Establishing a standardized quality management system for the European Health Network GA2LEN

Proteomic profiling of commercial dust mite skin prick test solutions and allergy vaccines from India

BACKGROUND

Skin prick test (SPT) solutions and allergy vaccines (AVs) are crucial tools for diagnosis and therapy of allergies. It was the aim of this study to corroborate the content of products for diagnosis and treatment of dust mite allergies that are produced and sold in India.

METHODS

SDS-PAGE, immunoblots and high-resolution mass spectrometric analysis was performed with 16 house dust mite (HDM) SPT solutions and AVs from 3 Indian manufacturers. Authority-approved European SPT solutions and in-house extracts were used as references.

RESULTS

From the 5 Indian Dermatophagoides pteronyssinus products, none contained proteins from this source. Instead, 1 sample contained Dermatophagoides farinae and human serum proteins, 4 products contained allergens from the storage mite Suidasia medanensis, allergens from the legume Cicer arietinum (chickpea), and proteins from baker's yeast. From 4 Indian D. farinae-labeled products, 2 contained human serum proteins and a limited number of D. farinae allergens. Two contained only Suidasia, Cicer, and yeast proteins. In contrast, the European authority-approved D. pteronyssinus and D. farinae SPT solutions that were used as reference in this study, contained exclusively proteins of the respective species and covered the expected allergen spectra. The Blomia tropicalis sample contained no Blomia allergens at all, but consisted exclusively of Suidasia, Cicer, and yeast proteins. All 6 HDM samples consisted of human serum proteins and limited amounts of D. farinae allergens.

CONCLUSIONS

All commercial Indian SPT solutions and AVs analyzed in this study are not suitable for dust mite allergy diagnosis and therapy, as they contain either no, or only a limited number of, HDM allergens. In addition, their use could lead to misdiagnosis since some of them contain allergens from other sources, including the storage mite Suidasia, chickpea, as well as baker's yeast. Further, their application might be harmful to patients, as some products contain large amounts of proteins of human origin. Analysis of European SPT solutions, on the other hand, confirmed their suitability for dust mite allergy diagnosis.

Exploratory analysis of CD63 and CD203c expression in basophils from hazelnut sensitized and allergic individuals

Background

Sensitization to hazelnut (HN) is frequent and requires clarification to determine whether this sensitization is clinically relevant. The aim of this study was to investigate basophil activation profiles in HN-sensitized and allergic subjects.

Methods

Basophil activation was determined by flow cytometric analyses of CD63 and CD203c expression using several HN allergen concentrations. Depending on their clinical reaction pattern, an oral allergy symptom group (OAS, n = 20), a systemic reaction group (n = 12) and a sensitized group without clinical symptoms (n = 20) were identified. Additionally, 10 non-allergic and non-sensitized individuals served as controls.

Results

CD63 and CD203c expression differed between allergic (OAS and systemic group) and sensitized subjects. The HN concentration required to activate 30% of CD203c⁺ basophils [effective concentration (EC)30] was significantly higher in sensitized versus the allergic group (p = 0.0089). This was more pronounced when the basophil allergen threshold sensitivity (CD-sens) was calculated (CD63: p = 0.018; CD203c: p = 0.009).

Conclusion

Our data indicate that the basophil activation test may provide information to better distinguish between sensitized and allergic subjects if several allergen concentrations are considered. CD203c expression displayed a better discrimination compared to CD63; therefore, its diagnostic value might be superior compared with CD63.

Electronic supplementary material

The online version of this article (doi:10.1186/s13601-016-0134-7) contains supplementary material, which is available to authorized users.

Definition, aims, and implementation of GA(2) LEN Urticaria Centers of Reference and Excellence

BACKGROUND

GA²LEN, the Global Allergy and Asthma European Network, has recently launched a program for the development, interaction, and accreditation of centers of reference and excellence in special areas of allergy embedded in its overall quality management of allergy centers of excellence. The first area chosen is urticaria. Urticaria is a common and debilitating condition and can be a challenge for both patients and treating physicians, especially when chronic. Centers of reference and excellence in urticaria (UCAREs) can help to improve the management of hard-to-treat conditions such as urticaria.

AIMS

Here, we describe the aims, the requirements and deliverables, the application process, and the audit and accreditation protocol for GA²LEN UCAREs.

RESULTS

The main aims of GA²LEN UCAREs are to provide excellence in urticaria management, to increase the knowledge of urticaria by research and education, and to promote the awareness of urticaria by advocacy activities. To become a certified GA²LEN UCARE, urticaria centers have to apply and fulfill 32 requirements, defined by specific deliverables that are assessed during an audit visit.

DISCUSSION AND CONCLUSION

The GA²LEN UCARE program will result in a strong network of urticaria specialists, promote urticaria research, and harmonize and improve urticaria management globally.

Monosensitization and polysensitization in allergic rhinitis

BACKGROUND

Polysensitization is common in patients with allergic rhinitis (AR) and may affect clinical feature. However, there are patients who remain monosensitized.

OBJECTIVE

This cross-sectional study aimed at evaluating a large cohort of AR patients to define the percentage and the features of mono- and poly-sensitized subjects.

METHODS

This observational cross-sectional study included a large group of AR patients: 2415 subjects (1958 males, mean age 24.6 ± 5 years) were consecutively evaluated. Symptom severity, type and number of sensitizations, and AR duration were considered.

RESULTS

621 patients (25.7%) were monosensitized: 377 to Parietaria, 194 to house dust mites, 19 to birch, 17 to grasses, 12 to molds, 2 to olive, and 1 to cypress. There was no difference between mono- and polysensitized patients concerning the duration of rhinitis (6 ± 2.14 years vs 6 ± 3.7). Severity of symptoms was higher in polysensitized patients than in monosensitized (p<0.05); in addition, there was a difference among monosensitized patients: Parietaria-allergy induces the most severe symptoms.

CONCLUSION

This study conducted in a large AR population might suggest that monosensitized and polysensitized AR patients could constitute two different categories. In addition, the specific type of allergy may condition the clinical feature.