Allergy to peanut oil – clinically relevant?

The increasing prevalence of food allergies (especially allergy to peanuts) has led to a discussion of how safe topical preparations containing peanut oil are with respect to allergy. The major allergens from peanuts are proteins that have been characterized at a molecular level and cloned. Clinical signs of peanut allergy symptoms can be observed on the skin (urticaria), or in the gastrointestinal and/or respiratory tract culminating in cardiovascular symptoms and anaphylactic reactions. In most cases, symptoms are elicited by oral uptake; rarely, a contact urticaria has been described. In vegetable oils, the contents of protein differ depending on the production process: crude oils contain approximately 100 times more proteins than refined oils. This has clear-cut implications for allergic individuals. Quantitative data are available regarding elicitation of symptoms in allergic individuals with a threshold dose of 0.1-1 mg peanut allergen in oral provocation tests. There are anecdotal reports of adverse reactions after topical use of peanut oils. In one epidemiological trial, an association between topical use of skin care products containing peanut oil and the development of peanut allergy was observed; however, the data reflect a retrospective analysis without specifying skin care products containing peanut oil and also without analysing the quantity of topicals used. In contrast, oral tolerance was prevented and allergic sensitization was enhanced in a mouse model using high concentrations of peanut protein. So far, no reliable data are available regarding doses required to induce sensitization against peanut allergen via the epidermal route. A possible induction of sensitization against peanut proteins through contact with the skin via skin care products and the respective protein concentrations is a matter of speculation. Patients with atopic diseases, namely eczema, need appropriate skin care because of the disturbed skin barrier function. The benefit of avoiding damage to skin barrier functions of atopic individuals by the use of peanut protein-containing skin care products seems to outweigh possible risks of sensitization and/or allergy induction against substances contained in those products containing refined peanut oil.     

Rekombinante Allergene

Component-resolved diagnosis of allergies allows disease-specific patterns of sensitization in some conditions such as allergic bronchopulmonary aspergillosis ABPA). By determination of IgE against important pollen allergens such as Bet v 1, Ole e 1 or Phl p1/Phl p 5, more precise guidance for allergen-specific immunotherapy may be achieved, as pollen extracts contain mostly these major allergens. Sensitizations against minor allergens such as profilins or polcalcins influence the outcome of IgE measurements against full allergen sources, but are often of limited clinical relevance. In food allergy, frequent cross reactivity between pollens such as birch pollen via Bet v 1/PR10 proteins can be identified. Sensitization against some storage proteins such as peanut (Ara h 2) or lipid transfer proteins of peach (Pru p 3) or hazelnut (Cor a 8) may indicate an increased risk of severe anaphylactic reactions. Exercise-induced anaphylaxis, unclear sensitizations against latex or double-positivity in insect allergy are other useful indications for component-resolved diagnosis. Microarray-based allergen chip diagnosis makes possible today the detection of IgE against more than 100 allergens in tiny amounts of serum and is very promising, but still needs evaluation and optimization in regard to allergen selection and sensitivity.     

牛乳蛋白敏感的婴儿湿疹患者生长发育过程中体内牛乳蛋白sIgE及血清总IgE的变化

目的:分析对牛乳蛋白过敏的婴儿湿疹患者在生长发育过程中特异性牛乳蛋白sIgE、血清总IgE和皮损表现的变化.方法:回顾性分析2015年7月至2020年7月57例严重婴儿湿疹患儿,观察期间(30个月)食用乳蛋白配方奶粉(氨基酸配方),严格规避牛乳蛋白及其制品,于入组开始和结束时评估患儿皮损积分,检测患儿血清牛乳蛋白sIg...     

Occupational protein contact dermatitis from spices in a butcher: a new presentation of the mugwort-spice syndrome

Protein contact dermatitis to meat is well known in butchers; spices are another source of potential contact allergy and usually are not recognized. We present a first case of contact-dermatitis to spice mix in a 39-year-old-butcher. The patient underwent skin prick testing (SPT) with standard allergens (ALK) and different meat and spice extracts (Stallergènes), scratch-patch testing with spice mix containing glutamate, paprika and other spices. Specific serum-IgE was measured with CAP-FEIA. SPT only showed an immediate-type sensitization to mugwort (+ +), as well as different spices (paprika +, curry +, cumin +) and camomile (+ + +). Scratch-patch tests were negative for different meat, but strongly positive for spice mix (+ + +) after 30 min (wheal and flare) and (+ +) after 48 h (infiltration and vesiculation). Two healthy controls were tested negative for spice mix used from that patient (scratch-patch). Specific IgE was slightly elevated for paprika 0.47 kU/L (CAP class 1), anise 0.43 kU/L, curry 0.36 kU/L and mugwort 3.83 kU/L. Sx1 atopy-multiscreen was 3.8 kU/L due to a sensitization to mugwort alone. The tests performed demonstrate an IgE-mediated contact allergy to spices but also a delayed type allergy to spice mix as a manifestation of the mugwort-spice syndrome in this individual. When testing for occupational dermatitis in butchers, protein contact allergy to spices must also be taken into consideration.     

Correlation among skin prick test, total and specific IgE UniCAP tests in atopic patients from Zagreb, Croatia

The correlation of pollen allergens, Dermatophagoides pteronyssinus and animal dender was assessed during a two-year period. Results of skin prick test, total and specific IgE UniCAP tests were compared in atopic patients (AP) with the following diagnoses: atopic dermatitis, allergic rhinitis, allergic conjunctivitis, allergic bronchitis or asthma, allergic urticaria and angioedema. The study included total and specific IgE (in vitro) tests to allergen mixtures (grass, tree, weed) or to single allergens of Dermatophagoides pteronyssinus (Der p), cat and dog fur, feather, etc. Comparison of skin prick test with total and specific IgE UniCAP immunoassay was done in 173 patients, i.e. 107 female and 66 male atopic patients aged 9-76 years. Allergies were most commonly recorded in the 25-35 age group. Total IgE ranged from 8.63 kU/l to >4000 kU/l, with specific IgE ranging from class 1 to class 5. Skin prick test showed high correlation with specific IgE for grass and weed pollen in patients with repiratory allergy (50.28%). Good correlation among all three tests was quite frequently observed. The results suggest that the study should be continued using these three tests in further cases of atopic dermatitis.     

P14Hydrolysed wheat protein: a new allergen in cosmetics and food

For the pas few years, mainly because of mad cow disease, hydrolysed wheat proteins (HWP) have been used in cosmetics and food as emulsifiers and stabilizers in replacement of bovine collagen. We report here contact urticaria to cosmetics induced by these HWP in 7 patients of which 6 had food allergy to modified gluten and the results of their immunological testing. These cases were regrouped through the french network REVIDAL‐GERDA.
All 7 women developped contact urticaria immediatly after applying cosmetics (mainly facial cream), from different brands, containing HWP. Six of them had also anaphylactic reactions or urticaria after eating preserved foods or delicatessen which contained modified gluten. Neither had allergic reaction after eating broad or bread.
Skin tests were positive with the cosmetics, HWP contained in them and, in case of food allergy, modified gluten. They were negative with natural wheat flour. Despite that, specific IgE to wheat flour were positive in 2 cases. Specific IgE to gluten were positive in 3 patients.
Sera were also investigated for their specificity toward wheat proteins and various preparations of gluten. Individual variations of specificity were observed. All sera contained IgE reacting with both hydrolysed peptides and some native flour proteins.
It appears that, from the medical history, allergy to cosmetics preceeded food allergy. In view of these elements, may be the use of HWP in cosmetics should be questionned.     

Total IgE levels in the serum in dermatologic diseases

A total of 2,951 determinations of total IgE serum levels in dermatologic patients revealed significantly elevated geometric mean values in 18 of 25 diagnostic groups. The highest IgE concentrations (geometric mean greater than 100 kU/l) were found in atopic diseases (atopic eczema, extrinsic asthma, allergic rhinitis), scabies, ichthyosis vulgaris and diseases of the prurigo group. Furthermore, total IgE was elevated in acute, chronic, and physical urticaria, in patients with immediate-type allergies, in various kinds of eczema, in patients with characteristic features of atopy (typus atopicus), in psoriasis, in pyogenic skin infections, and alopecia areata. The range of individual IgE values was wide: in all diagnostic groups individual IgE levels beneath the normal adult geometric mean of 14 kU/l were found; the maximum concentrations were 340-47,000 kU/l, thus exceeding the upper limit of 100 kU/l for individual values. Knowledge of the patient's clinical condition is a prerequisite for the diagnostic interpretation of an individual total IgE serum level.     

Berufliche Beifuß‐Allergie

Background: Mugwort (Artemisia vulgaris) has traditionally been used as a spice, vegetable and as a herbal medicine. The main representatives of the Artemisia family besides Artemisia vulgaris include Artemisia absinthum and Artemisia dracunculus (estragon). Mugwort pollen allergens are important in triggering late summer and fall pollinosis; in addition cross reactivity occurs between Artemisia vulgaris pollen allergens and celery, carrottes and certain spices belonging to the family of Umbelliferae. Patients: A florist with a pre‐existing sunflower allergy developed a life‐threatening glottal edema after occupational contact with mugwort. She did not suffer from an oral allergy syndrome towards mugwort pollen cross allergens. Results: Skin testing (prick and scratch testing) revealed a strong sensitisation against mugwort and estragon. Specific IgE antibodies against mugwort, sunflower, carrots, celery, fennel and anis were elevated in the peripheral blood. Conclusions: The observation of a severe mugwort allergy with life‐threatening complications in a florist underscores the high allergenic potential of Artemisia vulgaris and documents for the first time the occupational significance of this allergy.     

Prevalence of food avoidance and food allergy in Chinese patients with chronic urticaria

Summary Background Food avoidance is common among Chinese patients with chronic urticaria because food allergy is considered to be the cause of disease. The benefit of food avoidance and its relationship with food allergy is unknown. Objectives The aims of this study were to examine the prevalence and effect of food avoidance and food allergy in patients with chronic urticaria. Methods Four hundred and ninety‐four patients with chronic urticaria, who attended Peking University Third Hospital from January 2009 to December 2010, were studied. Food avoidance and its effect were investigated with a detailed questionnaire. Food allergy was diagnosed by serum food‐specific immunoglobulin E (IgE), elimination diet based on food‐specific IgE, and open food challenge. Results One hundred and fifty‐eight patients (32%) avoided fish, shrimp, crab, lamb or beef prior to evaluation and 82·9% of them reported food avoidance ineffective. Out of 341 patients tested for serum food‐specific IgE, 75 (22%) were positive, with soy, peanut, beef, lamb, chicken, crab and shrimp as the leading allergens. Chronic urticaria induced by food allergy was found in only 2·8% of patients. Conclusions The prevalence of food avoidance is high and mostly ineffective in Chinese patients with chronic urticaria. Foods avoided do not correspond to serum food‐specific IgE. The incidence of IgE‐mediated urticaria, as demonstrated by open food challenge, is low. Physicians and patients should be aware of unnecessary dietary avoidance while seeking treatment of chronic urticaria.     

IgE-binding components in Pityrosporum orbiculare identified by an immunoblotting technique.

IgE-binding components in crude extracts of Pityrosporum orbiculare were separated by sodium dodecylsulphate polyacrylamide gel electrophoresis and transferred to Immobilon membrane. The components were detected by P. orbiculare radioallergosorbent (RAST) positive sera (class 2-4) from 37 patients with atopic dermatitis and visualized by enzyme-labelled anti-human IgE antibodies in chromogenic substrate. Numerous IgE-binding compounds were demonstrated in the molecular weight (MW) range of 14-94 kD. Eight of them were characterized to molecular size, frequency of reacting sera and intensity of bands. Six of the defined components were found to be major allergens reacting with more than 50% of the sera. They had MWs 86, 76, 67, 28, 17 and 13 kD. Thirty-six of the 37 patients had elevated total serum IgE. Two other patient categories were studied; 11 patients with lymphatic filariasis (high total serum IgE, greater than 1,300 kU/l) and 15 pityriasis versicolor patients (normal total serum IgE, less than 122 kU/l). The P. orbiculare RAST values for these sera showed good accordance with the reactivity in immunoblotting experiments.     

Consensus Communication on Early Peanut Introduction and Prevention of Peanut Allergy in High‐Risk Infants

The purpose of this brief communication is to highlight emerging evidence regarding potential benefits of supporting early rather than delayed peanut introduction during the period of complementary food introduction in infants. This document should be considered as interim guidance based on consensus among the following organizations: American Academy of Allergy, Asthma, and Immunology, American Academy of Pediatrics, American College of Allergy, Asthma, and Immunology, Australasian Society of Clinical Immunology and Allergy, Canadian Society of Allergy and Clinical Immunology, European Academy of Allergy and Clinical Immunology, Israel Association of Allergy and Clinical Immunology, Japanese Society for Allergology, Society for Pediatric Dermatology, and World Allergy Organization. More formal guidelines regarding early‐life, complementary feeding practices and the risk of allergy development will follow in the next year from the National Institute of Allergy and Infectious Diseases—sponsored Working Group and the European Academy of Allergy and Clinical Immunology.     

花生过敏症

目前在世界范围内花生过敏的致命发生率有所增加。花生过敏症是由免疫球蛋白E(IgE)对花生蛋白质产生的过敏性反应,过敏原主要是通过摄食,其次为通过皮肤接触和吸入进入体内。临床症状经常涉及多个系统,包括皮肤、心血管、消化和呼吸系统。诊断花生过敏的第一步是详细询问病史和体格检查,诊断试验包括皮肤点刺试验(SPT)、体外花生特异性IgE测定、直接进食花生试验。花生过敏症的预防重点是教育患者及其家属避免接触含有花生成分的产品,此外还应该了解过敏反应的早期体征,学会对过敏症状的初步治疗,以及长期随访。目前,临床医生正在研究具有良好应用前景的新的免疫治疗方案。     

Patch test reactivity to feverfew‐containing creams in feverfew‐allergic patients

Background: The Compositae plant feverfew (Tanacetum parthenium) has long been recognized as an important sensitizer in European Compositae‐allergic patients, mainly because of its content of the sesquiterpene lactone parthenolide. Recently, a parthenolide‐depleted feverfew extract with claimed anti‐inflammatory properties has been developed for use in cosmetics. Objective: The aim of the study was to test, on the basis of patch test reactions, whether persons with contact allergy to feverfew could tolerate creams containing this feverfew extract. Patients/Materials/Methods: Seven patients with feverfew contact allergy were patch tested with two creams containing the feverfew extract. Subsequently, the creams were analysed by liquid chromatography with tandem mass spectrometry to detect parthenolide. Results: Four of the patients tested positive to one of the creams; reactivity was associated with simultaneous positive reactions to parthenolide. This cream was analysed about 2 years later, and no parthenolide was detected, probably because of degradation of the compound. Conclusions: Topical products containing parthenolide‐depleted feverfew extracts may elicit positive patch test reactions in feverfew‐sensitive patients. The reactivity may be enhanced by simultaneous testing with parthenolide, but the reactivity is lost over time, probably because of degradation of parthenolide.     

Two cases of pollen-food allergy syndrome to soy milk diagnosed by skin prick test, specific serum immunoglobulin E and microarray analysis

Oral allergy syndrome to soy milk is classified as a phenotype of pollen-food allergy syndrome (PFAS). As causative antigens, Gly m 4 (Bet v 1 homolog, 17 kD) and oleosin (23 kD), have been reported. In this study, we report two cases of PFAS to soy milk. Both cases showed positive reactions to soy milk in skin prick tests (SPT) and to Gly m 4 in specific serum immunoglobulin (Ig)E antibody. When we measured specific serum IgE antibody of soy-related proteins using a new laboratory testing method, microarray analysis, both cases showed a positive reaction for Bet v 1. One case was weakly positive for a soybean protein, β-conglycinin. Other results for reactivity to soy, peanut, cross-reactive carbohydrate determinants and profilin were negative. Based on these results, we diagnosed the two cases as PFAS to Gly m 4. We also performed protein microarray analysis and found it useful as a screening test for immediate allergy, such as PFAS.     

Food allergy

Food allergy is defined by a specific sensitization against food allergens which is associated with a clinical reaction. Immediate reactions are most common and the skin is most often involved in food allergy. Most food allergies are IgE‐mediated although eczema reactions in atopic dermatitis and in hematogenous contact dermatitis to foods can be mediated by specific T‐lymphocytes. Only few foods are responsible for the majority of most reactions in childhood. In adults up to 60% of all food allergic reactions are due to cross reactions between foods and inhalative allergens. A stepwise procedure which takes individual factors into account is necessary in the diagnostics of food allergy. The diagnostic algorithm in food allergy is not significantly different from that of other allergies. The oral provocation is the only method to prove food allergy in patients without a convincing history. A specific elimination diet is the only intervention which has been proven to be effective. Further therapeutic approaches are still under study and include specific immunotherapy, specific oral tolerance induction and treatment with anti‐IgE antibodies.     

Contact and photocontact allergy to octocrylene: a review

Octocrylene is an ultraviolet (UV)B and UVAII absorber that was introduced some 15 years ago, and is now widely used in sunscreen agents and skin care cosmetics. Since 2003, several studies, notably from France, Belgium, Spain, and Italy, have reported an increasing number of patients with photocontact allergy to octocrylene. This reaction is seen mainly in adult patients who have previously used topical products containing the non‐steroidal anti‐inflammatory drug ketoprofen. Photosensitization to ketoprofen leads, in many cases, to photocontact allergy to octocrylene; the mechanism of this reaction is unknown. Contact allergy to octocrylene also occurs, but is far less frequent, and is seen, in most cases, in children, resulting from the use of octocrylene‐containing sunscreen products. In this article, (photo)contact allergy to octocrylene is fully reviewed.     

Allergic contact dermatitis from dyes in wigs following diphencyprone treatment

Objectives:  To investigate symptoms from the eyes and airways, elicited by perfume and fragrance products and associations between such symptoms and skin prick test reactivity, metacholine bronchial hyperreactivity (BHR), contact allergy, and eczema in a population based sample.
Methods:  A questionnaire on mucosal symptoms elicited by fragrance products was mailed to 1189 persons who had participated in a Danish population‐based study of allergic diseases in 1997/98. The study included measurement of BHR, skin prick testing, patch testing and history of hand eczema.
Results:  The response rate to the questionnaire was 80%. Symptoms from the eyes or airways elicited by fragrance products were reported by 42%. There were no significant associations between these symptoms and skin prick test reactivity. Positive and independent statistical significant associations were found between BHR, perfume contact allergy and hand eczema, and symptoms from the eyes and airways elicited by fragrance products, also when adjusting for nickel contact allergy, age, gender psychological vulnerability, educational level and social class.
Conclusions:  Individuals with BHR, hand eczema and/or perfume contact allergy, as opposed to those without, are more frequently and more severely bothered from the eyes or airways after volatile exposure to fragrance products. The lack of association with skin prick test reactivity indicates that IgE mediated allergic mechanisms do not play a major role in the development of these symptoms. Having hand eczema has the greatest impact on reporting mucosal symptoms elicited by fragrance products.     

Occupational dermatoses and allergy to metals in Polish construction workers manufacturing prefabricated building units

The incidence of dermatoses and allergy to metals (Cr, Co, Ni) was determined in 1782 workers exposed to cement, waste fly ash and asbestos cement. They were also exposed to reclaimed (used), mineral oils. Dermatitis was found in 23.6% of the subjects, and oil acne in 11.2%. Allergy to chromium was found in 23% of the subjects; the % of definitely positive patch test results (the total of positive +(+) and strongly positive +(+)+ was, however, 8.6%. Allergy to cobalt was found in 13.4% of the subjects examined (definite in 3.1%). Allergy to nickel was found in 2.7% of the subjects (definite in 1.1%). The risks of occurrence of occupational skin disease and allergy to metals in subjects exposed to ash were found to be lower than in subjects exposed to cement, and were similar to those in subjects exposed to asbestos cement. Overall chromium, cobalt and nickel contents in ash and asbestos were higher than in cement. Soluble chromium compound content in ash was lower than in cement from European countries and similar to that in American cement.     

Peanut allergy

Peanut allergy is acute and severe with symptoms of immediate hypersensitivity. This allergy is very common, affecting 1% of preschoolers. The incidence has increased with succeeding generations, and is possibly due to the increasing exposure of children to peanuts at a young age. Diagnosis is via history, skin prick test, and serum IgE level. The mainstay of therapy is avoidance. Treatment of anaphylaxis includes epinephrine and antihistamines. Children usually will not outgrow this food allergy. Novel treatment with rush immunotherapy and enzyme-potentiated desensitization is not currently acceptable. We describe a 27-month-old Asian boy with a typical presentation of peanut hypersensitivity. A good understanding of the epidemiology of this illness is necessary for treatment and prevention.     

Anaphylaktische Reaktion durch Ficus benjamina (Birkenfeige)

Ficus benjamina (weeping fig) is a widespread indoor ornamental plant. Allergens of Ficus benjamina are a well-known cause of IgE-mediated respiratory diseases. We treated a 32-year-old female who for 10 years had suffered from perennial rhinoconjunctivitis. When dusting her 2 meter high Ficus benjamina, she developed an anaphylactic reaction which resolved without sequelae. Skin prick testing revealed a strong immediate type reaction to a Ficus extract, the serum concentration of specific IgE-antibodies to Ficus was %gt;100 kU/l (CAP class 6). In view of these strong test reactions and the conclusive history, no challenge tests with Ficus allergens were performed. After removal of the Ficus plants which she had owned for 17 years and after thorough cleaning of her dwelling, the patient's symptoms of perennial rhinoconjunctivitis stopped. The patient also was sensitized to, but not allergic to natural rubber latex, which occurs frequently in Ficus allergy and probably is due to cross reactivity to allergens from both sources. As Ficus benjamina is an important source of indoor allergens, it should not be used in dwellings or work places.