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Hugh A Sampson,
Roy Gerth van Wijk,
Carsten Bindslev-Jensen,
Scott Sicherer,
Suzanne S Teuber,
A Wesley Burks,
Anthony E J Dubois, Kirsten Beyer,
Philippe A Eigenmann,
Jonathan M Spergel,
Thomas Werfel,
Vernon M Chinchilli
The Journal of allergy and clinical immunology 12/2012; 130(6):1260-74. · 9.17 Impact Factor
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Pediatric Allergy and Immunology 09/2012; 23(6):506-8. · 2.46 Impact Factor
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The Journal of allergy and clinical immunology 08/2012; 130(2):549-51. · 9.17 Impact Factor
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The Journal of allergy and clinical immunology 04/2012; 130(1):261-3. · 9.17 Impact Factor
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ABSTRACT: Die Inzidenz allergischer Erkrankungen ist in den letzten Jahrzehnten deutlich gestiegen. Neben der Verbesserung therapeutischer
Behandlungsmöglichkeiten steht die Suche nach geeigneten präventiven Instrumenten. Als ein wichtiger Faktor zur Ausprägung
eines allergischen Phänotyps gilt unter anderem der Einfluss der frühkindlichen Ernährung. Gerade in diesem Bereich haben
sich in den letzten Jahren die Hypothesen hinsichtlich einer Allergie-Prävention gravierend geändert. Ging man bislang eher
von einer Allergenvermeidung im Sinne einer diätetischen Restriktion aus, wird jetzt eher eine Prävention durch Exposition
mit Allergenen im Sinne einer potentiellen Toleranzinduktion diskutiert. Diese Übersicht, die sich an den neuen S3-Leitlinien
zur Allergieprävention vom Frühjahr 2009 orientiert, soll die aktuellsten Empfehlungen hinsichtlich der Ernährungsoptionen
während Schwangerschaft, Stillzeit und des ersten Lebensjahrs darstellen. Zusammenfassend wird ein ausschließliches Stillen
in den ersten vier Monaten empfohlen. Für einen präventiven Effekt durch eine Verzögerung der Beikosteinführung über den 4.
Lebensmonat hinaus können keine Empfehlung mehr ausgesprochen werden. Auch für einen präventiven Effekt einer diätetischen
Restriktion durch Meidung potenter Nahrungsmittelallergene gibt es keine Belege. Eine allgemeine (restriktive) Diät für Mutter
und Kind kann nicht empfohlen werden. Hinweise jedoch gibt es darauf, dass Fischkonsum im 1. Lebensjahr bzw. in Schwangerschaft
und Stillzeit einen protektiven Effekt auf die Entwicklung atopischer Erkrankungen hat.
Journal für Verbraucherschutz und Lebensmittelsicherheit 04/2012; 4:21-23. · 0.63 Impact Factor
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A Wesley Burks,
Mimi Tang,
Scott Sicherer,
Antonella Muraro,
Philippe A Eigenmann,
Motohiro Ebisawa,
Alessandro Fiocchi,
Wen Chiang, Kirsten Beyer,
Robert Wood,
Jonathan Hourihane,
Stacie M Jones,
Gideon Lack,
Hugh A Sampson
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ABSTRACT: Food allergies can result in life-threatening reactions and diminish quality of life. In the last several decades, the prevalence of food allergies has increased in several regions throughout the world. Although more than 170 foods have been identified as being potentially allergenic, a minority of these foods cause the majority of reactions, and common food allergens vary between geographic regions. Treatment of food allergy involves strict avoidance of the trigger food. Medications manage symptoms of disease, but currently, there is no cure for food allergy. In light of the increasing burden of allergic diseases, the American Academy of Allergy, Asthma & Immunology; European Academy of Allergy and Clinical Immunology; World Allergy Organization; and American College of Allergy, Asthma & Immunology have come together to increase the communication of information about allergies and asthma at a global level. Within the framework of this collaboration, termed the International Collaboration in Asthma, Allergy and Immunology, a series of consensus documents called International Consensus ON (ICON) are being developed to serve as an important resource and support physicians in managing different allergic diseases. An author group was formed to describe the natural history, prevalence, diagnosis, and treatment of food allergies in the context of the global community.
The Journal of allergy and clinical immunology 02/2012; 129(4):906-20. · 9.17 Impact Factor
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ABSTRACT: Peanut allergy is a frequent and potentially life-threatening food allergy. Despite the large taxonomic distance between the plants, peanut-allergic patients often react to tree nuts such as walnuts. While the allergens of peanut and walnut have a high degree of homology in their amino-acid sequences, it is unknown whether this similarity is responsible for the observed co-reactivity. Therefore, we analyzed the binding of specific IgE antibodies to sequential epitopes of peanut and walnut in peanut-allergic patients with and without walnut allergy.
The IgE binding to previously described sequential epitopes of peanut and the homologous regions of walnut was assessed in 32 peanut-allergic patients using a peptide microarray technology. Twelve patients had a clinically relevant walnut allergy and 20 were tolerant to walnut. Inhibition assays with peanut peptides and corresponding walnut sequences were performed to show specific binding to sequential epitopes.
No differences in the recognition of sequential epitopes could be found between peanut-allergic patients with or without walnut allergy. Only a few patients showed IgE binding to walnut sequences that corresponded to sequential epitopes of peanut. In the inhibition assays, no relevant cross-reacting IgE antibodies could be detected for the peptides analyzed.
Our results indicate that although they share a rather high degree of homology with the corresponding regions of walnut allergens, the sequence stretches previously identified as sequential IgE binding epitopes of Ara h 1, Ara h 2 and Ara h 3 have no IgE binding equivalents in walnut allergens.
International Archives of Allergy and Immunology 01/2012; 157(3):238-45. · 2.40 Impact Factor
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ABSTRACT: Food-related symptoms are frequent in childhood, and pediatricians are often requested to initiate a food allergy diagnostic workup. A careful history is the cornerstone for assessing whether tests are needed and which diagnostic procedures are most appropriate. Skin prick tests should be performed only according to standard procedures by a skilled health professional. Determining serum IgE levels (in vitro tests) are available for a wide range of foods. Of utmost importance is the need to correlate test results to the clinical picture. When a conclusion cannot be reached, oral food challenges should be performed for a definite diagnosis.
Pediatric Clinics of North America 04/2011; 58(2):351-62, ix. · 2.24 Impact Factor
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Stephanie Hompes,
Alice Köhli,
Katja Nemat,
Kathrin Scherer,
Lars Lange,
Franziska Rueff,
Ernst Rietschel,
Thomas Reese,
Zsolt Szepfalusi,
Nicolaus Schwerk, Kirsten Beyer,
Thomas Hawranek,
Bodo Niggemann,
Margitta Worm
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ABSTRACT: To cite this article: Hompes S, Köhli A, Nemat K, Scherer K, Lange L, Rueff F, Rietschel E, Reese T, Szepfalusi Z, Schwerk N, Beyer K, Hawranek T, Niggemann B, Worm M. Provoking allergens and treatment of anaphylaxis in children and adolescents – data from the anaphylaxis registry of German-speaking countries. Pediatr Allergy Immunol 2011; 22: 568–574.AbstractAnaphylaxis is the most severe reaction of an IgE-mediated hypersensitivity. Data about affected patients may help to improve our knowledge of anaphylaxis and its medical care. We analysed data from the anaphylaxis registry of German speaking countries with regard to the provoking allergens and treatment modalities of anaphylaxis in children and adolescents.Inclusion criteria were severe systemic allergic reactions with concomitant pulmonary and/or cardiovascular symptoms. The data are collected by a password-controlled online-questionnaire. For this analysis, data of 197 reported anaphylactic reactions from children and adolescents registered between 2006 and 2009 were included.The data show that within the registered cases the most frequently affected organ systems for children and adolescents were the skin (89%) and the respiratory tract (87%) followed by symptoms of the cardiovascular system (47%) and the gastrointestinal tract (43%). The most frequent elicitors were food allergens accounting for 58% of cases, followed by insect venom (24%) and drugs (8%). The most frequent food allergens were peanuts followed by tree nuts and animal related food products. In 18% aggravating factors such as physical exercise were noted by the clinicians. 26% of the analysed patients had experienced more than one reaction. The data regarding the emergency treatment show that antihistamines (87%) and corticosteroids (85%) were often used but that adrenaline was rarely used (22% of the registered cases).Taken together these data show that the analysis of anaphylaxis by registration of affected individuals can provide data about provoking allergens and treatment measures but also suggest the impact of aggravating factors on anaphylactic reactions. The under-represented usage of adrenaline indicates the need of educational measures for patients and their physicians.
Pediatric Allergy and Immunology 03/2011; 22(6):568 - 574. · 2.46 Impact Factor
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Alessandro Fiocchi,
Holger J Schünemann,
Jan Brozek,
Patrizia Restani, Kirsten Beyer,
Riccardo Troncone,
Alberto Martelli,
Luigi Terracciano,
Sami L Bahna,
Fabienne Rancé,
Motohiro Ebisawa,
Ralf G Heine,
Amal Assa'ad,
Hugh Sampson,
Elvira Verduci,
G R Bouygue,
Carlos Baena-Cagnani,
Walter Canonica,
Richard F Lockey
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ABSTRACT: The 2nd Milan Meeting on Adverse Reactions to Bovine Proteins was the venue for the presentation of the first consensus-based approach to the management of cow's milk allergy. It was also the first time that the Grading of Recommendations, Assessments, Development, and Evaluation approach for formulating guidelines and recommendations was applied to the field of food allergy. In this report we present the contributions in allergen science, epidemiology, natural history, evidence-based diagnosis, and therapy synthesized in the World Allergy Organization Diagnosis and Rationale for Action against Cow's Milk Allergy guidelines and presented during the meeting. A consensus emerged between discussants that cow's milk allergy management should reflect not only basic research but also a newer and better appraisal of the literature in the light of the values and preferences shared by patients and their caregivers in partnership. In the field of diagnosis, atopy patch testing and microarray technology have not yet evolved for use outside the research setting. With foreseeable breakthroughs (eg, immunotherapy and molecular diagnosis) in the offing, the step ahead in leadership can only stem from a worldwide organization implementing consensus-based clinical practice guidelines to diffuse and share clinical knowledge.
The Journal of allergy and clinical immunology 12/2010; 126(6):1119-28.e12. · 9.17 Impact Factor
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Katharina Blumchen,
Helen Ulbricht,
Ute Staden,
Kerstin Dobberstein,
John Beschorner,
Lucila Camargo Lopes de Oliveira,
Wayne G Shreffler,
Hugh A Sampson,
Bodo Niggemann,
Ulrich Wahn, Kirsten Beyer
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ABSTRACT: The only treatment option for peanut allergy is strict avoidance.
To investigate efficacy and safety of oral immunotherapy (OIT) in peanut allergy.
Twenty-three children (age, 3.2-14.3 years) with IgE-mediated peanut allergy confirmed by positive double-blind, placebo-controlled food challenge (DBPCFC) received OIT following a rush protocol with roasted peanut for 7 days. If a protective dose of at least 0.5 g peanut was not achieved, patients continued with a long-term buildup protocol using biweekly dose increases up to at least 0.5 g peanut. A maintenance phase for 8 weeks was followed by 2 weeks of peanut avoidance and a final DBPCFC. Immunologic parameters were determined.
After OIT using the rush protocol, patients tolerated a median dose of only 0.15 g peanut. Twenty-two of 23 patients continued with the long-term protocol. After a median of 7 months, 14 patients reached the protective dose. At the final DBPCFC, patients tolerated a median of 1 g (range, 0.25-4 g) in comparison with 0.19 g peanut at the DBPCFC before OIT (range, 0.02-1 g). In 2.6% of 6137 total daily doses, mild to moderate side effects were observed; in 1.3%, symptoms of pulmonary obstruction were detected. OIT was discontinued in 4 of 22 patients because of adverse events. There was a significant increase in peanut-specific serum IgG(4) and a decrease in peanut-specific IL-5, IL-4, and IL-2 production by PBMCs after OIT.
Long-term OIT appears to be safe and of some benefit in many patients with peanut allergy. With an increase in threshold levels and a reduction of peanut-specific T(H)2 cytokine production, the induction of tolerance may be feasible in some patients.
The Journal of allergy and clinical immunology 07/2010; 126(1):83-91.e1. · 9.17 Impact Factor
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Alessandro Fiocchi,
Jan Brozek,
Holger Schünemann,
Sami L. Bahna,
Andrea von Berg, Kirsten Beyer,
Martin Bozzola,
Julia Bradsher,
Enrico Compalati,
Motohiro Ebisawa, [......],
Ralf G. Heine,
Paul Keith,
Gideon Lack,
Massimo Landi,
Alberto Martelli,
Fabienne Rancé,
Hugh Sampson,
Airton Stein,
Luigi Terracciano,
Stefan Vieths
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ABSTRACT: SECTION 1: INTRODUCTION: Allergy and clinical immunology societies have issued guidance for the management of food allergy.1,2 Guidelines are now regarded as translational research instruments, designed to provide cutting-edge benchmarks for good practice and bedside evidence for clinicians to use in an interactive learning context with their national or international scientific communities. In the management of cow's milk allergy (CMA), both diagnosis and treatment would benefit from a reappraisal of the more recent literature, for “current” guidelines summarize the achievements of the preceding decade, deal mainly with prevention,3–6 do not always agree on recommendations and date back to the turn of the century.7,8 In 2008, the World Allergy Organization (WAO) Special Committee on Food Allergy identified CMA as an area in need of a rationale-based approach, informed by the consensus reached through an expert review of the available clinical evidence, to make inroads against a burdensome, world-wide public health problem. It is in this context that the WAO Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines was planned to provide physicians everywhere with a management tool to deal with CMA from suspicion to treatment. Targeted (and tapped for their expertise), both on the DRACMA panel or as nonsitting reviewers, were allergists, pediatricians (allergists and generalists), gastroenterologists, dermatologists, epidemiologists, methodologists, dieticians, food chemists, and representatives of allergic patient organizations. Ultimately, DRACMA is dedicated to our patients, especially the younger ones, whose burden of issues we hope to relieve through an ongoing and collective effort of more interactive debate and integrated learning.
Definitions: Adverse reactions after the ingestion of cow's milk can occur at any age from birth and even among infants fed exclusively at the breast, but not all such reactions are of an allergic nature. A revision of the allergy nomenclature was issued in Europe in 20019 and was later endorsed by the WAO10 under the overarching definition of “milk hypersensitivity,” to cover nonallergic hypersensitivity (traditionally termed “cow's milk intolerance”) and allergic milk hypersensitivity (or “cow's milk allergy”). The latter definition requires the activation of an underlying immune mechanism to fit. In DRACMA, the term “allergy” will abide by the WAO definition (“allergy is a hypersensitivity reaction initiated by specific immunologic mechanisms”). In most children with CMA, the condition can be immunoglobulin E (IgE)-mediated and is thought to manifest as a phenotypical expression of atopy, together with (or in the absence of) atopic eczema, allergic rhinitis and/or asthma. A subset of patients, however, have non-IgE mediated (probably cell-mediated) allergy and present mainly with gastro-intestinal symptoms in reaction to the ingestion of cow's milk.
REFERENCES, SECTION 1:
1. American College of Allergy, Asthma, & Immunology. Food allergy: a practice parameter. Ann Allergy Asthma Immunol. 2006;96(Suppl 2):S1–S68.
2. Mukoyama T, Nishima S, Arita M, Ito S, Urisu A, et al. Guidelines for diagnosis and management of pediatric food allergy in Japan. Allergol Int. 2007;56:349–361.
3. Prescott SL. The Australasian Society of Clinical Immunology and Allergy position statement: Summary of allergy prevention in children. Med J Aust. 2005;182:464–467.
4. Muraro A, Dreborg S, Halken S, Høst A, Niggemann B, et al. Dietary prevention of allergic diseases in infants and small children. Part III: Critical review of published peer-reviewed observational and interventional studies and final recommendations. Pediatr Allergy Immunol. 2004;15:291–307.
5. Muraro A, Dreborg S, Halken S, Høst A, Niggemann B, et al. Dietary prevention of allergic diseases in infants and small children. Part I: immunologic background and criteria for hypoallergenicity. Pediatr Allergy Immunol. 2004;15:103–11.
6. Muraro A, Dreborg S, Halken S, Høst A, Niggemann B, Aalberse R, et al. Dietary prevention of allergic diseases in infants and small children. Part II. Evaluation of methods in allergy prevention studies and sensitization markers. Definitions and diagnostic criteria of allergic diseases. Pediatr Allergy Immunol. 2004;15:196–205.
7. Høst A, Koletzko B, Dreborg S, Muraro A, Wahn U, et al. Dietary products used in infants for treatment and prevention of food allergy. Joint Statement of the European Society for Paediatric Allergology and Clinical Immunology (ESPACI) Committee on Hypoallergenic Formulas and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition. Arch Dis Child. 1999;81:80–84.
8. American Academy of Pediatrics Committee on Nutrition. Hypoallergenic infant formulae. Pediatrics. 2000;106:346–349.
9. Johansson SG, Hourihane JO, Bousquet J. A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy. 2001;56:813–824.
10. Johansson SG, Bieber T, Dahl R. Revised nomenclature for allergy for global use: report of the Nomenclature Review Committee of the World Allergy Organization, 2003. J Allergy Clin Immunol. 2004;113:832–836.
World Allergy Organization Journal 03/2010; 3(4):57-161.
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ABSTRACT: Allergic reactions to walnuts and hazelnuts can be serious. The 11S globulins (legumins) have been identified as important allergens in these and other nuts and seeds. Here we identify the linear IgE-binding epitopes of walnut and hazelnut 11S globulins, and generate 3D 11S globulin models to map the locations of the epitopes for comparison to other allergenic homologues. Linear IgE-epitope mapping was performed by solid-phase overlapping 15-amino acid peptides probed with IgE from pooled allergic human sera. Several walnut (Jug r 4) and hazelnut (Cor a 9) 11S globulin peptides with reactivity to patient IgE were identified. Comparative alignment with cashew (Ana o 2), peanut (Ara h 3), and soybean G1 (Gly m 6.0101) and G2 (Gly m 6.0201) allergenic homologues revealed several shared allergenic 'hot spots'. Homology modeling was performed based on the atomic structure of the soybean glycinin. Surface map comparisons between the tree nut and peanut homologues revealed structural motifs that could be important for IgE elicitation and binding and show that, contrary to predictions, the reactive epitopes are widely distributed throughout the monomeric subunits, both internally and externally, including regions occluded by quaternary subunit association. These findings reveal structural features that may be important to allergenicity and cross-reactivity of this protein class.
Molecular Immunology 08/2009; 46(15):2975-84. · 2.90 Impact Factor
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ABSTRACT: Food allergy is a common disease in childhood. Natural tolerance development is frequent, but some children with cow's milk or hen's egg allergy and the majority of children with peanut allergy will remain allergic until adulthood. Within the last several years, the usefulness of oral immunotherapy has been investigated in food allergic patients. This review covers the most recent findings.
In cow's milk and hen's egg allergy, controlled trials have been conducted in children, showing that oral immunotherapy, in general, has been successful and safe. Moreover, rush protocols have been developed allowing desensitization in a short period of time. Although side effects are frequent, allergic reactions seem to be controllable by antihistamines, steroids, or epinephrine. For peanut allergy, the first results look promising and detailed data will be available shortly.
Several studies have shown that oral immunotherapy is a promising approach, especially in patients with severe and persistent food allergy. Side effects are frequent but seem controllable. So far, treatment protocols have been performed in highly supervised research settings. Until more experience is gained from larger long-term studies, oral immunotherapy should not be tried in clinical practice settings.
Current Opinion in Allergy and Clinical Immunology 01/2009; 8(6):553-6. · 4.11 Impact Factor
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ABSTRACT: Shellfish allergy is a prevalent, long-lasting disorder usually persisting throughout life. Few options are available for treatment, and avoidance is the only therapy recommended.
We sought to identify relevant crustacean allergens for use as diagnostic and safe immunotherapeutic agents for subjects with shellfish allergy.
Thirty-eight patients were selected with immediate allergic reactions to shrimp and increased shrimp-specific serum IgE levels. One-dimensional and 2-dimensional electrophoresis of shrimp extracts were followed by IgE immunoblotting. Protein identification was done with matrix-assisted laser desorption/ionization-mass spectrometry and Edman sequencing. A cDNA library was generated from white pacific shrimp (Litopenaeus vannamei) and screened with primers designed on the basis of internal sequences obtained from 2-dimensional tryptic digests. Full-length cDNA clones were isolated from the library and sequenced. Recombinant protein was expressed and tested with sera from patients with shrimp allergy.
Immunoblotting demonstrated IgE binding to a 20-kDa shrimp protein by 21 (55%) of 38 sera. Tryptic digestion of the protein followed by matrix-assisted laser desorption/ionization-mass spectrometric analysis and Edman sequencing identified it as a myosin light chain (MLC). Screening of the shrimp cDNA library resulted in isolation of a novel protein cDNA. Open reading frame translation provided the amino acid sequence of a new allergenic shrimp protein with high similarity to Bla g 8 (cockroach MLC). Recombinant protein was recognized by 17 patients, confirming the allergenicity of shrimp MLC.
We have identified and cloned a new major shrimp allergen, Lit v 3.0101, an MLC protein.
The Journal of allergy and clinical immunology 09/2008; 122(4):795-802. · 9.17 Impact Factor
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ABSTRACT: The spectrum of food allergy consists of a variety of different clinical pictures including immunoglobulin (Ig)E, and non-IgE food allergy as well as mixed, IgE and non-IgE disorders. In addition, eosinophilic diseases of the gastrointestinal (GI) tract with occasional IgE-type sensitization are increasingly recognized. As a consequence, the clinical picture of food allergy is pleomorphic and can range from chronic GI symptoms to severe anaphylaxis. The diagnosis of food allergy is mostly hampered by the lack of reliable in vitro tests for non-IgE-mediated diseases, and in most cases relies on a reoccurrence of symptoms upon re-exposure to the antigen; in general during a standardized food challenge. Currently, there is no safe and efficient treatment for food allergy and the treatment relies on avoidance diets. Priorities for research have been identified by iPAC (international Pediatric Allergy and Asthma Consortium) and outlined in this review. They include studies to better identify the pathogenesis of food allergy, including genetic aspects; studies to develop diagnostic and follow-up tests; studies for standardization of food challenges; as well as studies addressing a safe and efficient treatment of food allergy.
Pediatric Allergy and Immunology 09/2008; 19 Suppl 19:26-39. · 2.46 Impact Factor
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The Journal of allergy and clinical immunology 08/2008; 122(2):418-9. · 9.17 Impact Factor
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The Journal of allergy and clinical immunology 08/2008; 122(2):419-21. · 9.17 Impact Factor
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ABSTRACT: The symptoms of patients presenting with non-allergic food-related reactions may partly mimic allergic responses. Therefore, correct delineation of food allergies is often difficult and various differential diagnoses have to be considered. We describe three cases of differential diagnoses to food-induced symptoms: A 14-month-old with lactose intolerance, an 8-month-old with severe diet-induced malnutrition and subsequent development of kwashiorkor and a 12-yr-old with chronic urticaria due to colouring agents. These cases represent common symptom constellations involving food-induced reactions. A proper and correct diagnosis of food-related symptoms is particularly important for children - not only in order to find the appropriate diet but also to avoid unnecessary exclusion diets, which may lead to severe impairments in growth and development.
Pediatric Allergy and Immunology 03/2008; 19(1):92-6. · 2.46 Impact Factor
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ABSTRACT: As a result of methionine deficiency, legume proteins are considered to be incomplete, and therefore there is a need to explore ways to improve legume protein amino acid balance. Using rabbit anti-soybean sulfur-rich protein (SRP) polyclonal antibodies (pAb), sensitive immunoassays (nanogram sensitivity) were developed. The immunoassays detected SRP in all soybean seeds and soybean-based commercial samples examined. In addition, the presence of pAb cross-reactive proteins was detected in certain dry beans and oilseeds. The cross-reactive proteins were isolated using purified IgG-based immunoaffinity column chromatography. Biochemical analyses including N-terminal amino acid sequencing and amino acid composition indicated that the cross-reactive proteins were comparable to soybean SRP. The cross-reactive proteins contained methionine (1.6-2.4 residues/100 residues) and cysteine (2.4-3.6 residues/100 residues), which satisfies the FAO/WHO recommended pattern for sulfur amino acids in both adults and children (2-5 years old). The results suggest the presence of constitutive SRPs in several dry beans and oilseeds.
Journal of Agricultural and Food Chemistry 03/2008; 56(3):765-77. · 2.82 Impact Factor
