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Chong T, Olivieri B, Skypala IJ. Food-triggered anaphylaxis in adults. Curr Opin Allergy Clin Immunol 2024; 24:341-348. [PMID: 39079158 DOI: 10.1097/aci.0000000000001008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024]
Abstract
PURPOSE OF REVIEW Adult food allergy, either unresolved from childhood, or new-onset in adult-life, is known to be increasingly prevalent. Although much of the reported anaphylaxis in adults is due to drug reactions, foods are becoming an increasingly important trigger, affecting adults of all ages, with a wide variation in food triggers which are often quite different to those reported in children. RECENT FINDINGS Peanuts are well known to cause anaphylaxis in some adult populations, but other legumes such as soy may be more relevant in others. Reactions to natto, fermented soybeans, are currently mainly reported in Japan, but changing dietary practices and an increase in plant-based eating mean natto, other forms of soy and other legumes are increasingly linked to anaphylaxis in Western countries. Anaphylaxis to red meat, caused by sensitization to galactose-α-1,3-galactose and first reported in North America, is now a more world-wide concern. Co-factor induced anaphylaxis is increasingly associated with both wheat allergy and lipid transfer protein allergy. SUMMARY More research is urgently needed to characterize adult food allergy, its triggers and symptom severity. Unusual food triggers and potential co-factors should be considered, so that anaphylaxis in adults can be correctly managed, not merely labelled as idiopathic.
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Affiliation(s)
| | - Bianca Olivieri
- Department of Medicine, Asthma, Allergy and Clinical Immunology Section, University of Verona, Verona, Italy
| | - Isabel J Skypala
- Royal Brompton & Harefield Hospitals, part of Guys & St Thomas NHS Foundation Trust
- Department of Inflammation & Repair, Imperial College, London, UK
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2
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Olivieri B, Skypala IJ. The Diagnosis of Allergy to Lipid Transfer Proteins. Curr Allergy Asthma Rep 2024; 24:509-518. [PMID: 38990405 DOI: 10.1007/s11882-024-01164-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE OF REVIEW To provide an update on the diagnosis of non-specific Lipid Transfer Protein (nsLTP) allergy. RECENT FINDINGS More publications report the presence of nsLTP allergy in Northern European countries and nsLTP sensitisation in children. Individuals are more likely to have severe reactions if there is recognition of increasing numbers of LTP components. Diagnosis is problematic; not all those with nsLTP allergy will have a positive test to a peach extract containing Pru p 3, the peach nsLTP. Sensitisation to nsLTP is being reported in more countries, including to the nsLTP in Cannabis Sativa in North America. Meals containing multiple nsLTP foods are more likely to be involved in co-factor reactions. Component-resolved diagnostics are superior to skin prick tests, to determine sensitisation to the individual nsLTP allergens causing symptoms and, in the future, the Basophil Activation test may best discriminate between sensitization and clinical allergy.
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Affiliation(s)
- Bianca Olivieri
- Department of Medicine, Asthma, Allergy and Clinical Immunology Section, University of Verona, Verona, Italy
| | - Isabel J Skypala
- Department of Allergy & Clinical Immunology, Royal Brompton & Harefield Hospitals, part of Guys and St Thomas NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK.
- Department of Inflammation and repair, Imperial College, London, UK.
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3
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Biagioni B, Scala E, Cecchi L. What molecular allergy teaches us about genetics and epidemiology of allergies. Curr Opin Allergy Clin Immunol 2024; 24:280-290. [PMID: 38640142 DOI: 10.1097/aci.0000000000000990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
PURPOSE OF REVIEW To delineate pertinent information regarding the application of molecular allergology within the realm of both genetic and epidemiological facets of allergic diseases. RECENT FINDINGS The emergence of molecular allergy has facilitated the comprehension of the biochemical characteristics of allergens originating from diverse sources. It has allowed for the exploration of sensitization trajectories and provided novel insights into the influence of genetics and environmental exposure on the initiation and development of allergic diseases. This review delves into the primary discoveries related to the genetics and epidemiology of allergies, facilitated by the application of molecular allergy. It also scrutinizes the impact of environmental exposure across varied geoclimatic, socioeconomic, and lifestyle contexts. Additionally, the review introduces specific models of molecular allergy within the realms of plants and animals. SUMMARY The utilization of molecular allergy in clinical practice holds crucially acknowledged diagnostic and therapeutic implications. From a research standpoint, there is a growing need for the widespread adoption of molecular diagnostic tools to achieve a more profound understanding of the epidemiology and natural progression of allergic diseases.
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Affiliation(s)
- Benedetta Biagioni
- Allergy and Clinical Immunology Unit, San Giovanni di Dio Hospital, Florence
| | - Enrico Scala
- Clinical and Laboratory Molecular Allergy Unit, IDI-IRCCS, Rome
| | - Lorenzo Cecchi
- SOSD Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
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Sharma E, Vitte J. A systematic review of allergen cross-reactivity: Translating basic concepts into clinical relevance. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100230. [PMID: 38524786 PMCID: PMC10959674 DOI: 10.1016/j.jacig.2024.100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 10/29/2023] [Accepted: 01/03/2024] [Indexed: 03/26/2024]
Abstract
Access to the molecular culprits of allergic reactions allows for the leveraging of molecular allergology as a new precision medicine approach-one built on interdisciplinary, basic, and clinical knowledge. Molecular allergology relies on the use of allergen molecules as in vitro tools for the diagnosis and management of allergic patients. It complements the conventional approach based on skin and in vitro allergen extract testing. Major applications of molecular allergology comprise accurate identification of the offending allergen thanks to discrimination between genuine sensitization and allergen cross-reactivity, evaluation of potential severity, patient-tailored choice of the adequate allergen immunotherapy, and prediction of its expected efficacy and safety. Allergen cross-reactivity, defined as the recognition of 2 or more allergen molecules by antibodies or T cells of the same specificity, frequently interferes with allergen extract testing. At the mechanistic level, allergen cross-reactivity depends on the allergen, the host's immune response, and the context of their interaction. The multiplicity of allergen molecules and families adds further difficulty. Understanding allergen cross-reactivity at the immunologic level and translating it into a daily tool for the management of allergic patients is further complicated by the ever-increasing number of characterized allergenic molecules, the lack of dedicated resources, and the need for a personalized, patient-centered approach. Conversely, knowledge sharing paves the way for improved clinical use, innovative diagnostic tools, and further interdisciplinary research. Here, we aimed to provide a comprehensive and unbiased state-of-the art systematic review on allergen cross-reactivity. To optimize learning, we enhanced the review with basic, translational, and clinical definitions, clinical vignettes, and an overview of online allergen databases.
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Affiliation(s)
| | - Joana Vitte
- Aix-Marseille University, MEPHI, IHU Méditerranée Infection, Marseille, France
- Desbrest Institute of Epidemiology and Public Health (IDESP), University of Montpellier, INSERM, Montpellier, France
- University of Reims Champagne-Ardenne, INSERM UMR-S 1250 P3CELL and University Hospital of Reims, Immunology Laboratory, Reims, France
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5
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Kazancioglu A, Konuralp I, Sahiner UM, Soyer O, Sekerel BE. Understanding of lipid transfer protein sensitization patterns and its clinical significance in children. Allergy Asthma Proc 2024; 45:120-127. [PMID: 38449011 DOI: 10.2500/aap.2024.45.230075] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Background: Lipid transfer proteins (LTP) are the most common food allergens in the Mediterranean region. Objective: The study aimed to investigate co-sensitization patterns and cluster relationships between LTP allergen molecules across a broad range of allergen-specific sensitization patterns, and clinical outcomes in eastern Mediterranean children. Methods: Among 496 children evaluated for multiple sensitizations with multiplex testing, 105 children (21%) with 16 different LTP sensitizations were analyzed. Clinical reactivity was examined based on clear-cut history of immunoglobulin E mediated symptoms (oral allergy syndrome [OAS], systemic reactions, and anaphylaxis). Results: All children included were sensitive to food LTPs, but 56% were sensitive to pollen LTPs. The number of children with OAS and clinical reactivity was 12 and 59, respectively, and no cofactors were reported. The most common sensitizations were Pru p 3 (74%) and Cor a 8 (66%). Significant correlations were observed in the heatmap between the LTP molecules other than Par j 2 and Tri a 14. Overall, clinical reactivity was associated with increased age and number of LTP molecule positivity. Conclusion: In the eastern Mediterranean region, 21% of children with multiple food and/or pollen sensitizations were found to have LTP sensitization; however, almost half reported clinical reactivity. The hierarchical pathway highlights that distinct LTP allergen molecules can act as primary sensitizers. Clinical reactivity is linked to increasing numbers of LTP molecule positivity and increasing age.
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Affiliation(s)
- Alp Kazancioglu
- From the Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey, and
| | - Ilteber Konuralp
- Department of Statistics, Middle East Technical University, Ankara, Turkey
| | - Umit Murat Sahiner
- From the Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey, and
| | - Ozge Soyer
- From the Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey, and
| | - Bulent Enis Sekerel
- From the Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey, and
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6
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Ridolo E, Barone A, Ottoni M, Peveri S, Montagni M, Nicoletta F. Factors and co-factors influencing clinical manifestations in nsLTPs allergy: between the good and the bad. FRONTIERS IN ALLERGY 2023; 4:1253304. [PMID: 37841053 PMCID: PMC10568476 DOI: 10.3389/falgy.2023.1253304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023] Open
Abstract
Non-specific lipid transfer proteins (nsLTPs) are a family of plant pan-allergens that represent the primary cause of food allergies in the Mediterranean area, characterized by a wide range of clinical manifestations, ranging from the total absence of symptoms up to anaphylaxis. This wide variety of symptoms is related to the intrinsic capacity of nsLTPs to cause an allergic reaction in a specific subject, but also to the presence of co-factors exacerbating (i.e., exercise, NSAIDs, PPIs, alcohol, cannabis, prolonged fasting, menstruation, acute infections, sleep deprivation, chronic urticaria) or protecting from (i.e., co-sensitization to PR10, profilin or polcalcin) severe reactions. In this picture, recognizing some nsLTPs-related peculiarities (i.e., route, type and number of sensitizations, concentration of the allergen, cross-reactions) and eventual co-factors may help the allergist to define the risk profile of the single patient, in order to promote the appropriate management of the allergy from dietary advices up to the prescription of life-saving epinephrine autoinjector.
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Affiliation(s)
- Erminia Ridolo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Allergology Unit, University Hospital of Parma, Parma, Italy
| | | | - Martina Ottoni
- Allergology Unit, University Hospital of Parma, Parma, Italy
| | - Silvia Peveri
- Departmental Unit of Allergology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Marcello Montagni
- Departmental Unit of Allergology, Guglielmo da Saliceto Hospital, Piacenza, Italy
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Wang K, Gali-Moya J, Ruano-Zaragoza M, Cain K, D'Auria G, Daly M, Barran P, Crevel R, Mills ENC. Bile salts enhance the susceptibility of the peach allergenic lipid transfer protein, Pru p 3, to in vitro gastrointestinal proteolysis. Sci Rep 2023; 13:15155. [PMID: 37704681 PMCID: PMC10499906 DOI: 10.1038/s41598-023-39599-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/27/2023] [Indexed: 09/15/2023] Open
Abstract
Sensitisation to the lipid transfer protein Pru p 3 is associated with severe allergic reactions to peach, the proteins stability being thought to play a role in its allergenicity. Lipid binding increases susceptibility of Pru p 3 to digestion and so the impact of bile salts on the in vitro gastrointestinal digestibility of Pru p 3 was investigated and digestion products mapped by SDS-PAGE and mass spectrometry. Bile salts enhanced the digestibility of Pru p 3 resulting in an ensemble of around 100 peptides spanning the protein's sequence which were linked by disulphide bonds into structures of ~ 5-6 kDa. IgE binding studies with a serum panel from peach allergic subjects showed digestion reduced, but did not abolish, the IgE reactivity of Pru p 3. These data show the importance of including bile salts in vitro digestion systems and emphasise the need to profile of digestion in a manner that allows identification of immunologically relevant disulphide-linked peptide aggregates.
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Affiliation(s)
- Kai Wang
- School of Biological Sciences, Manchester Academic Health Sciences Centre, Manchester Institute of Biotechnology, 131 Princess Street, Manchester, M1 7DN, UK
| | - Judit Gali-Moya
- School of Biological Sciences, Manchester Academic Health Sciences Centre, Manchester Institute of Biotechnology, 131 Princess Street, Manchester, M1 7DN, UK
| | | | - Kathleen Cain
- Department of Chemistry, Manchester Institute of Biotechnology, 131 Princess Street, Manchester, M1 7DN, UK
| | - Giovanni D'Auria
- Department of Agricultural Sciences, University of Naples Federico II, Portici, Italy
| | - Matthew Daly
- School of Biological Sciences, Manchester Academic Health Sciences Centre, Manchester Institute of Biotechnology, 131 Princess Street, Manchester, M1 7DN, UK
| | - Perdita Barran
- Department of Chemistry, Manchester Institute of Biotechnology, 131 Princess Street, Manchester, M1 7DN, UK
| | - René Crevel
- School of Biological Sciences, Manchester Academic Health Sciences Centre, Manchester Institute of Biotechnology, 131 Princess Street, Manchester, M1 7DN, UK
- René Crevel Consulting Ltd, Suite A 82 James Carter Road, Mildenhall, IP28 7HP, UK
| | - E N Clare Mills
- School of Biological Sciences, Manchester Academic Health Sciences Centre, Manchester Institute of Biotechnology, 131 Princess Street, Manchester, M1 7DN, UK.
- School of Biosciences and Medicine, The University of Surrey, Guildford, GU2 7XH, Surrey, UK.
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8
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Cabrera CM, Horrillo ML, Brito FF, Palacios‐Cañas A. Would the choice of multiplex platform impact the management of the allergic patient? A first approach focusing on LTPs. J Clin Lab Anal 2023; 37:e24960. [PMID: 37638561 PMCID: PMC10561593 DOI: 10.1002/jcla.24960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/06/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND In the Mediterranean area, patients with LTP syndrome who are sensitized to multiple allergens are often tested for sIgE using multiplex platforms. The results obtained from different commercial platforms are not interchangeable, so it is important to compare and validate the platform selected for use. The objective of this study is to compare and validate the performance of the ImmunoCAP ISAC E112i and the macroarray ALEX2 in our daily practice. METHODS From August 2021 to March 2022, we tested 20 random serum samples from polysensitized patients using the ALEX2 test (MADx) and ImmunoCAP tIgE and ISAC E112i (Thermo Fisher Scientific). We compared the total IgE (tIgE) and sIgE levels for shared allergens. RESULTS The heatmap generally showed more intense results for ISAC. The overall correlation was good, but some exceptions were noted. The main discrepancies were found for Ole e 7, which was positive for 11 patients in ISAC but negative for all patients in ALEX2, and for nut LTPs, for which ISAC showed a threefold higher detection rate for Ara h 9 and a fivefold higher detection rate for Cor a 8 and Jug r 3 compared to ALEX2. The regression model showed no interchangeability of tIgE results. CONCLUSIONS Despite our small sample size and the complexity of comparing a quantitative and a semi-quantitative platform, our results suggest that patient diagnosis and management can be influenced by the platform used. Therefore, our findings must be taken into consideration when choosing a platform to use for some profiles of LTP-polysensitized patients, even though more data is needed.
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Affiliation(s)
- Carmen Maria Cabrera
- Allergy and Immunology SectionCiudad Real University General HospitalCiudad RealSpain
- Faculty of Medicine of Ciudad RealUniversity of Castilla‐La ManchaCiudad RealSpain
| | - Moisés Labrador Horrillo
- Allergy SectionVall d'Hebron University HospitalBarcelonaSpain
- Autonomous University of BarcelonaBarcelonaSpain
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Sara BV, Ulrike F, Bettina B, Yvonne W, Teresa P, Clara SB, Giovanna AS, Rocío CS, María T, Rocío L, Rosa MC, Joan B, Waltraud S, Mariona P. Improving In Vitro Detection of Sensitization to Lipid Transfer Proteins: A New Molecular Multiplex IgE Assay. Mol Nutr Food Res 2023; 67:e2200906. [PMID: 37195823 DOI: 10.1002/mnfr.202200906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/11/2023] [Indexed: 05/19/2023]
Abstract
SCOPE LTP-syndrome is characterized by sensitization (IgE) to multiple non-specific lipid transfer proteins (nsLTPs) with a variable clinical outcome. The treatment is primarily based on offending food avoidance. However, the determination of Pru p 3-specific IgE is currently the main diagnostic tool to assess sensitization to nsLTPs. Herein, the study evaluates improvement of LTP-syndrome diagnosis and clinical management using a new IgE multiplex-immunoblot assay with a high diversity of food nsLTPs. METHODS AND RESULTS An EUROLINE-LTP strip with 28 recombinant nsLTPs from 18 allergenic sources is designed. In total the study investigates 38 patients with LTP-syndrome and compares results from the nsLTPs (LTP-strip) with the respective food extracts of Prick-by-prick (PbP) testing. The agreement exceeds 70% for most nsLTPs, e.g., Pru p 3 (100%), Mal d 3 (97%), Pru av 3 (89%), Pha v 3 isoforms (87%/84%), Ara h 9 (82%), Cor a 8 (82%), and Jug r 3 (82%). The functionality and allergenic relevance of nine recombinant nsLTPs are proven by Basophil activation testing (BAT). CONCLUSIONS The new IgE multiplex-immunoblot nsLTP assay shows a good diagnostic performance allowing culprit food assessment. Negative results from LTP-strip may indicate potentially tolerable foods, improving diet intervention and patients' quality of life.
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Affiliation(s)
- Balsells-Vives Sara
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, 08036, Spain
| | - Flügge Ulrike
- EUROIMMUN AG A PerkinElmer Company, 23560, Lübeck, Germany
| | - Brix Bettina
- EUROIMMUN AG A PerkinElmer Company, 23560, Lübeck, Germany
| | - Weimann Yvonne
- EUROIMMUN AG A PerkinElmer Company, 23560, Lübeck, Germany
| | - Peralta Teresa
- Department of Clinical Immunology and Rheumatology, Pontificia Universidad Católica de Chile, 8331150, Santiago, Chile
| | - San Bartolomé Clara
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, 08036, Spain
- Immunology Department, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
| | - Araujo-Sánchez Giovanna
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, 08036, Spain
- Allergy Department, Institut Clinic Respiratori (ICR), Hospital Clinic, Universitat de Barcelona, Barcelona, 08036, Spain
| | - Casas-Saucedo Rocío
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, 08036, Spain
- Allergy Department, Institut Clinic Respiratori (ICR), Hospital Clinic, Universitat de Barcelona, Barcelona, 08036, Spain
- RETIC Asma, Reacciones Adversas a Fármacos y Alergia (ARADyAL) and RICORS Red de Enfermedades Inflamatorias (REI), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Torradeflot María
- Immunology Department, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
| | - Lara Rocío
- Immunology Department, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
| | - Munoz-Cano Rosa
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, 08036, Spain
- Allergy Department, Institut Clinic Respiratori (ICR), Hospital Clinic, Universitat de Barcelona, Barcelona, 08036, Spain
- RETIC Asma, Reacciones Adversas a Fármacos y Alergia (ARADyAL) and RICORS Red de Enfermedades Inflamatorias (REI), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Bartra Joan
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, 08036, Spain
- Allergy Department, Institut Clinic Respiratori (ICR), Hospital Clinic, Universitat de Barcelona, Barcelona, 08036, Spain
- RETIC Asma, Reacciones Adversas a Fármacos y Alergia (ARADyAL) and RICORS Red de Enfermedades Inflamatorias (REI), Instituto de Salud Carlos III, Madrid, 28029, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Campus Clínic, Universitat de Barcelona (UB), c. Casanova, 143, Barcelona, 08036, Spain
| | - Suer Waltraud
- EUROIMMUN AG A PerkinElmer Company, 23560, Lübeck, Germany
| | - Pascal Mariona
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, 08036, Spain
- Immunology Department, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- RETIC Asma, Reacciones Adversas a Fármacos y Alergia (ARADyAL) and RICORS Red de Enfermedades Inflamatorias (REI), Instituto de Salud Carlos III, Madrid, 28029, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Campus Clínic, Universitat de Barcelona (UB), c. Casanova, 143, Barcelona, 08036, Spain
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Romano A, Gaeta F, Caruso C, Fiocchi A, Valluzzi RL. Evaluation and Updated Classification of Acute Hypersensitivity Reactions to Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAID-Exacerbated or -Induced Food Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1843-1853.e1. [PMID: 36997117 DOI: 10.1016/j.jaip.2023.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND There are hypersensitivity reactions (HRs) to foods in which nonsteroidal anti-inflammatory drugs (NSAIDs) act as aggravating factors (NSAID-exacerbated food allergy [NEFA]) or cofactors (NSAID-induced food allergy [NIFA]), often misdiagnosed as HRs to NSAIDs. Urticarial/angioedematous and/or anaphylactic reactions to two or more chemically unrelated NSAIDs do not meet current classification criteria. However, they may be considered part of a cross-reactive type of acute HR, which is NSAID-induced urticaria/angioedema with or without respiratory or systemic symptoms of anaphylaxis. OBJECTIVE To evaluate patients reporting acute HRs to NSAIDs and classify them according to updated criteria. METHODS We prospectively studied 414 patients with suspected HRs to NSAIDs. For all whom met these criteria, NEFA/NIFA was diagnosed: (1) mild reactions to (NEFA) or tolerance of (NIFA) the suspected foods without taking NSAIDs; (2) cutaneous and/or anaphylactic reactions to the combination foods plus NSAIDs; (3) positive allergy tests to the suspected foods; and (4) negative drug challenges (DCs) with the NSAIDs involved. RESULTS A total of 252 patients were given the diagnosis of NSAID hypersensitivity (60.9%), 108 of whom had NSAID-induced urticaria/angioedema with or without respiratory or systemic symptoms of anaphylaxis. We excluded NSAID hypersensitivity in 162 patients (39.1%) who tolerated DCs with the suspected NSAIDs, nine of whom received a diagnosis of NEFA, and 66 of NIFA. Pru p 3 was implicated in 67 of those 75 patients who received a diagnosis of NEFA or NIFA. CONCLUSIONS NEFA and NIFA account for about 18% of patients reporting HRs to NSAIDs, in which Pru p 3 is the main responsible food allergen. Therefore, patients with cutaneous and/or anaphylactic reactions to NSAIDs should be carefully questioned about all foods ingested within 4 hours before or after NSAID exposure, and targeted food allergy tests should be considered in the diagnostic workup of these patients. If testing is positive, DCs with the suspected NSAIDs should also be considered.
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Affiliation(s)
| | | | - Cristiano Caruso
- UOSD Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandro Fiocchi
- Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rocco Luigi Valluzzi
- Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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11
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Peach extract induces systemic and local immune responses in an experimental food allergy model. Sci Rep 2023; 13:1892. [PMID: 36732575 PMCID: PMC9894845 DOI: 10.1038/s41598-023-28933-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
Peach allergy is among the most frequent food allergies in the Mediterranean area, often eliciting severe anaphylactic reactions in patients. Due to the risk of severe symptoms, studies in humans are limited, leading to a lack of therapeutic options. This study aimed to develop a peach allergy mouse model as a tool to better understand the pathomechanism and to allow preclinical investigations on the development of optimized strategies for immunotherapy. CBA/J mice were sensitized intraperitoneally with peach extract or PBS, using alum as adjuvant. Afterwards, extract was administered intragastrically to involve the intestinal tract. Allergen provocation was performed via intraperitoneal injection of extract, measuring drop of body temperature as main read out of anaphylaxis. The model induced allergy-related symptoms in mice, including decrease of body temperature. Antibody levels in serum and intestinal homogenates revealed a Th2 response with increased levels of mMCPT-1, peach- and Pru p 3-specific IgE, IgG1 and IgG2a as well as increased levels of IL-4 and IL-13. FACS analysis of small intestine lamina propria revealed increased amounts of T cells, neutrophils and DCs in peach allergic mice. These data suggest the successful establishment of a peach allergy mouse model, inducing systemic as well as local gastrointestinal reactions.
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12
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Multiplex Proteomic Evaluation in Inborn Errors with Deregulated IgE Response. Biomedicines 2023; 11:biomedicines11010202. [PMID: 36672710 PMCID: PMC9855860 DOI: 10.3390/biomedicines11010202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/23/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
(1) Background: Atopic dermatitis constitutes one of the most common inflammatory skin manifestations of the pediatric population. The onset of many inborn errors occurs early in life with an AD-like picture associated with a deregulated IgE response. The availability of proteomic tests for the simultaneous evaluation of hundreds of molecules allows for more precise diagnosis in these cases. (2) Methods: Comparative genomic hybridization microarray (Array-CGH) analysis and specific IgE evaluation by using allergenic microarray (ISAC) and microarray (ALEX2) systems were performed. (3) Results: Proteomic investigations that use multiplex methods have proven to be extremely useful to diagnose the sensitization profile in inborn errors with deregulated IgE synthesis. Four patients with rare diseases, such as recessive X-linked ichthyosis (RXLI, OMIM 308100), Comel-Netherton syndrome (NS, OMIM256500), monosomy 1p36 syndrome (OMIM: 607872), and a microduplication of Xp11.4 associated with extremely high levels of IgE: 7.710 kU/L, 5.300 kU/L, 1.826 kU/L, and 10.430 kU/L, respectively, were evaluated by micro- and macroarray multiplex methods. Polyreactivity to both environmental and food allergens was observed in all cases, including the first described case of association of X-chromosome microduplication and HIE. (4) Conclusions: Extensive use of proteomic diagnostics should be included among the procedures to be implemented in inborn errors with hyper-IgE.
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Costanzo G, Matolo A, Saderi L, Messina MR, Firinu D, Barca MP, Serra P, Corso N, Sotgiu G, Del Giacco S. Cofactors, age at onset, allergic comorbidities and gender are different in patients sensitized to omega-5 gliadin and Pru p 3. Sci Rep 2022; 12:20868. [PMID: 36460730 PMCID: PMC9718743 DOI: 10.1038/s41598-022-25368-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
Aim of this study is to clarify the impact of cofactors on allergic reactions in patients sensitized to LTP and ω-5-gliadin. We retrospectively examined the charts of our outpatients from January 2015 to July 2019 and identified 157 patients seen for urticaria/angioedema or anaphylaxis after a meal, in presence or absence of cofactors and sensitized to LTPs (Pru p 3 and/or Tri a 14) and/or ω-5-gliadin (Tri a 19). we compared LTPs-positive patients and those sensitized to Tri a 19 in order to assess the difference in cofactors involved and in frequency of clinical presentation. Our data show that exercise is the most frequent cofactor in FDEIAn and the involvement of exercise, alcohol and multiple cofactors was more frequently found in males than in females. We found that exercise, pollen counts peaks and multiple cofactors were more often related to anaphylaxis than mild reactions. Finally, we performed a comparison between patients LTPs+ and Tri a 19+ that showed in the latter group a lower frequency of allergic comorbidities, a higher median age at the onset of symptoms and frequency of alcohol exposure. Our data show that the search for possible cofactors involved in food allergy is essential not only for diagnostic purposes, but also for risk assessment strategies.
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Affiliation(s)
- Giulia Costanzo
- grid.7763.50000 0004 1755 3242Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, CA Italy
| | - Annalisa Matolo
- grid.7763.50000 0004 1755 3242Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, CA Italy
| | - Laura Saderi
- grid.11450.310000 0001 2097 9138Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Maria Rita Messina
- grid.7763.50000 0004 1755 3242Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, CA Italy
| | - Davide Firinu
- grid.7763.50000 0004 1755 3242Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, CA Italy
| | - Maria Pina Barca
- grid.7763.50000 0004 1755 3242Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, CA Italy
| | - Paolo Serra
- grid.7763.50000 0004 1755 3242Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, CA Italy
| | - Nicoletta Corso
- grid.7763.50000 0004 1755 3242Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, CA Italy
| | - Giovanni Sotgiu
- grid.11450.310000 0001 2097 9138Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Stefano Del Giacco
- grid.7763.50000 0004 1755 3242Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, CA Italy
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14
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Ridolo E, Pucciarini F, Kihlgren P, Barone A, Nicoletta F, Peveri S, Montagni M, Incorvaia C. Lipid transfer protein syndrome: How to save a life through careful education. World Allergy Organ J 2022; 15:100683. [PMID: 36119658 PMCID: PMC9468585 DOI: 10.1016/j.waojou.2022.100683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/07/2022] [Accepted: 07/29/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Lipid transfer proteins (nsLTPs) are ubiquitous allergens. Patients affected by nsLTP syndrome experience symptoms to various plant-derived foods, ranging from local manifestations to anaphylaxis, the critical treatment of which is represented by self-administration of adrenaline. The principle aim of this study is to assess how dietary recommendations influence the occurrence of new and severe cases and if poly-sensitization to different nsLTPs may play a role. We also investigated about the appropriate use of adrenaline auto-injector during the episodes of anaphylaxis. Moreover, we examinated how other features (ie, co-sensitization to profilin and PR-10 and the presence of risk co-factors) affect these events. Materials and methods We evaluated 78 patients allergic to nsLTPs, investigating adherence to diet and ability to use the adrenaline auto-injector. Number of sensitization to nsLTPs, co-sensitization to other panallergens, and presence of risk factors for new reactions were also assessed. Diagnosis was based on clinical history and positivity to in vivo and in vitro tests. During the follow-up, compliance, diet modifications, and new reactions were noted, and re-training for the use of epinephrine auto-injector was performed. At the last visit we evaluated the patients’ ability to use the self-injector. Results The whole of fruits belonging to the Rosaceae family emerged as the most frequent culprit foods (28%), followed by walnut (17%), peanut (17%), and hazelnut (10%). At the baseline visit 23% of the patients described the presence of a risk factor during the allergic reaction (mainly nonsteroidal anti-inflammatory drugs [NSAIDs] and exercise). Forty-five percent of the patients reported anaphylactic reactions; no association between the type of food and the severity of the reactions was found. The presence of sensitization to 4 or more nsLTPs was associated to more severe reactions (p < .05; OR 1.67). During the follow-up 38% of the patients experienced at least 1 new allergic reaction: in 79% of them the culprit food was previously tolerated, and in 69% the reaction was an anaphylaxis. Only 47% of the patients showed a proper use of adrenaline auto-injector during the final evaluation, but a significant correlation between periodic education and reduction of the probability of mistakes in the use was reported (p < .05; OR 0.34). Furthermore, an association between co-sensitization to PR-10 (in particular Bet v1) and profilin and less severe symptoms was found, but without a significant odds ratio. Conclusion A careful education aimed to the prevention of new reactions, through dietary restrictions and avoidance of risk co-factors, and to the management of anaphylaxis, through the training for the correct use of adrenaline auto-injector, should be a routine practice in nsLTP syndrome.
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Affiliation(s)
- Erminia Ridolo
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Allergology Unit, Hospital of Parma, Parma, Italy
| | | | - Paola Kihlgren
- Departmental Unit of Allergology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | | | - Silvia Peveri
- Departmental Unit of Allergology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Marcello Montagni
- Departmental Unit of Allergology, Guglielmo da Saliceto Hospital, Piacenza, Italy
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15
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Skypala IJ, Hunter H, Krishna MT, Rey-Garcia H, Till SJ, du Toit G, Angier E, Baker S, Stoenchev KV, Luyt DK. BSACI guideline for the diagnosis and management of pollen food syndrome in the UK. Clin Exp Allergy 2022; 52:1018-1034. [PMID: 35975576 DOI: 10.1111/cea.14208] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 02/06/2023]
Abstract
Pollen food syndrome (PFS) is a highly prevalent food allergy affecting pollen-sensitized children and adults. Sufferers experience allergic symptoms when consuming raw plant foods, due to the homology between the pollen allergens and unstable proteins in these foods. The triggers involved can vary depending on the pollen sensitization, which in turn is affected by geographical location. The British Society of Allergy and Clinical Immunology (BSACI) Standards of Care Committee (SOCC) identified a need to develop a guideline for the diagnosis and management of PFS in the United Kingdom (UK). Guidelines produced by the BSACI use either the GRADE or SIGN methodology; due to a lack of high-quality evidence these recommendations were formulated using the SIGN guidelines, which is acknowledged to be less robust than the GRADE approach. The correct diagnosis of PFS ensures the avoidance of a misdiagnosis of a primary peanut or tree nut allergy or confusion with another plant food allergy to non-specific lipid transfer proteins. The characteristic foods involved, and rapid-onset oropharyngeal symptoms, mean PFS can often be diagnosed from the clinical history alone. However, reactions involving tree nuts, peanuts and soya milk or severe/atypical reactions to fruits and vegetables may require additional diagnostic tests. Management is through the exclusion of known trigger foods, which may appear to be simple, but is highly problematic if coupled with a pre-existing food allergy or for individuals following a vegetarian/vegan diet. Immunotherapy to pollens is not an effective treatment for PFS, and although oral or sublingual immunotherapy to foods seems more promising, large, controlled studies are needed. The typically mild symptoms of PFS can lead to an erroneous perception that this condition is always easily managed, but severe reactions can occur, and anxiety about the onset of symptoms to new foods can have a profound effect on quality of life.
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Affiliation(s)
- Isabel J Skypala
- Department of Allergy & Clinical Immunology, Royal Brompton & Harefield Hospitals, Part of Guys & St Thomas NHS Foundation Trust, London, UK.,Inflammation, Repair & Development Section, National Heart & Lung Institute, Imperial College, London, UK
| | - Hannah Hunter
- Department of Allergy, Guys & St Thomas NHS Foundation Trust, London, UK.,Kings College, London, UK
| | - Mamidipudi Thirumala Krishna
- Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,The Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Helena Rey-Garcia
- Department of Allergy & Clinical Immunology, Royal Brompton & Harefield Hospitals, Part of Guys & St Thomas NHS Foundation Trust, London, UK
| | - Stephen J Till
- Department of Allergy, Guys & St Thomas NHS Foundation Trust, London, UK.,Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - George du Toit
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK.,Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, London, UK.,Department Women and Children's Health (Paediatric Allergy), Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Elizabeth Angier
- Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Kostadin V Stoenchev
- Department of Allergy & Clinical Immunology, Royal Brompton & Harefield Hospitals, Part of Guys & St Thomas NHS Foundation Trust, London, UK
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16
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Xu L, Luo W, Lu Y, Huang Z, Yu X, Liao C, Dai Y, Huang H, Gu W, Zheng P, Zhang X, Chen H, Huang L, Zheng J, Hao C, Sun B. A comprehensive analysis of the components of common weed pollen and related allergens in patients with allergic diseases in southern China. Mol Immunol 2022; 147:180-186. [PMID: 35633613 DOI: 10.1016/j.molimm.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 05/04/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pollen allergens are vital contributors to allergic diseases. The frequency and coreactivity pattern of allergens are closely related to geographical distribution. OBJECTIVE In this study, we aimed to characterize the prevalence of the molecular components of the common weed pollen allergens, birch pollen, walnut, and cross-reactive carbohydrate determinant (CCD), as well as investigate the relationship between the allergens and CCD in Chinese pollen-sensitized patients with allergic diseases. METHODS Based on previous vegetation surveys, serum samples from 165 pollen-sensitized patients with allergic diseases in Guangdong Province in southern China were used to test 19 crude allergen extracts, their components, and CCD using component-resolved diagnosis (CRD). Moreover, the potential associations among CCD, allergens, and their components were described. RESULTS In the 165 samples, the most common sensitized allergens were goosefoot (43.0%), ragweed (40.6%), walnut (37.6%), walnut tree (37.6%), and mugwort (37.0%), followed by platane (35.2%), cocklebur (27.9%), and birch (24.2%). The positivity rate of CCD was 39.4%. Among the samples positive for mugwort, 11 (18.0%), 15 (24.6%), and 15 (24.6%) were positive for Art v 1, Art v 2, and Art v 3, respectively. Among the 67 patients sensitized to ragweed, only five (7.5%) were positive for Amb a 1. In the 40 patients sensitized to birch, Bet v 2 had the highest positivity rate (40.0%). There were 62 patients who were sensitized to walnut. Their components had a lower positivity rate (less than 15%). The hierarchical clustering and optimal scale analysis showed that Art v 4 and Bet v 2 were closely related, and 91.9% of CCD-positive samples were polysensitized. Meanwhile, Spearman's rank correlation method showed that CCD was closely correlated with the sensitization of crude allergen extracts, and there was a low correlation between CCD and allergen components. CCD was highly correlated with goosefoot, ragweed, and walnut trees (r>0.8). Moreover, there was a strong relationship between the levels of Jug r 3 and Art v 3 (r = 0.78; P < 0.001). CONCLUSIONS In southern China, the weed pollens (ragweed, cocklebur, and goosefoot) exhibited higher positivity rates in adults and had a stronger relationship with CCD but not with mugwort. The positivity rate of allergen components was not high. CCD-positive samples were always polysensitized.
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Affiliation(s)
- Lina Xu
- Department of Respiratory Medicine, Children's Hospital of Soochow University, China
| | - Wenting Luo
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong 510120, China
| | - Yanhong Lu
- Department of Respiratory Medicine, Children's Hospital of Soochow University, China
| | - Zhifeng Huang
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong 510120, China
| | - Xingmei Yu
- Department of Respiratory Medicine, Children's Hospital of Soochow University, China
| | - Chenxi Liao
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong 510120, China
| | - Yinfang Dai
- Department of Respiratory Medicine, Children's Hospital of Soochow University, China
| | - Huimin Huang
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong 510120, China
| | - Wenjing Gu
- Department of Respiratory Medicine, Children's Hospital of Soochow University, China
| | - Peiyan Zheng
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong 510120, China
| | - Xinxing Zhang
- Department of Respiratory Medicine, Children's Hospital of Soochow University, China
| | - Hongling Chen
- Department of Respiratory Medicine, Children's Hospital of Soochow University, China
| | - Li Huang
- Department of Respiratory Medicine, Children's Hospital of Soochow University, China
| | - Jinping Zheng
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong 510120, China.
| | - Chuangli Hao
- Department of Respiratory Medicine, Children's Hospital of Soochow University, China.
| | - Baoqing Sun
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong 510120, China.
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17
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Barni S, Caimmi D, Chiera F, Comberiati P, Mastrorilli C, Pelosi U, Paravati F, Marseglia GL, Arasi S. Phenotypes and Endotypes of Peach Allergy: What Is New? Nutrients 2022; 14:998. [PMID: 35267973 PMCID: PMC8912752 DOI: 10.3390/nu14050998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/15/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023] Open
Abstract
Peach allergy is emerging as a common type of fresh-fruit allergy in Europe, especially in the Mediterranean area. The clinical manifestations of peach allergy tend to have a peculiar geographical distribution and can range from mild oral symptoms to anaphylaxis, depending on the allergic sensitization profile. The peach allergen Pru p 7, also known as peamaclein, has recently been identified as a marker of peach allergy severity and as being responsible for peculiar clinical features in areas with high exposure to cypress pollen. This review addresses the latest findings on molecular allergens for the diagnosis of peach allergy, the clinical phenotypes and endotypes of peach allergy in adults and children, and management strategies, including immunotherapy, for peach allergy.
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Affiliation(s)
- Simona Barni
- Allergic Unit, Department of Pediatric, Meyer Children’s Hospital, 50139 Florence, Italy;
| | - Davide Caimmi
- Allergy Unit, CHU de Montpellier, Université de Montpellier, 34295 Montpellier, France;
- IDESP, UMR A11–INSERM, Université de Montpellier, 34093 Montpellier, France
| | - Fernanda Chiera
- Department of Pediatrics, San Giovanni di Dio Hospital, 88900 Crotone, Italy; (F.C.); (F.P.)
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, 56126 Pisa, Italy
- Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Carla Mastrorilli
- Department of Pediatrics, University Hospital Consortium Corporation Polyclinic of Bari, Pediatric Hospital Giovanni XXIII, 70124 Bari, Italy;
| | - Umberto Pelosi
- Pediatric Unit, Santa Barbara Hospital, 09016 Iglesias, Italy;
| | - Francesco Paravati
- Department of Pediatrics, San Giovanni di Dio Hospital, 88900 Crotone, Italy; (F.C.); (F.P.)
| | - Gian Luigi Marseglia
- Department of Pediatrics, University of Pavia, San Matteo Foundation IRCCS Policlinico, 27100 Pavia, Italy;
| | - Stefania Arasi
- Area of Translational Research in Pediatric Specialities, Allergy Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
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18
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Asero R, Pravettoni V, Scala E, Villalta D. Lipid transfer protein allergy: A review of current controversies. Clin Exp Allergy 2021; 52:222-230. [PMID: 34773669 DOI: 10.1111/cea.14049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 01/04/2023]
Abstract
Sensitization to lipid transfer protein (LTP), the most frequent cause of food allergy in southern Europe, still shows several controversial, but also intriguing, aspects. Some of these include the degree of cross-reactivity between LTPs from botanically distant sources, the definition of risk factors, the role of some cofactors, clinical outcomes, geographical differences and the identification of the primary sensitizer in different areas. This review article tries to analyse and comment on these aspects point by point suggesting some explanatory hypotheses with the final scope to stimulate critical thoughts and elicit the scientific discussion about this issue in the readership.
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Affiliation(s)
- Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Milan, Italy
| | - Valerio Pravettoni
- Department of General Medicine, Immunology and Allergy, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Scala
- Clinical and Laboratory Molecular Allergy Unit, IDI - IRCCS, Rome, Italy
| | - Danilo Villalta
- Immunologia e allergologia, Ospedale S. Maria degli Angeli, Pordenone, Italy
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19
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Luo W, Yang S, Huang H, Wu L, Cheng ZJ, Zheng P, Zheng J, Sun B. Analysis of Peanut Allergen Components Sensitization and Cross Reaction with Pollen Allergen in Chinese Southerners with Allergic Rhinitis and/or Asthma. J Asthma Allergy 2021; 14:1285-1293. [PMID: 34737581 PMCID: PMC8560168 DOI: 10.2147/jaa.s335265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/13/2021] [Indexed: 11/26/2022] Open
Abstract
Objective Peanut is one of the most frequently reported allergens causing severe allergies in western countries. In China, however, there have been few reports of severe allergies caused by peanuts. We investigated the peanut allergen components sensitization and cross-reaction with pollen allergen in Chinese Southerners with allergic rhinitis and/or asthma. Methods Total IgE (tIgE) and specific IgE (sIgE) antibodies against Ara h 1, Ara h 8, Juglans pollen, Platanus pollen, birch pollen, Bet v 1, Bet v 4, and cross-reactive carbohydrate determinant (CCD) of 58 allergic patients, of whom 33 were peanut-sIgE positive and 25 were negative, were detected by the ImmunoCAP system. The relationships between peanut allergen and pollen allergens were analyzed. Results A 9.1% (3/33) of the patients with peanut sensitization were sensitized to Ara h 8, while 21.2% (7/33) were sensitized to Ara h 1. The peanut-sensitized group had significantly higher positive rates for sIgE antibodies against CCD (69.7% vs 4.0%), Juglans pollen (87.9% vs 12.0%), Platanus pollen (90.9% vs 16.0%), and birch pollen (60.6% vs 4.0%) than the peanut tolerance group (all P < 0.05). Spearman correlation showed that peanut-sIgE were significantly correlated with sIgE to CCD (rs=0.859), Juglans pollen (rs=0.772), Platanus pollen (rs=0.838) and birch pollen (rs=0.816). Conclusion The majority of patients sensitized to peanut allergen in Southern China tested positive for multiple pollen allergens. Peanut sensitization was highly correlated with Platanus, Juglans, and birch pollen sensitization, which suggested there may be cross-reactions between peanut and pollen allergens. Clinicians should pay attention to distinguish diagnosis in clinical peanut allergy diagnosis and treatment.
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Affiliation(s)
- Wenting Luo
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Shuwen Yang
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Huimin Huang
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Liting Wu
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Zhangkai J Cheng
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Peiyan Zheng
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Jinping Zheng
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Baoqing Sun
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, People's Republic of China
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20
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Can patients with oral allergy syndrome be at risk of anaphylaxis? Curr Opin Allergy Clin Immunol 2021; 20:459-464. [PMID: 32842037 DOI: 10.1097/aci.0000000000000679] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE OF REVIEW Oral allergy syndrome, also known as pollen-food syndrome (PFS), is a condition usually associated with adults and characterized by mild transient oropharyngeal symptoms. The purpose of this review is to determine whether systemic or anaphylactic reactions do occur and if so, who is affected and what are the triggers. RECENT FINDINGS An increasing number of studies demonstrate that PFS occurs all age groups, and a significant number of affected adults do experience systemic and anaphylactic reactions. The upsurge in the adoption of vegan lifestyles, increase in consumption of fruits and vegetables including smoothies and juices, and use of plant foods in nutritional or body-building supplements, could exacerbate this. Changes in pollen and pollution levels, cofactors and sensitization to other plant food allergens may also be involved. SUMMARY While the majority of those with PFS will continue to experience mild symptoms, all individuals should be properly advised regarding the dangers of concentrated or unusual forms of plant food allergens such as smoothies, juices, soy/nut milks and nutritional supplements. Further well characterized studies are needed to determine risk factors for severe reactions, and sensitization patterns to pollens and plant food allergens.
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Skypala IJ, Bartra J, Ebo DG, Antje Faber M, Fernández‐Rivas M, Gomez F, Luengo O, Till SJ, Asero R, Barber D, Cecchi L, Diaz Perales A, Hoffmann‐Sommergruber K, Anna Pastorello E, Swoboda I, Konstantinopoulos AP, Ree R, Scala E. The diagnosis and management of allergic reactions in patients sensitized to non-specific lipid transfer proteins. Allergy 2021; 76:2433-2446. [PMID: 33655502 DOI: 10.1111/all.14797] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/29/2021] [Accepted: 02/24/2021] [Indexed: 12/12/2022]
Abstract
Sensitization to one or more non-specific lipid transfer proteins (nsLTPs), initially thought to exist mainly in southern Europe, is becoming accepted as a cause of allergic reactions to plant foods across Europe and beyond. The peach nsLTP allergen Pru p 3 is a dominant sensitizing allergen and peaches a common food trigger, although multiple foods can be involved. A frequent feature of reactions is the requirement for a cofactor (exercise, alcohol, non-steroidal anti-inflammatory drugs, Cannabis sativa) to be present for a food to elicit a reaction. The variability in the food and cofactor triggers makes it essential to include an allergy-focused diet and clinical history in the diagnostic workup. Testing on suspected food triggers should also establish whether sensitization to nsLTP is present, using purified or recombinant nsLTP allergens such as Pru p 3. The avoidance of known trigger foods and advice on cofactors is currently the main management for this condition. Studies on immunotherapy are promising, but it is unknown whether such treatments will be useful in populations where Pru p 3 is not the primary sensitizing allergen. Future research should focus on the mechanisms of cofactors, improving diagnostic accuracy and establishing the efficacy of immunotherapy.
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Affiliation(s)
- Isabel J. Skypala
- Royal Brompton & Harefield NHS Foundation Trust London UK
- Department of Allergy and Clinical Immunology Imperial College London UK
| | - Joan Bartra
- Hospital Clinic Barcelona Spain
- IDIBAPS Universitat de Barcelona ARADyAL, Barcelona Spain
| | - Didier G. Ebo
- Department of Immunology, Allergology, Rheumatology Faculty of Medicine and Health Sciences Infla‐Med Centre of Excellence Antwerp University Hospital University of Antwerp Antwerp Belgium
- Jan Palfijn Ziekenhuis Ghent Ghent Belgium
| | - Margaretha Antje Faber
- Faculty of Medicine and Health Sciences Department of Immunology, Allergology, Rheumatology Infla‐Med Centre of Excellence Antwerp University Hospital University of Antwerp Antwerp Belgium
| | - Montserrat Fernández‐Rivas
- Department of Allergy Hospital Clínico San Carlos Universidad Complutense de Madrid IdISSC ARADyAL Madrid Spain
| | - Francisca Gomez
- Allergy Unit IBIMA—Hospital Regional Universitario de Malaga Malaga Spain
- Spanish Network for Allergy ‐ RETICS de Asma Reaccionesadversas y Alérgicas (ARADyAL Madrid Spain
| | - Olga Luengo
- Allergy Unit Internal Medicine Department Vall d'Hebron University Hospital Universitat Autònoma de Barcelona ARADyAL Barcelona Spain
| | - Stephen J. Till
- Peter Gorer Department of Immunobiology King’s College London London UK
- Department of Allergy Guy’s & St Thomas’ NHS Foundation Trust London UK
| | - Riccardo Asero
- Ambulatorio di Allergologia Clinica San Carlo Paderno Dugnano Italy
| | - Domingo Barber
- IMMA School of Medicine Universidad San Pablo CEU, Universities Madrid Spain
- RETIC ARADYAL RD16/0006/0015 Instituto de Salud Carlos III Madrid Spain
| | - Lorenzo Cecchi
- SOS Allergy and Clinical Immunology USL Toscana Centro Prato Italy
| | - Araceli Diaz Perales
- Centro de Biotecnología y Genómica de Plantas Universidad Politecnica Madrid Spain
| | | | - Elide Anna Pastorello
- Unit of Allergology and Immunology ASST Grande Ospedale Metropolitano Niguarda University of Milan Milan Italy
| | - Ines Swoboda
- Biotechnology Section Campus Vienna Biocenter FH Campus Wien, University of Applied Sciences Vienna Austria
| | | | - Ronald 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
| | - Enrico Scala
- Experimental Allergy Unit Istituto Dermopatico dell’Immacolata – IRCCS FLMM Rome Italy
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LTP Allergy Follow-Up Study: Development of Allergy to New Plant Foods 10 Years Later. Nutrients 2021; 13:nu13072165. [PMID: 34202484 PMCID: PMC8308245 DOI: 10.3390/nu13072165] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 01/27/2023] Open
Abstract
Introduction: Allergy to nonspecific lipid transfer protein (nsLTP) is the main cause of plant-food allergy in Spain. nsLTPs are widely distributed in the plant kingdom and have high cross-reactivity but extremely variable clinical expression. Little is known about the natural evolution of this allergy, which complicates management. The objective of this study was to assess the development of allergy to new plant foods in nsLTP-sensitized patients 10 years after diagnosis. Methods: One hundred fifty-one patients showing specific IgE to nsLTP determined by ISAC (Thermofisher) were included. After clinical workup (i.e., anamnesis, skin test, and challenge when needed), these patients were divided into two groups: 113 patients allergic to one or more plant food (74.5%) and 38 patients not allergic to any plant food (25.1%). Ten years later, a telephone interview was conducted to check whether patients had developed additional allergic reactions to plant foods. Results: Ten years after diagnosis, 35 of the 113 (31%) plant-food-allergic patients sensitized to nsLTP reported reactions to new, previously tolerated plant foods, mainly Rosaceae/Prunoideae fruits and nuts followed by vegetables, Rosacea/Pomoideae fruits, legumes, and cereals. Five out of 38 (13.2%) patients previously sensitized to nsLTP but without allergy to any plant food had experienced allergic reactions to some plant food: two to Rosaceae/Prunoideae fruits, two to Rosaceae/Prunoideae fruit and nuts, and one to legumes. Conclusion: Patients sensitized to nsLTP developed allergic reactions to other plant foods, mainly Rosaceae-Prunoideae fruits and nuts. This was more frequent among plant-food-allergic patients than among those who had never had plant-food allergy.
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23
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Skypala IJ, Asero R, Barber D, Cecchi L, Diaz Perales A, Hoffmann-Sommergruber K, Pastorello EA, Swoboda I, Bartra J, Ebo DG, Faber MA, Fernández-Rivas M, Gomez F, Konstantinopoulos AP, Luengo O, van Ree R, Scala E, Till SJ. Non-specific lipid-transfer proteins: Allergen structure and function, cross-reactivity, sensitization, and epidemiology. Clin Transl Allergy 2021; 11:e12010. [PMID: 34025983 PMCID: PMC8129635 DOI: 10.1002/clt2.12010] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/08/2021] [Indexed: 12/27/2022] Open
Abstract
Background Discovered and described 40 years ago, non‐specific lipid transfer proteins (nsLTP) are present in many plant species and play an important role protecting plants from stressors such as heat or drought. In the last 20 years, sensitization to nsLTP and consequent reactions to plant foods has become an increasing concern. Aim The aim of this paper is to review the evidence for the structure and function of nsLTP allergens, and cross‐reactivity, sensitization, and epidemiology of nsLTP allergy. Materials and Methods A Task Force, supported by the European Academy of Allergy & Clinical Immunology (EAACI), reviewed current evidence and provide a signpost for future research. The search terms for this paper were “Non‐specific Lipid Transfer Proteins”, “LTP syndrome”, “Pru p 3”, “plant food allergy”, “pollen‐food syndrome”. Results Most nsLTP allergens have a highly conserved structure stabilised by 4‐disulphide bridges. Studies on the peach nsLTP, Pru p 3, demonstrate that nsLTPs are very cross‐reactive, with the four major IgE epitopes of Pru p 3 being shared by nsLTP from other botanically related fruits. These nsLTP allergens are to varying degrees resistant to heat and digestion, and sensitization may occur through the oral, inhaled or cutaneous routes. In some populations, Pru p 3 is the primary and sole sensitizing allergen, but many are poly‐sensitised both to botanically un‐related nsLTP in foods, and non‐food sources of nsLTP such as Cannabis sativa, Platanus acerifolia, (plane tree), Ambrosia artemisiifolia (ragweed) and Artemisia vulgaris (mugwort). Initially, nsLTP sensitization appeared to be limited to Mediterranean countries, however more recent studies suggest clinically relevant sensitization occurs in North Atlantic regions and also countries in Northern Europe, with nsLTP sensitisation profiles being broadly similar. Discussion These robust allergens have the potential to sensitize and provoke symptoms to a large number of plant foods, including those which are raw, cooked or processed. It is unknown why some sensitized individuals develop clinical symptoms to foods whereas others do not, or indeed what other allergens besides Pru p 3 may be primary sensitising allergens. It is clear that these allergens are also relevant in non‐Mediterranean populations and there needs to be more recognition of this. Conclusion Non‐specific LTP allergens, present in a wide variety of plant foods and pollens, are structurally robust and so may be present in both raw and cooked foods. More studies are needed to understand routes of sensitization and the world‐wide prevalence of clinical symptoms associated with sensitization to these complex allergens.
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Affiliation(s)
- Isabel J Skypala
- Department of Allergy & Clinical Immunology Royal Brompton & Harefield NHS Foundation Trust Imperial College London UK
| | - Ricardo Asero
- Ambulatorio di Allergologia Clinica San Carlo Milan Italy
| | - Domingo Barber
- IMMA School of Medicine Universidad San Pablo CEU CEU Universities Madrid Spain.,RETIC ARADYAL RD16/0006/0015 Instituto de Salud Carlos III Madrid Spain
| | - Lorenzo Cecchi
- SOS Allergy and Clinical Immunology USL Toscana Centro Prato Italy
| | - Arazeli Diaz Perales
- Departamento de Biotecnología-Biología Vegetal Centro de Biotecnología y Genómica de Plantas (CBGP, UPM-INIA) Universidad Politécnica de Madrid Madrid Spain
| | | | - Elide A Pastorello
- Unit of Allergology and Immunology ASST Grande Ospedale Metropolitano Niguarda University of Milan Milan Italy
| | - Ines Swoboda
- Biotechnology Section FH Campus Wien University of Applied Sciences Vienna Austria
| | - Joan Bartra
- Hospital Clinic de Barcelona IDIBAPS Universitat de Barcelona ARADyAL Barcelona Spain
| | - Didier G Ebo
- Department of Immunology, Allergology, Rheumatology and Infla-Med Centre of Excellence Faculty of Medicine and Health Sciences University of Antwerp and Antwerp University Hospital Ghent Belgium
| | - Margaretha A Faber
- Department of Immunology, Allergology, Rheumatology and Infla-Med Centre of Excellence Faculty of Medicine and Health Sciences University of Antwerp and Antwerp University Hospital Ghent Belgium
| | - Montserrat Fernández-Rivas
- Department of Allergy Hospital Clínico San Carlos Universidad Complutense de Madrid IdISSC, ARADyAL Madrid Spain
| | - Francesca Gomez
- Allergy Unit IBIMA- Hospital Regional Universitario de Malaga Malaga and Spanish Network for Allergy - RETICS de Asma, Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
| | | | - Olga Luengo
- Allergy Unit, Internal Medicine Department Vall d'Hebron University Hospital Universitat Autònoma de Barcelona ARADyAL Barcelona Spain
| | - Ronald van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology Amsterdam University Medical Centers location AMC Amsterdam The Netherlands
| | - Enrico Scala
- Experimental Allergy Unit Istituto Dermopatico Dell'immacolata IRCCS FLMM Rome Italy
| | - Stephen J Till
- Peter Gorer Department of Immunobiology King's College London London UK.,Department of Allergy Guy's & St Thomas' NHS Foundation Trust London UK
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Di Muzio M, Wildner S, Huber S, Hauser M, Vejvar E, Auzinger W, Regl C, Laimer J, Zennaro D, Wopfer N, Huber CG, van Ree R, Mari A, Lackner P, Ferreira F, Schubert M, Gadermaier G. Hydrogen/deuterium exchange memory NMR reveals structural epitopes involved in IgE cross-reactivity of allergenic lipid transfer proteins. J Biol Chem 2021; 295:17398-17410. [PMID: 33453986 DOI: 10.1074/jbc.ra120.014243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/25/2020] [Indexed: 01/30/2023] Open
Abstract
Identification of antibody-binding epitopes is crucial to understand immunological mechanisms. It is of particular interest for allergenic proteins with high cross-reactivity as observed in the lipid transfer protein (LTP) syndrome, which is characterized by severe allergic reactions. Art v 3, a pollen LTP from mugwort, is frequently involved in this cross-reactivity, but no antibody-binding epitopes have been determined so far. To reveal human IgE-binding regions of Art v 3, we produced three murine high-affinity mAbs, which showed 70-90% coverage of the allergenic epitopes from mugwort pollen-allergic patients. As reliable methods to determine structural epitopes with tightly interacting intact antibodies under native conditions are lacking, we developed a straightforward NMR approach termed hydrogen/deuterium exchange memory (HDXMEM). It relies on the slow exchange between the invisible antigen-mAb complex and the free 15N-labeled antigen whose 1H-15N correlations are detected. Due to a memory effect, changes of NH protection during antibody binding are measured. Differences in H/D exchange rates and analyses of mAb reactivity to homologous LTPs revealed three structural epitopes: two partially cross-reactive regions around α-helices 2 and 4 as well as a novel Art v 3-specific epitope at the C terminus. Protein variants with exchanged epitope residues confirmed the antibody-binding sites and revealed strongly reduced IgE reactivity. Using the novel HDXMEM for NMR epitope mapping allowed identification of the first structural epitopes of an allergenic pollen LTP. This knowledge enables improved cross-reactivity prediction for patients suffering from LTP allergy and facilitates design of therapeutics.
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Affiliation(s)
- Martina Di Muzio
- Department of Biosciences, University of Salzburg, Salzburg, Austria; Christian Doppler Laboratory for Innovative Tools for Biosimilar Characterization, University of Salzburg, Salzburg, Austria
| | - Sabrina Wildner
- Department of Biosciences, University of Salzburg, Salzburg, Austria; Christian Doppler Laboratory for Innovative Tools for Biosimilar Characterization, University of Salzburg, Salzburg, Austria
| | - Sara Huber
- Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Michael Hauser
- Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Eva Vejvar
- Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Werner Auzinger
- Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Christof Regl
- Department of Biosciences, University of Salzburg, Salzburg, Austria; Christian Doppler Laboratory for Innovative Tools for Biosimilar Characterization, University of Salzburg, Salzburg, Austria
| | - Josef Laimer
- Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Danila Zennaro
- Centri Associati di Allergologica Molecolare (CAAM), Latina, Italy
| | - Nicole Wopfer
- Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Christian G Huber
- Department of Biosciences, University of Salzburg, Salzburg, Austria; Christian Doppler Laboratory for Innovative Tools for Biosimilar Characterization, University of Salzburg, Salzburg, Austria
| | - Ronald van Ree
- Department of Experimental Immunology and of Otorhinolaryngology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Adriano Mari
- Centri Associati di Allergologica Molecolare (CAAM), Latina, Italy
| | - Peter Lackner
- Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Fatima Ferreira
- Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Mario Schubert
- Department of Biosciences, University of Salzburg, Salzburg, Austria; Christian Doppler Laboratory for Innovative Tools for Biosimilar Characterization, University of Salzburg, Salzburg, Austria.
| | - Gabriele Gadermaier
- Department of Biosciences, University of Salzburg, Salzburg, Austria; Christian Doppler Laboratory for Innovative Tools for Biosimilar Characterization, University of Salzburg, Salzburg, Austria.
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25
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Passanisi S, Lombardo F, Crisafulli G, Salzano G, Aversa T, Pajno GB. Novel diagnostic techniques and therapeutic strategies for IgE-mediated food allergy. Allergy Asthma Proc 2021; 42:124-130. [PMID: 33685556 PMCID: PMC8133008 DOI: 10.2500/aap.2021.42.200129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background: Immunoglobulin E (IgE) mediated food allergy is a potentially life-threatening condition and represents a heavy burden for patients and their families. Identification of the most suitable way for management of each patient has currently become the primary goal for physicians. Methods: This study reviewed the current literature related to IgE-mediated food allergy. Results: The use of innovative diagnostic tools, such as allergen-specific IgG4 determination, basophil activation test, and component-resolved diagnostics, is currently available to facilitate a proper diagnosis of food allergy. After several decades of "passive clinical management" of the disease, which was based only on avoidance of the allergenic food and the use of epinephrine in the event of anaphylaxis, there has been a switch to active treatment. The most recent evidence-practice guidelines strongly recommend the use of immunotherapy as an effective therapeutic option, particularly in cases of allergy to cow's milk, egg, or peanut. The use of omalizumab, in association with immunotherapy or alone, has been tested in several studies, and results on its effectiveness seemed to be encouraging. Other biologics, such as dupilumab, reslizumab, mepolizumab, and other anticytokines therapies, are being investigated. Another interesting future treatment strategy could be the use of DNA vaccines. Conclusion: In recent years, the management of IgE-mediated food allergy has greatly improved. Knowledge of pathogenetic mechanisms, understanding of the disease course, and the introduction of novel biomarkers led to more accurate diagnoses along with the active treatment of patients.
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26
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Scheurer S, van Ree R, Vieths S. The Role of Lipid Transfer Proteins as Food and Pollen Allergens Outside the Mediterranean Area. Curr Allergy Asthma Rep 2021; 21:7. [PMID: 33537877 PMCID: PMC7858557 DOI: 10.1007/s11882-020-00982-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW To provide an overview of the prevalence and clinical manifestation of non-specific lipid transfer proteins (LTP)-mediated allergies outside the Mediterranean area and to address potential reasons for the different geographical significance of LTP-driven allergies. RECENT FINDINGS LTPs are major allergens in the Mediterranean area, which frequently can elicit severe reactions. Pru p 3 the LTP from peach is reported as genuine allergen and is considered a prototypic marker for LTP-mediated allergies. However, both food and pollen LTP allergies exist outside the Mediterranean area, but with lower clinical significance, different immunogenicity, and less clarified role. Evidence has been reported that in areas with high exposure to pollen, in particular to mugwort, pollen-derived LTPs can act as a primary sensitizer to trigger secondary food allergies. Co-sensitization to unrelated allergens might be causative for less severe reactions in response to LTPs. However, the reason for the geographical different sensitization patterns to LTPs remains unclear.
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Affiliation(s)
- Stephan Scheurer
- Molecular Allergology, Paul-Ehrlich-Institut, Paul-Ehrlich Str. 51-59, 63225, Langen, Germany.
| | - Ronald van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Stefan Vieths
- Molecular Allergology, Paul-Ehrlich-Institut, Paul-Ehrlich Str. 51-59, 63225, Langen, Germany
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27
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Midun E, Radulovic S, Brough H, Caubet JC. Recent advances in the management of nut allergy. World Allergy Organ J 2021; 14:100491. [PMID: 33510829 PMCID: PMC7811165 DOI: 10.1016/j.waojou.2020.100491] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 11/25/2022] Open
Abstract
Peanut/tree nut allergy is common and has been associated with particularly severe reactions. Epidemiological data have shown that the prevalence ranges between 0.05% and 4.9% for tree nut and between 0.5% and 3% for peanut. These large variations can be explained by differences in the age of included patients and the geographical region. In addition, the food consumption modality (ie, raw versus roasted) plays a major role, as heat treatment has the capacity to modify the allergenicity of nuts and legumes. Nut allergies tend to persist into adulthood and consequently have a high impact on quality of life. Recently, it has been demonstrated that a significant proportion of nut allergic patients are able to tolerate other nuts. As opposed to the avoidance of all nuts, this approach is currently proposed in several tertiary allergy centers. However, diagnosis of nut allergy is particularly difficult due to co-sensitization leading to high rate of false positive skin prick tests and/or specific IgE to whole allergen extracts. The use of component resolved diagnosis leads to major improvement of diagnosis, particularly to distinguish between primary and secondary nut allergies. The basophil activation test has been suggested to be useful but is still used mainly as a research tool. Thus, diagnosis remains mainly based on the oral food challenge, which is considered as the gold standard. Regarding treatment, avoidance remains the cornerstone of management of nut allergy. Oral immunotherapy is increasingly proposed as an alternative management strategy.
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Key Words
- Component-resolved diagnostic, CRD
- Cross reactivity
- Double-blind, placebo-controlled, food challenge, DBPCFC
- Food allergy
- Lipid transfer protein, LTP
- Oral allergy syndrome, OAS
- Oral food challenge, OFC
- Oral immunotherapy
- Oral induction tolerance, OIT
- Pathogenesis related protein type 10, PR-10
- Peanut
- Platelet-activating factor, PAF
- Pollen-food syndrome, PFS
- Precautionary Allergen Labels, (PAL)
- Skin prick test, SPT
- Tree nut
- Tree nut, TN
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Affiliation(s)
- Elise Midun
- Pediatric Allergy Unit, University Hospitals of Geneva and University of Geneva, Rue Willy Donzé 6, 1205 Geneva, Switzerland, University Lyon 1 Claude Bernard, 43 Boulevard Du 11-Novembre-1918, 69100, Villeurbanne, France
- Corresponding author.
| | - Suzana Radulovic
- Paediatric Allergy Group, Department of Women and Children's Health, King's College London, London, United Kingdom, Paediatric Allergy Group, Peter Gorer Dept of Immunobiology, School of Immunology & Microbial Sciences, King's College London, Guys' Hospital, London, United Kingdom, Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Helen Brough
- Paediatric Allergy Group, Department of Women and Children's Health, King's College London, London, United Kingdom, Paediatric Allergy Group, Peter Gorer Dept of Immunobiology, School of Immunology & Microbial Sciences, King's College London, Guys' Hospital, London, United Kingdom, Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Jean-Christoph Caubet
- Pediatric Allergy Unit, University Hospitals of Geneva and University of Geneva, Rue Willy Donzé 6, 1205, Geneva, Switzerland
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Identification and Purification of Novel Low-Molecular-Weight Lupine Allergens as Components for Personalized Diagnostics. Nutrients 2021; 13:nu13020409. [PMID: 33525401 PMCID: PMC7911308 DOI: 10.3390/nu13020409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 11/17/2022] Open
Abstract
Lupine flour is a valuable food due to its favorable nutritional properties. In spite of its allergenic potential, its use is increasing. Three lupine species, Lupinus angustifolius, L. luteus, and L. albus are relevant for human nutrition. The aim of this study is to clarify whether the species differ with regard to their allergen composition and whether anaphylaxis marker allergens could be identified in lupine. Patients with the following characteristics were included: lupine allergy, suspected lupine allergy, lupine sensitization only, and peanut allergy. Lupine sensitization was detected via CAP-FEIA (ImmunoCAP) and skin prick test. Protein, DNA and expressed sequence tag (EST) databases were queried for lupine proteins homologous to already known legume allergens. Different extraction methods applied on seeds from all species were examined by SDS-PAGE and screened by immunoblotting for IgE-binding proteins. The extracts underwent different and successive chromatography methods. Low-molecular-weight components were purified and investigated for IgE-reactivity. Proteomics revealed a molecular diversity of the three species, which was confirmed when investigated for IgE-reactivity. Three new allergens, L. albus profilin, L. angustifolius and L. luteus lipid transfer protein (LTP), were identified. LTP as a potential marker allergen for severity is a valuable additional candidate for molecular allergy diagnostic tests.
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29
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Čelakovská J, Bukač J, Vaňková R, Krejsek J, Andrýs C. The relation between the sensitization to molecular components of inhalant allergens and food reactions in patients suffering from atopic dermatitis. FOOD AGR IMMUNOL 2021. [DOI: 10.1080/09540105.2020.1865281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- J. Čelakovská
- Department of Dermatology and Venereology, Faculty Hospital, Medical Faculty of Charles University, Hradec Králové, Czech Republic
| | - J. Bukač
- Department of Medical Biophysic, Medical Faculty of Charles University, Hradec Králové, Czech republic
| | - R. Vaňková
- Department of Clinical Immunology and Allergy, Faculty Hospital, Medical Faculty of Charles University, Hradec Králové, Czech Republic
| | - J. Krejsek
- Department of Clinical Immunology and Allergy, Faculty Hospital, Medical Faculty of Charles University, Hradec Králové, Czech Republic
| | - C. Andrýs
- Department of Clinical Immunology and Allergy, Faculty Hospital, Medical Faculty of Charles University, Hradec Králové, Czech Republic
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30
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Structural Characterization of Act c 10.0101 and Pun g 1.0101-Allergens from the Non-Specific Lipid Transfer Protein Family. Molecules 2021; 26:molecules26020256. [PMID: 33419110 PMCID: PMC7825401 DOI: 10.3390/molecules26020256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/19/2020] [Accepted: 01/01/2021] [Indexed: 12/19/2022] Open
Abstract
(1) Background: Non-specific lipid transfer proteins (nsLTPs), which belong to the prolamin superfamily, are potent allergens. While the biological role of LTPs is still not well understood, it is known that these proteins bind lipids. Allergen nsLTPs are characterized by significant stability and resistance to digestion. (2) Methods: nsLTPs from gold kiwifruit (Act c 10.0101) and pomegranate (Pun g 1.0101) were isolated from their natural sources and structurally characterized using X-ray crystallography (3) Results: Both proteins crystallized and their crystal structures were determined. The proteins have a very similar overall fold with characteristic compact, mainly α-helical structures. The C-terminal sequence of Act c 10.0101 was updated based on our structural and mass spectrometry analysis. Information on proteins’ sequences and structures was used to estimate the risk of cross-reactive reactions between Act c 10.0101 or Pun g 1.0101 and other allergens from this family of proteins. (4) Conclusions: Structural studies indicate a conformational flexibility of allergens from the nsLTP family and suggest that immunoglobulin E binding to some surface regions of these allergens may depend on ligand binding. Both Act c 10.0101 and Pun g 1.0101 are likely to be involved in cross-reactive reactions involving other proteins from the nsLTP family.
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31
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Ruano-Zaragoza M, Somoza ML, Jiménez-Rodriguez TW, Soriano-Gomis V, González-Delgado P, Esteban-Rodriguez A, Palazón-Bru A, Blanca M, Fernández-Sánchez J. Lipid Transfer Protein Sensitization: Risk of Anaphylaxis and Molecular Sensitization Profile in Pru p 3-Sensitized Patients. Int Arch Allergy Immunol 2020; 182:425-432. [PMID: 33341818 DOI: 10.1159/000511977] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/02/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Component-resolved diagnosis reveals the IgE response to many inhaled, food, and other allergens, improving the understanding and diagnosis of allergic diseases. OBJECTIVE The aims of the study are to study the recognition of different lipid transfer proteins (LTPs) and other allergen families in a large group of people sensitized to Pru p 3 and to analyze the relationship between the clinical entities and the allergens. METHODS This cross-sectional study included a large cohort of patients with positive skin tests to peach fruit and Pru p 3 specific IgE antibodies. Respiratory and food allergy symptoms were collected, and we performed prick tests with pollen, plant food, and other allergens plus the ImmunoCAP ISAC assay. RESULTS Our sample consisted of 421 people with a mean age of 33.25 years (range 16-68); 54.6% were women. Clinical entities included anaphylaxis (37.1%), urticaria (67.9%), and oral allergy syndrome (59.1%). Rhinitis, rhinoconjunctivitis, and/or asthma were diagnosed in 71.8% of the participants. The most pronounced correlation existed between sensitization to Pru p 3 and to Jug r 3, Pla a 3, Ara h 9, and Cor a 8. We found a higher incidence of anaphylaxis in people with 5 or more recognized LTPs. No association was observed between inhaled and food allergies. CONCLUSION Most Pru p 3-sensitized participants were sensitized to additional allergens from the same family and, to a lesser extent, to other allergens, mainly in the profilin and PR-10 protein families. Anaphylaxis occurred in more than a third of the cases evaluated, and almost three-quarters of them had respiratory symptoms. Respiratory and food allergies involving LTPs do not seem to be associated.
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Affiliation(s)
- Maria Ruano-Zaragoza
- Allergy Section, ARADyAL Spanish Network, Alicante General University Hospital-ISABIAL, Alicante, Spain, .,PhD Program in Public Health, Medical and Surgical Sciences. Miguel Hernandez University, Alicante, Spain,
| | | | | | - Victor Soriano-Gomis
- Allergy Section, ARADyAL Spanish Network, Alicante General University Hospital-ISABIAL, Alicante, Spain.,Clinical Medicine Department, Miguel Hernandez University, Alicante, Spain
| | - Purificación González-Delgado
- Allergy Section, ARADyAL Spanish Network, Alicante General University Hospital-ISABIAL, Alicante, Spain.,Clinical Medicine Department, Miguel Hernandez University, Alicante, Spain
| | | | | | - Miguel Blanca
- Section of Allergy, Infanta Leonor University Hospital, Madrid, Spain
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Bogas G, Muñoz‐Cano R, Mayorga C, Casas R, Bartra J, Pérez N, Pascal M, Palomares F, Torres MJ, Gómez F. Phenotyping peach-allergic patients sensitized to lipid transfer protein and analysing severity biomarkers. Allergy 2020; 75:3228-3236. [PMID: 32535938 DOI: 10.1111/all.14447] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/10/2020] [Accepted: 05/18/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Patients with peach allergy due to nsLTP sensitization constitute a heterogeneous group in terms of sensitization profile and severity. This could be due to the presence of additional allergies to pollens. The aim of this study was to analyse the clinical characteristics, sensitization profile and severity of reactions in peach-allergic patients sensitized to nsLTP from two Mediterranean areas with different pollen exposure. METHODS Patients with diagnosis of LTP allergy from the Allergy Unit of Hospital Regional Universitario de Malaga (HRUM) and Hospital Clinic de Barcelona (HCB) were prospectively included and classified into two groups; (a) LTP-monoallergic: those that presented reaction only with peach and (b) LTP-Allergy: those that presented reaction with peach and at least another plant-food containing LTP. RESULTS A total of 252 patients were included, 235 (93.2%) had LTP-syndrome and 17 (6.8%) were LTP-monoallergic. We found a higher percentage of anaphylaxis and delayed onset of symptoms in the LTP-monoallergic group (P = .02 and P = .04, respectively). Moreover, anaphylaxis was less frequent in patients with profilin sensitization (P = .03). The comparison of patients' data from HRUM with data from HCB showed differences in sensitization to olive tree pollen and profilin (P = .01 and P = .001, respectively). CONCLUSION This study was undertaken to characterize two large group of subjects from to two regions with differing exposures to pollen. We found that more than 90% of peach-allergic patients in both populations evolved to LTP-Allergy and showed an early onset. Profilin sensitization could be more useful as a severity biomarker than the number of nsLTP, aeroallergen sensitizations or sIgE levels. This could provide clues regarding sensitization and severity patterns that might be relevant in other geographical areas.
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Affiliation(s)
- Gador Bogas
- Allergy Unit IBIMA‐ Hospital Regional Universitario de Malaga Malaga Spain
| | - Rosa Muñoz‐Cano
- Allergy Section Pneumology Department IDIBAPS Universitat de Barcelona, Hospital Clínic Barcelona Spain
- Spanish Network for Allergy ‐ RETICS de Asma Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
| | - Cristobalina Mayorga
- Allergy Unit IBIMA‐ Hospital Regional Universitario de Malaga Malaga Spain
- Spanish Network for Allergy ‐ RETICS de Asma Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
- Research Laboratory IBIMA‐ Hospital Regional Universitario de Malaga Malaga Spain
| | - Rocio Casas
- Allergy Section Pneumology Department IDIBAPS Universitat de Barcelona, Hospital Clínic Barcelona Spain
| | - Joan Bartra
- Allergy Section Pneumology Department IDIBAPS Universitat de Barcelona, Hospital Clínic Barcelona Spain
- Spanish Network for Allergy ‐ RETICS de Asma Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
| | - Natalia Pérez
- Allergy Unit IBIMA‐ Hospital Regional Universitario de Malaga Malaga Spain
| | - Mariona Pascal
- Allergy Section Pneumology Department IDIBAPS Universitat de Barcelona, Hospital Clínic Barcelona Spain
- Spanish Network for Allergy ‐ RETICS de Asma Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
| | - Francisca Palomares
- Research Laboratory IBIMA‐ Hospital Regional Universitario de Malaga Malaga Spain
| | - María José Torres
- Allergy Unit IBIMA‐ Hospital Regional Universitario de Malaga Malaga Spain
- Spanish Network for Allergy ‐ RETICS de Asma Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
- Research Laboratory IBIMA‐ Hospital Regional Universitario de Malaga Malaga Spain
| | - Francisca Gómez
- Allergy Unit IBIMA‐ Hospital Regional Universitario de Malaga Malaga Spain
- Spanish Network for Allergy ‐ RETICS de Asma Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
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Aruanno A, Urbani S, Frati F, Nucera E. LTP allergy/sensitization in a pediatric population. Allergol Immunopathol (Madr) 2020; 48:763-770. [PMID: 32402622 DOI: 10.1016/j.aller.2020.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/22/2020] [Accepted: 03/31/2020] [Indexed: 12/30/2022]
Abstract
Plant lipid transfer proteins (LTPs) are widespread plant food allergens, highly resistant to food processing and to the gastrointestinal environment, which have been described as the most common food allergens in the Mediterranean area. LTP allergy is widely described in adults, but it represents an emerging allergen also in the pediatric population. Little is known about the real prevalence and the clinical features of this allergy in children and it still often remains underdiagnosed in these patients. An early identification and a deeper knowledge of this allergy in childhood can avoid severe systemic reactions and improve the child's quality of life. Pediatricians should always consider the possibility of LTP involvement in cases of plant-derived food allergy.
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Affiliation(s)
- A Aruanno
- Allergy Unit, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy.
| | - S Urbani
- Allergy Unit, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy.
| | | | - E Nucera
- Allergy Unit, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy.
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Sasaki M, Morikawa E, Yoshida K, Fukutomi Y, Adachi Y, Odajima H, Akasawa A. The prevalence of oral symptoms caused by Rosaceae fruits and soybean consumption in children; a Japanese population-based survey. Allergol Int 2020; 69:610-615. [PMID: 32444307 DOI: 10.1016/j.alit.2020.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Pollen food Syndrome (PFS) to Rosaceae fruits and soybean, related to Bet v 1 homologue sensitization has been reported increasingly throughout Japan, possibly due to the wide distribution of alder. METHODS In 2015, we conducted a school-based questionnaire survey among two age groups; students in primary school (Years 1-2) and secondary school (Years 8-9) from each of the 47 prefectures of Japan. We analyzed the prevalence, demographic and clinical characteristics of children with oral symptoms to Rosaceae fruits/soybean; defined as oral symptoms occurring shortly after ingesting apple, peach, cherry or soybean. Additionally, we assessed the correlation between the prevalence and external data on alder sensitization rates by prefecture. RESULTS Responses from 41,264 primary and 35,302 secondary school students were analyzed. The prevalence of oral symptoms to Rosaceae fruits/soybean was 0.99%, 95%CI: 0.89-1.09% and 2.75%, 95%CI: 2.59-2.93% among each age group, respectively. Children with oral symptoms were more likely to have parental and personal history of allergic disease compared to those without symptoms. Oral symptoms were experienced more often in children with severe spring allergic rhinitis or have both allergic rhinitis and wheeze. There was a strong correlation between the prevalence of oral symptoms and alder sensitization rates by prefecture among both age groups (r = 0.63, p < 0.001 and r = 0.76, p < 0.001, respectively). CONCLUSIONS Oral symptoms to Rosaceae fruits/soybean, which is suggestive of PFS was reported by 1-3% Japanese school children. It was associated with the geographic alder sensitization rate, supporting the underlying sensitization to Bet v 1.
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Affiliation(s)
- Mari Sasaki
- Division of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
| | - Emi Morikawa
- Division of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan; Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Koichi Yoshida
- Division of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yuma Fukutomi
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Yuichi Adachi
- Department of Pediatrics, University of Toyama, Toyama, Japan
| | - Hiroshi Odajima
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Akira Akasawa
- Division of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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Scala E, Abeni D, Asero R. Disease-Specific Molecular Profiles Highlighted by Radar Graphic Display. Int Arch Allergy Immunol 2020; 181:536-539. [PMID: 32434187 DOI: 10.1159/000507217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 03/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Management of hundreds of analytes obtained from the molecular multiplex techniques currently available may represent a challenge for clinicians in daily clinical practice. OBJECTIVES The aim of the study was to describe a comprehensive and simple approach to assess such complex molecular results, to display relevant disease-specific signatures at a glance, and to facilitate their interpretation. METHOD A total of 6,332 consecutive allergic patients, categorized based on clinical symptoms reported at the time of the first visit before IgE testing, were evaluated through ImmunoCAP ISAC112®. RESULTS AND CONCLUSIONS The occurrence of bronchial asthma is associated with polcalcin, serum albumin, or lipocalin reactivity. Higher risk of severe reaction to food is linked to tropomyosin or nonspecific lipid transfer protein reactivity (in the absence of plant pathogenesis-related proteins [PR-10] or profilin sensitization). We used radar graphic display to highlight, at a glance, the molecular reactivity profiles associated with relevant disease-specific patterns.
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Affiliation(s)
- Enrico Scala
- Experimental Allergy Unit, IDI-IRCCS, Rome, Italy,
| | - Damiano Abeni
- Health Services Research Unit, IDI-IRCCS, Rome, Italy
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Milan, Italy
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Characteristics of pollen-related food allergy based on individual pollen allergy profiles in the Chinese population. World Allergy Organ J 2020; 13:100120. [PMID: 32435327 PMCID: PMC7229292 DOI: 10.1016/j.waojou.2020.100120] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/08/2020] [Accepted: 04/02/2020] [Indexed: 01/28/2023] Open
Abstract
Background Patients with pollinosis are often multi-sensitized to diverse pollen allergens. However, little is known about pollen allergy types among Chinese pollinosis patients. This study is aimed to characterize clinical manifestations of food allergy among patients with different types of pollen allergy. Methods We retrospectively analyzed 402 pollinosis patients from an outpatient allergy department of the Peking Union Medical College Hospital who had been diagnosed by experienced allergists. All included patients who answered a questionnaire regarding seasonal pollinosis and clinical symptoms after ingestion of food and underwent intradermal skin tests. Total IgE and specific IgE levels were quantified by ImmunoCAP, using 0.35 kUA/L as a threshold for positivity. Results The patients were divided into 3 groups, based on the season during which they experienced symptoms and the 2 peaks of Chinese airborne pollen: spring-tree pollen symptoms group (SG), autumn-weed pollen symptoms group (AG), and a combined spring and autumn pollen symptoms group (CG). Birch pollen (83%) and ash pollen (74%) were common allergens among patients with spring symptoms, while mugwort pollen (87%) was a common allergen among patients with autumn symptoms. In total, 30% of the study population experienced pollen-related food allergy. Pollen-related food allergies were more prevalent among the single-season symptom groups (68% and 50% for the SG and AG, respectively) than among the CG (20%). All patients with pollen-related food-induced anaphylaxis exhibited autumn weed pollen symptoms. Except for 2 patients, all patients with food-induced anaphylaxis were allergic to mugwort pollen. In the SG, all patients with food allergy were sensitive to birch pollen, with birch and Bet v 1-specific IgE levels higher in this group than in the group without food allergy (p < 0.001). In the AG, Art v 3 was more prevalent among patients with pollen-related food allergy than without food allergy (79% vs. 33%, p < 0.001), a proportion similar to the one in the CG (67% vs. 48%, p = 0.01). Meanwhile, the Art v 3-specific IgE levels among patients with pollen-related food allergy were higher than among tolerant patients in the AG (p < 0.001) and CG (p = 0.02). Unexpectedly, the Art v 3-specific IgE levels were higher in patients with food-induced anaphylaxis than with oral allergy syndrome only in the CG. Conclusions Bet v 1 (a Pathogenesis-related 10 protein) and Art v 3 (a non-specific lipid transfer protein; nsLTP) are candidate molecular biomarkers for the diagnosis of food allergies in patients with season-specific pollen-related allergies. Measuring pollen allergen component-specific IgE levels might be an effective tool for the management of pollinosis in clinical practice in China.
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Uasuf CG, De Angelis E, Guagnano R, Pilolli R, D’Anna C, Villalta D, Brusca I, Monaci L. Emerging Allergens in Goji Berry Superfruit: The Identification of New IgE Binding Proteins towards Allergic Patients' Sera. Biomolecules 2020; 10:E689. [PMID: 32365614 PMCID: PMC7277879 DOI: 10.3390/biom10050689] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 12/26/2022] Open
Abstract
The goji berry (Lycium barbarum L.) (GB) is gaining increasing attention with high consumption worldwide due to its exceptional nutritional value and medicinal benefits displayed in humans. Beyond their beneficial properties, GBs contain renowned allergenic proteins, and therefore deserve inclusion among the allergenic foods capable of inducing allergic reactions in sensitive consumers. GB allergy has been frequently linked to the panallergen lipid transfer protein (LTP), especially across the population of the Mediterranean area. Methods: In this study, we investigated the protein profile of GBs focusing on the most reactive proteins against immunoglobulins E (IgE) of allergic patients' sera, as ascertained by immunoblot experiments. The protein spots displaying a clear reaction were excised, in-gel digested, and analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) followed by data searching against a restricted database for a reliable protein identification. Results: According to our data, three main spots were identified in GB extract as IgE binding proteins after immunoblot analysis. Some major proteins were identified and the three proteins that provided the highest reactivity were putatively attributed to vicilin and legumin proteins followed by a protein matching with 11S globulin belonging to the cupin superfamily. Finally, the whole GB protein extract was also submitted to bottom-up proteomics followed by a software-based database (DB) screening and a more exhaustive list of GB proteins was compiled.
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Affiliation(s)
- Carina Gabriela Uasuf
- Allergy Diseases Center “Prof. Giovanni Bonsignore”, IRIB-CNR, 90146 Palermo, Italy; (C.G.U.); (C.D.)
| | - Elisabetta De Angelis
- Institute of Sciences of Food Production, National Research Council of Italy (ISPA-CNR), 70126 Bari, Italy; (E.D.A.); (R.G.); (R.P.)
| | - Rocco Guagnano
- Institute of Sciences of Food Production, National Research Council of Italy (ISPA-CNR), 70126 Bari, Italy; (E.D.A.); (R.G.); (R.P.)
| | - Rosa Pilolli
- Institute of Sciences of Food Production, National Research Council of Italy (ISPA-CNR), 70126 Bari, Italy; (E.D.A.); (R.G.); (R.P.)
| | - Claudia D’Anna
- Allergy Diseases Center “Prof. Giovanni Bonsignore”, IRIB-CNR, 90146 Palermo, Italy; (C.G.U.); (C.D.)
| | - Danilo Villalta
- SSD di Immunologia e Allergologia, Ospedale S. Maria degli Angeli, 33170 Pordenone, Italy;
| | - Ignazio Brusca
- U.O.C. di Patologia Clinica Ospedale Buccheri La Ferla F.B.F., 90123 Palermo, Italy;
| | - Linda Monaci
- Institute of Sciences of Food Production, National Research Council of Italy (ISPA-CNR), 70126 Bari, Italy; (E.D.A.); (R.G.); (R.P.)
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A WAO - ARIA - GA 2LEN consensus document on molecular-based allergy diagnosis (PAMD@): Update 2020. World Allergy Organ J 2020; 13:100091. [PMID: 32180890 PMCID: PMC7062937 DOI: 10.1016/j.waojou.2019.100091] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Precision allergy molecular diagnostic applications (PAMD@) is increasingly entering routine care. Currently, more than 130 allergenic molecules from more than 50 allergy sources are commercially available for in vitro specific immunoglobulin E (sIgE) testing. Since the last publication of this consensus document, a great deal of new information has become available regarding this topic, with over 100 publications in the last year alone. It thus seems quite reasonable to publish an update. It is imperative that clinicians and immunologists specifically trained in allergology keep abreast of the new and rapidly evolving evidence available for PAMD@. PAMD@ may initially appear complex to interpret; however, with increasing experience, the information gained provides relevant information for the allergist. This is especially true for food allergy, Hymenoptera allergy, and for the selection of allergen immunotherapy. Nevertheless, all sIgE tests, including PAMD@, should be evaluated within the framework of a patient's clinical history, because allergen sensitization does not necessarily imply clinical relevant allergies.
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Decuyper II, Pascal M, Van Gasse AL, Mertens C, Díaz‐Perales A, Araujo G, Torradeflot M, Rius J, Balsells S, Muñoz‐Cano RM, Bartra J, Li L, Sabato V, Hagendorens MM, Bridts CH, De Clerck LS, Ebo DG, Faber MA. Performance of basophil activation test and specific IgG4 as diagnostic tools in nonspecific lipid transfer protein allergy: Antwerp-Barcelona comparison. Allergy 2020; 75:616-624. [PMID: 31512256 DOI: 10.1111/all.14040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 07/23/2019] [Accepted: 08/07/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Recent studies show that nsLTP sensitization is not limited to the Mediterranean basin and can present diverse clinical phenotypes. It remains challenging to predict clinical outcome when specific IgE antibodies (sIgE) to nsLTPs are present. This study compares both clinical and in vitro allergy characteristics but also diagnostic performance of a basophil activation test (BAT) and sIgG4 in nsLTP-sensitized patients from Antwerp (ANT, Belgium) and Barcelona (BCN, Spain). METHODS Adult subjects with positive sIgE rPru p 3 and/or rMal d 3 ≥ 0.10 kUA /L (n = 182) and healthy controls (n = 37) were included. NsLTP-sensitized individuals were stratified according to clinical symptoms with peach/apple, respectively. BAT rPru p 3 and rMal d 3 were performed and sIgG4 antibodies to both components quantified. RESULTS In BCN, only ratios of sIgG4/sIgE rMal d 3 and BAT rMal d 3 (0.001 µg/mL) can identify clinically relevant Mal d 3 sensitization (sensitivity of 60%-63% and a specificity of 75%-67%, respectively). In ANT, only the sIgE/total IgE rPru p 3 ratio shows added value (sensitivity 60% and specificity 83%). Finally, it appears that symptomatic patients in BCN are more sensitive to lower allergen concentrations compared to ANT. In addition, it was shown that ANT patients were more often sensitized to pollen and that specific pollen sources differed between regions. CONCLUSIONS NsLTP-related allergy profiles and diagnostic performance differ significantly between regions and are component-specific, which makes extrapolation of data difficult to do. In addition, it seems that basophil sensitivity might show geographical differences. Additional research is needed to confirm these findings.
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Affiliation(s)
- Ine I. Decuyper
- Department of Immunology‐Allergology‐Rheumatology University of Antwerp and Antwerp University Hospital Antwerp Belgium
- Pediatric Department University of Antwerp and Antwerp University Hospital Antwerp Belgium
| | - Mariona Pascal
- Immunology Department Centre de Diagnòstic Biomèdic (CDB)Hospital Clínic de Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Universitat de Barcelona Barcelona Spain
- Spanish Network for Allergy – RETIC de Asma, Reacciones adversas y Alérgicas (ARADYAL) Madrid Spain
| | - Athina L. Van Gasse
- Department of Immunology‐Allergology‐Rheumatology University of Antwerp and Antwerp University Hospital Antwerp Belgium
- Pediatric Department University of Antwerp and Antwerp University Hospital Antwerp Belgium
| | - Christel Mertens
- Department of Immunology‐Allergology‐Rheumatology University of Antwerp and Antwerp University Hospital Antwerp Belgium
| | - Araceli Díaz‐Perales
- Spanish Network for Allergy – RETIC de Asma, Reacciones adversas y Alérgicas (ARADYAL) Madrid Spain
- Plant Biotechnology Institute (UPM‐INIA) Madrid Spain
| | - Giovanna Araujo
- Allergy Section Pneumology Department Institut Clínic Respiratori (ICR)Hospital Clínic de Barcelona Barcelona Spain
| | - Maria Torradeflot
- Immunology Department Centre de Diagnòstic Biomèdic (CDB)Hospital Clínic de Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Universitat de Barcelona Barcelona Spain
| | - Josefina Rius
- Immunology Department Centre de Diagnòstic Biomèdic (CDB)Hospital Clínic de Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Universitat de Barcelona Barcelona Spain
| | - Sara Balsells
- Immunology Department Centre de Diagnòstic Biomèdic (CDB)Hospital Clínic de Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Universitat de Barcelona Barcelona Spain
| | - Rosa M. Muñoz‐Cano
- Spanish Network for Allergy – RETIC de Asma, Reacciones adversas y Alérgicas (ARADYAL) Madrid Spain
- Allergy Section Pneumology Department Institut Clínic Respiratori (ICR)Hospital Clínic de Barcelona Barcelona Spain
| | - Joan Bartra
- Spanish Network for Allergy – RETIC de Asma, Reacciones adversas y Alérgicas (ARADYAL) Madrid Spain
- Allergy Section Pneumology Department Institut Clínic Respiratori (ICR)Hospital Clínic de Barcelona Barcelona Spain
| | - Lynne Li
- Department of Medicine University of British Columbia Vancouver BC Canada
| | - Vito Sabato
- Department of Immunology‐Allergology‐Rheumatology University of Antwerp and Antwerp University Hospital Antwerp Belgium
| | - Margo M. Hagendorens
- Department of Immunology‐Allergology‐Rheumatology University of Antwerp and Antwerp University Hospital Antwerp Belgium
- Pediatric Department University of Antwerp and Antwerp University Hospital Antwerp Belgium
| | - Chris H. Bridts
- Department of Immunology‐Allergology‐Rheumatology University of Antwerp and Antwerp University Hospital Antwerp Belgium
| | - Luc S. De Clerck
- Department of Immunology‐Allergology‐Rheumatology University of Antwerp and Antwerp University Hospital Antwerp Belgium
| | - Didier G. Ebo
- Department of Immunology‐Allergology‐Rheumatology University of Antwerp and Antwerp University Hospital Antwerp Belgium
| | - Margaretha A. Faber
- Department of Immunology‐Allergology‐Rheumatology University of Antwerp and Antwerp University Hospital Antwerp Belgium
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Ansotegui IJ, Melioli G, Canonica GW, Caraballo L, Villa E, Ebisawa M, Passalacqua G, Savi E, Ebo D, Gómez RM, Luengo Sánchez O, Oppenheimer JJ, Jensen-Jarolim E, Fischer DA, Haahtela T, Antila M, Bousquet JJ, Cardona V, Chiang WC, Demoly PM, DuBuske LM, Ferrer Puga M, Gerth van Wijk R, González Díaz SN, Gonzalez-Estrada A, Jares E, Kalpaklioğlu AF, Kase Tanno L, Kowalski ML, Ledford DK, Monge Ortega OP, Morais Almeida M, Pfaar O, Poulsen LK, Pawankar R, Renz HE, Romano AG, Rosário Filho NA, Rosenwasser L, Sánchez Borges MA, Scala E, Senna GE, Sisul JC, Tang ML, Thong BYH, Valenta R, Wood RA, Zuberbier T. IgE allergy diagnostics and other relevant tests in allergy, a World Allergy Organization position paper. World Allergy Organ J 2020; 13:100080. [PMID: 32128023 PMCID: PMC7044795 DOI: 10.1016/j.waojou.2019.100080] [Citation(s) in RCA: 233] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/08/2019] [Indexed: 02/06/2023] Open
Abstract
Currently, testing for immunoglobulin E (IgE) sensitization is the cornerstone of diagnostic evaluation in suspected allergic conditions. This review provides a thorough and updated critical appraisal of the most frequently used diagnostic tests, both in vivo and in vitro. It discusses skin tests, challenges, and serological and cellular in vitro tests, and provides an overview of indications, advantages and disadvantages of each in conditions such as respiratory, food, venom, drug, and occupational allergy. Skin prick testing remains the first line approach in most instances; the added value of serum specific IgE to whole allergen extracts or components, as well as the role of basophil activation tests, is evaluated. Unproven, non-validated, diagnostic tests are also discussed. Throughout the review, the reader must bear in mind the relevance of differentiating between sensitization and allergy; the latter entails not only allergic sensitization, but also clinically relevant symptoms triggered by the culprit allergen.
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Key Words
- AAAAI, American Academy of Allergy Asthma and Immunology
- ABA, Allergen Bead Array
- ACAAI, American College of Allergy Asthma and Immunology
- AEC, Allergen Exposure Chambers
- AIT, allergen immunotherapy
- AP, Alkaline Phosphatase
- AU/mL, Allergenic Units milliLiter
- Allergy
- Anti-IgE, Antibody against IgE
- BAT, Basophil Activation Test
- BAU/mL, Biologic Allergenic Units milliLiter
- CBA, Cytometric Bead Array
- CCD, Cross-reactive Carbohydrate Determinants
- CDER, Center for Drug Evaluation and Research (USA)
- CL, Chemiluminescence
- CaFE, Calibrated Fluorescence Enhancement
- DBPCFC, Double-Blind Placebo-Controlled Food Challenge
- Diagnostic strategies
- EAACI, European Academy of Allergy and Immunology
- EIA, Enzyme Immune Assay
- ELISA, Enzyme Linked Immuno Sorbent Analysis
- EMEA, European MEdicine Agencies
- ENPP-3, EctoNucleotide Pyrophosphatase/Phosphodiesterase 3
- FACS, Fluorescence-Activated Cell Sorting
- FDA, Food and Drug Administration (U.S. Department of Health and Human Services)
- FEIA, Fluorescent Enzyme Immunoassays
- FcεRI, High affinity IgE receptor
- H1, Histamine 1 receptor
- H2, Histamine 2 receptor
- HPO, Horseradish Peroxidase
- IDT, Intradermal Test
- ISAC, Immuno-Solid phase Allergen Chip
- IUIS, International Union of Immunological Societies
- IVD, in vitro diagnostic tool
- IgE
- IgE, immunoglobulin E
- In vitro tests
- LAMP-3, Lysosomal-Associated Membrane Protein
- MBAD, Molecule Based Allergy Diagnostics
- MRGPRX2, Mas-related G protein receptor 2
- NIH, National Institutes of Health (USA)
- NMBAs, NeuroMuscular Blocking Agents
- NPA, Negative Percent Agreement
- NSAIDs, Non-Steroidal Anti-Inflammatory Drugs
- PPA, Positive Percent Agreement
- PPT, Prick-Prick Test
- RAST, Radio Allergo Sorbent Test
- SCAR, severe cutaneous adverse drug reactions
- SPT, Skin prick test
- Skin tests
- kUA/L, kilo Units of Allergen/Liter for allergen-specific IgE antibody assays
- mAb, Monoclonal Antibody
- pNPP, p-Nitrophenylphosphate
- sIgE, specific IgE
- w/v, weight /volume
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Affiliation(s)
| | - Giovanni Melioli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
| | - Elisa Villa
- Azienda Sanitaria Locale di Vercelli, S.C. Pneumologia, Vercelli, Italia
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | | | - Didier Ebo
- Department of Immunology - Allergology - Rheumatology, Antwerp University Hospital, Antwerp University, Department Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium
| | | | - Olga Luengo Sánchez
- Allergy Section, Department of Internal Medicine, Vall d’Hebron University Hospital, Barcelona, Spain
| | | | - Erika Jensen-Jarolim
- Institute for Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, The Interuniversity Messerli Research Institute, University of Veterinary Medicine Vienna, Medical University Vienna, Vienna, Austria
| | - David A. Fischer
- Fischer Medicine Professional Corporation, Barrie, Ontario, Canada
| | - Tari Haahtela
- Skin and Allergy Hospital, University of Helsinki, Helsinki, Finland
| | | | - Jean J. Bousquet
- MACVIA-France, Montpellier, France
- INSERM, Villejuif, France
- Université Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, France
- Euforea, Brussels, Belgium
- CHU Montpellier, France
| | - Victoria Cardona
- Universitat Autónoma de Barcelona, Hospital Universitario Vall d'Hebron, Servicio de Medicina Interna, Sección de Alergología, Barcelona, Spain
| | - Wen Chin Chiang
- Mount Elizabeth Medical Centre, Chiang Children's Allergy & Asthma Clinic, Singapore, Singapore
| | - Pascal M. Demoly
- University Hospital Montpellier, Montpellier, France
- Sorbonne Université, Paris, France
| | | | - Marta Ferrer Puga
- The Unidad de Educación Médica, Department of Medical Education, School of Medicine, Clinica Universitad de Navarra, Navarra, Spain
| | | | | | | | | | | | | | - Marek L. Kowalski
- Faculty of Medicine, Department of Clinical Immunology & Allergy, Medical University of Łódź, Łódź, Poland
| | | | | | | | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Lars K. Poulsen
- Gentofte University Hospital, Lab for Allergology, Allergy Clinic, Hellerup, Denmark
| | - Ruby Pawankar
- Nippon Medical School, Dept. of Otolaryngology, Tokyo, Japan
| | - Harald E. Renz
- University Hospital GI & MR GmbH, Institute of Laboratory Medicine & Pathology, Standort Marburg, Marburg, Germany
| | | | | | - Lanny Rosenwasser
- University of Missouri at Kansas City, School of Medicine, Kansas City, MO, USA
| | | | - Enrico Scala
- Experimental Allergy Unit, Istituto Dermopatico dell'Immacolata, Rome, Italy
| | | | | | - Mimi L.K. Tang
- Royal Children's Hospital, Department of Allergy & Immunology, Parkville, Victoria, Australia
| | - Bernard Yu-Hor Thong
- Tan Tock Seng Hospital, Deptartment of Rheumatology, Allergy & Immunology, Singapore, Singapore
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
- NRC Institute of Immunology FMBA of Russia, Moscow, Russia
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Robert A. Wood
- Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Torsten Zuberbier
- Campus Charite Mitte, Klinik fur Dermatologie & Allergologie, Berlin, Germany
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41
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Scala E, Abeni D, Guerra EC, Pirrotta L, Locanto M, Meneguzzi G, Giani M, Russo G, Asero R. β-1,3-glucanase rOle e 9 and MnSOD rAsp f 6 IgE reactivity are the signature of atopic dermatitis in the Mediterranean area. Clin Exp Allergy 2020; 50:487-498. [PMID: 31885112 DOI: 10.1111/cea.13555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) represents a chronic skin disorder seriously affecting patients' QoL and is often associated with immunological imbalance, disorders of the skin barrier function and environmental factors. OBJECTIVE We extensively studied the proteomic IgE sensitization profile in a large AD Mediterranean cohort. METHODS A total of 588 individuals with moderate-severe (70.6%) or mild and/or history of (29.4%) AD were evaluated in comparison to 1285 unselected atopic controls (AC) with a history of adverse reactions to foods, allergic rhinitis and/or bronchial asthma by means of ImmunoCAP ISAC112 ® and Allergy Explorer-ALEX® microarray analysis. RESULTS The olive tree pollen β-1,3-glucanase rOle e 9 and the manganese superoxide dismutase from Aspergillus rAsp f 6 were the molecules most significantly associated with AD occurrence and allowed to discriminate among the moderate and severe forms of disease. An IgE hyper-reactivity to cypress, grasses, olive tree, house dust mites (including rDer p 11), and to all cross-reactive components except profilin and polcalcin was observed. About 60% of adults with severe AD were sensitized to nsLTPs. Cross-reactive carbohydrate determinants (CCDs) IgE was found in about one-third of AD participants. Hen eggs nGal d 1 IgE sensitization was more prevalent in the paediatric population, whilst rAsp f 6 and rOle e 9 reactivity was found particularly in older patients. Despite the status of widespread IgE sensitization to both environmental and food allergens, a reduced frequency of patient-reported severe reactions to food or of asthma was observed in AD patients compared to AC, particularly in case of concomitant Ole e 9 reactivity. CONCLUSION AND CLINICAL RELEVANCE Testing IgE reactivity to a large panel of molecular components unveils important associations between IgE reactivity profiles and AD clinical presentation, highlights the allergens useful for a precise AD signature and allows the detection of interesting sensitisations patterns.
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Affiliation(s)
- Enrico Scala
- Experimental Allergy Unit, IDI-IRCCS, Rome, Italy
| | - Damiano Abeni
- Health Services Research Unit, IDI-IRCCS, Rome, Italy
| | | | - Lia Pirrotta
- Experimental Allergy Unit, IDI-IRCCS, Rome, Italy
| | | | | | - Mauro Giani
- Experimental Allergy Unit, IDI-IRCCS, Rome, Italy
| | | | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Milan, Italy
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Rizzi A, Chini R, Inchingolo R, Carusi V, Pandolfi F, Gasbarrini A, Nucera E. Nickel allergy in lipid transfer protein sensitized patients: Prevalence and clinical features. Int J Immunopathol Pharmacol 2020; 34:2058738420974895. [PMID: 33242297 PMCID: PMC7705783 DOI: 10.1177/2058738420974895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/27/2020] [Indexed: 12/12/2022] Open
Abstract
Nickel (Ni), the main responsible for allergic contact dermatitis worldwide, is also involved in systemic condition called "Systemic Nickel Sulfate Allergy Syndrome (SNAS)." Likewise, IgE-mediated reactivity to Lipid Transfer Protein (LTP) represents the main cause of primary food allergy in adults of Mediterranean countries. We evaluated the prevalence of SNAS in LTP allergic patients and investigated patients' clinical features with double sensitization (LTP and Ni). A retrospective, single-center, observational study was conducted performing a complete allergological work-up including: (1) skin prick tests; (2) serum specific IgE for plant food allergens and rPru p3 (LTP); (3) patch test with 5% Ni sulfate in petrolatum. We enrolled 140 LTP allergic patients of which 36 patients (25.7% of sample) showed additional positivity to Ni patch test. Patients with double sensitization were more frequently females and reported fewer cutaneous symptoms. Higher values of sIgE for peach, apple, peanut, walnut, grain, corn, and garlic were found in LTP allergic patients, while higher values for hazelnut in the other subgroup. The prevalence of SNAS in the LTP allergic population is clinically relevant. Moreover, the clinical and immunological profiles of patients with double sensitization were different from patients monosensitized to LTP.
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Affiliation(s)
- Angela Rizzi
- UOSD Allergologia e Immunologia Clinica,
Dip. Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli
IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore,
Roma, Italy
| | - Raffaella Chini
- UOSD Allergologia e Immunologia Clinica,
Dip. Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli
IRCCS, Roma, Italy
| | - Riccardo Inchingolo
- Università Cattolica del Sacro Cuore,
Roma, Italy
- UOC Pneumologia, Dip. Scienze Mediche e
Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma,
Italy
| | - Valentina Carusi
- UOSD Allergologia e Immunologia Clinica,
Dip. Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli
IRCCS, Roma, Italy
| | - Franco Pandolfi
- UOSD Allergologia e Immunologia Clinica,
Dip. Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli
IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore,
Roma, Italy
| | - Antonio Gasbarrini
- Università Cattolica del Sacro Cuore,
Roma, Italy
- UOC Gastroenterologia, Dip. Scienze
Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma,
Italy
| | - Eleonora Nucera
- UOSD Allergologia e Immunologia Clinica,
Dip. Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli
IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore,
Roma, Italy
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43
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Elisyutina O, Fedenko E, Campana R, Litovkina A, Ilina N, Kudlay D, Egorenkov E, Smirnov V, Valenta R, Lupinek C, Khaitov M. Bet v 1-specific IgE levels and PR-10 reactivity discriminate silent sensitization from phenotypes of birch allergy. Allergy 2019; 74:2525-2528. [PMID: 31145475 DOI: 10.1111/all.13931] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
| | - Elena Fedenko
- NRC Institute of Immunology FMBA of Russia Moscow Russia
| | - Raffaela Campana
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Centre for Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | - Alla Litovkina
- NRC Institute of Immunology FMBA of Russia Moscow Russia
| | - Nataliya Ilina
- NRC Institute of Immunology FMBA of Russia Moscow Russia
| | - Dmitry Kudlay
- NRC Institute of Immunology FMBA of Russia Moscow Russia
| | | | - Valeriy Smirnov
- NRC Institute of Immunology FMBA of Russia Moscow Russia
- Sechenov First State Medical University Moscow Russian Federation
| | - Rudolf Valenta
- NRC Institute of Immunology FMBA of Russia Moscow Russia
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Centre for Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
- Sechenov First State Medical University Moscow Russian Federation
| | - Christian Lupinek
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Centre for Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | - Musa Khaitov
- NRC Institute of Immunology FMBA of Russia Moscow Russia
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Wildner S, Griessner I, Stemeseder T, Regl C, Soh WT, Stock LG, Völker T, Alessandri C, Mari A, Huber CG, Stutz H, Brandstetter H, Gadermaier G. Boiling down the cysteine-stabilized LTP fold - loss of structural and immunological integrity of allergenic Art v 3 and Pru p 3 as a consequence of irreversible lanthionine formation. Mol Immunol 2019; 116:140-150. [DOI: 10.1016/j.molimm.2019.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 01/27/2023]
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Navarro B, Alarcón E, Claver Á, Pascal M, Díaz-Perales A, Cisteró-Bahima A. Oral immunotherapy with peach juice in patients allergic to LTPs. Allergy Asthma Clin Immunol 2019; 15:60. [PMID: 31572454 PMCID: PMC6760060 DOI: 10.1186/s13223-019-0374-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 09/14/2019] [Indexed: 12/05/2022] Open
Abstract
Introduction To assess the safety and efficacy of an oral immunotherapy regimen in patients with allergy to lipid transfer proteins (LTPs). Materials and methods Prospective study of 24 patients allergic to LTP with positive skin test and a history of anaphylaxis. All patients underwent a desensitization protocol with commercial peach juice. Rising doses of peach juice were administered, starting with an initial dose of seven drops of a 1/1000 dilution and finishing with a dose of 5 ml at visit 17. At visit 18, all patients performed an open challenge with whole juice at a cumulative dose of 200 ml. All adverse reactions occurring during the administration of the different doses were recorded. Levels of rPru p 3 in the juice were quantified. Results There were no severe reactions during the desensitization process in the 24 patients. Seven patients (29%) reported mild oral symptoms, and two patients (8%) had urticaria associated with co-factors (one due to exercise and another due to non-steroidal anti-inflammatory drugs). Nineteen patients were able to swallow 5 ml of juice and five withdrew from the study. In two pregnant patients the final challenge was not performed. In all, 17/24 patients were able to consume 200 ml peach juice without developing symptoms. Conclusions Oral immunotherapy with the regimen used in this study is an effective and safe short-term therapeutic option for patients with allergy to LTPs. Commercial peach juice appears to be suitable for this treatment.
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Affiliation(s)
- Begoña Navarro
- 1Allergy Department, Hospital Universitari Dexeus (GQS), Universitat Autònoma de Barcelona, Calle Sabino Arana, 5-19, 08028 Barcelona, Spain
| | - Eladia Alarcón
- 1Allergy Department, Hospital Universitari Dexeus (GQS), Universitat Autònoma de Barcelona, Calle Sabino Arana, 5-19, 08028 Barcelona, Spain
| | - Ángela Claver
- 1Allergy Department, Hospital Universitari Dexeus (GQS), Universitat Autònoma de Barcelona, Calle Sabino Arana, 5-19, 08028 Barcelona, Spain
| | - Mariona Pascal
- 2Servicio de Inmunología, Centro de Diagnóstico Biomédico, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Araceli Díaz-Perales
- 3Escuela Técnica Superior de Ingeniero Agrónomos, Departamento de Biotecnología, Universidad Politécnica de Madrid, Madrid, Spain
| | - Anna Cisteró-Bahima
- 1Allergy Department, Hospital Universitari Dexeus (GQS), Universitat Autònoma de Barcelona, Calle Sabino Arana, 5-19, 08028 Barcelona, Spain
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Skypala IJ, Cecchi L, Shamji MH, Scala E, Till S. Lipid Transfer Protein allergy in the United Kingdom: Characterization and comparison with a matched Italian cohort. Allergy 2019; 74:1340-1351. [PMID: 30762886 PMCID: PMC6767535 DOI: 10.1111/all.13747] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/13/2018] [Accepted: 01/06/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Although pollen-related food allergy occurs in all European populations, lipid transfer protein (LTP) allergy is considered to manifest mainly in Mediterranean countries. We aimed to characterize adults presenting with LTP allergy in a northern European country. METHOD The clinical history and sensitization patterns of subjects born and residing in the United Kingdom (UK), with a prior diagnosis of LTP allergy and sensitization to the peach LTP allergen Pru p 3, were compared to UK subjects with pollen food syndrome (PFS). The sensitization patterns were also evaluated against a matched cohort of Italian subjects diagnosed with LTP allergy. RESULTS None of the 15 UK PFS subjects had a positive SPT to LTP-enriched peach reagent, compared to 91% of the 35 UK LTP subjects. The UK LTP cohort were also more likely to have positive skin prick tests to cabbage, lettuce and mustard and sensitization to the LTP allergens in peach, walnut, mugwort and plane tree These sensitization patterns to individual allergens were not significantly different to those obtained from the Italian LTP subjects, with significant correlations between Pru p 3 and the LTP allergens in peanuts, walnuts, plane tree and mugwort in both groups. CONCLUSION Native UK subjects with LTP allergy are not dissimilar to those with LTP allergy in southern Europe. Testing to LTP-enriched peach SPT reagent and/or LTP allergens in peach, walnut, mugwort and plane tree may enhance diagnostic accuracy.
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Affiliation(s)
- Isabel J. Skypala
- Royal Brompton & Harefield NHS Foundation Trust London UK
- Imperial College London London UK
| | - Lorenzo Cecchi
- SOS Allergy and Immunology USL Toscana Centro Prato Italy
| | | | - Enrico Scala
- Istituto Dermopatico dell'Immacolata IDI‐IRCCS Roma Italy
| | - Stephen Till
- Guy's & St Thomas’ NHS Foundation Trust London UK
- King's College London London UK
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Cipriani F, Tripodi S, Panetta V, Perna S, Potapova E, Dondi A, Bernardini R, Caffarelli C, Casani A, Cervone R, Chini L, Comberiati P, De Castro G, Miraglia Del Giudice M, Dello Iacono I, Di Rienzo Businco A, Gallucci M, Giannetti A, Mastrorilli C, Moschese V, Pelosi S, Sfika I, Varin E, Villella V, Zicari AM, Brindisi G, Ricci G, Matricardi PM. Early molecular biomarkers predicting the evolution of allergic rhinitis and its comorbidities: A longitudinal multicenter study of a patient cohort. Pediatr Allergy Immunol 2019; 30:325-334. [PMID: 30734368 DOI: 10.1111/pai.13036] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Pollen-related seasonal allergic rhinoconjunctivitis (SAR) is a very frequent pediatric disease in Westernized countries. Risk factors and disease phenotypes have been thoroughly examined in several cross-sectional studies. By contrast, only a few studies have examined disease evolution in patient cohorts. We investigated predictive biomarkers of disease evolution in a large cohort of children with SAR. METHODS During 2015-2017 (follow-up), we re-examined 401 patients from those enrolled in 2009-2011 (baseline) by the "Panallergens in Pediatrics" study, a large multicenter survey of Italian children with SAR. Information on clinical history (standard questionnaire, AllergyCARD®; TPS, Italy) and skin prick tests for inhalant and foods extracts (ALK-Abelló, Hørsholm, Denmark) was acquired as at baseline visit. Evolution in clinical and sensitization data of patients was analyzed over time, as well as their association with the main baseline characteristics and atopy risk factors. RESULTS The average age of participants was 10.4 ± 3.4 years at baseline and 16.2 ± 3.6 years at follow-up. SAR persisted in 93.3% of patients at follow-up and became more frequently associated with asthma (from 36.7% at baseline to 48.6% at follow-up) and oral allergy syndrome (OAS, from 23.4% to 37.7%). Compared to baseline, the prevalence of skin sensitization to some pollens (Phleum pratense, Corylus avellana, Platanus acerifolia, Artemisia vulgaris) and vegetables (hazelnut, wheat, and apple) significantly decreased at follow-up. Earlier onset of SAR and polysensitization at baseline were associated with incident asthma at follow-up. The presence at baseline of serum IgE to the following allergen molecules was identified as biomarkers of clinical evolution: (a) Phl p 1, for persistence of SAR; (b) Phl p 5, for persistence of both rhinitis and asthma; (c) Pru p 3, for new onset of asthma; (d) Bet v 1, for persistence of OAS. CONCLUSIONS Seasonal allergic rhinoconjunctivitis is clinically heterogeneous in its evolution from childhood to adolescence. The detection of serum IgE to specific molecules (Phl p 1, Phl p 5, Bet v 1, Pru p 3) may be useful as biomarkers to predict SAR persistence and future onset of comorbidities, such as asthma and/or OAS.
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Affiliation(s)
- Francesca Cipriani
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Salvatore Tripodi
- Pediatric Department and Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy
| | - Valentina Panetta
- Consultancy & Training, Biostatistics, L'altrastatistica srl, Rome, Italy.,Department of Pediatric Pneumology and Immunology, Charite Medical University, Berlin, Germany
| | - Serena Perna
- Department of Pediatric Pneumology and Immunology, Charite Medical University, Berlin, Germany
| | - Ekaterina Potapova
- Department of Pediatric Pneumology and Immunology, Charite Medical University, Berlin, Germany
| | - Arianna Dondi
- Department of Pediatric Pneumology and Immunology, Charite Medical University, Berlin, Germany.,Pediatric Emergency Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Carlo Caffarelli
- Clinica Pediatrica, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Rosa Cervone
- Pediatric Unit, San Giuseppe Hospital, Empoli, Italy
| | - Loredana Chini
- UOSD di Immunopatologia ed Allergologia Pediatrica, Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy.,Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Michele Miraglia Del Giudice
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università della Campania Luigi Vanvitelli, Naples, Italy
| | | | | | - Marcella Gallucci
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Arianna Giannetti
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carla Mastrorilli
- Department of Pediatric Pneumology and Immunology, Charite Medical University, Berlin, Germany.,Clinica Pediatrica, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Viviana Moschese
- UOSD di Immunopatologia ed Allergologia Pediatrica, Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | | | - Ifigenia Sfika
- Pediatric Department and Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy
| | - Elena Varin
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valeria Villella
- Pediatric Department and Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy
| | | | | | - Giampaolo Ricci
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Paolo Maria Matricardi
- Department of Pediatric Pneumology and Immunology, Charite Medical University, Berlin, Germany
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Abstract
PURPOSE OF REVIEW Food allergy symptoms may involve a wide variety of organs (skin, gastrointestinal tract, and eyes) and systems (respiratory, circulatory, and neurological). They are often associated. Their severity ranges from mild to potentially life-threatening reactions and the presentation from acute to chronic. RECENT FINDINGS Food allergies have been the focus of multiple studies, position papers, and guidelines in recent years. They have defined an approach in classifying symptoms as mild to anaphylactic, distinguishing objective from subjective symptoms, and describing their heterogeneity, specific phenotypes or syndromes (e.g., lipid transfer protein syndrome or pollen food syndrome). Cofactors can also influence food allergy reactions. Symptoms of non-IgE-gastrointestinal food allergies, illustrated by eosinophilic esophagitis and food-protein-induced enterocolitis syndrome, are also now better understood and defined. Improvement in the knowledge of food allergy symptoms is crucial for correct diagnosis and a personalized treatment approach. SUMMARY Through a better description and understanding of symptoms, the diversity of food allergies is now better known. The next step is to harmonize symptom assessment not only for clinicians but also for patients, researchers, and public health stakeholders, to describe food allergy phenotypes and their underlying mechanisms and endotypes, to develop targeted management.
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Gao Z, Fu WY, Sun Y, Gao B, Wang HY, Liu M, Luo FM, Zhou X, Jin J, Zhao L, Wu S, Liu Y, Wu L, Wang X, Tang NB, Guo BH, Feng Y, Zhou JY, Gadermaier G, Ferreira F, Versteeg SA, van Ree R. Artemisia pollen allergy in China: Component-resolved diagnosis reveals allergic asthma patients have significant multiple allergen sensitization. Allergy 2019; 74:284-293. [PMID: 30155917 PMCID: PMC6587742 DOI: 10.1111/all.13597] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/20/2018] [Accepted: 08/31/2018] [Indexed: 12/22/2022]
Abstract
Background Artemisia pollen allergy is a major cause of asthma in Northern China. Possible associations between IgE responses to Artemisia allergen components and clinical phenotypes have not yet been evaluated. This study was to establish sensitization patterns of four Artemisia allergens and possible associations with demographic characteristics and clinical phenotypes in three areas of China. Methods Two hundred and forty patients allergic to Artemisia pollen were examined, 178 from Shanxi and 30 from Shandong Provinces in Northern China, and 32 from Yunnan Province in Southwestern China. Allergic asthma, rhinitis, conjunctivitis, and eczema symptoms were diagnosed. All patients’ sera were tested by ImmunoCAP with mugwort pollen extract and the natural components nArt v 1, nArt ar 2, nArt v 3, and nArt an 7. Results The frequency of sensitization and the IgE levels of the four components in Artemisia allergic patients from Southwestern China were significantly lower than in those from the North. Art v 1 and Art an 7 were the most frequently recognized allergens (84% and 87%, respectively), followed by Art v 3 (66%) and Art ar 2 (48%). Patients from Northern China were more likely to have allergic asthma (50%) than patients from Southwestern China (3%), and being sensitized to more than two allergens increased the risk of allergic asthma, in which co‐sensitization to three major allergens Art v 1, Art v 3, and Art an 7 is prominent. Conclusions Component‐resolved diagnosis of Chinese Artemisia pollen‐allergic patients helps assess the potential risk of mugwort‐associated allergic asthma.
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Affiliation(s)
- Zhongshan Gao
- Allergy Research Center; Zhejiang University; Hangzhou China
- College of Agriculture and Biotechnology; Zhejiang University; Hangzhou China
- Department of Experimental Immunology; Amsterdam UMC; University of Amsterdam; Amsterdam The Netherlands
| | - Wan-Yi Fu
- College of Agriculture and Biotechnology; Zhejiang University; Hangzhou China
| | - Yuemei Sun
- Department of Allergy; Yu Huang Ding Hospital; Yantai China
| | - Biyuan Gao
- Hangzhou Aileji Biotech Ltd; Hangzhou China
| | - Hui-Ying Wang
- Department of Allergy; The Second Affiliated Hospital; College of Medicine; Zhejiang University; Hangzhou China
| | - Meiling Liu
- Department of Allergy; The Third People's Hospital of Datong; Shanxi China
| | - Fang-Mei Luo
- Department of Otorhinolaryngology; Qujing Chinese Traditional Medicine Hospital; Yunnan China
| | - Xiang Zhou
- College of Agriculture and Biotechnology; Zhejiang University; Hangzhou China
| | - Jing Jin
- College of Agriculture and Biotechnology; Zhejiang University; Hangzhou China
| | - Lan Zhao
- College of Agriculture and Biotechnology; Zhejiang University; Hangzhou China
| | - Shandong Wu
- Allergy Research Center; Zhejiang University; Hangzhou China
| | - Yi Liu
- Allergy Research Center; Zhejiang University; Hangzhou China
| | - Lingying Wu
- Department of Allergy; The Third People's Hospital of Datong; Shanxi China
| | - Xuefeng Wang
- Department of Allergy; The Third People's Hospital of Datong; Shanxi China
| | - Ning-Bo Tang
- Department of Allergy; Yu Huang Ding Hospital; Yantai China
| | - Bao-Hua Guo
- Department of Otorhinolaryngology; Qujing Chinese Traditional Medicine Hospital; Yunnan China
| | - Yan Feng
- Department of Otorhinolaryngology; The First Affiliated Hospital; Shanxi Medical University; Taiyuan China
| | - Jian Ying Zhou
- Department of Respiratory Disease; The First Affiliated Hospital; College of Medicine; Zhejiang University; Hangzhou China
| | | | - Fatima Ferreira
- Department of Biosciences; University of Salzburg; Salzburg Austria
| | - Serge A. Versteeg
- Department of Experimental Immunology; Amsterdam UMC; University of Amsterdam; Amsterdam The Netherlands
| | - Ronald van Ree
- Department of Experimental Immunology; Amsterdam UMC; University of Amsterdam; Amsterdam The Netherlands
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Deng S, Yin J. Mugwort Pollen-Related Food Allergy: Lipid Transfer Protein Sensitization and Correlation With the Severity of Allergic Reactions in a Chinese Population. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:116-128. [PMID: 30479082 PMCID: PMC6267181 DOI: 10.4168/aair.2019.11.1.116] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE Little is known about the importance of lipid transfer protein (LTP) sensitization in China. In this study, we investigated the relationship between LTP sensitization and the severity of clinical symptoms in a population of patients with mugwort pollen-related food allergy. METHODS Food-induced symptoms were evaluated in 148 patients with mugwort pollen allergy by a standardized questionnaire. Specific immunoglobulin E (IgE) to Art v 1, Art v 3, Pru p 3, Ara h 9 and Cor a 8 were quantified by ImmunoCAP. Immunoblotting of peach extracts were performed with sera from peach-allergic patients. RESULTS In total, 72% (107/148) of the study population experienced food allergy. Forty-eight percent (51/107) of patients with mugwort pollen-related food allergy experienced at least 1 episode of food-induced anaphylaxis. Food allergy correlated with IgE reactivity to Art v 3, but not to Art v 1. Sensitization to Pru p 3, Ara h 9 or Cor a 8 was prevalent (80%, 69 or 63%, respectively) among individuals with food allergy. Food allergic patients with systemic reactions (SR) had higher values for Pru p 3, Ara h 9 and Cor a 8 than patients with oral allergy syndrome (OAS). Furthermore, the strong IgE reactivity detected in immunoblots of peach extracts indicated that Pru p 3 was the major allergen and was more prevalent in patients with SR than in patients with OAS (100% vs. 55%). CONCLUSIONS LTPs are major food allergens for mugwort pollen-related food allergy in China, and may contribute to SR.
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Affiliation(s)
- Shan Deng
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment on Allergic Diseases, Beijing, China
| | - Jia Yin
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment on Allergic Diseases, Beijing, China.
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