Predictive value of the sulfidoleukotriene release assay in oral allergy syndrome to celery, hazelnut, and carrot.

BACKGROUND: Patients sensitized to birch pollen frequently suffer from a food allergy to plant foods such as celery, carrots, or hazelnut. One of the main manifestations of birch pollen-related food allergy is the oral allergy syndrome. Skin tests and allergen-specific immunoglobulin (Ig) E determinations are poor predictors of such reactions when assessed by double-blind placebo-controlled food challenge (DBPCFC). OBJECTIVE: To investigate whether a cellular test based on leukotriene release from basophils, the cellular antigen stimulation test in combination with enzyme-linked immunosorbent assay (CAST-ELISA), is predictive of pollen-related food allergy. METHODS: Birch pollen-sensitized patients with positive DBPCFC to celery (n=21), hazelnut (n=15), and carrot (n=7) underwent skin tests along with determination of specific IgE and CAST-ELISA for the respective allergens. The results were compared with those of 24 birch pollen-sensitized patients with negative open food challenge to celery, hazelnut, and carrot. RESULTS: While skin prick tests had a sensitivity of 85%, 80%, and 29% for commercial extracts of celery, hazelnut, and carrot, respectively, prick testing with self-prepared extracts yielded sensitivities of 100%, 80%, and 100%, respectively. For specific IgE determinations, sensitivities were 71%, 73%, and 57%, respectively, and the respective specificities were 67%, 73%, and 60%. For CAST-ELISA with various sources and doses of allergens, the sensitivity varied from 71% to 95% for celery, 73% to 80% for hazelnut, and 43% to 86% for carrot. The respective specificities were 67% to 92%, 75% to 88%, and 77% to 91%. Analysis of the predictive value of CAST-ELISA with receiver operating characteristic curves showed that the results of the tests were more predictive of pollen-related food allergy than quantitative allergen-specific IgE determinations. CONCLUSIONS: CAST-ELISA is more specific than routine diagnostic tests for the diagnosis of pollen-related food allergy to celery, hazelnut, and carrot.     

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.     

Double blind, placebo controlled food reactions do not correlate to IgE allergy in the diagnosis of staple food related gastrointestinal symptoms.

BACKGROUND: The mechanisms for adverse reactions to foods in the gastrointestinal tract are poorly understood. There is conflicting evidence in the literature on the role for IgE mediated allergy in gastrointestinal reactions to staple foods. AIM: The aim was therefore to study the role of IgE mediated allergy in a group of patients with a history of gastrointestinal symptoms related to staple foods (cows' milk, hens' egg, wheat and rye flour) verified in double blind placebo controlled challenges (DBPCFC). PATIENTS: Fifteen patients with DBPCFC, identified by screening of 96 consecutive patients referred to our allergy clinic for investigation of suspected gastrointestinal symptoms due to staple foods. METHODS: The screening included diaries as well as elimination diets and open and blinded food challenges. The frequency of atopy were compared between the double blind positive and double blind negative patients. RESULTS: The positive DBPCFC in the 15 patients included eight patients with milk intolerance, four with wheat flour, two with egg, and one with rye flour. There was no indications of an allergic pathogenesis in all 15 patients with positive DBPCFC, as the skin prick test and radioallergosorbent test were negative for the relevant allergens. The frequency of atopy was four of 21 (19%) in the double blind negative group and three of 15 (20%) in the double blind positive group. CONCLUSION: In adult patients with staple food induced gastrointestinal symptoms, objectively verified by DBPCFC, there were no indications of IgE mediated allergy to the relevant foods suggesting other mechanisms in adults than in children. Future studies may include measures of local events in the shock organs in relation to food intake, for instance utilising inflammatory markers in jejunal fluids.     

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.     

Assessment of IgE-mediated food allergies in children with atopic dermatitis

BackgroundAtopic dermatitis (AD) is an inflammatory disease of the skin, which is characterised by a chronic relapsing course.AimThe aim of the study was to assign the prevalence of clinically active food allergies among a group of children between 3 months and 7 years of age, with AD.MethodsEighty-eight children with AD were screened for specific IgE antibodies to food proteins. All patients with AD and specific IgE antibodies to food proteins were subjected to Oral Food Challenges (OFCs) with the relevant foods.ResultsFood-sensitised patients with moderate levels of sIgE had clinically active food allergy to milk (39.28%) and egg (42.34%) on the basis of positive OFCs. High IgE and eosinophilia had a prevalence of almost 80% and 25%, regardless of concomitant food sensitisation and disease severity.ConclusionsIn this study, clinically active food allergies were recognised in 26.13% of children with AD. Nevertheless, no association was confirmed between food sensitisation and AD severity. High IgE and peripheral eosinophilia have not been found more prevalent among children with severe AD nor among children with food sensitisation. Infants and younger children with AD should be screened for an underlying food allergy, regardless of disease severity.     

Drug-specific history,skin and in vitro tests can reduce the need for drug provocation tests in betalactam-hypersensitivity

BackgroundMany patients report questionable drug hypersensitivity reactions (DHR) to betalactam antibiotics. A workup is required for objectivation. Direct drug provocation tests (DPTs) omitting a prior allergy workup are increasingly recommended as the primary diagnostic approach. However, apart from the risk of severe side effects, DPTs often are a scarce resource in overloaded healthcare-systems. We investigated how many cases can be solved by drug-specific history, drug-specific IgE, and skin tests obviating the need for DPT.MethodsWe conducted a chart review in a retrospective cohort of 932 patients in an allergy outpatient centre from 2016 to 2017. Patients had been submitted to drug-specific history and specific IgE-, skin prick-, intradermal- and patch-tests with early and late readings with a series of penicillins and cephalosporins but DPTs were no option.ResultsOverall, positive in vitro and/or skin tests were found in 96/932 (10.3%) patients. Drug-specific IgE was detected in 40/932 (4.3%) patients, 61/787 (7.8%) patients had positive skin tests. In vitro tests to Pencillin V showed the highest rate of positivity 24/479 (5.0%) and early readings of ampicillin the highest amongst the skin tests (3/49, 6.1%). Immediate skin tests were more often positive than delayed ones (75:45). The combination of all parameters including drug-specific history solved 346/932 (37.1%) cases while 586/932 (62.9%) remained unresolved. Self-reported DHR could be less often confirmed in females and young children (p < 0.05).ConclusionsTesting with betalactams applying simple, cheap, and safe skin and blood tests can solve a third of DHR-cases on a high throughput scale.     

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.     

Double-blind food challenges in children in general paediatric practice: Useful and safe,but not without pitfalls

ObjectiveTo describe results of double-blind placebo-controlled food challenges (DBPCFC) with cow's milk, hen's egg, soy, peanut and hazelnut in general paediatric practice.MethodsFood challenges were performed between January 2006 and June 2011, in children 0–18 years of age, on two half-day hospital admissions with a one-week interval. Tests were performed in a double-blind fashion following a standardised protocol with validated recipes.ResultsOverall, 234 food challenges were performed in 209 children: 160 with cow's milk, 35 with peanut, 21 with hen's egg, 11 with hazelnuts, and 7 with soy. In two thirds of the cases, the DBPCFC was negative (cow's milk: 57.5%; peanut: 40.0%; hen's egg: 66.7%, hazelnut: 90.9%, soy: 100%). The only patient characteristic significantly associated with a positive DBPCFC was the presence of symptoms from three different organ systems (p = 0.007). Serious systemic allergic reactions with wheeze or anaphylaxis occurred in only two children (0.9%). Symptoms were recorded on 29.3% of placebo days. In 30/137 children with a negative test (22%), symptoms returned when reintroducing the allergen into the diet, mostly (66.7%) transient. Of the 85 tests regarded as positive by the attending physician, 19 (22.4%) did not meet predefined criteria for a positive test. This was particularly common with non-specific symptoms.ConclusionA DBPCFC can be safely performed in a general hospital for a range of food allergens. The test result is negative in most cases except for peanut. Non-specific symptoms may hamper the interpretation of the DBPCFC, increasing the risk of a false-positive result.     

Allergen-specific IgE to food molecular components and age: From early childhood to adulthood

BackgroundRespiratory allergy is characterised by an IgE-mediated reaction. The immune system functions, including IgE production, progressively decline over time with growing up and ageing. Molecular-based allergy diagnostic defines sensitisation profile. This study aimed to evaluate the impact of age on serum allergen-specific IgE to molecular component levels in a large sample of subjects.MethodsSerum IgE to: rCor a11, rPru p3, nJug r3, rAra h8, rGly m4, rCor a8, nPen m1, nAct d8, Bos d 8, and nGal d2 were assessed by ISAC method. Sera from 2795 patients, 1234 males (44.1%) and 1561 females (55.9%), median age 23 years (1st and 3rd quartiles: 9.7–43.7 years; age range: 1 month-103 years) were analysed.ResultsThe number of positive tests (i.e. sensitisation) tended to increase between birth and school-age until young adulthood and then decreased. A similar age-dependent trend was observed considering the levels of each allergen components: the levels of each allergen component tended to increase until early adulthood, but Gal d 2 and Bos d 8 (rapidly diminishing), and then to decrease over time. However, the pattern is significantly dependent on each single tested food.ConclusionsAllergen-specific IgE production to food molecular components tend to reduce with ageing, but with differences between allergens. This phenomenon should be adequately evaluated managing allergic patients.     

Mold-specific IgE antibodies in relation to exposure and skin test data in schoolchildren

BackgroundThe purpose of the present study was to compare mold specific IgE results with skin test and exposure data, as well as in relation to asthma and other allergic manifestations.MethodsWe performed skin prick tests (SPT) to 13 molds in 341 children from six schools and studied the microbial status of all school buildings. Subsequently, mold specific IgE was measured by enzyme immunoassay (EIA) to 10 molds in 31 of those children with a positive (≥ 3 mm) or weak SPT reaction (1–2 mm) and in 62 age- and sex-matched controls with no such reactions.ResultsMold-specific IgE was elevated by EIA (> 0.35 lU/mL) to at least one of the 10 studied species in 12 children (39%) with and in two children (3%) without skin test reactions. The calculated prevalence of elevated mold-specific IgE was 5% in the non-selected and 10% in children selected by respiratory morbidity. Six children had IgE to the dampness-indicative mold Aspergillus fumigatus, five children had IgE to the common outdoor mold Cladosporium herbarum and four children had IgE to the uncommon, but highly allergenic, indoor mold Rhizopus nigricans. All 14 children who had elevated IgE to molds were boys, 13 had atopy by skin tests and 12 had either asthma or had wheezed. However, no species-specific association was found between IgE or SPT responses and exposure to molds.ConclusionsMold allergy, as assessed by IgE measurements or skin tests, is rare in children. School- aged asthmatic boys having exposed to indoor air dampness seem to form a susceptible group for mold allergy, being at risk for worsening of their asthma.     

Clinical profile of a Mediterranean population sensitised to date palm pollen (Phoenix dactylifera). A retrospective study

BackgroundDate palm pollen allergy is frequently associated with polysensitisation. Observational studies have suggested that date-palm-sensitised individuals could be included in a distinct group of polysensitised patients. The objectives of the study were to analyse the clinical characteristics of a group of patients diagnosed of date-palm pollen allergy and to compare them with pollen allergic patients without date-palm sensitisation.MethodsForty-eight palm-pollen sensitised individuals were classified as Group A. A control group of 48 patients sensitised to pollens but without palm-pollen allergy were included as Group B. All individuals were skin prick tested with a common battery of aeroallergens. Information about age, sex, family history of atopy, respiratory symptoms, food allergy and sensitisation to other pollens were considered variables of the study. Specific IgE and the allergogram to date-palm pollen were determined in a subgroup of Group A.ResultsSignificant differences in the family history of atopy and number of sensitisations were observed. Both parameters were significantly higher in Group A. Group A showed high prevalence of asthma and higher level of sensitisation to foods (p < 0.05). Significant differences were obtained for sensitisation to epithelia and pollens. Pho d 2 was the most commonly recognised allergen (83.3%) in the palm-pollen allergic group.ConclusionsDate-palm pollen allergic patients constitute a homogeneous group characterised for showing bronchial asthma, sensitisation to food allergens and polysensitisation. These results suggest that the reasons for sensitisation to date-palm pollen remain to be elucidated, but could relate to the existence of as yet non-identified pan-allergens.     

Prevalence of wheat allergy in Japanese adults

BackgroundWheat is one of the most common causes of food allergies. The exact prevalence of wheat allergy has not been well delineated in Japanese adults.MethodsWe enrolled 935 adults in a cohort study established by Shimane University in order to examine the determinants of lifestyle-related diseases. A screening was conducted by a questionnaire-based examination and a detection of serum omega-5 gliadin-specific IgE. Subjects who tested positive in the questionnaire-based examination and/orthe serum omega-5 gliadin-specific IgE test were further examined by detailed interviews and skin prick tests.ResultsA total of 22 subjects were picked up by the screening process, and 17 of these were further examined by secondary testing. Only two subjects were conclusively identified as having wheat allergy.ConclusionsThe prevalence of wheat allergy in Japanese adults was found to be 0.21% by using a combination of questionnaire-based examination, skin prick test and serum omega-5 gliadin-specific IgE test.     

Primary and pollen-associated hazelnut allergy in school-aged children in Germany: A birth cohort study

BackgroundPrimary hazelnut allergy is a common cause of anaphylaxis in children, as compared to birch-pollen associated hazelnut allergy. Population-based data on hazelnut and concomitant birch-pollen allergy in children are lacking. We aimed to investigate the prevalence of primary and pollen-associated hazelnut allergy and sensitization profiles in school-aged children in Berlin, Germany.Methods1570 newborn children were recruited in Berlin in 2005–2009. The school-age follow-up (2014–2017) was based on a standardized web-based parental questionnaire and clinical evaluation by a physician including skin prick tests, allergen specific immunoglobulin E serum tests and placebo-controlled double-blind oral food challenges, if indicated.Results1004 children (63.9% response) participated in the school-age follow-up assessment (52.1% male). For 1.9% (n = 19, 95%-confidence interval 1.1%–2.9%) of children their parents reported hazelnut-allergic symptoms, for half of these to roasted hazelnut indicating primary hazelnut allergy. Symptoms of birch-pollen allergy were reported for 11.6% (n = 116 95%-CI 9.7%–13.7%) of the children. Both birch-pollen allergy and hazelnut allergy associated symptoms affected 0.6% (n = 6, 95%-CI 0.2%–1.3%) of children. Assessment of allergic sensitization was performed in 261 participants and showed that almost 20% of these children were sensitized to hazelnut, being the most frequent of all assessed food allergens, or birch-pollen, the majority to both.ConclusionsBased on parental reports hazelnut-allergic symptoms were far less common than sensitization to hazelnut. This needs to be considered by physicians to avoid unnecessary changes in diet due to sensitization profiles only, especially when there is a co-sensitization to hazelnut and birch-pollen.     

The association of month of birth with atopy in adult patients with asthma and rhinitis in Anatolia,Turkey

BackgroundExposure to allergens in early life may predispose subjects to develop allergies and diseases related to allergic sensitisation.ObjectiveTo determine the association between month of birth and atopic sensitisation in adult Turkish patients with rhinitis and/or asthma using the diagnostic method of skin prick tests.MethodsThis prospective cross-sectional study included all adult patients who underwent skin prick testing with rhinitis and asthma from November 2009 to June 2010. Sensitisation was categorised as any sensitisation, pollen sensitisation, and house dust mite sensitisation. Multivariate logistic regression model was employed with the primary predictor being month of birth. Diagnosis (asthma, rhinitis and both), age, gender and family history of atopy were considered as potential confounders in the model. The associations were presented with both unadjusted and adjusted odds ratios (OR) and their 95% confidence interval (CI).ResultsA total of 616 subjects were evaluated. Three-hundred and forty-one subjects had sensitisation to allergens according to skin prick tests. Analyses showed that subjects born in September were less likely to have documented skin test positively with pollen sensitisation [0.27 (0.09–0.84), p = 0.023].ConclusionThe results support the hypothesis that being born at the end of the pollen season may protect subjects from pollen sensitisation.     

In vitro diagnostic evaluation of patients with inhalant allergies: summary of probability outcomes comparing results of CLA- and CAP-specific immunoglobulin E test systems.

For the diagnosis of allergy, presence of allergen-specific immunoglobulin E (IgE) usually is established either by allergen skin tests or by in vitro allergen-specific IgE measurements. However, in vitro assays of specific IgE often are modified as manufacturers improve allergens or change reagents to optimize test performance, affecting the diagnostic performance of in vitro allergen-specific IgE assays. This investigation compares the diagnostic outcomes of the Hitachi Chemical Diagnostics chemiluminescent assay (CLA) and Pharmacia, capsulated hydrophilic carrier polymer (CAP) in vitro allergen-specific IgE test methods in patients with inhalant allergy to a panel of selected allergens. Sera were obtained from 60 consecutive patients who had a clinical history suggesting inhalant allergy and were evaluated by allergen skin-prick test (SPT). Only patients with clinical findings of allergic asthma or rhinoconjunctivitis were included. Sera from patients with at least one positive SPT, which clinically correlated with the case history, were used for specific IgE measurements. Sensitivity and specificity were defined as conditional probabilities describing performances of the CAP system and the CLA system in reference to a standard composed of a combination of allergen-specific symptoms and a positive SPT. A test concordance of 79% was found between the CLA and CAP test results with a correlation coefficient of 0.8. Allergen-specific IgE assay sensitivity of the CLA and CAP systems was similar and allergen dependent, ranging from 67 to 100%. Assay specificity ranged from 39 to 86% for the CLA system and from 36 to 81% for the CAP system. When comparing the specific IgE results with allergen SPTs, 75% (+/- 3%) of CLApositive patients had a positive SPT, and 92% (+/- 4%) of CAPpositive patients had a positive SPT. Eighty-four percent (+/- 4%) of CLAnegative patients had a negative SPT, whereas 69% (+/- 5%) of CAPnegative patients had a negative SPT. The overall concordance between skin tests and in vitro tests was 76% for CLA and 67% for CAP. CLA and CAP score values showed good correlation and both tests may be useful when skin tests cannot be performed to identify subjects with IgE-mediated allergy. The CLA and CAP assays for allergen-specific IgE may be useful as part of an initial allergy evaluation because of the high negative predictive value of negative test results. For the majority of allergens the sensitivity was high. However, the specificity of both in vitro tests was low, indicating that positive in vitro test results should be evaluated carefully in conjunction with clinical symptoms and allergen-specific skin tests to determine the clinical relevance of the allergen sensitization.     

Prevalence and risk factors for latex allergy: a cross sectional study on health-care workers of an Italian hospital.

OBJECTIVES: The aim of this study was to determine prevalence and risk factors for latex hypersensitivity among health care workers (HCW) of an Italian general hospital. METHODS: 1747 HCW of the Ospedale Maggiore Policlinico of Milan were asked to fill in a questionnaire regarding latex-related manifestations (LRM) and personal medical history, and latex-specific IgE were measured by RAST-Cap system. RESULTS: 672 out of 1747 HCW (38.4%) answered to the questionnaire. LRM were reported by 168 out of 672 HCW (25%). The most common manifestation was hand dermatitis and itching (86.3%), followed by urticaria (3.5%) and respiratory symptoms (2.9%). Among the HCW with LRM, 75 (44.6%) reported a personal history of atopy and 24 (14.3%) reported oral allergy syndrome. most commonly related to kiwi, tomato, peach and melon/watermelon. Latex-specific IgE were found in 62 out of 1747 HCW (3.6%). Among the subjects answering the questionnaire, latex-specific IgE positivity was associated with occurrence of LRM (most commonly allergic contact dermatitis) and a longer professional exposure. The risk of latex IgE sensitisation was four times higher in HCW reporting atopic manifestations than in HCW without atopic disorders. Prevalence of LRM and latex-specific IgE was significantly higher among workers of auxiliary staff than among other job categories. The highest latex-specific IgE levels were found in subjects with severe latex-related symptoms and a personal history of atopy. CONCLUSIONS: A high prevalence of LRM was found among the HCW of an Italian general hospital, although a true latex sensitisation was detected only in a minority of cases. Members of the auxiliary staff, who wear latex gloves for several hours a day, had an increased prevalence of LRM and latex sensitisation. Atopy was a major risk factor for LRM and latex-specific IgE response.     

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).     

Work up of patients with history of beta-lactam hypersensitivity

IntroductionBeta-lactam antibiotics are the most frequent cause of antibiotic hypersensitivity reactions. The study of all cases of suspected beta-lactam hypersensitivity is highly important, to avoid the use of less efficient or more expensive alternatives, for fear of a reaction.Materials and methodsSixty-seven consecutive patients with suspected beta-lactam hypersensitivity reactions were studied. Skin prick tests (SPT), intradermal tests (IDT) and specific IgE determination were performed. In non-immediate reactions, epicutaneous testing was also done. If all were negative, a drug challenge was performed.ResultsSixty-seven patients (54 ♀), with a mean age±SD of 36.6±19.3 years (4–78 years) were studied. The self-reported antibiotics were amoxicillin and amoxicillin/clavulanic acid in 30 (45%), penicillin in 24 (36%), cephalosporins in 11 (16%) and flucloxacillin in 2 (3%). SPT and IDT were positive in 6 patients (9%) and specific IgE in 11 (16%). Only one patient had both positive specific IgE and skin tests. Of the remaining 51 cases, 33 underwent a drug challenge with the culprit antibiotic, with a positive reaction in 2 (6%). In all positive cases and when a drug challenge with the suspected antibiotic was not indicated, a challenge with an alternative drug was done, all with negative results.ConclusionsOf the 67 studied cases with history of beta-lactam hypersensitivity reactions, 18 (27%) were confirmed after testing. A combination of skin testing, specific IgE determination and drug challenge is necessary since none has sufficient sensitivity to be used alone.     

Molecular diagnosis of allergy to Anisakis simplex and Gymnorhynchus gigas fish parasites

BackgroundThere has been an increase in the prevalence of hypersensitivity to Anisakis simplex. There are fish parasites other than Anisakis simplex whose allergenicity has not yet been studied.ObjectiveTo assess IgE hypersensitivity caused by fish parasite allergens in patients with gastro-allergic symptoms after consumption of fish, shellfish or cephalopods, compared with healthy subjects, pollen allergic individuals and children with digestive symptoms after eating marine food.MethodsWe carried out in vivo tests (skin prick) and in vitro tests (specific IgE determination, Western blot) and component resolved diagnostics (CRD) using microarray analysis in all patients.ResultsCRD better detected sensitisation to allergens from marine parasites than skin prick tests and determination of specific IgE by CAP. Sensitisation to Gymnorhynchus gigas was detected in 26% of patients measured by skin prick tests and 36% measured by IgE.ConclusionsThe prevalence of hypersensitivity to marine parasite allergens other than Anisakis simplex should be studied, and the most appropriate technique for this is CRD.     

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.