1
|
Bosco A, Altea V, Beretta P, Cacace R, Fanos V, Dessì A. Metabolomics in Children Cow's Milk Protein Allergy: Possible Contribution from a System Biology Approach? CHILDREN (BASEL, SWITZERLAND) 2024; 11:562. [PMID: 38790557 PMCID: PMC11120097 DOI: 10.3390/children11050562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/03/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024]
Abstract
One of the most frequent triggers of food anaphylaxis in pediatric age but also among the most common, early, and complex causes of childhood food allergy is cow's milk protein allergy (CMPA). The diagnostic course and management of this allergy is defined in a complex clinical picture due to several factors. First of all, the epidemiological data are not uniform, mainly as a consequence of the diagnostic methodology used in the various studies and the different age ranges covered. In addition, there is the complexity of terminology, since although CMPA traditionally refers to immune-mediated reactions to cow's milk, it is a term encompassing numerous clinical features with different symptoms and the requirement for specific treatments. Moreover, the differential diagnosis with other very frequent diseases, especially in the first year of life, such as gastro-esophageal reflux disease or colic, is still complex. This can result in misdiagnosis and incorrect treatment, with harmful health consequences and significant economic repercussions. In this context, the combination of several omics sciences together, which have already proved useful in clarifying the allergenicity of cow's milk proteins with greater precision, could improve the diagnostic tests currently in use through the identification of new, more specific, and precise biomarkers that make it possible to improve diagnostic accuracy and predict the patient's response to the various available treatments for the recovery of tolerance.
Collapse
Affiliation(s)
| | | | | | | | - Vassilios Fanos
- Department of Surgical Sciences, University of Cagliari and Neonatal Intensive Care Unit, AOU Cagliari, 09124 Cagliari, Italy; (A.B.); (V.A.); (P.B.); (R.C.); (A.D.)
| | | |
Collapse
|
2
|
Paquete AT, Martins R, Connolly MP, Meulle M, Pastor N, Benoist G, Tounian P. Cost-effectiveness of infant hypoallergenic formulas to manage cow's milk protein allergy in France. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2022; 11:2154418. [PMID: 36518150 PMCID: PMC9744214 DOI: 10.1080/20016689.2022.2154418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Clinician's choice of hypoallergenic formulas in the first-line management of cow's milk protein allergy (CMPA) should be informed by evidence on clinical efficacy and cost-effectiveness. OBJECTIVE We compare the cost-effectiveness of amino acid-based formula (AAF), extensively hydrolyzed casein formula with Lactobacillus rhamnosus Gorbach Goldin (EHCF+LGG), extensively hydrolyzed whey formula (EHWF), and rice hydrolyzed formula (RHF) in non-breastfed children in France. METHODS Immunotolerance and atopic manifestations' prevalence were based on a prospective non-randomized study with a 36-month follow-up. Resource utilization was sourced from a survey of French clinicians, and unit costs were based on national data. Costs and health consequences were discounted at 2.5% annually. Results were reported using the Collective and French National Health Insurance perspectives. RESULTS Children receiving EHCF+LGG were predicted to require less healthcare resources, given their reduced prevalence of CMPA symptoms at 3 years. In the base case, EHCF+LGG led to savings of at least €674 per child compared to AAF, EHWF, and RHF at 3 years, from both perspectives. Nutrition had the highest economic burden in CMPA, driven by hypoallergenic formulas and dietetic replacements costs. Results were robust to one-way and probabilistic sensitivity analyses. CONCLUSIONS EHCF+LGG was associated with more symptom-free time, higher immune tolerance, and lower costs.
Collapse
Affiliation(s)
- Ana Teresa Paquete
- Health Economics Unit, Health Economics Consultants, Global Market Access Solutions, St-Prex, Switzerland
| | - Rui Martins
- Health Economics Unit, Health Economics Consultants, Global Market Access Solutions, St-Prex, Switzerland
- Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Mark P. Connolly
- Health Economics Unit, Health Economics Consultants, Global Market Access Solutions, St-Prex, Switzerland
- Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Marie Meulle
- Benckiser Healthcare France, Reckitt Benckiser, Paris, France
| | - Nítida Pastor
- Medical and Scientific Affairs, Nutrition, Reckitt Benckiser, 47721, Evansville, IN, USA
| | - Grégoire Benoist
- Department of Pediatrics, CHU Ambroise Paré, APHP, 92100, Boulogne-Billancourt, France
| | - Patrick Tounian
- Pediatric Nutrition and Gastroenterology Department, Trousseau hospital, APHP, Sorbonne University, Paris, France
| |
Collapse
|
3
|
Paquete AT, Martins R, Connolly MP, Hegar B, Munasir Z, Stephanus S. Managing Cow's Milk Protein Allergy in Indonesia: A Cost-effectiveness Analysis of Hypoallergenic Milk Formulas from the Private Payers' Perspective. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2022; 9:77-85. [PMID: 36168595 PMCID: PMC9452772 DOI: 10.36469/001c.36407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/13/2022] [Indexed: 06/16/2023]
Abstract
Background: Cow's milk protein allergy is very common in early childhood. Extensively hydrolyzed formulas are recommended in the first-line management of cow's milk protein allergy in non-breastfed children. Choice of formulas should be informed by efficacy and cost data. Objectives: This study aims to compare the cost-effectiveness of extensively hydrolyzed casein formula with Lacticaseibacillus rhamnosus Gorbach Goldin (EHCF+LGG), extensively hydrolyzed whey formula (EHWF), amino acid formula, and soy formula in the first-line management of cow's milk protein allergy in non-breastfed children in Indonesia. Methods: A trial-based decision analytic cohort model was adapted to simulate the occurrence of cow's milk protein allergy symptoms or being symptom free. The model was based on a prospective nonrandomized study that followed up children for 36 months. Costs and health consequences were discounted at 3% annually. Resources required to manage cow's milk protein allergy and unit costs for clinical appointments and exams were based on a panel of 15 clinicians, from a private payers' perspective. Other unit costs were based on publicly available national data. Results were reported as cost per additional child free from allergic manifestations or per additional immunotolerant child at 3 years, and per life-years under the same conditions. Uncertainty was assessed using deterministic and probabilistic sensitivity analysis. Results: Children receiving EHCF+LGG were associated with more symptom-free time, a higher probability of cow's milk tolerance at 3 years, and lower healthcare resources and transportation use when compared with children receiving other formulas (with 38%-49% lower costs). Formula costs were lower for soy, but EHCF+LGG was predicted to save 9% and 54% of overall costs compared with extensively hydrolyzed whey formula and amino acid formula, respectively. Results were robust to sensitivity analyses. Conclusion: Use of EHCF+LGG resulted in more symptom-free time and the highest 3-year probability of cow's milk tolerance. It also led to healthcare resource and transportation savings when compared with other hypoallergenic milk formulas. Soy formula remained an alternative if formula price represents a major constraint.
Collapse
Affiliation(s)
| | - Rui Martins
- Global Market Access Solutions, St-Prex, Switzerland
| | | | - Badriul Hegar
- Department of Pediatrics, Faculty of Medicine, University of Indonesia
| | - Zakiudin Munasir
- Division of Allergy and Clinical Immunology, Faculty of Medicine, University of Indonesia
| | | |
Collapse
|
4
|
Bisdemethoxycurcumin attenuates OVA‑induced food allergy by inhibiting the MAPK and NF‑κB signaling pathways. Exp Ther Med 2022; 23:401. [PMID: 35619631 PMCID: PMC9115631 DOI: 10.3892/etm.2022.11328] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 02/01/2022] [Indexed: 11/08/2022] Open
Abstract
Bisdemethoxycurcumin (BDMC) is an important ingredient derived from turmeric in addition to curcumin. It has been reported that BDMC can be used to treat mast cell-mediated allergic diseases. In the present study, a food allergy (FA) murine model sensitized by intraperitoneal injection followed by oral challenge with ovalbumin (OVA) was established. BDMC was orally administered at 100 and 200 mg/kg for 11 days in the challenge phase to treat OVA-induced FA mice. FA symptoms such as diarrhea score, anaphylactic symptom score and rectal temperature were recorded. Intestinal tissue was also observed by hematoxylin and eosin staining. In addition, other allergic indicators were also analyzed by ELISA and western blot analysis. The present study demonstrated that BDMC could suppress the decreases in rectal temperature, diarrhea and anaphylactic symptoms in FA mice. BDMC could also ameliorate the inflammation of intestinal tissues in FA mice. BDMC not only decreased the production of OVA-specific immunoglobulin (OVA-sIg)E, IgG1, histamine, mouse mast cell protease-1, diamine oxidase, cytokines (IL-4, IL-5 and IL-13) but increased cytokines interferon-γ production. The protein expression results showed that the levels of Gata-3 were decreased but T-bet levels were increased. Furthermore, compared with the OVA group, phosphorylated (p)-p38, p-JNK, p-ERK and p-NF-κBp65 levels were decreased and p-IκBα level was increased. In conclusion, the results showed that BDMC possessed a protective effect on FA. Furthermore, BDMC was able to regulate the T-helper cells (Th)1/Th2 immune balance and inhibit the activation of MAPK and NF-κB pathways in FA mice.
Collapse
|
5
|
Identification of significant potential signaling pathways and differentially expressed proteins in patients with wheat intolerance based on quantitative proteomics. J Proteomics 2021; 246:104317. [PMID: 34217887 DOI: 10.1016/j.jprot.2021.104317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/18/2021] [Accepted: 06/28/2021] [Indexed: 11/24/2022]
Abstract
Wheat intolerance has various systemic manifestations that can affect people's quality of life, and few studies have focused on the mechanism of wheat intolerance and the signaling pathways involved in wheat intolerance have not been fully identified. We compared the protein profiles of patients with wheat intolerance with those of healthy controls using LASSO (least absolute shrinkage and selection operator) and PLS (partial least squares regression) to obtain DEPs (differentially expressed proteins) for GO (Gene Ontology) analysis, KEGG (Kyoto Encyclopedia of Genes and Genomes) pathway enrichment analysis, and PPI (protein-protein interaction) network analysis. Internal validation and external validation were conducted for target proteomics testing. The correlation between differently expressed protein and the wheat-specific IgG antibody concentration was analyzed. Then ROC curve (receiver operating characteristic curve) was generated to validate the differentially expressed proteins. We identified 33 DEPs as significant candidate proteins of wheat intolerance. These proteins were mainly enriched in complement and coagulation cascade pathways, immune activation, and immune response-related pathways. After internal and external target proteomics validation, CFHR3 (complement factor H-related protein 3) was identified as a key protein that may have an important role in wheat intolerance. We found CFHR3 protein expression abundance and the wheat-specific IgG antibody concentration were significantly negatively correlated (P = 0.035; Spearman correlation coefficient r = -0.565). The AUC (median area under the ROC curve) of CFHR3 is 0.857 in external verification data. This study provides insights into wheat intolerance that can be used to further explore the pathogenesis of this condition. SIGNIFICANCE: Proteomics has performed important potential in food allergy research and is conducive to improving our comprehension on molecular mechanisms of food allergy. The present study identified significant signaling pathways and differentially expressed proteins in patients with wheat intolerance by means of bioinformatics from the viewpoint of mass spectrometry-based proteomics, which provided insights into further research on the pathogenesis and timely diagnosis of wheat intolerance.
Collapse
|
6
|
Xepapadaki P, Christopoulou G, Stavroulakis G, Freidl R, Linhart B, Zuidmeer L, Lakoumentas J, van Ree R, Valenta R, Papadopoulos NG. Natural History of IgE-Mediated Fish Allergy in Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3147-3156.e5. [PMID: 33866031 DOI: 10.1016/j.jaip.2021.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Fish allergy is not uncommon, especially in countries with high fish consumption, it can frequently be severe and may affect dietetic and lifestyle choices. Nevertheless, data on its clinical course and natural history are scarce. OBJECTIVE To describe the natural history of immunoglobulin E-mediated fish allergy and the potential differential reactivity to various fish species and identify prognostic markers in children with confirmed disease. METHODS Clinical history, specific immunoglobulin E, and skin prick tests to various fish were recorded in 126 children with confirmed immunoglobulin E-mediated fish allergy. Immunoglobulin E reactivity was also evaluated by immunoblotting. Eligible participants proceeded to a series of food challenges to tuna, swordfish, and codfish. In total, 234 challenges were performed. RESULTS Fifty-eight children (9.7 ± 3.9 years) were included in the analysis. Age at first reaction was 0.5 to 5 years (median, 1.3 years). Thirteen children (22%) tolerated all fish tested, including cod, 1 to 14 years (mean, 8.2 ± 4.2 years) following their first reported reaction. Complete fish tolerance increased with age, ranging from 3.4% in preschool children to over 45% in adolescents (95% confidence interval, 26.3%-79.7%). Most children were able to tolerate swordfish (94%) and tuna (95%). Prechallenge specific immunoglobulin E to cod greater than 4.87 kUA/L was the best positive predictive marker for fish allergy persistence (94%), followed by skin prick tests to sardine greater than 6.5 mm (92%). CONCLUSIONS A considerable proportion of fish-allergic children develop tolerance around adolescence. Most fish-allergic children can consume tuna and swordfish, which, thus, provide safe alternatives for a balanced diet.
Collapse
Affiliation(s)
- Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Christopoulou
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - George Stavroulakis
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Raphaela Freidl
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Birgit Linhart
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Laurian Zuidmeer
- Department of Experimental Immunology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - John Lakoumentas
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Ronald van Ree
- Department of Experimental Immunology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands; Department of Otorhinolaryngology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Rudolf Valenta
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria; NRC Institute of Immunology FMBA of Russia; Laboratory for Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First, Moscow State Medical University, 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
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece; Division of Infection, Immunity, and Respiratory Medicine, The University of Manchester, Manchester, United Kingdom.
| |
Collapse
|
7
|
Horino S, Uneoka K, Nihei M, Aki H, Miura K. Home-based, slow up-dosing oral immunotherapy for hen's egg allergy in an adult patient. Asia Pac Allergy 2021; 11:e2. [PMID: 33604272 PMCID: PMC7870370 DOI: 10.5415/apallergy.2021.11.e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/11/2021] [Indexed: 11/18/2022] Open
Abstract
Standard therapy for food allergies involves avoiding causative foods until a patient has outgrown their allergies. Oral immunotherapy (OIT) is an optional treatment for children unlikely to outgrow their food allergy. However, information about OIT in adult patients with food allergies is very limited. We present a case of severe hen's egg allergy (HEA) in an adult who tried home-based, slow up-dosing OIT, reported to have been tolerable and effective in children. A 20-year-old woman with HEA experienced repeated anaphylaxis since childhood when she consumed a small quantity of hen's egg, so she completely avoided hen's eggs. She underwent inpatient oral food challenge (OFC) with 10-g boiled egg yolk and presented lip swelling and abdominal pain. OFC with 1-g boiled egg yolk the following day induced no adverse reaction. OIT was initiated using a home-based, slow up-dosing protocol. She consumed 1 g of boiled egg yolk at home every day, increasing this by 5%–10% every 2 weeks. She started 0.5-g boiled egg white after reaching a whole egg yolk. If adverse reactions occurred, the daily dose was decreased. After 59 months, she was able to eat an entire boiled egg. Anaphylaxis occurred 3 times during OIT due to accidental consumptions of egg products or insufficient heating of egg. Home-based, slow up-dosing OIT might be applicable for adults with severe HEA. It should be performed with appropriate equipment and education for patients, in case of emergency.
Collapse
Affiliation(s)
- Satoshi Horino
- Department of Allergy, Miyagi Children's Hospital, Sendai, Japan
| | - Kei Uneoka
- Department of Allergy, Miyagi Children's Hospital, Sendai, Japan
| | - Masato Nihei
- Department of Allergy, Miyagi Children's Hospital, Sendai, Japan.,Department of Pediatrics, Ishinomaki Red Cross Hospital, Ishinomaki, Japan
| | - Haruka Aki
- Department of Allergy, Miyagi Children's Hospital, Sendai, Japan
| | - Katsushi Miura
- Department of Allergy, Miyagi Children's Hospital, Sendai, Japan
| |
Collapse
|
8
|
Assessment of the effects of a work-related allergy to seafood on the reduction of earning capacity in the context of BK No. 5101. Allergol Select 2021; 5:33-44. [PMID: 33493250 PMCID: PMC7814778 DOI: 10.5414/al0db380e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/11/2020] [Indexed: 12/26/2022] Open
Abstract
Fish, crustaceans, and mollusks are among the most potent allergenic foods of animal origin and are thus important triggers of work-related immediate-food allergies. In Germany, work-related seafood allergies are of great importance in the fishing and processing industries as well as in the areas of food preparation, food control, and food sales. There is no causal therapy of seafood allergy, only the strict and lifelong avoidance of allergens remains. The following recommendations serve to assess the impact of a seafood allergy with regard to the work opportunities ended by it for the assessment of the reduction of earning capacity (MdE (German for Minderung der Erwerbsfähigkeit)) in the context of the occupational disease number 5101 of the Annex to the German regulation for occupational diseases. As a special feature of work-related seafood allergy with regard to insurance law aspects, it must be taken into account that there is a potential risk of systemic reaction with subsequent multi-organ involvement. For the estimation of MdE in the general labor market, the impact of a seafood allergy can therefore be assessed, depending on its clinical severity, as generally “mild” to “severe” in justified individual cases.
Collapse
|
9
|
Improving Successful Introduction after a Negative Food Challenge Test: How to Achieve the Best Result? Nutrients 2020; 12:nu12092731. [PMID: 32906786 PMCID: PMC7551318 DOI: 10.3390/nu12092731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 11/24/2022] Open
Abstract
Oral food challenges (OFC) confirm or exclude the presence of a food allergy. The outcome can be positive (allergic symptoms), inconclusive, or negative (no symptoms). In the case of a negative OFC, parents and children are advised to introduce the challenged food allergen into their diet. However, previous studies showed difficulties in a successful introduction at home. The aim of this prospective non-randomized intervention study is to evaluate the effect of a new strategy with more guidance regarding the dietary introduction after a negative food challenge test. We compared two cohorts: an historical (retrospective) control group of 157 children, previously described, who did not receive any special advice after a negative OFC, versus a new cohort consisting of 104 children, who were guided according to our new strategy of written introduction schemes, food diaries, and several phone calls. In the historical control group, introduction was successful in 56%, partially successful in 16%, and 28% failed to introduce at home. After introduction of our new strategy, complete introduction was found in 82%, 11% had partially introduced, and only 8% failed to introduce the allergen. In conclusion, comprehensive advice and dietary recommendation after a negative OFC results in an increase in successful home introduction. Therefore, more attention, guidance, and follow-up of children and parents are desirable after a negative OFC.
Collapse
|
10
|
Sievers S, Rohrbach A, Beyer K. Wheat-induced food allergy in childhood: ancient grains seem no way out. Eur J Nutr 2019; 59:2693-2707. [DOI: 10.1007/s00394-019-02116-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/11/2019] [Indexed: 12/29/2022]
|
11
|
Pineda J, Vargas R, Romero LA, Marrugo J, Meneses J, Marrugo AG. Robust automated reading of the skin prick test via 3D imaging and parametric surface fitting. PLoS One 2019; 14:e0223623. [PMID: 31634361 PMCID: PMC6802838 DOI: 10.1371/journal.pone.0223623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 09/24/2019] [Indexed: 11/18/2022] Open
Abstract
The conventional reading of the skin prick test (SPT) for diagnosing allergies is prone to inter- and intra-observer variations. Drawing the contours of the skin wheals from the SPT and scanning them for computer processing is cumbersome. However, 3D scanning technology promises the best results in terms of accuracy, fast acquisition, and processing. In this work, we present a wide-field 3D imaging system for the 3D reconstruction of the SPT, and we propose an automated method for the measurement of the skin wheals. The automated measurement is based on pyramidal decomposition and parametric 3D surface fitting for estimating the sizes of the wheals directly. We proposed two parametric models for the diameter estimation. Model 1 is based on an inverted Elliptical Paraboloid function, and model 2 on a super-Gaussian function. The accuracy of the 3D imaging system was evaluated with validation objects obtaining transversal and depth accuracies within ± 0.1 mm and ± 0.01 mm, respectively. We tested the method on 80 SPTs conducted in volunteer subjects, which resulted in 61 detected wheals. We analyzed the accuracy of the models against manual reference measurements from a physician and obtained that the parametric model 2 on average yields diameters closer to the reference measurements (model 1: -0.398 mm vs. model 2: -0.339 mm) with narrower 95% limits of agreement (model 1: [-1.58, 0.78] mm vs. model 2: [-1.39, 0.71] mm) in a Bland-Altman analysis. In one subject, we tested the reproducibility of the method by registering the forearm under five different poses obtaining a maximum coefficient of variation of 5.24% in the estimated wheal diameters. The proposed method delivers accurate and reproducible measurements of the SPT.
Collapse
Affiliation(s)
- Jesus Pineda
- Facultad de Ingeniería, Universidad Tecnologica de Bolivar, Cartagena, Colombia
| | - Raul Vargas
- Facultad de Ingeniería, Universidad Tecnologica de Bolivar, Cartagena, Colombia
| | - Lenny A. Romero
- Facultad de Ciencias Básicas, Universidad Tecnologica de Bolivar, Cartagena, Colombia
| | - Javier Marrugo
- Instituto de Investigaciones Inmunológicas, Universidad De Cartagena, Cartagena, Colombia
| | - Jaime Meneses
- Grupo de Óptica y Tratamiento de Señales, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Andres G. Marrugo
- Facultad de Ingeniería, Universidad Tecnologica de Bolivar, Cartagena, Colombia
| |
Collapse
|
12
|
Bavaro SL, De Angelis E, Barni S, Pilolli R, Mori F, Novembre EM, Monaci L. Modulation of Milk Allergenicity by Baking Milk in Foods: A Proteomic Investigation. Nutrients 2019; 11:E1536. [PMID: 31284583 PMCID: PMC6683078 DOI: 10.3390/nu11071536] [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: 05/31/2019] [Revised: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 12/26/2022] Open
Abstract
Cow's milk is considered the best wholesome supplement for children since it is highly enriched with micro and macro nutrients. Although the protein fraction is composed of more than 25 proteins, only a few of them are capable of triggering allergic reactions in sensitive consumers. The balance in protein composition plays an important role in the sensitization capacity of cow's milk, and its modification can increase the immunological response in allergic patients. In particular, the heating treatments in the presence of a food matrix have demonstrated a decrease in the milk allergenicity and this has also proved to play a pivotal role in developing tolerance towards milk. In this paper we investigated the effect of thermal treatment like baking of cow's milk proteins that were employed as ingredients in the preparation of muffins. A proteomic workflow was applied to the analysis of the protein bands highlighted along the SDS gel followed by western blot analyses with sera of milk allergic children in order to have deeper information on the impact of the heating on the epitopes and consequent IgE recognition. Our results show that incorporating milk in muffins might promote the formation of complex milk-food components and induce a modulation of the immunoreactivity towards milk allergens compared to milk baked in the oven at 180 °C for ten minutes. The interactions between milk proteins and food components during heating proved to play a role in the potential reduction of allergenicity as assessed by in vitro tests. This would help, in perspective, in designing strategies for improving milk tolerance in young patients affected from severe milk allergies.
Collapse
Affiliation(s)
- Simona L Bavaro
- Institute of Sciences of Food Production, Italian National Research Council (ISPA-CNR), Via Amendola 122/O, 70126 Bari, Italy
| | - Elisabetta De Angelis
- Institute of Sciences of Food Production, Italian National Research Council (ISPA-CNR), Via Amendola 122/O, 70126 Bari, Italy
| | - Simona Barni
- Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital, University of Florence, 50139 Florence, Italy
| | - Rosa Pilolli
- Institute of Sciences of Food Production, Italian National Research Council (ISPA-CNR), Via Amendola 122/O, 70126 Bari, Italy
| | - Francesca Mori
- Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital, University of Florence, 50139 Florence, Italy
| | - Elio M Novembre
- Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital, University of Florence, 50139 Florence, Italy
| | - Linda Monaci
- Institute of Sciences of Food Production, Italian National Research Council (ISPA-CNR), Via Amendola 122/O, 70126 Bari, Italy.
| |
Collapse
|
13
|
Epidemiology of Cow's Milk Allergy. Nutrients 2019; 11:nu11051051. [PMID: 31083388 PMCID: PMC6566637 DOI: 10.3390/nu11051051] [Citation(s) in RCA: 160] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 02/07/2023] Open
Abstract
Immunoglobulin E (IgE)-mediated cow's milk allergy (CMA) is one of the most common food allergies in infants and young children. CMA can result in anaphylactic reactions, and has long term implications on growth and nutrition. There are several studies in diverse populations assessing the epidemiology of CMA. However, assessment is complicated by the presence of other immune-mediated reactions to cow's milk. These include non-IgE and mixed (IgE and non-IgE) reactions and common non-immune mediated reactions, such as lactose intolerance. Estimates of prevalence and population-level patterns are further complicated by the natural history of CMA (given its relatively high rate of resolution) and variation in phenotype (with a large proportion of patients able to tolerate baked cow's milk). Prevalence, natural history, demographic patterns, and long-term outcomes of CMA have been explored in several disparate populations over the past 30 to 40 years, with differences seen based on the method of outcome assessment, study population, time period, and geographic region. The primary aim of this review is to describe the epidemiology of CMA. The review also briefly discusses topics related to prevalence studies and specific implications of CMA, including severity, natural course, nutritional impact, and risk factors.
Collapse
|
14
|
Carrera M, González-Fernández Á, Magadán S, Mateos J, Pedrós L, Medina I, Gallardo JM. Molecular characterization of B-cell epitopes for the major fish allergen, parvalbumin, by shotgun proteomics, protein-based bioinformatics and IgE-reactive approaches. J Proteomics 2019; 200:123-133. [PMID: 30974223 DOI: 10.1016/j.jprot.2019.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/30/2019] [Accepted: 04/07/2019] [Indexed: 12/01/2022]
Abstract
Parvalbumins beta (β-PRVBs) are the main fish allergens. The only proven and effective treatment for this type of hypersensitivity is to consume a diet free of fish. We present the molecular characterization of B-cell epitopes by shotgun proteomics of different β-PRVBs combined with protein-based bioinformatics and IgE-reactive approaches. The final goal of this work is to identify potential peptide vaccine candidates for fish allergy. Purified β-PRVBs from the main fifteen different fish species that cause allergy were analyzed by shotgun proteomics. Identified β-PRVBs peptide sequences and ninety-eight β-PRVB protein sequences from UniProtKB were combined, aligned and analyzed to determine B-cell epitopes using the Kolaskar and Tongaonkar algorithm. The highest rated predicted B-cell peptide epitopes were evaluated by ELISA using the corresponding synthetic peptides and sera from healthy and fish allergic patients. A total of 35 peptides were identified as B-cell epitopes. The top B-cell peptide epitopes (LKLFLQV, ACAHLCK, FAVLVKQ and LFLQNFV) that may induce protective immune responses were selected as potential peptide vaccine candidates. The 3D model of these peptides were located in the surface of the protein. This study provides the global characterization of B-cell epitopes for all β-PRVBs sequences that will facilitate the design of new potential immunotherapies. SIGNIFICANCE: This work provides the global characterization of B-cell epitopes for all β-PRVBs sequences by Shotgun Proteomics combined with Protein-based Bioinformatics and IgE-reactive approaches. This study will increase our understanding of the molecular mechanisms whereby fish allergens elicit allergic reactions and will facilitate the design of new potential peptide vaccine candidates.
Collapse
Affiliation(s)
- Mónica Carrera
- Spanish National Research Council (CSIC), Marine Research Institute (IIM), Food Technology, Vigo, Pontevedra, Spain.
| | - África González-Fernández
- Biomedical Research Center (CINBIO) (Centro Singular de Investigación de Galicia), University of Vigo, Immunology, Vigo, Pontevedra, Spain
| | - Susana Magadán
- Biomedical Research Center (CINBIO) (Centro Singular de Investigación de Galicia), University of Vigo, Immunology, Vigo, Pontevedra, Spain
| | - Jesús Mateos
- Spanish National Research Council (CSIC), Marine Research Institute (IIM), Food Technology, Vigo, Pontevedra, Spain
| | - Lelia Pedrós
- Hospital Meixoeiro of Vigo, Galicia Sur Health Research Institute, Complexo Hospitalario Universitario de Vigo (CHUVI), SERGAS, Vigo, Pontevedra, Spain
| | - Isabel Medina
- Spanish National Research Council (CSIC), Marine Research Institute (IIM), Food Technology, Vigo, Pontevedra, Spain
| | - José M Gallardo
- Spanish National Research Council (CSIC), Marine Research Institute (IIM), Food Technology, Vigo, Pontevedra, Spain
| |
Collapse
|
15
|
Cingi C, Bayar Muluk N, Scadding GK. Will every child have allergic rhinitis soon? Int J Pediatr Otorhinolaryngol 2019; 118:53-58. [PMID: 30580075 DOI: 10.1016/j.ijporl.2018.12.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/13/2018] [Accepted: 12/13/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Given the increasing prevalence of AR amongst children, we aimed to review the literature regarding the future of AR in this population. METHODS We searched the PubMed, Google and Proquest Central databases at Kırıkkale University Library. Search terms used were: "allergic rhinitis", "children", "paediatric", "allergy", "future", "risk factors", "treatment", "pharmacotherapy" and/or "allergen - specific immunotherapy". With regard to risk factors for allergic rhinitis, the terms "Environmental factors", "Improved hygiene", "Increased indoor allergen exposure", "Farms, villages, worms, and other parasites", "Environmental toxicants", "Diet", "Lifestyle changes", "Air pollution" and "Climate factors" were searched for. "Prevention of allergic diseases" and "Allergen-specific immunotherapy in the future" were also included in the search. RESULTS AR has a high prevalence and causes considerable morbidity, has associated comorbidity and features specific complications. The principal treatments rely on avoiding the allergens responsible, and administering drug treatment or immunotherapy, which targets specific antigens. Genetic drift does not explain the rising prevalence of allergic disorders, but multifactorial environmental factors are likely culprits. Amongst such environmental factors to consider are the rise in caesarean births, decreases in breast feeding, dietary changes resulting in less fresh produce being consumed, the eradication of intestinal worm infestations, alterations in the way homes are aired and heated, children taking less exercise and being outdoors for shorter periods, whilst also having more contact with pollution. CONCLUSION Barring substantial lifestyle alterations, more and more children are likely to develop AR. It may prove feasible to stop allergy developing in the first place through manipulation of the microbiome, but the exact format such a modification should involve remains to be discovered. Molecular allergological techniques do offer the prospect of more precisely targeted immunotherapy, the sole disease modifier at present. However, at present the complexity and cost of such interventions prevents their widespread use and research in this area is still needed. The majority of children with AR are going to be managed using nasal saline sprays, since they are the most straightforward and least risky alternative for first line treatment.
Collapse
Affiliation(s)
- Cemal Cingi
- Eskisehir Osmangazi University, Medical Faculty, Department of Otorhinolaryngology, Eskisehir, Turkey.
| | - Nuray Bayar Muluk
- Kirikkale University, Medical Faculty, Department of Otorhinolaryngology, Kirikkale, Turkey.
| | - Glenis K Scadding
- Honorary Consultant Allergist & Rhinologist, RNTNE Hospital, University College Hospitals, London, United Kingdom.
| |
Collapse
|
16
|
Jiang S, Da Y, Han S, He Y, Che H. Notch ligand Delta-like1 enhances degranulation and cytokine production through a novel Notch/Dok-1/MAPKs pathway in vitro. Immunol Res 2019; 66:87-96. [PMID: 29181775 DOI: 10.1007/s12026-017-8977-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Food allergy includes sensitization phase and effect phase, and effect cells degranulate and secrete cytokines in the effect phase, causing allergic clinical symptoms. We have demonstrated that Notch signaling plays an important role in the sensitization phase, but its role in effect phases still remains unclear. In this study, we investigated the role of Notch signaling in degranulation and cytokine production of the effect phase response. A RBL-2H3 cell model was used and Notch signaling was induced by priming with Notch ligands. Our results showed after priming with Notch ligand, Delta-like1(Dll1)-Fc, β-hexosaminidase release, and cytokines production, including TGF-β, IL-1β, IL-4, IL-6, and IL-13, were increased significantly, and the enhancement was abolished after DAPT treatment, a γ-secretase inhibitor, indicating that Dll1 Notch signaling enhanced RBL-2H3 cell degranulation and cytokine production. Western blot analysis showed that Dll1 Notch signaling augmented high-affinity IgE receptors-mediated phosphorylation of MAPKs through suppressing the expression of downstream tyrosine kinases 1 (Dok-1). Besides, a passive systemic anaphylaxis mouse model was used to confirm the role of Notch signaling. And our data showed that allergic clinical features of mice were alleviated, and the level of degranulation was decreased significantly after inhibiting Notch signaling in vivo. Therefore, we demonstrated Notch ligand Dll1 enhanced RBL-2H3 cell degranulation and cytokine production through a novel Notch/Dok-1/MAPKs pathway, suggesting Notch signaling played a key role in the effect phase of food allergy.
Collapse
Affiliation(s)
- Songsong Jiang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, No.17 Qinghua Donglu, Haidian District, Beijing, People's Republic of China
| | - Yifan Da
- College of Food Science and Nutritional Engineering, China Agricultural University, No.17 Qinghua Donglu, Haidian District, Beijing, People's Republic of China
| | - Shiwen Han
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, No.17 Qinghua Donglu, Haidian District, Beijing, People's Republic of China
| | - Yahong He
- College of Food Science and Nutritional Engineering, China Agricultural University, No.17 Qinghua Donglu, Haidian District, Beijing, People's Republic of China
| | - Huilian Che
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, No.17 Qinghua Donglu, Haidian District, Beijing, People's Republic of China.
| |
Collapse
|
17
|
Emons JAM, Gerth van Wijk R. Food Allergy and Asthma: Is There a Link? CURRENT TREATMENT OPTIONS IN ALLERGY 2018; 5:436-444. [PMID: 30524933 PMCID: PMC6244552 DOI: 10.1007/s40521-018-0185-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose of review To describe and understand the links and interactions between food allergy and asthma. Recent findings Food allergy and asthma are characterized by an increasing prevalence. Moreover, food allergy and asthma often coexist. Both conditions are associated with each other in different ways. It has been shown that food allergy is a risk factor of developing asthma. Atopic dermatitis appears to be the common denominator in this interaction. Loss-of-function variants of the filaggrin mutation result in an impaired epidermal barrier function and have been shown to be a risk factor for the development of atopic dermatitis, allergies, and asthma. Early introduction of food allergens and optimal treatment of the skin barrier are preventive interventions for the development of food allergy and asthma. Asthma is also a risk factor for the development of severe or even fatal anaphylaxis in patients with food allergy. Isolated asthma is not a feature of a food allergic reaction; however, respiratory symptoms may be part of anaphylactic reactions. In addition, during an allergic reaction to food, non-specific bronchial hyperreactivity may increase. Cross-reactive allergens may be responsible for asthma-associated food allergy. This is particularly true for severe asthma upon ingestion of snail in patients allergic to house-dust mites. Finally, airborne allergens from occupational sources such as wheat, fish, and seafood may induce asthmatic reactions. This phenomenon is sometimes seen in non-occupational settings. Summary Food allergy and asthma are interconnected with each other beyond the presence of simple comorbidity. Food allergy precedes and predisposes to asthma, and mutual interactions range from respiratory symptoms and bronchial hyperreactivity during food-induced anaphylaxis to severe asthma due to cross-reactive food allergens and to occupational asthma upon exposure to airborne allergens. Moreover, coexisting asthma in food allergies may result in severe and sometimes fatal anaphylactic reactions.
Collapse
Affiliation(s)
- Joyce A M Emons
- 1Erasmus MC, Department of Pediatrics, Division of Respiratory Medicine and Allergology, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roy Gerth van Wijk
- 2Erasmus Medical Center, Department of Internal Medicine, Section of Allergology, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
18
|
Kumar S, Sharma A, Gupta RK, Verma AK, Dwivedi PD. Allergenicity assessment of Buchanania lanzan protein extract in Balb/c mice. Int Immunopharmacol 2018; 63:170-182. [PMID: 30096600 DOI: 10.1016/j.intimp.2018.07.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/30/2018] [Accepted: 07/30/2018] [Indexed: 01/08/2023]
Abstract
Tree nuts are among "Big Eight" and have been reported globally for causing allergy. Buchanania lanzan (Bl) is one of the major tree nuts consumed by Indian population. However, very little is known about B. lanzan's induced allergic manifestation. Therefore, evaluation of it's allergenic potential was undertaken. Bl-crude protein extract sensitized BALB/c mice sera were used to identify the allergic proteins by it's IgE binding capability. The major IgE binding proteins found with molecular weight of 11, 20, 23, 25, 48, 54, and 65 kDa. Specific IgE, specific IgG1, MCPT-1, PGD2 and histamine were assessed in mice sera. Enormous amount of mast cell infiltration was noted in different organs. The levels of Th1/Th2 transcription factors GATA-3, SOCS3 and STAT-6 were found upregulated, whereas T-bet was downregulated. Furthermore, elevated Th1/Th2 cytokine responses were observed in mice sera. All together, these reactions developed systemic anaphylaxis upon Bl-CPE challenge in sensitized BALB/c mice. In order to confirm the evidences obtained from the studies carried out in BALB/c, the investigation was extended to human subjects as well. Control subjects and allergic patients were subjected to skin prick test (SPT). Later sera collected from those positive to SPT along with controls were used for IgE immunoblotting. The study evaluated the allergic manifestation associated with Bl, and identified it's proteins attributing Bl-mediated allergy. This work may help in managing tree nuts mediated allergies especially due to Buchanania lanzan sensitization.
Collapse
Affiliation(s)
- Sachin Kumar
- Food, Drug and Chemical Toxicology Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), VishVigyan Bhawan, 31, Mahatama Gandhi Marg, Lucknow 226001, Uttar Pradesh, India; Academy of Scientific and Innovative Research (AcSIR), CSIR-IITR Campus, Lucknow, India
| | - Akanksha Sharma
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Rinkesh Kumar Gupta
- Food, Drug and Chemical Toxicology Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), VishVigyan Bhawan, 31, Mahatama Gandhi Marg, Lucknow 226001, Uttar Pradesh, India
| | - Ajay Kumar Verma
- Department of Pulmonary and Critical Care Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Premendra D Dwivedi
- Food, Drug and Chemical Toxicology Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), VishVigyan Bhawan, 31, Mahatama Gandhi Marg, Lucknow 226001, Uttar Pradesh, India; Academy of Scientific and Innovative Research (AcSIR), CSIR-IITR Campus, Lucknow, India.
| |
Collapse
|
19
|
Burkhardt JG, Chapa-Rodriguez A, Bahna SL. Gluten sensitivities and the allergist: Threshing the grain from the husks. Allergy 2018; 73:1359-1368. [PMID: 29131356 DOI: 10.1111/all.13354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 12/12/2022]
Abstract
"Gluten sensitivity" has become commonplace among the public. Wheat allergy (WA) and celiac disease (CD) are well-defined entities, but are becoming a fraction of individuals following a gluten-free diet (GFD). Wheat allergy has a prevalence of <0.5%. Wheat, specifically its omega-5 gliadin fraction, is the most common allergen implicated in food-dependent, exercise-induced anaphylaxis. CD is a non-IgE hypersensitivity to certain cereal proteins: gluten in wheat, secalin in rye, hordein in barley, and to a lesser extent avenin in oat. It is a rare disease, with an estimated prevalence that varied widely geographically, being higher in Northern Europe and the African Saharawi region than in South-East Asia. In addition to suggestive symptoms, serologic testing has high diagnostic reliability and biopsy is a confirmatory procedure. Patients with CD have extra-intestinal autoimmune comorbid conditions more frequently than expected. A third entity is nonceliac gluten sensitivity, which has been created because of the increasing number of subjects who claim a better quality of life or improvement of their variety of symptoms on switching to a GFD. The phenomenon is being fueled by the media and exploited by the industry. The lack of a specific objective test has been raising substantial controversy about this entity. Allergists and gastroenterologists need to pay attention to the multitudes of individuals who elect to follow a GFD. Many such subjects might have WA, CD, or another illness. Providing them with appropriate evaluation and specific management would be of great advantages, medically and economically.
Collapse
Affiliation(s)
- J. G. Burkhardt
- Allergy & Immunology Section; Louisiana State University Health Sciences Center; Shreveport LA USA
| | - A. Chapa-Rodriguez
- Pediatric Gastroenterology & Nutrition Section; Louisiana State University Health Sciences Center; Shreveport LA USA
| | - S. L. Bahna
- Allergy & Immunology Section; Louisiana State University Health Sciences Center; Shreveport LA USA
| |
Collapse
|
20
|
Wang XY, Zhuang Y, Ma TT, Zhang B, Wang XY. Prevalence of Self-Reported Food Allergy in Six Regions of Inner Mongolia, Northern China: A Population-Based Survey. Med Sci Monit 2018; 24:1902-1911. [PMID: 29605827 PMCID: PMC5894567 DOI: 10.12659/msm.908365] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this study was to determine the prevalence of self-reported food allergy in 6 regions of Inner Mongolia, northern China. Material/Methods A random cluster sampling population study using a field questionnaire was distributed to 4714 individuals in 6 regions within Inner Mongolia, northern China; the study included ethnic Mongol minorities and Chinese Han populations. The questionnaire obtained data on ethnicity, age, sex, level of education, income, socioeconomic status, rural versus urban location, medical and family history, and food allergy. Results There were 4441 (73.5%) completed questionnaires. The prevalence of self-reported food allergy was 18.0% (15.2% men; 20.6% women) and was age-related, being significantly greater in children compared with adults (38.7% vs. 11.9%) (P<0.001). There was a significant difference in self-reported food allergy between rural and urban populations (14.6% vs. 21.4%) (P<0.001) and between Mongolian and Han populations (20.8% vs. 15.8%) (P<0.001). Socioeconomic status, higher education level, and increased family income were significantly correlated with the prevalence of food allergy (P<0.001). Participants with allergic diseases and atopic family history were at increased risk (OR>1, P<0.001). There were no significant associations between the prevalence of food allergy and birth history, infant feeding, and duration of breastfeeding. Conclusions An increase in the prevalence of self-reported food allergy was found in the Inner Mongolia region of northern China, which was greater in urban areas compared with rural areas.
Collapse
Affiliation(s)
- Xiao-Yan Wang
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Yan Zhuang
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Ting-Ting Ma
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Biao Zhang
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China (mainland)
| | - Xue-Yan Wang
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (mainland)
| |
Collapse
|
21
|
Meyer R, Groetch M, Venter C. When Should Infants with Cow's Milk Protein Allergy Use an Amino Acid Formula? A Practical Guide. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:383-399. [DOI: 10.1016/j.jaip.2017.09.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 09/04/2017] [Accepted: 09/16/2017] [Indexed: 12/18/2022]
|
22
|
Reier-Nilsen T, Michelsen MM, Lødrup Carlsen KC, Carlsen KH, Mowinckel P, Nygaard UC, Namork E, Borres MP, Håland G. Predicting reactivity threshold in children with anaphylaxis to peanut. Clin Exp Allergy 2018; 48:415-423. [DOI: 10.1111/cea.13078] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 12/08/2017] [Accepted: 12/17/2017] [Indexed: 11/27/2022]
Affiliation(s)
- T. Reier-Nilsen
- Division of Paediatric and Adolescent Medicine; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - M. M. Michelsen
- Division of Paediatric and Adolescent Medicine; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - K. C. Lødrup Carlsen
- Division of Paediatric and Adolescent Medicine; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - K.-H. Carlsen
- Division of Paediatric and Adolescent Medicine; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - P. Mowinckel
- Division of Paediatric and Adolescent Medicine; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - U. C. Nygaard
- Division of Infection Control and Environmental Health; Norwegian Institute of Public Health; Oslo Norway
| | - E. Namork
- Division of Infection Control and Environmental Health; Norwegian Institute of Public Health; Oslo Norway
| | - M. P. Borres
- Thermo-Fisher Scientific; Uppsala Sweden
- Institute of Maternal & Child Health; Uppsala University; Uppsala Sweden
| | - G. Håland
- Division of Paediatric and Adolescent Medicine; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| |
Collapse
|
23
|
Kostadinova AI, Middelburg J, Ciulla M, Garssen J, Hennink WE, Knippels LMJ, van Nostrum CF, Willemsen LEM. PLGA nanoparticles loaded with beta-lactoglobulin-derived peptides modulate mucosal immunity and may facilitate cow's milk allergy prevention. Eur J Pharmacol 2017; 818:211-220. [PMID: 29079360 DOI: 10.1016/j.ejphar.2017.10.051] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/22/2017] [Accepted: 10/23/2017] [Indexed: 02/07/2023]
Abstract
Beta-lactoglobulin (BLG)-derived peptides may facilitate oral tolerance to whey and prevent cow's milk allergy (CMA). Loading of BLG-peptides in poly(lactic-co-glycolic acid) (PLGA) nanoparticles (Pep-NP) may improve this. Here we studied the uptake of NP and the capacity of NP and Pep-NP to activate bone marrow dendritic cells (BMDC). Furthermore, CMA prevention was evaluated by orally exposing three-week-old female C3H/HeOuJ mice to Pep-NP, NP or free peptides (PepMix) for 6 days before oral sensitization with whole whey protein and effects on the spleen and small intestine lamina propria (SI-LP) were studied. In BMDC, NP and Pep-NP enhanced CD40 expression and IL-6 and TNF-α secretion, while tended to decrease CD80 expression and prevented PepMix-induced IL-12 secretion. In vivo, oral exposure to Pep-NP, but not NP or PepMix, prior to whey sensitization tended to partially prevent the acute allergic skin response to whole whey protein. Splenocytes of NP-pre-exposed mice secreted increased levels of whey-specific IL-6, but this was silenced in Pep-NP-pre-exposed mice which also showed reduced TNF-α and IFN-γ secretion. In the SI-LP, Pep-NP pre-exposure reduced the CD4+ T cell frequency in CMA mice compared to PBS pre-exposure. In addition, while NP increased whey-specific IL-6 secretion in the SI-LP, Pep-NP did not and maintained regulatory TGF-β secretion. This study presents a proof-of-concept that PLGA nanoparticles facilitate the capacity of BLG peptides to suppress the allergic response to whole whey protein. Hence, PLGA nanoparticles may be further developed as an adjunct strategy for BLG-peptide-based oral tolerance induction and CMA prevention.
Collapse
Affiliation(s)
- Atanaska I Kostadinova
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584CG Utrecht, The Netherlands; Department of Immunology, Nutricia Research, Uppsalalaan 12, 3584CT Utrecht, The Netherlands.
| | - Jim Middelburg
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584CG Utrecht, The Netherlands; Division of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584CG Utrecht, The Netherlands
| | - Michele Ciulla
- Division of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584CG Utrecht, The Netherlands
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584CG Utrecht, The Netherlands; Department of Immunology, Nutricia Research, Uppsalalaan 12, 3584CT Utrecht, The Netherlands
| | - Wim E Hennink
- Division of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584CG Utrecht, The Netherlands
| | - Leon M J Knippels
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584CG Utrecht, The Netherlands; Department of Immunology, Nutricia Research, Uppsalalaan 12, 3584CT Utrecht, The Netherlands
| | - Cornelus F van Nostrum
- Division of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584CG Utrecht, The Netherlands
| | - Linette E M Willemsen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584CG Utrecht, The Netherlands
| |
Collapse
|
24
|
Meyer R, Godwin H, Dziubak R, Panepinto JA, Foong RXM, Bryon M, Lozinsky AC, Reeve K, Shah N. The impact on quality of life on families of children on an elimination diet for Non-immunoglobulin E mediated gastrointestinal food allergies. World Allergy Organ J 2017; 10:8. [PMID: 28261374 PMCID: PMC5320765 DOI: 10.1186/s40413-016-0139-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 12/22/2016] [Indexed: 01/22/2023] Open
Abstract
Background The impact on health related quality of life (HRQL) has been well studied in children with Immunoglobulin E (IgE)-mediated food allergy. However limited data exists on related quality of life (QOL) of families who have a child suffering from food protein induced non-IgE mediated gastrointestinal allergies. We aimed to establish the QOL of families with children at the beginning of following an elimination diet for non-IgE mediated gastrointestinal food allergies. Methods A prospective, observational study was performed. Parents of children aged 4 weeks–16 years who improved after 4–8 weeks of following an elimination diet for suspected non-IgE mediated allergies were included. The Family Impact Module (FIM) of the Pediatric Quality of Life (PedsQL™) was used and we compared our data to two historical cohorts: one with sickle cell disease and another with intestinal failure. Results One hundred and twenty three children with a median age of 20 months were included (84 boys). The total FIM Score was 57.43 (SD 22.27) and particularly low for daily activities and worry. Factors that impacted significantly included age (p < 0.0001), number of foods excluded (p = 0.008), symptom severity (p = 0.041) and chronic nasal congestion (p = 0.012). Children with non-IgE mediated food allergies had worse scores in all domains (p < 0.0001) compared to sickle cell disease and worse physical (p = 0.04), emotional (p = 0.04) and worry (p = 0.01) domains compared to intestinal failure. Conclusions This study found that parent QOL and family functioning was worse in those families who had a child on an elimination diet for non-IgE mediated allergies compared to those with sickle cell disease and intestinal failure, highlighting the impact this disease has on families.
Collapse
Affiliation(s)
- Rosan Meyer
- Department Paediatrics, Imperial College, London, UK
| | - Heather Godwin
- Gastroenterology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Robert Dziubak
- Gastroenterology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Julie A Panepinto
- Department of Pediatrics, Children's Hospital of Wisconsin Research Institute/Medical College of Wisconsin, Hematology/Oncology/Bone Marrow Transplantation, Milwaukee, WI USA
| | - Ru-Xin M Foong
- University College of London/Institute of Child Health, London, UK
| | - Mandy Bryon
- Gastroenterology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Adriana Chebar Lozinsky
- Gastroenterology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kate Reeve
- The Royal London Hospital, Paediatric A&E, Whitechapel Road, London, E1 1BB UK
| | - Neil Shah
- Gastroenterology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| |
Collapse
|
25
|
Piscaglia AC, Laterza L, Cesario V, Gerardi V, Landi R, Lopetuso LR, Calò G, Fabbretti G, Brisigotti M, Stefanelli ML, Gasbarrini A. Nodular lymphoid hyperplasia: A marker of low-grade inflammation in irritable bowel syndrome? World J Gastroenterol 2016; 22:10198-10209. [PMID: 28028368 PMCID: PMC5155179 DOI: 10.3748/wjg.v22.i46.10198] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 10/25/2016] [Accepted: 11/16/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the prevalence of nodular lymphoid hyperplasia (NLH) in adult patients undergoing colonoscopy and its association with known diseases.
METHODS We selected all cases showing NLH at colonoscopy in a three-year timeframe, and stratified them into symptomatic patients with irritable bowel syndrome (IBS)-type symptoms or suspected inflammatory bowel disease (IBD), and asymptomatic individuals undergoing endoscopy for colorectal cancer screening. Data collection included medical history and final diagnosis. As controls, we considered all colonoscopies performed for the aforementioned indications during the same period.
RESULTS One thousand and one hundred fifty colonoscopies were selected. NLH was rare in asymptomatic individuals (only 3%), while it was significantly more prevalent in symptomatic cases (32%). Among organic conditions associated with NLH, the most frequent was IBD, followed by infections and diverticular disease. Interestingly, 31% of IBS patients presented diffuse colonic NLH. NLH cases shared some distinctive clinical features among IBS patients: they were younger, more often female, and had a higher frequency of abdominal pain, bloating, diarrhoea, unspecific inflammation, self-reported lactose intolerance and metal contact dermatitis.
CONCLUSION About 1/3 of patients with IBS-type symptoms or suspected IBD presented diffuse colonic NLH, which could be a marker of low-grade inflammation in a conspicuous subset of IBS patients.
Collapse
|
26
|
Venter C, Maslin K, Patil V, Kurukulaaratchy R, Grundy J, Glasbey G, Twiselton R, Dean T, Arshad SH. The prevalence, natural history and time trends of peanut allergy over the first 10 years of life in two cohorts born in the same geographical location 12 years apart. Pediatr Allergy Immunol 2016; 27:804-811. [PMID: 27434312 DOI: 10.1111/pai.12616] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study was to explore the natural history of peanut allergy in childhood in two birth cohorts from the same geographical region in the South of England. METHODS The FAIR birth cohort was established on the Isle of Wight (UK) between 2001 and 2002 (n = 969). Children were followed up prospectively, skin prick tested (SPT) to peanut allergens at 1, 2, 3 and 10 years and food challenges performed. The Isle of Wight (IOW) birth cohort was established in 1989 (n = 1456). SPTs were performed at 1, 2, 4 and 10 years. Peanut allergy was based on positive SPT and a good clinical history. RESULTS In the FAIR cohort, the prevalence of sensitization to peanut was 0.4%, 2.0%, 2.0% and 2.4% at 1, 2, 3 and 10 years, respectively. At 10 years of age, 12 of 828 (1.5%) children were diagnosed with peanut allergy. One child (8%) outgrew her peanut allergy between 3 and 10 years and two children (15%) presented with new onset peanut allergy. Over the first 10 years of life, 13 of 934 (1.4%) children were diagnosed with peanut allergy. In the IOW cohort, 6 of 1034 (0.58%) were diagnosed with peanut allergy at 10 years. We found no significant differences between the FAIR and the IOW birth cohort for any of the time points studied. CONCLUSION Peanut allergy appears to be stable over the first 10 years of life in our cohorts. There was no significant difference in peanut sensitization or clinical peanut allergy between 1989 and 2001.
Collapse
Affiliation(s)
- Carina Venter
- The David Hide Asthma and Allergy Research Centre, St. Mary's Hospital, Newport, UK.,School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK
| | - Kate Maslin
- The David Hide Asthma and Allergy Research Centre, St. Mary's Hospital, Newport, UK.,School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK
| | - Veeresh Patil
- The David Hide Asthma and Allergy Research Centre, St. Mary's Hospital, Newport, UK
| | | | - Jane Grundy
- The David Hide Asthma and Allergy Research Centre, St. Mary's Hospital, Newport, UK
| | - Gillian Glasbey
- The David Hide Asthma and Allergy Research Centre, St. Mary's Hospital, Newport, UK
| | - Roger Twiselton
- The David Hide Asthma and Allergy Research Centre, St. Mary's Hospital, Newport, UK
| | - Taraneh Dean
- The David Hide Asthma and Allergy Research Centre, St. Mary's Hospital, Newport, UK.,School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK
| | - Syed Hasan Arshad
- The David Hide Asthma and Allergy Research Centre, St. Mary's Hospital, Newport, UK.,Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| |
Collapse
|
27
|
Kuehn A, Codreanu-Morel F, Lehners-Weber C, Doyen V, Gomez-André SA, Bienvenu F, Fischer J, Ballardini N, van Hage M, Perotin JM, Silcret-Grieu S, Chabane H, Hentges F, Ollert M, Hilger C, Morisset M. Cross-reactivity to fish and chicken meat - a new clinical syndrome. Allergy 2016; 71:1772-1781. [PMID: 27344988 DOI: 10.1111/all.12968] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fish is one of the most allergenic foods. While clinical cross-reactivity among different fishes is a widely accepted feature of fish allergy, associations with other food allergies are not well understood. This study aims at analyzing the relevance of clinical cross-reactivity between fish and chicken meat in patients with allergy to chicken meat without sensitization to hen's eggs. METHODS Patients with food allergy to fish and chicken meat (n = 29) or chicken meat only (n = 7) were recruited. IgE-reactive chicken proteins were identified (Edman, MS analysis) and quantified (ELISA). Allergens were used in IgE ELISA and skin testing. RESULTS Chicken parvalbumin and two new allergens, aldolase and enolase, were identified at 12, 40, and 50 kDa, respectively. They were recognized by sIgE of 61%, 75%, and 83% of all patient sera which were in the majority of the cases positive for the fish homologues as well. Fish and chicken meat allergens were highly cross-reactive while high inhibition rates with fish or chicken allergens correlated with the patients' primary sensitization to fish or chicken. In cooked or roasted foods, enolase and aldolase were detectable in chicken breast while parvalbumin was detectable in chicken legs and wings. CONCLUSIONS Fish and chicken meat are cross-reactive foods; both fish-allergic and chicken meat-allergic patients might be at risk of developing a food allergy to chicken meat or to fish, respectively. This clinical phenomenon is proposed to be termed 'fish-chicken syndrome' with cross-reactive allergens involved being parvalbumins, enolases, and aldolases.
Collapse
Affiliation(s)
- A. Kuehn
- Department of Infection and Immunity; Luxembourg Institute of Health; Esch-sur-Alzette Luxembourg
| | - F. Codreanu-Morel
- National Unit of Immunology and Allergology; Centre Hospitalier de Luxembourg; Luxembourg Luxembourg
| | - C. Lehners-Weber
- National Unit of Immunology and Allergology; Centre Hospitalier de Luxembourg; Luxembourg Luxembourg
| | - V. Doyen
- Clinic of Immuno-Allergology; CHU Brugmann; Université Libre de Bruxelles; Brussels Belgium
| | | | - F. Bienvenu
- Allergology Unit; Immunology Laboratory; Centre Hospitalier Lyon-Sud; Lyon France
| | - J. Fischer
- Allergy Unit; Department of Dermatology; Faculty of Medicine; Eberhard Karls University; Tübingen Germany
| | - N. Ballardini
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Sachs' Children and Youth Hospital; Södersjukhuset; Stockholm Sweden
- St John's Institute of Dermatology; King's College London; London UK
| | - M. van Hage
- Immunology and Allergy Unit; Department of Medicine; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - J.-M. Perotin
- Department of Respiratory Medicine; INSERM UMRS 903; University Hospital; Reims France
| | - S. Silcret-Grieu
- Groupe Hospitalier Cochin; Service de Pathologie Professionnelle; Université Paris Descartes; Paris France
| | - H. Chabane
- Department of Pediatrics; Hôpital Delafontaine; Saint Denis France
| | - F. Hentges
- Department of Infection and Immunity; Luxembourg Institute of Health; Esch-sur-Alzette Luxembourg
- National Unit of Immunology and Allergology; Centre Hospitalier de Luxembourg; Luxembourg Luxembourg
| | - M. Ollert
- Department of Infection and Immunity; Luxembourg Institute of Health; Esch-sur-Alzette Luxembourg
- Department of Dermatology and Allergy Center; Odense Research Center for Anaphylaxis; University of Southern Denmark; Odense Denmark
| | - C. Hilger
- Department of Infection and Immunity; Luxembourg Institute of Health; Esch-sur-Alzette Luxembourg
| | - M. Morisset
- National Unit of Immunology and Allergology; Centre Hospitalier de Luxembourg; Luxembourg Luxembourg
| |
Collapse
|
28
|
Topal E, Catal F, Soylu N, Ozcan OO, Celiksoy MH, Babayiğit A, Erge D, Karakoç HTE, Sancak R. Psychiatric disorders and symptoms severity in pre-school children with cow's milk allergy. Allergol Immunopathol (Madr) 2016; 44:445-9. [PMID: 27240441 DOI: 10.1016/j.aller.2016.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 02/15/2016] [Accepted: 03/01/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Psychiatric disorders are seen frequently in atopic diseases. The present study aims to evaluate the frequency of psychiatric disorders and the severity of psychiatric symptoms in pre-school children with cow's milk allergy. METHODS The parents of the pre-school children with cow's milk allergy were interviewed in person and asked to fill out the Early Childhood Inventory-4 form. RESULTS The cow's milk allergy group included 40 children (27 male, 13 female) with mean age, 44.5±14.7 months, and the control group included 41 children (25 male, 16 female) with mean age, 47.6±15.2 months. It was established that 65% of the group with cow's milk allergy received at least one psychiatric diagnosis, while 36.6% of the control group received at least one psychiatric diagnosis, with a statistically significant difference (p=0.02). Within the psychiatric disorders, attention deficit hyperactivity disorders (odds ratio: 4.9, 95% CI: 1.472-16.856, p=0.006), oppositional defiant disorder (odds ratio: 5.6, 95% CI: 1.139-28.128, p=0.026), and attachment disorder (odds ratio: 4.8, 95% CI: 1.747-13.506, p=0.004) were found significantly higher compared with the healthy control group. When the groups were compared in terms of psychiatric symptom severity scores, calculated by using the Early Childhood Inventory-4 form, attention deficit hyperactivity disorders severity (p=0.006) and oppositional defiant disorder severity (p=0.037) were found to be higher in the cow's milk allergy group. CONCLUSION Psychiatric disorders are frequent and severe in pre-school children with cow's milk allergy.
Collapse
Affiliation(s)
- E Topal
- Department of Pediatric Allergy and Immunology, Inonu University Turgut Ozal Medical Center, Malatya, Turkey.
| | - F Catal
- Department of Pediatric Allergy and Immunology, Inonu University Turgut Ozal Medical Center, Malatya, Turkey
| | - N Soylu
- Department of Child and Adolescent Psychiatry, Inonu University Turgut Ozal Medical Center, Malatya, Turkey
| | - O O Ozcan
- Department of Child and Adolescent Psychiatry, Inonu University Turgut Ozal Medical Center, Malatya, Turkey
| | - M H Celiksoy
- Department of Pediatric Allergy and Immunology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - A Babayiğit
- Department of Pediatric Allergy and Immunology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - D Erge
- Department of Pediatric Allergy and Immunology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - H T E Karakoç
- Department of Pediatric Allergy and Immunology, Inonu University Turgut Ozal Medical Center, Malatya, Turkey
| | - R Sancak
- Department of Pediatric Allergy and Immunology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| |
Collapse
|
29
|
Pedrosa M, Boyano-Martínez T, García-Ara C, Quirce S. Shellfish Allergy: a Comprehensive Review. Clin Rev Allergy Immunol 2016; 49:203-16. [PMID: 24870065 DOI: 10.1007/s12016-014-8429-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Shellfish allergy is of increasing concern, as its prevalence has risen in recent years. Many advances have been made in allergen characterization. B cell epitopes in the major allergen tropomyosin have been characterized. In addition to tropomyosin, arginine kinase, sarcoplasmic calcium-binding protein, and myosin light chain have recently been reported in shellfish. All are proteins that play a role in muscular contraction. Additional allergens such as hemocyanin have also been described. The effect of processing methods on these allergens has been studied, revealing thermal stability and resistance to peptic digestion in some cases. Modifications after Maillard reactions have also been addressed, although in some cases with conflicting results. In recent years, new hypoallergenic molecules have been developed, which constitute a new therapeutic approach to allergic disorders. A recombinant hypoallergenic tropomyosin has been developed, which opens a new avenue in the treatment of shellfish allergy. Cross-reactivity with species that are not closely related is common in shellfish-allergic patients, as many of shellfish allergens are widely distributed panallergens in invertebrates. Cross-reactivity with house dust mites is well known, but other species can also be involved in this phenomenon.
Collapse
Affiliation(s)
- María Pedrosa
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain.
| | - Teresa Boyano-Martínez
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Carmen García-Ara
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Santiago Quirce
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
| |
Collapse
|
30
|
Chen X, Negi SS, Liao S, Gao V, Braun W, Dreskin SC. Conformational IgE epitopes of peanut allergens Ara h 2 and Ara h 6. Clin Exp Allergy 2016; 46:1120-1128. [PMID: 27238146 DOI: 10.1111/cea.12764] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/11/2016] [Accepted: 05/14/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cross-linking of IgE antibody by specific epitopes on the surface of mast cells is a prerequisite for triggering symptoms of peanut allergy. IgE epitopes are frequently categorized as linear or conformational epitopes. Although linear IgE-binding epitopes of peanut allergens have been defined, little is known about conformational IgE-binding epitopes. OBJECTIVE To identify clinically relevant conformational IgE epitopes of the two most important peanut allergens, Ara h 2 and Ara h 6, using phage peptide library. METHODS A phage 12mer peptide library was screened with allergen-specific IgE from 4 peanut-allergic patients. Binding of the mimotopes to IgE from a total of 29 peanut-allergic subjects was measured by ELISA. The mimotope sequences were mapped on the surface areas of Ara h 2 and Ara h 6 using EpiSearch. RESULTS Forty-one individual mimotopes were identified that specifically bind anti- Ara h 2/Ara h 6 IgE as well as rabbit anti-Ara h 2 and anti-Ara h 6 IgG. Sequence alignment showed that none of the mimotope sequences match a linear segment of the Ara h 2 or Ara h 6 sequences. EpiSearch analysis showed that all the mimotopes mapped to surface patches of Ara h 2 and Ara h 6. Eight of the mimotopes were recognized by more than 90% of the patients, suggesting immunodominance. Each patient had distinct IgE recognition patterns but the recognition frequency was not correlated to the concentration of peanut specific IgE or to clinical history. CONCLUSIONS The mimotopes identified in this study represent conformational epitopes. Identification of similar surface patches on Ara h 2 and Ara h 6 further underscores the similarities between these two potent allergens.
Collapse
Affiliation(s)
- Xueni Chen
- Division of Allergy and Clinical Immunology, Departments of Medicine and Immunology, University of Colorado Denver, Aurora, CO
| | - Surendra S Negi
- Sealy Center for Structural Biology and Molecular Biophysics, Department of Biochemistry and Molecular Biology, The University of Texas Medical Branch, Galveston, TX 77555
| | - Sumei Liao
- Division of Allergy and Clinical Immunology, Departments of Medicine and Immunology, University of Colorado Denver, Aurora, CO
| | - Valerie Gao
- Molecular Cellular Developmental Biology, University of Colorado, Boulder, CO
| | - Werner Braun
- Sealy Center for Structural Biology and Molecular Biophysics, Department of Biochemistry and Molecular Biology, The University of Texas Medical Branch, Galveston, TX 77555
| | - Stephen C Dreskin
- Division of Allergy and Clinical Immunology, Departments of Medicine and Immunology, University of Colorado Denver, Aurora, CO
| |
Collapse
|
31
|
Porcaro F, Caminiti L, Crisafulli G, Arasi S, Chiera F, La Monica G, Pajno GB. Management of Food Allergy to Fish with Oral Immunotherapy: A Pediatric Case Report. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2016; 29:104-107. [PMID: 35923026 DOI: 10.1089/ped.2015.0593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Fish allergy represents a persistent allergic disorder that usually does not improve spontaneously. Because neither fully effective therapeutic strategy nor truly curative approaches are currently available for food allergy, we report herein a case of fish allergy in a 11-year-old male patient treated with Oral Immunotherapy (OIT). The patient at the age of 4 years, for the first time, experienced immediate urticaria and angioedema, rhinitis, cough, and dyspnea after ingestion of both salmon and codfish. Skin prick test, specific IgE, and oral food challenge (OFC) were positive for both salmon and codfish. Therefore, positive allergy tests and challenge confirmed allergy to fish. The patient underwent oral administration of increasing doses of the offending food. He was initially treated by OIT using dehydrated codfish. When the dosage of 1 g was achieved and tolerated by the patient, a desensitization regimen was continued through the administration of cooked codfish. At the end of the protocol, the patient achieved desensitization also confirmed by negative OFC with fish. This case suggests that OIT could be used for treatment of food allergy caused by fish with successful results.
Collapse
Affiliation(s)
- Federica Porcaro
- Allergy Unit, Department of Paediatrics, University of Messina, Via Consolare Valeria, Messina 98125, Italy
| | - Lucia Caminiti
- Allergy Unit, Department of Paediatrics, University of Messina, Via Consolare Valeria, Messina 98125, Italy
| | - Giuseppe Crisafulli
- Allergy Unit, Department of Paediatrics, University of Messina, Via Consolare Valeria, Messina 98125, Italy
| | - Stefania Arasi
- Allergy Unit, Department of Paediatrics, University of Messina, Via Consolare Valeria, Messina 98125, Italy
| | - Fernanda Chiera
- Allergy Unit, Department of Paediatrics, University of Messina, Via Consolare Valeria, Messina 98125, Italy
| | - Giuseppina La Monica
- Allergy Unit, Department of Paediatrics, University of Messina, Via Consolare Valeria, Messina 98125, Italy
| | - Giovanni Battista Pajno
- Allergy Unit, Department of Paediatrics, University of Messina, Via Consolare Valeria, Messina 98125, Italy
| |
Collapse
|
32
|
Andersen HH, Lundgaard AC, Petersen AS, Hauberg LE, Sharma N, Hansen SD, Elberling J, Arendt-Nielsen L. The Lancet Weight Determines Wheal Diameter in Response to Skin Prick Testing with Histamine. PLoS One 2016; 11:e0156211. [PMID: 27213613 PMCID: PMC4877047 DOI: 10.1371/journal.pone.0156211] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 05/03/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Skin prick test (SPT) is a common test for diagnosing immunoglobulin E-mediated allergies. In clinical routine, technicalities, human errors or patient-related biases, occasionally results in suboptimal diagnosis of sensitization. OBJECTIVE Although not previously assessed qualitatively, lancet weight is hypothesized to be important when performing SPT to minimize the frequency of false positives, false negatives, and unwanted discomfort. METHODS Accurate weight-controlled SPT was performed on the volar forearms and backs of 20 healthy subjects. Four predetermined lancet weights were applied (25 g, 85 g, 135 g and 265 g) using two positive control histamine solutions (1 mg/mL and 10 mg/mL) and one negative control (saline). A total of 400 SPTs were conducted. The outcome parameters were: wheal size, neurogenic inflammation (measured by superficial blood perfusion), frequency of bleeding, and the lancet provoked pain response. RESULTS The mean wheal diameter increased significantly as higher weights were applied to the SPT lancet, e.g. from 3.2 ± 0.28 mm at 25 g to 5.4 ± 1.7 mm at 265 g (p<0.01). Similarly, the frequency of bleeding, the provoked pain, and the neurogenic inflammatory response increased significantly. At 265 g saline evoked two wheal responses (/160 pricks) below 3 mm. CONCLUSION AND CLINICAL RELEVANCE The applied weight of the lancet during the SPT-procedure is an important factor. Higher lancet weights precipitate significantly larger wheal reactions with potential diagnostic implications. This warrants additional research of the optimal lancet weight in relation to SPT-guidelines to improve the specificity and sensitivity of the procedure.
Collapse
Affiliation(s)
- Hjalte H. Andersen
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Anna Charlotte Lundgaard
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Anne S. Petersen
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Lise E. Hauberg
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Neha Sharma
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Sofie D. Hansen
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Jesper Elberling
- The Allergy Clinic, Copenhagen University Hospital, Gentofte, Copenhagen, Denmark
| | - Lars Arendt-Nielsen
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
33
|
Kool B, Chandra D, Fitzharris P. Adult food-induced anaphylaxis hospital presentations in New Zealand. Postgrad Med J 2016; 92:640-644. [DOI: 10.1136/postgradmedj-2015-133530] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 03/01/2016] [Accepted: 03/18/2016] [Indexed: 11/04/2022]
|
34
|
Kaczmarski M, Bartuzi Z. Wybrane aspekty epidemiologiczne alergii pokarmowej wieku dziecięco-młodzieżowego i dorosłego. ALERGOLOGIA POLSKA-POLISH JOURNAL OF ALLERGOLOGY 2016. [DOI: 10.1016/j.alergo.2016.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
35
|
Calderon-Rodriguez S, Pineda F, Perez R, Muñoz C. Tolerability to dogfish in children with fish allergy. Allergol Immunopathol (Madr) 2016; 44:167-9. [PMID: 26337570 DOI: 10.1016/j.aller.2015.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/22/2015] [Accepted: 05/26/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Fish is a potent food allergen. The aim of this work is to demonstrate that dogfish, a small shark, has low allergenicity in both its clinical tolerance as well as its molecular structure. METHODS We present a study of 34 paediatric patients with IgE-mediated immediate reactions after eating fish. The diagnosis of several fish allergies was demonstrated by skin prick techniques and determination of specific IgE, in all the cases excluding sensitisation to Anisakis simplex. Open oral challenge test was checked with dogfish. Analysis was by SDS-PAGE of dogfish and other fish (megrim, shark, hake, sole, cod, anchovy and tuna) and Western-blot with "pool" of patients polysensitised sera against extracts of dogfish and other fish, and ELISA - inhibition with the "pool" sera. RESULTS The prick-prick with raw dogfish was slightly positive in six patients, however cooked was negative in 34 cases. The specific IgE showed in the 34 cases class ≥2 for megrim, hake, sole, cod and anchovy, class 0 for tuna in 26 patients, class 0 for emperor in 18 patients and class 0 to Anisakis simplex in all cases. The IgE binding capacity for proteins of allergenic extracts of tested fish revealed, in immunoblotting, the absence of IgE-mediated recognition abstract dogfish by the "pool" of polysensitised patient sera. CONCLUSIONS Testing in vivo and in vitro demonstrated the low allergenicity of dogfish. Dogfish brings an alternative to eating fish in polysensitised patients.
Collapse
|
36
|
Xepapadaki P, Fiocchi A, Grabenhenrich L, Roberts G, Grimshaw KEC, Fiandor A, Larco JI, Sigurdardottir S, Clausen M, Papadopoulos NG, Dahdah L, Mackie A, Sprikkelman AB, Schoemaker AA, Dubakiene R, Butiene I, Kowalski ML, Zeman K, Gavrili S, Keil T, Beyer K. Incidence and natural history of hen's egg allergy in the first 2 years of life-the EuroPrevall birth cohort study. Allergy 2016; 71:350-7. [PMID: 26514330 DOI: 10.1111/all.12801] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Parents and health staff perceive hen's egg allergy (HEA) as a common food allergy in early childhood, but the true incidence is unclear because population-based studies with gold-standard diagnostic criteria are lacking. OBJECTIVE To establish the incidence and course of challenge-confirmed HEA in children, from birth until the age of 24 months, in different European regions. METHODS In the EuroPrevall birth cohort study, children with a suspected HEA and their age-matched controls were evaluated in 9 countries, using a standardized protocol including measurement of HE-specific immunoglobulin E-antibodies in serum, skin prick tests, and double-blind, placebo-controlled food challenges (DBPCFC). RESULTS Across Europe, 12 049 newborns were enrolled, and 9336 (77.5%) were followed up to 2 years of age. In 298 children, HEA was suspected and DBPCFC was offered. HEA by age two was confirmed in 86 of 172 challenged children (mean raw incidence 0.84%, 95% confidence interval (95% CI) 0.67-1.03). Adjusted mean incidence of HEA was 1.23% (95% CI 0.98-1.51) considering possible cases among eligible children who were not challenged. Centre-specific incidence ranged from United Kingdom (2.18%, 95% CI 1.27-3.47) to Greece (0.07%). Half of the HE-allergic children became tolerant to HE within 1 year after the initial diagnosis. CONCLUSIONS The largest multinational European birth cohort study on food allergy with gold-standard diagnostic methods showed that the mean adjusted incidence of HEA was considerably lower than previously documented, although differences in incidence rates among countries were noted. Half of the children with documented HEA gained tolerance within 1 year postdiagnosis.
Collapse
Affiliation(s)
- P. Xepapadaki
- Allergy Unit; 2nd Pediatric Clinic; University of Athens; Athens Greece
| | - A. Fiocchi
- Division of Allergy; Pediatric Hospital Bambino Gesù; Rome Italy
| | - L. Grabenhenrich
- Institute of Social Medicine, Epidemiology and Health Economics; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - G. Roberts
- Clinical and Experimental Sciences Academic Units; Faculty of Medicine; University of Southampton; Southampton UK
| | - K. E. C. Grimshaw
- Clinical and Experimental Sciences Academic Units; Faculty of Medicine; University of Southampton; Southampton UK
| | - A. Fiandor
- Department of Allergy; Hospital La Paz Institute for Health Research; Madrid Spain
| | - J. I. Larco
- Department of Allergy; Hospital La Paz Institute for Health Research; Madrid Spain
| | - S. Sigurdardottir
- Department of Immunology; Landspitali - The National University Hospital of Iceland; Reykjavik Iceland
| | - M. Clausen
- Children's Hospital; Landspitali - The National University Hospital of Iceland; Reykjavik Iceland
| | - N. G. Papadopoulos
- Allergy Unit; 2nd Pediatric Clinic; University of Athens; Athens Greece
- Centre for Paediatrics and Child Health; Institute of Human Development; University of Manchester; Manchester UK
| | - L. Dahdah
- Division of Allergy; Pediatric Hospital Bambino Gesù; Rome Italy
| | - A. Mackie
- Institute of Food Research; Norwich Research Park; Colney Norwich UK
| | - A. B. Sprikkelman
- Department of Pediatric Respiratory Medicine and Allergy; Emma Children's Hospital; Academic Medical Center; Amsterdam The Netherlands
| | - A. A. Schoemaker
- Department of Pediatric Respiratory Medicine and Allergy; Emma Children's Hospital; Academic Medical Center; Amsterdam The Netherlands
| | - R. Dubakiene
- Vilnius University Faculty of Medicine; Vilnius Lithuania
| | - I. Butiene
- Faculty of Health Sciences; Klaipeda University; Klaipeda Lithuania
| | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy; Medical University of Lodz; Lodz Poland
| | - K. Zeman
- Department of Pediatrics, Immunology and Nephrology; Polish Mother's Health Centre Research Institute Łódź; Lodz Poland
| | - S. Gavrili
- Neonatal Intensive Care Unit; Alexandra University Hospital; Athens Greece
| | - T. Keil
- Institute of Social Medicine, Epidemiology and Health Economics; Charité - Universitätsmedizin Berlin; Berlin Germany
- Institute for Clinical Epidemiology and Biometry; University of Würzburg; Würzburg Germany
| | - K. Beyer
- Department of Paediatric Pneumonology and Immunology; Charité - Universitätsmedizin Berlin; Berlin Germany
| |
Collapse
|
37
|
Quirce S, Boyano-Martínez T, Díaz-Perales A. Clinical presentation, allergens, and management of wheat allergy. Expert Rev Clin Immunol 2016; 12:563-72. [PMID: 26800201 DOI: 10.1586/1744666x.2016.1145548] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IgE-mediated allergy to wheat proteins can be caused by exposure through ingestion, inhalation, or skin/mucosal contact, and can affect various populations and age groups. Respiratory allergy to wheat proteins is commonly observed in adult patients occupationally exposed to flour, whereas wheat food allergy is more common in children. Wheat allergy is of growing importance for patients with recurrent anaphylaxis, especially when exercise related. The diagnosis of wheat allergy relies on a consistent clinical history, skin prick testing with well-characterized extracts and specific IgE tests. The accuracy of wheat allergy diagnosis may be improved by measuring IgE responses to several wheat components. However, a high degree of heterogeneity has been found in the recognition pattern of allergens among patient groups with different clinical profiles, as well as within each group. Thus, oral provocation with wheat or the implicated cereal is the reference test for the definitive diagnosis of ingested wheat/cereal allergy.
Collapse
Affiliation(s)
- Santiago Quirce
- a Department of Allergy , Hospital La Paz Institute for Health Research (IdiPAZ) , Madrid , Spain.,b CIBER of Respiratory Diseases CIBERES , Madrid , Spain
| | - Teresa Boyano-Martínez
- a Department of Allergy , Hospital La Paz Institute for Health Research (IdiPAZ) , Madrid , Spain
| | - Araceli Díaz-Perales
- c Centro de Biotecnología y Genómica de Plantas (UPM-INIA) , Pozuelo de Alarcón , Madrid , Spain
| |
Collapse
|
38
|
RANGEL AHDN, SALES DC, URBANO SA, GALVÃO JÚNIOR JGB, ANDRADE NETO JCD, MACÊDO CDS. Lactose intolerance and cow's milk protein allergy. FOOD SCIENCE AND TECHNOLOGY 2016. [DOI: 10.1590/1678-457x.0019] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
39
|
Affiliation(s)
- Anita L Kozyrskyj
- a Department of Pediatrics , University of Alberta , Edmonton , Canada
| |
Collapse
|
40
|
Otsu K, Guo R, Dreskin SC. Epitope analysis of Ara h 2 and Ara h 6: characteristic patterns of IgE-binding fingerprints among individuals with similar clinical histories. Clin Exp Allergy 2015; 45:471-84. [PMID: 25213872 DOI: 10.1111/cea.12407] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 07/15/2014] [Accepted: 08/14/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ara h 2 and Ara h 6 are moderately homologous and highly potent peanut allergens. OBJECTIVE To identify IgE-binding linear epitopes of Ara h 6, compare them to those of Ara h 2, and to stratify binding based on clinical histories. METHODS Thirty highly peanut-allergic subjects were stratified by clinical history. Sera were diluted to contain the same amount of anti-peanut IgE. IgE binding to overlapping 20-mer peptides of Ara h 2 and Ara h 6 was assessed using microarrays. RESULTS Each subject had a unique IgE-binding fingerprint to peptides; these data were coalesced into epitope binding. IgE from subjects with a history of more severe reactions (n = 19) had a smaller frequency of binding events (BEs) for both Ara h 2 (52 BEs of 152 (19X8epitopes) possible BEs and Ara h 6 (13 BEs of 133 (19X7 epitopes) possible BEs) compared to IgE from those with milder histories (n = 11) (Ara h 2: 47 BEs of 88 (11X8 epitopes) possible BEs, P < 0.01; Ara h 6: 25 BEs of 77 (11X7 epitopes) possible BEs, P < 0.001). Using an unsupervised hierarchal cluster analysis, subjects with similar histories tended to cluster. We have tentatively identified a high-risk pattern of binding to peptides of Ara h 2 and Ara h 6, predominantly in subjects with a history of more severe reactions (OR = 12.6; 95% CI: 2.0-79.5; P < 0.01). CONCLUSIONS AND CLINICAL RELEVANCE IgE from patients with more severe clinical histories recognize fewer linear epitopes of Ara h 2 and Ara h 6 than do subjects with milder reactions and bind these epitopes in characteristic patterns. Close examination of IgE binding to epitopes of Ara h 2 and Ara h 6 may have prognostic value.
Collapse
Affiliation(s)
- K Otsu
- Division of Allergy and Clinical Immunology and Departments of Medicine and Immunology, University of Colorado Denver, Aurora, CO, USA
| | | | | |
Collapse
|
41
|
Increased intake of vegetable oil rich in n-6 PUFA enhances allergic symptoms and prevents oral tolerance induction in whey-allergic mice. Br J Nutr 2015; 114:577-85. [PMID: 26179875 DOI: 10.1017/s0007114515002007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Increased intake of vegetable oils rich in n-6 PUFA, including soyabean oil, has been associated with an increase in allergic disease. The present study aimed to determine the effect of an increasing dose of dietary vegetable oil on allergic outcomes in mice. To study this, mice received a 7 v. 10 % soyabean oil diet before and during oral sensitisation with whey or whey hyperimmune serum transfer. Another group of mice received partial whey hydrolysate (pWH) while being fed the diets before oral sensitisation. The acute allergic skin response, serum Ig level, mouse mast cell protease-1 (mMCP-1) concentration and/or splenic T-cell percentages were determined upon whey challenge. When the diets were provided before and during oral sensitisation, the acute allergic skin response was increased in mice fed the 10 % soyabean oil diet compared with the 7 % soyabean oil diet. Whey IgE and IgG1 levels remained unaltered, whereas mMCP-1 levels increased in mice fed the 10 % soyabean oil diet. Furthermore, allergic symptoms were increased in naive mice fed the 10 % soyabean oil diet and sensitised with whey hyperimmune serum. In addition to enhancing the mast cell response, the 10 % soyabean oil diet increased the percentage of activated Th1 and Th2 cells as well as increased the ratios of Th2:regulatory T cells and Th2:Th1 when compared with the 7 % soyabean oil diet. Oral tolerance induction by pWH was abrogated in mice fed the 10 % soyabean oil diet compared with those fed the 7 % soyabean oil diet during pretreatment with pWH. In conclusion, increased intake of soyabean oil rich in n-6 PUFA suppresses tolerance induction by pWH and enhances the severity of the allergic effector response in whey-allergic mice. Dietary vegetable oils rich in n-6 PUFA may enhance the susceptibility to develop or sustain food allergy.
Collapse
|
42
|
Dickel H, Bruckner T, Altmeyer P, Künzlberger B. [Seafood allergy in cooks: a case series and review of the literature]. J Dtsch Dermatol Ges 2015; 12:891-902. [PMID: 25262894 DOI: 10.1111/ddg.12456_suppl] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 07/23/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Seafood is a very potent allergen. Epidemiological studies of seafood allergy in the highly exposed cooking profession are lacking. The objective of this first case series was to demonstrate the high relevance and consequences of seafood allergy in cooks. PATIENTS UND METHODS: Retrospective analysis of all the case files sent in which the presence of an occupational disease according to no. 5101 of the appendix of the German ordinance on industrial disease was to be clarified. RESULTS Thirty cooks (men 70 %) with an occupational seafood allergy were assessed between January 2008 and April 2014. Seafood allergy was observed in youngish workers(median age 24.7 yrs.) with an early manifestation of the disease (after 1.7 yrs. of occupation in median). In all except one (96.7 %) onset was localized on the hands.Most commonly documented were immediate sensitizations to cod, salmon, trout,and herring. Emergency treatment due to an anaphylactic shock at the workplace became necessary in 5 cases (16.7 %). In 27 cases (90 %) discontinuation of occupation was needed and was carried out after 6.3 yrs. of occupation in median. CONCLUSIONS Seafood allergy in cooks is mostly characterized by a quick progressive course of disease, already at the start of the cooking career. The prognosis for continuance in occupation is poor and an occupational disease is to be considered at a nearly stage. An emergency kit with an epinephrine auto-injector should be provided for life by the responsible accident insurer.
Collapse
Affiliation(s)
- Heinrich Dickel
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Bochum
| | | | | | | |
Collapse
|
43
|
Basera W, Botha M, Gray CL, Lunjani N, Watkins ASM, Venter C, Allen KJ, Hlela C, Zar HJ, Levin ME. The South African Food Sensitisation and Food Allergy population-based study of IgE-mediated food allergy: validity, safety, and acceptability. Ann Allergy Asthma Immunol 2015; 115:113-9. [PMID: 26105048 DOI: 10.1016/j.anai.2015.06.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 05/25/2015] [Accepted: 06/03/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Few studies exist on food sensitization and challenge-proven food allergy in low- and middle-income countries. OBJECTIVE To describe the study design and methodology to recruit infants from an African population for skin prick testing and oral food challenges and the use of preliminary data to investigate the extent to which the study sample is representative of the target population. METHODS Children 12 to 36 months old were recruited from childcare education facilities in Cape Town. Children underwent skin prick testing to foods. Those with a reactive wheal of at least 1 mm larger than the negative control and not clearly tolerant according to history to a full age-appropriate portion to at least 1 food underwent oral food challenges. Parents who chose not to participate completed a nonparticipant questionnaire. Interim analysis of at least 500 respondents was performed. Demographic features of participating children were compared with those of nonparticipants and the population demographics of the most recent Cape Town census data. RESULTS The response rate was 60.1%, with high participation and completion rates of 96.5% and 97.5%, respectively. Demographics of the completed participant sample were similar to those of the Cape Town census. Use of a nonrespondent questionnaire indicated no selection bias in favor of increased participation of participants with allergy. No ethnic differences in sensitization or food allergy were evident. CONCLUSION The study was safe and feasible and the recruitment was effective and representative of the target population. Future studies will aim to increase the precision of the prevalence of food sensitization and allergy, describe environmental risk factors, and include a rural black African cohort.
Collapse
Affiliation(s)
- Wisdom Basera
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Maresa Botha
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Claudia L Gray
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Nonhlanhla Lunjani
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Alexandra S M Watkins
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; University of Southampton, Southampton, United Kingdom
| | - Carina Venter
- The David Hide Asthma and Allergy Research Centre, Newport, Isle of Wight, United Kingdom; University of Portsmouth, Portsmouth, United Kingdom
| | - Katrina J Allen
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia; University of Manchester, Manchester, United Kingdom
| | - Carol Hlela
- Department of Dermatology, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; MRC Unit of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Michael E Levin
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
| |
Collapse
|
44
|
Meyer R, De Koker C, Dziubak R, Skrapac AK, Godwin H, Reeve K, Chebar-Lozinsky A, Shah N. A practical approach to vitamin and mineral supplementation in food allergic children. Clin Transl Allergy 2015; 5:11. [PMID: 25780558 PMCID: PMC4361144 DOI: 10.1186/s13601-015-0054-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/23/2015] [Indexed: 01/05/2023] Open
Abstract
Background The management of food allergy in children requires elimination of the offending allergens, which significantly contribute to micronutrient intake. Vitamin and mineral supplementation are commonly suggested as part of dietary management. However a targeted supplementation regime requires a complete nutritional assessment, which includes food diaries. Ideally these should be analysed using a computerised program, but are very time consuming. We therefore set out to evaluate current practice of vitamin and mineral supplementation in a cohort of children with non-Immunoglobulin E (IgE) mediated food allergies. Methods This prospective, observational study recruited children aged 4 weeks – 16 years, who required to follow an elimination diet for non-IgE mediated allergies. Only children that improved according to a symptom score and were on a vitamin and/or mineral supplement were included. A 3-day food diary including vitamin and mineral supplementation was recorded and analysed using Dietplan computer program. We assessed dietary adequacy with/without the supplement using the Dietary Reference Values. Results One hundred-and-ten children had completed food diaries and of these 29% (32/110) were taking vitamin and/or mineral supplements. Children on hypoallergenic formulas were significantly (p = 0.007) less likely to be on supplements than those on alternative over-the-counter milks. Seventy-one percent had prescribable supplements, suggested by a dietitian/physician. Sixty percent of those without a vitamin supplement had a low vitamin D intake, but low zinc, calcium and selenium was also common. Of the supplemented cohort many continued to be either under or over-supplemented. Conclusion This study has raised the question for the first time, whether clinicians dealing with paediatric food allergies should consider routine vitamin and/or mineral supplements in the light of deficient intake being so common in addition to being so difficult to predict.
Collapse
Affiliation(s)
- Rosan Meyer
- Department Gastroenterology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK
| | - Claire De Koker
- Department Nutrition and Dietetics, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Robert Dziubak
- Department Gastroenterology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK
| | - Ana-Kristina Skrapac
- Department Nutrition and Dietetics, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Heather Godwin
- Department Gastroenterology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK
| | - Kate Reeve
- Department Gastroenterology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK
| | - Adriana Chebar-Lozinsky
- Department Gastroenterology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK
| | - Neil Shah
- Department Gastroenterology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK ; Institute of Child Health, University College London, London, UK
| |
Collapse
|
45
|
Azad MB, Konya T, Guttman DS, Field CJ, Sears MR, HayGlass KT, Mandhane PJ, Turvey SE, Subbarao P, Becker AB, Scott JA, Kozyrskyj AL. Infant gut microbiota and food sensitization: associations in the first year of life. Clin Exp Allergy 2015; 45:632-43. [DOI: 10.1111/cea.12487] [Citation(s) in RCA: 276] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/22/2014] [Accepted: 12/21/2014] [Indexed: 12/20/2022]
Affiliation(s)
- M. B. Azad
- Department of Pediatrics; School of Public Health; University of Alberta; Edmonton AB Canada
- Department of Pediatrics & Child Health; Children's Hospital Research Institute of Manitoba; University of Manitoba; Winnipeg MB Canada
| | - T. Konya
- Dalla Lana School of Public Health; University of Toronto; Toronto ON Canada
| | - D. S. Guttman
- Centre for the Analysis of Genome Evolution and Function; University of Toronto; Toronto ON Canada
| | - C. J. Field
- Department of Agricultural, Food & Nutritional Science; University of Alberta; Edmonton AB Canada
| | - M. R. Sears
- Department of Medicine; McMaster University; Hamilton ON Canada
| | - K. T. HayGlass
- Department of Immunology; University of Manitoba; Winnipeg MB Canada
| | - P. J. Mandhane
- Department of Pediatrics; School of Public Health; University of Alberta; Edmonton AB Canada
| | - S. E. Turvey
- Department of Pediatrics, Child & Family Research Institute; BC Children's Hospital; University of British Columbia; Vancouver BC Canada
| | - P. Subbarao
- Department of Pediatrics; Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - A. B. Becker
- Department of Pediatrics & Child Health; Children's Hospital Research Institute of Manitoba; University of Manitoba; Winnipeg MB Canada
| | - J. A. Scott
- Dalla Lana School of Public Health; University of Toronto; Toronto ON Canada
| | - A. L. Kozyrskyj
- Department of Pediatrics; School of Public Health; University of Alberta; Edmonton AB Canada
- Department of Community Health Sciences; University of Manitoba; Winnipeg MB Canada
| | | |
Collapse
|
46
|
Abstract
PURPOSE OF REVIEW To summarize the latest information on the nutritional management of food protein-induced enterocolitis syndrome (FPIES), focusing on the foods implicated and how to avoid these whilst maintaining a nutritionally sound diet. RECENT FINDINGS A number of foods are implicated in FPIES such as milk, soy and grains, particularly rice. The number of foods implicated in FPIES per individual differs, but the majority of reported cases have two or fewer food triggers involved. SUMMARY FPIES is a complex presentation of non-IgE-mediated food allergy. Dietary management is complicated as both common food allergens as well as atypical food allergens can trigger FPIES. Sound nutritional advice is required to ensure appropriate food avoidance, adequate consumption of other foods and sufficient nutritional intake to maintain and ensure growth and development.
Collapse
|
47
|
van den Elsen LWJ, Bol-Schoenmakers M, van Esch BCAM, Hofman GA, van de Heijning BJM, Pieters RH, Smit JJ, Garssen J, Willemsen LEM. DHA-rich tuna oil effectively suppresses allergic symptoms in mice allergic to whey or peanut. J Nutr 2014; 144:1970-6. [PMID: 25342698 DOI: 10.3945/jn.114.198515] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Supplementation with long-chain n-3 polyunsaturated fatty acids (LCPUFAs) has been found to reduce the development of allergic disease. OBJECTIVE The aim of this study was to compare the effectiveness of fish oil diets rich in eicosapentaenoic acid (20:5n-3; EPA) or docosahexaenoic acid (22:6n-3; DHA) in suppressing food allergic symptoms. METHODS Mice were fed a control diet (10% soybean oil) or fish oil diet rich in EPA (4% soybean oil + 6% EPA oil containing 28.8% EPA and 13.7% DHA) or DHA (4% soybean oil + 6% DHA oil containing 7% EPA and 27.8% DHA), starting 14 d before and for 5 wk during oral sensitization with peanut extract (PE) or whey. Acute allergic skin responses, serum immunoglobulins (Igs), and mucosal mast cell protease-1 (mmcp-1) were assessed. Hyperimmune serum was transferred to naive recipient mice fed the different diets. RESULTS The DHA diet effectively reduced the acute allergic skin response compared with the control or EPA diet in PE-allergic mice (control, 159 ± 15, or EPA, 129 ± 8, vs. DHA, 78 ± 7 μm; P < 0.0001 or P < 0.05, respectively). In contrast, both the DHA and EPA diets reduced the allergic skin response in whey allergic mice (control, 169 ± 9, vs. DHA, 91 ± 13, or EPA, 106 ± 14 μm; P < 0.001 or P < 0.01, respectively); however, only the DHA diet reduced mmcp-1 and whey-specific IgE and IgG1. The DHA and EPA diets also reduced the acute skin response in passively immunized mice. CONCLUSIONS The DHA-rich fish oil diet reduced allergic sensitization to whey and allergic symptoms in both PE- and whey-allergic mice. These data suggest that DHA-rich fish oil is useful as an intervention to prevent or treat food allergy symptoms.
Collapse
Affiliation(s)
| | | | - Betty C A M van Esch
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science Nutricia Research, Centre for Specialised Nutrition, Utrecht, The Netherlands
| | - Gerard A Hofman
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science
| | | | - Raymond H Pieters
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands; and
| | - Joost J Smit
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands; and
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science Nutricia Research, Centre for Specialised Nutrition, Utrecht, The Netherlands
| | - Linette E M Willemsen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science
| |
Collapse
|
48
|
Shanahan L, Zucker N, Copeland WE, Costello EJ, Angold A. Are children and adolescents with food allergies at increased risk for psychopathology? J Psychosom Res 2014; 77:468-73. [PMID: 25454290 PMCID: PMC4307934 DOI: 10.1016/j.jpsychores.2014.10.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 10/02/2014] [Accepted: 10/07/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Living with food allergy is a unique and potentially life-threatening stressor that requires constant vigilance to food-related stimuli, but little is known about whether adolescents with food allergies are at increased risk for psychopathology-concurrently and over time. METHODS Data came from the prospective-longitudinal Great Smoky Mountains Study. Adolescents (N=1420) were recruited from the community, and interviewed up to six times between ages 10 and 16 for the purpose of the present analyses. At each assessment, adolescents and one parent were interviewed using the Child and Adolescent Psychiatric Assessment, resulting in N=5165 pairs of interviews. RESULTS Cross-sectionally, food allergies were associated with more symptoms of separation and generalized anxiety, disorder, attention deficit and hyperactivity disorder, and anorexia nervosa. Longitudinally, adolescents with food allergy experienced increases in symptoms of generalized anxiety disorder and depression from one assessment to the next. Food allergies were not, however, associated with a higher likelihood of meeting diagnostic criteria for a psychiatric disorder. CONCLUSION The unique constellation of adolescents' increased symptoms of psychopathology in the context of food allergy likely reflects an adaptive increase in vigilance rather than cohesive syndromes of psychopathology. Support and guidance from health care providers is needed to help adolescents with food allergies and their caregivers achieve an optimal balance between necessary vigilance and hypervigilance and unnecessary restriction.
Collapse
Affiliation(s)
- Lilly Shanahan
- University of North Carolina at Chapel Hill, United States.
| | - Nancy Zucker
- Developmental Epidemiology Program, Duke University Medical Center
,Duke Center for Eating Disorders
| | | | - E. Jane Costello
- Developmental Epidemiology Program, Duke University Medical Center
| | - Adrian Angold
- Developmental Epidemiology Program, Duke University Medical Center
| |
Collapse
|
49
|
Lebel MJ, Chapdelaine H, Paradis L, Des Roches A, Alvarez F. Increase in de novo food allergies after pediatric liver transplantation: tacrolimus vs. cyclosporine immunosuppression. Pediatr Transplant 2014; 18:733-9. [PMID: 25156571 DOI: 10.1111/petr.12342] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2014] [Indexed: 01/28/2023]
Abstract
Post-TAFA is an uncommon but serious complication of organ transplantation. This study aimed to compare the incidence of FA in CsA and tacrolimus-treated children following OLT and identify risk factors. The medical charts of all patients who underwent OLT at our institution were reviewed. Between 1985 and 2010, 218 OLTs were performed on 188 pediatric recipients, of which 154 were included in the study. Three patients (3%) of the 102 receiving CsA developed FA, compared with nine (17%) in the 52 tacrolimus-treated patients, the latter exceeding general population reported FA prevalence (RR 5.88; 95% CI: 1.66-20.81). All TAFA cases underwent transplantation before the age of three with an incidence of 29% (9/31) in the tacrolimus-treated children in comparison with 7% (3/41) in the CsA group (RR 3.97; 95% CI: 1.17-13.45). Eosinophilia was present in 81% of children receiving tacrolimus compared with 54% in the CsA group (p = 0.002). We observed a statistically significant increase incidence of FA in tacrolimus-treated children following an OLT and those under the age of three are particularly vulnerable. The underlying process is still unknown and probably multifactorial.
Collapse
Affiliation(s)
- Marie-Jeanne Lebel
- Centre Hospitalier Universitaire Mère-enfant Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | | | | | | | | |
Collapse
|
50
|
Dickel H, Bruckner T, Altmeyer P, Künzlberger B. Seafood allergy in cooks: a case series and review of the literature. J Dtsch Dermatol Ges 2014. [DOI: 10.1111/ddg.12456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Heinrich Dickel
- Department of Dermatology, Venereology, and Allergology, St. Josef-Hospital, University Hospital of the Ruhr-University Bochum; Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg; Germany
| | - Peter Altmeyer
- Department of Dermatology, Venereology, and Allergology, St. Josef-Hospital, University Hospital of the Ruhr-University Bochum; Germany
| | | |
Collapse
|