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Çelik V, Kılıc FE, Tanrıverdi H. Exploring Terebinth Cross-Sensitivity in Individuals with Pistachio Sensitivity. Int Arch Allergy Immunol 2024:1-7. [PMID: 38880088 DOI: 10.1159/000539324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 05/09/2024] [Indexed: 06/18/2024] Open
Abstract
INTRODUCTION Terebinth (Pistacia terebinthus) belongs to the same botanical family as pistachio (Pistacia vera) and cashew (Anacardium occidentale). Although it is known that there is cross-sensitivity between pistachio and cashew, the cross-sensitivity of terebinth with pistachio or cashew has not been investigated. The objective of our study was to evaluate the sensitivity to terebinth in children with pistachio sensitivity. METHODS This study was conducted between September 2021 and June 2022 at Adıyaman University Faculty of Medicine Hospital. It analyzed the results of children who underwent skin prick testing (SPT) for food allergy. Of the 712 food skin prick tests reviewed, 27 children were identified with pistachio sensitivity. Prick tests with commercial extract for cashew and prick-to-prick tests for terebinth were applied to these children. RESULTS The median age was two, and 78% were male. Of the children with pistachio sensitivity, 96% demonstrated cross-sensitivity to terebinth and 100% to cashew. There was a strong correlation between the size of SPT responses in pistachio, cashew, and terebinth. Only four children had previously consumed terebinth, and two of these children had allergic reactions. CONCLUSION Our study demonstrates a high cross-sensitivity between terebinth, pistachio, and cashew. We recommend that individuals with pistachio or cashew allergy/sensitivity avoid terebinth until tests confirm it is safe to consume. Further studies are needed to demonstrate the clinical significance of this cross-sensitivity and identify the major allergen involved.
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Affiliation(s)
- Velat Çelik
- Department of Pediatric Allergy and Immunology, Adıyaman University School of Medicine, Adıyaman, Turkey
| | - Fedli Emre Kılıc
- Department of Pediatrics, Adıyaman Training and Research Hospital, Adıyaman, Turkey
| | - Hüseyin Tanrıverdi
- Department of Pediatrics, Adıyaman University School of Medicine, Adıyaman, Turkey
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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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Hu J, Zhu LP, Wang RQ, Zhu L, Chen F, Hou Y, Ni K, Deng S, Liu S, Ying W, Sun JL, Li H, Jin T. Identification, Characterization, Cloning, and Cross-Reactivity of Zan b 2, a Novel Pepper Allergen of 11S Legumin. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2024; 72:8189-8199. [PMID: 38551197 PMCID: PMC11010233 DOI: 10.1021/acs.jafc.4c00351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 04/11/2024]
Abstract
Protein from Sichuan peppers can elicit mild to severe allergic reactions. However, little is known about their allergenic proteins. We aimed to isolate, identify, clone, and characterize Sichuan pepper allergens and to determine its allergenicity and cross-reactivities. Sichuan pepper seed proteins were extracted and then analyzed by SDS-PAGE. Western blotting was performed with sera from Sichuan pepper-allergic individuals. Proteins of interest were purified using hydrophobic interaction chromatography and gel filtration and further analyzed by analytical ultracentrifugation, circular dichroism spectroscopy, and mass spectrometry (MS). Their coding region was amplified in the genome. IgE reactivity and cross-reactivity of allergens were evaluated by dot blot, enzyme-linked immunosorbent assay (ELISA), and competitive ELISA. Western blot showed IgE binding to a 55 kDa protein. This protein was homologous to the citrus proteins and has high stability and a sheet structure. Four DNA sequences were cloned. Six patients' sera (60%) showed specific IgE reactivity to this purified 11S protein, which was proved to have cross-reactivation with extracts of cashew nuts, pistachios, and citrus seeds. A novel allergen in Sichuan pepper seeds, Zan b 2, which belongs to the 11S globulin family, was isolated and identified. Its cross-reactivity with cashew nuts, pistachios, and citrus seeds was demonstrated.
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Affiliation(s)
- Jing Hu
- Hefei
National Laboratory for Physical Sciences at Microscale, the CAS Key
Laboratory of Innate Immunity and Chronic Disease, School of Basic
Medicine Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Li-Ping Zhu
- Allergy
Department, State Key Laboratory of Complex Severe and Rare Diseases,
Peking Union Medical College Hospital, Chinese
Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Rui-qi Wang
- Allergy
Department, State Key Laboratory of Complex Severe and Rare Diseases,
Peking Union Medical College Hospital, Chinese
Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Lixia Zhu
- Hefei
National Laboratory for Physical Sciences at Microscale, the CAS Key
Laboratory of Innate Immunity and Chronic Disease, School of Basic
Medicine Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Feng Chen
- Hefei
National Laboratory for Physical Sciences at Microscale, the CAS Key
Laboratory of Innate Immunity and Chronic Disease, School of Basic
Medicine Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Yibo Hou
- Allergy
Department, State Key Laboratory of Complex Severe and Rare Diseases,
Peking Union Medical College Hospital, Chinese
Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Kang Ni
- Hefei
National Laboratory for Physical Sciences at Microscale, the CAS Key
Laboratory of Innate Immunity and Chronic Disease, School of Basic
Medicine Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Shasha Deng
- Hefei
National Laboratory for Physical Sciences at Microscale, the CAS Key
Laboratory of Innate Immunity and Chronic Disease, School of Basic
Medicine Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Siyu Liu
- Hefei
National Laboratory for Physical Sciences at Microscale, the CAS Key
Laboratory of Innate Immunity and Chronic Disease, School of Basic
Medicine Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Wantao Ying
- State
Key Laboratory of Medical Proteomics, Beijing Proteome Research Center,
National Center for Protein Sciences (Beijing), Beijing Institute
of Lifeomics, Beijing 102206, China
| | - Jin-Lyu Sun
- Allergy
Department, State Key Laboratory of Complex Severe and Rare Diseases,
Peking Union Medical College Hospital, Chinese
Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Hong Li
- Allergy
Department, State Key Laboratory of Complex Severe and Rare Diseases,
Peking Union Medical College Hospital, Chinese
Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Tengchuan Jin
- Hefei
National Laboratory for Physical Sciences at Microscale, the CAS Key
Laboratory of Innate Immunity and Chronic Disease, School of Basic
Medicine Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230027, China
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Gutiérrez-Díaz G, Betancor D, Parrón-Ballesteros J, Gordo RG, Castromil-Benito ES, Haroun E, Vázquez de la Torre M, Turnay J, Villalba M, Cuesta-Herranz J, Pastor-Vargas C. Identification of New Allergens in Macadamia Nut and Cross-Reactivity with Other Tree Nuts in a Spanish Cohort. Nutrients 2024; 16:947. [PMID: 38612981 PMCID: PMC11013893 DOI: 10.3390/nu16070947] [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] [Received: 02/26/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
The consumption of macadamia nuts has increased due to their cardioprotective and antioxidant properties. However, this rise is consistent with an increase in the cases of macadamia nut allergy, leading to severe reactions. Although two Macadamia integrifolia allergens (Mac i 1 and Mac i 2) have been identified in Australian and Japanese patients, the allergenic sensitization patterns in Western European populations, particularly in Spain, remain unclear. For this purpose, seven patients with macadamia nut allergy were recruited in Spain. Macadamia nut protein extracts were prepared and, together with hazelnut and walnut extracts, were used in Western blot and inhibition assays. IgE-reactive proteins were identified using MALDI-TOF/TOF mass spectrometry (MS). Immunoblotting assays revealed various IgE-binding proteins in macadamia nut extracts. Mass spectrometry identified three new allergens: an oleosin, a pectin acetylesterase, and an aspartyl protease. Cross-reactivity studies showed that hazelnut extract but not walnut extract inhibited macadamia nut oleosin-specific IgE binding. This suggests that oleosin could be used as marker for macadamia-hazelnut cross-reactivity. The results show an allergenic profile in the Spanish cohort different from that previously detected in Australian and Japanese populations. The distinct sensitization profiles observed highlight the potential influence of dietary habits and environmental factors exposure on allergenicity.
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Affiliation(s)
- Gloria Gutiérrez-Díaz
- Department of Biochemistry and Molecular Biology, Universidad Complutense de Madrid, 28040 Madrid, Spain; (G.G.-D.); (J.P.-B.); (R.G.G.); (E.S.C.-B.); (J.T.); (M.V.)
| | - Diana Betancor
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (UAM), 28040 Madrid, Spain; (D.B.); (J.C.-H.)
| | - Jorge Parrón-Ballesteros
- Department of Biochemistry and Molecular Biology, Universidad Complutense de Madrid, 28040 Madrid, Spain; (G.G.-D.); (J.P.-B.); (R.G.G.); (E.S.C.-B.); (J.T.); (M.V.)
| | - Rubén G. Gordo
- Department of Biochemistry and Molecular Biology, Universidad Complutense de Madrid, 28040 Madrid, Spain; (G.G.-D.); (J.P.-B.); (R.G.G.); (E.S.C.-B.); (J.T.); (M.V.)
| | - Estela S. Castromil-Benito
- Department of Biochemistry and Molecular Biology, Universidad Complutense de Madrid, 28040 Madrid, Spain; (G.G.-D.); (J.P.-B.); (R.G.G.); (E.S.C.-B.); (J.T.); (M.V.)
| | - Elisa Haroun
- Department of Allergy, Hospital Universitario Infanta Leonor, 28040 Madrid, Spain; (E.H.); (M.V.d.l.T.)
| | - María Vázquez de la Torre
- Department of Allergy, Hospital Universitario Infanta Leonor, 28040 Madrid, Spain; (E.H.); (M.V.d.l.T.)
| | - Javier Turnay
- Department of Biochemistry and Molecular Biology, Universidad Complutense de Madrid, 28040 Madrid, Spain; (G.G.-D.); (J.P.-B.); (R.G.G.); (E.S.C.-B.); (J.T.); (M.V.)
| | - Mayte Villalba
- Department of Biochemistry and Molecular Biology, Universidad Complutense de Madrid, 28040 Madrid, Spain; (G.G.-D.); (J.P.-B.); (R.G.G.); (E.S.C.-B.); (J.T.); (M.V.)
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) Red de Enfermedades Inflamatorias (REI)—RD21/0002/0028, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Javier Cuesta-Herranz
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (UAM), 28040 Madrid, Spain; (D.B.); (J.C.-H.)
- Red de Asma, Reacciones Adversas y Alérgicas (ARADyAL)—RD16/0006/0013, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Carlos Pastor-Vargas
- Department of Biochemistry and Molecular Biology, Universidad Complutense de Madrid, 28040 Madrid, Spain; (G.G.-D.); (J.P.-B.); (R.G.G.); (E.S.C.-B.); (J.T.); (M.V.)
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) Red de Enfermedades Inflamatorias (REI)—RD21/0002/0028, Instituto de Salud Carlos III, 28029 Madrid, Spain
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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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Giovannini M, Skypala IJ, Caubet JC, Du Toit G, Nowak-Wegrzyn A. Diagnosis and Management of Pollen Food Allergy Syndrome to Nuts. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:599-604. [PMID: 38280450 DOI: 10.1016/j.jaip.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 01/29/2024]
Abstract
Oral allergy syndrome or pollen food allergy syndrome (PFAS) represents a common clinical conundrum when the reported trigger food is a tree nut (usually almond or hazelnut) or peanut. The PFAS may give rise to uncertainty about the potential severity of the future reactions, indications for prescribing epinephrine, and the extent of the necessary dietary avoidance. As a food allergy, secondary to cross-reactivity with airborne pollen, PFAS usually manifests toward the end of the first decade of life as contact urticaria of the oropharyngeal mucous membranes. Molecular allergology facilitates diagnosis and risk stratification by establishing the profile of sensitization. Exclusive sensitization to pathogenesis-related proteins family 10 (PR10) and profilins indicates that signs and symptoms are due to PFAS, whereas sensitization to seed storage proteins with or without sensitization to PR10 and profilins may indicate a more severe primary nut allergy phenotype. Management relies on avoidance of the specific nut trigger, advice on the likelihood of more severe local or systemic symptoms, and treatment of reactions according to the severity. Future studies are needed to better delineate the risk of systemic reactions in individuals with nut PFAS and to establish the role of food or pollen allergen immunotherapy for the prevention or moderation of this condition.
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Affiliation(s)
- Mattia Giovannini
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy; Department of Health Sciences, University of Florence, Florence, Italy
| | - Isabel J Skypala
- Royal Brompton & Harefield Hospitals, Guys & St Thomas NHS Foundation Trust, London, United Kingdom; Department of Inflammation and Repair, Imperial College, London, United Kingdom.
| | - Jean Christoph Caubet
- Pediatric Allergy Unit, Department of Pediatrics, Gynecology and Obstetrics, University Hospital of Geneva, Geneva, Switzerland
| | - George Du Toit
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
| | - Anna Nowak-Wegrzyn
- Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York, NY; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
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Jeong K, Lee S. Natural course of IgE-mediated food allergy in children. Clin Exp Pediatr 2023; 66:504-511. [PMID: 37321568 PMCID: PMC10694555 DOI: 10.3345/cep.2022.01004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 02/03/2023] [Accepted: 03/28/2023] [Indexed: 06/17/2023] Open
Abstract
The prevalence of food allergy and food-induced anaphylaxis in children is increasing worldwide. Cow's milk, hen's eggs, and wheat allergies in young children have a more favorable prognosis with a relatively early outgrow, while allergies to peanuts, tree nuts, and seafood are more likely to be persistent. Although our understanding of the mechanism underlying the resolution of food allergy is incomplete, the roles of dendritic cells, regulatory T cells, and regulatory B cells are important. Many past studies on the natural course of food allergy were retrospective analyses of specific study groups, but large-scale population-based prospective studies are now being published. This review summarizes recent studies of the natural course of cow's milk, hen's eggs, wheat, peanuts, tree nuts, soy, sesame, and seafood allergies. The potential factors affecting the natural course of food allergy include symptom severity on ingestion, age at diagnosis, allergic comorbidities, skin prick test reaction size or serum food-specific immunoglobulin (Ig) E levels, changes in sensitization degree, IgE epitope specificity, ratio of food-specific IgE to IgG4, food-specific IgA levels, component-resolved diagnostic profile, diet, gut microbiome, and interventions such as immunotherapy. Since food allergy places a significant burden on patients and their caregivers in daily life, clinicians should be able to provide relevant knowledge on the natural course of food allergy, appropriately evaluate its resolution, and offer therapeutic options whenever possible.
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Affiliation(s)
- Kyunguk Jeong
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Sooyoung Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
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Konstantinou GN, Baker MG, Yu J, Ford LS, Bencharitiwong R, Grishina G, Sampson HA, Sicherer S, Nowak-Wegrzyn A. Citrin: a novel food allergen in citrus seeds and citrus-derived pectin that shows cross-reactivity with cashew and pistachio. Ann Allergy Asthma Immunol 2023; 131:759-765.e3. [PMID: 37659472 DOI: 10.1016/j.anai.2023.08.603] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Patients exquisitely sensitive to cashew/pistachio are at risk for allergic reactions to citrus seeds and pectin. OBJECTIVE In this study, we sought to evaluate whether pectin is contaminated with citrus seeds, to identify a culprit antigen in citrus seeds, and to assess for cross-reactivity among allergens in citrus seeds, citrus pectin, and cashew or pistachio. METHODS Proteins from orange seed coats, orange seed endosperms, lemon seeds, grapefruit seeds, citrus pectin, apple pectin, and grapefruit pectin were extracted. Protein concentrations in all extracts were determined and visualized using sodium dodecyl sulfate-polyacrylamide gel electrophoresis technique. Immunoglobulin E-binding capacity was determined with Western blot analyses and tandem mass spectrometry for the identification of the culprit allergen in citrus seeds and pectin. RESULTS In subjects with citrus seed, pectin, and cashew allergies, there was strong immunoglobulin E-reactivity to bands between 17 to 28 kDa and 28 to 38 kDa. The tandem mass spectrometry analysis of these bands indicated the presence of citrin as the culprit allergen. Citrin and Ana o 2 are both 11S globulins belonging to the cupin superfamily, and significant homology was found between these proteins. CONCLUSION Citrus pectin may be contaminated with citrus seeds. Citrin, a newly identified allergen in citrus seeds, seems to be the culprit antigen in citrus seeds and contaminated citrus pectin. Citrin is highly homologous with Ana o 2 in cashew and Pis v 2 in pistachio, suggesting potential for cross-reactivity and providing an explanation for co-allergenicity of cashew or pistachio, citrus seeds, and citrus pectin.
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Affiliation(s)
- George N Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, Greece; Elliot and Roslyn Jaffe Food Allergy Institute, Division of Pediatric Allergy & Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Mary Grace Baker
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Pediatric Allergy & Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joyce Yu
- Division of Allergy, Immunology & Rheumatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Lara S Ford
- Department of Allergy and Immunology, The Children's Hospital at Westmead, Westmead, Australia; Discipline of Child and Adolescent Health, University of Sydney School of Medicine, Sydney, Australia
| | - Ramon Bencharitiwong
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Pediatric Allergy & Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Galina Grishina
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Pediatric Allergy & Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hugh A Sampson
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Pediatric Allergy & Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Scott Sicherer
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Pediatric Allergy & Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anna Nowak-Wegrzyn
- NYU Grossman School of Medicine, Allergy and Immunology, Hassenfeld Children's Hospital, New York, New York; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
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Venter C, Shamir R, Fleischer DM. Early Introduction of Novel and Less-Studied Food Allergens in the Plant-Based Era: Considerations for US and EU Infant Formula Regulations. Nutrients 2023; 15:4530. [PMID: 37960183 PMCID: PMC10649096 DOI: 10.3390/nu15214530] [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: 09/06/2023] [Revised: 09/23/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Early life feeding practices may affect the long-term health of individuals, particularly in terms of the development of non-communicable diseases, such as metabolic and allergic diseases. Accumulating evidence suggests that the interplay of breastfeeding and/or formula feeding followed by the introduction of solids plays a role in the occurrence of non-communicable diseases both in the short and long term. International food allergy guidelines recommend that breastfeeding women do not need to avoid food allergens and do not recommend any infant formula for allergy prevention. Guidelines regarding solid food introduction for food allergy prevention recommend the introduction of well-cooked eggs and peanuts around 4-6 months of age, and not to delay the introduction of other food allergens. There is also an increasing trend to feed infants a plant-based or plant-forward diet and have access to infant formulas based on plant-based ingredients. The use of novel plant-based infant formulas raises a few questions reviewed in this paper: (1) Do fortified, plant-based infant formulas, compliant with US Food and Drug Administration (FDA) regulations and European Food Safety Authority (EFSA) (European) guidelines, support adequate infant growth? (2) Are plant-based infant formulas suitable for the management of cow's milk allergy? (3) Does feeding with novel, plant-based infant formulas increase the risk of food allergies to the food allergens they contain? (4) Does feeding infants plant-based food allergens in early life increase the risk of allergic and severe allergic reactions? The review of the literature indicated that (1) plant-based formulas supplemented with amino acids and micronutrients to comply with FDA regulations and EFSA guidelines, evaluated in sufficiently powered growth studies, can support adequate growth in infants; (2) currently available plant-based infant formulas are suitable for the management of CMA; (3) an early introduction and continuous intake of food allergens are more likely to prevent food allergies than to increase their risk; and (4) an early introduction of food allergens in young infants is safe.
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Affiliation(s)
- Carina Venter
- University of Colorado/Children’s Hospital Colorado: Section of Pediatric Allergy and Clinical Immunology, Aurora, CO 80045, USA;
| | - Raanan Shamir
- Institute for Gastroenterology, Nutrition and Liver Disease, Schneider Children’s Medical Center of Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv 74071-12-20, Israel;
| | - David Mark Fleischer
- University of Colorado/Children’s Hospital Colorado: Section of Pediatric Allergy and Clinical Immunology, Aurora, CO 80045, USA;
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10
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Yasudo H, Yamamoto-Hanada K, Mikuriya M, Ogino F, Fukuie T, Ohya Y. Association of walnut proteins in household dust with household walnut consumption and Jug r 1 sensitization. Allergol Int 2023; 72:607-609. [PMID: 37393135 DOI: 10.1016/j.alit.2023.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/09/2023] [Accepted: 05/26/2023] [Indexed: 07/03/2023] Open
Affiliation(s)
- Hiroki Yasudo
- Allergy Centre, National Centre for Child Health and Development, Tokyo, Japan; Department of Laboratory Medicine, Kyorin University School of Medicine, Tokyo, Japan.
| | | | | | | | - Tatsuki Fukuie
- Allergy Centre, National Centre for Child Health and Development, Tokyo, Japan
| | - Yukihiro Ohya
- Allergy Centre, National Centre for Child Health and Development, Tokyo, Japan
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11
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Kallen EJJ, Bollemeijer JF, Knulst AC, Ehlers AM, Welsing PMJ, van Ree R, Le TM. Component Ana o 3 versus extract for cashew nut allergy: A diagnostic test accuracy study in adults. Clin Exp Allergy 2023; 53:880-882. [PMID: 37246614 DOI: 10.1111/cea.14331] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/23/2023] [Accepted: 03/31/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Emily J J Kallen
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Juliette F Bollemeijer
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - André C Knulst
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anna M Ehlers
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paco M J Welsing
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ronald van Ree
- Departments of Experimental Immunology and Otorhinolaryngology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Thuy-My Le
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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12
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Beriziky P, Cherkaoui M, Linxe L, Perrin E, Rogniaux H, Denery-Papini S, Morisset M, Larré C, Dijk W. Hemp seed: An allergen source with potential cross-reactivity to hazelnut. Food Res Int 2023; 169:112932. [PMID: 37254358 DOI: 10.1016/j.foodres.2023.112932] [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: 10/03/2022] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 06/01/2023]
Abstract
The increasing exposure of the population to Cannabis sativa has revealed allergies to different parts of the plant, among which hemp seed. Nonetheless, the major hemp seed allergens remain to be identified. Several known families of allergens are present in hemp seed, including notably seed storage proteins. We therefore aimed to investigate the potential allergenicity of the hemp seed storage proteins and their potential cross-reactivity to different seeds and nuts. For this, we extracted hemp seed proteins sequentially using buffers with increasing levels of salinity (H2O, T2 and T3) to yield extracts differentially enriched in storage proteins. We used these extracts to perform immunoblots and ELISAs using sera of patients either sensitized to hemp seeds or sensitized/allergic to other seeds and nuts. Immunoblots and proteomics analyses identified vicilins and edestins as potential hemp seed allergens. Moreover, ELISA analyses revealed a correlation between sensitization to hazelnut and the hemp seed T3 extract (enriched in storage proteins). The possible cross-reactivity between hazelnut and hemp seed proteins was further strengthened by the results from inhibition ELISAs: the incubation of sera from hazelnut-sensitized individuals with increasing concentrations of the T3 extract inhibited serum IgE binding to the hazelnut extract by about 25-30%. Our study thus identifies vicilins and edestins as potential hemp seed allergens and highlights a possible cross-reactivity with hazelnut. The clinical relevance of this cross-reactivity between hemp seed and hazelnut needs to be further investigated in hazelnut-allergic individuals.
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Affiliation(s)
- Princy Beriziky
- INRAE, UR BIA, F-44316, Nantes, France; CHU d'Angers, unité d'allergologie, Angers, France
| | - Mehdi Cherkaoui
- INRAE, UR BIA, F-44316, Nantes, France; INRAE, PROBE research infrastructure, BIBS Facility, F-44316 Nantes, France
| | | | | | - Hélène Rogniaux
- INRAE, UR BIA, F-44316, Nantes, France; INRAE, PROBE research infrastructure, BIBS Facility, F-44316 Nantes, France
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13
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Xiao C, Ross G, Nielen MWF, Eriksson J, Salentijn GI, Mak WC. A portable smartphone-based imaging surface plasmon resonance biosensor for allergen detection in plant-based milks. Talanta 2023; 257:124366. [PMID: 36863294 DOI: 10.1016/j.talanta.2023.124366] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/23/2022] [Accepted: 02/13/2023] [Indexed: 02/22/2023]
Abstract
Food allergies are hypersensitivity immune responses triggered by (traces of) allergenic compounds in foods and drinks. The recent trend towards plant-based and lactose-free diets has driven an increased consumption of plant-based milks (PBMs) with the risk of cross-contamination of various allergenic plant-based proteins during the food manufacturing process. Conventional allergen screening is usually performed in the laboratory, but portable biosensors for on-site screening of food allergens at the production site could improve quality control and food safety. Here, we developed a portable smartphone imaging surface plasmon resonance (iSPR) biosensor composed of a 3D-printed microfluidic SPR chip for the detection of total hazelnut protein (THP) in commercial PBMs and compared its instrumentation and analytical performance with a conventional benchtop SPR. The smartphone iSPR shows similar characteristic sensorgrams compared with the benchtop SPR and enables the detection of trace levels of THP in spiked PBMs with the lowest tested concentration of 0.625 μg/mL THP. The smartphone iSPR achieved LoDs of 0.53, 0.16, 0.14, 0.06, and 0.04 μg/mL THP in 10x-diluted soy, oat, rice, coconut, and almond PBMs, respectively, with good correlation with the conventional benchtop SPR system (R2 0.950-0.991). The portability and miniaturized characteristics of the smartphone iSPR biosensor platform make it promising for the future on-site detection of food allergens by food producers.
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Affiliation(s)
- Chi Xiao
- Division of Sensor and Actuator Systems, IFM - Linköping University, S58183, Linköping, Sweden
| | - Georgina Ross
- Wageningen Food Safety Research (WFSR), Wageningen University & Research, P.O. Box 230, 6700, AE, Wageningen, the Netherlands; Laboratory of Organic Chemistry, Wageningen University, Helix Building 124, Stippeneng 4, 6708 WE, Wageningen, the Netherlands
| | - Michel W F Nielen
- Wageningen Food Safety Research (WFSR), Wageningen University & Research, P.O. Box 230, 6700, AE, Wageningen, the Netherlands; Laboratory of Organic Chemistry, Wageningen University, Helix Building 124, Stippeneng 4, 6708 WE, Wageningen, the Netherlands
| | - Jens Eriksson
- Division of Sensor and Actuator Systems, IFM - Linköping University, S58183, Linköping, Sweden
| | - Gert Ij Salentijn
- Wageningen Food Safety Research (WFSR), Wageningen University & Research, P.O. Box 230, 6700, AE, Wageningen, the Netherlands; Laboratory of Organic Chemistry, Wageningen University, Helix Building 124, Stippeneng 4, 6708 WE, Wageningen, the Netherlands.
| | - Wing Cheung Mak
- Division of Sensor and Actuator Systems, IFM - Linköping University, S58183, Linköping, Sweden; Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
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14
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Pasioti M, Savva M, Lakoumentas J, Kompoti E, Makris M, Xepapadaki P, Papadopoulos NG. Impact of Presumed Tree Nut and Peanut Allergy on Quality of Life at Different Ages. J Clin Med 2023; 12:jcm12103472. [PMID: 37240577 DOI: 10.3390/jcm12103472] [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: 01/20/2023] [Revised: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Tree nut and/or peanut allergy impairs patients' quality of life, but data on the impact of age and the type of nut or peanut on the quality of life are lacking. To evaluate the impact at different ages, age-appropriate survey questionnaires accompanied by FAQLQ and FAIM were distributed to patients with suspected tree nut and/or peanut allergy who presented at the allergy departments of three hospitals in Athens. Out of 200 questionnaires distributed, 106 met the inclusion criteria (46 children, 26 teenagers, 34 adults). The median score of each age group for FAQLQ was 4.6 (3.3-5.1), 4.7 (3.9-5.5), and 3.9 (3.2-5.1) and for FAIM was 3.7 (3.0-4.0), 3.4 (2.8-4.0), and 3.2 (2.7-4.1), respectively. FAQLQ and FAIM scores were correlated with the reported probability of using the rescue anaphylaxis set upon reaction (15.4%, p = 0.04 and 17.8%, p = 0.02, respectively) and pistachio allergy (FAQLQ: 4.8 vs. 4.0, p = 0.04; FAIM: 3.5 vs. 3.2, p = 0.03). Patients with additional food allergies reported worse FAQLQ scores (4.6 vs. 3.8, p = 0.05). Worse FAIM scores were associated with younger age (-18.2%, p = 0.01) and the number of life-threatening allergic reactions (25.3%, p < 0.001). The overall impact of tree nut and/or peanut allergy on patients' quality of life is moderate but differs with age, the type of nut, the use of adrenaline, and the number of previous reactions. The aspects of life affected and contributed factors also vary across age groups.
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Affiliation(s)
- Maria Pasioti
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens General Children's Hospital Panagioti and Aglaia Kyriakou, Thivon & Levadias, Ambelokipoi, 115 27 Athens, Greece
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Fidippidou Street, 4th Floor, Goudi, 115 27 Athens, Greece
| | - Maria Savva
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens General Children's Hospital Panagioti and Aglaia Kyriakou, Thivon & Levadias, Ambelokipoi, 115 27 Athens, Greece
| | - John Lakoumentas
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens General Children's Hospital Panagioti and Aglaia Kyriakou, Thivon & Levadias, Ambelokipoi, 115 27 Athens, Greece
| | - Evangelia Kompoti
- Allergology Department, "Laikon" General Hospital, 115 27 Athens, Greece
| | - Michael Makris
- Allergy Unit 'D. Kalogeromitros', 2nd Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, University General Hospital "Attikon", 124 62 Chaidari, Greece
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens General Children's Hospital Panagioti and Aglaia Kyriakou, Thivon & Levadias, Ambelokipoi, 115 27 Athens, Greece
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens General Children's Hospital Panagioti and Aglaia Kyriakou, Thivon & Levadias, Ambelokipoi, 115 27 Athens, Greece
- Division of Immunology, Immunity to Infection and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
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15
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Kamath SD, Bublin M, Kitamura K, Matsui T, Ito K, Lopata AL. Cross-reactive epitopes and their role in food allergy. J Allergy Clin Immunol 2023; 151:1178-1190. [PMID: 36932025 DOI: 10.1016/j.jaci.2022.12.827] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 03/17/2023]
Abstract
Allergenic cross-reactivity among food allergens complicates the diagnosis and management of food allergy. This can result in many patients being sensitized (having allergen-specific IgE) to foods without exhibiting clinical reactivity. Some food groups such as shellfish, fish, tree nuts, and peanuts have very high rates of cross-reactivity. In contrast, relatively low rates are noted for grains and milk, whereas many other food families have variable rates of cross-reactivity or are not well studied. Although classical cross-reactive carbohydrate determinants are clinically not relevant, α-Gal in red meat through tick bites can lead to severe reactions. Multiple sensitizations to tree nuts complicate the diagnosis and management of patients allergic to peanut and tree nut. This review discusses cross-reactive allergens and cross-reactive carbohydrate determinants in the major food groups, and where available, describes their B-cell and T-cell epitopes. The clinical relevance of these cross-reactive B-cell and T-cell epitopes is highlighted and their possible impact on allergen-specific immunotherapy for food allergy is discussed.
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Affiliation(s)
- Sandip D Kamath
- Division of Medical Biotechnology, Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria; Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia.
| | - Merima Bublin
- Division of Medical Biotechnology, Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Katsumasa Kitamura
- Department of Allergy, Allergy and Immunology Center, Aichi Children's Health and Medical CenterAichi, Japan
| | - Teruaki Matsui
- Department of Allergy, Allergy and Immunology Center, Aichi Children's Health and Medical CenterAichi, Japan
| | - Komei Ito
- Department of Allergy, Allergy and Immunology Center, Aichi Children's Health and Medical CenterAichi, Japan; Comprehensive Pediatric Medicine, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Andreas L Lopata
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia; Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia; Tropical Futures Institute, James Cook University, Singapore; Centre for Food and Allergy Research, Murdoch Childrens Research Institute, Melbourne, Australia.
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16
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Brocart C, Beck J, Collin S, Lamy P, Sabouraud-Leclerc D. L’induction de tolérance orale à la noix de cajou et/ou à la pistache chez 50 patients : l’expérience rémoise. REVUE FRANÇAISE D'ALLERGOLOGIE 2023. [DOI: 10.1016/j.reval.2022.103279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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17
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McWilliam VL, Koplin JJ, Allen K, Robinson M, Smart J, Loke P, Peters RL, Dang T, Lee KJ, Dalziel K, Tey D, Taranto M, Perrett KP. TreEAT trial: Protocol for a randomized controlled trial investigating the efficacy and safety of early introduction of tree nuts for the prevention of tree nut allergy in infants with peanut allergy. Pediatr Allergy Immunol 2023; 34:e13930. [PMID: 36974653 DOI: 10.1111/pai.13930] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/22/2022] [Accepted: 02/17/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Children with peanut allergy are at increased risk of developing tree nut allergies, which can be severe and for most lifelong. Introduction of peanut in the first year of life can reduce the risk of peanut allergy; however, prevention strategies for tree nut allergies have not been established. We aimed to test the efficacy and safety of a novel strategy, a supervised multi-nut oral food challenge (OFC) compared with standard care for tree nut allergy prevention in infants at high risk of developing tree nut allergy, TreEAT. METHODS AND ANALYSIS TreEAT is a 2-armed, open-label, randomized, controlled trial (RCT). Infants (n = 212) aged 4-11 months with peanut allergy will be randomized 1:1 at peanut allergy diagnosis to either a hospital-based multi-tree nut (almond, cashew, hazelnut, and walnut) OFC using multi-nut butter or standard care (home introduction of individual tree nuts). All infants will be assessed at age 18 months, with questionnaires and SPT to peanut and tree nuts. Peanut and tree nut OFCs will be performed as required to determine the allergy status for each nut. The primary outcome is tree nut allergy at age 18 months. Secondary outcomes include peanut allergy resolution, proportion, and severity of adverse events related to tree nut ingestion, number and frequency of tree nuts ingested, quality of life and parental anxiety, and allergy-related healthcare visits from randomization to 18 months of age. Analyses will be performed on an intention-to-treat basis. ETHICS AND DISSEMINATION TreEAT was approved by the Royal Children's Hospital Human Research Ethics Committee (#70489). Outcomes will be presented at scientific conferences and disseminated through publication. TRIAL REGISTRATION NUMBER ClinicalTrials.gov ID: NCT04801823.
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Affiliation(s)
- Vicki L McWilliam
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer J Koplin
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Katie Allen
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Marnie Robinson
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Joanne Smart
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Paxton Loke
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Monash Children's Hospital, Clayton, Victoria, Australia
| | - Rachel L Peters
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Thanh Dang
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Katherine J Lee
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Clinical Epidemiology & Biostatistics Unit (CEBU), Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Melbourne Children's Trial Centre, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kim Dalziel
- Health Economics Unit, Centre for Health Policy, The University of Melbourne, Parkville, Victoria, Australia
| | - Dean Tey
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Mark Taranto
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Kirsten P Perrett
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Melbourne Children's Trial Centre, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Centre Food & Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Multi-Target Detection of Nuts and Peanuts as Hidden Allergens in Bakery Products through Bottom-Up Proteomics and High-Resolution Mass Spectrometry. Foods 2023; 12:foods12040726. [PMID: 36832800 PMCID: PMC9955278 DOI: 10.3390/foods12040726] [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: 01/05/2023] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
Due to the growing global incidence of allergy to nuts and peanuts, the need for better protection of consumers sensitive to those products is constantly increasing. The best strategy to defend them against adverse immunological reactions still remains the total removal of those products from their diet. However, nuts and peanuts traces can also be hidden in other food products, especially processed ones, such as bakery products, because of cross-contamination occurring during production. Precautionary labelling is often adopted by producers to warn allergic consumers, usually without any evaluation of the actual risk, which would require a careful quantification of nuts/peanuts traces. In this paper, the development of a multi-target method based on liquid chromatography-tandem high resolution mass spectrometry (LC-MS, MS/MS), able to detect traces of five nuts species (almonds, hazelnuts, walnuts, cashews and pistachios) and of peanuts in an in-house incurred bakery product (cookie) through a single analysis is described. Specifically, allergenic proteins of the six ingredients were used as the analytical targets, and the LC-MS responses of selected peptides resulting from their tryptic digestion, after extraction from the bakery product matrix, were exploited for quantification, following a bottom-up approach typical of proteomics. As a result, nuts/peanuts could be detected/quantified down to mg·kg-1 levels in the model cookie, thus opening interesting perspectives for the quantification of hidden nuts/peanuts in bakery products and, consequently, for a more rational use of precautionary labelling.
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19
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Tree nut introduction in infants with peanut and/or egg allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:658-660. [PMID: 36347470 DOI: 10.1016/j.jaip.2022.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/17/2022] [Accepted: 10/27/2022] [Indexed: 11/08/2022]
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Jonas da Rocha Esperança V, Corrêa de Souza Coelho C, Tonon R, Torrezan R, Freitas-Silva O. A review on plant-based tree nuts beverages: technological, sensory, nutritional, health and microbiological aspects. INTERNATIONAL JOURNAL OF FOOD PROPERTIES 2022. [DOI: 10.1080/10942912.2022.2134417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Victor Jonas da Rocha Esperança
- Food and Nutrition Graduate Program, Federal University of State of Rio de Janeiro (PPGAN/ UNIRIO). Av. Pasteur, Rio de Janeiro, Brasil
| | - Caroline Corrêa de Souza Coelho
- Food and Nutrition Graduate Program, Federal University of State of Rio de Janeiro (PPGAN/ UNIRIO). Av. Pasteur, Rio de Janeiro, Brasil
| | - Renata Tonon
- Centro de Tecnologia Agrícola e Alimentar/CTAA, EMBRAPA Agroindústria de Alimentos, Av. das Américas, Rio de Janeiro, Brasil
| | - Renata Torrezan
- Centro de Tecnologia Agrícola e Alimentar/CTAA, EMBRAPA Agroindústria de Alimentos, Av. das Américas, Rio de Janeiro, Brasil
| | - Otniel Freitas-Silva
- Centro de Tecnologia Agrícola e Alimentar/CTAA, EMBRAPA Agroindústria de Alimentos, Av. das Américas, Rio de Janeiro, Brasil
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21
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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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22
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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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23
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Imran S, Neeland MR, Peng S, Vlahos A, Martino D, Dharmage SC, Tang MLK, Sawyer S, Dang TD, McWilliam V, Peters RL, Koplin JJ, Perrett KP, Novakovic B, Saffery R. Immuno-epigenomic analysis identifies attenuated interferon responses in naïve CD4 T cells of adolescents with peanut and multi-food allergy. Pediatr Allergy Immunol 2022; 33:e13890. [PMID: 36433861 DOI: 10.1111/pai.13890] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND IgE-mediated food allergies have been linked to suboptimal naïve CD4 T (nCD4T) cell activation in infancy, underlined by epigenetic and transcriptomic variation. Similar attenuated nCD4T cell activation in adolescents with food allergy have also been reported, but these are yet to be linked to specific epigenetic or transcriptional changes. METHODS We generated genome-wide DNA methylation data in purified nCD4 T cells at quiescence and following activation in a cohort of adolescents (aged 10-15 years old) with peanut allergy (peanut only or peanut + ≥1 additional food allergy) (FA, n = 29), and age-matched non-food allergic controls (NA, n = 18). Additionally, we assessed transcriptome-wide gene expression and cytokine production in these cells following activation. RESULTS We found widespread changes in DNA methylation in both NA and FA nCD4T cells in response to activation, associated with the T cell receptor signaling pathway. Adolescents with FA exhibit unique DNA methylation signatures at quiescence and post-activation at key genes involved in Th1/Th2 differentiation (RUNX3, RXRA, NFKB1A, IL4R), including a differentially methylated region (DMR) at the TNFRSF6B promoter, linked to Th1 proliferation. Combined analysis of DNA methylation, transcriptomic data and cytokine output in the same samples identified an attenuated interferon response in nCD4T cells from FA individuals following activation, with decreased expression of several interferon genes, including IFN-γ and a DMR at a key downstream gene, BST2. CONCLUSION We find that attenuated nCD4T cell responses from adolescents with food allergy are associated with specific epigenetic variation, including disruption of interferon responses, indicating dysregulation of key immune pathways that may contribute to a persistent FA phenotype. However, we recognize the small sample size, and the consequent restraint on reporting adjusted p-value statistics as limitations of the study. Further study is required to validate these findings.
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Affiliation(s)
- Samira Imran
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Melanie R Neeland
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Stephen Peng
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Amanda Vlahos
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| | - David Martino
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia.,Telethon Kids Institute, University of Western, Perth, Nedlands, Australia
| | - Shyamali C Dharmage
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia.,Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Susan Sawyer
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia.,Centre for Adolescent Health, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Thanh D Dang
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Vicki McWilliam
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Rachel L Peters
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Jennifer J Koplin
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Kirsten P Perrett
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Boris Novakovic
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
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24
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Shu J, Cui X, Liu X, Yu W, Zhang W, Huo X, Lu C. Licochalcone A inhibits IgE-mediated allergic reaction through PLC/ERK/STAT3 pathway. Int J Immunopathol Pharmacol 2022; 36:3946320221135462. [PMID: 36263976 PMCID: PMC9597022 DOI: 10.1177/03946320221135462] [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] [Indexed: 11/05/2022] Open
Abstract
Licochalcone (LicA) is a flavonoid commonly derived from the licorice plant that is reported to have a variety of pharmacological activities. However, few studies have focused on its anti-allergic properties. IgE-mediated passive and systemic anaphylaxis mice models were used to assess the in vivo anti-allergic effect of LicA and its underlying mechanism, while degranulation, cytokines, and chemokines released from laboratory of allergic disease (LAD2) cells were used to assess its in vitro anti-allergic effect. We used western blot analysis to explore the downstream signaling pathway of its anti-allergic effect. We found that in the mouse model, LicA attenuated IgE-mediated paw inflammation, recovered the allergy-induced drop in body temperature, and reduced the concentrations of tumor necrosis factor-alpha and monocyte chemo-attractant protein-1 in mouse serum in a dose-dependent manner. LicA inhibited the allergic reaction via inhibition of IgE-mediated LAD2 cell activation through the PLC/ERK/STAT3 pathway.
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Affiliation(s)
- Jin Shu
- Department of Gynecology, Xi’an Hospital of Traditional Chinese
Medicine, Xi’an, P. R. China
| | - Xu Cui
- Department of Joint Surgery, Xi’an
Hong Hui Hospital, Xi’an Jiaotong University Health
Science Center, Xi’an, P. R. China,Shaanxi University of Traditional
Chinese Medicine, Xi’an, P. R. China
| | - Xin Liu
- Department of Joint Surgery, Xi’an
Hong Hui Hospital, Xi’an Jiaotong University Health
Science Center, Xi’an, P. R. China
| | - Wenxing Yu
- Department of Joint Surgery, Xi’an
Hong Hui Hospital, Xi’an Jiaotong University Health
Science Center, Xi’an, P. R. China
| | - Weisong Zhang
- Department of Joint Surgery, Xi’an
Hong Hui Hospital, Xi’an Jiaotong University Health
Science Center, Xi’an, P. R. China
| | - Xiaojing Huo
- Department of Joint Surgery, Xi’an
Hong Hui Hospital, Xi’an Jiaotong University Health
Science Center, Xi’an, P. R. China
| | - Chao Lu
- Department of Joint Surgery, Xi’an
Hong Hui Hospital, Xi’an Jiaotong University Health
Science Center, Xi’an, P. R. China,Chao Lu, Department of Joint Surgery, Xi’an
Hong Hui Hospital, Xi’an Jiaotong University, No. 555, Youyi East Road,
Nanshaomen, Xi’an 710054, China.
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25
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Kubota K, Nagakura KI, Itonaga T, Sato S, Ebisawa M, Yanagida N. Macadamia nut-specific IgE levels for predicting anaphylaxis. Pediatr Allergy Immunol 2022; 33:e13852. [PMID: 36156824 DOI: 10.1111/pai.13852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/17/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite the high risk of anaphylaxis in patients with a macadamia nut allergy (MdA), little is known about the significance of macadamia nut-specific immunoglobulin E (Md-sIgE). Thus, this study aimed to investigate the utility of Md-sIgE for predicting anaphylaxis. METHODS Children with suspected MdA who visited our hospital were included. MdA was defined as either failing the 3-g macadamia nut (Md) oral food challenge (OFC) or confirming obvious immediate symptoms following Md ingestion. Non-MdA was defined as passing the 3-g Md OFC. RESULTS A total of 41 children (29 [71%] males) with a median age of 7.7 years were included. The median Md-sIgE level was 2.23 kUA /L. Among the 21 children diagnosed with MdA, eight and 13 children did (An group) and did not (non-An group) develop anaphylaxis. Twenty children were included in the non-MdA group. The Md-sIgE level was significantly higher in the An group relative to the others (7.97 vs. 1.92 kUA /L, p < .001). Furthermore, the Md-sIgE level was significantly higher in the An group than in the non-An group (7.97 vs. 1.92 kUA /L, p = .02). However, there was no significant difference in the Md-sIgE between the non-An and non-MdA groups (1.92 vs. 1.90 kUA /L, p > .99). The area under the curve for predicting anaphylaxis in Md-sIgE was 0.92 (95% CI: 0.83-1.00), and the optimal cut-off value was 3.76 kUA /L. CONCLUSION Md-sIgE levels were useful in predicting anaphylaxis. Above the cut-off value, we emphasize paying careful attention to the risk of anaphylaxis.
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Affiliation(s)
- Kei Kubota
- Department of Pediatrics, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Japan
| | - Ken-Ichi Nagakura
- Department of Pediatrics, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Japan.,Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan
| | - Takaaki Itonaga
- Department of Pediatrics, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Japan
| | - Sakura Sato
- Department of Allergy, Clinical Research Center for Allergology and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Japan
| | - Motohiro Ebisawa
- Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan.,Department of Allergy, Clinical Research Center for Allergology and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Japan
| | - Noriyuki Yanagida
- Department of Pediatrics, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Japan.,Department of Allergy, Clinical Research Center for Allergology and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Japan
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26
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Ducharme L, Gabrielli S, Clarke AE, Morris J, Gravel J, Lim R, Chan ES, Goldman RD, O'Keefe A, Gerdts J, Chu DK, Upton J, Hochstadter E, Bretholz A, McCusker C, Zhang X, Ben-Shoshan M. Tree Nut-Induced Anaphylaxis in Canadian Emergency Departments: Rate, Clinical Characteristics and Management. Ann Allergy Asthma Immunol 2022; 129:335-341. [PMID: 35718284 DOI: 10.1016/j.anai.2022.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/26/2022] [Accepted: 06/06/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Data are sparce regarding tree nut-induced anaphylaxis (TNA). OBJECTIVE We aimed to characterize rate, clinical characteristics, and management of TNA in children (0-17 years old) across Canada, and assess factors associated with severe reactions and epinephrine use. METHODS Between April 2011 and May 2020, data were collected on children presenting to five emergency departments (EDs) in Canada. Multivariate logistic analysis was used to evaluate factors associated with severe reactions (stridor, cyanosis, circulatory collapse, or hypoxia) and epinephrine use. RESULTS Among 3096 cases of anaphylaxis, 540 (17%) were induced by tree nut. The median age was 5.2 years [Interquartile range (IQR): 2.5-9.5] and 65.4% were males. Among all reactions, 7.0% were severe. The major tree nuts accounting for anaphylaxis were cashew (32.8%), hazelnut (20.0%) and walnut (11.5%). Cashew-induced anaphylaxis was more common in British Columbia [14.0% difference (95% CI, 1.6%-27.6%)] versus Ontario and Quebec, whereas pistachio-induced anaphylaxis was more common in Ontario and Quebec [6.3% difference (95% CI, 0.5%-12.2%)]. Pre-hospital and ED intramuscular (IM) epinephrine administration was documented in only 35.2% and 52.4% of cases, respectively. Severe reactions were more likely among males [adjusted Odds Ratio (aOR) 1.05 (95% CI, 1.01-1.10)] older children [aOR 1.00 (95% CI, 1.00-1.01)], and in reactions triggered by macadamia [aOR 1.27 (95% CI, 1.03-1.57)]. CONCLUSION Different TNA patterns in Canada may be due to differences in lifestyle (higher prevalence of Asian ethnicity in British Columbia versus Arabic ethnicity in Ontario and Quebec). IM epinephrine underutilization urges for EAI stocking in schools and restaurants, patient education, and consistent policies across Canada.
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Affiliation(s)
- Laurence Ducharme
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
| | - Sofianne Gabrielli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
| | - Ann E Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Judy Morris
- Department of Emergency Medicine, Sacré-Coeur Hôpital, Montreal, Quebec, Canada.
| | - Jocelyn Gravel
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
| | - Rodrick Lim
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at London Health Science Centre, London, Ontario, Canada.
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Ran D Goldman
- Division of Clinical Pharmacology and Emergency Medicine, Department of Pediatrics, BC Children's Hospital, and the BC Children's Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Andrew O'Keefe
- Department of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Newfoundland & Labrador, Canada.
| | - Jennifer Gerdts
- Executive Director, Food Allergy Canada, Toronto, Ontario, Canada.
| | - Derek K Chu
- Division of Clinical Immunology & Allergy, Department of Medicine, and Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada.
| | - Julia Upton
- Division of Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
| | - Elana Hochstadter
- Department of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Adam Bretholz
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, Montreal, QC, Canada.
| | - Christine McCusker
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
| | - Xun Zhang
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada.
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
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27
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Lyons SA, Welsing PMJ, Hakobyan M, Kansen HM, Knol EF, Otten HG, Ree R, Knulst AC, Le T. Measurement of IgE to hazelnut allergen components cannot replace hazelnut challenge in Dutch adults. Allergy 2022; 77:1559-1569. [PMID: 34731517 PMCID: PMC9298907 DOI: 10.1111/all.15166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 04/20/2021] [Accepted: 10/11/2021] [Indexed: 01/16/2023]
Abstract
Background Component‐resolved diagnostics (CRD) help predict hazelnut allergy (HA) in children, but are of unknown diagnostic value in adults. This study aimed to evaluate the diagnostic accuracy of IgE to hazelnut extract and components in adults. Methods A Dutch population of consecutively presenting adults suspected of HA, who underwent a double‐blind placebo‐controlled food challenge, were included. Serum IgE to hazelnut extract and Cor a 1, 8, 9, and 14 was measured on ImmunoCAP. Diagnostic accuracy was assessed by area under the curve (AUC) analysis. Results Of 89 patients undergoing challenge, 46 had challenge‐confirmed HA: 17 based on objective and 29 based on subjective symptoms. At commonly applied cutoffs 0.1 and 0.35 kUA/L, high sensitivity was observed for IgE to hazelnut extract and Cor a 1 (range 85–91%), and high specificity for IgE to Cor a 8, 9 and 14 (range 77–95%). However, the AUCs for hazelnut extract and components were too low for accurate prediction of HA (range 0.50–0.56). Combining hazelnut extract and component IgE measurements did not significantly improve accuracy. Higher IgE levels to Cor a 9 and 14 were tentatively associated with HA with objective symptoms, but the corresponding AUCs still only reached 0.68 and 0.63, respectively. Conclusions Although hazelnut allergic adults are generally sensitized to hazelnut extract and Cor a 1, and hazelnut tolerant adults are usually not sensitized to Cor a 8, 9, or 14, challenge testing is still needed to accurately discriminate between presence and absence of HA in adults from a birch‐endemic country.
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Affiliation(s)
- Sarah A. Lyons
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht University Utrecht the Netherlands
| | - Paco M. J. Welsing
- Division of internal medicine and dermatology University Medical Center Utrecht Utrecht University Utrecht the Netherlands
| | - Mariam Hakobyan
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht University Utrecht the Netherlands
| | - Hannah M. Kansen
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht University Utrecht the Netherlands
- Department of Pediatric Pulmonology and Allergology Wilhelmina Children’s Hospital University Medical Center Utrecht University Utrecht the Netherlands
| | - Edward F. Knol
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht University Utrecht the Netherlands
- Center of Translational Immunology University Medical Center Utrecht Utrecht the Netherlands
| | - Henny G. Otten
- Center of Translational Immunology University Medical Center Utrecht Utrecht the Netherlands
| | - Ronald Ree
- Department of experimental immunology Amsterdam University Medical Centers Amsterdam the Netherlands
- Department of otorhinolaryngology Amsterdam University Medical Centers Amsterdam the Netherlands
| | - André C. Knulst
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht University Utrecht the Netherlands
- Center of Translational Immunology University Medical Center Utrecht Utrecht the Netherlands
| | - Thuy‐My Le
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht University Utrecht the Netherlands
- Center of Translational Immunology University Medical Center Utrecht Utrecht the Netherlands
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28
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Juel-Berg N, Larsen LF, Küchen N, Norgil I, Hansen KS, Poulsen LK. Patterns of Clinical Reactivity in a Danish Cohort of Tree Nut Allergic Children, Adolescents, and Young Adults. FRONTIERS IN ALLERGY 2022; 3:824660. [PMID: 35958942 PMCID: PMC9361471 DOI: 10.3389/falgy.2022.824660] [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: 11/29/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Tree nut allergy is associated with severe reactions and poly-sensitization to other nuts and peanuts often occurs. There are regional differences in sensitization profiles that result in differences in clinical presentation. Denmark is located in a birch pollen endemic area, which could influence the allergy patterns due to pollen cross-sensitization. Objective This study aimed to investigate patterns of sensitization and clinical reactivity to tree nuts and peanuts and threshold levels for oral food challenges (OFCs) in a Danish cohort of tree nut allergic children, adolescents, and young adults. Methods Forty tree nut allergic subjects were assessed for clinical reactivity to six nuts, i.e., hazelnut, walnut, pistachio, cashew, almond, and peanut, by OFCs or convincing medical history of an immediate allergic reaction or tolerance. Clinical presentation and allergen-specific immunoglobulin E (sIgE) levels together with eliciting dose and rescue medication in OFCs were furthermore assessed. Results Allergy to two or more tree nuts was observed in most cases. Hazelnut-walnut dual allergy was common but not exclusively observed as concomitant allergies. Allergy to cashew was coincided in all but one of the assessed subjects with pistachio allergy. Half of all assessed subjects were allergic to peanuts. Oral symptoms followed by a skin reaction were the most common symptomatology that lead to OFC cessation and subjects often presented with symptoms from two or more organ systems. OFC threshold levels were within the same range, but cashew was distinguished from other nuts by causing allergic symptoms at the lowest dose. Clinical reactivity and the allergy patterns were to some extent reflected by sIgE levels and by correlations in sIgE between the nuts. Conclusions In this Northern European cohort, subjects with clinically relevant tree nut allergy were generally allergic to two or more tree nuts and close to half of them also to peanuts. There were two distinct and independent allergic phenotypes; the majority of hazelnut allergic subjects were also allergic to walnut, and all but one subject with cashew allergy were dual allergic to pistachio. These findings are consistent with a strong sIgE correlation between hazelnut and walnut and a close to total sIgE correlation between cashew and pistachio.
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Affiliation(s)
- Nanna Juel-Berg
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
- Department of Pediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Lau Fabricius Larsen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
| | - Niels Küchen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
- Department of Pediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Ida Norgil
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
- Department of Pediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Kirsten Skamstrup Hansen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
- Department of Pediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Lars K. Poulsen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
- *Correspondence: Lars K. Poulsen
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29
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Abstract
This review provides a global overview on Rosaceae allergy and details the particularities of each fruit allergy induced by ten Rosaceae species: almond/peach/cherry/apricot/plum (Amygdaleae), apple/pear (Maleae), and raspberry/blackberry/strawberry (Rosoideae). Data on clinical symptoms, prevalence, diagnosis, and immunotherapies for the treatment of Rosaceae allergy are herein stated. Allergen molecular characterization, cross-reactivity/co-sensitization phenomena, the impact of food processing and digestibility, and the methods currently available for the Rosaceae detection/quantification in foods are also described. Rosaceae allergy has a major impact in context to pollen-food allergy syndrome (PFAS) and lipid transfer protein (LTP) allergies, being greatly influenced by geography, environment, and presence of cofactors. Peach, apple, and almond allergies are probably the ones most affecting the quality of life of the allergic-patients, although allergies to other Rosaceae fruits cannot be overlooked. From patients' perspective, self-allergy management and an efficient avoidance of multiple fruits are often difficult to achieve, which might raise the risk for cross-reactivity and co-sensitization phenomena and increase the severity of the induced allergic responses with time. At this point, the absence of effective allergy diagnosis (lack of specific molecular markers) and studies advancing potential immunotherapies are some gaps that certainly will prompt the progress on novel strategies to manage Rosaceae food allergies.
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Affiliation(s)
- Joana Costa
- REQUIMTE-LAQV, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | - Isabel Mafra
- REQUIMTE-LAQV, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
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30
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Abrams EM, Sicherer SH. Tree nut introduction in a peanut-allergic child: To eat, to screen, or to avoid? Pediatr Allergy Immunol 2022; 33:e13669. [PMID: 34553798 DOI: 10.1111/pai.13669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/07/2021] [Accepted: 09/14/2021] [Indexed: 02/03/2023]
Abstract
There is no defined standard of care around tree nut introduction in a peanut-allergic child, and the role of screening prior to tree nut introduction is controversial. There is some evidence that peanut-allergic children are at increased risk of tree nut allergy, with approximately 23-68% of children with co-existent peanut/tree nut allergy. In some studies, it has been shown that tree nut allergy in children has the potential to be a severe allergy. However, this appears to be age-specific as infant anaphylaxis in general tends to be milder, and there has been no fatality reported on the first ingestion of an allergen in infancy. Familial hesitancy has been identified as a possible condition for undertaking screening tests prior to allergen introduction. Indeed, there has been limited evidence that caregiver hesitancy may exist in peanut-allergic families with tree nut introduction. However, pre-emptive screening has the potential to overdiagnose tree nut allergy and delay introduction (which could paradoxically increase risk). As a result, the decision is best made in the context of shared decision-making and patient preference-sensitive care.
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Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada.,Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Scott H Sicherer
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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31
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de Weger WW, Sprikkelman AB, Herpertz CEM, van der Meulen GN, Vonk JM, Kamps AWA, Koppelman GH. The dilemma of open or double-blind food challenges in diagnosing food allergy in children: Design of the ALDORADO trial. Pediatr Allergy Immunol 2022; 33:e13654. [PMID: 34435396 PMCID: PMC9293118 DOI: 10.1111/pai.13654] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/09/2021] [Accepted: 08/06/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND It is of major importance to diagnose food allergy accurately. Current guidelines support the use of oral food challenges to do so. The double-blind placebo-controlled food challenge (DBPCFC) has been regarded as the 'gold standard' for decades. However, DBPCFCs are costly, and time- and resource-intensive procedures. Structural implementation of less demanding open food challenges will only find support if research demonstrates that their outcome is comparable to DBPCFC, yet this has been proven difficult to investigate. METHODS We performed a literature review to investigate the diagnostic accuracy of oral food challenges and interviewed 19 parents of children with proven or suspected food allergy about the design of a trial to study this. RESULTS An overview of the dilemma of diagnosing food allergy using oral food challenges, and the methodological issues and parents' opinions to study this. No comparative studies have been performed using the latest guidelines on oral food challenges. CONCLUSIONS There is an urgent need to investigate the diagnostic accuracy of different oral food challenge protocols. We present the rationale and design of the ALDORADO trial (ALlergy Diagnosed by Open oR DOuble-blind food challenge) that has been set up to investigate whether the outcome of the open food challenge is comparable to DBPCFC.
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Affiliation(s)
- Wouter W. de Weger
- Department of PediatricsMartini HospitalGroningenThe Netherlands
- Department of Pediatric Pulmonology and Pediatric AllergologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
- University Medical Center GroningenGRIAC Research InstituteUniversity of GroningenGroningenThe Netherlands
| | - Aline B. Sprikkelman
- Department of Pediatric Pulmonology and Pediatric AllergologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
- University Medical Center GroningenGRIAC Research InstituteUniversity of GroningenGroningenThe Netherlands
| | | | | | - Judith M. Vonk
- University Medical Center GroningenGRIAC Research InstituteUniversity of GroningenGroningenThe Netherlands
- Department of EpidemiologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | | | - Gerard H. Koppelman
- Department of Pediatric Pulmonology and Pediatric AllergologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
- University Medical Center GroningenGRIAC Research InstituteUniversity of GroningenGroningenThe Netherlands
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32
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Röntynen P, Kukkonen K, Savinko T, Mäkelä MJ. Optimizing tools for evaluating challenge outcomes in children with cashew nut allergy. Ann Allergy Asthma Immunol 2021; 128:270-278. [PMID: 34896310 DOI: 10.1016/j.anai.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 11/02/2021] [Accepted: 12/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The incidence of cashew nut anaphylaxis is increasing and there is a need for accurate diagnostic tests. Age-specific cutoffs in children are lacking. Changes in serum tryptase levels are not well documented in pediatric food allergy, except in anaphylaxis. OBJECTIVE To evaluate the ability of various tests to diagnose cashew nut allergy and to predict reaction severity. We also investigated changes in tryptase and their correlation to reaction severity. METHODS We performed an open cashew nut challenge on 106 children (aged 1-16 years), who were sensitized to cashew nut with either previous allergic reaction to cashew nut or no known exposure. We analyzed the accuracy of Ana o 3 immunoglobulin E (IgE), cashew nut IgE, skin prick test, basophil activation test (BAT), and combinations thereof to diagnose cashew nut allergy and to predict reaction severity. Tryptase level was measured at the baseline and during an allergic reaction. RESULTS A total of 72 children had positive challenge outcomes. Ana o 3 IgE seemed to be the best single test to diagnose cashew allergy, with a 0.97 kU/L cutoff exhibiting 94.1% specificity and 61.1% sensitivity. Though BAT values of at least 22.8% best predicted reaction severity, with 91.7% specificity and 60.7% sensitivity, the cutoffs were age-specific. Tryptase levels increased substantially 1 to 2 hours after the first allergic symptoms compared with baseline. CONCLUSION Ana o 3 IgE seems to be the best diagnostic test in pediatric cashew nut allergy, and test combinations do not seem to improve the diagnostics. Cutoffs are age-specific. BAT is promising in predicting reaction severity. Tryptase levels should be measured 1 to 2 hours after initiation of an allergic reaction.
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Affiliation(s)
- Petteri Röntynen
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Kaarina Kukkonen
- Children's Hospital and Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Terhi Savinko
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika J Mäkelä
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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33
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Abstract
PURPOSE OF REVIEW B cells are known in food allergy pathogenesis for their production of IgE but their roles in the development of tolerance to foods are not well understood. Further understanding of B-cell biology in the context of food allergy is essential for the creation of effective prevention strategies and therapies. RECENT FINDINGS The majority of allergen-specific IgE in humans appears to arise from antigen-experienced B cells that have already undergone class switch recombination to other antibody isotypes, such as IgG1, and can also be produced by cells class switching to IgE locally in the gastrointestinal tract. Allergen-specific IgG4 can have protective effects in individuals and is associated with tolerance. Regulatory B cells, which can produce allergen-specific IgG4, are reduced in food-allergic individuals and may also be an important component of tolerance. Therapeutic approaches that block the generation and action of IgE and that enhance tolerizing immune responses are being evaluated for the treatment of food allergy. SUMMARY B cells play several roles in the development of food allergy versus tolerance. Their functions may translate into the care of food allergy as biomarkers or therapeutic targets and can be employed in other atopic diseases to better understand their pathogenesis and create new avenues for treatment.
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Affiliation(s)
- Chioma Udemgba
- Allergy and Clinical Immunology Fellowship Program, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Adora Lin
- Center for Cancer and Immunology Research, Children’s National Research Institute, Washington, DC
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34
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Storage Proteins Are Driving Pediatric Hazelnut Allergy in a Lipid Transfer Protein-Rich Area. Foods 2021; 10:foods10102463. [PMID: 34681512 PMCID: PMC8535272 DOI: 10.3390/foods10102463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 01/07/2023] Open
Abstract
Oral food challenge (OFC) remains the gold standard for the diagnosis of food allergies. However, this test is not without risks, given that severe allergic reactions can be triggered while it is conducted. The purpose of this study is to identify potential demographic variables, clinical characteristics of the patients and biomarkers that may be associated with severe reactions during the hazelnut oral challenge test. The sample included 22 children allergic to hazelnut who underwent a tree nut skin prick test (SPT), specific IgE (sIgE) to hazelnut, component-resolved diagnosis (CRD) with different hazelnut allergens (Cor a 1, Cor a 8, Cor a 9, Cor a 11, Cor a 14), and a single-blind placebo-controlled challenge with hazelnut. A statistically significant relationship was found between the severity of the reaction and the highest values of sIgE to hazelnut, Cor a 11 and Cor a 14, cumulative symptom-triggering dose and sunflower seed sensitization. The use of the CRD is a useful tool to identify patients at higher risk of developing a severe reaction. In this pediatric population sample from Spain, storage proteins were confirmed to be most involved in hazelnut allergy and the development of severe reactions.
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35
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Bager J, Tedner SG, Andersson N, Ballardini N, Borres MP, Konradsen JR, Nilsson C, Westman M, Kull I, Bergström A, van Hage M, Melen E, Asarnoj A. Prevalence and early-life risk factors for tree nut sensitization and allergy in young adults. Clin Exp Allergy 2021; 51:1429-1437. [PMID: 34357659 DOI: 10.1111/cea.13994] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/06/2021] [Accepted: 06/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tree nut allergy may cause anaphylaxis. There are limited population-based studies on prevalence and early-life risk factors. METHODS We evaluated the prevalence of reported symptoms and allergic sensitization to tree nuts at age 24 years in the BAMSE population-based cohort study and assessed early-life factors associated with the development of tree nut allergy. We estimated tree nut allergy prevalence, by analysing questionnaire data on tree nut ingestion and symptoms at age 12, 16 and 24 years, and IgE sensitization at age 24 years to hazelnut, walnut, pecan, cashew, pistachio, Brazil nut, almond extracts and allergen molecules Cor a 1, 9, 14 (hazelnut), Jug r 1 (walnut) and Ana o 3 (cashew). We evaluated eczema, asthma, food allergies, inherited risk of allergy and gender as potential early-life risk factors. RESULTS Data were available for 2215/4089 (54%) BAMSE study participants, for estimation of the prevalence of tree nut sensitization (21.2%), tree nut allergy symptoms (9.8%) and combined sensitization and symptoms (7.9%, 2.1% for storage protein sensitization and symptoms, 4.3% for any sensitization and non-mild symptoms). Sixty-three per cent of sensitized individuals (295/470) were asymptomatic, but only 76/470 (16%) storage protein sensitized individuals. Egg allergy (ORadj 8.50 95% CI 2.15-33.6), eczema (ORadj 2.53 95% CI 1.21-5.32) and asthma (ORadj 5.59 95% CI 2.35-13.3)) at pre-school age were associated with future development of tree nut symptoms and storage protein sensitization. At age 24 years, tree nut allergy was associated with current eczema and with markers of current asthma severity. Sensitization to storage proteins was more strongly associated with symptoms than sensitization to whole extract for all tree nuts evaluated. CONCLUSIONS In this Swedish cohort, we found tree nut whole extract sensitization is common but usually asymptomatic. Storage protein sensitization is a more reliable indicator of tree nut symptoms. Tree nut allergy is associated with early onset, persistent and severe atopic disease.
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Affiliation(s)
- Jessica Bager
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Sandra G Tedner
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Niklas Andersson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Natalia Ballardini
- Sachs' Children and Youth Hospital, Stockholm, Sweden.,Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Dermatology and Sexual Health, Stockholm, Sweden
| | - Magnus P Borres
- Department of Women's and Children's Health, Uppsala University and Thermo Fisher Scientific, Uppsala, Sweden
| | - Jon R Konradsen
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Caroline Nilsson
- Sachs' Children and Youth Hospital, Stockholm, Sweden.,Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Marit Westman
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Asthma and Allergy Clinic S:t Göran, Stockholm, Sweden
| | - Inger Kull
- Sachs' Children and Youth Hospital, Stockholm, Sweden.,Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm, Sweden
| | - Marianne van Hage
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Erik Melen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden.,Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Anna Asarnoj
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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36
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Maruyama N. Components of plant-derived food allergens: Structure, diagnostics, and immunotherapy. Allergol Int 2021; 70:291-302. [PMID: 34092500 DOI: 10.1016/j.alit.2021.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/19/2021] [Indexed: 12/11/2022] Open
Abstract
A large number of plant-derived food allergen components have been identified to date. Although these allergens are diverse, they often share common structural features such as numerous disulfide bonds or oligomeric structures. Furthermore, some plant-derived food allergen components cross-react with pollen allergens. Since the relationship between allergen components and clinical symptoms has been well characterized, measurements of specific IgE to these components have become useful for the accurate clinical diagnosis and selection of optimal treatment methods for various allergy-related conditions including allergy caused by plant-derived foods. Herein, I have described the types and structures of different plant allergen components and outlined the diagnosis as well as treatment strategies, including those reported recently, for such substances. Furthermore, I have also highlighted the contribution of allergen components to this field.
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Affiliation(s)
- Nobuyuki Maruyama
- Food Quality Design and Development Laboratory, Graduate School of Agriculture, Kyoto University, Gokasho, Uji, Kyoto 611-0011, Japan.
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37
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Midun E, Radulovic S, Brough H, Caubet JC. Recent advances in the management of nut allergy. World Allergy Organ J 2021; 14:100491. [PMID: 33510829 PMCID: PMC7811165 DOI: 10.1016/j.waojou.2020.100491] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 11/25/2022] Open
Abstract
Peanut/tree nut allergy is common and has been associated with particularly severe reactions. Epidemiological data have shown that the prevalence ranges between 0.05% and 4.9% for tree nut and between 0.5% and 3% for peanut. These large variations can be explained by differences in the age of included patients and the geographical region. In addition, the food consumption modality (ie, raw versus roasted) plays a major role, as heat treatment has the capacity to modify the allergenicity of nuts and legumes. Nut allergies tend to persist into adulthood and consequently have a high impact on quality of life. Recently, it has been demonstrated that a significant proportion of nut allergic patients are able to tolerate other nuts. As opposed to the avoidance of all nuts, this approach is currently proposed in several tertiary allergy centers. However, diagnosis of nut allergy is particularly difficult due to co-sensitization leading to high rate of false positive skin prick tests and/or specific IgE to whole allergen extracts. The use of component resolved diagnosis leads to major improvement of diagnosis, particularly to distinguish between primary and secondary nut allergies. The basophil activation test has been suggested to be useful but is still used mainly as a research tool. Thus, diagnosis remains mainly based on the oral food challenge, which is considered as the gold standard. Regarding treatment, avoidance remains the cornerstone of management of nut allergy. Oral immunotherapy is increasingly proposed as an alternative management strategy.
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Key Words
- Component-resolved diagnostic, CRD
- Cross reactivity
- Double-blind, placebo-controlled, food challenge, DBPCFC
- Food allergy
- Lipid transfer protein, LTP
- Oral allergy syndrome, OAS
- Oral food challenge, OFC
- Oral immunotherapy
- Oral induction tolerance, OIT
- Pathogenesis related protein type 10, PR-10
- Peanut
- Platelet-activating factor, PAF
- Pollen-food syndrome, PFS
- Precautionary Allergen Labels, (PAL)
- Skin prick test, SPT
- Tree nut
- Tree nut, TN
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Affiliation(s)
- Elise Midun
- Pediatric Allergy Unit, University Hospitals of Geneva and University of Geneva, Rue Willy Donzé 6, 1205 Geneva, Switzerland, University Lyon 1 Claude Bernard, 43 Boulevard Du 11-Novembre-1918, 69100, Villeurbanne, France
- Corresponding author.
| | - Suzana Radulovic
- Paediatric Allergy Group, Department of Women and Children's Health, King's College London, London, United Kingdom, Paediatric Allergy Group, Peter Gorer Dept of Immunobiology, School of Immunology & Microbial Sciences, King's College London, Guys' Hospital, London, United Kingdom, Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Helen Brough
- Paediatric Allergy Group, Department of Women and Children's Health, King's College London, London, United Kingdom, Paediatric Allergy Group, Peter Gorer Dept of Immunobiology, School of Immunology & Microbial Sciences, King's College London, Guys' Hospital, London, United Kingdom, Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Jean-Christoph Caubet
- Pediatric Allergy Unit, University Hospitals of Geneva and University of Geneva, Rue Willy Donzé 6, 1205, Geneva, Switzerland
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Lyons SA, Datema MR, Le TM, Asero R, Barreales L, Belohlavkova S, de Blay F, Clausen M, Dubakiene R, Fernández-Perez C, Fritsche P, Gislason D, Hoffmann-Sommergruber K, Jedrzejczak-Czechowicz M, Jongejan L, Kowalski ML, Kralimarkova TZ, Lidholm J, Papadopoulos NG, Pontoppidan B, Popov TA, Prado ND, Purohit A, Reig I, Seneviratne SL, Sinaniotis A, Vassilopoulou E, Versteeg SA, Vieths S, Zwinderman AH, Welsing PM, Mills EC, Ballmer-Weber BK, Knulst AC, Fernández-Rivas M, Van Ree R. Walnut Allergy Across Europe: Distribution of Allergen Sensitization Patterns and Prediction of Severity. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:225-235.e10. [DOI: 10.1016/j.jaip.2020.08.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/17/2020] [Accepted: 08/24/2020] [Indexed: 01/16/2023]
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López-Hidalgo C, Trigueros M, Menéndez M, Jorrin-Novo JV. Phytochemical composition and variability in Quercus ilex acorn morphotypes as determined by NIRS and MS-based approaches. Food Chem 2020; 338:127803. [PMID: 32822899 DOI: 10.1016/j.foodchem.2020.127803] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 12/29/2022]
Abstract
Quercus acorns have been used as a staple food since archeological times; currently, there is a renewed interest in the direct use of the acorns as nuts or as a source of consumable flour. In this regard, the phytochemical composition and variability of various morphotypes of acorns from Quercus ilex have been determined by using two platforms, near infrared spectroscopy (NIRS) and mass spectrometry (MS)-based metabolomics. According to NIRS, starch was the most abundant compound (50-60%). UHPLC-QToF analysis was used for untargeted metabolomic analysis and 192 metabolites were annotated. Principal component analysis (PCA) discriminated the morphotypes; 50 compounds out of 192 identified had the highest load over the first two PCA components (explaining 67.2% variability) and can be potential markers of variability. The data presented here support the value of acorns as a source of nutritionally rich compounds thus justifying their use a good alternative to other nuts.
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Affiliation(s)
- Cristina López-Hidalgo
- Agroforestry and Plant Biochemistry, Proteomics, and Systems Biology, Dpt. Biochemistry and Molecular Biology, ETSAM, University of Cordoba, UCO-CeiA3, Cordoba, Spain.
| | - Macedonia Trigueros
- Agroforestry and Plant Biochemistry, Proteomics, and Systems Biology, Dpt. Biochemistry and Molecular Biology, ETSAM, University of Cordoba, UCO-CeiA3, Cordoba, Spain
| | | | - Jesús V Jorrin-Novo
- Agroforestry and Plant Biochemistry, Proteomics, and Systems Biology, Dpt. Biochemistry and Molecular Biology, ETSAM, University of Cordoba, UCO-CeiA3, Cordoba, Spain.
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40
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Nowak-Wegrzyn A. Food allergy 2020: learning from the past, looking to the future. Ann Allergy Asthma Immunol 2020; 124:409-410. [PMID: 32336459 PMCID: PMC7180025 DOI: 10.1016/j.anai.2020.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/17/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Anna Nowak-Wegrzyn
- Department of Pediatrics, Allergy and Immunology, New York University Langone Health, New York, New York; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
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