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Castromil-Benito ES, Betancor D, Parrón-Ballesteros J, Bueno-Díaz C, Gutiérrez-Díaz G, Turnay J, Heras MDL, Cuesta-Herranz J, Villalba M, Pastor-Vargas C. Walnut Jug r 1 is Responsible for Primary Sensitization among Patients Suffering Walnut-Hazelnut 2S Albumin Cross-Reactivity. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2024; 72:18162-18170. [PMID: 39083591 PMCID: PMC11328161 DOI: 10.1021/acs.jafc.4c03603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Walnut and hazelnut coallergy is a frequent manifestation in clinical practice whose molecular basis remains unclear. For this purpose, walnut-hazelnut cross-reactivity was evaluated in 20 patients allergic to one or both tree nuts and sensitized to their 2S albumins. Immunoblotting assays showed that 85% of patients recognized Jug r 1, walnut 2S albumin, which was associated with the development of severe symptoms; 50% of them corecognized hazelnut 2S albumin, Cor a 14. Both allergens were isolated using chromatographic techniques. Inhibition ELISAs revealed that Jug r 1 strongly inhibited the binding of Cor a 14-specific IgE, but Cor a 14 only partially inhibited Jug r 1-specific IgE binding. Our results showed that patients sensitized to walnut/hazelnut 2S albumins were not a homogeneous population. There were patients sensitized to specific epitopes of walnut 2S albumins and patients sensitized to cross-reactive epitopes between walnut and hazelnut, with Jug r 1 being the primary sensitizer.
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Affiliation(s)
- Estela S Castromil-Benito
- Department of Biochemistry and Molecular Biology, Faculty of Chemical Sciences, Complutense University of Madrid, Madrid 28040, Spain
| | - Diana Betancor
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz UAM, Madrid 28015, Spain
| | - Jorge Parrón-Ballesteros
- Department of Biochemistry and Molecular Biology, Faculty of Chemical Sciences, Complutense University of Madrid, Madrid 28040, Spain
| | - Cristina Bueno-Díaz
- Department of Biochemistry and Molecular Biology, Faculty of Chemical Sciences, Complutense University of Madrid, Madrid 28040, Spain
| | - Gloria Gutiérrez-Díaz
- Department of Biochemistry and Molecular Biology, Faculty of Chemical Sciences, Complutense University of Madrid, Madrid 28040, Spain
| | - Javier Turnay
- Department of Biochemistry and Molecular Biology, Faculty of Chemical Sciences, Complutense University of Madrid, Madrid 28040, Spain
| | - Manuel de Las Heras
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz UAM, Madrid 28015, Spain
- Red de asma, reacciones adversas y alérgicas (ARADyAL) RD16/0006/0013, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Javier Cuesta-Herranz
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz UAM, Madrid 28015, Spain
- Red de asma, reacciones adversas y alérgicas (ARADyAL) RD16/0006/0013, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Mayte Villalba
- Department of Biochemistry and Molecular Biology, Faculty of Chemical Sciences, Complutense University of Madrid, Madrid 28040, Spain
- RICORS Red de Enfermedades Inflamatorias (REI) - RD21/0002/0028, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Carlos Pastor-Vargas
- Department of Biochemistry and Molecular Biology, Faculty of Chemical Sciences, Complutense University of Madrid, Madrid 28040, Spain
- RICORS Red de Enfermedades Inflamatorias (REI) - RD21/0002/0028, Instituto de Salud Carlos III, Madrid 28029, Spain
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Yang C, Negi SS, Schein CH, Braun W, Kim P. AllergenAI: a deep learning model predicting allergenicity based on protein sequence. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.22.600179. [PMID: 38979176 PMCID: PMC11230160 DOI: 10.1101/2024.06.22.600179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Innovations in protein engineering can help redesign allergenic proteins to reduce adverse reactions in sensitive individuals. To accomplish this aim, a better knowledge of the molecular properties of allergenic proteins and the molecular features that make a protein allergenic is needed. We present a novel AI-based tool, AllergenAI, to quantify the allergenic potential of a given protein. Our approach is solely based on protein sequences, differentiating it from previous tools that use some knowledge of the allergens' physicochemical and other properties in addition to sequence homology. We used the collected data on protein sequences of allergenic proteins as archived in the three well-established databases, SDAP 2.0, COMPARE, and AlgPred 2, to train a convolutional neural network and assessed its prediction performance by cross-validation. We then used Allergen AI to find novel potential proteins of the cupin family in date palm, spinach, maize, and red clover plants with a high allergenicity score that might have an adverse allergenic effect on sensitive individuals. By analyzing the feature importance scores (FIS) of vicilins, we identified a proline-alanine-rich (P-A) motif in the top 50% of FIS regions that overlapped with known IgE epitope regions of vicilin allergens. Furthermore, using∼ 1600 allergen structures in our SDAP database, we showed the potential to incorporate 3D information in a CNN model. Future, incorporating 3D information in training data should enhance the accuracy. AllergenAI is a novel foundation for identifying the critical features that distinguish allergenic proteins.
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Präger L, Simon JC, Treudler R. Food allergy - New risks through vegan diet? Overview of new allergen sources and current data on the potential risk of anaphylaxis. J Dtsch Dermatol Ges 2023; 21:1308-1313. [PMID: 37723909 DOI: 10.1111/ddg.15157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/25/2023] [Indexed: 09/20/2023]
Abstract
A vegan diet is increasingly en vogue, i.e., a diet based on plants, in which animal products are completely avoided, often for health and environmental reasons. The menu is supplemented with pulses (e.g., soy, lentils, peas), nuts (e.g., cashew, macadamia, almond, pecan, para, walnut) and seeds (e.g., chia, flaxseed) or pseudo-grains (quinoa, buckwheat). Indeed, the product range is expanding to include vegan foods such as milk alternatives (e.g., oat, almond, soy drinks) and cheese or meat substitutes (e.g., soy-based). Food allergies are also on the rise, with an increasing prevalence worldwide. It is worthy of note that the main allergens of anaphylactic reactions to food in adults are predominantly of plant origin, mainly pulses and nuts - the very foods that form the main source of protein in the vegan diet. In this context, allergies to storage proteins (e.g., Gly m 5 and Gly m 6 from soya beans) can lead to severe anaphylactic reactions, while highly processed substitute products containing plant protein isolates (e.g., pea flour) in concentrated form continue to be of particular concern and may therefore be allergologically problematic. In this article, we aim to provide an overview of allergens and emerging allergen sources in vegan foods and highlight the anaphylaxis risk of the vegan diet.
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Affiliation(s)
- Lea Präger
- Department of Dermatology, Venereology and Allergology, University Hospital Leipzig, Germany
- Leipzig Interdisciplinary Allergy Center (LICA-CAC), University Hospital Leipzig, Germany
| | - Jan Christoph Simon
- Department of Dermatology, Venereology and Allergology, University Hospital Leipzig, Germany
- Leipzig Interdisciplinary Allergy Center (LICA-CAC), University Hospital Leipzig, Germany
| | - Regina Treudler
- Department of Dermatology, Venereology and Allergology, University Hospital Leipzig, Germany
- Leipzig Interdisciplinary Allergy Center (LICA-CAC), University Hospital Leipzig, Germany
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Präger L, Simon JC, Treudler R. Nahrungsmittelallergie - Neue Risiken durch vegane Ernährung? Überblick zu neuen Allergenquellen und aktuelle Daten zum Anaphylaxierisiko: Food allergy - New risks through vegan diet? Overview of new allergen sources and current data on the potential risk of anaphylaxis. J Dtsch Dermatol Ges 2023; 21:1308-1314. [PMID: 37946654 DOI: 10.1111/ddg.15157_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/25/2023] [Indexed: 11/12/2023]
Abstract
ZusammenfassungZunehmend mehr Menschen ernähren sich aus gesundheitlichen und Umweltaspekten ausschließlich von pflanzlichen Nahrungsmitteln (vegan). Dabei werden vielfach Hülsenfrüchte (wie Soja, Linsen, Erbsen), Schalenfrüchte (Cashew, Macadamia, Mandel, Pekan‐, Para‐ und Walnuss), Samen und Saaten (wie Chia, Leinsamen) oder (Pseudo‐)Getreide (wie Quinoa, Buchweizen) verzehrt. Vegane Milchalternativen sind Hafer‐, Mandel‐ und Sojadrinks, auch Käse‐ sowie Fleischersatzprodukte basieren oft auf einer Sojagrundlage. Gleichzeitig nimmt die Prävalenz von Nahrungsmittelallergien weltweit zu. Pflanzenallergene aus Hülsen‐ und Schalenfrüchten, die in der veganen Ernährung die Hauptproteinquelle ausmachen, zählen zu den häufigsten Auslösern von Nahrungsmittelallergien bei Erwachsenen. Dabei kommt es bei Allergien auf Speicherproteine (wie Gly m 5 und Gly m 6 aus der Sojabohne) zu teils schweren anaphylaktischen Reaktionen. Besonderes Augenmerk liegt weiter auf hochverarbeiteten Ersatzprodukten, die Pflanzenproteinisolate (zum Beispiel Erbsenmehl) in konzentrierter Form enthalten und damit allergologisch problematisch werden können. In diesem Artikel geben wir einen Überblick über wichtige Allergene und neue Allergenquellen in ausgesuchten veganen Nahrungsmitteln und betrachten die vegane Ernährung unter allergologischen Aspekten.
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Affiliation(s)
- Lea Präger
- Klinik für Dermatologie, Venereologie und Allergologie, Universitätsmedizin Leipzig
- Leipziger Interdisziplinäres Allergiecentrum (LICA-CAC), Universitätsmedizin Leipzig
| | - Jan Christoph Simon
- Klinik für Dermatologie, Venereologie und Allergologie, Universitätsmedizin Leipzig
- Leipziger Interdisziplinäres Allergiecentrum (LICA-CAC), Universitätsmedizin Leipzig
| | - Regina Treudler
- Klinik für Dermatologie, Venereologie und Allergologie, Universitätsmedizin Leipzig
- Leipziger Interdisziplinäres Allergiecentrum (LICA-CAC), Universitätsmedizin Leipzig
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Sudharson S, Kalic T, Hafner C, Breiteneder H. Newly defined allergens in the WHO/IUIS Allergen Nomenclature Database during 01/2019-03/2021. Allergy 2021; 76:3359-3373. [PMID: 34310736 PMCID: PMC9290965 DOI: 10.1111/all.15021] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 01/03/2023]
Abstract
The WHO/IUIS Allergen Nomenclature Database (http://allergen.org) provides up‐to‐date expert‐reviewed data on newly discovered allergens and their unambiguous nomenclature to allergen researchers worldwide. This review discusses the 106 allergens that were accepted by the Allergen Nomenclature Sub‐Committee between 01/2019 and 03/2021. Information about protein family membership, patient cohorts, and assays used for allergen characterization is summarized. A first allergenic fungal triosephosphate isomerase, Asp t 36, was discovered in Aspergillus terreus. Plant allergens contained 1 contact, 38 respiratory, and 16 food allergens. Can s 4 from Indian hemp was identified as the first allergenic oxygen‐evolving enhancer protein 2 and Cic a 1 from chickpeas as the first allergenic group 4 late embryogenesis abundant protein. Among the animal allergens were 19 respiratory, 28 food, and 3 venom allergens. Important discoveries include Rap v 2, an allergenic paramyosin in molluscs, and Sal s 4 and Pan h 4, allergenic fish tropomyosins. Paramyosins and tropomyosins were previously known mainly as arthropod allergens. Collagens from barramundi, Lat c 6, and salmon, Sal s 6, were the first members from the collagen superfamily added to the database. In summary, the addition of 106 new allergens to the previously listed 930 allergens reflects the continuous linear growth of the allergen database. In addition, 17 newly described allergen sources were included.
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Affiliation(s)
- Srinidhi Sudharson
- Department of Dermatology University Hospital St. Poelten Karl Landsteiner University of Health Sciences St. Poelten Austria
- Division of Medical Biotechnology Department of Pathophysiology and Allergy Research Center of Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | - Tanja Kalic
- Department of Dermatology University Hospital St. Poelten Karl Landsteiner University of Health Sciences St. Poelten Austria
- Division of Medical Biotechnology Department of Pathophysiology and Allergy Research Center of Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | - Christine Hafner
- Department of Dermatology University Hospital St. Poelten Karl Landsteiner University of Health Sciences St. Poelten Austria
| | - Heimo Breiteneder
- Division of Medical Biotechnology Department of Pathophysiology and Allergy Research Center of Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
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Characterization of Relevant Biomarkers for the Diagnosis of Food Allergies: An Overview of the 2S Albumin Family. Foods 2021; 10:foods10061235. [PMID: 34072292 PMCID: PMC8228421 DOI: 10.3390/foods10061235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 11/17/2022] Open
Abstract
2S albumins are relevant and often major allergens from several tree nuts and seeds, affecting mainly children and young people. The present study aims to assess how the structural features of 2S albumins could affect their immunogenic capacity, which is essential to comprehend the role of these proteins in food allergy. For this purpose, twelve 2S albumins were isolated from their respective extracts by chromatographic methods and identified by MALDI-TOF mass-spectrometry. Their molecular and structural characterization was conducted by electrophoretic, spectroscopic and in silico methods, showing that these are small proteins that comprise a wide range of isoelectric points, displaying a general high structure stability to thermal treatment. Despite low amino acid sequence identity, these proteins share structural features, pointing conformational epitopes to explain cross-reactivity between them. Immunoblotting with allergic patients’ sera revealed those possible correlations between evolutionarily distant 2S albumins from different sources. The availability of a well-characterized panel of 2S albumins from plant-derived sources allowed establishing correlations between their structural features and their allergenic potential, including their role in cross-reactivity processes.
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Anaphylaxis after consumption of pumpkin seeds in a 2-y-old child tolerant to its pulp: A case study. Nutrition 2021; 89:111272. [PMID: 34091191 DOI: 10.1016/j.nut.2021.111272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/25/2021] [Accepted: 04/01/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Pumpkin and its seeds are increasingly consumed by children for their potential health benefits. Each day, approximately 30% of teenagers consume nuts and seeds, including pumpkin seeds. However, there is some evidence that pumpkin seeds may exert allergenic effects and induce severe life-threatening anaphylaxis. Allergy to melon, cucumber, and zucchini, which belong to the same Cucurbitaceae family as pumpkin, are well known, opposite to pumpkin allergy. Few descriptions of allergic reactions associated with pumpkin have been published, especially in children. To date, three cases of pumpkin pulp and two seed cases have been reported among children. Our case report describes a case of pumpkin seed anaphylaxis in a child with good tolerance of pulp. METHODS In the present study, a 2-y-old child experienced anaphylaxis, presenting with generalized urticaria, swollen lips, and increasing dyspnea after consuming pumpkin seeds. RESULTS The patient's history showed that, although the child had been receiving an elimination diet because of an immunoglobulin E (IgE)-mediated food allergy to cow's milk and eggs, the basic dietary element was pumpkin pulp. The skin-prick test was positive for pumpkin seed (5 mm) but negative for pumpkin pulp (1 mm), and allergen-specific IgE was 1.34 kUA/L for seed and 0.37 kUA/L for pulp. The component-resolved diagnostics (CRD) found IgE to sesame seed, buckwheat, and walnut (storage proteins). Based on these findings, severe anaphylactic reaction to pumpkin seeds was identified. CONCLUSIONS Pumpkin seed anaphylaxis can develop in a child with a tolerance to pumpkin pulp. Pumpkin seed allergens have not been well characterized. Homology between amino-acid sequences in storage proteins may indicate cross reactivity between different edible seeds and nuts.
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Dreskin SC, Koppelman SJ, Andorf S, Nadeau KC, Kalra A, Braun W, Negi SS, Chen X, Schein CH. The importance of the 2S albumins for allergenicity and cross-reactivity of peanuts, tree nuts, and sesame seeds. J Allergy Clin Immunol 2021; 147:1154-1163. [PMID: 33217410 PMCID: PMC8035160 DOI: 10.1016/j.jaci.2020.11.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 12/17/2022]
Abstract
Allergies to peanuts, tree nuts, and sesame seeds are among the most important food-related causes of anaphylaxis. Important clinical questions include: Why is there a variable occurrence of coallergy among these foods and Is this immunologically mediated? The clinical and immunologic data summarized here suggest an immunologic basis for these coallergies that is based on similarities among the 2S albumins. Data from component resolved diagnostics have highlighted the relationship between IgE binding to these allergens and the presence of IgE-mediated food allergy. Furthermore, in vitro and in vivo experiments provide strong evidence that the 2S albumins are the most important allergens in peanuts for inducing an allergic effector response. Although the 2S albumins are diverse, they have a common disulfide-linked core with similar physicochemical properties that make them prime candidates to explain much of the observed coallergy among peanuts, tree nuts, and sesame seeds. The well-established frequency of cashew and pistachio nut coallergy (64%-100%) highlights how the structural similarities among their 2S albumins may account for observed clinical cross-reactivity. A complete understanding of the physicochemical properties of the 2S albumins in peanuts, tree nuts, and sesame seeds will enhance our ability to diagnose, treat, and ultimately prevent these allergies.
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Affiliation(s)
- Stephen C Dreskin
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Colorado Denver, Aurora, Colo.
| | - Stef J Koppelman
- Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska, Lincoln, Neb
| | - Sandra Andorf
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| | - Anjeli Kalra
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Colorado Denver, Aurora, Colo
| | - Werner Braun
- Sealy Center for Structural Biology and Molecular Biophysics, The University of Texas Medical Branch, Galveston, Tex; Department of Biochemistry and Molecular Biology, The University of Texas Medical Branch, Galveston, Tex
| | - Surendra S Negi
- Sealy Center for Structural Biology and Molecular Biophysics, The University of Texas Medical Branch, Galveston, Tex; Department of Biochemistry and Molecular Biology, The University of Texas Medical Branch, Galveston, Tex
| | - Xueni Chen
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Colorado Denver, Aurora, Colo
| | - Catherine H Schein
- Department of Biochemistry and Molecular Biology, The University of Texas Medical Branch, Galveston, Tex; Institute for Human Infection and Immunity, The University of Texas Medical Branch, Galveston, Tex.
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Majsiak E, Choina M, Miśkiewicz K, Doniec Z, Kurzawa R. Oleosins: A Short Allergy Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1324:51-55. [PMID: 32910425 DOI: 10.1007/5584_2020_579] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In patients having a history of anaphylaxis after consumption of peanuts, sunflower seeds, or soy and skin or blood tests negative for the allergen extracts, oleosins could be the culprit. Oleosins are common and largely underestimated allergy inducers of plant origin, causing severe allergy symptoms, including the anaphylactic shock. They are resistant to high temperatures and digestive enzymes. The consumption of heat-treated oleosins has been associated with a higher risk of a severe anaphylactic reaction. Recent studies have shown that oleosins could be a biomarker of the allergy severity to peanuts. Oleosins have a hydrophobic structure and thus, are poorly soluble in aqueous solutions. The aqueous extraction, separation, and purification procedures do not guarantee their solubility. Oleosins dissolve only in the presence of detergents, which limits their use in both in vivo and in vitro allergy tests. Recently, a multiparameter allergy test that detects the allergen-specific immunoglobulin E (sIgE) against oleosins has become available. This capability may help to unravel the presence of oleosin source during the routine diagnostic of allergy, which is conducive to assessing the risk for severe anaphylaxis and may also help to clarify the ambiguous allergy cases.
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Affiliation(s)
- Emilia Majsiak
- Collegium Medicum, Cardinal Stefan Wyszynski University, Warsaw, Poland.
- Polish-Ukrainian Foundation of Medicine Development, Lublin, Poland.
| | - Magdalena Choina
- Polish-Ukrainian Foundation of Medicine Development, Lublin, Poland
| | - Karolina Miśkiewicz
- Department of Pneumonology of the National Research Institute for Tuberculosis and Lung Diseases, Regional Branch in Rabka-Zdrój, Rabka-Zdrój, Poland
| | - Zbigniew Doniec
- Department of Pneumonology of the National Research Institute for Tuberculosis and Lung Diseases, Regional Branch in Rabka-Zdrój, Rabka-Zdrój, Poland
| | - Ryszard Kurzawa
- Department of Allergology and Pneumonology of the National Research Institute for Tuberculosis and Lung Diseases, Regional Branch in Rabka-Zdrój, Rabka-Zdrój, Poland
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Martínez-López AL, Pangua C, Reboredo C, Campión R, Morales-Gracia J, Irache JM. Protein-based nanoparticles for drug delivery purposes. Int J Pharm 2020; 581:119289. [PMID: 32243968 DOI: 10.1016/j.ijpharm.2020.119289] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 02/07/2023]
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