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Incorvaia C.,Istituti Clinici di Perfezionamento | Rapetti A.,Transfusional Unit | Aliani M.,Pulmonary Unit | Castagneto C.,Internal Medical Unit | And 10 more authors.
Recent Patents on Inflammation and Allergy Drug Discovery

The diagnosis of food allergy, as assessed by skin tests or in vitro tests with allergen extracts, has insufficient diagnostic performance and needs to be confirmed by food challenges. However, the availability of molecular allergens (recombinant or highly purified) for laboratory methods has profoundly changed the diagnostic approach to food allergy. In fact, the allergy diagnosis conducted at the molecular level, which is defined internationally as component resolved diagnosis (CRD), allows to characterize more precisely the sensitization profile of the individual patient, distinguishing the sensitizations to allergens that are strongly associated with a given source (genuine sensitizers) from those to molecules that are common to many sources (panallergens) or cross-react with other components from the same family or from other families. This review provides an update on the allergen molecules from foods, including plant foods and animal foods, and on the techniques to detect them, by means of a single reagent (singleplex) or an array of molecules tested at the same time (multiplex). Such testing offers detailed information on the sensitization profile of patients and enables the physician to suitably manage their allergy. Moreover, identifying the real causative allergens will be crucial when allergen immunotherapy for food allergy will be introduced in the near future. We also address patents concerning food allergens in this review. © 2014 Bentham Science Publishers. Source

Scala E.,Experimental Allergy Unit
European Annals of Allergy and Clinical Immunology

Allergen immunotherapy (AIT) represents the only way to modify the natural history of allergic diseases. Unfortunately, AIT is not always followed by a reduction in symptoms. The main reasons for such failure can be inadequate diagnosis and/or the poor treatment. In both cases, an incomplete or insufficient understanding of the component(s) responsible for the IgE sensitization on the one hand, and, on the other hand, the lack of a steady and reliable allergen mixture to be used for the desensitization process, could explain unsuccessful treatment. A more comprehensive IgE reactivity profile evaluation of the patient can be achieved by means of a molecule-based diagnostic approach, in order to distinguish genuine from panallergen-driven antigen recognition. At the same time, a better delineation of AIT products by means of molecular dissection, can allow a stronger correlation between diagnostic findings and immunotherapeutic intervention, thus facilitating the right prescription to the right patient. Source

Canonica G.W.,University of Genoa | Passalacqua G.,University of Genoa | Incorvaia C.,Allergy Pulmonary Rehabilitation Unit | Cadario G.,Allergy and Clinical Immunology Unit | And 10 more authors.
Allergy and Asthma Proceedings

The efficacy of allergen immunotherapy (AIT) is well supported by evidence from trials and meta-analyses. However, its actual performance in daily practice may be diminished by several pitfalls, including inappropriate patient selection, and, especially, the use of allergen extracts of insufficient quality. We performed a survey, the Allergen Immunotherapy Decision Analysis, to evaluate which criteria specialists use to choose products for sublingual immunotherapy (SLIT) in adult patients suffering from allergic respiratory disease. We surveyed a total of 169 Italian allergists randomly chosen from a database belonging to a market research company (Lexis Ricerche, Milan, Italy). The survey was performed between October and November 2012 under the aegis of the European Center for Allergy Research Foundation and consisted of a questionnaire-based electronic survey prepared by a scientific board of 12 AIT experts. The questionnaire comprised two parts, the first of which contained 14 items to be ranked by each participant according to the importance assigned to each when choosing SLIT products. The physicians' rankings assigned major importance to the level of evidence-based validation of efficacy and safety, standardization of the product, efficacy based on personal experience, and defined content(s) of the major allergen(s) in micrograms. The results of this survey show that Italian allergists rank the quality-related characteristics of allergen extracts as highly important when choosing products for AIT. The allergists' preference for high-quality products should be addressed by regulatory agencies and by producers. Copyright © 2014, OceanSide Publications, Inc., U.S.A. Source

Cecchi L.,University of Florence | Scala E.,Experimental Allergy Unit | Ridolo E.,University of Parma | Makri E.,Allergy Pulmonary Rehabilitation | And 2 more authors.
Biologics: Targets and Therapy

The molecular allergy technique, currently defined as component-resolved diagnosis, significantly improved the diagnosis of allergy, allowing for differentiation between molecules actually responsible for clinical symptoms (genuine sensitizers) and those simply cross-reacting or shared by several sources (panallergens), thus influencing the appropriate management of a patient’s allergy. This also concerns allergen immunotherapy (AIT), which may be prescribed more precisely based on the component-resolved diagnosis results. However, the advance in diagnosis needs to be mirrored in AIT. According to consensus documents and to expectations of specialists, therapy should be based on standardized extracts containing measured amounts of the clinically relevant molecules, ie, the major allergens. The new generation of extracts for sublingual immunotherapy fulfills these requirements and are thus defined as biomolecular (BM). BM refers to natural extracts with a defined content of major allergens in micrograms. All Staloral BM products are indicated for the treatment of allergic rhinitis with or without asthma. The effectiveness of AIT is related to its ability to modify the immunological response of allergic subjects. The 5-grass and house dust mite extracts were evaluated addressing the T helper 1, T helper 2, and T helper 3 cells by polymerase chain reaction array on mRNA extracted from Waldeyer’s ring tissue (adenoids). Sublingual immunotherapy with a defined content of major allergens in micrograms induced a strong downregulation of genes involved in T helper 2 and T helper 1 activation and function, allowing the definition of the immunologic effect as “bio-homeostatic”. This clinical and immunological model must be implemented with respect to other allergens, thus expanding the application of a treatment with a unique disease-modifying capacity. © 2014 Frati et al. Source

Scala E.,Experimental Allergy Unit | Till S.J.,Kings College London | Asero R.,Ambulatorio di Allergologia | Abeni D.,Health Services Research Unit | And 7 more authors.
Allergy: European Journal of Allergy and Clinical Immunology

Background Nonspecific lipid transfer proteins (nsLTPs) represent a major cause of systemic food allergic reactions in the Mediterranean area. This study investigate hierarchical patterns and cluster relationships of IgE sensitization to different nsLTPs, and the relationship to clinical allergy in a large Italian cohort. Methods A total of 568 nsLTP-positive subjects after IgE ImmunoCAP-ISAC microarray analysis with Ara h 9, Art v 3, Cor a 8, Jug r 3, Pla a 3, Pru p 3 and Tri a 14 allergens were studied. IgE inhibition experiments were carried out with mugwort and plane tree pollen extracts. Results Eighty-two per cent of nsLTP-positive participants (94% if <6 years old) were Pru p 3pos, and 71% were Jug r 3pos. Participants who reacted to >5 nsLTPs reported a higher incidence of food-induced systemic reactions. Only Art v 3 and Pla a 3 (mugwort and plane tree nsLTPs, respectively) were associated with respiratory symptoms, and a correlation was observed between sensitization to pollen and plant food nsLTPs, particularly between Pla a 3 and tree nut/peanut nsLTPs. Co-sensitization to Par j 2 and PR-10 or profilin pan-allergens was associated with a lower prior prevalence of severe food-induced reactions. In inhibition assays, plane and mugwort pollen extracts inhibited 50-100% of IgE binding to food nsLTPs in microarrays. Conclusions Testing IgE reactivity to a panel of nsLTP allergens unveils important associations between nsLTP sensitization profiles and clinical presentation and allows the identification of novel cluster patterns indicating likely cross-reactivities and highlighting potential allergens for nsLTP immunotherapy. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Source

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