Allergen profile of Protophormia terraenovae, other species of calliphoridae, and Lumbricus terrestris in anglers allergic to maggots in Cáceres, Spain.

BACKGROUND: Our group previously found that up to 7% of amateur anglers in Caceres, Spain may be allergic to the larvae of Protophormia terraenovae (order Diptera, family Calliphoridae) used as live bait for fishing. OBJECTIVE: To identify the pattern of major allergens in P terraenovae and other species of Calliphoridae. MATERIALS AND METHODS: Extracts of P terraenovae, Calliphora vomitoria, Lucilia sericata and Lumbricus terrestris were characterized using sodium dodecyl sulfate polyacrylamide gel electrophoresis and IgE-immunoblotting techniques in individual sera from 24 patients with a positive skin test result and/or specific IgE determination (enzyme-linked immunosorbent assay [ELISA]) to P terraenovae. ELISA and IgE-immunoblotting inhibition studies were also performed to identify potential cross-reactive allergens between these species. RESULTS: IgE-immunoblotting with P terraenovae showed a band of 15.3 kDa recognized by 15 patients, in addition to 2 further allergens of 22.8 kDa and 69 kDa. For C vomitoria, 5 bands of 73, 46, 40, 28, and 14 kDa were observed. For L sericata, 2 major allergens of 73 kDa and 14 kDa were observed. In the case of L terrestris, IgE from 13 patients recognized 1 allergen of around 15.5 kDa. IgE-immunoblotting and ELISA inhibition revealed the presence of cross-reactivity, mainly between L terrestris and P terraenovae. CONCLUSIONS: P terraenovae appears to have species-specific allergens and allergens shared with C vomitoria and L sericata. Striking immunological cross-reactivity was observed between P terraenovae and L terrestris. An allergen of 15-16 kDa could be involved in this phenomenon.

Safety of measles-mumps-rubella vaccine (MMR) in patients allergic to eggs.

INTRODUCTION: Since the measles and mumps components used in MMR vaccine are grown in cultures of fibroblast from chick embryos, for a long time there have been concerns about the presence of egg protein in the vaccine and the recommendations given to egg allergic patients. We include in this paper our clinical experience vaccinating egg allergic patients with a regular triple viral vaccine, as well as an immunological study of each vaccine available in Spain. The aim of this study was to evaluate the clinical safety of a conventional MMR vaccine in a population of egg allergic patients and to determine the presence of egg allergens in a conventional MMR vaccine and if IgE antibodies from egg allergic can recognize egg allergens in this vaccine. MATERIALS AND METHODS: Children 15 months old with a confirmed diagnosed of egg allergy were included. In all patients, a skin prick test with non diluted MMR vaccine (Priorix, GSK) was made. If negative, each patient received a single dose of measles, mumps, rubella (MMR) vaccine. If positive, a fractionated injection of the vaccine was made following SEICAP recommendations (2004). SDS-PAGE immunoblotting was performed with Priorix vaccine. RESULTS: A cumulative total of 26 patients with egg allergy have safely received MMR vaccine in a single-dose (after a negative SPT in all cases) at our department without any reaction. 5 sera of vaccinated patients and 6 control sera of egg allergic patients (positive oral challenge) were used to immunolabel the membranes. No positive bands corresponding to egg proteins were found in any of the patients. CONCLUSION: Negative results found in SPT support the absence of clinical reaction against the components and Immunological studies point that there is no detectable amount of egg protein in this vaccine to produce an IgE mediated reaction. We can conclude that MMR can be safely administrated in children allergic to egg.

Selective sensitization to clavulanic acid and penicillin V.

Allergic reactions to beta-lactam antibiotics have been reported frequently and may occur because of sensitization to unique haptens or to determinants shared with other drugs. A woman who received 1 tablet of amoxicillin-clavulanic acid developed wheals and flares although she had previously tolerated the same preparation well. Levels of specific immunoglobulin (Ig) E to penicillin V, penicillin G, amoxicillin, and ampicillin were undetectable. Skin tests to amoxicillin, penicillin major determinant and minor determinant mixture were negative. The patient tolerated oral challenge with 500 mg of amoxicillin but developed wheals and flares when challenged with amoxicillin-clavulanic acid 500/125 mg. A histamine release test was negative with amoxicillin but positive with the amoxicillin-clavulanic acid and clavulanic acid. A prick test to the combination was positive. Specific IgE to penicillin V later became positive while remaining negative to other beta-lactams. No inhibition was obtained using penicillin V against clavulanic acid and amoxicillin but was complete when penicillin V was used in the solid-phase and as the inhibitor. No cross-reactivity was proven between these sensitizations.

Latex allergy in children: a follow-up study.

BACKGROUND: Natural rubber latex allergy is an important health problem. Multiple contacts with latex in childhood are a risk factor. Many aspects of this disease are still unknown, one of which is the clinical outcome of these children. The aim of this study was to evaluate the clinical and epidemiological features of latex allergy and compliance with latex avoidance instructions in allergic children. MATERIAL AND METHODS: Seventeen consecutive patients with a history of latex allergy, fruit allergy or chronic urticaria were selected. The patients underwent a skin prick test and determination of specific-IgE to latex at the start and at end of the study (median follow-up: 3 years). At diagnosis, patients with a positive result to one of the tests and a clinical history of latex allergy were considered allergic; patients with a positive test but without a clinical history suggestive of allergy were considered sensitized. These children were given latex avoidance instructions. RESULTS: Eleven children (64.7 %) were classified as allergic and 6 (35.3 %) as sensitized. Five patients had undergone latex-free surgery after diagnosis without incident. During follow-up, 11 patients (8 allergic and 3 sensitized) had contact with latex. Contact occurred in the home in 10 children, and all were symptomatic. Specific-IgE levels to latex at the end of the study were significantly higher in patients who had contact with latex during the follow-up period than in those without latex contact. CONCLUSIONS: Strict compliance with latex avoidance instructions is essential both inside and outside the hospital. Greater emphasis should be placed on reducing latex exposure in the home and school environments, as such contact could maintain positive IgE-antibody levels.

Manifestaciones clínicas de la hipersensibilidad a alimentos mediada por IgE / Clinical manifestations of IgE mediated food hipersensitivity

Las reacciones alérgicas a los alimentos dan lugar a respuestas clínicas que afectan al tracto gastrointestinal, la piel y el tracto respiratorio y dependen en su expresión del mecanismo inmunológico implicado en la patogénesis de la reacción. La piel es el órgano diana en las reacciones de hipersensibilidad a alimentos. Los síntomas cutáneos son las manifestacioes más frecuentes en la patología alérgica alimentaria, junto con la clínica digestiva. La manifestación cutánea más frecuente es la urticaria aguada, que puede ir acompañada o no de angioedema. La urticaria se presenta desde el 30% hasta el 60% de pacientes alérgicos a alimentos en diferentes series, siendo en alrededor del 44% de los pacientes manifestación clínica aislada sin acompañarse de afectación de otros órganos. A su vez, en a población infantil la primera causa de urticaria/angioedema de mecanismo igE mediado son los alimentos. Dentro de las manifestaciones digestivas mediadas por IgE se incluyen el síndrome de alergia oral y la anafilaxia gastrointestinal. La sintomatología respiratoria puede producirse por ingestión o por inhalación del alimento, y es mucho menos frecuente que la clínica dermatológica, asociándose usualmente a cuadro generalizado de anafilaxia. Aunue cualquier alimento puede provocar cualquier manifestación clínica, ciertos alimentos han sido citados más frecuentemente como una causa de anafilaxia grave o mortal, como cacahuetes, nueces y mariscos, ocupando un segundo lugar, leche, huevo, pescado y otros. La sintomatología clínica incluye participación variable de la piel (prurito, urticaria, angioedema), gastrointestinal 8naúseas, vómitos, dolor, diarrea), respiratoria (nasal, laríngea, pulmonar) y cardiovascular (hipotensión, síncope, arritmias)

Food allergic reactions include gastrointestinal, cutaneous and respiratory manifestations, depending on the immunological mechanism implicated. Skin and digestive manifestations are the most frequent symptoms in food allergic reactions. Acute urticaria, with or without angioedema, is the most frequent cutaneous symptom. 30 to 60% of food allergic patients have urticaria, without any other clinical manifestation in 44%. Food allergy is the first cause of igE mediated urticaria/angioedema in children. Specific-IgE mediated gastrointestinal manifestations include the oral allergy syndrome and the gastrointestinal anaphylaxis. Respiratory symptoms can be produced eating or breathing the food, and are less frequent than skin manifestations. They usually appear taking part of an anaphylaxis. Any food allergen can produce any clinical manifestations, but some foods had been described several times as responsible of severe anaphylaxis (peanuts, nuts and seafood, and after them milk, egg, fish and other), including skin manifestations (pruritus, urticaria, angioedema), digestive manifstations (nausea, vomiting, abdominal pain, diarrhea), respiratory symptoms(rhinitis, laryngeal or bronquial symptoms) and cardiovascular symptoms (hypotension, arrhythmia)