Respiratory allergy to fungi in Barcelona, Spain: Clinical aspects, diagnosis and specific treatment in a general allergy unit

BackgroundThe importance of hypersensitivity to fungal allergens is a relatively unknown and somewhat controversial subject.MethodsAn open prospective study was carried out in just one centre to determine the clinical and epidemiological characteristics as well as the diagnostic usefulness of skin prick and conjunctiva provocation tests, associated with total and specific IgE determination in two groups of patients, one of which was monosensitised to fungi and the other of which had multiple sensitisations, including fungi.ResultsRhinitis, exclusive or associated with asthma, was the main consultation cause (88% in monosensitised patients). Severe asthma was rarely found. In the polysensitised group, 64% were simultaneously allergic to moulds and mites.Alternaria alternata was the most common sensitising fungus, although a considerable number of cases were associated with other species such as Cladosporium, Penicillium and/or Aspergillus. The skin prick test gave the highest sensitivity and specificity. In 67% of the cases, the specific IgE was found between classes 3 and 4. The conjunctival provocation test was an innocuous and highly useful method for verifying the diagnosis and determining the degree of clinical sensitisation. A large number of patients exclusively allergic to fungi received specific immunotherapy, and it was generally well tolerated.ConclusionsThis protocolised study shows the importance of Alternaria and other fungi sensitisations in rhinitis alone or associated with asthma. Combined diagnosis of prick test, specific IgE and conjunctiva provocation test is very useful for deciding specific immunotherapy.     

Comparison of two diagnostic techniques,skin-prick test and component resolved diagnosis in the follow-up of a cohort of paediatric patients with pollinosis. Multicentre pilot study in a highly exposed allergenic area

BackgroundOver the last years, different works have been published about the importance of incorporating new diagnosis techniques in allergic patients such as component-resolved diagnosis (CRD). The objective of this study is to compare the evolution of allergic sensitisation profiles by means of CRD and cutaneous tests (SPT) on pollen-allergic patients.MethodsA total of 123 patients aged between 2 and 14 years were included in an open, prospective, multicentre study. All the children had symptoms suggestive of seasonal respiratory allergic disease, with the diagnosis confirmed by cutaneous tests. Specific-IgE to major pollen-allergens (CRD) and SPT were performed at basal and after three years of follow-up.ResultsOut of 123 patients included, a total of 85 were analysed. The mean age was 8 ± 3 years. Significant changes in the allergic sensitisation profiles were observed for the most prevalent allergens (Olea and grass) but it is in grass, the most relevant allergen in terms of allergen pressure, where changes in both absolute and relative frequencies between SPT and CRD were more evident.ConclusionCRD seems to be an essential tool to carry out an appropriate follow-up of patients with allergic respiratory disease, as well as to decide on the immunotherapy composition that best matches the allergic sensitisation profile of patients.     

A role for measurement of nasal IgE antibodies in diagnosis of Alternaria-induced rhinitis in children

BackgroundRhinitis is a very common disease, frequently caused by sensitisation to inhalant allergens. Negative results from skin prick tests (SPT) and in vitro IgE tests generally lead to a diagnosis of non-allergic rhinitis. However, it is possible, as indicated by studies addressed with dust mites or pollens that the production of specific IgE occurs exclusively at nasal level.MethodsWe measured specific nasal IgE in children suffering from rhinitis in the periods when Alternaria spores were present in the air.All subjects underwent SPT with a standard panel of aeroallergens (Stallergenes, Milan, Italy) and, in the same session, to nasal IgE test (NT). Nasal provocation test (NPT) with Alternaria was used as reference.ResultsFifty-six subjects were included in the study. Of them, 20 (37.5%) were positive to SPT and 45 (80.3%) were positive to NT. In particular, 11 subjects (19.6%) had a positive SPT and a negative NT; 36 (64.3%) had a negative SPT and a positive NT; and 9 (16.1%) were positive to both tests. Positivity of NT and NPT was observed in 36 patients (69.6%), while positivity of SPT and NPT was observed in 15 patients (26.8%). This difference was highly significant (p < 0.0001).ConclusionsThese findings suggest that sensitisation to Alternaria is frequently expressed by exclusive production of specific IgE in the nasal mucosa. Thus, measuring nasal IgE in children with rhinitis and negative SPT during the period of presence of Alternaria spores seems helpful to avoid a mistaken diagnosis of non-allergic rhinitis.     

Component-resolved diagnostics can be useful for identifying hazelnut allergy in Japanese children

BackgroundCor a 9 and Cor a 14 are effective markers for predicting hazelnut allergy. However, there have been no reports on the component-resolved diagnostics (CRD) of hazelnut allergy using an oral food challenge (OFC) for diagnosis in Asia. We hypothesized that CRD would improve the accuracy of diagnosing hazelnut allergies in Japanese children.MethodsWe recruited 91 subjects (median age: 7.3 years) who were sensitized to hazelnuts and had performed a hazelnut OFC at the National Hospital Organization Sagamihara National Hospital between 2006 and 2017. All subjects were classified as allergic or asymptomatic to 3 g of hazelnuts. The sIgE levels (hazelnut/Cor a 1/Cor a 8/Cor a 9/Cor a 14/alder pollen) were measured using ImmunoCAP. We aimed to determine the predictive factors of hazelnut allergy.ResultsNine subjects (10%) were allergic to ≤3 g of hazelnuts. Levels of sIgE for Cor a 9 in hazelnut-allergic subjects were significantly higher than those in asymptomatic subjects (4.47 vs. 0.76 kU_A/L, p = 0.039). Levels of sIgE to alder pollen and Cor a 1 in hazelnut-allergic subjects were significantly lower than those in asymptomatic subjects (<0.10 vs 13.0 kU_A/L, p = 0.004; <0.10 vs 5.03 kU_A/L, p = 0.025). The area under the receiver operating characteristics curve for hazelnut/alder/Cor a 1/Cor a 9 was 0.55/0.78/0.72/0.71, respectively, with p = 0.651/0.006/0.029/0.040, respectively.ConclusionsThe findings of a high sIgE level for Cor a 9 and a low sIgE level for Cor a 1 can improve the diagnostic accuracy to better identify Japanese children sensitized to hazelnuts.     

Differential patterns of fish sensitization in Asian populations: Implication for precision diagnosis

BackgroundThe current diagnostics of fish allergy lack sufficient accuracy such that more reliable tests such as component-resolved diagnosis (CRD) are urgently needed. This study aimed at identifying fish allergens of salmon and grass carp and evaluating the sensitization pattern in fish allergic subjects from two distinct populations in Asia.MethodsOne hundred and three fish allergic subjects were recruited from Hong Kong (67 subjects) and Japan (46 subjects). Western blot and mass spectrometry were used to identify allergens from salmon and grass carp. Fish allergens were purified and tested against 96 sera on ELISA to analyze patients’ sensitization pattern. The protein profiles of salmon meat prepared under different cooking methods until core temperature reached 80 °C were evaluated by SDS-PAGE and mass spectrometry.ResultsThree common allergens between salmon and grass carp, namely enolase, glycerldehyde-3-phosphate dehydrogenase (GAPDH) and parvalbumin, and two salmon-specific allergens collagen and aldolase were identified. Parvalbumin was the major allergen for both fishes showing an overall sensitization rate of 74.7%, followed by collagen (38.9%), aldolase (38.5%) and enolase (17.8%). Japanese subjects showed more diverse allergen sensitization pattern and more frequent IgE-binding to heat-labile salmon allergens. Compared with steaming and boiling, cooking by baking and frying retained more fish proteins inclusive of heat-labile allergens.ConclusionsFish allergic patients from different Asian populations show varying fish allergen sensitization profiles. The relevant extracts and components for diagnosis are population-dependent but parvalbumin and collagen are important biomarkers. Cooking methods modify allergen composition of salmon and appear to influence patients’ allergic manifestations.     

Clinical value of morphine,pholcodine and poppy seed IgE assays in drug-abusers and allergic people

BackgroundThe diagnosis of anaphylactic reactions due to opiates during anaesthesia can be difficult, since in most cases various drugs may have been administered. Detection of specific IgE to poppy seed might be a marker for sensitisation to opiates in allergic people and heroin-abusers. This study assessed the clinical value of morphine, pholcodine and poppy seed skin-prick and IgE determination in people suffering hypersensitivity reactions during anaesthesia or analgesia and drug-abusers with allergic symptoms.MethodsWe selected heroin abusers and patients who suffered severe reactions during anaesthesia and analgesia from a database of 23,873 patients. The diagnostic yield (sensitivity, specificity and predictive value) of prick and IgE tests in determining opiate allergy was analysed.ResultsOverall, 149 patients and 200 controls, mean age 32.9 ± 14.7 years, were included. All patients with positive prick to opiates showed positive prick and IgE to poppy seeds, but not to morphine or pholcodine IgE. Among drug-abusers, 13/42 patients (31%) presented opium hypersensitivity confirmed by challenge tests. Among non-drug abusers, sensitisation to opiates was higher in people allergic to tobacco (25%), P<.001. Prick tests and IgE against poppy seed had a good sensitivity (95.6% and 82.6%, respectively) and specificity (98.5% and 100%, respectively) in the diagnosis of opiate allergy.ConclusionsOpiates may be significant allergens. Drug-abusers and people sensitised to tobacco are at risk. Both the prick and specific IgE tests efficiently detected sensitisation to opiates. The highest levels were related to more-severe clinical profiles.     

Children with eosinophilic esophagitis in real life: 10 years’ experience with a focus on allergic management

Introduction and objectivesEosinophilic esophagitis (EoE) is frequently miss-diagnosed or overlooked for several years because of the invasiveness of investigations and the non-specificity of symptoms in childhood. Due to the lack of specific recommendations in children, its management remains very heterogeneous, especially concerning allergy testing. The aim of this study is to analyze our population and practices, in comparison with the literature, with a focus on allergic management, to harmonize and optimize our practice.Material and methodsWe included all children with a diagnosis of EoE at the Hospital Femme Mere Enfant, Bron, France. Data were collected via retrospective chart review.Results108 patients were included with an average age of 9.5 years. Average delay before diagnosis was 6.65 years. Symptoms varied with age, with a predominance of vomiting (60% of patients), feeding difficulties (72%) and growth difficulties (24%) in children <5 years, whereas older children often presented with feeding blockage (64%) and dysphagia (61%). Cough was frequent in our cohort (18.5%), especially in children <10 years (38.5% between three and five years). The allergic background was frequent (70.3%) and 80% of our patients benefited from allergy testing. Allergy testing was particularly useful to guide therapy as elimination diet represented an effective treatment in 60% of our patientsConclusionsAllergy testing has to be harmonized to include major allergens (egg, milk, peanut, fish, wheat, and soy), including prick and patch tests. Allergy-testing based diet seemed to be the best compromise between efficiency and constraints, especially in mono-sensitized patients.     

Evaluation of risk factors in patients diagnosed with bronchial asthma

Bronchial asthma is a public health problem with gradually increasing importance, affecting more than 100 million individuals worldwide and found independently of the level of development of the country. Factors related to lifestyle and the environment form the basis for the increase in the prevalence of the disease.AimTo evaluate our patients being followed-up with a diagnosis of bronchial asthma at the Allergy Clinic for risk factors and to determine their sociodemographic characteristicsMaterial and MethodThe risk factors of 3025 patients followed-up with a diagnosis of bronchial asthma at the Allergy Clinic of the Ministry of Health, Ankara Diskapi Children's Diseases Training and Research Hospital between January 1995 and March 2000 were evaluated retrospectively.ResultsA high percentage of our patients suffered from both asthma and allergic rhinitis and 45% of our asthmatic patients had allergic rhinitis while 93.5 % of those with allergic rhinitis were also asthmatic. Asthma was more common in males and those born in the summer months. 57.6 % of the patients had a history of atopy. Passive smoking was observed at a high rate and cigarette smoke was the most important factor increasing the symptoms. The symptoms increased during the winter. 92.8 % of the patients lived in the city. The average Ig E level was high and 60.9% of the patients were atopic on the skin prick test.ResultsAsthma seems to be an important health problem in our country. Recognizing the risk factors is important for the diagnosis and prevention of the disease.     

Clinical evolution of patients with respiratory allergic disease due to sensitisation to Alternaria alternata being treated with subcutaneous immunotherapy

IntroductionSensitisation to Alternaria is a cause of respiratory disease in Spain, particularly in childhood, but it is also a significant marker of the severity of this disease. Therefore, the use of an aetiological treatment (allergen specific immunotherapy) is essential, and both subjective and objective clinical parameters should be used to follow up this treatment.ObjectiveThis open-label, uncontrolled, observational, prospective study was designed in order to study the evolution of these patients on allergen specific immunotherapy therapy in daily clinical practice and to assess the use of different monitoring tools.Material and MethodsA total of 99 patients were included. They were monosensitised to this perennial allergen and treated with subcutaneous allergen specific immunotherapy. After one year of follow-up, these patients were assessed for the presence of symptoms, use of medication, clinical incidents, quality of life and asthma control.ResultsAfter one year of treatment a significant fall was observed in the use of concomitant medication (β2-agonists: p = 0.0278, inhaled corticosteroids: p = 0.0007, anti-leukotrienes: p = 0.0495), nasal symptoms (p = 0.0081), quality of life (PAQLQ, p < 0.0001) and asthma control (ACQ, p < 0.0001). Twenty-one patients had to attend emergency department due to exacerbation of their allergic disease, and only one of them had to be admitted to hospital.Conclusionrespiratory allergic disease due to Alternaria alternata is a disease which is hard to control, and in our daily practice, the use of specific subcutaneous immunotherapy can be of significant benefit in our paediatric patients.     

Perioperative allergic reactions: Experience in a Flemish referral centre

BackgroundThe incidence of perioperative anaphylactic reactions is overall estimated to be 1 per 10,000–20,000 anaesthetic procedures. We performed a retrospective analysis of patients referred to a University Allergy Centre in Belgium with the suspicion of an allergic reaction during or shortly after general anaesthesia.ObjectivesOur aim was to assess the causes of perioperative allergic reactions, to evaluate cross-reactivity among neuromuscular blocking agents (NMBA) and to analyze the diagnostic relevance of tryptase levels in the discrimination between IgE and non-IgE-mediated reactions.MethodsA total of 119 patients, referred from 2007 to 2011 were included. The diagnostic protocol consisted in case history, serum tryptase measurements, immunoassays and skin tests.ResultsA diagnosis of IgE-mediated reaction was established in 76 cases (63.9%). The most common agents were NMBA (61.8%), antibiotics (14.5%), latex (9.2%) and chlorhexidine (5.2%). Rocuronium was the most frequently causative NMBA (48.9%). Vecuronium cross-reactivity was established by skin testing in 47.6% of cases. Cisatracurium was the NMBA most frequently tolerated (cross-reaction in 13.9%). In 23.4% of NMBA allergic patients, the reaction occurred on the first exposure. Most IgE-mediated reactions occurred during the induction phase (72.4%). Latex-induced reactions occurred mainly during maintenance and recovery phases (71.4%; p < 0.02). Mean tryptase values were significantly higher in patients with IgE-mediated reactions (p = 0.0001), than in those with no identified cause.ConclusionsNMBA, antibiotics, latex and chlorhexidine were the main culprits of IgE-mediated perioperative reactions. Uncertainties remain concerning the specificity and sensitivity of skin testing. Tryptase assays can be useful in the discrimination of IgE and non-IgE-mediated reactions.     

Propolis suppresses cytokine production in activated basophils and basophil-mediated skin and intestinal allergic inflammation in mice

BackgroundPropolis is a resinous mixture produced by honey bees that contains cinnamic acid derivatives and flavonoids. Although propolis has been reported to inhibit mast cell functions and mast cell-dependent allergic responses, the effect of propolis on basophil biology remains unknown. This study aimed to investigate the inhibitory effect of propolis on FcεRI-mediated basophil activation.MethodsTo determine the inhibitory effect of propolis on basophil activation in vitro, cytokine production and FcεRI signal transduction were analyzed by ELISA and western blotting, respectively. To investigate the inhibitory effect of propolis in vivo, IgE-CAI and a food allergy mouse model were employed.ResultsPropolis treatment resulted in the suppression of IgE/antigen-induced production of IL-4, IL-6 and IL-13 in basophils. Phosphorylation of FcεRI signaling molecules Lyn, Akt and ERK was inhibited in basophils treated with propolis. While propolis did not affect the basophil population in the treated mice, propolis did inhibit IgE-CAI. Finally, ovalbumin-induced intestinal anaphylaxis, which involves basophils and basophil-derived IL-4, was attenuated in mice prophylactically treated with propolis.ConclusionsTaken together, these results demonstrate the ability of propolis to suppress IgE-dependent basophil activation and basophil-dependent allergic inflammation. Therefore, prophylactic treatment with propolis may be useful for protection against food allergic reactions in sensitive individuals.     

Microarray based IgE detection in poly-sensitized allergic patients with suspected food allergy - an approach in four clinical cases

BackgroundComponent-resolved diagnosis and microarray technology have been recently introduced into clinical allergy practice, and may be particularly useful in poly-sensitized allergic patients.MethodsWe compare the clinical usefulness of a microarray-based IgE detection assay (ISAC^®) with skin tests and specific IgE with standard allergens (sIgE) or their monocomponents in four case reports of patients poly-sensitized to aeroallergens and food.ResultsCase 1: a woman with rhinitis, oral allergy syndrome to several fruits and anaphylaxis to cherry. Diagnostic tests supported non-specific lipid transfer proteins (nsLTPs) primary sensitization.Case 2: a woman with exercise-induced asthma, rhino-conjunctivitis and oral allergy syndrome to fresh fruits of different families. A diagnosis of primary grass and weed pollen allergy with profilin and pathogenesis-related protein family 10 (PR-10) cross-reactive food allergy was proposed.Case 3: a man with atopic eczema, asthma, rhinitis, and multiple anaphylactic episodes with cashew nuts and oral allergy syndrome to fruits. The diagnostic workup supported a primary birch pollen allergy with PR-10 and nsLTPs cross-reactive food allergy.Case 4: a woman with rhino-conjunctivitis, per-operative anaphylaxis due to latex and recent pharyngeal angio-oedema episodes. The diagnosis was a primary grass and weed pollen allergy with equivocal profilin sensitization and no obvious cross-reactivity mediated by nsLTPs sensitization.ConclusionsThe possibility to carry out multiple sIgE measurements with single protein allergens, in particular with the microarray technique, is a useful, simple and non-invasive diagnostic tool in complex poly-sensitized allergic patients.     

Food allergy in Catalonia: Clinical manifestations and its association with airborne allergens

BackgroundFood allergy affects around 6% of the European population and its prevalence worldwide has been increasing in the last decades, but studies focused on investigating food allergy epidemiology in Europe are lacking.ObjectiveThe Cibus project was created to register the main culprit foods and their clinical manifestations in food allergic patients in Catalonia.MethodsA specific online database was designed. Allergists from eight different Catalan hospitals registered the new diagnoses of food allergy.Results618 food allergic patients were included. Egg and milk were the main elicitors in the early ages, while fruits and nuts were the most frequent in patients >14 years old. Fish was more frequent in children, while seafood and Anisakis allergy were more frequent in the >14-year-old group. Overall, peach was the most prevalent food eliciting an allergic reaction (10%). Food allergy diagnosis was reached using compatible clinical history and positive skin prick test to the involved food in 98% of cases. Globally, urticaria was the most frequently reported manifestation in our population (48.2%), followed by oral allergy syndrome (25.6%) and anaphylaxis (24.8%).ConclusionsThe Cibus project gives a full overview of the profile of food allergic patients in Catalonia and reinforces the predominance of plant food allergies in the Mediterranean area.     

Characteristics of patients with allergic rhinitis in an outpatient clinic: A retrospective study

BackgroundAllergic rhinitis affects a significant proportion of the European population. Few surveys have investigated this disorder in Greek adults. Our objective was to describe the characteristics of patients with allergic rhinitis in an adult outpatient clinic in Thessaloniki, Greece.MethodsWe studied the medical records of adult patients referred to a Clinical Immunology outpatient clinic from 2001 to 2007. The diagnostic procedure was not changed during the whole study period, including the same questionnaire used at the time of diagnosis, skin prick tests, and serum specific IgE.ResultsA total of 1851 patient files with diagnosed allergies were analysed and allergic rhinitis was confirmed in 711 subjects (38.4%). According to ARIA classification, persistent allergic rhinitis was more prevalent than intermittent (54.9% vs. 45.1%), while 60.8% of subjects suffered from moderate/severe disease. In multivariable analysis, factors associated with allergic rhinitis were age (for every 10 years increase, OR: 0.84, 95% CI: 0.77–0.91; p < 0.001); working in school environment (teachers or students) (OR: 1.46, 95% CI: 1.05–2.02; p = 0.023); parental history of respiratory allergy (OR: 2.41, 95% CI: 1.69–3.43; p < 0.001); smoking (OR: 0.71, 95% CI: 0.55–0.91; p = 0.007); presence of allergic conjunctivitis (OR: 6.16, 95% CI: 4.71–8.06; p < 0.001); and asthma (OR: 2.17, 95% CI: 1.57–3.01; p < 0.001). Analysis after multiple imputation corroborated the complete case analysis results.ConclusionsAllergic rhinitis was documented in 38.4% of studied patients and was frequently characterised by significant morbidity. Factors associated with allergic rhinitis provide insight into the epidemiology of this disorder in our region. Further studies on the general population would contribute to evaluating allergic rhinitis more comprehensively.     

Protophormia terraenovae. A new allergenic species in amateur fishermen of Caceres,Spain

BackgroundAsticot maggot (Blowfly, Calliphoridae family) is the most important live bait used for angling in our country. Prevalence of allergy to live fish bait in occupationally exposed workers has been described. The purpose of this study was to determine the prevalence of asticot allergy in amateur fishermen and the identification of marketed asticot species in Cáceres, Spain.Materials and MethodsSeventy-two randomised selected patients (Angler's Society of Cáceres) 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. Local asticot and common earthworm samples were obtained for taxonomic identification. Data were analysed using the SPSS 12.0 software.ResultsFive 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.ConclusionsCommercially available asticot, in Cáceres, is composed by P. terraenovae larvae (Diptera. Calliphoridae). A 7 % prevalence of P. terraenovae allergy in amateur fishermen of Cáceres was obtained. The allergenic potential of P. terraenovae seems to be greater than that of other blowflies and L. terrestris. The SPT with P. terraenovae extract is a very sensitive and specific technique in the diagnosis of live bait allergy in fishermen.     

The long-term outcomes of persistent childhood allergic asthma: A cross-sectional study from western Anatolia: Childhood persistent asthma in western Anatolia

BackgroundProspective cohort studies have provided useful knowledge about the natural history of asthma. However, most of the studies are conducted in western countries but the course of the disease and long-term outcomes may differ between countries due to environmental and cultural factors.ObjectiveThe aim of this study is to describe the long-term outcomes of childhood asthma, with data from a follow-up study of at least 10 years, in western Anatolia, Turkey.MethodsFifty-two patients diagnosed with persistent allergic asthma participated in the study. The patient's demographics, findings on admission, age at onset of disease, time of diagnosis, history of other allergic conditions, history of parental asthma and allergic disorders, presence of pharmacotherapy and immunotherapy were obtained from patients’ records. The factors influencing remission at the end of 10 years follow-up were evaluated.ResultsA total of 20 patients (38.5%) were on remission at the end of 10 years. The type of allergen, multi-allergen sensitivity, eosinophilia and elevated serum immunoglobulin E on admission, accompanying allergic disorders and atopy in parents, and allergen immunotherapy did not affect the remission rate (p > 0.05).ConclusionChildhood persistent asthma is not a homogeneous clinical entity but high clinical remission rates are obtained in western Anatolia. There is no significant predictor of clinical remission in long term follow-up. Prospective studies should be performed in larger asthmatic populations to obtain further data about the natural course of childhood asthma.     

ORMDL3/GSDMB genotype as a risk factor for early-onset adult asthma is linked to total serum IgE levels but not to allergic sensitization

BackgroundAn orosomucoid-like 3 (ORMDL3)/gasdermin B (GSDMB) gene locus on chromosome 17q is consistently associated with childhood-onset asthma, which is highly atopic. As some evidence suggests the relationship between asthma and allergic sensitization reflects asthma patient susceptibility to augmented IgE responses driven by common environmental allergens rather than an increased asthma risk after allergen exposure, we aimed to determine any relationships between this locus region and childhood-onset adult asthma with regard to serum total IgE levels or allergic sensitization.MethodsWe conducted a case–control association study using three independent Japanese populations (3869 total adults) and analyzed the ORs for association of rs7216389, an expression quantitative trait locus for ORMDL3/GSDMB, with adult asthma according to onset age. Additionally, associations between the rs7216389 genotype and total serum IgE levels or allergic sensitization was examined.ResultsRs7216389 was associated with both childhood-onset adult asthma (OR for asthmatic patients afflicted at the age of 10 years or younger = 1.61, p = 0.00021) and asthmatic patients with higher levels of total serum IgE (OR for asthmatic patients with IgE ≥1000IU/mL = 1.55, p = 0.0033). In both healthy controls and in the combined healthy and asthmatic individuals, rs7216389 was correlated with increased total serum IgE levels (p < 0.0005), but not allergic sensitization (p > 0.1).ConclusionsORMDL3/GSDMB is an important susceptibility gene for childhood-onset adult asthma in Japanese populations and this association is linked to elevated total serum IgE levels but not to allergic sensitization.     

Antigen-Induced Expression of CD203c on Basophils Predicts IgE-mediated Wheat Allergy

BackgroundFor in vitro diagnosis of wheat allergy, specific IgE to wheat is known to be a poor predictive marker. Oral food challenge, the gold standard for the diagnosis, is accompanied by a risk of severe induced reactions. Reliable in vitro tests are needed to be developed for safe indication for oral challenge.ObjectiveWe examined the utility of a basophil activation marker, CD203c, for the diagnosis of IgE-mediated wheat allergy.MethodsFifty-eight children with suspected wheat allergy with positive CAP-FEIA to wheat were enrolled. On 70 occasions, the clinical distinction between patients with wheat allergy (WA) and patients tolerant to wheat (TW) was made by means of an oral food challenge test or recent history of immediate allergic reactions or tolerance after ingestion of wheat. Twelve replicate evaluations were performed in 9 patients over more than a 6-month interval. Thirty two patients on 43 occasions were diagnosed with WA and 27 were confirmed to be TW. One patient had both diagnoses 18 months apart. Peripheral blood was incubated with fractionated wheat extracts, purified native omega-5 gliadin (nOG5) and recombinant omega-5 gliadin (rOG5). Expression of CD203c on basophils was then analyzed by flow cytometry using a commercial kit.ResultsAll wheat proteins induced concentration-dependent enhancement of CD203c expression in WA, but did not in TW. The analysis of receiver operating characteristics (ROC) showed that nOG5-induced CD203c^high% values provided the best power for discriminating between WA and TW, with a sensitivity of 85.0% and specificity of 77.0% at the cut-off level of 14.4%. AUC for CD203c with nOG5 were significantly higher than that for conventional CAP-FEIA, 0.89 and 0.73, respectively (p < 0.01).ConclusionsMeasurement of nOG-induced enhancement of CD203c on basophils is useful for the diagnosis of immediate wheat allergy in children.     

Skin prick test reactivity to common aeroallergens among allergic rhinitis patients in Iran

BackgroundAllergic rhinitis is the most common allergic disease with negative impacts on patients’ quality of life. The prevalence and pattern of sensitisation vary between different countries and populations. Identifi cation of the most prevalent aeroallergens in each area has a very important role in diagnosis and treatment of allergic rhinitis.Iran is a fairly large country with different geo-climatic conditions and there are no data about the most prevalent aeroallergen in Mashhad City, which is the second largest city in Iran, with a semiarid climate. The aim of this study was to evaluate the prevalence of positive skin test to various common aeroallergens among allergic rhinitis patients in the city of Mashhad.Materials and MethodsSkin prick tests were performed with 27 common regional aeroallergens including grass, weed, tree, mite and mould in 311 patients with allergic rhinitis.ResultsThe overall rate of sensitisation to any allergen was 81 %. 76 % of patients were poly-sensitised and weed and grass were the most prevalent allergens (77 % and 62 % respectively). Salsola Kali and mould were the most and the least prevalent individual allergens (72.5 % and 6.5 % respectively). Mean total IgE in patients with positive skin prick test was signifi cantly higher than in patients without any positive skin prick test (308 vs 128 IU/mL, P = 0.016). 97 % of atopic patients were sensitised to Salsola kali and or Fraxinus americana.ConclusionsOur work showed the importance of weeds, especially the Amaranthaceae and Chenopodiaceae families. Diagnosis of pollen allergy can be simplifi ed by using a combination of a few common aeroallergens.     

Safety of measles-mumps-rubella vaccine (MMR) in patients allergic to eggs

IntroductionSince the measles and mumps components used in MMR vaccine are grown in cultures of fibroblast from chick embryos, for a long time there have been concerns about the presence of egg protein in the vaccine and the recommendations given to egg allergic patients.We include in this paper our clinical experience vaccinating egg allergic patients with a regular triple viral vaccine, as well as an immunological study of each vaccine available in Spain. The aim of this study was to evaluate the clinical safety of a conventional MMR vaccine in a population of egg allergic patients and to determine the presence of egg allergens in a conventional MMR vaccine and if IgE antibodies from egg allergic can recognize egg allergens in this vaccineMaterials and methodsChildren 15 months old with a confirmed diagnosed of egg allergy were included.In all patients, a skin prick test with non diluted MMR vaccine (Priorix, GSK) was made.If negative, each patient received a single dose of measles, mumps, rubella (MMR) vaccine. If positive, a fractionated injection of the vaccine was made following SEICAP recommendations (2004).SDS-PAGE immunoblotting was performed with Priorix vaccine.ResultsA cumulative total of 26 patients with egg allergy have safely received MMR vaccine in a single-dose (after a negative SPT in all cases) at our department without any reaction.5 sera of vaccinated patients and 6 control sera of egg allergic patients (positive oral challenge) were used to immunolabel the membranes. No positive bands corresponding to egg proteins were found in any of the patients.ConclusionNegative results found in SPT support the absence of clinical reaction against the components and Immunological studies point that there is no detectable amount of egg protein in this vaccine to produce an IgE mediated reaction. We can conclude that MMR can be safely administrated in children allergic to egg.