Background There are few prospective studies on the natural course of chronic urticaria (CU) in children. Objective We sought to examine the natural history of CU in children and to identify ...predictors for remission. Methods Children 4 to 15 years of age with CU were investigated with a complete blood cell count, erythrocyte sedimentation rate, antinuclear antibody titer, complement CH50 level, thyroid studies, autologous serum skin test, skin-prick tests, food challenges, and stool examination for parasites. They were considered to be in remission if symptoms did not recur for at least 12 months without medication. Results In all, 92 children (53.3% female) with CU were recruited and followed up for a median duration of 4.3 years (range 2.5-5.8 years). Chronic autoimmune urticaria (CAU) was identified in 40% of the patients. Food allergy was found in 8.7% and parasitic infestations in 5.4%. Remission rates at 1, 3, and 5 years after the onset of CU symptoms were 18.5%, 54%, and 67.7%, respectively. The remission rate did not differ in CAU compared with non-CAU. No predictor of CU remission was identified. Limitations The basophil histamine release assay was not performed. Conclusion Children with CU have a favorable outcome. CAU did not have an intractable course.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Tolerance to shrimp has been reported in some patients with a history of shrimp allergy. The predictors of the natural resolution of shrimp allergy have not been widely explored. This study aimed to ...investigate the role of specific IgE (sIgE) and specific IgG4 (sIgG4) to shrimp extracts and the cross-reactive shrimp allergens tropomyosin (TM), arginine kinase (AK) and myosin light-chain (MLC), as markers of persistent or resolved shrimp allergy (PSA or RSA).
Seventeen patients with a 10-year history of allergy to
(
) and/or
(
) were recruited. Oral shrimp challenges identified 10 patients with PSA and 7 patients with RSA. Sera from these patients were evaluated for sIgE and sIgG4 to
and
extracts as well as to TM, AK and MLC.
The levels of sIgE to
and
extracts were lower in the RSA than in the PSA groups (
= 0.05 and
= 0.008, respectively), but sIgG4 or sIgG4:sIgE ratio did not show statistical significance. The sIgE to AK and MLC, but not TM, were lower in the RSA group than in the PSA group (
= 0.009 and
= 0.0008, respectively). There was no difference in sIgG4 to TM, AK and MLC between both groups. The ratio of sIgG4:sIgE to MLC, but not TM or AK, was higher in the RSA than in the PSA group (
= 0.02). A higher diversity of sIgE to shrimp components was found in the PSA group than in the RSA group (
= 0.006).
Specific bioassays can be used to identify patients with RSA. Oral shrimp challenges in these patients may provide a higher rate of passing the challenges and finally reintroducing shrimp in their diet.
Atopy patch test in children with atopic dermatitis Visitsunthorn, Nualanong; Chatpornvorarux, Sunsanee; Pacharn, Punchama ...
Annals of allergy, asthma, & immunology,
12/2016, Volume:
117, Issue:
6
Journal Article
Peer reviewed
Atopic dermatitis is frequently associated with food and/or aeroallergen allergy.
To evaluate atopy patch tests (APTs) and skin prick tests (SPTs) in children with atopic dermatitis, using allergen ...extracts from locally lyophilized foods (cow's milk, egg white, egg yolk, wheat, soy, and shrimp), Dermatophagoides pteronyssinus, Dermatophagoides farinae, and American cockroach.
This study was a prospective, self-controlled study in children with atopic dermatitis. APTs, SPTs, and oral food challenge tests were performed in the cases with written informed consent.
Fifty-six children with atopic dermatitis were enrolled. According to the Severity Scoring of Atopic Dermatitis Index, moderate atopic dermatitis was the most common severity (49.1%) followed by mild (20%) and severe atopic dermatitis (13.2%). APT results were positive for food allergens in 49% of participants; SPT results were positive in 54.7%. The sensitivity, specificity, positive predictive value, and negative predictive value of APTs for foods were 40%, 90.2%, 65.2%, and 76.6%, respectively. For SPTs, those values were 40%, 93.9%, 75%, and 77.3%, respectively. APT results for D farinae, D pteronyssinus, and American cockroach were positive in 33.9%, 35.8%, and 21.8% of participants, respectively. SPT results for these allergens were positive in 28.3%, 24.5%, and 9.4% of participants, respectively. No serious complications occurred.
APTs with locally prepared lyophilized allergen extracts were safe and had high specificity, median positive predictive value, and low sensitivity for evaluation of suspected food allergy in children with atopic dermatitis.
clinicaltrials.gov Identifier: NCT01164293.
Scope: Sensitization to giant freshwater shrimp Macrobrachium rosenbergii (Mr) was recently reported. However, the allergens have yet to be identified. This study aimed to identify and characterize a ...novel allergen of Mr shrimp.
Methods and results: Extracted proteins were separated and purified by anion and in some experiments, size‐exclusion chromatography. Serum IgE from shrimp allergic donors identified a candidate protein, which was characterized by LC‐MS/MS. The specificity of IgE binding was tested using immunoblotting and inhibition ELISA. The IgE‐binding profiles from 12 of 13 Mr allergic subjects that were pre‐incubated with an extract of Penaeus monodon showed residual binding to ∼60–80 kDa proteins. The 60–80 kDa IgE‐bound proteins were fractionated in the flow‐through of anion chromatography showing a high IgE reactivity. Peptides identified by LC‐MS/MS showed the proteins closely match subunits of hemocyanin (Hcs). Purified Hcs from hemolymph markedly inhibited binding of IgE from sera of Mr allergic subjects to solid‐phased Mr proteins in inhibition ELISA.
Conclusion: Hcs were identified as heat‐stable, non‐cross‐reactive, high‐molecular‐weight (MW) allergens from Mr shrimp. Since circulatory organs are not always removed during food preparation, high concentrations of Hcs may be present along with shrimp meat, which contains the known cross‐reactive tropomyosin protein.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
5.
ICON: chronic rhinosinusitis Bachert, Claus; Pawankar, Ruby; Zhang, Luo ...
The World Allergy Organization journal,
01/2014, Volume:
7, Issue:
1
Journal Article
Peer reviewed
Open access
Chronic rhinosinusitis (CRS) is a public health problem that has a significant socio-economic impact. Moreover, the complexity of this disease due to its heterogeneous nature based on the underlying ...pathophysiology - leading to different disease variants - further complicates our understanding and directions for the most appropriate targeted treatment strategies. Several International/national guidelines/position papers and/or consensus documents are available that present the current knowledge and treatment strategies for CRS. Yet there are many challenges to the management of CRS especially in the case of the more severe and refractory forms of disease. Therefore, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), a collaboration between EAACI, AAAAI, ACAAI, and WAO, has decided to propose an International Consensus (ICON) on Chronic Rhinosinusitis. The purpose of this ICON on CRS is to highlight the key common messages from the existing guidelines, the differences in recommendations as well as the gaps in our current knowledge of CRS, thus providing a concise reference. In this document we discuss the definition of the disease, its relevance, pharmacoeconomics, pathophysiology, phenotypes and endotypes, genetics and risk factors, natural history and co-morbidities as well as clinical manifestations and treatment options in both adults and children comprising pharmacotherapy, surgical interventions and more recent biological approaches. Finally, we have also highlighted the unmet needs that wait to be addressed through future research.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Rationale Within the past 2 decades, there was an increase in numbers of children presenting with IgE-mediated wheat reactions to Academic Centers in Thailand.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
7.
The Natural History of Shrimp Allergy in Thai Patients Ittiporn, Suttipong, MD; Pacharn, Punchama, MD; Visitsunthorn, Nualanong, MD ...
Journal of allergy and clinical immunology,
02/2017, Volume:
139, Issue:
2
Journal Article
Peer reviewed
Open access
Methods Patients who were diagnosed as having shrimp allergy by positive oral food challenge (OFC) to Penaeus monodon (Pm) and Macrobrachium rosenbergii (Mr) were recruited.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
To address inborn errors of immunity (IEI) which were underdiagnosed in resource-limited regions, our centre developed and offered free genetic testing for the most common IEI by Sanger sequencing ...(SS) since 2001. With the establishment of The Asian Primary Immunodeficiency (APID) Network in 2009, the awareness and definitive diagnosis of IEI were further improved with collaboration among centres caring for IEI patients from East and Southeast Asia. We also started to use whole exome sequencing (WES) for undiagnosed cases and further extended our collaboration with centres from South Asia and Africa. With the increased use of Next Generation Sequencing (NGS), we have shifted our diagnostic practice from SS to WES. However, SS was still one of the key diagnostic tools for IEI for the past two decades. Our centre has performed 2,024 IEI SS genetic tests, with in-house protocol designed specifically for 84 genes, in 1,376 patients with 744 identified to have disease-causing mutations (54.1%). The high diagnostic rate after just one round of targeted gene SS for each of the 5 common IEI (X-linked agammaglobulinemia (XLA) 77.4%, Wiskott–Aldrich syndrome (WAS) 69.2%, X-linked chronic granulomatous disease (XCGD) 59.5%, X-linked severe combined immunodeficiency (XSCID) 51.1%, and X-linked hyper-IgM syndrome (HIGM1) 58.1%) demonstrated targeted gene SS should remain the first-tier genetic test for the 5 common X-linked IEI.
This study investigates the utility of serum tryptase for the confirmation of shrimp-induced anaphylaxis.
Patients with a history of shrimp allergy and positive skin prick tests (SPT) to commercial ...shrimp extract were recruited for shrimp challenges. Serum total tryptase was obtained at baseline and 60 min (peak) after the onset of symptoms.
Thirty-nine patients were challenged. There were 12 patients with anaphylaxis, 20 with mild reactions and 7 without symptoms (control group). Characteristic features and baseline tryptase were not different among the 3 groups. The peak tryptase levels were higher than the baseline in anaphylaxis and mild reaction groups (P<0.05). The delta-tryptase (peak minus baseline) and the tryptase ratio (peak divided by baseline) in the anaphylaxis group were higher than the mild reaction and control groups (P<0.01). The optimum cut-off for peak tryptase to confirm anaphylaxis was 2.99 µg/L with 50% sensitivity, 85% specificity, 3.33 positive likelihood ratio (LR) and 0.59 negative LR. The manufacturer's cut-off for peak tryptase was >11.4 µg/L with 17% sensitivity, 100% specificity, infinity positive LR and 0.83 negative LR. The best cut-off for delta-tryptase was ≥0.8 µg/L with 83% sensitivity, 93% specificity, 11.86 positive LR and 0.18 negative LR. The best cut-off for tryptase ratio was ≥1.5 with 92% sensitivity, 96% specificity, 23 positive LR and 0.08 negative LR.
The peak tryptase level should be compared with the baseline value to confirm anaphylaxis. The tryptase ratio provide the best sensitivity, specificity, positive and negative LR than a single peak serum tryptase for the confirmation of shrimp-induced anaphylaxis.
Specific IgEs from their sera were analyzed to aeroallergens consisting of D. pteronyssinus, D. farinae, American cockroaches, cat dander, Bermuda and Johnson grass, and to common food allergens ...consisting of cow's milk, egg white and wheat by Euroline Allergy® and ImmunoCAP® concomitantly.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
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