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Thomander T, Toppila-Salmi S, Palosuo K, Voutilainen H, Kukkonen K, Pallasaho P, Kauppi P. Long-term clinical outcome of oral immunotherapy in adults with milk, peanut, and egg allergy: A pilot study. J Allergy Clin Immunol Pract 2024; 12:776-778.e2. [PMID: 37918650 DOI: 10.1016/j.jaip.2023.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/22/2023] [Accepted: 10/27/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Tuuli Thomander
- Doctoral Programme in Clinical Research, University of Helsinki, Helsinki, Finland; The Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
| | - Sanna Toppila-Salmi
- Department of Allergology, Skin and Allergy Hospital, Inflammation Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Department of Otorhinolaryngology, Kuopio University Hospital and School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Kati Palosuo
- Department of Allergology, Skin and Allergy Hospital, Inflammation Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Helena Voutilainen
- Department of Allergology, Skin and Allergy Hospital, Inflammation Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Kaarina Kukkonen
- Department of Allergology, Skin and Allergy Hospital, Inflammation Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Paula Pallasaho
- Department of Allergology, Skin and Allergy Hospital, Inflammation Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Paula Kauppi
- The Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Nieminen O, Palosuo K, Kukkonen K, Mäkelä M. Comparison of Severity Scorings in Oral Food Challenges With Cow's Milk. J Investig Allergol Clin Immunol 2024; 34:71-73. [PMID: 37219947 DOI: 10.18176/jiaci.0913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Affiliation(s)
- O Nieminen
- Helsinki Skin and Allergy Hospital, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Helsinki, Finland
| | - K Palosuo
- Helsinki Skin and Allergy Hospital, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Helsinki, Finland
| | - K Kukkonen
- Helsinki Skin and Allergy Hospital, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Helsinki, Finland
| | - M Mäkelä
- Helsinki Skin and Allergy Hospital, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Helsinki, Finland
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Dramburg S, Hilger C, Santos AF, de Las Vecillas L, Aalberse RC, Acevedo N, Aglas L, Altmann F, Arruda KL, Asero R, Ballmer-Weber B, Barber D, Beyer K, Biedermann T, Bilo MB, Blank S, Bosshard PP, Breiteneder H, Brough HA, Bublin M, Campbell D, Caraballo L, Caubet JC, Celi G, Chapman MD, Chruszcz M, Custovic A, Czolk R, Davies J, Douladiris N, Eberlein B, Ebisawa M, Ehlers A, Eigenmann P, Gadermaier G, Giovannini M, Gomez F, Grohman R, Guillet C, Hafner C, Hamilton RG, Hauser M, Hawranek T, Hoffmann HJ, Holzhauser T, Iizuka T, Jacquet A, Jakob T, Janssen-Weets B, Jappe U, Jutel M, Kalic T, Kamath S, Kespohl S, Kleine-Tebbe J, Knol E, Knulst A, Konradsen JR, Korošec P, Kuehn A, Lack G, Le TM, Lopata A, Luengo O, Mäkelä M, Marra AM, Mills C, Morisset M, Muraro A, Nowak-Wegrzyn A, Nugraha R, Ollert M, Palosuo K, Pastorello EA, Patil SU, Platts-Mills T, Pomés A, Poncet P, Potapova E, Poulsen LK, Radauer C, Radulovic S, Raulf M, Rougé P, Sastre J, Sato S, Scala E, Schmid JM, Schmid-Grendelmeier P, Schrama D, Sénéchal H, Traidl-Hoffmann C, Valverde-Monge M, van Hage M, van Ree R, Verhoeckx K, Vieths S, Wickman M, Zakzuk J, Matricardi PM, Hoffmann-Sommergruber K. EAACI Molecular Allergology User's Guide 2.0. Pediatr Allergy Immunol 2023; 34 Suppl 28:e13854. [PMID: 37186333 DOI: 10.1111/pai.13854] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/05/2022] [Indexed: 05/17/2023]
Abstract
Since the discovery of immunoglobulin E (IgE) as a mediator of allergic diseases in 1967, our knowledge about the immunological mechanisms of IgE-mediated allergies has remarkably increased. In addition to understanding the immune response and clinical symptoms, allergy diagnosis and management depend strongly on the precise identification of the elicitors of the IgE-mediated allergic reaction. In the past four decades, innovations in bioscience and technology have facilitated the identification and production of well-defined, highly pure molecules for component-resolved diagnosis (CRD), allowing a personalized diagnosis and management of the allergic disease for individual patients. The first edition of the "EAACI Molecular Allergology User's Guide" (MAUG) in 2016 rapidly became a key reference for clinicians, scientists, and interested readers with a background in allergology, immunology, biology, and medicine. Nevertheless, the field of molecular allergology is moving fast, and after 6 years, a new EAACI Taskforce was established to provide an updated document. The Molecular Allergology User's Guide 2.0 summarizes state-of-the-art information on allergen molecules, their clinical relevance, and their application in diagnostic algorithms for clinical practice. It is designed for both, clinicians and scientists, guiding health care professionals through the overwhelming list of different allergen molecules available for testing. Further, it provides diagnostic algorithms on the clinical relevance of allergenic molecules and gives an overview of their biology, the basic mechanisms of test formats, and the application of tests to measure allergen exposure.
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Affiliation(s)
- Stephanie Dramburg
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christiane Hilger
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Alexandra F Santos
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
- Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | | | - Rob C Aalberse
- Sanquin Research, Dept Immunopathology, University of Amsterdam, Amsterdam, The Netherlands
- Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Nathalie Acevedo
- Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia, Colombia
| | - Lorenz Aglas
- Department of Biosciences and Medical Biology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Friedrich Altmann
- Department of Chemistry, University of Natural Resources and Life Sciences, Vienna, Austria
| | - Karla L Arruda
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Sao Paulo, Brasil, Brazil
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| | - Barbara Ballmer-Weber
- Klinik für Dermatologie und Allergologie, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Domingo Barber
- Institute of Applied Molecular Medicine Nemesio Diez (IMMAND), Department of Basic Medical Sciences, Facultad de Medicina, Universidad San Pablo CEU, CEU Universities, Madrid, Spain
- RETIC ARADyAL and RICORS Enfermedades Inflamatorias (REI), Madrid, Spain
| | - Kirsten Beyer
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University Munich, Munich, Germany
| | - Maria Beatrice Bilo
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
- Allergy Unit Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Torrette, Italy
| | - Simon Blank
- Center of Allergy and Environment (ZAUM), Technical University of Munich, School of Medicine and Helmholtz Center Munich, German Research Center for Environmental Health, Munich, Germany
| | - Philipp P Bosshard
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Heimo Breiteneder
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Helen A Brough
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Merima Bublin
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Dianne Campbell
- Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia, Colombia
| | - Jean Christoph Caubet
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - Giorgio Celi
- Centro DH Allergologia e Immunologia Clinica ASST- MANTOVA (MN), Mantova, Italy
| | | | - Maksymilian Chruszcz
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, South Carolina, USA
| | - Adnan Custovic
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Rebecca Czolk
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Janet Davies
- Queensland University of Technology, Centre for Immunology and Infection Control, School of Biomedical Sciences, Herston, Queensland, Australia
- Metro North Hospital and Health Service, Emergency Operations Centre, Herston, Queensland, Australia
| | - Nikolaos Douladiris
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Bernadette Eberlein
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University Munich, Munich, Germany
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
| | - Anna Ehlers
- Chemical Biology and Drug Discovery, Utrecht University, Utrecht, The Netherlands
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Philippe Eigenmann
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - Gabriele Gadermaier
- Department of Biosciences and Medical Biology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Francisca Gomez
- Allergy Unit IBIMA-Hospital Regional Universitario de Malaga, Malaga, Spain
- Spanish Network for Allergy research RETIC ARADyAL, Malaga, Spain
| | - Rebecca Grohman
- NYU Langone Health, Department of Internal Medicine, New York, New York, USA
| | - Carole Guillet
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Christine Hafner
- Department of Dermatology, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - Robert G Hamilton
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Hauser
- Department of Biosciences and Medical Biology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Thomas Hawranek
- Department of Dermatology and Allergology, Paracelsus Private Medical University, Salzburg, Austria
| | - Hans Jürgen Hoffmann
- Institute for Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Tomona Iizuka
- Laboratory of Protein Science, Graduate School of Life Science, Hokkaido University, Sapporo, Japan
| | - Alain Jacquet
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thilo Jakob
- Department of Dermatology and Allergology, University Medical Center, Justus Liebig University Gießen, Gießen, Germany
| | - Bente Janssen-Weets
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
| | - Uta Jappe
- Division of Clinical and Molecular Allergology, Priority Research Area Asthma and Allergy, Research Center Borstel, Borstel, Germany
- Leibniz Lung Center, Airway Research Center North (ARCN), Member of the German Center for Lung Research, Germany
- Interdisciplinary Allergy Outpatient Clinic, Dept. of Pneumology, University of Lübeck, Lübeck, Germany
| | - Marek Jutel
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
| | - Tanja Kalic
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
- Department of Dermatology, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - Sandip Kamath
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Sabine Kespohl
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr- Universität Bochum, Bochum, Germany
| | - Jörg Kleine-Tebbe
- Allergy & Asthma Center Westend, Outpatient Clinic and Clinical Research Center, Berlin, Germany
| | - Edward Knol
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - André Knulst
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jon R Konradsen
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Korošec
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Annette Kuehn
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Gideon Lack
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
- Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Thuy-My Le
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Andreas Lopata
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Olga Luengo
- RETIC ARADyAL and RICORS Enfermedades Inflamatorias (REI), Madrid, Spain
- Allergy Section, Internal Medicine Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mika Mäkelä
- Division of Allergy, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Pediatric Department, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Clare Mills
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Manchester Institute of Biotechnology, The University of Manchester, Manchester, UK
| | | | - Antonella Muraro
- Food Allergy Referral Centre, Department of Woman and Child Health, Padua University Hospital, Padua, Italy
| | - Anna Nowak-Wegrzyn
- Division of Pediatric Allergy and Immunology, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York, New York, USA
- Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Roni Nugraha
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- Department of Aquatic Product Technology, Faculty of Fisheries and Marine Science, IPB University, Bogor, Indonesia
| | - Markus Ollert
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
| | - Kati Palosuo
- Department of Allergology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Sarita Ulhas Patil
- Division of Rheumatology, Allergy and Immunology, Departments of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Allergy and Immunology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas Platts-Mills
- Division of Allergy and Clinical Immunology, University of Virginia, Charlottesville, Virginia, USA
| | | | - Pascal Poncet
- Institut Pasteur, Immunology Department, Paris, France
- Allergy & Environment Research Team Armand Trousseau Children Hospital, APHP, Paris, France
| | - Ekaterina Potapova
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lars K Poulsen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Christian Radauer
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Suzana Radulovic
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr- Universität Bochum, Bochum, Germany
| | - Pierre Rougé
- UMR 152 PharmaDev, IRD, Université Paul Sabatier, Faculté de Pharmacie, Toulouse, France
| | - Joaquin Sastre
- Allergy Service, Fundación Jiménez Díaz; CIBER de Enfermedades Respiratorias (CIBERES); Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Sakura Sato
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Enrico Scala
- Clinical and Laboratory Molecular Allergy Unit - IDI- IRCCS, Fondazione L M Monti Rome, Rome, Italy
| | - Johannes M Schmid
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Schmid-Grendelmeier
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
| | - Denise Schrama
- Centre of Marine Sciences (CCMAR), Universidade do Algarve, Faro, Portugal
| | - Hélène Sénéchal
- Allergy & Environment Research Team Armand Trousseau Children Hospital, APHP, Paris, France
| | - Claudia Traidl-Hoffmann
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Marcela Valverde-Monge
- Allergy Service, Fundación Jiménez Díaz; CIBER de Enfermedades Respiratorias (CIBERES); Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Marianne van Hage
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ronald van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Kitty Verhoeckx
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Stefan Vieths
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - Magnus Wickman
- Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Josefina Zakzuk
- Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia, Colombia
| | - Paolo M Matricardi
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
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Bousquet J, Melén E, Haahtela T, Koppelman GH, Togias A, Valenta R, Akdis CA, Czarlewski W, Rothenberg M, Valiulis A, Wickmann M, Aguilar D, Akdis M, Ansotegui IJ, Barbara C, Bedbrook A, Bindslev Jensen C, Bosnic-Anticevich S, Boulet LP, Brightling CE, Brussino L, Burte E, Bustamante M, Canonica GW, Cecchi L, Celedon JC, Chaves-Loureiro C, Costa E, Cruz AA, Erhola M, Gemicioglu B, Fokkens WJ, Garcia Aymerich J, Guerra S, Heinrich J, Ivancevich JC, Keil T, Klimek L, Kuna P, Kupczyk M, Kvedariene V, Larenas-Linnemann DE, Lemonnier N, Lodrup Carlsen KC, Louis R, Makris M, Maurer M, Momas I, Morais-Almeida M, Mullol J, Naclerio RN, Nadeau K, Nadif R, Niedoszytko M, Okamoto Y, Ollert M, Papadopoulos NG, Passalacqua G, Patella V, Pawankar R, Pham-Thi N, Pfaar O, Regateiro FS, Ring J, Rouadi PW, Samolinski B, Sastre J, Savouré M, Scichilone N, Shamji MH, Sheikh A, Siroux V, Sousa-Pinto B, Standl M, Sunyer J, Taborda-Barata L, Toppila-Salmi S, Torres MJ, Tsiligianni I, Valovirta E, Vandenplas O, Ventura MT, Weiss S, Yorgancioglu A, Zhang L, Abdul Latiff AH, Aberer W, Agache I, Al-Ahmad M, Alobid I, Arshad HS, Asayag E, Baharudin A, Battur L, Bennoor KS, Berghea EC, Bergmann KC, Bernstein D, Bewick M, Blain H, Bonini M, Braido F, Buhl R, Bumbacea R, Bush A, Calderon M, Calvo G, Camargos P, Caraballo L, Cardona V, Carr W, Carreiro-Martins P, Casale T, Cepeda Sarabia AM, Chandrasekharan R, Charpin D, Chen YZ, Cherrez-Ojeda I, Chivato T, Chkhartishvili E, Christoff G, Chu DK, Cingi C, Correia da Sousa J, Corrigan C, Custovic A, D'Amato G, Del Giacco S, De Blay F, Devillier P, Didier A, do Ceu Teixeira M, Dokic D, Douagui H, Doulaptsi M, Durham S, Dykewicz M, Eiwegger T, El-Sayed ZA, Emuzyte R, Emuzyte R, Fiocchi A, Fyhrquist N, Gomez RM, Gotua M, Guzman MA, Hagemann J, Hamamah S, Halken S, Halpin DMG, Hofmann M, Hossny E, Hrubiško M, Irani C, Ispayeva Z, Jares E, Jartti T, Jassem E, Julge K, Just J, Jutel M, Kaidashev I, Kalayci O, Kalyoncu O, Kardas P, Kirenga B, Kraxner H, Kull I, Kulus M, La Gruta S, Lau S, Le Tuyet Thi L, Levin M, Lipworth B, Lourenço O, Mahboub B, Mäkelä MJ, Martinez-Infante E, Matricardi P, Miculinic N, Migueres N, Mihaltan F, Mohamad Y, Moniusko M, Montefort S, Neffen H, Nekam K, Nunes E, Nyembue Tshipukane D, O'Hehir RE, Ogulur I, Ohta K, Okubo K, Ouedraogo S, Olze H, Pali-Schöll I, Palomares O, Palosuo K, Panaitescu C, Panzner P, Park HS, Pitsios C, Plavec D, Popov TA, Puggioni F, Quirce S, Recto M, Repka-Ramirez R, Roballo-Cordeiro C, Roche N, Rodriguez-Gonzales M, Romantowski J, Rosario Filho N, Rottem M, Sagara H, Sarquis-Serpa F, Sayah Z, Scheire S, Schmid-Grendelmeier P, Sisul JC, Sole D, Soto-Martinez M, Sova M, Sperl A, Spranger O, Stelmach R, Suppli Ulrik C, Thomas M, To T, Todo-Bom A, Tomazic PV, Urrutia-Pereira M, Valentin-Rostan M, van Ganse E, Van Hage M, Vasankari T, Vichyanond P, Viegi G, Wallace D, Wang DY, Williams S, Worm M, Yiallouros P, Yiallouros P, Yusuf O, Zaitoun F, Zernotti M, Zidarn M, Zuberbier J, Fonseca JA, Zuberbier T, Anto JM. Rhinitis associated with asthma is distinct from rhinitis alone: The ARIA-MeDALL hypothesis. Allergy 2023; 78:1169-1203. [PMID: 36799120 DOI: 10.1111/all.15679] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
Asthma, rhinitis and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of "one-airway-one-disease", coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitisation and multimorbidity, (iii) advances in mHealth for novel phenotype definition, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut and neuropsychiatric multimorbidities, is the "Epithelial Barrier Hypothesis". This review determined that the "one-airway-one-disease" concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme "allergic" (asthma) phenotype combining asthma, rhinitis and conjunctivitis. Rhinitis alone and rhinitis and asthma multimorbidity represent two distinct diseases with the following differences: (i) genomic and transcriptomic background (Toll-Like Receptors and IL-17 for rhinitis alone as a local disease; IL-33 and IL-5 for allergic and non-allergic multimorbidity as a systemic disease), (ii) allergen sensitisation patterns (mono- or pauci-sensitisation versus polysensitisation), (iii) severity of symptoms and (iv) treatment response. In conclusion, rhinitis alone (local disease) and rhinitis with asthma multimorbidity (systemic disease) should be considered as two distinct diseases, possibly modulated by the microbiome, and may be a model for understanding the epidemics of chronic and auto-immune diseases.
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Affiliation(s)
- J Bousquet
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.,University Hospital Montpellier, Montpellier, France.,Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France
| | - E Melén
- Sach´s Children and Youth Hospital, Södersjukhuset, and Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - T Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - G H Koppelman
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Pulmonology and Pediatric Allergology, GRIAC Research Institute, Groningen, the Netherlands
| | - A Togias
- Division of Allergy, Immunology, and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases, NIH, Bethesda, USA
| | - R Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - C A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - W Czarlewski
- Medical Consulting Czarlewski, Levallois, France.,MASK-air, Montpellier, France
| | - M Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - A Valiulis
- Institute of Clinical Medicine and Institute of Health Sciences, Vilnius, Lithuania.,Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - M Wickmann
- Institute of Environmental medicine, Karolinska Institutet, Stockholm, Sweden
| | - D Aguilar
- Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBEREHD), Barcelona, Spain
| | - M Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - I J Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
| | - C Barbara
- Portuguese Nacional Programme for Respiratory Diseases, Direção -Geral da Saúde, Faculdade de Medicina de Lisboa, Instituto de Saúde Ambiental, Lisbon, Portugal
| | | | - C Bindslev Jensen
- Odense Research Center for Anaphylaxis (ORCA), and Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Finland
| | - S Bosnic-Anticevich
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| | - L P Boulet
- Quebec Heart and Lung Institute, Laval University, Québec City, Quebec, Canada
| | - C E Brightling
- Institute of Lung Health, NIHR Biomedical Research Centre, Department of Respiratory and Infection Sciences, University of Leicester, Leicester, UK
| | - L Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino, Torino, Italy.,Mauriziano Hospital, Torino, Italy
| | - E Burte
- Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France.,Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France
| | - M Bustamante
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.,ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - G W Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - L Cecchi
- SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - J C Celedon
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - C Chaves-Loureiro
- Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - E Costa
- UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing), Porto, Portugal
| | - A A Cruz
- Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil
| | - M Erhola
- Pirkanmaa Welfare district, Tampere, Finland
| | - B Gemicioglu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - W J Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - J Garcia Aymerich
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.,ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - S Guerra
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - J Heinrich
- Ludwig Maximilians University Munich, University Hospital Munich - Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Munich
| | - J C Ivancevich
- Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina
| | - T Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany.,State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - L Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Germany.,Center for Rhinology and Allergology, Wiesbaden, Germany
| | - P Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Poland
| | - M Kupczyk
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Poland
| | - V Kvedariene
- Institute of Clinical medicine, Clinic of Chest diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - D E Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | - N Lemonnier
- Institute for Advanced Biosciences, UGA - INSERM U1209 - CNRS UMR5309, Site Santé, Allée des Alpes, La Tronche, France
| | | | - R Louis
- Department of Pulmonary Medicine, CHU, Liege, Liège, Belgium.,GIGA I3 research group, University of Liege, Belgium
| | - M Makris
- Allergy Unit "D Kalogeromitros", 2nd Dpt of Dermatology and Venereology, National & Kapodistrian University of Athens, "Attikon" University Hospital, Greece
| | - M Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - I Momas
- Department of Public health and health products, Paris Descartes University-Sorbonne Paris Cité, EA 4064 and Paris Municipal Department of social action, childhood, and health, Paris, France
| | | | - J Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Barcelona, Spain.,Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Spain
| | - R N Naclerio
- Department of Otolaryngology - Head and Neck Surgery - Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - K Nadeau
- Stanford University School of Medicine, Sean N. Parker Center for Allergy and Asthma Research, Stanford, USA
| | - R Nadif
- Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France.,Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France
| | - M Niedoszytko
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | - Y Okamoto
- Chiba University Hospital, Chiba, Japan.,Chiba Rosai Hospital, Chiba, Japan
| | - M Ollert
- Odense Research Center for Anaphylaxis (ORCA), and Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Finland.,Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - N G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - G Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
| | - V Patella
- Division of Allergy and Clinical Immunology, Department of Medicine, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy.,Agency of Health ASL, Salerno, Italy
| | - R Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - N Pham-Thi
- Ecole Polytechnique Palaiseau, IRBA (Institut de Recherche bio-Médicale des Armées), Bretigny, France
| | - O Pfaar
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - F S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (ICBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - J Ring
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany.,Christine Kühne Center for Allergy Research and Education (CK-Care), Davos, Switzerland
| | - P W Rouadi
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon.,Department of Otorhinolaryngology-Head and Neck Surgery, Dar Al Shifa Hospital, Salmiya, Kuwait
| | - B Samolinski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Poland
| | - J Sastre
- Fundacion Jimenez Diaz, CIBERES, Faculty of Medicine, Autonoma University of Madrid, Madrid, Spain
| | - M Savouré
- Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France.,Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France
| | - N Scichilone
- PROMISE Department, University of Palermo, Palermo, Italy
| | - M H Shamji
- National Heart and Lung Institute, Imperial College, and NIHR Imperial Biomedical Research Centre, London, UK
| | - A Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - V Siroux
- INSERM, Université Grenoble Alpes, IAB, U 1209, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Université Joseph Fourier, Grenoble, France
| | - B Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research; University of Porto, Porto, Portugal.,RISE - Health Research Network; University of Porto, Porto, Portugal
| | - M Standl
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - J Sunyer
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.,ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - L Taborda-Barata
- Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal.,UBIAir - Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - S Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - M J Torres
- Allergy Unit, Málaga Regional University Hospital-IBIMA, Málaga, Spain
| | - I Tsiligianni
- International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland.,Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - E Valovirta
- Department of Lung Diseases and Clinical Immunology, University of Turku, Turku, Finland.,Terveystalo Allergy Clinic, Turku, Finland
| | - O Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL, Namur, and Université Catholique de Louvain, Yvoir, Belgium
| | - M T Ventura
- Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
| | - S Weiss
- Harvard Medical School and Channing Division of Network Medicine, Boston, USA
| | - A Yorgancioglu
- Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - L Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital and Beijing Institute of Otolaryngology, Beijing, China
| | - A H Abdul Latiff
- Allergy & Immunology Centre, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - W Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - I Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - M Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait
| | - I Alobid
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | - H S Arshad
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton.,David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | - E Asayag
- Argentine Society of Allergy and Immunopathology, Buenos Ayres, Argentian
| | - A Baharudin
- Department of Otorhinolaryngology, Head and Neck, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - L Battur
- Mongolian Association of Hospital Managers, Ulaanbaatar, Mongolia
| | - K S Bennoor
- Department of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh
| | - E C Berghea
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - K C Bergmann
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - D Bernstein
- Division of Immunology, Allergy and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - M Bewick
- University of Central Lancashire Medical School, Preston, UK
| | - H Blain
- Department of Geriatrics, Montpellier University hospital, MUSE, Montpellier, France
| | - M Bonini
- Department of Clinical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy and National Heart and Lung Institute, Royal Brompton Hospital & Imperial College London, UK
| | - F Braido
- University of Genoa, Department of Internal Medicine (DiMI), and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - R Buhl
- Dept of Pulmonary Medicine, Mainz University Hospital, Mainz, Germany
| | - R Bumbacea
- Department of Allergy, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania
| | - A Bush
- Imperial College and Royal Brompton Hospital, London, UK
| | - M Calderon
- Imperial College and National Heart and Lung Institute, London, UK
| | - G Calvo
- Pediatrics Department, Universidad Austral de Chile, Valvidia, Chile
| | - P Camargos
- Federal University of Minas Gerais, Medical School, Department of Pediatrics, Belo Horizonte, Brazil
| | - L Caraballo
- Institute for Immunological Research, University of Cartagena, Campus de Zaragocilla, Edificio Biblioteca Primer piso, Cartagena, Colombia
| | - V Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain.,ARADyAL research network, Barcelona, Spain
| | - W Carr
- Allergy & Asthma Associates of Southern California, A Medical Group , Southern California Research, Mission Viejo, CA, USA
| | - P Carreiro-Martins
- NOVA Medical School/Comprehensive Health Research Centre (CHRC), Lisbon, Portugal.,Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - T Casale
- Division of Allergy/immunology, University of South Florida, Tampa, FLA, USA
| | - A M Cepeda Sarabia
- Allergy and Immunology Laboratory, Metropolitan University, Simon Bolivar University, Barranquilla, Colombia and SLaai, Sociedad Latinoamericana de Allergia, Asma e Immunologia, Branquilla, Columbia
| | - R Chandrasekharan
- Department of ENT, Badr al Samaa Hospital, Salalah, Sultanate of Oman
| | - D Charpin
- Clinique des bronches, allergie et sommeil, Hôpital Nord, Marseille, France
| | - Y Z Chen
- The capital institute of pediatrics, Beijing, China
| | - I Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Guayas, Ecuador
| | - T Chivato
- School of Medicine, University CEU San Pablo, Madrid, Spain
| | - E Chkhartishvili
- David Tatishvili Medical Center; David Tvildiani Medical University-AIETI Medical School, Tbilisi, Georgia
| | - G Christoff
- Medical University - Sofia, Faculty of Public Health, Sofia, Bulgaria
| | - D K Chu
- Department of Health Research Methods, Evidence, and Impact & Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - C Cingi
- skisehir Osmangazi University, Medical Faculty, ENT Department, Eskisehir, Turkey
| | - J Correia da Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - C Corrigan
- Division of Asthma, Allergy & Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
| | - A Custovic
- National Heart and Lung Institute, Imperial College London, UK
| | - G D'Amato
- Division of Respiratory and Allergic Diseases,Hospital 'A Cardarelli', University of Naples Federico II, Naples, Italy
| | - S Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy
| | - F De Blay
- Allergy Division, Chest Disease Department, University Hospital of Strasbourg, and Federation of translational medicine, University of Strasbourg, Strasbourg, France
| | - P Devillier
- VIM Suresnes, UMR 0892, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France
| | - A Didier
- Department of Respiratory Diseases, Larrey Hospital, Toulouse University Hospital, Toulouse, France
| | - M do Ceu Teixeira
- Hospital Dr Agostinho Neto,Praia, Faculdade de Medicina de Cabo Verde
| | - D Dokic
- University Clinic of Pulmology and Allergy, Medical Faculty Skopje, Republic of Macedonia
| | - H Douagui
- Service de Pneumo-Allergologie, Centre Hospitalo-Universitaire de Béni-Messous, Algiers, Algeria
| | - M Doulaptsi
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Crete, Heraklion, Crete
| | - S Durham
- Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, London, UK
| | - M Dykewicz
- Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - T Eiwegger
- The Hospital for Sick Children, Department of Paediatrics, Division of Clinical Immunology and Allergy, Food allergy and Anaphylaxis Program, The University of Toronto, Toronto, Ontario, Canada
| | - Z A El-Sayed
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - R Emuzyte
- Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - R Emuzyte
- Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - A Fiocchi
- Allergy, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - N Fyhrquist
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - R M Gomez
- School of Health Sciences, Catholic University of Salta, Salta, Argentina
| | - M Gotua
- Center of Allergy and Immunology, Georgian Association of Allergology and Clinical Center of Allergy and Immunology, David Tvildiani Medical University, Tbilisi, Georgia
| | - M A Guzman
- Immunology and Allergy Division, Clinical Hospital, University of Chile, Santiago, Chile
| | - J Hagemann
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Germany
| | - S Hamamah
- Biology of reproduction department, INSERM 1203, University hospital, Montpellier, France
| | - S Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - D M G Halpin
- University of Exeter, Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - M Hofmann
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - E Hossny
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - M Hrubiško
- Department of Clinical Immunology and Allergy, Oncology Institute of St Elisabeth, Bratislava, Slovakia
| | - C Irani
- Department of Internal Medicine and Infectious Diseases, St Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Z Ispayeva
- President of Kazakhstan Association of Allergology and Clinical Immunology, Department of Allergology and clinical immunology of the Kazakh National Medical University, Almaty, Kazakhstan
| | - E Jares
- Servicio de Alergia, Consultorios Médicos Privados, Buenos Aires, Argentina
| | - T Jartti
- EDEGO Research Unit, University of Oulu, Oulu, Finland
| | - E Jassem
- Medical University of Gdańsk, Department of Pneumology, Gdansk, Poland
| | - K Julge
- Tartu University Institute of Clinical Medicine, Children's Clinic, Tartu, Estonia
| | - J Just
- Sorbonne université, Hôpital américain de Paris, Neuilly, France
| | - M Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland.,ALL-MED Medical Research Institute, Wroclaw, Poland
| | | | - O Kalayci
- Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey
| | - O Kalyoncu
- Hacettepe University, School of Medicine, Department of Chest Diseases, Immunology and Allergy Division, Ankara, Turkey
| | - P Kardas
- Department of Family Medicine, Medical University of Lodz, Poland
| | - B Kirenga
- Makerere University Lung Institute, Kampala, Uganda
| | - H Kraxner
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - I Kull
- Sach´s Children and Youth Hospital, Södersjukhuset, and Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - M Kulus
- Department of Pediatric Respiratory Diseases and Allergology, Medical University of Warsaw, Poland
| | - S La Gruta
- Institute of Translational Pharmacology, National Research Council, Palermo, Italy
| | - S Lau
- Department of Paediatric Respiratory Medicine, Immunology and Crital Care Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - L Le Tuyet Thi
- University of Medicine and Pharmacy, Hochiminh City, Vietnam
| | - M Levin
- Division Paediatric Allergology, University of Cape Town, Cape Town, South Africa
| | - B Lipworth
- Scottish Centre for Respiratory Research, Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, UK
| | - O Lourenço
- Faculty of Health Sciences and CICS - UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - B Mahboub
- Department of Pulmonary Medicine, Rashid Hospital, Dubai, UAE
| | - M J Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - P Matricardi
- Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - N Migueres
- Allergy Division, Chest Disease Department, University Hospital of Strasbourg, and Federation of translational medicine, University of Strasbourg, Strasbourg, France
| | - F Mihaltan
- National Institute of Pneumology M Nasta, Bucharest, Romania
| | - Y Mohamad
- National Center for Research in Chronic Respiratory Diseases, Tishreen University School of Medicine, Latakia and Syrian Private University-, Damascus, Syria
| | - M Moniusko
- Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, Bialystock, Poland
| | - S Montefort
- Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Msida, MSD, Malta
| | - H Neffen
- Director of Center of Allergy, Immunology and Respiratory Diseases, Santa Fe, Argentina
| | - K Nekam
- Hungarian Allergy Association, Budapest, Hungary
| | - E Nunes
- Eduardo Mondlane University · Faculty of Medicine, Maputo, Mozambique
| | | | - R E O'Hehir
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - I Ogulur
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - K Ohta
- National Hospital Organization Tokyo National Hospital, and JATA Fukujuji Hospital, Tokyo, Japan
| | - K Okubo
- Dept of Otolaryngology, Nippon Medical School, Tokyo, Japan
| | - S Ouedraogo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - H Olze
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, and Berlin Institute of Health, Berlin, Germany
| | - I Pali-Schöll
- Dept of Comparative Medicine; Messerli Research Institute of the University of Veterinary Medicine, Medical University, and University of Vienna, Vienna, Austria
| | - O Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain
| | - K Palosuo
- Department of Dermatology, University of Helsinki and Hospital for Skin and Allergic Diseases, Helsinki, Finland
| | - C Panaitescu
- OncoGen Center, County Clinical Emergency Hospital "Pius Branzeu," and University of Medicine and Pharmacy V Babes, Timisoara, Romania
| | - P Panzner
- Department of Immunology and Allergology, Faculty of Medicine and Faculty Hospital in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - H S Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - C Pitsios
- Medical School, University of Cyprus, Nicosia, Cyprus
| | - D Plavec
- Srebrnjak Children's Hospital, Zagreb; Medical Faculty, University JJ Strossmayer of Osijek, Croatia
| | - T A Popov
- Clinic of Occupational Diseases, University Hospital Sveti Ivan Rilski, Sofia, Bulgaria
| | - F Puggioni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - S Quirce
- QDepartment of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - M Recto
- Asian Hospital And Medical Center, Manilla, Philippines
| | - R Repka-Ramirez
- Division of Allergy, Asthma and Immunology, Clinics Hospital, San Lorenzo, Paraguay
| | | | - N Roche
- Pneumologie, AP-HP, Centre Université de Paris Cité, Hôpital Cochin, Paris, France.,UMR 1016, Institut Cochin, Paris, France
| | - M Rodriguez-Gonzales
- Pediatric Allergy and Clinical Immunology, Hospital Espanol de Mexico, Mexico City, Mexico
| | - J Romantowski
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | - N Rosario Filho
- Department of Pediatrics, Federal University of Parana, Curitiba, Brazil
| | - M Rottem
- Division of Allergy, Asthma and Clinical Immunology, Emek Medical Center, Afula, Israel
| | - H Sagara
- Showa University School of Medicine, Tokyo, Japan
| | - F Sarquis-Serpa
- Asthma Reference Center - School of Medicine of Santa Casa de Misericórdia of Vitória, Espírito Santo, Brazil
| | - Z Sayah
- SMAIC Société Marocaine d' Allergologie et Immunologie Clinique, Rabat, Morocco
| | - S Scheire
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - P Schmid-Grendelmeier
- Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zürich, Switzerland
| | - J C Sisul
- Allergy & Asthma, Medical Director, CLINICA SISUL, FACAAI, SPAAI, Asuncion, Paraguay
| | - D Sole
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - M Soto-Martinez
- Division of Respiratory Medicine, Department of Pediatrics, Hospital Nacional de Niños, Universidad de Costa Rica, San Jose, Costa Rica
| | - M Sova
- Department of Respiratory Medicine and Tuberculosis, University Hospital, Brno, Czech Republic
| | - A Sperl
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Germany
| | - O Spranger
- Global Allergy and Asthma Platform GAAPP, Vienna, Austria
| | - R Stelmach
- Pulmonary Division, Heart Institute (InCor), Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - C Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, and Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - M Thomas
- University of Southampton, Southampton, UK
| | - T To
- The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - A Todo-Bom
- Imunoalergologia, Centro Hospitalar Universitário de Coimbra, Faculty of Medicine, University of Coimbra, Portugal
| | - P V Tomazic
- Dept of General ORL, H&NS, Medical University of Graz, ENT-University Hospital Graz, Austria
| | | | | | - E van Ganse
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon1, Lyon, France
| | - M Van Hage
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - T Vasankari
- Fihla, Finnish Lung Association, Helsinki, Finland.,University of Turku, Turku, Finland
| | - P Vichyanond
- Division of Allergy and Immunology, Department of Pediatrics, Siriraj Hospital, Mahidol University Faculty of Medicine, Bangkok, Thailand
| | - G Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa
| | - D Wallace
- Nova Southeastern University, Florida, USA
| | - D Y Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - S Williams
- International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland
| | - M Worm
- Division of Allergy and Immunology Department of Dermatology, Allergy and Venerology Charité Universitätsmedizin Berlin Berlin, Germany
| | - P Yiallouros
- Medical School, University of Cyprus, Nicosia, Cyprus
| | - P Yiallouros
- Medical School, University of Cyprus, Nicosia, Cyprus
| | - O Yusuf
- The Allergy and Asthma Institute, Islamabad, Pakistan
| | - F Zaitoun
- Lebanese-American University, Clemenceau Medical Center DHCC, Dubai, UAE
| | - M Zernotti
- Universidad Católica de Córdoba, Universidad Nacional de Villa Maria, Argentina
| | - M Zidarn
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia.,University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - J Zuberbier
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, and Berlin Institute of Health, Berlin, Germany
| | - J A Fonseca
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research; University of Porto, Porto, Portugal.,RISE - Health Research Network; University of Porto, Porto, Portugal
| | - T Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - J M Anto
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.,ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Nieminen O, Palosuo K, Kukkonen K, Mäkelä M. Molecular allergy diagnostics in predicting oral cow's milk challenge outcome in Finnish children. Allergy Asthma Proc 2023; 44:71-77. [PMID: 36400429 DOI: 10.2500/aap.2023.44.220079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Oral food challenges (OFC) are required to diagnose food allergies but are resource-intensive. Objective: To reduce the need for OFCs, we sought to determine serum specific immunoglobulin E (sIgE) cutoff levels for cow's milk and its major allergens predicting oral milk challenge outcomes in children with suspected cow's milk allergy. Methods: A total of 135 Finnish children (median age, 1.8 years [range, 1.0-14.1 years]) with suspected cow's milk allergy underwent open OFC with unheated cow's milk. The sIgE levels to milk (f2), casein (Bos d 8), alpha-lactalbumin (Bos d 4), beta-lactoglobulin (Bos d 5), and bovine serum albumin (BSA) (Bos d 6) were measured and compared with the challenge outcomes. Results: Of the 135 OFCs, 5 were excluded from the study due to purely subjective symptoms. Of the 130 remaining OFCs, 98 results (75%) were positive. In a receiver operating characteristic analysis with 1-2-year-old children, no individual allergen sIgE had a better area under the curve than milk sIgE (0.824). A milk sIgE level > 6.30 kU/L gave 94% specificity and 33% sensitivity for positive OFCs. In 3-14-year-old children, a cutoff value >13.9 kU/L predicted a positive OFC result with 93% specificity and 25% sensitivity. Children with moderate-to-severe reactions had higher sIgE levels to milk, alpha-lactalbumin, and BSA than did children with mild reactions. Conclusion: Molecular allergy diagnostics did not improve the predictive performance compared with milk sIgE. The milk sIgE value that exceeds the cutoff for 95% specificity in combination with the clinical history may help to reduce the need for OFCs. The severity of an allergic reaction cannot reliably be predicted from sIgE measurements.
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Burman J, Palosuo K, Pelkonen A, Malmberg P, Remes S, Kukkonen K, Mäkelä MJ. Bronchial hyperresponsiveness and asthma during oral immunotherapy for egg or peanut allergy in children. Clin Transl Allergy 2022; 12:e12203. [PMID: 36246730 PMCID: PMC9549178 DOI: 10.1002/clt2.12203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/25/2022] [Accepted: 09/17/2022] [Indexed: 11/08/2022] Open
Abstract
Background Bronchial hyperresponsiveness (BHR) and asthma are frequently present in children with food allergy. We assessed BHR in children receiving oral immunotherapy (OIT) for persistent egg or peanut allergy and examined whether OIT affects asthma control. Methods Methacholine challenge testing was performed in 89 children with persistent egg or peanut allergy diagnosed by double‐blind, placebo‐controlled food challenge and 80 control children without food allergy. Of the 89 food‐allergic children, 50 started OIT for egg allergy and 39 for peanut allergy. Sensitization to aeroallergens was evaluated by skin prick testing. Forty of the 89 children with regular controller treatment for asthma underwent methacholine challenge testing and 34 measurement of exhaled nitric oxide (FeNO) at baseline and after 6–12 months of OIT. Results Methacholine challenge testing revealed significant BHR in 29/50 children (58%) with egg allergy, 15/39 children (38%) with peanut allergy, and 6/80 controls (7.5%). The mean cumulative dose of methacholine causing a 20% fall in FEV1 differed significantly between the egg and peanut‐allergic versus the control children (1009 μg, 1104 μg, and 2068 μg, respectively, p < 0.001). Egg or peanut OIT did not affect lung function, the degree of BHR or FeNO levels in children with asthma and had no adverse effect on asthma control. Lung function or BHR did not associate with the OIT outcome. Conclusion BHR was significantly more frequent in children with persistent egg or peanut allergy than in children without food allergy. Oral immunotherapy did not increase BHR and was safe for children on regular asthma medication.
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Affiliation(s)
- Janne Burman
- Skin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Kati Palosuo
- Skin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Anna Pelkonen
- Skin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Pekka Malmberg
- Skin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Sami Remes
- Department of PediatricsKuopio University HospitalKuopioFinland
| | - Kaarina Kukkonen
- Skin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Mika J. Mäkelä
- Skin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
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Karisola P, Palosuo K, Hinkkanen V, Wisgrill L, Savinko T, Fyhrquist N, Alenius H, Mäkelä MJ. Integrative Transcriptomics Reveals Activation of Innate Immune Responses and Inhibition of Inflammation During Oral Immunotherapy for Egg Allergy in Children. Front Immunol 2022; 12:704633. [PMID: 34975829 PMCID: PMC8714802 DOI: 10.3389/fimmu.2021.704633] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 11/24/2021] [Indexed: 12/22/2022] Open
Abstract
We previously reported the results of a randomized, open-label trial of egg oral immunotherapy (OIT) in 50 children where 44% were desensitized and 46% were partially desensitized after 8 months of treatment. Here we focus on cell-mediated molecular mechanisms driving desensitization during egg OIT. We sought to determine whether changes in genome-wide gene expression in blood cells during egg OIT correlate with humoral responses and the clinical outcome. The blood cell transcriptome of 50 children receiving egg OIT was profiled using peripheral blood mononuclear cell (PBMC) samples obtained at baseline and after 3 and 8 months of OIT. We identified 467 differentially expressed genes (DEGs) after 3 or 8 months of egg OIT. At 8 months, 86% of the DEGs were downregulated and played a role in the signaling of TREM1, IL-6, and IL-17. In correlation analyses, Gal d 1–4-specific IgG4 antibodies associated positively with DEGs playing a role in pathogen recognition and antigen presentation and negatively with DEGs playing a role in the signaling of IL-10, IL-6, and IL-17. Desensitized and partially desensitized patients had differences in their antibody responses, and although most of the transcriptomic changes were shared, both groups had also specific patterns, which suggest slower changes in partially desensitized and activation of NK cells in the desensitized group. OIT for egg allergy in children inhibits inflammation and activates innate immune responses regardless of the clinical outcome at 8 months. Changes in gene expression patterns first appear as posttranslational protein modifications, followed by more sustained epigenetic gene regulatory functions related to successful desensitization.
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Affiliation(s)
- Piia Karisola
- Human Microbiome (HUMI) Research Program, Medical Faculty, University of Helsinki, Helsinki, Finland
| | - Kati Palosuo
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Victoria Hinkkanen
- Human Microbiome (HUMI) Research Program, Medical Faculty, University of Helsinki, Helsinki, Finland.,Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Lukas Wisgrill
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Terhi Savinko
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Nanna Fyhrquist
- Human Microbiome (HUMI) Research Program, Medical Faculty, University of Helsinki, Helsinki, Finland.,Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden
| | - Harri Alenius
- Human Microbiome (HUMI) Research Program, Medical Faculty, University of Helsinki, Helsinki, Finland.,Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden
| | - Mika J Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Palosuo K, Karisola P, Savinko T, Fyhrquist N, Alenius H, Mäkelä MJ. A Randomized, Open-Label Trial of Hen's Egg Oral Immunotherapy: Efficacy and Humoral Immune Responses in 50 Children. J Allergy Clin Immunol Pract 2021; 9:1892-1901.e1. [PMID: 33529723 DOI: 10.1016/j.jaip.2021.01.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 12/22/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Egg allergy is the second most common food allergy in children. Persistent food allergy increases the risk of anaphylaxis and reduces the quality of life. OBJECTIVE To determine the efficacy of oral immunotherapy (OIT) with raw egg white powder and study its effects on humoral responses in children with persistent egg allergy. METHODS Fifty children aged 6 to 17 years with egg allergy, diagnosed by double-blind, placebo-controlled food challenge, were randomized 3:2 to 8 months of OIT with a maintenance dose of 1 g of egg white protein or 6 months of avoidance after which the avoidance group crossed over to OIT. We examined changes in IgE, IgG4, and IgA concentrations to Gal d 1-4 during OIT compared with avoidance and assessed clinical reactivity at 8 and 18 months. RESULTS After 8 months, 22 of 50 children (44%) on OIT and 1 of 21 (4.8%) on egg avoidance were desensitized to the target dose, 23 of 50 (46%) were partially desensitized (dose <1 g), and 5 of 50 (10%) discontinued. IgG4 concentrations to Gal d 1-4 and IgA to Gal d 1-2 increased significantly, whereas IgE to Gal d 2 decreased. A heatmap analysis of the IgE patterns revealed 3 distinct clusters linked with the clinical outcome. High baseline egg white-specific IgE and polysensitization to Gal d 1-4 related with failure to achieve the maintenance dose at 8 months. After 18 months of treatment, 36 of 50 patients (72%) were desensitized and 8 of 50 (16%) partially desensitized. CONCLUSIONS OIT with raw egg enables liberation of egg products into the daily diet in most patients. Subjects with high egg white-specific IgE concentrations and sensitization to multiple egg allergen components at baseline benefit from prolonged treatment.
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Affiliation(s)
- Kati Palosuo
- Skin and Allergy Hospital, Helsinki University Hospital, Meilahdentie 2, Helsinki, Finland; University of Helsinki, Helsinki, Finland.
| | - Piia Karisola
- Human Microbiome Research (HUMI), Medical Faculty, University of Helsinki, Haartmaninkatu 3, Helsinki, Finland
| | - Terhi Savinko
- Skin and Allergy Hospital, Helsinki University Hospital, Meilahdentie 2, Helsinki, Finland; University of Helsinki, Helsinki, Finland
| | - Nanna Fyhrquist
- Institute of Environmental Medicine (IMM), Karolinska Institutet, C6, Systems Toxicology, Stockholm, Sweden
| | - Harri Alenius
- Human Microbiome Research (HUMI), Medical Faculty, University of Helsinki, Haartmaninkatu 3, Helsinki, Finland; Institute of Environmental Medicine (IMM), Karolinska Institutet, C6, Systems Toxicology, Stockholm, Sweden
| | - Mika J Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital, Meilahdentie 2, Helsinki, Finland; University of Helsinki, Helsinki, Finland
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Affiliation(s)
- Janne Burman
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kati Palosuo
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kaarina Kukkonen
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anna Pelkonen
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mika J Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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10
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Palosuo K, Kukkonen AK, Pelkonen AS, Mäkelä MJ. Gal d 1-specific IgE predicts allergy to heated egg in Finnish children. Pediatr Allergy Immunol 2018; 29:637-643. [PMID: 29974523 DOI: 10.1111/pai.12954] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/15/2018] [Accepted: 05/22/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Allergen-specific IgE levels can be useful in predicting outcomes of oral food challenges, but optimal cutoff levels vary in different populations. The aim was to determine cutoff values for egg white- and Gal d 1-, Gal d 2-, Gal d 3-, and Gal d 4-specific IgE (sIgE) predicting positive oral heated egg challenges in 185 Finnish children and adolescents. METHODS A total of 185 egg-sensitized patients (age: 1-19 years, median: 6.3, mean: 7.0 years) with suspected egg allergy underwent double-blind, placebo-controlled (n = 78), or open (n = 107) oral food challenges with heated egg white. Specific IgE levels to egg white, Gal d 1 (ovomucoid), Gal d 2 (ovalbumin), Gal d 3 (conalbumin), and Gal d 4 (lysozyme) were measured by ImmunoCAP and compared with challenge outcomes. RESULTS Of the 185 challenges, 124 (67%) were positive. Gal d 1 sIgE levels were significantly higher in the challenge-positive (median 13.5 kU/L, mean 33.2 kU/L) than in the challenge-negative group (median 0.2 kU/L, mean 1.2 kU/L), P < 0.0001. The diagnostic capacity of sIgE to egg white and Gal d 2, 3, and 4 was clearly weaker. In ROC analysis, the AUC for egg white was 0.86, Gal d 2 0.84, Gal d 3 0.79, and Gal d 4 0.77. Sensitization to Gal d 1 with a cutoff of value of >3.7 kU/L predicted a positive challenge with a specificity of 95% and sensitivity of 78%. The likelihood ratio was 15.9. In ROC analysis, the area under the curve was 0.94 (95% CI, 0.91-0.97). With a cutoff value of >14 kU/L, all challenges were positive, and with a cutoff of <0.9 kU/L, 95% of the challenges were negative. In the children aged 1-5 years (n = 88), the cutoff for Gal d 1 was >3.8 kU/L, and in the children above 6 years of age (n = 97), it was >3.5 kU/L. CONCLUSION Gal d 1-specific IgE is useful in distinguishing egg-sensitized patients with clinically reactive egg allergy from those tolerant of heated egg. The optimal cutoff point in a Finnish population of 185 children and adolescents was 3.7 kU/L with no significant difference between the younger and older age groups.
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Affiliation(s)
- Kati Palosuo
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna Kaarina Kukkonen
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna Susanna Pelkonen
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Juhani Mäkelä
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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11
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Mäntylä J, Thomander T, Hakulinen A, Kukkonen K, Palosuo K, Voutilainen H, Pelkonen A, Kauppi P. The effect of oral immunotherapy treatment in severe IgE mediated milk, peanut, and egg allergy in adults. Immun Inflamm Dis 2018; 6:307-311. [PMID: 29542268 PMCID: PMC5946145 DOI: 10.1002/iid3.218] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/23/2018] [Accepted: 02/15/2018] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION The standard care of severe food allergy in both adults and children means avoidance of allergens. In recent years promising results of oral immunotherapy (OIT) have been reported in children. In adults, information on OIT in severe food allergy is very limited. OBJECTIVE We aimed to study if OIT is possible in adults. METHODS We report OIT results in 10 adult patients with milk OIT, nine adult patients with peanut OIT, and four adult patients with egg OIT. The allergy was confirmed with allergen specific IgE tests and oral food challenges (open in milk allergy and double-blind in peanut and egg allergy). The OIT was performed as open. RESULTS The median dose of protein that led to discontinuation of allergen challenge because of symptoms was 7.5 mg in milk allergy, 25 mg in peanut allergy, and 15 mg in egg allergy. The median period of OIT was 515 days. Currently on OIT are 6/10 milk allergic patients, 4/9 peanut allergic patients and 3/4 egg allergic patients. The median dose of milk protein increased by 60-fold during OIT compared to the allergen challenge dose. In peanut OIT the median dose increased by eightfold and in egg allergy the dose increased with OIT by 35-fold. Local itching was the most common side effect of OIT (73.9% of the patients), four patients reported having used epinephrine autoinjector and three patients having needed emergency room treatment. CONCLUSIONS AND CLINICAL RELEVANCE OIT can be given in adult patients with severe milk, peanut, or egg allergy only in selected cases. OIT leads into desensitization but it is not clear whether persistent tolerance can be achieved. Mild adverse events during OIT are common.
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Affiliation(s)
- Jarkko Mäntylä
- Respiratory Diseases and AllergologyUniversity of Helsinki and Helsinki University Hospital, Skin and Allergy HospitalHelsinkiFinland
| | - Tuuli Thomander
- Respiratory Diseases and AllergologyUniversity of Helsinki and Helsinki University Hospital, Skin and Allergy HospitalHelsinkiFinland
- University of Eastern FinlandKuopioFinland
| | - Auli Hakulinen
- Respiratory Diseases and AllergologyUniversity of Helsinki and Helsinki University Hospital, Skin and Allergy HospitalHelsinkiFinland
| | - Kaarina Kukkonen
- Respiratory Diseases and AllergologyUniversity of Helsinki and Helsinki University Hospital, Skin and Allergy HospitalHelsinkiFinland
| | - Kati Palosuo
- Respiratory Diseases and AllergologyUniversity of Helsinki and Helsinki University Hospital, Skin and Allergy HospitalHelsinkiFinland
| | - Helena Voutilainen
- Respiratory Diseases and AllergologyUniversity of Helsinki and Helsinki University Hospital, Skin and Allergy HospitalHelsinkiFinland
| | - Anna Pelkonen
- Respiratory Diseases and AllergologyUniversity of Helsinki and Helsinki University Hospital, Skin and Allergy HospitalHelsinkiFinland
| | - Paula Kauppi
- Respiratory Diseases and AllergologyUniversity of Helsinki and Helsinki University Hospital, Skin and Allergy HospitalHelsinkiFinland
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Pouessel G, Claverie C, Labreuche J, Renaudin JM, Dorkenoo A, Eb M, Moneret-Vautrin A, Deschildre A, Leteurtre S, Grabenhenrich L, Worm M, Dölle S, Scherer K, Hutteger I, Christensen M, Bindslev-Jensen C, Mortz C, Eller E, Kjaer HF, Carneiro-Leão L, Badas J, Coimbra A, Levy DP, Ben-Shoshan M, Rimon A, Benor S, Arends NJT, Edelbroek N, de Groot H, Emons JAM, Brand HKA, Verhoeven D, van Veen LN, de Jong NW, Noh G, Jang EH, Pascal M, Dominguez O, Piquer M, Alvaro M, Jimenez-Feijoo R, Lozano J, Machinena A, del Mar Folqué M, Giner MT, Plaza AM, Turner P, Patel N, Vazquez-Ortiz M, Lindsley S, Walker L, Rosenberg S, Mari A, Alessandri C, Giangrieco I, Tuppo L, Rafaiani C, Mitterer G, Ciancamerla M, Ferrara R, Bernardi ML, Zennaro D, Tamburrini M, Ciardiello MA, Harwanegg C, Fernandez A, Selb R, Egenmann P, Epstein M, Hoffmann-Sommergruber K, Koning F, Lovik M, Clare Mills EN, Moreno J, van Loveren H, Wal JM, Diesner S, Bergmayr C, Pfitzner B, Assmann VE, Starkl P, Endesfelder D, Eiwegger T, Szepfalusi Z, Fehrenbach H, Jensen-Jarolim E, Hartmann A, Pali-Schöll I, Untersmayr E, Wille S, Meyer P, Klingebiel C, Lidholm J, Ehrenberg A, Östling J, Cleach I, Mège JL, Vitte J, Aina R, Dubiela P, Pfeifer S, Bublin M, Radauer C, Humeniuk P, Kabasser S, Asero R, Bogas G, Gomez F, Campo P, Salas M, Doña I, Barrionuevo E, Guerrero MA, Mayorga C, Prieto A, Barber D, Torres MJ, Jamin A, Wangorsch A, Ballmer B, Vieths S, Scheurer S, Apostolovic D, Mihailovic J, Krstic M, Starkhammar M, Velickovic TC, Hamsten C, van Hage M, van Erp FC, Knol EF, Kansen HM, Pontoppidan B, Meijer Y, van der Ent CK, Knulst AC, Sayers R, Brown H, Custovic A, Simpson A, Mills C, Schulz J, Akkerdaas J, Totis M, Capt A, Herouet-Guicheney C, van Ree R, Banerjee T, Banerjee A, Claude M, Bouchaud G, Lupi R, Castan L, Tranquet O, Denery-Papini S, Bodinier M, Brossard C, De Poi R, Gritti E, De Dominicis E, Popping B, de Laureto PP, Palosuo K, Kukkonen AK, Pelkonen A, Mäkelä M, Lee NA, Rost J, Muralidharan S, Campbell D, Mehr S, Nock C, Baumert J, Taylor S, Mastrorilli C, Tripodi S, Caffarelli C, Perna S, Di Rienzo Businco A, Sfika I, Dondi A, Bianchi A, Dascola CP, Ricci G, Cipriani F, Maiello N, del Giudice MM, Frediani T, Frediani S, Macrì F, Pistoletti C, Iacono ID, Patria MF, Varin E, Peroni D, Comberiati P, Chini L, Moschese V, Lucarelli S, Bernardini R, Pingitore G, Pelosi U, Olcese R, Moretti M, Cirisano A, Faggian D, Travaglini A, Plebani M, Verga MC, Calvani M, Giordani P, Matricardi PM, Ontiveros N, Cabrera-Chavez F, Galand J, Beaudouin E, Pineau F, Sakai S, Matsunaga K, Teshima R, Larré C, Denery S, Tschirner S, Trendelenburg V, Schulz G, Niggemann B, Beyer K, Bouferkas Y, Belabbas Y, Saidi D, Kheroua O, Mecherfi KEE, Guendouz M, Haddi A, Kaddouri H, Amaral L, Pereira A, Rodrigues S, Datema M, Jongejan L, Clausen M, Knulst A, Papadopoulos N, Kowalski M, de Blay F, Zwinderman A, Hoffman-Sommergruber K, Ballmer-Weber B, Fernandez-Rivas M, Deng S, Yin J, Eisenmann C, Nassiri M, Reinert R, van der Valk JPM, van Wijk RG, Vergouwe Y, Steyerberg EW, Reitsma M, Wichers HJ, Savelkoul HFJ, Vlieg-Boerstra B, Dubois AEJ, de Jong NW, Carolino F, Rodolfo A, Cernadas J, Roa-Medellín D, Rodriguez-Fernandez A, Navarro J, Albendiz V, Baeza ML, Intente-Herrero S, Mikkelsen A, Mehlig K, Lissner L, Verrill L, Luccioli S, van Bilsen J, Kuper F, Wolterbeek A, Rankouhi TR, Verschuren L, Cnossen H, Jeurink P, Garssen J, Knippels L, Garthoff J, Houben G, Leeman W, Eleonore Pettersson M, Schins AMM, Koppelman GH, Kollen BJ, Zubchenko S, Kuntz S, Mérida P, Álvaro M, Piquer M, Riggioni C, Castellanos JH, Jimenez R, Cap M, Drumez E, Lejeune S, Thumerelle C, Mordacq C, Nève V, Ricò S, Varini M, Nocerino R, Cosenza L, Amoroso A, Di Costanzo M, Di Scala C, Bedogni G, Canani RB, Turner PJ, Poza-Guedes P, González-Pérez R, Sánchez-Machín I, Matheu-Delgado V, Wambre E, Ballegaard AS, Madsen C, Gregersen J, Bøgh KL, Aubert P, Neunlist M, Magnan A, Lozano-Ojalvo D, Pablos-Tanarro A, Pérez-Rodríguez L, Molina E, López-Fandiño R, Rekima A, Macchiaverni P, Turfkruyer M, Holvoet S, Dupuis L, Baiz N, Annesi-Maesano I, Mercenier A, Nutten S, Verhasselt V, Mrakovcic-Sutic I, Banac S, Sutic I, Baricev-Novakovic Z, Sutic I, Pavisic V, Muñoz-Cano R, Jiménez-Rodríguez T, Corbacho D, Roca-Ferrer J, Bartra J, Bulog A, Micovic V, Markiewicz L, Szymkiewicz A, Szyc A, Wróblewska B, Harvey BM, Harthoorn LF, Wesley Burks A, Rentzos G, Björk ALB, Bengtsson U, Barber C, Kalicinsky C, Breynaert C, Coorevits L, Jansen C, Van Hoeyveld E, Verbeke K, Kochuyt AM, Schrijvers R, Deleanu D, Muntean A, Konstantakopoulou M, Pasioti M, Papadopoulou A, Iliopoulou A, Mikos N, Kompoti E, de Castro ED, Bartalomé B, Ue KL, Griffiths E, Till S, Grimshaw K, Roberts G, Selby A, Butiene I, Larco JI, Dubakiene R, Fiandor A, Fiocchi A, Papadopoulos N, Sigurdardottir S, Sprikkelman A, Schoemaker AF, Xepapadaki P, Keil T, Cojocariu Z, Barbado BS, Iancu V, Arroabarren E, Esarte MG, Arteaga M, Andrade MC, Borges D, Kalil J, Bianchi PG, Agondi RC, Gupta RK, Sharma A, Gupta K, Das M, Dwivedi P, Karseladze R, Jorjoliani L, Saginadze L, Tskhakaia M, Basello K, Piuri G, Speciani AF, Speciani MC, Camerotto C, Zinno F, Pakholchuk O, Nedelska S, Pattini S, Costantino MT, Peveri S, Villalta D, Savi E, Costanzi A, Revyakina VA, Kiseleva MA, Kuvshinova ED, Larkova IA, Shekhetov AA, Silva D, Moreira A, Plácido J, van der Kleij H, van Twuijver E, Sutorius R, de Kam PJ, van Odijk J, Lindqvist H, Lustig E, Jácome AAA, Aguilar KLB, Domínguez MG, Hernández DAM, Caruso C, Casale C, Rapaccini GL, Romano A, De Vitis I, Cocco RR, Aranda C, Mallozi MC, Motta JF, Moraes L, Pastorino A, Rosario N, Goudouris E, Porto A, Wandalsen NF, Sarinho E, Sano F, Solé D, Pitsios C, Petrodimopoulou M, Papadopoulou E, Passioti M, Kontogianni M, Adamia N, Khaleva E, del Prado AP, Du Toit G, Krzych E, Samolinska-Zawisza U, Furmanczyk K, Tomaszewska A, Raciborski F, Lipiec A, Samel-Kowalik P, Walkiewicz A, Borowicz J, Samolinski B, Nano AL, Recto M, Somoza ML, López NB, Alzate DP, Ruano FJ, Garcimartín MI, Haroun E, de la Torre MV, Rojas A, Onieva ML, Canto G, Rodrigues A, Forno A, Cabral AJ, Gonçalves R, Vorozhko I, Sentsova T, Chernyak O, Denisova S, Ilènko L, Muhortnich V, Zimmermann C, Rohrbach A, Bakhsh FR, Boudewijn K, Oomkes-Pilon AM, Van Ginkle D, Šilar M, Jeverica A, Vesel T, Avčin T, Korošec P, van der Valk J, Berends I, Arends N, van Maaren M, Wichers H, Emons J, Dubois A, de Jong N, Matsyura O, Besh L, Huang CH, Jan TR, Stiefel G, Tratt J, Kirk K, Carolino F, Arasi S, Caminiti L, Crisafulli G, Fiamingo C, Fresta J, Pajno G, Remington B, Kruizinga A, Marty Blom W, Westerhout J, Bijlsma S, Baumert J, Blankestijn M, Otten H, Klemans R, Michelsen-Huisman AD, van Os-Medendorp H, Kruizinga AG, Versluis A, van Duijn G, de Zeeuw-Brouwer HML, Castenmiller JJM, Noteborn HPJM, Houben GF, Bravin K, Luyt D, Javed B, Couch P, Munro C, Padfield P, Sperrin M, Byrne A, Oosthuizen L, Kelleher C, Ward F, Brosnan N, King G, Corbet E, Guzmán JAH, García MB, Asensio O, Navarrete LV, Larramona H, Miró XD, Pyrz K, Austin M, Boloh Y, Couch P, Galloway D, Hernandez P, Hourihane JO, Kenna F, Majkowska-Wojciechowska B, Regent L, Themisb M, Schnadt S, Semic-Jusufagic A, Galvin AD, Kauppila T, Kuitunen M, Kitsioulis NA, Douladiris N, Kostoudi S, Manolaraki I, Mitsias D, Manousakis E, Papadopoulos NG, Knibb R, Hammond J, Cooke R, Yrjänä J, Hanni AM, Vähäsarja P, Mustonen O, Dunder T, Kulmala P, Lasa E, D’Amelio C, Martínez S, Joral A, Gastaminza G, Goikoetxea MJ, Candy DCA, Van Ampting MTJ, Oude Nijhuis MM, Butt AM, Peroni DG, Fox AT, Knol J, Michaelis LJ, Padua I, Padrao P, Moreira P, Barros R, Sharif H, Ahmed M, Gomaa N, Mens J, Smit K, Timmermans F, Poredoš T, Jeverica AK, Sedmak M, Benedik E, Accetto M, Zupančič M, Yonamine G, Soldateli G, Aquilante B, Pastorino AC, de Moraes Beck CL, Gushken AK, de Barros Dorna M, dos Santos CN, Castro APM, Al-Qahtani A, Arnaout R, Khaliq AR, Amin R, Sheikh F, Alvarez J, Anda M, Palacios M, De Prada M, Ponce C, Balbino B, Sibilano R, Marichal T, Gaudenzio N, Karasuyama H, Bruhns P, Tsai M, Reber LL, Galli SJ, Ferreira AR, Cernadas JR, del Campo García A, Fernández SP, Carrera NS, Sánchez-Cruz FB, Lorenzo JRF, Claus S, Pföhler C, Ruëff F, Treudler R, Jaume ME, Madroñero A, Perez MTG, Julia JC, Plovdiv CH, Gethings L, Langridge J, Adel-Patient K, Bernard H, Barcievic-Jones I, Sokolova R, Yankova R, Ivanovska M, Murdjeva M, Popova T, Dermendzhiev S, Karjalainen M, Lehnigk U, Brown D, Locklear JC, Locklear J, Maris I, Hourihane J, Ornelas C, Caiado J, Ferreira MB, Pereira-Barbosa M, Puente Y, Daza JC, Monteseirin FJ, Ukleja-Sokolowska N, Gawronska-Ukleja E, Zbikowska-Gotz M, Bartuzi Z, Sokolowski L, Adams A, Mahon B, English K, Gourdon-Dubois N, Sellam L, Pereira B, Michaud E, Messaoudi K, Evrard B, Fauquert JL, Palomares F, Gomez G, Rodriguez MJ, Galindo L, Molina A, Paparo L, Mennini M, Aitoro R, Wawrzeńczyk A, Przybyszewski M, Wawrzeńczyk A, Sarıcoban HE, Ugras M, Yalvac Z, Flokstra-de Blok BMJ, van der Velde JL, Vereda A, Ippolito C, Traversa A, Adriano D, Bianchi DM, Gallina S, Decastelli L, Makatsori M, Miles A, Devetak SP, Devetak I, Tabet SA, Trandbohus JF, Winther P, Malling HJ, Hansen KS, Garvey LH, Wang CC, Cheng YH, Tung CW, Dietrich M, Marenholz I, Kalb B, Grosche S, Blümchen K, Schlags R, Price M, Rietz S, Esparza-Gordillo J, Lau S, Lee YA, Almontasheri A, Bahkali MA, Elshorbagi S, Alfhaid A, Altamimi M, Madbouly E, Al-Dhekri H, Arnaout RK, Basagaña M, Miquel S, Bartolomé B, Brix B, Rohwer S, Brandhoff S, Berger A, Suer W, Weimann A, Bueno C, Martín-Pedraza L, Abián S, Segundo-Acosta PS, López-Rodríguez JC, Barderas R, Batanero E, Cuesta-Herranz J, Villalba MT, Correia M, Benito-Garcia F, Arêde C, Piedade S, Morais-Almeida M, Hindley J, Yarham R, Kuklinska-Pijanka A, Gillick D, Patient K, Chapman MD, Bøgh KL, Miranda A, Matos E, Sokolova A, Rao H, Baricevic-Jones I, Smith F, Xue W, Magnusdottir H, Vidarsdottir AG, Lund S, Jensen AB, Ludviksson BR, Simon R, Elfont R, Bennett S, Voyksner R, de Lurdes Torre M, Yürek S, Faber MA, Bastiaensen A, Mangodt E, van Gasse A, Decuyper I, Sabato V, Hagendorens MM, Bridts CH, De Clerck LS, Ebo D, Schwarz S, Ziegert M, Albroscheit S, Schwager C, Kull S, Behrends J, Röckendorf N, Schocker F, Frey A, Homann A, Becker WM, Jappe U, Zaabat N, Osscini S, Agabriel C, Sterling B, Carsin A, Liabeuf V, Maćków M, Zbróg A, Bronkowska M, Courtois J, Gadisseur R, Bertholet C, Lukas P, Cavalier E, Delahaut P, Quinting B, Gertmo MB, Hasseus ET, Barzylovych V, Oliveira J, Ensina LF, Aranda CS, Dopazo L, Lopez R, Perez R, Santos-Diez L, Bilbao A, Garcia JM, Núñez IG, Mármol MÁA, Villarejo MJB, Martos JAB, Vergara MS, García JMI, Michalska A, Sergiejko G, Zacniewski R, Ghiordanescu IM, Deaconu C, Popescu M, Bumbacea RS, Ibranji A, Nikolla E, Loloci G, Juel-Berg N, Larsen LF, Poulsen LK, Marcelino J, Prata R, Costa AC, Duarte F, Neto M, Santos J, Pestana LC, Sampaio D, Minale P, Dignetti P, Bignardi D, Nedelea I, Popescu FD, Vieru M, Secureanu FA, Ganea CS, Vieira M, Silva JPM, Watts T, Watts S, Lomikovska M, Peredelskaya M, Nenasheva N, Filipovic I, Zivkovic Z, Filipovic D, Higgs J, Warner A, Jones C. Abstracts from the Food Allergy and Anaphylaxis Meeting 2016. Clin Transl Allergy 2017. [PMCID: PMC5384531 DOI: 10.1186/s13601-017-0142-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Mäkelä MJ, Eriksson C, Kotaniemi-Syrjänen A, Palosuo K, Marsh J, Borres M, Kuitunen M, Pelkonen AS. Wheat allergy in children - new tools for diagnostics. Clin Exp Allergy 2015; 44:1420-30. [PMID: 25146380 DOI: 10.1111/cea.12393] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 08/07/2014] [Accepted: 08/14/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND The detection of wheat-specific IgE in children often leads to a suspicion of wheat allergy, but little information is available on the most reliable wheat allergens for predicting clinical reactivity. OBJECTIVE To evaluate the role of allergenic components of wheat in wheat allergy diagnostics. METHODS One hundred and eight children (median age 1.5 years; range 0.6-17.3 years) with suspected wheat allergy underwent open or double-blinded, placebo-controlled oral wheat challenges. Responsiveness to different allergenic components of wheat was studied by skin prick tests and by determination of serum IgE antibodies using a semi-quantitative microarray assay. RESULTS Thirty (28%) children reacted with immediate symptoms, and 27 (25%) with delayed symptoms to ingested wheat, whereas 51 (47%) children exhibited no reactions in oral wheat challenges. Positive IgE responses to any of the 12 allergenic components of wheat was seen in 93%, 41%, and 43% of those with immediate, delayed or no reactions to ingested wheat, respectively (P < 0.001 to P < 0.05 in every comparisons between those with immediate reactions and those with no reactions). Positive IgE responses to ≥5 different allergenic components improved significantly the diagnostic accuracy (with a positive likelihood ratio (LR+) of 5.10). Alpha-amylase inhibitors (AAI), in particular dimeric AAI 0.19 (LR+ 6.12), alpha-, beta-, and gamma-gliadins (LR+ from 3.57 to 4.53), and high-molecular-weight (HMW) glutenin subunits (LR+ 4.37) were the single allergenic components of wheat differentiating most effectively those with immediate symptoms from those who did not exhibit any reactions. CONCLUSIONS AND CLINICAL RELEVANCE Wheat allergy diagnostics is difficult, even using sophisticated component methods. Our results confirm earlier findings about gliadins and identify the dimeric AAI 0.19, as a relevant allergen in clinically reactive patients when compared to non-reactive subjects. The accuracy of wheat allergy diagnosis may be improved by measuring IgE responses to several components of wheat.
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Affiliation(s)
- M J Mäkelä
- Department of Allergology, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
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Abstract
The study was aimed to determine the natural history of wheat hypersensitivity, to define risk factors for persistent wheat hypersensitivity, and to evaluate the development of respiratory allergy in children with wheat hypersensitivity. The development and subsequent disappearance of wheat hypersensitivity, clinical findings, skin prick test (SPT) reactivity, and the development of allergic rhinoconjunctivitis and asthma were charted retrospectively in 28 children with wheat hypersensitivity proven by the open oral challenge at the median age of 21 months (range 6 to 75 months). Appearance of skin symptoms during the diagnostic wheat challenge was related to SPT-positive wheat hypersensitivity, while the appearance of gastrointestinal symptoms alone was associated with SPT-negative wheat hypersensitivity (p=0.002). Wheat was tolerated by 59%, 69%, 84%, and 96%, by age 4, 6, 10, and 16, respectively. Sensitization to gliadin with a SPT wheal of >or=5 mm at the time of the diagnostic challenge was associated with a slower course of recovery from wheat hypersensitivity (p=0.019), and a SPT wheal of >or=3 mm to gliadin at any time was associated with the development of asthma (p=0.022). SPT reactivity to wheat was associated with later SPT reactivity to birch pollen (p=0.001), and the development of allergic rhinoconjunctivitis (p=0.001). In conclusion, almost all children with wheat hypersensitivity can tolerate wheat by adolescence. Sensitization to gliadin is associated with a slower achievement of tolerance and an increased risk of asthma.
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Lehto M, Kotovuori A, Palosuo K, Varjonen E, Lehtimäki S, Kalkkinen N, Palosuo T, Reunala T, Alenius H. Hev b 6.01 and Hev b 5 induce pro-inflammatory cytokines and chemokines from peripheral blood mononuclear cells in latex allergy. Clin Exp Allergy 2007; 37:133-40. [PMID: 17210051 DOI: 10.1111/j.1365-2222.2006.02622.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Hev b 6.01 (prohevein) and Hev b 5 [acidic natural rubber latex (NRL) protein] are major IgE-binding allergens in NRL allergy. OBJECTIVE To examine allergen-specific cytokine and chemokine responses in NRL-allergic patients. METHODS Fourteen NRL-allergic patients and 10 healthy controls participated in the study. Hev b 6.01 and Hev b 5 were purified under non-denaturating conditions by chromatographic methods. Specific IgE antibodies were measured by ELISA and proliferation of peripheral blood mononuclear cells (PBMC) by (3)H-thymidine incorporation assay. Allergen-specific induction of cytokine and chemokine mRNA in PBMC was measured by real-time PCR and protein levels by ELISA. Surface expression of chemokine receptors was analysed by flow cytometry. RESULTS Twelve (86%) NRL-allergic patients had positive skin prick test reactions and IgE antibodies against Hev b 6.01, but less than 30% responded to Hev b 5. Cell proliferation against Hev b 6.01, but not against Hev b 5, was significantly increased. Both allergens elicited significantly higher expression of pro-inflammatory and T-helper type 2 cytokines (TNF, IL-12p40, IL-13) and chemokines (CCL3, CCL4, CCL20) in the NRL-allergic patients than in controls. Interestingly, mRNA expression of the regulatory cytokine TGF-beta1 was reduced, whereas IL-10 expression was enhanced after allergen stimulations in patients with NRL allergy. Finally, the NRL-allergic patients showed increased CCR4 expression on CD3(+)CD8(-) T cells and decreased CXCR3 expression on CD3(+)CD8(+) T cells. CONCLUSION Allergen-specific induction of cytokines and chemokines in PBMC and chemokine receptor expression on circulating T cells may contribute to the pathogenesis of NRL allergy.
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Affiliation(s)
- M Lehto
- Unit of Excellence for Immunotoxicology, Finnish Institute of Occupational Health, Helsinki, Finland.
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Daengsuwan T, Palosuo K, Phankingthongkum S, Visitsunthorn N, Jirapongsananuruk O, Alenius H, Vichyanond P, Reunala T. IgE antibodies to omega-5 gliadin in children with wheat-induced anaphylaxis. Allergy 2005; 60:506-9. [PMID: 15727584 DOI: 10.1111/j.1398-9995.2004.00656.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Wheat can cause severe immunoglobulin E (IgE)-mediated systemic reactions including anaphylaxis but knowledge on relevant wheat allergens at the molecular level is scanty. METHODS Seven children (aged from 6 months to 13 years) experiencing from 2 to 10 anaphylactic reactions in a year after eating food-containing wheat were examined. Purified omega-5 gliadin was used as an allergen in IgE enzyme-linked immunosorbent assay (ELISA) and in skin prick testing (SPT). Wheat CAP radioallergosorbent test (RAST) and SPT were also examined. RESULTS All seven anaphylactic children, but none of 15 control subjects had IgE antibodies to omega-5 gliadin in ELISA. Five of the six tested anaphylactic children showed positive SPT to omega-5 and crude gliadin, and all seven had positive wheat CAP RAST and SPT. One child was challenged with wheat, which caused anaphylaxis. After adherence to a wheat-free diet four children remained symptomless and three experienced one to two anaphylactic reactions. CONCLUSION The present results show that wheat omega-5 gliadin is a major sensitizing allergen in children with wheat-induced anaphylaxis. They also suggest that omega-5 gliadin IgE ELISA could be used as a diagnostic test for this severe allergy.
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Affiliation(s)
- T Daengsuwan
- Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Lehto M, Palosuo K, Kotovuori A, Varjonen E, Lehtimäki S, Majuri M, Reunala T, Kalkkinen N, Palosuo T, Alenius H. Allergen specific induction of proinflammatory cytokines and chemokines in peripheral blood mononuclear cells of latex allergic patients. J Allergy Clin Immunol 2005. [DOI: 10.1016/j.jaci.2004.12.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Palosuo K, Varjonen E, Nurkkala J, Kalkkinen N, Harvima R, Reunala T, Alenius H. Transglutaminase-mediated cross-linking of a peptic fraction of omega-5 gliadin enhances IgE reactivity in wheat-dependent, exercise-induced anaphylaxis. J Allergy Clin Immunol 2003; 111:1386-92. [PMID: 12789243 DOI: 10.1067/mai.2003.1498] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients with wheat-dependent, exercise-induced anaphylaxis (WDEIA) experience recurrent anaphylactic reactions when exercising after ingestion of wheat products. We have identified omega-5 gliadin (Tri a 19) as a major allergen in WDEIA, but the role of exercise in eliciting the symptoms remains obscure. OBJECTIVE The aim was to examine whether tissue transglutaminase (tTG)-mediated cross-linking could be involved in modulating the IgE-binding ability and in vivo reactivity of digested omega-5 gliadin peptides in WDEIA. METHODS Purified omega-5 gliadin was digested with pepsin or with pepsin and trypsin and treated with tTG. The binding of IgE antibodies in pooled sera from 10 patients with WDEIA was studied by means of immunoblotting before and after tTG treatment of the digested peptides. The peptides derived from pepsin digestion were separated by means of gel-filtration chromatography, and IgE reactivity of 4 different peptide fractions was studied by immunoblotting before and after tTG treatment. The fraction showing the greatest degree of cross-linking by tTG was further studied by means of IgE ELISA, ELISA inhibition, and skin prick testing. RESULTS The IgE-binding ability of omega-5 gliadin was retained after pepsin and pepsin-trypsin digestion. tTG treatment of the whole peptic digest formed large peptide complexes, with molecular weights ranging from 40 to greater than 200 kd. These cross-linked aggregates bound IgE antibodies in immunoblotting more intensely than untreated, pepsin-digested, or pepsin-trypsin-digested omega-5 gliadin. A gel-filtration fraction of the whole peptic digest corresponding to the highest peak of the chromatogram and showing the greatest degree of tTG-mediated cross-linking showed an increase in serum IgE reactivity in ELISA after tTG treatment, as well as a shift of reactivity to cross-linked complexes. In the 20 patients with WDEIA, the mean skin prick test wheal elicited by this tTG-treated peptic fraction was 77% larger (P <.001) than that elicited by the untreated peptic fraction and 56% larger (P <.01) than that elicited by intact omega-5 gliadin. CONCLUSIONS Omega-5 gliadin-derived peptides are cross-linked by tTG, which causes a marked increase in IgE binding both in vitro and in vivo. Activation of tTG during exercise in the intestinal mucosa of patients with WDEIA could lead to the formation of large allergen complexes capable of eliciting anaphylactic reactions.
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Affiliation(s)
- Kati Palosuo
- Department of Dermatology, Hospital for Skin and Allergic Diseases, University of Helsinki, Helsinki, Finland
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19
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Abstract
PURPOSE OF REVIEW Wheat is among the six foods responsible for approximately 90% of food allergies in children, and in recent years wheat has been increasingly recognized as a cause of food-dependent, exercise-induced anaphylaxis. Wheat flour is an important cause of baker's asthma, a well-known occupational respiratory allergy to inhaled flour. This review outlines the diverse clinical manifestations of IgE-mediated wheat hypersensitivity and summarizes recent advances in characterization of clinically significant allergens. RECENT FINDINGS Only a few of the numerous wheat proteins recognized by IgE of sensitized individuals have been characterized at the molecular level. Characterized allergens causing baker's asthma include several water/salt-soluble wheat proteins, however sensitization patterns show a great degree of individual variation. The insoluble gliadins have been implicated in IgE-mediated allergy to ingested wheat, and omega-5 gliadin has been identified as a major allergen in wheat-dependent, exercise-induced anaphylaxis. The presence of IgE to purified omega-5 gliadin in children was highly predictive of immediate clinical symptoms on oral wheat challenge. SUMMARY Diagnostic skin prick and in-vitro tests measuring sensitization against water/salt-soluble wheat proteins have poor predictive values. Quantification of gliadin-specific IgE in serum or skin prick testing with gliadin could serve as an additional tool in the diagnostic work-up of allergy to ingested wheat.
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Affiliation(s)
- Kati Palosuo
- Department of Dermatology, University of Helsinki and Hospital for Skin and Allergic Diseases, Helsinki, Finland.
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Lehto M, Palosuo K, Varjonen E, Majuri ML, Andersson U, Reunala T, Alenius H. Humoral and cellular responses to gliadin in wheat-dependent, exercise-induced anaphylaxis. Clin Exp Allergy 2003; 33:90-5. [PMID: 12534555 DOI: 10.1046/j.1365-2222.2003.01568.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Wheat-dependent, exercise-induced anaphylaxis (WDEIA) is a severe allergy where wheat ingestion together with physical exercise induces anaphylaxis. We have previously shown that patients with WDEIA have IgE antibodies against gliadin proteins and identified omega-5 gliadin (Tri a 19) as a major allergen. OBJECTIVE The aim of this study was to examine gliadin-specific IgG subclass, IgA and IgE antibodies, basophil histamine release and cell-mediated responses in WDEIA. METHODS Sera and peripheral blood mononuclear cells (PBMC) were obtained from patients with WDEIA and from controls without wheat allergy. Serum antibodies to crude gliadin extract (CGE) and purified omega-5 gliadin were measured by ELISA and basophil reactivity by histamine-release test. Gliadin-induced cell-mediated responses were assessed by lymphocyte proliferation assay, and cytokine mRNA expression with real-time quantitative PCR. RESULTS All patients with WDEIA, but none of the controls, had IgE antibodies to CGE and omega-5 gliadin. Both allergens released high levels of histamine from the basophils of patients with WDEIA. Levels of IgA antibodies to CGE and omega-5 gliadin were significantly elevated in the patients, but the distribution of IgG subclass antibodies showed no statistically significant differences between the two groups. Proliferative responses of PBMC to CGE were increased in patients with WDEIA, and stimulation of PBMC with CGE caused, both in patients and in controls, a clear induction of IL-10 mRNA. Compared with the controls, induction of IL-10 mRNA expression in patients with WDEIA was significantly (P < 0.01) suppressed. CONCLUSION These results suggest that, in addition to IgE antibodies against omega-5 gliadin, specific IgA antibodies may be involved in the pathogenesis of WDEIA. Decreased expression of IL-10 mRNA in PBMC during gliadin stimulation may facilitate the development of gliadin-specific T cell responses.
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Affiliation(s)
- M Lehto
- Finnish Institute of Occupational Health, Helsinki, Finland
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Palosuo K, Nurkkala J, Varijonen E, Kalkkinen N, Reunala T, Alenius HT. Tissue transglutaminase increases binding of IgE to ω-5 gliadin in wheat-dependent, exercise-induced anaphylaxis. J Allergy Clin Immunol 2002. [DOI: 10.1016/s0091-6749(02)81674-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Palosuo K, Varjonen E, Kekki OM, Klemola T, Kalkkinen N, Alenius H, Reunala T. Wheat omega-5 gliadin is a major allergen in children with immediate allergy to ingested wheat. J Allergy Clin Immunol 2001; 108:634-8. [PMID: 11590393 DOI: 10.1067/mai.2001.118602] [Citation(s) in RCA: 174] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sensitization to wheat by ingestion can lead to food allergy symptoms and wheat-dependent, exercise-induced anaphylaxis. Sensitization by inhalation causes bakers' asthma and rhinitis. Wheat allergens have been characterized at the molecular level in bakers' asthma and in wheat-dependent, exercise-induced anaphylaxis, in which omega-5 gliadin (Tri a 19) is a major allergen. However, little information is available regarding allergens responsible for hypersensitivity reactions to ingested wheat in children. OBJECTIVE The aim of this study was to examine whether children with allergy to ingested wheat have IgE antibodies to omega-5 gliadin. METHODS Sera were obtained from 40 children (mean age, 2.5 years; range, 0.7-8.2 years) with suspected wheat allergy who presented with atopic dermatitis and/or gastrointestinal and/or respiratory symptoms. Wheat allergy was diagnosed with open or double-blinded, placebo-controlled oral wheat challenge. Wheat omega-5 gliadin was purified by reversed-phase chromatography, and serum IgE antibodies to omega-5 gliadin were measured by means of ELISA. In vivo reactivity was studied by skin prick testing. Control sera were obtained from 22 children with no evidence of food allergies. RESULTS In oral wheat challenge, 19 children (48%) reacted with immediate and 8 children (20%) with delayed hypersensitivity symptoms. Sixteen (84%) of the children with immediate symptoms had IgE antibodies to purified omega-5 gliadin in ELISA. In contrast, IgE antibodies to omega-5 gliadin were not detected in any of the children with delayed or negative challenge test results or in the control children. The diagnostic specificity and positive predictive value of omega-5 gliadin ELISA were each 100% for immediate challenge reactions. Skin prick testing with omega-5 gliadin was positive in 6 of 7 children with immediate challenge symptoms and negative in 2 children with delayed challenge symptoms. CONCLUSION The results of this study show that omega-5 gliadin is a significant allergen in young children with immediate allergic reactions to ingested wheat. IgE testing with omega-5 gliadin could be used to reduce the need for oral wheat challenges in children.
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Affiliation(s)
- K Palosuo
- Department of Dermatology, University of Helsinki and Hospital for Skin and Allergic Diseases, Helsinki, Finland
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Palosuo K, Alenius H, Varjonen E, Kalkkinen N, Reunala T. Rye gamma-70 and gamma-35 secalins and barley gamma-3 hordein cross-react with omega-5 gliadin, a major allergen in wheat-dependent, exercise-induced anaphylaxis. Clin Exp Allergy 2001; 31:466-73. [PMID: 11260160 DOI: 10.1046/j.1365-2222.2001.01023.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patients with wheat-dependent, exercise-induced anaphylaxis experience severe allergic reactions when exercising after ingestion of wheat. The major wheat allergen associated with these reactions is a omega-5 gliadin, and patients following a gluten-free diet have remained free of symptoms. The aim of this study was to examine whether allergens cross-reacting with wheat omega-5 gliadin are present in rye, barley and oats. Sera from 23 adult patients with wheat-dependent, exercise-induced anaphylaxis were examined. Cereal allergens cross-reacting with wheat omega-5 gliadin were identified by immunoblot inhibition. The cross-reactive allergens were purified by gel filtration and reversed-phase chromatography and submitted to amino acid sequencing. Cross-reactivity was further studied by IgE ELISA and ELISA inhibition, and in vivo reactivity by skin prick testing. In immunoblotting rabbit anti-omega-5 gliadin antibodies bound to 70 kDa and 32 kDa proteins in rye and a 34-kDa protein in barley, but not to proteins in oats. N-terminal sequencing identified these proteins as rye gamma-70 secalin, rye gamma- 35 secalin and barley gamma-3 hordein, correspondingly. In ELISA 21/23 (91%) patients with wheat-dependent, exercise-induced anaphylaxis showed IgE antibodies to purified gamma-70 secalin, 19/23 (83%) to gamma-35 secalin and 21/23 (91%) to gamma-3 hordein. In ELISA inhibition omega-5 gliadin inhibited over 90% of the IgE binding of pooled patient sera to solid-phase gamma-secalins and gamma-3 hordein. Skin prick testing gave positive reactions to gamma-70 secalin in 10/15 (67%) patients, to gamma-35 secalin in 3/15 (20%) patients and to gamma-3 hordein in 7/15 (47%) patients. The results of this study show that gamma-70 and gamma-35 secalins in rye and gamma-3 hordein in barley cross-react with omega-5 gliadin, a major allergen in wheat-dependent, exercise-induced anaphylaxis. These findings suggest that also rye and barley may elicit symptoms in patients with wheat-dependent, exercise-induced anaphylaxis.
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Affiliation(s)
- K Palosuo
- Department of Dermatology, University of Helsinki and Hospital for Skin and Allergic Diseases, Helsinki, Finland
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Palosuo K, Alenius H, Varjonen E, Koivuluhta M, Mikkola J, Keskinen H, Kalkkinen N, Reunala T. A novel wheat gliadin as a cause of exercise-induced anaphylaxis. J Allergy Clin Immunol 1999; 103:912-7. [PMID: 10329828 DOI: 10.1016/s0091-6749(99)70438-0] [Citation(s) in RCA: 183] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Food-dependent, exercise-induced anaphylaxis is a severe form of allergy; the reaction is caused by ingestion of a specific food before exercise. This disorder often escapes diagnosis because neither the ingested food nor the exercise alone induces the symptoms. OBJECTIVE The aim of the study was to characterize the allergens involved in wheat-dependent, exercise-induced anaphylaxis and to describe the clinical outcome in a series of 18 adult patients. METHODS All 18 patients had experienced recurrent episodes of generalized urticaria during exercise, 17 patients in association with collapse and 15 patients with an anaphylactic reaction. The symptoms appeared only when the patients had eaten food containing wheat before exercise. Wheat allergens were detected by immunoblotting, purified by gel filtration and reversed-phase chromatography, and subjected to N-terminal sequencing. The IgE-binding ability of the purified proteins was studied by ELISA, and their in vivo reactivity was studied by skin prick testing. RESULTS IgE antibodies from pooled patient sera were bound to 65-kd and 40-kd wheat proteins in immunoblotting. The 65-kd allergen was a previously undescribed wheat protein, showing 61% sequence identity to gamma-gliadin, whereas the 40-kd allergen had 100% identity to alpha-gliadin. In ELISA, all 18 patients showed elevated IgE levels to the novel gamma-like gliadin, and 13 of the patients showed elevated IgE levels to the alpha-gliadin. None of the 54 control subjects with wheat allergy, urticaria, or coeliac disease had IgE antibodies to the gamma-like gliadin. The in vivo reactivity of the gamma-like gliadin was verified by positive skin prick test responses in all of the 15 patients who were tested. During the follow-up on a gluten-free or wheat-free diet, 3 patients experienced reactions after having unknowingly eaten wheat before exercise, but all the other patients who were adhering to the diet remained symptom-free. CONCLUSION This study shows that wheat is a frequent cause of food-dependent, exercise-induced anaphylaxis and suggests that the major allergen is a previously undescribed gamma-like gliadin. For screening of this life-threatening allergy, we recommend skin prick testing with crude gliadin and we recommend a gluten-free diet for treatment.
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Affiliation(s)
- K Palosuo
- Department of Dermatology, University of Helsinki and Hospital for Skin and Allergic Diseases, the Finnish Institute of Occupational Health, the National Public Health Institute, and the Institute of Biotechnology, University of Helsinki, Finland
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Palosuo K, Brummer-Korvenkontio H, Mikkola J, Sahi T, Reunala T. Seasonal increase in human IgE and IgG4 antisaliva antibodies to Aedes mosquito bites. Int Arch Allergy Immunol 1997; 114:367-72. [PMID: 9414141 DOI: 10.1159/000237696] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Mosquito bite-sensitive subjects frequently have circulating IgE and IgG4 antibodies to Aedes mosquito saliva proteins. METHODS In the present study we examined the antibody response during a mosquito season in 14 subjects living in Finnish Lapland. Immunoblotting was performed with Aedes communis saliva and the 22- and 36-kD antisaliva antibody bands were analyzed. RESULTS The preseason sera showed IgE antibodies to the main saliva antigens in 12, IgG4 antibodies in all 14 and IgG1 antibodies in 12 subjects, and the postseason sera in all but 1 subject. The postseason sera showed significantly more intense IgE (p < 0.05), IgG4 (p < 0.001) and IgG1 (p < 0.01) antibody bands than the preseason sera. CONCLUSION These results show that seasonal exposure to mosquito bites leads to an increased IgE, IgG4 and IgG1 antibody response, a phenomenon similar to that occurring e.g. in pollen allergy.
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Affiliation(s)
- K Palosuo
- Department of Dermatology, University Hospital and University of Helsinki, Finland
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Brummer-Korvenkontio H, Palosuo K, Palosuo T, Brummer-Korvenkontio M, Leinikki P, Reunala T. Detection of mosquito saliva-specific IgE antibodies by capture ELISA. Allergy 1997; 52:342-5. [PMID: 9140528 DOI: 10.1111/j.1398-9995.1997.tb01002.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We developed an IgE-capture ELISA and measured mosquito saliva-specific IgE antibodies in 27 children sensitive to mosquito bites. Children with large 15-min bite wheals had significantly higher (P < 0.0005) mosquito saliva-specific IgE levels than children with small wheals. In the latter group, the saliva-specific IgE level was significantly higher (P = 0.031) than the levels of six infants never exposed to mosquitoes. A positive correlation (r = 0.65; P = 0.0002) was found between the size of the 15-min wheal and the mosquito saliva-specific IgE antibody levels. These results further support the role of mosquito saliva-specific IgE antibodies in the pathogenesis of mosquito-bite whealing. Compared to immunoblotting, IgE-capture ELISA provides a quantitative method to measure mosquito saliva-specific IgE antibodies.
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Reunala T, Brummer-Korvenkontio H, Palosuo K, Miyanij M, Ruiz-Maldonado R, Löve A, François G, Palosuo T. Frequent occurrence of IgE and IgG4 antibodies against saliva of Aedes communis and Aedes aegypti mosquitoes in children. Int Arch Allergy Immunol 1994; 104:366-71. [PMID: 8038615 DOI: 10.1159/000236693] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We examined the prevalence of IgE and IgG4 class antibodies to the saliva of Aedes communis and Aedes aegypti mosquitoes in the sera of three groups of exposed children using a sensitive immunoblot method. The frequencies of IgE antibodies to the major 36-kD A. communis and A. aegypti saliva antigens ranged from 82 to 90% in the 20 Finnish, 17 Kenyan, and 20 Mexican children. The corresponding IgG4 antibody frequencies were 85, 41, and 20%, respectively. The nonexposed 20 Icelandic children did not show IgE or IgG4 antisaliva antibodies. Several of the Finnish children showed also IgE and IgG4 antibodies to a 22-kD A. communis saliva antigen. The Finnish children abnormally sensitive to mosquito bites had frequently IgE and IgG4 antibodies to the 22-kD A. communis saliva antigen, suggesting that these antibodies play a role in the pathogenesis of immediate cutaneous mosquito bite reactions. In contrast to this, no increase was found in the A. aegypti antibody frequencies in the Kenyan and Mexican children with papular urticaria, suggesting that humoral immune response to A. aegypti saliva is not involved in the development of this disorder. The present results show that humoral IgE and IgG4 immune responses to Aedes mosquito saliva antigens is common in children living both in temperature and tropical zones. The IgE antibodies seem to be involved in the immediate mosquito bite whealing, and the occurrence of the IgG4 subclass antisaliva antibodies might be an indicator of intense mosquito bite exposure.
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Affiliation(s)
- T Reunala
- Department of Dermatology, Helsinki University Hospital, Finland
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