Sensitization to human milk

Background Allergy to milk is one of the earliest manifestations of IgE‐mediated allergies and affects about 2.5% of newborn children. Several reports indicate that milk‐allergic patients may be sensitized also to human milk proteins. Objective To analyse the specificity and possible biological relevance of IgE reactivity to human milk antigens in milk‐allergic patients. Methods The specificity of IgE reactivity to cow's milk and human milk antigens was analysed with sera from milk‐allergic children and adults by IgE immunoblotting. IgE cross‐reactivity between milk antigens was studied by immunoblot inhibition experiments. That IgE reactivity to human milk antigens is not due to alloreactivity or due to the transmission of foreign antigens into mother's milk was demonstrated through the analysis of milk samples from genetically unrelated mothers before and after intake of dietary milk products. The biological relevance of IgE reactivity to human milk was confirmed by skin testing. Results IgE antibodies to human milk were found in more than 80% of the tested milk‐allergic patients. Cross‐reactive IgE‐reactive human antigens such as α‐lactalbumin and non‐cross‐reactive human milk antigens were identified. Immediate‐type skin reactions could be elicited with human milk samples in patients with IgE reactivity to human milk. Conclusion IgE reactivity to human milk in milk‐allergic patients can be due to cross‐ sensitization and genuine sensitization to human milk and may cause allergic symptoms. IgE‐mediated sensitization to human milk is common in milk‐allergic patients and may require diagnostic testing and monitoring.     

Recurrent pericarditis: a rare complication of allergen immunotherapy

We report on a 29-year-old woman suffering from hay fever due to grass and olive tree pollens. She developed recurrent pericarditis during her first course of immunotherapy with an alum-adsorbed pollen extract. A causal relationship was established between the allergen injections and the acute pericarditis episodes on two consecutive occasions, which presented with blood eosinophilia. Blood cultures and serological tests for microorganisms were negative. There were no signs of autoimmune disease or systemic vasculitis. To the best of our knowledge, allergen immunotherapy-induced pericarditis has not been previously reported.     

A double-blind, placebo-controlled oral challenge study with lyophilized larvae and antigen of the fish parasite, Anisakis simplex

BACKGROUND: The third-stage larvae of Anisakis simplex may be a hidden source of allergens in fish. The objective was to determine whether the ingestion of lyophilized A. simplex larvae, or antigen, induces clinical symptoms in a group of A. simplex-sensitized patients. METHODS: Double-blind, placebo-controlled oral challenges were conducted in 11 individuals who had experienced allergic reactions after eating fish. Another patient had chronic urticaria unrelated to the ingestion of fish. All patients had positive skin tests and specific IgE determinations for A. simplex and negative skin tests to a battery of fish species. Conjunctival tests with A. simplex extracts were conducted in all patients and in five controls. The 12 patients received capsules containing either lactose or one, five, or 25 lyophilized larvae of A. simplex at 2-h intervals in a double-blind fashion. The highest single dose was 100 larvae. ECP and tryptase levels in serum were measured before and after the last oral challenge. Lyophilized antigen was also given to five patients. RESULTS: None of the 12 patients experienced a positive reaction after the ingestion of the placebo, the lyophilized larvae, or the antigen. Tryptase and ECP levels before and after challenges did not change significantly. Conjunctival provocation tests were positive in 11 out of the 12 patients and in none of the controls. CONCLUSIONS: The ingestion of 100 lyophilized A. simplex larvae, or its equivalent in antigen, does not induce clinical symptoms in individuals with a clinical history and laboratory findings of hypersensitivity to A. simplex. The data suggest that only the ingestion of live larvae may be capable of inducing allergic manifestations.     

Coexistence of asthma and allergic rhinitis in adult patients attending allergy clinics: ONEAIR study.

BACKGROUND: Several studies have shown links between the upper and lower airways in allergic patients. OBJECTIVES: This study aimed to evaluate the prevalence of rhinitis in patients with allergic asthma attending allergy outpatient clinics and to examine the interrelationship between both conditions. METHODS: An epidemiological prospective study was carried out during the period 2004-2005 and 170 allergists from all over the country participated. After obtaining written informed consent, we collected clinical and demographic data, a personal and family history of allergic diseases, and data on the duration and severity of asthma and rhinitis. These data were classified according to the criteria of the Global Initiative for Asthma and the Allergic Rhinitis and its Impact on Asthma guidelines, respectively. RESULTS: A total of 968 subjects were screened and 942 were enrolled in the study. Mean (SD) age was 35.5 (14) years and 63% were female. Of these patients, 89.5% presented with allergic rhinitis. The duration of the disease was 12.6 (8.9) years for rhinitis and 11.4 (9.6) years for asthma (P < .0001). The severity of asthma was classified as intermittent (39%), mild persistent (30%), moderate persistent (27%), and severe persistent (4%). Rhinitis was classified as mild intermittent (24%), moderate/severe intermittent (22%), mild persistent (19%) and moderate/severe persistent (35%). A significant correlation was found (P < .0001) between the severity of rhinitis and asthma. The prevalence of allergic rhinitis was inversely correlated with the age of the patients (P < .0001) and the severity of asthma (P < .05). CONCLUSION: This study reinforces the high prevalence of allergic rhinitis in patients with asthma, which can affect as many as 89.5%.