Natural History of Perceived Food Hypersensitivity and IgE Sensitisation to Food Allergens in a Cohort of Adults

Patelis, Antonios; Gunnbjörnsdóttir, Mari­a; Borres, Magnus P.; Burney, Peter; Gíslason, Þórarinn; Forsberg, Bertil; Alving, Kjell; Malinovschi, Andreï; Janson, Christer

doi:10.1371/journal.pone.0085333

Cited by 28 publications

(33 citation statements)

References 40 publications

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“…It is also generally unclear how common sensitization to wheat is among individuals with grass pollen allergy. In the current study, close to two thirds of children displayed a low-level IgE-Ab response to wheat, supporting serological data from other studies [11, 12]. One of the strengths of our study is that all children included could tolerate wheat, and therefore sensitization to wheat was not related to present wheat food allergy.…”

Section: Discussionsupporting

confidence: 88%

Grass-Allergic Children Frequently Show Asymptomatic Low-Level IgE Co-Sensitization and Cross-Reactivity to Wheat

Nilsson

Ekoff

et al. 2018

Int Arch Allergy Immunol

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Background: Specific immunoglobulin E (IgE) sensitization to wheat is more common than a doctor’s confirmed wheat allergy and is also frequently observed in grass pollen-allergic patients (pollinosis patients). Thus, the objective of this study was to investigate the level and feature of serological IgE cross-reactivity between grass pollen and wheat in a cohort of pollinosis subjects with no diagnosis of wheat allergy. Methods: Seventy-two children, aged 5–17 years, with a doctor’s diagnosis of pollinosis, IgE towards grass pollen, and currently eating wheat were recruited. Serum samples were analyzed for IgE against wheat, timothy grass/wheat-specific allergen components, Pru p 3, and cross-reactive carbohydrate determinants (CCD) and specific IgE-binding inhibition experiments were performed. Results: Sixty percent of the grass pollen subjects were sensitized to wheat with a median of 0.5 kU_A/L. Wheat-sensitized subjects were more often sensitized to the two allergens, Phl p 12 and CCD, known to be cross-reactive between grass and wheat. Sensitizations to seven wheat-specific allergens derived from the gluten fraction were, with the exception of one individual, only found in wheat-sensitized subjects. These subjects also more often reported current and past history of allergy to staple foods (milk, egg, wheat, soy, and fish). Conclusion: Wheat sensitization caused by cross-reactivity but also by sensitization to wheat-specific allergens was common in the grass-allergic children and also associated with allergy to staple foods other than wheat. The results indicate the presence of a subgroup of pollinosis patients with simultaneous sensitization to wheat and food allergy not only caused by cross-reactions.

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Section: Discussionsupporting

confidence: 88%

Grass-Allergic Children Frequently Show Asymptomatic Low-Level IgE Co-Sensitization and Cross-Reactivity to Wheat

Nilsson

Ekoff

et al. 2018

Int Arch Allergy Immunol

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“…Available data on the natural evolution of IgE concentrations in adults are contradictory as discussed by Patelis et al . However, one large population‐based study ( n = 2300) in adults 30–40 years of age showed unchanged prevalence of IgE sensitization to basically all aeroallergens and increased total IgE concentrations over a 9‐year follow‐up period . Thus, there is little support for the view that the changes in IgE we see in the present one‐year follow‐up study would be due to natural changes.…”

Section: Discussioncontrasting

confidence: 77%

“…In other words, a larger proportion of the participants were at steps with either the highest or the lowest level of anti‐inflammatory treatment at the end of the study, as compared to baseline. Available data on the natural evolution of IgE concentrations in adults are contradictory as discussed by Patelis et al . However, one large population‐based study ( n = 2300) in adults 30–40 years of age showed unchanged prevalence of IgE sensitization to basically all aeroallergens and increased total IgE concentrations over a 9‐year follow‐up period .…”

Section: Discussionmentioning

confidence: 99%

Parallel reductions of IgE and exhaled nitric oxide after optimized anti‐inflammatory asthma treatment

Syk

Malinovschi

Borres

et al. 2016

Immunity Inflam & Disease

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Immunoglobulin E (IgE) is crucial for the development of airway inflammation in atopic asthma, and inhibition of IgE using monoclonal antibodies is now part of asthma therapy. However, the impact of ordinary anti‐inflammatory treatment on IgE is unclear. The aim of this study was to investigate if optimization of treatment with inhaled corticosteroid (ICS) and leukotriene‐receptor antagonist (LTRA) according to symptoms or exhaled nitric oxide (FENO) levels over a one‐year period affects IgE concentrations. Altogether, 158 relatively well‐controlled but multi‐sensitized asthmatics (age 18–65 years), with ongoing ICS treatment at baseline, were included in this post hoc analysis of data from a randomized, controlled trial on FENO‐guided asthma therapy. Asthma control and quality of life (Juniper ACQ and mAQLQ), FENO, and serum IgE were measured at baseline and after one year. Concentrations of IgE antibodies to six common perennial aeroallergens were summed up (perennial IgE). We found that perennial and total IgE decreased by 10.2% and 16.0% (P < .001 both comparisons). This was not related to allergen exposure, whereas the total use of ICS and LTRA during the year correlated with the reduction in perennial IgE (P = .030 and P = .013). The decrease in perennial and total IgE correlated significantly with the reduction in FENO (P < .003 and P < .001), and with improvements in ACQ and mAQLQ scores (P < 0.05, all comparisons). We conclude that one year of optimization of treatment with ICS and LTRA in patients with persistent atopic asthma resulted in significant decreases in total IgE and IgE antibodies; these decreases correlated with a reduction in FENO and improvements in asthma control and quality of life. Thus, IgE is reduced by ordinary asthma controller medications and the effect on IgE seems to be clinically important.

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“…A European systematic review found the overall point prevalence in Europe of self-reported FA to be 5.9% (95% CI: 5.7-6.1), compared with a food challenge confirmed FA rate of 0.9% (95% CI: 0.8-1.1) [ 6 ]. Reported FA persists over time in adults [ 7 ], and age-related changes can affect the immune system, increasing the potential for newly diagnosed food allergy in older adults [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

The development of a standardised diet history tool to support the diagnosis of food allergy

Skypala

Venter

Meyer

et al. 2015

Clinical & Translational All

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The disparity between reported and diagnosed food allergy makes robust diagnosis imperative. The allergy-focussed history is an important starting point, but published literature on its efficacy is sparse. Using a structured approach to connect symptoms, suspected foods and dietary intake, a multi-disciplinary task force of the European Academy of Allergy and Clinical Immunology developed paediatric and adult diet history tools. Both tools are divided into stages using traffic light labelling (red, amber and green). The red stage requires the practitioner to gather relevant information on symptoms, atopic history, food triggers, foods eaten and nutritional issues. The amber stage facilitates interpretation of the responses to the red-stage questions, thus enabling the practitioner to prepare to move forward. The final green stage provides a summary template and test algorithm to support continuation down the diagnostic pathway. These tools will provide a standardised, practical approach to support food allergy diagnosis, ensuring that all relevant information is captured and interpreted in a robust manner. Future work is required to validate their use in diverse age groups, disease entities and in different countries, in order to account for differences in health care systems, food availability and dietary norms.Electronic supplementary materialThe online version of this article (doi:10.1186/s13601-015-0050-2) contains supplementary material, which is available to authorized users.

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Natural History of Perceived Food Hypersensitivity and IgE Sensitisation to Food Allergens in a Cohort of Adults

Cited by 28 publications

References 40 publications

Grass-Allergic Children Frequently Show Asymptomatic Low-Level IgE Co-Sensitization and Cross-Reactivity to Wheat

Grass-Allergic Children Frequently Show Asymptomatic Low-Level IgE Co-Sensitization and Cross-Reactivity to Wheat

Parallel reductions of IgE and exhaled nitric oxide after optimized anti‐inflammatory asthma treatment

The development of a standardised diet history tool to support the diagnosis of food allergy

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