Allergy to all mammalian Bovidae proteins but cow's milk in a child

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Severe anaphylaxis to sheep's milk cheese in a child desensitized to cow's milk through specific oral tolerance induction.

Specific oral tolerance induction to food (SOTI) is a new promising treatmentfor persistent IgE-mediatedfood allergy. Our paper reports a case of a 5-year-old girl with cow's milk allergy, who developed severe anaphylaxis after the ingestion of a croissant containing sheep's milk ricotta cheese, even though she had been previously desensitized to cow's milk through SOTI. The sheep's milk specific allergen causing the severe allergic reaction (a derivative of alpha-casein of 54,1kDa) was identified by SDS-PAGE and immunoblotting. We conclude that SOTI is a species-specific procedure and the induced tolerance to cow's milk doesn't necessarily provide protection against milk of other mammals. Therefore, children desensitized to cow's milk through SOTI should strictly avoid the intake of milk of other mammals, until tolerance to those kinds of milk is documented by an oral food challenge.

Goat milk allergenicity as a function of αs1-casein genetic polymorphism.

Cow milk allergy is the most frequent allergy in the first years of life. Milk from other mammalian species has been suggested as a possible nutritional alternative to cow milk, but in several cases, the clinical studies showed a high risk of cross-reactivity with cow milk. In the goat species, αS1-casein (αS1-CN), coded by the CSN1S1 gene, is characterized by extensive qualitative and quantitative polymorphisms. Some alleles are associated with null (i.e., CSN1S1 0(1)) or reduced (i.e., CSN1S1 F) expression of the specific protein. The aim of this work was to obtain new information on goat milk and to evaluate its suitability for allergic subjects, depending on the genetic variation at αs1-CN. Individual milk samples from 25 goats with different CSN1S1 genotypes were analyzed by sodium dodecyl sulfate PAGE and immunoblotting, using monoclonal antibodies specific for bovine α-CN and sera from children allergic to cow milk. A lower reaction was observed to 2 goat milk samples characterized by the CSN1S1 0(1)0(1) and 0(1)F genotypes. Moreover, a fresh food skin prick test, carried out on 6 allergic children, showed the lack of positive reaction to the 0(1)0(1) milk sample and only one weak reactivity to the 0(1)F sample. The risk of cross-reactivity between cow and goat milk proteins suggests the need for caution before using goat milk for infant formulas. However, we hypothesize that it can be used successfully in the preparation of modified formulas for selected groups of allergic patients. The importance of taking the individual goat CN genetic variation into account in further experimental studies is evident from the results of the present work.

Respiratory allergy induced by exclusive polysensitization to serum albumins of furry animals.

In this report we describe un unusual case of exclusive allergic sensitization to furry animals, as a possible study model to speculate about different modalities ofsensitization to allergens of common and less common mammalian species. A 27-year-old woman referred in our Allergological Centre for the occurrence of conjunctival and severe respiratory symptoms after contact with several animals such as cats, dogs, rabbits, horses, cows etc. Patient underwent clinical and anamnestic evaluation including a detailed information on the modality of exposure to different furry animals. Skin-prick-test (SPT) was performed with our routine panel of commercial standardized extracts (Lofarma Laboratories, Milan, Italy). Some animal allergenic extracts (rabbit, horse, rat, mouse, cavia, cow and hamster) have been tested by SPT one week after the routine SPT A blood sample was taken for measurement of total IgE and specific IgE (CAP System, Phadia, Uppsala, Sweden) as well as Immunoblotting procedures. The results of in vivo and in vitro procedures revealed allergic sensitization only to animal-derived allergens. Total IgE were 59.3 kU/L. Immunoblotting showed a specific IgE-mediated sensitization of the patient to cow's, rabbit's and horse's serum albumins (SA). In conclusion, our case report confirms the role of SA as cross-reacting agent in allergic sensitization to furry animals. This finding suggests to perform SPTs to several furry animal allergens in all individuals with high level of allergic sensitization to common pets (cats and/or dogs) in order to identify allergy to other animals and consequently to avoid future exposures at risk.

Assessment of the tolerance to lupine-enriched pasta in peanut-allergic children.

BACKGROUND: Reports of allergy to lupine derivatives (as de novo sensitization or cross-reactivity in subjects allergic to peanut) are increasing as their use in food products increases. OBJECTIVES: The aim of this study was to assess: (1) lupine tolerance in a group of children allergic to peanut, using lupine enriched-pasta instead of raw flour as has been done in previous clinical studies; (2) whether technological treatments of lupine modify its cross-reactivity or co-sensitization with peanut; (3) the role of lupine seed proteins in sensitization, and (4) to identify the eliciting doses (EDs) by using double-blind, placebo-controlled food challenges (DBPCFC). METHODS: Twelve patients with a history of clinical allergic reactions to peanut were evaluated by skin prick tests (SPTs), the ImmunoCAP test, immunoblotting, and DBPCFC. The 12 selected subjects were included in a trial where lupine-enriched pasta and placebo pasta were administered in a DBPCFC protocol. RESULTS: Positive clinical reactions were observed in two children, the EDs being 0.2 and 6.4 g of pasta, corresponding to 50 mg and 1.6 g of lupine proteins, respectively. Beta-conglutin was the protein most involved in SPT positivity. CONCLUSION: Lupine-enriched pasta can be tolerated by most subjects suffering from peanut allergy, but a sizeable minority (2/12 of them in this case) can develop potentially dangerous clinical reactions. Information about possible reactions to lupine derivatives by those allergic to peanuts must be included in the labelling of lupine-enriched products to protect consumers at risk.

Immunoglobulin-A profile in breast milk from mothers delivering full term and preterm infants.

Recent advances in the care of low-birth-weight and preterm neonates have stimulated research into the best dietetic program to improve their survival and short/long term outcome. Some components of human milk that cannot be included in artificial formulas may be critical for survival. Of these, immunoglobulins are important, and in particular secretory immunoglobulins A (sIgA). The concentration of secretory IgA was measured by immunoblotting (an immunoelectrophoretic technique having high specificity and reliability) in milk from mothers delivering at term (TM) or prematurely (PM). In both groups, IgA concentrations were high very early on but quickly decreased during the first week of lactation. The early IgA mean concentration was higher in PM than in TM but, because of high variability in PM milk, the difference rarely reached statistical significance. This variability during lactation reflects the important role of human milk in supplying immunological factors to cope with the gastrointestinal absorption of high molecular weight proteins in the first days of life. Immunological protection is particularly critical for a preterm baby, so it is important to promote feeding with its own mothers milk if possible, paying strict attention to the timing of milk collection.

Characterization of bovine serum albumin epitopes and their role in allergic reactions.

OBJECTIVE: This review provides updated information on conformational and sequential epitopes identified in bovine serum albumin (BSA) and summarizes available data about the role of structural modifications on BSA antigenicity/allergenicity. DATA SOURCES: Data on beef allergy and BSA antigenicity are reported, with reference both to the basic literature and to clinical results obtained by our group. RESULTS AND DISCUSSION: BSA is an important allergen involved in milk and beef allergy. The presence of conformational epitopes has been suggested by indirect evidence, while at least one sequential epitope has been experimentally identified. The role of structural modifications on BSA antigenicity is discussed as well as the increased tolerance observed in allergic subjects consuming beef as strained (homogenized) and freeze-dried derivatives. CONCLUSION: Study of the molecular characteristics of a known major allergen allows the identification of technological processes that may be capable of improving the tolerance of allergic subjects to a specific food. Even though any hoped for reduced allergenicity must be verified under medical supervision, the use of new products could obviate the need to avoid important foods such as meat in childhood.

Ochratoxin A in conventional and organic cereal derivatives: a survey of the Italian market, 2001-02.

Ochratoxin A is a mycotoxin produced mainly by Penicillium verrucosum and Aspergillus ochraceus. Although typically considered a cereal contaminant, it has also been detected in dried fruit, nuts, meat and derivatives. To estimate the quantity of ochratoxin A that might be ingested by Italian consumers from these foods, 211 cereal derivatives (flours and bakery products) were analysed by high-performance liquid chromatography. Products were from conventional and organic agriculture and from integrated pest management agriculture. All commercial flours and derivatives examined contained ochratoxin A at concentrations very much below the legal limit (3 microg kg(-1)): the highest value, 0.816 microg kg(-1), was detected in a sample of spelt whole flour from organic agriculture. In many samples, the ochratoxin content was below the limit of detection; only rarely did values exceed 0.5 microg kg(-1). In baby foods, four samples were above the particularly restrictive Italian legal limit of 0.5 microg kg(-1). Although some significant differences were found between samples from conventional and organic agriculture when some product categories were examined (namely, baby foods as semolina and rice creams), no important difference was found between the two types of agricultural practice when all types of cereal derivatives were considered together.

Evaluation of residual immunoreactivity in red and white wines clarified with gluten or gluten derivatives.

Gluten or hydrolyzed gluten could be a suitable alternative to animal proteins in the wine clarification process, but their residues could represent a risk for individuals suffering from coeliac disease or allergic to cereal proteins. The aim of this study was to investigate the presence of gluten in wines treated with gluten or its hydrolysate in the clarification process and to assess its antigenicity in commercial products. The presence of residual immunoreactive gluten was evaluated by electrophoresis (SDS-PAGE) and immunoblotting. Data obtained in several red and white wine samples showed that no residue was detectable in any of the red wines. In white wines, gluten reduced the protein content less completely, but most samples showed no immunoreactivity after the wine had been treated with gluten or its derivatives, either alone or combined with bentonite, silica gel or tannins. The use of gluten derivatives coupled with bentonite was the most effective method of removing immunoreactive protein in white wines. In conclusion, the use of gluten derivatives in wine clarification seems to exclude a risk for subjects susceptible to coeliac disease or gluten allergy. However, it is recommended that wine producers continuously monitor the clarification process in order to protect the most sensitive individuals.

Assessment of residual immunoreactivity in red or white wines clarified with pea or lupin extracts.

Vegetable proteins could be a suitable alternative to animal proteins in the clarification of wine, but their residues could represent a risk for subjects with food allergy or intolerance. The aim of this study was to investigate the presence of specific immunoreactivity in red and white wines treated, as must or wine, with vegetable proteins in the clarification process. The proteins considered were prepared from lupins and peas, which are not included among the allergens listed in annex Illbis of Directive 2003/89/EC. The presence of residual immunoreactivity to specific rabbit anti-lupin and anti-pea polyclonal antibodies in treated wines was assessed by electrophoresis (SDS-PAGE) and immunoblotting. Residual protein was not detectable in red wines clarified with lupin, pea or a mixture of pea and lupin proteins or in white wines clarified with pea proteins. A small number of musts treated with lupin or pea proteins and white wines treated with lupin proteins yielded equivocal results, probably because of the presence of interfering material (e.g., sugar-rich proteins from grape and yeast). The use of bentonite as a secondary clarifying agent is therefore recommended since its combination with vegetable proteins is particularly effective in removing overall protein immunoreactivity.

Evaluation by SDS-Page and immunoblotting of residual antigenicity in gluten-treated wine: a preliminary study.

Hydrolyzed gluten could be a suitable alternative to animal proteins in the wine clarification process, but the residual proteins could constitute a risk for subjects suffering from celiac disease or allergy to cereals. The aim of this study was to investigate possible traces of gluten in treated wine and to assess its antigenicity in commercial products. The presence of gluten in treated wine was evaluated by an electrophoretic method [sodium dodecylsulfate-polyacrylamide gel electrophoresis (SDS-PAGE)] and its immunoreactivity was evaluated by immunoblotting. No traces of protein were found in untreated samples. A small quantity of protein was detected in treated wine but this produced no significant immunochemical reaction. In an experimental clarification process, a protein fraction was detectable in untreated samples and in the first stages of the clarification process. However, there was no significant gluten-associated immunochemical reaction in clarified wine samples, confirming strong binding between the clarifying agent and the phenolic fraction. In conclusion, the clarifying process strongly reduced the amount of protein material, at least in red wines. Under the most restrictive tests of the presence of gluten in the product, the predictable residue of gluten in wine was safe for celiac subjects. For allergic subjects the data are less conclusive because there is no known limit for allergic reactions, but clear labeling of the method of treating the wine should also protect this group of consumers.

Ochratoxin A in cereal-based baby foods: occurrence and safety evaluation.

Ochratoxin A is a typical cereal contaminant with strong nephrotoxic activity. To estimate the quantity of ochratoxin A that can be taken in by a child in the weaning period, several samples of cereal-based baby foods were analysed. Although most samples analysed contained ochratoxin A in undetectable amounts or below the Italian legal limit of 0.5 microg kg(-1), some irregular products were found. In particular, the analyses of the 119 batches (338 samples) of baby foods considered indicated that: 20 batches (16.8%) contained detectable quantities of ochratoxin A and four of these (3.4% of the total) contained ochratoxin A above the Italian permitted value. All samples coming from agricultural practices based on integrated pest management contained undetectable amounts of ochratoxin A, while approximately 5% of batches coming from conventional and organic agricultural practices were above the legal limit. On the basis of the established provisional tolerable weekly intake (PTWI), there is no significant toxicological risk for a child who occasionally consumes a formula with ochratoxin concentration slightly above the permitted level. However, stricter controls have to be applied to reject the batches containing irregular concentrations of ochratoxin A.

Antigenic determinants of bovine serum albumin.

BACKGROUND: Bovine serum albumin (BSA) is one of the most widely studied proteins; its structure is well known and its antigenic characteristics have been described in several papers. The aim of this research was the identification of the BSA antigenic determinants. METHODS: This study was performed using limited proteolysis and an immunoblotting technique, in which a commercial murine antibody and sera from children sensitized to BSA were used. RESULTS: Findings suggest amino acids (aa) 524-598 as an epitopic area for human species. The most critical sequence seems to be aa 524-542, even if it must be included in a longer fragment to be recognized by antibodies. Murine IgG antibodies also recognize fragments contained in the first half (NH(2)-terminal portion) of BSA. CONCLUSIONS: The results presented in this study indicate that the epitopic sites of an antigenic protein can be different when different species are considered, so that data obtained with antibodies from animal species cannot be directly extrapolated to the behavior of human IgEs.

Severe anaphylaxis induced by latex as a contaminant of plastic balls in play pits.

BACKGROUND: Latex causes anaphylaxis in specific contexts among children. We present 2 cases that show that severe reactions may occur in everyday circumstances with latex as a contaminant. OBJECTIVE: Because 2 cases of severe reactions to latex suggested similar circumstances of exposure, we investigated the immediate environment in which episodes occurred. METHODS: A 5-year-old girl presented to our casualty department with anaphylaxis after playing in a ball pit filled with approximately 10-cm diameter plastic balls in an American-style fast-food outlet. Two months later, a 9-year-old boy had severe anaphylaxis followed by an asthma attack with loss of consciousness while playing in the playpen of a different outlet belonging to the same company. Latex sensitization was confirmed in both cases by means of skin prick testing, latex glove skin prick testing, and 1-glove finger testing. Immunoblotting of elutions from a ball, the natural rubber latex foam pit lining, and its polyvinyl chloride sheet were performed. RESULTS: In the girl's immunoblot high levels of IgE specific to Hev b 4, Hev b 7, and Hev b 2 were found. The boy's immunoblot showed positivity to Hev b 7. The polyvinyl chloride ball sample showed a high concentration of specific Hevea species allergen similar to that of the foam layer sample. CONCLUSION: Severe anaphylaxis can result from contact with latex proteins as a contaminant, rather than as a component, of play area ball pits and therefore outside the reported settings. Emergency health care workers should be aware of this kind of risk. A latex-reduced environment might prevent potentially severe reactions in young customers of fast-food outlets.

Pulmonary sequestration in a child with acute myeloid leukemia.

The article describes a relatively rare congenital anomaly that was difficult to diagnose in a 10-year-old child with acute nonlymphoblastic leukemia. Just at diagnosis of leukemia, the patient showed a pathologic chest radiograph because of a parenchymal thickening at the right lung apex. The presence of bronchopneumonia was suspected, and broad-spectrum antibiotic therapy was started with subsequent antifungal treatment for persistent fever and concurrent chemotherapy-induced marrow aplasia, which did not favor pulmonary infiltrate recovery. Continuous culture tests, including bronchial swab, proved negative for Koch-Weeks bacillus, fungal organisms, and other pathogens. Computed tomography, however, was suggestive of Aspergillus lung involvement, and apical segmentectomy was performed. The anatomic pathologist suggested the diagnosis of intralobar sequestration. In summary, when pulmonary pathology with an excavation is found in a leukemic child, one must consider the possibility of pulmonary sequestration complicated by an infectious disease.

[Drug therapy of osteoarthrosis of the hip (author's transl)]. / Die medikamentöse Behandlung der Koxarthrose.

Experience in therapy with sulindac and S-adenosyl-L-methionine (SAMe) is reported. Sulindac is an indene derivative which is particularly indicated in degenerative skeletal diseases and is essentially free from the well-known side-effects of traditional analgesics. The results of therapy were good in 75%. SAMe is the most important methyl group donor and is consequently responsible for the methylation (inactivation) of histamine, upon which its antiphlogistic action is based. SAMe is also particularly involved in the transfer of sulfate groups in the body. Sulfur compounds are esentially involved in the synthesis of cartilage. The short-term trials with SAMe were altogether more favorable than the longterm trials, yet there was a longterm effect in about half the cases.

[Treatment of carpal acroparesthesias (author's transl)]. / Behandlung der karpalen Akroparästhesien

Topical steroid treatment of the carpal tunnel syndrome gives outstanding results in mild or moderately severe types of nerve lesion. In many patients in whom there was improvement of function and cessation of pain, not everything was achieved that we consider to be the aim of an ideal treatment. Normalisation of nerve function and the elimination of the pathophysiological mechanism responsible for the compression often make surgical treatment essential.