1
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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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2
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Borres MP, Sato S, Ebisawa M. Recent advances in diagnosing and managing nut allergies with focus on hazelnuts, walnuts, and cashew nuts. World Allergy Organ J 2022; 15:100641. [PMID: 35493774 PMCID: PMC9020091 DOI: 10.1016/j.waojou.2022.100641] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Magnus P. Borres
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Sakura Sato
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
- Corresponding author. Sakura Sato, M.D., Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, 18-1, Sakuradai, Minami-ku, Sagamihara, Kanagawa, 252-0392, Japan.
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
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3
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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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4
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Abstract
From a botanical point of view, a nut is a kind of dry, closed, unbroken, single-seeded fruit, which has a ligneous pericarp made up of several fruiting bodies surrounded by one free semen. The term “allergy to tree nuts” includes allergies to almonds, Brazil nuts, cashew nuts, hazelnuts, chestnuts, macadamia nuts, pecan nuts, pistachios and walnuts. All tree nuts belong to five orders of plants: Rosaceae, Fagales, Sapindales, Ericales and Proteales. Allergies to tree nuts usually start in childhood, but unlike other food allergies, they rarely fade away and generally persist throughout life. They are one of the main causes of serious allergic reactions ending in death in both children and adults. The epidemiology of allergy to nuts is variable and depends mainly on the geographical zone and eating habits. In northern Europe, hazelnut allergy is prevalent, whereas in the USA the most common is allergy to peanuts and, when taking tree nuts into consideration, to walnuts. The diagnosis of allergies to nuts is difficult and requires the use of the most modern research tools including molecular diagnostic techniques.
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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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Passanisi S, Lombardo F, Crisafulli G, Salzano G, Aversa T, Pajno GB. Novel diagnostic techniques and therapeutic strategies for IgE-mediated food allergy. Allergy Asthma Proc 2021; 42:124-130. [PMID: 33685556 DOI: 10.2500/aap.2021.42.200129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background: Immunoglobulin E (IgE) mediated food allergy is a potentially life-threatening condition and represents a heavy burden for patients and their families. Identification of the most suitable way for management of each patient has currently become the primary goal for physicians. Methods: This study reviewed the current literature related to IgE-mediated food allergy. Results: The use of innovative diagnostic tools, such as allergen-specific IgG4 determination, basophil activation test, and component-resolved diagnostics, is currently available to facilitate a proper diagnosis of food allergy. After several decades of "passive clinical management" of the disease, which was based only on avoidance of the allergenic food and the use of epinephrine in the event of anaphylaxis, there has been a switch to active treatment. The most recent evidence-practice guidelines strongly recommend the use of immunotherapy as an effective therapeutic option, particularly in cases of allergy to cow's milk, egg, or peanut. The use of omalizumab, in association with immunotherapy or alone, has been tested in several studies, and results on its effectiveness seemed to be encouraging. Other biologics, such as dupilumab, reslizumab, mepolizumab, and other anticytokines therapies, are being investigated. Another interesting future treatment strategy could be the use of DNA vaccines. Conclusion: In recent years, the management of IgE-mediated food allergy has greatly improved. Knowledge of pathogenetic mechanisms, understanding of the disease course, and the introduction of novel biomarkers led to more accurate diagnoses along with the active treatment of patients.
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7
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Führer S, Kamenik AS, Zeindl R, Nothegger B, Hofer F, Reider N, Liedl KR, Tollinger M. Inverse relation between structural flexibility and IgE reactivity of Cor a 1 hazelnut allergens. Sci Rep 2021; 11:4173. [PMID: 33603065 PMCID: PMC7892832 DOI: 10.1038/s41598-021-83705-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/05/2021] [Indexed: 11/09/2022] Open
Abstract
A major proportion of allergic reactions to hazelnuts (Corylus avellana) are caused by immunologic cross-reactivity of IgE antibodies to pathogenesis-related class 10 (PR-10) proteins. Intriguingly, the four known isoforms of the hazelnut PR-10 allergen Cor a 1, denoted as Cor a 1.0401-Cor a 1.0404, share sequence identities exceeding 97% but possess different immunologic properties. In this work we describe the NMR solution structures of these proteins and provide an in-depth study of their biophysical properties. Despite sharing highly similar three-dimensional structures, the four isoforms exhibit remarkable differences regarding structural flexibility, hydrogen bonding and thermal stability. Our experimental data reveal an inverse relation between structural flexibility and IgE-binding in ELISA experiments, with the most flexible isoform having the lowest IgE-binding potential, while the isoform with the most rigid backbone scaffold displays the highest immunologic reactivity. These results point towards a significant entropic contribution to the process of antibody binding.
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Affiliation(s)
- Sebastian Führer
- grid.5771.40000 0001 2151 8122Institute of Organic Chemistry and Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, Innrain 80/82, 6020 Innsbruck, Austria
| | - Anna S. Kamenik
- grid.5771.40000 0001 2151 8122Institute of General, Inorganic and Theoretical Chemistry and Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, Innrain 80/82, 6020 Innsbruck, Austria
| | - Ricarda Zeindl
- grid.5771.40000 0001 2151 8122Institute of Organic Chemistry and Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, Innrain 80/82, 6020 Innsbruck, Austria
| | - Bettina Nothegger
- grid.5361.10000 0000 8853 2677Department of Dermatology, Venerology and Allergology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Florian Hofer
- grid.5771.40000 0001 2151 8122Institute of General, Inorganic and Theoretical Chemistry and Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, Innrain 80/82, 6020 Innsbruck, Austria
| | - Norbert Reider
- grid.5361.10000 0000 8853 2677Department of Dermatology, Venerology and Allergology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Klaus R. Liedl
- grid.5771.40000 0001 2151 8122Institute of General, Inorganic and Theoretical Chemistry and Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, Innrain 80/82, 6020 Innsbruck, Austria
| | - Martin Tollinger
- Institute of Organic Chemistry and Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, Innrain 80/82, 6020, Innsbruck, Austria.
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8
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Caffarelli C, Mastrorilli C, Santoro A, Criscione M, Procaccianti M. Component-Resolved Diagnosis of Hazelnut Allergy in Children. Nutrients 2021; 13:nu13020640. [PMID: 33669377 PMCID: PMC7920284 DOI: 10.3390/nu13020640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/05/2021] [Accepted: 02/10/2021] [Indexed: 01/03/2023] Open
Abstract
Hazelnuts commonly elicit allergic reactions starting from childhood and adolescence, with a rare resolution over time. The definite diagnosis of a hazelnut allergy relies on an oral food challenge. The role of component resolved diagnostics in reducing the need for oral food challenges in the diagnosis of hazelnut allergies is still debated. Therefore, three electronic databases were systematically searched for studies on the diagnostic accuracy of specific-IgE (sIgE) on hazelnut proteins for identifying children with a hazelnut allergy. Studies regarding IgE testing on at least one hazelnut allergen component in children whose final diagnosis was determined by oral food challenges or a suggestive history of serious symptoms due to a hazelnut allergy were included. Study quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Eight studies enrolling 757 children, were identified. Overall, sensitivity, specificity, area under the curve and diagnostic odd ratio of Cor a 1 sIgE were lower than those of Cor a 9 and Cor a 14 sIge. When the test results were positive, the post-test probability of a hazelnut allergy was 34% for Cor a 1 sIgE, 60% for Cor a9 sIgE and 73% for Cor a 14 sIgE. When the test results were negative, the post-test probability of a hazelnut allergy was 55% for Cor a 1 sIgE, 16% for Cor a9 sIgE and 14% for Cor a 14 sIgE. Measurement of IgE levels to Cor a 9 and Cor a 14 might have the potential to improve specificity in detecting clinically tolerant children among hazelnut-sensitized ones, reducing the need to perform oral food challenges.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Dipartimento di Medicina e Chirurgia, Università di Parma, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy; (A.S.); (M.P.)
- Correspondence: ; Tel.: +39-0521-7022-07
| | - Carla Mastrorilli
- UO Pediatria e Pronto Soccorso, Azienda Ospedaliero-Universitaria Consorziale Policlinico, Ospedale Pediatrico Giovanni XXIII, 70126 Bari, Italy;
| | - Angelica Santoro
- Clinica Pediatrica, Dipartimento di Medicina e Chirurgia, Università di Parma, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy; (A.S.); (M.P.)
| | - Massimo Criscione
- Dipartimento di Medicina e Chirurgia, Università di Parma, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy;
| | - Michela Procaccianti
- Clinica Pediatrica, Dipartimento di Medicina e Chirurgia, Università di Parma, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy; (A.S.); (M.P.)
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9
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Scheurer S, van Ree R, Vieths S. The Role of Lipid Transfer Proteins as Food and Pollen Allergens Outside the Mediterranean Area. Curr Allergy Asthma Rep 2021; 21:7. [PMID: 33537877 PMCID: PMC7858557 DOI: 10.1007/s11882-020-00982-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW To provide an overview of the prevalence and clinical manifestation of non-specific lipid transfer proteins (LTP)-mediated allergies outside the Mediterranean area and to address potential reasons for the different geographical significance of LTP-driven allergies. RECENT FINDINGS LTPs are major allergens in the Mediterranean area, which frequently can elicit severe reactions. Pru p 3 the LTP from peach is reported as genuine allergen and is considered a prototypic marker for LTP-mediated allergies. However, both food and pollen LTP allergies exist outside the Mediterranean area, but with lower clinical significance, different immunogenicity, and less clarified role. Evidence has been reported that in areas with high exposure to pollen, in particular to mugwort, pollen-derived LTPs can act as a primary sensitizer to trigger secondary food allergies. Co-sensitization to unrelated allergens might be causative for less severe reactions in response to LTPs. However, the reason for the geographical different sensitization patterns to LTPs remains unclear.
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Affiliation(s)
- Stephan Scheurer
- Molecular Allergology, Paul-Ehrlich-Institut, Paul-Ehrlich Str. 51-59, 63225, Langen, Germany.
| | - Ronald van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Stefan Vieths
- Molecular Allergology, Paul-Ehrlich-Institut, Paul-Ehrlich Str. 51-59, 63225, Langen, Germany
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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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Pitre M, L’Hocine L, Achouri A, Blaquière M, Des Roches A. Immunoglobulin E-Binding Pattern of Canadian Peanut Allergic Children and Cross-Reactivity with Almond, Hazelnut and Pistachio. Biomolecules 2020; 10:E1091. [PMID: 32707944 PMCID: PMC7464554 DOI: 10.3390/biom10081091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 12/24/2022] Open
Abstract
Peanut allergic individuals can be both co-sensitized and co-allergic to peanut and tree nuts. At the moment, standard diagnostic approaches do not always allow differentiation between clinically relevant sensitization and nonsignificant cross-reactions, and the responsibility of each allergen remains unclear. The objective of this study was therefore to determine a peanut sensitization profile in a cohort of Canadian peanut allergic children and assess the immunoglobulin E (IgE) molecular cross-reactivity between peanut, almond, hazelnut and pistachio. The specific IgE (sIgE) levels of each patient serum were determined by ImmunoCAP, indirect ELISA and immunoblot to examine their sIgE-binding levels and profiles to peanut proteins. Reciprocal inhibition ELISA and immunoblotting were used to study sIgE cross-reactions between peanut and the selected tree nuts using an adjusted and representative serum pool of the nine allergic patients. The results showed that the prepared peanut and tree nut protein extracts allowed for the detection of the majority of peanut and selected tree nut known allergens. The reciprocal inhibition ELISA experiments showed limited sIgE cross-reactivities between peanut and the studied tree nuts, with peanut being most likely the sensitizing allergen and tree nuts the cross-reactive ones. In the case of hazelnut and pistachio, a coexisting primary sensitization to hazelnut and pistachio was also demonstrated in the serum pool. Reciprocal inhibition immunoblotting further revealed that storage proteins (2S albumin, 7S vicilin and 11S legumin) could possibly account for the observed IgE-cross-reactions between peanut and the studied tree nuts in this cohort of allergic individuals. It also demonstrated the importance of conformational epitopes in the exhibited cross-reactions.
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Affiliation(s)
- Mélanie Pitre
- Saint-Hyacinthe Research and Development Centre, Agriculture and Agri-Food Canada, 3600 Casavant Blvd. W. Saint-Hyacinthe, QC J2S 8E3, Canada; (M.P.); (A.A.)
| | - Lamia L’Hocine
- Saint-Hyacinthe Research and Development Centre, Agriculture and Agri-Food Canada, 3600 Casavant Blvd. W. Saint-Hyacinthe, QC J2S 8E3, Canada; (M.P.); (A.A.)
| | - Allaoua Achouri
- Saint-Hyacinthe Research and Development Centre, Agriculture and Agri-Food Canada, 3600 Casavant Blvd. W. Saint-Hyacinthe, QC J2S 8E3, Canada; (M.P.); (A.A.)
| | - Martin Blaquière
- Sherbrooke University Hospital Center, Hôtel-Dieu de Sherbrooke, Department of Pediatrics, 580 Bowen south, Sherbrooke, QC J1G 2E3, Canada;
| | - Anne Des Roches
- Immunoallergy and Rheumatology Service Department of Pediatrics Medical School CHU Sainte-Justine Institution, 3175 Côte Sainte-Catherine, Montreal, QC H3T 1C5, Canada;
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12
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Li J, Li Z, Kong D, Li S, Yu Y, Li H. IgE and IgG4 responses to shrimp allergen tropomyosin and its epitopes in patients from coastal areas of northern China. Mol Med Rep 2020; 22:371-379. [PMID: 32319635 PMCID: PMC7248481 DOI: 10.3892/mmr.2020.11084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 03/17/2020] [Indexed: 11/05/2022] Open
Abstract
Sensitization to allergens and their peptides varies among patients due to geographical or ethnic differences. The present study aimed to investigate immunoglobulin (Ig)E and IgG4 responses to tropomyosin and its peptides in shrimp allergic patients from northern China. A total of 92 subjects were studied, including 35 shrimp allergic patients, 29 patients with house dust mite (HDM) and/or cockroach allergic patients and 28 healthy volunteers. Serum IgE and IgG4 antibodies to recombinant shrimp tropomyosin (rPen a 1) and its peptides were measured by means of a light-initiated chemiluminescent assay. A total of 9 major sequential epitopes of Pen a 1 reported in the literature were synthesized. Of 35 shrimp allergic patients, 25 (71.4%) had positive Pen 1-specific IgE (sIgE) antibodies and 22 (62.9%) contained measurable rPen a 1-specific IgG4 (sIgG4) antibodies. A strong IgG4 response accompanied the presence of IgE to Pen a 1. None of the patients with HDM and/or cockroach allergy demonstrated IgE reactivity to rPen a 1. The reaction frequency of IgE binding epitope was 20–48%, while that of IgG4 binding epitope was 63.6–3.9%. The IgE and IgG4 recognition patterns of the tropomyosin peptides demonstrated high interpatient heterogeneity. Diversity of IgE binding epitopes was positively correlated with Pen a 1 sIgE levels. In the study population, tropomyosin was a major allergen recognized by the majority of shrimp allergic patients, which is consistent with previous reports. However, none of the 9 epitopes are major (reaction frequency >50%) IgE-binding regions, indicating the epitopes profile may be different in other regions.
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Affiliation(s)
- Junpu Li
- The Clinical Laboratory of Tianjin Chest Hospital, Tianjin 300222, P.R. China
| | - Zhiwei Li
- Department of Clinical Laboratory, School of Medical Laboratory, Tianjin Medical University, Tianjin 300203, P.R. China
| | - Deyu Kong
- Department of Laboratory Medicine, Tianjin Port Hospital, Tianjin 300456, P.R. China
| | - Shaoshen Li
- Department of Laboratory Medicine, Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin 300120, P.R. China
| | - Yang Yu
- Department of Clinical Laboratory, School of Medical Laboratory, Tianjin Medical University, Tianjin 300203, P.R. China
| | - Huiqiang Li
- Department of Clinical Laboratory, School of Medical Laboratory, Tianjin Medical University, Tianjin 300203, P.R. China
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Inoue Y, Sato S, Takahashi K, Yanagida N, Yamamoto H, Shimizu N, Ebisawa M. Component-resolved diagnostics can be useful for identifying hazelnut allergy in Japanese children. Allergol Int 2020; 69:239-245. [PMID: 31680009 DOI: 10.1016/j.alit.2019.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/21/2019] [Accepted: 10/02/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Cor a 9 and Cor a 14 are effective markers for predicting hazelnut allergy. However, there have been no reports on the component-resolved diagnostics (CRD) of hazelnut allergy using an oral food challenge (OFC) for diagnosis in Asia. We hypothesized that CRD would improve the accuracy of diagnosing hazelnut allergies in Japanese children. METHODS We recruited 91 subjects (median age: 7.3 years) who were sensitized to hazelnuts and had performed a hazelnut OFC at the National Hospital Organization Sagamihara National Hospital between 2006 and 2017. All subjects were classified as allergic or asymptomatic to 3 g of hazelnuts. The sIgE levels (hazelnut/Cor a 1/Cor a 8/Cor a 9/Cor a 14/alder pollen) were measured using ImmunoCAP. We aimed to determine the predictive factors of hazelnut allergy. RESULTS Nine subjects (10%) were allergic to ≤3 g of hazelnuts. Levels of sIgE for Cor a 9 in hazelnut-allergic subjects were significantly higher than those in asymptomatic subjects (4.47 vs. 0.76 kUA/L, p = 0.039). Levels of sIgE to alder pollen and Cor a 1 in hazelnut-allergic subjects were significantly lower than those in asymptomatic subjects (<0.10 vs 13.0 kUA/L, p = 0.004; <0.10 vs 5.03 kUA/L, p = 0.025). The area under the receiver operating characteristics curve for hazelnut/alder/Cor a 1/Cor a 9 was 0.55/0.78/0.72/0.71, respectively, with p = 0.651/0.006/0.029/0.040, respectively. CONCLUSIONS The findings of a high sIgE level for Cor a 9 and a low sIgE level for Cor a 1 can improve the diagnostic accuracy to better identify Japanese children sensitized to hazelnuts.
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Führer S, Zeindl R, Tollinger M. NMR resonance assignments of the four isoforms of the hazelnut allergen Cor a 1.04. BIOMOLECULAR NMR ASSIGNMENTS 2020; 14:45-49. [PMID: 31691092 PMCID: PMC7069924 DOI: 10.1007/s12104-019-09918-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/01/2019] [Indexed: 06/01/2023]
Abstract
In large parts of Europe, Northern America and China people are suffering from allergies after consuming certain kinds of fruits and vegetables. Typical allergic symptoms range from scratching and itching of the throat to severe symptoms like rhino conjunctivitis and anaphylaxis. For hazelnuts (Corylus avellana), these allergies result from initial sensitization to the birch (Betula verrucosa) pollen allergen Bet v 1 and subsequent development of allergic cross-reactions to proteins that are similar in their three-dimensional structure to the sensitizing protein Bet v 1. The cross-reactive proteins in hazelnut are the four isoforms Cor a 1.04 with a molecular weight of about 17.5 kDa. Significant differences regarding the immunologic behavior of these proteins have been reported. In this work we assigned backbone and side chain 1H, 13C, and 15N chemical shifts of these four isoforms, Cor a 1.0401, Cor a 1.0402, Cor a 1.0403, and Cor a 1.0404 by solution NMR spectroscopy. The chemical shift data confirm the characteristic Bet v onefold for all four isoforms, consisting of seven β-strands that are separated by two short α-helices, along with a long C-terminal α-helix. These data provide the basis for a comparative structural and dynamic analysis of these proteins by NMR in order to characterize their different immunologic cross-reactivities on a molecular level.
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Affiliation(s)
- Sebastian Führer
- Institute of Organic Chemistry, Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, Innrain 80/82, 6020, Innsbruck, Austria
| | - Ricarda Zeindl
- Institute of Organic Chemistry, Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, Innrain 80/82, 6020, Innsbruck, Austria
| | - Martin Tollinger
- Institute of Organic Chemistry, Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, Innrain 80/82, 6020, Innsbruck, Austria.
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15
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Lu JH, Hsia K, Lin CH, Chen CC, Yang HY, Lin MH. Dietary Supplementation with Hazelnut Oil Reduces Serum Hyperlipidemia and Ameliorates the Progression of Nonalcoholic Fatty Liver Disease in Hamsters Fed a High-Cholesterol Diet. Nutrients 2019; 11:nu11092224. [PMID: 31540081 PMCID: PMC6770627 DOI: 10.3390/nu11092224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/06/2019] [Accepted: 09/08/2019] [Indexed: 02/06/2023] Open
Abstract
Objective: Hazelnut oil (HO) is rich in monounsaturated fatty acids and polyunsaturated fatty acids. This study intended to analyze the effects of hazelnut oil supplementation on the serum lipid profile and nonalcoholic fatty liver disease in hamsters fed a high-cholesterol (HC) diet. Methods: Hamsters were fed a basic diet (control group) and an HC diet (HC group) for 16 weeks (n = 10 in each group). Hamsters were fed an HC diet for four weeks to induce hyperlipidemia and were then fed an HC diet enriched with 5% (low-dose HC + HO group; n = 10) and 10% HO (high-dose HC + HO group; n = 10) for 12 weeks. Serum lipid levels, hepatic changes (including steatosis, inflammation, and fibrosis), and hepatic prooxidant-antioxidant status (malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx), and glutathione S-transferase (GST)) were evaluated after the treatment period. Results: Hamsters in the control group showed normal serum lipid profiles, normal liver function, and moderate glycogen storage without hepatic steatosis. Hamsters in the HC group showed severe hyperlipidemia, severe hepatic steatosis, and moderate steatohepatitis (mononuclear cell and neutrophil infiltration, oval cell hyperplasia, and fibrosis). Compared to the HC group, both the low-dose and the high-dose HC + HO groups showed a significant reduction of hyperlipidemia (serum triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and very-low-density lipoprotein cholesterol (VLDL-C levels)) and improved liver function (serum glutamic-oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT)). Additionally, compared to the HC group, intrahepatic triglyceride accumulation (IHTC) was significantly higher in the HC + HO group, while the incidence of steatohepatitis was significantly lower. The intake of the HC diet was associated with a higher level of lipid peroxidation (malondialdehyde, MDA) and a lower concentration of hepatic antioxidant enzymes (SOD, GPx, and GST), and all these factors were partially improved in the low-dose and high-dose HC + HO groups. Conclusions: Our findings indicate that the intake of HO reduced serum hyperlipidemia and oxidative stress and ameliorated the progression of nonalcoholic fatty liver disease in hamsters fed a high-cholesterol diet.
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Affiliation(s)
- Jen-Her Lu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- Department of Pediatrics and Surgery, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
| | - Kai Hsia
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- Department of Pediatrics and Surgery, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
| | - Chih-Hsun Lin
- Department of Pediatrics and Surgery, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
- Division of Plastic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
| | - Chien-Chin Chen
- Department of Pathology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600, Taiwan.
- Department of Cosmetic Science, Chia-Nan University of Pharmacy and Science, Tainan 717, Taiwan.
| | - Hsin-Yu Yang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- Department of Pediatrics and Surgery, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
| | - Ming-Huei Lin
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- Department of Pediatrics and Surgery, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
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Calamelli E, Liotti L, Beghetti I, Piccinno V, Serra L, Bottau P. Component-Resolved Diagnosis in Food Allergies. ACTA ACUST UNITED AC 2019; 55:medicina55080498. [PMID: 31426616 PMCID: PMC6723663 DOI: 10.3390/medicina55080498] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/31/2019] [Accepted: 08/15/2019] [Indexed: 12/18/2022]
Abstract
Component-resolved diagnostics (CRD) in food allergies is an approach utilized to characterize the molecular components of each allergen involved in a specific IgE (sIgE)-mediated response. In the clinical practice, CRD can improve diagnostic accuracy and assist the physician in many aspects of the allergy work-up. CRD allows for discriminatory co-sensitization versus cross-sensitization phenomena and can be useful to stratify the clinical risk associated with a specific sensitization pattern, in addition to the oral food challenge (OFC). Despite this, there are still some unmet needs, such as the risk of over-prescribing unnecessary elimination diets and adrenaline auto-injectors. Moreover, up until now, none of the identified sIgE cutoff have shown a specificity and sensitivity profile as accurate as the OFC, which is the gold standard in diagnosing food allergies. In light of this, the aim of this review is to summarize the most relevant concepts in the field of CRD in food allergy and to provide a practical approach useful in clinical practice.
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Affiliation(s)
| | - Lucia Liotti
- Pediatric Unit, Civic Hospital, 60019 Senigallia, Italy
| | - Isadora Beghetti
- Pediatric Unit, Department of Medical and Surgical Sciences (DIMEC), S.Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy
| | | | - Laura Serra
- Pediatric and Neonatology Unit, Imola Hospital, 40026 Imola, Italy
| | - Paolo Bottau
- Pediatric and Neonatology Unit, Imola Hospital, 40026 Imola, Italy
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Vencia W, Minale P, Migone L, Lazzara F, Vito G, Ferrari A, Razzuoli E. Effects of thermal treatment on walnut detection and allergenicity. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2019; 99:2636-2640. [PMID: 30324619 DOI: 10.1002/jsfa.9428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 09/06/2018] [Accepted: 10/08/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Peanuts and tree nut allergies pose an increasing food safety problem. The aim of our study was to test the accuracy of different commercial enzyme-linked immunosorbent assay (ELISA) kits in the detection of the presence of walnuts in untreated and heat exposed food samples. The effects of thermal treatment of samples were evaluated by exposing walnuts to different heat treatments. All samples were first analysed by two different commercial ELISA assays. Then, we performed a skin prick test (SPT) on nine patients with proven nut allergy using small walnut pieces from raw and treated samples. RESULTS The presence of nuts proteins in thermally processed foods was not accurately detected by ELISA kits. All patients had a positive SPT reaction with raw walnut, while thermal treatments affected walnut allergenicity. The ELISA test gives a negative result in the case of strong thermal treatment, but at the same time allergic subjects react positively to stimulation with the same sample. CONCLUSION This study suggests that commercial ELISA kits may not be able to accurately determine the amount of proteins present in thermally processed foods due to changes in the solubility and immunoreactivity of the target proteins. Finally, the clinical results highlight that thermal treatment might induce a reduction in walnut allergenicity. © 2018 Society of Chemical Industry.
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Affiliation(s)
- Walter Vencia
- S.S Genova, Food Laboratory, Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e valle d'Aosta, Genoa, Italy
| | - Paola Minale
- U.O. Allergologia, A. O. San Martino, Largo Rosanna Benzi 10, Genova, Italy
| | - Laura Migone
- S.S Genova, Food Laboratory, Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e valle d'Aosta, Genoa, Italy
| | - Fabrizio Lazzara
- S.S Genova, Food Laboratory, Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e valle d'Aosta, Genoa, Italy
| | - Guendalina Vito
- S.S Genova, Food Laboratory, Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e valle d'Aosta, Genoa, Italy
| | - Angelo Ferrari
- S.S Genova, Food Laboratory, Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e valle d'Aosta, Genoa, Italy
| | - Elisabetta Razzuoli
- S.S Genova, Food Laboratory, Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e valle d'Aosta, Genoa, Italy
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18
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Linacero R, Sanchiz A, Ballesteros I, Cuadrado C. Application of real-time PCR for tree nut allergen detection in processed foods. Crit Rev Food Sci Nutr 2019; 60:1077-1093. [PMID: 30638046 DOI: 10.1080/10408398.2018.1557103] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Currently, food allergies are an important health concern worldwide. The presence of undeclared allergenic ingredients or the presence of traces of allergens due to accidental contamination during food processing poses a great health risk to sensitized individuals. Therefore, reliable analytical methods are required to detect and identify allergenic ingredients in food products. Real-time PCR allowed a specific and accurate amplification of allergen sequences. Some processing methods could induce the fragmentation and/or degradation of genomic DNA and some studies have been performed to analyze the effect of processing on the detection of different targets, as thermal treatment, with and without applying pressure. In this review, we give an updated overview of the applications of real-time PCR for the detection of allergens of tree nut in processed food products. The different variables that contribute to the performance of PCR methodology for allergen detection are also review and discussed.
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Affiliation(s)
- Rosario Linacero
- Departamento de Genética, Fisiología y Microbiología, Facultad de Biología, Universidad Complutense de Madrid, Madrid, Spain
| | - Africa Sanchiz
- Departamento de Tecnología de Alimentos, SGIT-INIA, Madrid, Spain
| | - Isabel Ballesteros
- Ingeniería en Biotecnología, Facultad de Ingenierías y Ciencias Aplicadas, Universidad de las Américas, Quito, Ecuador
| | - Carmen Cuadrado
- Departamento de Tecnología de Alimentos, SGIT-INIA, Madrid, Spain
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19
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Sensitization profiles to hazelnut allergens across the United States. Ann Allergy Asthma Immunol 2018; 122:111-116.e1. [PMID: 30292797 DOI: 10.1016/j.anai.2018.09.466] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 08/28/2018] [Accepted: 09/28/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Measurement of IgE antibody to hazelnut components can aid in the prediction of allergic responses to the food. OBJECTIVE To investigate the association between patient demographics (age, location) and patterns of allergic sensitization to hazelnut components across the United States and to investigate the degree of correlation between hazelnut sensitization with sensitization to other tree nuts, peanuts, and their components. METHODS Serum samples from 10,503 individuals with hazelnut extract specific IgE (sIgE) levels of 0.35 kUA/L or higher were analyzed for IgE antibodies to Cor a 1, 8, 9, and 14 by ImmunoCAP. A subset of these patients were analyzed for IgE antibodies to peanut, walnut, and cashew nut IgE along with associated components. RESULTS Among hazelnut sensitized individuals, children (<3 years old) were predominantly sensitized to Cor a 9 and Cor a 14. Conversely, Cor a 1 sIgE sensitization was much higher in adults than children, especially in the Northeastern United States. Cor a 8 sensitization was relatively constant (near 10%) across all ages. Cosensitization of hazelnut with other tree nuts and peanuts was related to correlation of IgE concentrations of individual component families. CONCLUSION We conclude that sensitization to individual hazelnut components is highly dependent on age and/or geographic location. Component correlations suggest that cosensitization to hazelnut and walnut may be caused by their pathogenesis-related protein 10 allergens, nonspecific lipid transfer proteins, or seed storage proteins, whereas hazelnut and peanut cosensitization is more often caused by cross-reactivity of pathogenesis-related protein 10 (Cor a 1 and Ara h 8) and nonspecific lipid transfer proteins (Cor a 8 and Ara h 9).
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20
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Rial MJ, Sastre J. Food Allergies Caused by Allergenic Lipid Transfer Proteins: What Is behind the Geographic Restriction? Curr Allergy Asthma Rep 2018; 18:56. [PMID: 30206718 DOI: 10.1007/s11882-018-0810-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW To critically examine evidence suggesting that food allergy induced by lipid transfer proteins (LTPs) follows a geographic pattern. RECENT FINDINGS LTP syndrome remains most common in the Mediterranean basin, with a clear gradient seen in prevalence of LTP sensitization between northern and southern Europe. We hypothesize that high levels of birch pollen seem to protect against LTP allergy, as these higher levels correlate with a lower prevalence of LTP hypersensitivity. Nevertheless, LTP food allergy cases still appear in areas having a high environmental level of birch pollen. Food allergy caused by LTP may be related to (1) primary sensitization to a food LTP allergen in the absence of pollinosis, (2) primary sensitization to LTP from a pollen source, and (3) co-sensitization to LTP from pollen and food.
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Affiliation(s)
- M J Rial
- Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain
- CIBERES, Instituto Salud Carlos III, Madrid, Spain
| | - J Sastre
- Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain.
- CIBERES, Instituto Salud Carlos III, Madrid, Spain.
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Li J, Zhang J, Qiong C, She T, Bian Y, Lin S, Li H. Component resolved diagnostic study of cow's milk allergy in infants and young children in northern China. Int Immunopharmacol 2018; 61:126-131. [PMID: 29859469 DOI: 10.1016/j.intimp.2018.05.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/25/2018] [Accepted: 05/25/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Increasing dairy consumption in China has been accompanied by rising incidence of milk allergy. Here we analyzed profiles of specific immunoglobulin E (sIgE) against cow's milk proteins, and assessed their value for milk allergy diagnosis among infants and young children from northern China. METHODS Sera collected from 48 patients with milk allergy and 27 negative control subjects was analyzed by enzyme-linked immunosorbent assay to measure sIgE to α-lactalbumin (Bos d 4), β-lactoglobulin (Bos d 5), α-casein (Bos d 9), β-casein (Bos d 11), and κ-casein (Bos d 12). RESULTS Among milk-allergic individuals, most were sensitized to at least one milk protein; about half were sensitized to Bos d 5, Bos d 9, Bos d 11 and Bos d 12, respectively, while few had positive serum sIgE against Bos d 4. Bos d 12 sIgE had the largest area under curve (AUC) (0.878; 95% CI, 0.800-0.957) and thus showed the best diagnostic performance in discriminating between milk-allergic and non-milk allergic patients, with a sensitivity of 92.6% and specificity of 72.9% using a statistically optimal cut-off value (OD450nm, 0.191). The combinations of Bos d 5 + Bos d 12 showed an AUC of 0.926, which was larger than for any individual components. CONCLUSIONS Our results revealed inter-individual variation in the sensitization to different milk allergen component. Bos d 12 sIgE showed best performance in diagnosing milk allergy. Milk allergy diagnostic accuracy was further improved using combinations of milk allergen components by application of ROC curves based on logistic regression.
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Affiliation(s)
- Junpu Li
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China; Department of Medical Laboratory, Tianjin Children's Hospital, Tianjin, China
| | - Jiayi Zhang
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China; Department of Medical Laboratory, Tianjin Children's Hospital, Tianjin, China
| | - Cuiya Qiong
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China; Department of Medical Laboratory, Tianjin Children's Hospital, Tianjin, China
| | - Tiantian She
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China; Department of Medical Laboratory, Tianjin Children's Hospital, Tianjin, China
| | - Ying Bian
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China; Department of Medical Laboratory, Tianjin Children's Hospital, Tianjin, China
| | - Shuxiang Lin
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China; Department of Medical Laboratory, Tianjin Children's Hospital, Tianjin, China
| | - Huiqiang Li
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China; Department of Medical Laboratory, Tianjin Children's Hospital, Tianjin, China.
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22
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Geiselhart S, Hoffmann-Sommergruber K, Bublin M. Tree nut allergens. Mol Immunol 2018; 100:71-81. [PMID: 29680588 DOI: 10.1016/j.molimm.2018.03.011] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/19/2018] [Indexed: 12/21/2022]
Abstract
Tree nuts are considered as part of a healthy diet due to their high nutritional quality. However, they are also a potent source of allergenic proteins inducing IgE mediated hypersensitivity often causing serious, life-threatening reactions. The reported prevalence of tree nut allergy is up to 4.9% worldwide. The general term "tree nuts" comprises a number of nuts, seeds, and drupes, derived from trees from different botanical families. For hazelnut and walnut several allergens have been identified which are already partly applied in component resolved diagnosis, while for other tree nuts such as macadamia, coconut, and Brazil nut only individual allergens were identified and data on additional allergenic proteins are missing. This review summarizes the current knowledge on tree nut allergens and describes their physicochemical and immunological characterization and clinical relevance.
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Affiliation(s)
- Sabine Geiselhart
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | | | - Merima Bublin
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
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Abstract
Tree nut (TN) allergy is common and often severe. It has become an important health concern as availability and consumption have increased. Prevalence varies by age and geographic region and appears to have increased in children. Accidental ingestion of TNs is common. Unfortunately, there is a lower likelihood of resolution of TN allergy, roughly 10%. TN-specific skin tests and serum immunoglobulin E levels can help aid in the diagnosis of TN allergy, but a careful medical history is important because a positive test in isolation is not typically diagnostic. Component-resolved diagnostic tests are being increasingly utilized and may improve accuracy. Management consists of strict avoidance of the causal nut(s) and prompt treatment of symptoms upon accidental exposure. A specific consideration with regard to the management of TN allergy is the decision to avoid all TNs or only the TNs to which a patient is clinically allergic. There are currently no data on the primary or secondary prevention of TN allergy. Treatment strategies are being evaluated.
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Affiliation(s)
- Tamar Weinberger
- The 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, NY, USA
| | - Scott Sicherer
- The 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, NY, USA
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Datema MR, van Ree R, 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, Knulst AC, Kowalski M, Kralimarkova TZ, Le TM, Lidholm J, Papadopoulos NG, Popov TA, del Prado N, Purohit A, Reig I, Seneviratne SL, Sinaniotis A, Versteeg SA, Vieths S, Zwinderman AH, Mills ENC, Fernández-Rivas M, Ballmer-Weber B. Component-resolved diagnosis and beyond: Multivariable regression models to predict severity of hazelnut allergy. Allergy 2018; 73:549-559. [PMID: 28986984 DOI: 10.1111/all.13328] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Component-resolved diagnosis (CRD) has revealed significant associations between IgE against individual allergens and severity of hazelnut allergy. Less attention has been given to combining them with clinical factors in predicting severity. AIM To analyze associations between severity and sensitization patterns, patient characteristics and clinical history, and to develop models to improve predictive accuracy. METHODS Patients reporting hazelnut allergy (n = 423) from 12 European cities were tested for IgE against individual hazelnut allergens. Symptoms (reported and during Double-blind placebo-controlled food challenge [DBPCFC]) were categorized in mild, moderate, and severe. Multiple regression models to predict severity were generated from clinical factors and sensitization patterns (CRD- and extract-based). Odds ratios (ORs) and areas under receiver-operating characteristic (ROC) curves (AUCs) were used to evaluate their predictive value. RESULTS Cor a 9 and 14 were positively (OR 10.5 and 10.1, respectively), and Cor a 1 negatively (OR 0.14) associated with severe symptoms during DBPCFC, with AUCs of 0.70-073. Combining Cor a 1 and 9 improved this to 0.76. A model using a combination of atopic dermatitis (risk), pollen allergy (protection), IgE against Cor a 14 (risk) and walnut (risk) increased the AUC to 0.91. At 92% sensitivity, the specificity was 76.3%, and the positive and negative predictive values 62.2% and 95.7%, respectively. For reported symptoms, associations and generated models proved to be almost identical but weaker. CONCLUSION A model combining CRD with clinical background and extract-based serology is superior to CRD alone in assessing the risk of severe reactions to hazelnut, particular in ruling out severe reactions.
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Affiliation(s)
- M. R. Datema
- Department of Experimental Immunology; Academic Medical Center; Amsterdam The Netherlands
| | - R. van Ree
- Department of Experimental Immunology; Academic Medical Center; Amsterdam The Netherlands
- Department of Otorhinolaryngology; Academic Medical Center; Amsterdam The Netherlands
| | - R. Asero
- Ambulatorio di Allergologia; Clinica San Carlo; Paderno Dugnano Italy
| | - L. Barreales
- Allergy Department; Hospital Clinico San Carlos, IdISSC; Madrid Spain
| | | | - F. de Blay
- Allergy Division; Chest Disease Department; Strasbourg University Hospital; Strasbourg France
| | - M. Clausen
- Faculty of Medicine; University of Iceland; Landspitali University Hospital; Reykjavik Iceland
| | - R. Dubakiene
- Medical Faculty; Vilnius University; Vilnius Lithuania
| | | | - P. Fritsche
- Allergy Unit; Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - D. Gislason
- Faculty of Medicine; University of Iceland; Landspitali University Hospital; Reykjavik Iceland
| | - K. Hoffmann-Sommergruber
- Department of Pathophysiology and Allergy Research; Medical University of Vienna; Vienna Austria
| | - M. Jedrzejczak-Czechowicz
- Department of Immunology, Rheumatology and Allergy; Faculty of Medicine; Medical University of Lodz; Lodz Poland
| | - L. Jongejan
- Department of Experimental Immunology; Academic Medical Center; Amsterdam The Netherlands
| | - A. C. Knulst
- Department of Dermatology and Allergology; University Medical Center Utrecht; Utrecht The Netherlands
| | - M. Kowalski
- Department of Immunology, Rheumatology and Allergy; Faculty of Medicine; Medical University of Lodz; Lodz Poland
| | - T. Z. Kralimarkova
- Clinic of Allergy and Asthma; Medical University of Sofia; Sofia Bulgaria
| | - T.-M. Le
- Department of Dermatology and Allergology; University Medical Center Utrecht; Utrecht The Netherlands
| | - J. Lidholm
- Thermo Fisher Scientific; Uppsala Sweden
| | - N. G. Papadopoulos
- Allergy Department; 2nd Pediatric Clinic; University of Athens; Athens Greece
- Centre for Paediatrics and Child Health; Institute of Human Development; University of Manchester; Manchester UK
| | - T. A. Popov
- Clinic of Allergy and Asthma; Medical University of Sofia; Sofia Bulgaria
| | - N. del Prado
- Clinical epidemiology Unit; Preventive Medicine Department; Hospital Clinico San Carlos, IdISSC; Madrid Spain
| | - A. Purohit
- Allergy Division; Chest Disease Department; Strasbourg University Hospital; Strasbourg France
| | - I. Reig
- Allergy Department; Hospital Clinico San Carlos, IdISSC; Madrid Spain
| | - S. L. Seneviratne
- Institute of Immunity and Transplantation; University College London; London UK
| | - A. Sinaniotis
- Allergy Department; 2nd Pediatric Clinic; University of Athens; Athens Greece
| | - S. A. Versteeg
- Department of Experimental Immunology; Academic Medical Center; Amsterdam The Netherlands
| | - S. Vieths
- Division of Allergology; Paul-Ehrlich-Institut; Federal Institute for Vaccines and Biomedicines; Langen Germany
| | - A. H. Zwinderman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics; Academic Medical Center; Amsterdam The Netherlands
| | - E. N. C. Mills
- Institute of Inflammation and Repair; Manchester Academic Health Science Centre; Manchester Institute of Biotechnology; The University of Manchester; Manchester UK
| | | | - B. Ballmer-Weber
- Allergy Unit; Department of Dermatology; University Hospital Zürich; Zürich Switzerland
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25
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Tham EH, Leung DYM. How Different Parts of the World Provide New Insights Into Food Allergy. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2018; 10:290-299. [PMID: 29949829 PMCID: PMC6021584 DOI: 10.4168/aair.2018.10.4.290] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/21/2017] [Accepted: 12/05/2017] [Indexed: 12/12/2022]
Abstract
The prevalence and patterns of food allergy are highly variable in different parts of the world. Differences in food allergy epidemiology may be attributed to a complex interplay of genetic, epigenetic, and environmental factors, suggesting that mechanisms of food allergy may differ in various global populations. Genetic polymorphisms, migration, climate, and infant feeding practices all modulate food allergy risk, and possibly also the efficacy of interventions aimed at primary prevention of food allergy development. Approaches to diagnosis, treatment, and prevention of food allergy should thus be tailored carefully to each population's unique genetic and environmental make-up. Future research in the context of food allergy prevention should focus on elucidating factors determining differential responses between populations.
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Affiliation(s)
- Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore.,Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA.,Department of Pediatrics, University of Colorado at Denver Health Sciences Center, Aurora, Colorado, USA.
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26
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Abstract
Daily food processing has the potential to alter the allergenicity of foods due to modification of the physico-chemical properties of proteins. The degree of such modifications depends on factors such as processing conditions, type of food considered, allergenic content, etc. The impact of daily food processing like boiling, roasting, frying or baking on food allergenicity have been extensively studied. The influence of other thermal treatments such as microwave heating or pressure cooking on allergenicity has also been analyzed. Non-thermal treatment such as peeling impacts on the allergenic content of certain foods such as fruits. In this review, we give an updated overview of the effects of daily processing treatments on the allergenicity of a wide variety of foods. The different variables that contribute to the modification of food allergenicity due to processing are also reviewed and discussed.
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Affiliation(s)
- Beatriz Cabanillas
- a Department of Dermatology and Allergy , University of Bonn Medical Center , Sigmund-Freud-Str., 25, Bonn , Germany
| | - Natalija Novak
- a Department of Dermatology and Allergy , University of Bonn Medical Center , Sigmund-Freud-Str., 25, Bonn , Germany
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27
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Nut Allergy in Two Different Areas of Spain: Differences in Clinical and Molecular Pattern. Nutrients 2017; 9:nu9080909. [PMID: 28825657 PMCID: PMC5579702 DOI: 10.3390/nu9080909] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/11/2017] [Accepted: 08/17/2017] [Indexed: 11/25/2022] Open
Abstract
Introduction: Different clinical and molecular patterns of food allergy have been reported in different areas of the world. The aim of the study is to evaluate differences in allergen patterns among nut-allergic patients in two different areas of Spain. Material and methods: A total of 77 patients with nut allergy from two different regions of Spain (Madrid and Asturias) were evaluated. Results: Hazelnut, peanut, and walnut were the three most frequent nuts eliciting allergy in both regions, but in a different order. Patients from Madrid experienced systemic reactions more often than patients from Asturias (73.5% Madrid vs. 50.0%, p < 0.05). The percentage of sensitizations to LTP (Lipid Transfer Protein) was higher than Bet v 1 (p < 0.05) in the Madrid area. The percentage of sensitizations in Asturias area was similar to LTP than Bet v 1 (Pru p 3 46.4%, Bet v 1 42.9%, ns). Bet v 1 was the predominant allergen involved among hazelnut-allergic patients (56.2%), while LTP was more common in peanut-allergic patients (61.5%). Conclusion: Walnut, hazelnut, and peanut were the most frequent nuts eliciting allergy in Spain. Despite this, important differences in molecular pattern were appreciated not only between both regions, but also among nut-allergic patients in Asturias. The different molecular pattern was linked to the frequency of systemic symptoms.
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28
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Kleine-Tebbe J, Jappe U. Molecular allergy diagnostic tests: development and relevance in clinical practice. Allergol Select 2017; 1:169-189. [PMID: 30402615 PMCID: PMC6040004 DOI: 10.5414/alx01617e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 07/10/2013] [Indexed: 01/09/2023] Open
Abstract
Molecular allergy is based on identification, characterization and subsequent use of single allergens, being components of complex allergen sources like pollen, mites, furred animals, foods or insect venoms. Only few protein families contain relevant allergens of similar sequence and structure, carrying common IgE epitopes as the basis of cross reactivity. Used as purified or recombinant (glyco)proteins single allergens can potentially improve in-vitro diagnostics, particularly allergen-specific IgE assays through a) increased sensitivity, b) use of risk and marker allergens, c) component-resolved diagnostics (CRD). CRD can differentiate primary, species-specific from secondary, cross-reactive sensitizations to single allergens. Allergen components facilitate an increased analytical sensitivity, particularly if they are underrepresented or missing in conventional allergen extracts. They are mainly used in single assays (singleplex) for the detection of IgE, but also in a microarray format (multiplex) with 112 components from 50 allergen sources with slightly decreased analytical sensitivity. Concepts of molecular allergy can only be separately defined and utilized for each allergen source (pollen, mites, foods or insect venoms). As soon as essential singe allergens are available, their specific role in diagnostics should be defined. This requires well characterized patient cohorts from various countries, since exposure, allergic immune response and clinical relevance can vary substantially between individual subjects and geographical regions. The patient's clinical information is essential for proper interpretation of molecular allergology results. The history and/or challenge test results will finally provide evidence, in how far a sensitization to single allergens might be clinically relevant or not.
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Affiliation(s)
- J. Kleine-Tebbe
- Allergie- und Asthma-Zentrum Westend, Praxis Hanf, Ackermann und Kleine-Tebbe, Berlin
| | - U. Jappe
- Forschungsgruppe Klinische und Molekulare Allergologie, Forschungszentrum Borstel, Deutsches Zentrum für Lungenforschung, and
- Klinik für Dermatologie, Allergologie und Venerologie, Universität zu Lübeck, Germany
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29
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Muraro A, Lemanske RF, Castells M, Torres MJ, Khan D, Simon HU, Bindslev-Jensen C, Burks W, Poulsen LK, Sampson HA, Worm M, Nadeau KC. Precision medicine in allergic disease-food allergy, drug allergy, and anaphylaxis-PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology. Allergy 2017; 72:1006-1021. [PMID: 28122115 DOI: 10.1111/all.13132] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2017] [Indexed: 12/30/2022]
Abstract
This consensus document summarizes the current knowledge on the potential for precision medicine in food allergy, drug allergy, and anaphylaxis under the auspices of the PRACTALL collaboration platform. PRACTALL is a joint effort of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology, which aims to synchronize the European and American approaches to allergy care. Precision medicine is an emerging approach for disease treatment based on disease endotypes, which are phenotypic subclasses associated with specific mechanisms underlying the disease. Although significant progress has been made in defining endotypes for asthma, definitions of endotypes for food and drug allergy or for anaphylaxis lag behind. Progress has been made in discovery of biomarkers to guide a precision medicine approach to treatment of food and drug allergy, but further validation and quantification of these biomarkers are needed to allow their translation into practice in the clinical management of allergic disease.
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Affiliation(s)
- A. Muraro
- Food Allergy Referral Centre Veneto Region; Department of Women and Child Health; Padua General University Hospital; Padua Italy
| | - R. F. Lemanske
- Department of Pediatrics; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - M. Castells
- Drug Hypersensitivity and Desensitization Center; Brigham & Women's Hospital; Harvard Medical School; Boston MA USA
| | - M. J. Torres
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; UMA; Malaga Spain
| | - D. Khan
- Division of Allergy & Immunology; Department of Internal Medicine; University of Texas Southwestern Medical Center; Dallas TX USA
| | - H.-U. Simon
- Institute of Pharmacology; University of Bern; Bern Switzerland
| | - C. Bindslev-Jensen
- Department of Dermatology and Allergy Centre; Odense Research Center for Anaphylaxis (ORCA); Odense University Hospital; Odense Denmark
| | - W. Burks
- Department of Pediatrics; University of North Carolina; Chapel Hill NC USA
| | - L. K. Poulsen
- Allergy Clinic; Copenhagen University Hospital at Gentofte Hospital; Copenhagen Denmark
| | - H. A. Sampson
- Icahn School of Medicine at Mount Sinai; New York NY USA
| | - M. Worm
- Klinik für Dermatologie; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - K. C. Nadeau
- Department of Medicine; Stanford University School of Medicine; Stanford CA USA
- Sean N. Parker Center for Allergy and Asthma Research; Stanford University School of Medicine; Stanford CA USA
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30
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Wangorsch A, Jamin A, Lidholm J, Gräni N, Lang C, Ballmer-Weber B, Vieths S, Scheurer S. Identification and implication of an allergenic PR-10 protein from walnut in birch pollen associated walnut allergy. Mol Nutr Food Res 2017; 61. [PMID: 28070926 DOI: 10.1002/mnfr.201600902] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/21/2016] [Accepted: 12/23/2016] [Indexed: 02/04/2023]
Abstract
SCOPE English walnut (Juglans regia) belongs to the most important allergenic tree nuts. Co-sensitization with birch (Betula verrucosa) pollen has been reported. We aimed to identify a walnut allergen homologous to the major birch pollen allergen Bet v 1. METHODS AND RESULTS A cDNA encoding a Bet v 1-homologous allergen (Jug r 5) in walnut kernels was cloned by RT-PCR. Jug r 5 was expressed in Escherichia coli, purified by column chromatography and characterized by circular dichroism spectroscopy. Specific IgE levels to walnut, Bet v 1, and Jug r 5 in birch pollen allergics (n = 16) with concomitant walnut allergy were measured by ImmunoCAP: 44% of the patients were tested positive to walnut while 94% were reactive to Jug r 5, and 100% to Bet v 1. Jug r 5 and Bet v 1 allergens showed bidirectional IgE cross-reactivity by competitive ELISA and were capable of inducing histamine release from effector cells. Immunoblot competition experiments demonstrated the presence of IgE-reactive Jug r 5 in walnut extract, but at low levels. CONCLUSION A Bet v 1-like allergen was identified in walnut. Diagnostic use of Jug r 5 will compensate for the low sensitivity of walnut extract for patients with birch pollen associated walnut allergy.
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Affiliation(s)
- Andrea Wangorsch
- VPr1 Research Group Molecular Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - Annette Jamin
- VPr1 Research Group Molecular Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | | | - Nora Gräni
- Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - Claudia Lang
- Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - Barbara Ballmer-Weber
- Department of Dermatology, University Hospital Zürich, Zürich, Switzerland.,Center of Dermatology and Allergology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Stefan Vieths
- VPr1 Research Group Molecular Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - Stephan Scheurer
- VPr1 Research Group Molecular Allergology, Paul-Ehrlich-Institut, Langen, Germany
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31
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Husslik F, Nürnberg J, Seutter von Loetzen C, Mews T, Ballmer-Weber BK, Kleine-Tebbe J, Treudler R, Simon JC, Randow S, Völker E, Reuter A, Rösch P, Vieths S, Holzhauser T, Schiller D. The conformational IgE epitope profile of soya bean allergen Gly m 4. Clin Exp Allergy 2016; 46:1484-1497. [PMID: 27533495 DOI: 10.1111/cea.12796] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/06/2016] [Accepted: 07/11/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Birch pollen-related soya allergy is mediated by Gly m 4. Conformational IgE epitopes of Gly m 4 are unknown. OBJECTIVE To identify the IgE epitope profile of Gly m 4 in subjects with birch pollen-related soya allergy utilizing an epitope library presented by Gly m 4-type model proteins. METHODS Sera from patients with (n = 26) and without (n = 19) allergy to soya as determined by oral provocation tests were studied. Specific IgE (Bet v 1/Gly m 4) was determined by ImmunoCAP. A library of 59 non-allergenic Gly m 4-type model proteins harbouring individual and multiple putative epitopes for IgE was tested in IgE binding assays. Primary, secondary and tertiary protein structures were assessed by mass spectrometry, circular dichroism and nuclear magnetic resonance spectroscopy. RESULTS All subjects were sensitized to Gly m 4 and Bet v 1. Allergen-specific serum IgE levels ranged from 0.94 to > 100 kUA /L. The avidities of serum IgE were 5.06 ng (allergic) and 1.8 ng (tolerant) as determined by EC50 for IgE binding to Gly m 4. 96% (46/48) of the protein variants bound IgE. Model proteins had Gly m 4-type conformation and individual IgE binding clustered in six major surface areas. Gly m 4-specific IgE binding could be inhibited to up to 80% by model proteins harbouring individual IgE binding sites in an epitope-wise equimolar fashion. Receiver operating curve analysis revealed an area under fitted curve of up to 0.88 for model proteins and 0.66 for Gly m 4. CONCLUSION AND CLINICAL RELEVANCE Serum levels and avidity of Gly m 4-specific IgE do not correlate with clinical reactivity to soya. Six IgE-binding areas, represented by 23 amino acids, account for more than 80% of total IgE binding capacity of Gly m 4. Model proteins may be used for epitope-resolved diagnosis to differentiate birch-soya allergy from clinical tolerance.
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Affiliation(s)
- F Husslik
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - J Nürnberg
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | | | - T Mews
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - B K Ballmer-Weber
- Centre for Dermatology and Allergology, Kantonsspital Luzern, Luzern, Switzerland.,Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | - R Treudler
- Department of Dermatology, Venereology and Allergology, University of Leipzig, Leipzig, Germany
| | - J-C Simon
- Department of Dermatology, Venereology and Allergology, University of Leipzig, Leipzig, Germany
| | - S Randow
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - E Völker
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - A Reuter
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - P Rösch
- Department of Biopolymers, University of Bayreuth, Bayreuth, Germany
| | - S Vieths
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - T Holzhauser
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - D Schiller
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany.
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32
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Turner PJ, Baumert JL, Beyer K, Boyle RJ, Chan CH, Clark AT, Crevel RWR, DunnGalvin A, Fernández-Rivas M, Gowland MH, Grabenhenrich L, Hardy S, Houben GF, O'B Hourihane J, Muraro A, Poulsen LK, Pyrz K, Remington BC, Schnadt S, van Ree R, Venter C, Worm M, Mills ENC, Roberts G, Ballmer-Weber BK. Can we identify patients at risk of life-threatening allergic reactions to food? Allergy 2016; 71:1241-55. [PMID: 27138061 DOI: 10.1111/all.12924] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2016] [Indexed: 12/31/2022]
Abstract
Anaphylaxis has been defined as a 'severe, life-threatening generalized or systemic hypersensitivity reaction'. However, data indicate that the vast majority of food-triggered anaphylactic reactions are not life-threatening. Nonetheless, severe life-threatening reactions do occur and are unpredictable. We discuss the concepts surrounding perceptions of severe, life-threatening allergic reactions to food by different stakeholders, with particular reference to the inclusion of clinical severity as a factor in allergy and allergen risk management. We review the evidence regarding factors that might be used to identify those at most risk of severe allergic reactions to food, and the consequences of misinformation in this regard. For example, a significant proportion of food-allergic children also have asthma, yet almost none will experience a fatal food-allergic reaction; asthma is not, in itself, a strong predictor for fatal anaphylaxis. The relationship between dose of allergen exposure and symptom severity is unclear. While dose appears to be a risk factor in at least a subgroup of patients, studies report that individuals with prior anaphylaxis do not have a lower eliciting dose than those reporting previous mild reactions. It is therefore important to consider severity and sensitivity as separate factors, as a highly sensitive individual will not necessarily experience severe symptoms during an allergic reaction. We identify the knowledge gaps that need to be addressed to improve our ability to better identify those most at risk of severe food-induced allergic reactions.
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Affiliation(s)
- P. J. Turner
- Section of Paediatrics (Allergy and Infectious Diseases) & MRC and Asthma UK Centre in Allergic Mechanisms of Asthma; Imperial College London; London UK
| | - J. L. Baumert
- Food Allergy Research and Resource Program; Department of Food Science and Technology; University of Nebraska; Lincoln NE USA
| | - K. Beyer
- Department of Pediatric Pneumology and Immunology; Charité Universitätsmedizin; Berlin Germany
| | - R. J. Boyle
- Section of Paediatrics (Allergy and Infectious Diseases) & MRC and Asthma UK Centre in Allergic Mechanisms of Asthma; Imperial College London; London UK
| | | | - A. T. Clark
- Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - R. W. R. Crevel
- Safety and Environmental Assurance Centre; Unilever; Colworth Science Park; Sharnbrook Bedford UK
| | - A. DunnGalvin
- Applied Psychology and Paediatrics and Child Health; University College Cork; Cork Ireland
| | | | | | - L. Grabenhenrich
- Institute for Social Medicine; Epidemiology and Health Economics; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - S. Hardy
- Food Standards Agency; London UK
| | | | - J. O'B Hourihane
- Paediatrics and Child Health; University College Cork; Cork Ireland
| | - A. Muraro
- Department of Paediatrics; Centre for Food Allergy Diagnosis and Treatment; University of Padua; Veneto Italy
| | - L. K. Poulsen
- Allergy Clinic; Copenhagen University Hospital at Gentofte; Copenhagen Denmark
| | - K. Pyrz
- Applied Psychology and Paediatrics and Child Health; University College Cork; Cork Ireland
| | | | - S. Schnadt
- German Allergy and Asthma Association (Deutscher Allergie- und Asthmabund (DAAB)); Mönchengladbach Germany
| | - R. van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - C. Venter
- School of Health Sciences and Social Work; University of Portsmouth; Portsmouth UK
- The David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Isle of Wight UK
| | - M. Worm
- Allergy-Center Charité; Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - E. N. C. Mills
- Institute of Inflammation and Repair; Manchester Academic Health Science Centre; Manchester Institute of Biotechnology; The University of Manchester; Manchester UK
| | - G. Roberts
- The David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Isle of Wight UK
- NIHR Respiratory Biomedical Research Unit; University Hospital Southampton NHS Foundation Trust and Human Development and Health Academic Unit; University of Southampton Faculty of Medicine; Southampton UK
| | - B. K. Ballmer-Weber
- Allergy Unit; Department of Dermatology; University Hospital; University Zürich; Zürich Switzerland
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33
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Mudnakudu Nagaraju KK, Babina M, Weise C, Kühl A, Schulzke J, Worm M. Bortezomib treatment diminishes hazelnut-induced intestinal anaphylaxis in mice. Eur J Immunol 2016; 46:1727-36. [PMID: 27111856 DOI: 10.1002/eji.201545918] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 04/01/2016] [Accepted: 04/19/2016] [Indexed: 12/31/2022]
Abstract
Food allergy is a common health problem and can cause anaphylaxis. Avoidance of the offending food allergen is still the mainstay therapeutic approach. In this study, we investigated the role of plasma cell reduction by proteasome inhibition in a murine model of food allergy and examined the impact of this treatment on the systemic and local immune response. For this purpose, intestinal anaphylaxis was induced in BALB/c mice with the food allergen hazelnut, in conjunction with different adjuvants (alum and Staphylococcal enterotoxin B SEB) and different administration routes (oral and intraperitoneal). In both models, allergy symptoms were observed, but the clinical severity was more pronounced in the hazelnut-alum model than in the hazelnut-SEB model. Accordingly, allergen-specific immunoglobulin E (IgE) against hazelnut was detectable, and mast cell protease-1 in serum was increased after allergen provocation. Treatment with the proteasome inhibitor bortezomib reduced plasma cells and resulted in an abolishment of hazelnut allergen-specific IgE, which was associated with amelioration of clinical symptoms as well as a significant decrease in both CD19(+) and follicular B lymphocytes. Our data demonstrate the importance of allergen-specific IgE in food allergy and point to B cells as potential therapeutic targets for its treatment.
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Affiliation(s)
| | - Magda Babina
- Department of Dermatology und Allergology, Allergie-Centrum-Charité, Charité - Universitätsmedizin, Berlin, Germany
| | - Christin Weise
- Department of Dermatology und Allergology, Allergie-Centrum-Charité, Charité - Universitätsmedizin, Berlin, Germany
| | - Anja Kühl
- Department of Medicine-I for Gastroenterology, Infectious Disease and Rheumatology, Research Center ImmunoSciences, Charité - Universitätsmedizin, Berlin, Germany
| | - Joerg Schulzke
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin, Berlin, Germany
| | - Margitta Worm
- Department of Dermatology und Allergology, Allergie-Centrum-Charité, Charité - Universitätsmedizin, Berlin, Germany
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Uotila R, Kukkonen AK, Pelkonen AS, Mäkelä MJ. Cross-sensitization profiles of edible nuts in a birch-endemic area. Allergy 2016; 71:514-21. [PMID: 26706253 DOI: 10.1111/all.12826] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sensitization to birch pollen causes cross-sensitization to nuts, but rarely leads to clinical nut allergy. The aim was to study sensitizations to nuts in individuals sensitized to birch pollen and examine cross-reactivities between birch and nut species. METHODS All subjects with skin prick tests (SPTs) for birch pollen conducted during 1997-2013 in the Skin and Allergy Hospital in Helsinki (n = 114 572) and their available SPTs for nuts (n = 50 604) were included. Nut sensitizations were analyzed both with and without cosensitization to birch and stratified into age-categories. Cross-reactivities were analyzed with hierarchical clustering. One group of 1589 patients was surveyed for symptoms. Data were gathered also from Lapland to examine sensitizations in an area with less birch-pollen exposure. RESULTS Of subjects with birch sensitization, 84% were cosensitized to hazelnut, 71% to almond, and 60% to peanut. In a subgroup without birch sensitization, young children (<5 years) were most commonly nut-sensitized (8-40%); and this prevalence decreased in adolescents and further in adults (4-12%). Cashew and pistachio (ρ = 0.66; P < 0.001) and pecan and walnut (ρ = 0.65; P < 0.001) correlated the strongest. The majority of nut-sensitized patients (71% hazelnut, 83% almond, 73% peanut) reported no or mild symptoms. Cosensitizations between nuts and birch were similar in Lapland with its lower birch-pollen exposure. CONCLUSION Birch-sensitized individuals are frequently cosensitized to hazelnut, almond, and peanut. Among the birch-negatives, prevalences of nut sensitizations decrease from early childhood to adolescence. Cashew and pistachio, and pecan and walnut cross-react the most.
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Affiliation(s)
- R. Uotila
- Skin and Allergy Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - A. K. Kukkonen
- Skin and Allergy Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - A. S. Pelkonen
- Skin and Allergy Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - M. J. Mäkelä
- Skin and Allergy Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
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Eller E, Mortz CG, Bindslev-Jensen C. Cor a 14 is the superior serological marker for hazelnut allergy in children, independent of concomitant peanut allergy. Allergy 2016; 71:556-62. [PMID: 26666993 DOI: 10.1111/all.12820] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hazelnut is the most frequent cause of tree nut allergy, but up to half of all children with hazelnut allergy additionally suffer from peanut allergy. Our aim was to identify diagnostic values of the most promising serological markers (Cor a 9 and Cor a 14) and to address the influence of concomitant peanut allergy and PR10 sensitization. METHOD We included 155 children suspected of hazelnut allergy and challenged according to the guidelines. Concomitant allergy to peanuts was verified or ruled out by challenge. Skin prick test, s-IgE and CRD to hazelnut, peanut, PR10 and LPT protein families were measured using ImmunoCAP. RESULTS Sixty-five children had a positive hazelnut challenge, and 60% of these also had a concomitant peanut allergy. Children allergic to hazelnut were sensitized to Cor a 9 and Cor a 14; peanut-allergic children were sensitized to Ara h 2. Sensitization to PR10 protein components was seen in 45% of all included children, irrelevant to allergy to peanut or hazelnut. A cut-off >0.72 kU/L of IgE towards Cor a 14 diagnosed 87% correctly, making Cor a 14 the superior serology marker. However, nine hazelnut-allergic children were primarily sensitized to Cor a 9. CONCLUSION Concomitant peanut allergy is common in hazelnut-allergic children, but decision points as well as diagnostic values for Cor a 14 are not affected. We found three independent and well-characterized serotypes; hazelnut-allergic children were sensitized to Cor a 14, peanut-allergic children were sensitized to Ara h 2, and independently of this were children sensitized to birch pollen (Bet v 1).
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Affiliation(s)
- E. Eller
- Odense Research Center for Anaphylaxis (ORCA); Odense University Hospital; Odense Denmark
- Department of Dermatology and Allergy Centre; Odense University Hospital; Odense Denmark
| | - C. G. Mortz
- Odense Research Center for Anaphylaxis (ORCA); Odense University Hospital; Odense Denmark
- Department of Dermatology and Allergy Centre; Odense University Hospital; Odense Denmark
| | - C. Bindslev-Jensen
- Odense Research Center for Anaphylaxis (ORCA); Odense University Hospital; Odense Denmark
- Department of Dermatology and Allergy Centre; Odense University Hospital; Odense Denmark
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Buyuktiryaki B, Cavkaytar O, Sahiner UM, Yilmaz EA, Yavuz ST, Soyer O, Sekerel BE, Tuncer A, Sackesen C. Cor a 14, Hazelnut-Specific IgE, and SPT as a Reliable Tool in Hazelnut Allergy Diagnosis in Eastern Mediterranean Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:265-72.e3. [DOI: 10.1016/j.jaip.2015.12.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 12/27/2015] [Accepted: 12/30/2015] [Indexed: 11/24/2022]
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Brough HA, Turner PJ, Wright T, Fox AT, Taylor SL, Warner JO, Lack G. Dietary management of peanut and tree nut allergy: what exactly should patients avoid? Clin Exp Allergy 2016; 45:859-871. [PMID: 25443673 DOI: 10.1111/cea.12466] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Peanut and tree nut allergies are the commonest cause of life-threatening food-allergic reactions and significantly affect quality of life in children and their families. Dietary nut avoidance and provision of emergency medication is currently the mainstay of treatment. Nut avoidance has consequences on both quality of life and nutrition. We review the terminology that may cause confusion and lead to unnecessary dietary restrictions. In peanut or tree nut-allergic children, introduction of specific nuts to which the child is not allergic may improve quality of life and should be considered in patients with multiple foods allergies, vegan or ethnic-specific diets, in whom nuts are an important source of protein. Nut-allergic consumers do not just need to avoid foods containing nuts as an ingredient, but also contend with pre-packed foods which frequently have precautionary allergen labelling (PAL) referring to possible nut contamination. Although the published rate of peanut contamination in 'snack' foods with PAL (see Box ) ranges from 0.9-32.4%, peanut contamination in non-snack items with PAL is far less common. We propose that in some peanut-allergic patients (depending on history of reactivity to trace levels of peanut, reaction severity, other medical conditions, willingness to always carry adrenaline, etc.), consideration may be given to allow the consumption of non-snack foods containing PAL following discussion with the patient's (and their family's) specialist. More work is needed to provide consumers with clearer information on the risk of potential nut contamination in pre-packed food. We also draw attention to the change in legislation in December 2014 that require mandatory disclosure of allergens in non-pre-packed foods.
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Affiliation(s)
- H A Brough
- Children's Allergy Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Division of Asthma, Allergy and Lung Biology & MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
| | - P J Turner
- Section of Paediatrics (Allergy & Immunology) & MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust / NIHR Biomedical Research Unit.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - T Wright
- Children's Allergy Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - A T Fox
- Children's Allergy Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Division of Asthma, Allergy and Lung Biology & MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
| | - S L Taylor
- Food Allergy Research & Resource Program, Department of Food Science & Technology, University of Nebraska, Lincoln, NE, USA
| | - J O Warner
- Section of Paediatrics (Allergy & Immunology) & MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust / NIHR Biomedical Research Unit
| | - G Lack
- Children's Allergy Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Division of Asthma, Allergy and Lung Biology & MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
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Abstract
The prevalence of food allergies has been on the increase over the last 2 decades. Diagnosing food allergies can be complicated, as there are multiple types that have distinct clinical and immunologic features. Food allergies are broadly classified into immunoglobulin E (IgE)-mediated, non-IgE-mediated, or mixed food allergic reactions. This review focuses on the clinical manifestations of the different categories of food allergies and the different tests available to guide the clinician toward an accurate diagnosis.
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Affiliation(s)
- Rebecca Sharon Chinthrajah
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Sean N Parker Center for Allergy Research, Stanford University, Stanford University School of Medicine, 269 Campus Drive, CCSR 3215, MC 5366, Stanford, CA 94305-5101, USA.
| | - Dana Tupa
- Sean N Parker Center for Allergy Research, Stanford University, Stanford University School of Medicine, 1291 Welch Road, Grant Building S303, Stanford, CA 94305, USA
| | - Benjamin T Prince
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Feinberg School of Medicine, 225 East Chicago Avenue Box 60, Chicago, IL, USA
| | - Whitney Morgan Block
- Sean N Parker Center for Allergy Research, Stanford University, 2500 Grant Road, PEC, 4th Floor Tower C, Mountain View, CA 94040, USA
| | - Jaime Sou Rosa
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Sean N Parker Center for Allergy Research, Stanford University, Stanford University School of Medicine, 269 Campus Drive, CCSR 3215, MC 5366, Stanford, CA 94305-5101, USA
| | - Anne Marie Singh
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 240 East Huron Street, M-317, McGaw Pavilion, Chicago, IL 60611, USA
| | - Kari Nadeau
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Sean N Parker Center for Allergy Research, Stanford University, Stanford University School of Medicine, 269 Campus Drive, CCSR 3215, MC 5366, Stanford, CA 94305-5101, USA
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Offermann LR, Bublin M, Perdue ML, Pfeifer S, Dubiela P, Borowski T, Chruszcz M, Hoffmann-Sommergruber K. Structural and Functional Characterization of the Hazelnut Allergen Cor a 8. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2015; 63:9150-8. [PMID: 26417906 PMCID: PMC4616228 DOI: 10.1021/acs.jafc.5b03534] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/23/2015] [Accepted: 09/28/2015] [Indexed: 05/28/2023]
Abstract
Nonspecific lipid transfer proteins (nsLTPs) are basic proteins, stabilized by four disulfide bonds, and are expressed throughout the plant kingdom. These proteins are also known as important allergens in fruits and tree nuts. In this study, the nsLTP from hazelnuts, Cor a 8, was purified and its crystal structure determined. The protein is stable at low pH and refolds after thermal denaturation. Molecular dynamics simulations were used to provide an insight into conformational changes of Cor a 8 upon ligand binding. When known epitope areas from Pru p 3 were compared to those of Cor a 8, differences were obvious, which may contribute to limited cross-reactivity between peach and hazelnut allergens. Differences in epitope regions may contribute to limited cross-reactivity between Cor a 8 and nsLTPs from other plant sources. The structure of Cor a 8 represents the first resolved structure of a hazelnut allergen.
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Affiliation(s)
- Lesa R. Offermann
- Department
of Chemistry and Biochemistry, University
of South Carolina, Columbia, South Carolina 29208, United States
- Department
of Chemistry, Davidson College, Davidson, North Carolina 28035, United States
| | - Merima Bublin
- Department
of Pathophysiology and Allergy Research, Center for Pathophysiology,
Infectiology and Immunology, Medical University
of Vienna, Vienna, Austria
| | - Makenzie L. Perdue
- Department
of Chemistry and Biochemistry, University
of South Carolina, Columbia, South Carolina 29208, United States
| | - Sabine Pfeifer
- Department
of Pathophysiology and Allergy Research, Center for Pathophysiology,
Infectiology and Immunology, Medical University
of Vienna, Vienna, Austria
| | - Pawel Dubiela
- Department
of Pathophysiology and Allergy Research, Center for Pathophysiology,
Infectiology and Immunology, Medical University
of Vienna, Vienna, Austria
| | - Tomasz Borowski
- Jerzy Haber
Institute of Catalysis and Surface Chemistry, Polish Academy of Sciences, Kraków, Poland
| | - Maksymilian Chruszcz
- Department
of Chemistry and Biochemistry, University
of South Carolina, Columbia, South Carolina 29208, United States
| | - Karin Hoffmann-Sommergruber
- Department
of Pathophysiology and Allergy Research, Center for Pathophysiology,
Infectiology and Immunology, Medical University
of Vienna, Vienna, Austria
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40
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Schussler E, Kattan J. Allergen Component Testing in the Diagnosis of Food Allergy. Curr Allergy Asthma Rep 2015; 15:55. [PMID: 26233426 DOI: 10.1007/s11882-015-0554-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IgE-mediated food allergies are an important public health problem, affecting 5 % of adults and 8 % of children, with numerous studies indicating that the prevalence is increasing. Food allergic reactions can range in severity from mild to severe and life threatening. Accurate diagnosis of food allergy is necessary not only to provide appropriate and potentially life-saving preventive measures but also to prevent unwarranted dietary restrictions. The diagnosis of food allergy has traditionally been based on clinical history and food specific IgE (sIgE) testing, including skin prick testing (SPT), serum tests, or both. These tests tend to be extremely sensitive, but positive test results to foods that are tolerated are common. Studies of allergen component-resolved diagnostics (CRD) show that adjuvant use of this modality may provide a more accurate assessment in the diagnosis of food allergy, though the reported benefits are questionable for a number of major allergens. Furthermore, diagnostic cutoff values have been difficult to determine for allergens where component testing has been demonstrated to be beneficial.
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Affiliation(s)
- Edith Schussler
- Division of Allergy and Immunology, Department of Pediatrics, Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1198, New York, NY, 10029-6574, USA,
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41
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Tuano KS, Davis CM. Utility of Component-Resolved Diagnostics in Food Allergy. Curr Allergy Asthma Rep 2015; 15:32. [PMID: 26141579 DOI: 10.1007/s11882-015-0534-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Allergen component-resolved diagnostic testing (CRD) is a new methodology in clinical food allergy diagnosis, improving the ability to identify specific clinical phenotypes. Instead of relying on the crude allergen extracts used in standard allergy diagnostics, CRD utilizes purified or recombinant allergens for identification of specific molecules causing sensitization or allergy. This method is able to determine risk of the severity of allergic reactions in specific cases, like soy, peanut, and hazelnut allergy. The severity of allergic reaction can be predicted in peanut allergy with Ara h 2, and clinically relevant disease in pollen-allergic patients can be identified. However, age and geographic differences affect CRD results and it should always be utilized in the context of a clinical history. In the future, clinical phenotypes may be differentiated with larger prospective studies utilizing food challenges.
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Affiliation(s)
- Karen S Tuano
- Department of Pediatrics, Section of Immunology, Allergy and Rheumatology, Texas Children's Hospital, Baylor College of Medicine, 1102 Bates, FC-330, Houston, TX, 77030, USA
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Abstract
IgE-mediated food allergy is a relevant health problem inducing symptoms ranging from mild local reactions up to severe life-threatening situations. Currently, no immunotherapy is available and avoidance of the incriminating food is the method of choice. Therefore, reliable diagnostic tools to formulate dietary recommendations and to avoid unnecessary exclusion diets for the individual patient are urgently needed. This review provides an update on the current knowledge on food allergens and their application in various diagnostic approaches such as skin prick test, basophil activation test, and serum IgE testing. Furthermore, these new approaches are discussed and compared to conventional extract-based assays and correlated to the gold standard of food allergy diagnosis, the double-blind placebo-controlled food challenge. Finally, the application of food allergens for preventive measurements such as allergen detection assays and the determination of threshold levels for allergen levels are discussed.
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Affiliation(s)
- Karin Hoffmann-Sommergruber
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, AKH-EBO3Q, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Sabine Pfeifer
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, AKH-EBO3Q, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Merima Bublin
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, AKH-EBO3Q, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Pfeifer S, Bublin M, Dubiela P, Hummel K, Wortmann J, Hofer G, Keller W, Radauer C, Hoffmann-Sommergruber K. Cor a 14, the allergenic 2S albumin from hazelnut, is highly thermostable and resistant to gastrointestinal digestion. Mol Nutr Food Res 2015; 59:2077-86. [PMID: 26178695 PMCID: PMC4973671 DOI: 10.1002/mnfr.201500071] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 05/07/2015] [Accepted: 06/25/2015] [Indexed: 01/23/2023]
Abstract
Scope Allergens from nuts frequently induce severe allergic reactions in sensitive individuals. The aim of this study was to elucidate the physicochemical characteristics of natural Cor a 14, the 2S albumin from hazelnut. Methods and results Cor a 14 was purified from raw hazelnuts using a combination of precipitation and chromatographic techniques. The protein was analyzed using gel electrophoresis, MS, and far‐UV circular dichroism (CD) analyses. The immunoglobulin E (IgE) binding of native, heat‐treated, and in vitro digested Cor a 14 was studied. We identified two different Cor a 14 isoforms and showed microclipping at the C‐terminus. CD spectra at room temperature showed the typical characteristics of 2S albumins, and temperatures of more than 80°C were required to start unfolding of Cor a 14 demonstrating its high stability to heat treatment. In vitro digestion experiments revealed that Cor a 14 is resistant to proteolytic degradation. Native and heat‐treated protein was recognized by sera from hazelnut allergic patients. However, denaturation of the allergen led to significantly reduced IgE binding. Conclusion We identified two different isoforms of Cor a 14 displaying high stability under heating and gastric and duodenal conditions. Data from IgE‐binding experiments revealed the existence of both, linear and conformational epitopes.
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Affiliation(s)
- Sabine Pfeifer
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Merima Bublin
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Pawel Dubiela
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Karin Hummel
- VetCore Facility, University of Veterinary Medicine, Vienna, Austria
| | - Judith Wortmann
- Institute of Molecular Biosciences, Structural Biology, University of Graz, Graz, Austria
| | - Gerhard Hofer
- Institute of Molecular Biosciences, Structural Biology, University of Graz, Graz, Austria
| | - Walter Keller
- Institute of Molecular Biosciences, Structural Biology, University of Graz, Graz, Austria
| | - Christian Radauer
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Karin Hoffmann-Sommergruber
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
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Blanc F, Bernard H, Ah-Leung S, Przybylski-Nicaise L, Skov PS, Purohit A, de Blay F, Ballmer-Weber B, Fritsche P, Rivas MF, Reig I, Sinaniotis A, Vassilopoulou E, Hoffmann-Sommergruber K, Vieths S, Rigby N, Mills C, Adel-Patient K. Further studies on the biological activity of hazelnut allergens. Clin Transl Allergy 2015; 5:26. [PMID: 26191402 PMCID: PMC4506444 DOI: 10.1186/s13601-015-0066-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 05/20/2015] [Indexed: 01/13/2023] Open
Abstract
Background Sensitization to hazelnut allergens vary depending on the geographic origin and age of the patients. The objective of this study was to further investigate the allergenic activity of hazelnut allergens using sera from patients recruited in various European regions and presenting different sensitization patterns to hazelnut proteins. Methods Natural Cor a 11 and Cor a 9 were purified from hazelnut whereas Cor a 1 and Cor a 8 were produced as recombinant proteins (rCor a 1.04 and rCor a 8). Sera from hazelnut allergic patients were collected in France (n = 5), Switzerland (n = 2), Greece (n = 11) and Spain (n = 3), within the Europrevall project. Total and allergen-specific IgE were quantified by enzyme allergosorbent test and IgE immunoblot were performed using pooled sera from birch-pollen endemic region or from Greece. Histamine Release (HR) assays were performed with stripped basophils passively sensitized with individual sera and challenged by a hazelnut extract or the different hazelnut allergens. Results As previously described, hazelnut allergic patients from Mediterranean countries are mainly sensitized to the nsLTP Cor a 8 whereas patients from France and Switzerland are sensitized to pollen-related allergens. Interestingly, an intermediate profile was evidenced in patients from Madrid. Hazelnut 7S globulin (Cor a 11) and 11S globulin (Cor a 9) were found to be minor allergens, recognized only by patients from Mediterranean countries. The biologic activity of the 4 tested allergens, analysed by HR assay, further confirmed the sensitization patterns, but also demonstrated the very high elicitation potency of Cor a 8. Conclusions This work, extending previously published researches, represents a step towards the better understanding of the complexity of hazelnut allergy and provides new data on the biological activity of hazelnut allergens and extracts. Electronic supplementary material The online version of this article (doi:10.1186/s13601-015-0066-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F Blanc
- INRA-CEA, Service de Pharmacologie et d'Immunoanalyse, Laboratoire d'Immuno-Allergie Alimentaire, Bât. 136-CEA de Saclay, 91191 Gif-sur-Yvette, France
| | - H Bernard
- INRA-CEA, Service de Pharmacologie et d'Immunoanalyse, Laboratoire d'Immuno-Allergie Alimentaire, Bât. 136-CEA de Saclay, 91191 Gif-sur-Yvette, France
| | - S Ah-Leung
- INRA-CEA, Service de Pharmacologie et d'Immunoanalyse, Laboratoire d'Immuno-Allergie Alimentaire, Bât. 136-CEA de Saclay, 91191 Gif-sur-Yvette, France
| | - L Przybylski-Nicaise
- INRA-CEA, Service de Pharmacologie et d'Immunoanalyse, Laboratoire d'Immuno-Allergie Alimentaire, Bât. 136-CEA de Saclay, 91191 Gif-sur-Yvette, France
| | | | - A Purohit
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - F de Blay
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - P Fritsche
- University Hospital Zurich, Zurich, Switzerland
| | | | - I Reig
- Hospital Clinico San Carlos, Madrid, Spain
| | - A Sinaniotis
- University of Athens & "Sotiria" Regional Chest Diseases Hospital of Athens, Athens, Greece
| | | | | | - S Vieths
- Paul-Ehrlich-Institut, Langen, Germany
| | - N Rigby
- Institute of Food Research, Norwich, UK
| | - C Mills
- University of Manchester, Manchester, UK
| | - K Adel-Patient
- INRA-CEA, Service de Pharmacologie et d'Immunoanalyse, Laboratoire d'Immuno-Allergie Alimentaire, Bât. 136-CEA de Saclay, 91191 Gif-sur-Yvette, France
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45
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Datema MR, Zuidmeer-Jongejan L, Asero R, Barreales L, Belohlavkova S, de Blay F, Bures P, Clausen M, Dubakiene R, Gislason D, Jedrzejczak-Czechowicz M, Kowalski ML, Knulst AC, Kralimarkova T, Le TM, Lovegrove A, Marsh J, Papadopoulos NG, Popov T, Del Prado N, Purohit A, Reese G, Reig I, Seneviratne SL, Sinaniotis A, Versteeg SA, Vieths S, Zwinderman AH, Mills C, Lidholm J, Hoffmann-Sommergruber K, Fernández-Rivas M, Ballmer-Weber B, van Ree R. Hazelnut allergy across Europe dissected molecularly: A EuroPrevall outpatient clinic survey. J Allergy Clin Immunol 2015; 136:382-91. [PMID: 25772593 DOI: 10.1016/j.jaci.2014.12.1949] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 11/25/2014] [Accepted: 12/04/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hazelnut allergy is birch pollen-driven in Northern/Western Europe and lipid transfer protein-driven in Spain and Italy. Little is known about other regions and other allergens. OBJECTIVE Establishing a molecular map of hazelnut allergy across Europe. METHODS In 12 European cities, subjects reporting reactions to hazelnut (n = 731) were evaluated and sensitization to 24 foods, 12 respiratory allergen sources, and latex was tested by using skin prick test and ImmunoCAP. A subset (124 of 731) underwent a double-blind placebo-controlled food challenge to hazelnut. Sera of 423 of 731 subjects were analyzed for IgE against 7 hazelnut allergens and cross-reactive carbohydrate determinants by ImmunoCAP. RESULTS Hazelnut allergy was confirmed in 70% of those undergoing double-blind placebo-controlled food challenges. Birch pollen-driven hazelnut sensitization (Cor a 1) dominated in most cities, except in Reykjavik, Sofia, Athens, and Madrid, where reporting of hazelnut allergy was less frequent anyhow. In Athens, IgE against Cor a 8 dominated and strongly correlated with IgE against walnut, peach, and apple and against Chenopodium, plane tree, and mugwort pollen. Sensitization to seed storage proteins was observed in less than 10%, mainly in children, and correlated with IgE to nuts, seeds, and legumes. IgE to Cor a 12, observed in all cities (10% to 25%), correlated with IgE to nuts, seeds, and pollen. CONCLUSIONS In adulthood, the importance of hazelnut sensitization to storage proteins, oleosin (Cor a 12), and Cor a 8 is diluted by the increased role of birch pollen cross-reactivity with Cor a 1. Cor a 8 sensitization in the Mediterranean is probably driven by diet in combination with pollen exposure. Hazelnut oleosin sensitization is prevalent across Europe; however, the clinical relevance remains to be established.
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Affiliation(s)
- Mareen R Datema
- Department of Experimental Immunology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| | - Laura Barreales
- Clinical Epidemiology Unit, Preventive Medicine Department, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | - Frédéric de Blay
- Allergy Division, Chest Disease Department, University Hospital of Strasbourg, Strasbourg, France
| | - Peter Bures
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - Michael Clausen
- Faculty of Medicine, University of Iceland, Landspitali University Hospital, Reykjavik, Iceland
| | | | - David Gislason
- Faculty of Medicine, University of Iceland, Landspitali University Hospital, Reykjavik, Iceland
| | | | - Marek L Kowalski
- Department of Immunology, Rheumatology and Allergy, Faculty of Medicine, Medical University of Lodz, Lodz, Poland
| | - André C Knulst
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tanya Kralimarkova
- Clinic of Allergy and Asthma, Medical University of Sofia, Sofia, Bulgaria
| | - Thuy-My Le
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alison Lovegrove
- Department of Plant Biology and Crop Science, Rothamsted Research, Harpenden, United Kingdom
| | - Justin Marsh
- Institute of Inflammation and Repair, Manchester Institute of Biotechnology, University of Manchester, Manchester, United Kingdom
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece; Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, United Kingdom
| | - Todor Popov
- Division of Allergology, Paul-Ehrlich-Insitut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | - Náyade Del Prado
- Clinical Epidemiology Unit, Preventive Medicine Department, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Ashok Purohit
- Allergy Division, Chest Disease Department, University Hospital of Strasbourg, Strasbourg, France
| | - Gerald Reese
- Division of Allergology, Paul-Ehrlich-Insitut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | - Isabel Reig
- Allergy Department, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Suranjith L Seneviratne
- Department of Clinical Immunology, St Mary's Hospital, and Imperial College London, London, United Kingdom
| | | | - Serge A Versteeg
- Department of Experimental Immunology, Academic Medical Center, Amsterdam, The Netherlands
| | - Stefan Vieths
- Division of Allergology, Paul-Ehrlich-Insitut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands
| | - Clare Mills
- Institute of Inflammation and Repair, Manchester Institute of Biotechnology, University of Manchester, Manchester, United Kingdom
| | | | | | | | - Barbara Ballmer-Weber
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - Ronald van Ree
- Department of Experimental Immunology, Academic Medical Center, Amsterdam, The Netherlands; Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands.
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Costa J, Mafra I, Carrapatoso I, Oliveira MBPP. Hazelnut Allergens: Molecular Characterization, Detection, and Clinical Relevance. Crit Rev Food Sci Nutr 2015; 56:2579-2605. [DOI: 10.1080/10408398.2013.826173] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Lange L, Finger A, Buderus S, Ott H. The Ratio Between Cor a 1- and Hazelnut-Specific IgE Predicts Negative Challenge Outcome in Children. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2015. [DOI: 10.1089/ped.2014.0408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lars Lange
- Department of Pediatrics, St.-Marien-Hospital, Bonn, Germany
| | - Antje Finger
- Department of Pediatrics, St.-Marien-Hospital, Bonn, Germany
| | - Stephan Buderus
- Department of Pediatrics, St.-Marien-Hospital, Bonn, Germany
| | - Hagen Ott
- Department of Pediatric Dermatology and Allergology, Catholic Children's Hospital, Hamburg, Germany
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Van Gasse AL, Mangodt EA, Faber M, Sabato V, Bridts CH, Ebo DG. Molecular allergy diagnosis: status anno 2015. Clin Chim Acta 2015; 444:54-61. [PMID: 25681645 DOI: 10.1016/j.cca.2015.02.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 02/01/2015] [Accepted: 02/02/2015] [Indexed: 12/21/2022]
Abstract
IgE antibodies play a key role in type I allergic reactions. Today, different in vitro immunoassays for allergen-specific IgE antibodies are available. However, some major issues should be taken into account for correct interpretation of specific IgE (sIgE) antibody results, as these assays do not demonstrate absolute positive and negative predictive values. Therefore, additional diagnostic tests are needed to make the correct diagnosis. During the last two decades significant progress in biochemistry and molecular biology enabled the detection and quantification of sIgE antibodies to allergen protein components and epitope-emulating peptides, also called molecular allergy diagnosis or component resolved diagnosis (CRD). In contrast to conventional sIgE antibody assays, molecular allergy diagnosis makes it possible to discriminate between genuine allergy and merely sensitisation, to establish personalized sensitization patterns and to assess the individual risk of severity of an allergic reaction and finally it helps us to predict the natural course. In this review the use of CRD in inhalant, food, latex and hymenoptera venom allergy will be discussed. The primary focus will be on the most relevant clinical applications of CRD rather than to describe all the currently available allergen components and epitopes. Appropriate experience of our own research group is provided.
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Affiliation(s)
- A L Van Gasse
- Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Immunology-Allergology-Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - E A Mangodt
- Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Immunology-Allergology-Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - M Faber
- Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Immunology-Allergology-Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - V Sabato
- Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Immunology-Allergology-Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - C H Bridts
- Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Immunology-Allergology-Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - D G Ebo
- Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Immunology-Allergology-Rheumatology, Antwerp University Hospital, Antwerp, Belgium.
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Guhsl EE, Hofstetter G, Lengger N, Hemmer W, Ebner C, Fröschl R, Bublin M, Lupinek C, Breiteneder H, Radauer C. IgE, IgG4 and IgA specific to Bet v 1-related food allergens do not predict oral allergy syndrome. Allergy 2015; 70:59-66. [PMID: 25327982 PMCID: PMC4283702 DOI: 10.1111/all.12534] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Birch pollen-associated plant food allergy is caused by Bet v 1-specific IgE, but presence of cross-reactive IgE to related allergens does not predict food allergy. The role of other immunoglobulin isotypes in the birch pollen-plant food syndrome has not been investigated in detail. METHODS Bet v 1-sensitized birch pollen-allergic patients (n = 35) were diagnosed for food allergy by standardized interviews, skin prick tests, prick-to-prick tests and ImmunoCAP. Concentrations of allergen-specific IgE, IgG1, IgG4 and IgA to seven Bet v 1-related food allergens were determined by ELISA. RESULTS Bet v 1, Cor a 1, Mal d 1 and Pru p 1 bound IgE from all and IgG4 and IgA from the majority of sera. Immunoglobulins to Gly m 4, Vig r 1 and Api g 1.01 were detected in <65% of the sera. No significant correlation was observed between plant food allergy and increased or reduced levels of IgE, IgG1, IgG4 or IgA specific to most Bet v 1-related allergens. Api g 1-specific IgE was significantly (P = 0.01) elevated in celeriac-allergic compared with celeriac-tolerant patients. Likewise, frequencies of IgE (71% vs 15%; P = 0.01) and IgA (86% vs 38%; P = 0.04) binding to Api g 1.01 were increased. CONCLUSION Measurements of allergen-specific immunoglobulins are not suitable for diagnosing Bet v 1-mediated plant food allergy to hazelnut and Rosaceae fruits. In contrast, IgE and IgA to the distantly related allergen Api g 1 correlate with allergy to celeriac.
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Affiliation(s)
- E. E. Guhsl
- Department of Pathophysiology and Allergy Research Medical University of Vienna Vienna Austria
| | - G. Hofstetter
- Department of Pathophysiology and Allergy Research Medical University of Vienna Vienna Austria
| | - N. Lengger
- Department of Pathophysiology and Allergy Research Medical University of Vienna Vienna Austria
| | - W. Hemmer
- Floridsdorf Allergy Center Vienna Austria
| | - C. Ebner
- Ambulatory for Allergy and Clinical Immunology Vienna Austria
| | - R. Fröschl
- Department of Laboratory Medicine Medical University of Vienna Vienna Austria
| | - M. Bublin
- Department of Pathophysiology and Allergy Research Medical University of Vienna Vienna Austria
| | - C. Lupinek
- Department of Pathophysiology and Allergy Research Medical University of Vienna Vienna Austria
| | - H. Breiteneder
- Department of Pathophysiology and Allergy Research Medical University of Vienna Vienna Austria
| | - C. Radauer
- Department of Pathophysiology and Allergy Research Medical University of Vienna Vienna Austria
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50
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Van Winkle RC, Chang C. The biochemical basis and clinical evidence of food allergy due to lipid transfer proteins: a comprehensive review. Clin Rev Allergy Immunol 2014. [PMID: 23179517 DOI: 10.1007/s12016-012-8338-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Plant lipid transfer proteins (LTPs) are ubiquitous proteins that are found in divergent plant species. Although the exact function of LTPs is not fully understood, LTPs are conserved across a broad range of plant species. Because LTPs share structural features, there is an increased probability for significant allergic cross-reactivity. The molecular features of LTPs also decrease the probability of degradation due to cooking or digestion, thereby increasing the probability of systemic absorption and severe allergic reactions. LTP allergy, unlike other forms of anaphylaxis, tends to occur more frequently in areas of lower latitude. The geographic distribution of LTP allergy, along with evidence of increased sensitization after respiratory exposure, has led to the hypothesis that LTP-related food allergy may be secondary to sensitization via the respiratory route. Clinical reactions associated with LTPs have broad clinical phenotypes and can be severe in nature. Life-threatening clinical reactions have been associated with ingestion of a multitude of plant products. Component-resolved diagnosis has played a significant role in research applications for LTP allergy. In the future, component-resolved diagnosis may play a significant role in day-to-day clinical care. Also, quantitative analysis of LTPs in foodstuffs may allow for the identification and/or production of low-LTP foods, thereby decreasing the risk to patients with LTP allergy. Furthermore, sublingual immunotherapy may provide a therapeutic option for patients with LTP allergy.
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Affiliation(s)
- R Christopher Van Winkle
- Division of Allergy and Immunology, Thomas Jefferson University, Nemours/A.I. duPont Hospital for Children, Philadelphia, PA, USA
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