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Asero R, Nucera E, Rizzi A, Aruanno A, Uasuf CG, Manzotti G, Villalta D, Conte M, Pastorello EA, Losappio L, Schroeder JV, Pinter E, Miglionico M, Vantaggio L, Macchia D, Radice A, Marra AM, Barzaghi C, Santucci A, Cortellini G, Peveri S, Montagni M, Demonte A, Borrelli P, Errico MA, Rivolta F, Pravettoni V, Sangalli A, Magnani M, Celi G, Yang B, Costantino MT, Deleonardi G, Boni E, Gattoni M, Rizzini FL, Di Paolo C, Montera M, Giordano A, De Carli M, Murzilli F, Fumagalli F, Maffeis L, Ghiglioni DG, Centonze S, Di Lizia M, Calafiore P, Scala E. Peanut allergy in Italy: A unique Italian perspective. J Allergy Clin Immunol Glob 2022; 1:61-66. [PMID: 37780582 PMCID: PMC10509966 DOI: 10.1016/j.jacig.2022.02.001] [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] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/12/2022] [Accepted: 02/15/2022] [Indexed: 10/03/2023]
Abstract
Background Peanut allergy has not been well characterized in Italy. Objective Our aim was to better define the clinical features of peanut allergy in Italy and to detect the peanut proteins involved in allergic reactions. Methods A total of 22 centers participated in a prospective survey of peanut allergy over a 6-month period. Clinical histories were confirmed by in vivo and/or in vitro diagnostic means in all cases. Potential risk factors for peanut allergy occurrence were considered. Levels of IgE to Arachis hypogea (Ara h) 1, 2, 3, 6, 8, and 9 and profilin were measured. Results A total of 395 patients (aged 2-80 years) were enrolled. Of the participants, 35% reported local reactions, 38.2% reported systemic reactions, and 26.6% experienced anaphylaxis. The sensitization profile was dominated by Ara h 9 (77% of patients were sensitized to it), whereas 35% were sensitized to pathogenesis-related protein 10 (PR-10) and 26% were sensitized to seed storage proteins (SSPs). Sensitization to 2S albumins (Ara h 2 and Ara h 6) or lipid transfer protein (LTP) was associated with the occurrence of more severe symptoms, whereas profilin and PR-10 sensitization were associated with milder symptoms. Cosensitization to profilin reduced the risk of severe reactions in both Ara h 2- and LTP-sensitized patients. SSP sensitization prevailed in younger patients whereas LTP prevailed in older patients (P < .01). SSP sensitization occurred mainly in northern Italy, whereas LTP sensitization prevailed in Italy's center and south. Atopic dermatitis, frequency of peanut ingestion, peanut consumption by other family members, or use of peanut butter did not seem to be risk factors for peanut allergy onset. Conclusions In Italy, peanut allergy is rare and dominated by LTP in the country's center and south and by SSP in the north. These 2 sensitizations seem mutually exclusive. The picture differs from that in Anglo-Saxon countries.
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Affiliation(s)
- Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Milan, Italy
| | - Eleonora Nucera
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore – Roma, Italy
| | - Angela Rizzi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore – Roma, Italy
| | - Arianna Aruanno
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore – Roma, Italy
| | - Carina G. Uasuf
- Allergy Center, Institute of Traslational Pharmacology, National Research Council (CNR), Palermo, Italy
| | | | - Danilo Villalta
- SSD di Immunologia e Allergologia, PO S. Maria degli Angeli, Pordenone, Italy
| | | | - Elide A. Pastorello
- Dipartimento di Allergologia, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Laura Losappio
- Dipartimento di Allergologia, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Jan V. Schroeder
- Dipartimento di Allergologia, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Elena Pinter
- UOC Medicina Interna e Immunologia Clinica, Dipartimento Medicina Traslazionale e di Precisione, Sapienza University of Rome, Rome, Italy
| | - Marzia Miglionico
- Allergy and Clinical Immunology Residency Program, Department of Molecular Medicine, Sapienza University of Rome, Italy
| | - Lorenzo Vantaggio
- Allergy and Clinical Immunology Residency Program, Department of Molecular Medicine, Sapienza University of Rome, Italy
| | - Donatella Macchia
- SOS Allergologia e Immunologia Clinica, Ospedale San Giovanni di Dio, Firenze, Italy
| | - Anna Radice
- SOS Allergologia e Immunologia Clinica, Ospedale San Giovanni di Dio, Firenze, Italy
| | - Alessandro M. Marra
- ASST Rhodense - UO Pneumologia - Ospedale di Garbagnate Milanese, Milan, Italy
| | - Claudio Barzaghi
- ASST Rhodense - Ambulatorio di Allergologia - Ospedale di Rho, Italy
| | - Annalisa Santucci
- Ausl Romagna, UOS interdipartimentale di Allergologia, Ospedale degli Infermi di Rimini, Italy
| | - Gabriele Cortellini
- Ausl Romagna, UOS interdipartimentale di Allergologia, Ospedale degli Infermi di Rimini, Italy
| | - Silvia Peveri
- UOsD Allergologia, Ospedale G. Da Saliceto, Piacenza, Italy
| | | | | | - Paolo Borrelli
- SSD Dermatologia - Ambulatorio Allergologia e Immunologia Clinica, Ospedale Beauregard, Aosta, Italy
| | - Micol A. Errico
- SSD Dermatologia - Ambulatorio Allergologia e Immunologia Clinica, Ospedale Beauregard, Aosta, Italy
| | - Federica Rivolta
- General Medicin, Immunology and Allergy Department - IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico - Milan, Italy
| | - Valerio Pravettoni
- General Medicin, Immunology and Allergy Department - IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico - Milan, Italy
| | - Andrea Sangalli
- Allergy and Clinical Immunology Residency, University of Milan, Italy
| | | | - Giorgio Celi
- Centro DH Allergologia e Immunologia Clinica, Ospedale Carlo Poma ASST-Mantova, Italy
| | - Baoran Yang
- Centro DH Allergologia e Immunologia Clinica, Ospedale Carlo Poma ASST-Mantova, Italy
| | - Maria T. Costantino
- Centro DH Allergologia e Immunologia Clinica, Ospedale Carlo Poma ASST-Mantova, Italy
| | | | - Elisa Boni
- Allergologia e autoimmunità LUM AUSL Bologna, Italy
| | - Marco Gattoni
- Scuola di Specializzazione in Allergologia e Immunologia Clinica Università degli Studi di Bologna, Italy
| | | | | | - Mariacarmela Montera
- Allergologia e Immunologia Clinica, Ospedale G. Fuscito, Mercato S. Severino; Ospedaliero-Universitaria Ruggi D'Aragona, Salerno, Italy
| | - Annaclaudia Giordano
- Allergologia e Immunologia Clinica, Ospedale G. Fuscito, Mercato S. Severino; Ospedaliero-Universitaria Ruggi D'Aragona, Salerno, Italy
| | - Marco De Carli
- S.O.C Medicina 2, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy
| | - Francesco Murzilli
- U.O.S.D. di Allergologia, Ospedale S.S. Filippo e Nicola, Avezzano, Italy
| | | | - Laura Maffeis
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Pediatric Intermediate Care Unit, Milan, Italy
| | - Daniele Giovanni Ghiglioni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Pediatric Highly Intensive Care Unit, Milan, Italy
| | | | | | | | - Enrico Scala
- Istituto Dermopatico dell’Immacolata, Roma, Italy
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Skypala IJ, Asero R, Barber D, Cecchi L, Diaz Perales A, Hoffmann-Sommergruber K, Pastorello EA, Swoboda I, Bartra J, Ebo DG, Faber MA, Fernández-Rivas M, Gomez F, Konstantinopoulos AP, Luengo O, van Ree R, Scala E, Till SJ. Non-specific lipid-transfer proteins: Allergen structure and function, cross-reactivity, sensitization, and epidemiology. Clin Transl Allergy 2021; 11:e12010. [PMID: 34025983 PMCID: PMC8129635 DOI: 10.1002/clt2.12010] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/08/2021] [Indexed: 12/27/2022] Open
Abstract
Background Discovered and described 40 years ago, non‐specific lipid transfer proteins (nsLTP) are present in many plant species and play an important role protecting plants from stressors such as heat or drought. In the last 20 years, sensitization to nsLTP and consequent reactions to plant foods has become an increasing concern. Aim The aim of this paper is to review the evidence for the structure and function of nsLTP allergens, and cross‐reactivity, sensitization, and epidemiology of nsLTP allergy. Materials and Methods A Task Force, supported by the European Academy of Allergy & Clinical Immunology (EAACI), reviewed current evidence and provide a signpost for future research. The search terms for this paper were “Non‐specific Lipid Transfer Proteins”, “LTP syndrome”, “Pru p 3”, “plant food allergy”, “pollen‐food syndrome”. Results Most nsLTP allergens have a highly conserved structure stabilised by 4‐disulphide bridges. Studies on the peach nsLTP, Pru p 3, demonstrate that nsLTPs are very cross‐reactive, with the four major IgE epitopes of Pru p 3 being shared by nsLTP from other botanically related fruits. These nsLTP allergens are to varying degrees resistant to heat and digestion, and sensitization may occur through the oral, inhaled or cutaneous routes. In some populations, Pru p 3 is the primary and sole sensitizing allergen, but many are poly‐sensitised both to botanically un‐related nsLTP in foods, and non‐food sources of nsLTP such as Cannabis sativa, Platanus acerifolia, (plane tree), Ambrosia artemisiifolia (ragweed) and Artemisia vulgaris (mugwort). Initially, nsLTP sensitization appeared to be limited to Mediterranean countries, however more recent studies suggest clinically relevant sensitization occurs in North Atlantic regions and also countries in Northern Europe, with nsLTP sensitisation profiles being broadly similar. Discussion These robust allergens have the potential to sensitize and provoke symptoms to a large number of plant foods, including those which are raw, cooked or processed. It is unknown why some sensitized individuals develop clinical symptoms to foods whereas others do not, or indeed what other allergens besides Pru p 3 may be primary sensitising allergens. It is clear that these allergens are also relevant in non‐Mediterranean populations and there needs to be more recognition of this. Conclusion Non‐specific LTP allergens, present in a wide variety of plant foods and pollens, are structurally robust and so may be present in both raw and cooked foods. More studies are needed to understand routes of sensitization and the world‐wide prevalence of clinical symptoms associated with sensitization to these complex allergens.
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Affiliation(s)
- Isabel J Skypala
- Department of Allergy & Clinical Immunology Royal Brompton & Harefield NHS Foundation Trust Imperial College London UK
| | - Ricardo Asero
- Ambulatorio di Allergologia Clinica San Carlo Milan Italy
| | - Domingo Barber
- IMMA School of Medicine Universidad San Pablo CEU CEU Universities Madrid Spain.,RETIC ARADYAL RD16/0006/0015 Instituto de Salud Carlos III Madrid Spain
| | - Lorenzo Cecchi
- SOS Allergy and Clinical Immunology USL Toscana Centro Prato Italy
| | - Arazeli Diaz Perales
- Departamento de Biotecnología-Biología Vegetal Centro de Biotecnología y Genómica de Plantas (CBGP, UPM-INIA) Universidad Politécnica de Madrid Madrid Spain
| | | | - Elide A Pastorello
- Unit of Allergology and Immunology ASST Grande Ospedale Metropolitano Niguarda University of Milan Milan Italy
| | - Ines Swoboda
- Biotechnology Section FH Campus Wien University of Applied Sciences Vienna Austria
| | - Joan Bartra
- Hospital Clinic de Barcelona IDIBAPS Universitat de Barcelona ARADyAL Barcelona Spain
| | - Didier G Ebo
- Department of Immunology, Allergology, Rheumatology and Infla-Med Centre of Excellence Faculty of Medicine and Health Sciences University of Antwerp and Antwerp University Hospital Ghent Belgium
| | - Margaretha A Faber
- Department of Immunology, Allergology, Rheumatology and Infla-Med Centre of Excellence Faculty of Medicine and Health Sciences University of Antwerp and Antwerp University Hospital Ghent Belgium
| | - Montserrat Fernández-Rivas
- Department of Allergy Hospital Clínico San Carlos Universidad Complutense de Madrid IdISSC, ARADyAL Madrid Spain
| | - Francesca Gomez
- Allergy Unit IBIMA- Hospital Regional Universitario de Malaga Malaga and Spanish Network for Allergy - RETICS de Asma, Reacciones adversas y Alérgicas (ARADyAL) Madrid Spain
| | | | - Olga Luengo
- Allergy Unit, Internal Medicine Department Vall d'Hebron University Hospital Universitat Autònoma de Barcelona ARADyAL Barcelona Spain
| | - Ronald van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology Amsterdam University Medical Centers location AMC Amsterdam The Netherlands
| | - Enrico Scala
- Experimental Allergy Unit Istituto Dermopatico Dell'immacolata IRCCS FLMM Rome Italy
| | - Stephen J Till
- Peter Gorer Department of Immunobiology King's College London London UK.,Department of Allergy Guy's & St Thomas' NHS Foundation Trust London UK
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Abstract
BACKGROUND On June 30, 2020, the WHO reported over 10 millions of COVID-19 cases worldwide with over half a million deaths. In severe cases the disease progresses into an Acute Respiratory Distress Syndrome (ARDS), which in turn depends on an overproduction of cytokines (IL-6, TNFα, IL-12, IL-8, CCL-2 and IL1) that causes alveolar and vascular lung damage. Clearly, it is essential to find an immunological treatment that controls the "cytokine storm". In the meantime, however, it is essential to have effective antiviral and anti-inflammatory drugs available immediately. PHARMACOLOGIC THERAPY FOR COVID-19 Hydroxychloroquine or chloroquine have been widely adopted worldwide for the treatment of SARS-CoV-2 pneumonia. However, the choice of this treatment was based on low quality of evidence, i.e. retrospective, non-randomized controlled studies. Recently, four large Randomized Controlled Trials (RCTs) have been performed in record time delivering reliable data: (1) the National Institutes of Health (NIH) RCT included 60 hospitals participating all over the world and showed the efficacy of remdesivir in reducing the recovery time in hospitalized adults with COVID-19 pneumonia; (2) three large RCTs already completed, for hydroxychloroquine, dexamethasone and Lopinavir and Ritonavir respectively. These trials were done under the umbrella of the 'Recovery' project, headed by the University of Oxford. The project includes 176 participating hospitals in the UK and was set up to verify the efficacy of some of the treatments used for COVID-19. These three 'Recovery' RCTs concluded definitely: (a) that treatment with hydroxychloroquine provides no benefits in patients hospitalized with COVID-19; (b) that treatment with dexamethasone reduced deaths by one-third in COVID-19 patients that were mechanically ventilated, and by one-fifth in patients receiving oxygen only; (c) that the combination of Lopinavir and Ritonavir is not effective in reducing mortality in COVID-19 hospitalized patients. CONCLUSIONS The results of these four large RCTs have provided sound indications to doctors for the treatment of patients with COVID-19 and prompted the correction of many institutional provisions and guidelines on COVID-19 treatments (i.e. FDA, NIH, UK Health Service, etc.). Even though a definitive treatment for COVID-19 has not yet been found, large RCTs stand as the Gold Standards for COVID-19 therapy and offer a solid scientific base on which to base treatment decisions.
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Affiliation(s)
- Claudio Ortolani
- Istituto Allergologico Lombardo. Casa Di Cura Ambrosiana, Cesano Boscone, Milano, Italy
| | - Elide A. Pastorello
- Unit of Allergy and Immunology, Università Degli Studi Di Milano, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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4
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Asero R, Abbadessa S, Aruanno A, Barilaro G, Barzaghi C, Bignardi D, Bilò MB, Borro M, Bresciani M, Busa M, Buzzulini F, Cavaliere C, Cecchi L, Ciccarelli A, Cortellini G, Cucinelli F, Deleonardi G, Emiliani F, Farsi A, Ferrarini E, Franchini M, Ingrassia A, Lippolis D, Losappio L, Marra AM, Martini M, Masieri S, Mauro M, Mazzolini M, Muratore L, Murzilli F, Nucera E, Pastorello EA, Pinter E, Polillo BR, Pravettoni V, Quercia O, Rizzi A, Russello M, Sacerdoti C, Scala E, Scala G, Scarpa A, Schroeder J, Uasuf CG, Villalta D, Yang B, Mistrello G, Amato S, Lidholm J. Detection of Gibberellin-Regulated Protein (Peamaclein) Sensitization among Italian Cypress Pollen-Sensitized Patients. J Investig Allergol Clin Immunol 2020; 32:40-47. [DOI: 10.18176/jiaci.0542] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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5
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Asero R, Aruanno A, Bresciani M, Brusca I, Carollo M, Cecchi L, Cortellini G, Deleonardi G, Farsi A, Ferrarini E, Gabrielli G, Ingrassia A, Mauro M, Murzilli F, Nucera E, Onida R, Pastorello EA, Pinter E, Rizzi A, Russello M, Sacerdoti C, Scala E, Scala G, Villalta D, Zampogna S, Amato S, Mistrello G. Evaluation of two commercial peach extracts for skin prick testing in the diagnosis of hypersensitivity to lipid transfer protein. A multicenter study. Eur Ann Allergy Clin Immunol 2020; 53:168-170. [PMID: 32347686 DOI: 10.23822/eurannaci.1764-1489.144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary The clinical usefulness of two commercial peach extracts for SPT (by Lofarma SpA and ALK-Abellò, respectively) was compared in a multicenter study carried out in Italy. Peach allergic patients were tested with the two extracts in parallel and underwent the detection of IgE specific for all three peach allergens currently available (Pru p1, Pru p3, and Pru p4, respectively). The two extracts were almost identical in terms of sensitivity and specificity, being able to detect virtually all patients sensitized to stable peach allergens (lipid transfer protein (LTP) and, presumably, peamaclein) but scoring negative in patients exclusively sensitive to labile allergens (either PR-10 and/or profilin). Thus, the two extracts represent an excellent tool to carry out a preliminary component-resolved diagnosis of peach allergy at the first patient visit.
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Affiliation(s)
- R Asero
- Allergology Clinic, Clinica San Carlo, Paderno Dugnano, Milan, Italy
| | - A Aruanno
- Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - M Bresciani
- Allergology Clinic, Asl RM 4, S. Paolo Civitavecchia Hospital, Civitavecchia, Italy
| | - I Brusca
- Clinical Pathology U.O.C., Buccheri La Ferla F.B.F. Hospital, Palermo, Italy
| | - M Carollo
- Pathology and Clinical Biochemistry, Magna Graecia University, Catanzaro, Italy
| | - L Cecchi
- Allergology and Immunology SOS, Prato-Azienda USL Toscana Centro, Prato, Italy
| | - G Cortellini
- Romagna Allergy Unit, Internist Department of Rimini, Rimini, Italy
| | - G Deleonardi
- Laboratorio Unico Metropolitano, AUSL Bologna, Bologna, Italy
| | - A Farsi
- Allergology and Immunology SOS, Prato-Azienda USL Toscana Centro, Prato, Italy
| | - E Ferrarini
- Allergology OUS, Umberto I Hospital, Siracusa, Italy
| | - G Gabrielli
- School of Specialization in Allergy and Clinical Immunology, Alma Mater Studiorum, Bologna, Italy
| | - A Ingrassia
- Allergology UO, District of Marsala, ASP 9, Trapani, Italy
| | - M Mauro
- Allergology UO, ASST Lariana, Como, Italy
| | - F Murzilli
- Allergology U.O.S.D., S.S. Filippo e Nicola Hospital, Avezzano, Italy
| | - E Nucera
- Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - R Onida
- Clinical Pathology U.O.C., Buccheri La Ferla F.B.F. Hospital, Palermo, Italy
| | - E A Pastorello
- Struttura Complessa di Allergologia e Immunologia, ASST GOM, Niguarda, Milan, Italy
| | - E Pinter
- Clinic Immunology U.O.C., Policlinico Umberto Primo, Rome, Italy
| | - A Rizzi
- Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - M Russello
- Allergology UO, ASST Lariana, Como, Italy
| | | | - E Scala
- Istituto Dermopatico dell'Immacolata, Rome, Italy
| | - G Scala
- Allergology UOSD, Loreto Crispi, ASL Napoli 1 Centro, Naples, Italy
| | - D Villalta
- Immunology and Allergology Unit, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - S Zampogna
- Pediatric First Aid, Pugliese Ciaccio Hospital, Catanzaro, Italy
| | - S Amato
- Lofarma SpA, R and D, Milan, Italy
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Farioli L, Losappio LM, Schroeder JW, Preziosi D, Scibilia J, Caron L, Nichelatti M, Pastorello EA. Basal Tryptase Levels Can Predict Clinical Severity in Hymenoptera Venom Anaphylaxis and Ischemic Cardiovascular Disorders. J Investig Allergol Clin Immunol 2019; 29:162-164. [PMID: 31017123 DOI: 10.18176/jiaci.0363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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)
- L Farioli
- Department of Laboratory Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - L M Losappio
- Department of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - J W Schroeder
- Department of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - D Preziosi
- Department of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - J Scibilia
- Department of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - L Caron
- Department of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - M Nichelatti
- Biostatistics Service, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - E A Pastorello
- Department of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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7
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Scibilia J, Rossi Carlo M, Losappio Laura M, Mirone C, Farioli L, Pravettoni V, Pastorello EA. Favorable Prognosis of Wheat Allergy in Adults. J Investig Allergol Clin Immunol 2019; 29:118-123. [PMID: 31017108 DOI: 10.18176/jiaci.0296] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Wheat ingestion can lead to disorders such as IgE-mediated food allergy and wheat-dependent exercise-induced anaphylaxis (WDEIA), both of which are associated with impaired quality of life and significant morbidity. Allergy to wheat is relatively benign in children, although its natural history in adults is still unknown. Objective: We used placebo-controlled challenge to evaluate the natural history of wheat hypersensitivity in atopic patients with adultonset wheat allergy. METHODS We enrolled 13 patients from an initial cohort of adult patients with IgE-mediated wheat allergy (mean age, 40 years). After diagnosis, the patients observed a wheat-free diet and were followed as outpatients for 5 years to evaluate wheat exposure. Wheat-IgEtiters were determined at the end of follow-up, and a second wheat-challenge was performed. RESULTS Ten out of 13 patients took part in the study. The mean period of wheat avoidance was 4.2 years. Three patients had spontaneously reintroduced wheat before the second evaluation, after a mean (IQR) of 28 (18-36) months, with only mild gastrointestinal discomfort at reintroduction. At the end of follow-up, 9 of the 10 patients were wheat-tolerant. Two patients had a history of WDEIA. We observed a reduction in IgE levels, with median (IQR) IgE falling from 2.77 (0.35-100) kU/L at diagnosis to 0.88 (0.1-20.8) kU/L. The association between IgE and a negative challenge result was not statistically significant. CONCLUSION IgE-mediated wheat allergy in adults is benign and represents a temporary break in gastrointestinal tolerance. Future studies may improve our knowledge of wheat allergens, routes of and factors leading to sensitization, and prognostic biomarkers.
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Affiliation(s)
- J Scibilia
- Unit of Allergology and Immunology, Dipartimento Medico Polispecialistico, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - M Rossi Carlo
- Unit of Allergology and Immunology, Dipartimento Medico Polispecialistico, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - M Losappio Laura
- Unit of Allergology and Immunology, Dipartimento Medico Polispecialistico, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - C Mirone
- Unit of Allergology and Immunology, Dipartimento Medico Polispecialistico, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - L Farioli
- Department of Laboratory Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - V Pravettoni
- Clinical Allergy and Immunology Unit, Foundation IRCCS Ca´ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - E A Pastorello
- Unit of Allergology and Immunology, Dipartimento Medico Polispecialistico, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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8
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Maurer M, Houghton K, Costa C, Dabove F, Ensina LF, Giménez-Arnau A, Guillet G, Konstantinou GN, Labrador-Horrillo M, Lapeere H, Meshkova R, Pastorello EA, Velásquez-Lopera M, Tamayo Quijano LM, Vestergaard C, Chapman-Rothe N. Differences in chronic spontaneous urticaria between Europe and Central/South America: results of the multi-center real world AWARE study. World Allergy Organ J 2018; 11:32. [PMID: 30464782 PMCID: PMC6238280 DOI: 10.1186/s40413-018-0216-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/09/2018] [Indexed: 11/10/2022] Open
Abstract
Background Global chronic urticaria (CU) disease experience and management is not well documented. This study descriptively compares these aspects among CU patients residing in Europe (EU) and Central and South America (C/SA). Methods AWARE (A World-wide Antihistamine-Refractory chronic urticaria patient Evaluation) is a global prospective, non-interventional study of CU in the real-world setting. Patients were ≥ 18 years with a diagnosis of H1-antihistamine-refractory CU for > 2 months. Differences between the EU and C/SA regions in demographic and clinical characteristics, quality of life (QoL), work and activity impairment, pharmacological treatment, and healthcare resource use were examined. Results In total, 4224 patients were included in the analysis (C/SA 492; EU 3732). Rates of untreated patients were greater in the C/SA region (45.1% vs. 31.9%; P < 0.005) and escalation to third-line therapy was rare in both regions. Differences in disease experience emerged, with C/SA patients more commonly experiencing angioedema (C/SA 50.8% vs. EU 46.1%; P = 0.03) or comorbid chronic inducible urticaria (C/SA 30% vs. EU 22%; P < 0.001). Correspondingly, rates of uncontrolled urticaria were higher among C/SA patients (82.8% vs. 77.5%; P = 0.017) and patients in the C/SA region showed significantly greater work and activity impairment (absenteeism: 10.4 ± 19.7 vs. 6.7 ± 19.0, P = 0.004; presenteeism: 30.3 ± 31.9 vs. 24.4 ± 25.8, P = 0.001; work productivity loss: 33.9 ± 33.9 vs. 26.5 ± 27.5, P < 0.001; activity impairment: 37.7 ± 34.7 vs. 32.7 ± 30.1, P = 0.001). However, QoL impairment was greater in the EU region (Dermatology Life Quality Index: C/SA 6.5 ± 5.9 vs. EU 8.3 ± 7.0; P < 0.001). There was a significant difference in use of healthcare resources, including emergency services (39.6% vs. 29.3%; P < 0.001), hospitalization (7.7% vs 21.9%; P < 0.001) general practitioners (31.7% vs 57.3%; P < 0.001), and additional allergists or dermatologists (50.6% vs. 47.3%, P < 0.001), among patients in the C/SA and EU region, respectively. In both regions, patients with a primary diagnosis of CU with angioedema had significantly greater impairment in work and non-work activities and healthcare resource utilization compared to those without angioedema. Conclusions This study revealed that CU is a heterogeneous condition with differences in healthcare utilization and outcomes between EU and C/SA. However, overall there is a high unmet need of H1-antihistamine-refractory CU patients, which is associated with high use of healthcare resources, and has a large negative effect on QoL and work productivity.
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Affiliation(s)
- M Maurer
- 1Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - K Houghton
- RTI Health Solutions, Carolina, North, USA
| | - C Costa
- 3Serviço de Imunoalergologia, Hospital de Santa Maria, Lisbon, Portugal
| | - F Dabove
- Center of Medical Specialties Lobos, Buenos Aires, Argentina
| | - L F Ensina
- CPAlpha Clinical Research Center, São Paulo, Brazil.,6Hospital Sírio-Libanês, São Paulo, Brazil
| | - A Giménez-Arnau
- 7Hospital del Mar, Parc de Salut Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - G Guillet
- 8Service de Dermato-allergologie, CHU Poitiers, Poitiers, France
| | - G N Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, Greece
| | - M Labrador-Horrillo
- 10Hospital Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - H Lapeere
- 11Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - R Meshkova
- 12Allergy and Clinical Immunology, Smolensk State Medical University, Smolensk, Russia
| | - E A Pastorello
- S.C. di Allergologia e Immunologia ASST Grande Ospedale Metropolitano Niguarda Milan, Milan, Italy
| | - M Velásquez-Lopera
- 14Centro de Investigaciones Dermatológicas, CIDERM, University of Antioquia, Medellín, Colombia
| | | | - C Vestergaard
- 16Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
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9
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Merante S, Ferretti VV, Elena C, Brazzelli V, Zanotti R, Neri I, Magliacane D, Belloni Fortina A, Ingeborg F, Pastorello EA, Pieri L, Papayannidis C, Mauro M, Grifoni F, Minelli R, Guggiari E, Difonzo E, Bocchia M, Caroppo F, Di Nuzzo S, Elli EM, Rondoni M, Ciccocioppo R, Di Stefano M, Bossi G, Boveri E, Bonadonna P, Giona F, Valent P, Triggiani M. The Italian Mastocytosis Registry: 6-year experience from a hospital-based registry. Future Oncol 2018; 14:2713-2723. [DOI: 10.2217/fon-2018-0291] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim: We collected ‘real-life’ data on the management of patients with mastocytosis in the Italian Mastocytosis Registry. Methods: Six hundred patients diagnosed with mastocytosis between 1974 and 2014 were included from 19 centers. Results: Among adults (n = 401); 156 (38.9%) patients were diagnosed with systemic mastocytosis. In 212 adults, no bone marrow studies were performed resulting in a provisional diagnosis of mastocytosis of the skin. This diagnosis was most frequently established in nonhematologic centers. In total, 182/184 pediatric patients had cutaneous mastocytosis. We confirmed that in the most patients with systemic mastocytosis, serum tryptase levels were >20 ng/ml and KIT D816V was detectable. Conclusion: The Italian Mastocytosis Registry revealed some center-specific approaches for diagnosis and therapy. Epidemiological evidence on this condition is provided.
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Affiliation(s)
- Serena Merante
- Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Hematology Department, James Cook University Hospital, South Tees Trust (NHS), Middlesbrough, UK
| | | | - Chiara Elena
- Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Iria Neri
- Dermatology, Department of Experimental, Diagnostic & Specialty Medicine, University of Bologna, Bologna, Italy
| | | | | | | | | | - Lisa Pieri
- Center of Research & Innovation of Myeloproliferative Neoplasms (CRIMM), Careggi University Hospital/University of Florence, Florence, Italy
| | | | | | - Federica Grifoni
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | | | | | - Elisa Difonzo
- Dermatology, University of Florence, Florence, Italy
| | | | | | | | - Elena Maria Elli
- Divisione di Ematologia, Ospedale San Gerardo, ASST Monza, Italy
| | | | - Rachele Ciccocioppo
- Gastroenterology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | - Grazia Bossi
- Pediatric Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emanuela Boveri
- Pathology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, University of Pavia, Italy
| | | | - Fiorina Giona
- Ematologia, Sapienza Università di Roma, Azienda Policlinico Umberto I Roma, Italy
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
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10
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Safi H, Wangorsch A, Lidholm J, Brini F, Spiric J, Rihs HP, Vieths S, Armentia A, Farioli L, Diaz-Perales A, Pastorello EA, Scheurer S. Identification and molecular characterization of allergenic non-specific lipid-transfer protein from durum wheat (Triticum turgidum). Clin Exp Allergy 2018; 49:120-129. [PMID: 30199586 DOI: 10.1111/cea.13271] [Citation(s) in RCA: 9] [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: 04/09/2018] [Revised: 07/06/2018] [Accepted: 07/15/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Common wheat (Triticum aestivum) and durum wheat (T. turgidum) are both involved in Baker's asthma (BA) and food allergy (FA) including wheat-dependent exercise-induced asthma (WDEIA). However, allergens in durum wheat have not been described, and the over-expression of T. turgidum non-specific lipid-transfer protein (nsLTPs) is considered to increase resistance to phytopathogens. OBJECTIVE To identify and assess the allergenicity of nsLTP from T. turgidum. METHODS Recombinant T. turgidum nsLTP Tri tu 14 was generated and tested for structural integrity (circular dichroism-spectroscopy) and purity (SDS-PAGE). Thirty-two wheat allergic patients were enrolled: 20 Spanish patients (BA) with positive bronchial challenge to wheat flour, and 12 Italian patients (wheat FA/WDEIA) with positive double-blind placebo-controlled food challenge/open food challenge (OFC) to pasta. IgE values to wheat, Tri tu 14, Tri a 14 (T. aestivum) and Pru p 3 (P. persica) were determined by ImmunoCAP testing. Allergenic potency (in vitro mediator release) and IgE cross-reactivity were investigated. RESULTS Tri tu 14 was found to share 49% and 52% amino acid identity with Tri a 14 and Pru p 3, respectively. Among 25 Tri a 14 CAP positive sera, 23 (92%) were reactive to wheat extract, 22 (88%) to Tri tu 14 and 20 (80%) to Pru p 3. The correlation between Tri a 14 and Tri tu 14 specific IgE levels was r = 0.97 (BA) and r = 0.93 (FA/WDEIA), respectively. FA/WDEIA patients showed higher specific IgE values to Tri tu 14 and Pru p 3 than BA patients. Tri tu 14 displayed allergenic activity by mediator release from effector cells and IgE cross-reactivity with Pru p 3. The degree of IgE cross-reactivity between the two wheat nsLTPs varied between individual patients. CONCLUSIONS AND CLINICAL RELEVANCE Sensitization to Tri tu 14 likely appears to be more important in wheat FA/WDEIA than in BA. Over-expression of Tri tu 14 in wheat would represent a risk for patients with nsLTP-mediated FA.
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Affiliation(s)
- Hela Safi
- Laboratory of Biotechnology and Plant Improvement, Centre of Biotechnology, Sfax, Tunisia.,Molecular Allergology, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | - Andrea Wangorsch
- Molecular Allergology, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | | | - Faiçal Brini
- Laboratory of Biotechnology and Plant Improvement, Centre of Biotechnology, Sfax, Tunisia
| | - Jelena Spiric
- Division Allergology, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | - Hans-Peter Rihs
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Institute of the Ruhr-University Bochum, Molecular Genetics, Bochum, Germany
| | - Stefan Vieths
- Molecular Allergology, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | | | - Laura Farioli
- Department of Laboratory Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Araceli Diaz-Perales
- Departamento de Biotecnología-Biología Vegetal, E. T.S. Ingenieros Agrónomos/Centro de Biotecnología y Genómica de Plantas (CBGP, UPM-INIA) Universidad Politécnica de Madrid, Madrid, Spain
| | - Elide A Pastorello
- Department of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stephan Scheurer
- Molecular Allergology, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
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11
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Bilò MB, Pravettoni V, Bignardi D, Bonadonna P, Mauro M, Novembre E, Quercia O, Cilia M, Cortellini G, Costantino MT, Cremonte L, Lodi Rizzini F, Macchia L, Marengo F, Murzilli F, Patella V, Reccardini F, Ricciardi L, Ridolo E, Romano A, Savi E, Schiavino D, Severino M, Pastorello EA. Hymenoptera Venom Allergy: Management of Children and Adults in Clinical Practice. J Investig Allergol Clin Immunol 2018; 29:180-205. [PMID: 30183660 DOI: 10.18176/jiaci.0310] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Hymenoptera venom allergy is an epidemiologically underestimated condition and a major cause of morbidity worldwide. Preventing future allergic reactions in patients who experience a systemic reaction is based on the correct management of the emergency followed by an accurate diagnosis, prescription of adrenaline autoinjectors, and, where indicated, specific venom immunotherapy. Some epidemiological studies highlight our poor knowledge of this disease and the frequent inadequacy of its management. Moreover, they emphasize the importance of such a life-saving treatment as specific immunotherapy. The availability of high-quality hymenoptera venom extracts for diagnostic and therapeutic use has dramatically improved the prognosis and quality of life of allergic patients. Subcutaneous venom immunotherapy is currently the most effective form of allergen-based immunotherapy, with a carry-over effect lasting up to several years after its interruption. This report on the management of hymenoptera venom-allergic children and adults was prepared by a panel of Italian experts. The main objective of this consensus document is to review the scientific evidence related to diagnosis, therapy, and management of patients allergic to hymenoptera venom. Thus, we can improve our knowledge of the disease and promote good clinical practices. The present document provides practical suggestions for correct diagnosis, prescription of emergency therapy and immunotherapy, and strategies for patient care.
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Affiliation(s)
- M B Bilò
- U.O.C. Allergology, Department of Internal Medicine, University-Hospital Ospedali Riuniti di Ancona, Italy
| | - V Pravettoni
- U.O.C. General Medicine - Immunology and Allergology, Foundation IRCCS Ca´ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - D Bignardi
- U.O.C. Allergology, Ospedale Policlinico San Martino, Genova, Italy
| | - P Bonadonna
- U.S.D. Allergology, Integrated University-Hospital of Verona, Italy
| | - M Mauro
- U.O.S. Allergology, Hospital S. Anna Como ASST Lariana, Italy
| | - E Novembre
- Complex Organizational Unit of Allergology, University-Hospital A. Meyer, Firenze, Italy
| | - O Quercia
- High Specialization Unit of Allergology, Hospital of Faenza, AUSL (Local Health Unit) of Romagna, Italy
| | - M Cilia
- Allergology Practice, C.d.S. of Scilla, Reggio Calabria, Italy
| | - G Cortellini
- Allergology, O.U. Internal Medicine and Rheumatology, Rimini, Local Health Unit of Romagna, Italy
| | - M T Costantino
- Departmental Structure Day Hospital Center, Allergology and Clinic Immunology Local Health Unit of Mantova, Intercompany Allergology ATS Val Padana, Italy
| | - L Cremonte
- SS Allergologia ASL AL Alessandria, Italy
| | - F Lodi Rizzini
- S.S.V.D. Allergology Civil Hospitals of Brescia, Department of Clinical and Experimental Sciences University of Brescia, Italy
| | - L Macchia
- School and Chair of Allergology and Clinical Immunology, University of Bari, Italy
| | - F Marengo
- Allergology and Clinical Immunology, A.O.U. Città della Salute e della Scienza di Torino
| | - F Murzilli
- U.O.S.D. of Allergology Hospital S.S. Filippo and Nicola, Avezzano (AQ), Italy
| | - V Patella
- Allergy and Clinical Immunology Division, Department of Medicine, Civil Hospital of Battipaglia, Salerno, Italy
| | - F Reccardini
- SOC Pneumology, Respiratory Physiopathology, integrated University Health Authority of Udine, Italy
| | - L Ricciardi
- Allergy and Clinical Immunology Unit - University Hospital AOU Policlinico G.Martino, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - E Ridolo
- Department of Medicine and Surgery, University of Parma, Italy
| | - A Romano
- Unit of Allergology, Presidio Columbus, Rome, Italy
| | - E Savi
- Operating Departmental Unit of Allergology, Hospital G. Da Saliceto, Piacenza, Italy
| | - D Schiavino
- Complex Operating Unit of Allergology, Policlinico Gemelli - School of Specialization in Allergology and Clinical Immunology, Catholic University, Rome, Italy
| | - M Severino
- Allergy Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - E A Pastorello
- Complex Unit of Allergology and Immunology at ASST Grande Ospedale Metropolitano Niguarda - School of Specialization in Allergology and Clinical Immunology at University of Milan, Italy
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12
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Losappio LM, Mirone C, Chevallard M, Farioli L, De Luca F, Pastorello EA. Tryptase as a marker of severity of aortic valve stenosis. Clin Mol Allergy 2018; 16:17. [PMID: 30093839 PMCID: PMC6080360 DOI: 10.1186/s12948-018-0095-6] [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: 01/24/2018] [Accepted: 07/27/2018] [Indexed: 12/02/2022] Open
Abstract
Background Severe aortic valve stenosis is one of the most common cause of mortality in adult patients affected with metabolic syndrome, a condition associated with an active inflammatory process involving also mast cells and their mediators, in particular tryptase. The aim of this study was to characterize the possible long-term prognostic role of tryptase in severe aortic valve stenosis. Case presentation The baseline serum tryptase was measured in 5 consecutive patients admitted to our Hospital to undergo aortic valve replacement for severe acquired stenosis. Within 2 years after, the patients were evaluated for the occurrence of major cardiovascular events (MACE). The tryptase measurements were higher in patients experiencing MACE (10.9, 11.7 and 9.32 ng/ml) than in non-MACE ones (5.69 and 5.58 ng/ml). Conclusions In patients affected with severe aortic stenosis, baseline serum tryptase may predict occurence of MACE. Further studies are needed to demonstrate the long-term prognostic role of this biomarker.
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Affiliation(s)
- Laura M Losappio
- The Department of Allergology and Immunology, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Corrado Mirone
- The Department of Allergology and Immunology, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michel Chevallard
- The Department of Allergology and Immunology, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Farioli
- The Department of Laboratory Medicine, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fabrizio De Luca
- The Department of Allergology and Immunology, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elide A Pastorello
- The Department of Allergology and Immunology, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy.,3Unit of Allergy and Immunology, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore, 3, 20162 Milan, Italy
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13
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Bilò MB, Martini M, Berra D, Scarpa A, Losappio L, Quercia O, Lodi Rizzini F, Bignardi D, Cortellini G, Zisa G, Del Giudice A, Manzotti G, Marcotulli C, Murzilli F, Cilia M, Pravettoni V, Borrelli P, Pastorello EA. Hymenoptera Venom Immunotherapy: How to Safely Switch to the Same Venom From a Different Manufacturer. J Investig Allergol Clin Immunol 2018; 28:205-208. [DOI: 10.18176/jiaci.0242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Asero R, Scala E, Villalta D, Pravettoni V, Arena A, Billeri L, Colombo G, Cortellini G, Cucinelli F, De Cristofaro ML, Farioli L, Iemoli E, Lodi Rizzini F, Longo R, Losappio L, Macchia D, Maietta G, Minale P, Murzilli F, Nebiolo F, Pastorello EA, Ventura MT, Voltolini S, Amato S, Mistrello G. Shrimp Allergy: Analysis of Commercially Available Extracts for In Vivo Diagnosis. J Investig Allergol Clin Immunol 2016; 27:175-182. [PMID: 27959286 DOI: 10.18176/jiaci.0127] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Skin prick testing (SPT) with commercial extracts is the first step in the diagnosis of shrimp allergy, although its clinical efficiency is unknown. Objective: To analyze the clinical usefulness of all commercial crustacean extracts available for SPT in Italy. METHODS We performed a multicenter study of 157 shrimp-allergic patients who underwent SPT with 5 commercial crustacean extracts and with house dust mite (HDM) extract. Commercial extracts were analyzed using SDS-PAGE and compared with a freshly prepared in-house shrimp extract. IgE to Pen a 1/Pen m 1, Pen m 2, and Pen m 4 was determined, and immunoblot analysis was performed on a large number of sera. RESULTS The skin reactions caused by commercial crustacean extracts were extremely heterogeneous, resulting in 32 clinical profiles, with marked differences in protein content and missing proteins at molecular weights corresponding to those of major shrimp allergens. Only strong Pen a 1/Pen m 1 reactors reacted to both HDM and all 5 commercial extracts in SPT. Most patients, including those who were tropomyosin-negative, reacted to HDM. Patients reacted to a large and variable array of proteins, and IgE reactivity was common at high molecular weights (>50 kDa). CONCLUSIONS The in vivo diagnosis of shrimp allergy must continue to be based on SPT with fresh material. Shrimp-allergic patients frequently react to a number of ill-defined high-molecular-weight allergens, thus leaving currently available materials for component-resolved diagnosis largely insufficient. Mites and crustaceans probably share several allergens other than tropomyosin.
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Affiliation(s)
- R Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano (MI), Italy
| | - E Scala
- Istituto Dermopatico dell´Immacolata - IRCCS, Roma, Italy
| | - D Villalta
- SSD di Allergologia e Immunologia Clinica, Azienda Ospedaliera S. Maria degli Angeli, Pordenone, Italy
| | - V Pravettoni
- UOC Clinical Allergy and Immunology, IRCCS Foundation Ca´ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Arena
- Ambulatorio Allergologia, Azienda Usl 5 di Messina, Messina, Italy
| | - L Billeri
- Department of Laboratory Medicine, University Hospital, Padova, Italy
| | - G Colombo
- Allergy and Clinical Immunology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - G Cortellini
- UO di Medicina Interna e Reumatologia, Azienda Sanitaria della Romagna, Rimini, Italy
| | - F Cucinelli
- UOSD di Allergologia, Ospedale SS Filippo e Nicola di Avezzano, Avezzano (AQ), Italy
| | - M L De Cristofaro
- Ambulatorio di Allergologia, Ospedale San Timoteo, Termoli (CB), Italy
| | - L Farioli
- Department of Laboratory Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - E Iemoli
- Allergy and Clinical Immunology Unit, ASST Fatebenefratelli/Sacco, Milano, Italy
| | - F Lodi Rizzini
- SSVD Allergologia, AO Spedali Civili di Brescia, Brescia, Italy
| | - R Longo
- Ambulatorio Territoriale di Allergologia, ASP Vibo Valentia, Italy
| | - L Losappio
- Department of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - D Macchia
- Allergologia Immunologia Clinica, PO S Giovanni di Dio, Firenze, Italy
| | - G Maietta
- Ambulatorio di Allergologia Accreditato ASL, Lecce, Italy
| | - P Minale
- UOC Allergologia IRCCS San Martino-IST, Genova, Italy
| | - F Murzilli
- UOSD di Allergologia, Ospedale SS Filippo e Nicola di Avezzano, Avezzano (AQ), Italy
| | - F Nebiolo
- Ambulatorio di Allergologia e Immunologia, AO Ordine Mauriziano, Torino, Italy
| | - E A Pastorello
- Department of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - M T Ventura
- Dipartimento di Medicina Interna, Immunologia e Malattie Infettive, Università di Bari, Policlinico, Bari, Italy
| | - S Voltolini
- UOC Allergologia IRCCS San Martino-IST, Genova, Italy
| | - S Amato
- R & D, Lofarma, Milano, Italy
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15
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Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, Valenta R, Hilger C, Hofmaier S, Aalberse RC, Agache I, Asero R, Ballmer-Weber B, Barber D, Beyer K, Biedermann T, Bilò MB, Blank S, Bohle B, Bosshard PP, Breiteneder H, Brough HA, Caraballo L, Caubet JC, Crameri R, Davies JM, Douladiris N, Ebisawa M, EIgenmann PA, Fernandez-Rivas M, Ferreira F, Gadermaier G, Glatz M, Hamilton RG, Hawranek T, Hellings P, Hoffmann-Sommergruber K, Jakob T, Jappe U, Jutel M, Kamath SD, Knol EF, Korosec P, Kuehn A, Lack G, Lopata AL, Mäkelä M, Morisset M, Niederberger V, Nowak-Węgrzyn AH, Papadopoulos NG, Pastorello EA, Pauli G, Platts-Mills T, Posa D, Poulsen LK, Raulf M, Sastre J, Scala E, Schmid JM, Schmid-Grendelmeier P, van Hage M, van Ree R, Vieths S, Weber R, Wickman M, Muraro A, Ollert M. EAACI Molecular Allergology User's Guide. Pediatr Allergy Immunol 2016; 27 Suppl 23:1-250. [PMID: 27288833 DOI: 10.1111/pai.12563] [Citation(s) in RCA: 500] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The availability of allergen molecules ('components') from several protein families has advanced our understanding of immunoglobulin E (IgE)-mediated responses and enabled 'component-resolved diagnosis' (CRD). The European Academy of Allergy and Clinical Immunology (EAACI) Molecular Allergology User's Guide (MAUG) provides comprehensive information on important allergens and describes the diagnostic options using CRD. Part A of the EAACI MAUG introduces allergen molecules, families, composition of extracts, databases, and diagnostic IgE, skin, and basophil tests. Singleplex and multiplex IgE assays with components improve both sensitivity for low-abundance allergens and analytical specificity; IgE to individual allergens can yield information on clinical risks and distinguish cross-reactivity from true primary sensitization. Part B discusses the clinical and molecular aspects of IgE-mediated allergies to foods (including nuts, seeds, legumes, fruits, vegetables, cereal grains, milk, egg, meat, fish, and shellfish), inhalants (pollen, mold spores, mites, and animal dander), and Hymenoptera venom. Diagnostic algorithms and short case histories provide useful information for the clinical workup of allergic individuals targeted for CRD. Part C covers protein families containing ubiquitous, highly cross-reactive panallergens from plant (lipid transfer proteins, polcalcins, PR-10, profilins) and animal sources (lipocalins, parvalbumins, serum albumins, tropomyosins) and explains their diagnostic and clinical utility. Part D lists 100 important allergen molecules. In conclusion, IgE-mediated reactions and allergic diseases, including allergic rhinoconjunctivitis, asthma, food reactions, and insect sting reactions, are discussed from a novel molecular perspective. The EAACI MAUG documents the rapid progression of molecular allergology from basic research to its integration into clinical practice, a quantum leap in the management of allergic patients.
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Affiliation(s)
- P M Matricardi
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - J Kleine-Tebbe
- Allergy & Asthma Center Westend, Outpatient Clinic Ackermann, Hanf, & Kleine-Tebbe, Berlin, Germany
| | - H J Hoffmann
- Department of Respiratory Diseases and Allergy, Institute of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - R Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - C Hilger
- Department of Infection & Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - S Hofmaier
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - R C Aalberse
- Sanquin Research, Department of Immunopathology, Amsterdam, The Netherlands
- Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - I Agache
- Department of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania
| | - R Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| | - B Ballmer-Weber
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - D Barber
- IMMA-School of Medicine, University CEU San Pablo, Madrid, Spain
| | - K Beyer
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - T Biedermann
- Department of Dermatology and Allergology, Technical University Munich, Munich, Germany
| | - M B Bilò
- Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Ancona, Italy
| | - S Blank
- Center of Allergy and Environment (ZAUM), Helmholtz Center Munich, Technical University of Munich, Munich, Germany
| | - B Bohle
- Division of Experimental Allergology, Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology & Immunology, Medical University of Vienna, Vienna, Austria
| | - P P Bosshard
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - H Breiteneder
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - H A Brough
- Paediatric Allergy, Department of Asthma, Allergy and Respiratory Science, King's College London, Guys' Hospital, London, UK
| | - L Caraballo
- Institute for Immunological Research, The University of Cartagena, Cartagena de Indias, Colombia
| | - J C Caubet
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - R Crameri
- Swiss Institute of Allergy and Asthma Research, University of Zürich, Davos, Switzerland
| | - J M Davies
- School of Biomedical Sciences, Institute of Biomedical Innovation, Queensland University of Technology, Brisbane, Qld, Australia
| | - N Douladiris
- Allergy Unit, 2nd Paediatric Clinic, National & Kapodistrian University, Athens, Greece
| | - M Ebisawa
- Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - P A EIgenmann
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - M Fernandez-Rivas
- Allergy Department, Hospital Clinico San Carlos IdISSC, Madrid, Spain
| | - F Ferreira
- Division of Allergy and Immunology, Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - G Gadermaier
- Division of Allergy and Immunology, Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - M Glatz
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
| | - R G Hamilton
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - T Hawranek
- Department of Dermatology, Paracelsus Private Medical University, Salzburg, Austria
| | - P Hellings
- Department of Otorhinolaryngology, Academic Medical Center (AMC), Amsterdam, The Netherlands
- Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium
| | - K Hoffmann-Sommergruber
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - T Jakob
- Department of Dermatology and Allergology, University Medical Center Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany
| | - U Jappe
- Division of Clinical and Molecular Allergology, Research Centre Borstel, Airway Research Centre North (ARCN), Member of the German Centre for Lung Research (DZL), Borstel, Germany
- Interdisciplinary Allergy Division, Department of Pneumology, University of Lübeck, Lübeck, Germany
| | - M Jutel
- Department of Clinical Immunology, 'ALL-MED' Medical Research Institute, Wrocław Medical University, Wrocław, Poland
| | - S D Kamath
- Molecular Allergy Research Laboratory, Centre for Biodiscovery and Molecular Development of Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville City, Qld, Australia
| | - E F Knol
- Departments of Immunology and Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Korosec
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - A Kuehn
- Department of Infection & Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - G Lack
- King's College London, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
- Division of Asthma, Allergy and Lung Biology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A L Lopata
- Department of Clinical Immunology, 'ALL-MED' Medical Research Institute, Wrocław Medical University, Wrocław, Poland
| | - M Mäkelä
- Skin and Allergy Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - M Morisset
- National Service of Immuno-Allergology, Centre Hospitalier Luxembourg (CHL), Luxembourg, UK
| | - V Niederberger
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - A H Nowak-Węgrzyn
- Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - N G Papadopoulos
- Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK
| | - E A Pastorello
- Unit of Allergology and Immunology, Niguarda Ca' Granda Hospital, Milan, Italy
| | - G Pauli
- Service de Pneumologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - T Platts-Mills
- Department of Microbiology & Immunology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - D Posa
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - L K Poulsen
- Allergy Clinic, Copenhagen University Hospital, Copenhagen, Denmark
| | - M Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Ruhr-University Bochum (IPA), Bochum, Germany
| | - J Sastre
- Allergy Division, Fundación Jimenez Díaz, Madrid, Spain
| | - E Scala
- Experimental Allergy Unit, IDI-IRCCS, Rome, Italy
| | - J M Schmid
- Department of Respiratory Diseases and Allergy, Institute of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - P Schmid-Grendelmeier
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
| | - M van Hage
- Department of Medicine Solna, Clinical Immunology and Allergy Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - R van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - S Vieths
- Department of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - R Weber
- School of Medicine, University of Colorado, Denver, CO, USA
- Department of Medicine, National Jewish Health Service, Denver, CO, USA
| | - M Wickman
- Sachs' Children's Hospital, Karolinska Institutet, Stockholm, Sweden
| | - A Muraro
- The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, Department of Mother and Child Health, University of Padua, Padua, Italy
| | - M Ollert
- Department of Infection & Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
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Pravettoni V, Piantanida M, Primavesi L, Forti S, Pastorello EA. Determinants of venom-specific IgE antibody concentration during long-term wasp venom immunotherapy. Clin Mol Allergy 2015; 13:29. [PMID: 26674806 PMCID: PMC4678606 DOI: 10.1186/s12948-015-0036-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 08/21/2015] [Accepted: 10/27/2015] [Indexed: 11/10/2022] Open
Abstract
Background Venom immunotherapy (VIT) is an effective treatment for subjects with systemic allergic reactions (SR) to Hymenoptera stings, however there are few studies concerning the relevance of the venom specific IgE changes to decide about VIT cessation. We assessed IgE changes during a 5-year VIT, in patients stung and protected within the first 3 years (SP 0–3) or in the last 2 years (SP 3–5), and in patients not stung (NoS), to evaluate possible correlations between IgE changes and clinical protection. Methods Yellow jacket venom (YJV)-allergic patients who completed 5 years of VIT were retrospectively evaluated. Baseline IgE levels and after the 3rd and the 5th year of VIT were determined; all patients were asked about field stings and SRs. Results A total of 232 YJV-allergic patients were included and divided into the following groups: 84 NoS, 72 SP 0–3 and 76 SP 3–5. IgE levels decreased during VIT compared to baseline values (χ2 = 346.029, p < 0.001). Recent vespid stings accounted for significantly higher IgE levels despite clinical protection. IgE levels after 5 years of VIT correlated significantly with Mueller grade (F = 2.778, p = 0.012) and age (F = 6.672, p = 0.002). During follow-up from 1 to 10 years after VIT discontinuation, 35.2 % of the contacted patients reported at least one field sting without SR. Conclusions The yellow jacket-VIT temporal stopping criterion of 5 years duration did not result in undetectable IgE levels, despite a long-lasting protection. A mean IgE decrease from 58 to 70 % was observed, and it was less marked in elderly patients or in subjects with higher Mueller grade SR.
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Affiliation(s)
- Valerio Pravettoni
- Clinical Allergy and Immunology Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Piantanida
- Clinical Allergy and Immunology Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Primavesi
- Clinical Allergy and Immunology Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stella Forti
- Unit of Audiology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Elide A Pastorello
- Unit of Allergology and Immunology, Niguarda Ca' Granda Hospital, Milan, Italy
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Pedotti R, Losappio L, Farinotti M, Preziosi D, Tramacere I, Stafylaraki C, Mascheri A, Filippini G, Pastorello EA. Accuracy of a questionnaire for identifying respiratory allergies in epidemiological studies. Rhinology 2015. [PMID: 25756078 DOI: 10.4193/rhin14.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The assessment of allergic asthma (AA) and allergic rhinitis (AR) in epidemiological studies is often challenging. We performed a cross-sectional study to test the accuracy of a Questionnaire aimed at Identifying subjects with Respiratory Allergy (QIRA) in a simple and fast way. METHODS One hundred-thirty subjects, 18-76 years of age, admitted consecutively at the Allergy Center of the Niguarda Ca` Granda Hospital of Milan were included. The questionnaire (index test) investigated the presence of AA and AR with seven questions enquiring history of symptoms, diagnosis made by a doctor, allergy tests performed, and treatments. After completing the questionnaire, all subjects were subsequently diagnosed by an allergist (reference standard). RESULTS The accuracy of the questionnaire for the diagnosis of AA and AR was high (sensitivity 94.7% [95% confidence interval CI: 74.0-99.9] and specificity 99.1% [95% CI 95.1-100.0] for AA; sensitivity 82.8% [95% CI 71.3-91.1] and specificity 98.5% [95% CI 91.8-100.0] for AR). CONCLUSION The questionnaire significantly distinguished subjects with respiratory allergy from those without. The QIRA represents a valid and accurate tool for classifying subjects as having or not AA and/or AR in epidemiological studies.
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Mirone C, Preziosi D, Mascheri A, Micarelli G, Farioli L, Balossi LG, Scibilia J, Schroeder J, Losappio LM, Aversano MG, Stafylaraki C, Nichelatti M, Pastorello EA. Identification of risk factors of severe hypersensitivity reactions in general anaesthesia. Clin Mol Allergy 2015; 13:11. [PMID: 26101469 PMCID: PMC4476085 DOI: 10.1186/s12948-015-0017-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 04/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypersensitivity reactions to anaesthetic agents are rare but often severe, with a mortality ranging from 4 to 9% in IgE-mediated events. Identification of the risk factors may contribute to limit the incidence of these reactions. The aim of our study was to search for possible risk factors of severe perioperative hypersensitivity reactions in our study population. METHODS For this study we retrospectively reviewed data from 193 patients who experienced drug hypersensitivity reactions during general anaesthesia. The diagnostic protocol consisted of 1) history of the reaction, 2) measurement of serum baseline tryptase and specific IgE-assays for latex, beta-lactams and succinylcholine, 3) skin tests for the agents listed in the anaesthesia chart and for others likely to be safe for future use, latex, and others medications administered during the perioperative period (i.e. antibiotics), 4) subdivision of our patients on the basis of two criteria: a) grade of severity of clinical reactions according to the Ring and Messmer classification; b) results of skin tests and/or serum specific IgE-assays. RESULTS One hundred of 193 patients had reactions of grade I, 32/193 patients had reactions of grade II, 55/193 patients had reactions of grade III and 6/193 patients had reactions of grade IV. A diagnosis of IgE-mediated reaction was established in 55 cases (28.50%); the most common causes were neuromuscular blocking agents, followed by latex and beta-lactams. Severe reactions were associated with older age (p = 0.025), asthma (p = 0.042), history of hypertension (p = 0.001), intake of serum angiotensin converting enzyme inhibitor medication (p = 0.012) or serum angiotensin II antagonist (p = 0.033), higher levels of basal tryptase (p = 0.0211). Cardiovascular symptoms (p = 0.006) and history of hypersensitivity to antibiotics (p = 0.029) were more frequently reported in IgE-mediated reactions. CONCLUSIONS We confirmed the relevance of several clinical features as risk factors for anaphylactic reactions induced by anaesthetic agents: older age, asthma, hypertension and antihypertensive drugs. We observed increased levels of serum basal tryptase in severe reactions: this finding may signify that this biomarker is useful for the identification of patients at risk.
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Affiliation(s)
- Corrado Mirone
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Donatella Preziosi
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Ambra Mascheri
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | | | - Laura Farioli
- Department of Laboratory Medicine Niguarda Ca' Granda Hospital, Milan, Italy
| | - Luca G Balossi
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Joseph Scibilia
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Jan Schroeder
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Laura M Losappio
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Maria G Aversano
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Chrysi Stafylaraki
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | | | - Elide A Pastorello
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital and Department of Clinical Science and Community Health Università degli Studi of Milan, Milan, 20162 Italy
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Pastorello EA, Schroeder JW, Veronese SM, Pravettoni V, De Gasperi A, Cantoni S, Losappio L, Farioli L, Qualizza R, Scarpati B, Mascheri A, Scibilia J. Two cases of elevated tryptase in abdominal aortic aneurysm. Eur Ann Allergy Clin Immunol 2015; 47:58-61. [PMID: 25781196] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION From the literature, patients with a history of anaphylaxis to hymenoptera venom and positive specific IgE have shown a correlation between elevated tryptase levels and two clinical situations: systemic mastocytosis and an increased risk of reactions to venom immunotherapy or hymenoptera sting. Other clinical scenarios could explain elevated tryptase levels. MATERIAL AND METHODS A 67 year old male (P1) and a 77 year old male (P2) were evaluated for previous severe anaphylaxis to hymenoptera sting. They underwent standard diagnostic work-up for hymenoptera venom allergy. Having found elevated tryptase levels, these were followed by a bone marrow biopsy to rule out systemic mastocytosis. RESULTS P1: specific IgE and skin tests were positive for Vespula species; tryptase 52.8 ng/ml; P2: specific IgE and skin tests were positive for Vespa cabro and tryptase 153 ng/ml. Bone marrow biopsy results were negative for mastocytosis. We carried out magnetic resonance imaging, in P1 to better characterize the severe osteoporosis and in P2 because during physical examination a pulsating mass had been identified in the mesogastrium, and an aneurysm of the abdominal aorta which required surgical intervention in both patients was detected. Eight months after surgery, tryptase levels had diminished significantly (P1: 11.6 ng/ml and P2: 14.5 ng/ml). DISCUSSION The elevated tryptase levels were correlated to abdominal aneurysm in both patients. In fact, post-surgery tryptase levels dramatically decreased. These two cases demonstrate that high tryptase levels in subjects with a history of hymenoptera venom anaphylaxis can be associated to undiagnosed aneurysmatic disease.
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Affiliation(s)
- E A Pastorello
- Department of Allergology and Immunology, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, Milan 20162, Italy. Phone: +39 02 6444 27 51 Fax: +39 02 6444 20 82 E-mail:
| | - J W Schroeder
- Department of Allergology and Immunology, Niguarda Ca' Granda Hospital, Milan, Italy
| | - S M Veronese
- Department of Anatomy Histology and Cytogenetics, Niguarda Ca' Granda Hospital, Milan, Italy
| | - V Pravettoni
- Clinical Allergy and Immunology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A De Gasperi
- Department of Anaesthesia and Intensive Care, Niguarda Ca' Granda Hospital, Milan, Italy
| | - S Cantoni
- Department of Hematology, Niguarda Ca' Granda Hospital, Milan, Italy
| | - L Losappio
- Department of Allergology and Immunology, Niguarda Ca' Granda Hospital, Milan, Italy
| | - L Farioli
- Department of Laboratory Medicine, Niguarda Ca' Granda Hospital, Milan, Italy
| | - R Qualizza
- Department of Allergology and Immunology, Niguarda Ca' Granda Hospital, Milan, Italy
| | - B Scarpati
- Department of Immunohematology and Transfusion Medicine, Niguarda Ca' Granda Hospital, Milan, Italy
| | - A Mascheri
- Department of Allergology and Immunology, Niguarda Ca' Granda Hospital, Milan, Italy
| | - J Scibilia
- Department of Allergology and Immunology, Niguarda Ca' Granda Hospital, Milan, Italy
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Pedotti R, Losappio L, Farinotti M, Preziosi D, Tramacere I, Stafylaraki C, Mascheri A, Filippini G, Pastorello EA. Accuracy of a questionnaire for identifying respiratory allergies in epidemiological studies. Rhinology 2015; 53:49-53. [DOI: 10.4193/rhino14.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background: The assessment of allergic asthma (AA) and allergic rhinitis (AR) in epidemiological studies is often challenging. We performed a cross-sectional study to test the accuracy of a Questionnaire aimed at Identifying subjects with Respiratory Allergy (QIRA) in a simple and fast way. Methods: One hundred-thirty subjects, 18-76 years of age, admitted consecutively at the Allergy Center of the Niguarda Ca` Granda Hospital of Milan were included. The questionnaire (index test) investigated the presence of AA and AR with seven questions enquiring history of symptoms, diagnosis made by a doctor, allergy tests performed, and treatments. After completing the questionnaire, all subjects were subsequently diagnosed by an allergist (reference standard). Results: The accuracy of the questionnaire for the diagnosis of AA and AR was high (sensitivity 94.7% [95% confidence interval CI: 74.0-99.9] and specificity 99.1% [95% CI 95.1-100.0] for AA; sensitivity 82.8% [95% CI 71.3-91.1] and specificity 98.5% [95% CI 91.8-100.0] for AR). Conclusion: The questionnaire significantly distinguished subjects with respiratory allergy from those without. The QIRA represents a valid and accurate tool for classifying subjects as having or not AA and/or AR in epidemiological studies.
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Mascheri A, Farioli L, Pravettoni V, Piantanida M, Stafylaraki C, Scibilia J, Mirone C, Preziosi D, Nichelatti M, Pastorello EA. Hypersensitivity to Tomato (Lycopersicon esculentum) in Peach-Allergic Patients: rPrup 3 and rPrup 1 Are Predictive of Symptom Severity. J Investig Allergol Clin Immunol 2015; 25:183-189. [PMID: 26182684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
UNLABELLED Background: The role of allergens in the severity of tomato allergy symptoms has not yet been studied. OBJECTIVES To evaluate the relationship between severe allergic reactions to peach and tomato and between tomato allergy symptoms and the pattern of IgE positivity for rPru p 1, rPru p 3, rPru p 4, rBetv 1, rBetv 2, rBetv4, rPhl p 1, and rPhl p 12 in order to identify the role of recombinant allergens in the severity of reactions to tomato. METHODS We studied peach-allergic patients with clinical reactions to tomato by performing an open food challenge, skin prick test, and determination of serum specific IgE to tomato and to recombinant peach, birch, and grass allergens. Statistical analysis was carried out to evaluate the relationship between the severity of tomato symptoms and IgE positivity to the different allergens and to peach-induced symptoms. RESULTS We found a significant association between severe reactions to tomato and severe reactions to peach (P = .01 7) and levels of IgE to rPru p3 (P = .029) and between mild tomato allergy symptoms and levels of IgE to rPru p1 (P = .047), anti-rBetv 1 (P = .0414), anti-rBetv 2 (P = .0457), and Phleum pratense (P = .0022). CONCLUSION We observed a significant relationship between peach and symptoms of tomato allergy. IgE positivity for rPru p3 seems to be a surrogate biochemical marker for severe tomato allergy, whereas the presence of anti-rPru p 1 IgE may be an indicator of mild tomato allergy.
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Volpicella M, Leoni C, Fanizza I, Placido A, Pastorello EA, Ceci LR. Overview of plant chitinases identified as food allergens. J Agric Food Chem 2014; 62:5734-5742. [PMID: 24841122 DOI: 10.1021/jf5007962] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Food allergies are induced by proteins belonging to a limited number of families. Unfortunately, relationships between protein structure and capacity to induce the immune response have not been completely clarified yet, which precludes possible improvements in the diagnosis, prevention, and therapy of allergies. Plant chitinases constitute a good example of food allergenic proteins for which structural analysis of allergenicity has only been carried out partially. In plants, there are at least five structural classes of chitinases plus a number of chitinase-related polypeptides. Their allergenicity has been mostly investigated for chitinases of class I, due to both their higher prevalence among plant chitinases and by the high structural similarity between their substrate-binding domain and hevein, a well-known allergen present in the latex of rubber trees. Even if allergenic molecules have been identified for at least three other classes of plant chitinases, the involvement of the different structural motifs in the allergenicity of molecules has been disregarded so far. In this review, we provide a structurally based catalog of plant chitinases investigated for allergenicity, which could be a useful base for further studies aimed at better clarifying the structure-allergenicity relationships for this protein family.
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Affiliation(s)
- Mariateresa Volpicella
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari , Via Amendola 165/A, 70126 Bari, Italy
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Pravettoni V, Piantanida M, Primavesi L, Forti S, Pastorello EA. Basal platelet-activating factor acetylhydrolase: prognostic marker of severe Hymenoptera venom anaphylaxis. J Allergy Clin Immunol 2013; 133:1218-20. [PMID: 24332861 DOI: 10.1016/j.jaci.2013.10.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 10/14/2013] [Accepted: 10/23/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Valerio Pravettoni
- Clinical Allergy and Immunology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Marta Piantanida
- Clinical Allergy and Immunology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Primavesi
- Clinical Allergy and Immunology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stella Forti
- Audiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Pastorello EA, Farioli L, Stafylaraki C, Scibilia J, Giuffrida MG, Mascheri A, Piantanida M, Baro C, Primavesi L, Nichelatti M, Schroeder JW, Pravettoni V. Fennel allergy is a lipid-transfer protein (LTP)-related food hypersensitivity associated with peach allergy. J Agric Food Chem 2013; 61:740-746. [PMID: 23210484 DOI: 10.1021/jf303291k] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Fennel allergy has been rarely reported, and the association with peach allergy has never been described. Our aim was to (i) study the correlation between symptom severity of peach and fennel and (ii) identify fennel allergens and the role of rPru p 3 antibodies in severe reactions to fennel. In 148 patients with peach allergy, we investigated 58 patients with symptoms and IgE antibodies positive to fennel. IgE to rPru p 1, 3, and 4 and rBet v 1, 2, and 4 were measured by immunoblotting, and the N-terminal amino acid sequences and relevant allergens were determined. We found significant association between severe reactions to fennel and peach (p = 0.0009). A major allergen was ~9 kDa lipid-transfer protein (LTP), cross-reactive with Pru p 3, a 15 kDa protein identified as a pathogenesis-related protein 1 of the Bet v 1 family. In conclusion, peach and fennel severe allergic symptoms are significantly related, and LTP is a major fennel allergen. Fennel should be included in the LTP syndrome.
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Affiliation(s)
- Elide A Pastorello
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, 20162 Milan, Italy.
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Pastorello EA, Farioli L, Scibilia G, Pravettoni V, Mascheri A, Stafylaraki C, Nichelatti M, Balossi L, Asero R. Baseline tryptase levels are related to age, total IgE, and anti-rPru p 3 IgE levels in peach-allergic patients. J Investig Allergol Clin Immunol 2013; 23:127-128. [PMID: 23654081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Affiliation(s)
- E A Pastorello
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milano, Italy
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Pastorello EA, Farioli L, Pravettoni V, Scibilia J, Mascheri A, Borgonovo L, Piantanida M, Primavesi L, Stafylaraki C, Pasqualetti S, Schroeder J, Nichelatti M, Marocchi A. Pru p 3-sensitised Italian peach-allergic patients are less likely to develop severe symptoms when also presenting IgE antibodies to Pru p 1 and Pru p 4. Int Arch Allergy Immunol 2011; 156:362-72. [PMID: 21829031 DOI: 10.1159/000324440] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 01/10/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The roles played by different peach allergens with respect to symptom severity have not been completely ascertained. We have evaluated the diagnostic efficacy of peach recombinant allergens ImmunoCAP compared to peach in the identification of subjects at an increased risk for severe reactions to peaches. METHODS 148 peach-allergic patients were divided based on their symptom severity into 2 groups: mild oral allergy syndrome (OAS) and severe OAS. Anti-rPru p 1, 3 and 4 IgE levels were measured. Statistical analyses were carried out using parametric and non-parametric tests. RESULTS anti-rPru p 1 and anti-rPru p 4 IgE levels were significantly higher in patients with mild OAS than in patients with severe OAS (p = 0.0001); in contrast, anti-rPru p 3 IgE levels were significantly higher in patients with severe OAS than in patients with mild OAS (p < 0.00005). Moreover, we found that any unitary increase in anti-rPru p 1 IgE values corresponded to a 2.48% reduction in the odds of having severe OAS (p = 0.048), whereas any unitary increase in anti-rPru p 3 IgE values corresponded to a 9.02% increase in the probability of having severe OAS (p = 0.001). Unexpectedly, we found that patients positive to rPru p 3 as well as rPru p 1 and 4 demonstrated a significant reduction of the odds of developing severe symptoms than those positive to rPru p 3 alone. Anti-rPru p 3 IgE levels were a significantly better indicator than anti-peach IgE values (p = 0.016) of patients with the highest risk for severe OAS. A cutoff of 2.69 kUA/l for anti-rPru p 3 IgE values better discriminated peach-allergic patients at a higher risk for symptoms. CONCLUSIONS Italian patients with positive anti-rPru p 1, 4 and 3 IgE levels seemed less likely to experience the clinical effects of high anti-rPru p 3 IgE values.
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Affiliation(s)
- Elide A Pastorello
- Unit of Allergology and Immunology, Niguarda Ca' Granda Hospital, Milan, Italy
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Pastorello EA, Pravettoni V, Farioli L, Primavesi L, Scibilia J, Piantanida M, Mascheri A, Conti A. Green bean (Phaseolus vulgaris): a new source of IgE-binding lipid transfer protein. J Agric Food Chem 2010; 58:4513-4516. [PMID: 20222729 DOI: 10.1021/jf100213g] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Green beans belong to the Fabaceae family, which includes widely consumed species, such as beans, peanuts, and soybeans. In the literature, few cases have described allergic reactions upon the exposure to green bean boiling steam or ingestion. Here, we describe five patients reporting documented adverse reactions upon the ingestion of cooked green beans, and we characterize the responsible allergen. Fresh and cooked green beans were tested by a prick + prick technique. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and IgE immunoblotting were performed with boiled vegetable extract, and the N-terminal sequence of the immunoreactive protein was obtained by analyzing the excised band in a protein sequencer. Immunoblotting inhibition of cooked green bean with in-house-purified peach lipid transfer protein (LTP) Pru p 3 was performed. An interesting green bean protein was chromatographically purified, tested with a pool serum, and inhibited with Pru p 3. Moreover, its molecular mass was determined by mass spectrometry. Prick + prick tests with raw and cooked green beans were positive for all of the patients. IgE immunoblotting showed that all of the patients reacted toward a unique IgE-binding protein at about 9 kDa. The obtained N-terminal sequence revealed the following amino acids: Ala-Ile-Ser-X-Gly-Qln-Val-Thr-Ser-Ser-Leu-Ala, corresponding to an LTP. A complete inhibition of the IgE binding to this protein, in both raw and purified extract, was obtained by purified peach Pru p 3, confirming previous IgE immunoblotting results.
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Affiliation(s)
- Elide A Pastorello
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
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Pastorello EA, Monza M, Pravettoni V, Longhi R, Bonara P, Scibilia J, Primavesi L, Scorza R. Characterization of the T-cell epitopes of the major peach allergen Pru p 3. Int Arch Allergy Immunol 2010; 153:1-12. [PMID: 20357479 DOI: 10.1159/000301573] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 11/05/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pru p 3 is the major peach allergen recognized by more than 90% of peach-allergic individuals of the Mediterranean area. Identification of the dominant Pru p 3 T-cell epitopes can improve our understanding of the immune responses against this protein and could be helpful in the development of hypoallergenic immunotherapy. For this purpose, we examined the phenotypes, specificities and cytokine secretion profiles of proliferating T cells in response to Pru p 3 in peach-allergic individuals. METHODS Peripheral blood mononuclear cells from 15 peach-allergic patients were incubated with Pru p 3. The proliferation of antigen-specific T-cell lines (TCLs) was assessed by tritiated methylthymidine incorporation. T-cell epitopes were identified by analyzing the reactivity of TCLs against 8 overlapping peptides spanning the entire length of Pru p 3. We characterized the phenotype of Pru-p-3-specific TCLs by flow cytometry and analyzed their production of interleukin (IL) 4 and gamma-interferon (IFN-gamma) by ELISA. RESULTS Ninety-two Pru-p-3-specific TCLs were isolated (stimulation index > or =5). These TCLs proliferated mainly in response to Pru p 3(12-27) and Pru p 3(57-72). Pru-p-3-specific TCLs were mainly CD4+ (81%) and expressed cell surface CD30. In addition, TCLs produced high levels of IL-4 and low levels of IFN-gamma, indicating a Th2 phenotype. CONCLUSIONS Two immunodominant T-cell-reactive regions of Pru p 3 were identified: Pru p 3(12-27) and Pru p 3(57-72). These peptides showed a differential ability to elicit a Th2 response. Taken together, our results provide a better understanding of the immunological T-cell reactivity against Pru p 3.
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Affiliation(s)
- E A Pastorello
- Unit of Allergology and Immunology, Niguarda Ca' Granda Hospital, Via Pace 9, Milan, Italy
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Pravettoni V, Primavesi L, Farioli L, Brenna OV, Pompei C, Conti A, Scibilia J, Piantanida M, Mascheri A, Pastorello EA. Tomato allergy: detection of IgE-binding lipid transfer proteins in tomato derivatives and in fresh tomato peel, pulp, and seeds. J Agric Food Chem 2009; 57:10749-10754. [PMID: 19919119 DOI: 10.1021/jf9022367] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
There is an increasing consumption of tomatoes worldwide: fresh in salads, cooked in household sauces, or industrially processed. Although many tomato allergens have been identified, there is no information in the literature on the allergenic components found in commercial tomato products. The primary aim of the study was to evaluate the allergenic profile of commercial tomato products by skin prick tests (SPTs) and IgE/immunoblotting in tomato-allergic subjects. The secondary end point was the study of the IgE-binding profile of tomato peel, pulp, and seeds. Forty tomato-allergic patients, reporting oral allergy syndrome (OAS) at different grades of severity for fresh and, in some cases, also for cooked tomato, were selected on the basis of positive tomato allergy history or open food challenge (OFC). They were evaluated by SPTs with different experimental tomato extracts. SDS-PAGE/immunoblotting was performed to detect tomato allergens, which were then identified by Edman degradation. Twenty-three patients (57.5%) presented first-grade OAS at the OFC, whereas 17 (42.5%) reported severe symptoms. Ten of these 17 patients (25%) reported allergic reactions to cooked tomatoes; in immunoblotting tests, their sera reacted only to lipid transfer protein (LTP). In commercial products, LTP was the only detectable allergen. In contrast to other LTP-containing fruits, in tomato, an IgE-binding LTP was identified not only in the peel but also in the pulp and seeds. This study demonstrates that, in fresh tomato, different LTP isoforms are present and allergenic. Industrial tomato derivatives still contain LTP, thus presenting a problem for LTP-allergic patients.
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Affiliation(s)
- Valerio Pravettoni
- Clinical Allergy and Immunology Unit, Foundation Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, IRCCS, Dipartimento di Scienze e Tecnologie Alimentari e Microbiologiche (DiSTAM), Università degli Studi di Milano, Milan, Italy.
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Pastorello EA, Farioli L, Pravettoni V, Scibilia J, Conti A, Fortunato D, Borgonovo L, Bonomi S, Primavesi L, Ballmer-Weber B. Maize food allergy: lipid-transfer proteins, endochitinases, and alpha-zein precursor are relevant maize allergens in double-blind placebo-controlled maize-challenge-positive patients. Anal Bioanal Chem 2009; 395:93-102. [PMID: 19669736 DOI: 10.1007/s00216-009-2945-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 06/29/2009] [Accepted: 06/29/2009] [Indexed: 11/28/2022]
Abstract
Italian patients with maize anaphylaxis have been shown to have IgE toward two major maize allergens: an alpha-amylase inhibitor and a 9-kDa LTP. A complete study on maize food allergens in patients with positive maize double-blind, placebo-controlled food challenge (DBPCFC) is lacking. The objective was to utilize the three maize protein fractions to identify and characterize the most relevant IgE-binding proteins recognized by the sera of Italian and Swiss patients with either a positive maize-DBPCFC or a history of maize-induced anaphylaxis. Osborne's protein fractions of maize were extracted to obtain water-soluble, total zein, and total protein fractions. Protein IgE-binding capacity was investigated by SDS-PAGE immunoblotting using the sera from DBPCFC-positive patients and from patients with maize-induced anaphylaxis. Purified maize LTP was used to inhibit the IgE immunoblotting of the three protein fractions. IgE immunoblotting demonstrated that the 9-kDa LTP was recognized by all the Italian patients and by none of the Swiss patients. Other allergens were: 14-kDa alpha-amylase inhibitor, 30-kDa endochitinases A and -B, 19 kDa zein-beta precursor, and 26 kDa zein-alpha precursor; a newly described allergen, the globulin-2 precursor, identified in the total protein fraction. It is noteworthy that maize LTP and endochitinase were cross-reactive with grape LTP and one grape endochitinase. LTP was found to be the only major allergen in Italian patients with either positive maize challenge or a history of maize-induced anaphylaxis. We have identified other maize allergens in subjects with maize food allergy, as grape cross-reactive endochitinase, however, the clinical significance of these proteins needs to be investigated in larger groups of patients with allergy to these food items.
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Affiliation(s)
- Elide A Pastorello
- Unit of Allergology and Immunology-Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
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Fasoli E, Pastorello EA, Farioli L, Scibilia J, Aldini G, Carini M, Marocco A, Boschetti E, Righetti PG. Searching for allergens in maize kernels via proteomic tools. J Proteomics 2009; 72:501-10. [DOI: 10.1016/j.jprot.2009.01.013] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Scibilia J, Pastorello EA, Zisa G, Ottolenghi A, Ballmer-Weber B, Pravettoni V, Scovena E, Robino A, Ortolani C. Maize food allergy: a double-blind placebo-controlled study. Clin Exp Allergy 2008; 38:1943-9. [PMID: 18778272 DOI: 10.1111/j.1365-2222.2008.03094.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Maize allergy is not very common especially in Europe. The number of studies that address IgE mediated maize allergy is all too few. OBJECTIVE Evaluate subjects with a history of maize allergy by double-blind, placebo-controlled food challenge; identify the spectrum of symptoms manifested during challenge; determine the lowest provocation dose (PD) during challenge; determine the performance characteristics of maize skin prick test and specific IgE. METHODS Twenty-seven patients with a history of maize allergy were enrolled to be evaluated by skin test, specific IgE and double-blind placebo-controlled maize challenge. RESULTS Forty-eight percent of the patients were challenge positive. PD range was 0.1-25 g. Fifty-four percent of the maize allergic subjects had a PD that was < or = 2.5 g; two subjects reacted to 100 mg of maize. Comparison of maize specific IgE levels and skin test results to the challenge results revealed the following (specific IgE level/skin testing): sensitivity 1.00/0.846, specificity 0.077/0.384, positive predictive value 0.520/0.579, and negative predictive value 1.00/0.714. CONCLUSION Maize is a cause of IgE-mediated allergic reactions to foods in adults and children. Nearly half of the subjects recruited were confirmed by challenge to be allergic to maize. Twenty-three percent of the positive challenge patients manifested symptoms that involved two organ systems, thus fulfilling the criteria for maize induced anaphylaxis. Maize is allergenic and can pose a risk for symptomatic food allergy at a dose of 100 mg.
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Affiliation(s)
- J Scibilia
- Unit of Allergology and Clinical Immunology, A.O. Niguarda Hospital, Milan, Italy
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Pastorello EA, Farioli L, Conti A, Pravettoni V, Bonomi S, Iametti S, Fortunato D, Scibilia J, Bindslev-Jensen C, Ballmer-Weber B, Robino AM, Ortolani C. Wheat IgE-mediated food allergy in European patients: alpha-amylase inhibitors, lipid transfer proteins and low-molecular-weight glutenins. Allergenic molecules recognized by double-blind, placebo-controlled food challenge. Int Arch Allergy Immunol 2007; 144:10-22. [PMID: 17496422 DOI: 10.1159/000102609] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Accepted: 02/21/2007] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Three main problems hamper the identification of wheat food allergens: (1) lack of a standardized procedure for extracting all of the wheat protein fractions; (2) absence of double-blind, placebo-controlled food challenge studies that compare the allergenic profile of Osborne's three protein fractions in subjects with real wheat allergy, and (3) lack of data on the differences in IgE-binding capacity between raw and cooked wheat. METHODS Sera of 16 wheat-challenge-positive patients and 6 patients with wheat anaphylaxis, recruited from Italy, Denmark and Switzerland, were used for sodium dodecyl sulfate-polyacrylamide gel electrophoresis/immunoblotting of the three Osborne's protein fractions (albumin/globulin, gliadins and glutenins) of raw and cooked wheat. Thermal sensitivity of wheat lipid transfer protein (LTP) was investigated by spectroscopic approaches. IgE cross-reactivity between wheat and grass pollen was studied by blot inhibition. RESULTS The most important wheat allergens were the alpha-amylase/trypsin inhibitor subunits, which were present in all three protein fractions of raw and cooked wheat. Other important allergens were a 9-kDa LTP in the albumin/globulin fraction and several low-molecular-weight (LMW) glutenin subunits in the gluten fraction. All these allergens showed heat resistance and lack of cross-reactivity to grass pollen allergens. LTP was a major allergen only in Italian patients. CONCLUSIONS The alpha-amylase inhibitor was confirmed to be the most important wheat allergen in food allergy and to play a role in wheat-dependent exercise-induced anaphylaxis, too. Other important allergens were LTP and the LMW glutenin subunits.
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Affiliation(s)
- Elide A Pastorello
- Unit of Allergology and Clinical Immunology, Niguarda Cà Granda Hospital, Milan, Italy.
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Primavesi L, Brenna OV, Pompei C, Pravettoni V, Farioli L, Pastorello EA. Influence of cultivar and processing on cherry (Prunus avium) allergenicity. J Agric Food Chem 2006; 54:9930-5. [PMID: 17177523 DOI: 10.1021/jf0622376] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Oral allergy syndrome is an immediate food allergic event that affects lips, mouth, and pharynx, is often triggered by fruits and vegetables, and may be associated with pollinosis. Here, we report on the allergenic pattern of different varieties of cherry (Prunus avium) and results obtained by applying several technological processes to the selected varieties. Whole cherries were submitted to chemical peeling, thermal treatment, and syruping processes, and the relative protein extracts were analyzed by in vitro (sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting analysis) and in vivo tests (skin prick test). Electrophoretic analyses demonstrated that there was no marked difference among cherry cultivars. Chemical peeling successfully removed Pru av 3, a lipid transfer protein (LTP) responsible for oral allergy syndrome in patients without pollinosis, leading to the industrial production of cherry hypoallergenic derivatives. Furthermore, the syruping process removed almost all allergenic proteins to whom patients with pollinosis are responsive. In vivo tests confirmed electrophoretic results.
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Affiliation(s)
- L Primavesi
- Department of Food Science and Microbiology, University of Milan, Milan, Italy
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Scibilia J, Pastorello EA, Zisa G, Ottolenghi A, Bindslev-Jensen C, Pravettoni V, Scovena E, Robino A, Ortolani C. Wheat allergy: a double-blind, placebo-controlled study in adults. J Allergy Clin Immunol 2006; 117:433-9. [PMID: 16461145 DOI: 10.1016/j.jaci.2005.10.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Revised: 10/12/2005] [Accepted: 10/12/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Wheat is believed to be an uncommon cause of food allergy in adults; the number of studies that address IgE mediated wheat allergy in adults is all too few. OBJECTIVE Determine how many subjects with a history of wheat allergy have real allergy by double-blind, placebo-controlled food challenge; identify the symptoms manifested during the challenge; determine the lowest provocation dose; determine the performance characteristics of wheat skin prick test and specific IgE; identify subjects with real wheat allergy for potential immunoblotting studies. METHODS Patients underwent skin test with commercial wheat extract; specific wheat IgE was determined. Subjects were challenged with 25 g wheat. Subjects who were positive to raw wheat challenge underwent cooked wheat challenge. RESULTS Thirty-seven double-blind placebo-controlled wheat challenges were performed on 27 patients. A total of 13 of 27 (48%) patients had a positive result. Eleven subjects with positive raw wheat challenge underwent cooked wheat challenge: 10 were positive. The provocation dose range was 0.1 to 25 g. Twenty-seven percent of the subjects allergic to wheat had a provocation dose that was < or =1.6 g. CONCLUSION Wheat causes real food allergy in adults. More than a quarter of the patients allergic to wheat reacted to less than 1.6 g wheat. Specific IgE was more sensitive than skin test for wheat; however, specificity and predictive values were low for both tests. Thus, these tests should not be used to validate diagnosis of wheat allergy.
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Affiliation(s)
- Joseph Scibilia
- Unit of Allergology and Clinical Immunology, Azienda Ospedaliera Niguarda Hospital, Milan, Italy
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Weichel M, Vergoossen NJ, Bonomi S, Scibilia J, Ortolani C, Ballmer-Weber BK, Pastorello EA, Crameri R. Screening the allergenic repertoires of wheat and maize with sera from double-blind, placebo-controlled food challenge positive patients. Allergy 2006; 61:128-35. [PMID: 16364168 DOI: 10.1111/j.1398-9995.2006.00999.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Food allergy to wheat and maize is an increasing factor of deterioration of life quality, especially childhood and can, in rare cases, even induce anaphylaxis. Although omega-5 gliadin from wheat and maize lipid transfer protein have been characterized as major cereal allergens on the molecular level, the list of food allergens is far to be complete. METHODS To identify the IgE-binding repertoires of wheat and maize we screened respective cDNA libraries displayed on phage surface with sera from patients with a confirmed food allergy. The study included six patients with a positive double-blind, placebo-controlled food challenge (DBPCFC) to wheat, nine patients with a positive DBPCFC to maize, and six patients with anaphylactic reactions after ingestion of wheat. RESULTS The enriched sequences encoding IgE-binding proteins showed heterogeneous repertoires for both, wheat and maize. The selected wheat repertoire yielded 12, the maize repertoire 11 open reading frames. Among these we identified allergens belonging to already characterized allergens families, such as gliadin, profilin and beta-expansin. Besides, we found novel proteins with high cross-reactive potential, such as thioredoxins, as well as sequences that had so far not been related to cereal allergy at all. The IgE-binding capacity of some selected proteins was evaluated in vitro and cross-reactivity was demonstrated by competition ELISA. CONCLUSION With regard to the heterogeneity of the characterized sequences as well as to the biochemical nature of the new allergens detected we conclude that wheat and maize-related food allergy is more complex than so far anticipated.
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Affiliation(s)
- M Weichel
- Swiss Institute of Allergy and Asthma Research (SIAF), Davos Platz, Switzerland
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Abstract
Adverse reactions to foods, aside from those considered toxic, are caused by a particular individual intolerance towards commonly tolerated foods. Intolerance derived from an immunological mechanism is referred to as Food Allergy, the non-immunological form is called Food Intolerance. IgE-mediated food allergy is the most common and dangerous type of adverse food reaction. It is initiated by an impairment of normal Oral Tolerance to food in predisposed individuals (atopic). Food allergy produces respiratory, gastrointestinal, cutaneous and cardiovascular symptoms but often generalized, life-threatening symptoms manifest at a rapid rate-anaphylactic shock. Diagnosis is made using medical history and cutaneous and serological tests but to obtain final confirmation a Double Blind Controlled Food Challenge must be performed. Food intolerances are principally caused by enzymatic defects in the digestive system, as is the case with lactose intolerance, but may also result from pharmacological effects of vasoactive amines present in foods (e.g. Histamine). Prevention and treatment are based on the avoidance of the culprit food.
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Affiliation(s)
- Claudio Ortolani
- Istituto Allergologico Lombardo, Piazza Monsignor Moneta 1, 20090 Cesano Boscone, Milan, Italy.
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38
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Abstract
Lipid transfer proteins are widespread plant food allergens, highly resistant to food processing and to the gastrointestinal environment, which have recently been described as true food allergens in the Mediterranean area, where they have been associated with severe allergic reactions to foods in patients without pollen allergy. In this review we analyze their molecular structure, biological function, and clinical relevance in food allergy.
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Affiliation(s)
- Elide A Pastorello
- Complex Unit of Allergology and Clinical Immunology, Niguarda Ca' Granda Hospital, Milan, Italy.
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Pastorello EA, Farioli L, Pravettoni V, Robino AM, Scibilia J, Fortunato D, Conti A, Borgonovo L, Bengtsson A, Ortolani C. Lipid transfer protein and vicilin are important walnut allergens in patients not allergic to pollen. J Allergy Clin Immunol 2004; 114:908-14. [PMID: 15480333 DOI: 10.1016/j.jaci.2004.06.020] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Walnut is the most common cause of allergic reactions to tree nuts, as reported by large population studies. Two major allergens of walnut have been identified up until now: a 2S albumin and a vicilin-like protein. OBJECTIVE This study was designed to identify the walnut major allergens in the Italian population and to compare the walnut IgE-binding profile in patients with or without pollen allergy. METHODS We selected 46 patients either with oral allergy syndrome confirmed by open oral challenge or with systemic symptoms after ingestion of walnut. These patients' sera were used for the immunoblotting of walnut extract; the identified allergens were purified by HPLC and sequenced. A peach-walnut cross-inhibition study was then performed. RESULTS The only major allergen recognized by our study population was a 9-kd lipid transfer protein (LTP), recognized by 37 patients. Two other minor allergens of approximately 9-kd molecular weight, both belonging to the vicilin family, were recognized by 10 patients. IgE binding to walnut LTP was completely inhibited by peach LTP. CONCLUSION In Italian patients with walnut allergy confirmed by documented history of severe systemic reactions or by open oral food challenge, the major allergen is an LTP. The sensitization to this protein seems to be secondary to the sensitization to peach LTP, which acts as the primary sensitizer. LTP and vicilins were able to sensitize patients not allergic to pollen.
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Affiliation(s)
- Elide A Pastorello
- Allergy Center, Department of Internal Medicine and Dermatology, Ospedale Maggiore Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy.
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Brenna OV, Pastorello EA, Farioli L, Pravettoni V, Pompei C. Presence of allergenic proteins in different peach (Prunus persica) cultivars and dependence of their content on fruit ripening. J Agric Food Chem 2004; 52:7997-8000. [PMID: 15612787 DOI: 10.1021/jf0491052] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
It has been reported that various cultivars of fruits and vegetables may present a different pattern for the contained allergens. Here, we report on the different content in allergenic proteins for different peach (Prunus persica) cultivars, sampled during two consecutive harvest seasons. Fruits from six cultivars of peaches were harvested fully ripe, and the proteins extracted from whole or chemically peeled fruits were analyzed by SDS-PAGE and immunoblotting. All the protein extracts from whole fruit contained a 9 kDa protein. This protein proved to be absent in the extracts taken from chemically peeled fruit. In four cultivars, this protein corresponds to the allergen Pru p3, a lipid transfer protein that causes the oral allergy syndrome (OAS) in sensitized people. In the following year, fruits from four of the six cultivars of peaches studied previously were harvested at different times, at one and two weeks before the commercial ripening time and when fully ripe, to ascertain whether the presence of the 9 kDa allergen might be related to the ripening process. Two cultivars out of four produced an intense allergenic band corresponding to a 9 kDa protein already two weeks before the commercial ripening date, while the others showed a progressive increment of the 9 kDa allergen during ripening.
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Affiliation(s)
- Oreste V Brenna
- Department of Food Science and Microbiology, University of Milan, Milan, Italy.
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Pastorello EA, Pompei C, Pravettoni V, Farioli L, Calamari AM, Scibilia J, Robino AM, Conti A, Iametti S, Fortunato D, Bonomi S, Ortolani C. Lipid-transfer protein is the major maize allergen maintaining IgE-binding activity after cooking at 100°C, as demonstrated in anaphylactic patients and patients with positive double-blind, placebo-controlled food challenge results. J Allergy Clin Immunol 2003; 112:775-83. [PMID: 14564361 DOI: 10.1016/s0091-6749(03)01942-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In a previous study a 9-kd lipid-transfer protein (LTP) was identified as the major allergen of raw maize in a population of 22 anaphylactic patients. However, the stability of this protein in cooked maize is unknown. OBJECTIVE We investigated the allergenicity of 5 maize hybrids and its modification after different thermal treatments by using sera from anaphylactic patients and patients with positive double-blind, placebo-controlled food challenges. METHODS Five maize hybrids were extracted by using different methods, obtaining the water-soluble, zein, total zein, glutelin, and total protein fractions. The IgE-binding capacity of the different extracts, both raw and after thermal treatment, was investigated by means of SDS-PAGE immunoblotting. A 9-kd heat-stable allergen was purified by means of HPLC and sequenced. Changes in its secondary structure during and after heating from 25 degrees C to 100 degrees C were monitored by means of circular dichroism. RESULTS All raw maize hybrids showed similar protein and IgE-binding profiles. The SDS-PAGE of all the heat-treated hybrids demonstrated a decreased number of stained bands in respect to the raw samples. The IgE immunoblotting demonstrated that the major allergen of the water-soluble, total zein, total protein, and glutelin fractions was a 9-kd protein identified by means of amino acid sequence as an LTP and a sub-tilisin-chymotrypsin inhibitor (in total zein fraction). The IgE-binding capacity of this 9-kd protein remained unchanged after thermal treatments, even though circular dichroism demonstrated an altered secondary structure. CONCLUSIONS Maize LTP maintains its IgE-binding capacity after heat treatment, thus being the most eligible candidate for a causative role in severe anaphylactic reactions to both raw and cooked maize.
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Affiliation(s)
- Elide A Pastorello
- 1st Division of General Medicine Ospedale Maggiore IRCCS, Department of Internal Medicine, University of Milan, Italy
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Pastorello EA, Farioli L, Pravettoni V, Ortolani C, Fortunato D, Giuffrida MG, Perono Garoffo L, Calamari AM, Brenna O, Conti A. Identification of grape and wine allergens as an endochitinase 4, a lipid-transfer protein, and a thaumatin. J Allergy Clin Immunol 2003; 111:350-9. [PMID: 12589356 DOI: 10.1067/mai.2003.35] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Few allergic reactions to grape are reported in the literature. In some cases an association with peach and cherry allergy was observed. No IgE-mediated reactions to wine have been described, and no grape major allergens have yet been identified. OBJECTIVE We describe several severe reactions to grape or wine. We characterized the grape major allergens and tried to identify the allergen in wine. METHODS We collected documented histories of allergic reactions to grape and wine. Grape allergens were identified by means of SDS-PAGE and immunoblotting and purified by means of HPLC. Using amino acid sequencing and mass spectrometry, we identified the family of proteins to which the allergens belong. Cross-reactivity with peach and cherry was evaluated by means of cross-wise inhibition experiments. RESULTS Eleven patients with reactions to grape and 3 with anaphylactic reactions to wine were recruited. The major allergens were an endochitinase 4A and a lipid-transfer protein (LTP) that was homologous to and cross-reactive with peach LTP. A 24-kd protein homologous to the cherry thaumatin-like allergen was a minor allergen. Endochitinase 4A is very likely the allergen in vino novello and in vino Fragolino. CONCLUSIONS Grape and wine might cause severe allergic reactions in sensitive patients. The major allergens of grape are endochitinase 4A, which is also the allergen of wine, and an LTP cross-reacting with the peach major allergen.
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Affiliation(s)
- Elide A Pastorello
- Allergy Center, First Division of General Medicine, Ospedale Maggiore IRCCS, Via Francesco Sforza 35, 20122 Milan, Italy
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Abstract
Plant-origin foods, especially nuts and seeds, are the most important sources of food allergic reactions. An important characteristic is the quantitative and qualitative variability of their content in allergenic molecules, depending on plant growth, ripening, environmental stresses or industrial processing. In this review we will focus on newly identified allergens. Recent research have characterized and extensively studied their biochemistry, structure and immunological properties.
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Affiliation(s)
- Elide A Pastorello
- Allergy Center, 3rd Division of General Medicine, Padiglione Granelli, Ospedale Maggiore IRCCS, Via Francesco Sforza 35, I-20122 Milan, Italy
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Pastorello EA, Pravettoni V, Farioli L, Rivolta F, Conti A, Ispano M, Fortunato D, Bengtsson A, Bianchi M. Hypersensitivity to mugwort (Artemisia vulgaris) in patients with peach allergy is due to a common lipid transfer protein allergen and is often without clinical expression. J Allergy Clin Immunol 2002; 110:310-7. [PMID: 12170274 DOI: 10.1067/mai.2002.125830] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The observation of mugwort-specific IgE antibodies in patients with peach allergy suggests that mugwort sensitization might play a role in sensitization to peach. OBJECTIVE We sought to study the clinical manifestations of mugwort hypersensitivity in patients with peach allergy, identify the common allergens, and evaluate their IgE crossreactivity. METHODS Patients with oral allergy syndrome for peach and specific IgE antibodies to mugwort were investigated for respiratory symptoms during the mugwort season. Peach and mugwort allergens were identified by means of SDS-PAGE and IgE immunoblotting. Immunoblotting inhibition experiments were done to study cross-reactivity between peach and mugwort and other pollens. RESULTS Seventeen patients were studied, 10 with no seasonal respiratory symptoms and 7 with clear late summer respiratory symptoms. In IgE immunoblotting the 10 asymptomatic patients reacted only to a 9-kd allergen of both mugwort and peach, whereas the 7 patients with pollinosis reacted to other allergens. Ten patients with mugwort allergy, no history of allergy to peach, and negative results for peach-specific IgE antibodies were also studied. The mugwort 9-kd protein was identified as a lipid transfer protein (LTP) homologous to peach LTP. Immunoblotting inhibition showed that IgE binding to the peach 9-kd band was totally inhibited by 4 microg of peach LTP but only by 400 microg of mugwort LTP, whereas 4 microg of both mugwort and peach LTP totally inhibited the mugwort immunoblotting. The results were similar with other pollens. CONCLUSIONS Patients sensitized only to the 9-kd LTP of mugwort do not present hay fever symptoms, and this sensitization is a consequence of the peach sensitization.
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Affiliation(s)
- Elide A Pastorello
- Allergy Center, 3rd Division of General Medicine, Ospedale Maggiore IRCCS, Via Francesco Sforza 35, 20122 Milan, Italy
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Poltronieri P, Cappello MS, Dohmae N, Conti A, Fortunato D, Pastorello EA, Ortolani C, Zacheo G. Identification and characterisation of the IgE-binding proteins 2S albumin and conglutin gamma in almond (Prunus dulcis) seeds. Int Arch Allergy Immunol 2002; 128:97-104. [PMID: 12065909 DOI: 10.1159/000059399] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Almond proteins can cause severe anaphylactic reactions in susceptible individuals. The aim of this study was the identification of IgE-binding proteins in almonds and the characterisation of these proteins by N-terminal sequencing. METHODS Five sera were selected from individuals with a positive reaction to food challenge. Sodium dodecylsulphate-polyacrylamide gel electrophoresis and immunoblotting were performed on almond seed proteins. Purified IgE-binding proteins were tested for immunoblot inhibition with sera pre-incubated with extracts of hazelnut and walnut. RESULTS N-terminal sequences of the 12-, 30- and 45-kD proteins were obtained. The 45- and 30-kD proteins shared the same N terminus, with 60% homology to the conglutin gamma heavy chain from lupine seed (Lupinus albus) and to basic 7S globulin from soybean (Glycine max). The sequences of the N-terminal 12-kD protein and of an internal peptide obtained by endoproteinase digestion showed good homology to 2S albumin from English walnut (Jug r 1). Immunoblot inhibition experiments were performed and IgE binding to almond 2S albumin and conglutin gamma was detected in the presence of cross-reacting walnut or hazelnut antigens. CONCLUSIONS Two IgE-binding almond proteins were N-terminally sequenced and identified as almond 2S albumin and conglutin gamma. Localisation and conservation of IgE binding in a 6-kD peptide obtained by endoproteinase digestion of 2S albumin was shown.
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Affiliation(s)
- P Poltronieri
- Istituto di Ricerca sulle Biotecnologie Agroalimentari, CNR, Lecce, Italy.
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Pastorello EA, Vieths S, Pravettoni V, Farioli L, Trambaioli C, Fortunato D, Lüttkopf D, Calamari M, Ansaloni R, Scibilia J, Ballmer-Weber BK, Poulsen LK, Wütrich B, Hansen KS, Robino AM, Ortolani C, Conti A. Identification of hazelnut major allergens in sensitive patients with positive double-blind, placebo-controlled food challenge results. J Allergy Clin Immunol 2002; 109:563-70. [PMID: 11898007 DOI: 10.1067/mai.2002.121946] [Citation(s) in RCA: 161] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The hazelnut major allergens identified to date are an 18-kd protein homologous to Bet v 1 and a 14-kd allergen homologous to Bet v 2. No studies have reported hazelnut allergens recognized in patients with positive double-blind, placebo-controlled food challenge (DBPCFC) results or in patients allergic to hazelnut but not to birch. OBJECTIVE We characterized the hazelnut allergens by studying the IgE reactivity of 65 patients with positive DBPCFC results and 7 patients with severe anaphylaxis to hazelnut. METHODS Hazelnut allergens were identified by means of SDS-PAGE and IgE immunoblotting. Further characterization was done with amino acid sequencing, evaluation of the IgE-binding properties of raw and roasted hazelnut with enzyme allergosorbent test inhibition, assessment of cross-reactivity with different allergens by means of immunoblotting inhibition, and purification by means of HPLC. RESULTS All the sera from the patients with positive DBPCFC results recognized an 18- and a 47-kd allergen; other major allergens were at molecular weights of 32 and 35 kd. Binding to the 18-kd band was inhibited by birch extract, indicating its homology with the birch major allergen, and abolished in roasted hazelnut. The 47-kd allergen is a sucrose-binding protein, the 35-kd allergen is a legumin, and the 32-kd allergen is a 2S albumin. Patients with severe anaphylactic reactions to hazelnut showed specific IgE reactivity to a 9-kd allergen, totally inhibited by purified peach lipid-transfer protein (LTP), which was heat stable and, when purified, corresponded to an LTP. CONCLUSIONS The major allergen of hazelnut is an 18-kd protein homologous to Bet v 1, and the 9-kd allergen is presumably an LTP. Other major allergens have molecular weights of 47, 32, and 35 kd.
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Affiliation(s)
- Elide A Pastorello
- Allergy Center, 3rd Division of General Medicine, Ospedale Maggiore IRCCS, Milan, Italy
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Abstract
Adverse reactions to food may be toxic or non toxic, depending on the susceptibility to a certain food; non toxic reactions that involve immune mechanisms are termed allergy if they are IgE-mediated. If no immunological mechanism is responsible, it is termed intolerance. The following disorders are considered a consequence of food allergy: gastrointestinal reactions (oral allergy syndrome, vomiting, diarrhea, protein-induced enterocolitic syndrome, eosinophilic gastroenteritis); respiratory reactions (rhinitis, asthma, laryngeal edema); cutaneous reactions (urticaria-angioedema, atopic dermatitis); anaphylaxis. There is much recent evidence to consider celiac disease an immunological disorder. Food allergy diagnosis is based on history, SPT, specific IgE, food challenges. DBPCFC is fundamental for diagnosing true food allergy; patients who have had anaphylaxis to food must not undergo DBPCFC. Rapidly progressive respiratory reactions and anaphylactic shock are life-threatening reactions that can be caused by food allergy. The doses of food inducing anaphylaxis can be very low, therefore commercial cross-contamination with an unsuspected food during food processing can be risky for the food allergic patient. The prevention of severe anaphylactic food reactions may lie in interdisciplinary collaboration among allergologists, chemists, food technologists, and experts in food industry research.
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Affiliation(s)
- C Ortolani
- Centro di Allergologia e Immunologia Clinica, Ospedale Niguarda Cà Granda, Milan, Italy.
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48
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Abstract
Plant lipid transfer proteins, a widespread family of proteins, have been recently identified as important food allergens. Their common structural features, such as eight conserved cysteines forming disulfide bridges, basic isoelectric point and high similarity in amino acid sequence, are the basis of allergic clinical cross-reactivity. This has been demonstrated for the LTP allergens of the Prunoideae subfamily, whose similarity is about 95% as demonstrated for the purified allergens of peach, apricot, plum and apple. A relevant aspect is the existence of sequence homology of LTPs of botanically unrelated foods, as demonstrated for LTPs of maize and peach. A class of food allergens of well recognized clinical importance is that of seed storage 2S albumins. They have been identified in the most diffused edible seeds and nuts, such as mustard, sesame, Brazil nut, walnut and peanut. In particular, a strong correlation between IgE-binding to these proteins and food-induced anaphylaxis has been demonstrated for Brazil nut and sesame seeds.
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Affiliation(s)
- E A Pastorello
- Allergy Centre, 3rd Division of General Medicine, Ospedale Maggiore IRCCS, Milan, Italy
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Pastorello EA, Farioli L, Robino AM, Trambaioli C, Conti A, Pravettoni V. A lipid transfer protein involved in occupational sensitization to spelt. J Allergy Clin Immunol 2001; 108:145-6. [PMID: 11447401 DOI: 10.1067/mai.2001.114988] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Pastorello EA, Farioli L, Robino AM, Trambaioli C, Conti A, Pravettoni V. A lipid transfer protein involved in occupational sensitization to spelt. J Allergy Clin Immunol 2001. [DOI: 10.1067/jmai.2001.114988] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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