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Allergy Advisor Digest - June 2012
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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IgE to recombinant allergens Api m 1, Ves v 1, and Ves v 5 distinguish double sensitization from crossreaction in venom allergy.

Allergy to deamidated gluten in patients tolerant to wheat: specific epitopes linked to deamidation.

Predictive value of IgE/IgG4 antibody ratio in children with egg allergy.

Hypersensitivity reactions to marijuana.

Korean squirrel: a new pet as a cause of asthma.

Allergen stabilities and compatibilities in mixtures of high-protease fungal and insect extracts.

ABIDEC drops and peanut allergy.

Contact allergy to sodium sulfite and its relationship to sodium metabisulfite.

Sodium metabisulfite as a contact allergen--an example of a rare chemical mechanism for protein modification.

Cobalt release from implants and consumer items and characteristics of cobalt sensitized patients with dermatitis.

Direct and indirect exposure to horse

Exposure to dog allergens and subsequent allergic sensitization: an updated review.

Update on food allergy in adults.

Insect anaphylaxis: where are we?

Varying allergen composition and content affects the in vivo allergenic activity of commercial Dermatophagoides pteronyssinus extracts.

Cof a 1: identification, expression and immunoreactivity of the first coffee allergen.

Anaphylaxis to peanut in a patient predominantly sensitized to Ara h 6.

Peanut and tree nut consumption during pregnancy and allergic disease in children-should mothers decrease their intake?

Identification of causative foods in children with eosinophilic esophagitis treated with an elimination diet.

Esophageal eosinophilia caused by milk proteins: From suspicion to evidence based on 2 case reports.

Peanut component Ara h 8 sensitization and tolerance to peanut.

Specific IgE against Staphylococcus aureus enterotoxins: An independent risk factor for asthma.

Can f 1 levels in hair and homes of different dog breeds: Lack of evidence to describe any dog breed as hypoallergenic.

Outcomes of 100 consecutive open, baked-egg oral food challenges in the allergy office.

Allergens in urban schools and homes of children with asthma.

Anaphylaxis due to chicken meat.

IgE to recombinant allergens Api m 1, Ves v 1, and Ves v 5 distinguish double sensitization from crossreaction in venom allergy.
Patients with Hymenoptera venom allergy are frequently positive to venoms of both honey bee and wasp (Vespula). Component-resolved analysis with recombinant species-specific major allergens (rSSMA) may help to distinguish true double sensitization from crossreactivity. 121 patients with systemic allergic reactions to Hymenoptera stings, 76 with double positivity of serum-specific IgE (sIgE) to both venoms, 45 with single positivity to bee or wasp venom, and 32 controls without history of systemic reactions to Hymenoptera stings and no sIgE to whole venoms were assessed.

Only 47% of 76 patients with double positivity to whole venoms reacted also to rSSMA of both species. Specificity of sIgE to the 3 rSSMA was very high, with no sIgE to rSSMA of the other species in single-positive venom-allergic patients and only one control with low sIgE to Ves v 1. All wasp-allergic single-positive patients had sIgE to Ves v 5 and/or Ves v 1, and 78.3% of single-positive bee venom-allergic patients had sIgE to Api m 1.

Specificity of sIgE to rSSMA of both species is excellent. Sensitivity of sIgE to rSSMA was optimal for wasp venom. Sensitivity of bee venom Api m 1 could be increased by adding rSSMA of other important bee venom allergens

IgE to recombinant allergens Api m 1, Ves v 1, and Ves v 5 distinguish double sensitization from crossreaction in venom allergy.
Muller U, Schmid-Grendelmeier P, Hausmann O, Helbling A.
Allergy 2012 Jun 8;

Allergy to deamidated gluten in patients tolerant to wheat: specific epitopes linked to deamidation.
Gluten proteins can be modified by deamidation to enhance their solubility and technological applications. However, severe allergic reactions have been reported after the consumption of food products containing deamidated gluten (DG) in subjects tolerant to wheat. This investigation aimed to characterize allergen profiles for these patients in comparison with those of patients allergic to wheat and to identify IgE-binding epitopes. Sera were obtained from 15 patients allergic to DG and from nine patients allergic to wheat proteins (WP). Compared to the heterogeneous pattern of allergens detected by IgE from patients allergic to WP, responses of patients allergic to DG were homogeneous. In ELISA, all the sera displayed IgE binding to deamidated gamma- and omega2-gliadins and deamidated total gliadins frequently with high concentrations. These modified proteins induced RBL degranulation with most of the sera from DG-allergic patients. A consensus epitope was found on native gamma- and omega2-gliadins (QPQQPFPQ); it was repeated several times in their sequences. The substitution of two or three glutamines of this epitope into glutamic acid at positions Q3 or Q4 and Q8 (QPEEPFPE) increased its recognition the best. Therefore allergy to deamidated gluten is a separate entity from wheat allergy. It can be evidenced by strong IgE binding to deamidated gliadins or peptides of the type QPEEPFPE.

Allergy to deamidated gluten in patients tolerant to wheat: specific epitopes linked to deamidation.
Denery-Papini S, Bodinier M, Larré C, Brossard C, Pineau F, Triballeau S, Pietri M, Battais F, Mothes T, Paty E, Moneret-Vautrin DA.
Allergy 2012 Jun 28;

Predictive value of IgE/IgG4 antibody ratio in children with egg allergy.
The aim of this study was to investigate the role of specific IgG4 antibodies to hen's egg white and determine their utility as a marker for the outcome of oral challenge test in children sensitized to hen's egg. Hen's egg oral food challenge test was performed in 105 sensitized children, and the titers of egg white-specific immunoglobulin G4 (IgG4) and immunoglobulin E (IgE) antibodies were measured. Sixty-four of 105 oral challenges with whole eggs were assessed as positive. The AUC for IgE, IgG4, and IgE/IgG4 for the prediction of positive results were 0.609, 0.724, and 0.847, respectively. Thus, the IgE/IgG4 ratio generated significantly higher specificity, sensitivity, positive predictive value (%), and negative predictive value (%) than the individual IgE and IgG4. Egg white-specific serum IgG4/IgE ratio is important for predicting reactivity to egg during food challenges.

Predictive value of IgE/IgG4 antibody ratio in children with egg allergy.
Okamoto S, Taniuchi S, Sudo K, Hatano Y, Nakano K, Shimo T, Kaneko K.
Allergy Asthma Clin Immunol 2012 Jun 7;8(1):9

Hypersensitivity reactions to marijuana.
Hypersensitivity reactions, including rhinoconjunctivitis, urticaria, and angioedema, have been reported to marijuana. A cohort of 17 individuals (2255 years of age) with symptoms of marijuana sensitivity were studied. SPT using an extract prepared by macerating buds and ?owers in water was used. 5 mm were regarded as positive. Fifteen patients with inhalation exposure manifested rhinitis and conjunctivitis (9), periorbital angioedema (4), sinusitis (1), wheezing (3), and swelling of the throat sensation (1). Fifteen patients reported contact symptoms, which included 13 occurrences of urticaria and 2 of periorbital angioedema. One patient presented with anaphylactic symptoms , which included anxiety, chest tightness, wheezing, gastrointestinal cramping, and vomiting after ingestion of marijuana tea. All of the patients reported symptoms with repeated exposures, and 15 con?rmed cessation of symptoms after avoidance of marijuana. All patients were SPT postive, with many showing large wheal and ?are responses.

Hypersensitivity reactions to marijuana.
Tessmer A, Berlin N, Sussman G, Leader N, Chung EC, Beezhold D.
Ann Allergy Asthma Immunol 2012 Apr;108(4):282-284

Korean squirrel: a new pet as a cause of asthma.
A 47-year-old woman with latex allergy presented with persistent rhinoconjunctivitis and daily asthma-like symptoms, shortness of breath, and wheezes. During the last year she had had a Korean squirrel in her house. Prick by prick skin test with Korean squirrel dander was performed, being positive with a wheal of 8 mm. Speci?c bronchial challenge with Korean chipmunk dander extract resulted in an immediate asthmatic reaction, dyspnea, and oral pruritus; no late asthmatic reaction was observed.

Eutamias sibiricus: a new pet as a cause of asthma.
Arochena L, ndregnette-Roscigno V, Gamez C, Del P, Fernandez-Nieto M.
Ann Allergy Asthma Immunol 2012 Jun;108(6):461-462

Allergen stabilities and compatibilities in mixtures of high-protease fungal and insect extracts.
Current practice guidelines state that protease-rich fungal and insect extracts can be combined when preparing immunotherapy vaccines, but data supporting the stability of allergens in these mixtures have not been reported. Mixtures containing Alternaria, German cockroach, and other fungal and insect extracts frequently included in immunotherapy vaccines were analyzed by a combination of quantitative analyses (enzyme-linked immunosorbent assays for multiallergen immunoglobulin E [IgE]-binding potency, major Alternaria allergen Alt a 1, and major German cockroach allergens Bla g 1 and Bla g 2) and qualitative methods (immunoblotting). Mixtures and analogous single-extract controls containing 10 to 50% glycerin were evaluated after storage for up to 12 months at 2 degrees C to 8 degrees C. Mixtures of extracts within the same phylogenetic groups (fungal-fungal, insect-insect) retained favorable Alternaria and German cockroach allergen levels and activities under most conditions examined. For several cross-taxonomic (fungal-insect) extract combinations at 10 to 25% glycerin concentrations, different immunochemical test methods measuring single (major) or multiple allergens yielded threefold to 10-fold variations in allergen recoveries.

Allergen stabilities and compatibilities in mixtures of high-protease fungal and insect extracts.
Grier TJ, Lefevre DM, Duncan EA, Esch RE, Coyne TC.
Ann Allergy Asthma Immunol 2012 Jun;108(6):439-447

ABIDEC drops and peanut allergy.
ABIDEC multivitamin drops are a commonly prescribed nutritional supplement for young infants in day-to-day practice. ABIDEC multivitamin drops contain 1333 IU retinol (as vitamin A palmitate), 400 IU ergocalciferol solution, 0.4 mg thiamine hydrochloride, 0.8 mg ribofl avin, 0.8 mg pyridoxine hydrochloride, 8 mg nicotinamide and 40 mg ascorbic acid in each 0.6 ml dose. The authors point out that the excipient used is peanut oil, and suggest that these drops should not be taken by patients known to be allergic to peanut and soya as per the manufacturers advice.

ABIDEC drops and peanut allergy.
Subramanian G, Santhanam G, Chandran D.
Arch Dis Child 2012 Mar;97(3):298

Contact allergy to sodium sulfite and its relationship to sodium metabisulfite.
There is increasing recognition of allergic contact dermatitis caused by sodium metabisulfite; however, contact allergy to sodium sulfite is less well recognized. This study sought to establish the prevalence of positive patch test reactions to sodium sulfite in a patient population and investigate its relationship with sodium metabisulfite. Over a 4-month period, 183 patients referred for patch testing were tested with sodium sulfite 1% pet. in addition to sodium metabisulfite 1% pet.

Positive allergic reactions occurred to sodium metabisulfite in 5.5% of the tested patients and to sodium sulfite in 3.8% of the tested patients. Sixty per cent of patients with a positive reaction to sodium metabisulfite were positive to sodium sulfite. Only 1 patient (0.6%) with a negative reaction to sodium metabisulfite showed a positive reaction to sodium sulfite.

This study shows that the majority of patients with positive reactions to sodium metabisulfite are also positive to sodium sulphite. Routinely patch testing with sodium sulfite is probably unnecessary, as most patients with positive reactions will also react to sodium metabisulfite. Clinicians should consider advising patients to avoid sodium sulfite and other sulfites when a positive allergic reaction to sodium metabisulfite occurs.

Contact allergy to sodium sulfite and its relationship to sodium metabisulfite.
Oliphant T, Mitra A, Wilkinson M.
Contact Dermatitis 2012 Mar;66(3):128-130

Sodium metabisulfite as a contact allergen--an example of a rare chemical mechanism for protein modification.
Skin-sensitizing chemicals that cause allergic contact dermatitis do so by reacting with self-proteins such that the modified structure becomes antigenic. The reaction chemistry involved is well characterized, but there are exceptions, such as the occasional allergen sodium metabisulfite. This study sought to identify the potential in cutaneo reaction chemistry of sodium metabisulfite. A probable mechanism for the in cutaneo modification of proteins by sodium metabisulfite involves the sulfite di-anion, acting as a nucleophile towards electrophilic centres in proteins, which is a rare mechanism, as most known skin-sensitizing chemicals behave as electrophiles. Sodium metabisulfite is an unusual but not infrequent contact allergen whose chemistry suggests a previously unrecognized protein modification mechanism involving nucleophilic attack by sulfite di-anions on target electrophilic centres in skin proteins. The chemical properties required for sensitization by nucleophilic attack on skin proteins are quite restrictive, so the domain of nucleophilic sensitizers is expected to be small. Thiourea derivatives are among the sensitizers likely to act by this mechanism

Sodium metabisulfite as a contact allergen--an example of a rare chemical mechanism for protein modification.
Roberts DW, Basketter D, Kimber I, White J, McFadden J, White IR.
Contact Dermatitis 2012 Mar;66(3):123-127

Cobalt release from implants and consumer items and characteristics of cobalt sensitized patients with dermatitis.
Cobalt allergy is prevalent in dermatitis patients. This study investigated sources of cobalt exposure and to presents selected epidemiological data on cobalt allergy from patch-tested dermatitis patients. 19,780 dermatitis patients aged 4-99 years were patch tested with nickel, chromium or cobalt between 1985 and 2010. The cobalt spot test was used to test for cobalt ion release from mobile phones as well as cobalt-containing dental alloys and revised hip implant components. Six of eight dental alloys and 10 of 98 revised hip implant components released cobalt in the cobalt spot test, whereas none of 50 mobile phones gave positive reactions. The clinical relevance of positive cobalt test reactions was difficult to determine in the majority of patients. Isolated patch test reactivity to cobalt was less associated with occupational dermatitis and hand eczema than patch test reactivity to cobalt in combination with other contact allergies.

Cobalt release from implants and consumer items and characteristics of cobalt sensitized patients with dermatitis.
Thyssen JP, Menne T, Liden C, Julander A, Jensen P, Jakobsen SS, Soballe K, Gotfredsen K, Jellesen MS, Johansen JD.
Contact Dermatitis 2012 Mar;66(3):113-122

Direct and indirect exposure to horse
(This is an excellent review article and not apparent from the abstract)

Most studies on the sensitization to horse allergens in populations without professional exposure have been carried out in geographical areas where the rate of horse ownership is high and horse riding is popular. Very few studies have been carried out in populations living in large urban areas. This gap in the literature probably reflects the widespread view that prevalence of horse-related allergy is low in urban populations because the latter are not regularly exposed to horses. The authors suggest that urban areas constitute a model useful to study potential modalities of exposure and sensitization to horse allergen by other routes of exposure than horse-riding. In this article, they describe the risks related to various modalities of exposure to horse allergen, clinical aspects of airway sensitization to horse allergens in patients living in urban areas, and non-occupational exposure to horse allergen. In addition, we illuminate some aspects related to dispersion of horse allergens from sources such as stables to indoor environments.

Direct and indirect exposure to horse: risk for sensitization and asthma.
Liccardi G, Emenius G, Merritt AS, Salzillo A, D'Amato M, D'Amato G.
Curr Allergy Asthma Rep 2012 Jun 21;

Exposure to dog allergens and subsequent allergic sensitization: an updated review.
This review provides an update on the research into dog exposure and the development and exacerbation of allergic sensitization, disease, and asthma. The various dog allergens and how they relate to the burden of illness associated with environmental allergens is discussed. The relationships of family demographics to dog ownership and allergic sensitization is discussed, and recent research into childhood exposure to dogs and the protective role it may play in later development of allergic symptoms is reviewed. Newly proposed treatments being evaluated to reduce or eliminate the symptoms of allergy stemming from sensitization to dog allergen are reviewed.

Exposure to dog allergens and subsequent allergic sensitization: an updated review.
Smallwood J, Ownby D.
Curr Allergy Asthma Rep 2012 Jun 9;

Update on food allergy in adults.
"Though much has been studied and written about food allergy, the majority of the available literature focuses on food allergies in the pediatric population. Unfortunately, it is likely that in regard to food allergies, adults are not just big children, and extrapolating findings from pediatric to adult patient populations might lead to erroneous assumptions. Thus, it is important to validate the correlation between pediatric and adult data, gather data regarding adult food allergy and understand the specific nuances of subsets of adults to better treat their food allergy. This review was conducted by identifying potentially relevant studies regarding food allergies in adults through electronic databases, including PubMed, Medline, and Google Scholar. The search terms included 'allergy', 'food' and 'adults'. Parameters of 19+ years of age were added to search terms and all journals were written in or translated to English. From these search results, focus was placed on studies from 2010 to 2012. This systematic update on food allergy in adults found that the evidence regarding prevalence, diagnosis and management of food allergies is very limited, with the majority of data derived from children and young adults"

Update on Food Allergy in Adults.
Chaudhry RQ, Oppenheimer JJ.
Curr Allergy Asthma Rep 2012 Jun 3;

Insect anaphylaxis: where are we?
This review focuses primarily on the changes between the 2004 and 2011 stinging insect practice parameter commissioned by the JTF on Practice Parameters, and highlight the differences between working groups.

Extract: "Although skin testing for venom-specific IgE remains the cornerstone for the evaluation of insect hypersensitivity, periodically a negative skin test may result, even with a convincing history of a systemic sting reaction. However, in such patients, a negative skin test result for venom-specific IgE should be interpreted with caution, especially when done within the first few weeks following a sting reaction. In such cases, in-vitro testing is indicated. Up to 20% of skin-test-positive individuals have undetectable serum levels of venom-specific IgE, whereas 1020% of patients with negative skin tests may have positive in-vitro results when highsensitivity assays are included. Consequently, skin testing and in-vitro immunoassays for venomspecific IgE may be considered complementary. Rare occurrences of anaphylaxis have been reported in individuals with negative skin testing in addition to negative in-vitro methods."

Insect anaphylaxis: where are we? The stinging facts 2012.
Tracy JM, Khan FS, Demain JG.
Curr Opin Allergy Clin Immunol 2012 Jun 22;

Varying allergen composition and content affects the in vivo allergenic activity of commercial Dermatophagoides pteronyssinus extracts.
The aim of this study was to analyze commercially available Dermatophagoides pteronyssinus extracts from different manufacturers regarding allergen composition and content and whether variations may affect their allergenic activity. Only Der p 1 and Der p 2 were detected in all extracts but their concentrations and ratios showed high variability (Der p 1: 6.0-40.8 microg ml(-1); Der p 2: 1.7-45.0 microg ml(-1)). At least 1 out of 4 allergens (i.e. Der p 5, 7, 10 and 21) was not detected in 8 of the studied extracts. Mite-allergic subjects showed different IgE reactivity profiles to the individual mite allergens, the extracts showed different allergenic activity in skin-prick tests and false-negative results. Commercially available D. pteronyssinus extracts lack important allergens, show great variability regarding allergen composition and content and some gave false-negative diagnostic test results in certain patients.

Varying allergen composition and content affects the in vivo allergenic activity of commercial Dermatophagoides pteronyssinus extracts.
Casset A, Mari A, Purohit A, Resch Y, Weghofer M, Ferrara R, Thomas WR, Alessandri C, Chen KW, de BF, Valenta R, Vrtala S.
Int Arch Allergy Immunol 2012 Jun 21;159(3):253-262

Cof a 1: identification, expression and immunoreactivity of the first coffee allergen.
Dust of green coffee beans is known to be a relevant cause for occupational type I allergy. Allergy diagnostics is based on native green coffee bean extract which exhibits insufficient specificity due to interfering substances as well as batch-to-batch variations. The aim of this study was to identify the first allergen of green coffee. Allergenicity of native green coffee bean extracts was assessed by means of ImmunoCAP in sera of 17 symptomatic coffee workers. IgE binding to coffee proteins with 2 sera from allergic coffee workers was conducted. A new coffee allergen (Cof a 1) was identified, expressed in Escherichia coli, and evaluated by Western blots. Cof a 1 is a 32-kDa C. arabica class III chitinase. Serum IgE antibodies to the recombinant allergen were found in 3 out of 17 symptomatic coffee workers (18%), whereas only 2 of them reacted to the commercial allergy test.

Cof a 1: identification, expression and immunoreactivity of the first coffee allergen.
Manavski N, Peters U, Brettschneider R, Oldenburg M, Baur X, Bittner C.
Int Arch Allergy Immunol 2012 Jun 20;159(3):235-242

Anaphylaxis to peanut in a patient predominantly sensitized to Ara h 6.
Peanut allergen component Ara h 2 is considered to indicate true peanut allergy. The component Ara h 6 is structurally similar to Ara h 2, but the diagnostic value of analyzing IgE antibodies to Ara h 6 is unclear. A boy sensitized to Ara h 8 but not to Ara h 1, Ara h 2 and Ara h 3 was challenged with peanut and developed grade II anaphylaxis. In serum collected at the time of challenge a doubling of IgE to the peanut allergen extract was observed compared to allergy testing 9 months earlier. In contrast, IgE levels to Ara h 1, Ara h 2, Ara h 3 and to Ara h 8 were rather unchanged. After another 2 months, Ara h 6 was analyzed and revealed a level of 24 kU(A)/l whilst Ara h 2 was 0.12 kU(A)/l. The auhors suggest that IgE sensitization to Ara h 6 caused the reaction and conclude that analyses of IgE levels to peanut and peanut components should be performed in connection with a challenge. Furthermore, levels to Ara h 2 below 0.35 kU(A)/l may still indicate a risk of severe reaction at the time of challenge since in rare cases, Ara h 6 IgE antibodies may be present without occurrence of IgE antibodies to Ara h 2.

Anaphylaxis to peanut in a patient predominantly sensitized to Ara h 6.
Asarnoj A, Glaumann S, Elfstrom L, Lilja G, Lidholm J, Nilsson C, Wickman M.
Int Arch Allergy Immunol 2012 Jun 1;159(2):209-212

Peanut and tree nut consumption during pregnancy and allergic disease in children-should mothers decrease their intake?
This stuy used data from the Danish National Birth Cohort to examine associations between maternal peanut and tree nut intake during pregnancy and allergic outcomes in children at 18 months and 7 years of age. The authors found that maternal intake of peanuts and tree nuts was inversely associated with asthma in children at 18 months of age. Compared with mothers consuming no peanuts, children whose mothers reported eating peanuts 1 or more times per week were 0.66 and 0.83 times as likely to have a registry-based and medication-related asthma diagnosis, respectively. Higher tree nut intake was inversely associated with a medication-related asthma diagnosis and self-reported allergic rhinitis. The study concludes that these results do not suggest that women should decrease peanut and tree nut intake during pregnancy; instead, consumption of peanuts and tree nuts during pregnancy might even decrease the risk of allergic disease development in children.

Peanut and tree nut consumption during pregnancy and allergic disease in children-should mothers decrease their intake? Longitudinal evidence from the Danish National Birth Cohort.
Maslova E, Granstrom C, Hansen S, Petersen SB, Strom M, Willett WC, Olsen SF.
J Allergy Clin Immunol 2012 Jun 26;

Identification of causative foods in children with eosinophilic esophagitis treated with an elimination diet.
This study concludes that an elimination diet based on SPT/APT results leads to resolution of esophageal eosinophilia in a similar proportion of patients as empiric removal of foods but required that fewer foods be removed. These observations suggest that both methods are acceptable options.

Identification of causative foods in children with eosinophilic esophagitis treated with an elimination diet.
Spergel JM, Brown-Whitehorn TF, Cianferoni A, Shuker M, Wang ML, Verma R, Liacouras CA.
J Allergy Clin Immunol 2012 Jun 26;

Esophageal eosinophilia caused by milk proteins: From suspicion to evidence based on 2 case reports.
Case 1, a 31-year-old woman , when 10 years of age, she started to have dysphagia 5 to 10 minutes after dairy product ingestion. Skin prick tests was negative to cows milk, a-lactal- bumin, and b-lactoglobulin and positive results to casein (4 mm). Total IgE was 290 IU/mL. Specific IgE was 0.10 kU/L to cows milk, 0.0 kU/L to a-lactalbumin, 0.0 kU/L to b-lactoglobulin, 0.12 kU/L to casein, 0.09 kU/L to goats milk, and 0.0 kU/L to sheeps milk. Food patch testing was negative for all the foods tested. A double-blind, placebo-controlled food challenge to cows milk was conducted. The patient reported pharyngeal pruritus and chest tightness, as well as dysphagia 15 to 20 minutes after milk ingestion. An esophagogastroendoscopy within 48 hours after milk intake revealed normal mucosa. A mean of 26 to 37 eosinophils per hpf was found.

Case 2: a 36-year-old woman with a knot-in-the-throat sensation and salivation immediately after consuming milk beginning at 14 years of age. SPT was positive for, among other, cows milk (6 mm), a-lactalbumin (9 mm), b-lactoglobulin (4 mm), and casein (4 mm). Total IgE was 22 IU/mL. Specific IgE was less than 0.05 kU/L to cows milk, a-lactalbumin, b-lactoglobulin, casein, and serum albumin. An esophagogastroendoscopy revealed normal esophageal mucosa. 7 to 8 eosinophils per hpf was shown. A double-blind, placebo-controlled food challenge to milk resulted in dysphagia and a burning chest 10 minutes after milk ingestion. And immediate laryngoscopy after the oral challenge was normal. A mean of 22 to 25 eosinophils per hpf was now seen.

Esophageal eosinophilia caused by milk proteins: From suspicion to evidence based on 2 case reports.
Terrados CS, ntolin-Amerigo D, Foruny JR, Gonzalez AS.
J Allergy Clin Immunol 2012 May;129(5):1416-1419

Peanut component Ara h 8 sensitization and tolerance to peanut.
Isolated Ara h 8 sensitization is suggested to be associated with no or mild symptoms among peanut-sensitized subjects. This study investigated the occurrence of systemic reactions in 144 children with isolated sensitization to Ara h 8 but not to Ara h 1, Ara h 2, or Ara h 3 (<0.35 kU(A)/L). An open oral challenge with peanut was performed in those subjects who did not consume peanut regularly, and an extended IgE reactivity profile was obtained. One hundred twenty-nine (89.5%) children were either peanut consumers or did not react to peanut challenge. Another 14 (9.7%) children experienced oral cavity symptoms at the first 2 but not subsequent challenge doses. At the time of the double-blind, placebo-controlled food challenge, 1 boy with a previous mild systemic reaction to peanut experienced lip swelling, stomach cramping, and objective tiredness. Reanalysis of IgE levels showed an increase in peanut IgE levels from 1.5 to 8.8 kU(A)/L, but IgE levels to Ara h 8 remained stable and IgE levels to Ara h 1, Ara h 2, and Ara h 3 were all still less than 0.35 kU(A)/L. The IgE level to Ara h 6 was 0.45 kU(A)/L.

Peanut component Ara h 8 sensitization and tolerance to peanut.
Asarnoj A, Nilsson C, Lidholm J, Glaumann S, Ostblom E, Hedlin G, van HM, Lilja G, Wickman M.
J Allergy Clin Immunol 2012 Jun 26;

Specific IgE against Staphylococcus aureus enterotoxins: An independent risk factor for asthma.
This study sought to investigate whether IgE to Staphylococcus aureus enterotoxins might be relevant to disease severity in adult asthmatic patients. Specific IgE antibody concentrations in serum against enterotoxins, grass pollen (GP), and house dust mite allergens and total IgE levels were measured in adults: 69 controls, 152 patients with nonsevere asthma, and 166 patients with severe asthma. Enterotoxin IgE positivity was significantly greater in patients with severe asthma (59.6%) than in healthy control subjects (13%, P < .001). Twenty-one percent of patients with severe asthma with enterotoxin IgE were considered nonatopic. Oral steroid use and hospitalizations were significantly increased in patients with enterotoxin IgE and nonatopic asthma. Staphylococcal enterotoxin IgE antibodies, but not IgE against inhalant allergens, appear to be risk factors for asthma severity. The authors hypothesize that the presence of enterotoxin IgE in serum indicates the involvement of staphylococcal superantigens in the pathophysiology of patients with severe asthma.

Specific IgE against Staphylococcus aureus enterotoxins: An independent risk factor for asthma.
Bachert C, van SK, Zhang N, Holtappels G, Cattaert T, Maus B, Buhl R, Taube C, Korn S, Kowalski M, Bousquet J, Howarth P.
J Allergy Clin Immunol 2012 Jun 26;

Can f 1 levels in hair and homes of different dog breeds: Lack of evidence to describe any dog breed as hypoallergenic.
Certain dog breeds are described and marketed as being 'hypoallergenic' on the basis of anecdotal reports that these dogs are better tolerated by patients allergic to dogs. This study investigated these claims by comparing Can f 1 (major dog allergen) levels in hair and coat samples and in the home environment of various hypoallergenic (Labradoodle, Poodle, Spanish Waterdog, and Airedale terrier) and non-hypoallergenic dogs (Labrador retriever and a control group). Significantly higher Can f 1 concentrations were found in hair and coat samples of hypoallergenic dogs than of non-hypoallergenic dogs. Differences between breeds were small, relative to the variability within a breed. Can f 1 levels in settled floor dust samples were lower for Labradoodles, but no differences were found between the other groups. No differences in airborne levels were found between breeds. There is no evidence for the classification of certain dog breeds as being 'hypoallergenic.'

Can f 1 levels in hair and homes of different dog breeds: Lack of evidence to describe any dog breed as hypoallergenic.
Vredegoor DW, Willemse T, Chapman MD, Heederik DJ, Krop EJ.
J Allergy Clin Immunol 2012 Jun 22;

Outcomes of 100 consecutive open, baked-egg oral food challenges in the allergy office.
The high prevalence of egg allergy reflects reactions following ingestion of raw or lightly cooked egg, many recent reports suggest that up to 70% of these egg-allergic patients can tolerate extensively heated or baked egg. The results of the first 100 open baked-egg OFCs is reported. The majority of egg-allergic children tolerate baked egg. Neither clinical history (ever having reaction or anaphylaxis to egg) nor skin prick test provided helpful information to identify the patients who tolerated baked egg.

Outcomes of 100 consecutive open, baked-egg oral food challenges in the allergy office.
Lieberman JA, Huang FR, Sampson HA, Nowak-Wegrzyn A.
J Allergy Clin Immunol 2012 Jun;129(6):1682-1684

Allergens in urban schools and homes of children with asthma.
Settled dust and airborne samples from 12 inner-city schools were analyzed for indoor allergens using multiplex array technology (MARIA). School samples were linked to students with asthma enrolled in the School Inner-City Asthma Study (SICAS). Settled dust samples from students' bedrooms were analyzed similarly. Mouse allergen levels in schools were substantial. In general, cat and dog allergen levels were low, but detectable, and were higher in schools. Aerosolization of mouse allergen in classrooms may be a significant exposure for students. Further studies are needed to evaluate the effect of indoor allergen exposure in schools on asthma morbidity in students with asthma.

Allergens in urban schools and homes of children with asthma.
Permaul P, Hoffman E, Fu C, Sheehan W, Baxi S, Gaffin J, Lane J, Bailey A, King E, Chapman M, Gold D, Phipatanakul W.
Pediatr Allergy Immunol 2012 Jun 6;

Anaphylaxis due to chicken meat.
This French language study reports on a 13-year-old girl, with a past history of allergic urticaria due to eggs, presented with acute facial edema, dysphonia, acute dyspnoea and a feeling of suffocation after ingestion of lightly grilled chicken meat. A few months later, the patient developed asthma in the vicinity of poultry and after contact with chicken feathers.

Anaphylaxis due to chicken meat. [French]
Cheikh RS, Bachouch I, Racil H, Chaouch N, Zarrouk M, Salmi L, Chabbou A.
Rev Mal Respir 2012 Jan;29(1):98-100

Allergen-, Food allergy-, Intolerance-related articles

Immediate reaction to articaine.
Aksu K, Kurt E. Allergol Immunopathol (Madr) 2012 Jun 8;

Non occupational chronic hypersensitivity pneumonitis due to Aspergillus fumigatus on leaky walls.
Mitsui C, Taniguchi M, Fukutomi Y, Saito A, Kawakami Y, Mori A, Akiyama K. Allergol Int 2012 Jun 25;0(0):

Food allergy after cord blood stem cell transplantation with tacrolimus therapy in two patients who developed veno-occlusive disease.
Inoue Y, Ochiai H, Hishiki T, Shimojo N, Yoshida H, Kohno Y. Allergol Int 2012 Jun 25;0(0):

IgE to recombinant allergens Api m 1, Ves v 1, and Ves v 5 distinguish double sensitization from crossreaction in venom allergy.
Muller U, Schmid-Grendelmeier P, Hausmann O, Helbling A. Allergy 2012 Jun 8;

Allergy to deamidated gluten in patients tolerant to wheat: specific epitopes linked to deamidation.
Denery-Papini S, Bodinier M, Larré C, Brossard C, Pineau F, Triballeau S, Pietri M, Battais F, Mothes T, Paty E, Moneret-Vautrin DA. Allergy 2012 Jun 28;

Predictive value of IgE/IgG4 antibody ratio in children with egg allergy.
Okamoto S, Taniuchi S, Sudo K, Hatano Y, Nakano K, Shimo T, Kaneko K. Allergy Asthma Clin Immunol 2012 Jun 7;8(1):9

Breast eczema: mobile phones must not be overlooked. [French]
Dannepond C, Armingaud P. Ann Dermatol Venereol 2012 Feb;139(2):142-143

Hypersensitivity reactions to marijuana.
Tessmer A, Berlin N, Sussman G, Leader N, Chung EC, Beezhold D. Ann Allergy Asthma Immunol 2012 Apr;108(4):282-284

Allergen of the Month-Stachybotrys chartarum.
Weber RW. Ann Allergy Asthma Immunol 2012 Jun;108(6):A9

Eutamias sibiricus: a new pet as a cause of asthma.
Arochena L, ndregnette-Roscigno V, Gamez C, Del P, Fernandez-Nieto M. Ann Allergy Asthma Immunol 2012 Jun;108(6):461-462

Allergen stabilities and compatibilities in mixtures of high-protease fungal and insect extracts.
Grier TJ, Lefevre DM, Duncan EA, Esch RE, Coyne TC. Ann Allergy Asthma Immunol 2012 Jun;108(6):439-447

Relationships between total and allergen-specific serum IgE concentrations and lung function in young adults.
Rajendra C, Zoratti E, Havstad S, Nicholas C, Wegienka G, Cross MT, Johnson CC, Ownby D. Ann Allergy Asthma Immunol 2012 Jun;108(6):429-434

Endotoxin exposure in inner-city schools and homes of children with asthma.
Sheehan WJ, Hoffman EB, Fu C, Baxi SN, Bailey A, King EM, Chapman MD, Lane JP, Gaffin JM, Permaul P, Gold DR, Phipatanakul W. Ann Allergy Asthma Immunol 2012 Jun;108(6):418-422

Molecular allergy diagnosis: we need to become more knowledgeable.
Melioli G, Canonica GW. Ann Allergy Asthma Immunol 2012 Jun;108(6):387

In vitro gastric and intestinal digestions of pulsed light-treated shrimp extracts.
Yang WW, Shriver SK, Chung SY, Percival S, Correll MJ, Rababah TM. Appl Biochem Biotechnol 2012 Mar;166(6):1409-1422

ABIDEC drops and peanut allergy.
Subramanian G, Santhanam G, Chandran D. Arch Dis Child 2012 Mar;97(3):298

Progress in food allergy diagnosis by antigen-specific ige antibody measurement (application of probability curve and allergen component). [Japanese]
Komata T, Ebisawa M. Arerugi 2012 May;61(5):599-606

The critical review of methodologies and approaches to assess the inherent skin sensitization potential (skin allergies) of chemicals. Part III.
Thyssen JP, Gimenez-Arnau E, Lepoittevin JP, Menne T, Boman A, Schnuch A. Contact Dermatitis 2012 Apr;66 Suppl 153-70

The critical review of methodologies and approaches to assess the inherent skin sensitization potential (skin allergies) of chemicals. Part II.
Thyssen JP, Gimenez-Arnau E, Lepoittevin JP, Menne T, Boman A, Schnuch A. Contact Dermatitis 2012 Apr;66 Suppl 125-52

The critical review of methodologies and approaches to assess the inherent skin sensitization potential (skin allergies) of chemicals. Part I.
Thyssen JP, Gimenez-Arnau E, Lepoittevin JP, Menne T, Boman A, Schnuch A. Contact Dermatitis 2012 Apr;66 Suppl 111-24

The critical review of methodologies and approaches to assess the inherent skin sensitization potential (skin allergies) of chemicals. Miscellaneous.
Contact Dermatitis 2012 Apr;66 Suppl 11-9

Allergic contact dermatitis caused by dexpanthenol: report of two cases.
Fernandes S, Macias V, Cravo M, Amaro C, Santos R, Cardoso J. Contact Dermatitis 2012 Mar;66(3):160-161

Allergic contact dermatitis caused by the emulsifier triceteareth-4-phosphate.
Madsen JT, Andersen KE. Contact Dermatitis 2012 Mar;66(3):159-160

The detection of clinically relevant contact allergens with a standard screening tray of 28 allergens.
Patel D, Belsito DV. Contact Dermatitis 2012 Mar;66(3):154-158

A pilot study aimed at finding a suitable eugenol concentration for a leave-on product for use in a repeated open application test.
Svedman C, Engfeldt M, Api AM, Politano VT, Belsito DV, Isaksson M, Bruze M. Contact Dermatitis 2012 Mar;66(3):137-139

Patch test concentrations (doses in mg/cm2 ) for the 12 non-mix fragrance substances regulated by European legislation.
Bruze M, Svedman C, Andersen KE, Bruynzeel D, Goossens A, Johansen JD, Matura M, Orton D, Vigan M. Contact Dermatitis 2012 Mar;66(3):131-136

Contact allergy to sodium sulfite and its relationship to sodium metabisulfite.
Oliphant T, Mitra A, Wilkinson M. Contact Dermatitis 2012 Mar;66(3):128-130

Sodium metabisulfite as a contact allergen--an example of a rare chemical mechanism for protein modification.
Roberts DW, Basketter D, Kimber I, White J, McFadden J, White IR. Contact Dermatitis 2012 Mar;66(3):123-127

Cobalt release from implants and consumer items and characteristics of cobalt sensitized patients with dermatitis.
Thyssen JP, Menne T, Liden C, Julander A, Jensen P, Jakobsen SS, Soballe K, Gotfredsen K, Jellesen MS, Johansen JD. Contact Dermatitis 2012 Mar;66(3):113-122

Non-occupational contact sensitization to epoxy resin of bisphenol A among general dermatology patients.
Majasuo S, Liippo J, Lammintausta K. Contact Dermatitis 2012 Mar;66(3):148-153

Direct and indirect exposure to horse: risk for sensitization and asthma.
Liccardi G, Emenius G, Merritt AS, Salzillo A, D'Amato M, D'Amato G. Curr Allergy Asthma Rep 2012 Jun 21;

Molecular approaches to allergen standardization.
Chapman MD, Briza P. Curr Allergy Asthma Rep 2012 Jun 29;

Food Allergy: Temporal Trends and Determinants.
Ben-Shoshan M, Turnbull E, Clarke A. Curr Allergy Asthma Rep 2012 Jun 22;

Exposure to dog allergens and subsequent allergic sensitization: an updated review.
Smallwood J, Ownby D. Curr Allergy Asthma Rep 2012 Jun 9;

Update on Food Allergy in Adults.
Chaudhry RQ, Oppenheimer JJ. Curr Allergy Asthma Rep 2012 Jun 3;

Physical Urticaria.
Abajian M, Mlynek A, Maurer M. Curr Allergy Asthma Rep 2012 Jun 1;

Diagnosis of occupational asthma: an update.
Jares EJ, Baena-Cagnani CE, Gomez RM. Curr Allergy Asthma Rep 2012 Jun;12(3):221-231

Hypersensitivity reactions to proton pump inhibitors.
Chang YS. Curr Opin Allergy Clin Immunol 2012 Jun 28;

Insect anaphylaxis: where are we? The stinging facts 2012.
Tracy JM, Khan FS, Demain JG. Curr Opin Allergy Clin Immunol 2012 Jun 22;

Drug hypersensitivity reactions presenting as a morbilliform eruption with islands of sparing.
Colaco SM, Bakr FS, Silvers DN, Grossman ME. Cutis 2012 Apr;89(4):173-174

Varying allergen composition and content affects the in vivo allergenic activity of commercial Dermatophagoides pteronyssinus extracts.
Casset A, Mari A, Purohit A, Resch Y, Weghofer M, Ferrara R, Thomas WR, Alessandri C, Chen KW, de BF, Valenta R, Vrtala S. Int Arch Allergy Immunol 2012 Jun 21;159(3):253-262

Cof a 1: identification, expression and immunoreactivity of the first coffee allergen.
Manavski N, Peters U, Brettschneider R, Oldenburg M, Baur X, Bittner C. Int Arch Allergy Immunol 2012 Jun 20;159(3):235-242

Diet influences growth rates and allergen and endotoxin contents of cultured Dermatophagoides farinae and Dermatophagoides pteronyssinus house dust mites.
Avula-Poola S, Morgan MS, Arlian LG. Int Arch Allergy Immunol 2012 Jun 20;159(3):226-234

Anaphylaxis to peanut in a patient predominantly sensitized to Ara h 6.
Asarnoj A, Glaumann S, Elfstrom L, Lilja G, Lidholm J, Nilsson C, Wickman M. Int Arch Allergy Immunol 2012 Jun 1;159(2):209-212

How can we better classify nsaid hypersensitivity reactions? - validation from a large database.
Caimmi S, Caimmi D, Bousquet PJ, Demoly P. Int Arch Allergy Immunol 2012 Jun 22;159(3):306-312

A high serum concentration of chemerin in pustular dermatitis paradoxically induced by etanercept.
Sawada Y, Nakamura M, Hama K, Hino R, Tokura Y. J Am Acad Dermatol 2012 May;66(5):e182-e184

Peanut and tree nut consumption during pregnancy and allergic disease in children-should mothers decrease their intake? Longitudinal evidence from the Danish National Birth Cohort.
Maslova E, Granstrom C, Hansen S, Petersen SB, Strom M, Willett WC, Olsen SF. J Allergy Clin Immunol 2012 Jun 26;

Identification of causative foods in children with eosinophilic esophagitis treated with an elimination diet.
Spergel JM, Brown-Whitehorn TF, Cianferoni A, Shuker M, Wang ML, Verma R, Liacouras CA. J Allergy Clin Immunol 2012 Jun 26;

Esophageal eosinophilia caused by milk proteins: From suspicion to evidence based on 2 case reports.
Terrados CS, ntolin-Amerigo D, Foruny JR, Gonzalez AS. J Allergy Clin Immunol 2012 May;129(5):1416-1419

Peanut component Ara h 8 sensitization and tolerance to peanut.
Asarnoj A, Nilsson C, Lidholm J, Glaumann S, Ostblom E, Hedlin G, van HM, Lilja G, Wickman M. J Allergy Clin Immunol 2012 Jun 26;

Specific IgE against Staphylococcus aureus enterotoxins: An independent risk factor for asthma.
Bachert C, van SK, Zhang N, Holtappels G, Cattaert T, Maus B, Buhl R, Taube C, Korn S, Kowalski M, Bousquet J, Howarth P. J Allergy Clin Immunol 2012 Jun 26;

Selection of contrast media in patients with delayed reactions should be based on challenge test results.
Gracia Bara MT, Moreno E, Laffond E, Munoz FJ, Macias E, Davila I. J Allergy Clin Immunol 2012 Jun 22;

Hypersensitivity to proton pump inhibitors: Diagnostic accuracy of skin tests compared to oral provocation test.
Bonadonna P, Lombardo C, Bortolami O, Bircher A, Scherer K, Barbaud A, Passalacqua G, Pagani M. J Allergy Clin Immunol 2012 Jun 22;

Mast cell anaphylatoxin receptor expression can enhance IgE-dependent skin inflammation in mice.
Schafer B, Piliponsky AM, Oka T, Song CH, Gerard NP, Gerard C, Tsai M, Kalesnikoff J, Galli SJ. J Allergy Clin Immunol 2012 Jun 22;

Can f 1 levels in hair and homes of different dog breeds: Lack of evidence to describe any dog breed as hypoallergenic.
Vredegoor DW, Willemse T, Chapman MD, Heederik DJ, Krop EJ. J Allergy Clin Immunol 2012 Jun 22;

Alternaria alternata allergen Alt a 1: A unique beta-barrel protein dimer found exclusively in fungi.
Chruszcz M, Chapman MD, Osinski T, Solberg R, Demas M, Porebski PJ, Majorek KA, Pomes A, Minor W. J Allergy Clin Immunol 2012 Jul;130(1):241-247

Methylene blue-treated plasma: An increased allergy risk?
Mertes PM, Demoly P, Alperovitch A, Bazin A, Bienvenu J, Caldani C, Lamy B, Laroche D, Leconte des Floris MF, Py JY, Rebibo D, Willaert B, Drouet C, Carlier M, Lienhart A. J Allergy Clin Immunol 2012 Jun 2;

Outcomes of 100 consecutive open, baked-egg oral food challenges in the allergy office.
Lieberman JA, Huang FR, Sampson HA, Nowak-Wegrzyn A. J Allergy Clin Immunol 2012 Jun;129(6):1682-1684

Ovomucoids IgE is a better marker than egg white-specific IgE to diagnose boiled egg allergy.
Haneda Y, Kando N, Yasui M, Kobayashi T, Maeda T, Hino A, Hasegawa S, Ichiyama T, Ito K. J Allergy Clin Immunol 2012 Jun;129(6):1681-1682

Effect of secondhand smoke on asthma control among black and Latino children.
Oh SS, Tcheurekdjian H, Roth LA, Nguyen EA, Sen S, Galanter JM, Davis A, Farber HJ, Gilliland FD, Kumar R, Avila PC, Brigino-Buenaventura E, Chapela R, Ford JG, Lenoir MA, Lurmann F, Meade K, . J Allergy Clin Immunol 2012 Jun;129(6):1478-1483

Associations between quantitative measures of fungi in home floor dust and lung function among older adults with chronic respiratory disease: a pilot study.
Shendell DG, Mizan SS, Yamamoto N, Peccia J. J Asthma 2012 Jun;49(5):502-509

Cockroach allergens induce biphasic asthma-like pulmonary inflammation in outbred mice.
Vaickus LJ, Bouchard J, Kim J, Natarajan S, Remick DG. J Asthma 2012 Jun;49(5):510-521

Prescription of a specific bronchial provocation test for the diagnosis of occupational asthma due to platinum salt. [Italian]
Porro S, Cerri S, Bernabeo F, Pisati G. Med Lav 2012 Mar;103(2):123-129

Allergens in urban schools and homes of children with asthma.
Permaul P, Hoffman E, Fu C, Sheehan W, Baxi S, Gaffin J, Lane J, Bailey A, King E, Chapman M, Gold D, Phipatanakul W. Pediatr Allergy Immunol 2012 Jun 6;

Anaphylaxis due to chicken meat. [French]
Cheikh RS, Bachouch I, Racil H, Chaouch N, Zarrouk M, Salmi L, Chabbou A. Rev Mal Respir 2012 Jan;29(1):98-100

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