Positive Skin Prick Test Research Articles

Efficacy and Safety of Sesame Oral Immunotherapy—A Real-World, Single-Center Study

The presence of sesame in Western diet is increasing, making its avoidance by sesame-allergic patients more challenging. To report the efficacy and safety of sesame oral immunotherapy (OIT). Sixty patients aged 4 years or older, diagnosed as sesame-allergic on the basis of a positive oral food challenge, were consecutively enrolled into OIT between November 2014 and November 2017. Fifteen patients with sesame allergy, based on a positive oral food challenge or a recent immediate reaction, and a positive skin prick test result or specific IgE, continued sesame elimination and served as observational controls. Immunologic parameters were measured in a subset (OIT, n= 16; controls, n= 11) at the start and end of the study. Fully desensitized patients continued daily consumption of 1200 mg sesame protein and challenged with 4000 mg after more than 6 months. Fifty-three OIT-treated patients (88.4%) were fully desensitized to sesame, compared with 0% of controls. Four additional patients (total 57 of 60= 95%) were desensitized to more than 1000 mg protein. Reactions occurred in 4.7% of hospital doses and 1.9% of home doses. Epinephrine-treated reactions occurred in 16.7% of patients for hospital and 8.3% for home doses. Significant decreases in rSes i 1 IgE (P= .007) and basophil reactivity (P= .001) and increases in sesame and rSes i 1 IgG4 (P= .001) occurred in OIT-treated patients but not in controls. Forty-seven patients desensitized to 4000 mg were evaluated more than 6 months after reaching maintenance. Only mild reactions were reported during maintenance, and all passed the 4000-mg challenge. Sesame-OIT is an effective alternative to sesame avoidance in allergic patients. The potential for adverse events necessitates its performance in specialized centers.

Identification of Der f 23 as a new major allergen of Dermatophagoides farinae

House dust mites (HDM) are common allergen sources worldwide. At present, 32 of the 37 internationally recognized HDM allergen groups have been identified in Dermatophagoides farinae. The present study study describes the identification of the first known D. farinae Group 23 allergen (Der f 23). Recombinant Der f 23 protein (rDer f 23) was cloned, expressed and purified. The open reading frame of rDer f 23 was 525 base pairs and encoded a 174-amino acid protein (GenBank accession no., KU166910.1). ELISAs indicated that 72/129 HDM allergic serum samples (55.8%) had specific immunoglobulin E (sIgE) binding activity to rDer f 23. Additionally, 3/10 patients with HDM allergies (30%) exhibited positive skin prick test reactions to rDer f 23. IgE western blot analysis data suggested that only 4/11 HDM allergic sera had a positive sIgE binding result. Sequence homology analysis revealed an extra P2 region (Ser56-Thr117) in Der f 23 that was not present in the D. pteronyssinus homolog, which may affect sIgE binding. Der f 23ΔP2 demonstrated binding with HDM allergic sera, whereas the P2 peptide alone did not. The sIgE binding ability of Der f 23 ΔP2 (Der f 23 with a truncated P2 region) was more marked compared with that of Der f 23 in an IgE ELISA. These data indicate that P2 region in Der f 23 attenuates IgE binding ability. In conclusion, the results of the present study indicate that Der f 23 is a major HDM allergen with predominantly conformational sIgE binding epitopes. The allergenic identification of Der f 23 and its inclusion in World Health Organization/International Union of Immunological Societies database contributes to the theoretical basis underlying the diagnosis and treatment of HDM allergic diseases.

Identification of immunodominant IgE binding epitopes of Der p 24, a major allergen of Dermatophagoides pteronyssinus

BackgroundThe identification of house dust mite (HDM) allergens and epitopes is important for allergy diagnosis and treatment. We sought to identify the Dermatophagoides pteronyssinus group 24 allergen (Der p 24) and to identify its immunodominant IgE epitope(s).MethodsDer p 24 cDNA was cloned and expressed in a pET expression system. The IgE binding activity of purified recombinant (r)Der p 24 was evaluated by western blotting. Truncated Der p 24 proteins and overlapping synthetic polypeptides were subjected to IgE binding assays. Balb/c mice were immunized to investigate IgE epitope induction of IgE production. IgE binding of the 32 N-terminal residues of Der p 24 was compared to other Der p epitopes in enzyme-linked immunosorbent assays and dot blot assays. Human skin prick tests (SPTs) were performed.ResultsWe cloned and expressed Der p 24 cDNA (GenBank accession no. KP893174.1). HDM allergic sera bound rDer p 24 in vitro and 5/10 HDM allergic patients (50%) had positive SPT reactions to rDer p 24. The immunodominant IgE epitope of Der p 24 was localized to the N-terminal 32-residue region, which produced a high specific IgE antibody titer in vivo and promoted mast cell β-hexosaminidase release. The IgE binding activity this N-terminal epitope of Der p 24 was stronger than that of Der p 1 or Der p 2 IgE epitopes.ConclusionsWe identified Der p 24 as a major HDM allergen with strong IgE binding activity via an immunodominant IgE epitope in the N-terminal 32-residue region, which triggers IgE production in vivo. The identified Der p 24 epitope may support HDM allergy diagnosis and treatment.

Distinctive lung function trajectories from age 10 to 26\u2009years in men and women and associated early life risk factors \u2013 a birth cohort study

Pre-bronchodilator lung function including forced vital capacity (FVC), forced expiratory flow in 1 second (FEV1), their ratio (FEV1/FVC), and forced expiratory flow 25–75% (FEF25–75) measured at age 10, 18, and 26 years in the Isle of Wight birth cohort was analyzed for developmental patterns (trajectories). Early life risk factors before the age of 10 years were assessed for the trajectories.MethodMembers of the birth cohort (1989/90) were followed at age 1, 2, 4, 10, 18, and 26 years. Allergic sensitization and questionnaire data were collected. Spirometry tests were performed and evaluated according to the American Thoracic Society (ATS) criteria at 10, 18, and 26 years. To identify developmental trajectories for FVC, FEV1, FEV1/FVC, and FEF25–75 from 10 to 26 years, a finite mixture model was applied to the longitudinal lung function data, separately for males and females. Associations of early life factors with the respective lung function trajectories were assessed using log-linear and logistic regression analyses.ResultsBoth high and low lung function trajectories were observed in men and women. FVC continued to grow beyond 18 years in men and women, whereas FEV1 peaked at age 18 years in female trajectories and in one male trajectory. For the FEV1/FVC ratios and FEF25–75 most trajectories appeared highest at age 18 and declined thereafter. However, the low FEV1/FVC trajectory in both sexes showed an early decline at 10 years. Lower birth weight was linked with lower lung function trajectories in males and females. Eczema in the first year of life was a risk factor for later lung function deficits in females, whereas the occurrence of asthma at 4 years of age was a risk factor for later lung function deficits in males. A positive skin prick test at age four was a risk for the low FEV1 trajectory in females and for the low FEV1/FVC trajectory in males.ConclusionMen and women showed distinctive lung function trajectories and associated risk factors. Lower lung function trajectories can be explained by not achieving maximally attainable function at age 18 years and by a function decline from 18 to 26 years.

Allergen-specific IgE to recombinant latex allergens in occupational allergy diagnostics.

ObjectivesSpecific challenge tests (SICs) are considered reference tests for allergic occupational diseases diagnosis. However, in numerous cases, SICs cannot be carried out in the diagnosis of allergy to latex due to the risk of generalized reactions. The aim of the study was to evaluate the usefulness of sIgE determination to recombinant latex allergens in diagnostics of occupational respiratory allergy.Materials and MethodsThe study group comprised 44 healthcare workers (HCW) suspected of suffering from occupational respiratory allergy to latex (they underwent a physical examination, skin‐prick tests (SPTs) to common and latex allergens, spirometry and SIC) and 17 controls not occupationally exposed to latex, with a positive sIgE against latex. Each serum was tested for allergen‐specific IgE to aeroallergens, latex, eight recombinant latex allergens and CCD‐markers.ResultsSpecific IgE against Hev b5, 6.01, and 6.02 were significantly more frequently detected in HCWs and their mean serum levels were higher compared with the control group. In 26 HCWs with occupational asthma (OA), sensitization to Hev b5, Hev b6.01, Hev b6.02 was significantly more frequent than in 18 HCWs with work‐exacerbated asthma (WEA); they had positive results SPT to latex significantly more frequently in comparison with subjects with WEA.ConclusionsTest for recombinant latex allergens is much more accurate in recognition of latex allergy than test for latex extract, which seems to produce false‐positive results in patients with pollen allergy. The measurements of sIgE against recombinant latex allergens Hev b 6.01, 6.02, 5, and 8 are useful in differentiating OA from WEA.

Association of molds and metrological parameters to frequency of severe asthma exacerbation

BackgroundSensitization to airborne molds may be a risk factor for severe asthma and direct cause of asthma exacerbation (AE).MethodsA prospective, 1-year (April 2016–March 2017) study, done in Kuwait Allergy Centre, investigated the link between AEs with exposure to outdoor molds and the role of meteorological parameters in mold sensitized patients and compared with non-allergic asthma patients who had asthma deterioration. The total of 676 adult asthmatics with moderate-severe AEs were included and divided into atopic (85.65%) and non-atopic group. Atopy was defined by positive skin prick test (SPT) to at least one inhalant allergen. Data regarding atopy and asthma severity were collected from patient’s records. Patients with symptoms and signs of acute respiratory infection and patient sensitized to indoor allergens only were excluded. Daily count of local pollens (Salsola kali, Bermuda grass) and molds (Aspergillus, Alternaria and Cladosporium) were obtained from the Aerobiology department. Daily metrological parameters (atmospheric pressure-AP, temperature-T and relative humidity-RH) were provided by Kuwait Environment Public Authority. Count of spores/m3 and weather variable are shown on weekly basis. The year circle was divided into 4 Seasons (1, 2, 3, 4) accordingly to typical desert climate.ResultsSensitization to molds was relatively high but significantly less (25.0%) if compared to the pollens sensitization. The highest number of AEs was in season 4 for both molds and pollens sensitized patients. Seasonal patterns for both allergens were significant and positively correlated with RH and AP. In season 1 only, mold sensitized patients showed higher rate of AEs. Non-atopic patients have been less sensitive to increased RH than atopic. Negative correlation with T was similar in both atopic and non-atopic patients.ConclusionDespite of high rate of sensitization to molds, their significant role in triggering AE was not found in desert environment. Typical desert climate and high allergencity of local weeds outweigh the influence of the molds.

The Association between Asthma and Obesity in Children - Inflammatory and Mechanical Factors.

BACKGROUND:Association of asthma and obesity has been demonstrated in numerous epidemiological studies. However, the underlying mechanisms of the association are not well understood. Both conditions are characterised by chronic tissue inflammation, which includes numerous different inflammatory markers, and possible atopy.AIM:The study aimed to investigate the association between asthma and obesity in children and assess several of potential underlying mechanisms, including the parameters of systemic inflammation (CRP, fibrinogen) and the mechanical effect of obesity on the respiratory system through parameters of lung function. An additional aim was to examine the role of atopy in overweight children with asthma and to investigate the type of respiratory inflammation.MATERIAL AND METHODS:This prospective study included 72 patients in the age group of 7-15 years, including 38 with high body mass index (BMI), 16 with asthma and normal BMI, and 18 with asthma and high BMI for sex and age. Non-specific inflammatory markers (fibrinogen, CRP), eosinophilia, and total serum IgE were investigated. The patients underwent a skin prick test (SPT) with standard inhalant allergen extracts, measurement of fractional exhaled nitric oxide Fe (NO), and an assessment of lung function.RESULTS:In overweight groups of children we determined significantly higher values (p < 0.001) of both acute inflammatory reactants, CRP and fibrinogen, with no difference between children with and without asthma. There was a significant increase in eosinophilia, total IgE, and positive SPT in the asthmatic groups compared to the group of non-asthmatic patients (p < 0.001 for the three parameters). Compared to the group composed of overweight patients without asthma, the asthmatic patients had higher NO values (p < 0.001). No significant difference in the lung function parameters was found between the three groups (p > 0.05).CONCLUSION:A positive association between asthma and obesity with inflammation as an underlying mechanism, eosinophilic one in asthmatic patients and non-eosinophilic one in overweight patients, was determined. It seems that the lung function parameters did not differ between asthmatic patients and overweight patients. No influence of atopy in the association between asthma and obesity was verified. Further analyses of specific inflammatory markers, for an in-depth evaluation of the mechanisms leading to the association of obesity and asthma, are warranted.

Prevalence of atopy and allergic rhinitis in patients with adult non-cystic fibrosis bronchiectasis

Background/aimNon-cystic fibrosis bronchiectasis (non-CF BR) is common in developing countries.Limited data are available regarding the impact of atopy, and no data are available regarding allergic rhinitis in patients with adult bronchiectasis.The aim of this study was to evaluate the prevalence of atopy and allergic rhinitis in the clinical conditions of patients with BR.Materials and methodsThe study enrolled 101 patients who were diagnosed with non-CF BR using high-resolution computed chest tomography. Allergic rhinitis (AR) was defined by skin prick test (SPT) positivity and the presence of any nasal symptoms (watery runny nose, nasal obstruction, nasal itching, and sneezing). ResultsThe mean age of patients was 48 ± 15 years (range 18–82); 55 (54.5%) patients were female. SPT positivity was detected in 37 (36.6%) cases. AR was detected in 32 (31.7%) patients with non-CF BR. AR was related to dyspnea (P = 0.04) and number of admissions to an emergency department in the previous year (P = 0.01). Forced expiratory volume in 1 s and forced vital capacity in patients with and without AR were different (P = 0.01 and P = 0.01, respectively). AR was correlated with number of admissions to an emergency department in the last year (r = 0.417, P = 0.005).ConclusionWe concluded that atopy was detected in more than one-third of adult non-CF BR patients. This study demonstrated that non-CF BR patients might have AR; it might be important to be aware of nasal symptoms in non-CF BR patients.

Demographic, Clinical, and Allergic Characteristics of Children with Eosinophilic Esophagitis in Isfahan, Iran

Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease isolated to the esophagus Food allergy is thought to play an important role in the pathophysiology of EOE. The aim of this study is to evaluate demographic features and sensitivity of patients with reference to common food allergens. Children with documented EoE were enlisted for this study. Skin prick test and patch test were done for all participants. Each test contained common food allergens. Other tests, such as evaluation of total IgE and eosinophil count, were also done. A total of 30 patients (the mean age of participants was 3±6 years) with 6 months to 15 years documented EoE participated in this study. The mean duration of symptoms was 2 years. Association with other allergic disorders was seen in 16 (32%) patients [Asthma in 8 (26.7%), allergic rhinitis in 5 (16.7%) and eczema in 3 (10%)]. The mean level of total IgE was 413.5±505.5 (IU/ML): total IgE level was above normal range for age in 17 children. The mean level of eosinophil was 372.2±305.2, and eosinophilia was seen in 11 patients (36.7%). The skin prick test and patch test findings showed that 28 patients (93%) and 17 of 30 patients (56.6%) tested positive to foods respectively. The most common positive skin prick test was for sesame and walnut. Patch test showed that the most common positive test was for fish. Evaluating the symptoms indicated that vomiting (70%) is the most prevalent symptom in patients; the less prevalent symptom was dysphagia (3.3%). Other prevalent symptoms were subsequent abdominal pain (33.3%), gaining weight failure (33.3%), heartburn (16.6%), cough (10%), fecal impaction (10%), and constipation (6.66%). Our series confirms the high degree of atopy in Iranian children with EoE. These patients seem to be polysensitized to several food allergens Because of different eating cultures in different countries, considering special food in selecting allergens for allergic tests is needed.

Sublingual immunotherapy alters salivary IgA and systemic immune mediators in timothy allergic children.

Immunomodulatory effects of sublingual immunotherapy on systemic and mucosal mediators in allergic children are largely unexplored. The aim of this study was to investigate allergy-related cytokine and chemokine levels, as well as IgA-responses upon a 3-year treatment with timothy grass pollen sublingual immunotherapy in children with allergic rhinoconjunctivitis. From children included in the GRAZAX® Asthma Prevention study, blood and saliva samples were analyzed at inclusion, after 3years of treatment, and 2years after treatment ending. By means of Luminex and ELISA methodologies, allergy-related cytokines and chemokines were measured in plasma samples and allergen-stimulated peripheral blood mononuclear cell supernatants. Furthermore, studies of total, secretory, and Phl p 1-specific salivary IgA antibodies were performed using the same methods. GRAZAX® -treated children exhibited significantly higher levels of Phl p 1-specific salivary IgA and serum IgG4 , along with significantly lower skin prick test positivity, after 3years of treatment and 2years after treatment cessation. Additionally, plasma levels of the Th1-associated chemokines CXCL10 and CXCL11 were significantly higher in treated than untreated children at these time points. Timothy-induced ratios of IL-5/IL-13 over IFN-γ were significantly decreased after 3years with active treatment, as were symptoms of allergic rhinitis in terms of both severity and visual analogue scale scores. However, no consistent correlations were found between the clinical outcomes and immunologic parameters. Phleum pratense sublingual immunotherapy in grass pollen allergic children modulates the immune response in the oral mucosa as well as systemically-by increasing Th1-responses, decreasing Th2-responses, and inducing immunoregulatory responses-all signs of tolerance induction.

Sensitization to Cat: When Is Nasal Challenge Needed?

Introduction: Although the skin prick test (SPT) is a reliable diagnostic tool in perennial allergic rhinitis (PER) for patients allergic to cats, the minimum necessary SPT wheal size required to distinguish cat sensitization from true allergy remains controversial. The cat nasal challenge test (cNCT) could be considered the gold standard for detecting true cat allergy. Aims: To assess the difference in the frequency of cNCT positivity between cat owners and non-owners and to determine an appropriate cut-off level for SPT wheal size in detecting positive cNCT in PER patients who are candidates for allergen immunotherapy (AIT) with cat allergen extracts. Subjects and Methods: cNCT in the form of a nasal spray was administered to 60 adult patients with PER, i.e., cat owners (n = 19) and cat non-owners (n = 41) with positive SPT to cat fur allergen (Diater, Spain). Subjective (total nasal symptom score [TNSS]) and objective measurements (peak nasal inspiratory flow [PNIF]) for assessment of nasal patency and nasal eosinophil count [NEo]) were used to assess the nasal response. Peak expiratory flow (PEF) was used as a safety parameter during cNCT. Results: No differences were obtained in SPT wheal size and cNCT positivity between cat owners and non-owners. Positive cNCT detecting true cat allergy could be predicted by a cat SPT wheal size > 6.5 mm with 71.11% sensitivity and 100% specificity. Conclusions: In adult patients with PER, the frequency of cat allergy was similar among cat owners and non-owners. A cat SPT wheal size ≥6.5 mm could be helpful in detecting true cat allergy by avoiding the demanding, time-consuming, and often unavailable cNCT when cat AIT is needed.

Severe anaphylaxis after pelvic examination: a case report of dual latex and chlorhexidine allergies

BackgroundNatural rubber latex and chlorhexidine have previously been identified as causative substances in perioperative anaphylaxis. A pelvic examinations is generally considered noninvasive, however, this procedure is rarely associated with severe allergic reactions. We reported a rare case of dual latex and chlorhexidine allergies which caused anaphylaxis after pelvic examination in a woman with a history of latex-related fruits allergy.Case presentationA 54-year-old woman had severe anaphylaxis after a pelvic examination due to dual latex and chlorhexidine (CHX) allergies. The gynecologist used CHX for the vaginal preparation and wore latex-containing gloves with lubricating gel during the examination. In vivo and in vitro tests revealed CHX sensitization by a positive skin prick test to chlorhexidine at a very low concentration (0.002 mg/mL), and a positive basophil activation test to CHX. Latex allergy was confirmed by a positive specific IgE to latex and a positive glove-use test at 20 min. An analysis of specific IgE to latex component revealed positive results for Hev b 1, 5, 6.02, and 11. As she also had a past history of fruit allergy, prick-to-prick testing with latex-related fruits was performed. The results were positive for avocado, banana, jackfruit, kiwi, and longan.ConclusionsConcomitant mucosal exposure of both natural rubber latex and CHX in highly sensitized patients during pelvic examinations can lead to severe anaphylaxis. Pre-procedural screening for an allergy to latex or CHX, or to any other allergen, should be performed in patients where there is suspicion of a specific allergy due to a previous allergic reaction. Increased awareness of these two allergens in all healthcare settings may improve patient safety.

Walnut oral immunotherapy for desensitisation of walnut and additional tree nut allergies (Nut CRACKER): a single-centre, prospective cohort study

The safety and efficacy of oral immunotherapy for tree nut allergy has not been demonstrated to date, and its effectiveness is complicated by the high prevalence of co-allergies to several nuts. This study aimed to investigate the use of walnut oral immunotherapy in the desensitisation of walnut and additional tree nuts in patients who are co-allergic to several nuts. In a single-centre, prospective cohort study (the Nut Co-Reactivity ACquiring Knowledge for Elimination Recommendations study) at the Institute of Allergy, Immunology, and Paediatric Pulmonology at the Yitzhak Shamir Medical Centre, we recruited patients aged 4 years or older who were allergic to walnut, with or without co-allergy to pecan, hazelnut, and cashew. The diagnosis of each food allergy was based on a positive skin prick test or specific serum IgE (≥0·35 kUA/L) to the corresponding nut together with a positive oral food challenge, unless an immediate (within 2 h of exposure) reaction in the past year had been documented. Patients with uncontrolled asthma or a medical contraindication to receive adrenaline were excluded. Patients were assigned to walnut oral immunotherapy or the control group (observation and strict dietary exclusion) on the basis of the order of presentation to the clinic. Oral immunotherapy began with a 4-day dose-escalation phase to establish the single highest tolerated dose, which was consumed daily at home for 24 days; subsequent monthly dose escalations were repeated until 4000 mg walnut protein was achieved. Patients who were desensitised to walnut continued to consume 1200 mg walnut protein daily for 6 months as maintenance. The primary outcome was walnut desensitisation (passing an oral food challenge with 4000 mg of walnut protein) at the end of the study, analysed by intention to treat. In patients who were co-allergic to pecan, hazelnut, and cashew, the proportion who achieved cross-desensitisation to these nuts in addition to walnut desensitisation was examined. 73 patients with a walnut allergy were enrolled between May 15, 2016, and Jan 14, 2018. 49 (89%) of 55 patients in the oral immunotherapy group were desensitised to walnut compared with none of 18 patients in the control group (odds ratio 9·2, 95% CI 4·3-19·5; p<0·0001). Following walnut desensitisation, all patients who were co-allergic to pecan (n=46) were also desensitised to pecan. Additionally, 18 (60%) of 30 patients who were co-allergic to hazelnut or cashew, and 14 (93%) of 15 patients who were co-allergic to hazelnut alone, were either fully desensitised or responded to treatment. 47 (85%) of 55 patients had an adverse reaction (mostly grade 1 or 2) during up-dosing in the clinic; eight patients required intramuscular epinephrine in response to a dose at home. Of 45 patients who had follow-up data for the maintenance phase, all maintained walnut desensitisation and one patient required epinephrine during this period. Walnut oral immunotherapy can induce desensitisation to walnut as well as cross-desensitisation to pecan and hazelnut in patients who have tree nut co-allergies, with a reasonable safety profile. A low daily dose of the allergen maintains desensitisation. None.

The efficacy of allergen-immunotherapy in patients with pollen allergy in the Central and Western regions of Ukraine considering the specifics of their sensitization

Various sorts of weed plants with allergenic properties are extended on the territory of Ukraine. Weed’s distribution has regional characteristics. Clinically significant weed allergens are found in pollen from wormwood, ragweed, quinoa, plantain, and thistle. The main treatment for hay fever is allergen immunotherapy. The modern development of molecular diagnostics makes it possible to clearly identify the main allergen of weed pollen and, on this basis, offer the patient a personalized choice of allergen immunotherapy with the possibility of predicting its effectiveness. In order to determine the characteristics of sensitization to weeds in patients of the Central and Western regions of Ukraine and to evaluate the effectiveness of sublingual allergen immunotherapy (SLIT), 1.400 patients from 3 to 65 years of age were examined in these regions. Patients were evaluated general laboratory and instrumental studies, skin prick-tests (SPT), level total serum and specific IgE and component studies. A two-year course of immunotherapy was performed using sublingual allergens of wormwood and ragweed. Evaluation of the effectiveness of SLIT was performed using a visual analogue scale (VAS). According to the results of the study, positive SPT for mugwort was detected 1.2 times more often among patients in the western regions compared with the central regions. Regarding sensitization to ragweed, on the contrary, it was 3.2 times more often observed in patients of the central region. Component diagnostic data confirmed the results of SPT. Patients taking SLIT showed significantly lower VAS (P &lt; 0.05) compared with patients receiving symptomatic therapy. The regional characteristics of sensitization to various types of weeds were found. Latent sensitization to ragweed is increasingly found in patients in the western regions of Ukraine. Use in patients with AR and/or BA SLIT with standardized allergens is an effective and safe treatment method that allows you to quickly control symptoms.&#x0D;

25-hydroxy Vitamin D Levels in Pediatric Asthma Patients and its Link with Asthma Severity.

AimAlthough the relationship between 25-hydroxy (25-OH) vitamin D and asthma is known, it is unknown if 25-OH vitamin D levels are correlated with asthma severity in pediatric patients. The aim of this study was to compare the blood 25-OH vitamin D levels of asthma patients and healthy control groups and to evaluate any correlation between asthma severity and blood 25-OH vitamin D levels in pediatric asthma patients.MethodsThis is a cross-sectional study which shows the 25-OH vitamin D levels of asthma patients and compared to healthy controls followed by a tertiary pediatric clinic. We investigated the effect of 25-OH vitamin D levels on the severity of asthma. The severity of asthma was determined mainly by the duration of asthma diagnosis, a number of attacks in the previous year, anti-inflammatory medication usage in a previous year, atopy presence in the family, skin prick test positivity, and immunoglobulin E (IgE) levels of asthma patients.ResultsCompared with control groups, asthma patients had significantly lower 25-OH vitamin D, calcium (Ca) levels, and higher number of patients who had a 25-OH vitamin D deficiency, (p<0.0001, p<0.0001, p<0.0001, respectively). We found a correlation between blood 25-OH vitamin D levels and force expiratory capacity in one second (FEV1) and forced vital capacity (FVC) respectively (p< 0.001, r=0.512), (p< 0.001, r=0.513). There was an association between FEV1, FVC and blood 25-OH vitamin D levels in terms of deficient levels (<20 ng/mL) or insufficient levels (≥20 and <30 ng/mL) (p<0.001, r=0.459), (p< 0.001, r=0.450), respectively.ConclusionsThe 25-OH vitamin D levels were lower in pediatric asthma patients with worse spirometry results. Effects of Vitamin D supplementation need to be evaluated by well-designed studies.

Lipid Transfer Protein allergy in the United Kingdom: Characterization and comparison with a matched Italian cohort.

BackgroundAlthough pollen‐related food allergy occurs in all European populations, lipid transfer protein (LTP) allergy is considered to manifest mainly in Mediterranean countries. We aimed to characterize adults presenting with LTP allergy in a northern European country.MethodThe clinical history and sensitization patterns of subjects born and residing in the United Kingdom (UK), with a prior diagnosis of LTP allergy and sensitization to the peach LTP allergen Pru p 3, were compared to UK subjects with pollen food syndrome (PFS). The sensitization patterns were also evaluated against a matched cohort of Italian subjects diagnosed with LTP allergy.ResultsNone of the 15 UK PFS subjects had a positive SPT to LTP‐enriched peach reagent, compared to 91% of the 35 UK LTP subjects. The UK LTP cohort were also more likely to have positive skin prick tests to cabbage, lettuce and mustard and sensitization to the LTP allergens in peach, walnut, mugwort and plane tree These sensitization patterns to individual allergens were not significantly different to those obtained from the Italian LTP subjects, with significant correlations between Pru p 3 and the LTP allergens in peanuts, walnuts, plane tree and mugwort in both groups.ConclusionNative UK subjects with LTP allergy are not dissimilar to those with LTP allergy in southern Europe. Testing to LTP‐enriched peach SPT reagent and/or LTP allergens in peach, walnut, mugwort and plane tree may enhance diagnostic accuracy.

Clinical and immunological differences between asymptomatic HDM-sensitized and HDM-allergic rhinitis patients.

Confirmation of the clinical relevance of sensitisation is important for the diagnosis of allergic rhinitis. To investigate the usefulness of an in vitro basophil activation test and component-resolved diagnosis in distinguishing between symptomatic allergic rhinitis patients and asymptomatic sensitization to house dust mites (HDMs). Thirty-six subjects with a positive skin prick test (SPT) for HDM were divided into a symptomatic (n=17) and an asymptomatic (n=19) group on the basis of their clinical history and a nasal provocation test. A basophil CD63 response to in vitro stimulation with Dermatophagoidespteronyssinus whole allergen extract and the IgE reactivity profiles for Der p 1, 2, 4, 5, 7, 10, 11, 14, 15, 18, 21, 23 were evaluated. Serum IgE and IgG specific to Dpteronyssinus whole allergen extract and total IgE were measured. There were no statistically significant differences in the levels of IgE (IgE levels were higher in symptomatic patients with P=0.055) and IgG specific to Dpteronyssinus and total IgE. Symptomatic patients showed a lower threshold for in vitro basophil activation (3.33ng/mL vs 33.3ng/mL), a higher area under the curve (AUC) of basophil activation (171 vs 127) (P=0.017), a higher response to positive control with anti-FcεRI stimulation (97% vs 79%) (P<0.001), a recognition of more HDM allergens (4 vs 2) and more frequent sensitization to rDer p 7 (P=0.016) and rDer p 23 compared to asymptomatic subjects (P=0.018). There was a positive correlation (r=0.63; P<0.001) between the number of recognized allergens and the AUC of basophil activation. In the subjects studied, the differences in the basophil response to Dpteronyssinus allergen extract, number of recognized HDM allergens and reactivity to rDer p 7 and rDer p 23 distinguish symptomatic from asymptomatic HDM sensitisation better than SPT or allergen extract-specific IgE. Information regarding the clinical relevance of sensitization is important for the prescription of allergen-specific immunotherapy.

Allergic Bronchopulmonary Mycosis due to fungi other than Aspergillus.

Allergic bronchopulmonary mycosis (ABPM) is a clinical syndrome associated with immune sensitivity to various fungi that colonize the airways. Early diagnosis and treatment with systemic corticosteroids is the key in preventing the progression of the disease to irreversible lung fibrosis. Although Aspergillus has progressively gained recognition as a causative agent in past few decades, other fungi, that have been reported to cause ABPM, are not yet widely evaluated. We studied hundred and two patients with asthma for occurrence of ABPM. Patients were tested for cutaneous hypersensitivity and serum precipitin to 12 common fungal antigens. The positive cases were further evaluated for ABPM using standard criteria. Out of 102 asthma patients screened, 18 patients had either skin prick test (SPT) and/or serum precipitin positive. While 14 patients were SPT positive for one or more fungal antigen, two patients were serum precipitin positive for one or more fungi. Two patients had both serum precipitin positive as well as SPT positive. Six (5.8%) patients were diagnosed as ABPM as they fulfilled the criteria. Three of these were because of Aspergillus sp. Two were because of fungi other than Aspergillus namely Schizophyllum and Curvularia. One patient had ABPM because of both Aspergillus and Curvularia. In our study absolute eosinophil count (AEC), total IgE, serum precipitin and SPT had sensitivity of 100%, 100% 50% and 83.3% respectively for diagnosing ABPM. The specificity of these tests was 44.79%, 64.58% 98.96% and 88.54% respectively. Specfic IgE was positive in 50% of patients with either serum precipitin or SPT positivity. SPT or serum precipitin followed by specific IgE had sensitivity of 100% and specificity of 96.88% for diagnosing ABPM. SPT alone followed by Specific IgE had a sensitivity of 83.33% and specificity of 96.88% for diagnosing ABPM. We found that fungi other than Aspergillus such as schizophyllum, and curvularia, can be implicated in ABPM. Multiple fungal agents may be responsible for ABPM in an individual. There is a subset of patients of BA who have fungal sensitization but do not fulfil the criteria for ABPM. SPT was the single most sensitive and specific test, AEC >350 and total IgE more than 417IU were most sensitive tests and SPT followed by specific IgE was most effective strategy for diagnosing ABPM.

Deciphering the Walnut-Pecan Allergy Paradigm Using Component Resolved Diagnostics

Current diagnostic methods for diagnosing walnut and pecan allergy are limited. The utility of walnut components to improve walnut and pecan allergy diagnosis was examined. Fifty-one patients with suspected walnut or pecan allergy were evaluated. Allergy to each nut was diagnosed based on a positive skin prick test together with a history of recent reaction or a positive oral food challenge. Analysis of sIgE to pecan and to walnut and its components (Jug r 1, Jug r 3, Jug r 4, and vicilins (natural processing products of Jug r 2 and Jug r 6)) was performed. Of the 51 patients studied, 36 (70.6%) were walnut-allergic and 28 (54.9%) had pecan allergy. All pecan-allergic patients had walnut allergy. Positive sIgE (≥0.35 kUA/L) to walnut was highly sensitive (0.92) but not specific (0.47) for diagnosing walnut allergy. Jug r 1 maintained high sensitivity (0.81) with improved specificity (0.8) while Jug r 3, Jug r 4 and the vicilins were significantly less sensitive (0.14-0.61) with moderate specificity (0.67-0.8). Combined Jug r 1 and Jug r 4 was optimal for diagnosing walnut allergy in our population, achieving a sensitivity of 0.94 and a specificity of 0.73. For differentiating walnut only from walnut-pecan dual allergic patients, Jug r 1 demonstrated a poor specificity (0.25), while Jug r 4 and the vicilins were more specific (0.75). sIgE to Jug r 1 improves the diagnosis of walnut allergy, whereas Jug r 4 and the vicilins may help to distinguish pecan-allergic patients from those with walnut allergy alone.

Disguised Dairy: Anaphylaxis to “Hidden” Allergens in Routine Vaccinations in Child with Severe Cow's Milk Allergy

IgE-mediated cow’s milk allergy (CMA) affects 2-3% of children under the age of 3. Allergic reactions to vaccines have been documented in egg allergic patients, however sparsely reported in the CMA population. A 5-year-old male with severe IgE-mediated CMA was evaluated for anaphylaxis following two routine vaccinations. The patient received Adacel-Polio (TDaP-IPV) and Priorix-Tetra (MMR-V) as per immunization schedule. Within minutes of being immunized, the patient developed itchy eyes, sneezing, and facial swelling. The patient was treated and recovered. Allergen investigation in vaccines identified casamino acids and lactose in the Adacel-Polio and Priorix-Tetra, respectively. Skin prick testing (SPT) to common allergens followed by SPT to full strength and intradermal testing (IDT) to 1/100 concentrations of Adacel-Polio and Priorix-Tetra vaccination were carried out. Milk protein was positive (15 mm). Very high levels of sIgE to total cow’s milk (>100 kU/L) and casein (79.80 kU/L) were found. Positive SPTs were identified to Adacel-Polio (7 mm) and Priorix-Tetra (5 mm). IDT were positive to Adacel-Polio (10 mm flare) and Priorix-Tetra (15 mm flare). Immunological assays (ELISA) for presence of cow’s milk protein in both vaccinations are pending. TDaP-IPV and MMR-V vaccinations are generally well tolerated in children with food allergies. However, both vaccines have derivatives of cow’s milk protein that may pose as an allergenic source in certain children with severe CMA. It is important to educate physicians of potential reactions as neither vaccine’s product monograph identifies any risk of allergic reaction in this population.