Clinical reactivity of celery cultivars in allergic patients: Role of Api g 1.

BACKGROUND: Celery (Apium graveolens L.) is a vegetable consumed world-wide. Celery stalks and celeriac roots are often ingredients in convenient food products like spice blends and soups. OBJECTIVE: In this study, we examined the allergenicity of distinct celeriac cultivars. METHODS: Sixteen celery-allergic patients were identified using a double-blind, placebo-controlled food challenge. Ten different celeriac cultivars were used for skin prick testing in the patients. Two cultivars were further applied for oral food challenges; their protein composition was analysed by immunoblotting, and contents of major allergen Api g 1 were quantified. RESULTS: From the 10 investigated celeriac cultivars, two cultivars elicited significantly different skin reactivity ("Anita": 5.0 [2.0-12.0] mm vs "Prinz": 7.0 [3.0-9.5] mm; P = .047). Moreover, "Anita" induced fewer symptoms after a controlled oral-celeriac challenge in 14 patient (P < .001). The protein profiles on 2DE protein gels showed distinct protein patterns and higher protein amounts of Api g 1 in "Prinz" than in "Anita." CONCLUSIONS AND CLINICAL RELEVANCE: Taken together, the data from this study suggest that cultivar Anita is better tolerated in celery-allergic patients than "Prinz." Differences in the protein expression profile between the cultivars, particularly the different content of Api g 1, could cause the different allergenicity.

Factors increasing the risk for a severe reaction in anaphylaxis: An analysis of data from The European Anaphylaxis Registry.

BACKGROUND: Preventive measures to decrease the frequency and intensity of anaphylactic events are essential to provide optimal care for allergic patients. Aggravating factors may trigger or increase the severity of anaphylaxis and therefore need to be recognized and avoided. OBJECTIVE: To identify and prioritize factors associated with an increased risk of developing severe anaphylaxis. METHODS: Data from the Anaphylaxis Registry (122 centers in 11 European countries) were used in logistic regression models considering existing severity grading systems, elicitors, and symptoms to identify the relative risk of factors on the severity of anaphylaxis. RESULTS: We identified higher age and concomitant mastocytosis (OR: 3.1, CI: 2.6-3.7) as the most important predictors for an increased risk of severe anaphylaxis. Vigorous physical exercise (OR: 1.5, CI: 1.3-1.7), male sex (OR: 1.2, CI: 1.1-1.3), and psychological burden (OR: 1.4, CI: 1.2-1.6) were more often associated with severe reactions. Additionally, intake of beta-blockers (OR: 1.9, CI: 1.5-2.2) and ACE-I (OR: 1.28, CI: 1.05, 1.51) in temporal proximity to allergen exposition was identified as an important factor in logistic regression analysis. CONCLUSION: Our data suggest it may be possible to identify patients who require intensified preventive measures due to their relatively higher risk for severe anaphylaxis by considering endogenous and exogenous factors.

Identification of putative new tomato allergens and differential interaction with IgEs of tomato allergic subjects.

BACKGROUND: Tomato became one of the world-wide most consumed vegetables, unfortunately accompanied by an increasing risk of tomato allergy affecting certain people. As tomato allergic subjects show highly variable reactions in clinical allergy tests, it is difficult to identify cultivars or differentially treated tomato plants where a significant reduction in the allergenic potential over all subjects of a cohort can be detected. OBJECTIVE: This study was carried out to test the hypothesis that individual variability is based on differential reactions of single subjects to particular allergens in tomato fruits of plants with certain genetic background or cultivated under distinct conditions. METHODS: Proteins were extracted from tomato fruits of the previously investigated genotypes 76R, its mycorrhizal mutant RMC, and the cultivar Counter, fertilized with different forms of nitrogen in deficit or excess. 2-D immunoblots were carried out with sera of nine tomato allergic subjects, beforehand analysed in skin prick tests. RESULTS: In total, ten putative tomato allergens were identified in these immunoblots. No correlation was detected between individual skin prick test results and the quantity of positive reactions to putative allergens. IgEs of each subject showed reactions to nearly every identified putative allergen, but reactions were dependent on genotype and growth conditions. Among the ten putative tomato allergens, five new candidates were identified as follows: an endo-ß-mannanase, a pectinacetylesterase, a pectinesterase inhibitor, an aspartyl protease family protein and a protein of unknown function. CONCLUSION AND CLINICAL RELEVANCE: The hypothesis that high interindividual differences in allergic reactions are based on the interactions between the IgEs of allergic subjects with particular allergens has to be rejected. However, five proteins with putative clinical relevance as tomato allergens could be newly identified.

[Food-associated anaphylaxis. Data from the anaphylaxis registry]. / Nahrungsmittelassoziierte Anaphylaxie. Daten aus dem Anaphylaxie-Register.

Severe allergic reactions are reported to the anaphylaxis registry in German-speaking countries. The data provides knowledge regarding the diagnosis and management of patients suffering from anaphylaxis. The ranking of the most frequent elicitors inducing anaphylaxis is age-dependent and also influenced by the group which is reporting the data. The list of food allergens inducing anaphylaxis also varies with age. In children and adolescents peanuts are common elicitors of food-dependent anaphylaxis: in adults wheat is the most frequent cause. Furthermore, the data from the anaphylaxis registry provides information about rare triggers, as well as alerting us to those causative agents which are increasing in frequency. The relevance of augmentation factors is most likely age-dependent, whereas co-morbidities including atopic diseases like atopic dermatitis and allergic asthma occur frequently in children suffering from food-dependent anaphylaxis. The present manuscript provides data on food allergens such as peas and cauliflower, which have been reported as rare causes of anaphylaxis.

Allergenic activity of different tomato cultivars in tomato allergic subjects.

BACKGROUND: Tomatoes (Solanum lycopersicum) are consumed worldwide and their amount of consumption is associated with the prevalence of tomato allergy. Therefore, identification of tomato cultivars with reduced allergenicity would potentially increase the quality of life of affected subjects. OBJECTIVE: In this study, we examined the allergenic and biological activity of two different tomato cultivars in tomato allergic subjects. METHODS: Twenty-five subjects with tomato allergy were identified using double-blind, placebo-controlled food challenges (DBPCFC). We applied skin prick test (SPT) and further DBPCFC to investigate the clinical differences between two tomato cultivars ('Reisetomate' and 'Matina'). To examine the molecular basis of allergenic activity, immunoblotting and basophil activation test (BAT) were performed. RESULTS: The cultivar 'Reisetomate' induced significantly less positive skin reactions (P = 0.045) and elicited fewer symptoms after oral challenge compared with 'Matina' (P = 0.047). Molecular assessment revealed that IgE-binding profiles were variable on an interindividual basis, but no major differences between 'Reisetomate' and 'Matina' were detectable. In contrast, BAT underpinned the clinical differences evoked by the different tomato cultivars and showed a left-shift of the dose-response curve obtained for 'Matina' extract (P = 0.046). CONCLUSIONS AND CLINICAL RELEVANCE: Tomato cultivars promote a distinct clinical reactivity in tomato allergic subjects, demonstrated using SPT, DBPCFC and BAT. The molecular background for these differences could not be clarified, as the IgE-binding profiles did not reveal significant alterations. This might be due to instabilities of physicochemical sensitive proteins and/or different isoform expression of allergens.

Long-term reduction in local inflammation by a lipid raft molecule in atopic dermatitis.

BACKGROUND: The complex pathogenesis of atopic dermatitis (AD) is guided by cell surface receptor-mediated signal transduction regulated in lipid rafts. Miltefosine is a raft-modulating molecule targeting cell membranes. With this controlled clinical study, the clinical and immunomodulatory efficacy of miltefosine was investigated in patients with AD in comparison with a topical corticosteroid treatment. METHODS: Sixteen patients with AD were treated topically with miltefosine and hydrocortisone localized on representative AD target lesions for 3 weeks. To assess the clinical efficacy, the three item severity (TIS) score was evaluated before, during and after treatment as well as after 4-week-follow-up period. To study the anti-inflammatory effect of miltefosine on the cellular T cell pattern, skin biopsies were analysed before and after treatment. RESULTS: The TIS score dropped in both groups significantly after treatment. A carry-over effect was exclusively seen for miltefosine after discontinuing the treatment. These findings were substantiated by thermographic imaging with a significant decrease in the maximum temperature (T(max)) after miltefosine application (P = 0.034, DeltaT(max) = 1.7 degrees C [2.1-3.9]). Immunohistochemically, a reduction in lesional CD4(+)-infiltrating T cells was observed in both treatments. Moreover, increased FoxP3(+) cells were present in the skin after miltefosine treatment (before 5.4% [1.9-9.8], after 6.2% [3.5-9.5]). CONCLUSION: We demonstrate that miltefosine is locally active in patients with AD and led to a sustained clinical improvement in local skin inflammation. Moreover, the increased frequency of FoxP3(+) cells in the skin of patients with AD suggests its immunomodulatory properties.

Docosahexaenoic acid (DHA) supplementation in atopic eczema: a randomized, double-blind, controlled trial.

BACKGROUND: The increasing prevalence of atopic eczema has been linked to the alteration of the Western diet, namely the reduced consumption of omega-3 (n-3) polyunsaturated fatty acids (PUFA) and an increased omega-6 (n-6) PUFA intake. OBJECTIVES: The aim of the pilot study was to determine the efficacy of dietary n-3 PUFA docosahexaenoic acid (DHA) in patients with atopic eczema. METHODS: Fifty-three patients suffering from atopic eczema aged 18-40 years were recruited into this randomized, double-blind, controlled trial and received either DHA 5.4 g daily (n = 21) or an isoenergetic control of saturated fatty acids (n = 23) for 8 weeks. At weeks 0, 4, 8 and 20 the clinical outcome was assessed by the SCORAD (severity scoring of atopic dermatitis) index. IgE production and activation of peripheral blood mononuclear cells (PBMC) were analysed. Plasma fatty acids were measured by gas chromatography. RESULTS: DHA, but not the control treatment, resulted in a significant clinical improvement of atopic eczema in terms of a decreased SCORAD [DHA: baseline 37.0 (17.9-48.0), week 8 28.5 (17.6-51.0); control: baseline 35.4 (17.2-63.0), week 8 33.4 (10.7-56.2)]. A significant reduction of anti-CD40/interleukin 4-mediated IgE synthesis of PBMC was detected in the DHA group only. Supplementation led to a modulated activation status of PBMC in both groups. The DHA group showed an increase of plasma n-3 PUFA and a decrease in the n-6/n-3 PUFA ratio. CONCLUSIONS: Our data suggest that dietary DHA could be bioactive and might have a beneficial impact on the outcome of atopic eczema, but our results need to be confirmed in a larger study.