B. Wüthrich

A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force.

This report has been prepared by an EAACI task force representing the five EAACI Sections and the EAACI Executive Committee composed of specialists that reflect the broad opinion on allergy expressed by various clinical and basic specialties dealing with allergy. The aim of this report is to propose a revised nomenclature for allergic and related reactions that can be used independently of target organ or patient age group. The nomenclature is based on the present knowledge of the mechanisms which initiate and mediate allergic reactions. However, the intention has not been to revise the nomenclature of nonallergic hypersensitivity.

Pollen-related allergy in Europe

The increasing mobility of Europeans for business and leisure has led to a need for reliable information about exposure to seasonal airborne allergens during travel abroad. Over the last 10 years or so, aeropalynologic and allergologic studies have progressed to meet this need, and extensive international networks now provide regular pollen and hay‐fever forecasts. Europe is a geographically complex continent with a widely diverse climate and a wide spectrum of vegetation. Consequently, pollen calendars differ from one area to another; however, on the whole, pollination starts in spring and ends in autumn. Grass pollen is by far the most frequent cause of pollinosis in Europe. In northern Europe, pollen from species of the family Betulaceae is a major cause of the disorder. In contrast, the mild winters and dry summers of Mediterranean areas favor the production of pollen types that are rarely found in central and northern areas of the continent (e.g., the genera Parietaria, Olea, and Cupressus). Clinical and aerobiologic studies show that the pollen map of Europe is changing also as a result of cultural factors (e.g., importation of plants for urban parklands) and greater international travel (e.g., the expansion of the ragweed genus Ambrosia in France, northern Italy, Austria, and Hungary). Studies on allergen‐carrying paucimicronic or submicronic airborne particles, which penetrate deep into the lung, are having a relevant impact on our understanding of pollinosis and its distribution throughout Europe.

The prevalence of positive reactions in the atopy patch test with aeroallergens and food allergens in subjects with atopic eczema: a European multicenter study

Background:  The atopy patch test (APT) was proposed to evaluate IgE‐mediated sensitizations in patients with atopic eczema (AE).

Epidemiology, clinical features, and immunology of the “intrinsic” (non‐IgE‐mediated) type of atopic dermatitis (constitutional dermatitis)

Departmentof Pharmacology, University of Bern, Bern, SwitzerlandKey words: atopic dermatitis; clinical features;constitutional dermatitis; epidemiology; extrinsictype; immunopathology; intrinsic type.Prof. Dr B. Wu¨thrichAllergy Unit, Department of DermatologyUniversity Hospital8091 ZurichSwitzerlandAccepted for publication 22 March 2001

Celery allergy associated with birch and mugwort pollinosis.

Skin prick tests (SPT) with various celery, carrot and potato preparations (raw, cooked, cooking water of each vegetable and allergen extracts) as well as specific IgE determinations by RAST to celery mix, celeriac (or root cellery), stick celery and heated celery extracts were performed in 70 patients with positive prick or intracutaneous tests to birch and/or mugwort pollens and celery (extract and/or raw). 94% of the patients showed positive prick tests to raw celeriac, 36% to cooked celeriac and 8/13 to cooking water. Celery‐birch positive patients (n= 13) showed negative or low RASTs to heated celery extracts and to stick celery. By contrast, in the celery‐mugwort sensitive patients (n= 6) the celery RASTs with heated celery extracts remained clearly positive and high RAST values to stick celery could be found. Celery‐birch‐mugwort‐association (n= 22) favoured more positive results with relatively high values of RAST to celeriac. The results of homologous and heterologous RAST inhibition experiments with birch, mugwort, unheated and heated celery (100°C) carried out in nine celery‐RAST positive sera are also discussed.

Roasted hazelnuts – allergenic activity evaluated by double‐blind, placebo‐controlled food challenge

Background: Allergy to hazelnuts is a common example of birch pollen related food allergy. Symptoms upon ingestion are often confined to the mouth and throat, but severe systemic reactions have been described in some patients. The aim of the study was to evaluate the reduction in allergenicity by roasting of the nuts.

Influence of food processing on the allergenicity of celery: DBPCFC with celery spice and cooked celery in patients with celery allergy

Background: Celery root is often consumed in a processed form as a cooked vegetable or as a spice. So far, however, there has been no information about the allergenicity of processed celery in celery‐allergic patients.

Trends in prevalence of asthma, allergic rhinitis and atopic dermatitis in 5-7-year old Swiss children from 1992 to 2001

Background:  Changing occurrence rates of asthma, allergic rhinitis and atopic dermatitis are of public health concern and require surveillance. Changes in prevalence rates of these atopic diseases were monitored during 10 years and their trend with time was determined taking into account the influence of personal and environmental risk factors.

CURRENT ALLERGIC ASTHMA AND RHINITIS: DIAGNOSTIC EFFICIENCY OF THREE COMMONLY USED ATOPIC MARKERS (IGE, SKIN PRICK TESTS, AND PHADIATOP). RESULTS FROM 8329 RANDOMIZED ADULTS FROM THE SAPALDIA STUDY

Total serum IgE, Phadiatop®, and the skin prick test (SPT) are commonly used to diagnose atopic diseases. However, no large study has ever been done to test their diagnostic efficiency. We studied the diagnostic value of these three atopic markers in 8329 well‐randomized adults from the Swiss Population Registry. The prevalence of current allergic asthma (CAA) was 1.8% and of current allergic rhinitis (CAR) 16.3%. The prevalences of positive Phadiatop, positive SPT (at least, one out of eight SPT to common aeroallergens with a wheal of >3 mm), and positive total IgE (IgE >100 kU/1) were 29, 23, and 23%, respectively. To diagnose CAA and CAR. the sensitivity of Phadiatop was significantly higher than that of SPT (72.5% vs 65.4%, 77.1% vs 68.4% respectively; P<0.01 and <0.001) and IgE (72.5% VA‐ 56.9%, 77.1% vs 43.9%, respectively; both p<0.001). The sensitivity of SPT was significantly higher (68.4% vs 43.9% P<0.001) than that of IgE to diagnose CAR. When CAA and CAR were excluded, the SPT specificity was significantly higher than that of Phadiatop (77.8% vs 71.9% and 85.9% vs 80.5%, respectively; both P<0.001): when CAR was excluded, SPT was significantly higher than IgE (85.9 vs 81.4%; P<0.001). SPT had significantly the best positive predictive value for CAA (5.2% for SPT vs 4.6% for both IgE and Phadiatop; both P<0.001) and CAR (48.7% for SPT vs 43.5% for Phadiatop and 31.6% for IgE; both P<0.001). The three markers of atopy had roughly the same negative predictive value (NPV) for CAA, but IgE had a significantly lower NPV for CAR than SPT and Phadiatop (88.1% vs 93.3% and 94.7%, respectively; both P<0.001). The diagnostic efficiency of SPT was significantly higher than that of Phadiatop (83.1% vs 79.9% and 77.6 vs 71.9%, respectively; both F<0.001) to diagnose CAR and CAA. IgE and SPT had equal efficiency (77.6%), which was significantly higher than that of Phadiatop, to diagnose CAA (71.9%; both P<0.001). In conclusion, SPT have the best positive predictive value and the best efficiency to diagnose respiratory atopic diseases. Furthermore, SPT give information on sensitivity to individual allergens and should therefore be used primarily by clinicians to assess respiratory allergic diseases. Moreover, they are cheaper and provide immediate, educational information for both patient and physician.

Food-induced cutaneous adverse reactions

The skin is the most frequently affected target organ in allergy or intolerance of food and food additives. The most common manifestation is acute urticaria (with or without angioedema), accounting for 40–60% of patients with IgE‐mediated food allergy, whereas food additives rather aggravate chronic urticaria (intolerance provocation). The role of food allergy in the pathogenesis of atopic dermatitis is still controversial; however, there is no doubt that, particularly in infants and young children, food allergens can induce atopic dermatitis or aggravate skin lesions. In adults, food allergy as a cause or a trigger of atopic dermatitis is very rare. However, in food‐allergic patients with atopic dermatitis, the ingestion of the food item can provoke the whole spectrum of IgE‐mediated symptoms, from oral allergy syndrome to severe anaphylaxis. Skin symptoms can also be induced not only after food ingestion in sensitized people, but also after direct skin contact, as lipophilic food allergens can penetrate the skin via the hair follicles or when the skin barrier function is defective. Immediate contact reactions of the skin are a heterogeneous group: they include not only contact urticaria (contact urticaria syndrome) on an immunologic or nonimmunologic basis, but also allergic or nonallergic eczematous reactions caused by food proteins (protein contact dermatitis). A prototype is bakers eczema in a restricted sense with immediate‐type sensitization to flour. Atopic eczema provoked by direct contact of the skin with food must also be taken into consideration. Finally, very rarely, allergic contact dermatitis that is due to type IV sensitization to food or food additives (positive delayed type reaction in the patch tests) can occur. The oral ingestion of these foods may provoke in these patients a generalized eczematous rash or dyshidrosiform reactions (vesicles) of the fingers, palms, and soles.