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Liu Y, Li Y, Ma X, Yu L, Liang Y, Li C. Comparative analysis of serum total IgE levels and specific IgE levels in children aged 6 to 9 years with tic disorder and normal children. BMC Pediatr 2023; 23:399. [PMID: 37580673 PMCID: PMC10424416 DOI: 10.1186/s12887-023-04233-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/07/2023] [Indexed: 08/16/2023] Open
Abstract
OBJECTIVE The study was to investigate serum total IgE levels and the distribution of specific IgE types in children aged 6-9 years with tic disorder, in order to provide knowledge for diagnosis and treatment of children with tic disorder. METHODS Total serum IgE levels were detected by enzyme-linked immunosorbent assay (ELISA). Specific IgE levels in 72 children with tic disorder and normal 31 children were detected by EUROblot, respectively. RESULTS The total serum IgE level of children with tic disorder aged 6-9 years was significantly higher than those of children in control group. Specific IgE distribution in tic disorder group was observed increased mainly including inhaled mugwort, dust mite combination 1 (house dust mite/dust mite), mold combination (penicillium point/mycobacteria/Aspergillus fumigatus/streptomyces), cockroaches in Germany respectively, and also food freshwater fish combination 1 (salmon/sea bass/carp), marine fish combination 1 (cod/lobster/scallop), egg white, and crab, while elevated specific IgE of normal children group was mainly food-based (egg white, milk, and soybean). The significant different specific IgE between two groups was dust mite combination 1 (house dust mite/dust mite) (P < 0.05). CONCLUSION The total serum IgE level of children with tic disorder aged 6-9 years was significantly increased, which may be related to the disease. Specific IgE in children with tic disorder was mainly inhalation allergens, especially dust mite combination 1 (house dust mite/dust mite), which should be avoided in clinical diagnosis and daily life.
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Affiliation(s)
- Yang Liu
- Department of Respiratory and Critical Care Medicine, the First Medical Center of PLA General Hospital, Beijing, 100853, P. R. China
| | - Yanqin Li
- Department of Respiratory and Critical Care Medicine, the First Medical Center of PLA General Hospital, Beijing, 100853, P. R. China
| | - Xiuqing Ma
- Department of Respiratory and Critical Care Medicine, the First Medical Center of PLA General Hospital, Beijing, 100853, P. R. China
| | - Ling Yu
- Department of Respiratory and Critical Care Medicine, the First Medical Center of PLA General Hospital, Beijing, 100853, P. R. China
| | - Yuan Liang
- Department of Respiratory and Critical Care Medicine, the First Medical Center of PLA General Hospital, Beijing, 100853, P. R. China
| | - Chunsun Li
- Department of Respiratory and Critical Care Medicine, the First Medical Center of PLA General Hospital, Beijing, 100853, P. R. China.
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Kespohl S, Warfolomeow I, Merget R, Brüning T, Raulf M. Hypersensitivity pneumonitis due to metal working fluids: detection of specific IgG antibodies to microbial antigens. Respir Physiol Neurobiol 2023:104107. [PMID: 37451418 DOI: 10.1016/j.resp.2023.104107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/22/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
Occupational exposure to microbially contaminated metal working fluids (MWF) can cause hypersensitivity pneumonitis (HP). An important step in the diagnosis of HP is to identify the triggering antigen by detection of corresponding specific IgG antibodies (sIgG). As commercial sIgG tests are currently not available, protein antigens were prepared from MWF-workplace samples and from MWF-typical bacterial isolates. In 57% of suspected HP-cases (n= 30) elevated sIgG concentrations were measured to at least one MWF-relevant antigen, of which Mycobacterium immunogenum was most prominent (88%), followed by Pseudomonas oleovorans and Pseudomonas spec (82% each), MWF-antigen mix and Pseudomonas alcaliphila (65% each). Elevated sIgG concentrations to other microorganisms were measured to Micropolyspora faeni (82%) and Aureobasidium pullulans (77%). Correlation of sIgG values of all tested microbial antigens showed a significant relationship of MWF-antigen mixture to Pseudomonas antigens, but a low correlation to moulds. These newly prepared MWF-antigens are useful tools for the diagnosis of patients with suspected MWF-HP and are available for further investigations.
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Affiliation(s)
- Sabine Kespohl
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany.
| | - Isabell Warfolomeow
- German Social Accident Insurance Institution for the Woodworking and Metalworking Industries, BGHM, Mainz
| | - Rolf Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
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3
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Kespohl S, Riebesehl J, Grüner J, Raulf M. Impact of climate change on wood and woodworkers- Cryptostroma corticale (sooty bark disease): A risk factor for trees and exposed employees. Front Public Health 2022; 10:973686. [PMID: 36330129 PMCID: PMC9623262 DOI: 10.3389/fpubh.2022.973686] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/21/2022] [Indexed: 01/21/2023] Open
Abstract
Climate changes have promoted an increased fungal infection of maple trees with Cryptostroma corticale, the causative agent of sooty bark disease. The hosts of C. corticale are maples, and since the early 2000s the fungus has been appearing more frequently in European forests, due to the droughts and hot summers of recent years. Infestation by C. corticale discolors the wood and makes it unusable for further processing, which leads to considerable economic damage in the timber industry. Therefore, the occurrence and spread of sooty bark disease raise serious problems. In addition to forestry and economic problems, the conidiospores of C. corticale can also cause health problems in exposed wood workers and they can trigger hypersensitivity pneumonitis (HP). Since the spores, which are deposited over the entire area under the bark of infected trees, can spread during processing, exposed workers must take special precautions to protect themselves against exposure. If an occupational disease is nevertheless suspected following exposure to C. corticale, valid diagnostics are required to confirm possible HP and derive appropriate therapies and exposure reduction or avoidance. Diagnosis of HP is based on several criteria, one of them is the detection of specific IgG in patient's serum against the potentially triggering antigens, in this case C. corticale antigens. To produce a diagnostic tool to measure C. corticale specific IgG, which is not commercially available so far, spores and mycelial material from ITS-sequenced strains of C. corticale was prepared and analyzed. These biochemically characterized extracts of spore and mycelial antigens were biotinylated and coupled to Streptavidin-ImmunoCAPs. To validate these diagnostic test tools the first step is to measure the concentration of C. corticale specific IgG in sera of healthy non-exposed and healthy exposed subjects to establish cut-off values. Suitable participants were recruited and the individual exposure to C. corticale and symptoms experienced during or after working with infected maple trees were recorded using questionnaires. Finally, diagnostic tools for serological testing in suspected cases of HP by C. corticale were created and evaluated. The following article provides recommendations for the treatment and disposal of infected damaged wood and for occupational health protection procedures. Secondly, the diagnosis of HP induced by exposure to C. corticale as an occupational disease is described including the verification of newly developed serological test tools for antigens of C. corticale.
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Affiliation(s)
- Sabine Kespohl
- Institute for Prevention and Occupational Medicine of the DGUV, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany,*Correspondence: Sabine Kespohl
| | - Janett Riebesehl
- Julius Kühn Institute (JKI)—Federal Research Centre for Cultivated Plants, Institute for Plant Protection in Horticulture and Forests, Braunschweig, Germany
| | - Jörg Grüner
- Department of Forest Protection, Forest Research Institute of Baden-Württemberg (FVA), Freiburg, Germany
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine of the DGUV, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
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Occupational immediate type allergy to soapnut and quillaja bark. Allergol Select 2021; 5:77-81. [PMID: 33524084 PMCID: PMC7841414 DOI: 10.5414/alx02131e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 12/12/2020] [Indexed: 11/18/2022] Open
Abstract
A 58-year-old non-atopic chemical worker complained about work-related asthma and rhinoconjunctivitis about 4 years after exposure to quillaja bark and soapnut. Bronchial hyperresponsiveness was demonstrated after withdrawal of medication for 12 hours. Skin prick tests with extracts from quillaja bark and soapnut from the workplace were positive, but ImmunoCAP was positive only with quillaja bark, probably due to the low protein content of the extract from soapnut. Sensitizations to quillaja bark and soapnut, but not to saponin were demonstrated by immunoblot. An inhalation test with a dosimeter was positive with the soapnut extract. A link between disease and exposure was documented by serial measurements of exhaled nitric oxide at and off work, despite preventive measures. A diagnosis of occupational allergy due to quillaja bark and soapnut was made. Further exposure reduction was recommended.
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Microbial contamination in water-based metalworking fluid as trigger for occupational hypersensitivity pneumonitis - development of specific IgG tools for a suspected clinical case. Allergol Select 2020; 4:110-117. [PMID: 33326510 PMCID: PMC7734872 DOI: 10.5414/alx02124e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/19/2020] [Indexed: 11/18/2022] Open
Abstract
Microbially contaminated metal-working fluid (MWF) can cause respiratory symptoms in exposed workers in the form of exogenous allergic alveolitis/hypersensitivity pneumonitis (HP). The diagnosis of HP is based, among others, on the identification of the culprit and the detection of corresponding specific IgG antibodies (sIgG) in the patient's serum. Commercial antigen tools for the detection of these HP triggers are rarely available; therefore, antigens from contaminated MWF workplace samples were isolated exemplarily for diagnosis of a suspected HP case. Various MWF-specific bacteria were identified in the workplace samples, including Pseudomonas oleovorans, Pseudomonas alcaliphila, Pseudomonas spec., Paenibacillus glucanolyticus, and Corynebacterium amycolatum. The sIgG antigen binding, detected by ImmunoCAP system against MWF antigens from workplace samples and against the identified bacterial antigens, was much stronger in the patient serum compared to selected reference sera. The highest sIgG concentrations in the patient's serum could be determined against Pseudomonas antigens. Inhibition tests showed cross-reactions of MWF and Pseudomonas antigens, whereby the Pseudomonas antigens cross-reacted less with each other. For in-vitro diagnosis in case of suspected HP caused by contaminated MWF, workplace-related antigens are now available.
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Unusual allergen in a butcher with respiratory symptoms. Allergol Select 2020; 4:105-109. [PMID: 33326509 PMCID: PMC7734871 DOI: 10.5414/alx02126e] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/25/2019] [Indexed: 11/24/2022] Open
Abstract
A 37-year-old butcher developed respiratory symptoms during sausage and chicken production in a large company. In addition to various spices, the enzyme transglutaminase was a possible cause. The lung function test showed mild partial reversible airway obstruction and severe bronchial hyperresponsiveness. The IgE test showed sensitizations to various spice mixtures, coriander (0.74 kU/L), and to the ImmunoCAP-bound transglutaminase preparation from the workplace (7.12 kU/L). The skin prick tests with this transglutaminase were also positive. In the immunoblot of this preparation, a 40-kD protein reacted with the patient’s IgE and was identified as transglutaminase from Streptomyces mobaraensis by inhibition experiments. This is the first case of a butcher with an allergy to transglutaminase. After moving to a small enterprise without enzyme use, his symptoms improved. Sensitization and the course of the symptoms indicate a dominant role of transglutaminase in the patient’s allergic asthma.
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Kuske M, Berndt K, Spornraft‐Ragaller P, Neumeister V, Raulf M, Sander I, Koschel D, Bickhardt J, Beissert S, Bauer A. Berufsbedingte Allergie gegen Phytase: Fallserie von acht Produktionsmitarbeitern, die Futtermittelzusatzstoffen ausgesetzt waren. J Dtsch Dermatol Ges 2020; 18:859-866. [DOI: 10.1111/ddg.14205_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 01/15/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Marvin Kuske
- Klinik und Poliklinik für Dermatologie Universitätsklinikum Carl Gustav Carus Technische Universität Dresden
| | - Katja Berndt
- Klinik und Poliklinik für Dermatologie Universitätsklinikum Carl Gustav Carus Technische Universität Dresden
| | - Petra Spornraft‐Ragaller
- Klinik und Poliklinik für Dermatologie Universitätsklinikum Carl Gustav Carus Technische Universität Dresden
| | - Volker Neumeister
- Institut für Klinische Chemie und Laboratoriumsmedizin Universitätsklinikum Carl Gustav Carus Technische Universität Dresden
| | - Monika Raulf
- Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung Ruhr‐Universität Bochum (IPA)
| | - Ingrid Sander
- Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung Ruhr‐Universität Bochum (IPA)
| | - Dirk Koschel
- Fachkrankenhaus Coswig GmbH Innere Medizin/Pneumologie Dresden
| | - Jakob Bickhardt
- Spezialpraxis und Ausbildungszentrum für Pneumologie Dresden
| | - Stefan Beissert
- Klinik und Poliklinik für Dermatologie Universitätsklinikum Carl Gustav Carus Technische Universität Dresden
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie Universitätsklinikum Carl Gustav Carus Technische Universität Dresden
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Kuske M, Berndt K, Spornraft‐Ragaller P, Neumeister V, Raulf M, Sander I, Koschel D, Bickhardt J, Beissert S, Bauer A. Occupational allergy to phytase: case series of eight production workers exposed to animal feed additives. J Dtsch Dermatol Ges 2020; 18:859-865. [DOI: 10.1111/ddg.14205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 01/15/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Marvin Kuske
- Department of Dermatology University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany
| | - Katja Berndt
- Department of Dermatology University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany
| | - Petra Spornraft‐Ragaller
- Department of Dermatology University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany
| | - Volker Neumeister
- Institute of Clinical Chemistry and Laboratory Medicine University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Ruhr‐Universität Bochum (IPA) Bochum Germany
| | - Ingrid Sander
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Ruhr‐Universität Bochum (IPA) Bochum Germany
| | - Dirk Koschel
- Municipal Hospital Coswig GmbH Department of Internal Medicine and Pneumology Dresden Germany
| | - Jakob Bickhardt
- Pulmonary Specialist Practice and Training Center Dresden Germany
| | - Stefan Beissert
- Department of Dermatology University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany
| | - Andrea Bauer
- Department of Dermatology University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany
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9
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Tampicofaser-Bystander-Exposition als Auslöser von beruflichem Asthma in einer Bürstenfabrik. ALLERGO JOURNAL 2019. [DOI: 10.1007/s15007-019-1831-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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El-Qutob D, Pineda F, Raducan I, Castillo M. Generalized urticaria caused by ingestion of sweet potato cake. Allergol Int 2018; 67:527-528. [PMID: 29754973 DOI: 10.1016/j.alit.2018.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/01/2018] [Accepted: 04/02/2018] [Indexed: 11/17/2022] Open
Affiliation(s)
- David El-Qutob
- Unit of Allergy, University Hospìtal of La Plana, Vila-Real, Castellon, Spain.
| | | | - Isabela Raducan
- Unit of Allergy, University Hospìtal of La Plana, Vila-Real, Castellon, Spain
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11
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Rolla G, Heffler E, Boita M, Doyen V, Mairesse M, Cvackova M, Debarbieux S, Kleine-Tebbe J, Ollert M, Raulf M, Bircher AJ, Hilger C. Pigeon tick bite: A neglected cause of idiopathic nocturnal anaphylaxis. Allergy 2018; 73:958-961. [PMID: 29083476 DOI: 10.1111/all.13344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2017] [Indexed: 11/28/2022]
Abstract
Anaphylaxis is a serious systemic allergic reaction with rapid onset and potentially life-threatening. We report in detail a case of severe nocturnal anaphylaxis due to pigeon tick bite showing the diagnostic value of the extract and the recombinant allergen in the diagnostic procedures (basophil activation test, IgE immunoblot, and experimental ImmunoCAP). Apart from the presented case, we describe that during the last 10 years, we have collected 28 cases of allergy to Argas reflexus from several European countries. We suspect that this allergy is underdiagnosed because of the lack of diagnostic reagents. Because of the growing number of pigeons in Middle and Southern Europe cities, some cases of idiopathic anaphylaxis could potentially be caused by A. reflexus in those countries. The identification of pigeon ticks as a trigger of anaphylaxis would greatly improve medical care and advice for these patients as the parasite can be exterminated by eradication measures to avoid further incidents.
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Affiliation(s)
- G. Rolla
- Allergy and Clinical Immunology; Department Medical Sciences; University of Torino; Torino Italy
| | - E. Heffler
- Department of Biomedical Sciences; Humanitas University; Milan Italy
| | - M. Boita
- Allergy and Clinical Immunology; Department Medical Sciences; University of Torino; Torino Italy
| | - V. Doyen
- Clinic of Immuno-Allergology; CHU Brugmann; Université Libre de Bruxelles (ULB); Brussels Belgium
| | - M. Mairesse
- Clinic of Immuno-Allergology; CHU Brugmann; Université Libre de Bruxelles (ULB); Brussels Belgium
| | - M. Cvackova
- Department of Allergy and Clinical Immunology; Faculty Hospital Kralovske Vinohrady; Prague Czech Republic
| | - S. Debarbieux
- Service de Dermatologie; Centre Hospitalier Lyon Sud; Pierre Bénite France
| | | | - M. Ollert
- Department of Dermatology and Allergy Center; Odense Research Center for Anaphylaxis; University of Southern Denmark; Odense Denmark
- Department of Infection and Immunity; Luxembourg Institute of Health; Esch-sur-Alzette Luxembourg
| | - M. Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA); Institute of the Ruhr-Universität Bochum; Bochum Germany
| | - A. J. Bircher
- Allergology; Department of Dermatology; University Hospital Basel; Basel Switzerland
| | - C. Hilger
- Department of Infection and Immunity; Luxembourg Institute of Health; Esch-sur-Alzette Luxembourg
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Merget R, Sander I, Fartasch M, van Kampen V, Röseler S, Merk H, Wurpts G, Raulf M, Brüning T. Occupational generalized urticaria and anaphylaxis after inhalation of cefuroxime in a nurse. Am J Ind Med 2018; 61:261-266. [PMID: 29114903 DOI: 10.1002/ajim.22788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2017] [Indexed: 12/21/2022]
Abstract
We present the case of a 53 years old nonatopic female nurse who experienced repeated anaphylactic reactions at work without involvement in drug-specific tasks such as crushing of tablets or preparation of injections. The causal allergen was not identified until a further severe anaphylactic reaction occurred after oral use of cefuroxime during a respiratory infection. Sensitization to cefuroxime was demonstrated by specific IgE, basophil activation test and skin prick test. An inhalation challenge with a dosimeter induced generalized urticaria after a cumulative dose of about 10 μg of the drug, but no asthmatic reaction. Complete exposure cessation was initiated and a 1-year follow-up was without further allergic reactions. We conclude that work-related systemic allergic reactions to β-lactam antibiotics may occur in nurses after inhalation of low doses and without perceived association with drug-specific tasks like handling of antibiotics.
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Affiliation(s)
- Rolf Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Ingrid Sander
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Manigé Fartasch
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Vera van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Stefani Röseler
- Department of Dermatology and Allergology, University Hospital Aachen, Aachen, Germany
| | - Hans Merk
- Department of Dermatology and Allergology, University Hospital Aachen, Aachen, Germany
| | - Gerda Wurpts
- Department of Dermatology and Allergology, University Hospital Aachen, Aachen, Germany
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
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Armentia A, Martín-Armentia B, Martín-Armentia S, Ruiz-Muñoz P, Quesada JM, Postigo I, Conde R, González-Sagrado M, Pineda F, Castillo M, Palacios R, Tejedor J. Cocaine Allergy in Drug-Dependent Patients and Allergic People. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:201-207. [PMID: 28863944 DOI: 10.1016/j.jaip.2017.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Adverse reactions to local anesthetics (LAs), especially esters, are not uncommon, but true allergy is rarely diagnosed. To our knowledge, currently there is no reliable method of determining IgE-mediated hypersensitivity to LAs and cocaine. OBJECTIVE To assess the clinical value of allergy tests (prick, IgE, challenges, and arrays) in people suffering hypersensitivity reactions (asthma and anaphylaxis) during local anesthesia with cocaine derivatives and drug abusers with allergic symptoms after cocaine inhalation. METHODS We selected cocaine-dependent patients and allergic patients who suffered severe reactions during local anesthesia from a database of 23,873 patients. The diagnostic yield (sensitivity, specificity, and predictive value) of allergy tests using cocaine and coca leaf extracts in determining cocaine allergy was assessed, taking a positive challenge as the criterion standard. RESULTS After prick tests, specific IgE, and challenge with cocaine extract, 41 of 211 patients (19.4%) were diagnosed as sensitized to cocaine. Prick tests and IgE to coca leaves (coca tea) had a good sensitivity (95.1% and 92.7%, respectively) and specificity (92.3 and 98.8%, respectively) for the diagnosis of cocaine allergy and LA-derived allergy. CONCLUSIONS Cocaine may be an important allergen. Drug abusers and patients sensitized to local anesthesia and tobacco are at risk. Both prick tests and specific IgE against coca leaf extract detected sensitization to cocaine. The highest levels were related to severe clinical profiles.
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Affiliation(s)
- Alicia Armentia
- Allergy Unit, Rio Hortega University Hospital, University of Valladolid, Valladolid, Spain.
| | - Blanca Martín-Armentia
- Allergy Unit, Rio Hortega University Hospital, University of Valladolid, Valladolid, Spain
| | - Sara Martín-Armentia
- Allergy Unit, Rio Hortega University Hospital, University of Valladolid, Valladolid, Spain
| | - Pedro Ruiz-Muñoz
- San Juan de Dios Center, Palencia and Castile-Leon Association for the Aid of Drug Abusers (ACLAD), Valladolid, Spain
| | - Jorge Martínez Quesada
- Immunology, Microbiology and Parasitology Department, University of the Basque Country, Vitoria, Spain
| | - Idoia Postigo
- Immunology, Microbiology and Parasitology Department, University of the Basque Country, Vitoria, Spain
| | - Rosa Conde
- Research Unit, Rio Hortega University Hospital, Valladolid, Spain
| | | | | | | | | | - Jesús Tejedor
- Government Delegation, Community of Castile and Leon, Valladolid, Spain
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14
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ImmunoCAP cellulose displays cross-reactive carbohydrate determinant (CCD) epitopes and can cause false-positive test results in patients with high anti-CCD IgE antibody levels. J Allergy Clin Immunol 2017; 141:372-381.e3. [PMID: 28506851 DOI: 10.1016/j.jaci.2017.04.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 03/13/2017] [Accepted: 04/12/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cross-reactive carbohydrate determinants (CCDs) in plants and insect venoms are a common cause of irrelevant positive test results during in vitro allergy diagnosis. We observed that some CCD-positive sera show nonspecific IgE binding even with CCD-free recombinant allergens when using the Phadia ImmunoCAP platform. OBJECTIVE We investigated whether cellulose used as an allergen carrier in ImmunoCAP harbors residual N-glycans, causing nonspecific background binding in CCD-positive sera. METHODS IgE binding to 6 samples of blank ImmunoCAPs coupled to either streptavidin (SA-CAP-1 or 2) or nonallergenic maltose-binding protein (MBP; MBP-CAP-1 to 4) and binding to a panel of 4 recombinant allergens were compared in CCD-positive sera before and after inhibition with a CCD inhibitor (MUXF3-human serum albumin). RESULTS Of 52 CCD-positive sera (bromelain, 1.01-59.6 kilounits of antigen per liter [kUA/L]) tested on SA-CAP-1, 35 (67%) showed IgE binding of greater than 0.35 kUA/L (0.41-4.22 kUA/L). Among those with anti-CCD IgE levels of greater than 7.0 kUA/L, 90% (26/29) were positive. IgE binding to SA-CAP-1 correlated with IgE binding to bromelain (r = 0.68) and was completely abolished by serum preincubation with the CCD inhibitor (n = 15). Binding scores with SA-CAP-2 and MBP-CAP-1 to MBP-CAP-4 were generally lower but strongly correlated with those of SA-CAP-1 and bromelain. IgE reactivity of 10 CCD-positive sera (14.0-52.5 kUA/L) with the recombinant allergens rPhl p 12, rFel d 1, rAra h 2, and rPru p 3 was positive to at least 1 allergen in 8 of 10 (0.36-1.63 kUA/L) and borderline in 2 of 10 (0.21-0.25 kUA/L). Binding correlated with antibody binding to bromelain (r = 0.61) and to all blank ImmunoCAPs (r > 0.90) and could be completely blocked by the CCD inhibitor. Overall, mean background binding to cellulose CCDs corresponded to 2% to 3% of the reactivity seen with bromelain. CONCLUSIONS Cellulose used as a solid-phase allergen carrier can contain varying amounts of CCDs sufficient to cause false-positive test results up to 2 kUA/L with nonglycosylated recombinant allergens in patients with high levels of anti-CCD IgE antibodies.
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Maruyama N, Nakagawa T, Ito K, Cabanos C, Borres MP, Movérare R, Tanaka A, Sato S, Ebisawa M. Measurement of specific IgE antibodies to Ses i 1 improves the diagnosis of sesame allergy. Clin Exp Allergy 2016; 46:163-71. [PMID: 26310924 DOI: 10.1111/cea.12626] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 07/30/2015] [Accepted: 08/13/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The number of reported cases of allergic reactions to sesame seeds (Sesamum indicum) has increased significantly. The specific IgE tests and skin prick tests presently available for diagnosis of sesame allergy are all based on crude sesame extract and are limited by their low clinical specificity. Thus, oral food challenge (OFC) is still the gold standard in the diagnosis. OBJECTIVE The aim was to identify the allergen components useful to diagnose sesame-allergic children with the goal to reduce the number of OFCs needed. METHODS Ninety-two sesame-sensitized children were consecutively enrolled and diagnosed based on OFC or convincing history. Specific IgE to purified native 11S globulin (nSes i 11S), 7S globulin (nSes i 7S), 2S albumin (nSes i 2S), and two recombinant 2S albumins (rSes i 1 and rSes i 2) was measured by ELISA and/or ImmunoCAP (rSes i 1/streptavidin application). RESULTS Based on area under curve (AUC) values from receiver operating characteristic (ROC) analysis, rSes i 1 was shown to have the best diagnostic performance of the allergen components in ELISA. The experimental rSes i 1 ImmunoCAP test had larger AUC (0.891; 95% CI, 0.826-0.955) compared to the commercially available sesame ImmunoCAP (0.697; 95% CI, 0.589-0.805). The clinical sensitivity and specificity for the rSes i 1 ImmunoCAP test at optimal cut-off (3.96 kUA /L) were 86.1% and 85.7%, respectively. CONCLUSION AND CLINICAL RELEVANCE Sensitization to Ses i 1 is strongly associated with clinical sesame allergy. Measurement of specific IgE to rSes i 1 could reduce the numbers of OFCs needed.
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Affiliation(s)
- N Maruyama
- Laboratory of Food Quality Design and Development, Graduate School of Agriculture, Kyoto University, Uji, Kyoto, Japan
| | - T Nakagawa
- Department of Allergy, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - K Ito
- Department of Allergy, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - C Cabanos
- Laboratory of Food Quality Design and Development, Graduate School of Agriculture, Kyoto University, Uji, Kyoto, Japan
| | - M P Borres
- Thermo Fisher Scientific, Uppsala, Sweden.,Department of Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - R Movérare
- Thermo Fisher Scientific, Uppsala, Sweden.,Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
| | - A Tanaka
- Thermo Fisher Scientific, Tokyo, Japan
| | - S Sato
- Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - M Ebisawa
- Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
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Stöcker B, Grundmann S, Mosters P, Nitzsche P, Brehler R. Occupational sensitization to lactase in the dietary supplement industry. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2016; 71:259-267. [PMID: 26134755 DOI: 10.1080/19338244.2015.1066294] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/19/2015] [Indexed: 06/04/2023]
Abstract
Aerogen lactase exposure carries a risk for the development of allergic asthma and rhinitis; only a few occupationally affected patients have been reported. The authors report the results of allergy testing with employees of a lactase tablets manufacturing plant. The survey involved 13 workers, including a questionnaire, spirometry, basophil activation test (BAT), and skin prick tests (SPTs) with lactase and a panel of common aeroallergens. Furthermore, lactase-specific immunoglobulin E (IgE) antibodies were analyzed. Sensitization to lactase could be proven for 9 workers by SPT and BAT; specific IgE antibodies could be detected in serum samples of all sensitized. However, IgE levels ≥0.35 kU/L were only found in 4 sera. These data confirm that occupational exposure to lactase can induce IgE-mediated respiratory sensitization resulting in allergic diseases. Protective measures should thus be obligatory when working with lactase.
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Affiliation(s)
- Benedikt Stöcker
- a Department of Dermatology , University Hospital Münster , Münster , Germany
| | - Sonja Grundmann
- a Department of Dermatology , University Hospital Münster , Münster , Germany
| | - Pia Mosters
- a Department of Dermatology , University Hospital Münster , Münster , Germany
| | - Paul Nitzsche
- b Werkarztzentrum Rietberg e.V. , Rietberg , Germany
| | - Randolf Brehler
- a Department of Dermatology , University Hospital Münster , Münster , Germany
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17
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Merget R, Sander I, van Kampen V, Raulf M, Brüning T. Triticale allergy in a farmer. Am J Ind Med 2016; 59:501-5. [PMID: 26814013 DOI: 10.1002/ajim.22567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2016] [Indexed: 11/11/2022]
Abstract
We present the case of a 29-year-old farmer with hay fever and atopic dermatitis since adolescence who had developed work-related asthma about 5 years earlier. He was sensitized to grass pollen, wheat and rye flour, dust from the floors of the animal facilities (cows and pigs) and grain barn, and a battery of animal feed from his farm. Work-relatedness of his asthma was demonstrated by serial measurements of spirometry and fractional exhaled nitric oxide at work and during a holiday. Immunoblot analyses revealed dominant IgE-binding to grass pollen and triticale (a hybrid of rye and wheat). IgE inhibition experiments demonstrated that sensitization to triticale was not due to cross-reactivity to grass pollen. Testing of specific IgE-antibodies to recombinant wheat allergens showed sensitizations to profilin, peroxidase, and nonspecific lipid transfer proteins type I subfamily 9.1 and 9.7. We conclude that triticale allergy may occur as a distinct allergy in farmers. Am. J. Ind. Med. 59:501-505, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Rolf Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr University Bochum (IPA); Bochum Germany
| | - Ingrid Sander
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr University Bochum (IPA); Bochum Germany
| | - Vera van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr University Bochum (IPA); Bochum Germany
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr University Bochum (IPA); Bochum Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr University Bochum (IPA); Bochum Germany
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18
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Vandenplas O, Froidure A, Meurer U, Rihs HP, Rifflart C, Soetaert S, Jamart J, Pilette C, Raulf M. The role of allergen components for the diagnosis of latex-induced occupational asthma. Allergy 2016; 71:840-9. [PMID: 26940537 DOI: 10.1111/all.12872] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recombinant Hevea brasiliensis (rHev b) natural rubber latex (NRL) allergen components have been developed to assess the patients' allergen sensitization profile and to improve the diagnosis of NRL allergy. OBJECTIVE To examine whether the determination of specific IgE (sIgE) reactivity to a panel of recombinant allergen components would be helpful for diagnosing NRL-induced occupational asthma (OA) in predicting the outcome of a specific inhalation test. METHODS sIgE levels to NRL extract and 12 recombinant NRL allergen components were assessed in 82 subjects with OA ascertained by a positive specific inhalation challenge (SIC) with NRL gloves and in 25 symptomatic subjects with a negative challenge. RESULTS The sensitivity, specificity, positive predictive value, and negative predictive value of a NRL-sIgE level ≥0.35 kUA /l as compared to the result of SICs were 94%, 48%, 86%, and 71%, respectively. The positive predictive value increased above 95% when increasing the cutoff value to 5.41 kUA /l. Subjects with a positive SIC showed a significantly higher rate of sIgE reactivity to rHev b 5, 6.01, 6.02, and 11 than those with a negative SIC. A sIgE sum score against rHev b 5 plus 6.01/6.02 ≥ 1.46 kUA /l provided a positive predictive value >95% with a higher sensitivity (79%) and diagnostic efficiency (Youden index: 0.67) as compared with a NRL-sIgE ≥5.41 kUA /l (49% and 0.41, respectively). CONCLUSION In suspected OA, high levels of sIgE against rHev b 5 combined with rHev b 6.01 or 6.02 are the most efficient predictors of a bronchial response to NRL.
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Affiliation(s)
- O. Vandenplas
- Department of Chest Medicine; Centre Hospitalier Universitaire de Dinant-Godinne; Université catholique de Louvain; Yvoir Belgium
- Institut de Recherche Expérimentale et Clinique; Pôle de Pneumologie; Université catholique de Louvain; Brussels Belgium
- Walloon Institute for Excellence in Lifesciences and Biotechnology (WELBIO); Brussels Belgium
| | - A. Froidure
- Institut de Recherche Expérimentale et Clinique; Pôle de Pneumologie; Université catholique de Louvain; Brussels Belgium
- Walloon Institute for Excellence in Lifesciences and Biotechnology (WELBIO); Brussels Belgium
- Department of Chest Medicine; Cliniques Universitaires Saint-Luc; Université catholique de Louvain; Brussels Belgium
| | - U. Meurer
- IPA Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr-Universität Bochum; Bochum Germany
| | - H.-P. Rihs
- IPA Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr-Universität Bochum; Bochum Germany
| | - C. Rifflart
- Department of Chest Medicine; Centre Hospitalier Universitaire de Dinant-Godinne; Université catholique de Louvain; Yvoir Belgium
| | - S. Soetaert
- Prévention et Protection au Travail - Centre de Service Interentreprises (CESI); Brussels Belgium
| | - J. Jamart
- Scientific Support Unit; Centre Hospitalier Universitaire de Dinant-Godinne; Université catholique de Louvain; Yvoir Belgium
| | - C. Pilette
- Institut de Recherche Expérimentale et Clinique; Pôle de Pneumologie; Université catholique de Louvain; Brussels Belgium
- Walloon Institute for Excellence in Lifesciences and Biotechnology (WELBIO); Brussels Belgium
- Department of Chest Medicine; Cliniques Universitaires Saint-Luc; Université catholique de Louvain; Brussels Belgium
| | - M. Raulf
- IPA Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr-Universität Bochum; Bochum Germany
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Quirce S, Vandenplas O, Campo P, Cruz MJ, de Blay F, Koschel D, Moscato G, Pala G, Raulf M, Sastre J, Siracusa A, Tarlo SM, Walusiak-Skorupa J, Cormier Y. Occupational hypersensitivity pneumonitis: an EAACI position paper. Allergy 2016; 71:765-79. [PMID: 26913451 DOI: 10.1111/all.12866] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2016] [Indexed: 12/14/2022]
Abstract
The aim of this document was to provide a critical review of the current knowledge on hypersensitivity pneumonitis caused by the occupational environment and to propose practical guidance for the diagnosis and management of this condition. Occupational hypersensitivity pneumonitis (OHP) is an immunologic lung disease resulting from lymphocytic and frequently granulomatous inflammation of the peripheral airways, alveoli, and surrounding interstitial tissue which develops as the result of a non-IgE-mediated allergic reaction to a variety of organic materials or low molecular weight agents that are present in the workplace. The offending agents can be classified into six broad categories that include bacteria, fungi, animal proteins, plant proteins, low molecular weight chemicals, and metals. The diagnosis of OHP requires a multidisciplinary approach and relies on a combination of diagnostic tests to ascertain the work relatedness of the disease. Both the clinical and the occupational history are keys to the diagnosis and often will lead to the initial suspicion. Diagnostic criteria adapted to OHP are proposed. The cornerstone of treatment is early removal from exposure to the eliciting antigen, although the disease may show an adverse outcome even after avoidance of exposure to the causal agent.
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Affiliation(s)
- S. Quirce
- Department of Allergy; Hospital La Paz Institute for Health Research (IdiPAZ) and CIBER de Enfermedades Respiratorias (CIBERES); Madrid Spain
| | - O. Vandenplas
- Department of Chest Medicine; Centre Hospitalier Universitaire de Mont-Godinne; Université Catholique de Louvain; Yvoir Belgium
| | - P. Campo
- Unidad de Gestión Clínica Allergy-IBIMA; Hospital Regional Universitario; Málaga Spain
| | - M. J. Cruz
- Pulmonology Service; Hospital Universitari Vall d'Hebron; Universitat Autonoma de Barcelona; Barcelona Spain
- CIBER de Enfermedades Respiratorias (CIBERES); Barcelona Spain
| | - F. de Blay
- Division of Asthma and Allergy; Department of Chest Diseases; University Hospital; Fédération de Médecine Translationnelle de Strasbourg; Strasbourg University; Strasbourg France
| | - D. Koschel
- Fachkrankenhaus Coswig GmbH Zentrum für Pneumologie, Allergologie, Beatmungsmedizin, Thorax- und Gefäßchirurgie; Coswig Germany
| | - G. Moscato
- Department of Public Health, Experimental and Forensic Medicine; University of Pavia; Pavia Italy
| | - G. Pala
- Occupational Physician's Division; Local Health Authority of Sassari; Sassari Italy
| | - M. Raulf
- IPA Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr-Universität Bochum; Bochum Germany
| | - J. Sastre
- Department of Allergy; Fundación Jiménez Díaz, and CIBER de Enfermedades Respiratorias (CIBERES); Madrid Spain
| | - A. Siracusa
- Formerly Department of Clinical and Experimental Medicine; University of Perugia; Perugia Italy
| | - S. M. Tarlo
- Department of Medicine and Dalla Lana School of Public Health; University of Toronto; Toronto ON Canada
- Respiratory Division Toronto Western Hospital; Gage Occupational and Environmental Health Unit; St Michael's Hospital; Toronto ON Canada
| | - J. Walusiak-Skorupa
- Department of Occupational Diseases and Toxicology; Nofer Institute of Occupational Medicine; Lodz Poland
| | - Y. Cormier
- Centre de Pneumologie; Institut Universitaire de Cardiologie et de Pneumologie de Québec; Université Laval; Québec City QC Canada
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Lipińska-Ojrzanowska A, Wiszniewska M, Pas-Wyroślak A, Walusiak-Skorupa J. Sensitization to xylanolytic enzymes: an underestimated health hazard among bakers. Occup Med (Lond) 2016; 66:415-8. [PMID: 27060799 DOI: 10.1093/occmed/kqw048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The most important occupational allergens in baking include flour and enzymes, especially α-amylase. Although xylanolytic enzymes have previously been described as sensitizers, they may be overlooked during assessment of bakery workers with work-related symptoms. AIMS To report a case of a baker who suffered from work-related respiratory, ocular and skin symptoms as a consequence of sensitization to xylanolytic enzymes. METHODS Physical examination, chest X-ray, routine laboratory tests, skin prick tests (SPTs) with common and occupational allergens (wheat, pearl, rye, corn and oat flours, α-amylase, bakery adjuvants) and spirometric measurements, as well as assessments by a laryngologist, dermatologist and ophthalmologist were performed. Specific IgE (sIgE) to occupational agents were evaluated for flours, α-amylase, xylanase, cellulose and glucoamylase. Specific inhalation challenges (SICs) with flours and bakery adjuvants were carried out. RESULTS Hypersensitivity to Aspergillus moulds, flours and α-amylase was confirmed in SPTs; however, SIC with those agents gave a negative result. Further investigation revealed the presence of sIgE to xylanolytic enzymes. During SIC with bakery adjuvants, allergic skin, ocular and respiratory symptoms occurred and were confirmed by objective assessment. CONCLUSIONS In the assessment of work-related allergic symptoms in bakers, sensitization to xylanolytic enzymes should be considered. Completion of diagnostic procedures having excluded asthma and rhino-conjunctivitis related to flour hypersensitivity might result in a false-negative assessment.
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Affiliation(s)
- A Lipińska-Ojrzanowska
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland.
| | - M Wiszniewska
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland
| | - A Pas-Wyroślak
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland
| | - J Walusiak-Skorupa
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland
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Corominas M, Postigo I, Cardona V, Lleonart R, Romero-Pinel L, Martinez J. IgE-Mediated Allergic Reactions after the First Administration of Glatiramer Acetate in Patients with Multiple Sclerosis. Int Arch Allergy Immunol 2015; 165:244-6. [PMID: 25634237 DOI: 10.1159/000371418] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 12/05/2014] [Indexed: 11/19/2022] Open
Affiliation(s)
- Mercè Corominas
- Division of Allergology, Department of Internal Medicine, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
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Component-resolved diagnosis of baker's allergy based on specific IgE to recombinant wheat flour proteins. J Allergy Clin Immunol 2015; 135:1529-37. [PMID: 25576081 DOI: 10.1016/j.jaci.2014.11.021] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 11/07/2014] [Accepted: 11/12/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Sensitization to wheat flour plays an important role in the development and diagnosis of baker's asthma. OBJECTIVES We evaluated wheat allergen components as sensitizers for bakers with work-related complaints, with consideration of cross-reactivity to grass pollen. METHODS Nineteen recombinant wheat flour proteins and 2 cross-reactive carbohydrate determinants were tested by using CAP-FEIA in sera of 101 bakers with wheat flour allergy (40 German, 37 Dutch, and 24 Spanish) and 29 pollen-sensitized control subjects with wheat-specific IgE but without occupational exposure. IgE binding to the single components was inhibited with wheat flour, rye flour, and grass pollen. The diagnostic efficiencies of IgE tests with single allergens and combinations were evaluated by assessing their ability to discriminate between patients with baker's allergy and control subjects based on receiver operating characteristic analyses. RESULTS Eighty percent of bakers had specific IgE levels of 0.35 kUA/L or greater and 91% had specific IgE levels of 0.1 kUA/L or greater to at least one of the 21 allergens. The highest frequencies of IgE binding were found for thiol reductase (Tri a 27) and the wheat dimeric α-amylase inhibitor 0.19 (Tri a 28). Cross-reactivity to grass pollen was proved for 9 components, and cross-reactivity to rye flour was proved for 18 components. A combination of IgE tests to 5 components, Tri a 27, Tri a 28, tetrameric α-amylase inhibitor CM2 (Tri a 29.02), serine protease inhibitor-like allergen (Tri a 39), and 1-cys-peroxiredoxin (Tri a 32), produced the maximal area under the curve (AUC = 0.84) in receiver operating characteristic analyses, but this was still lower than the AUC for wheat- or rye flour-specific IgE (AUC = 0.89 or 0.88, respectively). CONCLUSIONS Component-resolved diagnostics help to distinguish between sensitization caused by occupational flour exposure and wheat seropositivity based on cross-reactivity to grass pollen. For routine diagnosis of baker's allergy, however, allergen-specific IgE tests with whole wheat and rye flour extracts remain mandatory because of superior diagnostic sensitivity.
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Kim SJ, Goldberg BJ. Anaphylaxis due to topical pramoxine. Ann Allergy Asthma Immunol 2014; 114:72-3. [PMID: 25457867 DOI: 10.1016/j.anai.2014.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 09/17/2014] [Accepted: 10/14/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Susan J Kim
- Department of Allergy and Clinical Immunology, Kaiser Permanente Southern California, Los Angeles, California.
| | - Bruce J Goldberg
- Department of Allergy and Clinical Immunology, Kaiser Permanente Southern California, Los Angeles, California; Southern California Permanente Medical Group, Los Angeles, California
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Rihs HP, Armentia A, Sander I, Brüning T, Raulf M, Varga R. IgE-binding properties of a recombinant lipid transfer protein from Cannabis sativa. Ann Allergy Asthma Immunol 2014; 113:233-4. [PMID: 24954374 DOI: 10.1016/j.anai.2014.05.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 05/12/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Hans-Peter Rihs
- Institute for Prevention and Occupational Medicine, German Social Accident Insurance, Institute of the Ruhr-University Bochum, Bochum, Germany.
| | - Alicia Armentia
- Allergy Unit, Rio Hortega University Hospital, Valladolid, Spain
| | - Ingrid Sander
- Institute for Prevention and Occupational Medicine, German Social Accident Insurance, Institute of the Ruhr-University Bochum, Bochum, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine, German Social Accident Insurance, Institute of the Ruhr-University Bochum, Bochum, Germany
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine, German Social Accident Insurance, Institute of the Ruhr-University Bochum, Bochum, Germany
| | - Rita Varga
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
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Kespohl S, Maryska S, Zahradnik E, Sander I, Brüning T, Raulf-Heimsoth M. Biochemical and immunological analysis of mould skin prick test solution: current status of standardization. Clin Exp Allergy 2014; 43:1286-96. [PMID: 24152161 DOI: 10.1111/cea.12186] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 08/01/2013] [Accepted: 08/14/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sensitization prevalence to moulds reached from less than 10% in the general population to more than 25% in atopic and/or asthmatic subjects. To diagnose IgE-mediated mould sensitization, skin prick test (SPT) and specific IgE (sIgE) measurement are recommended. However, concordance of SPT and sIgE results is often less than 50% and standardization of the extracts is required to achieve reliable test results. OBJECTIVE The aim of our study was to analyse mould SPT solutions (SPTs) with respect to quantity and quality of protein, antigen and human IgE-binding content as a prerequisite for further in vivo studies. METHODS Commercial SPTs of Alternaria alternata, Aspergillus fumigatus, Cladosporium herbarum and Penicillium chrysogenum from six manufacturers as well as two in-house extracts from Aspergillus versicolor were investigated. Protein-, antigen- and IgE-binding contents were quantified by Bradford assay, sandwich ELISA and IgE-ImmunoCAP-inhibition tests. Protein composition and IgE and IgG binding were analysed by SDS-PAGE and immunoblotting, respectively. RESULTS Median protein concentrations were similar in all mould SPT extracts (90-110 μg/mL). In contrast, antigen contents and IgE-binding capacity showed a high variability with median antigen values from 4 to 118 μg/mL and IgE inhibition results between 30 to 95%. Whereas almost all SPTs of A. alternata and A. versicolor showed complete sIgE inhibition with mean values > 80%, only three extracts for A. fumigatus, two extracts for C. herbarum and none of the tested extracts for P. chrysogenum exceeded 50% sIgE reduction. Quantitative amounts of protein, antigenic and IgE-binding structures were not comparable with the quality of the corresponding protein or immunoblot pattern, with the exception of A. alternata SPTs. CONCLUSIONS AND CLINICAL RELEVANCE Commercially available mould SPT extracts showed high variability raising the question of comparability and reliability of SPT results. Possible consequences for diagnostic test outcome will be investigated in the next step.
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Affiliation(s)
- S Kespohl
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
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Baatjies R, Meijster T, Heederik D, Sander I, Jeebhay MF. Effectiveness of interventions to reduce flour dust exposures in supermarket bakeries in South Africa. Occup Environ Med 2014; 71:811-8. [PMID: 24899339 DOI: 10.1136/oemed-2013-101971] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
RATIONALE A recent study of supermarket bakery workers in South Africa demonstrated that 25% of workers were sensitised to flour allergens and 13% had baker's asthma. Evidence on exposure reduction strategies using specifically designed interventions aimed at reducing the risk of baker's asthma is scarce. OBJECTIVES The aim of this study was to evaluate the effectiveness of different control measures to reduce airborne flour dust exposure using a randomised design. METHODS A group-randomised study design was used to assign 30 bakeries of a large supermarket chain store to two intervention groups and a control group, of which 15 bakeries were studied. Full-shift environmental personal samples were used to characterise exposure to flour dust and wheat and rye allergens levels pre-intervention (n=176) and post-intervention (n=208). RESULTS The overall intervention effect revealed a 50% decrease in mean flour dust, wheat and rye allergen exposure. The reduction in exposure was highest for managers (67%) and bakers (47%), and lowest for counterhands (23%). For bakers, the greatest reduction in flour dust was associated with control measures such as the use of the mixer lid (67%), divider oil (63%) or focused training (54%). However, the greatest reduction (80%) was observed when using a combination of all control measures. CONCLUSIONS A specially designed intervention strategy reduced both flour dust and allergen levels. Best results were observed when combining both engineering controls and training. Further studies will investigate the long-term health impact of these interventions on reducing the disease burden among this group of bakers.
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Affiliation(s)
- Roslynn Baatjies
- Department of Environmental and Occupational Studies, Faculty of Applied Sciences, Cape Peninsula University of Technology, Cape Town, South Africa Centre for Occupational and Environmental Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Tim Meijster
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Dick Heederik
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Ingrid Sander
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Ruhr-University Bochum, Germany, Germany
| | - Mohamed F Jeebhay
- Centre for Occupational and Environmental Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Takahashi H, Chinuki Y, Tanaka A, Morita E. Laminin γ-1 and collagen α-1 (VI) chain are galactose-α-1,3-galactose-bound allergens in beef. Allergy 2014; 69:199-207. [PMID: 24180678 DOI: 10.1111/all.12302] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2013] [Indexed: 01/10/2023]
Abstract
BACKGROUND Sensitization to the carbohydrate galactose-α-1,3-galactose (α-Gal) has been reported in patients with beef allergy. However, the proteins responsible for this allergy have not yet been identified. This study aimed to identify beef proteins that predominantly react with serum IgE in Japanese patients with beef allergy. METHODS Sera were collected from 29 patients with beef allergy who had allergic reaction(s) such as urticaria, abdominal pain, vomiting, and anaphylactic shock after ingestion of beef and pork; the sera tested positive for IgE against beef and pork. IgE-binding proteins were detected by immunoblotting sera from the patients and identified using a combination of two-dimensional gel electrophoresis and peptide mass fingerprinting techniques. The involvement of carbohydrate in the binding of IgE to allergens was examined by periodate treatment and an inhibition assay with cetuximab by immunoblotting. Specific IgE binding to cetuximab was measured using the CAP-fluorescent enzyme immunoassay. RESULTS Two IgE-binding proteins (240 kDa and 140 kDa) were detected in beef extract and identified as laminin γ-1 and the collagen α-1 (VI) chain from Bos taurus, respectively. Periodate treatment or the inhibition assay resulted in the loss of IgE binding to these proteins. Immunoblotting with anti-α-Gal antibody revealed the presence of α-Gal on the 240- and 140-kDa beef proteins. The amount of IgE bound to cetuximab was significantly correlated with that to beef in the patients with beef allergy. CONCLUSION The carbohydrate moiety (α-Gal) on laminin γ-1 and collagen α-1 (VI) chain are possibly common IgE-reactive proteins in the Japanese patients with beef allergy.
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Affiliation(s)
- H. Takahashi
- Department of Dermatology; Shimane University Faculty of Medicine; Shimane Japan
| | - Y. Chinuki
- Department of Dermatology; Shimane University Faculty of Medicine; Shimane Japan
| | - A. Tanaka
- Thermo Fisher Scientific K.K.; Tokyo Japan
| | - E. Morita
- Department of Dermatology; Shimane University Faculty of Medicine; Shimane Japan
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Armentia A, Ruiz-Muñoz P, Quesada JM, Postigo I, Herrero M, Martín-Gil FJ, Gonzalez-Sagrado M, Martín B, Castrodeza J. Clinical value of morphine, pholcodine and poppy seed IgE assays in drug-abusers and allergic people. Allergol Immunopathol (Madr) 2013; 41:37-44. [PMID: 21940094 DOI: 10.1016/j.aller.2011.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 05/07/2011] [Accepted: 05/16/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND The diagnosis of anaphylactic reactions due to opiates during anaesthesia can be difficult, since in most cases various drugs may have been administered. Detection of specific IgE to poppy seed might be a marker for sensitisation to opiates in allergic people and heroin-abusers. This study assessed the clinical value of morphine, pholcodine and poppy seed skin-prick and IgE determination in people suffering hypersensitivity reactions during anaesthesia or analgesia and drug-abusers with allergic symptoms. METHODS We selected heroin abusers and patients who suffered severe reactions during anaesthesia and analgesia from a database of 23,873 patients. The diagnostic yield (sensitivity, specificity and predictive value) of prick and IgE tests in determining opiate allergy was analysed. RESULTS Overall, 149 patients and 200 controls, mean age 32.9 ± 14.7 years, were included. All patients with positive prick to opiates showed positive prick and IgE to poppy seeds, but not to morphine or pholcodine IgE. Among drug-abusers, 13/42 patients (31%) presented opium hypersensitivity confirmed by challenge tests. Among non-drug abusers, sensitisation to opiates was higher in people allergic to tobacco (25%), P<.001. Prick tests and IgE against poppy seed had a good sensitivity (95.6% and 82.6%, respectively) and specificity (98.5% and 100%, respectively) in the diagnosis of opiate allergy. CONCLUSIONS Opiates may be significant allergens. Drug-abusers and people sensitised to tobacco are at risk. Both the prick and specific IgE tests efficiently detected sensitisation to opiates. The highest levels were related to more-severe clinical profiles.
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Affiliation(s)
- A Armentia
- Allergy Unit, Rio Hortega University Hospital, UMDAI, Valladolid, Spain.
| | - P Ruiz-Muñoz
- San Juan de Dios Centre, Palencia and Castile-Leon Association For the Aid of Drug Abusers (ACLAD), Valladolid, Spain
| | - J M Quesada
- Immunology, Microbiology and Parasitology Department, University of the Basque Country, Vitoria, Spain
| | - I Postigo
- Immunology, Microbiology and Parasitology Department, University of the Basque Country, Vitoria, Spain
| | - M Herrero
- Allergy Unit, Rio Hortega University Hospital, UMDAI, Valladolid, Spain
| | - F J Martín-Gil
- Clinical Chemistry Service, Hospital Universitario Rio Hortega, Valladolid, Spain
| | | | - B Martín
- Research Unit, IEN, Rio Hortega University Hospital, Valladolid, Spain
| | - J Castrodeza
- Direction of Public Health, Investigation, Development and Innovation, SACYL, Valladolid, Spain
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García-Gallardo MV, Algorta J, Longo N, Espinel S, Aragones A, Lombardero M, Bernaola G, Jauregui I, Aranzabal A, Albizu MV, Gastaminza G. Evaluation of the effect of pollution and fungal disease on Pinus radiata pollen allergenicity. Int Arch Allergy Immunol 2012; 160:241-50. [PMID: 23075861 DOI: 10.1159/000341368] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 06/20/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pollutants and other stressing factors like mold infection might increase the production of pathogen-related proteins in plants. Since this is invoked as one of the causes for the high prevalence of allergic diseases in developed countries, we aimed to determine the potential effect of environmental pollution, with or without mold infection of the trees, on the allergenic potency of pine pollen (Pinus radiata). METHODS Pine pollen samples were recovered from three selected areas: low polluted (A), highly polluted (B) and highly polluted and infected with fungi (Spheropsis sapinea) (C). The allergenic potency of pollen from areas A, B or C were compared in vivo in 35 pine pollen-allergic patients by skin prick test and specific IgE (sIgE) quantification. Pollen was also analyzed in vitro by SDS-PAGE immunoblotting, RAST inhibition and cDNA-AFLP (amplified fragment length polymorphism) to compare differences in proteins and mRNA expression. RESULTS The allergenic potency measured by prick test, sIgE and RAST inhibition was greater in pollen A, which was exposed to smaller amounts of NO(x), PM(10) and SO(2) but greater amounts of O(3). No differences were found in IgE-binding bands in immunoblotting or densitometry of the bands. In cDNA-AFLP, three homologous transcript-derived fragments were expressed in samples B only, with an expressed sequence tag related with stress-regulated gene expression. CONCLUSIONS A greater allergenic potency, in terms of skin tests and sIgE, is observed in pine pollen coming from unpolluted areas. We consider that this fact might be related to a higher exposure to ozone, resulting in a greater expression of allergenic proteins.
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Akkerdaas J, Finkina EI, Balandin SV, Santos Magadán S, Knulst A, Fernandez-Rivas M, Asero R, van Ree R, Ovchinnikova TV. Lentil (Lens culinaris) lipid transfer protein Len c 3: a novel legume allergen. Int Arch Allergy Immunol 2011; 157:51-7. [PMID: 21912173 DOI: 10.1159/000324946] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 02/07/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Lentils are increasingly consumed in many parts of the world.Two allergens, Len c 1 and 2, have been reported previously. Recently, peanut and green bean lipid transfer proteins (LTPs) have been identified as the first two members of an important group of allergens that might be associated with severe food allergies. OBJECTIVE To investigate lentil LTP as a potential new allergen. METHODS Efficacy of LTP extraction was monitored at different acidic pH values, using immunoblotting with cross-reactive anti-peach LTP antiserum. Natural LTP was purified from lentil extract and expressed as recombinant allergen in Escherichia coli. Sera from 10 lentil-allergic and/or -sensitized patients (Spain: 6, Italy: 1 and the Netherlands: 3) were used to further characterize lentil LTP. RESULTS Natural lentil LTP, purified from the homogenized germinated seeds and optimally extracted at pH 3, was identified and designated as allergen Len c 3. By CAP, 9/10 sera showed specific IgE to Len c 3. Recombinant (r) Len c 3 was successfully purified. The natural (n) Len c 3 CAP was completely inhibited by rLen c 3/rPru p 3. IgE binding to lentil pH 3 extract blot was completely inhibited by rLen c 3. CONCLUSION The availability of immunochemically active nLen/rLen c 3 as a novel legume allergen facilitates further development and implementation of a third (next to peanut and green bean) legume LTP in component-resolved diagnosis strategies and contributes to evaluate the clinical importance of legume LTPs. Preferential extraction of Len c 3 (pH 3) will affect the production of sensitive extract-based diagnostic tests.
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Armentia A, Castrodeza J, Ruiz-Muñoz P, Martínez-Quesada J, Postigo I, Herrero M, Gonzalez-Sagrado M, de Luis D, Martín-Armentia B, Guisantes JA. Allergic hypersensitivity to cannabis in patients with allergy and illicit drug users. Allergol Immunopathol (Madr) 2011; 39:271-9. [PMID: 21272987 DOI: 10.1016/j.aller.2010.09.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 09/19/2010] [Accepted: 09/28/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cannabis is the illicit drug most widely used by young people in high-income countries. Allergy symptoms have only occasionally been reported as one of the adverse health effects of cannabis use. OBJECTIVES To study IgE-mediated response to cannabis in drug users, atopic patients, and healthy controls. METHODS Asthmatic patients sensitised to pollen, and all patients sensitised to tobacco, tomato and latex, considered as cross-reacting allergens, were selected from a data base of 21,582 patients. Drug users attending a drug-rehabilitation clinic were also included. Controls were 200 non-atopic blood donors. Specific IgE determination, prick tests and specific challenge with cannabis extracts were performed in patients and controls. RESULTS Overall, 340 patients, mean age 26.9±10.7 years, were included. Males (61.4%) were the most sensitised to cannabis (p<0.001). All cannabis-sensitised patients were alcohol users. Eighteen (72%) of the patients allergic to tomato were sensitised to cannabis, but a positive specific challenge to cannabis was highest in patients sensitised to tobacco (13/21, 61.9%), (p<0.001). Pollen allergy was not a risk factor for cannabis sensitisation. Prick tests and IgE for cannabis had a good sensitivity (92 and 88.1%, respectively) and specificity (87.1 and 96%) for cannabis sensitisation. CONCLUSIONS Cannabis may be an important allergen in young people. Patients previously sensitised to tobacco or tomato are at risk. Cannabis prick tests and IgE were useful in detecting sensitisation.
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Affiliation(s)
- A Armentia
- Direction of Public Health, Investigation, Development and Innovation, SACYL, Valladolid, Spain.
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Sander I, Rozynek P, Rihs HP, van Kampen V, Chew FT, Lee WS, Kotschy-Lang N, Merget R, Brüning T, Raulf-Heimsoth M. Multiple wheat flour allergens and cross-reactive carbohydrate determinants bind IgE in baker's asthma. Allergy 2011; 66:1208-15. [PMID: 21557753 DOI: 10.1111/j.1398-9995.2011.02636.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several wheat flour allergens relevant to baker's asthma have been identified in the last 25 years. The aim of this study was to determine the frequency of sensitization to these allergens in German bakers. METHODS Using recombinant DNA technology, the following wheat flour allergens were cloned, expressed in Escherichia coli and purified: five subunits of the wheat α-amylase inhibitors (WTAI-CM1, WTAI-CM2, WTAI-CM3, WDAI-0.19 and WMAI-0.28), thioredoxin, thiol reductase or 1-cys-peroxiredoxin homologues, triosephosphate-isomerase, αβ-gliadin, serpin, glyceraldehyde-3-phosphate-dehydrogenase, a nonspecific lipid transfer protein (nsLTP), dehydrin, profilin and peroxidase. In addition, ImmunoCAPs with the recombinant allergen ω-5-gliadin and two cross-reactive carbohydrate determinants (CCDs), horse radish peroxidase (HRP) and the N-glycan of bromelain (MUXF), were used. Specific IgE was measured in wheat flour-positive sera from 40 German bakers with work-related asthma/rhinitis and 10 controls with pollinosis. RESULTS Thirty bakers (75%) had IgE to at least one of the 19 single allergens. Most frequent was IgE to WDAI-0.19, HRP and MUXF (25% each), followed by WTAI-CM1 (20%), thiol reductase (16%), WTAI-CM3 (15%), WTAI-CM2 and thioredoxin (12.5%), WMAI-28, triosephosphate-isomerase, αβ-gliadin (10%), 1-cys-peroxiredoxin (7.5%), dehydrin, serpin, glyceraldehyde-3-phosphate-dehydrogenase (5%), ω-5-gliadin, nsLTP and profilin (2.5%). Fifteen bakers (38%) had IgE to any α-amylase inhibitor and 12 (30%) to at least one CCD. The controls reacted exclusively to CCDs (80%), profilin (60%), thioredoxin (30%), triosephosphate isomerase and nsLTP (10%). CONCLUSIONS The single allergen sensitization profiles obtained with 17 recombinant wheat flour allergens and two CCDs revealed no major allergen for German bakers. The highest frequencies were found for α-amylase inhibitors and CCDs.
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Affiliation(s)
- I Sander
- Institute for Prevention and Occupational Medicine, German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Department of Allergology/Immunology, Bürkle-de-la-Camp-Platz 1, Bochum, Germany.
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Kaulfürst-Soboll H, Mertens M, Brehler R, von Schaewen A. Reduction of cross-reactive carbohydrate determinants in plant foodstuff: elucidation of clinical relevance and implications for allergy diagnosis. PLoS One 2011; 6:e17800. [PMID: 21423762 PMCID: PMC3056789 DOI: 10.1371/journal.pone.0017800] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 02/15/2011] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A longstanding debate in allergy is whether or not specific immunoglobulin-E antibodies (sIgE), recognizing cross-reactive carbohydrate determinants (CCD), are able to elicit clinical symptoms. In pollen and food allergy, ≥20% of patients display in-vitro CCD reactivity based on presence of α1,3-fucose and/or β1,2-xylose residues on N-glycans of plant (xylose/fucose) and insect (fucose) glycoproteins. Because the allergenicity of tomato glycoallergen Lyc e 2 was ascribed to N-glycan chains alone, this study aimed at evaluating clinical relevance of CCD-reduced foodstuff in patients with carbohydrate-specific IgE (CCD-sIgE). METHODOLOGY/PRINCIPAL FINDINGS Tomato and/or potato plants with stable reduction of Lyc e 2 (tomato) or CCD formation in general were obtained via RNA interference, and gene-silencing was confirmed by immunoblot analyses. Two different CCD-positive patient groups were compared: one with tomato and/or potato food allergy and another with hymenoptera-venom allergy (the latter to distinguish between CCD- and peptide-specific reactions in the food-allergic group). Non-allergic and CCD-negative food-allergic patients served as controls for immunoblot, basophil activation, and ImmunoCAP analyses. Basophil activation tests (BAT) revealed that Lyc e 2 is no key player among other tomato (glyco)allergens. CCD-positive patients showed decreased (re)activity with CCD-reduced foodstuff, most obvious in the hymenoptera venom-allergic but less in the food-allergic group, suggesting that in-vivo reactivity is primarily based on peptide- and not CCD-sIgE. Peptide epitopes remained unaffected in CCD-reduced plants, because CCD-negative patient sera showed reactivity similar to wild-type. In-house-made ImmunoCAPs, applied to investigate feasibility in routine diagnosis, confirmed BAT results at the sIgE level. CONCLUSIONS/SIGNIFICANCE CCD-positive hymenoptera venom-allergic patients (control group) showed basophil activation despite no allergic symptoms towards tomato and potato. Therefore, this proof-of-principle study demonstrates feasibility of CCD-reduced foodstuff to minimize 'false-positive results' in routine serum tests. Despite confirming low clinical relevance of CCD antibodies, we identified one patient with ambiguous in-vitro results, indicating need for further component-resolved diagnosis.
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Affiliation(s)
| | - Melanie Mertens
- Department of Dermatology, University of
Münster, Münster, Germany
| | - Randolf Brehler
- Department of Dermatology, University of
Münster, Münster, Germany
| | - Antje von Schaewen
- Institute of Plant Biology and Biotechnology,
University of Münster, Münster, Germany
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Merget R, Sander I, van Kampen V, Beckmann U, Heinze E, Raulf-Heimsoth M, Bruening T. Allergic asthma after flour inhalation in subjects without occupational exposure to flours: an experimental pilot study. Int Arch Occup Environ Health 2011; 84:753-60. [PMID: 21279645 DOI: 10.1007/s00420-011-0617-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 01/12/2011] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Cross-reactivity between grass pollen and grain flour allergens is well known, but their significance in apprentice bakers with primary sensitization to grass pollen is not known. METHODS Twenty-five subjects with mild asthma (most of them with hay fever), but without prior occupational flour exposure, underwent standardized experimental inhalation challenges with placebo and wheat and rye flours in randomized order on three consecutive days. Sensitization to flours and environmental allergens was assessed by skin prick tests and specific IgE antibodies in sera. IgE inhibition experiments were performed with wheat and rye flours as solid phases, and grass and tree pollen as inhibitors. RESULTS Five subjects experienced a positive reaction after flour inhalation (responders), whereas 20 subjects did not show such a reaction (non-responders). All responders showed sensitizations to flours, whereas only 25% of the non-responders demonstrated the same sensitization. Specific IgE concentrations to flours, but also to grass and tree pollen, were higher in responders. Inhibition experiments demonstrated cross-reactivity between flours and grass or tree pollen, with higher inhibition rates in responders. CONCLUSIONS Subjects with pronounced sensitizations to grass or tree pollen, but without prior occupational exposure to flours, may experience both sensitization and allergic asthmatic reactions to flours due to cross-reactive grass and tree pollen allergens.
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Affiliation(s)
- R Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bürkle-de-la-Camp-Platz 1, Bochum, Germany.
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Jiang XD, Li GY, Dong Z, Zhu DD. Correlation analysis of two serum-specific immunoglobulin E test systems and skin-prick test in allergic rhinitis patients from northeast China. Am J Rhinol Allergy 2011; 25:116-9. [PMID: 21294972 DOI: 10.2500/ajra.2011.25.3572] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Skin-prick testing (SPT) is the most common screening method for allergy evaluation. The detection of serum-specific immunoglobulin E (sIgE) is also commonly used. The sensitivity and specificity of these testing methods may vary due to type of causative allergen and type of allergic manifestation. The purpose of this study was to evaluate the correlation between two methods of measuring sIgE (AllergyScreen [Mediwiss Analytic GmbH, Moers, Germany] and ImmunoCAP [Pharmacia, Uppsala, Sweden]) and SPT for the diagnosis of allergic rhinitis (AR). METHODS All 216 patients who were referred to the allergist for suspected AR from June to October 2009 had SPT and the two serological tests. One hundred fifty-eight patients had a positive clinical history and a related positive SPT. The SPT was used as reference standard, and we selected three allergens (Dermatophagoides pteronyssinus, mugwort, and ragweed), which were common in fall in northeast China, to analyze the correlation of the two serum tests and SPT. RESULTS Compared with the SPT, the diagnostic indexes (accuracy, sensitivity and specificity) of the AllergyScreen system and the ImmunoCAP system were 0.819 versus 0.810, 0.780 versus 0.872, and 0.862 versus 0.741, respectively. The accuracy was similar between the two systems (p > 0.05). The ImmunoCAP system method had a higher sensitivity (p < 0.01). The AllergyScreen system had a higher specificity (p < 0.01). CONCLUSION These data support that the AllergyScreen system and ImmunoCAP system can identify potentially significant allergens in the diagnosis of AR in patients from northeastern China.
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Affiliation(s)
- Xiao-Dan Jiang
- Department of Otorhinolaryngology, Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
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Postigo I, Gutiérrez-Rodríguez A, Fernández J, Guisantes JA, Suñén E, Martínez J. Diagnostic value of Alt a 1, fungal enolase and manganese-dependent superoxide dismutase in the component-resolved diagnosis of allergy to pleosporaceae. Clin Exp Allergy 2011; 41:443-51. [DOI: 10.1111/j.1365-2222.2010.03671.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Occupational asthma induced by Chrysonilia sitophila in a worker exposed to coffee grounds. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2010; 17:1645-6. [PMID: 20685936 DOI: 10.1128/cvi.00134-10] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A new case of occupational asthma caused by Chrysonilia sitophila (asexual state of Neurospora sitophila) was diagnosed by molecular identification of the mold and confirmed by skin prick test, peak expiratory flow rate measurements, and experimental immunoglobulin E analysis.
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Rodrigo MJ, Postigo I, Wangensteen O, Guisantes JA, Martínez J. A new application of Streptavidin ImmunoCAP for measuring IgG antibodies against non-available commercial antigens. Clin Chim Acta 2010; 411:1675-8. [PMID: 20619254 DOI: 10.1016/j.cca.2010.06.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 06/29/2010] [Accepted: 06/29/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND Enzyme immunoassay has been successfully used for the diagnosis of hypersensitivity pneumonitis (HP), but there are difficulties in standardising this method because of the difficulty in obtaining stable solid phases from a huge variety of heterogeneous antigenic sources. With this in mind, the aim of this work was to demonstrate the usefulness of the standard available fluoro-enzyme-immuno-assay (FEIA) to measure specific IgG to uncommon, commercially unavailable HP-causing antigens. METHODS Serum samples from patients suffering from HP caused by canary and pigeon protein exposure with positive immunoprecipitation values, as well as cystic fibrosis patients, patients with respiratory allergies, asymptomatic subjects exposed to canary proteins (canary breeders) and healthy unexposed individuals were evaluated by FEIA using biotinylated serum proteins coupled to streptavidin-activated solid phases. Statistical analyses were performed to compare the different groups and to evaluate the performance of this technique. RESULTS The group of patients with hypersensitivity pneumonitis caused by exposure to canary proteins showed the highest value of specific IgG (35.70 mg IgG/mL). ROC analysis demonstrated an optimal cut-off value of 8.44 mg IgG/mL with a sensitivity of 100% and a specificity of 91.76%. Comparisons with other groups revealed statistically significant differences. Comparison between ELISA and FEIA results revealed a strong positive relationship between values obtained in both assays. CONCLUSION The results demonstrate that Streptavidin ImmunoCAP is a sensitive, specific and efficient laboratory method for routine diagnostic testing of HP caused by protein antigens that are not commercially available.
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Affiliation(s)
- María J Rodrigo
- Unit of Immunology, Clinical Laboratories, University Hospital Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035-Barcelona, Spain
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Kespohl S, Schlünssen V, Jacobsen G, Schaumburg I, Maryska S, Meurer U, Brüning T, Sigsgaard T, Raulf-Heimsoth M. Impact of cross-reactive carbohydrate determinants on wood dust sensitization. Clin Exp Allergy 2010; 40:1099-106. [DOI: 10.1111/j.1365-2222.2010.03514.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Baatjies R, Meijster T, Lopata A, Sander I, Raulf-Heimsoth M, Heederik D, Jeebhay M. Exposure to flour dust in South African supermarket bakeries: modeling of baseline measurements of an intervention study. ACTA ACUST UNITED AC 2010; 54:309-18. [PMID: 20200089 DOI: 10.1093/annhyg/meq005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Exposure to flour dust has been reported as an important risk factor for allergic respiratory disease among bakery workers. A high prevalence of allergic sensitization and asthma was recently reported in South African supermarket bakeries. The aim of this study was to conduct a detailed exposure assessment of these bakeries so as to provide the baseline for a broader intervention study. METHODS A total of 211 full-shift personal samples were collected on randomly selected individuals within five different job categories in 18 bakeries. The samples were analyzed for particulate mass and specific flour dust allergens (wheat, rye, and fungal alpha-amylase). Exposure models were developed using job, bakery size, tasks, and specific ingredients used. Bakery and worker were regarded as random effect components. RESULTS Bread bakers had the highest average (geometric mean) exposures (1.33 mg m(-3) flour dust particulate, 13.66 microg m(-3) wheat allergens, and 5.14 microg m(-3) rye allergens). For alpha-amylase allergens, most samples were below the limit of detection for several occupational titles. In the mixed effect models, the significant predictors of elevated exposure to inhalable dust particulate as well as wheat and rye allergen concentrations were large bakery size, bread baking, and use of cereal flours, while tasks such as confectionery work were negatively correlated with these exposure metrics. Weighing tasks and use of premix products were associated with increased exposure to fungal alpha-amylase. A high correlation between particulate dust and wheat (r = 0.84) as well as rye (r = 0.86) was observed, with a much lower correlation between particulate dust and fungal alpha-amylase (r = 0.33). Overall, a low proportion (39%) of bakery stores implemented various control measures to reduce dust exposures in the bakeries. CONCLUSIONS This study confirms that current exposure control strategies in supermarket bakery stores are inadequate in reducing dust exposures to protect the health of bakery workers.
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Affiliation(s)
- Roslynn Baatjies
- Department of Environmental and Occupational Studies, Faculty of Applied Sciences, Cape Peninsula University of Technology, Cape Town 8001, South Africa
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Ibero M, Boné J, Martín B, Martínez J. Evaluation of an extensively hydrolysed casein formula (Damira 2000) in children with allergy to cow's milk proteins. Allergol Immunopathol (Madr) 2010; 38:60-8. [PMID: 20015589 DOI: 10.1016/j.aller.2009.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 08/25/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the allergenic capacity of a new extensively hydrolysed casein formula (Damira 2000) in vivo in children with allergy to cow's milk, and to conduct an immunochemical evaluation of the product. PATIENTS AND METHODS The study comprised 67 children (1 month-7 years) with allergy to cow's milk proteins (ACMP). Skin testing was made with whole milk, milk formula for infants, the study hydrolysate and the milk fractions (alpha-lactoalbumin, beta-lactoglobulin and casein). Specific IgE against these allergens, and oral provocation test were also performed. Immunochemical evaluation of the product was carried out with gel filtration chromatography, 4-15% acrylamide gradient gel electrophoresis, specific IgE quantification versus the casein hydrolysate and a study of its allergenic potency. RESULTS The hydrolysate was tolerated by 66 of the 67 patients (98.5%) with ACMP. Biochemical analysis of the product confirmed the absence of traces of whole milk proteins. Specific IgE against the hydrolysate proved negative in all cases, and it was unable to inhibit FEIA even at concentrations 10 times greater than those used in the whole milk inhibition control. Likewise, no immunoblotting inhibition was recorded. CONCLUSIONS The new extensively hydrolysed casein product is safe and well tolerated by most children with ACMP. However, as with other extensive hydrolysates, some highly sensitised patients may present clinical manifestations. Controlled tolerance testing is therefore advised, under specialised medical supervision.
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Affiliation(s)
- M Ibero
- Allergy Unit, Terrassa Hospital, Terrassa, Barcelona, Spain.
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van Kampen V, Merget R, Rabstein S, Sander I, Bruening T, Broding HC, Keller C, Muesken H, Overlack A, Schultze-Werninghaus G, Walusiak J, Raulf-Heimsoth M. Comparison of wheat and rye flour solutions for skin prick testing: a multi-centre study (Stad 1). Clin Exp Allergy 2009; 39:1896-902. [PMID: 19709069 DOI: 10.1111/j.1365-2222.2009.03342.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Skin prick testing (SPT) is the basic method for diagnosing IgE-mediated allergies. However, skin reactivity is related to the quality of allergen extracts, which are often poorly defined for occupational allergens. OBJECTIVE To compare wheat and rye flour SPT solutions from different producers. MATERIALS AND METHODS Standardized SPTs were performed in seven allergy centres with wheat and rye flour solutions from four producers in 125 symptomatic bakers. Optimal cut-off levels for weal sizes were assessed with the Youden Index. Comparisons between SPT results of different solutions were made with flour-specific IgE (sIgE) as the gold standard. Sensitivities, specificities, positive and negative predictive values, and test efficiencies were calculated and compared with McNemar and chi(2)-tests. The influence of the choice of the gold standard (sIgE or challenge) test was examined for 95 subjects. Additionally, SPT solutions were analysed for protein and antigen content. RESULTS The optimal cut-off level for all SPT solutions was a weal size of >or=1.5 mm. While differences between wheat and rye flours were small, differences between producers were important. Variability of sensitivities (0.31-0.96), negative predictive values (0.42-0.91), and test efficiencies (0.54-0.90) were higher than variations of specificities (0.74-1.00) and positive predictive values (0.88-1.00). Similar results were obtained when using challenge test results as the gold standard. Variability could be explained by the different antigen contents of the SPT solutions. CONCLUSION There is a wide variability of SPT solutions for wheat and rye flour from different producers, mainly with respect to sensitivities, negative predictive values, and test efficiencies. Improvement and standardization of SPT solutions used for the diagnosis of baker's asthma are highly recommended.
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Affiliation(s)
- V van Kampen
- BGFA - Research Institute of Occupational Medicine, Ruhr University, Bochum, Germany.
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Raulf-Heimsoth M, Rihs HP, Rozynek P, Cremer R, Gaspar A, Pires G, Yeang HY, Arif SAM, Hamilton RG, Sander I, Lundberg M, Brüning T. Quantitative analysis of immunoglobulin E reactivity profiles in patients allergic or sensitized to natural rubber latex (Hevea brasiliensis). Clin Exp Allergy 2007; 37:1657-67. [PMID: 17883426 DOI: 10.1111/j.1365-2222.2007.02833.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Characterized native and recombinant Hevea brasiliensis (rHev b) natural rubber latex (NRL) allergens are available to assess patient allergen sensitization profiles. OBJECTIVE Quantification of individual IgE responses to the spectrum of documented NRL allergens and evaluation of cross-reactive carbohydrate determinants (CCDs) for more definitive diagnosis. METHODS Sera of 104 healthcare workers (HCW; 51 German, 21 Portuguese, 32 American), 31 spina bifida patients (SB; 11 German, 20 Portuguese) and 10 Portuguese with multiple surgeries (MS) were analysed for allergen-specific IgE antibody (sIgE) to NRL, single Hev b allergens and CCDs with ImmunoCAP technology. RESULTS In all patient groups rHev b 5-sIgE concentrations were the most pronounced. Hev b 2, 5, 6.01 and 13 were identified as the major allergens in HCW and combined with Hev b 1 and Hev b 3 in SB. In MS Hev b 1 displayed an intermediate relevance. Different sIgE antibody levels to native Hevea brasiliensis (nHev b) 2 and rHev b 6.01 allowed discrimination of SB with clinical relevant latex allergy vs. those with latex sensitization. Sensitization profiles of German, Portuguese and American patients were equivalent. rHev b 5, 6.01 and nHev b 13 combined detected 100% of the latex-allergic HCW and 80.1% of the SB. Only 8.3% of the sera showed sIgE response to CCDs. CONCLUSIONS Hev b 1, 2, 5, 6.01 and 13 were identified as the major Hev b allergens and they should be present in standardized latex extracts and in vitro allergosorbents. CCDs are only of minor relevance in patients with clinical relevant latex allergy. Component-resolved diagnostic analyses for latex allergy set the stage for an allergen-directed immunotherapy strategy.
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Affiliation(s)
- M Raulf-Heimsoth
- BGFA-Research Institute of Occupational Medicine - German Social Accident Insurance, Ruhr-University Bochum, Bochum, Germany.
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Sharif S, Goldberg B. Detection of IgE antibodies to bacitracin using a commercially available streptavidin-linked solid phase in a patient with anaphylaxis to triple antibiotic ointment. Ann Allergy Asthma Immunol 2007; 98:563-6. [PMID: 17601270 DOI: 10.1016/s1081-1206(10)60736-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bacitracin is a commonly used topical antibiotic that has on occasion been reported to cause anaphylaxis. Evidence of the role of bacitracin specific IgE in such reactions has been demonstrated by skin testing. Because of the potential for provoking a systemic reaction by skin testing, it would be advantageous to develop an in vitro test for bacitracin specific IgE. OBJECTIVE To report our experience coupling bacitracin to a solid phase and using it to detect specific IgE to bacitracin by fluorescent enzyme immunoassay. METHODS A patient with a history of recurrent anaphylaxis that developed after application of triple antibiotic ointment to an open wound underwent skin testing with triple antibiotic ointment. Bacitracin was biotinylated and coupled to streptavidin ImmunoCAPs. IgE against bacitracin in the patient's serum was detected by fluorescent enzyme immunoassay. RESULTS Topical application of triple antibiotic ointment to intact skin produced a 7 X 8-mm wheal with pseudopods. IgE against bacitracin was detected using biotinylated bacitracin-streptavidin ImmunoCAPs at a level of approximately 0.6 KUA/L and confirmed with ImmunoCAPs using direct coupling of bacitracin to the solid phase. CONCLUSIONS We demonstrate the presence of IgE antibodies to bacitracin in a patient with anaphylaxis to triple antibiotic ointment using a recently described procedure for producing custom allergen solid phases for immunoassay.
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Affiliation(s)
- Saba Sharif
- Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California, USA.
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Abstract
PURPOSE OF REVIEW Isocyanates, reactive chemicals used to generate polyurethane, are a leading cause of occupational asthma worldwide. Workplace exposure is the best-recognized risk factor for disease development, but is challenging to monitor. Clinical diagnosis and differentiation of isocyanates as the cause of asthma can be difficult. The gold-standard test, specific inhalation challenge, is technically and economically demanding, and is thus only available in a few specialized centers in the world. With the increasing use of isocyanates, efficient laboratory tests for isocyanate asthma and exposure are urgently needed. RECENT FINDINGS The review focuses on literature published in 2005 and 2006. Over 150 articles, identified by searching PubMed using keywords 'diphenylmethane', 'toluene' or 'hexamethylene diisocyanate', were screened for relevance to isocyanate asthma diagnostics. New advances in understanding isocyanate asthma pathogenesis are described, which help improve conventional radioallergosorbent and enzyme-linked immunosorbent assay approaches for measuring isocyanate-specific IgE and IgG. Newer immunoassays, based on cellular responses and discovery science readouts are also in development. SUMMARY Contemporary laboratory tests that measure isocyanate-specific human IgE and IgG are of utility in diagnosing a subset of workers with isocyanate asthma, and may serve as a biomarker of exposure in a larger proportion of occupationally exposed workers.
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Affiliation(s)
- Adam V Wisnewski
- Yale University School of Medicine, Department of Internal Medicine, New Haven, Connecticut 06520-8057, USA.
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Lopata AL, Adams S, Kirstein F, Henwood N, Raulf-Heimsoth M, Jeebhay MF. Occupational allergy to latex among loom tuners in a textile factory. Int Arch Allergy Immunol 2007; 144:64-8. [PMID: 17505139 DOI: 10.1159/000102616] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Accepted: 12/20/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Occupational allergy to latex is generally reported from occupational groups such as health care workers; however, few reports derive from other occupational settings. METHODS Two male subjects working as loom tuners in a textile manufacturing plant developed severe allergic reactions during the cutting and weaving of elastic bands, initially not suspected to contain latex constituents. Clinical evaluation and lung function tests were supplemented by skin prick testing, specific IgE evaluation and basophil activation assays with extracted elastic bands. RESULTS Both workers presented with rhinitis, episodes of tight chest and itchy eyes. Initial spirometry was normal with no significant reversibility; however, a histamine challenge test was positive in one worker. Skin prick testing to a battery of common inhalant allergens was negative; however, raised IgE levels were detected to latex using ImmunoCAP. On further testing, the specific IgE response was directed mainly to the major latex allergens rHev b 5, rHev b 6.01, rHev b 6.02 and nHev b 13. Basophils of the two workers, but not the unaffected control subjects, were strongly activated by extracts of the elastic and the cutting dust material. CONCLUSIONS Workers are at high risk of becoming sensitised to latex allergens when exposed to excessive dust produced by loom tuning machines. Latex sensitisation should therefore be considered in workers developing unexplained work-related allergic reactions (including asthma) associated with unlabelled materials in the textile industry.
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Affiliation(s)
- Andreas L Lopata
- Allergy and Asthma Research Group, Division of Immunology, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, National Health Laboratory Service, University of Cape Town, Cape Town, South Africa.
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Sánchez-Velasco P, Antón E, Muñoz D, Martínez-Quesada J, Ruíz de Alegría C, López-Hoyos M, García-Martín A, Jiménez I, Alonso ST, Duque S, Suárez A, Jerez J, Leyva-Cobián F. Sensitivity to Bee Venom Antigen Phospholipase A2: Association With Specific HLA Class I and Class II Alleles and Haplotypes in Beekeepers and Allergic Patients. Hum Immunol 2005; 66:818-25. [PMID: 16112029 DOI: 10.1016/j.humimm.2005.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Revised: 03/20/2005] [Accepted: 04/01/2005] [Indexed: 11/22/2022]
Abstract
Bee venom hypersensitivity is a clinical entity of outstanding importance because bee stings are a leading cause of mortality worldwide. Individuals with immediate-type bee venom hypersensitivity, beekeepers, and healthy controls were examined for HLA-DRB1, DQB1, and DQA1 alleles by sequence-specific oligonucleotide probe typing. Defined hypersensitivity to bee venom antigen phospholipase A2 (vbPLA2) is significantly associated with the presence of susceptible HLA class II alleles: DRB1*0101 (RR = 2.7, p < 3 x 10(-3)), DRB1*0103 (RR = 21.2, p < 7.5 x 10(-11)), DQA1*0101 (RR = 1.2, p < 38.52 x 10(-10)), and DQB1*0501 (RR = 4, p < 2.18 x 10(-10)). Some HLA class I alleles were also associated with risk to bee venom allergy: A*01 (RR = 2.4, p < 7.5 x 10(-4)), B*57 (RR = 35.1, p < 3.5 x 10(-7)), and B*5901 (p < 3.5 x 10(-5)), but they are probably of secondary significance. Three- (DRB1*0103-DQA1*0101-DQB1*0501) (RR = 21.24, p < 7.5 x 10(-11)) and five-loci (A*01-B*59-DRB1*0103-DQA1*0101-DQB1*0501) (p < 2.3 x 10(-6)) extended haplotypes are also significantly carried by vbPLA2 allergic patients. When HLA allele frequencies from patients are compared with those from beekeepers, only HLA-DRB1*0103 (RR = 11.7, p < 8.5 x 10(-5)) and HLA-DQA1*0101 (p < 0.02) were significantly increased in the former. These observations emphasize the importance of the DRB1*0103-DQA1*0101-DQB1*0501 haplotype as a strong candidate for susceptibility to vbPLA2 hypersensitivity, at least in our region.
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Affiliation(s)
- Pablo Sánchez-Velasco
- Servicio de Inmunología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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