Rhinite et asthme professionnels par sensibilisation aux allergènes de porc (albumine,gammaglobulines et protéine de 26 kDa)

We report the case of a 39 years old female industrial pork butcher who developed urticaria, rhinitis and asthma in contact with pig gut and pig-gut soaking water (LR). In addition, she developed an asthma attack after ingestion of pork meat. She was atopic, allergic to cats and dogs, and lived with a cat. Skin prick tests were positive with commercial dog and cat dander extracts, pig albumin, cat and pig gamma globulin, and LR. She was found to have high serum levels of IgE specific for cat, pig and beef albumin, for beef, sheep and pork meat, and for pig gut and LR. A bronchial challenge test with LR induced an immediate bronchial response, with a 23% drop in FEV1. SDS-PAGE electrophoresis with pork meat and LR revealed albumin (mw 67 kDa) in these samples. Immunoblots and immunoblot-inhibition assays with the patient's serum revealed evidence of IgE specific for pig albumin and gamma globulin; an allergen band with mw 26 kDa, not previously reported, was also seen. Cross-reactions between pig and cat albumin and between pig and cat gamma globulin was demonstrated by RAST inhibition. This patient represents a case of cutaneous and respiratory occupational allergy caused by pig albumin and gamma globulin, in this case acting as aeroallergens. For this patient, who has what we might call the pig-cat syndrome, we recommended that she avoid occupational exposure to pork, avoid eating pork products, and also avoid exposure to cats.     

La comparaison des taux de sensibilisation IgE-dépendante aux moisissures,aux dermatophytes et aux levures dans les maladies allergiques générales et les dermatoses inflammatoires

We aimed to determine IgE-dependant skin sensitization rates to moulds, dermatophytes and yeasts in patients with typical allergic diseases in comparison to those with inflammatory dermatitis seen over the course of one year. Skin prick tests were done in 267 patients (172 women and 95 men; median age 38 years, range 25–50 years). We allocated them into 8 groups: 64 with head and neck atopic dermatitis; 11 with seborrheic dermatitis; 52 with eczema and not atopic dermatitis other than on the head and neck; 64 with rhinitis, conjunctivitis and asthma; 28 with urticaria; 10 with food allergy; and 12 healthy controls. Skin tests were done with the following aqueous standardized commercial extracts: Alternaria, Penicillium, Aspergillus, Cladosporium, Mucor, Trichophyton, Epidermophyton, Candida albicans, Malassezia and Saccharomyces cerevisiæ. Globally, positive skin test reactions occurred most frequently with the yeast extracts, less to the dermatophytes and even less to the moulds. The results were homogenous among members of each group. The relevance of our tests was reinforced by the fact that the moulds that gave positive skin tests most frequently were those most often isolated in the Belgian environment. In patients with atopic dermatitis of the head and neck, positive tests were most frequent with four moulds and three yeasts; compared to this group, positive tests were less frequent in patients with atopic dermatitis localized to other sites. In inflammatory dermatitis of the head and neck, the study of immediate hypersensitivity to yeasts seems to be important.     

Résultats de tests cutanés intradermiques sur un groupe de sujets contrôles avec le rocuronium et le cis-atracurium à la concentration de 1/10

To investigate the cause of a pre-operative adverse reaction, intradermal tests are the validated method used for the diagnosis of immediate allergic reactions to curares. The maximal concentrations to be injected are still under discussion. The aim of this study was, therefore, to show that tests done with 1/10 dilutions of rocuronium and cis-atracurium lead to false positive reactions. Twenty-six healthy volunteers were tested with rocuronium and 53 with cis-atracurium. Intradermal tests were done with concentrations of 1/10 (1 mg/ml and 0.1 mg/ml, respectively), the cutaneous responses being read 15-20 minutes later. A wheal with a diameter of at least twice the diameter of the wheal produced by the injection was considered positive. Our results showed a tendency toward nonspecific histamine liberation at the concentrations of the two myorelaxants used. Thus, we observed positive reactions in 11/26 (42%) of the rocuronium controls and 19/53 (36%) of the cis-atracurium controls. Our results support the present recommendations of the Société Française d’Anesthésie et de Réanimation concerning the dilutions to be used with rocuronium and cis-atracurium to avoid false positive skin tests. In screening for peri-operative allergy, the maximum concentration used in intradermal testing with these two curares should not exceed 1/100.     

Choc anaphylactique à l'Augmentin chez une patiente présentant des tests cutanés et un test de provocation négatifs à l'amoxicilline

Mme M. was seen in consultation with a history of possible allergy to penicillin. The patient reported that three months earlier she had experienced the sudden onset of a generalized but not very severe urticarial reaction, which included swelling of the face, beginning four days after taking amoxicillin, but not any other medication. She was not aware of any previous reaction associated with taking any drug, including penicillin. Skin tests with major and minor penicillin determinants, and then with amoxicillin, up to a concentration of 20 mg/ml intradermally were negative. It was then elected to do an oral provocation test with amoxicillin. She tolerated a single 1 g oral dose perfectly well. Eighteen months later, she was seen again following an episode of anaphylactic shock that had begun immediately after taking 1 g of amoxicillin associated with clavulanic acid (Augmentin^®). Between the two consultations, the patient had received no betalactamines, whereas she had tolerated two courses of treatment with macrolides. At the second consultation, skin tests with penicilloyl-polylysine and amoxicillin were definitely positive. This observation suggests two hypotheses, which are not however mutually exclusive: 1) The low predictive value of skin and provocation tests in patients weakly sensitized (Could such patients continue treatment with amoxicillin for several more days?); 2) the possibility that an initially weak sensitization was potentiated by the skin and provocation tests (Is it advisable to systematically do a second allergy workup several weeks after the first one to exclude the possibility of sensitization in this type of patient?).     

Valeurs diagnostique et prédictive des tests cutanés aux médicaments et substances biologiques

Immediate-reading skin tests (pricks and intradermal tests) are indicated in patients reporting symtoms suggesting immediate-type hypersensitivity reactions. The diagnostic and/or predictive value of these tests is good with betalactams, latex and myorelaxants, and several other substances such as corticosteroids, dyes, antiseptics, vaccines, etc. Non irritant concentrations have been determined for several substances (betalactams, myorelaxants, etc.), but are unknown for numerous other substances. For other substances, non irritant concentrations in skin tests should be evaluated in control patients, in parralel with skin tests performed in patients. The diagnostic value of nonimmediate-reading skin tests is highly variable, and depends on the drug and the nature of the symptoms. Although the sensitivity and the specificity of nonimmediate-reading skin tests are not perfect, these tests are useful in the diagnosis of mild to moderately severe toxidermias, such as nonimmediate urticarias and angio-oedemas, fixed drug eruptions, maculopapular rashes, and acute generalized exanthematic pustulosis. In contrast, their diagnostic value is low in potentially severe toxidermias. The diagnostic value of responses in intradermal tests is usually higher than in patch-tests. However, patch-tests may be positive in few patients with negative intradermal tests. Ideally, skin tests should be performed between 6 weeks and 1 to 2 years after the clinical reaction. However, most nonimmediate drug sensitizations can be diagnosed several years later.     

Quoi de neuf en allergologie pédiatrique en 2005 ? Partie 4. Allergie cutanée,alimentaire, médicamenteuse et aux insectes (Une revue de la littérature internationale d'octobre 2004 à octobre 2005)

Allergological work-up and treatment of french children with atopic dermatitis have been the subject of a recent consensus. Food avoidance is useless for prevention of atopic dermatitis, and should be indicated in children with severe atopic dermatitis associated with food allergy only. Exposure, sensitization and allergy rates to nuts increase with age, and avoidance of nuts (even tolerated) is recommended in young children allergic to one or several nuts to prevent the risk of sensitization and allergy to an increasing number of nuts. Threshold values of skin prick-tests and specific IgE determinations with a 90-100% predictive value for food allergy are highly variable from one study to another one, and depend on numerous factors such as age of the children, the allergens used, etc. The diagnostic value of patch-tests and skin application food tests remains controversial. Treatment of food allergy is based on the eviction of the allergenic foods. However, probiotics and « desensitization » to foods may be efficacious in some patients. In children that have outgrown their food allergy, tolerance should be maintened by regular consumption of the foods. However, the parents should be informed that relapses requiring an emergency treatment may occur. Finallly, in children as in adults, repeated mosquito bites induce a desensitization, and most children outgrow their allergy between five to fourteen years.     

Avantages et limites des tests sanguins in vitro lymphocytes T/interféron gamma comparativement au test intradermique à la tuberculine pour le diagnostic de tuberculose

The development of in vitro blood tests that measure the delayed hypersensitivity reaction developed after contact with Mycobacterium tuberculosis will change progressively the diagnosis of M. tuberculosis infection. These blood assays (Quantiferon TB Gold^TM, Cellestis, Australia; T-SPOT.TB^TM, Oxford Immunotec, United Kingdom) use specific, complex M. tuberculosis antigens (ESAT-6 and CFP-10), whereas the intradermal Mantoux test is done with tuberculin, a complex mixture of more than 200 antigens. ESAT-6 and CFP-10 are absent from all the BCG vaccine strains used throughout the world. Significant improvement in the specificity with equivalent or increased sensitivity of the in vitro tests compared to the Mantoux test will lead eventually to replacement of the latter.     

Quoi de neuf en allergologie pédiatrique en 2005 ? Partie 1 : épidémiologie,diagnostic précoce et prévention (une revue de la littérature internationale d'octobre 2004 à octobre 2005)

The most important notions published in 2004–2005 concern a positive relationship between the risk of in utero sensitization and allergen levels in maternal blood, a neonatal deficiency of immune responses to microbial components in atopy-prone children, varying patterns of sensitization to aeroallergens, with frequent remittance of early sensitizations to seasonal allergens, in contrast with persistence of sensitizations to perennial allergens, an increased risk of sensitization to aeroallergens in children exposed to long-term background ambient air pollutants, an increased risk of polysensitization in siblings of polysensitized children, and a low efficacy of rigorous dietary egg exclusion during gestation and breastfeeding. The relations between the risk of childhood atopy and maternal parity, neonatal and perinatal conditions, vaccinations and infectious diseases in infancy, and early exposure to pets remain controversial. The predictive value of biological tests in newborns (total serum IgE determination and eosinophil count) is still disputed. Finally, several studies confirm the end of the allergy « epidemics » in Europe, although the prevalence of childhood allergic diseases is still increasing in Eastern European countries.     

Dietary oil modifies the plasma proteome during aging in the rat

Fatty acids and other components of the diet may modulate, among others, mechanisms involved in homeostasis, aging, and age-related diseases. Using a proteomic approach, we have studied how dietary oil affected plasma proteins in young (6 months) or old (24 months) rats fed lifelong with two experimental diets enriched in either sunflower or virgin olive oil. After the depletion of the most abundant proteins, levels of less abundant proteins were studied using two-dimensional electrophoresis and mass spectrometry. Our results showed that compared with the sunflower oil diet, the virgin olive oil diet induced significant decreases of plasma levels of acute phase proteins such as inter-alpha inhibitor H4P heavy chain (at 6 months), hemopexin precursor (at 6 and 24 months), preprohaptoglobin precursor (at 6 and 24 months), and α-2-HS glycoprotein (at 6 and 24 months); antioxidant proteins such as type II peroxiredoxin (at 24 months); proteins related with coagulation such as fibrinogen γ-chain precursor (at 24 months), T-kininogen 1 precursor (at 6 and 24 months), and apolipoprotein H (at 6 and 24 months); or with lipid metabolism and transport such as apolipoprotein E (at 6 and 24 months) and apolipoprotein A-IV (at 24 months). The same diet increased the levels of apolipoprotein A-1 (at 6 and 24 months), diminishing in general the changes that occurred with age. Our unbiased analysis reinforces the beneficial role of a diet rich in virgin olive oil compared with a diet rich in sunflower oil, modulating inflammation, homeostasis, oxidative stress, and cardiovascular risk during aging.     

Comparative effects of Citrullus colocynthis, sunflower and olive oil-enriched diet in streptozotocin-induced diabetes in rats

Citrullus colocynthis (colocynth) seeds are traditionally used as antidiabetic medication in Mediterranean countries. The present study evaluated the differential effects of diets enriched with C. colocynthis, sunflower or olive oils on the pancreatic β-cell mass in streptozotocin (STZ)-induced diabetes in rats. STZ injection induced rapid hyperglycaemia in all animals. However, 2 months later, hyperglycaemia was significantly less pronounced in the rats fed a C. colocynthis oil-enriched diet compared with other rat groups (7.9 mM versus 12 mM and 16 mM with colocynth versus olive and sunflower oils, respectively). Assessment of insulin sensitivity using the homoeostasis model assessment (HOMA) method also indicated less insulin resistance in the rats fed a C. colocynthis oil-enriched diet versus the other rats. Finally, 2 months after STZ injection, the pancreatic β-cell mass was similar in both the STZ-treated rats fed the colocynth oil-enriched diet and their controls fed the same diet. In contrast, the pancreatic β-cell mass remained lower in the STZ-induced diabetic rats fed with olive oil- and sunflower oil-enriched diets compared with the C. colocynthis group. We conclude that C. colocynthis oil supplementation may have a beneficial effect by partly preserving or restoring pancreatic β-cell mass in the STZ-induced diabetes rat model.     

Utility of opium seed extract tests in preventing hypersensitivity reactions during surgery

BackgroundAnaphylaxis during anaesthesia is fatal in 3–9% of patients and analgesics, including opioids, and is the second most common medicament-related cause, although the prevalence is underestimated. We recently found that patients may generate IgE antibodies to opium seeds.ObjectivesTo determine the diagnostic accuracy of specific antibodies to morphine, codeine, rocuronium and oil body and aqueous fractions of Papaver somniferum seeds in the diagnosis and prevention of allergy to opioids.MethodsPatients with hypersensitivity reactions during surgery, and severe clinical allergy (pollen, tobacco), and illicit heroin users were selected. The sensitivity, specificity and predictive values of in vivo and in vitro diagnostic techniques including oil body and aqueous fractions of P. somniferum seeds were measured.ResultsWe studied 203 patients, with mean age 35.1 ± 17.1 and 200 healthy controls. Patients sensitised to heroin or with hypersensitivity reactions during surgery responded to P. somniferum seed tests. Of patients not known to be sensitised to opioids, the highest positivity was in patients sensitised to tobacco (p < 0.001). Opium seed skin tests and IgE, especially the oil body fraction, were more sensitive (64.2%) and specific (98.4%) than morphine, codeine and rocuronium tests for opioid sensitivity. Pollen allergy was not a risk factor for sensitisation to morphine.ConclusionsSensitivity to opioids and intraoperative anaphylaxis can be diagnosed by routine tests. IgE and skin tests for the oil body fraction of P. somniferum had the highest sensitivity for sensitisation to opioids.     

Étude de la faune acarologique des matelas de l'île de la Martinique

Background. – Levels and types of species of house dust mites (HDM) can vary according to environmental conditions. The objective of this study is to describe various species of house dust mites (HDM), which colonize mattresses in Martinique, a tropical island of the Caribbean, and to find out differences according to the characteristics of the mattress and housing.     

Diagnostic et fréquence de la rhinite allergique chez l'enfant asthmatique

This prospective study aimed to: 1) validate a paediatric questionnaire score from which allergic rhinitis (AR) could be diagnosed, 2) estimate its prevalence in asthmatic children, and 3) ascertain if AR is an additional risk factor for the severity of asthma. The questionnaire, modified from the adult form of the SFAR, was administered to 352 asthmatic children seen in consultation between June 2005 and April 2006. AR was diagnosed in 200 of these children (56.8%). AR was mild and intermittent in 45% of cases, moderate-to-severe and intermittent in 11%, mild and persistent in 27% and moderate-to-severe and persistent in 17%. A total score ≥ 9 was discriminant for AR (sensitivity = 90.5%, specificity = 94.7%, positive predictive value = 95.8%, negative predictive value = 88.3%, Youden's Index = 0.86). The proportion of children having mild or moderate-to-severe asthma was independent of the presence of AR (43.5% vs 48.6% and 56.5 vs 51.3%, respectively).     

Concentration plasmatique élevée de la vitamine B12 : un indicateur des maladies hépatiques ou tumorales

Purpose

To identify the diseases that are associated with a high plasma concentration of vitamin B12 and to measure the strength of this association.

Patients and methods

Retrospective study including all admissions between 1st May, 2005 and 30th April, 2008 in the UMAG pole departments (emergency, internal medicine, acute geriatrics and medical intensive care) with a test for plasma vitamin B12. The association between each of medical information system codes (solid tumors, malignant hematologic process, and renal disease) and a high or low vitamin B12 concentration was measured by odds ratios (OR) from logistic models taking into account repeated admissions, with adjustment for age and the weighted Charlson index.

Results

Among 3702 admissions, 12% had a B12 more than 820pg/ml, 10.4% a B12 less than 180 pg/ml and 77.6% a normal B12 concentration. After adjustment for age and the weighted Charlson index, high concentration of vitamin B12 was associated with interstitial renal diseases (OR 2.7; 95% CI: [1.7–4.2]), and cirrhosis or hepatitis (OR 4.3; [2.9–6.4]). After additional adjustment for these parameters, it was still associated with tumors (OR 1.8; [1.2–2.6]), malignant hematologic diseases (OR 2.1; [1.3–3.5]), metastasis (OR 2.9; [1.5–5.9]), liver metastasis (OR 6.2; [2.7–14.5]), liver carcinoma (LC) (OR 3.3; [1.1–10.4]), liver tumors other than LC (OR 4.7; [1.2–17.9]) and lymphoma (OR 3.2; [1.6–6.4]) but not with myeloma (OR 1.9; [0.6–1.4]). Low concentration of B12 was associated with myeloma (OR 2.9; [1.3–6.6]).

Conclusion

Finding a high plasma concentration of vitamin B12 should lead to a systematic search for a hepatic disease or a tumor, and particularly for a hepatic localization of a tumor.     

Console de jeu : mode de transmission de l'allergie à l'arachide

The authors report the case of a child allergic to peanuts since he was one year old who, at the age of 9 years, developed angioedema after playing with his "Play Station". This device had been used previously by his uncle who had eaten peanuts at a family get-together. This observation illustrates a new way of transmitting food allergies and provides an opportunity to review the principal situations in which this allergy can be transmitted by proxy.     

Histoire de l'allergie alimentaire : des précurseurs à l'histoire contemporaine

Food allergies are an important public health problem. Relatively unheard of during the 1970–1980 s, they had almost always been associated with the same allergens (cow milk, chicken eggs, and fish). Since then, they have become more frequent and more varied, involving about 4% of the general population of all ages; the prevalence may even be 5–6% or more among children. They are also becoming more and more severe, and interfering more in daily living. Beginning in the 1980 s, the story of food allergy has been marked by the explosion of the occurrence of peanut allergy, the prevalence of which has at least doubled over the past five years. Another important tendency has been an increase in the frequency of allergy to shelled fruits (e.g. exotic nuts) and to certain plant allergens (e.g. sesame, buckwheat and wheat). There has also been an increase in the number of near-fatal and fatal cases of food-related anaphylaxis, justifying the establishment of a monitoring network. The workup of food allergies has become more standardized, allowing a definitive diagnosis to be more easily established, thus justifying avoidance of the responsible substance. Indeed, until recently, in the absence of effective preventive measures and a good risk-benefit ratio, the prevention of food allergies depended on avoidance of the responsible food(s), which recommendation is nevertheless often not followed as prescribed. Other preventive measures (antihistamines, corticosteroids, adrenalin auto-injectors) are then adopted to avoid recurrences, which can be considered as evidence of treatment failure. Recent years have been marked by standardization of preventive measures based on the Project of Individual Care and by the establishment of educational protocols. The future may see the development of specific immunotherapy (until now, difficult and dangerous), modification of food allergens, and treatments that block IgE-dependant allergic reactions. For example, the preliminary results of a clinical trial of sublingual immunotherapy with hazelnut appear to be promising. Considering the difficulty of diagnosis and prevention, the social and psychological repercussions of food allergies are considerable for both children and their families.     

The Properties of Different Healing Agents Considering the Micro-Self-Healing Process of Asphalt with Encapsulations

Improving the self-healing performance of asphalt by employing encapsulation technology is a topic of wide interest. This study investigated the performance of sunflower oil, engine oil, and waste cooking oil based on the microhealing mechanism of asphalt with compartmented polymeric fiber. Capillary flow, contact angle, Brookfield viscosity, bar thin layer chromatography, and fatigue–recovery–fatigue tests were conducted to characterize the capillary flow capacity, wetting ability, viscosity reduction ability, suitability of components, and performance restoration ability of the different kinds of healing agents. The diffusion process of sunflower oil in asphalt was simulated using molecular dynamics. The results showed that sunflower oil exhibited the best capillary flow capacity, viscosity reduction ability, and the fastest wetting rate in asphalt. Engine oil exhibited the largest wetting work and the best recovery performance related to fatigue. The diffusion process of sunflower oil in asphalt could be divided into two stages. Two major factors (aging and higher temperature) increased the diffusion rate of sunflower oil in asphalt. The comprehensive analysis showed that sunflower oil was the most suitable to be encapsulated to improve the self-healing performance of asphalt.     

Mise au point d'un dosage automatisé des IgE spécifiques des allergènes des pollens de cyprès et de genévrier par VIDAS Stallergy

Study objective

Cypress pollen is a significant cause of allergies in the Mediterranean area. In order to improve the in vitro diagnosis to cypress sensitization, we used a Juniperus ashei extract to develop a new semi-quantitative test for the measurement of IgE specific to juniper and cypress pollen allergens based on the VIDAS automated system.

Methods

The VIDAS Stallergy^® assay combines a two-step enzyme immunoassay sandwich method with a final fluorescence detection. The reagent comprises the Solid Phase Receptacle (SPR) coated with a J. ashei extract, which serves as a solid phase as well as a pipetting device during the assay and a strip that contains all the ready-to-use reagents.

Results

The precision study shows coefficients of variation lower than 1.7% for intra-assay variability and between 1.6 and 9.5 for inter assays variability. Correlation with the CAP system^® method shows an 80.7% agreement to the nearest class (N = 57). For 65% of sera class results are similar with the two techniques, and for 33% of sera, class results are higher with the VIDAS method. Test specificity is confirmed by VIDAS inhibition experiments. A sensitivity study performed using 82 clinically recognized cypress allergic patients shows that 97.6% of the patients are detected with the VIDAS Stallergy^® Juniper reagent.

Conclusion

The Juniper Stallergy^® test allows to measure specific IgEs to cypress pollen, with a sensitivity of detection at least similar to the CAP system^® method.     

Ginger and turmeric lipid-solubles attenuate heated oil-induced oxidative stress in the brain via the upregulation of NRF2 and improve cognitive function in rats

In this study, we elucidated the modulatory potentials of lipid-solubles from ginger and turmeric that may migrate to oils during heating on the brain antioxidant defense and cognitive response in rats. Male Wistar rats were fed with control diet [including native canola oil (N-CNO), and native sunflower oil (N-SFO)], or experimental diets [including heated canola oil (H-CNO), heated sunflower oil (H-SFO), heated canola oil with ginger (H-CNO + GI), heated canola oil with turmeric (H-CNO + TU), heated sunflower oil with ginger (H-SFO + GI), heated sunflower oil with turmeric (H-SFO + TU)] for 90 days. Memory parameters [Morris water maze, elevated plus maze, novel object recognition test, T-maze (spontaneous alteration)], locomotor skills (open field test and rotarod test), antioxidant defense enzymes, reactive oxygen species, NOS2, ICAM-1, and NRF-2 level in the brain were assessed. Compared to their respective controls, heated oil-fed rats, but not those fed oils heated with ginger or turmeric, showed significant (p < 0.05) reduction in the memory, motor coordination skills, antioxidant defense enzymes, and NRF-2 activation in the brain. Compared to their respective controls, the brain NOS-2 and ICAM-1 were significantly (p < 0.05) increased in heated oil-fed rats, but not those fed oils heated with ginger or turmeric. Chronic intake of repeatedly heated oil causes brain dysfunction by inducing oxidative stress through NRF-2 downregulation. Lipid-solubles from ginger and turmeric that may migrate to oil during heating prevent the oxidative stress and cognitive dysfunction triggered by heated oils in rats.

     

Airborne allergy to sunflower seed.

BACKGROUND: There is increasing evidence that bird fanciers may develop airborne allergies to unusual allergens. OBJECTIVE: To detect the allergen source in a bird fancier with a history of asthma associated with bird cage cleaning activities and with contact with a Brazil parrot. METHODS: SPT with a large series of both airborne and food allergens were carried out. IgE reactivity to allergens causing wheal and flare reactions was confirmed by in-vitro investigations including ELISA/ELISA inhibition and immunoblot analysis. RESULTS: Strong skin reactivity to sunflower seed was observed. Immunoblot analysis showed IgE reactivity to low m.w. proteins, most probably 2S albumin, and ELISA inhibition studies showed the absence of cross-reactivity to mustard. CONCLUSION: Sunflower seed dust may sensitize patients via the respiratory tract. Differently from previously reported cases of sunflower seed allergy, no cross-reactivity to 2S albumin from botanically unrelated seeds was found.