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Allergy Advisor Digest - January 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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Delonix regia (Gulmohar tree) pollen and cross-reactivity studies with Peltophorum pterocarpum pollen: 2 dominant avenue trees from eastern India.

The natural history of wheat allergy.

Reactions to prick and intradermal skin tests.

Association of acute urticaria with Mycoplasma pneumoniae infection in hospitalized children.

Cutaneous allergy to cotton.

Anaphylaxis due to peach with negative ImmunoCAP result to peach allergens, including rPru p 1, rPru p 3, AND rPru p 4: a report of two cases.

Evaluation of relationships between foods and pollen antigens in peach oral allergy patients

Diagnosis of multiple chemical sensitivity by chemical compounds exposure.

IgE-binding reactivity of peptide fragments of Bla g 1.02, a major German cockroach allergen.

Wheat-dependent, exercise-induced anaphylaxis in Thai children

Impact of dietary regimen on the duration of cow's milk allergy: a random allocation study.

Component-resolved diagnosis of kiwifruit allergy with purified natural and recombinant kiwifruit allergens.

Anaphylaxis to mango fruit and crossreactivity with Artemisia vulgaris pollen.

Immediate hypersensitivity to latex in the absence of demonstrable specific immunoglobulin E.

Selective allergy to lobster in a case of primary sensitization to house dust mites.

Eosinophilic esophagitis due to profilin allergy.

Earl Grey tea intoxication.

Green tea-induced asthma.

Occupational allergic contact dermatitis from mioga (Zingiber mioga)

Concentrations of undeclared allergens in food products can reach levels that are relevant for public health.

Yellow jacket allergen Ves v 2: N-glycan structures are needed for the human antibody recognition.

The prognosis of wheat hypersensitivity in children.

Generalised allergic contact dermatitis from acrylate with artificial nails

Influence of thermal and acid treatment on the allergenicity of peanut proteins in the population of the region Fez-Meknes Morocco

Wine allergy in a wine-growing district: tolerance induction in a patient with allergy to grape lipid-transfer protein.

Common causes of anaphylaxis in children: the first report of anaphylaxis registry in Iran.

A case of anaphylaxis: horse-fly (Tabanus bovinus) or hymenoptera sting?

The prevalence of peanut allergy: three cohorts of children from the same geographical location in the UK.

Clinical reactivity to ingestion challenge with mixed mold extract may be enhanced in subjects sensitized to molds.

Delonix regia (Gulmohar tree) pollen and cross-reactivity studies with Peltophorum pterocarpum pollen: 2 dominant avenue trees from eastern India.
Delonix regia and Peltophorum pterocarpum pollen are important aeroallergens for type 1 hypersensitivity in the tropics. This study isolated and characterized the IgE-binding proteins of D regia pollen and investigated the cross-allergenity with P pterocarpum pollen, both family Leguminosae. Skin prick test results of the patients with respiratory allergies in Calcutta, India, showed 31.1% positivity with D regia pollen. Nine IgE-reactive protein components were found in the crude extract. Maximum IgE reactivity was shown to a 96- and 66-kDa IgE-reactive proteins. Remarkable 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.

Clinical and immunobiochemical characterization of airborne Delonix regia (Gulmohar tree) pollen and cross-reactivity studies with Peltophorum pterocarpum pollen: 2 dominant avenue trees from eastern India.
Mandal J, Manna P, Chakraborty P, Roy I, Gupta-Bhattacharya S.
Ann Allergy Asthma Immunol 2009 Dec;103(6):515-524

The natural history of wheat allergy.
The objectives of this article was to define the natural course of wheat allergy and identify factors that help predict outcome in a large referral population of children with wheat allergy. Of 103 patients who met the inclusion criteria, rates of resolution were 29% by 4 years, 56% by 8 years, and 65% by 12 years. Higher wheat IgE levels were associated with poorer outcomes. The peak wheat IgE level recorded was a useful predictor of persistent allergy, although many children outgrew wheat allergy with even the highest levels of wheat IgE.

The natural history of wheat allergy.
Keet CA, Matsui EC, Dhillon G, Lenehan P, Paterakis M, Wood RA.
Ann Allergy Asthma Immunol 2009 May;102(5):410-415

Reactions to prick and intradermal skin tests.
This study determined the 12-month incidence of systemic reactions (SRs) to skin prick testing (SPT) and intradermal skin testing (ST) and the symptoms and response to immediate treatment with epinephrine intramuscularly. A prospective study was conducted in 1,456 patients. Fifty-two patients (3.6%) had SRs (6 SPT and 46 intradermal), 17 (33%) had asthma. Systemic symptoms included (SPT/intradermal) pruritic eyes, nose, or pharynx (0%/46%); worsening cough (50%/26%); sensation of difficulty swallowing (0%/20%); worsening nasal congestion (17%/15%); rhinorrhea (17%/13%); chest tightness or shortness of breath (33%/11%); generalized pruritus (17%/11%); sneezing (33%/9%); wheeze (0%/4%); and urticaria (17%/2%). No severe asthma, shock, hypotension, unconsciousness, or biphasic reactions occurred. All 52 patients received epinephrine intramuscularly, 48 (92%) oral prednisone, 9 (17%) oral prednisone to take 6 to 8 hours after a reaction, 50 (96%) oral antihistamine, and 6 (12%) nebulized beta-agonist.

Reactions to prick and intradermal skin tests.
Bagg A, Chacko T, Lockey R.
Ann Allergy Asthma Immunol 2009 May;102(5):400-402

Association of acute urticaria with Mycoplasma pneumoniae infection in hospitalized children.
Hospitalized children with acute urticaria from Taiwan who did not respond to antihistamine treatment and avoidance of food allergens were studied. These patients with urticaria were compared with those who had other respiratory tract diseases and were classified into 2 groups: urticaria patients with and without M pneumoniae infection. The presence of M pneumoniae infection was determined by positive serologic findings. Sixty-five patients with acute urticaria and 49 patients with other respiratory tract diseases were enrolled in this study. Patients with urticaria had significantly less febrile duration but significantly higher platelet and lymphocyte counts than those with other respiratory tract diseases. Of the 65 patients with urticaria, 21 (32%) showed serologic evidence of M pneumoniae infection. Patients with M pneumoniae-associated urticaria received azithromycin treatment and needed a shorter time for improvement (P = .01) and complete resolution (P = .04). The total IgE levels and the results of specific IgE tests were not significantly different between urticaria patients with and without M pneumoniae infection. This study found that in Taiwan one-third of acute childhood urticaria leading to patient hospitalization was related to M pneumoniae infection. Therefore, children with urticaria who are not responding to antihistamine treatment and abstinence from food allergens should be encouraged to undergo serologic examinations for M pneumoniae to diagnose this antibiotic-responsive disorder.

Association of acute urticaria with Mycoplasma pneumoniae infection in hospitalized children.
Wu CC, Kuo HC, Yu HR, Wang L, Yang KD.
Ann Allergy Asthma Immunol 2009 Aug;103(2):134-139

Cutaneous allergy to cotton.
Cutaneous allergy to cotton in a 24-year-old woman, who reported itchy skin within minutes after wearing any cotton clothing and a flat erythematous eruption in the places where pure cotton brushed (he skin; this reaction subsided within 20 minutes once the cotton was removed. She did not have any occupational exposure to cotton or contact with cotton-fabric workers. In addition, she reported a history of seasonal rhinoconjunctivitis due to pollens. An SPT to cotton fiber extract was positive with surrounding flare. A rub test with sanitary cotton on the skin of the volar surface of the arm was performed, prompting a well-defined flat erythematous pruritic eruption. Protein bands ranging from 14 to 70 kDa was obtained with serum IgE reactivity to a 33-kDa band, and 3 peptides homologous with the cotton protein vicilin c72 precursor was identified. The most important allergenic vicilins reported are Ara h 1 and Jug r 2. Vicilin c72 precursor (a-globulin B) has been described in the cottonseed of Gossypium hirsutum (upland cotton) with a MW of 70.5 kDa.

Cutaneous allergy to cotton.
Gonzalez de OD, Subiza JL, Civantos E.
Ann Allergy Asthma Immunol 2009 Mar;102(3):263-264

Anaphylaxis due to peach with negative ImmunoCAP result to peach allergens, including rPru p 1, rPru p 3, AND rPru p 4: a report of two cases.
A report of 2 cases of anaphylactic reactions to peach with a negative peach ImmunoCAP. A 35-year-old man, who felt an itch in his oral cavity immediately after ingesting a whole fresh peach, rapidly developed generalized urticaria, dyspnea, vomiting, and loss of consciousness. Peach ImmunoCAP conducted for screening allergens was negative for peach and the cause of anaphylaxis remained unclear resulting in his referral. He was pollen allergic and reported previously experiencing an itch on his oral cavity after ingesting melon, watermelon, apple, and strawberry. Total serum IgE was 436 IU/ml. CAP-RAST was negative for peach, strawberry and kiwi. Skin prick tests with raw peach pulp, canned peach pulp, strawberry and kiwi were positive. The second patient, was a 30-year-old woman who felt an itch on her oral cavity accompanied by blepharedema, rhinorrhea, generalized urticaria, nausea, abdominal pain and diarrhea after eating peach. She was pollen allergic. She had previously developed urticaria after ingesting an apple. Total serum IgE was 85 IU/ml. ImmunoCAP was negative for peach and apple. SPTs with canned yellow peach, strawberry and apple were positive. In both patients ImmunoCAP to rPru p 1, rPru p 3, and rPru p 4 were negative. However, in IgE-immunoblotting of peach, serum IgE antibodies of two patients were bound to approximately 10 kDa proteins. These results suggest that in patients suspected of having peach anaphylaxis and with a negative peach ImmunoCAP, additional testing, such as SPT with peach, should be performed for diagnosis.

Anaphylaxis due to peach with negative ImmunoCAP result to peach allergens, including rPru p 1, rPru p 3, AND rPru p 4: a report of two cases. [Japanese]
Maeda N, Inomata N, Morita A, Kirino M, Moriyama T, Ikezawa Z.
Arerugi 2009 Feb;58(2):140-147

Evaluation of relationships between foods and pollen antigens in peach oral allergy patients
This Japanese study evaluated the relationships between foods and pollen allergens in oral allergy syndrome (OAS). The levels of specific IgE against recombinant peach allergens (rPru p 1, rPru p 3 and rPru p 4) in 17 peach OAS patients were examined. Patients positive to peach, rPru p 1, rPru p 4 and rPru p 3 RAST were 13 (76%), 14 (82%), 6 (35%) and 0 (0%), respectively. The RAST value of rPru p 1 was significantly correlated with that of natural birch pollen extract, but not with that of mugwort pollen extract. The RAST value of rPru p 4 was significantly correlated with that of mugwort pollen extract, but not with that of natural birch pollen extract. Therefore, with peach OAS, the most important cross-reactive antigen is Pru p 1 in birch pollinosis, and is Pru p 4 in mugwort pollinosis.

evaluation of relationships between foods and pollen antigens in peach oral allergy patients -serous specific IgE levels of peach recombinant Antigen-. [Japanese]
Asakura K, Yamamoto T, Shirasaki H, Honma T.
Arerugi 2009 Feb;58(2):133-139

Diagnosis of multiple chemical sensitivity by chemical compounds exposure.
Objective: There are no specific signs or symptoms in Multiple Chemical Sensitivity (MCS), so diagnosis of MCS depends on a history, QEESI symptom scores and exclusion of other diseases. A gold standard of diagnosis of MCS is a chemical compound exposure test in which changes of symptoms are used to decide the results positive or negative. We have done chemical compound exposure tests to diagnose MCS in 51 patients.

Methods: Chemical compound exposure tests were done in a special facility (the exposure chamber) in our hospital. Used VOC were formaldehyde or toluene. Maximum exposure concentrations were 0.08 ppm and 0.07 ppm for formaldehyde and toluene, respectively. Forty patients had the tests by a open test manner and 11 patients by a single blinded manner.

Results: In the open tests, 18 patients had positive results and 22 patients negative. In 22 patients who had negative results, eleven showed no symptoms by chemical exposures, and other 11 claimed symptoms before VOC went into the chamber. In the single blinded tests, 4 patients had positive results and 7 patients negative.

Conclusion: The chemical exposure test is the most reliable test to diagnose MCS, so standardization of the methods of the test is necessary.

Diagnosis of multiple chemical sensitivity by chemical compounds exposure. [Japanese]
Hasegawa M, Ohtomo M, Mizuki M, Akiyama K.
Arerugi 2009 Feb;58(2):112-118

IgE-binding reactivity of peptide fragments of Bla g 1.02, a major German cockroach allergen.
The aim of the present study was to identify linear IgE-binding epitopes of Bla g 1.02. The sera of 24 patients (64.9%) recognized the full-length Bla g 1.02 recombinant protein. Among 19 selected serum samples, 11 sera (57.9%) reacted to peptide fragment A, 5 sera (31.3%) to B, 4 sera (21.1%) to C, 9 sera (47.4%) to D, and 10 sera (52.6%) to peptide fragment E. IgE-binding epitopes are found to be distributed to each tandem repeat of Bla g 1. The combination of peptide fragments A, D, and E may able to detect all Bla g 1-sensitized subjects. We suggest that these peptide fragments may be useful in allergy diagnosis and the design of novel immunotherapeutics.

IgE-binding reactivity of peptide fragments of Bla g 1.02, a major German cockroach allergen.
Yi MH, Jeong KY, Kim CR, Yong TS.
Asian Pac J Allergy Immunol 2009 Jun;27(2-3):121-129

Wheat-dependent, exercise-induced anaphylaxis in Thai children
This study describes common clinical characteristics and laboratory manifestations of wheat-dependent, exercise-induced anaphylaxis of 5 children, aged 8-14 years. All patients had symptoms which involved the skin and three had hypotension. Serum specific IgE for wheat was positive in 2 patients. Four patients completed the three-day challenge protocol. Anaphylaxis occurred in 2 out of 4 patients who consumed more than 100 grams of wheat prior to the exercise.

Wheat-dependent, exercise-induced anaphylaxis in Thai children: a report of 5 cases.
Pacharn P, Jirapongsananuruk O, Daengsuwan T, Vichyanond P, Visitsunthorn N.
Asian Pac J Allergy Immunol 2009 Jun;27(2-3):115-120

Impact of dietary regimen on the duration of cow's milk allergy: a random allocation study.
"Patients not exposed to cow's milk protein residue achieve cow's milk tolerance earlier than patients who follow an extensively hydrolysed cow's milk diet. This may be due to residual antigenicity in hydrolysed milks. As the effect of dietary intervention is stronger in patients not sensitized to soy, we infer that when atopic disease has progressed to multiple sensitizations, the elimination of allergenic exposure may not be sufficient to reduce the duration of CMA."

Impact of dietary regimen on the duration of cow's milk allergy: a random allocation study.
Terracciano L, Bouygue GR, Sarratud T, Veglia F, Martelli A, Fiocchi A.
Clin Exp Allergy 2010 Jan 11;

Component-resolved diagnosis of kiwifruit allergy with purified natural and recombinant kiwifruit allergens.
Component-resolved diagnostics may enable significantly improved detection of sensitization to kiwifruit. This study evaluated the use of individual allergens for component-resolved in vitro diagnosis of kiwifruit allergy in 30 patients with a positive DBPCFC to kiwifruit, 10 atopic subjects with negative open provocation to kiwifruit, and 5 nonatopic subjects. Specific IgE to 7 individual allergens (nAct d 1-5 and rAct d 8-9) and allergen extracts was measured by ImmunoCAP. The diagnostic sensitivities of the commercial extract and of the sum of single allergens were 17% and 77%, respectively, whereas diagnostic specificities were 100% and 30%. A combination of the kiwi allergens Act d 1, Act d 2, Act d 4, and Act d 5 gave a diagnostic sensitivity of 40%, whereas diagnostic specificity remained high (90%). Exclusion of the Bet v 1 homolog recombinant (r) Act d 8 and profilin rAct d 9 from this allergen panel reduced sensitivity to 50% but increased specificity to 40%. Kiwifruit-monosensitized patients reacted more frequently (P < .001) with Act d 1 than polysensitized patients, whereas the latter group reacted more frequently with rAct d 8 (P = .004). Therefore use of single kiwifruit allergen ImmunoCAP increases the quantitative test performance and diagnostic sensitivity compared with the commercial extract. Bet v 1 homolog and profilin are important allergens in pollen-related kiwifruit allergy, whereas actinidin is important in monoallergy to kiwifruit, in which symptoms are often more severe.

Component-resolved diagnosis of kiwifruit allergy with purified natural and recombinant kiwifruit allergens.
Bublin M, Pfister M, Radauer C, Oberhuber C, Bulley S, Dewitt AM, Lidholm J, Reese G, Vieths S, Breiteneder H, Hoffmann-Sommergruber K, Ballmer-Weber BK.
J Allergy Clin Immunol 2010 Jan 8;

Anaphylaxis to mango fruit and crossreactivity with Artemisia vulgaris pollen.
Anaphylaxis to mango fruit and crossreactivity with Artemisia vulgaris pollen. Mango allergy may occur in isolation or in association with pollen or latex allergy. A 39-year-old woman who had an anaphylactic reaction immediately after ingestion of fruit salad containing fresh mango, strawberry, kiwi, orange, and pineapple. She experienced oral allergy syndrome, pruritus of the palms, facial angioedema, hoarseness, nausea, vomiting, and respiratory distress. She had previously eaten all these fruits, except mango. She subsequently ate all the culprit fruits except mango, with no reaction. She had allergic rhinitis with sensitization to house dust mites and Artemisia vulgaris pollen. SPT results were positive for mango and negative for the other fruits, and latex. SPT with fresh fruit were positive for mango only. Serum IgE for mango was 5.96 kUA/L, <0.35 kUA/L for other fruits, and for Artemisia vulgaris >100 kUA/L. Immunological study identified a 13-kDa protein from mango fruit involved in the cross-reactivity.

Anaphylaxis to mango fruit and crossreactivity with Artemisia vulgaris pollen.
Silva R, Lopes C, Castro E, Ferraz de OJ, Bartolome B, Castel-Branco MG.
J Investig Allergol Clin Immunol 2009;19(5):420-422

Immediate hypersensitivity to latex in the absence of demonstrable specific immunoglobulin E.
A report of 2 patients with a strong history of immediate hypersensitivity reactions to latex in the absence of demonstrable SSIgE, negative SPT, negative prick-prick test with an NRL glove, and, in 1 patient, negative BAT. This report demonstrates that immediate hypersensitivity to latex can occur in the absence of demonstrable specific IgE and a negative BAT result. Interestingly, neither case showed a positive response to prick-prick skin testing despite a positive result with provocation testing using the same glove. It is plausible that specific IgE in these patients is directed against an epitope that was either not present at a sufficient concentration or was absent or denatured in the SPT extract and in vitro tests.

Immediate hypersensitivity to latex in the absence of demonstrable specific immunoglobulin E.
Noorani S, Richter A, Fenn M, Read G, Huissoon A, Williams P, Williams A, Krishna MT.
J Investig Allergol Clin Immunol 2009;19(5):419-420

Selective allergy to lobster in a case of primary sensitization to house dust mites.
Allergy to only 1 kind of seafood is uncommon. A report of a 30-year-old man who suffered generalized urticaria, facial erythema, and pharyngeal pruritus after eating lobster. He had a long history of mild persistent asthma and sensitization to house dust mites. The patient's serum recognized 2 allergens of around 198 kDa and 2 allergens of around 65 kDa from the lobster extract, allergens of around 15, 90, and 120 kDa from Dermatophagoides pteronyssinus extract, and allergens of around 15 and 65 kDa from Dermatophagoides farinae extract. Serum did not recognize purified shrimp tropomyosin. Immunoblot-inhibition assay results indicated cross-reactivity between lobster and mite allergens. This is the first report of selective allergy to lobster.

Selective allergy to lobster in a case of primary sensitization to house dust mites.
Iparraguirre A, Rodriguez-Perez R, Juste S, Ledesma A, Moneo I, Caballero ML.
J Investig Allergol Clin Immunol 2009;19(5):409-413

Eosinophilic esophagitis due to profilin allergy.
Eosinophilic esophagitis due to profilin allergy. A 32-year-old man with a 10-year history of mild seasonal rhinoconjunctivitis. For the last 2 years, he had experienced oral pruritus after eating fresh, raw fruit and vegetables. As the pruritis was miil, he did not stop eating these foods. He tolerated cooked vegetables, jams, and pasteurized fruit juices. In the last year, he suffered dysphagia with solids. Gastroesophageal reflux disease was ruled out. SPT was positive for: grass pollen, olive, cat dander, tomato, melon, orange, and profilin. Total IgE was 78 kUA/L. Biopsy was positive. Fruit and vegetabies were oniy permitted if cooked. Four months iater, the patient was asymptomatic.

Eosinophilic esophagitis due to profilin allergy.
Dominguez-Ortega J, Perez-Bedmar J, Rodriguez-Jimenez B, Butron M, Kindelan C, Ledesma A.
J Investig Allergol Clin Immunol 2009;19(4):338-339

Earl Grey tea intoxication.
A 44-year-old man presented with muscle cramps. He had been drinking up to 4 L of black tea per day over the past 25 years. He had changed to Earl Grey which he thought would be less harmful to his stomach. 1 week after the change, he noticed repeated muscle cramps for some seconds in his right foot. The longer he drank Earl Grey tea, the more intense the muscle cramps became. After 3 weeks, they also occurred in the left foot. After 5 weeks, muscle cramps had spread towards the hands and the right calf. Occasionally, he observed fasciculations of the right adductor pollicis and gastrocnemius. Additionally, he noted distal paraesthesias in all limbs, and a feeling of pressure in his eyes, associated with blurred vision, particularly in darkness. On neurologic examination he had reduced visual acuity and fasciculations in the right tibialis anterior and adductor pollicis. Tests of thyroid, hepatic, adrenal, and kidney functions showed no abnormalities. Serum and urine potassium, chloride, calcium, magnesium, and phosphate were all within the normal range. The patient assumed that there was a relation between his symptoms and his tea consumption, and stopped drinking Earl Grey. Within 1 week, his symptoms had completely disappeared. The adverse effects of bergamot oil in this patient are explained by the effect of bergapten as a largely selective axolemmal potassium channel blocker, reducing potassium permeability at the nodes of Ranvier in a time-dependent manner. This may lead to hyperexcitability of the axonal membrane and phasic alterations of potassium currents, causing fasciculations and muscle cramps.

Earl Grey tea is composed of black tea and the essence of bergamot oil, an extract from the rind of bergamot orange (Citrus aurantium ssp bergamia), which has a pleasant, refreshing scent. Bergamot oil contains bergapten (5-methoxypsoralen), bergamottin (5-geranyloxypsoralen), and citropten (5,7-dimethoxycoumarin), which can be found in grapefruit juice, celery, parsnips, and Seville orange juice. Bergamot oil is a well-known UVA-induced photosensitiser.

Earl Grey tea intoxication.
Finsterer J.
Lancet 2002:359(9316):1484

Green tea-induced asthma.
Green tea-induced asthma.

Green tea-induced asthma. [Japanese]
Kawano T, Matsuse H, Fukahori S, Tsuchida T, Fukushima C, Kohno S.
Miscellaneous 2009 Apr 10;98(4):866-7.

Occupational allergic contact dermatitis from mioga (Zingiber mioga)
Mioga is a member of the ginger family (Zingiberaceae), which is native to tropical Asia. In Japan, the young flower buds are used as a spice, and hand dermatitis suspected as being an allergy to mioga has been recognized in mioga greenhouse cultivators.

Twenty householders cultivating mioga completed a questionnaire. Some subjects who had hand dermatitis were patch tested for mioga, four kinds of mioga extracts, and three kinds of natural rubber gloves. Of 35 cultivators from 16 households who completed the questionnaire, 8 (22.9%) stated that they had experienced hand dermatitis since they started mioga cultivation. Four of the 8 subjects were patch tested, of which 2 showed allergic reactions to mioga and the extracts. The other two showed irritation to mioga. The first two cases also showed allergic reactions to natural rubber gloves. (Minamoto 2007 ref.24383 5)

Occupational allergic contact dermatitis from mioga (Zingiber mioga rosc.) in greenhouse cultivators.
Minamoto K, Harada K, Wei QJ, Wei CN, Omori S, Ueda A.
Miscellaneous 2007 Apr-Jun;20(2 Suppl 2):31-4.

Concentrations of undeclared allergens in food products can reach levels that are relevant for public health.
A cows milk protein allergic patient experiencing a severe allergic reaction to a dark chocolate product that did not declare the potential presence of milk proteins. Spanjersberg and her co-workers analysed milk protein levels in the complaint sample and other product batches and brands.

Analysis of dark chocolate not labelled as may contain milk proteins were found to contain milk protein concentrations at levels that may elicit allergic reactions in up to 68 per cent of the adult allergic consumers.

Milk protein concentrations in unlabelled dark chocolate sprinkles, probably present as a result of cross-contact, were shown to reach levels that can cause serious allergic reactions within the milk-allergic population, wrote the researchers in the journal Food Additives and Contaminants.

Using risk assessment techniques based on probability, they found that, in some cases, the unintended presence of milk protein reached levels that could provoke an allergic reaction in a large part of the milk allergic population.

Concentrations of undeclared allergens in food products can reach levels that are relevant for public health. Food Addit Contam Part A Chem Anal Control Expo Risk Assess
Spanjersberg MQ, Knulst AC, Kruizinga AG, Van Duijn G, Houben GF.
Miscellaneous 2010 Feb;27(2):169-74.

Yellow jacket allergen Ves v 2: N-glycan structures are needed for the human antibody recognition.
Yellow jacket hyaluronidase (Ves v 2) is a mixture of two isoallergens, Ves v 2.01 and Ves v 2.02. Wasp and bee sensitized individuals frequently show IgE antibodies that in vitro recognize common carbohydrate structures across the hymenoptera species. The aim of the study was to characterize the glycosylation patterns in Ves v 2 isoallergens and to assess their immunological properties regarding antibody binding and T cell activation. Analysis of the glycopeptides showed that the majority of the N-glycans contained at least one alpha1,3-fucose and/or alpha1,6-fucose residues in a structure. Interestingly, serum IgE antibodies from vespid allergic patients recognized nVes v 2 but not rVes v 2. Non-glycosylated rVes v 2, however, induced T cell and cytokine responses comparable to glycosylated nVes v 2. The present study shows that N-glycan structures are needed for the antibody recognition but not for the T cell reactivity of Ves v 2 in vitro. (Seppälä 2009 ref.24362 5)

Structural and immunological characterization of the N-glycans from the major yellow jacket allergen Ves v 2: the N-glycan structures are needed for the human antibody recognition.
Seppälä U, Selby D, Monsalve R, King TP, Ebner C, Roepstorff P, Bohle B.
Mol Immunol 2009 Jun;46(10):2014-21.

The prognosis of wheat hypersensitivity in children.
"The study was aimed to determine the natural history of wheat hypersensitivity, to define risk factors for persistent wheat hypersensitivity, and to evaluate the development of respiratory allergy in children with wheat hypersensitivity. The development and subsequent disappearance of wheat hypersensitivity, clinical findings, skin prick test (SPT) reactivity, and the development of allergic rhinoconjunctivitis and asthma were charted retrospectively in 28 children with wheat hypersensitivity proven by the open oral challenge at the median age of 21 months (range 6 to 75 months). Appearance of skin symptoms during the diagnostic wheat challenge was related to SPT-positive wheat hypersensitivity, while the appearance of gastrointestinal symptoms alone was associated with SPT-negative wheat hypersensitivity (p = 0.002). Wheat was tolerated by 59%, 69%, 84%, and 96%, by age 4, 6, 10, and 16, respectively. Sensitization to gliadin with a SPT wheal of >/=5 mm at the time of the diagnostic challenge was associated with a slower course of recovery from wheat hypersensitivity (p = 0.019), and a SPT wheal of >/=3 mm to gliadin at any time was associated with the development of asthma (p = 0.022). SPT reactivity to wheat was associated with later SPT reactivity to birch pollen (p = 0.001), and the development of allergic rhinoconjunctivitis (p = 0.001). In conclusion, almost all children with wheat hypersensitivity can tolerate wheat by adolescence. Sensitization to gliadin is associated with a slower achievement of tolerance and an increased risk of asthma."

The prognosis of wheat hypersensitivity in children.
Kotaniemi-Syrjanen A, Palosuo K, Jartti T, Kuitunen M, Pelkonen AS, Makela MJ.
Pediatr Allergy Immunol 2009 Sep 30;

Generalised allergic contact dermatitis from acrylate with artificial nails
A 37-year-old woman suffered from generalized chronic lichenificated eczema associated to severe nail dystrophy since 8 months, resistant to the dermocorticoids. When she was directly questioned about artificial nails she admitted to using glue-on preformed acrylic nails everyday since 9 or 10 months. After cessation of the glue-nail application, the dermatitis progressively healed. Patch tests showed positive tests to ethyl methacrylate, ethyl acrylate, and 2-hydroxyethyl methacrylate.

Leczéma généralisé aux acrylates des ongles artificiels nest pas seulement professionnel
J. Waton, J.-F. Cuny, J.-L. Schmutz, A. Barbaud
Rev Fr Allergol 2010;50(1):40-42

Influence of thermal and acid treatment on the allergenicity of peanut proteins in the population of the region Fez-Meknes Morocco
In this Moroccon study, the objectives were, first, to evaluate the sensitivity to peanuts in the population in the region of Fès-Meknès, and then to study the effect of acid treatment and heating on the allergenicity of peanut proteins. A cross-sectional study at the University Hospital in which 442 adults were recruited, a detailed questionnaire on possible allergies was completed. Results showed that 9.5% of the patients reported allergy to food. Among these patients, 4.2% reported allergy to eggs, 2.5% to peanuts and 0.4 % to wheat flour. Temperature and acidity on the allergenicity of peanut proteins showed that it was reduced by more than 30% by heating at 100 °C and by acid treatment in sera of 50% of the patients. Immunoblots showed that the majority of the sera reacted with Arah1. This reactivity was strongly reduced by treatment of the peanut proteins, especially by treatment with acid.

Influence des traitements thermiques et acides sur lallergénicité des protéines darachide au niveau de la population de la région Fès-Meknès au Maroc
I. Ouahidi, L. Aarab, G.Dutau
Rev Fr Allergol 2010;50(1):15-21

Wine allergy in a wine-growing district: tolerance induction in a patient with allergy to grape lipid-transfer protein.
A report of an individual with repeated severe anaphylaxis after consumption of grapes, wine, and raisins, as result of an IgE-mediated allergy against grape lipid-transfer protein, who was submitted to a specific oral tolerance induction (SOTI) with increasing doses starting from approximately 20 mg of grapes. Within 3 days the patient reached tolerance to the daily maintenance dose of 20 g of grapes (about 3 grape pieces) without anaphylaxis symptoms. Two months later, a controlled challenge with a total of 66.5 mL of white wine was tolerated. Grape-specific IgE stayed stable at 2.37 kU/L (class 2) and grape-specific IgG4 was first detectable 21 months after SOTI. Prick-to-prick skin tests continued to be positive to grapes, to raisins, and to white and red wine. The basophil activation test still showed strong IgE-mediated activation of basophils after stimulation with grape extract. Immunoblotting still detected IgE binding to a 8-kDa protein.

Wine allergy in a wine-growing district: tolerance induction in a patient with allergy to grape lipid-transfer protein.
Schäd SG, Trcka J, Lauer I, Scheurer S, Trautmann A.
WAO Journal 2010;3(1):1-5

Common causes of anaphylaxis in children: the first report of anaphylaxis registry in Iran.
During 4 years, all children (<14 years old) in Iran with a history of anaphylactic reaction were registered. Skin prick tests with suspected agents according to their history and measured specific IgE against them by the ImmunoCAP test were measured. One hundred ninety-three nonfatal anaphylactic attacks among 63 children were recognized. In total, the most current cause of anaphylaxis in children was food (89.7%). Milk (49.3%) and wheat (26.1%) were the most common. Other foods were egg (8.7%), nuts (2.8%), and spices (2.8%). Six children (8.7%) were sensitive to multiple food allergens like milk, egg, and wheat. Five (7.1%) of 63 patients had anaphylactic attack because of stinging. Wasp was the trigger in 3 (4.3%) of them and honeybee was the cause in 1 (1.4%). The last one was because of unknown hymenoptera. There were 2 idiopathic cases of all 63 patients.

Common causes of anaphylaxis in children: the first report of anaphylaxis registry in Iran.
Barzegar S, Rosita A, Pourpak Z, Bemanian M, Mohammad H, et al.
WAO Journal 2010;3(1):6-8

A case of anaphylaxis: horse-fly (Tabanus bovinus) or hymenoptera sting?
A 51 year old man was stung by a yellow, black and green insect on the neck. Five minutes after the bite, he suffered generalized hitching and urticaria, oral cavity and lower limbs paresthesia, followed by lost of consciousness. The description of the insect as well as the lack of the sting on the site suggested a wasp as the culprit. Studying one of these insect that has been captured by the patient, it turned out it wasn't a Vespula, but a horsefly, the Tabanus bovinus, which resembles Hymenoptera. Skin prick test and RAST for Tabanus confirmed the allergology diagnosis. In conclusion, also Tabanus bovines can cause systemic reaction up to anaphylactic shock.

A case of anaphylaxis: horse-fly or hymenoptera sting?
Quercia O, Emiliani F, Foschi FG, Stefanini GF.
Eur Ann Allergy Clin Immunol 2009 Oct;41(5):152-154

The prevalence of peanut allergy: three cohorts of children from the same geographical location in the UK.
This article investigated the prevalence of peanut allergy in three cohorts of children (age 3-4 years) born on the Isle of Wight. Peanut sensitization increased significantly from 1.3% in Cohort A to 3.3% (P = 0.003) in Cohort B before falling back to 2.0% in Cohort C (P = 0.145). Similarly, clinical peanut allergy increased significantly from 0.5% in Cohort A to 1.4% (P = 0.023) in Cohort B, with a subsequent fall to 1.2% in Cohort C (P = 0.850). Data from three cohorts of 3- to 4-year-old children born in the same geographical area shows that peanut allergy prevalence has changed over time. Peanut sensitization and reported allergy in children born in 1994-1996 increased from 1989 but seems to have stabilized or slightly decreased since the late 1990s, although not significant.

Time trends in the prevalence of peanut allergy: three cohorts of children from the same geographical location in the UK.
Venter C, Hasan AS, Grundy J, Pereira B, Bernie CC, Voigt K, Higgins B, Dean T.
Allergy 2010 Jan;65(1):103-108

Clinical reactivity to ingestion challenge with mixed mold extract may be enhanced in subjects sensitized to molds.
Manifestations of mold allergy are classically associated with inhalation of mold spores leading to symptoms of asthma and other respiratory illnesses. It is largely unknown, however, whether ingestion of aeroallergenic molds, mold spores, or other fungi found in food can also elicit hypersensitivity reactions in mold-sensitive individuals. The aim of this study was to evaluate the association between exposure to molds by oral challenge and elicitation of symptoms in mold- versus nonmold-sensitive individuals. Thirty-four adult atopic subjects underwent a single-blinded, placebo-controlled food challenge to the MM preparation. All subjects tolerated challenges to the maximal oral mold dose concentration. However, higher symptom scores after challenge were found in mold-sensitive subjects compared with nonmold-sensitive subjects (p = 0.01). When mold-sensitive subjects were compared based on SPT and/or ID reactivity, higher symptom scores and lower symptom-eliciting concentrations of mold were associated with the SPT reactive subgroup compared with the subgroup with ID reactivity alone. Mold-sensitive subjects compared with nonmold-sensitive subjects experienced cumulatively higher symptom scores after oral challenge to an MM extract preparation. Future studies are warranted to confirm whether ingestion of aeroallergenic molds in food may be another contributor to symptoms in mold-sensitive individuals.

Clinical reactivity to ingestion challenge with mixed mold extract may be enhanced in subjects sensitized to molds.
Luccioli S, Malka-Rais J, Nsouli TM, Bellanti JA.
Allergy Asthma Proc 2009 Jul;30(4):433-442

Allergen-, Food allergy-, Intolerance-related articles

On the cover. Bahia grass.
Weber RW. Ann Allergy Asthma Immunol 2009 Dec;103(6):A4

Adverse reactions to vaccines.
Kelso JM, Li JT, Nicklas RA, Blessing-Moore J, Cox L, Lang DM, Oppenheimer J, Portnoy JM, Randolph C, Schuller DE, Spector SL, Tilles S, Wallace D, Ballas ZK, Baker JR, Bellanti JA, Ein D, Gra. Ann Allergy Asthma Immunol 2009 Oct;103(4 Suppl 2):S1-14

Phenytoin-induced DRESS.
Yazicioglu M, Mentes DA, Turgut B. Ann Allergy Asthma Immunol 2009 Dec;103(6):537-538

Handle with care ... nitroglycerin anaphylaxis.
Weiss L, Brady N, Hostoffer RW, Tcheurekdjian H. Ann Allergy Asthma Immunol 2009 Dec;103(6):536-537

Epinephrine auto-injectors: first-aid treatment still out of reach for many at risk of anaphylaxis in the community.
Simons FE. Ann Allergy Asthma Immunol 2009 May;102(5):403-409

The genus Bromus.
Weber RW. Ann Allergy Asthma Immunol 2009 Mar;102(3):A6

Occupational asthma caused by artificial cyanoacrylate fingernails.
Jurado-Palomo J, Caballero T, Fernandez-Nieto M, Quirce S. Ann Allergy Asthma Immunol 2009 May;102(5):440-441

Hypereosinophilia: a case with an elusive etiology.
Moore JC, Ballas ZK. Ann Allergy Asthma Immunol 2009 Aug;103(2):176-177

Parenting children with food allergy: preliminary development of a measure assessing child-rearing behaviors in the context of pediatric food allergy.
Williams NA, Parra GR, Elkin TD. Ann Allergy Asthma Immunol 2009 Aug;103(2):140-145

Palmer's Almaranth.
Weber RW. Ann Allergy Asthma Immunol 2009 Aug;103(2):A4

Aerial yellow jacket.
Weber RW. Ann Allergy Asthma Immunol 2009 May;102(5):A6, front

Dynamic evolution of serum immunoglobulin E to airborne allergens throughout childhood: results from the Multi-Centre Allergy Study birth cohort.
Matricardi PM, Bockelbrink A, Keil T, Gruber C, Niggemann B, Hamelmann E, Wahn U, Lau S. Clin Exp Allergy 2009 Oct;39(10):1551-1557

Diagnosing food allergy in children is a challenge.
Ostblom E, Nilsson C. Clin Exp Allergy 2010 Jan 14;

T cell responses to major peanut allergens in children with and without peanut allergy.
Flinterman AE, Pasmans SG, den Hartog Jager CF, Hoekstra MO, Bruijnzeel-Koomen CA, Knol EF, van HE. Clin Exp Allergy 2010 Jan 11;

nsLTP and profilin are allergens in mustard seeds: cloning, sequencing and recombinant production of Sin a 3 and Sin a 4.
Sirvent S, Palomares O, Vereda A, Villalba M, Cuesta-Herranz J, Rodriguez R. Clin Exp Allergy 2009 Dec;39(12):1929-1936

A new basophil activation test using CD63 and CCR3 in allergy to antibiotics.
Eberlein B, Suarez IL, Darsow U, Rueff F, Behrendt H, Ring J. Clin Exp Allergy 2010 Jan 14;

Multiple T cell epitope peptides suppress allergic responses in an egg allergy mouse model by the elicitation of forkhead box transcription factor 3- and transforming growth factor-beta-associated mechanisms.
Yang M, Yang C, Mine Y. Clin Exp Allergy 2010 Jan 14;

Cat sensitization according to cat window of exposure in adult asthmatics.
Oryszczyn MP, van RR, Maccario J, Nadif R, Kauffmann F. Clin Exp Allergy 2009 Oct;39(10):1515-1521

Ovalbumin content in 2009 to 2010 seasonal and H1N1 monovalent influenza vaccines.
Waibel KH, Gomez R. J Allergy Clin Immunol 2010 Jan 7;

Particle size of inhaled corticosteroids: does it matter?
Leach C, Colice GL, Luskin A. J Allergy Clin Immunol 2009 Dec;124(6 Suppl):S88-S93

Photoallergic contact dermatitis due to isoamyl-p-methoxycinnamate.
Monzon S, Abos T, Saenz D, Perez-Cinto N, Montijano R, Solano AM. J Investig Allergol Clin Immunol 2009;19(5):415-416

Management of cow's milk protein allergy in infants and young children: an expert panel perspective.
Allen KJ, Davidson GP, Day AS, Hill DJ, Kemp AS, Peake JE, Prescott SL, Shugg A, Sinn JK, Heine RG. J Paediatr Child Health 2009 Sep;45(9):481-486

Green tea-induced asthma. [Japanese]
Kawano T, Matsuse H, Fukahori S, Tsuchida T, Fukushima C, Kohno S. Miscellaneous 2009 Apr 10;98(4):866-7.

Management of nut allergy influences quality of life and anxiety in children and their mothers.
Cummings AJ, Knibb RC, Erlewyn-Lajeunesse M, King RM, Roberts G, Lucas JS. Pediatr Allergy Immunol 2010 Jan 14;

Breastfeeding and the prevalence of allergic diseases in schoolchildren: Does reverse causation matter?
Kusunoki T, Morimoto T, Nishikomori R, Yasumi T, Heike T, Mukaida K, Fujii T, Nakahata T. Pediatr Allergy Immunol 2010 Jan 14;

Variation of dust endotoxin concentrations by location and time within homes of young children.
Ownby DR, Peterson EL, Williams LK, Zoratti EM, Wegienka GR, Woodcroft KJ, Joseph CL, Johnson CC. Pediatr Allergy Immunol 2010 Jan 14;

Acute allergic skin response as a new tool to evaluate the allergenicity of whey hydrolysates in a mouse model of orally induced cow's milk allergy.
van Esch BC, Schouten B, Hofman GA, van BT, Nijkamp FP, Knippels LM, Willemsen LE, Garssen J. Pediatr Allergy Immunol 2009 Jun 26;

Multiple drug hypersensivity: insight into the underlying mechanism and correlation with autoimmune diseases.
Colombo G, Yacoub MR, Burastero SE, Garattini E, Girlanda S, Saporiti N, Salvo F, Sabbadini MG. Eur Ann Allergy Clin Immunol 2009 Apr;41(2):50-55

Oral food challenge in children: an expert review.
Rance F, Deschildre A, Villard-Truc F, Gomez SA, Paty E, Santos C, Couderc L, Fauquert JL, De BJ, Bidat E, Dupont C, Eigenmann P, Lack G, Scheinmann P. Eur Ann Allergy Clin Immunol 2009 Apr;41(2):35-49

Role of minor determinants of amoxicillin in the diagnosis of immediate allergic reactions to amoxicillin.
Torres MJ, Ariza A, Fernandez J, Moreno E, Laguna JJ, Montanez MI, Ruiz-Sanchez AJ, Blanca M. Allergy 2009 Nov 25;

Severe anaphylaxis to the antiseptic polyhexanide.
Kautz O, Schumann H, Degerbeck F, Venemalm L, Jakob T. Allergy 2010 Jan 22;

Ceftriaxone intradermal test-related fatal anaphylactic shock: a medico-legal nightmare.
Riezzo I, Bello S, Neri M, Turillazzi E, Fineschi V. Allergy 2010 Jan;65(1):130-131

Effect of evaporative coolers on skin test reactivity to dust mites and molds in a desert environment.
Prasad C, Hogan MB, Peele K, Wilson NW. Allergy Asthma Proc 2009 Nov;30(6):624-627

Pet dander and perennial allergic rhinitis: therapeutic options.
Wallace DV. Allergy Asthma Proc 2009 Nov;30(6):573-583

Egg allergy and influenza vaccination.
Settipane RA, Siri D, Bellanti JA. Allergy Asthma Proc 2009 Nov;30(6):660-665

Quantitative immunoglobulins in adulthood.
Crisp HC, Quinn JM. Allergy Asthma Proc 2009 Nov;30(6):649-654

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