtained via interviews. The patients were divided into 3 groups according to their ages (group 1, 2-6 years; group 2, 7-12 years; and group 3, 13-18 years). RESULTS Eighty-one of the 186 (43.5%) children with AD who were sensitized to birch pollen were diagnosed as having OAS. The prevalence of OAS in group 1 (the children who had AD and birch sensitization aged 2-6 years) was 36.6%. A greater predominance of men was noted in the non-OAS group (77.1%) compared to the OAS group (60.5%). Apples were the most common causative food in group 2 and 3 while kiwis were the most common cause of OAS in group 1. There was a statistically significant correlation between birch-sIgE levels and the prevalence of OAS (P = 0.000). The cut-off value was 6.77 kUA/L with 55.6% sensitivity and 79.0% specificity (area under the curve 0.653). CONCLUSION In our study, the prevalence of OAS in children with AD and birch sensitization was 43.5%. Even in the preschool age group, the prevalence of OAS was considerable. Patients with high levels of birch-sIgE were more likely to have OAS. Clinicians should therefore be vigilant about OAS in patients with a high degree of sensitization to birch pollen and even young children if they have birch sensitization.
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Affiliation(s)
- Kang-in Kim
- Pediatric Allergy and Respiratory Center, Department of Pediatrics, Soonchunhyang University Hospital, Seoul, Korea
| | - Bomi Lee
- Pediatric Allergy and Respiratory Center, Department of Pediatrics, Soonchunhyang University Hospital, Seoul, Korea
| | - Taek Ki Min
- Pediatric Allergy and Respiratory Center, Department of Pediatrics, Soonchunhyang University Hospital, Seoul, Korea
| | - Jeongho Lee
- Department of Pediatrics, Soonchunhyang University Hospital, Seoul, Korea
| | - Bok Yang Pyun
- Pediatric Allergy and Respiratory Center, Department of Pediatrics, Soonchunhyang University Hospital, Seoul, Korea
| | - You Hoon Jeon
- Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
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Abstract
The skin is outermost barrier of the body and protects us from various kinds of external stimuli. The barrier function of the skin is, however, not wholly perfect but include some 'security holes' where external antigen invades in. Further, external antigens themselves have some specific shunt pathways to breach the skin barrier. Recent studies revealed that percutaneous sensitization is a strong inducer of systemic immune responses and it is now considered that majority of food allergy is sensitized through body surfaces. Thus, to know about the fundamental structure of the skin barrier and its potential weak spots must be important for understanding the pathomechanism of 'skin-originated' allergic diseases. In this review, I overview the fundamental features of the skin barrier, and then, will discuss the pathomechanism how external antigens breach the barrier and induce subsequent systemic allergic reactions.
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Affiliation(s)
- Gyohei Egawa
- a Department of Dermatology , Kyoto University Graduate School of Medicine , Kyoto , Japan
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Olcese R, Silvestri M, Del Barba P, Brolatti N, Barberi S, Tosca MA, Ciprandi G. Mal d 1 and Bet v 1 sensitization pattern in children with Pollen Food Syndrome. Allergol Int 2019; 68:122-124. [PMID: 30100347 DOI: 10.1016/j.alit.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/11/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022] Open
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Hallmann E, Rozpara E, Słowianek M, Leszczyńska J. The effect of organic and conventional farm management on the allergenic potency and bioactive compounds status of apricots (Prunus armeniaca L.). Food Chem 2018; 279:171-178. [PMID: 30611476 DOI: 10.1016/j.foodchem.2018.12.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/01/2018] [Accepted: 12/04/2018] [Indexed: 12/01/2022]
Abstract
The present study shows a relationship between the use of organic or conventional practices and the allergenic properties and the bioactive compound content of apricots. The presented results indicate that organic apricots contain significantly more biologically active compounds from polyphenols group 53.75 mg/100 g FW and 31.52 mg/100 g FW and carotenoids 10.90 mg/100 g FW and 8.42 mg/100 g FW in than conventional apricots from polyphenols 16.83 mg/100 g FW and 27.27 mg/100 g FW and carotenoids 4.01 mg/100 g FW and 3.85 mg/100 g FW. Organic fruits are characterized by a higher allergenic potential. The authors of the current research have found a strong relationship between the content of polyphenolic compounds and the content of allergenic proteins for organic apricots R2 = 0.9044 and for conventional apricots R2 = 0.8169. The main conclusion is that some organic apricots, despite their better quality, would not be recommended for consumption by allergy sufferers.
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Affiliation(s)
- E Hallmann
- Warsaw University of Life Sciences, Faculty of Human Nutrition and Consumer Sciences, Department of Functional, Organic Food and Commodities, Nowoursynowska 159c, 02-776 Warsaw, Poland.
| | - E Rozpara
- Research Institute of Horticulture, Department of Pomology, Gene Resources and Nursery, Konstytucji 3 Maja 1/3, 96-100 Skierniewice, Poland
| | - M Słowianek
- Lodz University of Technology, Institute of General Food Chemistry, Faculty of Biotechnology and Food Sciences, Stefanowskiego 4/10, 90-924 Lodz, Poland
| | - J Leszczyńska
- Lodz University of Technology, Institute of General Food Chemistry, Faculty of Biotechnology and Food Sciences, Stefanowskiego 4/10, 90-924 Lodz, Poland
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Magnusdottir H, Vidarsdóttir A, Ludviksson B, Clausen M, Lund S, Jensen A, Sigurdardottir S. Ara h 1 and Ara h 6 Sensitization Causes Clinical Peanut Allergy in Ara h 2-Negative Individuals. Int Arch Allergy Immunol 2018; 178:66-75. [DOI: 10.1159/000493327] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/28/2018] [Indexed: 11/19/2022] Open
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Waibel K, Lee R, Coop C, Mendoza Y, White K. Food allergy guidance in the United States military: A work group report from the American Academy of Allergy, Asthma & Immunology's Military Allergy and Immunology Assembly. J Allergy Clin Immunol 2018; 142:54-59. [PMID: 29777733 DOI: 10.1016/j.jaci.2018.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 05/02/2018] [Accepted: 05/10/2018] [Indexed: 10/16/2022]
Abstract
A diagnosis of food allergy adversely affects one's ability to join or remain in the military. Inadequate knowledge or misconceptions of current military-specific standards regarding food allergy and how these apply to enlistment, induction, and retention in the US military can lead potentially to inaccurate counseling because each military service has specific regulations that affect the evaluation and decision-making process. Recognizing this knowledge gap, the American Academy of Allergy, Asthma & Immunology's Military Allergy and Immunology Assembly established a work group that reviewed and summarized all aspects of military instructions, policies, and regulations regarding IgE-mediated food allergy. A flowchart was developed outlining each step of the military entry process for an applicant with a history of food allergy. Furthermore, summary tables were made to provide improved "fluency" regarding each service's medical regulations, whereas key considerations were outlined for the allergist who is evaluating a subject who is seeking military entry or retention. Both civilian and military allergists play an essential role in the evaluation, counseling, and management of patients with a food allergy history. Understanding the service-specific language and regulations regarding food allergy will improve the allergist's awareness, counseling, and management of these individuals.
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Affiliation(s)
- Kirk Waibel
- Allergy Service, Division of Medicine, Landstuhl Regional Medical Center, Landstuhl, Germany.
| | - Rachel Lee
- Division of Allergy & Immunology, Department of Internal Medicine, Naval Medical Center, San Diego, Calif
| | - Christopher Coop
- Department of Allergy and Immunology, Wilford Hall Ambulatory Surgical Center, San Antonio, Tex
| | - Yun Mendoza
- Allergy Service, Division of Medicine, Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Kevin White
- Allergy and Immunization Clinic, 48th Medical Group, Lakenheath, United Kingdom
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Tuano KTS, Davis CM. Oral allergy syndrome in shrimp and house dust mite allergies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:2163-2164. [PMID: 29751156 DOI: 10.1016/j.jaip.2018.04.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/22/2018] [Accepted: 04/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Karen Thursday S Tuano
- Department of Pediatrics, Section of Immunology, Allergy and Rheumatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex.
| | - Carla M Davis
- Department of Pediatrics, Section of Immunology, Allergy and Rheumatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex
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Mäkelä MJ, Gyllfors P, Valovirta E, Steffensen MA, Grønager PM, Savolainen J, Winther L. Immunotherapy With the SQ Tree SLIT-tablet in Adults and Adolescents With Allergic Rhinoconjunctivitis. Clin Ther 2018; 40:574-586.e4. [PMID: 29551533 DOI: 10.1016/j.clinthera.2018.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/14/2018] [Accepted: 02/16/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE The SQ tree sublingual immunotherapy (SLIT)-tablet containing allergen extracts with the major allergen Bet v 1 from birch pollen is currently being developed for the treatment of tree pollen-induced allergic rhinitis/conjunctivitis with or without asthma. The aim of this Phase II trial was to investigate the dose-related efficacy and safety of the SQ tree SLIT-tablet. METHODS This study was a randomized, parallel-group, double-blind, placebo-controlled, multi-national trial conducted in Europe. A total of 637 participants were randomized equally to receive placebo or treatment with the SQ tree SLIT-tablet in doses of 0.5, 1, 2, 4, 7, or 12 development units (DU). Treatment was initiated ~16 weeks before onset of the 2013 birch pollen season (BPS) and was continued throughout the BPS with a total duration of at least 6 months. During the BPS and tree pollen season (TPS), subjects assessed rhinoconjunctivitis symptoms and medication use on a daily basis in an electronic diary; weekly assessments of rhinoconjunctivitis quality of life were also made. FINDINGS Analysis of the average daily symptom score during the BPS and the TPS showed that the difference between active treatment and placebo was statistically significant for the 7 DU group (BPS, P = 0.02; TPS, P = 0.03), with no clear dose-response relationship. All doses of the SQ tree SLIT-tablet induced changes from baseline in birch-specific IgE and IgG4 that were statistically significant compared with placebo at all time points assessed (P < 0.0001) with a clear dose-response relationship for birch specific IgG4. In general, the SQ tree SLIT-tablet was well tolerated, with the majority of treatment-related adverse events (≥95%) being mild or moderate in severity. The most frequently reported treatment-related adverse events were generally related to the sublingual administration of the tablet (ie, they occurred in the oral cavity). IMPLICATIONS The results from this trial suggest that the SQ tree SLIT-tablet in doses up to 12 DU has a tolerability profile suitable for at-home administration. The immunomodulatory changes indicate a dose-response relationship, but clinical efficacy parameters were inconclusive, probably due to low pollen counts, emphasizing the importance of pollen exposure for the outcome of a pollen allergy immunotherapy trial. EudraCT no: 2012-000031-59.
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Affiliation(s)
- Mika J Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Pär Gyllfors
- Asthma & Allergy Department, St. Göran's Hospital, Sweden
| | - Erkka Valovirta
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland; Terveystalo Allergy Clinic, Helsinki, Finland
| | | | | | - Johannes Savolainen
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Lone Winther
- Department of Dermato-Allergology, Copenhagen University Hospital, Copenhagen, Denmark
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27
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Iliopoulou A, Petrodimopoulou M, Konstantakopoulou M, Pasioti M, Papadopoulou A, Mikos N, Kompoti E, Korakianitis I, Kontogianni M, Pitsios C. Profilin sensitization and its clinical relevance to a population of atopic adults in Greece. REVUE FRANCAISE D ALLERGOLOGIE 2018. [DOI: 10.1016/j.reval.2017.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Venter C, Groetch M, Netting M, Meyer R. A patient-specific approach to develop an exclusion diet to manage food allergy in infants and children. Clin Exp Allergy 2018; 48:121-137. [DOI: 10.1111/cea.13087] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 12/19/2022]
Affiliation(s)
- C. Venter
- Children's Hospital Colorado; University of Colorado; Aurora CO USA
| | - M. Groetch
- Icahn School of Medicine at Mount Sinai; Jaffe Food Allergy Institute; New York NY USA
| | - M. Netting
- Healthy Mothers Babies and Children's Theme; South Australian Health & Medical Research Institute; Adelaide SA Australia
- Discipline of Paediatrics; School of Medicine; University of Adelaide; Adelaide SA Australia
- Nutrition Department; Women's and Children's Health Network; Adelaide SA Australia
| | - R. Meyer
- Department Paediatrics; Imperial College; London UK
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29
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Park YA, Jeong KU, Kim YH, Sol IS, Kim KW, Sohn MH, Lee SY, Kim KE. Etiology and clinical feature of oral allergy syndrome in children. ALLERGY ASTHMA & RESPIRATORY DISEASE 2018. [DOI: 10.4168/aard.2018.6.4.219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Young A Park
- Department of Pediatrics and Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung-Uk Jeong
- Department of Pediatrics, Ajou University College of Medicine, Suwon, Korea
| | - Yoon Hee Kim
- Department of Pediatrics and Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - In Suk Sol
- Department of Pediatrics and Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics and Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics and Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Young Lee
- Department of Pediatrics, Ajou University College of Medicine, Suwon, Korea
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Abstract
Understanding the epidemiology of food allergy is complicated by the difficulty of identifying it on a large scale. The prevalence of food allergy is higher in younger age groups and decreases with age. Allergy to peanut and egg seems to be more common in Northern Europe, the United States, Canada and Australia compared with Southern Europe, Eastern Europe and Asia, whereas shellfish and fish allergies may be more common in Asia. The rate of transient unrecognized food allergy may be high and variable recognition of food allergy may explain some of the differences seen in food allergy prevalence.
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Affiliation(s)
- Joan H Dunlop
- Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, CMSC 1102, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Corinne A Keet
- Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, CMSC 1102, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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Should patients with pollen fruit syndrome be prescribed an automatic epinephrine injector? Curr Opin Allergy Clin Immunol 2017; 16:370-4. [PMID: 27362323 DOI: 10.1097/aci.0000000000000278] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE OF REVIEW The review outlines recent insights into our understanding of the complex relationships between pollen and plant food sensitization patterns resulting in the pollen fruit syndrome and the possible risk, upon ingestion, of generalized symptoms rather than localized oropharyngeal reactions. Appreciation of this risk will inform management strategies, which include epinephrine prescription. RECENT FINDINGS In recent times, the ability to examine molecular components of foods and pollen has allowed further delineation of reactivity patterns. These reveal complex patterns of IgE reactivity and sensitization pathways. More precise definition of these patterns will allow a more accurate analysis of risk of severe food reactions following ingestion. SUMMARY Despite improvement in diagnostic tests, there remains no completely reliable way to determine whether an individual with pollen fruit syndrome is at risk of a systemic reaction. The decision to prescribe an epinephrine autoinjector must be based on a risk assessment for the individual patient.
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Galectin-1 inhibits oral-intestinal allergy syndrome. Oncotarget 2017; 8:13214-13222. [PMID: 28086216 PMCID: PMC5355090 DOI: 10.18632/oncotarget.14571] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 12/27/2016] [Indexed: 11/25/2022] Open
Abstract
Background and aims The pathogenesis of oral-intestinal allergy syndrome (OIAS) has not been well understood. Published data indicate that galectin (Gal) 1 has immune regulatory functions. This study tests a hypothesis that Gal1 inhibits oral-intestinal allergy syndrome. Methods Mice were sensitized to peanut extracts (PE) via the buccal mucosa with or without using Gal1 together. Results Upon re-exposure to specific antigen, the OIAS mice showed the systemic allergic response, the oral allergic reactions, and intestinal allergic inflammation, including increases in serum histamine, drop of the core temperature, higher levels of PE-specific IgE and interleukin (IL)-4. Increases in mast cell and eosinophil in the oral mucosa and intestinal mucosa were also observed. The OIAS was inhibited by co-administration with Gal1 via a mechanism of suppressing micro RNA (miR)-98 and reversing the expression of IL-10 in CD14+ cells in the intestine. Conclusions The OIAS can be induced by applying specific antigens to the oral mucosa, which can be inhibited by co-administration with Gal1.
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Bedolla-Barajas M, Kestler-Gramajo A, Alcalá-Padilla G, Morales-Romero J. Prevalence of oral allergy syndrome in children with allergic diseases. Allergol Immunopathol (Madr) 2017; 45:127-133. [PMID: 27567321 DOI: 10.1016/j.aller.2016.04.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 04/27/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The oral allergy syndrome (OAS) is a particular type of food allergy rarely explored in the paediatric population that is already considered an adult problem. OBJECTIVE Identify the prevalence of OAS, symptoms and pollen species associated with its presence in children affected by allergic diseases. METHODS A cross-sectional study was conducted. Consecutive sampling included children from 6 to 14 years who needed allergy treatment for the first time. A structured questionnaire was carried out to collect demographic and clinical data and history of OAS. Besides sensitisation to various allergens, the skin prick-by-prick test was performed to corroborate sensitisation to food related to OAS. Prevalence of OAS and its association with pollens was established following the covariate adjusted logistic regression. RESULTS 267 subjects were included. Overall prevalence of OAS was 8.9% (95%CI 6.1-13.1%). Prevalence of OAS for allergic rhinitis and asthma were 8.8% and 9.1%, respectively. In patients sensitised to pollen, the prevalence ranged from 9.6% to 12.2% depending on the type of pollen. 62.5% of children with OAS were sensitive to pineapple. After adjusting for gender and family history of atopic disease, trees from the Quercus species showed an association with OAS (OR=2.7, 95%CI 1.2-6.2). CONCLUSIONS OAS is not uncommon in our environment. Pineapple, a typical fruit from the region, was the main food related. Quercus sp., but not birch nor olive, was the pollen associated with this syndrome.
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Affiliation(s)
- M Bedolla-Barajas
- Servicio de Alergia e Inmunología Clínica, Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Salvador de Quevedo y Zubieta No. 750, Colonia La Perla, Guadalajara, Jalisco, C. P. 44340, Mexico.
| | - A Kestler-Gramajo
- Servicio de Alergología e Inmunología Clínica, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Coronel Calderón No. 777, Colonia El Retiro, Guadalajara, Jalisco, C. P. 44280, Mexico
| | - G Alcalá-Padilla
- Servicio de Alergología e Inmunología Clínica, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Coronel Calderón No. 777, Colonia El Retiro, Guadalajara, Jalisco, C. P. 44280, Mexico; Centro Universitario en Ciencias de la Salud, Universidad de Guadalajara, Sierra Mojada No. 950, Colonia Independencia Oriente, Guadalajara, Jalisco, C.P. 44340, Mexico
| | - J Morales-Romero
- Instituto de Salud Pública, Universidad Veracruzana, Av. Luis Castelazo Ayala s/n., Colonia Industrial Ánimas, Xalapa, Veracruz, C. P. 91190, Mexico
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Kim YH, Yang HJ, Choi JH, Kim DK, Yoo Y, Lee B, Kim MA, Kim BS, Kim WY, Kim JH, Park Y, Park SY, Bae WY, Song K, Yang MS, Lee SM, Lee YM, Lee HJ, Cho JH, Jee HM, Koh YI. Clinical diagnostic guidelines for allergic rhinitis: diagnosis. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2017. [DOI: 10.5124/jkma.2017.60.1.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Young Hyo Kim
- Department of Otorhinolaryngology, Inha University College of Medicine, Incheon, Korea
| | - Hyeon-Jong Yang
- Department of Pediatrics, Soonchunhyang University College of Medicine, Seoul, Korea
- SCH Biomedical Informatics Research Unit, Seoul, Korea
| | - Jeong-Hee Choi
- Department of Pulmonology and Allergy, Hallym University College of Medicine, Chuncheon, Korea
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Young Yoo
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
- Allergy Immunology Center, Korea University, Seoul, Korea
| | - Bora Lee
- Department of Biostatistics, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Mi-Ae Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Bong-Seong Kim
- Department of Pediatrics, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | | | - Jeong Hee Kim
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
| | - Yang Park
- Department of Pediatrics, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea
| | | | - Woo Yong Bae
- Department of Otorhinolaryngology, Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Keejae Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Catholic Kwandong Universtiy College of Medicine, Incheon, Korea
| | - Min-Suk Yang
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Sang Min Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gachon University College of Medicine, Incheon, Korea
| | | | | | | | - Hye Mi Jee
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea
| | - Young-Il Koh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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Lötzsch B, Dölle S, Vieths S, Worm M. Exploratory analysis of CD63 and CD203c expression in basophils from hazelnut sensitized and allergic individuals. Clin Transl Allergy 2016; 6:45. [PMID: 27999658 PMCID: PMC5153676 DOI: 10.1186/s13601-016-0134-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 11/18/2016] [Indexed: 04/26/2023] Open
Abstract
Background Sensitization to hazelnut (HN) is frequent and requires clarification to determine whether this sensitization is clinically relevant. The aim of this study was to investigate basophil activation profiles in HN-sensitized and allergic subjects. Methods Basophil activation was determined by flow cytometric analyses of CD63 and CD203c expression using several HN allergen concentrations. Depending on their clinical reaction pattern, an oral allergy symptom group (OAS, n = 20), a systemic reaction group (n = 12) and a sensitized group without clinical symptoms (n = 20) were identified. Additionally, 10 non-allergic and non-sensitized individuals served as controls. Results CD63 and CD203c expression differed between allergic (OAS and systemic group) and sensitized subjects. The HN concentration required to activate 30% of CD203c+ basophils [effective concentration (EC)30] was significantly higher in sensitized versus the allergic group (p = 0.0089). This was more pronounced when the basophil allergen threshold sensitivity (CD-sens) was calculated (CD63: p = 0.018; CD203c: p = 0.009). Conclusion Our data indicate that the basophil activation test may provide information to better distinguish between sensitized and allergic subjects if several allergen concentrations are considered. CD203c expression displayed a better discrimination compared to CD63; therefore, its diagnostic value might be superior compared with CD63. Electronic supplementary material The online version of this article (doi:10.1186/s13601-016-0134-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bianca Lötzsch
- Department of Dermatology and Allergology, Allergy-Center-Charité, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sabine Dölle
- Department of Dermatology and Allergology, Allergy-Center-Charité, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | | | - Margitta Worm
- Department of Dermatology and Allergology, Allergy-Center-Charité, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Mastrorilli C, Tripodi S, Caffarelli C, Perna S, Di Rienzo-Businco A, Sfika I, Asero R, Dondi A, Bianchi A, Povesi Dascola C, Ricci G, Cipriani F, Maiello N, Miraglia Del Giudice M, Frediani T, Frediani S, Macrì F, Pistoletti C, Dello Iacono I, Patria MF, Varin E, Peroni D, Comberiati P, Chini L, Moschese V, Lucarelli S, Bernardini R, Pingitore G, Pelosi U, Olcese R, Moretti M, Cirisano A, Faggian D, Travaglini A, Plebani M, Verga MC, Calvani M, Giordani P, Matricardi PM. Endotypes of pollen-food syndrome in children with seasonal allergic rhinoconjunctivitis: a molecular classification. Allergy 2016; 71:1181-91. [PMID: 26999633 DOI: 10.1111/all.12888] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pollen-food syndrome (PFS) is heterogeneous with regard to triggers, severity, natural history, comorbidities, and response to treatment. Our study aimed to classify different endotypes of PFS based on IgE sensitization to panallergens. METHODS We examined 1271 Italian children (age 4-18 years) with seasonal allergic rhinoconjunctivitis (SAR). Foods triggering PFS were acquired by questionnaire. Skin prick tests were performed with commercial pollen extracts. IgE to panallergens Phl p 12 (profilin), Bet v 1 (PR-10), and Pru p 3 (nsLTP) were tested by ImmunoCAP FEIA. An unsupervised hierarchical agglomerative clustering method was applied within PFS population. RESULTS PFS was observed in 300/1271 children (24%). Cluster analysis identified five PFS endotypes linked to panallergen IgE sensitization: (i) cosensitization to ≥2 panallergens ('multi-panallergen PFS'); (ii-iv) sensitization to either profilin, or nsLTP, or PR-10 ('mono-panallergen PFS'); (v) no sensitization to panallergens ('no-panallergen PFS'). These endotypes showed peculiar characteristics: (i) 'multi-panallergen PFS': severe disease with frequent allergic comorbidities and multiple offending foods; (ii) 'profilin PFS': oral allergy syndrome (OAS) triggered by Cucurbitaceae; (iii) 'LTP PFS': living in Southern Italy, OAS triggered by hazelnut and peanut; (iv) 'PR-10 PFS': OAS triggered by Rosaceae; and (v) 'no-panallergen PFS': mild disease and OAS triggered by kiwifruit. CONCLUSIONS In a Mediterranean country characterized by multiple pollen exposures, PFS is a complex and frequent complication of childhood SAR, with five distinct endotypes marked by peculiar profiles of IgE sensitization to panallergens. Prospective studies in cohorts of patients with PFS are now required to test whether this novel classification may be useful for diagnostic and therapeutic purposes in the clinical practice.
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Hao GD, Zheng YW, Wang ZX, Kong XA, Song ZJ, Lai XX, Spangfort MD. High correlation of specific IgE sensitization between birch pollen, soy and apple allergens indicates pollen-food allergy syndrome among birch pollen allergic patients in northern China. J Zhejiang Univ Sci B 2016; 17:399-404. [PMID: 27143268 PMCID: PMC4868831 DOI: 10.1631/jzus.b1500279] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/17/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Birch pollen sensitization and associated pollen-food syndrome among Chinese allergic patients have not been investigated. METHODS Sera from 203 allergic patients from the northern part of China and collected during February to July 2014 were investigated. Specific immunoglobulin E (IgE) against birch pollen extract Bet v and major birch pollen allergen Bet v 1 were measured using the ADVIA Centaur. The presence of major apple allergen Mal d 1 and soy bean allergen Gly m 4 specific IgE was measured by ImmunoCAP 100. RESULTS Among the 203 sera, 34 sera (16.7%) had specific IgE to Bet v and of these, 28 sera (82.4%) contained Bet v 1-specific IgE. Among the 28 sera with Bet v 1-specific IgE, 27 sera (96.4%) contained Mal d 1-specific IgE and 22 sera (78.6%) contained Gly m 4-specific IgE. Of the 34 Bet v-positive sera, 6 sera (17.6%) contained no specific IgE for Bet v 1, Mal d 1, or Gly m 4. Almost all Bet v-positive sera were donated during the birch pollen season. CONCLUSIONS The prevalence of birch allergy among patients visiting health care during pollen season can be as high as 16.7% in Tangshan City. The majority of Chinese birch allergic patients are IgE-sensitized to the major birch pollen allergen Bet v 1 as well as to the major apple allergen Mal d 1 and soy bean allergen Gly m 4. A relatively high number of patients (17.6%) are IgE-sensitized to birch pollen allergen(s) other than Bet v 1. The high prevalence of specific IgE to Mal d 1 and Gly m 4 among Bet v 1-sensitized patients indicates that pollen-food allergy syndrome could be of clinical relevance in China.
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Affiliation(s)
- Guo-dong Hao
- Department of Allergy, Tangshan Gongren Hospital, Tangshan 063000, China
| | - Yi-wu Zheng
- ALK China Research, ALK, Guangzhou 510300, China
| | - Zhi-xiang Wang
- Department of Allergy, Tangshan Gongren Hospital, Tangshan 063000, China
| | - Xing-ai Kong
- Department of Allergy, Tangshan Gongren Hospital, Tangshan 063000, China
| | - Zhi-jing Song
- Department of Allergy, Tangshan Gongren Hospital, Tangshan 063000, China
| | - Xu-xin Lai
- ALK China Research, ALK, Guangzhou 510300, China
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Ludman S, Jafari-Mamaghani M, Ebling R, Fox AT, Lack G, Du Toit G. Pollen food syndrome amongst children with seasonal allergic rhinitis attending allergy clinic. Pediatr Allergy Immunol 2016; 27:134-40. [PMID: 26534786 DOI: 10.1111/pai.12504] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is limited information regarding the onset and sensitization patterns of pollen food syndrome (PFS) in children. The aim was to explore this within children referred to a specialist allergy clinic at a London Tertiary Hospital. METHODS A total of 54 patients with seasonal allergic rhinitis (SAR) were enrolled in equal numbers in three age groups; 0-5, 6-10, 11-15 years. Families completed a questionnaire on rhinitis, food symptoms and quality of life. Children underwent skin prick testing (SPT) to fresh fruits, nuts and a blood test for microarray analysis. RESULTS Clinical diagnosis of PFS was made in 26/54 (48%), increasing with age (group 1 = 3 (17%), group 2 = 9 (50%), group 3 = 14 (78%) (p = 0.03)). Microarray demonstrates children aged 2.8 years sensitized to pan-allergens and 4.5 years symptomatic to pan-allergens. Peach, cherry, carrot and strawberry SPT had the highest sensitivity and NPV at 100%. The sensitivity of PR10 molecules on microarray was 92%, PPV 62% and NPV 87%. Microarray confirmed 69% of allergens on clinical history compared to 61% by SPT. Microarray and SPT had a 19% false-negative rate. The quality-of-life data showed moderate impact across all domains, and patients with PFS were significantly more likely to have increased anxiety over time spent preparing food (p = 0.029). CONCLUSIONS We demonstrate that SAR occurs in children from 1.4 years and PFS from 4.5 years with a changing pattern of pan-allergen sensitization. Microarray and SPT have moderate concordance in confirming allergens. PFS impacts negatively on quality of life and should be assessed in all paediatric allergy patients.
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Affiliation(s)
- Sian Ludman
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | - Rosemary Ebling
- Division of Asthma, Allergy and Lung Biology, Diagnostic Immunology, King's College London, Viapath, London, UK
| | - Adam T Fox
- Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gideon Lack
- Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - George Du Toit
- Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Brough HA, Turner PJ, Wright T, Fox AT, Taylor SL, Warner JO, Lack G. Dietary management of peanut and tree nut allergy: what exactly should patients avoid? Clin Exp Allergy 2016; 45:859-871. [PMID: 25443673 DOI: 10.1111/cea.12466] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Peanut and tree nut allergies are the commonest cause of life-threatening food-allergic reactions and significantly affect quality of life in children and their families. Dietary nut avoidance and provision of emergency medication is currently the mainstay of treatment. Nut avoidance has consequences on both quality of life and nutrition. We review the terminology that may cause confusion and lead to unnecessary dietary restrictions. In peanut or tree nut-allergic children, introduction of specific nuts to which the child is not allergic may improve quality of life and should be considered in patients with multiple foods allergies, vegan or ethnic-specific diets, in whom nuts are an important source of protein. Nut-allergic consumers do not just need to avoid foods containing nuts as an ingredient, but also contend with pre-packed foods which frequently have precautionary allergen labelling (PAL) referring to possible nut contamination. Although the published rate of peanut contamination in 'snack' foods with PAL (see Box ) ranges from 0.9-32.4%, peanut contamination in non-snack items with PAL is far less common. We propose that in some peanut-allergic patients (depending on history of reactivity to trace levels of peanut, reaction severity, other medical conditions, willingness to always carry adrenaline, etc.), consideration may be given to allow the consumption of non-snack foods containing PAL following discussion with the patient's (and their family's) specialist. More work is needed to provide consumers with clearer information on the risk of potential nut contamination in pre-packed food. We also draw attention to the change in legislation in December 2014 that require mandatory disclosure of allergens in non-pre-packed foods.
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Affiliation(s)
- H A Brough
- Children's Allergy Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Division of Asthma, Allergy and Lung Biology & MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
| | - P J Turner
- Section of Paediatrics (Allergy & Immunology) & MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust / NIHR Biomedical Research Unit.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - T Wright
- Children's Allergy Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - A T Fox
- Children's Allergy Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Division of Asthma, Allergy and Lung Biology & MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
| | - S L Taylor
- Food Allergy Research & Resource Program, Department of Food Science & Technology, University of Nebraska, Lincoln, NE, USA
| | - J O Warner
- Section of Paediatrics (Allergy & Immunology) & MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust / NIHR Biomedical Research Unit
| | - G Lack
- Children's Allergy Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Division of Asthma, Allergy and Lung Biology & MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
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40
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Breiteneder H. Grundlagen natürlicher Allergene. ALLERGOLOGIE 2016. [DOI: 10.1007/978-3-642-37203-2_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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41
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Chokshi NY, Sicherer SH. Interpreting IgE sensitization tests in food allergy. Expert Rev Clin Immunol 2015; 12:389-403. [DOI: 10.1586/1744666x.2016.1124761] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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42
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Guidelines for the use and interpretation of diagnostic methods in adult food allergy. Clin Mol Allergy 2015; 13:27. [PMID: 26441488 PMCID: PMC4593201 DOI: 10.1186/s12948-015-0033-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 09/15/2015] [Indexed: 12/27/2022] Open
Abstract
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.
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43
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Turner PJ, Campbell DE. A food allergy syndrome by any other name? Clin Exp Allergy 2015; 44:1458-60. [PMID: 25418448 DOI: 10.1111/cea.12425] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- P J Turner
- Section of Paediatrics (Allergy and Infectious Diseases) and MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK; Division of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
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44
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Just J, Saint Pierre P, Amat F, Gouvis-Echraghi R, Lambert-Guillemot N, Guiddir T, Annesi Maesano I. What lessons can be learned about asthma phenotypes in children from cohort studies? Pediatr Allergy Immunol 2015; 26:300-5. [PMID: 25703953 DOI: 10.1111/pai.12359] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2015] [Indexed: 01/01/2023]
Abstract
'Phenotyping' asthma by multivariate analyses and more recently by unsupervised analysis has been performed in children cohorts. We describe the key findings that have emerged from these cohorts. It would appear that there are three wheeze phenotypes in children of preschool age: the mild episodic viral wheeze phenotype; the multitrigger atopic wheeze; and, less often encountered, the severe non-atopic wheeze. Early onset of allergy in asthma (more prevalent in boys) is associated with poor prognosis unlike the severe non-atopic wheeze phenotype which has a female predominance. The prognosis of the severe non-atopic wheeze depends on time of onset (early or late) of allergic expression. At school age, the risk of severe asthmatic exacerbations is associated with eosinophil predominant inflammation frequently related to allergic asthma, whereas neutrophil inflammation is associated with moderate-to-severe asthma with poorer lung function. Nevertheless, allergic asthma is also a heterogeneous disease with a severe allergic phenotype strongly associated with atopic dermatitis and very high eosinophil-driven inflammatory markers. Further studies are required to find non-invasive biological markers in very young children to better define wheezing phenotypes associated with an elevated risk of developing severe asthma with a view to personalizing treatment.
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Affiliation(s)
- J Just
- Allergology Department, Centre de l'Asthme et des Allergies. Hôpital d'Enfants Armand-Trousseau (APHP) -, APHP, Paris 75012, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, Paris, France
| | - P Saint Pierre
- Laboratoire de statistiques théoriques et appliquées, Université Pierre et Marie Curie - Paris 06, Paris, France
| | - F Amat
- Allergology Department, Centre de l'Asthme et des Allergies. Hôpital d'Enfants Armand-Trousseau (APHP) -, APHP, Paris 75012, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, Paris, France
| | - R Gouvis-Echraghi
- Allergology Department, Centre de l'Asthme et des Allergies. Hôpital d'Enfants Armand-Trousseau (APHP) -, APHP, Paris 75012, France
| | - N Lambert-Guillemot
- Allergology Department, Centre de l'Asthme et des Allergies. Hôpital d'Enfants Armand-Trousseau (APHP) -, APHP, Paris 75012, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, Paris, France
| | - T Guiddir
- Allergology Department, Centre de l'Asthme et des Allergies. Hôpital d'Enfants Armand-Trousseau (APHP) -, APHP, Paris 75012, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, Paris, France
| | - I Annesi Maesano
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, Paris, France
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Abstract
Oral allergy syndrome (OAS) is an allergic reaction that occurs after consumption of fresh fruits and vegetables in patients with allergy to pollen. It is mediated by immunoglobulin E (IgE) antibodies and symptoms arise as a result of cross-reactivity between pollen and plant-derived food. OAS is rarely seen in young children, but the prevalence increases with age. The objectives of the study were to identify the prevalence of OAS and probable risk factors in children and adolescents with seasonal allergic rhinitis (AR). One-hundred and twenty patients with seasonal AR were included. Patients were diagnosed based on their clinical history, skin prick test outcome and specific IgE. In patients describing OAS, prick-by-prick tests with fresh fruit or vegetables were carried out. Thirty-two patients had OAS and it was more frequent in female patients than in male patients. OAS was more frequent in adolescents than in small children and in patients with higher total IgE. OAS was significantly more prevalent in patients with AR and asthma (P=0.0016), as was the case in patients with AR and atopic dermatitis (P=0.0004). OAS is rarely diagnosed in small children, partly because of an inadequate clinical history. Patients with OAS may have some risk factors in addition to pollen allergy, and those with more severe atopy are more likely to develop OAS.
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Affiliation(s)
- Irena Ivković-Jureković
- Pediatric Clinic, Department of Pulmonology, Allergology, Immunology and Rheumatology, Children's Hospital Zagreb, Zagreb, Croatia
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Turner PJ, Dawson TC, Skypala IJ, Fox AT. Management of pollen food and oral allergy syndrome by health care professionals in the United Kingdom. Ann Allergy Asthma Immunol 2015; 114:427-8.e1. [PMID: 25771156 DOI: 10.1016/j.anai.2015.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 02/04/2015] [Accepted: 02/11/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Paul J Turner
- Section of Paediatrics (Allergy & Infectious Diseases), MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, England.
| | - Tom C Dawson
- Section of Paediatrics (Allergy & Infectious Diseases), MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, England
| | - Isabel J Skypala
- Rehabilitation & Therapies Directorate, Royal Brompton & Harefield NHS Foundation Trust, London, England
| | - Adam T Fox
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Division of Asthma, Allergy and Lung Biology, King's College London, London, England; Department of Pediatric Allergy, Guy's and St Thomas' NHS Foundation Trust, London, England
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Abstract
Food allergies have increased in recent decades. However, they cannot be effectively treated by the current management, which is limited to the identification and avoidance of foods that induce allergies and to the use of medicines for symptoms relief. To meet the medical need of prevention and cure of food allergies, several therapeutic strategies are under investigation. Some newly developed biologics such as anti-IgE antibody and anti-interleukin (IL)-5 antibody directed against significant molecules in the allergic process have shown their potential for the treatment of food allergies. Allergen-specific immunotherapy is the therapy that induces immune tolerance and may reduce the need for conventional medication, severity of allergic symptoms and eliminate hypersensitivity. In this article, clinical studies of immunotherapy via subcutaneous, oral, sublingual, and epicutaneous routes are extensively reviewed for their safety and effectiveness on various food allergies. In addition, to reduce the risk of anaphylaxis and increase toleragenic immunity, many studies are focusing on the modification of traditional allergens used for immunotherapy. Moreover, a Chinese herbal formulation with potential anti-allergic effects is being evaluated for its efficacy in patients with peanut allergy. Although more studies are needed, accumulated data of current studies represent compelling evidence of curative effects of some strategies and give a hope that food allergies are likely to be successfully treated in the future.
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Affiliation(s)
- Yao-Hsu Yang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Number 8 Chung-Shan South Road, Taipei, 10061, Taiwan,
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48
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Brown CE, Katelaris CH. The prevalence of the oral allergy syndrome and pollen-food syndrome in an atopic paediatric population in south-west Sydney. J Paediatr Child Health 2014; 50:795-800. [PMID: 24953857 DOI: 10.1111/jpc.12658] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2014] [Indexed: 11/30/2022]
Abstract
AIM Oral allergy syndrome (OAS) and pollen-food syndrome (PFS) are regarded as uncommon manifestations of paediatric atopic disease. However, little Australian data exist. The aim of this study was to examine the prevalence of OAS in an atopic, paediatric population. METHODS This cross-sectional study assessed 163 patients aged 4-17 years from the Paediatric Allergy & Immunology Clinic at Campbelltown Hospital, which serves a population base >250,000 with approximately 28% under the age of 18 years. A questionnaire was administered and skin prick tests (SPTs) were performed utilising commercial extracts and fresh and frozen fruit samples. Frozen samples were created by reducing fresh fruit to a semi-solid state and storing at -20 degrees Celsius for up to 6 months. RESULTS Within the studied population, the prevalence of OAS was 14.7%, PFS 4.9%, PFS in those with allergic rhinitis 6.25% and PFS in those with allergic rhinitis and pollen sensitisation 12.1%. All PFS-implicated fruits were tropical fruits with watermelon the most common. The prevalence of OAS caused by food allergy was 13.6%, implicating peanut most frequently. The most common cause of OAS was immunoglobulin E-mediated food allergy (57.9%). Only frozen samples of watermelon, pineapple and rockmelon produced results consistent with the 'gold standard' of fresh fruit SPT. CONCLUSION This study suggests the prevalence of OAS and PFS are more common in paediatric populations than previously described, with tropical fruits predominantly implicated in PFS. Further research is required to determine whether frozen fruits are a reliable alternative to fresh fruit in SPT.
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Affiliation(s)
- Cassandra Eb Brown
- Faculty of Medicine, University of Western Sydney, Campbelltown, New South Wales, Australia
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49
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Luengo O, Cardona V. Component resolved diagnosis: when should it be used? Clin Transl Allergy 2014; 4:28. [PMID: 25250172 PMCID: PMC4171720 DOI: 10.1186/2045-7022-4-28] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 08/13/2014] [Indexed: 02/03/2023] Open
Abstract
The knowledge on molecular allergy diagnosis is continuously evolving. It is now time for the clinician to integrate this knowledge and use it when needed to improve the accuracy of diagnosis and thus provide more precise therapeutic and avoidance measures. This review does not intend to comprehensively analyze all the available allergen molecules, but to provide some practical clues on use and interpretation of molecular allergy diagnosis. The potential role of component resolved diagnosis in circumstances such as the indication of allergen immunotherapy, pollen polysensitization, food allergy, latex allergy or anaphylaxis, is assessed. Interpreting the information provided by molecular allergy diagnosis needs a structured approach. It is necessary to evaluate single positivities and negativities, but also to appraise "the big picture" with perspective.
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Affiliation(s)
- Olga Luengo
- Allergy Section, Department of Internal Medicine, Hospital Vall d’Hebron, Barcelona, Spain
- Allergy Research Group, Institut de Recerca Vall d’Hebron, Barcelona, Spain
| | - Victòria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d’Hebron, Barcelona, Spain
- Allergy Research Group, Institut de Recerca Vall d’Hebron, Barcelona, Spain
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Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, Nadeau K, Nowak-Wegrzyn A, Oppenheimer J, Perry TT, Randolph C, Sicherer SH, Simon RA, Vickery BP, Wood R, Bernstein D, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Spector S, Tilles SA, Wallace D, Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, Nadeau K, Nowak-Wegrzyn A, Oppenheimer J, Perry TT, Randolph C, Sicherer SH, Simon RA, Vickery BP, Wood R. Food allergy: a practice parameter update-2014. J Allergy Clin Immunol 2014; 134:1016-25.e43. [PMID: 25174862 DOI: 10.1016/j.jaci.2014.05.013] [Citation(s) in RCA: 508] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/02/2014] [Accepted: 05/06/2014] [Indexed: 02/06/2023]
Abstract
This parameter was developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology (JCAAI). The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Food Allergy: A practice parameter update-2014." This is a complete and comprehensive document at the current time. The medical environment is a changing one, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, ACAAI, and JCAAI. These parameters are not designed for use by pharmaceutical companies in drug promotion.
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