1
|
Srisuwatchari W, Suárez-Fariñas M, Delgado AD, Grishina G, Suprun M, Sang Eun Lee A, Vichyanond P, Pacharn P, Sampson HA. Utility of epitope-specific IgE, IgG4, and IgG1 antibodies for the diagnosis of wheat allergy. J Allergy Clin Immunol 2024:S0091-6749(24)00821-2. [PMID: 39154658 DOI: 10.1016/j.jaci.2024.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 08/01/2024] [Accepted: 08/05/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND The bead-based epitope assay has been used to identify epitope-specific (es) antibodies and successfully used to diagnose clinical allergy to milk, egg, and peanut. OBJECTIVE We sought to identify es-IgE, es-IgG4, and es-IgG1 of wheat proteins and determine the optimal peptides to differentiate wheat-allergic from wheat-tolerant using the bead-based epitope assay. METHODS Children and adolescents who underwent an oral food challenge to confirm their wheat allergy status were enrolled. Seventy-nine peptides from α-/β-gliadin, γ-gliadin, ω-5-gliadin, and high- and low-molecular-weight glutenin were commercially synthesized and coupled to LumAvidin beads (Luminex Corporation, Austin, Tex). Machine learning methods were used to identify diagnostic epitopes, and performance was evaluated using the DeLong test. RESULTS The analysis included 122 children (83 wheat-allergic and 39 wheat-tolerant; 57.4% male). Machine learning coupled with simulations identified wheat es-IgE, but not es-IgG4 or es-IgG1, to be the most informative for diagnosing wheat allergy. Higher es-IgE binding intensity correlated with the severity of allergy phenotypes, with wheat anaphylaxis exhibiting the highest es-IgE binding intensity. In contrast, wheat-dependent exercise-induced anaphylaxis showed lower es-IgG1 binding intensity than did all the other groups. A set of 4 informative epitopes from ω-5-gliadin and γ-gliadin were the best predictors of wheat allergy, with an area under the curve of 0.908 (sensitivity, 83.4%; specificity, 88.4%), higher than the performance exhibited by wheat-specific IgE (area under the curve = 0.646; P < .001). The predictive ability of our model was confirmed in an external cohort of 71 patients (29 allergic, 42 nonallergic), with an area under the curve of 0.908 (sensitivity, 75.9%; specificity, 90.5%). CONCLUSIONS The wheat bead-based epitope assay demonstrated greater diagnostic accuracy compared with existing specific IgE tests for wheat allergy.
Collapse
Affiliation(s)
- Witchaya Srisuwatchari
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Mayte Suárez-Fariñas
- Department of Population Health Science & Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Andrew D Delgado
- Department of Population Health Science & Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Galina Grishina
- Division of Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Maria Suprun
- Division of Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ashley Sang Eun Lee
- Division of Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Pakit Vichyanond
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Samitivej Allergy Institute, Samitivej Thonburi Hospital, Bangkok, Thailand
| | - Punchama Pacharn
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Hugh A Sampson
- Division of Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
| |
Collapse
|
2
|
Wongnate J, Piboonpocanun S, Kanchanapoomi K, Srisuwatchari W, Jirapongsananuruk O, Visitsunthorn N, Pacharn P. Clinical features of children with coconut allergy and its sIgE profiling using immunoblot analysis. Pediatr Allergy Immunol 2022; 33:e13874. [PMID: 36433854 DOI: 10.1111/pai.13874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/10/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Jirakiti Wongnate
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Kantima Kanchanapoomi
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Witchaya Srisuwatchari
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Orathai Jirapongsananuruk
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nualanong Visitsunthorn
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Punchama Pacharn
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
3
|
Amnuaycheewa P, Niemann L, Goodman RE, Baumert JL, Taylor SL. Challenges in Gluten Analysis: A Comparison of Four Commercial Sandwich ELISA Kits. Foods 2022; 11:706. [PMID: 35267339 PMCID: PMC8909647 DOI: 10.3390/foods11050706] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 02/05/2023] Open
Abstract
Gluten is composed of prolamin and glutelin proteins from several related grains. Because these proteins are not present in identical ratios in the various grains and because they have some differences in sequence, the ability to accurately quantify the overall amount of gluten in various food matrices to support gluten-free labeling is difficult. Four sandwich ELISAs (the R-Biopharm AG R5 RIDASCREEN®, the Neogen Veratox® R5, the Romer Labs AgraQuant® G12, and the Morinaga Wheat kits) were evaluated for their performance to quantify gluten concentrations in various foods and ingredients. The Morinaga and AgraQuant® G12 tests yielded results comparable to the two R5 kits for most, but not for certain, foods. The results obtained with the Morinaga kit were lower when compared to the other kits for analyzing powders of buckwheat and several grass-based products. All four kits were capable of detecting multiple gluten-containing grain sources including wheat, rye, barley, semolina, triticale, spelt, emmer, einkorn, Kamut™, and club wheat. Users of the ELISA kits should verify the performance in their hands, with matrices that are typical for their specific uses. The variation in results for some food matrices between test methods could result in trade disputes or regulatory disagreements.
Collapse
Affiliation(s)
- Plaimein Amnuaycheewa
- Department of Agro-Industrial, Food, and Environmental Technology, King Mongkut’s University of Technology North Bangkok (KMUTNB), Bangkok 10800, Thailand;
| | - Lynn Niemann
- Food Allergy Research and Resource Program (FARRP), Department of Food Science and Technology, University of Nebraska, Lincoln, NE 68588-6207, USA; (L.N.); (R.E.G.); (J.L.B.)
| | - Richard E. Goodman
- Food Allergy Research and Resource Program (FARRP), Department of Food Science and Technology, University of Nebraska, Lincoln, NE 68588-6207, USA; (L.N.); (R.E.G.); (J.L.B.)
| | - Joseph L. Baumert
- Food Allergy Research and Resource Program (FARRP), Department of Food Science and Technology, University of Nebraska, Lincoln, NE 68588-6207, USA; (L.N.); (R.E.G.); (J.L.B.)
| | - Steve L. Taylor
- Food Allergy Research and Resource Program (FARRP), Department of Food Science and Technology, University of Nebraska, Lincoln, NE 68588-6207, USA; (L.N.); (R.E.G.); (J.L.B.)
| |
Collapse
|
4
|
Clinical Manifestations of Pediatric Food Allergy: a Contemporary Review. Clin Rev Allergy Immunol 2021; 62:180-199. [PMID: 34519995 DOI: 10.1007/s12016-021-08895-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 12/12/2022]
Abstract
Food allergies (FAs) are an emerging health care issue, and a "second wave of the allergy epidemic" was named. There are extensive data that documented the prevalence rate as high as approximately 10%. FAs are immunological adverse reactions, including IgE-mediated mechanisms, cell-mediated mechanisms, or mixed IgE- and cell-mediated mechanisms. A diagnosis of FA is made by specific symptoms encounter with food, detailed past history, sensitization tests, and oral food challenges (OFCs) if necessary. The component-resolved diagnostics (CRD) test can distinguish true or cross-reaction. "Minimal elimination" from the results of CRD and OFC could avoid unnecessary food restriction. Strict food limitation is harsh and stressful on patients and their families. Children with FAs experience a higher rate of post-traumatic stress symptoms (PTSS) and bullying than others. In the last 20 years, oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and epicutaneous immunotherapy (EPIT) are treatment strategies. OIT and EPIT are the most two encouraging treatments for FA. This review aims to introduce FAs in diverse clinical disorders, new perspectives, and their practical implications in diagnosing and treating FA.
Collapse
|
5
|
Loo EXL, Lau HX, Suaini NHA, Wong LSY, Goh AEN, Teoh OH, Van Bever HP, Shek LPC, Lee BW, Tan KH, Godfrey KM, Eriksson JG, Chong YS, Tham EH. House dust mite sensitization, eczema, and wheeze increase risk of shellfish sensitization. Pediatr Allergy Immunol 2021; 32:1096-1099. [PMID: 33687761 PMCID: PMC7611115 DOI: 10.1111/pai.13493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/31/2021] [Accepted: 03/02/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Evelyn Xiu Ling Loo
- Agency for Science, Technology and Research (A*STAR), Singapore Institute for Clinical Sciences (SICS), Singapore, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Hui Xing Lau
- Agency for Science, Technology and Research (A*STAR), Singapore Institute for Clinical Sciences (SICS), Singapore, Singapore
| | - Noor Hidayatul Aini Suaini
- Agency for Science, Technology and Research (A*STAR), Singapore Institute for Clinical Sciences (SICS), Singapore, Singapore
| | - Lydia Su Yin Wong
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,National University Health System (NUHS), Khoo Teck Puat-National University Children's Medical Institute, Singapore, Singapore
| | - Anne Eng Neo Goh
- Allergy service, Department of Paediatrics, KK Women's and Children's Hospital (KKH), Singapore, Singapore
| | - Oon Hoe Teoh
- Respiratory Service, Department of Paediatrics, KK Women's and Children's Hospital (KKH), Singapore, Singapore
| | - Hugo Ps Van Bever
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,National University Health System (NUHS), Khoo Teck Puat-National University Children's Medical Institute, Singapore, Singapore
| | - Lynette Pei-Chi Shek
- Agency for Science, Technology and Research (A*STAR), Singapore Institute for Clinical Sciences (SICS), Singapore, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,National University Health System (NUHS), Khoo Teck Puat-National University Children's Medical Institute, Singapore, Singapore
| | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital (KKH), Singapore, Singapore
| | - Keith M Godfrey
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Medical Research Council Lifecourse Epidemiology Unit, Southampton, UK
| | - Johan Gunnar Eriksson
- Agency for Science, Technology and Research (A*STAR), Singapore Institute for Clinical Sciences (SICS), Singapore, Singapore.,Folkhälsan Research Center, Helsinki, Finland and Department of General Practise and Primary Health Care, University of Helsinki, Helsinki, Finland.,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore (NUS), National University Health System (NUHS), Singapore, Singapore.,Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Yap Seng Chong
- Agency for Science, Technology and Research (A*STAR), Singapore Institute for Clinical Sciences (SICS), Singapore, Singapore.,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore (NUS), National University Health System (NUHS), Singapore, Singapore
| | - Elizabeth Huiwen Tham
- Agency for Science, Technology and Research (A*STAR), Singapore Institute for Clinical Sciences (SICS), Singapore, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,National University Health System (NUHS), Khoo Teck Puat-National University Children's Medical Institute, Singapore, Singapore
| |
Collapse
|
6
|
Srisuwatchari W, Piboonpocanun S, Wangthan U, Jirapongsananuruk O, Visitsunthorn N, Pacharn P. Clinical and in vitro cross-reactivity of cereal grains in children with IgE-mediated wheat allergy. Allergol Immunopathol (Madr) 2020; 48:589-596. [PMID: 32327208 DOI: 10.1016/j.aller.2019.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 10/24/2019] [Accepted: 11/12/2019] [Indexed: 01/27/2023]
Abstract
INTRODUCTION AND OBJECTIVES Wheat and cereal grains have a broad range of cross-reactivity, but the clinical relevance of this cross-reactivity is uncertain. This study aimed to evaluate clinical and in vitro cross-reactivity with barley, oat, and Job's tears among wheat-allergic patients. MATERIALS AND METHODS Patients aged 5 to 15 years with IgE-mediated wheat allergy were enrolled. Skin prick test (SPT) and specific IgE (sIgE) to wheat, barley, and oat, and SPT to Job's tears were performed. Oral food challenge (OFC) was conducted if the SPT was ≤5 mm in size and there was no history of anaphylaxis to each grain. Profiles of sIgE bound allergens of wheat, barley, and oat, and inhibition ELISA of IgE binding to barley and oat with wheat were performed. RESULTS Ten patients with a median age of 8 years were enrolled. Nine of those patients had a history of wheat anaphylaxis. The median SPT size and sIgE level to wheat was 7.3 mm and 146.5 kUA/l, respectively. The cross-reactivity rate for barley, oat, and Job's tears was 60.0%, 33.3%, and 20.0%, respectively. Significantly larger SPT size and higher sIgE level were observed in patients with positive cross-reactivity to barley and oat when compared to patients without cross-reactivity. Barley and oat extracts inhibited 59% and 16% of sIgE bound to wheat gliadins and glutenins, respectively. CONCLUSION The cross-reactivity rate was quite low for oat and Job's tears compared to that of barley; therefore, avoidance of all cereal grains may be unnecessary in patients with severe wheat allergy.
Collapse
|
7
|
Hossny E, Ebisawa M, El-Gamal Y, Arasi S, Dahdah L, El-Owaidy R, Galvan CA, Lee BW, Levin M, Martinez S, Pawankar R, Tang ML, Tham EH, Fiocchi A. Challenges of managing food allergy in the developing world. World Allergy Organ J 2019; 12:100089. [PMID: 31871534 PMCID: PMC6909084 DOI: 10.1016/j.waojou.2019.100089] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/30/2019] [Accepted: 10/30/2019] [Indexed: 02/07/2023] Open
Abstract
Food allergy (FA) is currently a significant health care problem in the developing world. Widely varying study populations and methodologies, the use of surrogate markers such as self report or hospitalization rates due to anaphylaxis rather than objective methods, limits robust estimation of FA prevalence in low income settings. Also, allergy is under-recognized as a clinical specialty in the developing world which compromises the chance for accurate diagnosis. In this review, most published data on food allergens from developing or low income countries are displayed. The diagnostic challenges and limitations of treatment options are discussed. It seems that FA is an under-appreciated health care issue in the developing world, and accurate determination of its burden in low-income settings represents an important unmet need. Multicenter surveillance studies, using standardized methodologies, are, therefore, needed to reveal the true extent of the problem and provide epidemiological clues for prevention. Preventive strategies should be tailored to fit local circumstances in different geographic regions. In addition, studying the gene environment interactions and impact of early life microbiota on the expression of FA in developing communities would be worthwhile. Efforts and resources should be directed toward public health education and training of health care providers dealing with food allergic patients.
Collapse
Affiliation(s)
- Elham Hossny
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
| | - Yehia El-Gamal
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | | | - Lamia Dahdah
- Pediatric Hospital Bambino Gesù, Vatican City, Italy
| | - Rasha El-Owaidy
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Cesar A. Galvan
- Centro Nacional de Referencia de Alergia Asma e Inmunología (CERNAAI), Instituto Nacional de Salud del Niño, Lima-Perú, Peru
| | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Michael Levin
- Division Paediatric Allergology, University of Cape Town, Red Cross Children's Hospital, Cape Town, South Africa
| | - Santiago Martinez
- Arnold Palmer Hospital for Children, Florida State University College of Medicine, Florida, United States
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Mimi L.K. Tang
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Victoria, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Victoria, Melbourne, Australia
| | - Elizabeth H. Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | |
Collapse
|
8
|
Leung ASY, Leung NYH, Wai CYY, Leung TF, Wong GWK. Allergen immunotherapy for food allergy from the Asian perspective: key challenges and opportunities. Expert Rev Clin Immunol 2018; 15:153-164. [PMID: 30488732 DOI: 10.1080/1744666x.2019.1554432] [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] [Indexed: 01/02/2023]
Abstract
Introduction: Prevalence of food allergy is rising in different regions of the world. Asia has not been spared from this epidemic, but epidemiological data have revealed a different pattern of food allergens in this continent. Allergen-specific immunotherapy (AIT) for food allergy, which has been revolutionary as the main focus of research in recent years, needs to be adapted for the different populations in Asia. Areas covered: Recent evidence shows increasing popularity and superiority of AIT over strict food avoidance as the cornerstone of food allergy management. Asia is a distinctive continent with specific food allergy triggers, in particular, seafood, and wheat. Peanut, on the contrary, is not a common food allergen in most parts of Asia. The common Asian food allergens, as well as the rapidly developing food-specific AIT in this region will be covered in this article. Expert commentary: Evidence on oral immunotherapy for wheat allergy and preclinical data on shellfish AIT are promising. Further work should be done on resolving cross-sensitization between environmental allergens with wheat and shellfish allergens, and a modified AIT approach to enhance the safety and effectiveness of food-specific immunotherapy.
Collapse
Affiliation(s)
- Agnes Sze Yin Leung
- a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital Shatin , New Territories , Hong Kong
| | - Nicki Yat Hin Leung
- a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital Shatin , New Territories , Hong Kong
| | - Christine Yee Yan Wai
- a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital Shatin , New Territories , Hong Kong
| | - Ting Fan Leung
- a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital Shatin , New Territories , Hong Kong
| | - Gary Wing Kin Wong
- a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital Shatin , New Territories , Hong Kong
| |
Collapse
|
9
|
Chang YS. Spring and allergy. Asia Pac Allergy 2018; 8:e22. [PMID: 29732298 PMCID: PMC5931929 DOI: 10.5415/apallergy.2018.8.e22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 04/29/2018] [Indexed: 12/02/2022] Open
Affiliation(s)
- Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea
| |
Collapse
|