Magdalena Lluch-Bernal

Component-resolved in vitro diagnosis of hazelnut allergy in Europe

BACKGROUND Food allergy to hazelnut occurs both with and without concomitant pollen allergy. OBJECTIVE We sought to evaluate a panel of hazelnut allergens for diagnosis of hazelnut allergy in Spain, Switzerland, and Denmark. METHODS Fifty-two patients with a positive double-blind, placebo-controlled food challenge result with hazelnuts; 5 patients with a history of anaphylaxis; 62 patients with pollen allergy but hazelnut tolerance; and 63 nonatopic control subjects were included. Serum IgE levels to hazelnut extract, recombinant hazelnut allergens (rCor a 1.04, rCor a 2, rCor a 8, rCor a 11), and native allergens (nCor a 9, nCor a Bd8K, nCor a Bd11K) were analyzed by means of ImmunoCAP. RESULTS Among patients with hazelnut allergy, 91% (Switzerland/Spain, 100%; Denmark, 75%) had IgE to hazelnut extract, 75% to rCor a 1.04, 42% to rCor a 2, 28% to rCor a 8, and 2% to rCor a 11. The highest rate of sensitization to Cor a 1.04 was found in the northern regions (Switzerland/Denmark, 100%; Spain, 18%), whereas IgE to the lipid transfer protein rCor a 8 prevailed in Spain (Spain, 71%; Switzerland, 15%; Denmark, 5%). IgE to profilin rCor a 2 was equally distributed (40% to 45%). Among control subjects with pollen allergy, 61% had IgE to hazelnut extract, 69% to rCor a 1.04, 34% to rCor a 2, 10% to rCor a 8, and 6% to rCor a 11. CONCLUSION Component-resolved in vitro analyses revealed substantial differences in IgE profiles of hazelnut allergic and hazelnut tolerant patients across Europe.

Lack of allergic cross‐reactivity to cephalosporins among patients allergic to penicillins

There are some contradicting data about clinical allergic cross‐reactivity to cephalosporins among patients who have had a previous allergic reaction to penicillins.

Successful desensitization of a fixed drug eruption caused by allopurinol

acquired sensitization and desensitization also differed between the human and the rabbit, with the rabbit requiring a shorter time to develop desensitization (14 weeks) than the human (21 weeks). This could represent a true difference. It could also have occurred because the human had less frequent mosquito bites than the rabbit and received a relatively low dose of mosquito salivary antigen (100 bites every 2 weeks in a 70 kg human vs 140 bites every week in a 2 kg rabbit). We demonstrate prospectively for the first time that regular, continuous, high-dose, natural allergen exposure eventually leads to desensitization (defined as complete loss of delayed and immediate responsiveness) and that both IgE and IgG are involved in the sensitization process. This model offers an excellent opportunity for further in-depth study of immediate and delayed hypersensitivity responses in humans. The immunologic mechanisms involved may be different in humans than in animals (at least in rabbits) in which IgG acts as a blocking antibody. We thank Dr. Reinhart Brust and Mr. Ben Yang Ding for their contributions to this work.

Insulin lispro, an alternative in insulin hypersensitivity

References 1. Dhaliwal A, Fink J. Vaginal itching as a manifestation of seasonal allergic disease. J Allergy Clin Immunol 1995;95:780±782. 2. Turjanmaa K, Reunala T. Condoms as a source of latex allergen and cause of contact urticaria. Contact Dermatitis 1989;20:360±364. 3. Gonzales E. Latex hypersensitivity: a new and unexpected problem. Hosp Pract (Off Ed) 1992;27:137±151. 4. Kurup VP, Kelly KJ, Resnick A, Bansal NK, Fink JN. Characterization of latex antigen and demonstration of latex speci®c antibodies by enzyme linked immunosorbent assay in patients with latex hypersensitivity. Allergy Proc 1992;13:329±334. 5. Levine B, Siraganian R, Shenkein I. Allergy to human seminal plasma. N Engl J Med 1973;288:894±896. 6. Haye KR, Mandal D. Allergic vaginitis mimicking bacterial vaginosis. Int J STD AIDS 1990;1:440±442. 7. Witkin SS, Jan Jeremias AB, Ledger WJ. Recurrent vaginitis as a result of sexual transmission of IgE antibodies. Am J Obstet Gynecol 1988;159:32±36. 8. Beezhold D, Beck W. Surgical glove powder binds to latex antigen. Arch Surg 1992;127:1354±1357.

Clinical characteristics of melon (Cucumis melo) allergy.

Background Although melon is a frequent allergy-eliciting fruit, allergic reactions to melon have rarely been reported. Objective To evaluate and describe the clinical characteristics of melon allergy in melon-allergic patients. Materials and Methods We evaluated patients allergic to melon and a control group of patients allergic to pollen. The diagnosis of melon allergy was based on a convincing clinical history, positive skin test results (prick-by-prick test), and positive results on oral challenge tests to melon. Results A total of 161 patients were included in the study: 66 in the melon allergy group and 95 in the pollen control group. The melon allergy group included 35 female and 31 male patients with a mean age of 26.6 ± 2.7 years (range, 5-61 years). Although all patients had oral symptoms, 13 (19.7%) of the patients had extraoral symptoms and none experienced generalized urticaria or anaphylaxis. Excluding other Cucurbitaceae fruits, peach, fig, and kiwi most frequently elicited positive skin test results and symptoms. Up to 23% of melon-allergic patients had a concomitant latex sensitization. Melon allergy was especially linked to pollen allergy, since all the melon-allergic patients were also allergic to pollen. Some differential features with respect to the pollen allergy control group were a higher prevalence of asthma (odds ratio [OR], 2.13; P Ulmus (OR, 42.8) and Ambrosia (OR, 22.4). Conclusion The most important conditions linked to melon allergy are pollen allergy (100%), allergy to other nonrelated fruits, mainly peach (up to 62%), and latex sensitivity (up to 23%). Some differential features of the pollinosis in melon allergy were a higher prevalence of asthma and a higher frequency of sensitization to several weed and tree pollens.

Anaphylactic reaction to methotrexate

rophages, platelets, and B cells are also involved in this process. Transient, increased production of IgE could activate these cells; IgE may be part of the mechanism of the acute-phase response. This would corroborate recent results pointing to higher serum IgE levels during exacerbation of rheumatoid arthritis (12) and chrotiic obstructive pulmonary disease (13). The discovery of IgE gave an insight into the fundamental mechanism of allergy. Atopy, one of the most commoti genetically determined traits, characterized by overproduction of IgE, became well defined. The observations here briefly discussed point to still another role of IgE, a role in the acute-phase response, which should be carefully examined.

Cross-Reactivity between Anisakis spp. and Wasp Venom Allergens

Background: Anisakiasis is caused by the consumption of raw or undercooked fish or cephalopods parasitized by live L3 larvae of nematode Anisakis spp. Larvae anchor to stomach mucosa releasing excretion/secretion products which contain the main allergens. It has been described that nematode larvae release venom allergen-like proteins among their excretion/secretion products. We investigated potential cross-reactivity between Anisakis and wasp venom allergens. Methods: Two groups of 25 patients each were studied: wasp venom- and Anisakis-allergic patients. Sera from patients were tested by ImmunoCAP, dot-blotting with recombinant Anisakis allergens and ADVIA-Centaur system with Hymenoptera allergens. Cross-reactivity was assessed by IgE immunoblotting inhibition assays. Role of cross-reactive carbohydrate determinants (CCDs) was studied by inhibition with bromelain and periodate treatment. Results: A total of 40% of wasp venom-allergic patients had specific IgE to Anisakis simplex and 20% detected at least one of the Anisakis recombinant allergens tested. Likewise, 44% of Anisakis-allergic patients had specific IgE to Vespula spp. venom and 16% detected at least one of the Hymenoptera allergens tested. Wasp venom-allergic patients detected CCDs in Anisakis extract and peptide epitopes on Anisakis allergens rAni s 1 and rAni s 9, whereas Anisakis-allergic patients only detected CCDs on nVes v 1 allergen from Vespula spp. venom. The only Anisakis allergen inhibited by Vespula venom was rAni s 9. Conclusions: This is the first time that cross-sensitization between wasp venom and Anisakis is described. CCDs are involved in both cases; however, peptide epitopes are only recognized by wasp venom-allergic patients.

Reacción alérgica tardía a amlodipino con positividad de la prueba de transformación de linfocitos

Background : Amlodipine is one of the third generation dihydropyridine calcium channel blockers used for hypertension. Mild, moderate and severe reactions have been reported with calcium channel blockers. Cross-reactivity among these drugs has not been established. Case report: We have presented the case of a patient who developed a delayed pruritic, and erythematous maculopapular skin exanthema after the intake of amlodipine. A positive lymphocyte transformation test (LTT) confirmed the implication of amlodipine in the reaction and showed positivity to another calcium channel blocker, nifedipine, demonstrating cross reactivity. Conclusion: This is the first reported case of hypersensitivity to amlodipine in which the involvement of the drug is confirmed by a positive TTL. TTL could become a good diagnostic alternative for patients who experience late reactions to amlodipine and possibly cross-reactivity with nifedipine.

Clinical characteristics of melon (Cucumis melo) allergy

BACKGROUND Although melon is a frequent allergy-eliciting fruit, allergic reactions to melon have rarely been reported. OBJECTIVE To evaluate and describe the clinical characteristics of melon allergy in melon-allergic patients. MATERIALS AND METHODS We evaluated patients allergic to melon and a control group of patients allergic to pollen. The diagnosis of melon allergy was based on a convincing clinical history, positive skin test results (prick-by-prick test), and positive results on oral challenge tests to melon. RESULTS A total of 161 patients were included in the study: 66 in the melon allergy group and 95 in the pollen control group. The melon allergy group included 35 female and 31 male patients with a mean age of 26.6 +/- 2.7 years (range, 5-61 years). Although all patients had oral symptoms, 13 (19.7%) of the patients had extraoral symptoms and none experienced generalized urticaria or anaphylaxis. Excluding other Cucurbitaceae fruits, peach, fig, and kiwi most frequently elicited positive skin test results and symptoms. Up to 23% of melon-allergic patients had a concomitant latex sensitization. Melon allergy was especially linked to pollen allergy, since all the melon-allergic patients were also allergic to pollen. Some differential features with respect to the pollen allergy control group were a higher prevalence of asthma (odds ratio [OR], 2.13; P < 0.05) and a statistical increase in the frequency of sensitization to several tree and weed pollens, including Ulmus (OR, 42.8) and Ambrosia (OR, 22.4). CONCLUSION The most important conditions linked to melon allergy are pollen allergy (100%), allergy to other nonrelated fruits, mainly peach (up to 62%), and latex sensitivity (up to 23%). Some differential features of the pollinosis in melon allergy were a higher prevalence of asthma and a higher frequency of sensitization to several weed and tree pollens.