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Li Y, Devonshire A, Huang B, Andorf S. Risk subgroups and intervention effects among infants at high risk for peanut allergy: A model for clinical decision making. Clin Exp Allergy 2024; 54:185-194. [PMID: 38243616 PMCID: PMC10932885 DOI: 10.1111/cea.14452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/12/2023] [Accepted: 01/04/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND The Learning Early About Peanut Allergy (LEAP) trial showed that early dietary introduction of peanut reduced the risk of developing peanut allergy by age 60 months in infants at high risk for peanut allergy. In this secondary analysis of LEAP data, we aimed to determine risk subgroups within these infants and estimate their respective intervention effects of early peanut introduction. METHODS LEAP raw data were retrieved from ITNTrialShare.org. Conditional random forest was applied to participants in the peanut avoidance arm to select statistically important features for the classification and regression tree (CART) analysis to group infants based on their risk of peanut allergy at 60 months of age. Intervention effects were estimated for each derived risk subgroup using data from both arms. Our main model was generated based on baseline data when the participants were 4-11 months old. Specific IgE measurements were truncated to account for the limit of detection commonly used by laboratories in clinical practice. RESULTS The model found infants with higher predicted probability of peanut allergy at 60 months of age had a similar relative risk reduction, but a greater absolute risk reduction in peanut allergy with early introduction of peanut, than those with lower probability. The intervention effects were significant across all risk subgroups. Participants with baseline peanut sIgE ≥0.22 kU/L (n = 78) had an absolute risk reduction of 40.4% (95% CI 27.3, 51.9) whereas participants with baseline peanut sIgE<0.22 kU/L and baseline Ara h 2 sIgE <0.10 kU/L (n = 226) had an absolute risk reduction of 6.5% (95% CI 2.6, 11.0). These findings were consistent in sensitivity analyses using alternative models. CONCLUSION In this study, risk subgroups were determined among infants from the LEAP trial based on the probability of developing peanut allergy and the intervention effects of early peanut introduction were estimated. This may be relevant for further risk assessment and personalized clinical decision-making.
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Affiliation(s)
- Yuxiang Li
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Environmental & Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Ashley Devonshire
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Sandra Andorf
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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Połomska J, Dydak P, Sozańska B, Sikorska-Szaflik H. Peanut Allergy and Component-Resolved Diagnostics Possibilities-What Are the Benefits? Nutrients 2023; 15:5132. [PMID: 38140391 PMCID: PMC10746123 DOI: 10.3390/nu15245132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Peanut allergy is a widespread and potentially life-threatening condition that affects both children and adults, with a growing incidence worldwide. It is estimated to affect around 1-2% of the population in several developed countries. Component-resolved diagnostics is a modern approach to allergy diagnosis that focuses on identifying specific allergenic proteins to provide precise diagnoses and personalized treatment plans. It is a technique that enables the analysis of specific IgE antibodies against tightly defined molecules (components) that constitute the allergen. Component-resolved diagnostics is particularly valuable in peanut allergy diagnosis, helping to determine allergen components associated with severe reactions. It also aids in predicting the course of the allergy and enables the development of personalized immunotherapy plans; however, the full application of it for these purposes still requires more precise studies. In this paper, we present the current knowledge about peanut allergy and component-resolved diagnostics possibilities. We discuss the possibilities of using molecular diagnostics in the diagnosis of peanut allergy. We focus on examining and predicting the development of peanut allergy, including the risk of anaphylaxis, and describe the latest data related to desensitization to peanuts.
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Affiliation(s)
- Joanna Połomska
- Department and Clinic of Paediatrics, Allergology and Cardiology, Wroclaw Medical University, ul. Chałubińskiego 2a, 50-368 Wrocław, Poland; (J.P.); (B.S.)
| | - Paulina Dydak
- Clinical Department of Paediatrics, Specialist Hospital No. 2, Bytom, Silesian Medical University, 40-055 Katowice, Poland;
| | - Barbara Sozańska
- Department and Clinic of Paediatrics, Allergology and Cardiology, Wroclaw Medical University, ul. Chałubińskiego 2a, 50-368 Wrocław, Poland; (J.P.); (B.S.)
| | - Hanna Sikorska-Szaflik
- Department and Clinic of Paediatrics, Allergology and Cardiology, Wroclaw Medical University, ul. Chałubińskiego 2a, 50-368 Wrocław, Poland; (J.P.); (B.S.)
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Yan J, Chen J, Li H, Hu Y. The comparison of skin prick test, serological specific IgE test and solid phase immunoassay in the diagnosis of infantile allergic diseases. Minerva Pediatr (Torino) 2023; 75:455-459. [PMID: 30037186 DOI: 10.23736/s2724-5276.18.05199-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND This retrospective study was designed in order to compare the usefulness of skin prick tests, serological specific IgE tests and solid phase immunoassays in the diagnosis of infantile allergic diseases. METHODS Two hundred infants with allergic diseases (120 infants with eczema and 80 infants with asthma), diagnosed in the Pediatric Clinic of our hospital between June of 2011 and June of 2016, were selected to participate in the study. 100 healthy infants were included in a control group. All infants received a skin prick test, a serological specific IgE test or a solid phase immunoassay. A total of 38 allergens were used for the infants receiving skin prick test. The IgE in the serum samples of infants was detected by immunoblotting. And, allergens were detected by solid phase immunoassay in the infants receiving solid phase immunoassay. The positive predictive value, negative predictive value, specificity and sensitivity for these 3 diagnostic methods were analyzed after generating a ROC curve. RESULTS In the eczema group, the AUCs (the area under the ROC curve) for skin prick test, serological specific IgE test and solid phase immunoassay were 0.8685±0.0187, 0.8137±0.024 and 0.9682±0.0358, respectively. The sensitivities for skin prick test, serological specific IgE test and solid phase immunoassay were 85.70%, 83.62% and 88.72%, respectively. And, the specificities were 74%, 68% and 83%, respectively. The positive predictive values were 87.27%, 92.37% and 90.00%; and the negative predictive values were 57.04%, 51.11% and 78.15%, respectively. In the asthma group, the AUCs for skin prick test, serological specific IgE test and solid phase immunoassay were 0.8186±0.0161, 0.8037±0.0241 and 0.952±0.0421, respectively. The sensitivities for skin prick test, serological specific IgE test and solid phase immunoassay were 84.70%, 88.62% and 96.72%, respectively. The specificities were 76%, 64% and 81%, respectively; the positive predictive values were 81.34%, 85.59% and 84.54%, respectively. The negative predictive values were 69.29%, 67.14% and 70.08%, respectively. CONCLUSIONS While all three methods were effective in the diagnosis of infantile allergic diseases, the solid phase immunoassay was superior to the other two methods, as evidenced by the obtained values and we recommend it for clinical application as a goal standard.
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Affiliation(s)
- Junmei Yan
- Xuzhou Maternal and Child Health Hospital, Xuzhou Medical University, Xuzhou, China
| | - Jing Chen
- Department of Primary Child Care, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Haiqi Li
- Department of Primary Child Care, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Yan Hu
- Department of Primary Child Care, Children's Hospital, Chongqing Medical University, Chongqing, China -
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Carrette M, Couderc L, Bubenheim M, Vidal A, Youssouf A, Boyer O, Marguet C, Martinet J. The combination of Ara h 2-sIgE and basophil activation test could be an alternative to oral food challenge in cases of suspected peanut allergy. Pediatr Allergy Immunol 2023; 34:e14007. [PMID: 37622254 DOI: 10.1111/pai.14007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Most children with peanut sensitisation do not have a clinical peanut allergy (PA). Oral food challenge (OFC) is then necessary to diagnose PA and assess the reactive dose of the allergen. However, OFC is laborious to perform, expensive and stressful. We evaluated whether in vitro tests, such as basophil activation test (BAT), allergen-specific IgE (sIgE) and their combination, could be used to replace OFC for the diagnosis of PA in children. METHODS Ninety-one patients aged 6 months to 18 years with suspected PA were prospectively recruited. These patients then underwent an OFC to assess PA. Whole peanut-sIgE, Ara h 2-sIgE, Ara h 8-sIgE and %CD63+ basophils (CCR3+ /SCClow ) to peanut measured by BAT were investigated for PA diagnosis. RESULTS Forty-one patients had a positive peanut OFC, and the remaining 50 were only sensitised. All patients with Ara h 2-sIgE >7 kUA /L were allergic to peanut. A threshold of 6% for activated basophils yielded a sensitivity of 95% and a specificity of 54%. All patients with Ara h 2-sIgE ≤7 kUA /L and BAT ≤6% (n = 22) had a negative OFC except for one who presented an oral syndrome due to PR-10 sensitisation. CONCLUSIONS We have shown that Ara h 2-sIgE >7 kUA/L is a discriminating threshold for the diagnosis of PA. Furthermore, when Ara h 2-sIgE ≤7 kUA/L and BAT ≤6%, patients do not need to adjust their diet and, thus, do not need an OFC.
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Affiliation(s)
- Marion Carrette
- Department of Immunology and Biotherapy, INSERM U1234, CHU Rouen, Université de Rouen Normandie, Rouen, France
| | - Laure Couderc
- Department of Paediatrics and Adolescent Medicine, CIC INSERM 1404, EA 2656, CHU Rouen, Université de Rouen Normandie, Rouen, France
| | - Michael Bubenheim
- Department of Clinical Research and Innovation, CHU Rouen, Rouen, France
| | - Alexandra Vidal
- Department of Paediatrics and Adolescent Medicine, CIC INSERM 1404, EA 2656, CHU Rouen, Université de Rouen Normandie, Rouen, France
| | - Asmynour Youssouf
- École nationale de la statistique et de l'analyse de l'information (ENSAI), Bruz, France
| | - Olivier Boyer
- Department of Immunology and Biotherapy, INSERM U1234, CHU Rouen, Université de Rouen Normandie, Rouen, France
| | - Christophe Marguet
- Department of Paediatrics and Adolescent Medicine, CIC INSERM 1404, EA 2656, CHU Rouen, Université de Rouen Normandie, Rouen, France
| | - Jérémie Martinet
- Department of Immunology and Biotherapy, INSERM U1234, CHU Rouen, Université de Rouen Normandie, Rouen, France
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Duan L, Celik A, Hoang JA, Schmidthaler K, So D, Yin X, Ditlof CM, Ponce M, Upton JE, Lee J, Hung L, Breiteneder H, Palladino C, Atkinson AR, Kim VH, Berenjy A, Asper M, Hummel D, Wong S, Alexanian‐Farr M, Magder A, Chinthrajah SR, Mukai K, Tsai M, Nadeau K, Galli SJ, Ramani AK, Szepfalusi Z, Eiwegger T. Basophil activation test shows high accuracy in the diagnosis of peanut and tree nut allergy: The Markers of Nut Allergy Study. Allergy 2021; 76:1800-1812. [PMID: 33300157 DOI: 10.1111/all.14695] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Peanut and tree nut allergies are the most important causes of anaphylaxis. Co-reactivity to more than one nut is frequent, and co-sensitization in the absence of clinical data is often obtained. Confirmatory oral food challenges (OFCs) are inconsistently performed. OBJECTIVE To investigate the utility of the basophil activation test (BAT) in diagnosing peanut and tree nut allergies. METHODS The Markers Of Nut Allergy Study (MONAS) prospectively enrolled patients aged 0.5-17 years with confirmed peanut and/or tree nut (almond, cashew, hazelnut, pistachio, walnut) allergy or sensitization from Canadian (n = 150) and Austrian (n = 50) tertiary pediatric centers. BAT using %CD63+ basophils (SSClow/CCR3pos) as outcome was performed with whole blood samples stimulated with allergen extracts of each nut (0.001-1000 ng/mL protein). BAT results were assessed against confirmed allergic status in a blinded fashion to develop a generalizable statistical model for comparison to extract and marker allergen-specific IgE. RESULTS A mixed effect model integrating BAT results for 10 and 100 ng/mL of peanut and individual tree nut extracts was optimal. The area under the ROC curve (AUROC) was 0.98 for peanut, 0.97 for cashew, 0.92 for hazelnut, 0.95 for pistachio, and 0.97 for walnut. The BAT outperformed sIgE testing for peanut or hazelnut and was comparable for walnut (AUROC 0.95, 0.94, 0.92) in a sub-analysis in sensitized patients undergoing OFC. CONCLUSIONS Basophil activation test can predict allergic clinical status to peanut and tree nuts in multi-nut-sensitized children and may reduce the need for high-risk OFCs in patients.
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Greenhawt M, Shaker M, Wang J, Oppenheimer JJ, Sicherer S, Keet C, Swaggart K, Rank M, Portnoy JM, Bernstein J, Chu DK, Dinakar C, Golden D, Horner C, Lang DM, Lang ES, Khan DA, Lieberman J, Stukus D, Wallace D. Peanut allergy diagnosis: A 2020 practice parameter update, systematic review, and GRADE analysis. J Allergy Clin Immunol 2020; 146:1302-1334. [PMID: 32810515 DOI: 10.1016/j.jaci.2020.07.031] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/14/2020] [Accepted: 07/17/2020] [Indexed: 12/14/2022]
Abstract
Given the burden of disease and the consequences of a diagnosis of peanut allergy, it is important that peanut allergy be accurately diagnosed so that an appropriate treatment plan can be developed. However, a test that indicates there is peanut sensitization present (eg, a "positive" test) is not always associated with clinical reactivity. This practice parameter addresses the diagnosis of IgE-mediated peanut allergy, both in children and adults, as pertaining to 3 fundamental questions, and based on the systematic reviews and meta-analyses, makes recommendations for the clinician who is evaluating a patient for peanut allergy. These questions relate to when diagnostic tests should be completed, which diagnostic tests to utilize, and the utility (or lack thereof) of diagnostic testing to predict the severity of a future allergic reaction to peanut.
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Affiliation(s)
- Matthew Greenhawt
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
| | - Marcus Shaker
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Dartmouth Geisel School of Medicine, Lebanon, NH
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai and the Jaffe Food Allergy Institute, New York, NY
| | - John J Oppenheimer
- Department of Internal Medicine, New Jersey Medical School, Morristown, NJ
| | - Scott Sicherer
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai and the Jaffe Food Allergy Institute, New York, NY
| | - Corinne Keet
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Keri Swaggart
- Library Services, Children's Mercy Hospital, Kansas City, Mo
| | - Matthew Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Scottsdale, Ariz; Division of Pulmonology, Phoenix Children's Hospital, Phoenix, Ariz
| | - Jay M Portnoy
- Division of Allergy, Asthma & Immunology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Mo
| | - Jonathan Bernstein
- Division of Immunology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Derek K Chu
- Department of Health Research Methods, Evidence & Impact, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; The Research Institute of St. Joe's Hamilton, Hamilton, Ontario, Canada
| | - Chitra Dinakar
- Division of Allergy and Asthma, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif
| | - David Golden
- Department of Allergy-Clinical Immunology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md
| | - Carolyn Horner
- Division of Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine, St Louis, Mo
| | - David M Lang
- Department of Allergy and Clinical Immunology, Cleveland Clinic, Cleveland, Ohio
| | - Eddy S Lang
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David A Khan
- Division of Allergy & Immunology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Jay Lieberman
- Division of Allergy and Immunology, Department of Pediatrics, The University of Tennessee, Memphis, Tenn
| | - David Stukus
- Division of Allergy and Immunology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Dana Wallace
- Nova Southeastern University College of Allopathic Medicine, Fort Lauderdale, Fla
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Soller L, Abrams EM, Carr S, Kapur S, Rex GA, Leo S, McHenry M, Vander Leek TK, Yeung J, Cook VE, Wong T, Hildebrand KJ, Mak R, Gerstner TV, Cameron SB, Chan ES. First Real-World Effectiveness Analysis of Preschool Peanut Oral Immunotherapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1349-1356.e1. [PMID: 33221274 DOI: 10.1016/j.jaip.2020.10.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/22/2020] [Accepted: 10/12/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND We previously described safety of preschool peanut oral immunotherapy (P-OIT) in a real-world setting; 0.4% of patients experienced a severe reaction, and 4.1% received epinephrine, during build-up. OBJECTIVE To determine the effectiveness of preschool P-OIT after 1 year of maintenance. METHODS Preschoolers (9-70 months) with at least 1 objective reaction to peanut (during baseline oral food challenge (OFC) or P-OIT build-up) received a follow-up OFC to cumulative 4000 mg protein after 1 year on 300 mg peanut daily maintenance. Effectiveness of desensitization was defined as proportion of patients with a negative follow-up OFC. Symptoms and treatment at follow-up OFC were recorded. RESULTS Of the 117 patients who successfully completed 1 year of P-OIT and subsequently underwent a cumulative 4000-mg follow-up OFC, 92 (78.6%) had a negative OFC and 115 (98.3%) tolerated a cumulative dose of greater than or equal to 1000 mg. For the 25 (21.4%) who reacted, their threshold increased by 3376 mg (95% CI, 2884-3868) from baseline to follow-up; 17 (14.5%) patients experienced grade 1 reactions, 7 (6.00%) grade 2, and 1 (0.85%) grade 3. Two patients (1.71%) received epinephrine associated with P-OIT, and 1 (0.85%) went to the emergency department. CONCLUSIONS Our data demonstrate that real-world preschool P-OIT is effective after 1 year of maintenance for those who received a follow-up OFC. For those who reacted, their threshold increased sufficiently to protect against accidental exposures. P-OIT should be considered for preschoolers as an alternative to current recommendations to avoid peanut.
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Affiliation(s)
- Lianne Soller
- British Columbia Children's Hospital, Vancouver, BC, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
| | - Elissa M Abrams
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada; Meadowood Medical Center, Winnipeg, MB, Canada
| | - Stuart Carr
- Pediatric Allergy & Asthma, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Sandeep Kapur
- Division of Allergy, Department of Pediatrics, Dalhousie University/IWK Health Centre, Halifax, NS, Canada; Halifax Allergy & Asthma Associates, Halifax, NS, Canada
| | - Gregory A Rex
- Division of Allergy, Department of Pediatrics, Dalhousie University/IWK Health Centre, Halifax, NS, Canada; Halifax Allergy & Asthma Associates, Halifax, NS, Canada
| | - Sara Leo
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; West Coast Allergy and Immunology Clinic, Vancouver, BC, Canada
| | - Mary McHenry
- Division of Allergy, Department of Pediatrics, Dalhousie University/IWK Health Centre, Halifax, NS, Canada; Halifax Allergy & Asthma Associates, Halifax, NS, Canada
| | - Timothy K Vander Leek
- Pediatric Allergy & Asthma, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; Pediatric Allergy & Immunology, Edmonton, AB, Canada
| | - Joanne Yeung
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Vancouver Pediatric and Allergy Centre, Vancouver, BC, Canada
| | - Victoria E Cook
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Community Allergy Clinic, Victoria, BC, Canada
| | - Tiffany Wong
- British Columbia Children's Hospital, Vancouver, BC, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Kyla J Hildebrand
- British Columbia Children's Hospital, Vancouver, BC, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Raymond Mak
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Thomas V Gerstner
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada; Meadowood Medical Center, Winnipeg, MB, Canada
| | - Scott B Cameron
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Community Allergy Clinic, Victoria, BC, Canada
| | - Edmond S Chan
- British Columbia Children's Hospital, Vancouver, BC, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Feary JR, Schofield SJ, Canizales J, Fitzgerald B, Potts J, Jones M, Cullinan P. Laboratory animal allergy is preventable in modern research facilities. Eur Respir J 2019; 53:13993003.00171-2019. [PMID: 30956209 DOI: 10.1183/13993003.00171-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/23/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND Historical data suggest 15% of laboratory animal workers develop IgE sensitisation and 10% symptoms of laboratory animal allergy (LAA), including occupational asthma. Individually ventilated cages (IVCs) are replacing conventional open cages; we sought to evaluate their impact on the development of LAA. METHODS We surveyed 750 laboratory animal workers and measured airborne Mus m 1 (mouse allergen) levels in seven UK institutions. We compared the prevalence of sensitisation to mouse proteins (by specific IgE assay or skin prick test) and of work-related allergic symptoms in IVC-only and open cage units. RESULTS Full-shift Mus m 1 levels were lower in IVC than open cage units (geometric mean 1.00 (95% CI 0.73-1.36) versus 8.35 (95% CI 6.97-9.95) ng·m-3; p<0.001), but varied eight-fold across the IVC units (geometric mean range 0.33-4.12 ng·m-3). Primary analyses on data from 216 participants with ≤3 years exposure to mice revealed a lower prevalence of sensitisation in those working in IVC units compared with conventional cage units (2.4% (n=2) versus 9.8% (n=13); p=0.052). Sensitisation in IVC units varied from 0% to 12.5%; the use of fitted respiratory protection was less common in IVC units where prevalence of sensitisation was higher. Work-related allergy symptoms were more frequently reported by mouse-sensitised individuals (46.7% versus 10.9%; p<0.001) and only by those working in open cage units. CONCLUSION In contemporary practice, LAA is now largely preventable with the use of IVC systems and the judicious use of appropriate respiratory protection.
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Affiliation(s)
- Johanna R Feary
- Dept of Occupational Lung Disease, Royal Brompton and Harefield NHS Foundation Trust, London, UK .,Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Susan J Schofield
- Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Jennifer Canizales
- Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Bernadette Fitzgerald
- Dept of Occupational Lung Disease, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - James Potts
- Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Meinir Jones
- Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Paul Cullinan
- Dept of Occupational Lung Disease, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
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Brusca I, Barrale M, Onida R, La Chiusa SM, Gjomarkaj M, Uasuf CG. The extract, the molecular allergen or both for the in vitro diagnosis of peach and peanut sensitization? Clin Chim Acta 2019; 493:25-30. [DOI: 10.1016/j.cca.2019.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 01/20/2019] [Accepted: 01/20/2019] [Indexed: 01/02/2023]
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10
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Abstract
PURPOSE OF REVIEW To familiarize the reader with the concept of precision medicine in food allergy by dealing with the current biomarkers for the diagnosis, prognosis, and management of the disease. RECENT FINDINGS Many efforts have been devoted in order to characterize reliable biomarkers able to identify specific phenotypes and endotypes in food allergy. Specific IgE (sIgE), sIgE/total IgE ratios, and T cell assays are just a few candidates that have been investigated over time. With the advent of omics sciences, a new era is commencing. A better understanding of pathogenesis of food allergy and mechanisms of action of the different therapeutic options will allow the accurate selection of the appropriate patient. In the near future, advances in technologies and data interpretation will allow a better understanding of the pathogenesis of food allergy and the identification of proper biomarkers for a personalized treatment tailored on the specific patient's profile.
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Affiliation(s)
- Antonella Muraro
- Department of Woman and Child Health, Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, University of Padua, Via Giustiniani 3, 35128, Padua, Italy.
| | - Stefania Arasi
- Allergy Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
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Stiefel G, Anagnostou K, Boyle RJ, Brathwaite N, Ewan P, Fox AT, Huber P, Luyt D, Till SJ, Venter C, Clark AT. BSACI guideline for the diagnosis and management of peanut and tree nut allergy. Clin Exp Allergy 2018; 47:719-739. [PMID: 28836701 DOI: 10.1111/cea.12957] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/01/2017] [Accepted: 05/08/2017] [Indexed: 12/17/2022]
Abstract
Peanut nut and tree nut allergy are characterised by IgE mediated reactions to nut proteins. Nut allergy is a global disease. Limited epidemiological data suggest varying prevalence in different geographical areas. Primary nut allergy affects over 2% of children and 0.5% of adults in the UK. Infants with severe eczema and/or egg allergy have a higher risk of peanut allergy. Primary nut allergy presents most commonly in the first five years of life, often after the first known ingestion with typical rapid onset IgE-mediated symptoms. The clinical diagnosis of primary nut allergy can be made by the combination of a typical clinical presentation and evidence of nut specifc IgE shown by a positive skin prick test (SPT) or specific IgE (sIgE) test. Pollen food syndrome is a distinct disorder, usually mild, with oral/pharyngeal symptoms, in the context of hay fever or pollen sensitisation, which can be triggered by nuts. It can usually be distinguish clinically from primary nut allergy. The magnitude of a SPT or sIgE relates to the probability of clinical allergy, but does not relate to clinical severity. SPT of ≥ 8 mm or sIgE ≥ 15 KU/L to peanut is highly predictive of clinical allergy. Cut off values are not available for tree nuts. Test results must be interpreted in the context of the clinical history. Diagnostic food challenges are usually not necessary but may be used to confirm or refute a conflicting history and test result. As nut allergy is likely to be a long-lived disease, nut avoidance advice is the cornerstone of management. Patients should be provided with a comprehensive management plan including avoidance advice, patient specific emergency medication and an emergency treatment plan and training in administration of emergency medication. Regular re-training is required.
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Affiliation(s)
- G Stiefel
- Leicester Royal Infirmary, Leicester, UK
| | - K Anagnostou
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - N Brathwaite
- King's College Hospital NHS Foundation Trust, London, UK
| | - P Ewan
- Addenbrooke's Hospital, Cambridge, UK
| | - A T Fox
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - P Huber
- British Society for Allergy and Clinical Immunology, London, UK
| | - D Luyt
- Leicester Royal Infirmary, Leicester, UK
| | - S J Till
- King's College Hospital NHS Foundation Trust, London, UK
| | - C Venter
- St. Mary's Hospital, Isle of Wight, UK
| | - A T Clark
- Addenbrooke's Hospital, Cambridge, UK
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12
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Making the Most of In Vitro Tests to Diagnose Food Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:237-248. [PMID: 28283150 PMCID: PMC5345384 DOI: 10.1016/j.jaip.2016.12.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/05/2016] [Accepted: 12/19/2016] [Indexed: 01/24/2023]
Abstract
Various in vitro tests assess different aspects of the underlying immune mechanism of IgE-mediated food allergy. Some can be used for diagnostic purposes; specific IgE to allergen extracts is widely available; specific IgE to allergen components is used in most specialist centers, and the basophil activation test is becoming increasingly used clinically. IgE to allergen peptides, T-cell assays, allergen-specific/total IgE ratios, and allergen-specific IgG4/IgE ratios are currently reserved for research. Different factors can modulate the likelihood of IgE-mediated food allergy of a given allergy test result, namely, the patients' age, ethnicity, previous allergic reaction to the identified food, concomitant atopic conditions, and geographical location, and need to be taken into account when interpreting the allergy test results in the clinic. The importance of the specific food, the clinical resources available, and patient preferences are additional aspects that need to be considered when deciding whether an oral food challenge is required to reach an accurate diagnosis of IgE-mediated food allergy.
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13
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Chan JCK, Peters RL, Koplin JJ, Dharmage SC, Gurrin LC, Wake M, Tang MLK, Prescott S, Allen KJ. Food Challenge and Community-Reported Reaction Profiles in Food-Allergic Children Aged 1 and 4 Years: A Population-Based Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:398-409.e3. [PMID: 28283159 DOI: 10.1016/j.jaip.2016.12.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/30/2016] [Accepted: 12/27/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Oral food challenge is the main tool for diagnosing food allergy, but there is little data on the reaction profiles of young children undergoing challenges, nor how these reactions compare to reactions on accidental ingestion in the community. OBJECTIVES To compare reaction profiles from food challenges and parent-reported reactions on accidental ingestion, and assess predictors of severe reactions. METHODS HealthNuts is a longitudinal population-based cohort study of 5276 1-year-old infants. Infants underwent skin prick tests and those with identifiable wheals were offered food challenges. Food challenges were repeated at age 4 years in those with previous food allergy or reporting new food allergies. Community-reported reactions were ascertained from parent questionnaires. RESULTS Food challenges were undertaken in 916 children at age 1 year and 357 children at age 4 years (a total of 2047 peanut, egg, or sesame challenges). Urticaria was the most common sign in positive challenges at both ages (age 1 year, 88.7%, and age 4 years, 71.2%) although angioedema was significantly more common at age 4 years (40.1%) than at age 1 year (12.9%). Anaphylaxis was equally uncommon at both ages (2.1% and 2.8% of positive challenges at ages 1 and 4 years, respectively) but more common for peanut than for egg (4.5% and 1.2% of positive challenges at ages 1 and 4 years, respectively). The patterns of presenting signs reported during community reactions were similar to those observed in formal food challenges. Serum food-specific IgE levels of 15 kU/L or more were associated with moderate to severe reactions but skin prick test was not. CONCLUSIONS There was a shift from the most common presenting reaction of urticaria during food challenges toward more angioedema in older children. Serum food-specific IgE levels were associated with reaction severity.
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Affiliation(s)
- Joshua C K Chan
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Rachel L Peters
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Jennifer J Koplin
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia; School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Shyamali C Dharmage
- School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Lyle C Gurrin
- School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Melissa Wake
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Department of Paediatrics and the Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Mimi L K Tang
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Susan Prescott
- Telethon Kids Institute, School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Katrina J Allen
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia; Institute of Inflammation and Repair, University of Manchester, Manchester, United Kingdom.
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14
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Valcour A, Jones JE, Lidholm J, Borres MP, Hamilton RG. Sensitization profiles to peanut allergens across the United States. Ann Allergy Asthma Immunol 2017; 119:262-266.e1. [PMID: 28890021 DOI: 10.1016/j.anai.2017.06.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/09/2017] [Accepted: 06/28/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Measurement of IgE antibody to peanut components can aid in the prediction of allergic responses the food. OBJECTIVE To investigate the association between patient demographics (age, location) and allergic sensitization to peanut components across the United States. METHODS Serum samples from 12,155 individuals with peanut extract specific IgE levels of 0.35 kUA/L or higher were analyzed for IgE antibodies to Ara h 1, 2, 3, 8, and 9 by ImmunoCAP. RESULTS Among this population of peanut sensitized individuals, 79.1% of children (<3 years old) were sensitized to one or more peanut storage proteins (Ara h 1, 2, and/or 3), in contrast to 64.2% of adolescents (12-15 years old) and 22.1% of adults (>20 years old). Although sensitization was more prevalent to Ara h 2 than to the other storage proteins, a sizable fraction of patients were sensitized to Ara h 1 and/or 3 but not to Ara h 2 (eg, 13% of children <3 years old). Moreover, 9.6% of children, 10.2% of adolescents, and 10.5% of adults were sensitized to Ara h 9, whereas 2.4% of children, 49.4% of adolescents, and 42.9% of adults produced IgE to Ara h 8 (pathogenesis-related protein 10). Sensitization to Ara h 8 alone was markedly higher in the Northeastern United States relative to other regions of the country. CONCLUSION We conclude that sensitization to individual peanut components is highly dependent on age and geographic location. Given that a severe allergic reaction to peanut is unlikely in individuals with isolated sensitization to Ara h 8, a sizable fraction of patients, in particular adolescents and adults, may be at lower risk than anticipated based only on demonstration of sensitization to whole peanut extract.
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Affiliation(s)
- Andre Valcour
- Laboratory Corporation of America, Burlington, North Carolina.
| | - Joseph E Jones
- Thermo Fisher Scientific, Phadia US Inc, Portage, Michigan
| | | | - Magnus P Borres
- Thermo Fisher Scientific, Uppsala, Sweden; Department of Maternal and Child Health, Uppsala University, Uppsala, Sweden
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15
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Deschildre A, Elegbédé CF, Just J, Bruyère O, Van der Brempt X, Papadopoulos A, Beaudouin E, Renaudin JM, Crepet A, Moneret-Vautrin DA. Peanut-allergic patients in the MIRABEL survey: characteristics, allergists' dietary advice and lessons from real life. Clin Exp Allergy 2016; 46:610-20. [PMID: 26588036 DOI: 10.1111/cea.12681] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/17/2015] [Accepted: 10/20/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The MIRABEL survey is an observational study on peanut allergy in France, Belgium and Luxemburg. The objectives are to provide data on a large population, to analyse the consumer behaviour, to study the presence of peanut traces in pre-packed foods with/without precautionary allergen labelling (PAL), and to combine these data to quantify allergic risk and produce a cost/benefit analysis. This paper reports a real-life observatory of 785 patients (< 16y: 86%): medical characteristics, eliciting doses (ED) in real life and in oral food challenges (OFC), factors associated with severe reactions, allergist dietary advice and patients' anxiety regarding their allergy. METHODS Age and symptoms at diagnosis, route of exposure, comorbidities, allergy tests, ED (OFC/real life; mg peanut protein), dietary advice about PAL, and anxiety score were recorded. RESULTS Median age was 3 years; 85% were declared allergic. Severe/potentially severe reactions were reported in 30% of the allergic patients: serious systemic reaction (15%), laryngeal angioedema (8%), shock (4%) and acute asthma (3%); 66% had atopic dermatitis, 58% asthma. Median ara h 2 sIgE level was 11.5 kUA/L. Of the 278 OFCs, 225 were positive (median ED: 67.3 mg). Real-life ED was < 100 mg in 44.3%. Severe reactions were significantly more frequent in teenagers and adults (P = 0.004), asthmatic patients (P = 0.033), and patients who reacted to inhalation (P < 0.001). No significant association was found for OFC ED or ara h 2 sIgE. Factors associated with strict avoidance advice including PAL were OFC ED < 100 mg (P < 0.001), but not severe reaction history (P = 0.051) or asthma (P = 0.34). Anxiety was significantly associated with strict avoidance (P < 0.001). CONCLUSION AND CLINICAL RELEVANCE Severe/potentially severe reactions, allergic comorbidities, and low EDs in real life are frequent in peanut-allergic patients. Asthma, teenage/adulthood and reaction to inhalation are associated with severe symptoms. PAL and criteria guiding dietary advice need to be improved.
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Affiliation(s)
- A Deschildre
- CHU Lille, Pediatric Pulmonology and Allergy Department, hôpital Jeanne de Flandre, Lille, France.,Allergy Vigilance Network, Vandoeuvre les Nancy, France
| | - C F Elegbédé
- Risk Assessment Department (DER), French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Maisons-Alfort, France.,French National Institute for Agricultural Research (INRA), Paris Institute of Technology for Life, Food and Environmental Sciences (AgroParisTech), UMR Economie Publique INRA-AgroParisTech, Paris, France
| | - J Just
- Allergy Vigilance Network, Vandoeuvre les Nancy, France.,Allergology Department, Centre de l'Asthme et des Allergies, Hôpital d'Enfants Armand-Trousseau, APHP; Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, Paris, France
| | - O Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman, Liège, Belgium
| | - X Van der Brempt
- Allergy Vigilance Network, Vandoeuvre les Nancy, France.,Allergopôle, Clinique Saint-Luc, Bouge (Namur), Belgium
| | - A Papadopoulos
- Risk Assessment Department (DER), French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Maisons-Alfort, France
| | - E Beaudouin
- Allergy Vigilance Network, Vandoeuvre les Nancy, France.,Allergy Department, Centre Hospitalier E Durkheïm, Epinal, France
| | - J-M Renaudin
- Allergy Vigilance Network, Vandoeuvre les Nancy, France.,Allergy Department, Centre Hospitalier E Durkheïm, Epinal, France
| | - A Crepet
- Risk Assessment Department (DER), French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Maisons-Alfort, France
| | - D-A Moneret-Vautrin
- Allergy Vigilance Network, Vandoeuvre les Nancy, France.,Allergy Department, Centre Hospitalier E Durkheïm, Epinal, France.,Lorraine University, Nancy, France
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16
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Klemans RJB, van Os-Medendorp H, Blankestijn M, Bruijnzeel-Koomen CAFM, Knol EF, Knulst AC. Diagnostic accuracy of specific IgE to components in diagnosing peanut allergy: a systematic review. Clin Exp Allergy 2015; 45:720-30. [PMID: 25226880 DOI: 10.1111/cea.12412] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The diagnostic accuracy of skin prick test (SPT) and specific IgE (sIgE) to peanut extract in diagnosing peanut allergy is suboptimal. Recent studies have evaluated sIgE to peanut components as a possible new diagnostic tool. The aim of our review was to systematically search the literature to assess the diagnostic value of sIgE to peanut components in diagnosing peanut allergy. A literature search was performed in PubMed, Embase and the Cochrane Library. Results were subsequently screened for in- and exclusion criteria. The quality of eligible studies was assessed using a standardized quality assessment tool (QUADAS-2). Data on sensitivity, specificity, and positive and negative likelihood ratios were extracted or calculated for a descriptive analysis. Twenty-two studies were eligible, of which 21 studies in paediatric populations. Most studies reported on sIgE to peanut extract (15) and sIgE to Ara h 2 (12), followed by SPT (9) and sIgE to Ara h 1 (7). All studies were at risk of bias or caused applicability concerns on at least one item of the quality assessment tool. The best combination of diagnostic accuracy measures of all diagnostic tests was found for sIgE to Ara h 2. This finding was independent of geographical location. Compared to SPT and sIgE to peanut extract, sIgE to Ara h 2 was mainly superior in diagnosing peanut allergy in case of a positive test result. Worst diagnostic accuracy measures were found in general for sIgE to Ara h 8 and sIgE to Ara h 9. sIgE to Ara h 2 showed the best diagnostic accuracy of all diagnostic tests to diagnose peanut allergy. Compared to the currently used SPT and sIgE to peanut extract, sIgE to Ara h 2 was superior in diagnosing peanut allergy and should therefore replace these tests in daily clinical practice, especially in children.
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Affiliation(s)
- R J B Klemans
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
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17
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Kelso JM. How to apply the LEAP study. J Allergy Clin Immunol 2015; 137:332-334. [PMID: 26586035 DOI: 10.1016/j.jaci.2015.09.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 09/23/2015] [Indexed: 10/22/2022]
Affiliation(s)
- John M Kelso
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif.
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18
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Thalayasingam M, Noble V, Franzmann A, O'Sullivan M. Outcome of mixed nut biscuit challenges in low-risk patients who are on tree nut exclusion diet. Pediatr Allergy Immunol 2015; 26:682-4. [PMID: 26126774 DOI: 10.1111/pai.12437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Meera Thalayasingam
- Department of Paediatrics, International Medical University Clinical School, Seremban, Malaysia
| | - Valerie Noble
- Immunology Department, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Annkathrin Franzmann
- Immunology Department, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Michael O'Sullivan
- Immunology Department, Princess Margaret Hospital for Children, Perth, WA, Australia. michael.o'
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19
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A retrospective analysis of allergic reaction severities and minimal eliciting doses for peanut, milk, egg, and soy oral food challenges. Food Chem Toxicol 2015; 80:92-100. [DOI: 10.1016/j.fct.2015.02.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 02/24/2015] [Accepted: 02/26/2015] [Indexed: 11/23/2022]
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20
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Peters RL, Allen KJ, Dharmage SC, Koplin JJ, Dang T, Tilbrook KP, Lowe A, Tang MLK, Gurrin LC. Natural history of peanut allergy and predictors of resolution in the first 4 years of life: A population-based assessment. J Allergy Clin Immunol 2015; 135:1257-66.e1-2. [PMID: 25725989 DOI: 10.1016/j.jaci.2015.01.002] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/11/2014] [Accepted: 01/05/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are no prospectively collected data available on the natural history of peanut allergy in early childhood. Previous studies of predictors of tolerance development have been biased by failure to challenge high-risk children when IgE antibody levels are high, therefore potentially introducing bias to persistent allergy. OBJECTIVES We sought to describe the natural history of peanut allergy between 1 and 4 years of age and develop thresholds for skin prick test (SPT) results and specific IgE (sIgE) levels measured at age 1 and 4 years that have 95% positive predictive value (PPV) or negative predictive value for the persistence or resolution of peanut allergy. METHODS One-year-old infants with challenge-confirmed peanut allergy (n = 156) from the population-based, longitudinal HealthNuts Study (n = 5276) were followed up at 4 years of age with repeat oral food challenges, SPTs, and sIgE measurements (n = 103). Challenges were undertaken in all peanut-sensitized children at 1 and 4 years of age, irrespective of risk profile. RESULTS Peanut allergy resolved in 22% (95% CI, 14% to 31%) of children by age 4 years. Decreasing wheal size predicted tolerance, and increasing wheal size was associated with persistence. Thresholds for SPT responses and sIgE levels at age 1 year with a 95% PPV for persistent peanut allergy are an SPT-induced response of 13 mm or greater and an sIgE level of 5.0 kU/L or greater. Thresholds for SPT and sIgE results at age 4 years with a 95% PPV for persistent peanut allergy are an SPT response of 8 mm or greater and an sIgE level of 2.1 kU/L or greater. Ara h 2, tree nut, and house dust mite sensitization; coexisting food allergies; eczema; and asthma were not predictive of persistent peanut allergy. CONCLUSION These thresholds are the first to be generated from a unique data set in which all participants underwent oral food challenges at both diagnosis and follow-up, irrespective of SPT and sIgE results.
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Affiliation(s)
- Rachel L Peters
- Population Health, the Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Katrina J Allen
- Population Health, the Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia; School of Inflammation and Repair, the University of Manchester, Manchester, United Kingdom.
| | - Shyamali C Dharmage
- Population Health, the Murdoch Childrens Research Institute, Parkville, Australia; Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Australia
| | - Jennifer J Koplin
- Population Health, the Murdoch Childrens Research Institute, Parkville, Australia
| | - Thanh Dang
- Population Health, the Murdoch Childrens Research Institute, Parkville, Australia
| | - Kate P Tilbrook
- Population Health, the Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Adrian Lowe
- Population Health, the Murdoch Childrens Research Institute, Parkville, Australia; Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Australia
| | - Mimi L K Tang
- Population Health, the Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
| | - Lyle C Gurrin
- Population Health, the Murdoch Childrens Research Institute, Parkville, Australia; Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Australia
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21
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Incorvaia C, Mauro M, Ridolo E, Makrì E, Montagni M, Ciprandi G. A Pitfall to Avoid When Using an Allergen Microarray: The Incidental Detection of IgE to Unexpected Allergens. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 3:879-82. [PMID: 25609332 DOI: 10.1016/j.jaip.2014.09.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 09/14/2014] [Accepted: 09/18/2014] [Indexed: 12/23/2022]
Abstract
The introduction of new laboratory techniques to detect specific IgE antibodies against single allergen molecules rather than whole extracts represents a significant advance in allergy diagnostics. The advantages of such component-resolved diagnosis can be summarized as follows: (1) the ability to identify the truly responsible allergens in polysensitized patients, whether they be genuine (causing specific sensitization to their corresponding allergen source) or primary (the original sensitizing molecule); (2) distinguishing these allergens from simply cross-reactive components; (3) improving the appropriateness of the prescribed specific immunotherapy; and (4) identifying a risk profile for food allergens. Component-resolved diagnosis is performed using either a singleplex (1 assay per sample) platform or a multiplex (multiple assays per sample) platform. Using an immuno solid-phase allergen chip microarray that falls into the latter category--it currently tests sensitivity to 112 allergens--may lead to a pitfall: detecting IgE to unexpected allergens, such as Hymenoptera venom. In fact, testing insect venom sensitivity in individuals with no history of reactions to stings is contrary to current guidelines and presents the physician with the dilemma of how to manage this information; moreover, this may become a legal issue. Based on what is currently known about venom allergy, it remains likely that a positive sensitization test result will have no clinical significance, but the possibility of reacting to a future sting cannot be completely ruled out. Because this problem has not been previously encountered using the more common allergy tests, no indications are currently available on how to effectively manage these cases.
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Affiliation(s)
| | - Marina Mauro
- Allergy Service, Sant'Anna Hospital, Como, Italy
| | - Erminia Ridolo
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Eleni Makrì
- Allergy/Pulmonary Rehabilitation, ICP Hospital, Milan, Italy
| | - Marcello Montagni
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Giorgio Ciprandi
- Medicine Department, Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliera Universitaria San Martino, Genoa, Italy.
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22
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O’Keefe AW, De Schryver S, Mill J, Mill C, Dery A, Ben-Shoshan M. Diagnosis and management of food allergies: new and emerging options: a systematic review. J Asthma Allergy 2014; 7:141-64. [PMID: 25368525 PMCID: PMC4216032 DOI: 10.2147/jaa.s49277] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
It is reported that 6% of children and 3% of adults have food allergies, with studies suggesting increased prevalence worldwide over the last few decades. Despite this, our diagnostic capabilities and techniques for managing patients with food allergies remain limited. We have conducted a systematic review of literature published within the last 5 years on the diagnosis and management of food allergies. While the gold standard for diagnosis remains the double-blind, placebo-controlled food challenge, this assessment is resource intensive and impractical in most clinical situations. In an effort to reduce the need for the double-blind, placebo-controlled food challenge, several risk-stratifying tests are employed, namely skin prick testing, measurement of serum-specific immunoglobulin E levels, component testing, and open food challenges. Management of food allergies typically involves allergen avoidance and carrying an epinephrine autoinjector. Clinical research trials of oral immunotherapy for some foods, including peanut, milk, egg, and peach, are under way. While oral immunotherapy is promising, its readiness for clinical application is controversial. In this review, we assess the latest studies published on the above diagnostic and management modalities, as well as novel strategies in the diagnosis and management of food allergy.
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Affiliation(s)
- Andrew W O’Keefe
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
- Department of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, St John’s, NL, Canada
| | - Sarah De Schryver
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Jennifer Mill
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Christopher Mill
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Alizee Dery
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
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23
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Flinn A, Hourihane JO. Allergic reaction to peanuts: can we predict reaction severity in the wild? Curr Allergy Asthma Rep 2014; 13:645-50. [PMID: 23832622 DOI: 10.1007/s11882-013-0369-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Peanut allergy (PNA) is the main cause of food-induced anaphylaxis. Severe allergic reactions are more likely to occur in older patients and those with underlying asthma. Skin prick testing and measuring serum-specific IgE and recombinant peanut protein levels have been shown to be useful in the diagnosis of PNA and prediction of reactivity, but these tests are less consistent and reliable in terms of predicting the severity of reactions. Recent research has examined the role of biological mediators in allergic reactions such as platelet-activating factor. These may provide a future tool in predicting those at risk of severe reactions. Currently, there are no parameters that can predict with certainty those at risk of anaphylaxis, and management of PNA should continue to focus on patient and family education.
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Affiliation(s)
- Aisling Flinn
- Department of Pediatrics, Cork University Hospital, Cork, Ireland,
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Bégin P, Winterroth LC, Dominguez T, Wilson SP, Bacal L, Mehrotra A, Kausch B, Trela A, Hoyte E, O'Riordan G, Seki S, Blakemore A, Woch M, Hamilton RG, Nadeau KC. Safety and feasibility of oral immunotherapy to multiple allergens for food allergy. Allergy Asthma Clin Immunol 2014; 10:1. [PMID: 24428859 PMCID: PMC3913318 DOI: 10.1186/1710-1492-10-1] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 12/15/2013] [Indexed: 01/07/2023] Open
Abstract
Background Thirty percent of children with food allergy are allergic to more than one food. Previous studies on oral immunotherapy (OIT) for food allergy have focused on the administration of a single allergen at the time. This study aimed at evaluating the safety of a modified OIT protocol using multiple foods at one time. Methods Participants underwent double-blind placebo-controlled food challenges (DBPCFC) up to a cumulative dose of 182 mg of food protein to peanut followed by other nuts, sesame, dairy or egg. Those meeting inclusion criteria for peanut only were started on single-allergen OIT while those with additional allergies had up to 5 foods included in their OIT mix. Reactions during dose escalations and home dosing were recorded in a symptom diary. Results Forty participants met inclusion criteria on peanut DBPCFC. Of these, 15 were mono-allergic to peanut and 25 had additional food allergies. Rates of reaction per dose did not differ significantly between the two groups (median of 3.3% and 3.7% in multi and single OIT group, respectively; p = .31). In both groups, most reactions were mild but two severe reactions requiring epinephrine occurred in each group. Dose escalations progressed similarly in both groups although, per protocol design, those on multiple food took longer to reach equivalent doses per food (median +4 mo.; p < .0001). Conclusions Preliminary data show oral immunotherapy using multiple food allergens simultaneously to be feasible and relatively safe when performed in a hospital setting with trained personnel. Additional, larger, randomized studies are required to continue to test safety and efficacy of multi-OIT. Trial registration Clinicaltrial.gov NCT01490177
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Affiliation(s)
- Philippe Bégin
- Allergy, Immunology, and Rheumatology Division, Stanford University, CCSR 3215, Stanford, CA 94305, USA.
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25
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Baric̆ić TV, Dodig S. Genuine and Cross-Reactive Peanut Components in Birch-Sensitive Preschool Children. Lab Med 2013. [DOI: 10.1309/lmnc5cxg4zv2zivt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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26
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Caffarelli C, Dondi A, Povesi Dascola C, Ricci G. Skin prick test to foods in childhood atopic eczema: pros and cons. Ital J Pediatr 2013; 39:48. [PMID: 23902622 PMCID: PMC3734168 DOI: 10.1186/1824-7288-39-48] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 05/02/2013] [Indexed: 11/10/2022] Open
Abstract
Skin prick tests are the first investigation in allergy diagnostics and their use is described in all the guidelines on atopic eczema. However, the clinical usefulness of skin prick tests is the subject of great debate. On the one hand, skin prick tests allow the identification both of individuals at risk for food allergy and of the allergen inducing the eczematous flare. On the other hand, when performed by a non-specific specialist, positive skin prick tests to foods may wrongly lead to prolonged elimination diets, which may induce nutritional deficiencies and perhaps loss of tolerance to the avoided foods. Furthermore, skin prick tests increase health costs. A consensus on this topic has not yet been reached. Considering the diversity of clinical stages in which it occurs, atopic eczema presentation should be the starting point to determine whether or not skin prick tests should be carried out.
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Affiliation(s)
- Carlo Caffarelli
- Pediatric Unit, Department of Gynecological, Obstetric and Pediatric Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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27
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Schmied J, Rupa P, Garvie S, Wilkie B. Immune response phenotype of allergic versus clinically tolerant pigs in a neonatal swine model of allergy. Vet Immunol Immunopathol 2013; 154:17-24. [DOI: 10.1016/j.vetimm.2013.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 01/07/2013] [Accepted: 04/08/2013] [Indexed: 10/27/2022]
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Gómez E, Mayorga C, Gómez F, Blázquez AB, Díaz-Perales A, Blanca M, Torres MJ. Food allergy: management, diagnosis and treatment strategies. Immunotherapy 2013; 5:755-68. [DOI: 10.2217/imt.13.63] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Food allergy is an increasing problem in western countries, with strict avoidance being the only available reliable treatment. However, accidental ingestion can occur and anaphylactic reactions still happen. In recent years, many efforts have been made to better understand the humoral and cellular mechanisms involved in food allergy, and to improve the strategies for diagnosis and treatment. This review focuses on IgE-mediated food hypersensitivity and provides an overview of the diagnostic strategies and treatment advances. Specific immunotherapy, including different routes of administration and allergen sources, such as natural, recombinant and T-cell epitopes, are analyzed in detail. Other treatments such as anti-IgE monoclonal antibody therapy, adjuvant therapy and Chinese herbs will also be described.
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Affiliation(s)
- Enrique Gómez
- Research Laboratory for Allergic Diseases, Carlos Haya Hospital, Malaga, Spain
| | | | | | - Ana Belen Blázquez
- Research Laboratory for Allergic Diseases, Carlos Haya Hospital, Malaga, Spain
| | - Araceli Díaz-Perales
- Center for Plant Biotechnology & Genomics (UPM-INIA), Pozuelo de Alarcón, Madrid, Spain
| | - Miguel Blanca
- Allergy Service, Carlos Haya Hospital, Malaga, Spain
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Asai Y, Greenwood C, Hull PR, Alizadehfar R, Ben-Shoshan M, Brown SJ, Campbell L, Michel DL, Bussières J, Rousseau F, Fujiwara TM, Morgan K, Irvine AD, McLean WI, Clarke A. Filaggrin gene mutation associations with peanut allergy persist despite variations in peanut allergy diagnostic criteria or asthma status. J Allergy Clin Immunol 2013; 132:239-42. [PMID: 23684069 PMCID: PMC3919206 DOI: 10.1016/j.jaci.2013.03.043] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 02/19/2013] [Accepted: 03/28/2013] [Indexed: 12/19/2022]
Affiliation(s)
- Yuka Asai
- Division of Dermatology, Department of Medicine, McGill University, Montreal, Quebec, Canada
- Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Celia Greenwood
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Oncology and the Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Peter R. Hull
- Division of Dermatology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Reza Alizadehfar
- Division of Allergy and Clinical Immunology, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | | | | | - Deborah L. Michel
- Division of Dermatology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | | - T. Mary Fujiwara
- Departments of Human Genetics and Medicine, McGill University, Montreal, Quebec, Canada
| | - Kenneth Morgan
- Departments of Human Genetics and Medicine, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | | | | | - Ann Clarke
- Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- Division of Allergy/Clinical Immunology, Department of Medicine, McGill University, Montreal, Quebec, Canada
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Arshad SH, Dharmage SC, Ferreira F, Fixman ED, Gadermaier G, Hauser M, Sampson AP, Teran LM, Wallner M, Wardlaw AJ. Developments in the field of allergy in 2011 through the eyes of Clinical and Experimental Allergy. Clin Exp Allergy 2013. [PMID: 23181787 DOI: 10.1111/cea.12037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
As in previous years, we felt it would be of value to our readership to summarize the new information provided by the authors who have published in Clinical and Experimental Allergy in 2011 and set this in the context of recent advances in our understanding of the pathogenesis and management of allergic disease in all its many manifestations. In 2011, about 210 articles were published in Clinical and Experimental Allergy including editorials, reviews, opinion articles, guidelines, letters, book reviews and of course at the heart of the journal, papers containing original data. As before, this review is divided into sections based on the way the journal is structured, although this year we have grouped together all the papers dealing with mechanisms of allergic disease, whether they involve patients (clinical mechanisms), pure in vitro studies (basic mechanisms) or animal models (experimental models), as we felt this was a more coherent way to deal with the subject. In the field of asthma and rhinitis, the relationship between airway inflammation and airway dysfunction was of perennial interest to investigators, as were phenotypes and biomarkers. Aspirin hypersensitivity appeared in studies in several papers and there was new interest in asthma in the elderly. The mechanisms involved in allergic disease describe advances in our understanding of T cell responses, the relationship between inflammation and disease, mast cell and basophil activation, steroid resistance and novel therapies. In the section dealing with epidemiology, studies seeking to identify risk factors for allergic disease including vitamin D are prominent, as once again are studies investigating gene-environment interactions. The clinical allergy section focuses on drug allergy, food allergy and immunotherapy. The area of oral immunotherapy for food allergy is well covered and we were grateful to Stephen Durham for guest editing an outstanding special issue on immunotherapy in the centenary year of Leonard Noon's pioneering work. Lastly, in the field of allergens, the interest in component-resolved diagnosis continues to grow and there are also articles describing important novel cultivars and the effect of food processing on the allergenic properties of foods. Another terrific year, full of important and high-quality work,which the journal has been proud to bring to the allergy community.
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Affiliation(s)
- S H Arshad
- David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
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Sicherer SH, Wood RA. Advances in diagnosing peanut allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2012; 1:1-13; quiz 14. [PMID: 24229816 DOI: 10.1016/j.jaip.2012.10.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 10/08/2012] [Accepted: 10/12/2012] [Indexed: 12/14/2022]
Abstract
Peanut allergy is often severe, potentially fatal, usually persistent, and appears to have increased in prevalence. An accurate diagnosis is essential because there is a significant burden on quality of life. The tools available for diagnosis include the medical history, skin prick test (SPT), determination of serum peanut-specific IgE antibodies (PN-IgE), and medically supervised oral food challenges. Numerous studies, almost exclusively in children, have correlated clinical outcomes against SPTs and PN-IgE with informative results. The diagnostic utility of SPT and PN-IgE is maximized by considering the degree of positive result and consideration of the medical history (a priori estimation of risk). Emerging tests that evaluate IgE binding to specific proteins in peanut (component testing) add important additional diagnostic information in specific settings. Studies are increasingly focused on how the results of tests considered in combination (or performed serially) may increase diagnostic accuracy. Here, we review the utility of currently available tests and provide suggestions on how to best use them to accurately predict peanut allergy. Still, the physician-supervised oral food challenge remains the most definitive test available.
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Affiliation(s)
- Scott H Sicherer
- Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York, NY.
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Koplin JJ, Dharmage SC, Ponsonby AL, Tang MLK, Lowe AJ, Gurrin LC, Osborne NJ, Martin PE, Robinson MN, Wake M, Hill DJ, Allen KJ. Environmental and demographic risk factors for egg allergy in a population-based study of infants. Allergy 2012; 67:1415-22. [PMID: 22957661 DOI: 10.1111/all.12015] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although egg allergy is the most common food allergy in infants and young children, risk factors for egg allergy remain largely unknown. This study examined the relationship between environmental and demographic factors and egg allergy in a population-based infant cohort. METHODS In a study of 5276 infants (HealthNuts), infants underwent skin prick testing (SPT) to egg white at 12 months of age. Questionnaire data on relevant exposures were obtained. 699/873 (80%) infants eligible for oral food challenge (detectable wheal on SPT) attended for formal assessment of egg allergy status; 453 had confirmed egg allergy (positive challenge and SPT ≥ 2 mm). Associations between environmental and demographic factors and egg allergy were investigated using multivariable logistic regression. RESULTS Children with older siblings and those with a pet dog at home were less likely to develop egg allergy by 1 year of age (adjusted OR [aOR], 0.72; 95% CI, 0.62, 0.83 per sibling; and aOR, 0.72; 95% CI, 0.52, 0.99, respectively). Caesarean section delivery, antibiotic use in infancy, childcare attendance and maternal age were not associated with egg allergy. History of allergic disease in an immediate family member and having parents born in East Asia were strong risk factors for infantile egg allergy (aOR, 1.82; 95% CI, 1.40, 2.36; and aOR, 3.30; 95% CI, 2.45, 4.45, respectively). CONCLUSIONS Exposure in the first year of life to siblings and dogs may decrease the risk of subsequent egg allergy. Infants with a family history of allergy and those with parents born in East Asia are at increased risk of egg allergy.
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Affiliation(s)
| | | | - A.-L. Ponsonby
- Murdoch Childrens Research Institute; Parkville; Vic.; Australia
| | | | | | | | | | | | | | | | - D. J. Hill
- Murdoch Childrens Research Institute; Parkville; Vic.; Australia
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