Specific IgE Sensitization Research Articles

Sensitivity, specificity and positive predictive value of ALEX2 multiplex examination in patients suffering from atopic dermatitis and reaction to tomatoes

ABSTRACT The aim of the study is to evaluate the clinical reactions to tomatoes in atopic dermatitis (AD) patients, and to analyse the results of specific IgE to allergens of tomatoes and to molecular components of pollen, seeds, fruits, vegetables and latex with the use of ALEX2 Allergy Xplorer test. According to our results, 15% of AD patients suffer from clinical reactions to tomatoes; we confirmed the low sensitivity and low positive predictive value of specific IgE to molecular component Sola l 6 and allergen extract Sola l, the specificity of this test is higher. The significantly higher sensitisation to other nonspecific lipid transfer proteins is observed in patients sensitised to tomato allergens. An elimination diet and an exposure test are recommended to detect a reaction to tomatoes. ALEX2 Allergy Xplorer test gives us a comprehensive picture of sensitisation and the possibility of evaluation of cross-reacting allergens.

Revealing clinically relevant specific IgE sensitization patterns in Hymenoptera venom allergy with dimension reduction and clustering

BackgroundImmunoglobulin E (IgE) blood tests are used to detect sensitizations and potential allergies. Recent studies suggest that specific IgE sensitization patterns due to molecular interactions affect an individual's risk of developing allergic symptoms. ObjectiveThe aim of this study was to reveal specific IgE sensitization patterns and investigate their clinical implications in Hymenoptera venom allergy. MethodsIn this cross-sectional study, 257 hunters or fishers with self-filled surveys on previous Hymenoptera stings were analyzed. Blood samples were taken to determine Hymenoptera IgE sensitization levels. Using dimensionality reduction and clustering, specific IgE for 10 Hymenoptera venom allergens were evaluated for clinical relevance. ResultsThree clusters were unmasked using novel dimensionality reduction and clustering methods solely based on specific IgE levels to Hymenoptera venom allergens. These clusters show different characteristics regarding previous systemic reactions to Hymenoptera stings. ConclusionOur study was able to unmask non-linear sensitization patterns for specific IgE tests in Hymenoptera venom allergy. We were able to derive risk clusters for anaphylactic reactions following hymenoptera stings and pinpoint relevant allergens (rApi m 10, rVes v 1, whole bee, and wasp venom) for clustering.

Prospective assessment of pre-existing and de novo anti-HLA IgE in kidney, liver, lung and heart transplantation.

Antibody mediated rejection (ABMR) is a major factor limiting outcome after organ transplantation. Anti-HLA donor-specific antibodies (DSA) of the IgG isotype are mainly responsible for ABMR. Recently DSA of the IgE isotype were demonstrated in murine models as well as in a small cohort of sensitized transplant recipients. In the present study, we aimed to determine the frequency of pre-existing and de novo anti-HLA IgE antibodies in a cohort of 105 solid organ transplant recipients. We prospectively measured anti-HLA IgE antibodies in a cohort of kidney (n=60), liver, heart and lung (n=15 each) transplant recipients before and within one-year after transplantation, employing a single-antigen bead assay for HLA class I and class II antigens. Functional activity of anti-HLA IgE antibodies was assessed by an in vitro mediator release assay. Antibodies of the IgG1-4 subclasses and Th1 and Th2 cytokines were measured in anti-HLA IgE positive patients. Pre-existing anti-HLA IgE antibodies were detected in 10% of renal recipients (including 3.3% IgE-DSA) and in 4.4% of non-renal solid organ transplant recipients (heart, liver and lung cohort). Anti-HLA IgE occurred only in patients that were positive for anti-HLA IgG, and most IgE positive patients had had a previous transplant. Only a small fraction of patients developed de novo anti-HLA IgE antibodies (1.7% of kidney recipients and 4.4% of non-renal recipients), whereas no de novo IgE-DSA was detected. IgG subclass antibodies showed a distinct pattern in patients who were positive for anti-HLA IgE. Moreover, patients with anti-HLA IgE showed elevated Th2 and also Th1 cytokine levels. Serum from IgE positive recipients led to degranulation of basophils in vitro, demonstrating functionality of anti-HLA IgE. These data demonstrate that anti-HLA IgE antibodies occur at low frequency in kidney, liver, heart and lung transplant recipients. Anti-HLA IgE development is associated with sensitization at the IgG level, in particular through previous transplants and distinct IgG subclasses. Taken together, HLA specific IgE sensitization is a new phenomenon in solid organ transplant recipients whose potential relevance for allograft injury requires further investigation.

Clinical severity of LTP syndrome is associated with an expanded IgE repertoire, FDEIA, FDHIH, and LTP mono reactivity.

Background. LTP allergy is often a challenge for clinicians. We evaluated a multiplex diagnostic approach with diverse cofactors to stratify LTP syndrome risk. Methods. Of the 1,831 participants screened with 'Allergy Explorer-ALEX-2', 426 had reactions to at least one LTP. Data was gathered and recorded via an electronic database. Results. Reactivity to peach Pru p 3 was found in 77% of individuals with LTP allergy. Higher levels of specific IgE and concurrent sensitization to more than 5 molecules (50% of all LTP-sensitised participants, 62% of symptomatic cases) were significantly associated with an increased risk of severe reactions (p = 0.001). Several cofactors, either alone or in combination, also influenced patients' clinical outcomes. Some cofactors increased the risk of severe reactions, such as mono reactivity to LTP in 44.6% of cases (p = 0.001), FDEIA in 10.8% of patients (p = 0.001), and FDNIH in 11.5% (p = 0.005). On the other hand, reactivity to PR10 (24.2%; p = 0.001), profilin hypersensitivity (10.3%; p = 0.001), and/or atopic dermatitis (16.7%; p = 0.001) had a mitigating effect on symptom severity. Conclusions. Clinical severity of LTP syndrome is associated with an expanded IgE repertoire in terms of the number of LTP components recognized and increased IgE levels in individual molecules. Ara h 9, Cor a 8, and Mal d 3 showed the strongest association with clinical severity. In addition, several cofactors may either exacerbate (FDEIA, FDHIH, and LTP monoreactivity) or ameliorate (atopic dermatitis and co-sensitization to profilin and/or PR10) individual patient outcomes. These factors may be utilized for the daily clinical management of LTP syndrome.

Soy Gly m 8 sIgE Has Limited Value in the Diagnosis of Soy Allergy in Peanut Ara h 2-Sensitized Adults

Introduction: Recently, specific IgE (sIgE) sensitization against Gly m 8 (soy 2S albumin) has been described as a good diagnostic marker for soy allergy (SA). The aim of this study was to evaluate the diagnostic value of Gly m 8 by determining the sensitization profiles based on the homologues soy allergens Bet v 1, Ara h 1, Ara h 2, and Ara h 3. Methods: Thirty soy-allergic adults were included; sIgE to total soy extract, Gly m 8, Gly m 4, Gly m 5, Gly m 6, Bet v 1, Ara h 1, Ara h 2, and Ara h 3 were determined. Sensitization patterns were analyzed and determined. The clinical relevance of sIgE of Gly m 8 sensitization was measured by assessing its capacity to degranulate basophils in Gly m8-sensitized patients by an indirect basophil activation test (iBAT). Results: Based on the sIgE patterns of sensitization, two groups of SA patients were identified: (i) peanut-associated SA group (all patients were sensitized to one or more of the peanut compounds) and (ii) non-peanut/PR-10-associated SA group (22 patients were sensitized to Gly m 4 and Bet v 1 but not to any of the peanut compounds). A high and significant correlation between total soy extract and Gly m 6 (R2 = 0.97), Gly m 5 (R2 = 0.85), and Gly m 8 (R2 = 0.78) was observed. A nonsignificant correlation was observed between the levels of sIgE of Gly m 8 versus Ara h2. The iBAT results showed that Gly m 8 did not induce basophil degranulation in any of the peanut-associated patients, indicating that the Gly m8 sensitizations were not clinically relevant. Conclusions: Gly m 8 was not a major allergen in the selected soy-allergic population. The iBAT results indicated that Gly m 8 was not able to induce basophil degranulation in sIgE Gly m 8-sensitized soy-allergic patients. Thus, Gly m 8 would have no added value in the diagnosis of SA in the present study population.

Molecular sensitization patterns of common food-and respiratory allergens in the Hungarian population

BackgroundRecently developed Immunoglobulin-E (IgE) based molecular allergy diagnostics provide the ability of identifying allergenic components or ingredients at the molecular level (component-resolved-diagnosis, CRD). Compared to the classical IgE-based allergy diagnostics, molecular technology is providing more sensitive and specific IgE-sensitization patterns. Certain sensitization patterns are characteristic of large geographic regions. There are only few data available on the molecular IgE sensitization patterns in East-Central Europe. This study aims to present further data from this region. MethodsData of 3993 stored, anonymized molecular ImmunoCap IgE measurements (CRD), performed in Hungary between January-December 2019 from sera of 1288 subjects (mean age: 27 years ±18 years, male/female ratio 0.56) were analyzed retrospectively, in order to get a local distributional pattern of the sensitizing (IgE >0.35 KU/l) molecular allergens. ResultsThe proportion of CRD positive cases was 24.3%. Amongst them, the most prevalent inhalative allergens were Amb a 1 (18%) Art v 1 (8%) in adults and Der p 2 (3%) and Der p 1 (3%) and Amb a 1 (4%) in subjects below 18 years of age. The same for food allergens were Gal d 2 (21%), Bos d 4 (17%), Bos d 5 (11%) in adults and Gal d 2 (38%), Gal d 1 (28%), Bos d 4 (21%), Bos d 5 (13%) and Bos d 8 (7%) in children. The ratio of mono-sensitivities among CRD-positive cases was 37.5%. ConclusionOur results provide region-specific patterns of sensitization and molecular allergen spreading for Hungary. The relatively higher abundance of polysensitization's among allergic cases underlines the need for early diagnostic -and preventive measures in the future.

An ultra-sensitive homologous chemiluminescence immunoassay to tackle penicillin allergy

Penicillin is one of the most widely used antibiotics to treat bacterial infections in clinical practice. The antibiotic undergoes degradation under physiological conditions to produce reactive compounds that in vivo bind self-proteins. These conjugates might elicit an immune response and trigger allergic reactions challenging to diagnose due to the complex immunogenicity. Penicillin allergy delabeling initiatives are now part of antibiotic stewardship programs and include the use of invasive and risky in vivo tests. Instead, the in vitro quantification of specific IgE is highly useful to confirm immediate allergy to penicillins. However, discrepant results associated with the low sensitivity and accuracy of penicillin allergy in vitro tests have limited their routine diagnostic use for delabeling purposes. We aimed to develop a homologous chemiluminescence-based immunochemical method for the reliable determination of specific IgE to penicillin G, using unprecedented synthetic human-like standards. The synthetic standard targets the major antigenic determinant of penicillin G and the paratope of Omalizumab, acting as human-like specific IgE. It is a potent calibrator, highly stable, easy, and inexpensive to produce, overcoming the limitations of the pooled human serum preparations. The developed method achieved a good agreement and strong positive relationship, reaching a detection limit below 0.1 IU mL−1 and excellent reproducibility (RSD <9%). The clinical sensitivity of the assay significantly increased (66%), doubling the accuracy of the reference method with an overall specificity of 100%. The new diagnostic strategy compares favorably with results obtained by the standard procedure, paving the way towards the standardization of penicillin allergy testing, and enhancing the detection sensitivity of specific IgE in serum to tackle reliably β-lactam allergy delabeling.

Association of different enteroviruses with atopy and allergic diseases in early childhood.

Enterovirus (EV) infections, being among the most prevalent viruses worldwide, have been associated with reduced risk of allergic diseases. We sought to determine the association between EVs and allergic sensitization and disease in early childhood. The study was carried out in a nested case-control setting within a prospective birth cohort in Finland. We included 138 case children who had specific IgE (s-IgE) sensitization at the age of 5years and 138 control children without s-IgE sensitization. Allergic disease was recorded at study visits and identified with the ISAAC questionnaire. We screened for the presence of serotype-specific antibodies against 41 EVs at 1-5years of age and assessed their association with allergic sensitization and disease. The overall number of EV infections did not differ between s-IgE-sensitized children and non-sensitized control children. However, there was a tendency of case children with an allergic disease having less EV infections than their controls. This observation was statistically significant for species A EVs in case children with atopic dermatitis vs. control children: OR 0.6 (95% CI 0.36-0.99), p=.048. This study supports the evidence that EV exposure and development of allergic disease are inversely associated. Interestingly, the inverse association was not observed for bare atopic IgE sensitization, but for IgE sensitization coupled with clinical atopic disease. This suggests that environmental factors influencing IgE sensitization may differ from those influencing progression to clinical allergic disease.

A Randomized, Open-Label Trial of Hen's Egg Oral Immunotherapy: Efficacy and Humoral Immune Responses in 50 Children

Egg allergy is the second most common food allergy in children. Persistent food allergy increases the risk of anaphylaxis and reduces the quality of life. To determine the efficacy of oral immunotherapy (OIT) with raw egg white powder and study its effects on humoral responses in children with persistent egg allergy. Fifty children aged 6 to 17 years with egg allergy, diagnosed by double-blind, placebo-controlled food challenge, were randomized 3:2 to 8 months of OIT with a maintenance dose of 1 g of egg white protein or 6 months of avoidance after which the avoidance group crossed over to OIT. We examined changes in IgE, IgG4, and IgA concentrations to Gal d 1-4 during OIT compared with avoidance and assessed clinical reactivity at 8 and 18 months. After 8 months, 22 of 50 children (44%) on OIT and 1 of 21 (4.8%) on egg avoidance were desensitized to the target dose, 23 of 50 (46%) were partially desensitized (dose <1 g), and 5 of 50 (10%) discontinued. IgG4 concentrations to Gal d 1-4 and IgA to Gal d 1-2 increased significantly, whereas IgE to Gal d 2 decreased. A heatmap analysis of the IgE patterns revealed 3 distinct clusters linked with the clinical outcome. High baseline egg white-specific IgE and polysensitization to Gal d 1-4 related with failure to achieve the maintenance dose at 8 months. After 18 months of treatment, 36 of 50 patients (72%) were desensitized and 8 of 50 (16%) partially desensitized. OIT with raw egg enables liberation of egg products into the daily diet in most patients. Subjects with high egg white-specific IgE concentrations and sensitization to multiple egg allergen components at baseline benefit from prolonged treatment.

Predictive factors of allergy to pistachio in children allergic to cashew nut.

Cashew nut (CN) allergy prevalence has increased over the last few years. In children allergic to CN, complete avoidance of pistachio is usually recommended, but recent study showed that only one third of children allergic to CN were also allergic to pistachio. The aim of our study was to identify predictive factors of allergy to pistachio in children allergic to CN. All children who had a positive oral food challenge (OFC) to CN between November 2013 and October 2017 in the Paediatric Allergy Department of the University Hospital of Nancy were included. Logistic regression models were used to predict the probability of allergy to pistachio. Among the 147 children included, tolerance or allergy to pistachio was known for 51. Out of these, 40 were allergic to pistachio (78.4%). Children allergic to pistachio had a larger weal size of skin prick test to CN (P=.01) and pistachio (P=.0007) and a lower reaction dose to CN (P<.0001). In multivariate analysis, only the reaction dose to CN was significantly associated with allergy to pistachio. Children with a low reaction dose to CN were significantly more at risk to have an allergy to pistachio (P=.01). A low reaction dose to CN seems to be a predictive factor of allergy to pistachio in children allergic to CN. In order to limit unnecessary food eviction, a pistachio OFC should be performed in children having high reaction dose whatever the importance of the skin or the specific IgE sensitization to pistachio.

Use of mepolizumab in adult patients with cystic fibrosis and an eosinophilic phenotype: case series

BackgroundCystic fibrosis (CF) is characterized by inflammation, progressive lung disease, and respiratory failure. Although the relationship is not well understood, patients with CF are thought to have a higher prevalence of asthma than the general population. CF Foundation (CFF) annual registry data in 2017 reported a prevalence of asthma in CF of 32%. It is difficult to differentiate asthma from CF given similarities in symptoms and reversible obstructive lung function in both diseases. However, a specific asthma phenotype (type 2 inflammatory signature), is often identified in CF patients and this would suggest potential responsiveness to biologics targeting this asthma phenotype. A type 2 inflammatory condition is defined by the presence of an interleukin (IL)-4high, IL-5high, IL-13high state and is suggested by the presence of an elevated total IgE, specific IgE sensitization, or an elevated absolute eosinophil count (AEC). In this manuscript we report the effects of using mepolizumab in patients with CF and type 2 inflammation.ResultsWe present three patients with CF (63, 34 and 24 year of age) and personal history of asthma, who displayed significant eosinophilic inflammation and high total serum IgE concentrations (type 2 inflammation) who were treated with mepolizumab. All three patients were colonized with multiple organisms including Pseudomonas aeruginosa and Aspergillus fumigatus and tested positive for specific IgE to multiple allergens. We examined the effect of mepolizumab on patients’ lung function (FEV1), blood markers of type 2 inflammation, systemic corticosteroid use and frequency of CF exacerbations. One patient had a substantial increase in lung function after starting mepolizumab and all three patients had a substantial benefit in regards to reduced oral CCS use. While none of the patients showed significant changes in the exacerbation rates there was markedly reduced requirements for oral CCS with exacerbations. In addition, mepolizumab had a positive effect on type 2 inflammatory markers, reducing markers of allergic inflammation in all 3 patients.ConclusionsMepolizumab appears to have a positive effect on clinical course in patients with CF presenting with a type 2 phenotype characterized by allergic sensitization and hyper-eosinophilia.

Hypertrophy of adenoid vegetation: causes and methods of treatment

Topicality: Nasal congestion, nasal breathing disorders and nasal discharge are the most common complaints that parents of ill children refer to an otolaryngologist and pediatrician. The prevalence of allergic pathology in patients with adenoid vegetation hypertrophy (AН) varies from 22 to 73% according to various authors. Aim: To determine the prevalence of allergic rhinitis among patients with hypertrophy of adenoid vegetations, a prospective study was conducted. Materials and methods: 50 children with hypertrophy of adenoid vegetation aged 4 to 14 years were examined. A comprehensive screening study to detect specific IgE sensitization to the most common inhalation and food allergens. Results: Sensitization to inhaled allergens was detected in 48% of cases. In 8% of cases it coincided with food with food allergy. Only food allergy was detected in 1 child (2%). Timely etiopathogenetic therapy with topical nasal corticosteroids in patients with AN will avoid relapses after adenoidectomy and normalize nasal breathing, and in some cases, avoid surgery.

Chronic Rhinosinusitis with Nasal Polyps in Older Adults: Clinical Presentation, Pathophysiology, and Comorbidity.

Chronic rhinosinusitis and nasal polyps (CRSwNP) is a common condition that significantly affects patients' life. This work aims to provide an up-to-date overview of CRSwNP in older adults, focusing on its aging-related clinical presentations, pathophysiology, and comorbidity associations including asthma. Recent large population-based studies using nasal endoscopy have shown that CRSwNP is a mostly late-onset disease. Age-related changes in physiologic functions, including nasal epithelial barrier dysfunction, may underlie the incidence and different clinical presentations of CRSwNP in older adults. However, there is still a paucity of evidence on the effect of aging on phenotypes and endotypes of CRSwNP. Meanwhile, late-onset asthma is a major comorbid condition in patients with CRSwNP; they frequently present with type 2 inflammatory signatures that are refractory to conventional treatments when they are comorbid. However, as they are more commonly non-atopic, causative factors other than classical atopic sensitization, such as Staphylococcus aureus specific IgE sensitization, are suggested to drive the type 2 inflammation. There are additional comorbidity associations in older patients with CRSwNP, including those with chronic otitis media and head and neck malignancy. Age is a major determinant for the incidence and clinical presentations of CRSwNP. Given the heterogeneity in phenotypes and endotypes, longitudinal investigations are warranted to elucidate the effects of aging on CRSwNP.

Prevalence of Hymenoptera venom allergy and sensitization in the population-representative German KORA cohort

Purpose Allergic reactions to Hymenoptera venoms represent potentially life-threatening conditions. However, studies on their prevalence in Germany and their relation to specific IgE sensitization are rare. The aim of this study was to evaluate the prevalence of Hymenoptera venom allergy as well as the frequency of venom-specific IgE sensitization in a large population-based adult German cohort.

Food Allergy in Adults: Substantial Variation in Prevalence and Causative Foods Across Europe

According to the community-based EuroPrevall surveys, prevalence of self-reported food allergy (FA) in adults across Europe ranges from 2% to 37% for any food and 1% to 19% for 24 selected foods. To determine the prevalence of probable FA (symptoms plus specific IgE-sensitization) and challenge-confirmed FA in European adults, along with symptoms and causative foods. In phase I of the EuroPrevall project, a screening questionnaire was sent to a random sample of the general adult population in 8 European centers. Phase II consisted of an extensive questionnaire on reactions to 24 preselected commonly implicated foods, and measurement of specific IgE levels. Multiple imputation was performed to estimate missing symptom and serology information for nonresponders. In the final phase, subjects with probable FA were invited for double-blind placebo-controlled food challenge. Prevalence of probable FA in adults in Athens, Reykjavik, Utrecht, Lodz, Madrid, and Zurich was respectively 0.3%, 1.4%, 2.1%, 2.8%, 3.3%, and 5.6%. Oral allergy symptoms were reported most frequently (81.6%), followed by skin symptoms (38.2%) and rhinoconjunctivitis (29.5%). Hazelnut, peach, and apple were the most common causative foods in Lodz, Utrecht, and Zurich. Peach was also among the top 3 causative foods in Athens and Madrid. Shrimp and fish allergies were relatively common in Madrid and Reykjavik. Of the 55 food challenges performed, 72.8% were classified as positive. FA shows substantial geographical variation in prevalence and causative foods across Europe. Although probable FA is less common than self-reported FA, prevalence still reaches almost 6% in parts of Europe.

Prevalence of Hymenoptera venom allergy and sensitization in the population-representative German KORA cohort

Allergic reactions to Hymenoptera venoms represent potentially life-threatening conditions. However, studies on their prevalence in Germany and their relation to specific IgE sensitization are rare. The aim of this study was to evaluate the prevalence of Hymenoptera venom allergy as well as the frequency of venom-specific IgE sensitization in a large population-based adult German cohort. Questionnaire data were collected from the participants of the German population-based KORA (Cooperative Health Research in the Region of Augsburg) S4 baseline study population (n = 4,261) and the follow-up F4 study population (n = 3,074), which was conducted seven years later. Moreover, sIgE antibodies to honeybee (HBV) and yellow jacket venom (HJV) as well as to common aeroallergens were measured in the S4 study population. The prevalence of systemic sting reactions ranged between 2.3 % and 2.6 %. sIgE sensitization (≥ 0.35 kUA/L) to HBV and YJV was demonstrated in 23.1 % and 31.7 % of the population, respectively (41.6 % to HBV and/or YJV). Double-sensitization to both venoms occurred in 13.2 % of the individuals. Approximately 53 % and 77 % of the individuals who reported shock symptoms after honeybee and yellow jacket stings, respectively, exhibited sIgE ≥ 0.35 kUA/L to the culprit venom. In contrast, only 2.8 % of the venom-sensitized individuals reported symptoms exceeding local reactions. Local reactions were reported by 4.4 to 4.8 % of the population. Self-reported Hymenoptera sting reactions and venom sensitization are frequent in the general German population. In many cases, sensitization and clinically relevant allergy are not observed in the same individual, indicating that comprehensive diagnostic approaches are a prerequisite for the identification of patients at risk for severe reactions.

MARKERS OF TH2 INFLAMMATION IN PATIENTS WITH CHRONIC SPONTANEOUS URTICARIA: A SYSTEMATIC LITERATURE REVIEW

Introduction Identifying specific IgE sensitization in patients with chronic spontaneous urticaria (CSU) is not recommended by current guidelines. The objective of this review was to evaluate markers of TH2 inflammation in all patients with CSU undergoing treatment with omalizumab. Methods Systematic literature reviews were conducted using the PubMed, Medline and Google Scholar electronic databases for English studies published in peer-reviewed journals between 2010 to 2018 to identify studies of CSU where markers of TH2 inflammation were determined. Results A total of 18 studies were identified, involving 1892 patients. Thirteen studies found the mean total IgE levels in the CSU population to be elevated at 211.5 IU/ml (normal 133-570.6 IU/mL, and an absolute range of values of 0-5600 IU/mL. On average, 39% of the CSU population had IgG autoantibody directed to the high-affinity receptor for the Fc region of IgE (FcεRIa) compared to 2.9% in control groups. Patients with CSU were 5.4 times more likely to have IgG autoantibody to FcεRIa (95% CI 2.8-10.6) than the controls (p < 0.00001). Mean total blood eosinophil % was elevated at 5.5% (n = 279) (normal ≤ 4%), despite many patients being on systemic corticosteroids. Conclusions Elevated levels of total IgE, blood eosinophil counts, and FcεRIa-specific autoantibodies in the CSU population may indicate the importance of TH2 inflammation in the pathogenesis of CSU. Perhaps the role of specific IgE sensitization in CSU should be revisited. Identifying specific IgE sensitization in patients with chronic spontaneous urticaria (CSU) is not recommended by current guidelines. The objective of this review was to evaluate markers of TH2 inflammation in all patients with CSU undergoing treatment with omalizumab. Systematic literature reviews were conducted using the PubMed, Medline and Google Scholar electronic databases for English studies published in peer-reviewed journals between 2010 to 2018 to identify studies of CSU where markers of TH2 inflammation were determined. A total of 18 studies were identified, involving 1892 patients. Thirteen studies found the mean total IgE levels in the CSU population to be elevated at 211.5 IU/ml (normal 133-570.6 IU/mL, and an absolute range of values of 0-5600 IU/mL. On average, 39% of the CSU population had IgG autoantibody directed to the high-affinity receptor for the Fc region of IgE (FcεRIa) compared to 2.9% in control groups. Patients with CSU were 5.4 times more likely to have IgG autoantibody to FcεRIa (95% CI 2.8-10.6) than the controls (p < 0.00001). Mean total blood eosinophil % was elevated at 5.5% (n = 279) (normal ≤ 4%), despite many patients being on systemic corticosteroids. Elevated levels of total IgE, blood eosinophil counts, and FcεRIa-specific autoantibodies in the CSU population may indicate the importance of TH2 inflammation in the pathogenesis of CSU. Perhaps the role of specific IgE sensitization in CSU should be revisited.

Relationship between mold exposure, specific IgE sensitization, and clinical asthma: A case-control study

BackgroundMost of the findings related to the noxious effect of mold sensitization on asthma come from investigations based on Alternaria alternata, Cladosporium herbarum, and Aspergillus fumigatus. However, species such as Penicillium spp, Cladosporium sphaerospermum, Cladosporium cladosporioides, or Aspergillus versicolor display a more pronounced indoor tropism, and their potential harmful respiratory effects cannot be neglected. ObjectiveThe goal of this work was to relate mold sensitizations with asthma severity and with the level of indoor mold contamination among mold-sensitized patients with asthma and nonsensitized patients with asthma. MethodsA case-control study was conducted and several asthma severity markers were compared between patients with asthma with and without mold sensitization. Indoor contamination of patients’ dwellings was also investigated. ResultsOur findings confirmed the association between sensitization to A fumigatus and severity for patients with asthma in contrast with sensitization to other species. Indoor mold contamination was detected in approximately 90% of dwellings. Overall mold exposure was not associated with asthma severity. However, regardless of the sensitization, exposure to A fumigatus and Penicillium spp in dust was linked to an increased risk of severe asthma. ConclusionThe harmful nature of mold sensitization and mold exposure for patients with asthma was not confirmed in this study. However, sensitization to A fumigatus was associated with an increased risk for severe asthma. A better investigation of the properties of Penicillium spp is recommended because its exposure was found to be associated with a more pronounced impairment of lung function.

Specific IgE sensitization to honey bee venom and auto-injector adrenaline prescriptions for Japanese beekeepers

Specific IgE sensitization to honey bee venom and auto-injector adrenaline prescriptions for Japanese beekeepers

Evaluation of the sensitivity of Moroccans to shrimp tropomyosin and effect of heating and enzymatic treatments

ABSTRACTThe aim of this work was to evaluate the IgE-sensitivity to shrimp tropomyosin (ST) in a Moroccan population from Fez region, and then to study the effect of temperature and enzymatic digestion on the allergenicity of ST. This work was conducted with a questionnaire completed by a sera-bank, obtained from 500 patients recruited from Fez Hospitals. Their sera were analyzed for specific IgE-sensitivity to ST. From questionnaire, 9.8% reported allergy to fish and shellfish where shrimp was one of the most common species causing allergy in patients. Evaluation of specific IgE showed that 10.2% of patients present higher values. Further indirect ELISA and Dot-blot results indicated that ST showed a decrease in the human IgE binding under heating or pepsin hydrolysis. These results demonstrate that this population was sensitive to ST and the sensitivity could be reduced by heating and more where it was digested by pepsin.