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Jackson HA, Dembele V. Conducting a successful diet trial for the diagnosis of food allergy in dogs and cats. Vet Dermatol 2024. [PMID: 38956779 DOI: 10.1111/vde.13274] [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: 03/28/2024] [Revised: 04/15/2024] [Accepted: 05/31/2024] [Indexed: 07/04/2024]
Abstract
A limited antigen diet trial and subsequent food provocation is currently the optimal method of confirming a diagnosis of food allergy in dogs and cats. However, performing an effective diet trial can be challenging as it requires a high level of client and pet compliance, appropriate diet selection and correct interpretation of the provocative challenge. This narrative guides the clinician through the process, highlights potential pitfalls and specifies how these can be avoided to achieve a successful outcome.
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2
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Wang X, Chen L, Lan T, Wang H, Wang X. Profiles of apple allergen components and its diagnostic value in Northern China. Front Med (Lausanne) 2024; 11:1388766. [PMID: 38938380 PMCID: PMC11208676 DOI: 10.3389/fmed.2024.1388766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/31/2024] [Indexed: 06/29/2024] Open
Abstract
Background Limited is known on the profiles of apple allergy in China. Objective To explore the clinical significance of apple allergen components in northern China. Methods This study recruited 40 participants and categorized into apple tolerance (n = 19) and allergy (n = 21) group. The latter was categorized into oral allergy symptoms (OAS, n = 14) and generalized symptoms (GS, n = 7). All participants underwent ImmunoCAP screening to assess sIgE levels of birch, apple, and their components. Results The sensitization rates were 90% for Bet v 1, 85% for Mal d 1, 35% for Bet v 2, and 20% for Mal d 3. The overall positive rate for apple allergens was 97.5%, with half demonstrating mono-sensitization to Mal d 1. Birch, Bet v 1 and Mal d 1 sIgE levels had consistent areas under the curve (AUC 0.747, p = 0.037; AUC 0.799, p = 0.012; AUC 0.902, p < 0.001 respectively) in diagnosing apple allergy. The optimal cut-off values were determined to be 22.85 kUA/L (63.6% sensitivity, 85.7% specificity), 6.84 kUA/L (81.8% sensitivity, 71.4% specificity) and 1.61 kUA/L (93.8% sensitivity, 75.0% specificity), respectively. No allergens or components demonstrated diagnostic value in distinguishing between OAS and GS. Mal d 3 sensitization was correlated with mugwort allergy and higher risk of peach, nuts or legumes generalized allergy. Conclusion Mal d 1 was major allergen and the best for diagnosing apple allergy. Mal d 3 does not necessarily indicate severe allergic reaction to apples in northern China but may indicate mugwort sensitization and an increased risk of peach, nuts or legumes allergy.
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Affiliation(s)
- Xiaoyan Wang
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Beijing Laboratory of Allergic Diseases, Beijing Municipal Education Commission, Beijing, China
| | - Lijia Chen
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Beijing Laboratory of Allergic Diseases, Beijing Municipal Education Commission, Beijing, China
| | - Tianfei Lan
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Hongtian Wang
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xueyan Wang
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Beijing Laboratory of Allergic Diseases, Beijing Municipal Education Commission, Beijing, China
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Wong GWK. Food allergies around the world. Front Nutr 2024; 11:1373110. [PMID: 38938666 PMCID: PMC11208673 DOI: 10.3389/fnut.2024.1373110] [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: 01/19/2024] [Accepted: 04/03/2024] [Indexed: 06/29/2024] Open
Abstract
The increase in the prevalence of food allergy has been considered as the second wave in the allergy epidemic following the first wave of increase in asthma and allergic rhinitis. It is well known that the prevalence of allergic conditions would follow economic development and urbanization in many countries or regions. In developed countries, one in three children suffered from at least one allergic disorder and these conditions include food allergy, eczema, allergic rhinitis and asthma. Food allergy is very often the first allergic manifestation affecting infants and young children. The exact etiologies are not known. The clinical manifestations ranged from a simple rash or an itch around the mouth, to the more severe manifestations of angioedema and potentially fatal anaphylaxis. Among all cases of childhood anaphylaxis, food is the most common cause. The common allergens resulting in food allergies in developed countries include egg, milk, fish, wheat, peanuts and tree nuts. However, there are marked variations in the patterns of food allergens in developing countries. In line with the epidemiology of asthma, food allergy is also much less common in rural areas. Clear understanding of reasons explaining the disparity of food allergies between urban and rural population would pave the way to the development of effective primary prevention for food allergy.
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Affiliation(s)
- Gary Wing-Kin Wong
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Şirin S, Özkan Kırgın B, Özmen S, Akelma Z. Evaluation of Allergic Reactions and Tolerance with Fruit and Vegetable Allergy in Children. Int Arch Allergy Immunol 2024:1-8. [PMID: 38865980 DOI: 10.1159/000539216] [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: 03/04/2024] [Accepted: 05/02/2024] [Indexed: 06/14/2024] Open
Abstract
INTRODUCTION Despite the increasing prevalence of fruit and vegetable allergies in childhood over the past decades, the clinical course of reaction types and tolerance remain unclear. Our aim was to evaluate the clinical course, demographic characteristics, and tolerance rate of allergic reactions induced by fruits or vegetables. METHODS We conducted a retrospective, descriptive, cross-sectional study on patients who presented with suspected allergic reactions to fruit or vegetables. We used patient records to identify demographic data, skin prick test, prick-to-prick test, and oral food challenge test results and laboratory findings. RESULTS The study included 78 children with a median age of 61.5 months. Class 1 and 2 allergies were found in 65 and 13 cases, respectively. The most common allergens were potato (21.8%), banana (15.4%), peach (14.1%), and tomato (12.8%). Clinical symptoms included urticaria (75.6%), oral allergy syndrome (15.4%), angioedema (7.7%), and anaphylaxis (1.3%). Thirteen children achieved tolerance, while 61.7% did not. The median time to tolerance was 13.5 months after diagnosis, with a minimum of 9 months. Significant differences in reaction type, clinical presentation, pan-allergy to aeroallergens, and serum total IgE levels were found between the tolerant and non-tolerant groups (p = 0.006, 0.009, 0.005, and 0.001, respectively). CONCLUSION This is the first study to provide guidance on the tolerance rate and resolution time of fruit and vegetable allergies based on demographic and diagnostic parameters. Further research is needed to deepen our understanding of fruit and vegetable allergy.
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Affiliation(s)
- Seda Şirin
- Pediatric Allergy and Immunology Clinic, Dr. Sami Ulus Children's Research and Training Hospital, Ankara, Turkey
- Division of Pediatric Allergy and Immunology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Burcu Özkan Kırgın
- Pediatric Allergy and Immunology Clinic, Dr. Sami Ulus Children's Research and Training Hospital, Ankara, Turkey
| | - Serap Özmen
- Pediatric Allergy and Immunology Clinic, Dr. Sami Ulus Children's Research and Training Hospital, Ankara, Turkey
- Division of Pediatric Allergy and Immunology, Health Sciences University, Ankara, Turkey
| | - Zülfikar Akelma
- Pediatric Allergy and Immunology Clinic, Dr. Sami Ulus Children's Research and Training Hospital, Ankara, Turkey
- Division of Pediatric Allergy and Immunology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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5
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Matricardi PM, Potapova E, Panetta V, Lidholm J, Mattsson L, Scala E, Bernardini R, Caffarelli C, Casani A, Cervone R, Chini L, Comberiati P, De Castro G, Miraglia Del Giudice M, Dello Iacono I, Di Rienzo Businco A, Gallucci M, Giannetti A, Moschese V, Varin E, Bianchi A, Calvani M, Frediani T, Macrì F, Maiello N, Paravati F, Pelosi U, Peroni D, Pingitore G, Tosca M, Zicari AM, Ricci G, Asero R, Tripodi S. IgE to cyclophilins in pollen-allergic children: Epidemiologic, clinical, and diagnostic relevance of a neglected panallergen. J Allergy Clin Immunol 2024; 153:1586-1596.e2. [PMID: 38513837 DOI: 10.1016/j.jaci.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/25/2023] [Accepted: 01/26/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Cyclophilins are ubiquitous panallergens whose epidemiologic, diagnostic, and clinical relevance is largely unknown and whose sensitization is rarely examined in routine allergy practice. OBJECTIVE We investigated the epidemiologic, diagnostic, and clinical relevance of cyclophilins in seasonal allergic rhinitis and its comorbidities. METHODS We examined a random sample of 253 (25%) of 1263 Italian children with seasonal allergic rhinitis from the Panallergens in Pediatrics (PAN-PED) cohort with characterized disease phenotypes. Nested studies of sensitization prevalence, correlation, and allergen extract inhibition were performed in patients sensitized to birch pollen extract but lacking IgE to Bet v 1/2/4 (74/1263) or with highest serum level of IgE to Bet v 1 (26/1263); and in patients with sensitization to various extracts (ragweed, mugwort, pellitory, Plantago, and plane tree), but not to their respective major allergenic molecule, profilins, and polcalcins. IgE to cyclophilin was detected with recombinant Bet v 7, and extract inhibition tests were performed with the same rBet v 7. RESULTS IgE to rBet v 7 was detected in 43 (17%) of 253 patients. It was associated with asthma (P < .028) and oral allergy syndrome (P < .017) in univariate but not multivariate analysis adjusted for IgE to profilins (Phl p 12), PR-10s (Bet v 1), and lipid transfer proteins (Pru p 3). IgE to rBet v 7 was also highly prevalent (47/74, 63%) among patients with unexplained sensitization to birch pollen extract. In patients with unexplained sensitization to ragweed, mugwort, pellitory, Plantago and plane tree pollen, the levels of IgE to those extracts correlated with the levels of IgE to rBet v 7, and they were also significantly inhibited by rBet v 7 (inhibition range 45%-74%). CONCLUSIONS IgE sensitization to cyclophilin is frequent in pollen-allergic patients living in temperate areas and can produce "false" positive outcomes in skin prick and IgE tests to pollen extracts. Molecular diagnostic guidelines should include this panallergen family.
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MESH Headings
- Humans
- Immunoglobulin E/immunology
- Immunoglobulin E/blood
- Child
- Rhinitis, Allergic, Seasonal/immunology
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/blood
- Male
- Female
- Cyclophilins/immunology
- Allergens/immunology
- Pollen/immunology
- Adolescent
- Child, Preschool
- Antigens, Plant/immunology
- Italy/epidemiology
- Prevalence
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Affiliation(s)
- Paolo Maria Matricardi
- Charité-Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, the Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Berlin, Germany; Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.
| | - Ekaterina Potapova
- Charité-Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, the Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Berlin, Germany
| | - Valentina Panetta
- Consultancy & Training, Biostatistics, L'altrastatistica, Rome, Italy
| | | | | | - Enrico Scala
- Clinical and Laboratory Molecular Allergy Unit, IDI-IRCCS, Rome, Italy
| | | | - Carlo Caffarelli
- Department of Medicine and Surgery, Clinica Pediatrica, University of Parma, Parma, Italy
| | | | - Rosa Cervone
- Pediatric Unit, San Giuseppe Hospital, Empoli, Italy
| | - Loredana Chini
- UOSD di Immunopatologia ed Allergologia Pediatrica, Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | | | - Michele Miraglia Del Giudice
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università della Campania Luigi Vanvitelli, Naples, Italy
| | | | | | - Marcella Gallucci
- Pediatric Unit, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
| | - Arianna Giannetti
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Viviana Moschese
- UOSD di Immunopatologia ed Allergologia Pediatrica, Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Elena Varin
- Allergology Service, San Carlo Clinic, Paderno Dugnano, Milan, Italy
| | | | - Mauro Calvani
- Pediatric Unit, San Camillo Forlanini Hospital, Rome, Italy
| | | | | | - Nunzia Maiello
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università della Campania Luigi Vanvitelli, Naples, Italy
| | | | | | - Diego Peroni
- Pediatric Section, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | | | - Mariangela Tosca
- Pulmonary Disease and Allergy Unit, G. Gaslini Hospital, Genoa, Italy
| | | | - Giampaolo Ricci
- Pediatric Unit, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| | - Salvatore Tripodi
- Pediatric Department and Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy
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Gupta RS, Epstein E, Wood RA. The role of pediatricians in the diagnosis and management of IgE-mediated food allergy: a review. Front Pediatr 2024; 12:1373373. [PMID: 38873581 PMCID: PMC11169649 DOI: 10.3389/fped.2024.1373373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
Importance Food allergy can often cause a significant burden on patients, families, and healthcare systems. The complexity of food allergy management requires a multidisciplinary approach involving different types of healthcare providers, including allergists, dieticians, psychologists, nurses, family practitioners and, of particular relevance for this article, pediatric primary caretakers. Pediatricians may be the first-line healthcare providers for food allergy: strategies for management and guideline adherence have been highlighted. Observations This review article summarizes the up-to-date recommendations on the role of pediatricians in the diagnosis, management, and prevention of IgE-mediated food allergy. Early introduction of allergenic foods like peanut is known to be of importance to reduce the development of peanut allergy in infants, and pediatricians are essential for educating and supporting parents in this decision. In scenarios of limited allergist availability, as is often the case among rural, Medicaid and minority populations, pediatricians can assist in the evaluation and management of food allergy, and provide action plans, education and counselling for patients and families. Conclusions and relevance Pediatric primary caretakers play a key role in the diagnosis, management, and prevention of IgE-mediated food allergy. As more diagnostic tools and therapies in food allergy become available, the need for a multidisciplinary team is paramount to optimize patient care.
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Affiliation(s)
- Ruchi S. Gupta
- Institute for Public Health and Medicine, Center for Food Allergy & Asthma, Northwestern University, Chicago, IL, United States
| | - Ellen Epstein
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
| | - Robert A. Wood
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Bauernfeind C, Zettl I, Ivanova T, Goryainova O, Weijler AM, Pranz B, Drescher A, Focke-Tejkl M, Pavkov-Keller T, Eckl-Dorna J, Tillib SV, Flicker S. Trimeric Bet v 1-specific nanobodies cause strong suppression of IgE binding. Front Immunol 2024; 15:1343024. [PMID: 38784378 PMCID: PMC11112410 DOI: 10.3389/fimmu.2024.1343024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/27/2024] [Indexed: 05/25/2024] Open
Abstract
Background Around 20% of the population in Northern and Central Europe is affected by birch pollen allergy, with the major birch pollen allergen Bet v 1 as the main elicitor of allergic reactions. Together with its cross-reactive allergens from related trees and foods, Bet v 1 causes an impaired quality of life. Hence, new treatment strategies were elaborated, demonstrating the effectiveness of blocking IgG antibodies on Bet v 1-induced IgE-mediated reactions. A recent study provided evidence for the first time that Bet v 1-specific nanobodies reduce patients´ IgE binding to Bet v 1. In order to increase the potential to outcompete IgE recognition of Bet v 1 and to foster cross-reactivity and cross-protection, we developed Bet v 1-specific nanobody trimers and evaluated their capacity to suppress polyclonal IgE binding to corresponding allergens and allergen-induced basophil degranulation. Methods Nanobody trimers were engineered by adding isoleucine zippers, thus enabling trimeric formation. Trimers were analyzed for their cross-reactivity, binding kinetics to Bet v 1, and related allergens, and patients' IgE inhibition potential. Finally, their efficacy to prevent basophil degranulation was investigated. Results Trimers showed enhanced recognition of cross-reactive allergens and increased efficiency to reduce IgE-allergen binding compared to nanobody monomers. Furthermore, trimers displayed slow dissociation rates from allergens and suppressed allergen-induced mediator release. Conclusion We generated high-affine nanobody trimers that target Bet v 1 and related allergens. Trimers blocked IgE-allergen interaction by competing with IgE for allergen binding. They inhibited IgE-mediated release of biological mediators, demonstrating a promising potential to prevent allergic reactions caused by Bet v 1 and relatives.
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Affiliation(s)
- Clarissa Bauernfeind
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Ines Zettl
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Tatiana Ivanova
- Institute of Gene Biology, Russian Academy of Sciences, Moscow, Russia
| | - Oksana Goryainova
- Institute of Gene Biology, Russian Academy of Sciences, Moscow, Russia
| | - Anna Marianne Weijler
- Division of Transplantation, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Barbara Pranz
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | | | - Margarete Focke-Tejkl
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Tea Pavkov-Keller
- Institute of Molecular Biosciences, University of Graz, Graz, Austria
- BioTechMed Graz, Graz, Austria
- BioHealth Field of Excellence, University of Graz, Graz, Austria
| | - Julia Eckl-Dorna
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Sergei V. Tillib
- Institute of Gene Biology, Russian Academy of Sciences, Moscow, Russia
| | - Sabine Flicker
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
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Lundberg M, Voutilainen H, Lyly A, Karjalainen J, Huhtala H, Laidlaw TM, Lee SE, Nuutinen M, Toppila-Salmi S. Adult-onset asthma, allergy, and aspirin hypersensitivity associate with self-reported food avoidance. Eur Clin Respir J 2024; 11:2347073. [PMID: 38706510 PMCID: PMC11067555 DOI: 10.1080/20018525.2024.2347073] [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: 01/12/2024] [Accepted: 04/20/2024] [Indexed: 05/07/2024] Open
Abstract
Background The adoption of avoidance diets by adult-onset asthmatics has not previously been studied. We hypothesized that avoidance diets would associate with adult-onset asthma, allergy, and aspirin-exacerbated respiratory disease (AERD). Methods A total of 1247 subjects with adult-onset asthma (age range: 31-91) from the Finnish national registry, and age- and sex-matched controls (n = 1970) participated in a questionnaire study in 1997. We estimated the association between asthma/allergy/AERD and avoidance diets, adjusting for potential confounding factors and validated the results in two retrospective cohorts of 5080 rhinitis/rhinosinusitis patients and 167 AERD patients from 2019 to 2020. Results The presence of asthma positively associated with adoption of any avoidance diet (adjusted OR [CI95%] 1.24 [1.02-1.51], p = 0.029) as did allergic disease and self-reported AERD within the asthmatic group (1.79 [1.29-2.48], p = 0.001 and 1.69 [1.15-2.49], p = 0.007, respectively). Asthmatics and allergic asthmatics were more likely to report avoidance of fish, fruits and vegetables, and spices (p ≤ 0.03) compared to controls and non-allergic asthmatics. The adjusted OR for multiple diets among AERD patients was 2.57 [1.34-4.95] p = 0.005. In the validation, 26.2% of the allergic asthmatics and 10.8% of AERD patients had documented avoidance diets. Conclusions Our study shows a positive association between avoidance diets and adult-onset asthma, and with allergic disease or AERD within asthmatic patients. Although we lack information on the reason patients chose to observe a specific diet, our results reinforce the importance of asking patients about their diet and if needed, giving dietary advice for adult asthma patients to help them avoid the adoption of unnecessarily restrictive diets.
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Affiliation(s)
- Marie Lundberg
- Department of Otorhinolaryngology- Head and Neck surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Helena Voutilainen
- Department of Allergy, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Annina Lyly
- Department of Otorhinolaryngology- Head and Neck surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Allergy, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Tanya M. Laidlaw
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Stella E. Lee
- Division of Otolaryngology – Head and Neck Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Mikko Nuutinen
- Department of Allergy, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Haartman Institute, Medicum, University of Helsinki, Helsinki, Finland
| | - Sanna Toppila-Salmi
- Department of Allergy, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Haartman Institute, Medicum, University of Helsinki, Helsinki, Finland
- Department of Otolaryngology, University of Eastern Finland, Kuopio, Finland
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Lee Qiyu M, Dawson T, Moulsdale P. Allergen Component Testing: Key in Diagnosing Atypical Pollen-Food Allergy Syndrome. Cureus 2024; 16:e58722. [PMID: 38779239 PMCID: PMC11110472 DOI: 10.7759/cureus.58722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/25/2024] Open
Abstract
This case report details the complex presentation, diagnosis, and management of a teenager with pollen-food allergen syndrome (PFAS), formerly known as oral allergy syndrome. PFAS, mediated by immunoglobulin E (IgE) antibodies, stems from the cross-reactivity between pollens and uncooked plant-based foods, leading to a spectrum of symptoms, such as itching or tingling of the oral cavity. A UK survey indicated an average PFAS prevalence of 2%, with apples, hazelnuts, and kiwifruit commonly implicated. The presented case involved a 15-year-old girl referred from the respiratory clinic to the allergy clinic due to episodes of sore throat and urticaria rash following Nutella (chocolate paste containing hazelnut) and peanut consumption. Extensive diagnostic measures, including specific IgE testing, skin prick tests, and allergen component testing, revealed cross-reactivity between Bet v 1 and hazelnut allergens. The patient's atopic history, encompassing poorly controlled asthma, allergic rhinitis, and eczema, added layers of complexity to the diagnosis. Management strategies comprised dietary advice, allergen avoidance, and potential consideration of aeroallergen immunotherapy. A comprehensive dietary plan emphasized abstaining from specific foods and raising awareness of potential reactions. The patient, following guidance from the allergy clinic, exhibited improvements in allergic rhinitis and oral symptoms. This case underscores the importance of allergen component testing in diagnosing atypical PFAS presentations and tailoring management plans. Ongoing collaboration between healthcare providers, detailed patient education, and regular follow-ups are crucial for effective PFAS management and long-term care.
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Affiliation(s)
- Melvin Lee Qiyu
- Pediatrics, Worcestershire Acute Hospitals NHS Trust, Worcester, GBR
| | - Tom Dawson
- Pediatrics, Worcestershire Acute Hospitals NHS Trust, Worcester, GBR
| | - Phoebe Moulsdale
- Pediatrics, Worcestershire Acute Hospitals NHS Trust, Worcester, GBR
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10
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Lee ECK, Trogen B, Brady K, Ford LS, Wang J. The Natural History and Risk Factors for the Development of Food Allergies in Children and Adults. Curr Allergy Asthma Rep 2024; 24:121-131. [PMID: 38416390 PMCID: PMC10960768 DOI: 10.1007/s11882-024-01131-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE OF REVIEW This narrative review explores food allergy prevalence and natural history stratified by life stages, especially in context of evolving knowledge over the last few decades. RECENT FINDINGS The prevalence of food allergy remains highest in early childhood with common food triggers being cow's milk, soy, hen's egg, wheat, peanut, tree nuts, sesame, fish, and shellfish. This correlates with certain risk factors especially pertinent in the postnatal period which appear to predispose an individual to developing a food allergy. Some allergies (such as milk and egg) were previously thought to be easily outgrown in early life; however, recent studies suggest increasing rates of persistence of these allergies into young adulthood; the reason behind this is unknown. Despite this, there is also evidence demonstrating that food allergies can be outgrown in adolescents and adults. An understanding of the paradigm shifts in the natural history of food allergy allows clinicians to provide updated, age-appropriate, and tailored advice for patients on the management and prognosis of food allergy.
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Affiliation(s)
- Eric C K Lee
- The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Brit Trogen
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kathryn Brady
- Department of Pediatrics, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, USA
| | - Lara S Ford
- The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.
- Sydney Medical School, The University of Sydney, The University of Sydney, NSW, 2006, Australia.
| | - Julie Wang
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, USA
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Peddi NC, Muppalla SK, Sreenivasulu H, Vuppalapati S, Komuravelli M, Navab R. Navigating Food Allergies: Advances in Diagnosis and Treatment Strategies. Cureus 2024; 16:e56823. [PMID: 38654770 PMCID: PMC11037442 DOI: 10.7759/cureus.56823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2024] [Indexed: 04/26/2024] Open
Abstract
Food allergy is a major health concern worldwide, encompassing both immunologic and non-immunologic reactions. This review thoroughly examines the pathophysiology, clinical manifestations, and treatment options for various types of food allergies. Immunologic food allergies, including IgE-mediated reactions such as oral allergy syndrome and systemic anaphylaxis, pose various diagnostic and management challenges. Non-IgE-mediated reactions such as food protein-induced enterocolitis syndrome, dermatitis herpetiformis, and proctocolitis necessitate individualized patient care. In addition, mixed reactions such as eosinophilic esophagitis and atopic dermatitis complicate the clinical picture. Skin prick tests, serum-specific IgE tests, and oral food challenges are all necessary for accurate food allergy diagnosis. The primary therapeutic options are allergen avoidance, epinephrine-based emergency management, and emerging treatments like immunotherapy. Our review emphasizes the importance of multidisciplinary collaboration and ongoing research in improving our understanding and managing food allergies, promising a brighter future for those affected.
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Affiliation(s)
| | | | | | - Sravya Vuppalapati
- General Physician, PES Institute of Medical Sciences and Research, Kuppam, IND
| | - Myna Komuravelli
- Pediatrics, Chalmeda Anand Rao Institute of Medical Sciences, Hanamkonda, IND
| | - Rahul Navab
- Internal Medicine, PES Institute of Medical Sciences and Research, Kuppam, IND
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12
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Kàtcheff SC, Labrador-Horrillo M, Bartolomé B, Garriga-Baraut T. Allergy to Gibberellin-regulated proteins in an adolescent: A case of orange-induced anaphylaxis mediated by cofactors. Allergol Immunopathol (Madr) 2024; 52:48-50. [PMID: 38459890 DOI: 10.15586/aei.v52i2.1014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/15/2024] [Indexed: 03/11/2024]
Abstract
This report is a case of anaphylaxis in an adolescent due to allergy to gibberellin-regulated proteins mediated by cofactors, in probable relation to a pollen/food allergy syndrome. It should also emphasizes the importance of obtaining a faithful clinical history, especially when it comes to adolescent patients as they tend to initiate toxic habits.
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Affiliation(s)
- Sofia Carreras Kàtcheff
- Unitat d'Al•lergologia Pediàtrica. Servei de Pediatria. Hospital Universitari Vall d'Hebron, Barcelona, Catalonia
| | - Moises Labrador-Horrillo
- Secció d'Al•lergologia. Servei de Medicina Interna. Hospital Universitari Vall d'Hebron, Catalonia
| | | | - Teresa Garriga-Baraut
- Unitat d'Al•lergologia Pediàtrica. Servei de Pediatria. Hospital Universitari Vall d'Hebron, Barcelona, Catalonia;
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13
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Lee ASE, Ramsey N. Climate Change and Food Allergy. Immunol Allergy Clin North Am 2024; 44:75-83. [PMID: 37973261 DOI: 10.1016/j.iac.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
The role of environmental factors including climate change and consequent influences of air pollution on food allergy remains less explored compared with impacts on allergic rhinitis and asthma. In this review, we discuss the epithelial barrier hypothesis as a proposed mechanism of food allergy development that may be relevant in this context. We also discuss existing studies that provide insight into the intricate relationship between food allergy and climate-related environmental factors.
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Affiliation(s)
- Ashley Sang Eun Lee
- Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York 10029, USA; Department of Pediatrics, Jaffe Food Allergy Institute, 10540 Avenue K, Brooklyn, NY 11236-3018, USA.
| | - Nicole Ramsey
- Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York 10029, USA; Department of Pediatrics, Jaffe Food Allergy Institute, 10540 Avenue K, Brooklyn, NY 11236-3018, USA
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14
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Wu C, Tang H, Wei J, Chen H, Zhao Z, Norbäck D, Zhang X, Lu C, Yu W, Wang T, Zheng X, Li R, Zhang Y, Zhang L. Modification of Food Allergy on the Associations between Early Life Exposure to Size-Specific Particulate Matter and Childhood Allergic Rhinitis. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:1813-1822. [PMID: 38237043 DOI: 10.1021/acs.est.3c05532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Previous studies have reported the association between particulate matter (PM) and childhood allergic rhinitis (AR). However, it is unclear whether food allergy (FA) modifies the PM-AR association. We aimed at evaluating the effect of the modification of FA on PM-AR association in preschool children. We adopted a cross-sectional study and conducted a questionnaire survey among preschool children aged 3-6 years in 7 cities in China from June 2019 to June 2020 to collect information on AR and FA. We used a combination of multilevel logistic regression and restricted cubic spline functions to quantitatively assess whether FA modifies the associations between size-specific PM exposure (1 × 1 km) and the risk of AR. The adjusted odds ratios (ORs) for AR among the children with FA as per a 10 μg/m3 increase in early life PM1, PM2.5, and PM10 were significantly higher than the corresponding ORs among the children without FA [e.g., OR: 1.58, 95% CI: (1.32, 1.90) vs 1.29, 95% CI: (1.18, 1.41), per 10 μg/m3 increase in PM1]. The interactions between FA and size-specific PM exposure and their effects on AR were statistically significant (all p-int < 0.001). FA, as an important part of the allergic disease progression, may modify the PM-AR association in preschool children.
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Affiliation(s)
- Chuansha Wu
- Department of Environmental Hygiene and Occupational Medicine, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Haoran Tang
- Department of Environmental Hygiene and Occupational Medicine, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, Maryland 20740, United States
| | - Hao Chen
- Department of Environmental Hygiene and Occupational Medicine, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Zhuohui Zhao
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai 200030, China
| | - Dan Norbäck
- Department of Medical Sciences, Uppsala University, Uppsala SE 75185, Sweden
| | - Xin Zhang
- Research Centre for Environmental Science and Engineering, Shanxi University, Taiyuan 030006, China
| | - Chan Lu
- Department of Occupational and Environmental Health, School of Public Health, Xiangya Medical College, Central South University, Changsha 410078, China
| | - Wei Yu
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing 400045, China
| | - Tingting Wang
- School of Nursing and Health Management, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China
| | - Xiaohong Zheng
- School of Energy and Environment, Southeast University, Nanjing 210096, China
| | - Rui Li
- Hubei Key Laboratory of Genetic Regulation and Integrative Biology, School of Life Sciences, Central China Normal University, Wuhan 430079, China
| | - Yunquan Zhang
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan 430065, China
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Ling Zhang
- Department of Environmental Hygiene and Occupational Medicine, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan 430065, China
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15
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Gauld R, Walter G, Zhu R. Pollen food allergy syndrome secondary to molds and raw mushroom cross-reactivity: a case report. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2024; 20:2. [PMID: 38178177 PMCID: PMC10765729 DOI: 10.1186/s13223-023-00865-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Pollen food allergy syndrome (PFAS) is an immunoglobulin E (IgE) mediated reaction that causes oropharyngeal pruritus or angioedema due to homologous proteins present in the culprit food as well as a sensitizing aeroallergen. This cross-reactivity has been well established between pollen and fruits/vegetables. Given the evolutionary similarity between all fungi; cross-reactivity between spore forming microfungi and edible macrofungi have been suggested, however only a limited number of case reports have ever been published on this phenomenon. We present a case of a patient who experiences pollen food allergy syndrome-like symptoms following lightly cooked mushroom ingestion who otherwise was able to tolerate cooked mushrooms. We then review the literature to highlight the limited studies of an underrecognized PFAS cross-reactivity between molds and mushrooms. CASE PRESENTATION A 15-year-old male presents with symptoms of seasonal and perennial allergic rhinitis was found to have multiple environmental sensitizations to molds via skin prick testing (C. gramineum, A. Pullulans and B. cinerea) and ImmunoCAP serum-specific IgE (A. alternata, C. herbarum, and P. notatum). He developed throat pruritus and subjective throat tightness following ingestion of mushroom containing pizza. ImmunoCAP serum specific IgE to whole mushroom was negative but fresh food prick testing to fresh portobello mushroom and cremini mushroom were both positive with a negative test to canned mushroom. The patient then underwent a graded oral challenge and successfully tolerated canned mushrooms. CONCLUSION This case highlights the potential cross-reactivity between microfungi aeroallergens and edible fungi, leading to PFAS-like reactions in susceptible individuals. The patient's ability to tolerate canned mushrooms suggests a possible heat-labile protein as the cause of the reaction, similar to PFAS patients tolerating cooked but not raw fruits/vegetables. Positive skin prick test to both spore-forming fungi and edible fungi with negative and whole mushroom IgE results further support the hypothesis of cross-reactivity and sensitization. Further research is needed to identify the specific allergenic proteins involved in these cross-reactions and the susceptible species of mold and mushroom. Understanding these components will contribute to improved diagnosis and management of mold and mushroom allergies, and enhance our knowledge of allergenic cross-reactivity in general.
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Affiliation(s)
- Ryan Gauld
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON, Canada
| | - Graham Walter
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON, Canada
| | - Rongbo Zhu
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON, Canada.
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16
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Conner JE, Steinberg JA. Approach to Idiopathic Anaphylaxis in Adolescents. Med Clin North Am 2024; 108:123-155. [PMID: 37951646 DOI: 10.1016/j.mcna.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Anaphylaxis is a potentially-life threatening condition. Adolescents are particularly vulnerable due to increased risk-taking behaviors, poor disease management, and minimized perception of risk. Although most anaphylaxis can be attributed to food, drug, or venom allergy via a detailed history and confirmatory studies, in nearly 1 in 5 cases, the cause may not be obvious. Clinical differentials including rare allergens, cofactors, mast-cell disorders, and mimic disorders can increase the likelihood of discovering of the cause of anaphylaxis.
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Affiliation(s)
- Jeanne E Conner
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Medical College of Wisconsin, 9000 West Wisconsin Avenue. B440, Milwaukee, WI 53226, USA
| | - Joshua A Steinberg
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Medical College of Wisconsin, 9000 West Wisconsin Avenue. B440, Milwaukee, WI 53226, USA; Section of Allergy, Department of Medicine, Clement J. Zablocki Veterans' Affairs Medical Center, 5000 West National Avenue, 1AN, Milwaukee, WI 53295, USA.
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17
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Ringwald M, Moi L, Wetzel A, Comte D, Muller YD, Ribi C. Risk factors for allergy documentation in electronic health record: A retrospective study in a tertiary health center in Switzerland. Allergol Int 2024; 73:143-150. [PMID: 37455165 DOI: 10.1016/j.alit.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/27/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Most hospitals use electronic health records (EHR) to warn health care professionals of drug hypersensitivity (DH) and other allergies. Indiscriminate recording of patient self-reported allergies may bloat the alert system, leading to unjustified avoidances and increases in health costs. The aim of our study was to analyze hypersensitivities documented in EHR of patients at Lausanne University Hospital (CHUV). METHODS We conducted a retrospective study on patients admitted at least 24 h to CHUV between 2011 and 2021. After ethical clearance, we obtained anonymized data. Because culprit allergen could be either manually recorded or selected through a list, data was harmonized using a reference allergy database before undergoing statistical analysis. RESULTS Of 192,444 patients, 16% had at least one allergy referenced. DH constituted 60% of all allergy alerts, mainly beta-lactam antibiotics (BLA) (30%), NSAID (11%) and iodinated contrast media (ICM) (7%). Median age at first hospitalization and hospitalization length were higher in the allergy group. Female to male ratio was 2:1 in the allergic group. Reactions were limited to the skin in half of patients, and consistent with anaphylaxis in 6%. In those deemed allergic to BLA, culprit drug was specified in 19%, 'allergy to penicillin' otherwise. It was impossible to distinguish DH based on history alone or resulting from specialized work-up. CONCLUSIONS Older age, longer hospital stays, and female sex increase the odds of in-patient allergy documentation. Regarding DH, BLA were referenced in 4% of inpatient records. Specific delabeling programs should be implemented to increase data reliability and patient safety.
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Affiliation(s)
- Maxime Ringwald
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
| | - Laura Moi
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Alexandre Wetzel
- Data Science & Research, Direction of Informatics Systems, Department of Infrastructures, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Denis Comte
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Yannick D Muller
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Camillo Ribi
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
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18
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Yanagisawa R, Yamanaka M, Kawakami F, Nakazawa H. Sub-pollen in platelet products: A potential cause of allergic transfusion reactions. Allergol Int 2024; 73:184-186. [PMID: 37802754 DOI: 10.1016/j.alit.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 10/08/2023] Open
Affiliation(s)
- Ryu Yanagisawa
- Division of Blood Transfusion, Shinshu University Hospital, Matsumoto, Japan; Center for Advanced Cell Therapy, Shinshu University Hospital, Matsumoto, Japan.
| | - Manjiro Yamanaka
- Center for Advanced Cell Therapy, Shinshu University Hospital, Matsumoto, Japan
| | - Fumihiro Kawakami
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hideyuki Nakazawa
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, Matsumoto, Japan
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19
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Rojo Gutiérrez MI, Ballesteros González D. [Oral allergy syndrome (OAS)]. REVISTA ALERGIA MÉXICO 2023; 70:306-312. [PMID: 38506877 DOI: 10.29262/ram.v70i4.1315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
The pollen-food allergy syndrome, also known as oral allergy syndrome, is characterized by local reactions in the mouth and throat after consuming certain raw plant foods in individuals sensitized to pollen from grass, weeds, and trees. Birch-apple is the prototype of this syndrome, with apple, pear, and plum being the most commonly associated foods. Symptoms are usually limited to the oral cavity but can include systemic reactions, including anaphylaxis. Sensitization to pollen allergens, such as lipid transfer proteins, profilin, and PR-10 proteins, triggers this syndrome. Its prevalence varies by geographic region and the predominant pollen type, affecting between 30% and 60% of food allergies. Diagnosis involves a clinical history, skin tests, and, in ambiguous cases, double-blind, placebo-controlled oral food challenges. Treatment primarily involves avoiding trigger foods.
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Affiliation(s)
- María Isabel Rojo Gutiérrez
- Pediatra, Alergóloga e Inmunóloga; profesora de Alergia pediátrica, Facultad de Medicina; Presidenta electa de la Sociedad Latinoamericana de Alergia, Asma e Inmunología (SLAAI) Montevideo,
| | - Diego Ballesteros González
- Médico Cirujano y Partero, Escuela Superior de Medicina, Instituto Politécnico Nacional; Aler-gólogo e inmunólogo clínico, Hospital Juárez de México, Ciudad de México
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20
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Urrutia Pereira M, Solé D. [Food allergy and environmental contamination]. REVISTA ALERGIA MÉXICO 2023; 70:313-318. [PMID: 38506878 DOI: 10.29262/ram.v70i4.1342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/29/2023] [Indexed: 03/21/2024] Open
Abstract
The interaction between genetic potential and the environment, especially increased urbanization and inadequate waste management, contributes to the manifestation of allergic diseases. Pediatric patients are the most vulnerable, due to the immaturity of the respiratory and immune systems. Prenatal and postnatal exposure to air pollutants, both indoors and outdoors, accelerates or aggravates morbidity and mortality from allergic diseases. The "exposome," which encompasses all environmental exposures throughout life, influences health. Biological and chemical attacks alter the epithelial barrier, triggering inflammatory responses and favoring allergic diseases, such as food allergies. The uncontrolled use of toxic fuels, particulate matter, detergents and other factors contribute to the continuous deterioration of the intestinal epithelial barrier, increasing the risk of allergic diseases. It is important to take urgent action to address these issues and protect the health of the planet.
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Affiliation(s)
- Marilyn Urrutia Pereira
- Pediatra, profesora adjunta de la disciplina de Pediatría, Universidad Federal de Pampa, Uruguaiana, Brasil. Coordinadora del Programa de Prevención del Asma Infantil (PIPA),
| | - Dirceu Solé
- Pediatra, Alergólogo e Inmunólogo; profesor titular de la disciplina de Alergia, Inmunología Clínica y Reumatología, Departamento de Pediatría, Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, Brasil
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21
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Koken G, Ertoy Karagol HI, Polat Terece S, Cavdar Z, Cetin K, Egritas Gurkan O, Sari S, Dalgic B, Bakirtas A. Food-induced immediate response of the esophagus in pediatric eosinophilic esophagitis. Allergy 2023; 78:3235-3240. [PMID: 37701950 DOI: 10.1111/all.15881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/21/2023] [Accepted: 08/10/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Food-induced immediate response of the esophagus (FIRE) is a new phenomenon that has been described in eosinophilic esophagitis (EoE) patients. It is suspected when unpleasant symptoms occur suddenly on contact of the triggering food with the esophageal surface and recur with repeated exposures. It can often be mistaken for pollen-food allergy syndrome (PFAS) and solid food dysphagia. Data on FIRE is limited to one survey study and case reports, and there are no screening studies conducted on either adults or children with EoE. In this study, we aimed to screen children aged ≥7 years old with EoE for FIRE. METHODS Demographic data were collected from medical records. A questionnaire about FIRE was applied to all participants. Skin prick tests were done on suspected patients to identify the triggering foods. FIRE is defined as suitable clinical symptoms with suspected food allergen exposure. RESULTS A total of 78 patients (74.4% male, median age: 13.5 years) were included. Unpleasant and recurrent symptoms distinct from dysphagia with specific foods were reported in 16.7% of the patients, all of whom had concomitant allergic rhinitis (AR). The symptoms described by almost all patients were oropharyngeal itching and tingling (PFAS: 15.3%) excluding only one patient reporting retrosternal narrowing and pressure after specific food consumption (FIRE: 1.2%). CONCLUSIONS Although definitive conclusions regarding the true prevalence of FIRE cannot be made, it does not seem to be common as PFAS. However, it deserves questioning particularly in the presence of concurrent AR and/or PFAS in children with EoE.
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Affiliation(s)
- Gizem Koken
- Department of Pediatric Allergy, Gazi University Faculty of Medicine, Ankara, Turkey
- Gazi University Pediatric Eosinophilic Gastrointestinal Diseases Working Group, Ankara, Turkey
| | - Hacer Ilbilge Ertoy Karagol
- Department of Pediatric Allergy, Gazi University Faculty of Medicine, Ankara, Turkey
- Gazi University Pediatric Eosinophilic Gastrointestinal Diseases Working Group, Ankara, Turkey
| | - Sinem Polat Terece
- Department of Pediatric Allergy, Gazi University Faculty of Medicine, Ankara, Turkey
- Gazi University Pediatric Eosinophilic Gastrointestinal Diseases Working Group, Ankara, Turkey
| | - Zeynep Cavdar
- Department of Pediatric Allergy, Gazi University Faculty of Medicine, Ankara, Turkey
- Gazi University Pediatric Eosinophilic Gastrointestinal Diseases Working Group, Ankara, Turkey
| | - Kenan Cetin
- Department of Pediatric Allergy, Gazi University Faculty of Medicine, Ankara, Turkey
- Gazi University Pediatric Eosinophilic Gastrointestinal Diseases Working Group, Ankara, Turkey
| | - Odul Egritas Gurkan
- Gazi University Pediatric Eosinophilic Gastrointestinal Diseases Working Group, Ankara, Turkey
- Department of Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Sinan Sari
- Gazi University Pediatric Eosinophilic Gastrointestinal Diseases Working Group, Ankara, Turkey
- Department of Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Buket Dalgic
- Gazi University Pediatric Eosinophilic Gastrointestinal Diseases Working Group, Ankara, Turkey
- Department of Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Arzu Bakirtas
- Department of Pediatric Allergy, Gazi University Faculty of Medicine, Ankara, Turkey
- Gazi University Pediatric Eosinophilic Gastrointestinal Diseases Working Group, Ankara, Turkey
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22
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Chong AC, Izadi N, Chwa WJ, Tam JS. Fruitful or unfruitful: strawberry and tomato specific immunoglobulin E testing at a tertiary pediatric center. FRONTIERS IN ALLERGY 2023; 4:1277631. [PMID: 37908373 PMCID: PMC10613731 DOI: 10.3389/falgy.2023.1277631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/18/2023] [Indexed: 11/02/2023] Open
Abstract
Background Suspected strawberry and tomato (S/T) food allergy (FA) can be evaluated using specific immunoglobulin E (sIgE) testing despite its low specificity and positive predictive value. Objective This study aims to understand ordering patterns for S/T sIgE testing and identify relevant factors to clinical decision-making. Methods We retrospectively reviewed 814 patients with sIgE testing available for strawberries (651), tomatoes (276), or both (113) from January 2012 to May 2022 at a tertiary pediatric hospital. Patient demographics, provider specialty, and reasons for testing were collected. Student's t-test and multiple regression analyses were performed to test the association between the S/T sIgE level and clinically relevant outcome (CRO) status. Fisher's exact test and general linear models were used to evaluate and compare potential predictive factors for CRO status. Results Allergy and immunology, gastroenterology, and general pediatrics ordered most S/T sIgE testing. Testing was ordered most frequently for non-IgE-mediated gastrointestinal symptoms, mild possible IgE-mediated reactions, and eczema. Testing was most often ordered for infants and school-age children. Mean sIgE levels were higher for S/T tests resulting in a CRO when controlling for other predictor variables (p = 0.015; p = 0.002 for S/T, respectively). Only 2.2% and 5.4% of tests resulted in a CRO for S/T, and severe allergy was rare. Testing for non-IgE-mediated GI symptoms or eczema, or in non-atopic patients, yielded no CROs. Exposure and reaction history of present illness (ERH) was associated with CROs (p < 0.001; p = 0.04) with a high negative predictive value (99.5%; 100%) and low positive predictive value (11.5%; 15.0%). ERH (p < 0.001, η2 = 0.073; p = 0.009, η2 = 0.123) was a more significant predictor than the sIgE level (p = 0.002, η2 = 0.037; p = 0.212, η2 = 0.030) for CRO status. Conclusion The diagnosis of S/T food allergy is made primarily based on clinical history. S/T sIgE testing for children and adolescents should be avoided for patients without an ERH and in the workup of non-IgE-mediated GI symptoms. Testing for eczema and non-atopic patients is likely low-yield.
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Affiliation(s)
- Albert C. Chong
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Neema Izadi
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Division of Clinical Immunology and Allergy, Children’s Hospital Los Angeles, Los Angeles, CA, United States
| | - Won Jong Chwa
- Saint Louis University School of Medicine, Saint Louis University, Saint Louis, MO, United States
| | - Jonathan S. Tam
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Division of Clinical Immunology and Allergy, Children’s Hospital Los Angeles, Los Angeles, CA, United States
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23
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Shichkin VP, Kurchenko OV, Okhotnikova EN, Chopyak VV, Delfino DV. Enterosorbents in complex therapy of food allergies: a focus on digestive disorders and systemic toxicity in children. Front Immunol 2023; 14:1210481. [PMID: 37901242 PMCID: PMC10611465 DOI: 10.3389/fimmu.2023.1210481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023] Open
Abstract
The review analyzes mechanisms and concomitant factors in developing IgE-associated allergic diseases provoked by food allergens and discusses clinical symptoms and current approaches for the treatment of food allergies. The expediency of using enterosorbents in complex therapy of food allergies and skin and respiratory manifestations associated with gastroenterological disorders is substantiated. The review summarizes the experience of using enterosorbents in post-Soviet countries to detoxify the human body. In this regard, special attention is paid to the enterosorbent White Coal (Carbowhite) based on silicon dioxide produced by the Ukrainian company OmniFarma.
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Affiliation(s)
| | | | - Elena N. Okhotnikova
- Department of Pediatrics, Children’s Infectious Diseases, Immunology and Allergology, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Valentyna V. Chopyak
- Department of Clinical Immunology and Allergology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Domenico V. Delfino
- Master in Musculoskeletal and Rheumatological Physiotherapy, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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24
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Cohen B. Allergic Rhinitis. Pediatr Rev 2023; 44:537-550. [PMID: 37777655 DOI: 10.1542/pir.2022-005618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Allergic rhinitis (AR) affects more than 400 million people worldwide, making it 1 of the most prevalent chronic diseases. Childhood AR is increasing, and almost half of patients with AR develop symptoms before age 6 years. Although a diagnosis of AR is associated with higher socioeconomic status, underserved and urban populations have more indoor aeroallergen sensitizations and are likely underdiagnosed with AR, further exacerbating health-care disparities. AR negatively impacts quality of life, school performance, and overall health outcomes. Untreated AR in children increases the risk for poor asthma control, increased asthma severity, and exacerbations. Many patients believe that they have seasonal allergies only but in reality have both perennial and seasonal AR, which may change the approach to allergen avoidance measures and treatment recommendations. Pharmacotherapy of AR has expanded, with many intranasal corticosteroids, intranasal antihistamines, and second-generation oral antihistamines approved for pediatric use. Allergen immunotherapy, including both subcutaneous and sublingual forms, are approved for children and are disease modifying, potentially reducing further allergen sensitization and progression to asthma. Many of the currently available biological therapies indicated for pediatric asthma and/or atopic diseases reduce AR symptoms as well. Children with moderate to severe or refractory AR or those with comorbidities should be referred to allergists for diagnostic testing and expanded management options, including immunotherapy and potential biological treatment.
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Affiliation(s)
- Barrie Cohen
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
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25
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Czolk R, Ruiz‐Castell M, Hunewald O, Wanniang N, Le Coroller G, Hilger C, Vaillant M, Fagherazzi G, Morel‐Codreanu F, Ollert M, Kuehn A. Novel, computational IgE-clustering in a population-based cross-sectional study: Mapping the allergy burden. Clin Transl Allergy 2023; 13:e12292. [PMID: 37746799 PMCID: PMC10478827 DOI: 10.1002/clt2.12292] [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: 03/14/2023] [Revised: 07/12/2023] [Accepted: 07/27/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Even though the prevalence of allergies is increasing, population-based data are still scarce. As a read-out for chronic inflammatory information, new methods are needed to integrate individual biological measurements and lifestyle parameters to mitigate the consequences and costs of allergic burden for society. METHODS More than 480.000 data points were collected from 1462 Luxembourg adults during the representative, cross-sectional European Health Examination Survey, spanning health and lifestyle reports. Deep IgE-profiles based on unsupervised clustering were correlated with data of the health survey. FINDINGS 42.6% of the participants reported a physician-diagnosed allergy and 44% were found to be IgE-positive to at least one allergen or extract. The main sensitization sources were tree pollens followed by grass pollens and mites (52.4%, 51.8% and 40.3% of sensitized participants respectively), suggesting seasonal as well as perennial burden. The youngest group of participants (25-34 years old) showed the highest burden of sensitization, with 18.2% of them having IgE to 10 or more allergen groups. Unsupervised clustering revealed that the biggest cluster of 24.4% of participants was also the one with the highest medical need, marked by their multi-sensitization to respiratory sources. INTERPRETATION Our novel approach to analyzing large biosample datasets together with health information allows the measurement of the chronic inflammatory disease burden in the general population and led to the identification of the most vulnerable groups in need of better medical care.
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Affiliation(s)
- Rebecca Czolk
- Department of Infection and ImmunityLuxembourg Institute of HealthEsch‐sur‐AlzetteLuxembourg
- Faculty of Science, Technology and MedicineUniversity of LuxembourgEsch‐sur‐AlzetteLuxembourg
| | - Maria Ruiz‐Castell
- Epidemiology and Public Health Research UnitDepartment of Precision HealthLuxembourg Institute of HealthStrassenLuxembourg
| | - Oliver Hunewald
- Department of Infection and ImmunityLuxembourg Institute of HealthEsch‐sur‐AlzetteLuxembourg
| | - Naphisabet Wanniang
- Department of Infection and ImmunityLuxembourg Institute of HealthEsch‐sur‐AlzetteLuxembourg
- Faculty of Science, Technology and MedicineUniversity of LuxembourgEsch‐sur‐AlzetteLuxembourg
| | - Gwenaëlle Le Coroller
- Competence Center for Methodology and StatisticsTranslational Medicine Operations HubLuxembourg Institute of HealthStrassenLuxembourg
| | - Christiane Hilger
- Department of Infection and ImmunityLuxembourg Institute of HealthEsch‐sur‐AlzetteLuxembourg
| | - Michel Vaillant
- Competence Center for Methodology and StatisticsTranslational Medicine Operations HubLuxembourg Institute of HealthStrassenLuxembourg
| | - Guy Fagherazzi
- Epidemiology and Public Health Research UnitDepartment of Precision HealthLuxembourg Institute of HealthStrassenLuxembourg
| | - Françoise Morel‐Codreanu
- Department of Allergology and ImmunologyCentre Hospitalier de Luxembourg‐Kanner KlinikLuxembourgLuxembourg
| | - Markus Ollert
- Department of Infection and ImmunityLuxembourg Institute of HealthEsch‐sur‐AlzetteLuxembourg
- Department of Dermatology and Allergy CenterOdense Research Center for AnaphylaxisOdense University HospitalUniversity of Southern DenmarkOdenseDenmark
| | - Annette Kuehn
- Department of Infection and ImmunityLuxembourg Institute of HealthEsch‐sur‐AlzetteLuxembourg
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26
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Yamamoto R, Izawa K, Ando T, Kaitani A, Tanabe A, Yamada H, Uchida S, Yoshikawa A, Kume Y, Toriumi S, Maehara A, Wang H, Nagamine M, Negishi N, Nakano N, Ebihara N, Shimizu T, Ogawa H, Okumura K, Kitaura J. Murine model identifies tropomyosin as IgE cross-reactive protein between house dust mite and coho salmon that possibly contributes to the development of salmon allergy. Front Immunol 2023; 14:1238297. [PMID: 37711608 PMCID: PMC10498769 DOI: 10.3389/fimmu.2023.1238297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
Background Recently, we have developed a method to identify IgE cross-reactive allergens. However, the mechanism by which IgE cross-reactive allergens cause food allergy is not yet fully understood how. In this study, we aimed to understand the underlying pathogenesis by identifying food allergens that cross-react with house dust mite allergens in a murine model. Material and methods Allergenic protein microarray analysis was conducted using serum from mice intraperitoneally injected with Dermatophagoides pteronyssinus (Der p) extract plus alum or alum alone as controls. Der p, Dermatophagoides farinae (Der f), coho salmon extract-sensitized and control mice were analyzed. Serum levels of IgE against Der p, Der f, coho salmon extract, protein fractions of coho salmon extract separated by ammonium sulfate precipitation and anion exchange chromatography, and recombinant coho salmon tropomyosin or actin were measured by an enzyme-linked immunosorbent assay. A murine model of cutaneous anaphylaxis or oral allergy syndrome (OAS) was established in Der p extract-sensitized mice stimulated with coho salmon extract, tropomyosin, or actin. Results Protein microarray analysis showed that coho salmon-derived proteins were highly bound to serum IgE in Der p extract-sensitized mice. Serum IgE from Der p or Der f extract-sensitized mice was bound to coho salmon extract, whereas serum IgE from coho salmon extract-sensitized mice was bound to Der p or Der f extract. Analysis of the murine model showed that cutaneous anaphylaxis and oral allergic reaction were evident in Der p extract-sensitized mice stimulated by coho salmon extract. Serum IgE from Der p or Der f extract-sensitized mice was bound strongly to protein fractions separated by anion exchange chromatography of coho salmon proteins precipitated with 50% ammonium sulfate, which massively contained the approximately 38 kDa protein. We found that serum IgE from Der p extract-sensitized mice was bound to recombinant coho salmon tropomyosin. Der p extract-sensitized mice exhibited cutaneous anaphylaxis in response to coho salmon tropomyosin. Conclusion Our results showed IgE cross-reactivity of tropomyosin between Dermatophagoides and coho salmon which illustrates salmon allergy following sensitization with the house dust mite Dermatophagoides. Our method for identifying IgE cross-reactive allergens will help understand the underlying mechanisms of food allergies.
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Affiliation(s)
- Risa Yamamoto
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kumi Izawa
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomoaki Ando
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ayako Kaitani
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Tanabe
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiromichi Yamada
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shino Uchida
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akihisa Yoshikawa
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Otorhinolaryngology, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - Yasuharu Kume
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Shun Toriumi
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akie Maehara
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hexing Wang
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Science of Allergy and Inflammation, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - Masakazu Nagamine
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Naoko Negishi
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobuhiro Nakano
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobuyuki Ebihara
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Toshiaki Shimizu
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hideoki Ogawa
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ko Okumura
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Jiro Kitaura
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Science of Allergy and Inflammation, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan
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27
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Gil MV, Fernández-Rivera N, Pastor-Vargas C, Cintas P. Food Allergens: When Friends Become Foes-Caveats and Opportunities for Oral Immunotherapy Based on Deactivation Methods. Nutrients 2023; 15:3650. [PMID: 37630840 PMCID: PMC10458749 DOI: 10.3390/nu15163650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/12/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Food allergies represent a serious health concern and, since the 1990s, they have risen gradually in high-income countries. Unfortunately, the problem is complex because genetic, epigenetic, and environmental factors may be collectively involved. Prevention and diagnoses have not yet evolved into efficacious therapies. Identification and control of allergens present in edible substances hold promise for multi-purpose biomedical approaches, including oral immunotherapy. This review highlights recent studies and methods to modify the otherwise innocuous native proteins in most subjects, and how oral treatments targeting immune responses could help cancel out the potential risks in hypersensitive individuals, especially children. We have focused on some physical methods that can easily be conducted, along with chemo-enzymatic modifications of allergens by means of peptides and phytochemicals in particular. The latter, accessible from naturally-occurring substances, provide an added value to hypoallergenic matrices employing vegetal wastes, a point where food chemistry meets sustainable goals as well.
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Affiliation(s)
- M. Victoria Gil
- Departamento de Química Orgánica e Inorgánica, Facultad de Ciencias, IACYS-Unidad de Química Verde y Desarrollo Sostenible, Universidad de Extremadura, 06006 Badajoz, Spain
| | - Nuria Fernández-Rivera
- Departamento de Química Orgánica e Inorgánica, Facultad de Ciencias, IACYS-Unidad de Química Verde y Desarrollo Sostenible, Universidad de Extremadura, 06006 Badajoz, Spain
| | - Carlos Pastor-Vargas
- Departamento de Bioquímica y Biología Molecular, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Pedro Cintas
- Departamento de Química Orgánica e Inorgánica, Facultad de Ciencias, IACYS-Unidad de Química Verde y Desarrollo Sostenible, Universidad de Extremadura, 06006 Badajoz, Spain
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28
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Krajewski GS, Krajewski T. Evaluation and Management of Food Allergies in the Emergency Department. Immunol Allergy Clin North Am 2023; 43:491-501. [PMID: 37394255 DOI: 10.1016/j.iac.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Food allergies are a common and serious cause of illness, accounting for an increasing number of emergency department visits annually. Although definite diagnosis lays outside of an emergency department visit, the clinical management of the most serious food allergies highlights emergency care. The staple of acute care remains epinephrine in association with antihistamines and steroids. The greatest threat remains undertreatment for this group of disorders and underutilization of epinephrine. Those who have been treated for a food allergy need a follow-up allergist evaluation, guidance of food avoidance, and avoidance of foods with cross-sensitivities as well as ready access to epinephrine.
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Affiliation(s)
- Genevieve Schult Krajewski
- Ochsner Medical Center Emergency Department, 1514 Jefferson Highway, New Orleans, LA 70121, USA; Ochsner Emergency Medicine Residency, New Orleans, LA, USA; Ochsner Clinical School at the University of Queensland, New Orleans, LA, USA.
| | - Thomas Krajewski
- Ochsner Medical Center Emergency Department, 1514 Jefferson Highway, New Orleans, LA 70121, USA
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29
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Gómez ARG, Cañas AP, Sotomayor JM, Castelló MC, Borja Segade JM, Torrijos EG. Eosinophilic esophagitis and immunoglobulin E-mediated food allergy. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:273-274. [PMID: 38904526 DOI: 10.47102/annals-acadmedsg.202326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Affiliation(s)
| | | | | | - Miriam Clar Castelló
- Allergology Section, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | - Elisa Gomez Torrijos
- Allergology Section, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
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30
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Tekeli S, Şirin S, Özmen S. A hidden allergen of anaphylaxis: Beetroot. REVUE FRANÇAISE D'ALLERGOLOGIE 2023. [DOI: 10.1016/j.reval.2023.103631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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31
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Wise SK, Damask C, Roland LT, Ebert C, Levy JM, Lin S, Luong A, Rodriguez K, Sedaghat AR, Toskala E, Villwock J, Abdullah B, Akdis C, Alt JA, Ansotegui IJ, Azar A, Baroody F, Benninger MS, Bernstein J, Brook C, Campbell R, Casale T, Chaaban MR, Chew FT, Chambliss J, Cianferoni A, Custovic A, Davis EM, DelGaudio JM, Ellis AK, Flanagan C, Fokkens WJ, Franzese C, Greenhawt M, Gill A, Halderman A, Hohlfeld JM, Incorvaia C, Joe SA, Joshi S, Kuruvilla ME, Kim J, Klein AM, Krouse HJ, Kuan EC, Lang D, Larenas-Linnemann D, Laury AM, Lechner M, Lee SE, Lee VS, Loftus P, Marcus S, Marzouk H, Mattos J, McCoul E, Melen E, Mims JW, Mullol J, Nayak JV, Oppenheimer J, Orlandi RR, Phillips K, Platt M, Ramanathan M, Raymond M, Rhee CS, Reitsma S, Ryan M, Sastre J, Schlosser RJ, Schuman TA, Shaker MS, Sheikh A, Smith KA, Soyka MB, Takashima M, Tang M, Tantilipikorn P, Taw MB, Tversky J, Tyler MA, Veling MC, Wallace D, Wang DY, White A, Zhang L. International consensus statement on allergy and rhinology: Allergic rhinitis - 2023. Int Forum Allergy Rhinol 2023; 13:293-859. [PMID: 36878860 DOI: 10.1002/alr.23090] [Citation(s) in RCA: 72] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/11/2022] [Accepted: 09/13/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document. METHODS ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. RESULTS ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. CONCLUSION The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.
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Affiliation(s)
- Sarah K Wise
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Cecelia Damask
- Otolaryngology-HNS, Private Practice, University of Central Florida, Lake Mary, Florida, USA
| | - Lauren T Roland
- Otolaryngology-HNS, Washington University, St. Louis, Missouri, USA
| | - Charles Ebert
- Otolaryngology-HNS, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joshua M Levy
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Sandra Lin
- Otolaryngology-HNS, University of Wisconsin, Madison, Wisconsin, USA
| | - Amber Luong
- Otolaryngology-HNS, McGovern Medical School of the University of Texas, Houston, Texas, USA
| | - Kenneth Rodriguez
- Otolaryngology-HNS, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ahmad R Sedaghat
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Elina Toskala
- Otolaryngology-HNS, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Baharudin Abdullah
- Otolaryngology-HNS, Universiti Sains Malaysia, Kubang, Kerian, Kelantan, Malaysia
| | - Cezmi Akdis
- Immunology, Infectious Diseases, Swiss Institute of Allergy and Asthma Research, Davos, Switzerland
| | - Jeremiah A Alt
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fuad Baroody
- Otolaryngology-HNS, University of Chicago, Chicago, Illinois, USA
| | | | | | - Christopher Brook
- Otolaryngology-HNS, Harvard University, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Raewyn Campbell
- Otolaryngology-HNS, Macquarie University, Sydney, NSW, Australia
| | - Thomas Casale
- Allergy/Immunology, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Mohamad R Chaaban
- Otolaryngology-HNS, Cleveland Clinic, Case Western Reserve University, Cleveland, Ohio, USA
| | - Fook Tim Chew
- Allergy/Immunology, Genetics, National University of Singapore, Singapore, Singapore
| | - Jeffrey Chambliss
- Allergy/Immunology, University of Texas Southwestern, Dallas, Texas, USA
| | - Antonella Cianferoni
- Allergy/Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | - Anne K Ellis
- Allergy/Immunology, Queens University, Kingston, ON, Canada
| | | | - Wytske J Fokkens
- Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | | | - Matthew Greenhawt
- Allergy/Immunology, Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Amarbir Gill
- Otolaryngology-HNS, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashleigh Halderman
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Jens M Hohlfeld
- Respiratory Medicine, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover Medical School, German Center for Lung Research, Hannover, Germany
| | | | - Stephanie A Joe
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Shyam Joshi
- Allergy/Immunology, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Jean Kim
- Otolaryngology-HNS, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adam M Klein
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Helene J Krouse
- Otorhinolaryngology Nursing, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Edward C Kuan
- Otolaryngology-HNS, University of California Irvine, Orange, California, USA
| | - David Lang
- Allergy/Immunology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Matt Lechner
- Otolaryngology-HNS, University College London, Barts Health NHS Trust, London, UK
| | - Stella E Lee
- Otolaryngology-HNS, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Victoria S Lee
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Patricia Loftus
- Otolaryngology-HNS, University of California San Francisco, San Francisco, California, USA
| | - Sonya Marcus
- Otolaryngology-HNS, Stony Brook University, Stony Brook, New York, USA
| | - Haidy Marzouk
- Otolaryngology-HNS, State University of New York Upstate, Syracuse, New York, USA
| | - Jose Mattos
- Otolaryngology-HNS, University of Virginia, Charlottesville, Virginia, USA
| | - Edward McCoul
- Otolaryngology-HNS, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Erik Melen
- Pediatric Allergy, Karolinska Institutet, Stockholm, Sweden
| | - James W Mims
- Otolaryngology-HNS, Wake Forest University, Winston Salem, North Carolina, USA
| | - Joaquim Mullol
- Otorhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Jayakar V Nayak
- Otolaryngology-HNS, Stanford University, Palo Alto, California, USA
| | - John Oppenheimer
- Allergy/Immunology, Rutgers, State University of New Jersey, Newark, New Jersey, USA
| | | | - Katie Phillips
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael Platt
- Otolaryngology-HNS, Boston University, Boston, Massachusetts, USA
| | | | | | - Chae-Seo Rhee
- Rhinology/Allergy, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Sietze Reitsma
- Otolaryngology-HNS, University of Amsterdam, Amsterdam, Netherlands
| | - Matthew Ryan
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Joaquin Sastre
- Allergy, Fundacion Jiminez Diaz, University Autonoma de Madrid, Madrid, Spain
| | - Rodney J Schlosser
- Otolaryngology-HNS, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore A Schuman
- Otolaryngology-HNS, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marcus S Shaker
- Allergy/Immunology, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Aziz Sheikh
- Primary Care, University of Edinburgh, Edinburgh, Scotland
| | - Kristine A Smith
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | - Michael B Soyka
- Otolaryngology-HNS, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Masayoshi Takashima
- Otolaryngology-HNS, Houston Methodist Academic Institute, Houston, Texas, USA
| | - Monica Tang
- Allergy/Immunology, University of California San Francisco, San Francisco, California, USA
| | | | - Malcolm B Taw
- Integrative East-West Medicine, University of California Los Angeles, Westlake Village, California, USA
| | - Jody Tversky
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Matthew A Tyler
- Otolaryngology-HNS, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maria C Veling
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Dana Wallace
- Allergy/Immunology, Nova Southeastern University, Ft. Lauderdale, Florida, USA
| | - De Yun Wang
- Otolaryngology-HNS, National University of Singapore, Singapore, Singapore
| | - Andrew White
- Allergy/Immunology, Scripps Clinic, San Diego, California, USA
| | - Luo Zhang
- Otolaryngology-HNS, Beijing Tongren Hospital, Beijing, China
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Eczema phenotypes and IgE component sensitization in adolescents: A population-based birth cohort. Allergol Int 2023; 72:107-115. [PMID: 35781407 DOI: 10.1016/j.alit.2022.05.012] [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: 02/27/2022] [Revised: 05/14/2022] [Accepted: 05/22/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Eczema patients are commonly immunoglobulin (Ig)E polysensitized. Although atopic dermatitis (AD) phenotypes have been recognized, IgE sensitization patterns based on AD phenotypes have not been well illustrated. We aimed to investigate how eczema phenotypes impact IgE component sensitization patterns. METHODS This birth cohort study investigated a general population in the Tokyo Children's Health, Illness, and Development Study (T-Child Study) until children reached the age of 13 years. Eczema was assessed using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Allergen component specific IgE antibody titers were measured using a multiplex array ImmunoCAP ISAC. RESULTS Persistent eczema phenotype until adolescence was strongly associated with allergic march symptoms, such as wheezing and hay fever, and oral allergy symptoms, and IgE component sensitizations of airborne (Japanese cedar, house dust mite, Timothy, cat, and dog) and cross-reactive allergens (Bet v 1 family) compared to early-remission and late-onset eczema. On the other hand, late-onset eczema did not show any strong associations with allergic symptoms and IgE sensitization. Adolescents with persistent eczema have high comorbidity of symptoms of pollen-food allergy syndrome. CONCLUSIONS Early-onset eczema is deeply connected with the later allergic march, and late-onset eczema differs from the phenotype of allergic march. Early-onset eczema characterizing IgE sensitization was likely to be an extrinsic type, and late-onset eczema, which was not related to IgE sensitization, was likely an intrinsic type. Pollen-Food Allergy Syndrome is one of the allergic features in allergic march.
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Kato M, Miyamoto M, Takayanagi F, Ando Y, Fujita Y, Nakayama M, Yoshihara S. Pollen Food Allergy Syndrome in Japanese Children and Adolescents: Risk Factors and Pollen Sensitisation. J Immunol Res 2023; 2023:4075264. [PMID: 36937005 PMCID: PMC10019972 DOI: 10.1155/2023/4075264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 03/12/2023] Open
Abstract
Pollen food allergy syndrome (PFAS) is caused by cross-reactivity with pollen; however, not all-pollen-sensitised individuals develop PFAS, and studies on the characteristics of PFAS development are limited in Japan. We investigated the prevalence and risk factors for the development of PFAS in Japanese children and adolescents sensitised to pollen and their association with pollen-specific IgE levels. The characteristics of PFAS were investigated in patients with allergies aged 3-18 years who visited Dokkyo Medical University Hospital between January 2016 and December 2019. Specific IgE levels for alder, Japanese cedar, ragweed, and orchard grass were measured in patients sensitised to any of the pollens. Patients were categorised into preschool (G1), elementary school (G2), and middle-high school (G3) groups. Overall, 600 patients were enrolled. The prevalence of PFAS was 8.5% in G1, 20% in G2, and 36.3% in G3. Multivariate logistic regression analysis demonstrated strong associations between the risk of developing PFAS and older age (odds ratio (OR), 1.12; 95% confidence interval (CI), 1.06-1.19; P < 0.001), seasonal allergy rhinitis (OR, 6.93; 95% CI, 1.59-30.34; P = 0.010), and alder sensitisation (OR, 6.20; 95% CI, 2.66-14.49; P < 0.001). Spearman's correlation revealed statistically significant positive correlation between each pollen-specific IgE level; high pollen-specific IgE levels were also a risk factor. The OR for being sensitised to all four species was 36.83 (95% CI, 8.93-151.83, P < 0.001) when compared with Japanese cedar alone. Alder was most relevant, with an alder-specific IgE level cutoff value of 2.54 UA/mL. The sensitivity was 78.9%, and the specificity was 70.9%. In conclusion, preschool children develop PFAS with alder sensitisation, and higher pollen-specific IgE levels and increased number of pollen sensitisations are risk factors for developing PFAS.
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Affiliation(s)
- Masaya Kato
- Department of Pediatrics, Dokkyo Medical University, Tochigi, Japan
| | - Manabu Miyamoto
- Department of Pediatrics, Dokkyo Medical University, Tochigi, Japan
| | | | - Yusuke Ando
- Department of Pediatrics, Dokkyo Medical University, Tochigi, Japan
| | - Yuji Fujita
- Department of Pediatrics, Dokkyo Medical University, Tochigi, Japan
| | - Motoko Nakayama
- Department of Pediatrics, Dokkyo Medical University, Tochigi, Japan
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Open sesame: Shedding light on an emerging global allergen. Ann Allergy Asthma Immunol 2023; 130:40-45. [PMID: 35973653 DOI: 10.1016/j.anai.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Sesame allergy has been characterized in the Middle East for some time. However, it has become more widely recognized as foods containing sesame and sesame seeds have become increasingly available in Australia, Europe, and North America. With the passage of the Food Allergy Safety, Treatment, Education, and Research Act in 2021, the United States will join other countries in identifying sesame as a major food allergen and require sesame to be labeled as a food allergen beginning in 2023. OBJECTIVE To review the literature related to sesame allergy as an increasingly recognized food allergen around the world. DATA SOURCES English-language articles retrieved by PubMed searches with relevance to sesame allergy. STUDY SELECTIONS Articles were included using the search terms "sesame allergy" and "sesame seed allergy." RESULTS A total of 69 relevant articles regarding sesame allergy, relating to its prevalence, clinical presentation, natural history, allergenic epitopes, diagnosis, and treatment, were selected. CONCLUSION In recent decades, considerable gains have been made in determining prevalence and natural history of sesame allergy. With increased recognition and prevalence come the need for reliable methods of identification of sesame allergy and approaches for management.
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Yoshida T, Morita E, Chinuki Y, Kohno K, Yamasaki O. Usefulness of Gly m 4‐specific
IgE
test in the diagnosis of Rosaceae fruit‐oral allergy syndrome caused by Betulaceae pollen sensitization. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2022. [DOI: 10.1002/cia2.12291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Tokiko Yoshida
- Department of Dermatology Shimane University Faculty of Medicine Izumo Japan
| | - Eishin Morita
- Department of Dermatology Shimane University Faculty of Medicine Izumo Japan
| | - Yuko Chinuki
- Department of Dermatology Shimane University Faculty of Medicine Izumo Japan
| | - Kunie Kohno
- Department of Dermatology Shimane University Faculty of Medicine Izumo Japan
- Department of Clinical Trial Management, Clinical Research Center Shimane University Hospital Izumo Japan
| | - Osamu Yamasaki
- Department of Dermatology Shimane University Faculty of Medicine Izumo Japan
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36
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Devenir des allergies alimentaires à l’âge adulte. REVUE FRANÇAISE D'ALLERGOLOGIE 2022. [DOI: 10.1016/s1877-0320(22)00485-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Hwang Y, Motomura C, Fukuda H, Kishikawa R, Watanabe N, Yoshihara S. Relationship among airborne pollen, sensitization, and pollen food allergy syndrome in Asian allergic children. PeerJ 2022; 10:e14243. [PMID: 36340201 PMCID: PMC9635357 DOI: 10.7717/peerj.14243] [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: 05/20/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022] Open
Abstract
Background Causes of pediatric pollen food allergy syndrome (PFAS) differ depending on airborne pollen levels in a particular region. We aimed to analyze airborne pollen counts, IgE sensitization rates, and PFAS incidence among children with allergies in South Korea and Japan. Methods This cross-sectional study included children aged 5-17 years with allergies in 2017. Airborne pollen samples were collected from Busan in South Korea, and Fukuoka and Tochigi in Japan. Questionnaires were used to assess bronchial asthma, seasonal allergic rhinitis, atopic dermatitis, food allergy, and PFAS. The serum IgE specific to Dermatophagoides pteronyssinus, pollen, tomato, and peach were investigated. Results In total, 57, 56, and 20 patients from Busan, Fukuoka, and Tochigi, respectively, were enrolled. Airborne Japanese cedar and cypress pollen were predominant in Fukuoka and Tochigi, whereas pine and alder pollen were predominant in Busan. Children with allergies in Fukuoka and Tochigi had a significantly higher sensitization rate to Japanese cedar, cypress, juniper, orchard grass, ragweed, Japanese hop, and tomato compared with children in Busan. In Fukuoka and Tochigi, where Japanese cedar and cypress pollen were frequently scattered, high sensitizations among allergic children were observed. The sensitization rate was not affected by the pollen count in alder, grass, ragweed, and Japanese hop. In multivariable analysis, only alder sensitization was found to be associated with PFAS (odds ratio: 6.62, 95% confidence interval: 1.63-26.87, p = 0.008). In patients with PFAS in Busan and Tochigi, peach associated with birch allergen Bet v 1 was a causative food item for PFAS. Moreover, PFAS was associated with ragweed and Japanese hop pollen sensitization in Fukuoka. Conclusion Regardless of pollen counts, alder pollen sensitization was associated with PFAS in children. Ragweed and Japanese hop pollen sensitization were associated with PFAS, particularly among children in southern Japan.
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Affiliation(s)
- Yoonha Hwang
- Department of Pediatrics, Busan St. Mary’s Hospital, Busan, South Korea
| | - Chikako Motomura
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Hironobu Fukuda
- Department of Pediatrics, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Reiko Kishikawa
- Department of Allergy, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Naoto Watanabe
- Department of Allergy Internal Medicine, Seirei Yokohama Hospital, Kanagawa, Japan
| | - Shigemi Yoshihara
- Department of Pediatrics, Dokkyo Medical University Hospital, Tochigi, Japan
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Alves PB, Pereira HP, Alves MP, Roseta L, Tavares B, Loureiro G, Carrapatoso I, Todo-Bom A, Regateiro FS. Predictors of anaphylaxis to peanut and tree nuts in a Mediterranean population. Allergy Asthma Proc 2022; 43:533-542. [PMID: 36335421 DOI: 10.2500/aap.2022.43.220060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: Peanuts (PN) and tree nuts (TN) are major causes of anaphylaxis worldwide. We aimed to determine the clinical and demographic characteristics associated with anaphylaxis in patients sensitized to PN and/or TN in a Mediterranean population. Methods: We conducted a retrospective study, which included 198 patients allergic to PN and/or TN (allergy symptoms plus specific immunoglobulin E [sIgE] sensitization), evaluated in consultations from January 2015 to December 2020. Univariate analysis and multivariate logistic regression models were developed, including demographic, clinical, and laboratory data as independent variables, and anaphylaxis to each PN and/or TN as a dependent variables. Results: Anaphylaxis was associated with an earlier age of onset of allergy to PN, cashew and/or pistachio, and pine nut allergy but not to other TN allergies. Gender, atopic comorbidities, and cofactors were not associated with PN and/or TN anaphylaxis. Anaphylaxis to PN, cashew and/or pistachio, and pine nut were associated with reactivity to a fewer number of PN and/or TN foods. Although sIgE sensitization to lipid transfer proteins (LTP) was highly prevalent in our population, only seed storage protein (SSP) positivity was associated with anaphylaxis in PN allergy. The absence of pathogenesis-related protein family 10 sensitization correlated with PN and hazelnut anaphylaxis. A higher level of sIgE to almond extract predicted anaphylaxis but the level of sIgE to other PN and/or TN extracts did not predict it. Conclusion: The high prevalence of sensitization to the pan-allergen LTP did not seem to have a significant impact in PN and/or TN allergy severity in our study. Instead, other factors, such as early age of onset and positivity for SSPs, seem to strongly associate with anaphylaxis to specific PN and/or TN. These findings may contribute to individual risk assessment in these populations.
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Affiliation(s)
- Pedro B Alves
- From the Allergy and Clinical Immunology Unit, University Hospital of Coimbra, Coimbra, Portugal
| | - Helena P Pereira
- From the Allergy and Clinical Immunology Unit, University Hospital of Coimbra, Coimbra, Portugal
| | - Marta P Alves
- From the Allergy and Clinical Immunology Unit, University Hospital of Coimbra, Coimbra, Portugal
| | - Luis Roseta
- Clinical Pathology Unit, University Hospital of Coimbra, Coimbra, Portugal
| | - Beatriz Tavares
- From the Allergy and Clinical Immunology Unit, University Hospital of Coimbra, Coimbra, Portugal
| | - Graça Loureiro
- From the Allergy and Clinical Immunology Unit, University Hospital of Coimbra, Coimbra, Portugal
| | - Isabel Carrapatoso
- From the Allergy and Clinical Immunology Unit, University Hospital of Coimbra, Coimbra, Portugal
| | - Ana Todo-Bom
- From the Allergy and Clinical Immunology Unit, University Hospital of Coimbra, Coimbra, Portugal
| | - Frederico S Regateiro
- From the Allergy and Clinical Immunology Unit, University Hospital of Coimbra, Coimbra, Portugal
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Olivieri B, Stoenchev KV, Skypala IJ. Anaphylaxis across Europe: are pollen food syndrome and lipid transfer protein allergy so far apart? Curr Opin Allergy Clin Immunol 2022; 22:291-297. [PMID: 35942860 DOI: 10.1097/aci.0000000000000847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Traditionally pollen-food syndrome (PFS) is considered to be a mild cross-reacting food allergy affecting only Northern Europe, with lipid transfer protein (LTP) allergy being more severe and mainly occurring in Southern Europe. This review seeks to update the reader on both types of plant food allergy and to determine whether the stereotypical presentations of these plant food allergies remain the same, with a particular focus on reaction severity. RECENT FINDINGS Recent findings suggest that both these types of plant food allergy occur in children and adults. Although it is true that PFS allergy is more prevalent in Northern Europe and LTP allergy is more well known in Southern Europe, these conditions are not hidebound by geography, and the increasing spread and allergenicity of pollen due to global warming continues to change their presentation. Both conditions have a spectrum of symptom severity, with PFS sometimes presenting with more severe symptoms, including anaphylaxis and LTP allergy with milder reactions. SUMMARY It is important to consider that in many parts of Europe, reactions to plant foods, especially fruits or vegetables, could be mediated either by pollen cross-reactivity or primary sensitization to LTP allergens. All those presenting with symptoms to plant foods will benefit from a detailed clinical history and appropriate tests so that an accurate diagnosis can be made, and correct management implemented.
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Affiliation(s)
- Bianca Olivieri
- Department of Medicine, Asthma, Allergy and Clinical Immunology Section, University of Verona, Verona, Italy
| | - Kostadin V Stoenchev
- Royal Brompton & Harefield Hospitals, Part of Guys and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Isabel J Skypala
- Royal Brompton & Harefield Hospitals, Part of Guys and St Thomas NHS Foundation Trust, London, United Kingdom
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Diem L, Neuherz B, Rohrhofer J, Koidl L, Asero R, Brockow K, Diaz Perales A, Faber M, Gebhardt J, Torres MJ, Jensen‐Jarolim E, Zehetmayer S, Untersmayr E. Real-life evaluation of molecular multiplex IgE test methods in the diagnosis of pollen associated food allergy. Allergy 2022; 77:3028-3040. [PMID: 35485989 PMCID: PMC9790655 DOI: 10.1111/all.15329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/13/2022] [Accepted: 03/26/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Diagnosis of food allergies is challenging, as combining information from specific IgE (sIgE)-sensitization pattern and skin prick tests (SPTs) with clinical history is necessary for a personalized management of allergic patients. The aim of this study was to compare two molecular tests, the ImmunoCAP ISAC (ISAC) and the Allergy Explorer, version 2 (ALEX2 ) in the context of pollen food syndrome (PFS) diagnosis in a real-life scenario, to assess the benefit of multiplex testing in PFS patients. METHODS Diagnosis of food allergy was performed in 53 patients. Allergen-sIgE concentrations were measured with ISAC and ALEX2 . Results for sIgE were statistically compared with each other, with SPT results and with clinical presentation of the patients. RESULTS Using ISAC as reference test for sIgE measurements, the average sensitivity of ALEX2 for PR-10 allergens was 83.2% and the average specificity 88.0%. If only low sIgE concentrations were included, the sensitivity was 60.8% and the specificity 91.1%. Apple and hazelnut sensitizations were confirmed in most patients by concordance of sIgE and SPT results. Significant correlations were shown between clinical symptoms and Mal d 1- and Gly m 4-sIgE levels measured by both tests and for Cor a 1-sIgE levels measured by ALEX2 . In eight patients, profilin related symptoms were supported by Hev b 8-sensitization. CONCLUSION Multiplex testing is beneficial to understand patient-specific individual sensitization profiles and to providing personalized management recommendations. In the future, custom-designed test kits might enable reducing costs of multiplex testing for specific patient groups without compromising the diagnostic value.
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Affiliation(s)
- Luisa Diem
- Institute for Pathophysiology and Allergy ResearchCenter for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
| | - Bellinda Neuherz
- Institute for Pathophysiology and Allergy ResearchCenter for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
| | - Johanna Rohrhofer
- Institute for Pathophysiology and Allergy ResearchCenter for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
| | - Larissa Koidl
- Institute for Pathophysiology and Allergy ResearchCenter for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
| | - Riccardo Asero
- Ambulatorio di AllergologiaClinica San CarloPaderno Dugnano (MI)Italy
| | - Knut Brockow
- Department of Dermatology and Allergy BiedersteinFaculty of MedicineTechnical University of MunichMunichGermany
| | - Araceli Diaz Perales
- Centro de Biotecnología Y Genómica de Plantas (CBGP, UPM‐INIA)Universidad Politécnica de Madrid (UPM) ‐Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria (INIA)MadridSpain,Departamento de Biotecnología‐Biología VegetalEscuela Técnica Superior de Ingeniería AgronómicaAlimentaria y de Biosistemas. Universidad Politécnica de Madrid (UPM)MadridSpain
| | | | - Julia Gebhardt
- Department of Dermatology and Allergy BiedersteinFaculty of MedicineTechnical University of MunichMunichGermany
| | - María José Torres
- Allergy UnitHospital Regional Universitario de MálagaUniversidad de Málaga‐IBIMA‐BIONANDMálagaSpain
| | - Erika Jensen‐Jarolim
- Institute for Pathophysiology and Allergy ResearchCenter for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria,The Interuniversity Messerli Research Institute of the University of Veterinary Medicine ViennaMedical University of Vienna, and University of ViennaViennaAustria,AllergyCareAllergy Diagnosis and Study CenterViennaAustria
| | - Sonja Zehetmayer
- Center for Medical StatisticsInformatics and Intelligent Systems (Institute of Medical Statistics)Medical University of ViennaViennaAustria
| | - Eva Untersmayr
- Institute for Pathophysiology and Allergy ResearchCenter for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
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Demoly P, Liu AH, Rodriguez Del Rio P, Pedersen S, Casale TB, Price D. A Pragmatic Primary Practice Approach to Using Specific IgE in Allergy Testing in Asthma Diagnosis, Management, and Referral. J Asthma Allergy 2022; 15:1069-1080. [PMID: 35996427 PMCID: PMC9392458 DOI: 10.2147/jaa.s362588] [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: 03/10/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022] Open
Abstract
Asthma afflicts an estimated 339 million people globally and is associated with ill health, disability, and early death. Strong risk factors for developing asthma are genetic predisposition and environmental exposure to inhaled substances that may provoke allergic reactions. Asthma guidelines recommend identifying causal or trigger allergens with specific IgE (sIgE) testing after a diagnosis of asthma has been made. Allergy testing with sIgE targets subpopulations of patients considered at high risk, such as those with frequent exacerbations, emergency visits or hospitalizations, or uncontrolled symptoms. Specific recommendations apply to preschool children, school-age children, patients with persistent or difficult-to-control asthma, patients needing oral corticosteroids or high-dose inhaled steroids, patients seeking understanding and guidance about their disease, and candidates for advanced therapies (biologics, allergen immunotherapy). Allergen skin testing is common in specialized settings but less available in primary care. Blood tests for total and sIgE are accessible and yield quantifiable results for tested allergens, useful for detecting sensitization. Results are interpreted in the context of the patient’s clinical presentation, age, and relevant allergen exposures. Incorporating sIgE testing into asthma management adds objective information to identify specific allergies and can guide personalized treatment plans, which reinforce patient-doctor communication. Test results can also be used to predict exacerbations and response to therapies. Additional diagnostic information can be gleaned from (i) eosinophil count ≥300 μL, which significantly increases the odds of having exacerbations, and emerging eosinophil biomarkers (eg, eosinophil-derived neurotoxin), which can be measured in plasma or serum samples, and (ii) fractional exhaled nitric oxide (FeNO), with values ≥25 ppb regarded as the cutoff for diagnosis, evaluating inhaled corticosteroid response, and of probable response to anti-IgE, anti-IL4 and anti-IL5 receptor biologics. Referral to asthma/allergy specialists is warranted when the initial diagnosis is uncertain, and when asthma symptoms, impairment, or exacerbations are repeated or severe.
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Affiliation(s)
- Pascal Demoly
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, Montpellier, France.,IDESP Inserm, University, Hospital of Montpellier, Montpellier, France
| | - Andrew H Liu
- Airway Inflammation, Resilience & the Environment (AIRE) Program, Breathing Institute, Section of Pediatric Pulmonary & Sleep Medicine, Children's Hospital Colorado, Professor of Pediatrics, University of Colorado School of Medicine, Adjunct Professor of Pediatrics, National Jewish Health, Denver, CO, USA
| | | | - Soren Pedersen
- GINA Program, Department of Pediatrics, Kolding Hospital, Kolding, Denmark
| | - Thomas B Casale
- Food Allergy Research and Education (FARE), McLean, VA, USA.,Department of Medicine and Pediatrics, University of South Florida, Tampa, FL, USA
| | - David Price
- Observational and Pragmatic Research Institute, Singapore
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42
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Skypala IJ, Hunter H, Krishna MT, Rey-Garcia H, Till SJ, du Toit G, Angier E, Baker S, Stoenchev KV, Luyt DK. BSACI guideline for the diagnosis and management of pollen food syndrome in the UK. Clin Exp Allergy 2022; 52:1018-1034. [PMID: 35975576 DOI: 10.1111/cea.14208] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 02/06/2023]
Abstract
Pollen food syndrome (PFS) is a highly prevalent food allergy affecting pollen-sensitized children and adults. Sufferers experience allergic symptoms when consuming raw plant foods, due to the homology between the pollen allergens and unstable proteins in these foods. The triggers involved can vary depending on the pollen sensitization, which in turn is affected by geographical location. The British Society of Allergy and Clinical Immunology (BSACI) Standards of Care Committee (SOCC) identified a need to develop a guideline for the diagnosis and management of PFS in the United Kingdom (UK). Guidelines produced by the BSACI use either the GRADE or SIGN methodology; due to a lack of high-quality evidence these recommendations were formulated using the SIGN guidelines, which is acknowledged to be less robust than the GRADE approach. The correct diagnosis of PFS ensures the avoidance of a misdiagnosis of a primary peanut or tree nut allergy or confusion with another plant food allergy to non-specific lipid transfer proteins. The characteristic foods involved, and rapid-onset oropharyngeal symptoms, mean PFS can often be diagnosed from the clinical history alone. However, reactions involving tree nuts, peanuts and soya milk or severe/atypical reactions to fruits and vegetables may require additional diagnostic tests. Management is through the exclusion of known trigger foods, which may appear to be simple, but is highly problematic if coupled with a pre-existing food allergy or for individuals following a vegetarian/vegan diet. Immunotherapy to pollens is not an effective treatment for PFS, and although oral or sublingual immunotherapy to foods seems more promising, large, controlled studies are needed. The typically mild symptoms of PFS can lead to an erroneous perception that this condition is always easily managed, but severe reactions can occur, and anxiety about the onset of symptoms to new foods can have a profound effect on quality of life.
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Affiliation(s)
- Isabel J Skypala
- Department of Allergy & Clinical Immunology, Royal Brompton & Harefield Hospitals, Part of Guys & St Thomas NHS Foundation Trust, London, UK.,Inflammation, Repair & Development Section, National Heart & Lung Institute, Imperial College, London, UK
| | - Hannah Hunter
- Department of Allergy, Guys & St Thomas NHS Foundation Trust, London, UK.,Kings College, London, UK
| | - Mamidipudi Thirumala Krishna
- Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,The Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Helena Rey-Garcia
- Department of Allergy & Clinical Immunology, Royal Brompton & Harefield Hospitals, Part of Guys & St Thomas NHS Foundation Trust, London, UK
| | - Stephen J Till
- Department of Allergy, Guys & St Thomas NHS Foundation Trust, London, UK.,Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - George du Toit
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK.,Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, London, UK.,Department Women and Children's Health (Paediatric Allergy), Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Elizabeth Angier
- Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Kostadin V Stoenchev
- Department of Allergy & Clinical Immunology, Royal Brompton & Harefield Hospitals, Part of Guys & St Thomas NHS Foundation Trust, London, UK
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Sdona E, Ekström S, Andersson N, Håkansson N, Wolk A, Westman M, van Hage M, Kull I, Melén E, Bergström A. Dietary fibre in relation to asthma, allergic rhinitis and sensitization from childhood up to adulthood. Clin Transl Allergy 2022; 12:e12188. [PMID: 35990418 PMCID: PMC9382355 DOI: 10.1002/clt2.12188] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/05/2022] [Accepted: 08/04/2022] [Indexed: 12/11/2022] Open
Abstract
Background Dietary fibre may reduce the risk of allergy. Our aim was to investigate the association between fibre intake in childhood, asthma, allergic rhinitis and IgE sensitization up to adulthood. Methods The individual fibre intake of 2285 participants from the Swedish population‐based birth cohort BAMSE was estimated between 98‐ and 107‐item food frequency questionnaires at ages 8 and 16 years, respectively. At 8, 16 and 24 years, asthma and allergic rhinitis symptoms were assessed by questionnaires, and sensitization to common allergens by serum IgE. Longitudinal associations were analysed by generalized estimating equations, adjusting for potential confounders. Results An inverse overall association was indicated between fibre intake at 8 years and allergic rhinitis symptoms up to 24 years (OR per 5 g/d 0.86; 95% CI 0.77–0.96), particularly in combination with airborne (0.74; 0.62–0.89) and food (0.69; 0.54–0.88) allergen sensitization. Higher fibre intake was also associated with specific allergen sensitization, for example, birch (0.77; 0.67–0.88) and soy (0.68; 0.53–0.87). No association was observed with asthma. Regarding sources, fruit (0.79; 0.67–0.94) and other (potatoes, chips/popcorn, legumes, and nuts, 0.71; 0.50–0.99), but not cereal or vegetable fibre were associated with allergic rhinitis. In additional analyses, including long‐term fibre intake at 8 and 16 years, excluding participants with food‐related allergic symptoms to examine reverse causation, as well as adjusting for antioxidant intake, associations were attenuated and became non‐significant. Conclusion Higher fibre intake in mid‐childhood may be inversely associated with allergic rhinitis and sensitization to specific allergens up to adulthood. However, avoidance of food triggers of allergic symptoms in allergic rhinitis patients may contribute to the protective associations.
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Affiliation(s)
- Emmanouela Sdona
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
| | - Sandra Ekström
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden.,Centre for Occupational and Environmental Medicine Stockholm Sweden
| | - Niklas Andersson
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
| | - Niclas Håkansson
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
| | - Alicja Wolk
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden.,Department of Surgical Sciences Uppsala University Uppsala Sweden
| | - Marit Westman
- Department of Medicine Solna Division of Immunology and Allergy Karolinska Institutet Stockholm Sweden
| | - Marianne van Hage
- Department of Medicine Solna Division of Immunology and Allergy Karolinska Institutet Stockholm Sweden.,Department of Clinical Immunology and Transfusion Medicine Karolinska University Hospital Stockholm Sweden
| | - Inger Kull
- Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden.,Sachs' Children and Youth Hospital Södersjukhuset Stockholm Sweden
| | - Erik Melén
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden.,Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden.,Sachs' Children and Youth Hospital Södersjukhuset Stockholm Sweden
| | - Anna Bergström
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden.,Centre for Occupational and Environmental Medicine Stockholm Sweden
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Kamei A, Izawa K, Ando T, Kaitani A, Yamamoto R, Maehara A, Ide T, Yamada H, Kojima M, Wang H, Tokushige K, Nakano N, Shimizu T, Ogawa H, Okumura K, Kitaura J. Development of mouse model for oral allergy syndrome to identify IgE cross-reactive pollen and food allergens: ragweed pollen cross-reacts with fennel and black pepper. Front Immunol 2022; 13:945222. [PMID: 35958602 PMCID: PMC9358994 DOI: 10.3389/fimmu.2022.945222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/27/2022] [Indexed: 11/27/2022] Open
Abstract
Oral allergy syndrome (OAS) is an IgE-mediated immediate food allergy that is localized to the oral mucosa. Pollen food allergy syndrome (PFAS), a pollinosis-associated OAS, is caused by cross-reactivity between food and pollen allergens. However, we need to more precisely understand the underlying pathogenesis of OAS/PFAS. In the present study, we developed a method to comprehensively identify cross-reactive allergens by using murine model of OAS and protein microarray technology. We focused on lip angioedema, which is one of the most common symptoms of OAS, and confirmed that mast cells reside in the tissues inside the lower lip of the mice. Interestingly, when the food allergen ovalbumin (OVA) was injected inside the lower lip of mice with high levels of OVA-specific IgE followed by an intravenous injection of the Evans blue dye, we found immediate dye extravasation in the skin of the neck in a mast cell-dependent manner. In addition, the degree of mast cell degranulation in the oral cavity, reflecting the severity of oral allergic responses, can be estimated by measuring the amount of extravasated dye in the skin. Therefore, we used this model of OAS to examine IgE cross-reactive allergens in vivo. Protein microarray analysis showed that serum IgE from mice intraperitoneally sensitized with ragweed pollen, one of the major pollens causing pollinosis, bound highly to protein extracts from several edible plants including black peppercorn and fennel. We confirmed that the levels of black pepper-specific IgE and fennel-specific IgE were significantly higher in the serum from ragweed pollen-sensitized mice than in the serum from non-sensitized control mice. Importantly, analysis of murine model of OAS showed that the injection of black pepper or fennel extract induced apparent oral allergic responses in ragweed pollen-sensitized mice. These results indicate IgE cross-reactivity of ragweed pollen with black pepper and fennel. In conclusion, we developed mouse model of OAS to identify IgE cross-reactive pollen and food allergens, which will help understand the pathogenesis of OAS/PFAS.
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Affiliation(s)
- Anna Kamei
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Science of Allergy and Inflammation, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kumi Izawa
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- *Correspondence: Kumi Izawa, ; Jiro Kitaura,
| | - Tomoaki Ando
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ayako Kaitani
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Risa Yamamoto
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akie Maehara
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takuma Ide
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Otorhinolaryngology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiromichi Yamada
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mayuki Kojima
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hexing Wang
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Science of Allergy and Inflammation, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Koji Tokushige
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Science of Allergy and Inflammation, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobuhiro Nakano
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshiaki Shimizu
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hideoki Ogawa
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ko Okumura
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Jiro Kitaura
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- *Correspondence: Kumi Izawa, ; Jiro Kitaura,
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Yasudo H, Yamamoto-Hanada K, Yang L, Saito-Abe M, Sato M, Miyaji Y, Shimada M, Hirai S, Toyokuni K, Ishikawa F, Inuzuka Y, Kabashima S, Fukuie T, Ohya Y. Pollen Food Allergy Syndrome in Allergic March. Nutrients 2022; 14:nu14132658. [PMID: 35807837 PMCID: PMC9268136 DOI: 10.3390/nu14132658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/07/2022] [Accepted: 06/24/2022] [Indexed: 11/20/2022] Open
Abstract
The association between pollen food allergy syndrome (PFAS) and allergic march remains unclear. In this prospective cohort study of the general population in Tokyo (T-Child Study), we found that sensitization to Cry j 1 and Fel d 1 at ages 5 and 9 years was associated with an increased risk of PFAS at 13 years old (at 5 years, Cry j 1: adjusted odds ratio aOR, 2.74; 95% confidence interval CI, 1.53–4.91; Fel d 1: aOR, 2.61; 95% CI, 1.31–5.19; at 9 years, Cry j 1: adjusted odds ratio aOR, 4.28; 95% confidence interval CI, 1.98–9.25; Fel d 1: aOR, 2.40; 95% CI, 1.33–4.32). In particular, sensitization to Bet v 1 at ages 5 and 9 years was associated with a strong risk of PFAS at the age of 13 years (at 5 years: aOR, 10.6; 95% CI, 2.64–42.5; at 9 years: aOR, 9.1; 95% CI, 4.71–17.6). PFAS risk by age 13 years was increased by any allergic symptom at 5 or 9 years, a combination of wheezing, eczema, and rhinitis, and Bet v 1 sensitization. Our findings suggest that PFAS may be associated with allergic march.
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Klain A, Indolfi C, Dinardo G, Decimo F, Tosca MA, Miraglia Del Giudice M, Ciprandi G. Comparing available treatments for pollen-induced allergic rhinitis in children. Expert Rev Clin Immunol 2022; 18:835-843. [PMID: 35726790 DOI: 10.1080/1744666x.2022.2093188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Pollen-induced allergic rhinitis (PIAR) is a widespread disease in children, and its prevalence is rapidly evolving. In addition, it may be associated with other atopic diseases, in particular asthma. In most cases, PIAR can be treated effectively by avoiding exposure to responsible allergens and using symptomatic treatments, including intranasal/oral antihistamines or/and nasal corticosteroids, according to ARIA guidelines. In recent decades, new medicines have been studied and developed: allergen-specific immunotherapy (AIT), anti-IgE antibodies, and probiotics. In addition, nutraceuticals have also been used as add-on treatments. This review aims to discuss and compare the old and new therapeutic strategies for PIAR in children. AREAS COVERED Allergic rhinitis is a type 2 inflammatory disease. The management of patients with PIAR entails medications, AIT, and ancillary therapies. In addition, children with PIAR and associated severe asthma may be inclusively treated with biologics. Namely, subjects with allergic comorbidities could benefit from biological agents. However, AIT presently remains the unique causal treatment for PIAR. EXPERT OPINION New strategies may include combined treatments, mainly concerning fixed associations with antihistamines and corticosteroids, nutraceutical products, and new AIT formulations.
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Affiliation(s)
- Angela Klain
- Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Cristiana Indolfi
- Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Giulio Dinardo
- Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Fabio Decimo
- Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | | | - Michele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Giorgio Ciprandi
- Department of Outpatients, Casa Di Cura Villa Serena, Genoa, Italy
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47
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Vizuet-de-Rueda JC, Montero-Vargas JM, Galván-Morales MÁ, Porras-Gutiérrez-de-Velasco R, Teran LM. Current Insights on the Impact of Proteomics in Respiratory Allergies. Int J Mol Sci 2022; 23:ijms23105703. [PMID: 35628512 PMCID: PMC9144092 DOI: 10.3390/ijms23105703] [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: 04/23/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 12/11/2022] Open
Abstract
Respiratory allergies affect humans worldwide, causing extensive morbidity and mortality. They include allergic rhinitis (AR), asthma, pollen food allergy syndrome (PFAS), aspirin-exacerbated respiratory disease (AERD), and nasal polyps (NPs). The study of respiratory allergic diseases requires new technologies for early and accurate diagnosis and treatment. Omics technologies provide the tools required to investigate DNA, RNA, proteins, and other molecular determinants. These technologies include genomics, transcriptomics, proteomics, and metabolomics. However, proteomics is one of the main approaches to studying allergic disorders' pathophysiology. Proteins are used to indicate normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention. In this field, the principal goal of proteomics has been to discover new proteins and use them in precision medicine. Multiple technologies have been applied to proteomics, but that most used for identifying, quantifying, and profiling proteins is mass spectrometry (MS). Over the last few years, proteomics has enabled the establishment of several proteins for diagnosing and treating respiratory allergic diseases.
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48
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Castro-Jiménez A, Florido F, Alonso-Morales F, Gratacós-Gómez A, Alonso-Morales FJ, Gómez-Torrijos E. [Peculiarities of allergy to plant foods in South-Eastern Spain]. REVISTA ALERGIA MÉXICO 2022; 69:56-60. [PMID: 36927751 DOI: 10.29262/ram.v69i1.962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/01/2021] [Indexed: 11/24/2022] Open
Abstract
Allergy to fruits and vegetables is the most common primary food allergy in Mediterranean countries, especially the lipid transfer proteins (LTPs) syndrome. This study is the first research that studies multiple clinical, allergological and therapeutics characteristics of allergies to plants in the South-East of Spain, and assessing whether these characteristics differ in emergency room or outpatient clinic. This is a prospective study of patients who consult for the first time for allergy to vegetables at Granada, Spain. We record demographic data, symptoms, allergological study and indicated therapy. The characteristics obtained agree with the current bibliographic except the higher prevalence than other areas of positive sensitization of Pru p 3, Cor a 9 and Ara h 9, which predisposes to severe allergic reactions. We conclude: Allergy to plant food in Granada is a more severe phenotype than other geographic areas from Spain, especially in young adults sensitized by different LTPs and pollinosis to olive pollen.
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Affiliation(s)
| | - Fernando Florido
- Universidad de Granada, Hospital Universitario San Cecilio, Granada, España
| | | | | | | | - Elisa Gómez-Torrijos
- Universidad de Castilla-La Mancha, Hospital General Universitario de Ciudad Real, España
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49
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Song KB, Park MJ, Choi EJ, Jung S, Yoon J, Cho HJ, Kim BS, Ahn K, Kim KW, Shin YH, Suh DI, Hong SJ, Lee SY. Food allergy in early childhood increases the risk of oral allergy syndrome in schoolchildren: A birth cohort study. Pediatr Allergy Immunol 2022; 33:e13786. [PMID: 35616894 DOI: 10.1111/pai.13786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/01/2022] [Accepted: 04/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The level of pollen in Korea has increased over recent decades. Research suggests that oral allergy syndrome (OAS) may be more frequent in childhood than previously recognized. We aimed to investigate the prevalence and characteristics of OAS in children aged 6-10 years from a general-population-based birth cohort. METHODS We analyzed 930 children from the cohort for childhood origin of asthma and allergic diseases (COCOA). Allergic diseases were diagnosed annually by pediatric allergists. The skin prick tests were performed with 14 common inhalant allergens and four food allergens for the general population of children aged 3 and 7 years. RESULTS Of the 930 eligible children, 44 (4.7%) aged 6-10 years were diagnosed with OAS. The mean age at onset was 6.74 years. OAS prevalence was 7.2% among children with allergic rhinitis (AR) and 19.1% among those with pollinosis, depending on comorbidity. OAS was more prevalent in schoolchildren with atopic dermatitis, food allergy, and sensitization to food allergens and grass pollen in early childhood. In schoolchildren with AR, only a history of food allergy until the age of 3 years increased the risk of OAS (aOR 2.971, 95% CI: 1.159-7.615). CONCLUSION Food allergy and food sensitization in early childhood were associated with OAS in schoolchildren with AR. Further study is required to elucidate the mechanism by which food allergy in early childhood affects the development of OAS.
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Affiliation(s)
- Kun-Baek Song
- Department of Pediatrics, Childhood Asthma Atopy Center, Humidifier Disinfectant Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Jee Park
- Department of Pediatrics, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Korea
| | - Eom Ji Choi
- Department of Pediatrics, Childhood Asthma Atopy Center, Humidifier Disinfectant Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sungsu Jung
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jisun Yoon
- Department of Pediatrics, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun-Ju Cho
- Department of Pediatrics, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Bong-Seong Kim
- Department of Pediatrics, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Youn Ho Shin
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Humidifier Disinfectant Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So-Yeon Lee
- Department of Pediatrics, Childhood Asthma Atopy Center, Humidifier Disinfectant Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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50
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Jiang N, Xu W, Huang H, Hou X, Xiang L. Anaphylaxis in Chinese Children with Pollen Sensitization: Triggers, Clinical Presentation, and Acute Management. J Asthma Allergy 2022; 15:633-643. [PMID: 35603012 PMCID: PMC9122664 DOI: 10.2147/jaa.s363113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/05/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Pollen sensitization is increasing in children. However, there is little evidence regarding the characteristics of anaphylaxis in individuals with pollen sensitization. Patients and Methods We conducted a retrospective study of patients with anaphylaxis combined with pollen sensitization who attended an allergy department in a tertiary children’s hospital from 2014 to 2021. Results A total of 157 anaphylaxis events in 108 patients were analyzed; the mean age at the reaction was 5.8 ± 4.17 years. A total of 99.1% (107/108) of the patients came from northern China. The most common sensitizing pollen was mugwort (93.5%,101/108), followed by ragweed (68.5%, 74/108) and birch (40.7%, 44/108). A total of 76.9% (83/108) of the patients showed polysensitization to pollen. Allergic rhinitis/conjunctivitis was the most common comorbidity (87.0%, 94/108). Children with severe anaphylaxis were more likely to have a history of recurrent urticaria (16.1% vs 3.9%, p = 0.028). The most frequently implicated foods were fruits/vegetables (22.3%, 35/157), followed by wheat (8.9%, 14/157) and milk (8.3%, 13/157), and the most common fruit allergen was peach (n = 7). Of 14% (22/157) exercise-induced reactions, 63.6% (14/22) occurred in pollen season. Skin symptoms were the most frequent (86.0%, 135/157) symptoms, followed by respiratory (73.9%, 116/157) and gastrointestinal (21%, 33/157) symptoms. Regarding acute management, only 7.4% of the patients were treated with epinephrine. Conclusion Our findings revealed the characteristics of anaphylaxis in children with pollen sensitization. Fruits/vegetables accounted for a substantial percentage of anaphylaxis triggers. The suboptimal use of epinephrine highlights the need for educational programs promoting the use of epinephrine.
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Affiliation(s)
- Nannan Jiang
- Department of Allergy, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health; Key Laboratory of Major Diseases in Children, Ministry of Education; National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
| | - Wei Xu
- Department of Allergy, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health; Key Laboratory of Major Diseases in Children, Ministry of Education; National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
| | - Huijie Huang
- Department of Allergy, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health; Key Laboratory of Major Diseases in Children, Ministry of Education; National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
| | - Xiaoling Hou
- Department of Allergy, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health; Key Laboratory of Major Diseases in Children, Ministry of Education; National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
| | - Li Xiang
- Department of Allergy, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health; Key Laboratory of Major Diseases in Children, Ministry of Education; National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
- Correspondence: Li Xiang, Department of Allergy, Beijing Children’s Hospital, Capital Medical University, National Center for Children′s Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, People’s Republic of China, Tel +861059616934, Fax +861059616934, Email
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