Development of algorithms for the diagnosis and management of acute allergy in primary practice

Most patients presenting with allergies are first seen in the primary care setting. However, inadequacies in training and available guidance for general practitioners (GP) have been identified as significantly impacting the quality of care for these patients, resulting in inefficient use of healthcare resources. To address the lack of available guidance, a working group of French allergists has developed a series of online tools aimed at GPs. The expert panel developed algorithms for the diagnosis and treatment of common allergies by incorporating deliberations based on clinical guidelines and experience. In addition, they developed tables of common symptoms and detailed clinical cases that guide GPs through the typical decisions they are faced with in line with current best practice. These tools translate evidence-based recommendations from international clinical guidelines, outlining the key steps involved and assisting the physician in making decisions at each step. In addition to targeting improvements in diagnosis and standard of primary care, the tools also aim to reduce the burden on specialist allergy services by enabling GPs to diagnose and treat mild and moderate allergies, referring only severe and/or atypical cases to secondary care. The tools are adapted to the high primary care workload, enabling the physician to access essential information rapidly without unnecessary referrals to specialist allergy services. Keywords: Allergy, Primary care, Diagnosi

Immunoblotting analysis of wheat allergens: control of side reactions through wheat polypeptides naturally present in dried cow milk

Immunoblotting analysis of wheat allergens can be a two-step procedure: an incubation with a human serum and one with an anti-IgE-horseradish peroxidase (HRP) conjugate, visualised by chemiluminescence. Different procedures produced side reactions that appeared as non-specific additional bands which hampered the identification of specific IgE-reacting proteins. We then showed that the rabbit anti-human IgE-HRP conjugate most likely contains anti-wheat antibodies that bind with the proteins. We investigated another procedure to accurately identify wheat specific IgE-reacting proteins. The use of polyvinylpyrrolidone-40 throughout the procedure and 3% cow milk for the conjugate incubation provided signals clear-cut enough to detect proteins up to the allelic level. Tested against patients, the procedure identified IgE-reacting proteins. It also provided new data in terms of gliadins for patients suffering from hypersensitivity to hydrolysed wheat proteins. Lastly, we investigated why dried cow milk blocks. Using rabbit serum containing anti-wheat antibodies, we detected wheat cross-reacting polypeptides in it

A Recombinant omega-Gliadin-like D-Type Glutenin and an alpha-Gliadin from Wheat (Triticum aestivum): Two Immunoglobulin E Binding Proteins, Useful for the Diagnosis of Wheat-Dependent Allergies

Among the wheat prolamins, D-type glutenins display a highly repetitive sequence similar to omega-gliadins, but they contain a cysteine, that allows them to be included in the gluten macropolymers. An omega-gliadin-like D-type glutenin, an alpha-gliadin, and an omega 5-gliadin-like D-type glutenin were obtained as recombinant proteins and compared using synchrotron radiation circular dichroism. This technique evidenced the strong thermostability of the omega 5-gliadin-like protein. The IgE reactivity of recombinant proteins was evaluated using 45 sera from wheat-allergic patients. The sera from patients diagnosed with cutaneous hypersensitivity to hydrolyzed wheat proteins often reacted with the omega-gliadin-like D-type glutenin and alpha-gliadin, whereas the IgE reaction was less frequent after dietary sensitization. So, these two proteins could be useful to diagnose these diseases. The sera from patients with exercise-induced anaphylaxis recognized the omega 5-gliadin-like protein as a positive control and, less frequently, the other proteins tested. Only some sera from patients with baker's asthma reacted with the proteins tested

Cross-reactivity to fish and chicken meat – a new clinical syndrome

Background: Fish is one of the most allergenic foods. While clinical cross-reactivity among different fishes is a widely accepted feature of fish allergy, associations with other food allergies are not well understood. This study aims at analyzing the relevance of clinical cross-reactivity between fish and chicken meat in patients with allergy to chicken meat without sensitization to hen's eggs. Methods: Patients with food allergy to fish and chicken meat (n = 29) or chicken meat only (n = 7) were recruited. IgE-reactive chicken proteins were identified (Edman, MS analysis) and quantified (ELISA). Allergens were used in IgE ELISA and skin testing. Results: Chicken parvalbumin and two new allergens, aldolase and enolase, were identified at 12, 40, and 50 kDa, respectively. They were recognized by sIgE of 61%, 75%, and 83% of all patient sera which were in the majority of the cases positive for the fish homologues as well. Fish and chicken meat allergens were highly cross-reactive while high inhibition rates with fish or chicken allergens correlated with the patients' primary sensitization to fish or chicken. In cooked or roasted foods, enolase and aldolase were detectable in chicken breast while parvalbumin was detectable in chicken legs and wings. Conclusions: Fish and chicken meat are cross-reactive foods; both fish-allergic and chicken meat-allergic patients might be at risk of developing a food allergy to chicken meat or to fish, respectively. This clinical phenomenon is proposed to be termed ‘fish–chicken syndrome’ with cross-reactive allergens involved being parvalbumins, enolases, and aldolases.SCOPUS: ar.jFLWINinfo:eu-repo/semantics/publishe

Le syndrome poisson–poulet : une nouvelle allergie croisée

SCOPUS: sh.jinfo:eu-repo/semantics/publishe