10 research outputs found
Utility of Basophil Activation Test for monitoring the acquisition of clinical tolerance after oral desensitization to cow's milk: Pilot study
Objective: The quantification of basophil activation by flow cytometry is a useful tool for the assessment of immediate-type
responses to food allergens and the prediction of clinical tolerance in food allergy patients. The aim of this study is to
investigate how the analysis of allergen-induced CD63 up-regulation by flow cytometry can be effective in monitoring the
acquisition of clinical tolerance by specific oral desensitization in food allergy. To our knowledge, this is the first study to
examine this topic.
Materials and methods: Three male patients affected by cow’s milk allergy underwent successful oral desensitization to
cow’s milk. In order to monitor the acquired clinical tolerance that occurred after treatment, we performed laboratory tests
for total and specific IgE, specific IgG4 and the Basophil Activation Test (BAT) both at baseline and at the end of the
desensitization protocol.
Results: Using a fluorescent enzyme immunoassay, the comparison of specific cow’s milk antibodies before and after
treatment showed a decrease of specific IgE levels, without reaching normal values, and an increase of specific IgG4
levels. A complete suppression of cow’s milk proteins (a-lactoalbumin, b-lactoglobulin and casein) induced CD63 regulation
was observed in all three reported cases.
Conclusions: Using flow cytometry, food allergen-specific basophil responses could be monitored in order to identify an
acquired tolerance induced by desensitization treatment. Although further studies are needed to develop this important new
topic, it was interesting to note that the BAT seemed to be more sensitive and characterized by a close correlation with
clinical tolerance
Specific oral immunotherapy in food allergic patients: transient or persistent tolerance?
Introduction: The first therapeutic choice for food allergy is avoidance of the responsible food, but when this approach is not possible, specific oral desensitization could be considered as a good alternative. It is not clear yet whether the acquired tolerance is transient or persistent. Aim: We report on a subset of 13 patients of a larger study, treated successfully with specific oral tolerance induction who experienced secondary loss of tolerance after a period of allergen avoidance. Material and methods: Thirteen patients affected by IgE-mediated food allergy: to cow milk (3 patients), to hen egg (3 patients), to cod fish (2 patients), to peanuts (1 patient) and to corn (1 patient) confirmed by a complete allergological workup and a double-blind placebo-controlled food challenge (DBPCFC), were treated with sublingual-oral desensitization. After the interruption of the maintenance phase, the laboratory tests were performed and 12 of 13 patients underwent DBPCFC. Results: Oral specific desensitization was completed successfully in all the 13 reported patients. At different times after the end of treatment, they decided, on their own initiative, to stop the ingestion of incriminated food. A new food allergen re-exposure caused adverse reactions in 12 of 13 patients. The detection of specific IgE and IgG4 during the period of allergen avoidance showed an increase in or a stable level of specific IgE and a decrease in specific IgG4 in 8 patients. Conclusions: According to our experience, the tolerance obtained through the desensitizing treatment is transient and so the regular allergen intake is necessary for its maintenance
Difficult management of a patient with pr10 related anaphylaxis
International audience(Civ. 1re, 24 avr. 2013, n° 11-27.082, à paraître au Bulletin, D. 2013. 1132 ; Gaz. Pal. 4 juill. 2013, n° 185, p. 13, obs. D. Houtcieff
Anaphylaxis by antihistamine containing bovine gelatin: the utility of the basophil activation test in the diagnostic work-up
Hypersensitivity to major panallergens in a population of 120 patients
Introduction: Lipid transfer proteins (LTP), profilin and PR-10 are the most important panallergens in central and
southern Italy. Lipid transfer proteins are stable molecules, predominantly present in the fruit peel, which can induce
systemic symptoms after ingestion of vegetables. Profilin and PR-10 are randomly distributed in the pulp and peel.
Both are labile proteins and usually determine reactions restricted to the oral cavity. Panallergens-specific IgE may
cross-react with homologues from different plant sources, due to their conserved structure.
Aim: To assess the pattern of sensitization to panallergens and the correlation with the clinical history and the
allergological evaluation of food and aeroallergens.
Material and methods: One hundred and twenty patients with adverse reactions after vegetables ingestion underwent
skin prick tests (SPT) with commercial extracts of plant-derived foods and inhalant allergens and commercial
extracts of LTP, profilin and PR-10.
Results: Many patients presented positive SPT with different plant-food allergens. We found that 76 patients were
sensitized to LTP, 14 to profilin and 5 to PR-10. In the LTP-sensitized group, 64 (84%) patients suffered from systemic
symptoms while the patients sensitized only to profilin referred the oral allergy syndrome.
Conclusions: This study shows a high rate of sensitization to LTP in our population according to the literature about
food allergy in our geographical area and confirms the literature data about the symptoms referred by patients with
sensitization to panallergens. Panallergens should be considered as clinically relevant food allergens
Adverse reactions to nonsteroidal anti-inflammatory drugs and hypersensitivity to lipid transfer proteins
Lipid transfer proteins (LTP) constitute a family of proteins
widely distributed through the plant kingdom [1].
Allergenic LTP have been identified in tree pollen and
weeds, plant food allergen sources and latex. The primary
sensitizer agent and the fruit mostly involved seems
to be the peac
Profilin desensitization: A case series
The role of profilin as an allergen has long been questioned. The capacity of profilin to induce respiratory symptoms has recently been demonstrated; moreover, over 50% of patients sensitized to profilin experienced symptoms after the ingestion of plant-derived foods, suggesting that profilin should be considered as a clinically relevant food allergen.We describe the cases of seven allergic patients with oral allergy syndrome and other adverse reactions after eating plant-derived food, that have been undergone to profilin desensitization treatment.The protocol started with a drop of profilin solution (50 µg/mL) diluted 1:1018 in water until the highest dose of 10 drops of undiluted solution three times a week. At the end of the treatment we observed a decreased mean diameter of profilin wheal in skin prick test (SPT) in five of the seven participants and in profilin specific IgE values in six patients that repeated the test. Regarding basophil activation test (BAT) and the detection of IgG4, we do not have significant results because the tests have to be repeated in some patients. Regarding the double-blind placebo-controlled challenges, after about 10 months of induction phase all the patients showed tolerance to several foods that they previously did not tolerate.Moreover, the immunotherapy with profilin has proved to be safe because no serious adverse events have been reported in our patients.In summary, the results of this exploratory study of sublingual immunotherapy (SLIT) for profilin allergy show that it can be a promising therapeutic option that could modify the clinical reactivity of the patients to the intake of plant-derived food
Cross-reactivity and tolerability of Ertapenem in patients with IgE-mediated hypersensitivity to β-lactams
Background and Objective: Administration of carbapenems to β-lactam-allergic patients has always been considered potentially harmful
because of a 47.4% rate of cross-reactivity to imipenem reported in a single study. Nevertheless, recent studies have shown that the rate
of cross-reactivity of imipenem and meropenem with penicillins is lower than 1%. The aim of this study was to evaluate the possibility of
using ertapenem in patients with an established IgE-mediated β-lactam allergy.
Patients and Methods: We studied all participants who came to our allergy unit and had a clinical history of immediate hypersensitivity
reactions to β-lactams. The inclusion criteria were a positive skin test result to at least 1 β-lactam molecule and/or positive specific IgE
(when available). All participants underwent immediate-type skin tests with several β-lactam molecules including ertapenem. Challenges
with intravenous ertapenem were performed on 2 different days in patients with negative skin test results.
Results: We examined 49 patients with a clinical history of immediate reactions to β-lactams. All the patients had positive skin tests
and/or positive specific IgE to at least 1 β-lactam reagent and negative carbapenem skin tests. Thirty-six patients agreed to undergo the
challenges and 35 tolerated the full dose of ertapenem.
Conclusions: The practice of avoiding carbapenems in patients with β-lactam allergy should be abandoned considering the very low rate
of cross-reactivity. β-Lactam-allergic patients who need ertapenem therapy should undergo skin tests and, if negative, a graded challenge
to assess tolerability.
Key words: β-lactams. IgE-mediated hypersensitivity. Ertapenem. Cross-reactivity
Impact of nickel oral hyposensitization on quality of life in systemic nickel allergy syndrome
Nickel (Ni) oral hyposensitization treatment (NiOHT) is an effective management approach for Ni allergy. No healthrelated quality of life (HRQoL) data exist for the pre- and post-treatment with NiOHT in systemic nickel allergy syndrome (SNAS). The aims of this study were (a) to explore HRQoL in SNAS patients, (b) to assess changes of HRQoL after 1 year of NiOHT; (c) to evaluate psychological status of patients. SNAS patients completed the ShortForm 36-Item Health Survey and Psychological General Well-Being Index before and 1 week after the end of NiOHT. Moreover, psychological state was assessed with the Minnesota Multiphasic Personality Inventory (MMPI-2). A total of 52 patients self-reported pre- and post-treatment questionnaires. HRQoL was poor at baseline. After 1 year of NiOHT, all outcome measure scores improved by about 20% with respect to baseline data (P < 0.01 for all indices, except depressed mood). Finally, 33 patients performed the MMPI-2. High rates for hypochondriasis and depression were noted. Furthermore, most of the patients had high scores for anxiety, depression, and health concerns. This is the first study showing that NiOHT improves HRQoL of SNAS patients, which can be considered a \u201cpersonalized medicine\u201d approac