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Fujiwara M, Kimura T, Ohira J, Inotani M, Sakane T, Iwase M, Yamashita S, Araki T. New-onset egg allergy in an adult: A case report. FRONTIERS IN ALLERGY 2024; 5:1395807. [PMID: 38628872 PMCID: PMC11018937 DOI: 10.3389/falgy.2024.1395807] [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: 03/04/2024] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
Most adult cases of hen's egg allergy are carried over from childhood, and new-onset adult cases are rare. Such cases may result from cross-reactivity or sensitization by inhalation. Here we present a rare case of adult-onset egg allergy due to monosensitization to ovalbumin (Gal d 2) with an unclear sensitization pathway. A 27-year-old woman developed recurrent gastrointestinal symptoms after ingestion of raw and under-cooked eggs. She had never suffered from atopic dermatitis or food allergies. She had never kept birds as pets and had no history of exposure to egg allergens. Prick to prick testing was positive only with raw egg white. Specific IgE testing revealed monosensitization to Gal d 2. She was advised to avoid raw and undercooked eggs and her symptoms resolved. In the management of adult-onset egg allergy, evaluation of allergen components will lead to appropriate elimination guidelines, and investigation of sensitization pathways may help identify the cause of this disease.
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Riggioni C, Ricci C, Moya B, Wong D, van Goor E, Bartha I, Buyuktiryaki B, Giovannini M, Jayasinghe S, Jaumdally H, Marques-Mejias A, Piletta-Zanin A, Berbenyuk A, Andreeva M, Levina D, Iakovleva E, Roberts G, Chu D, Peters R, du Toit G, Skypala I, Santos AF. Systematic review and meta-analyses on the accuracy of diagnostic tests for IgE-mediated food allergy. Allergy 2024; 79:324-352. [PMID: 38009299 DOI: 10.1111/all.15939] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 11/28/2023]
Abstract
The European Academy of Allergy and Clinical Immunology (EAACI) is updating the Guidelines on Food Allergy Diagnosis. We aimed to undertake a systematic review of the literature with meta-analyses to assess the accuracy of diagnostic tests for IgE-mediated food allergy. We searched three databases (Cochrane CENTRAL (Trials), MEDLINE (OVID) and Embase (OVID)) for diagnostic test accuracy studies published between 1 October 2012 and 30 June 2021 according to a previously published protocol (CRD42021259186). We independently screened abstracts, extracted data from full texts and assessed risk of bias with QUADRAS 2 tool in duplicate. Meta-analyses were undertaken for food-test combinations for which three or more studies were available. A total of 149 studies comprising 24,489 patients met the inclusion criteria and they were generally heterogeneous. 60.4% of studies were in children ≤12 years of age, 54.3% were undertaken in Europe, ≥95% were conducted in a specialized paediatric or allergy clinical setting and all included oral food challenge in at least a percentage of enrolled patients, in 21.5% double-blind placebo-controlled food challenges. Skin prick test (SPT) with fresh cow's milk and raw egg had high sensitivity (90% and 94%) for milk and cooked egg allergies. Specific IgE (sIgE) to individual components had high specificity: Ara h 2-sIgE had 92%, Cor a 14-sIgE 95%, Ana o 3-sIgE 94%, casein-sIgE 93%, ovomucoid-sIgE 92/91% for the diagnosis of peanut, hazelnut, cashew, cow's milk and raw/cooked egg allergies, respectively. The basophil activation test (BAT) was highly specific for the diagnosis of peanut (90%) and sesame (93%) allergies. In conclusion, SPT and specific IgE to extracts had high sensitivity whereas specific IgE to components and BAT had high specificity to support the diagnosis of individual food allergies.
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Affiliation(s)
- Carmen Riggioni
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore City, Singapore
| | - Cristian Ricci
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-WEst University, Potchefstroom, South Africa
| | - Beatriz Moya
- Department of Allergy, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria, Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Dominic Wong
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Evi van Goor
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Elkerliek Hospital, Helmond, The Netherlands
| | - Irene Bartha
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Betul Buyuktiryaki
- Division of Pediatric Allergy, Department of Pediatrics, Koc University School of Medicine, Istanbul, Turkey
| | - Mattia Giovannini
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Sashini Jayasinghe
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Hannah Jaumdally
- Department of Women and Children's Health, 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
| | - Andreina Marques-Mejias
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Alexandre Piletta-Zanin
- Division of Pediatric Specialties, Department of Women, Children and Adolescents, Geneva University Hospitals, Geneva, Switzerland
| | - Anna Berbenyuk
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Margarita Andreeva
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Daria Levina
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Ekaterina Iakovleva
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Graham Roberts
- Clinical and Experimental Sciences and Human Development in Health, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK
| | - Derek Chu
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rachel Peters
- Murdoch Children's Research Institute Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - George du Toit
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Isabel Skypala
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Allergy & Clinical Immunology, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Alexandra F Santos
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
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Xu Y, Ahmed I, Zhao Z, Lv L. A comprehensive review on glycation and its potential application to reduce food allergenicity. Crit Rev Food Sci Nutr 2023:1-23. [PMID: 37683268 DOI: 10.1080/10408398.2023.2248510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Food allergens are a major concern for individuals who are susceptible to food allergies and may experience various health issues due to allergens in their food. Most allergenic foods are subjected to heat treatment before being consumed. However, thermal processing and prolonged storage can cause glycation reactions to occur in food. The glycation reaction is a common processing method requiring no special chemicals or equipment. It may affect the allergenicity of proteins by altering the structure of the epitope, revealing hidden epitopes, concealing linear epitopes, or creating new ones. Changes in food allergenicity following glycation processing depend on several factors, including the allergen's characteristics, processing parameters, and matrix, and are therefore hard to predict. This review examines how glycation reactions affect the allergenicity of different allergen groups in allergenic foods.
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Affiliation(s)
- Yue Xu
- College of Food Science and Engineering, Qingdao Agricultural University, Qingdao, China
| | - Ishfaq Ahmed
- Haide College, Ocean University of China, Qingdao, China
| | - Zhengxi Zhao
- College of Food Science and Engineering, Qingdao Agricultural University, Qingdao, China
| | - Liangtao Lv
- College of Food Science and Engineering, Qingdao Agricultural University, Qingdao, China
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Li L, Zhang B, Li Y, Huang L, Li S, Liu D, Yu Y, Li H. The Heterogeneity of Ovomucoid-Specific IgE Idiotype Is Associated With Egg Allergy Symptom Severity. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 15:109-118. [PMID: 36693362 PMCID: PMC9880306 DOI: 10.4168/aair.2023.15.1.109] [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: 04/08/2022] [Revised: 09/02/2022] [Accepted: 09/14/2022] [Indexed: 01/20/2023]
Abstract
Immunoglobulin E (IgE)-mediated egg allergy presents as one of the most common food allergies. The level of specific IgE (sIgE) antibody is widely used as an important in vitro diagnostic indicator. However, sIgE antibody levels are often inconsistent with the clinical manifestations of patients. The heterogeneity of egg-specific IgE idiotypes (sIgE-IDs) may help reflect clinical egg allergy severity. Eight peptides were synthesized, corresponding to the linear epitopes of ovomucoid (OVM). The sIgE-IDs of egg-allergic patients were detected by enzyme-linked immunosorbent assay. Fresh peripheral blood was collected from patients with different heterogeneity strength of sIgE-ID, and egg extract was used as a stimulus to the basophil activation test (BAT). RBL-2H3 cells were sensitized with serum with different strength of sIgE-ID heterogeneity and the release rate of β-hexosaminidase was calculated. Among 75 patients with egg allergy, 24% had sIgE for all epitopes and 85% had sIgE for at least one epitope. Analysis of individual patients revealed differences in epitope recognition patterns among the patients, that is, heterogeneity in sIgE-ID. More importantly, the number of IgE-positive peptides had a strong correlation with allergic symptoms in egg-allergic patients (r = 0.706). BAT and RBL-2H3 cell degranulation confirmed that higher sIgE-ID heterogeneity strength was more effective in inducing effector cell responses. Our results suggest that the greater the heterogeneity strength of OVM-sIgE-ID, the more severe the allergic symptoms.
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Affiliation(s)
- Liuxu Li
- Department of Clinical Immunology, School of Medical Laboratory, Tianjin Medical University, Tianjin, China.,Department of Clinical Laboratory, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Bei Zhang
- Department of Clinical Immunology, School of Medical Laboratory, Tianjin Medical University, Tianjin, China
| | - Yifan Li
- Department of Pediatrics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Lunhui Huang
- Department of Clinical Immunology, School of Medical Laboratory, Tianjin Medical University, Tianjin, China
| | - Shaoshen Li
- Department of Laboratory Medicine, Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Dandan Liu
- Department of Clinical Immunology, School of Medical Laboratory, Tianjin Medical University, Tianjin, China
| | - Yang Yu
- Department of Clinical Immunology, School of Medical Laboratory, Tianjin Medical University, Tianjin, China
| | - Huiqiang Li
- Department of Clinical Immunology, School of Medical Laboratory, Tianjin Medical University, Tianjin, China
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5
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Anagnostou A. A practical focus on egg oral immunotherapy. JOURNAL OF FOOD ALLERGY 2022; 4:132-135. [PMID: 39021845 PMCID: PMC11250443 DOI: 10.2500/jfa.2022.4.220013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Egg allergy usually develops in the first year of life, with an estimated prevalence of 2.6%-9%. Rates of resolution and timing vary, with approximately one-third of patients outgrowing their egg allergy by age 6 years. Persistent egg allergy has been associated with high egg white specific immunoglobulin E levels and sensitization to the egg allergen component Gal d 1, which is resistant to heat and digestion. These individuals seem to have a more severe and persistent phenotype of egg allergy. Recently, an active approach has emerged for patients with food allergy, including those with egg allergy, in the form of oral immunotherapy. Egg oral immunotherapy consists of the administration of gradually increasing doses of egg, with the aim to enable patients to consume small amounts of egg without having allergic reactions, which thus provides protection from accidental exposures to egg-containing foods. This article aims to discuss published evidence on egg oral immunotherapy, provide practical information on dosing protocols, and address special challenges associated with this intervention.
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Affiliation(s)
- Aikaterini Anagnostou
- From the Division of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children’s Hospital, Houston, Texas; and
- Division of Immunology, Allergy and Retrovirology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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6
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Xie Q, Xue W. IgE-Mediated food allergy: Current diagnostic modalities and novel biomarkers with robust potential. Crit Rev Food Sci Nutr 2022; 63:10148-10172. [PMID: 35587740 DOI: 10.1080/10408398.2022.2075312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Food allergy (FA) is a serious public health issue afflicting millions of people globally, with an estimated prevalence ranging from 1-10%. Management of FA is challenging due to overly restrictive diets and the lack of diagnostic approaches with high accuracy and prediction. Although measurement of serum-specific antibodies combined with patient medical history and skin prick test is a useful diagnostic tool, it is still an imprecise predictor of clinical reactivity with a high false-positive rate. The double-blind placebo-controlled food challenge represents the gold standard for FA diagnosis; however, it requires large healthcare and involves the risk of acute onset of allergic reactions. Improvement in our understanding of the molecular mechanism underlying allergic disease pathology, development of omics-based methods, and advances in bioinformatics have boosted the generation of a number of robust diagnostic biomarkers of FA. In this review, we discuss how traditional diagnostic modalities guide appropriate diagnosis and management of FA in clinical practice, as well as uncover the potential of the latest biomarkers for the diagnosis, monitoring, and prediction of FA. We also raise perspectives for precise and targeted medical intervention to fill the gap in the diagnosis of FA.
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Affiliation(s)
- Qiang Xie
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, P.R. China
| | - Wentong Xue
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, P.R. China
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7
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De Vlieger L, Nuyttens L, Matton C, Diels M, Verelst S, Leus J, Coppens K, Sauer K, Dilissen E, Coorevits L, Matthys C, Schrijvers R, Raes M, Bullens DMA. Guided Gradual Egg-Tolerance Induction in Hen's Egg Allergic Children Tolerating Baked Egg: A Prospective Randomized Trial. FRONTIERS IN ALLERGY 2022; 3:886094. [PMID: 35769568 PMCID: PMC9234941 DOI: 10.3389/falgy.2022.886094] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background Over the last few years, studies have shown that the majority of egg allergic children tolerate baked egg (e.g., cake), and that consuming baked egg accelerates the resolution of egg allergy. However, few prospective studies demonstrate the step-wise reintroduction of egg at home after developing baked egg tolerance. Although this could have a positive impact on the children's quality of life and nutrition. Additionally, research supporting the theoretical concept that heating in the presence or absence of wheat causes reduced allergenicity of egg proteins is limited. Objective To investigate the clinically most favorable duration of gradual egg-tolerance induction in baked egg tolerant children at home, with regard to complete raw egg tolerance. Methods Baked egg tolerant children above 12 months of age were randomly assigned to a short- or long arm protocol. In the short arm, egg-tolerance induction was studied over 18 months compared to 30 months in the long arm. Children were guided through this protocol involving the step-wise introduction of increasingly allergenic forms of egg starting with baked egg offered as cake, followed by hard-boiled egg, omelet/waffle/pancake, soft-boiled egg, and finally raw egg. We hereby designed this protocol based on the influence of thermal processing in the presence or absence of wheat on egg proteins, as investigated by ELISA, SDS-PAGE, and immunoblotting. At inclusion, children either passed an in-hospital cake challenge or had ovomucoid sIgE ≤1.2 kUA/L, which was considered safe for introduction at home. Results Gel electrophoresis revealed that the ovalbumin band became weaker with heating, while the ovomucoid band remained stable. In accordance, the IgE-binding to ovalbumin decreased with extensive heating, as opposed to ovomucoid. However, heating in the presence of wheat led to a decreased IgE reactivity to ovomucoid. Of the 78 children in the intention-to-treat group, 39 were randomized to each arm. Fifty-eight children reached the raw egg tolerance endpoint, of which 80% were in the short arm and 69% in the long arm. Within the short arm, the median time to raw egg tolerance was 24 months (95% CI, 21–27 months) compared to 30 months (95% CI, 28–32 months) in the long arm (p = 0.005). No grade IV reactions or cases of eosinophilic esophagitis were observed. The short arm was considered to be non-inferior to the long arm. Conclusion Our gradual short arm protocol appears to be safe and allows clinicians to guide baked egg tolerant children toward raw egg tolerance at home. The allergenicity of the egg proteins was affected by heating temperature and duration, as well as the presence of wheat.
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Affiliation(s)
- Liselot De Vlieger
- Department of Microbiology, Immunology and Transplantation, Allergy and Immunology Research Group, KU Leuven, Leuven, Belgium
- *Correspondence: Liselot De Vlieger
| | - Lisa Nuyttens
- Department of Microbiology, Immunology and Transplantation, Allergy and Immunology Research Group, KU Leuven, Leuven, Belgium
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | | | - Marianne Diels
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Sophie Verelst
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
- Department of Pediatrics, Jessa Hospital, Hasselt, Belgium
| | - Jasmine Leus
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
- Department of Pediatrics, AZ Maria Middelares, Ghent, Belgium
| | - Katrien Coppens
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
- Department of Pediatrics, Imelda Hospital, Bonheiden, Belgium
| | - Kate Sauer
- Department of Pediatrics, AZ Sint-Jan Hospital, Bruges, Belgium
| | - Ellen Dilissen
- Department of Microbiology, Immunology and Transplantation, Allergy and Immunology Research Group, KU Leuven, Leuven, Belgium
| | - Lieve Coorevits
- Department of Microbiology, Immunology and Transplantation, Allergy and Immunology Research Group, KU Leuven, Leuven, Belgium
| | - Christophe Matthys
- Department of Chronic Diseases and Metabolism, Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Rik Schrijvers
- Department of Microbiology, Immunology and Transplantation, Allergy and Immunology Research Group, KU Leuven, Leuven, Belgium
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Marc Raes
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
- Department of Pediatrics, Jessa Hospital, Hasselt, Belgium
| | - Dominique M. A. Bullens
- Department of Microbiology, Immunology and Transplantation, Allergy and Immunology Research Group, KU Leuven, Leuven, Belgium
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
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8
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Tuppo L, Giangrieco I, Tamburrini M, Alessandri C, Mari A, Ciardiello MA. Detection of Allergenic Proteins in Foodstuffs: Advantages of the Innovative Multiplex Allergen Microarray-Based Immunoassay Compared to Conventional Methods. Foods 2022; 11:foods11060878. [PMID: 35327300 PMCID: PMC8949930 DOI: 10.3390/foods11060878] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/12/2022] [Accepted: 03/17/2022] [Indexed: 02/04/2023] Open
Abstract
Several factors can affect the allergen content and profile of a specific food, including processing procedures often leading to a decrease in allergenicity, although no change, or even an increase, have also been reported. Evaluation of the effectiveness of a processing procedure requires the availability of reliable methodologies to assess the variation in molecules able to induce allergic reactions in the analyzed food. Conventional and innovative strategies and methodologies can be exploited to identify allergenic proteins in foodstuffs. However, depending on the specific purposes, different methods can be used. In this review, we have critically reviewed the advantages of an innovative method, the multiplex allergen microarray-based immunoassay, in the detection of allergens in foodstuffs. In particular, we have analyzed some studies reporting the exploitation of an IgE-binding inhibition assay on multiplex allergen biochips, which has not yet been reviewed in the available literature. Unlike the others, this methodology enables the identification of many allergenic proteins, some of which are still unknown, which are recognized by IgE from allergic patients, with a single test. The examined literature suggests that the inhibition test associated with the multiplex allergen immunoassay is a promising methodology exploitable for the detection of IgE-binding proteins in food samples.
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Affiliation(s)
- Lisa Tuppo
- Institute of Biosciences and BioResources (IBBR), CNR, 80131 Naples, Italy; (L.T.); (I.G.); (M.T.)
| | - Ivana Giangrieco
- Institute of Biosciences and BioResources (IBBR), CNR, 80131 Naples, Italy; (L.T.); (I.G.); (M.T.)
| | - Maurizio Tamburrini
- Institute of Biosciences and BioResources (IBBR), 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.)
- Allergy Data Laboratories (ADL), 04100 Latina, Italy
| | - Adriano Mari
- Associated Centers for Molecular Allergology (CAAM), 00100 Rome, Italy; (C.A.); (A.M.)
- Allergy Data Laboratories (ADL), 04100 Latina, Italy
| | - Maria Antonietta Ciardiello
- Institute of Biosciences and BioResources (IBBR), CNR, 80131 Naples, Italy; (L.T.); (I.G.); (M.T.)
- Correspondence:
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9
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Panaitescu C, Haidar L, Buzan MR, Grijincu M, Spanu DE, Cojanu C, Laculiceanu A, Bumbacea R, Agache IO. Precision medicine in the allergy clinic: the application of component resolved diagnosis. Expert Rev Clin Immunol 2022; 18:145-162. [PMID: 35078387 DOI: 10.1080/1744666x.2022.2034501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION A precise diagnosis is key for the optimal management of allergic diseases and asthma. In vivo or in vitro diagnostic methods that use allergen extracts often fail to identify the molecules eliciting the allergic reactions. AREAS COVERED Component-resolved diagnosis (CRD) has solved most of the limitations of extract-based diagnostic procedures and is currently valuable tool for the precision diagnosis in the allergy clinic, for venom and food allergy, asthma, allergic rhinitis, and atopic dermatitis. Its implementation in daily practice facilitates: a) the distinction between genuine multiple sensitizations and cross-reactive sensitization in polysensitized patients; b) the prediction of a severe, systemic reaction in food or insect venom allergy; c) the optimal selection of allergen immunotherapy based on the patient sensitization profile. This paper describes its main advantages and disadvantages, cost-effectiveness and future perspectives. EXPERT OPINION The diagnostic strategy based on CRD is part of the new concept of precision immunology, which aims to improve the management of allergic diseases.
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Affiliation(s)
- Carmen Panaitescu
- Department of Functional Sciences, Physiology, Center of Immuno-Physiology and Biotechnologies (CIFBIOTEH), "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania.,Centre for Gene and Cellular Therapies in The Treatment of Cancer - OncoGen, "Pius Brinzeu" Clinical Emergency Hospital, Timisoara, Romania
| | - Laura Haidar
- Department of Functional Sciences, Physiology, Center of Immuno-Physiology and Biotechnologies (CIFBIOTEH), "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania
| | - Maria Roxana Buzan
- Department of Functional Sciences, Physiology, Center of Immuno-Physiology and Biotechnologies (CIFBIOTEH), "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania.,Centre for Gene and Cellular Therapies in The Treatment of Cancer - OncoGen, "Pius Brinzeu" Clinical Emergency Hospital, Timisoara, Romania
| | - Manuela Grijincu
- Department of Functional Sciences, Physiology, Center of Immuno-Physiology and Biotechnologies (CIFBIOTEH), "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania.,Centre for Gene and Cellular Therapies in The Treatment of Cancer - OncoGen, "Pius Brinzeu" Clinical Emergency Hospital, Timisoara, Romania
| | | | - Catalina Cojanu
- Transylvania University Brasov - Faculty of Medicine, Brasov
| | | | - Roxana Bumbacea
- Department of Allergy, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania
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10
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Song KB, Yang SI, Jung S, Hwang KH, Kim MJ, Yoon J, Yu J. Serum IgE specific to egg white and its components and open baked egg oral food challenge tests in children younger than 6 years. ALLERGY ASTHMA & RESPIRATORY DISEASE 2022. [DOI: 10.4168/aard.2022.10.3.158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Kun-Baek Song
- Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Song-I Yang
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Sungsu Jung
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Keum-Hee Hwang
- Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Ju Kim
- Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jisun Yoon
- Department of Pediatrics, Chung-Ang University Gwang-Myeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Jinho Yu
- Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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11
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Difficulties in interpretation of oral food challenge results. Postepy Dermatol Alergol 2021; 38:721-726. [PMID: 34849115 PMCID: PMC8610045 DOI: 10.5114/ada.2021.106248] [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: 09/08/2020] [Accepted: 02/02/2021] [Indexed: 11/17/2022] Open
Abstract
Oral food challenge is the gold standard in diagnosing food allergies; however, many testing protocols are available. The present article illustrates the difficulties associated with interpreting oral challenge tests with the example of a six-year-old boy with allergy to hen’s eggs. The symptoms observed on the first day of challenge indicated a negative result; however, the consumption of the cumulative dose resulted in anaphylaxis. The interpretation of the oral food challenge can be complicated. The criteria used to determine a positive or negative result are sometimes ambiguous. An accurate interpretation of the results is key to determining correct management in children with food allergy.
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12
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Quoc QL, Bich TCT, Jang JH, Park HS. Recent update on the management of anaphylaxis. Clin Exp Emerg Med 2021; 8:160-172. [PMID: 34649404 PMCID: PMC8517462 DOI: 10.15441/ceem.21.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/04/2021] [Indexed: 12/12/2022] Open
Abstract
Anaphylaxis is a life-threatening systemic allergic reaction presenting various clinical manifestations. Its prevalence has increased in almost all age groups and both sexes. Food, venom, and drugs are major causes in both children and adults; a higher prevalence of food-induced anaphylaxis is noted in children, while a higher prevalence of drug-induced anaphylaxis is noted in adults. The pathogenic mechanism is mediated by immunologic and nonimmunologic mechanisms, where mast cells and basophils are key cells that release mediators. A diagnosis of anaphylaxis is mainly based on clinical symptoms and physical findings; however, an increased serum tryptase level is a useful biomarker. Epinephrine is the first-line drug to treat acute symptoms, and an epinephrine auto-injector should be prescribed for each patient. Antihistamines and systemic corticosteroids are used to relieve symptoms. This review updates current issues in the management of anaphylaxis as well as the new guidelines for proper diagnosis and treatment.
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Affiliation(s)
- Quang Luu Quoc
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.,Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea
| | - Tra Cao Thi Bich
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.,Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea
| | - Jae-Hyuk Jang
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.,Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.,Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea
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13
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Anagnostou A. Optimizing Patient Care in Egg Allergy Diagnosis and Treatment. J Asthma Allergy 2021; 14:621-628. [PMID: 34135601 PMCID: PMC8197590 DOI: 10.2147/jaa.s283307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/21/2021] [Indexed: 01/01/2023] Open
Abstract
Egg allergy occurs frequently in childhood with a reported prevalence of 1.3–1.6%. Providing optimal care to egg-allergic patients requires knowledge of the most up-to-date developments in both diagnosis and management, as well as effective communication skills, which will engage the patient in the shared decision-making process. This review aims to provide up-to-date information on egg allergy and also serve as a concise guide on optimal patient diagnosis and management. The field of food allergy has seen multiple advances in recent years, including use of component resolved diagnostics, early egg introduction into the infant diet as a way of preventing egg allergy, baked egg introduction and oral immunotherapy as a form of active therapy. Faced with a variety of options and treatment paths, it is important to ensure that patients and families taking part in the decision-making process have fully understood the potential outcomes and trade-offs and can undertake a detailed discussion of all options that are available to them. Shared decision-making remains the cornerstone of optimal patient care.
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Affiliation(s)
- Aikaterini Anagnostou
- Baylor College of Medicine, Section of Pediatric Immunology, Allergy and Retrovirology, Houston, TX, USA.,Texas Children's Hospital, Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Houston, TX, USA
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14
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Maesa JM, Dobrzynska A, Baños-Álvarez E, Isabel-Gómez R, Blasco-Amaro JA. ImmunoCAP ISAC in food allergy diagnosis: a systematic review of diagnostic test accuracy. Clin Exp Allergy 2021; 51:778-789. [PMID: 33847011 DOI: 10.1111/cea.13871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the diagnostic test accuracy of the component-resolved diagnosis device ImmunoCAP ISAC, compared with oral food challenge. DESIGN Systematic review reported according to the PRISMA-DTA recommendations. DATA SOURCES Medline, Embase and Cochrane Library databases were searched from inception to May 2019 and updated in March 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included diagnostic test accuracy studies comparing ISAC component results as the index test with oral food challenge as the reference test, in people of any age suspected of IgE mediated food allergy to milk, egg, peanut, shrimp, hake, apple, peach, kiwi, melon, walnut, hazelnut, wheat or pineapple. Risk of bias was evaluated using the QUADAS-2 tool. RESULTS We screened 799 titles and included 11 studies - seven prospective and two retrospective cohort studies, two case-control studies. Included studies evaluated IgE to Gald1 (three studies, 300 participants, 140 with egg allergy), Bosd5 (three studies, 242 participants, 146 with milk allergy) and Arah1 or 2 (seven studies, 546 participants, 346 with peanut allergy). No studies were identified for other ISAC components. Risk of bias was high or unclear mainly due to inadequate blinding. Applicability was of high or unclear concern due to unclear thresholds, inappropriate exclusions and variable populations. Gald1 sensitivity ranged from 58 to 84%, specificity 87%-97%. Bosd5 sensitivity 24%-40%, specificity 94%-95%. Arah1 sensitivity 45%-91%, specificity 41%-93%. Arah2 sensitivity 70%-94%, specificity 75%-95%. CONCLUSIONS Diagnostic test accuracy information for ISAC components was only available for milk, egg and peanut. Specificity is generally higher than sensitivity, which contrasts with the performance of skin prick and standard specific IgE tests for diagnosing food allergy. Higher quality information is needed to determine the clinical utility of ISAC for food allergy diagnosis. SYSTEMATIC REVIEW REGISTRATION Not registered.
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Affiliation(s)
- José-María Maesa
- Health Technology Assessment Area of Andalusia (AETSA), Fundación Pública Progreso y Salud, Sevilla, Spain
| | - Agnieszka Dobrzynska
- Health Technology Assessment Area of Andalusia (AETSA), Fundación Pública Progreso y Salud, Sevilla, Spain
| | - Elena Baños-Álvarez
- Health Technology Assessment Area of Andalusia (AETSA), Fundación Pública Progreso y Salud, Sevilla, Spain
| | - Rebeca Isabel-Gómez
- Health Technology Assessment Area of Andalusia (AETSA), Fundación Pública Progreso y Salud, Sevilla, Spain
| | - Juan-Antonio Blasco-Amaro
- Health Technology Assessment Area of Andalusia (AETSA), Fundación Pública Progreso y Salud, Sevilla, Spain
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15
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Yonkof JR, Mikhail IJ, Prince BT, Stukus D. Delayed and Severe Reactions to Baked Egg and Baked Milk Challenges. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:283-289.e2. [PMID: 33049390 DOI: 10.1016/j.jaip.2020.09.059] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/21/2020] [Accepted: 09/26/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although many egg- and milk-allergic children tolerate baked egg (BE) and baked milk (BM), reactions elicited by these oral food challenges (OFCs) can be severe. Previous studies comparing BE and BM reactions to other OFC reactions are limited. OBJECTIVE To compare the clinical features of reactions to BE and BM with other OFCs to promote challenge safety. METHODS A retrospective review of OFCs eliciting objective reactions to BE, BM, lightly cooked egg (CE), fresh cow's milk (CM), peanut (PN), and tree nuts (TN) which were performed at a tertiary referral center from June 1, 2017, to June 1, 2019. RESULTS We identified 174 OFCs conducted in 158 subjects, age 6 to 187 months (34 BE, 19 BM, 14 CE, 25 CM, 52 PN, and 30 TN). TN reactors were older than BE (P = .049) and PN (P < .01) reactors and had a higher frequency of persistent asthma than PN-reactive subjects (P = .02). Mucocutaneous symptoms occurred less frequently during BE (56%) and BM (42%) OFCs compared with other OFCs (P < .05). Lower respiratory tract reactions were increased during BM (37%) versus BE (12%), CM (8%), and PN (12%) OFCs (P < .05). Epinephrine was administered to more BE (44%) and TN (50%) than PN (17%) OFCs (P < .01). New reaction manifestations developed 60 minutes or later after OFC termination during 29% BE and 21% BM versus 0% PN OFCs (P < .05). One-third of anaphylactic reactions to BE began more than 60 minutes after OFC termination. CONCLUSIONS BE and BM challenge reactions differed phenotypically from other OFC reactions, including significantly increased frequencies of new symptoms beginning 60 minutes or later after challenge termination. Consider amended dose-escalation and prolonged observation after BE and BM OFCs.
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Affiliation(s)
- Jennifer R Yonkof
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio; Division of Allergy and Immunology, Department of Otolaryngology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Irene J Mikhail
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Benjamin T Prince
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - David Stukus
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
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16
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Yamamoto-Hanada K, Borres MP, Åberg MK, Yang L, Fukuie T, Narita M, Saito H, Ohya Y. IgE responses to multiple allergen components among school-aged children in a general population birth cohort in Tokyo. World Allergy Organ J 2020; 13:100105. [PMID: 32128024 PMCID: PMC7044531 DOI: 10.1016/j.waojou.2020.100105] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 11/29/2019] [Accepted: 01/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Response patterns to allergen components among Japanese children have not been studied extensively. OBJECTIVE Our aim was to examine the differences in sensitization patterns at ages 5 years and 9 years to identify longitudinal changes in the degree and patterns of sensitization in a birth cohort of Japanese children. METHODS Our study enrolled 984 children at aged 5 years between 2008 and 2010, and 729 children aged 9 years between 2012 and 2014. Allergic diseases were assessed using the ISAAC and UK Working Party's Diagnostic Criteria. Serum-specific IgE titers to allergen components were measured by multiplex array ImmunoCAP ISAC when the children were aged 5 and 9 years. Principal component analysis (PCA) was performed to characterize IgE sensitization to allergen components. RESULTS The prevalence of allergic rhinitis increased considerably over time (10.6%-31.2%). Furthermore, the sensitization prevalence to allergen-specific IgE (sIgE) also increased from 57.8% at age 5 years to 74.8% at age 9 years. IgE sensitization prevalence to Der f 1 (mites) was 42.1% at age 5 years and 54.3% at age 9 years. Furthermore, children were highly sensitized to Cry j 1 (Japanese cedar) (32.8% at age 5 years and 57.8% at age 9 years). Principle component analysis showed that sensitization to PR-10 cross-reactive components was independent of sensitization to mite and that no children acquired sensitization to pollen before acquiring sensitization to mite. CONCLUSIONS The prevalence of allergic rhinitis and related allergen components increased from age 5 years to age 9 years in Japanese children.
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Key Words
- Allergy
- Asthma
- Atopic dermatitis
- CCD, Cross-reactive carbohydrate determinant
- CRD, Component-resolved diagnostics
- Child
- Cohort
- Eczema
- HDM, House dust mite
- ISAAC
- ISAAC, The International Study of Asthma and Allergies in Childhood
- ISAC
- ISAC, Immuno-solid-phase Allergen Chip
- IgE
- IgE, Immunoglobulin E
- JECS, The Japan Environment and Children's Study
- PC, Principal component
- PCA, Principal component analysis
- PR, Pathogenesis-related
- Prospective birth cohort
- Rhinitis
- Sensitization
- UK, The United Kingdom
- US, The United States
- Wheeze
- sIgE, Allergen-specific IgE
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Affiliation(s)
| | - Magnus P. Borres
- Thermo Fisher Scientific, Uppsala, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Limin Yang
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Tatsuki Fukuie
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Masami Narita
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Hirohisa Saito
- Department of Allergy and Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
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17
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Callery EL, Keymer C, Barnes NA, Rowbottom AW. Component-resolved diagnostics in the clinical and laboratory investigation of allergy. Ann Clin Biochem 2019; 57:26-35. [PMID: 31480853 DOI: 10.1177/0004563219877434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The diagnosis and management of allergy is complex; the clinical symptoms associated with allergic reactions span a broad spectrum of severity, from mild hay fever-type symptoms through to life-threatening anaphylaxis. Obtaining an allergy-focused clinical history is therefore vital for identifying possible allergic triggers and directing testing. However, this focus could be changing as scientific and technological advances have paved the way for developments within in vitro testing for allergy. With knowledge of allergens at the molecular level expanding, there are now the facilities to characterize the sensitization profiles of allergy sufferers and determine the specific molecules (or components) against which the allergen-inducing immunoglobulin type E proteins have been produced. This technology is termed component-resolved diagnostics. We know that accurate identification of immunoglobulin type E specificity, the source of the causative allergen, and knowledge of potential allergic cross-reactivities are required for optimal clinical management of allergy patients. These factors can make allergy a diagnostic challenge outside of a specialist centre, and contribute to the difficulties associated with requesting and interpreting allergy tests. The incorporation of component-resolved diagnostics into current practice has provided a platform for patient-tailored risk stratification and improved the application of allergen-specific immunotherapy, revolutionizing specialist management of these patients. This review discusses the roles of each type of testing in allergy management and predictions for future pathways.
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Affiliation(s)
- Emma L Callery
- Department of Immunology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Catherine Keymer
- Department of Immunology, Royal Liverpool University Hospital, Liverpool, UK
| | - Nicholas A Barnes
- Faculty of Biology Medicine and Health, Manchester Academy for Healthcare Scientist Education, The University of Manchester, Manchester, UK
| | - Anthony W Rowbottom
- Department of Immunology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.,School of Medicine, University of Central Lancashire, Preston, UK
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18
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Calamelli E, Liotti L, Beghetti I, Piccinno V, Serra L, Bottau P. Component-Resolved Diagnosis in Food Allergies. ACTA ACUST UNITED AC 2019; 55:medicina55080498. [PMID: 31426616 PMCID: PMC6723663 DOI: 10.3390/medicina55080498] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/31/2019] [Accepted: 08/15/2019] [Indexed: 12/18/2022]
Abstract
Component-resolved diagnostics (CRD) in food allergies is an approach utilized to characterize the molecular components of each allergen involved in a specific IgE (sIgE)-mediated response. In the clinical practice, CRD can improve diagnostic accuracy and assist the physician in many aspects of the allergy work-up. CRD allows for discriminatory co-sensitization versus cross-sensitization phenomena and can be useful to stratify the clinical risk associated with a specific sensitization pattern, in addition to the oral food challenge (OFC). Despite this, there are still some unmet needs, such as the risk of over-prescribing unnecessary elimination diets and adrenaline auto-injectors. Moreover, up until now, none of the identified sIgE cutoff have shown a specificity and sensitivity profile as accurate as the OFC, which is the gold standard in diagnosing food allergies. In light of this, the aim of this review is to summarize the most relevant concepts in the field of CRD in food allergy and to provide a practical approach useful in clinical practice.
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Affiliation(s)
| | - Lucia Liotti
- Pediatric Unit, Civic Hospital, 60019 Senigallia, Italy
| | - Isadora Beghetti
- Pediatric Unit, Department of Medical and Surgical Sciences (DIMEC), S.Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy
| | | | - Laura Serra
- Pediatric and Neonatology Unit, Imola Hospital, 40026 Imola, Italy
| | - Paolo Bottau
- Pediatric and Neonatology Unit, Imola Hospital, 40026 Imola, Italy
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19
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Brossard C, Rancé F, Drouet M, Paty E, Juchet A, Guérin-Dubiard C, Pasco M, Tranquet O, Nau F, Denery-Papini S. Relative reactivity to egg white and yolk or change upon heating as markers for baked egg tolerance. Pediatr Allergy Immunol 2019; 30:225-233. [PMID: 30475427 DOI: 10.1111/pai.13009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/31/2018] [Accepted: 11/16/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hen's egg food allergy is frequent in childhood and phenotypically heterogeneous. Some children can tolerate extensively heated egg. We investigated whether individual relative responses could differentiate children who tolerate baked egg. METHODS Reactivities to raw, pasteurized or hard-boiled egg (E), egg white (EW), and egg yolk (EY) fractions were tested by skin prick test (SPT) in 54 egg-allergic children. IgE-sensitization to EW and EY was determined by ImmunoCAP and IgE-binding to EW and 8 EW proteins and to EY and 4 EY sub-fractions by ELISA. Population heterogeneity was assessed by hierarchical ascending classification upon individual variations of reactivity and links between classifications and clinical features by analyzing the contingency tables. RESULTS All children had positive SPT to raw E and raw EW and 72% to raw EY. Heating decreased SPT-reactivity for some children, pasteurization being less effective than hard-boiling. Children were classed into three classes from relative SPT-reactivity to raw fractions, two from variations of SPT-reactivity with each thermal processing or EW/EY ratio of sensitization, and four from their sensitization pattern. Classifications according to heating were found independent of each other. SPT variations with hard-boiling, IgE-sensitization (ratio or pattern) were linked to allowance by the physicians of egg in baked products. CONCLUSIONS Egg-allergic children were often both sensitized to EY and EW, and heterogeneous patterns of relative responses were evidenced. Irrespective of age and level of sensitization, a low EW/EY ratio or SPT getting null with hard-boiling was found in children allowed to eat baked egg.
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Affiliation(s)
- Chantal Brossard
- INRA, UR 1268 Biopolymères, Interactions, Assemblages, Nantes, France
| | - Fabienne Rancé
- CHU Toulouse - Pédiatrie - Pneumologie, Allergologie, Toulouse, France
| | - Martine Drouet
- Unité Allergologie Générale, Département Pneumologie, CHU d'Angers, Angers, France
| | - Evelyne Paty
- CHU Necker, Pneumo Allergologie Infantile, Paris, France
| | - Agnes Juchet
- CHU Toulouse - Pédiatrie - Pneumologie, Allergologie, Toulouse, France
| | - Catherine Guérin-Dubiard
- Agrocampus Ouest, UMR1253 Sciences et Technologie du Lait et de l'Œuf, Rennes, France.,INRA, UMR1253 Sciences et Technologie du Lait et de l'Œuf, Rennes, France
| | - Maryvonne Pasco
- Agrocampus Ouest, UMR1253 Sciences et Technologie du Lait et de l'Œuf, Rennes, France.,INRA, UMR1253 Sciences et Technologie du Lait et de l'Œuf, Rennes, France
| | - Olivier Tranquet
- INRA, UR 1268 Biopolymères, Interactions, Assemblages, Nantes, France
| | - Françoise Nau
- Agrocampus Ouest, UMR1253 Sciences et Technologie du Lait et de l'Œuf, Rennes, France.,INRA, UMR1253 Sciences et Technologie du Lait et de l'Œuf, Rennes, France
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20
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Dang TD, Peters RL, Koplin JJ, Dharmage SC, Gurrin LC, Ponsonby AL, Martino DJ, Neeland M, Tang MLK, Allen K. Egg allergen specific IgE diversity predicts resolution of egg allergy in the population cohort HealthNuts. Allergy 2019; 74:318-326. [PMID: 30035811 DOI: 10.1111/all.13572] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/06/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND IgE-mediated egg allergy presents as one of the most common food allergies in children. Measurement of egg white specific IgE (sIgE) levels in serum or skin prick test has been shown to be a poor predictor of clinical allergy to raw egg white, and also to baked or cooked egg. Recent developments in component resolved diagnostic (CRD) technology have enabled us to improve the way in which we diagnose and predict peanut allergy by examining IgE specificity to individual peptides. OBJECTIVES We aimed to investigate whether egg CRD could improve current methods to diagnose various egg allergy phenotypes as well as predict the development of tolerance to egg. METHODS Using the HealthNuts cohort of food challenge-proven egg allergic and egg-sensitized and egg-tolerant, age-matched 12-month infants with longitudinal follow-up at 2 and 4 years (n = 451), we measured serum egg white, Gal d 1, 2, 3 and 5 sIgE using ImmunoCAP. RESULTS Gal d 1 sensitization increased the risk of persistent egg allergy by 2.5-fold. The production of sIgE to all four egg allergens (Gal d 1, 2, 3 or 5) increased the risk of having persistent raw egg allergy fourfold (OR 4.19 (95% CI: 1.25-14.07). We did not find any improvements of using Gal d 1, 2, 3 or 5 to diagnose current egg allergy compared to egg white sIgE. CONCLUSION Sensitization to multiple egg allergens Gal d 1, 2, 3 or 5 may be a prognostic marker that could be useful for patient management and identifying individuals at risk of developing persistent egg allergy.
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Affiliation(s)
- Thanh D. Dang
- Murdoch Children's Research Institute; Parkville Victoria Australia
- Department of Paediatrics; University of Melbourne; Parkville Victoria Australia
| | - Rachel L. Peters
- Murdoch Children's Research Institute; Parkville Victoria Australia
- Department of Paediatrics; University of Melbourne; Parkville Victoria Australia
| | - Jennifer J. Koplin
- Murdoch Children's Research Institute; Parkville Victoria Australia
- Department of Paediatrics; University of Melbourne; Parkville Victoria Australia
| | - Shyamali C. Dharmage
- Murdoch Children's Research Institute; Parkville Victoria Australia
- The Centre for Molecular, Environmental, Genetic and Analytic Epidemiology; University of Melbourne; Parkville Victoria Australia
| | - Lyle C. Gurrin
- Murdoch Children's Research Institute; Parkville Victoria Australia
- The Centre for Molecular, Environmental, Genetic and Analytic Epidemiology; University of Melbourne; Parkville Victoria Australia
| | - Anne-Louise Ponsonby
- Murdoch Children's Research Institute; Parkville Victoria Australia
- Department of Paediatrics; University of Melbourne; Parkville Victoria Australia
| | - David J. Martino
- Murdoch Children's Research Institute; Parkville Victoria Australia
- Department of Paediatrics; University of Melbourne; Parkville Victoria Australia
| | - Melanie Neeland
- Murdoch Children's Research Institute; Parkville Victoria Australia
- Department of Paediatrics; University of Melbourne; Parkville Victoria Australia
| | - Mimi L. K. Tang
- Murdoch Children's Research Institute; Parkville Victoria Australia
- Department of Paediatrics; University of Melbourne; Parkville Victoria Australia
- Department of Allergy and Immunology; Royal Children's Hospital; Parkville Victoria Australia
| | - Katrina J. Allen
- Murdoch Children's Research Institute; Parkville Victoria Australia
- Department of Paediatrics; University of Melbourne; Parkville Victoria Australia
- Department of Allergy and Immunology; Royal Children's Hospital; Parkville Victoria Australia
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21
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Affiliation(s)
- Meng Chen
- Department of Medicine, Section on Allergy & Immunology, University of California, 8899 University City Lane, Suite 230, San Diego, CA 92122, USA
| | - Michael Land
- Allergy Department, Kaiser Permanente, San Diego, CA, USA
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22
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Palosuo K, Kukkonen AK, Pelkonen AS, Mäkelä MJ. Gal d 1-specific IgE predicts allergy to heated egg in Finnish children. Pediatr Allergy Immunol 2018; 29:637-643. [PMID: 29974523 DOI: 10.1111/pai.12954] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/15/2018] [Accepted: 05/22/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Allergen-specific IgE levels can be useful in predicting outcomes of oral food challenges, but optimal cutoff levels vary in different populations. The aim was to determine cutoff values for egg white- and Gal d 1-, Gal d 2-, Gal d 3-, and Gal d 4-specific IgE (sIgE) predicting positive oral heated egg challenges in 185 Finnish children and adolescents. METHODS A total of 185 egg-sensitized patients (age: 1-19 years, median: 6.3, mean: 7.0 years) with suspected egg allergy underwent double-blind, placebo-controlled (n = 78), or open (n = 107) oral food challenges with heated egg white. Specific IgE levels to egg white, Gal d 1 (ovomucoid), Gal d 2 (ovalbumin), Gal d 3 (conalbumin), and Gal d 4 (lysozyme) were measured by ImmunoCAP and compared with challenge outcomes. RESULTS Of the 185 challenges, 124 (67%) were positive. Gal d 1 sIgE levels were significantly higher in the challenge-positive (median 13.5 kU/L, mean 33.2 kU/L) than in the challenge-negative group (median 0.2 kU/L, mean 1.2 kU/L), P < 0.0001. The diagnostic capacity of sIgE to egg white and Gal d 2, 3, and 4 was clearly weaker. In ROC analysis, the AUC for egg white was 0.86, Gal d 2 0.84, Gal d 3 0.79, and Gal d 4 0.77. Sensitization to Gal d 1 with a cutoff of value of >3.7 kU/L predicted a positive challenge with a specificity of 95% and sensitivity of 78%. The likelihood ratio was 15.9. In ROC analysis, the area under the curve was 0.94 (95% CI, 0.91-0.97). With a cutoff value of >14 kU/L, all challenges were positive, and with a cutoff of <0.9 kU/L, 95% of the challenges were negative. In the children aged 1-5 years (n = 88), the cutoff for Gal d 1 was >3.8 kU/L, and in the children above 6 years of age (n = 97), it was >3.5 kU/L. CONCLUSION Gal d 1-specific IgE is useful in distinguishing egg-sensitized patients with clinically reactive egg allergy from those tolerant of heated egg. The optimal cutoff point in a Finnish population of 185 children and adolescents was 3.7 kU/L with no significant difference between the younger and older age groups.
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Affiliation(s)
- Kati Palosuo
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna Kaarina Kukkonen
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna Susanna Pelkonen
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Juhani Mäkelä
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Flores Kim J, McCleary N, Nwaru BI, Stoddart A, Sheikh A. Diagnostic accuracy, risk assessment, and cost-effectiveness of component-resolved diagnostics for food allergy: A systematic review. Allergy 2018; 73:1609-1621. [PMID: 29319184 PMCID: PMC6055682 DOI: 10.1111/all.13399] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Component-resolved diagnostics (CRD) are promising tools for diagnosing food allergy, offering the potential to determine specific phenotypes and to develop patient-tailored risk profiles. Nevertheless, the diagnostic accuracy of these tests varies across studies; thus, their clinical utility remains unclear. Therefore, we synthesized the evidence from studies investigating the diagnostic accuracy, risk assessment ability, and cost-effectiveness of CRD for food allergy. METHODS We systematically searched 10 electronic databases and four clinical trial registries for studies published from January 2000 to February 2017. The quality of included studies was assessed using QUADAS-2. Due to heterogeneity, we narratively synthesized the evidence. RESULTS Eleven studies met inclusion criteria, altogether recruiting 1098 participants. The food allergies investigated were cow's milk, hen's egg, peanut, hazelnut, and shrimp. The components with the highest diagnostic accuracy for each allergen, along with their sensitivity-specificity pairs, were as follows: Bos d 4 for cow's milk (62.0% and 87.5%), Gal d 1 for hen's egg (84.2% and 89.8% for heated egg, and 60.6% and 97.1% for raw egg), Ara h 6 for peanut (94.9% and 95.1%), Cor a 14 for hazelnut (100% and 93.8%), and Lit v 1 for shrimp (82.8% and 56.3%) allergy. CONCLUSION Selected components of cow's milk, hen's egg, peanut, hazelnut, and shrimp allergen showed high specificity, but lower sensitivity. However, few studies exist for each component, and studies vary widely regarding the cutoff values used, making it challenging to synthesize findings across studies. Further research is needed to determine clinically appropriate cutoff values, risk assessment abilities, and cost-effectiveness of CRD approaches.
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Affiliation(s)
- J. Flores Kim
- Asthma UK Centre for Applied ResearchCentre for Medical InformaticsUsher Institute of Population Health Sciences and InformaticsThe University of EdinburghEdinburghUK
| | - N. McCleary
- Asthma UK Centre for Applied ResearchCentre for Medical InformaticsUsher Institute of Population Health Sciences and InformaticsThe University of EdinburghEdinburghUK
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
| | - B. I. Nwaru
- Asthma UK Centre for Applied ResearchCentre for Medical InformaticsUsher Institute of Population Health Sciences and InformaticsThe University of EdinburghEdinburghUK
- Krefting Research CentreInstitute of MedicineUniversity of GothenburgGothenburgSweden
- School of Health SciencesUniversity of TampereTampereFinland
- Wallenberg Centre for Molecular and Translational MedicineInstitute of MedicineUniversity of GothenburgGothenburgSweden
| | - A. Stoddart
- Asthma UK Centre for Applied ResearchCentre for Medical InformaticsUsher Institute of Population Health Sciences and InformaticsThe University of EdinburghEdinburghUK
- Edinburgh Clinical Trials UnitCentre for Medical InformaticsUsher Institute of Population Health Sciences and InformaticsThe University of EdinburghEdinburghUK
| | - A. Sheikh
- Asthma UK Centre for Applied ResearchCentre for Medical InformaticsUsher Institute of Population Health Sciences and InformaticsThe University of EdinburghEdinburghUK
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Jimenez-Rodriguez TW, Garcia-Neuer M, Alenazy LA, Castells M. Anaphylaxis in the 21st century: phenotypes, endotypes, and biomarkers. J Asthma Allergy 2018; 11:121-142. [PMID: 29950872 PMCID: PMC6016596 DOI: 10.2147/jaa.s159411] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Anaphylaxis is the most serious of all allergic reactions and can be fatal. The diagnosis is frequently delayed, and misdiagnosis often occurs with asthma or urticaria. Biomarkers such as tryptase are not routinely checked, and appropriate treatment with epinephrine is not administered in a majority of cases, increasing the risk of poor outcomes. The objective of this review is to provide a better understanding of the pathophysiology of anaphylaxis with a description of phenotypes, endotypes, and biomarkers available in both the clinical and research settings. Expanding knowledge with regard to the presentation, causes, and triggers for anaphylaxis among health care providers will improve its diagnosis and management, increase patient safety, and decrease morbidity and mortality.
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Affiliation(s)
- Teodorikez Wilfox Jimenez-Rodriguez
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Allergy Section, Alicante General University Hospital, Alicante, Spain
- PhD Program in Public Health, Medical and Surgical Sciences, Miguel Hernandez University, Alicante, Spain
| | - Marlene Garcia-Neuer
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Leila A Alenazy
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mariana Castells
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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25
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Li J, Zhang J, Qiong C, She T, Bian Y, Lin S, Li H. Component resolved diagnostic study of cow's milk allergy in infants and young children in northern China. Int Immunopharmacol 2018; 61:126-131. [PMID: 29859469 DOI: 10.1016/j.intimp.2018.05.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/25/2018] [Accepted: 05/25/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Increasing dairy consumption in China has been accompanied by rising incidence of milk allergy. Here we analyzed profiles of specific immunoglobulin E (sIgE) against cow's milk proteins, and assessed their value for milk allergy diagnosis among infants and young children from northern China. METHODS Sera collected from 48 patients with milk allergy and 27 negative control subjects was analyzed by enzyme-linked immunosorbent assay to measure sIgE to α-lactalbumin (Bos d 4), β-lactoglobulin (Bos d 5), α-casein (Bos d 9), β-casein (Bos d 11), and κ-casein (Bos d 12). RESULTS Among milk-allergic individuals, most were sensitized to at least one milk protein; about half were sensitized to Bos d 5, Bos d 9, Bos d 11 and Bos d 12, respectively, while few had positive serum sIgE against Bos d 4. Bos d 12 sIgE had the largest area under curve (AUC) (0.878; 95% CI, 0.800-0.957) and thus showed the best diagnostic performance in discriminating between milk-allergic and non-milk allergic patients, with a sensitivity of 92.6% and specificity of 72.9% using a statistically optimal cut-off value (OD450nm, 0.191). The combinations of Bos d 5 + Bos d 12 showed an AUC of 0.926, which was larger than for any individual components. CONCLUSIONS Our results revealed inter-individual variation in the sensitization to different milk allergen component. Bos d 12 sIgE showed best performance in diagnosing milk allergy. Milk allergy diagnostic accuracy was further improved using combinations of milk allergen components by application of ROC curves based on logistic regression.
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Affiliation(s)
- Junpu Li
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China; Department of Medical Laboratory, Tianjin Children's Hospital, Tianjin, China
| | - Jiayi Zhang
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China; Department of Medical Laboratory, Tianjin Children's Hospital, Tianjin, China
| | - Cuiya Qiong
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China; Department of Medical Laboratory, Tianjin Children's Hospital, Tianjin, China
| | - Tiantian She
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China; Department of Medical Laboratory, Tianjin Children's Hospital, Tianjin, China
| | - Ying Bian
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China; Department of Medical Laboratory, Tianjin Children's Hospital, Tianjin, China
| | - Shuxiang Lin
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China; Department of Medical Laboratory, Tianjin Children's Hospital, Tianjin, China
| | - Huiqiang Li
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China; Department of Medical Laboratory, Tianjin Children's Hospital, Tianjin, China.
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26
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Pablos-Tanarro A, Lozano-Ojalvo D, Molina E, López-Fandiño R. Assessment of the Allergenic Potential of the Main Egg White Proteins in BALB/c Mice. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2018; 66:2970-2976. [PMID: 29493227 DOI: 10.1021/acs.jafc.8b00402] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This work aimed to assess the contribution of the major egg white proteins, ovalbumin, ovomucoid, and lysozyme, to the induction and elicitation of allergenic responses. For this purpose, BALB/c mice were orally administered either the individual egg allergens or a mixture of the three proteins in the same proportion, to evaluate their relative allergenicity avoiding their different abundance in egg white. Cholera toxin was used as a T helper 2 (Th2)-polarizing adjuvant. Ovomucoid and lysozyme triggered the most severe anaphylaxis reactions upon oral challenge. In comparison to ovalbumin and ovomucoid, lysozyme was a more active promotor of early immunoglobulin E and immunoglobulin G1 production and stimulated stronger Th2-biased responses from both mesenteric lymph node and spleen cells. These results indicate that lysozyme is highly immunogenic and should be considered as a major allergen, whose clinical usefulness in the diagnosis, prognosis, and therapeutic approaches of egg allergy deserves further consideration.
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Affiliation(s)
- Alba Pablos-Tanarro
- Instituto de Investigación en Ciencias de la Alimentación (CIAL) , Consejo Superior de Investigaciones Científicas y Universidad Autónoma de Madrid (CSIC-UAM) , Nicolás Cabrera 8 , 28049 Madrid , Spain
| | - Daniel Lozano-Ojalvo
- Instituto de Investigación en Ciencias de la Alimentación (CIAL) , Consejo Superior de Investigaciones Científicas y Universidad Autónoma de Madrid (CSIC-UAM) , Nicolás Cabrera 8 , 28049 Madrid , Spain
| | - Elena Molina
- Instituto de Investigación en Ciencias de la Alimentación (CIAL) , Consejo Superior de Investigaciones Científicas y Universidad Autónoma de Madrid (CSIC-UAM) , Nicolás Cabrera 8 , 28049 Madrid , Spain
| | - Rosina López-Fandiño
- Instituto de Investigación en Ciencias de la Alimentación (CIAL) , Consejo Superior de Investigaciones Científicas y Universidad Autónoma de Madrid (CSIC-UAM) , Nicolás Cabrera 8 , 28049 Madrid , Spain
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27
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Westwood M, Ramaekers B, Lang S, Armstrong N, Noake C, de Kock S, Joore M, Severens J, Kleijnen J. ImmunoCAP® ISAC and Microtest for multiplex allergen testing in people with difficult to manage allergic disease: a systematic review and cost analysis. Health Technol Assess 2018; 20:1-178. [PMID: 27623692 DOI: 10.3310/hta20670] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Allergy is a form of immune-mediated exaggerated sensitivity (hypersensitivity) to a substance that is either inhaled, swallowed, injected or comes into contact with the skin. Foreign substances that provoke allergies are called allergens. It has been claimed that multiplex allergen testing may help in diagnosing the cause of symptoms in patients with an unclear cause of allergy or who are allergic to more than one substance. OBJECTIVES To evaluate multiplex allergen testing [devices that can measure the presence of multiple immunoglobulin E (IgE) antibodies in a patient's blood at the same time], by assessing (1) clinical effectiveness (allergy symptoms, incidence of acute exacerbations, mortality, adverse events of testing and treatment, health-care presentations or admissions, health-related quality of life); (2) effects on treatment (diet, immunotherapy medications, other potential testing); (3) any additional diagnostic information provided by multiplex allergen testing; and (4) cost-effectiveness (cost of different assessment strategies). METHODS Fifteen databases were searched from 2005 to April 2015, including MEDLINE (via OvidSp), MEDLINE In-Process Citations, MEDLINE Daily Update, PubMed (National Library of Medicine), EMBASE, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA) database, Science Citation Index (SCI), Conference Proceedings Citation Index-Science (CPCI-S), BIOSIS Previews, Latin American and Caribbean Health Sciences Literature (LILACS), National Institute for Health Research (NIHR) HTA programme, and the US Food and Drug Administration (FDA); supplementary searches of conference proceedings and trials registries were performed. Review methods followed published guidance from the Cochrane Collaboration and the Centre for Reviews and Dissemination, University of York, UK. The methodological quality of included studies was assessed using appropriate published tools or a review-specific tool designed by the project team. Studies were summarised in a narrative synthesis. Owing to a lack of data on the clinical effectiveness of multiplex allergen testing, no long-term cost-effectiveness model was developed. A conceptual model structure was developed and cost analyses were performed to examine the short-term costs of various possible diagnostic pathways. RESULTS Fifteen studies were included in the review. The very limited available data indicated that the addition of multiplex allergen testing [ImmunoCAP(®) Immuno Solid-phase Allergen Chip (ISAC), Thermo Fisher Scientific/Phadia AB, Uppsala, Sweden] to standard diagnostic work-up can change the clinicians' views on the diagnosis, management and treatment of patients. There was some indication that the use of ImmunoCAP ISAC testing may be useful to guide decisions on the discontinuation of restrictive diets, the content of allergen-specific immunotherapy (SIT) prescriptions, and whether or not patients should receive SIT. However, none of the studies that we identified reported any information on clinical outcomes subsequent to changes in treatment or management. There was some evidence that ImmunoCAP ISAC may be useful for discriminating allergens that are structurally similar and are recognised by the same IgE antibody (cross-immunoreactive). No data were available for Microtest (Microtest Matrices Ltd, London, UK). Detailed cost analyses suggested that multiplex allergen testing would have to result in a substantial reduction of the proportions of patients receiving single IgE testing and oral food challenge tests in order to be cost-saving in the short term. CONCLUSIONS No recommendations for service provision can be made based on the analyses included in this report. It is suggested that a consensus-based protocol for the use of multiplex allergen testing be developed. The clinical effectiveness and cost-effectiveness of the proposed protocol should then be assessed by comparing long-term clinical and quality of life outcomes and resource use in patients managed using the protocol with those managed using a standard diagnostic pathway. STUDY REGISTRATION This study is registered as PROSPERO CRD42015019739. FUNDING This project was a Diagnostic Assessment Report commissioned by the NIHR HTA programme on behalf of the National Institute for Health and Care Excellence.
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Affiliation(s)
| | - Bram Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Shona Lang
- Kleijnen Systematic Reviews Ltd, York, UK
| | | | - Caro Noake
- Kleijnen Systematic Reviews Ltd, York, UK
| | | | - Manuela Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Johan Severens
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jos Kleijnen
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
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28
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Larenas-Linnemann D, Luna-Pech JA, Mösges R. Debates in Allergy Medicine: Allergy skin testing cannot be replaced by molecular diagnosis in the near future. World Allergy Organ J 2017; 10:32. [PMID: 29043011 PMCID: PMC5604190 DOI: 10.1186/s40413-017-0164-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 07/07/2017] [Indexed: 01/23/2023] Open
Abstract
Percutaneous skin prick tests (SPT) have been considered the preferred method for confirming IgE-mediated sensitization. This reliable and minimally invasive technique correlates with in vivo challenges, has good reproducibility, is easily quantified, and allows analyzing multiple allergens simultaneously. Potent extracts and a proficient tester improve its accuracy. Molecular-based allergy diagnostics (MA-Dx) quantifies allergenic components obtained either from purification of natural sources or recombinant technology to identify the patient’s reactivity to those specific allergenic protein components. For a correct allergy diagnosis, the patient selection is crucial. MA-Dx has been shown to have a high specificity, however, as MA-Dx testing can be ordered by any physician, the pre-selection of patients might not always be optimal, reducing test specificity. Also, MA-Dx is less sensitive than in vitro testing with the whole allergen or SPT. Secondly, no allergen-specific immunotherapy (AIT) trial has yet shown efficacy with patients selected on the basis of their MA-Dx results. Thirdly, why would we need molecular diagnosis, as no molecular treatment can yet be offered? Then there are the practical arguments of costs (SPT highly cost-efficient), test availability for MA-Dx still lacking in wide areas of the world and scarce in others. As such, it is hard physicians can build confidence in the test and their interpretation of the MA-Dx results. In conclusion: as of now these techniques should be reserved for situations of complex allergies and polysensitization; in the future MA-Dx might help to reduce the number of allergens for AIT, but trials are needed to prove this concept.
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Affiliation(s)
- Désirée Larenas-Linnemann
- Investigational Unit, Hospital Médica Sur, Torre 2, consultorio 602, Puente de Piedra 150, Col. Toriello Guerra, Del. Tlalpan, 14050 Mexico City, Mexico
| | - Jorge A Luna-Pech
- Departamento de Disciplinas Filosófico, Metodológico e Instrumentales, CUCS, Universidad de Guadalajara, Guadalajara, Mexico
| | - Ralph Mösges
- Institute of Medical Statistics and Epidemiology, Faculty of Medicine, University of Cologne, Cologne, Germany
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29
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Alessandri C, Ferrara R, Bernardi ML, Zennaro D, Tuppo L, Giangrieco I, Tamburrini M, Mari A, Ciardiello MA. Diagnosing allergic sensitizations in the third millennium: why clinicians should know allergen molecule structures. Clin Transl Allergy 2017; 7:21. [PMID: 28725346 PMCID: PMC5513363 DOI: 10.1186/s13601-017-0158-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 06/05/2017] [Indexed: 01/06/2023] Open
Abstract
Diagnostic tests to detect allergic sensitization were introduced at the end of the nineteenth century but only in the late 1990s did the advent of molecular allergology revolutionize the approach to the allergic patient. Personalized Medicine, a medical procedure that separates patients into different groups with different medical decisions, practices and interventions has sanctioned this change. In fact, in the last few years molecular allergology and the observation that not every patient has the same allergic profile, even when allergic to the same allergenic source, has originated the concept "one size does not fit all". This new approach requires the identification of still unknown allergens, but also the more detailed investigation of those already known. In depth studies of the structure-function relationships in allergenic molecules can reveal the structural determinants involved in the IgE-binding. Then, the knowledge of the epitope profile of each allergen and of the environmental/experimental conditions affecting the exposure of IgE-binding epitopes can provide important contributions to the understanding of cross-reaction processes and to the improvement of diagnosis, immunotherapy and the overall patient treatment. The evolution of diagnostic systems cannot ignore these new needs in this field.
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Affiliation(s)
- C Alessandri
- CAAM - Centri Associati di Allergologia Molecolare, Rome, Italy
| | - R Ferrara
- CAAM - Centri Associati di Allergologia Molecolare, Rome, Italy
| | - M L Bernardi
- CAAM - Centri Associati di Allergologia Molecolare, Rome, Italy
| | - D Zennaro
- CAAM - Centri Associati di Allergologia Molecolare, Rome, Italy
| | - L Tuppo
- Istituto di Bioscienze e Biorisorse - IBBR-CNR, Naples, Italy
| | - I Giangrieco
- Istituto di Bioscienze e Biorisorse - IBBR-CNR, Naples, Italy
| | - M Tamburrini
- Istituto di Bioscienze e Biorisorse - IBBR-CNR, Naples, Italy
| | - A Mari
- CAAM - Centri Associati di Allergologia Molecolare, Rome, Italy.,Allergy Data Laboratories s.c., Latina, Italy
| | - M A Ciardiello
- Istituto di Bioscienze e Biorisorse - IBBR-CNR, Naples, Italy
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30
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Verduci E, Martelli A, Miniello VL, Landi M, Mariani B, Brambilla M, Diaferio L, Peroni DG. Nutrition in the first 1000 days and respiratory health: A descriptive review of the last five years' literature. Allergol Immunopathol (Madr) 2017; 45:405-413. [PMID: 28411961 DOI: 10.1016/j.aller.2017.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 12/22/2016] [Accepted: 01/07/2017] [Indexed: 11/19/2022]
Abstract
The aim of this paper is to discuss the current evidence regarding short and long-term health respiratory effects of nutrients and dietary patterns during the first 1000 days from conception. Population of interest included children from birth to two years and their mothers (during pregnancy and lactation). Studies were searched on MEDLINE® and Cochrane database, inserting individually and using the Boolean ANDs and ORs, 'nutrients', 'micronutrients', 'LC-PUFA', 'Mediterranean Diet', 'human milk', 'complementary food', 'pregnancy', 'respiratory disease', 'pulmonary disease', 'asthma', 'epigenetics', 'first 1000 days', 'maternal diet' and 'respiratory health'. All sources were retrieved between 01-09-2015 and 07-12-2016. While unhealthy maternal dietary patterns (high fat intake) during pregnancy can result in alteration of foetal lung development, with increased risk of respiratory disorders, Mediterranean diet has been associated with a lower risk of allergic sensitisation and allergic rhinitis. Breastfeeding has beneficial effects on respiratory infections while evidences about its protective effect on allergic disorders are unclear. During complementary feeding there is no evidence to avoid or encourage exposition to 'highly allergenic' foods to have modification of tolerance development. In children from birth to two years of age, Mediterranean diet has been associated with a lower risk of atopy, wheezing and asthma. Micronutrients, antioxidant and LCPUFA supplementation is not recommended and a whole food approach should be preferred, except for Vitamin D.
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Affiliation(s)
- E Verduci
- Department of Paediatrics, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy.
| | - A Martelli
- Paediatric Unit, Garbagnate Hospital, Garbagnate, Italy
| | - V L Miniello
- Department of Paediatrics, Aldo Moro University of Bari, Giovanni XXIII Hospital, Bari, Italy
| | - M Landi
- Primary Care Paediatrics, Turin, Italy; Unit Research of Paediatric Pulmonology and Allergy, Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo, Italy
| | - B Mariani
- Department of Paediatrics, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy
| | - M Brambilla
- Department of Paediatrics, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy
| | - L Diaferio
- Department of Paediatrics, Aldo Moro University of Bari, Giovanni XXIII Hospital, Bari, Italy
| | - D G Peroni
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Italy
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31
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Lee JO, Sung D, Park SH, Lee J, Kim J, Shon DH, Ahn K, Han Y. Effect of acid treatment on allergenicity of peanut and egg. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2017; 97:2116-2121. [PMID: 27571929 DOI: 10.1002/jsfa.8017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 08/10/2016] [Accepted: 08/25/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Many food experts have studied various treatments or processing techniques in order to develop hypoallergenic foods. In a previous study, acid treatment dramatically mitigated the allergenicity of peanut, especially Ara h 2. RESULTS Gel electrophoresis showed that most protein bands of acid-treated peanut were not detected, but protein bands of egg white became weaker and broader by acid treatment. In immunoblotting using a rabbit antibody, the antigenicity against ovalbumin or ovomucoid in acid-treated egg white was decreased but the antigenicity against Ara h 1 or Ara h 2 in peanut treated with pH 2 acetic acid was completely undetected. The allergenicity of ovalbumin and peanut fell significantly to 1/1022 and 1/5380, respectively, when measured as IC50 in the sample treated with pH 2.0 acetic acid. CONCLUSION This study showed that acid treatment was more effective in peanut and barely effective in ovomucoid. This may contribute to the development of hypoallergenic food and clinical management of food allergy. © 2016 Society of Chemical Industry.
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Affiliation(s)
- Jeong-Ok Lee
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
| | - Dongeun Sung
- Department of Food Science and Technology, College of Engineering, Ewha Womans University, Seoul, Korea
| | - Su Hwa Park
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
| | - Jinyoung Lee
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
| | - Jihyun Kim
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Hwa Shon
- Research Group of Nutraceuticals for Metabolic Syndrome Division of Functional Food Research, Korea Food Research Institute, Gyeonggi, Korea
- Food Biotechnology Program, Korea University of Science and Technology, Daejeon 305-350, Korea
| | - Kangmo Ahn
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Youngshin Han
- Department of Medical Science, Sungkyunkwan University School of Medicine, Seoul, Korea
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32
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Gradman J, Mortz CG, Eller E, Bindslev-Jensen C. Relationship between specific IgE to egg components and natural history of egg allergy in Danish children. Pediatr Allergy Immunol 2016; 27:825-830. [PMID: 27565949 DOI: 10.1111/pai.12644] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The majority of egg-allergic children develop tolerance over time. However, it may take numerous of consecutive egg challenges to get there as no good indices to predict tolerance exist. OBJECTIVE To investigate whether serial measurements of specific IgE to egg white, ovomucoid, ovalbumin, conalbumin, lysozyme, and egg yolk could improve the specificity of the diagnostic workup and aid in the decision when to rechallenge egg-allergic children. METHODS The outcome of oral food challenges with hen's egg and corresponding specific IgE levels were evaluated in children referred to The Allergy Center within an 8-year period. The egg-allergic children were rechallenged and had specific IgE levels measured once a year. RESULTS During a median follow-up of 26 months, 287 challenges and corresponding 287 serum analyses were performed in 130 children. Of the 130 children, 99 were egg allergic and 82 of these were rechallenged. Based on the initial diagnostic challenges only, area under the curve (AUC) estimates of the ability of specific IgE titers to distinguish between egg sensitization and egg allergy were only modest (maximum 0.83) and provided no clinical meaningful decision points. Specific IgE levels at baseline did not differ between tolerant and persistent allergic children. However longitudinally, acquisition of tolerance was associated with a decrease in IgE to egg white and to ovomucoid. In all cases of an increase in IgE to ovomucoid, the rechallenge was positive. CONCLUSION The decision when to rechallenge egg-allergic children should encounter the course of specific IgE.
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Affiliation(s)
- Josefine Gradman
- Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark
| | - Charlotte G Mortz
- Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark.,ORCA, Odense Research Center for Anaphylaxis, Odense, Denmark
| | - Esben Eller
- Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark.,ORCA, Odense Research Center for Anaphylaxis, Odense, Denmark
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark.,ORCA, Odense Research Center for Anaphylaxis, Odense, Denmark
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33
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Abstract
Baked milk and egg have the potential to act as a form of oral immunotherapy (OIT). Clinical studies have shown that a majority of milk- and egg-allergic children can tolerate these allergens modified in baked form, and immunologic changes reported in subjects ingesting baked milk and egg mirror those seen in food allergy OIT trials. In addition, several studies have indicated that resolution of milk and egg allergies occur sooner in populations regularly ingesting baked milk and egg. Oral food challenges remain the best method for determining tolerability of baked milk and egg since baseline characteristics and diagnostic testing have not been reliable predictors. In this review, we explore the tolerability of baked milk and egg and their potential as OIT treatment for milk and egg allergy.
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Benedé S, López-Expósito I, Molina E, López-Fandiño R. Egg proteins as allergens and the effects of the food matrix and processing. Food Funct 2016; 6:694-713. [PMID: 25598200 DOI: 10.1039/c4fo01104j] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hen eggs are an important and inexpensive source of high-quality proteins in the human diet. Egg, either as a whole or its constituents (egg yolk and white), is a key ingredient in many food products by virtue of its nutritional value and unique functional properties, such as emulsifying, foaming, and gelling. Nevertheless, egg is also known because of its allergenic potential and, in fact, it is the second most frequent source of allergic reactions, particularly in children. This review deals with the structural or functional properties of egg proteins that make them strong allergens. Their ability to sensitize and/or elicit allergic reactions is linked to their resistance to gastroduodenal digestion, which ultimately allows them to interact with the intestinal mucosa where absorption occurs. The factors that affect protein digestibility, whether increasing it, decreasing it, or inducing a different proteolysis pattern, and their influence on their capacity to induce or trigger an allergic reaction are discussed. Special attention is paid to the effect of the food matrix and the processing practices on the capacity of egg proteins to modulate the immune response.
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Affiliation(s)
- S Benedé
- Instituto de Investigación en Ciencias de la Alimentación (CIAL, CSIC-UAM), Nicolás Cabrera 9, 28049 Madrid, Spain.
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Leonard SA, Caubet JC, Kim JS, Groetch M, Nowak-Węgrzyn A. Baked milk- and egg-containing diet in the management of milk and egg allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 3:13-23; quiz 24. [PMID: 25577613 DOI: 10.1016/j.jaip.2014.10.001] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/24/2014] [Accepted: 10/02/2014] [Indexed: 01/06/2023]
Abstract
Cow's milk (CM) and hen's egg allergies are among the most common food allergies in children. With evidence of increasing food allergy prevalence and more persistent disease, it has become vital to improve the management of CM and egg allergies. The ability to tolerate baked milk or egg, such as in a cake or muffin, has been associated with an increased chance of tolerance development. Studies report that about 70% of CM- and egg-allergic children can tolerate baked milk or egg and that incorporating baked milk or egg into the diet is well tolerated. Being able to add baked milk or egg into the diet can also increase quality of life by expanding the diet, boosting nutrition, and promoting inclusion in social activities. There is some debate over how baked milk and egg should be introduced, at home or in a supervised setting. Anaphylaxis and treatment with epinephrine during baked milk or egg challenges have been reported. Study of potential biomarkers to predict tolerability of baked milk and egg, such as serum specific IgE levels and skin prick test wheal diameters, is ongoing. Many parents can reliably report that their CM- or egg-allergic child is already consuming baked goods without symptoms. However, for those who cannot report such tolerance, the most prudent approach is to perform a supervised oral food challenge to determine the tolerability of baked milk and egg. The purpose of this article was to review the pathophysiology, clinical data, and safety of baked milk and egg and provide a practical guide to managing CM allergy and/or egg allergy. Recipes for baked milk and egg challenges and guidance on how to add baked milk and egg if tolerated to the child's regular diet are provided.
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Affiliation(s)
- Stephanie A Leonard
- Division of Pediatric Allergy & Immunology, Rady Children's Hospital San Diego, University of California, San Diego, Calif
| | - Jean-Christoph Caubet
- Department of Child and Adolescent, Division of Pediatric Allergy, Geneva University Hospitals, Geneva, Switzerland
| | | | - Marion Groetch
- Division of Pediatric Allergy, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai New York, NY
| | - Anna Nowak-Węgrzyn
- Division of Pediatric Allergy, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai New York, NY.
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Chokshi NY, Sicherer SH. Interpreting IgE sensitization tests in food allergy. Expert Rev Clin Immunol 2015; 12:389-403. [DOI: 10.1586/1744666x.2016.1124761] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Reese I, Lange L. Allergie gegen Kuhmilch und Hühnerei: Was bietet die molekulare Allergiediagnostik? ALLERGO JOURNAL 2015. [DOI: 10.1007/s15007-015-0981-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Schussler E, Kattan J. Allergen Component Testing in the Diagnosis of Food Allergy. Curr Allergy Asthma Rep 2015; 15:55. [PMID: 26233426 DOI: 10.1007/s11882-015-0554-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IgE-mediated food allergies are an important public health problem, affecting 5 % of adults and 8 % of children, with numerous studies indicating that the prevalence is increasing. Food allergic reactions can range in severity from mild to severe and life threatening. Accurate diagnosis of food allergy is necessary not only to provide appropriate and potentially life-saving preventive measures but also to prevent unwarranted dietary restrictions. The diagnosis of food allergy has traditionally been based on clinical history and food specific IgE (sIgE) testing, including skin prick testing (SPT), serum tests, or both. These tests tend to be extremely sensitive, but positive test results to foods that are tolerated are common. Studies of allergen component-resolved diagnostics (CRD) show that adjuvant use of this modality may provide a more accurate assessment in the diagnosis of food allergy, though the reported benefits are questionable for a number of major allergens. Furthermore, diagnostic cutoff values have been difficult to determine for allergens where component testing has been demonstrated to be beneficial.
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Affiliation(s)
- Edith Schussler
- Division of Allergy and Immunology, Department of Pediatrics, Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1198, New York, NY, 10029-6574, USA,
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Tallar MT, Grayson MH. Component-resolved allergen testing: The new frontier. World J Transl Med 2015; 4:44-50. [DOI: 10.5528/wjtm.v4.i2.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/03/2015] [Accepted: 04/14/2015] [Indexed: 02/05/2023] Open
Abstract
The discovery that allergen specific IgE (sIgE) identified individuals who were allergic to specific allergens, revolutionized allergy and immunology. Recently, component-resolved allergen testing (CRD) has shown promise in improving the field yet again. Prior to development of CRD immunoassays, whole allergen extracts were used to detect IgE mediated allergic disease either by oral, cutaneous, or conjunctival provocation. The most widely used immunoassays detect sIgE to either whole allergen sources or individual allergic components. The use of CRD micro-assay technology (not Food and Drug Administration approved in the United States) has been used to evaluate multiple allergens in parallel. This technique allows for determination of primary vs secondary sensitizations from either close sequence homology or cross-reactive carbohydrate determinants. Published studies have shown beneficial uses in hymenoptera venom immunotherapy, anaphylaxis, and food allergy. The use of component testing for aeroallergen immunotherapy has been studied, however clinical use is hampered by lack of allergen components approved for injection. Therefore, although promising in many respects, the frontier of CRD testing requires more data before it can be widely used in clinical practice.
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Comberiati P, Cipriani F, Schwarz A, Posa D, Host C, Peroni DG. Diagnosis and treatment of pediatric food allergy: an update. Ital J Pediatr 2015; 41:13. [PMID: 25880827 PMCID: PMC4339416 DOI: 10.1186/s13052-014-0108-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 12/30/2014] [Indexed: 11/16/2022] Open
Abstract
The prevalence of pediatric food allergy and anaphylaxis has increased in the last decades, especially in westernized countries where this emerging phenomenon was marked as a "second wave" of the allergic epidemic. Over recent years great advances have been achieved in the field of in vitro allergy testing and component-resolved diagnosis has increasingly entered clinical practice. Testing for allergen components can contribute to a more precise diagnosis by discriminating primary from cross-reactive sensitizations and assessing the risk of severe allergic reactions.The basic concept of the management of food allergy in children is also changing. Avoidance of the offending food is still the mainstay for disease management, especially in primary health care settings, but it severely affects the patients' quality of life without reducing the risk of accidental allergic reactions. There is a growing body of evidence to show that specific oral tolerance induction can represent a promising treatment option for food allergic patients. In parallel, education of food allergic patients and their caregivers as well as physicians about anaphylaxis and its treatment is becoming recognized a fundamental need. International guidelines have recently integrated these new evidences and their broad application all over Europe represents the new challenge for food allergy specialists.
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Affiliation(s)
- Pasquale Comberiati
- Pediatric Clinic, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy.
| | - Francesca Cipriani
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Alina Schwarz
- Department of Pediatric Pneumology and Immunology, Charité Medical School, Berlin, Germany.
| | - Daniela Posa
- Department of Pediatric Pneumology and Immunology, Charité Medical School, Berlin, Germany.
| | - Cristina Host
- Dipartimento Riproduzione e Accrescimento, Sezione di Pediatria, Azienda Ospedaliero-Universitaria di Ferrara, Via A. Moro 8, Cona, 44124, Ferrara, Itali.
| | - Diego G Peroni
- Dipartimento Riproduzione e Accrescimento, Sezione di Pediatria, Azienda Ospedaliero-Universitaria di Ferrara, Via A. Moro 8, Cona, 44124, Ferrara, Itali.
- University of Ferrara, Section of Paediatrics, Corso Giovecca 203, 44100, Ferrara, Italy.
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Benhamou Senouf AH, Borres MP, Eigenmann PA. Native and denatured egg white protein IgE tests discriminate hen's egg allergic from egg-tolerant children. Pediatr Allergy Immunol 2015; 26:12-7. [PMID: 25443975 DOI: 10.1111/pai.12317] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Accurate diagnosis of egg allergy by IgE testing is challenged by a large number of atopic subjects sensitized, but clinically tolerant to eggs. In addition, discrimination between allergy to raw only, or raw and cooked egg allergy is important. In this study, we investigate the diagnostic performance of IgE tests to native and denatured egg proteins. METHODS According to food challenges and clinical tolerance, study subjects were randomized to the following groups: (Group A) sensitized but clinically tolerant to egg, (Group B) allergic to raw egg only, or (Group C) allergic to raw and cooked egg. Serum-specific IgE to native or reduced and oxidized egg white, ovomucoid, and ovalbumin were measured. RESULTS Increasing titers of specific IgE to the various proteins were found according to the degree of the egg allergy. Cut-off values for IgE testing to native egg could be determined to distinguish between raw egg allergic and egg-tolerant subjects (1.6 kU/l), as well as raw and cooked egg allergic and egg-tolerant subjects (4.1 kU/l). ROC curves analysis showed that native ovalbumin was the best test for the diagnosis of allergy to raw and cooked egg, and native ovomucoid was best to distinguish between allergy to raw only, and allergy to raw and cooked egg. Sequential testing improved the diagnosis, when in addition to IgE to native egg white, IgE to native ovalbumin was tested for the diagnosis of raw and cooked egg allergy, and IgE to native ovomucoid for the discrimination between allergy to raw only, or to raw and cooked eggs. CONCLUSION The diagnosis of egg allergy can be significantly improved using a panel of IgE tests to egg proteins in the native or denatured form. The accuracy can be improved using combined IgE testing.
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Affiliation(s)
- Avigael H Benhamou Senouf
- Department of Child and Adolescent, Pediatric Allergy Unit, University Hospitals, Geneva, Switzerland
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Jhon J, Lee KE, Kim MN, Hong JY, Kim MJ, Kim YH, Park HB, Han YK, Lee HS, Kim KW, Sohn MH, Park JW, Kim KE. Diagnostic utility of skin prick test to cooked egg in children with egg allergy. ALLERGY ASTHMA & RESPIRATORY DISEASE 2015. [DOI: 10.4168/aard.2015.3.1.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jin Jhon
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Eun Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Na Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Yeon Hong
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Hee Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Bin Park
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ki Han
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Seon Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Won Park
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu-Earn Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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44
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Bartnikas LM, Sheehan WJ, Tuttle KL, Petty CR, Schneider LC, Phipatanakul W. Ovomucoid specific immunoglobulin E as a predictor of tolerance to cooked egg. ALLERGY & RHINOLOGY (PROVIDENCE, R.I.) 2015; 6:198-204. [PMID: 26686214 PMCID: PMC5391491 DOI: 10.2500/ar.2015.6.0135] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Ovomucoid is the dominant allergen in hen's egg. Although several studies evaluated the utility of ovomucoid specific immunoglobulin E (sIgE) levels in predicting baked (e.g., muffin or cupcake) or raw egg food challenge outcomes, studies that evaluated ovomucoid sIgE as a predictor of cooked egg (e.g., scrambled or hard boiled) challenge outcomes are limited. OBJECTIVE To determine the relation of ovomucoid sIgE levels with cooked egg food challenge outcomes. METHODS A retrospective review of 44 children who underwent cooked egg food challenge and who had the ovomucoid sIgE level measured. RESULTS Thirty-six of 44 children (81.8%) passed cooked egg challenge. The ovomucoid sIgE level predicted cooked egg challenge outcome (passed median, <0.35 kU/L [range, <0.35-0.64 kU/L]; failed median, 0.40 kU/L [range, <0.35-3.13 kU/L]; p = 0.004). Ovomucoid sIgE levels correlated with egg white (EW) sIgE levels (Spearman correlation coefficient, 0.588; p < 0.001). Receiver operating characteristic curve analysis of ovomucoid and EW sIgE demonstrated areas under the curve of 0.711 and 0.766, respectively. No significant difference was observed among those immunologic parameters in their abilities to predict cooked egg challenge outcome (p = 0.559). CONCLUSION The ovomucoid sIgE level may be helpful in predicting cooked egg challenge outcomes. However, our study did not support a role for ovomucoid sIgE replacing EW sIgE testing in evaluating egg allergy.
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Affiliation(s)
- Lisa M. Bartnikas
- From the Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - William J. Sheehan
- From the Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Katherine L. Tuttle
- Harvard Medical School, Boston, Massachusetts
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, and
| | - Carter R. Petty
- Clinical Research Center, Boston Children's Hospital, Boston, Massachusetts
| | - Lynda C. Schneider
- From the Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Wanda Phipatanakul
- From the Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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45
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Abstract
Accurately diagnosing a patient with a possible food allergy is important to avoid unnecessary dietary restrictions and prevent life-threatening reactions. Routine testing modalities have limited accuracy, and an oral food challenge is often required to make a definitive diagnosis. Given that they are labor intensive and risk inducing an allergic reaction, several alternative diagnostic modalities have been investigated. Testing for IgE antibodies to particular protein components in foods has shown promise to improve diagnostics and has entered clinical practice. Additional modalities show potential, including epitope binding, T-cell studies, and basophil activation.
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Affiliation(s)
- Jacob D Kattan
- Department of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1198, New York, NY 10029, USA.
| | - Scott H Sicherer
- Department of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1198, New York, NY 10029, USA
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46
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Dang TD, Mills CEN, Allen KJ. Determination of the clinical egg allergy phenotypes using component-resolved diagnostics. Pediatr Allergy Immunol 2014; 25:639-43. [PMID: 25376255 DOI: 10.1111/pai.12301] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 11/27/2022]
Abstract
IgE-mediated egg allergy presents as one of the most common food allergies in children and is a food which is widely consumed all over the world. Measurement of egg white-specific IgE levels has been shown to be a poor predictor of clinical phenotypes of egg allergy, including to raw egg white, but particularly to baked or cooked egg. Egg white and yolk contain more than 20 different glycoproteins, including ovomucoid, ovalbumin, ovotransferrin, alpha-livetin, and the newly identified Gal d 6. Recent developments in component-resolved diagnostic technology, including microarrays, have enabled us to improve the way in which we diagnose food allergy. This technology allows us to measure specific IgE antibodies to individual egg allergens which have been highly purified. Characterization of the major egg allergens could help profile the relevant binding epitopes to each region and may also help diagnose the different clinical phenotypes of egg allergy.
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Affiliation(s)
- Thanh D Dang
- Centre of Food and Allergy Research, Murdoch Childrens Research Institute, Parkville, Vic., Australia; Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia
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O’Keefe AW, De Schryver S, Mill J, Mill C, Dery A, Ben-Shoshan M. Diagnosis and management of food allergies: new and emerging options: a systematic review. J Asthma Allergy 2014; 7:141-64. [PMID: 25368525 PMCID: PMC4216032 DOI: 10.2147/jaa.s49277] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
It is reported that 6% of children and 3% of adults have food allergies, with studies suggesting increased prevalence worldwide over the last few decades. Despite this, our diagnostic capabilities and techniques for managing patients with food allergies remain limited. We have conducted a systematic review of literature published within the last 5 years on the diagnosis and management of food allergies. While the gold standard for diagnosis remains the double-blind, placebo-controlled food challenge, this assessment is resource intensive and impractical in most clinical situations. In an effort to reduce the need for the double-blind, placebo-controlled food challenge, several risk-stratifying tests are employed, namely skin prick testing, measurement of serum-specific immunoglobulin E levels, component testing, and open food challenges. Management of food allergies typically involves allergen avoidance and carrying an epinephrine autoinjector. Clinical research trials of oral immunotherapy for some foods, including peanut, milk, egg, and peach, are under way. While oral immunotherapy is promising, its readiness for clinical application is controversial. In this review, we assess the latest studies published on the above diagnostic and management modalities, as well as novel strategies in the diagnosis and management of food allergy.
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Affiliation(s)
- Andrew W O’Keefe
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
- Department of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, St John’s, NL, Canada
| | - Sarah De Schryver
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Jennifer Mill
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Christopher Mill
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Alizee Dery
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
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Mari A, Antonietta Ciardiello M, Passalacqua G, Vliagoftis H, Wardlaw AJ, Wickman M. Developments in the field of allergy in 2012 through the eyes of Clinical & Experimental Allergy. Clin Exp Allergy 2014; 43:1309-32. [PMID: 24118214 DOI: 10.1111/cea.12212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In 2012, we received 683 submissions and published 20 editorials, 38 reviews, 11 letters and 128 original articles. This represents an acceptance rate for original papers in the range of 20%. About 30% of original papers were triaged not to go out to review, either because the editors did not feel they had sufficient priority for publication or because the topic did not feel right for the readers of the journal. We place great emphasis on obtaining sufficient high-quality reviews to make our decisions on publication fair and consistent. Inevitably, however, there is a degree of luck about what gets published and which papers miss out, and we are always happy to receive an appeal on our decisions either at the triage stage or after review. This gives us the opportunity to revisit the decision and revise it or explain in more detail to the authors the basis for the decision. Once again in 2012, we were delighted by the quality of the papers submitted and the breadth and depth of research into allergic disease that it revealed. The pattern of papers submitted was similar in previous years with considerable emphasis on all aspects of asthma and rhinitis. We were particularly pleased with our special issue on severe asthma. Elucidating mechanisms using either animal models or patients has always been a major theme of the journal, and the excellent work in these areas has been summarized by Harissios Vliagoftis with a particularly interesting section on early-life events guiding the development of allergic disease, which understandably continue to be a major theme of research. Magnus Wickman summarized the papers looking at the epidemiology of allergic disease including work from birth cohorts, which are an increasingly rich source of data on risk factors for allergic disease, and two papers on the epidemiology of anaphylaxis. Giovanni Passalacqua discussed the papers in the clinical allergy section of the journal, and Adriano Mari who runs the excellent Allergome website discussed the papers looking at allergens including characterization and the relative usefulness of allergen arrays versus single extracts in diagnosis and management.
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Affiliation(s)
- A Mari
- Allergome, Allergy Data Laboratories s.c., Latina, Italy
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49
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Abstract
Presently, allergy diagnosis and therapy procedures are undergoing a transition phase in which allergen extracts are being step-by-step replaced by molecule-based products. The new developments will allow clinicians to obtain detailed information on sensitization patterns, more accurate interpretation of allergic symptoms, and thus improved patients' management. In this respect, recombinant technology has been applied to develop this new generation of molecule-based allergy products. The use of recombinant allergens allows full validation of identity, quantity, homogeneity, structure, aggregation, solubility, stability, IgE-binding and the biologic potency of the products. In contrast, such parameters are extremely difficult to assay and standardize for extract-based products. In addition to the possibility of bulk production of wild type molecules for diagnostic purposes, recombinant technology opened the possibility of developing safer and more efficacious products for allergy therapy. A number of molecule-based hypoallergenic preparations have already been successfully evaluated in clinical trials, bringing forward the next generation of allergy vaccines. In this contribution, we review the latest developments in allergen characterization, molecule-based allergy diagnosis, and the application of recombinant allergens in therapeutic setups. A comprehensive overview of clinical trials using recombinant allergens as well as synthetic peptides is presented.
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Affiliation(s)
- Fatima Ferreira
- Christian Doppler Laboratory for Allergy Diagnosis and Therapy, Department of Molecular Biology, University of Salzburg, Salzburg, Austria.
| | - Martin Wolf
- Christian Doppler Laboratory for Allergy Diagnosis and Therapy, Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - Michael Wallner
- Christian Doppler Laboratory for Allergy Diagnosis and Therapy, Department of Molecular Biology, University of Salzburg, Salzburg, Austria
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50
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Ovomucoid is not superior to egg white testing in predicting tolerance to baked egg. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 1:354-60. [PMID: 24013255 DOI: 10.1016/j.jaip.2013.04.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Children with egg allergy may tolerate baked egg products. Ovomucoid specific IgE (sIgE) antibody levels have been suggested to predict outcomes of baked egg challenges. OBJECTIVE We determined the relationship of ovomucoid and egg white sIgE levels and egg white skin prick test (SPT) wheal size with baked egg challenge outcome. METHODS Retrospective review of 1186 patients who underwent ovomucoid sIgE blood testing. Subset analysis was of 169 patients who underwent baked egg food challenges. RESULTS Egg white sIgE, ovomucoid sIgE, and egg white SPT were different among those eating regular egg, eating baked egg only, or avoiding all egg (P < .001 for all). One hundred forty-two of 169 patients (84.0%) passed baked egg challenges. We were able to establish >90% predictive values for passing baked egg challenge for egg white sIgE, ovomucoid sIgE, and egg white SPT.No patient with egg white SPT wheal <3 mm failed a baked egg challenge. Receiver operating characteristic curve analysis of egg white sIgE, ovomucoid sIgE, and egg white SPT showed areas under the curve of 0.721, 0.645, and 0.624, respectively. No significant difference was observed among these immunologic parameters in their abilities to predict baked egg challenge outcome (P [ .301). CONCLUSION Most children with egg allergy in this study passed baked egg challenges. Ovomucoid sIgE, although a useful clinical predictor of baked egg tolerance, was not superior to egg white SPT or sIgE in predicting outcome of baked egg challenge.
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