allergy
Genetic basis of the latex-fruit syndrome: association with HLA class II alleles in a Spanish population.

Blanco C, Sanchez-Garcia F, Torres-Galvan MJ, Dumpierrez AG, Almeida L, Figueroa J, Ortega N, Castillo R, Gallego MD, Carrillo T.

Servicio de Alergia, Hospital de Gran Canaria Dr. Negrin, C/Bco de la Ballena s/n, 35012 Las Palmas de Gran Canaria, Spain. cblague gobiernodecanarias.org

BACKGROUND: The latex-fruit syndrome is a well-defined disorder whose genetic background has not been elucidated. OBJECTIVE: To study the genetic basis of the latex-fruit syndrome. METHODS: In a case-control study, we have investigated a carefully selected group of patients allergic to latex, searching for association between latex-fruit allergy and HLA class I and II genes, HLA-DR functional groups, and markers IL4-R1 and FcepsilonRI-betaca . RESULTS: Seventy-eight patients allergic to latex without spina bifida, 33% of them also allergic to fruits, were included in our protocol. Skin prick test results with both a commercial latex extract and purified hevein were significantly greater in patients allergic to latex and fruit than in patients allergic to latex and not fruit. A cutoff point of >7 mm for commercial latex skin prick test diagnosed latex-fruit allergy with a sensitivity of 66.7% (95% CI, 41.0-86.6) and a specificity of 83.3% (95% CI, 68.6-93.0) in our series of patients. No significant differences were found regarding HLA class I, IL4-R1 , or FcepsilonRI-betaca allele distributions. However, comparison of HLA class II allelic frequencies between patients allergic to latex and fruit and patients allergic to latex and not fruit showed significant associations of latex-fruit allergy with DQB1 *0201 (corrected P value, .001; odds ratio, 7.3; 95% CI, 2.6-20.0), as well as with HLA-DR functional group E (corrected P value, .028; odds ratio, 16.0; 95% CI, 1.9-134.1). When comparing allelic distribution among different subgroups of patients allergic to latex, additional significant associations of latex-fruit allergy with DRB1 *0301 and *0901, and of latex and not fruit allergy with DQB1 *0202, DRB1 *0701 and *1101, were demonstrated. CONCLUSIONS: Latex-fruit allergy is associated with HLA-DQB1 *0201, DRB1 *0301, and *0901, as well as with HLA-DR functional group E, whereas latex-not-fruit allergy is associated with DQB1 *0202, and with both DRB1 *0701 and *1101 alleles.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15536412&dopt=Abstract allergy medicine



allergy
Development of a questionnaire to measure quality of life in families with a child with food allergy.

Cohen BL, Noone S, Munoz-Furlong A, Sicherer SH.

Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Mount Sinai School of Medicine, Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA.

BACKGROUND: Food allergy is potentially severe, affects approximately 5% of children, and requires numerous measures for food avoidance to maintain health. The effect of this disease on health-related quality of life (HRQL) has been documented by using generic instruments, but no disease-specific instrument is available. OBJECTIVE: To create a validated, food allergy-specific HRQL instrument to measure parental burden associated with having a child with food allergy: the Food Allergy Quality of Life-Parental Burden questionnaire. METHODS: After identification of 74 items affecting families with children with food allergy, 88 families were approached for effect scoring. Final items were generated by score results, elimination of redundancies, and content review. Resulting high-effect areas were queried for validation with a 7-point Likert scale. A final instrument including 17 items and 2 expectation of outcome questions was distributed to 352 families for validation. RESULTS: Areas of effect included family/social activities (restaurant meals, social activities, child care, vacation), school, time for meal preparation, health concerns, and emotional issues. Validation steps showed strong internal validity (Cronbach alpha, 0.95) and good correlation with expectation of outcome questions ( r = 0.412; P < .01) and scores on a generic HRQL instrument, the Children's Health Questionnaire-PF50 ( r = -0.36 to -0.4; P < .01). The instrument showed the ability to discriminate by disease burden: parents whose children had multiple (>2) food allergies were more affected than parents whose children had fewer allergies (scores, 3.1 vs 2.6; P < .001). CONCLUSIONS: The Food Allergy Quality of Life-Parental Burden demonstrates strong internal and cross-sectional validity. Its discriminative ability suggests that it will be a useful tool to measure outcomes in treatment studies of food allergy for children.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15536425&dopt=Abstract allergy medicine



allergy
Health-related quality of life among adolescents with allergy-like conditions - with emphasis on food hypersensitivity.

Marklund B, Ahlstedt S, Nordstrom G.

Centre for Allergy Research, Karolinska Institutet, S-171 77 Solna, Sweden. birgitta.marklund omv.ki.se

BACKGROUND: It is known that there is an increase in the prevalence of allergy and that allergic diseases have a negative impact on individuals' health-related quality of life (HRQL). However, research in this field is mainly focused on individuals with verified allergy, i.e. leaving out those with self-reported allergy-like conditions but with no doctor-diagnosis. Furthermore, studies on food hypersensitivity and quality of life are scarce. In order to receive information about the extent to which adolescent females and males experience allergy-like conditions and the impact of these conditions on their everyday life, the present study aimed to investigate the magnitude of self-reported allergy-like conditions in adolescence and to evaluate their HRQL. Special focus was put on food hypersensitivity as a specific allergy-like condition and on gender differences. METHODS: In connection with lessons completed at the children's school, a study-specific questionnaire and the generic instrument SF-36 were distributed to 1488 adolescents, 13-21 years old (response rate 97%). RESULTS: Sixty-four per cent of the respondents reported some kind of allergy-like condition: 46% reported hypersensitivity to defined substances and 51% reported allergic diseases (i.e. asthma/wheezing, eczema/rash, rhino-conjunctivitis). A total of 19% reported food hypersensitivity. Females more often reported allergy-like conditions compared with males (p < 0.001). The adolescents with allergy-like conditions reported significantly lower HRQL (p < 0.001) in seven of the eight SF-36 health scales compared with adolescents without such conditions, regardless of whether the condition had been doctor-diagnosed or not. Most adolescents suffered from complex allergy-like conditions. CONCLUSIONS: The results indicate a need to consider the psychosocial impact of allergy-like conditions during school age. Further research is needed to elucidate the gender differences in this area. A team approach addressing better understanding of how allergy-like conditions impair the HRQL may improve the management of the adolescent's health problems, both in health-care services and in schools.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15555064&dopt=Abstract allergy medicine



allergy
A survey of antibiotic prescribing and knowledge of penicillin allergy.

Puchner TC Jr, Zacharisen MC.

Allergy/Immunology, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, USA.

BACKGROUND: Cephalosporins can cause allergic reactions in patients with penicillin (PCN) allergy. Physicians' prescribing habits for patients with PCN allergy can vary. OBJECTIVES: 1) Survey community and academic physicians, students, residents, and allergists on their tendencies to prescribe cephalosporins and/or perform PCN skin testing in patients with different histories of PCN allergy. 2) Evaluate PCN allergy knowledge in these groups. METHODS: A questionnaire consisting of four case scenarios and five true/false questions on PCN allergy was distributed at various conferences and by mailings. RESULTS:Three hundred seventy-eight completed surveys were analyzed. Given a patient with a history of rash with PCN, an equal number of allergists and nonallergists (36%) prescribed cephalosporins, although there was a difference between pediatricians (56%) and internists (22%). Given a history of PCN anaphylaxis, no allergists but 11% of nonallergists prescribed a cephalosporin. Skin testing was infrequently requested by nonallergists. The correct response rate for the true/false questions was 89% for allergists, community (63%) and academic (67%) physicians, pediatricians (61%), internists (67%), residents (68%), and students (68%). Pediatric residents had the highest (74%) and community pediatricians the lowest (59%) correct response rate. CONCLUSIONS: There is marked variation in prescribing cephalosporins and in requesting PCN skin testing in patients with varied histories of PCN allergy. The survey results indicate a need for increased PCN allergy education.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11814274&dopt=Abstract allergy medicine



allergy
Bowel wall thickening in infants with food allergy.

Kino M, Kojima T, Yamamoto A, Sasal M, Taniuchi S, Kobayashi Y.

Department of Paediatrics, Kansai Medical University, 10-15 Fumizonocho, Moriguchi, Osaka 570-8506, Japan.

BACKGROUND: Food allergy may be partly due to impairment of the intestinal barrier and is frequently associated with atopic dermatitis (AD) in early life. OBJECTIVE: To determine whether bowel wall thickening, as demonstrated by US, is useful for the identification of food allergy. MATERIALS AND METHODS: We used US to study eight infants with food allergy and ten non-allergic controls to clarify whether specific intestinal findings in the jejunum, ileum and colon are present in infants with AD who have food allergy. RESULTS: Wall thickening was observed in all eight patients with food allergy, but only in the jejunum; it disappeared after elimination of suspected dietary allergens. Bowel wall thickening returned in the two allergic patients who received a food challenge test. CONCLUSIONS: Wall thickening of more than 2 mm on US in the jejunum in infants with AD may be a useful marker to evaluate the presence of food allergy and therapeutic effects.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11819060&dopt=Abstract allergy medicine



allergy
Experiences from an allergy prevention programme in schoolchildren in a Swedish community.

Hannerz A.

Health Centre of Rosenlund, Jonkoping, Sweden.

OBJECTIVE: To evaluate an allergy prevention programme in a community. DESIGN: Allergy prevention programme initiated by a special community allergy prevention committee and evaluation of this programme by means of a questionnaire to schoolchildren on repeated occasions during the period 1980 to 1998. SETTING: The community of Habo in Sweden with about 9500 inhabitants. MAIN OUTCOME MEASURES: Prevalence of allergy manifestations according to the questionnaire. RESULTS: In contrast to what is mostly reported, the prevalence of allergic manifestations seemed to decrease in the community of Habo during the observation period. CONCLUSION: The results indicate a benefit from an intensified allergy prevention programme on the local level, but additional observations from other communities are needed in order to draw safe conclusions about the effect of allergy prevention programmes.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11822652&dopt=Abstract allergy medicine



allergy
Cell-surface expression of CD25, CD26, and CD30 by allergen-specific T cells is intrinsically different in cow's milk allergy.

Schade RP, Van Ieperen-Van Dijk AG, Versluis C, Van Reijsen FC, Kimpen JL, Bruijnzeel-Koomen CA, Knol EF, Van Hoffen E.

Department of Dermatology/Allergology, University Medical Center, Utrecht, The Netherlands.

BACKGROUND: The release of T(H)2 cytokines by food-specific T cells is thought to be important in the etiology of food allergy. It has been suggested that the activation state of food-specific T cells also plays a significant role, but this has not yet been studied at the single-cell level. OBJECTIVE: Differences in the expression of cell-surface markers by cow's milk protein (CMP)-specific T cells between infants with and without cow's milk allergy (CMA) were evaluated at the clonal level. In addition, expression after the spontaneous development of tolerance of cow's milk in infants with CMA was analyzed. METHODS: We established CMP-specific T-cell clones (TCCs) from blood of infants with CMA and atopic dermatitis, from atopic controls with atopic dermatitis but without CMA, and from nonatopic controls. In addition, we established TCCs from infants with CMA after they had spontaneously developed tolerance to cow's milk. Expression levels of CD25, CD26, and CD30 by each TCC were analyzed by use of flow cytometry. RESULTS: Cow's milk protein-specific T cells from infants with CMA expressed much higher levels of CD25 and CD30 than CMP-specific T cells from infants without CMA. Expression of CD26 was much lower than in normal controls. After development of tolerance for cow's milk, expression of CD25 and CD30 was decreased, whereas the expression of CD26 was increased to normal levels. CONCLUSION: Antigen-specific T cells from patients with food allergy display an increased expression of cell-surface markers of activation compared with cells of patients without food allergy. This suggests an intrinsically stronger food-specific T-cell response in food-allergic patients, and points to the key role of food-specific T cells in the pathogenesis of food allergy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11842309&dopt=Abstract allergy medicine