Allergy Patients Research Articles

Immunoproteomics of non water-soluble allergens from 4 legumes flours: peanut, soybean, sesame and lentil

Peanut, soybean, sesame and lentil are members of legumes worldwide consumed by human that can induce food allergy in genetically predisposed individuals. Several protein allergens, mainly water-soluble, have been described. We studied the non water-soluble fraction from these 4 food sources using immunoproteomics tools and techniques. Flour extracts were solubilized in detergent and chaotropes and analysed in 1 and 2 dimensional gel electrophoresis (2D). Results showed numerous proteins exhibiting wide ranges of isoelectric points and relative molecular masses. When IgE immunoreactivities of 18 food allergy patients were individually tested in 1 and 2D western-blots, a very diversified IgE repertoire was observed, reflecting extensive cross-reactivities but also co-sensitizations. Besides already well known and characterized allergens, mass spectrometry analysis allowed the identification of 22 allergens undescribed until now: 10 in peanut, 2 in soybean, 3 in sesame and 7 in lentil. Three allergens are legume storage proteins and the others belong to transport proteins, nucleotide binding proteins and proteins involved in the regulation of metabolism. Seven proteins are potentially similar to allergens described in plants and fungi and 11 are not related to any known allergen. Our results contribute to increase the repertoire of legume allergens that may improve the diagnosis, categorize patients and thus provide a better treatment of patients.

Search for Allergens from the Pollen Proteome of Sunflower (Helianthus annuus L.): A Major Sensitizer for Respiratory Allergy Patients.

BackgroundRespiratory allergy triggered by pollen allergens is increasing at an alarming rate worldwide. Sunflower pollen is thought to be an important source of inhalant allergens. Present study aims to identify the prevalence of sunflower pollinosis among the Indian allergic population and characterizes the pollen allergens using immuno-proteomic tools.MethodologyClinico-immunological tests were performed to understand the prevalence of sensitivity towards sunflower pollen among the atopic population. Sera from selected sunflower positive patients were used as probe to detect the IgE-reactive proteins from the one and two dimensional electrophoretic separated proteome of sunflower pollen. The antigenic nature of the sugar moiety of the glycoallergens was studied by meta-periodate modification of IgE-immunoblot. Finally, these allergens were identified by mass-spectrometry.ResultsPrevalence of sunflower pollen sensitization was observed among 21% of the pollen allergic population and associated with elevated level of specific IgE and histamine in the sera of these patients. Immunoscreening of sunflower pollen proteome with patient sera detected seven IgE-reactive proteins with varying molecular weight and pI. Hierarchical clustering of 2D-immunoblot data highlighted three allergens characterized by a more frequent immuno-reactivity and increased levels of IgE antibodies in the sera of susceptible patients. These allergens were considered as the major allergens of sunflower pollen and were found to have their glycan moiety critical for inducing IgE response. Homology driven search of MS/MS data of these IgE-reactive proteins identified seven previously unreported allergens from sunflower pollen. Three major allergenic proteins were identified as two pectate lyases and a cysteine protease.ConclusionNovelty of the present report is the identification of a panel of seven sunflower pollen allergens for the first time at immuno-biochemical and proteomic level, which substantiated the clinical evidence of sunflower allergy. Further purification and recombinant expression of these allergens will improve component-resolved diagnosis and therapy of pollen allergy.

β-Lactoglobulin mutant Lys69Asn has attenuated IgE and increased retinol binding activity

β-Lactoglobulin (β-LG) is a member of lipocalin superfamily of transporters for small hydrophobic molecules such as retinoids, fatty acids, drugs, and vitamins. β-LG also is one of the major allergens in milk. Despite a lot of research on decreasing cow’s milk allergenicity, the effects of mutations of β-LG on recognition by IgE from cow’s milk allergy (CMA) patients have not been investigated. We describe here the expression in the yeast Pichia pastoris of a mutant bovine β-LG, in which lysine at position 69, in the main epitopes of the protein, was changed into asparagine (Lys69Asn). The purity and native like folded structure of the recombinant Lys69Asn β-LG was confirmed by HPLC, SDS-PAGE, mass spectrometry and circular dichroism. Lys69Asn β-LG has a fourfold stronger affinity than the wild-type protein for retinol, palmitic acid, and resveratrol, as determined by quenching of the intrinsic tryptophan fluorescence. At the same time the Lys69Asn mutant had a 9 fold attenuated, compared with the wild-type, affinity for IgE of sera from patients suffering from cow’s milk allergy, whereas no difference could be detected between mutant and wild-type for binding of the IgGs of four monoclonal antibodies. The results of this study demonstrated the significant role of Lys69 residue on the binding and immuoreactivity properties of β-LG.

β-lactoglobulin mutation Ala86Gln improves its ligand binding and reduces its immunoreactivity

β-Lactoglobulin (β-LG) is a member of lipocalin superfamily of transporters for small hydrophobic molecules. β-LG is also one of the major allergens in milk. Despite a lot of researches on decreasing of cow's milk allergenicity, the effects of the mutation of β-LG on its recognition by IgE from cow's milk allergy (CMA) patients have not been investigated. We described here the expression in the yeast Pichia pastoris of a mutant β-LG, in which Alanine 86 was changed into Glutamine (Ala86Gln; a mutation on one of the major epitopes of the protein). The purity and native like folded structure of the recombinant Ala86Gln have been demonstrated using circular dichroism, HPLC, SDS-PAGE and mass spectrometry. The effect of the mutation on the binding of IgE from CMA patients to mutant protein was evaluated by ELISA methods and the results showed that the mutation of Ala-86 was associated with weaker binding of IgE from CMA patients to Ala86Gln mutant protein. Subsequently, the binding of various ligands such as retinol, palmitic acid, resveratrol and serotonin, with native, recombinant wild type and Ala86Gln mutant β-LGs were investigated by fluorescence spectroscopy and an improvement on the binding affinity of the mutated protein to various ligands was observed.

In vitro effects of zinc on the cytokine production from peripheral blood mononuclear cells in patients with zinc allergy.

Metals, such as nickel, cobalt, chromium and zinc, are ubiquitous in the environment. Systemic reactions, including hand dermatitis and generalized eczematous reactions, can be caused by the dietary ingestion of metals. In this study, we aimed to determine whether the cytokine production from peripheral blood mononuclear cells (PBMCs) obtained from zinc allergy patients can be used as a sensitive marker to investigate zinc-allergic contact dermatitis. The diagnosis of sensitivity to metal was made based on the results of a metal patch test. The PBMCs were stimulated with various concentrations (5–100 μM) of zinc sulfate (ZnSO4) for 24 h. The culture supernatants were collected and analyzed using ELISA for measurement of the cytokine production. The levels of IFN-γ, TNF-α, IL-1β, IL-5, IL-13 and MIF were significantly higher in the zinc-allergic patients (n = 5) than in the healthy controls (n = 5) at 100 μM of ZnSO4 stimulation. Although, patch testing is considered as standard test to diagnose metal allergy but false-positive and -negative reactions may limit its use in conditions of existing dermatitis. Therefore, this study suggest that in support of patch testing the determination of cytokine production using PBMCs cultures would be helpful for making an early diagnosis of such conditions.

A 'difficult' insect allergy patient: reliable history of a sting, but all testing negative.

Few conditions are as treatable as allergy to stinging insects, with venom immunotherapy (VIT) providing up to 98% protection to subsequent stings. The challenge with VIT is not in the treatment, but in the diagnosis. To offer VIT, one must determine a history of a systemic reaction to a stinging insect in conjunction with the presence venom-specific IgE. Current diagnostic methods, although sensitive and specific, are imperfect, and some newer testing options are not widely available. A conundrum occasionally faced is the patient with a reliable and compelling history of a systemic allergic reaction yet negative venom-specific testing. This diagnostic dilemma presents an opportunity to consider possible causes for this diagnostic challenge. Our evolving understanding of the role of occult mast cell disease may begin to help us understand this situation and develop appropriate management strategies. Venom-specific skin testing has long been the cornerstone of the evaluation of venom sensitivity and is often combined with in-vitro assays to add clarity, but even these occasionally may fall short. Exploring novel venom diagnostic testing methods may help to fill in some of the diagnostic gaps. Do currently available venom vaccines contain all the key venom species? Are there enough differences between insect species that we may simply be missing the relevant allergens? What is the significance of the antigenicity of carbohydrate moieties in venoms? What is the role of recombinant venom extracts? VIT is the definitive treatment for insect allergic individuals. To utilize VIT, identification of the relevant Hymenoptera is necessary. Unfortunately, this cannot always be accomplished. This deficiency can have several causes: a potential comorbid condition such as occult mast cell disease, limitations of currently available diagnostic resources, or testing vaccines with an insufficient coverage of relevant venom allergens. Exploring these potential causes may help to provide important insight into this important diagnostic conundrum. The use of a case report may help clarify this challenge.

Penicillin allergy label persists despite negative testing

Studies support a public health imperative to de-label patients of penicillin allergy, however, “de-labeling” is only effective if acted upon. We hypothesized that persistence of a penicillin allergy label despite negative penicillin testing (PT) would be prevalent, impairing the utility and cost-effectiveness of PT.

Eighteen cases of wheat allergy and wheat‐dependent exercise‐induced urticaria/anaphylaxis sensitized by hydrolyzed wheat protein in soap

Glupearl 19S, an acid-hydrolyzed wheat protein (HWP), is used widely in Japan as a moisturizing ingredient in facial soaps. Since 2010, there has been an increasing number of reports of contact urticaria and wheat allergy resulting from the use of products containing this substance. Sixty-one patients who had used HWP-containing facial soap visited our hospital. Thirty-five of these experienced urticaria or anaphylaxis after consuming wheat-containing food. Eighteen of the 35 patients tested positive to 0.01% Glupearl 19S solution. Wheat-specific IgE and serum gluten-specific IgE were higher in the patients with HWP allergy than in non-HWP allergy patients. Among the patients who tested positive to Glupearl 19S on the skin prick test, nine experienced HWP-wheat-dependent exercise-induced anaphylaxis, and four experienced food-dependent anaphylaxis. Moreover, four of these patients not only experienced food-dependent anaphylaxis but also a worsening of the symptoms during exercise. The clinical symptomology was so variable that the patients were classified into six groups. We found that patients with HWP allergy tended to manifest symptoms of both HWP-wheat-dependent exercise-induced anaphylaxis and contact urticaria. The etiology of hydrolyzed wheat protein allergy is unknown. Patients with a history of these symptoms need to be informed about the risk of consuming wheat-containing foods and the importance of excluding such items from their diet.

Utility of Basophil Activation Test for monitoring the acquisition of clinical tolerance after oral desensitization to cow's milk: Pilot study.

The quantification of basophil activation by flow cytometry is a useful tool for the assessment of immediate-type responses to food allergens and the prediction of clinical tolerance in food allergy patients. The aim of this study is to investigate how the analysis of allergen-induced CD63 up-regulation by flow cytometry can be effective in monitoring the acquisition of clinical tolerance by specific oral desensitization in food allergy. To our knowledge, this is the first study to examine this topic. Three male patients affected by cow's milk allergy underwent successful oral desensitization to cow's milk. In order to monitor the acquired clinical tolerance that occurred after treatment, we performed laboratory tests for total and specific IgE, specific IgG4 and the Basophil Activation Test (BAT) both at baseline and at the end of the desensitization protocol. Using a fluorescent enzyme immunoassay, the comparison of specific cow's milk antibodies before and after treatment showed a decrease of specific IgE levels, without reaching normal values, and an increase of specific IgG4 levels. A complete suppression of cow's milk proteins (α-lactoalbumin, β-lactoglobulin and casein) induced CD63 regulation was observed in all three reported cases. Using flow cytometry, food allergen-specific basophil responses could be monitored in order to identify an acquired tolerance induced by desensitization treatment. Although further studies are needed to develop this important new topic, it was interesting to note that the BAT seemed to be more sensitive and characterized by a close correlation with clinical tolerance.

A review of biomarkers for predicting clinical reactivity to foods with a focus on specific immunoglobulin E antibodies.

The purpose of this study is to assess the latest studies that focus on specific immunoglobulin (Ig)E antibodies for predicting clinical reactivity to foods. Persistent hen's egg and cow's milk allergy patients have higher antigen-specific IgE levels at all ages than those who have outgrown these allergies. Recent studies on the natural histories of hen's egg and cow's milk allergies suggested that baseline antigen-specific IgEs are the most important predictors of tolerance. Oral immunotherapy (OIT), which is a novel therapeutic approach for food allergy, requires biomarkers for predicting outcomes after therapy. Several studies indicate that the initial antigen-specific IgE level may be a useful biomarker for the prognosis of OIT. Recently, component-resolved diagnostics (CRD) has been used for food allergy diagnosis. Current studies have suggested that Ara h 2, omega-5 gliadin and ovomucoid are good diagnostic markers for peanut, wheat and egg allergies, respectively. Antigen-specific IgE can be a useful biomarker for predicting clinical reactivity to food allergies. Monitoring hen's egg and cow's milk-specific IgE is useful for predicting prognosis, and baseline specific IgE levels may be associated with the outcome of OIT. The use of CRD provides us with a better tool for diagnosing food allergy.

Modulation of couples' stress hormones in everyday life through a minimal couple intervention

psychocutaneous diseases) have demonstrated a high distress vulnerability, including also an increased skin perspiration to sad music (as a distressing stimulus). These patients show personality traits characterized by high stress load and increased vulnerability to stress that may influence disease progression and coping strategies. The somatopsychic recoil (revealed by the existence of high levels of anxiety and depression)maymaintain increased reactivity to stress. The similarities between drug allergy patients and psychocutaneous disease patients may be explained by the role of the skin as a shock organ and the low presence of drug anaphylaxis among drug allergy patients.

Authorised allergen products for intracutaneous testing may no longer be available in Germany: Allergy textbooks have to be re-written.

Background:Beside the skin prick test, the intracutaneous test represents the most important skin test method for detecting type-1 allergies. With the incorporation of European directives into national law, test allergens used for allergy diagnosis are deemed medicinal products within the meaning of the German Medicinal Products Act (Arzneimittelgesetz) and therefore require marketing authorisation for distribution in Germany. The high costs of acquiring and maintaining these authorisations have lead to no new finished intracutaneous test products being authorized in Germany for more than 20 years. Instead, most manufacturers have voluntarily withdrawn their existing marketing authorisations for intracutaneous test extracts. The last manufacturer to offer approved finished allergen products for intracutaneous tests recently announced that it would now cease production and distribution of these solutions.Methods:Research on the current European and German legislation; selective literature search in Medline, including national and international guidelines and Cochrane meta-analyses; licensing information on the Paul-Ehrlich-Institute homepage (www.pei.de) as well as in the Bundesanzeiger (Federal Gazette).Results:According to information on www.pei.de, marketing authorisations still existed as of 31.01.2015 for intracutaneous test solutions of six grass/cereal/herbal pollens, seven tree pollens, ten food allergens, twelve moulds and yeasts as well as two fungal mixtures, five house dust and storage mites and five animal epithelia/danders, all held by only one company in Germany. These marketing authorisations were granted between 16th March 1987 and 17th January 1992; more recent marketing authorisations do not exist.Conclusions:European legislation and the associated increase in production and licensing costs have already lead to numerous suppliers withdrawing their marketing authorisation for diagnostic test allergens — marketing authorisations for 443 diagnostic allergens were voluntarily withdrawn by manufacturers in 2013 alone. If the announced restrictions on the allergen portfolio go ahead, considerable problems in the management of allergy patients in Germany due to the discontinuation of the intracutaneous test are likely to be encountered. Moreover, the fact that a diagnostic procedure that has been established for decades seems set to disappear quite simply because all the requisite substances vanish from the market in one fell swoop may well be without parallel in modern medicine.The situation for skin prick test allergens is less dramatic, although, here again, the available range is becoming increasingly limited.

G439(P) Tale of allergy testing: implementing rcpch allergy care pathways in a district general hospital

Introduction RCPCH allergy care pathways recommend use of either RAST or skin prick testing for diagnosis only when there is clinical suspicion of allergy. Pathways further recommend use of measurements of skin prick and specific IgE test results to optimise the timing of food challenges. This audit aimed to compare our practice against national standards. Method A retrospective analysis of all notes for food challenges between May 2013–May 2014 was undertaken. Total of 29 food challenges were identified. Results More than half of our patients were males. Majority of the patients (69%) had RAST test done at time of diagnosis. 7% of patients had both skin prick and RAST done. However, 21% of allergy patients did not have any test done at time of diagnosis and diagnosis was made on history only. In regards to food challenge, more then half of patients were aged 8 years or above at time of challenge. Only 66% of patients passed food challenge. 79% of patients have either RAST or Skin prick test done prior to challenge. 21% of our patients had no form of testing prior to challenge. Of all patients who passed challenge 53% of patients have both tests done in contrast to all patients who failed challenge only 30% have both tests done. All patients who had both tests negative passed the food challenge. All the patients who failed the challenge had a positive RAST test prior to challenge. Recommendations An allergy clinic proforma was introduced as an aide–memoir to facilitate appropriate testing at diagnosis and prior to challenge. Failed food challenges bring disappointment for child, parents and unnecessary burden on NHS budget. Choosing the right patient is the key to prevent failed challenges, hence, referral process for challenges was re evaluated and now clinicians will make sure that both tests are done prior to food challenges. We aim to re audit in six months.

Perfil clínico-epidemiológico de pacientes con sospecha de alergia alimentaria en México. Estudio Mexipreval

Adverse reaction to food has increased around the world in last years. Prevalence of food allergy raises between 2-4% in adults, and 6-8% in children. The clinical presentation is heterogeneous and varies from mild symptoms to anaphylactic reactions. Even the clinical history focused in the food is important; demonstration of allergen sensitization is mandatory. To describe the profile of the patients with suspicion of food allergy and the regular clinical practice followed in Mexico. An observational, descriptive, cross-sectional study was carried out from March 2013 to March 2014 using a convenience sample of allergic patients who were treated in the office, both private and public, of those physicians who seen food allergy patients. Clinical, epidemiological, diagnostic and therapeutic data were collected from 1,971 suspicious food allergic patients presenting for the first time in the departments of the researchers involved in the study. No difference was found in relation to gender. In relation to age, a bimodal distribution, with peaks at 2 and 35 years old, was found. A history of respiratory allergy was present in 75% of cases; 80% of patients had had any previous symptoms before seeking consultation and the most frequent clinical manifestations were cutaneous, 5% reported anaphylaxis. The foods involved in reactions change with age. The clinical presentation changes with the food, although the skin is the most frequently affected organ. Even if the suspicious were high, the confirmation with specific diagnostic tools is strongly recommended.

Integrative medicine is integral to providing patient-centered care

Integrative medicine is integral to providing patient-centered care

Penicillin Allergy Label Persists Despite Negative Testing

RationaleStudies support a public health imperative to de-label patients of penicillin allergy, however, “de-labeling” is only effective if acted upon. We hypothesized that persistence of a penicillin allergy label despite negative penicillin testing (PT) would be prevalent, impairing the utility and cost-effectiveness of PT.MethodsA retrospective EMR chart review of 100 patients who underwent PT from January 2010 (due to Pre-Pen availability) to May 2014 in a tertiary outpatient clinic was performed to assess the primary outcome of penicillin allergy labeling changes following PT. Covariates included antibiotic utilization before and after testing, reaction history, number of additional drug allergy labels and beta-lactam exposure following PT. Patients were contacted to complete a survey regarding their interpretation of PT results.ResultsFollowing negative PT, 26/69 patients (37.7%) remained labeled as penicillin allergic in the EMR. 26 patients tolerated subsequent exposure to penicillin either through oral challenge (n=7) or treatment course (n= 19). 19.2% of patients who tolerated penicillin didn’t have their label removed. Although 100% (n=40) of patients contacted could correctly identify the result of their PT, 39% (9/23) with negative PT have either kept their allergy label or continue to avoid penicillins.ConclusionsPT impacted future therapy in only 17.3% of patients with negative PT. The benefits of PT in clinical practice will only be realized if the results of negative testing are acknowledged and acted upon. This suggests approaches to standardize PT procedures and reporting must be addressed to close this efficacy-effectiveness gap. RationaleStudies support a public health imperative to de-label patients of penicillin allergy, however, “de-labeling” is only effective if acted upon. We hypothesized that persistence of a penicillin allergy label despite negative penicillin testing (PT) would be prevalent, impairing the utility and cost-effectiveness of PT. Studies support a public health imperative to de-label patients of penicillin allergy, however, “de-labeling” is only effective if acted upon. We hypothesized that persistence of a penicillin allergy label despite negative penicillin testing (PT) would be prevalent, impairing the utility and cost-effectiveness of PT. MethodsA retrospective EMR chart review of 100 patients who underwent PT from January 2010 (due to Pre-Pen availability) to May 2014 in a tertiary outpatient clinic was performed to assess the primary outcome of penicillin allergy labeling changes following PT. Covariates included antibiotic utilization before and after testing, reaction history, number of additional drug allergy labels and beta-lactam exposure following PT. Patients were contacted to complete a survey regarding their interpretation of PT results. A retrospective EMR chart review of 100 patients who underwent PT from January 2010 (due to Pre-Pen availability) to May 2014 in a tertiary outpatient clinic was performed to assess the primary outcome of penicillin allergy labeling changes following PT. Covariates included antibiotic utilization before and after testing, reaction history, number of additional drug allergy labels and beta-lactam exposure following PT. Patients were contacted to complete a survey regarding their interpretation of PT results. ResultsFollowing negative PT, 26/69 patients (37.7%) remained labeled as penicillin allergic in the EMR. 26 patients tolerated subsequent exposure to penicillin either through oral challenge (n=7) or treatment course (n= 19). 19.2% of patients who tolerated penicillin didn’t have their label removed. Although 100% (n=40) of patients contacted could correctly identify the result of their PT, 39% (9/23) with negative PT have either kept their allergy label or continue to avoid penicillins. Following negative PT, 26/69 patients (37.7%) remained labeled as penicillin allergic in the EMR. 26 patients tolerated subsequent exposure to penicillin either through oral challenge (n=7) or treatment course (n= 19). 19.2% of patients who tolerated penicillin didn’t have their label removed. Although 100% (n=40) of patients contacted could correctly identify the result of their PT, 39% (9/23) with negative PT have either kept their allergy label or continue to avoid penicillins. ConclusionsPT impacted future therapy in only 17.3% of patients with negative PT. The benefits of PT in clinical practice will only be realized if the results of negative testing are acknowledged and acted upon. This suggests approaches to standardize PT procedures and reporting must be addressed to close this efficacy-effectiveness gap. PT impacted future therapy in only 17.3% of patients with negative PT. The benefits of PT in clinical practice will only be realized if the results of negative testing are acknowledged and acted upon. This suggests approaches to standardize PT procedures and reporting must be addressed to close this efficacy-effectiveness gap.

Clinical and Immunological Assessment of Efficacy Specific Sublingual Immunotherapy in Respiratory Allergy Patients

Clinical and Immunological Assessment of Efficacy Specific Sublingual Immunotherapy in Respiratory Allergy Patients

Allergen Specific IgE Detection Performance of Allergyq® System in Korean Allergy Patients

Allergen Specific IgE Detection Performance of Allergyq® System in Korean Allergy Patients

Positive Reactions to Nickel on a Patch Test Do Not Predict Clinical Outcome of Nickel Alloy-Based Atrial Septal Defect Occluder Implantation

Background: Patch testing is thought to be necessary prior to metal device implantation to rule out metal allergy-related complications; however, there are controversies over the effects of nickel allergy on the outcome of nickel alloy-based device implantation. Objective: This study aimed to evaluate the adverse events in a Korean population of nickel allergy patients who underwent atrial septal defect (ASD) closure with a nickel-titanium alloy-based device. Methods: We retrospectively reviewed the medical records of patients who underwent ASD closure with a nitinol device. Results: Among 38 patients who had ASD closure, 4 of 5 nickel-allergic patients and 10 of the 33 non-nickel-allergic patients had post-closure complications. All patients fared well, without device failure culminating in device removal. Conclusion: In this study, positive reactions to nickel in a patch test were not associated with adverse early or late outcomes following ASD closure with a nickel alloy-based device.

Difficulties of caregivers of cow's milk allergy patients in understanding the labeling of processed products

This article was originally published online on 8 April 2015 Cow's Milk Allergy (CMA) is the main food allergy (FA) in children and its treatment includes restricted milk diet. The correct identification of terms that mean milk ensures the efficacy of treatment.The aim of this study was to identify the main factors involved in the caregivers’ ability to recognize the presence of milk in products labels. Cross-sectional and descriptive study was carried out with CMA patient’s caregivers in follow-up at a pediatric reference center for FA. All of them were previously instructed about labels. This study included a questionnaire about the knowledge regarding the labels reading. Caregivers evaluated 20 labels (15 of foods, 3 of medicines and 2 of cosmetics) and should decide if the product was safe and the reason it can or not be offered to the patients. 15/20 contained words meaning milk protein. Results were expressed in number of labels reading (20 labels/caregivers) Twenty-eight caregivers fulfilled the questionnaire. The caregivers were 78.5% mothers and 21.5% fathers and about their schooling years 78.2% finished high school or college degree. The median of patient’s follow-up was 12 months (0.03-144). Twenty caregivers deal with patients that presented at least one episode of anaphylaxis. All caregivers referred label reading: 25 read every time they buy the product and only 9 read the labels after buying, before storing and offering.Labels were correctly read in 75.7 % being lactose, casein and whey protein the most common correctly identified terms. The most common mistakes were related to the terms lactil and caramel color. About medicines the most difficulties was to localize de terms related to milk in the package leaflet. Main factors regarding wrong comprehension were small or unclear printing, difficult localization and ingredients in foreign language Labels reading is part of food allergy treatment and demands constant reinforcements stressing the necessity of continuous label reading. Labels quality must improve in many aspects in order to help caregivers understanding of milk labels and avoid patient’s accidental intake.