Riccardo Asero

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..Tomato contains many allergens but their clinical relevance is poorly defined and the usefulness of available diagnostic methods is unknown...

..The present article, written by a panel of experts, reports the main recommendations for the practical clinical management of patients with a history of urticaria/angioedema induced by multiple NSAID based on current knowledge...

..A case of mono-sensitization to a heat- and pepsin-stable allergen in zucchini is described...

..A patient monosensitized to plane pollen is described On ISAC 103 the patients showed IgE reactivity to both Pla a 1 and Pla a 2, but on immunoblot analysis the serum showed a single IgE reactivity at about 50 kDa allergen...

..Previous surveys performed in this area showed that the age at onset of ragweed allergy in monosensitized subjects is about 35...

..Extra-European immigrants are increasingly seen in allergy clinics. In view of their different genetic background they represent an opportunity to investigate the dynamics of sensitization to airborne allergens...

..The objective of this study was to measure tryptase levels in subjects with respiratory allergy and analyze the results in the light of tolerance/intolerance to injection SIT...

..Kiwi allergy is frequent and can be the result of sensitization to a number of allergens showing different physicochemical characteristics. Component-resolved diagnosis of kiwi allergy is still unavailable in routine clinical practice...

..In profilin-hypersensitive patients this has not been investigated so far...

..Such mechanism seems to be active in the majority of CU patients, however their relationship with anti-FcepsilonRI or anti-IgE autoantibodies is still matter of research...

..Recent studies show that patients with multiple nonsteroidal anti-inflammatory drug (NSAID) intolerance are frequently characterized by autoreactivity; this can be detected by autologous serum skin test (ASST)...

..A careful diagnostic workup revealed that the disorder was caused by sodium glutamate intolerance. This is the first study showing an association between intolerance to food additives and nasal polyposis...

..Adverse reactions to Rosaceae, tree nuts, peanut, beer, maize, mustard, asparagus, grapes, mulberry, cabbage, dates, orange, fig, kiwi, lupine, fennel, celery, tomato, eggplant, lettuce, chestnut and pineapple have been recorded...

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..In patients with a history of urticaria induced by a single nonsteroidal anti-inflammatory drug (NSAID), advising elimination of all drugs that inhibit cyclooxygenase 1 (COX-1) can lead to unnecessary avoidance of useful NSAIDs...

..Conclusion In subjects with a history of urticaria induced by a single NSAID (other than aspirin) the diagnostic workup should start with an aspirin challenge in order to detect single/multiple NSAID reactors...

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..Although both these substances are potent inductors of contraction of airway smooth muscle, pulmonary function and airway hyperresponsiveness have not been systematically investigated in patients with CU...

..These findings put under a new light some rather sparse studies of the effect of drugs active on the coagulation system (heparin and oral anticoagulants) in patients with CU...

..Clinical and serological studies showed that ragweed and mugwort sensitization are often associated and this poses relevant clinical problems in patients for whom specific immunotherapy is warranted...

..Autologous serum skin tests (ASSTs) and in vitro histamine release assays seem to look into distinct aspects of the disease, and the specificity of ASST has been questioned...

..This event might theoretically involve cross-reacting pollen allergens, such as profilin or polcalcins, posing a risk of SIT-induced polysensitization to pollens in patients who were originally monosensitized...

..This study confirms the association between profilin sensitization and melon allergy...

..Recent investigations have found that patients with CU show signs of thrombin generation and activation of the tissue factor pathway of the coagulation cascade...

..Profilin, a pan-allergen present in all eukaryotic cells, is one of the main causes of cross-sensitization between pollen and plant-derived foods, but its clinical relevance as a food allergen is still debated...

..Inhibition studies carried out in-vitro showed the complete cross-reactivity between the relevant tomato allergen and purified peach lipid transferprotein (LTP). Tomato LTP may sometimes cause severe allergic reactions...

..Olive pollen sensitization is surprisingly frequent in Milan, an area that is virtually both olive- and ash-free...

..Activation of the coagulation cascade and hyper-expression of vascular endothelial growth factor (VEGF) were recently found in CU, and there is sparse evidence that the same may occur in asthma...

..Few studies analyze cross-reactivity between lipid transfer proteins (LTP) from a large spectrum of botanically unrelated plant-derived foods using routine diagnostic tests...

..Sparse clinical observations suggest a possible association between food allergy to lipid transfer protein (LTP) and chronic urticaria (CU)...

..The observed cross-reactivity between pollen and plant-food LTPs has led to hypothesize that primary sensitisation to this allergen may occur through the airways...

..Markers able to predict whether a patient sensitized to a certain food but not yet clinically allergic will develop allergy would be extremely helpful...

..Peach-induced contact urticaria is frequent in peach-allergic subjects...

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..Immune-mediated inflammation and coagulation are strictly linked, and coagulation activation has been described in CU patients as shown by the elevation of plasma prothrombin fragment F1+2 and, in severe cases, of d-dimer as well...

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..Calcium-binding proteins (polcalcins) and profilin are cross-reacting panallergens that sensitize a minority of pollen-allergic patients. Their clinical relevance remains controversial...

..Chronic urticaria (CU) patients often present activation of the coagulation cascade and fibrinolysis whose markers correlate with disease severity...

..Data about food-induced anaphylaxis in Italy are missing. Objective: It was the aim of this study to detect the main foods/food allergens causing anaphylaxis in Italy...

..Studies of the prevalence of different types of food allergy in adults are lacking...

..Based on a comparison with currently known tomato allergens, this seems to be a novel allergen protein...

..This review article aims to reappraise the pros and cons of DBPCFC and to elicit some critical thoughts and discussions about the real indications of this diagnostic procedure in adult patients in everyday practice...

..Patients allergic to nonspecific lipid transfer protein (LTP) frequently score positive on SPT with legumes but virtually never report adverse reactions eating these foods...

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..Previous studies suggest that allergen-specific immunotherapy (SIT) with a single allergen may prevent sensitization to other airborne allergens...

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..One hypothesis is that COX-1 inhibition may play a relevant pathogenic role. If so, drugs that are not active on COX-1 would be expected to be well tolerated by CU patients...

..This study investigated the immunologic cross-reactivity between profilins from Parietaria, grass and birch pollen...

..Recent studies demonstrated that chronic idiopathic urticaria (CIU) is an autoimmune disease at least in a subset of patients, but familial studies have not yet been conducted...

..Approximately 30% of patients with chronic idiopathic urticaria, a condition frequently characterized by autoreactivity on autologous serum skin test (ASST), experience flares of hives after taking chemically unrelated NSAIDs...

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..about one fourth of patients with chronic idiopathic urticaria (CIU) experience flares of hives after taking chemically unrelated nonsteroidal anti-inflammatory drugs (NSAID). The reasons for such intolerance are still elusive...

..Lipid transfer proteins (LTPs) are the major allergens in patients sensitive to Rosaceae (apple, peach, apricot, cherry, plum, and pear) who are not allergic to birch pollen...

..Lipid transfer proteins (LTPs) are highly conserved proteins present in a broad spectrum of fruits and vegetables that might represent a novel plant panallergen...

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..The recent literature published in English was reviewed to find controlled studies able to confirm this observation...

..The role of specific immunotherapy (SIT) in elderly allergic patients is still debated...

..There is increasing evidence that bird fanciers may develop airborne allergies to unusual allergens...

..The significance of Candida albicans as an allergen is still unclear. This study aimed at investigating the clinical features of patients monosensitized to Candida...

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..In children presenting with chronic or recurrent urticaria the diagnostic workup should include the autologous serum skin test...

..A non-specific release of bradykinins during clotting of blood samples has been suggested; however, ASST seems rather specific and some data point to the existence of a mast cell-specific histamine-releasing factor...

..This raises the possibility that the novel sensitization to cross-reacting allergens may cause food allergies...

..In view of the high prevalence and severity of the allergic reactions induced, hazelnut, walnut, and peanut should be regarded as potentially hazardous for these patients...

..Since many apple cultivars exist some of them might contain sufficiently low amounts of Mal d 1 to be tolerated by most allergic patients...

..Peach surface fuzz might represent a potential vehicle of LTP...

..The former induce only OAS, whereas stable allergens may induce systemic reactions. Component-resolved diagnosis (CRD) of allergy to plant foods is therefore essential for the clinical management of allergic patients...

..However, the long-term efficacy of SIT for apple allergy has not been assessed...

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..CONCLUSION: LTP is a true pan-allergen with a degree of cross-reactivity comparable to profilin. Due to its extreme resistance to pepsin digestion, LTP is a potentially severe food allergen...

..We suggest that circulating histamine-releasing factors, probably represented by histamine-releasing autoantibodies, might be involved in the pathophysiology of both chronic urticaria and asthma...

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..CONCLUSION: The heat-resistance of stable apple allergens like LTP can be usefully exploited to prepare extracts for allergen-resolved diagnosis in-vivo...

..In patients with chronic urticaria (CU), plasma shows signs of thrombin generation and autologous plasma skin tests score positive in as many as 95% of cases...

..Immunoblot analysis showed IgE reactivity to two distinct bee moth proteins at 23 and 70 kDa, respectively. ELISA inhibition studies excluded cross-reactivity to the other popular live bait, fly larva...

..All patients tolerated the drug at therapeutic doses. The study suggests that etoricoxib, with its favourable COX-1/COX-2 ratio, is well tolerated by patients with chronic urticaria exacerbated by NSAID intolerance...

..The increased IL-18 levels in the ASST-positive patients with most active chronic urticaria may reflect stronger immune system activation and possibly an involvement of IL-18 as a direct histamine-releasing factor...

..8% in the general population agrees with the data reported from a number of countries with temperate climate. The prevalence of 4.5% in foresters attributed to this population a risk only slightly increased...

..Warfarin therapy may also be considered in some patients with chronic urticaria and angioedema unresponsive to antihistamines...

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..Both multiple and single NSAID reactors with a history of aspirin-induced urticaria seem at higher risk for CU than patients with a history of single intolerance to NSAIDs other than aspirin...

..Matrix metalloproteinase-9 (MMP-9) is an endopeptidase produced by many inflammatory cells that has been found in increased amounts in plasma from patients with chronic urticaria (CU)...

..Subcutaneous immunotherapy is effective for the treatment of respiratory allergy, and it is largely used in Italy, but no systematic safety assessment has been carried out so far...

..These results suggest that substance P does not play an important role as histamine-releasing factor in COU in general but only in occasional patients in whom it might act as a trigger of urticarial symptoms...

..Epinephrine is the treatment of choice for acute food-allergic reactions but existing guidelines state that it should be prescribed uniquely to patients who already experienced at least one food-induced anaphylactic episode...

..Eosinophils, which are involved in CU skin lesions, have recently been demonstrated as the major source of TF in human blood. We assessed whether eosinophils are the cellular source of TF in CU skin lesions...