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Guiddir T, Siberil A, Lepape F, Hacker M, Nemni A. Can cashew nut allergy resolve spontaneously? Clin Transl Allergy 2024; 14:e12385. [PMID: 39138025 DOI: 10.1002/clt2.12385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/28/2024] [Accepted: 07/12/2024] [Indexed: 08/15/2024] Open
Affiliation(s)
- Tamazoust Guiddir
- Pulmonology and Allergology Pediatric Unit, AP-HP, Bicêtre Hospital, Le Kremlin Bicêtre, France
| | - Audrey Siberil
- Pulmonology and Allergology Pediatric Unit, AP-HP, Bicêtre Hospital, Le Kremlin Bicêtre, France
| | | | - Marion Hacker
- Children and Adult Allergology Department, Robert Ballanger Hospital, Aulnay-sous-Bois, France
| | - Ariane Nemni
- Children and Adult Allergology Department, Robert Ballanger Hospital, Aulnay-sous-Bois, France
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2
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Tuppo L, Alessandri C, Zaccaro L, Giangrieco I, Tamburrini M, Mari A, Ciardiello MA. Isolation, Characterization and IgE Binding of Two 2S Albumins of Pomegranate Seeds. Foods 2024; 13:1965. [PMID: 38998471 PMCID: PMC11241328 DOI: 10.3390/foods13131965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/14/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
Literature reports suggest that the presence of proteins in pomegranate seeds is responsible for sensitization and IgE-mediated allergic reactions. The objective of this study was the analysis of a pomegranate seed extract and the isolation and characterization of proteins contained in high amounts. The extract characterization showed a protein profile with main bands at about 18 kDa and below 10 kDa upon SDS-PAGE, and molecules were recognized by specific IgEs upon immunoblotting. Then, two new 2S albumins, a monomeric and a heterodimeric one, were isolated by using classical biochemical methods. They were identified via direct protein sequencing and mass spectrometry, and their primary structure was analyzed and compared with homologous allergenic proteins via bioinformatics. In an Italian population of 703 suspected allergic patients, analyzed by using the FABER® test, the frequency of sensitization to the monomeric and heterodimeric 2S albumins was 1.7% and 0.28%, respectively. This study reports for the first time the isolation and characterization of two 2S albumins from pomegranate seeds. The clinical relevance of these molecules needs further investigation, for instance in populations having different exposures and allergy profiles.
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Affiliation(s)
- Lisa Tuppo
- Institute of Biosciences and BioResources (IBBR), National Research Council of Italy (CNR), 80131 Naples, Italy; (L.T.); (I.G.); (M.T.)
| | - Claudia Alessandri
- Associated Centers for Molecular Allergology (CAAM), 00100 Rome, Italy; (C.A.); (A.M.)
| | - Laura Zaccaro
- Institute of Biostructures and Bioimaging (IBB), National Research Council of Italy (CNR), 80131 Naples, Italy;
| | - Ivana Giangrieco
- Institute of Biosciences and BioResources (IBBR), National Research Council of Italy (CNR), 80131 Naples, Italy; (L.T.); (I.G.); (M.T.)
| | - Maurizio Tamburrini
- Institute of Biosciences and BioResources (IBBR), National Research Council of Italy (CNR), 80131 Naples, Italy; (L.T.); (I.G.); (M.T.)
| | - Adriano Mari
- Associated Centers for Molecular Allergology (CAAM), 00100 Rome, Italy; (C.A.); (A.M.)
| | - Maria Antonietta Ciardiello
- Institute of Biosciences and BioResources (IBBR), National Research Council of Italy (CNR), 80131 Naples, Italy; (L.T.); (I.G.); (M.T.)
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3
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Brasal-Prieto M, Fernández-Prades L, Dakhaoui H, Sobrino F, López-Enríquez S, Palomares F. Update on In Vitro Diagnostic Tools and Treatments for Food Allergies. Nutrients 2023; 15:3744. [PMID: 37686776 PMCID: PMC10489659 DOI: 10.3390/nu15173744] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/15/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Food allergy (FA) is an adverse immunological reaction to a specific food that can trigger a wide range of symptoms from mild to life-threatening. This adverse reaction is caused by different immunological mechanisms, such as IgE-mediated, non-IgE-mediated and mixed IgE-mediated reactions. Its epidemiology has had a significant increase in the last decade, more so in developed countries. It is estimated that approximately 2 to 10% of the world's population has FA and this number appears to be increasing and also affecting more children. The diagnosis can be complex and requires the combination of different tests to establish an accurate diagnosis. However, the treatment of FA is based on avoiding the intake of the specific allergenic food, thus being very difficult at times and also controlling the symptoms in case of accidental exposure. Currently, there are other immunomodulatory treatments such as specific allergen immunotherapy or more innovative treatments that can induce a tolerance response. It is important to mention that research in this field is ongoing and clinical trials are underway to assess the safety and efficacy of these different immunotherapy approaches, new treatment pathways are being used to target and promote the tolerance response. In this review, we describe the new in vitro diagnostic tools and therapeutic treatments to show the latest advances in FA management. We conclude that although significant advances have been made to improve therapies and diagnostic tools for FA, there is an urgent need to standardize both so that, in their totality, they help to improve the management of FA.
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Nachshon L, Schwartz N, Levy MB, Goldberg MR, Epstein-Rigbi N, Katz Y, Elizur A. Factors associated with home epinephrine-treated reactions during peanut and tree-nut oral immunotherapy. Ann Allergy Asthma Immunol 2023; 130:340-346.e5. [PMID: 36509409 DOI: 10.1016/j.anai.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Home reactions requiring epinephrine administration, a marker of their severity, restrict the widespread use of oral immunotherapy (OIT), but their risk factors are largely not known. OBJECTIVE To identify risk factors for such reactions during OIT to most allergenic foods. METHODS All patients who began OIT for peanut, tree nuts, sesame, or egg allergy at the Shamir Medical Center between April 2010 and January 2020 were enrolled. The patients were instructed to use their epinephrine autoinjectors during reactions consisting of severe abdominal pain, significant shortness of breath, or lethargy, or whenever in uncertainty of reaction severity. Patients with and without home epinephrine-treated reactions (HETRs) were compared. RESULTS A total of 757 OIT treatments for peanut (n = 346), tree nuts (n = 221; walnut n = 147, cashew n = 57, hazelnut n = 16, almond n = 1), sesame (n = 115), and egg (n = 75) allergies were administered to 644 patients. Eighty-three (10.9%) patients experienced HETRs. The highest rate of HETRs was experienced during walnut (20.4%) or hazelnut (25%) OIT, followed by peanut (9.8%), sesame (6.1%), egg (6.7%), and cashew (5.3%) OIT. Risk factors for HETRs included a reaction treated in an emergency department (ER) (P = .005) before starting OIT and a reaction treated with epinephrine during in-clinic induction (P < .001). Significantly fewer patients with (73.6%) than without (88.3%) HETRs achieved full desensitization (P = .001), but only a few patients with HETRs (8.4%) failed treatment. CONCLUSION Previous reaction severity is the main predictor for HETRs during OIT. These reactions are more frequent during walnut and hazelnut OIT than during OIT for other foods studied. Most patients experiencing HETRs achieved desensitization.
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Affiliation(s)
- Liat Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel; Department of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Naama Schwartz
- School of Public Health-University of Haifa, Haifa, Israel
| | - Michael B Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naama Epstein-Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yitzhak Katz
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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5
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El Hanache H, Perennec T, Beaumont P, Puillandre E, Schwender D, Louis Donguy F, Froidefond C, Jarlot S, Petit N, Nootens C, Pirson F, Sullerot I, Nicolie B, Van der Brempt X, Morisset M. Food anaphylaxis in the elderly: Analysis of allergy vigilance network data from 2002 to 2021. Clin Exp Allergy 2023; 53:561-572. [PMID: 36811252 DOI: 10.1111/cea.14297] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Few studies have focused on food allergies in the elderly, even though it may persist or appear de novo. METHODS We reviewed data for all cases of food-induced anaphylaxis in people age ≥ 60 reported to the French "Allergy Vigilance Network" (RAV) between 2002 and 2021. RAV collates data reported by French-speaking allergists regarding cases of anaphylaxis graded II to IV according to the Ring and Messmer classification. RESULTS In total, 191 cases were reported, with an even sex distribution and mean age was 67.4 years (range 60 to 93). The most frequent allergens were mammalian meat and offal (31 cases, 16.2%), often associated with IgE to α-Gal. Legumes were reported in 26 cases (13.6%), fruits and vegetables in 25 cases (13.1%), shellfish 25 cases (13.1%), nuts 20 cases (10.5%), cereals 18 cases (9.4%), seeds 10 cases (5.2%), fish 8 cases (4.2%) and anisakis 8 cases (4.2%). Severity was grade II in 86 cases (45%), grade III in 98 cases (52%) and grade IV in 6 cases (3%) with one death. Most episodes occurred at home or in a restaurant and in most cases adrenaline was not used to treat the acute episode. Potentially relevant cofactors such as beta-blocker, alcohol or non-steroidal anti-inflammatory drug intake were present in 61% of cases. Chronic cardiomyopathy, present in 11.5% of the population, was associated with greater, grade III or IV reaction severity (OR 3.4; 1.24-10.95). CONCLUSION Anaphylaxis in the elderly has different causes to younger people and requires detailed diagnostic testing and individualized care plans.
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Affiliation(s)
- Hassan El Hanache
- Allergy Unit, Nantes University Hospital, Nantes, France.,Allergy Unit, Angers University Hospital, Angers, France
| | | | | | | | | | | | | | | | - Nicolas Petit
- Allergy unit, Verdun Hospital Center, Verdun, France
| | | | - Françoise Pirson
- Pneumology Unit, Saint-Luc University Clinics, Brussels, Belgium
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6
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Shen Y, Yu T, Wang Z, Li X, Wu Y, Chen H. Non-thermal processing of cashews: irradiation reduces allergenicity by altering the structure of Ana o 3. Food Funct 2023; 14:1962-1970. [PMID: 36723115 DOI: 10.1039/d2fo03057h] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Traditional thermal processing of cashews not only results in nutrient loss and harmful by-products, but also does not significantly reduce allergenicity. Irradiation could be an important non-thermal processing method to reduce cashew allergens' allergenicity and retain their nutritional properties. This study aimed to evaluate the effects of gamma irradiation processing on the structure and potential allergenicity of Ana o 3. The Ana o 3 solutions were gamma-irradiated at 0, 1, 3, 5, and 10 kGy. The structure change was monitored by Tricine-SDS-PAGE, circular dichroism spectroscopy, and fluorescence spectroscopy. The potential allergenicity was tested by immunoblotting, indirect competitive ELISA, and the human basophil KU812 degranulation assay using serum from cashew allergy patients. The results of CD spectroscopy showed that the content of α-helices decreased from 46.8% to 30.9% after 3 to 10 kGy, while the content of random coils increased from 23.7% to 33.3%. Meanwhile, a large number of hydrophobic regions were exposed, resulting in an increase in the hydrophobic surface of the protein. In terms of allergenicity, the IC50 values obtained by the competitive inhibition ELISA after irradiation increased from 0.628 to 4.054 μg mL-1, indicating that irradiation reduced the IgE binding capacity of Ana o 3, which was consistent with the results of western blotting. In addition, the basophil degranulation analysis showed that the release of IL-6, TNF-α, and histamine was decreased. It was shown that the potential allergenicity of the irradiated Ana o 3 was remarkably decreased since irradiation could mask or destroy the allergen epitopes, providing a new approach to reduce the allergenicity of cashew products.
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Affiliation(s)
- Yunpeng Shen
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China. .,College of Food Science and Technology, Nanchang University, Nanchang 330031, P R. China.,Sino-German Joint Research Institute, Nanchang University, Nanchang 330047, China
| | - Tian Yu
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China. .,College of Food Science and Technology, Nanchang University, Nanchang 330031, P R. China.,Sino-German Joint Research Institute, Nanchang University, Nanchang 330047, China
| | - Zhongliang Wang
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China. .,College of Food Science and Technology, Nanchang University, Nanchang 330031, P R. China.,Sino-German Joint Research Institute, Nanchang University, Nanchang 330047, China
| | - Xin Li
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China. .,College of Food Science and Technology, Nanchang University, Nanchang 330031, P R. China
| | - Yong Wu
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China. .,Sino-German Joint Research Institute, Nanchang University, Nanchang 330047, China
| | - Hongbing Chen
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China. .,Sino-German Joint Research Institute, Nanchang University, Nanchang 330047, China
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7
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Changes in Serum Protein-Peptide Patterns in Atopic Children Allergic to Plant Storage Proteins. Int J Mol Sci 2023; 24:ijms24021804. [PMID: 36675318 PMCID: PMC9861933 DOI: 10.3390/ijms24021804] [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: 12/30/2022] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Next to cow's milk and eggs, plant foods, i.e., legumes, tree nuts and cereal grains, most often sensitise atopic children. Storage proteins constitutes the most relevant protein fraction of plant foods, causing primary sensitisation. They exhibit strong allergenic properties and immunogenicity. Our goal was to analyse sensitisation to 26 plant storage proteins in a group of 76 children aged 0-5 years with chronic symptoms of atopic dermatitis using Allergy Explorer ALEX2 and to discover changes in serum protein-peptide patterns in allergic patients with the use of MALDI-TOF-MS. We reported that 25% of children were allergic to 2S albumins, 19.7% to 7S globulins, 13.2% to 11S globulins and 1.3% to cereal prolamins. The most common allergenic molecules were Ara h 1 (18.4%), Ara h 2 (17.1%), Ara h 6 (15.8%) and Ara h 3 (11.8%) from peanuts, and the mean serum sIgE concentrations in allergic patients were 10.93 kUA/L, 15.353 kUA/L, 15.359 kUA/L and 9.038 kUA/L, respectively. In children allergic to storage proteins compared to the other patients (both allergic and non-allergic), the cell cycle control protein 50A, testis-expressed sequence 13B, DENN domain-containing protein 5A and SKI family transcriptional corepressor 2 were altered. Our results indicate that the IgE-mediated allergy to storage proteins is a huge problem in a group of young, atopic children, and show the potential of proteomic analysis in the prediction of primary sensitisation to plant foods. It is the next crucial step for understanding the molecular consequences of allergy to storage proteins.
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Gomułka K, Wójcik E, Szepietowski JC. Serum Levels of Eosinophil-Derived Neurotoxin, Platelet-Activating Factor and Vascular Endothelial Growth Factor in Adult Patients with Atopic Dermatitis-A Pilot Study. Biomedicines 2022; 10:biomedicines10123109. [PMID: 36551865 PMCID: PMC9775762 DOI: 10.3390/biomedicines10123109] [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: 10/21/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
Atopic dermatitis (AD) is a chronic, highly pruritic, relapsing-remitting inflammatory skin disease. The etiology of AD has not been fully explained yet and complex interactions of various small molecules are still being taken into account. The aim of this research was to investigate the serum eosinophil-derived neurotoxin (EDN), platelet activating factor (PAF) and vascular endothelial growth factor (VEGF) concentrations in relation to the disease severity and pruritus intensity in adult patients with AD. This pilot study was performed on 30 participants (15 patients with AD and 15 healthy controls). Blood samples were taken to examine the serum levels of EDN, PAF and VEGF using the enzyme-linked immunosorbent assay (ELISA) test. The severity of disease was assessed by the Scoring Atopic Dermatitis (SCORAD) index. The intensity of pruritus, as a subjective symptom, was determined by the Visual Analogue Scale (VAS). Obtained results revealed that the EDN (p = 0.016) and VEGF (p = 0.032), but not PAF (p = 0.841) concentrations were significantly higher in patients with AD compared with those of the control group. There was positive correlation between the EDN level and the SCORAD index in patients with AD (r = -0.9, p = 0.037) which was not found for the PAF and VEGF levels. Circulating EDN, PAF and VEGF levels were not significantly correlated with the severity of pruritus. Our results suggest that the END and VEGF serum levels are significantly increased in patients with AD compared to control group. Moreover, EDN might be useful to reflect the severity of symptoms.
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Affiliation(s)
- Krzysztof Gomułka
- Clinical Department of Internal Medicine, Pneumology and Allergology, Wroclaw Medical University, 50-369 Wroclaw, Poland
- Correspondence:
| | - Ewa Wójcik
- Clinical Department of Dermatology, Venerology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland
| | - Jacek Cezary Szepietowski
- Clinical Department of Dermatology, Venerology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland
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9
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Elizur A, Appel MY, Nachshon L, Levy MB, Epstein‐Rigbi N, Koren Y, Holmqvist M, Porsch H, Lidholm J, Goldberg MR. Cashew oral immunotherapy for desensitizing cashew-pistachio allergy (NUT CRACKER study). Allergy 2022; 77:1863-1872. [PMID: 35000223 DOI: 10.1111/all.15212] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/12/2021] [Accepted: 12/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Oral immunotherapy (OIT) is a treatment option for patients with milk, egg, and peanut allergy, but data on the efficacy and safety of cashew OIT are limited. METHODS A cohort of 50 cashew-allergic patients aged ≥4 years, who were consecutively enrolled into cashew OIT (target dose 4000 mg protein) between 4/2016 and 12/2019. Fifteen cashew-allergic patients who continued cashew elimination served as observational controls. Co-allergy to pistachio and walnut was determined. Full desensitization rate and associated immunological changes in both groups were compared. Patients fully desensitized to cashew were instructed to consume a dose of 1200 mg cashew protein for 6 months and were then challenged to a full dose. Patients with co-allergy to pistachio or walnut were challenged to the respective nut. RESULTS Forty-four of 50 OIT-treated patients (88%) compared to 0% in controls tolerated a dose of 4000 mg cashew protein at the end of the study (odds ratio 8.3, 95% CI 3.9-17.7, p < 0.001). An additional three patients were desensitized to 1200 mg cashew protein, and three patients stopped treatment. Three patients (6%) were treated with injectable epinephrine for home reactions. Desensitized patients had decreased SPT, sIgE, basophil reactivity, and increased sIgG4, following treatment. Following cashew desensitization, all pistachio (n = 35) and four of eight walnut co-allergic patients were cross-desensitized to the respective nut. All (n = 44) patients consuming a low cashew dose for ≥6 months following desensitization passed a full-dose cashew OFC. CONCLUSIONS Cashew OIT desensitizes most cashew-allergic patients and cross-desensitizes to pistachio. Safety is similar to OIT for other foods.
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Affiliation(s)
- Arnon Elizur
- Yitzhak Shamir Medical Center Institute of Allergy, Immunology and Pediatric Pulmonology Zerifin Israel
- Department of Pediatrics Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Michael Y. Appel
- Yitzhak Shamir Medical Center Institute of Allergy, Immunology and Pediatric Pulmonology Zerifin Israel
| | - Liat Nachshon
- Yitzhak Shamir Medical Center Institute of Allergy, Immunology and Pediatric Pulmonology Zerifin Israel
- Department of Medicine Sackler Faculty of Medicine Tel Aviv University Israel
| | - Michael B. Levy
- Yitzhak Shamir Medical Center Institute of Allergy, Immunology and Pediatric Pulmonology Zerifin Israel
| | - Naama Epstein‐Rigbi
- Yitzhak Shamir Medical Center Institute of Allergy, Immunology and Pediatric Pulmonology Zerifin Israel
- Department of Pediatrics Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Yael Koren
- Yitzhak Shamir Medical Center Institute of Allergy, Immunology and Pediatric Pulmonology Zerifin Israel
| | | | | | | | - Michael R. Goldberg
- Yitzhak Shamir Medical Center Institute of Allergy, Immunology and Pediatric Pulmonology Zerifin Israel
- Department of Pediatrics Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
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10
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Borres MP, Sato S, Ebisawa M. Recent advances in diagnosing and managing nut allergies with focus on hazelnuts, walnuts, and cashew nuts. World Allergy Organ J 2022; 15:100641. [PMID: 35493774 PMCID: PMC9020091 DOI: 10.1016/j.waojou.2022.100641] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Magnus P. Borres
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Sakura Sato
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
- Corresponding author. Sakura Sato, M.D., Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, 18-1, Sakuradai, Minami-ku, Sagamihara, Kanagawa, 252-0392, Japan.
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
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11
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Kabasser S, Pratap K, Kamath S, Taki AC, Dang T, Koplin J, Perrett K, Hummel K, Radauer C, Breiteneder H, Lopata AL, Bublin M. Identification of vicilin, legumin and antimicrobial peptide 2a as macadamia nut allergens. Food Chem 2022; 370:131028. [PMID: 34525424 PMCID: PMC7614219 DOI: 10.1016/j.foodchem.2021.131028] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/13/2021] [Accepted: 08/29/2021] [Indexed: 12/20/2022]
Abstract
Macadamia nut is an increasingly popular food item of a healthy diet. However, macadamia nut is also a potent allergenic food. To date, there is little information about the allergenic proteins involved. In this study, using sera from macadamia nut allergic individuals, four IgE-binding proteins were detected. Their identities were determined by tandem mass spectrometry with de novo sequencing. Three IgE-reactive proteins, the vicilin Mac i 1, the legumin Mac i 2 and the antimicrobial peptide 2a/Mac i 1 (28-76) were purified from the nut while the non-specific lipid transfer protein was produced as a recombinant in Pichia pastoris. IgE-binding assays using sera from well-characterized groups of tree nut and/or peanut allergic patients revealed that the allergens were mainly recognized by sera from macadamia nut allergic individuals. Hence, these newly discovered allergens will enable molecular diagnostics to identify patients at high risk of macadamia nut allergy.
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Affiliation(s)
- Stefan Kabasser
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Kunal Pratap
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia,Center for Molecular Therapeutics, James Cook University, Townsville, QLD, Australia
| | - Sandip Kamath
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia,Center for Molecular Therapeutics, James Cook University, Townsville, QLD, Australia
| | - Aya C. Taki
- School of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Thanh Dang
- Department of Paediatrics, Murdoch Children’s Research Institute, The University of Melbourne, Flemington Road, Parkville, VIC, Australia
| | - Jennifer Koplin
- Department of Paediatrics, Murdoch Children’s Research Institute, The University of Melbourne, Flemington Road, Parkville, VIC, Australia
| | - Kirsten Perrett
- Department of Paediatrics, Murdoch Children’s Research Institute, The University of Melbourne, Flemington Road, Parkville, VIC, Australia
| | - Karin Hummel
- VetCore Facility for Research, University of Veterinary Medicine, Vienna, Austria
| | - Christian Radauer
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Heimo Breiteneder
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Andreas L. Lopata
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia,Center for Molecular Therapeutics, James Cook University, Townsville, QLD, Australia,Corresponding authors: Merima Bublin, PhD, Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. ; Andreas L. Lopata, PhD, Pharmacy and Medical Research Building, James Cook University, Townsville, QLD, Australia,
| | - Merima Bublin
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
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12
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Mattison CP, Vant-Hull B, de Castro ACR, Chial HJ, Bren-Mattison Y, Bechtel PJ, de Brito ES. Characterization of Anti-Ana o 3 Monoclonal Antibodies and Their Application in Comparing Brazilian Cashew Cultivars. Antibodies (Basel) 2021; 10:antib10040046. [PMID: 34939998 PMCID: PMC8698838 DOI: 10.3390/antib10040046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/11/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
Ana o 3 is an immuno-dominant cashew nut allergen. Four monoclonal antibodies to Ana o 3 (2H5, 6B9C1, 19C9A2, and 5B7F8) were characterized by ELISA and in silico modeling. The 2H5 antibody was the only antibody specific for cashew nut extract. In addition to cashew nut extract, the 6B9C1 and 19C9A2 antibodies recognized pistachio extract, and the 5B7F8 recognized pecan extract. All four antibodies recognized both recombinant Ana o 3.0101 and native Ana o 3. ELISA assays following treatment of purified Ana o 3 with a reducing agent indicated that the 6B9C1 and 19C9A2 antibodies likely recognize conformational epitopes, while the 2H5 and 5B7F8 antibodies likely recognize linear epitopes. In silico modeling predicted distinct epitopes for each of the anti-Ana o 3 antibodies. Screening extracts from 11 Brazilian cashew nut cultivars using all four antibodies showed slight differences in Ana o 3 bindings, demonstrating that these antibodies could identify cultivars with varying allergen content.
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Affiliation(s)
- Christopher P. Mattison
- Southern Regional Research Center, FPSQ, ARS, U.S. Department of Agriculture, New Orleans, LA 70124, USA;
- Correspondence:
| | | | | | - Heidi J. Chial
- BioMed Bridge LLC., 3700 Quebec Street, Suite 100-230, Denver, CO 80207, USA;
| | - Yvette Bren-Mattison
- Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA;
- New Orleans Louisiana Neuroendocrine Tumor Specialists (NOLANETS), Ochsner Medical Center, Kenner, LA 70065, USA
| | - Peter J. Bechtel
- Southern Regional Research Center, FPSQ, ARS, U.S. Department of Agriculture, New Orleans, LA 70124, USA;
| | - Edy Sousa de Brito
- Embrapa Agroindústria Tropical, Fortaleza 60511-110, CE, Brazil; (A.C.R.d.C.); (E.S.d.B.)
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13
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Tarczoñ I, Jedynak-Wąsowicz U, Lis G, Tomasik T, Brzyski P, Cichocka-Jarosz E. Is the clinical manifestation of anaphylaxis in children influenced by the trigger of reaction? Postepy Dermatol Alergol 2021; 38:788-797. [PMID: 34849125 PMCID: PMC8610057 DOI: 10.5114/ada.2020.95650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/27/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The number of anaphylaxis diagnoses in children is rising, being still based on the clinical picture. AIM To determine whether triggers of anaphylaxis influence its clinical characteristics in children and adolescents. MATERIAL AND METHODS The study group included 114 children (5 months-17 years, mean age: 8.0 ±4.8 years), (66%: boys) with the episode of anaphylaxis up to 1 year back. Medical data were entered to the NORA Registry by means of a validated structured on-line questionnaire. RESULTS Three most frequent triggers of anaphylaxis were: insect venom (47.4%), food (35.1%), drugs (5.3%), with a predominance of food (egg white, cow's milk, nuts and peanuts) in the 0-6 years age group, while insect venom (bee predominance) in the 7-17 years age group (p = 0.016). Clinical manifestations differed between food vs. venom allergic reactions and presented as gastro-intestinal (GI) (61.4%) (p = 0.004), respiratory (RS) (93.9%) (p = 0.036), and cardiovascular (CVS) (74.6%) (p = 0.022) symptoms. Among objective symptoms, vomiting was the most common symptom in the 0-2 years age group (47.1%) (p = 0.006), while hypotension in those aged 7-12 years (40%) (p = 0.010). Severity of symptoms evaluated as Mueller's grade (IV - 74.5%) and as Ring and Messmer's grade (III - 65.8%), depended on the trigger (p = 0.028, p = 0.029, respectively). Life-threatening symptoms occurred in 26 children (fall of the blood pressure - 22%, loss of consciousness - 4.4%). CONCLUSIONS The clinical manifestation of anaphylaxis in children is both trigger and age dependent, irrespective of the gender. A typical patient with food anaphylaxis was younger, presenting predominantly GI symptoms, while a typical patient with venom anaphylaxis was older, with mostly cardiovascular symptoms.
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Affiliation(s)
| | | | - Grzegorz Lis
- Department of Paediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Tomasik
- Department of Paediatrics, Jagiellonian University Medical College, Krakow, Poland
| | | | - Ewa Cichocka-Jarosz
- Department of Paediatrics, Jagiellonian University Medical College, Krakow, Poland
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14
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Maruyama N. Components of plant-derived food allergens: Structure, diagnostics, and immunotherapy. Allergol Int 2021; 70:291-302. [PMID: 34092500 DOI: 10.1016/j.alit.2021.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/19/2021] [Indexed: 12/11/2022] Open
Abstract
A large number of plant-derived food allergen components have been identified to date. Although these allergens are diverse, they often share common structural features such as numerous disulfide bonds or oligomeric structures. Furthermore, some plant-derived food allergen components cross-react with pollen allergens. Since the relationship between allergen components and clinical symptoms has been well characterized, measurements of specific IgE to these components have become useful for the accurate clinical diagnosis and selection of optimal treatment methods for various allergy-related conditions including allergy caused by plant-derived foods. Herein, I have described the types and structures of different plant allergen components and outlined the diagnosis as well as treatment strategies, including those reported recently, for such substances. Furthermore, I have also highlighted the contribution of allergen components to this field.
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Affiliation(s)
- Nobuyuki Maruyama
- Food Quality Design and Development Laboratory, Graduate School of Agriculture, Kyoto University, Gokasho, Uji, Kyoto 611-0011, Japan.
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15
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A severity grading system of food-induced acute allergic reactions to avoid the delay of epinephrine administration. Ann Allergy Asthma Immunol 2021; 127:462-470.e2. [PMID: 33895419 DOI: 10.1016/j.anai.2021.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/11/2021] [Accepted: 04/16/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Substantial discrepancies among anaphylaxis severity scores may delay epinephrine administration. OBJECTIVE The study aims to develop a transparent severity grading system of food-induced acute allergic reactions with a decision model for epinephrine use. METHODS The natural course of 315 acute food-induced allergic reactions in children hospitalized at the Allergology department between May 2016 and July 2019 owing to follow-up treatment and allergy diagnostics was evaluated. The severity of episodes was classified according to the 5 most accepted grading systems. The interrater reliability of classification between anaphylaxis severity scores was assessed. All symptoms were grouped into a heat map according to their real-life incidence and clinical relevance. Based on the heat map analysis, a severity grading system of food-induced acute allergic reactions in children with the epinephrine administration decision model was created. RESULTS Data from 259 food-induced anaphylaxis episodes in 157 children were included in the analysis. Comparing the grading systems, we observed a 24.7% to 70.2% disagreement between severity scores. The heat map illustrated a strong association between 29 symptoms and their categorization. A new severity grading system was developed and a 2-stage decision model was proposed: "epinephrine yes" (any rapidly progressing symptoms, even mild ones or from 1 organ system; any symptoms from more than 1 organ system; or every grade of anaphylaxis), and "epinephrine available and prepared to use" (nonprogressing mild systemic allergic reaction from 1 system area only; no anaphylaxis). CONCLUSION A new severity grading system of food-induced acute allergic reactions in children could serve as a clinical tool for health care professionals to avoid epinephrine administration delay.
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16
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Crespo JF, Bueno C, Villalba M, Monaci L, Cuadrado C, Novak N, Cabanillas B. Epitope mapping of the major allergen 2S albumin from pine nut. Food Chem 2020; 339:127895. [PMID: 32866706 DOI: 10.1016/j.foodchem.2020.127895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
The epitopes of the major allergen of pine nut, Pin p 1, were analyzed using a peptide library and sera from patients with clinical allergy to pine nut in order to deepen into the allergenic characteristics of Pin p 1. Analyses of epitope similarities and epitopes location in a 3D-model were also performed. Results showed that three main regions of Pin p 1 containing 5 epitopes were recognized by patient sera IgE. The epitopes of Pin p 1 had important similarities with epitopes of allergenic 2S albumins from peanut (Ara h 2 and 6) and Brazil nut (Ber e 1). The epitopes of Pin p 1 were found in α-helices and coils in the 3D protein structure. Interestingly, all epitopes were found to be well-exposed in the protein surface, which suggests facile access for IgE-binding to the structure of Pin p 1 which is known to be highly resistant.
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Affiliation(s)
- Jesus F Crespo
- Department of Allergy, Research Institute Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | - Cristina Bueno
- Departamento de Bioquímica y Biología Molecular, Facultad de Ciencias Químicas, Universidad Complutense de Madrid, Madrid, Spain
| | - Mayte Villalba
- Departamento de Bioquímica y Biología Molecular, Facultad de Ciencias Químicas, Universidad Complutense de Madrid, Madrid, Spain
| | - Linda Monaci
- Institute of Sciences of Food Production, CNR-ISPA, 70126 Bari, Italy
| | - Carmen Cuadrado
- Department of Food Technology, National Institute of Agricultural, Food Research, and Technology (INIA), Ctra. La Coruña Km. 7.5, 28040 Madrid, Spain
| | - Natalija Novak
- Department of Dermatology and Allergy, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Beatriz Cabanillas
- Department of Allergy, Research Institute Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain.
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17
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Buyuktiryaki B, Santos AF. Food allergy severity predictions based on cellular in vitro tests. Expert Rev Mol Diagn 2020; 20:679-692. [PMID: 32536279 DOI: 10.1080/14737159.2020.1782192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Food allergy is increasing in prevalence and the severity of allergic reactions is unpredictable. Identifying food-allergic patients at high risk of severe reactions would allow us to offer a personalized and improved management for these patients. AREAS COVERED We review the evidence for using the levels of specific IgE, the nature of the allergen, and cellular tests to identify patients at high risk of developing severe allergic reactions to foods. EXPERT OPINION The evidence about whether the quantity of allergen-specific IgE reflects the severity of allergic reactions to foods is conflicting, with some positive and some negative studies. For some foods, specific IgE to individual components (e.g. Ara h 2 in peanut) can provide additional information. However, more important than the quantity of IgE is possibly the quality of IgE, which can be captured by individual measurements of affinity/avidity, diversity, and specific activity, but is best measured overall using the basophil and mast cell activation tests, which assess the function of IgE in its ability to induce cell activation, degranulation, and mediator release. Biomarkers look at a single aspect of the allergic response and should be interpreted in the broader clinical context for each individual patient assessed.
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Affiliation(s)
- Betul Buyuktiryaki
- Division of Pediatric Allergy, Koc University Hospital , İstanbul, Turkey.,Department of Paediatric Allergy, Evelina London, Guy's and ST Thomas' Hospital NHS Foundation Trust , London, UK
| | - Alexandra F Santos
- Department of Paediatric Allergy, Evelina London, Guy's and ST Thomas' Hospital NHS Foundation Trust , London, UK.,Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London , London, UK.,Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London , London, UK.,Asthma UK Centre in Allergic Mechanisms of Asthma , London, UK
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18
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Saba L, Clerc-Urmès I, Delahaye C, Chevillot E, Jarlot-Chevaux S, Dumond P, Schweitzer C, Divaret-Chauveau A. Predictive factors of allergy to pistachio in children allergic to cashew nut. Pediatr Allergy Immunol 2020; 31:506-514. [PMID: 32124486 DOI: 10.1111/pai.13238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 02/14/2020] [Accepted: 02/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cashew nut (CN) allergy prevalence has increased over the last few years. In children allergic to CN, complete avoidance of pistachio is usually recommended, but recent study showed that only one third of children allergic to CN were also allergic to pistachio. The aim of our study was to identify predictive factors of allergy to pistachio in children allergic to CN. METHODS All children who had a positive oral food challenge (OFC) to CN between November 2013 and October 2017 in the Paediatric Allergy Department of the University Hospital of Nancy were included. Logistic regression models were used to predict the probability of allergy to pistachio. RESULTS Among the 147 children included, tolerance or allergy to pistachio was known for 51. Out of these, 40 were allergic to pistachio (78.4%). Children allergic to pistachio had a larger weal size of skin prick test to CN (P = .01) and pistachio (P = .0007) and a lower reaction dose to CN (P < .0001). In multivariate analysis, only the reaction dose to CN was significantly associated with allergy to pistachio. Children with a low reaction dose to CN were significantly more at risk to have an allergy to pistachio (P = .01). CONCLUSION A low reaction dose to CN seems to be a predictive factor of allergy to pistachio in children allergic to CN. In order to limit unnecessary food eviction, a pistachio OFC should be performed in children having high reaction dose whatever the importance of the skin or the specific IgE sensitization to pistachio.
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Affiliation(s)
- Lucile Saba
- Pediatric Allergy Department, Children's Hospital, University Hospital of Nancy, Vandoeuvre les Nancy, France
| | - Isabelle Clerc-Urmès
- Clinical Research Support Facility PARC, UMDS, University Hospital of Nancy, Vandoeuvre les Nancy, France
| | - Clémence Delahaye
- Pediatric Allergy Department, Children's Hospital, University Hospital of Nancy, Vandoeuvre les Nancy, France
| | - Emilie Chevillot
- Pediatric Allergy Department, Children's Hospital, University Hospital of Nancy, Vandoeuvre les Nancy, France
| | - Sophie Jarlot-Chevaux
- Pediatric Allergy Department, Children's Hospital, University Hospital of Nancy, Vandoeuvre les Nancy, France
| | - Pascale Dumond
- Pediatric Allergy Department, Children's Hospital, University Hospital of Nancy, Vandoeuvre les Nancy, France
| | - Cyril Schweitzer
- Department of Pediatric Lung Function Testing, Children's Hospital, University Hospital of Nancy, Vandoeuvre les Nancy, France.,EA 3450 DevAH-Department of Physiology, Faculty of Medicine, University of Lorraine, Vandoeuvre les Nancy, France
| | - Amandine Divaret-Chauveau
- Pediatric Allergy Department, Children's Hospital, University Hospital of Nancy, Vandoeuvre les Nancy, France.,EA 3450 DevAH-Department of Physiology, Faculty of Medicine, University of Lorraine, Vandoeuvre les Nancy, France.,UMR/CNRS 6249 Chrono-environnement, University of Franche Comté, Besançon, France
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19
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Lee Y, Chang HY, Kim SH, Yang MS, Koh YI, Kang HR, Choi JH, Kim CW, Park HK, Kim JH, Nam YH, Kim TB, Hur GY, Jung JW, Park KH, Kim MA, Kim J, Yoon J, Ye YM. A Prospective Observation of Psychological Distress in Patients With Anaphylaxis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:496-506. [PMID: 32141262 PMCID: PMC7061156 DOI: 10.4168/aair.2020.12.3.496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/29/2019] [Accepted: 01/07/2020] [Indexed: 02/01/2023]
Abstract
Purpose Anaphylaxis is an immediate allergic reaction characterized by potentially life-threatening, severe, systemic manifestations. While studies have evaluated links between serious illness and posttraumatic stress disorder (PTSD), few have investigated PTSD after anaphylaxis in adults. We sought to investigate the psychosocial burden of recent anaphylaxis in Korean adults. Methods A total of 203 (mean age of 44 years, 120 females) patients with anaphylaxis were recruited from 15 university hospitals in Korea. Questionnaires, including the Impact of Event Scale-Revised-Korean version (IES-R-K), the Korean version of the Beck Anxiety Inventory (K-BAI), and the Korean version of the Beck Depression Inventory (K-BDI), were administered. Demographic characteristics, causes and clinical features of anaphylaxis, and serum inflammatory markers, including tryptase, platelet-activating factor, interleukin-6, tumor necrosis factor-α, and C-reactive protein, were evaluated. Results PTSD (IES-R-K ≥ 25) was noted in 84 (41.4%) patients with anaphylaxis. Of them, 56.0% had severe PTSD (IES-R-K ≥ 40). Additionally, 23.2% and 28.1% of the patients had anxiety (K-BAI ≥ 22) and depression (K-BDI ≥ 17), respectively. IES-R-K was significantly correlated with both K-BAI (r = 0.609, P < 0.0001) and K-BDI (r = 0.550, P < 0.0001). Among the inflammatory mediators, tryptase levels were lower in patients exhibiting PTSD; meanwhile, platelet-activating factor levels were lower in patients exhibiting anxiety and depression while recovering from anaphylaxis. In multivariate analysis, K-BAI and K-BDI were identified as major predictive variables of PTSD in patients with anaphylaxis. Conclusions In patients with anaphylaxis, we found a remarkably high prevalence of PTSD and associated psychological distresses, including anxiety and depression. Physicians ought to be aware of the potential for psychological distress in anaphylactic patients and to consider psychological evaluation.
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Affiliation(s)
- Youngsoo Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hyoung Yoon Chang
- Department of Psychiatry and Behavioral Sciences, Ajou University School of Medicine, Suwon, Korea
| | - Sang Ha Kim
- Department of Internal Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Min Suk Yang
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Young Il Koh
- Division of Allergy, Asthma, and Clinical Immunology, Chonnam National University Medical School, Gwangju, Korea
| | - Hye Ryun Kang
- Division of Allergy and Clinical Immunology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Hee Choi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Cheol Woo Kim
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Hye Kyung Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Joo Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Young Hee Nam
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Tae Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, Seoul, Korea
| | - Gyu Young Hur
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jae Woo Jung
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung Hee Park
- Division of Allergy and Immunology, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Ae Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, CHA University, Seongnam, Korea
| | - Jiwoong Kim
- Clinical Trial Center, Ajou University Hospital, Suwon, Korea
| | - Jiwon Yoon
- Clinical Trial Center, Ajou University Hospital, Suwon, Korea
| | - Young Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
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