Carmen García-Ara

Accidental allergic reactions in children allergic to cow's milk proteins

BACKGROUND Cows milk is the main cause of food allergy in children. Patients allergic to food frequently experience accidental exposure. There are few studies analyzing this problem, most of them concerning peanut allergy. OBJECTIVE We sought to calculate the frequency of accidental exposure reactions in children allergic to cows milk during a 12-month period, to analyze the clinical characteristics and circumstances surrounding the reactions, and to identify risk factors for severe reactions. METHODS Eighty-eight children allergic to cows milk (44 boys; median age, 32.5 months) were included in the study. A systematized questionnaire about accidental exposure was used. Reactions were classified as mild, moderate, and severe. Cows milk- and casein-specific IgE antibody titers were determined. RESULTS Thirty-five (40%) children had 53 reactions in the previous year (53% mild, 32% moderate, and 15% severe). Most reactions took place at home (47%) under daily life circumstances (85%). Specific IgE levels to cows milk were higher in children with severe reactions than in those with moderate (median, 37.70 vs 7.71 KUA/L; P = .04) or mild (3.37 KUA/L; P = .04) reactions. The frequency of severe reactions was 10-fold higher in asthmatic children (odds ratio, 10.2; 95% CI, 1.13-91.54). CONCLUSIONS Reactions to accidental exposure are frequent in children with cows milk allergy. The proportion of severe reactions was 15%. The risk factors for such reactions included very high levels of specific IgE to cows milk and casein and asthma.

Shellfish Allergy: a Comprehensive Review

Shellfish allergy is of increasing concern, as its prevalence has risen in recent years. Many advances have been made in allergen characterization. B cell epitopes in the major allergen tropomyosin have been characterized. In addition to tropomyosin, arginine kinase, sarcoplasmic calcium-binding protein, and myosin light chain have recently been reported in shellfish. All are proteins that play a role in muscular contraction. Additional allergens such as hemocyanin have also been described. The effect of processing methods on these allergens has been studied, revealing thermal stability and resistance to peptic digestion in some cases. Modifications after Maillard reactions have also been addressed, although in some cases with conflicting results. In recent years, new hypoallergenic molecules have been developed, which constitute a new therapeutic approach to allergic disorders. A recombinant hypoallergenic tropomyosin has been developed, which opens a new avenue in the treatment of shellfish allergy. Cross-reactivity with species that are not closely related is common in shellfish-allergic patients, as many of shellfish allergens are widely distributed panallergens in invertebrates. Cross-reactivity with house dust mites is well known, but other species can also be involved in this phenomenon.

Efficacy and safety of oral desensitization in children with cow's milk allergy according to their serum specific IgE level

BACKGROUND Oral desensitization in children allergic to cows milk proteins is not risk free. The analysis of factors that may influence the outcome is of utmost importance. OBJECTIVE To analyze the efficacy and safety of the oral desensitization according to specific IgE (sIgE) level and adverse events during the maintenance phase. METHODS Thirty-six patients allergic to cows milk (mean age, 7 years) were included in an oral desensitization protocol. Patients were grouped according to sIgE levels (ImmunoCAP) into groups 1 (sIgE <3.5 kU/L), 2 (3.5-17 kU/L), and 3 (>17-50 kU/L). Nineteen children were included as a control group. Serum sIgE levels to cows milk and its proteins were determined at inclusion and 6 and 12 months after finishing the desensitization protocol. RESULTS Thirty-three of 36 patients were successfully desensitized (200 mL): 100% of group 1 and 88% of groups 2 and 3. Desensitization was achieved in a median of 3 months (range, 1-12 months); 90% of the patients in group 1, 50% of the patients in group 2, and 30% of the patients in group 3 achieved tolerance in less than 3 months (P = .04). In the control group only 1 child tolerated milk in oral food challenge after 1 year. During the induction phase, there were 53 adverse events in 27 patients (75%). Patients of groups 2 and 3 had more severe adverse events compared with group 1. During the maintenance phase, 20 of 33 patients (60%) had an adverse event. CONCLUSION Oral desensitization is efficacious. Tolerance is achieved earlier when sIgE is lower. Severe adverse events are frequent, especially in patients with higher sIgE levels.

Relationship between pollinosis and fruit or vegetable sensitization

The prevalence of vegetable sensitization in children with pollinosis (Group A; n = 48) and the prevalence of pollen sensitization in children with fruit or vegetable allergy (Group B; n = 42) were studied by means of prick‐test and determination of serum specific IgE to several pollens, fruits and vegetables. Fifteen patients from Group A (31%) showed sensitivity to fruits and/or vegetables, but only three of them had any symptoms after ingestions. Twenty nine patients from Group B (69%) showed pollen sensitization, mainly to grass and Compositae pollen. An association was found between sensitivity to Compositae pollen and sensitivity to several fruits and vegetables (Compositae, Fagaceae, Brassica, Betulaceae and Leguminoseae.)

Peach allergy in spanish children: tolerance to the pulp and molecular sensitization profile

Peach allergy is the main cause of vegetable food allergy in the Mediterranean area. Pru p 3 is the major allergen, and it is mainly found in the peel.

Microarrayed Jug r 1 shows the best diagnostic performance in walnut allergy

Several walnut (WN) allergens have been identified to date: Jug r 1 (2S albumin), Jug r 2 (7S globulin), Jug r 3 (LTP), Jug r 4 (11S globulin) and Jug r 5 (profilin), but their clinical significance is still to be determined in some cases. Allergen microarray (ISAC) provides information for three of these allergens. The aim of the study was to determine the importance of component resolved diagnosis in WN allergic patients. Ninety children suspected to have allergy to fruit, nuts and/or legumes were selected. Patients were classified as allergic if they presented at least 2 reactions unequivocally related to WN ingestion in the last 2 years. Patients were defined as tolerant if they consumed WN on a regular basis. Clinical questionnaire, skin prick test (SPT), total and specific IgE and ImmunoCAP ISAC (Thermo Fisher) were performed. Thirty-one patients (18 males) were defined as allergic and 59 (36 males) tolerant. WN-SPT wheal size (median diameter 5.25 mm; IQR: 4-7 vs. 0 mm; IQR: 0-2, p=0.000) and WN-sIgE (median 5.35 kU/L; IQR: 3.52-12.84 vs. 0.65 kU/L; IQR: 0.08-1.86, p=0.000) were significantly greater in allergic than in tolerant children. Positive Jug r 1-sIgE was significantly more frequent in allergic patients (80.65% vs. 5.08%, p=0.000). Jug r 1-sIgE values were also significantly higher in allergic children (median 2.5 ISU; IQR: 0-7.6 vs. 0 ISU; IQR: 0-0, p=0.000). This was not found for Jug r 2 or Jug r 3. ROC curves were constructed for the three allergens showing Jug r 1 the best diagnostic performance (AUC: 0.876, 95%CI: 0.788-0.965, p=0.000) (Figure ​(Figure11 and Table ​Table11). Figure 1 ROC curves for Walnut allergens Table 1 Diagnostic performance of walnut allergens (MAISAC) In conclusion, Jug r 1-sIgE is the best discriminating allergen in WN allergic patients.

Sensitization to microarrayed species-specific plant components precedes that of cross-reacting allergens

Microarrayed allergen immunoassays are increasingly being used to determine sensitization to multiple allergenic components1. However, there is scarce data on the development and progression of sensitization to vegetal allergens in early life. This study aimed to detect the profile of sensitization to allergenic components from vegetal foods and pollens using ISAC-IgE microarray (ISAC-IgE) (Thermo Fisher Scientific, Uppsala, Sweden) over 4 years in children diagnosed with allergy to cows milk proteins (CMPA). This article is protected by copyright. All rights reserved.

Sensitisation to peanut LTP (rAra h 9) in children allergic to peach

Non-specific lipid transfer proteins (LTPs) are panallergens present in plant foods and are recognized as maior allergens in patients allergic to Rosaceae family fruits from the Mediterranean area. On the contrary, seed storage proteins are the most important allergens in peanut allergy worldwide, although some authors from Southern Europe found Ara h 9 (peanut LTP) as the maior allergen. The aim of the study was to analyze the sensitization to Ara h 9 in children allergic to peach, and the association with clinical tolerance to peanut.