Oscar Mazzina

Lupin and Other Potentially Cross-Reactive Allergens in Peanut Allergy

Purpose of ReviewThe presence of IgE cross-reactivity between peanut allergens and allergens from other legumes and tree nuts has been demonstrated, but the identification of the involved individual allergens is still limited. The aim of this review is to describe new allergenic findings, of potential relevance for cross-reactivity among peanut and lupin.Recent FindingsSeventeen allergens of peanut have been included in the official allergen nomenclature database to date. Lupin sensitization has been observed in 15–20% of individuals with known peanut allergy, The majority of lupin seed proteins are comprised of α-conglutins (legumin-like) and β-conglutins (vicilin-like), and to a lesser extent γ-conglutins (vicilin-like) and δ-conglutins (2S albumins).SummarySeveral molecules may fuel peanut-lupin cross-reactivity. Awareness among physicians and general public could avoid unexpected allergic reactions. However, these do not appear frequent and no data suggest a precautionary labelling of lupin in foods.

IgE Immunoadsorption Knocks Down the Risk of Food-Related Anaphylaxis.

The effects of an immunoadsorption procedure, specifically designed to remove immunoglobulin E (IgE), on food-induced anaphylaxis have never been evaluated. We evaluate the effects of IgE removal on the allergic thresholds to foods. A 6-year-old boy with anaphylaxis to multiple foods and steroid-resistant unstable allergic asthma displayed serum IgE levels of 2800 to 3500 kU/L. To lower IgE serum concentrations, which could be overridden by a high dose of omalizumab, 1.5 plasma volumes were exchanged in 8 apheresis sessions. During the procedure, serum IgE levels fell to 309 kU/L. After the procedure, the threshold of reactivity to baked milk increased from 0.125 to 5 g of milk protein (full tolerance) after the first session, and the threshold of reactivity to hazelnut increased from 0.037 to 0.142 g of protein after the first session, 0.377 g after the eighth, and 1.067 g (full tolerance) after the first administration of omalizumab. Immediately after the sixth IgE immunoadsorption, we started omalizumab therapy. In the next 40 days, the threshold of reactivity to hazelnut increased to 7.730 (full tolerance). Asthma control was obtained, treatment with montelukast was stopped, and fluticasone was tapered from 500 to 175 μg/day. The boy became partially or fully tolerant to all the tested foods, and quality of life was improved. IgE immunoadsorption, used to establish the starting basis for omalizumab administration, is able to increase the tolerance threshold to foods.

Doctor, when should I feed solid foods to my infant?

Purpose of reviewModalities and timing of the introduction of solid foods to infants may influence growth, obesity, atherosclerosis, hyperlipidemia, hypertension, diabetes, and metabolic disease. The most debated effects of solid foods introduction are those on the development of food allergy. Recent findingsFor the first time, in recent years prospective studies have been published about the effects of early vs. delayed introduction of allergenic foods into the infants’ diet on food allergy. According to these studies, the early introduction of peanut may be a powerful protecting factor against peanut allergy in some risk categories. This seems not be true for wheat, cows milk, sesame, and whitefish. The effect of early introduction of egg on egg allergy are controversial. SummaryThe recent studies have changed the practice recommendations given by healthcare providers to families. We review the modifications of the recommendations of international societies on the introduction of solid foods, both to the general population and to infants at risk for allergy.

Preacutionary labelling of cross-reactive foods: The case of rapeseed

Food allergic individuals are exposed to unnecessary dietary restrictions due to precautionary food allergy labelling (PFAL). Two forms of PFAL exist: type I identifies the possible presence of allergenic contaminaion in foods (‘may content…’), type II indicates as potentially dangerous ingredients or contaminants that do no belong to official list of food allergens. PFAL type II is based on the fear of cross-reactivity with foods belonging to that list. PFAL type II is less known, but may be tempting for the legal offices of food companies, for clinicians in a ‘defensive medicine’ key, and even for legislators. We identify here a case of PFAL type II, allergy to rapeseed (belonging to the family of Brassicaceae). Increasingly used for their nutritional and nutraceutic value in asthma prevention, rapeseed has been indicated by regulatory authorities in Canada and Europe as potential cross-reactor with mustard. In this review, we provide the elements for a risk assessment of cross-reactivity of rapeseed/mustard allergy in the general population both clinically and from the point of view of the molecular allergy. Three findings emerge:1. Allergic reactions to rapeseed are exceptional2. The allergens identified in rapeseed and mustard are similar, but not identical3. Reactions to rapeseed have never been described in mustard-allergic patients.On the ground of existing evidence, a precautionary labeling for rapeseed as potentially dangerous for patients allergic to mustard is not justified. In the interest of patients with multiple food allergy, PFAL type II must be avoided.

A MALDI-TOF MS Approach for Mammalian, Human, and Formula Milks’ Profiling

Human milk composition is dynamic, and substitute formulae are intended to mimic its protein content. The purpose of this study was to investigate the potentiality of matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS), followed by multivariate data analyses as a tool to analyze the peptide profiles of mammalian, human, and formula milks. Breast milk samples from women at different lactation stages (2 (n = 5), 30 (n = 6), 60 (n = 5), and 90 (n = 4) days postpartum), and milk from donkeys (n = 4), cows (n = 4), buffaloes (n = 7), goats (n = 4), ewes (n = 5), and camels (n = 2) were collected. Different brands (n = 4) of infant formulae were also analyzed. Protein content (<30 kDa) was analyzed by MS, and data were exported for statistical elaborations. The mass spectra for each milk closely clustered together, whereas different milk samples resulted in well-separated mass spectra. Human samples formed a cluster in which colostrum constituted a well-defined subcluster. None of the milk formulae correlated with animal or human milk, although they were specifically characterized and correlated well with each other. These findings propose MALDI-TOF MS milk profiling as an analytical tool to discriminate, in a blinded way, different milk types. As each formula has a distinct specificity, shifting a baby from one to another formula implies a specific proteomic exposure. These profiles may assist in milk proteomics for easiness of use and minimization of costs, suggesting that the MALDI-TOF MS pipelines may be useful for not only milk adulteration assessments but also for the characterization of banked milk specimens in pediatric clinical settings.

Food allergy and anaphylaxis – 2061. Clinical symptoms and molecular characterization of hazelnut allergy in Italian children

Methods Thirty-five children (median age: 8.3, range2.2–14.2 yr) reported with immediate reactions to hazelnut ingestion underwent food challenge (DBPCFC) between April 2007 and May 2012. Skin prick test (SPT), specific IgE determination at ImmunoCAP with whole food allergens and with allergen components at ImmunoCAP ISAC microarray chip were performed. The molecular profile of reactivity was compared to SPT and specific IgE testing. This report focuses on the hazelnut-associated allergens Cor.a.1.01, Cor.a.1.04, Cor.a.8 and Cor.a.9.

Very-early-onset FPIES and its difficult management

A 6-month-old girl presented referred for FPIES of difficult management. Admitted for suspected sepsis at 15 days after receiving milk thickened with cream of rice, she was hospitalized for suspected anaphylaxis at 5 months soon after her first rice-containing meal. Correctly diagnosed with rice-induced FPIES, she was challenged with maize to which she reacted with vomiting, hypotonia and bloody diarrhoea. Referred to this institution for investigation of cereal tolerance, we suspected industrial maize food contamination with rice and requested from a manufacturer a whole wheat flour which was tolerated at challenge. The girl reacted strongly to two accidental contacts with rice. A special diet was initiated in collaboration with the manufacturers who used the same rice-free flour to make pasta to which she did not react. Introduction of solids was predicated on a series of challenges, including beef, carrot, potato, pork, chicken, zucchini and spinach. Of note, after 5 symptom-free months, the girl reacted to accidental ingestion of a fragment of a sweet left over from the day before. This case report highlights how FPIES onset can be very early, though patients may respond to dietary management with cross-contaminant-free baby foods.