Allergy Digest-GREAT allergy/reaction abstracts/case studies

[Guest guest]

Some great case studies below! Hey, I think we should all be submitting LEAP

case studies to these journals!

With MRT/LEAP, we've seen often that toothpaste/mouthwash/mint/shampoo

trigger symptoms, so found the related abstract below interesting. Also, the

food

coloring abstract.

I've yet to have a client that eats kangaroo!

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Jan

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CONTENTS:

1. A selection of allergy & intolerance articles and data added to

Allergy Advisor last month

2. View the contents of recent Allergy and Dietetics journals -

http://allallergy.net/abstracts/journalContentsList.cfm

3. Allergy Advisor Information

Part of the Allergy Resources International family:

* Allergy Advisor

* Allergy Advisor Digest

* Allergy Advisor Educational Review

* Allergy Advisor Food Matters

* AllAllergy.net

____________________________________

1. SELECTION OF ALLERGY & INTOLERANCE ARTICLES

This newsletter only highlights some of the more interesting articles being

added to Allergy Advisor. More articles and abstracts can be viewed at

Allergen Advisor Digest - http://allallergy.net/abstracts/index.cfm

Grapple® Allergy: The Grape or the Apple?

This study reports on the first 2 case reports of food allergy to a new

fruit called Grapple. These cases illustrate the importance of consumer

labeling

laws and careful identification of component ingredients by food-allergic

individuals. Grapple is the registered brand name for a commercially marketed

apple that is supposed to taste like a grape. The product is created by

soaking a Fuji apple in artificial grape flavoring (according to the

ingredients

listed on the label). " Imagine the sweet distinctive flavor of Concord grapes

combined with the crispness of a fresh, juicy Washington Extra Fancy apple. "

" This process is complex and the ingredient mix primarily includes

concentrated grape flavor and pure water. "

Otto HF, Tankersley MS.

Grapple® Allergy: The Grape or the Apple?

Int Arch Allergy Immunol 2007 Feb 9;143(3):211-215

____________________________________

Delayed anaphylaxis to walnut following epinephrine administration.

Delayed anaphylaxis to walnut following epinephrine administration. A report

of a 7-year-old girl with known walnut allergy but a highly atypical

reaction. Following accidental ingeston of one bite of a walnut-containing

salad,

the patient's mother injected her with 0.15 mg epinephrine within 5 min of

ingestion although no clinical reaction was noted prior to administration.

After

90 mins of observation (2.5 hours after ingestion), the patient acutely

developed diffuse pruritus, cough, wheeze, erythema, and urticaria. Further

treatment resulted in resolution of symptoms.

Green TD, Palmer KP, Burks AW.

Delayed anaphylaxis to walnut following epinephrine administration.

J Pediatr 2006 Nov;149(5):733-734

____________________________________

White button mushroom food hypersensitivity in a child.

A 13-year-old boy with anaphylaxis to edible white button mushroom, a

disorder not previously described. For the previous two years, he complained of

increasing nausea, discomfort in the mouth and throat and itching of the ears

whenever he ingested mushroom in food. A year previously, after ingesting

mushroom in pasta, he rapidly developed discomfort in the mouth, itchy ears,

nausea and diaphoresis. Profuse vomiting developed after 20 mins but symptoms

then

resolved. Six month previously, while his mother was cooking white button

mushroom at home, while in an adjacent area and within 2 min of commencement of

cooking the mushroom, he developed pruritus of the face, ears and neck,

discomfort in the throat and he became distressed, Skin prick test was positive

for raw and cooked mushroom.

Ho MH, Hill DJ.

White button mushroom food hypersensitivity in a child.

J Paediatr Child Health 2006 Sep;42(9):555-556

____________________________________

Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines

for effective dietary management.

Dietary fructose induces abdominal symptoms in patients with fructose

malabsorption, but there are no published guidelines on its dietary management.

The

objective was to retrospectively evaluate a potentially successful diet

therapy in patients with irritable bowel syndrome and fructose malabsorption.

Tables detailing the content of fructose and fructans in foods were

constructed.

A dietary strategy comprising avoidance of foods containing substantial free

fructose and short-chain fructans, limitation of the total dietary fructose

load, encouragement of foods in which glucose was balanced with fructose, and

co-ingestion of free glucose to balance excess free fructose was devised.

Sixty-two consecutively referred patients with irritable bowel syndrome and

fructose malabsorption on breath hydrogen testing underwent dietary

instruction.

Forty-six (74%) of all patients responded positively in all abdominal

symptoms. Positive response overall was significantly better in those adherent

than nonadherent (85% vs 36 %), as was improvement in individual symptoms.

Shepherd SJ, Gibson PR.

Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines

for effective dietary management.

J Am Diet Assoc 2006 Oct;106(10):1631-1639

____________________________________

IgE cross-reactivity between the major peanut allergen Ara h 2 and tree nut

allergens.

In this study, the major peanut allergen Ara h 2 was cloned from peanut

cDNA, expressed in E. coli. Pre-incubation of serum from peanut allergic

patients

with increasing concentrations of almond or Brazil nut extract inhibited IgE

binding to rAra h 2. Purified rAra h 2-specific serum IgE antibodies also

bound to proteins present in almond and Brazil nut extracts by immunoblotting.

This indicates that the major peanut allergen, Ara h 2, shares common

IgE-binding epitopes with almond and Brazil nut allergens, which may contribute

to

the high incidence of tree nut sensitisation in peanut allergic individuals.

de Leon MP, Drew AC, Glaspole IN, Suphioglu C, O'Hehir RE, Rolland JM.

IgE cross-reactivity between the major peanut allergen Ara h 2 and tree nut

allergens.

Mol Immunol 2007 Jan;44(4):463-471

____________________________________

Anaphylaxis to kangaroo meat.

Anaphylaxis to kangaroo meat. A 23-year-old man, within 30 min of ingesting

kangaroo meat, developed respiratory distress and generalized urticaria. No

treatment was administered and symptoms settled within hours. On a previous

occasion, he had developed tongue paraesthesia and lip swelling within 30 min

of ingesting kangaroo meat. SPT were negative to common food allergens, lamb

and beef extracts. The SPT to uncooked kangaroo meat was positive with a 20

mm wheal at 15 min, and linear urticaria extending to the upper arm at 30 min.

The urticaria persisted for 24 h, but there was no other systemic reaction.

Immunoblotting demonstrated IgE-reactivity in the patient's serum to a

heat-labile 66 kDa protein present in kangaroo and wallaby meats.

Boyle RJ, Russo VC, Andaloro E, Mehr SM, Tang ML.

Anaphylaxis to kangaroo meat - identification of a new marsupial allergen.

Allergy 2007 Feb;62(2):209-211

____________________________________

Rhinitis because of toothpaste and other menthol-containing products.

A 44-year-old man, with a history of aspirin intolerance, rhinitis and mild

asthma, reported that each time he brushed his teeth, pronounced rhinitis

occurred. Profound nasal symptoms also occurred after shampooing, and after

intake of certain sweets such as Fishermans Friend . The patient himself

suspected that menthol could be the cause of his symptoms. a tooth brushing

provocation was undertaken twice. Once after regular (once daily) use of

antihistamines and intranasal steroid, and once without. Immediate and

pronounced nasal

symptoms occurred within 10 min after tooth brushing without any regular

treatment, but no symptoms were observed when on treatment. Forced expiratory

volume in 1 s decreased 10 min after tooth brushing. Positive-contact

urticarial

reactions were seen when applying menthol 2% petrolatum, peppermint oil 5% in

petrolatum, toothpastes Colgate and Aquafresh, and a chewing-gum (extra

strong mint) to the forearm.

Andersson M, Hindsen M.

Rhinitis because of toothpaste and other menthol-containing products.

Allergy 2007 Mar;62(3):336-337

____________________________________

Severe skin reaction due to excipients (Sunset yellow / Orange yellow S) of

an oral iron treatment.

A 43-year-old female with a persistent iron de?ciency anaemia had been on

oral iron therapy with ferric propionate for at least 15 years without

signi?cant problems. That drug was replaced with another preparation (ferrous

sulphate), Twenty-four hours after beginning this treatment, the patient

developed a

severe facial erythema with itching and skin oedema. The ferrous sulphate

is prepared as tablets containing Sunset Yellow FC & C No.6 (E110), Erithrosine

(E127), Titanium Dioxide (E171), and methylmethacrylate as excipients. Patch

test resulted in an intense itching immediately appeared at the site of the

patch and the patient reported the onset of slight facial erythema 6 h after

the application. The test proved positive after 48 h for orange disperse 3

(3+), para-phenylendiamine (3+), and after 72 h for thimerosal (2+), gentamicin

(3+), nickel sulphate (3+). Of these, only orange disperse was present in the

iron formulation (as Sunset Yellow). A single-blind, placebo-controlled oral

challenge was then made , with ferrous sulphate eliciting facial itching and

erythema and no reaction with ferric propionate. It is likely that she had

become sensitized to these substances during her former occupation as a

hairdresser.

Rogkakou A, Guerra L, Scordamaglia A, Canonica GW, Passalacqua G.

Severe skin reaction due to excipients of an oral iron treatment.

Allergy 2007 Mar;62(3):334-335

____________________________________

Four cases of wheat-dependent exercise-induced anaphylaxis with negative

gluten cap-rast score.

Either omega-5 gliadin or high molecular weight glutenin is known to be a

major allergen in wheat-dependent exercise-induced anaphylaxis (WDEIA). It is

generally considered that gluten specific IgE score is more reliable than that

of wheat specific IgE score for the diagnosis of WDEIA. The aim of this

study was to verify the significance of gluten specific IgE in the diagnosis of

WDEIA. The result of gluten CAP-RAST score and omega-5 gliadin specific IgE

score on four WDEIA patients, whose diagnosis were onfirmed by prick tests,

immunoblot tests and provocation tests were evaluated. All four patients showed

negative gluten CAP-RAST scores, however all patient's omega-5 gliadin

specific IgE scores were positive. The study concludes that the results suggest

that gluten specific CAP-RAST score is unreliable in the diagnosis of WDEIA. On

the other hand omega-5 gliadin specific IgE score is possibly a better

candidate as a diagnostic tool for WDEIA. [Editor: Phadia have recently release

a

recombinant Tri a 19 (omega-5 gliadin) diagnostic test that may be useful in

this condition)

Harada S, Iijima M, Nakamura A, Yoshizaki Y, Matsuo H, Morita E.

Four cases of wheat-dependent exercise-induced anaphylaxis with negative

gluten cap-rast score. [Japanese]

Arerugi 2007 Jan;56(1):41-48

____________________________________

Cat-pork syndrome: a case report with a thee years follow-up.

A 17-year-old male patient with cat-pork syndrome is reported. The patient

was sensitized to cat epithelium, house dust mite and grass pollen. In 2001 he

had an immediate reaction with urticaria, angioedema and dyspnea after

eating grilled meat and sausage. Skin tests and CAP/RAST revealed a

sensitization

to pork meat (4.7 KU/L for pork meat, 55 KU/L for cat epithelium). The

elimination of pork meat from the diet was incomplete, with slight skin

reactions

to small amounts of cooked pork meat but tolerance to seasoned pork products

such as salami. A challenge test with pork meat in 2004 was positive, with

angioedema and asthma symptoms, and CAP/RAST showed a value of 43 KU/L for cat

epithelium and 4 KU/L for pork meat. RAST inhibition confirmed the significant

cross-reactivity between the two allergen sources. These findings provide

some knowledge on the natural history of the cat-pork syndrome, and confirm

that very prolonged avoidance of the offending foods are needed to expect a

loss of sensitization.

Savi E, Rossi A, Incorvaia C.

Cat-pork syndrome: a case report with a thee years follow-up.

Allerg Immunol (Paris) 2006 Dec;38(10):366-368

____________________________________

Other interesting articles featured this month can be viewed at

http://allallergy.net/abstracts/index.cfm and include:

Prevention of latex allergy among health care workers and in the general

population: latex protein content in devices

Prevention of allergic disease during childhood by allergen avoidance

Asian ladybugs (Harmonia axyridis): a new seasonal indoor allergen.

Mala s 12 from the yeast Malassezia is a major allergen in patients with

atopic eczema

Occupational asthma due to spores of Oyster Mushroom.

Food-exercise-induced anaphylaxis in a boy successfully desensitized to cow

milk.

Implications for atopy prevalence of microbial content of drinking water.

Crossreactivity Between Curvularia lunata and Alternaria alternata

Airway disease in highway and tunnel construction workers exposed to silica.

Association between sensitization to Aureobasidium pullulans (Pullularia sp)

and severity of asthma.

A case of occupational contact urticaria and oral allergy syndrome due to

seafood.

Assessment of allergen cross-reactivity.

Anaphylaxis to honey in pollinosis to mugwort.

SPT with heat-processed apple peel extract to detect LTP hypersensitivity.

____________________________________

2. MONTHLY CONTENTS LIST OF ALLERGY & DIETETIC JOURNALS

View the monthly listing of journal contents of all the major allergy and

intolerance-related journals in print or online at Allergy Advisor Journal

Contents. A number of new journals have been added.

The Allergy Advisor Web site is at http://AllergyAdvisor.com/ and the links

to this great feature is accessible through the menu bar below along the top

of the site. A " Search " facility has been added.

Contents List of Allergy & Dietetic Journals by Journal:

_http://allallergy.net/abstracts/journalContents.cfm_

(http://allallergy.net/abstracts/journalContents.cfm)

Contents List of Allergy & Dietetic Journals by Month:

_http://allallergy.net/abstracts/journalContentsMonth.cfm_

(http://allallergy.net/abstracts/journalContentsMonth.cfm)

List of ALL Allergy Articles This Month:

_http://allallergy.net/abstracts/journalContentsList.cfm_

(http://allallergy.net/abstracts/journalContentsList.cfm)

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Signet Diagnostic Corporation

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Mediator Release Testing and LEAP Diet Protocol for Irritable Bowel

Syndrome, Migraine, Fibromyalgia and more, caused by food sensitivity

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