Teresa Carrillo

Class I chitinases with hevein-like domain, but not class II enzymes, are relevant chestnut and avocado allergens☆☆☆★★★

BACKGROUND Several foods associated with the latex-fruit syndrome present relevant allergens of around 30 kd. Neither these components nor any other responsible for the reported cross-reactions have been identified and purified. OBJECTIVE We sought to isolate and characterize the 30 kd allergens from avocado fruit and chestnut seed, two of the main allergenic foods linked with latex allergy. METHODS Sera from patients allergic to chestnut and avocado were selected according to clinical symptoms, specific IgE levels, and positive skin prick test responses. Class I and II chitinases were purified by affinity and cation-exchange chromatography and characterized by specific IgE and anti-chitinase immunodetection, immunoblot inhibition assays, enzymatic activity tests, and N-terminal sequencing. RESULTS Relevant 32 kd allergens were detected by specific IgE immunodetection in both avocado and chestnut crude extracts. The same bands, together with others of 25 kd, were revealed by a monospecific antiserum against class II chitinases. Purification and characterization of the 32 kd allergens from both plant sources allowed their identification as class I chitinases with an N-terminal hevein-domain. The purified allergens fully inhibited IgE binding by the corresponding crude extract when tested in immunoblot inhibition assays. Highly related 25 kd class II chitinases that lack the hevein-like domain were also isolated from the same protein preparations. No IgE-binding capacity was shown by these class II enzymes. CONCLUSION Class I chitinases are relevant allergens of avocado and chestnut and could be the panallergens responsible for the latex-fruit syndrome. The hevein-like domain seems to be involved in their allergenic reactivity.

Intolerance to nonsteroidal antiinflammatory drugs: Results of controlled drug challenges in 98 patients

BACKGROUND Controlled oral challenge is the only definitive way to detect the different clinical manifestations of intolerance to nonsteroidal antiinflammatory drugs (NSAIDs). OBJECTIVE This study was carried out to describe the clinical manifestations of drug challenges in a population with histories of intolerance to NSAIDs. METHODS Two-hundred forty subjects were included in a single-blind, placebo-controlled drug challenge protocol. RESULTS Eighty patients exhibited a positive response to drug challenge: 52 had isolated periorbital angioedema, 13 had cutaneous rashes, eight had bronchial asthma (7 with associated periorbital angioedema), three had nasoocular reactions, and four had systemic anaphylaxis. In another 18 patients who were referred for treatment because of a reaction suggesting systemic anaphylaxis, the implicated drug was not given, but tolerance to other NSAIDs was found. The mean age of patients with isolated periorbital angioedema was significantly lower (p < 0.001) than that of the other groups of NSAID reactors. A significant increase (p < 0.001) in atopy was found among patients with isolated periorbital angioedema (100%) in comparison with other patients with NSAID intolerance (45.6%). NSAID cross-reactivity was a common finding, but cross-reactivity was not found in two cases of periorbital angioedema, one case of urticaria, one case of bronchial asthma, and 18 cases of systemic anaphylaxis. CONCLUSION In atopic subjects, isolated periorbital angioedema constitutes the most frequent manifestation of NSAID intolerance. Such patients are younger than other NSAID reactors and commonly have intolerance to several NSAIDs.

Greater epitope recognition of shrimp allergens by children than by adults suggests that shrimp sensitization decreases with age

BACKGROUND Shellfish allergy is a long-lasting disorder typically affecting adults. Despite its high prevalence, there is limited information about allergenic shrimp proteins and the epitopes implicated in such allergic reactions. OBJECTIVE We sought to identify the IgE-binding epitopes of the 4 shrimp allergens and to characterize epitope recognition profiles of children and adults with shrimp allergy. METHODS Fifty-three subjects, 34 children and 19 adults, were selected with immediate allergic reactions to shrimp, increased shrimp-specific serum IgE levels, and positive immunoblot binding to shrimp. Study subjects and 7 nonatopic control subjects were tested by means of peptide microarray for IgE binding with synthetic overlapping peptides spanning the sequences of Litopenaeus vannamei shrimp tropomyosin, arginine kinase (AK), myosin light chain (MLC), and sarcoplasmic calcium-binding protein (SCP). The Wilcoxon test was used to determine significant differences in z scores between patients and control subjects. RESULTS The median shrimp IgE level was 4-fold higher in children than in adults (47 vs 12.5 kU(A)/L). The frequency of allergen recognition was higher in children (tropomyosin, 81% [94% for children and 61% for adults]; MLC, 57% [70% for children and 31% for adults]; AK, 51% [67% for children and 21% for adults]; and SCP, 45% [59% for children and 21% for adults]), whereas control subjects showed negligible binding. Seven IgE-binding regions were identified in tropomyosin by means of peptide microarray, confirming previously identified shrimp epitopes. In addition, 3 new epitopes were identified in tropomyosin (epitopes 1, 3, and 5b-c), 5 epitopes were identified in MLC, 3 epitopes were identified in SCP, and 7 epitopes were identified in AK. Interestingly, frequency of individual epitope recognition, as well as intensity of IgE binding, was significantly greater in children than in adults for all 4 proteins. CONCLUSIONS Children with shrimp allergy have greater shrimp-specific IgE antibody levels and show more intense binding to shrimp peptides and greater epitope diversity than adults.

Prevalence of latex allergy among greenhouse workers

ment regimens do not prevent this complication, and because it may recur, this case would not support the use of nonionic low contrast medium as a preventive measure for subsequent needed procedures. Although rare, acute pulmonary edema after administration of radiographic contrast media is potentially life-threatening. Ticeatment must be directed toward diuresis and the maintenance of adequate gas exchange. Acute pulmonary edema taust not be confused with the more typical bronchospastic ana, phylactoid reaction in order to avoid delay in starting appropriate therapy. ~ s case reinforces the need for a high index of suspicion for this problem in any patient experieneing acute dyspnea after a radiologic procedure with any of the eurrently available contrast media,

Differences among Pollen-Allergic Patients with and without Plant Food Allergy

Background: A considerable number of pollen-allergic patients develops allergy to plant foods, which has been attributed to cross-reactivity between food and pollen allergens. The aim of this study was to analyze the differences among pollen-allergic patients with and without plant food allergy. Methods: Eight hundred and six patients were recruited from 8 different hospitals. Each clinical research group included 100 patients (50 plant food-allergic patients and 50 pollen-allergic patients). Diagnosis of pollen allergy was based on typical case history of pollen allergy and positive skin prick tests. Diagnosis of plant-food allergy was based on clear history of plant-food allergy, skin prick tests and/or plant-food challenge tests. A panel of 28 purified allergens from pollens and/or plant foods was used to quantify specific IgE (ADVIA-Centaur® platform). Results: Six hundred and sixty eight patients (83%) of the 806 evaluated had pollen allergy: 396 patients with pollen allergy alone and 272 patients with associated food and pollen allergies. A comparison of both groups showed a statistically significant increase in the food and pollen allergy subgroup in frequency of: (1) asthma (47 vs. 59%; p < 0.001); (2) positive skin test results to several pollens: Plantago,Platanus,Artemisia,Betula,Parietaria and Salsola (p < 0.001); (3) sensitization to purified allergens: Pru p 3, profilin, Pla a 1 – Pla a 2, Sal k 1, PR-10 proteins and Len c 1. Conclusion: Results showed relevant and significant differences between both groups of pollen-allergic patients depending on whether or not they suffered from plant-derived food allergy.

Reduction of house dust mite allergens after dehumidifier use

It has been recognized that relative humidity is a key factor in mite popula t ion growth and allergen p roduc t ion? We under took a control led study to determine whether the levels o f mite allergen collected f rom mattresses decreased after dehumidifier use. The study was carried out in the Canary Islands, a subtropical area at sea level, where a prevalence o f 43% of allergic diseases (asthma, rhinitis, or both) and 48.5% of skin test reactivity to Dermatophagoides pteronyssinus has been r e p o r t e d ?

A randomized comparison of the effects of budesonide and mometasone furoate aqueous nasal sprays on nasal peak flow rate and symptoms in perennial allergic rhinitis

BACKGROUND Using conventional methods, it has been difficult to show differences in efficacy between intranasal corticosteroids in perennial rhinitis. OBJECTIVE To compare the effects of budesonide and mometasone on nasal symptoms and nasal airflow in perennial allergic rhinitis. METHODS Four hundred thirty-eight patients (age > 18 years old) were randomized to budesonide, 256 microg or 128 microg, mometasone furoate 200 microg, or placebo, once daily for 4 weeks. Efficacy was evaluated by nasal index score (NIS; the sum of scores for blocked nose, runny nose, and itchy nose/sneezing) and peak nasal inspiratory flow (PNIF). RESULTS All three active treatments significantly reduced the NIS compared with placebo. There was no significant difference between the treatments, although the effect of budesonide, 256 microg, tended to be greater than that of the other regimens. PNIF was significantly improved with all three active treatments: the effect of budesonide 256 microg on morning and evening PNIF was significantly greater than that of mometasone furoate and 128 microg budesonide. Budesonide had a rapid onset of action, showing a significantly greater effect on evening PNIF than mometasone furoate during the first 10 days. For all active treatments, significant improvements in NIS were seen within 4 hours of the first dose. All three treatments were well tolerated. CONCLUSION The objective parameter PNIF was capable of demonstrating greater efficacy of budesonide 256 microg compared with budesonide 128 microg and mometasone furoate 200 microg, whereas the combined nasal symptom score could only distinguish active treatment from placebo.

Association of HLA-DR11 with the anaphylactoid reaction caused by nonsteroidal anti-inflammatory drugs.

BACKGROUND Several HLA alleles have been associated with asthma induced by nonsteroidal anti-inflammatory drugs (NSAIDs). The existence of HLA markers linked to other NSAID-induced reactions, such as cutaneous and anaphylactoid reactions, has not been established. OBJECTIVE The purpose of our work was to study the HLA-DRB1 and HLA-DQB1 alleles in patients with cutaneous and anaphylactoid reactions caused by NSAIDs. METHODS We have analyzed 114 HLA DRB1 and 26 HLA-DQB1 alleles in 21 patients with anaphylactoid reactions caused by NSAIDs, 47 patients who had exclusively cutaneous reactions during single-blind, placebo-controlled oral challenges with NSAIDs, and 167 tolerant control subjects (29 of whom had also had an IgE-mediated anaphylaxis to different agents). HLA-DRB1 and HLA-DQB1 alleles were typed by the polymerase chain reaction sequence-specific primers method with genomic DNA. RESULTS The frequency of HLA-DR11 alleles was 58.8% in the anaphylactoid reaction group, compared with 15.9% in the NSAID-tolerant healthy control subjects (OR, 7:3; 95% confidence interval, 2.8-19.0; P <.02) and 6.3% in the group of the patients with a tolerance for NSAIDs and with IgE-mediated anaphylaxis (OR, 18.75; 95% confidence interval, 4.3-81.1; P <.004). No differences were observed among HLA-DR11 alleles analyzed. There were no significant HLA-DQB1 associations with NSAID-induced anaphylactoid reactions. Patients with cutaneous reactions had HLA frequencies that did not differ significantly from the tolerant control subjects. CONCLUSION The HLA-DRB1*11 alleles showed a positive association with NSAID-induced anaphylactoid reactions.

Comparison of the efficacy of budesonide and fluticasone propionate aqueous nasal spray for once daily treatment of perennial allergic rhinitis

BACKGROUND Intranasal corticosteroids, such as budesonide and fluticasone propionate, are widely prescribed in the treatment of perennial allergic rhinitis. Once daily budesonide dry powder and fluticasone propionate aqueous suspension have been found to provide similar efficacy in controlling symptoms of perennial allergic rhinitis. OBJECTIVE The purpose of this study was to assess the efficacy and safety of treatment with once daily budesonide aqueous nasal spray. METHODS This study involved a multicenter, blinded, randomized, parallel-group, placebo-controlled trial of adults with perrenial allergic rhinitis. Patients (n = 273) recorded daily nasal symptoms for 8 to 14 days (baseline) and 6 weeks (treatment). RESULTS Budesonide decreased combined symptoms to a significantly greater extent than did fluticasone (P =.03); both treatments significantly decreased mean combined nasal symptoms scores compared with placebo. Of the 3 nasal symptoms assessed (ie, nasal blockage, runny nose, and sneezing), nasal blockage was significantly (P =. 009) more decreased with budesonide compared with fluticasone. Both treatments also significantly improved runny nose and sneezing compared with placebo. Improvement in combined nasal symptom scores of the budesonide-treated group reached statistical significance within 36 hours compared with placebo (P =.01); in those patients treated with fluticasone, significant improvement compared with placebo was first observed within 60 hours. Adverse events were mild and transient. CONCLUSIONS Once daily budesonide aqueous nasal spray, 256 microgram, was significantly better in controlling the symptoms of perrenial allergic rhinitis than once daily fluticasone propionate, 200 microgram, especially nasal blockage. Both treatments were superior to placebo. Budesonide may have a faster onset of action than fluticasone.

The Involvement of Thaumatin-Like Proteins in Plant Food Cross-Reactivity: A Multicenter Study Using a Specific Protein Microarray

Cross-reactivity of plant foods is an important phenomenon in allergy, with geographical variations with respect to the number and prevalence of the allergens involved in this process, whose complexity requires detailed studies. We have addressed the role of thaumatin-like proteins (TLPs) in cross-reactivity between fruit and pollen allergies. A representative panel of 16 purified TLPs was printed onto an allergen microarray. The proteins selected belonged to the sources most frequently associated with peach allergy in representative regions of Spain. Sera from two groups of well characterized patients, one with allergy to Rosaceae fruit (FAG) and another against pollens but tolerant to food-plant allergens (PAG), were obtained from seven geographical areas with different environmental pollen profiles. Cross-reactivity between members of this family was demonstrated by inhibition assays. Only 6 out of 16 purified TLPs showed noticeable allergenic activity in the studied populations. Pru p 2.0201, the peach TLP (41%), chestnut TLP (24%) and plane pollen TLP (22%) proved to be allergens of probable relevance to fruit allergy, being mainly associated with pollen sensitization, and strongly linked to specific geographical areas such as Barcelona, Bilbao, the Canary Islands and Madrid. The patients exhibited >50% positive response to Pru p 2.0201 and to chestnut TLP in these specific areas. Therefore, their recognition patterns were associated with the geographical area, suggesting a role for pollen in the sensitization of these allergens. Finally, the co-sensitizations of patients considering pairs of TLP allergens were analyzed by using the co-sensitization graph associated with an allergen microarray immunoassay. Our data indicate that TLPs are significant allergens in plant food allergy and should be considered when diagnosing and treating pollen-food allergy.