Luís Amaral

Safety of chitosan processed wine in shrimp allergic patients

Wine is an ubiquitous product all over the world, but up to 1 in 10 investigators. The researchethics committee, ComissãodeÉticapara consumers reports intolerance or allergy-like symptoms after drinking wine.1 Chitosan is a linear polysaccharide and the product of the deacetylation of chitin, the main component of the cell walls of some fungi; the exoskeletons of arthropods, such as crustaceans and insects; and the beaks of cephalopods.2 It alsomay be used inwine processing. Concerns have been raised that wines processed with chitosan could trigger reactions in patients with seafood allergy. Nevertheless, biological plausibility is scarce. Major allergens involved in shrimp allergy are muscle proteins, although someminor allergens, such as arginine kinase, which was found to be clinically relevant, have been found in shrimp shells.3 The chitosan isolation procedure is expected to remove all proteins and contaminants. Fear of ingesting a shellfish-derived product may lead to unnecessary avoidance of wine produced with chitosan films. Recently, anaphylactic reaction to a-1,3-galactose has been identified.4Chitosan isstructurallydifferent froma-galbecause it is a linear cationic (1/4)-2-amino-2-deoxy-b-D-glucan. There is only one case report of an immediate anaphylactic reactionwith health food (fungiderived) chitosan ingestion, with documented sensitization by skin prick tests.5 Shrimp-derived chitosanhas been given the classification of generally recognized as safe (GRAS) by the US Food and Drug Administration (FDA) in 2012.6 Moreover, evidence supporting this classification is limited by the lack of inclusion of individuals with shrimp allergy and the absence of food challenges. To our knowledge, no previous studies have evaluated the safety of chitosan as a food additive in shrimp allergic patients. Therefore, we aimed to assess the safety of chitosan processed wine in shrimp allergic patients. This double-blind, placebo-controlled trial was registered at ClinicalTrials.gov (NCT02151279). Adults (18e65 years) with evidence of IgE-mediated sensitization to shrimp and a history of anaphylaxis to shrimp and/or a positive oral challenge result to shrimp were selected. Participants were recruited from the food allergy unit of an allergy department of a university hospital. A control group of 6 healthy, nonatopic, nonefood allergic individuals were invited to participate. All individuals included in this study were regular consumers of wine and were asked to avoid alcohol ingestion for at least 3 days before the challenge. Nineteen individuals were enrolled, including 13 with anaphylaxis to shrimp (Table 1) and 6 healthy controls. Skin prick-to-prick testswithwineswere performed, as well as a double-blind, placebo-controlled challenge with both wines (with and without chitosan) in all participants. The challenges were performed on the same day, separated by at least 2 hours. Successive increasing doses were administered in 4 steps with 15-minute intervals up to a total of 100mLof eachwineduring each challenge.On completion, participants were observed for 2 hours, and, in case of any delayed reaction, participants were instructed to contact the

Jellyfish ingestion was safe for patients with crustaceans, cephalopods, and fish allergy

Portugal has a native Rhizostomeae jellyfish, named Catostylus tagi by Haeckel in 1869, which occurs abundantly in the summer in the Sado and Tejo estuaries. Previous studies demonstrated that the umbrella of this species contains relevant concentrations of very long chain fatty acids, antioxidants, collagen, and taurine [3], making it a possible source of food supplements. However, jellyfish consumption is not common in Portugal although the country has one of the highest seafood consumption per capita in Europe (61.1 kg/capita) [4]. One of the reasons for this disinterest may be the well-known deleterious effects of jellyfish stings, such as acute cutaneous inflammation with erythema, swelling, vesicles, and bullae [5]. These reactions are attributed to the compounds stored in its nematocysts which are not present in the edible umbrella. Also, jellyfish occasionally induce cutaneous lesions through delayed allergic mechanisms [5, 6] whereas immediate anaphylactic allergy to jellyfish stings is extremely rare, and there are only 2 case reports of anaphylaxis by jellyfish stings [7, 8].

Eating jellyfish: safety, chemical and sensory properties: Eating jellyfish

BACKGROUND Peoples preference for fish with a high trophic level, like Atlantic cod and tuna, leads to a large food footprint. Responsible seafood consumption should include underutilised local products; hence the culinary use of edible jellyfish can be an effective contribution. The present work focused on Catostylus tagi to contribute to the consumption of edible jellyfish in the West. RESULTS A questionnaire conducted with 192 young people showed an interest in tasting jellyfish-based food (64.6%). The resulting product, obtained by an alternative cooking process to traditional Asian ones, was chemically characterised and underwent microbiological and heavy metals control. The results indicated its non-toxicity. Patients who were allergic to seafood as well as non-allergic volunteers revealed no allergic reaction to the jellyfish umbrella product (intakes up to 5 mg/kg body weight and 8 mg/kg, respectively). Seafood-trained panellists defined the products main impact on the mouth as freshness (72 mg/kg body weight). The preliminary snack, a pâté, was positively accepted by allergic (7 in 9; n = 20) and non-allergic volunteers (6 in 7; n = 21). CONCLUSION The present study confirmed that jellyfish intake is safe, even for allergic individuals, and its organoleptic properties were accepted by the study population.

Use of the Control of Allergic Rhinitis and Asthma Test and pulmonary function tests to assess asthma control in pregnancy

Asthma is one of the most prevalent chronic medical conditions to complicate pregnancy. Similarly, active management strategies that prioritise asthma control in this vulnerable population can have a far‐reaching impact.

Adrenaline auto-injector prescription and patients’ administration proficiency

Results A total of 36 individuals (50% male, mean age 34.5 years) were included; 28 with HVA (26 on venom immunotherapy) and 8 with FA. Twenty-seven went to an ED. Adrenaline was administered in only 3 and just5 of them were discharged with an AAI prescription. The remaining 22 had their AAI prescribed and taught how to use it, only after consultation with an Allergist. Twenty-three (64%) had their Anapen with them and 19 (53%) admitted carrying it on a daily basis. Fourteen (39%) performed the simulation correctly, although 7 of them did not massage the injection site, as instructed by the manufacturer. On average, 2 training sessions were performed per patient but, despite this, 22 (61%) failed at various steps, including 4 who injected with the wrong end. Six reported using their Anapen in a real life situation, but curiously 4 of them did not simulate the administration effectively. Comments According to the WAO guidelines, patients with anaphylaxis history should carry an AAI. Adrenaline underuse and a deficient prescription of adrenaline (14%) on discharge from the ED as well in non-specialized centres was evident. Approximately two thirds of our patients failed to demonstrate proper administration, regardless of previous patient education. This is an unacceptably high proportion of at risk patients. This device requires repeated and regular training sessions since this is the only AAI available in Portugal. Adrenaline is potentially lifesaving if the patient is willing to use it and is capable of injecting it correctly. Practice makes perfect.