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DuToit G, Smith P, Muraro A, Fox AT, Roberts G, Ring J, Worm M. Identifying patients at risk of anaphylaxis. World Allergy Organ J 2024; 17:100904. [PMID: 38966605 PMCID: PMC11223123 DOI: 10.1016/j.waojou.2024.100904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 03/31/2024] [Accepted: 04/05/2024] [Indexed: 07/06/2024] Open
Abstract
Anaphylaxis is an acute, potentially fatal, systemic hypersensitivity reaction that warrants prompt diagnosis and management. It continues to be challenging to anticipate who may be at risk of a severe, life-threatening allergic reaction. Anaphylaxis can be caused by a range of allergens, such as certain foods, medications, latex, insect stings, etc. Cofactors that augment the severity of clinical symptoms and increase the risk of poor outcomes include exercise, stress, infectious diseases, underlying mast cell disease, active allergic disease such as asthma, advanced age, intake of certain medications, history of previous anaphylaxis, and delayed or missed administration of adrenaline. According to the European Anaphylaxis Registry, food is the major elicitor of anaphylaxis, especially eggs, cow milk, and nuts, in children and adolescents. Reaction to insect venom has also been noted in young adulthood. Early recognition of signs and symptoms and prompt treatment are crucial in anaphylaxis management to avoid serious and even fatal outcomes. It is crucial for both individuals and clinicians to identify the cause of anaphylaxis. Biomarkers of anaphylaxis, such as histamine, tryptase, platelet activation factor (PAF), chymase, carboxypeptidase A3, dipeptidyl peptidase I (DPPI), basogranulin, CCL-2, hsa-miR-451a, may be useful in diagnosis and management. The purpose of this review article is to present a comprehensive overview of current evidence and expert opinions regarding the risk factors that predispose individuals to anaphylaxis. Additionally, it provides insights into potential biomarkers and genetic markers for accurate diagnosis and management. This review underscores the significance of expert guidance in enhancing patient outcomes and enabling self-management of anaphylactic episodes.
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Affiliation(s)
- George DuToit
- Pediatric Allergy King's College London and Guy's and St Thomas', London, United Kingdom
| | - Pete Smith
- Clinical School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Antonella Muraro
- Food Allergy Referral Centre, Department of Woman and Child Health, Padua University Hospital, Padua, Italy
| | - Adam T. Fox
- Children's Allergy Service, Guy's and St Thomas' Hospitals NHS Foundation Trust, Westminster Bridge, London, United Kingdom
| | - Graham Roberts
- University of Southampton, Pediatric Allergy & Respiratory Medicine, Tremona Road, Southampton, United Kingdom
| | - Johannes Ring
- Technical University Munich (TUM), Dept Dermatology Allergology Biederstein, Germany
| | - Margitta Worm
- Allergologie und Immunologie, Klinik für Dermatologie, Venerologie und Allergologie, Campus Charité Mitte, Universitätsmedizin Berlin, Berlin, Germany
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Giannetti A, Pession A, Bettini I, Ricci G, Giannì G, Caffarelli C. IgE Mediated Shellfish Allergy in Children-A Review. Nutrients 2023; 15:3112. [PMID: 37513530 PMCID: PMC10386692 DOI: 10.3390/nu15143112] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Shellfish is a leading cause of food allergy and anaphylaxis worldwide. Recent advances in molecular characterization have led to a better understanding of the allergen profile. High sequence homology between shellfish species and between shellfish and house dust mites leads to a high serological cross-reactivity, which does not accurately correlate with clinical cross-reactions. Clinical manifestations are immediate and the predominance of perioral symptoms is a typical feature of shellfish allergy. Diagnosis, as for other food allergies, is based on SPTs and specific IgE, while the gold standard is DBPCFC. Cross-reactivity between shellfish is common and therefore, it is mandatory to avoid all shellfish. New immunotherapeutic strategies based on hypoallergens and other innovative approaches represent the new frontiers for desensitization.
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Affiliation(s)
- Arianna Giannetti
- Paediatrics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.G.); (A.P.)
| | - Andrea Pession
- Paediatrics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.G.); (A.P.)
| | - Irene Bettini
- Paediatrics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.G.); (A.P.)
| | - Giampaolo Ricci
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy;
| | - Giuliana Giannì
- Clinica Pediatrica, Azienda Ospedaliero-Universitaria, Medicine and Surgery Department, Università di Parma, 43126 Parma, Italy;
| | - Carlo Caffarelli
- Clinica Pediatrica, Azienda Ospedaliero-Universitaria, Medicine and Surgery Department, Università di Parma, 43126 Parma, Italy;
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Caminati M, Giorgis V, Palterer B, Racca F, Salvottini C, Rossi O. Allergy and Sexual Behaviours: an Update. Clin Rev Allergy Immunol 2019; 56:269-277. [PMID: 28653246 DOI: 10.1007/s12016-017-8618-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The exact prevalence of hypersensitivity reactions related to sexual behaviours is not known; however, they heavily impact on the quality of life and of sex life of affected patients. In fact, not only common respiratory and skin allergies, such as asthma, rhinitis, urticaria and atopic dermatitis, but also food and drug allergy have been found to negatively affect the quality of sex life. Allergic diseases impact on the sexual function in both physical and psychological ways, representing one of the main complaints of a considerable proportion of patients. Sexual behaviours may act as the triggers of allergic reactions or as the carriers of allergens. Food and drug allergens can be carried through human organic fluids, like saliva and semen. Latex in condoms and numerous substances in lubricants, spermicides, topical medications and cosmetics can cause allergic reactions or contact dermatitis. Sexual activity itself is also a potential trigger of symptoms in patients affected by respiratory allergies, like honeymoon asthma and rhinitis. In seminal plasma hypersensitivity, seminal fluid proteins are the culprit allergens. The present review aims at summarizing the state of the art about allergy and sexual behaviours. In clinical practice, the influence of common allergic diseases on the sexual quality of life should be taken carefully into account. Sexual behaviours need to be accounted in the differential diagnosis of hypersensitivity reactions, and awareness on those exposure routes should be raised between different specialists and general practitioners.
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Affiliation(s)
- Marco Caminati
- Allergy Unit and Asthma Center, Verona University and General Hospital, Verona, Italy
| | - Veronica Giorgis
- SSDDU Allergologia e Immunologia Clinica, Department of Medical Sciences, AO Ordine Mauriziano "Umberto I", University of Turin, Corso Re Umberto 109, 10128, Torino, Italy.
| | - Boaz Palterer
- Department of Experimental and Clinical Medicine, University of Florence, AOU Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Francesca Racca
- Personalized Medicine Clinic Asthma and Allergy, Humanitas Clinical and Research Center, Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
| | - Chiara Salvottini
- Department of Internal Medicine and Therapeutics, University of Pavia, Piazzale Golgi, 19, 27100, Pavia, Italy
| | - Oliviero Rossi
- Department of Internal Medicine, Section of Immunoallergology and Respiratory Diseases, University of Florence, Florence, Italy
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Faisal M, Buckow R, Vasiljevic T, Donkor O. Effect of simulated digestion on antigenicity of banana prawn (Fenneropenaeus merguiensis) after high pressure processing at different temperatures. Food Control 2019. [DOI: 10.1016/j.foodcont.2019.04.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Kounis NG, Koniari I, Velissaris D, Tzanis G, Hahalis G. Kounis Syndrome—not a Single-organ Arterial Disorder but a Multisystem and Multidisciplinary Disease. Balkan Med J 2019; 36:212-221. [PMID: 31198019 PMCID: PMC6636655 DOI: 10.4274/balkanmedj.galenos.2019.2019.5.62] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Coronary symptoms associated with conditions related to mast cell activation and inflammatory cell interactions, such as those involving T-lymphocytes and macrophages, further inducing allergic, hypersensitivity, anaphylactic, or anaphylactic insults, are currently referred to as the Kounis syndrome. Kounis syndrome is caused by inflammatory mediators released during allergic insults, post-inflammatory cell activation, and interactions via multidirectional stimuli. A platelet subset of 20% with high- and low-affinity IgE surface receptors is also involved in this process. Kounis syndrome is not just a single-organ but also a complex multisystem and multi-organ arterial clinical condition; it affects the coronary, mesenteric, and cerebral arteries and is accompanied by allergy–hypersensitivity–anaphylaxis involving the skin, respiratory, and vascular systems in the context of anesthesia, surgery, radiology, oncology, or even dental and psychiatric medicine; further, it has significantly influences both morbidity and mortality. Kounis syndrome might be caused by numerous and continuously increasing causes, with broad clinical symptoms and signs, via multi-organ arterial system involvement, in patients of any age, thereby demonstrating predominant anaphylactic features in terms of a wide spectrum of mast cell-association disorders. Cardiac symptoms, such as chest pain, coronary vasospasm, angina pectoris, myocardial infarction, stent thrombosis, acute cardiac failure, and sudden cardiac death associated with subclinical, clinical, acute, or chronic allergic reactions, constitute the clinical manifestations of this syndrome. Since its first description, a common pathway between allergic and non-allergic coronary events has been demonstrated. The hypothesis is based on the existence of a much higher degree of mast cell degranulation at plaque erosion or rupture sites compared with at the adjacent areas or even more distant segments in post-acute myocardial infarction of non-allergic etiology. Although mast cell activation, differentiation, and mediator release takes days or weeks, the mast cell degranulation may occur just before any acute coronary event, further resulting in coronary artery vasoconstriction and atheromatous plaque rupture. It seems that medications and natural molecules stabilizing the mast cell membrane as well as monoclonal antibodies protecting the mast cell surface can emerge as novel therapeutic modalities for acute coronary and cerebrovascular event prevention.
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Affiliation(s)
- Nicholas G. Kounis
- Department of Cardiology, Patras University School of Medicine, Patras, Greece
| | - Ioanna Koniari
- Electrophysiology and Device Department University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Dimitrios Velissaris
- Department of Internal Medicine, Patras University School of Medicine, Patras, Greece
| | - George Tzanis
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Via Madonna di Genova, Cotignola RA, Italy
| | - George Hahalis
- Department of Cardiology, Patras University School of Medicine, Patras, Greece
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Kounis NG, Ren HL, Kavalioti M, Koniari I, Theoharides TC. Intimate Contact Could Be Dangerous for Your Health. Clin Ther 2019; 41:1222-1226. [PMID: 31076202 DOI: 10.1016/j.clinthera.2019.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/28/2019] [Accepted: 04/09/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To review evidence of hypersensitivity reactions to allergens and/or pathogens transmitted via intimate contact. METHODS We reviewed PubMed for publications in English between 1980 and 2018 using the terms allergy, drugs, foods, hypersensitivity, intercourse, kissing, Kounis syndrome, mast cells, and semen. FINDINGS In human RELATIONSHIPS, intimate contact can occasionally have disastrous or even fatal consequences because antigens and pathogens can be transmitted via the oral and vaginal mucosa. Hypersensitivity to semen is an underrecognized problem. Some individuals also developed acute coronary hypersensitivity, which mimics myocardial infarction, known as Kounis syndrome. IMPLICATIONS Hypersensitivity reactions to allergens and/or pathogens via intimate contact are common and should be recognized. Sensitive patients should be evaluated for atopic diathesis because such patients may be more susceptible and could also develop Kounis syndrome.
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Affiliation(s)
- Nicholas G Kounis
- Patras Highest Institute of Education and Technology, Patras, Greece
| | - Huali L Ren
- Department of Otolaryngology, Beijing Electric Power Hospital, Beijing, China
| | - Maria Kavalioti
- Department of Biomedical Sciences, University of Greenwich, United Kingdom
| | - Ioanna Koniari
- Patras Highest Institute of Education and Technology, Patras, Greece
| | - Theoharis C Theoharides
- Laboratory of Molecular Immunopharmacology and Drug Discovery, Department of Immunology, Tufts University School of Medicine, Boston, MA, USA; Department of Internal Medicine, Tufts University School of Medicine, Boston, MA, USA.
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Faisal M, Vasiljevic T, Donkor ON. A review on methodologies for extraction, identification and quantification of allergenic proteins in prawns. Food Res Int 2019; 121:307-318. [PMID: 31108753 DOI: 10.1016/j.foodres.2019.03.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/13/2019] [Accepted: 03/17/2019] [Indexed: 12/26/2022]
Abstract
Prawn allergy is one of the most common food-borne allergies and current prevention is by avoidance. This review paper summarised different methodologies for the extraction, identification and quantification of prawn protein allergens, reported in various research studies. Following extraction, allergenic components have been analysed using well-established methodologies, such as SDS-PAGE, Immunoblotting, ELISA, CD Spectroscopy, HPLC, DBPCFC, SPT etc. Moreover, the preference towards Aptamer-based technique for allergenicity analysis has also been highlighted in this review paper. The summary of these methodologies will provide a reference platform for present and future research directions.
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Affiliation(s)
- M Faisal
- Advanced Food Systems Research Unit, Institute of Sustainable Industries & Liveable Cities and College of Health and Biomedicine, Victoria University, Werribee Campus, PO Box 14428, Melbourne, Victoria 8001, Australia.
| | - T Vasiljevic
- Advanced Food Systems Research Unit, Institute of Sustainable Industries & Liveable Cities and College of Health and Biomedicine, Victoria University, Werribee Campus, PO Box 14428, Melbourne, Victoria 8001, Australia.
| | - O N Donkor
- Advanced Food Systems Research Unit, Institute of Sustainable Industries & Liveable Cities and College of Health and Biomedicine, Victoria University, Werribee Campus, PO Box 14428, Melbourne, Victoria 8001, Australia.
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Pascal M, Kamath SD, Faber M. Diagnosis and Management of Shellfish Allergy: Current Approach and Future Needs. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0186-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Burkhardt S, Genet P, Sabatasso S, La Harpe R. Death by anaphylactic shock in an institution: an accident or negligence? Int J Legal Med 2018; 133:561-564. [PMID: 30187123 DOI: 10.1007/s00414-018-1929-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 08/29/2018] [Indexed: 01/01/2023]
Abstract
This is a description of a man, institutionalised for learning difficulties, known to have an allergy to seafood. After eating a pie, the patient quickly developed dyspnoea and vomiting. The staff at the institution administered epinephrine and called the emergency services. Despite cardiopulmonary resuscitation, the patient died shortly after being admitted to the emergency department of the University Hospitals of Geneva. In the light of the circumstances of the death and of a discrepancy between the information given to the police by the staff at the institution looking after the patient on the one hand, and the preliminary elements of the investigation on the other hand, it was suspected that there was failure in care of the patient and our institute was asked to carry out an autopsy. Basing on all the investigations carried out, the cause of death was anaphylactic reaction following the ingestion of seafood, contrary to what had been alleged by the staff at the home.
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Affiliation(s)
- Sandra Burkhardt
- University Center of Legal Medicine, Lausanne-Geneva, 1, rue Michel Servet, 1211, Geneva 4, Switzerland.
| | - Pia Genet
- University Center of Legal Medicine, Lausanne-Geneva, 1, rue Michel Servet, 1211, Geneva 4, Switzerland
| | - Sara Sabatasso
- University Center of Legal Medicine, Lausanne-Geneva, 1, rue Michel Servet, 1211, Geneva 4, Switzerland
| | - Romano La Harpe
- University Center of Legal Medicine, Lausanne-Geneva, 1, rue Michel Servet, 1211, Geneva 4, Switzerland
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10
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Faisal M, Vasiljevic T, Donkor ON. Effects of selected processing treatments on antigenicity of banana prawn (Fenneropenaeus merguiensis
) tropomyosin. Int J Food Sci Technol 2018. [DOI: 10.1111/ijfs.13922] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Md Faisal
- Advanced Food Systems Research Unit; Institute of Sustainable Industries & Liveable Cities and College of Health and Biomedicine; Victoria University; Werribee Campus, PO Box 14428 Melbourne Vic. 8001 Australia
| | - Todor Vasiljevic
- Advanced Food Systems Research Unit; Institute of Sustainable Industries & Liveable Cities and College of Health and Biomedicine; Victoria University; Werribee Campus, PO Box 14428 Melbourne Vic. 8001 Australia
| | - Osaana N. Donkor
- Advanced Food Systems Research Unit; Institute of Sustainable Industries & Liveable Cities and College of Health and Biomedicine; Victoria University; Werribee Campus, PO Box 14428 Melbourne Vic. 8001 Australia
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11
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Dubois AEJ, Turner PJ, Hourihane J, Ballmer-Weber B, Beyer K, Chan CH, Gowland MH, O'Hagan S, Regent L, Remington B, Schnadt S, Stroheker T, Crevel RWR. How does dose impact on the severity of food-induced allergic reactions, and can this improve risk assessment for allergenic foods?: Report from an ILSI Europe Food Allergy Task Force Expert Group and Workshop. Allergy 2018; 73:1383-1392. [PMID: 29331070 PMCID: PMC6032860 DOI: 10.1111/all.13405] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 11/29/2022]
Abstract
Quantitative risk assessment (QRA) for food allergens has made considerable progress in recent years, yet acceptability of its outcomes remains stymied because of the limited extent to which it has been possible to incorporate severity as a variable. Reaction severity, particularly following accidental exposure, depends on multiple factors, related to the allergen, the host and any treatments, which might be administered. Some of these factors are plausibly still unknown. Quantitative risk assessment shows that limiting exposure through control of dose reduces the rates of reactions in allergic populations, but its impact on the relative frequency of severe reactions at different doses is unclear. Food challenge studies suggest that the relationship between dose of allergenic food and reaction severity is complex even under relatively controlled conditions. Because of these complexities, epidemiological studies provide very limited insight into this aspect of the dose-response relationship. Emerging data from single-dose challenges suggest that graded food challenges may overestimate the rate of severe reactions. It may be necessary to generate new data (such as those from single-dose challenges) to reliably identify the effect of dose on severity for use in QRA. Success will reduce uncertainty in the susceptible population and improve consumer choice.
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Affiliation(s)
- A. E. J. Dubois
- University Medical Centre Groningen; Groningen The Netherlands
| | | | | | | | - K. Beyer
- Charité Universitätsmedizin Berlin; Berlin Germany
| | | | | | | | - L. Regent
- Anaphylaxis Campaign; Farnborough UK
| | - B. Remington
- The Netherlands Organisation for Applied Scientific Research (TNO); Zeist The Netherlands
| | - S. Schnadt
- German Allergy and Asthma Association (DAAB); Mönchengladbach DE
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Abstract
PURPOSE OF REVIEW Intimate behaviours may represent an unusual way of exposure to a culprit allergen, or the frame for sex-related allergies due to triggers typically linked to that situation. The present review aims at summarizing the state of the art about the topic, in order to spread the awareness and the basic know-how in the field of sexual-related allergies. RECENT FINDINGS Kiss-related IgE-mediated reactions are caused in sensitized partners mainly by the passive transport of allergenic molecules through saliva, skin or oral mucosa. It has also been recently suggested that kissing may act as an epicutaneous way for induction of allergic sensitization. Among food and drugs, not only but mostly, peanuts and beta-lactams, respectively, are the usual trigger. Although controversial, 1-hour wait before kissing and a proper mouth cleaning have been suggested as prevention strategies. Sexual intercourse related local or systemic symptoms can be caused by seminal plasma hypersensitivity, an IgE-mediated/type IV reaction due to prostate-specific antigen, which carries high homology to the canine prostatic kallikrein (Can f 5). Although applied to few patients, successful desensitization and immunotherapy protocols have been proposed. SUMMARY Intimate behaviours are possible modalities of contact with the allergen. The exact prevalence of such hypersensitivity reactions is not known, but for its implications on Quality of Life and reproductive wishes, the possible link between sex and allergy should become part of the personal culture of clinical allergists and every clinician, in order to extend and improve the diagnosis of unusual or unexplained conditions.
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Mejrhit N, Azdad O, Chda A, El Kabbaoui M, Bousfiha A, Bencheikh R, Tazi A, Aarab L. Evaluation of the sensitivity of Moroccans to shrimp tropomyosin and effect of heating and enzymatic treatments. FOOD AGR IMMUNOL 2017. [DOI: 10.1080/09540105.2017.1323187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Najlae Mejrhit
- Faculty of Sciences & Techniques, Laboratory of Bioactive Molecules (LMBSF), University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Ouarda Azdad
- Faculty of Sciences & Techniques, Laboratory of Bioactive Molecules (LMBSF), University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Alae Chda
- Faculty of Sciences & Techniques, Laboratory of Bioactive Molecules (LMBSF), University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Mohamed El Kabbaoui
- Faculty of Sciences & Techniques, Laboratory of Bioactive Molecules (LMBSF), University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Amal Bousfiha
- Faculty of Sciences & Techniques, Laboratory of Bioactive Molecules (LMBSF), University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Rachid Bencheikh
- Faculty of Sciences & Techniques, Laboratory of Bioactive Molecules (LMBSF), University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Abdelali Tazi
- Faculty of Sciences & Techniques, Laboratory of Bioactive Molecules (LMBSF), University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Lotfi Aarab
- Faculty of Sciences & Techniques, Laboratory of Bioactive Molecules (LMBSF), University Sidi Mohamed Ben Abdellah, Fez, Morocco
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Kounis NG. Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management. ACTA ACUST UNITED AC 2016; 54:1545-59. [DOI: 10.1515/cclm-2016-0010] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 02/03/2016] [Indexed: 12/14/2022]
Abstract
AbstractKounis syndrome has been established as a hypersensitivity coronary disorder induced by various conditions, drugs, environmental exposures, foods and coronary stents. Allergic, hypersensitivity, anaphylactic and anaphylactoid reactions are associated with this syndrome. Vasospastic allergic angina, allergic myocardial infarction and stent thrombosis with occluding thrombus infiltrated by eosinophils and/or mast cells constitute are the three reported, so far, variants of this syndrome. Apart from coronary arteries, it affects the cerebral and mesenteric arteries. Its manifestations are broadening and its etiology is continuously increasing. Kounis syndrome is a ubiquitous disease which represents a magnificent natural paradigm and nature’s own experiment in a final trigger pathway implicated in cases of coronary artery spasm and plaque rupture. Kounis syndrome seems to be not a rare disease but an infrequently diagnosed clinical entity which has revealed that the same mediators released from the same inflammatory cells are also present and in acute coronary events of non allergic etiology. These cells are not only present in the culprit region before plaque erosion or rupture but they release their contents just before an actual coronary event. Therefore, awareness of etiology, epidemiology, pathogenesis and clinical manifestations seems to be important for its prognosis, diagnosis, treatment, prevention.
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Long F, Yang X, Wang R, Hu X, Chen F. Effects of combined high pressure and thermal treatments on the allergenic potential of shrimp (Litopenaeus vannamei) tropomyosin in a mouse model of allergy. INNOV FOOD SCI EMERG 2015. [DOI: 10.1016/j.ifset.2015.03.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ballmer-Weber BK, Fernandez-Rivas M, Beyer K, Defernez M, Sperrin M, Mackie AR, Salt LJ, Hourihane JO, Asero R, Belohlavkova S, Kowalski M, de Blay F, Papadopoulos NG, Clausen M, Knulst AC, Roberts G, Popov T, Sprikkelman AB, Dubakiene R, Vieths S, van Ree R, Crevel R, Mills EC. How much is too much? Threshold dose distributions for 5 food allergens. J Allergy Clin Immunol 2015; 135:964-971. [DOI: 10.1016/j.jaci.2014.10.047] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 10/07/2014] [Accepted: 10/15/2014] [Indexed: 11/29/2022]
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Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, Nadeau K, Nowak-Wegrzyn A, Oppenheimer J, Perry TT, Randolph C, Sicherer SH, Simon RA, Vickery BP, Wood R, Bernstein D, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Spector S, Tilles SA, Wallace D, Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, Nadeau K, Nowak-Wegrzyn A, Oppenheimer J, Perry TT, Randolph C, Sicherer SH, Simon RA, Vickery BP, Wood R. Food allergy: a practice parameter update-2014. J Allergy Clin Immunol 2014; 134:1016-25.e43. [PMID: 25174862 DOI: 10.1016/j.jaci.2014.05.013] [Citation(s) in RCA: 520] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/02/2014] [Accepted: 05/06/2014] [Indexed: 02/06/2023]
Abstract
This parameter was developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology (JCAAI). The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Food Allergy: A practice parameter update-2014." This is a complete and comprehensive document at the current time. The medical environment is a changing one, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, ACAAI, and JCAAI. These parameters are not designed for use by pharmaceutical companies in drug promotion.
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Kounis NG, Mazarakis A, Almpanis G, Gkouias K, Kounis GN, Tsigkas G. The more allergens an atopic patient is exposed to, the easier and quicker anaphylactic shock and Kounis syndrome appear: Clinical and therapeutic paradoxes. J Nat Sci Biol Med 2014; 5:240-4. [PMID: 25097390 PMCID: PMC4121890 DOI: 10.4103/0976-9668.136145] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Kounis syndrome is a condition that combines allergic, hypersensitivity, anaphylactic or anaphylactoid reactions with acute coronary syndromes including vasospastic angina, acute myocardial infarction and stent thrombosis. This syndrome is a ubiquitous disease affecting patients of any age, involving numerous and continuously increasing causes, with broadening clinical manifestations and covering a wide spectrum of mast cell activation disorders. Drugs, environmental exposures and various conditions are the main offenders. Clinical and therapeutic paradoxes concerning Kounis syndrome therapy, pathophysiology, clinical course and causality have been encountered during its clinical course. Drugs that counteract allergy, such as H2-antihistamines, can induce allergy and Kounis syndrome. The more drugs an atopic patient is exposed to, the easier and quicker anaphylaxis and Kounis syndrome can occur. Every anesthetized patient is under the risk of multiple drugs and substances that can induce anaphylactic reaction and Kounis syndrome. The heart and the coronary arteries seem to be the primary target in severe anaphylaxis manifesting as Kounis syndrome. Commercially available adrenaline saves lives in anaphylaxis but it contains as preservative sodium metabisulfite and should be avoided in the sulfite allergic patients. Thus, careful patient past history and consideration for drug side effects and allergy should be taken into account before use. The decision to prescribe a drug where there is a history of previous adverse reactions requires careful assessment of the risks and potential benefits.
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Affiliation(s)
- N G Kounis
- Department of Medical Sciences, Patras Highest Institute of Education and Technology, Patras, Achaia, Greece
| | - A Mazarakis
- Department of Cardiology, "Saint Andrews" State General Hospital, Patras, Achaia, Greece
| | - G Almpanis
- Department of Cardiology, "Saint Andrews" State General Hospital, Patras, Achaia, Greece
| | - K Gkouias
- Department of Cardiology, "Saint Andrews" State General Hospital, Patras, Achaia, Greece
| | - G N Kounis
- Department of Medical Sciences, Patras Highest Institute of Education and Technology, Patras, Achaia, Greece
| | - G Tsigkas
- Department of Cardiology, University of Patras Medical School, Patras, Achaia, Greece
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Khanaruksombat S, Srisomsap C, Chokchaichamnankit D, Punyarit P, Phiriyangkul P. Identification of a novel allergen from muscle and various organs in banana shrimp (Fenneropenaeus merguiensis). Ann Allergy Asthma Immunol 2014; 113:301-6. [PMID: 24996992 DOI: 10.1016/j.anai.2014.06.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 04/08/2014] [Accepted: 06/05/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND The increasing consumption of shellfish can cause an increase in allergic symptoms. Shrimp allergy can be species specific, but specific allergies in different organs have not been studied. Identification of allergens in muscle and others organs of banana shrimp is necessary for improved diagnostics of allergies for shrimp and food safety control. OBJECTIVE To identify the IgE-binding proteins in various organs of Fenneropenaeus merguiensis by immunoblotting and tandem mass spectrometry. METHODS Proteomic methods were used to investigate the allergenic proteins from banana shrimp. Proteins from muscle and various organs were separated by denaturing polyacrylamide gel electrophoresis. Allergens were analyzed by immunoblotting with pooled sera from shrimp allergic patients (n = 21) and tandem mass spectrometry. RESULTS The important allergens in banana shrimp are arginine kinase, sarcoplasmic calcium-binding protein, myosin heavy chain, hemocyanin, enolase, and glyceraldehyde-3-phosphate dehydrogenase, which can be demonstrated by immunoblotting in muscle and shell. Moreover, vitellogenin, ovarian peritrophin 1 precursor, β-actin, and 14-3-3 protein were suggested as allergens in the ovary at different stages of ovarian development. CONCLUSION Ten allergens were identified as allergens in various organs, and they are suggested as novel allergens in banana shrimp. The major allergen in muscle and shell from this shrimp is arginine kinase, whereas the major allergen in the ovary is vitellogenin.
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Affiliation(s)
- Suparada Khanaruksombat
- Division of Biochemistry, Faculty of Liberal Arts and Science, Kasetsart University, Kamphaeng Saen Campus, Nakhon Pathom, Thailand; Center for Advanced Studies in Tropical Natural Resources, National Research University-Kasetsart University, Kasetsart University, Chatuchak, Bangkok, Thailand; Bioproducts Science, Department of Science, Faculty of Liberal Arts and Science, Kasetsart University, Kamphaeng Saen Campus, Nakhon Pathom, Thailand
| | | | | | - Phaibul Punyarit
- Department of Pathology, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Pharima Phiriyangkul
- Division of Biochemistry, Faculty of Liberal Arts and Science, Kasetsart University, Kamphaeng Saen Campus, Nakhon Pathom, Thailand; Center for Advanced Studies in Tropical Natural Resources, National Research University-Kasetsart University, Kasetsart University, Chatuchak, Bangkok, Thailand; Bioproducts Science, Department of Science, Faculty of Liberal Arts and Science, Kasetsart University, Kamphaeng Saen Campus, Nakhon Pathom, Thailand.
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Kounis NG. Coronary hypersensitivity disorder: the Kounis syndrome. Clin Ther 2013; 35:563-71. [PMID: 23490289 DOI: 10.1016/j.clinthera.2013.02.022] [Citation(s) in RCA: 207] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 02/21/2013] [Accepted: 02/25/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND When allergy or hypersensitivity and anaphylactic or anaphylactoid insults lead to cardiovascular symptoms and signs, including acute coronary events, the result might be the recently defined nosologic entity Kounis syndrome. Vasospastic allergic angina, allergic myocardial infarction, and stent thrombosis with occluding thrombus infiltrated by eosinophils and/or mast cells are the 3 reported variants of this syndrome. OBJECTIVE The purpose of this review was to highlight and consolidate the recent literature on allergic angina and allergic myocardial infarction and to propose new therapeutic modalities for stabilizing mast cells. METHODS A search for current literature on the pathophysiology, causality, clinical appearance, variance, prevention, and treatment of Kounis syndrome was conducted. RESULTS Kounis syndrome is caused by inflammatory mediators such as histamine; neutral proteases, including tryptase, chymase, and cathepsin-D; arachidonic acid products; platelet-activating factor; and a variety of cytokines and chemokines released during the mast-cell activation. Platelets with Fc γ receptor (FcγR) Ι, FcγRII, FcεRI, and FcεRII also have a role in the activation cascade. The same mediators released from the similar inflammatory cells are involved in acute coronary events of nonallergic etiology. These cells are not only present in the involved region before plaque erosion or rupture but also release their contents just before an acute coronary event. Pro-inflammatory mediators similar to those found in Kounis syndrome are found in some cases with nonallergic etiology, suggesting that this is a more general problem. The acute coronary and cerebrovascular events in Kounis syndrome may be prevented by the inhibition of mast-cell degranulation. Substances and natural molecules that protect the mast-cell surface and stabilize the mast-cell membrane are emerging as novel agents in the prevention of acute coronary and other arterial events. CONCLUSIONS The 3 reported variants of Kounis syndrome-vasospastic allergic angina, allergic myocardial infarction, and stent thrombosis with occluding thrombus-are caused by inflammatory mediators. Agents that inhibit mast-cell degranulation may be efficacious in preventing the acute coronary and cerebrovascular events of Kounis syndrome.
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Affiliation(s)
- Nicholas G Kounis
- Department of Medical Sciences, Patras Highest Institute of Education and Technology, Patras, Greece.
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Kounis NG, Giannopoulos S, Goudevenos J. Beware of, not only the dogs, but the passionate kissing and the Kounis syndrome. J Cardiovasc Med (Hagerstown) 2011; 12:149-50. [DOI: 10.2459/jcm.0b013e328341aeaf] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
INTRODUCTION Ingestion is the principal route for food allergens to trigger allergic reaction in atopic persons. However, in some highly sensitive patients severe symptoms may develop upon skin contact and by inhalation. The clinical spectrum ranges from mild facial urticaria and angioedema to life-threatening anaphylactic reactions. OUTLINE OF CASES We describe cases of severe anaphylactic reactions by skin contact, induced by kissing in five children with prior history of severe anaphylaxis caused by food ingestion. These cases were found to have the medical history of IgE mediated food allergy, a very high total and specific serum IgE level and very strong family history of allergy. CONCLUSION The presence of tiny particles of food on the kisser's lips was sufficient to trigger an anaphylactic reaction in sensitized children with prior history of severe allergic reaction caused by ingestion of food. Allergic reaction provoked with food allergens by skin contact can be a risk factor for generalized reactions. Therefore, extreme care has to be taken in avoiding kissing allergic children after eating foods to which they are highly allergic. Considering that kissing can be a cause of severe danger for the food allergic patient, such persons should inform their partners about the risk factor for causing their food hypersensitivity.
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Liu GM, Cheng H, Nesbit JB, Su WJ, Cao MJ, Maleki SJ. Effects of boiling on the IgE-binding properties of tropomyosin of shrimp (Litopenaeus vannamei). J Food Sci 2010; 75:T1-5. [PMID: 20492208 DOI: 10.1111/j.1750-3841.2009.01391.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The thermal stability and IgE binding of raw and boiled shrimp extracts and the tropomyosins (TM) have not been reported. In this study, we compare the stability of raw and boiled shrimp TM of Litopenaeus vannamei and evaluate how boiling may alter the allergenicity of L. vannamei. Extracts were prepared from raw and boiled shrimp and analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and two-dimensional electrophoresis. The IgE-binding of the extracts was determined by western-blot and competitive inhibition enzyme-linked immunosorbent assay (iELISA). The TM was then purified from raw and boiled shrimp, the secondary structures analyzed by circular dichroism (CD) spectroscopy, and the IgE binding compared by slot blot analysis. The soluble protein content decreased and the higher molecular weight proteins increased in the extracts from boiled versus raw shrimp. Similar IgE binding characteristics were seen by extracts when using western blot analysis. Although iELISA results showed that extracts from raw shrimp bound higher IgE than extracts from boiled shrimp, dot-blot assay demonstrates higher IgE binding to purified TM from boiled shrimp than raw shrimp. The purified TM had a typical alpha-helical secondary structure and the stability of boiled TM was lower than that of raw TM. Extracts from boiled shrimp produce lower IgE binding than extracts from raw shrimp, which suggest that boiling can be used as a tool in attempting to reduce shrimp allergenicity. However, the purified TM from boiled shrimp, which shows enhanced IgE binding over that of raw shrimp, may be a more effective antigen in diagnosing shrimp allergy through immunoassay.
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Affiliation(s)
- Guang-Ming Liu
- College of Biological Engineering, The Key Lab. of Science and Technology for Aquaculture and Food Safety, Jimei Univ., 43 Yindou Rd., Xiamen, Fujian, China
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Ayuso R, Grishina G, Bardina L, Carrillo T, Blanco C, Ibáñez MD, Sampson HA, Beyer K. Myosin light chain is a novel shrimp allergen, Lit v 3. J Allergy Clin Immunol 2008; 122:795-802. [PMID: 18760458 DOI: 10.1016/j.jaci.2008.07.023] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Revised: 07/16/2008] [Accepted: 07/18/2008] [Indexed: 12/16/2022]
Abstract
BACKGROUND Shellfish allergy is a prevalent, long-lasting disorder usually persisting throughout life. Few options are available for treatment, and avoidance is the only therapy recommended. OBJECTIVE We sought to identify relevant crustacean allergens for use as diagnostic and safe immunotherapeutic agents for subjects with shellfish allergy. METHODS Thirty-eight patients were selected with immediate allergic reactions to shrimp and increased shrimp-specific serum IgE levels. One-dimensional and 2-dimensional electrophoresis of shrimp extracts were followed by IgE immunoblotting. Protein identification was done with matrix-assisted laser desorption/ionization-mass spectrometry and Edman sequencing. A cDNA library was generated from white pacific shrimp (Litopenaeus vannamei) and screened with primers designed on the basis of internal sequences obtained from 2-dimensional tryptic digests. Full-length cDNA clones were isolated from the library and sequenced. Recombinant protein was expressed and tested with sera from patients with shrimp allergy. RESULTS Immunoblotting demonstrated IgE binding to a 20-kDa shrimp protein by 21 (55%) of 38 sera. Tryptic digestion of the protein followed by matrix-assisted laser desorption/ionization-mass spectrometric analysis and Edman sequencing identified it as a myosin light chain (MLC). Screening of the shrimp cDNA library resulted in isolation of a novel protein cDNA. Open reading frame translation provided the amino acid sequence of a new allergenic shrimp protein with high similarity to Bla g 8 (cockroach MLC). Recombinant protein was recognized by 17 patients, confirming the allergenicity of shrimp MLC. CONCLUSIONS We have identified and cloned a new major shrimp allergen, Lit v 3.0101, an MLC protein.
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Affiliation(s)
- Rosalía Ayuso
- Division of Allergy and Immunology and the Jaffe Food Allergy Research Institute, Mount Sinai School of Medicine, New York, NY.
| | - Galina Grishina
- Division of Allergy and Immunology and the Jaffe Food Allergy Research Institute, Mount Sinai School of Medicine, New York, NY
| | - Ludmilla Bardina
- Division of Allergy and Immunology and the Jaffe Food Allergy Research Institute, Mount Sinai School of Medicine, New York, NY
| | - Teresa Carrillo
- Section of Allergy and Respiratory Diseases, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Carlos Blanco
- Section of Allergy, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Hugh A Sampson
- Division of Allergy and Immunology and the Jaffe Food Allergy Research Institute, Mount Sinai School of Medicine, New York, NY
| | - Kirsten Beyer
- Department of Pediatric Pneumology and Immunology, University Children's Hospital Charité, Berlin, Germany
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Abstract
Peanut and tree nut allergies present multiple challenges in their presentation and management. These challenges have become increasingly relevant in recent years, as these allergies appear to have become more common. An estimated 1-2% of the population in the USA is allergic to peanut or tree nuts. Peanut allergy typically presents with symptoms in one of the first few exposures to peanut. Diagnosis is based on clinical history along with skin prick test, or quantitation of allergen-specific immunoglobulin E (IgE), and oral food challenges when indicated. Once the diagnosis is confirmed, the only current management approach is strict avoidance of the food. This is clearly an imperfect option as it can be difficult to avoid completely peanut and tree nuts and accidental exposures are not uncommon. Only about 20% of those with peanut allergy, and <10% of those with tree nut allergy, are reported to acquire tolerance. Additionally, peanut allergy can recur, with one study finding a recurrence rate of 8%. Peanut and tree nuts are the foods most frequently associated with fatal episodes of anaphylaxis. This is of particular concern in adolescents and young adults, among whom life-threatening and fatal food allergy-related reactions are most common.
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Affiliation(s)
- Justin M Skripak
- Division of Allergy and Immunology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Buchanan R, Dennis S, Gendel S, Acheson D, Assimon SA, Beru N, Bolger P, Carlson D, Carvajal R, Copp C, Falci K, Garber E, Harden E, Kane R, Kvenberg J, Luccioli S, Park D, Raybourne R, Troxell T, Vierk K. Approaches to establish thresholds for major food allergens and for gluten in food. J Food Prot 2008; 71:1043-88. [PMID: 18522044 DOI: 10.4315/0362-028x-71.5.1043] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Robert Buchanan
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, 5100 Paint Branch Parkway, College Park, Maryland 20740-3835, USA
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Liccardi G, Senna G, Rotiroti G, D'Amato G, Passalacqua G. Intimate behavior and allergy: a narrative review. Ann Allergy Asthma Immunol 2007; 99:394-400. [PMID: 18051207 DOI: 10.1016/s1081-1206(10)60562-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine how sex and intimate contacts can represent a risk factor for allergic reactions, because they may favor direct contact with sensitizing substances. DATA SOURCES We collected in this review the available literature on this subject. The MEDLINE database was searched by a combination of keywords: sex OR sexual intercourse OR kiss OR seminal plasma OR condom AND allergy OR allergic reaction. STUDY SELECTION The studies retrieved were independently evaluated by the authors and included in this review based on their clinical pertinence (i.e., dealing with clinical presentation, diagnosis, or treatment). RESULTS Sex and intimate behavior seem to be increasingly described as triggers of allergic reactions, although the pertaining literature is represented mostly by case reports. Kissing has been described as a risk factor for food- and drug-induced severe reactions. Seminal plasma allergy has been repeatedly described and investigated. In this case, practical diagnostic algorithms have been proposed, and desensitization protocols are available. Similarly, there are numerous case reports of allergic reaction due to latex condoms, for which the diagnostic procedure is standardized. CONCLUSIONS The available literature on intimate behavior, and sex in general, as a trigger of allergic reactions is not abundant. This is probably because of the particular nature of the problem, which concerns intimacy. Nevertheless, reliable diagnostic procedures are available in some specific cases. The possible link between sex and allergy should become part of the personal culture of allergists to extend and improve the diagnosis of unusual or unexplained conditions.
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Affiliation(s)
- Gennaro Liccardi
- Division of Pneumology and Allergology, Department of Chest Diseases, A. Cardarelli Hospital, Naples, Italy
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Teufel M, Biedermann T, Rapps N, Hausteiner C, Henningsen P, Enck P, Zipfel S. Psychological burden of food allergy. World J Gastroenterol 2007; 13:3456-65. [PMID: 17659692 PMCID: PMC4146781 DOI: 10.3748/wjg.v13.i25.3456] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
One fifth of the population report adverse reactions to food. Reasons for these symptoms are heterogeneous, varying from food allergy, food intolerance, irritable bowel syndrome to somatoform or other mental disorders. Literature reveals a large discrepancy between truly diagnosed food allergy and reports of food allergy symptoms by care seekers. In most studies currently available the characterization of patient groups is incomplete, because they did not distinguish between immunologic reactions and other kinds of food reactions. In analysing these adverse reactions, a thorough physical and psychological diagnostic approach is important. In our qualitative review, we present those diagnostic measures that are evidenced-based as well as clinically useful, and discuss the various psychological dimensions of adverse reactions to food. It is important to acknowledge the complex interplay between body and mind: Adults and children suffering from food allergy show impaired quality of life and a higher level of stress and anxiety. Pavlovian conditioning of adverse reactions plays an important role in maintaining symptoms. The role of personality, mood, or anxiety in food reactions is debatable. Somatoform disorders ought to be identified early to avoid lengthy and frustrating investigations. A future task will be to improve diagnostic algorithms, to describe psychological aspects in clearly characterised patient subgroups, and to develop strategies for an optimized management of the various types of adverse reactions to food.
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Affiliation(s)
- Martin Teufel
- Department of Internal Medicine VI-Psychosomatic Medicine and Psychotherapy, University of Tubingen, Osianderstrasse 5, D-72076 Tubingen, Germany.
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Affiliation(s)
- Giuseppe Mancuso
- Department of Dermatology of Municipal Hospital of Lugo (RA), Ravenna, Italy.
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Abstract
A 31-year-old man presented with a long history of rhinoconjunctivitis and sneezing that lasted from March to May. The man kept a chameleon (Chamaeleo calyptratus) as a pet and reported about recurrent urticarial lesions, erythema, and itch after skin contact with the animal. The reactions started within a few minutes and were restricted specifically to the contact sites with the animal's claws. No comparable reactions occurred in other subjects. Allergy testing confirmed allergy to hazel, alder, birch, and ash pollen, and additionally revealed sensitization to house dust mite, cat, and Ficus benjamina. Apparently the contact dermatitis originated from passive transfer of Ficus benjamina allergens to the patient's skin by the reptile which habitually climbed on a big Ficus benjamina tree in the patient's home, thereby contaminating its claws with the plant's allergenic milky sap. Careful examination revealed strong perforation of many leaves by the pointed claws. The patient denied respiratory symptoms from Ficus benjamina and intolerance of Ficus-associated fruits.
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Grims RH, Reiter H, Aberer W, Kranke B. Masked penicillin exposure leading to intensive care unit treatment. Br J Dermatol 2005; 153:228-9. [PMID: 16029369 DOI: 10.1111/j.1365-2133.2005.06714.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brzezinski JL. Detection of crustacean DNA and species identification using a PCR-restriction fragment length polymorphism method. J Food Prot 2005; 68:1866-73. [PMID: 16161686 DOI: 10.4315/0362-028x-68.9.1866] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The detection of potentially allergenic proteins, such as those derived from crustaceans, in food products is a major concern for the food processing industry. A PCR-restriction fragment length polymorphism (PCR-RFLP) method was designed to detect the presence of crustacean DNA in food products and to determine the species source of the DNA. This PCR assay amplifies an approximately 205-bp fragment of the 16S rRNA gene in crustacean species, including shrimp, crab, lobster, and crawfish. This reaction will not amplify DNA derived from mammals, such as cow and sheep. After amplification, the PCR product is digested with differential restriction endonucleases to determine the species source of the crustacean DNA. The specificity of this assay was demonstrated using four species of shrimp, three species of crab, and two species of lobster and crawfish. This assay is sensitive enough to detect crustacean DNA in a raw meat mixture containing <0.1% shrimp.
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Affiliation(s)
- Jennifer L Brzezinski
- U.S. Food and Drug Administration, Forensic Chemistry Center, 6751 Steger Drive, Cincinnati, Ohio 45237, USA.
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Mari A, Ballmer-Weber BK, Vieths S. The oral allergy syndrome: improved diagnostic and treatment methods. Curr Opin Allergy Clin Immunol 2005; 5:267-73. [PMID: 15864087 DOI: 10.1097/01.all.0000168793.27948.b0] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this article is to review recent clinical and molecular findings related to the oral allergy syndrome in order to define its relevance in the field of food allergy, describe current diagnostic approaches and discuss attempts to use specific immunotherapy for treatment. RECENT FINDINGS New allergenic sources causing the oral allergy syndrome have been reported. Their allergenic molecules have been identified. In most of those studies oral allergy syndrome is reported as a clinical manifestation among more severe ones. Some of the molecules generally considered not to be at risk for severe reactions have been demonstrated to pose a threat for inducing generalized reactions. Some studies tried to assess the usefulness of immunotherapy with birch pollen extract by either subcutaneous or sublingual routes for the treatment of associated food allergies. In most of the cases, a well defined study design and a molecular approach at different study levels are lacking and thus the value of the obtained results is limited. To date, no final conclusion can be drawn on the basis of reported results. SUMMARY The knowledge about the highly prevalent phenomenon of oral allergy syndrome is still incomplete, in respect to both, epidemiology and foods inducing symptoms. It is very important to reach consensus on several aspects of this food-induced allergic disease. Further studies are required to highlight whether immunotherapy using co-recognized inhalant allergens is an effective way of curative treatment, or if co-treatment with purified pollen-related food allergens will be required to obtain a long-lasting effect.
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Affiliation(s)
- Adriano Mari
- Allergy Unit, National Health Service, Rome, Italy.
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Abstract
Fish and shellfish are important in the American diet and economy. Nearly $27 billion are spent each year in the United States on seafood products. Fish and shellfish are also important causes of food hypersensitivity. In fact, shellfish constitute the number one cause of food allergy in the American adult. During the past decade, much has been learned about allergens in fish and shellfish. The major allergens responsible for cross-reactivity among distinct species of fish and amphibians are parvalbumins. The major shellfish allergen has been identified as tropomyosin. Many new and important potential cross-reacting allergens have been identified within the fish family and between shellfish, arachnids, and insects. Extensive research is currently underway for the development of safer and more effective methods for the diagnosis and management of fish and shellfish hypersensitivity.
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Affiliation(s)
- Laurianne G Wild
- Tulane University Health Sciences Center, 1430 Tulane Avenue, SL-57, New Orleans, LA 70112, USA
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Abstract
Adult food allergy is estimated at approximately 3.2% worldwide. The persistence of childhood food allergy is unusual, peanut allergies excepted. Once established in adults, food allergy is rarely cured. Factors favoring the acquisition of allergy could be sensitization to pollens, occupational sensitization by inhalation, drugs (such as tacrolimus), and sudden dietary changes. Severe anaphylaxis and oral allergy syndrome are frequent. The fatality risk is estimated at 1% in severe anaphylaxis. Risk factors for severe anaphylaxis are agents causing increased intestinal permeability, such as alcohol and aspirin. b-blockers, angiotensin-converting enzyme (ACE) inhibitors, and exercise are other factors. Gastrointestinal food allergy remains, to a large extent, undiagnosed in adults. Food allergens are mainly fruit and vegetable, related to pollen sensitizations, or to latex allergy. Wheat flour allergy is increasing. The diagnosis relies on prick skin tests, detection of specific IgEs, and standardized oral challenges. Strict avoidance diets are necessary. Specific immunotherapy to pollens may be efficient for cross-reactive food allergies.
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Affiliation(s)
- Denise A Moneret-Vautrin
- Department of Internal Medicine, Clinical Immunology and Allergology, University Hospital, 29 Avenue de Lattre de Tassigny, 54035 Nancy, France.
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Bischoff S, Crowe SE. Gastrointestinal food allergy: new insights into pathophysiology and clinical perspectives. Gastroenterology 2005; 128:1089-113. [PMID: 15825090 DOI: 10.1053/j.gastro.2004.08.015] [Citation(s) in RCA: 179] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Adverse reactions to food that result in gastrointestinal symptoms are common in the general population; while only a minority of such individuals will have symptoms due to immunologic reactions to foods, gastrointestinal food allergies do exist in both children and adults. These immune reactions are mediated by immunoglobulin E-dependent and -independent mechanisms involving mast cells, eosinophils, and other immune cells, but the complexity of the underlying mechanisms of pathogenesis have yet to be fully defined. Knowledge of the spectrum of adverse reactions to foods that affect the digestive system, including gastrointestinal food allergy, is essential to correctly diagnose and manage the subset of patients with immunologically mediated adverse reactions to foods. Potentially fatal reactions to food necessitate careful instruction and monitoring on the part of health care workers involved in the care of individuals at risk of anaphylaxis. New methods of diagnosis and novel strategies for treatment, including immunologic modulation and the development of hypoallergenic foods, are exciting developments in the field of food allergy.
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Affiliation(s)
- Stephan Bischoff
- Department of Gastroenterology, University Medical School of Hannover, Germany
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Brouse SD, Phillips SM. Amiodarone Use in Patients with Documented Allergy to Iodine-Containing Compounds. Pharmacotherapy 2005; 25:429-34. [PMID: 15843290 DOI: 10.1592/phco.25.3.429.61602] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The popularity of amiodarone has grown due to its effectiveness in converting arrhythmia and its formulation availability. Formulations of the drug also contain iodine; the iodine content is 75 mg in a 200-mg tablet of amiodarone and 18.7 mg/ml in the intravenous solution. Approximately 10% of the iodine content of oral amiodarone is released into the circulatory system and may increase the risks of hypersensitivity reactions in iodine-sensitive patients. Documented allergies to contrast media or shellfish should not imply that a patient is allergic to iodine. Reactions to contrast media are likely due to the high osmolar or ionic content of the dye. The primary allergen in shellfish that stimulates allergic reactions is tropomyosin. Although amiodarone can cause thyroid disorders due to the high iodine load delivered to the body with each dose, no known association exists between amiodarone and reactions to contrast media or shellfish. Three patients whose medical charts listed an allergy to iodine were administered amiodarone for chemical cardioversion of arrhythmia to normal sinus rhythm. No anaphylactic or anaphylactoid reactions were observed in any of the patients during oral or intravenous amiodarone administration. In patients with true iodine hypersensitivity, however, the potential for such reactions exists.
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Affiliation(s)
- Sara D Brouse
- Texas Tech University Health Sciences Center School of Pharmacy, Dallas, Texas 75216-7167, USA.
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Lipozencić J, Wolf R. Life-threatening severe allergic reactions: urticaria, angioedema, and anaphylaxis. Clin Dermatol 2005; 23:193-205. [PMID: 15802213 DOI: 10.1016/j.clindermatol.2004.06.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Urticaria, angioedema and anaphylaxis are life threatening skin diseases. Allergological emergencies are common; drugs, food, food ingredients/additives, insects, and many other factors have been reported to elicit anaphylactic reactions. The severity of symptoms ranges from pruritus to generalized skin eruptions, gastrointestinal, bronchial problems to systemic anaphylaxis and cardiovascular emergencies. The pathomechanisms and treatment of urticarias, angioedema and anaphylaxis are described. In some situations emergency kit: antihistamines, steroids, betamimetics and adrenaline is needed. Familiarity with the early diagnosis and correct management should be acknowledegable for dermatologists to recognize these allergic reactions and must be prepared to administer emergency kit.
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Affiliation(s)
- Jasna Lipozencić
- Department of Dermatovenerology, Zagreb University Hospital Center, 10000 Zagreb, Croatia.
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Abstract
PURPOSE OF REVIEW The present review addresses the current literature regarding the impact of diet and the development of atopic disease. A search of the literature was carried out covering the following topics: diet and nutrition combined with immediate hypersensitivity, atopy, atopic disease, atopic dermatitis, and food allergy. RECENT FINDINGS The search results identified a significant contribution in the form of reviews considering this important topic, which ultimately led to the author's recommendation of these reviews to impress upon readers the impact of the atopy triad: atopic dermatitis to allergic rhinitis and asthma. SUMMARY A great deal of information exists in the pathomechanisms of atopic disease that will affect the classification of allergic and non-allergic atopic diseases. Increasing data on the genetic, humoral and cellular forms associated with these diseases will provide more clear-cut diagnostic criteria, treatment regimens and a more strict definition of the disease variants.
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Affiliation(s)
- Ricki M Helm
- Department of Microbiology/Immunology, Arkansas Children's Nutrition Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Abstract
PURPOSE OF REVIEW Given the importance and prevalence of seafood in our economy and diet, interest in the adverse effects of seafood-induced allergic reactions has increased both in the lay population and the scientific arena. The purpose for this review article is to provide an overview and discussion of current seafood-allergy research. RECENT FINDINGS Current research has produced the discovery of new seafood allergens as well as a better understanding of the interactions of allergens with the host, and the relationships of IgE antibodies with specific allergens. Crossreactivity of similar molecules from seafood and nonseafood sources provides a better understanding of an allergen's role in seafood allergy and a basis to improve patient identification and treatment. SUMMARY Findings in recent literature show potential for more precise diagnosis and safer, more effective treatment of seafood allergies.
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Affiliation(s)
- Linda Ree-Kim
- Section of Allergy and Clinical Immunology, Tulane University School of Medicine, 1700 Perdido Street, New Orleans, LA 70112, USA
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