Clinical and Experimental Allergy最新文献

{"title":"Basophil Activation and Histamine Release Tests in Relation to Omalizumab Response in Peanut-Allergic Children","authors":"Christian Nielsen, Per Stahl Skov, Carsten Bindslev-Jensen, Charlotte G. Mortz","doi":"10.1111/cea.70058","DOIUrl":"10.1111/cea.70058","url":null,"abstract":"<p>The growing prevalence of food allergy (FA) worldwide [<span>1</span>] poses an increasing challenge for public health and a significant burden on affected individuals and their families. Among children, food allergy remains the leading cause of anaphylaxis, with peanut allergy as the primary cause of severe food-related allergic reactions [<span>2</span>]. Standard care includes allergen avoidance and access to self-injectable epinephrine for emergency situations. However, these measures are reactive rather than preventive, leaving a need for effective long-term therapeutic options.</p><p>Recent advancements in treatment options, such as oral immunotherapy (OIT) and biological agents, show promise in altering the natural course of FA. Among biologics, Omalizumab (Xolair), an anti-IgE humanised monoclonal antibody, offers potential as either monotherapy or in combination with OIT in severe FA cases [<span>3</span>]. By binding to free circulating IgE, Omalizumab inhibits IgE-mediated responses, specifically preventing the binding of IgE to FcεRI receptors on effector cells like basophils and mast cells. This inhibition reduces cell degranulation and, consequently, the release of pro-inflammatory mediators, thereby targeting FA at a fundamental immunological level.</p><p>To explore the performance of BAT and BHRA results in predicting Omalizumab treatment and the correlation to clinical response, a single-centre, double-blind, placebo-controlled study was conducted at the Allergy Centre, Odense University Hospital, Denmark (TOFAC: Treatment with Omalizumab in food-allergic children; clinicaltrials.gov: ID NCTO4037176) [<span>4</span>]. The study included peanut-allergic children aged 6–17 years with a cumulative threshold dose at or below 443 mg peanut protein determined by double-blind, placebo-controlled food challenges [DBPCFC]. Participants were randomised to receive Omalizumab or a placebo (3:1) and were re-evaluated after three and 6 months by DBPCFC to assess treatment efficacy. Patients' characteristics are given in reference [<span>4</span>]. Our focus was to evaluate the performance of the Basophil Activation Test (BAT) and the Basophil Histamine Release Assay (BHRA) in predicting and correlating with clinical outcomes following Omalizumab therapy.</p><p>BAT and BHRA are two in vitro tests that measure basophil degranulation in response to allergens, with distinct methodologies and endpoints [<span>5</span>]. BAT assesses basophil degranulation by measuring the cell surface expression of exposed granular membrane markers, specifically CD63, on activated basophils, while BHRA quantifies histamine release directly from activated basophils. Both tests have been instrumental in identifying patients responsive to Omalizumab in conditions such as asthma and chronic spontaneous urticaria, and are increasingly used to assess treatment efficacy [<span>6, 7</span>].</p><p>In our study, BAT and BHRA were conducted as previously described [<span>","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"55 9","pages":"840-844"},"PeriodicalIF":5.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.70058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Untargeted Metabolomic Analysis of Exhaled Breath Condensate Identifies Disease-Specific Signatures in Adults With Asthma.","authors":"Hongfei Zhao, Yujuan Yang, Yan Hao, Wenbin Zhang, Limei Cui, Jianwei Wang, Ying Chen, Ting Zuo, Hang Yu, Yu Zhang, Xicheng Song","doi":"10.1111/cea.70059","DOIUrl":"https://doi.org/10.1111/cea.70059","url":null,"abstract":"<p><strong>Purpose: </strong>An objective test for the auxiliary diagnosis of asthma is still lacking. The aim of this study was to discriminate asthma signatures via an untargeted metabolomic analysis of exhaled breath condensate.</p><p><strong>Materials and methods: </strong>This study enrolled 19 patients diagnosed with asthma and 23 healthy volunteers. Samples of exhaled breath condensate (EBC) were collected from both groups. Untargeted metabolomic analyses of EBC were used to identify disease-specific signatures for asthma.</p><p><strong>Result: </strong>There were 30 identifiable differentially expressed metabolites and 7 disordered metabolic pathways between the EBCs of asthmatic patients and healthy control subjects. The main differential pathways included biosynthesis of unsaturated fatty acids, HIF-1 signalling pathway, Glutathione metabolism, Ascorbate and aldarate metabolism, and fatty acid biosynthesis. The integrated machine learning method was used to construct an asthma EBC metabolomic signature model from four differential metabolites; 3,4'-dimethoxy-2'-hydroxychalcone, C17-sphinganine, (z)-6-octadecenoic acid, and 2-butylaniline. The model showed a high level of discrimination efficiency (area under curve (AUC) = 0.98), with robust validation through logistic regression (LR), random forest (RF), and support vector machine (SVM) (LR AUC = 0.98, RF AUC = 0.94, SVM AUC = 1.00). The discriminative ability of the EBC metabolomic signature model in both the training set (AUC = 1.0) and testing data (AUC = 0.817) was superior to that of FeNO (AUC = 0.515 and 0.567, respectively) and FEV1/FVC % predicted (AUC = 0.767 and 0.765, respectively). Among the four biomarkers, (z)-6-octadecenoic acid was significantly correlated with serum IgE.</p><p><strong>Conclusion: </strong>The EBC metabolomic signature model demonstrated good feasibility for assisting in the diagnosis of asthma in adults.</p>","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Burden of Drug-Induced Severe Cutaneous Adverse Reactions Associated With 33 Classes of Antibiotics (1968–2024): An Analysis of International Pharmacovigilance Reports","authors":"Jaehyun Kong,&nbsp;Jeongseon Oh,&nbsp;Jaeyu Park,&nbsp;Hyesu Jo,&nbsp;Tae Hyeon Kim,&nbsp;Jae E. Lee,&nbsp;Jaehyeong Cho,&nbsp;Sooji Lee,&nbsp;Hayeon Lee,&nbsp;Michael Miligkos,&nbsp;Jiyoung Hwang,&nbsp;Dong Keon Yon,&nbsp;Nikolaos G. Papadopoulos","doi":"10.1111/cea.70056","DOIUrl":"10.1111/cea.70056","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"55 9","pages":"837-839"},"PeriodicalIF":5.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-Related Changes in Serum Cytokine Patterns in Patients With Atopic Dermatitis","authors":"Xingyu Chen,&nbsp;Yu Zhang,&nbsp;Mingyang Wu,&nbsp;Yang Luo,&nbsp;Yingxia Gao,&nbsp;Wei Li,&nbsp;Xiaochun Liu,&nbsp;Xu Yao","doi":"10.1111/cea.70054","DOIUrl":"10.1111/cea.70054","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"55 9","pages":"864-866"},"PeriodicalIF":5.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Asthmatic Patients, Sexual Dimorphism correlates With Androgen Receptor Expression in ILC2s at Single Cell-Resolution","authors":"Nina Anesi,&nbsp;Mathilde Calmels,&nbsp;Laurent Guilleminault,&nbsp;Flora Abbas,&nbsp;Claire Cenac,&nbsp;Thomas Villeneuve,&nbsp;Guillaume de Bonnecaze,&nbsp;Sophie Laffont,&nbsp;Jean-Charles Guéry","doi":"10.1111/cea.70047","DOIUrl":"10.1111/cea.70047","url":null,"abstract":"&lt;p&gt;Asthma, a chronic inflammatory airway condition, is the most common respiratory disease. There is a sex bias in asthma with a predominance of females affected by this disease in adulthood [&lt;span&gt;1&lt;/span&gt;]. Type 2 innate lymphoid cells (ILC2s) have been identified as key players during allergic and/or asthmatic responses [&lt;span&gt;2&lt;/span&gt;] through their capacity to licence dendritic cells (DC) for optimal Th2 cell priming [&lt;span&gt;3&lt;/span&gt;]. The ILC2/IL33 axis was also reported to maintain airway hyperreactivity and remodelling in a chronic asthma model independently of T cells [&lt;span&gt;4&lt;/span&gt;]. Indeed, the non-redundant role of ILC2 in recruiting eosinophils in the airway in allergic asthma models has been established in mice selectively lacking ILC2 [&lt;span&gt;5&lt;/span&gt;]. ILC2 are found at higher numbers in female tissues, including the lung, compared to males, and express high levels of the &lt;i&gt;Nr3c4&lt;/i&gt; androgen receptor (AR) [&lt;span&gt;6, 7&lt;/span&gt;]. Androgen, via the AR receptor, acts directly within ILC2s to limit their expansion and cytokine production, thus protecting males and females from ILC2-dependent lung inflammation [&lt;span&gt;6, 7&lt;/span&gt;]. Interestingly, children and adults with complete androgen insensitivity syndrome due to inherited loss of AR activity exhibit an increased asthma risk [&lt;span&gt;8&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Studies investigating sex-bias in ILC2 in asthmatic subjects, as well as AR gene expression in human ILC2, are scarce. Here, we analysed the frequency of circulating ILC2s in adult male and female asthmatic patients without pre-selection criteria based on sex (Table S1). However, since the prevalence of asthma is higher in women compared to males, as reported by others [&lt;span&gt;1&lt;/span&gt;], fewer males were recruited during the course of the study. ILC2s were identified as CD45&lt;sup&gt;+&lt;/sup&gt;Lin&lt;sup&gt;−&lt;/sup&gt;CD7&lt;sup&gt;+&lt;/sup&gt;CD127&lt;sup&gt;hi&lt;/sup&gt;CD161&lt;sup&gt;+&lt;/sup&gt;CRTH2&lt;sup&gt;+&lt;/sup&gt; (Figure 1A; Figure S1) and their frequency was significantly higher in asthmatic females compared to males. The sex-bias was more pronounced in younger individuals than in patients above 40, suggesting a role for sexual hormones. Interestingly, the frequency of ILC2 was markedly higher in females with uncontrolled asthma when compared to males (Figure 1A). Since androgen-signalling has been reported to negatively control ILC2 numbers in mice, we next investigated whether human inflammatory ILC2 express &lt;i&gt;AR&lt;/i&gt; gene at single-cell resolution (Figure 1B). Because tissue ILC2s could be easily obtained from nasal polyp (NP), we isolated NP-ILC2 and expanded them in vitro (Figure S2A). Moreover, the presence of inflammatory CD45RO+ ILC2s in NP has been linked to severe asthma and steroid resistance [&lt;span&gt;9&lt;/span&gt;]. After 7 to 10 days of culture, we obtained homogeneous populations of lymphoid cells expressing the expected ILC2 markers, CD7, CD161 and GATA-3, and lacking T cell markers such as CD3 (Figure S2B) and CD4 (data not shown). After PMA/ionomycin activation, these ILC2s p","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"55 9","pages":"851-853"},"PeriodicalIF":5.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.70047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histamine H3 and H4 Receptor Antagonists Differentially Inhibit Mast Cell Activation via FcεRI and MRGPRX2 Pathways","authors":"Yuxin Zhang,&nbsp;Jiahua Guo,&nbsp;Dan Ye,&nbsp;Xi Zhao,&nbsp;Hongmei Zhou,&nbsp;Mengyao Yang,&nbsp;Songmei Geng,&nbsp;Weihui Zeng,&nbsp;Zhao Wang","doi":"10.1111/cea.70048","DOIUrl":"10.1111/cea.70048","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"55 9","pages":"854-856"},"PeriodicalIF":5.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Restoration of IFN-γ-Producing MAIT Cell Correlates to Beneficial Allergen Immunotherapy in Allergic Rhinitis Patients","authors":"Ying Jiang,&nbsp;Xin Wang,&nbsp;Qing Jiang,&nbsp;Hao Chen,&nbsp;Lin Yang,&nbsp;Wei Wang,&nbsp;Junmei Weng,&nbsp;Mi Wu,&nbsp;Ting Zhou,&nbsp;Yin Yao,&nbsp;Shuyan Guo,&nbsp;Jin Xiong,&nbsp;Xiang Lu,&nbsp;Rongfei Zhu,&nbsp;Xiufang Weng","doi":"10.1111/cea.70051","DOIUrl":"10.1111/cea.70051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Mucosal-associated invariant T cells (MAIT) are emerging as important regulators at mucosal surfaces. While these cells have been linked to a Th1-biased immune response and support for B cells, their roles in allergic diseases characterised by type 2 inflammation remain elusive. The study seeks to characterise MAIT cells in house dust mite (HDM)-induced allergic rhinitis (AR) and subsequent allergen immunotherapy (AIT), aiming to elucidate their clinical significance in AR and potential to enhance AIT effectiveness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>MAIT cells were assessed in patients with AR and individuals undergoing AIT. The ratio and cytokine-producing capacity of these cells were analysed to explore their correlations with AR progression and their responsiveness to HDM extracts and MAIT cell-specific agonists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In AR patients, there was an increase in the ratios of circulating MAIT cells and tonsil follicular T helper-like MAIT cells, alongside a decrease in the IFN-γ-producing MAIT cells. AIT restored their IFN-γ producing capacity, which was further boosted by T cell receptor (TCR) activation using MAIT cell-specific agonist-loaded artificial antigen-presenting cells (aAPCs). Synergistic effects of aAPCs and HDM enhance MAIT cell activation and IFN-γ production while reducing HDM-induced IgE levels in PBMC cocultures. Moreover, higher ratios of MAIT cells and IFN-γ-producing MAIT cells correlated with decreased IgE and increased IgG4 and improved clinical outcomes during AIT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings underscore the compromised IFN-γ-producing MAIT cells in AR and their restoration following AIT and TCR stimulation, highlighting the cell's therapeutic potential and predictive value for clinical outcomes in AR and AIT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"55 5","pages":"403-412"},"PeriodicalIF":6.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.70051","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inequalities in Access to Specialist Allergy Services in the United Kingdom: A Report From the BSACI Registry for Immunotherapy (BRIT)","authors":"Mich Erlewyn-Lajeunesse,&nbsp;Luciano Perfetti Villa,&nbsp;Shifa Shaikh,&nbsp;Maria Smith,&nbsp;Vasiliki Balodima,&nbsp;Sarah Baker,&nbsp;Tom Dawson,&nbsp;Pamela Ewan,&nbsp;Sujoy Khan,&nbsp;Deborah Marriage,&nbsp;Louise Michaelis,&nbsp;Leyla Pur Ozygit,&nbsp;Anna Thursby-Pelham,&nbsp;Amena Warner,&nbsp;Olga Maslovskaya,&nbsp;the BRIT Practitioners Group","doi":"10.1111/cea.70034","DOIUrl":"10.1111/cea.70034","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There is an unmet need for specialist allergy treatment in the United Kingdom. Allergen immunotherapy and treatment with omalizumab for chronic spontaneous urticaria (CSU) are key markers for these services. The British Society for Allergy and Clinical Immunology (BSACI) Registry for Immunotherapy (BRIT) is a national project to record the real-world effectiveness, safety and access to treatment for aero-allergen, venom and peanut immunotherapy as well as omalizumab for CSU.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We described participant demographics, the index of multiple deprivation (IMD) and access to treatment from the registry launch. Data for 1835 participants were available for analysis from 63 centres enrolled between 1st October 2018 and 24th August 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>96.5% (1771/1835) were living in England, with only 3.5% (64) being from the devolved nations. 14.4% (251/1748) were in the most affluent IMD decile compared to 4.5% (78/1748) in the most deprived IMD decile. White participants were 1.74 times more likely to be referred directly from primary care compared to people of Asian, black, mixed or other minority ethnic groups. Instead, these groups were referred more frequently from secondary or tertiary hospital services. The median distance travelled from home to the treatment centre was 15.2 miles, with evidence of clustering around specialist centres.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We have described disparities and unwarranted variation in the provision of treatment around the UK. The data suggest that there is limited access to immunotherapy in the devolved nations. Access is also reduced by socioeconomic deprivation. White participants were more likely to receive a direct referral from primary care than those from other ethnic groups whose referral pathways were more complex. Registry data are limited by participant enrolment and may have selection bias. Nevertheless, BRIT has highlighted inequity in access to specialist allergy services in the UK.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"55 6","pages":"458-468"},"PeriodicalIF":6.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.70034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adult Food Allergy—Public Perception and Reality","authors":"I. J. Skypala,&nbsp;C. E. N. Mills,&nbsp;A. Simpson","doi":"10.1111/cea.70044","DOIUrl":"10.1111/cea.70044","url":null,"abstract":"<p>Although the prevalence of IgE-mediated food allergy (IgE-FA) in adults varies, it is now considered to be equal to that seen in children and also increasingly affecting older adults [<span>1</span>]. However, the foods involved are often at odds with the public perception of common food triggers, and the study on wheat allergy by Neyer and colleagues in this issue demonstrates this clearly. Extrapolation of their data showed that the prevalence of self-reported wheat sensitivity was 13.1% of the German population, but the confirmed prevalence of wheat allergy in adults was 0.25% [95% CI 0.08–0.9]. Although wheat is predominantly a carbohydrate, 10%–15% of the mass is made up of a complex collection of proteins, 28 of which have been identified as allergens (Figure 1). Wheat proteins are known to be associated with several diseases, including coeliac disease (Figure 2), which affects ~1% of the UK population, and bakers' asthma, which affects ~5% of bakers. Wheat allergy affects ~0.5% of children, often starting in infancy (and frequently associated with allergies to milk and egg) as a systemic IgE-mediated allergic reaction, and usually outgrown by adolescence (&gt; 80%) [<span>2</span>].</p><p>The study from Neyer and colleagues measured the prevalence of allergy to wheat in adults (and adolescents). Of note, only three subjects showed positive serology to whole wheat extract (and only one to wheat allergen components Tri a 19 and Tri a 14). The authors do not comment on whether these were adult-onset cases, or whether they were co-factor dependent. That is, ~1 in 50 of those with symptoms had confirmed food allergy to wheat. However, the design of the study, where sensitisation was only assessed in those with a history of reproducible symptoms on ingestion of wheat, risks missing cases. Wheat allergy can present with a variety of manifestations in adults and is not always obvious from the history as reactions can be infrequent and may only occur in the presence of cofactors. One study reported that 80% of patients with wheat anaphylaxis only reacted in conjunction with exercise [<span>3</span>]. Other co-factors include non-steroidal anti-inflammatory drugs and alcohol. Adults presenting with moderate or severe reactions, where no discernible food trigger seems to be implicated due to perhaps having eaten more than 2 h before or after the symptoms, should always be investigated for co-factor involvement. Wheat dependent exercise-induced anaphylaxis is notoriously difficult to diagnose although sensitisation to ω-5 gliadin has been shown to be a good diagnostic marker. Symptoms may not be reproducible on challenge as a large dose of gluten protein is frequently required to elicit symptoms. This was reflected in the challenge protocol employed in this study, where gluten doses roughly equating to 20 slices of ordinary bread were given [<span>4</span>]. The prevalence figures found in this study are similar to those observed by others usually ","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"55 4","pages":"291-293"},"PeriodicalIF":6.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.70044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterising Lipid Transfer Protein Allergy in UK Adults","authors":"I. J. Skypala,&nbsp;B. Olivieri,&nbsp;G. Scadding","doi":"10.1111/cea.70050","DOIUrl":"10.1111/cea.70050","url":null,"abstract":"&lt;p&gt;Although Pollen Food Syndrome (PFS), involving reactions to pathogenesis-related proteins, is the most prevalent plant food allergy affecting United Kingdom adults [&lt;span&gt;1&lt;/span&gt;], lipid transfer proteins (LTP) are an increasing cause of allergic reactions to plant foods [&lt;span&gt;2-4&lt;/span&gt;]. To evaluate the clinical features of LTP allergy, we undertook an audit of records of adult patients seen at the Royal Brompton &amp; Harefield Hospitals, London, between 2012 and 2022, who had a positive IgE test (≥ 0.35 KUA/l) to the peach LTP, Pru p 3. The anonymised and retrospective nature of the data collection meant no ethical approval was required. Statistical analysis (SPSS.inc. 29.0, Chicago, IL) included differences in quantitative (Student's &lt;i&gt;t&lt;/i&gt;-test) and qualitative data (Pearson chi square).&lt;/p&gt;&lt;p&gt;Of 1642 adults tested to Pru p 3, 308 (19%) were positive, 285 of whom had complete data. Of these, 157 (55%) were diagnosed with LTP allergy (LTP+ve) and 128 (LTP-ve) with an alternative diagnosis on the basis of clinical history and test results (Table 1). There were no differences in age, gender or seasonal allergic rhinitis (SAR), but asthma and atopic dermatitis were more commonly reported by the LTP-ve patients. Food triggers were similar in both groups, but LTP + ve patients frequently reacted to composite foods (containing products of both plant origin and processed animal origin), tomato puree/soup, dried fruit, peaches and grapes. Urticaria, angioedema, and generalised pruritus were more often reported by the LTP+ve cohort, 59% of whom also had severe Grade 4/5 symptoms compared to 46% of LTP-ve patients (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) (FASS-5 symptom severity score [&lt;span&gt;5&lt;/span&gt;]). The LTP+ve group were also more likely to have attended a hospital emergency department and prescribed adrenaline autoinjectors. Reactions linked to co-factors were reported by 72 (46%) of the LTP+ve group and 13 (10%) of the LTP-ve group, most often exercise (38%) and/or alcohol (29%), with 21/72 only reacting to foods when a co-factor was present.&lt;/p&gt;&lt;p&gt;Reported SAR affected over 70% of both groups (&lt;i&gt;p&lt;/i&gt; = 0.418). Although 82% LTP+ve and 91% LTP-ve patients had positive tests to tree and/or grass pollen (&lt;i&gt;p&lt;/i&gt; = 0.038), LTP+ve adults were less often sensitised to Timothy grass (&lt;i&gt;Phleum pratense&lt;/i&gt;) (&lt;i&gt;p&lt;/i&gt; &lt; 0.00001) and birch (&lt;i&gt;Betula verrucosa&lt;/i&gt;) (&lt;i&gt;p&lt;/i&gt; = 0.003) and more often sensitised to mugwort (&lt;i&gt;Artemisia vulgaris&lt;/i&gt;) (&lt;i&gt;p&lt;/i&gt; = 0.006). There was no significant difference in symptom severity score, likelihood of emergency hospital visits or use of AAI between the LTP + ve patients who were/were not sensitised to pollen. The LTP + ve patients who also had a diagnosis of PFS were more likely to have a FASS-5 score of 4/5 (&lt;i&gt;p&lt;/i&gt; &lt; 0.0001), attend hospital for a food allergic reaction (&lt;i&gt;p&lt;/i&gt; = 0.004), experience co-factor reactions (&lt;i&gt;p&lt;/i&gt; = 0.0001), report symptoms of urticaria (&lt;i&gt;p&lt;/i&gt; &lt; 0.0001), angioedema (&lt;i&gt;p&lt;/i&gt;","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"55 9","pages":"860-863"},"PeriodicalIF":5.2,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.70050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}