Venom immunotherapy during COVID-19 pandemic: Experience from a University Allergy Center in Northern Italy.

During the ongoing pandemic of Coronavirus Disease 2019 (COVID-19) allergic patients need to continue their constant and proper treatment, including allergen-specific immunotherapy. These patients are expected to be at a higher risk for exacerbation of lung inflammation during viral infection. We investigated the putative interplay existing between allergen-specific immunotherapy and COVID-19 infection in a Hymenoptera venom-allergic population. We evaluated the frequency and severity of COVID-19 infection in a cohort of 211 subjects referring to our center for the regular administration of venom immunotherapy (VIT). Our result showed that the median age of our cohort is similar to the one that in our region has been associated with a high incidence of COVID-19 infection, increased hospitalization, and mortality rates. We reported only an isolated positivity of COVID-19 in the overall group; whereas none suffered from upper airway symptoms associated with COVID-19 (fever, cough, dyspnoea, sore throat, anosmia, and/or ageusia). Even though the demographic characteristics pose a substantial risk for such a population, we suggest that a regular administration of VIT may help in the development of an immunological milieu able to down modulate the Th1/Th17 environment that has been linked to inflammatory manifestations of COVID-19. To the best of our knowledge, this is the first description of the incidence of COVID-19 infection in Hymenoptera venom allergic patients treated with VIT, suggesting indirectly that venom immune tolerance-inducing treatment may be capable of reducing the aberrant inflammatory response induced by the virus in this specific population.

Office-based ocular procedures for the allergist.

PURPOSE OF REVIEW: The aim of this study is to suggest principles for ocular procedures to be performed by allergists in their offices in helping their diagnosis of ocular diseases and suggest better interactions between allergists and ophthalmologists. RECENT FINDINGS: Diagnosis of ocular allergy is based on clinical history and signs and symptoms, with the support of in-vivo and in-vitro tests for the identification of the specific allergen. Unfortunately, ocular manifestations are frequently misdiagnosed and not properly managed. SUMMARY: A multidisciplinary allergist-ophthalmologist approach may improve early differential diagnosis and the prognosis of patients with allergic disease and conjunctivitis through shared management and earlier etiological treatment.

Microarray-based IgE detection in tears of patients with vernal keratoconjunctivitis.

BACKGROUND: A specific allergen sensitization can be demonstrated in approximately half of the vernal keratoconjunctivitis (VKC) patients by conventional allergic tests. The measurement of specific IgE in tears using a multiplex allergen microarray may offer advantages to identify local sensitization to a specific allergen. METHODS: In spring-summer 2011, serum and tears samples were collected from 10 active VKC patients (three females, seven males) and 10 age-matched normal subjects. Skin prick test, symptoms score and full ophthalmological examination were performed. Specific serum and tear IgE were assayed using ImmunoCAP ISAC, a microarray containing 103 components derived from 47 allergens. RESULTS: Normal subjects resulted negative for the presence of specific IgE both in serum and in tears. Of the 10 VKC patients, six resulted positive to specific IgE in serum and/or tears. In three of these six patients, specific IgE was found positive only in tears. Cross-reactivity between specific markers was found in three patients. Grass, tree, mites, animal but also food allergen-specific IgE were found in tears. Conjunctival provocation test performed out of season confirmed the specific local conjunctival reactivity. CONCLUSIONS: Multiple specific IgE measurements with single protein allergens using a microarray technique in tear samples are a useful, simple and non-invasive diagnostic tool. ImmunoCAP ISAC detects allergen sensitization at component level and adds important information by defining both cross- and co-sensitization to a large variety of allergen molecules. The presence of specific IgE only in tears of VKC patients reinforces the concept of possible local sensitization.

Time to reconsider the clinical value of immunoglobulin G4 to foods?

BACKGROUND: The usefulness of serum antibodies to common food antigens (immunoglobulin G4; IgG4) assay in management of patients suffering from food intolerance was assessed. METHODS: A total of 22 asymptomatic healthy subjects and 68 patients with symptoms referred for suspected food intolerance were studied. Serum IgG4 to 19 common foods was measured by an automated immunoassay. RESULTS: The area under the receiver operating characteristic curve was 0.92 (standard error 0.04) and, at a threshold value of 2.3 U/mL, the IgG4 determination had a sensitivity of 0.81, with a specificity of 0.87. With a pre-test probability of 5% and 20%, the post-test probability of having disease was found to be 24% and 61%, respectively, and 1.1% and 5% if the result was negative. Cohen's K value (0.83) indicated a good agreement between symptoms and IgG4 concentrations. CONCLUSION: Serum IgG4 assay may play a role in rul-ing out food intolerance, because of its satisfactory negative predictive value (0.99).

Respiratory allergy to lipid transfer protein.

BACKGROUND: Due to unclear reasons, allergy to lipid transfer protein (LTP) is frequent in Mediterranean countries but rare in Northern Europe. OBJECTIVE: We report a paradigmatic case of primarily airborne sensitization to LTP that might explain the geographical distribution of this type of food allergy. METHODS: A 21-year-old woman began having severe perennial rhinitis 6 months after she started working in a wholesale fruit storehouse in Southern Italy where large amounts of fruits, including peaches, were handled; symptoms subsided when she left the workplace for >5 days and relapsed as soon as she was back at work. Later on, she developed severe food allergies to peach, hazelnut, peanut, apricot, plum and tomato. The patient underwent a nasal challenge with peach peel extract, and IgE reactivity was assessed by immunoblot analysis. RESULTS: In vivo and in vitro analyses showed sensitivity to LTP. The nasal challenge with peach peel extract (6 microg protein) induced acute, severe respiratory symptoms. On immunoblot with peach peel extract patient's serum reacted uniquely against LTP, as demonstrated by inhibition assays with the recombinant peach protein. CONCLUSION: LTP may induce sensitization via the respiratory tract due to inhalation of air-dispersed food particles, and this may precede the onset of food allergy. If this way of sensitization were effective in the majority of LTP allergic patients (e.g. by exposure to peaches showing intact fuzz in areas where peaches are grown and directly sold on the market) our findings could explain the strange geographical distribution of this type of food allergy.

In vivo and in vitro allergy diagnostics: it's time to re-appraise the costs.

BACKGROUND: The in vivo skin prick test (SPT) is widely considered less expensive than in vitro gamma-immunoglobulin E (IgE) determination in the diagnosis of allergy. The aim of the present paper is to evaluate the relevance of component-resolved in vitro diagnosis in comparison to extract-based diagnosis and the relative global costs in relation to clinical outcomes. METHODS: For 50 individuals with suspected seasonal allergic rhinitis, we compared the costs of skin testing with those of specific IgE antibody measurement. RESULTS: The costs were higher for in vitro than in vivo testing. However, the clinical information obtained using recombinant reagents allowed correct identification of the sensitizing molecule. CONCLUSIONS: Recombinant allergens for specific IgE in vitro measurement provide more reliable information for immunotherapy prescription. This should be translated into a significant reduction in the overall costs sustained by the healthcare system.

Maize flour-induced rhinitis.

Food allergy rarely causes allergic rhinitis. We report the case of a patient who developed non-occupational persistent rhinitis in adult age, evoked by the ingestion of maize (corn) flour. The symptoms and typical reactions of food allergy occurred only 15 years after the onset of the rhinitis signs.