Alternaria as an Inducer of Allergic Sensitization

Alternaria alternata is a saprophytic mold whose spores are disseminated in warm dry air, the typical weather of the Mediterranean climate region (from 30° to 45°), with a peak during the late summer and early autumn. Alternaria spores are known to be biological contaminants and a potent source of aeroallergens. One consequence of human exposure to Alternaria is an increased risk of developing asthma, with Alt a 1 as its main elicitor and a marker of primary sensitization. Although the action mechanism needs further investigation, a key role of the epithelium in cytokine production, TLR-activated alveolar macrophages and innate lymphoid cells in the adaptive response was demonstrated. Furthermore, sensitization to A. alternata seems to be a trigger for the development of co-sensitization to other allergen sources and may act as an exacerbator of symptoms and an elicitor of food allergies. The prevalence of A. alternata allergy is increasing and has led to expanding research on the role of this fungal species in the induction of IgE-mediated respiratory diseases. Indeed, recent research has allowed new perspectives to be considered in the assessment of exposure and diagnosis of fungi-induced allergies, although more studies are needed for the standardization of immunotherapy formulations.

Case series of seven cases of urticaria, angioedema, and anaphylaxis (LTP syndrome) due to foods (nuts, lentils, and citrus foods) related to tree pollen (Prosopis juliflora and Holoptelea integrifolia) sensitization

Lipid transfer protein syndrome (LTPS) results from a primary sensitization to LTP belonging to the PR-14 family of pathogenesis-related PR-proteins which are plant food allergens, stable against heat and digestive enzymes, and can induce systemic reactions of urticaria, angioedema, and anaphylaxis. Here, we report a case series of seven patients with nsLTP syndrome. Our six cases of LTPS were significantly sensitized to Prosopis juliflora and Holoptelea integrifolia and one case was sensitized to H. integrifolia only. In our seven cases, we hypothesized that symptoms of hypersensitivity reaction to foods were due to cross-reactivity by IgE reactive protein of ns-LTP as a major allergenic protein in foods.

A Case Report of Allergy to Peach’s Lipid Transfer Protein

Peach belongs to the Rosaceae family. One of the particularities of this allergy is the difference in clinical reactivity according to geography. We report a 4-year 8-month-old boy with well-controlled asthma and no symptoms of allergic rhinitis, that at the age of 1 year, 15 minutes after the ingestion of a fruit compote, presented urticaria with respiratory discomfort. At the age of 3 years, following ingestion of fruit salad, the child presented a few minutes later, a similar episode but of greater intensity. At the age of 4, following contact with a fruit basket, the child immediately presented a generalized reaction more severe and intense than the previous ones. Investigation of allergies to aerial allergens was negative. Skin tests for cooked and raw peach were positive for the peel and pulp. Specific-IgE was positive for Pru p 3 (5.7 KIU/l) and negative for Pru p 1. LTPs are particularly stable and resistant to proteolysis and heat. Management consisted of avoidance of peach, education of the child and family, and prescription of an emergency kit including self-injectable adrenaline. Our observation highlights the strong association between Pru p 3: peach’s Lipid Transfer Protein (LTP) positivity and the severity of allergy symptoms. We consider this case as a primary sensitization to peach’s LTP.

Clinical and immunological characteristics of sensitization to tropomyosins

Tropomyosins are a family of allergenic proteins found in large quantities in all invertebrates. Tropomyosins sensitization causes a life-threatening allergic reaction up to anaphylaxis after eating seafood. Identifying the source of primary sensitization is important to predict the allergic reaction severity. This article describes a clinical case of chronic recurrent urticaria in an 8-year-old boy with tropomyosins sensitization. An 8-year-old boy was diagnosed with the following: controlled atopic phenotype bronchial asthma, food allergy (oral allergy syndrome), and chronic recurrent spontaneous urticaria. Component diagnostics revealed IgE-aB to tropomyosins in high concentrations from 38.79 to 43.38 kUA/l and cat and dog uteroglobin and lipocalins in high concentrations from 7.79 to 43.38 kUA/l. It is necessary to specify the primary sensitizer to analyze the clinical significance of allergens that provoke sensitization to various groups of allergens. In this case, sensitization to tropomyosins is most likely described as caused by either a helminthic invasion or midge bites. Therefore, food allergic reactions to tropomyosins caused from crustaceans were not observed.

HYPERSENSITIVITY TO DOG ALLERGENS (CLINICAL CASES)

HYPERSENSITIVITY TO DOG ALLERGENS (CLINICAL CASES) M. A. Lykova Shupyk National Healthcare University of Ukraine, KIA «Forpost», Kyiv, Ukraine Abstract. The aim of the study: to analyze the clinical cases of sensitization to dog allergens and tactics of management of patients in accordance with the results of component allergodiagnostics. Materials and methods of research. Analysis of these case histories of three patients, the results of their clinical, laboratory and functional studies. Research results. In all clinical cases included in this study, patients had complaints of animal allergy symptoms, confirmed by skin prick tests. However, the results of component allergodiagnostics revealed differences in the profile of sensitization to the respective allergens. For example, patient №1 was sensitized to the canine allergen Can f5, a urinary kallikrein found only in male dogs, as well as the minor component Can f3, which may cross-react with serum albumin from mammalian meat and milk. Patient №2 showed primary sensitization to dog allergens and cross-hypersensitivity to cat allergens due to lipocalins. Treatment tactics were chosen for both patients — allergen-specific immunotherapy (ASIT) with dog allergens. In patient №3, primary sensitization to the main allergen of the dog was confirmed, which makes it possible to predict the high efficiency of ASIT. Conclusions. Component (molecular) allergodiagnostics is an important method of determining the sensitization profile of patients with hypersensitivity to dog allergens, which allows to establish a correct diagnosis, choose treatment tactics and predict the effectiveness of ASIT in each case. Key words: component allergodiagnostics, dog allergens, hypersensitivity, allergic rhinitis, bronchial asthma.

Effect of low-intensity radiation on the morphological features of Peyer's plaque

Radiation has a negative impact on human health because of its high penetrating power. Mitoti-cally dividing cells and the lymphoid tissue of the gastrointestinal tract are most radiosensitive. The intestine is the major zone of sensitization and recycling of immunocytes that populate the mucous membranes of other organs. Immune-competent tissues of the digestive tract are repre-sented by lymphoid tissue, where the leading role belongs to Peyer's plaques-group accumula-tions of lymphoid tissue. The antigen-sensitized lymphocytes of Peyer's plaques migrate to the mesenteric lymph nodes, and from there through the lymphatic vessels through the thoracic duct and circulatory system and are directed to their own layer of the intestinal mucosa, mainly as IgA-secreting cells. This mechanism ensures the formation of clones of lymphocytes and the for-mation of specific antibodies in the areas of the mucous membrane that are remote from the fo-cus of primary sensitization. The important thing is that, unlike other lymphoid tissues that require infection or local immunization to form a germinal center, reproduction centers are always pre-sent in Peyer's plaques, regardless of the presence of infection.

Marker allergens in Hymenoptera venom allergy — Characteristics and potential use in precision medicine

Background A comprehensive diagnostic work-up is essential to ensure adequate patient management for the potentially life-threatening condition of Hymenoptera venom allergy (HVA). This includes an unambiguous identification of the allergy-relevant venom as prerequisite for successful venom-specific immunotherapy (VIT). If the clinical history does not allow the identification of the culprit insect, diagnosis is often hampered by positive test results to various venoms. Modern component-resolved diagnostics (CRD) applying marker allergens of Hymenoptera venoms has created new opportunities which facilitate therapeutic decisions and may allow personalized risk stratification for individual patients. Methods Comprehensive literature search and critical analysis of recently published studies on Hymenoptera venom allergens and CRD. Results and discussion Changing the research focus from whole venom extracts to individual allergenic molecules led to the development of CRD in HVA. The currently available CRD is a valuable tool to resolve cross-reactivity and primary sensitization, particularly in honeybee and vespid venom allergy. Hence, CRD has simplified therapeutic decisions in case of multiple positive test results, especially in patients who were not able to identify the culprit insect or in cases of discrepancies between clinical history and classical diagnostic results. Moreover, there is first evidence that sensitization to particular allergens might serve as biomarkers to predict risk for severe side-effects during VIT or even for VIT failure. To date, a clear limitation of CRD is the currently available allergen panel which does not allow a definite resolution of allergy to different vespid species such as yellow jackets and European paper wasps.

Natural Tr1-like cells do not confer long-term tolerogenic memory

IL-10-producing Tr1 cells promote tolerance but their contributions to tolerogenic memory are unclear. Using 10BiT mice that carry a Foxp3-eGFP reporter and stably express CD90.1 following IL-10 production, we characterized the spatiotemporal dynamics of Tr1 cells in a house dust mite model of allergic airway inflammation. CD90.1+Foxp3-IL-10+ Tr1 cells arise from memory cells and rejoin the tissue-resident memory T-cell pool after cessation of IL-10 production. Persistent antigenic stimulation is necessary to sustain IL-10 production and Irf1 and Batf expression distinguishes CD90.1+Foxp3-IL-10+ Tr1 cells from CD90.1+Foxp3-IL-10- ‘former’ Tr1. Depletion of Tr1-like cells after primary sensitization exacerbates allergic airway inflammation. However, neither transfer nor depletion of former Tr1 cells influences either Tr1 numbers or the inflammatory response during subsequent allergen memory re-challenge weeks later. Together these data suggest that naturally-arising Tr1 cells do not necessarily give rise to more Tr1 upon allergen re-challenge or contribute to tolerogenic memory. This phenotypic instability may limit efforts to re-establish tolerance by expanding Tr1 in vivo.