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Castromil-Benito ES, Betancor D, Parrón-Ballesteros J, Bueno-Díaz C, Gutiérrez-Díaz G, Turnay J, Heras MDL, Cuesta-Herranz J, Villalba M, Pastor-Vargas C. Walnut Jug r 1 is Responsible for Primary Sensitization among Patients Suffering Walnut-Hazelnut 2S Albumin Cross-Reactivity. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2024; 72:18162-18170. [PMID: 39083591 PMCID: PMC11328161 DOI: 10.1021/acs.jafc.4c03603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Walnut and hazelnut coallergy is a frequent manifestation in clinical practice whose molecular basis remains unclear. For this purpose, walnut-hazelnut cross-reactivity was evaluated in 20 patients allergic to one or both tree nuts and sensitized to their 2S albumins. Immunoblotting assays showed that 85% of patients recognized Jug r 1, walnut 2S albumin, which was associated with the development of severe symptoms; 50% of them corecognized hazelnut 2S albumin, Cor a 14. Both allergens were isolated using chromatographic techniques. Inhibition ELISAs revealed that Jug r 1 strongly inhibited the binding of Cor a 14-specific IgE, but Cor a 14 only partially inhibited Jug r 1-specific IgE binding. Our results showed that patients sensitized to walnut/hazelnut 2S albumins were not a homogeneous population. There were patients sensitized to specific epitopes of walnut 2S albumins and patients sensitized to cross-reactive epitopes between walnut and hazelnut, with Jug r 1 being the primary sensitizer.
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Affiliation(s)
- Estela S Castromil-Benito
- Department of Biochemistry and Molecular Biology, Faculty of Chemical Sciences, Complutense University of Madrid, Madrid 28040, Spain
| | - Diana Betancor
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz UAM, Madrid 28015, Spain
| | - Jorge Parrón-Ballesteros
- Department of Biochemistry and Molecular Biology, Faculty of Chemical Sciences, Complutense University of Madrid, Madrid 28040, Spain
| | - Cristina Bueno-Díaz
- Department of Biochemistry and Molecular Biology, Faculty of Chemical Sciences, Complutense University of Madrid, Madrid 28040, Spain
| | - Gloria Gutiérrez-Díaz
- Department of Biochemistry and Molecular Biology, Faculty of Chemical Sciences, Complutense University of Madrid, Madrid 28040, Spain
| | - Javier Turnay
- Department of Biochemistry and Molecular Biology, Faculty of Chemical Sciences, Complutense University of Madrid, Madrid 28040, Spain
| | - Manuel de Las Heras
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz UAM, Madrid 28015, Spain
- Red de asma, reacciones adversas y alérgicas (ARADyAL) RD16/0006/0013, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Javier Cuesta-Herranz
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz UAM, Madrid 28015, Spain
- Red de asma, reacciones adversas y alérgicas (ARADyAL) RD16/0006/0013, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Mayte Villalba
- Department of Biochemistry and Molecular Biology, Faculty of Chemical Sciences, Complutense University of Madrid, Madrid 28040, Spain
- RICORS Red de Enfermedades Inflamatorias (REI) - RD21/0002/0028, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Carlos Pastor-Vargas
- Department of Biochemistry and Molecular Biology, Faculty of Chemical Sciences, Complutense University of Madrid, Madrid 28040, Spain
- RICORS Red de Enfermedades Inflamatorias (REI) - RD21/0002/0028, Instituto de Salud Carlos III, Madrid 28029, Spain
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Pasioti M, Xepapadaki P, Mathioudakis AG, Lakoumentas J, Efstathiou E, Papadopoulos NG. Current options in the management of tree nut allergy: A systematic review and narrative synthesis. Pediatr Allergy Immunol 2024; 35:e14132. [PMID: 38727626 DOI: 10.1111/pai.14132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/19/2024] [Accepted: 04/10/2024] [Indexed: 07/12/2024]
Abstract
Tree nut allergy is a lifelong and potentially life-threatening condition. The standard of care is strictly avoiding the culprit nut and treating accidental reactions symptomatically. To evaluate potential therapeutic options for desensitizing patients with IgE-mediated tree nut allergy, we systematically searched three bibliographic databases for studies published until January 2024. We looked for active treatments of IgE-mediated allergy to tree nuts (walnut, hazelnut, pistachio, cashew, almond, pecan, macadamia nut, and brazil nut). We focused on allergen-specific immunotherapy (AIT) using oral (OIT), sublingual (SLIT), epicutaneous (EPIT), or subcutaneous (SCIT) delivery, or other disease-modifying treatments. We found 19 studies that met our criteria: 3 studies investigated sublingual immunotherapy, 5 studied oral immunotherapy to a single tree nut, and 6 used multi-food oral immunotherapy with or without omalizumab. The remaining studies investigated the effectiveness of monoclonal antibodies or IgE-immunoadsorption in multi-food allergic patients, including patients with tree nut allergy. The heterogeneity of the studies prevented pooling and meta-analysis. Oral immunotherapy, single or multi-nut, with or without omalizumab, was the most studied approach and appears effective in conferring protection from accidental exposures. Omalizumab monotherapy is the only approved alternative management for reducing allergic reactions that may occur with accidental exposure.
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Affiliation(s)
- Maria Pasioti
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - John Lakoumentas
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Elvira Efstathiou
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
- Division of Immunology, Immunity to Infection and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Pasioti M, Savva M, Lakoumentas J, Kompoti E, Makris M, Xepapadaki P, Papadopoulos NG. Impact of Presumed Tree Nut and Peanut Allergy on Quality of Life at Different Ages. J Clin Med 2023; 12:jcm12103472. [PMID: 37240577 DOI: 10.3390/jcm12103472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Tree nut and/or peanut allergy impairs patients' quality of life, but data on the impact of age and the type of nut or peanut on the quality of life are lacking. To evaluate the impact at different ages, age-appropriate survey questionnaires accompanied by FAQLQ and FAIM were distributed to patients with suspected tree nut and/or peanut allergy who presented at the allergy departments of three hospitals in Athens. Out of 200 questionnaires distributed, 106 met the inclusion criteria (46 children, 26 teenagers, 34 adults). The median score of each age group for FAQLQ was 4.6 (3.3-5.1), 4.7 (3.9-5.5), and 3.9 (3.2-5.1) and for FAIM was 3.7 (3.0-4.0), 3.4 (2.8-4.0), and 3.2 (2.7-4.1), respectively. FAQLQ and FAIM scores were correlated with the reported probability of using the rescue anaphylaxis set upon reaction (15.4%, p = 0.04 and 17.8%, p = 0.02, respectively) and pistachio allergy (FAQLQ: 4.8 vs. 4.0, p = 0.04; FAIM: 3.5 vs. 3.2, p = 0.03). Patients with additional food allergies reported worse FAQLQ scores (4.6 vs. 3.8, p = 0.05). Worse FAIM scores were associated with younger age (-18.2%, p = 0.01) and the number of life-threatening allergic reactions (25.3%, p < 0.001). The overall impact of tree nut and/or peanut allergy on patients' quality of life is moderate but differs with age, the type of nut, the use of adrenaline, and the number of previous reactions. The aspects of life affected and contributed factors also vary across age groups.
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Affiliation(s)
- Maria Pasioti
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens General Children's Hospital Panagioti and Aglaia Kyriakou, Thivon & Levadias, Ambelokipoi, 115 27 Athens, Greece
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Fidippidou Street, 4th Floor, Goudi, 115 27 Athens, Greece
| | - Maria Savva
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens General Children's Hospital Panagioti and Aglaia Kyriakou, Thivon & Levadias, Ambelokipoi, 115 27 Athens, Greece
| | - John Lakoumentas
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens General Children's Hospital Panagioti and Aglaia Kyriakou, Thivon & Levadias, Ambelokipoi, 115 27 Athens, Greece
| | - Evangelia Kompoti
- Allergology Department, "Laikon" General Hospital, 115 27 Athens, Greece
| | - Michael Makris
- Allergy Unit 'D. Kalogeromitros', 2nd Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, University General Hospital "Attikon", 124 62 Chaidari, Greece
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens General Children's Hospital Panagioti and Aglaia Kyriakou, Thivon & Levadias, Ambelokipoi, 115 27 Athens, Greece
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens General Children's Hospital Panagioti and Aglaia Kyriakou, Thivon & Levadias, Ambelokipoi, 115 27 Athens, Greece
- Division of Immunology, Immunity to Infection and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
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Eigenmann P. Stratégies thérapeutiques à l’heure de la médecine 6P. REVUE FRANÇAISE D'ALLERGOLOGIE 2023. [DOI: 10.1016/j.reval.2023.103283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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McWilliam VL, Koplin JJ, Allen K, Robinson M, Smart J, Loke P, Peters RL, Dang T, Lee KJ, Dalziel K, Tey D, Taranto M, Perrett KP. TreEAT trial: Protocol for a randomized controlled trial investigating the efficacy and safety of early introduction of tree nuts for the prevention of tree nut allergy in infants with peanut allergy. Pediatr Allergy Immunol 2023; 34:e13930. [PMID: 36974653 DOI: 10.1111/pai.13930] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/22/2022] [Accepted: 02/17/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Children with peanut allergy are at increased risk of developing tree nut allergies, which can be severe and for most lifelong. Introduction of peanut in the first year of life can reduce the risk of peanut allergy; however, prevention strategies for tree nut allergies have not been established. We aimed to test the efficacy and safety of a novel strategy, a supervised multi-nut oral food challenge (OFC) compared with standard care for tree nut allergy prevention in infants at high risk of developing tree nut allergy, TreEAT. METHODS AND ANALYSIS TreEAT is a 2-armed, open-label, randomized, controlled trial (RCT). Infants (n = 212) aged 4-11 months with peanut allergy will be randomized 1:1 at peanut allergy diagnosis to either a hospital-based multi-tree nut (almond, cashew, hazelnut, and walnut) OFC using multi-nut butter or standard care (home introduction of individual tree nuts). All infants will be assessed at age 18 months, with questionnaires and SPT to peanut and tree nuts. Peanut and tree nut OFCs will be performed as required to determine the allergy status for each nut. The primary outcome is tree nut allergy at age 18 months. Secondary outcomes include peanut allergy resolution, proportion, and severity of adverse events related to tree nut ingestion, number and frequency of tree nuts ingested, quality of life and parental anxiety, and allergy-related healthcare visits from randomization to 18 months of age. Analyses will be performed on an intention-to-treat basis. ETHICS AND DISSEMINATION TreEAT was approved by the Royal Children's Hospital Human Research Ethics Committee (#70489). Outcomes will be presented at scientific conferences and disseminated through publication. TRIAL REGISTRATION NUMBER ClinicalTrials.gov ID: NCT04801823.
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Affiliation(s)
- Vicki L McWilliam
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer J Koplin
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Katie Allen
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Marnie Robinson
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Joanne Smart
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Paxton Loke
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Monash Children's Hospital, Clayton, Victoria, Australia
| | - Rachel L Peters
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Thanh Dang
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Katherine J Lee
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Clinical Epidemiology & Biostatistics Unit (CEBU), Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Melbourne Children's Trial Centre, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kim Dalziel
- Health Economics Unit, Centre for Health Policy, The University of Melbourne, Parkville, Victoria, Australia
| | - Dean Tey
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Mark Taranto
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Kirsten P Perrett
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Melbourne Children's Trial Centre, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Centre Food & Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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6
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Labrosse R, Graham F, Caubet JC. Recent advances in the diagnosis and management of tree nut and seed allergy. Curr Opin Allergy Clin Immunol 2022; 22:194-201. [DOI: 10.1097/aci.0000000000000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Akarsu A, Ocak M, Sahiner UM, Soyer O, Sekerel BE. Multiplex component-based allergen macroarray test is useful to predict clinical reactivity to tree nuts in children. Allergol Int 2022; 71:236-247. [PMID: 34755603 DOI: 10.1016/j.alit.2021.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/12/2021] [Accepted: 09/22/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In tree nut (TN) allergy, singleplex tests showed the diagnostic utility of rAna o 3, rCor a 14/nCor a 9, and nJug r 1/nJug r 4 for cashew/pistachio, hazelnut, and walnut allergies, respectively. However, disadvantages of the tests include high costs and excessive blood sampling in multi-sensitized patients, and a limited number of components. We investigated the utility of a multiplex macroarray (i.e., the ALEX2 test) in TN allergy. METHODS In 169 children, skin prick test, the component- and extract-specific IgEs of TNs were investigated for clinical reactivity and tolerance. RESULTS The predictors (AUC = 0.962-0.749) of clinical reactivity to cashew, pistachio, hazelnut, and walnut were rPis v 1/rAna o 3, rPis v 1/rAna o 3/nPis v 2/nPis v 3, rCor a 14/nCor a 11/nCor a 9, and nJug r 1/nJug r 2/nJug r 6/nJug r 4, respectively. More than 93% of the patients with clinical reactivity to pistachio/cashew, hazelnut and walnut had positivity of (≥0.3 kUA/L) rPis v 1/rAna o 3, rCor a 14 and nJug r 1/nJug r 2, respectively. The highest accuracies of clinical reactivity to culprit nut were obtained with combination of rPis v 1, sIgE and SPT positivities for cashew/pistachio, rPis v 1 ≥ 1.0 kUA/L for pistachio, rCor a 14 ≥ 1.0 kUA/L for hazelnut and combination of nJug r 1 and nJug r 2 positivities for walnut, respectively. Also, higher concentrations of rPis v 1 (≥15.0 kUA/L), rCor a 14 (≥5.0 kUA/L) and nJug r 1/nJug r 2 (≥15.0 kUA/L) had %100 specificity and PPV in predicting clinical reactivity to cashew, hazelnut and walnut, respectively. CONCLUSIONS Multiplex macroarray test is useful and reliable in the diagnosis of TN allergy in children, confirms and expands existing knowledge, and can be used as a stand-alone tool in the bottom-up diagnostic approach.
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Dang TD, Peters R, Neeland MR, Brettig T, Green H, McWilliam V, Tang MLK, Dharmage S, Ponsonby AL, Koplin J, Perrett KP. Ana o 3 sIgE testing increases the accuracy of cashew allergy diagnosis using a two-step model. Pediatr Allergy Immunol 2022; 33:e13705. [PMID: 34821421 DOI: 10.1111/pai.13705] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 10/20/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Measurement of cashew-specific IgE (sIgE) is often used to confirm sensitization but does not reliably diagnose clinical allergy. Ana o 3 is the dominant cashew allergen detected in 75-100% of patients with cashew allergy but not currently used in clinical practice. OBJECTIVES To determine if component-resolved diagnostics using specific IgE to the 2 S albumin from cashew, Ana o 3, improves the accuracy of diagnosing cashew allergy, thereby circumventing the need for an oral food challenge (OFC) in some patients. METHODS A population-based sample of 5276 children was recruited at age 1 year and followed up at age 6 years. Children with positive cashew skin prick test at age 6 underwent an OFC to clarify allergy status. Forty-seven children (mean age 5.02 ± 0.2) (33 cashew-allergic and 14 cashew-tolerant) had cashew sIgE and Ana o 3 sIgE quantified by ImmunoCAP System FEIA. RESULTS A cutoff of >0.32 kUA/L for Ana o 3 sIgE provided 95% specificity and 90% sensitivity and correctly identified 90% of clinical cashew allergy. At the same specificity, the sensitivity for cashew sIgE (>8.5 kUA/L) was only 26%. Sequential measurement of cashew sIgE followed by Ana o 3 sIgE diagnosed 90% of children with cashew allergy without the need for an OFC. CONCLUSION Ana o 3 sIgE testing provides higher diagnostic accuracy than cashew sIgE. Sequential measurement of cashew sIgE followed by Ana o 3 removed the need for a food challenge from 66% down to 12.8% (5-fold) of children compared with cashew sIgE testing alone.
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Affiliation(s)
- Thanh D Dang
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Food & Allergy Research, Melbourne, Victoria, Australia
| | - Rachel Peters
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Food & Allergy Research, Melbourne, Victoria, Australia
| | - Melanie R Neeland
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Tim Brettig
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Food & Allergy Research, Melbourne, Victoria, Australia
| | - Hayden Green
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vicki McWilliam
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Food & Allergy Research, Melbourne, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Food & Allergy Research, Melbourne, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Shyamali Dharmage
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Food & Allergy Research, Melbourne, Victoria, Australia.,The Allergy and Lung Health Unit for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia
| | - Anne-Louise Ponsonby
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Centre for Food & Allergy Research, Melbourne, Victoria, Australia.,The Allergy and Lung Health Unit for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer Koplin
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Food & Allergy Research, Melbourne, Victoria, Australia
| | - Kirsten P Perrett
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Food & Allergy Research, Melbourne, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
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Tagliati S, Barni S, Giovannini M, Liccioli G, Sarti L, Alicandro T, Paladini E, Perferi G, Azzari C, Novembre E, Mori F. Nut Allergy: Clinical and Allergological Features in Italian Children. Nutrients 2021; 13:4076. [PMID: 34836333 PMCID: PMC8623984 DOI: 10.3390/nu13114076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/11/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Nut allergies are an increasingly frequent health issue in the pediatric population. Tree nuts (TN) and peanuts are the second cause of food anaphylaxis in Italy. Unfortunately, knowledge of the clinical characteristics of a TN allergy in Italian children is limited. Our study aimed to identify the clinical and allergological characteristics of Italian children with a nut allergy (TN and peanut). METHODS A retrospective observational analysis was performed on the clinical charts of children with a history of nut reaction referred to the allergy unit of the hospital from 2015 to 2019. The studied population was represented by children with a confirmed nut allergy based on positive prick by prick and/or serum-specific IgE to nut plus a positive nut oral food challenge. Demographic, clinical, and allergological features were studied and compared among different nuts. RESULTS In total, 318 clinical charts were reviewed. Nut allergy was confirmed in 113 patients. Most patients (85/113, 75%) had a familial history of allergy and/or a concomitant allergic disorder (77/113, 68%). Hazelnut and walnut were the more common culprit nuts observed in allergic children. Anaphylaxis was the first clinical manifestation of nut allergy in a high percentage of children (54/113, 48%). The mean age of the first nut reaction was statistically higher with pine nuts. Over 75% of children reported a single nut reaction. During the OFCs, the signs and symptoms involved mainly the gastrointestinal system (82/113, 73%) and resolved spontaneously in most cases. Severe reactions were not frequent (22/113, 19%). CONCLUSION To our knowledge, this is the first Italian study that provided a comprehensive characterization of children with a nut allergy. These results are important for clinicians treating children with a nut allergy.
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Affiliation(s)
- Sylvie Tagliati
- Pediatric Unit, Sant’Anna University Hospital of Ferrara, 44124 Ferrara, Italy;
| | - Simona Barni
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (S.B.); (G.L.); (L.S.); (E.N.); (F.M.)
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (S.B.); (G.L.); (L.S.); (E.N.); (F.M.)
| | - Giulia Liccioli
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (S.B.); (G.L.); (L.S.); (E.N.); (F.M.)
| | - Lucrezia Sarti
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (S.B.); (G.L.); (L.S.); (E.N.); (F.M.)
| | - Tatiana Alicandro
- Division of Allergy and Clinical Immunology, Dermatology Unit, Surgical, Medical and Dental Department of Morphological Science Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Erika Paladini
- Pediatric Respiratory and Allergy Unit, Women’s and Children’s Health Department, University of Padua, 35128 Padua, Italy;
| | - Giancarlo Perferi
- Section of Pediatrics, Department of Health Sciences, University of Florence and Meyer Children’s Hospital, 50139 Florence, Italy; (G.P.); (C.A.)
| | - Chiara Azzari
- Section of Pediatrics, Department of Health Sciences, University of Florence and Meyer Children’s Hospital, 50139 Florence, Italy; (G.P.); (C.A.)
| | - Elio Novembre
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (S.B.); (G.L.); (L.S.); (E.N.); (F.M.)
| | - Francesca Mori
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (S.B.); (G.L.); (L.S.); (E.N.); (F.M.)
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10
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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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Hazelnut Allergy. ACTA ACUST UNITED AC 2021; 57:medicina57010067. [PMID: 33466577 PMCID: PMC7828647 DOI: 10.3390/medicina57010067] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/08/2021] [Accepted: 01/10/2021] [Indexed: 01/14/2023]
Abstract
Background and Objectives: Hazelnuts are frequently involved in IgE-mediated reactions and represent the main culprit of nut allergy in Europe. The clinical presentation varies from mild symptoms limited to the oropharynx [oral allergy syndrome (OAS)], due to the cross-reaction with homologues in pollen allergens and more severe events caused by the primary sensitization to highly stable molecules contained in hazelnuts. The aim of this review is to summarize the most relevant concepts in the field of hazelnut allergy and to provide a practical approach useful in the clinical practice Materials and Methods: References were identified by PubMed searches dating from January 2000 up to November 2020 using the search terms: “component resolved diagnosis” and “Hazelnut allergy. Results: The storage proteins Cor a 9 and Cor a 14 resulted highly specific for primary hazelnut allergy and strongly associated with severe reactions, while the cross reactive Cor a 1, an homolog of the birch Bet v1, were related to OAS. Any cut-off has shown a specificity and sensitivity pattern as high as to replace the oral food challenge (OFC), which still remains the gold standard in the diagnosis of hazelnut allergy. To date there is still no definitive treatment. Hazelnut free-diet and treatment of symptoms with emergency management, including the prescription of auto-injective epinephrine, still represent the main approach. Oral allergen immunotherapy (AIT) appears a promising therapeutic strategy and the definition of individual clinical threshold would be useful for sensitized individuals, caregivers, and physicians to reduce social limitation, anxiety, and better manage food allergy. Conclusions: An accurate diagnostic work-up including clinical history, in vivo and in vitro test including component resolved diagnosis and OFC are essential to confirm the diagnosis, to assess the risk of a severe reaction, and to prescribe an adequate diet and treatment.
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Penumarti A, Szczepanski N, Kesselring J, Gabel E, Sheth R, Berglund J, Kim EH, Burks AW, Kulis MD. Irradiated Tree Nut Flours for Use in Oral Immunotherapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:321-327. [PMID: 33217614 DOI: 10.1016/j.jaip.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Tree nut allergies affect an estimated 1% of the US population and is lifelong in 90% of allergic individuals. Oral immunotherapy (OIT) for food allergies is an effective method to induce desensitization in a majority of participants in trials of peanut, egg, and milk OIT. Limited trials using tree nut OIT have been reported, possibly due to the lack of standardized drug products. OBJECTIVE Food products used in OIT are considered drugs by the Food and Drug Administration (FDA) because they are intended to modulate the individuals' immune responses to the food allergens. As such, OIT drug products must meet FDA standards for acceptable levels of microbes and undergo testing for allergenic proteins. We aimed to determine the suitability of walnut, cashew, hazelnut, and almond flours for use in OIT trials. METHODS We employed gamma irradiation on commercially available walnut, cashew, hazelnut, and almond flours and tested their levels of microbial contamination, total protein, and allergen content, along with stability of these parameters over time. RESULTS Our results demonstrate that irradiation of tree nut flours greatly diminishes the levels of total aerobic bacteria, mold, yeast, Escherichia coli, and Salmonella, whereas there are no substantial changes in total protein or allergen content. Importantly, the microbial levels, protein, and allergen content remained stable over a 24-month period. CONCLUSION Irradiation of tree nut flours is a safe and effective method of processing to allow tree nut products to meet the FDA standards for OIT drug products.
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Affiliation(s)
- Anusha Penumarti
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of North Carolina at Chapel Hill Food Allergy Initiative, Chapel Hill, NC.
| | - Nicole Szczepanski
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of North Carolina at Chapel Hill Food Allergy Initiative, Chapel Hill, NC
| | - Janelle Kesselring
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of North Carolina at Chapel Hill Food Allergy Initiative, Chapel Hill, NC
| | - Elizabeth Gabel
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of North Carolina at Chapel Hill Food Allergy Initiative, Chapel Hill, NC
| | - Rohini Sheth
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of North Carolina at Chapel Hill Food Allergy Initiative, Chapel Hill, NC
| | - Jelena Berglund
- Duke Translational Medicine Institute, Duke University Medical Center, Durham, NC
| | - Edwin H Kim
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of North Carolina at Chapel Hill Food Allergy Initiative, Chapel Hill, NC; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - A Wesley Burks
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of North Carolina at Chapel Hill Food Allergy Initiative, Chapel Hill, NC
| | - Michael D Kulis
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of North Carolina at Chapel Hill Food Allergy Initiative, Chapel Hill, NC
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Santos AF, Bergmann M, Brough HA, Couto-Francisco N, Kwok M, Panetta V, Haddad D, Lack G, Eigenmann P, Caubet JC. Basophil Activation Test Reduces Oral Food Challenges to Nuts and Sesame. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:2016-2027.e6. [PMID: 33385591 PMCID: PMC8110244 DOI: 10.1016/j.jaip.2020.12.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Nut allergic patients are often IgE sensitized to other nuts/seeds and need multiple oral food challenges (OFCs) before the safe nuts can be introduced in the diet. However, OFCs are time-consuming and risky procedures. OBJECTIVE To assess the utility of the basophil activation test (BAT) to predict the allergic status and reduce the need for an OFC in children with 1 or more nut or seed allergies. METHODS Participants in the Pronuts study recruited at the Geneva and the London centers were tested on the BAT to hazelnut, cashew nut, sesame, almond, and peanut, Ara h 1, Ara h 2, Ara h 6, using FlowCAST, a commercially available BAT kit, and flow cytometry. RESULTS The BAT to hazelnut, cashew nut, sesame, almond, and peanut discriminated between allergic and nonallergic children, to the respective nut or seed. The optimal allergen concentration and their optimal, positive, and negative cutoffs were identified for the BAT and the other tests, for each nut and seed. Using the BAT as a second step in the diagnostic process, after equivocal skin prick test and IgE to extracts and components, reduced the number of total OFCs by 5% to 15% and positive OFCs by 33% to 75% (except for hazelnut) with 0% false-negatives and a diagnostic accuracy of 96% to 100%. CONCLUSION The BAT proved to be a useful diagnostic tool, used in a stepwise approach, to predict the allergic status and reduce the number of OFCs in the Pronuts study participants with at least 1 nut allergy willing to consume selected nuts.
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Affiliation(s)
- Alexandra F Santos
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom; Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.
| | - Marcel Bergmann
- Pediatric Allergy Unit, Department of Pediatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Helen A Brough
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Natália Couto-Francisco
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Matthew Kwok
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Valentina Panetta
- L'altrastatistica srl, Consultancy & Training, Biostatistics Office, Rome, Italy
| | - Diab Haddad
- Department of Pediatrics, St Peters' Hospital, London, United Kingdom
| | - Gideon Lack
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom; Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Philippe Eigenmann
- Pediatric Allergy Unit, Department of Pediatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Jean-Christoph Caubet
- Pediatric Allergy Unit, Department of Pediatrics, University Hospitals of Geneva, Geneva, Switzerland
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Muthukumar J, Selvasekaran P, Lokanadham M, Chidambaram R. Food and food products associated with food allergy and food intolerance – An overview. Food Res Int 2020; 138:109780. [DOI: 10.1016/j.foodres.2020.109780] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 02/07/2023]
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Abstract
Food allergy is a significant public health concern, with a rising prevalence. Elimination diets remain the cornerstone of food allergy management, and they are not without nutritional risk. Children who avoid nutritionally important foods, such as milk or multiple foods allergens, may be at greater risk. Even adults with food allergies may encounter challenges to meet current recommended dietary guidelines for health and reduced risk of chronic disease. The type of food allergy disorder will also impact nutritional risk. A food allergy affects food choices, nutritional intake, and health; therefore, guidance to provide nutritionally appropriate substitutes within the context of the elimination diet is invaluable.
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Affiliation(s)
- Marion Groetch
- From the Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, New York, and
| | - Carina Venter
- From the Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, New York, and
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16
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Akarsu A, Soyer O, Sahiner UM, Valenta R, Sekerel BE. Improving the diagnostic utility of lip dose challenges to diagnose tree nut allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:534-536.e2. [PMID: 32947027 DOI: 10.1016/j.jaip.2020.08.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/20/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Aysegul Akarsu
- Division of Allergy and Asthma, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ozge Soyer
- Division of Allergy and Asthma, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Umit Murat Sahiner
- Division of Allergy and Asthma, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Rudolf Valenta
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria; Laboratory for Molecular Allergology, NRC Institute of Immunology FMBA of Russia, Moscow, Russia; Laboratory for Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia; Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Bulent Enis Sekerel
- Division of Allergy and Asthma, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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17
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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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18
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Echeverría-Zudaire LÁ. TREE NUTS ALLERGY: Knowledge, gaps and practical implications. Allergol Immunopathol (Madr) 2020; 48:313-315. [PMID: 32616197 DOI: 10.1016/j.aller.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
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Eiwegger T, Hung L, San Diego KE, O'Mahony L, Upton J. Recent developments and highlights in food allergy. Allergy 2019; 74:2355-2367. [PMID: 31593325 DOI: 10.1111/all.14082] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 02/06/2023]
Abstract
The achievement of long-lasting, safe treatments for food allergy is dependent on the understanding of the immunological basis of food allergy. Accurate diagnosis is essential for management. In recent years, data from oral food challenges have revealed that routine allergy testing is poor at predicting clinical allergy for tree nuts, almonds in particular. More advanced antigen-based tests including component-resolved diagnostics and epitope reactivity may lead to more accurate diagnosis and selection of therapeutic intervention. Additional diagnostic accuracy may come from cellular tests such as the basophil activation test or mast cell approaches. In the context of clinical trials, cellular tests have revealed specific T-cell and B-cell populations that are more abundant in food-allergic individuals with distinct mechanistic features. Awareness of clinical markers, such as the ability to eat baked forms of milk and egg, continues to inform the understanding of natural tolerance development. Mouse models have allowed for investigation into multiple mechanisms of food allergy including modification of epithelial metabolism, and the induction of regulatory cell subsets and the microbiome. Increasing numbers of children who underwent food immunotherapy enlarged the body of evidence on mechanisms and predictors of treatment success. Experimental immunological markers in conjunction with clinical determinants such as lower age and lower initial specific IgE appear to be of benefit. More research on the optimal dose, preparation, and route of application integrating a high-level safety and efficacy is demanded. Alternatively, biologics blocking TSLP, IL-33, IL-4 and IL-13, or IgE may help to achieve that.
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Affiliation(s)
- Thomas Eiwegger
- Translational Medicine Program Research Institute Hospital for Sick Children Toronto ON Canada
- Department of Immunology University of Toronto Toronto ON Canada
- Division of Immunology and Allergy Food Allergy and Anaphylaxis Program Departments of Paediatrics The Hospital for Sick Children University of Toronto Toronto ON Canada
| | - Lisa Hung
- Translational Medicine Program Research Institute Hospital for Sick Children Toronto ON Canada
- Department of Immunology University of Toronto Toronto ON Canada
| | | | - Liam O'Mahony
- Departments of Medicine and Microbiology APC Microbiome Ireland National University of Ireland Cork Ireland
| | - Julia Upton
- Translational Medicine Program Research Institute Hospital for Sick Children Toronto ON Canada
- Division of Immunology and Allergy Food Allergy and Anaphylaxis Program Departments of Paediatrics The Hospital for Sick Children University of Toronto Toronto ON Canada
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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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Ana o 3-specific IgE is a predictive marker for cashew oral food challenge failure. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2909-2911.e4. [PMID: 31108216 DOI: 10.1016/j.jaip.2019.04.049] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/17/2019] [Accepted: 04/29/2019] [Indexed: 01/22/2023]
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22
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D'Auria E, Abrahams M, Zuccotti GV, Venter C. Personalized Nutrition Approach in Food Allergy: Is It Prime Time Yet? Nutrients 2019; 11:E359. [PMID: 30744105 PMCID: PMC6412250 DOI: 10.3390/nu11020359] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/03/2019] [Accepted: 02/05/2019] [Indexed: 02/06/2023] Open
Abstract
The prevalence of food allergy appears to be steadily increasing in infants and young children. One of the major challenges of modern clinical nutrition is the implementation of individualized nutritional recommendations. The management of food allergy (FA) has seen major changes in recent years. While strict allergen avoidance is still the key treatment principle, it is increasingly clear that the avoidance diet should be tailored according to the patient FA phenotype. Furthermore, new insights into the gut microbiome and immune system explain the rising interest in tolerance induction and immunomodulation by microbiota-targeted dietary intervention. This review article focuses on the nutritional management of IgE mediated food allergy, mainly focusing on different aspects of the avoidance diet. A personalized approach to managing the food allergic individual is becoming more feasible as we are learning more about diagnostic modalities and allergic phenotypes. However, some unmet needs should be addressed to fully attain this goal.
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Affiliation(s)
- Enza D'Auria
- Department of Pediatrics, Children's Hospital V. Buzzi, University of Milan, Milan 20154, Italy.
| | - Mariette Abrahams
- Faculty of Social Sciences, University of Bradford, Bradford BD7 1DP, UK.
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Children's Hospital V. Buzzi, University of Milan, Milan 20154, Italy.
| | - Carina Venter
- Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado, Aurora, CO 80045, USA.
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Managing Cross-Reactivity in Those with Peanut Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:381-386. [DOI: 10.1016/j.jaip.2018.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 11/18/2022]
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Patterns of tree nut sensitization and allergy in the first 6 years of life in a population-based cohort. J Allergy Clin Immunol 2019; 143:644-650.e5. [DOI: 10.1016/j.jaci.2018.07.038] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/28/2018] [Accepted: 07/10/2018] [Indexed: 01/29/2023]
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25
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Wang J, Lack G. Food Allergy: Unmet Needs and New Perspectives. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 5:295. [PMID: 28283155 DOI: 10.1016/j.jaip.2017.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 01/14/2023]
Affiliation(s)
- Julie Wang
- Pediatric Allergy & Immunology, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Gideon Lack
- Department of Paediatric Allergy, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Division of Asthma, Allergy and Lung Biology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
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26
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Li PH, Rutkowski K, Kennard L, Sellaturay P, Watts TJ, Haque R, Wagner A. Challenge-confirmed peanut allergy in older patients: Performance of skin tests, specific immunoglobulin E, and ara h 2. Ann Allergy Asthma Immunol 2018; 120:334-335. [PMID: 29508723 DOI: 10.1016/j.anai.2017.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/15/2017] [Accepted: 12/20/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Philip H Li
- Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Krzysztof Rutkowski
- Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Lucinda Kennard
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Priya Sellaturay
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Timothy J Watts
- Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Rubaiyat Haque
- Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Annette Wagner
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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27
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Dantzer JA, Wood RA. The impact of tree nut oral food challenges on quality of life and acute reactions in nut allergic patients. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:698-700.e1. [PMID: 30312806 DOI: 10.1016/j.jaip.2018.09.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 09/20/2018] [Accepted: 09/25/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Jennifer A Dantzer
- Division of Allergy & Immunology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Robert A Wood
- Division of Allergy & Immunology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
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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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29
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Oh JW. Is There Any Necessity to Prescribe Consumption of Walnuts Cooked by Different Processing Techniques to Patients With Walnut Allergy? ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2018; 10:287-289. [PMID: 29949828 PMCID: PMC6021589 DOI: 10.4168/aair.2018.10.4.287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 04/09/2018] [Indexed: 11/26/2022]
Abstract
The present study focused on identifying the usual methods of cooking walnuts in order to investigate changes in walnut allergen activity caused by cooking and evaluated the allergenic changes in walnut proteins within raw, dry-fried and boiled walnuts. Previous studies have reported a decrease in the allergen activity of walnut by thermal processing methods, which are not used in Korean kitchens, such as dry-frying and boiling. In Korea, Walnuts are consumed with rice and usually boiled and stir-fried with seasoning. Thus, the present study clarified the protein bands corresponding to raw walnuts and confirmed that the patterns of each walnut protein differ depending on cooking methods. This concern may be a very crucial point to understand the other tree nuts allergy as well as walnut allergy. The results of the present study differ from those of previous studies performed in Europe, although further studies with older participants are needed in order to draw more definite conclusions on lipid transfer protein (LTP). The other crucial point is that the findings of the present study support existing findings that the allergenic components of walnut have varying antigenicity depending on cooking methods. The allergenic components of walnut identified using diagnostic tests for walnut allergic patients could be reduced in walnuts cooked by different processing techniques. The allergenic components of walnut have varying allergen activity depending on cooking methods. Therefore, the allergenic components of walnuts identified using diagnostic tests for walnut allergic patients could allow physicians to prescribe consumption of walnuts cooked by different processing techniques to patients with walnut allergy.
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Affiliation(s)
- Jae Won Oh
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
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30
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Jimenez-Rodriguez TW, Garcia-Neuer M, Alenazy LA, Castells M. Anaphylaxis in the 21st century: phenotypes, endotypes, and biomarkers. J Asthma Allergy 2018; 11:121-142. [PMID: 29950872 PMCID: PMC6016596 DOI: 10.2147/jaa.s159411] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Anaphylaxis is the most serious of all allergic reactions and can be fatal. The diagnosis is frequently delayed, and misdiagnosis often occurs with asthma or urticaria. Biomarkers such as tryptase are not routinely checked, and appropriate treatment with epinephrine is not administered in a majority of cases, increasing the risk of poor outcomes. The objective of this review is to provide a better understanding of the pathophysiology of anaphylaxis with a description of phenotypes, endotypes, and biomarkers available in both the clinical and research settings. Expanding knowledge with regard to the presentation, causes, and triggers for anaphylaxis among health care providers will improve its diagnosis and management, increase patient safety, and decrease morbidity and mortality.
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Affiliation(s)
- Teodorikez Wilfox Jimenez-Rodriguez
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Allergy Section, Alicante General University Hospital, Alicante, Spain
- PhD Program in Public Health, Medical and Surgical Sciences, Miguel Hernandez University, Alicante, Spain
| | - Marlene Garcia-Neuer
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Leila A Alenazy
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mariana Castells
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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31
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Application of precision medicine to the treatment of anaphylaxis. Curr Opin Allergy Clin Immunol 2018; 18:190-197. [DOI: 10.1097/aci.0000000000000435] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Deschildre A, Lejeune S, Cap M, Flammarion S, Jouannic L, Amat F, Just J. Food allergy phenotypes: The key to personalized therapy. Clin Exp Allergy 2018; 47:1125-1137. [PMID: 28710890 DOI: 10.1111/cea.12984] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Food allergies (FAs) are of increasing public health concern and are characterized by a large spectrum of diseases. Their diversity is well known for immunologic pathways (IgE, non-IgE-mediated FAs) and natural history. Many other factors and patient characteristics are involved including type of food, exposure route, allergic comorbidities, gender, racial and ethnic backgrounds, cofactors and health conditions. Food allergen components and sensitization profiles are also involved in FA phenotypes. A new approach to chronic disorders based on the identification of phenotypes through extensive knowledge of all the complex components is also applicable to FAs and could lead towards integrative care management. Diagnostic biomarkers for FAs are emerging which also contribute to better care modalities. The aim of this article was to highlight current knowledge regarding the phenotypic diversity of FA. This review will focus on IgE-mediated FAs and how identifying phenotypes may help to better understand the pathophysiological complexity, improve diagnosis and lead to personalized treatment strategies.
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Affiliation(s)
- A Deschildre
- CHU Lille, Pediatric Pulmonology and Allergy unit, Hôpital Jeanne de Flandre, Université Nord de France, Lille, France
| | - S Lejeune
- CHU Lille, Pediatric Pulmonology and Allergy unit, Hôpital Jeanne de Flandre, Université Nord de France, Lille, France
| | - M Cap
- CHU Lille, Pediatric Pulmonology and Allergy unit, Hôpital Jeanne de Flandre, Université Nord de France, Lille, France
| | - S Flammarion
- CHU Lille, Pediatric Pulmonology and Allergy unit, Hôpital Jeanne de Flandre, Université Nord de France, Lille, France
| | - L Jouannic
- Nutrition Department, CHU Lille, Hôpital Jeanne de Flandre, Lille, France
| | - F Amat
- Asthma and Allergy Center, Hôpital d'Enfants Armand, Sorbonne Universités, UPMC Univ Paris 06 - Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - J Just
- Asthma and Allergy Center, Hôpital d'Enfants Armand, Sorbonne Universités, UPMC Univ Paris 06 - Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
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33
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Abrams EM, Chan ES. Potential Pitfalls in Applying Screening Criteria in Infants at Risk of Peanut Allergy. J Pediatr 2018; 195:269-274. [PMID: 29352591 DOI: 10.1016/j.jpeds.2017.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 11/01/2017] [Accepted: 12/04/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
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34
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Schatz M, Sicherer SH, Zeiger RS. The Journal of Allergy and Clinical Immunology: In Practice 2017 Year in Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:328-352. [PMID: 29397373 DOI: 10.1016/j.jaip.2017.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 12/19/2017] [Indexed: 12/29/2022]
Abstract
An impressive number of clinically impactful studies and reviews were published in The Journal of Allergy and Clinical Immunology: In Practice in 2017. As a service to our readers, the editors provide this Year in Review article to highlight and contextualize the advances published over the past year. We include information from articles on asthma, allergic rhinitis, rhinosinusitis, immunotherapy, atopic dermatitis, contact dermatitis, food allergy, anaphylaxis, drug hypersensitivity, urticarial/angioedema, eosinophilic disorders, and immunodeficiency. Within each topic, epidemiologic findings are presented, relevant aspects of prevention are described, and diagnostic and therapeutic advances are enumerated. Treatments discussed include behavioral therapy, allergen avoidance therapy, positive and negative effects of pharmacologic therapy, and various forms of immunologic and desensitization management. We hope this review will help readers consolidate and use this extensive and practical knowledge for the benefit of patients.
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Affiliation(s)
- Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif.
| | - Scott H Sicherer
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif
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35
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Venter C, Groetch M, Netting M, Meyer R. A patient-specific approach to develop an exclusion diet to manage food allergy in infants and children. Clin Exp Allergy 2018; 48:121-137. [DOI: 10.1111/cea.13087] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 12/19/2022]
Affiliation(s)
- C. Venter
- Children's Hospital Colorado; University of Colorado; Aurora CO USA
| | - M. Groetch
- Icahn School of Medicine at Mount Sinai; Jaffe Food Allergy Institute; New York NY USA
| | - M. Netting
- Healthy Mothers Babies and Children's Theme; South Australian Health & Medical Research Institute; Adelaide SA Australia
- Discipline of Paediatrics; School of Medicine; University of Adelaide; Adelaide SA Australia
- Nutrition Department; Women's and Children's Health Network; Adelaide SA Australia
| | - R. Meyer
- Department Paediatrics; Imperial College; London UK
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36
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Effects of the Varietal Diversity and the Thermal Treatment on the Protein Profile of Peanuts and Hazelnuts. J FOOD QUALITY 2018. [DOI: 10.1155/2018/7635957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Several buffer compositions were compared for their efficiency in protein extraction from both raw and roasted peanut and hazelnut samples, the final goal being to understand the modification of protein solubility upon roasting and maximize the extraction yield. Denaturant conditions provided by urea-TBS buffer resulted in satisfactory extraction yields for both peanut and hazelnut samples, before and after the thermal treatment. In addition, different varieties of peanuts and hazelnuts were characterized to highlight the extent of variability in the protein profile accounted by the varietal factor and eventual differential resistance among cultivars to protein modification induced by the thermal processing. The protein profile was characterized by gel electrophoresis, and specific bands were analyzed by micro-HPLC-MS/MS coupled to software-based protein identification. No significant difference was observed for the investigated hazelnut cultivars, namely, Campana, Romana, and Georgia, whereas interesting features were presented for the peanut varieties Virginia, Zambia, and China. In particular, Zambia variety lacked two bands of approximately 36 and 24 kDa that were visible in Virginia and China varieties, which could suggest a lower allergenic potential of this particular variety which deserves to be further investigated before drawing final conclusions.
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37
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Planque M, Arnould T, Dieu M, Delahaut P, Renard P, Gillard N. Liquid chromatography coupled to tandem mass spectrometry for detecting ten allergens in complex and incurred foodstuffs. J Chromatogr A 2017; 1530:138-151. [PMID: 29169644 DOI: 10.1016/j.chroma.2017.11.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/06/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022]
Abstract
Food allergy is a considerable heath problem, as undesirable contaminations by allergens during food production are still widespread and may be dangerous for human health. To protect the population, laboratories need to develop reliable analytical methods in order to detect allergens in various food products. Currently, a large majority of allergen-related food recalls concern bakery products. It is therefore essential to detect allergens in unprocessed and processed foodstuffs. In this study, we developed a method for detecting ten allergens in complex (chocolate, ice cream) and processed (cookie, sauce) foodstuffs, based on ultra-high performance liquid chromatography coupled to tandem mass spectrometry (UHPLC-MS/MS). Using a single protocol and considering a signal-to-noise ratio higher than 10 for the most abundant multiple reaction monitoring (MRM) transition, we were able to detect target allergens at 0.5mg/kg for milk proteins, 2.5mg/kg for peanut, hazelnut, pistachio, and cashew proteins, 3mg/kg for egg proteins, and 5mg/kg for soy, almond, walnut, and pecan proteins. The ability of the method to detect 10 allergens with a single protocol in complex and incurred food products makes it an attractive alternative to the ELISA method for routine laboratories.
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Affiliation(s)
- M Planque
- CER Groupe, Health Department, Rue du Point du Jour, 8, 6900 Marloie, Belgium; Laboratory of Biochemistry and Cell Biology (URBC)-Namur Research Institute for Life Sciences (NARILIS), University of Namur, 61, rue de Bruxelles, 5000 Namur, Belgium
| | - T Arnould
- Laboratory of Biochemistry and Cell Biology (URBC)-Namur Research Institute for Life Sciences (NARILIS), University of Namur, 61, rue de Bruxelles, 5000 Namur, Belgium
| | - M Dieu
- Laboratory of Biochemistry and Cell Biology (URBC)-Namur Research Institute for Life Sciences (NARILIS), University of Namur, 61, rue de Bruxelles, 5000 Namur, Belgium
| | - P Delahaut
- CER Groupe, Health Department, Rue du Point du Jour, 8, 6900 Marloie, Belgium
| | - P Renard
- Laboratory of Biochemistry and Cell Biology (URBC)-Namur Research Institute for Life Sciences (NARILIS), University of Namur, 61, rue de Bruxelles, 5000 Namur, Belgium
| | - N Gillard
- CER Groupe, Health Department, Rue du Point du Jour, 8, 6900 Marloie, Belgium.
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38
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Castells M. Diagnosis and management of anaphylaxis in precision medicine. J Allergy Clin Immunol 2017; 140:321-333. [PMID: 28780940 DOI: 10.1016/j.jaci.2017.06.012] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 06/28/2017] [Accepted: 06/29/2017] [Indexed: 12/18/2022]
Abstract
Anaphylaxis is the most severe and frightening of the allergic reactions, placing patients at high risk and demanding prompt recognition and immediate management by health care providers. Yet because its symptoms imitate those of other diseases, such as asthma and urticaria, current data suggest that its diagnosis is often missed, with underuse of tryptase measurement; its treatment is delayed, with little use of epinephrine; and its underlying cause or causes are poorly investigated. Deaths from anaphylaxis are difficult to investigate because of miscoding. Surprisingly, patients treated with new and powerful chemotherapy agents and humanized mAbs present with nonclassical symptoms of anaphylaxis, and patients may present with unrecognized clonal mast cell disorders with KIT mutations may present as Hymenoptera-induced or idiopathic anaphylaxis. The goal of this review is to recognize the presentations of anaphylaxis with the description of its current phenotypes, to provide new insight and understanding of its mechanisms and causes through its endotypes, and to address its biomarkers for broad clinical use. Ultimately, the aim is to empower allergists and heath care providers with new tools that can help alleviate patients' symptoms, preventing and protecting them against anaphylaxis.
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Affiliation(s)
- Mariana Castells
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
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39
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Sato S, Yamamoto M, Yanagida N, Ito K, Ohya Y, Imai T, Nagao M, Borres MP, Movérare R, Ebisawa M. Jug r 1 sensitization is important in walnut-allergic children and youth. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:1784-1786.e1. [PMID: 28552380 DOI: 10.1016/j.jaip.2017.04.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/09/2017] [Accepted: 04/17/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Sakura Sato
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - Mikita Yamamoto
- Department of Pediatrics, Sagamihara National Hospital, Kanagawa, Japan
| | - Noriyuki Yanagida
- Department of Pediatrics, Sagamihara National Hospital, Kanagawa, Japan
| | - Komei Ito
- Department of Allergy, Aichi Children's Health and Medical Center, Obu, Japan
| | - Yukihiro Ohya
- Department of Allergy, National Center for Child Health and Development, Tokyo, Japan
| | - Takanori Imai
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Mizuho Nagao
- Institute for Clinical Research, Mie National Hospital, Mie, Japan
| | - Magnus P Borres
- Thermo Fisher Scientific, Uppsala, Sweden; Department of Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Robert Movérare
- Thermo Fisher Scientific, Uppsala, Sweden; Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan.
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