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Allergy Advisor Digest - December 2011
Editor: Dr. Harris A. Steinman

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This is a monthly digest of interesting information that is being added to Allergy Advisor. While we add a great deal of information every month, here we highlight some of the more interesting articles.
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Ice cream urticaria.

The prevalence of aspirin hypersensitivity in patients with nasal polyposis and contributing factors.

Thirty-year survey on airborne pollen concentrations in Genoa, Italy

Milk allergy is frequent in patients with chronic sinusitis and nasal polyposis.

New allergen involved in a case of allergy to Solea solea, common sole.

The sting of the honeybee: an allergic perspective.

London Plane Tree bioaerosol exposure and allergic sensitization in Sydney, Australia.

Anaphylactoid reaction to facial adder bite.

Is epitope recognition of shrimp allergens useful to predict clinical reactivity?

Bet v 1-like pollen allergens of multiple Fagales species can sensitize atopic individuals.

Ovomucoid (Gal d 1) specific IgE detected by microarray system predict tolerability to boiled hen's egg and an increased risk to progress to multiple environmental allergen sensitisation.

Anaphylaxis in Turkish children: a multi-centre, retrospective, case study.

An increase in serum tryptase even below 11.4 ng/mL may indicate a mast cell-mediated hypersensitivity reaction: a prospective study in Hymenoptera venom allergic patients.

Management of multiple drug allergies in children.

Exposure to biomass smoke as a cause for airway disease in women and children.

Parental eczema increases the risk of double-blind, placebo-controlled reactions to milk but not to egg, peanut or hazelnut.

Clinical utility of ige antibodies to omega-5 gliadin in the diagnosis of wheat allergy

Degree of flowering implicates multiple Chenopodiaceae/Amaranthaceae species in allergy.

Temporal changes in total serum immunoglobulin E levels in East German children and the effect of potential predictors.

Rice-Induced Anaphylaxis: IgE-Mediated Allergy against a 56-kDa Glycoprotein.

Added value of IgE detection to rApi m 1 and rVes v 5 in patients with Hymenoptera venom allergy.

Predominant localization of the major Alternaria allergen Alt a 1 in the cell wall of airborne spores.

The who, where, and when of IgE in allergic airway disease.

Risk factors for new-onset cat sensitization among adults.

Late asthmatic reaction induced by exposure to raw Swiss chard.

Garlic-induced severe anaphylaxis in a nonatopic patient.

Fish allergy risk derived from ambiguous vernacular fish names.

The predictive value of skin prick testing for challenge-proven food allergy: A systematic review.

Inadvertent exposures in children with peanut allergy.

Mite allergens: an overview.

Anaphylaxis in an infant caused by menthol-containing cologne.

Diagnostic value of hazelnut allergy tests including rCor a 1 spiking in double-blind challenged children.

Computationally predicted IgE epitopes of walnut allergens contribute to cross-reactivity with peanuts.

Ice cream urticaria.
Ice cream urticaria. A healthy 43-year-old man experienced sudden dyspnea when eating ice cream and was soon unconscious. He was treated emergently for anaphylaxis, recovered

promptly. Total serum IgE was 998 IU/mL. RAST tests for specific IgE antibodies were all negative. Skin prick tests were negative for egg yolk and milk. Apart from ingredients of ice cream, cold hypersensitivity was suspected. An ice cube applied to the forearm for 5 minutes resulted in a wheal on the provocation area within 3 minutes of removal, disclosing he had cold urticaria. To confirm the anaphylaxis while eating ice cream had been due to a mucosa symptom of cold urticaria, an oral ice cube challenge test was conducted. Because cold urticaria causes edema in only coldstimulated areas, he lay on his right side with the ice cube touching only his right buccal mucosa. Marked edema developed on his right buccal mucosa.

Ice cream urticaria.
Ota M, Kawasaki H, Horimoto M.
Am J Med 2010 Dec;123(12):e1-e2

The prevalence of aspirin hypersensitivity in patients with nasal polyposis and contributing factors.
This study was designed to determine the prevalence of aspirin (acetylsalicylic acid [ASA]) hypersensitivity and factors associated with ASA hypersensitivity in patients with nasal polyps (NPs). Sixty-eight patients with NPs with or without asthma were recruited. Oral aspirin provocation test (APT) was performed in 53 (21 women/ 32 men) patients and was positive in 12 patients (22.6%) of whom 3 (25%) had no history of ASA hypersensitivity. Of the positive APTs, three were isolated rhinitis and nine had classic responses. APT was negative in 41 patients (77.4%) although three (7.3%) had a history of ASA hypersensitivity. ASA hypersensitivity is quite common in patients with NP. Patients with extensive and long-term NP with multiple polyp operations require evaluation for the presence of ASA hypersensitivity in terms of chronic management and future risks of the disease.

The prevalence of aspirin hypersensitivity in patients with nasal polyposis and contributing factors.
Bavbek S, Dursun B, Dursun E, Korkmaz H, Sertkaya KD.
Am J Rhinol Allergy 2011 Nov;25(6):411-415

Thirty-year survey on airborne pollen concentrations in Genoa, Italy
This 30-year study conducted in an urbanized area provides evidence that Betulaceae sensitization significantly increased, pollen load significantly augmented, and climate and air pollution changed with a possible influence on pollen release.

Thirty-year survey on airborne pollen concentrations in Genoa, Italy: Relationship with sensitizations, meteorological data, and air pollution.
Negrini AC, Negrini S, Giunta V, Quaglini S, Ciprandi G.
Am J Rhinol Allergy 2011 Nov;25(6):232-241

Milk allergy is frequent in patients with chronic sinusitis and nasal polyposis.
This study was initiated to scrutinize the relationship of wheat and milk allergies to chronic polypoid sinusitis (CPS) and recurrent disease. Blood samples of 50 patients with clinically and radiologically diagnosed CPS and nasal polyposis were screened for common food allergies including wheat and milk allergy. Fifteen of 100 tested subjects (15%) revealed a previously undiagnosed allergy to inhalant (dust, rye, and pollens) and other food allergens (corn and egg white). Six of 50 patients (12%) with CPS exhibited a wheat allergy, and a milk allergy could be identified in 7 patients (14%). In the control group, seven healthy subjects (14%) showed a wheat allergy and no case of milk allergy could be identified. The authors conclude that cow's milk but not wheat allergy might be a relevant pathogenetic entity in chronic nasal polyps.

Milk allergy is frequent in patients with chronic sinusitis and nasal polyposis.
Lill C, Loader B, Seemann R, Zumtobel M, Brunner M, Heiduschka G, Thurnher D.
Am J Rhinol Allergy 2011 Nov;25(6):221-224

New allergen involved in a case of allergy to Solea solea, common sole.
A 2-year-old Spanish girl with a history of food allergy to fish and other foods (cows milk, eggs, kiwi, and banana). At 1 year of age she developed urticaria and vomiting after eating haddock. Skin prick testing to commercially available fish extracts yielded positive results for haddock (5 mm), common sole (5 mm), sardine (5 mm), and anchovy (8 mm). Skin testing with the prick-by-prick method elicited positive responses to cooked sole (16 mm) and haddock (10 mm). Specific IgE were positive for salmon (0.43 kU/L), haddock (0.91 kU/L), and cod (0.92 kU/L) and were negative for tuna (0.35 kU/L). An open oral challenge test was performed, eliciting a urticarial reaction 15 minutes after eating 10 g of cooked common sole. Incubation with patient serum showed a main IgE-binding band with an apparent molecular weight of approximately 28 kDa which was identified as triosephosphate isomerase.

New allergen involved in a case of allergy to Solea solea, common sole.
Perez-Gordo M, Pastor VC, Cases B, De las HM, Sanz A, Vivanco F, Cuesta-Herranz J.
Ann Allergy Asthma Immunol 2010 Apr;104(4):352-353

The sting of the honeybee: an allergic perspective.
Honeybee is a significant cause of venom hypersensitivity. By understanding unique behaviors of honeybees, proper avoidance measures may be addressed with patients. Honeybee venom is complex, and the delivery mechanism provides for a large but often variable amount of injected venom. Diagnosis of honeybee allergy by imperfect skin and serologic testing further complicated by cross-reactivity is often difficult. Generally, honeybee immunotherapy is less safe and less effective than for other flying Hymenoptera.

The sting of the honeybee: an allergic perspective.
Brown TC, Tankersley MS.
Ann Allergy Asthma Immunol 2011 Dec;107(6):463-470

London Plane Tree bioaerosol exposure and allergic sensitization in Sydney, Australia.
Exposure to London Plane Tree (Platanus) bioaerosols in Sydney, Australia has been anecdotally linked to respiratory irritation, rhinitis, and conjunctivitis. This study evaluated the relationships between Platanus bioaerosol exposure, allergic sensitization, and symptoms in 64 subjects with self-reported Platanus symptoms. Platanus pollen constituted 76% of total pollen between July 2006 and April 2007. Airborne concentrations of Platanus pollen peaked from August until October. Non-Platanus pollen peaked from July to December. Elevated concentrations of trichomes and achene fibers occurred from September to December and August to October, respectively. As determined by SPT, 85.9% of subjects were sensitized, 65.6% to any pollen tested, 56.3% to Lolium perenne, and 23.4% to Platanus. Higher mean daily symptom scores were only associated with high counts of non-Platanus pollens. HIA analysis demonstrated IgE binding to Platanus pollen in all Platanus sensitized subjects. Personal nasal air sampling detected airborne trichomes that were capable of being inhaled. Platanus trichomes or achene fibers did not bind IgE from any subject. Therefore Platanus bioaerosols exist in high concentrations between August and November in inner-urban Sydney but were not associated with seasonal symptoms. Platanus trichomes are inhaled and may constitute a respiratory irritant.

London Plane Tree bioaerosol exposure and allergic sensitization in Sydney, Australia.
Sercombe JK, Green BJ, Rimmer J, Burton PK, Katelaris CH, Tovey ER.
Ann Allergy Asthma Immunol 2011 Dec;107(6):493-500

Anaphylactoid reaction to facial adder bite.
Anaphylactoid reaction to facial adder bite. A 3-year-old boy was found holding aloft a snake recognisable as an adder, which was coiling around both forearms. He said look and the snake struck and bit him twice on the face. The snake was thrown to the ground, but the boy did not express pain or distress. On admission he was vomiting, wheezy and tachypnoeic with facial swelling. He was tachycardic, obtunded and poorly perfused. Following treatment, which included intubation and ventilation, he normalised by the following morning and lactic acidosis resolved within hours. There was no evidence of skin necrosis, but facial nerve paresis was still present 2 weeks later despite oral steroids.

Anaphylactoid reaction to facial adder bite.
Forbes T, O'Donnell R.
Arch Dis Child 2011 Sep;96(9):822

Is epitope recognition of shrimp allergens useful to predict clinical reactivity?
Due to issues, e.g., cross-reactivity, diagnosis of shrimp allergy is still inaccurate, requiring the need for double-blind, placebo-controlled food challenges (DBPCFC). The objective of this study was to determine whether sensitization to certain shrimp allergens or recognition of particular IgE epitopes of those allergens are good biomarkers of clinical reactivity to shrimp. Thirty-seven consecutive patients with clinical histories of shrimp allergy were studied. Of 37 patients, 17 (46%) had a positive challenge to shrimp (11 children and 6 adults). Patients with positive challenges showed more intense binding to shrimp peptides than those with negative challenges. Statistically significant differences in terms of the frequency and intensity of IgE binding to some epitopes were observed between the two groups. Diagnostic efficiency was higher for individual epitopes than for proteins. Efficiency was particularly highest for certain Lit v 1 and Lit v 2 epitopes, followed by Lit v 3 and Lit v 4 epitopes.

Is epitope recognition of shrimp allergens useful to predict clinical reactivity?
Ayuso R, Sanchez-Garcia S, Pascal M, Lin J, Grishina G, Fu Z, Ibanez MD, Sastre J, Sampson HA.
Clin Exp Allergy 2011 Dec 22;

Bet v 1-like pollen allergens of multiple Fagales species can sensitize atopic individuals.
Fagales pollen allergy represents the main cause of winter/spring pollinosis in temperate climate zone of the Northern hemisphere. Among Fagales trees, pollen allergies are strongly associated within the Betulaceae and the Fagaceae families. It is widely accepted that Fagales pollen allergies are initiated by sensitization against Bet v 1, the birch pollen major allergen, although evidence is accumulating that the allergenic activity of some Bet v 1-like molecules has been underestimated. This study investigated the allergenic potential of the clinically most important Fagales pollen allergens from birch, alder, hazel, hornbeam, hop-hornbeam, oak, beech and chestnut, and to obtain the full spectrum of allergens, the three previously unavailable members of the Bet v 1-family, hop-hornbeam Ost c 1, chestnut Cas s 1 and beech Fag s 1, were identified in the respective pollen extracts, cloned and produced as recombinant proteins. Together with recombinant Bet v 1, Aln g 1, Car b 1, Cor a 1 and Que a 1, the molecules were characterized physicochemically, mediator release assays were performed and IgE cross-reactivity was evaluated by ELISA and ISAC IgE inhibition assays. All allergens showed the typical Bet v 1-like secondary structure elements, and they were all able to bind serum IgE from Fagales allergic donors. Strong IgE binding was observed for Betuloideae and Coryloideae allergens, however, cross-reactivity between the two subfamilies was limited. In contrast, IgE binding to members of the Fagaceae could be strongly inhibited by serum pre-incubation with allergens of the Betuloideae subfamily. The data suggests that Bet v 1-like allergens of the Betuloideae and Coryloideae subfamily might have the potential to induce IgE antibodies with different specificities, while allergic reactions towards Fagaceae allergens are the result of IgE cross-reactivity.

Bet v 1-like pollen allergens of multiple Fagales species can sensitize atopic individuals.
Hauser M, Asam C, Himly M, Palazzo P, Voltolini S, Montanari C, Briza P, Bernardi ML, Mari A, Ferreira F, Wallner M.
Clin Exp Allergy 2011 Dec;41(12):1804-1814

Ovomucoid (Gal d 1) specific IgE detected by microarray system predict tolerability to boiled hen's egg and an increased risk to progress to multiple environmental allergen sensitisation.
Detecting hen's egg (HE) allergy outgrowing and reintroduction of food containing egg is problematic. This study sought to evaluate the suitability of boiled egg food challenge compared with IgE to allergenic molecules from HE white using a microarray system Sixty-eight children with a suspected egg allergy were enrolled. Nineteen subjects (28%) were reactive to both raw and boiled egg, 14 (20.5%) to raw egg only and 35 (51.4%) tolerated both boiled and raw egg. Forty four of 47 Gal d 1 negative patients tolerated boiled egg (94%). Conversely, 20 of 21 Gal d 1 positive patients reacted to raw egg (95%). None of the other tests was able to discriminate patients' response to HE challenge. Furthermore, Gal d 1 positivity seems to lead to broader environmental allergen IgE sensitization. The Gal d 1 IgE reactivity appears to be a very good predictor of HE clinical allergy. Gal d 1 positive children have a high frequency of HE allergy, whereas Gal d 1 negative children have a high frequency of tolerance to boiled egg. Multiple specific IgE detection by means of ISAC improves the diagnostic approach in HE allergic children, disclosing other food and inhalant allergic sensitizations, anyhow requiring a comprehensive clinical evaluation.

Ovomucoid (Gal d 1) specific IgE detected by microarray system predict tolerability to boiled hen's egg and an increased risk to progress to multiple environmental allergen sensitisation.
Alessandri C, Zennaro D, Scala E, Ferrara R, Bernardi ML, Santoro M, Palazzo P, Mari A.
Clin Exp Allergy 2011 Dec 14;

Anaphylaxis in Turkish children: a multi-centre, retrospective, case study.
This Turkish study describes the demographic characteristics, clinical features, causes, settings, and administered therapy for anaphylaxis in Turkish children. Two hundred and twenty-four cases of anaphylaxis were reported in 137 children (88 boys). The mean age at the referral was 7.7 years (range: 4 months-17 years). Ninety-eight episodes (43.8%) occurred at home. The symptoms were cutaneous in 222 (99.1%) episodes, respiratory in 217 (96.9%), neuro-psychiatric in 118 (52.7%), cardiovascular in 92 (41.1%), and gastrointestinal in 88 (39.3%). Biphasic reaction was reported in seven episodes (3.1%). Death occurred in one case. Treatment was available in 158 episodes (70.5%). The causative agents were foods in 86 (38.4%), hymenoptera venom in 84 (37.5%), drugs and medications in 47 (21.0%), and latex in 5 (2.2%). In two episodes (0.9%), the causative agent was unidentified.

Anaphylaxis in Turkish children: a multi-centre, retrospective, case study.
Orhan F, Canitez Y, Bakirtas A, Yilmaz O, Boz AB, Can D, Kuyucu S, Harmanci K, Tahan F, Reisli I, Karakas T, Baki A, Cokugras H, Cakir M, Yuksel H.
Clin Exp Allergy 2011 Dec;41(12):1767-1776

An increase in serum tryptase even below 11.4 ng/mL may indicate a mast cell-mediated hypersensitivity reaction: a prospective study in Hymenoptera venom allergic patients.
During a systemic hypersensitivity reaction (SR), an increase in serum tryptase compared to the baseline value is an indicator of mast cell activation, most often due to an IgE-mediated mechanism. This study examined the relevance of an increase in serum tryptase below the upper normal value of 11.4 ng/mL and concludes that serum tryptase values obtained during a suspected hypersensitivity reaction must always be compared to a baseline value. A relative tryptase increase to >/=135% of the baseline value during a suspected hypersensitivity reaction indicates mast cell activation even below 11.4 ng/mL

An increase in serum tryptase even below 11.4 ng/mL may indicate a mast cell-mediated hypersensitivity reaction: a prospective study in Hymenoptera venom allergic patients.
Borer-Reinhold M, Haeberli G, Bitzenhofer M, Jandus P, Hausmann O, Fricker M, Helbling A, Muller U.
Clin Exp Allergy 2011 Dec;41(12):1777-1783

Management of multiple drug allergies in children.
"Children with multiple drug allergies are likely to require treatment with one or more of the drugs to which they may have had a reaction, when there is no alternate effective drug available. Detailed review of their history and/or use of appropriate diagnostic studies will help determine the potential safety of readministering the desired drug as well as the method for its readministration, most likely in the form of a drug challenge or desensitization. A practical approach to the diagnosis and treatment of children with multiple drug allergies is described in this review."

Management of multiple drug allergies in children.
Dioun AF.
Curr Allergy Asthma Rep 2011 Dec 3;

Exposure to biomass smoke as a cause for airway disease in women and children.
An estimated 3 billion people (about half the world's population) burn biomass fuel (wood, crop residues, animal dung and coal) for cooking and heating purposes exposing a large population, especially women and children, to high levels of indoor air pollution. Biomass smoke comprises gaseous air pollutants as well as particulate matter air pollutants, which have significant harmful effects. Exposure to biomass smoke is a major contributor to morbidity and mortality. Children, women and the elderly are most affected. Apart from poor lung growth seen in growing children, the risk of developing respiratory tract infections (both upper as well as lower) is greatly increased in children living in homes using biomass. Women who spend many hours cooking food in poorly ventilated homes develop chronic obstructive lung disease (COPD), asthma, respiratory tract infections, including tuberculosis and lung cancer. It has been argued that exposure to biomass fuel smoke is a bigger risk factor for COPD than tobacco smoking.

Exposure to biomass smoke as a cause for airway disease in women and children.
Kodgule R, Salvi S.
Curr Opin Allergy Clin Immunol 2011 Dec 9;

Parental eczema increases the risk of double-blind, placebo-controlled reactions to milk but not to egg, peanut or hazelnut.
This study aimed to determine whether parental atopic diseases are associated with a higher risk of a reaction to common allergenic foods when tested in a double-blind, placebo-controlled food challenge (DBPCFC). Data from 553 double-blind food challenges performed in 396 children were analyzed. The foods tested were milk (n = 185), egg (n = 110), peanut (n = 198) and hazelnut (n = 60). Children with a positive DBPCFC to milk more frequently have parents with eczema than children with a negative test. This effect of parental eczema was not seen in children challenged with egg, peanut or hazelnut.

Parental eczema increases the risk of double-blind, placebo-controlled reactions to milk but not to egg, peanut or hazelnut.
van den Berg ME, Flokstra-de Blok BM, Vlieg-Boerstra BJ, Kerkhof M, van der HS, Koppelman GH, Postma DS, Dubois AE.
Int Arch Allergy Immunol 2011 Dec 29;158(1):77-83

Clinical utility of ige antibodies to omega-5 gliadin in the diagnosis of wheat allergy
There are contradictory results regarding the clinical usefulness of the determination of IgE antibodies to omega-5 gliadin in children with a suspicion of wheat allergy (WA). 311 children and young adults with suspected wheat intolerance, with the exception of 25, were found to be positive in specific IgE antibody determinations to wheat. Ages ranged from 6 months to 20.4 years. Possible relationships between IgE antibodies to omega-5 gliadin and a physician's diagnosis of WA and challenge symptoms were studied. The mean concentration of IgE antibodies to omega-5 gliadin was 1.2 kU(A)/l in WA patients and <0.35 kU(A)/l in patients without WA. Seventy-two percent of the WA patients had positive omega-5 gliadin levels and 75% of the patients without WA had negative levels. Logistic regression showed a significant relationship between the probability of WA and the concentration of IgE antibodies to omega-5-gliadin with a 2.6-fold increased risk. Age was an important factor to consider. Therefore detection of IgE to omega-5 gliadin seems to be associated with responsiveness to the challenge test and is particularly useful in infants with a suspicion of WA.

Clinical utility of ige antibodies to omega-5 gliadin in the diagnosis of wheat allergy: a pediatric multicenter challenge study.
Ebisawa M, Shibata R, Sato S, Borres MP, Ito K.
Int Arch Allergy Immunol 2011 Dec 29;158(1):71-76

Degree of flowering implicates multiple Chenopodiaceae/Amaranthaceae species in allergy.
IgE-mediated sensitization to the Chenopodiaceae/Amaranthaceae families is a cause of allergic symptoms in arid areas. Salsola kali and Chenopodium album are considered the main species responsible; however, there is a discrepancy between the pollination period of these two plants and clinical symptoms. This study's objective was to identify new Chenopodiaceae/Amaranthaceae members with sensitization capacity and to correlate symptoms, pollen counts and degree of flowering of different species. 37 individuals monosensitized to S. kali and C. album were included in the study. Extracts from Chenopodium (album, vulvaria and murale), Salsola (kali, vermiculata, and oppositifolia), Bassia scoparia, Atriplex (patula and halimus) and Amaranthus (deflexus and muricatus) were used in skin prick tests (SPTs). Protein content and IgE binding were assessed for each extract. Symptom scores demonstrated a positive correlation with pollen counts even outside the pollination period of S. kali. Positive SPTs were obtained with all 11 species tested, which showed common proteins with IgE-binding capacity. Different species flowered at different times during the pollen season. Therefore different taxonomically related species of Chenopodiaceae/Amaranthaceae can induce allergic sensitization and should be considered for use in diagnosis and treatment. Degree of flowering is a complementary method for assessing pollination that could be used for botanical families with indistinguishable pollen grains.

Assessing degree of flowering implicates multiple Chenopodiaceae/Amaranthaceae species in allergy.
Ferrer L, Carnes J, Rojas-Hijazo B, Lopez-Matas MA, Sobrevia MT, Colas C.
Int Arch Allergy Immunol 2011 Dec 29;158(1):54-62

Temporal changes in total serum immunoglobulin E levels in East German children and the effect of potential predictors.
Elevated total serum immunoglobulin E (IgE) levels are a prominent feature of allergic and parasitic diseases. An epidemiologic study was conducted in East German children to describe trends in the development of total serum IgE levels and analyze the impact of potential determinants. The study consisted of three cross-sectional surveys in 1992-1993, 1995-1996 and 1998-1999 and was conducted in three areas of the former German Democratic Republic. Total serum IgE levels decreased significantly with a linear trend in East German schoolchildren between 1992 and 1999, the effect being stronger in nonatopic children. Total serum IgE declined parallel to helminth infestation; however, the latter explained the decrease only in part. Furthermore, total IgE developed in an opposite direction to specific IgE, indicating that it has determinants other than allergic sensitization.

Temporal changes in total serum immunoglobulin E levels in East German children and the effect of potential predictors.
Flohrs K, Bruske I, Thiering E, Rzehak P, Wichmann HE, Heinrich J.
Int Arch Allergy Immunol 2011 Dec 28;158(1):27-34

Rice-Induced Anaphylaxis: IgE-Mediated Allergy against a 56-kDa Glycoprotein.
In this case study rice allergens were identified, presumably responsible for anaphylaxis after ingestion of rice in a German patient. Prick-to-prick tests were positive to raw and cooked rice (basmati rice and long-grain rice) and preparations of different rice extracts. Specific IgE against rice (f9) was 1.87 kU(A)/l. The BAT showed specific IgE-mediated activation of basophils after stimulation with rice extracts. Four IgE-reactive rice proteins with an apparent molecular weight of 49, 52, 56 and 98 kDa were identified. Only binding to the 56-kDa glycoprotein was at least partially independent from cross-reactive carbohydrate determinants (CCD), whereas IgE binding to the other rice proteins was completely inhibited by pre-incubation with the CCD MUXF derived from bromelain. Therefore, yet unidentified high-molecular-weight allergens from rice seeds, predominantly a 56-kDa glycoprotein, seem to be responsible for anaphylaxis after consumption of rice in a German patient.

Rice-Induced Anaphylaxis: IgE-Mediated Allergy against a 56-kDa Glycoprotein.
Trcka J, Schad SG, Scheurer S, Conti A, Vieths S, Gross G, Trautmann A.
Int Arch Allergy Immunol 2011 Dec 28;158(1):9-17

Added value of IgE detection to rApi m 1 and rVes v 5 in patients with Hymenoptera venom allergy.
Added value of IgE detection to rApi m 1 and rVes v 5 in patients with Hymenoptera venom allergy: this study demonstrates that using the recombinant species-specific major allergens of bee venom, rApi m 1, and Vespula species venom, rVes v 5, detects IgE in patients with Hymenoptera venom allergy with high sensitivity and specificity.

Added value of IgE detection to rApi m 1 and rVes v 5 in patients with Hymenoptera venom allergy.
Hofmann SC, Pfender N, Weckesser S, Huss-Marp J, Jakob T.
J Allergy Clin Immunol 2010 Aug 16;

Predominant localization of the major Alternaria allergen Alt a 1 in the cell wall of airborne spores.
The localization of Alt a 1 and Alt a 8 (recognized by 41% of Alternaria-sensitized patients was investigated. Alt a 1 was exclusively found in the cell wall, and there in the melanin layer of older spores. In contrast, Alt a 8 could be localized only in the cytoplasm of hyphae but not in spores.

Predominant localization of the major Alternaria allergen Alt a 1 in the cell wall of airborne spores.
Twaroch TE, Arcalis E, Sterflinger K, Stoger E, Swoboda I, Valenta R.
J Allergy Clin Immunol 2011 Nov 11;

The who, where, and when of IgE in allergic airway disease.
"Allergic asthma and allergic rhinitis/conjunctivitis are characterized by a T(H)2-dominated immune response associated with increased serum IgE levels in response to inhaled allergens. Because IgE is a key player in the induction and maintenance of allergic inflammation, it represents a prime target for therapeutic intervention. However, our understanding of IgE biology remains fragmentary. This article puts together our current knowledge on IgE in allergic airway diseases with a special focus on the identity of IgE-secreting cells ('who'), their location ('where'), and the circumstances in which they are induced ('when'). We further consider the therapeutic implications of the insights gained."

The who, where, and when of IgE in allergic airway disease.
Dullaers M, De BR, Ramadani F, Gould HJ, Gevaert P, Lambrecht BN.
J Allergy Clin Immunol 2011 Dec 9;

Risk factors for new-onset cat sensitization among adults.
Cat exposure during childhood has been shown to increase the risk of developing cat sensitization, while the effect of cat exposure in adulthood has not yet been established. This study evaluated new-onset sensitization to cat in adulthood in relation to changes in cat keeping in 6292 European Community Respiratory Health Survey I (ECRHS I) participants aged 20 to 44 years from 28 European centers, who were not sensitized to cat, and were reevaluated 9 years later in ECRHS II. A total of 4468 subjects did not have a cat in ECRHS I or ECRHS II, 473 had a cat only at baseline, 651 acquired a cat during the follow-up, and 700 had a cat at both evaluations. Two hundred thirty-one subjects (3.7%) became sensitized to cat. Cat acquisition during follow-up was significantly associated with new-onset cat sensitization (relative risk = 1.85, 95% CI 1.23-2.78) when compared with those without a cat at both surveys.

Risk factors for new-onset cat sensitization among adults: A population-based international cohort study.
Olivieri M, Zock JP, Accordini S, Heinrich J, Jarvis D, Kunzli N, Anto JM, Norback D, Svanes C, Verlato G.
J Allergy Clin Immunol 2011 Dec 9;

Late asthmatic reaction induced by exposure to raw Swiss chard.
Late asthmatic reaction induced by exposure to raw Swiss chard. A 52-year-old housewife with a history of allergic rhinoconjunctivitis due to grass pollen who experienced 2 episodes of wheezy dyspnea and cough within 8 to 10 hours of handling raw Swiss chard at home. Positive skin prick results were obtained for Lolium, Olea, Cupressus,

and Chenopodium pollen, raw Swiss chard, and spinach. A skin patch test with raw Swiss chard was negative. Total serum IgE was 803 kU/L. Specifi c IgE (kU/L) was positive for sugar beet (2.62) and rBet v 1 (2.16) and negative for spinach. A specific inhalation challenge (SIC)

performed by asking the patient to handle Swiss chard as she would do at home elicited a 20% fall in PEF from baseline with dyspnea 10 hours after the test, and a 32% fall in FEV1 24 hours after the challenge. No immediate asthmatic reaction was observed. Several IgE-binding bands were observed in the raw extract with the patients serum (molecular masses of 16, 33, 36, 45, 70, 80, and 92 kDa), but no bands were observed with the cooked Swiss chard extract.

Late asthmatic reaction induced by exposure to raw Swiss chard.
Valbuena T, Barranco P, Pascual C, Lopez-Serrano MC, Quirce S.
J Investig Allergol Clin Immunol 2010;20(3):268-269

Garlic-induced severe anaphylaxis in a nonatopic patient.
Garlic-induced severe anaphylaxis in a nonatopic patient. A 52-year-old man reported 2 anaphylactic episodes that had occurred in the past 10 months, both in association with the ingestion of garlic. The fi rst episode had occurred 8 months before the visit. Approximately 15 minutes after eating mackerel with string beans and a yogurt, cucumber, and garlic sauce, he developed erythematous, pruritic palms and angioedema of the upper lip, followed by dizziness and finally, loss of consciousness. The second episode occurred 40 days prior to the visit while the patient was eating cod with a garlic-based sauce. The symptoms were erythema and pruritus of the palms and angioedema of the upper lip about 30 minutes after ingestion. He tolerated onion, leek, and various types of fish. Specific IgE to onion was 0.75 kU/L and for garlic 0.81 kU/L. Total serum IgE was 56.0 kU/L. The SPTs and prick-to-prick tests with extracts and fresh foods, respectively, proved to be the most reliable methods for diagnosing garlic allergy and locating the culprit allergen (garlic germ induced the greatest wheal reaction).

Garlic-induced severe anaphylaxis in a nonatopic patient.
Vovolis V, Kalogiros L, Ivanova D, Koutsostathis N.
J Investig Allergol Clin Immunol 2010;20(4):356

Fish allergy risk derived from ambiguous vernacular fish names.
Vernacular names may not distinguish fish species, like in Greece, where hake, cod and other Gadoids are generically named with the same Greek word Bakaliaros. The purpose of the study was to detect and quantify allergenic fish species contained in commercial seafood labelled with generic and unspecific names. Commercial samples were obtained at random from Greek fish markets and fish species were identified based on PCR fragments of the 5S rDNA. Almost 85% of the analysed products contained highly allergenic hake or grenadier species and only 15% contained less allergenic species like cod and haddock. The study concluded that commercial fish markets are potential hotspots of allergy risk, and suggest labelling containing species names and consumer education for reading labels as preventive measures. (Triantafyllidis 2010 ref.27117 7)

Fish allergy risk derived from ambiguous vernacular fish names: Forensic DNA-based detection in Greek markets.
Triantafyllidis A, Karaiskou N, Perez J, Martinez JL, Roca A, Lopez B, Garcia-Vazquez E.
Miscellaneous Food Research International 2010;43(8):2214-16.

The predictive value of skin prick testing for challenge-proven food allergy: A systematic review.
To reduce the need for oral food challenges (OFCs), it has been suggested that children forgo an OFC if their SPT wheal size exceeds a cutoff that has a high predictability for food allergy. Although data for these studies are almost always gathered from high-risk populations, the 95% positive predictive values (PPVs) vary substantially between studies. SPT thresholds with a high probability of food allergy generated from these studies may not be generalizable to other populations, because of highly selective samples and variability in participant's age, test allergens, and food challenge protocol. Standardization of SPT devices and allergens, OFC protocols including standardized cessation criteria, and population-based samples would all help to improve generalizability of PPVs of SPTs.

The predictive value of skin prick testing for challenge-proven food allergy: A systematic review.
Peters RL, Gurrin LC, Allen KJ.
Pediatr Allergy Immunol 2011 Dec 4;

Inadvertent exposures in children with peanut allergy.
From 2004 to November 2009, parents of Canadian children with a physician-confirmed peanut allergy completed entry and follow-up questionnaires about accidental exposures over the preceding year. A total of 1411 children [61.3% boys, mean age 7.1 yr] participated. 266 accidental exposures occurred over 2227 patient-years, yielding an annual incidence rate of 11.9%. Only 21% of moderate and severe reactions were treated with epinephrine. Age >/=13 yr at study entry and a severe previous reaction to peanut were associated with an increased risk of accidental exposure, and increasing disease duration with a decreased risk.

Inadvertent exposures in children with peanut allergy.
Nguyen-Luu NU, Ben-Shoshan M, Alizadehfar R, Joseph L, Harada L, Allen M, St-Pierre Y, Clarke A.
Pediatr Allergy Immunol 2011 Dec 4;

Mite allergens: an overview.
"Mite allergens from the Pyroglyphidae family are the most frequent and potent sources of perennial asthma and rhinitis. Since 1988 molecular knowledge has considerably increased and structures and functions have been determined for most of them. Of the 22 denominated allergens, Der p 1 and Der p 2 are major allergens recognized by more than 80% of lgE from Dpt allergic patients in Europe. Der p 4, Der p 5 and Der p 7 appeared to be intermediate allergens. The binding of IgE to groups 3, 6, 8, 9, 10 and 20 is constantly low. Most of the allergens can be identified by amino-acid sequences and the tertiary structure of the major allergens has been solved. Most Dpt mite allergens are proteolytic enzymes: Der p 1 for instance is a cysteine protease. Der p 2 has structural homology with MD-2, a co-receptor of the Toll-like receptor (TLR4) whose ligand is LPS. Knowledge of the mite allergens structure has allowed a better interpretation of cross reactions between allergens from the same family or from more distant families. From a practical point of view molecular epidemiology has allowed a better choice of allergen molecules useful for diagnosis. Finally, new concepts of immunotherapy based on genetically engineered hypoallergenic variants of major allergens, used alone or in combination, can be considered."

Mite allergens: an overview.
Bessot JC, Pauli G.
Eur Ann Allergy Clin Immunol 2011 Oct;43(5):141-156

Anaphylaxis in an infant caused by menthol-containing cologne.
A 2-month-old infant developed anaphylaxis after application of cologne to his face by his mother. He developed facial oedema, shortness of breath and cyanosis after application of menthol-containing cologne to his face.

Anaphylaxis in an infant caused by menthol-containing cologne.
Arikan-Ayyildiz Z, Akgül F, Yilmaz S, Ozdemir D, Uzuner N.
Allergol Immunopathol (Madr) 2011 Dec 30;

Diagnostic value of hazelnut allergy tests including rCor a 1 spiking in double-blind challenged children.
The aim of this study was to analyze the performance of current diagnostic tests for hazelnut allergy in children and the effect of spiking with Cor a 1. Data of 151 children who underwent a double-blind placebo-controlled food challenge for hazelnut were analyzed. The positive predictive value and negative predictive value (PPV/NPV) of level of specific IgE (sIgE) for hazelnut, the influence of rCor a 1 spiking of the ImmunoCAP, and size of the skin prick test (SPT) for hazelnut were determined, also in relation to the severity of the hazelnut allergy. Reported accidental ingestion leading to an allergic reaction to hazelnut was also analyzed in relation to hazelnut allergy. Specific IgE >/=0.35 kU(A) /l for hazelnut was a moderate predictor for hazelnut allergy. The spiking decreased the PPV from 41% to 38% and increased the NPV from 91% to 100% for sIgE >/=0.35 kU(A) /l. The maximum reached PPV was 73% for sIgE cutoff of 26 kU(A) /l. Level of sIgE before spiking was significantly different between different grades of severity and was lost after spiking. Skin prick test was a better predictor for hazelnut allergy and severity than the level of sIgE. A history of accidental ingestion leading to an allergic reaction to hazelnut had a predictive value of 59% for hazelnut allergy.

Diagnostic value of hazelnut allergy tests including rCor a 1 spiking in double-blind challenged children.
Masthoff LJ, Pasmans SG, van HE, Knol MJ, Bruijnzeel-Koomen CA, Flinterman AE, Kentie P, Knulst AC, Meijer Y.
Allergy 2011 Dec 19;

Computationally predicted IgE epitopes of walnut allergens contribute to cross-reactivity with peanuts.
Cross-reactivity between peanuts and tree nuts implies that similar immunoglobulin E (IgE) epitopes are present in their proteins. This study determined whether walnut sequences similar to known peanut IgE-binding sequences, according to the property distance (PD) scale implemented in the Structural Database of Allergenic Proteins, react with IgE from sera of patients with allergy to walnut and/or peanut. Sequences from the vicilin walnut allergen Jug r 2, which had low PD values to epitopes of the peanut allergen Ara h 2, a 2S albumin, bound to IgE in sera from five patients who reacted to either walnut or peanut or both. A walnut epitope recognized by sera from six patients mapped to a surface-exposed region on a model of the N-terminal pro-region of Jug r 2. This predicted walnut epitope competed for IgE binding to Ara h 2 in serum as well as the known IgE epitope from Ara h 2. Therefore sequences with low PD value (< 8.5) to known IgE epitopes could contribute to cross-reactivity between allergens.

Computationally predicted IgE epitopes of walnut allergens contribute to cross-reactivity with peanuts.
Maleki SJ, Teuber SS, Cheng H, Chen D, Comstock SS, Ruan S, Schein CH.
Allergy 2011 Dec;66(12):1522-1529

Allergen-, Food allergy-, Intolerance-related articles

Ice cream urticaria.
Ota M, Kawasaki H, Horimoto M. Am J Med 2010 Dec;123(12):e1-e2

The prevalence of aspirin hypersensitivity in patients with nasal polyposis and contributing factors.
Bavbek S, Dursun B, Dursun E, Korkmaz H, Sertkaya KD. Am J Rhinol Allergy 2011 Nov;25(6):411-415

Thirty-year survey on airborne pollen concentrations in Genoa, Italy: Relationship with sensitizations, meteorological data, and air pollution.
Negrini AC, Negrini S, Giunta V, Quaglini S, Ciprandi G. Am J Rhinol Allergy 2011 Nov;25(6):232-241

Reliability of basophil activation test using CD203c expression in diagnosis of pollen allergy.
Ozdemir SK, Guloglu D, Sin BA, Elhan AH, Ikinciogullari A, Misirligil Z. Am J Rhinol Allergy 2011 Nov;25(6):225-231

Milk allergy is frequent in patients with chronic sinusitis and nasal polyposis.
Lill C, Loader B, Seemann R, Zumtobel M, Brunner M, Heiduschka G, Thurnher D. Am J Rhinol Allergy 2011 Nov;25(6):221-224

New allergen involved in a case of allergy to Solea solea, common sole.
Perez-Gordo M, Pastor VC, Cases B, De las HM, Sanz A, Vivanco F, Cuesta-Herranz J. Ann Allergy Asthma Immunol 2010 Apr;104(4):352-353

A multi-center, retrospective review of patch testing for contact dermatitis in allergy practices.
Camacho-Halili M, Axelrod S, Michelis MA, Lighvani S, Khan F, Leon S, Aquino MR, vis-Lorton M, Fonacier LS. Ann Allergy Asthma Immunol 2011 Dec;107(6):487-492

The sting of the honeybee: an allergic perspective.
Brown TC, Tankersley MS. Ann Allergy Asthma Immunol 2011 Dec;107(6):463-470

Comparing specific IgE values of 2 different assays.
Williams PB, Portnoy J. Ann Allergy Asthma Immunol 2011 Dec;107(6):550

Macrogol hypersensitivity in multiple drug allergy.
Bommarito L, Mietta S, Nebiolo F, Geuna M, Rolla G. Ann Allergy Asthma Immunol 2011 Dec;107(6):542-543

Successful use of prasugrel, an alternative antiplatelet agent, in a patient with clopidogrel allergy.
Chopra P, Verma P, Klaustermeyer WB. Ann Allergy Asthma Immunol 2011 Dec;107(6):541-542

Allergy to Jerusalem artichoke due to immediate IgE reaction to Bet v1-like allergen.
Doyen V, Leduc V, Ledent C, Michel O, Mairesse M. Ann Allergy Asthma Immunol 2011 Dec;107(6):540-541

Challenge sting: to bee or not to bee.
Freeman TM. Ann Allergy Asthma Immunol 2011 Dec;107(6):538-539

London Plane Tree bioaerosol exposure and allergic sensitization in Sydney, Australia.
Sercombe JK, Green BJ, Rimmer J, Burton PK, Katelaris CH, Tovey ER. Ann Allergy Asthma Immunol 2011 Dec;107(6):493-500

Anaphylactoid reaction to facial adder bite.
Forbes T, O'Donnell R. Arch Dis Child 2011 Sep;96(9):822

Laboratory diagnosis of acute anaphylaxis.
Brown SG, Stone SF. Clin Exp Allergy 2011 Dec;41(12):1660-1662

Is epitope recognition of shrimp allergens useful to predict clinical reactivity?
Ayuso R, Sanchez-Garcia S, Pascal M, Lin J, Grishina G, Fu Z, Ibanez MD, Sastre J, Sampson HA. Clin Exp Allergy 2011 Dec 22;

Bet v 1-like pollen allergens of multiple Fagales species can sensitize atopic individuals.
Hauser M, Asam C, Himly M, Palazzo P, Voltolini S, Montanari C, Briza P, Bernardi ML, Mari A, Ferreira F, Wallner M. Clin Exp Allergy 2011 Dec;41(12):1804-1814

Ovomucoid (Gal d 1) specific IgE detected by microarray system predict tolerability to boiled hen's egg and an increased risk to progress to multiple environmental allergen sensitisation.
Alessandri C, Zennaro D, Scala E, Ferrara R, Bernardi ML, Santoro M, Palazzo P, Mari A. Clin Exp Allergy 2011 Dec 14;

Anaphylaxis in Turkish children: a multi-centre, retrospective, case study.
Orhan F, Canitez Y, Bakirtas A, Yilmaz O, Boz AB, Can D, Kuyucu S, Harmanci K, Tahan F, Reisli I, Karakas T, Baki A, Cokugras H, Cakir M, Yuksel H. Clin Exp Allergy 2011 Dec;41(12):1767-1776

An increase in serum tryptase even below 11.4 ng/mL may indicate a mast cell-mediated hypersensitivity reaction: a prospective study in Hymenoptera venom allergic patients.
Borer-Reinhold M, Haeberli G, Bitzenhofer M, Jandus P, Hausmann O, Fricker M, Helbling A, Muller U. Clin Exp Allergy 2011 Dec;41(12):1777-1783

Management of multiple drug allergies in children.
Dioun AF. Curr Allergy Asthma Rep 2011 Dec 3;

Exposure to biomass smoke as a cause for airway disease in women and children.
Kodgule R, Salvi S. Curr Opin Allergy Clin Immunol 2011 Dec 9;

Parental eczema increases the risk of double-blind, placebo-controlled reactions to milk but not to egg, peanut or hazelnut.
van den Berg ME, Flokstra-de Blok BM, Vlieg-Boerstra BJ, Kerkhof M, van der HS, Koppelman GH, Postma DS, Dubois AE. Int Arch Allergy Immunol 2011 Dec 29;158(1):77-83

Clinical utility of ige antibodies to omega-5 gliadin in the diagnosis of wheat allergy: a pediatric multicenter challenge study.
Ebisawa M, Shibata R, Sato S, Borres MP, Ito K. Int Arch Allergy Immunol 2011 Dec 29;158(1):71-76

Assessing degree of flowering implicates multiple Chenopodiaceae/Amaranthaceae species in allergy.
Ferrer L, Carnes J, Rojas-Hijazo B, Lopez-Matas MA, Sobrevia MT, Colas C. Int Arch Allergy Immunol 2011 Dec 29;158(1):54-62

Temporal changes in total serum immunoglobulin E levels in East German children and the effect of potential predictors.
Flohrs K, Bruske I, Thiering E, Rzehak P, Wichmann HE, Heinrich J. Int Arch Allergy Immunol 2011 Dec 28;158(1):27-34

Rice-Induced Anaphylaxis: IgE-Mediated Allergy against a 56-kDa Glycoprotein.
Trcka J, Schad SG, Scheurer S, Conti A, Vieths S, Gross G, Trautmann A. Int Arch Allergy Immunol 2011 Dec 28;158(1):9-17

Predominant localization of the major Alternaria allergen Alt a 1 in the cell wall of airborne spores.
Twaroch TE, Arcalis E, Sterflinger K, Stoger E, Swoboda I, Valenta R. J Allergy Clin Immunol 2011 Nov 11;

The who, where, and when of IgE in allergic airway disease.
Dullaers M, De BR, Ramadani F, Gould HJ, Gevaert P, Lambrecht BN. J Allergy Clin Immunol 2011 Dec 9;

Advanced glycation end products contribute to the immunogenicity of IFN-beta pharmaceuticals.
Bozhinov A, Handzhiyski Y, Genov K, Daskalovska V, Niwa T, Ivanov I, Mironova R. J Allergy Clin Immunol 2011 Dec 7;

Anaphylaxis to apple and orange seed.
Turner PJ, Gray PE, Wong M, Varese N, Rolland JM, O'Hehir R, Campbell DE. J Allergy Clin Immunol 2011 Dec;128(6):1363-1365

Garlic-induced severe anaphylaxis in a nonatopic patient.
Vovolis V, Kalogiros L, Ivanova D, Koutsostathis N. J Investig Allergol Clin Immunol 2010;20(4):356

Fish allergy risk derived from ambiguous vernacular fish names: Forensic DNA-based detection in Greek markets.
Triantafyllidis A, Karaiskou N, Perez J, Martinez JL, Roca A, Lopez B, Garcia-Vazquez E. Miscellaneous Food Research International 2010;43(8):2214-16.

The predictive value of skin prick testing for challenge-proven food allergy: A systematic review.
Peters RL, Gurrin LC, Allen KJ. Pediatr Allergy Immunol 2011 Dec 4;

The EuroPrevall birth cohort study on food allergy: baseline characteristics of 12,000 newborns and their families from nine European countries.
McBride D, Keil T, Grabenhenrich L, Dubakiene R, Drasutiene G, Fiocchi A, Dahdah L, Sprikkelman AB, Schoemaker AA, Roberts G, Grimshaw K, Kowalski ML, Stanczyk-Przyluska A, Sigurdardottir . Pediatr Allergy Immunol 2011 Dec 23;

Inadvertent exposures in children with peanut allergy.
Nguyen-Luu NU, Ben-Shoshan M, Alizadehfar R, Joseph L, Harada L, Allen M, St-Pierre Y, Clarke A. Pediatr Allergy Immunol 2011 Dec 4;

Total viable molds and fungal DNA in classrooms and association with respiratory health and pulmonary function of European schoolchildren.
Simoni M, Cai GH, Norback D, nnesi-Maesano I, Lavaud F, Sigsgaard T, Wieslander G, Nystad W, Canciani M, Viegi G, Sestini P. Pediatr Allergy Immunol 2011 Dec;22(8):843-852

Mite allergens: an overview.
Bessot JC, Pauli G. Eur Ann Allergy Clin Immunol 2011 Oct;43(5):141-156

Anaphylaxis in an infant caused by menthol-containing cologne.
Arikan-Ayyildiz Z, Akgül F, Yilmaz S, Ozdemir D, Uzuner N. Allergol Immunopathol (Madr) 2011 Dec 30;

Human blood basophils do not act as antigen-presenting cells for the major birch pollen allergen Bet v 1.
Kitzmuller C, Nagl B, Deifl S, Walterskirchen C, Jahn-Schmid B, Zlabinger GJ, Bohle B. Allergy 2011 Dec 20;

Diagnostic value of hazelnut allergy tests including rCor a 1 spiking in double-blind challenged children.
Masthoff LJ, Pasmans SG, van HE, Knol MJ, Bruijnzeel-Koomen CA, Flinterman AE, Kentie P, Knulst AC, Meijer Y. Allergy 2011 Dec 19;

Computationally predicted IgE epitopes of walnut allergens contribute to cross-reactivity with peanuts.
Maleki SJ, Teuber SS, Cheng H, Chen D, Comstock SS, Ruan S, Schein CH. Allergy 2011 Dec;66(12):1522-1529

Diagnosis and treatment of grass pollen-induced allergic rhinitis in specialized current clinical practice in Spain.
Valero A, Chivato T, Justicia JL, Navarro AM. Allergy Asthma Proc 2011 Sep;32(5):384-389

Indoor allergen sensitization and the risk of asthma and eczema in children in Pittsburgh.
McHugh BM, Macginnitie AJ. Allergy Asthma Proc 2011 Sep;32(5):372-376

An extremely unusual case presentation of aspirin-exacerbated respiratory disease (AERD).
Woessner KM, Simon RA, White A, Stevenson DD. Allergy Asthma Proc 2011 Sep;32(5):399-400

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