[THE CORRELATION OF ALLERGY SPECIFIC IGE MEASUREMENT REAGENT IMMNOCAP, ALASTAT, AND ORITON IGE].

BACKGROUND: The reagent which is available for single allergenic tests is Oriton IgE, ImmnoCAP, Alastat in Japan. No study has investigated the correlations of Oriton IgE and ImmnoCAP or Alastat, and, used for specific IgE antibody testing. METHOD: Six frequently tested allergens (dust mite, cedar pollen, dog dander, egg white, milk, and candida) were measured by three methods, and Spearman rank correlation coefficient and class-judged agreement were evaluated. Furthermore, we did the evaluation like other 2 methods when we made small short sample volumes of Oriton IgE. RESULT: As for the examination result of Oriton IgE and ImmnoCAP or Alastat, constant correlation was confirmed. However, the tendency was a different result by assay method and an allergenic item. No significant differences were observed in the results of the Oriton IgE test when standard sample volumes and small short sample volumes were used. CONCLUSION: These comparison results help us to understand each characteristic and select an optimal test method. In addition, it can be inferred that it is beneficial to choose tests requiring small sample volumes in pediatric patients.

Allergic hypersensitivity to garlic and onion in children and adults

BACKGROUND: China and Spain are world leaders in the consumption of edible bulbs (garlic and onion), but there are few references to their capacity to cause allergic symptoms. The target was to study allergic sensitization and clinical symptoms associated with garlic and onion consumption in a large sample of allergic patients. METHODS: An observational cross-sectional study was conducted, testing garlic and onion extracts in 8109 patients of all ages seen by our allergy clinic in 2018. Forty-four aeroallergens and foods were tested, including garlic and onion, with prick test and determination of specific IgE. Oral provocation and contact tests were performed if a delayed reaction was suspected. Western Blot was performed in the serum of patients positive to garlic and onion. RESULTS: We conducted 356,798 skin tests and 4254 specific IgE determinations. Of the 8109 patients tested, 2508 (30.92%) presented with symptoms associated with food intake and, in these patients, food hypersensitivity was detected by skin test, positive specific IgE or provocation in 924 patients, and was caused by garlic or onions in 27, indicating a prevalence of 2.92%. Immunodetection showed an association between the symptoms and a specific LTP to these bulbs, without cross-reactivity with other LTPs in the Mediterranean diet (peach, wheat). CONCLUSIONS: Allergic hypersensitivity to garlic and onions should not be underestimated and, given their high consumption, should be included in the diagnostic food allergy battery

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Sulfonamide Hypersensitivity: Fact and Fiction.

Sulfonamide antimicrobials are commonly reported as causing drug allergy and have been implicated in a variety of hypersensitivity reactions including immediate IgE-mediated reactions, benign T-cell-mediated rashes, and severe cutaneous adverse reactions such as Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms. Cross-reactivity is unlikely between sulfonamide antimicrobials and sulfonamide non-antimicrobials. In patients who develop reactions to a sulfonamide non-antimicrobial, there is no evidence to suggest that sulfonamide antimicrobials and other sulfonamide non-antimicrobials would cross-react. Although immediate skin testing can be performed in patients with histories of immediate reactions, they are infrequently positive and wane over time. Delayed skin testing including patch tests to sulfonamides is rarely positive. Drug challenges are a useful tool for patients with both immediate and delayed reactions to sulfonamides. The role of sulfamethoxazole desensitization is controversial as rates of hypersensitivity reactions are similar between desensitization and drug challenge.

The prevalence of allergic diseases in school children of metropolitan city in Indonesia shows a similar pattern to that of developed countries

BACKGROUND: The prevalence of allergy among Surabaya school children is currently unknown. OBJECTIVE: To identify the prevalence of the common allergic sensitization and allergic diseases among school children and undergraduate students in suburban of Surabaya by epidemiologic data collection. METHODS: A multistage simple random sampling was done to select 5 primary schools, 8 secondary schools (4 of junior high schools and senior high schools, respectively), and 1 university from 5 districts in Surabaya city. Out of 550 invited respondents, 499 (128 primary school, 221 secondary school, and 150 undergraduate) respondents gave their consent. A complete personal history, allergic symptoms, environmental exposure of common allergens was obtained from interview and the physical examinations were performed. Skin prick test (SPT) was done using 45 different allergen extracts. Total serum IgE and specific IgE radioallergosorbent test levels were measured for respondents with allergic manifestations. RESULTS: There was an increasing SPT positivity among study respondents, from primary school, secondary school, to undergraduate students (21.90%, 28.95%, to 45.30% respectively). Cockroach (42.85%) and fungi/mold spore (42.85%) were the most common allergens in primary school children. House dust mites was the most common allergen in secondary school (63.16%) and undergraduate students (58.82%). Urticaria and rhinitis were the commonest allergic diseases manifestation. History of atopy was positive in 60.79% of the allergic respondents. CONCLUSION: The prevalence of allergic sensitization among school children and undergraduate students in Surabaya suburb areas were increased compared to previous estimates in 1998. While house dust mites are known as important allergens, surprisingly cockroach was the common allergen among the younger school children.

A case of anhidrotic ectodermal dysplasia presenting with pyrexia, atopic eczema, and food allergy

Anhidrotic ectodermal dysplasia (AED) is a rare hereditary disorder with a triad of sparse hair, dental hypoplasia, and anhidrosis. Here we report a case of AED with food allergy and atopic eczema. The patient was a 11-month-old boy admitted to our hospital with pyrexia for 2 weeks. He presented with a history of dry skin, eczema, and food allergy to egg. On clinical examination, his body temperature was 38.8°C, with dry skin and eczema almost all over the body, sparse eyebrows, and scalp hair. Laboratory investigations and physical examination did not show any evidence of infection. Radioallergosorbent test was positive to egg yolk, egg white, ovomucoid, milk, house dust, and house dust mite. As the child did not sweat despite the high fever, we performed the sweat test which revealed a total lack of sweat glands. Genetic examination revealed a mutation of the EDA gene and he was diagnosed as AED. His pyrexia improved upon cooling with ice and fan. His mother had lost 8 teeth and her sweat test demonstrated low sweating, suggestive of her being a carrier of AED. Atopy and immune deficiencies have been shown to have a higher prevalence in patients with AED. Disruption of the skin barrier in patients with AED make them more prone to allergic diseases such as atopic eczema, bronchial asthma, allergic rhinitis and food allergy. Careful assessment of the familial history is essential to differentiate AED when examining patients with pyrexia of unknown origin and comorbid allergic diseases.

Incidence of allergic rhinitis in children with residual snoring and sleep symptoms after adenotonsillectomy.

BACKGROUND AND OBJECTIVES: Allergic rhinitis may contribute to sleep disordered breathing (SDB) in children. Although adenotonsillectomy is commonly performed to treat SDB, some patients will return to their primary practitioners with residual sleep symptoms. The aim of this study was to assess the incidence of allergic rhinitis via radioallergosorbent testing (RAST) in children undergoing adenotonsillectomy who had residual snoring or sleep symptoms. METHOD: A retrospective analysis of 500 patients post-adenotonsillectomy was undertaken. The incidence of residual snoring, residual sleep symptoms and results of RAST, as well as total immunoglobulin E (IgE) after surgical intervention, were documented. RESULTS: Children with positive RAST results or elevated total IgE had a significantly greater incidence of residual snoring post-adenotonsillectomy (P = 0.049) and residual sleep symptoms after surgery (P <0.0001). DISCUSSION: A positive RAST or elevated IgE in children with SDB was associated with incomplete resolution of snoring and residual sleep symptoms after adenotonsillectomy. Thus, there should be raised suspicion of allergic rhinitis in this population.

Biomarkers of respiratory allergy in laboratory animal care workers: an observational study.

OBJECTIVES: Laboratory animal allergy is a highly prevalent occupational disease among exposed workers. The aim of the study was to validate the biomarkers of airway inflammation in laboratory animal (LA) care workers. METHODS: All of the participants in this observational study (63 LA care workers and 64 controls) were administered a clinical questionnaire, underwent spirometry and a skin prick or radioallergosorbent test for common and occupational aeroallergens, and the fraction of exhaled nitric oxide (FeNO50), exhaled breath condensate hydrogen peroxide (EBC H2O2) and serum pneumoprotein levels were measured. Multivariate analysis (ANCOVA) was used to assess the interactions of the variables. RESULTS: FeNO50 levels correlated with exposure (p = 0.002), sensitisation (p = 0.000) and age (p = 0.001), but there was no interaction between exposure and sensitisation when age was considered in the model (p = 0.146). EBC-H2O2 levels were higher in the sensitised workers than in the sensitised controls [0.14 (0.08-0.29) µM vs 0.07 (0.05-0.12) µM; p < 0.05]. Serum surfactant protein A (SP-A) levels were unaffected by exposure, sensitisation or age, although higher levels were observed in symptomatic workers; however, SP-D levels were influenced by exposure (p = 0.024) and age (p = 0.022), and club cell 16 levels were influenced by sensitisation (p = 0.027) and age (p = 0.019). CONCLUSIONS: The presence of the clinical symptoms associated with LA exposure and high FeNO levels should prompt further medical assessments in LA workers. Although EBC-H2O2 levels do not seem to reflect eosinophilic inflammation, serum SP-A levels could be used to monitor progression from rhinitis to asthma.

The Incidence of Delayed-Type Hypersensitivity Reactions to Apples Among Patients Allergic to Birch Pollen

The major apple allergen Mal d 1 cross-reacts with the homologous birch pollen allergen Bet v 1 and causes immunoglobulin E (IgE)-mediated immediate-type allergic reactions. In some patients, delayed-type hypersensitivity to apples may develop within 72 hours without evidence of specific IgE or a positive skin prick test (SPT). The aim of the study was to evaluate the concomitance of delayed-type hypersensitivity reactions and immediate IgE-mediated reactions against high- and low-allergenic apple cultivars in patients with birch pollen allergy. Data were obtained from 45 adults with clinical symptoms of birch pollen allergy. Patients were exposed to apple pulp via atopy patch tests (APTs) and SPTs. Levels of IgE specific to Bet v 1 and Mal d 1 were measured with a radioallergosorbent test. Patients allergic to birch pollen showed the highest rate of positive SPT responses to Golden Delicious apples and the lowest rate to low-allergenic cultivar Grey French Reinette. Among these patients, 9% developed delayed hypersensitivity reactions to either Golden Delicious or Grey French Reinette apples; these reactions manifested clinically as erythema with papules (class ++). Fifty percent of APT-positive patients were concomitantly SPT-negative. Here, we show for the first time the clinical relevance of T cell-driven allergic reactions to apples. APTs may reveal type IV sensitization in patients who are negative for the corresponding type I sensitization tests. Thus, utilization of the APT procedure with fresh apple appears to be a valuable tool for the diagnosis of apple allergy and may improve the accuracy of food allergy diagnoses.

Prevalence of food allergies and intolerances documented in electronic health records.

BACKGROUND: Food allergy prevalence is reported to be increasing, but epidemiological data using patients' electronic health records (EHRs) remain sparse. OBJECTIVE: We sought to determine the prevalence of food allergy and intolerance documented in the EHR allergy module. METHODS: Using allergy data from a large health care organization's EHR between 2000 and 2013, we determined the prevalence of food allergy and intolerance by sex, racial/ethnic group, and allergen group. We examined the prevalence of reactions that were potentially IgE-mediated and anaphylactic. Data were validated using radioallergosorbent test and ImmunoCAP results, when available, for patients with reported peanut allergy. RESULTS: Among 2.7 million patients, we identified 97,482 patients (3.6%) with 1 or more food allergies or intolerances (mean, 1.4 ± 0.1). The prevalence of food allergy and intolerance was higher in females (4.2% vs 2.9%; P < .001) and Asians (4.3% vs 3.6%; P < .001). The most common food allergen groups were shellfish (0.9%), fruit or vegetable (0.7%), dairy (0.5%), and peanut (0.5%). Of the 103,659 identified reactions to foods, 48.1% were potentially IgE-mediated (affecting 50.8% of food allergy or intolerance patients) and 15.9% were anaphylactic. About 20% of patients with reported peanut allergy had a radioallergosorbent test/ImmunoCAP performed, of which 57.3% had an IgE level of grade 3 or higher. CONCLUSIONS: Our findings are consistent with previously validated methods for studying food allergy, suggesting that the EHR's allergy module has the potential to be used for clinical and epidemiological research. The spectrum of severity observed with food allergy highlights the critical need for more allergy evaluations.

Identification of allergens by IgE-specific testing improves outcomes in atopic dermatitis.

INTRODUCTION: IgE quantitative assaying of allergens (IgEQAA) has long been implemented by allergists in determining patients' reactivities for allergic rhinitis and asthma, two of the three diagnoses in atopic syndrome. This test operates by measuring the patient's IgE response to different allergens and can identify potential triggers for a patient's symptoms. Despite this, IgEQAA has yet to see the same widespread use in the field of dermatology, specifically in the treatment of patients with atopic dermatitis (AD). MATERIALS AND METHODS: The affected body surface area (BSA) at first presentation, IgEQAA classes, and total immunoglobulin E (IgE) concentration were taken retrospectively for 54 patients with AD. RESULTS: Of the 54 patients observed, 41 had an abnormally high total IgE concentration (76%). Additionally, it was observed that nine (17%) of our patients significantly improved after making lifestyle changes. CONCLUSION: Knowledge of the identified specific antigens can guide patients to make lifestyle modifications that may improve disease outcomes. IgEQAA and avoidance of allergens may help some patients with AD.

Allergy Testing.

Allergic diseases are common in outpatient primary care. Allergy testing can guide management to determine allergy as a cause of symptoms and target therapeutic interventions. This article provides a review of common methods of allergy testing available so that physicians may counsel and refer patients appropriately. Immediate-type hypersensitivity skin tests can be used for airborne allergens, foods, insect stings, and penicillin. Radioallergosorbent testing can be used to evaluate immediate-type hypersensitivity. Delayed-type hypersensitivity or patch-type skin tests are used in patients with suspected contact dermatitis.

IgE mediated sensitisation to aeroallergens in an asthmatic cohort: relationship with inflammatory phenotypes and disease severity.

BACKGROUND: Atopy is known to play an important role in the asthmatic disease. The main objective of this study was to evaluate the frequency of sensitisation to common aeroallergens in a cohort of asthmatics with different inflammatory phenotypes and disease severity. METHODS: We have conducted a retrospective cross-sectional study including 772 asthmatics recruited between 2003 and 2014 in our Asthma Clinic. The patients were defined as asthmatics on the basis of respiratory symptoms together with a positive methacholine test (PC20M) < 16 mg/ml and/or a reversibility to short-acting ß2-agonists (salbutamol) ≥ 12% and 200 ml. Sensitisation to house dust mites, grass and birch pollens, cats, dogs and moulds was assessed by RAST and a specific immunoglobulin E (IgE) > 0.35 kU/l was considered as significant. Inflammatory phenotypes were subdivided between pauci-granulocytic (n = 309) (40%), eosinophilic (n = 311) (40%), neutrophilic (N = 134) (17%) and mixed-granulocytic (N = 18) (3%) asthmatics. Severe asthmatics (n = 118) were defined according to the American Thoracic Society (ATS 2000) criteria and compared with mild-to-moderate asthmatics (N = 654). RESULTS: The eosinophilic phenotype was associated with higher levels of total serum IgE compared with neutrophilic and pauci-granulocytic asthma (p < 0.001 for both). Sensitisation rate to dogs and cats was higher in eosinophilic asthmatics (31% and 37%, respectively, p < 0.01 both) compared with neutrophilic (18% and 23% respectively) and pauci-granulocytic asthmatics (20% and 24%, respectively), while sensitisation rate to house dust mites and moulds were rather similar between the groups (ranging from 33% to 40% and from 10% to 16%, respectively). Severe asthmatics had slightly increased total serum IgE compared with mild-to-moderate asthmatics (p < 0.05) without any difference in the sensitisation rate to common aeroallergens. CONCLUSION: Eosinophilic asthma exhibits higher total serum IgE and sensitisation rate towards animal dander while clinical severity, though also associated with higher total IgE, did not preferentially relate to any type of common aeroallergens.

ALERGIA ALIMENTARIA EN LACTANTE ALIMENTADO CON SENO MATERNO EXCLUSIVO / Food allergy in an exclusively breastfed infant

El término alergia alimentaria se refiere a los eventos adversos a alimentos originados por mecanismo inmunológico. La alergia alimentaria puede aparecer en cualquier etapa de la vida. Es un padecimiento que, en general, se manifiesta en el lactante por llanto excesivo, cólicos, vómitos, diarreas, acompañadas de sangre y eccema en la piel. El objetivo de la investigación es demostrar la sensibilización del lactante a los alérgenos alimentarios que recibió en el útero de la madre y a través de la lactancia materna exclusiva. La metodología fue reporte de un caso al que se le suspendió la lactancia materna exclusiva y se introdujo leche en polvo hipoalergénica Puramino. La IgE total fue de 1.136 kU/l y los valores de IgE alérgeno específico para leche, el huevo y el maní mayores de 100 kU/l y para el trigo 24,4 kU/l. Se concluye así que la leche de vaca, el huevo, el maní y el trigo pueden sensibilizar al niño durante el embarazo y a través del seno materno. El uso de una dieta hipoalergénica durante el período de lactante puede revertir el proceso.(AU)

The term food allergy refers to adverse events caused by immunologic mechanism. Food allergy may appear at any stage of life, it is a condition that generally manifests itself in the baby's excessive crying, colic, vomiting, diarrhea accompanied by blood and skin eczema. The objective of the research is to demonstrate awareness infant to food allergens received in the mother's womb and through the exclusive breastfeeding. The methodology was a case report that was suspended exclusive breastfeeding and milk powder was introduced into hypoallergenic Puramino. The total IgE was 1.136 kU/L and allergen specific IgE values for milk, egg and peanut higher than 100 kU/L and wheat: 24. 4 kU/L. It is concluded that cow's milk, egg, peanuts and wheat can sensitize the child during pregnancy and through the womb. The use of a hypoallergenic diet during the infant can reverse the process.(AU)

Diagnòstic molecular en al·lergologia pediàtrica. Implicacions diagnòstiques i terapèutiques / Diagnóstico molecular en alergología pediátrica. Implicaciones diagnósticas y terapéuticas / Component-resolved diagnostic in pediatric allergy. Diagnostic and therapeutic implications

Fonament: els extractes obtinguts a partir de les fonts al•lergògenes completes sovint són barreges mal definides d'al•lèrgens principals, al•lèrgens de reactivitat encreuada i material no al•lergogen. Quan són utilitzades en els mètodes diagnòstics de sensibilització al•lèrgica (tant in vivocom in vitro), sovint no permeten un diagnòstic precís de l'al•lergen responsable de la simptomatologia, especialment en els pacients sensibilitzats a més d'una font al•lergògena. Els avenços en la caracterització d'al•lèrgens (biologia molecular i tècniques de DNA recombinant) han permès que disposem de noves eines diagnòstiques, com els al•lèrgens recombinants i els al•lèrgens purificats. Objectiu: revisar si la utilització d'al•lèrgens recombinants i al•lèrgens purificats pot millorar l'eficàcia dels mètodes diagnòstics convencionals utilitzats fins ara en al•lergologia pediàtrica. Mètode: revisió bibliogràfica fins al desembre del 2014. Es revisen els articles en què s'ha avaluat la utilitat del diagnòstic molecular en població al•lèrgica pediàtrica. Resultats: la utilització d'al•lèrgens recombinants i al•lèrgens purificats millora l'eficàcia dels mètodes diagnòstics convencionals, ja que ens permet definir les sensibilitzacions genuïnes i les que són conseqüència dels fenòmens de reac tivitat encreuada amb més precisió diagnòstica. Amb l'apli cació del diagnòstic molecular s'espera aconseguir una millor tipificació de la patologia al•lèrgica de la població pediàtrica polisensibilitzada i amb patologia al•lèrgica complexa. Conclusions: el diagnòstic al•lergològic molecular pot ser una eina molt útil per prendre decisions clíniques apropiades i a temps per als pacients, i oferir als metges la possi-bilitat d'individualitzar les accions terapèutiques

Fundamento. Los extractos obtenidos a partir de las fuentes alergénicas completas a menudo son mezclas mal definidas de alérgenos principales, alérgenos de reactividad cruzada y material no alergénico. Cuando se utilizan en los métodos diagnósticos de sensibilización alergénica (tanto in vivo como in vitro), a menudo no permiten un diagnóstico preciso del alérgeno responsable de la sintomatología, especialmente en los pacientes sensibilizados a más de una fuente alergénica. Los avances en la caracterización de los alérgenos (biología molecular y técnicas de DNA recombinante) han permitido que dispongamos de nuevas herramientas diagnósticas, como los alérgenos recombinantes y los alérgenos purificados. Objetivo. Revisar si la utilización de alérgenos recombinantes y alérgenos purificados puede mejorar la eficacia de los métodos diagnósticos convencionales utilizados en alergología pediátrica hasta ahora. Método. Revisión bibliográfica hasta diciembre de 2014. Se revisan los artículos en los que se evaluó la utilidad del diagnóstico molecular en población alérgica pediátrica. Resultados. La utilización de alérgenos recombinantes y alérgenos purificados mejora la eficacia de los métodos diagnósticos convencionales, ya que nos permite definir las sensibilizaciones genuinas y las que son consecuencia de los fenómenos de reactividad cruzada con una mayor precisión diagnóstica. Con la aplicación del diagnóstico molecular se espera conseguir una mayor tipificación de la patología alérgica de la población pediátrica polisensibilizada y con patología alérgica compleja. Conclusiones. El diagnóstico molecular puede ser una herramienta muy útil a la hora de establecer decisiones clínicas apropiadas y a tiempo para nuestros pacientes alérgicos, y ofrecer a los médicos la posibilidad de individualizar las mejores acciones terapéuticas (AU)

Background. Extracts obtained from complete allergenic sources are usually poorly defined mixtures of major allergens, cross-reactive allergens, and non-allergenic material. The analysis of those extracts seldom allows for a precise diagnosis of the allergen responsible for the symptoms (in vivo or in vitro), especially in patients sensitized to more than one allergenic source. Advances in the characterization of allergens (molecular biology and recombinant DNA techniques) have allowed for the development of new diagnostic tools based on purified and recombinant allergens. Objective. To review the effect that advances in the characterization of purified and recombinant allergens have had in the diagnostics of pediatric allergy. Method. Literature review of manuscripts published until December 2014. Articles evaluating the usefulness of molecular diagnosis in pediatric allergy were reviewed. Results. Advances in the characterization of allergens have facilitated the development of new diagnostic tools based on purified and recombinant allergens that can improve the efficiency of conventional allergy diagnosis methods. The use of recombinant and purified allergens for the study of the allergic sensitization of polysensitized patients and of patients with complex allergic disease may help discern genuine sensitization of the patient from crossreactivity with greater accuracy. Conclusions. The identification of the specific allergen that is sensitizing the patient is an essential requirement for optimal diagnosis and treatment; multiplexed molecular diagnosis can provide very useful information to aid in the management of these children (AU)

Effect of inhaled corticosteroids on bronchial asthma in Japanese athletes.

BACKGROUND: Asthma has a higher prevalence in athlete populations such as Olympic athletes than in the general population. Correct diagnosis and management of asthma in athletes is important for symptom control and avoidance of doping accusations. However, few reports are available on asthma treatment in the athlete population in clinical practice. In this study, we focused on the clinical efficacy of inhaled corticosteroid (ICS) for asthma in a Japanese athlete population. METHODS: The study subjects included athletes who visited the Niigata Institute for Health and Sports Medicine, Niigata, Japan for athletic tests and who were diagnosed with asthma on the basis of respiratory symptoms and positive results in a bronchodilator or bronchial provocation test such as exercise, hypertonic saline, or methacholine provocation. The athletes received ICS alone for at least 3 months, and the clinical background, sports type, and treatment efficacy were analyzed. RESULTS: The study population comprised 80 athletes (59 men and 21 women) with a median age of 16.0 years. Regarding sports type, 28 athletes engaged in winter sports (35%), 22 in endurance sports (27.5%), and 25 in indoor sports (31.3%). Although ICS is the primary treatment in athlete asthma, 16.3% of the athletes showed an unsatisfactory response to treatment according to the Global Evaluation of Treatment Effectiveness (GETE). These subjects were characterized by a decreased response to methacholine and lower values for FEV1/FVC and type 2 helper T cell (Th2)-associated biomarkers relative to responsive athletes. In multivariate analysis, FEV1/FVC and the logarithm to the base 10 of the IgE level were independently associated with the ICS response. CONCLUSIONS: These data suggest that ICS is effective for asthma in most athletes. However, certain asthmatic athletes are less responsive to ICS than expected. The pathogenesis in these subjects may differ from that of conventional asthma characterized by chronic allergic airway inflammation.

Value of microarray allergen assay in the management of eosinophilic oesophagitis

BACKGROUND: Eosinophilic oesophagitis (EoE) is a disorder characterised by oesophageal dysfunction and, histologically, by eosinophilic inflammation. Although treatment, which includes dilatations, oral corticosteroids and restrictive diets, is often effective, choosing the foods to be eliminated from the diet is difficult. OBJECTIVE: Component resolved diagnostic by microarray allergen assay may be useful in detecting allergens that might be involved in the inflammatory process. METHODS: We studied 67 patients with EoE, diagnosed clinically and histologically by endoscopic biopsy. CRD analysis with microarray technology was carried out in the 67 EoE patients, 50 patients with pollen allergy without digestive symptoms, and 50 healthy controls. RESULTS: Allergies were not detected by microarray in only seven of the 67 patients with EoE. Controls with pollen allergy showed sensitisation to different groups of pollen proteins without significant differences. In EoE patients with response to some allergens, the predominant allergens were grasses group 1 and, in particular, nCyn d 1 (Cynodon dactylon) or Bermuda grass pollen in 59.5%, followed by lipid transfer proteins (LTP) of peach (19.40%), hazelnut (17.91%) and Artemisia (19.40%)

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Screening for hen's egg and chicken meat specific IgE antibodies in Saudi patients with allergic disorders.

BACKGROUND: Allergy to hen's egg and meat contributes significantly to the manifestations of food allergy all over the world. OBJECTIVES: This study was performed to assess the presence of hen's egg and meat specific IgE antibodies among patients investigated for various allergic disorders. METHODS: This is a retrospective study performed at King Khalid University Hosptial, Riyadh. Data from 421 patients with allergic disorders screened for food specific IgE antibodies between January 2009 and March 2011 were analyzed. Sixty (14.25%) patients including 42 males and 18 females with the mean age (sd) of 7.5 (7.4) years were found to have specific IgE antibodies against hen's egg and chicken meat. There were 56 (93.3%) children and 4 (6.7%) adult patients. Specific IgE antibodies were measured by radioallergosorbent test (RAST) using Pharmacia ImmunoCAP 250 analyzer. RESULTS: Atopic dermatitis was the most common (55%) clinical condition. Out of the total 60 patients harboring hen's egg and chicken meat specific IgE antibodies high levels of egg white, yolk and chicken meat specific IgEs were detected in 58 (96.6%), 37 (61.6%) and 6 (10%) patients respectively. Both the egg white and yolk antibodies coexisted in 35 (58.3%) patients. CONCLUSION: Sensitization against hen's egg was higher compared to the chicken meat. Egg white sensitization higher than the egg yolk particularly in Saudi children with food related allergic disorders.

Pruebas epicutáneas en pacientes con eczema perianal / Patch Testing in Patients With Perianal Eczema

INTRODUCCIÓN Y OBJETIVOS: La prevalencia de parches positivos en los pacientes afectados por una dermatitis anogenital oscila según las series entre un 25-78%, justificándose por tanto la realización de pruebas epicutáneas ante eczemas de esta localización. Los objetivos del presente estudio son por un lado determinar los alérgenos más frecuentes en los pacientes con eczema perianal y, por otro, establecer las baterías de alérgenos más útiles para el estudio con pruebas epicutáneas de esta afección. MATERIAL Y MÉTODOS: Se han revisado retrospectivamente (años 2001-2012) los resultados obtenidos al estudiar con pruebas epicutáneas a aquellos pacientes que presentaban exclusivamente un eczema perianal. RESULTADOS: De los 37 pacientes con esta clínica en 16 se observó alguna reacción positiva, siendo el metilcloroisotiazolinona/metilisotiazolinona el principal alérgeno implicado. Excepto un caso con sensibilización a gentamicina, todas las positividades con relevancia presente correspondieron a alérgenos de la batería estándar del Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea (GEIDAC) o a productos propios del paciente. CONCLUSIONES: En nuestra experiencia la metilcloroisotiazolinona/metilisotiazolinona es el principal alérgeno implicado en los eczemas perianales, procediendo esta sensibilización frecuentemente del uso de toallitas higiénicas. El estudio epicutáneo de un eczema perianal deberá realizarse básicamente con la batería estándar y los productos propios

INTRODUCTION AND OBJECTIVES: Reports show that between 25% and 78% of patients with anogenital dermatitis have positive patch test results. Consequently, patch testing would appear to be warranted in patients presenting with eczema in the anogenital region. The objectives of the present study were to identify the most common allergens in patients with perianal eczema and to determine which allergen series are most useful for patch testing in patients with this condition. MATERIAL AND METHODS: We performed a retrospective review of patch test results in patients with only perianal eczema between 2001 and 2012. RESULTS: Of the 37 patients with perianal eczema, 16 had a positive reaction; methylchloroisothiazolinone/methylisothiazolinone was the main allergen involved. With the exception of 1 case of sensitization to gentamicin, all the positive results with present relevance were to allergens from the standard series of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) or to the patient's own products. CONCLUSIONS: In our experience, methylchloroisothiazolinone/methylisothiazolinone is the main allergen involved in perianal eczema, and sensitization often results from using wet wipes. Patch testing in perianal eczema should be based on the GEIDAC standard series and the patient's own products