S. G. O. Johansson

Passive IgE-sensitization by blood transfusion

Background:u2002 To study the mechanisms of passive sensitization of patients receiving plasma containing IgE antibodies to a defined allergen.

Basophil allergen threshold sensitivity, CD‐sens, IgE‐sensitization and DBPCFC in peanut‐sensitized children

To cite this article: Glaumann S, Nopp A, Johansson SGO, Rudengren M, Borres MP, Nilsson C. Basophil allergen threshold sensitivity, CD‐sens, IgE‐sensitization and DBPCFC in peanut‐sensitized children. Allergy 2012; 67: 242–247.

The size of the disease relevant IgE antibody fraction in relation to total-IgE predicts the efficacy of anti-IgE (Xolair ) treatment

Background:u2002 Some patients with allergic asthma treated with anti‐IgE (Xolair®) do not become symptom free. Better criteria for response assessment than allergy skin tests or IgE determination are needed. The impact of the size of the disease relevant allergen‐specific IgE antibody fraction, i.e. the percentage of IgE antibody of total IgE, was evaluated in cat allergic patients treated with the recommended doses of Xolair®. Results were measured as changes in basophil allergen threshold sensitivity (CD‐sens).

Basophil allergen threshold sensitivity, CD-sens, is a measure of allergen sensitivity in asthma

Background Allergic asthma is IgE‐mediated and the IgE‐sensitisation is usually demonstrated by skin prick tests (SPT) and IgE antibody determinations in serum. The SPT and IgE‐antibody values do not directly predict if the allergy clinically contributes to the asthma. There is therefore a need for new objective tests that may indicate the clinical importance of an IgE‐sensitisation.

IgE antibodies to Pityrosporum orbiculare and Staphylococcus aureus in patients with very high serum total IgE

Serum IgE antibodies were detected with the radioallergosorbent test (RAST) to a panel of allergens which included Pityrosporum orbiculare, Candida albicans, Trichophyton rubrum, Cladosporium herbarum, Staphylococcus aureus, animal dander, deciduous tree pollens, grass pollens and foods in 81 consecutive patients with total IgE ≥ 3000 kU/1. Data on atopic and infectious disease characteristics were collected by a questionnaire. IgE antibody concentrations to P. orbiculare were significantly higher than to the other fungi and of the same magnitude as those to animal danders and pollens. High levels of P. orbiculare IgE antibodies were associated with current eczema, especially when it was the only atopic manifestation and demanding specialist care. IgE antibodies to P. orbiculare had the best explanatory value for current eczema in logistic regression analysis. Head‐neck‐face dermatitis was also associated with high levels of specific IgE to the yeast. IgE antibodies to S. aureus were detected in few patients and at low concentrations. Six patients had a history of systemic staphylococcal infections and presented a clinical picture, which was very similar to the hyperimmunoglobulinaemia E syndrome. Among the six were the two cases with the highest levels of IgE antibodies to S. aureus. The demonstration of high levels of IgE antibodies to P. orbiculare, which is a major part of human normal skin microflora, suggests that allergy to this yeast plays an important pathogenic role in eczema.

Basophil allergen threshold sensitivity and component‐resolved diagnostics improve hazelnut allergy diagnosis

IgE sensitization to hazelnut is common, especially in birch endemic areas. However, its clinical significance often needs to be confirmed by a food challenge.

Allergy in chronic haemodialysis. 1. Double-blind intravenous challenge with formaldehyde

Patients undergoing chronic haemodialysis are often exposed to formaldehyde, formaldehyde (F) has been reported to cause IgE‐mediated anaphylactic shock. Many other patients reported pruritus or anaphylaxis‐like symptoms when dialysed with F‐sterilized dialysers. Ten patients presenting such symptoms were compared with five control subjects. Intravenous double‐blind challenges were performed on six consecutive occasions, with capillary flow dialysers sterilized with or without F. Dialysis was performed by an investigator who was not aware of the sterilization procedure. Among the ten F‐sensitive patients, five had symptoms with F‐sterilized dialysers and no symptoms with new dialysers, sterilized by ethylene oxide and free of F. Symptoms included pruritus and hypotension. These five patients were subsequently dialysed with new dialysers, not sterilized with F, and symptoms subsided. The five other patients had inconclusive challenges. The five control subjects had no symptoms during challenges. Skin‐prick tests with F showed that only one of the five patients who had symptoms with F‐dialysers had a strongly positive prick test. RAST to F was titrated with HSA‐discs but it was negative in all patients and control subjects. Formaldehyde was shown to cause symptoms in some patients under chronic haemodialysis but an IgE‐mediated mechanism was not demonstrated.

Individually dosed omalizumab: an effective treatment for severe peanut allergy

Treatment with omalizumab has shown a positive effect on food allergies, but no dosages are established. Basophil allergen threshold sensitivity (CD‐sens) can be used to objectively measure omalizumab treatment efficacy and correlates with the outcome of double‐blind placebo‐controlled food challenge to peanut.

Successful management of severe cow's milk allergy with omalizumab treatment and CD-sens monitoring

Food allergy is common in children and young adults and may be difficult to diagnose and is at present treated with avoidance of the food in question. The aim of this report is to share our clinical experiences monitoring omalizumab treatment by basophil allergen threshold sensitivity, CD-sens. Five children, 6-16 years of age, with a severe milk allergy including episodes of anaphylaxis and IgE-antibodies, between 30 and 160 kUA/L to casein and alpha-lactalbumin (milk proteins), were treated with omalizumab. CD-sens, was tested prior to and after 4 months of omalizumab and if turned negative, it was followed by an oral milk challenge. All children became negative in CD-sens and had a negative milk challenge, but one child required doubling of the omalizumab dose to achieve a negative CD-sens before a challenge was done. Omalizumab appears useful in treatment of severe food allergy, e.g., anaphylaxis to milk, and CD-sens monitoring may decide when and how to perform a food challenge.

IMMUNOGLOBULIN E IN BRONCHIAL ASTHMA

The introduction of the radioimmunosorbent technique (RIST) (18) for quantitation of IgE gave the clinician another tool in the diagnosis oi asthma. Preliminary studies indicated that high IgE values occurred in a large proportion of patients with extrinsic asthma (7). Later reports (4, 17) did not give such conclusive results. As the selection of patients is of great importance in analysis ot asthma, as well as for other diseases, we thought it would be interesting to analyze IgE in a randomly selected, well-defined population of patients (fi-om our outpatient clinic) with intrinsic or extrinsic astlima. These patients were also studied during hyposensitization. In a previous paper we reported the serum levels of IgG, IgA and IgM in patients drawn from the same population (3).