Allergy Reactions Research Articles

An interdisciplinary student-led multifaceted intervention addressing overuse of broad-spectrum antibiotics for patients with penicillin allergies

BackgroundThough 15% of hospitalized patients have a documented penicillin (PCN) allergy, fewer than 1% have an IgE-mediated reaction that necessitates avoidance of β-lactam antibiotics.ObjectiveOur interdisciplinary team of medical and nursing students led and executed a two-pronged quality improvement intervention to reduce prescribing of non-β-lactam antibiotics (NBLs) for patients with reported PCN allergies. To the best of our knowledge, this is the first multidisciplinary student-led intervention aimed at educating providers on low-risk penicillin allergy and encouraging best antibiotic prescribing practices.Design and participantsThe intervention took place from June 2021 to February 2022. We developed and provided clinician education modules, including peer-to-peer information sharing and in-person small group discussions, as well as clinical decision support (CDS) strategies through the electronic medical record (EMR). The target population was attendings, residents, nurse practitioners, and physician assistants on the hospital medicine service at a large urban academic tertiary care center. We followed the SQUIRE 2.0 guidelines for reporting on quality improvement.Main measuresPrimary outcome measures included number of NBL prescriptions and use of nonspecific descriptors (e.g., “other” or “unknown”) for PCN allergy reaction type, and were compared with a pre-intervention period.Key resultsThe percent of β-lactam prescriptions for patients with a PCN allergy after the intervention increased from 19 to 23% (p = 0.006). For patients with a low severity PCN allergy, the percent of β-lactam prescriptions increased from 20 to 28% (p = 0.001). There was a significant decrease in nonspecific PCN allergy reaction type from 23% in the pre-intervention period to 20% post-intervention (p = 0.012).ConclusionsAn intervention focused on educating prescribers and CDS strategies delivered through the EMR increased appropriate β-lactam prescribing for patients with a documented low-risk PCN allergy and reduced the use of nonspecific PCN allergy reaction type in EMR documentation.

Safety evaluation of the food enzyme endo-polygalacturonase from the genetically modified Aspergillus niger strain EPG.

The food enzyme endo-polygalacturonase ((1-4)-α-d-galacturonan glycanohydrolase; EC 3.2.1.15) is produced with the genetically modified Aspergillus niger strain EPG by DSM Food Specialties B.V. The genetic modifications do not give rise to safety concerns. The food enzyme is free from viable cells of the production organism and its DNA. It is intended to be used in fruit and vegetable processing for juice production. The dietary exposure to the food enzyme-total organic solids (TOS) was estimated to be up to 0.122mg TOS/kg body weight (bw) per day in European populations. Genotoxicity tests did not indicate a safety concern. The systemic toxicity was assessed by means of a repeated dose 90-day oral toxicity study in rats. The Panelidentified a no observed adverse effect level of 1,014mg TOS/kg bw per day, the highest dose tested, which, when compared with the estimated dietary exposure, resulted in a margin of exposure at least 8,311. A search for the similarity of the amino acid sequence of the food enzyme to known allergens was made and 38 matches were found, two of which are food allergens. The Panelconsidered that, under the intended conditions of use, the risk of allergic reactions upon dietary exposure to this food enzyme cannot be excluded, in particular for individuals sensitised to papaya or maize, but that the risk will not exceed that of consumption of papaya or maize. In addition, oral allergy reactions cannot be excluded in pollen-sensitised individuals. Based on the data provided, the Panelconcluded that this food enzyme does not give rise to safety concerns, under the intended conditions of use.

Allergenicity and Bioavailability of Nickel Nanoparticles Compared to Nickel Microparticles in Mice

Metal allergy is a common disease that afflicts many people. Nevertheless, the mechanism underlying metal allergy development has not been completely elucidated. Metal nanoparticles might be involved in the development of a metal allergy, but the associated details are unknown. In this study, we evaluated the pharmacokinetics and allergenicity of nickel nanoparticles (Ni-NPs) compared with those of nickel microparticles (Ni-MPs) and nickel ions. After characterizing each particle, the particles were suspended in phosphate-buffered saline and sonicated to prepare a dispersion. We assumed the presence of nickel ions for each particle dispersion and positive control and orally administered nickel chloride to BALB/c mice repeatedly for 28 days. Results showed that compared with those in the Ni-MP administration group (MP group), the Ni-NP administration group (NP group) showed intestinal epithelial tissue damage, elevated serum interleukin (IL)-17 and IL-1β levels, and higher nickel accumulation in the liver and kidney. Additionally, transmission electron microscopy confirmed the accumulation of Ni-NPs in the livers of both the NP and nickel ion administration groups. Furthermore, we intraperitoneally administered a mixed solution of each particle dispersion and lipopolysaccharide to mice and then intradermally administered nickel chloride solution to the auricle after 7 days. Swelling of the auricle was observed in both the NP and MP groups, and an allergic reaction to nickel was induced. Particularly in the NP group, significant lymphocytic infiltration into the auricular tissue was observed, and serum IL-6 and IL-17 levels were increased. The results of this study showed that in mice, Ni-NP accumulation in each tissue was increased after oral administration and toxicity was enhanced, as compared to those with Ni-MPs. Orally administered nickel ions transformed into nanoparticles with a crystalline structure and accumulated in tissues. Furthermore, Ni-NPs and Ni-MPs induced sensitization and nickel allergy reactions in the same manner as that with nickel ions, but Ni-NPs induced stronger sensitization. Additionally, the involvement of Th17 cells was suspected in Ni-NP-induced toxicity and allergic reactions. In conclusion, oral exposure to Ni-NPs results in more serious biotoxicity and accumulation in tissues than Ni-MPs, suggesting that the probability of developing an allergy might increase.

Pediatric Eosinophilia: A Review and Multiyear Investigation into Etiologies.

To identify the etiology of peripheral eosinophilia in a large pediatric population and to develop a diagnostic algorithm to help guide diagnosis and management of peripheral eosinophilia in the outpatient pediatric population. We performed a retrospective chart review of children presenting to Texas Children's Hospital in Houston with peripheral eosinophilia between January 1, 2011 and December 31, 2019. Eosinophilia was classified as mild (absolute eosinophil count [AEC] >500 and<1500cells/μL), moderate (AEC >1500 and<4500cells/μL), or severe (AEC >4500cells/μL). Demographic information and diagnostic workup data were collected. A total of 771 patients aged <18years were evaluated. The most common cause of eosinophilia was allergy (n=357; 46%), with atopy (n=296) and drug reaction (n=54) the most common subcauses. This was followed by unknown etiology (n=274; 36%), infectious causes (n=72; 9%), and eosinophilic disorders (n=47; 6%). Many patients with an unknown cause (n=202; 74%) had limited or no follow-up testing. More information on the etiology of pediatric eosinophilia and workup data could help identify the causes. This study provides important information on the evaluation of eosinophilia in the US pediatric population, including a diagnostic algorithm to guide primary care pediatricians.

Investigation of Tryptase Gene Composition as a Potential Biomarker of Food Allergy Reaction Severity

Increased TPSAB1 copy number encoding ⍺-tryptase is associated with severe reactions in adults with Hymenoptera venom allergy, systemic mastocytosis, and idiopathic anaphylaxis. Tryptase gene composition as a potential biomarker for food allergy severity has not been studied. We hypothesized that increased relative TPSAB1 copy number encoding ⍺-tryptase would be enriched in children with severe reactions to peanut.

Investigating Food Allergy Reactions and Overall Impact on College Campuses

Investigating Food Allergy Reactions and Overall Impact on College Campuses

Abstract 2646: The effect of Chinese Traditional Medicine Herbal Decoction Tea on respiratory allergy profile region XVII and possibility of affecting the liver as seen in respiratory allergy (IgE) reaction as well as in the Aspartate Aminotransferase (AST) and Alanine

Abstract 2646: The effect of Chinese Traditional Medicine Herbal Decoction Tea on respiratory allergy profile region XVII and possibility of affecting the liver as seen in respiratory allergy (IgE) reaction as well as in the Aspartate Aminotransferase (AST) and Alanine

High-stable perovskite nanocrystal fluorescent probe-based aptasensor for ultrasensitive detection of peanut allergen Ara h1

Food allergy is a serious immune allergy reaction, that has attracted public attention all over the world due to the increasing incidence. Ara h1, the most abundant allergenic protein in peanuts, has been identified as a biomarker of peanut allergen. Therefore, a sensitive, efficient method for Ara h1 detection is urgently needed to protect allergy sufferers. In this study, a simple and efficient fluorescent aptasensor was proposed for ultrasensitive and rapid detection of peanut allergen Ara h1. The aptamer against Ara h1 was conjugated onto the surface of high-stable perovskite nanocrystal (PNCs) to serve as the fluorescence-labeled recognition probe as well as the signal probe, while the magnetic nanoparticles Fe3O4 (MNPs) were functionalized with the aptamer complementary DNA (cDNA) as the separation probe. The high-stable PNCs-labeled aptasensor Apt-PNCs@cDNA-MNPs gives the combined merits of the extraordinary optical properties of PNCs, the efficient magnetic separation capability of MNPs as well as the high specificity of aptamers. The developed high-stable PNCs-labeled aptasensor exhibited excellent linearity (0.1–100 ng/mL), and low limit of detection (0.04 ng/mL). The aptasensor was successfully applied for the determination of Ara h1 in food samples, implying great potential in the field of allergen assay.

Dynamic reaction picklist for improving allergy reaction documentation: A usability study

ObjectiveTo assess novel dynamic reaction picklists for improving allergy reaction documentation compared to a static reaction picklist. Materials and methodsWe developed three web-based user interfaces (UIs) mimicking the Mass General Brigham’s EHR allergy module: the first and second UIs (i.e., UI-1D, UI-2D) implemented two dynamic reaction picklists with different ranking algorithms and the third UI (UI-3S) implemented a static reaction picklist like the one used in the current EHR. We recruited 18 clinicians to perform allergy entry for 10 test cases each via UI-1D and UI-3S, and another 18 clinicians via UI-2D and UI-3S. Primary measures were the number of free-text entries and time to complete the allergy entry. Clinicians were also interviewed using 30 questions before and after the data entry. Results and discussionsAmong 36 clinicians, less than half were satisfied with the current EHR reaction picklists, due to their incomprehensiveness, inefficiency, and lack of intuitiveness. The clinicians used significantly fewer free-text entries when using UI-1D or UI-2D compared to UI-3S (p < 0.05). The clinicians used on average 51 s (15 %) less time via UI-1D and 50 s (16 %) less time via UI-2D in completing the allergy entries versus UI-3S, and there was not a statistically significant difference in documentation time for either group between the dynamic and static UIs. Overall, 15–17 (83–94 %) clinicians rated UI-1D and 13–15 (72–83 %) clinicians rated UI-2D as efficient, easy to use, and useful, while less than half rated the same for UI-3S. Most clinicians reported that the dynamic reaction picklists always or often suggested appropriate reactions (n = 30, 83 %) and would decrease the free-text entries (n = 26, 72 %); nearly all preferred the dynamic picklist over the static picklist (n = 32, 89 %). ConclusionWe found that dynamic reaction picklists significantly reduced the number of free-text entries and could reduce the time for allergy documentation by 15%. Clinicians preferred the dynamic reaction picklist over the static picklist.

What's New in Adult Reconstructive Knee Surgery.

What's New in Adult Reconstructive Knee Surgery.

Correlation between adiponectin level and obesity as a risk factor for allergy disease

Much research has focused on the connection between two inflammatory conditions, allergic reactions and obesity which has led to a focus on adiponectin, hormone with anti-inflammatory properties secreted by adipose tissue. The aim of this study was to determine the association of adiponectin with obesity, as a risk factor for the development of allergic condition in order to rationalize approach to its treatment. Research methods for inflammatory markers and biochemical parameters involve immunoassay technique. Statistical analysis was performed with Student’s t-test, Wilcoxon T-test and coefficient of correlation. The study included apparently healthy subjects and patients with allergy conditions with confirmed presence of specific IgE, classified into 2 groups according to their body mass index (BMI). The obtained data showed negative correlation (cor = – 0.6), between adiponectin levels and BMI values. Thus, decreased level of adiponectin is associated with increased BMI. The mean values of adiponectin in the studied population, with high statistical differen­ces between the groups (19.1 ± 1.5; 17.7 ± 0.9), (18.8± 1.1; 16.6 ± 1.0) demonstrated the relationship between low adiponectin level and development of obesity, and what, in turn, increasd risk of developing allergic conditions. The assumption was made that adiponectin may be used as a sensitive biochemical marker for early diagnostics of allergic reactions. Keywords: adiponectin, allergy reactions, obesity, specific IgE

The Activity of Strawberry Extract as Sunscreen on Guinea Pigs Exposed to Sunlight

Sunscreen that is often used contains synthetic compounds causing undesirable effects such as irritation, allergy, and anaphylactic reactions. One of the natural ingredients with this potential is strawberry. Therefore, this experimental study aims to determine the activity of strawberry extract as a sunscreen on guinea pig skin exposed to sunlight. The 24 guinea pigs used were divided into 4 groups and terminated on day 14, while the changes in the amount of melanin pigment were examined after the treatment. The results showed that the melanin in the skin tissue was reduced after the application of the extract. This indicated that there is a significant effect on the amount of melanin pigment of guinea pig skin tissue exposed to sunlight with F count (741.787) < F-table (4.27) and sig-p = 0.000 < 0.05. Moreover, the decrease in the amount of melanin pigment was higher in group C compared to group D.

Consumption of Nuts and Seeds and Health Outcomes Including Cardiovascular Disease, Diabetes and Metabolic Disease, Cancer, and Mortality: An Umbrella Review.

Consumption of nuts and seeds is associated with a range of health outcomes. Summarizing the best evidence on essential health outcomes from the consumption of nuts is essential to provide optimal recommendations. Our objective is to comprehensively assess health outcome associations related to the consumption of nuts and seeds, using a culinary definition including tree nuts and peanuts (registered in PROSPERO: CRD42021258300). Health outcomes of interest include cardiovascular disease, cancer, diabetes, obesity, respiratory disease, mortality, and their disease biomarkers. We present associations for high compared with low consumption, per serving, and dose-response relations. MEDLINE, Embase, Cochrane, and Epistemonikos were searched and screened for systematic reviews and meta-analyses. Evidence was extracted from 89 articles on the consumption of nuts and relevant health outcomes, including 23 articles with meta-analysis on disease and mortality, 66 articles on biomarkers for disease, and 9 articles on allergy/adverse outcomes. Intake of nuts was associated with reduced risk of cardiovascular diseases and related risk factors, with moderate quality of evidence. An intake of 28 g/d nuts compared with not eating nuts was associated with a 21% RR reduction of cardiovascular disease (including coronary heart disease incidence and mortality, atrial fibrillation, and stroke mortality), an 11% risk reduction of cancer deaths, and 22% reduction in all-cause mortality. Nut consumption was also inversely associated with mortality from respiratory diseases, infectious diseases, and diabetes; however, associations between nut consumption and diabetes incidence were mixed. Meta-analyses of trials on biomarkers for disease generally mirrored meta-analyses from observational studies on cardiovascular disease, cancers, and diabetes. Allergy and related adverse reactions to nuts were observed in 1-2% of adult populations, with substantial heterogeneity between studies. Overall, the current evidence supports dietary recommendations to consume a handful of nuts and seeds per day for people without allergies to these foods.

ProAll-D: protein allergen detection using long short term memory - a deep learning approach.

BackgroundAn allergic reaction is the immune system's overreacting to a previously encountered, typically benign molecule, frequently a protein. Allergy reactions can result in rashes, itching, mucous membrane swelling, asthma, coughing, and other bizarre symptoms. To anticipate allergies, a wide range of principles and methods have been applied in bioinformatics. The sequence similarity approach's positive predictive value is very low and ineffective for methods based on FAO/WHO criteria, making it difficult to predict possible allergens.MethodThis work advocated the use of a deep learning model LSTM (Long Short-Term Memory) to overcome the limitations of traditional approaches and machine learning lower performance models in predicting the allergenicity of dietary proteins. A total of 2,427 allergens and 2,427 non-allergens, from a variety of sources, including the Central Science Laboratory and the NCBI are used. The data was divided 80:20 for training and testing purposes. These techniques have all been implemented in Python. To describe the protein sequences of allergens and non-allergens, five E-descriptors were used. E1 (hydrophilic character of peptides), E2 (length), E3(propensity to form helices), E4(abundance and dispersion), and E5 (propensity of beta strands) are used to make the variable-length protein sequence to uniform length using ACC transformation. A total of eight machine learning techniques have been taken into consideration.ResultsThe Gaussian Naive Bayes as accuracy of 64.14 %, Radius Neighbour's Classifier with 49.2 %, Bagging Classifier was 85.8 %, ADA Boost was 76.9 %, Linear Discriminant Analysis has 76.13 %, Quadratic Discriminant Analysis was 84.2 %, Extra Tree Classifier was 90%, and LSTM is 91.5 %.ConclusionAs the LSTM, has an AUC value of 91.5 % is regarded best in predicting allergens. A web server called ProAll-D has been created that successfully identifies novel allergens using the LSTM approach. Users can use the link https://doi.org/10.17632/tjmt97xpjf.1 to access the ProAll-D server and data.

Evaluation of Anterior Lumbar Interbody Fusion Performed Using a Stand-Alone, Integrated Fusion Cage.

Anterior lumbar interbody fusion (ALIF) has been performed for many years. Often, posterior supplemental fixation has been used to provide additional stability to the operated segment. Interbody implants have evolved to incorporate unique designs, polyetheretherketone, integrated screws, and surface texture. With these changes, the need for supplemental posterior fixation has been debated. The purpose of this study was to evaluate the clinical outcome of stand-alone ALIF. A surgery log was reviewed to identify the consecutive series of 58 patients undergoing ALIF using a STALIF stand-alone cage from March 2011 (first case) to December 2018 (minimum 24 months postoperative) with a mean follow-up of 30.6 months. All patients were treated for symptomatic degenerative conditions. Charts were reviewed to collect general patient information, operative data, and patient-reported outcomes, including the Oswestry Disability Index (ODI), visual analog scales (VAS) separately assessing back pain and leg pain, and re-operations. For patients who were not seen recently in clinic for follow-up, current outcome data were collected through mailings. The mean operative blood loss was 52.1 mL. There was a statistically significant improvement in mean ODI scores from 41.7 preoperatively to 21.0 at follow-up (P < 0.01). There was also significant improvement (P < 0.01) in VAS back pain (6.0-2.5) and leg pain (4.1-1.3). Subsequent surgery was performed on 9 patients. Reasons for re-operation were pseudoarthrosis (n = 3), progressive cage subsidence (n = 1), foraminal stenosis at the index level (n = 1), metal allergy reaction (n = 2), adjacent segment degeneration (n = 1), and ongoing pain (n = 1). There were no cases of device failure, vertebral body fracture, or screws backing out of the implant. Stand-alone ALIF was associated with statistically significant improvements in ODI scores, back pain, and leg pain. The re-operation rate for clear pseudoarthrosis or cage subsidence was 6.8%. These results support that stand-alone ALIF produces good outcomes in patients treated for symptomatic disc degeneration while avoiding the use of posterior fixation and its complication risk and cost. The results of this study support that stand-alone ALIF is a viable procedure for the treatment of symptomatic disc degeneration unresponsive in patients who have failed nonoperative care and who do not have specific indications for supplemental posterior instrumentation.

Doubtful Guests, Harassed Hosts, and the Golden Rule

Doubtful Guests, Harassed Hosts, and the Golden Rule

Expanding the reaction picklist in electronic health records improves allergy documentation

Documentation of an allergy or adverse drug reaction in the electronic health record (EHR) requires entering data in several fields (allergen, reaction[s], severity, etc) in the EHR allergy module. In most EHR systems, allergies are recorded in a structured format via dropdown picklists or checkboxes, or in an unstructured format as free text. Despite advances in EHR documentation, EHR allergy modules lack a comprehensive, standardized reaction picklist that lets clinicians encode and communicate adverse reactions accurately and effectively.

Association Between Earlier Introduction of Peanut and Prevalence of Peanut Allergy in Infants in Australia

Randomized clinical trials showed that earlier peanut introduction can prevent peanut allergy in select high-risk populations. This led to changes in infant feeding guidelines in 2016 to recommend early peanut introduction for all infants to reduce the risk of peanut allergy. To measure the change in population prevalence of peanut allergy in infants after the introduction of these new guidelines and evaluate the association between early peanut introduction and peanut allergy. Two population-based cross-sectional samples of infants aged 12 months were recruited 10 years apart using the same sampling frame and methods to allow comparison of changes over time. Infants were recruited from immunization centers around Melbourne, Australia. Infants attending their 12-month immunization visit were eligible to participate (eligible age range, 11-15 months), regardless of history of peanut exposure or allergy history. Questionnaires collected data on demographics, food allergy risk factors, peanut introduction, and reactions. All infants underwent skin prick tests to peanut and those with positive results underwent oral food challenges. Prevalence estimates were standardized to account for changes in population demographics over time. This study included 7209 infants (1933 in 2018-2019 and 5276 in 2007-2011). Of the participants in the older vs more recent cohort, 51.8% vs 50.8% were male; median (IQR) ages were 12.5 (12.2-13.0) months vs 12.4 (12.2-12.9) months. There was an increase in infants of East Asian ancestry over time (16.5% in 2018-2019 vs 10.5% in 2007-2011), which is a food allergy risk factor. After standardizing for infant ancestry and other demographics changes, peanut allergy prevalence was 2.6% (95% CI, 1.8%-3.4%) in 2018-2019, compared with 3.1% in 2007-2011 (difference, -0.5% [95% CI, -1.4% to 0.4%]; P = .26). Earlier age of peanut introduction was significantly associated with a lower risk of peanut allergy among infants of Australian ancestry in 2018-2019 (age 12 months compared with age 6 months or younger: adjusted odds ratio, 0.08 [05% CI, 0.02-0.36]; age 12 months compared with 7 to less than 10 months: adjusted odds ratio, 0.09 [95% CI, 0.02-0.53]), but not significant among infants of East Asian ancestry (P for interaction = .002). In cross-sectional analyses, introduction of a guideline recommending early peanut introduction in Australia was not associated with a statistically significant lower or higher prevalence of peanut allergy across the population.

A Four-Year Old with Severe Idiopathic Hypereosinophilia

Abstract&#x0D; Background:&#x0D; Background: Eosinophils are granulocytes that have a role in allergy and immune defense reactions. They represent a small percentage of circulating WBCs, and marked increases in their numbers can cause significant detrimental effects. Hypereosinophilia can be allergic, inflammatory, infectious, or malignant in origin. Hypereosinophilic syndrome is an uncommon disorder of eosinophils that can cause significant end-organ damage (Chen YY, Khoury P, Ware JM, et al.)&#x0D; Case presentation: A 4-year-old female presented with fever and abdominal pain and was found to have cervical and axillary lymphadenopathy spontaneously resolved and with an incidental finding of hypereosinophilia. The patient had an extensive workup, which was negative for common allergic, infectious, inflammatory, and neoplastic etiologies. She continued to show clinical and laboratory improvement and was discharged with the diagnosis of the idiopathic hypereosinophilic syndrome after the exclusion of other etiologies. Her follow-up after discharge showed improvement in eosinophil counts, and she is still being monitored. Given the lack of clear etiology and end-organ damage, she meets the definition of hypereosinophilia of undetermined significance. However, a gastroenterology workup is still considered as future symptoms evolve.&#x0D; Conclusion: Hypereosinophilia is a relatively uncommon disorder in the pediatric population that could be asymptomatic and discovered incidentally through laboratory workup; however, if it goes unrecognized, it can cause significant morbidity secondary to end-organ damage.&#x0D; &#x0D; Keywords: absolute eosinophil count, eosinophilia, hypereosinophilic syndrome.&#x0D;

Delayed allergic reaction to eating lemon

Lemon allergy can be caused by both IgE-mediated and IgG-dependent mechanisms, or by a combination of the two. Allergic reactions to lemon are clinically evidenced by a variety of symptoms, including digestive system disorders (cheilitis, eosinophilic esophagitis, gastroenteritis, colitis, and irritable bowel syndrome). Contact dermatitis is the only condition included among delayed allergic reactions to components of the fruit or lemon essential oils. Data on reactions to lemon and its components from the gastrointestinal tract are scarce in modern publications, and most of what is available are either a description of a single case or an analysis of the frequency of sensitization to lemon among groups of patients with allergic pathology of the digestive system.&#x0D; For the first time, a clinical instance of a simultaneous acute and delayed allergic reaction to eating a lemon, manifesting as an oral allergy condition and gastrointestinal symptoms, in a 31-year-old woman, was described. The patient was diagnosed with polysensitization to various food, household, and pollen antigens, and cross-allergy to fruits of the Rutaceae family (orange, tangerine, and grapefruit). She was diagnosed with allergy and sensitivity to the allergens in the lemon pulp after undergoing a prick + prick test and an enzyme-linked immunosorbent assay. It has been found that lemon pulp contains one or more thermolabile antigens that cause both acute and delayed allergic symptoms. It has also been demonstrated that thermolabile allergens and/or particular antigenic determinants can cause delayed allergy reactions, despite the action of proteolytic enzymes of the gastrointestinal tract and hydrochloric acid. To confirm these properties of allergenic epitopes, additional research, not limited to research on thermal effects alone, but also treatment with hydrochloric acid and enzymes, is highly recommended.&#x0D; Thus, for the first time, we have demonstrated that allergic reactions to lemon, with the accompanying gastrointestinal manifestations, are not limited to IgE-dependent or cell-mediated types of hypersensitivity. Clarification of specific mechanisms of allergy development and characteristics of epitopes of molecules that cause allergic reactions necessitates comprehensive diagnostics research that includes both laboratory methods (including molecular-based methods) and conducting provocative tests.&#x0D; Additional studies are required to determine the sensitivity of protein molecules of allergens to the effects of various factors in the gastrointestinal tract. This will enable us to further determine the resistance of individual antigenic epitopes of lemon allergens to these factors.