Allergy to Gibberellin-regulated proteins in an adolescent: A case of orange-induced anaphylaxis mediated by cofactors / Alergia a proteínas reguladas por giberelinas en un adolescente: un caso de anafilaxia inducida por naranja mediada por cofactores

This report is a case of anaphylaxis in an adolescent due to allergy to gibberellin-regulated proteins mediated by cofactors, in probable relation to a pollen/food allergy syndrome. It should also emphasizes the importance of obtaining a faithful clinical history, especially when it comes to adolescent patients as they tend to initiate toxic habits.(AU)

Allergy to Gibberellin-regulated proteins in an adolescent: A case of orange-induced anaphylaxis mediated by cofactors.

This report is a case of anaphylaxis in an adolescent due to allergy to gibberellin-regulated proteins mediated by cofactors, in probable relation to a pollen/food allergy syndrome. It should also emphasizes the importance of obtaining a faithful clinical history, especially when it comes to adolescent patients as they tend to initiate toxic habits.

Snail-induced anaphylaxis in patients with underlying Artemisia vulgaris pollinosis: the role of carbohydrates

Purpose: The importance of carbohydrates in anaphylaxis has been described with some foods. The current work intends to obtain clinical and immunological evidence of the importance of the O-glycans for IgE binding activity in anaphylactic reactions due to Helix aspersa (HA) ingestión and Artemisia vulgaris (AV) exposition. Methods: The studio focused on two cases of IgE-mediated anaphylaxis induced by snail ingestion in patients with underlying rhino-conjunctivitis and asthma due to AV. We performed on both patients: skin prick tests ( SPTs) with HA and AV and with a battery of aeroallergen, controlled nasal challenge and specific IgE to HA and AV, ImmunoCAP ISAC®, and a differential pattern of IgE recognition with SDS-PAGE Immunoblotting (SDSI) when these allergens have suffered an O-deglycosylation procedure. Results: The patients showed positive results in SPTs, nasal challenges, and serum-specific IgE against HA and AV. In patient 1, the SDSI detected several IgE-binding proteins in AV with a molecular mass of 22, 24, and 44 kDa, whereas a band of 12 kDa was detected in HA. On the other hand, patient 2’s serum revealed an IgE-binding zone between 75 and 20 kDa in the AV and a band of 24 kDa in the HA. When glycans were removed, patient 1’s serum only revealed the AV’s 22 and 24 kDa bands, whereas patient 2’s serum did not detect any IgE-reactive protein in the HA. Conclusions: Our data suggest that O-glycosylation can be relevant in patients with anaphylaxis due to snails and allergy to Artemisia vulgaris. This new entity representing cross-reactivity between AV and HA could be named Snail-Artemisia Syndrome (AU)

Snail-induced anaphylaxis in patients with underlying Artemisia vulgaris pollinosis: the role of carbohydrates.

PURPOSE: The importance of carbohydrates in anaphylaxis has been described with some foods. The current work intends to obtain clinical and immunological evidence of the importance of the O-glycans for IgE binding activity in anaphylactic reactions due to Helix aspersa (HA) ingestión and Artemisia vulgaris (AV) exposition. METHODS: The studio focused on two cases of IgE-mediated anaphylaxis induced by snail ingestion in patients with underlying rhino-conjunctivitis and asthma due to AV. We performed on both patients: skin prick tests ( SPTs) with HA and AV and with a battery of aeroallergen, controlled nasal challenge and specific IgE to HA and AV, ImmunoCAP ISAC®, and a differential pattern of IgE recognition with SDS-PAGE Immunoblotting (SDSI) when these allergens have suffered an O-deglycosylation procedure. RESULTS: The patients showed positive results in SPTs, nasal challenges, and serum-specific IgE against HA and AV. In patient 1, the SDSI detected several IgE-binding proteins in AV with a molecular mass of 22, 24, and 44 kDa, whereas a band of 12 kDa was detected in HA. On the other hand, patient 2's serum revealed an IgE-binding zone between 75 and 20 kDa in the AV and a band of 24 kDa in the HA. When glycans were removed, patient 1's serum only revealed the AV's 22 and 24 kDa bands, whereas patient 2's serum did not detect any IgE-reactive protein in the HA. CONCLUSIONS: Our data suggest that O-glycosylation can be relevant in patients with anaphylaxis due to snails and allergy to Artemisia vulgaris. This new entity representing cross-reactivity between AV and HA could be named Snail-Artemisia Syndrome.

The relevance of oral food challenge in a patient allergic to peanut and tree nuts.

Peanut allergy is one of the most common food allergies in childhood. In vitro cross-sensitization between peanut and tree nuts (TN) is high, but only a subgroup of patients allergic to peanut will have a concomitant allergy to one or several TN. In this article, the authors report a case of a 12-year-old boy who experienced 1 episode of lips and mouth itching, generalized urticarial, and eyelid angioedema 20 minutes after ingestion of peanut at 4 years of age. The immunoallergological study revealed the presence of a concomitant allergy to peanut, pistachio, and cashew confirmed with medically supervised oral food challenges (OFC) in a child who had never eaten these TN. The mechanism of IgE-mediated hypersensitivity was demonstrated by positive skin prick tests (SPT) with commercial extracts, although the specific IgE (sIgE) for these foods was negative. As described in the literature, we concluded that serum peanut and TN sIgE measurements have lower sensitivity than SPT to assess IgE sensitization, and OFC is the gold standard for accurate diagnosis of food allergy. We highlight the relevance of excluding or confirming TN allergy in a peanut-allergic patient who had never ingested certain TN, and of knowing the clinical relevant cross-reactivity patterns between TN, pistachio/cashew, and walnut/pecan, that could reduce the need for OFC in clinical practice, reducing allergy rates and financial and health burdens of food allergy.

Baker's rhinitis and asthma with concomitant wheat anaphylaxis: a rare overlap of clinical entities / Rinite e asma do padeiro com anafilaxia após ingestão de trigo: um caso raro de sobreposição de entidades clínicas

Wheat is one of the fundamental sources of food worldwide. Baker's asthma and occupational rhinitis are both frequent and can be attributable to work exposure in bakers. However, the association between baker's asthma and wheat allergy is very rare. The authors report the case of a bakery worker who developed baker's asthma and occupational rhinitis after years of working in a bakery and later developed anaphylactic reactions after wheat ingestion.

O trigo é uma das fontes alimentares mais importantes em todo o mundo. A asma do padeiro e a rinite ocupacional são frequentes e podem ser atribuídas à exposição a farinhas em padeiros. No entanto, a associação entre asma do padeiro e alergia alimentar ao trigo é muito rara. Os autores descrevem um caso em que um trabalhador de panificação desenvolveu asma do padeiro e rinite ocupacional após anos trabalhando em uma padaria, e posteriormente desenvolveu reações anafiláticas após a ingestão de trigo.

Clinical Characteristics and Sensitization Profile of Patients Allergic to Cow Epithelium.

INTRODUCTION: Cow epithelium allergy (CEA) has been described in workers highly exposed to cattle, such as farmers and veterinarians, being a health problem in this population since it is their main livelihood. This study aimed to characterize the main clinical manifestations and define the sensitization profile of the cow epithelium-allergic population treated in our health area. METHODS: This is a retrospective study including a total of 34 patients with a clinical diagnosis of CEA, confirmed by skin tests, bovine epithelium-specific IgE levels and allergen-specific conjunctival challenge test in some cases. They were distributed by age, sex, profession, clinical symptoms, specific IgE levels to other mammalian epithelia, pollens, mites, and foods. Immunoblotting was performed with extracts from cow dander, cow body fluids (urine and saliva), bull urine, and 17 sera from immunotherapy-untreated CEA patients. RESULTS: The mean age of the patients was 44 years, with a higher incidence in cattle farmers. Rhinoconjunctivitis occurred in 100% of cases, with 35% having monosensitization to cow epithelium. Sera from most patients detected a 20-kDa IgE-binding band in cow dander, cow saliva, cow urine, and bull urine, corresponding to the major allergen Bos d 2 (bovine lipocalin). In 70% of the patients, a 25-kDa band was detected in cow and bull urine extracts, whose identification by mass spectrometry and investigation with protein databases led to the identification of a Bos taurus lipocalin (UniProt protein ID: A0A3Q1LGU7_BOVIN). CONCLUSION: CEA should be considered in patients exposed to cattle and as a cause of occupational disease. The IgE immunodetection revealed sensitization to a protein present in cow and bull urine (odorant-binding protein) not previously described.

Pork-cat syndrome as cause of anaphylactic reaction to well-cooked meat / Síndrome gato-porco como causa de reação anafilática à carne cozida

Pork-cat syndrome is a rare clinical syndrome that can cause lifethreatening reactions. Occuring in patients allergic to cat dander, it involves cross-reactivity between cat and pig serum albumin. Cat allergy usually precedes food allergies, suggesting primary sensitization to cat serum albumin. Since these proteins are thermolabile, the reaction tends to be more severe in undercooked meat. A 27-year-old woman with persistent moderate-to-severe rhinoconjunctivitis since childhood reported 2 immediate mucocutaneous reactions after eating small amounts of pork. Skin prick tests with commercial extracts showed sensitization to pork, and prick-to-prick tests confirmed sensitization to raw pork and raw beef. Specific IgE was positive for pork, and ISAC microarray also showed sensitization to Fel d 2. SDS-PAGE and IgE immunoblotting assays were performed with raw and cooked pork extract and detected in a 60 kDa band. In the immunoblotting-inhibition assays, cat serum albumin completely inhibited IgE binding to pork extract. The patient underwent 2 oral food challenges with well-cooked pork and beef, both causing an anaphylactic reaction. The patient's history and in-vivo and in-vitro tests led to a diagnosis of pork-cat syndrome with clinical cross-reactivity to another mammalian serum albumin. This case should stimulate oral food challenges with other well-cooked mammalian meats in patients with this syndrome to establish a tolerance threshold and avoid possible unexpected anaphylactic reactions.

A síndrome gato-porco é rara e ocorre em doentes alérgicos ao pêlo de gato, envolvendo reatividade cruzada entre as albuminas séricas (AS) de gato e de porco. Normalmente, a doença respiratória a pêlo de gato precede a alergia alimentar, sugerindo uma sensibilização primária à albumina sérica de gato. Uma vez que estas proteínas são termolábeis, as reações tendem a ser mais graves com carnes menos cozidas. Mulher de 27 anos com rinoconjuntivite persistente moderada a grave desde a infância que refere duas reações imediatas mucocutâneas após ingestão de pequenas quantidades de carne de porco. Os testes cutâneos por picada com extratos comerciais mostraram sensibilização à carne de porco e os testes prick-to-prick confirmaram sensibilização à carne de porco e de vaca cruas. A IgE específica (sIgE) foi positiva para carne de porco, e o ensaio ISAC mostrou sensibilização a Fel d 2. Foram realizados ensaios de immunoblotting SDS-PAGE IgE com extratos de carne de porco crua e cozidas que detectaram uma banda de 60 kDA. Nos ensaios de inibição por immunoblotting a albumina sérica de gato produziu uma inibição total da ligação da IgE ao extrato de carne de porco. A doente realizou duas provas de provocação oral com carne de porco e de vaca cozidas, ambas positivas com desenvolvimento de reação anafilática. A história clínica, os testes in-vivo e in-vitro levaram ao diagnóstico de síndrome gato-porco com reatividade cruzada clínica a outras albuminas séricas de mamíferos. A síndrome gato-porco é rara e pode causar reações fatais. Este caso frisa a importância da realização de provas de provocação oral com outras carnes de mamíferos bem cozidas em doentes com esta síndrome, de forma a estabelecer um limiar de tolerância e evitar possíveis reações anafiláticas inesperadas.

The Role of Molecular Allergens in the Diagnosis of Cat-Pork Syndrome: An Unusual Case Report.

Cat-pork syndrome is a rare condition, with few cases reported in the literature. This syndrome is justified by the homology between serum albumins from cat and pork. Evidence suggests that a primary sensitization to cat serum albumin Fel d 2 occurs, followed by allergic reactions after ingestion of pork meat containing serum albumin Sus s 1. Due to homology between other mammalian serum albumins, reactions with other meats can also be present. We report a well-documented case report of a patient with cat-pork syndrome, with initial mild and non-specific manifestations to well-cooked pork that were overlooked. Component resolved diagnosis was essential to establish the diagnosis, which confirmed the involvement of Fed 2 and Sus s 1, but less relevant in helping to define avoidance diets, since the sensitization profile was not in accordance with clinical manifestations.

A síndrome do gato-porco é rara, com poucos casos relatados na literatura. Esta patologia é justificada pela homologia entre albuminas séricas de gato e de porco. A evidência sugere que ocorre uma sensibilização primária à albumina sérica de gato Fel d 2, seguida por reações alérgicas após a ingestão de carne de porco contendo albumina sérica Sus s 1. Devido à homologia com outras albuminas séricas de mamíferos, reações com outras carnes também podem ocorrer. Reportamos um caso clínico bem documentado de uma doente com síndrome do gato-porco, com sintomas clínicos ligeiros e inespecíficos com ingestão de carne de porco cozinhada, que foram desvalorizados. O diagnóstico por componentes moleculares foi fundamental para estabelecer o diagnóstico, confirmando o envolvimento do Fed 2 e do Sus s 1, mas foi, no entanto, menos relevante na definição de dietas e evicção, uma vez que o perfil de sensibilização não se mostrou concordante com as manifestações clínicas.

Anaphylaxis to Agaricus bisporus ingestion.

A 33-year-old male with house dust mite allergic rhinitis and asthma reported an episode of facial and lip angioedema, dyspnea, cough and dysphagia at the age of 25, minutes after eating a mushroom ( Agaricus bisporus ) pizza. He denied any drug intake, hymenoptera stings or other possible triggers, and no identifiable cofactors were present. Since then he avoided all types of mushrooms, however an accidental contact occurred with mushroom sauce that resulted in angioedema of the lip within minutes. The allergy workup included measurements of total IgE and specific IgE to mushroom, and skin prick test to aeroallergens sources, possible food allergen sources and mushroom extract, a prick to prick test with raw and cooked A. bisporus , in addition to a SDS-PAGE and immunoblotting assay. The study revealed a specific IgE to mushroom of 0.76kUA/L positive skin prick test to mushroom extract, and prick to prick test positive to white and brown A. bisporus (raw and cooked). The immunoblotting identified two IgE binding proteins with 10kDa and 27kDa. We report a case of A. bisporus anaphylaxis probably due to primary mushroom sensitization. We detected two IgE-reactive proteins with 10kDa and 27kDa as possible culprit allergens.

Anaphylaxis to Agaricus bisporus ingestion / Anafilaxia por ingestão de Agaricus bisporus

ABSTRACT A 33-year-old male with house dust mite allergic rhinitis and asthma reported an episode of facial and lip angioedema, dyspnea, cough and dysphagia at the age of 25, minutes after eating a mushroom ( Agaricus bisporus ) pizza. He denied any drug intake, hymenoptera stings or other possible triggers, and no identifiable cofactors were present. Since then he avoided all types of mushrooms, however an accidental contact occurred with mushroom sauce that resulted in angioedema of the lip within minutes. The allergy workup included measurements of total IgE and specific IgE to mushroom, and skin prick test to aeroallergens sources, possible food allergen sources and mushroom extract, a prick to prick test with raw and cooked A. bisporus , in addition to a SDS-PAGE and immunoblotting assay. The study revealed a specific IgE to mushroom of 0.76kUA/L positive skin prick test to mushroom extract, and prick to prick test positive to white and brown A. bisporus (raw and cooked). The immunoblotting identified two IgE binding proteins with 10kDa and 27kDa. We report a case of A. bisporus anaphylaxis probably due to primary mushroom sensitization. We detected two IgE-reactive proteins with 10kDa and 27kDa as possible culprit allergens.

RESUMO Paciente do sexo masculino, 33 anos, com asma e rinite alérgica desencadeadas por ácaros, relatou episódio de angioedema facial e labial, dispneia, tosse e disfagia aos 25 anos, minutos após a ingestão de uma pizza de cogumelo ( Agaricus bisporus ). O paciente negou consumo de medicamentos, picadas de himenópteros, ou quaisquer outros possíveis desencadeadores ou cofatores que pudessem estar presentes. Desde então, evita todos os tipos de cogumelos, até a ocorrência de um contato acidental com molho de cogumelo, que resultou em angioedema labial minutos após. O estudo imunoalergológico incluiu doseamento de IgE total e específica para cogumelos, testes cutâneos para aeroalérgenos, possíveis alérgenos alimentares e extrato de cogumelos, teste prick to prick com A. bisporus cru e cozido e teste de SDS-PAGE immunoblotting . O estudo revelou IgE específica para cogumelos de 0,76kUA/L, teste cutâneo positivo para extrato de cogumelos e teste prick to prick positivo para A. bisporus branco e castanho (cru e cozido). O immunoblotting identificou duas proteínas de ligação de IgE, de 10kDa e 27kDa. Relatamos, assim, um caso de anafilaxia por ingestão de A. bisporus , provavelmente explicado por sensibilização primária a cogumelos. Detectamos duas proteínas IgE-reativas de 10kDa e 27kDa como os possíveis alérgenos responsáveis.

Beer: an uncommon cause of anaphylaxis.

Beer is one of the most consumed alcoholic beverages worldwide but allergic reactions to this beverage are uncommon. The authors present a case report of a 32-year-old male patient, sent to our Allergy and Immunology Department due to anaphylaxis minutes after Franziskaner beer ingestion. He tolerates all other alcoholic beverages. Prick tests to cereals were positive to wheat, corn and barley, as well as to peach. Prick-to-prick tests were performed with nine beer brands, all positive. Immunoglobulin (Ig)E to Pru p 3 was 14.8 kU/L. Sodium dodecyl sulfate polyacrylamide gel electrophoresis inhibition immunoblotting was performed with the Franziskaner beer extract in solid phase and both cereal extracts (wheat, barley and corn) and Pru p 3 as inhibitors. Extracts from wheat, barley and corn, and Pru p 3 purified protein were able to inhibit almost totally the IgE-binding to the Franziskaner beer extract. It seemed likely that the IgE-binding bands detected in the Franziskaner beer extract could be an LTP from cereals.