Evaluation of the Cytokine Response Induced by Specific Allergen Immunotherapy in Patients with Vespa velutina Anaphylaxis.

INTRODUCTION: Changes in the cytokine profile from type 2 to type 1 together with the induction of regulatory cells are expected during hymenoptera venom immunotherapy (VIT). The present study was aimed to investigate the changes in type 1, type 2, and regulatory cytokines induced by a Vespula spp. VIT in patients with anaphylaxis to Vespa velutina. METHODS: Twenty consecutive patients with anaphylaxis due to Vespa velutina were treated with Vespula spp. VIT. Serum cytokines (IL-4, IL-5, IL-10, IL-13, and IFN-É£) were measured at baseline, 6, and 12 months after starting VIT. RESULTS: A significant increase in serum IFN-y was detected after 6 and 12 months of VIT. An increase in serum IL-10 and a decrease in IL-5 were observed after 12 months. IL-4 was undetectable all along the study, and an unexpected increase of IL-13 was present at 12 months of treatment. CONCLUSION: Vespula spp. VIT seems to be able to induce a shift to type 1 cytokine production measured through IFN-y levels and IL-10 production after, at least, 6 and 12 months of VIT, respectively.

Minor interference of cross-reactive carbohydrates with the diagnosis of respiratory allergy in standard clinical conditions.

BACKGROUND: Immunoglobulin E (IgE) to N-glycans from plant and invertebrate glycoproteins induces extensive in vitro cross-reactivity. This study investigates the prevalence and diagnostic relevance of IgE to these N-glycans [cross-reactive carbohydrate determinants (CCDs)] in patients with suspicion of respiratory allergy. METHODS: A total of 1,025 adult subjects with symptoms of rhinitis and/or asthma from a reference allergy clinic were studied. Determinations included a structured questionnaire, skin prick tests (SPT), total IgE, a multiallergen IgE test and specific IgE (sIgE) to bromelain, MUXF (the bromelain-type N-glycan) and honeybee phospholipase-A2. Inhibition studies with CCDs were performed in selected cases. RESULTS: The prevalence of CCD sensitization (MUXF sIgE and/or bromelain-sIgE ≥0.1 kU(A)/l) was 18.0%. Male sex and atopy (SPT positivity) were associated with CCD sensitization. Sensitization was more frequent in patients sensitized to pollens than in those sensitized to mites, the most common inhalant allergens in the area. A history of Hymenoptera stings was associated with CCD sensitization and multiallergen IgE test positivity. CCD sensitization was not significantly associated with age, rural residence, alcohol consumption or smoking. Only 58 patients (5.6%) showed CCD-sIgE levels ≥0.35 kU(A)/l. CCD-induced inhibition of pollen-sIgE or mite-sIgE in patients with respective positive SPT was minimal or absent in most cases. CONCLUSIONS: In this population of predominantly mite-allergic patients, CCD sensitization is relatively rare and CCD-sIgE levels are low. Thus, CCDs do not represent a major obstacle for the diagnosis of respiratory allergy in a specialized setting. Hymenoptera stings are associated with CCD sensitization.

Assessment of short-term changes induced by a Dermatophagoides pteronyssinus extract on asthmatic patients. Randomised, double-blind, placebo-controlled trial.

BACKGROUND: Once the optimal dose is reached, subcutaneous immunotherapy [SCIT] with mite extract is capable of reducing symptoms and the need for rescue medication. OBJECTIVE: To assess the capacity of a subcutaneous extract of mites [D. pteronyssinus] to bring about a reduction in concomitant medication as well as in vivo and in vitro changes in just 2-3 months of treatment in patients with allergic asthma. METHODS: A total of 45 patients with persistent mild-moderate allergic asthma due to sensitisation to D. pteronyssinus were included in a multi-centre, double-blind, placebo-controlled trial. Length of treatment was 4 months. After a period for adjusting medication in order to classify asthma severity appropriately, patients were commenced on treatment of 400 or 800 g/day of budesonide as concomitant medication. RESULTS: After 4 months of treatment there were no significant changes in the budesonide dose between the active group and the placebo group. In the active group there was a significant difference between active and placebo group in sIgG4 [p=.0003], as well as a significant increase in the cutaneous tolerance index [2.81, CI 95%: 1.29 - 7.48, which was significant with a Confidence Interval of 95%]. These changes were not observed in the placebo group. CONCLUSION: After just 4 months of treatment, SCIT was capable of inducing in vivo and in vitro changes, but these changes were not reflected in improved clinical outcome within the first 4 months of therapy.

Anaphylaxis to Hippobosca equina (louse fly).

BACKGROUND: IgE-mediated allergy to insects different from Hymenoptera species is seldom reported. OBJECTIVE: To describe and study the case of a previously nonatopic man with an anaphylactic reaction (grade III, Müeller) caused by a bite from a louse fly (Hippobosca equina). METHODS: In vivo (skin prick tests) and in vitro (enzyme-linked immunosorbent assay and sodium dodecyl sulfatepolyacrylamide gel electrophoresis immunoblotting) tests were used for diagnosis. Cross-reactivity between H. equina and different insects was investigated. RESULTS: Results of skin prick tests and serum specific IgE were positive to H. equina. Immunoblot inhibition studies identified common bands in H. equina, Apis mellífera, and Musca domestica, but this cross-reactivity did not affect a band of 16 or 15 kDa. This molecular weight is similar to that of phospholipase A2 in A mellifera venom. CONCLUSION: We describe a case of IgE-mediated allergy to H. equina in which specific molecular band proteins seemed to be responsible for the reaction.

Food allergy to Paracentrotus lividus (sea urchin roe).

BACKGROUND: Sea urchins are increasingly used as culinary products in Japanese and Korean cuisine throughout the world. OBJECTIVE: To investigate a possible IgE-mediated allergy in a patient who experienced an anaphylactic reaction after eating sea urchin roe and mussels. PATIENT AND METHODS: A 40-year-old man experienced generalized pruritus and urticaria, shortness of breath, and wheezing 10 minutes after eating steamed mussels and boiled sea urchin roe. Investigations included skin prick tests, serum specific IgE determinations, oral challenge tests, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and immunoblotting. RESULTS: Results of skin prick tests with common aeroallergens were negative. Positive prick test responses were obtained with boiled and raw sea urchin extracts, boiled and raw sea urchins themselves, and boiled sea urchin water. Results of an oral challenge test with steamed mussels were negative. Five minutes after the oral mucosa contacted the boiled sea urchin extract, lip pruritus was present. Specific IgE concentrations to boiled sea urchin water and boiled and raw sea urchins surpassed the criterion for a positive result (1.1, 0.6, and 0.4 kU/L, respectively). In boiled sea urchin extract, a 118-kDa band appeared as the unique relevant IgE-binding antigen. CONCLUSION: In this patient with IgE-mediated food allergy to sea urchin roe, a 118-kDa protein seemed to be the antigen responsible for the reaction.

Anaphylaxis to Cyphomandra betacea Sendth (tamarillo) in an obeche wood (Triplochiton scleroxylon)--allergic patient.

BACKGROUND: Anaphylaxis after the first exposure to a food allergen is uncommon unless a cross-reaction is present. OBJECTIVE: To investigate a possible relationship between the fruit Cyphomandra betacea Sendth (commonly known as tamarillo) and the wood of Triplochiton scleroxylon (obeche) in a patient with allergic occupational bronchial asthma due to obeche wood who began to experience anaphylaxis episodes after eating tamarillo. METHODS: A 33-year-old carpenter exposed to obeche wood in his occupation was initially seen with rhinitis and bronchial asthma. The causal relationship of these symptoms to obeche wood exposure was investigated by means of peak flow monitoring and bronchial inhalation testing. Furthermore, the patient had 2 acute episodes of anaphylaxis a few minutes after eating salad containing tamarillo. He had never tasted tamarillo before. The allergologic study included skin prick tests, serum specific IgE determinations, bronchial challenges, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and immunoblotting. RESULTS: Results of skin prick tests with common aeroallergens were negative. Strong skin prick test responses were obtained with obeche and tamarillo. Results of bronchial challenge testing with obeche extract were positive. In tamarillo extract, a 28-kDa band appeared as the most relevant IgE-binding antigen. A similar band of 28 kDa happens to be frequently detected in obeche-allergic patients. CONCLUSION: To our knowledge, this is the first reported case of anaphylaxis to tamarillo presented in a patient allergic to obeche, which raises the question of a new cross-reactivity antigen.