Oral Allergy Research Articles

CRITERIA FOR SELECTING SPECIAL HEALTH CARE NEEDS PATIENTS FOR GENERAL ANESTHESIA IN DENTAL TREATMENT: A SYSTEMATIC REVIEW

Objective:This systematic review aimed to investigate the available evidence on how to decide whether your special health care needs patient needs GA for dental treatments or not. Materials and methods:A systematic search was conducted in four electronic databases PubMed, Google Scholar, ResearchGate and SDL. The search was restricted to articles published between 2005 and 2020. Publications reporting on the special health care needs patients dental treatment were included. The papers were analyzed regarding title and abstract contents to eliminate the ones that were out of context and not relevant to the review. Results:The search strategy resulted in 99 unique and potentially relevant articles. In total, 6 publications which include 5 retrospective articles and one cross-sectional study were selected. Conclusions:The main standards for selecting patients for hospitalized dental treatments include a full analysis of SNP including their medical history, behavior and emotional factors, oral health status, allergies, social and non-clinical factors, and caregivers factors. It is important for general dentists and families of these patients to be acquainted with the procedure, its need, and its contraindications.

Subchronic exposure to a glyphosate-based herbicide causes dysplasia in the digestive tract of Wistar rats

Glyphosate-based herbicides (GBH) are the most widely used herbicide for treatment of crops in the world. The digestive tract is one of the first systems exposed to pesticides, and damage to this system can affect the general health of individuals. The aim of this study was to evaluate the effects of subchronic inhalation and oral exposure to GBH on the digestive tract in rats. Six groups of Wistar rats (male and female) were exposed to nebulization with three concentrations of GBH [3.71 × 10-3 grams of active ingredient per hectare (g.a.i./ha), 6.19 × 10-3 g.a.i./ha and 9.28 × 10-3 g.a.i./ha] administered orally or by inhalation for 75 days. Bone marrow cells, smears of the tongue and fragments of the tongue, oesophagus, stomach and intestine were collected for histopathological analysis. Congestion, inflammation, an increase in the number of mast cells and nucleoli-organizing regions were detected in the tongue in the groups exposed to GBH. Females had a higher number of mast cells in the tongue than males. Animals in the groups exposed to higher concentrations of GBH showed dysplasia in the oesophagus and small and large intestine regardless of sex. Gastric changes were not observed. Animals exposed to GBH showed increased micronucleus formation. Our data indicate that GBH causes oral allergies and dysplastic lesions in the oesophagus and small and large intestine and has genotoxic potential.

Sensitisation to lipid transfer proteins in pollen - allergic adults with food allergy.

IntroductionFood allergy affects 6–17% of Europeans and in 60% of the cases it is accompanied by inhalation allergy. This is due to two phenomena, namely co-sensitisation and cross-reactivity, which are caused by panallergens, such as lipid transfer proteins (LTP). These proteins are classified as defence proteins PR-14 and are responsible for protecting the plant from bacterial and fungal infections. Clinically, LTP allergy manifests with severe anaphylactic reactions or milder reactions, such as oral allergy syndrome.AimTo assess the incidence of specific IgE to components belonging to LTP based on molecular testing.Material and methodsThe study was conducted at the Department of Allergy, Clinical Immunology and Internal Diseases in Bydgoszcz, Poland. A total of 50 subjects participated in the study. Each subject had their asIgE levels determined with ImmunoCap ISAC.Results and ConclusionsAntigen-specific IgE antibodies to LTP components were identified in 24% of the subjects. In subjects with LTP allergy, adverse skin reactions were the most common after consumption of sensitising foods. Peach was the most common food allergen triggering these reactions. The Artemisia vulgaris component Art v 3 was the precursor of LTP allergy in our study population: the highest incidence and the highest mean levels of asIgE were demonstrated for this component.

成人気管支喘息と食品アレルギー : 第2報 Oral Allergy Syndrome-スギ花粉症との関係

成人気管支喘息と食品アレルギー : 第2報 Oral Allergy Syndrome-スギ花粉症との関係

Oral Cavity and Allergy: Meeting the Diagnostic and Therapeutic Challenge

Allergic reactions of the oral mucosa are associated with diverse symptoms and can severely affect patients’ quality of life. Oral mucosa changes such as stomatitis or lichenoid reactions can be the first evidence of a contact allergy, with oral lichenoid reactions after contact with dental restorations, especially amalgam fillings, being among the most common clinical reactions. Additives in foods and oral hygiene products may also cause allergic mucosal reactions. Subjective symptoms, such as pain, burning feeling, or dryness of the oral mucosa, as well as cheilitis or lip and facial swelling, may not only have an allergic component but may also be associated with other diseases that have to be excluded. A complete and thorough clinical examination of the oral mucosa is the first step in the diagnosis of a contact allergy. A detailed history of the patient’s oral care products, drugs, and dental materials is both essential and helpful for the clinician. As a result of the presence of mucosal changes, a patch test can be used for the diagnosis of contact allergy of delayed type. Although the patch test is the standard diagnostic tool for such types of contact allergy, proper interpretation of patch-test results and their clinical relevance can be challenging. As the number of patients with allergies resulting from different materials increases over the years, and a larger number of different dental materials are found to induce an allergy, it is essential for dentists to be aware of the possible allergic reactions to dental materials. Thus, we aimed to develop a systematic approach for contact allergy of the oral cavity, focusing not only on clinical manifestations and diagnosis but also on management and prediction of the risk of oral allergic reactions. A multidisciplinary approach for patients with an oral allergy is essential, with participation of physicians of different specialties, including dentists, allergists and dermatologists.

Proposal for a Short Patch Test Series of Dental Materials for Patients with Suspected Oral Contact Allergy

The selection of patch test haptens contained in oral rehabilitation materials is not an easy task, therefore baseline series and additional dental series are used for screening and to increase the chance for the detection of patient's contact sensitizations. Moreover, the clinical relevance of positive patch tests must be evaluated. We conducted a biomedical literature search, covering a period of thirty years, using the keywords: contact, allergy, dental, allergens, patch, patients, screening, in order to evaluate many studies including large numbers of patients, tested to various hapten series, in different departments, for the detection of the most common contact allergens involved in dental contact hypersensitivity. We propose a short patch test series of oral rehabilitation materials for patients including six metal haptens present in dental alloys for inlays, crowns, bridges and dentures, one monofunctional methacrylate and one epoxy prepolymer present in dental composite resins, dentin bonding agents and prosthetic materials, one epoxy resin type present in root canal sealants, three odorant constituents contained in provisional restorative and root canal filling materials, periodontal dressings and dental impression materials. Contact allergy to dental haptens is a constant studied subject, but the cost of patch testing with screening and additional or extensive series is relevant, therefore the proposal of a shorter dental material series for patients is aimed to promote sustainability of oral rehabilitation and contact hypersensitivity care and to reduce costs in some real-world settings.

Multicentre Double-Blind Placebo-Controlled Food Challenge Study in Children Sensitised to Cashew Nut.

BackgroundFew studies with a limited number of patients have provided indications that cashew-allergic patients may experience severe allergic reactions to minimal amounts of cashew nut. The objectives of this multicentre study were to assess the clinical relevance of cashew nut sensitisation, to study the clinical reaction patterns in double-blind placebo-controlled food challenge tests and to establish the amount of cashew nuts that can elicit an allergic reaction.Methods and FindingsA total of 179 children were included (median age 9.0 years; range 2–17 years) with cashew nut sensitisation and a clinical history of reactions to cashew nuts or unknown exposure. Sensitised children who could tolerate cashew nuts were excluded. The study included three clinical visits and a telephone consultation. During the first visit, the medical history was evaluated, physical examinations were conducted, blood samples were drawn and skin prick tests were performed. The children underwent a double-blind placebo-controlled food challenge test with cashew nut during the second and third visits. The study showed that 137 (76.5%) of the sensitised children suspected of allergy to cashew nut had a positive double-blind placebo-controlled food challenge test, with 46% (63) manifesting subjective symptoms to the lowest dose of 1 mg cashew nut protein and 11% (15) developing objective symptoms to the lowest dose. Children most frequently had gastro-intestinal symptoms, followed by oral allergy and skin symptoms. A total of 36% (49/137) of the children experienced an anaphylactic reaction and 6% (8/137) of the children were treated with epinephrine.ConclusionThis prospective study demonstrated a strikingly high percentage of clinical reactions to cashew nut in this third line population. Severe allergic reactions, including anaphylaxis requiring epinephrine, were observed. These reactions were to minimal amounts of cashew nut, demonstrated the high potency of this allergens.Trial Registrationwww.ncbi.nlm.nih.gov/pubmed NTR3572

MUTZ-3 Langerhans cell maturation and CXCL12 independent migration in reconstructed human gingiva.

Here we describe a reconstructed full thickness human oral mucosa (gingiva) equivalent with integrated Langerhans Cells (GE-LC) and use it to compare LC activation and migration from oral versus skin epithelium. The physiologically representative models consist of differentiated reconstructed epithelium (keratinocytes and Langerhans-like cells derived from the MUTZ-3 cell line) on a fibroblast-populated collagen hydrogel which serves as a lamina propria for gingiva and dermis for skin. Topical exposure of GE-LC and the skin equivalent (SE-LC) to sub-toxic concentrations of the allergens cinnamaldehyde, resorcinol and nickel sulphate, resulted in LC migration out of the epithelia. Neutralizing antibody to CXCL12 blocked allergen-induced LC migration in SE-LC but not in GE-LC. Also, gingival fibroblasts secreted very low amounts of CXCL12 compared to skin fibroblasts even when stimulated with rhTNFα or rhIL-1α. Surprisingly, cinnamaldehyde exposure of GE-LC resulted in an increase in MUTZ-3 LC and CD83 mRNA in the hydrogel but did not result in an increase in CD1a+ cells in the collagen hydrogel (as was observed for SE-LC. These results indicate that in gingiva, upon allergen exposure, MUTZ-3 LC migrate in a CXCL12 independent manner from epithelium-to-lamina propria and in doing so mature become CD1a- and increase CD83+ mRNA. These physiologically relevant in vitro models which not only are human but which also resemble specific tissues, may aid in the identification of factors regulating immune stimulation which in turn will aid the development of therapeutic interventions for allergy and inflammation, anti-cancer vaccines as well as improving diagnostics for skin and oral allergy.

Continuing the quest for autoimmunity due to oral metal exposure

Aim: The role of metal exposure in the development of autoimmune disease (AID) is still controversial. Here, we studied the relationship between oral metal exposure, metal allergy and autoimmunity. Methods: A mixed population (n = 78) of non-allergic volunteers, metal-allergic patients and patients with oral problems putatively due to metal alloys was evaluated for oral Ni, Pd, Au and Hg exposure and skin hypersensitivity. Clinical autoimmune parameters were based on medical histories; additionally, serum levels of the four most common autoantibodies were measured. Results: Skin hypersensitivity, as seen mainly for Ni and/or Pd, was not positively associated with autoimmune parameters. In contrast, metal hypersensitive individuals showed an extremely low frequency of thyroid autoantibodies (3% vs 20% in non-hypersensitive controls). Next, the relation between metal exposure and autoimmunity was evaluated in individuals >35 years (n = 58), since from that age on metal exposure had plateaued and was not correlated with age. In this subgroup, oral Ni exposure was associated (p < 0.01) with self-reported AID, irrespective of autoantibody levels. These unexpected findings warrant further confirmation in a larger test group. Of note, oral Pd, Au or Hg contacts were not associated with any of the clinical or serological autoimmune phenomena tested. Conclusion: The results of this study support the view that development of metal contact allergies may prevent autoimmune activation, and, second, that oral exposure to Pd, Au or Hg does not facilitate the development of AID.

Toxoplasma gondii infection modulate systemic allergic immune response in BALB/c mice

The increased prevalence of allergies in developed countries has been attributed to a reduced exposure to some microbes. In agreement with epidemiological studies, we previously showed that Toxoplasma gondii infection prevents allergic airway inflammation. The mechanisms would be related to the strong Th1 response induced by the parasite and to regulatory cell induction. Herein we further characterized whether T. gondii allergy modulation extents to a systemic level or if it is limited to the lung. Parasite infection before allergic sensitization resulted in a diminished Th2 cytokine response and, when sensitized during acute infection, an increased in TGF-β production was detected. Allergen specific T cell proliferation was also reduced. Sensitization during both acute and chronic phases of infection resulted in a decreased anaphylaxis reaction. Our results extend earlier work and show that, in addition to lung airway inflammation, T. gondii infection can suppress allergic responses at systemic level. These results open the possibility that this protozoan infection could modulate other allergic disorders such as atopic dermatitis or oral allergies. Understanding the mechanisms by which different microorganisms regulate inflammation may potentially lead to the development of strategies aimed to control atopic diseases.

A systematic review of randomised controlled trials, non-randomised controlled trials and observational studies to ascertain the role of pollen-specific immunotherapy in improving clinical outcomes in pollen-food (ORAL ALLERGY) syndrome

Background Pollen Food(Oral allergy) Syndrome (PFS) is a food allergy which is caused by cross-reactivity between inhalant pollen allergens and food allergens, causing mild to severe symptoms upon ingestion of the cross-reacting foods. PFS has a high and increasing prevalence in pollen-allergic patients. The role of pollen-specific immunotherapy in improving clinical outcomes for patients with PFS has not been established. To date, there are no systematic reviews which have been identified in the background research in this field. Aim of the review was to evaluate the evidence and determine whether pollenspecific immunotherapy clinically improves symptoms of PFS in pollen-allergic patients.

Food allergy competencies of dietitians in the United Kingdom, Australia and United States of America.

BackgroundA knowledgeable and competent dietitian is an integral part of the food allergy multidisciplinary team, contributing to effective diagnosis and management of food allergic disorders. Little is currently known about the food allergy training needs and preferences of dietitians. The purpose of this paper is to measure and compare self-reported food allergy competencies of dietitians based in the UK, Australia and USA.MethodsA survey of USA-based paediatric dietitians was developed to measure self-reported proficiency and educational needs in the area of food allergy. The survey was modified slightly and circulated online to paediatric and adult dietitians in the UK and Australia. Descriptive statistics and Pearson correlations are presented.ResultsA total of 797 dietitians completed the questionnaire. Competency in “developing food challenge protocols” and “managing feeding problems” were rated the poorest overall across all three settings. A higher level of competency was significantly positively associated with length of practice as a dietitian, percentage of caseload composed of patients with food allergy and training in food allergy. The most popular topics for further training were food additives, pharmacological reactions and oral allergy syndrome.ConclusionsThere is a need amongst dietitians to increase their knowledge in different aspects of food allergy diagnosis and management, specifically the areas of developing food challenge protocols and management of feeding problems. This study provides valuable information for designing targeted food allergy education for dietitians.Electronic supplementary materialThe online version of this article (doi:10.1186/2045-7022-4-37) contains supplementary material, which is available to authorized users.

Anaphylactic Shock in Oral Allergy

Anaphylactic Shock in Oral Allergy

Oral Food Challenge and Food Allergy Quality of Life in Caregivers of Food Allergic Children

Oral Food Challenge and Food Allergy Quality of Life in Caregivers of Food Allergic Children

Anaphylactic versus Mild Reactions to Hazelnut and Apple in a Birch-Endemic Area: Different Sensitization Profiles?

Background: Hazelnut and apple are common causes of food allergy in Europe. In northern Europe, symptoms are usually mild and associated with cross-reactivity to the birch pollen allergen, Bet v 1. In the Mediterranean area, symptoms are more frequently severe and associated with sensitization to lipid transfer protein (LTP). This study compared patients with anaphylactic versus mild reactions to hazelnut and apple in The Netherlands, a birch-endemic area, with respect to sensitization to Bet v 1-homologues (i.e. PR10-proteins) and LTP. Methods: Twenty-one patients fulfilling the criteria for anaphylaxis and 21 with only mild symptoms (oral allergy) to hazelnut and/or apple were recruited. Specific immunoglobulin E to birch pollen, apple, hazelnut and PR10-proteins (rBet v 1, rPru p 1, rMal d 1 and rCor a 1) and recombinant LTP (rPru p 3 and rCor a 8) was measured by ImmunoCAP. Results: Both mild and anaphylactic apple-allergic patients were sensitized to PR10-proteins, whereas only 1/7 of the mild and none of the anaphylactic apple-allergic patients was sensitized to LTP. In contrast, anaphylactic hazelnut-allergic patients displayed no such clear sensitization pattern: some were sensitized to both PR10-proteins and hazelnut LTP (1/9), and others to only LTP (2/9) or to only PR10-proteins (4/9) or to neither PR10-proteins nor LTP (2/9). Conclusion: This study shows that in a birch-endemic area, the sensitization profile to PR10-proteins and LTP in anaphylactic patients may differ between different plant foods. In this patient group, anaphylaxis to hazelnut can be LTP-associated, whereas anaphylaxis to apple is not.

Assessing Specialists’ Opinion Related to Prescribing Auto-injectable Epinephrine In An Unusual Case of Peanut Sensitivity with Oral Allergy

Assessing Specialists’ Opinion Related to Prescribing Auto-injectable Epinephrine In An Unusual Case of Peanut Sensitivity with Oral Allergy

Bacterial strain‐specific induction of Foxp3+ T regulatory cells is protective in murine allergy models

The incidence of atopic disease has increased dramatically during recent decades and the potential immunoregulatory influence of the microbiota in these individuals is under investigation. The aim of our study was to identify a bacterial strain that is protective in murine allergy models and to determine if microbial induction of T regulatory cells was associated with protection from allergic inflammation. Three microbes (Bifidobacterium breve AH1205, B. longum AH1206 and Lactobacillus salivarius AH102) of human origin were fed to newborn, adult and germ-free animals. Induction of Foxp3(+) T regulatory cells was assessed by flow cytometry. Gene array analysis was performed on Peyer's patches. Strains were also examined for their protective effects in the ovalbumin (OVA) respiratory allergy model and the OVA-cholera toxin dietary allergy model. Bifidobacterium longum AH1206 consumption resulted in increased numbers of Foxp3(+) T regulatory cells in infant, adult and germ-free animals. B. breve AH1205 induced Foxp3(+) T regulatory cell expansion only in infant mice while L. salivarius AH102 did not alter T regulatory cell numbers in any animal model tested. B. longum AH1206 reduced the Peyer's patch gene expression associated with antigen presentation, TLR signalling and cytokine production while increasing the expression of genes associated with retinoic acid metabolism. B. longum AH1206 protected against airway inflammation in OVA-sensitized animals and B. longum AH1206 blocked the induction of IgE to orally administered OVA. Neither B. breve AH1205 nor L. salivarius AH102 had a protective effect in either model. Bacterial strain-specific induction of Foxp3(+) T regulatory cells in vivo is associated with protection from respiratory and oral allergy.

Effect of Lactobacillus rhamnosus GG on rBet v1 and rMal d1 specific IgA in the saliva of patients with birch pollen allergy

Lactobacillus rhamnosus GG (LGG) has demonstrated promising results in the treatment and prevention of atopic eczema. To study the effects of LGG on the oral immune response in adolescents and adults with birch pollen allergy combined with oral allergy syndrome. Patients received either LGG (n = 19) or a placebo (n = 19) for 5.5 months (from February 8 to August 6, 1999), starting 2.5 months before the birch pollen season. An oral apple challenge test was performed before, during, and after the pollen season. Saliva samples were collected before and after the challenges, and serum samples were collected before the challenges. Total IgA, IgG, and IgM and rBet v1 and rMal dl specific IgA, IgG, IgG1, and IgG4 levels were measured from saliva with an enzyme-linked immunosorbent assay (ELISA). Serum rBet v1 specific IgE ELISA and birch radioallergosorbent testing were performed. After 5.5 months, rBet v1 and rMal dl specific IgA levels had increased from baseline in the LGG compared with the placebo group (delta rBet v1 IgA, 0.319 vs. -0.136 relative units; P = .02; delta rMal d1 IgA, 0.097 vs -0.117, P = .02). rBet v1 specific IgE serum levels did not differ between the groups. In the LGG group, rBet v1 specific IgE levels correlated positively with stimulated total IgA (P = .04) and IgG (P = .003) in saliva. In the placebo group, rBet vl specific IgE levels correlated negatively with stimulated rBet v1 and rMal d1 IgA levels (P = .009 for both) and IgG (P = .02 and P = .03, respectively). LGG showed immunostimulating effects on oral mucosa seen as increased allergen specific IgA levels in saliva.

Requirements for Physician Competencies in Allergy: Key Clinical Competencies Appropriate for the Care of Patients With Allergic or Immunologic Diseases: A Position Statement of the World Allergy Organization

Allergic diseases are quite prevalent worldwide, and the incidence of allergy is increasing everywhere [1-7]. Because allergic and immunologic processes overlap all organ systems, allergy is not always taught in medical schools as a separate subject. Indeed, lack of recognition of the specialty and of the need to teach about allergic and immunologic diseases results in allergy not being included at all in some medical school curricula [8]. With an estimated 22% of the global population experiencing allergic and immunologic diseases, it is time to recognize and strengthen education in allergy and immunology [8]. The World Allergy Organization (WAO), an alliance of 74 national and regional allergy societies, created this consensus document to establish educational guidelines for worldwide application to help identify and correct allergy education and training deficiencies and to define appropriate competencies. In creating this consensus, it is recognized that each country has its own principles and goals in medical education at the undergraduate and postgraduate levels. This document defines what WAO considers medical practitioners should know to care appropriately for allergic patients.

Lipid transfer protein–linked hazelnut allergy in children from a non-Mediterranean birch-endemic area

Hazelnut allergy in birch pollen-exposed areas is usually due to cross-reactivity (Cor a 1 and 2) and is usually mild in nature (oral allergy). In areas without birches, severe reactions are more prevalent and linked to sensitization to the lipid transfer protein (LTP) Cor a 8. We sought to investigate whether sensitization to LTP plays a role in more severe (objective) hazelnut-induced symptoms in children from a birch-endemic area. Sensitization to Cor a 8, Cor a 2, Cor a 1, and Bet v 1 was determined by means of RASTs and immunoblotting in hazelnut-sensitized children with (n = 8) and without (n = 18) objective reactions during double-blind, placebo-controlled food challenges. Additionally, samples from 191 hazelnut-sensitized nonchallenged children were analyzed. Children with objective reactions during double-blind, placebo-controlled food challenge had higher IgE titers to hazelnut (P < .001) and recognized more allergens on immunoblotting (P = .001) than those without such reactions. All children with objective symptoms were sensitized to Cor a 8 (0.51-23.3 IU/mL) compared with only 1 child without objective reactions (0.90 IU/mL). In a multivariate analysis only IgE against Cor a 8 remained as an independent risk factor (undefined odds ratio; P < .0001). In the group of nonchallenged children (n = 191), the prevalence of LTP sensitization was greater than 30%. Unexpectedly, sensitization to Cor a 1 was observed in children not sensitized to Bet v 1. Sensitization to hazelnut LTP is a risk factor for objective symptoms in children from a birch-endemic area.