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    ABSTRACT: This review highlights some of the research advances in anaphylaxis; hypersensitivity reactions to foods, drugs, and insects; and allergic skin diseases that were reported in the Journal in 2011. Food allergy appears to be increasing in prevalence and carries a strong economic burden. Risk factors can include dietary ones, such as deficiency of vitamin D and timing of complementary foods, and genetic factors, such as filaggrin loss-of-function mutations. Novel mechanisms underlying food allergy include the role of invariant natural killer T cells and influences of dietary components, such as isoflavones. Among numerous preclinical and clinical treatment studies, promising observations include the efficacy of sublingual and oral immunotherapy, a Chinese herbal remedy showing promising in vitro results, the potential immunotherapeutic effects of having children ingest foods with baked-in milk if they tolerate it, and the use of anti-IgE with or without concomitant immunotherapy. Studies of allergic skin diseases, anaphylaxis, and hypersensitivity to drugs and insect venom are elucidating cellular mechanisms, improved diagnostics, and potential targets for future treatment. The role of skin barrier abnormalities, as well as the modulatory effects of the innate and adaptive immune responses, are major areas of investigation.
    The Journal of allergy and clinical immunology 01/2012; 129(1):76-85. DOI:10.1016/j.jaci.2011.11.016 · 11.25 Impact Factor
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    ABSTRACT: Anaphylaxis to egg or severe egg allergy has been considered a contraindication to receiving trivalent seasonal influenza vaccine (TIV). To evaluate the safety of TIV among severely egg allergic children. A 2-phase, multicenter study at 7 sites was conducted between October 2010 and March 2012. Inclusion criteria included a history of a severe reaction, including anaphylaxis, to the ingestion of egg and a positive skin test result or evidence of serum specific IgE antibody to egg. Phase 1 consisted of a randomized, prospective, double-blind, placebo controlled trial of TIV administration to egg allergic children, using a 2-step approach; group A received 0.1 mL of influenza vaccine, followed in 30 minutes if no reaction with the remainder of an age-appropriate dose, whereas group B received an injection of normal saline followed in 30 minutes if no reaction with the full 100% of the age-appropriate dose. Phase 2 was a retrospective analysis of single dose vs split-dose administration of TIV in eligible study participants who declined participation in the randomized controlled trial. Thirty-one study participants were prospectively evaluated in the randomized controlled trial (group A, 14; group B, 17); 45.1% had a history of anaphylaxis after egg ingestion. A total of 112 participants were retrospectively evaluated (87 with the single dose and 25 with the split dose); 77.6% of participants had a history of anaphylaxis after egg ingestion. All participants in both phases received TIV without developing an allergic reaction. TIV administration is safe even in children with histories of severe egg allergy. Use of 2-step split dosing appears unnecessary because a single dose was well tolerated.
    Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 12/2012; 109(6):426-30. DOI:10.1016/j.anai.2012.09.011 · 2.75 Impact Factor
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    ABSTRACT: Together with cow's milk and peanuts, hen's eggs are one of the three principal food allergens affecting children. The symptoms of food allergy (FA) to hen's eggs are above all those due to an IgE-dependant immediate allergy; non-IgE-dependant allergic hypersensitivity is rare. There are at least two phenotypes of FA due to eggs: patients allergic to raw and to cooked eggs (where ovomucoid is usually the cause) and those who react to raw eggs but tolerate cooked eggs. The diagnosis of IgE-dependant FA to egg is easy. It is based on: i) the clinical history; ii) allergy skin prick-tests (SPT); iii) assay for specific serum IgE (IgE); iv) an oral provocation test (OPT) done under close supervision in a specialized center being the diagnostic reference. A combination of the results of the SPT and the serum IgE makes it possible to estimate the threshold values above which the probability of having a positive OPT is high (above 90%). IgE assays for various egg allergens (Gal d 1 to Gal d 6) and microarray assay methods provide means to refine the diagnosis according to its various clinical forms: i) allergy to both raw and cooked eggs; ii) allergy to raw eggs and tolerance to cooked eggs. Overall, the prognosis of FA to eggs is good since three-quarters of the patients outgrow this allergy before 18 years of age. Children allergic to raw eggs but who tolerate cooked eggs have the better prognosis. In cases with persistent hen's egg FA, tolerance induction protocols provide a way to cure this allergy or at least to an increase of the amount of allergen the patient can tolerate. Children who are allergic to eggs are at increased risk for the development of atopic conditions (rhinitis, asthma and eczema) due to other foods or to airborne allergens.
    Revue Française d'Allergologie 12/2012; 52(8):515–520. DOI:10.1016/j.reval.2012.06.004 · 0.35 Impact Factor