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This study explores the downsizing propensity of family and non-family firms by considering their territorial embeddedness during both periods of economic stability and financial crisis. By drawing on a panel dataset of Spanish manufacturing firms for the period 2002–2015, we show that, all things being equal, family firms have a lower propensity to downsizing than non-family firms. When considering the effect of territorial embeddedness, we found that territorially embedded family firms have an even lower propensity to downsizing than their non-family counterparts. Furthermore, the concern of territorially embedded family firms for their employees’ welfare was particularly pronounced during the years of the global financial crisis. This result is explained by the existence of socially proximate relationships with the firms’ immediate surroundings, based on similarity and a sense of belonging, which push deeply rooted family firms to treat their employees as salient stakeholders during hard times. Overall, our study stresses the importance of local roots in moderating the relationship between family firms and downsizing.

The empirical evidence of family business phenomenon in terms of employment outcomes is contradictory highlighting the micro–macro gap in the existing research. To address this contradiction, our study disentangles the role of context in family firms’ employment outcomes. To do so, we conduct a systematic literature review of 67 articles focusing on three employment-related outcomes—namely, growth, downsizing, and quality of labour—published in peer-reviewed journals from 1980 to 2020. Based on a two-by-two framework to classify this extant research, we unpack what we know about family firms and employment outcomes and where we can go from here. We highlight three main findings. First, current research is context-less since has mainly focused on the firm level in one context (i.e., region or country) and there is a lack of studies comparing family firms’ employment outcomes in different contexts and explicitly measuring the effects of contextual dimensions on family firms’ employment outcomes. This context-less approach could explain the conflicting results and lack of theoretical predictability about the family effect on employment across contexts. Second, the lack of understanding of the context in which family firms dwell highlights the need for future research to focus on context by theorizing about employment outcomes—that is, measuring context and its interactions with family- and job-related variables. Third, there is a need to further explore, analyse, and theorize on the aggregate effect of family firms on employment outcomes at different level of analysis (e.g., local, regional, and national).

PurposeThis study investigates the relationship between family-managed firms and firm employment growth by considering the effects of location and economic crisis as moderating variables.Design/methodology/approachThe study uses random-effect models on a large panel dataset of Spanish manufacturing firms covering 2003 to 2015 to estimate the joint effects of municipality size and economic crisis on firm employment growth.FindingsThe analysis reveals a positive association between family-managed firms and employment growth. However, this association is not uniform across space and time. When it considers location, the study finds that municipality size positively affects employment growth in family-managed firms but not in non-family firms. Additionally, while the study reveals that both firm types experience negative employment growth during the early stage of the global economic crisis (2007–08), it also finds that family-managed firms located in small municipalities downsize less than their non-family counterparts.Originality/valueThis study provides new evidence on the resilience of family-managed firms during economic crises, particularly those located in geographically bounded settings, such as small municipalities. When an adverse event, such as an economic crisis, jeopardizes employment levels, the embedded and trust-based relationships, between a family firm and its community leads them to prioritize employees' claims. However, family-managed firms' commitment to preserve jobs in small municipalities cannot be maintained over the long term; this effect disappears if the economic crisis is protracted. This study sheds new light on family-managed firms' distinctive behavior toward with local communities.

By combining arguments from regional economics and family business research, the aim of this article is to test the relationships among local export spillovers, management characteristics, and expo...

Family firms are a keystone in many countries as they provide employment opportunities and help the economy grow and prosper. As a result, family firms have been extensively studied; however, there are important aspects that still need to be better understood. One of these is the relationship between family firms and the socio-spatial context in which they act, that is, their local embeddedness. This study adds to existing research by placing family firms in their regional context and assessing whether and to what extent they are more locally embedded than their non-family counterparts. We measure local embeddedness through place tenure and distance to the local firm for key firm stakeholders. Our findings show that family firms rely greatly on more enduring and spatially proximate stakeholders and therefore show a stronger link with the socio-economic milieu in which they dwell. Relevant contributions to family business and regional studies, together with public policy implications, are discussed.

PurposeA burgeoning body of evidence points out the importance of spatial proximity in influencing firm efficiency besides internal characteristics. Nevertheless, the family status of the firm has been traditionally overlooked in that debate. Therefore, this study aims to investigate productivity spillovers stemming from the geographical closeness to innovators and family firms.Design/methodology/approachUsing secondary data on Italian technology-intensive manufacturing firms, the paper exploits spatial econometric models to estimate productivity spillovers across firms.FindingsAs regards the presence of spatial dependence, this study reveals that a firm's level of efficiency and productivity is influenced by that of nearby firms. Specifically, three main results emerge. First, spatial proximity to innovators is beneficial for the productivity of neighbouring firms. Second, closeness to family firms is a source of negative externalities for spatially proximate firms. However, and this is the third result, the adverse effect vanishes when the nearby family firms are also innovators.Research limitations/implicationsAs the study relies on cross-sectional data, future research should explore productivity spillovers in a longitudinal setting. Additionally, the channels through which productivity spillovers occur should be measured.Practical implicationsThe study highlights the importance of co-location for public policy initiatives to strengthen the competitiveness of firms and, indirectly, that of localities and regions. Moreover, the findings show the crucial role of innovation in mitigating the productivity gap between family and non-family firms.Social implicationsNotwithstanding the advent of the digital era, spatial proximity and localized social relationships are still a relevant factor affecting firms' performance.Originality/valueBy exploring the role of family firms in influencing the advantages of geographical proximity, this study contributes to the growing efforts to explore family enterprises across spatial settings.

Background: Peach gibberellin-regulated protein (peamaclein) has recently emerged as a relevant food allergen in cypress pollen–hypersensitive patients. Objective: We investigated monosensitization to peamaclein among Italian cypress pollen–allergic patients. Patients: A total of 835 cypress pollen–hypersensitive patients from 28 Italian allergy centers underwent a thorough work-up to determine food-allergic reactions and performed skin prick testing with a commercial peach extract containing peamaclein. IgE to rPru p 3 was measured in peach reactors, and those with negative results were enrolled as potentially monosensitized to peamaclein. IgE reactivity to rPru p 7 was evaluated using immunoblot and an experimental ImmunoCAP with rPru p 7. Results: Skin prick tests were positive to peach in 163 patients (19.5%); however, 127 (77.9%) were excluded because they reacted to Pru p 3. Twenty-four patients (14.7%) corresponding to 2.8% of the entire study population) were considered potentially monosensitized to peamaclein. No geographic preference was observed. Seventeen of the 24 patients (70.8%) had a history of food allergy, mainly to peach (n=15). Additional offending foods included other Rosaceae, citrus fruits, fig, melon, tree nuts, and kiwi. On peach immunoblot, only 3 of 18 putative peamaclein–allergic patients reacted to a band at about 7 kDa; an additional 4 patients reacted at about 50-60 kDa. Ten of 18 patients (56%) had a positive result for Pru p 7 on ImmunoCAP. Conclusion: Allergy and sensitization to peamaclein seem rare in Italy. Most patients react to peach, although other Rosaceae fruits and several citrus fruits may also be offending foods. Peach and cypress pollen probably also share cross-reacting allergens other than peamaclein.

Summary The clinical usefulness of two commercial peach extracts for SPT (by Lofarma SpA and ALK-Abello, respectively) was compared in a multicenter study carried out in Italy. Peach allergic patients were tested with the two extracts in parallel and underwent the detection of IgE specific for all three peach allergens currently available (Pru p1, Pru p3, and Pru p4, respectively). The two extracts were almost identical in terms of sensitivity and specificity, being able to detect virtually all patients sensitized to stable peach allergens (lipid transfer protein (LTP) and, presumably, peamaclein) but scoring negative in patients exclusively sensitive to labile allergens (either PR-10 and/or profilin). Thus, the two extracts represent an excellent tool to carry out a preliminary component-resolved diagnosis of peach allergy at the first patient visit.

Seed storage proteins are extremely stable allergens in nuts, seeds, and legumes and are responsible for the most severe allergic reactions to these foods. The cross-reactivity between seed storage proteins from different sources has not been studied at a molecular level so far. This study aimed to ascertain the cross-reactivity between walnut and hazelnut seed storage proteins using recombinant allergens. Sera from 13 consecutive patients with severe primary walnut and/or hazelnut allergy and hypersensitive to both nuts were studied. IgE specific for rCor a 9, rCor a 14, and rJug r 1 was measured, and inhibition experiments were carried out by measuring IgE reactivity after absorption of patients’ sera with freshly prepared walnut extract. All 13 sera showed strong IgE reactivity against walnut 2S albumin, Jug r 1, 12 reacted to hazelnut 2S albumin, Cor a 14, and 8 to the hazelnut legumin, Cor a 9. In inhibition experiments, absorption of sera with whole walnut extract led to the complete disappearance of IgE reactivity to Jug r 1 in 12/13 cases, as expected, but also to the complete disappearance of specific IgE to Cor a 14 in 9/12 sera, and of IgE reactivity to Cor a 9 in 7/8. In the remaining cases a dramatic drop in IgE reactivity was observed. The study shows that patients primarily allergic to either walnut or hazelnut showing a skin or serological reactivity to the other nut also are potentially at risk of severe allergic reactions caused by cross-reactivity between 2S albumins and legumins.

Mosquito bite is usually followed by a local reaction, but severe or systemic reaction may, in rare cases, occur. Allergic reactions to Aedes communis (Ac) may be underestimated due to the lack of reliable diagnostic tools. In this multicenter study, 205 individuals reporting large local reactions to Ac were enrolled and studied for cutaneous or IgE reactivity to Ac, Blattella germanica, Penaeus monodon, and Dermatophagoides pteronyssinus. Extract and molecular IgE reactivity to bees, wasps, hornets, and yellow jacket venoms were also studied in 119 patients with a clinical history of adverse reaction to Hymenoptera. Immunoblot (IB) analysis and immunoCAP IgE inhibition experiments were carried out in selected sera. Ac sensitization was recorded in 96 (46.8%) patients on SPT. Strict relationship between Ac and D. pteronyssinus, B. germanica, P. monodon, or Apis mellifera reactivity on SPT was observed. Ac IgE recognition was seen in 60/131 (45.8%) patients, 49 (81.6%) of them SPT positive, and 5/14 IB reactors. Ac IgE sensitization was associated with Tabanus spp, A. mellifera, Vespula vulgaris, and Polistes dominula reactivity. A strict relationship between Ac IgE reactivity and Api m 1, Api m 2, Api m 3, Api m 5, and Api m 10 was recorded. IgE reactivity to AC was inhibited in 9/15 cases after serum absorption with the A. mellifera extract. Both SPT and IgE Ac reactivity is observed in about half of patients with a history of large local reactions to mosquito bites. The significant relationship between Ac sensitization and either extract or single bee venom components is suggestive of a “bee-mosquito syndrome” occurrence.

According to a recent trend of research, there is a growing interest in applications of machine learning techniques to business analytics. In this work, both supervised and unsupervised machine learning techniques are applied to the analysis of a dataset made of both family and non-family firms. This is worth investigating, because the two kinds of firms typically differ in some aspects related to performance, which can be reflected in balance sheet data. First, binary classification techniques are applied to discriminate the two kinds of firms, by combining an unlabeled dataset with the labels provided by a survey. The most important features for performing such binary classification are identified. Then, clustering is applied to highlight why supervised learning can be effective in the previous task, by showing that most of the largest clusters found are quite unequally populated by the two classes.

Clinical relevance of Der p23 in a multicenter Italian study

Key attributes of Embedded Charge Trap (eCTTM) Flash technology are presented. Automotive MCUs with 40nm eCT Flash are currently in volume production at UMC. The eCT technology features industry-leading cell size at the 40nm node, and scaling by more than 30% has been demonstrated at the 22nm node. eCT utilizes source-side injection (SSI) for programming and band-to-band (BTB) hot- hole injection for erasing to meet the high-speed requirements of automotive applications. Furthermore, random access time of 8 ns is achieved across the full range of operational temperature (-40 °C to 150 °C) and voltage (0.99 V to 1.21 V).

Mosquito bite is usually followed by a local reaction, but severe or systemic reaction may, in rare cases, occur. Allergic reactions to Aedes communis (Ac) may be underestimated due to the lack of reliable diagnostic tools. In this multicenter study, 205 individuals reporting large local reactions to Ac were enrolled and studied for cutaneous or IgE reactivity to Ac, Blattella germanica, Penaeus monodon, and Dermatophagoides pteronyssinus. Extract and molecular IgE reactivity to bees, wasps, hornets, and yellow jacket venoms were also studied in 119 patients with a clinical history of adverse reaction to Hymenoptera. Immunoblot (IB) analysis and immunoCAP IgE inhibition experiments were carried out in selected sera. Ac sensitization was recorded in 96 (46.8%) patients on SPT. Strict relationship between Ac and D. pteronyssinus, B. germanica, P. monodon, or Apis mellifera reactivity on SPT was observed. Ac IgE recognition was seen in 60/131 (45.8%) patients, 49 (81.6%) of them SPT positive, and 5/14 IB reactors. Ac IgE sensitization was associated with Tabanus spp, A. mellifera, Vespula vulgaris, and Polistes dominula reactivity. A strict relationship between Ac IgE reactivity and Api m 1, Api m 2, Api m 3, Api m 5, and Api m 10 was recorded. IgE reactivity to AC was inhibited in 9/15 cases after serum absorption with the A. mellifera extract. Both SPT and IgE Ac reactivity is observed in about half of patients with a history of large local reactions to mosquito bites. The significant relationship between Ac sensitization and either extract or single bee venom components is suggestive of a "bee-mosquito syndrome" occurrence.

Summary The nocebo reaction, namely the undesirable effect of an inert substance (placebo), is a phenomenon rarely investigated in literature. A better knowledge of this reaction may help clinicians in the management of these patients in clinical practice. Patients with drug adverse reactions (ADR) undergoing the drug challenge test are an ideal model for studying the nocebo effect, and the study aims to investigate their clinical and psychological features. One hundred and twenty patients (Mage = 46.59, SD = 15.5; 82% female), of which 90 non responders and 30 with nocebo reactions (25%) were recruited, and completed a battery of psychological measures: State-Trait Anxiety Inventory X1-X2, Beck Depression Inventory II, Symptoms Checklist-90-R, Difficulties in Emotion Regulation Scale, Toronto Alexithymia Scale. Clinical features (individual characteristics and ADR clinical history) were collected by clinicians. The results show that older age (p = 0.002), low level of education (p = 0.039) and a depressive tendency (p = 0.030) appear to be potential risk factors for nocebo effects. Although none of the features related to the previous clinical history appear to represent a risk factor for the nocebo reactions (p minor 0.05), significant correlations between some of the clinical and psychological characteristics considered (p values from 0.005 to 0.042) help to better delineate the profile of these reactive patients. A specific training of the sanitary team about psychological aspects is recommendable.

Background and objective Skin prick testing (SPT) with commercial extracts is the first step in the diagnosis of shrimp allergy, although its clinical efficiency is unknown. Objective: To analyze the clinical usefulness of all commercial crustacean extracts available for SPT in Italy. Methods We performed a multicenter study of 157 shrimp-allergic patients who underwent SPT with 5 commercial crustacean extracts and with house dust mite (HDM) extract. Commercial extracts were analyzed using SDS-PAGE and compared with a freshly prepared in-house shrimp extract. IgE to Pen a 1/Pen m 1, Pen m 2, and Pen m 4 was determined, and immunoblot analysis was performed on a large number of sera. Results The skin reactions caused by commercial crustacean extracts were extremely heterogeneous, resulting in 32 clinical profiles, with marked differences in protein content and missing proteins at molecular weights corresponding to those of major shrimp allergens. Only strong Pen a 1/Pen m 1 reactors reacted to both HDM and all 5 commercial extracts in SPT. Most patients, including those who were tropomyosin-negative, reacted to HDM. Patients reacted to a large and variable array of proteins, and IgE reactivity was common at high molecular weights (>50 kDa). Conclusions The in vivo diagnosis of shrimp allergy must continue to be based on SPT with fresh material. Shrimp-allergic patients frequently react to a number of ill-defined high-molecular-weight allergens, thus leaving currently available materials for component-resolved diagnosis largely insufficient. Mites and crustaceans probably share several allergens other than tropomyosin.

Part 8: Modular Design and Products; International audience; In business to business manufacturing, a major competitive advantage comes from the personalization of the product for the customer. In order to customize a product, companies go through a long process of customer interviews and specialized product development processes: this results in a time-consuming design phase and in a highly variable production process. In this paper, a method to improve the efficiency of product development and manufacturing, keeping a high degree of customization, is presented. A standardization effort is performed to identify a set of interchangeable components and to define a set of functional constraints. The consequences of such standardization are a dramatic reduction of the time expected to design and produce an item, as well as in lowered degree of variability of both the manufacturing process and the warehouses content. The presented methodology has been applied to a manufacturer of ink dispensing systems.

We link covering spaces with the theory of functions of bounded variation, in order to study minimal networks in the plane and Plateau’s problem without fixing a priori the topology of solutions. We solve the minimization problem in the class of (possibly vector-valued) $\mathrm{BV}$ functions defined on a covering space of the complement of an ${(n-2)}$-dimensional compact embedded Lipschitz manifold S without boundary. This approach has several similarities with Brakke’s “soap films” covering construction. The main novelty of our method stands in the presence of a suitable constraint on the fibers, which couples together the covering sheets. In the case of networks, the constraint is defined using a suitable subset of transpositions of m elements, m being the number of points of S. The model avoids all issues concerning the presence of the boundary S, which is automatically attained. The constraint is lifted in a natural way to Sobolev spaces, allowing also an approach based on Γ-convergence.

Background Up to 50% of patients with pollen allergy are sensitized to at least 1 of the 2 pollen pan-allergens profilin and polcalcin. These allergens could have clinical relevance but the content of profilin and polcalcin in commercial extracts for allergen immunotherapy (AIT) is unknown. Objective To detect these pan-allergens in commercial pollen extracts for AIT from various sources. Methods Immunoglobulin E (IgE) reactivity to Phl p 7 and Bet v 2 of sera from 18 adults hypersensitive to profilin and/or polcalcin was investigated by enzyme-linked immunosorbent assay before and after absorption with grass, birch, ragweed, pellitory, and olive pollen extracts for AIT from different producers. Immunoblot inhibition experiments also were carried out using the same allergens. Results Birch, grass, ragweed, and olive pollen extracts for AIT contained large amounts of profilin, inducing 80% to 90% inhibition in most cases; Parietaria AIT extract appeared to contain little profilin. On immunoblot, grass and birch pollen extracts for sublingual AIT completely absorbed IgE specific for rBet v 2. Interestingly, only grass pollen extracts induced a significant inhibition of IgE binding to rPhl p 7 on enzyme-linked immunosorbent assay and immunoblot. A grass pollen allergoid lost most of its inhibitory potency, suggesting a much weakened affinity for specific IgE. Conclusion With the exception of Parietaria , commercial extracts for AIT of most pollens are rich in profilin and, hence, potentially able to desensitize to this allergen; in contrast, only grass pollen extracts seem rich in polcalcin. These are the pollens to use in case of severe symptoms induced by pollen pan-allergens.

Background Most cases of beer allergy reported so far have been associated with hypersensitivity to the non-specific lipid transfer protein (LTP). In view of the marked differences in brewing processes we assessed IgE reactivity as well as tolerance to many different beers in an allergic patient. Methods A 45 year-old man hypersensitive to grass pollen, cat dander and Alternaria tenuis with a history of urticaria and dyspnoea after drinking beer and a weak skin reactivity to commercial corn extract was studied. The patient underwent SPT with 36 different brands of beer and an open challenge with those scoring negative was performed. An immunoblot analysis was carried out using 2 SPT-positive beers, 2 SPT-negative beers, and barley, wheat, and maize extracts using both patient's serum and a maize LTP-specific in-house developed polyclonal antibody from rabbit. Further, the immune reactive LTP of one beer was separated by HPLC and the chromatogram was compared to that of purified maize LTP. Results Beer SPT scored positive in 30/36 cases. The immunoblot analysis showed IgE reactivity at about 10 kDa against the two SPT-positive beers and against maize with both patient's serum and the polyclonal anti-LTP rabbit serum, whereas the two SPT-negative beers, and barley extract scored negative. The immunodetected protein co-migrated with maize LTP. Conclusion In beer-allergic patients the diagnostic workup may point to the detection of some tolerated products that can be consumed risk-free.

Background: Shrimp is a frequent cause of food allergy worldwide. Besides tropomyosin, several allergens have been described recently. Objective: We investigated which allergens are involved in Italian shrimp-allergic adults. Methods: Sera from 116 shrimp-allergic patients selected in 14 Italian allergy centers were studied. Skin prick tests with house dust mite (HDM) as well as measurements of IgE to Pen a 1 (shrimp tropomyosin) and whole shrimp extract were performed. All sera underwent shrimp immunoblot analysis, and inhibition experiments using HDM extract as inhibitor were carried out on some Pen a 1-negative sera. Results: Immunoblots showed much variability. IgE reactivity at about 30 kDa (tropomyosin) was found in 90 kDa was frequent. Further reactivities at 14–18, 25, 43–50, about 60 and about 80 kDa were detected. Most subjects had a history of shrimp-induced systemic symptoms irrespective of the relevant allergen protein. IgE to Pen a 1 were detected in sera from 46 (41%) patients. Skin reactivity to HDM was found in 43/61 (70%) Pen 1-negative subjects and inhibition studies showed that pre-adsorption of sera with HDM extract induced a marked weakening of the signal at >67 kDa. Conclusions: Several allergens other than tropomyosin are involved in shrimp allergy in adult Italian patients. Some hitherto not described high molecular weight allergens seem particularly relevant in this population and their cross-reactivity with HDM allergens makes them novel potential panallergens of invertebrates.

Previous studies suggest cross-reactivity between specific ragweed pollen and melon allergens. This study was designed to clarify the origin of the cross-reactivity between ragweed pollen and the gourd family. One thousand ragweed-allergic subjects were interviewed about the presence of oral allergy syndrome (OAS) induced by melon or watermelon and were divided into reactive to ≤3 seasonal allergen sources or3 seasonal allergen sources. Patients reporting melon and/or watermelon allergy underwent a skin-prick test (SPT) with fresh melon and, after 2006, also with profilin-enriched date palm pollen extract. Because no IgE reactivity to melon extract was detected in vitro, ELISA was performed using date palm pollen extract, and inhibition experiments were performed using grass pollen, date palm profilin, and bovine serum albumin (BSA) as inhibitors. Six hundred forty-six and 354 subjects reacted to ≤3 seasonal allergens or3 seasonal allergens, respectively; 4/646 (1%) and 81/354 (23%) reported a history of melon/watermelon-induced OAS (p0.0001). Forty-three of 46 (93%) melon reactors scored positive on SPT with the profilin-enriched extract, which was positive in 0/2 (0%) versus 43/44 (98%) reactive to ≤3 or3 seasonal allergen sources, respectively (p0.0001). in vitro, serum from melon-allergic subjects showed a strong IgE reactivity to the profilin-enriched date palm pollen extract, which was abolished by preabsorption with both grass pollen extract and date palm pollen extract, but not by BSA. In ragweed pollen-allergic subjects, melon allergy is most likely associated with cross-sensitization to the plant pan-allergen profilin and not to specific ragweed pollen allergens. This study confirms the association between profilin sensitization and melon allergy.

To cite this article: Heffler E, Nebiolo F, Asero R, Guida G, Badiu I, Pizzimenti S, Marchese C, Amato S, Mistrello G, Canaletti F, Rolla G. Clinical manifestations, co-sensitizations, and immunoblotting profiles of buckwheat-allergic patients. Allergy 2011; 66: 264–270. Abstract Background: Buckwheat allergy is a rare food allergy in Europe and North America, whereas it is often described and studied in Asia. The aim of this study was to describe a series of patients with proven buckwheat allergy evaluated in an Italian allergy clinic. Co-sensitization to other food and inhalant allergens and immunoblotting profiles of buckwheat-allergic patients were studied. Methods: Patients with suspected buckwheat allergy who attended the allergy clinic between January 1, 2006, and September 30, 2008, were evaluated. All patients underwent skin prick tests for a standard panel of inhalant and food allergens, prick-by-prick with buckwheat flour, buckwheat-specific IgE determinations, and double-blind placebo-controlled food challenge (DBPCFC) with buckwheat flour. Immunoblotting with buckwheat flour extract was performed on sera from buckwheat-allergic patients. Results: Among 72 patients with suspected buckwheat allergy, 30 (41.7%) were sensitized to buckwheat and 24 had a positive DBPCFC. The mean buckwheat IgE level was 6.23 kUA/l (range, 0.16 to >100 kUA/l). Several IgE-binding proteins were identified and grouped into three patterns: a 16-kDa band in patients with predominantly gastrointestinal symptoms with grass and wheat flour co-sensitization, a 25-kDa band in patients with predominantly cutaneous symptoms and a low frequency of co-sensitization, and a 40-kDa band in patients with anaphylaxis and a low frequency of co-sensitization. Conclusions: Buckwheat allergy is an emerging food allergy in Italy. We identified three distinct patterns of clinical and laboratory characteristics, suggesting that specific allergens could be more frequently associated with clinical manifestations of different severity.

Background: Due to unclear reasons, allergy to lipid transfer protein (LTP) is frequent in Mediterranean countries but rare in Northern Europe. Objective: We report a paradigmatic case of primarily airborne sensitization to LTP that might explain the geographical distribution of this type of food allergy. Methods: A 21-year-old woman began having severe perennial rhinitis 6 months after she started working in a wholesale fruit storehouse in Southern Italy where large amounts of fruits, including peaches, were handled; symptoms subsided when she left the workplace for >5 days and relapsed as soon as she was back at work. Later on, she developed severe food allergies to peach, hazelnut, peanut, apricot, plum and tomato. The patient underwent a nasal challenge with peach peel extract, and IgE reactivity was assessed by immunoblot analysis. Results: In vivo and in vitro analyses showed sensitivity to LTP. The nasal challenge with peach peel extract (6 µg protein) induced acute, severe respiratory symptoms. On immunoblot with peach peel extract patient’s serum reacted uniquely against LTP, as demonstrated by inhibition assays with the recombinant peach protein. Conclusion: LTP may induce sensitization via the respiratory tract due to inhalation of air-dispersed food particles, and this may precede the onset of food allergy. If this way of sensitization were effective in the majority of LTP allergic patients (e.g. by exposure to peaches showing intact fuzz in areas where peaches are grown and directly sold on the market) our findings could explain the strange geographical distribution of this type of food allergy.