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Dramburg S, Hilger C, Santos AF, de Las Vecillas L, Aalberse RC, Acevedo N, Aglas L, Altmann F, Arruda KL, Asero R, Ballmer-Weber B, Barber D, Beyer K, Biedermann T, Bilo MB, Blank S, Bosshard PP, Breiteneder H, Brough HA, Bublin M, Campbell D, Caraballo L, Caubet JC, Celi G, Chapman MD, Chruszcz M, Custovic A, Czolk R, Davies J, Douladiris N, Eberlein B, Ebisawa M, Ehlers A, Eigenmann P, Gadermaier G, Giovannini M, Gomez F, Grohman R, Guillet C, Hafner C, Hamilton RG, Hauser M, Hawranek T, Hoffmann HJ, Holzhauser T, Iizuka T, Jacquet A, Jakob T, Janssen-Weets B, Jappe U, Jutel M, Kalic T, Kamath S, Kespohl S, Kleine-Tebbe J, Knol E, Knulst A, Konradsen JR, Korošec P, Kuehn A, Lack G, Le TM, Lopata A, Luengo O, Mäkelä M, Marra AM, Mills C, Morisset M, Muraro A, Nowak-Wegrzyn A, Nugraha R, Ollert M, Palosuo K, Pastorello EA, Patil SU, Platts-Mills T, Pomés A, Poncet P, Potapova E, Poulsen LK, Radauer C, Radulovic S, Raulf M, Rougé P, Sastre J, Sato S, Scala E, Schmid JM, Schmid-Grendelmeier P, Schrama D, Sénéchal H, Traidl-Hoffmann C, Valverde-Monge M, van Hage M, van Ree R, Verhoeckx K, Vieths S, Wickman M, Zakzuk J, Matricardi PM, Hoffmann-Sommergruber K. EAACI Molecular Allergology User's Guide 2.0. Pediatr Allergy Immunol 2023; 34 Suppl 28:e13854. [PMID: 37186333 DOI: 10.1111/pai.13854] [Citation(s) in RCA: 48] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/05/2022] [Indexed: 05/17/2023]
Abstract
Since the discovery of immunoglobulin E (IgE) as a mediator of allergic diseases in 1967, our knowledge about the immunological mechanisms of IgE-mediated allergies has remarkably increased. In addition to understanding the immune response and clinical symptoms, allergy diagnosis and management depend strongly on the precise identification of the elicitors of the IgE-mediated allergic reaction. In the past four decades, innovations in bioscience and technology have facilitated the identification and production of well-defined, highly pure molecules for component-resolved diagnosis (CRD), allowing a personalized diagnosis and management of the allergic disease for individual patients. The first edition of the "EAACI Molecular Allergology User's Guide" (MAUG) in 2016 rapidly became a key reference for clinicians, scientists, and interested readers with a background in allergology, immunology, biology, and medicine. Nevertheless, the field of molecular allergology is moving fast, and after 6 years, a new EAACI Taskforce was established to provide an updated document. The Molecular Allergology User's Guide 2.0 summarizes state-of-the-art information on allergen molecules, their clinical relevance, and their application in diagnostic algorithms for clinical practice. It is designed for both, clinicians and scientists, guiding health care professionals through the overwhelming list of different allergen molecules available for testing. Further, it provides diagnostic algorithms on the clinical relevance of allergenic molecules and gives an overview of their biology, the basic mechanisms of test formats, and the application of tests to measure allergen exposure.
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Affiliation(s)
- Stephanie Dramburg
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christiane Hilger
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Alexandra F Santos
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
- Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | | | - Rob C Aalberse
- Sanquin Research, Dept Immunopathology, University of Amsterdam, Amsterdam, The Netherlands
- Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Nathalie Acevedo
- Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia, Colombia
| | - Lorenz Aglas
- Department of Biosciences and Medical Biology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Friedrich Altmann
- Department of Chemistry, University of Natural Resources and Life Sciences, Vienna, Austria
| | - Karla L Arruda
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Sao Paulo, Brasil, Brazil
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| | - Barbara Ballmer-Weber
- Klinik für Dermatologie und Allergologie, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Domingo Barber
- Institute of Applied Molecular Medicine Nemesio Diez (IMMAND), Department of Basic Medical Sciences, Facultad de Medicina, Universidad San Pablo CEU, CEU Universities, Madrid, Spain
- RETIC ARADyAL and RICORS Enfermedades Inflamatorias (REI), Madrid, Spain
| | - Kirsten Beyer
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University Munich, Munich, Germany
| | - Maria Beatrice Bilo
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
- Allergy Unit Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Torrette, Italy
| | - Simon Blank
- Center of Allergy and Environment (ZAUM), Technical University of Munich, School of Medicine and Helmholtz Center Munich, German Research Center for Environmental Health, Munich, Germany
| | - Philipp P Bosshard
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Heimo Breiteneder
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Helen A Brough
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Merima Bublin
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Dianne Campbell
- Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia, Colombia
| | - Jean Christoph Caubet
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - Giorgio Celi
- Centro DH Allergologia e Immunologia Clinica ASST- MANTOVA (MN), Mantova, Italy
| | | | - Maksymilian Chruszcz
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, South Carolina, USA
| | - Adnan Custovic
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Rebecca Czolk
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Janet Davies
- Queensland University of Technology, Centre for Immunology and Infection Control, School of Biomedical Sciences, Herston, Queensland, Australia
- Metro North Hospital and Health Service, Emergency Operations Centre, Herston, Queensland, Australia
| | - Nikolaos Douladiris
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Bernadette Eberlein
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University Munich, Munich, Germany
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
| | - Anna Ehlers
- Chemical Biology and Drug Discovery, Utrecht University, Utrecht, The Netherlands
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Philippe Eigenmann
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - Gabriele Gadermaier
- Department of Biosciences and Medical Biology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Francisca Gomez
- Allergy Unit IBIMA-Hospital Regional Universitario de Malaga, Malaga, Spain
- Spanish Network for Allergy research RETIC ARADyAL, Malaga, Spain
| | - Rebecca Grohman
- NYU Langone Health, Department of Internal Medicine, New York, New York, USA
| | - Carole Guillet
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Christine Hafner
- Department of Dermatology, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - Robert G Hamilton
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Hauser
- Department of Biosciences and Medical Biology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Thomas Hawranek
- Department of Dermatology and Allergology, Paracelsus Private Medical University, Salzburg, Austria
| | - Hans Jürgen Hoffmann
- Institute for Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Tomona Iizuka
- Laboratory of Protein Science, Graduate School of Life Science, Hokkaido University, Sapporo, Japan
| | - Alain Jacquet
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thilo Jakob
- Department of Dermatology and Allergology, University Medical Center, Justus Liebig University Gießen, Gießen, Germany
| | - Bente Janssen-Weets
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
| | - Uta Jappe
- Division of Clinical and Molecular Allergology, Priority Research Area Asthma and Allergy, Research Center Borstel, Borstel, Germany
- Leibniz Lung Center, Airway Research Center North (ARCN), Member of the German Center for Lung Research, Germany
- Interdisciplinary Allergy Outpatient Clinic, Dept. of Pneumology, University of Lübeck, Lübeck, Germany
| | - Marek Jutel
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
| | - Tanja Kalic
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
- Department of Dermatology, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - Sandip Kamath
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Sabine Kespohl
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr- Universität Bochum, Bochum, Germany
| | - Jörg Kleine-Tebbe
- Allergy & Asthma Center Westend, Outpatient Clinic and Clinical Research Center, Berlin, Germany
| | - Edward Knol
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - André Knulst
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jon R Konradsen
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Korošec
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Annette Kuehn
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Gideon Lack
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
- Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Thuy-My Le
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Andreas Lopata
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Olga Luengo
- RETIC ARADyAL and RICORS Enfermedades Inflamatorias (REI), Madrid, Spain
- Allergy Section, Internal Medicine Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mika Mäkelä
- Division of Allergy, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Pediatric Department, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Clare Mills
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Manchester Institute of Biotechnology, The University of Manchester, Manchester, UK
| | | | - Antonella Muraro
- Food Allergy Referral Centre, Department of Woman and Child Health, Padua University Hospital, Padua, Italy
| | - Anna Nowak-Wegrzyn
- Division of Pediatric Allergy and Immunology, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York, New York, USA
- Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Roni Nugraha
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- Department of Aquatic Product Technology, Faculty of Fisheries and Marine Science, IPB University, Bogor, Indonesia
| | - Markus Ollert
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
| | - Kati Palosuo
- Department of Allergology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Sarita Ulhas Patil
- Division of Rheumatology, Allergy and Immunology, Departments of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Allergy and Immunology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas Platts-Mills
- Division of Allergy and Clinical Immunology, University of Virginia, Charlottesville, Virginia, USA
| | | | - Pascal Poncet
- Institut Pasteur, Immunology Department, Paris, France
- Allergy & Environment Research Team Armand Trousseau Children Hospital, APHP, Paris, France
| | - Ekaterina Potapova
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lars K Poulsen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Christian Radauer
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Suzana Radulovic
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr- Universität Bochum, Bochum, Germany
| | - Pierre Rougé
- UMR 152 PharmaDev, IRD, Université Paul Sabatier, Faculté de Pharmacie, Toulouse, France
| | - Joaquin Sastre
- Allergy Service, Fundación Jiménez Díaz; CIBER de Enfermedades Respiratorias (CIBERES); Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Sakura Sato
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Enrico Scala
- Clinical and Laboratory Molecular Allergy Unit - IDI- IRCCS, Fondazione L M Monti Rome, Rome, Italy
| | - Johannes M Schmid
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Schmid-Grendelmeier
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
| | - Denise Schrama
- Centre of Marine Sciences (CCMAR), Universidade do Algarve, Faro, Portugal
| | - Hélène Sénéchal
- Allergy & Environment Research Team Armand Trousseau Children Hospital, APHP, Paris, France
| | - Claudia Traidl-Hoffmann
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Marcela Valverde-Monge
- Allergy Service, Fundación Jiménez Díaz; CIBER de Enfermedades Respiratorias (CIBERES); Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Marianne van Hage
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ronald van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Kitty Verhoeckx
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Stefan Vieths
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - Magnus Wickman
- Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Josefina Zakzuk
- Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia, Colombia
| | - Paolo M Matricardi
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
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Changes in Serum Protein-Peptide Patterns in Atopic Children Allergic to Plant Storage Proteins. Int J Mol Sci 2023; 24:ijms24021804. [PMID: 36675318 PMCID: PMC9861933 DOI: 10.3390/ijms24021804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Next to cow's milk and eggs, plant foods, i.e., legumes, tree nuts and cereal grains, most often sensitise atopic children. Storage proteins constitutes the most relevant protein fraction of plant foods, causing primary sensitisation. They exhibit strong allergenic properties and immunogenicity. Our goal was to analyse sensitisation to 26 plant storage proteins in a group of 76 children aged 0-5 years with chronic symptoms of atopic dermatitis using Allergy Explorer ALEX2 and to discover changes in serum protein-peptide patterns in allergic patients with the use of MALDI-TOF-MS. We reported that 25% of children were allergic to 2S albumins, 19.7% to 7S globulins, 13.2% to 11S globulins and 1.3% to cereal prolamins. The most common allergenic molecules were Ara h 1 (18.4%), Ara h 2 (17.1%), Ara h 6 (15.8%) and Ara h 3 (11.8%) from peanuts, and the mean serum sIgE concentrations in allergic patients were 10.93 kUA/L, 15.353 kUA/L, 15.359 kUA/L and 9.038 kUA/L, respectively. In children allergic to storage proteins compared to the other patients (both allergic and non-allergic), the cell cycle control protein 50A, testis-expressed sequence 13B, DENN domain-containing protein 5A and SKI family transcriptional corepressor 2 were altered. Our results indicate that the IgE-mediated allergy to storage proteins is a huge problem in a group of young, atopic children, and show the potential of proteomic analysis in the prediction of primary sensitisation to plant foods. It is the next crucial step for understanding the molecular consequences of allergy to storage proteins.
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Blum LA, Ahrens B, Klimek L, Beyer K, Gerstlauer M, Hamelmann E, Lange L, Nemat K, Vogelberg C, Blümchen K. White Paper Erdnussallergie - Teil 2: Diagnostik der Erdnussallergie unter besonderer Berücksichtigung der molekularen Komponentendiagnostik. ALLERGO JOURNAL 2021. [DOI: 10.1007/s15007-021-4931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Fuhrmann V, Huang HJ, Akarsu A, Shilovskiy I, Elisyutina O, Khaitov M, van Hage M, Linhart B, Focke-Tejkl M, Valenta R, Sekerel BE. From Allergen Molecules to Molecular Immunotherapy of Nut Allergy: A Hard Nut to Crack. Front Immunol 2021; 12:742732. [PMID: 34630424 PMCID: PMC8496898 DOI: 10.3389/fimmu.2021.742732] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/23/2021] [Indexed: 12/02/2022] Open
Abstract
Peanuts and tree nuts are two of the most common elicitors of immunoglobulin E (IgE)-mediated food allergy. Nut allergy is frequently associated with systemic reactions and can lead to potentially life-threatening respiratory and circulatory symptoms. Furthermore, nut allergy usually persists throughout life. Whether sensitized patients exhibit severe and life-threatening reactions (e.g., anaphylaxis), mild and/or local reactions (e.g., pollen-food allergy syndrome) or no relevant symptoms depends much on IgE recognition of digestion-resistant class I food allergens, IgE cross-reactivity of class II food allergens with respiratory allergens and clinically not relevant plant-derived carbohydrate epitopes, respectively. Accordingly, molecular allergy diagnosis based on the measurement of allergen-specific IgE levels to allergen molecules provides important information in addition to provocation testing in the diagnosis of food allergy. Molecular allergy diagnosis helps identifying the genuinely sensitizing nuts, it determines IgE sensitization to class I and II food allergen molecules and hence provides a basis for personalized forms of treatment such as precise prescription of diet and allergen-specific immunotherapy (AIT). Currently available forms of nut-specific AIT are based only on allergen extracts, have been mainly developed for peanut but not for other nuts and, unlike AIT for respiratory allergies which utilize often subcutaneous administration, are given preferentially by the oral route. Here we review prevalence of allergy to peanut and tree nuts in different populations of the world, summarize knowledge regarding the involved nut allergen molecules and current AIT approaches for nut allergy. We argue that nut-specific AIT may benefit from molecular subcutaneous AIT (SCIT) approaches but identify also possible hurdles for such an approach and explain why molecular SCIT may be a hard nut to crack.
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Affiliation(s)
- Verena Fuhrmann
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Huey-Jy Huang
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Aysegul Akarsu
- Division of Allergy and Asthma, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Igor Shilovskiy
- Laboratory for Molecular Allergology, National Research Center (NRC) Institute of Immunology Federal Medical-Biological Agency (FMBA) of Russia, Moscow, Russia
| | - Olga Elisyutina
- Laboratory for Molecular Allergology, National Research Center (NRC) Institute of Immunology Federal Medical-Biological Agency (FMBA) of Russia, Moscow, Russia
| | - Musa Khaitov
- Laboratory for Molecular Allergology, National Research Center (NRC) Institute of Immunology Federal Medical-Biological Agency (FMBA) of Russia, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Marianne van Hage
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University, Hospital, Stockholm, Sweden
| | - Birgit Linhart
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Margarete Focke-Tejkl
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
- Laboratory for Molecular Allergology, National Research Center (NRC) Institute of Immunology Federal Medical-Biological Agency (FMBA) of Russia, Moscow, Russia
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Bulent Enis Sekerel
- Division of Allergy and Asthma, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Brand HK, Schreurs MWJ, Emons JAM, Gerth van Wijk R, de Groot H, Arends NJT. Peanut components measured by ISAC: comparison with ImmunoCap and clinical relevance in peanut allergic children. Clin Mol Allergy 2021; 19:14. [PMID: 34372856 PMCID: PMC8353733 DOI: 10.1186/s12948-021-00153-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background Specific IgE (sIgE) against the peanut component Arachis hypogaea (Ara h) 2 has been shown to be the most important allergen to discriminate between peanut allergy and peanut tolerance. Several studies determined sIgE cut off values for Ara h 2, determined by singleplex measurements. However, cut off values for Ara h 2 from multiplex arrays are less well defined. The aim of this study was to evaluate the correlation between Ara h 2 sIgE determined by singleplex versus multiplex measurements and to assess the diagnostic value of the different peanut components included in Immuno Solid-phase Allergen Chip (ISAC) multiplex analysis in children with a suspected peanut allergy. Methods In this retrospective study we analyzed Ara h 2 sIgE values with singleplex Fluorescence Enzyme Immunoassay (FEIA, ImmunoCap) and multiplex microarray (ISAC) measurements in 117 children with a suspected peanut allergy. Also, other peanut components measured by ISAC were analyzed. Double blinded placebo controlled oral food challenges were used as golden standard. Results Among all studied peanut components FEIA Ara h 2 sIgE showed the highest area under the curve (AUC, 0.922), followed by ISAC Ara h 6 and Ara h 2 sIgE with AUCs of respectively 0.906 and 0.902. Best cut off values to diagnose peanut allergy were 4.40 kU/l for FEIA Ara h 2 sIgE and, 7.43 ISU and 8.13 ISU for respectively Ara h 2 and Ara h 6 sIgE in ISAC microarray. Ara h 2 sIgE determined in FEIA and ISAC showed a good correlation (r = 0.88; p < 0.01). Conclusion Ara h 6 and Ara h 2 sIgE in multiplex ISAC are both good predictors of clinical peanut allergy in Dutch children, and their performance is comparable to the use of Ara h 2 in singleplex FEIA. The simultaneous measurement of different peanut components using ISAC is an advantage and clinically useful to detect peanut allergic children that are Ara h 2 negative but sensitized to other peanut proteins such as Ara h 6.
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Affiliation(s)
- H K Brand
- Department of Pediatric Pulmonology and Allergology, Emma Children's Hospital, Amsterdam University Medical Centres, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - M W J Schreurs
- Department of Immunology, Laboratory Medical Immunology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - J A M Emons
- Department of Pediatric Pulmonology and Allergology, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands
| | - R Gerth van Wijk
- Department of Internal Medicine, Section of Allergology and Clinical Immunology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - H de Groot
- Department of Allergology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - N J T Arends
- Department of Pediatric Pulmonology and Allergology, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands
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6
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Čelakovská J, Bukač J, Vaňková R, Krejsek J, Andrýs C. Peanuts allergy in atopic dermatitis patients, analysis of sensitization to molecular components. FOOD AGR IMMUNOL 2021. [DOI: 10.1080/09540105.2021.1911958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- J. Čelakovská
- Department of Dermatology and Venereology, Faculty Hospital and Medical Faculty of Charles University, Hradec Králové, Czech Republic
| | - J. Bukač
- Department of Medical Biophysic, Medical Faculty of Charles University, Hradec Králové, Czech Republic
| | - R. Vaňková
- Department of Clinical Immunology and Allergy, Faculty Hospital and Medical Faculty of Charles University, Hradec Králové, Czech Republic
| | - J. Krejsek
- Department of Clinical Immunology and Allergy, Faculty Hospital and Medical Faculty of Charles University, Hradec Králové, Czech Republic
| | - C. Andrýs
- Department of Clinical Immunology and Allergy, Faculty Hospital and Medical Faculty of Charles University, Hradec Králové, Czech Republic
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7
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Mattsson L, Valcour A, Holmqvist M, Larsson H, Lidholm J. Cyclophilin - A novel cross-reactive determinant in peanut. Clin Exp Allergy 2021; 51:620-622. [PMID: 33497485 DOI: 10.1111/cea.13833] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/21/2020] [Accepted: 01/19/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | - Andre Valcour
- Laboratory Corporation of America, Burlington, NC, USA
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8
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Shi Y, Wang M, Ding Y, Chen J, Niu B, Chen Q. Effects of Maillard reaction on structural modification and potential allergenicity of peanut 7S globulin (Ara h 1). JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2020; 100:5617-5626. [PMID: 32608517 DOI: 10.1002/jsfa.10614] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 05/16/2020] [Accepted: 07/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Ara h 1 is a major food allergen in peanuts. Recently, many studies have revealed that the Maillard reaction (MR) affects the allergenicity of food proteins. RESULTS To investigate the influence of the MR on the allergenicity of Ara h 1, R-Ara h 1 was processed with glucose in dry heating conditions for different periods. The extent of the MR was assessed by four methods. The changes in secondary and tertiary structures were characterized through spectroscopy assays. Advanced glycation end products (AGE) structures were identified by protein sample dry heating for 60 min, indicating the formation of AGE-Ara h 1. Simulated gastric fluid (SGF) digestion analysis showed that AGE-Ara h 1 has higher resistance to peptic digestion than R-Ara h 1. The BALB/c mouse model was also utilized to explore the effect of the MR on the allergenicity of Ara h 1, and the results showed that the Th2-type cytokines, antibodies, and histamine content increased, and there was a greater degree of degranulation of rat basophilic leukemia (RBL) cells in the AGE-Ara h 1 group compared with the R-Ara h 1 group. CONCLUSION During the process of dry heating, proteins participated in the MR with changes in secondary and tertiary structures. The condition applying a temperature of 100 °C for 60 min caused the formation of AGE-Ara h 1. Simulated gastric fluid digestion analysis showed that AGE-Ara h 1 had a greater resistance to peptic digestion than R-Ara h 1. The BALB/c mouse model showed that AGE-Ara h 1 had more allergenicity, indicating that the MR could enhance the allergenicity of Ara h 1. © 2020 Society of Chemical Industry.
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Affiliation(s)
- Yunfeng Shi
- School of Life Sciences, Shanghai University, Shanghai, China
- Shanghai Institute of Biological Products Co., ltd., Shanghai, China
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9
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Thouvenot B, Roitel O, Tomasina J, Hilselberger B, Richard C, Jacquenet S, Codreanu-Morel F, Morisset M, Kanny G, Beaudouin E, Delebarre-Sauvage C, Olivry T, Favrot C, Bihain BE. Transcriptional frameshifts contribute to protein allergenicity. J Clin Invest 2020; 130:5477-5492. [PMID: 32634131 PMCID: PMC7524509 DOI: 10.1172/jci126275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 07/01/2020] [Indexed: 01/07/2023] Open
Abstract
Transcription infidelity (TI) is a mechanism that increases RNA and protein diversity. We found that single-base omissions (i.e., gaps) occurred at significantly higher rates in the RNA of highly allergenic legumes. Transcripts from peanut, soybean, sesame, and mite allergens contained a higher density of gaps than those of nonallergens. Allergen transcripts translate into proteins with a cationic carboxy terminus depleted in hydrophobic residues. In mice, recombinant TI variants of the peanut allergen Ara h 2, but not the canonical allergen itself, induced, without adjuvant, the production of anaphylactogenic specific IgE (sIgE), binding to linear epitopes on both canonical and TI segments of the TI variants. The removal of cationic proteins from bovine lactoserum markedly reduced its capacity to induce sIgE. In peanut-allergic children, the sIgE reactivity was directed toward both canonical and TI segments of Ara h 2 variants. We discovered 2 peanut allergens, which we believe to be previously unreported, because of their RNA-DNA divergence gap patterns and TI peptide amino acid composition. Finally, we showed that the sIgE of children with IgE-negative milk allergy targeted cationic proteins in lactoserum. We propose that it is not the canonical allergens, but their TI variants, that initiate sIgE isotype switching, while both canonical and TI variants elicit clinical allergic reactions.
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Affiliation(s)
| | | | | | | | | | | | - Françoise Codreanu-Morel
- Unité Nationale d’Immunologie et d’Allergologie, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Martine Morisset
- Unité d’Allergologie, Département de Pneumologie, Centre Hospitalier Universitaire Angers, Angers, France
| | - Gisèle Kanny
- Service de Médecine Interne, Immunologie Clinique et Allergologie, Hôpitaux de Brabois, Centre Hospitalier Universitaire de Nancy, Vandœuvre-lès-Nancy, France
| | - Etienne Beaudouin
- Unité d’Allergologie, Centre Hospitalier Régional de Metz, Metz, France
| | - Christine Delebarre-Sauvage
- Allergology Center Saint-Vincent de Paul Hospital, Groupe Hospitalier de l’Institut Catholique de Lille, Lille, France
| | - Thierry Olivry
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Claude Favrot
- Clinic for Small Animal Internal Medicine, University of Zurich, Zurich, Switzerland
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10
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Pahlow Mose A, Mortz E, Stahl Skov P, Mortz CG, Eller E, Sprogøe U, Barington T, Bindslev‐Jensen C. The quest for ingested peanut protein in human serum. Allergy 2020; 75:1721-1729. [PMID: 31715004 DOI: 10.1111/all.14109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 09/15/2019] [Accepted: 10/07/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is mounting evidence that systemic uptake of food allergens is key to triggering anaphylaxis. However, direct proof for this theory is still lacking. The purpose of this study was to quantify the absorption and to determine the absorption kinetics of immunoreactive peanut protein in relation to the allergic response in human. METHODS Quantitative protein assays including mass spectrometry, dot blots and Western blotting were developed to determine the level of Ara h 2 absorption in human serum. The double monoclonal sandwich ELISA was applied to quantify absorbed Ara h 2 and 6, and the basophil histamine release assay and the human passive cutaneous anaphylaxis test were utilized to study the absorption kinetics of immunologically intact peanut proteins. RESULTS The protein assays worked but were not sensitive enough to trace the minute amounts of absorbed Ara h 2 in human serum. The level of Ara h 6 in serum was found to be up to 0.2 ng/mL, but Ara h 2 could not be detected with the ELISA. Both the in vivo and the in vitro methods were successful in demonstrating that: immunoreactive peanut protein was absorbed shortly after ingestion (≤5 minutes); the peanut protein concentration peaks between 1 and 4 hours; and peanut proteins can circulate for at least 48 hours in the bloodstream. CONCLUSION Ingested peanut protein is absorbed systemically and retains its immunoreactive capacity in human serum. However, the precise quantities and the implication for the elicitation of anaphylaxis remains to be elucidated.
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Affiliation(s)
- Anja Pahlow Mose
- Odense Research Center for Anaphylaxis (ORCA) Odense University Hospital Odense Denmark
- Department of Dermatology and Allergy Center Odense University Hospital Odense Denmark
| | | | - Per Stahl Skov
- Odense Research Center for Anaphylaxis (ORCA) Odense University Hospital Odense Denmark
- RefLab Aps. Copenhagen Denmark
| | - Charlotte Gotthard Mortz
- Odense Research Center for Anaphylaxis (ORCA) Odense University Hospital Odense Denmark
- Department of Dermatology and Allergy Center Odense University Hospital Odense Denmark
| | - Esben Eller
- Odense Research Center for Anaphylaxis (ORCA) Odense University Hospital Odense Denmark
- Department of Dermatology and Allergy Center Odense University Hospital Odense Denmark
| | - Ulrik Sprogøe
- Department of Clinical Immunology Odense University Hospital Odense Denmark
| | - Torben Barington
- Department of Clinical Immunology Odense University Hospital Odense Denmark
| | - Carsten Bindslev‐Jensen
- Odense Research Center for Anaphylaxis (ORCA) Odense University Hospital Odense Denmark
- Department of Dermatology and Allergy Center Odense University Hospital Odense Denmark
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11
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Gray CL. Current Controversies and Future Prospects for Peanut Allergy Prevention, Diagnosis and Therapies. J Asthma Allergy 2020; 13:51-66. [PMID: 32021312 PMCID: PMC6970608 DOI: 10.2147/jaa.s196268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 12/18/2019] [Indexed: 12/20/2022] Open
Abstract
Peanut allergy has increased substantially in the past few decades, both in developed and developing countries. Peanut allergy has become a major public health concern, affecting up to 1 in 50 children, with repercussions for school and airline policies. Recent research findings have shown that, contrary to the long-standing teaching of "delayed" introduction of allergens, early introduction of peanut protein is of benefit as an allergy prevention strategy, especially in high-risk cases. Ideal dose, frequency and duration of "proactive" peanut therapy for maximum protection remain to be determined in order for it to become acceptable and practical on a large scale. Logistics around widespread screening of high-risk patients remain complex. The correct diagnosis of peanut allergy is crucial and diagnostic tests have been fine-tuned in the past 2 decades in order to help differentiate true allergy from false-positive sensitization through cross-reactivity. Component-resolved diagnostics have become routinely available, and the use of basophil activation tests has increased, although standardization and availability remain issues. Future tests, including epitope testing and histamine-release assays, promise to be even more specific in ruling out false positives and reducing the need for incremental food challenges. Stringent peanut avoidance and prompt treatment of reactions remain the cornerstone of treatment. The concept of exposing the allergic body to small amounts of peanut protein in a cautious, orderly, escalating fashion in the form of desensitization has been widely applied in the past 10-15 years, mainly in the research domain, but of late spilling over into every-day practice. However, desensitization does not equate to a cure, and has significant safety concerns and practical ramifications; probably requiring lifelong-controlled peanut ingestion for ongoing protection. Further strategies to enhance the safety and efficacy of immunotherapy are under exploration, many with a non-specific immune-modifying effect. Despite recent advances in peanut allergy, we still need to go back to basics with accurate diagnosis, nutritional counselling, well-organized allergy action plans and accessible emergency kits.
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Affiliation(s)
- Claudia Liesel Gray
- Red Cross Children's Hospital and University of Cape Town, Cape Town, South Africa.,Kidsallergy Centre, Vincent Pallotti Hospital, Cape Town, South Africa
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12
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Molecular evolution of genes encoding allergen proteins in the peanuts genus Arachis: Structural and functional implications. PLoS One 2019; 14:e0222440. [PMID: 31675366 PMCID: PMC6824556 DOI: 10.1371/journal.pone.0222440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/29/2019] [Indexed: 12/14/2022] Open
Abstract
Food allergies are severe immune responses to plant and animal products mediated by immunoglobulin E (IgE). Peanuts (Arachis hypogaea L.) are among the top 15 crops that feed the world. However, peanuts is among the “big eight food allergens”, and allergies induced by peanuts are a significant public health problem and a life-threatening concern. Targeted mutation studies in peanuts demonstrate that single residue alterations in these allergen proteins could result in substantial reduction in allergenicity. Knowledge of peanut allergen proteins is confined to the allotetraploid crop and its two progenitors. We explored frequencies and positions of natural mutations in the hyperallergenic homologues Ara h 2 and Ara h 6 in newly generated sequences for 24 Arachis wild species and the crop species, assessed potential mutational impact on allergenicity using immunoblots and structural modeling, and evaluated whether these mutations follow evolutionary trends. We uncovered a wealth of natural mutations, both substitutions and gaps, including the elimination of immunodominant epitopes in some species. These molecular alterations appear to be associated with substantial reductions in allergenicity. The study demonstrated that Ara h 2 and Ara h 6 follow contrasting modes of natural selection and opposing mutational patterns, particularly in epitope regions. Phylogenetic analysis revealed a progressive trend towards immunodominant epitope evolution in Ara h 2. The findings provide valuable insight into the interactions among mutations, protein structure and immune system response, thus presenting a valuable platform for future manipulation of allergens to minimize, treat or eliminate allergenicity. The study strongly encourages exploration of genepools of economically important plants in allergenicity research.
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13
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Elegbede CF, Papadopoulos A, Just J, Moneret-Vautrin DA, Deschildre A, Crépet A. Gender, prick test size and rAra h 2 sIgE level may predict the eliciting dose in patients with peanut allergy: Evidence from the Mirabel survey. Clin Exp Allergy 2019; 49:677-689. [PMID: 30689235 DOI: 10.1111/cea.13348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/30/2018] [Accepted: 12/02/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Peanut allergy management is based on active avoidance and access to emergency treatment including self-injectable adrenaline. Knowing the dose at which a patient is likely to react is crucial for risk assessment and could significantly improve management by integrating a personalized approach. OBJECTIVE To develop a threshold dose distribution curve model from routinely collected data. METHODS The MIRABEL survey is an observational study of 785 patients with peanut allergy/sensitization conducted in France, Belgium and Luxemburg. The current analysis included the 238 participants for whom medical and oral food challenge data were available. Several statistical models (Kaplan-Meier, Cox model, Weibull and Lognormal with predictive factors, basic Weibull and Lognormal) were compared to select the best model and predictive factor combination associated with the threshold doses. Inferences were made with a Bayesian approach. RESULTS Patients were mainly children (mean age: 9 years [IQR: 6-11]; 87% < 16 years) and males (62%). Median Ara h2 s IgE was of 8kUA/L [IQR: 1-55] and median skin prick test size of 10 mm [IQR: 7-13]. OFC was positive in 204 patients (86%). The median threshold dose was of 67 mg of peanut protein [IQR: 16-244]. The dose at which 1% of the patients are likely to react with objective symptoms was 0.26 [0.03; 2.24] mg of peanut protein. Gender, size of the skin prick test (SPT) and Ara h 2 specific IgE level had a significant impact on the threshold dose distribution curve. The Cox model was the most effective to predict threshold doses with this combination of factors. Girls react to lower doses than boys with a beta coefficient associated to the risk and a 95% credible interval of 0.44 [0.04; 0.77]. The higher the size of the SPT and the Ara h 2 specific IgE level are, the higher the risk of reacting to a small amount of peanut, with beta coefficients associated to the risk and 95% credible intervals of 0.05 [0.02; 0.08] and 0.01 [0.01; 0.02], respectively. CONCLUSION AND CLINICAL RELEVANCE According to the model, routinely collected data could be used to estimate the threshold dose. The consequences could be the identification of high-risk patients who are susceptible to react to small amounts of peanut and a personalized management of peanut allergy integrating the risk of allergic reaction. Limitations of this study are that assessors of OFC outcome were aware of SPT and Arah2 results, and a further validation study is required to confirm the predictive value of these parameters.
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Affiliation(s)
- Chabi Fabrice Elegbede
- French Agency for Food, Environmental and Occupational Health Safety (ANSES), Risk Assessment Department (DER), Methology and Studies Unit, 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, Thiverval-Grignon, France
| | - Alexandra Papadopoulos
- French Agency for Food, Environmental and Occupational Health Safety (ANSES), Risk Assessment Department (DER), Methology and Studies Unit, Maisons-Alfort, France
| | - Jocelyne Just
- Asthma and Allergy Center, Hôpital d'Enfants Armand-Trousseau, Paris, France.,INSERM, UMR_S 1136, Sorbonne Universités, UPMC Univ Paris 06, Paris, France.,Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, Paris, France
| | - Denise Anne Moneret-Vautrin
- Allergy Department, Centre Hospitalier E Durckheim, Epinal, France.,Allergyvigilance Network, Vandoeuvre les Nancy, France.,Lorraine University, Nancy, France
| | - Antoine Deschildre
- Pediatric Pulmonology and Allergy Department, CHU Lille, Hôpital Jeanne de Flandre, Lille, France
| | - Amélie Crépet
- French Agency for Food, Environmental and Occupational Health Safety (ANSES), Risk Assessment Department (DER), Methology and Studies Unit, Maisons-Alfort, France
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14
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Zambrano Ibarra G, Fuentes Aparicio V, Infante Herrero S, Blanca M, Zapatero Remon L. Peanut Allergy in Spanish Children: Comparative Profile of Peanut Allergy versus Tolerance. Int Arch Allergy Immunol 2019; 178:370-376. [DOI: 10.1159/000495579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/19/2018] [Indexed: 11/19/2022] Open
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15
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Chinthrajah RS, Purington N, Andorf S, Rosa JS, Mukai K, Hamilton R, Smith BM, Gupta R, Galli SJ, Desai M, Nadeau KC. Development of a tool predicting severity of allergic reaction during peanut challenge. Ann Allergy Asthma Immunol 2018; 121:69-76.e2. [PMID: 29709643 DOI: 10.1016/j.anai.2018.04.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/18/2018] [Accepted: 04/23/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Reliable prognostic markers for predicting severity of allergic reactions during oral food challenges (OFCs) have not been established. OBJECTIVE To develop a predictive algorithm of a food challenge severity score (CSS) to identify those at higher risk for severe reactions to a standardized peanut OFC. METHODS Medical history and allergy test results were obtained for 120 peanut allergic participants who underwent double-blind, placebo-controlled food challenges. Reactions were assigned a CSS between 1 and 6 based on cumulative tolerated dose and a severity clinical indicator. Demographic characteristics, clinical features, peanut component IgE values, and a basophil activation marker were considered in a multistep analysis to derive a flexible decision rule to understand risk during peanut of OFC. RESULTS A total of 18.3% participants had a severe reaction (CSS >4). The decision rule identified the following 3 variables (in order of importance) as predictors of reaction severity: ratio of percentage of CD63hi stimulation with peanut to percentage of CD63hi anti-IgE (CD63 ratio), history of exercise-induced asthma, and ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) ratio. The CD63 ratio alone was a strong predictor of CSS (P < .001). CONCLUSION The CSS is a novel tool that combines dose thresholds and allergic reactions to understand risks associated with peanut OFCs. Laboratory values (CD63 ratio), along with clinical variables (exercise-induced asthma and FEV1/FVC ratio) contribute to the predictive ability of the severity of reaction to peanut OFCs. Further testing of this decision rule is needed in a larger external data source before it can be considered outside research settings. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02103270.
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Affiliation(s)
- R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, California; Department of Medicine, Stanford University School of Medicine, Stanford, California; Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Natasha Purington
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, California; School of Medicine, Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
| | - Sandra Andorf
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, California; Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jaime S Rosa
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, California; Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Kaori Mukai
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, California; Department of Pathology, Stanford University School of Medicine, Stanford, California; Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, California
| | - Robert Hamilton
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bridget Marie Smith
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, Illinois
| | - Ruchi Gupta
- Department of Pediatrics and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Stephen J Galli
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, California; Department of Pathology, Stanford University School of Medicine, Stanford, California; Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, California
| | - Manisha Desai
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, California; School of Medicine, Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California; Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, California; Department of Medicine, Stanford University School of Medicine, Stanford, California; Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
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16
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Petersen TH, Mortz CG, Bindslev-Jensen C, Eller E. Cow's milk allergic children-Can component-resolved diagnostics predict duration and severity? Pediatr Allergy Immunol 2018; 29:194-199. [PMID: 29314279 DOI: 10.1111/pai.12854] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cow's milk allergy (CMA) affects 2% of all children. This study investigatescomponent-resolved diagnostics(CRD) to cow's milk proteins in children suspected of CMA, by correlating the level of CRD with outcome of the oral challenge. Furthermore, we evaluate the ability of serial CRD measurements to distinguish children with persistent CMA from children developing tolerance. METHODS We included data from 78 children referred to the Allergy Centre during a 13-year period. Results from oral food challenges including threshold, severity, and sensitization data (IgE antibodies to whole milk protein, IgE components toward milk and skin prick test (SPT)) were collected. The milk allergic children were re-evaluated with sensitization data and rechallenges regularly. RESULTS Thirty-nine children had negative first challenges, and 39 had positive first challenges. The positive group was rechallenged and separated into 3 groups depending on time to remission. At inclusion, children with persistent CMA had significantly larger size of SPT and higher levels of s-IgE to milk and CRD compared to the other groups. SPT wheal size was significantly larger in children with persistent CMA compared to children outgrowing CMA. Furthermore, a correlation between s-IgE level to cow's milk and casein and the severity of the allergic reaction elicited by food challenges was found. CONCLUSION Oral food challenge cannot be replaced by s-IgE to whole milk protein or milk components nor SPT in the diagnosis of CMA; however, high levels of milk components and s-IgE to milk increase the risk of a long-lasting or persisting CMA.
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Affiliation(s)
- Thomas Houmann Petersen
- Department of Dermatology & Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Charlotte Gotthard Mortz
- Department of Dermatology & Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Carsten Bindslev-Jensen
- Department of Dermatology & Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Esben Eller
- Department of Dermatology & Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
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17
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Patelis A, Gunnbjornsdottir M, Alving K, Borres MP, Högman M, Janson C, Malinovschi A. Allergen extract vs. component sensitization and airway inflammation, responsiveness and new-onset respiratory disease. Clin Exp Allergy 2017; 46:730-40. [PMID: 26243058 DOI: 10.1111/cea.12607] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/20/2015] [Accepted: 07/19/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND The absence of IgE sensitization to allergen components in the presence of sensitization to the corresponding extract has been reported, but its clinical importance has not been studied. OBJECTIVE To evaluate the clinical significance of IgE sensitization to three aeroallergen extracts and the corresponding components in relation to the development of respiratory disease. METHODS A total of 467 adults participated in the European Community Respiratory Health Survey (ECRHS) II and 302 in ECRHS III, 12 years later. IgE sensitization to allergen extract and components, exhaled nitric oxide (FeNO) and bronchial responsiveness to methacholine were measured in ECRHS II. Rhinitis and asthma symptoms were questionnaire-assessed in both ECRHS II and III. RESULTS A good overall correlation was found between IgE sensitization to extract and components for cat (r = 0.83), timothy (r = 0.96) and birch (r = 0.95). However, a substantial proportion of subjects tested IgE positive for cat and timothy allergen extracts but negative for the corresponding components (48% and 21%, respectively). Subjects sensitized to both cat extract and components had higher FeNO (P = 0.008) and more bronchial responsiveness (P = 0.002) than subjects sensitized only to the extract. Further, subjects sensitized to cat components were more likely to develop asthma (P = 0.005) and rhinitis (P = 0.007) than subjects sensitized only to cat extract. CONCLUSION Measurement of IgE sensitization to cat allergen components would seem to have a higher clinical value than extract-based measurement, as it related better to airway inflammation and responsiveness and had a higher prognostic value for the development of asthma and rhinitis over a 12-year period.
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Affiliation(s)
- A Patelis
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - M Gunnbjornsdottir
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - K Alving
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - M P Borres
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Thermo Fisher Scientific, Immunodiagnostics, Uppsala, Sweden
| | - M Högman
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.,Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - C Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - A Malinovschi
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
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18
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Abstract
PURPOSE OF THE REVIEW Whilst food allergy seems to have increased significantly in many developed countries in the past few decades, quality data on the burden of food allergy in many developing countries is scanty. Until recently, South Africa had a dearth of robustly designed food allergy studies. This article summarizes some of the recent research and observations regarding food allergy from the South African setting. RECENT FINDINGS South Africa has recently seen two important food allergy prevalence studies in selected and unselected populations. Both show allergy rates in keeping with those in several westernized countries. The major difference between sensitization and allergy rates in these studies emphasizes the vital role of the food challenge in differentiating true food allergy from asymptomatic sensitisation in equivocal cases. Eczema, young age and living in an urban population are important risk factors for food allergy in South Africa. Egg and peanut allergy are the most common food allergies in both selected and unselected populations in South Africa. In peanut allergy, Ara h 2 is the most useful component in differentiating true allergy from tolerance in peanut-sensitized patients. Use of internationally derived 95% positive predictive values for peanut and egg allergy produced many false positives in South African studies. Studies in South Africa show a trend towards more conservative introduction of peanut in eczema patients, which needs to be addressed in the light of recent studies showing a protective effect of earlier introduction of peanut. "Novel" allergies such as galactose-alpha-1,3-galactose allergy, food protein-induced enterocolitis syndrome and eosinophilic oesophagitis are being described with increasing frequency in South Africa. The surprisingly high prevalence of food allergy in South Africa points towards possible involvement of South Africa in the so-called "food allergy epidemic". This has major implications on the planning of health services in the allergy sector. Food challenges will form a vital role in allergy services. Ninety-five percent positive predictive values for peanut and egg allergy may need revision to be more applicable to the local population.
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19
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Blankestijn MA, Otten HG, Suer W, Weimann A, Knol EF, Knulst AC. Specific IgE to peanut 2S albumin Ara h 7 has a discriminative ability comparable to Ara h 2 and 6. Clin Exp Allergy 2017; 48:60-65. [PMID: 28906044 DOI: 10.1111/cea.13030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/15/2017] [Accepted: 09/04/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Little is known on the clinical relevance of peanut 2S albumin Ara h 7. OBJECTIVE To investigate the discriminative ability of Ara h 7 in peanut allergy and assess the role of cross-reactivity between Ara h 2, 6 and Ara h 7 isoforms. METHODS Sensitization to recombinant peanut storage proteins Ara h 1, 2, 3, 6, and 7 was assessed using a line blot in sera from 40 peanut-tolerant and 40 peanut-allergic patients, based on food challenge outcome. A dose-dependent ELISA inhibition experiment was performed with recombinant Ara h 2, 6 and Ara h 7 isoforms. RESULTS For Ara h 7.0201, an area under the ROC curve was found of 0.83, comparable to Ara h 2 (AUC 0.81) and Ara h 6 (AUC 0.85). Ara h 7 intensity values strongly correlated with those from Ara h 2 and 6 (rs = 0.81). Of all patients sensitized to 2S albumins Ara h 2, 6, or 7, the majority was co-sensitized to all three (n = 24, 68%), although mono-sensitization to either 2S albumin was also observed in selected patients (Ara h 2: n = 6, 17%; Ara h 6: n = 2, 6%; Ara h 7: n = 2, 6%). Binding to Ara h 7.0101 could be strongly inhibited by Ara h 7.0201, but not the other way around. CONCLUSIONS AND CLINICAL RELEVANCE Specific IgE against Ara h 7.0201 has a predictive ability for peanut allergy similar to Ara h 2 and 6 and possesses unique IgE epitopes as well as epitopes shared between the other Ara h 7 isoform and Ara h 2 and 6. While co-sensitization to all three 2S albumins is most common, mono-sensitization to either Ara h 2, 6, or 7 occurs in selected patients, leading to a risk of misdiagnosis when testing for a single 2S albumin.
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Affiliation(s)
- M A Blankestijn
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - H G Otten
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - W Suer
- EUROIMMUN, Lübeck, Germany
| | | | - E F Knol
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - A C Knulst
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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20
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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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21
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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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22
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Alvarez-Arango S, Hou A, Lowes MA, Jerschow E. Isotretinoin treatment in a patient with known peanut allergy and positive IgE test results for soybean. Ann Allergy Asthma Immunol 2016; 117:558-559. [PMID: 27670093 DOI: 10.1016/j.anai.2016.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/15/2016] [Accepted: 08/15/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Santiago Alvarez-Arango
- Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Angela Hou
- Division of Dermatology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Michelle A Lowes
- Division of Dermatology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Elina Jerschow
- Division of Allergy/Immunology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
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23
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Park KH, Son YW, Lee SC, Jeong K, Sim DW, Park HJ, Lee S, Lee JH, Park JW. Clinical Significance of Component Allergens in Fagales Pollen-Sensitized Peanut Allergy in Korea. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2016; 8:505-11. [PMID: 27582401 PMCID: PMC5011050 DOI: 10.4168/aair.2016.8.6.505] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 03/15/2016] [Accepted: 04/25/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE Clinical features of peanut allergy can range from localized to systemic reactions. Because peanut and birch pollen have cross-reactivity, peanut can lead to localized allergic reaction in Fagales pollen-sensitized oral allergy syndrome (OAS) patients without peanut sensitization per se. The purpose of this study was to discriminate true peanut food allergy from cross-reactive hypersensitivity in birch-sensitized peanut allergy. METHODS Birch-sensitized (n=81) and peanut anaphylaxis patients (n=12) were enrolled. Peanut-related allergic reactions and sensitization profiles were examined. Specific IgE to Fagales tree pollens (birch, oak), peanut, and their component allergens (Bet v 1, Bet v 2, Ara h 1, Ara h 2, Ara h 3, Ara h 8, and Ara h 9) were evaluated. Based on these specific IgEs and clinical features, the patients were classified into 4 groups: group 1 (Fagales pollen allergy without OAS), group 2 (Fagales pollen allergy with OAS), group 3 (OAS with peanut anaphylaxis), and group 4 (peanut anaphylaxis). RESULTS After peanut consumption, one-third of OAS patients experienced oral symptoms not associated with peanut sensitization. Ara h 1 or Ara h 2 was positive in peanut anaphylaxis patients, whereas Ara h 8 was positive in OAS patients. There were 4 patients with both peanut anaphylaxis and OAS (group 3). Both Ara h 2 and Ara h 8 were positive in these patients. Foods associated with OAS in Korea showed unique patterns compared to Westernized countries. CONCLUSIONS Ara h 2 and Ara h 8 may be important component allergens for discriminating peanut allergy.
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Affiliation(s)
- Kyung Hee Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Young Woong Son
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Chul Lee
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyunguk Jeong
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Da Woon Sim
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Jung Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Sooyoung Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Jae Hyun Lee
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Won Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea.
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24
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What is new in food allergy diagnostics? A practice-based approach. Ann Allergy Asthma Immunol 2016; 117:462-464. [PMID: 27788871 DOI: 10.1016/j.anai.2016.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/27/2016] [Accepted: 06/02/2016] [Indexed: 11/24/2022]
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25
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van der Valk JPM, Schreurs MWJ, El Bouch R, Arends NJT, de Jong NW. Mono-sensitisation to peanut component Ara h 6: a case series of five children and literature review. Eur J Pediatr 2016; 175:1227-1234. [PMID: 27206507 PMCID: PMC5005383 DOI: 10.1007/s00431-016-2733-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 03/20/2016] [Accepted: 05/11/2016] [Indexed: 11/24/2022]
Abstract
UNLABELLED Here, we summarise the current clinical knowledge on Ara h 6 sensitisation and clinical relevance of this sensitisation pattern using five illustrative clinical cases. The literature search yielded a total of 166 papers, and an additional relevant article was found by 'snowballing'. A total of ten articles were considered relevant for this review. Most studies included patients with a sensitisation to Ara h 6 and cosensitisation to Ara h 2. Only three studies showed patients with a mono-sensitisation to Ara h 6. This illustrates that Ara h 6 mono-sensitisation has been neglected in literature. We present a case series of five children with sensitisation to peanut component Ara h 6. Only one of these five patients showed Ara h 8 cosensitivity. Three out of the five children had a positive double-blind placebo-controlled food challenge (DBPCFC), with moderate to strong reactions. CONCLUSION A mono-sensitisation to peanut component Ara h 6 is uncommon but can cause severe allergic reactions. Therefore, the determination of sIgE to Ara h 6 is warranted in patients with a suspected peanut allergy, especially in the absence of sensitisation to Ara h 1, 2, 3 and 9. WHAT IS KNOWN • Peanut allergy is common and can cause severe allergic reactions. • The diagnostics of peanut allergy has recently improved with the use of component resolved diagnosis What is new: • A mono-sensitisation to peanut component Ara h 6 is uncommon, but can cause severe allergic reactions • Determination of sIgE to Ara h 6 is warranted in patients with a suspected peanut allergy, especially in the absence of sensitisation to Ara h 1, 2, 3 and 9.
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Affiliation(s)
- J P M van der Valk
- Department of Internal Medicine, section of Allergology, Erasmus MC, Office Gk 323, P.O. box 2040, 3000CA, Rotterdam, The Netherlands.
| | - M W J Schreurs
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, The Netherlands
| | - R El Bouch
- Department of Internal Medicine, section of Allergology, Erasmus MC, Office Gk 323, P.O. box 2040, 3000CA, Rotterdam, The Netherlands
| | - N J T Arends
- Department of Internal Medicine, section of Allergology, Erasmus MC, Office Gk 323, P.O. box 2040, 3000CA, Rotterdam, The Netherlands
- Department of Paediatric Allergology, Diaconessenhuis Voorburg, Reinier de Graaf Group, Delft, The Netherlands
| | - N W de Jong
- Department of Internal Medicine, section of Allergology, Erasmus MC, Office Gk 323, P.O. box 2040, 3000CA, Rotterdam, The Netherlands
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26
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Gregory JA, Shepley-McTaggart A, Umpierrez M, Hurlburt BK, Maleki SJ, Sampson HA, Mayfield SP, Berin MC. Immunotherapy using algal-produced Ara h 1 core domain suppresses peanut allergy in mice. PLANT BIOTECHNOLOGY JOURNAL 2016; 14:1541-50. [PMID: 26801740 PMCID: PMC5066676 DOI: 10.1111/pbi.12515] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/12/2015] [Accepted: 11/13/2015] [Indexed: 05/26/2023]
Abstract
Peanut allergy is an IgE-mediated adverse reaction to a subset of proteins found in peanuts. Immunotherapy aims to desensitize allergic patients through repeated and escalating exposures for several months to years using extracts or flours. The complex mix of proteins and variability between preparations complicates immunotherapy studies. Moreover, peanut immunotherapy is associated with frequent negative side effects and patients are often at risk of allergic reactions once immunotherapy is discontinued. Allergen-specific approaches using recombinant proteins are an attractive alternative because they allow more precise dosing and the opportunity to engineer proteins with improved safety profiles. We tested whether Ara h 1 and Ara h 2, two major peanut allergens, could be produced using chloroplast of the unicellular eukaryotic alga, Chlamydomonas reinhardtii. C. reinhardtii is novel host for producing allergens that is genetically tractable, inexpensive and easy to grow, and is able to produce more complex proteins than bacterial hosts. Compared to the native proteins, algal-produced Ara h 1 core domain and Ara h 2 have a reduced affinity for IgE from peanut-allergic patients. We further found that immunotherapy using algal-produced Ara h 1 core domain confers protection from peanut-induced anaphylaxis in a murine model of peanut allergy.
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Affiliation(s)
- James A Gregory
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ariel Shepley-McTaggart
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michelle Umpierrez
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Barry K Hurlburt
- U.S. Department of Agriculture, Agricultural Research Service, Southern Regional Research Center, New Orleans, LA, USA
| | - Soheila J Maleki
- U.S. Department of Agriculture, Agricultural Research Service, Southern Regional Research Center, New Orleans, LA, USA
| | - Hugh A Sampson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stephen P Mayfield
- Department of Biology, University of California San Diego, La Jolla, CA, USA
| | - M Cecilia Berin
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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27
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Ma S, Nie L, Li H, Wang R, Yin J. Component-Resolved Diagnosis of Peanut Allergy and Its Possible Origins of Sensitization in China. Int Arch Allergy Immunol 2016; 169:241-8. [PMID: 27240834 DOI: 10.1159/000446156] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 04/11/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Clinical and immunological characteristics of food allergies vary depending on geographic regions. Little is known about peanut allergy in China. The aim of this study was to investigate the peanut sensitization profile in China. METHODS Thirty-eight participants with immunoglobulin E (IgE)-positive responses to peanuts (peanut-sensitized) were included in our study, and clinical characteristics were evaluated. Total and specific IgE reactivity against peanuts, other plant-derived foods, pollens, and related allergen components were determined. RESULTS Eighteen patients were symptomatic when exposed to peanuts. The majority of them presented with systemic reactions. More than half of the peanut-sensitized subjects also suffered from mugwort pollinosis and peach allergy. In patients with both peanut and peach allergies, reactions to peanuts were the same as or severer than those to peaches. Positivity rates of IgE response to rAra h 1-3, 8, and 9 in the peanut allergy group were 5.6, 11.1, 5.6, 22.2, and 83.3%, respectively. 66.7% (12/18) of the peanut-allergic patients were monosensitized to rAra h 9. Anti-nArt v 3 [mugwort nonspecific lipid transfer protein (nsLTP)] IgE positivity in the peanut allergy group was significantly higher than that in the asymptomatic peanut-sensitized group. In Ara h 9 (peanut nsLTP)-sensitized patients with mugwort pollinosis, anti-nArt v 3 IgE levels were remarkably higher than anti-rAra h 9 (peanut nsLTP) IgE levels as well as anti-Pru p 3 (peach nsLTP) IgE levels. CONCLUSIONS Ara h 9 was the major allergen of peanut, and Ara h 9 monosensitization was the most common peanut sensitization pattern in our population. Furthermore, there was a strong correlation between peanut sensitization and mugwort pollinosis, as well as peach allergy, in our country.
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Affiliation(s)
- Shikun Ma
- Department of Allergy, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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28
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Martinet J, Couderc L, Renosi F, Bobée V, Marguet C, Boyer O. Diagnostic Value of Antigen-Specific Immunoglobulin E Immunoassays against Ara h 2 and Ara h 8 Peanut Components in Child Food Allergy. Int Arch Allergy Immunol 2016; 169:216-22. [PMID: 27225199 DOI: 10.1159/000446181] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 04/12/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Peanut allergy is one of the most severe food allergies in children. The diagnostic gold standard is the oral food challenge (OFC). However, OFC has inherent risks and is time consuming. The measurement of specific immunoglobulin E (sIgE) to peanut components in blood detects peanut sensitization, but the decision point predicting allergy is still unclear. The aim of this study was to determine the diagnostic value of these tests for the evaluation of child peanut allergy. METHODS In this retrospective study, 81 children were referred for peanut allergy. The diagnosis of peanut allergy was based on the clinical context and a positive OFC. Levels of sIgE against whole peanuts or peanut components (Ara h 2 and Ara h 8) were determined by immunoassay. RESULTS The Ara h 2 sIgE assay has the best negative predictive value (0.93) and positive predictive value (1) at a cutoff of 0.1 kU/l. Ara h 2 sIgE titers can predict the risk of anaphylaxis (<0.44 kU/l, low risk; >14 kU/l, high risk). The Ara h 8 sIgE assay is not able to discriminate peanut-allergic patients but can be used to evaluate possible cross-reactions to birch pollen with a low risk of anaphylaxis. The best diagnostic strategy is to first determine the Ara h 2 sIgE level and, if negative, evaluate Ara h 8 sIgE. CONCLUSIONS We propose an algorithm for a better use of peanut component sIgE immunoassays that should improve their diagnostic value and avoid unnecessary OFC.
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Affiliation(s)
- Jérémie Martinet
- Department of Immunology, Rouen University Hospital, Rouen, France
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Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, Valenta R, Hilger C, Hofmaier S, Aalberse RC, Agache I, Asero R, Ballmer-Weber B, Barber D, Beyer K, Biedermann T, Bilò MB, Blank S, Bohle B, Bosshard PP, Breiteneder H, Brough HA, Caraballo L, Caubet JC, Crameri R, Davies JM, Douladiris N, Ebisawa M, EIgenmann PA, Fernandez-Rivas M, Ferreira F, Gadermaier G, Glatz M, Hamilton RG, Hawranek T, Hellings P, Hoffmann-Sommergruber K, Jakob T, Jappe U, Jutel M, Kamath SD, Knol EF, Korosec P, Kuehn A, Lack G, Lopata AL, Mäkelä M, Morisset M, Niederberger V, Nowak-Węgrzyn AH, Papadopoulos NG, Pastorello EA, Pauli G, Platts-Mills T, Posa D, Poulsen LK, Raulf M, Sastre J, Scala E, Schmid JM, Schmid-Grendelmeier P, van Hage M, van Ree R, Vieths S, Weber R, Wickman M, Muraro A, Ollert M. EAACI Molecular Allergology User's Guide. Pediatr Allergy Immunol 2016; 27 Suppl 23:1-250. [PMID: 27288833 DOI: 10.1111/pai.12563] [Citation(s) in RCA: 500] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The availability of allergen molecules ('components') from several protein families has advanced our understanding of immunoglobulin E (IgE)-mediated responses and enabled 'component-resolved diagnosis' (CRD). The European Academy of Allergy and Clinical Immunology (EAACI) Molecular Allergology User's Guide (MAUG) provides comprehensive information on important allergens and describes the diagnostic options using CRD. Part A of the EAACI MAUG introduces allergen molecules, families, composition of extracts, databases, and diagnostic IgE, skin, and basophil tests. Singleplex and multiplex IgE assays with components improve both sensitivity for low-abundance allergens and analytical specificity; IgE to individual allergens can yield information on clinical risks and distinguish cross-reactivity from true primary sensitization. Part B discusses the clinical and molecular aspects of IgE-mediated allergies to foods (including nuts, seeds, legumes, fruits, vegetables, cereal grains, milk, egg, meat, fish, and shellfish), inhalants (pollen, mold spores, mites, and animal dander), and Hymenoptera venom. Diagnostic algorithms and short case histories provide useful information for the clinical workup of allergic individuals targeted for CRD. Part C covers protein families containing ubiquitous, highly cross-reactive panallergens from plant (lipid transfer proteins, polcalcins, PR-10, profilins) and animal sources (lipocalins, parvalbumins, serum albumins, tropomyosins) and explains their diagnostic and clinical utility. Part D lists 100 important allergen molecules. In conclusion, IgE-mediated reactions and allergic diseases, including allergic rhinoconjunctivitis, asthma, food reactions, and insect sting reactions, are discussed from a novel molecular perspective. The EAACI MAUG documents the rapid progression of molecular allergology from basic research to its integration into clinical practice, a quantum leap in the management of allergic patients.
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Affiliation(s)
- P M Matricardi
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - J Kleine-Tebbe
- Allergy & Asthma Center Westend, Outpatient Clinic Ackermann, Hanf, & Kleine-Tebbe, Berlin, Germany
| | - H J Hoffmann
- Department of Respiratory Diseases and Allergy, Institute of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - R Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - C Hilger
- Department of Infection & Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - S Hofmaier
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - R C Aalberse
- Sanquin Research, Department of Immunopathology, Amsterdam, The Netherlands
- Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - I Agache
- Department of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania
| | - R Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| | - B Ballmer-Weber
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - D Barber
- IMMA-School of Medicine, University CEU San Pablo, Madrid, Spain
| | - K Beyer
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - T Biedermann
- Department of Dermatology and Allergology, Technical University Munich, Munich, Germany
| | - M B Bilò
- Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Ancona, Italy
| | - S Blank
- Center of Allergy and Environment (ZAUM), Helmholtz Center Munich, Technical University of Munich, Munich, Germany
| | - B Bohle
- Division of Experimental Allergology, Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology & Immunology, Medical University of Vienna, Vienna, Austria
| | - P P Bosshard
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - H Breiteneder
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - H A Brough
- Paediatric Allergy, Department of Asthma, Allergy and Respiratory Science, King's College London, Guys' Hospital, London, UK
| | - L Caraballo
- Institute for Immunological Research, The University of Cartagena, Cartagena de Indias, Colombia
| | - J C Caubet
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - R Crameri
- Swiss Institute of Allergy and Asthma Research, University of Zürich, Davos, Switzerland
| | - J M Davies
- School of Biomedical Sciences, Institute of Biomedical Innovation, Queensland University of Technology, Brisbane, Qld, Australia
| | - N Douladiris
- Allergy Unit, 2nd Paediatric Clinic, National & Kapodistrian University, Athens, Greece
| | - M Ebisawa
- Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - P A EIgenmann
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - M Fernandez-Rivas
- Allergy Department, Hospital Clinico San Carlos IdISSC, Madrid, Spain
| | - F Ferreira
- Division of Allergy and Immunology, Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - G Gadermaier
- Division of Allergy and Immunology, Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - M Glatz
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
| | - R G Hamilton
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - T Hawranek
- Department of Dermatology, Paracelsus Private Medical University, Salzburg, Austria
| | - P Hellings
- Department of Otorhinolaryngology, Academic Medical Center (AMC), Amsterdam, The Netherlands
- Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium
| | - K Hoffmann-Sommergruber
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - T Jakob
- Department of Dermatology and Allergology, University Medical Center Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany
| | - U Jappe
- Division of Clinical and Molecular Allergology, Research Centre Borstel, Airway Research Centre North (ARCN), Member of the German Centre for Lung Research (DZL), Borstel, Germany
- Interdisciplinary Allergy Division, Department of Pneumology, University of Lübeck, Lübeck, Germany
| | - M Jutel
- Department of Clinical Immunology, 'ALL-MED' Medical Research Institute, Wrocław Medical University, Wrocław, Poland
| | - S D Kamath
- Molecular Allergy Research Laboratory, Centre for Biodiscovery and Molecular Development of Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville City, Qld, Australia
| | - E F Knol
- Departments of Immunology and Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Korosec
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - A Kuehn
- Department of Infection & Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - G Lack
- King's College London, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
- Division of Asthma, Allergy and Lung Biology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A L Lopata
- Department of Clinical Immunology, 'ALL-MED' Medical Research Institute, Wrocław Medical University, Wrocław, Poland
| | - M Mäkelä
- Skin and Allergy Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - M Morisset
- National Service of Immuno-Allergology, Centre Hospitalier Luxembourg (CHL), Luxembourg, UK
| | - V Niederberger
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - A H Nowak-Węgrzyn
- Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - N G Papadopoulos
- Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK
| | - E A Pastorello
- Unit of Allergology and Immunology, Niguarda Ca' Granda Hospital, Milan, Italy
| | - G Pauli
- Service de Pneumologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - T Platts-Mills
- Department of Microbiology & Immunology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - D Posa
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - L K Poulsen
- Allergy Clinic, Copenhagen University Hospital, Copenhagen, Denmark
| | - M Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Ruhr-University Bochum (IPA), Bochum, Germany
| | - J Sastre
- Allergy Division, Fundación Jimenez Díaz, Madrid, Spain
| | - E Scala
- Experimental Allergy Unit, IDI-IRCCS, Rome, Italy
| | - J M Schmid
- Department of Respiratory Diseases and Allergy, Institute of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - P Schmid-Grendelmeier
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
| | - M van Hage
- Department of Medicine Solna, Clinical Immunology and Allergy Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - R van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - S Vieths
- Department of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - R Weber
- School of Medicine, University of Colorado, Denver, CO, USA
- Department of Medicine, National Jewish Health Service, Denver, CO, USA
| | - M Wickman
- Sachs' Children's Hospital, Karolinska Institutet, Stockholm, Sweden
| | - A Muraro
- The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, Department of Mother and Child Health, University of Padua, Padua, Italy
| | - M Ollert
- Department of Infection & Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
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Paris C, Herin F, Penven E, Thaon I, Richard C, Jacquenet S, Barbaud A, Poussel M. First evidence of occupational asthma to argan powder in a cosmetic factory. Allergy 2016; 71:550-5. [PMID: 26606505 DOI: 10.1111/all.12811] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Argan is used worldwide in numerous cosmetic products, as this fruit is supposed to have many beneficial properties on health. New cases of allergy can be expected with the growing use of argan. We investigated all workers (9) employed by a cosmetic factory and exposed to argan powder to identify possible allergies related to exposure to argan powder. METHODS Patients were investigated in the occupational disease department and, according to their symptoms, underwent pulmonary function testing, methacholine challenge, specific inhalation challenge to argan powder, skin prick tests, and immunoblotting analysis. RESULTS We report three cases of occupational asthma to argan powder and a probable case of rhinitis. Fifteen argan proteins were recognized by the patients' IgE. Identification of proteins, cross-reactions to nuts, and ELISA inhibition tests suggested that some argan allergens can cross-react in vitro with hazelnut allergens, including 11S globulin and vicilin. CONCLUSION High-level exposure to argan powder should be considered to be a potential cause of IgE-mediated allergy, and workers handling argan powder should be carefully investigated.
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Affiliation(s)
- C. Paris
- Occupational Diseases Department; Bâtiment Philippe Canton; CHU Nancy; Vandoeuvre-lès-Nancy France
- EA-7298 INGRES; Université de Lorraine; Nancy France
| | - F. Herin
- INSERM UMR1027 (The French National Institute of Health and Medical Research); Toulouse France
- University of Toulouse III Paul Sabatier; Toulouse France
- Occupational diseases department; Toulouse University Hospital; Toulouse France
| | - E. Penven
- Occupational Diseases Department; Bâtiment Philippe Canton; CHU Nancy; Vandoeuvre-lès-Nancy France
- EA-7298 INGRES; Université de Lorraine; Nancy France
| | - I. Thaon
- Occupational Diseases Department; Bâtiment Philippe Canton; CHU Nancy; Vandoeuvre-lès-Nancy France
- EA-7298 INGRES; Université de Lorraine; Nancy France
| | | | | | - A. Barbaud
- EA-7298 INGRES; Université de Lorraine; Nancy France
- Dermatology and Allergy Department; Bâtiment Philippe Canton; CHU Nancy; Vandoeuvre-lès-Nancy France
| | - M. Poussel
- Department of Pulmonary Function Testing and Exercise Physiology; CHU Nancy; Vandoeuvre-lès-Nancy France
- EA 3450 DevAH - Development, Adaptation and Disadvantage. Cardiorespiratory regulations and motor control; Université de Lorraine; Nancy France
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Schots M, de Mol AC, Vermeer HJ, Roosen YM, Vriesman AW. Is Ara h 2 indeed the best predictor for peanut allergy in Dutch children? Diagnosis (Berl) 2016. [DOI: 10.1515/dx-2015-0032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractSpecific immunoglobulin E to Ara h 2 (sIgE to Ara h 2) is described as an upcoming predicting factor for diagnosing peanut allergy in children. The gold standard for diagnosing peanut allergy is a double blind placebo controlled food challenge, however this is time consuming and potentially harmful. We investigate Ara h 2 as a preliminary less invasive diagnostic tool for diagnosing peanut allergy in a general population of peanut sensitized children.Children (n=52) with peanut sensitization were retrospectively included. An oral food challenge (OFC) confirmed peanut allergy or tolerance, as primary outcome. Individual candidate predictors were identified by univariate regression analysis and used in a prediction model. Different cut-off values were obtained and receiver operating characteristic curves were plotted.Multivariate analyses resulted in Ara h 2 as best predictor, with a discriminative ability of 0.87 (95% confidence interval, 0.77–0.97). Sensitivity and specificity of 55% and 95%, respectively, were found for a sIgE to Ara h 2 cut-off value of 4.25 kU/L. The highest positive predictive value of 100% was reached at 5.61 kU/L. No absolute relation was found between the value of Ara h 2 and the severity of the reaction during OFC.This study developed a prediction model in which sIgE to Ara h 2 was the best predictor for peanut allergy in sensitized children in a general hospital. Therefore depending on the history and the Ara h 2 results, an OFC is not always needed to confirm the diagnosis.
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Burk CM, Kulis M, Leung N, Kim EH, Burks AW, Vickery BP. Utility of component analyses in subjects undergoing sublingual immunotherapy for peanut allergy. Clin Exp Allergy 2016; 46:347-53. [PMID: 26362760 PMCID: PMC4732904 DOI: 10.1111/cea.12635] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 08/07/2015] [Accepted: 08/24/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND Sublingual immunotherapy (SLIT) with peanut changes clinical and immune responses in most peanut-allergic individuals, but the response is highly variable. OBJECTIVE We sought to examine the component-specific effects of peanut SLIT and determine whether peanut component testing could predict the outcome of a double-blind, placebo-controlled food challenge (DBPCFC) after 12 months of peanut SLIT. METHODS We included 33 subjects who underwent peanut SLIT with a DBPCFC of 2500 mg of peanut protein performed after 12 months of therapy. Plasma samples from baseline and after 12 months of peanut SLIT were assayed using ImmunoCAP for IgE and IgG4 against whole peanut, Ara h 1, Ara h 2, Ara h 3, Ara h 8, and Ara h 9. RESULTS Following 12 months of SLIT, 10 subjects (30%) passed the DBPCFC without symptoms and were considered desensitized. Subjects that failed the DBPCFC tolerated a median of 460 mg peanut protein (range: 10-1710 mg). The desensitized group had significantly lower baseline levels of IgE against peanut (median 40.8 vs. 231 kUA /L, P = 0.0082), Ara h 2 (median 17 vs. 113 kUA /L, P = 0.0082), and Ara h 3 (median 0.3 vs. 8.5 kUA /L, P = 0.0396). ROC curves indicated that baseline IgE against peanut and Ara h 2 were equally effective at discriminating between the two groups (AUC = 0.7957, P = 0.007752 for both). CONCLUSION AND CLINICAL RELEVANCE In this cohort of subjects undergoing SLIT for peanut allergy, lower baseline levels of IgE against Ara h 2, Ara h 3, and peanut were associated with successful desensitization.
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Affiliation(s)
- C M Burk
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Kulis
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - N Leung
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - E H Kim
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A W Burks
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - B P Vickery
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Faber MA, Donné I, Herrebosch E, Sabato V, Hagendorens MM, Bridts CH, De Clerck LS, Ebo DG. Sensitization profiles to peanut allergens in Belgium; cracking the code in infants, children and adults. Acta Clin Belg 2016; 71:32-7. [PMID: 27075794 DOI: 10.1080/17843286.2015.1109170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Peanut allergy shows distinct clinical patterns that can be predicted by component resolved diagnosis. However, data about peanut sensitization profiles in populations with a broad age stratification are scarce. METHODS Sera of 89 peanut allergic patients (age 1-70 years), 21 infants (<1 year) with atopic dermatitis (AD) sensitized to peanut, 24 age matched peanut-tolerant individuals with positive specific IgE (sIgE) to peanut and 15 healthy individuals were tested for sIgE reactivity to rAra h 1, rAra h 2, rAra h 3, rAra h 8, rAra h 9 and rBet v 1 (FEIA ImmunoCAP, Thermo Fisher Scientific). RESULTS In infants with AD, Ara h 1, Ara h 2 and Ara h 3 enabled to explain 14/21 (67%) of peanut sensitizations. No sensitization to Ara h 8 or Bet v 1 was observed. Patients with generalized reactions were more frequently sensitized to Ara h 1, Ara h 2 and Ara h 3 compared to patients with an oral allergy syndrome (OAS) and peanut-tolerant patients. Sensitization to Ara h 8 was significantly more observed in patients with an OAS. Ara h 2 showed to be the best marker to distinguish patients with generalized reactions from patients with an OAS and/or peanut sensitized patients but tolerating the legume. CONCLUSION Sensitization to Ara h 1, Ara h 2 and Ara h 3 can have an early onset and is predominantly associated with a more severe outcome. Ara h 2 is the best marker of a generalized peanut allergy.
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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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Gray CL, Levin ME, du Toit G. Ethnic differences in peanut allergy patterns in South African children with atopic dermatitis. Pediatr Allergy Immunol 2015; 26:721-30. [PMID: 26267015 DOI: 10.1111/pai.12459] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The prevalence of peanut allergy in South Africa is unknown, but previously thought to be low, particularly in black South Africans. This study aimed to determine the prevalence of component patterns and predictive values of screening tests in peanut allergy in South African children with atopic dermatitis (AD). METHODOLOGY This was a prospective, observational study in a pediatric university hospital in Cape Town. Children with AD, aged 6 months to 10 years, were recruited randomly. They were assessed for sensitization and allergy to peanut by questionnaire, skin prick tests (SPT), Immuno Solid Phase Allergen Chip test, ImmunoCAP component tests to Ara h 1, 2, 3, 8, and 9, and incremental food challenges. RESULTS A total of 100 participants (59 black Africans and 41 of mixed race) were enrolled, median age 42 months. There was a high and comparable rate of peanut sensitization in both black African (41%) and mixed race patients (50%), but a significantly lower prevalence of peanut allergy in the black African group (15% vs. 38%, p = 0.01). The component Ara h 2 was the most useful in differentiating allergy from tolerance in both ethnic groups, but had a significantly lower predictive value for peanut allergy in blacks (53%) vs. mixed race (93%). Overall, SPT and Ara h 2 produced the highest area under the receiver operating characteristic curve. A total of 95% positive predictive values (PPV) for SPT, peanut-specific IgE, and Ara h 2 levels varied significantly between the two ethnic groups. CONCLUSION The prevalence of peanut allergy is high in South African children with AD, but significantly lower in blacks compared to mixed race patients. The component Ara h 2 is useful for differentiating allergy from tolerance in both ethnic groups. Ninety-five% PPV for peanut allergy tests may need to be revised by ethnic group.
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Affiliation(s)
- Claudia L Gray
- Division of Allergology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Michael E Levin
- Division of Allergology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - George du Toit
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.,King's College London, King's Health Partners, MRM & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK.,Department of Paediatric Allergy, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Kim HY, Han Y, Kim K, Lee JY, Kim MJ, Ahn K, Kim J. Diagnostic Value of Specific IgE to Peanut and Ara h 2 in Korean Children with Peanut Allergy. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2015; 8:156-60. [PMID: 26739409 PMCID: PMC4713879 DOI: 10.4168/aair.2016.8.2.156] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/14/2015] [Indexed: 01/04/2023]
Abstract
PURPOSE The purpose of this study was to establish the diagnostic decision point (DDP) of peanut specific IgE (sIgE) for predicting the outcome of oral food challenge (OFC). We also evaluated the usefulness of sIgE to peanut components (Ara h 1, 2, 3, 8, and 9) in diagnosing peanut allergy. METHODS Korean children aged over 12 months with a suspected peanut allergy were enrolled. Diagnosis of peanut allergy was confirmed by an open OFC or through the convincing history of anaphylaxis. Cutoff levels of sIgE to peanut and peanut components were determined by analyzing receiver operating characteristic curves. RESULTS Forty-eight children (22 boys and 26 girls) with a suspected peanut allergy were enrolled. The previously established DDP for peanut-sIgE antibodies (14 kU/L) showed a sensitivity of 22.7%, specificity of 100%, positive predictive value (PPV) of 100%, and negative predictive value of 60.4% in our study population. The median levels of peanut-sIgE (5.4 kU/L vs 1.1 kU/L, P<0.001) and Ara h 2-sIgE (0.8 kU/L vs 0 kU/L, P<0.001) were significantly higher in the peanut allergy group than in the peanut tolerance group. The peanut-sIgE concentration indicating a PPV of 100% was 10.3 kU/L. The Ara h 2-sIgE level of 4.0 kU/L had a PPV of 100%. CONCLUSIONS Our results showed that the cutoff levels for peanut (10.3 kU/L) and Ara h 2 (4.0 kU/L) established in this study is useful for the diagnosis of peanut allergy in Korean children.
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Affiliation(s)
- Hye Young Kim
- Department of Pediatrics, Medical Research Institute of Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Youngshin Han
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
| | - Kwanghoon Kim
- Department of Pediatrics, Medical Research Institute of Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Ji Young Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
| | - Min Ji Kim
- Department of Biostatistics, Samsung Biomedical Research Institute, Seoul, Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
| | - Jihyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea.
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Leo SH, Dean JM, Jung B, Kuzeljevic B, Chan ES. Utility of Ara h 2 sIgE levels to predict peanut allergy in Canadian children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 3:968-9. [DOI: 10.1016/j.jaip.2015.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 03/22/2015] [Accepted: 04/09/2015] [Indexed: 11/28/2022]
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Kukkonen AK, Pelkonen AS, Mäkinen-Kiljunen S, Voutilainen H, Mäkelä MJ. Ara h 2 and Ara 6 are the best predictors of severe peanut allergy: a double-blind placebo-controlled study. Allergy 2015; 70:1239-45. [PMID: 26095653 DOI: 10.1111/all.12671] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Component-resolved diagnostics offers a modern tool in peanut allergy, but studies applying consistently double-blind placebo-controlled challenges are lacking. We aimed to optimize diagnostics for moderate-to-severe peanut allergy in a birch-endemic region and to create an oral-peanut challenge with its allergen activity characterized. METHODS We performed double-blind placebo-controlled peanut challenges for a referred sample of 6- to 18-year-olds with peanut sensitization or a high suspicion of peanut allergy, including anaphylaxis. We measured specific IgE (sIgE) to Ara h 1, 2, 3, 6, 8, and 9. Testing of allergen activity of the challenge products was by IgE microarray inhibition. RESULTS Of the 102 patients, 69 were challenge positive: 25 (36%) had severe, 36 (52%) moderate, and 8 (12%) mild symptoms; 38 (37%) received adrenalin. SIgE to Ara h 6 AUC 0.98 (95%CI, 0.96-1.00) was the best marker of moderate-to-severe allergy. When sIgE to Ara h 2 and Ara h 6 was measured together, all (100%) severe reactions at low doses were successfully diagnosable. SIgE to Ara h 8 had no diagnostic value, AUC 0.42 (95%CI, 0.30-0.52). Both nonroasted and roasted peanut inhibited 100% of IgE binding to Ara h 1, 2, 3, and 6. Nonroasted peanut inhibited 87% of IgE binding to Ara h 8, roasted inhibited 30%. The products lacked Ara h 9 activity. CONCLUSION Co-sensitization to Ara h 2 and Ara h 6 was associated with severe reactions distinguishing severe allergy from mild symptoms. SIgE to Ara h 8 added no diagnostic value. Component-resolved diagnostics reduce the need for oral challenges in peanut allergy.
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Affiliation(s)
- A. K. Kukkonen
- The Skin and Allergy Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - A. S. Pelkonen
- The Skin and Allergy Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - S. Mäkinen-Kiljunen
- The Skin and Allergy Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - H. Voutilainen
- The Skin and Allergy Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - M. J. Mäkelä
- The Skin and Allergy Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
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Joshi AA, Peczuh MW, Kumar CV, Rusling JF. Ultrasensitive carbohydrate-peptide SPR imaging microarray for diagnosing IgE mediated peanut allergy. Analyst 2015; 139:5728-33. [PMID: 25259443 DOI: 10.1039/c4an01544d] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Severity of peanut allergies is linked to allergen-specific immunoglobulin E (IgE) antibodies in blood, but diagnostics from assays using glycoprotein allergen mixtures may be inaccurate. Measuring IgEs specific to individual peptide and carbohydrate epitopes of allergenic proteins is promising. We report here the first immunoarray for IgEs utilizing both peptide and carbohydrate epitopes. A surface plasmon resonance imaging (SPRi) microarray was equipped with peptide and β-xylosyl glycoside (BXG) epitopes from major peanut allergen glycoprotein Arachis hypogaea h2 (Ara-h2). A monoclonal anti-IgE antibody was included as positive control. IgEs were precaptured onto magnetic beads loaded with polyclonal anti-IgE antibodies to enhance sensitivity and minimize non-specific binding. As little as 0.1 attomole (0.5 pg mL(-1)) IgE was detected from dilute serum in 45 min. IgEs binding to Ara-h2 peptide and BXG were quantified in 10 μL of patient serum and correlated with standard ImmunoCAP values.
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Affiliation(s)
- Amit A Joshi
- Department of Chemistry, University of Connecticut, U-3060, Storrs, CT 06269-3060, USA.
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Rentzos G, Lundberg V, Lundqvist C, Rodrigues R, van Odijk J, Lundell AC, Pullerits T, Telemo E. Use of a basophil activation test as a complementary diagnostic tool in the diagnosis of severe peanut allergy in adults. Clin Transl Allergy 2015; 5:22. [PMID: 26075055 PMCID: PMC4464723 DOI: 10.1186/s13601-015-0064-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 05/19/2015] [Indexed: 11/10/2022] Open
Abstract
Background Diagnosis of severe peanut allergy is difficult and delays in making an accurate diagnosis may place the patient at risk. Adults with a history of anaphylaxis must strictly avoid any contact with peanuts or products that may contain traces of peanuts. For these persons, conventional evaluations with skin prick testing (SPT) and IgE tests may not be sufficient to assess the risk of anaphylaxis. Therefore, we investigated whether the basophil activation test (BAT) could be used for the diagnosis of severe peanut allergy in adults. We compared the non-invasive BAT with conventional laboratory diagnostic tests, including SPT and specific IgE to allergen extracts and components, for the diagnosis of severe peanut allergy. Methods Forty-seven persons with severe allergy to peanuts and a clinical diagnosis of anaphylaxis (PA-group), 22 subjects with peanut sensitization (PS-group) and 22 control (C-group) subjects, all in the age range of 18–60 years, were recruited retrospectively and prospectively into the study. Thirty-four patients with peanut allergy and 11 peanut-sensitized patients were sensitized to soy, while 36 patients in the PA-group and 20 patients in the PS-group were sensitized to birch pollen. All the patients and control subjects were investigated with BAT and SPT for responses to peanut, soy and birch extracts and their serum samples were assayed for the presence of specific IgE to peanut, soy and birch extracts, as well as IgE to allergen components (ISAC). Results In a multivariate factor analysis, severe peanut allergy (PA) was positively associated with SPT to peanut, IgE to peanut, BAT to peanut and IgE to rAra h 1, 2, 3 and 6 peanut components, as well as to soy components (nGly m 5 and nGly m 6). In contrast, peanut sensitization was positively associated with increased levels of IgE to rAra h 8, birch and birch-related components. BAT-detected reactivity to peanut was significantly higher in patients who had a history of severe allergy to peanuts, as compared with patients who were sensitized to peanuts (p < 0.001), and the receiver operating curve (ROC) analysis showed that BAT had high sensitivity and specificity for predicting severe peanut allergy, with a ROC area under the curve of 0.862. However, in the PA-group, the BAT results for peanut correlated only weakly with the levels of IgE to rAra h 1, 2 and 3 and nAra h 6. Study limitations: oral provocation in the patients with a history of severe peanut allergy could not be performed to compare clinical reactivity with the BAT result due to ethical constraints. Neither was it possible to perform BAT with peanut recombinant allergens which were not available at the time the study commenced Conclusions BAT is useful in determining the severity of peanut allergy and may be used as a complementary diagnostic tool to ensure accurate diagnosis of severe peanut allergy in adults. Thus, it may reduce the need to subject these patients to further tests, including an open challenge with peanuts. Electronic supplementary material The online version of this article (doi:10.1186/s13601-015-0064-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Georgios Rentzos
- Sahlgrenska University Hospital, Section of Allergology, Gothenburg, Sweden ; Department of Respiratory Medicine and Allergology, Section of Allergology, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Vanja Lundberg
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christina Lundqvist
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rui Rodrigues
- Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jenny van Odijk
- Sahlgrenska University Hospital, Section of Allergology, Gothenburg, Sweden
| | - Anna-Carin Lundell
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Teet Pullerits
- Sahlgrenska University Hospital, Section of Allergology, Gothenburg, Sweden
| | - Esbjörn Telemo
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Utility of specific IgE to Ara h 6 in peanut allergy diagnosis. Ann Allergy Asthma Immunol 2015; 115:108-12. [PMID: 26073164 DOI: 10.1016/j.anai.2015.05.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/19/2015] [Accepted: 05/25/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Specific IgE to Ara h 2 has been shown to be useful in the diagnosis of peanut allergy, whereas the peanut lipid transfer protein, Ara h 9, has been suggested to be responsible for peanut allergy in the Mediterranean population. OBJECTIVE To better characterize peanut allergy in children from a Mediterranean area and determine the value of specific IgE to Ara h 6 (conglutinin, 2S albumin) for the diagnosis of peanut allergy. METHODS Ninety-one children with suspected allergy to edible vegetables were included in the study. They were classified as allergic or tolerant to peanut. Specific IgE to peanut allergens was measured by a commercially available microarray (ImmunoCAP ISAC 112, ThermoFisher, Uppsala, Sweden). RESULTS Patients allergic to peanut showed positive specific IgE changes to peanut seed storage proteins (Ara h 1, Ara h 2, Ara h 3, and Ara h 6) more frequently than tolerant subjects. Ara h 9 showed a similar frequency of reactivity in the 2 groups. Ara h 6 was the allergen most frequently recognized by patients with allergy. Four patients with allergy were found to be mono-sensitized to Ara h 6. Ara h 2 and Ara h 6 showed similar diagnostic accuracy (areas under the curve 0.792 and 0.852). A combined cutoff point for Ara h 2 (≥0.1 ISU) and Ara h 6 (≥2 ISU) yielded the best diagnostic performance (sensitivity 0.77, specificity 0.97, positive predictive value 0.89, negative predictive value 0.93). CONCLUSION Peanut allergy cannot be ruled out without obtaining a negative determination of Ara h 6.
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Glaumann S, Nilsson C, Johansson SGO, Asarnoj A, Wickman M, Borres MP, Nopp A. Evaluation of basophil allergen threshold sensitivity (CD-sens) to peanut and Ara h 8 in children IgE-sensitized to Ara h 8. Clin Mol Allergy 2015; 13:5. [PMID: 25878561 PMCID: PMC4397898 DOI: 10.1186/s12948-014-0007-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 12/15/2014] [Indexed: 12/04/2022] Open
Abstract
Background Diagnosing peanut allergy properly is important and can be achieved by combining clinical history with various diagnostic methods such as IgE-antibody (IgE-ab) measurements, skin-prick test, basophil allergen threshold sensitivity (CD-sens) and food challenge. We aimed to evaluate CD-sens to peanut, Ara h 8 and Gly m 4 in relation to an oral peanut challenge in children IgE-sensitized to birch, peanut and Ara h 8 avoiding peanuts. Methods Twenty children IgE-sensitized to birch pollen and Ara h 8, but not to Ara h 1, Ara h 2 or Ara h 3 were challenged orally with roasted peanuts. Blood samples were drawn for IgE-ab and CD-sens analysis. To measure CD-sens, basophils were stimulated in vitro with decreasing doses of allergens until threshold sensitivity was reached. Results All children passed challenge without objective symptoms, but mild oral allergy syndrome (OAS) symptoms were reported in 6/20 children. Nineteen of twenty children were negative in CD-sens to peanut but 17/20 were positive to rAra h 8. Eleven of twenty children were positive in CD-sens to rGly m 4. Conclusion Positive CD-sens to rAra h 8 show that the Ara h 8 IgE-ab sensitized basophils can be activated by a rAra h 8 allergen and initiate an allergic inflammation despite a negative challenge. Hence, children sensitized to Ara h 8 but not to peanut storage proteins may be at risk for systemic allergic reaction when eating larger amounts of peanuts but most likely don’t have to fear smaller amounts. Electronic supplementary material The online version of this article (doi:10.1186/s12948-014-0007-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susanne Glaumann
- Department of Clinical Science and Education, Södersjukhuset, Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden ; Sachs' Children and Youth Hospital, Södersjukhuset, 118 83 Stockholm, Sweden
| | - Caroline Nilsson
- Department of Clinical Science and Education, Södersjukhuset, Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden ; Sachs' Children and Youth Hospital, Södersjukhuset, 118 83 Stockholm, Sweden
| | - S G O Johansson
- Department of Medicine, Clinical Immunology and Allergy Unit, Karolinska Institutet and Hospital, Stockholm, Sweden
| | - Anna Asarnoj
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ; Department of Women's and Children's Health, Karolinska Institutet at Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Magnus Wickman
- Sachs' Children and Youth Hospital, Södersjukhuset, 118 83 Stockholm, Sweden ; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus P Borres
- Thermo Fisher Scientific, Uppsala, Sweden ; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna Nopp
- Department of Medicine, Clinical Immunology and Allergy Unit, Karolinska Institutet and Hospital, Stockholm, Sweden
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Ballmer-Weber BK, Lidholm J, Fernández-Rivas M, Seneviratne S, Hanschmann KM, Vogel L, Bures P, Fritsche P, Summers C, Knulst AC, Le TM, Reig I, Papadopoulos NG, Sinaniotis A, Belohlavkova S, Popov T, Kralimarkova T, de Blay F, Purohit A, Clausen M, Jedrzejczak-Czechowcz M, Kowalski ML, Asero R, Dubakiene R, Barreales L, Clare Mills EN, van Ree R, Vieths S. IgE recognition patterns in peanut allergy are age dependent: perspectives of the EuroPrevall study. Allergy 2015; 70:391-407. [PMID: 25620497 DOI: 10.1111/all.12574] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND We tested the hypothesis that specific molecular sensitization patterns correlate with the clinical data/manifestation in a European peanut-allergic population characterized under a common protocol. METHODS Sixty-eight peanut-allergic subjects and 82 tolerant controls from 11 European countries were included. Allergy to peanut and lowest symptom-eliciting dose was established by double-blind placebo-controlled food challenge in all but anaphylactic subjects. Information of early or late (before or after 14 years of age) onset of peanut allergy was obtained from standardized questionnaires. IgE to peanut allergens rAra h 1-3, 6, 8-9, profilin and CCD was determined using ImmunoCAP. RESULTS Seventy-eight percent of peanut allergics were sensitized to peanut extract and 90% to at least one peanut component. rAra h 2 was the sole major allergen for the peanut-allergic population. Geographical differences were observed for rAra h 8 and rAra h 9, which were major allergens for central/western and southern Europeans, respectively. Sensitization to rAra h 1 and 2 was exclusively observed in early-onset peanut allergy. Peanut-tolerant subjects were frequently sensitized to rAra h 8 or 9 but not to storage proteins. Sensitization to Ara h 2 ≥ 1.0 kUA /l conferred a 97% probability for a systemic reaction (P = 0.0002). Logistic regression revealed a significant influence of peanut extract sensitization and region on the occurrence of systemic reactions (P = 0.0185 and P = 0.0436, respectively). CONCLUSION Sensitization to Ara h 1, 2 and 3 is usually acquired in childhood. IgE to Ara h 2 ≥ 1.0 kUA /l is significantly associated with the development of systemic reactions to peanut.
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Affiliation(s)
- B. K. Ballmer-Weber
- Allergy Unit; Department of Dermatology; University Hospital; Zürich Switzerland
| | - J. Lidholm
- Thermo Fisher Scientific; Uppsala Sweden
| | | | - S. Seneviratne
- Department of Clinical Immunology; Royal Free Hospital and University College; London UK
| | - K.-M. Hanschmann
- Division of Biostatistics; Paul-Ehrlich-Institut; Langen Germany
| | - L. Vogel
- Division of Allergology; Paul-Ehrlich-Institut; Langen Germany
| | - P. Bures
- Allergy Unit; Department of Dermatology; University Hospital; Zürich Switzerland
| | - P. Fritsche
- Allergy Unit; Department of Dermatology; University Hospital; Zürich Switzerland
| | - C. Summers
- Manchester Royal Infirmary; Manchester UK
| | - A. C. Knulst
- Department of Dermatology/Allergology; University Medical Center; Utrecht The Netherlands
| | - T.-M. Le
- Department of Dermatology/Allergology; University Medical Center; Utrecht The Netherlands
| | - I. Reig
- Allergy Department; Hospital Clinico San Carlos; IdISSC; Madrid Spain
| | - N. G. Papadopoulos
- Allergy Department; 2nd Pediatric Clinic; University of Athens; Athens Greece
- Centre for Paediatrics and Child Health; Institute of Human Development; University of Manchester; Manchester UK
| | - A. Sinaniotis
- Allergy Department; 2nd Pediatric Clinic; University of Athens; Athens Greece
| | - S. Belohlavkova
- Pediatric Department; Faculty Hospital Bulovka; Prague Czech Republic
| | - T. Popov
- Clinic of Allergy & Asthma; Medical University of Sofia; Sofia Bulgaria
| | - T. Kralimarkova
- Clinic of Allergy & Asthma; Medical University of Sofia; Sofia Bulgaria
| | - F. de Blay
- Allergy division; Chest disease department; University Hospital of Strasbourg; Strasbourg France
| | - A. Purohit
- Allergy division; Chest disease department; University Hospital of Strasbourg; Strasbourg France
| | - M. Clausen
- Department of Allergy; Respiratory Medicine and Sleep; Landspitali University Hospital; Reykjavík Iceland
| | - M. Jedrzejczak-Czechowcz
- Department of Immunology, Rheumatology and Allergy; Faculty of Medicine; Medical University of Lodz; Lodz Poland
| | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy; Faculty of Medicine; Medical University of Lodz; Lodz Poland
| | - R. Asero
- Ambulatorio di Allergologia; Clinica San Carlo; Paderno Dugnano Italy
| | - R. Dubakiene
- Medical Faculty Vilnius University; Vilnius Lithuania
| | - L. Barreales
- Clinical Epidemiology Unit; Preventive Medicine Department; Hospital Clinico San Carlos; IdISSC; Madrid Spain
| | - E. N. Clare Mills
- Institute of Inflammation and Repair and Manchester Institute of Biotechnology; Manchester Academic Health Sciences Centre; The University of Manchester; Manchester UK
| | - R. van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology; Academic Medical Center of the University of Amsterdam; Amsterdam The Netherlands
| | - S. Vieths
- Division of Allergology; Paul-Ehrlich-Institut; Langen Germany
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Mirabel: An integrated project for risk and cost/benefit analysis of peanut allergy. Regul Toxicol Pharmacol 2015; 71:178-83. [DOI: 10.1016/j.yrtph.2014.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 12/08/2014] [Accepted: 12/09/2014] [Indexed: 11/22/2022]
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Ackerbauer D, Bublin M, Radauer C, Varga EM, Hafner C, Ebner C, Szépfalusi Z, Fröschl R, Hoffmann-Sommergruber K, Eiwegger T, Breiteneder H. Component-resolved IgE profiles in Austrian patients with a convincing history of peanut allergy. Int Arch Allergy Immunol 2015; 166:13-24. [PMID: 25765158 DOI: 10.1159/000371422] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 12/05/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Peanut allergy develops after primary sensitization to peanut allergens and/or IgE cross-sensitization with homologous allergens from various plants. Therefore, heterogeneous patterns of sensitization to individual peanut allergens are observed in different countries. The aim of this study was to examine the IgE sensitization patterns of Austrian peanut-allergic patients. METHODS Sera from 65 peanut-allergic patients and 20 peanut-tolerant atopics were obtained in four Austrian allergy clinics. Sensitization patterns against peanut allergens Ara h 1-3, 6, 8 and 9 were identified by ImmunoCAP and ImmunoCAP ISAC. RESULTS Austrian peanut-allergic patients were sensitized to Ara h 2 and 6 (71%), followed by Ara h 1 (62%), Ara h 8 (45%), Ara h 3 (35%) and Ara h 9 (11%). All sera containing Ara h 2-specific IgE were also positive for Ara h 6, with Ara h 6-specific IgE levels significantly (p < 0.05) higher compared with Ara h 2. Twelve percent displayed IgE reactivity exclusively to Ara h 8. Peanut extract and Ara h 8 showed low diagnostic specificities of 25 and 10%, respectively. The other peanut allergens showed 100% specificity. Diagnostic sensitivities determined by ImmunoCAP ISAC and ImmunoCAP were highly similar for Ara h 2, 3 and 8. CONCLUSIONS The majority of symptomatic peanut-allergic patients are sensitized to Ara h 2 and Ara h 6. In peanut-symptomatic patients with additional birch pollen allergy, other peanut allergens, especially Ara h 8, should be tested when IgE reactivity to Ara h 2 is absent.
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Affiliation(s)
- Daniela Ackerbauer
- Departments of Pathophysiology and Allergy Research, University of Vienna, Vienna, Austria
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IgG4 inhibits peanut-induced basophil and mast cell activation in peanut-tolerant children sensitized to peanut major allergens. J Allergy Clin Immunol 2015; 135:1249-56. [PMID: 25670011 PMCID: PMC4418748 DOI: 10.1016/j.jaci.2015.01.012] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 01/26/2015] [Accepted: 01/26/2015] [Indexed: 12/24/2022]
Abstract
Background Most children with detectable peanut-specific IgE (P-sIgE) are not allergic to peanut. We addressed 2 non–mutually exclusive hypotheses for the discrepancy between allergy and sensitization: (1) differences in P-sIgE levels between children with peanut allergy (PA) and peanut-sensitized but tolerant (PS) children and (2) the presence of an IgE inhibitor, such as peanut-specific IgG4 (P-sIgG4), in PS patients. Methods Two hundred twenty-eight children (108 patients with PA, 77 PS patients, and 43 nonsensitized nonallergic subjects) were studied. Levels of specific IgE and IgG4 to peanut and its components were determined. IgE-stripped basophils or a mast cell line were used in passive sensitization activation and inhibition assays. Plasma of PS subjects and patients submitted to peanut oral immunotherapy (POIT) were depleted of IgG4 and retested in inhibition assays. Results Basophils and mast cells sensitized with plasma from patients with PA but not PS patients showed dose-dependent activation in response to peanut. Levels of sIgE to peanut and its components could only partially explain differences in clinical reactivity between patients with PA and PS patients. P-sIgG4 levels (P = .023) and P-sIgG4/P-sIgE (P < .001), Ara h 1–sIgG4/Ara h 1–sIgE (P = .050), Ara h 2–sIgG4/Ara h 2–sIgE (P = .004), and Ara h 3–sIgG4/Ara h 3–sIgE (P = .016) ratios were greater in PS children compared with those in children with PA. Peanut-induced activation was inhibited in the presence of plasma from PS children with detectable P-sIgG4 levels and POIT but not from nonsensitized nonallergic children. Depletion of IgG4 from plasma of children with PS (and POIT) sensitized to Ara h 1 to Ara h 3 partially restored peanut-induced mast cell activation (P = .007). Conclusions Differences in sIgE levels and allergen specificity could not justify the clinical phenotype in all children with PA and PS children. Blocking IgG4 antibodies provide an additional explanation for the absence of clinical reactivity in PS patients sensitized to major peanut allergens.
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Beyer K, Grabenhenrich L, Härtl M, Beder A, Kalb B, Ziegert M, Finger A, Harandi N, Schlags R, Gappa M, Puzzo L, Röblitz H, Millner-Uhlemann M, Büsing S, Ott H, Lange L, Niggemann B. Predictive values of component-specific IgE for the outcome of peanut and hazelnut food challenges in children. Allergy 2015; 70:90-8. [PMID: 25308885 DOI: 10.1111/all.12530] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Oral challenges are the gold standard in food allergy diagnostic, but time-consuming. Aim of the study was to investigate the role of peanut- and hazelnut-component-specific IgE in the diagnostics of peanut and hazelnut allergy and to identify cutoff levels to make some challenges superfluous. METHODS In a prospective and multicenter study, children with suspected peanut or hazelnut allergy underwent oral challenges. Specific IgE to peanut, hazelnut, and their components (Ara h 1, Ara h 2, Ara h 3, and Ara h 8, Cor a 1, Cor a 8, Cor a 9, and Cor a 14) were determined by ImmunoCAP-FEIA. RESULTS A total of 210 children were challenged orally with peanut and 143 with hazelnut. 43% of the patients had a positive peanut and 31% a positive hazelnut challenge. With an area under the curve of 0.92 and 0.89, respectively, Ara h 2 and Cor a 14-specific IgE discriminated between allergic and tolerant children better than peanut- or hazelnut-specific IgE. For the first time, probability curves for peanut and hazelnut components have been calculated. A 90% probability for a positive peanut or hazelnut challenge was estimated for Ara h 2-specific IgE at 14.4 kU/l and for Cor a 14-specific IgE at 47.8 kU/l. A 95% probability could only be estimated for Ara h 2 at 42.2 kU/l. CONCLUSIONS Ara h 2- and Cor a 14-specific IgE are useful to estimate the probability for a positive challenge outcome in the diagnostic work-up of peanut or hazelnut allergy making some food challenges superfluous.
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Affiliation(s)
- K. Beyer
- Department of Pediatric Pneumology and Immunology; Charité Universitätsmedizin Berlin; Berlin Germany
- Icahn School of Medicine at Mount Sinai; New York NY USA
| | - L. Grabenhenrich
- Institute for Social Medicine, Epidemiology, and Health Economics; Charité Universitätsmedizin Berlin; Berlin Germany
| | - M. Härtl
- Department of Pediatric Pneumology and Immunology; Charité Universitätsmedizin Berlin; Berlin Germany
| | - A. Beder
- Department of Pediatric Pneumology and Immunology; Charité Universitätsmedizin Berlin; Berlin Germany
| | - B. Kalb
- Department of Pediatric Pneumology and Immunology; Charité Universitätsmedizin Berlin; Berlin Germany
| | - M. Ziegert
- Department of Pediatric Allergology; German Red Cross Hospital; Berlin Germany
| | - A. Finger
- Department for Pediatrics, St. Marien-Hospital; Bonn Germany
| | - N. Harandi
- Department of Pediatrics, Waldburg-Zeil Clinic; Wangen Germany
| | - R. Schlags
- Department of Pediatrics, Waldburg-Zeil Clinic; Wangen Germany
| | - M. Gappa
- Department of Pediatrics, Marien-Hospital; Wesel Germany
| | - L. Puzzo
- Department of Pediatrics, Marien-Hospital; Wesel Germany
| | - H. Röblitz
- Department of Pediatrics, Sana Klinikum Lichtenberg; Berlin Germany
| | | | - S. Büsing
- Childrens Hospital; Osnabrück Germany
| | - H. Ott
- Catholic Childrens Hospital Wilhemsstift; Hamburg Germany
| | - L. Lange
- Department for Pediatrics, St. Marien-Hospital; Bonn Germany
| | - B. Niggemann
- Department of Pediatric Pneumology and Immunology; Charité Universitätsmedizin Berlin; Berlin Germany
- Department of Pediatric Allergology; German Red Cross Hospital; Berlin Germany
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Affiliation(s)
| | - Lina Mayorga
- Research Laboratory and Allergy Service; IBIMA-Regional University Hospital of Malaga; Malaga Spain
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Agabriel C, Ghazouani O, Birnbaum J, Liabeuf V, Porri F, Gouitaa M, Cleach I, Grob JJ, Bongrand P, Sarles J, Vitte J. Ara h 2 and Ara h 6 sensitization predicts peanut allergy in Mediterranean pediatric patients. Pediatr Allergy Immunol 2014; 25:662-7. [PMID: 25376086 DOI: 10.1111/pai.12299] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 01/03/2023]
Abstract
BACKGROUND Peanut allergy (PA) management was improved by the introduction of molecular allergology, but guidelines for Mediterranean patients are lacking. We aimed at evaluating peanut component-resolved diagnosis as a diagnostic and prognostic tool in children from Southern France. METHODS In 181 pediatric patients, PA diagnosis was founded on medical history, skin prick testing, serum-specific IgE to Arachis hypogea extract and components, Pru p 4, and plant carbohydrates, and oral food challenge. Allergen microarray was also performed in 68 of these patients. RESULTS In peanut-allergic children (n = 117), IgE to Ara h 6 were most prevalent (64%), followed by Ara h 2 (63%), Ara h 1 (60%), and Ara h 9 (52%). Ara h 6 was the best predictor of PA. The second best predictor was the ratio of Ara h 2 IgE to peanut IgE (cutoff 0.113). Persistent childhood PA was associated with complex molecular profiles. Comparison of singleplex and microarray results showed poor concordance for Ara h 2 and Ara h 9. CONCLUSION Ara h 6 and Ara h 2 are the best predictors of PA at diagnosis in Mediterranean pediatric patients. Ara h 1, Ara h 8, and molecular complexity are associated with PA persistence.
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Affiliation(s)
- Chantal Agabriel
- Multidisciplinary Pediatrics Department, APHM Assistance Publique Hôpitaux de Marseille, La Timone Hospital, Marseille, France
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Lange L, Beyer K, Kleine-Tebbe J. Benefits and limitations of molecular diagnostics in peanut allergy: Part 14 of the series Molecular Allergology. ACTA ACUST UNITED AC 2014; 23:158-163. [PMID: 26120527 PMCID: PMC4479434 DOI: 10.1007/s40629-014-0019-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 05/29/2014] [Indexed: 11/29/2022]
Abstract
Allergic reactions to peanut (Arachis hypogaea, Ara h) are caused by immunoglobulin E (IgE)-mediated sensitizations to various proteins. The stability and relative proportion of these proteins in peanut determine the risk of hazardous reactions. Hazardous sensitization to seed storage proteins [S2 albumins (Ara h 2, 6 and 7) > other seed storage proteins (Ara 1 and 3) > oleosins (Ara h 10 and 11)] are distinct from sensitizations to lipid transfer protein (Ara h 9) with moderate risk or cross-sensitizations to Bet v 1-homologous PR-10 protein (Ara h 8) and to profilin (Ara h 5) with low risk. A specific IgE test, e.g. to Ara h 2 in the case of suspected systemic reaction, or where this should be ruled out, can facilitate easier risk assessment. Results, however, are only relevant in the presence of corresponding clinical symptoms. IgE sensitization to peanut extract without hazardous reactions is often caused in this part of the world by Bet v 1-related cross reactions (in birch pollen allergy sufferers), cross-reactive carbohydrate determinants (CCD) or profilin sensitizations. In the case of doubt, clinical relevance can only be established by means of oral challenge, particularly since not all peanut allergens (e. g., oleosins) are available as yet for diagnostic purposes.
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Affiliation(s)
- Lars Lange
- Department of Pediatrics, St. Marien-Hospital, Robert-Koch-Str. 1, 53115 Bonn, Germany
| | - Kirsten Beyer
- Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
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