Re: Allergy Digest Newsletter - Allergy research summaries -Dec 2008 issue

[Guest guest]

Just forwading an Allergy Newsletter, FYI, with my comments.

I love this newsletter and the website, _www.allergyadvisor.com_

(http://www.allergyadvisor.com) for their great summaries and educational case

studies

for dietitians. (_http://www.allergyadvisor.com/Educational/index.html_

(http://www.allergyadvisor.com/Educational/index.html) )

Once again, forwarding their latest newsletter. Subscription info is below

if you want your own subscription.

Even though most of my work is with non-IgE Adverse Food Reactions, there's

still much to be gleaned here, especially since many LEAP clients have both

IgE and non-IgE food and/or chemical sensitivities.

Of interest to me in this newsletter:

1. Milk allergy and exercised induced asthma sensitization due to external

exposure and reactions in ovulatory phase of menstrual cycle but not at

another time of the menstrual cycle.

2. " Fruit proteins " and vomiting in child - but, I'd sure like to see the

full article - how did they identify it was " proteins " vs. " something else? " in

the fruit. Sounds like a possible Type 3 or 4 response.

Mike? Can you find the article?

Bruni F, Peroni DG, Piacentini GL, De Luca G, Boner AL.

Fruit proteins: another cause of food protein-induced enterocolitis syndrome.

Allergy 2008 Dec;63(12):1645-6.

3. The article about " Carbohydrate moieties are frequently encountered in

food and can elicit IgE responses, "

So, somebody correct me if I'm wrong, but isn't this suggesting IgE allergy

from non-proteins? What a paradigm shift in IgE allergy. Or, am I missing

something here?

Enjoy!

Jan Patenaude, RD, CLT

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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

Anaphylactic reaction to Camomile tea.

A type-IV-allergic reaction to German camomile (Matricaria chamomilla) in a

form of allergic contact dermatitis is not unusual. However, only a few

cases of anaphylactic reaction to camomile have been described in the

literature.

A 38-year-old Caucasian man who developed an episode of severe anaphylaxis

with generalized urticaria, angioedema and severe dyspnoea one hour after

consuming camomile tea is described. Total serum IgE of 123kU/l with specific

IgE

against camomile (4,94kU/l, class 3) was demonstrated. Skin prick test and

labial provocation test with camomile showed a strong positive reaction. This

case confirms the presence of a type-I allergy to orally ingested camomile

and indicates that the incidence and risk may be underestimated.

Andres C, Chen WC, Ollert M, Mempel M, Darsow U, Ring J.

Anaphylactic Reaction to Camomile Tea.

Allergol Int 2008 Dec 1;58(1):

____________________________________

Cows Milk-Dependent Exercise-Induced Anaphylaxis influenced by premenstrual

or ovulatory phase.

A 24 year-old woman with atopic dermatitis occasionally developed symptoms,

including dyspnea and generalized urticaria, following ingestion of food

containing cows milk. Similar episodes had continued, and had been treated

empirically since the age of 16 years. Although a skin test and IgE RAST showed

positive reactions to cows milk, a provocation test with cows milk alone did

not induce any symptoms. Therefore, food-dependent exercise-induced anaphylaxis

(FDEIA) was suspected, but examination using various combinations of cows

milk, aspirin and exercise failed to elicit any symptoms. Finally, a

provocation test during the ovulatory phase with cows milk followed by aspirin

and

exercise evoked systemic urticaria, dyspnea and hypotension. The symptoms

against

cows milk began when she took baths with bath salts containing cows milk as

its main ingredient for one year at the age 15 years. Sensitization to cows

milk through eczematous skin is indicated from this history. Hormonal change

during a premenstrual or ovulatory phase is also an important factor for the

development of FDEIA in this case.

Bito T, Kanda E, Tanaka M, Fukunaga A, Horikawa T, Nishigori C.

Cows Milk-Dependent Exercise-Induced Anaphylaxis under the Condition of a

Premenstrual or Ovulatory Phase Following Skin Sensitization.

Allergol Int 2008 Dec;57(4):437-439

____________________________________

Fruit proteins: another cause of food protein-induced enterocolitis

syndrome.

Food protein-induced enterocolitis syndrome as a result of fruit, in a 5

month old infant. An oral food challenge with 10 g of mixed fruits (apple, pear

and banana) was performed. The dose was administered gradually over a period

of 45 min. Two hours later, the patient developed repetitive vomiting, had a

decrease in blood pressure, and became lethargic.

Bruni F, Peroni DG, Piacentini GL, De Luca G, Boner AL.

Fruit proteins: another cause of food protein-induced enterocolitis

syndrome.

Allergy 2008 Dec;63(12):1645-6.

____________________________________

Clinical relevance of sensitization to lupine in peanut-sensitized adults.

The aim of the study was to investigate the frequency of sensitization to

lupine, and in addition to pea and soy, and its clinical relevance, in

peanut-sensitized patients, and to determine the eliciting dose (ED) for lupine

using

double-blind placebo-controlled food challenges. Thirty-nine unselected

peanut-sensitized patients were evaluated by skin prick tests (SPT) and

ImmunoCAP to lupine, pea, and soy. Eighty-two percent of the study population

was

sensitized to lupine, 55% to pea, and 87% to soy. Clinically relevant

sensitization to lupine, pea, or soy occurred in 35%, 29%, and 33% respectively

of the

study population. The lowest eliciting dose for lupine, inducing mild

subjective symptoms, was 0.5 mg, and the no observed adverse effect level

(NOAEL)

was 0.1 mg. Therefore in peanut-sensitized patients, clinically relevant

sensitization to either lupine or to pea or soy occurs frequently. The ED for

lupine is low (0.5 mg), which is only fivefold higher than for peanut.

Peeters KA, Koppelman SJ, Penninks AH, Lebens A, Bruijnzeel-Koomen CA, Hefle

SL, SL, van HE, Knulst AC.

Clinical relevance of sensitization to lupine in peanut-sensitized adults.

Allergy 2008 Dec 4;

____________________________________

Impact of peanut allergy on quality of life, stress and anxiety in the

family.

This study sought to establish the impact of peanut allergy (PA) on quality

of life (QoL) and reported anxiety of children with clinically confirmed PA,

their parents and older siblings. Forty-six families, who had a child with

PA, completed QoL, anxiety and perceived stress scales. Mothers rated their own

psychological (P < 0.01) and physical (P < 0.05) QoL significantly worse

than fathers rated theirs, and had higher scores than fathers for anxiety (P <

0.05) and stress (P < 0.001). Children with PA had significantly poorer

physical health-related QoL (P < 0.05), QoL within school (P < 0.01) and

general

QoL (P < 0.05) than their siblings did, and greater separation anxiety (P <

0.05). The majority of differences were between girls with PA and female

siblings. Mothers felt that there was a greater impact on QoL for their PA

child,

compared with that reported by siblings, fathers or the PA children themselves

(P < 0.01).

King RM, Knibb RC, Hourihane JO.

Impact of peanut allergy on quality of life, stress and anxiety in the

family.

Allergy 2008 Dec 4;

____________________________________

Changes in skin test reactivity among adults with atopic disease: a 3-year

prospective study.

This study concludes that 4 of 10 adults with atopic disease will have

changes in skin prick test status during a 3-year period, and most will gain

new

sensitizations. Women with atopic disease are at increased risk of developing

new sensitizations compared with men. From a sample of 1,186 candidates,

ranging in age from 14 to 44 years, who in a screening questionnaire reported

symptoms suggestive of respiratory allergic disease, 344 individuals with a

positive skin prick test (SPT) result concomitantly with asthma and/or rhinitis

were clinically studied on 2 occasions, 3 years apart. In total, 134 (39% of

the study population) had a different SPT result at follow-up compared with

baseline, based on a diagnostic criterion of 3 mm for a positive test result;

77 (22%) developed de novo sensitizations to 1 or more allergens, 45 (13%)

had remission of 1 or more sensitizations, and 12 (4%) both gained and lost

sensitizations.

Aslund N, Thomsen SF, Molgaard E, Nolte H, Backer V.

Changes in skin test reactivity among adults with atopic disease: a 3-year

prospective study.

Ann Allergy Asthma Immunol 2008 Nov;101(5):524-528

____________________________________

Anaphylaxis following the ingestion of flour contaminated by house dust

mites

Two patients in Singapore developed anaphylaxis after eating

mite-contaminated food. Patient A developed anaphylaxis twenty minutes

following the

ingestion of home-made fried fish coated with Japanese flour, while Patient B

developed similar life-threatening symptoms one hour after the ingestion of

home

baked scones. Both patients were NSAID-intolerant and had a history of

allergic rhinitis. Skin prick tests showed a strong positive result for

dust-mites

and for extracts prepared from the ingested flour. Flour samples revealed

large numbers of live Dermatophagoides farinae dust-mites. A survey of 57 flour

samples showed that 4 samples (7%) were contaminated with dust mites.

Yan TS, T, Tzien YC, Cheng YF, Jiayi C, Nge C, Yan CK, Wah LB.

Anaphylaxis following the ingestion of flour contaminated by house dust

mites--a report of two cases from Singapore.

Asian Pac J Allergy Immunol 2008 Jun;26(2-3):165-170

____________________________________

Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat

in patients with IgE antibodies specific for galactose-alpha-1,3-galactose.

Carbohydrate moieties are frequently encountered in food and can elicit IgE

responses, the clinical significance of which has been unclear. Recent work,

however, has shown that IgE antibodies to galactose-alpha-1,3-galactose

(alpha-gal), a carbohydrate commonly expressed on nonprimate mammalian

proteins,

are capable of eliciting serious, even fatal, reactions. This study sought to

determine whether IgE antibodies to alpha-gal are present in sera from

patients who report anaphylaxis or urticaria after eating beef, pork, or lamb.

Twenty-four patients with IgE antibodies to alpha-gal were identified. These

patients described a similar history of anaphylaxis, angiodema or urticaria 3

to

6 hours after the ingestion of meat and reported fewer or no episodes when

following an avoidance diet. SPTs to mammalian meat produced wheals of usually

less than 4 mm, whereas intradermal or fresh-food SPTs provided larger and

more consistent wheal responses. CAP-RAST testing revealed specific IgE

antibodies to beef, pork, lamb, cow's milk, cat, and dog but not turkey,

chicken,

or fish. Absorption experiments indicated that this pattern of sensitivity

was explained by an IgE antibody specific for alpha-gal.

Commins SP, Satinover SM, Hosen J, Mozena J, Borish L, BD, Woodfolk

JA, Platts-Mills TA.

Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat

in patients with IgE antibodies specific for galactose-alpha-1,3-galactose.

J Allergy Clin Immunol 2008 Dec 11;

____________________________________

Food allergy is associated with potentially fatal childhood asthma.

The objective of this study was to determine whether self-reported food

allergy is significantly associated with potentially fatal childhood asthma.

Medical records from 72 patients admitted to a pediatric intensive care unit

for

asthmatic exacerbation were reviewed and compared in a case-control design

with 2 randomly selected groups of 108 patients admitted to a regular nursing

floor for asthma and 108 ambulatory patients with asthma. At least one food

allergy was documented for 13% (38/288) of the patients. Egg, peanut,

fish/shellfish, milk, and tree nut accounted for 78.6% of all food allergies.

Children admitted to the PICU were significantly more likely to report food

allergy

(p = 0.004) and 3.3 times more likely to report at least one food allergy

compared with children admitted to a regular nursing floor, and significantly

more likely to report food allergy (p < 0.001) and 7.4 times more likely to

report at least one food allergy compared with children seen in the ambulatory

setting. Children admitte d to either the PICU or the regular nursing floor

were significantly more likely be African-American (p < 0.001) and to be

younger (p < 0.01) compared with children seen in the ambulatory setting. The

study concludes that self-reported food allergy is an independent risk factor

for

potentially fatal childhood asthma. Asthmatic children or adolescents with

food allergy are a target population for more aggressive asthma management.

Vogel NM, Katz HT, R, Lang DM.

Food allergy is associated with potentially fatal childhood asthma.

J Asthma 2008 Dec;45(10):862-866

____________________________________

Allergies to fruits and vegetables.

" Allergic reactions to fruits and vegetables are frequently observed in

older children and adolescents. They can result from a primary sensitization

to

food allergens or from a primary sensitization to inhalant allergens such as

pollens or latex. In the case of fruit allergies, the stability of the

allergens involved is crucial to the sensitization pathway and in the clinical

presentation of the food allergy. Two patients allergic to fruits are presented

and discussed in the light of the allergens involved. Patient 1 was a 14

yr-old girl with a grass and olive pollen allergy who developed oropharyngeal

symptoms typical of the oral allergy syndrome (OAS) with multiple fruits from

taxonomically unrelated families, and who was sensitized to profilin. Patient 2

was an 8 yr-old girl, with no pollen allergies, who developed systemic

reactions to peach and apple, and who was sensitized to non-specific lipid

transfer

proteins (LTP). Profilins are labile allergens present in pollens and

foods, and sensitization occur s through the respiratory route to pollen

profilin.

The cross-reactive IgE antibodies generated can elicit local reactions in

the oropharyngeal mucosa (OAS) when exposed to fruit profilins. In contrast,

LTPs are a family of stable allergens that resist thermal treatment and

enzymatic digestion, and can thus behave as true food allergens inducing

primary

(non-pollen related) sensitizations and triggering systemic reactions. These

two

cases represent two distinct patterns of sensitization and clinical

expression of fruit allergies that are determined by the panallergens involved

(LTPs

and profilins) and their intrinsic physicochemical properties. Additionally,

these two cases also show the improved diagnostic value of Component

Resolved Diagnosis, and strengthen its utility in the routine diagnosis and

management of patients. "

Fernández-Rivas M, Benito C, González-Mancebo E, Díaz de Durana MDA.

Allergies to fruits and vegetables.

Pediatr Allergy Immunol 2008 Dec;19(8):675-681.

____________________________________

Other interesting articles featured this month can be viewed at

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

Prevalence of immediate hypersensitivity reactions to cow's milk in Turkish

infants.

IgE profiles of Bermuda grass pollen sensitised patients evaluated by Phleum

pratense allergens Phl P 1, 2, 4, 5, 6 , 7, 11, 12.

Auto- and cross-reactivity to thioredoxin allergens in allergic

bronchopulmonary aspergillosis.

Contact allergy in children referred for patch testing.

Hydrophobic allergens from the bottom fraction membrane of Hevea

brasiliensis.

Allergic contact dermatitis to acid blue 158 in suture material.

Tefillin contact dermatitis

Lavender oil lacks natural protection against autoxidation, forming strong

contact allergens on air exposure.

A correlation found between gold concentration in blood and patch test

reactions in patients with coronary stents.

Human seminal plasma allergy type I

Intraoperative anaphylactic shock in a child with no history of type I

hypersensitivity.

Allergy after inhalation and ingestion of cereals involve different

allergens in allergic and celiac disease.

Determinants of indoor allergens in tropical child care centers.

____________________________________

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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Jan Patenaude, RD, CLT

Consultant, Writer, Speaker

Director of Medical Nutrition

Signet Diagnostic Corporation

(Mountain Time)

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Mediator Release Testing and LEAP Diet Protocol for Irritable Bowel

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