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Kedar O, Golberg A, Obolski U, Confino-Cohen R. Allergic to bureaucracy? Regulatory allergenicity assessments of novel food: Motivations, challenges, compromises, and possibilities. Compr Rev Food Sci Food Saf 2024; 23:e13300. [PMID: 38477215 DOI: 10.1111/1541-4337.13300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 03/14/2024]
Abstract
New sources of proteins are essential to meet the demands of the growing world population and evolving food trends. Assessing the allergenicity of proteins in novel food (NF) poses a significant food safety regulatory challenge. The Codex Alimentarius Commission presented an allergenicity assessment protocol for genetically modified (GM) foods, which can also be adapted for NF. Since no single laboratory test can adequately predict the allergenic potential of NF, the protocol follows a weight-of-evidence approach, evaluated by experts, as part of a risk management process. Regulatory bodies worldwide have adopted this safety protocol, which, among other things, promotes global harmonization. This review unravels the reliability and various motivations, terms, concepts, and approaches of allergenicity assessments, aiming to enhance understanding among manufacturers and the public. Health Canada, Food Safety Commission JAPAN, and Food Standards Australia New Zealand were surveyed, focusing on the European Food Safety Authority and the US Food Safety Administration for examples of scientific opinions regarding allergenicity assessments for novel and GM foods, from 2019 to 2023. According to our findings, current regulatory allergenicity assessments for NF approval primarily rely on literature reviews. Only a few of the NF assessments proactively presented additional tests. We recommend conducting bioinformatic analyses on NF when a panel of experts deems that there is insufficient prior scientific research.
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Affiliation(s)
- Odeya Kedar
- Faculty of Exact Sciences, Department of Environmental Studies, The Porter School of Environment and Earth Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Golberg
- Faculty of Exact Sciences, Department of Environmental Studies, The Porter School of Environment and Earth Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Uri Obolski
- Faculty of Exact Sciences, Department of Environmental Studies, The Porter School of Environment and Earth Sciences, Tel Aviv University, Tel Aviv, Israel
- Faculty of Medicine, School of Public Health, Department of Epidemiology and Preventive Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Confino-Cohen
- Allergy and Clinical Immunology Unit, Meir Medical Center, Kfar Saba, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Zhang Y, Shang M, Tian Y, Liu X, Sun X, Gao L. Allergen sensitization study in Dongying, China: An epidemiological study. Medicine (Baltimore) 2024; 103:e36862. [PMID: 38241586 PMCID: PMC10798692 DOI: 10.1097/md.0000000000036862] [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: 10/27/2023] [Accepted: 12/14/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND To explore the relationship between specific immunoglobulin E levels in response to prevalent pollen and food allergens among patients suffering from localized allergic diseases in the Dongying area of China, and to analyze the interconnectivity among these factors. METHODS This research encompassed allergic patients who visited the Allergy Department of Shengli Oilfield Central Hospital from January 2022 to January 2023. We examined the specific immunoglobulin E levels in the blood of 230 patients utilizing the Fobock platform provided by Jiangsu Haoeubo Company. Statistical analysis was conducted with SPSS 25.0 statistical software. The chi-square test evaluated the relevance of differences in gender and age. A value of P < .05 was considered statistically significant. RESULTS In this study, eggs emerged as the allergen with the highest number of sensitized individuals, closely followed by dust mite. Conversely, the least sensitized allergen was the cypress tree, closely followed by mango. Notably, male patients exhibited higher sensitivities to cottonwood (P < .05) and egg (P < .001) compared to female patients. Children aged 0 to 10 years showed increased sensitivity to variety of allergens. A significant correlation was observed among different allergens. The top ten allergen pairs with the highest correlation included Birch Tree and Cottonwood (0.88, P < .001), Cottonwood and Pine Tree (0.86, P < .001), Birch Tree and Pine Tree (0.84, P < .001), Pine Tree and Paulownia (0.81, P < .001), Dust Mite and House Dust Mite (0.76, P < .001), Birch Tree and Paulownia (0.73, P < .001), Cashew and Pistachio (0.71, P < .001), Apple and Hazelnut (0.71, P < .001), Cottonwood and Paulownia (0.71, P < .001), and Pine Tree and Ordinary Ragweed (0.70, P < .001). CONCLUSION This research sheds light on the patterns of allergen sensitization in Dongying, Shandong, highlighting that egg is the most prevalent sensitizing allergen. A notably high correlation was observed between Birch Tree and Cottonwood. This study enhanced the understanding of allergic diseases, explored the causes and mechanisms of allergies, strengthened the management of allergic diseases. Furthermore, it offers valuable insights for the clinical diagnosis and prevention of allergic diseases.
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Affiliation(s)
- Yingying Zhang
- Department of Pediatrics, Shengli Oilfield Central Hospital, Dongying City, Shandong Province, China
| | - Mei Shang
- Department of Pediatrics, Shengli Oilfield Central Hospital, Dongying City, Shandong Province, China
| | - Ying Tian
- Department of Pediatrics, Shengli Oilfield Central Hospital, Dongying City, Shandong Province, China
| | - Xuwei Liu
- Department of Pediatrics, Shengli Oilfield Central Hospital, Dongying City, Shandong Province, China
| | - Xuhui Sun
- Department of Pediatrics, Shengli Oilfield Central Hospital, Dongying City, Shandong Province, China
| | - Lianjun Gao
- Department of Pediatrics, Shengli Oilfield Central Hospital, Dongying City, Shandong Province, China
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3
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Identification and Annotation of Peptide Allergens in Prunus dulcis. Int J Pept Res Ther 2022. [DOI: 10.1007/s10989-022-10468-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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A spotlight on analytical prospects in food allergens: From emerging allergens and novel foods to bioplastics and plant-based sustainable food contact materials. Food Chem 2022; 388:132951. [PMID: 35447585 DOI: 10.1016/j.foodchem.2022.132951] [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: 08/02/2021] [Revised: 04/06/2022] [Accepted: 04/09/2022] [Indexed: 11/21/2022]
Abstract
The present review throws a spotlight on new and emerging food safety concerns in view of a well-established food allergen risk arising from global socio-economic changes, international trade, circular economy, environmental sustainability, and upcycling. Food culture globalization needs harmonization of regulations, technical specifications, and reference materials towards mutually recognised results. In parallel, routine laboratories require high-throughput reliable analytical strategies, even in-situ testing devices, to test both food products and food contact surfaces for residual allergens. Finally, the currently neglected safety issues associated to possible allergen exposure due to the newly proposed bio- and plant-based sustainable food contact materials require an in-depth investigation.
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Zimmer J, Bridgewater J, Ferreira F, van Ree R, Rabin RL, Vieths S. The History, Present and Future of Allergen Standardization in the United States and Europe. Front Immunol 2021; 12:725831. [PMID: 34594335 PMCID: PMC8477030 DOI: 10.3389/fimmu.2021.725831] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/23/2021] [Indexed: 02/05/2023] Open
Abstract
The topic of standardization in relation to allergen products has been discussed by allergists, regulators, and manufacturers for a long time. In contrast to synthetic medicinal products, the natural origin of allergen products makes the necessary comparability difficult to achieve. This holds true for both aspects of standardization: Batch-to-batch consistency (or product-specific standardization) and comparability among products from different manufacturers (or cross-product comparability). In this review, we focus on how the United States and the European Union have tackled the topic of allergen product standardization in the past, covering the early joint standardization efforts in the 1970s and 1980s as well as the different paths taken by the two players thereafter until today. So far, these two paths have been based on rather classical immunological methods, including the corresponding benefits like simple feasability. New technologies such as mass spectrometry present an opportunity to redefine the field of allergen standardization in the future.
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Affiliation(s)
- Julia Zimmer
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - Jennifer Bridgewater
- Division of Bacterial, Parasitic, and Allergenic Products, Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States
| | - Fatima Ferreira
- Department of Biosciences, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Ronald van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Ronald L. Rabin
- Division of Bacterial, Parasitic, and Allergenic Products, Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States
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van Ree R, Sapiter Ballerda D, Berin MC, Beuf L, Chang A, Gadermaier G, Guevera PA, Hoffmann-Sommergruber K, Islamovic E, Koski L, Kough J, Ladics GS, McClain S, McKillop KA, Mitchell-Ryan S, Narrod CA, Pereira Mouriès L, Pettit S, Poulsen LK, Silvanovich A, Song P, Teuber SS, Bowman C. The COMPARE Database: A Public Resource for Allergen Identification, Adapted for Continuous Improvement. FRONTIERS IN ALLERGY 2021; 2:700533. [PMID: 35386979 PMCID: PMC8974746 DOI: 10.3389/falgy.2021.700533] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/06/2021] [Indexed: 11/14/2022] Open
Abstract
Motivation: The availability of databases identifying allergenic proteins via a transparent and consensus-based scientific approach is of prime importance to support the safety review of genetically-modified foods and feeds, and public safety in general. Over recent years, screening for potential new allergens sequences has become more complex due to the exponential increase of genomic sequence information. To address these challenges, an international collaborative scientific group coordinated by the Health and Environmental Sciences Institute (HESI), was tasked to develop a contemporary, adaptable, high-throughput process to build the COMprehensive Protein Allergen REsource (COMPARE) database, a publicly accessible allergen sequence data resource along with bioinformatics analytical tools following guidelines of FAO/WHO and CODEX Alimentarius Commission. Results: The COMPARE process is novel in that it involves the identification of candidate sequences via automated keyword-based sorting algorithm and manual curation of the annotated sequence entries retrieved from public protein sequence databases on a yearly basis; its process is meant for continuous improvement, with updates being transparently documented with each version; as a complementary approach, a yearly key-word based search of literature databases is added to identify new allergen sequences that were not (yet) submitted to protein databases; in addition, comments from the independent peer-review panel are posted on the website to increase transparency of decision making; finally, sequence comparison capabilities associated with the COMPARE database was developed to evaluate the potential allergenicity of proteins, based on internationally recognized guidelines, FAO/WHO and CODEX Alimentarius Commission
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Affiliation(s)
- Ronald van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Dexter Sapiter Ballerda
- Joint Institute for Food Safety and Applied Nutrition (JIFSAN), University of Maryland, College Park, MD, United States
| | - M. Cecilia Berin
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Laurent Beuf
- Limagrain Field Seeds, Centre de Recherche, Route d'Ennezat, Chappes, France
| | - Alexander Chang
- Joint Institute for Food Safety and Applied Nutrition (JIFSAN), University of Maryland, College Park, MD, United States
| | - Gabriele Gadermaier
- Department of Biosciences, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Paul A. Guevera
- Joint Institute for Food Safety and Applied Nutrition (JIFSAN), University of Maryland, College Park, MD, United States
| | | | - Emir Islamovic
- Regulatory Science Seeds and Traits, BASF Corporation, Morrisville, NC, United States
| | - Liisa Koski
- Health and Environmental Sciences Institute (HESI), Washington, DC, United States
| | - John Kough
- Office of Pesticide Programs, Microbial Pesticides Branch, US Environmental Protection Agency, Washington, DC, United States
| | | | - Scott McClain
- Syngenta Crop Protection LLC, Research Triangle Park, NC, United States
| | - Kyle A. McKillop
- Joint Institute for Food Safety and Applied Nutrition (JIFSAN), University of Maryland, College Park, MD, United States
| | | | - Clare A. Narrod
- Joint Institute for Food Safety and Applied Nutrition (JIFSAN), University of Maryland, College Park, MD, United States
| | - Lucilia Pereira Mouriès
- Health and Environmental Sciences Institute (HESI), Washington, DC, United States
- *Correspondence: Lucilia Pereira Mouriès
| | - Syril Pettit
- Health and Environmental Sciences Institute (HESI), Washington, DC, United States
| | - Lars K. Poulsen
- Allergy Clinic, Department of Dermatology and Allergy, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andre Silvanovich
- Bayer U.S., Crop Science Regulatory Science Building FF4, Chesterfield, MO, United States
| | - Ping Song
- Seeds Regulatory Science, Corteva Agriscience LLC, Indianapolis, IN, United States
| | - Suzanne S. Teuber
- Department of Internal Medicine, School of Medicine, University of California, Davis, Davis, CA, United States
- Division of Rheumatology, Allergy, and Clinical Immunology, Davis, CA, United States
- Veterans Affairs Northern California Healthcare System, Mather, CA, United States
| | - Christal Bowman
- Formerly: Human Safety Regulatory Toxicology, Bayer CropScience LP, Research Triangle Park, NC, United States
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Takai T. Allergens in modern society: 2021. Allergol Int 2021; 70:279-280. [PMID: 34176582 DOI: 10.1016/j.alit.2021.06.003] [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] Open
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Kleine-Tebbe J. Molekulare Allergiediagnostik. Drug Res (Stuttg) 2020; 70:S17-S21. [PMID: 33202472 DOI: 10.1055/a-1119-2751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
This perspective study addresses the main causes of adverse reactions to foods in humans, by taking into account the main allergic reactions that may occur as a result of food ingestion, as well the main allergens present in food and how their allergenicity change as a result of food preparation. In addition, European legislation on food labeling and novel foods was taken into account. The case study of this perspective is on the potential allergenicity of edible flowers as well as evidence of phytochemistry and toxic compounds and the risk associated with their ingestion. Regarding edible flowers, a key issue to address is if they are safe to consume or not. In the framework of the project “Innovative activities for the development of the cross-border supply chain of the edible flower” (ANTEA), we considered 62 different species and varieties of edible flowers. The results obtained by consulting two databases on allergens, COMPRISE and Allergen Nomenclature, marked two alerts for two species of edible flowers selected in the project. Moreover, based on edible flower consumption, about ten grams per serving, and on their protein content, we can also state that the risk of allergic reactions due to edible flower ingestion is very low.
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Marzano V, Tilocca B, Fiocchi AG, Vernocchi P, Levi Mortera S, Urbani A, Roncada P, Putignani L. Perusal of food allergens analysis by mass spectrometry-based proteomics. J Proteomics 2020; 215:103636. [DOI: 10.1016/j.jprot.2020.103636] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/19/2019] [Accepted: 01/05/2020] [Indexed: 12/30/2022]
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Volpicella M, Leoni C, Dileo MCG, Ceci LR. Progress in the Analysis of Food Allergens through Molecular Biology Approaches. Cells 2019; 8:E1073. [PMID: 31547388 PMCID: PMC6770348 DOI: 10.3390/cells8091073] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/04/2019] [Accepted: 09/10/2019] [Indexed: 01/29/2023] Open
Abstract
Food allergies associated with class E immunoglobulins (IgE) are a serious health problem that affects between 1% and 10% of the population of developing countries, with a variability that depends on the geographical area and age range considered. These allergies are caused by a cross-link reaction between a specific food protein (the allergen) and the host IgE. Allergic reactions can range from mild itching to anaphylactic shock and there are no clues to predict the effects of an allergen. Strict avoidance of allergenic food is the only way to avoid possible serious allergic reactions. In the last 30 years a growing number of molecular studies have been conducted to obtain information on the diffusion of food allergens and to establish the structural basis of their allergenicity. At the same time, these studies have also allowed the development of molecular tools (mainly based on synthetic peptides and recombinant allergens) that can be of great help for diagnostic and therapeutic approaches of food allergies. Accordingly, this review focuses on advances in the study of food allergens made possible by molecular technologies and how results and technologies can be integrated for the development of a systematic food molecular allergology. The review may be of interest both to scientists approaching this field of investigation and to physicians who wish to have an update on the progress of research in diagnosis and therapy of food allergies.
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Affiliation(s)
- Mariateresa Volpicella
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, Via Amendola 165/a, 70126 Bari, Italy.
- Institute of Bioenergetics, Biomembranes and Molecular Biotechnologies, Italian National Research Council, Via Amendola 165/a, 70126 Bari, Italy.
| | - Claudia Leoni
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, Via Amendola 165/a, 70126 Bari, Italy.
| | - Maria C G Dileo
- Department of Biology, University of Bari, Via Amendola 165/a, 70126 Bari, Italy.
| | - Luigi R Ceci
- Institute of Bioenergetics, Biomembranes and Molecular Biotechnologies, Italian National Research Council, Via Amendola 165/a, 70126 Bari, Italy.
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Distinguishing allergens from non-allergenic homologues using Physical-Chemical Property (PCP) motifs. Mol Immunol 2018; 99:1-8. [PMID: 29627609 DOI: 10.1016/j.molimm.2018.03.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/22/2018] [Accepted: 03/27/2018] [Indexed: 02/07/2023]
Abstract
Quantitative guidelines to distinguish allergenic proteins from related, but non-allergenic ones are urgently needed for regulatory agencies, biotech companies and physicians. In a previous study, we found that allergenic proteins populate a relatively small number of protein families, as characterized by the Pfam database. However, these families also contain non-allergenic proteins, meaning that allergenic determinants must lie within more discrete regions of the sequence. Thus, new methods are needed to discriminate allergenic proteins within those families. Physical-Chemical Properties (PCP)-motifs specific for allergens within a Pfam class were determined for 17 highly populated protein domains. A novel scoring method based on PCP-motifs that characterize known allergenic proteins within these families was developed, and validated for those domains. The motif scores distinguished sequences of allergens from a large selection of 80,000 randomly selected non-allergenic sequences. The motif scores for the birch pollen allergen (Bet v 1) family, which also contains related fruit and nut allergens, correlated better than global sequence similarities with clinically observed cross-reactivities among those allergens. Further, we demonstrated that the average scores of allergen specific motifs for allergenic profilins are significantly different from the scores of non-allergenic profilins. Several of the selective motifs coincide with experimentally determined IgE epitopes of allergenic profilins. The motifs also discriminated allergenic pectate lyases, including Jun a 1 from mountain cedar pollen, from similar proteins in the human microbiome, which can be assumed to be non-allergens. The latter lacked key motifs characteristic of the known allergens, some of which correlate with known IgE binding sites.
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WHO/IUIS Allergen Nomenclature: Providing a common language. Mol Immunol 2018; 100:3-13. [PMID: 29625844 DOI: 10.1016/j.molimm.2018.03.003] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 03/06/2018] [Indexed: 11/23/2022]
Abstract
A systematic nomenclature for allergens originated in the early 1980s, when few protein allergens had been described. A group of scientists led by Dr. David G. Marsh developed a nomenclature based on the Linnaean taxonomy, and further established the World Health Organization/International Union of Immunological Societies (WHO/IUIS) Allergen Nomenclature Sub-Committee in 1986. Its stated aim was to standardize the names given to the antigens (allergens) that caused IgE-mediated allergies in humans. The Sub-Committee first published a revised list of allergen names in 1986, which continued to grow with rare publications until 1994. Between 1994 and 2007 the database was a text table online, then converted to a more readily updated website. The allergen list became the Allergen Nomenclature database (www.allergen.org), which currently includes approximately 880 proteins from a wide variety of sources. The Sub-Committee includes experts on clinical and molecular allergology. They review submissions of allergen candidates, using evidence-based criteria developed by the Sub-Committee. The review process assesses the biochemical analysis and the proof of allergenicity submitted, and aims to assign allergen names prior to publication. The Sub-Committee maintains and revises the database, and addresses continuous challenges as new "omics" technologies provide increasing data about potential new allergens. Most journals publishing information on new allergens require an official allergen name, which involves submission of confidential data to the WHO/IUIS Allergen Nomenclature Sub-Committee, sufficient to demonstrate binding of IgE from allergic subjects to the purified protein.
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Mueller GA. Contributions and Future Directions for Structural Biology in the Study of Allergens. Int Arch Allergy Immunol 2017; 174:57-66. [PMID: 28992615 DOI: 10.1159/000481078] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Allergy is defined as an inappropriate immune response to something normally considered harmless. The symptomatic immune response is driven by IgE antibodies directed against allergens. The study of allergens has contributed significantly to our understanding of allergic disease in 3 main areas. First, identifying allergens as the cause of symptoms and developing allergen standards has led to many advances in exposure assessment and patient diagnostics. Second, a biochemical understanding of allergens has suggested a number of hypotheses related to the mechanisms of allergic sensitization. And finally, studies of allergen-antibody interactions have contributed to understanding the cross-reactivity of allergens, mapping patient epitopes, and the development of hypoallergens. In this review, a few select cases are highlighted where structural biology, in particular, has contributed significantly to allergen research and provided new avenues for investigation.
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Affiliation(s)
- Geoffrey A Mueller
- Department of Health and Human Services, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
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