This document discusses molecular-based allergy diagnostics and provides definitions and concepts. It outlines how molecular allergy diagnostics can increase the accuracy of allergy diagnosis by helping to resolve cross-reactivity between allergens and distinguish primary sensitizations. It also describes how molecular diagnostics can help assess the risk and type of allergic reaction, and identify specific allergens relevant for immunotherapy. A wide range of purified and recombinant food, aeroallergen, and other allergens are available to facilitate these applications.
Allergies are becoming increasingly common in Australia for a range of reasons. These slides were developed for a course created to help the community better understand and more effectively manage allergies.
The document provides market data on antihistamine drugs in Bangladesh for the first quarter of 2015. It details the total market size of 293.60 crore and lists the top selling generic drugs by value, led by cetirizine at 68.79 crore. The market share of each generic is also shown, with cetirizine and fexofenadine each holding 23% and 22% respectively. Growth rates for the market are provided, with rupatadine seeing the highest growth of 67.93%. Brand performance data for rupatadine brands in Bangladesh is outlined. Finally, the document introduces Exalin, a new 10mg rupatadine tablet from Opso Saline
This document discusses molecular-based allergy diagnostics and provides definitions and concepts. It outlines how molecular allergy diagnostics can increase the accuracy of allergy diagnosis by helping to resolve cross-reactivity between allergens and distinguish primary sensitizations. It also describes how molecular diagnostics can help assess the risk and type of allergic reaction, and identify specific allergens relevant for immunotherapy. A wide range of purified and recombinant food, aeroallergen, and other allergens are available to facilitate these applications.
Allergies are becoming increasingly common in Australia for a range of reasons. These slides were developed for a course created to help the community better understand and more effectively manage allergies.
The document provides market data on antihistamine drugs in Bangladesh for the first quarter of 2015. It details the total market size of 293.60 crore and lists the top selling generic drugs by value, led by cetirizine at 68.79 crore. The market share of each generic is also shown, with cetirizine and fexofenadine each holding 23% and 22% respectively. Growth rates for the market are provided, with rupatadine seeing the highest growth of 67.93%. Brand performance data for rupatadine brands in Bangladesh is outlined. Finally, the document introduces Exalin, a new 10mg rupatadine tablet from Opso Saline
Anaphylaxis is an acute multi-system allergic reaction that can involve the skin, airways, blood vessels, and gastrointestinal tract. It is a severe and immediate hypersensitivity reaction. The most common causes are foods, drugs, and insect bites or stings. Symptoms affect multiple body systems and can include skin issues like hives or swelling, respiratory issues like difficulty breathing, and cardiovascular issues like dizziness or fainting. Diagnosis is based on symptoms occurring after exposure to a potential trigger. Treatment involves epinephrine, antihistamines, corticosteroids, monitoring for several hours, and prevention through allergen avoidance and carrying emergency medication.
A food allergy occurs when the immune system mistakenly identifies a harmless food protein as dangerous and releases antibodies to attack it. This can trigger histamine release and cause symptoms ranging from mild to severe like anaphylaxis. Common food allergens include peanuts, tree nuts, eggs, milk, fish and shellfish. While symptoms vary, anaphylaxis affects breathing, blood pressure and could be fatal without treatment. Food allergies impact about 4% of the population so facilities need trained staff, individualized emergency plans and protocols to safely manage guests' allergies and reactions.
This document discusses allergy diagnosis and testing. It provides information on:
1. The types of allergies including asthma, rhinitis, food allergy.
2. Allergy tests including skin prick tests, specific IgE tests, basophil histamine release tests.
3. Indications for allergy testing including persistent asthma, occupational exposures, and before immunotherapy.
4. Cases demonstrating how test results along with clinical history are used to diagnose conditions like allergic rhinitis, Churg-Strauss syndrome, and food allergy.
At present, 1 in 5 Australians is affected by an allergy, of which food allergies constitute the majority. Often one test cannot conclusively diagnose an allergen and a combination of tests may need to be conducted for certainty.
Oral allergy syndrome (OAS) is caused by cross-reactivity between pollen and certain raw fruits and vegetables. It occurs in up to 70% of pollen-allergic patients and involves oral itching and inflammation upon eating raw foods. Cross-reactivity is due to structural similarities between pollen and food allergens like profilin, PR-10, and lipid transfer proteins. Diagnosis involves a clinical history and skin or blood tests to specific food allergens. Treatment focuses on avoidance of raw foods and use of antihistamines for symptoms.
La guía mexicana de inmunoterapia 2019 describe las pruebas diagnósticas para identificar la sensibilización alérgica mediada por IgE. Recomienda las pruebas cutáneas como la principal herramienta de diagnóstico, mientras que las pruebas de laboratorio son útiles como complemento. Describe los alérgenos comunes que deben incluirse en las pruebas cutáneas en México y proporciona pautas sobre la preparación, aplicación e interpretación de los resultados. No recomienda repetir las pruebas cutáne
Este documento resume la información sobre el Síndrome de Alergia Oral (SAO). El SAO, también conocido como síndrome de polen-alimento, es un tipo de alergia alimentaria limitada a la mucosa oral desencadenada por frutas, verduras, especias y nueces en individuos con alergia al polen. El SAO se produce por una reacción alérgica de contacto mediada por IgE debido a la reactividad cruzada entre alérgenos de polen y alimentos. Los síntomas más comunes son el prurito
This document provides an overview of peanut allergy, including its epidemiology, allergens, clinical manifestations, diagnosis, and management. Peanut allergy prevalence is around 1-2% in western countries and appears to be less common in Asia. It is caused by sensitization to 17 major peanut allergens, especially seed storage proteins which are highly stable and associated with severe reactions. Symptoms range from mild to anaphylaxis. Diagnosis involves clinical history, skin prick testing, peanut-specific IgE levels, and oral food challenges. Component resolved testing helps identify primary versus cross-sensitization. Strict peanut avoidance is the primary management approach.
Seasonal allergies, also known as hay fever, are caused by an allergic reaction to pollen from trees, grasses, and weeds or mold spores. Common symptoms include a runny nose, sneezing, itchy eyes, and congestion. While avoidance of allergens is difficult, medications can help control symptoms, including over-the-counter antihistamines and prescription nasal steroids, decongestants, or sprays. Allergy shots are also available to reduce sensitivity to allergens over time.
Presentación sobre el síndrome de Alergia oral, también conocido como polen fruta. Definición, alimentos implicados, fisiopatología, diagnóstico, tratamiento.
This document discusses food allergens and their management. It begins by introducing common food allergens like milk, eggs, fish, shellfish, tree nuts, peanuts, soy, wheat, and others. For each allergen, it identifies major allergenic proteins and cross-reactivity. It then discusses how to manage allergens by identifying critical control points in product design, ingredients, processing, packaging, storage and labeling. Proper cleaning, separation of ingredients and equipment, and avoidance of cross-contamination are important. The VITAL system provides a standardized way for companies to communicate potential trace allergen risks to consumers. Overall, good management practices and controls are vital for effective allergen control.
The document provides information about allergy diagnostics and testing. It discusses the different types of allergies including food, environmental, occupational and insect allergies. It describes the importance of taking a thorough case history and outlines different diagnostic methods used to identify allergens including skin prick tests, patch tests and allergen-specific IgE blood tests. Accurately identifying the specific allergens responsible for a patient's symptoms is key to successful management and treatment of their condition.
Shellfish allergy is estimated to affect up to 3% of the population depending on region, with higher prevalence in Asia-Pacific populations. Tropomyosin is a major shellfish allergen due to its stability and high homology between different shellfish. Clinical manifestations of shellfish allergy can range from mild to life-threatening and there is significant risk of cross-reactivity between different shellfish due to shared allergens. Diagnosis involves careful history, skin prick testing, and oral food challenges. Management focuses on strict avoidance of shellfish and emergency treatment of reactions.
El documento resume la alergia a pescado y mariscos. Describe que estos alimentos han sido consumidos por el hombre desde hace 150,000 años y son una fuente valiosa de nutrientes. Explica la taxonomía de peces, crustáceos y moluscos, así como sus principales alérgenos como la parvalbúmina, aldolasa A, β-enolasa y tropomiosina. Finalmente, analiza la epidemiología, fisiopatología y alérgenos de pescado y mariscos implicados con mayor frecuencia en reacciones alérg
Este documento discute la alergia a pescados y mariscos. En 3 oraciones:
1) El consumo de pescado y mariscos ha aumentado debido a preocupaciones sobre la grasa en la carne roja, pero también ha causado un aumento en las reacciones alérgicas. 2) Los mariscos más comúnmente asociados con reacciones alérgicas son el cangrejo, el ostión, el camarón y la langosta. 3) La tropomiosina se ha identificado como un importante alérgeno de mariscos con alta re
1. The document provides instructions for calibrating and using a conductivity meter, including turning the meter on and off, selecting the automatic temperature compensation mode, rinsing and drying the electrode, calibrating the meter using standard buffer solutions, taking conductivity measurements of samples, and storing the electrode.
2. Key steps include rinsing the electrode with deionized water before and after use, calibrating the meter using a 1413 μS buffer solution, fully immersing the electrode in calibration solutions and samples, and allowing readings to stabilize before recording them.
3. The electrode must be kept clean by rinsing with water or detergent and recalibrating the meter before each use.
This document summarizes information about atopic dermatitis presented by José Antonio Ortega Martell, M.D. at Atopic Dermatitis Advances 2018. It discusses the pathophysiology of atopic dermatitis involving skin barrier dysfunction and immune system dysregulation. It also summarizes new therapeutic options for atopic dermatitis including the PDE4 inhibitor crisaborole and the biological agent dupilumab, which is a monoclonal antibody that targets the IL-4Rα receptor. The document concludes by noting the promising future of personalized treatment for atopic dermatitis using biological agents and biomarkers to target specific disease endotypes.
This document discusses food allergies and sensitivities. It begins by defining allergens and listing the most common food allergens, which are milk, eggs, fish, shellfish, tree nuts, peanuts, wheat and soybeans according to US law. It describes symptoms of allergic reactions ranging from mild to the most severe form, anaphylaxis, which can result in death. The document provides tips for keeping people with food allergies safe at gatherings by avoiding allergens in dishes and properly labeling foods. It concludes by wishing readers a safe holiday season.
This document discusses food-dependent exercise-induced anaphylaxis (FDEIA). It provides details on the clinical features, pathophysiology, differential diagnosis, diagnosis, and management of FDEIA. Key points include:
- FDEIA involves anaphylaxis triggered by food ingestion followed by exercise. Symptoms occur within 1-2 hours and include urticaria, angioedema, and potentially life-threatening airway obstruction.
- The pathophysiology is not fully understood but may involve increased gastrointestinal permeability during exercise, mobilization of immune cells, or alterations in blood flow redirecting allergens to tissues.
- Differential diagnoses include cholinergic urticaria, cold
Anaphylaxis is an acute multi-system allergic reaction that can involve the skin, airways, blood vessels, and gastrointestinal tract. It is a severe and immediate hypersensitivity reaction. The most common causes are foods, drugs, and insect bites or stings. Symptoms affect multiple body systems and can include skin issues like hives or swelling, respiratory issues like difficulty breathing, and cardiovascular issues like dizziness or fainting. Diagnosis is based on symptoms occurring after exposure to a potential trigger. Treatment involves epinephrine, antihistamines, corticosteroids, monitoring for several hours, and prevention through allergen avoidance and carrying emergency medication.
A food allergy occurs when the immune system mistakenly identifies a harmless food protein as dangerous and releases antibodies to attack it. This can trigger histamine release and cause symptoms ranging from mild to severe like anaphylaxis. Common food allergens include peanuts, tree nuts, eggs, milk, fish and shellfish. While symptoms vary, anaphylaxis affects breathing, blood pressure and could be fatal without treatment. Food allergies impact about 4% of the population so facilities need trained staff, individualized emergency plans and protocols to safely manage guests' allergies and reactions.
This document discusses allergy diagnosis and testing. It provides information on:
1. The types of allergies including asthma, rhinitis, food allergy.
2. Allergy tests including skin prick tests, specific IgE tests, basophil histamine release tests.
3. Indications for allergy testing including persistent asthma, occupational exposures, and before immunotherapy.
4. Cases demonstrating how test results along with clinical history are used to diagnose conditions like allergic rhinitis, Churg-Strauss syndrome, and food allergy.
At present, 1 in 5 Australians is affected by an allergy, of which food allergies constitute the majority. Often one test cannot conclusively diagnose an allergen and a combination of tests may need to be conducted for certainty.
Oral allergy syndrome (OAS) is caused by cross-reactivity between pollen and certain raw fruits and vegetables. It occurs in up to 70% of pollen-allergic patients and involves oral itching and inflammation upon eating raw foods. Cross-reactivity is due to structural similarities between pollen and food allergens like profilin, PR-10, and lipid transfer proteins. Diagnosis involves a clinical history and skin or blood tests to specific food allergens. Treatment focuses on avoidance of raw foods and use of antihistamines for symptoms.
La guía mexicana de inmunoterapia 2019 describe las pruebas diagnósticas para identificar la sensibilización alérgica mediada por IgE. Recomienda las pruebas cutáneas como la principal herramienta de diagnóstico, mientras que las pruebas de laboratorio son útiles como complemento. Describe los alérgenos comunes que deben incluirse en las pruebas cutáneas en México y proporciona pautas sobre la preparación, aplicación e interpretación de los resultados. No recomienda repetir las pruebas cutáne
Este documento resume la información sobre el Síndrome de Alergia Oral (SAO). El SAO, también conocido como síndrome de polen-alimento, es un tipo de alergia alimentaria limitada a la mucosa oral desencadenada por frutas, verduras, especias y nueces en individuos con alergia al polen. El SAO se produce por una reacción alérgica de contacto mediada por IgE debido a la reactividad cruzada entre alérgenos de polen y alimentos. Los síntomas más comunes son el prurito
This document provides an overview of peanut allergy, including its epidemiology, allergens, clinical manifestations, diagnosis, and management. Peanut allergy prevalence is around 1-2% in western countries and appears to be less common in Asia. It is caused by sensitization to 17 major peanut allergens, especially seed storage proteins which are highly stable and associated with severe reactions. Symptoms range from mild to anaphylaxis. Diagnosis involves clinical history, skin prick testing, peanut-specific IgE levels, and oral food challenges. Component resolved testing helps identify primary versus cross-sensitization. Strict peanut avoidance is the primary management approach.
Seasonal allergies, also known as hay fever, are caused by an allergic reaction to pollen from trees, grasses, and weeds or mold spores. Common symptoms include a runny nose, sneezing, itchy eyes, and congestion. While avoidance of allergens is difficult, medications can help control symptoms, including over-the-counter antihistamines and prescription nasal steroids, decongestants, or sprays. Allergy shots are also available to reduce sensitivity to allergens over time.
Presentación sobre el síndrome de Alergia oral, también conocido como polen fruta. Definición, alimentos implicados, fisiopatología, diagnóstico, tratamiento.
This document discusses food allergens and their management. It begins by introducing common food allergens like milk, eggs, fish, shellfish, tree nuts, peanuts, soy, wheat, and others. For each allergen, it identifies major allergenic proteins and cross-reactivity. It then discusses how to manage allergens by identifying critical control points in product design, ingredients, processing, packaging, storage and labeling. Proper cleaning, separation of ingredients and equipment, and avoidance of cross-contamination are important. The VITAL system provides a standardized way for companies to communicate potential trace allergen risks to consumers. Overall, good management practices and controls are vital for effective allergen control.
The document provides information about allergy diagnostics and testing. It discusses the different types of allergies including food, environmental, occupational and insect allergies. It describes the importance of taking a thorough case history and outlines different diagnostic methods used to identify allergens including skin prick tests, patch tests and allergen-specific IgE blood tests. Accurately identifying the specific allergens responsible for a patient's symptoms is key to successful management and treatment of their condition.
Shellfish allergy is estimated to affect up to 3% of the population depending on region, with higher prevalence in Asia-Pacific populations. Tropomyosin is a major shellfish allergen due to its stability and high homology between different shellfish. Clinical manifestations of shellfish allergy can range from mild to life-threatening and there is significant risk of cross-reactivity between different shellfish due to shared allergens. Diagnosis involves careful history, skin prick testing, and oral food challenges. Management focuses on strict avoidance of shellfish and emergency treatment of reactions.
El documento resume la alergia a pescado y mariscos. Describe que estos alimentos han sido consumidos por el hombre desde hace 150,000 años y son una fuente valiosa de nutrientes. Explica la taxonomía de peces, crustáceos y moluscos, así como sus principales alérgenos como la parvalbúmina, aldolasa A, β-enolasa y tropomiosina. Finalmente, analiza la epidemiología, fisiopatología y alérgenos de pescado y mariscos implicados con mayor frecuencia en reacciones alérg
Este documento discute la alergia a pescados y mariscos. En 3 oraciones:
1) El consumo de pescado y mariscos ha aumentado debido a preocupaciones sobre la grasa en la carne roja, pero también ha causado un aumento en las reacciones alérgicas. 2) Los mariscos más comúnmente asociados con reacciones alérgicas son el cangrejo, el ostión, el camarón y la langosta. 3) La tropomiosina se ha identificado como un importante alérgeno de mariscos con alta re
1. The document provides instructions for calibrating and using a conductivity meter, including turning the meter on and off, selecting the automatic temperature compensation mode, rinsing and drying the electrode, calibrating the meter using standard buffer solutions, taking conductivity measurements of samples, and storing the electrode.
2. Key steps include rinsing the electrode with deionized water before and after use, calibrating the meter using a 1413 μS buffer solution, fully immersing the electrode in calibration solutions and samples, and allowing readings to stabilize before recording them.
3. The electrode must be kept clean by rinsing with water or detergent and recalibrating the meter before each use.
This document summarizes information about atopic dermatitis presented by José Antonio Ortega Martell, M.D. at Atopic Dermatitis Advances 2018. It discusses the pathophysiology of atopic dermatitis involving skin barrier dysfunction and immune system dysregulation. It also summarizes new therapeutic options for atopic dermatitis including the PDE4 inhibitor crisaborole and the biological agent dupilumab, which is a monoclonal antibody that targets the IL-4Rα receptor. The document concludes by noting the promising future of personalized treatment for atopic dermatitis using biological agents and biomarkers to target specific disease endotypes.
This document discusses food allergies and sensitivities. It begins by defining allergens and listing the most common food allergens, which are milk, eggs, fish, shellfish, tree nuts, peanuts, wheat and soybeans according to US law. It describes symptoms of allergic reactions ranging from mild to the most severe form, anaphylaxis, which can result in death. The document provides tips for keeping people with food allergies safe at gatherings by avoiding allergens in dishes and properly labeling foods. It concludes by wishing readers a safe holiday season.
This document discusses food-dependent exercise-induced anaphylaxis (FDEIA). It provides details on the clinical features, pathophysiology, differential diagnosis, diagnosis, and management of FDEIA. Key points include:
- FDEIA involves anaphylaxis triggered by food ingestion followed by exercise. Symptoms occur within 1-2 hours and include urticaria, angioedema, and potentially life-threatening airway obstruction.
- The pathophysiology is not fully understood but may involve increased gastrointestinal permeability during exercise, mobilization of immune cells, or alterations in blood flow redirecting allergens to tissues.
- Differential diagnoses include cholinergic urticaria, cold
Applicazione del Test di Nutrigenomica come strumento di ausilio Clinico e Diagnostico:
Sindrome Metabolica
Predisposizione al Diabete di Tipo 2
Intolleranza al Lattosio e Glutine
Gluten Sensitivity
Cardiologia di segnale: i buoni e i cattivi.Carlo Maggio
La medicina di segnale nasce dall'idea del dottor Luca Speciani di valorizzare l'alimentazione e l'attività fisica come regolatori delle funzioni fisiologiche basilari. Il ruolo della nutrizione e dell'esercizio fisico è fondamentale per la modulazione del sistema neuro-endocrino-metabolico. In questa presentazione si parla di come preservare la salute del cuore tramite la Medicina di Segnale.
Franco Berrino - Il Codice Europeo contro il cancro e le Istituzioni SanitarieAPAB
Intervento alla sessione ALLEANZE PER ALIMENTAZIONE E SALUTE del 33° Convegno di Agricoltura Biodinamica del 21 febbraio 2015 presso l'Università Bocconi di Milano. Importantissimo contributo che rende edotti della scarsa responsabilità delle istituzioni verso le direttive anti cancro legate all'alimentazione.
Il mio intervento di apertura al convegno "Il futuro della panificazione artigianale: allergie e intolleranze alimentari", tenutosi il 31-05-14 alla "XI Sagra del pane tipico Gonnose" dal titolo "Allergie e Intolleranze: tra percezione e realtà."
201911 - Tripodi - Immunoterapia specifica alla luce della e-mobile health?Asmallergie
1. The document discusses using digital solutions like mobile health to improve allergen immunotherapy (AIT) by combining clinical research data and mobile health for AIT prescription.
2. It proposes the "@IT-2020" process, a flexible 4-step modular approach for prescribing AIT for pollen allergy patients in Southern Europe/Mediterranean countries, to be validated in a pilot study (2016-2017) and multicenter study (2018-2019).
3. The 4 diagnostic steps of "@IT-2020" and validation testing are described, aiming to determine genuine vs false sensitization, primary sensitization, and the relationship between sensitization and symptoms to guide personalized AIT prescription.
201911 - Rossi - L'asma grave è sempre “grave”?Asmallergie
This document discusses a study of 437 patients with severe asthma (GINA step V) in Italy. The main findings were:
- The average annual exacerbation rate was 3.75.
- The mean blood eosinophil level was 536.7 cells/mcL and average serum total IgE was 470.3 kU/L.
- 64% were on regular oral corticosteroids, 57% with omalizumab and 11.2% with mepolizumab.
- The most common comorbidities were rhinitis, nasal polyposis, and bronchiectasis. Bronchiectasis was associated with more frequent severe exacerbations.
201911 - Conte - Asma eosinofilico: i farmaci biologici che contrastano l'azi...Asmallergie
This document summarizes a presentation about eosinophilic asthma and biological drugs that target interleukin-5 (IL-5). It discusses the role of eosinophils and IL-5 in asthma, clinical studies of anti-IL-5 drugs like mepolizumab and benralizumab, and real-world experience with these therapies. The presentation covers the pathophysiology of eosinophilic asthma, how anti-IL-5 drugs work, results from major clinical trials showing reduced exacerbations and oral corticosteroid use, and insights from real-world studies on treatment response and outcomes. It emphasizes the importance of patient phenotypes and endotypes in guiding therapy selection for severe asthma.
201911 - Villalta - Novità in ambito di diagnostica molecolare nella sensibil...Asmallergie
This document discusses advances in molecular diagnostics for mite sensitization. It begins with a brief history of allergy to house dust mites and an overview of the major allergenic molecules from mites, including Der p 1, Der p 2, and Der p 23. It describes the concept of "molecular spreading" where the IgE response spreads from initial sensitization to major allergens to include other milder allergens over time. The document then covers classical and molecular diagnostic techniques for mite allergy. It concludes by discussing the potential predictive role of antibody patterns to different mite allergens.
20191109 - Incorvaia - L'efficacia della SLIT: dai trial alla real-life
20171111 - Villalta - Allergia alimentare
1. NOVITA’ IN DIAGNOSTICA
ALLERGOLOGICA MOLECOLARE
ALLERGIA ALIMENTARE
Danilo Villalta
Immunologia e Allergologia
Ospedale «S. Maria degli Angeli»
Pordenone
2. • Generalità sulla diagnostica molecolare
dell’allergia alimentare
• L’allergia al grano
• L’allergia alla carne
• Il problema delle omologie
3. • Generalità sulla diagnostica molecolare
dell’allergia alimentare
• L’allergia al grano
• L’allergia alla carne
• Il problema delle omologie
4. 1. Resolving genuine versus cross-reactive sensitization in poly-
sensitized patients
2. Assessing the risk of severe, systemic versus mild local reactions
in food allergy, thereby reducing unnecessary anxiety for the
patient and the need for food challenge testing
3. Identifying patients and triggering allergens for specific
immunotherapy (SIT)
6. Protein family Function Source Allergens
Prolamin superfamily Prolamins Seed storage Cereals Tri a19, gliadins,
gluten components
2S albumins Seed storage Peanut, tree nuts,
mustard
Ber e1, Jug r1, Ara h2,
Ara h 6, Cor a 14
nsLTP Plant defence All type of plant, latex Pru p3, Tri a 14, Cor a
8, Jug r 3
α-amylase/prot.
inhibitors
Cereals Tri a 30 (Tri a aA_TI )
Cupin superfamily 7S globulins Seed storage Legumes, nuts, seeds Ara h 1, Jug r 2, Ses i1
11S globulins Seed storage Penaut tree nuts Ara h3, Cor a9
Profilins Actin binding All type of plant foods,
latex
Bet v 2, Hev b 8, Phl p
12
PR-10 (Bet v 1 related
proteins)
Plant defence All type of plant Bet v 1, Gly m4, Act
d8, Pru p1
Oleosins Stabilizing oil body Legumes, nuts, seeds
Endochitinases Plant defence, chitin
hydrolisis
Banana, avocado,
chestnut, latex
Pers a1, Cas s5, Vit v5
(Hev b6)
β-1,3 glucanases Plant defence Banana, avocado,
chestnut, latex
Hev b2, Mus a5, Ole
e9
Thaumatin-like
proteins
Plant defence Kiwi, citrus and
Rosaceae fruit, grape
Act d2, Mal d2, Pru
av2
7. Protein family Function Source Allergens
Tropomyosins Muscle contraction Crustaceans, molluscs,
fish parasite (Anisakis)
Pen a1, Pen m1, Ani s3,
Der p10
Parvalbumins Ca++-binding proteins Fish, amphibians Cyp c1, Gad c1
Caseins Increase C++ level in milk Milk Bos d8
α-Lactalbumin
(C-type lysozyme)
Ca++ binding protein Milk Bod d4
β-lactoglobulin
((Lipocalins)
Carrier of small
molecules
Milk Bos d5
Kazal-type protease
inhibitors (ovomucoid)
Protease inhibitor Egg Gal d1
Serpin serine protease
inhibitor (Ovoalbumin)
Protease inhibitor Egg Gal d2
Iron-binding
glycoproteins
Iron-binding Egg Gal d3
C-type lysozyme Egg Gal d4
From Hoffmann-Sommergruber K & Mills K. Anal Bioanal Chem 2009
8. * Currently available for
sigleplex diagnostics
** Available only in
multiplex (ISAC)
diagnostics
Villalta D et al.
Eur Ann Allergy Immunol
(in press)
12. Ricerca marcatori di sensibilizzazione primaria
(termo- e gastro-stabili)
Ricerca marcatori di cross-
reattività
Profiline (Bet v2/ Phl p 12)
PR-10 (Bet v 1/Cor a 1)
CCD
Clinica suggestiva per allergia alimentare
Test con allergene estrattivo
POS
NEG Bassa probabilità di allergia
alimentare
• Lipid tranfer proteins (LTP)
• 2S-albumine
• Cupine
• Tropomiosine
• Parvalbumine
• altro
Alto rischio di reazione
sistemica
Basso rischio di reazione
sistemica
Villalta D et al IJLM 2016
13. • Generalità sulla diagnostica molecolare
dell’allergia alimentare
• L’allergia al grano
• L’allergia alla carne
• Il problema delle omologie
18. 18
Allergen MW Biochemical name
Tri a 12 14 Profilin
Tri a 14 9 Non-specific lipid tranfer
protein (LTP)
Tri a 15 Monomeric alpha-amylase
inhibitor
Tri a 18 Agglutinin Isolectin I
Tri a 19 65 Omega-5 gliadin
Tri a 21 Alpa-beta-gliadin
Ti a 25 Thioredoxin
Tri a 26 88 HMW glutenin
Tri a 27 27 Thiol reductase
Tri a 28 13 Dimeric alpha-amylase
Inhibitor
Allergen MW Biochemical name
Tri a 29 13 Tetrameric alpha-amylase
inhibitor CM1/CM2
Tri a 30 16 Tetrameric alpha-amylase
inhibitor CM3
Tri a 31 Triosephosphate-isomerarase
Tri a 32 1-cys-peroxiredoxin
Tri a 33 Serpin
Tri a 34 Gliceraldehyde-3-phosphate-
dehydrog.
Tri a 35 Dehydrin
Tri a 36 40 LMW glutenin
Tri a 37 12 Alpha purothionin
Tri a 39 Serin protease Inhib.
19. 19
Allergen MW Biochemical name
Tri a 12 14 Profilin
Tri a 14 9 Non-specific lipid tranfer
protein (LTP)
Tri a 15 Monomeric alpha-amylase
inhibitor
Tri a 18 Agglutinin Isolectin I
Tri a 19 65 Omega-5 gliadin
Tri a 21 Alpa-beta-gliadin
Ti a 25 Thioredoxin
Tri a 26 88 HMW glutenin
Tri a 27 27 Thiol reductase
Tri a 28 13 Dimeric alpha-amylase
Inhibitor
Allergen MW Biochemical name
Tri a 29 13 Tetrameric alpha-amylase
inhibitor CM1/CM2
Tri a 30 16 Tetrameric alpha-amylase
inhibitor CM3
Tri a 31 Triosephosphate-isomerarase
Tri a 32 1-cys-peroxiredoxin
Tri a 33 Serpin
Tri a 34 Gliceraldehyde-3-phosphate-
dehydrog.
Tri a 35 Dehydrin
Tri a 36 40 LMW glutenin
Tri a 37 12 Alpha purothionin
Tri a 39 Serin protease Inhib.
20. Wheat-dependent, exercise-induced anaphylaxis (WDEIA)
Wheat
Shrimp
Cuttlefish
Crab
Grape
Nuts
Buckwheat
Fish
57%18%
Morita E. J Derm Sci 2007
Triggering factors
Foods (amount, sort and combination)
Exercise (strength, type, duration and
timing after meal)
General conditions (cold, stress,
menstruation, etc)
Alcohol
Drugs (aspirin and NSAIDs)
-FDEIA: - 0.06% of the elementary school students
- 0.21% of the high school students
- peak incidence in the second decade
- M/F = 2:1
Tanaka S 1994
21. Wheat
Tri a 19 ( ω 5 Gliadin )
Matsuo et al:J Biol Chem 2004
IgE cross-reactivity
γ-70 secalin (91%)
γ-35 secalin (83%)
γ-3 hordein (91%)
Transglutaminase-mediated cross
linking of ω-5-gliadin proteins
Formation of large allergen complexes
capable to eliciting anaphylactic
reaction
Palosuo et al. JACI 2003
80%
20%
WDEIA
22. Morita E, et al J Dermatol Sci 2007
Increased GI permeability
Increased Il-6 and increased tTG
Increased plasma osmolarity
Changes in acid-base balance
Redistribution of blood flow from
visceral organs to skeletal muscle,
skin, and heart
2015; 70:1212-21
23. Morita E et al J Dermatol Sci 2007
Oral Food Challenge
24. Caso Clinico 1
M.T. ♂ 59 aa
Mentre ballava dopo aver cenato (antipasto di moscardini,
pasta alla scogliera, verdura mista e 2 bicchieri di vino
bianco) ha accusato orticaria e lieve difficoltà respiratoria.
Anamnesi negativa per allergopatie. Riferisce, però, che a
volte negli ultimi 2-3 anni ha presentato prurito post-
prandiale, ma non lo ha mai correlato con assunzione di un
cibo specifico.
In seguito a tale episodio ha assunto ancora pasta e vino,
ma non ha più mangiato pesce e crostacei.
26. Dopo 1 anno in cui non ha più eseguito
esercizio fisico e assunto alcol dopo assunzione
di cibi contenenti grano non ha più presentato
sintomi ed è scomparso il prurito post-prandiale
Diagnosi finale: WDEIA
27. Caso Clinico 2
A.V. ♂ 63 aa
Dopo intervento ortopedico alla spalla, mentre era
ancora ricoverato, subito dopo aver assunta 1 cps
di Ibuprofene da 600 mg e aver fatta colazione con
fette biscottate, marmellata di mirtilli e un succo di
arancia ha accusata una reazione di orticaria-
angioedema.
Sospeso il trattamento con il FANS, è stata chiesta
una consulenza allergologica
28. Dall’anamnesi emerge che il paziente nel corso
dell’ultimo anno ha accusati almeno altri tre
episodi di orticaria che erano regrediti
spontaneamente e a cui non aveva dato molto
peso.
Non sa riferire associazioni con cibi specifici, o
di aver assunti farmaci in tali circostanze
29. Uovo Neg
Latte Neg
Noce Neg
Nocciola Neg
Pesca Neg
Cereali mix 1+
Arachide Neg
Soia Neg
Carni mix Neg
Pesce Neg
Crostacei Neg
SPT Dosaggio IgE specifiche
Pheum P <0.01 kUA/L
Cynodon d <0.01 kUA/L
Grano 1.6 kUA/L
Gliadine 10.8 kUA/L
Tria 19 36.8 kUA/L
TPO con Ibuprofene: NEGATIVO
Diagnosi: Allergia al grano associata
a presenza di cofattori (FANS)
30. Caso Clinico 3
R.A. ♂ 34 aa
Mentre correva in mountain-bike in una strada di
montagna, dopo aver pranzato in un rifugio con uova e
speck, una fetta di torta al grano saraceno e una birra
weiss, ha iniziato ad accusare sudorazione profusa,
nausea, prurito diffuso, edema labiale
Due settimane dopo, sempre mentre era in mountain-bike,
1 ora dopo aver assunta un barretta al sesamo (che ricorda
di aver assunta anche la volta precedente) e circa 20’ dopo
essersi fermato al rifugio e aver pranzato con un piatto di
formaggio, speck e rafano e aver ribevuta una birra weiss,
ha presentato nuovamente orticaria
31. Uovo Neg
Latte Neg
Noce Neg
Nocciola Neg
Pesca Neg
Cereali mix Neg
Arachide Neg
Soia Neg
Carni mix Neg
Pesce Neg
Crostacei Neg
Sesamo (PbP) Neg
SPT IgE specifiche
Sesamo <0.01 kUA/L
Grano saraceno <0.01 kUA/L
Grano 0.98 kUA/L
Orzo 0.56 kUA/L
Gliadine 2.70 kUA/L
Tri a 14 0.45 kUA/L
Tri a19 9.60 kUA/L
Da 2 anni il paziente non assume più cibi
contenenti grano 1 ora dopo aver termimato
esercizio fisico e non esegue esercizio fisico
entro le 4 ore dall’assunzione di gliadine e non
ha più accusati sintomi
Diagnosi: WDEIA
32. • Generalità sulla diagnostica molecolare
dell’allergia alimentare
• L’allergia al grano
• L’allergia alla carne
• Il problema delle omologie
33. Allergia di tipo immediato:
* Carni di mammiferi(bue, maiale,
etc.)
* Carni di volatili (pollo, tacchino)
Allergia di tipo ritardato:
* Carni di mammiferi
34. Allergia di tipo immediato:
* Carni di mammiferi(bue, maiale,
etc.)
* Carni di volatili (pollo, tacchino)
35. Species
(common name
Species
(latin name)
Allergen name Biochemical
name
Molecular
weight (kDa)
Cow Bos domesticus Bos d 6 * Serum albumin 67
Cow Bos domesticus Bos d 7 Immunoglobulin 160
Pork Sus scrofa Sus s 1 * Serum albumin 60
Chicken Gallus
domesticus
Gal d 5 ** Serum albumin 69
Meat allergens present in the list of the Allergen Nomenclature Sub-
Committee of the International Union of Immunological Societies (IUIS)
* ImmunoCAP
** ISAC
37. Cross-reattività
• Tra carni di differenti animali
• Tra carne e altri cibi
• Tra carne ed epiteli animali (della stessa
specie o di specie diverse)
38. Cross-reattività
• Tra carni di differenti animali
• Tra carne e altri cibi
• Tra carne ed epiteli animali (della stessa
specie o di specie diverse)
39. RESULTS:
The findings suggest that animal monoclonal antibodies specific for cow's milk
proteins are able to recognize the major part of milk proteins from mammals
bred in Mediterranean countries (sheep, goat, and buffalo); weak cross-
reactivity was observed with milk proteins from mares and donkeys. None of the
antibodies used in our studies reacted with proteins from an exotic mammalian
species: the camel. Similar cross-reactions were found with human circulating
immunoglobulin E from children allergic to milk. With regard to beef allergy,
monoclonal antibodies specific for bovine serum albumin cross-reacted only with
ovine serum albumin, whereas the number of sera from allergic children able to
recognize other mammalian serum albumins depended directly on the
closeness of phylogenetic relationship between animal species and
inversely on the percent identity with human serum albumin in the main epitopic
sequence.
Ann Allergy Asthma Immunol. 2002 Dec;89(6 Suppl 1):11-5.
Cross-reactivity between mammalian proteins.
Restani P1, Beretta B, Fiocchi A, Ballabio C, Galli CL.
41. Cross-reattività
• Tra carni di differenti animali
• Tra carne e altri cibi
• Tra carne ed epiteli animali (della stessa
specie o di specie diverse)
42. Ann Allergy Asthma Immunol. 2002 Dec;89(6 Suppl 1):38-43.
Beef allergy in children with cow's milk allergy; cow's milk
allergy in children with beef allergy.
Martelli A1, De Chiara A, Corvo M, Restani P, Fiocchi A.
RESULTS:
In the literature, between 13 and 20% of children with cow's milk allergy also
have beef allergy. In our personal series of patients, 28 children (18 boys and
10 girls) diagnosed with beef allergy underwent skin prick tests and double-
blind, placebo-controlled food challenge, which showed that 26 (92.9%) were
allergic to cow's milk. Two children nonallergic to cow's milk were the only
ones who were not sensitized to bovine serum albumin.
CONCLUSIONS:
Most children with beef allergy are also allergic to cow's milk and should
avoid the consumption of dairy products. Sensitization to bovine serum
albumin is a marker of cow's milk allergy in children with beef allergy.
Elimination of beef from the diet of children with cow's milk allergy should be
evaluated on an individual basis after diagnostic workup.
43. Cross-reattività
• Tra carni di differenti animali
• Tra carne e altri cibi
• Tra carne ed epiteli animali (della stessa
specie o di specie diverse)
44. Monogr Allergy. 1996;32:164-73.
The pork/cat syndrome or crossed reactivity between cat epithelia
and pork meat.
Drouet M1, Sabbah A.
Cat serum albumin (Fel d 2) Pork serum albumin (Sus s 1)
Matricardi et al EAACI Mol
ecluar Allergology User’s Guide
45. Posthumus J et al JACI 2013,131.923-5
Fel d 2
Can f 3 *
Bos d 6
* ISAC
46.
47. Int Arch Allergy Appl Immunol. 1988;87(2):143-50.
Bird-egg syndrome. Cross-reactivity between bird antigens and
egg-yolk livetins in IgE-mediated hypersensitivity.
Mandallaz MM1, de Weck AL, Dahinden CA.
Bird albumin Chicken serum albumin (egg-yolk α-
livetin) (Gal d 5)
Allergy 2001
48. Allergia di tipo immediato:
* Carni di mammiferi(bue, maiale,
etc.)
* Carni di volatili (pollo, tacchino)
Allergia di tipo ritardato:
* Carni di mammiferi
58. Caso clinico
♂ 55 aa
2 episodi di anafilassi (marzo 2013 e agosto 2013)
Dopo il primo episodio aveva eseguita valutazione
allergologica con esito completamente negativo.
conclusione episodio di anafilassi idiopatica.
Rivalutazione allergologica dopo il secondo episodio.
Dall’anamnesi emergeva che aveva pranzato 5-6 ore prima
con carne, frutta e vino.
Prick test alimenti standard negativo
Prick by prick con carne di agnello, bue e porco negativo
59. Dall’anamnesi emergeva che il paziente tra il 2013 e il 2013 era stato punto
più volte da zecche.
Prick by prick con fegato e rene di bue positivo
IgE specifiche
α-Gal >100 kUA/L a ottobre 2013 e 41 kUA/L a giugno 2014.
Diagnosi finale: anafilassi ritardata da carne rossa alpha-Gal dipendente
60. - ♂ 55 anni
- 2 episodi di anafilassi (marzo 2013 e
agosto 2013)
- Nel secondo episodio aveva assunto
carne rossa 6 ore prima
- Prick test alimenti standard negativo
- Prick by prick con carne di agnello, bue e
porco negativo
- Prick by prick con fegato e rene di bue
positivo
- IgE specifiche α-Gal >100 kUA/L a ottobre
2013 e 41 kUA/L a giugno 2014.
- Il paziente nell’estate 2012 e 2013 era
stato più volte morso da zecche
Diagnosi finale: anafilassi ritardata da carne rossa alpha-Gal dipendente
71. 0
10
20
30
40
50
60
70
80
90
100
Bet v 2 Ole e 2 Hev b 8 Mer a 1 Phl p12
Prevalenza della positività degli omologhi di Bet v 2 in
pazienti allergici alla betulla
Villalta D & Asero R. JIACI 2010
72. Equ c 1, Fel d 4,
Can f 6
Can f 1, Can f 2,
Can f 4
Lipocaline
76. Ana o 3 Ara h 2 Ara h 6 Ara h 7 Ber e 1 Bra j 1 Bra n 1 Bra r 1 Car i 1 Cor a 14 Fag e 2 Fag t 2 Gly m 8 Jug n 1 Jug r 1 Pis v 1 Ric c 1 Ses i 1 Ses i 2 Sin a 1
20,9 24,5 22,1 27,2 20,7 20,7 21,9 34 37,6 21,6 22,4 14,6 30,2 31,3 64,4 16,2 32,9 24 16,7 Ana o 3
50,6 32,8 22,5 16,7 14,8 18,5 19,3 24,6 20,6 21,2 31,5 22,1 22 21,9 14,8 23,9 20,4 15,7 Ara h 2
34,5 24,8 13,8 14,1 20,5 22,9 31,2 23,7 24,3 30,5 21,8 22,3 24,3 14,9 25,8 23,1 13,9 Ara h 6
19,3 13,6 13,2 16 19 21,8 18,4 16,2 23,5 21,1 20,5 18,5 12,3 20,7 17,7 11,6 Ara h 7
16,2 17,4 17,9 36,2 40,5 19,1 20,7 16,6 33,5 37,5 28 14,9 30,8 35,1 14,8 Ber e 1
88,4 60,6 20,8 19,1 12,8 14,8 11,3 18,2 20,7 21,7 10,9 17,7 15,2 79,3 Bra j 1
61,6 20,8 18,5 13 14,3 12,1 19,3 20,7 20,8 12,2 17,4 15,5 80,7 Bra n 1
21,9 19,8 17,1 18,2 14,8 19,8 20,2 25,8 15,8 24,1 20,6 67,7 Bra r 1
59,7 22,3 22,3 16,6 77,6 86 30,9 17,7 35,6 32,4 19,1 Car i 1
21,5 20,7 16,2 58,5 61,7 35,8 22,7 39,8 32,7 14,8
Cor a
14
82,5 21 20,5 22,6 20,7 15,6 21,6 20 12 Fag e 2
21,4 20,4 22,6 21,3 14,9 20,4 21,9 13,8 Fag t 2
12,7 15,8 19,5 12,6 16,1 17,7 11,9 Gly m 8
83,2 29,4 18,1 32,1 28 16,8 Jug n 1
30,9 18,1 34,4 29 18,4 Jug r 1
16,6 29,9 23,5 20 Pis v 1
22,9 14,8 10,1 Ric c 1
35,7 17,3 Ses i 1
14,1 Ses i 2
Sin a 1
Amino acid
identities (%)
among 2s Albumin
Courtesy of E. Scala
77. Ana o 1 Ara h 1 Car i 2
Cor a
11 Fag e 3 Gly m 5 Jug n 2 Jug r 2 Len c 1 Lup an 1 Pin k 2 Pis s 1 Pis s 2 Pis v 3 Ses i 3
23,3 24,5 44,8 5,5 23,7 29,8 31,3 22,5 25,6 28,5 23,3 28,9 76,3 42,6 Ana o 1
24,8 25,3 4,7 38,4 28,3 30 35,8 41,4 21,6 34,5 39,1 24,4 26,6 Ara h 1
26,6 5,4 22,5 56,1 69,3 19,8 28,5 20 20 25,2 25,9 32,2 Car i 2
3 25,3 43,4 35,9 30,9 26,2 32,9 31,9 29,1 48,6 41
Cor a
11
6 5 7 8 4,8 5 7 5 4 5,6 Fag e 3
29,6 29,2 40,1 43,3 22 40,8 42,9 26,2 26,4 Gly m 5
78,2 31,9 31,1 33,8 32,6 30,8 33,4 34,4 Jug n 2
25,7 33,5 28 26,5 31,6 34,8 39 Jug r 2
38,4 26,4 90,1 48,7 24,8 21,1 Len c 1
23,7 38,7 44,8 25,5 29,1
Lup an
1
26,5 23,9 29,5 28,3 Pin k 2
47,2 25,5 22 Pis s 1
27,8 27,8 Pis s 2
44,3 Pis v 3
Ses i 3
Amino acid
identities (%)
among Vicilins (7s globulin)
Courtesy of E. Scala
78. Ana o 2 Ara h 3 Ber e 2 Cor a 9 Gly m 6 Jug r 4 Pis v 2 Pis v 5 Pru du 6 Ses i 6 Ses i 7 Sin a 2
38,6 46,4 49,7 45,2 54 44,8 75,5 40,9 37,5 44.8 41,2 Ana o 2
33,2 41,4 53,8 41,2 34,3 38,9 37,1 29,8 31,2 27,7 Ara h 3
47,4 37,5 47,6 44,3 46,3 39,8 38,7 44,7 36,2 Ber e 2
42,3 71,6 46,7 53,2 48,9 36,5 45,4 40,3 Cor a 9
44,5 38,2 44,8 37,4 29,9 36,1 32,6 Gly m 6
46,1 55 48,3 39,2 46,3 38,9 Jug r 4
48,3 39,2 35,2 45,4 36,8 Pis v 2
43,5 37,5 44,6 41,9 Pis v 5
34,5 35,9 40,8 Pru du 6
35,4 31,5 Ses i 6
36,4 Ses i 7
Sin a 2
Amino acid
identities (%)
among Legumins (11s Globulin)
Courtesy of E. Scala
80. • Idealmente un risultato negativo per una
classe molecolare (es 2S albumine) per una
specifica fonte, può escludere sia una cross-
reattività sierologica che clinica
• In un pannello di risultati di test eseguiti per
molecole omologhe (es 2S albumine) il
risultato più alto verosimilmente indica il
sensibilizzante primario, anche se ciò non è
sempre comprovato
Regole empiriche
81. Nelle allergie alimentari da vegetali le cross-
reattività sierologiche e cliniche è più
probabile che avvengano fra classe di
alimenti più strettamente apparentati da un
punto di vista botanico (generi, famiglie)
82. Come interpretare il caso dove sIgE sono
positivi per proteine omologhe presenti in
diverse specie (es Ara h 2, Cor a 14, Jug r 1,
Ber e 1, Ses i 1) ?
-Storia clinica
-Challenge orale