Diagnostic and Therapeutic Principles In Allergy

2018 ◽  
Author(s):  
Mitchell H. Grayson ◽  
Peter Mustillo
Keyword(s):  
Food Allergy ◽  
Immunoglobulin E ◽  
Skin Testing ◽  
Allergic Sensitization ◽  
Allergic Diseases ◽  
Specific Ige ◽  
Severe Form ◽  
Therapeutic Principles ◽  
Anticytokine Therapy ◽  
Release Assay

The incidence of allergic diseases, like asthma, allergic rhinitis, and food allergy, is increasing in Westernized countries. This chapter discusses the importance of taking a careful and focused history and physical examination, as well as the laboratory studies that can be used to demonstrate the presence of allergic sensitization. Treatment for allergic disease is discussed, with an emphasis on new biologic therapies that have been developed. Finally, the chapter explores relatively new studies on the potential for interventions to prevent food allergy.  Allergy is defined as an untoward physiologic event mediated by immune mechanisms, usually involving the interaction between an allergen and the allergic antibody, immunoglobulin E (IgE). Allergic reactions typically occur due to exposure to either airborne allergens, foods, drugs, chemicals, or Hymenoptera (such as wasps, bees and fire ants). Allergies manifest in numerous ways, including allergic asthma, allergic rhinoconjunctivitis, urticaria, eczema, and in its most severe form, anaphylaxis. This review contains 4 videos, 5 figures, 4 tables and 42 references Key Words: Delayed allergic reaction (Alpha-gal), Allergy diagnosis, Measurement of specific IgE, Allergy and asthma therapies, Anticytokine therapy (dupilumab, mepolizumab, reslizumab), AntiIgE therapy (omalizumab), Allergy skin testing, Basophil histamine release assay

scholarly journals The role of IgE, IgG, and IgA in tolerance, sensitization, and targeted treatment of allergic disease

2021 ◽  
Author(s):  
Mohamed Shamji ◽  
Rudolf Valenta ◽  
Theodore Jardetzky ◽  
Valerie Verhasselt ◽  
Stephen Durham ◽  
...  
Keyword(s):  
Immunoglobulin E ◽  
Allergic Sensitization ◽  
Passive Immunization ◽  
Allergic Inflammation ◽  
Allergic Diseases ◽  
Immediate Release ◽  
Specific Ige ◽  
Allergen Specific Immunotherapy ◽  
Effector Cells ◽  
Iga Antibodies

Immunoglobulin E (IgE)-mediated allergy is the most common hypersensitivity disease affecting more than 30% of the population. In genetically-predisposed subjects exposure to minute quantities of allergens leads to the production of IgE antibodies which is termed allergic sensitization and mainly occurs in early childhood. Allergen-specific IgE then binds to the high (FcRI) and low affinity receptors (FcRII, also called CD23) for IgE on effector cells and antigen-presenting cells, respectively. Subsequent and repeated allergen exposure increases allergen-specific IgE levels and, by receptor cross-linking, triggers immediate release of inflammatory mediators from mast cells and basophils whereas IgE-facilitated allergen presentation perpetuates T cell-mediated allergic inflammation. Due to engagement of receptors which are highly selective for IgE even tiny amounts of allergens can induce massive inflammation. Naturally occurring allergen-specific IgG and IgA antibodies usually recognize different epitopes on allergens compared to IgE, and do not efficiently interfere with allergen-induced inflammation. However IgG and IgA antibodies to these important IgE epitopes can be induced by allergen-specific immunotherapy or by passive immunization. These will lead to competition with IgE for binding with the allergen and prevent allergic responses. Similarly, anti-IgE treatment does the same by preventing IgE from binding to its receptor on mastcells and basophils. Here we review the complex interplay of allergen-specific IgE, IgG and IgA and the corresponding cell receptors in allergic diseases and its relevance for diagnosis, treatment and prevention of allergy.

scholarly journals The role of IgE, IgG, and IgA in tolerance, sensitization, and targeted treatment of allergic disease

2021 ◽  
Author(s):  
Mohamed Shamji ◽  
Rudolf Valenta ◽  
Theodore Jardetzky ◽  
Valerie Verhasselt ◽  
Stephen Durham ◽  
...  
Keyword(s):  
Immunoglobulin E ◽  
Allergic Sensitization ◽  
Passive Immunization ◽  
Allergic Inflammation ◽  
Allergic Diseases ◽  
Immediate Release ◽  
Specific Ige ◽  
Allergen Specific Immunotherapy ◽  
Effector Cells ◽  
Iga Antibodies

Immunoglobulin E (IgE)-mediated allergy is the most common hypersensitivity disease affecting more than 30% of the population. In genetically-predisposed subjects exposure to minute quantities of allergens leads to the production of IgE antibodies which is termed allergic sensitization and mainly occurs in early childhood. Allergen-specific IgE then binds to the high (FcRI) and low affinity receptors (FcRII, also called CD23) for IgE on effector cells and antigen-presenting cells, respectively. Subsequent and repeated allergen exposure increases allergen-specific IgE levels and, by receptor cross-linking, triggers immediate release of inflammatory mediators from mast cells and basophils whereas IgE-facilitated allergen presentation perpetuates T cell-mediated allergic inflammation. Due to engagement of receptors which are highly selective for IgE even tiny amounts of allergens can induce massive inflammation. Naturally occurring allergen-specific IgG and IgA antibodies usually recognize different epitopes on allergens compared to IgE, and do not efficiently interfere with allergen-induced inflammation. However IgG and IgA antibodies to these important IgE epitopes can be induced by allergen-specific immunotherapy or by passive immunization. These will lead to competition with IgE for binding with the allergen and prevent allergic responses. Similarly, anti-IgE treatment does the same by preventing IgE from binding to its receptor on mastcells and basophils. Here we review the complex interplay of allergen-specific IgE, IgG and IgA and the corresponding cell receptors in allergic diseases and its relevance for diagnosis, treatment and prevention of allergy.

scholarly journals Investigation of markers of allergic sensitization and viral infections in children with allergy and asthma

2017 ◽  
Vol 24 (3) ◽  
pp. 145-152
Author(s):  
Rūta Dubakienė ◽  
Vilija Rubinaitė ◽  
Malvina Petronytė ◽  
Indrė Dalgėdienė ◽  
Odilija Rudzevičienė ◽  
...  
Keyword(s):  
Viral Infections ◽  
Allergic Sensitization ◽  
Allergic Diseases ◽  
Developed Countries ◽  
Specific Ige ◽  
High Rate ◽  
Control Group ◽  
Igg Antibodies ◽  
Airway Infections ◽  
Respiratory Viral Infections

Background. Allergic diseases are the most prevalent chronic diseases in the developed countries. It is believed that early allergic sensitization and respiratory viral infections play an important role in the development of allergic diseases and asthma. Methods. The current study investigated the correlation between asthma, allergy, and various markers – allergen-specific IgE, IgG4 and IgA, ECP, IgM, and IgG antibodies against respiratory viruses hRSV and hPIV1-4 – in blood serum samples from 80 children (mean age 5.2 years) recruited from the Lithuanian birth cohort. Children were divided into three groups according to their diagnosis: asthma (n = 25), allergy without asthma (n = 14), and control group (n = 41). Results. Based on retrospective data, airway infections and bronchitis by the age of two years were associated with asthma in later childhood. The presence of IgM and IgG antibodies against hRSV and hPIV1–4 at the age of five years were not associated with asthma and allergy: a high rate of persistent or past respiratory viral infections was revealed in all three groups. Among allergic children, increased levels of allergen-specific IgE and d1-specific IgG4 were determined. Conclusion. The current study provides new insights into the relationships between allergic sensitization and respiratory virus infections in children.

scholarly journals The Study of a Possible Correlation between Serum Levels of Interleukin 17 and Clinical Severity in Patients with Allergic Rhinitis

2017 ◽  
Vol 8 (3) ◽  
pp. ar.2017.8.0207
Author(s):  
Mai Aly Gharib Aly ◽  
Mohamed Tawfik El Tabbakh ◽  
Waheed Fawzy Heissam ◽  
Said Hamed Abbadi
Keyword(s):  
Allergic Rhinitis ◽  
Immunoglobulin E ◽  
Skin Testing ◽  
Allergic Diseases ◽  
Serum Levels ◽  
Clinical Severity ◽  
Total Serum ◽  
Interleukin 17 ◽  
Serum Ige ◽  
Cluster Immunotherapy

Introduction Allergic rhinitis (AR) is one of the most common allergic diseases, which affects ~20% of the world's population. T-helper (Th) type 2 cells produce interleukin (IL) 4 and IL-13, and mediate allergic responses, and these cytokines have been extensively studied as key players in the atopic airway diseases. However, the involvement of Th17 cells and IL-17 in AR has not been clearly examined. Aim To reevaluate AR clinical severity with serum IL-17, whether IL-17 affects the disease alone or in contribution with the atopic predisposition. Patients and Methods During an 18-month period, 39 individuals were divided into three groups: A, (13 control), B (13 with mild-to-moderate AR), and C (13 with severe AR). Both group B and group C patients (26) were subjected to clinical examination and allergy skin testing, and to measurement of both total serum immunoglobulin E (IgE) and IL-17 levels. Eleven patients with AR then were exposed to 6 months of cluster immunotherapy, whereas the rest of the patients were not exposed. Results Revealed a significant elevation of serum IL-17 levels with an associated increase in serum IgE in the patients with AR compared with controls and revealed that the serum levels of both total serum IgE and IL-17 decreased significantly after cluster immunotherapy. Conclusion These preliminary results added new data about the use of injective immunotherapy as well as reported on the use of sublingual immunotherapy.

scholarly journals Novel Bead-Based Epitope Assay is a sensitive and reliable tool for profiling epitope-specific antibody repertoire in food allergy

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Maria Suprun ◽  
Robert Getts ◽  
Rohit Raghunathan ◽  
Galina Grishina ◽  
Marc Witmer ◽  
...  
Keyword(s):  
Food Allergy ◽  
Specific Antibody ◽  
Allergic Sensitization ◽  
Specific Ige ◽  
Antibody Binding ◽  
Peptide Microarrays ◽  
Short Period ◽  
Reading Order ◽  
Multiple Sample ◽  
The Relationship

AbstractIdentification of allergenic IgE epitopes is instrumental for the development of novel diagnostic and prognostic methods in food allergy. In this work, we present the quantification and validation of a Bead-Based Epitope Assay (BBEA) that through multiplexing of epitopes and multiple sample processing enables completion of large experiments in a short period of time, using minimal quantities of patients’ blood. Peptides that are uniquely coupled to beads are incubated with serum or plasma samples, and after a secondary fluorophore-labeled antibody is added, the level of fluorescence is quantified with a Luminex reader. The signal is then normalized and converted to epitope-specific antibody binding values. We show that the effect of technical artifacts, i.e. well position or reading order, is minimal; and batch effects - different individual microplate runs - can be easily estimated and eliminated from the data. Epitope-specific antibody binding quantified with BBEA is highly reliable, reproducible and has greater sensitivity of epitope detection compared to peptide microarrays. IgE directed at allergenic epitopes is a sensitive biomarker of food allergy and can be used to predict allergy severity and phenotypes; and quantification of the relationship between epitope-specific IgE and IgG4 can further improve our understanding of the immune mechanisms behind allergic sensitization.

Assessment of serum levels of allergen-specific immunoglobulin E in different seasons and breeds in healthy horses

2014 ◽  
Vol 17 (2) ◽  
pp. 331-337 ◽  
Author(s):  
P.M. Wilkołek ◽  
Z.J.H. Pomorski ◽  
M.P. Szczepanik ◽  
Ł. Adamek ◽  
M. Pluta ◽  
...  
Keyword(s):  
Immunoglobulin E ◽  
Winter Season ◽  
Allergic Diseases ◽  
Serum Levels ◽  
Specific Ige ◽  
Diagnostic Tools ◽  
Storage Mites ◽  
Acarus Siro ◽  
Different Seasons ◽  
Domestic Mites

Abstract The present study was designed to asses specific IgE towards environment allergens in 42 healthy horses. Determination of this immunoglobulin in serum serve as diagnostic tools in allergic diseases to improve efficacy of the treatment and proper allergen selection to specific immunotherapy. Serum levels of allergen specific IgE were measured with equine monoclonal antibody, using 15 individual and 5 mix allergens in North European Panel. The study revealed season dependent increased levels of allergen specific IgE in normal horses. It is noteworthy that healthy horses show high percentage of positive reactions, most commonly towards to domestic mites D. farinae (80%), D. pteronyssinus (35.71%) and storage mites T. putrenscentiae (42.86%), Acarus siro (40.48%). These allergens play an important role in equine, canine and feline atopic dermatitis. We also demonstrated high IgE levels in the group of horse specific insect allergens. Tabanus sp. (35.71%), Culicoides sp. (28.57%) and Simulium sp. (26.19%) were the most frequent insect positive reaction allergens. No positive reactions in all groups of allergens were found in winter season, low and merely detectable levels of antibodies have been found relating to D. farianae and T. putrescentiae allergen. We observed elevated mould-IgE levels in horses that live in stables, while outdoor living horses showed very low levels. Amongst all positive reactions we observed only weak and moderate reactions but no strong positive reactions were found. No significant differences were observed between three breeds of horses with the exception of moulds and D. pteronyssinus allergens

scholarly journals Laboratory screening test with inhalant and food allergens in atopic Brazilian children and adolescents: a performance

2021 ◽  
Vol 49 (5) ◽  
pp. 42-48
Author(s):  
Ana Carolina Rozalem-Reali ◽  
Felipe Faria Pierotti ◽  
Aranda Carolina ◽  
Renata Rodrigues Cocco ◽  
Emanuel Cavalcanti Sarinho ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Immunoglobulin E ◽  
Allergic Sensitization ◽  
Screening Method ◽  
High Sensitivity ◽  
Allergic Diseases ◽  
Cross Sectional Study ◽  
Food Allergens ◽  
Cross Sectional ◽  
Brazilian Children

The Phadiatop Infant® (PhInf) is a panel developed to assess allergic sensitization (immunoglobulin E [IgE]) in children aged <5 years and combines inhalant and food allergens. The test has not been evaluated outside Europe. This is a cross-sectional study conducted at 11 pediatric allergy centers to evaluate PhInf as an allergic disease screening method in Brazilian children. Children as controls and patients (aged 6 months–18 years) were grouped according to their primary disease and age group. PhInf and specific serum IgE (sIgE) screening was performed for Dermatophagoides pteronyssinus (DP), cat and dog epithelia, a mix of grasses and pollens, eggs, cow’s milk, peanuts, and shrimp. Values ≥ 0.35 kUA/L (or PAU/L) were considered positive. A total of 470 children and adolescents, which included 385 patients and 85 controls, participated in the study (47.7% boys, average age: 6.3 years). In all, 72.6% of the participants had positive PhInf test (n = 341), with a higher proportion of those having food allergy (92.6%), atopic dermatitis (91.9%), and those aged >13 years having allergy (95%). The PhInf and sIgE agreement between patients (Kappa = 0.94, P < 0.001) and controls (Kappa = 0.84, P < 0.001) was high. PhInf and DP agreement in patients aged >13 years was excellent (Kappa = 0.936, P < 0.001). Compared with sIgE dosage, PhInf had high sensitivity (97%) and specificity (93%). Positivity of PhInf test in this population was high and had an excellent correlation with the allergens comprising the panel. It is a useful method for screening children suspected of having allergic diseases in a non-European country.

scholarly journals Tracing IgE-Producing Cells in Allergic Patients

Cells ◽  
2019 ◽  
Vol 8 (9) ◽  
pp. 994 ◽  
Author(s):  
Julia Eckl-Dorna ◽  
Sergio Villazala-Merino ◽  
Nicholas James Campion ◽  
Maria Byazrova ◽  
Alexander Filatov ◽  
...  
Keyword(s):  
Plasma Cells ◽  
Immunoglobulin E ◽  
Current Knowledge ◽  
Allergic Diseases ◽  
Specific Ige ◽  
Allergen Exposure ◽  
World Population ◽  
Effector Cells ◽  
Ige Receptors ◽  
Pre Treatment

Immunoglobulin E (IgE) is the key immunoglobulin in the pathogenesis of IgE associated allergic diseases affecting 30% of the world population. Recent data suggest that allergen-specific IgE levels in serum of allergic patients are sustained by two different mechanisms: inducible IgE production through allergen exposure, and continuous IgE production occurring even in the absence of allergen stimulus that maintains IgE levels. This assumption is supported by two observations. First, allergen exposure induces transient increases of systemic IgE production. Second, reduction in IgE levels upon depletion of IgE from the blood of allergic patients using immunoapheresis is only temporary and IgE levels quickly return to pre-treatment levels even in the absence of allergen exposure. Though IgE production has been observed in the peripheral blood and locally in various human tissues (e.g., nose, lung, spleen, bone marrow), the origin and main sites of IgE production in humans remain unknown. Furthermore, IgE-producing cells in humans have yet to be fully characterized. Capturing IgE-producing cells is challenging not only because current staining technologies are inadequate, but also because the cells are rare, they are difficult to discriminate from cells bearing IgE bound to IgE-receptors, and plasma cells express little IgE on their surface. However, due to the central role in mediating both the early and late phases of allergy, free IgE, IgE-bearing effector cells and IgE-producing cells are important therapeutic targets. Here, we discuss current knowledge and unanswered questions regarding IgE production in allergic patients as well as possible therapeutic approaches targeting IgE.

scholarly journals Additives and preservatives: Role in food allergy

2020 ◽  
Vol 2 (1) ◽  
pp. 119-123
Author(s):  
Amber N. Pepper ◽  
Panida Sriaroon ◽  
Mark C. Glaum
Keyword(s):  
Food Allergy ◽  
Immunoglobulin E ◽  
Skin Prick Testing ◽  
Food Additives ◽  
Specific Ige ◽  
Food Additive ◽  
Blood Testing ◽  
Commercial Products ◽  
Natural Substances ◽  
Ige Mediated

Food additives are natural or synthetic substances added to foods at any stage of production to enhance flavor, texture, appearance, preservation, safety, or other qualities. Common categories include preservatives and antimicrobials, colorings and dyes, flavorings, antioxidants, stabilizers, and emulsifiers. Natural substances rather than synthetics are more likely to cause hypersensitivity. Although rare, food additive hypersensitivity should be suspected in patients with immunoglobulin E (IgE)-mediated reactions to multiple, unrelated foods, especially if the foods are prepared outside of the home or when using commercial products. A complete and thorough history is vital. Skin prick testing and/or specific IgE blood testing to food additives, if available, additive avoidance diets, and blind oral challenges can help establish the diagnosis. Once an allergy to a food additive is confirmed, management involves avoidance and, if necessary, carrying self-injectable epinephrine.

scholarly journals Food allergy and atopic dermatitis

2020 ◽  
Vol 2 (1) ◽  
pp. 35-38
Author(s):  
Tina Banzon ◽  
Donald Y.M. Leung ◽  
Lynda C. Schneider
Keyword(s):  
Atopic Dermatitis ◽  
Food Allergy ◽  
Immunoglobulin E ◽  
Growth Failure ◽  
Skin Barrier ◽  
Clinical History ◽  
Skin Inflammation ◽  
Specific Ige ◽  
Nutritional Deficiencies ◽  
Detailed Clinical History

Atopic dermatitis (AD), characterized by intense pruritus, eczematous lesions, and a relapsing disease course, is a chronic inflammatory skin disease that affects both children and adults. AD often begins in infancy and is associated with atopic diseases in the personal or family history.1 Environmental factors may trigger AD by affecting the skin barrier and by triggering inflammation. The elicitation of T-helper type 2 cytokines further impairs the epidermal barrier and leads to the penetration of irritants and allergens into the epidermis and thereby perpetuating inflammation. The presence of AD and its severity has been shown to positively correlate with risk of developing food allergy (FA). Children with AD are estimated to be six times more likely to develop FA compared with their healthy peers. It has been reported that nearly 40% of children with moderate-to-severe AD have immunoglobulin E (IgE) mediated FA compared with only 6% in the general population. Although analysis of experimental data has linked skin inflammation in AD to FA, with food challenges reproducing symptoms and avoidance diets improving AD, elimination diets are not known to cure AD and may have unfavorable consequences, such as loss of tolerance, which leads to immediate-type allergy, including anaphylaxis, nutritional deficiencies, growth failure, and reduction of quality of life for the patient and family. Exacerbation of AD can be inaccurately attributed to foods. Individuals with AD are often sensitized to foods with positive testing results, however, able to tolerate the food. In light of widespread ordering and commercial availability of serum specific IgE for FA, testing for FA is recommended only if, from a detailed clinical history, immediate-type allergic symptoms occur with ingestion of food, or in infants with AD who do not improve with optimal skin care.

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