Determination of the clinical egg allergy phenotypes using component‐resolved diagnostics

IgE‐mediated egg allergy presents as one of the most common food allergies in children and is a food which is widely consumed all over the world. Measurement of egg white‐specific IgE levels has been shown to be a poor predictor of clinical phenotypes of egg allergy, including to raw egg white, but particularly to baked or cooked egg. Egg white and yolk contain more than 20 different glycoproteins, including ovomucoid, ovalbumin, ovotransferrin, alpha‐livetin, and the newly identified Gal d 6. Recent developments in component‐resolved diagnostic technology, including microarrays, have enabled us to improve the way in which we diagnose food allergy. This technology allows us to measure specific IgE antibodies to individual egg allergens which have been highly purified. Characterization of the major egg allergens could help profile the relevant binding epitopes to each region and may also help diagnose the different clinical phenotypes of egg allergy.     

How relevant is panallergen sensitization in the development of allergies?

Panallergens comprise various protein families of plant as well as animal origin and are responsible for wide IgE cross‐reactivity between related and unrelated allergenic sources. Such cross‐reactivities include reactions between various pollen sources, pollen and plant‐derived foods as well as invertebrate‐derived inhalants and foodstuff. Here, we provide an overview on the most clinically relevant panallergens from plants (profilins, polcalcins, non‐specific lipid transfer proteins, pathogenesis‐related protein family 10 members) and on the prominent animal‐derived panallergen family, tropomyosins. In addition, we explore the role of panallergens in the sensitization process and progress of the allergic disease. Emphasis is given on epidemiological aspects of panallergen sensitization and clinical manifestations. Finally, the issues related to diagnosis and therapy of patients sensitized to panallergens are outlined, and the use of panallergens as predictors for cross‐reactive allergy and as biomarkers for disease severity is discussed.     

Hypersensitivity reactions to non‐betalactam antibiotics in children: An extensive review

In contrast to hypersensitivity reactions (HSRs) to β‐lactam antibiotics in children, studies about HSR to non‐β‐lactam antibiotics (NBLAs) such as sulfonamides, macrolides, quinolones, and antituberculosis agents are scarce, and information is generally limited to case reports. The aim of this extensive review was to summarize our present knowledge on clinical characteristics, evaluation, and management of HSR to NBLAs in children based on the literature published between 1980 and 2013. NBLAs have been reported to induce a wide spectrum of HSRs from mild eruptions to severe, and sometimes fatal, systemic drug reactions, especially in some high‐risk groups. The diagnosis relied upon history and remained unconfirmed by allergological tests in most of the cases. Obtaining a detailed history is valuable in the diagnosis of suspected reactions to NBLAs. Diagnostic in vivo and in vitro tests for NBLAs lack validation, which makes the diagnosis challenging. The definitive diagnosis of NBLA hypersensitivity frequently depends upon drug provocation tests. Studies including children showed that only 7.8 to 36% of suspected immediate and delayed HSRs to NBLAs could be confirmed by skin and/or provocation tests. Therefore, a standardized diagnostic approach and management strategy should be developed and employed for pediatric patients in the evaluation of suspected HSRs to NBLAs, some of which may be critical and unreplaceable in certain clinical situations.     

Establishing the diagnosis of peanut allergy in children never exposed to peanut or with an uncertain history: a cross‐Canada study

Ben‐Shoshan M, Kagan R, Primeau M‐N, Alizadehfar R, Turnbull E, Harada L, Dufresne C, Allen M, Joseph L, St. Pierre Y, Clarke A. Establishing the diagnosis of peanut allergy in children never exposed to peanut or with an uncertain history: a cross‐Canada study.
Pediatr Allergy Immunol 2010: 21: 920–926.
© 2010 John Wiley & Sons A/S The diagnosis of peanut allergy (PA) can be complex especially in children never exposed to peanut or with an uncertain history. The aim of the study is to determine which diagnostic algorithms are used by Canadian allergists in such children. Children 1–17 yrs old never exposed to peanut or with an uncertain history having an allergist‐confirmed diagnosis of PA were recruited from the Montreal Children’s Hospital (MCH) and allergy advocacy organizations. Data on their clinical history and confirmatory testing were compared to six diagnostic algorithms: I. Skin prick test (SPT) ≥8 mm or specific IgE ≥5 kU/l or positive food challenge (+FC); II. SPT ≥8 or IgE ≥15 or +FC; III. SPT ≥13 or IgE ≥5 or +FC; IV. SPT ≥13 or IgE ≥15 or +FC; V. SPT ≥3 and IgE ≥5 or IgE ≥5 or +FC; VI. SPT ≥3 and IgE ≥15 or IgE ≥15 or +FC. Multivariate logistic regression analysis was used to identify factors associated with the use of each algorithm. Of 497 children recruited, 70% provided full data. The least stringent algorithm, algorithm I, was applied in 81.6% (95% CI, 77–85.6%) of children and the most stringent, algorithm VI, in 42.6% (95% CI, 37.2–48.1%).The factor most associated with the use of all algorithms was diagnosis made at the MCH in those never exposed to peanut. Other factors associated with the use of specific diagnostic algorithms were higher paternal education, longer disease duration, and the presence of hives, asthma, eczema, or other food allergies. Over 18% (95% CI, 14.4–23.0%) of children were diagnosed with PA without fulfilling even the least stringent diagnostic criteria.