|
 |
| | Allergy Advisor Digest - June 2009 Editor: Dr. Harris A. Steinman |
Previous Issues
May 2006
June 2006
July 2006
August 2006
September 2006
October 2006
November 2006
December 2006
January 2007
February 2007
March 2007
April 2007
May 2007
June 2007
July 2007
August 2007
September 2007
October 2007
November 2007
December 2007
January 2008
February 2008
March 2008
April 2008
May 2008
June 2008
July 2008
August 2008
September 2008
October 2008
November 2008
December 2008
January 2009
February 2009
March 2009
April 2009
May 2009
June 2009
This is a monthly digest of interesting information that is being added to Allergy Advisor. While we add a great deal of information every month, here we highlight some of the more interesting articles.
Want to subscribe to our reminder service? Tell a Friend!
Search
|
|  | The prevalence of sensitization to lupin flour in France and Belgium. |
|  | Lactose intolerance. |
|  | Maggot fishing bait: Protophormia terraenovae. A new allergenic species in amateur fishermen of Caceres, Spain. |
|  | Dual sensitization to rat and mouse urinary allergens reflects cross-reactive molecules rather than atopy. |
|  | Increasing insect reactions in Alaska: Is this related to changing climate? |
|  | Sex-specific differences in allergic sensitization to house dust mites. |
|  | A review of cases of food-dependent exercise-induced anaphylaxis. |
|  | Single blind food challenge using dried food powder: Raw Whole Egg and Egg. [Japanese] |
|  | Allergenicity of native/recombinant tropomyosin, per a 7, of American cockroac |
|  | Seasonal levels of the major American cockroach allergen Per a 9 (arginine kinase) in Bangkok |
|  | IgE-binding epitopes and recombinant IgE reactivity of a latex cross-reacting Indian jujube allergen. |
|  | Basophil activation tests for the diagnosis of food allergy in children. |
|  | Identification of two pistachio allergens, Pis v 1 and Pis v 2, belonging to the 2S albumin and 11S globulin family. |
|  | Occupational airborne allergic contact dermatitis from potassium metabisulfite. |
|  | Recurrent tongue swelling: an unusual manifestation of allergic contact dermatitis. |
|  | Contact urticaria and protein contact dermatitis to chapatti flour. |
|  | Contact allergy to fragrances and parabens in an atopic baby. |
|  | Allergic contact stomatitis presenting as geographical tongue with pruritus. |
|  | Seasonal inhalant insect allergy: Harmonia axyridis ladybug. |
|  | Double-blind, placebo-controlled food challenge in adults in everyday clinical practice |
|  | The effect of heating and food matrix on food protein allergenicity. |
|  | Mammalian milk allergy |
|  | Characterization of Allergens in Four South American Snake Species. |
|  | Causes of Food-Induced Anaphylaxis in Italian Adults |
|  | Food allergy and food allergy attitudes among college students. |
|  | Summary of the 2008 National Institute of Allergy and Infectious Diseases-US Food and Drug Administration Workshop on Food Allergy Clinical Trial Design. |
|  | Sarcoplasmic calcium-binding protein, identified as a new shrimp allergen. |
|  | Work Group report: oral food challenge testing. |
|  | Recombinant allergenic determinants of alphaS1-casein, a major cow's milk allergen. |
|  | Parent-reported information of peanut and nut allergy in Australian school children. |
|  | An association between tick bite reactions and red meat allergy in humans. |
|  | Cow's milk allergy related pediatric constipation. |
|  | Identification of the etiologies of chronic urticaria in children: A prospective study of 94 patients. |
|  | Horse allergens: An underestimated risk for allergic sensitization in an urban atopic population without occupational exposure. |
 |
The prevalence of sensitization to lupin flour in France and Belgium.
A prospective study carried out by members of the Allergy Vigilance Network, using prick-tests with a commercial lupin flour extract in patients with various allergic symptoms. Over a two-month period, 88 French and Belgian allergists tested 5,366 patients: 2,680 children and 2,686 adults aged over 16 years. Of the 2,680 children, 11.15% presented with peanut allergy. The frequency of cross-reactivity with lupin was 17.1% for patients with peanut allergy, 2.5% for children with current atopic disease and 1.7% for healthy children with latent atopy. In the 2,686 adults, peanut allergy was diagnosed in 1.86% of patients with cross-reactivity to lupin in 14.6%. Sensitization to lupin was detected in 3.7% of patients with current atopic disease and in 1.8% of those with latent atopy.
The prevalence of sensitization to lupin flour in France and Belgium: a prospective study in 5,366 patients, by the Allergy Vigilance Network.
Gayraud J, Mairesse M, Fontaine JF, Thillay A, Leduc V, Rance F, Parisot L, Moneret-Vautrin DA.
Eur Ann Allergy Clin Immunol 2009 Feb;41(1):17-22
|
|
 |
 |
Lactose intolerance.
"Lactose malabsorption is a very common condition characterized by intestinal lactase deficiency. Primary lactose malabsorption is an inherited deficit present in the majority of the world's population, while secondary bypolactasia can be the consequence of an intestinal disease. The presence of malabsorbed lactose in the colonic lumen may cause gastrointestinal symptoms. This condition is known as lactose intolerance. Lactase non-persistence is the ancestral state, whilst two single nucleotide polymorphisms in the lactase gene have been associated with lactase persistence. These are C/T 13910 and G/A 22018 substitutions. Lactase persistence, this Mendelian dominant trait, only became advantageous after the invention of agriculture, when milk from domesticated animals became available for adults to drink. Lactase persistence is then strongly correlated with the diary history of the population. Diagnosis is assessed clinically by elimination of dietary lactose or, better, by non-invasive tests including hydrogen breath test and genetic test. In patients with lactase non-persistence, treatment should be considered exclusively if intolerance symptoms are present. In the absence of guidelines, the common therapeutic approach tends to exclude milk and dairy products from the diet. However, this strategy may have serious nutritional disadvantages. Several studies have been carried out to find alternative approaches, such as exogenous beta-galactosidase, yogurt and probiotics for their bacterial lactase activity, strategies that can prolong contact time between enzyme and substrate delaying gastrointestinal transit time, and chronic lactose ingestion to enhance colonic adaptation."
Lactose intolerance: a non-allergic disorder often managed by allergologists.
Perino A, Cabras S, Obinu D, Cavalli SL.
Eur Ann Allergy Clin Immunol 2009 Feb;41(1):3-16
|
|
 |
 |
Maggot fishing bait: Protophormia terraenovae. A new allergenic species in amateur fishermen of Caceres, Spain.
Asticot maggot is the most important live bait used for angling in Spain. The purpose of this study was to determine the prevalence of asticot allergy in amateur fishermen and the identification of marketed asticot species in Caceres, Spain. Seventy-two randomised selected patients completed a questionnaire about fishing habits and allergic symptoms related with live bait handling. Skin prick test (SPT) with local asticot and common earthworm extracts were performed. Serum IgE levels to imported species (Protophormia terraenovae, Calliphora vomitoria, Lucilia sericata, Lumbricus terrestris) were measured. Five patients (7 %) reported allergic symptoms caused by asticot maggots. All of them were positive for SPT to asticot and specific IgE to P. terraenovae. Sensitisation to P. terraenovae was found in 40 patients (58.8 %). No associated factors for asticot allergy were observed. Larvae and adult flies of local asticot samples were identified as P. terraenovae. The allergenic potential of P. terraenovae seems to be greater than that of other blowflies and L. terrestris.
Protophormia terraenovae. A new allergenic species in amateur fishermen of Caceres, Spain.
Porcel CS, Pineda de la LF, Frontera CE, Rodriguez ME, Ramos CA, Sanchez GA, Rodriguez TA, Jimenez TS, Alvarado AM, Medina V, Rodriguez MM, Hernandez AJ.
Allergol Immunopathol (Madr) 2009 Mar;37(2):68-72
|
|
 |
 |
Dual sensitization to rat and mouse urinary allergens reflects cross-reactive molecules rather than atopy.
Sensitization to rats and mice can develop in laboratory animal workers exposed to only one species. Reasons for this dual sensitization are unclear but may reflect a genetic predisposition to developing allergy (atopy) or alternatively cross-reactivity between rat and mouse urinary allergens. This study examined cross-reactivity between rat and mouse urine and the effect atopy has on dual sensitization in laboratory animal workers. In a cross-sectional study the frequency of sensitization to rat and/or mouse was analysed in 498 employees exposed to both rat and mouse at work and 220 to rat only. Fourteen per cent of workers were sensitized to rats and 9% to mouse. Over half (62%) of rat sensitized individuals were also mouse sensitized and the majority (91%) of mouse sensitized individuals were also rat sensitized. IgE cross-reactivity was demonstrated between rat and mouse urine using RAST inhibitions. Rates of atopy did not differ between rat only sensitized individuals compared with those sensitized to both species. Sensitization to cats and rabbits was more common amongst those with dual sensitization. Conclusions: Dual sensitization to rat and mouse reflects IgE cross-reactivity rather than atopy. Individuals with dual sensitization are more likely to be sensitized to other animal allergens.
Dual sensitization to rat and mouse urinary allergens reflects cross-reactive molecules rather than atopy.
Jeal H, Harris J, Draper A, Taylor AN, Cullinan P, Jones M.
Allergy 2009 Jun;64(6):855-861
|
|
 |
 |
Increasing insect reactions in Alaska: Is this related to changing climate?
In 2006, Fairbanks, AK, reported its first cases of fatal anaphylaxis as a result of Hymenoptera stings concurrent with an increase in insect reactions observed throughout the state. A retrospective review of three independent patient databases in Alaska was conducted to identify trends of patients seeking medical care for adverse reactions after insect-related events. Each database revealed a statistically significant trend in patients seeking care for insect reactions. Hospitals reported between a three to fourfold increase in patients in 2006 compared with previous years. A retrospective review of the Alaska Medicaid database from 1999 to 2006 showed increases in medical claims for insect reactions among all regions, with the largest percentage of increases occurring in the most northern areas. Increases in insect reactions in Alaska have occurred after increases in annual and winter temperatures, and these findings may be causally related.
Increasing insect reactions in Alaska: Is this related to changing climate?
Demain JG, Gessner BD, McLaughlin JB, Sikes DS, Foote JT.
Allergy Asthma Proc 2009 May;30(3):238-243
|
|
 |
 |
Sex-specific differences in allergic sensitization to house dust mites.
The prevalence of allergic airway diseases in childhood is higher in boys than in girls but switches toward a female predominance in adolescents and adults. The sex-specific prevalence of allergic sensitization to 1 of the most common allergens worldwide, house dust mite (HDM), has not been examined systematically by age group and species. The objective of this study was to systematically review the literature to examine sex-specific differences in the prevalence of allergic sensitization to HDM. The study concludes that in adults, the male predominance in sensitization to HDM seems to be contrary to the prevalence of allergic airway symptoms, which has a female predominance. The male predominance is even higher in allergic sensitization to D farinae than to D pteronyssinus. Further research is necessary regarding sex-specific differences in allergy and asthma
Sex-specific differences in allergic sensitization to house dust mites: a meta-analysis.
Goldhahn K, Bockelbrink A, Nocon M, Almqvist C, Dunngalvin A, Willich SN, Keil T.
Ann Allergy Asthma Immunol 2009 Jun;102(6):487-494
|
|
 |
 |
A review of cases of food-dependent exercise-induced anaphylaxis.
A retrospective analysis of six Japanese cases of food-dependent exercise-induced anaphylaxis (FDEIA) seen over three years, reports that patients' ages were from 8 to 47 years of age. The trigger allergens were wheat, shrimp, and grapefruit. The trigger exercises were running, volleyball, as well as taking a bath. In four cases, the patients had history of allergic disease such as atopic dermatitis, allergic rhinitis, and so on. In two cases of wheat-dependent exercise-induced anaphylaxis, the IgE levels for omega5-gliadin (a major wheat allergen) in a RAST were positive.
A clinical study of admitted the review of cases of food-dependent exercise-induced anaphylaxis. [Japanese]
Matsumoto R, Ogawa T, Makino T, Okano M.
Arerugi 2009 May;58(5):548-553
|
|
 |
 |
Single blind food challenge using dried food powder: Raw Whole Egg and Egg. [Japanese]
"Aim: We have analyzed data of raw whole egg and egg yolk challenges performed in single-blinded manner.
Subjects and Methods: We have performed 92 whole egg challenges and 109 egg yolk challenges in admission from 1995 to 2005.
Results: The positive rate of whole egg challenges was 76.1%, and the most frequent symptoms seen during challenges involved gastrointestinal (GI) system, followed by skin, and respiratory system. The rate of anaphylaxis was 4.3%. Among 70 raw-egg positive cases, 62 heated-egg challenges were performed in open manner, which resulted in 18 negative cases (29%) against it. When we compared IgE CAP RAST against egg white between challenge positive cases and negative ones, IgE CAP RAST against egg white was significantly higher in positive group. With regards to yolk egg challenges, positive rate was 23.9%, and evoked symptoms were most frequently seen in skin, followed by GI system, and respiratory system. No case of anaphylaxis was observed.
Conclusions: Single-blinded challenge tests against whole egg and egg yolk were useful for the diagnosis of pediatric egg allergy. IgE CAP RAST against egg white was useful when we considered timing of egg challenge tests. Among raw egg allergies, around 30% of patients could eat heated-whole egg. In order to improve egg allergy patients' quality of life, it is important to first introduce egg yolk challenges followed by heated-whole egg challenges, and finally raw-egg challenges, if it is necessary, in blinded manner."
Single blind food challenge using dried food powder -1st Report. Raw Whole Egg and Egg. [Japanese]
Komata T, Shukuya A, Imai T, Tachimoto H, Ebisawa M.
Arerugi 2009 May;58(5):524-536
|
|
 |
 |
Allergenicity of native/recombinant tropomyosin, per a 7, of American cockroac
In this study, native tropomyosin (Per a 7) of American cockroach (CR), Periplaneta americana, caught in Thailand was purified. Amino acid sequence had 98.59% identity with the sequences of Per a 7.0101 and Per a 7.0102 and was 97.18% identical to the Bla g 7 sequence of German cockroach, Blatella germanica. The native and recombinant tropomyosins (approximately 34 kDa) were used for detecting specific IgE in serum samples of 14 consented allergic patients who were positive by skin test to crude CR extract in comparison to 5 individuals who were skin test negative. Eight (57%) and 6 (43%) of the CR allergic patients gave positive IgE binding results to the native and the recombinant proteins, respectively, while none of the controls.
Allergenicity of native/recombinant tropomyosin, per a 7, of American cockroach (CR), Periplaneta americana, among CR allergic Thais.
Sookrung N, Indrawattana N, Tungtrongchitr A, Bunnag C, Tantilipikorn P, Kwangsri S, Chaicump W.
Asian Pac J Allergy Immunol 2009 Mar;27(1):9-17
|
|
 |
 |
Seasonal levels of the major American cockroach allergen Per a 9 (arginine kinase) in Bangkok
A cross-sectional survey of the levels of a major American cockroach allergen, i.e. Per a 9 (arginine kinase) in dust samples collected in various seasons throughout the year 2007 from 76 houses of CR allergic Thai patients in the Bangkok metropolitan area were determined. The detection limit of the assay was 122 pg of the allergen or 0.024 microg per gram of fine dust powder. The concentrations of Per a 9 were found to be highest during the winter months and lowest in summer. The levels of this CR allergen had a direct correlation with disease exacerbation; i.e. the majority of the CR allergic patients had their most severe clinical manifestations during winter. The CR allergen levels were found to be higher in wood based-houses than in concrete houses.
Seasonal levels of the major American cockroach allergen Per a 9 (arginine kinase) in Bangkok and their relevance for disease severity.
Tungtrongchitr A, Sookrung N, Indrawattana N, Sae-Lim J, Puduang S, Phonrat B, Wanachiwanawin D, Chaicumpa W.
Asian Pac J Allergy Immunol 2009 Mar;27(1):1-7
|
|
 |
 |
IgE-binding epitopes and recombinant IgE reactivity of a latex cross-reacting Indian jujube allergen.
Ziz m 1 is a major Indian jujube (Zizyphus mauritiana) allergen involved in latex-fruit syndrome. Four corresponding peptides were synthesized, and these peptides reacted with 70%, 100%, 70% and 70% of 10 allergic sera tested.
Identification of immunoglobulin E (IgE)-binding epitopes and recombinant IgE reactivities of a latex cross-reacting Indian jujube Ziz m 1 allergen.
Lee MF, Tsai JJ, Hwang GY, Lin SJ, Chen YH.
Clin Exp Immunol 2008 Jun;152(3):464-471
|
|
 |
 |
Basophil activation tests for the diagnosis of food allergy in children.
Positive skin prick tests (SPT) for food allergens and specific IgE (sIgE) in serum indicate sensitization but do not enable distinction between sensitized but tolerant and clinically allergic patients. In this study, the clinical relevance of basophil activation tests (BATs) for peanut or egg allergy diagnosis was evaluted in 32 peanut-allergic, 14 peanut-sensitized (sIgE(+) and/or SPT(+) to peanuts) but tolerant children and 29 controls with no history of an adverse reaction to peanuts. Similarly, 31 egg-allergic, 14 egg-sensitized children (sIgE(+) and/or SPT(+) to egg white) and 22 controls were studied. Flow cytometric analysis of CD63 expression or CD203c upregulation on basophils and the production of leukotrienes (LT) were performed in response to an in vitro crude peanut extract or ovalbumin (OVA) challenge.
After in vitro peanut challenge, the basophils from peanut-allergic children showed significantly higher levels of activation than those from controls (P<0.001). After OVA challenge, a similar distinction (P<0.001) was observed between egg-allergics and controls. Interestingly, the majority of egg- or peanut-sensitized children failed to activate basophils, respectively, in response to OVA and peanut challenge. The sensitivity of the CD63, CD203c and LT assay was 86.7%, 89.5% and 76.0% with a specificity of 94.1%, 97.1% and 94.6% for peanut allergy diagnosis. The corresponding performances of BATs applied to egg allergy diagnosis were 88.9%, 62.5% and 77.8% for the sensitivity and 100%, 96.4% and 96.4% for the specificity.
Therefore neither conventional tests nor BATs are sensitive and specific enough to predict food allergy accurately. However, BATs may helpfully complete conventional tests, especially SPT, allowing improved discrimination between allergic and non-allergic individuals
Basophil activation tests for the diagnosis of food allergy in children.
Ocmant A, Mulier S, Hanssens L, Goldman M, Casimir G, Mascart F, Schandene L.
Clin Exp Allergy 2009 Jun 22;
|
|
 |
 |
Identification of two pistachio allergens, Pis v 1 and Pis v 2, belonging to the 2S albumin and 11S globulin family.
This study attempted to identify pistachio allergens and to clone the encoding genes, utilizing sera from 28 pistachio-allergic individuals. Nineteen out of 28 patients (68%) showed IgE binding to a 7 kDa protein fraction, while 14 (50%) showed specific IgE to a 32 kDa protein fraction. These proteins were shown to be homologues to the cashew nut allergens Ana o 3 and Ana o 2, respectively. Two new allergenic pistachio proteins were identified. Recombinant proteins were recognized by six out of six selected patients. The new allergens were named Pis v 1 and Pis v 2. The novel allergens in pistachio, Pis v 1 and Pis v 2, belong to 2S albumin and 11S globulin family, respectively.
Identification of two pistachio allergens, Pis v 1 and Pis v 2, belonging to the 2S albumin and 11S globulin family.
Ahn K, Bardina L, Grishina G, Beyer K, Sampson HA.
Clin Exp Allergy 2009 Jun;39(6):926-934
|
|
 |
 |
Occupational airborne allergic contact dermatitis from potassium metabisulfite.
Sulfites are heterogeneous compounds that are widely used in occupational and non-occupational fields as preservatives and antioxidants in foods, beverages, drugs, and cosmetics as fixatives in the photographic industry, and as acidifying agents in tanning of leather. They mainly cause immunoglobulin E-mediated disorders, but contact dermatitis from sodium metabisulfite is reported.
Occupational airborne allergic contact dermatitis from potassium metabisulfite. A 37-year-old non-atopic male agricultural worker presented with a 5-year history of itchy erythema, swelling and scaling of his face, including the eyelids, and more severe on the forehead and malar areas. An itchy eryth-ematopapular scaly dermatitis was also present on the extensor part of the forearms. His condition had seasonal relapses, occurring after the grape harvest and persisting through the period of grape fermentation in the wine cellar. During these periods, the patient added potassium metabisulfite to the must to prevent yeast and bacteria proliferation and wine oxidation. When away from work, the dermatitis spontaneously healed in 10 days, and there were no relapses when he was assigned to other duties in the same vineyard. Positive reactions to potassium metabisulfite and sodium metabisulfite were observed in patch tests. Positive delayed eczematous reactions to prick and intradermal tests with potassium metabisulfite and sodium metabisulfite were observed. The patient did not report any problems after ingestion of food and drink containing sulfites.
Occupational airborne allergic contact dermatitis from potassium metabisulfite.
Stingeni L, Bianchi L, Lisi P.
Contact Dermatitis 2009 Jan;60(1):52-53
|
|
 |
 |
Recurrent tongue swelling: an unusual manifestation of allergic contact dermatitis.
A 47-year-old woman presented with a 3-year history of approximately monthly episodes of angioedema involving her eyelids and lips. There was no airway involvement, but she did report tongue swelling. Investigations showed an isolated elevated antinuclear factor of > 1:400 and slightly low C4 of 0.12. Extractable nuclear antigens, IgE, RAST to house dust mite, yeast and fish, and mast cell tryptase were normal (at the time of swelling). At the time of presentation, during an attack, she was noted to have dry scaly, purple discoloured swollen eyelids. This was in keeping with an allergic contact dermatitis. She had a weakly positive reaction to tosylamide/formaldehyde resin and a strongly positive reaction to her own nail hardener on patch tests. The patient recalled that the episodes of eyelid swelling coincided with nail varnish application and the tongue swelling with biting off her nail varnish! Tosylamide/formaldehyde resin is an allergen commonly found in nail varnishes and nail hardeners.
Recurrent tongue swelling: an unusual manifestation of allergic contact dermatitis.
Moran B, Murphy GM.
Contact Dermatitis 2009 Feb;60(2):114-115
|
|
 |
 |
Contact urticaria and protein contact dermatitis to chapatti flour.
Chapatti flour is a wholewheat flour often blended with malted barley and is used frequently in Asian cookery. Chapattis are an every day staple food and are cooked in many Asian households several times a week by combining the flour with water and then cooking them on a flat heavy hot plate.
One case of contact urticaria and two cases of protein contact dermatitis to chapatti flour in Asian housewives. A 36-year-old woman presented with a history of developing itchy weals on her hands immediately after handling chapatti flour. Prick testing to her chapatti flour as well as wheat flour and a scratch patch test to chapatti flour all produced positive weal and flare reactions.
A 36 year-old woman was presented with a 10-year history of hand eczema, particularly in the fingertip distribution, as well as sneezing within minutes of exposure to chapatti flour. Patch testing to her flour was negative, but scratch patch testing to chapatti flour and prick testing to wheat were both positive. Another 37-year-old woman with a history of lifelong atopic dermatitis reported a 3-year history of persistent hand eczema, affecting the palmar surface of both hands and fingertips. On direct questioning, she admitted to itching and burning of her hands immediately after handling chapatti flour. Skin prick tests to chapatti and wheat flour were both positive. None of the patients reported any symptoms after eating cooked chapatti.
Contact urticaria and protein contact dermatitis to chapatti flour.
Davies E, Orton D.
Contact Dermatitis 2009 Feb;60(2):113-114
|
|
 |
 |
Contact allergy to fragrances and parabens in an atopic baby.
A 10-month-old Caucasian atopic baby girl was seen with a 6-week history of a persistent diaper (nappy) rash. She was being fed with a 'hypoallergenic milk product' and had eaten fruits, vegetables, and meat since she was 5 months, without any evidence for intolerance. The baby had a severe erythematous eruption with red papules, scaly plaques, and small erosions on the convex skin surfaces of the pubic area and buttocks with sparing of the skin folds. She also had eczematous areas on the forehead and cheeks. Because the lesions did recur despite the use of the prescribed topical corticosteroid preparation and a moisturizing cream prepared by a pharmacist, patch testing was performed when the baby was 14 months old. Positive reactions were noted to fragrance mix, paraben mix, and to several skin care products that had been applied to the baby's skin since birth. The cosmetic products that tested positive did contain parabens and fragrances. 1 month later, the baby's lesions had again flared. the pharmacist who had prepared the prescribed creams, had indeed added parabens by mistake. The component of the fragrance mix responsible was identified as isoeugenol.
Contact allergy to fragrances and parabens in an atopic baby.
Nardelli A, Morren MA, Goossens A.
Contact Dermatitis 2009 Feb;60(2):107-109
|
|
 |
 |
Allergic contact stomatitis presenting as geographical tongue with pruritus.
Cobalt chloride is the third most frequent allergen in children. This metal is frequently used in the dental prosthesis. But oral manifestation of metal contact allergy is very rare.
Allergic contact stomatitis is rare. A case of cobalt contact allergy in the mouth presented as an itching geographical tongue in a 7-year-old girl, with pruritus and pain in the mouth that started 9 months before. One year before, she had a traumatic avulsion of the upper left first incisor, which was replaced by a resin prosthesis maintained by a metallic hook. Clinical examination showed areas of depapillation and 1-cm erosion of the tongue. This presentation evoked a geographical tongue with traumatic erosion. A patch test for cobalt chloride was positive.
Allergic contact stomatitis presenting as geographical tongue with pruritus.
Waroquier D, Evrard L, Nelis M, Parent D.
Contact Dermatitis 2009 Feb;60(2):106
|
|
 |
 |
Seasonal inhalant insect allergy: Harmonia axyridis ladybug.
Seeking winter hibernation sites, ladybug swarms will invade human habitats in the fall. Large fall swarms and smaller spring dispersions produce corresponding peaks in ladybug allergy. Ladybug allergy prevalence in endemic areas has been reported as high as 10%. For some individuals ladybug allergy is their first expression of allergic disease. Exposures at home, work, school, and in other settings may be sensitizing. Ladybug hemolymph is the primary source of allergens. Har a 1 and Har a 2 major ladybug allergens have been characterized. 'Reflex bleeding' from tibiofemoral joints (for communication and during alarm) disperses these allergens.
Seasonal inhalant insect allergy: Harmonia axyridis ladybug.
Goetz DW.
Curr Opin Allergy Clin Immunol 2009 Jun 5;
|
|
 |
 |
Double-blind, placebo-controlled food challenge in adults in everyday clinical practice
"PURPOSE OF REVIEW: The double-blind, placebo-controlled food challenge (DBPCFC) is widely considered as the 'gold standard' for the diagnosis of food allergy. However, in adult patients, this procedure is rather rarely performed outside the academic context. This review article aims to reappraise the pros and cons of DBPCFC and to elicit some critical thoughts and discussions about the real indications of this diagnostic procedure in adult patients in everyday practice.
RECENT FINDINGS: There are many data showing that the DBPCFC poses a number of critical problems that are difficult to overcome in normal outpatient clinics and hospitals, and that are generally not addressed in most articles dealing with this issue.
SUMMARY: Performing DBPCFC poses a number of practical problems and has several pitfalls, which make its routine use in normal clinical settings generally impossible. This review article shows that the need for this procedure in adult patients seems in effect very little and specifies new, more limited indications to its use in everyday practice. Further, it suggests a role for the open challenge, which lacks several of the disadvantages of DBPCFC".
Double-blind, placebo-controlled food challenge in adults in everyday clinical practice: a reappraisal of their limitations and real indications.
Asero R, Fernandez-Rivas M, Knulst AC, Bruijnzeel-Koomen CA.
Curr Opin Allergy Clin Immunol 2009 May 28;
|
|
 |
 |
The effect of heating and food matrix on food protein allergenicity.
This article reviews the recent advances in the area of food allergen processing and the effect on protein allergenicity. Heating generally decreases protein allergenicity by destroying conformational epitopes. In peanut and shrimp, heat-induced Maillard reaction (glycation) may increase allergenicity. The majority of milk and egg-allergic children tolerate extensively heated (baked with wheat matrix) milk and egg. Introduction of extensively heated milk and egg proteins is associated with decreasing sizes of skin prick test wheals and increasing serum food-specific IgG4 levels. Heating and other methods of food processing have different effects on food allergens, even those contained in the same complex food. Structural homology does not reliably predict the effect of processing on allergenicity, and individual food allergens have to be tested. Interactions with other proteins, fat, and carbohydrates in the food matrix are complex and poorly understood. Introduction of extensively heated milk and egg proteins into the diet of allergic children may represent an alternative approach to oral tolerance induction. Better characterization of these aspects of food allergy is critical for elucidation of food protein interactions with the gut-associated lymphoid tissue, the ability to induce IgE sensitization, the potential to trigger hypersensitivity reactions, and different clinical phenotypes of food allergy with regard to severity and persistence.
Rare, medium, or well done? The effect of heating and food matrix on food protein allergenicity.
Nowak-Wegrzyn A, Fiocchi A.
Curr Opin Allergy Clin Immunol 2009 Jun;9(3):234-237
|
|
 |
 |
Mammalian milk allergy
This review examines recent studies on the diagnosis of cow's milk allergy as well as on the allergenicity of milk from other mammalian species. Resolution of symptoms during strict milk avoidance and their re-appearance during the double-blind, placebo-controlled milk challenge remains the gold standard for the diagnosis of cow's milk allergy. Allergic eosinophilic esophagitis/gastroenteritis requires confirmatory endoscopic biopsy. There are increasing data in various populations on cut-off points based on positive predictive values for skin prick test and milk-specific IgE measurements to aid in the diagnosis of cow's milk allergy and to decrease the number of unnecessary food challenges. For non-IgE-mediated manifestations, noninvasive diagnostic tests are still largely lacking. The significant homology between milk from cow, sheep and goat results in clinical cross-reactivity. However, mare's or donkey's milk may be tolerated by some individuals. Data have been accumulating on the utility of diagnostic tools for mostly IgE-mediated milk allergy and allergenicity of milk from other mammalian species, although further studies are sought.
Mammalian milk allergy: clinical suspicion, cross-reactivities and diagnosis.
Jarvinen KM, Chatchatee P.
Curr Opin Allergy Clin Immunol 2009 Jun;9(3):251-258
|
|
 |
 |
Characterization of Allergens in Four South American Snake Species.
A 55-year-old herpetologist developed rhinitis, asthma, urticaria and anaphylaxis when handling 4 different viper snake venoms. Allergen characterizations were done. SDS-PAGE showed several protein bands ranging from 5 to 99 kDa in each of the 4 snake venoms. Immunoblotting demonstrated 4 IgE-binding bands in the Bothrops extract of about 60, 28, 14 and 7 kDa. The bands of 28 and 14 kDa were also present in Lachesis muta. Two IgE-binding proteins of about 50 and 35 kDa were found in Bothrops atrox and L. muta, respectively. A strong inhibition of IgE binding to immobilize Bothrops asper proteins was observed after preabsorption of sera with B. asper, B. atrox,Bothrops xanthograma and L. muta extracts. A 14-kDa phospholipase was shown and the 60- and 28-kDa proteins showed significant similarity with metalloproteinases.
Characterization of Allergens in Four South American Snake Species.
Madero MF, Gamez C, Madero MA, Fernandez-Nieto M, Sastre J, Del P.
Int Arch Allergy Immunol 2009 Jun 4;150(3):307-310
|
|
 |
 |
Causes of Food-Induced Anaphylaxis in Italian Adults
The objective of this study was to detect the main foods/food allergens causing anaphylaxis in Italy. The frequency of anaphylaxis and the relative importance of many offending foods were assessed in 1,110 adult patients with food allergy diagnosed by common criteria at 19 allergy centres scattered throughout Italy from 1 January to 31 December 2007. Fifty-eight of 1,110 (5%) food-allergic patients experienced at least 1 episode of anaphylaxis. On average, they were older than other food-allergic patients (34 vs. 31 years). The majority of anaphylactic episodes occurred in patients sensitized to lipid transfer protein (LTP; n = 19), followed by shrimp (n = 10), tree nuts (n = 9), legumes other than peanut (n = 4), and seeds (n = 2); peanut, spinach, celery, buckwheat, wheat, avocado, tomato, fish, meat, and Anisakis caused an anaphylactic reaction in single patients. Among LTP-hypersensitive patients, peach caused 13/19 anaphylactic episodes. Shrimp-allergic patients were significantly older than other patients with food-induced anaphylaxis (p < 0.05), whereas patients allergic to LTP experienced their anaphylactic episodes at a younger age (p < 0.001). The frequency of anaphylaxis among patients sensitized to LTP, shrimp or tree nuts did not differ between northern and central/southern Italy. In Italy, LTP is the most important allergen causing food-induced anaphylaxis, peach being the most frequently offending food. Peanut-induced anaphylaxis seems very uncommon. Geographic and environmental differences both between Italy and other countries and within Italy seem to play a relevant role in the pattern of sensitization to foods.
Causes of Food-Induced Anaphylaxis in Italian Adults: A Multi-Centre Study.
Asero R, Antonicelli L, Arena A, Bommarito L, Caruso B, Colombo G, Crivellaro M, De CM, Della TE, Della TF, Heffler E, Lodi RF, Longo R, Manzotti G, Marcotulli M, Melchiorre A, Minale P, Moran.
Int Arch Allergy Immunol 2009 Jun 4;150(3):271-277
|
|
 |
 |
Food allergy and food allergy attitudes among college students.
The ojbective of this study was to assess food allergy trends and behavioral attitudes on a large university campus using an online survey distributed by e-mail to local university undergraduate students. A total of 513 individuals responded, with 57% reporting an allergic reaction to food. Of this group, 36.2% reported symptoms consistent with anaphylaxis, and these reactions frequently occurred while enrolled. Allergy to milk, tree nut, shellfish, and peanut was significantly associated with having symptoms of anaphylaxis. Some form of emergency medication was reportedly maintained in 47.7%, including self-injectable epinephrine, although only 6.6% reported always carrying this device. Only 39.7% reported always avoiding foods to which they were allergic.
Food allergy and food allergy attitudes among college students.
Greenhawt J, Singer M, Baptist P.
J Allergy Clin Immunol 2009 Jun 26;
|
|
 |
 |
Summary of the 2008 National Institute of Allergy and Infectious Diseases-US Food and Drug Administration Workshop on Food Allergy Clinical Trial Design.
"This article summarizes the proceedings of a 2008 Workshop on Food Allergy Clinical Trials Design co-organized by the National Institute of Allergy and Infectious Diseases and the US Food and Drug Administration. The use of food allergens both as therapy and for oral food challenges is associated with a risk of anaphylaxis. Investigators are strongly encouraged to address regulatory considerations by discussing proposed studies with the US Food and Drug Administration. Food allergen administration through the oral or sublingual routes might be less risky than through the subcutaneous route, but this hypothesis has not been proved, and subjects with food allergy might still be at high risk of allergic reactions to such allergen administration. Two distinct mechanisms might lead to beneficial clinical outcomes: desensitization (reversible when food allergen therapy is stopped) and tolerance (persistent benefit even after allergen therapy is stopped). There are important clinical distinctions between desensitization and tolerance. The efficacy of a therapy for food allergy can be evaluated by assessing changes in the dose response to double-blind, placebo-controlled oral food challenges before and after therapy and also by assessing changes in the number of allergic episodes during a longitudinal natural history/exposure study; both approaches have strengths and limitations"
Summary of the 2008 National Institute of Allergy and Infectious Diseases-US Food and Drug Administration Workshop on Food Allergy Clinical Trial Design.
Plaut M, Sawyer RT, Fenton MJ.
J Allergy Clin Immunol 2009 Jun 26;
|
|
 |
 |
Sarcoplasmic calcium-binding protein, identified as a new shrimp allergen.
Fifty-two adults and children with a history of immediate allergic reactions to shrimp and elevated serum IgE to shrimp were selected for this study. Tryptic digests from a 20-kd IgE-binding protein were analyzed, identifying the protein as a sarcoplasmic-calcium-binding protein. Recombinant SCP was tested with patients' sera. Immunoblotting demonstrated IgE binding by 31 of 52 (59.6%) of the sera to a 20-kd shrimp protein. Recombinant SCP was recognized by serum IgE from 20 of 52 (38.4%) subjects, of whom 17 of 20 (85%) were children. ELISA inhibition of pooled sera IgE reactivity to BS extract using recombinant SCP was significant (as high as 79%). For some subjects, mediator release induced by recombinant SCP was higher than that induced by recombinant tropomyosin. In conclusion, this study reports on the identification and cloning of a new shrimp allergen, Lit v 4.0101, an SCP, which appears to be of particular importance in the pediatric population.
Sarcoplasmic calcium-binding protein is an EF-hand-type protein identified as a new shrimp allergen.
Ayuso R, Grishina G, Ibanez MD, Blanco C, Carrillo T, Bencharitiwong R, Sanchez S, Nowak-Wegrzyn A, Sampson HA.
J Allergy Clin Immunol 2009 Jul;124(1):114-120
|
|
 |
 |
Work Group report: oral food challenge testing.
"Oral food challenges are procedures conducted by allergists/immunologists to make an accurate diagnosis of immediate, and occasionally delayed, adverse reactions to foods. The timing of the challenge is carefully chosen based on the individual patient history and the results of skin prick tests and food specific serum IgE values. The type of the challenge is determined by the history, the age of the patient, and the likelihood of encountering subjective reactions. The food challenge requires preparation of the patient for the procedure and preparation of the office for the organized conduct of the challenge, for a careful assessment of the symptoms and signs and the treatment of reactions. The starting dose, the escalation of the dosing, and the intervals between doses are determined based on experience and the patient's history. The interpretation of the results of the challenge and arrangements for follow-up after a challenge are important. A negative oral food challenge result allows introduction of the food into the diet, whereas a positive oral food challenge result provides a sound basis for continued avoidance of the food."
Work Group report: oral food challenge testing.
Nowak-Wegrzyn A, Assa'ad AH, Bahna SL, Bock SA, Sicherer SH, Teuber SS.
J Allergy Clin Immunol 2009 Jun;123(6 Suppl):S365-S383
|
|
 |
 |
Recombinant allergenic determinants of alphaS1-casein, a major cow's milk allergen.
This study isolated a cDNA coding for a major cow's milk allergen, alphaS1-casein. Recombinant alphaS1-casein. IgE epitopes of alphaS1-casein were assessed using sera from 66 cow's milk-sensitized patients. The results demonstrate that ralphaS1-casein as well as alphaS1-casein-derived peptides exhibit IgE reactivity, but mainly the intact ralphaS1-casein induced strong basophil degranulation. These results suggest that primarily intact alphaS1-casein or larger IgE-reactive portions thereof are responsible for IgE-mediated symptoms of food allergy. Recombinant alphaS1-casein as well as alphaS1-casein-derived peptides may be used in clinical studies to further explore pathomechanisms of food allergy as well as for the development of new diagnostic and therapeutic strategies for milk allergy
Cloning, expression, and mapping of allergenic determinants of alphaS1-casein, a major cow's milk allergen.
Schulmeister U, Hochwallner H, Swoboda I, Focke-Tejkl M, Geller B, Nystrand M, Harlin A, Thalhamer J, Scheiblhofer S, Keller W, Niggemann B, Quirce S, Ebner C, Mari A, Pauli G, Herz U, Valent.
J Immunol 2009 Jun 1;182(11):7019-7029
|
|
 |
 |
Parent-reported information of peanut and nut allergy in Australian school children.
A population-based, cross-sectional study in the Australian National Capital of 3851 children, parents reported 127 had a strong allergic reaction to peanuts and 19 to other nuts ever. Nut allergy ever prevalence was 3.8%, and of peanut allergy ever 3.3% (2.8-3.9%). Children with nut allergy were more likely to have hay fever, eczema and wheeze in the last 12 months and have been breastfed than those who did not. 32% had been prescribed an adrenalin autoinjector (6% had used one) and 46% were not eating peanut.
The parent-reported prevalence and management of peanut and nut allergy in school children in the Australian Capital Territory.
Kljakovic M, Gatenby P, Hawkins C, Attewell RG, Ciszek K, Kratochvil G, Moreira A, Ponsonby AL.
J Paediatr Child Health 2009 Mar;45(3):98-103
|
|
 |
 |
An association between tick bite reactions and red meat allergy in humans.
Twenty-five patients living in a tick-endemic region of Sydney, New South Wales developed red meat allergy after experiencing large local reactions to tick bites. This represents a potentially novel cross-reaction between an arthropod and a food protein.
An association between tick bite reactions and red meat allergy in humans.
Van Nunen SA, O'Connor KS, Clarke LR, Boyle RX, Fernando SL.
Med J Aust 2009 May 4;190(9):510-511
|
|
 |
 |
Cow's milk allergy related pediatric constipation.
This study aimed to evaluate the extent of cow's milk allergy (CMA) as a cause of pediatric constipation and determine the appropriate timing of tolerance to cow milk in such patients. The study included 60 patients suffering from chronic functional constipation, 27 of whom did not respond to 2 month laxative therapy (group I). Withdrawal of cow milk and dairy products for a 1 month period was then followed by cow milk re-challenge over 2 wk. The frequency of CMA among constipated patients was 77.7%. Mean values of serum specific IgE to whole cow milk protein and beta-lactoglobulins were significantly higher in constipated patients (0.82 +/- 0.08, 0.79 +/- 0.13 IU/ml, respectively) compared with controls. Serum specific IgE was positive in 85.7% of CMA group, predominantly in class 2. Tolerance to cow milk was achieved after 6 months in only 22.2% compared with 88.8% after 12 months of elimination. In conclusion, CMA is shown to be a significant etiologic factor for constipation in infants and young children. Serum levels of IgE to cow milk proteins are helpful although not definitive for diagnosis.
Cow's milk allergy related pediatric constipation: Appropriate time of milk tolerance.
El-Hodhod MA, Younis NT, Zaitoun YA, Daoud SD.
Pediatr Allergy Immunol 2009 Jun 25;
|
|
 |
 |
Identification of the etiologies of chronic urticaria in children: A prospective study of 94 patients.
"The etiologies of chronic urticaria (CU) in childhood remains incompletely understood because of limited data in children. The objective of this study was to examine some of the possible etiologies of CU in children by focusing on the functional autoantibody to FcepsilonRIalpha and IgE, thyroid autoimmunity, urticarial vasculitis, parasitic infestation and food allergy. Children 4-15 yr of age with CU were investigated for complete blood count, erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA), CH(50), free-T4 (FT(4)), thyroid stimulating hormone (TSH), anti-thyroglobulin and anti-microsomal antibody, autologous serum skin test (ASST), skin prick tests (SPT) for foods, food challenges, and stool examination for parasites. Ninety-four children who met the criteria for CU were recruited. Patients with physical urticaria were excluded. Eosinophilia and elevated ESR were found in 23% and 13%, respectively. High ANA titers were found in 2%. None of these patients had clinical features of urticarial vasculitis, abnormal CH(50) level, abnormal TSH and FT(4). Anti-thyroglobulin and anti-microsomal antibodies were not detected. Positive ASST was found in 38%. There were no differences in medication requirement and CU remission between patients with positive and negative ASST. Parasites were found in 5% without clinical correlation. SPT to foods was positive in 35%. Positive food challenges were found in six/nine patients with positive history of food allergy and two/seven patients with negative history. Food avoidance was beneficial to the subgroup of patients with positive history of food allergy only"
Identification of the etiologies of chronic urticaria in children: A prospective study of 94 patients.
Jirapongsananuruk O, Pongpreuksa S, Sangacharoenkit P, Visitsunthorn N, Vichyanond P.
Pediatr Allergy Immunol 2009 Jun 25;
|
|
 |
 |
Horse allergens: An underestimated risk for allergic sensitization in an urban atopic population without occupational exposure.
From among 1822 consecutive Italian outpatients, we selected all subjects who had an immediate skin reaction to horse dander. Of 1201 SPT-positive patients, 35 (3.43%) were sensitized to horse dander. No patient was mono-sensitized. Six individuals reported having direct horse contact, 10 subjects had occasional contact with horse owners (indirect exposure), and 19 denied direct or indirect exposure to horses or horse allergens. Twenty of the 35 horse-sensitized patients reported both nasal and bronchial symptoms, 14 had rhinitis without asthma and one had asthma without rhinitis. Our results suggest that allergic sensitization to horse allergens is more frequent than expected in urban-dwelling subjects without direct or occupational exposure to horses.
Horse allergens: An underestimated risk for allergic sensitization in an urban atopic population without occupational exposure.
Liccardi G, Salzillo A, Dente B, Piccolo A, Lobefalo G, Noschese P, Russo M, Gilder JA, D'Amato G.
Respir Med 2009 Mar;103(3):414-420
|
|
 |
Previous Issues of Allergy Advisor Digest
May 2006
June 2006
July 2006
August 2006
September 2006
October 2006
November 2006
December 2006
January 2007
February 2007
March 2007
April 2007
May 2007
June 2007
July 2007
August 2007
September 2007
October 2007
November 2007
December 2007
January 2008
February 2008
March 2008
April 2008
May 2008
June 2008
July 2008
August 2008
September 2008
October 2008
November 2008
December 2008
January 2009
February 2009
March 2009
April 2009
May 2009
June 2009
| To subscribe to future Digest installments , subscribe here, and we will notify you when the new Digest is published.
|
|