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Background Allergen identification is the first step for allergen-specific immunotherapy (AIT) of allergic rhinitis (AR). Currently, the diagnosis of AR is based mainly on the positive results of the skin prick test (SPT) and/or serum specific immunoglobulin E (sIgE) measurement. However, the results of these two tests may not always directly correlate with AR. Objective To investigate the importance of nasal provocation testing (NPT) in the diagnosis of Dermatophagoides pteronyssinus (Der p)-induced AR. Methods Rhinitis patients willing to undergo AIT (n = 171) were enrolled. The correlations of Der p SPT, sIgE, NPT, and clinical symptom severity were assessed. Results NPT-positive responses were more common in patients with higher SPT and sIgE levels. The optimal cut-off value for a NPT-positive response for SPT was 5.5 mm and for sIgE was 2.77 kUA/L, based on the respective receiver operating characteristic (ROC) curves. The area under the curve (AUC) of the ROCs was 0.814 (SPT only) and 0.794 (sIgE only) and increased to 0.828 with the combination of SPT and sIgE. The Der p-NPT concentration was inversely correlated with SPT and sIgE levels ( r = −0.477, P Conclusion For patients who are willing to receive Der p AIT, NPT is a useful and safe test to confirm diagnosis prior to treatment initiation, especially in patients with lower levels of Der p SPT (

Antecedentes: Existen lineamientos para el diagnóstico de las enfermedades alérgicas y la aplicación de inmunoterapia con alérgenos (ITA).Objetivo: Describir cómo los alergólogos mexicanos diagnostican y tratan con ITA las alergias alimentaria y respiratoria.Métodos: Se encuestó a 227 alergólogos que acudieron a un simposio de inmunoterapia; se indagaron prácticas cotidianas en el diagnóstico de las alergias respiratoria y alimentaria, así como en la forma de aplicar la ITA.Resultados: Los alergólogos utilizan las pruebas cutáneas por punción para el diagnóstico de las alergias respiratorias y alimentarias en 100 y 87.7 % de los casos de una y otra; diagnóstico in vitro mediante determinación de IgE alérgeno-específica en 55.5 y 63 %; y diagnóstico molecular por componentes en 14.1 y 13.2 %. Para los aeroalérgenos, 81 % emplea ITA subcutánea; 77.9 %, ITA sublingual líquida; 1.8 %, ITSL en tabletas; 45 % indicó que estaba dispuesto a emplear tabletas en el futuro. Para los alérgenos de alimentos, la mayoría no utilizaba ITA, aunque 55 % se interesa en la ITA oral y 59 %, en la ITA sublingual.Conclusiones: En términos generales, el diagnóstico y tratamiento de las enfermedades alérgicas se realizan conforme los lineamientos internacionales, además, los alergólogos encuestados mostraron flexibilidad para adoptar nuevos esquemas.

Al·lèrgia; Diagnòstic molecular; Recomanacions Alergia; Diagnóstico molecular; Recomendaciones Allergy; Molecular diagnosis; Recommendations The introduction of molecular diagnosis into routine clinical practice has substantially improved the diagnosis and management of allergic patients by allowing clinicians to precisely identify the allergenic molecule responsible for immunoglobulin E (IgE)-mediated allergies. However, it can be challenging to accurately interpret the results of molecular assays, partly due to the limited evidence base. In this context, a panel of experts with extensive experience in interpreting in vitro measures of total and serum specific IgE reviewed the available scientific evidence. After this review, the panel selected a series of representative case studies to demonstrate how determination of specific and total IgE values and the relationship between them (ratio analysis) can add value to the diagnostic process by more precisely defining the patient’s sensitization profile. Finally, the experts developed a series of recommendations on the clinical application of ratio analysis to optimize and complement the classical approach to allergy diagnosis.

There is little understanding of the mechanisms by which food allergy (FA) develops into persistent disease, or by which symptoms it regresses. Food allergy is a major health problem in developed countries, where the prevalence reaches up to 6% in children and 3% in the adult population.Children with food allergy remission (FAR) and those without FAR below five years of age, were compared 7-10 years with respect to clinical data and expression of glycoprotein A repetitions predominant (GARP) on peripheral blood mononuclear cells.Forty children with FAR and 40 children without FAR at age 7-10, in whom FA was previously diagnosed at age below five years were evaluated. In this prospective study, demographic and clinical data were taken, patients were classified as atopic based on history and serum specific IgE (sIgE) for a specific allergen. Blood samples were obtained from all patients to assess expression of GARP.We observed higher expression of GARP in children with FAR compared to children without FA (p=0.005); optimal cut-off for GARP prediction of the remission was 20.1%. Children with FAR and food-specific IgE in serum had higher expression of GARP compared to children with low food specific IgE (0.35kU/L). Keeping pets at home decreased, and presence of allergic rhinitis increased ORs for high expression of GARP (hGARP) in our patients.hGARP (20.1%) is related with FAR in school children. Allergic rhinitis, and pets at home modify this effect of GARP. Children with allergic rhinitis have less chance of developing remission despite maintaining immune tolerance (hGARP); quite the opposite case with pets at home.

In recent years, there has been a tendency towards an increase in the incidence of allergic dermatoses, especially their severe cases, which are resistant to treatment. It results from environmental pollution, increased radiation background, the wide use of immunosuppressants, broad-spectrum antibiotics, etc. The disease is diagnosed based on the anamnesis, the results of skin and provocative tests, and the assessment of serum specific IgE. However, the diagnosis of allergic dermatoses presents some difficulties that are caused by polysensitization, when the above diagnostic methods for identifying a causally significant or true allergen are sometimes not sufficient. The introduction of modern methods of diagnosing allergic dermatoses into dermatological practice will allow doctors to expand the methodological tactics of optimal therapy methods, which ultimately will result in the improvement of the quality of life of patients. The present article analyzes modern methods for the diagnosis of allergic skin diseases that contribute to determining the severity of the clinical course and patient management tactics.

To investigate immunoglobulin E (IgE)-mediated hypersensitivity to chlorhexidine (CHX), and association between CHX exposure and serum specific IgE (SIgE) levels, among first-year dental students. Participants completed a questionnaire on medical health, history of allergies/hypersensitivities and CHX exposure. A sample of venous blood (3 mL) was drawn and subjected to SIgE test to CHX; sensitisation defined as SIgE level of ≥0.10 kUA/L. Fifty-eight (98.3%) participants, consisting of 69% (n = 40) female with a mean age of 21, were recruited; three quarters (84%) reported no known health issue, and over half had no history of allergies (57%); less than 20% reported having had exposure to CHX-containing products with the majority from toothpaste (9%) and mouthwash (12%). The CHX SIgE test showed that 8.6% (n = 5) were sensitised. No association between CHX exposure history and the level of SIgE antibody was noted. Although most participants reported no known exposure to CHX, 8.6% showed CHX sensitisation suggesting unknown exposure and the potential risk of developing hypersensitivity and adverse reactions in the future.

Background Laboratory animal allergy (LAA) has not been sufficiently investigated, although LAA is a relatively common work-related condition and important occupational hazard. Objective This study aimed to evaluate the prevalence of LAA and analyze the diagnostic value of serum specific IgE (sIgE) using the skin prick test (SPT) as a comparative standard. Methods Korean laboratory animal researchers who attended an annual symposium were requested to answer questionnaires regarding demographic characteristics, laboratory animal exposure, and symptoms related to laboratory animal exposure. A total of 213 participants underwent a SPT with mouse and rat epithelial allergen extract. We measured sIgE against rodent urine, epithelium, and serum allergens from 63 participants. SPT outcome served as the comparison method. Results Among 223 participants, 213 had direct/indirect exposure to mice or rats, and 30% and 14% of them complained of allergic symptoms after exposure to mouse and rat, respectively. Sensitization rates were 28% for mouse epithelium and 23% for rat epithelium. Compared to a positive SPT with wheal ≥ 3 mm, presence of sIgE against rodent allergens showed a higher positive predictive value of 87-91% at a cut-off level of 0.35 KUA/L. Agreement between SPT and sIgE test was determined to be fair to moderate. Conclusions Sensitization and allergy to mouse and rat were prevalent among laboratory personnel in Korea. When evaluating cases of potential LAA, the sIgE test can provide added diagnostic value if the skin test is positive. Careful interpretation of two tests is required to accurately diagnose LAA.

Food allergy is common, it can lead to significant morbidity andnegatively impacts on quality of life; therefore, it is vitally important we get the diagnosis right. However, making the diagnosis can be complex. Clinical history is the most important diagnostic tool and subsequent investigation may help confirm the diagnosis. The investigations available to most paediatric departments are skin prick testing and specific IgE so we will focus on these. Within this article we explore the evidence related to targeted testing and how to interpret these within the clinical context.

BACKGROUND: Allergic conjunctivitis (AC) is predominantly caused by serum specific-IgE (sIgE)-mediated type I allergy. This study aims to analyze the distribution of sIgE in children with AC, and the concomitant allergic diseases. METHODS: The clinical data from 310 children, diagnosed with AC and admitted to our hospital from January 2017 to January 2019 were retrospectively collected. The children were divided into three groups: infant group (2 months to 1 year old, 91 cases), child group (1 to 3 years old, 112 cases), and preschool group (3 to 6 years old, 107 cases). Children in every group were analyzed for positive rates, the number of positive sIgE types, the distribution of positive inhaling and ingesting allergens and concomitant allergic diseases. RESULTS: The sIgE positive rate of infant was significantly lower than that of the other two groups, and the number of 18.75% sIgE positive species was 1. The number of sIgE positive species in the child group and preschool group was more than 2 (78.30%, 71.15%). The positive rate of sIgE to dust mites, house dust, animal dander, eggs, beef, mutton and mango in the preschool group was significantly higher than the other groups (P

BACKGROUND Wheat extracts containing both water/salt and alcohol soluble proteins may increase extract's accuracy for diagnosing IgE-mediated wheat allergy. OBJECTIVE This study aimed to determine the performance of new invented in-house prepared wheat extracts for skin prick test (SPT). METHODS Children aged 1-18 years with history of immediate wheat allergy were recruited. Four in-house prepared wheat extracts (wheat-Coca-10%EtOH, and 3 new invented extracts, wheat-salt, gliadin, and glutenin) and a commercial wheat extract were used for SPT. Serum specific IgE (sIgE) to wheat and omega-5 (ω-5) gliadin were also determined. Oral food challenge (OFC) with wheat flours was performed in all patients except those with history of wheat-induced anaphylaxis or with recent symptoms within the past 6 months. RESULTS Thirty-one children were recruited. Of those, 14 were excluded from OFC (12 with history of anaphylaxis and 2 with recent symptom). OFC was positive in 8 of 17 children. Of the 5 extracts and sIgE to wheat and ω-5 gliadin, gliadin extract provided the best SPT performance with 84.2% sensitivity, 88.9% specificity, 94.1% positive predictive value (PPV), 72.7% negative predictive value (NPV), 7.59 positive likelihood ratio (LR), 0.18 negative LR, and 85.7% accuracy. CONCLUSIONS Compared to other in-house and commercial wheat extracts and sIgE to wheat and ω-5 gliadin, SPT with an in-house gliadin extract yielded the highest performance for the diagnosis IgE-mediated wheat allergy.

Background: Nut allergies are an increasingly frequent health issue in the pediatric population. Tree nuts (TN) and peanuts are the second cause of food anaphylaxis in Italy. Unfortunately, knowledge of the clinical characteristics of a TN allergy in Italian children is limited. Our study aimed to identify the clinical and allergological characteristics of Italian children with a nut allergy (TN and peanut). Methods: A retrospective observational analysis was performed on the clinical charts of children with a history of nut reaction referred to the allergy unit of the hospital from 2015 to 2019. The studied population was represented by children with a confirmed nut allergy based on positive prick by prick and/or serum-specific IgE to nut plus a positive nut oral food challenge. Demographic, clinical, and allergological features were studied and compared among different nuts. Results: In total, 318 clinical charts were reviewed. Nut allergy was confirmed in 113 patients. Most patients (85/113, 75%) had a familial history of allergy and/or a concomitant allergic disorder (77/113, 68%). Hazelnut and walnut were the more common culprit nuts observed in allergic children. Anaphylaxis was the first clinical manifestation of nut allergy in a high percentage of children (54/113, 48%). The mean age of the first nut reaction was statistically higher with pine nuts. Over 75% of children reported a single nut reaction. During the OFCs, the signs and symptoms involved mainly the gastrointestinal system (82/113, 73%) and resolved spontaneously in most cases. Severe reactions were not frequent (22/113, 19%). Conclusion: To our knowledge, this is the first Italian study that provided a comprehensive characterization of children with a nut allergy. These results are important for clinicians treating children with a nut allergy.

The performance of specific inhalation challenge test (SICT) - reference method in diagnostics of occupational allergy - has some limitations due to health status of a particular patient. Therefore, it is extremely important to identify usefulness of other tests, and the evaluation of diagnostic accuracy of commercially available serum specific immunoglobulin E (sIgE) kits to the most common high molecular weight agents has been launched.The study group comprised 141 subjects - 110 bakers and 31 farmers - with suspicion of occupational airway allergy. All patients underwent evaluation of serum sIgE to occupational allergens with the use of Phadia and Allergopharma kits: in bakers to flour mix and α-amylase, in farmers to epithelium of cow, pig and feathers. Specific inhalation challenge test with workplace allergens performed in all subjects was a reference method for further analysis.Serum specific IgE to flour mix had the highest sensitivity (Phadia - 95.6%, Allergopharma - 88.3%), while its specificity was relatively low (Phadia - 47.8%, Allergopharma - 25%). There were numerous discrepancies between the results of sIgE estimation for particular single allergens (k87, e4, e83), as well as for their mixtures (fx901, fx20, ex71), performed with the kits of both companies (Phadia vs. Allergopharma).Evaluation of serum specific IgE is characterized by inadequate sensitivity, specificity and predictive value to take the place of specific inhalation challenge test in diagnostics of occupational respiratory allergy. Med Pr 2017;68(1):31-43.Test swoistej prowokacji wziewnej – metoda referencyjna w diagnostyce alergii zawodowej – u niektórych chorych nie może być przeprowadzony z powodu przeciwwskazań zdrowotnych. Ponieważ ustalenie rzeczywistej przydatności innych testów jest niezwykle ważne, podjęto badanie, którego celem było określenie trafności i przydatności diagnostycznej dostępnych komercyjnie odczynników do oznaczania alergenowo swoistych przeciwciał immunoglobuliny E (asIgE) w surowicy w diagnostyce IgE-zależnej alergii dróg oddechowych na najczęstsze alergeny pochodzenia roślinnego.Badaniem objęto grupę 141 pacjentów – 110 piekarzy i 31 rolników – z podejrzeniem zawodowej alergii dróg oddechowych. U wszystkich badanych oznaczono asIgE dla alergenów zawodowych w surowicy odczynnikami firm Phadia i Allergopharma: u piekarzy dla mieszaniny mąk i α-amylazy, u rolników dla alergenów naskórka krowy, naskórka świni i mieszaniny piór. Metodę referencyjną do oceny powyższych testów diagnostycznych stanowił wykonany u wszystkich badanych test swoistej prowokacji wziewnej z alergenami z miejsca pracy.Najwyższą czułością charakteryzowały się oznaczenia asIgE dla alergenów mąk (Phadia – 95,6% i Allergopharma – 88,3%), przy stosunkowo niskiej swoistości (Phadia – 47,8% i Allergopharma – 25%). Rozbieżności między wynikami uzyskanymi przy użyciu zestawów Phadia vs Allergopharma dotyczyły oznaczeń asIgE zarówno dla pojedynczych alergenów (k87, e4, e83), jak i mieszanin alergenów (fx901, fx20, ex71).Oznaczanie asIgE w surowicy nie charakteryzuje się wystarczającą czułością, swoistością i wartością predykcyjną, żeby zastąpić test swoistej prowokacji wziewnej w diagnostyce zawodowej alergii dróg oddechowych. Med. Pr. 2017;68(1):31–43.

The job of cleaning has developed dynamically as a working service, and women constitute the majority of all professional cleaning workers. Cleaners are at an increased risk of work-related asthma (WRA). This study characterizes work-related respiratory symptoms reported by female cleaners, evaluates any associated factors of WRA, and shows diagnostic management of medical certification. The study group comprised 50 professional cleaning women referred to our Occupational Diseases Department due to suspicion of occupational asthma (OA). A questionnaire, skin prick tests, serum specific IgE antibodies, and specific inhalant challenge were performed in all of the participants. Work-related asthma was recognized in 46% of symptomatic cleaners, of whom 15 were considered as having work-exacerbated asthma (WEA) and 8 as having OA. Sensitization to latex and disinfectants played an important role as a causative agent in OA of cleaners.

Background Only a limited number of studies have included objective measures of allergic sensitisation (such as skin-prick test [SPT] and serum specific IgE [sIgE]) when studying time trends in allergic respiratory disease in adults within the current millennium. Methods Five health examination studies of random samples of individuals aged 18-69 years resident in the Copenhagen region were conducted in 1990-1991, 2006-2008, 2010-2011, 2012-2015, and 2016-2017. Allergic sensitisation was defined by sIgE (in 1990-1991, 2006-2008, and, 2012-2015) or SPT (in 2006-2008, 2010-2011, and 2016-2017) to at least one of the allergens: birch, grass, house dust mite, or cat. Allergic rhinitis was defined as sensitisation and self-reported nasal symptoms. Results The age- and sex-standardised prevalence of sIgE-defined sensitisation increased from 16% in 1990-1991, to 26% in 2006-2008, and to 29% in 2012-2015. The age- and sex-standardised prevalence of SPT-defined sensitisation increased from 27% in 2006-2008, to 28% in 2010-2011, and to 32% in 2016-2017. Changes in sIgE-defined and SPT-defined allergic rhinitis showed similar increasing trends. Conclusion The prevalence of allergic sensitisation and allergic rhinitis increased in a general adult Danish population over the last three decades and has thus continued to increase in the current millennium.

durmus, sinem/0000-0002-9272-9098; Uzun, Hafize/0000-0002-1347-8498 WOS:000475757700007 PubMed ID: 31360927 Objective: Eosinophil cationic protein (ECP) plays a significant role in the pathogenesis of atopic diseases such as allergic rhinitis (AR) and asthma. Using saliva as a diagnostic material is a non-invasive, simple method. Analysis of ECP in saliva was shown as an alternative diagnostic contribution in patients with asthma. In this study we aimed to assess a possible association between the levels of salivary ECP and the diagnosis of AR by comparing serum ECP and salivary ECP levels. Methods: Thirty-five allergic rhinitis patients (study group) sensitive to Dermatophagoides farinae (D2) in skin prick test (SPT) and 35 nonallergic, SPT negative, healthy volunteers (control group) were included in the study. Salivary ECP, serum ECP and specific IgE D2 levels were measured. Results: Distribution of age and gender were similar in the study and the control groups (p>0.05). Serum specific IgE D2 levels were significantly higher in the study group compared to the control group (p

Background Diagnosis of Periplaneta americana (American cockroach, ACR) allergy is commonly performed based on clinical history and skin prick test (SPT) or specific serum IgE (sIgE) measurement. The concordance of the findings with the SPT and sIgE results has never been investigated. Objective To compare the results of SPT with commercial ACR-extract (C-ACE) and sIgE measurement, using commercial kit and in-house enzyme-linked immunosorbent assay (ELISA) to the locally produced ACR extract (L-ACE) and native Per a 1, Per a 5, Per a 7, and Per a 9. Methods Sera from 66 individuals clinically diagnosed with chronic allergic rhinitis were included; 46 were positive SPT to C-ACE, and 20 were negative. Specific serum IgE levels were established by using a commercial test kit (ImmunoCap) and an in-house IgE-ELISA Results The percentage the C-ACE SPT-positive cases that were positive by the ImmunoCap-sIgE was 32.6%, indicating low concordance of the 2 assays. With the in-house ELISA, Per a 9 gave the highest sensitivity (98.00%), positive predictive value (PPV; 95.74%), and negative predictive value (NPV; 94.74%) of the sIgE quantification. The correlation coefficients (R) of the L-ACE-SPT and sIgE to L-ACE, Per a 1, Per a 5, Per a 7, and Per a 9 and ImmunoCap sIgE were 0.133, 0.278, 0.419, 0.280, and 0.432, and 0.256, respectively. Conclusion Skin prick test and sIgE measurement using commercial reagents have low concordance. Data of this study showed that sIgE to the native Per a 9 should be considered as an adjunct to the clinical history in diagnosis of ACR sensitization/allergy, particularly when the SPT and the nasal challenge, which is the gold standard method, cannot be performed.

Food allergies are recognized as a major public health issue, especially in early childhood, with no preventive treatment. The diagnosis of food allergies currently relies on careful study of the patient’s history and diagnostic tests such as the skin prick test (SPT), serum specific IgE (immunoglobulin E) testing and, if indicated, oral food challenges, which are often risky. In this study, a sandwich-type immunocomplex was formed between different food allergens, specific IgE from sera and secondary anti-IgE conjugated with the enzyme horseradish peroxidase. Gold(III) chloride was subsequently added as a visual reader reagent. The color change from red to blue and the associated change in intensity at 550 nm was proportional to the concentration of remaining hydrogen peroxide after decomposition by horseradish peroxidase, which in turn triggers the aggregation of gold nanoparticles generating a blue color with a decrease in intensity at 550 nm. The generation of the visible blue color reports the presence of allergy issues compared to the red color in healthy subjects, and the consequent drop in intensity at 550 nm measures the amount of serum specific IgE, which corroborated the SPT results from the corresponding patients. This multiplexed visual diagnostic system for specific IgE against different food allergens using plasmonic phenomena of the aggregated gold nanoparticles has been a rapid, cheap, sensitive and high through put assay for the detection and determination of the severity of food allergens with a very low sample requirement (5 μl).

No allergens related to paprika or cayenne respiratory allergy have been identified thus far. We describe a previously healthy 28-year woman who developed work-related rhinoconjunctivitis after four years of kebab-restaurant work. The allergy was studied using skin prick tests, serum specific IgE and nasal provocation tests. Specific IgE protein reactions were studied by Western blot analysis. Paprika, cayenne and curry allergens were identified from the strongest immunoblot bands using tandem mass spectrometry. A positive skin prick test, high specific IgE and positive nasal provocation test confirmed occupational rhinoconjunctivitis from Capsicum spices. Defensin J1 and Vicilin were identified as major paprika and cayenne allergens in this case. Vicilin was detected also from the curry ingredients. Two new occupational respiratory allergens from the Capsicum species were identified. These differ from previously reported bell pepper allergens. We emphasize that substantial spice handling at work poses an allergy risk. Am. J. Ind. Med. 58:791–794, 2015. © 2015 Wiley Periodicals, Inc.

Background The responsiveness to a nonendemic grass species is unknown and cannot be research without an allergen challenge chamber. Objective To determine the clinical responsiveness to timothy grass pollen (TGP) in participants without known natural exposure in an allergen challenge chamber (ACC). Methods Of the 26 screened participants, 22 met screening criteria and completed the 2 chamber exposures. The study consisted of an initial screening visit that included a blood draw for serum specific IgE (ssIGE) to Bermuda grass pollen and TGP followed by a 4½-day run-in phase and two 3-hour ACC exposure visits. This study was performed early in the first week of December 2013, when no seasonal pollens were detected in San Antonio, Texas. Symptom scores were recorded at baseline and every 30 minutes. Results Of the 26 screened participants, 22 met the screening criteria and completed the 2 chamber exposures. Thirteen participants had always lived in South Texas without natural exposure, and 9 had previously lived in areas with TGP exposure. All participants tested positive to TGP and Bermuda grass pollen. Twelve and 13 of 22 had positive ssIgE test results to Timothy and Bermuda allergens, respectively, with 11 having positive results for both allergens. There were strong correlations among skin prick test size, a positive ssIgE test result, and high symptoms from TGP exposure. There was little difference in symptoms between those who had lived their entire lives in South Texas and those who had lived elsewhere. Conclusion In Texas, where exposure to TGP is minimal, strongly positive SPT and ssIgE test results were predictors of high symptoms to TGP exposure. Never exposed participants in South Texas reacted to TGP similar to those who had previous natural exposure, suggesting that in vivo cross-reactivity may be higher than predicted by prior in vitro data and may allow the use in clinical trials of allergens not endemic to the locale of an ACC.

Background: Allergen extracts may be different due to the difference in dissemination of allergen-containing species in various geographical areas. Therefore, we wish to develop our own extracts to ensure the precision and quality of diagnosis. Objectives: To compare the efficacy and safety of our locally prepared pollen allergen extracts to imported ones, using skin prick testing (SPT) and serum specific IgE (sIgE) as references. Methods: This prospective, randomized, double-blinded, self-controlled study was performed in respiratory allergic adult volunteers who are sensitized to at least one kind of pollen. Each subject was pricked with our Bermuda grass, Johnson grass and careless weed pollen allergen extracts, and also with the imported ones. sIgE levels were measured by using ImmunoCAP®. Results: In 68 volunteers, our Bermuda, Johnson and careless weed extracts showed 91.2%, 45.6% and 54.4% positive SPTs, respectively, while for the imported ones 73.5%, 45.6% and 54.4% SPTs were positive, respectively. No adverse reaction was found in all procedures. The concentration of 10,000 BAU/mL of Bermuda grass, 1 : 20 w/v or 10,000 PNU/mL of Johnson grass and 1 : 40 w/v or 10,000 PNU/mL of careless weed yielded the most positive SPT results. There was no significant difference in mean wheal diameter (MWD) yielded from using local and imported extracts. Significant correlation was found between MWDs of imported pollen extracts and serum sIgE levels (p < 0.01). Conclusion: No significant difference between SPT results of local and imported pollen allergen extracts was found. Significant correlation was found between MWDs of imported pollen extract SPT and serum sIgE levels.

Bu çalışma ile Samsun ili ve çevresindeki Atopik Dermatitis (AD)’li köpeklerde ilk kez serum spesifik immunoglobin E (IgE) ile alerjen profillerinin belirlenmesi amaçlanmıştır. Değişik ırk, cinsiyet ve yaşlardaki 21 adet köpeğe Favrot Kriterleri ile AD teşhisi konulmuştur. Köpeklere ait serum örnekleri serolojik olarak 20 farklı alerjene spesifik IgE yönünden incelenmiştir. AD’li köpeklerde 20 farklı alerjenin görülme oranlarına cinsiyet, yaş ve beslenme şekillerinin etkisi araştırılmıştır. Samsun ili ve çevresindeki AD’li köpeklerdeki farklı alerjen profilleri arasında en yüksek %95 oranında ev tozu akarı Dermatophagoides farinae seropozitifliği saptanmıştır. Bununla birlikte köpeklerde farklı oranlarda diğer alerjenlere yönelik seropozitiflik saptanmıştır. Dişi köpeklerde erkek köpeklere oranla sadece Ctenocephalides spp. seropozitifliğinin yüksek olduğu istatistiksel olarak tespit edilmiştir (p0,05). Samsun ili ve çevresindeki AD’li köpeklerde ev tozu ile depo akarlarının serum spesifik IgE değerlerinin çok yüksek oranlarda pozitiflik verdiği saptanmıştır. It is aimed to detect allergen determination via serum specific immunoglobulin E (IgE) for the first time in dogs diagnosed as Atopic Dermatitis (AD) from Samsun and vicinity within this present study. Twenty one dogs with different age, breed and gender diagnosed with AD based up on the Favrot’s criteria. Serum samples of the dogs were analyzed by detection of serum specific IgE for determination of 20 different allergens. The effects of gender, age and the feeding routes for those 20 different allergens separately were analyzed. Based up on the grading of the allergens detected in 21 dogs with AD from Samsun and vicinity; results reflects that Dermatophagoides farinae was stated as first degree within a very high seropositivity rate (95%). Moreover, in varying degree of seropositivitiy rates of other allergens were also detected. Females showed statistically (p0.05). Dogs with AD from Samsun and vicinity had very high serum specific IgE levels against to the house dust and storage mites. Keywords: Allergen, Atopic dermatitis, Dog, Samsun, Specific IgE

BACKGROUND: Rhinitis and asthma are linked, but substantial knowledge gaps in this relationship exist. OBJECTIVE: To determine the prevalence of rhinitis and its phenotypes in children and adolescents with asthma, assess symptom severity and medication requirements for rhinitis control, and investigate associations between rhinitis and asthma. METHODS: 749 children with asthma participating in the Asthma Phenotypes in the Inner-City study received baseline evaluations and were managed for 1 year with algorithm-based treatments for rhinitis and asthma. Rhinitis was diagnosed by questionnaire focusing on individual symptoms, and pre-defined phenotypes were determined by combining symptom patterns with skin testing and serum specific IgE. RESULTS: Analyses were done on 619 children with asthma who completed at least 4 of 6 visits. Rhinitis was present in 93.5%, and phenotypes identified at baseline were confirmed during the observation/management year. Perennial allergic rhinitis with seasonal exacerbations (PARSE) was most common (34.2%) and severe. Nonallergic rhinitis was least common (11.3%) and least severe. The majority of children remained symptomatic despite the use of nasal corticosteroids ± oral antihistamines. Rhinitis was worse in difficult-to-control vs. easy-to-control asthma and its seasonal patterns partially corresponded to those of difficult-to-control asthma. CONCLUSION: Rhinitis is almost ubiquitous in urban children with asthma, and its activity tracks that of lower airway disease. PARSE is the most severe phenotype and most likely to be associated with difficult-to-control asthma. This study offers strong support to the concept that rhinitis and asthma represent the manifestations of one disease in two parts of the airways. CAPSULE SUMMARY: Almost all children and adolescents with asthma have rhinitis of various, stable phenotypes based on sensitization and seasonal pattern. Conventional medications control rhinitis symptoms only in a minority. Difficult-to- control asthma is associated with worse rhinitis.

This review draws comparisons between wheat-dependent exercise-induced anaphylaxis (WDEIA) and other food-dependent exercise-induced anaphylaxis (FDEIAs) and discusses the importance of co-factors in its pathophysiology. FDEIA remains an enigmatic condition since it was first described 30 years ago. The sporadic and unpredictable nature of its reactions has puzzled clinicians and scientists for decades, but recent studies on WDEIA have enlightened us about the pathophysiology of this condition. The identification of defined allergic epitopes such as Tri a 19, α-gliadin, β-gliadin and γ-gliadin in WDEIA enables it to become the perfect model for studying FDEIA, but WDEIA is by no means a unique condition. On a larger scale, FDEIA represents a crucial link between IgE-mediated and anaphylactoid reactions and provides supportive evidence for the concept of 'summation anaphylaxis' and the need to overcome the 'allergen threshold'. Future work should focus on identifying more of the FDEIA epitopes and understanding their distinct molecular properties. The development of a biomarker in order to identify patients susceptible to co-factor influences would be invaluable.

Background Oral desensitization in children allergic to cow's milk proteins is not risk free. The analysis of factors that may influence the outcome is of utmost importance. Objective To analyze the efficacy and safety of the oral desensitization according to specific IgE (sIgE) level and adverse events during the maintenance phase. Methods Thirty-six patients allergic to cow's milk (mean age, 7 years) were included in an oral desensitization protocol. Patients were grouped according to sIgE levels (ImmunoCAP) into groups 1 (sIgE 17-50 kU/L). Nineteen children were included as a control group. Serum sIgE levels to cow's milk and its proteins were determined at inclusion and 6 and 12 months after finishing the desensitization protocol. Results Thirty-three of 36 patients were successfully desensitized (200 mL): 100% of group 1 and 88% of groups 2 and 3. Desensitization was achieved in a median of 3 months (range, 1-12 months); 90% of the patients in group 1, 50% of the patients in group 2, and 30% of the patients in group 3 achieved tolerance in less than 3 months ( P = .04). In the control group only 1 child tolerated milk in oral food challenge after 1 year. During the induction phase, there were 53 adverse events in 27 patients (75%). Patients of groups 2 and 3 had more severe adverse events compared with group 1. During the maintenance phase, 20 of 33 patients (60%) had an adverse event. Conclusion Oral desensitization is efficacious. Tolerance is achieved earlier when sIgE is lower. Severe adverse events are frequent, especially in patients with higher sIgE levels. Trial Registration clinicaltrials.gov Identifier: NCT01641731

Background Determining whether patients with cow's milk allergy (CMA) can tolerate foods produced with baked milk could provide a better quality of life, a better prognosis, and an option for desensitization. Objectives The aim of this study was to identify which patients over four years of age with persistent CMA could tolerate baked milk, to compare the clinical and laboratory characteristics of reactive and non-reactive groups and to describe their clinical evolution. Materials and methods A cross-sectional study was conducted (January/13 to November/14) that included all the patients followed at a food allergy center who met the inclusion criteria. The patients underwent an oral food challenge (OFC) with a muffin (2.8 g of cow's milk protein). To exclude cow's milk (CM) tolerance, the patients were subsequently challenged with unheated CM. Results Thirty patients met all the inclusion criteria. Fourteen patients (46.7%) were considered non-reactive to baked milk and reactive to unheated CM. When the groups that were reactive and non-reactive to baked milk were compared, no statistically significant differences in clinical features were found. The prick test for α-lactalbumin (p = 0.01) and casein (p = 0.004) and the serum specific IgE for casein (p = 0.05) presented statistical differences. After one year, none of the patients who were reactive to baked milk were ingesting CM, while 28% of the tolerant patients were consuming fresh CM (p = 0.037). Conclusions Baked milk can be tolerated by patients with CMA, especially those with lower levels of casein and α-lactalbumin. This option can improve quality of life and accelerate tolerance.

RESUMO Teste de contato atopico com aeroalergenos: uma ferramenta promissora no diagnostico da dermatite atopica 1 Servico de Alergia, Hospital Sao Zacharias, Rio de Janeiro, RJ. 2 Hospital Geral de Nova Iguacu, Nova Iguacu, RJ. 3 Servico de Imunologia, Hospital Universitario Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ. 4 FDA Allergenic. Artigo Original Braz J Allergy Immunol. 2013;1(1):65-70. Atopy patch test with aeroallergens: a promising tool in the diagnosis of atopic dermatitis Sergio Duarte Dortas Junior, MD, MSc1,2, Soloni Afra Pires Levy, MD1, Andrea Huguenim Silva Pires, MD, MSc1, Augusto Tiaqui Abe, MD1, Solange Oliveira Rodrigues Valle, MD, PhD1,3, Vilma Perez Coelho, MD1, Ludwig Ruppert Hahnstadt, MSc4, Alfeu Tavares Franca, MD, PhD1,3 Objetivos: Avaliar a padronizacao do metodo com relacao a concentracao do aeroalergeno, tempo de oclusao, de interpretacao; e determinar a especificidade e a sensibilidade do teste de contato alergico (TCA) em relacao ao teste por puntura e a dosagem de IgE especifica, na verificacao da sensibilizacao a acaros em criancas com dermatite atopica (DA). Metodos: Foram selecionadas 72 criancas com idade entre 2 e 12 anos, acompanhadas no ambulatorio de alergia do Hospital Sao Zacharias. Estas foram submetidas a teste de puntura, dosagem de IgEs especificas e TCA para acaros (Dermatophagoides pteronyssinus, Dermatophagoides farinae e Blomia tropicalis). Os testes foram realizados em 3 grupos: (1) DA com ou sem rinite e asma, (2) Rinite e/ou asma sem DA, (3) Saudaveis (controle). Resultados: No grupo 1, 40% dos pacientes apresentaram reacao positiva. A sensibilidade foi maior nos pacientes com maior tempo de exposicao (48 h e 72 h). No grupo 2, o TCA foi mais especifico que sensivel para todos os extratos, com aumento da sensibilidade quanto maior o tempo de exposicao (72 h). No grupo 3, apenas 8,3% apresentaram positividade a algum aeroalergeno do TCA. Conclusao: O TCA mostrou ter valor diagnostico em relacao as reacoes de fase tardia a acaros (D. pteronyssinus, D. farinae e B. tropicalis), com elevada especificidade. Ele demonstrou ser um teste confiavel quando comparado aos resultados do grupo controle. Descritores: Dermatite atopica, teste de contato atopico, acaros. Objectives: To evaluate the standardization of the atopy patch test (APT) with regard to concentration of aeroallergens, occlusion time, and interpretation, and to determine the specificity and sensitivity of the method in relation to prick test and serum specific IgE determination in the investigation of dust mite sensitization in children with atopic dermatitis (AD). Methods: Seventytwo children, ranging from 2 to 12 years of age, were selected among those receiving care at the allergy outpatient clinic of Sao Zacharias Hospital. Children underwent skin prick testing, specific IgE measurements, and APT for mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae, and Blomia tropicalis). Tests were performed in three groups: (1) AD with or without rhinitis and asthma; (2) rhinitis and/or asthma without AD; (3) healthy individuals (controls). Results: In group 1, 40% of the patients presented positive reactions. Sensitivity was higher in patients with longer exposure times (48 h and 72 h). In group 2, APT was more specific than sensitive for all extracts, with increasing sensitivity associated with longer times of exposure (72 h). In group 3, only 8.3% of the individuals were positive to any aeroallergen on APT. Conclusion: APT seems to have diagnostic value in identifying late phase reactions to mites (D. pteronyssinus, D. farinae, and B. tropicalis), with high specificity, and proved to be a reliable test when compared with the results obtained for controls.

Background Childhood food allergy is a serious health problem. However, little is known about the frequency and manner in which it is currently diagnosed. Objective To describe parent report of physician practices in the diagnosis of pediatric food allergy. Methods Data from children with food allergy were identified for analysis from a representative survey administered in US households with children from June 2009 to February 2010. Analyses were performed at the level of the allergy. Demographic characteristics, symptom prevalence, and diagnostic methods were calculated as weighted proportions. Adjusted models were estimated to examine the association of reaction history and allergenic food with odds of physician diagnosis and testing. Results Food allergies (n = 3,218) to 9 common allergens were reported among 2,355 children in a sample of 38,480. We found that 70.4% of reported food allergy was diagnosed by a physician. Among physician-diagnosed food allergy, 32.6% was not evaluated with diagnostic testing, 47.3% was assessed with a skin prick test, 39.9% with a serum specific IgE test, and 20.2% with an oral food challenge. Odds of physician diagnosis and testing were significantly higher for severe versus mild/moderate food allergy. Urticaria and angioedema were not reported as symptoms in 40.7% and 34.6% of severe food allergies, respectively. Conclusion Thirty percent of parent-reported food allergies in this study were not diagnosed by a physician. One in 5 physician-diagnosed allergies was evaluated with oral food challenge. Understanding parent report of practices in food allergy provides insight into ways in which to streamline the diagnosis and management of care.

Longitudinal data on serum specific sIgE and sIgG4 to allergen component of Dermatophagoides pteronyssinus (Der p) during allergen immunotherapy (AIT) are limited in Chinese populations. We serially followed up serum sIgE and sIgG4 to Der p and its components (Der p 1 and 2) in 51 Der p-sensitized children receiving guideline-based medications alone and additional 36-month AIT. The the Der p 1 and Der p 2 sIgE levels were elevated at 6 months and progressively declined from 12 months; the sIgG4 levels for Der p, Der p 1 and Der p 2 were increasing during the first year and reached a plateau thereafter; the sIgE/sIgG4 ratios for Der p 1 and Der p 2 decreased continuously from 6 through 24 months of AIT. Subgroup analysis showed that younger children (≤8years) experienced a greater increase in sIgG4 levels for Der p, Der p 1 and Der p 2 during AIT compared with older children (9-16 years). In summary, sIgE and sIgG4 to Der p 1 and Der p 2 may be more useful than those to Der p in reflecting the change in immunological reactivity during AIT. Earlier delivery of AIT may yield greater increase in sIgG4 after 36-month treatment than given later in life.

Food allergy is a common medical problem in infants, children and teenagers. With a good history, appropriate allergy tests and some training, food allergy is relatively easy to diagnose. A correct diagnosis can allow the child to avoid the relevant allergens and reduce their risk of experiencing further allergic reactions. They and their families can also be taught how to recognize and manage any future reactions. This is important as allergenic foods can precipitate anaphylaxis, particularly in children with co-existing asthma. This article will provide a description of how to diagnose and manage infants, children and teenagers with possible food allergy.

Background. Allergen-specific immunotherapy (SIT) is one of the important regimens for the treatment of allergic diseases. Predictive tests for the clinical response to SIT are limited. In this study we aimed to evaluate whether specific IgE/total IgE levels can predict clinical improvement in monosensitized patients to house dust mite treated with immunotherapy. Patients and Methods. We analyzed 32 patients who had undergone 2 years of SIT. Serum t-IgE and s-IgE levels, and serum s-IgE/t-IgE ratios were calculated and tested for correlation with clinical response to SIT. Asthma symptom score (ASS), rhinitis symptom score (RSS), pulmonary functions and visual analogue scales (VAS) were evaluated at the beginning and after 2 years. Results. There were 17 boys and 15 girls with the mean age of 10.78±3.03 years. The mean serum house dust mite s-IgE level was 128.62±142.61 kU/L, t-IgE 608.90±529.98 IU/mL, and s-IgE/t-IgE ratio 33.83±53.18. Before immunotherapy, ASS was 6.23±1.63, RSS; 8.20±1.88, VAS; 7.38±2.01, FEV1 (%); 89.14±8.48, PEF (%); 88.93±13.57, and after 2 years, these values were determined as 1.90±1.10, 3.05±1.39, 1.35±1.24, 97.6±11.26, and 97.0±11.55, respectively. s-IgE/t-IgE ratio was correlated with change in RSS (r=−0.392, P=0.08) and VAS (r=−0.367, P=0.05). Conclusion. Although SIT is very effective treatment, all patients do not benefit from treatment. We assumed that s-IgE/t-IgE ratio would be useful to predict the clinical response to SIT.

SUMMARY Anti-Echinococcus serum immunoglobulin (Ig)E was assessed by the ImmunoCAP system and compared with anti-Echinococcus serum IgG assessed by enzyme-linked immunosorbent assay (ELISA) and Western blot. The ImmunoCAP system revealed very high specificity (one false positive of 110 healthy individuals), low cross-reactivity (one false positive of 58 patients with other diseases) and decreased sensitivity (73AE55%). Receiver operating characteristic analysis displayed a beneficial diagnostic value with high accuracy. Comparison of the ImmunoCAP system with ELISA and Western blot showed significantly higher specificity and significantly lower cross-reactivity compared with the ELISA. Examination of sera from 155 patients with cystic echinococcosis (CE) showed varying levels of antiEchinococcus IgE (range, 0AE01–118AE33 kUA ⁄ L). However, most samples had moderately elevated IgE levels. Analysis of serum-specific IgE revealed significantly higher sensitivity of the ImmunoCAP system and significantly higher antibody levels in hepatic CE compared with pulmonary CE.

Summary Introduction. Sensitization to cat allergens is common worldwide. Currently, there is a trend towards costly and often unavailable diagnostic analysis. Objectives. The aim is to assess the reliability of skin prick test (SPT) and serum specific IgE (ssIgE) to cat sensitization, by performing nasal challenge test (NCT) in a community with low cat ownership but common presence of stray cats. Patients and methods. Forty-one pa-tients with perennial allergic rhinitis (AR) who were mono or polysensitized (including cat) were included. We had 31 cat non-owners and 10 present cat owners. SPT (> 5 mm / diameter), ssIgE (≥ 0.70 IU/ml), nasal smear for eosinophil (Eo) and NCT were compared between groups. Outcomes included nasal challenge score, nasal Eo positivity, peak inspiratory and expiratory flow (PIF and PEF) 2 and 8 hours after the NCT, and were compared to baseline. Results. Baseline SPT wheal size and ssIgE level were similar in both groups. NCT positivity was more frequent in cat owners. The strongest nasal reaction was on the top concentration in both groups. Nasal Eo positivity in cat owners was higher before and 2 hours after NCT, but similar to non-owners at last measurement. NCT positive cat non-owners had bigger SPT wheal size than NCT negative non-owners, but smaller than NCT positive cat owners. In contrast to PEF, a significant fall in PIF was noticed in both groups. Mono and polysensitised patients showed similar NCT positivity. Conclusion. Stray cats may pose a relevant risk of developing perennial AR. Regardless of cat ownership status, SPT and ssIgE should be the first diagnostic tool. Nasal Eo and NCT seem to be good diagnostic tools in cat non-owners if diagnosis is elusive.

Background The ability of prick puncture skin test (PPST) results and the presence of serum specific IgE (sIgE) to Dermatophagoides pteronyssinus to predict positive or negative nasal challenge (NC) results has not been determined in older adults. Objective To determine if allergy skin test and/or serum sIgE is diagnostic of allergic rhinitis in older adults. Methods Forty-eight adults (20 younger and 28 older) with rhinitis underwent NC to D pteronyssinus 1 to 4 weeks after PPST and sIgE to D pteronyssinus . Patients were not aware of their in vivo or in vitro results at the time of their NC. Results Fourteen of 48 adults (10 younger and 4 older) were NC positive. The positive predictive values for older adults with positive NC results ranged from 28.57% to 42.86% for PPST and was 16.67% for sIgE. In contrast, positive predictive values in younger adults ranged from 76.92% to 100% for PPST and was 100% for sIgE. However, negative PPST results and sIgE had high predictive values for a negative NC result to D pteronyssinus in older adults (90.48%-95.24% for PPST and 89.47% for sIgE). Conclusions Although PPST and sIgE negative results were good predictors of negative NC outcomes, neither positive PPST results nor serum sIgE to D pteronyssinus predicted positive NC results in older adults. PPST and sIgE to D pteronyssinus were excellent predictors of both positive and negative NC outcomes in younger adults.

Purpose of review Diagnostic decision points for food allergen-specific serum IgE concentration and for skin prick test results have been established for several foods, reducing the requirement for food challenges in a number of patients. Many patients, however, still need to undergo oral food challenges because their food-specific IgE level is in the undefined range. In addition, diagnostic decision points could not be established for several foods. It appears that measurement of serum specific IgE concentrations to individual allergens is superior to determination of specific IgE to the crude food extract containing allergenic and nonallergenic proteins. This review will outline recent advantages in characterization of food allergens as well as the relevance of this knowledge for use in recently developed protein microarray technology. Recent findings Protein microarrays have been developed to profile allergen-specific IgE antibodies from human serum with the advantage of screening hundreds of allergens in parallel using minute amounts of blood. This technology, however, requires prior knowledge of the proteins to be studied. The identification and characterization of clinically relevant allergens have increased dramatically within the last several years. Relevant new allergens have been identified, especially in tree nuts and seeds. Interestingly, most of these allergens belong to the same family of seed storage proteins. In addition, known food allergens have been further characterized and IgE-binding sites have been determined. Moreover, 'informative' peptides shown to be predictive for the persistence of food allergy have been identified. Summary The combination of food allergen characterization and protein or peptide microarray technology will enable us to develop improved diagnostic tools in food allergy.