1
|
Treudler R, Franke A, Schmiedeknecht A, Ballmer-Weber B, Worm M, Werfel T, Jappe U, Biedermann T, Schmitt J, Brehler R, Kleinheinz A, Kleine-Tebbe J, Brüning H, Ruëff F, Ring J, Saloga J, Schäkel K, Holzhauser T, Vieths S, Simon JC. BASALIT trial: double-blind placebo-controlled allergen immunotherapy with rBet v 1-FV in birch-related soya allergy. Allergy 2017; 72:1243-1253. [PMID: 27998002 DOI: 10.1111/all.13112] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Conflicting results exist on the effect of allergen immunotherapy (AIT) on pollen-related food allergy. We aimed to investigate the efficacy of one-year AIT with the folding variant (FV) of recombinant (r) Bet v 1 on birch-related soya allergy. METHODS Of 138 subjects with Bet v 1 sensitization, 82 were positive at double-blind placebo-controlled food challenge (DBPCFC) with soya. A total of 56 of 82 were randomized in the ratio of 2:1 (active: placebo). Per-protocol population (PPP) had received ≥150 μg of allergen or placebo preparation. OUTCOME MEASURES lowest observed adverse effect levels (LOAEL), postinterventional occurrence of objective signs (objS) at any dose level, sIgE/IgG4 against Bet v 1 and Gly m 4. Between-group changes were investigated (ancova, Mann-Whitney U-test, Fisher exact test). RESULTS Baseline characteristics including LOAELs were comparable in both groups with objS and subjS occurring in 82% and 95% of active (n = 38) vs 78% and 83% of placebo group (n = 18). After AIT, objS occurred in 24% and 47%, respectively. LOAEL group differences showed a beneficial tendency (P = 0.081) for LOAELobjective in PPP (30 active, 15 placebo). sIgG4 raised only in active group (Bet v 1: P = 0.054, Gly m 4: P = 0.037), and no relevant changes occurred for sIgE. Only 56% of the intended sample size was recruited. CONCLUSION For the first time, we present data on the effect of rBet v 1-FV on birch-related soya allergy. rBet v 1-FV AIT induced significant immunogenic effects. Clinical assessment showed a tendency in favour of the active group but did not reach statistical significance.
Collapse
Affiliation(s)
- R Treudler
- Department of Dermatology, Venerology and Allergology, Universität Leipzig, Leipzig, Germany
| | - A Franke
- Clinical Trial Centre Leipzig (ZKS), Universität Leipzig, Leipzig, Germany
| | - A Schmiedeknecht
- Clinical Trial Centre Leipzig (ZKS), Universität Leipzig, Leipzig, Germany
| | - B Ballmer-Weber
- Allergy Unit, Department of Dermatology, University Hospital Zürich and Centre of Dermatology and Allergology, Luzerner Kantonsspital, Luzern, Germany
| | - M Worm
- Allergy Center Charité, Department of Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T Werfel
- Department of Dermatology and Allergology, MH Hannover, Hannover, Germany
| | - U Jappe
- Division of Clinical & Molecular Allergology Research Center Borstel, Airway Research Center North (ARCN) and Member of the German Center for Lung Research (DZL), Borstel, Germany
- Interdisciplinary Allergy Outpatient Clinic, Department of Internal Medicine, University of Lübeck, Lübeck, Germany
| | - T Biedermann
- Department of Dermatology, Universität Tübingen, Tübingen, Germany
- Department of Dermatology and Allergology, Technical University Munich, Munich, Germany
| | - J Schmitt
- Department of Dermatology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
- Center for Evidence-based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - R Brehler
- Department of Dermatology, Universität Münster, Münster, Germany
| | - A Kleinheinz
- Department of Dermatology, Elbekliniken Buxtehude, Buxtehude, Germany
| | | | - H Brüning
- Day care clinic for Allergy and Dermatology, Kiel, Germany
| | - F Ruëff
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - J Ring
- Department of Dermatology and Allergology, Technical University Munich, Munich, Germany
| | - J Saloga
- Department of Dermatology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - K Schäkel
- Department of Dermatology, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - T Holzhauser
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - S Vieths
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - J C Simon
- Department of Dermatology, Venerology and Allergology, Universität Leipzig, Leipzig, Germany
| |
Collapse
|
2
|
Kaul S, Zimmer J, Dehus O, Constanzo A, Daas A, Buchheit KH, Asturias J, Arilla MC, Barber D, Bertocchi A, Brunetto B, Carnes JA, Chapman M, Chaudemanche G, Dayan-Kenigsberg J, Döring S, Führer F, Gallego MT, Iacovacci P, Hanschmann KM, Holzhauser T, Hrabina M, Ledesma A, Moingeon P, Nony E, Pini C, Plunkett G, Raulf M, Reese G, Sandberg E, Sander I, Smith B, Strecker D, Valerio C, van Ree R, Weber B, Vieths S. Validation of ELISA methods for quantification of the major birch allergen Bet v 1 (BSP090). Pharmeur Bio Sci Notes 2017; 2017:69-87. [PMID: 29143737] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
To date, the potency of allergen products in Europe is expressed in manufacturer-specific units relative to a product-specific in-house reference. Consequently, cross-product comparability of allergen products from different manufacturers with respect to strength and efficacy is impossible. The Biological Standardisation Programme (BSP) project BSP090 addresses this issue via the establishment of reference standards in conjunction with ELISA methods for the quantification of major allergens in allergen products. Since the initiation of BSP090, the recombinant major allergen Bet v 1 has been adopted by the European Pharmacopoeia Commission as a Chemical Reference Substance (CRS). In parallel, two sandwich ELISA systems for quantification of Bet v 1 were found suitable in preliminary phases of BSP090 to be validated in a large collaborative study. In this study, the candidate ELISA systems were compared with respect to accuracy, precision and variability. Thirteen participating laboratories tested model samples containing the CRS as well as spiked and unspiked birch pollen extracts. Both in pre-testing and in the collaborative study, the 2 candidate ELISA systems confirmed their suitability to quantify recombinant and native Bet v 1. As no clear-cut decision for one of the ELISA systems could be made based on the results of the collaborative study, a post-study testing was performed. Bet v 1 content of 30 birch pollen allergen products was determined in parallel in both ELISA systems. Consequently, 1 candidate ELISA system was selected to be proposed as the future European Pharmacopoeia standard method for Bet v 1 quantification.
Collapse
Affiliation(s)
- S Kaul
- Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, D-63225 Langen, Germany
| | - J Zimmer
- Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, D-63225 Langen, Germany
| | - O Dehus
- Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, D-63225 Langen, Germany
| | - A Constanzo
- European Directorate for the Quality of Medicines & HealthCare (EDQM), 7 allée Kastner, CS 30026, F-67081 Strasbourg, France
| | - A Daas
- European Directorate for the Quality of Medicines & HealthCare (EDQM), 7 allée Kastner, CS 30026, F-67081 Strasbourg, France
| | - K-H Buchheit
- European Directorate for the Quality of Medicines & HealthCare (EDQM), 7 allée Kastner, CS 30026, F-67081 Strasbourg, France
| | - J Asturias
- Roxall Medicina España, Parque Científico y Tecnológico de Bizkaia, Ed. 401, 48170 Zamudio, Spain
| | - M C Arilla
- Roxall Medicina España, Parque Científico y Tecnológico de Bizkaia, Ed. 401, 48170 Zamudio, Spain
| | - D Barber
- ALK-Abelló S.A., Miguel Fleta 19, ES-28037 Madrid, Spain
| | - A Bertocchi
- ANSM, 143 boulevard Anatole France, 93285 Saint Denis Cedex, France
| | - B Brunetto
- ISS CNCF, Viale Regina Elena 299, I-00161 Roma, Italy
| | - J A Carnes
- Laboratorios Leti S.L., Calle Del Sol 5, 28760 Tres Cantos, Spain
| | - M Chapman
- Indoor Biotechnologies, 700 Harris Street, 22903 Charlotteville, USA
| | - G Chaudemanche
- ANSM, 143 boulevard Anatole France, 93285 Saint Denis Cedex, France
| | | | - S Döring
- Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, D-63225 Langen, Germany
| | - F Führer
- Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, D-63225 Langen, Germany
| | - M T Gallego
- Laboratorios Leti S.L., Calle Del Sol 5, 28760 Tres Cantos, Spain
| | - P Iacovacci
- ISS CNCF, Viale Regina Elena 299, I-00161 Roma, Italy
| | - K M Hanschmann
- Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, D-63225 Langen, Germany
| | - T Holzhauser
- Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, D-63225 Langen, Germany
| | - M Hrabina
- Stallergenes Greer, 6 rue Alexis de Tocqueville, 92183 Antony Cedex, France
| | - A Ledesma
- ALK-Abelló S.A., Miguel Fleta 19, ES-28037 Madrid, Spain
| | - P Moingeon
- Stallergenes Greer, 6 rue Alexis de Tocqueville, 92183 Antony Cedex, France
| | - E Nony
- Stallergenes Greer, 6 rue Alexis de Tocqueville, 92183 Antony Cedex, France
| | - C Pini
- ISS CNCF, Viale Regina Elena 299, I-00161 Roma, Italy
| | - G Plunkett
- ALK-Abelló Inc., 1700 Royston Lane, Round Rock, Texas 78664, USA
| | - M Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Ruhr-Universität Bochum (IPA), Bürkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany
| | - G Reese
- Allergopharma GmbH & Co. KG, Hermann-Kröner-Str. 52, D-21465 Reinbek, Germany
| | - E Sandberg
- Danish Medicines Agency, Axel Heides Gade 1, 2300 Copenhagen S, Denmark
| | - I Sander
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Ruhr-Universität Bochum (IPA), Bürkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany
| | - B Smith
- Indoor Biotechnologies, 700 Harris Street, 22903 Charlotteville, USA
| | - D Strecker
- Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, D-63225 Langen, Germany
| | - C Valerio
- Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993-0002, USA
| | - R van Ree
- Academic Medical Centre, Meigbergdreef 9, 1105 AZ, Amsterdam, Netherlands
| | - B Weber
- Allergopharma GmbH & Co. KG, Hermann-Kröner-Str. 52, D-21465 Reinbek, Germany
| | - S Vieths
- Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, D-63225 Langen, Germany
| |
Collapse
|
3
|
Treudler R, Franke A, Schmiedeknecht A, Ballmer-Weber BK, Worm M, Werfel T, Jappe U, Biedermann T, Schmitt J, Brehler R, Kleinheinz A, Kleine-Tebbe J, Brüning H, Ruëff F, Ring J, Saloga J, Schäkel K, Holzhauser T, Vieths S, Simon JC. Standardization of double blind placebo controlled food challenge with soy within a multicentre trial. Clin Transl Allergy 2016; 6:39. [PMID: 27826414 PMCID: PMC5098282 DOI: 10.1186/s13601-016-0129-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 10/14/2016] [Indexed: 11/17/2022] Open
Abstract
Background Multicentre trials investigating food allergies by double blind placebo controlled food challenges (DBPCFC) need standardized procedures, challenge meals and evaluation criteria. We aimed at developing a standardized approach for identifying patients with birch related soy allergy by means of DBPCFC to soy, including determination of threshold levels, in a multicentre setting. Methods Microbiologically stable soy challenge meals were composed of protein isolate with consistent Gly m 4 levels. Patients sensitized to main birch allergen Bet v 1 and concomitant sensitization to its soy homologue Gly m 4 underwent DBPCFC. Outcome was defined according to presence and/or absence of ten objective signs and intensity of eight subjective symptoms as measured by visual analogue scale (VAS). Results 138 adult subjects (63.8% female, mean age 38 years) underwent DBPCFC. Challenge meals and defined evaluation criteria showed good applicability in all centres involved. 45.7% presented with objective signs and 65.2% with subjective symptoms at soy challenge. Placebo challenge meals elicited non-cardiovascular objective signs in 11.6%. In 82 (59.4%) subjects DBPCFC was judged as positive. 70.7% of DPBCFC+ showed objective signs and 85.4% subjective symptoms at soy challenge. Subjective symptoms to soy challenge meal in DBPCFC+ subjects started at significantly lower dose levels than objective signs (p < 0.001). Median cumulative eliciting doses for first objective signs in DBPCFC+ subjects were 4.7 g [0.7–24.7] and 0.7 g [0.2–4.7] total soy protein for first subjective symptoms (p = 0.01). Conclusions We present the hitherto largest group of adults with Bet v 1 and Gly m 4 sensitization being investigated by DBPCFC. In this type of food allergy evaluation of DBPCFC outcome should not only include monitoring of objective signs but also scoring of subjective symptoms. Our data may contribute to standardize DBPCFC in pollen-related food allergy in multicentre settings. Trial registration EudraCT: 2009-011737-27.
Collapse
Affiliation(s)
- R Treudler
- Department of Dermatology, Venerology and Allergology, Universität Leipzig, Leipzig, Germany ; Leipziger Interdisziplinäres Centrum für Allergologie (LICA) - Comprehensive Allergy Centre (CAC), Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Philipp-Rosenthal-Straße 23, 04103 Leipzig, Germany
| | - A Franke
- Clinical Trial Centre Leipzig (ZKS), Universität Leipzig, Leipzig, Germany
| | - A Schmiedeknecht
- Clinical Trial Centre Leipzig (ZKS), Universität Leipzig, Leipzig, Germany
| | - B K Ballmer-Weber
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zurich, Switzerland
| | - M Worm
- Allergy Center Charité, Department of Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T Werfel
- Department of Dermatology and Allergology, MH Hannover, Hannover, Germany
| | - U Jappe
- Division of Clinical and Molecular Allergology Research Center Borstel, Airway Research Center North (ARCN), Borstel, Germany ; Department of Internal Medicine, University of Lübeck, Lübeck, Germany
| | - T Biedermann
- Department of Dermatology, Universität Tübingen, Tübingen, Germany ; Department of Dermatology and Allergology, Technical University Munich, Munich, Germany
| | - J Schmitt
- Department of Dermatology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany ; Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - R Brehler
- Department of Dermatology, Universität Münster, Münster, Germany
| | - A Kleinheinz
- Department of Dermatology, Elbekliniken Buxtehude, Buxtehude, Germany
| | | | - H Brüning
- Day Care Clinic for Allergy and Dermatology, Kiel, Germany
| | - F Ruëff
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - J Ring
- Department of Dermatology and Allergology, Technical University Munich, Munich, Germany
| | - J Saloga
- Department of Dermatology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - K Schäkel
- Department of Dermatology, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - T Holzhauser
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - St Vieths
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - J C Simon
- Department of Dermatology, Venerology and Allergology, Universität Leipzig, Leipzig, Germany ; Leipziger Interdisziplinäres Centrum für Allergologie (LICA) - Comprehensive Allergy Centre (CAC), Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Philipp-Rosenthal-Straße 23, 04103 Leipzig, Germany
| |
Collapse
|
4
|
Kaul S, Zimmer J, Dehus O, Costanzo A, Daas A, Buchheit KH, Asturias JA, Barber D, Carnés J, Chapman M, Dayan-Kenigsberg J, Döring S, Führer F, Hanschmann KM, Holzhauser T, Ledesma A, Moingeon P, Nony E, Pini C, Plunkett G, Reese G, Sandberg E, Sander I, Strecker D, Valerio C, van Ree R, Vieths S. Standardization of allergen products: 3. Validation of candidate European Pharmacopoeia standard methods for quantification of major birch allergen Bet v 1. Allergy 2016; 71:1414-24. [PMID: 27018782 DOI: 10.1111/all.12898] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The BSP090 project aims at establishing European Pharmacopoeia Reference Substances in combination with the corresponding ELISA methods for the quantification of major allergens in allergen products. Two sandwich ELISAs proved suitable for quantification of Bet v 1, the major birch pollen allergen, in preceding phases of BSP090. METHODS Two Bet v 1-specific ELISA systems were compared with respect to accuracy and precision in a ring trial including 13 laboratories. Model samples containing recombinant rBet v 1.0101 as well as native birch pollen extracts were measured independently at least three times in each facility. The assessment was completed with a comparative quantification of Bet v 1 in 30 marketed birch allergen products in one laboratory, simulating the future use as reference method. RESULTS In the collaborative study, both candidate ELISAs confirmed their suitability to quantify recombinant and native Bet v 1. ELISA-A showed higher precision and lower interlaboratory variability, yet ELISA-B exhibited slightly higher accuracy. Subsequent parallel measurement of Bet v 1 in a panel of 'real-life' birch allergen products indicated better repeatability of ELISA-B. Both systems detected substantial differences in Bet v 1 content between allergen products, but the effect was more pronounced using ELISA-B due to persistently higher values compared to ELISA-A. CONCLUSIONS In the collaborative study, no deciding differences were observed between the two candidate ELISAs. Further comparison under conditions simulating the intended use combined with the criterion of long-term availability enabled the selection of one Bet v 1-specific ELISA for proposal as European Pharmacopoeia standard method.
Collapse
Affiliation(s)
- S. Kaul
- Paul-Ehrlich-Institut; Langen Germany
| | - J. Zimmer
- Paul-Ehrlich-Institut; Langen Germany
| | - O. Dehus
- Paul-Ehrlich-Institut; Langen Germany
| | - A. Costanzo
- European Directorate for the Quality of Medicines & HealthCare (EDQM); Strasbourg France
| | - A. Daas
- European Directorate for the Quality of Medicines & HealthCare (EDQM); Strasbourg France
| | - K. H. Buchheit
- European Directorate for the Quality of Medicines & HealthCare (EDQM); Strasbourg France
| | | | | | - J. Carnés
- Laboratorios Leti S.L.; Tres Cantos Spain
| | - M. Chapman
- Indoor Biotechnologies; Charlottesville VA USA
| | | | - S. Döring
- Paul-Ehrlich-Institut; Langen Germany
| | - F. Führer
- Paul-Ehrlich-Institut; Langen Germany
| | | | | | | | | | - E. Nony
- Stallergenes Greer; Antony Cedex France
| | | | | | - G. Reese
- Allergopharma GmbH & Co. KG; Reinbek Germany
| | - E. Sandberg
- Danish Medicines Agency; Copenhagen S Denmark
| | - I. Sander
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Ruhr-Universität Bochum (IPA); Bochum Germany
| | | | - C. Valerio
- Food and Drug Administration; Silver Spring MD USA
| | - R. van Ree
- Academic Medical Centre; Amsterdam The Netherlands
| | - S. Vieths
- Paul-Ehrlich-Institut; Langen Germany
| |
Collapse
|
5
|
Husslik F, Nürnberg J, Seutter von Loetzen C, Mews T, Ballmer-Weber BK, Kleine-Tebbe J, Treudler R, Simon JC, Randow S, Völker E, Reuter A, Rösch P, Vieths S, Holzhauser T, Schiller D. The conformational IgE epitope profile of soya bean allergen Gly m 4. Clin Exp Allergy 2016; 46:1484-1497. [PMID: 27533495 DOI: 10.1111/cea.12796] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/06/2016] [Accepted: 07/11/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Birch pollen-related soya allergy is mediated by Gly m 4. Conformational IgE epitopes of Gly m 4 are unknown. OBJECTIVE To identify the IgE epitope profile of Gly m 4 in subjects with birch pollen-related soya allergy utilizing an epitope library presented by Gly m 4-type model proteins. METHODS Sera from patients with (n = 26) and without (n = 19) allergy to soya as determined by oral provocation tests were studied. Specific IgE (Bet v 1/Gly m 4) was determined by ImmunoCAP. A library of 59 non-allergenic Gly m 4-type model proteins harbouring individual and multiple putative epitopes for IgE was tested in IgE binding assays. Primary, secondary and tertiary protein structures were assessed by mass spectrometry, circular dichroism and nuclear magnetic resonance spectroscopy. RESULTS All subjects were sensitized to Gly m 4 and Bet v 1. Allergen-specific serum IgE levels ranged from 0.94 to > 100 kUA /L. The avidities of serum IgE were 5.06 ng (allergic) and 1.8 ng (tolerant) as determined by EC50 for IgE binding to Gly m 4. 96% (46/48) of the protein variants bound IgE. Model proteins had Gly m 4-type conformation and individual IgE binding clustered in six major surface areas. Gly m 4-specific IgE binding could be inhibited to up to 80% by model proteins harbouring individual IgE binding sites in an epitope-wise equimolar fashion. Receiver operating curve analysis revealed an area under fitted curve of up to 0.88 for model proteins and 0.66 for Gly m 4. CONCLUSION AND CLINICAL RELEVANCE Serum levels and avidity of Gly m 4-specific IgE do not correlate with clinical reactivity to soya. Six IgE-binding areas, represented by 23 amino acids, account for more than 80% of total IgE binding capacity of Gly m 4. Model proteins may be used for epitope-resolved diagnosis to differentiate birch-soya allergy from clinical tolerance.
Collapse
Affiliation(s)
- F Husslik
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - J Nürnberg
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | | | - T Mews
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - B K Ballmer-Weber
- Centre for Dermatology and Allergology, Kantonsspital Luzern, Luzern, Switzerland.,Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | - R Treudler
- Department of Dermatology, Venereology and Allergology, University of Leipzig, Leipzig, Germany
| | - J-C Simon
- Department of Dermatology, Venereology and Allergology, University of Leipzig, Leipzig, Germany
| | - S Randow
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - E Völker
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - A Reuter
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - P Rösch
- Department of Biopolymers, University of Bayreuth, Bayreuth, Germany
| | - S Vieths
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - T Holzhauser
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - D Schiller
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany.
| |
Collapse
|
6
|
Muraro A, Hoffmann-Sommergruber K, Holzhauser T, Poulsen LK, Gowland MH, Akdis CA, Mills ENC, Papadopoulos N, Roberts G, Schnadt S, van Ree R, Sheikh A, Vieths S. EAACI Food Allergy and Anaphylaxis Guidelines. Protecting consumers with food allergies: understanding food consumption, meeting regulations and identifying unmet needs. Allergy 2014; 69:1464-72. [PMID: 24888964 DOI: 10.1111/all.12453] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
Abstract
Individuals suffering from IgE-mediated food allergy usually have to practise life-long food allergen avoidance. This document aims to provide an overview of recent evidence-based recommendations for allergen risk assessment and management in the food industry and discusses unmet needs and expectations of the food allergic consumer in that context. There is a general duty of care on the food industry and obligations in European Union legislation to reduce and manage the presence of allergens alongside other food hazards. Current evidence enables quantification of allergen reference doses used to set-up reliable food safety management plans for some foods. However, further work is required to include a wider variety of foods and to understand the impact of the food matrix as well as additional factors which affect the progression and severity of symptoms as a function of dose. Major concerns have been raised by patients, carers and patient groups about the use of precautionary 'may contain' labelling to address the issue of unintended presence of allergens; these therefore need to be reconsidered. New and improved allergen detection methods should be evaluated for their application in food production. There is an urgent requirement for effective communication between healthcare professionals, patient organizations, food industry representatives and regulators to develop a better approach to protecting consumers with food allergies.
Collapse
Affiliation(s)
- A. Muraro
- The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region; Department of Mother and Child Health; Padua University Hospital; Padua Italy
| | | | - T. Holzhauser
- Division of Allergology; Paul-Ehrlich Institute; Langen Germany
| | - L. K. Poulsen
- Allergy Clinic; Copenhagen University Hospital; Copenhagen Denmark
| | | | - C. A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
- Christine Kühne-Center for Allergy Research and Education (CK-CARE); Davos Switzerland
| | - E. N. C. Mills
- Institute of Inflammation and Repair; Manchester Academic Health Science Centre; Manchester Institute of Biotechnology; University of Manchester; Manchester UK
| | - N. Papadopoulos
- Allergy Department; 2nd Pediatric Clinic; University of Athens; Athens Greece
- Centre for Pediatrics and Child Health Institute of Human Development; The University of Manchester; Manchester UK
| | - G. Roberts
- David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Isle of Wight UK
- Human Development in Health and Clinical and Experimental Sciences Academic Units; Faculty of Medicine; University of Southampton; Southampton UK
- NIHR Respiratory Biomedical Research Unit; NHS Foundation Trust; University Hospital Southampton; Southampton UK
| | - S. Schnadt
- Deutscher Allergie- und Asthmabund e.V.; Mönchengladbach Germany
| | - R. van Ree
- Departments of Experimental Immunology and Otorhinolaryngology; Academic Medical Center; Amsterdam University; Amsterdam the Netherlands
| | - A. Sheikh
- Allergy and Respiratory Research Group; Centre for Population Health Sciences; The University of Edinburgh; Edinburgh UK
- Department of Medicine; Harvard Medical School; Boston MA USA
- Division of General Internal Medicine and Primary Care; Brigham and Women's Hospital; Boston MA USA
| | - S. Vieths
- Division of Allergology; Paul-Ehrlich Institute; Langen Germany
| | | |
Collapse
|
7
|
Pekar C, Berkner H, Vogel L, Gubesch M, Meisel L, Randow S, Ries L, Holzhauser T, Lidholm J, Vieths S, Rösch P, Hartl-Spiegelhauer O, Schiller D. Generation of a protein scaffold for the analysis of functional immunoglobulin epitopes of Bet v 1-like allergens. Clin Transl Allergy 2013. [PMCID: PMC3723550 DOI: 10.1186/2045-7022-3-s3-p102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- C Pekar
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - H Berkner
- Thermo Fisher Scientific, Freiburg, Germany
| | - L Vogel
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - M Gubesch
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - L Meisel
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - S Randow
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - L Ries
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - T Holzhauser
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - J Lidholm
- Thermo Fisher Scientific, Uppsala, Sweden
| | - S Vieths
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - P Rösch
- Department of Biopolymers, University of Bayreuth, Bayreuth, Germany
| | | | - D Schiller
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| |
Collapse
|
8
|
Groh N, Subbarayal B, Vogel L, Möbs C, de Jong NW, Pfützner W, van Wijk RG, Lidholm J, Meisel L, Randow S, Holzhauser T, Bohle B, Vieths S, Schiller D. Immunoglobulin E and G4 epitopes of the major allergen of birch pollen Bet v 1 share residues critical for antibody binding. Clin Transl Allergy 2013. [PMCID: PMC3723447 DOI: 10.1186/2045-7022-3-s3-o15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
9
|
Ballmer-Weber BK, Skamstrup Hansen K, Sastre J, Andersson K, Bätscher I, Östling J, Dahl L, Hanschmann KM, Holzhauser T, Poulsen LK, Lidholm J, Vieths S. Component-resolved in vitro diagnosis of carrot allergy in three different regions of Europe. Allergy 2012; 67:758-66. [PMID: 22486768 DOI: 10.1111/j.1398-9995.2012.02827.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Carrot is a frequent cause of food allergy in Europe. The objective of this study was to evaluate a panel of carrot allergens for diagnosis of carrot allergy in Spain, Switzerland and Denmark. METHODS Forty-nine carrot allergic patients, 71 pollen allergic but carrot-tolerant patients and 63 nonatopic controls were included. Serum IgE to carrot extract, recombinant carrot allergens (rDau c 1.0104; rDau c 1.0201; rDau c 4; the isoflavone reductase-like proteins rDau c IFR 1, rDau c IFR 2; the carrot cyclophilin rDau c Cyc) were analyzed by ImmunoCAP. RESULTS The sensitivity of the carrot extract-based test was 82%. Use of the recombinant allergens increased the sensitivity to 90%. The Dau c 1 isoforms were major allergens for Swiss and Danish carrot allergic patients, the profilin rDau c 4 for the Spanish patients. The rDau c IFR 1 and rDau c IFR 2 were recognized by 6% and 20% of the carrot allergics, but did not contribute to a further increase of sensitivity. Among pollen allergic controls, 34% had IgE to carrot extract, 18% to each of rDau c 1.0104, rDau c 1.0201 and rDau c 4, 8% to rDau c IFR 1 and 7% to rDau c IFR 2. Sensitization to rDau c Cyc occurred in one carrot allergic patient and one nonatopic control. CONCLUSION Component-resolved in vitro analyses revealed a significant difference in IgE sensitization pattern between geographical regions and in the prevalence of sensitization to carrot components between carrot allergic and carrot-tolerant but pollen sensitized patients.
Collapse
Affiliation(s)
- B. K. Ballmer-Weber
- Allergy Unit; Department of Dermatology; University Hospital; Zürich; Switzerland
| | | | - J. Sastre
- Servicio de Alergologia; Fundación Jiménez Diaz; Madrid; Spain
| | | | - I. Bätscher
- Allergy Unit; Department of Dermatology; University Hospital; Zürich; Switzerland
| | | | - L. Dahl
- Division of Allergology; Paul-Ehrlich-Institut; Langen; Germany
| | | | - T. Holzhauser
- Division of Allergology; Paul-Ehrlich-Institut; Langen; Germany
| | - L. K. Poulsen
- Allergy Unit; Department of Dermatology; University Hospital; Zürich; Switzerland
| | | | - S. Vieths
- Division of Allergology; Paul-Ehrlich-Institut; Langen; Germany
| |
Collapse
|
10
|
Kuehne Y, Niggemann B, Ballmer-Weber B, Scibilia J, Bindslev-Jensen C, Wackermann O, Reese G, Vieths S, Holzhauser T. Gly m 5 is a Major Soybean Allergen in European Children: Comparative Investigation of Linear B-cell Epitopes of Gly m 5 and Ara h 1, the Homologous Peanut Allergen. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.665] [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: 11/17/2022]
|
11
|
Crevel RWR, Ballmer-Weber BK, Holzhauser T, Hourihane JO, Knulst AC, Mackie AR, Timmermans F, Taylor SL. Thresholds for food allergens and their value to different stakeholders. Allergy 2008; 63:597-609. [PMID: 18394134 DOI: 10.1111/j.1398-9995.2008.01636.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [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: 12/20/2022]
Abstract
Thresholds constitute a critical piece of information in assessing the risk from allergenic foods at both the individual and population levels. Knowledge of the minimum dose that can elicit a reaction is of great interest to all food allergy stakeholders. For allergic individuals and health professionals, individual threshold data can inform allergy management. Population thresholds can help both the food industry and regulatory authorities assess the public health risk and design appropriate food safety objectives to guide risk management. Considerable experience has been gained with the double-blind placebo-controlled food challenge (DBPCFC), but only recently has the technique been adapted to provide data on thresholds. Available data thus vary greatly in quality, with relatively few studies providing the best quality individual data, using the low-dose DBPCFC. Such high quality individual data also form the foundation for population thresholds, but these also require, in addition to an adequate sample size, a good characterization of the tested population in relation to the whole allergic population. Determination of thresholds at both an individual level and at a population level is influenced by many factors. This review describes a low-dose challenge protocol developed as part of the European Community-funded Integrated Project Europrevall, and strongly recommends its wider use so that data are generated that can readily increase the power of existing studies.
Collapse
Affiliation(s)
- R W R Crevel
- Safety & Environmental Assurance Centre, Unilever, Colworth Science Park, Bedford, UK
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Gubesch M, Theler B, Dutta M, Baumer B, Mathis A, Holzhauser T, Vieths S, Ballmer-Weber BK. Strategy for allergenicity assessment of 'natural novel foods': clinical and molecular investigation of exotic vegetables (water spinach, hyacinth bean and Ethiopian eggplant). Allergy 2007; 62:1243-50. [PMID: 17919138 DOI: 10.1111/j.1398-9995.2007.01474.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [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: 11/28/2022]
Abstract
BACKGROUND Foods not commonly consumed in the European Union must be proven safe before being brought to market, including an assessment of allergenicity. We present a three-stepwise strategy for allergenicity assessment of natural novel foods using three novel vegetables, namely, water spinach, hyacinth bean, Ethiopian eggplant. METHODS First, vegetable extracts were analyzed for the presence of pan-allergens [Bet v 1 homologous proteins, profilins, nonspecific lipid transfer proteins (LTP)] by immunoblot analysis with specific animal antibodies. Secondly, the IgE-binding of the food extracts was investigated by EAST (Enzyme-allergosorbent test) and immunoblot analysis using sera with IgE-reactivity to known pan-allergens or to phylogenetically related foods from subjects (i) allergic to birch, grass and mugwort pollen, (ii) with food allergy to soy, peanut, tomato, multiple pollen-related foods and (iii) sensitized to LTP. Thirdly, the clinical relevance of IgE-binding was assessed in vivo by skin prick testing (SPT) and open oral food challenges (OFC). RESULTS Profilin and LTP were detected by animal antibodies in all vegetables, a Bet v 1 homologue selectively in hyacinth bean. IgE-binding to LTP, profilin and a Bet v 1 homologue was proven by immunoblot analysis and EAST. Positive SPT and OFC results were observed for all vegetables in pollen-allergic patients. CONCLUSIONS Our stepwise procedure confirmed the presence and IgE-binding capacity of novel vegetable proteins homologous to known allergens in endemic vegetable foods. In vivo testing proved the potential of the novel vegetables to elicit clinical allergy. Hence, our described algorithm seems to be applicable for allergenicity testing of natural novel foods.
Collapse
Affiliation(s)
- M Gubesch
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Lepp US, Holzhauser T, Röder M, Vieths S, Weber W, Brockow K, Fiocchi A, Ballmer-Weber B, Szepfalusi S, Steinke M, Wezel R, Paschke A, Ring J. Symposium 10: Nahrungsmittelallergie. Allergo J 2007. [DOI: 10.1007/bf03370585] [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: 11/30/2022]
|
14
|
Pedersen M, Skov P, Holzhauser T, Bindslev-Jensen C, Brinch D, Poulsen L. Immunochemical and Biological Methods for Estimation of Allergen Content Used for Soy Allergy Risk Assessments of Biotechnologically Derived Products. J Allergy Clin Immunol 2007. [DOI: 10.1016/j.jaci.2006.11.434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
15
|
Holzhauser T, Ballmer-Weber B, Bindslev-Jensen C, Scibilia J, Zisa G, Ortolani C, Mittag D, Petrovskaya O, Utsumi S, Goodman R, Vieths S. Identification of soybean allergens with sera from subjects having a positive DBPCFC or history of anaphylaxis to soy. J Allergy Clin Immunol 2005. [DOI: 10.1016/j.jaci.2004.12.169] [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: 10/25/2022]
|
16
|
Holzhauser T, Mergemeier S, Kuhn M. Analytik und Bedeutung versteckter Allergene in verarbeiteten Lebensmitteln. Akt Ernähr Med 2003. [DOI: 10.1055/s-2003-37990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
17
|
Holzhauser T, Wangorsch A, Vieths S. Polymerase chain reaction (PCR) for detection of potentially allergenic hazelnut residues in complex food matrixes. Eur Food Res Technol 2000. [DOI: 10.1007/s002170000152] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
18
|
Holzhauser T, Vieths S. Quantitative sandwich ELISA for determination of traces of hazelnut (Corylus avellana) protein in complex food matrixes. J Agric Food Chem 1999; 47:4209-4218. [PMID: 10552792 DOI: 10.1021/jf990478q] [Citation(s) in RCA: 39] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A hazelnut-specific sandwich-type ELISA based on polyclonal antisera was developed for detection of hidden hazelnut protein residues in complex food matrixes. In the absence of a food matrix, extractable protein from different native and toasted hazelnuts was detected at rates of 94 +/- 13 and 96 +/- 7% applying standards prepared from native and toasted hazelnuts, respectively. From complex food matrixes, 0.001-10% of hazelnut was recovered between 67 and 132%, in average by 106 +/- 17%. Depending on the food matrix, hazelnut protein could be detected down to the ppb (ng/g) level. Intraassay precision was <6% for hazelnut >/= 0.001% and interassay precision was <15% for hazelnut >/= 0.01%. In 12 of 28 commercial food products without labeling or declaration of hazelnut components, between 2 and 421 ppm of hazelnut protein was detected, demonstrating a remarkable presence of potentially allergenic hazelnut protein "hidden" in commercial food products.
Collapse
Affiliation(s)
- T Holzhauser
- Department of Allergology, Paul-Ehrlich-Institut, Paul-Ehrlich-Strasse 51-59, D-63225 Langen, Germany
| | | |
Collapse
|
19
|
Holzhauser T, Vieths S. Indirect competitive ELISA for determination of traces of peanut (Arachis hypogaea L.) protein in complex food matrices. J Agric Food Chem 1999; 47:603-611. [PMID: 10563939 DOI: 10.1021/jf980775f] [Citation(s) in RCA: 39] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
An indirect competitive ELISA was developed allowing the detection of hidden peanut protein residues down to 2 ppm (micorgrams per gram) in various foods. The high-titer, peanut-specific polyclonal antiserum used recognized potentially allergenic proteins in both native and roasted peanuts. In the absence of a food matrix, extractable protein from roasted peanuts was detected at 104 +/- 13%. From various food items, peanut protein at > or =13 ppm was recovered between 84 and 126%, and at 2 ppm of peanut protein recovery was 143 +/- 6%. Intra- and interassay precision was <15%. In 5 of 17 commercial food products without declaration of peanut components, between 2 and 18 ppm of peanut protein was detected. This is the first assay based on commercially available reactants that allows the reliable determination of trace amounts of hidden peanut allergens in a variety of complex food matrices.
Collapse
Affiliation(s)
- T Holzhauser
- Department of Allergology, Paul-Ehrlich-Institut, Paul-Ehrlich-Strasse 51-59, D-63225 Langen, Germany
| | | |
Collapse
|
20
|
Abstract
Food extracts for diagnostic purposes often lack sufficient activity and consistency. Biologically standardized food extracts are not available on the market. Using extracts from plant-derived foods as examples, we investigated factors which may be important for the quality of such extracts. Divergent allergenic activities were found between strains of apples, but not within varieties of celery tuber (celeriac), hazelnut, and peanut, respectively. Heating of the food remarkably reduced the activity of apple, hazelnut, and celeriac, but had little effect on peanut. By contrast, heating of semipurified protein extracts from celery tuber and apple for 30 min at 100 degrees C did not deplete the immunoreactivity of the major allergens, indicating that this is an inappropriate test for identifying labile food allergens. Due to their high endogenous enzyme activities, apples and other fruits require special extraction procedures applying either low temperature or enzyme inhibitors. Variation of extraction conditions had little effect on the composition and activity of extracts from hazelnut. The storage stability of skin test solutions from plant foods can be improved by avoiding phenol as an additive and by including 50% of glycerol. For model studies considering neoallergens, IgE was raised in mice against native and heated celery tuber, respectively. When extracts from nonthermally and thermally processed celeriac were subjected to an RBL-cell mediator release assay with these sera, an inverse ranking was obtained with anti-heated celeriac IgE and anti-native celeriac IgE, respectively. These data indicated that new epitopes had been formed by the heating process. Since all parameters were tested in model experiments with either human or murine IgE, their relevance has to be proven in further clinical investigations.
Collapse
Affiliation(s)
- S Vieths
- Department of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | | | | | | | | | | |
Collapse
|
21
|
Holzhauser T, Dehne LI, Hoffmann A, Haustein D, Vieths S. Rocket immunoelectrophoresis (RIE) for determination of potentially allergenic peanut proteins in processed foods as a simple means for quality assurance and food safety. ACTA ACUST UNITED AC 1998. [DOI: 10.1007/s002170050203] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|