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Allergy Advisor Digest - April 2013
Editor: Dr. Harris A. Steinman

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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.
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Serum gliadin monitoring extracts patients with false negative results in challenge tests for the diagnosis of wheat-dependent exercise-induced anaphylaxis.

Systemic contact dermatitis due to zinc successfully treated with a zinc-restricted diet: a case report.

'Bitter Sweet': A child case of erythritol-induced anaphylaxis.

Cedar and cypress pollen counts are associated with the prevalence of allergic diseases in Japanese schoolchildren.

Moving from peanut extract to peanut components: towards validation of component-resolved IgE tests.

Double-blind, placebo-controlled, dose-ranging study of new recombinant hypoallergenic Bet v 1.

Skin test concentrations for systemically administered drugs - an ENDA/EAACI Drug Allergy Interest Group position paper.

Factors that predict the clinical reactivity and tolerance in children with cow's milk allergy.

Diagnosis and management of immediate hypersensitivity reactions to cephalosporins.

Airborne seafood allergens as a cause of occupational allergy and asthma.

New food allergies in a European Non-Mediterranean Region: Is Cannabis sativa to blame?

Efficacy of recombinant allergens for diagnosis of cockroach allergy in patients with asthma and/or rhinitis.

Administration of yellow fever vaccine in patients with egg allergy.

Rice allergy demonstrated by double-blind placebo-controlled food challenge in peach-allergic patients is related to lipid transfer protein reactivity.

Oral challenges with four apple cultivars result in significant differences in oral allergy symptoms.

Loss-of-function mutations in the filaggrin gene and self-reported food allergy and alcohol sensitivity.

Gly m 4 as a marker for severe food-allergic reactions to soy.

Peanut protein in household dust is related to household peanut consumption and is biologically active.

Distribution of peanut protein in the home environment.

Sensitization to Cor a 9 and Cor a 14 is highly specific for a hazelnut allergy with objective symptoms in Dutch children and adults.

Vitamin D insufficiency is associated with challenge-proven food allergy in infants.

Immediate allergic hypersensitivity to quinolones associates with neuromuscular blocking agent sensitization

Dehydrated egg white: An allergen source for improving efficacy and safety in the diagnosis and treatment for egg allergy.

Characterization of the sensitization profile to lupin in peanut-allergic children and assessment of cross-reactivity risk.

Serum gliadin monitoring extracts patients with false negative results in challenge tests for the diagnosis of wheat-dependent exercise-induced anaphylaxis.
Challenge testing with wheat plus exercise and/or aspirin is a gold standard for the diagnosis of wheat-dependent exercise-induced anaphylaxis (WDEIA); however, the test may often yield false-negative results. The authors previous study suggested that an increase in serum wheat gliadin levels is required to induce allergic symptoms in patients with WDEIA. This study sought to extract the patients with false negative results in the challenge tests of WDEIA. Thirty-six patients with suspected WDEIA were enrolled. Positive results for wheat plus exercise and/or aspirin challenge tests gave a diagnosis of definite WDEIA in 17 of 36 patients (Group I). Of the remaining 19 challenge negative patients, serum gliadin was undetectable in ten patients (Group II). Of the ten patients (Group II), three of them were diagnosed as definite WDEIA by retesting and six of them were diagnosed as probable WDEIA using a wheat elimination diet, whereas one patient was non-WDEIA. In the rest of the nine challenge negative patients, serum gliadin was detectable (Group III). No allergic episodes with a normal diet provided a diagnosis of non-WDEIA in seven of the nine patients, whereas the remaining two patients were probable WDEIA or had another food allergy because of repeated episodes. Therefore serum gliadin monitoring during challenge testing is useful.

Serum gliadin monitoring extracts patients with false negative results in challenge tests for the diagnosis of wheat-dependent exercise-induced anaphylaxis.
Kohno K, Matsuo H, Takahashi H, Niihara H, Chinuki Y, Kaneko S, Honjoh T, Horikawa T, Mihara S, Morita E.
Allergol Int 2013 Apr 25;

Systemic contact dermatitis due to zinc successfully treated with a zinc-restricted diet: a case report.
A case of systemic contact dermatitis due to zinc that was successfully treated with a zinc-restricted diet. A 58-year-old female experienced multiple pruritic eruptions covering her entire body in June 2010. Although several therapies, including the application of steroid ointment and administration of anti-allergic drugs and cyclosporine were performed at another hospital, the eruptions were not improved. A patch test was highly positive to only zinc chloride only. In addition,

flare-ups of the original eruptions occurred around the area of zinc patch test. Systemic contact dermatitis due to zinc in foods was suspected, because she had daily eaten a lot of almonds, chocolates and cheeses, which include high levels of zinc. She started avoiding of foods that have high levels of zinc, such as those foods, liver and oyster. 3 The eruptions gradually started improving two or three weeks later, and she no longer needed treatment four months after starting the zinc-restricted diet. In addition, the eruptions flared up after she ate chocolate cake. According to these clinical and laboratory findings, we concluded that the refractory eruptions were systemic contact dermatitis due to dietary zinc.

Systemic contact dermatitis due to zinc successfully treated with a zinc-restricted diet: a case report.
Sakai T, Hatano Y, Fujiwara S.
Allergol Int 2013 Apr 25;

'Bitter Sweet': A child case of erythritol-induced anaphylaxis.
An 11-year-old boy admitted for anaphylaxis. At the age of 7, he began to experience episodes of urticaria and wheezing after ingesting foods. Based on his history and positive tests for IgE specific for wheat and peanuts at the initial examination, he was instructed to avoid eating wheat and peanuts. Despite this he was hospitalized because of anaphylaxis after ingesting a diet sauce when he was 10. At the age of 11, he again experienced severe wheezing and generalized urticaria after eating a health-food made from grapefruit (but not after eating fresh grapefruit). On oral challenge, he developed cutaneous pruritus followed by wheezing, dyspnea and generalized urticaria immediately after ingestion of the erythritol-containing sweetener, but not after ingestion of granulated sugar. A skin-prick test was performed using two commercially available erythritol-containing sweeteners. Both sweeteners induced wheals having half the diameter of that induced by histamine.

'Bitter Sweet': A child case of erythritol-induced anaphylaxis.
Shirao K, Inoue M, Tokuda R, Nagao M, Yamaguchi M, Okahata H, Fujisawa T.
Allergol Int 2013 Apr 25;

Cedar and cypress pollen counts are associated with the prevalence of allergic diseases in Japanese schoolchildren.
Patients allergic to pollen have been known to become more symptomatic during pollen season compared with the nonpollen season. This ecological analysis was conducted to evaluate whether pollen exposure is associated with the prevalence of allergic diseases in schoolchildren. Pollen count data of Japanese cedar and Japanese cypress, the major pollen allergens in Japan. The prevalence of allergic rhinoconjunctivitis in children aged 6-7 years was positively associated with both cedar and cypress pollen counts, whereas the prevalence of allergic rhinoconjunctivitis in children aged 13-14 years was positively associated with only cypress pollen counts. Furthermore, the prevalence of asthma was positively associated with cedar pollen counts in 6- to 7-year-old children but not cypress pollen counts in either age group.

Cedar and cypress pollen counts are associated with the prevalence of allergic diseases in Japanese schoolchildren.
Yoshida K, Adachi Y, Akashi M, Itazawa T, Murakami Y, Odajima H, Ohya Y, Akasawa A.
Allergy 2013 Apr 29;

Moving from peanut extract to peanut components: towards validation of component-resolved IgE tests.
Plasma samples from 64 peanut-positive children (42 reactors, 22 nonreactors in a double-blind, placebo-controlled food challenge) were used to compare IgE reactivity to six recombinant peanut allergens with reactivity to natural peanut proteins extracted at neutral or low pH. The hypothesis that poor extractability of Ara h 9 and other basic allergens at neutral pH leads to under-representation of patients with such sensitization was tested. IgE reactivity to the components did not fully explain IgE reactivity to peanut extract in 5 of 32 reactors with IgE to peanut extract

Moving from peanut extract to peanut components: towards validation of component-resolved IgE tests.
Aalberse JA, Meijer Y, Derksen N, van dP, Knol E, Aalberse RC.
Allergy 2013 Apr 29;

Double-blind, placebo-controlled, dose-ranging study of new recombinant hypoallergenic Bet v 1.
This study aimed to find the optimal dose of a new hypoallergenic folding variant of recombinant Bet v 1 (rBet v 1-FV) as SIT for patients with birch pollen allergy, and concludes that considering efficacy, immunological response, and tolerability, a maintenance dose of 80 mug of rBet v 1-FV appears to be the ideal dose for allergen immunotherapy in birch pollen allergic patients.

Double-blind, placebo-controlled, dose-ranging study of new recombinant hypoallergenic Bet v 1 in an environmental exposure chamber.
Meyer W, Narkus A, Salapatek AM, Hafner D.
Allergy 2013 Apr 27;

Skin test concentrations for systemically administered drugs - an ENDA/EAACI Drug Allergy Interest Group position paper.
Skin tests are of paramount importance for the evaluation of drug hypersensitivity reactions. Drug skin tests are often not carried out because of lack of concise information on specific test concentrations. The diagnosis of drug allergy is often based on history alone, which is an unreliable indicator of true hypersensitivity.To promote and standardize reproducible skin testing with safe and nonirritant drug concentrations in the clinical practice, the European Network and European Academy of Allergy and Clinical Immunology (EAACI) Interest Group on Drug Allergy has performed a literature search on skin test drug concentration in MEDLINE and EMBASE, reviewed and evaluated the literature in five languages using the GRADE system for quality of evidence and strength of recommendation. Where the literature is poor, they have taken into consideration the collective experience of the group and recommend drug concentration for skin testing aiming to achieve a specificity of at least 95%. It has been possible to recommend specific drug concentration for betalactam antibiotics, perioperative drugs, heparins, platinum salts and radiocontrast media. For many other drugs, there is insufficient evidence to recommend appropriate drug concentration. There is urgent need for multicentre studies designed to establish and validate drug skin test concentration using standard protocols. For most drugs, sensitivity of skin testing is higher in immediate hypersensitivity compared to nonimmediate hypersensitivity.

Skin test concentrations for systemically administered drugs - an ENDA/EAACI Drug Allergy Interest Group position paper.
Brockow K, Garvey LH, Aberer W, tanaskovic-Markovic M, Barbaud A, Bilo MB, Bircher A, Blanca M, Bonadonna B, Campi P, Castro E, Cernadas JR, Chiriac AM, Demoly P, Grosber M, Gooi J, Lombardo .
Allergy 2013 Apr 25;

Factors that predict the clinical reactivity and tolerance in children with cow's milk allergy.
The objective of this study was to examine the performance of sIgE analysis and the utility of the genetic variants of CD14, STAT6, IL13, IL10, SPINK5, and TSLP in predicting the clinical course in children with CMA. Serum sIgE levels of 94 children who underwent open food challenges and 54 children with anaphylaxis due to cow's milk (CM) were retrospectively analyzed between January 2002 and May 2009. The genetic polymorphisms were determined in 72 children. A total of 148 children were followed up for a median of 3.5 years, and 42 of the 94 challenge results were positive. The probability curves with 95% decision points were 2.8 kU/L for younger than 1 year, 11.1 for younger than 2 years, 11.7 for younger than 4 years, and 13.7 for younger than 6 years. Sixty-six children outgrew CMA during follow-up. Children with initial an CM sIgE level less than 6 kU/L outgrew CMA earlier than children with an initial CM sIgE level of 6 kU/L or higher (P < .001). The age of tolerance development for CM was significantly higher in children with the GG genotype at rs324015 of the STAT6 gene compared with those with the AA+AG genotype (2 years [range, 1.5-3.9 years] vs 1.2 years [range, 1.0-2.2 years]) (P = .02). The decision points of sIgE obtained in different age groups may help to determine the likelihood of clinical reactivity more precisely. The results suggest that sIgE levels and STAT6 gene variants may be important determinants to predict longer persistence of CMA.

Factors that predict the clinical reactivity and tolerance in children with cow's milk allergy.
Yavuz ST, Buyuktiryaki B, Sahiner UM, Birben E, Tuncer A, Yakarisik S, Karabulut E, Kalayci O, Sackesen C.
Ann Allergy Asthma Immunol 2013 Apr;110(4):284-289

Diagnosis and management of immediate hypersensitivity reactions to cephalosporins.
Cephalosporins are one of the most commonly prescribed classes of antibiotics. Immediate IgE-mediated hypersensitivity reactions have been reported with use of a specific cephalosporin, as a cross-reaction between different cephalosporins or as a cross-reaction to other beta-lactam antibiotics, namely, penicillin. Historically, frequent reports of anaphylaxis following administration of first- and second-generation cephalosporins to patients with a history of penicillin allergy led to the belief of a high degree of allergic cross-reactivity. More recent evidence reveals a significantly lower risk of cross-reactivity between penicillins and the newer-generation cephalosporins. The current thought is that a shared side chain, rather than the beta-lactam ring structure, is the determining factor in immunologic cross-reactivity. Understanding the chemical structure of these agents has allowed us to identify the allergenic determinants for penicillin; however, the exact allergenic determinants of cephalosporins are less well understood. For this reason, standardized diagnostic skin testing is not available for cephalosporins as it is for penicillin. Nevertheless, skin testing to the cephalosporin in question, using a nonirritating concentration, provides additional information, which can further guide the work-up of a patient suspected of having an allergy to that drug. Together, the history and the skin test results can assist the allergist in the decision to recommend continued drug avoidance or to perform a graded challenge versus an induction of tolerance procedure

Diagnosis and management of immediate hypersensitivity reactions to cephalosporins.
Dickson SD, Salazar KC.
Clin Rev Allergy Immunol 2013 Apr 2;

Airborne seafood allergens as a cause of occupational allergy and asthma.
Occupational allergy and asthma is a serious adverse health outcome affecting seafood-processing workers. Allergic reactions are directed to two major seafood groups: fish and shellfish, with the latter group comprising crustaceans and molluscs. Several allergenic proteins have been identified in these different groups, but few have been characterised on a molecular level. Parvalbumin appears to be the major fish allergen, while tropomyosin the major crustacean allergen. Other IgE-binding proteins have also been identified in molluscs and other seafood-associated agents (e.g. Anisakis sp), although their molecular nature has not been characterised. Aerosolised allergens can be identified and quantified using immunological and chemical approaches, detecting levels as low as 10 ng/m3. This contemporary review discusses interesting and recent findings in the area of occupational seafood allergy including high-risk occupations, environmental risk factors for airborne exposures, major and minor allergens implicated and innovative approaches in diagnosing and managing occupational allergy and asthma associated with seafood processing

Airborne seafood allergens as a cause of occupational allergy and asthma.
Lopata AL, Jeebhay MF.
Curr Allergy Asthma Rep 2013 Apr 11;

New food allergies in a European Non-Mediterranean Region: Is Cannabis sativa to blame?
Allergy to fruit and vegetables exhibit geographic variation regarding the severity of symptoms and depending on the sensitization profile of the patient. These sensitization profiles and routes remain incompletely understood. Cannabis is a very popular drug and derived from Cannabis sativa, a plant containing lipid transfer proteins (LTP) also known as important allergens in plant and fruit allergies. In this study we sought to elucidate a potential connection between C. sativa allergy and plant food allergies. A case-control study involving 21 patients consulting for plant food allergies. Twelve patients were cannabis allergic and 9 had a pollen or latex allergy without cannabis allergy. Testing for cannabis IgE implied measurement of specific IgE, skin testing and basophil activation tests. Allergen component analysis was performed with a microarray technique. Plant food allergy in patients with documented cannabis allergy had more severe reactions than patients without cannabis allergy and frequently implied fruits and vegetables that are not observed in a (birch) pollen-related food syndrome. With the exception of 1 patient with cannabis allergy, all were sensitized to nonspecific (ns)-LTP. This data suggests that illicit cannabis abuse can result in cannabis allergy with sensitization to ns-LTP. This sensitization might result in various plant-food allergies.

New food allergies in a European Non-Mediterranean Region: Is Cannabis sativa to blame?
Ebo DG, Swerts S, Sabato V, Hagendorens MM, Bridts CH, Jorens PG, De Clerck LS.
Int Arch Allergy Immunol 2013 Mar 15;161(3):220-228

Efficacy of recombinant allergens for diagnosis of cockroach allergy in patients with asthma and/or rhinitis.
The aim of this study was to assess the effectiveness of recombinant cockroach allergens for skin testing, and to determine sensitization profiles among cockroach-allergic patients living in Brazil. Fifty-seven cockroach-allergic patients with asthma and/or rhinitis were recruited. Skin testing with recombinant ® allergens from Periplaneta americana (rPer a 1 and rPer a 7) and Blattella germanica (rBla g 2, rBla g 4 and rBla g 5) were performed at 10 mug/ml and 5 mug/ml (rPer a 1). IgE antibodies to rPer a 7 and rPer a 1 were quantitated by ELISA. Of 57 patients tested, 3 (5.3%), 24 (42.1%), 4 (7%), 3 (5.3%) and 4 (7%) showed positive reactions to rPer a 1, rPer a 7, rBla g 2, rBla g 4 and rBla g 5, respectively. Twenty-eight patients (49.1%) had positive tests to at least one allergen. In keeping with skin test results, 31/57 patients (54.4%) and 5/55 patients (9%) had detectable IgE to rPer a 7 and rPer a 1, respectively. Levels of IgE to rPer a 7 were higher in patients with positive tests to rPer a 7 than those with negative tests (geometric mean 13.2 and 1.8 IU/ml, p < 0.05). There was good concordance of results of skin tests and measurements of serum IgE to rPer a 7. IgE reactivity to rPer a 7 (P. americana tropomyosin) was dominant among patients in Brazil. However, 50% of the patients did not present reactivity to any of the recombinant allergens tested.

Efficacy of recombinant allergens for diagnosis of cockroach allergy in patients with asthma and/or rhinitis.
Barbosa MC, Santos AB, Ferriani VP, Pomes A, Chapman MD, Arruda LK.
Int Arch Allergy Immunol 2013 Mar 15;161(3):213-219

Administration of yellow fever vaccine in patients with egg allergy.
The population of large parts of Africa, South America and travellers to these areas are at risk of yellow fever (YF) with a 50% mortality risk. Yellow fever vaccine (YFV) propagated in hens' eggs confers protection in 95% of the vaccinated. The rate of anaphylaxis for YFV ranges from 0.42 to 1.8/100,000 doses with most cases considered to be due to egg allergy. Egg allergy is a contraindication for the YFV. Nevertheless, the potential fatal sequelae from YF give the incentive to protect everyone at risk irrespective of their allergic status. Six subjects who had had a recent reaction to egg and who were travelling to endemic areas (3 adults and 3 children) underwent skin prick tests (SPT) with undiluted YFV and egg extract. Intradermal tests for YFV were undertaken at a 1:10 dilution. In 4 egg-allergic patients with a positive SPT to YFV, a 7-step desensitization protocol was used. A 2-step (10 + 90%) protocol was used in the 2 subjects with a negative YFV SPT. Premedication was not administered. All 6 patients were successfully vaccinated. Four patients completed desensitization: 1 developed mild local erythema at the injection site, 1 had fleeting generalized urticaria with local erythema/angioedema and 2 did not experience any adverse reactions. Patients who received YFV in 2 steps developed no adverse reactions.

Administration of yellow fever vaccine in patients with egg allergy.
Rutkowski K, Ewan PW, Nasser SM.
Int Arch Allergy Immunol 2013 Mar 15;161(3):274-278

Rice allergy demonstrated by double-blind placebo-controlled food challenge in peach-allergic patients is related to lipid transfer protein reactivity.
The risk factors for sensitisation to rice and the involved allergens are still partially unknown. In this study we evaluated the clinically relevant aspects of rice allergy in DBPCF-positive patients, the major rice allergens, the severity of peach- and rice-induced symptoms in respect to Pru p 3 sensitisation and the role of anti-rPru p 3 IgE levels as a risk factor for rice allergy. In 148 peach-allergic subjects, patients with allergic reactions to rice and rice-positive serum IgE were selected. Symptoms were verified by double-blind placebo-controlled food challenges (DBPCFCs), performed at a maximum dosage of 25 g. Eight out of 10 recruited rice-allergic patients had positive DBPCFCs, while 2 patients were not challenged due to their previously documented severe reactions. All patients with rice-induced symptoms were Pru p 3 positive and presented with higher anti-rPru p 3 levels than the rice-sensitised but tolerant patients. A 9-kDa lipid transfer protein, which was highly homologous to Pru p 3, was identified as the major rice allergen and elicited a positive response in all of the patients. Five patients reacted to a putative 15- to 17-kDa rice allergenic protein, and 3 patients reacted to an [alpha]-amylase/subtilisin inhibitor that was approximately 20 kDa. The study concludes that allergic reactions to rice can arise in patients with peach allergies who are sensitised to Pru p 3, particularly in patients with high anti-rPru p 3 IgE levels.

Rice allergy demonstrated by double-blind placebo-controlled food challenge in peach-allergic patients is related to lipid transfer protein reactivity.
Pastorello EA, Scibilia J, Farioli L, Primavesi L, Giuffrida MG, Mascheri A, Piantanida M, Mirone C, Stafylaraki C, Violetta MR, Nichelatti M, Preziosi D, Losappio L, Pravettoni V.
Int Arch Allergy Immunol 2013 Mar 15;161(3):265-273

Oral challenges with four apple cultivars result in significant differences in oral allergy symptoms.
The hypoallergenic potential of a recently bred apple selection with unusually low content of Mal d 1 was assessed, using an oral challenge model with three additional apple cultivars for comparison. Sixty-six birch pollen-allergic individuals with a history of oral allergy syndrome after apple intake were subjected to a double-blind oral provocation with two apple cultivars (B:0654 and 'Discovery'). Thirteen also tested two other apple cultivars ('Ingrid Marie' and 'Gloster'). B:0654 induced significantly higher TOS than 'Discovery' when tested by 66 individuals, in spite of its lower Mal d 1 content. TOS values were higher in females and increased with increasing age of the individuals when challenged with 'Discovery'. Among the 13 individuals who tested all four cultivars, B:0654 produced a higher score after the second dose compared to 'Ingrid Marie'. This was also the case after the third dose compared to 'Ingrid Marie' and 'Gloster', and again 30 min after the last intake compared to each of the other three cultivars, as well as a higher TOS compared to each of the other three cultivars (all p < 0.01). Therefore significant differences were seen among the apple cultivars and contrary to expectations, B:0654 was less well tolerated than the other three cultivars.

Oral challenges with four apple cultivars result in significant differences in oral allergy symptoms.
Nybom H, Cervin-Hoberg C, Andersson M.
Int Arch Allergy Immunol 2013 Mar 15;161(3):258-264

Loss-of-function mutations in the filaggrin gene and self-reported food allergy and alcohol sensitivity.
Loss-of-function mutations of the filaggrin (FLG) gene cause an impaired skin barrier and increase the risk of atopic dermatitis. Interestingly, FLG mutations have also been found to be associated with a high risk of peanut allergy. This study found that loss-of-function mutations in the FLG gene were significantly associated with self-reported food allergy and alcohol sensitivity, but not with oral allergy syndrome (OAS). These findings, if confirmed, support the idea that skin barrier functions may be involved in the pathogenesis of food allergy

Association between loss-of-function mutations in the filaggrin gene and self-reported food allergy and alcohol sensitivity.
Linneberg A, Fenger RV, Husemoen LL, Thuesen BH, Skaaby T, Gonzalez-Quintela A, Vidal C, Carlsen BC, Johansen JD, Menne T, Stender S, Melgaard M, Szecsi PB, Berg ND, Thyssen JP.
Int Arch Allergy Immunol 2013 Mar 15;161(3):234-242

Gly m 4 as a marker for severe food-allergic reactions to soy.
Gly m 5 and Gly m 6 are known to induce severe reactions in soy-allergic patients. For birch pollen (BP)-allergic patients, the Bet v 1 homologous allergen Gly m 4 is also a potential trigger of generalized severe reactions upon soy consumption. IgE reactivity from sera of 20 patients from a BP environment with reported soy allergy was assessed. Nineteen of 20 patients were BP allergic (positive SPT and/or CAP results for BP extract and Bet v 1). Eighteen soy-allergic patients were tested positive with soy drink in SPT. Soy CAP results were negative in the majority of tests (15/20), whereas 19/20 sera had specific IgE to Gly m 4. In the microarray approach, 14/20 sera displayed Gly m 4-specific IgE, the additional 6 sera had IgE levels below 0.3 ISAC standardized units. The BP-negative serum had Gly m 5- and Gly m 6-specific IgE which correlated with positive soy ImmunoCAP. In this patient cohort, Gly m 4 sensitization was linked to the development of severe and generalized allergic reactions upon soy consumption.

Allergen chip diagnosis for soy-allergic patients: Gly m 4 as a marker for severe food-allergic reactions to soy.
Berneder M, Bublin M, Hoffmann-Sommergruber K, Hawranek T, Lang R.
Int Arch Allergy Immunol 2013 Mar 15;161(3):229-233

Peanut protein in household dust is related to household peanut consumption and is biologically active.
This study sought to explore the relationship between reported household peanut consumption (HPC; used as an indirect marker of environmental peanut exposure) and peanut protein levels in an infant's home environment and to determine the biological activity of environmental peanut. Peanut protein was quantified in wipe and dust samples collected from 45 homes with infants by using a polyclonal peanut ELISA. Environmental peanut protein levels were compared with peanut consumption assessed by using a validated peanut food frequency questionnaire and other clinical and household factors. Biological activity of peanut protein in dust was assessed with a basophil activation assay. There was a positive correlation between peanut protein levels in the infant's bed, crib rail, and play area and reported HPC over 1 and 6 months. On multivariate regression analysis, HPC was the most important variable associated with peanut protein levels in the infant's bed sheet and play area. Dust samples containing high peanut protein levels induced dose-dependent activation of basophils in children with peanut allergy. Therefore an infant's environmental exposure to peanut is most likely to be due to HPC. Peanut protein in dust is biologically active and should be assessed as a route of possible early peanut sensitization in infants.

Peanut protein in household dust is related to household peanut consumption and is biologically active.
Brough HA, Santos AF, Makinson K, Penagos M, Stephens AC, Douiri A, Fox AT, Du Toit TG, Turcanu V, Lack G.
J Allergy Clin Immunol 2013 Apr 19;

Distribution of peanut protein in the home environment.
Peanut spread easily around the home and might be resistant to usual cleaning methods. Peanut protein can be transferred into the environment by means of hand transfer and saliva but is unlikely to be aerosolized

Distribution of peanut protein in the home environment.
Brough HA, Makinson K, Penagos M, Maleki SJ, Cheng H, Douiri A, Stephens AC, Turcanu V, Lack G.
J Allergy Clin Immunol 2013 Apr 19;

Sensitization to Cor a 9 and Cor a 14 is highly specific for a hazelnut allergy with objective symptoms in Dutch children and adults.
This Dutch study sought to evaluate whether component-resolved diagnosis might help to identify patients at risk of objective allergic reactions to hazelnut. 161 hazelnut-sensitized patients were evaluated: 40 children and 15 adults with objective symptoms on double-blind, placebo-controlled food challenges (DBPCFCs) and 24 adults with a convincing objective history were compared with 41 children and 41 adults with no or subjective symptoms on DBPCFCs (grouped together). IgE levels to hazelnut extract were significantly higher in children with objective than with no or subjective symptoms. In 13% of children and 49% of adults with hazelnut allergy with objective symptoms, only sensitization to rCor a 1.04 was observed and not to other water-soluble allergens. Sensitization to rCor a 8 was rare, which is in contrast to rCor a 1. Sensitization to nCor a 9, rCor a 14, or both was strongly associated with hazelnut allergy with objective symptoms. By using adapted cutoff levels, a diagnostic discrimination between severity groups was obtained. IgE levels to either nCor a 9 of 1 kUA/L or greater or rCor a 14 of 5 kUA/L or greater (children) and IgE levels to either nCor a 9 of 1 kUA/L or greater or rCor a 14 of 1 kUA/L or greater (adults) had a specificity of greater than 90% and accounted for 83% of children and 44% of adults with hazelnut allergy with objective symptoms. The study concludes that sensitization to Cor a 9 and Cor a 14 is highly specific for patients with objective symptoms in DBPCFCs as a marker for a more severe hazelnut allergic phenotype

Sensitization to Cor a 9 and Cor a 14 is highly specific for a hazelnut allergy with objective symptoms in Dutch children and adults.
Masthoff LJ, Mattsson L, Zuidmeer-Jongejan L, Lidholm J, Andersson K, Akkerdaas JH, Versteeg SA, Garino C, Meijer Y, Kentie P, Versluis A, den Hartog Jager CF, Bruijnzeel-Koomen CA, Knulst.
J Allergy Clin Immunol 2013 Apr 10;

Vitamin D insufficiency is associated with challenge-proven food allergy in infants.
Epidemiological evidence has shown that pediatric food allergy is more prevalent in regions further from the equator, suggesting that vitamin D insufficiency may play a role in this disease. This study investigated the role of vitamin D status in infantile food allergy. A population sample of 5276 one-year-old infants underwent skin prick testing to peanut, egg, sesame, and cow's milk or shrimp. All those with a detectable wheal and a random sample of participants with negative skin prick test results attended a hospital-based food challenge clinic. Serum 25-hydroxyvitamin D levels were measured. Infants of Australian-born parents, but not of parents born overseas, with vitamin D insufficiency (/=2) rather than a single food allergy. The authors conclude that these results provide the first direct evidence that vitamin D sufficiency may be an important protective factor for food allergy in the first year of life.

Vitamin D insufficiency is associated with challenge-proven food allergy in infants.
Allen KJ, Koplin JJ, Ponsonby AL, Gurrin LC, Wake M, Vuillermin P, Martin P, Matheson M, Lowe A, Robinson M, Tey D, Osborne NJ, Dang T, Tina Tan HT, Thiele L, Anderson D, Czech H, Sanjeevan J, .
J Allergy Clin Immunol 2013 Apr;131(4):1109-1116

Immediate allergic hypersensitivity to quinolones associates with neuromuscular blocking agent sensitization
This reports on a high prevalence of quaternary ammonium sensitization in patients with quinolone allergic hypersensitivity. These results suggest a new way for NMBA sensitization. It thus seems appropriate to investigate neuromuscular blocking agents sensitization when quinolone allergic hypersensitivity is diagnosed.

Immediate allergic hypersensitivity to quinolones associates with neuromuscular blocking agent sensitization
Paul Rouzaire, Audrey Nosbaum, Christine Mullet, Nathalie Diot, Rolande Dubost, Françoise Bienvenu, Laurence Guilloux, Vincent Piriou, Jacques Bienvenu, Frédéric Bérard
J Allergy Clin Immunol: In Practise 2013;1(3):

Dehydrated egg white: An allergen source for improving efficacy and safety in the diagnosis and treatment for egg allergy.
This is the first time that it is shown that the allergenicity of commercially available dehydrated egg white (DEW) is equivalent to raw egg whites. In vivo and in vitro tests showed that processing of DEW does not affect the allergenicity of egg proteins. DEW is an effective and microbiologically safer source of allergen for the diagnosis of egg allergy. Furthermore, DEW can be used in egg oral immunotherapy.

Dehydrated egg white: An allergen source for improving efficacy and safety in the diagnosis and treatment for egg allergy.
Escudero C, Sanchez-Garcia S, Rodriguez Del RP, Pastor-Vargas C, Garcia-Fernandez C, Perez-Rangel I, Ramirez-Jimenez A, Ibanez MD.
Pediatr Allergy Immunol 2013 May;24(3):263-269

Characterization of the sensitization profile to lupin in peanut-allergic children and assessment of cross-reactivity risk.
Case reports of allergy to lupin, due to primary sensitization or cross-reactions with other legumes, are increasing as a consequence of the augmented use of lupin flour in bakery, pasta formulations and other food items. The main allergens that have been associated with the sensitization to lupin are alpha- and beta-conglutins and, to a lesser extent, gamma- and delta-conglutin, but no conclusive data are available so far. The aim of this study was to characterize the sensitization pattern to lupin in a group of 12 Italian children allergic to peanut and identify the specific lupin proteins involved in the cross-reactivity with peanut. The results showed that beta-conglutin was recognized by cutaneous IgEs from 7/12 peanut-allergic children in FFSPT and serum IgEs from 5/12 in immunoblotting, while 4/12 and 8/12 patients tested positive to gamma-conglutin in FFSPT and immunoblotting, respectively. No significant immunoreactive responses were observed to alpha- and delta-conglutins under non-reducing conditions, but they were bound in FFSPT by the sera of 5/12 and 3/12 patients, respectively. In this group of allergic children, beta-conglutin has been identified as the major lupin allergen involved both in vitro and in vivo cross-reactivity with peanut proteins.

Characterization of the sensitization profile to lupin in peanut-allergic children and assessment of cross-reactivity risk.
Ballabio C, Penas E, Uberti F, Fiocchi A, Duranti M, Magni C, Restani P.
Pediatr Allergy Immunol 2013 May;24(3):270-275

Allergen-, Food allergy-, Intolerance-related articles

Serum gliadin monitoring extracts patients with false negative results in challenge tests for the diagnosis of wheat-dependent exercise-induced anaphylaxis.
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Positive skin prick test to cefcapene pivoxil hydrochloride hydrate: a case report.
Yamazato S, Nakai N, Katoh N. Allergol Int 2013 Apr 25;

Systemic contact dermatitis due to zinc successfully treated with a zinc-restricted diet: a case report.
Sakai T, Hatano Y, Fujiwara S. Allergol Int 2013 Apr 25;

'Bitter Sweet': A child case of erythritol-induced anaphylaxis.
Shirao K, Inoue M, Tokuda R, Nagao M, Yamaguchi M, Okahata H, Fujisawa T. Allergol Int 2013 Apr 25;

The crux with a reliable in vitro and in vivo diagnosis of allergy.
Crameri R. Allergy 2013 Apr 27;

Cedar and cypress pollen counts are associated with the prevalence of allergic diseases in Japanese schoolchildren.
Yoshida K, Adachi Y, Akashi M, Itazawa T, Murakami Y, Odajima H, Ohya Y, Akasawa A. Allergy 2013 Apr 29;

Moving from peanut extract to peanut components: towards validation of component-resolved IgE tests.
Aalberse JA, Meijer Y, Derksen N, van dP, Knol E, Aalberse RC. Allergy 2013 Apr 29;

A phase 1 study of heat/phenol-killed, E. coli-encapsulated, recombinant modified peanut proteins Ara h 1, Ara h 2, and Ara h 3 (EMP-123) for the treatment of peanut allergy.
Wood RA, Sicherer SH, Burks AW, Grishin A, Henning AK, Lindblad R, Stablein D, Sampson HA. Allergy 2013 Apr 29;

IgE-mediated anaphylaxis and allergic reactions to idursulfase in patients with Hunter syndrome.
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Double-blind, placebo-controlled, dose-ranging study of new recombinant hypoallergenic Bet v 1 in an environmental exposure chamber.
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Skin test concentrations for systemically administered drugs - an ENDA/EAACI Drug Allergy Interest Group position paper.
Brockow K, Garvey LH, Aberer W, tanaskovic-Markovic M, Barbaud A, Bilo MB, Bircher A, Blanca M, Bonadonna B, Campi P, Castro E, Cernadas JR, Chiriac AM, Demoly P, Grosber M, Gooi J, Lombardo . Allergy 2013 Apr 25;

Introduction of complementary foods in infancy and atopic sensitization at the age of 5 years: timing and food diversity in a Finnish birth cohort.
Nwaru BI, Takkinen HM, Niemela O, Kaila M, Erkkola M, Ahonen S, Tuomi H, Haapala AM, Kenward MG, Pekkanen J, Lahesmaa R, Kere J, Simell O, Veijola R, Ilonen J, Hyoty H, Knip M, Virtanen SM. Allergy 2013 Apr;68(4):507-516

Can allergen-specific IgE antibodies diagnose egg allergy accurately?
Kim KW, Kim KE. Allergy Asthma Immunol Res 2013 May;5(3):117-118

Nasal provocation test using allergen extract versus cold dry air provocation test: Which and when?
Kim YH, Jang TY. Am J Rhinol Allergy 2013 Mar;27(2):113-117

Allergen of the month-European olive.
Weber RW. Ann Allergy Asthma Immunol 2013 Apr;110(4):A19

Novel case of anaphylaxis to sturgeon fish.
Yip SK, Gomez RA, White KM, England RW. Ann Allergy Asthma Immunol 2013 Apr;110(4):306-307

Anaphylactic reaction to dietary oats.
Inuo C, Kondo Y, Itagaki Y, Kurihara K, Tsuge I, Yoshikawa T, Urisu A. Ann Allergy Asthma Immunol 2013 Apr;110(4):305-306

Successful intravaginal graded challenge after a systemic reaction with skin prick testing to seminal fluid.
Baker TW, Ghosh D, Bernstein JA. Ann Allergy Asthma Immunol 2013 Apr;110(4):301-303

Factors that predict the clinical reactivity and tolerance in children with cow's milk allergy.
Yavuz ST, Buyuktiryaki B, Sahiner UM, Birben E, Tuncer A, Yakarisik S, Karabulut E, Kalayci O, Sackesen C. Ann Allergy Asthma Immunol 2013 Apr;110(4):284-289

Role of parental atopy in cow's milk allergy: a population-based study.
Goldberg M, Eisenberg E, Elizur A, Rajuan N, Rachmiel M, Cohen A, Zadik-Mnuhin G, Katz Y. Ann Allergy Asthma Immunol 2013 Apr;110(4):279-283

Clinical value of radiocontrast media skin tests as a prescreening and diagnostic tool in hypersensitivity reactions.
Kim SH, Jo EJ, Kim MY, Lee SE, Kim MH, Yang MS, Song WJ, Choi SI, Kim JH, Chang YS. Ann Allergy Asthma Immunol 2013 Apr;110(4):258-262

Characteristics of allergic sensitization among asthmatic adults older than 55 years: results from the National Health and Nutrition Examination Survey, 2005-2006.
Busse PJ, Cohn RD, Salo PM, Zeldin DC. Ann Allergy Asthma Immunol 2013 Apr;110(4):247-252

Allergic fungal rhinosinusitis.
Silva MP, Baroody FM. Ann Allergy Asthma Immunol 2013 Apr;110(4):217-222

The epidemiology of food allergy in Europe: protocol for a systematic review.
Nwaru BI, Panesar SS, Hickstein L, Rader T, Werfel T, Muraro A, Hoffmann-Sommergruber K, Roberts G, Sheikh A. Clin Transl Allergy 2013;3(1):13

Diagnosis and management of immediate hypersensitivity reactions to cephalosporins.
Dickson SD, Salazar KC. Clin Rev Allergy Immunol 2013 Apr 2;

What is the source of serum allergen-specific IgE?
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Airborne seafood allergens as a cause of occupational allergy and asthma.
Lopata AL, Jeebhay MF. Curr Allergy Asthma Rep 2013 Apr 11;

The value of mucosal allergen challenge for the diagnosis of food allergy.
Kvenshagen BK, Jacobsen M. Curr Opin Allergy Clin Immunol 2013 Apr 6;

Food allergy: the perspectives of prevention using vitamin D.
Peroni DG, Boner AL. Curr Opin Allergy Clin Immunol 2013 Apr 3;

Randomized controlled trials investigating the role of allergen exposure in food allergy: where are we now?
Metcalfe J, Prescott SL, Palmer DJ. Curr Opin Allergy Clin Immunol 2013 Apr 3;

Occupational causes of constrictive bronchiolitis.
Kreiss K. Curr Opin Allergy Clin Immunol 2013 Apr;13(2):167-172

The use of specific inhalation challenge in hypersensitivity pneumonitis.
Munoz X, Morell F, Cruz MJ. Curr Opin Allergy Clin Immunol 2013 Apr;13(2):151-158

New food allergies in a European Non-Mediterranean Region: Is Cannabis sativa to blame?
Ebo DG, Swerts S, Sabato V, Hagendorens MM, Bridts CH, Jorens PG, De Clerck LS. Int Arch Allergy Immunol 2013 Mar 15;161(3):220-228

Efficacy of recombinant allergens for diagnosis of cockroach allergy in patients with asthma and/or rhinitis.
Barbosa MC, Santos AB, Ferriani VP, Pomes A, Chapman MD, Arruda LK. Int Arch Allergy Immunol 2013 Mar 15;161(3):213-219

Allergy prevention via co-administration of intact food allergen and its epitope soup?
Jarvinen KM. Int Arch Allergy Immunol 2013 Mar 15;161(3):195-196

Allergen content and in vivo allergenic activity of house dust mite extracts.
Casset A, Valenta R, Vrtala S. Int Arch Allergy Immunol 2013 Mar 15;161(3):287-288

Administration of yellow fever vaccine in patients with egg allergy.
Rutkowski K, Ewan PW, Nasser SM. Int Arch Allergy Immunol 2013 Mar 15;161(3):274-278

Rice allergy demonstrated by double-blind placebo-controlled food challenge in peach-allergic patients is related to lipid transfer protein reactivity.
Pastorello EA, Scibilia J, Farioli L, Primavesi L, Giuffrida MG, Mascheri A, Piantanida M, Mirone C, Stafylaraki C, Violetta MR, Nichelatti M, Preziosi D, Losappio L, Pravettoni V. Int Arch Allergy Immunol 2013 Mar 15;161(3):265-273

Oral challenges with four apple cultivars result in significant differences in oral allergy symptoms.
Nybom H, Cervin-Hoberg C, Andersson M. Int Arch Allergy Immunol 2013 Mar 15;161(3):258-264

Allergen chip diagnosis for soy-allergic patients: Gly m 4 as a marker for severe food-allergic reactions to soy.
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Peanut protein in household dust is related to household peanut consumption and is biologically active.
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Distribution of peanut protein in the home environment.
Brough HA, Makinson K, Penagos M, Maleki SJ, Cheng H, Douiri A, Stephens AC, Turcanu V, Lack G. J Allergy Clin Immunol 2013 Apr 19;

Allergic fungal rhinosinusitis-more than a fungal disease?
Dutre T, Al DS, Zhang N, Bachert C. J Allergy Clin Immunol 2013 Apr 19;

Sensitization to Cor a 9 and Cor a 14 is highly specific for a hazelnut allergy with objective symptoms in Dutch children and adults.
Masthoff LJ, Mattsson L, Zuidmeer-Jongejan L, Lidholm J, Andersson K, Akkerdaas JH, Versteeg SA, Garino C, Meijer Y, Kentie P, Versluis A, den Hartog Jager CF, Bruijnzeel-Koomen CA, Knulst. J Allergy Clin Immunol 2013 Apr 10;

Vitamin D insufficiency is associated with challenge-proven food allergy in infants.
Allen KJ, Koplin JJ, Ponsonby AL, Gurrin LC, Wake M, Vuillermin P, Martin P, Matheson M, Lowe A, Robinson M, Tey D, Osborne NJ, Dang T, Tina Tan HT, Thiele L, Anderson D, Czech H, Sanjeevan J, . J Allergy Clin Immunol 2013 Apr;131(4):1109-1116

Determination of allergen specificity by heavy chains in grass pollen allergen-specific IgE antibodies.
Gadermaier E, Flicker S, Lupinek C, Steinberger P, Valenta R. J Allergy Clin Immunol 2013 Apr;131(4):1185-1193

Treatment of patients with a history of penicillin allergy in a large tertiary-care academic hospital
Matthieu Picard, Philippe Bégin, Hugues Bouchard, Jonathan Cloutier, Jonathan Lacombe-Barrios, Jean Paradis, Anne Des Roches, Brian Laufer, Louis Paradis J Allergy Clin Immunol: In Practise 2013;1(3):

Safely diagnosing clinically significant penicillin allergy using only penicilloyl-poly-lysine, penicillin, and oral amoxicillin
Eric Macy, Eunis W. Ngor J Allergy Clin Immunol: In Practise 2013;1(3):

The time for penicillin skin testing is here. Editorial
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Immediate allergic hypersensitivity to quinolones associates with neuromuscular blocking agent sensitization
Paul Rouzaire, Audrey Nosbaum, Christine Mullet, Nathalie Diot, Rolande Dubost, Françoise Bienvenu, Laurence Guilloux, Vincent Piriou, Jacques Bienvenu, Frédéric Bérard J Allergy Clin Immunol: In Practise 2013;1(3):

Canadian allergists' and nonallergists' perception of epinephrine use and vaccination of persons with egg allergy
Marylin Desjardins, Ann Clarke, Reza Alizadehfar, Danielle Grenier, Harley Eisman, Stuart Carr, Timothy K. Vander Leek, Lee Teperman, Niamh Higgins, Lawrence Joseph, Greg Shand, Moshe Ben-Shoshan J Allergy Clin Immunol: In Practise 2013;1(3):289-294

Ask the expert: anaphylactic reaction to white-faced hornet sting and elevated baseline (asymptomatic) serum tryptase
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Successful treatment of idiopathic angioedema with ecallantide
Alalia Berry, Rafael Firszt J Allergy Clin Immunol: In Practise 2013;1(3):

Gelatin-containing sweets can elicit anaphylaxis in a patient with sensitization to galactose-a-1,3-galactose
Patricia Caponetto, Jörg Fischer, Tilo Biedermann J Allergy Clin Immunol: In Practise 2013;1(3):302-303

Dehydrated egg white: An allergen source for improving efficacy and safety in the diagnosis and treatment for egg allergy.
Escudero C, Sanchez-Garcia S, Rodriguez Del RP, Pastor-Vargas C, Garcia-Fernandez C, Perez-Rangel I, Ramirez-Jimenez A, Ibanez MD. Pediatr Allergy Immunol 2013 May;24(3):263-269

Barley's lipid transfer protein: a new emerging allergen in pediatric anaphylaxis.
Nemni A, Borges JP, Rouge P, Barre A, Just J. Pediatr Allergy Immunol 2013 Apr 3;

Predicting positive food challenges in children sensitised to peanuts/tree nuts.
Ludman S, Ballabeni P, Eigennman PA, Wassenberg J. Pediatr Allergy Immunol 2013 May;24(3):276-281

Phenobarbital-induced severe cutaneous adverse drug reactions are associated with CYP2C19*2 in Thai children.
Manuyakorn W, Siripool K, Kamchaisatian W, Pakakasama S, Visudtibhan A, Vilaiyuk S, Rujirawat T, Benjaponpitak S. Pediatr Allergy Immunol 2013 May;24(3):299-303

Sensitization to Malassezia in children with atopic dermatitis combined with food allergy.
Kekki OM, Scheynius A, Poikonen S, Koskinen A, Kautiainen H, Turjanmaa K. Pediatr Allergy Immunol 2013 May;24(3):244-249

Characterization of the sensitization profile to lupin in peanut-allergic children and assessment of cross-reactivity risk.
Ballabio C, Penas E, Uberti F, Fiocchi A, Duranti M, Magni C, Restani P. Pediatr Allergy Immunol 2013 May;24(3):270-275

The most common aeroallergens in a tropical region in Southwestern Iran
Mohammad-Ali Assarehzadegan*, AbdolHossein Shakurnia and Akram Amini WAO Journal 2013;6(1):7

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