Characterized allergens causing bakers' asthma

Allergenicity assessment and allergen profile analysis of different Chinese wheat cultivars

Backgrounds

As one of the most important cereals, wheat (Triticum aestivum) can cause severe allergic reactions, such as baker's asthma, allergic rhinitis, and atopic dermatitis. A growing number of people are developing allergies to Chinese wheat; however, only a few wheat cultivars have been screened on allergenicity in China.

Objective

The aim of the present study was to assess the allergenicity of different Chinese wheat cultivars and characterize wheat allergen profiles of patients with allergic rhinitis.

Methods

We determined protein (soluble protein, gliadin, and glutenin) composition in Chinese wheat by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), and the immunoglobulin E (IgE) binding capacity by enzyme-linked immunosorbent assay (ELISA) and Western blot using 10 positive sera from wheat allergy patients. We identified 5 gel bands with significant IgE binding capacity using liquid chromatography-tandem mass spectrometry (LC-MS/MS).

Results

Soluble protein, albumin, and globulin, showed the highest allergenicity, followed by gliadin, while glutenin only had slight allergenicity. In soluble protein, 5 protein bands with molecular weights of 27, 28, 53, 58, and 62 kDa showed very significant allergenicity. Meanwhile, the relative abundances of 28 kDa-protein and 58 kDa-protein were significantly positively correlated with the IgE-binding capacity of Chinese wheat cultivars, which were identified as rRNA N-glycosidase and β-amylase, respectively, among other proteins in those highly complex gel bands.

Conclusion and clinical relevance

28 kDa-protein (rRNA N-glycosidase) and 58 kDa-protein (β-amylase) were speculated to be the main allergens of Chinese wheat causing baker's asthma and allergic rhinitis. These results provide new insights into the prevention and treatment of wheat allergy and the development of hypoallergenic wheat products, whose clinical significance is worth further evaluation.

Upper and Lower Respiratory Signs and Symptoms in Workers Occupationally Exposed to Flour Dust

A group of 142 bakers was studied in order to investigate the relationship between higher/lower respiratory signs/symptoms and inflammation biomarkers and occupational exposure to flour dust. A complete upper and lower respiratory tract evaluation was performed. Seven percent of bakers complained of lower respiratory symptoms, while 22% of them complained of upper respiratory symptoms. Fifty five percent of the bakers were allergic, and 37.1% showed sensitization to occupational allergens. Abnormal spirometries were found in 15% of bakers, while fractional exhaled nitric oxide (FeNO) was above the normal reference in 24.5% of them. Moreover, 23.8% of bakers were found to be hyposmic. Population mean peak nasal inspiratory flow (PNIF) was in the normal range even if almost all the workers suffered from neutrophilic rhinitis at nasal cytology with the number of nasal neutrophils increasing with the increase of the duration of exposure to flour dust (p = 0.03). PNIF and FEV1 (forced expiratory volume in the 1st second) showed a positive correlation (p = 0.03; r = 0.19). The Tiffeneau index decreased with the increase of dust (p = 0.017). A similar result was obtained once we divided our population into smokers and non-smokers (p = 0.021). Long-term exposure to bakery dusts can lead to a status of minimal nasal inflammation and allergy.

Predicting occupational asthma and rhinitis in bakery workers referred for clinical evaluation

BACKGROUND

Occupational allergic diseases are a major problem in some workplaces like in the baking industry. Diagnostic rules have been used in surveillance but not yet in the occupational respiratory clinic.

OBJECTIVE

To develop diagnostic models predicting baker's asthma and rhinitis among bakery workers at high risk of sensitisation to bakery allergens referred to a specialised clinic.

METHODS

As part of a medical surveillance programme, clinical evaluation was performed on 436 referred Dutch bakery workers at high risk for sensitisation to bakery allergens. Multivariable logistic regression analyses were developed to identify the predictors of onset of baker's asthma and rhinitis using a self-administered questionnaire and compared using a structured medical history. Performance of models was assessed by discrimination (area under the receiver operating characteristics curve) and calibration (Hosmer-Lemeshow test). Internal validity of the models was assessed by a bootstrapping procedure.

RESULTS

The prediction models included the predictors of work-related upper and lower respiratory symptoms, the presence of allergy and allergic symptoms, use of medication (last year), type of job, type of shift and working years with symptoms (≥10 years). The developed models derived from both self-administered questionnaire and the medical history showed a relatively good discrimination and calibration. The internal validity showed that the models developed had satisfactory discrimination. To improve calibrations of models, shrinkage factors were applied to model coefficients.

CONCLUSION

The probability of allergic asthma and rhinitis in referred bakers could be estimated by diagnostic models based on both a self-administered questionnaire and by taking a structured medical history.

Wheat protein recognition pattern in tolerant and allergic children

BACKGROUND

Wheat is one of the most common food allergens in early childhood. In contrast to other food allergies, wheat-specific IgE correlates badly with clinical symptoms and relevant components have been identified mostly for wheat-depended exercise-induced anaphylaxis. Moreover, a high percentage of patients present with immediate type symptoms but wheat-specific IgE cannot be detected with commercial available systems.

OBJECTIVE

We addressed the question whether the IgE recognition pattern between wheat allergic (WA) and clinically tolerant (WT) children differs in order to identify individual proteins useful for component-resolved diagnostics.

METHODS

Sera of 106 children with suspected wheat allergy, of whom 44 children had clinical relevant wheat allergy and 62 were tolerant upon oral food challenge, were analyzed for wheat-specific IgE using the ImmunoCap system as well as immunoblots against water and salt soluble, and water-insoluble protein fractions. 40 randomly selected sera were analyzed for specific IgE to ω5-gliadin.

RESULTS

Sixty-three percent of the WT and 86% of the WA children were sensitized to wheat with >0.35 kUA /l in ImmunoCAP analysis. We could confirm the role of α-, ß-, γ-, and ω-gliadins, and LMW glutenin subunits as major allergens and found also IgE binding to a broad spectrum of water- and salt-soluble protein bands. It is of great importance that wheat allergic and tolerant patients showed IgE binding to the same protein bands. WT and WA did not significantly differ in levels of ω5-gliadin-specific IgE.

CONCLUSIONS & CLINICAL RELEVANCE

Children with challenge proven clinical relevant food allergy and tolerant ones had a similar spectrum of IgE binding to the same protein bands. These findings imply that component-resolved diagnostics might not be helpful in the diagnostic work-up of wheat allergy.

Digestion and Gastrointestinal Absorption of the 14–16-kDa Rice Allergens

The digestibility and gastrointestinal absorption of 14-16-kDa rice allergens (RAs) were investigated. RAs and bovine serum albumin (BSA) were first evaluated for their digestibility. BSA was digested completely by in vitro incubation with some proteases, but RAs remained almost intact. Administered orally (20 mg per mouse), intact RAs were clearly detected in the small intestine even 60 min after the administration, the amount of total RAs in the small intestine being estimated to be 0.59 mg. RAs were then biotinylated and infused into the duodenal lumen of anesthetized mice, and portal blood was collected. The RA concentrations in the portal plasma were respectively estimated to be 0.4-0.9 and 0.3-2.5 microg/ml for 0.4 and 4 mg doses. These results suggest that RAs are highly resistant to digestive enzymes and that about 1/100 of orally administered RAs remain intact in the small intestine, while at least 1/1,000-1/10,000 is absorbed and delivered into circulated blood.

Diagnosis and frequency of work-exacerbated asthma among bakers

BACKGROUND

Work-exacerbated asthma (WEA) is asthma worsened by workplace exposures, although the asthma is not caused by sensitizers in the work environment.

OBJECTIVES

To evaluate the frequency of WEA in bakers reporting work-related respiratory symptoms and the usefulness of diagnostic tests in differentiating WEA from occupational asthma (OA).

METHODS

The study group included 393 bakers reporting respiratory symptoms at the workplace. In all patients, questionnaire, spirometry, skin prick tests (SPTs), and evaluation of serum total and specific IgE levels were performed. Recognition of OA was based on a specific inhalation challenge test.

RESULTS

Occupational asthma was found in 44.5% of patients, whereas WEA was recognized in 16%. The latency period was 11.2 ± 8.2 years in patients with OA vs 13.3 ± 9.7 years in those with WEA. Sixty percent of patients with OA and 50.8% of those with WEA had positive SPT reactions to common allergens; occupational SPT results were positive in 74.9% and 34.9%, respectively. Specific IgE to flours were found in 61.7% of patients with OA and 28.6% of those with WEA. In addition, OA frequently coexisted with occupational rhinitis (53.7% of patients), whereas WEA and rhinitis were found in 31.7% of patients.

CONCLUSION

Work-exacerbated asthma was diagnosed in 16% of bakers who reported allergic respiratory symptoms. The specific challenge test for occupational allergens should be performed in bakers with suspected work-related asthma, because an assessment of sensitization (SPT to occupational allergens, evaluation of specific IgE) is not specific enough to differentiate OA from WEA.

Current topics in occupational asthma

The study of occupational asthma (OA) provides insights into asthma in general, as the cause is known. The relationships between the cause and response can be measured and modifying factors can be identified and their influence quantified. Developing OA has much more serious consequences for the patient than new onset asthma unrelated to work exposures, as the patient's livelihood is nearly always affected. Many healthcare professionals are more ready to accept and act on asthmatic symptoms when they are unrelated to work than when work may be the cause; antagonism can also occur in the workplace. This article reviews some of the areas where development and controversy enrich the study of OA. It makes no attempt to be comprehensive.

Production and characterisation of monoclonal antibodies for the quantification of potentially allergenic xylanase from Aspergillus niger

Xylanase from Aspergillus niger (ANX) is widely used in bakeries as a processing aid since it stabilises and improves dough quality. An association between allergic symptoms among bakery workers and sensitisation to ANX has been reported, indicating that this enzyme is an occupational allergen. The presence of ANX in dough improvers and semi-finished goods is often hidden due to incomplete and unclear labelling. The quantification of microbial enzymes in these products is necessary and the determination of the actual concentration of ANX in workplaces is therefore essential to assess the occupational risk. To this purpose we have developed and characterised monoclonal antibodies to ANX. The monoclonal antibodies do not show any cross-reaction with other commonly used microbial enzymes, and they allow the detection of ANX in complex mixtures by ELISA inhibition assays down to the concentration limit of approximately 10 µg kg(-1). These mAbs are a valuable tool to detect and quantify ANX and to investigate its allergenic potential in the workplace.

IFN-γ induction on carbohydrate binding module of fungal immunomodulatory protein in human peripheral mononuclear cells

FIP-fve is a protein that is isolated from Flammulina velutipes . Its known immunomodulatory activities are elicitation of the production of type II interferon from human peripheral mononuclear cells (hPBMCs) and hemagglutination. How the target receptors mediate activation of FIP-fve-induced immunomodulatory effects remains to be elucidated. This study postulates the three-dimensional structures to determine whether the carbohydrate binding module family 34 (CBM-34) on FIP-fve is conserved to site N of Thermoactinomyces vulgaris R-47 α-amylase I. Experimental site-directed mutagenesis data as well as ligand-specific binding competition assay are adopted to identify the key residues W24, T28, D34, T90, I91, and W111 of FIP-fve that participate in binding to polysaccharides that are linked to the membrane of immune cells. Treatments of hPBMCs with tunicamycin and deglycosylation enzymes that removed the carbohydrate moieties reduced the secretion of IFN-γ induction from hPBMCs. In conclusion, the experiments herein demonstrated the ligand-binding CBM-34 on FIP-fve and ligand-like glycoproteins on the surface of hPBMCs must be required to induce physiological immunomodulatory effects.

Proteome mining for novel IgE-binding proteins from the German cockroach (Blattella germanica) and allergen profiling of patients

Although cockroaches are known to produce allergens that can cause IgE-mediated hypersensitivity reactions, including perennial rhinitis and asthma, the various cockroach allergens have not yet been fully studied. Many proteins from the German cockroach show high IgE reactivity, but have never been comprehensively characterized. To identify these potential allergens, proteins were separated by 2-DE and IgE-binding proteins were analyzed by nanoLC-MS/MS or N-terminal sequencing analysis. Using a combination of proteomic techniques and bioinformatic allergen database analysis, we identified a total of ten new B. germanica IgE-binding proteins. Of these, aldolase, arginine kinase, enolase, Hsp70, triosephosphate isomerase, and vitellogenin have been reported as allergens in species other than B. germanica. Analysis of the Food Allergy Research and Resource Program allergen database indicated that arginine kinase, enolase, and triosephosphate isomerase showed significant potential cross-reactivity with other related allergens. This study revealed that vitellogenin is an important novel B. germanica allergen. Personalized profiling and reactivity of IgE Abs against the panel of IgE-binding proteins varied between cockroach-allergic individuals. These findings make it possible to monitor the individual IgE reactivity profile of each patient and facilitate personalized immunotherapies for German cockroach allergy disorders.

High-pressure cornstarch inhalation--a rare but life-threatening occupational injury

Cornstarch is a white, taste- and odorless powder widely used for food processing, papermaking, production of industrial adhesives, and is also a component of many cosmetic products. We herein report a case of severe cornstarch inhalation in a 49-year-old male who was exposed to high amounts of cornstarch powder while unloading a cornstarch transporter system. To our knowledge this is the first report on a high-pressure cornstarch inhalation during occupational activities. This report demonstrates the initial clinical situation, the patient's symptoms, and the severe clinical course. Finally the problems during the management of this rare but life-threatening accident are discussed.

Thaumatin-like protein and baker's respiratory allergy

BACKGROUND

Baker's asthma and rhinitis are among the most common occupational diseases. Inhaled cereal flours, such as wheat, especially cause this disease.

OBJECTIVE

To identify and test in vivo clinically important wheat allergens in baker's respiratory allergy in a Finnish population.

METHODS

Potential wheat allergens were purified using chromatographic methods from salt-soluble protein extracts of wheat flour and were used in skin prick tests with serial 10-fold dilutions (0.5-0.005 mg/mL). Twenty patients with baker's rhinitis, asthma, or both participated in this study. All the patients had positive skin prick test reactions and specific IgE antibodies to wheat flour. The control group consisted of 10 healthy individuals. Molecular identities of purified wheat allergens were characterized using sodium dodecyl sulfate-polyacrylamide gel electrophoresis and tandem mass spectrometry.

RESULTS

Allergen concentrations of 0.3-0.5 mg/mL revealed that 12 patients reacted to a-amylase inhibitor (alpha-AI), 9 to peroxidase I (PI), 9 to thaumatin-like protein (TLP), and 6 to lipid transfer protein 2G (LTP2G). Conversely, with allergen concentrations of 0.05 mg/mL, 5 patients responded to alpha-AI, 3 to PI, 4 to LTP2G, and 6 to TLP. Of these, TLP and LTP2G are now observed to be new allergens associated with baker's asthma.

CONCLUSIONS

In addition to the earlier-described alpha-AI and PI, TLP and LTP2G are important in vivo wheat allergens in baker's allergies in Finland. Further studies are needed to elucidate the role of these novel wheat allergens in respiratory disorders.

Identification of three wheat globulin genes by screening a Triticum aestivum BAC genomic library with cDNA from a diabetes-associated globulin

BACKGROUND

Exposure to dietary wheat proteins in genetically susceptible individuals has been associated with increased risk for the development of Type 1 diabetes (T1D). Recently, a wheat protein encoded by cDNA WP5212 has been shown to be antigenic in mice, rats and humans with autoimmune T1D. To investigate the genomic origin of the identified wheat protein cDNA, a hexaploid wheat genomic library from Glenlea cultivar was screened.

RESULTS

Three unique wheat globulin genes, Glo-3A, Glo3-B and Glo-3C, were identified. We describe the genomic structure of these genes and their expression pattern in wheat seeds. The Glo-3A gene shared 99% identity with the cDNA of WP5212 at the nucleotide and deduced amino acid level, indicating that we have identified the gene(s) encoding wheat protein WP5212. Southern analysis revealed the presence of multiple copies of Glo-3-like sequences in all wheat samples, including hexaploid, tetraploid and diploid species wheat seed. Aleurone and embryo tissue specificity of WP5212 gene expression, suggested by promoter region analysis, which demonstrated an absence of endosperm specific cis elements, was confirmed by immunofluorescence microscopy using anti-WP5212 antibodies.

CONCLUSION

Taken together, the results indicate that a diverse group of globulins exists in wheat, some of which could be associated with the pathogenesis of T1D in some susceptible individuals. These data expand our knowledge of specific wheat globulins and will enable further elucidation of their role in wheat biology and human health.

Physical and biochemical properties of airborne flour particles involved in occupational asthma

Aerosol particles which deeply penetrate the human airways and which trigger baker's asthma manifestations are known to represent only a part of flour and of airborne particles found in bakeries. They were a major focus of this study. To this end, aerosols were produced from different wheat and rye flours, using an automatic generator designed for bronchial challenge. Particles were characterized for their size distribution, their ability to be deposited in the airways, their protein content, their histological composition and their reactivity with immunoglobulin E (IgE) present in sera from asthmatic bakers. Like dust particles collected in the bakery, the aerosols produced showed increased protein content but decreased IgE reactive protein content when compared to the corresponding bulk flours. The sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis of these particles showed a predominance of endosperm gluten proteins. Under scanning electron microscopy, flour particles displayed various tissue fragments with entrapped large A-starch and small B- or C-starch granules, whereas aerosol particles appeared primarily as a mixture of the endosperm intracellular interstitial protein matrix and small B- or C-starch granules free or still associated. These observations showed that aerosols supposed to penetrate deeply the airways, mainly correspond to intracellular fragments of endosperm cells enriched in gluten proteins but with lower amount of allergens belonging to albumins or globulins.

Molecular and immunological characterization of a wheat serine proteinase inhibitor as a novel allergen in baker's asthma

IgE-mediated sensitization to wheat flour belongs to the most frequent causes of occupational asthma. A cDNA library from wheat seeds was constructed and screened with serum IgE from baker's asthma patients. One IgE-reactive phage clone contained a full-length cDNA coding for an allergen with a molecular mass of 9.9 kDa and an isoelectric point of 6. According to sequence analysis it represents a member of the potato inhibitor I family, a group of serine proteinase inhibitors, and thus is the first allergen belonging to the group 6 pathogenesis-related proteins. The recombinant wheat seed proteinase inhibitor was expressed in Escherichia coli and purified to homogeneity. According to circular dichroism analysis, it represented a soluble and folded protein with high thermal stability containing mainly beta-sheets, random coils, and an alpha-helical element. The recombinant allergen showed allergenic activity in basophil histamine release assays and reacted specifically with IgE from 3 of 22 baker's asthma patients, but not with IgE from grass pollen allergic patients or patients suffering from food allergy to wheat. Allergen-specific Abs were raised to localize the allergen by immunogold electron microscopy in the starchy endosperm and the aleuron layer. The allergen is mainly expressed in mature wheat seeds and, despite an approximately 50% sequence identity, showed no relevant cross-reactivity with allergens from other plant-derived food sources such as maize, rice, beans, or potatoes. Recombinant wheat serine proteinase inhibitor, when used in combination with other specific allergens, may be useful for the diagnosis and therapy of IgE-mediated baker's asthma.

Identification of wheat gliadins as an allergen family related to baker's asthma

BACKGROUND

Flour is still one of the most common causes of occupational asthma worldwide. Thus far, little is known about the relevant allergens causing baker's asthma. Therefore the reliability of current diagnostic procedures is insufficient. Only few of the suspected causative wheat allergens have been hitherto characterized on the molecular level.

OBJECTIVE

The aim was to identify and characterize unknown wheat allergens related to baker's asthma to improve the reliability of diagnostic procedures.

METHODS

A wheat pJuFo cDNA phage display library was created and screened for IgE binding to wheat proteins with pooled sera from patients with baker's asthma. After identifying an alphabeta-gliadin, the frequency of sensitization was investigated by means of ELISA screening of 153 bakers' sera with the recombinant alphabeta-gliadin. Furthermore, the allergenicity of native total gliadin (alphabeta, gamma, omega) was analyzed by means of ImmunoCAP.

RESULTS

One cDNA clone was identified as an alphabeta-gliadin. Serum IgE antibodies to the recombinant allergen were found in 12% of bakers with occupational asthma. Of the asthmatic bakers, 33% showed sensitization to native total gliadin; 4% of them had negative results on routine IgE testing with wheat extract.

CONCLUSIONS

Gliadins represent a newly discovered family of inhalable allergens in baker's asthma. This finding demonstrates that water-insoluble proteins might also represent causative allergens.

Allergic reactions to foods by inhalation

Although allergic reactions to foods occur most commonly after ingestion, inhalation of foods can also be an underlying cause of these reactions. For example, published reports have highlighted the inhalation of allergens from fish, shellfish, seeds, soybeans, cereal grains, hen's egg, cow's milk, and many other foods in allergic reactions. Symptoms have typically included respiratory manifestations such as rhinoconjunctivitis, coughing, wheezing, dyspnea, and asthma. In some cases, anaphylaxis has been observed. In addition, there have been many investigations of occupational asthma following the inhalation of relevant food allergens. This report reviews the current literature focusing on allergic reactions to foods by inhalation.

Full-fledged proteomic analysis of bioactive wheat amylase inhibitors by a 3-D analytical technique: Identification of new heterodimeric aggregation states

Wheat proteinaceous alpha-amylase inhibitors (alpha-AIs) are increasingly investigated for their agronomical role as natural defence molecules of plants against the attack of insects and pests, but also for their effects on human health. The wheat genomes code for several bioactive alpha-AIs that share sequence homology, but differ in their specificity against alpha-amylases from different species and for their aggregation states. Wheat alpha-AIs are traditionally classified as belonging to the three classes of tetrameric, homodimeric and monomeric forms, each class being constituted by a number of polypeptides that display different electrophoretic mobilities. Here we describe a proteomic approach for the identification of bioactive alpha-AIs from wheat and, in particular, a 3-D technique that allows to best identify and characterize the dimeric fraction. The technique takes advantage of the thermal resistance of alpha-AIs (resistant to T > 70 degrees C) and consists in the separation of protein mixtures by 2-D polyacrylamide/starch electrophoresis under nondissociating PAGE (ND-PAGE, first dimension) and dissociating (urea-PAGE or U-PAGE second dimension) conditions, followed by in-gel spontaneous reaggregation of protein complexes and identification of the alpha-amylase inhibitory activity (antizymogram, third dimension) using enzymes from human salivary glands and from the larvae of Tenebrio molitor coleopter (yellow mealworm). Dimeric alpha-AIs from Triticum aestivum (bread wheat) were observed to exist as heterodimers. The formation of heterodimeric complexes was also confirmed by in vitro reaggregation assays carried out on RP-HPLC purified wheat dimeric alpha-AIs, and their bioactivity assayed by antizymogram analysis. The present 3-D analytical technique can be exploited for fast, full-fledged identification and characterization of wheat alpha-AIs.

A unique cause of asthma in a baker

Occupational asthma has been a recognized cause of respiratory disease for centuries, and bakers' asthma, in particular, has been well described. This case report identifies egg white protein as the trigger of asthma in an atopic baker. It highlights the clinical spectra of bakers' asthma, emphasizing the importance of occupational exposures in adult onset asthma.

Wheat and maize thioredoxins: a novel cross-reactive cereal allergen family related to baker's asthma

BACKGROUND

Baker's asthma is a serious problem for a significant proportion of workers in bakeries, confectionaries, and the food industry. Although several wheat allergens related to baker's asthma have been described, standardized reagents for a reliable diagnosis are not yet available.

OBJECTIVE

To clone novel wheat allergens related to baker's asthma and investigate the cross-reactive potential of their maize and human homologues.

METHODS

A wheat cDNA phage display library was screened with sera from bakers with occupational asthma for IgE-binding structures. Homologous sequences from maize and human thioredoxins were amplified from corresponding cDNA libraries.

RESULTS

Within the enriched wheat cDNA repertoire we identified, among others, the sequence encoding wheat thioredoxin-hB (Triticum aestivum allergen 25 [Tri a 25]). The recombinant protein displayed enzymatic activity, and we observed a sensitization rate of 47% among bakers with occupational asthma and of 35% among patients with grass pollen allergy, but without a clinical history of cereal allergy. Furthermore, the previously characterized maize thioredoxin-h1 (Zea mays allergen 25 [Zea m 25]), sharing 74% identity with Tri a 25, exhibited distinct IgE cross-reactivity with its wheat homologue. Two bakers also showed sensitization to human thioredoxin, which shares 29% identity with Tri a 25. In a comparative study, we included recombinant alpha-amylase inhibitor 0.19, showing a sensitization rate of 65% in individuals with baker's asthma.

CONCLUSION

Thioredoxins represent a novel family of cross-reactive allergens that might contribute to the symptoms of baker's asthma and might in addition be related to grass pollen allergy, as indicated by the reactivity of grass pollen allergic patients to cereal thioredoxins.

CLINICAL IMPLICATIONS

The recombinant cereal thioredoxins will, together with the already reported wheat allergens, contribute to a more reliable diagnosis of baker's asthma and, perhaps, become a tool for the development of component-resolved immunotherapy.

Adverse reactions to foods

Food allergy encompasses a variety of immune-mediated adverse reactions to foods. IgE-mediated, cell-mediated, and mixed-mechanism food allergy disorders are recognized. Over the past 2 decades, the prevalence of food allergy doubled and its phenotypic expression increased in Westernized societies. Major food allergens have been identified for many common foods. Laboratory diagnosis of food allergy relies heavily on the detection of food-specific IgE antibodies, but novel approaches include tests for T-cell-mediated disorders and tests for prediction of tolerance. OFC remains the diagnostic standard for food allergy. Management of food allergy focuses on avoidance of the offending foods, nutritional support, and prompt recognition and treatment of acute food allergic reactions. Anti-IgE monoclonal antibody is the first potential therapy for food allergy that is under-going testing in clinical trials.

Genetically modified plants and food hypersensitivity diseases: usage and implications of experimental models for risk assessment

The recent advances in biotechnology in the plant industry have led to increasing crop production and yield that in turn has increased the usage of genetically modified (GM) food in the human food chain. The usage of GM foods for human consumption has raised a number of fundamental questions including the ability of GM foods to elicit potentially harmful immunological responses, including allergic hypersensitivity. To assess the safety of foods derived from GM plants including allergenic potential, the US FDA, Food and Agriculture Organization of the United Nations (FAO)/World Health Organization (WHO), and the EU have developed approaches for evaluation assessment. One assessment approach that has been a very active area of research and debate is the development and usage of animal models to assess the potential allergenicity of GM foods. A number of specific animal models employing rodents, pigs, and dogs have been developed for allergenicity assessment. However, validation of these models is needed and consideration of the criteria for an appropriate animal model for the assessment of allergenicity in GM plants is required. We have recently employed a BALB/c mouse model to assess the potential allergenicity of GM plants. We have been able to demonstrate that this model is able to detect differences in antigenicity and identify aspects of protein post-translational modifications that can alter antigenicity. Furthermore, this model has also enabled us to examine the usage of GM plants as a therapeutic approach for the treatment of allergic diseases. This review discusses the current approaches to assess the allergenic potential of GM food and particularly focusing on the usage of animal models to determine the potential allergenicity of GM foods and gives an overview of our recent findings and implications of these studies.

Hypersensitivity to Forcipomyia taiwana (biting midge): clinical analysis and identification of major For t 1, For t 2 and For t 3 allergens

BACKGROUND

Forcipomyia taiwana is a tiny, blood-sucking midge that cause intense pruritus and swelling in sensitive individuals. It is distributed island-wide in rural Taiwan and Southern China.

OBJECTIVE

This study aimed to study the allergic immune responses and identify F. taiwana allergens.

METHODS

Crude whole body F. taiwana extracts were prepared with phosphate-buffered saline. The specific IgE antibody was determined by enzyme-linked immunoassay and immunoblotting. Protein was analyzed by electrospray ionization tandem mass spectrometry.

RESULTS

Among the 372 subjects that were exposed to F. taiwana bites, 179 (48%) reported an immediate skin reaction with/without delay reaction and 41(11.1%) reported a solely delay reaction. The skin of 21 subjects was tested with F. taiwana extract. Of these 21 subjects, 12 (57.1%) produced immediate skin reactions and contained high levels of specific IgE antibody against F. taiwana. Immunoblotting revealed that 11 allergenic components are able to bind specific IgE. Allergens of 22, 24, 35, 36, and 64 kDa bound 50, 50, 75, 66.7, and 75% of IgE-containing sera tested, respectively. Tryptic fragments of the 24, 35, 36, and 64 kDa allergens were analyzed by ESI-MS/MS. Selected tryptic peptides of 24, 35, and 36, and 64 kDa allergens exhibited significant sequence identity with triosephosphate isomerase of Anopheles merus,Tenebrio molitor,Ochlerotatus togoi, and Chrysops vittatus, fructose 1,6-bisphosphate aldolase of Antheraea yamamai and Homalodisca coagulata, and a slow muscle myosin S1 heavy chain of Homarusamericanus and a protein with unknown function from A. gambiae, respectively. The 35 and 36 kDa proteins may represent different isoforms of the fructose 1,6-bisphosphate aldolase.

CONCLUSION

We conclude that immediate reaction to F. taiwana bites is IgE mediated and the 24 (For t 1), 35 (For t 2), and 64 kDa (For t 3) proteins are candidates for major F. taiwana allergens. Further studies are needed to confirm these allergens.

Common respiratory manifestations of food allergy: a critical focus on otitis media

Previous investigations have established the pathogenic role of food allergy in respiratory tract symptoms, which rarely occur in isolation. Specific foods have been implicated in these reactions. The role of food allergy in otitis media is controversial, probably uncommon, and further studies are needed. Food-induced asthma is more common in young pediatric patients, especially those with atopic dermatitis. Asthma induced by food allergy is considered a risk factor for fatal and near-fatal anaphylactic reactions. Moreover, food allergy can elicit airway hyperreactivity and asthmatic responses. Therefore, evaluation for food allergy should be considered among patients with recalcitrant or otherwise unexplained acute severe asthma exacerbations; asthma triggered by ingestion of particular foods; and asthma and other manifestations of food allergy (eg, anaphylaxis, moderate to severe atopic dermatitis).

Evaluation of the prevalence of antiwheat-, anti-flour dust, and anti-alpha-amylase specific IgE antibodies in US blood donors

BACKGROUND

Asthma in bakery workers is one of the most frequently occurring forms of occupational asthma in the world. Experience from other countries has shown the prevalence of sensitization (IgE) to bakery-associated allergens (BAAs) (wheat [W], flour dust [FD], alpha-amylase [AA]) in bakery workers to be 5% to 53%, whereas the prevalence in nonoccupationally exposed individuals was estimated to be 1.2% to 6.4%.

OBJECTIVE

To estimate the prevalence of BAA sensitization by measuring BAA specific IgE in the residual serum tubes of volunteer blood donors.

METHODS

Serum samples from 534 volunteer blood donors were measured for anti-W, anti-FD, and anti-AA specific IgE antibodies (in duplicate) using the AlaSTAT microplate assay. Samples with BAA IgE concentrations of 0.35 kU/L or greater were considered positive.

RESULTS

Nineteen of 530 serum samples (3.6%; 95% confidence interval [CI], 3.3%-3.9%) were positive for W (range, 0.38-3.61 kU/L), whereas 31 of 534 (5.8%; 95% CI, 5.3%-6.3%) were positive for FD (range, 0.35-2.34 kU/L) and 5 of 529 (1.0%; 95% CI, 0.9%-1.1%) were positive for AA (range, 0.38-1.59 kU/L). Thirteen serum samples were positive for both W and FD; 1 sample each was positive for W and AA and FD and AA.

CONCLUSIONS

The prevalence of IgE sensitization in serum samples from a relatively large unselected population of volunteer blood donors is 1.0% for AA, 3.6% for W, and 5.8% for FD, which agrees well with data from other countries for sensitization prevalence rates for nonoccupationally exposed individuals.

Respiratory allergy in apprentice bakers: do occupational allergies follow the allergic march?

BACKGROUND

This prospective study describes the incidence, risk factors and natural history of occupational respiratory allergy in apprentice bakers.

METHODS

Two hundred and eighty-seven apprentice bakers were examined using a questionnaire, skin prick tests (SPTs) to common and occupational allergens, evaluation of total serum IgE level and specific anti-flour and alpha-amylase IgE, before, 1 year and 2 years after the onset of vocational training. To diagnose occupational respiratory disease, spirometry, histamine and allergen-specific inhalation challenge tests were performed.

RESULTS

The incidence of work-related chest symptoms was 4.2% in the first year and 8.6% in the second year of exposure. Hypersensitivity to occupational allergens developed in 4.6 and 8.2% of subjects, respectively. The incidence of occupational allergic rhinitis was 8.4% after 1 year and 12.5% after 2 years, and that of occupational asthma/cough-variant asthma 6.1 and 8.7%, respectively. The latency period of work-related rhinitis symptoms was 11.6 +/- 7.1 months and chest symptoms 12.9 +/- 5.5 months. Only in 20% of occupational asthmatics could allergic rhinitis be diagnosed a stage earlier. In 21 out of 25 subjects with occupational asthma, chronic cough was the sole clinical manifestation of the disease. Stepwise logistic regression analysis revealed that positive SPT to common allergens was a significant risk factor of hypersensitivity to occupational allergens (OR = 10.6, 95% CI 5.27; 21.45), occupational rhinitis (OR = 3.9, 95% CI 1.71; 9.14) and occupational asthma (OR = 7.4, 95% CI 3.01; 18.04). Moreover, positive SPT to occupational allergens on entry to the training was a significant risk factor of asthma (OR = 6.9, 95% CI 0.93; 51.38).

CONCLUSIONS

The incidence of occupational asthma and rhinitis in apprentice bakers is high and increases z with the duration of exposure. Skin reactivity to common and occupational allergens is the main risk factor of bakers' asthma. Most cases of work-related respiratory symptoms among apprentice bakers are related to a specific sensitization. In most subjects who developed occupational asthma, rhinitis occurred at the same time as the chest symptoms did.

Comparison of wheat and rye flour skin prick test solutions for diagnosis of baker's asthma

BACKGROUND

Skin prick tests (SPTs) play an important role in the diagnosis of baker's asthma and in the investigation of sensitization frequencies in field studies. It was the aim of our study to compare different SPT solutions for wheat and rye flour sensitization and to assess the validity of test results.

METHODS

Skin prick tests with wheat and rye flour were performed in parallel with extracts from different companies and compared with the results of bronchial challenge tests with both flours (69 rye flour and 51 wheat flour challenge tests). Additionally, specific immunoglobulin E (sIgE) to wheat and rye flour were tested. SPT solutions were analysed for protein content and by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE).

RESULTS

Skin prick test solutions for diagnosis of wheat and rye flour sensitization from three companies differed in protein concentrations and composition with the consequence of widely differing SPT results. Sensitivity of SPTs in comparison with allergen-specific bronchial challenge as a gold standard was between 40 and 67%, specificity was between 86 and 100%, the positive predictive value (PPV) ranged from 81 to 100% and the negative predictive value (NPV) from 44 to 70%. These numbers were only marginally affected by using a combination of challenge test result and sIgE value as a more specific gold standard.

CONCLUSION

Improvement and standardization of SPT extracts for wheat and rye flour is highly recommended.

Clinical value and measurement of specific IgE

The diagnosis of human allergic diseases involves the combined use of a careful clinical history, physical examination, and in vitro and in vivo assay methods for the detection of IgE antibodies of defined allergen specificities. In vivo (skin testing) and in vitro (measurement of specific IgE in serum) techniques cannot be considered interchangeable, the former reflecting not only the presence of IgE but also mast cell integrity, vascular and neural responsiveness. Both techniques have similarities and differences, advantages and disadvantages. Recently introduced "second generation" immunoassays have continued to improve the analytical sensitivity and reproducibility thanks to automation and improved reagent quality. Quantitative assays may allow the use of specific clinical thresholds able to differentiate symptomatic from asymptomatic patients. False-negative and false-positive results should derive from lability of some major extracts, and from possible cross-reactivities, respectively. Characterization of allergens at a molecular and submolecular level and, where necessary, the use of recombinant allergens can reduce cross-reactions and further improve the quality of immunoassays.

Wheat flour exposure results in recruitment of inflammatory cells in the lungs of healthy individuals

BACKGROUND

Flour dust in bakeries is known to cause allergic as well as nonallergic respiratory symptoms. Fungal alpha-amylase is a commonly used baking additive that has been shown to have allergenic properties. The aim of this study was to investigate any effects on bronchoalveolar lavage (BAL) cells and peripheral blood lymphocytes (PBL) of healthy individuals exposed to airborne wheat flour dust with or without fungal alpha-amylase added.

METHODS

Fifteen subjects were exposed during 1 hr in an exposure chamber, ten individuals to wheat flour alone and five with alpha-amylase added. BAL was performed 2-6 weeks before and 1 day after the exposure. BAL cells were differentially counted and flowcytometric analysis of the expression of activation, adhesion, and subset markers on alveolar macrophages (AM) and T cells in BAL fluid and peripheral blood were carried out.

RESULTS

Exposure to wheat flour dust increased the total number of cells in BAL fluid from 75.4 (i.q. range 70.4-104.1) to 127.4 (92.1-187.4) cells x 10(6)/L, P < 0.01. There was a significant difference in the change of total BAL cell concentration between the study group exposed to wheat flour only (n = 10; increase with 91.9 x 10(6)/L) and the group exposed to wheat flour with the baking additive fungal alpha-amylase (n = 5; decrease with 5.4 x 10(6)/L). The exposure level of respirable dust was lower in the group that received alpha-amylase and the increase in BAL cell concentration showed a positive correlation with the concentration of respirable dust in the exposure chamber (r = 0.80, P < 0.001). The phenotypic analysis of AM indicated an influx of monocytic cells.

CONCLUSIONS

The results indicate that the concentration of respirable dust, but not alpha-amylase, is of importance for the recruitment of inflammatory cells to the peripheral airways in healthy individuals exposed to wheat flour dust.

Update on wheat hypersensitivity

PURPOSE OF REVIEW

Wheat is among the six foods responsible for approximately 90% of food allergies in children, and in recent years wheat has been increasingly recognized as a cause of food-dependent, exercise-induced anaphylaxis. Wheat flour is an important cause of baker's asthma, a well-known occupational respiratory allergy to inhaled flour. This review outlines the diverse clinical manifestations of IgE-mediated wheat hypersensitivity and summarizes recent advances in characterization of clinically significant allergens.

RECENT FINDINGS

Only a few of the numerous wheat proteins recognized by IgE of sensitized individuals have been characterized at the molecular level. Characterized allergens causing baker's asthma include several water/salt-soluble wheat proteins, however sensitization patterns show a great degree of individual variation. The insoluble gliadins have been implicated in IgE-mediated allergy to ingested wheat, and omega-5 gliadin has been identified as a major allergen in wheat-dependent, exercise-induced anaphylaxis. The presence of IgE to purified omega-5 gliadin in children was highly predictive of immediate clinical symptoms on oral wheat challenge.

SUMMARY

Diagnostic skin prick and in-vitro tests measuring sensitization against water/salt-soluble wheat proteins have poor predictive values. Quantification of gliadin-specific IgE in serum or skin prick testing with gliadin could serve as an additional tool in the diagnostic work-up of allergy to ingested wheat.

Occupational asthma caused by high-molecular-weight substances

More than 250 agents that are encountered in the workplace have been shown to induce asthma in susceptible individuals. It is estimated that 2% to 15% of cases of asthma may be occupational. High-molecular-weight substances, such as plant and animal proteins, enzymes, and large carbohydrate molecules, can induce IgE-mediated occupational asthma. The incidence of disease varies among industries and is dependent on the physiochemical properties of the agent, the level and duration of exposure, industrial hygiene, engineering practices, and host factors. Risk factors, common high-molecular-weight workplace antigens, diagnosis, treatment, and prognosis are discussed.

Humoral and cellular responses to gliadin in wheat-dependent, exercise-induced anaphylaxis

BACKGROUND

Wheat-dependent, exercise-induced anaphylaxis (WDEIA) is a severe allergy where wheat ingestion together with physical exercise induces anaphylaxis. We have previously shown that patients with WDEIA have IgE antibodies against gliadin proteins and identified omega-5 gliadin (Tri a 19) as a major allergen.

OBJECTIVE

The aim of this study was to examine gliadin-specific IgG subclass, IgA and IgE antibodies, basophil histamine release and cell-mediated responses in WDEIA.

METHODS

Sera and peripheral blood mononuclear cells (PBMC) were obtained from patients with WDEIA and from controls without wheat allergy. Serum antibodies to crude gliadin extract (CGE) and purified omega-5 gliadin were measured by ELISA and basophil reactivity by histamine-release test. Gliadin-induced cell-mediated responses were assessed by lymphocyte proliferation assay, and cytokine mRNA expression with real-time quantitative PCR.

RESULTS

All patients with WDEIA, but none of the controls, had IgE antibodies to CGE and omega-5 gliadin. Both allergens released high levels of histamine from the basophils of patients with WDEIA. Levels of IgA antibodies to CGE and omega-5 gliadin were significantly elevated in the patients, but the distribution of IgG subclass antibodies showed no statistically significant differences between the two groups. Proliferative responses of PBMC to CGE were increased in patients with WDEIA, and stimulation of PBMC with CGE caused, both in patients and in controls, a clear induction of IL-10 mRNA. Compared with the controls, induction of IL-10 mRNA expression in patients with WDEIA was significantly (P < 0.01) suppressed.

CONCLUSION

These results suggest that, in addition to IgE antibodies against omega-5 gliadin, specific IgA antibodies may be involved in the pathogenesis of WDEIA. Decreased expression of IL-10 mRNA in PBMC during gliadin stimulation may facilitate the development of gliadin-specific T cell responses.

Glucoamylase: another fungal enzyme associated with baker's asthma

BACKGROUND

Aspergillus-derived enzymes are widely used as dough additives in the baking industry. These enzymes may give rise to immunoglobulin (Ig)E-mediated sensitization and occupational asthma. Glucoamylase (or amyloglucosidase) is an important industrial enzyme obtained from Aspergillus niger and used to provide fermentable sugars for yeast to improve loaf volume and texture.

OBJECTIVE

The aim of our study was to investigate the potential allergenic role of glucoamylase in baker's asthma.

METHODS

We report four subjects with work-related allergic respiratory symptoms who were exposed to glucoamylase and other starch-cleaving enzymes used as baking additives. The causative role of glucoamylase in work-related asthma was investigated by immunologic tests and specific inhalation challenges (SIC). Glucoamylase allergenic components were characterized by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting.

RESULTS

Skin prick tests to glucoamylase (10 mg/mL) gave a positive response in all patients. Further, a positive skin prick test to alpha-amylase was obtained in the four patients and to hemicellulase in two of them. SIC to glucoamylase elicited isolated early asthmatic responses in the three patients tested, and SIC to alpha-amylase elicited early asthmatic responses in two patients and a dual asthmatic response in another patient. Immunoblotting with glucoamylase showed several IgE-binding bands with molecular masses between 33 and 96 kD. IgE-inhibition assays showed scarce to moderate allergenic cross-reactivity between glucoamylase and alpha-amylase.

CONCLUSIONS

These bakers had developed IgE-mediated occupational asthma to glucoamylase and alpha-amylase. Fungal glucoamylase is widely used as a baking additive and this enzyme may give rise to allergic respiratory reactions among exposed workers.

Allergic and latex-specific sensitization: route, frequency, and amount of exposure that are required to initiate IgE production

Quantitative data that documents human exposure-response relationships for IgE sensitization to allergens are limited. Although seemingly straightforward, documentation of exposure-response relationships can be difficult. Issues that are related to study design, allergen standardization, exposure assessment, and evaluation for sensitization can impact greatly on study results. Despite these issues, exposure-response relationships for sensitization to protein allergens have been documented in several occupational groups, which include enzyme-detergent workers, bakers, and laboratory animal workers. In general, atopy acts as an effect modifier in these settings, steepening the exposure-response relationship. Several studies suggest that the greatest risk for sensitization is within the first several years of exposure. For 1 allergen, the protease subtilisin, a short-term exposure limit of 60 ng/m(3) has been recommended by the American Council of Governmental Industrial Hygienists. With regard to natural rubber latex, exposure-related factors such as number of operations have been shown to be risk factors for sensitization of children with spina bifida. By contrast, fewer studies show exposure-response relationships for IgE sensitization of health care workers to natural rubber latex, and the area remains controversial. However, a recent cohort study that evaluated incident sensitization in dental hygiene students suggests strongly that, with sufficient exposure, employment in health care can lead to an increased risk of IgE sensitization to natural rubber latex.

IgE binding to soluble and insoluble wheat flour proteins in atopic and non-atopic patients suffering from gastrointestinal symptoms after wheat ingestion

BACKGROUND

The involvement of IgE-mediated hypersensitivity reactions in the genesis of gastrointestinal symptoms after ingestion of foods containing wheat has been rarely reported.

OBJECTIVE

To detect IgE specifically binding to wheat proteins in the sera of atopic and non-atopic patients suffering from gastrointestinal symptoms after ingestion of wheat and to evaluate the reliability of skin prick test and CAP in the diagnosis of food allergy to wheat.

METHODS

The sera of patients (10 atopic and 10 non-atopic) previously diagnosed as suffering from irritable bowel syndrome and complaining of symptoms after wheat ingestion were analysed by immunoblotting for IgE binding to water/salt-soluble and insoluble wheat flour proteins.

RESULTS

All the atopic patients and only one of the non-atopic patients were positive to wheat CAP. For the patients tested, skin prick test was positive for all the atopic patients and for only one of the non-atopic patients. However, immunoblotting experiments showed the presence of specific IgE to wheat proteins in all the patients. Ten out of 11 of the wheat CAP-positive patients had IgE binding to a soluble 16-kDa band, but the same band was recognized, in a slighter way, by only two out of nine of the wheat CAP-negative patients. Moreover, although almost all of the patients were negative in CAP testing with gluten, 19 out of 20 recognized protein bands belonging to the prolamin fraction.

CONCLUSIONS

For the atopic patients the positivity to skin prick test and CAP to wheat was in accordance with the immunoblotting results and a food allergy to wheat could be diagnosed. In these patients a major allergen was a 16-kDa band corresponding to members of the cereal alpha-amylase/trypsin inhibitors protein family, the major allergens involved in baker's asthma. In the non-atopic patients the positive immunoblotting results contrasted with the responses of the allergologic tests, indicating that the allergenic wheat protein preparations currently used are of limited value in detecting specific IgE to wheat and that the fraction of irritable bowel syndrome (IBS) patients with food allergy may be larger than believed.

A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force

This report has been prepared by an EAACI task force representing the five EAACI Sections and the EAACI Executive Committee composed of specialists that reflect the broad opinion on allergy expressed by various clinical and basic specialties dealing with allergy. The aim of this report is to propose a revised nomenclature for allergic and related reactions that can be used independently of target organ or patient age group. The nomenclature is based on the present knowledge of the mechanisms which initiate and mediate allergic reactions. However, the intention has not been to revise the nomenclature of nonallergic hypersensitivity.