What 2012 food allergy

WHAT YOU SHOULD HAVE READ BUT….2012

 food allergy
Attilio Boner
University of
Verona, Italy

•Epidemiology

•Prevalence

•Time trends

Personal and parental nativity as risk factors for food
sensitization Keet JACI 2012;129:169

OR for sensitization
Nativity classified as to any food
2.5 –
US-born or
foreign-born, and 2.0 –
the age of immigration
was estimated. 1.5 –
2.05
p<0.001
1.0 –
Food sensitization
defined specific IgE 0.5 -
level ≥0.35 kU/L
to milk, egg, or peanut. 0.0
Compared with those born
outside the United States (US),
US-born children and
adolescents.


Nativity classified as to any food among the
US-born or 3.0 – foreign-born group
foreign-born, and
2.68
2.5 –
the age of immigration
was estimated. 2.0 –
p<0.02
1.5 –
1.0 –
defined specific IgE
level ≥0.35 kU/L 0.5 -
to milk, egg, or peanut.
0.0
Children arrived before
2 years of age.


Nativity classified as to any food within the
US-born or US-born group
2.5 –
foreign-born, and
the age of immigration 2.0 –
was estimated.
1.5 –

Food sensitization 1.0 –
1.53
defined specific IgE p<0.02
level ≥0.35 kU/L 0.5 -
to milk, egg, or peanut.
0.0
Compared with children
of immigrants.


Although OR for sensitization
Nativity classified as to any food within the
foreign-born children
US-born or US-born group
and adolescents 2.5 –
foreign-born, and risk
are at lower
the age of sensitization
of food immigration 2.0 –
was estimated.
compared with those 1.5 –
born in the US,
among those born 1.0 –
1.53
definedUS, the IgE
in the specific children p<0.02
level ≥0.35 kU/L are
of immigrants 0.5 -
milk, egg, or peanut
to at the highest risk..
0.0
Compared with children
of immigrants.

Season of birth and childhood food allergy in Australia
Mullins Pediat Allergy Immunol 2011;22:583

Among food allergic children
60 –
p<0.001
50 –
57%
 Season of birth in 40 –
835 children aged
30 –
43%
0–4 yr assessed
1995–2009 20 –

10 –

0
Autumn-winter Spring-summer
BORN


Among children prescribed EpiPens
60 –
p<0.001
50 –
54%
 Season of birth in
835 children aged
40 –
46%
30 –
0–4 yr assessed
1995–2009 20 –

10 –

0
BORN


Among children prescribed
hypoallergenic formula
60 –
p<0.001
50 –
54%
835 children aged
40 –
46%
30 –
0–4 yr assessed
1995–2009 20 –

10 –

0
BORN


835 children aged
0–4 yr assessed
1995–2009

The relationship between average monthly
ultraviolet radiation exposure and food and
peanut allergy rates per month.


Suggest that
ultraviolet light
 Season of birth in D
exposure/vitamin
835 children aged
status may be one
0–4 yr assessed
of many potential
1995–2009
factors contributing
to childhood food
allergy pathogenesis.

The relationship between average monthly
ultraviolet radiation exposure and food and
peanut allergy rates per month.

Race, ancestry and development of food-allergen
sensitization in early childhood Kumar Pediatrics 2011;128:e821

% children with food sensitization
sIgE of ≥0.35 kUA/L
40 –
 1104 children
(mean age: 2.7 yrs).
 IgE levels
30 –

20 –
35.5%
of ≥0.35 kilo-units
of allergen (kUA/L)
for any of 8 common 10 –
food allergens.
0


OR for food sensitization

3 –
 1104 children
 IgE levels
2 –
2.34
of allergen (kUA/L) 1 –
for any of 8 common
food allergens.
0
Black race


OR for food sensitization

African ancestry 3 –
 1104 children
were associated
 IgE levels a high
with
number (≥3)
2 –
2.34
of allergen (kUA/L)
of food
for any of 8 common
1 –

sensitizations.
food allergens.
0
Black race

Gene-vitamin D interactions on food sensitization:
a prospective birth cohort study Liu, Allergy 2011;66:1442

% children with
 649 children enrolled at
birth;
50 –
 Vitamin D deficiency as cord
blood 25(OH)D < 11 ng/ml; 40 – 44%
 Food sensitization:
30 – 37%
sIgE ≥ 0.35 kUA/l to any
of 8 common food allergens;
20 –
 Single-nucleotide
polymorphisms (SNPs) in 11 10 –
genes known to be involved in
regulating IgE and 25(OH)D 0
concentrations. Vitamin D deficiency Food sensitization


 649 children enrolled at OR for food sensitization in
birth; children with vitamin D
 Vitamin D deficiency as cord deficiency
blood 25(OH)D < 11 ng/ml; 2 –
sIgE ≥ 0.35 kUA/l to any 1.79
of 8 common food allergens; 1 –
polymorphisms (SNPs) in 11
0
regulating IgE and 25(OH)D
concentrations. IL4 gene polymorphism
(rs2243250) CC/CT genotypes


Similar but weaker
 Vitamin D deficiency as cord deficiency
interactions were
blood 25(OH)D < 11 ng/ml;
observed for SNPs 2 –
in MS4 A2
sIgE ≥ 0.35 kUA/l to any
(rs512555), FCERIG 1.79
of 8 (rs2070901), and
common food allergens; 1 –
CYP24A1
(rs2762934).
0


 Vitamin D all four SNPs
When deficiency as cord deficiency
blood 25(OH)D < 11 ng/ml;
were simultaneously 2 –
 Food sensitization:strong
considered, a
gene-VSS interaction
sIgE ≥ 0.35 kUA/l to any 1.79
of 8 commonevident
was food allergens;
1 –
(pinteraction =9x10-6)
0

The incidence and risk factors of immediate type food
allergy during the first year of life in Korean infants:
a birth cohort study. Kim Pediat Allergy Immunol 2011;22:715

% infants with food allergy
 Pregnant women
6 –
≥34 weeks of gestation
were enrolled. 5 –

 1177 infants.
4 – 5.3%
3 –
 through telephone 2 –
interviews at 4, 8,
1 –
and 12 months of age.
0

The incidence and risk factors of immediate type food
allergy during the first year of life in Korean infants:
a birth cohort study. Kim Pediat Allergy Immunol 2011;22:715

OR for food allergy
4.0 –
 Pregnant women
≥34 weeks of gestation
were enrolled. 3.0 – 3.48
3.2
p=0.005
 1177 infants. 2.0 – p=0.012

 through telephone
1.0 –
interviews at
4, 8, and
12 months of age. 0.0
History of Born in autumn
maternal AD vs spring

Anisakis hypersensitivity in Italy: prevalence and clinical
features: a multicenter study Asero, Allergy 2011;66:1563

% Subjects
0,6 –
 10 570 subjects.
 Consecutive subjects seen 0.4 –
4.5 %
at 34 Italian allergy
centers from October to (474/10570)
0.2 –
December 2010.

 Skin prick test (SPT) with 0.0 –
Anisakis simplex extract. Anisakis simplex
(+) SPTs


% Subjects
,6 –

• 34 (52%) patients were
.4 –
4.5 % monosensitized to Anisakis.
(474/10570)
.2 – • And 66 of these
(14% of those sensitized)
had a history of As allergy.
.0 –
Anisakis simplex
(+) SPTs


% Subjects
,6 –
Marinated
• 34anchovies were
(52%) patients were
.4 –
4.5 % the most
monosensitized to Anisakis.
(474/10570) frequent cause
• And 66 of these
.2 –
of allergic
(14% of those sensitized)
reactions
had a history of As allergy.
.0 –
Anisakis simplex
(+) SPTs

• Food allergy natural
history

Ovomucoid (Gal d 1) specific IgE detected by microarray
system predict tolerability to boiled hen’s egg
and an increased risk to progress to multiple environmental
allergen sensitization. Alessandri, Clin Exp Allergy 2012;42:441

% subjects
 68 children
with a suspected 60 –
egg allergy. 50 –
51.4%
 Double- 40 –
blind, placebo-
controlled 30 –
food challenge 28%
20 –
with boiled & raw eggs. 20.5%
10 –
 sIgE to egg allergens
available on the 00
immunosolid phase Reactive to both Reactive to Tolerated both
raw&boiled egg raw egg only raw&boiled egg
allergen chip (ISAC)
103 microarray.


% Gal d 1 negative subjects
 68 children
100 –
with a suspected
egg allergy.
94%
90 –
80 –
 Double-blind, 70 –
placebo-controlled
60 –
food challenge
50 –
with boiled & raw eggs.
40 –
 sIgE to egg allergens 30 –
available on the 20 –
immunosolid phase
10 –
0
103 microarray.
tolerated boiled egg


% Gal d 1 negative subjects
 68 children
100 –
with a suspected
egg allergy.
94%
90 –

 Double- d 1 negative
Gal 80 –
70 –
blind, children placebo-
have 60 –
controlled frequency
a high 50 –
food challenge
with boiledtolerance
of & raw eggs. 40 –
to boiled egg. 30 –
available on the
10 –
immunosolid phase
0
tolerated boiled egg
103 microarray.


% Gal d 1 positive subjects
 68 children
100 –
with a suspected
egg allergy.
95%
90 –
80 –
 Double- 70 –
blind, placebo-
60 –
controlled
50 –
food challenge
with boiled & raw eggs. 40 –
30 –
available on the
10 –
immunosolid phase
0
reacting to raw eggs
103 microarray.


% Gal d 1 positive subjects
 68 children
100 –
with a suspected
egg allergy.
95%
90 –
80 –
 Double-blind,1 positive
Gal d 70 –
placebo-controlled
children have
food challenge
60 –

witha high frequency
boiled & raw eggs. 50 –

of hen’s egg allergy.
 sIgE to egg allergens
40 –
30 –
available on the 20 –
immunosolid phase
10 –
0
103 microarray.
reacting to raw eggs

Presence of functional, autoreactive human milk-specific
IgE in infants with cow’s milk allergy.
Järvinen, Clin Exp Allergy 2012;42:238

Background Occasionally, exclusively breastfed infants
with cow’s milk allergy (CMA) remain symptomatic
despite strict maternal milk avoidance.

Objective To determine whether or not persistence
of symptoms could be due to sensitization against
endogenous human milk proteins with a high degree
of similarity to bovine allergens.


1. 9 of the 15 breastfed
 10 peptides representing known
bovine milk IgE-binding epitopes
infants became
[α-lactalbumin (ALA), β- and k-casein] asymptomatic
and the corresponding, highly during strict maternal
homologous human milk peptides avoidance of milk
labelled with sera from 15 breastfed & other major food
infants with CMA.
allergens.
 Functional capacity of specific IgE
antibodies assessed by measuring 2. 6 infants remained
β-hexosaminidase release from rat
basophilic leukaemia cells passively
symptomatic until
sensitized and stimulated with weaned.
human and bovine ALA.


% of allergic infants with serum IgE
recognizing at least 1 human milk peptide
 10 peptides representing known 100 –
90 –
[α-lactalbumin (ALA), β- and k-casein]
and the corresponding, highly 80 –
homologous human milk peptides 70 –
labelled with sera from 15 breastfed 60 –

60%
infants with CMA.
50 –
 Functional capacity of specific IgE 40 –
antibodies assessed by measuring 30 – 9/15
20 –
10 –
sensitized and stimulated with
human and bovine ALA. 0


% of allergic infants with serum IgE
recognizing at least 1 human milk peptide
 10 peptides representing known
There was a trend 100 –
towards specific IgE
[α-lactalbumin (ALA), β- and k-casein] 90 –
being detected
and the corresponding, highly 80 –
homologous human milk peptides
to more human milk peptides 70 –
labelled with sera from 15 breastfed
in those infants who 60 –

60%
infants with CMA. respond
did not 50 –
to the maternal
 Functional capacity of specific IgE 40 –
antibodies assessed by measuring
milk elimination diet 30 – 9/15
than in those who did 20 –
(p=0.099).
sensitized and stimulated with 10 –

human and bovine ALA. 0

Seafood allergy in children: a descriptive study
Turner Ann Allergy Asthma Immunol 2011;106:494

% children with co-existent
atopic disease
100 –
90 –

 167 children with
80 –
70 – 94%
history of 60 –

definite clinical 50 –

reaction to 40 –

seafood and/or 30 –

positive food 20 –

challenge. 10 –
0


Common seafood triggers in
children with seafood allergy

 Prawn/shrimp was
the most common
seafood implicated.

 One-fifth
presented with
a history of
anaphylaxis to
seafood.


Size of skin prick test (SPT) wheal in relation to outcome of oral food challenges
performed to seafood (all challenges), crustacean only, and canned fish.


Size of skin prick test (SPT) wheal in relation to outcome of oral food challenges
Over 50% of crustacean-allergic children
performed to seafood (all challenges), crustacean only, and canned fish.
could tolerate non-crustacean fish.


Risk Factors for Anaphylaxis to Seafood

a

a

Spice allergy
Chen Ann Allergy Asthma Immunol 2011;107:191

1) Spice allergy seems to be rare, affecting between 4 and 13 of
10,000 adults and occurring more often in women because of
cosmetic use.
2) Most spice allergens are degraded by digestion; therefore,
IgE sensitization is mostly through inhalation of
cross-reacting pollens, particularly mugwort and birch.
3) The symptoms are more likely to be respiratory when exposure
is by inhalation and cutaneous if by contact.
4) Studies on skin testing and specific IgE assays are limited and
showed low reliability.
5) The diagnosis primarily depends on a good history taking and
confirmation with oral challenge.

Spice allergy

Manifestations of Immunologically Mediated Reactions to Spices

Spice allergy
Allergens Identified in Spicesa

aFrom Scholl and Jensen-Jarolim, Vieths et al, Breiteneder and Radauer, Egger et al,
and Gomez-Gomez et al.

• Food allergy diagnosis
• SPTs
• sIgE

Is epitope recognition of shrimp allergens useful to
predict clinical reactivity? Ayuso, Clin Exp Allergy 2012;42:293

Background Shrimp is a frequent cause of severe
allergic reactions world-wide. Due to issues such as
cross reactivity, diagnosis of shrimp allergy is still
inaccurate, requiring the need for double-blind,
placebo-controlled food challenges (DBPCFC).
A better understanding of the relationship between
laboratory findings and clinical reactivity is needed.
Objective To determine whether sensitization to certain
shrimp allergens or recognition of particular IgE epitopes
of those allergens are good biomarkers of clinical reactivity
to shrimp.


% of patients with a positive
challenge to shrimps
100 –
 37 patients with 90 –
shrimp allergy. 80 –
70 –
 Skin prick test,
60 –
sIgE, DBPCFC.
50 –
 IgE binding to synthetic
46%
40 –
peptides 30 –
(Lit v1, Lit v2, Lit v3, Lit v4). 20 –
10 –
17/37
0



 37 patientsmicroarray,
By with 100 –
90 –
patients
with positive 70 –
 Skin prick
test,
challenges showed
specific IgE 60 –
more intense binding
determinations, DBPCFC. 50 –

to shrimp peptides.
46%
40 –
 IgE binding to synthetic
Particularly
peptides (Lit v1, Lit
30 –
20 –
v2, for Lit v1 & Lit v2
Lit v3, Lit v4). 10 –
17/37
epitopes. 0


100 –
 37 patients with 90 –
IgE antibodies

 Skin prick these shrimp
to 70 –

epitopes could be IgE
test, specific used 60 –

as biomarkers for
determinations, DBPCFC. 50 –

46%
40 –
 IgE prediction of clinical
binding to synthetic 30 –
reactivity.
peptides (Lit v1, Lit 20 –
v2, Lit v3, Lit v4). 10 –
17/37
0

Tropomyosin IgE-positive results are a good predictor of
shrimp allergy Gàmez, Allergy 2011;66:1375

Background: Shrimp is a common cause of
food allergy. Our aims were to determine
the value of IgE antibodies in the
diagnosis of shrimp allergy and to study
red shrimp (Solenocera melantho)
tropomyosin both as a new allergen and as
a crossreactive IgE-binding protein.


1) Shrimp allergy was confirmed in
18 shrimp-allergic patients.

45 subjects; 2) Skin prick test and IgE
antibodies to shrimp were
positive in all shrimp-allergic
Skin prick test (SPT)
patients.
and specific IgE (sIgE) to
shrimp, recombinant and 3) sIgE to rPen a 1 was detected in
natural shrimp 98% of these patients.
tropomyosins rPen a 1 and
nPen m 1, recombinant 4) Of the 18 shrimp-tolerant
Der p 10, and patients, 61% had positive SPT to
Dermatophagoides shrimp, 55% were IgE-positive to
pteronyssinus shrimp, and 33% showed IgE
antibodies to rPen a 1.


1) Shrimp allergy was confirmed in
18 shrimp-allergic patients.

45 subjects; 2) Skin prick test and IgE
antibodies to shrimp were
IgE levels positive in all shrimp-allergic
Skin prick test (SPT)
patients.
and specific IgEa 1
to rPen (sIgE) to
provided
shrimp, recombinant and 3) sIgE to rPen a 1 was detected in
natural shrimp value
additional
98% of these patients.
tropomyosinsdiagnosis and
to the rPen a 1
of
nPen m 1, recombinant 4) Of the 18 shrimp-tolerant
Der p shrimp allergy.
10, and patients, 61% had positive SPT to
Dermatophagoides shrimp, 55% were IgE-positive to
pteronyssinus shrimp, and 33% showed IgE
antibodies to rPen a 1.

Patients suffering from non-IgE-mediated cow’s milk
protein intolerance cannot be diagnosed based on
IgG subclass or IgA responses to milk allergens
Hochwallner H, Allergy 2011;66:1201

Background: Cow’s milk is one of the most common causes of food
allergy. In two-thirds of patients, adverse symptoms following milk
ingestion are caused by IgE-mediated allergic reactions, whereas
for one-third, the mechanisms are unknown.
Aim of this study was to investigate whether patients suffering
from non-IgE-mediated cow’s milk protein intolerance can be
distinguished from persons without cow’s milk protein intolerance
based on serological measurement of IgG and IgA specific for
purified cow’s milk antigens.

Patients suffering from non-IgE-mediated cow’s milk
protein intolerance cannot be diagnosed based on
IgG subclass or IgA responses to milk allergens
Hochwallner H, Allergy 2011;66:1201

 IgG1–4 subclass and IgA antibody
to recombinant αS1-casein, Cow’s milk protein
αS2-casein, β-casein, κ-casein, intolerant patients
α-lactalbumin, and β-lactoglobulin. cannot be
distinguished from
 Patients with IgE-mediated cow’s
persons without
milk allergy (CMA, n = 25),
cow’s milk protein
patients with non-IgE-mediated
intolerance (CMPI, n = 19), intolerance on the
patients with gastrointestinal basis of
symptoms not associated with IgG subclass or
cow’s milk ingestion (GI, n = 15) IgA reactivity to
and control persons (C, n = 26) cow’s milk allergens.

• Food allergy diagnosis
• challenges

The eliciting dose of peanut in double-blind, placebo
controlled food challenges decreases with increasing age
and specific IgE level in children and young adults
Zee, JACI 2011;128:1031

Background:
Several risk factors for severe anaphylactic reactions to food
in daily life are known.
However, to date, it is not possible to predict the severity
of allergic reactions to food in the individual patient with accuracy.
Some studies show that a history of severe reactions is associated
with a lower eliciting dose in double-blind, placebo-controlled food
challenges (DBPCFCs). Therefore, in this study, the eliciting dose
was used as a measure of clinical sensitivity.

Zee, JACI 2011;128:1031

The cumulative doses of peanut
in the 3 age groups.
 Children who had
clinical reactions to
peanut during DBPCFCs
(2001-2009).
 126 positive DBPCFCs.

Zee, JACI 2011;128:1031
Kaplan-Meier survival curves Kaplan-Meier survival curves for
for 3 age groups. children in tertiles of specific IgE.

Age older than JACI 2011;128:1031
Zee, 10 years and a specific IgE
Kaplan-Meier survival curves lowest tertile (≥5.6 kU/L) for
level above the Kaplan-Meier survival curves
were associated with
reactions to lower doses.

Zee, JACI 2011;128:1031
This finding may explain why adolescents experience
Kaplan-Meier survival curves
severe allergic reactions in daily life to curves for
Kaplan-Meier survival peanut
more often than do younger children.

Outcomes of office-based, open food challenges in the
management of food allergy. Lieberman, JACI 2011;128:1120

 Open oral food challenges
(OFCs) performed at % of (+) challenge
outpatient practice. 25 –

 Patients were typically 20 –
not referred if the
likelihood of a
positive reaction
15 – 18.8%
was thought to be >50%. 10 –
 sIgE levels and/or SPT. 05 –
 A total of 701 open OFCs
in 521 different patients. 0


 Open oral food challenges
All but 1 reaction
(OFCs) performed the
was managed in at % of (+) challenge
outpatient practice.
office setting; 25 –

 Patients weretransferred
1 patient was typically 20 –
not referred if the
to the emergency
likelihood of a
department
positive reaction and
15 – 18.8%
for monitoring
was thought to be >50%.
intravenous fluids due 10 –
to persistent vomiting
 sIgE levels and/or SPT. 05 –
following a challenge
 A totalto peanut. OFCs
of 701 open
in 521 different patients. 0


• Patients who passed the OFC without adverse symptoms
had significantly smaller SPT wheal size
(median=3.00 mm vs 4.00 mm, p=0.0001) and significantly
lower sIgE levels to the challenged foods
(median=0.63 kUA/L vs 1.06 kUA/L, p=0.027) as compared with the group
that had a reaction during the OFC.
• Patients who had an identifiable history of anaphylaxis to the
challenged food were more likely to have a reaction during the OFC
(38.5%) than those who did not have a history of anaphylaxis (18.6%).
• Patients who had never actually ingested the challenged food
but were avoiding it because of evidence of sensitization
were less likely to have a reaction during the OFC (14.0%)
as compared with those patients who had previously ingested
the challenged food and had a reaction (23.8%), p=0.0013.


% of reactions
100 –

080 – 87.9%
060 –
56.8%
040 –

020 – 9%
5% 1.5%
00
Involving Antihistamine epinephrine prednisolone albuterol
the skin alone
TREATED WITH


• Given the median specific IgE levels and the skin test results,
the majority of these patients were at relatively ‘‘low risk’’
for reaction.
• It is this exact population for which the risk-to-benefit ratio
is optimal for performing an OFC.
• A previous report of open OFC by Perry et al (JACI2004;114:1164)
in a higher-risk population (ie, individuals with higher median specific
IgE levels) demonstrated an OFC reaction rate of 43% which is
higher than may be desirable for a busy office practice.

Blood pressure monitoring in children undergoing food
challenge: association with anaphylaxis
Caffarelli, Ann Allergy Asthma Immunol 2012;108:285

The diagnosis of food allergy is based mainly on
oral food challenge (OFC).

Anaphylaxis represents the most serious outcome of OFC.

Anaphylaxis has been proposed to be highly likely when
exposure to known allergens elicits a 30% or greater
decrease in systolic blood pressure (SBP) or a low SBP for
age either isolated or accompanied by gastrointestinal,
skin, or respiratory symptoms.


 80 children % Patients with:
(18 months to 16 years).
40 –
 Not antihistamines for
7 days and corticosteroids, 30 – 32%
theophylline, leukotriene (26/80)
modifiers, or 20 –
chromoglycates for 24 h.
10 – 13.75%
 Increasing doses of food 1.25%
(egg, milk, wheat, soy). 0
Skin Gastro Bronchospasm,
 Brachial blood pressures symptoms intestinal wheezing,
were measured. reactions and coughing


 80 children % Patients with:
(18 months to 16 years).
40 – 3 of the 26 children
 Not antihistamines for with positive OFC
results had
7 days and corticosteroids, 30 – 32% symptoms consistent
theophylline, leukotriene (26/80) with anaphylaxis
modifiers, or 20 –
chromoglycates for 24 h.
10 – 13.75%
 Increasing doses of food 1.25%
(egg, milk, wheat, soy). 0
Skin Gastro Bronchospasm,
 Brachial blood pressures symptoms intestinal wheezing,
were measured. reactions and coughing


Percentage of systolic blood pressure decrease in children
with positive or negative oral food challenge results

SBP

Positive oral Negative oral
food challenge food challenge
(n=26) (n=54)



SBP

children who
had anaphylaxis

(n=26) (n=54)


Among reactive children, a SBP decrease
greater than 30% was measured in 1 child
when anaphylactic symptoms occurred.

SBP

children who
had anaphylaxis

(n=26) (n=54)


with positive or negative oral not associated
Decreased SBP was food challenge results
with the outcomes of OFCs.

SBP

children who
had anaphylaxis

(n=26) (n=54)

Thermographic imaging during nasal peanut challenge may
be useful in the diagnosis of peanut allergy.
Clark, Allergy 2012;67:574

Background: Double-blinded challenges are widely used for diagnosing
food allergy but are time-consuming and cause severe reactions.
Outcome relies on subjective interpretation of symptoms, which leads
to variations in outcome between observers.
Facial thermography combined with nasal peanut challenge was
evaluated as a novel objective indicator of clinical allergy.


Change in mean nasal temperature from baseline
(Δt) over time (min) for placebo and active peanut
nasal challenge arms.

 16 children with positive
peanut challenge.
 Nasal challenge with 10 μg
peanut protein or placebo.
 Mean skin temperatures
recorded from
the mouth & nose using
infrared thermography
over 18 min.


(Δt) over time (min) for placebo and active peanut
The area under curve nasal challenge arms.
of nasal skin temperature
 16 children with elevated
was significantly positive
peanut peanut vs placebo
after challenge.
(18.2 vs 4.8°Cmin).
 Nasal maximum increase μg
The challenge with 10
in temperature was also
significantly greater
 Mean aftertemperatures
skin peanut:
recorded from +0.9°C.
mean difference
over 18 min.


Thermography (Δt) over time (min) for placebo and active peanut
can detect inflammation nasal challenge arms.
caused by nasal challenges
 16 children with positive
whilst employing 1000-fold
peanutpeanut than an oral
less challenge.
challenge.
 Nasal challenge with 10 μg
This novel technique could
be developed to provide
a rapid, safe
 Mean skin temperatures
recorded from clinical
and objective
allergy test.
over 18 min.

Effect of roasting on the allergenicity of major peanut
allergens Ara h 1 and Ara h 2/6: the necessity of
degranulation assays. Vissers CEA 2011;41:1631

Background
Peanuts are often consumed after roasting,
a process that alters the three-dimensional
structure of allergens and leads to Maillard
modification.
Such changes are likely to affect their allergenicity.

Objective
We aimed to establish the effect of thermal treatment
mimicking the roasting process on the allergenicity of Ara h 1
and a mix of 2S albumins from peanut (Ara h 2/6).

Effect of roasting on the allergenicity of major peanut
allergens Ara h 1 and Ara h 2/6: the necessity of
degranulation assays. Vissers CEA 2011;41:1631

Conclusions and Clinical Relevance
Extensive heating:

1) reduced the degranulation capacity
of Ara h 2/6 but
2) significantly increased the
degranulation capacity of Ara h 1.

This observation can have important
ramifications for component-resolved
approaches for diagnosis.

Small-bowel capsule endoscopy in patients with
gastrointestinal food allergy. Hagel, Allergy 2012;67:286

Background: Food allergy may present
with a plethora of gastrointestinal
and extraintestinal symptoms such as
abdominal pain, diarrhea, cardiocirculatory symptoms,
cutaneous reactions, or rhinitis.
Macropathological lesions like lymphofollicular hyperplasia
and erosive or ulcerative lesions have seldom been
described in gastroscopy and colonoscopy previously.

% of patients with
100 –
90 –
 15 patients presenting with 80 –
unspecific abdominal symptoms 70 –
in which food allergy was 60 –
detected. 50 –
40 –
 Indications for small-bowel
30 –
capsule endoscopy:
- weight loss;
20 –
28.6%
10 –
- anemia. 4/15
0

Erosive lesions such as aphtoid
lesions, erosions and petechiae.

% of patients with
100 –
90 –
unspecific abdominal symptoms
Anemia improved 70 –
within 1 yr
detected. 50 –
after adequate 40 –
 Indications for small-bowel
antiallergic 30 –
capsule endoscopy:
treatment.
- weight loss;
20 –
28.6%
10 –
- anemia. 4/15
0

Erosive lesions such as aphtoid
lesions, erosions and petechiae.

% of patients with
100 –
90 –
detected. 50 –
40 –
57.1%
 Indications for small-bowel 8/15
30 –
capsule endoscopy:
20 –
- weight loss;
10 –
- anemia.
0

Nonerosive lesions such as
erythema, swelling, lymphoid
hyperplasia.

% of patients with
100 –
90 –
Lymphoid
hyperplasia
was the most
detected.
prominent finding in 50 –
57.1%
7 patients (50%),
 Indications for small-bowel 40 –
30 – 8/15
albeit
capsule endoscopy:
20 –
- weight loss; disease
infectious 10 –
- anemia.
had been 0
excluded.
Nonerosive lesions such as
erythema, swelling, lymphoid
hyperplasia.

• Food allergy
pathogenesis

Cutaneous lymphocyte antigen and α4β7 T-lymphocyte
responses are associated with peanut allergy and
tolerance in children. Chan, Allergy 2012;67:336

Background: It is unclear whether the initial route of allergen
exposure in early life could influence the subsequent development
of allergy, with cutaneous sensitization leading to peanut allergy,
and tolerance induced by oral exposure.
The skin- and gastrointestinal (GI)-homing markers, cutaneous
lymphocyte antigen (CLA) (skin) and α4β7 integrin
(gastrointestinal), are used to determine whether the state of
peanut allergy correlates with peanut-specific CLA responses, with
tolerance associated with predominant α4β7 responses.

Stimulation indices to increasing peanut antigen
concentration in the CLA+ & α4β7+ subsets of
peanut allergic&non-allergic participants.
 Proliferation of CLA+
and α4β7+ memory
T-cells isolated and
cultured with peanut
extract. p=0.008
 Stimulation indices
compared in peanut
allergic & non-allergic
(NA) groups.

The predominance of peanut allergic&non-allergic participants.
 Proliferation+ of CLA+
the CLA response
andto peanut in peanut
α4β7+ memory
allergic patients
is consistent with
extract.
the hypothesis that p=0.008
 Stimulationsensitization
allergic indices
occurs through
compared in peanut
the skin.
(NA) groups.

peanut allergic&non-allergic participants.
The predominant α4β7
 Proliferation of CLA+ +
and response in peanut
α4β7+ memory
tolerant groups
suggests that allergen
exposure through the
extract. p=0.008
GI tract induces
 Stimulation indices
tolerance.
compared in peanut
(NA) groups.

T cell activation genes differentially expressed at birth in
-

CD4+ T cells from children who develop IgE food allergy
-

Martino, Allergy 2012;67:191

 T-cell gene expression in
longitudinal samples collected at At birth,
birth and at 1 yr of age. the allergic group showed
a reduced n°of genes
 Children with (n=30) upregulated in response to
& without (n=30)
IgE-mediated food allergy.
anti–CD3 treatment
on the microarray
 A low-level soluble anti-CD3 and a reduced
stimulus to activate lymphoproliferative
the T-cell receptor (TCR) capacity, suggesting
and surveyed gene expression
by DNA microarray
clear differences
in purified CD4+ T-cells. in T-cell signalling
pathways.

T cell activation genes differentially expressed at birth in
-

CD4+ T cells from children who develop IgE food allergy
-

Martino, Allergy 2012;67:191

Although transient,
 T-cell gene expression in
longitudinal samples collected at
suboptimal neonatal At birth,
birth andactivationage.
T-cell at 1 yr of pathways the allergic group showed
that signal through a reduced n°of genes
 Children with (n=30)
the NF-kB complex upregulated in response to
& without (n=30)
may affect the
IgE-mediated food allergy.
anti–CD3 treatment
developmental transition on the microarray
of T-cell phenotypes
 A low-level soluble anti-CD3 and a reduced
in the periphery
stimulus to activate lymphoproliferative
shortly after birth
the T-cell receptor (TCR) capacity, suggesting
and may increase
and surveyed gene expression
by DNA microarray of
clear differences
the risk
in purified CD4+ T-cells.
food allergy.
in T-cell signalling
pathways.

Early complementary feeding and risk of food
sensitization in a birth cohort. Joseph JACI 2011;127:1203

% Infant exposure to
complementary food <4 months
 Introduction of
complementary food 40 –
<4 months.

 IgE to
30 – 39.7%
egg, milk, and 20 –
peanut allergen at 2
yrs. 10 –

 594 maternal-infant 00
pairs.


% children with sIgE ≥0.35 IU/mL
at age 2 yrs
35 –
 Introduction of 30 –
complementary food 30.6%
25 –
<4 months.
20 – 23.9%
 IgE to 15 –
egg, milk, and
10 –
peanut allergen at 2 11.4%
yrs. 05 –

00
 594 maternal-infant
Egg Milk Peanut
pairs.


at age 2 yrs
35 –
 Introduction of
Early feeding reduced 30 –
complementary food 30.6%
the risk of peanut 25 –
<4 months.
sensitization among 20 – 23.9%
children with a parental
IgE to 15 –
history
egg, milk, and
peanut allergen at0.2;
(adjusted OR= 2 10 –
11.4%
yrs. P = 0.007 ) 05 –

00
Egg Milk Peanut
pairs.


at age 2 yrs
35 –
 Introduction of 30 –

The association food
complementary between
25 –
30.6%
<4 months.
early feeding and
sensitization was modified
20 – 23.9%
 IgE to
egg,parental history of
by milk, and 15 –

asthma or allergy.
peanut allergen at 2 10 –
11.4%
yrs. 05 –

00
Egg Milk Peanut
pairs.

The introduction of allergenic foods and the development
of reported wheezing and eczema in childhood
Tromp APAM 2011;165:933

% children wheezing

 605 preschool children. 40 –

 Timing of introduction 30 –
of cow’s milk, hen’s 31%
egg, peanuts, tree 20 –
nuts, soy, and gluten
collected by
questionnaires at 6 and
10 –
14%
12 months of age. 0
2 yrs 3-4 yrs

Tromp APAM 2011;165:933

% children with eczema

 605 preschool children. 40 –

 Timing of introduction 30 – 38%
of cow’s milk, hen’s egg,
peanuts, tree nuts, soy, 20 –
and gluten collected by
questionnaires at 6 and 10 –
20% 18%
12 months of age. 18%
0
2 3 4
age (years)

Tromp APAM 2011;165:933
with cow’s milk introduction ≤6 mo
OR for eczema at age
1.0 –
 605 preschool children.
0.95
 Timing of introduction 0.91 0.88
of cow’s milk, hen’s egg,
peanuts, tree nuts, soy, 0.5 –
and gluten collected by
questionnaires at 6 and
12 months of age.
0.0

2 yrs 3 yrs 4 yrs

Effect of a partially hydrolyzed whey infant formula
at weaning risk of allergic disease in high-risk children:
a randomized controlled trial Lowe JACI 2011;128:360

Background
Partially hydrolyzed whey formula (pHWF)
has been recommended for infants with a family history
of allergic disease at the cessation of exclusive breast-feeding
to promote oral tolerance and prevent allergic disease.
Objectives
To determine whether feeding infants pHWF
reduces their risk of allergic disease.


 To compare a conventional
cow’s milk formula, a
pHWF, or a soy formula. There was no evidence
 620 infants with a family that infants allocated
history of allergic disease to the pHWF
were recruited and randomized or the soy formula
to receive the allocated were at lower risk
formula at cessation
of breast-feeding.
of allergic manifestations
in infancy compared with
 Follow-up at 2 yrs, at 6 or 7 conventional formula.
yrs.


 To compare a conventional
cow’s milk formula, ano evidence
We found
pHWF, support recommending
to or a soy formula. There was no evidence
the use of pHWF
 620 infants with a family that infants allocated
history of allergic disease the
at weaning for to the pHWF
were recruited and randomized
prevention of allergic or the soy formula
to receive the allocated were at lower risk
disease in
formula at cessation
high-risk infants.
of breast-feeding.
of allergic manifestations
in infancy compared with
 Follow-up at 2 yrs, at 6 or 7 conventional formula.
yrs.

Soybean isoflavones regulate dendritic cell function
and suppress allergic sensitization to peanut
Masilamani, JACI 2011;128:1242

Background:
Although peanut and soybean proteins share extensive
amino acid sequence homology, the incidence and severity of
allergic reactions to soy are much less than those to peanut.
Soybeans are rich in anti-inflammatory isoflavones and
are the most common source of isoflavones in the human food supply.
Objective:
We hypothesized that the active isoflavones in the gut milieu
are capable of modulating immune responses to dietary antigens
by regulating dendritic cell (DC) function.


Sensitized and challenged with peanut

Fed a diet fed
containing a soy-free
genistein diet
and daidzein

• Dietary isoflavones significantly reduced the
anaphylactic symptoms and mast cell degranulation
in vivo after peanut challenge.
• Serum peanut-specific antibodies were markedly
reduced in mice fed the isoflavone diet.


Activated with cholera toxin
in the presence of isoflavones

Human monocyte-derived
dendritic cells
Isoflavones inhibited
cholera toxin–induced DC maturation
and subsequent
DC-mediated CD4+ T-cell function
in vitro.


Chemical structure of the soybean isoflavones:

• Isoflavones belong to a class of molecules related to flavonoids.
• Soybeans are the most common source of isoflavones
in the human diet.
• Isoflavones, such as genistein, daidzein, and glycitein, have been shown
to have anti-inflammatory and antioxidant properties.
Barnes, Lymphat Res Biol 2010;8:89


• The immune-regulatory effects of isoflavones,
specifically genistein, have been extensively investigated.
Sakai, J Med Invest 2008;55:167
• The high intake of soy-containing foods and isoflavones
is associated with reduced prevalence of allergic rhinitis
and better lung function in asthmatic patients.
Miyake, J Allergy Clin Immunol 2005;115:1176
Smith, J Asthma 2004;41:833
• Dietary soy supplementation reduced:
- antigen-induced eosinophilia in the lungs in a pig model of asthma;
- eosinophil leukotriene C4 synthesis and eosinophilic airway inflammation
ii in asthmatic patients.
Regal, Proc Soc Exp Biol Med 2000;223:372
Kalhan, Clin Exp Allergy 2008;38:103

Single nut or total nut avoidance in nut allergic children:
outcome of nut challenges to guide exclusion diets
Ball Pediat Allergy Immunol 2011;22:808

In children allergic to peanut
 The challenge food was % reacting to treanut challenge
35 –
administered by way of
30 –
a homemade biscuit
containing 8 g of each 25 – 31.2%
nut given in increasing 20 –
visually measured doses. 15 –
10 –
 145 children peanut
allergic or tree nut 05 –
allergic. 00
0%
(-) (+)
Treanut SPTs


In children allergic to peanut
 The challenge food was % reacting to treanut challenge
35 –
Children allergic
30 –
to peanuts with
a homemade biscuit
31.2%
containing 8 g of each
negative allergy 25 –
nut given in increasing
tests to tree 20 –
visually measured doses.
nuts had no 15 –

co-existing
 145 children peanut 10 –

allergy.
allergic or tree nut 05 –
0%
allergic. 00
(-) (+)
Treanut SPTs


In children allergic to treanut
 The challenge food was % reacting to peanut challenge
40 –
38.4%
35 –
a homemade biscuit 30 –
25 –
20 –
15 –
 145 children peanut 10 –
allergic or tree nut
allergic.
05 –
00
7.9%
(-) (+)
Peanut SPTs


In children allergic to treanut
Children with tree
 The challenge food was % reacting to peanut challenge
40 –
administered by were
nut allergy way of
38.4%
35 –
a homemade biscuit
at risk of 30 –
co-existing peanut
25 –
or other tree nut
20 –

allergy whether 15 –
 145 children peanut
SPTs were positive 10 –
allergic or tree nut
or negative.
allergic.
05 –
00
7.9%
(-) (+)
Peanut SPTs

Parental perceptions and dietary adherence
in children with seafood allergy
Ng Pediat Allergy Immunol 2011;22:720

% parents unable to correctly
recall the dietary advice
30 –
 94 children with 25 –
seafood allergy.
20 –

15 –
25%
 Postal questionnaire
10 –

05 –

0


% parents using a safe diet
90 –

89%
80 –

 94 children with 70 –

seafood allergy. 60 –

50 –

40 –
30 –

20 –

10 –

0


% parents using a safe diet
90 –

But over half
89%
80 –

 94 children with more
followed a 70 –

seafood allergy. 60 –
stringent 50 –
elimination than 40 –
that 30 –

recommended. 20 –

10 –

0


Seafood triggers identified Size of skin prick test (SPT) wheal
in relation to reaction severity


Schema demonstrating study population
and degree of cross-reactivity between
crustacean, mollusc and fish.

 94 children with
seafood allergy.



 A common scenario for the parents of crustacean-allergic
children (who have previously tolerated finned fish) is to
exclude all seafood and fish from the child’s diet, even though
the child has no evidence of sensitization to non-crustacea
and had previously tolerated finned fish.
 In view of our experience lack of reactions which can be
accounted to ‘traces’ in the context of seafood allergy,
avoidance of foods labelled ‘may contain traces’ has not been
our universal recommendation with commercially produced
foods of Australian origin.
 Is theoretically possible that overadherence may result in
the development of sensitization owing to the avoidance of
a previously tolerated allergen in an atopic child.

Parents report better health-related quality of life for
their food-allergic children than children themselves
van der Velde CEA 2011;41:1431

 To compare child- and
parent-proxy reports on FAQLQ score
HRQL in food-allergic 4.0 –
children (8–12 years).
3.0 – 3.74
 Food Allergy Quality of
Life Questionnaire-Child
Form (FAQLQ-CF), and
2.0 – 2.68
Parent Form (FAQLQ-PF).
1.0 –

 Where 1 indicates no
impairment and 7 indicates 0 0
extreme impairment) Child Parents

Parents report better health-related quality of life for
their food-allergic children than children themselves
van der Velde CEA 2011;41:1431

 To compare child- and
parent-proxy reports on FAQLQ score
Parents reported
HRQL in food-allergic 4.0 –
significantly less
children (8–12 years).
impact of food 3.0 – 3.74
 Food Allergy Quality of
Lifeallergy on the
Questionnaire-Child 2.0 – 2.68
child's HRQL than
Form (FAQLQ-CF), and
children
Parent Form (FAQLQ-PF).
1.0 –
themselves.
 Where 1 indicates no
impairment and 7 indicates 0 0
extreme impairment) Child Parents

Inadvertent exposures in children with peanut allergy
Nguyen-Luu, Pediatr Allergy Immunol 2012;23:133

% children with
accidental exposures
 1411 children mean age 15 –
7.1 yr
 parents of children with
a physician-confirmed 10 – 12.5%
peanut allergy
 questionnaires about
accidental exposures 05 –
over the preceding year

0


OR for accidental exposure
7.1 yr
 parents of children with 2.33
a physician-confirmed
peanut allergy
02 –
2.04
01 –
over the preceding year 0.88
0 severe increasing
Age ≥13 yr
previous reaction disease duration
to peanut


OR for accidental exposure
7.1 yr
Children with a
 parents of children with 2.33
recent diagnosis and
peanut allergyare at
02 –
2.04
adolescents
higher risk
01 –
over the preceding year 0.88
0 severe increasing
Age ≥13 yr
previous reaction disease duration
to peanut


Annual incidence rate of accidental
exposure stratified by disease duration

 1411 children mean age
7.1 yr
 parents of children with
peanut allergy
over the preceding year

Restaurant staff's knowledge of anaphylaxis
and dietary care of people with allergies
Bailey CEA 2011;41:713

 Telephone 100 – % staff member reporting
questionnaire to 90 –
a member of staff
at 90 table-service
80 –
70 –
90%
restaurants in 60 –
Brighton. 50 –
40 –
30 –
20 – 33%
10 –
0
Food hygiene Specific food
training allergy training.

Restaurant staff's knowledge of anaphylaxis
and dietary care of people with allergies
Bailey CEA 2011;41:713

% staff members believing
 Telephone 40 –
questionnaire to
a member of staff
38%
30 –
at 90 table-service
restaurants in
Brighton.
20 –
23%
10 – 16%
00
An individual Consuming a Cooking food
experiencing a small amount prevents it
reaction should of an allergen causing allergy
drink water to is safe
dilute the allergen

The high prevalence of peanut sensitization in childhood
is due to cross-reactivity to pollen
Niggemann, Allergy 2011;66:979
Point prevalence of sensitization to
peanut in general and to peanut
without birch and/or grass

 13 100 children aged
3-17 years.

 Specific IgE
concentrations to
common aeroallergens
and foods;

Our data indicate without birch and/or grass
that the high
 Specific IgE
sensitization of
concentrationspeanut
10.9 % to to
common aeroallergens and
is predominantly
foods;due to cross-
reactivity to
 13 100 children aged 3-
pollen irrespective
17 years. age of the
of the
children

The observed without birch and/or grass
high peanut
 Specific IgE
sensitization
concentrations to
therefore does
common aeroallergens and
not indicate a
foods;
high risk for the
development of
 13 100 children aged 3-
primary allergy
17 years.
to peanut

Cow’s milk allergy as a cause of anaphylaxis to systemic
corticosteroids
Savvatianos, Siragakis, Allergy 2011;66:983
milk

 Immediate IgE-mediated allergic reactions to corticosteroids
are rather uncommon, whereas causative agents usually involve
the native steroid molecule or a pharmaceutical excipient, in
most cases as succinate ester bound to methyl-prednisolone or
hydrocortisone;

 We here report two cases of immediate reaction to
methyl-prednisolone, attributed to milk allergen contamination.

corticosteroids
milk

1) A 9 yrs old boy with severe persistent cow’s milk allergy
(CMA) was seen for asthma exacerbation;

2) The boy was administered 40 mg of methyl-prednisolone by
intravenous injection;

3) Paradoxically, wheezing deteriorated;

4) The boy was given another course of the same medication on
assumption of clinical under-responsiveness;

5) Within a few minutes the patient acutely collapsed.

corticosteroids
milk

a) Another patient, a 7-year-old boy with severe CMA was
similarly treated with intravenous administration of 40 mg
methyl-prednisolone;

b) The therapeutic intervention resulted in a full-blown
anaphylactic reaction;

c) Both children were evaluated within the next 6 months for
assumed IgE-mediated reactivity to methyl-prednisolone.

corticosteroids
milk

Skin testing results in both patients with acute
reaction to lactose-containing succinylated
methyl-prednisolone

corticosteroids
milk

Sensitization to theresultssteroid molecule andwith acute
Skin testing native in both patients to the succinate
reaction to lactose-containing succinylated
ester was ruled out by negative skin tests, while both patients exhibited
positive skin response exclusively to lactose-containing preparations.
methyl-prednisolone

corticosteroids
milk
Subsequent drug provocation tests were negative in both patients
Skin a full therapeuticboth patients with acute reaction
for testing results in dose (125 mg) of non-lactose
to lactose-containing succinylated methyl-prednisolone
containing, otherwise identical to the one that elicited the
reaction, succinylated methyl-prednisolone preparation
(Solu-Medrol 125 mg, Pfizer)

Hypersensitivity to total parenteral nutrition
fat-emulsion component in an egg-allergic child
Lunn Pediatrics 2011;128:e1025

 Intravenous fat emulsions (IFEs) are a vital component of total
parental nutrition, because they provide essential fatty acids.

 IFE is a sterile fat emulsion that contains
egg-yolk phospholipids.

 Although egg allergy is listed as a
contraindication, adverse reactions are uncommon.


 2-year-old patient with previously undocumented egg allergy.
 Placed on total parental nutrition and a 20% IFE postoperatively
and developed diffuse pruritus 14 days after initiation of
therapy.


therapy.
 She showed transient improvement with intravenous
antihistamine, but her symptoms did not resolve until the IFE
was stopped.


therapy.
was stopped.
 On the basis of clinical history, including aversion to egg,
we performed skin-prick testing, the results of which were
positive for egg white allergy.


Although ingestion of egg lecithin
in cooked food
therapy.
is generally tolerated by egg-allergic people,
administration of
intravenous egg-containing lipid
was stopped.
 On the basis of clinical may cause significant egg,
emulsions history, including aversion to
adverse reactions.
we performed skin-prick testing, the results of which were
positive for egg white allergy.

Identification of a Dau c PRPlike protein (Dau c 1.03)
as a new allergenic isoform in carrots (cultivar Rodelika).
Wangorsch, Clin Exp Allergy 2012;42:156

1) Carrot (Daucus carota) allergy is one of the most common
types of birch pollen-related food allergy in central Europe.
2) Approximately 24% of food allergic subjects suffer
from allergic symptoms after ingestion of carrots.
3) Adverse reactions to carrots are elicited due to
cross-reactive IgE-epitopes between the major
birch pollen allergen, Bet v 1 and homologous food proteins.
4) Bet v 1 and the major carrot allergen Dau c 1 belong
to the family of pathogenesis related proteins 10 (PR-10).


•The Dau c PRPlike protein
Objective To investigate was identified as a new
potential allergenic properties allergenic isoform, Dau c
of a Dau c PRPlike protein, 1.03, in carrot roots.
a novel isoform of the
pathogenesis related proteins •68% of carrot allergic
10 (PR-10) protein family in patients were sensitized to
carrot. rDau c 1.03.


Dau c 1.03 appears •The Dau c PRPlike protein
to contribute to the was identified as a new
Objective To investigate
allergenicity allergenic isoform, Dau c
potential carrots and should
of allergenic properties 1.03, in carrot roots.
of a Dau cbe considered
PRPlike protein,
a novel isoform ofsilencing
for gene the PR-10 •68% of carrot allergic
protein family in carrot.
of carrot allergens. patients were sensitized to
rDau c 1.03.

Allergenic activity of different tomato cultivars in
tomato allergic subjects. Dölle CEA 2011;41:1643

Background
Tomatoes (Solanum lycopersicum) are consumed worldwide and
their amount of consumption is associated with the prevalence
of tomato allergy. Therefore, identification of tomato cultivars
with reduced allergenicity would potentially increase the quality
of life of affected subjects.
Objective
In this study, we examined the allergenic and biological activity
of two different tomato cultivars in tomato allergic subjects.

Allergenic activity of different tomato cultivars in
tomato allergic subjects. Dölle CEA 2011;41:1643

SPT reactions to ‘Reisetomate’ (RT) and
‘Matina’ (MT). The median is depicted as
 25 subjects with black line, and outliers are shown as dots.
tomato allergy.
A
 Skin prick test
and DBPCFC to
investigate the
clinical differences
between two tomato
cultivars
(‘Reisetomate’
and ‘Matina’).

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