allergy
A link between skin and airways regarding sensitivity to fragrance products?

Elberling J, Linneberg A, Mosbech H, Dirksen A, Frolund L, Madsen F, Nielsen NH, Johansen JD.

The National Allergy Reseasrch Centre for Consumer Products, Department of Dermatology, Gentofte University Hospital, Ledreborg Alle 40,1, DK-2820 Gentofte, Denmark. jeel gentoftehosp.kbhamt.dk

BACKGROUND: Exposure to volatile fragrances is commonplace and may be related to various eye and airway symptoms. Skin exposure to fragrances is known to cause perfume contact allergy and eczema, but it is unknown whether eye or airway symptoms elicited by fragrance products are associated with contact allergy or eczema. OBJECTIVES: To investigate if eye and airway symptoms elicited by fragrance products are associated with perfume contact allergy or hand eczema in a population-based sample. METHODS: A questionnaire on eye and airway symptoms elicited by fragrance products was mailed to 1189 individuals who had recently participated in a Danish population-based study of allergic diseases. Results from the questionnaire about localization and character of the symptoms were compared with data on patch testing and 1-year prevalence of hand eczema collected during the health examination. RESULTS: Positive, independent and significant (P < 0.05) associations were found between eye and airway symptoms elicited by fragrance products and perfume contact allergy (adjusted odds ratios 2.0-3.7) and hand eczema (adjusted odds ratios 1.6-2.6). In further analysis, similar and consistent results were found regarding severity of the symptoms. No associations were found between nickel contact allergy and the symptoms. Female sex and psychological vulnerability were independently associated with eye and airway symptoms elicited by fragrance products, but adjustment in multivariate analysis did not change the results regarding perfume contact allergy and hand eczema. CONCLUSIONS: Individuals with perfume contact allergy and/or hand eczema, as opposed to those without, have more frequent and more severe eye or airway symptoms after exposure to volatile fragrance products. Having hand eczema has the greatest impact on reporting eye and airway symptoms elicited by fragrance products.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15606515&dopt=Abstract allergy medicine



allergy
A rational clinical approach to suspected insulin allergy: status after five years and 22 cases.

Bodtger U, Wittrup M.

Steno Diabetes Centre, Gentofte, Denmark. ub-all rh.dk

AIMS: Allergy to recombinant human (rDNA) insulin preparations is a rare complication of insulin therapy. However, insulin preparations contain several allergens, and several disorders can resemble insulin allergy. Studies evaluating the diagnostic procedures on suspected insulin allergy are extremely few. METHODS: Since January 1998, we have used a standardized investigative procedure during admittance to the medical ward allowing observation and repeated recording of reactions to intradermal skin test (performed with a commercially available kit containing isolated insulin allergens). Data on all investigated cases until April 2003 were collected retrospectively, and self-reported efficacy of intervention was compared to clinical data. RESULTS: Twenty-two patients were included. In nine (41%) cases, non-insulin allergic causes were discovered and successfully treated: poor injection technique (n = 5), skin disease (n = 3) and other systemic allergy (n = 1). Nine other patients were found to be allergic to protamine (n = 3) or rDNA insulin (n = 6), and specific treatment was associated with relief in 8 patients (89%). Four patients had local reactions of unknown causes but symptom relief was obtained in three cases by unspecific therapy. Overall, 20 (91%) reported relief of symptoms. CONCLUSION: Our standardized investigative procedure of suspected insulin preparation (IP) allergy was associated with relief of symptoms in > 90% of patients. IP allergy was diagnosed in 41%, and intradermal testing with isolated insulin allergens was a prerequisite in identification of culprit allergen and targeting of treatment.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15606700&dopt=Abstract allergy medicine



allergy
Occupational allergy in medical doctors.

Sato K, Kusaka Y, Suganuma N, Nagasawa S, Deguchi Y.

Department of Environmental Health, School of Medicine, University of Fukui, Fukui, Japan. satokazu fmsrsa.fukui-med.ac.jp

Allergic diseases have increased in many developed countries including Japan. Doctors are also at risk for allergic diseases from exposure to allergens in working conditions and hospital environments. We investigated the factors relating to occupational allergy in doctors. Self-administered questionnaires were mailed to all doctors (n=895) who had previously graduated from School of Medicine, Fukui Medical University. Data from 307 responders (response rate: 34.3%, male 241, female 66, mean age +/- S.D., 30.8 +/- 4.2) were analyzed. Eighty-nine doctors stated that they had occupational allergy including contact dermatitis, allergic rhinitis and/or asthma. Fifty-four had contact dermatitis caused by surgical gloves; 77 had contact dermatitis from disinfectants, e.g. 23 from chlorhexidine gluconate; 21 from povidone iodine; and 15 from ethanol. Fifteen doctors experienced allergic rhinitis and/or asthma caused by handling laboratory animals. Univariate analysis showed that profession (surgical doctors) and past histories of allergic diseases (rhinitis, sinusitis, or atopic dermatitis) were significantly related to occupational allergy in doctors, but that gender, smoking or physical exercise were not significantly related to it. A logistic regression analysis showed that past histories of allergic diseases and the profession of surgical doctors were significantly related to occupational allergy, but that gender, age or smoking were not significantly related to it. The results of the present study suggest that past history of allergic diseases is a factor predisposing to occupational allergy in doctors. It is necessary and possible to extend more prophylactic measures for doctors, especially for surgeons, because exposure to responsible agents and materials for them can be more frequent.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15090693&dopt=Abstract allergy medicine



allergy
Diagnostic value of birch recombinant allergens (rBet v 1, profilin rBet v 2) in children with pollen-related food allergy.

Cudowska B, Kaczmarski M.

III Department of Paediatrics, Medical University of Bialystok, Poland. becud wp.pl

PURPOSE: Pollen-related food allergy to fresh fruits and vegetables is a well-known clinical phenomenon. Bet v 1, the major birch pollen allergen, has been cloned and shows homologies to various food allergens (e.g. hazelnut, apple, celery, tomato). Allergy to profilin Bet v 2 was also described in 10-15% of patients sensitized to birch pollen. Objective of our work was to assess the diagnostic value of recombinant allergens (rBet v 1, rBet v 2) for diagnosis of children sensitized to birch pollen with associated food allergy. MATERIAL AND METHODS: The investigations were carried out on the group of 14 children aged 4-17 years, with a history of allergic reactions and sensitized to birch pollen with associated food allergy. Skin prick tests were performed with natural foods and commercial aeroallergens (Bencard). Sera-specific IgE antibodies to recombinant and other allergens (Pharmacia Upjohn) were measured with a fluoroimmunoenzymatic essay (UniCAP). Oral food challenge tests were performed to confirm adverse food reactions. RESULTS: 64% were sensitized to rBet v 1, 14% to rBet v 2, 7% to both of them. 50% of children with allergy to Bet v 1 had also concomitant allergy to other pollens and food allergy to fruits from family Rosaceae. Patients with positive reaction to Bet v 2 represented allergy to vegetables from family Umbelliferae. The most common form of allergic reactions were: allergic rhinitis in 64%, atopic dermatitis in 36%, oral allergy syndrom in 21% of investigated children. CONCLUSIONS: Use of two recombinant allergens permits the diagnosis of birch pollen sensitization in children with food-pollen related allergy and gives the pattern of possible cross-reactivity between pollen and food allergens in children with allergic diseases.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15631325&dopt=Abstract allergy medicine



allergy
Allergy after ingestion or inhalation of cereals involves similar allergens in different ages.

Armentia A, Rodriguez R, Callejo A, Martin-Esteban M, Martin-Santos JM, Salcedo G, Pascual C, Sanchez-Monge R, Pardo M.

The Allergy and Medicine Sections, Rio Hortega Hospital, Valladolid, Spain. jmartinsantos nexo.es

BACKGROUND: Cereals are among the major foods that account for food hypersensitivity reactions. Salt-soluble proteins appear to be the most important allergens contributing to the asthmatic response. In contrast, very limited information is available regarding cereal allergens responsible for allergic reactions after ingestion of cereal proteins. OBJECTIVE: The aim of this study was to evaluate the allergenic reactivity of ingested and inhaled cereal allergens in different ages, in order to investigate if the response to different allergens would depend on the sensitization route. METHODS: We included 66 patients in three groups. Group 1: 40 children aged 3 to 6 months who suffered from diarrhoea, vomiting, eczema or weight loss after the introduction of cereal formula in their diet and in which a possibility of coeliac disease was discarded. Group 2: 18 adults with food allergy due to cereals tested by prick tests, specific IgE and food challenge. Group 3: eight patients previously diagnosed as having baker's asthma. Sera pool samples were collected from each group of patients and IgE immunoblotting was performed. RESULTS: We found an important sensitization to cereal in the 40 children. The most important allergens were wheat followed by barley and rye. Among the adults with cereal allergy, sensitization to other allergens was common, especially to Lolium perenne (rye grass) pollen. Immunoblotting showed similar allergenic detection in the three groups. CONCLUSION: Clinically significant reactivity to cereal may be observed in early life. Inhalation and ingestion routes causing cereal allergy seem to involve similar allergens. The diet control was more effective in children. The possibility of cereal allergy after the introduction of cereal formula during the lactation period should not be underestimated.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12190662&dopt=Abstract allergy medicine



allergy
[Asthma and food allergy: report of 163 pediatric cases]

[Article in French]

Rance F, Dutau G.

Service d'allergologie et de pneumologie, hopital des Enfants, CHU Toulouse, 330, avenue de Grande-Bretagne, 31026 Toulouse, France. rance.f chu-toulouse.fr

The prevalence of food as a cause for asthma is not well known. The aim of this study was to define with standardized tests the incidence of food-induced asthma, the distribution of foods allergens in asthmatic children with food allergy. The study was carried on 163 asthmatic children with food allergy followed during average of 5.5 years. Asthma has been identified with pulmonary function tests (reversibility of FEV1 to bronchodilators) and food allergy has been documented by double-blind placebo-controlled food challenge (DBPCFC). Familial atopic disease was found in 148 children (90.7%). Inhalant sensitization was documented in 132 children (81%). Positive DBPCFC were observed in 250 of 385 challenges (65%) carried on these 163 children. The most frequent offending foods were, sometimes in association, peanut (30.6%), egg (23.1%), cow's milk (9.3%), mustard (6.9%), codfish (6%), shrimp (4.5%), kiwi fruit (3.6%), hazelnut (2.7%), cashew nut (2.1%), almond (1.5%), garlic (1.2%). Symptoms occurring during DBPCFC were cutaneous (143 cases, 59%), respiratory symptoms (58 cases, 23.9%), gastrointestinal symptoms (28 cases, 11.5%) and 15 anaphylactic shock (6.1%). Respiratory symptoms were oral allergy syndrome in 13 cases (5.3%), rhinoconjunctivitis in 15 cases (6.1%), asthma in 23 cases (9.5%). Only seven of these children had asthma only (2.8% of cases). The prevalence of asthma induced by food allergy is low. In our study, asthma induced by food allergy concerned 9.5% of cases and asthma alone was identified in only 2.8% of cases. We observed new food allergens associated with respiratory symptoms such as kiwi fruit, tree-nuts (hazelnut, cashew) and spices. Diagnosis relied upon data obtained from history, skin prick-tests and specific IgE. Oral food challenge is the corner stone of the diagnosis. Asthma induced by food allergens is potentially severe leading to prescribe to these patients a first aid kit with bronchodilators and epinephrine auto-injectors.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12205816&dopt=Abstract allergy medicine



allergy
Incidence of allergic contact sensitization in Danish adults between 1990 and 1998; the Copenhagen Allergy Study, Denmark.

Nielsen NH, Linneberg A, Menne T, Madsen F, Frolund L, Dirksen A, Jorgensen T.

Department of Dermatology K, Gentofte Hospital, University of Copenhagen, 65, Niels Andersens Vej, DK-2900 Hellerup, Denmark. ninie gentoftehosp.dk

BACKGROUND: Studies of incidence of contact allergy in a general population have not been reported. Data from incidence studies may support and direct strategies for prevention of contact allergy and allergic contact dermatitis. OBJECTIVE: To study the incidence of contact allergy and evaluate risk factors for developing contact allergy in an adult general population sample. PATIENTS AND METHODS: In 1990 a random sample of 567 persons of the 15-69-year-old population living in the western part of Copenhagen County (Denmark) was patch tested in a cross-sectional study. In 1998 a follow-up study was performed. Of 540 invited, 365 (68%) were patch tested again. RESULTS: In the follow-up study, 37 persons (12%) of the 313 patch-test-negative persons in 1990 had developed one or more positive patch tests (incident contact allergy). Twenty cases (6%) of incident nickel allergy and 25 cases (8%) of incident contact allergy to one or more haptens other than nickel were found. The data indicate that female sex, young age and ear piercing (before 1990) were risk factors for developing nickel allergy. Between 1990 and 1998 metal contact dermatitis was reported in seven women with incident nickel allergy. Six of these women had bought the eliciting item in Denmark before 1995, when vigorous control of the Danish nickel legislation was introduced. CONCLUSIONS: We found a considerable number of incident cases of contact allergy in the adult population. The results of the study support the actions taken to restrict the use of the allergens most frequently encountered, and to increase the labelling demands to products intended for prolonged contact with the skin or a combined action.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12207588&dopt=Abstract allergy medicine