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San Carlo Canavese, Italy

Asero R.,Ambulatorio di Allergologia
International Archives of Allergy and Immunology | Year: 2011

Background: Peach-induced contact urticaria is frequent in peach-allergic subjects. Objective: It was the aim of this study to detect whether contact urticaria is associated with a specific peach allergen. Methods: Ninety-two peach-allergic subjects were studied. Patients were diagnosed as being sensitized to lipid transfer protein (LTP; Pru p 3) or as having a pollen-food allergy syndrome induced by Pru p 1 and/or profilin, Pru p 4, on the basis of the results of a skin prick test containing these allergenic proteins in an isolated form. Specific IgE to peach extract was measured as well. Contact urticaria was confirmed by a contact test with intact, untreated peach. A contact test with nectarine was carried out as control. Results: Overall, contact urticaria was present in 21% of patients; the peach contact test scored positive in all cases. Contact urticaria was significantly more frequent in patients hypersensitive to LTP (63%) than in subjects with pollen-food allergy syndrome (6%; p < 0.001) and was not associated with a higher level of peach-specific IgE. In several cases, contact urticaria preceded the onset of food allergy by years. The contact test with nectarine scored negative in 5/5 cases. Conclusions: Although the peach contact test was not performed in all subjects, and peach allergy was not confirmed by oral challenges, this study shows that peach-induced contact urticaria is associated with sensitization to peach LTP. The negative clinical history and contact test with nectarine along with the well-known high concentration of LTP in peach fuzz suggest that peach fuzz plays a role in the pathogenesis of contact urticaria. Copyright © 2010 S. Karger AG. Source


Asero R.,Ambulatorio di Allergologia
European Annals of Allergy and Clinical Immunology | Year: 2011

Background: Olive pollen sensitization is surprisingly frequent in Milan, an area that is virtually both olive- and ash-free.Objective:To establish the prevalence of olive pollen sensitization north of Milan, and to investigate the allergens involved.Methods: 300 pollenallergic patients living in this area were randomly selected. Based on SPT results, olive pollen reactors were classified as multi-sensitized, oligo-sensitized, or mono-sensitized. IgE to markers of primary sensitization to olive pollen (Ole e 1), as well as to pollen pan-allergens such as profilin (Phl p 12) or polcalcin (Phl p 7) were measured. Further, the putative cross-reactivity between grass group XI allergen and Ole e 1 was investigated.Results: 107 (36%) patients were sensitized to olive pollen; 67 (63%) were multi-sensitized, while only 4 (4%) were mono-sensitized. Specific IgE to Ole e 1 were found in 32/46 (70%) cases; 22 of them (69%) co-recognized pollen pan-allergens, as shown by IgE reactivity to Phl p 7 and/or Phl p 12. Sera from 14 (30%) patients did not react to Ole e 1; of these, 10 (71%) were pan-allergens reactors. No correlation was found between IgE levels to Phl p 11 and Ole e 1. Conclusions: A majority of olive pollen-sensitized subjects seen in the surroundings ofMilan are truly allergic to Oleaceae. In the absence of both olive and ash trees exposure to privet pollen might represent the source of this kind of sensitization. Source


Asero R.,Ambulatorio di Allergologia
European Annals of Allergy and Clinical Immunology | Year: 2014

Background. Lipid transfer protein (LTP) is a widely cross-reacting allergen in plant foods. Objective. To assess whether IgE to vegetable foods show predictable trends in LTP allergic patients. Methods. Clinical allergy to plant foods other than peach was sought in 15 consecutive peach-allergic adults monosensitized to LTP. IgE specific for peach, apple, hazelnut, walnut, peanut, lentil, maize, soybean, tomato, sesame, mustard melon, kiwi, and celery as well as to mugwort pollen was measured. Results. Peach-specific IgE levels exceeded IgE to all other study foods. The higher were peach-specific IgE levels, the higher was the probability that other plant-derived foods scored positive. Mean IgE levels specific for all study foods were strongly correlated to peach specific IgE. Food-specific IgE followed a rather precise hierarchy, both in terms of number of positive in-vitro tests and of IgE levels, with apple at the second place after peach, followed by walnut, hazelnut, peanut, lentil, maize, soybean, tomato, kiwi, sesame, mustard, melon, and celery. Such hierarchy was not necessarily paralleled by clinical allergy as lentil, maize, and soybean scored positive in the majority of patients, but induced allergy in 0, 1, and 0 patients, respectively. IgE levels were not necessarily correlated with the severity of clinical allergy. Little or no IgE reactivity to mugwort pollen was found. Conclusion. In LTP syndrome, IgE reactivity to foods other than peach is in most cases predictable and follows a regular sequence that probably depends on the degree of homology with Pru p 3. The reasons why some foods are tolerated by most patients despite elevated IgE reactivity remains to be elucidated. © 2014, EDRA LSWR. All Rights Reserved. Source


Asero R.,Ambulatorio di Allergologia
European Annals of Allergy and Clinical Immunology | Year: 2011

Background: Sparse clinical observations suggest a possible association between food allergy to lipid transfer protein (LTP) and chronic urticaria (CU). Objective: To investigate the possible association between LTP hypersensitivity and CU. Methods: History of CU, and/or of NSAID hypersensitivity was prospectively assessed in 75 consecutive LTP-allergic subjects (M/F27/48; age 33.6 years); those with positive histories underwent an autologous serum skin test (ASST). 100 atopic subjects not sensitized to LTP and 100 subjects with chronic urticaria served as controls. Results: 16/75 (21%) patients had a history of current or past CU. 7 (9%) had a history of NSAID-induced urticaria, and the ASST scored positive in 9/11 patients (82%). By comparison with atopic controls patients showeda significantlyhigher prevalence ofCU (21% vs 6%; p< 0.01), a > 4 times more frequent history ofNSAID hypersensitivity (9% vs 2%), and a higher prevalence offemales (p< 0.05). In contrast, patients and controls with chronic urticaria showed a similar sex distribution, prevalence of positive ASST, and prevalence of NSAID hypersensitivity. Conclusion: An unidirectional association between LTP hypersensitivity and chronic urticaria seems to exist. The reasons for this are unclear although it is possible that CU makes mast cells more easily excitable by food allergens. Further, it has been shown that NSAIDs may up-regulate type 1 allergic responses to foods, possibly increasing permeability of the gut mucosa. Source


Background: Multiple nonsteroidal anti-inflammatory drug (NSAID) cutaneous reactors may be otherwise normal or have underlying chronic spontaneous urticaria (CSU). This study compared these two phenotypes of NSAID-hypersensitive subjects. Methods: A total of 97 multiple NSAID reactors underwent oral challenges with paracetamol, etoricoxib and tramadol. Atopic status was investigated in all patients, and autoreactivity was ascertained in some cases as well. Otherwise normal multiple NSAID reactors were reevaluated after 1-5 years in order to detect their proneness to CSU. Results: At the first visit, 41 patients had CSU and 56 had multiple NSAID intolerance without any underlying cutaneous disease. Altogether, 22, 10 and 6% of patients did not tolerate paracetamol, etoricoxib and tramadol, respectively, on oral challenge. Intolerance to these alternative drugs showed a strong association (p < 0.01 with all combinations). The two subgroups of patients did not show any difference in terms of mean age, gender distribution, prevalence of atopic diseases, prevalence of single offending NSAIDs and prevalence of intolerance to paracetamol, etoricoxib or tramadol on oral challenge. In all, 20% of multiple NSAID reactors without CSU at presentation developed CSU between 6 months and 5 years after the initial clinical evaluation. Conclusions: Multiple NSAID cutaneous reactors with or without CSU seem identical from a clinical point of view, and some of the latter group show a propensity to acquire the former phenotype over time. A subset of patients apparently identical to the general population of multiple NSAID reactors also react to drugs exerting little or no cyclooxygenase-1 enzyme inhibition and might represent a distinct phenotype of NSAID-hypersensitive patients possibly characterized by a different underlying pathogenesis. © 2013 S. Karger AG, Basel. Source

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