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Allergy Advisor Digest - March 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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Occupational immediate-type asthma and rhinitis due to rhodium salts.

Exposure to the airborne mould Botrytis and its health effects.

Oral allergy syndrome: a clinical, diagnostic, and therapeutic challenge.

Thaumatin-like protein and baker's respiratory allergy.

Sensitization to casein and beta-lactoglobulin (BLG) in children with cow's milk allergy.

Antacids and dietary supplements with an influence on the gastric pH increase the risk for food sensitization.

IgE reactivity in 23 077 subjects using an allergenic molecule-based microarray detection system.

The role of iodine in hypersensitivity reactions to radio contrast media.

Clinical value of negative skin tests to iodinated contrast media.

Threshold dose for peanut: Risk characterization - oral challenge of 286 peanut-allergic individuals.

Prevalence of Tyrophagus putrescentiae hypersensitivity in subjects over 70 years of age in a veterans' nursing home in Taiwan.

Pest and allergen exposure and abatement in inner-city asthma.

Measurement of IgE antibodies to shrimp tropomyosin is superior to skin prick testing

Correlation of IgE/IgG4 milk epitopes and affinity of milk-specific IgE antibodies with different phenotypes of clinical milk allergy.

The natural history of soy allergy.

Characterization, antigenicity and detection of fish gelatine and isinglass used as processing aids in wines.

Key nasal symptoms predicting a positive skin test in allergic rhinitis and patient characteristics according to ARIA classification.

Occupational asthma and allergy in snow crab processing in Newfoundland and Labrador.

Specific profiles of house dust mite sensitization in children with asthma and in children with eczema.

Partially hydrolysed formula based on rice protein in the treatment of infants with cow's milk protein allergy.

Hypersensitivity pneumonitis with proteolytic enzymes from Bacillus subtilis

Angioedema secondary to gastrointestinal reflux?

House dust mites as an allergen source in henhouse

Occurence and hygienic/ allergological relevance of mould

Application of recombinant allergens in allergologic diagnostics

Frozen native food allergens applied to prick-skin test are stable for months up to years

Rush specific oral tolerance induction in school-age children with severe egg allergy: one year follow up.

Occupational immediate-type asthma and rhinitis due to rhodium salts.
A 27-year-old atopic operator of an electroplating plant developed work-related shortness of breath and runny nose with sneezing after exposure to rhodium salts. The patient showed positive SPT reactions and positive bronchial immediate-type reactions with rhodium and platinum salts. Sensitivity to rhodium salt was much higher than to platinum salt; the molar concentrations differed by a factor of 256 in SPT and a factor of 16 in bronchial challenges. Rhodium salts should be considered as occupational immediate-type allergens.

Occupational immediate-type asthma and rhinitis due to rhodium salts.
Merget R, Sander I, van K, Raulf-Heimsoth M, Ulmer HM, Kulzer R, Bruening T.
Am J Ind Med 2010 Jan;53(1):42-46

Exposure to the airborne mould Botrytis and its health effects.
"In this review, we investigate the airborne exposure level and health effect of Botrytis, both at general exposure and in occupational settings. The surveyed papers show that Botrytis is found globally with different spore seasons depending on the region investigated. The levels of Botrytis in the percentage of all fungi have a calculated median of around 1.1% in the different environments, confirming that it is among the less prevalent fungi. Furthermore, a substantial proportion of patients and workers are allergic to Botrytis cinerea, and when B. cinerea was included in extended test panels additional allergic patients were found. Thus, B. cinerea is as important as the more prevalent mould genera Cladosporium and Alternaria and we suggest that it should be included in standard allergic tests panels."

Exposure to the airborne mould Botrytis and its health effects.
Jurgensen CW, Madsen A.
Ann Agric Environ Med 2009 Dec;16(2):183-196

Oral allergy syndrome: a clinical, diagnostic, and therapeutic challenge.
The purpose of this article was to provide a review of the literature and discuss the clinical, pathophysiologic, diagnostic, and therapeutic challenges of oral allergy syndrome (OAS). OAS occurs in patients with a prior cross-reactive aeroallergen sensitization and clinically presents with initial oralpharyngeal symptoms after ingestion of a triggering fruit or vegetable. Although controversial, these symptoms may progress to systemic symptoms outside the gastrointestinal tract in 8.7% of patients and anaphylactic shock in 1.7%. OAS's underlying pathophysiology may play a role in clinical presentation and outcome, depending on whether the cross-reactive protein is a heat-labile PR-10 protein, a partially labile profilin, or a relatively heat-stable lipid transfer protein. Diagnostic testing is variable based on the underlying food tested, but fresh food skin prick test typically has the highest sensitivity. Treatment centers on avoidance and the consideration of self-injectable epinephrine. Because of its relationship with a cross-reactive aeroallergen sensitization, subcutaneous immunotherapy and sublingual immunotherapy have also been therapeutically tried with mixed results.

Oral allergy syndrome: a clinical, diagnostic, and therapeutic challenge.
Webber CM, England RW.
Ann Allergy Asthma Immunol 2010 Feb;104(2):101-108

Thaumatin-like protein and baker's respiratory allergy.
Baker's asthma and rhinitis are among the most common occupational diseases. The objective of this study was to identify and test in vivo clinically important purified wheat allergens in baker's respiratory allergy in a Finnish population using skin prick tests in 20 patients with baker's rhinitis, asthma, or both. All the patients had positive skin prick test reactions and specific IgE antibodies to wheat flour. Allergen concentrations of 0.3-0.5 mg/mL showed that 12 patients reacted to alpha-amylase inhibitor (alpha-AI), 9 to peroxidase I (PI), 9 to thaumatin-like protein (TLP), and 6 to lipid transfer protein 2G (LTP2G). With allergen concentrations of 0.05 mg/mL, 5 patients responded to alpha-AI, 3 to PI, 4 to LTP2G, and 6 to TLP. Of these, TLP and LTP2G are new allergens associated with baker's asthma.

Thaumatin-like protein and baker's respiratory allergy.
Lehto M, Airaksinen L, Puustinen A, Tillander S, Hannula S, Nyman T, Toskala E, Alenius H, Lauerma A.
Ann Allergy Asthma Immunol 2010 Feb;104(2):139-146

Sensitization to casein and beta-lactoglobulin (BLG) in children with cow's milk allergy.
The objective of this study was to analyze the sensitization to casein and beta-lactoglobulin (BLG) in children with cow's milk allergy (CMA) in Japan. 115 CMA children were selected based on cow's milk-specific IgE antibodies in serum and compatible clinical history. Titer of anti-casein IgE was significantly higher than that of anti-BLG IgE in CMA patients. IgE antibodies specific to casein were positive in 107 patients (97.3%), while those to BLG were positive in 51 patients (46.6%). Forty-eight patients (43.6%) were positive to both casein and BLG. The patients were divided into two groups: sensitized to casein only (C group) and sensitized to both casein and BLG (C/B group). No significant difference was seen in sensitization rate to white egg between C/B group and C group. However titer of anti-white egg IgE was significantly higher in C/B group than C group. Sensitization rate and levels of specific antibodies to mite and Japanese cedar pollen showed no difference between two groups. Rates of resolution of CMA at the 3 years of age were higher in the C group than C/B group.

Sensitization to casein and beta-lactoglobulin (BLG) in children with cow's milk allergy. [Japanese]
Nakano T, Shimojo N, Morita Y, Arima T, Tomiita M, Kohno Y.
Arerugi 2010 Feb;59(2):117-122

Antacids and dietary supplements with an influence on the gastric pH increase the risk for food sensitization.
Elevation of the gastric pH increases the risk for sensitization against food allergens by hindering protein breakdown. This can be caused by acid-suppressing medication like sucralphate, H2-receptor blockers and proton pump inhibitors, as shown in recent murine experimental and human observational studies.

The aim of this study was to assess the sensitization capacity of the dietary supplement base powder and of over-the-counter antacids. To examine the in vivo influence, BALB/c mice were fed codfish extract with one of the acid-suppressing substances. The pH of hydrochloric acid was substantially increased in vitro by base powder as well as antacids in a time- and dose-dependent manner. This elevation hindered the digestion of codfish proteins in vitro. A significant increase in codfish-specific IgE antibodies was found in the groups fed codfish combined with Rennie((R)) Antacidum or with base powder; the latter also showed significantly elevated IgG1 and IgG2a levels. The induction of an anaphylactic immune response was proven by positive results in intradermal skin tests. The study demonstates that antacids and dietary supplements influence the gastric pH and increase the risk for sensitization against allergenic food proteins. As these substances are commonly used in the general population without consulting a physician, this may have a practical and clinical impact.

Antacids and dietary supplements with an influence on the gastric pH increase the risk for food sensitization.
Pali-Scholl I, Herzog R, Wallmann J, Szalai K, Brunner R, Lukschal A, Karagiannis P, Diesner SC, Jensen-Jarolim E.
Clin Exp Allergy 2010 Mar 4;

IgE reactivity in 23 077 subjects using an allergenic molecule-based microarray detection system.
In this Italian study, the ISAC, a microarray system, was used for specific IgE detection using 75 different allergenic molecules. Sera were collected from 23 077 unselected consecutive individuals complaining about any allergic disease. Sixteen thousand four hundred and eight of 23 077 patients had IgE to at least one of 75 allergenic molecules. The top-ranked molecules in this cohort were Cup a 1 (42.7%), Der f 2 (38.7%), and Phl p 1 (37.9%), whereas all the other allergens tested scored in a range between 36.8% and 0.04%, including the first food allergen, Pru p 3, ranked 15th (9.79%). Prevalence varied quite markedly depending on the age range considered, and showing a different behaviour in the lifetime sensitization process.

Cross-sectional survey on immunoglobulin E reactivity in 23 077 subjects using an allergenic molecule-based microarray detection system.
Scala E, Alessandri C, Bernardi ML, Ferrara R, Palazzo P, Pomponi D, Quaratino D, Rasi C, Zaffiro A, Zennaro D, Mari A.
Clin Exp Allergy 2010 Mar 1;

The role of iodine in hypersensitivity reactions to radio contrast media.
"Hypersensitivity reactions to iodinated radio contrast media (RCM) are either immediate-type (IT) or delayed reactions (DT). In IT, the pathomechanism is unclear. In DT, delayed positive patch (PT) and intradermal tests (IDT) and RCM-specific T cells suggest a T cell-mediated mechanism. In both, the role of iodine has not been clarified; however, patients are often labelled as 'iodine allergic'. Occasionally, positive skin tests to iodine-containing drugs are observed. "

The objective of this study was to investigate the presence of hypersensitivity to iodine in patients with a history of hypersensitivity reactions to RCM. In the IT group, skin tests were positive in three out of nine patients to one RCM. One patient with negative skin tests reacted twice to oral iodine with urticaria. In the DT group, sensitization to one or several RCM was identified in 10 out of 10 patients. In seven out of 10 patients, additional sensitizations to the iodine formulations were found. Two patients developed a mild exanthema after oral provocation with Lugol's solution (LS). The authors conclude that they had previously demonstrated in patients with iodine mumps that an oral challenge with LS is a valid means to elicit hypersensitivity reactions to iodine. In 19 patients, iodine was shown to be rarely the eliciting agent in hypersensitivity reactions to RCM. Only one patient with a late urticaria to an RCM with a late urticaria to LS and two patients with DT and broad sensitization to all RCM tested reacted to LS with an exanthema. In most cases, more likely the RCM molecules and not iodine are the eliciting compounds.

The role of iodine in hypersensitivity reactions to radio contrast media.
Scherer K, Harr T, Bach S, Bircher AJ.
Clin Exp Allergy 2010 Mar;40(3):468-475

Clinical value of negative skin tests to iodinated contrast media.
Skin testing for iodinated contrast medium hypersensitivity has a negative predictive value of 96.6% (95% CI: 89.9-103.2) and none of the reactions in skin-test-negative patients were severe. Multi-centric large surveys are still needed for confirmation.

Clinical value of negative skin tests to iodinated contrast media.
Caimmi S, Benyahia B, Suau D, Bousquet-Rouanet L, Caimmi D, Bousquet PJ, Demoly P.
Clin Exp Allergy 2010 Mar 12;

Threshold dose for peanut: Risk characterization - oral challenge of 286 peanut-allergic individuals.
Clinical records of 286 consecutive patients reacting positively with objective symptoms to double-blind, placebo-controlled oral peanut challenges at University Hospital, Nancy, France were examined for individual No Observed Adverse Effect Levels (NOAELs) and Lowest Observed Adverse Effect Levels (LOAELs). The ED(10) and ED(05) were 14.4 and 7.3mg (expressed as whole peanut), respectively, with 95% lower confidence intervals of 10.7 and 5.2mg, respectively. Compared to results from a previous study where the ED(10) was based upon individual peanut thresholds gleaned from 12 publications, a statistically significant difference was observed between the ED(50)'s, but not the ED(10)'s of the two probability distribution curves. The Nancy patient group contains more sensitive subjects than the group from the published literature thus contributing to the observed differences. Minimum eliciting dose-distributions for patients with histories of more severe reactions (grade 4 or 5; 40 subjects) did not differ significantly from those of patients with histories of less severe reactions (grades 1-3; 123 subjects).

Threshold dose for peanut: Risk characterization based upon diagnostic oral challenge of a series of 286 peanut-allergic individuals.
Taylor SL, Moneret-Vautrin DA, Crevel RW, Sheffield D, Morisset M, Dumont P, Remington BC, Baumert JL.
Food Chem Toxicol 2010 Mar;48(3):814-9.

Prevalence of Tyrophagus putrescentiae hypersensitivity in subjects over 70 years of age in a veterans' nursing home in Taiwan.
The main objective of this study was to investigate the prevalence of Tyrophagus putrescentiae (Tp) sensitization in elderly subjects in a veterans' nursing home in Taiwan using mite allergen extracts and recombinant allergens. 199 subjects were enrolled in this study: 112 elderly subjects from a nursing home and 87 healthy young adults from the hospital staff as controls. 39.3% (44/112) of the elderly population were sensitized to Tp and 17.9% (20/112) to Tp alone. There was a significantly higher prevalence of Tp hypersensitivity in elderly subjects in comparison with the young adult population. In the age association study of Tp and Dp sensitization, the elderly subjects were more sensitized to Tp than to Dp. Among the elderly subjects with chronic obstructive pulmonary disease (COPD) 45.8% (11/24) were Tp sensitive. The major allergens, Tyr p 2 and Tyr p 3, were identified with molecular weights of 16 kDa (53%) and 26 kDa (50%).

Prevalence of Tyrophagus putrescentiae hypersensitivity in subjects over 70 years of age in a veterans' nursing home in Taiwan.
Liao EC, Ho CM, Tsai JJ.
Int Arch Allergy Immunol 2010 Mar 3;152(4):368-377

Pest and allergen exposure and abatement in inner-city asthma.
"Our work group report details the importance of pest allergen exposure in inner-city asthma. We will focus specifically on mouse and cockroach exposure. We will discuss how exposure to these pests is common in the inner city and what conditions exist in urban areas that might lead to increased exposure. We will discuss how exposure is associated with allergen sensitization and asthma morbidity. Finally, we will discuss different methods of intervention and the effectiveness of these tactics"

Pest and allergen exposure and abatement in inner-city asthma: a work group report of the American Academy of Allergy, Asthma & Immunology Indoor Allergy/Air Pollution Committee.
Sheehan WJ, Rangsithienchai PA, Wood RA, Rivard D, Chinratanapisit S, Perzanowski MS, Chew GL, Seltzer JM, Matsui EC, Phipatanakul W.
J Allergy Clin Immunol 2010 Mar;125(3):575-581

Measurement of IgE antibodies to shrimp tropomyosin is superior to skin prick testing
Shrimp is a frequent cause of food allergy. Tropomyosin is the major allergen in shrimp, and it shares homology to tropomyosins from other crustaceans, dust mites, cockroach, and parasites.

The aim of this study was to determine the value of detection of IgE to shrimp tropomyosin in the diagnosis of shrimp allergy, in a study of 35 patients with asthma, rhinitis, or both who were sensitized to Dermatophagoides pteronyssinus. Oral challenges confirmed the diagnosis of shrimp allergy in 7 patients. IgE measurement to shrimp tropomyosin was positive in 71.4% of the patients with shrimp allergy. Of the 28 patients without shrimp allergy, only 7.1% (2/28) had IgE to shrimp tropomyosin compared with 25% (7/28) who had IgE to shrimp and 35.7% (10/28) who had positive skin prick test responses to shrimp. Sensitivity was similar for all 3 methods (71.4%); in contrast, specificity of IgE to shrimp tropomyosin (92.8%) was greater than that of IgE to shrimp (75%) and skin prick testing (64.2%). With regard to diagnostic efficiency, measurement of IgE to shrimp tropomyosin was superior to measurement of IgE to shrimp and skin prick testing (88.5%, 74.2%, and 65.7%, respectively). Therefore measurements of IgE to shrimp tropomyosin provided added value to the diagnosis of shrimp allergy.

Measurement of IgE antibodies to shrimp tropomyosin is superior to skin prick testing with commercial extract and measurement of IgE to shrimp for predicting clinically relevant allergic reactions after shrimp ingestion.
Yang AC, Arruda LK, Santos AB, Barbosa MC, Chapman MD, Galvao CE, Kalil J, Morato-Castro FF.
J Allergy Clin Immunol 2010 Mar 10;

Correlation of IgE/IgG4 milk epitopes and affinity of milk-specific IgE antibodies with different phenotypes of clinical milk allergy.
Results of this study demonstrated that subjects with milk allergy had increased epitope diversity compared with those who outgrew their allergy. heated milk (HM)-tolerant subjects had IgE-binding patterns similar to those who had outgrown their allergy, but IgG4-binding patterns that were more similar to those of the allergic group. Binding to higher numbers of IgE peptides was associated with more severe allergic reactions during challenge. There was no association between IgG4 peptides and clinical features of milk allergy. Allergic patients demonstrated a combination of high- and low-affinity IgE binding, whereas HM-tolerant subjects and those who had outgrown their milk allergy had primarily low-affinity binding. Therefore greater IgE epitope diversity and higher affinity, as determined by using the peptide microarray, were associated with clinical phenotypes and severity of milk allergy.

Correlation of IgE/IgG4 milk epitopes and affinity of milk-specific IgE antibodies with different phenotypes of clinical milk allergy.
Wang J, Lin J, Bardina L, Goldis M, Nowak-Wegrzyn A, Shreffler WG, Sampson HA.
J Allergy Clin Immunol 2010 Mar;125(3):695-702, 702

The natural history of soy allergy.
This article describes the natural history of soy allergy and identify predictors of oral tolerance/outgrowing soy allergy. One hundred thirty-three patients were studied. Eighty-five (64%) had asthma, 95 (71%) had allergic rhinitis, and 108 (85%) had atopic dermatitis. Eighty-eight percent had concomitant peanut allergy. The median age at the initial visit was 1 year (range, 2 months to 17.5 years). Kaplan-Meier analysis predicted resolution of soy allergy in 25% by age 4 years, 45% by age 6 years, and 69% by age 10 years. By age 6 years, 59% of children with a peak soy IgE level of less than 5 kU/L, 53% of children with a peak s-IgE level of 5 to 9.9 kU/L, 45% of children with a peak s-IgE level of 10 to 49.9 kU/L, and 18% of children with a peak s-IgE level of greater than 50 kU/L had outgrown soy allergy (P < .01 for trend). In this referral population approximately 50% of children with soy allergy outgrew their allergy by age 7 years. Absolute soy IgE levels were useful predictors of outgrowing soy allergy.

The natural history of soy allergy.
Savage JH, Kaeding AJ, Matsui EC, Wood RA.
J Allergy Clin Immunol 2010 Mar;125(3):683-686

Characterization, antigenicity and detection of fish gelatine and isinglass used as processing aids in wines.
"Fish gelatine (FG) and isinglass (IG) are widely used in the pharmaceutical industry and as ingredients or processing aids in food production. Both products are the focus of interest since several countries, particularly the member states of the EU and Japan, USA, Australia and New Zealand, have introduced special labelling regulations for allergenic foodstuffs, such as fish and products thereof. Thus, there is a demand for a reliable and sensitive method for the detection of FG and IG in foodstuffs. In this study, the characterization of various FGs and IGs, polyclonal antibodies raised against fish collagen and the development of a sensitive indirect ELISA for the detection of FG and IG is described. The ELISA method detected < or =0.11 microg ml(-1) from all FGs and IGs tested. The indirect ELISA was applied to various experimental wines where FG and IG had been used as processing aids and to several commercial wines. No residues of FG and IG were detected in the experimental wines additionally treated with bentonite, a strong adsorbent for proteins, and successive filtration. Additionally, no residues were found in the commercial wines. However, amounts of up to 0.33 microg ml(-1) were found in some experimental wines not treated with bentonite and successive filtration. Therefore, wines may contain traces of FG and IG that were used as processing aids during wine production. However, treatment with bentonite in combination with additional filtration had a clear impact on these residues."

Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2010 Mar;27(3):273-82.

Characterization, antigenicity and detection of fish gelatine and isinglass used as processing aids in wines.
Weber P, Steinhart H, Paschke A.
Miscellaneous

Key nasal symptoms predicting a positive skin test in allergic rhinitis and patient characteristics according to ARIA classification.
In this Thai study of patients with allergic rhinitis, of 434 patients, 277 (63.8%) were skin prick test positive.

Results of allergen skin prick tests: 277 patients

Allergen - pos - Percent

D.farinae - 229 (82.7)

D. pteronyssinus - 225 (81.2)

House dust - 180 (65.0)

American cockroach - 156 (56.3)

Bermuda grass - 65 (23.5)

Feather - 42 (15.2)

Johnson grass - 39 (14.1)

Cat - 36 (13.0)

Kapok - 25 (9.0)

Cotton - 26 (9.4)

Dog - 11 (4.0)

Penicillium - 9 (3.2)

Alternaria - 6 (2.2)

Aspergillus - 6 (2.2) (Chaiyasate 2009 ref.23808 7)

Key nasal symptoms predicting a positive skin test in allergic rhinitis and patient characteristics according to ARIA classification.
Chaiyasate S, Roongrotwattanasiri K, Fooanant S, Sumitsawan Y.
Miscellaneous J Med Assoc Thai 2009 Mar;92(3):377-81.

Occupational asthma and allergy in snow crab processing in Newfoundland and Labrador.
The objective of this study was to estimate the prevalence of occupational asthma (OA) and occupational allergy (OAl) in snow crab-processing workers n Newfoundland and Labrador and to determine their relationship with exposure to snow crab allergens and other potential risk factors. 215 workers (120 female/95 male) were recruited. The prevalences of almost certain or highly probable OA and OAl were 15.8% and 14.9%, respectively. A high cumulative exposure to crab allergens, in jobs mostly held by women, was associated with OA and with OAl; job held when symptoms started (cleaning, packing, freezing) also predicted OA. Atopy, female gender and smoking were significant determinants for OA.

Occupational asthma and allergy in snow crab processing in Newfoundland and Labrador.
Gautrin D, Cartier A, Howse D, Horth-Susin L, Jong M, Swanson M, Lehrer S, Fox G, Neis B.
Occup Environ Med 2010 Jan;67(1):17-23

Specific profiles of house dust mite sensitization in children with asthma and in children with eczema.
Previously data from Singapore suggest that individuals with skin allergies show preferred sensitization to Dermatophagoides pteronyssinus while individuals with pure respiratory allergies show preferred sensitization to Blomia tropicalis. The aim of this study was to compare the sensitization profiles between children with asthma and those with eczema to D. pteronyssinus and B. tropicalis and their specific allergens. A total of 60 children, 30 with asthma and 30 with eczema were recruited. The asthma group showed highest sensitization to Blo t5 while the eczema group showed highest sensitization to Der p5. The eczema group had significantly higher IgE levels for Der p and its allergens Der p1 and Der p5. Generally, the eczema group was more sensitized to the panel of allergens compared to the asthma group. Individuals with asthma and those with eczema showed different sensitization profiles to HDM.

Specific profiles of house dust mite sensitization in children with asthma and in children with eczema.
Shek LP, Chong AR, Soh SE, Cheong N, Teo AS, Yi FC, Giam YC, Chua KY, Van Bever HP.
Pediatr Allergy Immunol 2010 Mar 19;

Partially hydrolysed formula based on rice protein in the treatment of infants with cow's milk protein allergy.
A prospective open, randomized clinical study to compare the clinical tolerance of a new hydrolysed rice protein formula (HRPF) with an extensively hydrolysed CMP formula (EHF) in the feeding of infants with IgE-mediated cow's milk allergy was conducted in 92 infants aged 1.1-10.1 months diagnosed with IgE-mediated cow's milk allergy. Patients were randomized to receive either an EHF based on CMP or a new HRPF. Follow-up was at 3, 6, 12, 18 and 24 months. Growth parameters were measured at each visit. One infant showed immediate allergic reaction to EHF, but no reaction was shown by any infant in the HRPF group. HRPF was well tolerated by infants with moderate to severe symptoms of IgE-mediated CMP allergy. Children receiving this formula showed similar growth and development of clinical tolerance to those receiving an EHF.

The effect of a partially hydrolysed formula based on rice protein in the treatment of infants with cow's milk protein allergy.
Reche M, Pascual C, Fiandor A, Polanco I, Rivero-Urgell M, Chifre R, Johnston S, Martin-Esteban M.
Pediatr Allergy Immunol 2010 Mar 10;

Hypersensitivity pneumonitis with proteolytic enzymes from Bacillus subtilis
The authors report a case of a worker who was exposed to proteolytic enzymes of Bacillus subtilis while soaking clothes. A diagnosis of hypersensitivity pneumonitis was based on the clinical presentation (dyspnoea, fever, crepitations) and the results of complimentary investigations. Hypersensitivity pneumonitis due to proteolytic enzymes of B. subtilis is rare and not recognized as an occupational disease in Tunisia.

Pneumopathie dhypersensibilité aux enzymes protéolytiques du Bacillus subtilis dans lindustrie de délavage des Jean. / Hypersensitivity pneumonitis with proteolytic enzymes from Bacillus subtilis in the industry washout of John. Presentation of a case
A. Benzarti Mezni, N. Mhiri, M. Beji, A. Ben Jemaa
Rev Fr Allergol 2010;50(2):77-81

Angioedema secondary to gastrointestinal reflux?
"According to the mediator, angioedemas are currently subdivided into histaminergic and bradykinin-induced types. Despite advanced investigations, most of the cases remain still unexplained. The possible link between foregut and angioedema has been suggested after we noticed a recovery secondary to a Nissen fundoplication. Afterwards, in 105 of the 116 patients who consulted about symptoms evocating of angioedema, radiography, endoscopy and/or scintigraphy mere performed in search of gastro-oesophagal reflux. Two groups were distinguished. In the first one including people with reflux, antireflux treatment allowed to control eruptive crisis in more than 90% of the cases. In the second one with people without reflux, treatment was effective only in 23% of cases. The variability of used treatments suggests that effectiveness is the result of reflux control and not of direct medicinal effect on the skin (e.g. anti h2 effect)."

Langioedème allergie alimentaire ou pathologie digestive / Angioedema food allergy or digestive disease
J.-L. Halloy
Rev Fr Allergol 2010;50(2):62-65

House dust mites as an allergen source in henhouse
Storage mites (SM) are important allergen sources in the working environment of German farms. 29 samples of dust from ten henhouses were analysed. House dust mites (HDM) in both high abundance and steadiness were found. 92.1% of all mites found were domestic mites (DM = HDM + SM), whereby 52.3% of the DM found belonged to the HDM. 13 DM species (ten SM, three HDM) could be identified. 24/29 samples contained 2,452 HDM and 2,237 SM (= 4,689 DM in 24 g of dust). Summarizing abundance and steadiness showed the followings ranking: Lepidoglyphus destructor > Dermatophagoides farinae > Dermatophagoides pteronyssinus > Euroglyphus longior > Thyreophagus entomophagus > Glycyphagus domesticus > Acarus siro > Tyrophagus longior > Tyrophagus palmarum > Acarus immobilis > Glycyphagus geniculatus > Acarus farris > Gohieria fusca.

Original Article House dust mites as an allergen source in henhouses
J.-T. Franz, H. Müsken
Allergo J 2010;1:106 -

Occurence and hygienic/ allergological relevance of mould
In a health study of the State Health Agency (LGA) children attending Class 4 of a primary school were tested by an in-vitro allergy screening for the mould allergens mx1 (Penicillium chrysogenum m1, Cladosporium herbarum m2, Aspergillus fumigatus m3 and Alternaria alternata m6). About 5% of the children were sensitized against mould associated with the ambient air. Most of the children were sensitized against Alternaria alternata and IgE-concentration was highest for Alternaria alternata. Children with sensitization against mould were often polysensitized. It was unclear if the allergy screening for mould mx1 included moulds indicative of the indoor moulds such as Acremonium spp., Aspergillus penicillioides, Aspergillus restrictus, Aspergillus versicolor, Chaetomium spp., Phialophora spp., Stachybotrys chartarum, Tritirachium (Engyodontium) album and Trichoderma spp. as a result of crossreactvity.

Occurence and hygienic/ allergological relevance of mould from point of view of the environmental medicine
T. Gabrio und U. Weidner
Allergologie 2010;33(3):101-

Application of recombinant allergens in allergologic diagnostics
"Allergological diagnostics and therapy are performed with native allergen extracts so far. These extracts contain a mixture of proteins from pure allergen sources of different allergenicity. With the introduction of genetic engineering techniques single allergen components can be separated and recombinantly produced. The importance of single allergen proteins is explained by the example of timothy grass and birch pollen, which reflect leading allergens in their plant families. Timothy grass reaches its high allergenicity by the marker allergens Phl p 1 and 5 as major allergens and Phl p 7 and 12 as minor allergens. In analogy Bet v 1 is the major birch pollen allergen, Bet v 2 and 4 are the relevant minor allergens. IgE antibodies (AB) against minor allergens lead in the absence of major allergen AB to an apparent poly-sensitization. These minor allergens represent profilins and calcium-binding proteins (CBP) as pan-allergen families. Profilins as well as CBPs have high rates of cross reactivity in their groups und can be responsible for the intolerance of many vegetable and animal foods. Further relevant pan-allergen families are tropomyosins, prolamins, and cupins. In summary, recombinant allergens provide the expansion of the diagnostic spectrum in serological allergy diagnostics. By excellent IgE binding ability, recombinant allergens are suitable for cutaneous as well as for in vitro diagnostics. This turns out to be a special advantage in clinical practice in the detection of primary allergies in poly-sensitized patients. In the future patient-tailored therapies and preventive vaccinations are imaginable."

Application of recombinant allergens in allergologic diagnostics
G. Mühlmeier und H. Maier
Allergologie 2010;33(3):114-

Frozen native food allergens applied to prick-skin test are stable for months up to years
"In 2001 we described a new technique of freezing allergens in the form of juice or pulp for skin prick test. Frozen allergens without interruption of freezing were tested 4 month up to 8 years after freezing. All these frozen native allergens turned out still to produce positive skin tests after these long periods of freezing. This observation is an important condition to apply frozen allergens for prick skin test."

Frozen native food allergens applied to prick-skin test are stable for months up to years
J. Sennekamp und M. Joest
Allergologie 2010;33(3):97-

Rush specific oral tolerance induction in school-age children with severe egg allergy: one year follow up.
The objectives of this study was to perform rush SOTI for school-age patients with severe egg allergy, and to evaluate the safety and efficacy of this method for one year. Six school-age children (7-12 years of age) with severe IgE-mediated egg allergy confirmed by double-blind, placebo-controlled food challenge (DBPCFC) underwent rush SOTI, in which patients ingested increasing doses of egg several times every day. After rush SOTI, patients ingested the maintenance dose of egg at least twice a week. In DBPCFC, the median threshold dose of egg white inducing allergic reactions was 0.152 g (0.012-0.360 g). All subjects acquired tolerance to more than one whole egg (60 g). It took only 12 days (9-18 days). None experienced any serious reaction.

Rush specific oral tolerance induction in school-age children with severe egg allergy: one year follow up.
Itoh N, Itagaki Y, Kurihara K.
Allergol Int 2010 Mar;59(1):43-51

Allergen-, Food allergy-, Intolerance-related articles

Occupational immediate-type asthma and rhinitis due to rhodium salts.
Merget R, Sander I, van K, Raulf-Heimsoth M, Ulmer HM, Kulzer R, Bruening T. Am J Ind Med 2010 Jan;53(1):42-46

House-dust mite nasal provocation: A diagnostic tool in perennial rhinitis.
Chusakul S, Phannaso C, Sangsarsri S, Aeumjaturapat S, Snidvongs K. Am J Rhinol Allergy 2010 Mar;24(2):133-136

Influence of hyperosmotic conditions on basophil CD203c upregulation in patients with food-dependent exercise-induced anaphylaxis.
Wolanczyk-Medrala A, Barg W, Gogolewski G, Panaszek B, Liebhart J, Litwa M, Medrala W. Ann Agric Environ Med 2009 Dec;16(2):301-304

Oral allergy syndrome: a clinical, diagnostic, and therapeutic challenge.
Webber CM, England RW. Ann Allergy Asthma Immunol 2010 Feb;104(2):101-108

Castor bean, Ricinus communis.
Weber RW. Ann Allergy Asthma Immunol 2010 Feb;104(2):A4

Dapsone hypersensitivity syndrome during delayed pressure urticaria treatment.
do Valle SO, Franca AT, Pires GV, Guimaraes P, Dias GA, Levy SA. Ann Allergy Asthma Immunol 2010 Feb;104(2):181-182

A comparison of 4 epinephrine autoinjector delivery systems: usability and patient preference.
Guerlain S, Hugine A, Wang L. Ann Allergy Asthma Immunol 2010 Feb;104(2):172-177

Effects of summer mailing on in vivo and in vitro relative potencies of standardized timothy grass extract.
Moore M, Tucker M, Grier T, Quinn J. Ann Allergy Asthma Immunol 2010 Feb;104(2):147-151

Thaumatin-like protein and baker's respiratory allergy.
Lehto M, Airaksinen L, Puustinen A, Tillander S, Hannula S, Nyman T, Toskala E, Alenius H, Lauerma A. Ann Allergy Asthma Immunol 2010 Feb;104(2):139-146

Sensitization to casein and beta-lactoglobulin (BLG) in children with cow's milk allergy. [Japanese]
Nakano T, Shimojo N, Morita Y, Arima T, Tomiita M, Kohno Y. Arerugi 2010 Feb;59(2):117-122

Highly sensitive enzyme-linked immunosorbent assay for the quantification of allergens from Dermatophagoides, DER p 1 and DER f 1. [Japanese]
Kondoh M, Fukada K, Shimada T, Kitamura Y, Yasueda H, Enomoto T. Arerugi 2010 Feb;59(2):109-116

To promise personalized medicine: development of world's fastest SNP detection method to circumvent drug-induced adverse reactions. [Japanese]
Ishikawa T, Aw W, Lezhava A, Hayashizaki Y. Arerugi 2010 Feb;59(2):98-108

Immediate type hypersensitivity to chemotherapeutic agents in pediatric patients.
Visitsunthorn N, Utsawapreechawong W, Pacharn P, Jirapongsananuruk O, Vichyanond P. Asian Pac J Allergy Immunol 2009 Dec;27(4):191-197

Does avoidance of peanuts in early life reduce the risk of peanut allergy?
McLean S, Sheikh A. BMJ 2010;340c424

Should allergic reactions to radio-contrast media be investigated by an allergist?
Nasser S. Clin Exp Allergy 2010 Mar 1;

Longitudinal validity and responsiveness of the Food Allergy Quality of Life Questionnaire - Parent Form in children 0-12 years following positive and negative food challenges.
Dunngalvin A, Cullinane C, Daly DA, Flokstra-de Blok BM, Dubois AE, Hourihane JO. Clin Exp Allergy 2010 Mar;40(3):476-485

The role of iodine in hypersensitivity reactions to radio contrast media.
Scherer K, Harr T, Bach S, Bircher AJ. Clin Exp Allergy 2010 Mar;40(3):468-475

Immediate and dual response to nasal challenge with Dermatophagoides pteronyssinus in local allergic rhinitis.
Lopez S, Rondon C, Torres MJ, Campo P, Canto G, Fernandez R, Garcia R, Martinez-Canavate A, Blanca M. Clin Exp Allergy 2010 Mar 12;

Clinical value of negative skin tests to iodinated contrast media.
Caimmi S, Benyahia B, Suau D, Bousquet-Rouanet L, Caimmi D, Bousquet PJ, Demoly P. Clin Exp Allergy 2010 Mar 12;

What's eating you? Cat flea (Ctenocephalides felis).
Golomb MR, Golomb HS. Cutis 2010 Jan;85(1):10-11

Pest and allergen exposure and abatement in inner-city asthma: a work group report of the American Academy of Allergy, Asthma & Immunology Indoor Allergy/Air Pollution Committee.
Sheehan WJ, Rangsithienchai PA, Wood RA, Rivard D, Chinratanapisit S, Perzanowski MS, Chew GL, Seltzer JM, Matsui EC, Phipatanakul W. J Allergy Clin Immunol 2010 Mar;125(3):575-581

Utility of peanut-specific IgE levels in predicting the outcome of double-blind, placebo-controlled food challenges.
van Nieuwaal NH, Lasfar W, Meijer Y, Kentie PA, Flinterman AE, Pasmans SG, Knulst AC, Hoekstra MO. J Allergy Clin Immunol 2010 Mar 19;

Is the detection of IgE to multiple Bet v 1-homologous food allergens by means of allergen microarray clinically useful?
Villalta D, Asero R. J Allergy Clin Immunol 2010 Mar 19;

The structure of the dust mite allergen Der p 7 reveals similarities to innate immune proteins.
Mueller GA, Edwards LL, Aloor JJ, Fessler MB, Glesner J, Pomes A, Chapman MD, London RE, Pedersen LC. J Allergy Clin Immunol 2010 Mar 10;

Allergen-induced, eotaxin-rich, proangiogenic bone marrow progenitors: A blood-borne cellular envoy for lung eosinophilia.
Asosingh K, Hanson JD, Cheng G, Aronica MA, Erzurum SC. J Allergy Clin Immunol 2010 Mar 12;

Risks associated with foods having advisory milk labeling.
Crotty MP, Taylor SL. J Allergy Clin Immunol 2010 Mar 12;

Risk of severe anaphylaxis for patients with Hymenoptera venom allergy: Are angiotensin-receptor blockers comparable to angiotensin-converting enzyme (ACE) inhibitors?
Caviglia AG, Passalacqua G, Senna G. J Allergy Clin Immunol 2010 Mar 25;

Increased risk of eczema but reduced risk of early wheezy disorder from exclusive breast-feeding in high-risk infants.
Giwercman C, Halkjaer LB, Jensen SM, Bonnelykke K, Lauritzen L, Bisgaard H. J Allergy Clin Immunol 2010 Mar 15;

False positive results can occur on delayed reading of intradermal tests with cisplatin.
Guyot-Caquelin P, Granel F, Kaminsky MC, Trechot P, Schmutz JL, Barbaud A. J Allergy Clin Immunol 2010 Mar 23;

Measurement of IgE antibodies to shrimp tropomyosin is superior to skin prick testing with commercial extract and measurement of IgE to shrimp for predicting clinically relevant allergic reactions after shrimp ingestion.
Yang AC, Arruda LK, Santos AB, Barbosa MC, Chapman MD, Galvao CE, Kalil J, Morato-Castro FF. J Allergy Clin Immunol 2010 Mar 10;

Administration of influenza vaccines to patients with egg allergy.
Kelso JM. J Allergy Clin Immunol 2010 Mar 10;

Correlation of IgE/IgG4 milk epitopes and affinity of milk-specific IgE antibodies with different phenotypes of clinical milk allergy.
Wang J, Lin J, Bardina L, Goldis M, Nowak-Wegrzyn A, Shreffler WG, Sampson HA. J Allergy Clin Immunol 2010 Mar;125(3):695-702, 702

Temporary henna tattoos with long-term consequences.
Almeida PJ, Borrego L. Med J Aust 2009 Dec 7;191(11-12):687

Indoor allergen exposure, sensitization, and development of asthma in a high-risk birth cohort.
Carlsten C, mich-Ward H, Becker AB, Ferguson A, Chan HW, Dybuncio A, Chan-Yeung M. Pediatr Allergy Immunol 2010 Mar 19;

The effect of a partially hydrolysed formula based on rice protein in the treatment of infants with cow's milk protein allergy.
Reche M, Pascual C, Fiandor A, Polanco I, Rivero-Urgell M, Chifre R, Johnston S, Martin-Esteban M. Pediatr Allergy Immunol 2010 Mar 10;

[Sensitization to three species of mites in allergic patients from the coastal area of Havana city].
Almarales RL, Castello MA, Diaz MR, Canosa JS, Gomez IG, Leon MG, Dominguez IE, Rosado AL, Viltre BI, Diaz YO, Morejon MM. Rev Alerg Mex 2009 Mar;56(2):31-35

[Epidemiological characteristics of patients with food allergy assisted at Regional Center of Allergies and Clinical Immunology of Monterrey].
Rodriguez-Ortiz PG, Munoz-Mendoza D, rias-Cruz A, Gonzalez-Diaz SN, Herrera-Castro D, Vidaurri-Ojeda AC. Rev Alerg Mex 2009 Nov;56(6):185-191

[Prevalence of allergic diseases in Mexico City].
Lopez PG, Morfin Maciel BM, Huerta LJ, Mejia CF, Lopez LJ, Aguilar G, Rivera Perez JL, Lopez ML, Vargas F. Rev Alerg Mex 2009 May;56(3):72-79

[Allergens used in skin tests in Mexico].
Larenas LD, Arias CA, Guidos Fogelbach GA, Cid del Prado ML. Rev Alerg Mex 2009 Mar;56(2):41-47

[Sensitization to pollens of Oleaceae family in a group of patients from Mexico City].
Morfin-Maciel BM, Flores I, Rosas-Alvarado A, Bautista M, Lopez-Lopez JR. Rev Alerg Mex 2009 Nov;56(6):198-203

[Risk factors of food allergy].
Hidalgo-Castro EM, del Rio-Navarro BE, Sienra-Monge JJ. Rev Alerg Mex 2009 Sep;56(5):158-164

[Anesthesiologist's aptitude for peri-operative detection and treatment of latex allergy].
Cabrera-Pivaral CE, Rangel-Ramirez AA, Franco-Chavez S, Gamez-Nava JI, Riebeling C, Nava A. Rev Alerg Mex 2009 Jul;56(4):108-114

[Sensitization to mites. Relation with atopic diseases in school children from San Antonio de los Banos].
Diaz RA, Fabre Ortiz DE, Coutin MG, Gonzales MT. Rev Alerg Mex 2009 May;56(3):80-85

Comment tester lallergie de contact à la colle tissulaire au 2-octylcyanoacrylate (Dermabond®) ? / How to test the contact allergy to the tissue adhesive 2-octylcyanoacrylate (Dermabond ®)?
M. Studer, C. Pouget-Jasson, J. Waton, J.-L. Schmutz, A. Barbaud Rev Fr Allergol 2010;50(2):75-76

Recurrent angioedema associated with efalizumab.
Mallbris L, von BF, van HM, Stahle M. Acta Derm Venereol 2009 Nov;89(6):665-666

In-vitro-Diagnostik im Fokus.
H. F. Merk, T. Jakob Allergo J 2010;1:81 -

Allergy News Augen auf bei alten Antihistaminika Seelische Spätfolgen Der Smiley-Test: Erkennen uns Bienen? Exotische Dermatitis Silikon-Allergie bei Herzschrittmacher
Allergo J 2010;1:86 -

Journal Club Erdnüsse für Mäusemütter Anaphylaxieschutz für Mäusekinder Allergieprävention durch Synbiotika?
Allergo J 2010;1:88 -

Guidelines In vitro allergy diagnostics
H. Renz, T. Biedermann, A. Bufe, B. Eberlein, U. Jappe, M. Ollert, A. Petersen, J. Kleine-Tebbe, M. Raulf-Heimsoth, J. Saloga, T. Werfel, M. Worm Allergo J 2010;1:110 -

CME In-vitro-Allergiediagnostik
Allergo J 2010;1:129 -

Methods of in-vitro allergy diagnostic
R. Wahl und R. Krause Allergologie 2010;33(3):121-

Position paper Fructose malabsorption
C. Schäfer, I. Reese, B.K. Ballmer-Weber et al. Allergologie 2010;33(3):134-

A case of drug-induced hypersensitivity syndrome-like symptoms following HHV-6 encephalopathy.
Saida S, Yoshida A, Tanaka R, Abe J, Hamahata K, Okumura M, Momoi T. Allergol Int 2010 Mar;59(1):83-86

Role of the hypothalamo-pituitary-adrenal axis in the modulation of pollinosis induced by pollen antigens.
Hashimoto M, Sato EF, Hiramoto K, Kasahara E, Inoue M. Allergol Int 2010 Mar 25;59(2):

Wheat-dependent exercise-induced anaphylaxis exclusively during menstruation.
Fischer J, Schuck E, Biedermann T. Allergy 2010 Mar 19;

Fish allergy: in Cyp c1 we trust.
Agabriel C, Robert P, Bongrand P, Sarles J, Vitte J. Allergy 2010 Mar 22;

Oral mite anaphylaxis.
Sanchez-Machin I, Glez-Paloma PR, Iglesias-Souto J, Iraola V, Matheu V. Allergy 2010 Mar 10;

Anaphylaxis after consuming soy products in patients with birch pollinosis.
van Zuuren EJ, Terreehorst I, Tupker RA, Hiemstra PS, Akkerdaas JH. Allergy 2010 Mar 5;

Accuracy of a point-of-care testing device in children with suspected respiratory allergy.
Serratud T, Donnanno S, Terracciano L, Trimarco G, Martelli A, Petersson C, Borres M, Fiocchi A, Cavagni G. Allergy Asthma Proc 2010 Mar 16;

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