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Terlouw S, van Boven FE, Borsboom-van Zonneveld M, de Graaf-in ‘t Veld C, van Splunter ME, van Daele PLA, van Maaren MS, Schreurs MWJ, de Jong NW. Homemade Food Allergen Extracts for Use in Skin Prick Tests in the Diagnosis of IgE-Mediated Food Allergy: A Good Alternative in the Absence of Commercially Available Extracts? Nutrients 2022; 14:nu14030475. [PMID: 35276832 PMCID: PMC8839075 DOI: 10.3390/nu14030475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The skin prick test (SPT) is the first step in the diagnosis of an immunoglobulin E (IgE)-mediated food allergy. The availability of commercial food allergen extracts is very limited, resulting in a need for alternative extraction methods of food allergens. The objective of this study was to compare the SPT results of homemade food allergen extracts with commercially available extracts. Methods: Adult patients with a suspected food allergy were included. Food allergen-specific symptoms were scored using a questionnaire. SPTs were performed with homemade and commercially available extracts (ALK-Abelló, Kopenhagen, Denmark) from almond, apple, hazelnut, peach, peanut, and walnut. Serum-specific IgE was measured with ISAC or ImmunoCAP™. Intra-class correlation coefficients (ICC) between the SPT results of both extract methods were calculated. The proportion of agreement with food allergen-specific symptoms was analyzed. Results: Fifty-four patients (mean age 36; range 19–69 years; female/male: 42/12) were included. The intra-class correlation coefficient (ICC) between the SPT results of both extract methods were strong for hazelnut 0.79 (n = 44) and walnut 0.78 (n = 31), moderate for apple 0.74 (n = 21) and peanut 0.66 (n = 28), and weak for almond 0.36 (n = 27) and peach 0.17 (n = 23). The proportion of agreement between SPT results and food allergen-specific symptoms was comparable for homemade and commercially available extracts, except for peach; 0.77 versus 0.36, respectively. Conclusion: In the diagnostic procedures to identify an IgE-mediated food allergy, homemade extracts from hazelnut and walnut appear to be a good alternative in the absence of commercially available food allergen extracts.
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Affiliation(s)
- Severina Terlouw
- Department of Allergology, Albert Schweitzer Hospital, 3331 LZ Zwijndrecht, The Netherlands; (M.B.-v.Z.); (C.d.G.-i.‘t.V.)
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
- Correspondence: ; Tel.: +31-640149222
| | - Frank E. van Boven
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
| | - Monika Borsboom-van Zonneveld
- Department of Allergology, Albert Schweitzer Hospital, 3331 LZ Zwijndrecht, The Netherlands; (M.B.-v.Z.); (C.d.G.-i.‘t.V.)
| | - Catharina de Graaf-in ‘t Veld
- Department of Allergology, Albert Schweitzer Hospital, 3331 LZ Zwijndrecht, The Netherlands; (M.B.-v.Z.); (C.d.G.-i.‘t.V.)
| | - Marloes E. van Splunter
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
| | - Paul L. A. van Daele
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
| | - Maurits S. van Maaren
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
| | - Marco W. J. Schreurs
- Laboratory Medical Immunology, Department of Immunology, Erasmus Medical Centre, 3015 GD Rotterdam, The Netherlands;
| | - Nicolette W. de Jong
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
- Department of Pediatric Allergology, Sophia Children Hospital, Erasmus Medical Centre, 3015 GD Rotterdam, The Netherlands
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Zhu LG, Li ZY. [Research advances in influencing factors for immune tolerance to food allergens in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:613-618. [PMID: 31208519 PMCID: PMC7389578 DOI: 10.7499/j.issn.1008-8830.2019.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/04/2019] [Indexed: 06/09/2023]
Abstract
Food allergen-specific immune tolerance is defined as nonresponsiveness of the adaptive immune system to food antigens. Failed development or inhibition of such tolerance may cause food allergy. With the increasing incidence rate of food allergy year by year, more and more studies have found the association between food allergy and various diseases. The development of food allergen-specific immune tolerance in childhood has been taken more and more seriously. In recent years, many studies have shown that the development of food allergen-specific immune tolerance is influenced by various factors, which can be roughly divided into antigens, organisms, and environment. This article reviews the influencing factors for the development of immune tolerance to food allergens in children, in order to provide help for reducing the incidence of food allergy and improving the prognosis of food allergy.
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Affiliation(s)
- Li-Guang Zhu
- Department of Gastroenterology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
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Lin C, Lee IT, Sampath V, Dinakar C, DeKruyff RH, Schneider LC, Nadeau KC. Combining anti-IgE with oral immunotherapy. Pediatr Allergy Immunol 2017; 28:619-627. [PMID: 28782296 DOI: 10.1111/pai.12767] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2017] [Indexed: 12/24/2022]
Abstract
Food allergy is a significant medical problem that affects up to 8% of children in developed countries. At present, there are no curative therapies available in routine practice and management of food allergy involves strict allergen avoidance, education, and prompt treatment upon accidental exposure. Oral immunotherapy (OIT) is an efficacious experimental approach to food allergy and has been shown to provide a substantial benefit in terms of allergen desensitization. However, OIT is associated with high rates of allergic reactions, and the period of protection offered by OIT appears to be limited and highly variable. Recurrence of allergen sensitivity after a period of treatment discontinuation is commonly observed. With the aim of overcoming these limitations of OIT, several trials have studied omalizumab (anti-IgE monoclonal antibody) as an adjuvant treatment for patients undergoing OIT. Results from these trials have shown that the addition of omalizumab to OIT leads to a significant decrease in the frequency and severity of reactions, which allows for an increase in the threshold of tolerance to food allergens. This review provides a summary of the current literature and addresses some of the key questions that remain regarding the use of omalizumab in conjunction with OIT.
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Affiliation(s)
- Chunrong Lin
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Ivan T Lee
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Vanitha Sampath
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Chitra Dinakar
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Rosemarie H DeKruyff
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | | | - Kari Christine Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
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Pali‐Schöll I, De Lucia M, Jackson H, Janda J, Mueller RS, Jensen‐Jarolim E. Comparing immediate-type food allergy in humans and companion animals-revealing unmet needs. Allergy 2017; 72:1643-1656. [PMID: 28394404 DOI: 10.1111/all.13179] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 12/15/2022]
Abstract
Adverse food reactions occur in human as well as veterinary patients. Systematic comparison may lead to improved recommendations for prevention and treatment in both. In this position paper, we summarize the current knowledge on immediate-type food allergy vs other food adverse reactions in companion animals, and compare this to the human situation. While the prevalence of food allergy in humans has been well studied for some allergens, this remains to be investigated for animal patients, where owner-reported as well as veterinarian-diagnosed food adverse reactions are on the increase. The characteristics of the disease in humans vs dogs, cats, and horses are most often caused by similar, but sometimes species-dependent different pathophysiological mechanisms, prompting the specific clinical symptoms, diagnoses, and treatments. Furthermore, little is known about the allergen molecules causative for type I food allergy in animals, which, like in human patients, could represent predictive biomarkers for risk evaluation. The definite diagnosis of food allergy relies-as in humans-on elimination diet and provocation tests. Besides allergen avoidance in daily practice, novel treatment options and tolerization strategies are underway. Taken together, numerous knowledge gaps were identified in veterinary food allergy, which need to be filled by systematic comparative studies.
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Affiliation(s)
- I. Pali‐Schöll
- Comparative Medicine The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna Medical University of Vienna and University of Vienna Vienna Austria
| | - M. De Lucia
- Clinica Veterinaria Privata San Marco Padova Italy
| | - H. Jackson
- Dermatology Referral Services LTD Glasgow Scotland UK
| | - J. Janda
- Faculty of Science Charles University Prague Czech Republic
| | - R. S. Mueller
- Centre for Clinical Veterinary Medicine Ludwig Maximilian University Munich Munich Germany
| | - E. Jensen‐Jarolim
- Comparative Medicine The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna Medical University of Vienna and University of Vienna Vienna Austria
- Institute of Pathophysiology and Allergy Research Center of Pathophysiology Infectiology and Immunology Medical University of Vienna Vienna Austria
- Allergy Care Allergy Diagnosis and Study Center Vienna Austria
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Wilder-Smith CH, Olesen SS, Materna A, Drewes AM. Predictors of response to a low-FODMAP diet in patients with functional gastrointestinal disorders and lactose or fructose intolerance. Aliment Pharmacol Ther 2017; 45:1094-1106. [PMID: 28233394 DOI: 10.1111/apt.13978] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 10/25/2016] [Accepted: 01/18/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Diets low in fermentable sugars (low-FODMAP diets) are increasingly adopted by patients with functional gastrointestinal disorders (FGID), but outcome predictors are unclear. AIM To identify factors predictive of an efficacious response to a low-FODMAP diet in FGID patients with fructose or lactose intolerance thereby gaining insights into underlying mechanisms. METHODS Fructose and lactose breath tests were performed in FGID patients to determine intolerance (positive symptom score) and malabsorption (increased hydrogen or methane concentrations). Patients with fructose or lactose intolerance consumed a low-FODMAP diet and global adequate symptom relief was assessed after 6-8 weeks and correlated with pre-diet clinical symptoms and breath test results. RESULTS A total of 81% of 584 patients completing the low-FODMAP diet achieved adequate relief, without significant differences between FGID subgroups or types of intolerance. Univariate analysis yielded predictive factors in fructose intolerance (chronic diarrhoea and pruritus, peak methane concentrations and fullness during breath tests) and lactose intolerance (peak hydrogen and methane concentrations and flatulence during breath tests). Using multivariate analysis, symptom relief was independently and positively predicted in fructose intolerance by chronic diarrhoea [odds ratio (95% confidence intervals): 2.62 (1.31-5.27), P = 0.007] and peak breath methane concentrations [1.53 (1.02-2.29), P = 0.042], and negatively predicted by chronic nausea [0.33 (0.16-0.67), P = 0.002]. No independent predictive factors emerged for lactose intolerance. CONCLUSIONS Adequate global symptom relief was achieved with a low-FODMAP diet in a large majority of functional gastrointestinal disorders patients with fructose or lactose intolerance. Independent predictors of a satisfactory dietary outcome were only seen in fructose intolerant patients, and were indicative of changes in intestinal host or microbiome metabolism.
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Affiliation(s)
- C H Wilder-Smith
- Brain-Gut Research Group, Gastroenterology Group Practice, Bern, Switzerland
| | - S S Olesen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - A Materna
- Brain-Gut Research Group, Gastroenterology Group Practice, Bern, Switzerland
| | - A M Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
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Praktischer Einsatz von Adrenalinautoinjektoren. Monatsschr Kinderheilkd 2016. [DOI: 10.1007/s00112-016-0225-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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