Ara h 2 and Ara 6 are the best predictors of severe peanut allergy: a double-blind placebo-controlled study.

BACKGROUND: Component-resolved diagnostics offers a modern tool in peanut allergy, but studies applying consistently double-blind placebo-controlled challenges are lacking. We aimed to optimize diagnostics for moderate-to-severe peanut allergy in a birch-endemic region and to create an oral-peanut challenge with its allergen activity characterized. METHODS: We performed double-blind placebo-controlled peanut challenges for a referred sample of 6- to 18-year-olds with peanut sensitization or a high suspicion of peanut allergy, including anaphylaxis. We measured specific IgE (sIgE) to Ara h 1, 2, 3, 6, 8, and 9. Testing of allergen activity of the challenge products was by IgE microarray inhibition. RESULTS: Of the 102 patients, 69 were challenge positive: 25 (36%) had severe, 36 (52%) moderate, and 8 (12%) mild symptoms; 38 (37%) received adrenalin. SIgE to Ara h 6 AUC 0.98 (95%CI, 0.96-1.00) was the best marker of moderate-to-severe allergy. When sIgE to Ara h 2 and Ara h 6 was measured together, all (100%) severe reactions at low doses were successfully diagnosable. SIgE to Ara h 8 had no diagnostic value, AUC 0.42 (95%CI, 0.30-0.52). Both nonroasted and roasted peanut inhibited 100% of IgE binding to Ara h 1, 2, 3, and 6. Nonroasted peanut inhibited 87% of IgE binding to Ara h 8, roasted inhibited 30%. The products lacked Ara h 9 activity. CONCLUSION: Co-sensitization to Ara h 2 and Ara h 6 was associated with severe reactions distinguishing severe allergy from mild symptoms. SIgE to Ara h 8 added no diagnostic value. Component-resolved diagnostics reduce the need for oral challenges in peanut allergy.

Occupational allergic contact urticaria to yucca (Yucca aloifolia), weeping fig (Ficus benjamina), and spathe flower (Spathiphyllum wallisii).

BACKGROUND: Occupational contact urticaria (CU) from plants is often reported, but it is less often attributed to decorative houseplants. We present an atopic gardener and caretaker of plants who developed CU when occupationally exposed to weeping fig, spathe flower, and yucca. METHODS: Sensitization was evaluated by skin prick tests (SPT) and analyses for IgE antibodies. RESULTS: SPT were positive to all three plants, and IgE antibodies were found to weeping fig and spathe flower. SPT were also performed with several decorative houseplants in more than 600 patients. Positive SPT was found to weeping fig (12%), African milk tree (8.3%), yucca (5.8%), Chinese rose (4.7%), massangana (4.6%), bird's nest fern (3.2%), and spathe flower (3.2%). CONCLUSION: Our study indicates that SPT and tests for IgE antibody are useful in detecting occupational CU caused by houseplants.

Dog allergen in indoor air and dust during dog shows.

BACKGROUND AND METHODS: Dog dander is one of the most important indoor allergens in Nordic countries. Due to the population flow into cities, the number of dogs in urban areas has increased. Dog allergens can be found practically everywhere indoors. We measured allergen content in indoor air and dust during dog shows. RESULTS: In facilities used for dog shows, the dog allergen content was exceptionally high, up to 2,100,000 ng Can f 1/g dust, but it can be reduced by proper cleaning. The efficiency of cleaning will remain poor if furniture and textiles are not cleaned or the distribution of airborne allergen cannot be prevented. CONCLUSIONS: Dog shows should not be held in public facilities, such as schools, where a significant proportion of occupants are hypersensitive to dog allergens and may therefore suffer symptoms due to the exposure to dog dander.

A baker's occupational allergy to flour moth (Ephestia kuehniella).

BACKGROUND: Allergy to insects is common. However, few reports cover occupational sensitization to flour moth (Ephestia [syn. Anagasta] kuehniella). We describe a baker who suffered from IgE-mediated occupational respiratory allergy to flour moth. METHODS: The skin prick test (SPT) and serum IgE tests were used to evaluate the patient's sensitivity to flour moth. Allergen cross-reactivity with mites was evaluated in IgE-inhibition studies. Clinical sensitivity was evaluated by nasal challenge test. Pulmonary function tests were repeatedly monitored. RESULTS: SPT with flour moth gave a 6-mm wheal, and an elevated level of flour moth-specific IgE was measured in the patient's serum (1.9 PRU/ml, RAST class 2). Immunoblotting with the patient's serum revealed at least seven heavy IgE-binding bands with molecular masses of 22, 35, 43, 53, 65, 77, and >86 kDa in the extract of flour moth. Allergen cross-reactivity with mites was demonstrated in inhibition studies. Immediate-type allergy to flour moth was confirmed by nasal challenge. Increased daily variability of PEF values was observed during workplace exposure. CONCLUSION: A baker's occupational respiratory allergy to flour moth was confirmed.

Allergic reactions to measles-mumps-rubella vaccination.

OBJECTIVE: Immunization of egg-allergic children against measles, mumps, and rubella (MMR) is often deferred or even denied, although the safety of this vaccination has been clearly shown. Moreover, the majority of severe allergic reactions have occurred in egg-tolerant vaccinees. Other allergenic vaccine components have been sought, and gelatin has been suggested as one cause of allergic adverse events. The aim of this study was to further characterize the actual allergenic vaccine components. METHODS: Serum samples from 36 recipients of MMR vaccine with anaphylaxis, urticaria with or without angioedema, asthmatic symptoms, or Henoch-Schönlein purpura were analyzed by CAP System radioallergosorbent test (RAST) and immunospot methods to detect the allergenic vaccine component. To evaluate the correspondence between the findings in the CAP System RAST or the immunospot and clinical symptoms, histories of allergies and present hypersensitivity symptoms were assessed. RESULTS: Of the 36 participants, 10 were demonstrated to be allergic to gelatin. Seven of them had persistent allergic symptoms, possibly attributable to foods containing gelatin or cross-reactive allergens. The results of the immunospot suggested concomitant allergy to gelatin and egg, chicken, and feathers, as well as cow's milk, or they reflected allergen cross-reactivity. CONCLUSIONS: Although severe allergic adverse events attributable to MMR vaccination are extremely rare, all serious allergic reactions should be further assessed to detect the likely causative vaccine component, including gelatin. The current recommendation for immunization of egg-allergic persons according to standard MMR vaccination schedules is reinforced. measles, mumps, and rubella vaccine, immunization, adverse effects, allergic reactions, gelatin allergy, CAP System, radioallergosorbent test, immunospot, immunoglobulin E.

Delayed generalized allergic reactions to corticosteroids.

A 37-year-old patient presented with a severe allergic local reaction upon inhalation of budesonide for asthma. Skin tests were positive for budesonide and amcinonide (group B) and elicited a strong local reaction and a disseminated macular exanthema. Corticosteroids from other groups were well tolerated. A 38-year-old male patient had first an allergic contact dermatitis to topically applied prednisolone acetate and then a disseminated eczematous exanthema upon oral intake of prednisone. A delayed-type sensitization to corticosteroids from group A such as hydrocortisone, prednisone and tixocortol pivalate was identified. A detailed diagnosis in patients with allergic reactions to corticosteroids is crucial with regard to their use in emergency therapy.

Occurrence of dog, cat, and mite allergens in public transport vehicles.

BACKGROUND AND METHODS: Helsinki City Transport buses, trams, and underground trains carry 687,000 passengers on a weekday. Of the passengers, 0.13% travel with a pet. We interviewed passengers and measured allergen levels in vehicles to determine what difficulties allergens cause to passengers with allergy and asthma. RESULTS: Of 2,021 interviewed passengers, 14% complained about inconvenience caused by pets, usually health problems. Of 324 adult passengers with allergy or asthma, 53% had experienced symptoms in public transport; the corresponding figure for 75 children was 32%. The median concentration of the main dog allergen, Can f 1, in dust from seats and floors in public transport vehicles was 2,400 ng per g of dust (range 20-8,500 ng/g). For the main cat allergen, Fel d 1, the median was 870 ng/g (range 3-2,600 ng/g). These levels can be regarded as low or moderate, and they cause symptoms in sensitive persons. Concentrations of mite allergens were undetectable or low. Allergen levels were lower in vehicles where pets were not allowed than in vehicles where pets were allowed, lower in dust from uncovered seats than in dust from seats with a covering, and lower after cleaning vehicle floors and seats than before cleaning. CONCLUSIONS: Dog and cat allergens are present in public transport vehicles in Helsinki at levels that cause symptoms in sensitive persons. Prohibiting pets would probably bring only a modest reduction in levels, as few pets are carried, and much allergen contamination comes from passengers' clothes.

Immediate contact allergy from hydrolyzed wheat in a cosmetic cream.

Immediate contact allergy to cosmetics seems to be rare, since only a few case reports on it have been published. We report on a case of IgE-mediated allergic contact urticaria caused by hydrolyzed wheat in a body cream.

Cow's milk challenge through human milk evokes immune responses in infants with cow's milk allergy.

OBJECTIVES: In order to measure the immune response evoked in breast-fed infants with cow's milk allergy (CMA) by cow's milk challenge through human milk, mothers were given increasing doses of cow's milk after they had been on a cow's milk elimination diet. Another objective was to study the secretion of beta-lactoglobulin (BLG) into human milk before and during milk challenge in relation to the appearance of symptoms in infants. STUDY DESIGN: Seventeen asymptomatic mothers who had infants with challenge-proven CMA and 10 asymptomatic mothers who had healthy infants were recruited. Infants ranged in age from 1.8 to 9.4 months. A solid-phase enzyme-linked immunoassay (ELISPOT) was used to assess the total number of immunoglobulin-secreting and specific antibody-secreting cells. Flow cytometry was used to enumerate different lymphocyte subpopulations among peripheral blood lymphocytes primed during provocation by cow's milk antigens. BLG levels were assessed in human milk before the challenge and 1, 2, 3, and 4 hours after the commencement of the challenge. RESULTS: All but one of the infants with CMA showed symptoms of CMA during cow's milk challenge through human milk. There was a significant rise in the total number of immunoglobulin-secreting cells in the IgA and IgG classes associated with a positive cow's milk challenge response, but the proportions of peripheral blood B cells bearing CD19, CD23, CD19 and 23, CD5, or CD19 and CD5 were comparable. BLG levels were comparable in both study groups. CONCLUSIONS: Most of the infants with CMA reacted to cow's milk challenge through human milk. Hypersensitivity reactions to food antigens through human milk may be more common than previously thought.

Occupational allergic rhinitis and contact urticaria caused by bishop's weed (Ammi majus).

Bishop's weed (Ammi majus) has been known to induce toxic phytophotodermatitis. We now describe IgE-mediated rhinitis and contact urticaria caused by exposure to bishop's weed in a 31-year-old atopic female florist. A skin prick-prick test with bishop's weed flowers gave an 8-mm wheal, and the bishop's weed-specific IgE level in the patient's serum was 9.7 PRU/ml (RAST class 3). In an immunoblotting experiment with the patient's serum, nine IgE-binding protein bands with the molecular weights 19, 34, 39-41 (doublet), 52-61 (doublet), and >67 (triplet) kDa were detected in bishop's weed extract. The patient became symptomless after she had ceased to work as a florist.

Cow's milk casein, a hidden allergen in natural rubber latex gloves.

BACKGROUND: We have previously noted that one natural rubber latex (NRL) glove brand used for skin prick testing in the diagnosis of NRL allergy contained cow's milk casein. OBJECTIVE: We sought to examine whether other commonly marketed NRL glove brands contain cow's milk casein. METHODS: The casein content of 30 NRL glove extracts (1:5 wt/vol) was measured by RAST inhibition and by rocket immunoelectrophoresis and rocket radioimmunoelectrophoresis by using casein-specific rabbit antiserum, a serum pool from patients with cow's milk allergy, and radiolabeled anti-human IgE. The NRL allergen content was measured by ELISA inhibition. RESULTS: The casein content of the glove used in NRL allergy screening (Triflex, Baxter) was rather high (ie, about 400 microgram/g of glove). Its total protein content was 1000 microgram/g of glove. Rocket radioimmunoelectrophoresis detected distinct amounts of casein in 8, minimal amounts in 7, and no casein in the remaining 15 NRL glove brands. CONCLUSIONS: Several brands of NRL gloves were found to contain casein, implying that extracts prepared from such gloves can cause false-positive skin prick test reactions when diagnosing NRL allergy. The use of casein as a stabilizer in glove manufacture without appropriate labeling should be stopped because it can also cause contact urticaria syndrome in individuals with cow's milk allergy.

Contact urticaria from protein hydrolysates in hair conditioners.

Protein hydrolysates (PHs) are added to hair-care products (to "repair" broken hair), soaps, bath gels, creams, etc. From one to 22 PHs used in hair-care products (collagen, keratin, elastin, milk, wheat, almond, and silk) were tested in three patient groups: A) 11 hairdressers with hand dermatitis B) 2160 consecutive adults with suspected allergic respiratory disease subjected to routine skin prick tests C) 28 adults with atopic dermatitis. In group A, all the 22 PHs were tested with scratch and patch tests. In groups B and C, one to three PHs were tested with prick tests. Positive scratch/prick test reactions were seen in 12 patients from three PHs altogether. All were women with atopic dermatitis, and all reacted to at least hydroxypropyl trimonium hydrolyzed collagen (Crotein Q). In three patients, prick and open tests with a hair conditioner containing Crotein Q were performed with positive results. One patient reported contact urticaria on her hands, and two reported acute urticaria on their head, face, and upper body from a hair conditioner containing Crotein Q. In seven of the eight studied sera, specific IgE to Crotein Q was detected. In conclusion, PHs of hair cosmetics can cause contact urticaria, especially in patients with atopic dermatitis.