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Background: House dust mites (HDM) are among the most important sources for airborne allergens with high relevance for atopic diseases. Routine tests contain only 4 of 32 registered allergens of Dermatophagoides pteronyssinus. Clinical relevance and pathomechanistic properties of many allergens are not well understood. Objective: The association of several HDM allergens with allergic rhinitis, allergic asthma, and atopic dermatitis was investigated to identify allergens with biomarker potential and to transfer them into diagnostics. Methods: Eight out of nine D. pteronyssinus allergens (nDer p 1, rDer p 2, rDer p 5, rDer p 7, rDer p 10, rDer p 13, rDer p 20, rDer p 21, rDer p 23) were recombinantly expressed and purified. Sensitization patterns of 384 HDM‐allergic individuals exhibiting different clinical phenotypes were analyzed with a serum‐saving multiplex array. Results: Sensitization to more than three mite allergens (sensitization count) was associated with allergic asthma and/or atopic dermatitis. Reactions to Der p 5 and Der p 21 were more frequent in allergic asthma compared to allergic rhinitis. Atopic dermatitis patients were more often sensitized to Der p 5, Der p 20, and Der p 21 among others. Der p 20‐IgE > 80 kU/L was associated with severe atopic dermatitis in 75% of patients. Conclusion: This study demonstrates the clinical importance of the sensitization count and of certain allergens (Der p 5, Der p 20, and Der p 21) not available for routine diagnostics yet. Implementing them as well as the sensitization count in diagnostic measures will improve diagnosis and risk assessment of HDM‐allergic patients. [ABSTRACT FROM AUTHOR]

Since the discovery of immunoglobulin E (IgE) as a mediator of allergic diseases in 1967, our knowledge about the immunological mechanisms of IgE‐mediated allergies has remarkably increased. In addition to understanding the immune response and clinical symptoms, allergy diagnosis and management depend strongly on the precise identification of the elicitors of the IgE‐mediated allergic reaction. In the past four decades, innovations in bioscience and technology have facilitated the identification and production of well‐defined, highly pure molecules for component‐resolved diagnosis (CRD), allowing a personalized diagnosis and management of the allergic disease for individual patients. The first edition of the "EAACI Molecular Allergology User's Guide" (MAUG) in 2016 rapidly became a key reference for clinicians, scientists, and interested readers with a background in allergology, immunology, biology, and medicine. Nevertheless, the field of molecular allergology is moving fast, and after 6 years, a new EAACI Taskforce was established to provide an updated document. The Molecular Allergology User's Guide 2.0 summarizes state‐of‐the‐art information on allergen molecules, their clinical relevance, and their application in diagnostic algorithms for clinical practice. It is designed for both, clinicians and scientists, guiding health care professionals through the overwhelming list of different allergen molecules available for testing. Further, it provides diagnostic algorithms on the clinical relevance of allergenic molecules and gives an overview of their biology, the basic mechanisms of test formats, and the application of tests to measure allergen exposure. [ABSTRACT FROM AUTHOR]

Background: Children with atopic dermatitis (AD) have multiple risk factors for accidental fractures, injuries that can lead to significant morbidity and mortality. However, little is known about the factors that mediate the relationship between AD and fracture in children. Objective: Our purpose was to examine the association of AD with fracture and to identify potential mediating factors. Methods: This retrospective cohort study examined children with and without AD from a longitudinal matched cohort database of 353,040 children registered in the national health insurance service and participated in the national health- screening program of Korea. We defined AD using medical claims and medication prescription records. We investigated accidental fracture events between the index date and the end of follow- up in a propensity score-- matched cohort. Pre- specified subgroup analyses considered fractures in four different regions of the body. The mediating effects of 10 possible clinical factors (including the use of antihistamines and systemic corticosteroids) and social factors (including nutritional status and parental safety awareness) were determined. Results: There were 145,704 participating children, 20% with AD and 49% girls. Fractures occurred in 6,652 of the children with AD (23%, mean age: 64.6 ± 29.2 months) and in 24,698 of the control group (21%, mean age 65.0 ± 28.9 months). Children with AD had an 8% greater risk of fracture events overall (adjusted relative risk [aRR]: 1.08, 95% CI: 1.05-1.10). In subgroup analysis, AD was related to increased rates of skull and facial bone fracture (aRR: 1.09, 95% CI: 1.04-1.14), for trunk including vertebrae (aRR: 1.58, 95% CI: 1.22-2.05), and for distal limbs (aRR: 1.11, 95% CI: 1.07-1.15). However, the relationship with proximal limb fracture was insignificant. Duration of systemic corticosteroid prescription was the largest mediating factor, followed by duration of antihistamine prescription, and infant feeding practices. In particular, the duration of systemic corticosteroid prescription was significantly associated with fracture events (incidence: 20.1% at the 25th percentile and 23.6% at the 75th percentile; difference: 3.4% [95% CI: 2.8-4.0%]). Conclusions: Children with AD were related to increased fracture events. The key factors with mediating effects were systemic use of corticosteroid and antihistamine. Infant feeding practices had weaker mediating effects. [ABSTRACT FROM AUTHOR]

Keywords: allergy diagnosis; atopic dermatitis; food allergy EN allergy diagnosis atopic dermatitis food allergy 3845 3848 4 12/01/21 20211201 NES 211201 Atopic dermatitis (AD) typically develops in infancy and affects up to 20% of children in high-income countries.1 I Immediate i (IgE-mediated) food allergy (FA) affects around 3% of children.2 Children with AD are at higher risk of I immediate i - I type i FA.3,4 Up to a third of children with moderate to severe AD have FA.3 A Danish population-based study, evaluating children from birth to 6 years, showed that 15% of all children with AD had concomitant FA and almost all children with FA had concomitant AD.4 In a recent review, the likelihood of food sensitization was reported to be 6 times higher in patients with AD compared to healthy controls at 3 months of age.5 Furthermore, up to 15% of subjects with AD had a positive oral food challenge (OFC).5 A population-based study from Australia showed that one out of five infants with AD, mainly infants with early-onset AD (<3 months), were allergic to peanut, egg white, or sesame compared to one in 20 without AD,6 when evaluated by an oral food challenge at 12 months. Some of the guidance highlight increased risk factors for the development of FA, particularly AD, hence the importance of early diagnosis and management of AD and FA. As around 20% of children in the general population have AD and only around 3% of children have FA, an algorithm which directs the evaluation of infants and small children with AD for FA will prove useful for clinicians. [Extracted from the article]

Keywords: allergy diagnosis; atopic dermatitis; challenge tests; complementary feeding; food allergy; pediatrics; prevention; weaning EN allergy diagnosis atopic dermatitis challenge tests complementary feeding food allergy pediatrics prevention weaning 1592 1594 3 05/17/21 20210501 NES 210501 Oral tolerance induction (OTI) is the only RCT-proven effective intervention for preventing childhood food allergy.1,2 OTI to peanut is highly effective in a high-risk population with an 81% relative risk ration (RRR) to peanut allergy.3 OTI also reduced egg allergy in the general population in a per-protocol analysis.1 These published RCT findings have changed practice and many governmental and allergy societies now recommend introducing peanut in infancy; some suggest that other foods, such as well-cooked egg, are also introduced. Commencing multiple food OTI at 4 months of age has no detrimental effect on established breastfeeding.6,7 All children may adopt a diverse weaning diet,8 including allergenic foods such as well-cooked egg and peanut, as soon as weaning commences. Allergy diagnosis, atopic dermatitis, challenge tests, complementary feeding, food allergy, pediatrics, prevention, weaning. [Extracted from the article]

Objective: Eosinophilic chronic rhinosinusitis (ECRS) is frequently complicated by asthma, and recognized as refractory and persistent rhinosinusitis. However, the detailed pathophysiology of ECRS has not been elucidated yet. In this study, we investigated the association between recurrent ECRS and intradermal testing to multi-antigens including Candida albicans.Methods: The subjects were 49 cases of bilateral chronic rhinosinusitis including 24 ECRS cases. They underwent endoscopic sinus surgery and submitted to pathological examination. Prior to surgery, peripheral blood eosinophil count, total and antigen-specific IgE levels (11 categories), and intradermal tests (5 categories) were carried out in all patients. These patients were followed-up for longer than 3 months. We compared the results of preoperative and postoperative clinical examination data between ECRS and non-ECRS (NECRS) cases.Results: Positive reaction of the delayed type of intradermal testing to C. albicans was significantly more often observed in ECRS than NECRS cases. (P<0.01) Additionally, these positive reaction cases exhibited significantly higher recurrence of nasal polyps and symptoms of ECRS (P<0.05).Conclusion: These results suggest the involvement of (Coombs) type IV allergic reaction to C. albicans in the pathophysiology of ECRS. [ABSTRACT FROM AUTHOR]

Background: Little is known about the associations between allergic disease, sleep-disordered breathing (SDB), and childhood nocturnal enuresis (NE). We examined whether allergic disease and SDB were associated with childhood NE. Methods: Data were assessed from the 2007-2012 Taiwan National Health Insurance Research Database. We enrolled 4308 children aged 5-18 years having NE diagnosis and age- and sex-matched 4308 children as the control group. The odds ratios of NE were calculated to determine an association with preexisting allergic disease and SDB. Results: A total of 8616 children were included in the analysis. Prevalence of allergic diseases and SDB was significantly higher for the NE group than the control group (all p < 0.001). After adjusting odds ratios for potential confounding factors, except asthma, children with allergic rhinitis, atopic dermatitis, allergic conjunctivitis, and obstructive sleep apnea (OSA) had significantly higher odds of NE compared with children never diagnosed. With stratification for sex, girls with allergic rhinitis, atopic dermatitis, allergic conjunctivitis, OSA, and snoring had significantly higher odds of NE, compared with girls never diagnosed. Only boys with allergic rhinitis and OSA were associated with increased odds of NE. With stratification for age, children aged 5-12 years with allergic rhinitis, atopic dermatitis, allergic conjunctivitis, and OSA had significantly higher odds of NE compared with those never diagnosed. Odds of NE increased with the number of comorbid allergic diseases. Conclusions: Allergic diseases and SDB are associated with increased odds of childhood NE. The odds of NE increased with the number of comorbid allergic diseases present. [ABSTRACT FROM AUTHOR]

Background: Early recognition of inflammatory markers and their relation to asthma, adverse drug reactions, allergic rhinitis, atopic dermatitis and other allergic diseases is an important goal in allergy. The vast majority of studies in the literature are based on classic statistical methods; however, developments in computational techniques such as soft computing-based approaches hold new promise in this field. Objective: The aim of this manuscript is to systematically review the main soft computing-based techniques such as artificial neural networks, support vector machines, bayesian networks and fuzzy logic to investigate their performances in the field of allergic diseases. Methods: The review was conducted following PRISMA guidelines and the protocol was registered within PROSPERO database (CRD42016038894). The research was performed on PubMed and ScienceDirect, covering the period starting from September 1, 1990 through April 19, 2016. Results: The review included 27 studies related to allergic diseases and soft computing performances. We observed promising results with an overall accuracy of 86.5%, mainly focused on asthmatic disease. The review reveals that soft computing-based approaches are suitable for big data analysis and can be very powerful, especially when dealing with uncertainty and poorly characterized parameters. Furthermore, they can provide valuable support in case of lack of data and entangled cause--effect relationships, which make it difficult to assess the evolution of disease. Conclusions: Although most works deal with asthma, we believe the soft computing approach could be a real breakthrough and foster new insights into other allergic diseases as well. Keywords: Allergy, Artificial intelligence, Artificial neural networks, Asthma, Fuzzy logic [ABSTRACT FROM AUTHOR]

Background The atopy patch test ( APT) has been defined as an important tool in the diagnosis of cutaneous hypersensitivity caused by house dust mites in atopic dermatitis ( AD). Objective The aim of this study was to evaluate the diagnostic value of the APT to mite allergens by comparing its positive results with those of the skin prick test ( SPT) and serum specific IgE test in Chinese AD patients. Methods The APT, SPT and serum specific IgE test with Dermatophagoiodes pteronyssinus and Dermatophagoides farina were performed on a total of 120 patients with atopic dermatitis. Results Overall, 37.5% of the patients showed a positive APT reaction to mite allergens. A statistically significant association was observed between positive APT results and air-exposed eczema pattern. The positive APT results were not significantly associated with SCORAD scores and accompanied atopic respiratory disorders in AD patients. A higher frequency of APT positive reactions to mite allergens was observed in adolescent and adult patients. There was no significant difference in APT positivity between extrinsic patients (40.7%) and intrinsic patients (27.6%). Conclusion This study identified house dust mite induced cutaneous hypersensitivity in Chinese patients with AD by APT, especially in air-exposed distribution patterns or adolescent and adult patients. Both intrinsic and extrinsic AD patients showed positive APT reactions to house dust mite. [ABSTRACT FROM AUTHOR]

Allergic skin diseases may result from various types of chemical and biological allergens. This study investigated the association between ambient bioaerosol exposure and allergic skin diseases by using the exposure data obtained from land use regression models and interpolated data. Data on daily average outpatient visits for atopic dermatitis (ICD-9-CM 691.8) and contact dermatitis and other eczema (ICD-9-CM 692.9) between November 2011 and August 2012 were obtained from the National Health Insurance Research Database. A generalized estimating equation was used to analyze the associations between the skin diseases and ambient bioaerosol levels. The results indicated that during the study period, contact dermatitis and other eczema were more prevalent than atopic dermatitis in the study area. Most cases were observed in districts of Taipei City and 3 major districts of New Taipei City, namely Xinzhuang, Banqiao, and Xindian. In univariate analysis, most bioaerosols were positively associated with both skin diseases. After adjustment for air pollution and sociodemographic factors, exposure to total fungal spores was significantly associated with atopic dermatitis in males (relative risk [RR] = 1.12; 95% confidence interval [CI] = 1.05–1.19). Contact dermatitis and other eczema had significant relationships with Cladosporium in males (RR = 1.07; 95% CI = 1.02–1.14) and with Aspergillus / Penicillium in females (RR = 1.04; 95% CI = 1.02–1.07). Meteorological parameters, namely wind speed, temperature, and rainfall, were also significantly associated with skin diseases. Our findings reveal that exposure to ambient bioaerosols is a significant and independent risk factor for allergic skin diseases. [ABSTRACT FROM AUTHOR]

The availability of allergen molecules ('components') from several protein families has advanced our understanding of immunoglobulin E (IgE)-mediated responses and enabled 'component-resolved diagnosis' ( CRD). The European Academy of Allergy and Clinical Immunology ( EAACI) Molecular Allergology User's Guide ( MAUG) provides comprehensive information on important allergens and describes the diagnostic options using CRD. Part A of the EAACI MAUG introduces allergen molecules, families, composition of extracts, databases, and diagnostic IgE, skin, and basophil tests. Singleplex and multiplex IgE assays with components improve both sensitivity for low-abundance allergens and analytical specificity; IgE to individual allergens can yield information on clinical risks and distinguish cross-reactivity from true primary sensitization. Part B discusses the clinical and molecular aspects of IgE-mediated allergies to foods (including nuts, seeds, legumes, fruits, vegetables, cereal grains, milk, egg, meat, fish, and shellfish), inhalants (pollen, mold spores, mites, and animal dander), and Hymenoptera venom. Diagnostic algorithms and short case histories provide useful information for the clinical workup of allergic individuals targeted for CRD. Part C covers protein families containing ubiquitous, highly cross-reactive panallergens from plant (lipid transfer proteins, polcalcins, PR-10, profilins) and animal sources (lipocalins, parvalbumins, serum albumins, tropomyosins) and explains their diagnostic and clinical utility. Part D lists 100 important allergen molecules. In conclusion, IgE-mediated reactions and allergic diseases, including allergic rhinoconjunctivitis, asthma, food reactions, and insect sting reactions, are discussed from a novel molecular perspective. The EAACI MAUG documents the rapid progression of molecular allergology from basic research to its integration into clinical practice, a quantum leap in the management of allergic patients. [ABSTRACT FROM AUTHOR]

There are several skin conditions that can be triggered by allergy. These allergies can be extremely uncomfortable, cause a great deal of distress, anxiety and embarrassment, and have a significant impact on patients' quality of life. This article describes the causes of skin allergies, highlights the importance of taking a thorough medical and allergy history, and outlines the principles of diagnosis and management. [ABSTRACT FROM AUTHOR]

Hanifin and Rajka's criteria are the gold standard for diagnosis of atopic dermatitis (AD). However, none of the major criteria is specific/restricted to AD. Thus in a case with strong clinical suspicion, minor criteria can be used as auxiliary diagnostic aid, when major criteria are uncertain. Seventy clinically suspected cases of AD (<13 years) were evaluated for major and minor clinical criteria; their diagnostic significance was statistically analyzed with seventy age-matched controls. The most frequent major criteria were atopy history (75.7% of patients) and pruritus (72.9%). Only 14 patients (20%) fulfilled at least 3 major criteria, the remainder (56 patients-80%) fulfilled less than 3 (35 patients- 2 major, 18- 1 major criteria, 3- none). The most frequent minor criteria were xerosis (75.7%), peri-follicular accentuation (40%), hand/foot dermatitis (24.3%) and scalp-scaling (21.4%). Overall, 26 patients (37.1%) fulfilled at least 3 minor criteria, irrespective of major criteria. Of these 26, only 9 children fulfilled Hanifin and Rajka's criteria (3 major +3 minor). The remaining 17 had less than 3 major criteria. If only minor criteria were taken into consideration, these additional 17 could be diagnosed as AD. Almost all minor criteria were more frequent in children with AD as compared to controls, the difference being statistically significant (p<0.005) for xerosis, peri-follicular accentuation, Dennie-Morgan folds, hand-foot dermatitis and periorbital darkening. Patients who fulfill at least 3 minor criteria, especially the above mentioned significant ones, irrespective of number of major criteria fulfilled, should be strongly suspected to have AD. [ABSTRACT FROM AUTHOR]

Background Distinguishing between patients with allergic bronchopulmonary aspergillosis ( ABPA) and Aspergillus fumigatus (Af)-sensitized asthmatic patients without ABPA is sometimes difficult owing to the IgE-cross-reactivity between Af and other fungal allergens. Objective To establish the usefulness of molecular-based allergy diagnostics using allergen components from Af in distinguishing ABPA from Af-sensitized asthma without ABPA. Methods Sera from Japanese patients with ABPA ( n = 53) and Af-sensitized asthma without ABPA ( n = 253) were studied. The levels of IgE and IgG antibodies to allergen components from Af and IgE antibodies to different fugal allergen extracts were measured by Immuno CAP. Comorbid atopic dermatitis ( AD) was taken into consideration in the sensitization profile analysis. Results Patients with ABPA possessed significantly higher levels of IgE antibodies to Asp f 1, and Asp f 2 than asthmatic patients without ABPA. The areas under the receiver operating characteristic curves for the levels of IgE to Asp f 1 and Asp f 2 as diagnostic markers of ABPA were 0.75 and 0.78, respectively. The presence of IgE positivity to Asp f 1 and/or Asp f 2 resulted in increased sensitivity while losing little specificity. Comorbid AD was associated with higher levels of IgE to Asp f 6 (manganese superoxide dismutase from Af, a ubiquitous pan-allergen in fungi) and low but positive levels of IgE to other Af-components, which hampered the serological discrimination of ABPA. Conclusions and Clinical Relevance The levels of IgE to Asp f 1 and/or Asp f 2 can effectively differentiate ABPA from Af-sensitized asthma, suggesting that the amounts of IgE specific for these molecules are markers for genuine Af-sensitization in ABPA. However, comorbid AD must be taken into consideration in the interpretation of high IgE to Asp f 6. Establishing of IgE-sensitization profiles using panel of Af-allergen components provides valuable information for distinguishing genuine vs. cross-reactive sensitization in Af-sensitized patients. [ABSTRACT FROM AUTHOR]

Background Contact sensitization in children is more frequent than previously thought. Methods The ESSCA collected patch test data from 11 European countries aggregated to 4 European regions. Results Six thousand and eight patients aged 1-16 years old with suspected allergic contact dermatitis were analyzed during a period of 8 years (2002-2010). The overall prevalence of at least one positive reaction to a hapten was 36.9%. The 10 most frequent haptens were as follows: nickel sulfate, cobalt chloride and potassium dichromate, neomycin sulfate, Myroxylon pereirae resin (balsam of Peru), para-phenylenediamine, chloromethylisothiazolinone/methylisothiazolinone 3:1, fragrance mix, lanolin alcohols, and colophony. No difference was found in the prevalence of at least one positive reaction to at least one hapten between boys and girls and between children with atopic dermatitis and children without. Children without atopic dermatitis, when compared with those with, had a significantly higher prevalence of contact sensitization for nickel sulfate (20.91% vs 16.87%, respectively), 4-tert. butylphenol formaldehyde resin (1.61% vs. 0.7%), and para-phenylenediamine (2.49% vs. 1.3%). Limitations of the study Chamber loading is not an exact science and variation may occur between staff and departments. Interinstitution variations in readings can occur. A possible geographic confounder is that the southern regions tested more children in the younger age group. Relevance was not addressed due to difficulties in the application of a set of uniform definitions. Conclusions Our study adds information on the most common contact allergens detected in children which could help to define a Standard European Pediatric Baseline Series. [ABSTRACT FROM AUTHOR]

Background: Chronic allergic skin disorders are the inflammatory and proliferative conditions in which both genetic and environmental factors play important roles. Chronic idiopathic urticaria (CIU) and atopic dermatitis (AD) are among the most common chronic allergic skin disorders. These can be provoked by various food and aeroallergens. Skin prick tests (SPTs) represent the cheapest and most effective method to diagnose type I hypersensitivity. Positive skin tests with a history suggestive of clinical sensitivity strongly incriminate the allergen as a contributor to the disease process. Aim s and Objectives: To determine the incidence of positive SPT in patients with chronic allergic skin disorders and to identify the various allergens implicated in positive SPT. Methods: Fifty patients of chronic allergic disorders were recruited in this study. They were evaluated by SPT with both food and aeroallergens. Results: In our study, SPT positivity in patients of CIU was 63.41% and in AD was 77.78%. Out of the 41 patients of CIU, the most common allergen groups showing SPT positivity were dust and pollen, each comprising 26.83% patients. SPT reaction was positive with food items (21.6%), insects (17.07%), fungus (12.20%), and Dermatophagoides farinae, that is, house dust mite (HDM) (7.32%). The allergen which showed maximum positivity was grain dust wheat (19.51%). Among nine patients of AD, maximum SPT positivity was seen with Dermatophagoides farinae, pollen Amaranthus spinosus, grain dust wheat, and cotton mill dust; each comprising 22.22% of patients. Conclusion: Our study showed that a significant number of patients of CIU and AD showed sensitivity to dust, pollen, insects, Dermatophagoides farinae, and fungi on SPT. Thus, it is an important tool in the diagnosis of CIU and AD. [ABSTRACT FROM AUTHOR]

Objective: The aims of the study were to evaluate the characteristics of children with atopic dermatitis and presence of concurrent atopic diseases among these patients. Materials and Methods: One hundred and eighty-one patients followed-up with a diagnosis of atopic dermatitis were evaluated. The age of the patients ranged from 2 months to 13 years and 70.2% were male. Of these patients, 146 had been diagnosed with atopic dermatitis, 29 with atopic dermatitis and asthma, and 6 with atopic dermatitis and allergic rhinitis. Results: Of the patients 37.6% were found to have allergic sensitization by skin prick test. The IgE level and eosinophil count of the sensitized group were higher (p: < 0.001,0.002; respectively). The rate of concurrent asthma or rhinitis in the sensitized group was 38.2%, while it was 8% in the group without sensitization (p: < 0.001). Conclusion: The most important factors affecting sensitization were high IgE levels and eosinophilia. In the presence of sensitization, asthma or rhinitis development is more common. More cohort studies are needed to unravel the factors associated with development of asthma in children with atopic dermatitis. [ABSTRACT FROM AUTHOR]

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The non-communicable disease pandemic includes immune-mediated diseases such as asthma and allergy, which are likely originating in early life where the immature immune system is prone to alterations caused by the exposome. The timing of exposure seems critical for the developing immune system, and certain exposures may have detrimental effects in the earliest life, but no or even beneficial effects later. The human microbiome and infections are candidates as intermediary in the interaction between the host and the environment. The evidence seems inconsistent as infections as well as particular colonization patterns in neonates drive both short-term and long-term asthma symptoms, while, on the other hand, the composition of the microbiome in early life may protect against asthma and allergy in later life. This apparent contradiction may be explained by a deeper disease heterogeneity than we are currently able to discriminate, and in particular, the indiscriminate lumping together of different diseases into one atopic disease category. Also, the microbiome needs a differentiated understanding, considering balance between microbial groups, diversity and microbial genetic capability. Furthermore, the effects of the microbial exposure may only affect individuals with certain susceptibility genes. Few of the observations have been replicated, and publication bias is likely. Therefore, we are still far from understanding, or having proved, causal effects of the human microbiome. Still, the microbiome-gene interaction is a fascinating paradigm that fosters exiting research and promises a breakthrough in the understanding of the mechanisms driving asthma, allergy and eczema, and potentially also other immune-mediated non-communicable diseases. [ABSTRACT FROM AUTHOR]

Background. In Central Europe, hazel (Corylus sp.) pollen is considered to be an important aeroallergen in early spring. Objective. This study examines hazel pollen levels in Poznań, western Poland, and the clinical relevance of this aeroallergen in the city. Methods. Corylus pollen data (1996-2010) were obtained by volumetric spore trap located near the centre of Poznań. Clinical data (2006-2010), i.e. skin prick test (SPT) and allergen-specific IgE measurements (asIgE), were supplied by the Allergy Diseases Diagnostic Centre in Poznań. Results. Mean diurnal hazel pollen concentrations peaked around 14:00-16:00 when mean bi-hourly pollen concentrations were ~60 P m(-3). Onset of the hazel pollen season varied up to 87 days annually, and was significantly (r=-0.647; p<0.01) related to mean maximum temperature during late December. SPT data revealed that ~11% of allergy patients had positive skin reactions to Corylus pollen allergens, and most of these (94.4%) reacted to pollen allergens from other members of the Betulaceae family - alder or birch. Of those sensitized, 53% suffered from atopic dermatitis. Of patients examined for serum asIgE, 26.0% had asIgE measurements in classes 5 and 6. Conclusions. Hazel pollen has a detrimental effect on the allergic population of Poznań, with more than half of those sensitised to hazel pollen allergens showing symptoms of atopic dermatitis. Hazel pollen concentrations reach levels recognized as being able to induce allergy symptoms, especially in the afternoon and early evening when many people are returning home from work. The cross-reactivity with other members of the Fagales order also increases the allergenic potential of hazel pollen. [ABSTRACT FROM AUTHOR]

Purpose: Prevalence and clinical significance of cross sensitization in children up to 3 years old, diagnosed with atopic dermatitis. Material and Method: The retrospective study included 69 children up to 3 years old with atopic dermatitis. Allergological diagnostics was performed based on skin tests, determination of total IgE concentration and allergen-specific IgE. Results: Cross sensitization was found in 26% of children. Other patients were qualified to the control group. The sensitization to trees pollen and fruits as well as grass pollen and vegetables were the most frequent types of cross allergy. The patient's family history was positive with regard to atopy in 72% of children from the study group vs. 31% of children from the control group. The statistically higher prevalence of allergic rhinitis and bronchial asthma as well as co-existence of sensitization to house dust mite and animal dander were revealed in the study group. The total concentration of IgE, eosinophilia and SCORAD values were statistically higher in the study group. Children with cross sensitization required systemic steroid therapy more frequently. Conclusion: In children up to 3 years with atopic dermatitis and sensitization to plant pollen, the role of a pollen-food allergy syndrome must be taken into account in the pathogenesis of the disease. In children with cross sensitization, the course of atopic dermatitis is more severe; the symptoms from the respiratory and digestive system co-exist. The positive family history is a factor, predisposing to the development of cross sensitization in infants and toddlers. [ABSTRACT FROM AUTHOR]

Background. Limonene is a common fragrance terpene that, in its pure form, is not allergenic or is a very weak allergen. However, limonene autoxidizes on air exposure, and the oxidation products can cause contact allergy. Oxidized R-limonene has previously been patch tested in multicentre studies, giving 2-3% positive patch test reactions in consecutive patients. Objectives. To investigate whether oxidized R-limonene 3.0% in petrolatum, with a stable concentration of the main haptens, limonene hydroperoxides (Lim-OOHs), could be a useful tool for the detection of contact allergy in an international setting. Methods. Oxidized R-limonene 3.0% (Lim-OOHs 0.33%) pet. was tested in 2900 consecutive dermatitis patients in Denmark, the United Kingdom, Singapore, Spain, Sweden, and Australia. Results. Overall, 5.2% (range 2.3-12.1%) of the patients showed a positive patch test reaction to oxidized R-limonene. Doubtful reactions were found in 7.0% of the patients (range 0-24%). Few irritant reactions were seen. Conclusions. Oxidized R-limonene at 3.0% pet. with a specified content of Lim-OOHs 0.33% is a standardized and useful tool for the detection of contact allergy in dermatitis patients. Many patients showing positive patch test reactions to oxidized R-limonene would not be informed of their fragrance allergy if this specific test had not been performed. [ABSTRACT FROM AUTHOR]

This review highlights some of the research advances in anaphylaxis; hypersensitivity reactions to foods, drugs, and insects; and allergic skin diseases that were reported in the Journal in 2012. Studies support an increase in peanut allergy prevalence in children and exposure to the antibacterial agent triclosan and having filaggrin (FLG) loss-of-function mutations as risk factors for food sensitization. The role of specific foods in causing eosinophilic esophagitis is elucidated by several studies, and microRNA analysis is identified as a possible noninvasive disease biomarker. Studies on food allergy diagnosis emphasize the utility of component testing and the possibility of improved diagnosis through stepped approaches, epitope-binding analysis, and bioinformatics. Treatment studies of food allergy show promise for oral immunotherapy, but tolerance induction remains elusive, and additional therapies are under study. Studies on anaphylaxis suggest an important role for platelet-activating factor and its relationship to the need for prompt treatment with epinephrine. Insights on the pathophysiology and diagnosis of non–IgE-mediated drug allergy are offered, with novel data regarding the interaction of drugs with HLA molecules. Numerous studies support influenza vaccination of persons with egg allergy using modest precautions. Evidence continues to mount that there is cross-talk between skin barrier defects and immune responses in patients with atopic dermatitis. Augmentation of the skin barrier with reduction in skin inflammatory responses will likely lead to the most effective intervention in patients with this common skin disease. [ABSTRACT FROM AUTHOR]

The article reports that nearly 40% of children are being affected by allergic disease and is becoming more frequent. Sources of allergies vary from food and drugs to latex. Allergy is attributed to causing asthma, eczema and rhinitis. Food allergies reportedly affect around 8% of the children and can be difficult to diagnose. Ranging from a mild urticaria to full-blown anaphylaxis, the allergic response can vary in severity.

We review the particular characteristics of atopic dermatitis (AD) in adult life, and compare findings with those of AD in childhood. AD affects 1-3% of adults world-wide, and can present as adult-onset AD, or as infantile/childhood AD that persists, or recurs after many years. Eczema in adults usually exists for years, compromising quality of life, sex life and occupational choices. The flexural areas, shoulders, head-and-neck, and hands are typically affected. In elderly adults, eczematous erythroderma is common. The intrinsic (non-IgE-allergic) eczema subtype affects 5-15% of cases. Classical food allergy has a low importance, although non-IgE-mediated and pseudoallergic reactions can cause eczema. Sensitivity to aeroallergens, especially dust mite, is demonstrated in the majority of adult AD patients, including elderly adults, by immunoglobulin E-mediated tests and/or atopy patch tests. Occupational allergic and irritant contact dermatitis is increased. In adults, as in children, Staphylococcus aureus colonization is very high, whereas adult skin is more heavily colonized with Malassezia yeasts. Immediate and delayed sensitization to Malassezia sympodialis is specific for intrinsic and extrinsic AD, occurring especially in head-and-neck eczema. Concerning therapy, older patients are prone to certain adverse drug effects. In conclusion, differences exist between childhood and adult disease. As we should be seeing more adults with AD in the future, there is a need for more clinical and immunological studies in older patients. [ABSTRACT FROM AUTHOR]

Background: Several international guidelines on immunotherapy exist, but they only apply partially in Mexico. The Mexican guideline of immunotherapy dates from 1998. Objectives: To establish clinical recommendations and suggestions for Allergy residents and specialists for skin testing and allergen immunotherapy based on evidence and Mexican expert opinion, according to the GRADE system. Methods: The guidelines were developed following the methodology of a guideline for clinical practice starting with the formulation of clinical questions, in the context of Mexican environmental conditions and morbidity, with the participation of allergists from all regions of the country. External validation was obtained. Its development followed three steps: 1. formulation of 24 clinical questions. 2. Search for consensus on the answers among members of the Regional chapters of both Mexican Colleges of Allergists (CMICA and COMPEDIA) during regional meetings. 3. Literature search for articles related to the questions and grading of its quality according to GRADE. Results: Based on the regional consensus, 116 articles and the safety, patient acceptance/ comfort and cost clinical recommendations and suggestions were developed on basic aspects of skin testing, subcutaneous and sublingual immunotherapy (patient preparation, vial preparation and application schedules) and the treatment of eventual adverse reactions. Conclusions: A clinical guideline was developed respecting particular methodology, validated by CMICA and COMPEDIA for its implementation among Mexican allergists. Several aspects deserve further study to improve scientific evidence. [ABSTRACT FROM AUTHOR]

Background: ω-5 gliadin is a major allergen in exercise-induced wheat allergy (EIWA), but it is also implicated in immediate-type reactions to wheat. An ImmunoCAP assay to measure ω-5 gliadin-specific IgE has become available. This study aimed to evaluate this new biological test in wheat allergy diagnosis and to also determine if it was able to discriminate EIWA from other types of wheat allergy. Methods: Sixty-one patients with wheat allergy were divided into 3 groups as a function of their symptoms (EIWA, immediate-type reactions and atopic dermatitis). These patients underwent skin prick tests with purified ω gliadins and ImmunoCAP to wheat flour, gluten and recombinant ω-5 gliadin. Results: The experimental data showed that 78% of EIWA patients had a positive skin prick test to natural ω-5 gliadin and the same proportion had detectable specific IgE to recombinant ω-5 gliadin, indicating that ω-5 gliadin is the main allergen, but not the only one, in our population. Additionally, we showed that this detection was not EIWA specific since ω-5 gliadin-specific IgE was detected in 30% of other patients who had a wheat allergy. These results lead to a positive predictive value of 37.5% and to a negative predictive value of 91%. Conclusions: Although not specific to EIWA, the new ImmunoCAP ω-5 gliadin is an important biological test because of its negative predictive value. In case of food-dependent exercise-induced allergy, the absence of ω-5 gliadin-specific IgE will almost completely exclude the implication of wheat. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

This study determines the prevalence of atopic dermatitis, asthma, rhinoconjunctivitis, food hypersensitivity and urticaria and the frequency of sensitization in children with and without clinical allergic disease. In an ongoing prospective non-interventional birth cohort study of 562 unselected children, 404 children were subjected to interview, clinical examination, lung function measurements and allergy testing at 6 yr of age. Sensitization measured by skin prick test (SPT) and specific immunoglobulin E (S-IgE) was determined for 24 different allergens. The 1-yr period prevalence of atopic dermatitis, asthma and rhinoconjunctivitis was 14.4%, 6.2% and 13.6%. 25.7% of the children suffered from at least one of the three diseases. The frequency of sensitization in children with no disease (controls), any allergic disease, atopic dermatitis, asthma and rhinoconjunctivitis was 17%, 45%, 47%, 56% and 55% (defined as SPT ≥3 mm and/or S-IgE ≥0.35 kU/l for at least one allergen). Symptoms were linked to sensitization for 44% in the asthma group and 42% in the rhinoconjunctivitis group, whereas sensitization could not be linked to worsening of the eczema in any cases of atopic dermatitis. Overlap between the three diseases was significantly more frequent in sensitized children than in non-sensitized (19/46 = 41% vs. 9/58 = 16%, p = 0.004). The prevalence of food hypersensitivity and urticaria was 1.2% and 5.4% respectively. In unselected 6 yr old children, approximately half of the children with atopic dermatitis, asthma or rhinoconjunctivitis are IgE-sensitized. Sensitization tends to link these diseases to each other. [ABSTRACT FROM AUTHOR]

Total IgE levels are usually elevated in allergic diseases, being highest in atopic eczema, followed by atopic asthma and allergic rhinitis. Genetic factors are believed to play a role in total IgE levels, with higher levels seen in Black African subjects. Total IgE is also raised in parasite infection. Thus, the higher total IgE levels in Black Africans could be because of environmental rather than genetic factors. Few studies have investigated the usefulness of total IgE levels in the evaluation of atopy in Black Africans. The objective of this study was to determine the total IgE levels in unselected urban Black African high school children and to correlate this with atopy and ascaris sensitization. Atopic status was assessed by means of specific allergen sensitization (skin prick tests to eight inhalant and four food allergens), self-reported asthma and bronchial hyper-responsiveness measured by methacholine challenge. Ascaris sensitization was assessed by means of ascaris IgE measured by CAP-RAST. Total IgE levels were markedly skewed toward the left and were not distributed in a Gaussian or a log-normal distribution. Skin prick tests were positive for aeroallergens in 32.3% of subjects. Thirty four percent had elevated ascaris IgE. Total IgE was higher in atopic vs. non-atopic subjects and correlated with the number of positive skin prick tests, self-reported asthma and bronchial hyper-responsiveness. Subjects without allergy (or) atopy had a median total IgE of 80–90 kU/I. In addition total IgE correlated with ascaris IgE. Subjects with no ascaris sensitization had median total IgE of 77.1 kU/l. Subjects with neither atopy/asthma nor ascaris sensitisation had a median total IgE of 69.9 kU/I, similar to the levels seen in people of other genetic origins. This study suggests that helminthic infection rather than genetic differences, may be the major determining factor of IgE levels in certain populations. [ABSTRACT FROM AUTHOR]

The validity of the PhadiatopTM test as compared to the skin-prick test (SPT) for diagnosing atopy in the epidemiological field has not been studied in schoolchildren. The aim of the present study was to evaluate its validity for classifying schoolchildren 9–12 yr old into atopics and non-atopics. A total of 621 children whose parents authorized both a SPT and a blood extraction from all children participating in the phase II of the International Study of Allergies in Children (ISAAC) in Cartagena (Spain) were included in the analysis. A positive SPT was that with at least a wheal having a maximum diameter of 3 mm, once the negative value had been subtracted. PhadiatopTM was performed according to the manufacturer instructions. Diagnostic tests using SPT as the gold standard were calculated for the whole group of children and also for those with asthma or rhinoconjunctivitis and for children without any of them. The results of the tests were: sensitivity 85.0% (95% CI 82.2–87.8%), specificity 85.5% (95%CI 82.7–88.3%), positive predictive value 72.7% (95%CI 69.0–76.1%), negative predictive value 92.7% (95%CI 90.6–94.7%) and accuracy 85.3% (95%CI 82.3–88.0%). The results improved among the symptomatic groups. PhadiatopTM can be used as a valid alternative to SPT in the epidemiological setting to diagnose atopy. [ABSTRACT FROM AUTHOR]

Sesame food allergy (SFA) in children is an increasingly recognized one in many countries. Our objective was to describe the course and natural history of SFA. Seventy-four patients sensitized to sesame were evaluated using clinical records, questionnaires, skin prick tests (SPT), in vitro specific immunoglobulin (sIg) E, and oral challenges (OC) and categorized into three groups: group A: patients who experienced allergic reaction after ingestion of sesame-containing food (n = 45); group B: patients evaluated for atopic dermatitis and found to be sesame SPT-positive (n = 11); group C: patients with sensitization to sesame allergen (n = 18). Group A patients were followed for an average of 6.7 yr. Analysis of our results revealed that 76% of patients in group A developed the allergy by the age of 2. The median age at onset of allergy in these patients was 1 yr. Immediate reaction to a minimal amount of sesame was characteristic. Skin was the most common site of involvement, followed by respiratory and gastrointestinal systems. Tolerance developed in only 20% of the patients. High sIgE (>0.15 IU) was demonstrated only in 75% of those in which it was examined. Sixteen patients performed oral sesame food challenge which was found positive in 88%. No correlation was found between the size of SPT and the level of in vitro sesame IgE antibodies, the outcome of OC results, and the development of tolerance to sesame. In conclusion, SFA tends to appear early in life, but unlike cow's milk and egg allergy, persists in 80% of the cases. Typical reactions combined with positive sesame SPT are reliable for diagnosis. [ABSTRACT FROM AUTHOR]

Studies on the role of non-milk fluids in the development of child atopic disease are scarce. We had a unique opportunity to investigate prospective association between the introduction of fruit syrup, orange juice, sterilized water, vitamins and honey at 1 month and the development of child atopic disease. The exposure of interest was measured by parental report of non-milk fluids introduction to infants aged 1 month at the Tasmanian Infant Health Survey, 1988–89, Tasmania. Data on the outcomes of interest (atopic sensitization, asthma, eczema and hay fever) were collected during the 1997 Childhood Allergy and Respiratory Health Study when children were 8 yr old. Relative risks were derived from generalized linear model with a log link function and binomial error structure. None of the non-milk fluids appeared to be a significant predictor of atopic sensitization. Only sterilized water was a significant risk factor for asthma (adjusted relative risk = 1.59; 95% confidence intervals: 1.14–2.22), which may be partly because of associated overall better hygienic conditions and decreased exposure to early infections in the household. In summary, we were unable to find evidence for an association between introduction of non-milk fluids in infancy and childhood atopic disease. [ABSTRACT FROM AUTHOR]

The role of allergy in atopic dermatitis is controversial. The atopy patch test (APT) has been used to investigate the association between atopic dermatitis and aeroallergen allergy. To determine the proportion of patients with atopic dermatitis with positive patch tests to common local aeroallergens and to compare this to controls with and without respiratory atopy, we performed APT, skin-prick tests (SPT) and IgE radioallergosorbent tests (RAST) on 73 patients with atopic dermatitis and on 38 nonatopic controls (13 with and 25 without respiratory atopy). The allergens used were house dust mite, cat dander, Bermuda grass and German cockroach. Only the APT for house dust mite showed a significant difference between the two groups. APT for house dust mite correlated with the RAST test, while APT for cat fur correlated with the SPT. The APT may be useful to evaluate aeroallergens in atopic dermatitis, but further work is needed to make it more reliable. [ABSTRACT FROM AUTHOR]

Hansen TK, Høst A, Bindslev-Jensen C. An evaluation of the diagnostic value of different skin tests with egg in clinically egg-allergic children having atopic dermatitis.Pediatr Allergy Immunol 2004: 15: 428–434.© 2004 Blackwell MunksgaardSkin testing is a common diagnostic procedure in food allergy, but the final diagnosis of food allergy is based on the clinical response to food challenge. We studied the value of theskin prick-prick test (SPT), skin application food test (SAFT) and atopy patch test (APT) with fresh egg extract in diagnosing egg allergy. Ten clinically egg-allergic children with atopic dermatitis (AD; age 10 months to 8.4 yr, mean 3.4 yr) and 10 egg-tolerant children with and 10 without AD (age 2.4–11 yr, mean 5.5 yr) participated. In SAFT several false-negative reactions were seen, whereas all clinically egg-allergic children were positive in SPT and 40–60% in APT. In APT and in SPT false-positive reactions to egg were observed. In this study comprising a small number of patients including control subjects, neither SAFT nor APT with fresh whole egg extract were able to increase the diagnostic accuracy in detecting egg-allergic children with AD compared with SPT. [ABSTRACT FROM AUTHOR]

Diagnosis of food allergy in children with atopic dermatitis (AD) relies on a good knowledge of the prevalence of the disease and of the foods most frequently involved. Our objective was to define these characteristics in a population of Swiss children with AD. Patients referred to a pediatric allergist or a dermatologist for AD were routinely tested by skin‐prick test (SPT) to seven common food allergens (milk, egg, peanut, wheat, soy, fish, and nuts), and to all other foods suspected by history. Patients with positive SPTs were further evaluated for specific serum immunoglobulin E (IgE) antibodies (by using the CAP System FEIA™). CAP values were interpreted following previously published predictive values for clinical reactivity. Patients with inconclusive results (between the 95% negative predictive value [NPV] and the 95% positive predictive value [PPV]) were challenged with the suspected food. A total of 74 children with AD were screened for food allergies. Negative SPTs excluded the diagnosis in 30 subjects. Nineteen patients were diagnosed by histories suggestive of recent anaphylactic reactions to foods and/or CAP values above the 95% PPV. Forty‐three food challenges (35 open challenges and eight double‐blind, placebo‐controlled in children with persistent lesions of AD despite aggressive topical skin treatment) were performed in patients with positive SPTs but with inconclusive CAP values. Six patients were diagnosed as positive to 15 foods. Challenges were not performed to high‐allergenic foods in young children (under 12 months of age for egg and fish, and under 3 years of age for peanuts and nuts). Altogether, 33.8% (25 of 74) of the AD patients were diagnosed with food allergy. The prevalence of food allergy was 27% (seven of 25) in the group referred to the dermatologist for primary care of AD. The foods most frequently incriminated were egg, milk, and peanuts. The prevalence of food allergy in our population was comparable to that in other westernized countries, suggesting an incidence of food allergy in approximately one‐third of children with persistent lesions of AD. Together with milk and eggs, peanuts were most frequently involved in allergic reactions. [ABSTRACT FROM AUTHOR]

Investigates the early diet of preterm infants and the development of allergic diseases. Evaluation of the incidence of allergic reactions in 18 months old infants; Manifestation of greater allergic risk in infants receiving preterm formula instead of human milk; Implications of a family history of atopy.

In some patients with atopic dermtalitis (AD), delayed-type allergy lo aeroallergens, such as house dust mite, can be demonstrated by patch testing. Positive patch tests can be expected only in patients with AD and, in them, only to aeroallergens to which type I reactions have also been demonstrated. In an as yet unknown number of such cases. aeroallergens appear to play a role in Al). Studies to date have varied too widely in experimental method and design to allow more definite conclusions to be drawn. It is essential that future studies are standardized with regard to patch test system and designed to include adequate controls and assessment of relevance. [ABSTRACT FROM AUTHOR]

Total and antigen-specific IgE levels using the radioallergosorbent test (RAST) were measured in a prospective study of thirty-seven infants with dermatitis of early infancy, with the aim of distinguishing between atopic and infantile seborrhoeic dermatitis at an earlier age than is usually possible on clinical grounds. The results were correlated with the clinical diagnoses made after 1-2 years close follow-up. They showed that a RAST screen to egg white and to milk antibodies, and to a lesser extent total IgE levels, are of value in diagnosing atopic dermatitis at an early age and distinguishing this from infantile seborrhoeic dermatitis. [ABSTRACT FROM AUTHOR]

The appearance of metachromatic cells in nasal scrapings was studied prospectively in 67 children from birth to 18 months of age. The findings were related to family history of atopy and development of allergic disease in the infants. Allergic disease was diagnosed during the 18- month follow-up period in 54% of the infants with heredity for atopic disease. The corresponding figure for children with no heredity was 11%. Using a gentle scraping-cytocentrifugation method for collection of mucosal specimens, metachromatic cells were identified in the nasal scrapings in 20 of 30 children who developed definite allergic disease (67%) and in 6 of 9 with probable allergy. The cells appeared before or at the time of diagnosis in 19 of the infants with definite allergic disease. Metachromatic cells were also found in 7 of 25 healthy children who did not develop allergic disease during the follow-up period. Six of them had definite and one possible heredity for allergic disease. No metachromatic cells were found in any of the 8 infants who lacked heredity for atopy and did not develop atopic disease. In conclusion, the appearance of metachromatic cells in the nasal mucosa during the first 18 months of life of infants was associated with atopic propensity, as defined by development of atopic disease and/or a strong family history of allergy. [ABSTRACT FROM AUTHOR]

A case study is presented of a 42-year-old female patient suffering from allergic contact dermatitis resulting from colophonium and atopic dermatitis. It states that she presented with worsening of eczema on her arms and hands and after a patch test developed recall dermatitis at the tested patch sites following injection of the dupilumab. It speculates that effector memory T cells at areas previously affected by allergic contact dermatitis could be responsible for the recall dermatitis.

Summary: Epigenetics has recently been considered as a potential mechanism involved in the development of many disorders, including allergic diseases. Animal models have shown that environmental factors such as maternal tobacco smoke or mechanical ventilation can alter gene transcription and consequently the structure and function of lungs. Moreover, asthma and other allergic diseases (atopic dermatitis and food allergy) are influenced by epigenetics. In fact, the exposure to environmental factors during early childhood may induce a long-lasting altered genetic state adapting to a persistent “Th2 state” thus influencing the development of asthma or atopic dermatitis and food allergy if alterations involve the filaggrin gene. In conclusion, progresses have been made linking environmental pollution, environmental tobacco smoke (ETS) and diet exposure with atopy through epigenetic mechanisms. Furthermore, considerable advances have been made implicating epigenetic mechanisms in T cell differentiation. However, much more research is still needed, in particular to define the clinical consequences of such epigenetic alterations. [Copyright &y& Elsevier]

The article presents a study on the selective allergy for Venus antiqua, commonly known as King Broderip clam. It discusses a case of a 68-year-old non-atopic man who was diagnosed with isolated food allergy to King Broderip clam. The patient reported with shortness on breathing after eating the canned King Broderip clam, palpebral oedema, and scalp. It notes that the case demonstrates a selective food allergy of the patient for the canned King Broderip clam, but can tolerate other moluscs food.

Focuses on the use of atopy patch testing in diagnosing atopic dermatitis. Atopic dermatitis and aeroallergens; Provocative factors of atopic dermatitis.