Georgios Rentzos

Health-related quality of life in children with objectively diagnosed staple food allergy assessed with a disease-specific questionnaire

Among Swedish children of 0–12 years old, we investigated various food allergy‐related exposures associated with health‐related quality of life using a food allergy‐specific questionnaire among children allergic to the staple foods cows milk, hens egg and/or wheat, and contextualised worse food allergy‐associated health‐related quality of life using a generic questionnaire versus controls.

Use of a basophil activation test as a complementary diagnostic tool in the diagnosis of severe peanut allergy in adults

BackgroundDiagnosis of severe peanut allergy is difficult and delays in making an accurate diagnosis may place the patient at risk. Adults with a history of anaphylaxis must strictly avoid any contact with peanuts or products that may contain traces of peanuts. For these persons, conventional evaluations with skin prick testing (SPT) and IgE tests may not be sufficient to assess the risk of anaphylaxis. Therefore, we investigated whether the basophil activation test (BAT) could be used for the diagnosis of severe peanut allergy in adults. We compared the non-invasive BAT with conventional laboratory diagnostic tests, including SPT and specific IgE to allergen extracts and components, for the diagnosis of severe peanut allergy.MethodsForty-seven persons with severe allergy to peanuts and a clinical diagnosis of anaphylaxis (PA-group), 22 subjects with peanut sensitization (PS-group) and 22 control (C-group) subjects, all in the age range of 18–60 years, were recruited retrospectively and prospectively into the study. Thirty-four patients with peanut allergy and 11 peanut-sensitized patients were sensitized to soy, while 36 patients in the PA-group and 20 patients in the PS-group were sensitized to birch pollen. All the patients and control subjects were investigated with BAT and SPT for responses to peanut, soy and birch extracts and their serum samples were assayed for the presence of specific IgE to peanut, soy and birch extracts, as well as IgE to allergen components (ISAC).ResultsIn a multivariate factor analysis, severe peanut allergy (PA) was positively associated with SPT to peanut, IgE to peanut, BAT to peanut and IgE to rAra h 1, 2, 3 and 6 peanut components, as well as to soy components (nGly m 5 and nGly m 6). In contrast, peanut sensitization was positively associated with increased levels of IgE to rAra h 8, birch and birch-related components. BAT-detected reactivity to peanut was significantly higher in patients who had a history of severe allergy to peanuts, as compared with patients who were sensitized to peanuts (p < 0.001), and the receiver operating curve (ROC) analysis showed that BAT had high sensitivity and specificity for predicting severe peanut allergy, with a ROC area under the curve of 0.862. However, in the PA-group, the BAT results for peanut correlated only weakly with the levels of IgE to rAra h 1, 2 and 3 and nAra h 6. Study limitations: oral provocation in the patients with a history of severe peanut allergy could not be performed to compare clinical reactivity with the BAT result due to ethical constraints. Neither was it possible to perform BAT with peanut recombinant allergens which were not available at the time the study commencedConclusionsBAT is useful in determining the severity of peanut allergy and may be used as a complementary diagnostic tool to ensure accurate diagnosis of severe peanut allergy in adults. Thus, it may reduce the need to subject these patients to further tests, including an open challenge with peanuts.

Socioeconomic evaluation of well-characterized allergy to staple foods in adults

The aim of the present study was to evaluate if total, direct, indirect, and intangible costs differ between a cohort of adults with well‐characterized allergy to staple foods (‘cases’) and controls.

Intestinal allergic inflammation in birch pollen allergic patients in relation to pollen season, IgE sensitization profile and gastrointestinal symptoms

BackgroundBirch pollen allergic patients frequently experience gastrointestinal upset accompanied by a local allergic inflammation in the small intestine especially during the pollen season. However, it is not known if the GI pathology is connected to the subjective symptoms of the patient. The objective of this study was to evaluate the immune pathology of the duodenal mucosa and the serum IgE antibody profiles in birch pollen allergic patients in relation to their gastrointestinal symptoms, during and outside the birch pollen season.MethodsThirty-two patients with birch pollen allergy and sixteen healthy controls were enrolled in the study. Twenty allergic patients had gastrointestinal symptoms and twelve did not. All participants underwent an allergy investigation and gastroscopy with duodenal biopsy. The duodenal biopsies were retrieved during the pollen season (May-June) and off-season (November-March). The biopsies were immunostained for mast cells (IgE and tryptase), eosinophils, T cells (CD3), and dendritic cells (CD11c). Pollen-specific IgE antibodies were determined by ImmunoCAP and component microarray (ISAC).ResultsPatients in both pollen allergic groups showed similar degree of intestinal allergic inflammation during the pollen season regardless of gastrointestinal symptoms. The eosinophils, mast cells and dendritic cells were increased in the mucosa. Patients with gastrointestinal symptoms had significantly elevated IgE antibodies to birch (rBet v 1), hazelnut (rCor a 1), and apple (rMal d1) during the pollen season.ConclusionsPatients allergic to birch pollen have clear signs of an ongoing allergic inflammation in their intestinal mucosa, which is aggravated during the pollen season. The magnitude of the allergic intestinal inflammation is not associated with subjective gastrointestinal symptoms of the individual patient.

Health-related quality of life in children and adolescents allergic to staple foods

Methods Swedish children (0-12 years) and adolescents (13-17 years) with objectively diagnosed food allergy to staple foods were recruited in an outpatient allergy clinic. Ageand sex-matched controls were included. Food-allergic adolescents themselves and the parents of food-allergic children answered a food-allergy specific HRQL questionnaire (FAQLQ), developed within EuroPrevall. A generic HRQL questionnaire, EQ-5D, was answered by parents to cases and controls. In total, 85 children and 58 adolescents (cases), and 94 children and 56 adolescents (controls) participated.

Socio-economic impact of objectively-diagnosed allergy to staple foods in children and adolescents

Background Our group has previously described that indirect and intangible costs substantially burden households with a food allergic adult. We now extend our investigation to children and adolescents. Objective To estimate the total, direct, indirect and intangible costs of food allergy, in households with at least one child or adolescent with objectively-diagnosed allergy to staple foods (cow’ sm ilk, wheat and/or hen’s egg), and to compare these costs with age- and sex- matched controls. Methods Participants included 84 children and 60 adolescents (cases), and 94 children and 56 adolescents (controls). Direct and indirect cost data collected via the Food Allergy Socio-Economic Questionnaire (developed by EuroPrevall) from parents of children and adolescents with objectivelydiagnosed allergy to staple foods (cases) were compared to data from age- and sex-matched controls, and calculated as annual household costs. Total costs were defined as direct + indirect costs. Direct and indirect costs were also considered independently. Intangible costs included measures of self-reported health, standard of living and losses of well-being. Results

Ongoing seasonal intestinal inflammation in birch pollen allergic patients without gastrointestinal symptoms

Background A previous study by our group (JACI 2003;112:45-50) showed a significant allergic gastrointestinal inflammation in birch pollen allergic patients with gastrointestinal symptoms during the birch pollen season. The pathophysiological mechanisms of this type of allergic reaction are still poorly studied. However it is not yet explored if all birch pollen patients have signs of gastrointestinal inflammation during the pollen season.