L’allergie aux Rosacées chez l’enfant : à propos de vingt-deux cas

Rosaceae allergy is the fourth most frequent food allergy in Spanish children whereas it is rare in French children. The aim of the present study was to analyse the natural history of Rosaceae allergy in French children living in the Mediterranean area and to underline its specificities. We reviewed the case records of 22 children. The diagnosis of Rosaceae allergy was based on the clinical history and confirmed by skin prick tests with fresh foods and with commercial extracts and the Pharmacia CAP-RAST. Sensitivity to birch was also assessed by prick tests. The patients were divided into two groups: 12 children who were sensitised to Rosaceae and to birch pollen and eight who were sensitised to Roseacea only. The diagnostic value of prick tests with commercial extracts for Roseacea allergy was poor in both of these groups. The birch-negative group had become allergic to peaches first, and all of these children were sensitive to extracts of the cooked native fruits that were responsible for their clinical reactivity. Severe allergic reactions had occurred more frequently in this group. Prick tests with commercial extracts were positive only in this group. In contrast, the birch-positive group was more frequently allergic to apples, and the oral allergy syndrome was common among them. The median level of sensitisation to fresh fruits was also higher in this group. French children living in the Mediterranean appear to have a specific Rosaceae sensitisation profile: 60% of them have a Northern Europe profile (birch–apple allergy) and 40% of them have a Spanish–Italian profile (lipid-transfer protein allergy).     

Cross-reactivity among the pollen proteins of birch and apple trees

In the spring of 1986, the pollen were collected from apple trees in full blossom, and were investigated for their allergenicity. The patients selected for study were subjects with a combined inhalant allergy to birch pollen and an oral allergy to apple fruit. The apple pollen extract yielded about the same percentage of nondialysable substance as obtained from birch pollen. In contrast to the latter, UV-spectroscopy revealed no flavonoids adsorbed to the apple pollen proteins. Patients with a combined allergy to birch pollen and apple fruit showed positive skin reactions to both birch and apple pollen extract. Inhibition of IgE-binding in RAST to birch pollen was observed by apple pollen extract at a 1000-fold lower potency than the homologous birch allergens. Immunoblotting demonstrated IgG-antibodies in birch-allergic sera cross-reactive with apple pollen components. It is concluded that minor allergenic determinants cross-reactive with birch pollen epitopes occur not only in the fruit, but also in the pollen of the apple tree.     

Allergy to Anacardiaceae: description of cashew and pistachio nut allergens.

Some members of the Anacardiaceae family, such as cashew nut, pistachio nut and mango, have been reported to cause immediate allergic reactions. We report three cases of anaphylaxis to cashew nuts. With the aim of describing the allergens existing in cashew and pistachio nuts, patients were prick tested with cashew and pistachio extracts. Specific IgE against both nuts was studied by CAP and SDS-PAGE/immunoblotting. It was found that skin tests and specific IgE to cashew and pistachio nuts were positive in the three patients. Both nuts showed several protein bands in SDS-PAGE. The strongest IgE-binding bands had similar molecular weights (15, 30 and 60 kDa) in cashew and pistachio nuts. These main bands were found to be sensitive to reducing agents. It was concluded that these three patients suffered immediate reactions to cashew nut due to an IgE-mediated mechanism.     

Extracts of Anacardium occidentale (cashew) pollen in patients with allergic bronchial asthma.

Allergic reactions to the pollen of trees is among the most prevalent allergic sensitivities. The cashew tree grows in abundance in the northeast region of the Brazil, mainly in Fortaleza city, in state of the Ceará. It flowers once a year between August and October. This is the first study conducted to establish the possible role of the cashew pollen extract in causing skin test reactivity in patients with allergic asthma. A stock solution of pollen extract was prepared with the standard weight/volume method for intradermal skin tests and for the protein content of the extract, estimated with the use of Folin phenol reagent and a spectrophotometer. Ten nonallergic volunteers and 80 subjects with allergic asthma, as documented by previous positive skin test reactions to various pollens, were studied. All of the 80 patients (100%) had positive test reactions (grade III and grade IV reactions). None of the control subjects (n = 10) had positive responses to the intradermal tests. This study provided us with knowledge of an additional pollen extract of the Anacardium occidentale, which could provoke skin test reactivities in asthmatic individuals from the northeastern area of Brazil. The results suggest a relationship between the period of flowering of the cashew tree and the increased number of allergic asthma cases.     

Latex allergy and fruit cross-reaction in subjects who are nonatopic.

Since the first case reported in 1927, latex allergy has attracted the attention of allergists including its capacity to cross-react with fruits. To evaluate the frequency of sensitivity to some fruit allergens shown to cross-react with latex, we evaluated 82 patients (43 men and 39 women, aged between 18 and 45 years) with latex allergy. All patients underwent skin tests with various fruit extracts that potentially cross-react with latex. Only patients with negative prick tests successively underwent prick-by-prick tests with fresh fruits. Thirty-nine of 82 patients (47.5%) were found to have positive skin tests. Prick tests with fruit extracts were positive in 28 patients (kiwi, 21 patients; banana, 17 patients; avocado, 8 patients; and papaya, 3 patients), and the prick-by-prick test had positive results in 11 patients (kiwi, 7 patients; banana, 4 patients; and avocado, 3 patients). In our experience patients with latex allergy are at a high risk of sensitization to some fruits and they often develop allergic reactions, even severe ones, after eating them; for this reason fruit sensitization should be taken into consideration when investigating patients allergic to natural rubber latex.     

Immunoblot studies in birch pollen-allergic patients with and without fruit hypersensitivity: part I: antibody pattern for birch pollen extract.

About 40-70% of birch pollen allergic patients show allergic symptoms after ingesting or handling raw fruits. Several investigations have indicated a partial immunological identity between birch pollen and stone fruit. To further clarify this association, we investigated 59 patients with allergic symptoms (conjunctivitis, rhinitis, and asthma during the birch pollen season) and 18 nonatopic controls by skin prick test (SPT) and RAST with birch pollen, fresh apple, cherry, and peach as well as freshly prepared fruit extracts. According to a questionnaire dealing with symptoms after ingestion of raw fruits, the subjects were divided into groups with (35 FH+) and without (24 FH-) fruit hypersensitivity. IgE, IgG, IgG1, IgG4, IgA, and IgM binding patterns to birch pollen extracts were performed with 33 sera (12 FH+, 11 FH-, and 10 nonatopic controls) using the immunoblot-technique. Patients with FH+ expressed a significantly stronger sensitization to birch pollen than patients without FH-, as measured by RAST and SPT. Native fruits induced stronger SPT reactions than fruit extracts, and patients with FH+ showed a significantly higher skin index with all fruits and fruit extracts tested. Specific IgE, IgG, IgG1, IgG4, IgM and IgA to birch pollen extracts could be detected by immunoblot in all groups, albeit with different frequencies and intensities. From this data we conclude that fruit hypersensitivity is related more to the 17 kd and 67-85 kd than to the 26-28 kd or 36 kd protein bands of the birch pollen extract. The relationship of specific IgE > IgG > IgM to a single protein band seems to be associated with the development of symptomatic type I allergy.     

Prevalence of latex allergy and evaluation of some risk factors in a population of atopic children.

The aims of our study were to evaluate (1) the prevalence of natural rubber latex (NRL) allergy in an unselected population of atopic children; (2) the diagnostic efficacy of skin prick tests (SPTs) with latex extracts; (3) the correlation between positive SPTs to latex and risk factors such as atopy, fruit allergy, history of surgery cares or dental cares. We randomly enrolled 151 unselected atopic and 59 nonatopic children who underwent SPTs with common inhalant and food allergens, and SPTs with two different latex extracts. A clinical history concerning allergic history, symptoms after contact with latex objects or after ingestion of fruits or vegetables, dental and surgical treatments was obtained. Six of the 151 atopic children were positive to latex SPTs, but only one out of 59 nonatopic children was positive to latex SPTs. Concerning risk factors, 86% of children with SPT positive to latex were atopic, 71.4% had a clinical history of surgery, and none of them had undergone dental or orthodontic treatments. The prevalence of NRL sensitization in our unselected population of atopic children was 3.9%, but the prevalence of NRL allergy was 2.6%. Concerning NRL allergy, the sensitivity and the specificity of SPTs with latex extracts are high (1.00 and 0.98, respectively), as well as negative predicting value (1.00); the positive predictive value is low (0.70). We conclude that atopy, surgical treatments, and sensitization to foods cross-reacting with NRL are important risk factors for NRL sensitization. We have no data concerning dental or orthodontic cares.     

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.     

Epidemiological study of oral allergy syndrome in birch pollen dispersal-free regions

BackgroundOral allergy syndrome (OAS) is an immediate allergy caused by a cross-reaction of highly homologous common antigens (pan-allergens) contained in fruits/vegetables and pollen.MethodsA questionnaire was provided to 6824 outpatient visitors and serum levels of specific IgEs against crude antigens and pan-allergen components were measured to study the relationship between the prevalence of OAS and pollinosis in the Fukui Prefecture where there is almost no dispersal of birch pollen.ResultsThe prevalence of OAS was 10.8%. The rate of pollinosis complication in the OAS group was 67.4%, and OAS was observed in 16.8% of pollinosis patients. Causative foods in order of frequency were melon, pineapple, kiwi fruit, peach, and apple. A significantly higher number of patients from the OAS group were positive for birch, alder, and timothy grass-specific IgE. The rate of positivity for anti-component IgE corresponding to pollen in OAS group was also significantly higher. Of 34 patients with OAS caused by eating apples, 28 (82.4%) were positive for Mal d1-specific IgE. Of the 52 patients with peach-induced OAS, 41 (78.8%) were positive for Pur p1-specific IgE. The concordance rates between crude antigen-specific IgE and anti-PR-10 component-specific IgE were 87.1% and 93.3% for apple and peach respectively.ConclusionsIn regions where birch pollen is not dispersed, OAS patients have a significant association with the onset of Bet v1-associated allergy. Anti-PR-10 component IgE was useful in diagnosing OAS, and crude antigen-specific IgE was also associated with apple and peach allergies.     

Anaphylaxis to pine nuts and immunological cross-reactivity with pine pollen proteins.

Despite the wide use of pine nuts, the fruit of Pinus pinea, only a few reports of allergic reactions to them have been published. We present herein a case of food allergy to pine nuts in a patient who showed no clinical symptoms to pine pollen despite the presence in her serum of specific IgE antibodies. In order to verify whether the reaction against pine nuts was IgE mediated, specific IgE against pine nuts and pollen were evaluated by skin-prick test, prick by prick and RAST. Immunoblotting and immunoblotting-inhibition were used to evaluate the allergenic components of both extracts and their cross-reactivity. Prick by prick with fresh pine nuts and RAST with pine nut and pine pollen extracts showed that the patient had high levels of specific IgE against both extracts. Immunoblotting experiments showed the presence in serum of IgE antibodies against several components in pine nuts and pollen. Immunoblotting-inhibition experiments demonstrated the presence of some cross-reacting components. These data confirm the existence of food allergy induced by pine nuts. This sensitization to pine nuts developed with no symptoms of pine pollinosis. Development of pollinosis may require a longer time of exposure to allergens. Based on the cross-reactivity between pine nut and pine pollen extracts, cosensitization to these two allergens could be possible.     

Latex anaphylaxis caused by a Swan-Ganz catheter

A 78-year-old woman visited the division of cardiovascular disease in our hospital. She underwent a cardiac catheter examination, and a Swan-Ganz catheter was inserted. Several minutes later, she developed anaphylactic shock. She had no past history of latex allergy, but did have a banana allergy. Skin prick tests showed a positive reaction to an extract of latex gloves and an extract of the balloon of a Swan-Ganz catheter. Anaphylactic shock caused by the latex balloon of a Swan-Ganz catheter was diagnosed. It is necessary to pay attention to not only latex allergy but also fruit allergies with a cross-reactivity to latex.     

Allergy to hazelnut in adults: A two-step study

BackgroundAlthough hazelnut consumption is very high in Turkey, the prevalence of hazelnut allergy is still unknown. This study's objective was to investigate the prevalence of hazelnut sensitisation and to verify its clinical importance using double-blind, placebo-controlled challenge (DBPCFC) in an adult population.MethodsPrick-to-prick skin tests were performed with fresh hazelnut in 904 patients admitted to the allergy department. Among the 904 subjects, 20 patients with a history of allergic reactions to hazelnut and/or positive skin tests were recalled for further evaluation. Specific IgE was measured in these subjects. Eleven (11/20) patients accepted to undergo DBPCFC with hazelnut.ResultsAmong the 904 individuals, the history of reactions to hazelnut was positive in 16 subjects (1.8%); prick-to-prick skin tests were positive in 13 (1.4%); prick tests with the commercial product were positive in nine (0.9%); and history plus skin tests were positive in 16 (1.8%). Specific IgE to hazelnut was positive in only three patients. DBPCFC was conducted in 11 subjects with a positivity rate of 63.6% (7/11). We observed six mild and one moderate systemic reactions during the DBPCFC. Among seven subjects with a positive DBPCFC, six (85.7%) had a history of hazelnut allergy, and five (71.4%) had both history and skin test positivity.ConclusionSkin test sensitisation to hazelnut was found to be 1.76% (16/904) which is similar to the sensitisation rate in previous reports. However, DBPCFC was positive in 63% of cases with a history of hazelnut allergy and/or positive skin tests in this study. These results indicate that the presence of history with a positive skin test can be suggestive of hazelnut allergy; however an oral food challenge is needed to confirm the diagnosis.     

Specific and non-specific skin test reactions with animal dander extract.

Intradermal skin tests have been performed in atopic patients with allergenic extracts of different animal danders at uniform concentration. A high incidence of positive test was recorded which could not be related to the clinical histories, especially with the allergens of horse, cow and dog dander (NR). Better correlation was observed with guinea pig and cat allergens (R). The incidence of NR reactions was highest in the house dust allergy group of patients; with the exception of horse dander allergen, the frequency of R reactions was more pronounced in the grass pollen group. It is suggested that both allergen-specific and non-allergen-specific mechanisms may contribute to positive wheal and flare reactions.     

Results of the National Institute of Allergy and Infectious Diseases Collaborative Clinical Trial to test the predictive value of skin testing with major and minor penicillin derivatives in hospitalized adults.

BACKGROUND--A history (or lack thereof) of penicillin allergy is known to be unreliable in predicting reactions on subsequent administration of the drug. This study tests the usefulness of four penicillin allergen skin tests in the prediction of IgE-mediated reactions subsequent to administration of penicillin. METHODS--Eight centers cooperated in the National Institute of Allergy and Infectious Diseases trial of the predictive value of skin testing with major and minor penicillin derivatives. Hospitalized adults were tested with a major determinant (octa-benzylpenicilloyl-ocytalysine) and a minor determinant mixture and its components (potassium benzylpenicillin, benzylpenicilloate, and benzylpenicilloyl-N-propylamine). Patients then received a therapeutic course of penicillin and were observed, for 48 hours, for adverse reactions compatible with an IgE-mediated immediate or accelerated allergy. RESULTS--Among 726 history-positive patients, 566 with negative skin tests received penicillin and only seven (1.2%) had possibly IgE-mediated reactions. Among 600 history-negative patients, 568 with negative skin tests received penicillin and none had a reaction. Only nine of the 167 positive skin test reactors received a penicillin agent and then usually by cautious incremental dosing. Two (22%) of these nine patients had reactions compatible with IgE-mediated immediate or accelerated penicillin allergy; both were positive to the two determinants. CONCLUSIONS--These data corroborate previous data about the negative predictive value of negative skin tests to these materials. The reaction rate in skin test-positive patients was significantly higher than in those with negative skin tests, demonstrating the positive predictive value of positive tests to both major and minor determinants. The number of patients positive only to the major determinant or only to the minor determinant mix was too small to draw conclusions about the positive predictive value of either reagent alone.     

Allergies in immigrants

We studied the influence of environmental factors on allergy disease in immigrants that came to Israel during the last 20 years from A) Ethiopia and B) former Soviet Union. Immigrants who came from Ethiopia had no allergies upon arrival; they suffered from severe parasitic infections and had extremely elevated IgE levels. They got thorough anti parasitic treatment and were gradually integrated in the old timer Israeli population. After 5-10 years from arrival, follow up assessments showed a significant drop in IgE levels while respiratory allergies with positive skin tests Respiratory allergies with positive skin tests) to aero allergens appeared at a prevalence of 11%. Israeli born newborns and children from Ethiopian descent had no stool parasites and their total IgE levels were similar to those of the indigenous population. Immigrants from former Soviet Union who had respiratory allergies upon arrival, showed skin tested hypersensitivity to pollen common in their Russian, homelands while they were not sensitive to the Mediterranean pollen common in Israel. At yearly follow up testing over the first 10 years in Israel, odds for sensitization to Russian pollen decreased while odds for sensitization to Israeli pollen increased significantly. The results of our studies plead the case for the very important role played by the environment in the dynamics of allergy diseases.     

Aerobiological investigation and in vitro studies of pollen grains from 2 dominant avenue trees in Kolkata, India.

BACKGROUND: Peltophorum pterocarpum and Delonix regia are dominant avenue trees in the city of Kolkata in India. They are well adapted to the humid tropical climate and also grow commonly in different parts of the country. Their pollen grains are reported to be airborne. OBJECTIVE: The aim of this study was to conduct an aerobiological survey in Kolkata to determine the concentration and seasonal periodicity of pollen grains from P pterocarpum and D regia and to analyze the meteorological factors responsible for their levels in the atmosphere. In addition, we analyzed the prevalence of sensitization due to these grains among patients with seasonal respiratory allergy. METHODS: An aerobiological survey was conducted with a volumetric Burkard sampler from 2004 to 2006. Correlations between meteorological parameters and pollen grain concentrations were assessed by Spearman correlation test. The protein profile of the pollen extracts was studied by sodium dodecyl sulfate polyacrylamide gel electrophoresis. Finally, the allergenic potential of the pollen extracts was evaluated in patients with respiratory allergy by skin prick test, immunoglobulin (Ig) E enzyme-linked immunosorbent assay, and IgE immunoblotting. RESULTS: P pterocarpum and D regia pollen grains occur from March to June and April to July, respectively. The pollen concentrations showed statistically significant positive correlations with maximum temperature and wind speed. Positive reactions to P pterocarpum and D regia were observed in 26% and 22% of the patients, respectively. Many protein bands were detected in the pollen extracts over a wide molecular weight range. A total of 5 (P pterocarpum pollen) and 8 (D regia pollen) protein fractions were detected by IgE immunoblotting. CONCLUSION: P pterocarpum and D regia pollen grains are dominant in the atmosphere of south Kolkata and they are influenced by temperature. The pollen grains release proteins that may be responsible for immediate hypersensitivity reactions in sensitive patients.     

New onset egg allergy in an adult.

We report newly presenting systemic and local allergic reactions to egg in a 55-year-old woman. The patient did not have a history of egg allergy in childhood or occupational exposure to egg proteins; nor did she report any disease that is known to be related to food allergy. A skin prick test with commercial extracts, prick-to-prick test, CAP radioallergosorbent assay, and a double-blind, placebo-controlled food challenge test were used to prove egg allergy. Because egg allergy mainly affects children and symptoms frequently disappear with age, the late onset in this patient is rare.     

Allergie alimentaire au litchi et à mangue

The case of a young man with allergy to litchi and mango revealed the progressive mode of appearance of allergy symptoms with the possibility of their evolving over several years. In addition to a complete physical examination, the importance of complete, precise questioning carried out well is emphasized by this case. The allergy workup included prick tests and serum IgE antibody assays adapted to the clinical data. The distinction between cross-reactivity with mugwort pollen on the one hand and food allergy to litchi and exotic fruits on the other hand was arrived at by a labial provocation test.     

In vitro basophil activation using CD63 expression in patients with bee and wasp venom allergy.

The diagnosis of insect venom allergy and the indication for specific immunotherapy is based on history, skin tests and demonstration of hymenoptera venom-specific IgE-antibodies. Cellular tests can add useful information but the role of basophil activation tests for the different venoms has to be elucidated further. We evaluated positive reactions in a basophil activation test using CD63 expression as marker independently for bee or wasp venom in patients with hymenoptera allergy. Fifty-seven patients with a history of insect venom anaphylaxis were examined (12 x bee venom, 39 x wasp venom, 6 x bee plus wasp venom). Skin tests and determination of specific IgE-antibodies were performed. Basophil activation test (BAT) using CD63 expression was performed after stimulation with different concentrations of bee and wasp venom. The BAT is based on double staining with anti-IgE antibodies and anti-CD63 and subsequent determination of the percentage of activated basophils by flow cytometry. In patients with bee venom allergy, BAT was positive in 100% to bee venom and 75% to wasp venom. In patients with bee and wasp venom allergy, positive reactions for both venoms were found in 100%. In patients with wasp venom allergy, 97% reacted positive to wasp venom and only 56% to bee venom. These results show the reliability of the basophil activation test as a cellular test in the in vitro diagnosis in patients with bee and wasp venom allergy. They also show that positive reactions in the basophil activation test reflect both sensitization status and cross-reactivity between venom species.     

Severe tomato allergy (Lycopersicon esculentum).

Although tomatoes are a commonly consumed food, severe allergic reactions to tomatoes are unusual or rarely reported. Previously reported allergic manifestations to tomato include urticaria/angioedema, dermatitis, oral allergy syndrome, rhinitis, and abdominal pain. The aim of this study was to report two patients with significant immediate hypersensitivity reactions to tomato and characterize the responsible allergen. We reviewed the history and documentation of tomato-specific immunoglobulin E (IgE) of two patients with adverse symptoms after ingesting tomato. Fresh tomato extracts prepared from the skin, seeds, and flesh of red, ripe tomatoes were evaluated for total protein content and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) was performed to characterize the tomato protein. IgE enzyme-linked immunosorbent assay (ELISA) using the patients' serum against the various tomato extracts was accomplished and IgE immunoblot was performed. Percutaneous skin tests or radioallergosorbent tests (RASTs) were positive to tomato in both patients. Both adults experienced laryngeal edema and one had anaphylaxis. Similar total protein contents were found in each of the tomato extracts and gel electrophoresis revealed similar protein profile for skin and seed extracts with protein bands discernible at molecular weights of 21, 33, and 43 kDa. One patient reacted specifically to a 43-kDa protein band on IgE immunoblot. The two cases show that severe allergic reactions to tomato occur in adults and one is associated with IgE binding to a 43-kDa protein.