Ans F.M. Lebens

Clinical relevance of sensitization to lupine in peanut-sensitized adults

Background:  The use of lupine in food has been increasing during the last decade and allergic reactions to lupine have been reported, especially in peanut‐allergic patients. The frequency and the degree of cross‐reactivity to other legumes are not known. The aim of the study was to investigate the frequency of sensitization to lupine, and in addition to pea and soy, and its clinical relevance, in peanut‐sensitized patients. Furthermore, to determine the eliciting dose (ED) for lupine using double‐blind placebo‐controlled food challenges (DBPCFC).

Quality of life is more impaired in patients seeking medical care for food allergy.

Background: Food allergy (FA) affects 2-4% of adults, but only a small percentage visit an outpatient clinic for a thorough evaluation. Methods: A matched case-control study was used to compare health-related quality of life (HRQL) of the Dutch general population that did not seek medical care for their FA with outpatients who did seek medical care. All participants were diagnosed as food allergic (i.e. with a suggestive history and corresponding positive IgE). HRQL was measured using the Food Allergy Quality of Life Questionnaire - Adult Form (FAQLQ-AF). A food allergy independent measure (FAIM) was used to evaluate the adults perception of the severity of his/her disease. Results: Total FAQLQ-AF score in individuals who never visited a doctor for their FA was significantly lower than that of patients who sought medical care (2.4 vs. 3.9, p = 0.03), indicating that the former had a better quality of life than patients who did seek medical care. Regarding the different domains of FAQLQ, the score for allergen avoidance and dietary restrictions and the score for emotional impact (EI) was significantly higher in the group that sought medical care (p = 0.02 and 0.03, respectively), indicating the importance of these domains. The FAIM score was significantly higher in the group that sought medical care, indicating that they perceived their FA as more severe. Conclusion and Clinical Relevance: Patients who seek medical care for their FA have a more impaired HRQL and perceive their FA as more severe. Food avoidance and issues related to the EI of FA are key areas of intervention aimed at improving HRQL in patients with FA.

The degree of whey hydrolysis does not uniformly affect in vitro basophil and T cell responses of cow's milk-allergic patients

Several studies investigated whether hydrolysed proteins can induce tolerance to cows milk (CM) in children at risk of developing CM allergy. Due to methodological problems and inconsistent findings, the evidence for a tolerogenic effect is limited. A major problem is that different hydrolysates may give different outcomes due to variations in their production and composition.

Anaphylactic versus Mild Reactions to Hazelnut and Apple in a Birch-Endemic Area: Different Sensitization Profiles?

Background: Hazelnut and apple are common causes of food allergy in Europe. In northern Europe, symptoms are usually mild and associated with cross-reactivity to the birch pollen allergen, Bet v 1. In the Mediterranean area, symptoms are more frequently severe and associated with sensitization to lipid transfer protein (LTP). This study compared patients with anaphylactic versus mild reactions to hazelnut and apple in The Netherlands, a birch-endemic area, with respect to sensitization to Bet v 1-homologues (i.e. PR10-proteins) and LTP. Methods: Twenty-one patients fulfilling the criteria for anaphylaxis and 21 with only mild symptoms (oral allergy) to hazelnut and/or apple were recruited. Specific immunoglobulin E to birch pollen, apple, hazelnut and PR10-proteins (rBet v 1, rPru p 1, rMal d 1 and rCor a 1) and recombinant LTP (rPru p 3 and rCor a 8) was measured by ImmunoCAP. Results: Both mild and anaphylactic apple-allergic patients were sensitized to PR10-proteins, whereas only 1/7 of the mild and none of the anaphylactic apple-allergic patients was sensitized to LTP. In contrast, anaphylactic hazelnut-allergic patients displayed no such clear sensitization pattern: some were sensitized to both PR10-proteins and hazelnut LTP (1/9), and others to only LTP (2/9) or to only PR10-proteins (4/9) or to neither PR10-proteins nor LTP (2/9). Conclusion: This study shows that in a birch-endemic area, the sensitization profile to PR10-proteins and LTP in anaphylactic patients may differ between different plant foods. In this patient group, anaphylaxis to hazelnut can be LTP-associated, whereas anaphylaxis to apple is not.

Characterization of T Cell Epitopes in Bovine α-Lactalbumin

Background: Recent studies have indicated that peptides containing T cell epitopes may be used for immunotherapy. While for several cows milk allergens the T cell epitopes have been described, the T cell epitopes in the major allergen α-lactalbumin (α-LAC) are unknown. Therefore, the aim of this study was to determine the T cell epitopes in α-LAC. Methods: Nineteen synthetic peptides spanning α-LAC were obtained. Cows milk-specific T cell lines (TCLs) of 46 subjects were generated and tested for their specificity for α-LAC. The lines responding to α-LAC were subsequently tested to determine their activation in response to the peptides. Results: More than half of the TCLs generated did not respond to α-LAC or lost their responsiveness during subsequent experiments, which indicates that α-LAC has low immunogenicity. Only 8 TCLs recognized 1 or more peptides. The recognition of the peptides was diverse and no major epitopes could be defined. Conclusion: The immunogenicity of α-LAC is very low compared to other major allergens in cows milk. Moreover, there seems to be no dominant epitope present in the protein. Therefore, it seems unlikely that peptides of this protein can be used for immunotherapy.

Food allergy in the Netherlands: differences in clinical severity, causative foods, sensitization and DBPCFC between community and outpatients

BackgroundIt is unknown whether food allergy (FA) in an unselected population is comparable to those from an outpatient clinic population.ObjectiveTo discover if FA in a random sample from the Dutch community is comparable to that of outpatients.MethodsThis study was part of the Europrevall-project. A random sample of 6600 adults received a questionnaire. Those with symptoms to one of 24 defined priority foods were tested for sIgE. Participants with a positive case history and elevated sIgE were evaluated by double-blind placebo-controlled food challenge (DBPCFC). Outpatients with a suspicion of FA were evaluated by questionnaire, sIgE and DBPCFC.ResultsIn the community, severe symptoms were reported less often than in outpatients (39.3% vs. 54.3%). Participants in the community were less commonly sensitized to any of the foods. When selecting only those with a probable FA (i.e. symptoms of priority food and elevation of sIgE to the respective food), no major differences were observed with respect to severity, causative foods, sensitization and DBPCFC between the groups.ConclusionIn the Netherlands, there are large differences in self-reported FA between community and outpatients. However, Dutch community and outpatients with a probable FA do not differ with respect to severity, causative foods, sensitization and DBPCFC-outcome.

Contents Vol. 162, 2013

W. Aberer, Graz M. Akdis, Davos I.J. Ansotegui, Belfast L.K. Arruda, Ribeirão Preto C.E. Baena-Cagnani, Cordoba T. Biedermann, Tübingen S.C. Bischoff , Stuttgart H. Breiteneder, Vienna G.W. Canonica, Genova M. Capron, Lille M.D. Chapman, Charlottesville, Va. K.Y. Chua, Singapore M. Ebisawa, Kanagawa E. Fernández-Caldas, Seefeld F. Ferreira, Salzburg H. Grönlund, Stockholm K.T. HayGlass, Winnipeg, Man. K. Hoff mann-Sommergruber, Vienna P.G. Holt, Perth F. Horak, Vienna E. Jensen-Jarolim, Vienna M. Jutel, Wroclaw D. Kabelitz, Kiel A. Kapp, Hannover D. Kraft , Vienna M. Larché, Hamilton, Ont. E. Maggi, Florence R.N. Maini, London A. Mari, Latina S.F. Martin, Freiburg M. Maurer, Berlin F. Melchers, Basel N.G. Papadopoulos, Athens O. Pérez, Havana City W.J. Pichler, Bern T.A.E. Platts-Mills, Charlottesville, Va. H. Renz, Marburg/Lahn N. Rezaei, Teheran L.J. Rosenwasser, Kansas City, Mo. K. Roux, Tallahassee, Fla. J.-M. Saint-Rémy, Leuven H.A. Sampson, New York, N.Y. R. Sepiashvili, Moscow Y. Shoenfeld, Tel Hashomer H.-U. Simon, Bern J. Smolen, Vienna Z. Szépfalusi, Vienna E. Toubi, Haifa P. Valent, Vienna M. van Hage, Stockholm D.V. Wallace, Fort Lauderdale, Fla. H. Wekerle, Martinsried T. Werfel, Hannover G. Wick, Innsbruck M. Wickman, Stockholm U. Wiedermann, Vienna S. Wöhrl, Vienna H. Yssel, Montpellier Founded 1950 by D. Harley, P. Kallós, W. Löffl er and F.W. Wittich Continued by E.A. Brown (1952–1954), W. Kaufman (1955–1967), F. Hahn (1961–1972), H.C. Goodman (1963–1975), R.R.A. Coombs (1955–1984), Z. Trnka (1972–1987), P. Kallós (1950–1988), G.B. West (1959–1991), J. Bienenstock (1990–1991), L.Å. Hanson (1981–1991), K. Kano (1982–1991), F. Milgrom (1965–1991), K. Rother (1982–1991), G. Wick (1991–1997), B. Grubeck-Loebenstein (1991–1997), D. Kraft (1998–2002) Official Journal of the