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Suriyamoorthy P, Madhuri A, Tangirala S, Michael KR, Sivanandham V, Rawson A, Anandharaj A. Comprehensive Review on Banana Fruit Allergy: Pathogenesis, Diagnosis, Management, and Potential Modification of Allergens through Food Processing. PLANT FOODS FOR HUMAN NUTRITION (DORDRECHT, NETHERLANDS) 2022; 77:159-171. [PMID: 35661960 DOI: 10.1007/s11130-022-00976-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
The pulp of the banana fruit is rich in bioactive compounds like dietary fibers, low glycemic carbohydrates, natural sugars, vitamins, minerals and antioxidants. These beneficial compounds are responsible for the proper functioning of immune system and enhance prevention against various deadly diseases like cancer, diabetes and heart diseases. Despite having, positive effects, the fruit are recognized as an important source for causing allergy to 0.6% of people in general population and up to 67 and 46% for people with asthma or atopic dermatitis. Fruit allergy is one of the most common food allergies witnessed worldwide. Banana fruit allergy results from the abnormal immune response to the banana proteins soon after its consumption. Symptoms range from oral allergy syndrome (OAS) to the life-threatening anaphylaxis. IgE reactivity of banana is associated with different proteins of which six proteins have been identified as major allergens, viz., Mus a1 (Profilin-actin binding protein), Mus a 2 (Class 1 chitinase), Mus a 3 (Nonspecific lipid transfer protein), Mus a 4 (Thaumatin like protein), Mus a 5 (Beta 1,3 glucanase) and Mus a 6 (Ascorbate peroxidase). This review focuses on pathogenesis, clinical features, diagnosis, and different food processing methods to mitigate the allergenicity of banana fruit.
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Affiliation(s)
- Priyanga Suriyamoorthy
- Department of Food Safety and Quality Testing, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India
| | - Alluru Madhuri
- Academics and Human Resources Department, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India
| | - Srikanth Tangirala
- Department of Food Safety and Quality Testing, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India
- Centre of Excellence in Non-Thermal Processing, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India
| | - Karunai Raj Michael
- Department of Food Safety and Quality Testing, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India
| | - Vignesh Sivanandham
- Academics and Human Resources Department, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India
| | - Ashish Rawson
- Department of Food Safety and Quality Testing, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India.
- Centre of Excellence in Non-Thermal Processing, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India.
| | - Arunkumar Anandharaj
- Department of Food Safety and Quality Testing, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India.
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Gabrielli S, Clarke AE, Morris J, Gravel J, Lim R, Chan ES, Goldman RD, O'Keefe A, Gerdts J, Chu DK, Upton J, Hochstadter E, Moisan J, Bretholz A, McCusker C, Zhang X, Protudjer JLP, Abrams EM, Simons E, Ben-Shoshan M. Fruit-Induced Anaphylaxis: Clinical Presentation and Management. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2825-2830.e2. [PMID: 33727108 DOI: 10.1016/j.jaip.2021.02.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Data are sparse regarding the clinical characteristics and management of fruit-induced anaphylaxis. OBJECTIVE To assess clinical characteristics and management of patients with fruit-induced anaphylaxis and determine factors associated with severe reactions and epinephrine use. METHODS Over 9 years, children and adults presenting with anaphylaxis to seven emergency departments in four Canadian provinces and patients requiring emergency medical services in Outaouais, Quebec were recruited as part of the Cross-Canada Anaphylaxis Registry. A standardized form documenting symptoms, triggers, and management was collected. Multivariate logistic regression was used to identify factors associated with severe reactions and epinephrine treatment in the pre-hospital setting. RESULTS We recruited 250 patients with fruit-induced anaphylaxis, median age 10.2 years (interquartile range, 3.6-23.4 years); 48.8% were male. The most common fruit triggers were kiwi (15.6%), banana (10.8%), and mango (9.2%). Twenty-three patients reported having eczema (9.3%). Epinephrine use was low in both the pre-hospital setting and the emergency department (28.4% and 40.8%, respectively). Severe reactions to fruit were more likely to occur in spring and among those with eczema (adjusted odds ratio [aOR] = 1.12, 95% confidence interval [CI], 1.03-1.23; and 1.17, 95% CI, 1.03-1.34, respectively). Patients with moderate and severe reactions (aOR = 1.23; 95% CI, 1.06-1.43) and those with a known food allergy (aOR = 1.38; 95% CI, 1.24-1.54) were more likely to be treated with epinephrine in the pre-hospital setting. CONCLUSIONS Severe anaphylaxis to fruit is more frequent in spring. Cross-reactivity to pollens is a potential explanation that should be evaluated further.
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Affiliation(s)
- Sofianne Gabrielli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
| | - Ann E Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Judy Morris
- Department of Emergency Medicine, Sacré-Coeur Hôpital, Montreal, QC, Canada
| | - Jocelyn Gravel
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Rodrick Lim
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at London Health Science Centre, London, ON, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Ran D Goldman
- Division of Clinical Pharmacology and Emergency Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Andrew O'Keefe
- Department of Pediatrics, Faculty of Medicine, Memorial University, St John's, NL, Canada
| | | | - Derek K Chu
- Division of Clinical Immunology and Allergy, Department of Medicine, and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Julia Upton
- Division of Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Elana Hochstadter
- Department of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jocelyn Moisan
- Emergency Medical Services of Outaouais, Outaouais, QC, Canada
| | - Adam Bretholz
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, Montreal, QC, Canada
| | - Christine McCusker
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Xun Zhang
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Elinor Simons
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
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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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Thongkhom R, Oncham S, Sompornrattanaphan M, Laisuan W. Banana anaphylaxis in Thailand: case series. Asia Pac Allergy 2020; 10:e4. [PMID: 32099826 PMCID: PMC7016326 DOI: 10.5415/apallergy.2020.10.e4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 01/22/2020] [Indexed: 11/24/2022] Open
Abstract
Background Banana fruit has been recognized as an important food allergen source. Nowadays banana hypersensitivity had been reported more frequently with various presentations from oral allergy syndrome to anaphylaxis. Objective This study aims to describe the pattern of banana hypersensitivity and the sensitivity of diagnostic test. Methods Six patients who experienced banana hypersensitivity were recruited from adult allergy clinic, Ramathibodi Hospital, Mahidol University between 2015–2018. Demographic data, pattern of banana allergy consisted of the onset of reaction, symptoms, severity, cross-reactivity to kiwi, avocado, latex including type and amount of banana were collected. Skin test, serum specific IgE to banana and open-label food challenge test had been applied. Results All patients experienced multiple episodes of banana anaphylaxis. Regarding the diagnostic investigation, prick-to-prick skin test had higher sensitivity (sensitivity, 100%; 95% confidence interval [CI], 54.07%–100%) than the commercial banana extract (sensitivity, 83.33%; 95% CI, 35.88%–99.58%) and serum specific IgE to banana (sensitivity, 50%; 95% CI, 11.81%–88.19%). The discordance between skin prick test using commercial banana extract and skin test was reported. The cross-reactivity between the species of banana, kiwi, the avocado was documented in all patients. Latex skin prick test and application test were applied with negative results. From the oral food challenge test, a case of banana anaphylaxis patient can tolerate heated banana. Conclusion The various phenotypes of banana hypersensitivity were identified. The prick-to-prick test showed the highest sensitivity for diagnosis of banana allergy. However, component resolved diagnostics might be needed for conclusive diagnosis.
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Affiliation(s)
- Ratchataporn Thongkhom
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Supa Oncham
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Mongkhon Sompornrattanaphan
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wannada Laisuan
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Suh SM, Park SB, Kim MJ, Kim HY. Simultaneous detection of fruit allergen-coding genes in tomato, apple, peach and kiwi through multiplex PCR. Food Sci Biotechnol 2019; 28:1593-1598. [PMID: 31695960 PMCID: PMC6811467 DOI: 10.1007/s10068-019-00591-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/22/2019] [Accepted: 02/22/2019] [Indexed: 10/27/2022] Open
Abstract
Fruit allergies have become more common in recent years, and are now a serious health problem. In this study, a multiplex PCR assay was used to detect potential fruit allergens causing food allergy labeling in Korea. For the detection of these allergens, specific primer pairs were designed to amplify the allergen-coding genes Cyclophilin (tomato), Mdtl 1 (apple), Pru p 2.01A (peach) and Pectin methylesterase inhibitor (kiwi), and primer pair targeting the 18S ribosomal RNA gene was additionally used as an endogenous control. Primer specificity was assessed with 23 plant species. A mixture of DNA from the four fruits was serially diluted and used to determine the sensitivity of the multiplex PCR assay, which was approximately 0.08 ng. Eleven commercial fruit products were evaluated to verify the applicability of the multiplex PCR assay. This assay is expected to be a specific and efficient method for detecting fruit allergens in foods.
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Affiliation(s)
- Seung-Man Suh
- Institute of Life Sciences and Resources, Department of Food Science and Biotechnology, Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin, 17104 Republic of Korea
| | - Saet-Byul Park
- Institute of Life Sciences and Resources, Department of Food Science and Biotechnology, Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin, 17104 Republic of Korea
| | - Mi-Ju Kim
- Institute of Life Sciences and Resources, Department of Food Science and Biotechnology, Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin, 17104 Republic of Korea
| | - Hae-Yeong Kim
- Institute of Life Sciences and Resources, Department of Food Science and Biotechnology, Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin, 17104 Republic of Korea
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Kong N, Kim S, Lee SC, Park KH, Lee JH, Park JW. Subcutaneous Immunotherapy in Patients with Fagales Pollen-Induced Oral Allergy Syndrome. Yonsei Med J 2019; 60:389-394. [PMID: 30900426 PMCID: PMC6433571 DOI: 10.3349/ymj.2019.60.4.389] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/02/2019] [Accepted: 02/22/2019] [Indexed: 11/27/2022] Open
Abstract
Oral allergy syndrome (OAS) is the most common food allergy-related condition in adults. This study aimed to investigate whether subcutaneous immunotherapy (SCIT) with Fagales pollen-containing extracts can improve the clinical symptoms of OAS in Korea. In total, 56 OAS patients were included: 19 subjects treated with SCIT, which included Fagales pollen extracts, and 37 not treated with immunotherapy (IT). We reviewed the patients' medical records and administered a telephone questionnaire at one point to assess baseline OAS features and changes in the patients' OAS and allergic rhinoconjunctivitis (ARC) symptoms after treatment. Only 12 patients who received SCIT and 15 patients that did not receive SCIT could report on changes in OAS symptoms after treatment because the other patients practiced strict avoidance of their culprit fruits and vegetables, and they could not respond to the status of OAS. SCIT reduced the severity of OAS (p=0.005). Nine of the 12 patients (75%) that received SCIT reported a more than 50% reduction in OAS symptoms. In contrast, only three of the 15 patients (20%) that did not receive IT reported more than a 50% reduction in OAS symptoms. SCIT also reduced the severity of ARC symptoms (p<0.001). The results indicate that SCIT with Fagales pollen-containing extracts is associated with improved OAS symptoms in Korea.
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Affiliation(s)
- Nasil Kong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sunyoung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Chul Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hee Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hyun Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Won Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea.
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Ukleja-Sokołowska N, Zacniewski R, Gawrońska-Ukleja E, Żbikowska-Gotz M, Lis K, Sokołowski Ł, Adamczak R, Bartuzi Z. Food-dependent, exercise-induced anaphylaxis in a patient allergic to peach. Int J Immunopathol Pharmacol 2018; 32:2058738418803154. [PMID: 30270687 PMCID: PMC6168719 DOI: 10.1177/2058738418803154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Determining the single factor that triggered anaphylactic shock can be challenging. We present an interesting case of a 25-year-old female patient with recurrent anaphylactic reactions developing after eating various foods, particularly in presence of co-factors of allergic reactions. Symptoms occurred after consumption of various kinds of foods - peach, pancakes with cottage cheese and fruit, a meal from a Chinese restaurant - all eaten on other occasions without symptoms. During diagnosis, skin prick tests were negative for all tested allergen extracts (both inhalatory and food) from Allergopharma. Prick by prick tests were positive for the peach - wheal diameter - 6 mm, nectarine - 4 mm (histamine 4 mm, negative control 0 mm). Increased levels of asIgE were found for allergens of peach (0.55 kU/L).Open challenge test with one mid-size peach combined with the physical exercise challenge test was positive. ImmunoCAP ISAC test indicated increased levels of IgE specific for the lipid transfer protein (LTP) for walnut (nJug r 3), peach (Pru p 3), wheat (rTri a 14) and plane tree (rPla a 3). The patient was diagnosed with food-dependent, exercise-induced anaphylaxis associated with an allergy to lipid transport proteins (LTPs).
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Affiliation(s)
- Natalia Ukleja-Sokołowska
- 1 Department of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Robert Zacniewski
- 1 Department of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Ewa Gawrońska-Ukleja
- 1 Department of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Magdalena Żbikowska-Gotz
- 1 Department of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Kinga Lis
- 1 Department of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Łukasz Sokołowski
- 2 Division of Ergonomics and Exercise Physiology, Department of Hygiene, Epidemiology and Ergonomics, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Rafał Adamczak
- 3 Department of Obstetrics and Gynecology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Zbigniew Bartuzi
- 1 Department of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
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Farshidi N, Moghaddam M, Yaghoubi V, Ayati SH, Varasteh AR, Sankian M. Type IV chitinase quantification in four different grape cultivars (Vitis vinifera) in northeast of Iran by an indirect sandwich enzyme-linked immunosorbent assay. J Immunoassay Immunochem 2018; 40:139-148. [PMID: 30346872 DOI: 10.1080/15321819.2018.1535439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The incidence of grape (Vitis vinifera) allergy in the northeast of Iran is second to melon allergy. Type IV chitinase is one of the major grape allergens. The current study investigates the level of type IV chitinase in four grape variants for the first time in Khorasan Razavi Province using a highly sensitive sandwich enzyme-linked immunosorbent assay (ELISA). This assay was developed using a polyclonal antibody as a capture antibody and monoclonal antibody as a secondary one. Finally, the amount of type IV chitinase was measured by the validated ELISA test. The sensitivity of the developed sandwich ELISA is 16 ± 0.05 ng/ml, and its mean coefficients of intraday and interday variations are <5% and <15%, respectively. The recovery of the designed ELISA is 64 ± 0.9 %. The assessments showed that the highest level of type IV chitinase was 39.7 ± 2.3 μg/g in Peykani grape, whereas in the Sultana cultivar, it was 1.76 ± 0.1 μg/g. According to the data, the level of type IV chitinase is variable in different cultivars, and hence, it will be helpful for clinicians to recommend a less allergenic variety to the patient.
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Affiliation(s)
- Narges Farshidi
- a Immunology research center , Mashhad University of Medical Sciences, VakilAbad , Mashhad , Khorasan Razavi province , Iran (the Islamic Republic of)
| | - Maliheh Moghaddam
- b Department of Immunobiochemistry , Bu-Ali Research Institute , Mashhad , Iran (the Islamic Republic of)
| | - Vahid Yaghoubi
- c Immunology research center , Mashhad University of Medical Sciences , Mashhad , Iran (the Islamic Republic of)
| | - Seyed Hasan Ayati
- c Immunology research center , Mashhad University of Medical Sciences , Mashhad , Iran (the Islamic Republic of)
| | - Abdol-Reza Varasteh
- d Department of Immunology , School of Medicine Mashhad University of Medical Sciences , Mashhad , Iran (the Islamic Republic of)`
| | - Mojtaba Sankian
- e Immunology, Buali Research center , School of Medicine Mashhad University of Medical Sciences , Mashhad , Iran (the Islamic Republic of)
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Ukleja-Sokołowska N, Gawrońska-Ukleja E, Żbikowska-Gotz M, Bartuzi Z, Sokołowski Ł. Sunflower seed allergy. Int J Immunopathol Pharmacol 2016; 29:498-503. [PMID: 27222528 DOI: 10.1177/0394632016651648] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 05/03/2016] [Indexed: 01/31/2023] Open
Abstract
Sunflower seeds are a rare source of allergy, but several cases of occupational allergies to sunflowers have been described. Sunflower allergens on the whole, however, still await precise and systematic description. We present an interesting case of a 40-year-old male patient, admitted to hospital due to shortness of breath and urticaria, both of which appeared shortly after the patient ingested sunflower seeds. Our laryngological examination revealed swelling of the pharynx with retention of saliva and swelling of the mouth and tongue. During diagnostics, 2 months later, we found that skin prick tests were positive to mugwort pollen (12/9 mm), oranges (6/6 mm), egg protein (3/3 mm), and hazelnuts (3/3 mm). A native prick by prick test with sunflower seeds was strongly positive (8/5 mm). Elevated concentrations of specific IgE against weed mix (inc. lenscale, mugwort, ragweed) allergens (1.04 IU/mL), Artemisia vulgaris (1.36 IU/mL), and Artemisia absinthium (0.49 IU/mL) were found. An ImmunoCap ISAC test found an average level of specific IgE against mugwort pollen allergen component Art v 1 - 5,7 ISU-E, indicating an allergy to mugwort pollen and low to medium levels of specific IgE against lipid transfer proteins (LTP) found in walnuts, peanuts, mugwort pollen, and hazelnuts. Through the ISAC inhibition test we proved that sunflower seed allergen extracts contain proteins cross-reactive with patients' IgE specific to Art v 1, Art v 3, and Jug r 3. Based on our results and the clinical pattern of the disease we confirmed that the patient is allergic to mugwort pollen and that he had an anaphylactic reaction as a result of ingesting sunflower seeds. We suspected that hypersensitivity to sunflower LTP and defensin-like proteins, both cross-reactive with mugwort pollen allergens, were the main cause of the patient's anaphylactic reaction.
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Affiliation(s)
- Natalia Ukleja-Sokołowska
- Department and Clinic of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz NCU, Poland
| | - Ewa Gawrońska-Ukleja
- Department and Clinic of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz NCU, Poland
| | - Magdalena Żbikowska-Gotz
- Department and Clinic of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz NCU, Poland
| | - Zbigniew Bartuzi
- Department and Clinic of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz NCU, Poland
| | - Łukasz Sokołowski
- Department of Hygiene, Epidemiology and Ergonomics, Division of Ergonomics and Exercise Physiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz NCU, Poland
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Goodman RE, Ebisawa M, Ferreira F, Sampson HA, van Ree R, Vieths S, Baumert JL, Bohle B, Lalithambika S, Wise J, Taylor SL. AllergenOnline: A peer-reviewed, curated allergen database to assess novel food proteins for potential cross-reactivity. Mol Nutr Food Res 2016; 60:1183-98. [PMID: 26887584 DOI: 10.1002/mnfr.201500769] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 02/04/2016] [Accepted: 02/09/2016] [Indexed: 01/15/2023]
Abstract
SCOPE Increasingly regulators are demanding evaluation of potential allergenicity of foods prior to marketing. Primary risks are the transfer of allergens or potentially cross-reactive proteins into new foods. AllergenOnline was developed in 2005 as a peer-reviewed bioinformatics platform to evaluate risks of new dietary proteins in genetically modified organisms (GMO) and novel foods. METHODS AND RESULTS The process used to identify suspected allergens and evaluate the evidence of allergenicity was refined between 2010 and 2015. Candidate proteins are identified from the NCBI database using keyword searches, the WHO/IUIS nomenclature database and peer reviewed publications. Criteria to classify proteins as allergens are described. Characteristics of the protein, the source and human subjects, test methods and results are evaluated by our expert panel and archived. Food, inhalant, salivary, venom, and contact allergens are included. Users access allergen sequences through links to the NCBI database and relevant references are listed online. Version 16 includes 1956 sequences from 778 taxonomic-protein groups that are accepted with evidence of allergic serum IgE-binding and/or biological activity. CONCLUSION AllergenOnline provides a useful peer-reviewed tool for identifying the primary potential risks of allergy for GMOs and novel foods based on criteria described by the Codex Alimentarius Commission (2003).
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Affiliation(s)
- Richard E Goodman
- Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Motohiro Ebisawa
- Department of Allergy, Sagamihara National Hospital, Sagamihara, Japan
| | - Fatima Ferreira
- Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - Hugh A Sampson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ronald van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - Stefan Vieths
- Department of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - Joseph L Baumert
- Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Barbara Bohle
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Sreedevi Lalithambika
- Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - John Wise
- Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Steve L Taylor
- Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska-Lincoln, Lincoln, NE, USA
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11
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Chokshi NY, Sicherer SH. Interpreting IgE sensitization tests in food allergy. Expert Rev Clin Immunol 2015; 12:389-403. [DOI: 10.1586/1744666x.2016.1124761] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Omidi A, Sauvage C, Vandezande L, Wallaert B. La LTP du cannabis : une voie de sensibilisation aux LTP alimentaires. REVUE FRANCAISE D ALLERGOLOGIE 2015. [DOI: 10.1016/j.reval.2015.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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Scientific Opinion on the evaluation of allergenic foods and food ingredients for labelling purposes. EFSA J 2014. [DOI: 10.2903/j.efsa.2014.3894] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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14
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Skypala IJ, Bull S, Deegan K, Gruffydd-Jones K, Holmes S, Small I, Emery PW, Durham SR. The prevalence of PFS and prevalence and characteristics of reported food allergy; a survey of UK adults aged 18-75 incorporating a validated PFS diagnostic questionnaire. Clin Exp Allergy 2013; 43:928-40. [DOI: 10.1111/cea.12104] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 02/12/2013] [Accepted: 02/14/2013] [Indexed: 12/16/2022]
Affiliation(s)
- I. J. Skypala
- Royal Brompton & Harefield NHS Foundation Trust; London UK
| | - S. Bull
- Old Leake Medical Centre; Boston UK
| | - K. Deegan
- Upper Norwood Group Practice; Croydon UK
| | | | | | - I. Small
- Peterhead Health Centre; Aberdeenshire UK
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15
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Chen JYF, Quirt J, Lee KJ. Proposed new mechanism for food and exercise induced anaphylaxis based on case studies. Allergy Asthma Clin Immunol 2013; 9:11. [PMID: 23509907 PMCID: PMC3608993 DOI: 10.1186/1710-1492-9-11] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 02/15/2013] [Indexed: 11/10/2022] Open
Abstract
We present two cases of food and exercise-induced anaphylaxis (FEIA) in patients with a diagnosis of oral allergy syndrome (OAS) to the implicated foods. Patient A had FEIA attributed to fresh coriander and tomato and Patient B to fresh celery. These food allergens have been implicated in OAS and have structural antigenic similarity to that of birch and/or grass. Both patients' allergies were confirmed by fresh skin prick tests. In both cases, strenuous exercise was antecedent to the systemic anaphylaxis reaction and subsequent ingestion without exercise produced only local symptoms of perioral pruritus. We review the current proposed mechanisms for food and exercise induced anaphylaxis to oral allergens and propose a novel and more biologically plausible mechanism. We hypothesize that the inhibitory effects of exercise on gastric acid secretion decreases the digestion of oral allergens and preserves structural integrity, thereby allowing continued systemic absorption of the allergen whether it be profilins, lipid transfer proteins, or other antigenic determinants.
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Affiliation(s)
- Jennifer Yan Fei Chen
- Division of Allergy and Clinical Immunology, St, Michael's Hospital, University of Toronto, Toronto, ON, Canada.
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16
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Pascal M, Muñoz-Cano R, Reina Z, Palacín A, Vilella R, Picado C, Juan M, Sánchez-López J, Rueda M, Salcedo G, Valero A, Yagüe J, Bartra J. Lipid transfer protein syndrome: clinical pattern, cofactor effect and profile of molecular sensitization to plant-foods and pollens. Clin Exp Allergy 2013; 42:1529-39. [PMID: 22994350 DOI: 10.1111/j.1365-2222.2012.04071.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Multiple plant-food sensitizations with a complex pattern of clinical manifestations are a common feature of lipid transfer protein (LTP)-allergic patients. Component-resolved diagnosis permits the diagnosis of the allergen sensitization profile. OBJECTIVE We sought to clinically characterize and describe the plant-food and pollen molecular sensitization profile in patients with LTP syndrome. METHODS Forty-five subjects were recruited, after being diagnosed with multiple plant-food allergies sensitized to LTP, but not to any other plant-food allergen, according to the molecular allergen panel tested (Pru p 3 (LTP), Pru p 1 (Bet v 1-like), Pru p 4 (profilin) and those included in a commercial microarray of 103 allergenic components). IgE-mediated food-allergy symptoms and pollinosis were collected. Patients were skin prick tested with a plant-food and pollens panel, and specific IgE to Tri a 14 was evaluated. RESULTS A heterogeneous group of plant-foods was involved in local and systemic symptoms: oral allergy syndrome (75.6%), urticaria (66.7%), gastrointestinal disorders (55.6%) and anaphylaxis (75.6%), 32.4% of which were cofactor dependent (Non-Steroidal Anti-inflammatory Drugs, exercise). All tested subjects were positive to peach and Pru p 3, Tri a 14 and to some of the LTPs included in the microarray. Pollinosis was diagnosed in 75.6% of subjects, with a broad spectrum of pollen and pollen-allergen sensitization. Plane tree and mugwort were the statistically significant pollens associated with Pru p 3. CONCLUSIONS AND CLINICAL RELEVANCE Several plant-foods, taxonomically unrelated, independent of peach involvement, are implicated in LTP syndrome. Local symptoms should be evaluated as a risk marker for anaphylaxis because they are frequently associated with cofactor-dependent anaphylaxis. The association of these symptoms with pollinosis, especially plane tree pollinosis, could be part of this syndrome in our area.
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Affiliation(s)
- M Pascal
- Servei d'Immunologia, Centre de Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain
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17
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Wang HY, Gao ZS, Yang ZW, Shao JX, Zhao XZ, Dai Y, Van Ree R. Anaphylaxis and generalized urticaria from eating Chinese bayberry fruit. J Zhejiang Univ Sci B 2013; 13:851-4. [PMID: 23024053 DOI: 10.1631/jzus.b1200150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chinese bayberry Myrica rubra is a very popular fruit in southeastern China. In spite of its wide consumption, no allergies to this fruit have been reported previously. Here we report on a 40-year-old woman suffering from anaphylaxis to Chinese bayberry fruit. Prick-prick skin tests revealed strong reactions to fresh Chinese bayberry fruits as well as to peach, and weaker reactions to some other fruits including apple, melon, and banana. ImmunoCAP analysis revealed identical titers of specific IgE (4.3 kU(A)/L) to peach extract and its lipid transfer protein (LTP, rPru p 3), which was confirmed by detection of a 9 kD band following immunoblotting. Immunoblot analysis with Chinese bayberry extract gave bands of 22, 45, and 90 kD, but no 9 kD band was recognized. There was also no evidence of LTP recognition for loquat (36 kD) or melon (24 kD). This first report of a severe allergic reaction to Chinese bayberry fruit in a patient with LTP-mediated peach allergy indicates that other as yet unidentified non-pollen related fruit allergens are involved in this new severe fruit allergy.
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Affiliation(s)
- Hui-ying Wang
- Department of Allergy and Clinical Immunology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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18
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Sekerkova A, Polackova M, Striz I. Detection of Phl p 1, Phl p 5, Phl p 7 and Phl p 12 specific IgE antibodies in the sera of children and adult patients allergic to Phleum pollen. Allergol Int 2012; 61:339-46. [PMID: 22526205 DOI: 10.2332/allergolint.11-oa-0372] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 12/27/2011] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Grasses belong to major sources of inhaled allergens. The knowledge of particular molecules responsible for hypersensitivity is of crucial importance for better understanding of individual differences among single allergic subjects and allergic populations living in various world-areas. METHODS Specific-IgE-antibodies against Phl p 1, Phl p 5, Phl p 7, Phl p 12 were detected in a group of 130 Phleum-allergic-subjects (82 children, 48 adults). RESULTS Phl p 1 antibodies were detected in most pediatric and adult patients, however, the children were associated with higher RAST classes more often. Anti-Phl p 5-antibodies were found more frequently in adults. An increase was observed in the number of pediatric patients reacting to Phl p 7 and Phl p 12. There were no differences in concentrations of specific-IgE against Phl p 5, Phl p 7 and Phl p 12 depending on age. Almost 10% of allergic children produced antibodies directed exclusively against minor allergens or did not produce specific-IgE-antibodies against tested molecules. Part of the patients reacted to profilin and calcium-binding protein originating from only one source (Phl p 12/Bet v 2 and Phl p 7/Bet v 4). CONCLUSIONS Antibodies against Phl p 1 and Phl p 5 can be used as a marker of allergy to grasses in adult patients. Children reacted exclusively to minor allergens more frequently than adults. Prolonged allergen exposure is evidently necessary to induce sensitization to Phl p 5. A high level of homology between profilins and calcium-binding proteins enables only one allergen to be used for diagnostic purposes but a possibility of a reaction to species-bound epitopes should be taken into account.
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Affiliation(s)
- Alena Sekerkova
- Department of Clinical and Transplant Immunology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
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19
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Skypala I. Adverse Food Reactions—An Emerging Issue for Adults. ACTA ACUST UNITED AC 2011; 111:1877-91. [DOI: 10.1016/j.jada.2011.09.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 05/20/2011] [Indexed: 01/03/2023]
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20
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Soukhtanloo M, Falak R, Sankian M, Varasteh AR. Generation and characterization of anti-chitinase monoclonal antibodies. Hybridoma (Larchmt) 2011; 30:145-51. [PMID: 21529287 DOI: 10.1089/hyb.2010.0088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Class IV chitinase, an allergenic protein of Vitis vinifera (grape), was purified by anion exchange chromatography and used for immunization of Balb/c mice. Monoclonal antibodies (MAbs) were raised by hybridoma technology using Sp2/0 myeloma cells. Finally after three limiting dilutions, six stable clones were generated. Antibody isotyping showed that IgG(2a), IgG(2b), and IgM were produced by one, two, and three of the clones, respectively. All of the MAbs had kappa light chain. The affinities were in the range of 3 × 10(8) to 1.2 × 10(9) M(-1). The MAbs were specific for grape chitinase as confirmed by Western blotting. In conclusion, we successfully produced several MAbs against grape class IV chitinase, which could be used for assessment of this allergen in different grape cultivars.
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Affiliation(s)
- Mohammad Soukhtanloo
- Department of Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Khorasan Razavi, Islamic Republic of Iran
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Skypala IJ, Calderon MA, Leeds AR, Emery P, Till S, Durham SR. Development and validation of a structured questionnaire for the diagnosis of oral allergy syndrome in subjects with seasonal allergic rhinitis during the UK birch pollen season. Clin Exp Allergy 2011; 41:1001-11. [DOI: 10.1111/j.1365-2222.2011.03759.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Aira MJ, Rodríguez-Rajo FJ, Fernández-González M, Jato V. Airborne pollen of ornamental tree species in the NW of Spain. ENVIRONMENTAL MONITORING AND ASSESSMENT 2011; 173:765-775. [PMID: 20300833 DOI: 10.1007/s10661-010-1421-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 02/25/2010] [Indexed: 05/29/2023]
Abstract
This study analyzed airborne pollen counts for the tree taxa most widely used for ornamental purposes in the northwestern Iberian Peninsula (Platanus, Cupressaceae, Olea, Myrtaceae, Cedrus, and Casuarina) at four sites (Vigo, Ourense, Santiago, and Lugo), using aerobiological data recorded over a long period (1993-2007). The abundance and the temporal and spatial distribution of these pollen types were analyzed, and the influence of weather-related factors on airborne pollen counts was assessed. Platanus (in Ourense) and Olea (in Vigo) were the taxa contributing most to pollen counts. In general terms, the results may be taken as indicators of potential risk for pollen-allergy sufferers and therefore used in planning future green areas.
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Affiliation(s)
- María Jesús Aira
- Departamento de Botánica, Facultad de Farmacia, Universidad de Santiago de Compostela, Campus Sur, 15782, Santiago, Spain.
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Abstract
PURPOSE OF REVIEW This paper reviews current concepts in our understanding of oral allergy or pollen-food syndrome. As technology has improved, much more accurate profiling of food allergic individuals is now possible, resulting in more precise diagnosis, elucidation of cross reactivity patterns and more helpful prediction of risk of anaphylaxis. RECENT FINDINGS The identification and characterization of various ubiquitous plant proteins have led to greater understanding of food cross reactive reactions. Newer diagnostic techniques utilizing purified and recombinant allergens are available for more precise diagnosis and clinical profiling of patients presenting with food allergy. SUMMARY In-vitro screening of food allergic patients with large panels of allergens will change the accuracy of diagnosis resulting in better management. Allergens are now available for use in the allergist's office to improve diagnostic accuracy of skin tests in patients presenting with plant-food allergy. Knowledge of the specific sensitization of individual patients has consequences for both risk assessment and dietary management.
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De Knop KJ, Bridts CH, Verweij MM, Hagendorens MM, De Clerck LS, Stevens WJ, Ebo DG. Component-resolved allergy diagnosis by microarray: potential, pitfalls, and prospects. Adv Clin Chem 2010; 50:87-101. [PMID: 20521442 DOI: 10.1016/s0065-2423(10)50005-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diagnosis of IgE-mediated allergies is not always straightforward, as traditional tests can yield equivocal or negative results and provocation tests are hampered by several practical and ethical limitations. During the last decades two new in vitro techniques have entered the field of allergy diagnosis, that is, flow-assisted analysis of allergen-specific activated basophils and component-resolved diagnosis (CRD). This review focuses on component-resolved allergy diagnosis by microarray that has evolved from recent advances in molecular allergology and biochip technology. The technique allows a comprehensive analysis of individual sensitization profiles with multiplexed purified and recombinant allergens within a single run using only a minute amount of serum, providing information that largely exceeds the output from current sIgE capturing tools. Actually, multiplexing allows identification of diagnostic patterns that may facilitate the formulation of diagnostic algorithms. Although CRD by microarray sounds promising, the diagnostic performance requires further intensive assessment before it can enter mainstream application. In our opinion, the technique should currently be considered a complementary diagnostic tool rather than a first-line choice.
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Affiliation(s)
- K J De Knop
- Department of Immunology-Allergology-Rheumatology, Faculty of Medicine, University of Antwerp, Antwerpen, Belgium
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Ricci G, Dondi A, Belotti T, Baldi E, Tartarini S, Paris R, Pagliarani G, Serafini-Fracassini D, Casadio R, Giannetti A, Masi M. Allergenicity of different apple cultivars assessed by means of skin prick test and sensitisation to recombinant allergens Mal d 1 and Mal d 3 in a group of Italian apple-allergic patients. Int J Food Sci Technol 2010. [DOI: 10.1111/j.1365-2621.2010.02300.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Peroni DG, Piacentini GL, Piazza M, Cametti E, Boner AL. Combined cetirizine-montelukast preventive treatment for food-dependent exercise-induced anaphylaxis. Ann Allergy Asthma Immunol 2010; 104:272-3. [PMID: 20377120 DOI: 10.1016/j.anai.2009.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Manifestations cliniques de l’allergie aux protéines de transfert lipidique. REVUE FRANCAISE D ALLERGOLOGIE 2009. [DOI: 10.1016/j.reval.2009.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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