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Allergy Advisor Digest - February 2010
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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Allergy to Royal Poinciana (Gulmohar tree) and Yellow Poinciana (Yellow flame tree)

Pomegranate (Punica granatum) allergy.

Identification of a novel 17-kDa protein as a ferret allergen.

Allergic reaction due to Anisakis simplex after the ingestion of salted fish guts made of Sagittated calamari

Anti-allergic activity of naringenin chalcone from a tomato skin extract.

Should avoidance of foods be strict in prevention and treatment of food allergy?

Work-Related Allergy and Asthma in Spice Mill Workers - the Impact of Processing

Features of feather duvet lung.

A novel major Japanese cedar pollen allergen belonging to the aspartic protease family.

Major cat allergen Fel d 1 is maintained among the main anatomical sites of production.

Toxocariasis (Roundworm of dogs) resulting in seeming allergy.

Caterpillars and moths: Dermatologic manifestations of encounters with Lepidoptera.

Voluntarily reported unintentional injections from epinephrine auto-injectors.

Allergy or tolerance in children sensitized to peanut: prevalence and differentiation using component-resolved diagnostics.

Food allergy due to olive.

Molecular diagnosis of allergy to the management of pediatric patients with allergy to pollen.

Diagnosing human anisakiasis: recombinant Ani s 1 and Ani s 7 allergens versus CAP

Higher histamine sensitivity in non-atopic subjects by skin prick test may result in misdiagnosis of eggplant allergy.

Detailed proteomic analysis on donkey milk.

Pine nut anaphylaxis after eating muesli.

A novel Cladosporium herbarum allergen - alpha/beta hydrolase

Effect of the introduction of solid foods during the first year and allergic sensitization at age 5 years.

Pre-lethal anaphylaxis to carboxymethylcellulose confirmed by identification of specific IgE

Insect allergy: house fly, mosquito, horsefly.

In vitro allergy diagnostic tests and cross-reactivity.

Stressful life events in childhood and allergic sensitisation.

IgE to peanut allergen components: relation to peanut symptoms and pollen sensitization

Sesame allergy: role of specific IgE and skin-prick testing in predicting food challenge results.

Numismedica: health problems caused by coins.

Allergy to Royal Poinciana (Gulmohar tree) and Yellow Poinciana (Yellow flame tree)
Delonix regia (Royal Poinciana / Gulmohar tree) and Peltophorum pterocarpum (Yellow Poinciana / Yellow flame tree) pollen are important aeroallergens for type 1 hypersensitivity in the tropics. This study characterized the IgE-binding proteins of D regia pollen and investigated the cross-allergenity with P pterocarpum pollen (Both are Leguminosae). Of a total of 2,234 patients with respiratory allergies in Calcutta, India, skin prick tested with D regia allergen extract, 695 (31.1%) showed a +1 and 130 (5.8%) showed a +2/+3 reaction on SPT. Nine IgE-reactive protein components were found. Maximum IgE reactivity, contained 2 (96 and 66 kDa) IgE-reactive protein components. Marked cross-reactivity between D regia and P pterocarpum pollen was found. Shared IgE-binding components (66, 56, 32, 28, 25, and 23 kDa) were observed between D regia and P pterocarpum pollen extracts, whereas the 96 and 43 kDa components were specific to D regia.

Biomolecular identification of allergenic pollen: a new perspective for aerobiological monitoring?
Longhi S, Cristofori A, Gatto P, Cristofolini F, Grando MS, Gottardini E.
Ann Allergy Asthma Immunol 2009 Dec;103(6):508-514

Pomegranate (Punica granatum) allergy.
The first case series of patients with allergic symptoms that developed after eating fresh pomegranate fruit:

(1) a 19-year-old man who complained of 2 episodes of angioedema of the upper lips and tongue, which appeared a few minutes after ingestion of the fresh fruit;

(2) a 13-year-old boy who had an episode of widespread urticaria and angioedema of the lips after ingestion of the fresh fruit;

(3) a 31-year-old woman who complained of an episode of urticaria 20 minutes after ingestion of the fresh fruit; and

(4) a 23-year-old woman who complained of an episode of angioedema of the face and lips, itching of the throat, abdominal pain, and widespread urticaria, which developed approximately an hour after ingestion of pomegranate fruit.

SPT with Pomegranate extracts were positive in all. Protein bands were seen at 29 and 12 kDa, and immunoblotting analysis showed IgE reactivity of patients serum to a single band at 29 kDa. Two patients (patients 1 and 3) had a history of seasonal respiratory symptoms, and 3 (patients 1, 2, and 3) showed specific IgE to pollens. Eating peaches and walnuts also resulted in symptoms.

Pomegranate (Punica granatum) allergy: clinical and immunological findings.
Damiani E, Aloia AM, Priore MG, Nardulli S, Ferrannini A.
Ann Allergy Asthma Immunol 2009 Aug;103(2):178-180

Identification of a novel 17-kDa protein as a ferret allergen.
29-year-old man had a 3-year history of mild perennial asthma. He reported aggravation of these symptoms in the previous 2 years, coinciding with the entry of 2 ferrets into his house. SPT was positive to, among other, epithelium from cat, dog, horse, and rabbit. Protein bands ranging from 14 to 66 kDa in both types of ferret extracts (ferret hair and ferret urine). Ferret urine immunoblotting showed IgE-binding proteins of 59, 34, 25, and 17 kDa in reducing conditions and 42, 23, 18, 16, and 15 kDa in nonreducing conditions. A 19-kDa IgE-binding band was revealed with extracts from dog dander, cat epithelium, and hamster urine. Inhibition assays with male ferret urine as inhibitor and dog and cat epithelium extracts in solid phase showed total IgE-binding inhibition on 19and 39-kDa bands, respectively. The 17-kDa protein was studied because it was the ferret urine protein with the highest IgE-binding capacity. It did not correspond to any previously reported allergens compared with the databases. The SPT was performed with this purified allergen with positive results.

Identification of a novel 17-kDa protein as a ferret allergen.
Gonzalez de OD, Pastor VC, Cases OB, Perez-Gordo M, Moral D, Vivanco F, Bartolome B.
Ann Allergy Asthma Immunol 2009 Aug;103(2):177-178

Allergic reaction due to Anisakis simplex after the ingestion of salted fish guts made of Sagittated calamari
A 75-year-old man ingested salted fish guts made of Sagittated calamari which he caught in the daytime, with alcohol and then dozed. Five hours later, he woke up due to itching over his entire body and noticed generalized urticaria and a swollen tongue, which was too large for him to close his mouth. Serum total IgE was 456 IU/ml and ImmunoCAP was positive for anisakis, but negative for squid, shrimp, and ascaris. A skin prick test (SPT) was positive for anisakis extract (10 mg/ml) and house dust mites, but negative for squid and shrimp. He was diagnosed with IgE-mediated allergy due to Anisakis simplex after the ingestion of salted fish guts made of Sagittated calamari, which had been parasitized by Anisakis simplex. SPT with six extracts of purified or recombinant allergens (Ani s 1, 3, 4, 5, 6, and 8) was performed to identify the causative allergens in this case. Only Ani s 3 (tropomyosin) was positive, indicating that Ani s 3 was the causative allergen in this case. Third stage larvae of the nematode Anisakis simplex often parasitize not only marine fish but also invertebrates, including squid. It is necessary to consider Anisakis simplex allergy for urticarial reactions that develop after the ingestion of squid.

A case of an allergic reaction due to Anisakis simplex after the ingestion of salted fish guts made of Sagittated calamari: allergen analysis with recombinant and purified Anisakis simplex allergens. [Japanese]
Shigehira Y, Inomata N, Nakagawara R, Okawa T, Sawaki H, Nakamura K, Kobayashi Y, Shiomi K, Ikezawa Z.
Arerugi 2010 Jan;59(1):55-60

Anti-allergic activity of naringenin chalcone from a tomato skin extract.
Tomato skin extract contains naringenin chalcone (trans-2'4'6'4-tetrahydroxychalcone) which strongly inhibits histamine release. Naringenin chalcone inhibited histamine release with an IC(50) value of 68 microg/ml. (Could this influence prick-prick testing? Ed.)

Anti-allergic activity of naringenin chalcone from a tomato skin extract.
Yamamoto T, Yoshimura M, Yamaguchi F, Kouchi T, Tsuji R, Saito M, Obata A, Kikuchi M.
Biosci Biotechnol Biochem 2004 Aug;68(8):1706-11.

Should avoidance of foods be strict in prevention and treatment of food allergy?
"Recent data indicate that strict allergen avoidance is not always necessary for treatment, exposure may be therapeutic, and extended delay in introduction of food allergens to the diet of young children may increase allergy risks. However, in many circumstances strict avoidance is clearly necessary for treatment. Additional studies are needed to determine the risks and benefits of exposure to tolerated allergen, including identification of biomarkers to identify patients who may benefit."

Should avoidance of foods be strict in prevention and treatment of food allergy?
Kim JS, Sicherer S.
Curr Opin Allergy Clin Immunol 2010 Feb 16;

Work-Related Allergy and Asthma in Spice Mill Workers - the Impact of Processing
This study demonstrated IgE reactivity to multiple spice allergens in workers exposed to high levels of inhalable spice dust. Processed garlic and onion powder demonstrated stronger IgE reactivity than the raw plant. Atopy and polysensitization to various plant profilins, suggesting pollen-food syndrome, represent additional risk factors for sensitizer-induced work-related asthma in spice mill workers.

Work-Related Allergy and Asthma in Spice Mill Workers - The Impact of Processing Dried Spices on IgE Reactivity Patterns.
van der Walt A, Lopata AL, Nieuwenhuizen NE, Jeebhay MF.
Int Arch Allergy Immunol 2010 Feb 12;152(3):271-278

Features of feather duvet lung.
Feather duvet lung (FDL) is a rare subgroup of bird fancier's lung. It is caused by inhalation of organic dust due to goose or duck feathers in duvets or pillows. A retrospective review of the medical records of 13 patients with FDL was performed to assess the specific history and review clinical characteristics of patients with this disease. All patients were female with aged 26-71 years. They were recently exposed to feather duvets (6), pillows (1) or both (6). Specific histories were duvets or pillows filled with raw goose feathers from their own farms (4), intensive contact with goose feathers in youth (3), and bird exposure prior to symptom onset (5). In all patients specific IgG antibodies to goose and/or duck feathers were detected. The clinical findings of FDL are typical of extrinsic allergic alveolitis. Primary sensitization could be due to former exposure to bird antigens at home or goose/duck feather exposure in youth.

Presenting Features of Feather Duvet Lung.
Koschel D, Wittstruck H, Renck T, Muller-Wening D, Hoffken G.
Int Arch Allergy Immunol 2010 Feb 12;152(3):264-270

A novel major Japanese cedar pollen allergen belonging to the aspartic protease family.
This study reports the molecular cloning and immunochemical characterization of a novel C. japonica pollen allergen belonging to the aspartic protease family. An approx 40% sequence identity to members of the plant atypical aspartic protease family was shown. The protein was recognized by IgE antibodies in the serum of 58% (18/31) of Japanese cedar pollinosis patients.

Molecular cloning and immunochemical characterization of a novel major Japanese cedar pollen allergen belonging to the aspartic protease family.
Ibrahim AR, Kawamoto S, Aki T, Shimada Y, Rikimaru S, Onishi N, Babiker EE, Oiso I, Hashimoto K, Hayashi T, Ono K.
Int Arch Allergy Immunol 2010 Feb 10;152(3):207-218

Major cat allergen Fel d 1 is maintained among the main anatomical sites of production.
This study aimed at elucidating the polymorphism of Fel d 1 from cat dander from the site of production and the resulting immunological behavior of the allergen. It identified truncated dimers of Fel d 1, probably resulting from proteolytic degradation of both chains and present in all cats. The core fragments were largely distributed among anatomical sites of production and especially well represented in anal sacs They were recognized as intact allergens by antibodies and may therefore introduce discrepancies in allergen measurement depending on the variable amount of intact and degraded Fel d 1 produced by the cat.

Distribution of core fragments from the major cat allergen Fel d 1 is maintained among the main anatomical sites of production.
Bienboire-Frosini C, Lebrun R, Vervloet D, Pageat P, Ronin C.
Int Arch Allergy Immunol 2010 Feb 10;152(3):197-206

Toxocariasis (Roundworm of dogs) resulting in seeming allergy.
Toxocara canis is an intestinal nematode affecting dogs and cats that causes human infestations by ingestion of embryonated eggs excreted in dogs' faeces. Humans are transport hosts, in whom the larvae do not develop to adult worms, but may migrate to various tissues and organs, and survive for several years, giving rise to several clinical symptoms, which include allergy-like presentations.

Three cases presenting as dermatitis, rhinitis, asthma, and conjunctivitis which were diagnosed and unsuccessfully treated as allergy are reported. The correct diagnosis was established after detecting anti-Toxocara antibodies. All clinical symptoms showed improvement after starting treatment with mebendazole and subsequent courses of the antiparasitic drug resulted in full recovery. This suggests the possible role of Toxocara canis in inducing chronic symptoms of allergic type. This is particularly important for asthma, where it has been demonstrated that Toxocara canis infection causes allergic inflammation in the lungs associated with bronchial hyperreactivity.

Toxocariasis resulting in seeming allergy.
Qualizza R, Megali R, Incorvaia C.
Iran J Allergy Asthma Immunol 2009 Sep;8(3):161-164

Caterpillars and moths: Dermatologic manifestations of encounters with Lepidoptera.
Caterpillars and moths (order Lepidoptera) are uncommonly recognized causes of adverse cutaneous reactions, such as localized stings, papular dermatitis, and urticarial wheals. These reactions are typically mild and self-limited; however, in South America, the sting of Lonomia caterpillars can cause a potentially fatal hemorrhagic diathesis related to massive fibrinolysis. Ocular inflammation and prominent arthralgias have been reported to be caused by exposure to caterpillar. Part II of this two-part series on caterpillars and moths reviews the varied symptoms caused by Lepidopteran exposures, the differential diagnosis, and appropriate treatment.

Caterpillars and moths: Part II. Dermatologic manifestations of encounters with Lepidoptera.
Hossler EW.
J Am Acad Dermatol 2010 Jan;62(1):13-28

Voluntarily reported unintentional injections from epinephrine auto-injectors.
From 1994 to 2007, a total of 15,190 unintentional injections from epinephrine auto-injectors were reported to US Poison Control Centers, 60% of them from 2003 to 2007. Those unintentionally injected had a median age of 14 years, 55% were female, and 85% were injected in a home or other residence. Management was documented in only 4101 cases (27%), of whom 53% were observed without intervention, 29% were treated, 13% were neither held for observation nor treated, and 4% refused treatment. In contrast, from 1969 to 2007, only 105 unintentional injections from epinephrine auto-injectors were reported to MedWatch. Forty percent of these occurred during attempts to treat allergic reactions. Injuries resulting in permanent sequelae were rarely reported to either US Poison Control Centers or to MedWatch. To prevent these unintentional injections, improved epinephrine auto-injector design is needed, along with increased vigilance in training the trainers and in training and coaching the users, as well as efforts to increase public awareness of the role of epinephrine auto-injectors in the first-aid treatment of anaphylaxis in the community

Voluntarily reported unintentional injections from epinephrine auto-injectors.
Simons FE, Edwards ES, Read EJ, Clark S, Liebelt EL.
J Allergy Clin Immunol 2010 Feb;125(2):419-423

Allergy or tolerance in children sensitized to peanut: prevalence and differentiation using component-resolved diagnostics.
Not all peanut-sensitized children develop allergic reactions on exposure. This study aimed to establish by oral food challenge the proportion of children with clinical peanut allergy among those considered peanut-sensitized by using skin prick tests and/or IgE measurement, and to investigate whether component-resolved diagnostics using microarray could differentiate peanut allergy from tolerance. Of 933 children, 110 (11.8%) were peanut-sensitized. Nineteen were not challenged. Twelve with a convincing history of reactions on exposure, IgE > or =15 kUa/L and/or skin test > or =8mm were considered allergic without challenge. Of the remaining 79 children who underwent challenge, 7 had > or =2 objective signs and were designated as having peanut allergy. The estimated prevalence of clinical peanut allergy among sensitized subjects was 22.4%. By using component-resolved diagnostics, marked differences were detected in the pattern of component recognition between children with peanut allergy (n = 29; group enriched with 12 children with allergy) and peanut-tolerant children (n = 52). The peanut component Ara h 2 was the most important predictor of clinical allergy. Therefore the majority of children considered peanut-sensitized on the basis of standard tests do not have peanut allergy. Component-resolved diagnostics may facilitate the diagnosis of peanut allergy.

Allergy or tolerance in children sensitized to peanut: prevalence and differentiation using component-resolved diagnostics.
Nicolaou N, Poorafshar M, Murray C, Simpson A, Winell H, Kerry G, Harlin A, Woodcock A, Ahlstedt S, Custovic A.
J Allergy Clin Immunol 2010 Jan;125(1):191-197

Food allergy due to olive.
A 28-year-old man presented with palatal itching and genaralized urticaria following ingestion of olive 3 years after being diagnosed with olive pollen allergy. The patient did not have a history of food allergy or urticaria. He reported palatal itching beginning minutes after ingestion of olive fruit followed by generalized urticaria about 1 hour later. These symptoms subsided spontaneously within hours. He had experienced these symptoms several times following ingestion of olive fruit. Skin prick tests with aeroallergens including latex were positive for house dust mite and olive pollen. Prick tests and prick-to-prick tests for olive fruit were positive, as were those of specific immunoglobulin E tests to olive pollen and fruit. Prick tests to peach, pear, kiwi, melon, and nut were negative. Nasal provocation with olive pollen was positive. An open oral provocation test with olive oil did not cause symptoms. This case is unique in that the patient developed olive fruit allergy in the presence of olive pollinosis, and he did not experience allergic symptoms to fruits other than olive, thus enabling us to define a new pollen-food (olive-olive) syndrome.

Food allergy due to olive.
Unsel M, Ardeniz O, Mete N, Ersoy R, Sin AZ, Gulbahar O, Kokuludag A.
J Investig Allergol Clin Immunol 2009;19(6):497-499

Molecular diagnosis of allergy to the management of pediatric patients with allergy to pollen.
This study assessed the usefulness of molecular diagnosis in childhood allergies. A total of 162 children aged 4-16 years diagnosed with allergic rhinitis or asthma/rhinitis caused by pollen were referred for recombinant allergen-based diagnosis. Specific immunoglobulin (Ig) E against pollen allergens and purified recombinant Phleum pratense pollen allergens were measured using the recombinant allergens Phl p 1+Phl p 5 as P pratense--specific allergens and Phl p 7+Phl p 12 as cross-reacting allergens. Specific IgE antibodies against P pratense were detected in 99.4% of serum samples, and cross-reacting allergens in 46%. Multiple sensitization to pollen was documented in 38% of patients, with Plantago lanceolata as the main cause. Patients with specific IgE values of 75-80 kU(A)/L to Phl p 1+Phl p 5 were 75% more likely to present values > or = 2 kUA/L to Phl p 7+Phl p 12. The authors conclude that these results show that recombinant DNA technology can help diagnose allergy in cases of multiple sensitization and crossreactivity, and is therefore a promising option for improving prognosis and management of allergic pediatric populations.

Contribution of molecular diagnosis of allergy to the management of pediatric patients with allergy to pollen.
Casquete-Roman E, Rosado-Gil T, Postigo I, Perez-Vicente R, Fernandez M, Torres HE, Martinez-Quesada J.
J Investig Allergol Clin Immunol 2009;19(6):439-445

Diagnosing human anisakiasis: recombinant Ani s 1 and Ani s 7 allergens versus CAP
To compare the diagnostic and clinical value of ELISA methods based on Ani s 1 and Ani s 7 recombinant allergens and the CAP FEIA system, sera from 495 allergic and 25 non-food related allergic patients were tested. Considering sera that tested positive by either Ani s 1 or Ani s 7 ELISA, the CAP FEIA classified 25% of sera as false positives, mainly in the group of patients with the lowest levels of anti-Anisakis IgE antibodies, and 1.28% of positive sera as false negatives. The overall sensitivity of Ani s 7 ELISA and Ani s 1 ELISA was respectively 94% and 61%. The results also showed that anti-Anisakis IgE antibodies can be detected in serum for longer with Ani s 1 ELISA than with Ani s 7 ELISA and CAP FEIA. Our findings suggest that ELISA methods with Ani s 7 and Ani s 1 allergens as targets of IgE antibodies are currently the best option for serodiagnosis of human anisakiasis, combining specificity and sensitivity. (Anadón 2010 ref.24678 0)

Diagnosing human anisakiasis: recombinant Ani s 1 and Ani s 7 allergens versus CAP FEIA(R).
Anadón AM, Rodríguez E, Gárate MT, Cuéllar C, Romarís F, Chivato T, Rodero M, González-Díaz H, Ubeira FM.
Miscellaneous Clin Vaccine Immunol 2010 Jan 27. [ahead of print]

Higher histamine sensitivity in non-atopic subjects by skin prick test may result in misdiagnosis of eggplant allergy.
A high incidence of allergic reactions to eggplant (aubergine) appears to be commonly experienced among Indians, presumably due to its high histamine content. This study investigated the histamine content of different varieties of eggplant (green and purple round; green and purple slender long) using raw, cooked, and dialyzed extracts. A significant varietal difference in the histamine content of eggplant varieties was observed. Highest amount was present in the green round variety (2.41 mg/100 g fresh weight in raw and 2.07 mg/100 g in cooked extracts). The histamine content of other varieties (in mg/100 g raw) is: green slender long (1.80), purple slender long (1.35), and purple round (0.89). Histamine was stable to heat-processing, since only 11-14% loss was observed upon cooking. Skin prick test (SPT) on non-atopic subjects (without any history of eggplant allergy) using four varieties of raw and cooked eggplant extracts revealed that only subjects with a lower threshold for histamine produce positive results equivalent to that seen between 10-100 microg/mL histamine dihydrochloride. It can be concluded that the amount of histamine present in eggplant does not produce a positive SPT response in a majority of non-atopic subjects, and that a positive response in a few subjects are likely to be misdiagnosed as eggplant allergy.

Higher histamine sensitivity in non-atopic subjects by skin prick test may result in misdiagnosis of eggplant allergy.
Kumar MN, Babu BN, Venkatesh YP.
Miscellaneous 2009;38(1):93-103.

Detailed proteomic analysis on donkey milk.
A deeper knowledge of proteins in donkey milk (DM) is necessary to evaluate the immunological and physiological properties of this natural substitute for cow's milk. The paper offers a detailed comparative analysis among the protein fractions of DM, CM and human milk, following an extensive proteomic study of the casein and whey proteins of DM. The detailed protein composition and structural features reported in this study provide insight into the molecular reasons for the hypoallergenicity of DM. Whole DM might constitute a valid substitute of CM in feeding children with CM protein allergy and it might also constitute the basis for formulas suitable for allergic subjects in the first year of life.

Detailed proteomic analysis on DM: insight into its hypoallergenicity.
Bertino E, Gastaldi D, Monti G, Baro C, Fortunato D, Perono Garoffo L, Coscia A, Fabris C, Mussap M, Conti A.
Miscellaneous Front Biosci (Elite Ed) 2010 Jan 1;2:526-36.

Pine nut anaphylaxis after eating muesli.
A patient with severe anaphylaxis, angioedema, hypotension and shock after eating yogurt with muesli containing pine nuts. The patient developed an acute infero-posterolateral myocardial infarction due to systemic hypotension and shock. Food allergy to pine nut was demonstrated by dosage of specific IgE to pine nut.

A not so healthy muesli: a case report.
Meysman M, Schelfaut D, Vincken W.
Miscellaneous Acta Clin Belg 2009 Jul-Aug;64(4):366-8.

A novel Cladosporium herbarum allergen - alpha/beta hydrolase
Screening a C. herbarum cDNA library with IgE antibodies pooled from 3 mold-reactive sera, a novel allergen candidate (29.9kDa) exhibiting considerable (three-dimensional) homology to the alpha/beta hydrolase fold superfamily was isolated. A recombinant non-fusion C. herbarum hydrolase displayed a prevalence of IgE reactivity of approximately 17% in in vitro immunoblot experiments.

Isolation and immunological characterization of a novel Cladosporium herbarum allergen structurally homologous to the alpha/beta hydrolase fold superfamily.
Rid R, Onder K, Hawranek T, Laimer M, Bauer JW, Holler C, Simon-Nobbe B, Breitenbach M
Mol Immunol 2009 Dec 18. [Epub ahead of print]

Effect of the introduction of solid foods during the first year and allergic sensitization at age 5 years.
The goal of this study was to examine the relationship between age at the introduction of solid foods during the first year of life and allergic sensitization in 5-year-old children. Data from the Finnish Type 1 Diabetes Prediction and Prevention nutrition study was assessed (994 children with HLA-conferred susceptibility to type 1 diabetes mellitus for whom information on breastfeeding, age at the introduction of solid foods, and allergen-specific immunoglobulin E levels at 5 years was available.) The study reports that late introduction of solid foods was associated with increased risk of allergic sensitization to food and inhalant allergens.

Age at the introduction of solid foods during the first year and allergic sensitization at age 5 years.
Nwaru BI, Erkkola M, Ahonen S, Kaila M, Haapala AM, Kronberg-Kippila C, Salmelin R, Veijola R, Ilonen J, Simell O, Knip M, Virtanen SM.
Pediatrics 2010 Jan;125(1):50-59

Pre-lethal anaphylaxis to carboxymethylcellulose confirmed by identification of specific IgE
Carboxymethylcellulose (CMC) is used extensively in the pharmaceutical and food industries on account of its various properties. Anaphylactic reactions are rare. It has been reported principally after intra-articular infiltration of sustained-release corticosteroids containing CMC and, very rarely, after barium enema. A case of pre-lethal anaphylactic shock after barium enema was studied by prick-test, intra-dermal reaction (IDR), leukocyte histamine release test (LHRT), basophil activation test (BAT), cystein-leukotriene release test (CAST) and dot-blot analysis. IDR to CMC was positive. BAT and CAST were positive. Specific IgE were identified. This is the third report of CMC-specific IgE and the second of anaphylaxis to CMC associated with a barium suspension in contact with GI tract mucosa. CMC as an excipient in medicinal products may therefore be a risk factor for severe anaphylaxis after injection or following contact with GI tract mucosa.

Pre-lethal anaphylaxis to carboxymethylcellulose confirmed by identification of specific IgE--review of the literature.
Dumond P, Franck P, Morisset M, Sainte LJ, Kanny G, Moneret-Vautrin DA.
Eur Ann Allergy Clin Immunol 2009 Dec;41(6):171-176

Insect allergy: house fly, mosquito, horsefly.
"Apart from Hymenoptera venom allergy, allergic reactions caused by insects may also occur after bites from blood-feeding species as well as after exposure to airborne insect particles and ingestion of insect proteins. The contribution of insects to respiratory allergies is not yet well understood. Ubiquitous insect proteins cross-reactive with minor house dust mite allergens, like tropomyosins and arginine kinases, may play a role within the scope of arthropod panallergy. On the other hand, there is good evidence from occupational settings for the occurrence of more restricted sensitization to particular insect groups. We present the case of a female farmer allergic to house fly (Musca domestica). Her IgE response was highly specific for the Muscidae family with no cross-reactivity observed with flies and midges from other families. Blood-feeding insects commonly elicit various local adverse reactions mostly representing either type I- or type IV-allergic immune responses. Several saliva allergens have been characterized in mosquitoes (Culicidae). Rarely, blood-feeding insects may also cause generalized reactions. We present a patient having experienced anaphylaxis twice after bites by horseflies (Tabanidae), which together with Triatoma bugs (Reduviidae) and mosquitoes are the blood-feeding insects most often causing systemic reactions. Food allergy to insects is primarily described from Asian countries, where moth larvae and other insects are more regularly consumed. Furthermore, allergic reactions may occur after ingestion of carmine (a natural food coloring made from female cochineal insects) and honeybee royal jelly. The presented case refers to a patient with a previous history of silk allergy who developed anaphylaxis after drinking a tea mixture contaminated with silk allergens. Presumably, some herbal material was infested with flour moths (Pyralidae) or other moth pests thereby leading to contamination with silk proteins from pupal cocoons."

Insect allergy: house fly, mosquito, horsefly. [German]
R. Jarisch und W. Hemmer
Allergologie 2010;33(2):86-

In vitro allergy diagnostic tests and cross-reactivity.
"Immunologic cross-reactivity is the binding of antibodies or activation of sensitized T-cells to similar antigens: proteins, carbohydrates, or glycoproteins which contain similar or identical determinants. The similarity may be based on sequential or conformational similarity. Most allergens, particularly allergens of plant origin, are glycoproteins, carrying (frequently) N-glycans and O-glycans. Due to their involvement in a wide spectrum of cross-reactivities, these N-glycans have been named cross-reactive carbohydrate determinants (CCD). In contrast to peptide epitopes, glycan epitopes may share significant structural elements with allergens of other, non-related protein families, whereby they induce IgE-cross-reactions between allergens from completely different sources, i.e. plant-derived pollen, natural rubber latex and insect venoms. The clinical relevance of CCDs is still controversial, and they seem to be responsible for decreased specificity of in vitro diagnostic test currently used for allergy diagnosis, which complicates the identification of the allergens responsible for a sometimes severe allergic reaction. Members of certain protein families may cause cross-reactions, i.e. profilins, Bet-v-1-homologous proteins and lipid transfer proteins. Component-resolved diagnosis (CRD) using single allergens allow the molecule-specific detection of IgE. The significance of the results, however, has to be evaluated with regard to the source of allergen in question and with regard to the individual patient. CRD is based on purified natural or recombinant single allergens, which may contain cross-reactive peptide epitopes, as well. In general, the sensitivity of IgE detection increases, but not necessarily the diagnostic specificity. Diagnostic tests for allergy based on human cells indirectly detecting IgE-mediated sensitization are not superior to direct IgE-detection methods with regard to cross-reactivity, for example, via CCD, and are, therefore, indicated for allergy testing in selected cases only. The application of marker allergens, i.e. screening with CCDs and/or CCD-carrying allergens, and inhibition assays with a superior or at least relevant CCD-carrying allergen can help to decrease CCD interference in diagnostic tests of allergy. The well designed use of natural and recombinant allergens may additionally improve the specificity of IgE-detection."

In vitro allergy diagnostic tests and cross-reactivity. [German]
U. Jappe
Allergologie 2010;33(1):43-

Stressful life events in childhood and allergic sensitisation.
"Stressful life events evidently have an impact on development of allergic diseases, but the mechanism linking stress to pathological changes of immune system function is still not fully understood. The aim of our study was to investigate the relationship between stressful life events, neuropeptide and cytokine concentrations in children as well as the association between early stressful life events and atopic eczema (AE). Within the LISAplus (Life style Immune system Allergy) study, blood samples from children of 6 years of age were analyzed for concentration of the neuropeptides vasoactive intestinal peptide (VIP), somatostatin (SOM), substance P (SP) and the Th1/Th2 cytokines IFN-g and IL-4. Life events such as severe disease or death of a family member, unemployment or divorce of the parents were assessed with a questionnaire filled in by the parents. Furthermore, lifetime prevalence of AE and incidence after the assessment period of life events were compared. Our data suggest that separation/divorce of parents increase childrens risk of developing AE later in life. Children with separated/divorced parents showed high VIP levels and high concentrations of the Th2 cytokine IL-4 in their blood. Severe diseases and death of a family member were neither associated with neuropeptide levels nor with cytokine concentrations. Unemployment of the parents was associated with decreased IFN-g concentrations in childrens blood but not with neuropeptide levels. Thus, the neuropeptide VIP might be a mediator between stressful life events and immune regulation contributing to the Th2 shifted immune response in children with separated/divorced parents."

Stressful life events in childhood and allergic sensitisation [German]
G. Herberth, S. Röder, A. Bockelbrink, T. Schäfer, M. Borte, O. Herbarth, U. Krämer, H. Behrendt, S. Sausenthaler, J. Heinrich und I. Lehmann
Allergologie 2010;33(2):55-

IgE to peanut allergen components: relation to peanut symptoms and pollen sensitization
The aim was to investigate IgE reactivity to peanut allergen components in children from a birch-rich region in relation to pollen sensitization and peanut symptoms.

Different peanut/birch sensitization phenotypes were defined among 200 selected children. IgE reactivity to peanut and pollen allergen components was analysed using microarray technique. Peanut symptoms were reported in 87% of the children with IgE reactivity to any of the peanut allergens Ara h 1, 2 or 3 but not to Ara h 8 (n = 46) vs 17% of children with IgE reactivity to Ara h 8 but not to Ara h 1, 2 or 3 (n = 23). Furthermore, symptoms were more severe in children with Ara h 1, 2 or 3 reactivity. Children with IgE reactivity both to Ara h 2 and to Ara h 1 or 3 more often reported peanut symptoms than children with IgE only to Ara h 2 (97%vs 70%), particularly respiratory symptoms (50%vs 9%, P = 0.002). Therefore IgE analysis to peanut allergen components may be used to distinguish between peanut-sensitized individuals at risk of severe symptoms and those likely to have milder or no symptoms to peanut if sensitized to pollen allergens and their peanut homologue allergens.

IgE to peanut allergen components: relation to peanut symptoms and pollen sensitization in 8-year-olds.
Asarnoj A, Moverare R, Ostblom E, Poorafshar M, Lilja G, Hedlin G, van HM, Ahlstedt S, Wickman M.
Allergy 2010 Feb 8;

Sesame allergy: role of specific IgE and skin-prick testing in predicting food challenge results.
This USA study examined the correlation of sesame ImmunoCAP and SPT results with oral challenge outcomes in children, aged 2-12 years, suspected of having a sesame food allergy. Thirty-three oral sesame challenges were conducted. Of the 33 challenges performed, 21% (n = 7) failed and 79% (n = 26) passed. A sesame-specific IgE level of > or = 7 kU(A)/L showed specificity of >90%. An SPT wheal size of > or = 6 mm showed specificity of >90%. This study represents the largest number of sesame challenges performed to evaluate the diagnostic value of both sesame-specific IgE and SPT. Based on our sample, both tests are not good predictors of true sesame allergy as determined by an oral challenge. The study was unable to establish a threshold with a 95% positive predictive value for both sesame-specific IgE and SPT.

Sesame allergy: role of specific IgE and skin-prick testing in predicting food challenge results.
Permaul P, Stutius LM, Sheehan WJ, Rangsithienchai P, Walter JE, Twarog FJ, Young MC, Scott JE, Schneider LC, Phipatanakul W.
Allergy Asthma Proc 2009 Nov;30(6):643-648

Numismedica: health problems caused by coins.
Coins occasionally cause health problems. These have a wide range of presentations and can affect multiple organ systems. This article presents a review of the medical literature addressing health problems caused by coins. These problems can be categorized as follows: (1) respiratory manifestations of ingested coins, (2) gastrointestinal manifestations of swallowed coins, (3) systemic effects of swallowed coins, (4) clinical management of swallowed coins, (5) allergic manifestations of coin exposure, and (6) miscellaneous health issues related to swallowed coins.

The metal content of coins can cause cutaneous allergic reactions through direct contact with the skin. The are describes multiple reports of coin-related nickel contact dermatitis and cases of copper and cobalt contact dermatitis. Occupational coin exposure among cashiers can produce contact dermatitis. Can the nickel in Euro coins cause dermatitis? Read the article!

Numismedica: health problems caused by coins.
Olive KE.
Am J Med Sci 2009 Jun;337(6):445-50.

Allergen-, Food allergy-, Intolerance-related articles

Biomolecular identification of allergenic pollen: a new perspective for aerobiological monitoring?
Longhi S, Cristofori A, Gatto P, Cristofolini F, Grando MS, Gottardini E. Ann Allergy Asthma Immunol 2009 Dec;103(6):508-514

Allergy to pumpkin with cyclophilin as the relevant allergen.
De Olano DG, Gonzalez-Mancebo E, Macadan SS, Cano MG, Perez-Gordo M, Ortega BC, Vivanco F, Vargas CP. Ann Allergy Asthma Immunol 2010 Jan;104(1):98-99

Allergy to prairie dog lipocalins.
De Olano DG, Bartolome B, Ortega BC, Perez-Gordo M, Vivanco F, Vargas CP. Ann Allergy Asthma Immunol 2010 Jan;104(1):97-98

Pomegranate (Punica granatum) allergy: clinical and immunological findings.
Damiani E, Aloia AM, Priore MG, Nardulli S, Ferrannini A. Ann Allergy Asthma Immunol 2009 Aug;103(2):178-180

Identification of a novel 17-kDa protein as a ferret allergen.
Gonzalez de OD, Pastor VC, Cases OB, Perez-Gordo M, Moral D, Vivanco F, Bartolome B. Ann Allergy Asthma Immunol 2009 Aug;103(2):177-178

Latex: a hidden occupational allergen.
Anibarro B, Seoane FJ, Perpina MA, Carnes J. Ann Allergy Asthma Immunol 2010 Jan;104(1):94-95

Role of food labels in accidental exposures in food-allergic individuals in Canada.
Sheth SS, Waserman S, Kagan R, Alizadehfar R, Primeau MN, Elliot S, St PY, Wickett R, Joseph L, Harada L, Dufresne C, Allen M, Allen M, Godefroy SB, Clarke AE. Ann Allergy Asthma Immunol 2010 Jan;104(1):60-65

Anaphylaxis in the obstetric patient: analysis of a statewide hospital discharge database.
Mulla ZD, Ebrahim MS, Gonzalez JL. Ann Allergy Asthma Immunol 2010 Jan;104(1):55-59

Pinaceae.
Weber RW. Ann Allergy Asthma Immunol 2010 Jan;104(1):A4

A case of an allergic reaction due to Anisakis simplex after the ingestion of salted fish guts made of Sagittated calamari: allergen analysis with recombinant and purified Anisakis simplex allergens. [Japanese]
Shigehira Y, Inomata N, Nakagawara R, Okawa T, Sawaki H, Nakamura K, Kobayashi Y, Shiomi K, Ikezawa Z. Arerugi 2010 Jan;59(1):55-60

Regional differences in the prevalence of Japanese cedar-pollen allergy. [Japanese]
Murayama K, Baba K, Okubo K. Arerugi 2010 Jan;59(1):47-54

The effect of chronic infection with Aspergillus fumigatus on lung function and hospitalization in patients with cystic fibrosis.
Amin R, Dupuis A, Aaron SD, Ratjen F. Chest 2010 Jan;137(1):171-176

Responses to odors in occupational environments.
Dalton PH, Jaen C. Curr Opin Allergy Clin Immunol 2010 Feb 12;

Sensitization to Inhaled Ryegrass Pollen by Collateral Priming in a Murine Model of Allergic Respiratory Disease.
Cadot P, Meyts I, Vanoirbeek JA, Vanaudenaerde B, Bullens DM, Ceuppens JL. Int Arch Allergy Immunol 2010 Feb 11;152(3):233-242

Long-term characteristics of hazelnut allergy in an adjuvant-free mouse model.
Gonipeta B, Parvataneni S, Paruchuri P, Gangur V. Int Arch Allergy Immunol 2010 Feb 10;152(3):219-225

Allergy or Tolerance, That's the Question.
Jahn-Schmid B. Int Arch Allergy Immunol 2010 Feb 10;152(3):195-196

Variant Hypersensitivity Reaction (HSR) Presented with Persistent Dry Cough after Receiving Oxaliplatin in a Pancreatic Cancer Patient.
Li J, Peccerillo J, Kaley K, Saif MW. Iran J Allergy Asthma Immunol 2009 Sep;8(3):165-168

Caterpillars and moths: Part I. Dermatologic manifestations of encounters with Lepidoptera.
Hossler EW. J Am Acad Dermatol 2010 Jan;62(1):1-10

Case reports by Cochard and Eigenmann.
Thompson JC, Morris MS. J Allergy Clin Immunol 2010 Jan;125(1):277-278

Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects in 2009.
Sicherer SH, Leung DY. J Allergy Clin Immunol 2010 Jan;125(1):85-97

Induction of anergic allergen-specific suppressor T cells using tolerogenic dendritic cells derived from children with allergies to house dust mites.
Pacciani V, Gregori S, Chini L, Corrente S, Chianca M, Moschese V, Rossi P, Roncarolo MG, Angelini F. J Allergy Clin Immunol 2010 Feb 10;

Clavulanic acid can be the component in amoxicillin-clavulanic acid responsible for immediate hypersensitivity reactions.
Torres MJ, Ariza A, Mayorga C, Dona I, Blanca-Lopez N, Rondon C, Blanca M. J Allergy Clin Immunol 2010 Feb;125(2):502-505

Cats and dogs: An attractive remedy versus atopy?
Brenna OV. J Allergy Clin Immunol 2010 Feb 4;

Naturally processed T-cell-activating peptides of the major birch pollen allergen.
Mutschlechner S, Egger M, Briza P, Wallner M, Lackner P, Karle A, Vogt AB, Fischer GF, Bohle B, Ferreira F. J Allergy Clin Immunol 2010 Feb 2;

Are neighborhood-level characteristics associated with indoor allergens in the household?
Rosenfeld L, Rudd R, Chew GL, Emmons K, cevedo-Garcia D. J Asthma 2010 Feb;47(1):66-75

Severe asthma with fungal sensitization: a case report and review of literature.
Madani Y, Barlow A, Taher F. J Asthma 2010 Feb;47(1):2-6

New item on pediatric menu: food allergy.
Voelker R. JAMA 2010 Feb 10;303(6):497-498

Allergenicity of Hev b 13, a major esterase allergen in natural rubber latex (Hevea brasiliensis) allergy, does not only depend on its carbohydrate moiety.
Rouge P, Culerrier R, Campistron M, Granier C, Bienvenu F, Bienvenu J, Didier A, Barre A. Mol Immunol 2010 Jan;47(4):871-877

Dissecting cross-reactivity in hymenoptera venom allergy by circumvention of alpha-1,3-core fucosylation.
Seismann H, Blank S, Braren I, Greunke K, Cifuentes L, Grunwald T, Bredehorst R, Ollert M, Spillner E. Mol Immunol 2010 Jan;47(4):799-808

New developments improve food allergy management.
Eur Ann Allergy Clin Immunol 2009 Dec;41(6):190-191

Dynamics in cytokine responses during the development of occupational sensitization to rats.
Krop EJ, van de Pol MA, Lutter R, Heederik DJ, Aalberse RC, van der Zee JS. Allergy 2010 Jan 28;

Health-related quality of life of food allergic patients measured with generic and disease-specific questionnaires.
Flokstra-de Blok BM, van d, Vlieg-Boerstra BJ, Oude Elberink JN, Dunngalvin A, Hourihane JO, Duiverman EJ, Dubois AE. Allergy 2010 Feb 1;

Usefulness of the basophil activation test (BAT) in the diagnosis of life-threatening drug anaphylaxis.
Garcia-Ortega P, Marin A. Allergy 2010 Feb 10;

Systemic photoallergy to terbinafine.
Spiewak R. Allergy 2010 Jan 28;

Toothpaste-induced anaphylaxis caused by mint (Mentha) allergy.
Paiva M, Piedade S, Gaspar A. Allergy 2010 Feb 10;

Anaphylaxis to Raphanus niger.
Sousa N, Gaspar A, Morais-Almeida M. Allergy 2010 Feb 10;

Temporal changes in UK birth order and the prevalence of atopy.
Upchurch S, Harris JM, Cullinan P. Allergy 2010 Feb 4;

IgE-mediated anaphylaxis to pristinamycin - report of a case.
Rubio M, Bousquet PJ, Demoly P. Allergy 2010 Feb 4;

Aspirin tolerance in patients with NSAID-hypersensitivity.
Malskat WS, van der TC, Knulst AC, Bruijnzeel-Koomen CA, Rockmann H. Allergy 2010 Feb 4;

The allergen Bet v 1 in fractions of ambient air deviates from birch pollen counts.
Buters JT, Weichenmeier I, Ochs S, Pusch G, Kreyling W, Boere AJ, Schober W, Behrendt H. Allergy 2010 Feb 4;

Effects of omalizumab in patients with food allergy.
Rafi A, Do LT, Katz R, Sheinkopf LE, Simons CW, Klaustermeyer W. Allergy Asthma Proc 2010 Jan;31(1):76-83

Sesame allergy: role of specific IgE and skin-prick testing in predicting food challenge results.
Permaul P, Stutius LM, Sheehan WJ, Rangsithienchai P, Walter JE, Twarog FJ, Young MC, Scott JE, Schneider LC, Phipatanakul W. Allergy Asthma Proc 2009 Nov;30(6):643-648

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