Cross-reactive epitopes and their role in food allergy

 Kamath SD, Bublin M, Kitamura K, Matsui T, Ito K, Lopata AL.  J Allergy Clin Immunol. 2023 Mar 15:S0091-6749(23)00148-3. doi: 10.1016/j.jaci.2022.12.827. 

Abstract: Allergenic cross-reactivity among food allergens complicates the diagnosis and management of food allergy. This can result in many patients being sensitized (having allergen-specific IgE) to foods without exhibiting clinical reactivity. Some food groups such as shellfish, fish, tree nuts, and peanuts have very high rates of cross-reactivity.

In contrast, relatively low rates are noted for grains and milk, whereas many other food families have variable rates of cross-reactivity or are not well studied.

Perspectives on Non-IgE-Mediated Gastrointestinal Food Allergy in Pediatrics: A Review of Current Evidence and Guidelines.

Al-Iede M, Sarhan L, Alshrouf MA, Said Y. J Asthma Allergy. 2023 Mar 14;16:279-291. doi: 10.2147/JAA.S284825. 

Abstract: Food allergy is an immune-mediated disease that can result in considerable morbidity and even mortality, with a significant negative impact on patients’ quality of life. It is characterized by allergic symptoms that can occur shortly after a relevant food allergen ingestion, or can be delayed or chronic, which make it more difficult for diagnosis. 

The symptoms of this disease can range from mild to severe, and rarely can cause anaphylaxis, a life-threatening allergic reaction. The prevalence of non-immunoglobulin E (IgE)-mediated food allergy is poorly established outside of cow’s milk allergy, with an adjusted incidence ranging between 0.13% and 0.72%. Several disorders are classified as non-immunoglobulin E (IgE)-mediated food allergies that predominantly affect the gastrointestinal tract including food protein-induced enterocolitis syndrome (FPIES), food protein-induced allergic proctocolitis (FPIAP), food protein-induced allergic enteropathy (FPE), and food protein-induced dysmotility disorders (GORD and constipation). Eosinophilic esophagitis (EoE) is listed in this group, even though it considered by some authorities to be mixed reaction with both IgE and cell-mediated immune response to be involved in the reaction.

A molecular sensitization map of European children reveals exposome- and climate-dependent sensitization profiles

Kiewiet MBG, Lupinek C, Vrtala S, et al.  Allergy. 2023 Feb 23. doi: 10.1111/all.15689. Open Access.

Abstract

Background

Understanding differences in sensitization profiles at the molecular allergen level is important for diagnosis, personalized treatment and prevention strategies in allergy.

Methods

Immunoglobulin E (IgE) sensitization profiles were determined in more than 2800 sera from children in nine population-based cohorts in different geographical regions of Europe; north [BAMSE (Sweden), ECA (Norway)], west/central [PIAMA (the Netherlands), BiB (the United Kingdom), GINIplus (Germany)], and south [INMA Sabadell and Gipuzkoa (Spain) and ROBBIC Rome and Bologna (Italy)] using the MeDALL-allergen chip.

Results

Sensitization to grass pollen allergen, Phl p 1, and to major cat allergen, Fel d 1, dominated in most European regions whereas sensitization to house dust mite allergens Der p 1, 2 and 23 varied considerably between regions and were lowest in the north. Less than half of children from Sabadell which has a hot and dry climate were sensitized to respiratory allergens, in particular house dust mite allergens as compared to Gipuzkoa nearby with a more humid climate.

Allergic March in Children: The Significance of Precision Allergy Molecular Diagnosis (PAMD@) in Predicting Atopy Development and Planning Allergen-Specific Immunotherapy

Nutrients. 2023 Feb; 15(4): 978. doi: 10.3390/nu15040978

Abstract:

The allergic march is a progression of naturally occurring symptoms whose nature changes with age. The classic allergic march typically begins in infancy and manifests in the form of atopic dermatitis and food allergy. As immune tolerance develops over time, these conditions may resolve by the age of 3–5 years; however, they may evolve into allergic rhinitis and bronchial asthma.

International consensus statement on allergy and rhinology: Allergic rhinitis - 2023.

Wise SK, Damask C, Roland LT, et al.  Int Forum Allergy Rhinol. 2023 Apr;13(4):293-859. doi: 10.1002/alr.23090. 

Abstract

Background

In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document.

Methods

ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic.

Real-life evidence in allergen immunotherapy: Moving forward with mHealth apps.

Sousa-Pinto B, Pfaar O, Bousquet J. Allergol Select. 2023 Mar 1;7:47-56. doi: 10.5414/ALX02343E.

Abstract

Aim: The efficacy and safety of allergen immunotherapy (AIT) in allergic rhinitis has been classically assessed using randomized controlled trials (RCTs). However, RCTs may have limitations in their external validity, and their evidence may be complemented with that from real-world studies. We aimed to review the mHealth apps that can be used for retrieving real-world data on AIT in allergic rhinitis. 

Materials and methods: We applied an automatic tool to identify the mHealth apps (available in the Google Play and Apple App stores) that can be used to assess patients under AIT for allergic rhinitis.

Sublingual immunotherapy (SLIT) for house dust mite - when to take a break? An unusual reaction to SLIT post-vaccinations

Gallagher A, Trujillo J.  Ann Allergy Asthma Immunol. 2023 Mar 14:S1081-1206(23)00174-6. doi: 10.1016/j.anai.2023.03.008.

Allergic conditions such as allergic rhinitis are on the rise in recent years leading to the development of many forms of immunotherapy. One such recent development is the standardized quality (SQ) house dust mite (HDM) allergen extract tablets (Acarizax), which have been proven a safe and effective management option for sublingual allergy immunotherapy (SLIT) in adults with confirmed HDM-induced allergic rhinitis or allergic asthma. Acarizax is generally well tolerated by adults with allergic rhinitis, however some experience mild to moderate allergic reactions in the mouth, which generally subside within a few days. A recent real world study published in 2021 reported mild to moderate adverse events such as oral pruritus, throat irritation, ear pruritus, mouth swelling and eye pruritus. I would like to report an interesting case of a patient with confirmed HDM allergic rhinitis, commenced on Acarizax with subsequent unusual reaction...

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Safety and Tolerability of Bilastine 0.6% Ophthalmic Solution: An 8-Weeks Phase III Study

Kuna P, Jutel M, Pulka G, Tokarski S, Arranz P, Hernández G, Fernández Hernando N. Clin Ophthalmol. 2023 Mar 4;17:735-746. doi: 10.2147/OPTH.S398168.

Purpose: The objective of this study was to assess the safety and tolerability of preservative-free bilastine 0.6% ophthalmic solution after 8 weeks of once-daily administration in patients with allergic conjunctivitis (AC).

Patients and Methods: Multi-center, international, randomized, double blind, placebo-controlled, parallel-group, phase III study of adult patients with seasonal or perennial AC. The study was conducted in 26 centers of 5 European countries. Duration of daily treatment with bilastine 0.6% ophthalmic solution or placebo was 8 weeks.