Skin Prick Test Reactivity Research Articles

Anaphylaxis to viscotoxins of mistletoe ( Viscum album) extracts

Extracts of mistletoe (Viscum album) are used in many countries for adjuvant cancer therapy. These extracts contain mistletoe lectins and viscotoxins that are supposed to have immunostimulating and cytotoxic effects, respectively. The treatment is usually well tolerated. To report a case of severe anaphylaxis secondary to mistletoe extract administration with demonstrable anti-IgE antibodies to mistletoe. Skin prick tests, basophil histamine release, basophil activation test, and immunoblotting were performed to characterize the pathophysiology of this reaction. The patient had immediate-type skin prick test reactions to the whole commercial preparation and to its mistletoe extract component. A histamine release test and a flow cytometric basophil activation test performed with the patient's peripheral blood leukocytes by incubation with the mistletoe extract yielded a concentration-dependent histamine release and expression of the activation marker gp53 in up to 98% of anti-IgE-positive cells. Immunoblotting revealed IgE binding to 5-kDa proteins of mistletoe in the patient's serum, which corresponds to the molecular weight of viscotoxins. The results of all these tests were negative in controls. Until now, anaphylaxis to mistletoe extracts has been only rarely reported. In our patient, viscotoxin specific IgE evidently had induced an anaphylactic reaction.

Anaphylaxis to quail egg

AllergyVolume 60, Issue 1 p. 128-129 Anaphylaxis to quail egg C. Alessandri, C. Alessandri Piazza Volsinio 7 00199 Roma Italy E-mail: claudia.alessandri@fastwebnet.itSearch for more papers by this authorM. Calvani Jr, M. Calvani Jr Piazza Volsinio 7 00199 Roma Italy E-mail: claudia.alessandri@fastwebnet.itSearch for more papers by this authorL. Rosengart, L. Rosengart Piazza Volsinio 7 00199 Roma Italy E-mail: claudia.alessandri@fastwebnet.itSearch for more papers by this authorC. Madella, C. Madella Piazza Volsinio 7 00199 Roma Italy E-mail: claudia.alessandri@fastwebnet.itSearch for more papers by this author C. Alessandri, C. Alessandri Piazza Volsinio 7 00199 Roma Italy E-mail: claudia.alessandri@fastwebnet.itSearch for more papers by this authorM. Calvani Jr, M. Calvani Jr Piazza Volsinio 7 00199 Roma Italy E-mail: claudia.alessandri@fastwebnet.itSearch for more papers by this authorL. Rosengart, L. Rosengart Piazza Volsinio 7 00199 Roma Italy E-mail: claudia.alessandri@fastwebnet.itSearch for more papers by this authorC. Madella, C. Madella Piazza Volsinio 7 00199 Roma Italy E-mail: claudia.alessandri@fastwebnet.itSearch for more papers by this author First published: 02 November 2004 https://doi.org/10.1111/j.1398-9995.2004.00449.xCitations: 13 Anaphylaxis to quail egg due to cross-reactivity with hen egg. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume60, Issue1January 2005Pages 128-129 RelatedInformation

Inhibition of immediate type hypersensitivity reaction by combined irradiation with ultraviolet and visible light

Recently we found that ultraviolet B (UVB) irradiation in erythematous doses significantly inhibited the immediate type hypersensibility reaction in the skin. In the present study we investigated the effects of different wavelengths on the skin prick test reaction (SPT). The forearm of ragweed allergic patients was irradiated with increasing doses of ultraviolet A (UVA), visible light (VIS) or combined UVB, UVA and VIS light, referred to as mUV/VIS. SPTs were performed 24 h after irradiation both on irradiated and non-irradiated control skin areas using ragweed extract. UVA and VIS irradiation led to a slight, not significant inhibition of allergen-induced wheal formation. Mixed irradiation with mUV/VIS light resulted in a dose-dependent inhibition of the allergen-induced wheal formation. The inhibition was significant already at suberythematous doses. As there is a good correlation between SPT and the nasal symptoms in patients with hay fever these data suggest that phototherapy with mUV/VIS light might be an effective and safe treatment modality for immediate type hypersensibility reactions in the skin and nasal mucosa.

Elevated Levels of IgG and IgG4 to Malassezia Allergens in Atopic Eczema Patients with IgE Reactivity to Malassezia

Background: The opportunistic yeast Malassezia is considered to be one of the factors that can contribute to atopic eczema (AE). Elevated serum IgE levels, T-cell proliferation and positive skin prick test (SPT) and atopy patch test (APT) reactions to Malassezia are found among AE patients. Methods: Sera from 127 AE patients, 14 patients with seborrheic dermatitis (SD) and 33 healthy controls were investigated for IgE and IgG4 to M. sympodialis extract and four recombinant Malassezia allergens; rMala s 1, rMala s 5, rMala s 6, and rMala s 9. In addition, IgG to the recombinant allergens was analyzed. The IgG and IgG4 levels were compared to IgE levels and in vivo reactions (SPT and APT) to Malassezia. Results: AE patients with serum IgE levels >0.35 kU/l to M. sympodialis extract had significantly higher IgG4 levels to M. sympodialis extract than AE patients without detectable serum IgE to M. sympodialis extract, SD patients and healthy controls. Among the AE patients with and without detectable serum IgE to M. sympodialis extract, respectively, there were no differences in IgG4 levels between patients with positive or negative in vivo reactions to M. sympodialis extract. IgG4 to the rMala s allergens was almost exclusively found among patients with IgE to the same allergen. Within the four tested rMala s allergens, most IgG4 reactions were found to rMala s 6, an allergen with homology to cyclophilin. Conclusions: Elevated serum IgG4 to M. sympodialis extract accompanies elevated serum IgE to the extract. This is further confirmed by the association between IgG/IgG4 and IgE to recombinant Malassezia allergens.

Latex allergy and skin

In this review we address the prevalence and outcome of latex allergy in health care workers (HCWs). Recent findings in natural rubber latex (NRL) allergens and trials of specific immunotherapy (SIT) are also of interest. A study involving skin prick test (SPT) screening in HCWs in Russia and adjacent countries found a prevalence of latex allergy of 1.9%. Questionnaire studies performed in Wales and in the USA identified prevalence rates of about 0.6%. An intervention undertaken at the Mayo Clinic, in which only gloves with low or undetectable allergen levels were allowed, reduced markedly the incidence of NRL allergy. Two studies, one from Finland and another from Ohio, showed that outcomes in latex-allergic HCWs are generally good. A study involving SPT screening showed that 6% of construction workers had latex allergy. A questionnaire study among allergists practicing in the USA showed that 62% performed latex SPT and 6% reported anaphylaxis, which mostly occurred while using a homemade SPT solution. Hev b 2, Hev b 5, Hev b 6.01 and Hev b 13 produced positive SPT reactions in over 60% of latex-allergic individuals. Topical application of NRL in a murine model of protein contact dermatitis caused a striking increase in prohevein-specific (Hev b 6.01) immunoglobulin E levels, together with a T-helper-2 type dermatitis. A placebo-controlled SIT trial with NRL extract alleviated cutaneous symptoms but caused some systemic reactions in latex-allergic patients. Low prevalence rates suggest that the peak of the latex allergy epidemic has already passed in HCWs. Hospital-wide interventions requiring use of low-allergen gloves reduce sensitization and changing gloves to nonlatex ones, or even using low-allergen latex gloves, in the affected individuals appears to confer adequate secondary prevention. In the USA there is an urgent need for standardized latex SPT reagent. Hev b 5 and Hev b 6.01 are major in vivo NRL allergens. Findings in mice suggest that NRL proteins eluting from latex gloves may also cause hand eczema in humans. SIT with NRL extract must still be considered an experimental treatment.

Immunoblot and radioallergosorbent test inhibition studies of allergenic cross-reactivity of the predatory mite Amblyseius cucumeris with the house dust mite Dermatophagoides pteronyssinus

In 1999, an extensive study among bell pepper growers showed that a predatory mite, Amblyseius cucumeris, is a potentially relevant source of occupational allergens because 23% of the population had positive skin prick test reactions. To investigate whether cross-reactivity between A. cucumeris and Dermatophagoides pteronyssinus is responsible for the cosensitization to both mite species found in 58.7% of A. cucumeris-sensitized greenhouse workers. Fifteen serum samples from greenhouse workers with work-related inhalant allergy and a positive radioallergosorbent test (RAST) reaction to A. cucumeris or D. pteronyssinus were selected for immunoblot analysis using extracts of both mites. A subselection (n = 5) was used for RAST and immunoblot inhibition to investigate potential cross-reactivity. On immunoblot, 2 distinct patterns were observed: one pattern showed common protein bands in A. cucumeris and D. pteronyssinus blots suggestive of cross-reactivity between A. cucumeris and D. pteronyssinus and the other pattern showed no shared protein bands. Dermatophagoides pteronyssinus RAST inhibition with A. cucumeris extract was low in 4 serum samples (<25% inhibition) and nearly absent in 1 serum sample; A. cucumeris RAST inhibition with D. pteronyssinus extract was high in 1 serum sample (75% inhibition), low in 2 serum samples (35% and <15% inhibition), and absent in 2 serum samples. These results were confirmed by immunoblot inhibition experiments. Amblyseius cucumeris, a new occupational allergen, has species-specific antigens and common antigens that are cross-reactive with the house dust mite D. pteronyssinus.

Vitamin C in breast milk may reduce the risk of atopy in the infant.

To assess the effects of maternal dietary and supplement intake of vitamins C and E on breast milk antioxidant composition (vitamin C, alpha-tocopherol and beta-carotene) and their protective potential against the development of atopy in the infant. Mothers with atopic disease were recruited at the end of gestation and maternal sensitization was assessed by skin-prick testing. The 4-day food records of the mothers and breast milk samples were collected at the infants' age of 1 month. Infants' atopy was defined by the presence of atopic dermatitis during the first year of life and a positive skin-prick test reaction at 12 months of age (n=34). Maternal intake of vitamin C in diet but not as supplement was shown to determine the concentration of vitamin C in breast milk. A higher concentration of vitamin C in breast milk was associated with a reduced risk of atopy in the infant (OR=0.30; 95% CI 0.09-0.94; P=0.038), whereas alpha-tocopherol had no consistent relationship with atopy. The group at risk of suboptimal vitamin C supply from breast milk was identified as infants whose mothers suffer from food hypersensitivity. A maternal diet rich in natural sources of vitamin C during breastfeeding could reduce the risk of atopy in high-risk infants.

Schistosoma mansoni infection modulates the immune response against allergic and auto-immune diseases.

Chronic Schistosoma mansoni infection leads to a type 2-immune response with increased production of interleukin (IL-10). Evidence indicates chronic exposure to S. mansoni down regulates the type 1 immune response and prevents the onset of Th1-mediated diseases such as multiple sclerosis, diabetes mellitus and Crohn's disease. Furthermore, our own studies have revealed that chronic exposure to S. mansoni also down regulates atopic disease, Th2-mediated diseases. Our studies show an inverse association between the skin prick test reactivity and infection with S. mansoni and show the severity of asthma is reduced in subjects living in an endemic area of S. mansoni. Moreover, we hypothesize the mechanisms involved in the modulation of inflammatory response in atopic individuals, is likely dependent on IL-10 production, an anti-inflammatory cytokine elevated during helminth infections. Patients with asthma and helminth infections produced less IL-5 than patients with asthma without helminth infections, and this down regulation could, in part, be mediated by IL-10. In conclusion, helminthic infections, through induction of regulatory mechanisms, such as IL-10 production, are able to modulate the inflammatory immune response involved in the pathology of auto-immune and allergic disease.

Coexistence of IgE-Mediated Allergy and Type 1 Diabetes in Childhood

Background: Autoimmune disorders are considered to be associated with a Th1 immune response while allergic diseases with a Th2 response. We carried out a study to determine whether there is an inverse relationship between allergic diseases in IgE-sensitized children or positive skin-prick test reactions to allergens and type 1 diabetes mellitus (DM1) in children. Methods: Sixty-three children with DM1 and 108 controls were enrolled. Parents of all children compiled a questionnaire on allergic diseases. All children underwent skin-prick tests for common aero-allergens and food-allergens. Results: A history of allergic symptoms, especially wheezing, asthma and allergic rhinitis was significantly less common in the group with DM1. Allergic symptoms in children with IgE sensitization or parental atopy were no more likely in children with DM1 than in normal control subjects. There was no association between skin-prick test results to inhalants and food allergens and DM1. Conclusions: Consistently with the Th1/Th2 paradigm, we observed a reduction in the frequency of allergic symptoms in children with DM1. However, our study did not succeed in demonstrating an inverse relation between Th1- and Th2-mediated diseases in children with IgE sensitization or an atopic genetic predisposition.

Intranasal irradiation with the xenon chloride ultraviolet B laser improves allergic rhinitis

We earlier reported that the 308 nm xenon chloride (XeCl) ultraviolet B (UVB) laser is highly effective for the treatment of inflammatory skin diseases. Since UVB irradiation has been shown to exert both local and systemic immunosuppression, we investigated the clinical efficacy of UVB irradiation in allergic rhinitis. In an open study, groups of patients with severe allergic rhinitis received intranasal irradiation with a 308 nm XeCl UVB excimer laser for two weeks. In the low-dose group ( n=10), treatment was given twice weekly, starting with 0.25 × the individual minimal erythema dose (MED), whereas patients in the medium-dose group ( n=8) were treated four times weekly, starting with 0.4 × MED. In each group, the dosage was gradually increased. Evaluation was based on the symptom scores. The effect of the XeCl laser on the skin prick test reaction was also studied. In the low-dose group, seven patients completed the study, and there was no improvement in the nasal symptoms. In the medium-dose group, the XeCl UVB irradiation significantly inhibited the rhinorrhoea, the sneezing, the nasal obstruction and the total nasal score ( p<0.05). The XeCl UVB excimer laser also inhibited the allergen-induced skin prick test in a dose-dependent manner. These results suggest that the XeCl UVB excimer laser might serve as a new therapeutic tool in the treatment of allergic rhinitis.

Effect of reduced exposure on natural rubber latex sensitization in health care workers

Knowledge about the long-term course of allergy or sensitization to natural rubber latex (NRL) is insufficient. To investigate the long-term effect of preventive measures on sensitization variables in health care workers who had been diagnosed as having NRL allergy (NRLA) or NRL sensitization (NRLS) without clinical symptoms. Repeated follow-up investigations, skin prick tests, and NRL specific IgE serum antibodies were performed in 88 health care workers-33 with NRLA and 55 with NRLS. All workers had been instructed to avoid NRL exposure. At the workplace, powder-free NRL gloves for all other employees were gradually introduced. Re-evaluations were done at 14 +/- 3.7 (N = 86) and 38 +/- 4.0 (N = 78) months after the first examination. At the last follow-up, a loss of skin prick test reactivity to NRL was observed in 1 of 29 subjects with NRLA (3.4%) and 16 of 35 with NRLS (45.7%) with previous skin test reactions (P < .001). Among those subjects who demonstrated a kU/L level (CAP class) equal to or greater than class I to NRL at the initial examination, NRL-specific IgE was absent at the last follow-up in 8 (32.0%) of 25 subjects with NRLA and 14 (38.9%) of 36 with NRLS. At the final examination, we could no longer demonstrate sensitization to NRL by any method in 24 (27.3%) of 88 health care workers. Complete loss of NRL sensitization was less frequent in subjects with NRLA than in those with NRLS (1 of 33 or 3.0% vs 23 of 55 or 41.8%; P < .001). Implementation of simple preventive measures lowers markers of sensitization to NRL quickly in many health care workers with NRLA or NRLS.

Association between polymorphisms in serine protease inhibitor, kazal type 5 and asthma phenotypes in a large German population sample.

Atopic diseases are characterized by immunoglobulin E (IgE)-mediated immune responses towards common allergens, many of which are proteases. Recently it has been suggested that a proteinase inhibitor gene, SPINK5, which is located on chromosome 5q31, may play a role in the pathogenesis of atopic diseases. We investigated the association between the polymorphism G1258A leading to a putative amino acid change (Glu420Lys) in serine protease inhibitor, kazal type 5 (SPINK5) and phenotypes of atopic diseases in a large general population sample of German children. Parental questionnaires were used and children underwent skin prick testing, pulmonary function testing and bronchial challenge. Blood was collected for serum IgE measurements and DNA extraction. In total, 1161 children were genotyped for the SPINK5 Glu420Lys polymorphism and association studies were performed. A significant association between SPINK5 420Lys and the development of asthma was observed (OR 1.77; 95%CI: 1.02-3.06, P=0.041 for 420Lys homocygotes). Atopic carriers of SPINK5 420Lys showed an increased risk for asthma and asthma symptoms (OR 2.06; 95%CI: 1.01-4.20, P=0.047). When children with a combination of asthma and atopic dermatitis were compared with normal controls, the SPINK5 420Lys genotype was more prevalent in the disease group (OR 4.56; 95%CI: 1.370-15.12, P=0.007). No association between SPINK5 420Lys genotypes and total serum IgE levels, skin prick test (SPT) reactivity or atopic dermatitis was observed. These results suggest that SPINK5 Glu420Lys polymorphism may be associated with certain asthma phenotypes characterized by the concomitant expression of asthma and atopic dermatitis or SPT reactivity.

FS06.6 Mucosal symptoms elicited by fragrances; a population‐based study

Objectives: To investigate symptoms from the eyes and airways, elicited by perfume and fragrance products and associations between such symptoms and skin prick test reactivity, metacholine bronchial hyperreactivity (BHR), contact allergy, and eczema in a population based sample.Methods: A questionnaire on mucosal symptoms elicited by fragrance products was mailed to 1189 persons who had participated in a Danish population‐based study of allergic diseases in 1997/98. The study included measurement of BHR, skin prick testing, patch testing and history of hand eczema.Results: The response rate to the questionnaire was 80%. Symptoms from the eyes or airways elicited by fragrance products were reported by 42%. There were no significant associations between these symptoms and skin prick test reactivity. Positive and independent statistical significant associations were found between BHR, perfume contact allergy and hand eczema, and symptoms from the eyes and airways elicited by fragrance products, also when adjusting for nickel contact allergy, age, gender psychological vulnerability, educational level and social class.Conclusions: Individuals with BHR, hand eczema and/or perfume contact allergy, as opposed to those without, are more frequently and more severely bothered from the eyes or airways after volatile exposure to fragrance products. The lack of association with skin prick test reactivity indicates that IgE mediated allergic mechanisms do not play a major role in the development of these symptoms. Having hand eczema has the greatest impact on reporting mucosal symptoms elicited by fragrance products.

Construction of hevein (Hev b 6.02) with reduced allergenicity for immunotherapy of latex allergy by comutation of six amino acid residues on the conformational IgE epitopes.

Recently we have established that IgE Abs bind to conformational epitopes in the N- and C-terminal regions of the major natural rubber latex allergen, hevein (Hev b 6.02). To identify the critical amino acid residues that interact with IgE, the hevein sequence was scanned by using site-specific mutations. Twenty-nine hevein mutants were designed and produced by a baculovirus expression system in insect cells and tested by IgE inhibition-ELISA using sera from 26 latex allergic patients. Six potential IgE-interacting residues of hevein (Arg(5), Lys(10), Glu(29), Tyr(30), His(35), and Gln(38)) were identified and characterized further in detail. Based on these six residues, two triple mutants (Hdelta3A, Hdelta3B) and hevein mutant where all six residues were mutated (Hdelta6), were designed, modeled, and produced. Structural and functional properties of these combinatory mutants were compared experimentally and in silico with those of recombinant hevein. The IgE-binding affinity of the mutants decreased by three to five orders of magnitude as compared with that of recombinant hevein. Skin prick test reactivity of the triple mutant HDelta3A was drastically reduced and that of the six-residue mutant Hdelta6 was completely abolished in all patients examined in this study. The approach presented in this paper offers tools for identification and modification of amino acid residues on conformational epitopes of allergens that interact with IgE. Hevein with a highly reduced ability to bind IgE should provide a valuable candidate molecule for immunotherapy of latex allergy and is anticipated to have a low risk of systemic side effects.

Comparison of allergic status of adopted Indian born and native Icelandic children

Rationale The increased incidence of allergic diseases in “westernized societies” may be due to increased hygiene. To evaluate the impact of prenatal and postnatal environment on the development of allergic disease, we compared children born in different conditions, but subsequently raised in similar environments: Icelandic adoptees born in Calcutta, India (Group I) and native Icelandic children (Group II). Methods Atopic status of Group I and II was compared using a standardized questionnaire (ISAAC), skin prick testing (SPT) for 8 aeroallergens and 5 food allergens and total IgE (CAP). Children in Group I were less than 2 years of age at time of adoption and had all lived in Iceland for over a year. Age matched controls were recruited during same time period from relatives or friends. Results 46 and 26 children were recruited to Group I and II, respectively, mean age 8 and 7,4 years. No differences were between the groups with regards to frequency of positive SPT: 18 (39%) vs. 7 (27%) (OR: 1,5; p=0,6); history of wheezing 13 (28%) vs. 8 (30%), (OR: 0,9; p=1,0); pollen allergy 8 (17%) vs. 4 (15%) or eczema 12 (27%) vs. 9 (35%), for Group I and II, respectively. The geometric mean total IgE was 65,4 vs. 19,1 kU/L (P=0,024; T-test) in group I and II, respectively. Conclusions No significant difference was found in SPT reactivity or history of atopic disease in children who were born in India and adopted to Iceland, compared with native Icelandic children of the same age. However, total IgE was higher in the adopted children.

Frequent occurrence of IgE to seeds of rape, oilseed rape, mustard and soy in children suspected for food allergies

Rationale We have noted strongly positive skin prick test (SPT) reactions to seeds of Brassicaceae family foods, i.e., rape, oilseed rape and mustard in infants and children suspected for food allergies. Sensitization pathways are not known and some the youngest infants had been exclusively on breast-feeding. Methods Extracts were prepared from seeds and used as solid-phase antigens in IgE ELISA and immunoblotting. Sera from 61 children (aged 3 months to 14 years), all with positive SPT to 1-4 of the foodstuffs, were analyzed. Results In ELISA 64% of the children showed clear IgE binding to rape, 61% to oilseed rape, 69% to mustard, and 38% to soy. Parallel IgE binding to rape, oilseed rape and mustard was common and correlated to the intensity of SPT reactions and serum IgE levels. In IgE immunoblotting major reactivity was to a 9-11 kDa protein which was partially purified by reversed-phase-HPLC and shown to bind IgE from the patient sera in ELISA. Conclusions Children reacting to seeds of rape, oilseed rape and mustard in SPT show also frequently IgE antibodies in ELISA. Major IgE binding allergen seems to be a 9-11 kDa protein, but the route of sensitization and its clinical importance remain to be elucidated.

Xenon chloride ultraviolet-B laser phototherapy in allergic rhinitis

Rationale Since ultraviolet-B (UVB) lht has been shown to exert both local and systemic immunosuppression, we investigated the clinical efficacy of UVB light in allergic rhinitis. Methods In an open study, groups of patients with severe allergic rhinitis received intranasal irradiation with 308 nm xenon chloride (XeCl) UVB excimer laser for two weeks. In the low-dose group (n=7), treatment was given twice weekly, started with 0.25 × minimal erythema dose (MED), measured on the gluteal skin, whereas patients in the medium-dose group (n=8) were treated four times weekly starting with 0.4 × MED. In each group the light dosage was increased gradually. Evaluation was based on the symptom scores. The effect of XeCl laser on the skin prick test (SPT) reaction was also studied. Results In the low-dose group there was no improvement in the nasal symptoms. In the medium-dose group the XeCl UVB light significantly reduced rhinorrhoea, sneezing, nasal obstruction and total nasal score (p<0.05). The XeCl UVB excimer laser also inhibited the allergen induced skin prick reaction (SPT) in a dose dependent manner. Conclusions XeCl UVB excimer laser might be a new therapeutic tool in the treatment of allergic rhinitis.

Skin prick test reactivity to dust mites, cockroach and molds correlates with reactivity to distinct sets of environmental allergens

Rationale The high humidity the Texas coastal areas increases exposure to allergens such as molds, dustmites, and cockroaches. These potent allergens contain proteases. These proteases augment permeability of the airway epithelium independent of adaptive immunity, and may enhance passage of other environmental allergens across the epithelial barrier inducing allergic sensitization to them. Methods We performed a retrospective chart review of 39 random patients with positive skin prick tests from the Galveston and Texas City areas and recorded the size of skin prick tests (SPT) of 57 inhaled allergens. The size of SPT of molds, dustmite and cockroach were correlated with the size of SPT of other allergens using Pearson Statistics. Statistical significance was set at <0.05. Results SPT reactivity to Alternaria significantly correlated with SPT to Johnson Grass (R=0.568, p=0.0001), Ragweed (R=0.388, p=0.015). Aspergillus correlated with Johnson (R=0.643, p=0.0001) and Elm (R=0.619, p=0.0001). Neither molds correlated with mite, cockroach, cat or dog. D. pteronyssinus and D. farinae correlated with cat [(R=0.577, p=0.0001) and (R=0.390, p=0.014), respectively], but not with pollen. Cockroach correlated with both cat (R=0.472, p=0.002) and dog (R=0.458, p=0.003), but not with mites or pollen. Conclusions There was a significant correlation between SPT to specific environmental allergens and protease rich allergens. Future mechanistic studies should attempt to explain the molecular basis of this phenomenon of “collateral sensitization”.

IgE-mediated anaphylaxis to viscotoxins of mistletoe (Viscum album) extracts

Rationale Extracts of mistletoe (Viscum album) are used in many countries for adjuvant cancer therapy. The extracts contain mistletoe lectins and viscotoxins supposed to have immunostimulating and cytotoxic effects, respectively. The treatment usually is well tolerated. We here report on a 59-year-old female who had received for adjuvant treatment of colon cancer injections of a mistletoe extract (Iscador® M c. Hg, Weleda, Germany) every two weeks for more than two years without any side effects. Two months prior to presentation she suddenly had developed generalized urticaria, swelling of lips and tongue, nausea, vomiting, and shortness of breath within 10 minutes after the injection. Methods Allergologic tests were performed to characterize the pathomechanism of this reaction. Results In the patient there were immediate type skin prick test reactions to the whole commercial preparation and to its mistletoe extract component (kindly supplied by the manufacturer). A histamine release test and a flowcytometric basophil activation test performed with the patient's peripheral blood leucocytes by incubation with the mistletoe extract yielded a concentration-dependent histamine release up to 100% of total histamine and expression of the activation marker gp53 in 98% of anti-IgE positive cells. Immunoblotting revealed in the patient's serum IgE binding to 5-kD-proteins of mistletoe which corresponds to the molecular weight of viscotoxins. All these tests were negative in controls. Conclusions Anaphylaxis to mistletoe extracts has been rarely reported. In our patient evidently viscotoxin-specific IgE had induced an anaphylactic reaction.

Allergen Skin Test Reaction Patterns in Children (≤10 Years Old) from Atopic Families Suggest Age-Dependent Changes in Allergen-IgE Binding in Early Life

Background: Genetic studies of atopy rely upon evidence of abnormal IgE production, usually elevated total IgE or skin prick test (SPT) reactions. However, these measures may change with subject age. Methods: We screened 1,099 members of atopic families (aged 6–87 years) by serum total IgE and SPT for 14 allergens. For those SPT negative, we screened for Amb a 1- and Der p 1-specific IgE. Der p 1 IgE-Der p 1 allergen binding affinities were done on randomly selected subjects. Results: There were significantly fewer atopics ≤10 years old (69.1%) compared to those >10 years old (75.8%) based upon any SPT-positive result. Children ≤10 years had fewer SPT-positive reactions and smaller SPT wheal reaction areas. Yet, mean total IgE values were comparable to those of the older group. Screens for specific IgE showed no differences in proportions of atopics (≤10 years old = 83.1% and >10 years old = 82.3%). Among those SPT-positive for house dust mite extract, there was a positive correlation between Der p 1 binding affinity and the wheal area of the house dust mite extract. There was a positive correlation between the number of SPT-positive reactions and total IgE for both age groups. However, there was only a significant relationship between SPT-positive wheal area and total IgE for those >10 years old and no apparent relationship between wheal area and total IgE for those ≤10 years old. Conclusion: These results suggest that atopy-specific physiological mechanisms, primarily those involving allergen-IgE binding, change during the earliest years of life.