1
|
Ishii T, Miyoshi H, Kubo T, Tsutsumi YM, Horikawa YT, Tanaka H. Delayed Nonimmune Anaphylaxis Caused by Ropivacaine for Preoperative Nerve Blocks: A Case Report. A A Pract 2023; 17:e01727. [PMID: 37948548 DOI: 10.1213/xaa.0000000000001727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Ropivacaine is an amide local anesthetic with rare reports of anaphylaxis. To our knowledge, this is the first report of delayed nonimmune anaphylaxis induced by ropivacaine. A 70-year-old man underwent general anesthesia with a nerve block for a total knee arthroplasty. The patient developed symptoms of anaphylaxis 3.5 hours after receiving ropivacaine for femoral and tibial nerve blocks. A basophil activation test (BAT) revealed ropivacaine as the causative agent. Notably, anaphylaxis can be caused by medications even hours after their administration, and all administered drugs should be suspected of potentially causing anaphylaxis.
Collapse
Affiliation(s)
- Tomomi Ishii
- From the Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Hirotsugu Miyoshi
- From the Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Takashi Kubo
- Department of Anesthesiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Yasuo M Tsutsumi
- From the Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Yousuke T Horikawa
- Department of Pediatrics, Sharp Rees-Stealy Medical Group, San Diego, California
| | - Hiroyuki Tanaka
- Department of Anesthesiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| |
Collapse
|
2
|
Srisuwatchari W, Kanchanaphoomi K, Nawiboonwong J, Thongngarm T, Sompornrattanaphan M. Food-Dependent Exercise-Induced Anaphylaxis: A Distinct Form of Food Allergy-An Updated Review of Diagnostic Approaches and Treatments. Foods 2023; 12:3768. [PMID: 37893663 PMCID: PMC10606284 DOI: 10.3390/foods12203768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 09/30/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Food-dependent exercise-induced allergic reactions (FDEIA) represent a distinct clinical phenomenon where symptoms arise during exercise following the consumption of specific trigger foods, with the most severe manifestation being anaphylaxis-a condition distinct from typical exercise-induced or food-induced anaphylaxis. In FDEIA, patients can either exercise or tolerate specific foods separately without experiencing any allergic reactions. Diagnosis relies on patient history and provocation testing, requiring rigorous implementation within a supervised hospital environment. Positive symptoms and clinical signs during testing confirm FDEIA, while negative outcomes do not preclude its presence. Exercise stands as the primary trigger, followed by nonsteroidal anti-inflammatory drugs (NSAIDs) and alcohol. The utilization of various protocols for food cofactor challenges to confirm FDEIA yields differing diagnostic outcomes. We highlight the updated concept of food cofactor challenges, incorporating protocols reported in the literature, and summarize current recommendations and comprehensive management approaches for FDEIA patients.
Collapse
Affiliation(s)
- Witchaya Srisuwatchari
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (W.S.); (K.K.)
- Faculty of Medicine, Center of Research Excellence in Allergy and Immunology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (J.N.); (T.T.)
| | - Kantima Kanchanaphoomi
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (W.S.); (K.K.)
- Faculty of Medicine, Center of Research Excellence in Allergy and Immunology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (J.N.); (T.T.)
| | - Jutamard Nawiboonwong
- Faculty of Medicine, Center of Research Excellence in Allergy and Immunology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (J.N.); (T.T.)
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Torpong Thongngarm
- Faculty of Medicine, Center of Research Excellence in Allergy and Immunology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (J.N.); (T.T.)
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Mongkhon Sompornrattanaphan
- Faculty of Medicine, Center of Research Excellence in Allergy and Immunology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (J.N.); (T.T.)
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| |
Collapse
|
3
|
Ebisawa Y, Masumoto S, Okiyama N, Yoshimoto H, Maeno T. The Onset of Food-dependent Exercise-induced Anaphylaxis in an Elderly Patient. Intern Med 2023; 62:2907-2909. [PMID: 36725048 PMCID: PMC10602828 DOI: 10.2169/internalmedicine.0659-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/12/2022] [Indexed: 02/03/2023] Open
Abstract
The development of allergic diseases is common in the young but rare in the elderly. We encountered an elderly patient with food-dependent exercise-induced anaphylaxis (FDEIA). An 82-year-old man was rushed to the hospital for symptoms of anaphylaxis. Because the symptoms occurred after ingestion of wheat products and exercise, we made a diagnosis of FDEIA based on a high ω5-gliadin IgE level and a positive exercise test. Based on our review of the existing literature, this was the oldest patient to ever be diagnosed with FDEIA in Japan. This case suggests that physicians should keep in mind that older adults can develop FDEIA.
Collapse
Affiliation(s)
- Yuka Ebisawa
- Department of General Medicine and Primary Care, Faculty of Medicine, University of Tsukuba, Japan
| | - Shoichi Masumoto
- Department of General Medicine and Primary Care, Faculty of Medicine, University of Tsukuba, Japan
- Tsukuba Central Hospital, Japan
| | - Naoko Okiyama
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Japan
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Hisashi Yoshimoto
- Department of General Medicine and Primary Care, Faculty of Medicine, University of Tsukuba, Japan
- Kitaibaraki Center for Family Medicine, Japan
| | - Tetsuhiro Maeno
- Department of General Medicine and Primary Care, Faculty of Medicine, University of Tsukuba, Japan
| |
Collapse
|
4
|
Guo L, Chen H, Zhang Y, Yan S, Chen X, Gao X. Starch granules and their size distribution in wheat: Biosynthesis, physicochemical properties and their effect on flour-based food systems. Comput Struct Biotechnol J 2023; 21:4172-4186. [PMID: 37675285 PMCID: PMC10477758 DOI: 10.1016/j.csbj.2023.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023] Open
Abstract
Starch is a vital component of wheat grain and flour, characterized by two distinct granule types: A-type starch (AS) with granules larger than 10 µm in diameter, and B-type starch (BS) with granules measuring no more than 10 µm in diameter. This review comprehensively evaluates the isolation, purification, and biosynthesis processes of these types of granules. In addition, a comparative analysis of the structure and properties of AS and BS is presented, encompassing chemical composition, molecular, crystalline and morphological structures, gelatinization, pasting and digestive properties. The variation in size distribution of granules leads to differences in physicochemical properties of starch, influencing the formation of polymeric proteins, secondary and micro-structures of gluten, chemical and physical interactions between gluten and starch, and water absorption and water status in dough system. Thus, starch size distribution affects the quality of dough and final products. In this review, we summarize the up-to-date knowledge of AS and BS, and propose the possible strategies to enhance wheat yield and quality through coordinated breeding efforts. This review serves as a valuable reference for future advancements in wheat breeding.
Collapse
Affiliation(s)
- Lei Guo
- Shandong Academy of Agricultural Sciences / National Engineering Research Center of Wheat and Maize/ Key Laboratory of Wheat Biology and Genetic Improvement in North Yellow & Huai River Valley, Ministry of Agriculture / Shandong Provincial Technology Innovation Center for Wheat, Jinan, Shandong 250100, China
- State Key Laboratory of Crop Stress Biology in Arid Areas and College of Agronomy, Northwest A&F University, Yangling, Shaanxi 712100, China
| | - Heng Chen
- Shandong Academy of Agricultural Sciences / National Engineering Research Center of Wheat and Maize/ Key Laboratory of Wheat Biology and Genetic Improvement in North Yellow & Huai River Valley, Ministry of Agriculture / Shandong Provincial Technology Innovation Center for Wheat, Jinan, Shandong 250100, China
- State Key Laboratory of Crop Stress Biology in Arid Areas and College of Agronomy, Northwest A&F University, Yangling, Shaanxi 712100, China
| | - Yizhi Zhang
- State Key Laboratory of Crop Stress Biology in Arid Areas and College of Agronomy, Northwest A&F University, Yangling, Shaanxi 712100, China
| | - Shuai Yan
- Shandong Academy of Agricultural Sciences / National Engineering Research Center of Wheat and Maize/ Key Laboratory of Wheat Biology and Genetic Improvement in North Yellow & Huai River Valley, Ministry of Agriculture / Shandong Provincial Technology Innovation Center for Wheat, Jinan, Shandong 250100, China
- State Key Laboratory of Crop Stress Biology in Arid Areas and College of Agronomy, Northwest A&F University, Yangling, Shaanxi 712100, China
| | - Xueyan Chen
- Shandong Academy of Agricultural Sciences / National Engineering Research Center of Wheat and Maize/ Key Laboratory of Wheat Biology and Genetic Improvement in North Yellow & Huai River Valley, Ministry of Agriculture / Shandong Provincial Technology Innovation Center for Wheat, Jinan, Shandong 250100, China
| | - Xin Gao
- Shandong Academy of Agricultural Sciences / National Engineering Research Center of Wheat and Maize/ Key Laboratory of Wheat Biology and Genetic Improvement in North Yellow & Huai River Valley, Ministry of Agriculture / Shandong Provincial Technology Innovation Center for Wheat, Jinan, Shandong 250100, China
| |
Collapse
|
5
|
Yeğit OO, Aslan AF, Coşkun R, Karadağ P, Toprak İD, Can A, Öztop N, Demir S, Ünal D, Olgaç M, Gelincik A. Comparison of recent anaphylaxis diagnostic criteria in real life: Can more patients be diagnosed as having anaphylaxis? World Allergy Organ J 2023; 16:100810. [PMID: 37663085 PMCID: PMC10470287 DOI: 10.1016/j.waojou.2023.100810] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/26/2023] [Accepted: 08/11/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction In 2020, World Allergy Organization (WAO) updated their diagnostic criteria for anaphylaxis, which differed as a result from the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network (NIAID/FAAN) criteria which were still used in the 2021 update of the European Academy of Allergy and Clinical Immunology (EAACI) anaphylaxis guideline. Our aim was to evaluate and to compare both diagnostic criteria and attempt to identify factors affecting severity of anaphylaxis. Methods The medical records of the patients who were evaluated with suspected anaphylaxis at 3 medical centers in Türkiye between 2014 and 2021, and underwent a detailed diagnostic work-up, were analyzed retrospectively. Diagnosis of anaphylaxis was evaluated based on the WAO 2020 and EAACI 2021 and NIAID/FAAN diagnostic criteria. The severity of anaphylaxis was determined according to the WAO systemic allergic reaction grading system. Grade 5 anaphylaxis was defined as having respiratory failure, collapse/hypotension, loss of consciousness. Patients' demographic and clinical characteristics were further analyzed depending on the severity of the reaction. Results One thousand and six patients were evaluated and 232 patients without a convincing diagnosis of anaphylaxis were excluded from the study. The remaining 774 patients (70.6% female, median [Inter quartile range (IQR) 25-75] age: 42 [33-52]) were included for further examination. Anaphylaxis was diagnosed in 729 (94.2%) patients meeting both criteria whereas 35 patients (4.5%) with isolated laryngeal involvement and 10 (1.3%) patients with isolated respiratory involvement were only diagnosed according to the WAO 2020 criteria. Twenty-three patients (3.0%) had a diagnosis of indolent systemic mastocytosis. Mastocytosis was related to grade 5 anaphylaxis [p = 0.022, OR (CI) = 2.9 (1.1-7.6)]. Venom allergy was a risk factor for grade 5 anaphylaxis among those for whom an eliciting allergen could be determined [p = 0.03, OR (CI) = 2.7 (1.1-6.8)]. For drug induced anaphylaxis, parenteral route of drug administration and proton pump inhibitor (PPI) allergy were considered as risk factors for grade 5 anaphylaxis [p < 0.001, OR (CI) = 6.5 (2.5-17.0); p = 0.011, OR (CI) = 10.3 (1.6-63.3)]. Conclusion This multicenter study demonstrated that both criteria identified the majority of patients with anaphylaxis, but the WAO 2020 diagnostic criteria identified an additional 6%. Hymenoptera stings, PPI allergy, parenteral drug administration, and underlying mastocytosis were associated with more severe episodes.
Collapse
Affiliation(s)
- Osman Ozan Yeğit
- Department of Internal Medicine, Division of Immunology and Allergy, Istanbul University, Istanbul, Türkiye
| | - Ayşe Feyza Aslan
- Department of Internal Medicine, Division of Immunology and Allergy, Istanbul University, Istanbul, Türkiye
| | - Raif Coşkun
- Adult Immunology and Allergy Clinic, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Türkiye
| | - Pelin Karadağ
- Department of Internal Medicine, Division of Immunology and Allergy, Istanbul University, Istanbul, Türkiye
| | - İlkim Deniz Toprak
- Department of Internal Medicine, Division of Immunology and Allergy, Istanbul University, Istanbul, Türkiye
| | - Ali Can
- Department of Internal Medicine, Division of Immunology and Allergy, Istanbul University, Istanbul, Türkiye
| | - Nida Öztop
- Department of Internal Medicine, Division of Immunology and Allergy, Istanbul University, Istanbul, Türkiye
| | - Semra Demir
- Department of Internal Medicine, Division of Immunology and Allergy, Istanbul University, Istanbul, Türkiye
| | - Derya Ünal
- Department of Internal Medicine, Division of Immunology and Allergy, Istanbul University, Istanbul, Türkiye
| | - Müge Olgaç
- Adult Immunology and Allergy Clinic, Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Türkiye
| | - Aslı Gelincik
- Department of Internal Medicine, Division of Immunology and Allergy, Istanbul University, Istanbul, Türkiye
| |
Collapse
|
6
|
Tsurunaga Y, Arima S, Kumagai S, Morita E. Low Allergenicity in Processed Wheat Flour Products Using Tannins from Agri-Food Wastes. Foods 2023; 12:2722. [PMID: 37509814 PMCID: PMC10378952 DOI: 10.3390/foods12142722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/05/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
The present study aimed to investigate the effect of the addition of tannins from unutilized resources on wheat allergen reduction, antioxidant properties, and quality by substituting 3%, 5%, and 10% of the flour with chestnut inner skin (CIS) and young persimmon fruit (YPF) powders to produce cookies. The enzyme-linked immunosorbent assay and Western blotting showed significantly lower wheat allergen content in CIS- or YPF-substituted cookies than in control cookies, and this effect was pronounced for CIS-substituted cookies. In addition, the tannin content and antioxidant properties of the CIS- or YPF-substituted cookies were markedly higher than those of the control cookies. Quality analysis of the CIS- and YPF-substituted cookies showed that the specific volume and spread factor, which are quality indicators for cookies, were slightly lower in the CIS- and YPF-substituted cookies than in the control cookies. Compared to the control, CIS substitution did not affect the breaking stress and total energy values of the cookies; however, YPF substitution at 10% increased these values. Color was also affected by the addition of CIS and YPF. The results suggest that the addition of CIS and YPF can reduce wheat allergens in cookies and improve tannin content and antioxidant properties.
Collapse
Affiliation(s)
- Yoko Tsurunaga
- Faculty of Human Science, Shimane University, Shimane 690-8504, Japan
| | - Shiori Arima
- Faculty of Human Science, Shimane University, Shimane 690-8504, Japan
| | - Sae Kumagai
- Graduate School of Human and Social Sciences, Shimane University, Shimane 690-8504, Japan
| | - Eishin Morita
- Department of Dermatology, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan
| |
Collapse
|
7
|
Kulthanan K, Ungprasert P, Jirapongsananuruk O, Rujitharanawong C, Munprom K, Trakanwittayarak S, Pochanapan O, Panjapakkul W, Maurer M. Food-Dependent Exercise-Induced Wheals/Angioedema, Anaphylaxis, or Both: A Systematic Review of Phenotypes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1926-1933. [PMID: 36997120 DOI: 10.1016/j.jaip.2023.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Food-dependent exercise-induced allergic reactions can manifest with wheals, angioedema, and anaphylaxis, alone or in combination. OBJECTIVE To systematically review the clinical manifestation, culprit foods and exercise, augmenting factors, comorbidities, and treatment options of each phenotype. METHODS Using predefined search terms, we assessed and analyzed the relevant literature until June 2021. Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations were applied to this systematic review. RESULTS A total of 231 studies with 722 patients were included. The most common phenotype was anaphylaxis with wheals, angioedema, or both, reported in 80% of patients. This was associated with a higher number of anaphylactic episodes, augmenting factors, and use of on-demand antihistamine compared with the least common phenotype, anaphylaxis without wheals or angioedema, reported in 4% of patients. Anaphylaxis with wheals/angioedema was also associated with distinct characteristics compared with stand-alone wheals, angioedema, or both, in 17% of patients. Patients with anaphylaxis were older at the time of disease onset, less often had a history of atopy, showed more positive results in response to food and exercise provocation tests, had a more restricted spectrum of culprit foods, and more often used on-demand epinephrine. CONCLUSIONS The three phenotypes of allergic reactions to food and exercise differ in clinical characteristics, triggers, and response to treatment. Knowledge of these differences may help with patient education and counseling as well as disease management.
Collapse
Affiliation(s)
- Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patompong Ungprasert
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Orathai Jirapongsananuruk
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chuda Rujitharanawong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanyalak Munprom
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Oraya Pochanapan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Waratchaya Panjapakkul
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Marcus Maurer
- Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany.
| |
Collapse
|
8
|
Du Z, Li L, Liu J, Xu Y, Cui L, Yin J. Clinical profiles of patients with wheat-induced anaphylaxis at various ages of onset. World Allergy Organ J 2023; 16:100767. [PMID: 37128249 PMCID: PMC10148224 DOI: 10.1016/j.waojou.2023.100767] [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: 11/30/2022] [Revised: 03/16/2023] [Accepted: 03/27/2023] [Indexed: 05/03/2023] Open
Abstract
Background Wheat-induced anaphylaxis (WIA) is a serious and potentially life-threatening wheat allergy, more common in adults than in children. Little is known about the differences in clinical profiles in WIA among patients of various ages in China. Methods We analyzed data retrospectively from an allergy department in a tertiary hospital that included 248 patients (208 adults and 40 children and adolescents) with a history of WIA. Results We found that alcohol was more frequent in patients aged ≥50 years [older adults] (19.0%, 4/21) than in those aged 12-17 years [adolescents] (0%, 0/33; p = 0.019). The frequency of NSAID use in older adults (42.9%, 9/21) was significantly higher than that in adolescents (0%, 0/33; p < 0.001), and patients aged 18-49 years [young adults] (2.8%, 5/178; p < 0.001). During WIA, cardiovascular symptoms in children were less frequent than those in other age groups (children, 28.6%; adolescents, 87.9%; young adults, 93.0%; older adults, 95.2%; p < 0.001). The consciousness loss rate in adults (both age groups; p < 0.001) and the hypotension rate in older adults (p = 0.006) were higher than those in other age groups. Compared with adults (young and older adults), children had a higher rate of allergic comorbidities (p = 0.004, 0.001, respectively) and a higher rate of other food allergies (p < 0.001, <0.001, respectively). Compared with the mild-to-moderate anaphylaxis group, the severe anaphylaxis group had a higher onset age (p = 0.001), higher cofactor prevalence (p = 0.004), lower allergic comorbidity rate (p = 0.014), and higher positive rate of specific IgE to omega-5 gliadin (ω-5 gliadin) (p = 0.023). Conclusion Clinical profiles of patients with WIA are different among various onset age/severity groups. An improved understanding of WIA symptoms in various age/severity groups could help accelerate diagnosis, suggest preventive measures, and contribute to improved patient care.
Collapse
Affiliation(s)
- Zhirong Du
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, Beijing, 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, 100730, China
| | - Lun Li
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, Beijing, 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, 100730, China
| | - Juan Liu
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, Beijing, 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, 100730, China
| | - Yingyang Xu
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, Beijing, 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, 100730, China
| | - Le Cui
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, Beijing, 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, 100730, China
| | - Jia Yin
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, Beijing, 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, 100730, China
- Corresponding author. Department of Allergy, Peking Union Medical College Hospital, No. 1 Shuaifuyuan Street, Wangfujing, Beijing, 100730, China.
| |
Collapse
|
9
|
Morita E, Matsuo H, Kohno K, Yokooji T, Yano H, Endo T. A Narrative Mini Review on Current Status of Hypoallergenic Wheat Development for IgE-Mediated Wheat Allergy, Wheat-Dependent Exercise-Induced Anaphylaxis. Foods 2023; 12:foods12050954. [PMID: 36900471 PMCID: PMC10000922 DOI: 10.3390/foods12050954] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/08/2023] [Accepted: 02/16/2023] [Indexed: 02/26/2023] Open
Abstract
Immunoglobulin E (IgE)-mediated food allergies to wheat that develop after school age typically shows a type of wheat-dependent exercise-induced anaphylaxis (WDEIA). At present, avoidance of wheat products or postprandial rest after ingesting wheat is recommended for patients with WDEIA, depending on the severity of the allergy symptoms. ω5-Gliadin has been identified as the major allergen in WDEIA. In addition, α/β-, γ-, and ω1,2-gliadins, high and low molecular weight-glutenins, and a few water-soluble wheat proteins have been identified as IgE-binding allergens in a small proportion of patients with IgE-mediated wheat allergies. A variety of approaches have been manufactured to develop hypoallergenic wheat products that can be consumed by patients with IgE-mediated wheat allergies. In order to analyze such approaches, and to contribute to the further improvement, this study outlined the current status of these hypoallergenic wheat productions, including wheat lines with a reduced allergenicity that are mostly constructed for the patients sensitized to ω5-gliadin, hypoallergenic wheat by enzymic degradation/ion exchanger deamidation, and hypoallergenic wheat by thioredoxin treatment. The wheat products obtained by these approaches significantly reduced the reactivity of Serum IgE in wheat-allergic patients. However, either these were not effective on some populations of the patients, or low-level IgE-reactivity to some allergens of the products was observed in the patients. These results highlight some of the difficulties faced in creating hypoallergenic wheat products or hypoallergenic wheat lines through either traditional breeding or biotechnology approaches in developing hypoallergenic wheat completely safe for all the patients allergic to wheat.
Collapse
Affiliation(s)
- Eishin Morita
- Department of Dermatology, Shimane University Faculty of Medicine, Izumo 693-8501, Japan
- Correspondence: ; Tel.: +81-853-20-2210
| | - Hiroaki Matsuo
- Department of Pharmaceutical Services, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Kunie Kohno
- Department of Dermatology, Shimane University Faculty of Medicine, Izumo 693-8501, Japan
- Department of Clinical Trial Management, Clinical Research Center, Shimane University Hospital, Izumo 693-8501, Japan
| | - Tomoharu Yokooji
- Department of Frontier Science for Pharmacotherapy, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan
| | - Hiroyuki Yano
- National Food Research Institute, National Agriculture and Food Research Organization, Tsukuba 305-8642, Japan
| | | |
Collapse
|
10
|
Dutau G. Démembrement des anaphylaxies dépendantes de l’ingestion d’aliments et de l’exercice physique. REVUE FRANÇAISE D'ALLERGOLOGIE 2023. [DOI: 10.1016/j.reval.2023.103292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
|
11
|
Efficacy and safety of omalizumab in adult patients with wheat-dependent exercise-induced anaphylaxis: Reduction of in vitro basophil activation and allergic reaction to wheat. Allergol Int 2023:S1323-8930(22)00142-3. [PMID: 36641300 DOI: 10.1016/j.alit.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/17/2022] [Accepted: 11/30/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In patients with wheat-dependent exercise-induced anaphylaxis (WDEIA), anaphylactic shock occurs frequently, therefore avoidance of wheat products is recommended. We aimed to evaluate efficacy and safety of long-term omalizumab treatment for adult patients with WDEIA. METHODS In this phase 2, multicentre single-arm trial, 20 adult patients with WDEIA were enrolled (UMIN 000019250). All patients were administered 150-600 mg of omalizumab subcutaneously and evaluations (basophil activation and blood examination) were performed at regular intervals during administration period (0-48 weeks) and observation period (48-68 weeks). Primary endpoint was proportion of the patients who achieved a basophil activation rate below 10% with fractionated wheat preparations, and secondary endpoint was proportion of the patients with no allergic reactions after wheat products ingestion. RESULTS During the omalizumab treatment, more than 80% of the patients achieved the basophil activation rate less than 10% against all fractionated wheat preparations, and 68.8% of the patients who achieved the primary endpoint experienced no allergic reaction. During the observation period, the proportion of the patients who achieved a basophil activation rate below 10% decreased gradually, and the proportion of patients with positive allergic reactions increased gradually thereafter and reached maximum of 46.7%. Severe adverse events were not observed during the study. CONCLUSIONS Long-term omalizumab treatment is safe and effective for adult patients with WDEIA when assessed by basophil activation rate with wheat allergens as well as allergic reactions after lifting of restrictions on wheat intake. However, this is not enough to achieve desensitization.
Collapse
|
12
|
Sayed KM, Ali AH. IgE Mediated Wheat Allergy Associated with Resistant and Severe Forms of Allergic Conjunctivitis. Open Respir Med J 2022. [DOI: 10.2174/18743064-v16-e2208170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective:
This study aimed to determine the prevalence and criteria of wheat allergy (WA) among patients with resistant allergic conjunctivitis (AC).
Methods:
A prospective comparative study was conducted on 100 patients with resistant AC. Skin prick-tests (SPTs), total and sIgE against a panel of inhalant and food allergens were performed in all patients’ sera. They were divided into 2 groups according to skin prick test (SPT) and specific IgE (sIgE) level, namely the wheat sensitive group (WSG) and wheat tolerant group (WTG). Total ocular symptom scores (TOSS) and 4-point sign scales were correlated for both groups.
Results:
Ten patients out of 100 with IgE-mediated resistant AC were wheat sensitive, and the other 90 were wheat tolerant patients. WSG included patients of significantly younger age. Positive family history of atopy was proven in 100% of WSG vs. 67% of WTG. A significantly higher frequency of multiorgan allergy was detected in 100% of WSG vs. 20% in WTG (P = 0.0001). Thirty (30%) of WSG had associated allergic rhinitis (AR) and bronchial asthma (BA). Another 30% had an associated AR only, 10% had an associated BA only, and another 20% had an associated skin allergy. TOSS, 4- point sign scale, and total IgE level were significantly higher in WSG.
Conclusion:
This study provides novel evidence that wheat allergy is responsible for some severe forms of AC.
Collapse
|
13
|
Guo L, Wang Q, Chen H, Wu D, Dai C, Chen Y, Ma Y, Wang Z, Li H, Cao X, Gao X. Moderate addition of B-type starch granules improves the rheological properties of wheat dough. Food Res Int 2022; 160:111748. [DOI: 10.1016/j.foodres.2022.111748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/16/2022] [Accepted: 07/26/2022] [Indexed: 11/27/2022]
|
14
|
Kulthanan K, Ungprasert P, Jirapongsananuruk O, Rujitharanawong C, Munprom K, Trakanwittayarak S, Pochanapan O, Panjapakkul W, Maurer M. Food-Dependent Exercise-Induced Wheals, Angioedema, and Anaphylaxis: A Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2280-2296. [PMID: 35752432 DOI: 10.1016/j.jaip.2022.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/24/2022] [Accepted: 06/06/2022] [Indexed: 05/03/2023]
Abstract
BACKGROUND Food-dependent exercise-induced wheals, angioedema, and anaphylaxis remain insufficiently characterized. OBJECTIVE We systematically reviewed the literature on clinical manifestations, laboratory investigations, culprit foods, triggering exercise, comorbidities, and treatment outcomes. METHODS Using predefined search terms and Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) recommendations, we searched 3 electronic databases to identify relevant literature published before July 2021. RESULTS Of 722 patients (median age 25 years; 55.4% male) from 231 studies (43 cohort studies, 15 cases series, and 173 case reports), 79.6% and 3.7% had anaphylaxis with and without wheals and/or angioedema, respectively. The remaining 16.6% had wheals and/or angioedema without anaphylaxis. The duration from eating to exercising and from exercising to symptom onset ranged from 5 minutes to 6 hours (median 1 hour) and from 5 minutes to 5 hours (median 30 minutes), respectively, and virtually all patients exercised within 4 hours after eating and developed symptoms within 1 hour after exercising. Wheat was the most common culprit food. Running was the most common trigger exercise. Most patients were atopic, and 1 in 3 had a history of urticaria. Aspirin and wheat-based products were the most frequent augmenting factors. On-demand antihistamines, corticosteroids, and epinephrine were commonly used and reported to be effective. Patients who stopped eating culprit foods before exercise no longer developed food-dependent exercise-induced allergic reactions. CONCLUSIONS Food-dependent exercise-induced allergic reactions are heterogeneous in their clinical manifestations, triggers, and response to treatment. Patients benefit from avoidance of culprit foods before exercise, which highlights the need for allergological diagnostic workup and guidance.
Collapse
Affiliation(s)
- Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patompong Ungprasert
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Orathai Jirapongsananuruk
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chuda Rujitharanawong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanyalak Munprom
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Oraya Pochanapan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Waratchaya Panjapakkul
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Marcus Maurer
- Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany.
| |
Collapse
|
15
|
Ridolo E, Pucciarini F, Kihlgren P, Barone A, Nicoletta F, Peveri S, Montagni M, Incorvaia C. Lipid transfer protein syndrome: How to save a life through careful education. World Allergy Organ J 2022; 15:100683. [PMID: 36119658 PMCID: PMC9468585 DOI: 10.1016/j.waojou.2022.100683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/07/2022] [Accepted: 07/29/2022] [Indexed: 11/05/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Erminia Ridolo
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Allergology Unit, Hospital of Parma, Parma, Italy
| | | | - Paola Kihlgren
- Departmental Unit of Allergology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | | | - Silvia Peveri
- Departmental Unit of Allergology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Marcello Montagni
- Departmental Unit of Allergology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | |
Collapse
|
16
|
Du Z, Gao X, Li J, Li L, Liu J, Yin J. Clinical features and outcomes of patients with wheat-dependent exercise-induced anaphylaxis: a retrospective study. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2022; 18:61. [PMID: 35791000 PMCID: PMC9254488 DOI: 10.1186/s13223-022-00702-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022]
Abstract
Background Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a serious and potentially life-threatening form of wheat allergy. Further episodes can only be prevented by avoiding wheat ingestion or avoiding exercise after wheat intake. Anaphylaxis may recur in some patients post-diagnosis. This study aimed to analyze the clinical features and management/outcomes of WDEIA in China. Methods We retrospectively analyzed the clinical characteristics, and laboratory testing of 197 patients with WDEIA. After diagnosis, the patients were followed up as outpatients to evaluate dietary/exercise choice and clinical outcomes. Results Among the 197 WDEIA patients (median age, 37 years), 53.8% were male and 28.4% had other allergic disorders. The median duration of anaphylaxis before diagnosis was 16 months. Significant delays in diagnosis (> 1 years) were recorded in 52.7% of the patients, which has not decreased by years (P = 0.064). Exercise (83.8%), alcohol (12.2%), and nonsteroidal anti-inflammatory drugs (7.1%) were the most common cofactors. The most common clinical features were urticaria (100%), loss of consciousness (82.7%), dyspnea (50.8%), and hypotension (47.2%). Of the 197 eligible patients, 155 responded (78.7%), and 124 (80.0%) of which had no anaphylaxis post-diagnosis. A wheat-free diet prevented future anaphylaxis in 91.7% of the patients, followed by the avoidance of wheat combined with exercise (87%) and reduced wheat intake combined with exercise avoidance (80.5%). Conclusion The diagnosis of WDEIA is frequently delayed. Therefore, when patients present with unexplained anaphylaxis, the possibility of WDEIA should be considered. A wheat-free diet or avoiding wheat combined with exercise or reduced wheat combined with exercise avoidance helps to significantly reduce the onset of future anaphylaxis. However, approximately one-fifth of patients continue to experience anaphylaxis post-diagnosis. Thus, these patients must always carry epinephrine autoinjectors. Supplementary Information The online version contains supplementary material available at 10.1186/s13223-022-00702-1.
Collapse
Affiliation(s)
- Zhirong Du
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Street, Wangfujing, Beijing, 100730, China.,Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, Beijing, 100730, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, 100730, China
| | - Xiang Gao
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Street, Wangfujing, Beijing, 100730, China.,Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, Beijing, 100730, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, 100730, China
| | - Junda Li
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Street, Wangfujing, Beijing, 100730, China.,Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, Beijing, 100730, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, 100730, China
| | - Lun Li
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Street, Wangfujing, Beijing, 100730, China.,Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, Beijing, 100730, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, 100730, China
| | - Juan Liu
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Street, Wangfujing, Beijing, 100730, China.,Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, Beijing, 100730, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, 100730, China
| | - Jia Yin
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Street, Wangfujing, Beijing, 100730, China. .,Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, Beijing, 100730, China. .,National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, 100730, China.
| |
Collapse
|
17
|
Drugs and Vaccines Hypersensitivity in Children with Mastocytosis. J Clin Med 2022; 11:jcm11113153. [PMID: 35683540 PMCID: PMC9181546 DOI: 10.3390/jcm11113153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023] Open
Abstract
Mastocytosis, a heterogeneous mastcell disease, include three different entities: cutaneous mastocytosis, systemic mastocytosis (SM) and mast-cell sarcoma. Tryptase levels can differentiate cutaneous mastocytosis from SM. In mastocytosis, quick onset drug hypersensitivity reactions (DHRs) that are facilitated by mastcell mediators, are investigated in adults. Due to the limited number of children with mastcell disease and increased serum tryptase levels, the role of drugs in this age group is less studied. In this review, we critically assessed relevant papers related with immediate DHRs in children with mastocytosis and discuss practical issues of the management. In childhood mastocytosis, anaphylaxis is frequently idiopathic, and elevated level of basal tryptase, and high burden of disease may increase the risk. Among drugs, antibiotics, NSAIDs and opioids can potentially induce anaphylaxis, anyway avoidance should be recommended only in case of previous reactions. Moreover, vaccinations are not contraindicated in patients with mastocytosis. The risk of severe systemic reactions after drugs intake seems to be extremely low and in general lower in children than in adults. Anyway, studies on this topic especially focusing on children, are missing to state final recommendations.
Collapse
|
18
|
Identification of peroxidase-1 and beta-glucosidase as cross-reactive wheat allergens in grass pollen-related wheat allergy. Allergol Int 2021; 70:215-222. [PMID: 33616048 DOI: 10.1016/j.alit.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/08/2020] [Accepted: 09/13/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Some patients with wheat-dependent exercise-induced anaphylaxis (WDEIA) or wheat allergy showed negative ω-5 gliadin-specific IgE test and high level of grass pollen-specific IgE. It was presumed that these patients developed allergic reaction upon cross-reaction of their IgE antibodies raised against grass pollen allergens to wheat allergens. This study aimed to clarify clinical characteristics and wheat allergens of this phenotype of WDEIA/wheat allergy, which were tentatively diagnosed as grass pollen-related wheat allergy (GPWA). METHODS A total of six patients with GPWA were enrolled, and controls were 17 patients with grass pollen allergy but no episode of wheat allergy, and 29 patients with other wheat allergies: 18 with conventional WDEIA and 11 with hydrolyzed wheat protein allergy. Sensitization to wheat proteins was determined by basophil activation test (BAT). IgE-binding proteins in wheat flour were identified by immunoblotting followed by mass spectrometry. Wheat allergen-specific IgE tests were established by CAP-FEIA system. RESULTS All the six patients with GPWA were sensitized to water-soluble wheat proteins in BAT and IgE-immunoblotting, and peroxidase-1 (35 kDa) and beta-glucosidase (60 kDa) were identified as specific IgE-binding wheat proteins. The binding of patient IgE to these proteins was inhibited by pre-incubation of patient sera with grass pollen. The peroxidase-1- and beta-glucosidase-specific IgE tests identified three and four of six patients with GPWA, respectively, but only two of 29 controls, indicating high specificity of these tests. CONCLUSIONS Peroxidase-1 and beta-glucosidase are specific wheat allergens for GPWA among grass pollen allergy and other types of wheat-induced food allergies.
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW The prevalence of food allergy is increasing on a global scale, and therefore increased attention is being paid to specific food allergy epidemiology and management. There has been a large amount of progress made in the last decade on human trials of wheat oral immunotherapy (WOIT). RECENT FINDINGS To date, there has been one multicenter, double-blind, randomized controlled trial of WOIT, one randomized, noncontrolled trial of WOIT, and several smaller, nonrandomized clinical trials of WOIT. WOIT trials are generally limited by smaller sample sizes, affecting the demographic skew of evaluated patients. In addition, there is minimal standardization of efficacy and safety outcomes between trial protocols, making head-to-head comparison challenging. However, some common themes emerge. The majority of WOIT regimens result in successful desensitization, and success is more likely with higher maintenance dosing for longer periods of time. Limited studies have looked at sustained unresponsiveness in WOIT. WOIT can induce allergic reactions, including anaphylaxis, but more severe reactions often have an associated augmenting factor, such as exercise. Lower maintenance doses likely are associated with less severe reactions, and food modification and/or adjunct therapeutics may also decrease the risk of reactions. SUMMARY WOIT trials are ongoing and will optimize updosing protocols and maintenance doses to improve efficacy and safety.
Collapse
|
20
|
|
21
|
Akimoto S, Yokooji T, Ogino R, Chinuki Y, Taogoshi T, Adachi A, Morita E, Matsuo H. Identification of allergens for food-dependent exercise-induced anaphylaxis to shrimp. Sci Rep 2021; 11:5400. [PMID: 33686124 PMCID: PMC7940642 DOI: 10.1038/s41598-021-84752-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
Shrimp is a causative food that elicits food-dependent exercise-induced anaphylaxis (FDEIA). In this study, we sought to identify IgE-binding allergens in patients with shrimp-FDEIA. Sera were obtained from eight patients with shrimp-FDEIA and two healthy control subjects. Proteins were extracted from four shrimp species by homogenization in Tris buffer. Immunoblot analysis revealed that IgE from patient sera bound strongly to a 70-kDa and a 43-kDa protein in a preparation of Tris-soluble extracts from Litopenaeus vannamei. Mass spectrometry identified the 70-kDa and 43-kDa proteins as a P75 homologue and fructose 1,6-bisphosphate aldolase (FBPA), respectively. To confirm that the putative shrimp allergens were specifically recognized by serum IgE from shrimp-FDEIA patients, the two proteins were purified by ammonium sulfate precipitation followed by reversed-phase HPLC and/or anion-exchange hydrophobic interaction chromatography and then subjected to immunoblot analysis. Purified P75 homologue and FBPA were positively bound by serum IgE from one and three, respectively, of the eight patients with shrimp-FDEIA, but not by sera from control subjects. Thus, P75 homologue and FBPA are identified as IgE-binding allergens for shrimp-FDEIA. These findings could be useful for the development of diagnostic tools and desensitization therapy for shrimp-FDEIA patients.
Collapse
Affiliation(s)
- Shiori Akimoto
- Department of Pharmaceutical Services, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Tomoharu Yokooji
- Department of Pharmaceutical Services, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan. .,Department of Frontier Science for Pharmacotherapy, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Ryohei Ogino
- Department of Dermatology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Yuko Chinuki
- Department of Dermatology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Takanori Taogoshi
- Department of Pharmaceutical Services, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Atsuko Adachi
- Department of Dermatology, Hyogo Prefectural Kakogawa Medical Center, Kakogawa, Japan
| | - Eishin Morita
- Department of Dermatology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Hiroaki Matsuo
- Department of Pharmaceutical Services, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| |
Collapse
|
22
|
|
23
|
Ring J, Beyer K, Biedermann T, Bircher A, Fischer M, Fuchs T, Heller A, Hoffmann F, Huttegger I, Jakob T, Klimek L, Kopp MV, Kugler C, Lange L, Pfaar O, Rietschel E, Rueff F, Schnadt S, Seifert R, Stöcker B, Treudler R, Vogelberg C, Werfel T, Worm M, Sitter H, Brockow K. Guideline (S2k) on acute therapy and management of anaphylaxis: 2021 update: S2k-Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Medical Association of German Allergologists (AeDA), the Society of Pediatric Allergology and Environmental Medicine (GPA), the German Academy of Allergology and Environmental Medicine (DAAU), the German Professional Association of Pediatricians (BVKJ), the Society for Neonatology and Pediatric Intensive Care (GNPI), the German Society of Dermatology (DDG), the Austrian Society for Allergology and Immunology (ÖGAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Anaesthesiology and Intensive Care Medicine (DGAI), the German Society of Pharmacology (DGP), the German Respiratory Society (DGP), the patient organization German Allergy and Asthma Association (DAAB), the German Working Group of Anaphylaxis Training and Education (AGATE). ALLERGO JOURNAL INTERNATIONAL 2021; 30:1-25. [PMID: 33527068 PMCID: PMC7841027 DOI: 10.1007/s40629-020-00158-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Johannes Ring
- Department Dermatology and Allergology Biederstein, Technical University Munich, Biedersteiner Straße 29, 80802 Munich, Germany
| | - Kirsten Beyer
- Department of Pediatrics, Division of Pulmonology, Immunology and Critical Care Medicine, Charité—University Hospital Berlin, Berlin, Germany
| | - Tilo Biedermann
- Department Dermatology and Allergology Biederstein, Technical University Munich, Biedersteiner Straße 29, 80802 Munich, Germany
| | - Andreas Bircher
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
| | - Matthias Fischer
- Clinic for Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, ALB FILS Hospitals Göppingen, Göppingen, Germany
| | - Thomas Fuchs
- Department of Dermatology, University Hospital Göttingen, Göttingen, Germany
| | - Axel Heller
- Department of Anesthesiology and Operative Intensive Care Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Florian Hoffmann
- Dr. von Hauner Children’s Hospital, Ludwig Maximilians University, Munich, Germany
| | - Isidor Huttegger
- Department of Pediatrics, University Hospital Salzburg, Salzburg, Austria
| | - Thilo Jakob
- Department of Dermatology and Allergology, University Medical Center Gießen (UKGM), Justus-Liebig-University Gießen, Gießen, Germany
| | - Ludger Klimek
- Center of Rhinology and Allergology, Wiesbaden, Germany
| | - Matthias V. Kopp
- Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claudia Kugler
- Department Dermatology and Allergology Biederstein, Technical University Munich, Biedersteiner Straße 29, 80802 Munich, Germany
| | | | - Oliver Pfaar
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany
| | - Ernst Rietschel
- Department of Pediatrics, University Hospital Cologne, Cologne, Germany
| | - Franziska Rueff
- Department of Dermatology and Allergology, Hospital of the Ludwig Maximilians University, Munich, Germany
| | - Sabine Schnadt
- German Allergy and Asthma Association, Mönchengladbach, Germany
| | - Roland Seifert
- Institute of Pharmacology, Hannover Medical School, Hannover, Germany
| | - Britta Stöcker
- Medical practice for pediatrics and youth medicine, Poppelsdorfer Allee, Bonn, Germany
| | - Regina Treudler
- Department of Dermatology, Venereology, and Allergology, Leipzig Interdisciplinary Allergy Center, University Hospital Leipzig, Leipzig, Germany
| | - Christian Vogelberg
- Department of Pediatric Pneumology and Allergology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Thomas Werfel
- Immunodermatology and Experimental Allergology Unit, Department of Dermatology, Allergology, and Venereology, Medical University Hannover, Hannover, Germany
| | - Margitta Worm
- Department of Dermatology, Venereology, and Allergology, Charité—University Hospital Berlin, Berlin, Germany
| | - Helmut Sitter
- Institute for Surgical Research, Philipps-University Marburg, Marburg, Germany
| | - Knut Brockow
- Department Dermatology and Allergology Biederstein, Technical University Munich, Biedersteiner Straße 29, 80802 Munich, Germany
| |
Collapse
|
24
|
González-Santamaría J, Arámburo-Gálvez JG, Beltrán-Cárdenas CE, Mora-Melgem JA, Figueroa-Salcido OG, Ramírez-Torres GI, Cárdenas-Torres FI, Carvalho Gomes I, Geralda André T, Macêdo-Callou MA, Braga Rocha ÉM, Ontiveros N, Cabrera-Chávez F. Design, Assessment, and Validation of a Questionnaire to Estimate Food-Dependent Exercise-Induced Anaphylaxis Prevalence in Latin American Population. Healthcare (Basel) 2020; 8:healthcare8040519. [PMID: 33260469 PMCID: PMC7712264 DOI: 10.3390/healthcare8040519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 12/28/2022] Open
Abstract
There are no epidemiological data about food-dependent exercise-induced anaphylaxis (FDEIA) in Latin America. Our aim was to design, assess, and validate a questionnaire to identify potential FDEIA cases and/or estimate its prevalence by self-report. Questions were included in the instrument to address the main symptoms of FDEIA, type/intensity of physical activity, and anaphylaxis. The instrument’s clarity, comprehension and repeatability were evaluated. These evaluations were carried out by Hispanic people (Argentinians/Colombians/Mexicans/Peruvians), including nine individuals with medical diagnosis of FDEIA, and Brazilians. The Flesch–Kincaid score was calculated using the INFLESZ software. The instrument was translated from Spanish to Brazilian Portuguese following the translation back-translation procedure. The participants rated the two versions of the questionnaire as clear and comprehensible (three-point ordinal scale) and very easy to understand [0.33; average (scale 0–10)]. For these evaluations, the Kendall’s W coefficient showed strong agreement among raters (W = 0.80; average). The Flesch–Kincaid score was 63.5 in average (documents considered as readable). The Cohen’s Kappa coefficient showed almost perfect agreement in repeatability (0.88; average). The validation process of two versions of an instrument, used to identify potential FDEIA cases, was successfully carried out and it was found applicable to Latin American countries for generating epidemiological data.
Collapse
Affiliation(s)
- Jhonatan González-Santamaría
- Nutrition Sciences, Faculty of Nutrition Sciences, University of Sinaloa, Culiacán 80019, Sinaloa, Mexico
- Faculty of Health and Sports Sciences, University Foundation of the Andean Area, Pereira 66001, Risaralda, Colombia
| | | | | | - José Antonio Mora-Melgem
- Nutrition Sciences, Faculty of Nutrition Sciences, University of Sinaloa, Culiacán 80019, Sinaloa, Mexico
| | | | | | | | | | | | - María Auxiliadora Macêdo-Callou
- Department of Nutrition, University Center of Juazeiro do Norte, Juazeiro do Norte, Juazeiro do Norte 63010-215, Ceara, Brazil
| | - Élida Mara Braga Rocha
- Department of Nutrition, University Center of Juazeiro do Norte, Juazeiro do Norte, Juazeiro do Norte 63010-215, Ceara, Brazil
| | - Noé Ontiveros
- Clinical and Research Laboratory (LACIUS, URS), Department of Chemical, Biological, and Agricultural Sciences (DC-QB), Division of Sciences and Engineering, University of Sonora, Navojoa 85880, Sonora, Mexico
| | - Francisco Cabrera-Chávez
- Nutrition Sciences, Faculty of Nutrition Sciences, University of Sinaloa, Culiacán 80019, Sinaloa, Mexico
| |
Collapse
|
25
|
Gao X, Wen L, Li H, Wang R, Yin J. Genetic variation at the interleukin-18 locus is associated with wheat-dependent exercise-induced anaphylaxis in the Han Chinese population. Gene 2020; 737:144462. [DOI: 10.1016/j.gene.2020.144462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 02/05/2020] [Accepted: 02/07/2020] [Indexed: 01/08/2023]
|
26
|
Chinuki Y, Yagami A, Adachi A, Matsunaga K, Ugajin T, Yokozeki H, Hayashi M, Katayama I, Kohno K, Shiwaku K, Morita E. In vitro basophil activation is reduced by short-term omalizumab treatment in hydrolyzed wheat protein allergy. Allergol Int 2020; 69:284-286. [PMID: 31753713 DOI: 10.1016/j.alit.2019.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 09/15/2019] [Accepted: 09/16/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Yuko Chinuki
- Department of Dermatology, Shimane University Faculty of Medicine, Shimane, Japan.
| | - Akiko Yagami
- Department of Allergology, Fujita Health University School of Medicine, Aichi, Japan
| | - Atsuko Adachi
- Department of Dermatology, Hyogo Prefectural Kakogawa Medical Center, Hyogo, Japan
| | - Kayoko Matsunaga
- Department of Integrative Medical Science for Allergic Disease, Fujita Health University School of Medicine, Aichi, Japan
| | - Tsukasa Ugajin
- Department of Dermatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroo Yokozeki
- Department of Dermatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Misa Hayashi
- Department of Dermatology, Osaka General Medical Center, Osaka, Japan
| | - Ichiro Katayama
- Department of Pigmentation Research and Therapeutics, Osaka City University, Osaka, Japan
| | - Kunie Kohno
- Department of Dermatology, Shimane University Faculty of Medicine, Shimane, Japan; Center for Community-Based Health Research and Education (COHRE), Organization for Research and Academic Information, Shimane University, Shimane, Japan
| | | | - Eishin Morita
- Department of Dermatology, Shimane University Faculty of Medicine, Shimane, Japan
| |
Collapse
|
27
|
De Martinis M, Sirufo MM, Viscido A, Ginaldi L. Food Allergy Insights: A Changing Landscape. Arch Immunol Ther Exp (Warsz) 2020; 68:8. [PMID: 32239297 DOI: 10.1007/s00005-020-00574-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 02/27/2020] [Indexed: 12/15/2022]
Abstract
The panorama of food allergies (FA) has changed profoundly in recent years. In light of recent advances in knowledge of pathogenetic mechanisms and a greater attention to the multifaceted range of possible clinical manifestations, there is a need for a critical review of past classifications. Changes in nutrition, environment and lifestyles around the world are modifying the global FA epidemiology and new FA phenotypes are also emerging. Furthermore, both biotechnological advances in this field and recent personalized therapies have improved the diagnostic and therapeutic approach to FA. Consequently, both the prevention and clinical management of FA are rapidly changing and new therapeutic strategies are emerging, even revolutionizing the current medical practice. Given the significant increase in the prevalence of FA in recent years, the objective of this review is to provide an updated and complete overview of current knowledge in its etiopathogenesis, diagnostics and therapy, useful not only for a better understanding of this frequent and complex pathology but also for practical guidance in its clinical management.
Collapse
Affiliation(s)
- Massimo De Martinis
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy. .,Allergy and Clinical Immunology Unit, AUSL 04, Teramo, Italy.
| | - Maria Maddalena Sirufo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Allergy and Clinical Immunology Unit, AUSL 04, Teramo, Italy
| | - Angelo Viscido
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Lia Ginaldi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Allergy and Clinical Immunology Unit, AUSL 04, Teramo, Italy
| |
Collapse
|
28
|
Marín-Sanz M, Giménez MJ, Barro F, Savin R. Prolamin Content and Grain Weight in RNAi Silenced Wheat Lines Under Different Conditions of Temperature and Nitrogen Availability. FRONTIERS IN PLANT SCIENCE 2020; 11:314. [PMID: 32265965 PMCID: PMC7100604 DOI: 10.3389/fpls.2020.00314] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/03/2020] [Indexed: 05/14/2023]
Abstract
Temperature and nitrogen (N) availability are two important environmental factors that may produce important changes in grain composition during grain filling of bread wheat. In this study, four wheat lines with the down-regulation of gliadins by means of RNA interference (RNAi) have been characterized to determine the effect of thermal stress and N availability on grain weight and quality; with focus on gliadin and glutenin protein fractions. Grain weight was reduced with heat stress (HS) in all RNAi lines, whereas gliadin content was increased in the wild-types. With respect to gliadin content, RNAi lines responded to HS and N availability differently from their respective wild-types, except for ω-gliadin content, indicating a very clear stability of silencing under different environmental conditions. In a context of increased temperature and HS events, and in environments with different N availability, the RNAi lines with down-regulated gliadins seem well suited for the production of wheat grain with low gliadin content.
Collapse
Affiliation(s)
- Miriam Marín-Sanz
- Department of Plant Breeding, Institute for Sustainable Agriculture (IAS-CSIC), Córdoba, Spain
| | - María J. Giménez
- Department of Plant Breeding, Institute for Sustainable Agriculture (IAS-CSIC), Córdoba, Spain
| | - Francisco Barro
- Department of Plant Breeding, Institute for Sustainable Agriculture (IAS-CSIC), Córdoba, Spain
| | - Roxana Savin
- Department of Crop and Forest Sciences, University of Lleida, Lleida, Spain
| |
Collapse
|
29
|
Li PH, Thomas I, Wong JCY, Rutkowski K, Lau CS. Differences in omega-5-gliadin allergy: East versus West. Asia Pac Allergy 2020; 10:e5. [PMID: 32099827 PMCID: PMC7016325 DOI: 10.5415/apallergy.2020.10.e5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/23/2020] [Indexed: 11/19/2022] Open
Abstract
Background Omega-5-gliadin (O5G) allergy, also known as wheat-dependent exercise-induced anaphylaxis, is commonly reported in the Western, but not Asian, populations. Although significant differences in O5G allergy presentation across different populations are likely but there have been no previous reports on this important topic. Objective To report on the prevalence and characteristics of O5G allergy in Hong Kong (HK) compared with the United Kingdom (UK). Methods O5G allergy patients attending Queen Mary Hospital (HK cohort), and Guy's and St Thomas' Hospital, London (UK cohort) were studied and compared. Results A total of 46 O5G allergy patients (16 HK; 30 UK) were studied. In the HK cohort, 55% of all patients previously labeled as “idiopathic anaphylaxis” were diagnosed with O5G allergy. Exercise was the most common cofactor in both cohorts, followed by alcohol and nonsteroidal anti-inflammatory drugs (NSAID). A higher proportion of the HK cohort reported NSAID as a cofactor (13% vs. 0%, p = 0.048). In the HK cohort, more patients presented with urticaria and cardiovascular manifestations (100% vs. 77%, p = 0.036; 100% vs. 70%, p = 0.015, respectively); the range of presentation was more diverse in the UK cohort. In HK fewer patients adhered to wheat avoidance (50% vs. 87%, p = 0.007) and more patients avoided cofactors only (44% vs. 10%, p = 0.008). Conclusion O5G allergy appears relatively underdiagnosed in HK. Urticaria and cardiovascular manifestations are common; NSAID plays an important role as a cofactor and patients are less concordant with dietary avoidance measures than in the Western population.
Collapse
Affiliation(s)
- Philip Hei Li
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Iason Thomas
- Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jane Chi-Yan Wong
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Krzysztof Rutkowski
- Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Chak-Sing Lau
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| |
Collapse
|
30
|
Hossny E, Ebisawa M, El-Gamal Y, Arasi S, Dahdah L, El-Owaidy R, Galvan CA, Lee BW, Levin M, Martinez S, Pawankar R, Tang MLK, Tham EH, Fiocchi A. Challenges of managing food allergy in the developing world. World Allergy Organ J 2019; 12:100089. [PMID: 31871534 PMCID: PMC6909084 DOI: 10.1016/j.waojou.2019.100089] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/30/2019] [Accepted: 10/30/2019] [Indexed: 02/07/2023] Open
Abstract
Food allergy (FA) is currently a significant health care problem in the developing world. Widely varying study populations and methodologies, the use of surrogate markers such as self report or hospitalization rates due to anaphylaxis rather than objective methods, limits robust estimation of FA prevalence in low income settings. Also, allergy is under-recognized as a clinical specialty in the developing world which compromises the chance for accurate diagnosis. In this review, most published data on food allergens from developing or low income countries are displayed. The diagnostic challenges and limitations of treatment options are discussed. It seems that FA is an under-appreciated health care issue in the developing world, and accurate determination of its burden in low-income settings represents an important unmet need. Multicenter surveillance studies, using standardized methodologies, are, therefore, needed to reveal the true extent of the problem and provide epidemiological clues for prevention. Preventive strategies should be tailored to fit local circumstances in different geographic regions. In addition, studying the gene environment interactions and impact of early life microbiota on the expression of FA in developing communities would be worthwhile. Efforts and resources should be directed toward public health education and training of health care providers dealing with food allergic patients.
Collapse
Affiliation(s)
- Elham Hossny
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
| | - Yehia El-Gamal
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | | | - Lamia Dahdah
- Pediatric Hospital Bambino Gesù, Vatican City, Italy
| | - Rasha El-Owaidy
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Cesar A Galvan
- Centro Nacional de Referencia de Alergia Asma e Inmunología (CERNAAI), Instituto Nacional de Salud del Niño, Lima-Perú, Peru
| | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Michael Levin
- Division Paediatric Allergology, University of Cape Town, Red Cross Children's Hospital, Cape Town, South Africa
| | - Santiago Martinez
- Arnold Palmer Hospital for Children, Florida State University College of Medicine, Florida, United States
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Mimi L K Tang
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, Australia.,Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Victoria, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Victoria, Melbourne, Australia
| | - Elizabeth H Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | |
Collapse
|
31
|
Yamada Y, Yokooji T, Ninomiya N, Taogoshi T, Morita E, Matsuo H. Evaluation of the allergenicity of ω5-gliadin-deficient Hokushin wheat (1BS-18) in a wheat allergy rat model. Biochem Biophys Rep 2019; 20:100702. [PMID: 31720438 PMCID: PMC6838741 DOI: 10.1016/j.bbrep.2019.100702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 11/02/2022] Open
Abstract
We previously developed Hokushin wheat line as a hypoallergenic wheat lacking ω5-gliadin (1BS-18), a major allergen for wheat-dependent exercise-induced anaphylaxis. However, the allergenicity of 1BS-18 has not been understood completely. In this study, we evaluated the allergenicity of 1BS-18 such as anaphylactic elicitation ability and sensitization ability using rats sensitized with ω5-gliadin or glutens prepared from Hokushin (Hokushin gluten) or 1BS-18 (1BS-18 gluten). Rats were sensitized by intraperitoneal administration of ω5-gliadin, Hokushin gluten or 1BS-18 gluten. Immunoglobulin E-mediated systemic anaphylaxis was evaluated by measuring changes in rectal temperature for 30 min after intravenous challenge with ω5-gliadin or the test glutens in unsensitized rats or rats sensitized with ω5-gliadin or the test glutens. In ω5-gliadin-sensitized rats, intravenous challenge with ω5-gliadin or Hokushin gluten significantly decreased the rectal temperature at 30 min after challenge while challenge with 1BS-18 gluten did not reduce the rectal temperature. Furthermore, intravenous challenge with ω5-gliadin significantly decreased the rectal temperature in rats sensitized with Hokushin gluten or 1BS-18 gluten. However, the reduced degree observed in 1BS-18 gluten-sensitized rats was smaller than that in Hokushin gluten-sensitized rats. In conclusion, 1BS-18 elicited no allergic reaction in ω5-gliadin-sensitized rats and had less sensitization ability for ω5-gliadin than that of Hokushin wheat.
Collapse
Key Words
- 1BS-18, hypoallergenic wheat lacking ω5-gliadin
- Ab, antibody
- Allergenicity
- BN, Brown-Norway
- ELISA, enzyme linked immunosorbent assay
- HRP, horseradish peroxidase
- Hypoallergenic wheat
- Ig, immunoglobulin
- OVA, ovalbumin
- PBS, phosphate-buffered saline
- PBS-T, phosphate-buffered saline contining 0.1% Tween 20
- QOL, quality of life
- Rat
- WDEIA, wheat-dependent exercise-induced anaphylaxis
- Wheat allergy
- ω5-Gliadin
Collapse
Affiliation(s)
- Yukinori Yamada
- Department of Pharmaceutical Services, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Tomoharu Yokooji
- Department of Pharmaceutical Services, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Naoki Ninomiya
- Department of Pharmaceutical Services, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Takanori Taogoshi
- Department of Pharmaceutical Services, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Eishin Morita
- Department of Dermatology, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo, 693-8501, Japan
| | - Hiroaki Matsuo
- Department of Pharmaceutical Services, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| |
Collapse
|
32
|
Christensen MJ, Eller E, Mortz CG, Brockow K, Bindslev-Jensen C. Exercise Lowers Threshold and Increases Severity, but Wheat-Dependent, Exercise-Induced Anaphylaxis Can Be Elicited at Rest. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019. [PMID: 29524997 DOI: 10.1016/j.jaip.2017.12.023] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Wheat-dependent, exercise-induced anaphylaxis (WDEIA) is a severe form of allergy in which exercise is being considered as mandatory. The diagnosis is often complex and the clinical reproducibility low. OBJECTIVE The aims of this study were to establish a standardized challenge method for the diagnosis of WDEIA and to investigate whether exercise is an essential trigger factor or alternatively an augmentation factor able to lower threshold and increase severity. METHODS We investigated 71 patients (age, 18.6-73.7 years) with a case history of WDEIA. Skin prick test (SPT) and measurement of specific IgE (sIgE) were followed by an oral food challenge with gluten at rest and in combination with treadmill exercise. RESULTS A clinical reaction was elicited in 47 of 71 (66%), and in 26 of these (37%) the reaction could be elicited at rest. The median dose required at rest was 48 g (8-80 g) and in combination with exercise 24 g (4-80 g). Severity was significantly higher with exercise (2.3) than at rest (1.1) using Sampson severity score. In the challenge, SPT was positive to wheat in 93.6% (44 of 47) and to gluten in 95.7% (45 of 47). sIgE to wheat, gliadin, and omega-5 gliadin was present in 78.7% (37 of 47), 76.5% (36 of 47), and 91.4% (43 of 47) of the patients. Receiver operating characteristic-curve analysis for sIgE to omega-5 gliadin, a component of the gluten fraction and the major allergen in WDEIA, showed best sensitivity (91%) and specificity (92%) when gluten was combined with exercise. CONCLUSIONS A challenge test with gluten at rest and combined exercise is a safe confirmatory test for WDEIA. A reaction can be elicited at rest (without exercise), but exercise is able to lower the threshold and increase the severity.
Collapse
Affiliation(s)
- Morten J Christensen
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis, Odense University Hospital, Odense C, Denmark.
| | - Esben Eller
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis, Odense University Hospital, Odense C, Denmark
| | - Charlotte G Mortz
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis, Odense University Hospital, Odense C, Denmark
| | - Knut Brockow
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis, Odense University Hospital, Odense C, Denmark; Department of Dermatology and Allergy Biederstein, Technische Universität München, Munich, Germany
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis, Odense University Hospital, Odense C, Denmark
| |
Collapse
|
33
|
Calamelli E, Liotti L, Beghetti I, Piccinno V, Serra L, Bottau P. Component-Resolved Diagnosis in Food Allergies. ACTA ACUST UNITED AC 2019; 55:medicina55080498. [PMID: 31426616 PMCID: PMC6723663 DOI: 10.3390/medicina55080498] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/31/2019] [Accepted: 08/15/2019] [Indexed: 12/18/2022]
Abstract
Component-resolved diagnostics (CRD) in food allergies is an approach utilized to characterize the molecular components of each allergen involved in a specific IgE (sIgE)-mediated response. In the clinical practice, CRD can improve diagnostic accuracy and assist the physician in many aspects of the allergy work-up. CRD allows for discriminatory co-sensitization versus cross-sensitization phenomena and can be useful to stratify the clinical risk associated with a specific sensitization pattern, in addition to the oral food challenge (OFC). Despite this, there are still some unmet needs, such as the risk of over-prescribing unnecessary elimination diets and adrenaline auto-injectors. Moreover, up until now, none of the identified sIgE cutoff have shown a specificity and sensitivity profile as accurate as the OFC, which is the gold standard in diagnosing food allergies. In light of this, the aim of this review is to summarize the most relevant concepts in the field of CRD in food allergy and to provide a practical approach useful in clinical practice.
Collapse
Affiliation(s)
| | - Lucia Liotti
- Pediatric Unit, Civic Hospital, 60019 Senigallia, Italy
| | - Isadora Beghetti
- Pediatric Unit, Department of Medical and Surgical Sciences (DIMEC), S.Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy
| | | | - Laura Serra
- Pediatric and Neonatology Unit, Imola Hospital, 40026 Imola, Italy
| | - Paolo Bottau
- Pediatric and Neonatology Unit, Imola Hospital, 40026 Imola, Italy
| |
Collapse
|
34
|
Zhu YQ, Wang DQ, Liu B, Hu Y, Shen YY, Xu JH, Tang H. Wheat-dependent exercise-induced anaphylaxis in Chinese people: a clinical research on 33 cases with antigenic analysis of wheat proteins. Clin Exp Dermatol 2019; 45:56-62. [PMID: 31267575 DOI: 10.1111/ced.14035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a severe allergic condition in which wheat ingestion together followed by physical exercise induces anaphylaxis. For patients with WDEIA, omega-5 gliadin is considered to be one of the major allergens. AIM To analyse the clinical features and allergen spectrum of WDEIA and to investigate the relationship between WDEIA and serum levels of platelet-activating factor (PAF), interleukin (IL)-9 and IL-33. METHODS Medical histories and conditions of WDEIA cases were collected and summarized, with allergen tests of wheat proteins measured at the same visit. Of the 33 patients enrolled, 13 also had serum levels of PAF, IL-9 and IL-33 measured. The healthy control (HC) group consisted of 13 healthy individuals, who also underwent both the wheat-protein allergen tests and the inflammatory-mediator tests. RESULTS All patients experienced severe allergic reaction during exercise after wheat ingestion. Manifestations of WDEIA included facial oedema, generalized urticaria and respiratory symptoms. Unconsciousness was also observed in 21 cases. In the patient group, 57.6% were confirmed as hypersensitive to glyceraldehyde-3-phosphate dehydrogenase (GAPDH), while 54.5% were allergic to omega-5 gliadin. PAF concentration was significantly higher in patients with WDEIA compared with HCs, whereas there was no significant difference in IL-9 or IL-33 between the two groups. CONCLUSIONS WDEIA is a rare type of anaphylaxis. GAPDH and omega-5 gliadin may be the most common allergy-causing wheat proteins for Chinese people. PAF may be associated with the onset and development of WDEIA.
Collapse
Affiliation(s)
- Y-Q Zhu
- Department of Dermatology, Huashan Hospital affiliated to Fudan University, No. 12, Wulumuqi Zhong Rd, Shanghai, 200040, China
| | - D-Q Wang
- Department of Dermatology, Huashan Hospital affiliated to Fudan University, No. 12, Wulumuqi Zhong Rd, Shanghai, 200040, China
| | - B Liu
- Department of Dermatology, The Fifth People's Hospital of Shanghai affiliated to Fudan University, No. 128, Ruili Rd, Shanghai, 200040, China
| | - Y Hu
- Department of Dermatology, Huashan Hospital affiliated to Fudan University, No. 12, Wulumuqi Zhong Rd, Shanghai, 200040, China
| | - Y-Y Shen
- Department of Dermatology, Huashan Hospital affiliated to Fudan University, No. 12, Wulumuqi Zhong Rd, Shanghai, 200040, China
| | - J-H Xu
- Department of Dermatology, Huashan Hospital affiliated to Fudan University, No. 12, Wulumuqi Zhong Rd, Shanghai, 200040, China
| | - H Tang
- Department of Dermatology, Huashan Hospital affiliated to Fudan University, No. 12, Wulumuqi Zhong Rd, Shanghai, 200040, China
| |
Collapse
|
35
|
Benito-Garcia F, Ansotegui IJ, Morais-Almeida M. Diagnosis and prevention of food-dependent exercise-induced anaphylaxis. Expert Rev Clin Immunol 2019; 15:849-856. [PMID: 31305164 DOI: 10.1080/1744666x.2019.1642747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Introduction: Food-dependent, exercise-induced anaphylaxis (FDEIA) is a rare type of anaphylaxis with a growing incidence. Although the precise mechanism by which the patient reacts only in a combination of a culprit food and cofactors are not currently understood, many advances in diagnosis and management have been made since their first description. Areas covered: A literature search in PubMed was performed to review the diagnosis and management of FDEIA. Clinicians should have a high level of suspicion for identification of the culprit foods and the cofactors involved. Component-resolved diagnosis and more accurate provocation tests have revolutionized the diagnosis accuracy. Management is not easy and involves educating the patient to evict the combination of exposure to the culprit foods and the cofactors that elicit anaphylaxis, and how to act and treat if a reaction occurs. Expert opinion: FDEIA is currently misdiagnosed and the authors believe that there are many FDEIA patients labelled as idiopathic anaphylaxis with unnecessary evictions and with a poor quality of life because of the fear of an imminent reaction. Due to recent advances in diagnostic tools and the use of monoclonal antibodies for prophylaxis in persistent cases, FDEIA can have a better prognosis improving the quality of life of the patients and their families.
Collapse
|
36
|
Yokooji T, Fukushima T, Hamura K, Ninomiya N, Ohashi R, Taogoshi T, Matsuo H. Intestinal absorption of the wheat allergen gliadin in rats. Allergol Int 2019; 68:247-253. [PMID: 30559050 DOI: 10.1016/j.alit.2018.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/03/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Aspirin enhances food allergy symptoms by increasing absorption of ingested allergens. The objective of this study is to elucidate the role of aspirin in facilitating intestinal absorption of the wheat allergen, gliadin, in rats. METHODS Plasma concentrations of gliadin were determined after oral administration by gavage or administration into a closed intestinal loop in rats. We used an in situ intestinal re-circulating perfusion experiment to examine the effect of pepsin on aspirin-facilitated gliadin absorption. Fluorescein isothiocyanate (FITC)-labeled dextran-40 (FD-40) was used as a marker of non-specific absorption. The molecular size of gliadin and its allergenicity in plasma were examined using immunoblot analysis and intradermal reaction tests with Evans blue dye (EBD) extravasation, respectively. RESULTS Aspirin increased plasma concentrations of gliadin after oral administration but had no effect in the closed intestinal loop study. An in situ intestinal re-circulating perfusion study showed that FITC-labeled gliadin was absorbed similarly to FD-40. Aspirin increased absorption of both intact and pepsin-digested gliadin, with a more significant effect on absorption of pepsin-treated gliadin. Immunoblotting showed that most gliadin was absorbed in intact form. When the gliadin fraction was extracted from rat plasma after gavage and injected intradermally into gliadin-sensitized rats, EBD extravasation was observed at injection sites in a gliadin dose-dependent manner. CONCLUSIONS Aspirin increased the absorption of intact and pepsin-digested gliadin via the paracellular pathway, maintaining their allergenicity. Moreover, the effect of aspirin on gliadin absorption was enhanced by modification and digestion of gliadin in the stomach.
Collapse
|
37
|
Wheat allergy in patients with recurrent urticaria. World Allergy Organ J 2019; 12:100013. [PMID: 30937139 PMCID: PMC6439404 DOI: 10.1016/j.waojou.2019.100013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/03/2018] [Accepted: 01/08/2019] [Indexed: 12/03/2022] Open
Abstract
Background Clinical observation revealed that most of wheat-induced anaphylaxis (WIA)/wheat-dependent exercise-induced anaphylaxis (WDEIA) patients showed a history of recurrent urticaria. We aim to determine the association between recurrent urticaria and anaphylaxis in wheat allergy. Methods Population-based cohort study involved patients with WIA (n = 193, including WDEIA n = 104), recurrent urticaria (n = 177), non-wheat-related anaphylaxis (n = 584), atopic disease (excluding anaphylaxis, n = 221) and healthy control (n = 95) from 2009 to 2016. Detailed course of urticaria and anaphylaxis were obtained from medical records and following-up questionnaire. Serum IgE specific to wheat, gluten and ω-5 gliadin and skin prick test to wheat were examined. Clinical and laboratory data were statistically analyzed. Results In recurrent urticaria patients, wheat allergy was not rare, and 6.8% (n = 12) was diagnosed as wheat-induced urticaria. Patients with WIA/WDEIA had higher prevalence of recurrent urticaria history than those with non-wheat-related anaphylaxis (164/193, 84.9% vs 85/584, 14.5%), and 70.4% of them (136/193) had recurrent urticaria prior to their first anaphylactic attack. Among patients with WIA/WDEIA and previous urticaria, 46.3% experienced an exacerbation of urticaria. The value of serum specific IgE to ω-5 gliadin was significantly higher in patients with WIA/WDEIA than those with wheat-induced urticaria. Conclusions We recommend screening wheat allergy in recurrent urticaria to identify patients who have a potential risk to develop severe reactions earlier.
Collapse
|
38
|
Farrell A, Judge C, Redenbaugh V, Awad H, Conlon N. Food-dependent exercise-induced reactions: lessons from a 15-year retrospective study. Ir J Med Sci 2019; 188:815-819. [PMID: 30661174 DOI: 10.1007/s11845-019-01965-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Food-dependent exercise-induced anaphylaxis (FDEIA) is a life-threatening disorder in which the signs and symptoms of anaphylaxis occur if physical exertion occurs within a few hours of exposure to a food. AIMS The aim of this study was to characterise patients diagnosed with FDEIA and related disorders. METHODS A retrospective review of electronic clinical data from 2001 to 2016 was carried out. Fifty-seven cases were identified and analysed to establish clinical features, triggering factors and sensitisation patterns. RESULTS The number of patients per annum diagnosed with FDEIA or related reactions increased from 1 in 2001 to 18 patients in 2016. Sixty-nine percent reported systemic symptoms consistent with anaphylaxis, and 31% had skin manifestations only. In 33% of cases, the level of triggering exercise was mild. Forty-four percent of patients were sensitised to the omega-5-gliadin fraction of wheat. CONCLUSIONS FDEIA is an increasingly recognised serious allergic disease. The clinical diagnosis is supported by targeted sensitisation testing and molecular-based allergy diagnostics. These tools allow implementation of effective dietary and lifestyle modifications that mitigate against future serious reactions. Given the limited access to physicians with specialist allergy training in Ireland, increased awareness of this condition amongst sports medicine specialists and general physicians is required.
Collapse
Affiliation(s)
- Aisling Farrell
- Department of Immunology, St. James's Hospital, Dublin, Ireland.
| | - Ciaran Judge
- Department of Immunology, St. James's Hospital, Dublin, Ireland
| | | | - Hanna Awad
- Department of Immunology, St. James's Hospital, Dublin, Ireland
| | - Niall Conlon
- Department of Immunology, St. James's Hospital, Dublin, Ireland
- Department of Immunology, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
39
|
Christensen MJ, Eller E, Kjaer HF, Broesby-Olsen S, Mortz CG, Bindslev-Jensen C. Exercise-induced anaphylaxis: causes, consequences, and management recommendations. Expert Rev Clin Immunol 2019; 15:265-273. [DOI: 10.1080/1744666x.2019.1562904] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Morten J. Christensen
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Esben Eller
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Henrik F. Kjaer
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Sigurd Broesby-Olsen
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| |
Collapse
|
40
|
Carter MC, Metcalfe DD, Matito A, Escribano L, Butterfield JH, Schwartz LB, Bonadonna P, Zanotti R, Triggiani M, Castells M, Brockow K. Adverse reactions to drugs and biologics in patients with clonal mast cell disorders: A Work Group Report of the Mast Cells Disorder Committee, American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol 2018; 143:880-893. [PMID: 30528617 DOI: 10.1016/j.jaci.2018.10.063] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 09/06/2018] [Accepted: 10/09/2018] [Indexed: 12/27/2022]
Abstract
Providers caring for patients with mastocytosis are tasked with the decision to consider therapeutic options. This can come with some trepidation because information available in the public domain lists numerous mast cell (MC) activators based on data that do not discriminate between primates, rodents, and MC lines; do not consider dosage; and do not take into account previous exposure and resultant clinical findings. This being said, there is support in the literature for an enhanced MC response in some patients with mastocytosis and in cases in which there is a greater incidence of adverse reactions associated with certain antigens, such as venoms and drugs. Thus this report provides a comprehensive guide for those providers who must decide on therapeutic options in the management of patients with clonal MC disease.
Collapse
Affiliation(s)
- Melody C Carter
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.
| | - Dean D Metcalfe
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Almudena Matito
- Instituto de Estudios de Mastocitosis de Castilla-La Mancha (CLMast), Hospital Virgen del Valle, Toledo, Spain; Spanish Network on Mastocytois (REMA), Toledo, Spain
| | - Luis Escribano
- Servicio General de Citometría, Centro de Investigación del Cáncer/IBMCC (USAL/CSIC) and Departamento de Medicina, Universidad de Salamanca and IBSAL, Salamanca, Spain; Spanish Network on Mastocytois (REMA), Toledo, Spain
| | - Joseph H Butterfield
- Division of Allergic Diseases and the Program for Mast Cell and Eosinophil Disorders, Mayo Clinic, Rochester, Minn
| | - Lawrence B Schwartz
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Va
| | - Patrizia Bonadonna
- Allergy Unit, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy; Multidisplinary Outpatients Clinic for Mastocytosis (GISM), Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Roberta Zanotti
- Multidisplinary Outpatients Clinic for Mastocytosis (GISM), Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy; Department of Medicine, Haematology Unit, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Mariana Castells
- Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| |
Collapse
|
41
|
Leung ASY, Leung NYH, Wai CYY, Leung TF, Wong GWK. Allergen immunotherapy for food allergy from the Asian perspective: key challenges and opportunities. Expert Rev Clin Immunol 2018; 15:153-164. [PMID: 30488732 DOI: 10.1080/1744666x.2019.1554432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Introduction: Prevalence of food allergy is rising in different regions of the world. Asia has not been spared from this epidemic, but epidemiological data have revealed a different pattern of food allergens in this continent. Allergen-specific immunotherapy (AIT) for food allergy, which has been revolutionary as the main focus of research in recent years, needs to be adapted for the different populations in Asia. Areas covered: Recent evidence shows increasing popularity and superiority of AIT over strict food avoidance as the cornerstone of food allergy management. Asia is a distinctive continent with specific food allergy triggers, in particular, seafood, and wheat. Peanut, on the contrary, is not a common food allergen in most parts of Asia. The common Asian food allergens, as well as the rapidly developing food-specific AIT in this region will be covered in this article. Expert commentary: Evidence on oral immunotherapy for wheat allergy and preclinical data on shellfish AIT are promising. Further work should be done on resolving cross-sensitization between environmental allergens with wheat and shellfish allergens, and a modified AIT approach to enhance the safety and effectiveness of food-specific immunotherapy.
Collapse
Affiliation(s)
- Agnes Sze Yin Leung
- a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital Shatin , New Territories , Hong Kong
| | - Nicki Yat Hin Leung
- a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital Shatin , New Territories , Hong Kong
| | - Christine Yee Yan Wai
- a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital Shatin , New Territories , Hong Kong
| | - Ting Fan Leung
- a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital Shatin , New Territories , Hong Kong
| | - Gary Wing Kin Wong
- a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital Shatin , New Territories , Hong Kong
| |
Collapse
|
42
|
Tsedendorj O, Chinuki Y, Ueda K, Kohno K, Adachi A, Morita E. Tropomyosin is a minor but distinct allergen in patients with shrimp allergies in Japan. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2018. [DOI: 10.1002/cia2.12019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Onon Tsedendorj
- Department of Dermatology; Shimane University Faculty of Medicine; Izumo Japan
| | - Yuko Chinuki
- Department of Dermatology; Shimane University Faculty of Medicine; Izumo Japan
| | - Kiyoe Ueda
- Department of Dermatology; Shimane University Faculty of Medicine; Izumo Japan
| | | | - Atsuko Adachi
- Department of Dermatology; Hyogo Prefectural Kakogawa Medical Centre; Kakogawa Japan
| | - Eishin Morita
- Department of Dermatology; Shimane University Faculty of Medicine; Izumo Japan
| |
Collapse
|
43
|
Abstract
Among various routes of immunotherapy for food allergy, oral immunotherapy (OIT) appears to have a promising result due to its ability to modify abnormal immunologic mechanism of IgE-mediated food allergy. Other methods for immunomodulation such as sublingual (SLIT) or epicutaneous (EPIT) immunotherapy which carry lower rates of systemic reactions, may have less efficacy. Wheat has recently been recognized as a more common cause of food-induced anaphylaxis than previously recognized, especially among young children, around the world. In wheat allergic patients, avoidance recommended as standard recommendation is not easy to follow, because wheat has been used as a common constituents in various kinds of consumed foods in every day's life. Therefore, wheat OIT may be considered as an alternative treatments of those in which wheat avoidance is not sufficient to avert frequent events of anaphylaxis resulting from inadvertent exposure to small amount of wheat among this population. Currently, only few clinical trials about wheat OIT are available. In this review, we discuss available protocols of wheat OIT, initial starting dose, maintenance dose, and the strategies to minimize the side effects during the treatment.
Collapse
Affiliation(s)
- P Pacharn
- a Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok , Thailand
| | - P Vichyanond
- b Samitivej Allergy Institute (SAI), Samitivej Thonburi Hospital , Bangkok , Thailand
| |
Collapse
|
44
|
Vasconcelos MJ, Delgado L, Silva D. Food-Dependent Exercise-Induced Anaphylaxis. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0171-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
45
|
Lee EC, Fragala MS, Kavouras SA, Queen RM, Pryor JL, Casa DJ. Biomarkers in Sports and Exercise: Tracking Health, Performance, and Recovery in Athletes. J Strength Cond Res 2018; 31:2920-2937. [PMID: 28737585 PMCID: PMC5640004 DOI: 10.1519/jsc.0000000000002122] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Lee, EC, Fragala, MS, Kavouras, SA, Queen, RM, Pryor, JL, and Casa, DJ. Biomarkers in sports and exercise: tracking health, performance, and recovery in athletes. J Strength Cond Res 31(10): 2920–2937, 2017—Biomarker discovery and validation is a critical aim of the medical and scientific community. Research into exercise and diet-related biomarkers aims to improve health, performance, and recovery in military personnel, athletes, and lay persons. Exercise physiology research has identified individual biomarkers for assessing health, performance, and recovery during exercise training. However, there are few recommendations for biomarker panels for tracking changes in individuals participating in physical activity and exercise training programs. Our approach was to review the current literature and recommend a collection of validated biomarkers in key categories of health, performance, and recovery that could be used for this purpose. We determined that a comprehensive performance set of biomarkers should include key markers of (a) nutrition and metabolic health, (b) hydration status, (c) muscle status, (d) endurance performance, (e) injury status and risk, and (f) inflammation. Our review will help coaches, clinical sport professionals, researchers, and athletes better understand how to comprehensively monitor physiologic changes, as they design training cycles that elicit maximal improvements in performance while minimizing overtraining and injury risk.
Collapse
Affiliation(s)
- Elaine C Lee
- 1Department of Kinesiology, University of Connecticut, Storrs, Connecticut; 2Quest Diagnostics, Madison, New Jersey; 3Department of Health, Human Performance, & Recreation, University of Arkansas, Fayetteville, Arkansas; 4Department of Biomedical Engineering and Mechanics, Virginia Tech University, Blacksburg, Virginia; and 5Department of Kinesiology, California State University, Fresno, California
| | | | | | | | | | | |
Collapse
|
46
|
Kennard L, Thomas I, Rutkowski K, Azzu V, Yong PFK, Kasternow B, Hunter H, Cabdi NMO, Nakonechna A, Wagner A. A Multicenter Evaluation of Diagnosis and Management of Omega-5 Gliadin Allergy (Also Known as Wheat-Dependent Exercise-Induced Anaphylaxis) in 132 Adults. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1892-1897. [PMID: 29477569 DOI: 10.1016/j.jaip.2018.02.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 01/23/2018] [Accepted: 02/06/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Omega-5 gliadin allergy (also known as wheat-dependent exercise-induced anaphylaxis) is a rare allergy to wheat that often presents with intermittent severe anaphylaxis in the context of a cofactor, such as exercise. OBJECTIVE To undertake a detailed clinical characterization of the largest cohort of patients with omega-5 gliadin allergy to date. METHODS We retrospectively analyzed the demographic characteristics, presentation, investigation, and management of 132 patients presenting with omega-5 gliadin allergy in 4 UK centers. RESULTS There were significant delays in diagnosis of 1 to 5 years (40% of patients) and more than 5 years (29% of patients). The commonest cofactors were exercise (80%), alcohol (25%), and nonsteroidal anti-inflammatory drugs (9%). A minority of patients (11%) had no identifiable cofactor. The level of specific IgE to omega-5 gliadin does not predict the severity of allergic reactions. Patients who adhered to a gluten-free diet and those who avoided wheat in combination with exercise achieved the largest reductions in subsequent allergic reactions of 67% and 69%, respectively. CONCLUSION Omega-5 gliadin allergy is a rare wheat allergy that presents with severe anaphylaxis. The diagnosis is frequently delayed, and therefore we recommend that all adult patients presenting with anaphylaxis of unclear cause should have omega-5 gliadin specific IgE tested. A gluten-free diet or avoidance of wheat-based meals in combination with exercise (if the cofactor is exercise) helps to significantly decrease the risk of future allergic reactions. However, antihistamines and an epinephrine autoinjector must always be prescribed because one-third of patients continue to have allergic reactions despite dietary advice.
Collapse
Affiliation(s)
- Lucinda Kennard
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
| | - Iason Thomas
- Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Krzysztof Rutkowski
- Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Vian Azzu
- Department of Medicine (Gastroenterology and Hepatology Subdivision), University of Cambridge, Cambridge, United Kingdom
| | - Patrick F K Yong
- Department of Allergy and Clinical Immunology, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Bogusia Kasternow
- Department of Allergy and Clinical Immunology, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Hannah Hunter
- Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Naeema M O Cabdi
- Department of Allergy, Broadgreen Hospital, Liverpool, United Kingdom
| | - Alla Nakonechna
- Department of Allergy, Broadgreen Hospital, Liverpool, United Kingdom; Liverpool Hope University, Liverpool, United Kingdom
| | - Annette Wagner
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| |
Collapse
|
47
|
Senders A, Oropeza AR, Kristensen B, Eller E, Kjaer H, Bindslev-Jensen C, Mortz C. Food-dependent exercise-induced anaphylaxis due to almond in a PR-10–sensitized patient. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:683-684. [DOI: 10.1016/j.jaip.2017.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/10/2017] [Accepted: 12/11/2017] [Indexed: 01/21/2023]
|
48
|
Muñoz-Cano R, Pascal M, Araujo G, Goikoetxea MJ, Valero AL, Picado C, Bartra J. Mechanisms, Cofactors, and Augmenting Factors Involved in Anaphylaxis. Front Immunol 2017; 8:1193. [PMID: 29018449 PMCID: PMC5623009 DOI: 10.3389/fimmu.2017.01193] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/08/2017] [Indexed: 01/12/2023] Open
Abstract
Anaphylaxis is an acute and life-threatening systemic reaction. Many triggers have been described, including food, drug, and hymenoptera allergens, which are the most frequently involved. The mechanisms described in anaphylactic reactions are complex and implicate a diversity of pathways. Some of these mechanisms may be key to the development of the anaphylactic reaction, while others may only modify its severity. Although specific IgE, mast cells, and basophils are considered the principal players in anaphylaxis, alternative mechanisms have been proposed in non-IgE anaphylactic reactions. Neutrophils, macrophages, as well as basophils, have been involved, as have IgG-dependent, complement and contact system activation. A range of cationic substances can induce antibody-independent mast cells activation through MRGPRX2 receptor. Cofactors and augmenting factors may explain why, in some patients, food allergen exposure can cause anaphylaxis, while in other clinical scenario it can be tolerated or elicits a mild reaction. With the influence of these factors, food allergic reactions may be induced at lower doses of allergen and/or become more severe. Exercise, alcohol, estrogens, and some drugs such as Non-steroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, β-blockers, and lipid-lowering drugs are the main factors described, though their mechanisms and signaling pathways are poorly understood.
Collapse
Affiliation(s)
- Rosa Muñoz-Cano
- Unitat d'Allergia, Servei de Pneumologia, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mariona Pascal
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Servei d'Immunologia, Centre de Diagnòstic Biomèdic (CDB), Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Giovanna Araujo
- Unitat d'Allergia, Servei de Pneumologia, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M J Goikoetxea
- Allergy and Immunology Department, Universidad de Navarra, Navarra, Spain
| | - Antonio L Valero
- Unitat d'Allergia, Servei de Pneumologia, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Cesar Picado
- Unitat d'Allergia, Servei de Pneumologia, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Joan Bartra
- Unitat d'Allergia, Servei de Pneumologia, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| |
Collapse
|
49
|
Le TA, Al Kindi M, Tan JA, Smith A, Heddle RJ, Kette FE, Hissaria P, Smith WB. The clinical spectrum of omega-5-gliadin allergy. Intern Med J 2017; 46:710-6. [PMID: 27059930 DOI: 10.1111/imj.13091] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/17/2016] [Accepted: 03/29/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND IgE-mediated allergy to the wheat protein omega-5-gliadin (O5G) is associated with wheat-dependent exercise-induced anaphylaxis (WDEIA), where exercise acts as a cofactor, triggering anaphylaxis after wheat ingestion. The wider application of O5G-specific IgE (sIgE) testing has revealed that the manifestations of O5G allergy extend beyond WDEIA. AIMS This study documents clinical manifestations in a large series of patients with sIgE to O5G. METHODS A retrospective clinical audit was performed on adult patients with a positive O5G sIgE (>0.35kU/L) between 2007 and 2013 compared with a group who had negative O5G sIgE. Clinical characteristics and skin prick test (SPT) results were examined. RESULTS Sixty-seven patients were characterised, 26 of whom presented with food-dependent exercise-induced allergy, whilst others presented with exercise-induced symptoms without apparent food association (16/67), idiopathic anaphylaxis (10/67), food-induced allergic symptoms without exercise (10/67) or recurrent acute urticaria (5/67). Specific IgE to O5G had 91% sensitivity and 92% specificity for wheat-related allergic symptoms. SPT had sensitivity of 92% and specificity of 84%. CONCLUSION WDEIA is the most common manifestation of O5G allergy, but patients may present with a variety of allergic manifestations, and wheat allergy is not always obvious on history. Non-exercise cofactors or a lack of cofactors were identified in many patients. A distinctive feature of this allergy is that despite regular wheat ingestion, allergic reactions to wheat occur infrequently. Testing for sIgE to O5G should be considered in patients presenting with exercise-induced urticaria/anaphylaxis, idiopathic anaphylaxis and recurrent acute (but not chronic) urticaria.
Collapse
Affiliation(s)
- T A Le
- Division of Human Immunology, SA Pathology, Adelaide, South Australia, Australia.,Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - M Al Kindi
- Division of Human Immunology, SA Pathology, Adelaide, South Australia, Australia
| | - J-A Tan
- Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - A Smith
- Allergy and Clinical Immunology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - R J Heddle
- Division of Human Immunology, SA Pathology, Adelaide, South Australia, Australia.,Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - F E Kette
- Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - P Hissaria
- Division of Human Immunology, SA Pathology, Adelaide, South Australia, Australia.,Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - W B Smith
- Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| |
Collapse
|
50
|
Food-induced anaphylaxis and cofactors - data from the anaphylaxis registry. Allergol Select 2017; 1:21-27. [PMID: 30402598 PMCID: PMC6039999 DOI: 10.5414/alx01401e] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 01/04/2011] [Indexed: 11/18/2022] Open
Abstract
Food allergens are frequent causes of anaphylaxis. In particular in children and adolescents they are the most frequent elicitors of severe allergic reactions, and in adults food allergens rank third behind insect venom and drugs. Since July 2006 severe allergic reactions from Germany, Austria, and Switzerland are collected in the anaphylaxis registry. Currently 78 hospitals and private practises are connected. From July 2006 until February 2009 1,156 severe allergic reactions were registered. Among children and adolescents (n = 187, age range from 3 months to 17 years) food allergens were the most frequent triggers, comprising 58% of cases. In the adult group (n = 968, 18 – 85 years) food allergens were in the third position (16.3%) behind insect venom and drugs. In children legumes (31%) and in particular peanuts were frequently responsible food allergens, followed by tree nuts (25%) with hazelnut being the most frequent elicitor. In adults fruits (13.4%) most often induced severe food-dependent anaphylaxis, but also animal products (12.2%); among these most frequently crustaceans and molluscs. Cofactors were often suspected in food-dependent anaphylaxis, namely in 39% of the adult group and in 14% of the pediatric group. In adults drugs (22%) and physical activity (10%) were reported to be the most frequent cofactors, in children physical activity was suspected in 8.7% and drugs in 2.6%. Concomitant diseases like atopic dermatitis, allergic asthma, or allergic rhinoconjunctivitis were reported in 78% of children and adolescents and in 67% of the adults. In conclusion, food-induced anaphylaxis, its cofactors and concomitant diseases are age-dependent. The data offers to identify risk factors of anaphylaxis.
Collapse
|