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Pérez-Sánchez N, Rondón C, Cañas JA, de Santa María-García RS, Rodríguez J, Andugar-Moreno M, Mayorga C, Torres MJ, Gómez F. Reaction severity and peach threshold amount during oral challenge in nonspecific lipid transfer protein allergy. Allergy 2024. [PMID: 38979766 DOI: 10.1111/all.16228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 06/20/2024] [Accepted: 06/29/2024] [Indexed: 07/10/2024]
Affiliation(s)
| | - Carmen Rondón
- Allergy Clinical Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - José Antonio Cañas
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA-BIONAND), Málaga, Spain
| | | | - Julia Rodríguez
- Allergy Clinical Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Cristobalina Mayorga
- Allergy Clinical Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA-BIONAND), Málaga, Spain
| | - María José Torres
- Allergy Clinical Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA-BIONAND), Málaga, Spain
- Medicine Department, Universidad de Málaga (UMA), Málaga, Spain
| | - Francisca Gómez
- Allergy Clinical Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
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Kazancioglu A, Konuralp I, Sahiner UM, Soyer O, Sekerel BE. Understanding of lipid transfer protein sensitization patterns and its clinical significance in children. Allergy Asthma Proc 2024; 45:120-127. [PMID: 38449011 DOI: 10.2500/aap.2024.45.230075] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Background: Lipid transfer proteins (LTP) are the most common food allergens in the Mediterranean region. Objective: The study aimed to investigate co-sensitization patterns and cluster relationships between LTP allergen molecules across a broad range of allergen-specific sensitization patterns, and clinical outcomes in eastern Mediterranean children. Methods: Among 496 children evaluated for multiple sensitizations with multiplex testing, 105 children (21%) with 16 different LTP sensitizations were analyzed. Clinical reactivity was examined based on clear-cut history of immunoglobulin E mediated symptoms (oral allergy syndrome [OAS], systemic reactions, and anaphylaxis). Results: All children included were sensitive to food LTPs, but 56% were sensitive to pollen LTPs. The number of children with OAS and clinical reactivity was 12 and 59, respectively, and no cofactors were reported. The most common sensitizations were Pru p 3 (74%) and Cor a 8 (66%). Significant correlations were observed in the heatmap between the LTP molecules other than Par j 2 and Tri a 14. Overall, clinical reactivity was associated with increased age and number of LTP molecule positivity. Conclusion: In the eastern Mediterranean region, 21% of children with multiple food and/or pollen sensitizations were found to have LTP sensitization; however, almost half reported clinical reactivity. The hierarchical pathway highlights that distinct LTP allergen molecules can act as primary sensitizers. Clinical reactivity is linked to increasing numbers of LTP molecule positivity and increasing age.
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Affiliation(s)
- Alp Kazancioglu
- From the Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey, and
| | - Ilteber Konuralp
- Department of Statistics, Middle East Technical University, Ankara, Turkey
| | - Umit Murat Sahiner
- From the Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey, and
| | - Ozge Soyer
- From the Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey, and
| | - Bulent Enis Sekerel
- From the Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey, and
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Wawrzeńczyk A, Rawicka E, Napiórkowska-Baran K, Alska E, Bartuzi Z. Cross-reactive aeroallergens – the main cause of food allergy. FOOD AGR IMMUNOL 2023. [DOI: 10.1080/09540105.2022.2133090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Adam Wawrzeńczyk
- Department of Allergology, Clinical Immunology and Internal Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Emilia Rawicka
- Department of Allergology, Clinical Immunology and Internal Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Katarzyna Napiórkowska-Baran
- Department of Allergology, Clinical Immunology and Internal Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Ewa Alska
- Department of Allergology, Clinical Immunology and Internal Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Zbigniew Bartuzi
- Department of Allergology, Clinical Immunology and Internal Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
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Ridolo E, Barone A, Ottoni M, Peveri S, Montagni M, Nicoletta F. Factors and co-factors influencing clinical manifestations in nsLTPs allergy: between the good and the bad. FRONTIERS IN ALLERGY 2023; 4:1253304. [PMID: 37841053 PMCID: PMC10568476 DOI: 10.3389/falgy.2023.1253304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023] Open
Abstract
Non-specific lipid transfer proteins (nsLTPs) are a family of plant pan-allergens that represent the primary cause of food allergies in the Mediterranean area, characterized by a wide range of clinical manifestations, ranging from the total absence of symptoms up to anaphylaxis. This wide variety of symptoms is related to the intrinsic capacity of nsLTPs to cause an allergic reaction in a specific subject, but also to the presence of co-factors exacerbating (i.e., exercise, NSAIDs, PPIs, alcohol, cannabis, prolonged fasting, menstruation, acute infections, sleep deprivation, chronic urticaria) or protecting from (i.e., co-sensitization to PR10, profilin or polcalcin) severe reactions. In this picture, recognizing some nsLTPs-related peculiarities (i.e., route, type and number of sensitizations, concentration of the allergen, cross-reactions) and eventual co-factors may help the allergist to define the risk profile of the single patient, in order to promote the appropriate management of the allergy from dietary advices up to the prescription of life-saving epinephrine autoinjector.
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Affiliation(s)
- Erminia Ridolo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Allergology Unit, University Hospital of Parma, Parma, Italy
| | | | - Martina Ottoni
- Allergology Unit, University Hospital of Parma, Parma, Italy
| | - Silvia Peveri
- Departmental Unit of Allergology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Marcello Montagni
- Departmental Unit of Allergology, Guglielmo da Saliceto Hospital, Piacenza, Italy
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Sara BV, Ulrike F, Bettina B, Yvonne W, Teresa P, Clara SB, Giovanna AS, Rocío CS, María T, Rocío L, Rosa MC, Joan B, Waltraud S, Mariona P. Improving In Vitro Detection of Sensitization to Lipid Transfer Proteins: A New Molecular Multiplex IgE Assay. Mol Nutr Food Res 2023; 67:e2200906. [PMID: 37195823 DOI: 10.1002/mnfr.202200906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/11/2023] [Indexed: 05/19/2023]
Abstract
SCOPE LTP-syndrome is characterized by sensitization (IgE) to multiple non-specific lipid transfer proteins (nsLTPs) with a variable clinical outcome. The treatment is primarily based on offending food avoidance. However, the determination of Pru p 3-specific IgE is currently the main diagnostic tool to assess sensitization to nsLTPs. Herein, the study evaluates improvement of LTP-syndrome diagnosis and clinical management using a new IgE multiplex-immunoblot assay with a high diversity of food nsLTPs. METHODS AND RESULTS An EUROLINE-LTP strip with 28 recombinant nsLTPs from 18 allergenic sources is designed. In total the study investigates 38 patients with LTP-syndrome and compares results from the nsLTPs (LTP-strip) with the respective food extracts of Prick-by-prick (PbP) testing. The agreement exceeds 70% for most nsLTPs, e.g., Pru p 3 (100%), Mal d 3 (97%), Pru av 3 (89%), Pha v 3 isoforms (87%/84%), Ara h 9 (82%), Cor a 8 (82%), and Jug r 3 (82%). The functionality and allergenic relevance of nine recombinant nsLTPs are proven by Basophil activation testing (BAT). CONCLUSIONS The new IgE multiplex-immunoblot nsLTP assay shows a good diagnostic performance allowing culprit food assessment. Negative results from LTP-strip may indicate potentially tolerable foods, improving diet intervention and patients' quality of life.
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Affiliation(s)
- Balsells-Vives Sara
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, 08036, Spain
| | - Flügge Ulrike
- EUROIMMUN AG A PerkinElmer Company, 23560, Lübeck, Germany
| | - Brix Bettina
- EUROIMMUN AG A PerkinElmer Company, 23560, Lübeck, Germany
| | - Weimann Yvonne
- EUROIMMUN AG A PerkinElmer Company, 23560, Lübeck, Germany
| | - Peralta Teresa
- Department of Clinical Immunology and Rheumatology, Pontificia Universidad Católica de Chile, 8331150, Santiago, Chile
| | - San Bartolomé Clara
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, 08036, Spain
- Immunology Department, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
| | - Araujo-Sánchez Giovanna
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, 08036, Spain
- Allergy Department, Institut Clinic Respiratori (ICR), Hospital Clinic, Universitat de Barcelona, Barcelona, 08036, Spain
| | - Casas-Saucedo Rocío
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, 08036, Spain
- Allergy Department, Institut Clinic Respiratori (ICR), Hospital Clinic, Universitat de Barcelona, Barcelona, 08036, Spain
- RETIC Asma, Reacciones Adversas a Fármacos y Alergia (ARADyAL) and RICORS Red de Enfermedades Inflamatorias (REI), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Torradeflot María
- Immunology Department, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
| | - Lara Rocío
- Immunology Department, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
| | - Munoz-Cano Rosa
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, 08036, Spain
- Allergy Department, Institut Clinic Respiratori (ICR), Hospital Clinic, Universitat de Barcelona, Barcelona, 08036, Spain
- RETIC Asma, Reacciones Adversas a Fármacos y Alergia (ARADyAL) and RICORS Red de Enfermedades Inflamatorias (REI), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Bartra Joan
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, 08036, Spain
- Allergy Department, Institut Clinic Respiratori (ICR), Hospital Clinic, Universitat de Barcelona, Barcelona, 08036, Spain
- RETIC Asma, Reacciones Adversas a Fármacos y Alergia (ARADyAL) and RICORS Red de Enfermedades Inflamatorias (REI), Instituto de Salud Carlos III, Madrid, 28029, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Campus Clínic, Universitat de Barcelona (UB), c. Casanova, 143, Barcelona, 08036, Spain
| | - Suer Waltraud
- EUROIMMUN AG A PerkinElmer Company, 23560, Lübeck, Germany
| | - Pascal Mariona
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, 08036, Spain
- Immunology Department, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- RETIC Asma, Reacciones Adversas a Fármacos y Alergia (ARADyAL) and RICORS Red de Enfermedades Inflamatorias (REI), Instituto de Salud Carlos III, Madrid, 28029, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Campus Clínic, Universitat de Barcelona (UB), c. Casanova, 143, Barcelona, 08036, Spain
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Núñez R, Rodríguez MJ, Lebrón-Martín C, Martín-Astorga MDC, Ramos-Soriano J, Rojo J, Torres MJ, Cañas JA, Mayorga C. A synthetic glycodendropeptide induces methylation changes on regulatory T cells linked to tolerant responses in anaphylactic-mice. Front Immunol 2023; 14:1165852. [PMID: 37334360 PMCID: PMC10272618 DOI: 10.3389/fimmu.2023.1165852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/22/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Lipid transfer proteins (LTPs) are allergens found in a wide range of plant-foods. Specifically, Pru p 3, the major allergen of peach, is commonly responsible for severe allergic reactions. The need for new alternatives to conventional food allergy treatments, like restrictive diets, suggests allergen immunotherapy as a promising option. It has been demonstrated that sublingual immunotherapy (SLIT) with synthetic glycodendropeptides, such as D1ManPrup3, containing mannose and Pru p 3 peptides induced tolerance in mice and that the persistence of this effect depends on treatment dose (2nM or 5nM). Moreover, it produces changes associated with differential gene expression and methylation profile of dendritic cells, as well as phenotypical changes in regulatory T cells (Treg). However, there are no works addressing the study of epigenetic changes in terms of methylation in the cell subsets that sustain tolerant responses, Treg. Therefore, in this work, DNA methylation changes in splenic-Treg from Pru p 3 anaphylactic mice were evaluated. Methods It was performed by whole genome bisulphite sequencing comparing SLIT-D1ManPrup3 treated mice: tolerant (2nM D1ManPrup3), desensitized (5nM D1ManPrup3), and sensitized but not treated (antigen-only), with anaphylactic mice. Results Most of the methylation changes were found in the gene promoters from both SLIT-treated groups, desensitized (1,580) and tolerant (1,576), followed by the antigen-only (1,151) group. Although tolerant and desensitized mice showed a similar number of methylation changes, only 445 genes were shared in both. Remarkably, interesting methylation changes were observed on the promoter regions of critical transcription factors for Treg function like Stat4, Stat5a, Stat5b, Foxp3, and Gata3. In fact, Foxp3 was observed exclusively as hypomethylated in tolerant group, whereas Gata3 was only hypomethylated in the desensitized mice. Discussion In conclusion, diverse D1ManPrup3 doses induce different responses (tolerance or desensitization) in mice, which are reflected by differential methylation changes in Tregs.
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Affiliation(s)
- Rafael Núñez
- Laboratory of Allergy, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA-BIONAND), Málaga, Spain
| | - María J. Rodríguez
- Laboratory of Allergy, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA-BIONAND), Málaga, Spain
| | - Clara Lebrón-Martín
- Laboratory of Allergy, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA-BIONAND), Málaga, Spain
| | - María del Carmen Martín-Astorga
- Laboratory of Allergy, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA-BIONAND), Málaga, Spain
- Department of Medicine, Universidad de Málaga (UMA), Málaga, Spain
| | - Javier Ramos-Soriano
- Laboratory of Glycosystems, Institute of Chemical Research (IIQ), Centro Superior de Investigaciones Científicas (CSIC) - Universidad de Sevilla, Sevilla, Spain
| | - Javier Rojo
- Laboratory of Glycosystems, Institute of Chemical Research (IIQ), Centro Superior de Investigaciones Científicas (CSIC) - Universidad de Sevilla, Sevilla, Spain
| | - María J. Torres
- Laboratory of Allergy, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA-BIONAND), Málaga, Spain
- Department of Medicine, Universidad de Málaga (UMA), Málaga, Spain
- Clinical Unit of Allergy, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - José A. Cañas
- Laboratory of Allergy, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA-BIONAND), Málaga, Spain
| | - Cristobalina Mayorga
- Laboratory of Allergy, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA-BIONAND), Málaga, Spain
- Clinical Unit of Allergy, Hospital Regional Universitario de Málaga, Málaga, Spain
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Romano A, Gaeta F, Caruso C, Fiocchi A, Valluzzi RL. Evaluation and Updated Classification of Acute Hypersensitivity Reactions to Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAID-Exacerbated or -Induced Food Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1843-1853.e1. [PMID: 36997117 DOI: 10.1016/j.jaip.2023.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND There are hypersensitivity reactions (HRs) to foods in which nonsteroidal anti-inflammatory drugs (NSAIDs) act as aggravating factors (NSAID-exacerbated food allergy [NEFA]) or cofactors (NSAID-induced food allergy [NIFA]), often misdiagnosed as HRs to NSAIDs. Urticarial/angioedematous and/or anaphylactic reactions to two or more chemically unrelated NSAIDs do not meet current classification criteria. However, they may be considered part of a cross-reactive type of acute HR, which is NSAID-induced urticaria/angioedema with or without respiratory or systemic symptoms of anaphylaxis. OBJECTIVE To evaluate patients reporting acute HRs to NSAIDs and classify them according to updated criteria. METHODS We prospectively studied 414 patients with suspected HRs to NSAIDs. For all whom met these criteria, NEFA/NIFA was diagnosed: (1) mild reactions to (NEFA) or tolerance of (NIFA) the suspected foods without taking NSAIDs; (2) cutaneous and/or anaphylactic reactions to the combination foods plus NSAIDs; (3) positive allergy tests to the suspected foods; and (4) negative drug challenges (DCs) with the NSAIDs involved. RESULTS A total of 252 patients were given the diagnosis of NSAID hypersensitivity (60.9%), 108 of whom had NSAID-induced urticaria/angioedema with or without respiratory or systemic symptoms of anaphylaxis. We excluded NSAID hypersensitivity in 162 patients (39.1%) who tolerated DCs with the suspected NSAIDs, nine of whom received a diagnosis of NEFA, and 66 of NIFA. Pru p 3 was implicated in 67 of those 75 patients who received a diagnosis of NEFA or NIFA. CONCLUSIONS NEFA and NIFA account for about 18% of patients reporting HRs to NSAIDs, in which Pru p 3 is the main responsible food allergen. Therefore, patients with cutaneous and/or anaphylactic reactions to NSAIDs should be carefully questioned about all foods ingested within 4 hours before or after NSAID exposure, and targeted food allergy tests should be considered in the diagnostic workup of these patients. If testing is positive, DCs with the suspected NSAIDs should also be considered.
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Affiliation(s)
| | | | - Cristiano Caruso
- UOSD Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandro Fiocchi
- Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rocco Luigi Valluzzi
- Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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Bartra J, Turner PJ, Muñoz-Cano RM. Cofactors in food anaphylaxis in adults. Ann Allergy Asthma Immunol 2023; 130:733-740. [PMID: 36958469 DOI: 10.1016/j.anai.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/25/2023]
Abstract
Around 25% to 50% of food-induced allergic reactions in adults cause anaphylaxis, and epidemiologic evidence suggests that food is the most common cause of anaphylaxis. Reaction severity is unpredictable, and patients will often experience reactions of variable severity, even to an identical exposure (both dose and allergen). A common explanation for this phenomenon has been the impact of "cofactors"-factors that might contribute to reaction severity independent of the allergen exposure. Cofactors can influence reaction severity in 2 ways: either by reducing the reaction threshold (ie, the dose needed to trigger any symptoms) so that patients have no symptoms in the absence of the cofactor and only react with the cofactor present, or by increasing reaction severity such that individuals have only mild symptoms in the absence of the cofactor, but a more severe reaction when the cofactor is present. Indeed, the same patient may have reactions with different cofactors or even need more than one cofactor to develop a severe reaction. Cofactors reportedly play a role in approximately 30% of anaphylaxis reactions in adults. Exercise, nonsteroidal, anti-inflammatory drugs, alcohol, and sleep deprivation are the most frequent cofactors reported. Routine evaluation of the possible involvement of cofactors is essential in managing patients with food anaphylaxis: in patients with a suggestive history but a negative oral food challenge, cofactors should be taken into account to provide appropriate advice to reduce the risk of future anaphylaxis.
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Affiliation(s)
- Joan Bartra
- Department of Allergy, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), RETIC ARADyAL, RICORs REI, Barcelona, Spain
| | - Paul J Turner
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | - Rosa M Muñoz-Cano
- Department of Allergy, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), RETIC ARADyAL, RICORs REI, Barcelona, Spain
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9
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Indolfi C, Dinardo G, Klain A, Contieri M, Umano GR, Decimo F, Abbadessa S, Vitulano C, Ciprandi G, Miraglia del Giudice M. Sensitization to nsLTP: A Retrospective Study in An Italian Pediatric Population over the Last Decade. J Immunol Res 2023; 2023:4053799. [PMID: 37228443 PMCID: PMC10205406 DOI: 10.1155/2023/4053799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/18/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023] Open
Abstract
Background Food allergy is common in the Mediterranean, especially concerning lipid transfer proteins (LTPs) allergy. LTPs are widespread plant food allergens in fruits, vegetables, nuts, pollen, and latex. Also, LTPs are prevalent food allergens in the Mediterranean area. They can sensitize via the gastrointestinal tract and cause a wide range of conditions: from mild reactions, such as oral allergy syndrome, to severe reactions, such as anaphylaxis. LTP allergy in the adult population is well described in the literature, concerning both the prevalence and clinical characteristics. However, there is poor knowledge about its prevalence and clinical manifestation in children living in the Mediterranean. Materials and Methods This study, including 800 children aged from 1 to 18 years, investigated the prevalence of 8 different molecules of nonspecific LTP over time in an Italian pediatric population visited over the last 11 years. Results About 52% of the test population was sensitized to at least one LTP molecule. For all the LTPs analyzed, sensitization increased over time. In particular, using the years 2010 through 2020 as a comparison, the major increases were observed for the LTPs of the English walnut Jug r 3, the peanut Ara h 9, and the plane tree Pla a 3 (about 50%); the increase of the LTP of the Hazelnut Cor a 8 was about 36%, and that of the LTP of the artemisia Art v 3 was approximately 30%. Conclusions The latest evidence in the literature indicates an increase in food allergy prevalence in the general population, including children. Therefore, the present survey represents an interesting perspective about the pediatric population of the Mediterranean area, exploring the trend of LTP allergy.
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Affiliation(s)
- Cristiana Indolfi
- Department of Woman, Child and of General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giulio Dinardo
- Department of Woman, Child and of General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Angela Klain
- Department of Woman, Child and of General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Marcella Contieri
- Department of Woman, Child and of General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giuseppina Rosaria Umano
- Department of Woman, Child and of General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Fabio Decimo
- Department of Woman, Child and of General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Salvatore Abbadessa
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Carolina Vitulano
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | | | - Michele Miraglia del Giudice
- Department of Woman, Child and of General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
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Muñoz-Osores E, Aguirre J, Concha S, Borzutzky A, Hoyos-Bachiloglu R. Lipid transfer protein allergy and anaphylaxis in children. Ann Allergy Asthma Immunol 2023; 130:520-522. [PMID: 36681275 DOI: 10.1016/j.anai.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 01/20/2023]
Affiliation(s)
- Elizabeth Muñoz-Osores
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Joaquín Aguirre
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sara Concha
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Arturo Borzutzky
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute on Immunology and Immunotherapy, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Hoyos-Bachiloglu
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
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11
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Poziomkowska-Gęsicka I. Idiopathic Anaphylaxis? Analysis of Data from the Anaphylaxis Registry for West Pomerania Province, Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16716. [PMID: 36554595 PMCID: PMC9779638 DOI: 10.3390/ijerph192416716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
The most common causes of anaphylaxis, according to various authors and depending on the age of the studied groups, are: Hymenoptera venom, food, and medications. Unfortunately, we are not always able to indicate the cause of anaphylaxis. There are data in the literature where as many as 41% of all cases are idiopathic anaphylaxis. Since the introduction of new diagnostic methods such as molecular diagnostics (MD) in our centre, the percentage of idiopathic anaphylaxis in the Anaphylaxis Register has significantly decreased. The purpose of this study was to identify possible causes of idiopathic anaphylaxis in patients with a history of moderate to severe anaphylactic reactions. After using MD, the causative agent was found in another 29 people. The proportion of people with idiopathic anaphylaxis in the Registry decreased from 9.2% to 3.5%. There were no significant differences in the incidence, although men appear to be slightly more common in primary idiopathic anaphylaxis. The mean age of primary idiopathic anaphylaxis was 40 years, but this was as high as 51 for anaphylaxis with alpha-gal allergy. Exercise may or may not be present as a cofactor despite its established role, e.g., in wheat-dependent exercise-induced anaphylaxis (WDEIA). In most of the analyzed cases, i.e., 70%, the reaction took place within an hour. The longest time interval from exposure to the development of symptoms is in the case of alpha-gal allergy; in this analysis, it was at least 5 h after ingestion of the so-called "red meat". Patients are not aware of the disease, or further attacks cannot be prevented. As many as 80% had idiopathic anaphylaxis prior to visiting the centre, and 80% developed anaphylaxis after visiting the centre, which emphasizes the need to not stop the medical team in their search for the causes. As many as 93% of cases required medical intervention, of which adrenaline was used only in 34.5%, antihistamines in 86%, systemic glucocorticosteroids (sCS) in 75%, and fluids in 62% of cases. A total of 83% of patients received an emergency kit for self-administration. Idiopathic anaphylaxis can be resolved as known-cause anaphylaxis after a thorough medical history and, if possible, without exposing the patient after using appropriate, modern in vitro diagnostic methods, including molecular diagnostics. The diagnosis of idiopathic anaphylaxis should extend the diagnosis to include alpha-gal syndrome, LTP syndrome and WDEIA.
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Affiliation(s)
- Iwona Poziomkowska-Gęsicka
- Clinical Allergology Department, Pomeranian Medical University (PMU) in Szczecin, 70-111 Szczecin, Poland
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12
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Costanzo G, Matolo A, Saderi L, Messina MR, Firinu D, Barca MP, Serra P, Corso N, Sotgiu G, Del Giacco S. Cofactors, age at onset, allergic comorbidities and gender are different in patients sensitized to omega-5 gliadin and Pru p 3. Sci Rep 2022; 12:20868. [PMID: 36460730 PMCID: PMC9718743 DOI: 10.1038/s41598-022-25368-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
Aim of this study is to clarify the impact of cofactors on allergic reactions in patients sensitized to LTP and ω-5-gliadin. We retrospectively examined the charts of our outpatients from January 2015 to July 2019 and identified 157 patients seen for urticaria/angioedema or anaphylaxis after a meal, in presence or absence of cofactors and sensitized to LTPs (Pru p 3 and/or Tri a 14) and/or ω-5-gliadin (Tri a 19). we compared LTPs-positive patients and those sensitized to Tri a 19 in order to assess the difference in cofactors involved and in frequency of clinical presentation. Our data show that exercise is the most frequent cofactor in FDEIAn and the involvement of exercise, alcohol and multiple cofactors was more frequently found in males than in females. We found that exercise, pollen counts peaks and multiple cofactors were more often related to anaphylaxis than mild reactions. Finally, we performed a comparison between patients LTPs+ and Tri a 19+ that showed in the latter group a lower frequency of allergic comorbidities, a higher median age at the onset of symptoms and frequency of alcohol exposure. Our data show that the search for possible cofactors involved in food allergy is essential not only for diagnostic purposes, but also for risk assessment strategies.
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Affiliation(s)
- Giulia Costanzo
- grid.7763.50000 0004 1755 3242Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, CA Italy
| | - Annalisa Matolo
- grid.7763.50000 0004 1755 3242Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, CA Italy
| | - Laura Saderi
- grid.11450.310000 0001 2097 9138Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Maria Rita Messina
- grid.7763.50000 0004 1755 3242Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, CA Italy
| | - Davide Firinu
- grid.7763.50000 0004 1755 3242Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, CA Italy
| | - Maria Pina Barca
- grid.7763.50000 0004 1755 3242Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, CA Italy
| | - Paolo Serra
- grid.7763.50000 0004 1755 3242Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, CA Italy
| | - Nicoletta Corso
- grid.7763.50000 0004 1755 3242Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, CA Italy
| | - Giovanni Sotgiu
- grid.11450.310000 0001 2097 9138Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Stefano Del Giacco
- grid.7763.50000 0004 1755 3242Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, CA Italy
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13
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Alexiou A, Höfer V, Dölle-Bierke S, Grünhagen J, Zuberbier T, Worm M. Elicitors and phenotypes of adult patients with proven IgE-mediated food allergy and non-immune-mediated food hypersensitivity to food additives. Clin Exp Allergy 2022; 52:1302-1310. [PMID: 35851700 DOI: 10.1111/cea.14203] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/30/2022] [Accepted: 07/10/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Food allergy is a growing health concern with a prevalence of 2%-3% in the adult population in Europe. Non-immune-mediated food hypersensitivities, which include reactions after ingestion of food additives, affect 1% of adults and may resemble IgE-induced allergic reactions without identifiable immunologic sensitization. A double-blind placebo-controlled food challenge (DBPCFC) is the gold standard for the diagnosis of any food hypersensitivity. OBJECTIVE We analysed a large group of adult patients with suspected food hypersensitivity, who had undergone DBPCFC, to better understand IgE-mediated food allergy and non-immune-dependent food hypersensitivity to food additives in adults regarding elicitors, symptoms and positivity rates of oral challenges. METHODS Data from 541 patients with suspected food hypersensitivity were analysed, who underwent an oral food challenge between 2010 and 2019. RESULTS IgE-dependent food allergy was confirmed in 114 of 329 adult patients (34.6%). The confirmation rate was lower in the group of patients with suspected non-immune-mediated reactions to food additives (65 of 286, 22.7%). Urticaria and angioedema appeared more frequently in patients with IgE-mediated food allergies. By contrast, flush and diarrhoea were the most frequent symptoms after a challenge in the group with the non-immune-mediated reactions to food additives. Wheat and celery were the most frequently identified food allergens in adults, whereas colourings and preservatives were the most frequent elicitors of non-immune-mediated food hypersensitivity. CONCLUSION The importance of oral food challenges for the diagnosis of food hypersensitivity is confirmed. IgE-dependent food allergy is more frequently proven, reaching a positivity rate of one-third and only about 20% for non-immune-mediated hypersensitivity. Future studies should elaborate on the mechanisms of non-immune-mediated food hypersensitivity and the clinical impact of cofactors in this setting.
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Affiliation(s)
- Aikaterina Alexiou
- Division of Allergy and Immunology, Department of Dermatology and Allergology, Charité -Universitätsmedizin Berlin, Berlin, Germany
| | - Veronika Höfer
- Division of Allergy and Immunology, Department of Dermatology and Allergology, Charité -Universitätsmedizin Berlin, Berlin, Germany
| | - Sabine Dölle-Bierke
- Division of Allergy and Immunology, Department of Dermatology and Allergology, Charité -Universitätsmedizin Berlin, Berlin, Germany
| | - Josefine Grünhagen
- Division of Allergy and Immunology, Department of Dermatology and Allergology, Charité -Universitätsmedizin Berlin, Berlin, Germany
| | - Torsten Zuberbier
- Division of Allergy and Immunology, Department of Dermatology and Allergology, Charité -Universitätsmedizin Berlin, Berlin, Germany
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology and Allergology, Charité -Universitätsmedizin Berlin, Berlin, Germany
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14
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Ridolo E, Pucciarini F, Kihlgren P, Barone A, Nicoletta F, Peveri S, Montagni M, Incorvaia C. Lipid transfer protein syndrome: How to save a life through careful education. World Allergy Organ J 2022; 15:100683. [PMID: 36119658 PMCID: PMC9468585 DOI: 10.1016/j.waojou.2022.100683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/07/2022] [Accepted: 07/29/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Lipid transfer proteins (nsLTPs) are ubiquitous allergens. Patients affected by nsLTP syndrome experience symptoms to various plant-derived foods, ranging from local manifestations to anaphylaxis, the critical treatment of which is represented by self-administration of adrenaline. The principle aim of this study is to assess how dietary recommendations influence the occurrence of new and severe cases and if poly-sensitization to different nsLTPs may play a role. We also investigated about the appropriate use of adrenaline auto-injector during the episodes of anaphylaxis. Moreover, we examinated how other features (ie, co-sensitization to profilin and PR-10 and the presence of risk co-factors) affect these events. Materials and methods We evaluated 78 patients allergic to nsLTPs, investigating adherence to diet and ability to use the adrenaline auto-injector. Number of sensitization to nsLTPs, co-sensitization to other panallergens, and presence of risk factors for new reactions were also assessed. Diagnosis was based on clinical history and positivity to in vivo and in vitro tests. During the follow-up, compliance, diet modifications, and new reactions were noted, and re-training for the use of epinephrine auto-injector was performed. At the last visit we evaluated the patients’ ability to use the self-injector. Results The whole of fruits belonging to the Rosaceae family emerged as the most frequent culprit foods (28%), followed by walnut (17%), peanut (17%), and hazelnut (10%). At the baseline visit 23% of the patients described the presence of a risk factor during the allergic reaction (mainly nonsteroidal anti-inflammatory drugs [NSAIDs] and exercise). Forty-five percent of the patients reported anaphylactic reactions; no association between the type of food and the severity of the reactions was found. The presence of sensitization to 4 or more nsLTPs was associated to more severe reactions (p < .05; OR 1.67). During the follow-up 38% of the patients experienced at least 1 new allergic reaction: in 79% of them the culprit food was previously tolerated, and in 69% the reaction was an anaphylaxis. Only 47% of the patients showed a proper use of adrenaline auto-injector during the final evaluation, but a significant correlation between periodic education and reduction of the probability of mistakes in the use was reported (p < .05; OR 0.34). Furthermore, an association between co-sensitization to PR-10 (in particular Bet v1) and profilin and less severe symptoms was found, but without a significant odds ratio. Conclusion A careful education aimed to the prevention of new reactions, through dietary restrictions and avoidance of risk co-factors, and to the management of anaphylaxis, through the training for the correct use of adrenaline auto-injector, should be a routine practice in nsLTP syndrome.
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Affiliation(s)
- Erminia Ridolo
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Allergology Unit, Hospital of Parma, Parma, Italy
| | | | - Paola Kihlgren
- Departmental Unit of Allergology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | | | - Silvia Peveri
- Departmental Unit of Allergology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Marcello Montagni
- Departmental Unit of Allergology, Guglielmo da Saliceto Hospital, Piacenza, Italy
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15
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Skypala IJ, Hunter H, Krishna MT, Rey-Garcia H, Till SJ, du Toit G, Angier E, Baker S, Stoenchev KV, Luyt DK. BSACI guideline for the diagnosis and management of pollen food syndrome in the UK. Clin Exp Allergy 2022; 52:1018-1034. [PMID: 35975576 DOI: 10.1111/cea.14208] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 02/06/2023]
Abstract
Pollen food syndrome (PFS) is a highly prevalent food allergy affecting pollen-sensitized children and adults. Sufferers experience allergic symptoms when consuming raw plant foods, due to the homology between the pollen allergens and unstable proteins in these foods. The triggers involved can vary depending on the pollen sensitization, which in turn is affected by geographical location. The British Society of Allergy and Clinical Immunology (BSACI) Standards of Care Committee (SOCC) identified a need to develop a guideline for the diagnosis and management of PFS in the United Kingdom (UK). Guidelines produced by the BSACI use either the GRADE or SIGN methodology; due to a lack of high-quality evidence these recommendations were formulated using the SIGN guidelines, which is acknowledged to be less robust than the GRADE approach. The correct diagnosis of PFS ensures the avoidance of a misdiagnosis of a primary peanut or tree nut allergy or confusion with another plant food allergy to non-specific lipid transfer proteins. The characteristic foods involved, and rapid-onset oropharyngeal symptoms, mean PFS can often be diagnosed from the clinical history alone. However, reactions involving tree nuts, peanuts and soya milk or severe/atypical reactions to fruits and vegetables may require additional diagnostic tests. Management is through the exclusion of known trigger foods, which may appear to be simple, but is highly problematic if coupled with a pre-existing food allergy or for individuals following a vegetarian/vegan diet. Immunotherapy to pollens is not an effective treatment for PFS, and although oral or sublingual immunotherapy to foods seems more promising, large, controlled studies are needed. The typically mild symptoms of PFS can lead to an erroneous perception that this condition is always easily managed, but severe reactions can occur, and anxiety about the onset of symptoms to new foods can have a profound effect on quality of life.
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Affiliation(s)
- Isabel J Skypala
- Department of Allergy & Clinical Immunology, Royal Brompton & Harefield Hospitals, Part of Guys & St Thomas NHS Foundation Trust, London, UK.,Inflammation, Repair & Development Section, National Heart & Lung Institute, Imperial College, London, UK
| | - Hannah Hunter
- Department of Allergy, Guys & St Thomas NHS Foundation Trust, London, UK.,Kings College, London, UK
| | - Mamidipudi Thirumala Krishna
- Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,The Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Helena Rey-Garcia
- Department of Allergy & Clinical Immunology, Royal Brompton & Harefield Hospitals, Part of Guys & St Thomas NHS Foundation Trust, London, UK
| | - Stephen J Till
- Department of Allergy, Guys & St Thomas NHS Foundation Trust, London, UK.,Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - George du Toit
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK.,Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, London, UK.,Department Women and Children's Health (Paediatric Allergy), Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Elizabeth Angier
- Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Kostadin V Stoenchev
- Department of Allergy & Clinical Immunology, Royal Brompton & Harefield Hospitals, Part of Guys & St Thomas NHS Foundation Trust, London, UK
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16
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Sánchez-Ruano L, Fernández-Lozano C, Ferrer M, Gómez F, de la Hoz B, Martínez-Botas J, Goikoetxea MJ. Differences in Linear Epitopes of Ara h 9 Recognition in Peanut Allergic and Tolerant, Peach Allergic Patients. FRONTIERS IN ALLERGY 2022; 3:896617. [PMID: 35935018 PMCID: PMC9352880 DOI: 10.3389/falgy.2022.896617] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022] Open
Abstract
Background Peanut-allergic patients from the Mediterranean region are predominantly sensitized to the lipid transfer protein (LTP) Ara h 9, and the peach LTP Pru p 3 seems to be the primary sensitizer. However, LTP sensitization in peanut allergy is not a predictive marker for clinically relevant symptoms. Objective We aimed to identify sequential epitopes of IgE and IgG4 from Pru p 3 and Ara h 9 in peach-allergic patients sensitized to peanuts. We also sought to determine the differences in IgE and IgG4 binding between patients who had developed peanut allergy and those tolerating peanuts. Methods A total of 46 peach-allergic patients sensitized to peanuts were selected. A total of 35 patients were allergic to peanuts (peanut-allergic group) and 11 were tolerant to peanuts (peanut-tolerant group). We measured sIgE and sIgG4 in peanut, peach, and their recombinant allergen (Ara h 1, Ara h 2, Ara h 3, Ara h 8, and Ara h 9) with fluorescence enzyme immunoassay. We examined the IgE and IgG4 binding to sequential epitopes using a peptide microarray corresponding to linear sequences of the LTPs Ara h 9 and Pru p 3 with a library of overlapping peptides with a length of 20 amino acids (aa) and an offset of 3 aa. Results The frequency and the intensity of IgE recognition of Ara h 9 and Pru p 3 peptides were higher in the peanut-tolerant group than in the peanut-allergic group. We found four Ara h 9 peptides (p4, p14, p21, and p25) and four Pru p 3 peptides (p1, p3, p21, and p24) with a significantly elevated IgE recognition in peanut-tolerant patients. Only one peptide of Ara h 9 (p4) recognized by IgG4 was significantly elevated in the peanut-tolerant group. The IgG4/IgE ratio of Ara h 9 peptide 4 was significantly higher in peanut-tolerant patients than in peanut-allergic patients, while no significant differences were observed in the IgG4/IgE ratio of this peptide in Pru p 3. Conclusion Although we found significant differences in IgE and IgG4 recognition of Ara h 9 and Pru p 3 between peanut-tolerant and peanut-allergic patients (all of whom were allergic to peach), polyclonal IgE peptide recognition of both LTPs was observed in peach-allergic patients tolerating peanuts. However, the IgG4 blocking antibodies against Ara h 9 peptide 4 could provide an explanation for the absence of clinical reactivity in peanut-tolerant peach-allergic patients. Further studies are needed to validate the usefulness of IgG4 antibodies against Ara h 9 peptide 4 for peanut allergy diagnosis.
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Affiliation(s)
- L. Sánchez-Ruano
- Allergy Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - C. Fernández-Lozano
- Servicio de Bioquímica-Investigación, Hospital Universitario Ramón y Cajal - Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - M. Ferrer
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Navarra Health Research Institute (IDISNA, Instituto de Investigacion Sanitaria de Navarra), Pamplona, Spain
- Research Network on Asthma, Drug Adverse Reactions and Allergy (ARADyAL, Red de Investigacion en Asma, Reacciones Adversas a Farmacos y Alergia), Málaga, Spain
| | - F. Gómez
- Research Network on Asthma, Drug Adverse Reactions and Allergy (ARADyAL, Red de Investigacion en Asma, Reacciones Adversas a Farmacos y Alergia), Málaga, Spain
- Allergy Clinical Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - B. de la Hoz
- Allergy Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Research Network on Asthma, Drug Adverse Reactions and Allergy (ARADyAL, Red de Investigacion en Asma, Reacciones Adversas a Farmacos y Alergia), Málaga, Spain
| | - J. Martínez-Botas
- Servicio de Bioquímica-Investigación, Hospital Universitario Ramón y Cajal - Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN)-Instituto de Salud Carlos III, Madrid, Spain
- *Correspondence: J. Martínez-Botas
| | - M. J. Goikoetxea
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Navarra Health Research Institute (IDISNA, Instituto de Investigacion Sanitaria de Navarra), Pamplona, Spain
- Research Network on Asthma, Drug Adverse Reactions and Allergy (ARADyAL, Red de Investigacion en Asma, Reacciones Adversas a Farmacos y Alergia), Málaga, Spain
- M. J. Goikoetxea
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17
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Mameri H, Gaudin JC, Lollier V, Tranquet O, Brossard C, Pietri M, Marion D, Codreanu-Morel F, Beaudouin E, Wien F, Gohon Y, Briozzo P, Denery-Papini S. Critical structural elements for the antigenicity of wheat allergen LTP1 (Tri a 14) revealed by site-directed mutagenesis. Sci Rep 2022; 12:12253. [PMID: 35851276 PMCID: PMC9293932 DOI: 10.1038/s41598-022-15811-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/29/2022] [Indexed: 11/09/2022] Open
Abstract
Lipid transfer proteins (LTPs) were identified as allergens in a large variety of pollens and foods, including cereals. LTPs belong to the prolamin superfamily and display an α-helical fold, with a bundle of four α-helices held together by four disulfide bonds. Wheat LTP1 is involved in allergic reactions to food. To identify critical structural elements of antibody binding to wheat LTP1, we used site-directed mutagenesis on wheat recombinant LTP1 to target: (i) sequence conservation and/or structure flexibility or (ii) each disulfide bond. We evaluated the modifications induced by these mutations on LTP1 secondary structure by synchrotron radiation circular dichroism and on its antigenicity with patient's sera and with mouse monoclonal antibodies. Disruption of the C28-C73 disulfide bond significantly affected IgE-binding and caused protein denaturation, while removing C13-C27 bond decreased LTP1 antigenicity and slightly modified LTP1 overall folding. In addition, we showed Lys72 to be a key residue; the K72A mutation did not affect global folding but modified the local 3D structure of LTP1 and strongly reduced IgE-binding. This work revealed a cluster of residues (C13, C27, C28, C73 and K72), four of which embedded in disulfide bonds, which play a critical role in LTP1 antigenicity.
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Affiliation(s)
- Hamza Mameri
- INRAE, UR 1268 Biopolymères Interactions Assemblages (BIA), 44316, Nantes, France. .,UMR 1208 IATE, Univ Montpellier, INRAE, L'Institut-Agro Montpellier, 34060, Montpellier, France.
| | - Jean-Charles Gaudin
- INRAE, UR 1268 Biopolymères Interactions Assemblages (BIA), 44316, Nantes, France.,INRAE, UMR 0588 Biologie intégrée pour la valorisation de la diversité des arbres et de la forêt (BIOFORA), 45075, Orléans, France
| | - Virginie Lollier
- INRAE, UR 1268 Biopolymères Interactions Assemblages (BIA), 44316, Nantes, France.,INRAE, UR BIA, 44316, Nantes, France.,INRAE, PROBE Research Infrastructure, BIBS Facility, 44316, Nantes, France
| | - Olivier Tranquet
- INRAE, UR 1268 Biopolymères Interactions Assemblages (BIA), 44316, Nantes, France.,INRAE UMR 1163 Biodiversité et Biotechnologie Fongiques (BBF), 13288, Marseille, France
| | - Chantal Brossard
- INRAE, UR 1268 Biopolymères Interactions Assemblages (BIA), 44316, Nantes, France
| | - Manon Pietri
- INRAE, UR 1268 Biopolymères Interactions Assemblages (BIA), 44316, Nantes, France.,Institut de Cancérologie de l'Ouest, Centre René Gauducheau, 44805, Saint Herblain Cedex, France
| | - Didier Marion
- INRAE, UR 1268 Biopolymères Interactions Assemblages (BIA), 44316, Nantes, France
| | - Fanny Codreanu-Morel
- CHU Luxembourg, Centre Hospitalier de Luxembourg, Kanner Klinik, 1210, Luxembourg, Luxembourg
| | - Etienne Beaudouin
- Service d'Allergologie, Hôpital de Mercy, CHR Metz, 57000, Metz, France
| | - Frank Wien
- Synchrotron Soleil, Saint-Aubin, 91192, Gif-sur-Yvette, France
| | - Yann Gohon
- INRAE, UMR 1318 Institut Jean-Pierre Bourgin, 78026, Versailles, France
| | - Pierre Briozzo
- INRAE, UMR 1318 Institut Jean-Pierre Bourgin, 78026, Versailles, France
| | - Sandra Denery-Papini
- INRAE, UR 1268 Biopolymères Interactions Assemblages (BIA), 44316, Nantes, France.
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18
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Skypala IJ, Jeimy S, Brucker H, Nayak AP, Decuyper II, Bernstein JA, Connors L, Kanani A, Klimek L, Lo SCR, Murphy KR, Nanda A, Poole JA, Walusiak-Skorupa J, Sussman G, Zeiger JS, Goodman RE, Ellis AK, Silvers WS, Ebo DG. Cannabis-related allergies: An international overview and consensus recommendations. Allergy 2022; 77:2038-2052. [PMID: 35102560 PMCID: PMC9871863 DOI: 10.1111/all.15237] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/10/2022] [Accepted: 01/23/2022] [Indexed: 01/26/2023]
Abstract
Cannabis is the most widely used recreational drug in the world. Cannabis sativa and Cannabis indica have been selectively bred to develop their psychoactive properties. The increasing use in many countries has been accelerated by the COVID-19 pandemic. Cannabis can provoke both type 1 and type 4 allergic reactions. Officially recognized allergens include a pathogenesis-related class 10 allergen, profilin, and a nonspecific lipid transfer protein. Other allergens may also be relevant, and recognition of allergens may vary between countries and continents. Cannabis also has the potential to provoke allergic cross-reactions to plant foods. Since cannabis is an illegal substance in many countries, research has been hampered, leading to challenges in diagnosis since no commercial extracts are available for testing. Even in countries such as Canada, where cannabis is legalized, diagnosis may rely solely on the purchase of cannabis for prick-to-prick skin tests. Management consists of avoidance, with legal issues hindering the development of other treatments such as immunotherapy. Education of healthcare professionals is similarly lacking. This review aimed to summarize the current status of cannabis allergy and proposes recommendations for the future management of this global issue.
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Affiliation(s)
- Isabel J. Skypala
- Department of Allergy & Clinical Immunology, Royal Brompton & Harefield Hospitals, and Imperial College, London, UK
| | - Samira Jeimy
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Ontario, Canada
| | | | - Ajay P. Nayak
- Center for Translational Medicine and Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ine I. Decuyper
- Department of Pediatrics, Faculty of Medicine and Health Sciences, University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium
| | - Jonathan A. Bernstein
- Division of Immunology/Allergy Section, Department of Internal Medicine, University of Cincinnati College of Medicine and Bernstein Allergy Group; Bernstein Clinical Research Center, Cincinnati, Ohio, USA
| | - Lori Connors
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amin Kanani
- Division of Allergy and Immunology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ludger Klimek
- Center for Rhinology and Allergy, Wiesbaden, Germany
| | - Shun Chi Ryan Lo
- Division of Allergy and Immunology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin R. Murphy
- Division of Allergy, Asthma and Pediatric Pulmonology, Department of Pediatrics, Boys Town National Research Hospital, Omaha, Nebraska, USA
| | - Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, Dallas, Texas, USA,Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jill. A. Poole
- Division of Allergy and Immunology, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jolanta Walusiak-Skorupa
- Department of Occupational Medicine and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Gordon Sussman
- Department of Medicine and Division of Clinical Immunology & Allergy, University of Toronto, Toronto, Ontario, Canada
| | | | - Richard E. Goodman
- Food Allergy Research and Resource Program, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Anne K. Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - William S. Silvers
- Division of Allergy Clinical Immunology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Didier G. Ebo
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium,Department of Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium,Department of Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium
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19
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Ruano‐Zaragoza M, Casas‐Saucedo R, De la Cruz Martinez CA, Araujo‐Sanchez G, Gelis S, González MF, San Bartolomé C, Pascal M, Jiménez‐Rodriguez TW, Gonzalez‐Delgado P, Fernandez‐Sanchez J, Muñoz‐Cano R, Bartra J. Advances in the understanding of the cofactor effect in lipid transfer protein food allergy: From phenotype description to clinical management. Allergy 2022; 77:1924-1926. [PMID: 35322440 DOI: 10.1111/all.15291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/08/2022] [Accepted: 03/17/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Maria Ruano‐Zaragoza
- Allergy Department Hospital Clinic Barcelona Spain
- Clinical & Experimental Respiratory Immunoallergy Institut Investigacions Biomediques August Pi I Sunyer (IDIBAPS) Barcelona Spain
- Asma Reacciones Adversas y Alergia (ARADyAL) Instituto de Salud Carlos III Madrid Spain
| | - Rocío Casas‐Saucedo
- Allergy Department Hospital Clinic Barcelona Spain
- Clinical & Experimental Respiratory Immunoallergy Institut Investigacions Biomediques August Pi I Sunyer (IDIBAPS) Barcelona Spain
- Asma Reacciones Adversas y Alergia (ARADyAL) Instituto de Salud Carlos III Madrid Spain
| | | | - Giovanna Araujo‐Sanchez
- Allergy Department Hospital Clinic Barcelona Spain
- Clinical & Experimental Respiratory Immunoallergy Institut Investigacions Biomediques August Pi I Sunyer (IDIBAPS) Barcelona Spain
- Asma Reacciones Adversas y Alergia (ARADyAL) Instituto de Salud Carlos III Madrid Spain
| | - Sonia Gelis
- Allergy Department Hospital Clinic Barcelona Spain
- Clinical & Experimental Respiratory Immunoallergy Institut Investigacions Biomediques August Pi I Sunyer (IDIBAPS) Barcelona Spain
| | - Maria Fernanda González
- Allergy Department Hospital Clinic Barcelona Spain
- Clinical & Experimental Respiratory Immunoallergy Institut Investigacions Biomediques August Pi I Sunyer (IDIBAPS) Barcelona Spain
| | - Clara San Bartolomé
- Clinical & Experimental Respiratory Immunoallergy Institut Investigacions Biomediques August Pi I Sunyer (IDIBAPS) Barcelona Spain
- Asma Reacciones Adversas y Alergia (ARADyAL) Instituto de Salud Carlos III Madrid Spain
- Immunology Department Centre de Diagnòstic Biomèdic (CDB) Hospital Clínic de Barcelona Barcelona Spain
| | - Mariona Pascal
- Clinical & Experimental Respiratory Immunoallergy Institut Investigacions Biomediques August Pi I Sunyer (IDIBAPS) Barcelona Spain
- Asma Reacciones Adversas y Alergia (ARADyAL) Instituto de Salud Carlos III Madrid Spain
- Immunology Department Centre de Diagnòstic Biomèdic (CDB) Hospital Clínic de Barcelona Barcelona Spain
| | - Teodorikez Wilfox Jiménez‐Rodriguez
- Asma Reacciones Adversas y Alergia (ARADyAL) Instituto de Salud Carlos III Madrid Spain
- Allergy Section Alicante University Hospital Alicante Spain
- UMH‐ISABIAL Alicante University Hospital Alicante Spain
| | - Purificación Gonzalez‐Delgado
- Asma Reacciones Adversas y Alergia (ARADyAL) Instituto de Salud Carlos III Madrid Spain
- Allergy Section Alicante University Hospital Alicante Spain
- UMH‐ISABIAL Alicante University Hospital Alicante Spain
| | - Javier Fernandez‐Sanchez
- Asma Reacciones Adversas y Alergia (ARADyAL) Instituto de Salud Carlos III Madrid Spain
- Allergy Section Alicante University Hospital Alicante Spain
- UMH‐ISABIAL Alicante University Hospital Alicante Spain
| | - Rosa Muñoz‐Cano
- Allergy Department Hospital Clinic Barcelona Spain
- Clinical & Experimental Respiratory Immunoallergy Institut Investigacions Biomediques August Pi I Sunyer (IDIBAPS) Barcelona Spain
- Asma Reacciones Adversas y Alergia (ARADyAL) Instituto de Salud Carlos III Madrid Spain
| | - Joan Bartra
- Allergy Department Hospital Clinic Barcelona Spain
- Clinical & Experimental Respiratory Immunoallergy Institut Investigacions Biomediques August Pi I Sunyer (IDIBAPS) Barcelona Spain
- Asma Reacciones Adversas y Alergia (ARADyAL) Instituto de Salud Carlos III Madrid Spain
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20
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Balsells-Vives S, San Bartolomé C, Casas-Saucedo R, Ruano-Zaragoza M, Rius J, Torradeflot M, Bartra J, Munoz-Cano R, Pascal M. Low Levels Matter: Clinical Relevance of Low Pru p 3 sIgE in Patients With Peach Allergy. FRONTIERS IN ALLERGY 2022; 3:868267. [PMID: 35769570 PMCID: PMC9234939 DOI: 10.3389/falgy.2022.868267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Many clinical lab settings still use 0.35 KUA/L as the cut-off for serum specific-IgE (sIgE) immunoassays, while the detection limit is 0.1 KUA/L. The clinical relevance of -low-level sIgE (0.1–0.35 KUA/L) remains controversial. Pru p 3 sIgE is considered to be the main routine tool for assessing lipid transfer protein (LTP) sensitization. We aimed to evaluate the clinical relevance of Pru p 3 sIgE low levels in a population diagnosed with LTP allergy. Adults diagnosed with LTP allergy and Pru p 3 sIgE ≥ 0.1 KUA/L between 2012 and 2019 were included. Clinical data were reviewed. nPru p 3 basophil activation test (BAT) was performed and basophil reactivity (BR) and sensitivity (BS) correlated with the peach allergy symptoms. Pru p 3 sIgE from 496 subjects was recorded, 114 (23.0%) between 0.1 and 0.34 KUA/L (grLOW), the rest ≥ 0.35 KUA/L (grB). A total of 44.7% in grLOW and 59.9% in grB were allergic. Urticaria was more frequent in grLOW. In grLOW, Pru p 3 sIgE was higher in patients with local compared with systemic symptoms. In grB, Pru p 3 sIgE was higher in allergic patients. Pru p 3/Total IgE ratios were higher in allergic vs. tolerant in both groups. In BAT, BR was similar in both groups. In grLOW, it was higher on allergic compared with tolerant (p = 0.0286), and on those having systemic vs. local symptoms (p = 0.0286). BS showed no significant difference between groups. Patients with low levels represent a non-negligible fraction and around 45% are peach allergic. BAT showed functional sIgE in them. Pru p 3 sensitizations should be carefully evaluated even when sIgE levels are low.
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Affiliation(s)
- Sara Balsells-Vives
- Clinical and Experimental Respiratory Immunoallergy (IRCE), Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Clara San Bartolomé
- Clinical and Experimental Respiratory Immunoallergy (IRCE), Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Department of Immunology, Centre de Diagnòstic Biomedic (CDB), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Rocío Casas-Saucedo
- Clinical and Experimental Respiratory Immunoallergy (IRCE), Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Allergy Section, Department of Pneumology, Institut Clínic Respiratori (ICR), Hospital Clínic de Barcelona, Barcelona, Spain
- Spanish Research Network on Allergy (ARADyAL, Red Nacional de Alergia–Asma, Reacciones Adversas y Alérgicas-), Instituto de Salud Carlos III, Madrid, Spain
| | - María Ruano-Zaragoza
- Clinical and Experimental Respiratory Immunoallergy (IRCE), Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Allergy Section, Department of Pneumology, Institut Clínic Respiratori (ICR), Hospital Clínic de Barcelona, Barcelona, Spain
- Spanish Research Network on Allergy (ARADyAL, Red Nacional de Alergia–Asma, Reacciones Adversas y Alérgicas-), Instituto de Salud Carlos III, Madrid, Spain
| | - Josefina Rius
- Department of Immunology, Centre de Diagnòstic Biomedic (CDB), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Maria Torradeflot
- Department of Immunology, Centre de Diagnòstic Biomedic (CDB), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joan Bartra
- Clinical and Experimental Respiratory Immunoallergy (IRCE), Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Allergy Section, Department of Pneumology, Institut Clínic Respiratori (ICR), Hospital Clínic de Barcelona, Barcelona, Spain
- Spanish Research Network on Allergy (ARADyAL, Red Nacional de Alergia–Asma, Reacciones Adversas y Alérgicas-), Instituto de Salud Carlos III, Madrid, Spain
- *Correspondence: Joan Bartra
| | - Rosa Munoz-Cano
- Clinical and Experimental Respiratory Immunoallergy (IRCE), Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Allergy Section, Department of Pneumology, Institut Clínic Respiratori (ICR), Hospital Clínic de Barcelona, Barcelona, Spain
- Spanish Research Network on Allergy (ARADyAL, Red Nacional de Alergia–Asma, Reacciones Adversas y Alérgicas-), Instituto de Salud Carlos III, Madrid, Spain
| | - Mariona Pascal
- Clinical and Experimental Respiratory Immunoallergy (IRCE), Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Department of Immunology, Centre de Diagnòstic Biomedic (CDB), Hospital Clínic de Barcelona, Barcelona, Spain
- Spanish Research Network on Allergy (ARADyAL, Red Nacional de Alergia–Asma, Reacciones Adversas y Alérgicas-), Instituto de Salud Carlos III, Madrid, Spain
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21
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Phenotypes and Endotypes of Peach Allergy: What Is New? Nutrients 2022; 14:nu14050998. [PMID: 35267973 PMCID: PMC8912752 DOI: 10.3390/nu14050998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/15/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023] Open
Abstract
Peach allergy is emerging as a common type of fresh-fruit allergy in Europe, especially in the Mediterranean area. The clinical manifestations of peach allergy tend to have a peculiar geographical distribution and can range from mild oral symptoms to anaphylaxis, depending on the allergic sensitization profile. The peach allergen Pru p 7, also known as peamaclein, has recently been identified as a marker of peach allergy severity and as being responsible for peculiar clinical features in areas with high exposure to cypress pollen. This review addresses the latest findings on molecular allergens for the diagnosis of peach allergy, the clinical phenotypes and endotypes of peach allergy in adults and children, and management strategies, including immunotherapy, for peach allergy.
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22
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Does the Food Ingredient Pectin Provide a Risk for Patients Allergic to Non-Specific Lipid-Transfer Proteins? Foods 2021; 11:foods11010013. [PMID: 35010137 PMCID: PMC8750200 DOI: 10.3390/foods11010013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 12/27/2022] Open
Abstract
Pectin, a dietary fiber, is a polysaccharide that is widely used in food industry as a gelling agent. In addition, prebiotic and beneficial immunomodulatory effects of pectin have been demonstrated, leading to increased importance as food supplement. However, as cases of anaphylactic reactions after consumption of pectin-supplemented foods have been reported, the present study aims to evaluate the allergy risk of pectin. This is of particular importance since most of the pectin used in the food industry is extracted from citrus or apple pomace. Both contain several allergens such as non-specific lipid transfer proteins (nsLTPs), known to induce severe allergic reactions, which could impair the use of pectins in nsLTP allergic patients. Therefore, the present study for the first time was performed to analyze residual nsLTP content in two commercial pectins using different detection methods. Results showed the analytical sensitivity was diminished by the pectin structure. Finally, spiking of pectin with allergenic peach nsLTP Pru p 3 led to the conclusion that the potential residual allergen content in both pectins is below the threshold to induce anaphylactic reactions in nsLTP-allergic patients. This data suggests that consumption of the investigated commercial pectin products provides no risk for inducing severe reactions in nsLTP-allergic patients.
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23
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Asero R, Pravettoni V, Scala E, Villalta D. Lipid transfer protein allergy: A review of current controversies. Clin Exp Allergy 2021; 52:222-230. [PMID: 34773669 DOI: 10.1111/cea.14049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 01/04/2023]
Abstract
Sensitization to lipid transfer protein (LTP), the most frequent cause of food allergy in southern Europe, still shows several controversial, but also intriguing, aspects. Some of these include the degree of cross-reactivity between LTPs from botanically distant sources, the definition of risk factors, the role of some cofactors, clinical outcomes, geographical differences and the identification of the primary sensitizer in different areas. This review article tries to analyse and comment on these aspects point by point suggesting some explanatory hypotheses with the final scope to stimulate critical thoughts and elicit the scientific discussion about this issue in the readership.
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Affiliation(s)
- Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Milan, Italy
| | - Valerio Pravettoni
- Department of General Medicine, Immunology and Allergy, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Scala
- Clinical and Laboratory Molecular Allergy Unit, IDI - IRCCS, Rome, Italy
| | - Danilo Villalta
- Immunologia e allergologia, Ospedale S. Maria degli Angeli, Pordenone, Italy
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24
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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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25
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Ukleja-Sokołowska N, Zacniewski R, Lis K, Żbikowska-Gotz M, Kuźmiński A, Bartuzi Z. Exercise induced anaphylaxis in kiwi allergic patient: case report. Allergy Asthma Clin Immunol 2021; 17:91. [PMID: 34496953 PMCID: PMC8425102 DOI: 10.1186/s13223-021-00595-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/30/2021] [Indexed: 11/21/2022] Open
Abstract
Background An allergy to kiwi is rare in Poland. Most (65–72%) of the patients who are allergic to kiwi report symptoms of an oral allergy syndrome (OAS); however, systemic manifestations (18–28%) have also been reported. Case report A 27-year-old male patient, previously not suffering from chronic diseases, exercised in the gym. He began with isometric training and then continued with aerobic exercise on a treadmill. After exercise, he ate 2 kiwi (Actinidia deliciosa) fruits. He experienced a swelling of the lips after eating the fruit, followed by an itchy scalp and a swollen face. Approximately 60 min later, the symptoms worsened: the patient suffered from generalized hives, general weakness and a "rumbling" sensation in ears. The patient's condition improved upon the consumption of antihistamines. However, the swelling of the face persisted for 24 h despite previously eating a kiwi without any side effects. By means of diagnostics based on allergen components, an allergy to grass allergen components, especially timothy grass—Phl p 1, Phl p 2 and Phl p 5, was confirmed. The presence of IgE that is specific for Act d 2 kiwi was also found. The patient had an oral food challenge with kiwi fruit at rest and after exercise provocation test. The challenge was negative at rest and positive after exercise. A food-dependent exercise-induced anaphylaxis gathered with a kiwi sensitization was diagnosed. Conclusion To our knowledge, this case is the first report of a kiwi-allergic patient in whom exercise was a necessary cofactor to induce an anaphylactic reaction.
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Affiliation(s)
- Natalia Ukleja-Sokołowska
- Department of Allergology, Clinical Immunology and Internal Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, ul. Ujejskiego 75, 85-168, Bydgoszcz, Poland.
| | - Robert Zacniewski
- Department of Allergology, Clinical Immunology and Internal Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, ul. Ujejskiego 75, 85-168, Bydgoszcz, Poland
| | - Kinga Lis
- Department of Allergology, Clinical Immunology and Internal Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, ul. Ujejskiego 75, 85-168, Bydgoszcz, Poland
| | - Magdalena Żbikowska-Gotz
- Department of Allergology, Clinical Immunology and Internal Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, ul. Ujejskiego 75, 85-168, Bydgoszcz, Poland
| | - Andrzej Kuźmiński
- Department of Allergology, Clinical Immunology and Internal Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, ul. Ujejskiego 75, 85-168, Bydgoszcz, Poland
| | - Zbigniew Bartuzi
- Department of Allergology, Clinical Immunology and Internal Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, ul. Ujejskiego 75, 85-168, Bydgoszcz, Poland
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26
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Epitope Mapping of Allergenic Lipid Transfer Proteins. Methods Mol Biol 2021. [PMID: 34115355 DOI: 10.1007/978-1-0716-1562-1_8] [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: 11/08/2023]
Abstract
Food allergy is becoming a great problem in industrialized countries. Thus, there is the need for a robust understanding of all aspects characterizing IgE response to allergens. The epitope mapping of B-cell epitopes has the potential to become a fundamental tool for food allergy diagnosis and prognosis and to lead to a better understanding of the pathogenesis. Using this approach, we have worked on epitope mapping of the most important plant food allergens identified in the Mediterranean area. The final aim of this study is to define the immune response regarding B epitopes and its clinical relevance in LTP allergy. This chapter describes the protocol to produce microarrays using a library of overlapping peptides corresponding to the primary sequences of allergenic lipid transfer proteins.
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27
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Can patients with oral allergy syndrome be at risk of anaphylaxis? Curr Opin Allergy Clin Immunol 2021; 20:459-464. [PMID: 32842037 DOI: 10.1097/aci.0000000000000679] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE OF REVIEW Oral allergy syndrome, also known as pollen-food syndrome (PFS), is a condition usually associated with adults and characterized by mild transient oropharyngeal symptoms. The purpose of this review is to determine whether systemic or anaphylactic reactions do occur and if so, who is affected and what are the triggers. RECENT FINDINGS An increasing number of studies demonstrate that PFS occurs all age groups, and a significant number of affected adults do experience systemic and anaphylactic reactions. The upsurge in the adoption of vegan lifestyles, increase in consumption of fruits and vegetables including smoothies and juices, and use of plant foods in nutritional or body-building supplements, could exacerbate this. Changes in pollen and pollution levels, cofactors and sensitization to other plant food allergens may also be involved. SUMMARY While the majority of those with PFS will continue to experience mild symptoms, all individuals should be properly advised regarding the dangers of concentrated or unusual forms of plant food allergens such as smoothies, juices, soy/nut milks and nutritional supplements. Further well characterized studies are needed to determine risk factors for severe reactions, and sensitization patterns to pollens and plant food allergens.
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28
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Shin M. Food allergies and food-induced anaphylaxis: role of cofactors. Clin Exp Pediatr 2021; 64:393-399. [PMID: 33181008 PMCID: PMC8342881 DOI: 10.3345/cep.2020.01088] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/08/2020] [Indexed: 11/29/2022] Open
Abstract
Food allergies and food-induced anaphylaxis are important health problems. Several cofactors modulating the onset of anaphylaxis have been identified. In the presence of cofactors, allergic reactions may be induced at lower doses of food allergens and/or become severe. Exercise and concomitant infections are well-documented cofactors of anaphylaxis in children. Other factors such as consumption of nonsteroidal anti-inflammatory drugs, alcohol ingestion, and stress have been reported. Cofactors reportedly play a role in approximately 30% of anaphylactic reactions in adults and 14%-18.3% in children. Food-dependent exercise-induced anaphylaxis (FDEIA) is the best-studied model of cofactor-induced anaphylaxis. Wheat-dependent exercise-induced anaphylaxis, the most common FDEIA condition, has been studied the most. The mechanisms of action of cofactors have not yet been fully identified. This review aims to educate clinicians on recent developments in the role of cofactors and highlight the importance of recognizing cofactors in food allergies and food-induced anaphylaxis.
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Affiliation(s)
- Meeyong Shin
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
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29
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Skypala IJ, Bartra J, Ebo DG, Antje Faber M, Fernández‐Rivas M, Gomez F, Luengo O, Till SJ, Asero R, Barber D, Cecchi L, Diaz Perales A, Hoffmann‐Sommergruber K, Anna Pastorello E, Swoboda I, Konstantinopoulos AP, Ree R, Scala E. The diagnosis and management of allergic reactions in patients sensitized to non-specific lipid transfer proteins. Allergy 2021; 76:2433-2446. [PMID: 33655502 DOI: 10.1111/all.14797] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/29/2021] [Accepted: 02/24/2021] [Indexed: 12/12/2022]
Abstract
Sensitization to one or more non-specific lipid transfer proteins (nsLTPs), initially thought to exist mainly in southern Europe, is becoming accepted as a cause of allergic reactions to plant foods across Europe and beyond. The peach nsLTP allergen Pru p 3 is a dominant sensitizing allergen and peaches a common food trigger, although multiple foods can be involved. A frequent feature of reactions is the requirement for a cofactor (exercise, alcohol, non-steroidal anti-inflammatory drugs, Cannabis sativa) to be present for a food to elicit a reaction. The variability in the food and cofactor triggers makes it essential to include an allergy-focused diet and clinical history in the diagnostic workup. Testing on suspected food triggers should also establish whether sensitization to nsLTP is present, using purified or recombinant nsLTP allergens such as Pru p 3. The avoidance of known trigger foods and advice on cofactors is currently the main management for this condition. Studies on immunotherapy are promising, but it is unknown whether such treatments will be useful in populations where Pru p 3 is not the primary sensitizing allergen. Future research should focus on the mechanisms of cofactors, improving diagnostic accuracy and establishing the efficacy of immunotherapy.
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Affiliation(s)
- Isabel J. Skypala
- Royal Brompton & Harefield NHS Foundation Trust London UK
- Department of Allergy and Clinical Immunology Imperial College London UK
| | - Joan Bartra
- Hospital Clinic Barcelona Spain
- IDIBAPS Universitat de Barcelona ARADyAL, Barcelona Spain
| | - Didier G. Ebo
- Department of Immunology, Allergology, Rheumatology Faculty of Medicine and Health Sciences Infla‐Med Centre of Excellence Antwerp University Hospital University of Antwerp Antwerp Belgium
- Jan Palfijn Ziekenhuis Ghent Ghent Belgium
| | - Margaretha Antje Faber
- Faculty of Medicine and Health Sciences Department of Immunology, Allergology, Rheumatology Infla‐Med Centre of Excellence Antwerp University Hospital University of Antwerp Antwerp Belgium
| | - Montserrat Fernández‐Rivas
- Department of Allergy Hospital Clínico San Carlos Universidad Complutense de Madrid IdISSC ARADyAL Madrid Spain
| | - Francisca Gomez
- Allergy Unit IBIMA—Hospital Regional Universitario de Malaga Malaga Spain
- Spanish Network for Allergy ‐ RETICS de Asma Reaccionesadversas y Alérgicas (ARADyAL Madrid Spain
| | - Olga Luengo
- Allergy Unit Internal Medicine Department Vall d'Hebron University Hospital Universitat Autònoma de Barcelona ARADyAL Barcelona Spain
| | - Stephen J. Till
- Peter Gorer Department of Immunobiology King’s College London London UK
- Department of Allergy Guy’s & St Thomas’ NHS Foundation Trust London UK
| | - Riccardo Asero
- Ambulatorio di Allergologia Clinica San Carlo Paderno Dugnano Italy
| | - Domingo Barber
- IMMA School of Medicine Universidad San Pablo CEU, Universities Madrid Spain
- RETIC ARADYAL RD16/0006/0015 Instituto de Salud Carlos III Madrid Spain
| | - Lorenzo Cecchi
- SOS Allergy and Clinical Immunology USL Toscana Centro Prato Italy
| | - Araceli Diaz Perales
- Centro de Biotecnología y Genómica de Plantas Universidad Politecnica Madrid Spain
| | | | - Elide Anna Pastorello
- Unit of Allergology and Immunology ASST Grande Ospedale Metropolitano Niguarda University of Milan Milan Italy
| | - Ines Swoboda
- Biotechnology Section Campus Vienna Biocenter FH Campus Wien, University of Applied Sciences Vienna Austria
| | | | - Ronald Ree
- Department of Experimental Immunology Amsterdam University Medical Centers, location AMC Amsterdam The Netherlands
- Department of Otorhinolaryngology Amsterdam University Medical Centers, location AMC Amsterdam The Netherlands
| | - Enrico Scala
- Experimental Allergy Unit Istituto Dermopatico dell’Immacolata – IRCCS FLMM Rome Italy
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LTP Allergy Follow-Up Study: Development of Allergy to New Plant Foods 10 Years Later. Nutrients 2021; 13:nu13072165. [PMID: 34202484 PMCID: PMC8308245 DOI: 10.3390/nu13072165] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 01/27/2023] Open
Abstract
Introduction: Allergy to nonspecific lipid transfer protein (nsLTP) is the main cause of plant-food allergy in Spain. nsLTPs are widely distributed in the plant kingdom and have high cross-reactivity but extremely variable clinical expression. Little is known about the natural evolution of this allergy, which complicates management. The objective of this study was to assess the development of allergy to new plant foods in nsLTP-sensitized patients 10 years after diagnosis. Methods: One hundred fifty-one patients showing specific IgE to nsLTP determined by ISAC (Thermofisher) were included. After clinical workup (i.e., anamnesis, skin test, and challenge when needed), these patients were divided into two groups: 113 patients allergic to one or more plant food (74.5%) and 38 patients not allergic to any plant food (25.1%). Ten years later, a telephone interview was conducted to check whether patients had developed additional allergic reactions to plant foods. Results: Ten years after diagnosis, 35 of the 113 (31%) plant-food-allergic patients sensitized to nsLTP reported reactions to new, previously tolerated plant foods, mainly Rosaceae/Prunoideae fruits and nuts followed by vegetables, Rosacea/Pomoideae fruits, legumes, and cereals. Five out of 38 (13.2%) patients previously sensitized to nsLTP but without allergy to any plant food had experienced allergic reactions to some plant food: two to Rosaceae/Prunoideae fruits, two to Rosaceae/Prunoideae fruit and nuts, and one to legumes. Conclusion: Patients sensitized to nsLTP developed allergic reactions to other plant foods, mainly Rosaceae-Prunoideae fruits and nuts. This was more frequent among plant-food-allergic patients than among those who had never had plant-food allergy.
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Hanada M, Nakagawa M, Hamabata A, Amano H. Lipid transfer protein syndrome due to wild grape juice and various vegetables: A life-threatening food allergen. J Dermatol 2021; 48:1439-1441. [PMID: 34115395 DOI: 10.1111/1346-8138.16010] [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: 12/09/2020] [Revised: 05/07/2021] [Accepted: 05/14/2021] [Indexed: 11/29/2022]
Abstract
We report a 16-year-old Japanese male with mugwort pollinosis in whom ingestion of wild grape juice and various vegetables caused recurrent general urticaria, abdominal pain, dyspnea, and loss of consciousness. A skin prick test demonstrated positive reactions to a wide variety of both non-heated and heated vegetables and fruits such as wild grape, bell pepper, onion, Chinese cabbage, tomato, eggplant, and broccoli. The serum immunoglobulin E levels (ImmunoCAP ISAC® ) for Art v 3, Pla a 3, Pru p 3, and Jug r 3, which are lipid transfer protein (LTP) homologs, were positive but those for Bet v 1 and Bet v 2 were negative. We diagnosed the patient as having LTP syndrome, a condition in which additional factors such as exercise, non-steroidal anti-inflammatory drugs, or alcohol may trigger an allergic reaction. Wild grapes contain a large amount of salicylic acid, and in our patient ingestion of wild grape juice led to immediate loss of consciousness in the absence of exercise. This suggests that salicylic acid contained in fruits and vegetables may act as an important cofactor in LTP syndrome. Although sensitization to LTP is rarely reported in Asia, LTP are considered to be potentially life-threatening food allergens, and therefore warrant attention.
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Affiliation(s)
- Miho Hanada
- Department of Dermatology, Iwate Medical University School of Medicine, Shiwa-gun, Japan
| | - Michiyo Nakagawa
- Department of Dermatology, Iwate Medical University School of Medicine, Shiwa-gun, Japan
| | - Akemi Hamabata
- Department of Dermatology, Iwate Medical University School of Medicine, Shiwa-gun, Japan
| | - Hiroo Amano
- Department of Dermatology, Iwate Medical University School of Medicine, Shiwa-gun, Japan
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32
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Skypala IJ, Asero R, Barber D, Cecchi L, Diaz Perales A, Hoffmann-Sommergruber K, Pastorello EA, Swoboda I, Bartra J, Ebo DG, Faber MA, Fernández-Rivas M, Gomez F, Konstantinopoulos AP, Luengo O, van Ree R, Scala E, Till SJ. Non-specific lipid-transfer proteins: Allergen structure and function, cross-reactivity, sensitization, and epidemiology. Clin Transl Allergy 2021; 11:e12010. [PMID: 34025983 PMCID: PMC8129635 DOI: 10.1002/clt2.12010] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/08/2021] [Indexed: 12/27/2022] Open
Abstract
Background Discovered and described 40 years ago, non‐specific lipid transfer proteins (nsLTP) are present in many plant species and play an important role protecting plants from stressors such as heat or drought. In the last 20 years, sensitization to nsLTP and consequent reactions to plant foods has become an increasing concern. Aim The aim of this paper is to review the evidence for the structure and function of nsLTP allergens, and cross‐reactivity, sensitization, and epidemiology of nsLTP allergy. Materials and Methods A Task Force, supported by the European Academy of Allergy & Clinical Immunology (EAACI), reviewed current evidence and provide a signpost for future research. The search terms for this paper were “Non‐specific Lipid Transfer Proteins”, “LTP syndrome”, “Pru p 3”, “plant food allergy”, “pollen‐food syndrome”. Results Most nsLTP allergens have a highly conserved structure stabilised by 4‐disulphide bridges. Studies on the peach nsLTP, Pru p 3, demonstrate that nsLTPs are very cross‐reactive, with the four major IgE epitopes of Pru p 3 being shared by nsLTP from other botanically related fruits. These nsLTP allergens are to varying degrees resistant to heat and digestion, and sensitization may occur through the oral, inhaled or cutaneous routes. In some populations, Pru p 3 is the primary and sole sensitizing allergen, but many are poly‐sensitised both to botanically un‐related nsLTP in foods, and non‐food sources of nsLTP such as Cannabis sativa, Platanus acerifolia, (plane tree), Ambrosia artemisiifolia (ragweed) and Artemisia vulgaris (mugwort). Initially, nsLTP sensitization appeared to be limited to Mediterranean countries, however more recent studies suggest clinically relevant sensitization occurs in North Atlantic regions and also countries in Northern Europe, with nsLTP sensitisation profiles being broadly similar. Discussion These robust allergens have the potential to sensitize and provoke symptoms to a large number of plant foods, including those which are raw, cooked or processed. It is unknown why some sensitized individuals develop clinical symptoms to foods whereas others do not, or indeed what other allergens besides Pru p 3 may be primary sensitising allergens. It is clear that these allergens are also relevant in non‐Mediterranean populations and there needs to be more recognition of this. Conclusion Non‐specific LTP allergens, present in a wide variety of plant foods and pollens, are structurally robust and so may be present in both raw and cooked foods. More studies are needed to understand routes of sensitization and the world‐wide prevalence of clinical symptoms associated with sensitization to these complex allergens.
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Affiliation(s)
- Isabel J Skypala
- Department of Allergy & Clinical Immunology Royal Brompton & Harefield NHS Foundation Trust Imperial College London UK
| | - Ricardo Asero
- Ambulatorio di Allergologia Clinica San Carlo Milan Italy
| | - Domingo Barber
- IMMA School of Medicine Universidad San Pablo CEU CEU Universities Madrid Spain.,RETIC ARADYAL RD16/0006/0015 Instituto de Salud Carlos III Madrid Spain
| | - Lorenzo Cecchi
- SOS Allergy and Clinical Immunology USL Toscana Centro Prato Italy
| | - Arazeli Diaz Perales
- Departamento de Biotecnología-Biología Vegetal Centro de Biotecnología y Genómica de Plantas (CBGP, UPM-INIA) Universidad Politécnica de Madrid Madrid Spain
| | | | - Elide A Pastorello
- Unit of Allergology and Immunology ASST Grande Ospedale Metropolitano Niguarda University of Milan Milan Italy
| | - Ines Swoboda
- Biotechnology Section FH Campus Wien University of Applied Sciences Vienna Austria
| | - Joan Bartra
- Hospital Clinic de Barcelona IDIBAPS Universitat de Barcelona ARADyAL Barcelona Spain
| | - Didier G Ebo
- Department of Immunology, Allergology, Rheumatology and Infla-Med Centre of Excellence Faculty of Medicine and Health Sciences University of Antwerp and Antwerp University Hospital Ghent Belgium
| | - Margaretha A Faber
- Department of Immunology, Allergology, Rheumatology and Infla-Med Centre of Excellence Faculty of Medicine and Health Sciences University of Antwerp and Antwerp University Hospital Ghent Belgium
| | - Montserrat Fernández-Rivas
- Department of Allergy Hospital Clínico San Carlos Universidad Complutense de Madrid IdISSC, ARADyAL Madrid Spain
| | - Francesca Gomez
- Allergy Unit IBIMA- Hospital Regional Universitario de Malaga Malaga and Spanish Network for Allergy - RETICS de Asma, Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
| | | | - Olga Luengo
- Allergy Unit, Internal Medicine Department Vall d'Hebron University Hospital Universitat Autònoma de Barcelona ARADyAL Barcelona Spain
| | - Ronald van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology Amsterdam University Medical Centers location AMC Amsterdam The Netherlands
| | - Enrico Scala
- Experimental Allergy Unit Istituto Dermopatico Dell'immacolata IRCCS FLMM Rome Italy
| | - Stephen J Till
- Peter Gorer Department of Immunobiology King's College London London UK.,Department of Allergy Guy's & St Thomas' NHS Foundation Trust London UK
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Sánchez‐López J, Araujo G, Cardona V, García‐Moral A, Casas‐Saucedo R, Guilarte M, Torres MJ, Doña I, Picado C, Pascal M, Muñoz‐Cano R, Bartra J. Food-dependent NSAID-induced hypersensitivity (FDNIH) reactions: Unraveling the clinical features and risk factors. Allergy 2021; 76:1480-1492. [PMID: 33289951 DOI: 10.1111/all.14689] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 10/10/2020] [Accepted: 10/19/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND In up to 70%-80% of patients with a suspected non-steroidal anti-inflammatory drug hypersensitivity (NSAIDH), challenge tests with the culprit drug yield negative results. On the other hand, there could be a NSAIDH overdiagnosis when anaphylaxis is the clinical manifestation. We hypothesize that some negative NSAID challenge tests and an overdiagnosis of NSAIDH occur in patients with food-dependent NSAID-induced hypersensitivity (FDNIH). METHODS We studied 328 patients with a suspected acute NSAIDH. FDNIH was diagnosed in patients meeting all the following: (1) tolerance to the food ingested more temporally closed before the reaction, later the episode, (2) respiratory or cutaneous symptoms or anaphylaxis related to NSAID, (3) positive skin prick test to foods and/or specific IgE to food allergens (Pru p 3, Tri a 19, Pen a 1) involved in the reaction, and (4) negative oral provocation test to the culprit NSAID. RESULTS 199 patients (60%) were diagnosed with NSAIDH and 52 (16%) with FDNIH. Pru p 3 was involved in 44 cases (84.6%) and Tri a 19 in 6 cases (11%). FDNIH subjects were younger (p < .001), with a higher prevalence of rhinitis (p < .001) and previous food allergy (p < .001), together with a higher proportion of subjects sensitized to pollens (p < .001) and foods (p < .001). Using just four variables (Pru p 3 sensitization, Tri a 19 sensitization, anaphylaxis, and any NSAID different from pyrazolones), 95.3% of cases were correctly classified, with a sensitivity of 92% and specificity of 96%. CONCLUSION Evaluation of FDNIH should be included in the diagnostic workup of NSAIDH.
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Affiliation(s)
- Jaime Sánchez‐López
- Department of Pulmonology and Respiratory Allergy Allergy Section Hospital Clinic Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Universitat de Barcelona Barcelona Spain
| | - Giovanna Araujo
- Department of Pulmonology and Respiratory Allergy Allergy Section Hospital Clinic Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Universitat de Barcelona Barcelona Spain
| | - Victoria Cardona
- Department of Internal medicine, Allergy Section Hospital Universitari Vall d'Hebron Universitat Autònoma de Barcelona Barcelona Spain
- Vall d'Hebron Research Institute Allergy Research Unit Barcelona Spain
- Spanish Network for Allergy—RETIC de Asma, Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
| | - Alba García‐Moral
- Department of Pulmonology and Respiratory Allergy Allergy Section Hospital Clinic Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Universitat de Barcelona Barcelona Spain
| | - Rocío Casas‐Saucedo
- Department of Pulmonology and Respiratory Allergy Allergy Section Hospital Clinic Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Universitat de Barcelona Barcelona Spain
- Spanish Network for Allergy—RETIC de Asma, Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
| | - Mar Guilarte
- Department of Internal medicine, Allergy Section Hospital Universitari Vall d'Hebron Universitat Autònoma de Barcelona Barcelona Spain
- Vall d'Hebron Research Institute Allergy Research Unit Barcelona Spain
- Spanish Network for Allergy—RETIC de Asma, Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
| | - María José Torres
- Spanish Network for Allergy—RETIC de Asma, Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
- Allergy Unit Hospital Regional Universitario de Málaga Malaga Spain
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA Malaga Spain
| | - Inmaculada Doña
- Spanish Network for Allergy—RETIC de Asma, Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
- Allergy Unit Hospital Regional Universitario de Málaga Malaga Spain
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA Malaga Spain
| | - Cesar Picado
- Department of Pulmonology and Respiratory Allergy Allergy Section Hospital Clinic Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Universitat de Barcelona Barcelona Spain
- CIBERES CIBER of Respiratory Diseases Madrid Spain
| | - Mariona Pascal
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Universitat de Barcelona Barcelona Spain
- Spanish Network for Allergy—RETIC de Asma, Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
- Immunology Department Centre de Diagnòstic Biomèdic (CDB) Hospital Clínic de Barcelona Barcelona Spain
| | - Rosa Muñoz‐Cano
- Department of Pulmonology and Respiratory Allergy Allergy Section Hospital Clinic Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Universitat de Barcelona Barcelona Spain
- Spanish Network for Allergy—RETIC de Asma, Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
| | - Joan Bartra
- Department of Pulmonology and Respiratory Allergy Allergy Section Hospital Clinic Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Universitat de Barcelona Barcelona Spain
- Spanish Network for Allergy—RETIC de Asma, Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
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Beitia JM, Vega Castro A, Cárdenas R, Peña-Arellano MI. Pru p 3 Sublingual Immunotherapy in Patients with Lipid Transfer Protein Syndrome: Is It Worth? Int Arch Allergy Immunol 2021; 182:447-454. [PMID: 33588417 DOI: 10.1159/000512613] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Lipid transfer proteins (LTPs) syndrome is an important cause of multiple plant food allergy in the Mediterranean area. The effectiveness of sublingual immunotherapy (SLIT) with the LTP Pru p 3 extract has been little investigated in the real-world setting. This study aimed to investigate the outcome of Pru p 3 SLIT in real-life patients with LTP syndrome with/without concurrent reactions to peanut and/or nuts. METHODS This was a prospective real-life study including all patients diagnosed with LTP allergy and treated with Pru p 3 SLIT between 2011 and 2018 in a tertiary hospital in Spain. Patients underwent open oral food challenge (OFC) tests for unpeeled peach and nuts/peanuts 1 year after the treatment started to assess food tolerance. A control group of patients diagnosed with LTP allergy who refused treatment with immunotherapy were included. Severity of symptoms and diet avoidance was recorded in both groups. RESULTS Twenty-nine patients with a median age of 24.7 years (range 5.5-43.1) were included: 100% were allergic to fruit; 72%, to peanut and/or nuts; 19 had a history of severe systemic reactions. Seven patients discontinued therapy; 3 (10%), due to adverse events. One year after SLIT start, 16 (73%) patients had negative OFC to peach; 95%, after 2 years; 69% had negative OFC to nuts/peanuts. The control group included 13 patients: 53.8% experienced reactions with new foods; severity of symptoms increased significantly (p < 0.001), and diet restrictions were maintained in this group. CONCLUSIONS SLIT with Pru p 3 shows a good safety profile, and avoid dietary restrictions in patients with LTP syndrome treated in the real-life setting.
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Affiliation(s)
- Juan María Beitia
- Allergy Service, Hospital Universitario de Guadalajara, Guadalajara, Spain.,ARADyAL Spanish Thematic Network and Co-operative Research Centre RD16/0006/0023, Spain
| | - Arantza Vega Castro
- Allergy Service, Hospital Universitario de Guadalajara, Guadalajara, Spain, .,ARADyAL Spanish Thematic Network and Co-operative Research Centre RD16/0006/0023, Spain,
| | - Remedios Cárdenas
- Allergy Service, Hospital Universitario de Guadalajara, Guadalajara, Spain.,ARADyAL Spanish Thematic Network and Co-operative Research Centre RD16/0006/0023, Spain
| | - Maria Isabel Peña-Arellano
- Allergy Service, Hospital Universitario de Guadalajara, Guadalajara, Spain.,ARADyAL Spanish Thematic Network and Co-operative Research Centre RD16/0006/0023, Spain
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35
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Čelakovská J, Bukač J, Vaňková R, Krejsek J, Andrýs C. The relation between the sensitization to molecular components of inhalant allergens and food reactions in patients suffering from atopic dermatitis. FOOD AGR IMMUNOL 2021. [DOI: 10.1080/09540105.2020.1865281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- J. Čelakovská
- Department of Dermatology and Venereology, Faculty Hospital, Medical Faculty of Charles University, Hradec Králové, Czech Republic
| | - J. Bukač
- Department of Medical Biophysic, Medical Faculty of Charles University, Hradec Králové, Czech republic
| | - R. Vaňková
- Department of Clinical Immunology and Allergy, Faculty Hospital, Medical Faculty of Charles University, Hradec Králové, Czech Republic
| | - J. Krejsek
- Department of Clinical Immunology and Allergy, Faculty Hospital, Medical Faculty of Charles University, Hradec Králové, Czech Republic
| | - C. Andrýs
- Department of Clinical Immunology and Allergy, Faculty Hospital, Medical Faculty of Charles University, Hradec Králové, Czech Republic
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Poziomkowska-Gęsicka I, Kostrzewska M, Kurek M. Comorbidities and Cofactors of Anaphylaxis in Patients with Moderate to Severe Anaphylaxis. Analysis of Data from the Anaphylaxis Registry for West Pomerania Province, Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18010333. [PMID: 33466336 PMCID: PMC7794698 DOI: 10.3390/ijerph18010333] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/28/2020] [Accepted: 12/31/2020] [Indexed: 12/19/2022]
Abstract
Anaphylaxis is a severe, potentially life-threatening systemic hypersensitivity reaction that is still rarely diagnosed. For safety reasons, patients should visit an allergologist to identify potential causes and cofactors of this reaction. This paper presents the analysis of data from the Anaphylaxis Registry gathered over ten years at the Allergy Clinic, Pomeranian Medical University (PMU). A questionnaire-based survey was used for patients visiting the Allergy Clinic to identify potential augmentation factors/comorbidities and/or cofactors of anaphylaxis in patients with a history of moderate to severe anaphylaxis. The registry comprised patients with grade II or higher anaphylaxis. The gathered data concerned chronic comorbidities (cardiovascular diseases, respiratory diseases, and others), recurrence of anaphylaxis, and potential cofactors in anaphylaxis. In the analyzed group, the incidence rate of anaphylaxis was the highest for women aged 19–60 years. Most common comorbidities in patients with moderate to severe anaphylaxis included: cardiovascular diseases, respiratory tract diseases, features of atopy, and thyroid diseases. More than 30% of drug-induced reactions were anaphylactic reactions due to the re-exposure to the same drug, which points to the need for educational initiatives in this area. The incidence rate of anaphylaxis induced by Hymenoptera stings was comparable in patients who had a previous generalized reaction and those who had good tolerance to the previous sting. It is important to take these cofactors into consideration when evaluating patients with anaphylaxis as they may play a role in future anaphylactic reactions.
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Affiliation(s)
- Iwona Poziomkowska-Gęsicka
- Clinical Allergology Department, Pomeranian Medical University (PMU) in Szczecin, 70-204 Szczecin, Poland;
- Correspondence:
| | - Magdalena Kostrzewska
- Department of Pulmonology, Allergology and Respiratory Oncology, University of Medical Sciences, 60-569 Poznan, Poland;
| | - Michał Kurek
- Clinical Allergology Department, Pomeranian Medical University (PMU) in Szczecin, 70-204 Szczecin, Poland;
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Kang JB, Hwang YH. A case report of recurrent anaphylaxis in a 36-year-old female: Lipid transfer protein syndrome. ALLERGY ASTHMA & RESPIRATORY DISEASE 2021. [DOI: 10.4168/aard.2021.9.2.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jae Been Kang
- Department of Pediatrics, Busan Saint Mary's Hospital, Busan, Korea
| | - Yoon Ha Hwang
- Department of Pediatrics, Busan Saint Mary's Hospital, Busan, Korea
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38
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Ruano-Zaragoza M, Somoza ML, Jiménez-Rodriguez TW, Soriano-Gomis V, González-Delgado P, Esteban-Rodriguez A, Palazón-Bru A, Blanca M, Fernández-Sánchez J. Lipid Transfer Protein Sensitization: Risk of Anaphylaxis and Molecular Sensitization Profile in Pru p 3-Sensitized Patients. Int Arch Allergy Immunol 2020; 182:425-432. [PMID: 33341818 DOI: 10.1159/000511977] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/02/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Component-resolved diagnosis reveals the IgE response to many inhaled, food, and other allergens, improving the understanding and diagnosis of allergic diseases. OBJECTIVE The aims of the study are to study the recognition of different lipid transfer proteins (LTPs) and other allergen families in a large group of people sensitized to Pru p 3 and to analyze the relationship between the clinical entities and the allergens. METHODS This cross-sectional study included a large cohort of patients with positive skin tests to peach fruit and Pru p 3 specific IgE antibodies. Respiratory and food allergy symptoms were collected, and we performed prick tests with pollen, plant food, and other allergens plus the ImmunoCAP ISAC assay. RESULTS Our sample consisted of 421 people with a mean age of 33.25 years (range 16-68); 54.6% were women. Clinical entities included anaphylaxis (37.1%), urticaria (67.9%), and oral allergy syndrome (59.1%). Rhinitis, rhinoconjunctivitis, and/or asthma were diagnosed in 71.8% of the participants. The most pronounced correlation existed between sensitization to Pru p 3 and to Jug r 3, Pla a 3, Ara h 9, and Cor a 8. We found a higher incidence of anaphylaxis in people with 5 or more recognized LTPs. No association was observed between inhaled and food allergies. CONCLUSION Most Pru p 3-sensitized participants were sensitized to additional allergens from the same family and, to a lesser extent, to other allergens, mainly in the profilin and PR-10 protein families. Anaphylaxis occurred in more than a third of the cases evaluated, and almost three-quarters of them had respiratory symptoms. Respiratory and food allergies involving LTPs do not seem to be associated.
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Affiliation(s)
- Maria Ruano-Zaragoza
- Allergy Section, ARADyAL Spanish Network, Alicante General University Hospital-ISABIAL, Alicante, Spain, .,PhD Program in Public Health, Medical and Surgical Sciences. Miguel Hernandez University, Alicante, Spain,
| | | | | | - Victor Soriano-Gomis
- Allergy Section, ARADyAL Spanish Network, Alicante General University Hospital-ISABIAL, Alicante, Spain.,Clinical Medicine Department, Miguel Hernandez University, Alicante, Spain
| | - Purificación González-Delgado
- Allergy Section, ARADyAL Spanish Network, Alicante General University Hospital-ISABIAL, Alicante, Spain.,Clinical Medicine Department, Miguel Hernandez University, Alicante, Spain
| | | | | | - Miguel Blanca
- Section of Allergy, Infanta Leonor University Hospital, Madrid, Spain
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39
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Bogas G, Muñoz‐Cano R, Mayorga C, Casas R, Bartra J, Pérez N, Pascal M, Palomares F, Torres MJ, Gómez F. Phenotyping peach-allergic patients sensitized to lipid transfer protein and analysing severity biomarkers. Allergy 2020; 75:3228-3236. [PMID: 32535938 DOI: 10.1111/all.14447] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/10/2020] [Accepted: 05/18/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Patients with peach allergy due to nsLTP sensitization constitute a heterogeneous group in terms of sensitization profile and severity. This could be due to the presence of additional allergies to pollens. The aim of this study was to analyse the clinical characteristics, sensitization profile and severity of reactions in peach-allergic patients sensitized to nsLTP from two Mediterranean areas with different pollen exposure. METHODS Patients with diagnosis of LTP allergy from the Allergy Unit of Hospital Regional Universitario de Malaga (HRUM) and Hospital Clinic de Barcelona (HCB) were prospectively included and classified into two groups; (a) LTP-monoallergic: those that presented reaction only with peach and (b) LTP-Allergy: those that presented reaction with peach and at least another plant-food containing LTP. RESULTS A total of 252 patients were included, 235 (93.2%) had LTP-syndrome and 17 (6.8%) were LTP-monoallergic. We found a higher percentage of anaphylaxis and delayed onset of symptoms in the LTP-monoallergic group (P = .02 and P = .04, respectively). Moreover, anaphylaxis was less frequent in patients with profilin sensitization (P = .03). The comparison of patients' data from HRUM with data from HCB showed differences in sensitization to olive tree pollen and profilin (P = .01 and P = .001, respectively). CONCLUSION This study was undertaken to characterize two large group of subjects from to two regions with differing exposures to pollen. We found that more than 90% of peach-allergic patients in both populations evolved to LTP-Allergy and showed an early onset. Profilin sensitization could be more useful as a severity biomarker than the number of nsLTP, aeroallergen sensitizations or sIgE levels. This could provide clues regarding sensitization and severity patterns that might be relevant in other geographical areas.
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Affiliation(s)
- Gador Bogas
- Allergy Unit IBIMA‐ Hospital Regional Universitario de Malaga Malaga Spain
| | - Rosa Muñoz‐Cano
- Allergy Section Pneumology Department IDIBAPS Universitat de Barcelona, Hospital Clínic Barcelona Spain
- Spanish Network for Allergy ‐ RETICS de Asma Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
| | - Cristobalina Mayorga
- Allergy Unit IBIMA‐ Hospital Regional Universitario de Malaga Malaga Spain
- Spanish Network for Allergy ‐ RETICS de Asma Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
- Research Laboratory IBIMA‐ Hospital Regional Universitario de Malaga Malaga Spain
| | - Rocio Casas
- Allergy Section Pneumology Department IDIBAPS Universitat de Barcelona, Hospital Clínic Barcelona Spain
| | - Joan Bartra
- Allergy Section Pneumology Department IDIBAPS Universitat de Barcelona, Hospital Clínic Barcelona Spain
- Spanish Network for Allergy ‐ RETICS de Asma Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
| | - Natalia Pérez
- Allergy Unit IBIMA‐ Hospital Regional Universitario de Malaga Malaga Spain
| | - Mariona Pascal
- Allergy Section Pneumology Department IDIBAPS Universitat de Barcelona, Hospital Clínic Barcelona Spain
- Spanish Network for Allergy ‐ RETICS de Asma Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
| | - Francisca Palomares
- Research Laboratory IBIMA‐ Hospital Regional Universitario de Malaga Malaga Spain
| | - María José Torres
- Allergy Unit IBIMA‐ Hospital Regional Universitario de Malaga Malaga Spain
- Spanish Network for Allergy ‐ RETICS de Asma Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
- Research Laboratory IBIMA‐ Hospital Regional Universitario de Malaga Malaga Spain
| | - Francisca Gómez
- Allergy Unit IBIMA‐ Hospital Regional Universitario de Malaga Malaga Spain
- Spanish Network for Allergy ‐ RETICS de Asma Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
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Abstract
Pollen-food allergy syndrome (PFAS) is an immunoglobulin E-mediated immediate allergic reaction caused by cross-reactivity between pollen and the antigens of foods-such as fruits, vegetables, or nuts-in patients with pollen allergy. A 42.7% prevalence of PFAS in Korean pediatric patients with pollinosis was recently reported. PFAS is often called oral allergy syndrome because of mild symptoms such as itching, urticaria, and edema mainly in the lips, mouth, and pharynx that appear after food ingestion. However, reports of systemic reactions such as anaphylaxis have been increasing recently. This diversity in the degree of symptoms is related to the types of trigger foods and the characteristics of allergens, such as heat stability. When pediatric patients with pollen allergy are treated, attention should be paid to PFAS and an active effort should be made to diagnose it.
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Affiliation(s)
- You Hoon Jeon
- Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
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41
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Barre A, Damme EJV, Simplicien M, Benoist H, Rougé P. Are Dietary Lectins Relevant Allergens in Plant Food Allergy? Foods 2020; 9:foods9121724. [PMID: 33255208 PMCID: PMC7760050 DOI: 10.3390/foods9121724] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/18/2020] [Accepted: 11/21/2020] [Indexed: 01/17/2023] Open
Abstract
Lectins or carbohydrate-binding proteins are widely distributed in seeds and vegetative parts of edible plant species. A few lectins from different fruits and vegetables have been identified as potential food allergens, including wheat agglutinin, hevein (Hev b 6.02) from the rubber tree and chitinases containing a hevein domain from different fruits and vegetables. However, other well-known lectins from legumes have been demonstrated to behave as potential food allergens taking into account their ability to specifically bind IgE from allergic patients, trigger the degranulation of sensitized basophils, and to elicit interleukin secretion in sensitized people. These allergens include members from the different families of higher plant lectins, including legume lectins, type II ribosome-inactivating proteins (RIP-II), wheat germ agglutinin (WGA), jacalin-related lectins, GNA (Galanthus nivalis agglutinin)-like lectins, and Nictaba-related lectins. Most of these potentially active lectin allergens belong to the group of seed storage proteins (legume lectins), pathogenesis-related protein family PR-3 comprising hevein and class I, II, IV, V, VI, and VII chitinases containing a hevein domain, and type II ribosome-inactivating proteins containing a ricin B-chain domain (RIP-II). In the present review, we present an exhaustive survey of both the structural organization and structural features responsible for the allergenic potency of lectins, with special reference to lectins from dietary plant species/tissues consumed in Western countries.
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Affiliation(s)
- Annick Barre
- UMR 152 PharmaDev, Institut de Recherche et Développement, Université Paul Sabatier, Faculté de Pharmacie, 35 Chemin des Maraîchers, 31062 Toulouse, France; (A.B.); (M.S.); (H.B.)
| | - Els J.M. Van Damme
- Department of Biotechnology, Faculty of Bioscience Engineering, Ghent University, Coupure links 653, B-9000 Ghent, Belgium;
| | - Mathias Simplicien
- UMR 152 PharmaDev, Institut de Recherche et Développement, Université Paul Sabatier, Faculté de Pharmacie, 35 Chemin des Maraîchers, 31062 Toulouse, France; (A.B.); (M.S.); (H.B.)
| | - Hervé Benoist
- UMR 152 PharmaDev, Institut de Recherche et Développement, Université Paul Sabatier, Faculté de Pharmacie, 35 Chemin des Maraîchers, 31062 Toulouse, France; (A.B.); (M.S.); (H.B.)
| | - Pierre Rougé
- UMR 152 PharmaDev, Institut de Recherche et Développement, Université Paul Sabatier, Faculté de Pharmacie, 35 Chemin des Maraîchers, 31062 Toulouse, France; (A.B.); (M.S.); (H.B.)
- Correspondence: ; Tel.: +33-069-552-0851
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Aruanno A, Urbani S, Frati F, Nucera E. LTP allergy/sensitization in a pediatric population. Allergol Immunopathol (Madr) 2020; 48:763-770. [PMID: 32402622 DOI: 10.1016/j.aller.2020.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/22/2020] [Accepted: 03/31/2020] [Indexed: 12/30/2022]
Abstract
Plant lipid transfer proteins (LTPs) are widespread plant food allergens, highly resistant to food processing and to the gastrointestinal environment, which have been described as the most common food allergens in the Mediterranean area. LTP allergy is widely described in adults, but it represents an emerging allergen also in the pediatric population. Little is known about the real prevalence and the clinical features of this allergy in children and it still often remains underdiagnosed in these patients. An early identification and a deeper knowledge of this allergy in childhood can avoid severe systemic reactions and improve the child's quality of life. Pediatricians should always consider the possibility of LTP involvement in cases of plant-derived food allergy.
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Affiliation(s)
- A Aruanno
- Allergy Unit, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy.
| | - S Urbani
- Allergy Unit, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy.
| | | | - E Nucera
- Allergy Unit, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy.
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Wawrzeńczyk A, Żbikowska-Gotz M, Wawrzeńczyk A, Bartuzi Z. Sensitisation to lipid transfer proteins in pollen - allergic adults with food allergy. Postepy Dermatol Alergol 2020; 37:508-512. [PMID: 32994771 PMCID: PMC7507168 DOI: 10.5114/ada.2020.98278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/28/2018] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Food allergy affects 6-17% of Europeans and in 60% of the cases it is accompanied by inhalation allergy. This is due to two phenomena, namely co-sensitisation and cross-reactivity, which are caused by panallergens, such as lipid transfer proteins (LTP). These proteins are classified as defence proteins PR-14 and are responsible for protecting the plant from bacterial and fungal infections. Clinically, LTP allergy manifests with severe anaphylactic reactions or milder reactions, such as oral allergy syndrome. AIM To assess the incidence of specific IgE to components belonging to LTP based on molecular testing. MATERIAL AND METHODS The study was conducted at the Department of Allergy, Clinical Immunology and Internal Diseases in Bydgoszcz, Poland. A total of 50 subjects participated in the study. Each subject had their asIgE levels determined with ImmunoCap ISAC. RESULTS AND CONCLUSIONS Antigen-specific IgE antibodies to LTP components were identified in 24% of the subjects. In subjects with LTP allergy, adverse skin reactions were the most common after consumption of sensitising foods. Peach was the most common food allergen triggering these reactions. The Artemisia vulgaris component Art v 3 was the precursor of LTP allergy in our study population: the highest incidence and the highest mean levels of asIgE were demonstrated for this component.
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Affiliation(s)
- Adam Wawrzeńczyk
- Department and Clinic of Allergology, Clinical Immunology and Internal Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Magdalena Żbikowska-Gotz
- Department and Clinic of Allergology, Clinical Immunology and Internal Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Anna Wawrzeńczyk
- Department and Clinic of Vascular Diseases and Internal Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Zbigniew Bartuzi
- Department and Clinic of Allergology, Clinical Immunology and Internal Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
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Irahara M, Nomura I, Takeuchi I, Yamamoto-Hanada K, Shimizu H, Fukuie T, Yoshioka T, Arai K, Ohya Y. Pediatric patient with eosinophilic esophagitis and pollen-food allergy syndrome. Asia Pac Allergy 2020; 10:e28. [PMID: 32789113 PMCID: PMC7402953 DOI: 10.5415/apallergy.2020.10.e28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/03/2020] [Indexed: 11/28/2022] Open
Abstract
The incidence of eosinophilic esophagitis (EoE) and pollen-food allergy syndrome (PFAS) is increasing worldwide, and coexistence of these 2 diseases has been reported in adults. In children, however, these conditions have not been reported as comorbidities probably because sensitization to aeroallergens occurs at an older age. We report the case of a boy with EoE and PFAS. He had had intermittent vomiting since 2 years of age. At 7 years of age, he experienced an episode of itchiness of the lips and throat for the first time, followed by vomiting, immediately after ingesting some raw fruits. We diagnosed PFAS based on the skin prick test at 8 years of age and diagnosed EoE by esophagogastroduodenoscopy 11 months after the diagnose of PFAS. His digestive symptoms did not disappear despite eliminating the fruits responsible for PFAS, but esomeprazole improved his symptoms. The incidence of EoE and PFAS as comorbidities in children might increase in the future.
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Affiliation(s)
- Makoto Irahara
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Ichiro Nomura
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Ichiro Takeuchi
- Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | | | - Hirotaka Shimizu
- Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Tatsuki Fukuie
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Takako Yoshioka
- Department of Pathology, National Center for Child Health and Development, Tokyo, Japan
| | - Katsuhiro Arai
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan.,Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
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González Pérez A, Carbonell Martínez A, Escudero Pastor AI, Navarro Garrido C, Miralles López JC. Pru p 3 oral immunotherapy efficacy, induced immunological changes and quality of life improvement in patients with LTP syndrome. Clin Transl Allergy 2020; 10:20. [PMID: 32523680 PMCID: PMC7278159 DOI: 10.1186/s13601-020-00325-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 05/25/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Alejandra González Pérez
- Allergy Section, Reina Sofía University General Hospital, Intendente Jorge Palacios Avenue, 1, 30003 Murcia, Spain
| | - Antonio Carbonell Martínez
- Allergy Section, Reina Sofía University General Hospital, Intendente Jorge Palacios Avenue, 1, 30003 Murcia, Spain
| | - Ana Isabel Escudero Pastor
- Allergy Section, Reina Sofía University General Hospital, Intendente Jorge Palacios Avenue, 1, 30003 Murcia, Spain
| | - Cristina Navarro Garrido
- Allergy Section, Reina Sofía University General Hospital, Intendente Jorge Palacios Avenue, 1, 30003 Murcia, Spain
| | - Juan Carlos Miralles López
- Allergy Section, Reina Sofía University General Hospital, Intendente Jorge Palacios Avenue, 1, 30003 Murcia, Spain
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47
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Dhar N, Caruana J, Erdem I, Raina R. An Arabidopsis DISEASE RELATED NONSPECIFIC LIPID TRANSFER PROTEIN 1 is required for resistance against various phytopathogens and tolerance to salt stress. Gene 2020; 753:144802. [PMID: 32454178 DOI: 10.1016/j.gene.2020.144802] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 01/02/2023]
Abstract
Synchronous and timely regulation of multiple genes results in an effective defense response that decides the fate of the host when challenged with pathogens or unexpected changes in environmental conditions. One such gene, which is downregulated in response to multiple bacterial pathogens, is a putative nonspecific lipid transfer protein (nsLTP) of unknown function that we have named DISEASE RELATED NONSPECIFIC LIPID TRANSFER PROTEIN 1 (DRN1). We show that upon pathogen challenge, DRN1 is strongly downregulated, while a putative DRN1-targeting novel microRNA (miRNA) named DRN1 Regulating miRNA (DmiR) is reciprocally upregulated. Furthermore, we provide evidence that DRN1 is required for defense against bacterial and fungal pathogens as well as for normal seedling growth under salinity stress. Although nsLTP family members from different plant species are known to be a significant source of food allergens and are often associated with antimicrobial properties, our knowledge on the biological functions and regulation of this gene family is limited. Our current work not only sheds light on the mechanism of regulation but also helps in the functional characterization of DRN1, a putative nsLTP family member of hitherto unknown function.
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Affiliation(s)
- Nikhilesh Dhar
- Department of Biology, Syracuse University, Syracuse, NY 13210, United States; Department of Plant Pathology, University of California, Davis, Salinas, CA 93905, United States
| | - Julie Caruana
- Department of Biology, Syracuse University, Syracuse, NY 13210, United States; American Society for Engineering Education Postdoctoral Fellow, Washington DC 20375, United States
| | - Irmak Erdem
- Department of Biology, Syracuse University, Syracuse, NY 13210, United States
| | - Ramesh Raina
- Department of Biology, Syracuse University, Syracuse, NY 13210, United States.
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48
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Osawa Y, Ito Y, Takahashi N, Sugimoto C, Kohno Y, Mori S, Morikawa T, Kato Y, Okamoto M, Kanno M, Takabayashi T, Fujieda S. Epidemiological study of oral allergy syndrome in birch pollen dispersal-free regions. Allergol Int 2020; 69:246-252. [PMID: 31708436 DOI: 10.1016/j.alit.2019.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/12/2019] [Accepted: 09/25/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Oral allergy syndrome (OAS) is an immediate allergy caused by a cross-reaction of highly homologous common antigens (pan-allergens) contained in fruits/vegetables and pollen. METHODS A questionnaire was provided to 6824 outpatient visitors and serum levels of specific IgEs against crude antigens and pan-allergen components were measured to study the relationship between the prevalence of OAS and pollinosis in the Fukui Prefecture where there is almost no dispersal of birch pollen. RESULTS The prevalence of OAS was 10.8%. The rate of pollinosis complication in the OAS group was 67.4%, and OAS was observed in 16.8% of pollinosis patients. Causative foods in order of frequency were melon, pineapple, kiwi fruit, peach, and apple. A significantly higher number of patients from the OAS group were positive for birch, alder, and timothy grass-specific IgE. The rate of positivity for anti-component IgE corresponding to pollen in OAS group was also significantly higher. Of 34 patients with OAS caused by eating apples, 28 (82.4%) were positive for Mal d1-specific IgE. Of the 52 patients with peach-induced OAS, 41 (78.8%) were positive for Pur p1-specific IgE. The concordance rates between crude antigen-specific IgE and anti-PR-10 component-specific IgE were 87.1% and 93.3% for apple and peach respectively. CONCLUSIONS In regions where birch pollen is not dispersed, OAS patients have a significant association with the onset of Bet v1-associated allergy. Anti-PR-10 component IgE was useful in diagnosing OAS, and crude antigen-specific IgE was also associated with apple and peach allergies.
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Affiliation(s)
- Yoko Osawa
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan; Department of Otorhinolaryngology, Japanese Red Cross Fukui Hospital, Fukui, Japan
| | - Yumi Ito
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Noboru Takahashi
- Department of Otorhinolaryngology, Fukui Sougou Clinic, Fukui, Japan
| | - Chizuru Sugimoto
- Department of Otorhinolaryngology, Fukui Katsuyama General Hospital, Fukui, Japan
| | | | | | - Taiyo Morikawa
- Department of Otorhinolaryngology, Japanese Red Cross Fukui Hospital, Fukui, Japan
| | - Yukinori Kato
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Masayuki Okamoto
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Masafumi Kanno
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Tetsuji Takabayashi
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Shigeharu Fujieda
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan.
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Oeo‐Santos C, Navas A, Benedé S, Ruíz‐León B, Díaz‐Perales A, Vogel L, Moreno‐Aguilar C, Jurado A, Villalba M, Barderas R. New insights into the sensitization to nonspecific lipid transfer proteins from pollen and food: New role of allergen Ole e 7. Allergy 2020; 75:798-807. [PMID: 31605380 DOI: 10.1111/all.14086] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ole e 7 is a nonspecific lipid transfer protein (nsLTP) from olive pollen, one of the main allergenic pollens worldwide. This allergenic nsLTP is responsible for severe symptoms in regions with high olive pollen exposure, where many Ole e 7-sensitized patients exhibit a co-sensitization to the peach nsLTP, Pru p 3. However, there is no evidence of cross-reactivity, which explains this observed co-sensitization. Therefore, the purpose of this study was to explore the relationship between Ole e 7 and Pru p 3. METHODS A total of 48 patients sensitized to Ole e 7 and/or Pru p 3 were included in the study. Specific IgE serum levels were measured by ImmunoCAP 250 and ELISA. Inhibition assays were performed to determine the existence of cross-reactivity between both nsLTPs. Allergic response was analyzed ex vivo (basophil activation test) and in vitro (RBL-2H3 mast cell model). RESULTS Common IgG and IgE epitopes were identified between both allergens. IgE-binding inhibition was detected in Ole e 7-monosensitized patients using rPru p 3 as inhibitor, reaching inhibition values of 25 and 100%. Ex vivo and in vitro assays revealed a response against rPru p 3 in four (31%) Ole e 7-monosensitized patients. CONCLUSIONS Our results suggest that Ole e 7 could play a new role as primary sensitizer in regions with high olive pollen exposure, leading to the peach nsLTP sensitization. This co-sensitization process would occur because of the cross-reactivity between Ole e 7 and Pru p 3 observed in some allergic patients.
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Affiliation(s)
- Carmen Oeo‐Santos
- Departamento de Bioquímica y Biología Molecular Facultad de Ciencias Químicas Universidad Complutense de Madrid Madrid Spain
| | - Ana Navas
- UGC Inmunología y Alergia Hospital Universitario Reina Sofía de Córdoba Córdoba Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía/Universidad de Córdoba Córdoba Spain
| | - Sara Benedé
- Departamento de Bioquímica y Biología Molecular Facultad de Ciencias Químicas Universidad Complutense de Madrid Madrid Spain
| | - Berta Ruíz‐León
- UGC Inmunología y Alergia Hospital Universitario Reina Sofía de Córdoba Córdoba Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía/Universidad de Córdoba Córdoba Spain
- Allergy Network ARADyAL Instituto de Salud Carlos III Madrid Spain
| | - Araceli Díaz‐Perales
- Allergy Network ARADyAL Instituto de Salud Carlos III Madrid Spain
- Centro de Biotecnología y Genómica de Plantas (CBGP, UPM‐INIA) Campus de Montegancedo‐UPM Madrid Spain
| | - Lothar Vogel
- Division of Allergology Paul‐Erlich‐Institut Langen Germany
| | - Carmen Moreno‐Aguilar
- UGC Inmunología y Alergia Hospital Universitario Reina Sofía de Córdoba Córdoba Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía/Universidad de Córdoba Córdoba Spain
- Allergy Network ARADyAL Instituto de Salud Carlos III Madrid Spain
| | - Aurora Jurado
- UGC Inmunología y Alergia Hospital Universitario Reina Sofía de Córdoba Córdoba Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía/Universidad de Córdoba Córdoba Spain
- Allergy Network ARADyAL Instituto de Salud Carlos III Madrid Spain
| | - Mayte Villalba
- Departamento de Bioquímica y Biología Molecular Facultad de Ciencias Químicas Universidad Complutense de Madrid Madrid Spain
- Allergy Network ARADyAL Instituto de Salud Carlos III Madrid Spain
| | - Rodrigo Barderas
- Allergy Network ARADyAL Instituto de Salud Carlos III Madrid Spain
- UFIEC, Chronic Disease Programme Instituto de Salud Carlos III Madrid Spain
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50
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Decuyper II, Pascal M, Van Gasse AL, Mertens C, Díaz‐Perales A, Araujo G, Torradeflot M, Rius J, Balsells S, Muñoz‐Cano RM, Bartra J, Li L, Sabato V, Hagendorens MM, Bridts CH, De Clerck LS, Ebo DG, Faber MA. Performance of basophil activation test and specific IgG4 as diagnostic tools in nonspecific lipid transfer protein allergy: Antwerp-Barcelona comparison. Allergy 2020; 75:616-624. [PMID: 31512256 DOI: 10.1111/all.14040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 07/23/2019] [Accepted: 08/07/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Recent studies show that nsLTP sensitization is not limited to the Mediterranean basin and can present diverse clinical phenotypes. It remains challenging to predict clinical outcome when specific IgE antibodies (sIgE) to nsLTPs are present. This study compares both clinical and in vitro allergy characteristics but also diagnostic performance of a basophil activation test (BAT) and sIgG4 in nsLTP-sensitized patients from Antwerp (ANT, Belgium) and Barcelona (BCN, Spain). METHODS Adult subjects with positive sIgE rPru p 3 and/or rMal d 3 ≥ 0.10 kUA /L (n = 182) and healthy controls (n = 37) were included. NsLTP-sensitized individuals were stratified according to clinical symptoms with peach/apple, respectively. BAT rPru p 3 and rMal d 3 were performed and sIgG4 antibodies to both components quantified. RESULTS In BCN, only ratios of sIgG4/sIgE rMal d 3 and BAT rMal d 3 (0.001 µg/mL) can identify clinically relevant Mal d 3 sensitization (sensitivity of 60%-63% and a specificity of 75%-67%, respectively). In ANT, only the sIgE/total IgE rPru p 3 ratio shows added value (sensitivity 60% and specificity 83%). Finally, it appears that symptomatic patients in BCN are more sensitive to lower allergen concentrations compared to ANT. In addition, it was shown that ANT patients were more often sensitized to pollen and that specific pollen sources differed between regions. CONCLUSIONS NsLTP-related allergy profiles and diagnostic performance differ significantly between regions and are component-specific, which makes extrapolation of data difficult to do. In addition, it seems that basophil sensitivity might show geographical differences. Additional research is needed to confirm these findings.
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Affiliation(s)
- Ine I. Decuyper
- Department of Immunology‐Allergology‐Rheumatology University of Antwerp and Antwerp University Hospital Antwerp Belgium
- Pediatric Department University of Antwerp and Antwerp University Hospital Antwerp Belgium
| | - Mariona Pascal
- Immunology Department Centre de Diagnòstic Biomèdic (CDB)Hospital Clínic de Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Universitat de Barcelona Barcelona Spain
- Spanish Network for Allergy – RETIC de Asma, Reacciones adversas y Alérgicas (ARADYAL) Madrid Spain
| | - Athina L. Van Gasse
- Department of Immunology‐Allergology‐Rheumatology University of Antwerp and Antwerp University Hospital Antwerp Belgium
- Pediatric Department University of Antwerp and Antwerp University Hospital Antwerp Belgium
| | - Christel Mertens
- Department of Immunology‐Allergology‐Rheumatology University of Antwerp and Antwerp University Hospital Antwerp Belgium
| | - Araceli Díaz‐Perales
- Spanish Network for Allergy – RETIC de Asma, Reacciones adversas y Alérgicas (ARADYAL) Madrid Spain
- Plant Biotechnology Institute (UPM‐INIA) Madrid Spain
| | - Giovanna Araujo
- Allergy Section Pneumology Department Institut Clínic Respiratori (ICR)Hospital Clínic de Barcelona Barcelona Spain
| | - Maria Torradeflot
- Immunology Department Centre de Diagnòstic Biomèdic (CDB)Hospital Clínic de Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Universitat de Barcelona Barcelona Spain
| | - Josefina Rius
- Immunology Department Centre de Diagnòstic Biomèdic (CDB)Hospital Clínic de Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Universitat de Barcelona Barcelona Spain
| | - Sara Balsells
- Immunology Department Centre de Diagnòstic Biomèdic (CDB)Hospital Clínic de Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Universitat de Barcelona Barcelona Spain
| | - Rosa M. Muñoz‐Cano
- Spanish Network for Allergy – RETIC de Asma, Reacciones adversas y Alérgicas (ARADYAL) Madrid Spain
- Allergy Section Pneumology Department Institut Clínic Respiratori (ICR)Hospital Clínic de Barcelona Barcelona Spain
| | - Joan Bartra
- Spanish Network for Allergy – RETIC de Asma, Reacciones adversas y Alérgicas (ARADYAL) Madrid Spain
- Allergy Section Pneumology Department Institut Clínic Respiratori (ICR)Hospital Clínic de Barcelona Barcelona Spain
| | - Lynne Li
- Department of Medicine University of British Columbia Vancouver BC Canada
| | - Vito Sabato
- Department of Immunology‐Allergology‐Rheumatology University of Antwerp and Antwerp University Hospital Antwerp Belgium
| | - Margo M. Hagendorens
- Department of Immunology‐Allergology‐Rheumatology University of Antwerp and Antwerp University Hospital Antwerp Belgium
- Pediatric Department University of Antwerp and Antwerp University Hospital Antwerp Belgium
| | - Chris H. Bridts
- Department of Immunology‐Allergology‐Rheumatology University of Antwerp and Antwerp University Hospital Antwerp Belgium
| | - Luc S. De Clerck
- Department of Immunology‐Allergology‐Rheumatology University of Antwerp and Antwerp University Hospital Antwerp Belgium
| | - Didier G. Ebo
- Department of Immunology‐Allergology‐Rheumatology University of Antwerp and Antwerp University Hospital Antwerp Belgium
| | - Margaretha A. Faber
- Department of Immunology‐Allergology‐Rheumatology University of Antwerp and Antwerp University Hospital Antwerp Belgium
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