Diagnosis of Sesame Allergy: Analysis of Current Practice and Exploration of Sesame Component Ses i 1

Saf, Sarah; Sifers, Travis; Baker, Mary Grace; Warren, Christopher; Knight, Christopher; Bakhl, Katrina; Kattan, Jacob D.; Sampson, Hugh A.; Nowak‐Węgrzyn, Anna

doi:10.1016/j.jaip.2019.11.028

Cited by 31 publications

(34 citation statements)

References 44 publications

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“…From our data, SPT is a more accurate predictor of shrimp allergy compared with shrimp sIgE that is also similarly reported for sesame allergy. 24 Our study also corroborated with published studies that SPT and sIgE levels had a high sensitivity of >90% but a low specificity of 28% (SPT) and 35% (shrimp sIgE) at the standard cutoff points, as well as low AUC values that indicate their low diagnostic power to shrimp allergy. 25,26 IgE crosslinking assays were shown to closely resemble the clinical phenotype of food-allergic patients and reflect the severity and threshold of allergic reactions, 15,27,28 as these tests took into account the levels, specificity, diversity, and affinity of allergen-specific IgE as well as possible interference by other allergen-specific antibodies such as IgG4.…”

Section: Discussionsupporting

confidence: 91%

Cell-Based Functional IgE Assays Are Superior to Conventional Allergy Tests for Shrimp Allergy Diagnosis

Wai

Leung

et al. 2021

The Journal of Allergy and Clinical Immunology: In Practice

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What is already known about this topic? Shrimp allergy is prevalent, but conventional diagnostic methods including skin prick test (SPT) and specific IgE (sIgE) measurements have low specificity. Testing for tropomyosin improves diagnostic accuracy for shrimp allergy in Caucasians, but this has not been replicated among Asians.What does this article add to our knowledge? BAT has superior diagnostic performance for shrimp allergy than SPT and sIgE measurement. Tropomyosin may not be the most appropriate diagnostic marker in the Chinese population. The IgE crosslinkingeinduced luciferase expression (EXiLE) test can be a good alternative to BAT.How does this study impact current management guidelines? A single step of BAT may replace SPT and sIgE in the diagnosis of patients with clinical history suggestive of shrimp allergy. The EXiLE test can be a suitable alternative with respect to cost and sampling constraint.BACKGROUND: The diagnosis of shellfish allergy currently relies on patient history, skin prick test (SPT), and serum specific IgE (sIgE) quantification. These methods lack sufficient diagnostic accuracy, whereas the gold standard of oral food challenges is risky and burdensome. Markers of reactivity and severity of allergic reactions to shellfish will improve clinical care of these patients. OBJECTIVES: This study compared the diagnostic performance of SPT, sIgE, basophil activation test (BAT), and IgE crosslinkingeinduced luciferase expression (EXiLE) test for shrimp allergy. METHODS: Thirty-five subjects with documented history of shrimp allergic reactions were recruited and grouped according to results of double-blind, placebo-controlled food challenge (DBPCFC). In addition to routine diagnostics, BAT (Flow CAST) and EXiLE test with shrimp extract and tropomyosin were performed. RESULTS: Of 35 subjects, 15 were shrimp allergic with pruritus, urticaria, and itchy mouth on DBPCFC, whereas 20 were tolerant to shrimp. Tropomyosin only accounted for 53.3% of sensitization among subjects with challenge-proven shrimp allergy. BAT using shrimp extract as stimulant showed the highest area under curve value (0.88), Youden Index (0.81), likelihood ratio (14.73), odds ratio (104), and variable importance (4.27) when compared with other assays and tropomyosin diagnosis. Results of BAT significantly correlated with those of EXiLE (r [ 0.664, P < .0001). CONCLUSIONS: BAT is a more accurate diagnostic marker for shrimp allergy than SPT and shrimp sIgE, whereas the EXiLE test based on an IgE crosslinking assay is a good alternative to

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Section: Discussionsupporting

confidence: 91%

Cell-Based Functional IgE Assays Are Superior to Conventional Allergy Tests for Shrimp Allergy Diagnosis

Wai

Leung

et al. 2021

The Journal of Allergy and Clinical Immunology: In Practice

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“…The clinical role of a particular allergen component may be geographical and population‐specific, but the demonstrated diagnostic efficacy of Ses i 1 in Japan, 6 United States, 7 and currently in Israel makes it likely to be a globally important determinant in sesame allergy. Interestingly, among the allergic patients, Ses i 1 test results correlated with the BAT results, though not with those of HPSE‐SPT.…”

Section: Discussionmentioning

confidence: 99%

“…Detection of sensitization by measurement of specific IgE antibodies in serum may be advantageous compared to SPT, since it facilitates simultaneous testing of a far greater number of allergens. Regarding sesame allergen reagents, specific component testing with the 2S albumin Ses i 1 showed superior diagnostic accuracy over sIgE to whole sesame extract 6,7 . No report has so far explored the use of Ses i 1 in conjunction with BAT for diagnosis of sesame allergy.…”

Section: Introductionmentioning

confidence: 99%

Combinatorial advantage of Ses i 1‐specific IgE and basophil activation for diagnosis of sesame food allergy

Goldberg

Appel

Nachshon

et al. 2021

Pediatric Allergy Immunology

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The prevalence of allergy to sesame seeds (Sesamum indicum) is increasing, attributed in part to the widespread introduction of the so-called Mediterranean diet. It is estimated that the incidence of sesame food allergy (SFA) in the United States is approximately 0.2% which would place it in the same order of magnitude as other recognized major food allergens. 1 This has resulted in the passage of the Food Allergy Safety, Treatment, Education, and Research Act of 2021 which declared sesame as an additional major allergen subject to food labeling requirements. 2 This legislation should mitigate the potential for anaphylaxis upon inadvertent exposures to sesame and

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“…Yanagida et al identi ed that Ses i 1 sIgE better predicted the probability of a sesame induced reaction compared to sesame sIgE 15 . Recently, Saf et al found that sesame skin-prick-testing has better accuracy at predicting an allergy to sesame compared to sesame sIgE Sesame SPT is a more accurate predictor of sesame allergy compared with sesame sIgE 22 . Additionally, published studies investigating legume OFC outcomes have focused on the use of skin prick testing as a diagnostic test 16,17,18 .…”

Section: Introductionmentioning

confidence: 99%

Legume and Sesame Oral Food Challenge Outcomes

Pozin

Devonshire

Tom³

et al. 2020

Preprint

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Background: Legume and sesame are emerging food allergens. The utility of specific IgE testing (sIgE) to predict clinical reactivity to these allergens is not well described.Objective: To describe clinical outcomes and sIgE in sesame and legume OFCs. Methods: We performed a retrospective review of 74 legume and sesame oral food challenges (OFC) performed between 2007-2017 at the Ann & Robert H. Lurie Children’s Hospital of Chicago. Clinical data, OFC outcome, and sIgE to legume and sesame were collected. Receiver operating characteristic curves (ROC) and logistic regression models predicting OFC outcome were generated. Results: Twenty-eight patients (median age 6.15 years) passed legume OFC (84.85%), and twenty-five patients (median age 5.91 years) passed sesame OFC (60.98%). The median sIgE to legume was 1.41 kUa/L, and 2.34 kUa/L, to sesame. For patients who failed legume OFC, 67% had cutaneous, 16.5% had gastrointestinal, and 16.5% had anaphylaxis. Of these reactions, 80% were controlled with Benadryl alone and 20% required epinephrine. For patients who failed sesame OFC, 53% had cutaneous, 12% had gastrointestinal, and 35% had anaphylaxis. Of these reactions, 6% required epinephrine, 31% were controlled with Benadryl alone, and 63% required additional epinephrine or steroids. Conclusion: Most OFC to legumes were passed and reactions to failed legume OFCs were more likely to be non-severe. Failing an OFC to sesame was almost twice as likely compared to failing a legume OFC, and reactions to failed sesame OFC were often more severe. Sesame sIgE did not correlate with OFC outcome.

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Diagnosis of Sesame Allergy: Analysis of Current Practice and Exploration of Sesame Component Ses i 1

Cited by 31 publications

References 44 publications

Cell-Based Functional IgE Assays Are Superior to Conventional Allergy Tests for Shrimp Allergy Diagnosis

Cell-Based Functional IgE Assays Are Superior to Conventional Allergy Tests for Shrimp Allergy Diagnosis

Combinatorial advantage of Ses i 1‐specific IgE and basophil activation for diagnosis of sesame food allergy

Legume and Sesame Oral Food Challenge Outcomes

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