Mugwort Pollen-Related Food Allergy: Lipid Transfer Protein Sensitization and Correlation With the Severity of Allergic Reactions in a Chinese Population

The role of major allergens Art v 1 and Art v 3 in Artemisia pollen-induced asthma: a mouse model study

Background

Artemisia pollen is a major airborne allergen contributing to seasonal allergic rhinitis and bronchial asthma worldwide. However, the specific allergenic potential of different Artemisia species and their major allergens, Art v 1 and Art v 3, remains poorly understood.

Methods

This study utilized a BALB/c mouse model to comparatively assess the allergenic potential of A. vulgaris, A. absinthium, and A. annua. Mice were sensitized and challenged with standardized pollen extracts, and allergic responses were evaluated through serum IgE levels, airway hyperreactivity, ear swelling, and histopathological lung analysis. The correlation between allergen content (Art v 1 and Art v 3) and allergic outcomes was also examined.

Results

A. vulgaris exhibited the highest allergenicity, inducing the most pronounced IgE response, airway hyperresponsiveness, and severe pulmonary pathology. A. absinthium displayed intermediate allergenic potential, while A. annua elicited the mildest allergic response. Art v 1 levels strongly correlated with key clinical and pathological markers of asthma, whereas Art v 3 showed no significant association. Notably, the Art v 1/Art v 3 ratio emerged as the strongest predictor of pulmonary pathology.

Conclusion

These findings establish Art v 1 as the key driver of Artemisia-induced allergic inflammation and emphasize its dominance over Art v 3 in pollen as a critical factor in the development of allergic lung pathology. These findings provide new insights into the molecular basis of Artemisia pollen allergy and may inform future diagnostic and therapeutic strategies.

Allergic Potential of Medicinal Plants From the Asteraceae Family

Background and Aims

The popularity of herbal medicine continues to increase in modern health care practices; therefore, it is imperative to recognize and address potential risks associated with its everyday use. The Asteraceae family is one of the most extensively utilized medicinal plant families due to its abundance and diversity of bioactive secondary metabolites. The aim of this article is to review the current understanding of the allergic potential of the most significant medicinal plant species belonging to the Asteraceae family.

Methods

This review utilized various search engines, including PubMed Central, Cochrane Central, Google Scholar, and others, up to January 2024, considering only articles in English.

Results

Asteraceae have long been acknowledged as important sensitizers within occupational environments, eliciting both immediate and delayed hypersensitivity reactions. Recent investigations have indicated the presence of panallergens in Asteraceae pollen, predominantly identified in Ambrosia artemisiifolia and Artemisia spp., which are pervasive across many species within the family. These panallergens contribute to cross-reactivity phenomena, serving as primary triggers for pollinosis and pollen-food or pollen-medicine allergy syndrome. In addition, the diverse array of secondary metabolites present in the Asteraceae family, particularly sesquiterpene lactones (SLs), possesses sensitizing properties capable of inducing skin irritation and inflammation. Moreover, SLs have the potential to incite systemic reactions, posing a risk to sensitized individuals upon ingestion. Although extensive cross-reactivity among SLs has been reported, further investigations are warranted to elucidate the underlying mechanisms and implications.

Conclusion

As numerous uncertainties persist regarding critical Asteraceae allergens and sensitizers further research is critical to augment our understanding of the potential risks posed by Asteraceae herbal medicine.

Fructose-Bisphosphate Aldolase Mediating Pollen-Food Allergy Syndrome

Pollen-food allergy syndrome is an IgE-mediated allergic reaction arising from cross-reactive homologous allergens found in both food and pollen. Allergens, such as pathogenesis-related protein class 10 and profilin, usually trigger oropharyngeal itching and numbness in patients, whereas lipid transfer proteins tend to induce anaphylaxis. This article presents a case study of an individual with Artemisia pollen allergy who experienced anaphylaxis after consuming red fruit ginseng, a perennial herb belonging to the Campanulaceae family. This study revealed a novel allergen component mediating cross-allergy between Artemisia pollen and food, fructose-bisphosphate aldolase, which has not been documented in the literature concerning the pollen-food allergy syndrome. Fructose-bisphosphate aldolase tends to induce anaphylaxis in patients with Artemisia pollen-allergy and warrants clinicians' attention.

Elena RM, Carlos LT, Marta BL, Ochoa M. Luisa B. Clinical and sensitization profile in peach allergy due to LTP sensitization

Background

Lipid transfer proteins (LTP) are associated with a wide range of severity of allergic reactions. However, the risk factors associated with this severity are not fully understood.

Objectives

To describe the clinical characteristics of peach-allergic patients due to LTP sensitization and analyze the relationship between the severity of the reactions and patients' sensitization profiles.

Methods

A retrospective study of peach-allergic patients was performed. Patients were classified into LTP-monoallergic (only peach allergy) or LTP-Syndrome (peach allergy and allergy to other plants-foods related with LTP). Symptoms with Rosaceae family and other related plant foods, skin prick tests (SPTs), and IgE values were recorded.

Results

Seventy-one patients were included, 46.5% suffering from anaphylaxis, 32.3% from urticaria angioedema, and 21.2% from oral allergy syndrome. Six had monoallergy to LTP and 65 LTP syndrome. Clinical severity showed no differences according to peach SPT wheal size or Pru p 3 IgE levels. We also found no differences between the components of LTP-containing foods analyzed, the number of LTPs recognized, and the severity of symptoms. However, anaphylaxis was more frequent in patients with concomitant allergies to ≥3 groups of plant foods.

Conclusions

LTP syndrome was the most common presentation in patients with Rosaceae food allergy. The severity of the reactions was not related to peach SPT wheal size or sIgE levels to Pru p 3, but concomitant allergies to ≥3 plant food groups could be a good marker of severity.

Food-Pollen Cross-Reactivity and its Molecular Diagnosis in China

PURPOSE OF REVIEW

Plant-derived foods are one of the most common causative sources of food allergy in China, with a significant relationship to pollinosis. This review aims to provide a comprehensive overview of this food-pollen allergy syndrome and its molecular allergen diagnosis to better understand the cross-reactive basis.

RECENT FINDINGS

Food-pollen cross-reactivity has been mainly reported in Northern China, Artemisia pollen is the major related inhalant source, followed by tree pollen (Betula), while grass pollen plays a minor role. Pollen allergy is relatively low in Southern China, with allergies to grass pollen being more important than weed and tree pollens. Rosaceae fruits and legume seeds stand out as major related allergenic foods. Non-specific lipid transfer protein (nsLTP) has been found to be the most clinically relevant cross-reacting allergenic component, able to induce severe reactions. PR-10, profilin, defensin, chitinase, and gibberellin-regulated proteins are other important cross-reactive allergen molecules. Artemisia pollen can induce allergenic cross-reactions with a wide range of plant-derived foods in China, and spring tree pollens (Betula) are also important. nsLTP found in both pollen and plant-derived food is considered the most significant allergen in food pollen cross-reactivity. Component-resolved diagnosis with potential allergenic proteins is recommended to improve diagnostic accuracy and predict the potential risk of causing allergic symptoms.

Food-dependent exercise-induced anaphylaxis (FDEIA) suspected triggered by lipid transfer protein in a Chinese child: A case report

Lipid transfer protein (LTP) has been documented as the dominant protein involved in food-induced anaphylaxis and food-dependent exercise-induced anaphylaxis (FDEIA) patients from Mediterranean European countries. To date, there is no report of FDEIA triggering by LTP in China. A 12-year-old Chinese boy experienced recurrent anaphylaxis during intense exercise for 3 months. Specific immunoglobulin E was performed using ImmunoCAP (Thermo Fisher Scientific, Sweden) and Euroline (EUROIMMUN, Germany). He was sensitized to several pollens, mainly mugwort (62 KUA/L), and was found to have detectable immunoglobulin E in multiple foods: cereal (wheat, barley, oat maize, rice, buckwheat, and common millet), fruits (peach, apple, grape, cherry, and orange), vegetables (lettuce, cabbage, broccoli, cauliflower, tomato, and celery), and legumes and nuts (soybean, peanut, and walnut). He also showed sensitization to LTP components from mugwort Art v3 (79.7 KUA/L) and wheat Tri a14 (12.4 KUA/L), but negative to gluten, gliadin, and omega-5 gliadin. We advised our patient to carry an epinephrine auto-injector, not to exercise alone, and to avoid wheat and fruit/vegetable ingestion for at least 4 hours before exercise or when taking non-steroidal anti-inflammatory drugs. After a 6-month follow-up, the patient has experienced no episode of anaphylaxis. We reported the first documented FDEIA case suspected triggered by LTP in a Chinese child. Clinicians should be aware of LTP sensitization when anaphylaxis occurs during exercise in individuals with multiple pollen and food sensitization.

What molecular allergy teaches us about genetics and epidemiology of allergies

PURPOSE OF REVIEW

To delineate pertinent information regarding the application of molecular allergology within the realm of both genetic and epidemiological facets of allergic diseases.

RECENT FINDINGS

The emergence of molecular allergy has facilitated the comprehension of the biochemical characteristics of allergens originating from diverse sources. It has allowed for the exploration of sensitization trajectories and provided novel insights into the influence of genetics and environmental exposure on the initiation and development of allergic diseases. This review delves into the primary discoveries related to the genetics and epidemiology of allergies, facilitated by the application of molecular allergy. It also scrutinizes the impact of environmental exposure across varied geoclimatic, socioeconomic, and lifestyle contexts. Additionally, the review introduces specific models of molecular allergy within the realms of plants and animals.

SUMMARY

The utilization of molecular allergy in clinical practice holds crucially acknowledged diagnostic and therapeutic implications. From a research standpoint, there is a growing need for the widespread adoption of molecular diagnostic tools to achieve a more profound understanding of the epidemiology and natural progression of allergic diseases.

Profiles of apple allergen components and its diagnostic value in Northern China

Background

Limited is known on the profiles of apple allergy in China.

Objective

To explore the clinical significance of apple allergen components in northern China.

Methods

This study recruited 40 participants and categorized into apple tolerance (n = 19) and allergy (n = 21) group. The latter was categorized into oral allergy symptoms (OAS, n = 14) and generalized symptoms (GS, n = 7). All participants underwent ImmunoCAP screening to assess sIgE levels of birch, apple, and their components.

Results

The sensitization rates were 90% for Bet v 1, 85% for Mal d 1, 35% for Bet v 2, and 20% for Mal d 3. The overall positive rate for apple allergens was 97.5%, with half demonstrating mono-sensitization to Mal d 1. Birch, Bet v 1 and Mal d 1 sIgE levels had consistent areas under the curve (AUC 0.747, p = 0.037; AUC 0.799, p = 0.012; AUC 0.902, p < 0.001 respectively) in diagnosing apple allergy. The optimal cut-off values were determined to be 22.85 kUA/L (63.6% sensitivity, 85.7% specificity), 6.84 kUA/L (81.8% sensitivity, 71.4% specificity) and 1.61 kUA/L (93.8% sensitivity, 75.0% specificity), respectively. No allergens or components demonstrated diagnostic value in distinguishing between OAS and GS. Mal d 3 sensitization was correlated with mugwort allergy and higher risk of peach, nuts or legumes generalized allergy.

Conclusion

Mal d 1 was major allergen and the best for diagnosing apple allergy. Mal d 3 does not necessarily indicate severe allergic reaction to apples in northern China but may indicate mugwort sensitization and an increased risk of peach, nuts or legumes allergy.

Pru p 3-specific IgE affinity is crucial in severe peach-allergy patients

Background

Peach allergy is common food allergen. Allergen components-specific antibodies of different isotypes in peach-allergy patients are poorly studied. Factors other than Pru p 3-sIgE levels may be related to severe symptoms.

Objective

To evaluated peach component-specific-IgE, IgG1, and IgG4 characteristics in individuals with and without peach allergy, and Pru p 3-sIgE affinity in patients with different clinical symptoms.

Methods

Fifteen healthy controls and 32 peach-allergy patients were enrolled. sIgE, sIgG1, and sIgG4 to 5 Escherichia coli-expressed peach-allergen components were determined by enzyme-linked immunosorbent assays. Pru p 3-sIgE affinity was measured in Pru p 3-sIgE-positive patients, using immunoadsorbance.

Results

Patients were divided into oral allergy syndrome (OAS) and peach-induced anaphylaxis (PIA) groups. Serum Pru p 1-, Pru p 2-, Pru p 3-, Pru p 4-, and Pru p 7-sIgG1s were detected. Pru p 1- and Pru p 2-sIgG1 levels were higher in healthy controls, but Pru p 3-sIgG1 levels were significantly higher in peach-allergy patients. Pru p 1-, Pru p 3-, and Pru p 4-sIgG4-positivity was significantly greater among patients than among controls. Pru p 3 was the predominant allergen in peach-allergy patients. Allergen-sIgG1 and sIgG4 were similar between OAS and PIA patients. Pru p 3-sIgE levels were significantly higher in PIA patients, but Pru p 3-sIgE-positivity was similar in both groups. In Pru p 3-sIgE-positive patients, Pru p 3-sIgE affinity was significantly higher in PIA than OAS patients.

Conclusions

Allergen-sIgG1 was associated with allergen exposure. Both Pru p 3-sIgE levels and affinity are key factors in severe peach-allergy patients.

Worldwide Heterogeneity of Food Allergy: Focus on Peach Allergy in Southern Italy

Food allergy (FA) has shown an increasing prevalence in the last decades, becoming a major public health problem. However, data on the prevalence of FA across the world are heterogeneous because they are influenced by several factors. Among IgE-mediated FA, an important role is played by FA related to plant-derived food which can result from the sensitization to a single protein (specific FA) or to homologous proteins present in different foods (cross-reactive FA) including non-specific lipid transfer proteins (nsLTPs), profilins, and pathogenesis-related class 10 (PR-10). In addition, the clinical presentation of FA is widely heterogeneous ranging from mild symptoms to severe reactions up to anaphylaxis, most frequently associated with nsLTP-related FA (LTP syndrome). Considering the potential life-threatening nature of nsLTP-related FA, the patient's geographical setting should always be taken into account; thereby, it is highly recommended to build a personalized approach for managing FA across the world in the precision medicine era. For this reason, in this review, we aim to provide an overview of the prevalence of nsLTP-mediated allergies in the Mediterranean area and to point out the potential reasons for the different geographical significance of LTP-driven allergies with a particular focus on the allergenic properties of food allergens and their cross reactivity.

A comprehensive review on mango allergy: Clinical relevance, causative allergens, cross-reactivity, influence of processing techniques, and management strategies

Mangoes (Mangifera indica) are widely prized for their abundant nutritional content and variety of beneficial bioactive compounds and are popularly utilized in various foods, pharmaceuticals, and cosmetics industries. However, it is important to note that certain proteins present in mango can trigger various allergic reactions, ranging from mild oral allergy syndrome to severe life-threatening anaphylaxis. The immunoglobulin E-mediated hypersensitivity of mango is mainly associated with three major allergenic proteins: Man i 1 (class IV chitinase), Man i 2 (pathogenesis-related-10 protein; Bet v 1-related protein), and Man i 4 (profilin). Food processing techniques can significantly affect the structure of mango allergens, reducing their potential to cause allergies. However, it is worth mentioning that complete elimination of mango allergen immunoreactivity has not been achieved. The protection of individuals sensitized to mango should be carefully managed through an avoidance diet, immediate medical care, and long-term oral immunotherapy. This review covers various aspects related to mango allergy, including prevalence, pathogenesis, symptoms, and diagnosis. Furthermore, the characterization of mango allergens and their potential cross-reactivity with other fruits, vegetables, plant pollen, and seeds were discussed. The review also highlights the effects of food processing on mango and emphasizes the available strategies for managing mango allergy.

Blueberry (Vaccinium myrtillus) Induced Anaphylaxis in a Chinese Child with Lipid Transfer Protein Sensitization

Purpose

Fruits have been identified as the primary triggers of anaphylaxis in older children in the Chinese population, especially among individuals with pollen sensitization. To date, no allergies have been reported after blueberry ingestion in the Chinese population.

Case Report

A 12-year-old girl experienced one episode of anaphylaxis within 30 minutes of having breakfast (including milk, egg, wheat bread, and blueberry) while walking to school. She menstruated during this episode. Prompt treatment with epinephrine and fluid therapy led to full recovery within 24 h. Specific IgE was conducted using ImmunoCAP, and the patient exhibited sensitization to several pollens, mainly Japanese hop (74.3 kUa/L) and mugwort (26.5 kUa/L). Regarding specific IgE to allergen components, the patient showed sensitization primarily to lipid transfer protein (LTP) components from mugwort Art v 3 (79.7 kUa/L), wheat Tri a 14 (12.4 kUa/L) and peach Pru p 3 (2.15 kUa/L), but tested negative for omega-5 gliadin. The prick test results were positive for blueberries (wheal size 9.5 mm), cherries (wheal size 6.5 mm), kiwifruits (wheal size 6 mm), and pears (wheal size 4.5 mm). Our patient was provided with an epi-pen and was advised to avoid consuming relevant fruits. After four months of follow-up, the patient had not experienced any episodes of anaphylaxis since these recommendations were implemented.

Conclusion

We report for the first time a Chinese child with severe IgE-mediated immediate-type anaphylactic reaction to blueberries, in whom we identified LTP as the suspected allergen component.

Profiles of Birch Allergen Component Sensitization and Its Association with Pollen Food Allergy Syndrome in Northern China

Purpose

To investigate the major allergen components associated with birch pollen allergy in northern China and elucidate clinical relevance to pollen food allergy syndrome (PFAS).

Methods

Fifty-eight patients were recruited for a cross-sectional study and categorized into two groups: PFAS group and non-PFAS group, as well as apple allergy group and non-apple allergy group. The sIgE levels of birch pollen and its components, namely Bet v 1, Bet v 2, Bet v 4, and Bet v 6, were analyzed.

Results

Among 58 participants, 44 individuals (75.9%) reported PFAS. 32 out of 44 (72.7%) participants reported apple allergy. Bet v 1 exhibited the highest sensitization rate at 82.8%, followed by Bet v 2 (29.3%) and Bet v 6 (1.7%). The combined sensitization rate for Bet v 1 and/or Bet v 2 was 93.1%. A total of 77.6% of the subjects demonstrated sensitization to single component, while 19.0% exhibited sensitization to two components. The sIgE levels of birch pollen and Bet v 1 were significantly elevated in PFAS group compared to non-PFAS group (p=0.001, p<0.001, respectively), as well as in apple-allergic and non-apple-allergic group (p<0.001, p<0.001, respectively). The optimal cut-off values for birch pollen and Bet v 1 sIgE were determined to be 7.09 kUA/L (with a sensitivity of 84.1% and specificity of 78.6%) and 5.11 kUA/L (with a sensitivity of 75.0% and specificity of 85.7%) when diagnosing PFAS. In terms of apple allergy, the optimal cut-off value were 9.40 kUA/L (with a sensitivity of 81.3% and specificity of 76.9%) and 6.53 kUA/L (with a sensitivity of 84.4% and specificity of 84.6%), respectively.

Conclusion

The predominant sensitization pattern is mono-sensitization to Bet v 1, but when considering immunotherapy, Bet v 2 should also be taken into account. Bet v 1 serves as a valuable biomarker for diagnosing PFAS and apple allergy.

Molecular allergy diagnosis is sensitive and avoids misdiagnosis in patients sensitized to seasonal allergens

BACKGROUND

The specificity of extract-based pollen allergy diagnosis is decreased due to cross-reactivity via cross-reactive carbohydrate determinants (CCDs) or panallergens such as profilins or polcalcins. This study aimed to explore the prevalence of sensitization to seasonal extracts, CCDs, profilin and polcalcin and investigate the sensitivity and specificity of seasonal molecular allergy diagnosis (MAD) using commercially available test methods.

METHODS

2948 patients were screened for specific immunoglobulin E to ash, birch, mugwort, ragweed and timothy grass pollen extracts and grouped according to the number of positive tests (1-5). 100 patients from each group and a control group were randomly selected to calculate the prevalence of CCD and panallergen sensitization. With 742 patients, sensitivity and specificity of MAD (Alt a 1, Fra/Ole e 1, Bet v 1, Phl p 1, Art v 1, and Amb a 1) was determined.

RESULTS

1627 patients (55.2%) were positive to at least one, and 1002 patients (34.0%) were positive to multiple of the five pollen allergens investigated; 18.5% of the pollen-sensitized patients had sensitization to CCDs or panallergens. Specifically, sensitization to CCDs, profilins, and polcalcins was observed in 8.7%, 10.9%, and 2.9% of these patients, respectively. The sensitivity of MAD was high, with sensitivities between 96.2% and 100% using ImmunoCAP and 91.5% and 100% using ALEX2 . Specificity was 100% for both assays.

CONCLUSIONS

Due to cross-reactivity, about one-fifth of pollen-sensitized patients is at risk of misdiagnosis. However, MAD is sensitive, specific and helps to avoid misdiagnosis and select primary allergen sources for immunotherapy.

Lipid transfer protein syndrome: How to save a life through careful education

Introduction

Lipid transfer proteins (nsLTPs) are ubiquitous allergens. Patients affected by nsLTP syndrome experience symptoms to various plant-derived foods, ranging from local manifestations to anaphylaxis, the critical treatment of which is represented by self-administration of adrenaline. The principle aim of this study is to assess how dietary recommendations influence the occurrence of new and severe cases and if poly-sensitization to different nsLTPs may play a role. We also investigated about the appropriate use of adrenaline auto-injector during the episodes of anaphylaxis. Moreover, we examinated how other features (ie, co-sensitization to profilin and PR-10 and the presence of risk co-factors) affect these events.

Materials and methods

We evaluated 78 patients allergic to nsLTPs, investigating adherence to diet and ability to use the adrenaline auto-injector. Number of sensitization to nsLTPs, co-sensitization to other panallergens, and presence of risk factors for new reactions were also assessed. Diagnosis was based on clinical history and positivity to in vivo and in vitro tests. During the follow-up, compliance, diet modifications, and new reactions were noted, and re-training for the use of epinephrine auto-injector was performed. At the last visit we evaluated the patients’ ability to use the self-injector.

Results

The whole of fruits belonging to the Rosaceae family emerged as the most frequent culprit foods (28%), followed by walnut (17%), peanut (17%), and hazelnut (10%). At the baseline visit 23% of the patients described the presence of a risk factor during the allergic reaction (mainly nonsteroidal anti-inflammatory drugs [NSAIDs] and exercise). Forty-five percent of the patients reported anaphylactic reactions; no association between the type of food and the severity of the reactions was found. The presence of sensitization to 4 or more nsLTPs was associated to more severe reactions (p < .05; OR 1.67). During the follow-up 38% of the patients experienced at least 1 new allergic reaction: in 79% of them the culprit food was previously tolerated, and in 69% the reaction was an anaphylaxis. Only 47% of the patients showed a proper use of adrenaline auto-injector during the final evaluation, but a significant correlation between periodic education and reduction of the probability of mistakes in the use was reported (p < .05; OR 0.34). Furthermore, an association between co-sensitization to PR-10 (in particular Bet v1) and profilin and less severe symptoms was found, but without a significant odds ratio.

Conclusion

A careful education aimed to the prevention of new reactions, through dietary restrictions and avoidance of risk co-factors, and to the management of anaphylaxis, through the training for the correct use of adrenaline auto-injector, should be a routine practice in nsLTP syndrome.

Differences in Linear Epitopes of Ara h 9 Recognition in Peanut Allergic and Tolerant, Peach Allergic Patients

Background

Peanut-allergic patients from the Mediterranean region are predominantly sensitized to the lipid transfer protein (LTP) Ara h 9, and the peach LTP Pru p 3 seems to be the primary sensitizer. However, LTP sensitization in peanut allergy is not a predictive marker for clinically relevant symptoms.

Objective

We aimed to identify sequential epitopes of IgE and IgG4 from Pru p 3 and Ara h 9 in peach-allergic patients sensitized to peanuts. We also sought to determine the differences in IgE and IgG4 binding between patients who had developed peanut allergy and those tolerating peanuts.

Methods

A total of 46 peach-allergic patients sensitized to peanuts were selected. A total of 35 patients were allergic to peanuts (peanut-allergic group) and 11 were tolerant to peanuts (peanut-tolerant group). We measured sIgE and sIgG4 in peanut, peach, and their recombinant allergen (Ara h 1, Ara h 2, Ara h 3, Ara h 8, and Ara h 9) with fluorescence enzyme immunoassay. We examined the IgE and IgG4 binding to sequential epitopes using a peptide microarray corresponding to linear sequences of the LTPs Ara h 9 and Pru p 3 with a library of overlapping peptides with a length of 20 amino acids (aa) and an offset of 3 aa.

Results

The frequency and the intensity of IgE recognition of Ara h 9 and Pru p 3 peptides were higher in the peanut-tolerant group than in the peanut-allergic group. We found four Ara h 9 peptides (p4, p14, p21, and p25) and four Pru p 3 peptides (p1, p3, p21, and p24) with a significantly elevated IgE recognition in peanut-tolerant patients. Only one peptide of Ara h 9 (p4) recognized by IgG4 was significantly elevated in the peanut-tolerant group. The IgG4/IgE ratio of Ara h 9 peptide 4 was significantly higher in peanut-tolerant patients than in peanut-allergic patients, while no significant differences were observed in the IgG4/IgE ratio of this peptide in Pru p 3.

Conclusion

Although we found significant differences in IgE and IgG4 recognition of Ara h 9 and Pru p 3 between peanut-tolerant and peanut-allergic patients (all of whom were allergic to peach), polyclonal IgE peptide recognition of both LTPs was observed in peach-allergic patients tolerating peanuts. However, the IgG4 blocking antibodies against Ara h 9 peptide 4 could provide an explanation for the absence of clinical reactivity in peanut-tolerant peach-allergic patients. Further studies are needed to validate the usefulness of IgG4 antibodies against Ara h 9 peptide 4 for peanut allergy diagnosis.

Anaphylaxis in Chinese Children with Pollen Sensitization: Triggers, Clinical Presentation, and Acute Management

Purpose

Pollen sensitization is increasing in children. However, there is little evidence regarding the characteristics of anaphylaxis in individuals with pollen sensitization.

Patients and Methods

We conducted a retrospective study of patients with anaphylaxis combined with pollen sensitization who attended an allergy department in a tertiary children’s hospital from 2014 to 2021.

Results

A total of 157 anaphylaxis events in 108 patients were analyzed; the mean age at the reaction was 5.8 ± 4.17 years. A total of 99.1% (107/108) of the patients came from northern China. The most common sensitizing pollen was mugwort (93.5%,101/108), followed by ragweed (68.5%, 74/108) and birch (40.7%, 44/108). A total of 76.9% (83/108) of the patients showed polysensitization to pollen. Allergic rhinitis/conjunctivitis was the most common comorbidity (87.0%, 94/108). Children with severe anaphylaxis were more likely to have a history of recurrent urticaria (16.1% vs 3.9%, p = 0.028). The most frequently implicated foods were fruits/vegetables (22.3%, 35/157), followed by wheat (8.9%, 14/157) and milk (8.3%, 13/157), and the most common fruit allergen was peach (n = 7). Of 14% (22/157) exercise-induced reactions, 63.6% (14/22) occurred in pollen season. Skin symptoms were the most frequent (86.0%, 135/157) symptoms, followed by respiratory (73.9%, 116/157) and gastrointestinal (21%, 33/157) symptoms. Regarding acute management, only 7.4% of the patients were treated with epinephrine.

Conclusion

Our findings revealed the characteristics of anaphylaxis in children with pollen sensitization. Fruits/vegetables accounted for a substantial percentage of anaphylaxis triggers. The suboptimal use of epinephrine highlights the need for educational programs promoting the use of epinephrine.

Artemisia sieversiana pollen allergy and immunotherapy in mice

This study developed a murine model of asthma using Artemisia sieversiana pollen extract (ASE) and subcutaneous immunotherapy (SCIT) without an adjuvant. BALB/c mice were sensitized subcutaneously with 25 μg of ASE and challenged with 0.1% ASE aerosol. To investigate the efficacy of SCIT, mice were subcutaneously injected with 0.3 mg ASE without adjuvant once a week for 8 weeks, followed by challenge for 3 additional days. Airway hyperresponsiveness (AHR) to methacholine, pulmonary inflammatory cell infiltration, cytokine levels of bronchoalveolar lavage fluid, histopathology of the lung, and serum allergen-specific serum IgE and IgG2a levels were assessed following the final challenge. Mice sensitized with ASE developed AHR and had significantly higher interleukin (IL)-4, IL-5, and IL-13 levels as well as lower IL-12 level than those of control mice. Moreover, mice sensitized with ASE showed increased plasma levels of allergen-specific IgE, and histologic analyses showed peribranchial infiltration of inflammatory cells and mucosal hyperplasia. After SCIT, allergic symptoms and immunological parameters were effectively improved, and the plasma level of allergen-specific IgG2a was significantly increased cmpared to that in the vehicle group. These findings described successful development of an A. sieversiana pollen-induced asthma model in BALB/c mice, with in vivo findings revealing that SCIT without adjuvant significantly improved the symptoms and pathophysiology of asthmatic mice.

Global patterns in anaphylaxis due to specific foods: A systematic review

BACKGROUND

There are increasing global data relating to prevalence of food allergy and food-induced anaphylaxis; however, this is often based on surrogate measures of sensitization rather than objective symptoms at food challenge. In terms of protecting food-allergic consumers from reactions, to our knowledge, there has been no global survey assessing geographic differences in the proportion of anaphylaxis triggered by specific foods.

OBJECTIVE

We sought to identify common triggers for food-induced anaphylaxis and how these vary from country to country.

METHODS

Systematic review of relevant reports published between January 2010 and November 2020. Results were reported following PRISMA guidelines. Publications were screened and data extracted by 2 independent reviewers, and the risk of bias was assessed.

RESULTS

Sixty-five studies (encompassing 41 countries and all 6 regions as defined by the Food and Agriculture Organization of the United Nations) were included. Significant regional variations in the most common triggers of food anaphylaxis were seen; however, in general, there was good agreement between local legislative requirements for allergen disclosure and the most common allergens for each region or nation.

CONCLUSIONS

Local legislation for allergen disclosure generally reflects those allergens commonly responsible for food anaphylaxis. Cow's milk and crustaceans appear to cause a higher proportion of anaphylaxis compared to peanut in some regions.

Clinical relevance of Alternaria alternata sensitization in patients within type 2-high and type 2-low asthma

Alternaria sensitization is correlated with persistent asthma. Type 2 (T2)-asthma endotypes are characterized by the release of eosinophils. However, the prevalence and sensitization patterns in patients with Alternaria asthma between T2-high and T2-low endotypes are unknown. We retrospectively reviewed 582 patients with Alternaria asthma and divided them into T2-high (n = 376) and T2-low (n = 206) groups with a threshold of 300 cells/µL in blood eosinophil counts. Data for basic information, skin test or IgE detection results, and blood eosinophil counts were collected. The age of patients in the T2-high group (13.66 ± 13.23) was lower than that of the T2-low group (18.02 ± 15.03). Patients with T2-high asthma had relatively higher rates of taking inhaled corticosteroids (ICS) and positive family history than the T2-low group. Pet keepers and allergen immunotherapy (AIT) patients were comparable between these groups, In the T2-high group, patients had higher levels of total serum IgE (T-IgE) and showed a significant positive correlation with eosinophil counts (r = 0.166, P = 0.001), followed by higher Alternaria-specific IgE (sIgE) levels (median, 13.7; range, 4.86-25.3). Compared to the T2-low group, the frequency of poly-sensitized patients and the rate of each allergen among the nine common allergens were all higher in the T2-high group; the statistical differences mainly focused on pollens such as birch (P = 0.005), firmiana (P = 0.004), and mugwort (P = 0.005). Young, male patients had a high prevalence of T2-high Alternaria asthma, along with higher rates of T-IgE, sIgE levels, and poly-sensitized patterns.

Analysis of Peanut Allergen Components Sensitization and Cross Reaction with Pollen Allergen in Chinese Southerners with Allergic Rhinitis and/or Asthma

Objective

Peanut is one of the most frequently reported allergens causing severe allergies in western countries. In China, however, there have been few reports of severe allergies caused by peanuts. We investigated the peanut allergen components sensitization and cross-reaction with pollen allergen in Chinese Southerners with allergic rhinitis and/or asthma.

Methods

Total IgE (tIgE) and specific IgE (sIgE) antibodies against Ara h 1, Ara h 8, Juglans pollen, Platanus pollen, birch pollen, Bet v 1, Bet v 4, and cross-reactive carbohydrate determinant (CCD) of 58 allergic patients, of whom 33 were peanut-sIgE positive and 25 were negative, were detected by the ImmunoCAP system. The relationships between peanut allergen and pollen allergens were analyzed.

Results

A 9.1% (3/33) of the patients with peanut sensitization were sensitized to Ara h 8, while 21.2% (7/33) were sensitized to Ara h 1. The peanut-sensitized group had significantly higher positive rates for sIgE antibodies against CCD (69.7% vs 4.0%), Juglans pollen (87.9% vs 12.0%), Platanus pollen (90.9% vs 16.0%), and birch pollen (60.6% vs 4.0%) than the peanut tolerance group (all P < 0.05). Spearman correlation showed that peanut-sIgE were significantly correlated with sIgE to CCD (r_s=0.859), Juglans pollen (r_s=0.772), Platanus pollen (r_s=0.838) and birch pollen (r_s=0.816).

Conclusion

The majority of patients sensitized to peanut allergen in Southern China tested positive for multiple pollen allergens. Peanut sensitization was highly correlated with Platanus, Juglans, and birch pollen sensitization, which suggested there may be cross-reactions between peanut and pollen allergens. Clinicians should pay attention to distinguish diagnosis in clinical peanut allergy diagnosis and treatment.

Update on pollen-food allergy syndrome

INTRODUCTION

Allergies affect 20-30% of the population and respiratory allergies are mostly due to pollen grains from anemophilous plants. One to 5% of people suffer from food allergies and clinicians report increasing numbers of pollen-food allergy syndrome (PFAS), such that the symptoms have broadened from respiratory to gastrointestinal, and even to anaphylactic shock in the presence of cofactors. Thirty to 60% of food allergies are associated with pollen allergy while the percentage of pollen allergies associated to food allergy varies according to local environment and dietary habits.

AREAS COVERED

Articles published in peer-reviewed journals, covered by PubMed databank, clinical data are discussed including symptoms, diagnosis, and management. A chapter emphasizes the role of six well-known allergen families involved in PFAS: PR10 proteins, profilins, lipid transfer proteins, thaumatin-like proteins, isoflavone reductases, and β-1,3 glucanases. The relevance in PFAS of three supplementary allergen families is presented: oleosins, polygalacturonases, and gibberellin-regulated proteins. To support the discussion a few original relevant results were added.

EXPERT OPINION

Both allergenic sources, pollen and food, are submitted to the same stressful environmental changes resulting in an increase of pathogenesis-related proteins in which numerous allergens are found. This might be responsible for the potential increase of PFAS.

Can patients with oral allergy syndrome be at risk of anaphylaxis?

PURPOSE OF REVIEW

Oral allergy syndrome, also known as pollen-food syndrome (PFS), is a condition usually associated with adults and characterized by mild transient oropharyngeal symptoms. The purpose of this review is to determine whether systemic or anaphylactic reactions do occur and if so, who is affected and what are the triggers.

RECENT FINDINGS

An increasing number of studies demonstrate that PFS occurs all age groups, and a significant number of affected adults do experience systemic and anaphylactic reactions. The upsurge in the adoption of vegan lifestyles, increase in consumption of fruits and vegetables including smoothies and juices, and use of plant foods in nutritional or body-building supplements, could exacerbate this. Changes in pollen and pollution levels, cofactors and sensitization to other plant food allergens may also be involved.

SUMMARY

While the majority of those with PFS will continue to experience mild symptoms, all individuals should be properly advised regarding the dangers of concentrated or unusual forms of plant food allergens such as smoothies, juices, soy/nut milks and nutritional supplements. Further well characterized studies are needed to determine risk factors for severe reactions, and sensitization patterns to pollens and plant food allergens.

The diagnosis and management of allergic reactions in patients sensitized to non-specific lipid transfer proteins

Sensitization to one or more non-specific lipid transfer proteins (nsLTPs), initially thought to exist mainly in southern Europe, is becoming accepted as a cause of allergic reactions to plant foods across Europe and beyond. The peach nsLTP allergen Pru p 3 is a dominant sensitizing allergen and peaches a common food trigger, although multiple foods can be involved. A frequent feature of reactions is the requirement for a cofactor (exercise, alcohol, non-steroidal anti-inflammatory drugs, Cannabis sativa) to be present for a food to elicit a reaction. The variability in the food and cofactor triggers makes it essential to include an allergy-focused diet and clinical history in the diagnostic workup. Testing on suspected food triggers should also establish whether sensitization to nsLTP is present, using purified or recombinant nsLTP allergens such as Pru p 3. The avoidance of known trigger foods and advice on cofactors is currently the main management for this condition. Studies on immunotherapy are promising, but it is unknown whether such treatments will be useful in populations where Pru p 3 is not the primary sensitizing allergen. Future research should focus on the mechanisms of cofactors, improving diagnostic accuracy and establishing the efficacy of immunotherapy.

Components of plant-derived food allergens: Structure, diagnostics, and immunotherapy

A large number of plant-derived food allergen components have been identified to date. Although these allergens are diverse, they often share common structural features such as numerous disulfide bonds or oligomeric structures. Furthermore, some plant-derived food allergen components cross-react with pollen allergens. Since the relationship between allergen components and clinical symptoms has been well characterized, measurements of specific IgE to these components have become useful for the accurate clinical diagnosis and selection of optimal treatment methods for various allergy-related conditions including allergy caused by plant-derived foods. Herein, I have described the types and structures of different plant allergen components and outlined the diagnosis as well as treatment strategies, including those reported recently, for such substances. Furthermore, I have also highlighted the contribution of allergen components to this field.

Lipid transfer protein syndrome due to wild grape juice and various vegetables: A life-threatening food allergen

We report a 16-year-old Japanese male with mugwort pollinosis in whom ingestion of wild grape juice and various vegetables caused recurrent general urticaria, abdominal pain, dyspnea, and loss of consciousness. A skin prick test demonstrated positive reactions to a wide variety of both non-heated and heated vegetables and fruits such as wild grape, bell pepper, onion, Chinese cabbage, tomato, eggplant, and broccoli. The serum immunoglobulin E levels (ImmunoCAP ISAC^® ) for Art v 3, Pla a 3, Pru p 3, and Jug r 3, which are lipid transfer protein (LTP) homologs, were positive but those for Bet v 1 and Bet v 2 were negative. We diagnosed the patient as having LTP syndrome, a condition in which additional factors such as exercise, non-steroidal anti-inflammatory drugs, or alcohol may trigger an allergic reaction. Wild grapes contain a large amount of salicylic acid, and in our patient ingestion of wild grape juice led to immediate loss of consciousness in the absence of exercise. This suggests that salicylic acid contained in fruits and vegetables may act as an important cofactor in LTP syndrome. Although sensitization to LTP is rarely reported in Asia, LTP are considered to be potentially life-threatening food allergens, and therefore warrant attention.

Non-specific lipid-transfer proteins: Allergen structure and function, cross-reactivity, sensitization, and epidemiology

Background

Discovered and described 40 years ago, non‐specific lipid transfer proteins (nsLTP) are present in many plant species and play an important role protecting plants from stressors such as heat or drought. In the last 20 years, sensitization to nsLTP and consequent reactions to plant foods has become an increasing concern.

Aim

The aim of this paper is to review the evidence for the structure and function of nsLTP allergens, and cross‐reactivity, sensitization, and epidemiology of nsLTP allergy.

Materials and Methods

A Task Force, supported by the European Academy of Allergy & Clinical Immunology (EAACI), reviewed current evidence and provide a signpost for future research. The search terms for this paper were “Non‐specific Lipid Transfer Proteins”, “LTP syndrome”, “Pru p 3”, “plant food allergy”, “pollen‐food syndrome”.

Results

Most nsLTP allergens have a highly conserved structure stabilised by 4‐disulphide bridges. Studies on the peach nsLTP, Pru p 3, demonstrate that nsLTPs are very cross‐reactive, with the four major IgE epitopes of Pru p 3 being shared by nsLTP from other botanically related fruits. These nsLTP allergens are to varying degrees resistant to heat and digestion, and sensitization may occur through the oral, inhaled or cutaneous routes. In some populations, Pru p 3 is the primary and sole sensitizing allergen, but many are poly‐sensitised both to botanically un‐related nsLTP in foods, and non‐food sources of nsLTP such as Cannabis sativa, Platanus acerifolia, (plane tree), Ambrosia artemisiifolia (ragweed) and Artemisia vulgaris (mugwort). Initially, nsLTP sensitization appeared to be limited to Mediterranean countries, however more recent studies suggest clinically relevant sensitization occurs in North Atlantic regions and also countries in Northern Europe, with nsLTP sensitisation profiles being broadly similar.

Discussion

These robust allergens have the potential to sensitize and provoke symptoms to a large number of plant foods, including those which are raw, cooked or processed. It is unknown why some sensitized individuals develop clinical symptoms to foods whereas others do not, or indeed what other allergens besides Pru p 3 may be primary sensitising allergens. It is clear that these allergens are also relevant in non‐Mediterranean populations and there needs to be more recognition of this.

Conclusion

Non‐specific LTP allergens, present in a wide variety of plant foods and pollens, are structurally robust and so may be present in both raw and cooked foods. More studies are needed to understand routes of sensitization and the world‐wide prevalence of clinical symptoms associated with sensitization to these complex allergens.

The Role of Lipid Transfer Proteins as Food and Pollen Allergens Outside the Mediterranean Area

PURPOSE OF REVIEW

To provide an overview of the prevalence and clinical manifestation of non-specific lipid transfer proteins (LTP)-mediated allergies outside the Mediterranean area and to address potential reasons for the different geographical significance of LTP-driven allergies.

RECENT FINDINGS

LTPs are major allergens in the Mediterranean area, which frequently can elicit severe reactions. Pru p 3 the LTP from peach is reported as genuine allergen and is considered a prototypic marker for LTP-mediated allergies. However, both food and pollen LTP allergies exist outside the Mediterranean area, but with lower clinical significance, different immunogenicity, and less clarified role. Evidence has been reported that in areas with high exposure to pollen, in particular to mugwort, pollen-derived LTPs can act as a primary sensitizer to trigger secondary food allergies. Co-sensitization to unrelated allergens might be causative for less severe reactions in response to LTPs. However, the reason for the geographical different sensitization patterns to LTPs remains unclear.

Lipid Transfer Protein Sensitization: Risk of Anaphylaxis and Molecular Sensitization Profile in Pru p 3-Sensitized Patients

BACKGROUND

Component-resolved diagnosis reveals the IgE response to many inhaled, food, and other allergens, improving the understanding and diagnosis of allergic diseases.

OBJECTIVE

The aims of the study are to study the recognition of different lipid transfer proteins (LTPs) and other allergen families in a large group of people sensitized to Pru p 3 and to analyze the relationship between the clinical entities and the allergens.

METHODS

This cross-sectional study included a large cohort of patients with positive skin tests to peach fruit and Pru p 3 specific IgE antibodies. Respiratory and food allergy symptoms were collected, and we performed prick tests with pollen, plant food, and other allergens plus the ImmunoCAP ISAC assay.

RESULTS

Our sample consisted of 421 people with a mean age of 33.25 years (range 16-68); 54.6% were women. Clinical entities included anaphylaxis (37.1%), urticaria (67.9%), and oral allergy syndrome (59.1%). Rhinitis, rhinoconjunctivitis, and/or asthma were diagnosed in 71.8% of the participants. The most pronounced correlation existed between sensitization to Pru p 3 and to Jug r 3, Pla a 3, Ara h 9, and Cor a 8. We found a higher incidence of anaphylaxis in people with 5 or more recognized LTPs. No association was observed between inhaled and food allergies.

CONCLUSION

Most Pru p 3-sensitized participants were sensitized to additional allergens from the same family and, to a lesser extent, to other allergens, mainly in the profilin and PR-10 protein families. Anaphylaxis occurred in more than a third of the cases evaluated, and almost three-quarters of them had respiratory symptoms. Respiratory and food allergies involving LTPs do not seem to be associated.

Molecular approach to a patient's tailored diagnosis of the oral allergy syndrome

Oral allergy syndrome (OAS) is one of the most common IgE-mediated allergic reactions. It is characterized by a number of symptoms induced by the exposure of the oral and pharyngeal mucosa to allergenic proteins belonging to class 1 or to class 2 food allergens. OAS occurring when patients sensitized to pollens are exposed to some fresh plant foods has been called pollen food allergy syndrome (PFAS). In the wake of PFAS, several different associations of allergenic sources have been progressively proposed and called syndromes. Molecular allergology has shown that these associations are based on IgE co-recognition taking place between homologous allergens present in different allergenic sources. In addition, the molecular approach reveals that some allergens involved in OAS are also responsible for systemic reactions, as in the case of some food Bet v 1-related proteins, lipid transfer proteins and gibberellin regulated proteins. Therefore, in the presence of a convincing history of OAS, it becomes crucial to perform a patient's tailored molecule-based diagnosis in order to identify the individual IgE sensitization profile. This information allows the prediction of possible cross-reactions with homologous molecules contained in other sources. In addition, it allows the assessment of the risk of developing more severe symptoms on the basis of the features of the allergenic proteins to which the patient is sensitized. In this context, we aimed to provide an overview of the features of relevant plant allergenic molecules and their involvement in the clinical onset of OAS. The value of a personalized molecule-based approach to OAS diagnosis is also analyzed and discussed.

Characteristics of pollen-related food allergy based on individual pollen allergy profiles in the Chinese population

Background

Patients with pollinosis are often multi-sensitized to diverse pollen allergens. However, little is known about pollen allergy types among Chinese pollinosis patients. This study is aimed to characterize clinical manifestations of food allergy among patients with different types of pollen allergy.

Methods

We retrospectively analyzed 402 pollinosis patients from an outpatient allergy department of the Peking Union Medical College Hospital who had been diagnosed by experienced allergists. All included patients who answered a questionnaire regarding seasonal pollinosis and clinical symptoms after ingestion of food and underwent intradermal skin tests. Total IgE and specific IgE levels were quantified by ImmunoCAP, using 0.35 kUA/L as a threshold for positivity.

Results

The patients were divided into 3 groups, based on the season during which they experienced symptoms and the 2 peaks of Chinese airborne pollen: spring-tree pollen symptoms group (SG), autumn-weed pollen symptoms group (AG), and a combined spring and autumn pollen symptoms group (CG). Birch pollen (83%) and ash pollen (74%) were common allergens among patients with spring symptoms, while mugwort pollen (87%) was a common allergen among patients with autumn symptoms. In total, 30% of the study population experienced pollen-related food allergy. Pollen-related food allergies were more prevalent among the single-season symptom groups (68% and 50% for the SG and AG, respectively) than among the CG (20%). All patients with pollen-related food-induced anaphylaxis exhibited autumn weed pollen symptoms. Except for 2 patients, all patients with food-induced anaphylaxis were allergic to mugwort pollen. In the SG, all patients with food allergy were sensitive to birch pollen, with birch and Bet v 1-specific IgE levels higher in this group than in the group without food allergy (p < 0.001). In the AG, Art v 3 was more prevalent among patients with pollen-related food allergy than without food allergy (79% vs. 33%, p < 0.001), a proportion similar to the one in the CG (67% vs. 48%, p = 0.01). Meanwhile, the Art v 3-specific IgE levels among patients with pollen-related food allergy were higher than among tolerant patients in the AG (p < 0.001) and CG (p = 0.02). Unexpectedly, the Art v 3-specific IgE levels were higher in patients with food-induced anaphylaxis than with oral allergy syndrome only in the CG.

Conclusions

Bet v 1 (a Pathogenesis-related 10 protein) and Art v 3 (a non-specific lipid transfer protein; nsLTP) are candidate molecular biomarkers for the diagnosis of food allergies in patients with season-specific pollen-related allergies. Measuring pollen allergen component-specific IgE levels might be an effective tool for the management of pollinosis in clinical practice in China.

Are the most common food allergens in an Iranian atopic population compatible with worldwide reports? A systemic review and meta-analysis with molecular classification of frequent allergens

BACKGROUND

Undesirable immunological responses to alimentary allergens are one of the hallmarks of atopic diseases. The prevalence of common food allergens is dissimilar among different communities with distinct nutritional habits and genetic characteristics.

AIM

To assess the prevalence of the most common food allergens in Iran, using different reliable studies.

METHODS

All studies determining sensitization to common food allergens that were indexed in PubMed, Web of Science, Google Scholar, ProQuest, Scopus, Iran Medex, and Magiran were included in this review. To perform a meta-analysis, STATA 14 and metaprop command was applied. A logistic-normal random-effects model with Freeman-Tukey double arcsin transformation was applied to combine the findings of different studies and evaluate their heterogeneity. Random pooled estimate (ES) (pooled prevalence), 95% confidence interval (95% CI) and p-value were determined.

RESULTS

A total of 23 studies with data from a total of 6126 children and adults met the inclusion criteria for entering this meta-analysis. The respective pooled prevalence of a positive family history of allergy and positive specific IgE to at least one food allergen was 72% (95% CI: 66-77%) and 41% (95% CI: 33-49%), respectively. Our results in the total population revealed that allergic sensitization to egg yolk, cow's milk (CM), egg white, and wheat were 25% (95% CI: 16%-35%), 24% (95% CI: 19-29%), 23% (95% CI: 18%-28%), and 9% (95% CI: 6%-14%), respectively. Walnut, peanut, and soybean sensitization was detected in 23% (95% CI: 17%-31%), 23% (95% CI: 13%-33%), and 20% (95% CI: 12%-28%) of patients, respectively. Random pooled ES for sensitization to shrimp and fish was 32% (95% CI: 21-45%) and 12% (95% CI: 6-20%), respectively. The result of analysis in different age groups revealed that allergic sensitization to milk, egg white, and egg yolk declines in higher age groups; while shrimp sensitization increases in older patients. In patients with atopic dermatitis, egg white was the most frequent food allergen 29% (95% CI = 18-42%); while wheat was the least frequent 8% (95% CI = 4-14%).

CONCLUSIONS

Considering the prevalence of different food allergens, the results of the current meta-analysis revealed that egg yolk and cow's milk had the second and third rate after shrimp, respectively. The high prevalence of sensitization to shrimp may be attributed to its high consumption in coastal areas and/or cross-reactivity of shrimp with some aeroallergens such as mites.

Clinical utility of basophil activation test in diagnosis and predicting severity of mugwort pollen-related peach allergy

Background

Cross-reactivity between pollen and plant foods results in low specificity of food-IgE and skin prick testing, which may cause over-diagnosis. A test that can accurately diagnose pollen-related food allergy and identify patients at risk of developing severe reactions is needed. This study evaluates basophil CD63 expression as a biomarker for diagnosis and predicting severity of mugwort pollen-related peach allergy.

Methods

Based on their allergic reactions to peach, an oral allergy symptom group (OAS, n ​= ​15), a systemic reaction group (SR, n ​= ​23), a peach-sensitized but tolerant group (PST, n ​= ​21) and a non-peach-sensitized nonallergic group (NSE, n ​= ​10) were identified among mugwort pollen allergic patients. Measurements of specific IgE to peach and its components, and basophil activation test (BAT) were performed.

Results

Upon stimulation with peach extract, BAT in peach-allergic patients (OAS and SR groups) showed a significant dose-dependent upregulation of CD63 compared with PST patients, but showed no difference between SR and OAS groups. BAT to Pru p 3 could discriminate not only between sensitization and clinical allergy, but also between OAS and systemic reactions. BAT to Pru p 3 revealed 92% sensitivity, 95% specificity, 92% positive predictive value, and 92% negative predictive value. Receiver operating characteristic curves showed that BAT to Pru p 3 had the largest area under the curve.

Conclusions

In the diagnosis of mugwort pollen-related peach allergy, BAT to Pru p 3 is superior to testing for IgE specific for peach and its components. Additionally, basophil activation can predict clinical severity.

POLLEN–FOOD ALLERGY SYNDROME AMONG CHILDREN WITH SENSITIZED TO SPRING TREES

It is known that among 40–70 % of patients pollinosis can run in conjunction with pollen-food allergy syndrome (PFS), while development of PFS is associated with the consumption of fresh fruits, vegetables, nuts and spices. Clinical course and severity of the disease depend on the sensitization profile, which can be represented by proteins-panallergens (PR-10, profilins, nsLTPs). However, there is little information about the sensitization profiles of patients with pollinosis caused by pollen of spring trees in Ukraine. Aim. To study the profiles of sensitization of children with spring pollinosis. Methods. We examined 61 children (aged 4-17 years) with spring seasonal allergic rhinitis/rhinoconjunctivitis (SAR). To establish the diagnosis, all children were given questionnaires, skin prick tests (SPTs) with commercial pollen extracts, and prick to prick tests with fresh fruits, vegetables and nuts. Component resolved diagnosis (CRD) were detected using an ImmunoCAP system. (Phadia, 100). Results. It has been found that in 43 children (70.5 %) had polinosis in combination with PFS, the main clinical manifestation of which was an oral allergic syndrome in 43 children (100 %). Among the causal food allergens that caused the manifestations of PFS were more apples, peaches, carrots and hazelnuts (consumption of which led to 11.6 % of children before the development of anaphylaxis). All of the examined children (100 %) had a positive IgE response to rBet v 1 at significant concentrations. In 9.3 % of children, panallergens were found at once from several botanical groups. Such panallergens: rBet v 2, rBet v 4, rPhl p 7, rPhl p 12, rArt v 3 are generally not defined in the control group children. Conclusions. Birch related PFS are common in Ukrainian pollen-allergic children with nuts and fruits predominantly implicated. Sensitization profile of children with Birch-pollen syndrome is complex and associated with sensitization to panalergens. Clinicians should be worried of PFS in patients with a high degree of sensitization to birch pollen and even young children if they have birch sensitization.