Search Results (372)

Phospholipase A1 (Ves a 1), a major toxin from Vespa affinis venom, poses significant risks to allergic individuals. Nevertheless, the epitope determinants of Ves a 1 have not been characterized. Thus, identifying its linear B-cell epitopes is crucial for understanding envenomation mechanisms. In this study, we predicted and identified B-cell epitopes EP5 and EP6 as potential candidates. EP5 formed an α-helix at the active site of Ves a 1, whereas EP6 adopted an extended loop conformation. Both synthetic peptides were synthesized and evaluated for their inhibitory effects using immune-inhibitory assays with polyclonal antibodies (pAbs) targeting both native (nVes a 1) and recombinant (rVes a 1) forms. The Ves a 1 polyclonal antibodies (pAb-nVes a 1 and pAb-Ves a 1) were produced, and their specificity binding to Ves a 1 was confirmed by Western blot. Next, ELISA inhibition assays showed that EP5 and EP6 significantly blocked pAb binding to both nVes a 1 and rVes a 1. Dot blot and Western blot assays supported these findings, particularly with stronger inhibition toward rVes a 1. Furthermore, enzymatic assays indicated that nVes a 1 and rVes a 1 retained phospholipase activity. Immunoinformatics docking showed that EP5 and EP6 specifically bind to a single-chain variable fragment antibody (scFv) targeting Naja naja PLA2. Molecular analysis revealed similar amino acid interactions to the template, suggesting effective paratope–epitope binding. These results support the potential of EP5 and EP6 for future diagnosis and therapy of V. affinis venom allergy. Full article

Biotin (vitamin B7) is a common, naturally occurring water-soluble vitamin. It belongs to the broad group of B vitamins. It is a common ingredient in dietary supplements, cosmetics, medicines, and parapharmaceutical preparations administered orally or applied topically (to the skin, hair, nails). The problem of the relationship between vitamin B supplementation and sensitivity seems to be multi-threaded. There is little literature data that would confirm that oral vitamin B supplementation or local exposure to biotin is a significant sensitizing factor. Moreover, it seems that allergy to vitamin B7 is very rare. It is possible, however, that the relationship between biotin and hypersensitivity is not limited to its direct action, but results from its essential metabolic function. Vitamin B7, as a cofactor of five carboxylases, affects the main pathways of cellular metabolism. Both deficiency and excess of biotin can result in metabolic disorders, which can have a significant impact on the homeostasis of the entire organism, including the efficient functioning of the immune system. Dysregulation of immune systems leads to its dysfunctional functioning, which can also lead to sensitization to various environmental antigens (allergens). Biotin is also used as an element of some methodological models in immunochemical tests (in vitro diagnostics), including methods used to measure the concentration of immunoglobulin E (IgE), both total (tIgE) and allergen-specific (sIgE). For this reason, vitamin B7 supplementation can be a significant interfering factor in some immunochemical tests, which can lead to false laboratory test results, both false positive and false negative, depending on the test format. This situation can have a direct impact on the quality and effectiveness of diagnostics in various clinical situations, including allergy diagnostics. This review focuses on the role of biotin in allergic reactions, both as a causative factor (allergen/hapten), a factor predisposing to the development of sensitization to various allergens, and an interfering factor in immunochemical methods used in laboratory diagnosis of hypersensitivity reactions and how it can be prevented. Full article

The diagnosis of allergic diseases and anaphylaxis is complex and encompasses a broad spectrum of in vitro and in vivo diagnostic tests. The choice of diagnostic tests is related to the presumed pathophysiological mechanism of the allergic reaction. In the past decade the implementation of component-resolved diagnostics (CRD) into clinical practice has significantly improved the depicting of sensitization profiles, which has aided in the assessment of clinically relevant allergen components that are associated with true allergy, as well as the levels of risk of severe anaphylactic reactions. Recently, multiplex-specific immunoglobulin E (IgE) platforms have emerged for better selection of patients at risk for anaphylaxis and have improved the selection criteria for patients undergoing allergen immunotherapy, including novel regimes such as oral immunotherapy. This review describes the advantages of the utilization of component-resolved diagnostics and multiplex assays in clinical settings, especially in cases of anaphylaxis when no clear trigger is recognized or where multiple culprits are suspected. As multiplex component-resolved diagnostics becomes more readily available globally and with the use of novel approaches, CRD will certainly be a crucial tool in personalized and individually tailored management plans and reduce the financial burden of anaphylaxis. Full article

Background/Objectives: Adolescents with chronic physical health conditions (CHCs) use specific coping strategies to respond to condition-related stressors. However, most studies of CHC-related stress and coping focus on a single condition. The objective of this study was to measure CHC-related stress and identify associated coping strategies in adolescents with a variety of CHCs. A secondary objective was to examine the relationship between CHC-related stress, coping strategies, health-related quality of life, and perceived severity of chronic illness. Methods: Teens (n = 38, 68.42% female, mean age 17.9 years) with CHCs completed the Responses to Stress Questionnaire (RSQ) for CHC-related stress, the PedsQL to assess health-related quality of life, and the Perceptions of the Severity of Chronic Illness (PSCI) measure. The most frequently reported conditions were asthma, food allergies, and multiple conditions. We used fuzzy cluster analysis to identify two clusters, high stress and low stress, based on ratings of CHC-related stressors. Relationships between coping strategies and the PedsQL and PSCI, and between the PSCI and PedsQL, were assessed using Pearson partial correlations. Relationships between the PSCI, PedsQL, and coping strategies for the two clusters were assessed using adjusted mean differences. We adjusted for multiple comparisons by controlling the false discovery rate. Significance was set at p < 0.05. Results: Teens were most likely to use secondary control engagement coping and involuntary engagement to respond to CHC-related stressors. Teens in the two clusters differed on health-related quality of life but not coping strategies or perceived condition severity. CHC diagnosis category was associated with cluster membership. Conclusions: This exploratory study highlighted relationships among quality of life, coping strategies, and CHC diagnosis category that should be explored in future studies. Improved understanding of CHC-related stress and coping strategies in teens with CHCs could have an impact on their quality of life and well-being. Full article

Non-steroidal anti-inflammatory drugs (NSAIDs) can cause hypersensitivity reactions and lead to anaphylactic shock. These drugs also act as cofactors in allergic reactions. Lipid transfer proteins (LTPs), found in plants, represent a unique group of allergens in which cofactors play a crucial role. This case report describes a 26-year-old female who developed anaphylactic symptoms after ingesting grapes and taking ketoprofen. The patient experienced swelling of the lips, tongue, and throat, as well as shortness of breath, dizziness, and loss of consciousness, after consuming grapes and taking ketoprofen. She had previously used ketoprofen and acetylsalicylic acid without issues but had developed urticaria on several occasions after consuming multi-ingredient dishes. Skin prick tests showed positive results for peanut and orange allergens. Further testing using the ALEX multiparametric test detected antibodies to several LTP allergens. Intradermal tests with ketoprofen yielded a positive result, although irritant reactions could not be ruled out. A provocation test with acetylsalicylic acid (ASA) showed no adverse reactions. Skin tests with ibuprofen were negative, and provocation tests confirmed its tolerance. A diagnosis of LTP allergy and selective ketoprofen allergy was made, with the recommendation to avoid ketoprofen and follow a diet excluding foods from the LTP group. Full article

Allergic diseases have been increasing in prevalence over the last years. In a polluted environment, this problem can worsen and become more complex. Long-term exposure to air pollution can lead to the aggravation of allergic rhinitis (AR) and even to the development of seasonal asthma. Climate changes can accelerate and extend the pollination season. Research indicates that air pollution may modify the properties of pollen, making it more aggressive. Asymptomatic allergic people disclose their allergies in a polluted environment. A polluted environment complicates the diagnosis of seasonal allergies. The treatment might be more challenging as standard allergy medications may not be enough to control symptoms. The causal treatment of allergic rhinitis is specific allergen immunotherapy (AIT), which may prove less effective in people living in a polluted environment. The problem may lie in the proper evaluation for AIT as well as the assessment of its effectiveness. To date, the best way to confirm an allergy and qualify a patient for AIT seems to be molecular diagnostics. The question arises whether patients exposed to air pollution, which could potentially reduce the effectiveness of AIT, are still eligible for AIT. It is also debatable whether molecular diagnostics remain effective in such cases. Advancing precision medicine alongside environmental management represents a critical pathway toward reducing the growing global burden of allergic diseases. Full article

The efficacy of Hymenoptera venom immunotherapy is contingent upon the accurate identification of the insect responsible for the allergic reaction. The techniques used to detect specific IgE suffer from difficulties due to the cross-reactivity between Hymenoptera venoms (false positives), diagnostic ability, and the limited availability of allergenic components (false negatives). In this study, we analyzed the discrepancies in the results obtained with Euroline^® DPA-Dx and ImmunoCAP^® in the diagnosis of allergic reactions due to Hymenoptera stings in 151 patients. The results (positive/negative) of ImmunoCAP^® and Euroline^® agreed in 77/151 (50.99%) cases; with 15/151 (9.93%) cases positive for the same insect, and 61/151 (40.4%) cases positive for multiple insects. When the results were used to decide which venom to use for immunotherapy, there was a statistically significant discrepancy for Polistes dominula (21.8% of cases with ImmunoCAP^® compared to only 8.4% with Euroline^®). The presence of Polistes venom phospholipase (Pol d 1) in Euroline^® did not increase its ability to differentiate double sensitization to wasps. ImmunoCAP^® and Euroline^® exhibited comparable diagnostic performance in bee venom allergy. For vespid venom allergy—particularly involving Polistes species—ImmunoCAP^® appeared to show a slight diagnostic advantage, although this finding should be interpreted with caution. Full article

Grass pollen allergies significantly contribute to atopic diseases such as asthma and allergic rhinitis, resulting in considerable healthcare burdens. Objective: In this study, molecular sensitization patterns to grass pollen in Swiss patients were addressed. The research utilized a retrospective cohort approach using ImmunoCAP™ ISAC testing from October 2015 to July 2020. Clinical histories, demographics, and skin prick test results were collected for analysis. The minimum patient age was 18 years and the average patient age was 41.3 years, with a female predominance (68.5%). In total, 4814 measurements were analyzed. Allergic rhinitis was the most common clinical symptom, followed by asthma and urticaria. A total of 1963 patients (40.8%) revealed sensitization to grass pollen. The most common sensitizations were found to the major allergens Phl p 1 (86%) and Phl p 5 (65%), but also to Phl p 4 (62%). Monosensitization was mostly found to allergens Phl p 1 (266/13.5%) and Phl p 4 (157/7.9%), and less so to Phl p 5 (33/1.7%). Notably, the Phl p 4-monosensitized subgroup showed only an 18% positivity rate in skin prick tests and presented mostly with urticaria. This study gives insights into the spectrum of grass pollen allergies in a Central European setting and underscores the possibly underestimated role of Phl p 4 among grass pollen allergens, especially in a subgroup that suffers mainly from seasonal urticaria. Monovalent sensitization to Phl p 4 can also cause seasonal rhinitis and might therefore be missed if only Phl p 1/p 5 are tested. A better understanding of sensitization patterns will further improve diagnosis and treatment options. Full article

Background: Eosinophilic esophagitis is a chronic immune-mediated disease with increasing prevalence. In pediatric populations, it often coexists with IgE-mediated food sensitization. This dual diagnosis presents unique therapeutic challenges, including on the one hand both temporary and lifelong dietary restrictions, and on the other hand, therapeutic interventions with a potential impact on quality of life (QoL). Objectives: This study prospectively evaluated the prevalence of IgE-mediated food sensitization and allergy in children with EoE attending a tertiary center in Flanders, Belgium. Additionally, it prospectively documented dietary habits and restrictions in these children, with or without concomitant IgE-mediated food allergies, and assessed the impact of dietary management on quality of life compared to pharmacological treatment. Methods: We consecutively followed 30 children with biopsy-confirmed pediatric EoE (PedEoE) attending a tertiary referral center for at least 12 months. Patient demographics, allergy testing, dietary history, and treatment modalities were recorded. Symptom score and PedEoE QoL were assessed using validated Pediatric Eosinophilic Esophagitis Symptom Score (PEESS 2.0) and Pediatric Quality of Life Inventory (PedsQL 3.0) questionnaires. Statistical analysis was performed using the Mann–Whitney U test and Kruskal–Wallis test with Dunn’s test as a post hoc test. Results: Among 30 children with EoE (60% male, median age 8 years), 60 PedEoE QoL (PedsQL) and 39 symptom (PEESS) questionnaires were collected at one or more time points over a median follow-up of 14.5 months. IgE sensitization to common dietary triggers was observed in multiple patients, with varying clinical reactivity. Symptom scores tended to be higher in children without histological remission, though differences were not statistically significant (median PEESS 23.75 vs. 17.50, p = 0.1934). Grouped by degree of dietary restriction, QoL scores showed significant differences (child p = 0.0102; parent p = 0.0203), with children in the 1–2 food elimination group reporting better QoL compared to the 0 food elimination and >6 food elimination groups. No clear statistically significant differences were observed between the 1–2 food elimination group and the 3–4 or 5–6 food elimination groups. Conclusions: IgE sensitization is prevalent among pediatric EoE patients and has significant clinical implications for disease management. Treatment choice can influence not only disease control but also the QoL of both patients and their families. Full article

Type I allergies are triggered by immunoglobulin E (IgE)-mediated hypersensitivity reactions upon allergen exposure. Dogs are diagnosed with allergic dermatitis based on history, clinical signs, and allergen-specific IgE detection. Using the multiple allergen simultaneous test (MAST)–immunoblot assay, this study measured IgE concentrations and analyzed the proportion of dogs showing allergen-specific IgE positivity, and IgE concentrations of environmental and food allergens in South Korea. We examined data from canine serum using the MAST assay in 2023; the allergen panel included 130 allergens. Data were analyzed, with results greater than zero regarded as positive for the prevalence measurements and concentrations compared among subgroups. Overall, 2663 samples were evaluated to assess the proportion of dogs showing allergen-specific IgE positivity and mean concentrations of environmental and food allergens. Among the environmental allergens, Alternaria spp. had the highest IgE prevalence, whereas Japanese cedar had the highest mean IgE concentration. Allergen-specific differences were observed among subgroups categorized by age, sex, and breed. To our knowledge, this research is the first large-scale study to analyze canine serum using a MAST assay to assess the IgE prevalence of allergen-specific IgE positivity and concentration and to examine data by age, sex, and breed. These findings provide information for diagnosis and management of canine allergies. Full article

Food-Induced Immediate Response of the Esophagus (FIRE) is a newly described syndrome observed in eosinophilic esophagitis (EoE) patients. It is defined by an immediate hypersensitivity reaction of the esophagus that occurs when specific foods and beverages interface with esophageal mucosa. The available data regarding this topic is scarce. Therefore, we aimed to review relevant publications in order to better characterize the main aspects of this syndrome and hypothesize about potential mechanisms underlying FIRE syndrome and possible future therapeutic approaches. We searched PubMed, Embase, and Web of Science databases for relevant articles published before February 1st, 2025. The results were narrowed down to four articles describing a total of 105 cases of FIRE syndrome. These patients had a distinct clinical presentation, characterized by retrosternal discomfort or pain, differentiating it from solid food dysphagia or pollen-food allergy syndrome (PFAS). Currently, diagnosis is based on clinical presentation, with no diagnostic tests or biomarkers available. Emerging evidence suggests that IgE-mediated hypersensitivity, mast cells, and neuroimmune interactions may play a central role in the pathogenesis of FIRE syndrome. The therapeutic approaches remain speculative, with trigger avoidance being the main option. This article brings to the forefront the need for continued research to address current knowledge gaps regarding FIRE syndrome, which is important for optimizing patient management. Full article

Background and Objectives: Shellfish allergies are common in Vietnam. The basophil activation test (BAT) is a powerful tool in the diagnosis of food allergies. We aimed to evaluate the application of BAT to distinguish shrimp allergy in comparison with skin prick test and specific IgE measurement. Materials and Methods: We recruited adult shrimp- or prawn-allergic subjects from the University Medical Center (Vietnam). BAT was performed using the in-house crude extracts for two allergens: black tiger shrimp Penaeus monodon (shrimp) and giant freshwater prawn Macrobrachium rosenbergii (prawn). The percentages of CD63 in response to shrimp and prawn were recorded. The results of skin prick tests (SPT) and the specific IgE (sIgE) levels in response to commercial shrimp/prawn were noted. Receiver operating characteristic (ROC) analysis and area under the curve (AUC) were calculated. Results: Of 43 recruited subjects, 9 (26.5%) subjects had a specific allergy to shrimp, 2 (5.9%) subjects had a specific allergy to prawn, and 23 (67.6%) subjects had both shrimp and prawn allergy. Basophil CD63% was significantly increased in subjects with allergy to shrimp and prawn (p < 0.05% for all). Compared with SPT and sIgE, CD63 expression-based BAT was better in discriminating subjects with allergies to these species from their non-allergic counterparts (AUC/sensitivity/specificity = 0.88/77%/89% for shrimp, and 0.74/88%/77% for prawn, p < 0.05 for all). The addition of SPT and BAT improved the diagnostic power. A positive BAT could help identify shrimp/prawn allergy among cases with negative SPT/sIgE to shrimp/prawn. BAT facilitated the diagnosis of shrimp allergy among prawn-allergic subjects (100% accurate). Conclusions: The BAT test can help predict clinical reactions to shrimp and prawn in allergic patients, and enhance diagnostic accuracy in cases where SPT or specific IgE tests yield negative results. Full article

Allergic diseases represent a major and growing global health concern, with increasing prevalence among both children and adults. This manuscript presents an extensive review of allergy mechanisms, epidemiology, diagnostics, and clinical challenges, highlighting the complex interplay between immune system dysregulation and environmental exposures. The authors provide a structured analysis of hypersensitivity types, with particular focus on IgE-mediated responses, and emphasize the role of immune barrier defects, epigenetics, and the microbiota in allergic pathogenesis. This manuscript explores diagnostic limitations, including test sensitivity, specificity, and the presence of hidden allergens, as well as challenges in identifying food-related or atypical allergic reactions. A novel and valuable aspect is the discussion of allergy as a potential clinical manifestation of primary immunodeficiencies, such as selective IgA deficiency, Wiskott–Aldrich syndrome, hyper-IgE syndrome, and Netherton syndrome. This review also outlines challenges in treatment, especially among polysensitized patients, and examines the psychosocial burden and complications of allergic diseases, including mental health, nutritional deficiencies, and impaired sleep. This comprehensive synthesis underscores the need for early diagnosis, multidisciplinary management, and personalized therapeutic strategies to improve quality of life of allergic patients. Full article

Background. Cow’s milk allergy (CMA) is one of the most common food allergies in infancy, with prevalence estimates of 0.5–7.5% in high-income countries. Data from low- and middle-income regions remain limited, and the predominant immune mechanism (IgE or non-IgE mediated) may vary across populations. Objective. We aimed to determine the prevalence and clinical characteristics of CMA in infants from an urban, low-income Chilean population. Methods. A prospective cohort study was conducted at Padre Hurtado Hospital in Santiago, Chile. Healthy term newborns were recruited and followed for up to 12 months. Sociodemographic, perinatal data and parental atopy were recorded. Parents were contacted monthly to screen for CMA symptoms. Infants with ≥two symptoms underwent clinical evaluation, a 4-week cow’s milk protein exclusion diet, and an open oral food challenge (OFC). Diagnosis followed international consensus guidelines. Results. Of 552 enrolled infants (48% male), 27 were diagnosed with CMA, yielding a prevalence of 4.9% (95% CI 3.1–7.0%). All cases exhibited non-IgE-mediated symptoms, including vomiting, dermatitis, colic, and perianal erythema. CMA was diagnosed before 6 months of age in 74% of cases. At 12 months, 40% had developed oral tolerance. Sociodemographic and perinatal characteristics were similar between groups, but some self-reported parental atopic traits were more frequent in CMA cases. Conclusions. CMA prevalence in this Chilean cohort was comparable to that reported in high-income countries, with a predominance of non-IgE-mediated forms. These findings support the need for standardized diagnostic protocols, including OFC, in diverse populations. Future studies should explore long-term outcomes and risk factors in non-IgE-mediated CMA. Full article

Background: The symptoms of cow’s milk allergy (CMA) can vary widely in severity and course, so diagnosis and treatment are still challenging. Objective: This study aims to establish the phenotype of severe CMA in children with the greatest improvement following the application of amino acid-based formula (AAF). Methods: This is a post hoc analysis of data from the multicenter, real-life study assessing the clinical effectiveness of a 5-week AAF intervention in 232 infants with severe CMA. A cluster analysis based on symptom severity at the 1st visit was performed. The differences in the severity scale of each symptom before and after the intervention were assessed and compared within and between clusters. The clustering results were validated in a separate cohort of infants with CMA (n = 157). Results: Three clusters were identified: cluster A (38.8% of patients) with moderate-to-severe gastrointestinal symptoms, cluster B (34.1%) with severe skin symptoms, and cluster C (25.9%) with combined moderate-to-severe gastrointestinal and severe skin symptoms. In the validation cohort, three clusters with the same pattern of symptoms were observed among children with moderate-to-severe CMA. The multivariate model of linear regression showed that severity score reductions after AAF treatment were significantly higher in cluster C than in clusters A and B, in children with a positive family history of allergy, and in children with growth retardation at baseline. Conclusion: Symptoms of severe CMA in children are grouped into three distinct phenotypes—gastrointestinal, skin, and combined gastrointestinal and skin. The most significant improvement after AAF implementation was obtained in patients with a combined phenotype. Full article