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Safety of chitosan processed wine in shrimp allergic patients
Wine is an ubiq uit ous product all o ver the world, but up to 1 in 10
consumers reports intoler ance or allergy-like symptoms after drinking
Chitosan is a linear polysaccharide and the product of the
deacetylation of chitin, the main component of the cell walls of some
fungi; the exoskelet ons of arthropods, such as crustaceans and insects;
and the beaks of cephalopods.
It also may be used in wine processing.
Concerns have been raised that wines processed with chitosan
could trigger reactions in patients with seafood allergy. Neverthe-
less, biological plausibility is scarce. Major allergens involved in
shrimp allergy are muscle proteins, although some minor allergens,
such as arginine kinase, which was found to be clinically relevant,
have been found in shrimp shells.
The chitosan isolation procedure
is expected to remove all proteins and contaminants. Fear of
ingesting a shellsh-derived product may lead to unnecessary
avoidance of wine produced with chitosan lms.
Recently, anaphy lactic reaction to
-1,3-galactose has been iden-
Chitosanisstructurally differentfrom
-gal becauseitisa linear
cationic (1/4)-2-amino-2-deoxy-
-glucan. There is only one case
report of an immediate anaphylactic reaction with health food (fungi-
derived) chitosan ingestion, with documented sensitization by skin
prick tests.
Shrimp-derived chitosan has been given the classication
of generally recognized as safe (GRAS) by the US Food and Drug
Administration (FDA) in 201 2.
Moreover, evidence supporting this
classication is limited by the lack of inclusion of individuals with
shrimp allergy and the absence of food challenges. To our knowledge,
no previous studies have evaluated the safety of chitosan as a food
additive in shrimp allergic patients. Therefore, we aimed to assess the
safety of chitosan processed wine in shrimp allergic patients.
This double-blind, placebo-controlled trial was registered at (NCT02151279). Adults (18e65 years) with evi-
dence of IgE-mediated sensitization to shrimp and a history of
anaphylaxis to shrimp and/or a positive oral challenge result to
shrimp were selected. Participants were recruited from the food
allergy unit of an allergy department of a university hospital.
A control group of 6 healthy, nonatopic, nonefood allergic in-
dividuals were invited to participate. All individuals included in this
study were regular consumers of wine and were asked to avoid
alcohol ingestion for at least 3 days before the challenge. Nineteen
individuals were enrolled, including 13 with anaphylaxis to shrimp
(Table 1) and 6 healthy controls.
Skin prick-to-prick tests with wines were performed, as well as a
double-blind, placebo-controlled challenge with both wines (with
and without chitosan) in all participants. The challenges were per-
formed on the same day, separated by at least 2 hours. Successive
increasing doses were administered in 4 steps with 15-minute in-
tervals up to a total of 100 mL of each wine during each challenge. On
completion, participants were observed for 2 hours, and, in case of
any delayed reaction, participants were instructed to contact the
investigators. The research ethicscommittee,Comissão de Ética para
a Saúde do Centro Hospitalar São João e Faculdade de Medicina da
Universidade do Porto, approved the study, and signed informed
consent was obtained from all participants.
The wines processed with chitosan-based lms (active chal-
lenge) and the wines conserved with sulfur dioxide were indistin-
guishable in color, smell, or taste, at least for nonsommelier study
participants. After fermentation, instead of using sulfur dioxide for
wine preservation, chitosan lms cross-linked with genipin were
immersed in the wine in a proportion of 60 cm
/L of wine.
A positive skin test result was dened as the presence after 15
minutes of a wheal mean diameter of 3 mm or larger than that eli-
cited by the negative control accompanied by erythema. Positive
(histamine, 10 mg/mL) and negative (saline solution) controls were
also included. During challenges, occultation was performed by an
ombudsman, and each wine was placed in identied equal
containers. The randomization codes were packed in sealed, non-
transparent envelopes that remained closed until the end of the
study. Only 1 shrimp allergic participant had positive skin prick test
result to both wines. All the other participants had negative skin test
results to both wines. None of the 13 shrimp allergic patients and
none of the control participants had immediate- or late-phase re-
actions to any of the wines. No subjective symptoms were reported;
therefore, no medical intervention was necessary.
Our study found thatwine processed withchitosan-based lms as
a preservative agent may be safely consumed by shrimp allergic in-
dividuals. We selected patients with severe shrimp allergy, and all of
them tolerated this wine; consequently, it is unlikely that individuals
with a similar history of allergic reactions or mild allergic reactions
would react to this type of wine. To our knowledge, this is the rst
study to evaluate the safety of seafood-derived chitosan in shrimp
allergic patients, using double-blind, placebo-controlled challenges.
W e also found that the isolated use of skin testing is insufcient for
diagnosis. One patient had positive skin test results to both wines. Skin
prick t esting with nonstandardized matrices, such as wine, can be
associated with nonspecic testing, as previously described for orange
However, there was no clinical signicance of the positiv e skin
test results because the oral challenge result was negative. Another
strength is that our sample only included patients with anaphylaxis to
shrimp. This decreases the concern that reactions may occur only in a
dose-dependent manner and reinforces the statement of the FDA that
chitosan is GRAS, even in patients with severe shrimp allergy.
Chitosan is considered to be a nontoxic and nonallergenic
material that is suitable for use in medical and pharmaceutical
Furthermore, it has been tested as topic bandages in
shellsh allergic patients, and no adverse reactions were
Our study contributes to overcome the paucity of data
regarding the patients with shrimp allergy. Furthermore, evidence
that sulte-free chitosan-treated wines are also a safe alternative
for shrimp allergic patients broadens its use.
Disclosures: Authors have nothing to disclose.
Contents lists available at ScienceDirect
1081-1206/Ó 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Ann Allergy Asthma Immunol xxx (2016) 1e2
The number of included participants may be a limitation.
Nonetheless, all the participants had previous history of anaphylaxis
to shrimp and other seafood, and all of them had atopic comorbid-
ities, making them a particularly high-risk group. In conclusion, this
study indicates that wine treated with chitosan is unlikely to trigger
allergic reactions in patients with shrimp allergy.
Luís Amaral, MD
Diana Silva, MD
Mariana Couto, MD
Cláudia Nunes, PhD
Sílvia M. Rocha, PhD
Manuel A. Coimbra, PhD
Alice Coimbra, MD
André Moreira, MD, PhD
Serviço de Imunoalergologia
Centro Hospitalar São João
Faculty of Medicine of University of Porto
Allergy Unit
Hospital & Instituto CUF Porto
Porto, Portugal
QOPNA & Departamento de Química
Universidade de Aveiro
Aveiro, Portugal
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Table 1
Demographic and clinical characteristics of the shrimp allergic patients
Characteristics N (%)
Age (years), median IQR 34, [26e42]
Female 10 (77)
House dust mite sensitization 11 (85)
Atopic diseases 13 (100)
Allergic rhinitis 13 (100)
Asthma 5 (38.5)
Atopic eczema 2 (15.4)
Anaphylaxis 13 (100)
Cutaneous 13 (100)
13 (100)
Time (years) since last shrimp allergic reaction, median IQR 2, [1e4]
Wheal size of skin prick test with shrimp extract, mean (sd) 6.1 (2.1)
Wheal size of skin prick-prick test, mean (sd) 9.4 (7.5)
Shrimp sIgE (kU/L), mean (sd) 12.5 (31.4)
Abbreviations: IQR, interquartile range; sd, standard deviation; sIgE, specic IgE.
Data is presented as number and percentage, except when otherwise stated.
Dyspnea, throat tightness, oropharyngeal pruritus, hypotension, vomit, abdominal
pain and diarrhea.
Letter / Ann Allergy Asthma Immunol xxx (2016) 1e22
... shrimp, lobster, and crab (Vilá y Rico et al., 2015). However, two clinical trials show that chitosan per se does not trigger allergic reactions in populations with a shellfish allergy (Amaral et al., 2016;Waibel, Haney, Moore, Whisman, & Gomez, 2011). Hence the trigger of the allergic reaction is more by the protein or peptide impurities in the product containing chitosan rather than by the chitosan itself, and "allergy to shellfish" should not be used as the contraindication for applying chitosan product either topically or orally in this population. ...
Chitosan has many desirable attributes e.g. antimicrobial properties and promoting wound healing, and is used in various applications. This article first discusses how degree of deacetylation (DD) and molecular weight (MW) impacts on what level of bioactivities chitosan manifests, then introduces the “molecular chain configuration” model to explain various possible mechanisms of antimicrobial interactions between chitosan with different MW and different types of bacteria. Similarly, the possible pathways of how chitosan reacts with cancer and the body's immune system to demonstrate immune and antitumor effects are also discussed by using this model. Moreover, the possible mechanisms of how chitosan enhances coagulation and wound healing are also discussed. With these beneficial bioactivities in mind, the application of chitosan in surgery, tissue engineering and oncology is outlined. This review concludes that as chitosan demonstrates many beneficial bioactivities via multiple mechanisms, it is an important polymer with a promising future in medicine.
... Challenges in the wine industry are preventing wine spoilage, maintaining wine color, and avoiding aromatic defects by limiting oxidation. Sulfur dioxide may be added to achieve these objectives; however, sulfur dioxide may have adverse effects on human health, such as pseudo-allergies [100,101], and winemakers are, therefore, trying to limit the use of sulfites (mainly sulfur dioxide) in the winemaking process [14,102,103]. Natural products such as metabolites produced by living organisms and/or those naturally occurring in nature have been studied, aiming to prevent microbial spoilage, and thus are an appropriate alternative to the use of synthetic products, such as sulfur dioxide [104]. ...
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... For natural biomaterials, especially for animal-derived materials, allergens, viruses, other pathogens and immunogenic substances should also be considered [50]. For example, chitosan [52] extracted from shellfish should be used with caution for safety in people with shellfish allergies. For synthetic materials, especially biodegradable synthetic materials, such as poly-lactic acid (PLA) [53] and polyethylene glycol (PEG) [54], the main safety issue is the effect of degradation products, which are mainly acidic substances that may lower the pH of the local tissue microenvironment and potentially cause inflammation [55]. ...
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... The current chitosan production routes include a sequence of treatments for, especially deproteination that is expected to decrease greatly or even omit allergenicity effects. Although there are not many studies in the literature on this subject, no allergic reaction is observed in wines processed with the chitosan-based film [148] or after the use of chitosan bandages [149]. The use of fungi-based chitosan could be an alternative to that obtained from crustaceans, although possible residue of mycotoxins and spores may then be a drawback that should be considered carefully [150,151]. ...
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... crustacean or from insects) may contribute to further contain the overall cost of its addition. However, issues about allergenicity (in the case of seafoods) are still to be concretely dispelled, though some reports suggest a lack of actual risks (Amaral et al. 2016). ...
Chitosan is a natural polymer that has quite recently been approved as an aid for microbial control, metal chelation, clarification, and reduction of contaminants in enology. In foods other than wine, chitosan has also been evidenced to have some other activities such as antioxidant and antiradical properties. Nevertheless, the actual extent of its activities in must and wines has not been fully established. This review aimed to gather and discuss the available scientific information on the efficacy of chitosan as a multifaceted aid in winemaking, including antimicrobial, chelating, clarifying and antioxidant activities, while summarizing the chemical mechanisms underlying its action. Attention has been specifically paid to those data obtained by using unmodified chitosan in wine or in conditions pertinent to its production, intentionally excluding functionalized polymers, not admitted in enology. Unconventional utilizations together with future perspectives and research needs targeting, for example, the use of chitosan from distinct sources, production strategies to increase its efficacy or the potential sensory impact of this polysaccharide, have also been outlined.
Chitosan is a modified natural carbohydrate polymer derived from chitin that occurs in many natural sources. It has a diverse range of applications in medical and pharmaceutical sciences. Its primary and permitted use is biomaterial in medical devices. Chitosan and its derivatives also find utility in pharmaceuticals as an excipient, drug carrier, or therapeutic agent. The USFDA has approved chitosan usage as a biomaterial but not for pharmaceutical use, primarily because of the concerns over its source, purity, and immunogenicity. A large number of clinical studies are underway on chitosan-based materials/ products because of their diverse applications. Herein, we analyze clinical studies to understand their clinical usage portfolio. Our analysis shows that >100 clinical studies are underway to investigate the safety/efficacy of chitosan or its biomaterials/ nanoparticles, comprising ~95% interventional and ~ 5% observational studies. The regulatory considerations that limit the use of chitosan in pharmaceuticals are also deliberated. Teaser Clinical Trials of Chitosan.
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Chitosan-genipin films have been proposed for preservation of white wine, maintaining their varietal key odorants and organoleptic characteristics of sulfur dioxide treated wines. Nevertheless, these wines showed aroma notes that slightly distinguish them. It is possible that during the contact of films with wine for at least 2 months, after fermentation and prior to bottling, interactions or chemical reactions are promoted. In this work, wine model solutions with volatile compounds in contact with chitosan-genipin films were performed to evaluate their evolution along time. To complement these analyses, the volatile compounds of white and red wines kept in contact with chitosan-genipin films during 2 and 8 months were also studied. The results obtained allowed us to conclude that the contact of chitosan-genipin films with both white and red wines tend to retain long carbon chain volatile compounds, such as ethyl hexanoate and octan-3-one. It also promoted the formation of Maillard reaction products, such as furfural by dehydration of pentoses and Strecker aldehydes, such as 3-methylbutanal and phenylacetaldehyde, by degradation of amino acids. This study reveals that the use of chitosan-genipin films for wine preservation is also able to promote the formation of compounds that can modulate the wines aroma, maintaining the varietal notes.
The main objective of this study was to assess the pesticide removal efficiency of chitosan in grape juice during clarification. The grape juice was spiked with six selected pesticides (chlorpyrifos, ethion, diazinon, fenitrothion, fenthion and phorate) and clarified with chitosan at different concentrations and at three different incubation times (1, 2 and 4 h). The effect of chitosan on the level of pesticides in grape juice during clarification was quantified using modified QuEChERS method with gas chromatography with tandem mass spectrometry (GC-MS/MS). The method for pesticide quantification has been validated. The maximum removal was obtained for chlorpyrifos (98%) and ethion (97%) at 0.5% of chitosan concentration for 1 h incubation followed by phorate (96%), fenthion (95%), fenitrothion (94%) and diazinon (86%) at 1% of chitosan concentration for 2 h incubation time. The juice was clarified with other clarifying agents such as activated carbon, gelatin, casein and bentonite and its pesticide removal efficiency was compared with chitosan. The pesticide removal level could be correlated with the properties of selected pesticides and clarifying agents. The results indicated that the chitosan can act as an effective pesticide scavenger and it leads to the potential application of chitosan in fruit juice clarification.
A temperature sensitive anti-adhesive poloxamer (TAP) hydrogel has been developed to reduce post-operative adhesion. The purpose of this study was to evaluate the efficacy and safety of TAP hydrogel on fascial adhesion and clinical outcomes including range of motion, pain, and patient satisfaction after total knee arthroplasty. Sixty patients who underwent unilateral primary total knee arthroplasty for knee osteoarthritis were included and randomized to either TAP group or control group. After capsular closure, TAP hydrogel was applied on the fascial layer in 30 patients of the TAP hydrogel group, while normal saline was applied to 30 patients of the control group. The primary variable was range of motion at postoperative seven days, three months, and one year. As secondary outcomes, degree of skin fold, fascial thickness measured with ultra-sonography, postoperative pain visual analogue scale, total cumulative analgesics consumption, clinical scores, and degree of satisfaction were evaluated. There were no significant differences in range of motion after surgery between the two groups. However, the degree of suprapatellar skin folding in the TAP hydrogel group was less than that of the control group at six weeks after surgery (p = 0.041). There were no significant differences in postoperative fascial thickness, pain visual analogue scale, analgesics consumption, clinical scores, or degree of satisfaction. No surgical site complication was observed. The use of TAP hydrogel failed to enhance range of motion. However, application of TAP hydrogel on the fascial layer after capsular closure in total knee arthroplasty may decrease early postoperative fascial adhesion without any complications.
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Anaphylaxis is a severe allergic reaction that can be rapidly progressing and fatal, and therefore establishing its cause is pivotal to long-term risk management. Our recent work has identified a novel IgE antibody response to a mammalian oligosaccharide epitope, galactose-alpha-1,3-galactose (alpha-gal). IgE to alpha-gal has been associated with 2 distinct forms of anaphylaxis: (1) immediate-onset anaphylaxis during first exposure to intravenous cetuximab and (2) delayed-onset anaphylaxis 3 to 6 hours after ingestion of mammalian food products (eg, beef and pork). Results of our studies and those of others strongly suggest that tick bites are a cause, if not the only significant cause, of IgE antibody responses to alpha-gal in the southern, eastern, and central United States; Europe; Australia; and parts of Asia. Typical immune responses to carbohydrates are considered to be T-cell independent, whereas IgE antibody production is thought to involve sequential class-switching that requires input from T cells. Therefore, establishing the mechanism of the specific IgE antibody response to alpha-gal will be an important aspect to address as this area of research continues. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
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Wine is an ancient food product, ubiquitous across cultures all over the world. Its effects on health have been extensively studied, yet there have been only a few case reports of wine intolerance or wine allergy. We studied the prevalence of self-reported wine intolerance in the adult population of Mainz, Germany. In 2010, a questionnaire-based cross-sectional study was conducted to assess the prevalence of wine intolerance among adults in Mainz, a city in the wine-cultivating area of Rhine-Hesse. 4000 persons randomly chosen from population lists were asked to fill out a questionnaire about their alcohol intake and the occurrence of various intolerance reactions and allergy-like symptoms after drinking wine. Of the 4000 who received the questionnaire, 948 (23.7%) filled it out and returned it to us. 68 (7.2% of respondents) reported intolerance to wine and/or allergy-like symptoms after drinking wine. Self-reported wine intolerance was more prevalent in women than in men (8.9% vs. 5.2%, p = 0.026). Wine-intolerant persons also more commonly reported intolerance to beer and alcohol in general. Allergy-like symptoms were more common after the consumption of red wine. The most commonly reported reactions to wine were cutaneous flushing, itch, and nasal congestion. Wine intolerance was found to be more common than expected. The data reported here are less suggestive of an immunologically mediated allergy than of intolerance to alcohol, biogenic amines, or other ingredients of wine.
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Due to the fact that some individuals are allergic to crustaceans, the presumed relationship between allergy and the presence of chitin in crustaceans has been investigated. In vivo, chitin is part of complex structures with other organic and inorganic compounds: in arthropods chitin is covalently linked to proteins and tanned by quinones, in fungi it is covalently linked to glucans, while in bacteria chitin is diversely combined according to Gram(+/-) classification. On the other hand, isolated, purified chitin is a plain polysaccharide that, at the nano level, presents itself as a highly associated structure, recently refined in terms of regularity, nature of bonds, crystallinity degree and unusual colloidal behavior. Chitins and modified chitins exert a number of beneficial actions, i.e., (i) they stimulate macrophages by interacting with receptors on the macrophage surface that mediate the internalization of chitin particles to be degraded by lysozyme and N-acetyl-beta-glucosaminidase (such as Nod-like, Toll-like, lectin, Dectin-1, leukotriene 134 and mannose receptors); (ii) the macrophages produce cytokines and other compounds that confer non-specific host resistance against bacterial and viral infections, and anti-tumor activity; (iii) chitin is a strong Th1 adjuvant that up-regulates Th1 immunity induced by heat-killed Mycobacterium bovis, while down- regulating Th2 immunity induced by mycobacterial protein; (iv) direct intranasal application of chitin microparticles into the lung was also able to significantly down-regulate allergic response to Dermatophagoids pteronyssinus and Aspergillus fumigatus in a murine model of allergy; (v) chitin microparticles had a beneficial effect in preventing and treating histopathologic changes in the airways of asthmatic mice; (vi) authors support the fact that chitin depresses the development of adaptive type 2 allergic responses. Since the expression of chitinases, chitrotriosidase and chitinase-like proteins is greatly amplified during many infections and diseases, the common feature of chitinase-like proteins and chitinase activity in all organisms appears to be the biochemical defense of the host. Unfortunately, conceptual and methodological errors are present in certain recent articles dealing with chitin and allergy, i.e., (1) omitted consideration of mammalian chitinase and/or chitotriosidase secretion, accompanied by inactive chitinase-like proteins, as an ancestral defensive means against invasion, capable to prevent the insurgence of allergy; (2) omitted consideration of the fact that the mammalian organism recognizes more promptly the secreted water soluble chitinase produced by a pathogen, rather than the insoluble and well protected chitin within the pathogen itself; (3) superficial and incomplete reports and investigations on chitin as an allergen, without mentioning the potent allergen from crustacean flesh, tropomyosine; (4) limited perception of the importance of the chemical/biochemical characteristics of the isolated chitin or chitosan for the replication of experiments and optimization of results; and (5) lack of interdisciplinarity. There is quite a large body of knowledge today on the use of chitosans as biomaterials, and more specifically as drug carriers for a variety of applications: the delivery routes being the same as those adopted for the immunological studies. Said articles, that devote attention to the safety and biocompatibility aspects, never reported intolerance or allergy in individuals and animals, even when the quantities of chitosan used in single experiments were quite large. Therefore, it is concluded that crab, shrimp, prawn and lobster chitins, as well as chitosans of all grades, once purified, should not be considered as "crustacean derivatives", because the isolation procedures have removed proteins, fats and other contaminants to such an extent as to allow them to be classified as chemicals regardless of their origin.
Background: The increasing consumption of shellfish can cause an increase in allergic symptoms. Shrimp allergy can be species specific, but specific allergies in different organs have not been studied. Identification of allergens in muscle and others organs of banana shrimp is necessary for improved diagnostics of allergies for shrimp and food safety control. Objective: To identify the IgE-binding proteins in various organs of Fenneropenaeus merguiensis by immunoblotting and tandem mass spectrometry. Methods: Proteomic methods were used to investigate the allergenic proteins from banana shrimp. Proteins from muscle and various organs were separated by denaturing polyacrylamide gel electrophoresis. Allergens were analyzed by immunoblotting with pooled sera from shrimp allergic patients (n = 21) and tandem mass spectrometry. Results: The important allergens in banana shrimp are arginine kinase, sarcoplasmic calcium-binding protein, myosin heavy chain, hemocyanin, enolase, and glyceraldehyde-3-phosphate dehydrogenase, which can be demonstrated by immunoblotting in muscle and shell. Moreover, vitellogenin, ovarian peritrophin 1 precursor, β-actin, and 14-3-3 protein were suggested as allergens in the ovary at different stages of ovarian development. Conclusion: Ten allergens were identified as allergens in various organs, and they are suggested as novel allergens in banana shrimp. The major allergen in muscle and shell from this shrimp is arginine kinase, whereas the major allergen in the ovary is vitellogenin.
The use of chitosan films has been limited due to their high degradability in aqueous acidic media. In order to produce chitosan films with high antioxidant activity and insoluble in acid solutions caffeic acid was grafted to chitosan by a radical mechanism using ammonium cerium (IV) nitrate (60mM). Genipin was used as cross-linker. This methodology originated films with 80% higher antioxidant activity than the pristine film. Also, these films only lost 11% of their mass upon seven days immersion into an aqueous solution at pH 3.5 under stirring. The films surface wettability (contact angle 105°), mechanical properties (68MPa of tensile strength and 4% of elongation at break), and thermal stability for temperatures lower than 300°C were not significantly influenced by the covalent linkage of caffeic acid and genipin to chitosan. Due to their characteristics, mainly higher antioxidant activity and lower solubility, these are promising materials to be used as active films.
This chapter focuses and reviews on the characteristics and biomedical application of chitosan and collagen from marine products and advantages and disadvantages of regeneration medicine. The understanding of the production processes of chitosan and collagen and the conformation of these biomaterials are indispensable for promoting the theoretical and practical availability. The initial inflammatory reactions associated with chitosan application to hard and soft tissues need to be controlled before it can be considered for clinical application as scaffold. Further, as chitosan takes too long for biodegradation in vivo, generally it is not suitable for the scaffold for degenerative medicine in especially dental pulp tissue. The collagen extract from the scales of tropical fish has been reported to have a degeneration temperature of 35°C. The properties of biocompatibility and biodegradation of fish atelocollagen are suitable for the scaffold in regenerative medicine.
In 2005, the Office of the Surgeon General mandated that every soldier carry a HemCon bandage. Made from chitosan, a polysaccharide derived from shrimp shells, this bandage effectively stops bleeding. There are no studies reporting the safety of this bandage in shellfish allergic patients. Patients who reported shellfish allergy were recruited. Initial assessment included a detailed history, IgE skin prick testing (SPT), and serum testing to shellfish allergens. Participants who demonstrated specific shellfish IgE underwent a bandage challenge. Nineteen participants were enrolled; 10 completed the study. Seven (70%) were male and the average age was 44.8 + 10 years. Nine (90%) reported a shrimp allergy history and five (50%) reported multiple shellfish allergies. All participants completing the study had positive SPT and serum IgE testing to at least one shellfish; eight (80%) had shrimp positive SPT and ten (100%) demonstrated shrimp-specific IgE. No participant had a positive SPT to chitosan powder or experienced an adverse reaction during bandage challenges. No protein bands were visualized during gel electrophoresis analysis of chitosan powder. All participants tolerated the HemCon bandage without reaction. This is the first study demonstrating the safety of this bandage in shellfish allergic subjects.
Oranges are suspected of inducing adverse skin reactions in patients with atopic eczema. We studied 21 adult patients with atopic eczema and a history of adverse reactions to oranges and 10 patients without. A dietary history, skin tests, serum IgE and oral provocation tests with oranges were obtained. Severity of eczema was monitored by SCORAD, and serum tryptase, eosinophil cationic protein and urinary methylhistamine were measured. No allergic reactions were found to orange in skin prick or patch tests. However, 23 patients (74%) had specific serum IgE to orange. Oral provocation testing resulted in pruritic eczematous or maculopapular skin lesions predominantly at the predilection sites in 16 patients (52%). The SCORAD increased significantly in patients positive to the oral provocation test (p <0.05). Specific IgE to orange did not correlate with the clinical outcome of the oral provocation test. No significant changes were found in serum mast cell tryptase, eosinophil cationic protein or in urinary methylhistamine excretion. The negative results in the skin tests and a lack of correlation between specific IgE and oral provocation tests indicate that non-IgE-mediated mechanisms are involved in cutaneous adverse reactions to oranges in patients with atopic eczema.
Chitosan is a linear polysaccharide with about 10(5)-10(6) molecular weight existing in cell walls of zygomycetes. Chitosan decreases serum neutral fat and cholesterol levels and has dietary fiber action, and many products have recently been sold as health foods. Here, we report a case of immediate-type allergy for chitosan-containing health food with a review of the literature. The patient was a 47-year-old female person who developed systemic urticaria and difficulty in breathing after oral ingestion of chitosan. Since skin tests (prick test and scratch patch test) were positive, the test was done using another commercial chitosan, and was positive. The patient was diagnosed as having chitosan-induced immediately-type allergy, and was instructed to avoid ingestion of chitosan. The patient has developed no symptom thereafter. Regarding allergic reactions to chitin and chitosan, contact dermatitis induced by chitosan-containing cream has been reported from France and Portugal, but to our knowledge, there has been no report of immediate-type allergic reactions. Chitosan is a polysaccharide, not protein, but may have functioned as a food allergen because of its molecular weight and general properties.