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Peters RL, Soriano VX, Allen KJ, Tang MLK, Perrett KP, Lowe AJ, Wijesuriya R, Parker KM, Loke P, Dharmage SC, Koplin JJ. The Prevalence of IgE-Mediated Food Allergy and Other Allergic Diseases in the First 10 Years: The Population-Based, Longitudinal HealthNuts Study. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00277-0. [PMID: 38597846 DOI: 10.1016/j.jaip.2024.03.015] [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] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/15/2024] [Accepted: 03/07/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND There are limited longitudinal data on the population prevalence of allergic conditions during childhood, and few studies have incorporated the reference standard oral food challenge to confirm food allergy. OBJECTIVE To describe the population prevalence of IgE-mediated food allergy, eczema, asthma, and rhinitis at ages 6 and 10 years in Melbourne, Australia. METHODS The HealthNuts study recruited 5,276 1-year-old infants in Melbourne, Australia, with repeat assessments at ages 6 and 10 years. At ages 6 and 10 years, carers completed a questionnaire on symptoms and doctor diagnosis of allergic conditions (International Study of Asthma and Allergies in Children). Children were invited to attend a clinic assessment including skin prick test, lung function tests, and oral food challenges when indicated. To minimize the impact of attrition bias, prevalence estimates among participants at ages 6 and 10 years were weighted to reflect characteristics of the whole cohort at recruitment. RESULTS In total, 4,455 and 4,065 families participated at ages 6 and 10 years, respectively (84% and 77% of the original cohort). Of those, 73% and 55% of participants ages 6 and 10 years, respectively, completed clinical assessments. Overall, 36.5% (95% CI, 34.8-38.2) and 38.2% (95% CI, 36.5-40.1%) of 6- and 10-year-olds had at least one current allergic disease, and around one third of those had two or more allergic diseases. Food allergy occurred in 6.4% (95% CI, 5.6-7.2) of 6-year olds and 6.3% (95% CI, 5.5-7.2) of 10-year-olds. Among infants with challenge-confirmed food allergy in infancy, 45% had persistent disease at age 10 years. The prevalence of current diagnosed asthma at ages 6 and 10 years were 12.1% (95% CI, 10.9-13.3) and 13.1% (95% CI, 11.9-14.4), respectively, current eczema decreased slightly from 15.3% (95% CI, 14.1-19.7) at age 6 years to 12.9% (95% CI, 11.7-14.2) at age 10 years, and current rhinitis increased from 15.1% (95% CI, 13.9-16.5) at age 6 years to 25.0% (95% CI, 23.4-26.7) at age 10 years. CONCLUSIONS Allergic diseases affect 40% of primary school-age children; one third have multiple allergic diagnoses. Challenge-confirmed food allergy prevalence remains high, and 45% of infants with food allergy have persistent disease to age 10 years.
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Affiliation(s)
- Rachel L Peters
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
| | - Victoria X Soriano
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Katrina J Allen
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Kirsten P Perrett
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Adrian J Lowe
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rushani Wijesuriya
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Kayla M Parker
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Paxton Loke
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia
| | - Shyamali C Dharmage
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer J Koplin
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
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Kothandaraman K, Mohindra S, Panda NK, Nayak GR, Munjal S. Unveiling the Allergy-Meniere Connection: Exploring the Impact of Allergen Positivity on Meniere's Disease Severity. Indian J Otolaryngol Head Neck Surg 2024; 76:1509-1515. [PMID: 38566680 PMCID: PMC10982253 DOI: 10.1007/s12070-023-04337-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/01/2023] [Indexed: 04/04/2024] Open
Abstract
Meniere's Disease is a rare ear disorder that can cause severe morbidity to the patient and has no definitive treatment to date. Endolymphatic hydrops is the critical event. Though symptomatology is well understood, the exact etiology of Endolymphatic hydrops attack is still unclear. Twenty-five consecutive patients of Meniere's Disease diagnosed in the Vertigo clinic aged 12 to 70 years were included. Their allergic status was evaluated using a skin prick test. Allergic and non-allergic patients were then identified. Comparison between the two groups was made to identify the effect of allergy on the severity of symptoms using vertigo scales, Functional level scale, Dizziness handicap index, and Pure tone average staging. The prevalence of allergy among Meniere's Disease patients was 56%. The most common allergen found in our study was tyrophagus(n = 8). Polysensitization was more common(n = 12). Airborne allergens were more common than food allergens. There was no significant relationship between the severity scales and the allergen positivity status (p > 0.05). The prevalence of allergy is more among patients with Meniere's Disease. The Endolymphatic sac is allergy prone. The occurrence of endolymphatic hydrops may be due to a cross-reaction of allergen-induced IgE antibodies to self-antigen. Management of the specific allergen may help decrease symptomatology in these patients. Allergen-specific therapies have a promising role in the treatment of allergic conditions and provide a long-term symptom-free period in affected individuals. This can be applied in patients with Meniere's Disease having associated allergic features based on their skin prick test results.
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Affiliation(s)
- Kirubakaran Kothandaraman
- Department of Otolaryngology and Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Satyawati Mohindra
- Department of Otolaryngology and Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh Kumar Panda
- Department of Otolaryngology and Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gyana Ranjan Nayak
- Department of Otolaryngology and Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Munjal
- Department of Audiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Airaksinen L, Suojalehto H, Lindström I, Sund J, Pallasaho P, Puustinen A. Characterization of Relevant Bovine Dander Allergen Components. J Investig Allergol Clin Immunol 2024; 34:20-29. [PMID: 36193743 DOI: 10.18176/jiaci.0863] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Diagnostic tests in occupational allergic diseases are highly dependent on the quality of available allergen extracts and specific IgE tests. To enhance diagnostic testing in cattle-related occupational rhinitis, asthma, and urticaria, we produced an in- house cow dander extract, assessed its allergen profile and performance in clinical tests, and compared it with commercial bovine dander extracts. METHODS One hundred patients with a suspected cattle-related occupational disease underwent skin prick tests (SPTs) with in-house and 1 or 2 commercial bovine dander extracts. Nasal allergen provocation tests were performed on 31 patients with suspected occupational rhinitis. We used Western blot to study the specific IgE-protein reactions from the sera of the patients with positive provocation test results and identified allergens from immunoblot bands using tandem mass spectrometry. RESULTS The odorant-binding protein Bos d OBP, bovine serum albumin (Bos d 6), and the lipocalin (Bos d 2) were identified as the major allergens. We found a total of 24 bovine dander allergens, of which several were formerly unknown. The sensitivity and specificity of the in-house extract in SPTs were 100% and 94%, respectively, in 87 patients. The SPT results were negative in 20 healthy controls. Nasal allergen provocation tests with in-house extract detected occupational rhinitis with 100% sensitivity in 21 patients. The provocation results remained negative in 5 healthy controls. CONCLUSIONS Three major and several minor allergens in bovine dander caused occupational rhinitis. Diagnosis of bovine allergen-related occupational diseases requires a sufficient concentration and variety of tested allergens.
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Affiliation(s)
- L Airaksinen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - H Suojalehto
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - I Lindström
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - J Sund
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - P Pallasaho
- Finnish Institute of Occupational Health, Helsinki, Finland
- Western Uusimaa Wellbeing Services County, Western Uusimaa, Finland
| | - A Puustinen
- Finnish Institute of Occupational Health, Helsinki, Finland
- Helsinki University, Helsinki, Finland
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Yuan X, Xie S, Meng L, Zhong W, Zhang H, Wang F, Fan R, Jiang W, Xie Z. Does skin prick test response intensity predict symptom severity and efficacy of subcutaneous immunotherapy in allergic rhinitis? Eur Arch Otorhinolaryngol 2024; 281:767-774. [PMID: 37715808 DOI: 10.1007/s00405-023-08220-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/31/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVES To investigate the effect of response intensity of allergen skin prick test (SPT) on symptom severity and long-term efficacy of dust mite subcutaneous immunotherapy (SCIT) in allergic rhinitis (AR). METHODS AR Patients diagnosed with dust mite allergy and completed 3 years of SCIT were collected and classified into three groups: grade 2 (SPT of + +), grade 3 (SPT of + + +) and grade 4 (SPT of + + + +). Comparisons between groups were performed to examine the associations of SPT categories and symptom severity and the long-term efficacy of SCIT in AR. RESULTS 181 AR patients were included. There was no significant difference in the baseline TNSS, SMS, RQLQ and VAS, and particularly to symptom severity grading among three SPT grade groups (P > 0.05). The moderate-severe AR was more likely to be smoking and accompany with asthma and had higher prevalence of sensitization to cockroach, mixed grass and tree pollen than mild AR (P < 0.05). Prevalence of sensitization to cockroach, mixed grass, ragweed and animal dander was increased in AR patients with asthma and allergic conjunctivitis (P < 0.05). Furthermore, after 3 years of SCIT, no statistical differences in TNSS, SMS, RQLQ, VAS and long-term efficacy were observed among the three SPT grade groups (P > 0.05). Similarly, long-term outcomes of patients with different SPT grades did not differ among different clinical characteristics and different efficacy determination criteria (P > 0.05). CONCLUSIONS The SPT response intensity cannot be used as an objective evaluation index for symptom severity and the long-term efficacy of SCIT in AR patients.
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Affiliation(s)
- Xuan Yuan
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Kaifu District, Changsha, 410008, People's Republic of China
- Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Shaobing Xie
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Kaifu District, Changsha, 410008, People's Republic of China
- Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Lai Meng
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Kaifu District, Changsha, 410008, People's Republic of China
- Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Wei Zhong
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Kaifu District, Changsha, 410008, People's Republic of China
- Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Hua Zhang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Kaifu District, Changsha, 410008, People's Republic of China
- Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Fengjun Wang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Kaifu District, Changsha, 410008, People's Republic of China
- Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Ruohao Fan
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Kaifu District, Changsha, 410008, People's Republic of China
- Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Weihong Jiang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Kaifu District, Changsha, 410008, People's Republic of China.
- Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China.
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, People's Republic of China.
| | - Zhihai Xie
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Kaifu District, Changsha, 410008, People's Republic of China.
- Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China.
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, People's Republic of China.
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Lee YZ, Kow ASF, Jacquet A, Lee MT, Tham CL. House dust mite allergy in Malaysia: review of research gaps in the current scenario and the way forward. Exp Appl Acarol 2023; 91:509-539. [PMID: 37995026 DOI: 10.1007/s10493-023-00857-5] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/20/2023] [Indexed: 11/24/2023]
Abstract
The prevalence of house dust mite (HDM) allergy, especially in Asian countries with rapid urbanization, has been increasing. House dust mites thrive in places with relatively high humidity. With the combination of climate change, naturally high humidity, and urbanization, tropical countries like Malaysia are becoming a hotspot for HDM allergy fast. With a previously reported sensitization rate of between 60 and 80%, it is a worrying trend for Malaysia. However, due to incomplete and out-of-date data, as seen by the limited study coverage in the past, these numbers do not paint a complete picture of the true HDM allergy scene in Malaysia. This review briefly discusses the HDM fauna, the HDM sensitization rate, the common diagnosis and therapeutic tools for HDM allergy in Malaysia, and makes suggestions for possible improvements in the future. This review also highlights the need of more comprehensive population-based prevalence studies to be done in Malaysia, encompassing the three main HDMs-Dermatophagoides pteronyssinus, Dermatophagoides farinae, and Blomia tropicalis-as the lack of up-to-date studies failed to give a clearer picture on the current scenario of HDM allergy in Malaysia. Future studies will be beneficial to the nation in preparing a better blueprint for the management and treatment of HDM allergy.
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Affiliation(s)
- Yu Zhao Lee
- Office of Postgraduate Studies, UCSI University, 56000, Kuala Lumpur, Malaysia
| | | | - Alain Jacquet
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Ming Tatt Lee
- Faculty of Pharmaceutical Sciences, UCSI University, 56000, Kuala Lumpur, Malaysia
- Graduate Institute of Pharmacology, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan
- Centre of Research for Mental Health and Wellbeing, UCSI University, 56000, Kuala Lumpur, Malaysia
| | - Chau Ling Tham
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Malaysia.
- Natural Medicines and Products Research Laboratory, Institute of Bioscience, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
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Brettig T, Soriano VX, Dharmage SC, McWilliam V, Peters RL, Perrett K, Koplin JJ. Cashew Allergy Prevalence and Sensitization in 1-Year-Old Infants. J Allergy Clin Immunol Pract 2023; 11:3478-3484.e5. [PMID: 37481112 DOI: 10.1016/j.jaip.2023.07.019] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Cashew allergy is the most common tree nut allergy in Australia, but there are limited data on the population-level prevalence and risk factors. OBJECTIVE Describe the prevalence of cashew sensitization and allergy in 12-month-old infants and identify risk factors. METHODS Data were from the EarlyNuts cohort, a population-based sample of infants recruited in Melbourne, Australia. Families completed a questionnaire and infants underwent a skin prick test (SPT) to cashew. Infants with positive SPTs were offered food challenges. Questionnaires collected demographic data and allergy risk factors. Allergy outcomes were determined by challenge outcomes or a convincing history of an allergic reaction. We used weights to adjust estimated prevalence to reflect the distribution of risk factors among the combined sample of participants and nonparticipants. RESULTS We recruited 1,933 participants and identified 1,414 cashew allergy outcomes. Of these, 1.96% (95% CI, 1.28-2.99) had an SPT result of 3 mm or greater and 1.49% (95% CI, 0.91-2.44) were allergic to cashew. Infants with eczema or peanut allergy in the first year of life were more likely to be allergic to cashew (adjusted odds ratio = 5.75; 95% CI, 2.08-15.88; P = .001; and adjusted odds ratio = 19.30; 95% CI, 5.44-68.43; P < .001, respectively). Twenty-five percent of participants had cashew introduced before 12 months (95% CI, 22.7-27.8). There was no association between the timing of cashew introduction and cashew allergy. CONCLUSIONS To our knowledge, this is the first study describing the prevalence of and risk factors for cashew allergy in a population-based infant cohort. Eczema and peanut allergy were associated with an increased risk of cashew allergy. Few infants were introduced to cashew before age 12 months, which suggests that infant feeding guidelines have not yet translated to the earlier introduction of all allergens.
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Affiliation(s)
- Tim Brettig
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia; Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia
| | - Victoria X Soriano
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia; School of Population and Global Health, University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - Vicki McWilliam
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Melbourne, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia
| | - Rachel L Peters
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - Kirsten Perrett
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia; Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Melbourne, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia
| | - Jennifer J Koplin
- Population Allergy Group, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia; Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia; Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia.
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Kothandarama K, Mohindra S, Arungovind K, Mahendru S. Prevelance of Common Aeroallergens in Allergic Rhinitis and its Correlation with Bronchial Asthma: A Study on 798 Patients by Skin Prick Test. Indian J Otolaryngol Head Neck Surg 2023; 75:1651-1659. [PMID: 37636627 PMCID: PMC10447666 DOI: 10.1007/s12070-023-03643-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 02/26/2023] [Indexed: 08/29/2023] Open
Abstract
Allergic rhinitis affects 30% of the Indian population (Dey et al. in Int Arch Allergy Immunol 178:60-65, 2019). Patients can be sensitive to single or multiple allergens. Polysensitization is more common (Bousquet et al. in Ann Epidemiol 20:797-803, 2010; Arbes et al. in J Allergy Clin Immunol 116:377-383, 2005). Sensitization to multiple allergens may have a role in the severity and the association of Asthma in such patients. A total of 798 patients with allergic rhinitis (SFAR ≥ 7) were included. Disease severity and associated symptoms were evaluated using questionnaire. Each patient underwent a Skin prick test with an allergen panel of 35 allergens each (Annesi-Maesano et al. in Allergy 57:107-114, 2002) and the results were evaluated to study the association of asthma and severity of Allergic rhinitis. Data consisting of 389 (48.7%) males and 409 (51.3%) females were assessed. A total of 82.2% of the study population of symptomatic patients were sensitized to at least one of the allergens. Seventy patients (8.78%) had associated asthma. Forty-four patients were polysensitized and fifteen were mono sensitized. Among polysensitized patients, 36 patients had sensitization to at least 6 different allergens. Dermatophagoides pteronyssinus was the most common allergen among asthma patients. This study provides a thorough knowledge of locally prevalent aeroallergens which is essential for the prompt diagnosis and treatment of allergic patients. Skin prick test can be a non-invasive vital tool in analyzing patterns of allergen exposure, the prevalence of allergen, sensitizing potential of different allergens in that specific geographic area.
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Affiliation(s)
| | - Satyawati Mohindra
- Department of Otolaryngology, Head and Neck Surgery, Pgimer, Chandigarh India
| | - K. Arungovind
- Department of Otolaryngology, Head and Neck Surgery, Pgimer, Chandigarh India
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Yang L, Li W, Qi S, Jiang Q, Huang N, Yang Y, Ma D, Zhang W, Chen H, Zhu R. A Survey of Airborne Fungi and Their Sensitization Profile in Wuhan, China. Int Arch Allergy Immunol 2023; 184:1153-1164. [PMID: 37611554 DOI: 10.1159/000531245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 02/16/2023] [Accepted: 05/09/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION Airborne fungi induce allergic symptoms in 3-10% of the population worldwide. To better prevent and manage fungi-related allergic diseases, it is essential to identify the genus and the distribution profile of airborne fungi. METHODS With this purpose in mind, we carried out a 12-month volumetric sampling study to monitor the airborne fungi and retrospectively analyzed the sensitization profile of four dominant fungi (Cladosporium, Alternaria, Aspergillus, and Penicillium) among respiratory allergies during the same study period in Wuhan, China. RESULTS A total of 29 different fungal genuses were identified, and the peak fungal concentration period was found to be in September and October, followed by May and June. The most prevalent fungi in this area were Cladosporium (36.36%), Ustilago (20.12%), and Alternaria (13.87%). In addition, the skin prick test data from 1,365 respiratory allergies patients showed that 202 (14.80%) of them were sensitized to fungi. The sensitization rates to Cladosporium, Alternaria, Aspergillus, and Penicillium were 11.72%, 4.69%, 1.98%, and 4.76%, respectively. The seasonal fluctuation of Alternaria and Aspergillus correlated with their sensitization rates. Among the fungal sensitized patients, 76 (37.62%) were sensitized to two or more kinds of fungi. The serum-specific IgE tests suggested low to high correlations existed between these fungi; however, these correlations were not found between fungi and other allergens. CONCLUSION Our study provides the distribution profile and reveals the clinical significance of the airborne fungi in Wuhan, which will facilitate the precise management of fungal allergy.
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Affiliation(s)
- Lin Yang
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,
- Institute of Allergy and Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,
| | - Wenjing Li
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shanshan Qi
- Department of Allergy, Wuhan No. 1 Hospital, Wuhan, China
| | - Qing Jiang
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nan Huang
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaqi Yang
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongxia Ma
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Zhang
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Chen
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Allergy and Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rongfei Zhu
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Allergy and Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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9
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Jarupund P, Jantrakulroj P, Suwanphakdee C, Sinthuvanich C. A Pilot Study to Identify Grass Species That Mediate Pollen Allergy in Thailand. Int Arch Allergy Immunol 2023; 184:875-881. [PMID: 37402353 DOI: 10.1159/000530976] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/28/2023] [Indexed: 07/06/2023] Open
Abstract
INTRODUCTION Some grass species that are either common or widely spread in Thailand have not been used for pollen allergy diagnosis. In order to improve diagnostic accuracy, the aim of this pilot study was to identify the grass species responsible for pollen allergy in Thailand. METHODS The skin sensitization of pollen extracts from six different grass species, including rice (Oryza sativa), corn (Zea mays), sorghum (Sorghum bicolor), para grass (Urochloa mutica), ruzi grass (Urochloa eminii), and green panic grass (Megathyrsus maximus), was evaluated by skin prick test (SPT). Serum's IgE specific to each pollen extract was analyzed by Western blot (WB). The ImmunoCAPTM test for Johnson grass was also evaluated. RESULTS Of the thirty-six volunteers who participated in this study, eighteen tested positive for at least one of the diagnostic tests, namely SPT, WB analysis, or ImmunoCAPTM. Notably, skin reactivity to para grass, corn, sorghum, and rice was more commonly observed compared to ruzi grass and green panic grass. However, in the WB analysis, individuals with pollen-specific IgE were more frequently detected in sorghum, green panic grass, corn, rice, and ruzi grass than para grass. CONCLUSION In this pilot investigation, our findings indicate that the pollen extracts of rice, corn, sorghum, and para grass are associated with pollen allergy in Thailand. These results contribute to the current knowledge on the identification of grass species that are associated with pollen allergy in Thailand and Southeast Asia.
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Affiliation(s)
- Pakawat Jarupund
- Department of Botany, Faculty of Science, Kasetsart University, Bangkok, Thailand
| | | | | | - Chomdao Sinthuvanich
- Department of Biochemistry, Faculty of Science, Kasetsart University, Bangkok, Thailand
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10
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Devonshire A, Gautam Y, Johansson E, Mersha TB. Multi-omics profiling approach in food allergy. World Allergy Organ J 2023; 16:100777. [PMID: 37214173 PMCID: PMC10199264 DOI: 10.1016/j.waojou.2023.100777] [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: 11/30/2022] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 05/24/2023] Open
Abstract
The prevalence of food allergy (FA) among children is increasing, affecting nearly 8% of children, and FA is the most common cause of anaphylaxis and anaphylaxis-related emergency department visits in children. Importantly, FA is a complex, multi-system, multifactorial disease mediated by food-specific immunoglobulin E (IgE) and type 2 immune responses and involving environmental and genetic factors and gene-environment interactions. Early exposure to external and internal environmental factors largely influences the development of immune responses to allergens. Genetic factors and gene-environment interactions have established roles in the FA pathophysiology. To improve diagnosis and identification of FA therapeutic targets, high-throughput omics approaches have emerged and been applied over the past decades to screen for potential FA biomarkers, such as genes, transcripts, proteins, and metabolites. In this article, we provide an overview of the current status of FA omics studies, namely genomic, transcriptomic, epigenomic, proteomic, exposomic, and metabolomic. The current development of multi-omics integration of FA studies is also briefly discussed. As individual omics technologies only provide limited information on the multi-system biological processes of FA, integration of population-based multi-omics data and clinical data may lead to robust biomarker discovery that could translate into advances in disease management and clinical care and ultimately lead to precision medicine approaches.
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Affiliation(s)
- Ashley Devonshire
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Yadu Gautam
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Elisabet Johansson
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tesfaye B. Mersha
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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11
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Cichocka-Jarosz E, Brzyski P, Jedynak-Wąsowicz U, Mól N, Klasa B, Mazurek-Durlak Z, Lis G, Nowak-Węgrzyn A. Skin prick tests are not useful for the qualification for venom immunotherapy in children. World Allergy Organ J 2023; 16:100775. [PMID: 37351272 PMCID: PMC10282561 DOI: 10.1016/j.waojou.2023.100775] [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: 10/12/2022] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 06/24/2023] Open
Abstract
Background The basis for qualification for venom immunotherapy (VIT) is the fulfilment of both the clinical and immunological criteria. Diagnostic tests that confirm the immunological criterion of an IgE-mediated sensitization include skin prick tests (SPT), intradermal tests (IDT), and serum specific IgE (sIgE) for the culprit venom. Objective This study aimed to assess the usefulness of SPT as the immunological marker in the diagnosis of insect venom sensitization in children with history of systemic reaction (SR) to insect sting evaluated by means of I-IV-grades Mueller's scale. There are no such studies in children. Methods This cross-sectional study sample consisted of 416 children aged 3-18 years (mean age 10.6 ± 3.8), 76% males, all with the history of a systemic reaction (SR) after a Hymenoptera sting (48% of grade III/IV according to Mueller scale), diagnosed between 1999 and 2019 in the tertiary referral centre. The standard diagnostic tests were used. Specificity, sensitivity, and positive and negative predictive values were computed to assess the diagnostic properties of the clinical tests to distinguish between mild and severe SR. To assess the relative value of an individual test in predicting the qualification to VIT we incorporated the Shapley value (SV). Results Positive SPT results were found in up to no more than 3% of children; among them less than 1% had only positive SPT and were negative for sIgE and IDT. Approximately 85% of the children had detectable venom sIgE, followed by positive IDT (75%). Almost 70% of children had positive both sIgE and IDT results. In children with grade III/IV reaction, about 80% of children had positive results of both of these tests. sIgE and IDT had sensitivity >0.80, whereas SPT had high specificity (>0.97) in differentiating between mild and severe SR. Relative value of diagnostic tests in predicting qualification to VIT varied between venoms. Bee venom IDT had higher SV (0.052) than sIgE (0.041). In contrast, wasp venom sIgE had higher SV (0.075) than IDT (0.035). Conclusion SPTs are not an useful immunological marker of venom sensitization in children, and eliminating SPT does not result in a loss of diagnostic accuracy. Limiting diagnostics to venom sIgE and IDT would shorten the procedure and reduce costs. Future studies are needed to determine if venom sIgE as the first line diagnostic test, with IDT added only if the venom sIgE is undetectable, is an optimal diagnostic process.
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Affiliation(s)
- Ewa Cichocka-Jarosz
- Department of Paediatrics, Jagiellonian University Medical College, 265 Wielicka St, 30-663 Krakow, Poland
| | | | - Urszula Jedynak-Wąsowicz
- Department of Paediatrics, Jagiellonian University Medical College, 265 Wielicka St, 30-663 Krakow, Poland
| | - Nina Mól
- Department of Paediatrics, Jagiellonian University Medical College, 265 Wielicka St, 30-663 Krakow, Poland
| | - Barbara Klasa
- Department of Paediatrics, Jagiellonian University Medical College, 265 Wielicka St, 30-663 Krakow, Poland
| | - Zofia Mazurek-Durlak
- Department of Paediatrics, Jagiellonian University Medical College, 265 Wielicka St, 30-663 Krakow, Poland
| | - Grzegorz Lis
- Department of Paediatrics, Jagiellonian University Medical College, 265 Wielicka St, 30-663 Krakow, Poland
| | - Anna Nowak-Węgrzyn
- Department of Pediatrics at NYU Grossman School of Medicine, New York, USA
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Pemberton MA, Kreuzer K, Kimber I. Challenges in the classification of chemical respiratory allergens based on human data: Case studies of 2-hydroxyethylmethacrylate (HEMA) and 2-hydroxypropylmethacrylate (HPMA). Regul Toxicol Pharmacol 2023; 141:105404. [PMID: 37105297 DOI: 10.1016/j.yrtph.2023.105404] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 04/29/2023]
Abstract
Occupational asthma resulting from workplace exposure to chemical respiratory allergens is an important disease. No widely accepted or formally validated tests for the identification of chemical respiratory sensitizers. Consequently, there is a heavy reliance on human data from clinical examinations. Unfortunately, however, although such investigations are critical for the diagnosis of occupational asthma, and in guiding remedial actions, they do not reliably identify specific chemicals within the workplace that are the causative agents. There are several reasons for this, including the fact that specific inhalation tests conducted as part of clinical investigations are frequently performed with complex mixtures rather than single substances, that sometimes inhalation challenges are conducted at concentrations above the OEL and STEL, where effects may be confounded by irritation, and that involvement of immune mechanisms cannot be assumed from the observation of late asthmatic reactions. Further, caution should be taken when implicating substances on lists of "recognised" asthmagens unless they have undergone a formal weight of evidence assessment. Here the limitations of clinical investigations as currently performed for the purposes of regulatory classification and decision making are explored by reference to previously published case studies that implicate 2-hydroxyethylmethacrylate (HEMA) and/or 2-hydroxypropylmethacrylate (HPMA) as respiratory allergens.
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Affiliation(s)
| | | | - Ian Kimber
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Shafi T, Rasool R, Ayub S, Bhat IA, Shah IH, Hussain S, Shah ZA, Baba SM, Makhdoomi R, Bashir SA. Unveiling the TGF- β1 paradox: Significant implication of TGF- β1 promoter variants and its mRNA and protein expression in atopic dermatitis. Mol Immunol 2023; 157:214-224. [PMID: 37084506 DOI: 10.1016/j.molimm.2023.04.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Atopic Dermatitis (AD) is a chronic inflammatory skin disorder with evidence of lichenification in later stages. There is mounting evidence supporting the role of TGF- β1 in mediating inflammation as well as subsequent tissue remodeling, often resulting in fibrosis. Given the role of genetic variants in the differential expression of TGF-β1 in various diseases, this study seeks to ascertain the role of TGF-β1 promoter variants (rs1800469 and rs1800468) in AD susceptibility, as well as their association with TGF- β1 mRNA expression, TGF- β1 serum levels and skin prick test positivity in Atopic Dermatitis patients. METHODS An aggregate of 246 subjects including 134 AD cases and 112 matched healthy controls were genotyped for TGF-β1 promoter polymorphisms by PCR-RFLP. TGF- β1 mRNA was quantified by quantitative Real-Time PCR (qRT-PCR), Vitamin-D levels by chemiluminescence, and serum TGF- β1, and total IgE levels were determined by ELISA. In-vivo allergy testing was performed for the evaluation of allergic reactions to house dust mites and food allergens. RESULTS A higher frequency of TT genotypes of rs1800469 (OR = 7.7, p = 0.0001) and GA+AA genotypes of rs1800468 (OR-4.4, p < 0.0001) were observed in AD cases than those in controls. Haplotype analysis demonstrated that TG haplotype carriers had an increased risk of AD (p = 0.013). Quantitative analysis revealed a significant upregulation of both mRNA (p = 0.0002) and serum levels (p < 0.0001) of TGF- β1 with a substantial positive correlation between them (Correlation coefficient=0.504; p = 0.01). Moreover, serum TGF-β1 levels were associated with quality of life (p = 0.03), the severity of the disease (p = 0.03), and House dust mite allergy (p = 0.01) whereas TGF-β1 mRNA levels positively correlated with disease severity(p = 0.02). Stratification analysis revealed that the TT genotype of rs1800469 was associated with higher IgE levels (p = 0.01) and eosinophil percentage(p = 0.007) whereas the AA genotype of rs1800468 correlated with elevated serum IgE levels (p = 0.01). Besides, no significant association of genotypes with mRNA and serum expression of TGF-β1 was observed. CONCLUSION Our study indicates that TGF-β1 promoter SNPs bear a significant risk of AD development. Moreover, upregulation of TGF-β1 mRNA and serum levels and their association with disease severity, quality of life, and HDM allergy suggests its role as a diagnostic/prognostic biomarker that could help in the development of new therapeutic and prevention strategies.
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Affiliation(s)
- Tabasum Shafi
- Department of Immunology & Molecular Medicine, SKIMS, Srinagar 190011, India
| | - Roohi Rasool
- Department of Immunology & Molecular Medicine, SKIMS, Srinagar 190011, India.
| | - Sakeena Ayub
- Department of Immunology & Molecular Medicine, SKIMS, Srinagar 190011, India
| | - Imtiyaz A Bhat
- Department of Immunology & Molecular Medicine, SKIMS, Srinagar 190011, India
| | - Iffat Hassan Shah
- Department of Dermatology, Venereology, and Leprosy, GMC- Srinagar 190010, India
| | - Showkat Hussain
- Department of Immunology & Molecular Medicine, SKIMS, Srinagar 190011, India
| | - Zafar A Shah
- Department of Immunology & Molecular Medicine, SKIMS, Srinagar 190011, India
| | - Shahid M Baba
- Department of Immunology & Molecular Medicine, SKIMS, Srinagar 190011, India
| | | | - Sheikh Adil Bashir
- Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar 190011, India
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Patel K, Gupta N, Prajapati BJ, Prajapati A, Sharma S, Rathava D. Study on Effects of Sublingual Immunotherapy in Allergic Rhinitis Patients. Indian J Otolaryngol Head Neck Surg 2023; 75:804-808. [PMID: 37206799 PMCID: PMC10188826 DOI: 10.1007/s12070-022-03366-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/04/2022] [Indexed: 12/30/2022] Open
Abstract
Allergic Rhinitis is one of the most common allergic disease and characterized by sneezing, rhinorrhea, nasal congestion and nasopharyngeal itching. The initial management includes pharmacological treatment and the patients who are refractory to pharmacological treatment are then reffered for immunotherapy. SLIT has been widely used for treatment of allergic rhinitis and has proven its clinical efficacy. The objective of the present study was to assess the clinical effects, safety and tolerability of sublingual immunotherapy (SLIT) among the patients suffering from allergic rhinitis. The study was conducted from Aug 2018 to April 2021 and 40 patients with convincing history, positive skin prick test to one or more allergen extracts were recruited. SLIT was conducted with antigens (mix), namely dust mites, tree pollens, grass pollens and weed pollens in patients of allergic rhinitis for 1 year. There was significant improvement in quality of life and symptoms severity(Nasal and Non-Nasal) from base line to end of 1 year. SLIT lowers the total IgE, absolute eosinophilic count and medication requirement. Sublingual Immunotherapy for specific allergens decreases clinical symptoms in patients with allergic rhinitis and sensitivity to multiple allergen.
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Affiliation(s)
- Keval Patel
- Department of OtoRhinoLaryngology Civil Hospital, Ahmedabad, Gujarat India
| | - Nandini Gupta
- Department of OtoRhinoLaryngology Civil Hospital, Ahmedabad, Gujarat India
| | - Bela J. Prajapati
- Department of OtoRhinoLaryngology Civil Hospital, Ahmedabad, Gujarat India
| | - Arpit Prajapati
- Department of OtoRhinoLaryngology Civil Hospital, Ahmedabad, Gujarat India
| | - Shweta Sharma
- Department of OtoRhinoLaryngology Civil Hospital, Ahmedabad, Gujarat India
| | - Dhara Rathava
- Department of OtoRhinoLaryngology Civil Hospital, Ahmedabad, Gujarat India
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Sikdar A, Suda A, Phatak S, Nivsarkar S, Agarwal R. Pattern of Food Allergen Sensitivity Amongst Adult Allergic Rhinitis Patients: A Four Year Central Indian Study. Indian J Otolaryngol Head Neck Surg 2023; 75:994-1002. [PMID: 37206762 PMCID: PMC10188673 DOI: 10.1007/s12070-023-03544-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/29/2023] [Indexed: 02/16/2023] Open
Abstract
AIMS Only limited Indian data is available regarding the food allergy pattern among allergic rhinitis patients in Indian population. This study aims to assess the pattern of food allergen sensitivity amongst allergic rhinitis patients in central India. MATERIAL AND METHODS A total of 218 subjects with allergic rhinitis were enrolled in the study (from May 2018 to August 2022). Skin prick test was done in all subjects with proper technique and precautions by using 125 common food allergens and 75 aero allergens. The test readings were noted after 20 minutes by comparing the wheals so formed with the negative control of Saline and positive control of Histamine. Any reaction with a wheal diameter of 3mm or greater was considered as positive. RESULTS While test results of both food and inhalant allergens were issued to individual patients, this study was restricted to detection and analysis of pattern of food allergens. Our study observed male preponderance with predominantly a third decade affliction. The most common food allergen in the study population was beetle nut (29.3%) followed by chilli powder and spinach (28.8% each). CONCLUSION Along with aeroallergens, food allergens are also important provocateurs of allergic rhinitis. Diagnosing the offending food allergens and its avoidance reduces patient morbidity, need for pharmaceutical agents and subsequently drug dependence and its side effects. Offering subjects a replacement diet with food items of similar taste and nutritive character helps in sustainable avoidance therapy.
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Affiliation(s)
- Abhik Sikdar
- Department of ENT, Choithram Hospital and Research Center, Flat no 902, Block A3, Avasa Housing, Opp Phalbag, AB Road, 452012 Indore, MP India
| | - Anuja Suda
- Department of ENT, Choithram Hospital and Research Center, Flat no 902, Block A3, Avasa Housing, Opp Phalbag, AB Road, 452012 Indore, MP India
| | - Shrikant Phatak
- Department of ENT, Choithram Hospital and Research Center, Flat no 902, Block A3, Avasa Housing, Opp Phalbag, AB Road, 452012 Indore, MP India
| | - Sameer Nivsarkar
- Department of ENT, Choithram Hospital and Research Center, Flat no 902, Block A3, Avasa Housing, Opp Phalbag, AB Road, 452012 Indore, MP India
| | - Richa Agarwal
- Department of ENT, Choithram Hospital and Research Center, Flat no 902, Block A3, Avasa Housing, Opp Phalbag, AB Road, 452012 Indore, MP India
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Teo YX, Friedmann PS, Polak ME, Ardern-Jones MR. Utility and Safety of Skin Tests in Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS): A Systematic Review. J Allergy Clin Immunol Pract 2023; 11:481-491.e5. [PMID: 36154897 DOI: 10.1016/j.jaip.2022.09.011] [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] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 08/10/2022] [Accepted: 09/11/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Determination of culprit drug in drug reaction with eosinophilia and systemic symptoms (DRESS) is crucial. Skin tests have been used, although it remains unclear how sensitive these are. OBJECTIVE To determine the value of skin tests in the assessment of drug causality in DRESS. METHODS A systematic literature search was conducted for publications from 1996 onward of skin tests (skin prick test = SPT, patch test = PT, intradermal test = IDT) performed in clearly defined DRESS cases. Outcomes of testing, drug culpability assessments, and challenge test data were extracted. RESULTS A total of 17 articles met inclusion criteria. In 290 patients with DRESS, patch testing was most frequent (PT = 97.2% [n = 282], IDT = 12.4% [n = 36], SPT = 3.1% [n = 9]). Positive results were noted in 58.4% (n = 160 of 282) of PTs, 66.5% of IDTs, and 25% of SPTs. When confidence of drug causality was high (n = 73 of 194), testing did not correlate well with clinical suspicion: PTs, 37.6%; IDTs, 36.5%. Direct comparison of skin testing with provocation testing (n = 12) showed 83.3% correlation. Positive IDT results were reported in 8 negative PT cases. CONCLUSIONS Skin tests, particularly PTs and IDTs, have been reported as tools for diagnosis of causal drugs in DRESS. Heterogeneity in methodology, results analysis, and reporting of cohorts make meta-analysis to determine sensitivity and specificity of published literature impossible and highlight weaknesses in the field. We propose that international collaboration is essential to harmonize the methodology and reporting measures from hypersensitivity testing studies in larger cohorts.
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Affiliation(s)
- Ying Xin Teo
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Department of Dermatology, Southampton General Hospital, University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Peter Simon Friedmann
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Department of Dermatology, Southampton General Hospital, University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Marta Ewa Polak
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Michael Roger Ardern-Jones
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Department of Dermatology, Southampton General Hospital, University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom.
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Usha G, Pal I, Kumar S, Mondal B, Basu G. Assessment of Nasal Smear Eosinophil Counts in Allergic Rhinitis: How Useful is it? Indian J Otolaryngol Head Neck Surg 2022; 74:540-546. [PMID: 36514434 PMCID: PMC9741681 DOI: 10.1007/s12070-022-03109-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 05/09/2022] [Indexed: 12/15/2022] Open
Abstract
Objectives: The aim was to find the relationship between nasal smear eosinophil (NSE) counts and allergic rhinitis (AR) along with the impact of treatment on peak nasal inspiratory flow rates and symptom scores in these patients. Material and methods: An observational, comparative study was carried out with 75 patients of AR. Nasal smears were drawn and eosinophil counts were estimated. Nasal symptoms were assessed and compared by visual analogue scale (VAS) and peak nasal inspiratory flow (PNIF) rates before and after treatment. Equal number of healthy individuals formed the control group. Results: There was a strong association between increase in eosinophil count in nasal smears and AR (p = 0.000). A NSE count of 0.2/HPF had a specificity of 98.7%, sensitivity of 53.3%, and positive predictive value of 97.6% in the diagnosis of AR. The mean VAS scores for nasal obstruction improved from 7.35 to 1.01 and the mean peak nasal inspiratory flow from 69.00 L/min to 103.73 L/min (p < 0.0001) after treatment. The mean NSE counts reduced from 4.20/HPF to 0.090/HPF proving a strong correlation between improvement of symptom scores and NSE counts (p = 0.000) in AR. The study also determined that a PNIF value of ≤ 77.50 L/min can be used as a cut off for diagnosing nasal obstruction in these patients. Conclusion: A NSE count of ≥ 0.2 /HPF is to be considered as diagnostic of AR. Nasal congestion is the commonest symptom associated with AR and addition of systemic decongestant is required for management of these patients.
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Affiliation(s)
- G. Usha
- Department of Otorhinolaryngology, Swami Vivekananda Medical College, Hospital and Research Institute, Unjanai, Elayampalayam, Tiruchangode, Tamil Nadu 637205 India
| | - Indranil Pal
- Department of ENT, Head and Neck Surgery, College of Medicine and JNM Hospital, Kalyani, Nadia district, West Bengal 741235 India
| | - Saumitra Kumar
- Department of ENT, Head and Neck Surgery, College of Medicine and JNM Hospital, Kalyani, Nadia district, West Bengal 741235 India
| | - Bibhas Mondal
- Department of ENT, Head and Neck Surgery, College of Medicine and JNM Hospital, Kalyani, Nadia district, West Bengal 741235 India
| | - Gandhari Basu
- Department of ENT, Head and Neck Surgery, College of Medicine and JNM Hospital, Kalyani, Nadia district, West Bengal 741235 India
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Palliyalthodi RH, Datta B, Thomas AM, Kamala R, Poojari BA, Manjula BV, Rao UW. Minimum Allergen Screening Panel for Allergic Rhinitis in Bangalore: A Cross Sectional Study. Indian J Otolaryngol Head Neck Surg 2022; 74:1202-1206. [PMID: 36452631 PMCID: PMC9701987 DOI: 10.1007/s12070-020-02280-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022] Open
Abstract
Allergic rhinitis (AR) is a very common condition presenting to an Otorhinolaryngologist. Prevalence of AR is on the increase and it has significant impact on quality of life of the patient. Skin prick test (SPT) is a simple test to determine allergen sensitization status in patients with AR. There is wide variation in allergen panel used in SPT among various allergy clinics and many centres use a large panel of allergens which requires multiple skin pricks for the patient undergoing the test. Our aim was to identify a minimum panel of allergens among patients with symptoms of AR undergoing SPT which could be used as a screening panel for AR. The present study is a cross sectional study in patients with symptoms of AR undergoing SPT at Allergy clinic of Bangalore Baptist hospital over a period of 18 months from January 2018. 149 patients were included in the study and 26 patients who had negative SPT for all allergens tested were excluded. Prevalence of sensitization for individual allergens was calculated. House dust mite (Dermatophagoides pteronyssinus and Dermatophagoides farinae) was the most prevalent allergen to which 73.9% and 65.8% of our study population was sensitized respectively. We identified a minimum allergen panel of 3 allergens (Dermatophagoides pteronyssinus, Lambs quarter and Dermatophagoides farinae) which could identify > 90% of patients sensitized in the study group.
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Affiliation(s)
- Rafees Hassan Palliyalthodi
- Department of ENT, Bangalore Baptist Hospital, Hebbal, Bangalore, India
- NIBRAS, 38/919 A1, Athanikkal, Westhill, Calicut, Kerala 673005 India
| | - Badari Datta
- Department of ENT, Bangalore Baptist Hospital, Hebbal, Bangalore, India
| | | | - R. Kamala
- Department of ENT, Bangalore Baptist Hospital, Hebbal, Bangalore, India
| | - Brinda A. Poojari
- Department of ENT, Bangalore Baptist Hospital, Hebbal, Bangalore, India
| | - B. V. Manjula
- Department of ENT, Bangalore Baptist Hospital, Hebbal, Bangalore, India
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19
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Katoch C, Kumar K, Marwah V, Bhatti G. Pattern of skin sensitivity to various aeroallergens by skin prick test in patients of allergic airway disease in South Western Maharashtra. Med J Armed Forces India 2022; 78:400-404. [PMID: 36267511 PMCID: PMC9577266 DOI: 10.1016/j.mjafi.2020.06.011] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022] Open
Abstract
Background The prevalence of allergic diseases such as asthma and allergic rhinitis is high in the general population, and aeroallergens are the most common allergens that cause airway inflammation. Skin prick testing (SPT) is a validated method to diagnose IgE-mediated allergic diseases. The knowledge of allergen sensitivity pattern in this part of India is limited. The present study was undertaken to identify common aeroallergens prevalent in this area using a standardized SPT. Methods We did a cross-sectional hospital-based study. A total of 330 patients of proven allergic airway disease underwent SPT. We used a validated skin prick test which included 22 allergen extracts, 1 positive control, and 1 negative control. Results A total of 327 patients were included in the study. Two hundred seventy-one (82.27%, n = 327) patients had a positive SPT to one or more aeroallergen extract. The sensitivity of Dermatophagoides pteronyssinus (49.85%) was seen in the maximum number of people followed by Dermatophagoides farinae (47.70%). Conclusions In our study, dust mites were the most common aeroallergen seen in maximum study subjects.
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Affiliation(s)
- C.D.S. Katoch
- Professor & Head (Pulmonary, Critical Care & Sleep Medicine), Army Institute of Cardiothoracic Sciences (AICTS), Pune, India
| | - Kunal Kumar
- Graded Specialist, (Pulmonary, Critical Care & Sleep Medicine), Army Institute of Cardiothoracic Sciences (AICTS), Pune, India
| | - Vikas Marwah
- Senior Advisor & Professor, (Pulmonary, Critical Care & Sleep Medicine), Army Institute of Cardiothoracic Sciences (AICTS), Pune, India
| | - Gaurav Bhatti
- Assistant Professor & Graded Specialist, (Pulmonary, Critical Care & Sleep Medicine), Army Institute of Cardiothoracic Sciences (AICTS), Pune, India
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20
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Shikha G, Swami H. Trends of sensitization pattern to aeroallergens among the patients with allergic rhinitis and/or bronchial asthma in Bangalore: A cross sectional study. Med J Armed Forces India 2022; 78:430-436. [PMID: 36267519 PMCID: PMC9577270 DOI: 10.1016/j.mjafi.2020.11.017] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 11/16/2020] [Indexed: 11/22/2022] Open
Abstract
Background Allergic rhinitis (AR) is rather erroneously viewed as a trivial disease. It is a chronic or recurrent allergen-specific, IgE-mediated inflammation that primarily affects the membrane lining the nose. However, due to the united airway concept, it is also found to be associated with bronchial asthma. AR commonly remains underdiagnosed or misdiagnosed and thus, leads to either undertreatment or inappropriately prolonged medication. Methods Four hundred adults having allergic rhinitis and/or bronchial asthma, fulfilling the criteria as per Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines, underwent skin prick test (SPT). Those having rhinitis due to nonallergic causes were excluded. SPT was carried out using a customized panel of 21 aeroallergens. The result was compared with the reaction of histamine, which was taken as a positive control. Results Majority of 228 (58.02%) of the patients showed a positive reaction to the tested panel of allergens. However, 165 (41.98%) showed no reaction to the tested panel of allergens can be due to various factors like reduced skin sensitivity, antihistaminic medications, etc. Conclusion Skin prick test accurate test for determining offending allergens in allergic conditions. House dust mites (41%) were the most common offending aeroallergen among patients with allergic rhinitis and/or bronchial asthma residing in Bangalore. The identification of offending aeroallergens have helped patients in avoiding unnecessary medications, take appropriate preventive measures or plan appropriate immunotherapy.
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Affiliation(s)
| | - Himanshu Swami
- Senior Advisor & Head (ENT), Army Hospital (R&R), Delhi Cantt, India
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21
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Mohana Karthikeyan S, Nikisha GN. Efficacy and Safety of Diethylcarbamazine in Treatment of Allergic Rhinitis: A Double Blind Randomised Controlled Trial. Indian J Otolaryngol Head Neck Surg 2022; 74:1169-1177. [PMID: 36452711 PMCID: PMC9702384 DOI: 10.1007/s12070-020-02249-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/24/2020] [Indexed: 10/23/2022] Open
Abstract
There are many evidences showing diethylcarbamazine as a potential drug for the treatment of allergic rhinitis. This study evaluated the effectiveness of diethylcarbamazine in the treatment of allergic rhinitis and compared it with montelukast and levocetirizine. This parallel double-blind randomized clinical trial was done in allergic rhinitis patients. Seven hundred and twelve participants who met the inclusion criteria and provided informed written consent were randomized and divided into 2 equal groups. Diethylcarbamazine 300 mg/day orally in divided doses was given to group A, and montelukast 10 mg and levocetirizine 5 mg/day orally at night for 21 days was given to group B. Primary outcomes were the change in symptoms, absolute eosinophil count, serum total IgE, phadiatop and response in skin prick from baseline to 21 days and 3 months after treatment. Secondary outcome was to compare it with montelukast and levocetirizine. The mean (SD) age of the patients was 33 (10.6) years, with 374 (52.5%) males and 338 (47.5%) females. There was statistically significant improvement in all the parameters in both groups. Improvement was better with diethylcarbamazine compared to montelukast and levocetirizine and the effects were sustained for 3 months in diethylcarbamazine group. The findings suggest that diethylcarbamazine is effective in the treatment of allergic rhinitis. It gives better control and is cost-effective than montelukast and levocetirizine. Trial Registration: https://www.ctri.nic.in Identifier: CTRI/2020/03/024145 registered on 20-03-2020.
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Affiliation(s)
- S. Mohana Karthikeyan
- Department of ENT and Head and Neck Surgery, Karpaga Vinayaka Institute of Medical Sciences and Research Center, Chinna Kolambakkam, Madurantagam, Tamil Nadu 603308 India
| | - G. N. Nikisha
- Department of ENT and Head and Neck Surgery, Karpaga Vinayaka Institute of Medical Sciences and Research Center, Chinna Kolambakkam, Madurantagam, Tamil Nadu 603308 India
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22
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Glenn KC, Silvanovich A, Lee SG, Allen A, Park S, Dunn SE, Kessenich C, Meng C, Vicini JL, Jez JM. Biochemical and clinical studies of putative allergens to assess what distinguishes them from other non-allergenic proteins in the same family. Transgenic Res 2022; 31:507-524. [PMID: 35939227 PMCID: PMC9489553 DOI: 10.1007/s11248-022-00316-8] [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: 11/16/2021] [Accepted: 07/21/2022] [Indexed: 10/26/2022]
Abstract
Many protein families have numerous members listed in databases as allergens; however, some allergen database entries, herein called "orphan allergens", are members of large families of which all other members are not allergens. These orphan allergens provide an opportunity to assess whether specific structural features render a protein allergenic. Three orphan allergens [Cladosporium herbarum aldehyde dehydrogenase (ChALDH), Alternaria alternata ALDH (AaALDH), and C. herbarum mannitol dehydrogenase (ChMDH)] were recombinantly produced and purified for structure characterization and for clinical skin prick testing (SPT) in mold allergic participants. Examination of the X-ray crystal structures of ChALDH and ChMDH and a homology structure model of AaALDH did not identify any discernable epitopes that distinguish these putative orphan allergens from their non-allergenic protein relatives. SPT results were aligned with ChMDH being an allergen, 53% of the participants were SPT (+). AaALDH did not elicit SPT reactivity above control proteins not in allergen databases (i.e., Psedomonas syringae indole-3-acetaldehyde dehydrogenase and Zea mays ALDH). Although published results showed consequential human IgE reactivity with ChALDH, no SPT reactivity was observed in this study. With only one of these three orphan allergens, ChMDH, eliciting SPT(+) reactions consistent with the protein being included in allergen databases, this underscores the complicated nature of how bioinformatics is used to assess the potential allergenicity of food proteins that could be newly added to human diets and, when needed, the subsequent clinical testing of that bioinformatic assessment.Trial registration number and date of registration AAC-2017-0467, approved as WIRB protocol #20172536 on 07DEC2017 by WIRB-Copernicus (OHRP/FDA Registration #: IRB00000533, organization #: IORG0000432).
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Affiliation(s)
- Kevin C Glenn
- Bayer Crop Science, 700 Chesterfield Pkwy W, Chesterfield, MO, 63017, USA
| | - Andre Silvanovich
- Bayer Crop Science, 700 Chesterfield Pkwy W, Chesterfield, MO, 63017, USA
| | - Soon Goo Lee
- Department of Biology, Washington University, CB 1137, One Brookings Dr., St. Louis, MO, 63130, USA.,Department of Chemistry and Biochemistry, University of North Carolina Wilmington, Wilmington, NC, 28403, USA
| | - Aron Allen
- Department of Biology, Washington University, CB 1137, One Brookings Dr., St. Louis, MO, 63130, USA
| | - Stephanie Park
- Allergy and Asthma Care of St. Louis, 8888 Ladue Road, Suite 105, St. Louis, MO, 63124, USA
| | - S Eliza Dunn
- Bayer Crop Science, 700 Chesterfield Pkwy W, Chesterfield, MO, 63017, USA
| | - Colton Kessenich
- Bayer Crop Science, 700 Chesterfield Pkwy W, Chesterfield, MO, 63017, USA
| | - Chen Meng
- Bayer Crop Science, 700 Chesterfield Pkwy W, Chesterfield, MO, 63017, USA
| | - John L Vicini
- Bayer Crop Science, 700 Chesterfield Pkwy W, Chesterfield, MO, 63017, USA.
| | - Joseph M Jez
- Department of Biology, Washington University, CB 1137, One Brookings Dr., St. Louis, MO, 63130, USA
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23
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Suriyamoorthy P, Madhuri A, Tangirala S, Michael KR, Sivanandham V, Rawson A, Anandharaj A. Comprehensive Review on Banana Fruit Allergy: Pathogenesis, Diagnosis, Management, and Potential Modification of Allergens through Food Processing. Plant Foods Hum Nutr 2022; 77:159-171. [PMID: 35661960 DOI: 10.1007/s11130-022-00976-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
The pulp of the banana fruit is rich in bioactive compounds like dietary fibers, low glycemic carbohydrates, natural sugars, vitamins, minerals and antioxidants. These beneficial compounds are responsible for the proper functioning of immune system and enhance prevention against various deadly diseases like cancer, diabetes and heart diseases. Despite having, positive effects, the fruit are recognized as an important source for causing allergy to 0.6% of people in general population and up to 67 and 46% for people with asthma or atopic dermatitis. Fruit allergy is one of the most common food allergies witnessed worldwide. Banana fruit allergy results from the abnormal immune response to the banana proteins soon after its consumption. Symptoms range from oral allergy syndrome (OAS) to the life-threatening anaphylaxis. IgE reactivity of banana is associated with different proteins of which six proteins have been identified as major allergens, viz., Mus a1 (Profilin-actin binding protein), Mus a 2 (Class 1 chitinase), Mus a 3 (Nonspecific lipid transfer protein), Mus a 4 (Thaumatin like protein), Mus a 5 (Beta 1,3 glucanase) and Mus a 6 (Ascorbate peroxidase). This review focuses on pathogenesis, clinical features, diagnosis, and different food processing methods to mitigate the allergenicity of banana fruit.
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Affiliation(s)
- Priyanga Suriyamoorthy
- Department of Food Safety and Quality Testing, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India
| | - Alluru Madhuri
- Academics and Human Resources Department, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India
| | - Srikanth Tangirala
- Department of Food Safety and Quality Testing, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India
- Centre of Excellence in Non-Thermal Processing, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India
| | - Karunai Raj Michael
- Department of Food Safety and Quality Testing, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India
| | - Vignesh Sivanandham
- Academics and Human Resources Department, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India
| | - Ashish Rawson
- Department of Food Safety and Quality Testing, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India.
- Centre of Excellence in Non-Thermal Processing, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India.
| | - Arunkumar Anandharaj
- Department of Food Safety and Quality Testing, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India.
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24
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Lie A, Wärnberg Gerdin S, Skrindo I, Rehbinder EM, Jonassen CM, LeBlanc M, Staff AC, Söderhäll C, Vettukattil R, Ådalen S, Aaneland H, Lødrup Carlsen KC, Skjerven HO, Nordlund B. Evaluation of Skin Prick Test Reading Time at 10 versus 15 min in Young Infants. Int Arch Allergy Immunol 2022; 183:824-834. [PMID: 35350034 PMCID: PMC9533466 DOI: 10.1159/000522526] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/07/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction The optimal time point for reading the mean wheal diameter (MWD) of a skin prick test (SPT) in infants is not established. We aimed to assess if either of two reading time points of the SPT, 10 or 15 min, was superior to detect allergic sensitization (AS) in 6-month-old infants. Methods In 1,431 6-month-old infants from the population-based Preventing Atopic Dermatitis and ALLergies in children (PreventADALL) mother-child cohort, the SPT was performed with standard solutions for egg, cow's milk, peanut, wheat, soy, birch, timothy, dog, and cat. The MWD was measured after 10 and 15 min. AS was defined as a positive SPT with MWD ≥2 mm larger than the negative control. Results Overall, 149 (10.4%) infants were sensitized to at least one allergen at 10 and/or 15 min, while 138 (9.6%) had a positive SPT at 10 min and 141 (9.9%) at 15 min. A total of 12,873 allergen pricks were performed with 212 (1.6%) being positive at any time point, 194 (1.5%) positive at 10 min, and 196 (1.5%) positive at 15 min. The mean (95% CI) histamine MWD of 3.8 (3.8, 3.9) mm at 10 min was significantly larger than the 3.6 (3.6, 3.7) mm at 15 min. Discussion/Conclusions Reading the SPT after both 10 and 15 min increased the number of 6-month-old infants with documented AS compared to reading after one time point only. As neither 10 nor 15 min reading time was superior to the other in detecting AS, our results indicate that readings at both time points should be considered. However, the histamine MWD was significantly larger at 10 min compared to 15 min. Reappraisal of SPT reading in infancy may be warranted.
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Affiliation(s)
- Anine Lie
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Sabina Wärnberg Gerdin
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ingebjørg Skrindo
- Department of Otorhinolaryngology, Akershus University Hospital, Lorenskog, Norway
| | - Eva Maria Rehbinder
- Department of Dermatology and Vaenerology, Oslo University Hospital, Oslo, Norway
| | - Christine Monceyron Jonassen
- Centre for Laboratory Medicine, Østfold Hospital Trust, Grålum, Norway.,Department of Chemistry, Biotechnology and Food science, Norwegian University of Life Sciences, Ås, Norway
| | - Marissa LeBlanc
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Anne Cathrine Staff
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Cilla Söderhäll
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Riyas Vettukattil
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Sigve Ådalen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Pediatrics, Østfold Hospital Trust, Grålum, Norway
| | - Hilde Aaneland
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Karin Cecilie Lødrup Carlsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Håvard Ove Skjerven
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Björn Nordlund
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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25
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Mori S, Kurihara K, Inuo C. Case of a 6-year-old boy with anaphylaxis induced by erythritol with positive skin prick test and negative basophil activation test. Allergy Asthma Clin Immunol 2022; 18:28. [PMID: 35331324 PMCID: PMC8951716 DOI: 10.1186/s13223-022-00670-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/13/2022] [Indexed: 11/10/2022]
Abstract
Erythritol is widely used as an additive in foods and pharmaceuticals. We present the case of a 6-year-old boy who developed an allergy to erythritol. He showed a positive skin prick test result and a negative basophil activation test result. In cases involving allergens with low molecular weights, the test results should be carefully interpreted.
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Affiliation(s)
- Satomi Mori
- Department of General Medicine, Kanagawa Children's Medical Center, 2-138-4, Mutsukawa, Minami-ku, Yokohama, Kanagawa, 232-8555, Japan.
| | - Kazuyuki Kurihara
- Department of Allergy, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Chisato Inuo
- Department of Allergy, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
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26
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Kajita N, Kanamori K, Yamamoto S. Generalized urticaria caused by glycerin enema in an infant. J Investig Allergol Clin Immunol 2021; 32:318-319. [PMID: 34779771 DOI: 10.18176/jiaci.0760] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- N Kajita
- Division of Allergy, Tokyo Metropolitan Children's Medical Center, 2-8-29Musashidai,Fuchu, Tokyo, Japan
| | - K Kanamori
- Division of Neurology, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, Japan
| | - S Yamamoto
- Division of General pediatrics, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, Japan
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27
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Abstract
Food allergy is an immune-mediated disease and must be differentiated from other adverse effects related to food that are non-immune mediated. Symptoms of immunoglobulin (Ig) E-mediated allergy can range from mild to severe, and life-threatening anaphylaxis may occur. Current recommended strategies for diagnosis include the use of skin prick tests, allergen-specific serum IgE, and/or oral food challenges. Management entails allergen avoidance and appropriate treatment of allergic reactions should accidental ingestions occur. Treatment approaches under investigation include immunotherapy as well as biologics and novel vaccines. Attention has also recently focused on implementing strategies for prevention of food allergy.
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Affiliation(s)
- Roxanne Carbonell Oriel
- Department of Pediatrics, Division of Allergy & Immunology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1198, New York, NY 10029, USA
| | - Julie Wang
- Department of Pediatrics, Division of Allergy & Immunology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1198, New York, NY 10029, USA.
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28
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Fereidouni M, Mahdavi R, Mahmoudzade S, Rezapoor H, Fereidouni A, Bahrami A. Evaluation of The Safety and Efficacy of Newly Developed Domestic Allergenic Extracts for Skin Prick Testing. Rep Biochem Mol Biol 2021; 10:257-65. [PMID: 34604415 DOI: 10.52547/rbmb.10.2.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 11/27/2020] [Indexed: 11/18/2022]
Abstract
Background Allergic disorders are common health problems worldwide with significant socio-economic impacts. The best diagnostic method using allergenic extract is the skin prick test. Regarding the effects of geo-climatic factors and allergenic extract source material quality, the aim of study was to determine the safety and efficacy of some in-house-developed allergenic extracts. Methods Forty-five different allergenic extracts, including common regional pollen, foods, and dog and cat hair, as well as positive and negative extracts, were prepared from domestic sources using optimum extraction methods. All extracts passed stability and sterility testing, and sterile final products containing 50% glycerin in 10 and 20 w/v concentrations were used. Skin prick testing was performed on volunteers and immediate or late side effects were recorded. Results In total, 56 students (mean age: 21.2±2.3y, M/F ratio: 1.07) participated in this study. For inhalant allergens, all extracts except dog hair extract caused positive responses. Salsola kali (Russian thistle) and Fraxinus velutina (ash tree) were the most common grass and tree pollen extracts, respectively. Of 18 different food extracts, five, including egg white, tomato, fig, melon, and green pepper caused skin reactivity in only one person. No participant reported any immediate or late side effects, including large local reaction or systemic response. Conclusion The result of the current study confirmed the safety of all our in-house-developed allergenic extracts. Regarding efficacy, almost all inhalant and five food allergens caused positive skin responses.
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29
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Jafari A, Kayvanloo S, Moazzen N, Motevalli Haghi N, Sedghi N, Khoshkhui M, Ahanchian H. Prevalence of IgE-Mediated Food Hypersensitivity to Cereals and Beans Based on Skin Prick Test in Children with Celiac Disease. Middle East J Dig Dis 2021; 13:339-342. [PMID: 36606013 PMCID: PMC9489450 DOI: 10.34172/mejdd.2021.244] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 06/07/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Celiac disease is a non-IgE mediated food allergy, which can cause extensive villus atrophy. Because of increased food allergen absorption, there are elevated IgA and IgG antibodies in these patients, so there is a concern about IgE antibody production against wheat and other cereals. METHODS In this study, we evaluated IgE-mediated hypersensitivity to wheat, rice, and other cereals in children with celiac disease. RESULTS 22 patients (50%) had at least one positive skin prick test to food allergens. The most frequent food allergen was peanut (31.8%), followed by wheat (18.2%), corn (9.1%), and rice (4.5%). The results revealed no significant correlation between age, sex, and the results of the skin prick test (p >0.05). The correlation between diagnosis time of celiac disease and results of skin prick test was also not significant statistically (p >0.05). CONCLUSION Because of the high prevalence of IgE mediated hypersensitivity to cereals and beans in children with celiac disease, a skin prick test might be considered in these patients, especially in refractory cases.
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Affiliation(s)
- Ali Jafari
- Clinical Research Development unit of Akbar Hospital, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran
| | - Somayeh Kayvanloo
- Clinical Research Development unit of Akbar Hospital, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran
| | - Nasrin Moazzen
- Clinical Research Development unit of Akbar Hospital, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran.
,Corresponding Author: Nasrin Moazzen, MD Address : Shadid Kaveh Blvd, Akbar children’s hospital, Mashhad, Iran Tel : 0098 5138713801 Fax : 0098 5138709201
| | - Nasrinsadat Motevalli Haghi
- Clinical Research Development unit of Akbar Hospital, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran
| | - Nilufar Sedghi
- Clinical Research Development unit of Akbar Hospital, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran
| | - Maryam Khoshkhui
- Allergy research center, Mashhad University of medical sciences, Mashhad, Iran
| | - Hamid Ahanchian
- Clinical Research Development unit of Akbar Hospital, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran
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30
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Tsuge M, Ikeda M, Mitani O, Yasui M, Tsukahara H. Anaphylaxis after jellyfish ingestion with no history of stings: a pediatric case report. Allergy Asthma Clin Immunol 2021; 17:99. [PMID: 34565454 DOI: 10.1186/s13223-021-00601-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Jellyfish stings are known to induce allergic skin reactions; however, case reports of anaphylaxis after jellyfish ingestion have been increasing, especially in Asian countries. Some cases of anaphylaxis after jellyfish ingestion have been reported in patients with a previous history of frequent jellyfish stings. Herein, we report a pediatric patient with anaphylaxis after jellyfish ingestion with no history of jellyfish stings. CASE PRESENTATION A 14-year-old girl developed two episodes of anaphylaxis, and her diet diaries revealed that edible jellyfish was common to the meals in both the anaphylaxis events. A skin prick test using five types of edible jellyfish products revealed a positive reaction to some jellyfish, and anaphylaxis was observed after the ingestion of jellyfish in an oral food challenge test. She had no history of jellyfish stings or frequent swimming in the ocean. The basophil activation test showed positive results on stimulation with extracts from various types of edible jellyfish. We observed serum immunoglobulin E (IgE) reactivity to purified jellyfish collagen and jellyfish acid-soluble extracts. Moreover, immunoblotting analysis showed IgE reactivity to two bands at approximately 40 and 70 kDa using purified jellyfish collagen, which may be a causative antigen. CONCLUSIONS Edible salted jellyfish can be one of the causative foods of anaphylaxis. Clinicians should be aware of the possibility of anaphylactic reactions due to jellyfish ingestion even without a history of jellyfish stings.
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Abstract
Diagnostics in type-1 allergy rely on medical history and clinical examination. Extent and severity of signs and symptoms can be documented by standardized scores and questionnaires. Both skin prick test and intradermal test are useful for search of immunoglobulin E-mediated sensitizations but the availability of commercially available diagnostic extracts has been markedly reduced during the last years. Investigation of total and of specific serum IgE is the most important in vitro diagnostic analyte in type-1 allergy. Identification of the individual molecules to which patients are sensitized, known as molecular or component-resolved diagnostics (CRD), has recently markedly improved management of type-1 allergy to pollen, food and hymenoptera venoms. Main features of CRD are increased analytic sensitivity, detection of cross-reactivity and determination of individual sensitization profiles which allow for risk assessment and facilitate decisions for or against allergen immunotherapy. Basophil activation test as well as determination of selected biomarkers (e.g. tryptase) may also be helpful in some cases. If any allergy test is positive, one will have to distinguish reactions, which are clinically relevant, from those, which are not. In vivo provocation tests (e.g. nasal provocation, oral drug or food challenge) may help to clarify the relevance of a sensitization.
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Affiliation(s)
- Regina Treudler
- Department of Dermatology, Venereology and Allergology, Leipzig Interdisciplinary Allergy Centre - Comprehensive Allergy Centre, University Medicine Leipzig, Leipzig, Germany.
| | - Jan-Christoph Simon
- Department of Dermatology, Venereology and Allergology, Leipzig Interdisciplinary Allergy Centre - Comprehensive Allergy Centre, University Medicine Leipzig, Leipzig, Germany
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Suzuki K, Futamura K, Hasegawa E, Aoki Y, Nakamura M, Matsunaga K, Yagami A. Adult-Onset Sheep's Milk Allergy in a Patient Without Cow's Milk Allergy. J Investig Allergol Clin Immunol 2021; 31:273-274. [PMID: 32856594 DOI: 10.18176/jiaci.0578] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- K Suzuki
- Department of Allergology, Fujita Health University School of Medicine, Aichi, Japan
| | - K Futamura
- Department of Allergology, Fujita Health University School of Medicine, Aichi, Japan
| | - E Hasegawa
- Department of Integrative Medical Science for Allergic Disease, Fujita Health University School of Medicine, Aichi, Japan.,General Research and Development Institute, Hoyu Co., Ltd., Aichi, Japan
| | - Y Aoki
- Department of Integrative Medical Science for Allergic Disease, Fujita Health University School of Medicine, Aichi, Japan.,General Research and Development Institute, Hoyu Co., Ltd., Aichi, Japan
| | - M Nakamura
- Department of Integrative Medical Science for Allergic Disease, Fujita Health University School of Medicine, Aichi, Japan.,General Research and Development Institute, Hoyu Co., Ltd., Aichi, Japan
| | - K Matsunaga
- Department of Allergology, Fujita Health University School of Medicine, Aichi, Japan.,Department of Integrative Medical Science for Allergic Disease, Fujita Health University School of Medicine, Aichi, Japan
| | - A Yagami
- Department of Allergology, Fujita Health University School of Medicine, Aichi, Japan
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Domić I, Budmir J, Novak I, Mravak-Stipetić M, Lugović-Mihić L. ASSESSMENT OF ALLERGIES TO FOOD AND ADDITIVES IN PATIENTS WITH ANGIOEDEMA, BURNING MOUTH SYNDROME, CHEILITIS, GINGIVOSTOMATITIS, ORAL LICHENOID REACTIONS, AND PERIORAL DERMATITIS. Acta Clin Croat 2021; 60:276-281. [PMID: 34744278 PMCID: PMC8564830 DOI: 10.20471/acc.2021.60.02.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 12/03/2019] [Indexed: 11/30/2022] Open
Abstract
Oral cavity and perioral area are constantly exposed to a variety of antigens, including food and additives, which have a potential role in the development of different oral mucosal and perioral cutaneous diseases since they can cause hypersensitivity reactions. Oral and perioral diseases mainly include angioedema, burning mouth syndrome, cheilitis, gingivostomatitis, oral lichenoid reactions, and perioral dermatitis. Previous studies were focused on delayed-type oral allergies by performing patch testing but did not include tests for immediate-type allergic reactions. Therefore, the objective of this study was to determine common nutritive and additive allergens in the prevalent oral and perioral diseases by using skin prick tests. Our study evaluated 230 participants, i.e. 180 patients with oral/perioral diseases (angioedema, burning mouth syndrome, cheilitis, gingivostomatitis, oral lichenoid reactions, and perioral dermatitis), and 50 healthy control subjects. The results of skin prick tests showed that immediate-type allergic reactions to food and additives were mostly seen in patients with burning mouth syndrome (40%) and cheilitis (33.3%), whereas allergies were least frequently observed in perioral dermatitis (10%) and gingivostomatitis (20%). Fruits, mushrooms, and vegetables were the most frequent causes of nutritive allergies in oral and perioral diseases. The most commonly identified additive allergens were glutaraldehyde, citric acid, and sodium glutamate. Study results suggest the possible association with nutritive and additive allergies be considered in cases of persistent oral mucosal or perioral skin disease accompanied by respective medical history.
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Affiliation(s)
| | - Jozo Budmir
- 1Department of Dermatovenereology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Ina Novak
- 1Department of Dermatovenereology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Marinka Mravak-Stipetić
- 1Department of Dermatovenereology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Liborija Lugović-Mihić
- 1Department of Dermatovenereology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Zagreb, Croatia
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Foong RX, Dantzer JA, Wood RA, Santos AF. Improving Diagnostic Accuracy in Food Allergy. J Allergy Clin Immunol Pract 2021; 9:71-80. [PMID: 33429723 PMCID: PMC7794657 DOI: 10.1016/j.jaip.2020.09.037] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 02/08/2023]
Abstract
The diagnosis of food allergy can have a major impact on the lives of patients and families, imposing dietary restrictions and limitations on social activities. On the other hand, misdiagnosis can place the patient at risk of a potentially severe allergic reaction. Therefore, an accurate diagnosis of food allergy is of utmost importance. The diagnosis of food allergy is often established by the combination of the clinical history and allergen-specific IgE; however, without a clear history of an allergic reaction, the interpretation of IgE sensitization tests can be difficult. There are also rare cases of clinical food allergy in the absence of IgE sensitization. For that reason, testing for suspected food allergy ideally requires access to oral food challenges (OFCs), which are currently the gold standard tests to diagnose food allergy. As OFCs are time consuming and involve the risk of acute allergic reactions of unpredictable severity, the question remains: how can we improve the accuracy of diagnosis before referring the patient for an OFC? Herein, we review the predictive value of different tests used to support the diagnosis of food allergy, discuss implications for therapy and prognosis, and propose a diagnostic approach to be applied in clinical practice.
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Affiliation(s)
- Ru-Xin Foong
- Faculty of Life Sciences and Medicine, Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jennifer A Dantzer
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Robert A Wood
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Alexandra F Santos
- Faculty of Life Sciences and Medicine, Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Asthma UK Centre for Allergic Mechanisms of Asthma, London, United Kingdom.
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35
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Davis CM, Gupta RS, Aktas ON, Diaz V, Kamath SD, Lopata AL. Clinical Management of Seafood Allergy. J Allergy Clin Immunol Pract 2021; 8:37-44. [PMID: 31950908 DOI: 10.1016/j.jaip.2019.10.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 02/06/2023]
Abstract
Seafood plays an important role in human nutrition and health. A good patient workup and sensitive diagnostic analysis of IgE antibody reactivity can distinguish between a true seafood allergy and other adverse reactions generated by toxins or parasites contaminating ingested seafood. The 2 most important seafood groupings include the fish and shellfish. Shellfish, in the context of seafood consumption, constitutes a diverse group of species subdivided into crustaceans and mollusks. The prevalence of shellfish allergy seems to be higher than that of fish allergy, with an estimate of up to 3% in the adult population and fin fish allergy prevalence of approximately 1%. Clinical evaluation of the seafood-allergic patient involves obtaining a detailed history and obtaining in vivo and/or in vitro testing with careful interpretation of results with consideration of cross-reactivity features of the major allergens. Oral food challenge is useful not only for the diagnosis but also for avoiding unnecessary dietary restrictions. In this review, we highlight some of the recent reports to provide solid clinical and laboratory tools for the differentiation of fish allergy from shellfish allergy, enabling best treatment and management of these patients.
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Affiliation(s)
- Carla M Davis
- Texas Children's Hospital Food Allergy Program, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
| | - Ruchi S Gupta
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Ozge N Aktas
- Department of Pediatrics, University of Illinois College of Medicine at Chicago, Chicago, Ill
| | - Veronica Diaz
- Texas Children's Hospital Food Allergy Program, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Sandip D Kamath
- College of Public Health, Medical and Veterinary Sciences, Australian Institute of Tropical Health and Medicine, Molecular Allergy Research Laboratory, James Cook University, Townsville, QLD, Australia
| | - Andreas L Lopata
- College of Public Health, Medical and Veterinary Sciences, Australian Institute of Tropical Health and Medicine, Molecular Allergy Research Laboratory, James Cook University, Townsville, QLD, Australia
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36
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Sicherer SH, Warren CM, Dant C, Gupta RS, Nadeau KC. Food Allergy from Infancy Through Adulthood. J Allergy Clin Immunol Pract 2021; 8:1854-1864. [PMID: 32499034 DOI: 10.1016/j.jaip.2020.02.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/21/2020] [Accepted: 02/11/2020] [Indexed: 12/26/2022]
Abstract
Food allergies are the result of immune responses that cause adverse reactions to foods. Immune responses to foods may produce a spectrum of symptoms and disorders, including acute allergic reactions and anaphylaxis, food protein-induced allergic proctocolitis, food protein-induced enterocolitis syndrome, food-dependent, exercise-induced anaphylaxis, and oral allergy syndrome (pollen-food allergy syndrome). Food-allergic responses also contribute to chronic inflammatory disorders such as eosinophilic esophagitis and atopic dermatitis. Although food allergy affects people from infancy through adulthood, there are allergic features that differ according to age (ie, presentation, triggers, and natural course) and have important implications for diagnosis, prognosis, and management. New food allergies can develop at any age, and we propose similarities in the etiology of de novo food allergy whether in infancy or adulthood. The approach to managing food allergy changes dramatically over the life course, and physicians and patients must respond accordingly to optimize care. Food allergy therapies are emerging, and the efficacy and safety of these interventions could differ by age group of those treated. In this review, we highlight interesting observations on the etiology and characteristics of food allergy presenting at different ages and discuss clinical management as it relates to life stage.
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Affiliation(s)
- Scott H Sicherer
- Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Christopher M Warren
- Center for Food Allergy & Asthma Research, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| | - Christopher Dant
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| | - Ruchi S Gupta
- Center for Food Allergy & Asthma Research, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
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Beken B, Celik V, Gokmirza Ozdemir P, Yazicioglu M. Think Twice before Interpreting the Skin Prick Test as Age, Body Mass Index, and Atopy Affect Reaction Time and Size. Int Arch Allergy Immunol 2021; 182:835-843. [PMID: 33946081 DOI: 10.1159/000515414] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/24/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The skin prick test (SPT) is a reliable method to confirm sensitization in IgE-mediated allergic diseases; however, it has been reported to be affected by several personal and environmental factors. Our objective was to determine the factors affecting the skin reactivity to histamine and allergens and investigate whether it differs according to age in terms of reading time. METHODS A total of 500 patients, aged 4 months-18 years, were enrolled in the study. Wheal and flare reaction sizes were documented as the mean of the longest and the midpoint perpendicular diameter in the 5th, 10th, 15th, and 20th min. Skin reactivity was compared between children >24 and ≤24 months of age. RESULTS We found larger histamine and allergen wheal sizes in children >24 months than the ones ≤24 months of age (p < 0.001 and p = 0.007, respectively). The duration of maximum histamine reactivity was 15 min for children >24 months whereas 10 min for children ≤24 months of age. The number of children losing their histamine reactivity after 15 and 20 min was significantly higher in the smaller age-group. Multiple regression analysis revealed a larger histamine reactivity in children >24 months of age, having obesity, and having allergen sensitization (p = 0.002, p = 0.003, and p = 0.018, respectively). CONCLUSION It seems more accurate to evaluate SPT after 10 min in children ≤24 months of age. Cutoff values and ideal measurement time according to individual factors such as age, body mass index, or atopy are needed.
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Affiliation(s)
- Burcin Beken
- Department of Pediatric Allergy and Immunology, Trakya University School of Medicine, Edirne, Turkey
| | - Velat Celik
- Department of Pediatric Allergy and Immunology, Trakya University School of Medicine, Edirne, Turkey
| | - Pınar Gokmirza Ozdemir
- Department of Pediatric Allergy and Immunology, Trakya University School of Medicine, Edirne, Turkey
| | - Mehtap Yazicioglu
- Department of Pediatric Allergy and Immunology, Trakya University School of Medicine, Edirne, Turkey
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Songnuy T, Petchuay P, Chutiyon W, Nurak A. Correlation between fractional exhaled nitric oxide level and clinical outcomes among childhood asthmatic patients: community hospital-based perspective. Heliyon 2021; 7:e06925. [PMID: 34007928 PMCID: PMC8111257 DOI: 10.1016/j.heliyon.2021.e06925] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/02/2021] [Accepted: 04/22/2021] [Indexed: 11/17/2022] Open
Abstract
A fractional exhaled nitric oxide (FeNO) device has been developed for the evaluation of clinical control in asthmatic patients, instead of for uses in only analyzing clinical data and spirometry. The implementation of the FeNO device in daily practice has demonstrated both positive and negative results. Community hospital settings in Thailand have never used this method for the evaluation of disease control in asthmatics. The aim of this study was to assess the correlation between FeNO levels and asthma control, as determined by physicians. We recruited asthmatic patients aged from 4-15-years-old (after informed consent approval was obtained from their guardians) from May 15, 2018, to July 20, 2019. All of the patients had already been diagnosed as having asthma by physicians and had been prescribed inhaled corticosteroid medications. After routine visits, skin prick tests with 8 aeroallergens were performed. If a positive result was shown for at least 1 allergen, then the FeNO device was applied for the assessment of the level of inflammation. Data were analyzed by using SPSS Statistics version 21.0. Agreement index and Kruskal Wallis tests were used to measure the correlations. From 178 asthmatic patients, the mean age was 94.9 ± 36.75 months, and 59% of them were male. The educational levels of the guardians of the patients mostly consisted of primary school, and the household income was less than 333 US dollars per month. Inhaled corticosteroids were prescribed among the patients for disease control. The correlation between the FeNO level and the control level demonstrated a high agreement (accuracy index: 91.57%). The medians of the mean wheal diameters of Dermatophagoids pteronyssinus, Dermatophagoids farinae and Cladosporium spp. were significantly related to the FeNO level (with p-values of 0.024, 0.003 and 0.045, respectively). Conversely, a number of positive skin responses to aeroallergens were not related with the FeNO level. In conclusion, a lower level of FeNO correlates with good asthma control level in pediatric allergic asthma. The medians of the mean wheal diameters of Dermatophagoids pteronyssinus, Dermatophagoids farinae and Cladosporium spp. correlated with higher FeNO levels. A device assessing FeNO seems beneficial for evaluating the level of disease control among childhood asthmatic patients in a primary care setting.
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Affiliation(s)
- Theerapan Songnuy
- Department of Clinical Medical Sciences, Walailak University, School of Medicine, Nakhon Si Thammarat, 80160, Thailand
| | - Prachyapan Petchuay
- Department of Clinical Medical Sciences, Walailak University, School of Medicine, Nakhon Si Thammarat, 80160, Thailand
| | - Wongwat Chutiyon
- Division of Pediatrics, Thasala Hospital, Nakhon Si Thammarat, 80160, Thailand
| | - Awirut Nurak
- Division of Pediatrics, Thasala Hospital, Nakhon Si Thammarat, 80160, Thailand
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Mavi AK, Spalgais S, Singh K, Kumar U, Kumar R. Expression profile of MUC1 protein in Pigeon allergens positive asthmatic. Immunobiology 2021; 226:152086. [PMID: 33784545 DOI: 10.1016/j.imbio.2021.152086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/12/2021] [Accepted: 03/10/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Certain urban areas could contain many pigeon's allergens, which may play an imperative role in the exacerbation of asthma in pigeon allergen sensitive asthma patients. The circulating form of MUC1 in human serum has been considered as a biomarker for some allergic diseases. The study aimed to investigate the role of MUC1 in pigeon allergens positive asthma patients. METHODS We were enrolled 200 asthma patients including 81 males and 119 females. After positive pigeon exposure history, 108 patients underwent SPT testing against pigeon allergens (dropping and feather). A total of 17 patients, who had exposure history with SPT positive were undergone detail clinical examination. Serum MUC1expression analysis was done by western blotting method. RESULTS Out of 200 asthmatic patients, 108 (54%) patients had a history of exposure to pigeons. Skin prick test against pigeon (feather & dropping) allergens was positive in 17 (15.7%) patients among exposure asthmatics. The mean age of the study population was 28.8 ± 10.4 years with 9 males and 8 females. Baseline airway obstruction was seen in 58.8% cases. Out of 17 pigeons expose and sensitive asthmatic the MUC1 expression was up-regulated in 15 (88.2%) and down-regulated in 2 (11.8%). The mean value MUC1 fold change of 15 patients with up-regulation was 4.63 ± 3.00 fold. CONCLUSION MUC1 expression was up-regulated in 88.2% of patients, who were exposed and sensitive to pigeon allergen (dropping and feather). MUC1 may consider as a biomarker in pigeon sensitive asthma patients.
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Affiliation(s)
- Anil Kumar Mavi
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110007, India
| | - Sonam Spalgais
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110007, India
| | - Kamal Singh
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110007, India
| | - Umesh Kumar
- School of Biosciences, IMS Ghaziabad, NH9 Ghaziabad 201015, Uttar Pradesh, India
| | - Raj Kumar
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110007, India.
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Hamed A, Todd I, Tighe PJ, Powell RJ, Harrison T, Fairclough LC. Array-based measurements of aero-allergen-specific IgE correlate with skin-prick test reactivity in asthma regardless of specific IgG4 or total IgE measurements. J Immunol Methods 2021; 492:112999. [PMID: 33609533 DOI: 10.1016/j.jim.2021.112999] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/28/2020] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
Skin prick testing (SPT) and measurement of serum allergen-specific IgE (sIgE) are used to investigate asthma and other allergic conditions. Measurement of serum total IgE (tIgE) and allergen-specific IgG4 (sIgG4) may also be useful. The aim was to ascertain the correlation between these serological parameters and SPT. Sera from 60 suspected asthmatic patients and 18 healthy controls were assayed for sIgE and sIgG4 reactivity against a panel of 70 SPT allergen preparations, and for tIgE. The patients were also assessed by skin prick tests for reactivity to cat, dog, house dust mite and grass allergens. Over 50% of the patients had tIgE levels above the 75th percentile of the controls. 58% of patients and 39% of controls showed sIgE reactivity to ≥1 allergen. The mean number of allergens detected by sIgE was 3.1 in suspected asthma patients and 0.9 in controls. 58% of patients and 50% of controls showed sIgG4 reactivity to ≥1 allergen. The mean number of allergens detected by sIgG4 was 2.5 in patients and 1.7 in controls. For the patients, a strong correlation was observed between clinical SPT reactivity and serum sIgE levels to cat, dog, house dust mite (HDM) and grass allergens. SPT correlations using sIgE/sIgG4 or sIgE/tIgE ratios were not markedly higher. The measurement of serum sIgE by microarray using SPT allergen preparations showed good correlation with clinical SPT reactivity to cat, dog, HDM and grass allergens. This concordance was not improved by measuring tIgE or sIgG4.
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Affiliation(s)
- Aljali Hamed
- School of Life Sciences, The University of Nottingham, Nottingham NG7 2UH, UK; Department of Laboratory Medicine, Faculty of Medical Technology, Omar Al-Mukhtar University, Al Bayda City, Libya
| | - Ian Todd
- School of Life Sciences, The University of Nottingham, Nottingham NG7 2UH, UK
| | - Patrick J Tighe
- School of Life Sciences, The University of Nottingham, Nottingham NG7 2UH, UK
| | - Richard J Powell
- School of Life Sciences, The University of Nottingham, Nottingham NG7 2UH, UK
| | - Tim Harrison
- School of Medicine, Division of Respiratory Medicine, Clinical Sciences Building, City Hospital Campus, University of Nottingham, Nottingham NG5 1PB, UK
| | - Lucy C Fairclough
- School of Life Sciences, The University of Nottingham, Nottingham NG7 2UH, UK.
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Mustonen N, Siljander H, Niemelä O, Ilonen J, Haahtela T, Knip M. Allergy-Related Symptoms Are Poorly Predicted by IgE and Skin Prick Testing in Early Life. Int Arch Allergy Immunol 2021; 182:574-584. [PMID: 33550294 DOI: 10.1159/000512109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION In childhood, the so-called allergic march involves progression from IgE sensitization to allergy-related symptoms. Both IgE sensitization and relevant clinical symptoms are required for the diagnosis of allergy, but concordance between test results and clinical symptoms varies greatly, creating challenges for the diagnostics and for the prediction of outcomes. We assessed the prevalence of IgE sensitization and allergy symptoms, concordance between 2 IgE sensitization testing methods, and predictive value of these tests in relation to clinical symptoms in young Finnish children. METHODS The current study included 2 series of children: a birth cohort, in which the participants were followed prospectively from birth up to 3 years, and a young children cohort observed from 3 to 5 years of age. They were regularly monitored for sensitization by measuring serum allergen-specific IgEs (sIgEs) and performing skin prick tests (SPTs). The emergence of atopic dermatitis, wheezing, and symptoms associated with food allergies was recorded. RESULTS Over the first 5 years of life, the prevalence of sIgE sensitization was 46%, while it was 36% for positive SPTs. Disease prevalence was 26% for atopic dermatitis, 25% for wheezing, and 19% for symptoms associated with food allergies. Concordance between sIgE and SPT results was good for aeroallergens, but poor for dietary allergens. The association between clinical symptoms and sensitization was stronger at 5 years than at 3 years of age. The proportion of children with concordant combinations of allergy symptoms and sensitization markers in contrast to those with discordant combinations increased from 3 to 5 years. CONCLUSION In early childhood, testing for IgE sensitization predicts allergy-related symptoms in an age-dependent manner, but not particularly well. Tests predict symptoms caused by aeroallergens clearly better than those caused by dietary allergens. The clinical relevance of sensitization testing in early life is therefore limited in the prediction of true allergy.
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Affiliation(s)
- Neea Mustonen
- Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Heli Siljander
- Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and University of Tampere, Seinäjoki, Finland
| | - Jorma Ilonen
- Immunogenetics Laboratory, Institute of Biomedicine, University of Turku, Turku, Finland.,Clinical Microbiology, Turku University Hospital, Turku, Finland
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Mikael Knip
- Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland, .,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland, .,Folkhälsan Research Center, Helsinki, Finland, .,Tampere Center for Child Health Research, Tampere University Hospital, Tampere, Finland,
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Casimir-Brown RS, Kennard L, Kayode OS, Siew LQC, Makris M, Tsilochristou O, Chytiroglou E, Nakonechna A, Rutkowski K, Mirakian R, Wagner A. Piperacillin-Tazobactam Hypersensitivity: A Large, Multicenter Analysis. J Allergy Clin Immunol Pract 2021; 9:2001-2009. [PMID: 33444815 DOI: 10.1016/j.jaip.2020.12.051] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/03/2020] [Accepted: 12/16/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Piperacillin/tazobactam is a broad-spectrum penicillin. Hypersensitivity reactions are less commonly reported than with other penicillins except in patients with cystic fibrosis. OBJECTIVE Detailed clinical characterization of a patient cohort referred with suspected piperacillin-tazobactam hypersensitivity. METHODS Retrospective analysis of the demographic characteristics, clinical presentation, investigation, and management of 87 patients presenting to 5 European allergy centers. Patients underwent skin prick and intradermal testing with piperacillin/tazobactam, major (penicilloyl-polylysine) and minor (sodium penilloate) determinants, amoxicillin, benzylpenicillin, flucloxacillin, co-amoxiclav, clavulanic acid, and meropenem with immediate and, where appropriate, delayed reading of tests. Skin test-negative patients underwent drug provocation to piperacillin/tazobactam and/or other penicillins. A multistep protocol was used, depending on risk assessment. RESULTS Forty-eight of 87 (55%) patients were diagnosed with hypersensitivity to piperacillin/tazobactam with either positive skin or drug provocation test results, of whom 10 (21%) had a diagnosis of cystic fibrosis. Twenty-six (54%) patients presented with immediate and 22 (45%) with nonimmediate hypersensitivity. Patients with cystic fibrosis predominantly presented with nonimmediate hypersensitivity (70%). Reactions were severe in 52% of immediate reactors (Brown's anaphylaxis grade 3) and moderately severe (systemic involvement) in 75% of nonimmediate reactors. The number of patients with negative skin test results tolerating reintroduction was comparable in immediate (80%) and nonimmediate (88%) hypersensitivity. One-third of patients were cross-sensitized to other penicillins. The cross-sensitization pattern raised the possibility of tazobactam allergy in 3 patients. In 21 patients selectively sensitized to piperacillin/tazobactam (12 immediate, 9 nonimmediate), tolerance to other beta-lactams was demonstrated by drug provocation testing. CONCLUSIONS Piperacillin-tazobactam caused immediate and nonimmediate hypersensitivity with similar frequency. Most patients were selectively sensitized and tolerated other penicillins. Some patients may be allergic to the beta-lactamase inhibitor only.
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Affiliation(s)
| | - Lucinda Kennard
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Leonard Q C Siew
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Michael Makris
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, University General Hospital "Attikon", Athens, Greece
| | - Olympia Tsilochristou
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Peter Gorer Department of Immunobiology, King's College London, London, United Kingdom
| | - Evangelia Chytiroglou
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, University General Hospital "Attikon", Athens, Greece
| | - Alla Nakonechna
- Clinical Immunology & Allergy Unit, Sheffield Teaching Hospital, Sheffield, United Kingdom; Royal Preston Hospital, Lancashire Teaching Hospitals, NHS Foundation Trust, Lancashire, United Kingdom; University of Liverpool, Liverpool, United Kingdom
| | - Krzysztof Rutkowski
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Rita Mirakian
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Annette Wagner
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Santos AF, Bergmann M, Brough HA, Couto-Francisco N, Kwok M, Panetta V, Haddad D, Lack G, Eigenmann P, Caubet JC. Basophil Activation Test Reduces Oral Food Challenges to Nuts and Sesame. J Allergy Clin Immunol Pract 2020; 9:2016-2027.e6. [PMID: 33385591 PMCID: PMC8110244 DOI: 10.1016/j.jaip.2020.12.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Nut allergic patients are often IgE sensitized to other nuts/seeds and need multiple oral food challenges (OFCs) before the safe nuts can be introduced in the diet. However, OFCs are time-consuming and risky procedures. OBJECTIVE To assess the utility of the basophil activation test (BAT) to predict the allergic status and reduce the need for an OFC in children with 1 or more nut or seed allergies. METHODS Participants in the Pronuts study recruited at the Geneva and the London centers were tested on the BAT to hazelnut, cashew nut, sesame, almond, and peanut, Ara h 1, Ara h 2, Ara h 6, using FlowCAST, a commercially available BAT kit, and flow cytometry. RESULTS The BAT to hazelnut, cashew nut, sesame, almond, and peanut discriminated between allergic and nonallergic children, to the respective nut or seed. The optimal allergen concentration and their optimal, positive, and negative cutoffs were identified for the BAT and the other tests, for each nut and seed. Using the BAT as a second step in the diagnostic process, after equivocal skin prick test and IgE to extracts and components, reduced the number of total OFCs by 5% to 15% and positive OFCs by 33% to 75% (except for hazelnut) with 0% false-negatives and a diagnostic accuracy of 96% to 100%. CONCLUSION The BAT proved to be a useful diagnostic tool, used in a stepwise approach, to predict the allergic status and reduce the number of OFCs in the Pronuts study participants with at least 1 nut allergy willing to consume selected nuts.
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Affiliation(s)
- 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; Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.
| | - Marcel Bergmann
- Pediatric Allergy Unit, Department of Pediatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - 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
| | - Natália Couto-Francisco
- 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; Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Matthew Kwok
- 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; Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Valentina Panetta
- L'altrastatistica srl, Consultancy & Training, Biostatistics Office, Rome, Italy
| | - Diab Haddad
- Department of Pediatrics, St Peters' Hospital, London, United Kingdom
| | - 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; Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Philippe Eigenmann
- Pediatric Allergy Unit, Department of Pediatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Jean-Christoph Caubet
- Pediatric Allergy Unit, Department of Pediatrics, University Hospitals of Geneva, Geneva, Switzerland
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Kilic M, Altunoglu MK, Akdogan GE, Akpınar S, Taskın E, Erkal AH. Airborne fungal spore relationships with meteorological parameters and skin prick test results in Elazig, Turkey. J Environ Health Sci Eng 2020; 18:1271-1280. [PMID: 33312641 PMCID: PMC7721787 DOI: 10.1007/s40201-020-00545-1] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 09/21/2020] [Indexed: 05/02/2023]
Abstract
BACKGROUND Since fungi spores have high concentrations in the atmosphere during most of the year, they have an important place in respiratory allergies. In this regard, the preparation of calendars showing fungi spore loads for residential areas has much importance in the treatment of the patients. The first aim of this study was to present the airborne fungal spore research results from Eastern Anatolia in Turkey. Then, the mold spores' relationships with the meteorological parameters and skin prick test results were also evaluated. The presence of fungal spores was investigated using a volumetric spore trap in 2018 year. METHODS In this study, fungal spores within the atmosphere of the Elazığ city of Turkey was measured through the volumetric method, using a Lanzoni VPPS 2000 device (VPPS 2000 Lanzoni, Bologna, Italy), in 2018 year. Annual data of temperature, humidity, precipitation and wind speed were used for comparing meteorological data with airborne fungal spore counts. In addition, 637 children who were admitted to a pediatric allergy clinic with allergic complaints were enrolled in the study. RESULTS A total of 145,099 spores/m3 and 20 fungal taxa belonging to the molds were recorded. Ustilago was the predominant genus (18.10%), followed by Oidium (18.01%), Drechslera (12.82%), and Fusarium (11.60%), which were the most common fungal spores found in Elazig's atmosphere. The total mold spores in the atmosphere reached the highest level, with 28,153 spores/m3, in July (mid-summer). Moreover, we found a positive correlation between the mold spores and the temperature, but negative correlations with the humidity and wind speed. In the skin prick tests in the children with allergic complaints, we detected sensitization to Alternaria alternata in 4.4%, Cladosporium herbarum in 3.0%, Penicillium notatum in 1.4%, and Aspergillus fumigatus in 1.1%. Additionally, there was no correlation between fungal spore concentration in the atmosphere with fungal spores sensitization in the skin prick test. CONCLUSIONS This study was the first aerofungal survey of the Eastern Anatolia region in Turkey; therefore, new information has been introduced in the field of aerobiology in Turkey.
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Affiliation(s)
- Mehmet Kilic
- Department of Pediatrics, Division of Allergy and Immunology, University of Firat, Elazig, Turkey
- Cocuk Sagligi ve Hastalikları Anabilim Dalı, Fırat Universitesi Tip Fakultesi, 23119 Elazig, Turkey
| | | | - Gül Esma Akdogan
- Faculty of Arts and Sciences, Department of Biology, University of Kafkas, Kars, Turkey
| | - Salih Akpınar
- Faculty of Arts and Sciences, Department of Biology, University of Kafkas, Kars, Turkey
| | - Erdal Taskın
- Department of Pediatrics, Division of Neonatology, University of Firat, Elazig, Turkey
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Kang SY, Yang MS, Park SY, Kim JH, Won HK, Kwon OY, Lee JH, Kang YW, Jung JW, Song WJ, Kim SH, Lee SM, Lee SP. The role of allergen-specific IgE in predicting allergic symptoms on dog and cat exposure among Korean pet exhibition participants. World Allergy Organ J 2020; 13:100488. [PMID: 33312333 PMCID: PMC7702179 DOI: 10.1016/j.waojou.2020.100488] [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: 06/24/2020] [Revised: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The values of the skin prick test (SPT) and allergen-specific IgE (sIgE) measurement in predicting dog and cat allergies remain unclear. We aimed to evaluate the usefulness of SPT and sIgE measurement in predicting self-reported allergic symptoms during exposure to dogs and cats in Korean adults. METHODS A total of 552 participants in a pet exhibition in Korea completed questionnaires regarding exposure to dog or cat and the development of allergic symptoms during exposure. Study participants also underwent SPT using 3 different commercially available reagents, and had their blood drawn for measurement of serum total IgE and dog/cat-dander-IgE using ImmunoCAP®. RESULTS Measurement of sIgE for dog and cat dander allergens provided the highest positive and negative predictive values and sensitivity, but not specificity (58%, 87.2%, 67.9%, and 93.1% for allergic symptoms on dog exposure; 64.7%, 83.2%, 74.8%, and 88.9% for those on cat exposure, respectively), in predicting self-reported allergic symptoms on dog and cat exposure. The sIgE level consistently exhibited the highest area under the receiver operating characteristic curve (0.749 and 0.719 for allergic symptoms on dog and cat exposure, respectively). Careful interpretation of SPT and sIgE measurements maximized the positive and negative predictive values, sensitivity, and specificity for predicting allergic symptoms on dog exposure (71.4%, 87.3%, 75.3%, and 99.3%) and those on cat exposure (71.4%, 85.3%, 79.3%, and 98.9%). CONCLUSIONS The measurement of dog and cat dander sIgE levels may be useful for the exclusion of allergic symptoms related to pet exposure. Collective interpretation of SPT and sIgE tests facilitates identification of allergic symptoms on dog or cat exposure, giving a better rule-in test result.
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Key Words
- A/H ratio, Allergen-to-histamine ratio
- AUC, Area under the curve
- Allergy
- Cats
- Dogs
- MWD, Mean wheal diameter
- NPV, Negative predictive value
- PPV, Positive predictive value
- ROC, Receiver-operating characteristic
- SN, Sensitivity
- SP, Specificity
- SPT, Skin prick test
- Skin prick test
- Specific IgE
- sIgE, Allergen-specific IgE
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Affiliation(s)
- Sung-Yoon Kang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Min-Suk Yang
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - So-Young Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jung-Hyun Kim
- Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Ha-Kyeong Won
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Oh Young Kwon
- DreamKwon Internal Medicine Allergy Clinic, Seoul, Republic of Korea
| | - Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ye-Won Kang
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Jae-Woo Jung
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sang Min Lee
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Sang Pyo Lee
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
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Vilar LK, Araújo FA, Santos TP, Menezes TT, Cheik MF, Segundo GRS. Baked Tolerance in Cow's Milk Allergy: Quite Frequent, Hard to Predict! Int Arch Allergy Immunol 2020; 182:319-323. [PMID: 33053550 DOI: 10.1159/000511148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/25/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Cow's milk protein allergy (CMA) is the most common type of food allergy in childhood and exclusion diet is a challenge for patients. OBJECTIVE The study aim was to investigate the frequency of tolerance to baked foods containing milk and evaluate immediate skin prick test (SPT) and specific IgEs for different cow's milk (CM) protein types as predictors of tolerance to baked foods containing milk for CMA patients. METHODS A cross-sectional study was performed. Fifty-four CMA patients were enrolled and oral food challenge (OFC) was performed with baked product, 6 different milk SPTs and specific IgEs to CM, casein, α-lactalbumin, and β-lactoglobulin. RESULTS Thirty-nine (72.2%) patients tolerated OFC with baked milk cupcake. CM-specific IgE and casein SPT showed statistical difference between positive and negative OFC groups. Probability curves for baked milk tolerance were created for specific CM IgE (Z = 2.542, p < 0.0110) and casein SPT (Z = 2.290, p < 0.0220) using logistic regression. CONCLUSIONS The high percentage of patients able to tolerate baked goods enables an improvement in intake possibilities and quality of life of CMA patients and families. Specific CM IgE and casein SPT demonstrated to be useful predictors in relation to baked milk tolerance.
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Affiliation(s)
- Lisis Karine Vilar
- Setor de Alergia e Imunologia, Departamento de Pediatria, Universidade Federal de Uberlândia/Hospital de Clínicas, Uberlândia, Brazil
| | - Flávia Alves Araújo
- Setor de Alergia e Imunologia, Departamento de Pediatria, Universidade Federal de Uberlândia/Hospital de Clínicas, Uberlândia, Brazil
| | - Thalita Pereira Santos
- Setor de Alergia e Imunologia, Departamento de Pediatria, Universidade Federal de Uberlândia/Hospital de Clínicas, Uberlândia, Brazil
| | - Thatiana Tavares Menezes
- Setor de Alergia e Imunologia, Departamento de Pediatria, Universidade Federal de Uberlândia/Hospital de Clínicas, Uberlândia, Brazil
| | - Marina F Cheik
- Setor de Alergia e Imunologia, Departamento de Pediatria, Universidade Federal de Uberlândia/Hospital de Clínicas, Uberlândia, Brazil
| | - Gesmar Rodrigues Silva Segundo
- Setor de Alergia e Imunologia, Departamento de Pediatria, Universidade Federal de Uberlândia/Hospital de Clínicas, Uberlândia, Brazil,
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Lange L, Gernert S. [Pitfalls in the diagnostics of food allergies in children and adolescents]. Hautarzt 2020; 71:903-13. [PMID: 32997217 DOI: 10.1007/s00105-020-04692-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
For the diagnostics of food allergies several points need to be considered. Firstly, it is important to recognize the various clinical pictures that can be caused by a food allergy. The assignment to a disease decides which further examinations are necessary and reasonable. In immunoglobulin (Ig) E‑mediated allergies, the detection of sensitization by determining the specific IgE or the prick test in addition to the medical history is an important mainstay of the diagnostics. Crucial is the fact that the detection of a sensitization against an extract from an allergen source only rarely implies an actual allergy. The majority of positive findings are not clinically relevant. The modern procedure of component-resolved allergy diagnostics improves the significance. Nevertheless, the diagnosis can often only be achieved by oral provocation tests. This article points out possible difficulties with the interpretation of the findings.
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Almeida ALM, Perger ELP, Gomes RHM, Sousa GDS, Vasques LH, Rodokas JEP, Olbrich Neto J, Simões RP. Objective evaluation of immediate reading skin prick test applying image planimetric and reaction thermometry analyses. J Immunol Methods 2020; 487:112870. [PMID: 32961242 DOI: 10.1016/j.jim.2020.112870] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/13/2020] [Accepted: 09/13/2020] [Indexed: 10/23/2022]
Abstract
The skin prick test is used to diagnose patients' sensitization to antigens through a mediated IgE response. It is a practical and quick exam, but its diagnosis depends on instruments for measuring the allergic response and observer's interpretation. The conventional method for inferring about the allergic reaction is performed from the dimensions of the wheals, which are measured using a ruler or a caliper. To make this diagnosis less dependent on human interpretation, the present study proposes two alternative methods to infer about the allergic reaction: computational determination of the wheal area and a study of the temperature variation of the patient's skin in the puncture region. For this purpose, prick test using histamine was performed on 20 patients randomly selected. The areas were determined by the conventional method using the dimensions of the wheals measured with a digital caliper 30 min after the puncture. The wheal areas were also determined by a Python algorithm using photographs of the puncture region obtained with a smartphone. A variable named circularity deviation was also determined for each analyzed wheal. The temperature variation was monitored using an infrared temperature sensor, which collected temperature data for 30 min. All results were statistically compared or correlated. The results showed that the computational method to infer the wheal areas did not differ significantly from the areas determined by the conventional method (p-value = 0.07585). Temperature monitoring revealed that there was a consistent temperature increase in the first minutes after the puncture, followed by stabilization, so that the data could be adjusted by a logistic equation (R2 = 0.96). This adjustment showed that the optimal time to measure the temperature is 800 s after the puncture, when the temperature stabilization occurs. The results have also shown that this temperature stabilization has a significant positive correlation with wheal area (p-value = 0.0015). Thus, we concluded that the proposed computational method is more accurate to infer the wheal area when compared to the traditional method, and that the temperature may be used as an alternative parameter to infer about the allergic reaction.
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Affiliation(s)
- Ana Laura Mendes Almeida
- Medical School, Sao Paulo State University (UNESP), Prof. Mário Rubens Guimarães Montenegro Avenue, s/n, Botucatu, SP, Brazil
| | - Edson Luiz Pontes Perger
- Medical School, Sao Paulo State University (UNESP), Prof. Mário Rubens Guimarães Montenegro Avenue, s/n, Botucatu, SP, Brazil
| | - Ramon Hernany Martins Gomes
- Department of Bioprocess and Biotechnology, School of Agriculture, Sao Paulo State University (UNESP), 3780 Universitária Avenue, Botucatu, SP, Brazil
| | - Guilherme Dos Santos Sousa
- Medical School, Sao Paulo State University (UNESP), Prof. Mário Rubens Guimarães Montenegro Avenue, s/n, Botucatu, SP, Brazil
| | - Lucas Hecker Vasques
- Department of Bioprocess and Biotechnology, School of Agriculture, Sao Paulo State University (UNESP), 3780 Universitária Avenue, Botucatu, SP, Brazil
| | - José Eduardo Petit Rodokas
- Medical School, Sao Paulo State University (UNESP), Prof. Mário Rubens Guimarães Montenegro Avenue, s/n, Botucatu, SP, Brazil; School of Engineering, Sao Paulo State University (UNESP), 14-01 Eng. Luiz Edmundo Carrijo Coube Avenue, Bauru, SP, Brazil
| | - Jaime Olbrich Neto
- Medical School, Sao Paulo State University (UNESP), Prof. Mário Rubens Guimarães Montenegro Avenue, s/n, Botucatu, SP, Brazil
| | - Rafael Plana Simões
- Medical School, Sao Paulo State University (UNESP), Prof. Mário Rubens Guimarães Montenegro Avenue, s/n, Botucatu, SP, Brazil; Department of Bioprocess and Biotechnology, School of Agriculture, Sao Paulo State University (UNESP), 3780 Universitária Avenue, Botucatu, SP, Brazil.
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Lassmann-Klee PG, Piirilä PL, Brumpton B, Larsson M, Sundblad BM, Põlluste J, Juusela M, Rouhos A, Meren M, Lindqvist A, Kankaanranta H, Backman H, Langhammer A, Rönmark E, Lundbäck B, Sovijärvi ARA. Parallel gradients in F ENO and in the prevalences of asthma and atopy in adult general populations of Sweden, Finland and Estonia - A Nordic EpiLung study. Respir Med 2020; 173:106160. [PMID: 33011446 DOI: 10.1016/j.rmed.2020.106160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/18/2020] [Accepted: 09/15/2020] [Indexed: 11/23/2022]
Abstract
The prevalence of asthma is higher in Sweden and Finland than in neighbouring eastern countries including Estonia. Corresponding difference in bronchial eosinophilic inflammation could be studied by FENO measurements. We aimed to compare FENO in adult general populations of Sweden, Finland, and Estonia, to test the plausibility of the west-east disparity hypothesis of allergic diseases. We conducted clinical interviews (N = 2658) with participants randomly selected from the general populations in Sweden (Stockholm and Örebro), Finland (Helsinki), and Estonia (Narva and Saaremaa), and performed FENO (n = 1498) and skin prick tests (SPT) in 1997-2003. The median (interquartile range) of FENO (ppb) was 15.5 (9.3) in Sweden, 15.4 (13.6) in Finland and 12.5 (9.6) in Estonia. We found the lowest median FENO values in the Estonian centres Saaremaa 13.1 (9.5) and Narva 11.8 (8.6). In the pooled population, asthma was associated with FENO ≥25 ppb, odds ratio (OR) 3.91 (95% confidence intervals: 2.29-6.32) after adjusting for SPT result, smoking, gender and study centre. A positive SPT test increased the likelihood of asthma OR 3.19 (2.02-5.11). Compared to Saaremaa, the likelihood of having asthma was higher in Helsinki OR 2.40 (1.04-6.02), Narva OR 2.45 (1.05-6.19), Örebro OR 3.38 (1.59-8.09), and Stockholm OR 5.54 (2.18-14.79). There was a higher prevalence of asthma and allergic airway inflammation in adult general populations of Sweden and Finland compared to those of Estonia. Atopy and elevated FENO level were independently associated with an increased risk of asthma. In conclusion, the findings support the earlier west-east disparity hypothesis of allergic diseases.
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Erskine J, Brooker E, Leech S, Chalkidou A, Keevil S, North J. A Retrospective Clinical Audit of the ImmunoCAP ISAC 112 for Multiplex Allergen Testing. Int Arch Allergy Immunol 2020; 182:14-20. [PMID: 32781452 DOI: 10.1159/000509776] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/26/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Complex cases of multiple allergies can be particularly difficult to diagnose using standard methods such as skin prick tests and assessment of a patient's allergic history. Multiplex allergy testing may improve outcomes for allergy patients by avoiding misdiagnosis and providing reassurance. The ImmunoCAP Immuno Solid-Phase Allergen Chip (ISAC) 112 is a CE-marked, molecular, multiplex, allergy test that can test for IgE antibodies to 112 components from 51 allergen sources. However, its clinical utility is unknown and is difficult to estimate due to the complexity of the diagnostic pathway in which it is used. OBJECTIVE To assess how the ImmunoCAP ISAC 112 is currently being used in UK practice. The patient populations in which it may have the most benefit were examined, and the sequence of other tests implemented alongside ISAC was determined. METHODS A retrospective audit of 100 patient cases from 2 UK tertiary allergy clinics was performed. Fifty paediatric and fifty adult cases were selected for audit. The indications for ordering an ISAC test, the other tests used alongside ISAC, and changes in management actioned by the ISAC test were investigated. RESULTS 73.6% of paediatric and 78% of adult patients referred for an ISAC test were suspected to have multiple sensitizations. The sequence of testing varied greatly between cases, but 70% of adult and 98% of paediatric patients had at least one other investigation prior to an ISAC test. In most cases, ISAC testing confirmed clinical suspicion. CONCLUSIONS A prospective research study is necessary to further investigate the clinical utility and cost-effectiveness of the ISAC. A UK national registry would be of great benefit but will require a large resource base.
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Affiliation(s)
- Jamie Erskine
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom,
| | - Elspeth Brooker
- Department of Paediatric Allergy, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Susan Leech
- Department of Paediatric Allergy, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Anastasia Chalkidou
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Stephen Keevil
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Jonathan North
- Department of Immunology, City Hospital, Birmingham, United Kingdom
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