Spice allergy.

OBJECTIVES: To provide a review on spice allergy and its implementation in clinical practice. DATA SOURCES: PubMed searches were performed using spice allergy as the keyword for original and review articles. Selected references were also procured from the reviewed articles' references list. STUDY SELECTION: Articles were selected based on their relevance to the topic. RESULTS: Spices are available in a large variety and are widely used, often as blends. Spice allergy seems to be rare, reportedly affecting between 4 and 13 of 10,000 adults and occurring more often in women because of cosmetic use. No figures were available on children. Most spice allergens are degraded by digestion; therefore, IgE sensitization is mostly through inhalation of cross-reacting pollens, particularly mugwort and birch. The symptoms are more likely to be respiratory when exposure is by inhalation and cutaneous if by contact. Studies on skin testing and specific IgE assays are limited and showed low reliability. The diagnosis primarily depends on a good history taking and confirmation with oral challenge. The common use of spice blends makes identifying the particular offending component difficult, particularly because their components are inconsistent. CONCLUSION: Spices are widely used and contain multiple allergens, yet spice allergy is probably markedly underdiagnosed. There is a need for reliable skin testing extracts and serum specific IgE assays. Currently, the diagnosis depends on a good history taking and well-designed titrated challenge testing. Until immunotherapy becomes developed, treatment is strict avoidance, which may be difficult because of incomplete or vague labeling.

Differences among heat-treated, raw, and commercial peanut extracts by skin testing and immunoblotting.

BACKGROUND: Peanut allergenicity has been reported to be influenced by heat treatment, yet the commonly available extracts for skin prick testing (SPT) are derived from raw extracts. OBJECTIVE: To assess the effect of heat treatment on the SPT reactivity and specific IgE binding to peanut. METHODS: Three commercial extracts and 3 laboratory-prepared extracts, including raw, roasted, and boiled, were used for SPT in 19 patients with suspected peanut allergy and in 4 individuals who eat peanut without any symptoms. Serum samples were obtained to measure total IgE in addition to specific IgE binding to the study extracts by immunoblotting. Peanut allergy was confirmed with challenge test unless the individual had a convincing history of a severe reaction. RESULTS: Eleven study participants were considered peanut allergic based on a strong history or positive challenge test result. SPT with the prepared and commercial reagents showed that the boiled extract had the highest specificity (67% vs 42%-63% for the other extracts). The prepared extracts showed similar SPT sensitivity (81%). Three patients with a history of severe reaction and elevated specific IgE levels to peanut to the 3 study extracts had variable SPT reactivity to 1 or more of the commercial extracts. IgE binding to Ara h 2 was found in nearly all patients, regardless of their clinical reactivity. CONCLUSIONS: None of the extracts tested showed optimal diagnostic reliability regarding both sensitivity and specificity. Perhaps testing should be performed with multiple individual extracts prepared by different methods.

Hypoallergenic formulas: optimal choices for treatment versus prevention.

OBJECTIVES: To provide information on certain formulas that are relevant to allergy practice, focusing on their protein source and allergenicity, and to provide recommendations for selecting an optimal formula, taking into consideration efficacy, safety, palatability, and cost. DATA SOURCES: A literature search using the PubMed database for the following keywords: hypoallergenic formulas, infant formulas, hydrolysate formulas, elemental formulas, and amino acids formulas. STUDY SELECTION: Information was derived from pertinent original studies and selected reviews, including recent Cochrane Database Systematic Reviews, published in the English-language literature. RESULTS: For a formula to be considered hypoallergenic, it should be well tolerated by at least 90% of individuals who are allergic to the parent protein from which that formula has been derived. Extensively hydrolyzed formulas (EHFs), derived from bovine casein or whey, are tolerated by approximately 95% of cow's milk allergic individuals. Elemental formulas are prepared from synthesized free amino acids and are well tolerated practically by all individuals, including those who are allergic to EHFs. Partially hydrolyzed whey formula (PHWFs) cause allergy in one-third to half of milk allergic individuals and are not considered hypoallergenic. Both EHFs and PHWFs seem to be equally effective in reducing the risk of development of allergy in infants of atopic families. CONCLUSION: The EHFs and amino acids formulas, but not the partially hydrolyzed formulas, are optimal for milk allergic individuals. All 3 types of formulas are useful for prevention. The cost and palatability should be considered in deciding which formula to use.

Risk factors for the development of food allergy.

Both genetic and environmental factors seem to predispose to the development of food allergy. A most notable factor is diet, particularly during infancy. Possible other factors include maternal diet during pregnancy and lactation, birth by cesarean section, exposure to tobacco smoke, multivitamin supplementation, and intake of antacids. It is important to identify and control such risk factors to reduce the development of food allergy.