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Background Grass and olive are the most frequently pollens that induce seasonal allergic rhinitis in Spain. Cross-reactivity due to panallergens shared by them and overlapping pollination complicates the recognition of allergy-causing agents, making it difficult to identify the most appropriate allergen immunotherapy ( AIT) to use. The aim of this study was to determine the sensitization pattern to major grass and olive pollen allergens using component-resolved diagnostics in patients with seasonal allergic rhinitis ( SAR) and positive skin prick test to grass and olive pollens and evaluate how knowledge of the sensitization patterns might influence AIT prescription. Methods After informed written consent, a total of 1263 patients were recruited. A serum determination of specific IgE levels to Ole e 1 and Phl p 1 + 5 was performed to all patients. A comparison was made before and after obtaining the specific IgE results, and differences in diagnosis were stated. Results At the 0.35 kU/l cut-off point, 71.2% of patients were positive to Ole e 1 and Phl p 1 + 5, 14% were positive only to Phl p 1 + 5 and 12% were positive only to Ole e 1. Based on available clinical data and skin prick test results, 922 (73%) patients would have been indicated for a mixture of grass and olive pollens for AIT. In 56.8% of patients, there was non-coincidence in the composition of AIT that would be selected before and after investigators received the in vitro data. Conclusion The diagnostic accuracy of the recombinant allergen-specific IgE test could help to improve the selection of specific-allergen immunotherapy in polysensitized patients. [ABSTRACT FROM AUTHOR]

Different molecular mechanisms may modulate sensitization and natural or induced tolerance to allergens. We have searched for differential mechanisms at humoral and cellular level in the olive pollen allergic response, checking the influence of exposure to allergens of subjects from an area with extremely high antigenic load during the pollen season. Sera and PBMCs were obtained during and outside the pollen season. Distinct Ig subtypes (total IgE and specific IgE, IgG4 and IgA), and Thl, Th2 and regulatory T cells (Treg) cytokines were analyzed in 5 groups of subjects: Group 1, non-allergic; Group 2, asymptomatic, sensitized to olive pollen; Group 3, allergic to pollen other than olive; Group 4, allergic to olive pollen (not treated); and Group 5, allergic to olive pollen, and getting specific immunotherapy. Asymptomatic subjects showed the highest total IgE levels. The major difference found between untreated and treated subjects was the high levels of non-inflammatory antibodies (IgG4) in treated patients. The main result of cytokine analyses was the statistically significant decrease in TGF-β levels in untreated olive pollen allergic subjects (pollen season) compared with treated. A significant decrease in forkhead winged-helix transcription factor (FOXP3) mRNA expression (marker of regulatory response) and a lower presence of Treg cells in PBMCs of olive pollen allergic subjects was found. The results point to a decrease in the cellular regulatory mechanisms mediated by TGF-β and FOXP3 in olive-pollen allergic patients that could be restored after specific-immunotherapy. [ABSTRACT FROM AUTHOR]

Background: Allergy diagnosis in patients exposed to multiple pollen species is complex and misdiagnosis is often a cause for unsuccessful specific immunotherapy. Objective: We studied the sensitization profile of individual allergens (major, minor and pan-allergens) in pollen-sensitized patients in a region with high exposure to olive pollen by investigating the influence of minor allergens on allergic disease and the association between pan- and minor allergen sensitizations. Methods: A panel of 13 purified allergens, which included the most relevant allergens in the area, as well as minor olive allergens and pan-allergens, were screened using a high-capacity technology (ADVIA-Centaur®) in 891 patients. Results: Olive allergy as measured by specific IgE to Ole e 1 was the leading pollinosis in the area. The minor olive allergens Ole e 7 and Ole e 9 were markers of more severe allergic illness. Profilin sensitization was associated mainly with grass allergy, the second most prevalent pollinosis. Salsola kali pollen allergy was the third most common cause of pollinosis in the area. The prevalence of sensitization to the peach allergen Pru p 3, a nonspecific lipid-transfer protein, was notable. Conclusion: Epidemiological analysis by component-resolved diagnosis is a new method, which elucidates the interaction between allergen exposure gradient and patient sensitization. High exposure leads to differential sensitization profiles some of which are associated with more severe allergic conditions. Profilin sensitization, related mainly to grass pollinosis, was a marker of more severe grass pollen sensitization. [ABSTRACT FROM AUTHOR]

Background: Sinapis alba (white mustard) is a entomophilic species included in the Brassicaceae family. To date it has not been related to allergic sensitization or clinical respiratory disease. Methods: Twelve olive orchard workers had a history of rhinitis and/or bronchial asthma that occurred during control weed management and/or harvest, from January to March. They underwent skin prick tests (SPT) with S. alba pollen extract and a standard battery of aeroallergens. Sinapis alba pollen extract was prepared for performing quantitative skin tests, enzyme allergosorbent test and nasal challenge test (NCT). A portable monitoring station and an urban volumetric Hirst-type spore trap were used for the aerobiological study. Results: Eleven patients suffered from rhinitis and bronchial asthma and one had only from rhinitis. All patients were sensitized to S. alba pollen extract, and they showed a positive NCT response. In the urban aerobiologic monitoring station the amount of S. alba pollen only exceptionally reached peaks of 21 grains/m3, whereas in the work environment peaks of 1801 grains/m3 were detected between 15 February and 7 April. Conclusions: We demonstrate the existence of a new occupational allergen for olive farmers: S. alba pollen. We point out the importance of perform aerobiological sampling within the occupational environment for the detection and quantification of the allergenic source. [ABSTRACT FROM AUTHOR]

Background: Polcalcins are pollen-specific allergens with two EF-hand calcium-binding sites that exhibit strong cross-reactivity. Our objective was to isolate and express the cDNA coding of the EF-hand calcium-binding allergen from lilac pollen and to study cross-reactivity with other polcalcins from related and nonrelated pollen sources with different specific antibodies and sera from two different populations. Methods: Specific cDNA was amplified by PCR, cloned and expressed in Escherichia coli. Purification was achieved by gel permeation and ion exchange chromatographies. ELISA titration and inhibition assays were performed using the recombinant forms of Syr v 3, Ole e 3, Che a 3 and Phl p 7 with sera from two Spanish regions with different sensitization profiles, as well as Phl p 7- and Ole e 3-specific polyclonal rabbit antisera, and an Ole e 3-specific monoclonal antibody. Results: Syr v 3 displays two EF-hand consensus sites and 8863 Da of theoretical molecular mass. The allergen consists of 80 residues with identities ranging from 66 to 87% with polcalcins included in this study. Syr v 3, Ole e 3, Che a 3 and Phl p 7 showed a similar IgG- and IgE-binding capacity although differences at quantitative level were observed depending on the population of patients’ sera. Conclusion: Syr v 3 is a polcalcin with structural and antigenic similarities to the members of this family. Diagnosis of polcalcin-sensitized patients could be performed whatever polcalcin used, whereas for immunotherapy, primary sensitization to a particular allergenic source should be considered. [ABSTRACT FROM AUTHOR]

1,3-β-glucanases (group 2 of pathogenesis-related proteins) are enzymes widely distributed among higher plants and have been recently proven to be significant allergens.The aim of this work was to study the potential implication of 1,3-β-glucanases in cross-reactivities among latex, pollen and vegetable foods.The cDNA encoding the N-terminal domain (NtD) of Ole e 9, a major allergenic 1,3-β-glucanase from olive pollen, was amplified by polymerase chain reaction and produced as a recombinant protein inPichia pastoris(recombinant N-terminal domain, rNtD). Circular dichroism, ELISA, immunoblotting and immunoblotting inhibition experiments were carried out. Sera from olive pollen allergic patients and a rNtD-specific polyclonal antiserum were used.The NtD of Ole e 9 has been produced at high yield in the yeastP. pastorisand possesses 1,3-β-glucanase activity. The expressed polypeptide conserves IgE and IgG immunodominant epitopes of the whole Ole e 9. A rNtD-specific polyclonal antiserum and sera from olive pollen allergic patients allowed detection of IgG and IgE reactive peptidic epitopes common to 1,3-β-glucanase Ole e 9 in extracts from ash and birch pollen, tomato, potato, bell-pepper, banana and latex.rNtD and homologous glucanases are new molecules to be used in diagnostic protocols as they could help to identify allergic pollen patients who are at risk for developing allergic symptoms to fruits, vegetables and latex. [ABSTRACT FROM AUTHOR]

The clinical characteristics in olive pollen allergy are dependent on the antigenic load, the allergens profile, and the genetic restrictions. Our objective was to determine specific response pattern in Ole e 2 and Ole e 10 sensitization at those levels.We studied 146 patients with seasonal rhinitis and/or asthma and positive prick test toOlea europaeapollen. IgE against Ole e 2 and Ole e 10 were detected by skin prick test and ELISA. HLA-DRB1 and HLA-DQB1 loci were typed by polymerase chain reaction sequence-specific primers method.A total of 102 (69.9%) and 79 (54.0%) patients showed significant IgE antibody response against Ole e 2 and Ole e 10, respectively. There was a significant association between Ole e 2 (OR 2.2,P = 0.04) and Ole e 10 reactivities (OR 2.8,P = 0.007) with asthma. In addition, total and specific IgE antibody levels significantly correlated with asthma (P < 0.05). Patients who reacted to both allergens reached the highest asthma risk factor (OR 4.3,P = 0.002). Phenotypic frequency of DR7 (OR 5.4,Pc = 0.003) and DQ2 (OR 3.6,Pc = 0.02) were increased in positive Ole e 2 patients compared with control subjects. DR2(15) phenotypic frequency was significantly increased (OR 5.6,Pc = 0.02) in positive Ole e 10 patients compared with control subjects.Our data suggest an association of Ole e 2 and Ole e 10 with bronchial asthma. Also, we found a genetic control of Ole e 2 and Ole e 10 IgE-specific responses that could be relevant to clinical disease in olive pollen allergy. [ABSTRACT FROM AUTHOR]

Summary Background Several Ca2+ -binding proteins, which possess EF-hand sites with a high sequence similarity, have been found to be able to induce Type-I allergy. Objective To study whether the common EF-hand sequential motifs can be involved in the IgE-reactivity of these proteins, thus being responsible of a degree of cross-reactivity among different Ca2+ -binding proteins. Methods Two olive pollen allergens, Ole e 3 and Ole e 8, have been used in the study. Parvalbumin and calmodulin were included in immunological analyses. Sera from patients allergic to olive pollen, as well as Ole e 3- and Ole e 8-specific rabbit antisera were used in indirect enzyme-linked immunosorbent assay (ELISA), ELISA inhibition assays and immunobloting. Conformational analyses (circular dichroism spectra and thermal stability) and specific immunodetection assays were performed in the presence and the absence of Ca2+ . Chemical breakdown and high-performance liquid chromatography (HPLC) was used to obtain fragments from Ole e 3 containing a single EF-hand motif. Results Thirty-four (17%) and 16 (8.2%) out of 195 sera from patients allergic to olive pollen contained specific IgE against Ole e 3 and Ole e 8, respectively. The IgE-binding of 12 allergic sera diminished up to 22% for Ole e 3 and to 82% for Ole e 8, when depleted Ca2+ . A pool of these sera recognized the two olive allergens and parvalbumin, but at very different extent. Inhibition of the IgE-binding was only achieved between two olive allergens. No structural relationships between Ole e 3 and Ole e 8 were established when specific polyclonal antisera against both proteins were used. Conclusion EF-hand Ca2+ -binding sites can not be considered as general allergenic motifs responsible for the cross-reactivity between Ca 2+ -binding allergens. Different families of Ca 2+ -binding allergens have specific epitopes that could be involved in the... [ABSTRACT FROM AUTHOR]

Background Olive tree (Olea europaea ) pollen is an important cause of pollinosis in the countries of the Mediterranean area. Objective This work aimed to study the IgE-binding frequency of Ole e 1, Ole e 2, Ole e 3, Ole e 6 and Ole e 7 from O. europaea pollen in a large population of olive pollen-allergic patients. Methods We studied: 119 consecutive patients with seasonal rhinitis and/or asthma and a positive skin prick test to O. europaea pollen extract; 10 atopic patients without history of pollinosis and a negative skin prick test to O. europaea; and 10 healthy controls. Allergens were purified from O. europaea pollen extract by reverse phase HPLC and characterized by N-terminal amino acid sequencing, MALDI analysis, and specific IgE immunodetection. Skin prick tests and ELISA titration against above mentioned purified olive pollen allergens were performed in all pollinic patients and controls. Results One-hundred and seven (90.7%) patients had a positive skin response to Ole e 1; 88 (74.6%) reacted to Ole e 2; 57 (47.9%) reacted to both Ole e 6 and Ole e 7; and 43 (37.8%) reacted to Ole e 3. The allergenic activity determined by ELISA to Ole e 1 was found in 84%; to Ole e 2 in 61.3%; to Ole e 3 in 31.9%; to Ole e 6 in 39.4%; and to Ole e 7 in 41.2% of patients. All patients had positive skin responses to at least one of the allergens tested, However, a combination of Ole e 1 and Ole e 2 together with a minor allergen Ole e 6 or Ole e 7, disclosed the same diagnostic value that was obtained with the use of crude olive pollen extract. The nonatopic and atopic control subjects did not react to any purified allergens on the skin prick test. Conclusions These results indicate that Ole e 1 and Ole e 2 are major allergens in patients with O. europaea pollinosis in our population. A combination of a few olive pollen allergens can substitute the crude extract for in vivo as well as in vitro diagnostic purposes. [ABSTRACT FROM AUTHOR]

Background: Rhinoconjunctivitis and bronchial asthma are atopic diseases with a high prevalence in the Canary Islands (Spain). Given that the most prevalent allergen is the house-dust mite Dermatophagoides pteronyssinus, early detection of genetically susceptible subjects would allow the application of preventive measures. The objective was to investigate the possible association of IL4-R1 (chromosome 5q31-q33) and FceRI-bca (chromosome 11q13) markers with the atopic disease in our population. Methods: We performed a case/control study in which patients were recruited on the basis of diagnosis of rhinoconjunctivitis and/or bronchial asthma, and positive skin prick test to D. pteronyssinus. Analysis of IL4-R1 and FceRI-bca microsatellites was carried out by PCR and electrophoresis in acrylamide gels. Results: We have not found evidence of association between IL4-R1 and FceRI-bca markers and atopic disease in our population. In addition, these markers have shown a high percentage of homozygosis. Conclusions: IL4-R1 and FceRI-bca markers have not proved to be useful genetic markers for linkage or association studies in our population. [ABSTRACT FROM AUTHOR]

Background: Many studies have attempted to identify an association between HLA genes and atopy, given the role of HLA molecules in the regulation of the immune response. In the case of house-dust mites, it is difficult to find an association with a particular HLA allele, due to the complexity of the allergen. The objective was to investigate whether HLA-DRB1 functional groups are better correlated with the atopic disease in our population than DRB1 alleles. Methods: The method was reanalysis of the HLA-DRB1 data of a previous case/control study. Results: The “Dr” group was found to be associated with the atopic disease in our population. Conclusions: Grouping HLA-DRB1 alleles into functional categories may assist in the search for predictive factors in relation to atopic disease. [ABSTRACT FROM AUTHOR]

Background: Olea europaea pollen is an important cause of seasonal allergic rhinitis and bronchial asthma in southern Spain. For patients allergic to grass pol– len the critical concentration of airborn pollen is 50 grains/m[sup 3] , but in the case of Olea pollinosis no data is available. Methods: Fifty–six seasonal allergic rhinitis patients (29 in 1994 and 27 in 1995) were included in this study, all of whom lived in Jaen. Daily symptom card were filled in and pollen counts during May and June were performed in both years. A linear regression model was used for analysis of the airborne pollen concentration and the symptom score. Results: Significant correlations among daily counts of Olea pollen and rhinitis symptoms were obtained. Most of our monosensitized patients needed a high Olea pollen concentration in the atmosphere (around 400 grains/m[sup 3] ) to suffer at least from mild allergic rhinitis symptoms. Conclusion: Local conditions with a wide area dedicated to olive tree cultivars result in a high concentration of this pollen in the atmosphere. Monosensitized Olea patients in our area seem to need exceptionally high levels to suffer from allergic symptoms. [ABSTRACT FROM AUTHOR]

We report an insulin-treated diabetic patient who suffered, in a 2-month period, three severe anaphylactic reactions immediately after self-administered subcutaneous injections of neutral protamine Hagedorn (NPH) human recombinant-DNA insulin. These reactions consisted of local and systemic symptoms, including dyspnea and hypotension. A simultaneous sensitization to human insulin and to protamine was demonstrated, both by skin tests and by the determination of serum specific IgE. Suspecting protamine allergy, we performed a test dose to human lente insulin with perfect tolerance. After a 1-year follow-up with lente-insulin treatment, no reactions have occurred, despite treatment interruptions. Therefore, protamine IgE-mediated allergy probably caused our patient's reactions. In conclusion, protamine sensitization should be ruled out in any patient with a history of reactions to subcutaneous protamine-containing insulins, even if insulin sensitization is present. [ABSTRACT FROM AUTHOR]

We report a case of occupational bronchial asthma and rhinoconjunctivitis caused by Phoenix canariensis (PC) pollen. The canary palm is a type of palm tree, belonging to the Arecaceae family, which is widely distributed in frost-free regions as an ornamental tree. Our patient was referred because he suffered symptoms of bronchial asthma, rhinoconjunctivitis, and contact urticaria when pruning dried leaves from PC during the pollination months. The skin prick test (SPT) with a PC pollen extract was positive, as was the specific IgE to PC pollen determined by Phadezym RAST, indicating an IgE-mediated sensitization. The nonspecific bronchial provocation test (BPT) performed with methacholine disclosed a mild bronchial hyperreactivity, and specific BPT with PC pollen elicited an immediate fall of 25% in FEV1 with respect to baseline. On RAST inhibition studies, a significant cross-reactivity was found between PC pollen and date palm (P. dactylifera) pollen. These results suggest that PC pollen could be a potential allergen in PC-growing areas. [ABSTRACT FROM AUTHOR]

We have studied the diagnostic reliability of the specific skin tests done in 30 subjects who presented with chronic bronchitis (CB) as the only clinical manifestation related to exposure to pigeons and in 21 subjects with CB and known risk factors. Additionally, two control groups were included (24 asymptomatic subjects exposed and sensitized to pigeons and 10 subjects not exposed and not sensitized to pigeons). The skin prick tests with pigeon serum were negative in all the subjects tested. The intradermal skin tests showed an immediate positive reaction in 16 of the 30 CB-affected patients and in six of the control group of exposed asymptomatic subjects (chi square: 3.376) (P < 0.1; nearly significant); after 6 h, a positive reaction was recorded in 14 of the CB-affected patients and in three subjects of the control group (chi square: 5.187) (P < 0.005). A delayed reaction was seen in 10/30 CB patients and in only three of the 24 subjects of the control group (chi square: 2.218) (nonsignificant). In the group of the 21 CB patients with known risk factors and not sensitized to pigeons, only two patients showed immediate skin reactivity; the remaining readings were negative. Lastly, in the control group of 10 unexposed, nonsensitized subjects, the intradermal skin tests in the different readings were negative. Our results show that although the skin tests with pigeon serum have low sensitivity, they can be a useful supplement in distinguishing cases of CB attributable to chronic pigeon exposure from those cases attributable to another cause, especially in the consideration of immediate and late readings. [ABSTRACT FROM AUTHOR]

The avocado (Av) is a fruit that belongs to the Lauraceae family. We report 17 patients with immediate hypersensitivity to avocado. Clinical manifestations in relation to avocado ingestion were as follows: systemic anaphylaxis in seven patients, angioedema/urticaria in six, vomiting in two, bronchial asthma in one, and rhinoconjunctivitis in one Skin prick test (SFT) with fresh avocado was positive in all patients with the Strong avocado variety (SAy) and in 14 patients with the Hass avocado variety (HAy). Our patient-associated sensitizations were as follows: 10 to latex, eight to chestnut, eight to banana four to kiwi, and four to walnut. Avocado sensitizations patients with latex allergy' were typically middle-aged women, professionally exposed to latex, who also exhibited frequent associated sensitizations to chestnut. banana; and other fruits. Specific IgE against avocado was demonstrated in 11 of our patients by both commercial CAP and RAST with avocado extract coupled to nitrocellulose disks. Despite its lower protein content. SAv seems to be more allergenic than HAv both in vivo and in vitro. On incubating a pool of sera from our patients with avocado, latex , chestnut and banana extracts, a progressive RAST inhibition was obtained with SAv- and chestnut-marked disks. This suggests the existence of common antigenic determinants among these allergens. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented related to nonsteroidal anti-inflammatory agents (NSAIDs) hypersensitivity (NH) reactions classification which is based on phenotypes.

Bronchocentric granulomatosis developed in a patient with previously diagnosed pure red cell aplasia and lymphadenopathy. There was an excellent response to corticosteroid treatment. An immunological pathogenesis common to bronchocentric granulomatosis and pure red cell aplasia is suggested. [ABSTRACT FROM PUBLISHER]

Presents a patient with proven immunoglobulin E-mediated hypersensitivity due to erythromycin. Development of pruritic blisters on the penis with local hyperpigmentation; Fixed drug eruption and urticaria due to cross-reactivity; Epicutaneous patch tests on unaffected skin using different macrolides; Oral challenges with increasing doses of azithromycin; Basic structure of macrolides.

Focuses on a number of clinical findings in a patient group with sensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin. Clinical manifestations of the syndrome, including periobital angioedema and anaphylactoid reaction; Mite-ingestion reactions syndrome.

This article presents information on a case study related to contact urticaria in a child from raw potato. A 4-year-old boy, with a history of perennial rhinitis and a positive prick test to dermatophagoides pteronyssinus, exhibited symptoms of immediate urticaria related to contact with raw potato pulp. He suffered from erythema and severe itching with progressive onset of wheals, restricted to the contact area with raw potato pulp. Potato contact hypersensitivity is usually occupational but in this case, only sporadic exposure can be documented.

Parabens are preservatives widely used in drugs and cosmetics and rarely induce systemic contact dermatitis. In the patient, patch testing confirmed parabens as the cause of previously suspected allergic contact dermatitis from cosmetics. However, a detailed history ruled out this sensitization as the cause of her postoperative reaction. Instead, a positive patch test to suxamethonium and parenteral administration of the drug explain these clinical features. Muscle relaxants are the most common causes of immediate IgE-mediated reactions during general anesthesia. The quaternary ammonium group is the main epitope eliciting such reactions. All muscle relaxants exhibited a high degree of in vivo and in vitro cross-reactivity, based on this specific structure.

The article presents a case study of a 53-year-old man with an acutely inflamed right elbow who was treated with Inacid gel (indomethacin 1%).

Reports on a fixed drug eruption associated with dimenhydrinate, in a nonprescription motion sickness medicine and on allergenic cross-reactivity in the Liliaceae family. Clinical presentation of the allergic reactions; Diagnosis; Tests and treatments conducted on patients.