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Bahri R, Custovic A, Korosec P, Tsoumani M, Barron M, Wu J, Sayers R, Weimann A, Ruiz-Garcia M, Patel N, Robb A, Shamji MH, Fontanella S, Silar M, Mills ENC, Simpson A, Turner PJ, Bulfone-Paus S. Mast cell activation test in the diagnosis of allergic disease and anaphylaxis. J Allergy Clin Immunol 2018. [PMID: 29518421 PMCID: PMC6075471 DOI: 10.1016/j.jaci.2018.01.043] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Food allergy is an increasing public health issue and the most common cause of life-threatening anaphylactic reactions. Conventional allergy tests assess for the presence of allergen-specific IgE, significantly overestimating the rate of true clinical allergy and resulting in overdiagnosis and adverse effect on health-related quality of life. Objective To undertake initial validation and assessment of a novel diagnostic tool, we used the mast cell activation test (MAT). Methods Primary human blood-derived mast cells (MCs) were generated from peripheral blood precursors, sensitized with patients' sera, and then incubated with allergen. MC degranulation was assessed by means of flow cytometry and mediator release. We compared the diagnostic performance of MATs with that of existing diagnostic tools to assess in a cohort of peanut-sensitized subjects undergoing double-blind, placebo-controlled challenge. Results Human blood-derived MCs sensitized with sera from patients with peanut, grass pollen, and Hymenoptera (wasp venom) allergy demonstrated allergen-specific and dose-dependent degranulation, as determined based on both expression of surface activation markers (CD63 and CD107a) and functional assays (prostaglandin D2 and β-hexosaminidase release). In this cohort of peanut-sensitized subjects, the MAT was found to have superior discrimination performance compared with other testing modalities, including component-resolved diagnostics and basophil activation tests. Using functional principle component analysis, we identified 5 clusters or patterns of reactivity in the resulting dose-response curves, which at preliminary analysis corresponded to the reaction phenotypes seen at challenge. Conclusion The MAT is a robust tool that can confer superior diagnostic performance compared with existing allergy diagnostics and might be useful to explore differences in effector cell function between basophils and MCs during allergic reactions.
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Affiliation(s)
- Rajia Bahri
- Division of Musculoskeletal and Dermatological Sciences & Manchester Collaborative Centre for Inflammation Research (MCCIR), School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Adnan Custovic
- Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom
| | - Peter Korosec
- Laboratory for Clinical Immunology & Molecular Genetics, University Hospital for Respiratory and Allergic Diseases, Golnik, Slovenia
| | - Marina Tsoumani
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, and NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Martin Barron
- Division of Musculoskeletal and Dermatological Sciences & Manchester Collaborative Centre for Inflammation Research (MCCIR), School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Jiakai Wu
- Division of Musculoskeletal and Dermatological Sciences & Manchester Collaborative Centre for Inflammation Research (MCCIR), School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Rebekah Sayers
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, and NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | | | - Monica Ruiz-Garcia
- Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom
| | - Nandinee Patel
- Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom
| | - Abigail Robb
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, and NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Mohamed H Shamji
- Section of Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sara Fontanella
- Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom
| | - Mira Silar
- Laboratory for Clinical Immunology & Molecular Genetics, University Hospital for Respiratory and Allergic Diseases, Golnik, Slovenia
| | - E N Clare Mills
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, and NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Angela Simpson
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, and NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Paul J Turner
- Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom.
| | - Silvia Bulfone-Paus
- Division of Musculoskeletal and Dermatological Sciences & Manchester Collaborative Centre for Inflammation Research (MCCIR), School of Biological Sciences, University of Manchester, Manchester, United Kingdom.
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Al Sallakh MA, Vasileiou E, Rodgers SE, Lyons RA, Sheikh A, Davies GA. Defining asthma and assessing asthma outcomes using electronic health record data: a systematic scoping review. Eur Respir J 2017; 49:49/6/1700204. [DOI: 10.1183/13993003.00204-2017] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/09/2017] [Indexed: 01/25/2023]
Abstract
There is currently no consensus on approaches to defining asthma or assessing asthma outcomes using electronic health record-derived data. We explored these approaches in the recent literature and examined the clarity of reporting.We systematically searched for asthma-related articles published between January 1, 2014 and December 31, 2015, extracted the algorithms used to identify asthma patients and assess severity, control and exacerbations, and examined how the validity of these outcomes was justified.From 113 eligible articles, we found significant heterogeneity in the algorithms used to define asthma (n=66 different algorithms), severity (n=18), control (n=9) and exacerbations (n=24). For the majority of algorithms (n=106), validity was not justified. In the remaining cases, approaches ranged from using algorithms validated in the same databases to using nonvalidated algorithms that were based on clinical judgement or clinical guidelines. The implementation of these algorithms was suboptimally described overall.Although electronic health record-derived data are now widely used to study asthma, the approaches being used are significantly varied and are often underdescribed, rendering it difficult to assess the validity of studies and compare their findings. Given the substantial growth in this body of literature, it is crucial that scientific consensus is reached on the underlying definitions and algorithms.
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Patterns of IgE responses to multiple allergen components and clinical symptoms at age 11 years. J Allergy Clin Immunol 2015; 136:1224-31. [PMID: 25935108 PMCID: PMC4649774 DOI: 10.1016/j.jaci.2015.03.027] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 03/12/2015] [Accepted: 03/18/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND The relationship between sensitization to allergens and disease is complex. OBJECTIVE We sought to identify patterns of response to a broad range of allergen components and investigate associations with asthma, eczema, and hay fever. METHODS Serum specific IgE levels to 112 allergen components were measured by using a multiplex array (Immuno Solid-phase Allergen Chip) in a population-based birth cohort. Latent variable modeling was used to identify underlying patterns of component-specific IgE responses; these patterns were then related to asthma, eczema, and hay fever. RESULTS Two hundred twenty-one of 461 children had IgE to 1 or more components. Seventy-one of the 112 components were recognized by 3 or more children. By using latent variable modeling, 61 allergen components clustered into 3 component groups (CG1, CG2, and CG3); protein families within each CG were exclusive to that group. CG1 comprised 27 components from 8 plant protein families. CG2 comprised 7 components of mite allergens from 3 protein families. CG3 included 27 components of plant, animal, and fungal origin from 12 protein families. Each CG included components from different biological sources with structural homology and also nonhomologous proteins arising from the same biological source. Sensitization to CG3 was most strongly associated with asthma (odds ratio [OR], 8.20; 95% CI, 3.49-19.24; P < .001) and lower FEV1 (P < .001). Sensitization to CG1 was associated with hay fever (OR, 12.79; 95% CI, 6.84-23.90; P < .001). Sensitization to CG2 was associated with both asthma (OR, 3.60; 95% CI, 2.05-6.29) and hay fever (OR, 2.52; 95% CI, 1.38-4.61). CONCLUSIONS Latent variable modeling with a large number of allergen components identified 3 patterns of IgE responses, each including different protein families. In 11-year-old children the pattern of response to components of multiple allergens appeared to be associated with current asthma and hay fever but not eczema.
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Gupta RS, Lau CH, Dyer AA, Sohn MW, Altshuler BA, Kaye BA, Necheles J. Food allergy diagnosis and management practices among pediatricians. Clin Pediatr (Phila) 2014; 53:524-30. [PMID: 24419266 DOI: 10.1177/0009922813518425] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Our goals were to (1) estimate the rates of parent-reported versus physician-diagnosed food allergy, (2) determine pediatrician adherence to national guidelines, and (3) obtain pediatricians' perspectives on guideline nonadherence. A mixed method approach was used, including survey, chart review, and qualitative methods. Overall, 10.9% of parents reported having a child with food allergy and two thirds of these cases were detected by the pediatrician. Chart reviews revealed high rates of guideline adherence with respect to allergist referral (67.3%), but less consistent adherence regarding documentation of reaction history (38.8%), appropriate use of diagnostic tests (34.7%), prescription of epinephrine autoinjectors (44.9%), and counseling families in food allergy management (24.5%). Pediatricians suggested that poor adherence was due to lack of documentation, familiarity with guidelines, and clarity regarding the pediatrician's role in managing food allergy. Findings emphasize the need to better establish the role of the pediatrician and to improve awareness and adherence to guidelines.
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Affiliation(s)
- Ruchi S Gupta
- 1Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Darsow U, Brockow K, Pfab F, Jakob T, Petersson CJ, Borres MP, Ring J, Behrendt H, Huss-Marp J. Heterogeneity of molecular sensitization profiles in grass pollen allergy - implications for immunotherapy? Clin Exp Allergy 2014; 44:778-86. [DOI: 10.1111/cea.12303] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 02/05/2014] [Accepted: 02/12/2014] [Indexed: 11/30/2022]
Affiliation(s)
- U. Darsow
- Department of Dermatology and Allergy; Technische Universität München; Munich Germany
- ZAUM-Center for Allergy and Environment; Helmholtz Center Munich; Technische Universität München; Munich Germany
| | - K. Brockow
- Department of Dermatology and Allergy; Technische Universität München; Munich Germany
- ZAUM-Center for Allergy and Environment; Helmholtz Center Munich; Technische Universität München; Munich Germany
| | - F. Pfab
- Department of Dermatology and Allergy; Technische Universität München; Munich Germany
- ZAUM-Center for Allergy and Environment; Helmholtz Center Munich; Technische Universität München; Munich Germany
| | - T. Jakob
- Allergy Research Group; Department of Dermatology; Medical Center; University of Freiburg; Freiburg Germany
| | | | - M. P. Borres
- Thermo Fisher Scientific; Phadia AB; Uppsala Sweden
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - J. Ring
- Department of Dermatology and Allergy; Technische Universität München; Munich Germany
| | - H. Behrendt
- ZAUM-Center for Allergy and Environment; Helmholtz Center Munich; Technische Universität München; Munich Germany
| | - J. Huss-Marp
- Allergy Research Group; Department of Dermatology; Medical Center; University of Freiburg; Freiburg Germany
- Thermo Fisher Scientific; Phadia GmbH; Freiburg Germany
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Jimenez-Lopez JC, Kotchoni SO, Hernandez-Soriano MC, Gachomo EW, Alché JD. Structural functionality, catalytic mechanism modeling and molecular allergenicity of phenylcoumaran benzylic ether reductase, an olive pollen (Ole e 12) allergen. J Comput Aided Mol Des 2013; 27:873-95. [PMID: 24154826 DOI: 10.1007/s10822-013-9686-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 10/16/2013] [Indexed: 01/22/2023]
Abstract
Isoflavone reductase-like proteins (IRLs) are enzymes with key roles in the metabolism of diverse flavonoids. Last identified olive pollen allergen (Ole e 12) is an IRL relevant for allergy amelioration, since it exhibits high prevalence among atopic patients. The goals of this study are the characterization of (A) the structural-functionality of Ole e 12 with a focus in its catalytic mechanism, and (B) its molecular allergenicity by extensive analysis using different molecular computer-aided approaches covering (1) physicochemical properties and functional-regulatory motifs, (2) sequence analysis, 2-D and 3D structural homology modeling comparative study and molecular docking, (3) conservational and evolutionary analysis, (4) catalytic mechanism modeling, and (5) sequence, structure-docking based B-cell epitopes prediction, while T-cell epitopes were predicted by inhibitory concentration and binding score methods. Structural-based detailed features, phylogenetic and sequences analysis have identified Ole e 12 as phenylcoumaran benzylic ether reductase. A catalytic mechanism has been proposed for Ole e 12 which display Lys133 as one of the conserved residues of the IRLs catalytic tetrad (Asn-Ser-Tyr-Lys). Structure characterization revealed a conserved protein folding among plants IRLs. However, sequence polymorphism significantly affected residues involved in the catalytic pocket structure and environment (cofactor and substrate interaction-recognition). It might also be responsible for IRLs isoforms functionality and regulation, since micro-heterogeneities affected physicochemical and posttranslational motifs. This polymorphism might have large implications for molecular differences in B- and T-cells epitopes of Ole e 12, and its identification may help designing strategies to improve the component-resolving diagnosis and immunotherapy of pollen and food allergy through development of molecular tools.
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Affiliation(s)
- Jose C Jimenez-Lopez
- Department of Biochemistry, Cell and Molecular Biology of Plants, Estación Experimental del Zaidín, Spanish National Research Council (CSIC), Profesor Albareda 1, 18008, Granada, Spain,
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Russo P, Siani A. The role of nuts in the optimal diet: time for a critical appraisal? Nutr Metab Cardiovasc Dis 2012; 22:1019-1023. [PMID: 23199613 DOI: 10.1016/j.numecd.2012.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 10/29/2012] [Indexed: 10/27/2022]
Abstract
During the last decades, nuts have attracted the attention of researchers for their potential benefits in cardiovascular prevention. We discuss here some aspects of the assumed beneficial effects of nuts, weighing them against potential harm. Epidemiological observations and controlled intervention trials consistently suggest that nuts consumption is associated with improved serum lipid profile, thus helping decrease cardiovascular risk. Being nuts an energy dense food, their impact on energy balance and body weight should be considered. In particular, the claim that adding nuts to the habitual diet, thus increasing calorie intake, does not cause body fat accumulation still needs evidence and biological plausibility. The potential risk associated with the relatively frequent occurrence of allergic reactions following the consumption of nuts is also discussed.
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Affiliation(s)
- P Russo
- Institute of Food Sciences, CNR, Avellino, Italy
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Identification of a new IgE-binding epitope of peanut oleosin that cross-reacts with buckwheat. Biosci Biotechnol Biochem 2012; 76:1182-8. [PMID: 22790944 DOI: 10.1271/bbb.120063] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Peanut and buckwheat induce a severe allergic reaction, anaphylaxis, which is considered to be mediated by immunoglobulin E (IgE). We identified in this study a new IgE-binding epitope of the peanut allergen that cross-reacted with buckwheat. The phosphate-buffered saline-soluble fraction of buckwheat inhibited the binding between IgE and the peanut allergen. A cross-reactive peptide was isolated from the α-chymotrypsin hydrolysate of peanut. Based on the amino acid sequence and mass spectrometric analysis data, the peptide was identified as Ser-Asp-Gln-Thr-Arg-Thr-Gly-Tyr (SDQTRTGY); this sequence is identical to amino acids 2-9 in the N-terminal hydrophilic domain of oleosin 3 which is located on the surface of the lipid storage body. Synthetic SDQTRTGY was found to bind with IgE in the sera of all eight peanut-allergic patients tested. Since many foods of plant origin contain oleosin, the possibility of an anaphylactic cross-reaction in allergic patients should always be considered.
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