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Background: Allergen immunotherapy remains a widely recognized and widely used method for the treatment of selected allergic diseases. Currently, according to the European Academy Of Allergy and Clinical Immunology (EAACI) guidelines, venom immunotherapy (VIT) may be considered for patients over 60. Nevertheless, no separate studies have confirmed the efficacy and safety of this therapy. This study aimed to evaluate the short-term effectiveness of VIT against wasp allergens in an ultra-rush protocol for older patients compared to young patients. Methods: Among the 113 patients included in this study, 51 were older than 60 years (Group A), and 62 formed the control "young group" (age range: 18–35 years). All patients were desensitized to wasp venom using the ultra-rush protocol according to Muller and aqueous solutions of vaccines containing wasp venom. A basophil activation test (Basotest, Orpegen Pharma, Germany) and intracutaneous tests with dilutions of wasp allergen and specific IgE to extract wasp venom were performed at the start and after six months of VIT. The safety of VIT was assessed on the basis of the international Mueller scale. Results: One hundred and eleven patients with confirmed wasp allergies completed six months of VIT: 51 participants over 60 years of age (Group A) and 60 young people (Group B). No systemic adverse reactions were observed during the VIT induction phase. However, large local reactions were noted in 17% of older patients and 20% of young patients at a similar level (p > 0.05). During maintenance VIT, two mild grade I systemic reactions were confirmed in young patients. These symptoms resolved spontaneously. There were no such reactions in older patients. The effectiveness of VIT was tested using BAT. There was a statistically significant reduction in CD63 reactivity in 86% of patients in Group A, and a comparable and substantial decrease in 84% of young patients in Group B. According to the BAT test, the mean reductions in the area under the curve (AUC) after six months of VIT were significant (p < 0.05) and comparable between Groups A and B: −6.52 vs. 7.21. Conclusions: VIT against wasp venom is safe and effective in short-term observation, and is comparable to that used for young patients. [ABSTRACT FROM AUTHOR]

Background: Allergen immunotherapy remains a widely recognized and widely used method for the treatment of selected allergic diseases. Currently, according to the European Academy Of Allergy and Clinical Immunology (EAACI) guidelines, venom immunotherapy (VIT) may be considered for patients over 60. Nevertheless, no separate studies have confirmed the efficacy and safety of this therapy. This study aimed to evaluate the short-term effectiveness of VIT against wasp allergens in an ultra-rush protocol for older patients compared to young patients. Methods: Among the 113 patients included in this study, 51 were older than 60 years (Group A), and 62 formed the control “young group” (age range: 18–35 years). All patients were desensitized to wasp venom using the ultra-rush protocol according to Muller and aqueous solutions of vaccines containing wasp venom. A basophil activation test (Basotest, Orpegen Pharma, Germany) and intracutaneous tests with dilutions of wasp allergen and specific IgE to extract wasp venom were performed at the start and after six months of VIT. The safety of VIT was assessed on the basis of the international Mueller scale. Results: One hundred and eleven patients with confirmed wasp allergies completed six months of VIT: 51 participants over 60 years of age (Group A) and 60 young people (Group B). No systemic adverse reactions were observed during the VIT induction phase. However, large local reactions were noted in 17% of older patients and 20% of young patients at a similar level (p > 0.05). During maintenance VIT, two mild grade I systemic reactions were confirmed in young patients. These symptoms resolved spontaneously. There were no such reactions in older patients. The effectiveness of VIT was tested using BAT. There was a statistically significant reduction in CD63 reactivity in 86% of patients in Group A, and a comparable and substantial decrease in 84% of young patients in Group B. According to the BAT test, the mean reductions in the area under the curve (AUC) after six months of VIT were significant (p < 0.05) and comparable between Groups A and B: −6.52 vs. 7.21. Conclusions: VIT against wasp venom is safe and effective in short-term observation, and is comparable to that used for young patients.

Background: Anaphylaxis is a potentially fatal severe systemic hypersensitivity reaction that causes symptoms in multiple organs such as the skin, respiratory tract, and gastrointestinal tract; however, no nationwide epidemiological survey on anaphylaxis has been conducted in Japan. This survey aimed to elucidate the triggers and treatment of anaphylaxis in Japan. Methods: Between February 2015 and October 2017, we prospectively collected clinical data on the triggers and treatment of patients who developed anaphylaxis or were admitted to the emergency room with anaphylaxis in the training and teaching facilities of the Japanese Society of Allergology. Results: This study included 79 of the 451 affiliated facilities (18%), and a total of 767 patients were enrolled; 73% of them were aged

Anaphylaxis is a potentially fatal severe systemic hypersensitivity reaction that causes symptoms in multiple organs such as the skin, respiratory tract, and gastrointestinal tract; however, no nationwide epidemiological survey on anaphylaxis has been conducted in Japan. This survey aimed to elucidate the triggers and treatment of anaphylaxis in Japan. Between February 2015 and October 2017, we prospectively collected clinical data on the triggers and treatment of patients who developed anaphylaxis or were admitted to the emergency room with anaphylaxis in the training and teaching facilities of the Japanese Society of Allergology. This study included 79 of the 451 affiliated facilities (18%), and a total of 767 patients were enrolled; 73% of them were aged <18 years and 7% had in-hospital triggers. The most common triggers were food (68%), drugs (12%), food-dependent exercise-induced anaphylaxis (5%), insects (4%), and oral immunotherapy (3%), with drugs being the most common in-hospital trigger and food being the most common out-of-hospital trigger. Intramuscular injection of adrenaline was administered therapeutically to 38% of the patients, with 10% requiring multiple doses. Adrenaline auto-injectors were used in 12% of out-of-hospital patients. The present survey revealed the most common triggers and treatments for anaphylaxis in Japan. Self-management and adrenaline administration as first-line treatment may not be done sufficiently. Therefore, it is necessary to thoroughly educate and train patients and physicians about anaphylaxis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Allergic reactions to mosquito bites are an increasing clinical concern. Due to the lack of availability of mosquito salivary allergens, they are underdiagnosed. Here, we reported a newly cloned mosquito Aedes (Ae.) aegypti salivary allergen. METHODS: A cDNA encoding a 30-kDa Ae. aegypti salivary protein, designated Aed a 3, was isolated from an expression library. The full-length cDNA was cloned into a baculovirus expression vector, and recombinant Aed a 3 (rAed a 3) was expressed, purified, and characterized. Skin prick tests with purified rAed a 3 and Ae. aegypti bite tests were performed in 43 volunteers. Serum rAed a 3-specific IgE levels were measured in 28 volunteers. RESULTS: The primary nucleotide sequence, deduced amino acid sequence, and IgE-binding sites of Aed a 3 were identified. rAed a 3-selected antibodies recognized a 30-kDa Ae. aegypti saliva protein. rAed a 3 bound IgE in mosquito-allergic volunteers and the binding could be inhibited by the addition of natural mosquito extract dose dependently. Immediate skin test reactions to rAed a 3 correlated significantly with mosquito bite-induced reactions. Of the bite test-positive volunteers, 32% had a positive rAed a 3 skin test and 46% had specific IgE. No bite test-negative volunteers reacted to rAed a 3 in either the skin tests or the IgE assays, confirming the specificity of the assay. CONCLUSIONS: Aed a 3 that corresponds to the Aegyptin protein is a major mosquito salivary allergen. Its recombinant form has biological activity and is suitable for use in skin tests and specific IgE assays in mosquito-allergic individuals.

Insect stings can cause large local reactions (LLRs) that are IgE-mediated and associated with considerable morbidity. A risk for systemic reactions including anaphylaxis to subsequent stings has been reported and is often noted by patients and health care providers. Guidelines do not recommend venom immunotherapy (VIT) for LLRs based on the relatively low risk of anaphylaxis, but this is debated in this review. On the pro side: the risk of anaphylaxis may be higher than reported in the limited literature, especially in patients who had only 1 LLR; new species with more potent stings are spreading into new areas; the quality of life can be markedly impaired by LLRs; and VIT is generally safe and highly effective. On the con side: LLRs are benign, stings occur infrequently, VIT has significant cost, systemic reactions occur more often to VIT than to stings in patients with LLRs, and Food and Drug Administration approval and published guidelines do not recommend VIT for LLRs. In practice, shared decision-making is appropriate to incorporate knowledge of the natural history and known high-risk factors in the context of the patient's personal values and preferences., (Copyright © 2024 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Evaluation and management of insect sting allergy are often not straightforward when there is uncertainty about the history of reaction, the significance of test results, and the risk of severe reaction to future stings. Patients encounter misinformation about the chance of reaction and may have strong beliefs about the need for treatment. Shared decision-making encourages the clinician to listen to the patients' concerns and beliefs, share relevant information and evidence, and partner with patients to incorporate their values and preferences. This review discusses some major decision points in diagnosis and treatment of insect-allergic patients, with attention to the potential burdens or harms that are important to patients and factors that relate to patients' values and preferences concerning the choices they must make. This is especially true in patients with no history of moderate to severe sting anaphylaxis in whom the risk may be overestimated, but it can also be important in patients who underestimate the risk associated with severe sting anaphylaxis. Clinicians should become more knowledgeable about patient-important beliefs and outcomes and engage in shared decision-making to help patients understand and be comfortable with the choices they must make., (Copyright © 2024 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

The fifth class of immunoglobulin, immunoglobulin E (IgE) was discovered in 1967 and has had immense importance for the understanding, diagnosis, and treatment of allergic disease. More than 50 years have passed and efforts to characterize, standardize, and refine allergens with the aim to improve clinical diagnosis and allergen-specific immunotherapy are still ongoing. Another important breakthrough was made in 1999 with the introduction of component-resolved diagnostics (CRD), making it possible to quantify IgE antibodies against individual allergen proteins for diagnostic purposes at a molecular level. The progress and developments made in allergy diagnosis often originate from clinical observations and case studies. Observant physicians and health-care personnel have reported their findings in the medical literature, which in turn has inspired researchers to become involved in clinical research. Allergists continuously encounter new allergies and are often asked by their patients how to prevent new reactions. In the current article, we focus on recent clinical observations that can now be explained by CRD. The examples taken concern allergic reactions toward peanuts, tree nuts, lemon kernels, health drinks, meat, insects, dog dander, cannabis, and semen. We now have an improved understanding of why patients may react in a serious or unexpected way, as illustrated by these examples, yet many other clinical observations remain unexplained. The aim of this review is to highlight the importance of clinical observations among allergic patients, focusing on systemic, or unusual and unexpected allergic reactions, where component-testing has further refined the diagnosis of IgE-mediated allergy. [ABSTRACT FROM AUTHOR]

Abstract Background The aetiology of anaphylaxis differs according to types of foods consumed, fauna and foliage and cultural practices. Although the aetiology of anaphylaxis in Western countries are well known, the causes in South Asian countries have not been reported. We sought to determine the causes of anaphylaxis in patients referred to an immunology clinic in Colombo, Sri Lanka. Methods 238 episodes of anaphylaxis were reviewed in 188 patients who were referred and skin prick tests and in vitro tests (ImmunoCap) were carried out to assess the presence of allergen specific IgE. Clinical features and severity of anaphylaxis was also recorded along with treatment received. Results Anaphylaxis to food either following direct exposure 90/238 (37.5%) or after exercise in the form of food dependent exercise induced anaphylaxis 29/238 (12.2%) was the predominant cause of anaphylaxis. Allergy to cow’s milk and red meat, after immediate exposure, accounted for 66/238 (27.7%) of instances of all episodes of anaphylaxis and 66/90 (73.33%) of anaphylaxis due to food. Vaccines accounted for 28/238 (11.8%) of instances of anaphylaxis, especially among children. Of those who developed anaphylaxis to the MMR (n = 14), 71.4% of them had specific IgE to cow’s milk and 35.7% of them had specific IgE to beef. Of those who developed anaphylaxis to insect stings, 27/42 of these episodes occurred following stings of ants (family Formicidae). The predominant cause of anaphylaxis changed with the age, with food allergy being the most frequent trigger of anaphylaxis in childhood, while drug allergy and idiopathic anaphylaxis being more frequent after 30 years of age. Conclusions In this cohort, anaphylaxis to red meat appears to be the predominant cause of food induced anaphylaxis and presence of beef specific IgE and cow’s milk, appears to be a predisposing factor for vaccine induced anaphylaxis.

Background: Papular urticaria (PU) is a common insect bite skin hypersensitivity in tropical countries. In order to gain insight into its causal allergens, we aimed to evaluate cellular and humoral immune responses to the recombinant salivary antigen Cte f 2 from the cat flea Ctenocephalides felis. Method: Sixty patients with PU and 27 healthy controls were included in this study. Specific IgE, IgG, IgG1, and IgG4 against Cte f 2 and C. felis extract were determined by ELISA. The T-cell response was analyzed using a carboxyfluorescein succinimidyl ester (CFSE)-based dilution assay and Th1/Th2/Th17 cytokine measurements. In addition, a proteomic analysis of IgG and IgE reactive spots of C. felis extract was performed. Results: The frequency of IgE sensitization to Cte f 2 was similar between patients (36.7%) and controls (40.7%). The specific IgE, IgG1, and IgG4 responses to Cte f 2 and C. felis extract were not significantly different between patients and controls. Among the 3 conditions (i.e., Cte f 2, C. felis extract, and only medium) Cte f 2 was the strongest inducer of CD3+CD4+ proliferation in the patients; however, the mean response was not significantly different from those in controls (Cte f 2: 4.5 vs. 2.5%; p = 0.46). No salivary proteins were identified in C. felis, and most of the spots were identified as muscle-skeletal components (tropomyosin, actin, myosin, and ankirin). Conclusions: Cte f 2 induces IgE and IgG production as well as T-cell proliferation in children living in a geographical area where PU induced by a flea bite is common. The use of C. felis extract is not recommended for the study of bite-induced hypersensitivity disease since salivary antigens are not well represented. [ABSTRACT FROM AUTHOR]

Summary: Background: The prevalence and predisposing factors of asymptomatic sensitization to Hymenoptera venom marker allergens are largely unknown. Objective: To evaluate sensitization profiles in a group of 490 dermatologic patients without a history of sting‐induced anaphylaxis. Methods: Clinical data were collected using a structured questionnaire; sera were tested for total IgE and specific IgE to venom preparations, recombinant venom marker allergens, inhalative allergens, and cross‐reactive carbohydrate determinants. Results: The lifetime prevalence of Hymenoptera stings was 85.3%. IgE rates exceeding cut‐off values of 0.35 kUA/L were 17.3% for rVes v 1, 18.0% for rVes v 5, and 3.5% for rApi m 1. Median specific/total IgE ratios for the above mentioned marker allergens were 0.05%, 0.02%, and 0.00%, respectively. Marker allergen‐directed sensitization was detectable in 85.5% of 138 Vespula venom‐reactive sera. Of 68 bee venom‐reactive participants, 23.5% were sensitized to rApi m 1 and 64.7% to any one or several of five commercially available bee venom allergens. Although double reactivity to bee and Vespula venom was clearly associated with sensitization to cross‐reactive carbohydrate determinants (P < 0.001), sensitization to marker allergens of both species was detectable in most double‐reactive sera (56.5%). Vespula venom marker allergen‐directed sensitization was associated with recent stings (P = 0.010), large local reactions (P = 0.009), total IgE elevation (P < 0.001), and sensitization to cross‐reactive carbohydrate determinants (P = 0.008). Conclusions and Clinical Relevance: The high sensitization rates observed in individuals without a history of sting‐induced anaphylaxis as well as total IgE levels and cross‐reactive carbohydrate determinant‐directed reactivity as potential confounders need to be considered in any interpretation of positive test results for Hymenoptera venom marker allergens. [ABSTRACT FROM AUTHOR]

Résumé Les points forts de cette revue sont les suivants : les manifestations cliniques de l’anaphylaxie diffèrent chez les grands enfants (souvent cardiovasculaires) et les plus jeunes (gastro-intestinales et respiratoires), chez lesquels elles doivent faire suspecter une réaction anaphylactique lorsqu’elles surviennent brutalement ; des premiers cas d’anaphylaxie à certains aliments exotiques (crocodile, natto, etc.) ont été publiés et ont probablement un « bel avenir » ; la tendance à faire effectuer des tests de provocation prolongés d’emblée, avant tout testing cutané et biologique, se confirme chez les enfants rapportant des réactions non immédiates peu préoccupantes aux bêtalactamines ; les réactions d’hypersensibilité allergique aux anti-inflammatoires non stéroïdiens seraient plus fréquentes chez l’enfant que chez l’adulte, chez qui prédominent les réactions d’hypersensibilité non allergique ; les réactions locales aux vaccins sont fréquentes et récidivent fréquemment tandis que les réactions généralisées post-vaccinales, plus préoccupantes, sont rares et récidivent rarement, exception faite des réactions anaphylactiques immédiates ; les hémaglutinines des vaccins grippaux et les anatoxines des vaccins pneumococciques conjugués peuvent induire des réactions anaphylactiques ; la mastocytose pourrait représenter un facteur de risque d’anaphylaxie vaccinale ; de même que « l’allergie » aux moustiques, l’allergie aux hyménoptères tend à guérir chez les enfants rapportant des réactions systémiques bénignes à modérées ; chez les enfants rapportant des réactions graves aux piqûres d’hyménoptères, la désensibilisation est vraiment efficace, mais son efficacité tend à diminuer avec le temps et ainsi exposer les patients à des réactions anaphylactiques lors de repiqûres accidentelles. Most interesting findings are as follows: clinical symptoms of anaphylaxis are not similar in older children (cardiovascular) and younger ones (gastro-intestinal and respiratory) in whom sudden occurrence of such symptoms should evoke anaphylaxis; first cases of anaphylaxis to exotic foods (crocodile, natto, etc.) have been published and will probably increase during near future; prolonged provocation tests should precede skin and in vitro tests in children reporting non-immediate and non-severe reactions to beta-lactams; allergic hypersensitivity to non-steroidal anti-inflammatory drugs is probably more frequent in children than in adults, in whom most reactions are non-allergic; local reactions to vaccines are relatively frequent and reccur frequently, but are benign-moderately severe. In contrast, generalized reactions are rare and relapses are infrequent, except for immediate anaphylactic reactions; hemagglutinins of influenza viruses (influenza vaccines) and toxoids in conjugated vaccines (pneumococcal) may induce anaphylactic reactions; mast cell diseases may be a risk of vaccine-induced anaphylaxis; as well as mosquito « allergy », hymenoptera venom allergy resolve spontaneously in children reporting mild to moderately severe generalized reactions to hymenoptera stings; in children reporting severe reactions to hymenoptera stings, specific immunotherapy is efficient, but efficiency decreases with age and patients may have anaphylaxis when restung several years after the end of immunotherapy. [ABSTRACT FROM AUTHOR]

Insects represent an alternative for meat and fish in satisfying the increasing demand for sustainable sources of nutrition. Approximately two billion people globally consume insects. They are particularly popular in Asia, Latin America, and Africa. Most research on insect allergy has focussed on occupational or inhalation allergy. Research on insect food safety, including allergenicity, is therefore of great importance. The objective of this review is to provide an overview of cases reporting allergy following insect ingestion, studies on food allergy to insects, proteins involved in insect allergy including cross-reactive proteins, and the possibility to alter the allergenic potential of insects by food processing and digestion. Food allergy to insects has been described for silkworm, mealworm, caterpillars, Bruchus lentis , sago worm, locust, grasshopper, cicada, bee, Clanis bilineata , and the food additive carmine, which is derived from female Dactylopius coccus insects. For cockroaches, which are also edible insects, only studies on inhalation allergy have been described. Various insect allergens have been identified including tropomyosin and arginine kinase, which are both pan-allergens known for their cross-reactivity with homologous proteins in crustaceans and house dust mite. Cross-reactivity and/or co-sensitization of insect tropomyosin and arginine kinase has been demonstrated in house dust mite and seafood (e.g. prawn, shrimp) allergic patients. In addition, many other (allergenic) species (various non-edible insects, arachnids, mites, seafoods, mammals, nematoda, trematoda, plants, and fungi) have been identified with sequence alignment analysis to show potential cross-reactivity with allergens of edible insects. It was also shown that thermal processing and digestion did not eliminate insect protein allergenicity. Although purified natural allergens are scarce and yields are low, recombinant allergens from cockroach, silkworm, and Indian mealmoth are readily available, giving opportunities for future research on diagnostic allergy tests and vaccine candidates. [ABSTRACT FROM AUTHOR]

Background Saliva and muscle-derived mosquito allergens have been purified and characterized. However, the complete set of allergens remains to be elucidated. In this study, we identified and characterized IgE-binding proteins from the mosquito species Aedes aegypti. Methods Serum was obtained from 15 allergic individuals with asthma and/or rhinitis and sensitized to mosquito. IgE binding was determined by ELISA. Total proteins from freeze-dried bodies of A. aegypti were extracted and IgE-reactive proteins were identified by 2D gel electrophoresis, followed by Western blot with pooled or individual sera. IgE-reactive spots were further characterized by mass spectrometry. Results Twenty-five IgE-reactive spots were identified, corresponding to 10 different proteins, some of which appeared as different variants or isoforms. Heat-shock cognate 70 ( HSC-70) and tropomyosin showed IgE reactivity with 60% of the sera, lysosomal aspartic protease, and ' AAEL006070- PA' (Uniprot: Q177P3) with 40% and the other proteins with <33.3% of the sera. Different variants or isoforms of tropomyosin, arginine or creatine kinase, glyceraldehyde-3-phosphate dehydrogenase ( GPDH), calcium-binding protein, and phosphoglycerate mutase were also identified. The mixture of three allergens (Aed a 6, Aed a 8, and Aed a 10) seems to identify more than 80% of A. aegypti-sensitized individuals, indicating that these allergens should be considered when designing of improved mosquito allergy diagnostic tools. Conclusions The newly identified allergens may play a role in the pathophysiology of mosquito allergy in the tropics, and some of them might be important arthropod-related proteins involved in cross-reactivity between A. aegypti and other allergenic arthropods. [ABSTRACT FROM AUTHOR]

Résumé En 2015, la majorité des études confirment, tout en les complétant et précisant, les résultats d’études publiées antérieurement. Toutefois, certains articles ont semblé particulièrement intéressants. C’est ainsi que : (1) même si l’on ignore encore la signification du phénomène, les IgE maternelles traversent le placenta sous forme de complexes immuns IgE-IgG anti-IgE interagissant avec les récepteurs placentaires des IgG ; (2) les écoles devraient disposer de stylos d’adrénaline auto-injectables non nominatifs, autorisant des injections à n’importe quel enfant ou adulte présentant une réaction anaphylactique, notamment inaugurale ; (3) outre l’adrénaline, les corticoïdes diminuent la gravité et le risque de prolongation ou de récidive des réactions anaphylactiques ; (4) le diagnostic d’allergie alimentaire ou de tolérance naturelle ou acquise suite à une éviction ou une désensibilisation pourrait être amélioré par l’établissement du rapport entre les IgE sériques spécifiques et les IgE totales, plus que par le simple dosage des IgE spécifiques et la surveillance de leur évolution ; (5) les tests de provocation orale alimentaires donnent moins de réactions graves lorsque les doses progressivement croissantes d’aliments sont administrées toutes les 30 min que lorsqu’elles sont administrées plus rapidement ; (6) le diagnostic des réactions non immédiates et/ou non préoccupantes aux médicaments repose avant tout sur les tests de provocation/réintroduction, éventuellement prolongés au domicile des enfants, et non sur les tests cutanés et/ou les examens biologiques ; (7) enfin, il faut absolument penser aux additifs et contaminants chez les enfants réagissant à de nombreux aliments et/ou médicaments et substances biologiques. Most studies published in 2015 confirm, but also complete and precise, results of previous studies. However, some interesting news arise from recent publications: (1) although the signification of the phenomenon remains unknown, maternal IgE are transferred transplacentally as IgE-IgG anti-IgE immune complexes interacting with the placental IgG receptor; (2) schools should be allowed to use non nominative self-injectable epinephrine pens to treat anaphylactic reactions occurring in any child or staff patient; (3) corticosteroids administered rapidly after epinephrine significantly reduce the severity and risk of duration/relapse of anaphylactic reactions; (4) diagnosis of food allergy and of food tolerance (natural, acquired based on eviction or specific sublingual/oral immunotherapy) may be improved by establishment of serum specific/total IgE concentrations, rather than on (repeated) dosages of specific IgE; (5) oral food challenges induce less severe reactions when increasing doses are administered at 30 min intervals than when they are administered more rapidly; (6) diagnosis of non-immediate and/or non-severe reactions to drugs is based on challenge tests with the suspected drugs (betalactams especially), including prolonged challenge tests performed at home, and not on skin and/or biological tests; (7) finally, one may perform skin and/or oral challenge tests with additives and contaminants in children reporting allergic-like reactions to numerous foods and/or drugs or biological substances. [ABSTRACT FROM AUTHOR]

In contrast with Drosophila melanogaster , practically nothing is known about the involvement of the TGF-β signaling pathway in the metamorphosis of hemimetabolan insects. To partially fill this gap, we have studied the role of Smad factors in the metamorphosis of the German cockroach, Blattella germanica . In D. melanogaster , Mad is the canonical R-Smad of the BMP branch of the TGF-β signaling pathway, Smox is the canonical R-Smad of the TGF-β/Activin branch and Medea participates in both branches. In insects, metamorphosis is regulated by the MEKRE93 pathway, which starts with juvenile hormone (JH), whose signal is transduced by Methoprene-tolerant (Met), which stimulates the expression of Krüppel homolog 1 (Kr-h1) that acts to repress E93, the metamorphosis trigger. In B. germanica , metamorphosis is determined at the beginning of the sixth (final) nymphal instar (N6), when JH production ceases, the expression of Kr-h1 declines, and the transcription of E93 begins to increase. The RNAi of Mad, Smox and Medea in N6 of B. germanica reveals that the BMP branch of the TGF-β signaling pathway regulates adult ecdysis and wing extension, mainly through regulating the expression of bursicon, whereas the TGF-β/Activin branch contributes to increasing E93 and decreasing Kr-h1 at the beginning of N6, crucial for triggering adult morphogenesis, as well as to regulating the imaginal molt timing. [ABSTRACT FROM AUTHOR]

Background Venom immunotherapy is efficient to desensitize people suffering from insect sting allergies. However, the numerous injections required over several years and important risks of severe side reactions complicate the widespread use of immunotherapy. In the search for novel approaches to blunt the overwhelming pro-allergic Th2 response, we evaluated the therapeutic efficacy of a treatment based on a denatured form of the major allergen, phospholipase A2, associated with microbubbles ( PLA2denat- MB) in a mouse model of honeybee venom allergy. Methods Antibodies measured by ELISA, T-cell responses assessed by CFSE-based proliferation assays and ELISA, and basophil degranulation were examined after PLA2denat- MB-based therapeutic treatment of sensitized mice. Mice were challenged with a lethal dose of PLA2 to evaluate protection against anaphylaxis. Results Therapeutic subcutaneous administration of two different PLA2denat- MB formulations, in contrast to PLA2denat alone, reduced allergic symptoms and protected all mice from anaphylaxis-mediated death after allergen challenge. At the functional level, the use of PLA2denat decreased IgE-mediated basophil degranulation as compared to the native form of the allergen. In comparison with PLA2denat alone, both PLA2denat- MB formulations decreased allergen-specific Th2 CD4 T-cell reactivity. At the mechanistic level, PLA2denat- MB containing 20% palmitic acid and PEG induced PLA2-specific IgA and increased Foxp3+ Treg frequencies and TGF-β production, whereas the formulation bearing 80% palmitic acid triggered the production of IFN-γ, IgG2a, and IgG3. Conclusions In contrast to conventional PLA2 subcutaneous immunotherapy, the therapeutic administration of PLA2- MB treatment to mice that already had established allergy to PLA2 protects all subsequently challenged animals. [ABSTRACT FROM AUTHOR]

Interactions between insects and fungi are widespread, and important mediators of these interactions are fungal chemicals that can therefore be considered as allelochemicals. Numerous studies suggest that fungal chemicals can affect insects in many different ways. Here, we apply the terminology established by insect-plant ecologists for categorizing the effect of fungal allelochemicals on insects and for evaluating the application potential of these chemicals in insect pest management. Our literature survey shows that fungal volatile and non-volatile chemicals have an enormous potential to influence insect behavior and fitness. Many of them still remain to be discovered, but some recent examples of repellents and toxins could open up new ways for developing safe insect control strategies. However, we also identified shortcomings in our understanding of the chemical ecology of insect-fungus interactions and the way they have been investigated. In particular, the mode-of-action of fungal allelochemicals has often not been appropriately designated or examined, and the way in which induction by insects affects fungal chemical diversity is poorly understood. This review should raise awareness that in-depth ecological studies of insect-fungus interactions can reveal novel allelochemicals of particular benefit for the development of innovative insect pest management strategies. [ABSTRACT FROM AUTHOR]

The prevalence of insect allergy and specific features of hypersensitivity to stinging insects are considered. The importance of pathogenetic treatment for this type of allergies is shown, as well as its solution via the creation of a new domestic drug, a bee venom allergoid, and its adoption into practical allergology. [ABSTRACT FROM AUTHOR]

Background Forcipomyia taiwana (biting midge) is the most prevalent allergenic biting insect in Taiwan, and 60% of the exposed subjects develop allergic reactions. Subjects with insect allergy frequently limit their outdoor activities to avoid the annoyingly intense itchy allergic reactions, leading to significant worsening of their quality of life. Allergen-specific immunotherapy is the only known therapy that provides long-term host immune tolerance to the allergen, but is time-consuming and cumbersome. This study tested whether the For t 2 DNA vaccine can prevent allergic symptoms in For t 2-sensitized mice. Materials and Methods Two consecutive shots of For t 2 DNA vaccine were given to mice with a 7-day interval before sensitization with recombinant For t 2 proteins, using the two-step sensitization protocol reported previously. Results The For t 2 DNA vaccine at 50 μg prevented the production of For t 2-specific IgE ( P < 0.05), as well as midge allergen-challenge-induced scratch bouts, midge allergen-induced IL-13 and IL-4 production from splenocytes, and inflammatory cell infiltrations in the lesions 48 h after intradermal challenge. Conclusions This study is the first to demonstrate that DNA vaccine encoding midge allergen is effective in preventing allergic skin inflammation induced by biting midge. Immunotherapy using For t 2 DNA vaccine can protect mice from being sensitized by midge allergen and may be a promising treatment for biting midge allergy in the future. [ABSTRACT FROM AUTHOR]

Edible insects are currently being evaluated as an alternative and more sustainable protein source for humans. The introduction of new food sources can lead to development of novel allergies. Because in the Western world, insects are unlikely to be consumed raw, it is important to know how processing and in vitro digestion might influence their allergenicity. Three edible mealworm species ( Tenebrio molitor , Zophobas atratus and Alphitobius diaperinus ) subjected to processing and in vitro digestion were analysed for IgE cross-reactivity. Immunoblot and MALDI-MS/MS analyses revealed that IgE from crustaceans or House dust mite (HDM) allergic patients showed cross-reactivity to mealworm tropomyosin or α-amylase, hexamerin 1B precursor and muscle myosin, respectively. Heat processing as well as in vitro digestion did diminish, but not eliminate, HDM or tropomyosin IgE cross-reactivity. Results show that individuals allergic to HDM or crustaceans might be at risk when consuming mealworms, even after heat processing. [ABSTRACT FROM AUTHOR]

Background: The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing the EAACI Guidelines for Allergen Immunotherapy (AIT) for the Management of Insect Venom Allergy. We seek to critically assess the effectiveness, cost-effectiveness and safety of AIT in the management of insect venom allergy. Methods: We will undertake a systematic review, which will involve searching international biomedical databases for published, in progress and unpublished evidence. Studies will be independently screened against pre-defined eligibility criteria and critically appraised using established instruments. Data will be descriptively and, if possible and appropriate, quantitatively synthesised. Discussion: The findings from this review will be used to inform the development of recomendations for EAACI's Guidelines on AIT. [ABSTRACT FROM AUTHOR]

The main insects causing allergy reactions to stinging insect in humans are Apidae (bees), Vespidae (wasps, yellow jackets and hornets) and Formicidae (ants). Their venom stings are composed of various biologically active peptides and protein components, some of which can cause toxicity or anaphylaxis in humans. The protein venom demonstrate some common allergenic activity such as for fire ants and vespids, which have two common allergens that are phospholipase A 1 (enzymatic activity) and antigen 5 with unknown biological activity. The common allergens seem to share some degree of immunological cross-reactivity, particularly when the sequence homology is above 70%. Therefore immunotherapeutic approaches targeting more than one specific species are of interest. Recent widespread increases of various ant species in many countries have resulted in higher number of reported about serious allergic reactions to stings. Most insect-allergy related cases have been reported for species from Solenopsis , Myrmecia and Pachycondyla genera, and their stings can often result in human fatalities. In addition, stinging ants can have serious health effects on livestock, agricultural damage adversely affecting the biodiversity of the region. This review discusses the impact of important ant species on human health in the Asia-Pacific region along with the molecular immunological aspects of the identified venoms and current status of diagnostics and therapeutics. [ABSTRACT FROM AUTHOR]

Medical conditions arising from hymenopteran sting allergy or mass envenomation are a serious health concern, particularly in austere environments. Both practicing allergists and entomological pest control personnel should consider the relevance of stinging insects when responding to problems with Hymenoptera. Recent occupational reviews of civilian deaths from insect bites and stings prompted our review of the US Air Force Mortality Registry to determine the relevance of insect stings and bites as a cause of death in the US Air Force. After reviewing over 40 years of death records we identified 23 death records, among US Air Force Active duty, guard, or retirees that arose directly from hymenopteran stings. [ABSTRACT FROM AUTHOR]

Background and objective The allergenicity of several German cockroach (Bla-g) antigens at the level of IgE responses is well established. However, less is known about the specificity of CD4+ TH responses, and whether differences exist in associated magnitude or cytokine profiles as a function of disease severity. Methods Proteomic and transcriptomic techniques were used to identify novel antigens recognized by allergen-specific T cells. To characterize different TH functionalities of allergen-specific T cells, ELISPOT assays with sets of overlapping peptides covering the sequences of known allergens and novel antigens were employed to measure release of IL-5, IFNγ, IL-10, IL-17 and IL-21. Results Using these techniques, we characterized TH responses in a cohort of adult Bla-g-sensitized subjects, either with ( n = 55) or without ( n = 17) asthma, and nonsensitized controls ( n = 20). T cell responses were detected for ten known Bla-g allergens and an additional ten novel Bla-g antigens, representing in total a 5-fold increase in the number of antigens demonstrated to be targeted by allergen-specific T cells. Responses of sensitized individuals regardless of asthma status were predominantly TH2, but higher in patients with diagnosed asthma. In asthmatic subjects, Bla-g 5, 9 and 11 were immunodominant, while, in contrast, nonasthmatic-sensitized subjects responded mostly to Bla-g 5 and 4 and the novel antigen NBGA5. Conclusions Asthmatic and nonasthmatic cockroach-sensitized individuals exhibit similar TH2-polarized responses. Compared with nonasthmatics, however, asthmatic individuals have responses of higher magnitude and different allergen specificity. [ABSTRACT FROM AUTHOR]

The article presents a study that aimed to define the house dust mite (HDM) allergens that bind immunoglobulin E (IgE) from patients with scabies. The study used nine purified or recombinant HDM allergens to measure antibody-binding activities of IgE, IgG1 and IgG4. The authors suggest that epitopes with useful immuno-modulatory properties can be defined by understanding the environment or genetic interactions in allergy and asthma.

Background Proteinase-activated receptor 2 ( PAR2) is a G protein-coupled receptor activated by trypsin-like serine proteinases. PAR2 activation has been associated with inflammation including allergic airway inflammation. We have also shown that PAR2 activation in the airways leads to allergic sensitization. The exact contribution of PAR2 in the development of eosinophilic inflammation and airway hyperresponsiveness ( AHR) in sensitized individuals is not clear. Objective To investigate whether functional inhibition of PAR2 during allergen challenge of allergic mice would inhibit allergen-induced AHR and inflammation in mouse models of asthma. Methods Mice were sensitized and challenged with ovalbumin ( OVA) or cockroach extract ( CE). To investigate the role of PAR2 in the development of AHR and airway inflammation, we administered blocking anti- PAR2 antibodies, or a cell permeable peptide inhibitor of PAR2 signalling, pepducin, i.n. before allergen challenges and then assessed AHR and airway inflammation. Results Administration of anti- PAR2 antibodies significantly inhibited OVA- and CE-induced AHR and airway inflammation. In particular, two anti- PAR2 antibodies, the monoclonal SAM-11 and polyclonal B5, inhibited AHR, airway eosinophilia, the increase of cytokines in the lung tissue and antigen-specific T cell proliferation, but had no effect on antigen-specific IgG and IgE levels. Pepducin was also effective in inhibiting AHR and airway inflammation in an OVA model of allergic airway inflammation. Conclusions and Clinical Relevance Functional blockade of PAR2 in the airways during allergen challenge improves allergen-induced AHR and inflammation in mice. Therefore, topical PAR2 blockade in the airways, through anti- PAR2 antibodies or molecules that interrupt PAR2 signalling, has the potential to be used as a therapeutic option in allergic asthma. [ABSTRACT FROM AUTHOR]

Résumé Plus les années passent, plus c’est « un peu la même chose ». Le lait maternel transfère des allergènes, qui, au moins chez la souris, induisent une sensibilisation du souriceau dont les conséquences (tolérogènes ou allergisantes) restent à déterminer. Un allaitement au sein prolongé et une diversification incluant des fruits et des légumes frais, et des repas « maison » avec des aliments frais diminueraient le risque d’allergie, alimentaire notamment. Les chances de guérison, spontanée ou induite par la désensibilisation, sont inversement proportionnelles au degré de sensibilisation initiale et à la gravité de l’allergie alimentaire. La désensibilisation aux aliments doit initialement être effectuée en milieu sécurisé, puis entretenue à domicile par des familles bien informées et éduquées, compte tenu de la fréquence élevée des réactions, parfois graves. Lorsque la tolérance est acquise, elle paraît durable, sous réserve de poursuivre une consommation régulière de l’aliment concerné. La majorité des études confirme que seule une faible proportion des enfants consultant pour suspicion d’allergie médicamenteuse est réellement atteinte d’une hypersensibilité allergique ou non allergique aux médicaments. Lorsqu’ils sont validés, les tests cutanés présentent une bonne valeur diagnostique dans les réactions IgE-médiées, alors que le diagnostic des réactions non IgE-médiées repose le plus souvent sur l’histoire clinique (toxidermies potentiellement sévères notamment) ou sur la positivité des tests de provocation/réintroduction. Enfin, la prévalence de l’allergie aux bêta-lactamines chez les enfants atteints de mucoviscidose est, contrairement à la notion classique, extrêmement faible, peut-être parce que les traitements répétés à fortes doses exercent des effets tolérogènes. Years go by but most things seem to remain the same. Breast milk passively transfers aeroallergens and food allergens to the child, and, at least in mice, these allergens can induce sensitization in the offspring; still, the consequences – tolerogenic or allergenic – of the sensitization remain unknown. Breastfeeding for at least 4 months, early introduction of fresh vegetables and fruits, and homemade meals with fresh foods may reduce the risk of subsequent food allergy. Regarding food-allergic children, the probability of tolerance development following avoidance or allergen immunotherapy is correlated inversely with the degree of sensitization and the severity of the child's symptoms. Due to the potentially high incidence of reactions, often severe, specific food immunotherapy should be initiated in a well-equipped medical setting with experienced personnel, initially escalating the dose administered. Maintenance at home can be carried out by parents who have been well prepared and who are well equipped, e.g., for epinephrine injection. When tolerance has developed, it will persist if the child continues regular and frequent consumption of the food involved. It has been reported that only a small fraction of children with suspected drug hypersensitivity are actually allergic to the suspected drug. In children with a history of an immediate-type hypersensitivity reaction to a drug, a positive immediate skin test has good diagnostic value. On the contrary, the diagnosis of delayed-type hypersensitivity reactions to drugs is mainly based on the clinical history; it may be supported by a drug provocation test. To close, the prevalence of beta-lactam allergy in children with cystic fibrosis appears very low. This may be the result of their frequent treatment with high doses of a beta-lactam, which has induced tolerance. [ABSTRACT FROM AUTHOR]

Recent research has demonstrated extensive within-species variation in pheromone expression in insect species, contrary to the view that pheromones are largely invariant within species. In fact, many studies on insect cuticular hydrocarbons (CHCs) show that pheromones can be highly dynamic traits that can express significant short-term plasticity across both abiotic and social environments. It is likely that this variability in CHC expression contributes to their important role in sexual signaling and mate choice. In this review, I discuss CHC plasticity and how this might influence sexual communication. I also highlight two important avenues for future research: examining plasticity in how individuals respond to CHC signals, and testing how sexual communication varies across abiotic and social environments. [ABSTRACT FROM AUTHOR]

The article discusses the first recorded occurrence of the dicrotendipes inouei (D. inouei) Hashimoto, 1984 in Zhejiang Province, China. Topics discussed include the consideration of the dicrotendipes as pests due to implication of allergic reactions among humans in Africa, the collection of four D. inouei adults by using sweep nets, and the habitat tolerance of halophilous chironomids to brackish water influenced by sea water.

Myrmecia pilosula is an endemic Australian ant whose sting is a frequent cause of insect allergy in southeast Australia, and several deaths due to M. pilosula sting envenomation have been documented. In this review, we discuss the composition and bioactivity of M. pilosula venom. In addition to various enzymes and pharmacologically active constituents, the venom contains four families of highly basic low molecular weight peptides trivially named Pilosulins. These peptides are unique and have low structural homology to other Hymenoptera venom peptides. Moreover, M. pilosula venom is relatively simple in its composition with 5 predominant peptides making up about 90% by weight. These peptides display cytotoxic, hypotensive, histamine-releasing and antimicrobial activities. Within the M. pilosula venom, Pilosulin 3 has been classified as a major allergen and [Ile 5 ]pilosulin 1 and Pilosulin 4.1 are classified as minor allergens. Several uncharacterised higher molecular weight components with allergenic activities have also been identified. The revised naming of M. pilosula venom peptides according to the International Union of Immunological Societies (IUIS) criteria for allergen nomenclature is discussed in this review. [ABSTRACT FROM AUTHOR]

Allergies caused by mosquito bites may produce local or systemic reactions. The inhalation of mosquito allergens may also cause asthma and/or allergic rhinoconjunctivitis in sensitized individuals. The mechanisms implicated in the development of these immune responses involve IgE antibodies, different subtypes of IgG and proinflammatory cytokines as well as basophils, eosinophils and mast cells. Several allergenic components have been identified in the saliva and bodies of mosquitoes and some of these are present in different mosquito species. The most common species implicated in allergic reactions belong to the genera Aedes, Culex and Anopheles. Several Aedes aegypti allergens have been cloned and sequenced. The recombinant molecules show IgE reactivity similar to that of the native allergens, making them good candidates for the diagnosis of mosquito allergies. Allergen-specific immunotherapy with mosquito extracts induces a protective response characterized by a decreased production of IgE antibodies, increased IgG levels, a reduction in the severity of cutaneous and respiratory symptoms and the need for medication. The aims of this review are to summarize the progress made in the characterization of mosquito allergens and discuss the types of immune responses induced by mosquito bites and the inhalation of mosquito allergens in atopic individuals. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Setae from Thaumetopoea pityocampa larvae (the pine processionary moth or PPM) can induce hypersensitivity reactions, but their clinical role in IgE-mediated responses is still subject to discussion. The aim of this study was to evaluate a setae extract for in vivo and in vitro diagnosis in nonhospitalized patients with reactions to PPM. Methods: Forty-eight adult patients presenting with PPM cutaneous reactions were studied by skin prick test (SPT) and specific IgE using setae and whole larval (WL) extracts. Biological standardized extracts were used for skin tests. Results: A total of 47.9% patients had a positive SPT for PPM (70% to both extracts, 17% only to the WL extract and 13% only to the setae extract). IgE immunoblotting detected several reactive bands in 91% of the SPT-positive cases. In multivariate analysis, male sex, immediate latency (<1 h) and duration of skin symptoms (<24 h) were independent predictors of a positive SPT. Conclusions: IgE sensitization to PPM was found in 48% of the study patients, which was associated with immediate reactions and evanescent cutaneous lesions. Most of these patients reacted to both WL and setae extracts, but some reacted to only one of them. According to our data, skin and in vitro tests to PPM should be performed using both extracts. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: There are scarce data about the prevalence of Hymenoptera venom allergy in the general population. The aim of this study was to determine the prevalence of Hymenoptera venom allergy in the general adult population of Istanbul. Methods: A total of 17,064 randomly selected telephone numbers were contacted and 11,816 (69.25%) individuals who agreed to participate completed a questionnaire. Those who disclosed hypersensitivity reactions due to Hymenoptera stings in this initial survey were called again and given another questionnaire. Those who were suspected of experiencing hypersensitivity reactions to Hymenoptera stings were invited for a clinical investigation with in vivo and in vitro diagnostic tests. Results: According to the first questionnaire, a total of 1171 (9.9%: 95% Cl: 9.38-10.47%) were suspected of having a hypersensitivity to Hymenoptera stings. 51.75% (n: 606) answered the second questionnaire and 21% (n: 128) of these were still suspected of having a hypersensitivity to Hymenoptera stings (1.1%; 95% Cl: 0.9-1.29%). The confirmed prevalence of hypersensitivity to Hymenoptera stings according to skin tests and in vitro slgE levels was 0.2% (95% Cl: 0.14-0.30%). Nearly all of the participants with systemic reactions were admitted to the emergency department, although only one tenth of them received adrenaline in the emergency room. 2.3% carried an adrenaline injector, whereas none of the patients received venom immunotherapy. Conclusions: The prevalence of Hymenoptera sting reactions in our geographical region is comparable with other European studies. There is a need to increase the awareness of adrenaline in the emergency management of insect sting anaphylaxis and venom immunotherapy in the prophylaxis. [ABSTRACT FROM AUTHOR]