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606 Asthma after consumption of snails in housedust mite allergic patients: a case of IgE crossreactivity
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605
606
Abstracts
M o n o s p e c i f i c A l l e r g y to S w o r d f i s h . JM Kelso MD. RT Jones BS. JW Yunginger MD. San Diego, CA and Rochester, MN Fish is a relatively common food allergen and may cause fatal anaphylactic reactions. Fish allergic subjects usually demonstrate lgE antibody to several fish species, although clinical cross reactivity may be more limited. We report a patient clinically allergic to swordfish bat no other fish. This exclusive sensitivity was confirmed by in vivo and/n vitro testing and a unique swordfish allergen was identified. A 29 year old man reported that whenever he ate swordfish, about an hour later he had hives, nausea, vomiting and shortness of breath. He maintained that such reactions did not happen with any other fish. He was skin tested with ten different commercial fish extracts (catfish, cod, halibut, salmon, snapper, sole, trout, tuna, swordfish, and whitefish) and showed a reaction only to the swordfish. Immunoassay for IgE antibody was positive to fresh and cooked swordfish, but negative to other fish. Protein immunoblotting for IgE antibody was performed using serum from this patient. As a control, serum from another patient allergic to all fish species was also analyzed. The multiple fish-allergic patient demonstrated IgE antibody to a 13 kd protein in all fish species tested (probably the cod allergen Gad e 1 or its analogue in other species). The swordfish-allergic patient did not recognize the 13 kd band, but did have IgE antibody to a 25 kd band only in the swordfish. We thus report a patient who is clinically allergic exclusively to swordfish and who demonstrates lgE antibody solely to a unique swordfish allergen. This allergen is different than an allergen common to many fish species previously described in multiple fish-allergic patients. It is interesting to note that swordfish (Xyphias gladius) is the only member of the Xiphiidae fish family.
A s t h m a a f t e r c o n s u m p t i o n o f s n a i l s in h o u s e d u s t m i t e allergic patients: a ease of IgE crossreaetivity. R van Ree~ JH Akkerdaas~ GB Paino ~ L Corbetta F G Ferro~ M Zambito, MS Oarritani, F Bonifazi, R C Aalberse, L Antonicelli, Amsterdam, The Netherlands, Ancona/Messina/Palermo/Venczia, Italy A group of 28 patients from Italy was studied, that demonstrated asthmatic episodes after consumption of snail. Other symptoms observed were rhinitis, urticaria and anaphylaxis. All patients also had asthma and/or rhinitis caused by housedust mite. Sixteen patients were receiving mite immunotberapy (IT). RAST analysis confirmed the combined allergy to snail and mite. In a few sara IgE antibodies to other foods of invertebrate animal origin (mussel and shrimp) were detected. By means of P A S T inhibition it was shown that (most of the) IgE antibodies against snail were crossreactive with housedust mite. In contrast, the mite RAST was not inhibited by snail. This indicates that housedust mite was the sensitizing agent. Immunoblot analysis revealed multiple bands recognized by lgE in snail extract. In contrast to what has been described for crossreactivity between shrimp and mite, tropomyosin played no dominant role as a crossreactive allergen in these patients: only two patients recognized tropomyosin in snail. In conclusion: snail allergy can aggrevate asthmatic symptoms in house(lust mite allergic patients. The earlier observation that mite IT can induce IgE antibodies to snarl suggests that IT might be a risk factor for the development of food allergy. It is, therefore, worthwile to screen mite allergic asthma patients on IgE ant~odies against snarl and other foods of invertebrate animal origin, especially when they are receiving IT.
J ALLERGY CLIN IMMUNOL JANUARY 1996
607
Eggplant Anaphylaxis: Isolation of the Major Allergens and Demonstration of Cross-Reactivity With Other Solanaceae. R Muthiah PhD. A Zondlo. J Zondlo MD. $ Kaoen MD. Appleton, Wl The eggplant is a member of the Solanaceae, or nightshade family, which is a major source of foods and drugs worldwide. Related members of the eggplant include the white potato, red peppers and tomatoes. Here we present the isolation and characterization of the major allergen of the eggplant responsible for inducing anaphylaxis in our index patient. A 16 y female admitted to having symptoms of angioedema, asthma and pruritus immediately after eating at a restaurant. Being unable to identify the offending food, allergy skin testing to foods was performed. Food skin testing was positive for tomato, white potato, red pepper, dill seed, mustard and parsley. Inhalant reactions to grass, birch, ragweed, domestic mites, storage mites and epidermals of horse and dog origin. In vitro eggplant-specific IgE studies were positive, as was tomato. Immunoblotting revealed several IgE binding eggplant proteins. ELISA inhibition studies confirmed cross-reactivity with tomato and grass allergens. Eggplant must now be added to the list of grass cross-reactive foods.
608
PEACH ALLERGY WITH NO POLLEN SENSITIZATION IN CHILDREN M M o r a l s A l m e i d a . C S a n t a M a r t a . S Prates. J M Abrct, No~,ueira. JE R o s a d o Pinto~ I m m u n o a l l e r g y , D.Es~ef'ania Hospital, L i s b o n , P o r t u g a l Fruits are a heterogeneous group of foods responsible for allergic reactions, ranged from mild to severe symptoms. In most cases, fruit allergy is related with sensitization to pollen and other food allergens. In nothem and central Europe it was found a significant correlation between fruit allergy end pollinosis (namely birch-pollen allergy). In south Europe, erossreactivRy with grass, plantago end artemisia was found. The authors present 5 eases of children, aged between 5 and 13 years, 2 males and 3 females, without familial history of atopy, consecutively referred to our Unit (1994) with the following history of immediate allergic reactions to peach: anaphylatic shock (2), ttaiearia / angioedema (2) and oral allergy syndrome (1). These complaints were only related to peach ingestion. Skin prick tests (SPT) were performed with comercial extracts (negative or weak results) and with peach flesh and skin - all the patients had positive results with the fresh fruit (wheal areas> 20ram2). The SPT were negative to other fruits and pollemxs. A control population of 10 healthy children were tested with fresh peach - 100% negative results. Three patients show elevated levels of peach specific IgE antibodies. In two children, who accept to performe open food challenge, it was positive. We conclude that clinical history and SPT of children studied, fail to show any correlation between peach sensitization and any other inhalant or fruit. We didn't find significant differeaeies of potency of extracts prepared from peach skin or flesh, that could be related to different allergenic activity. Our results indicate that in children, peach allergy could be responsible for severe allergic syndromes and occur without predisposing factors.
605
606
Abstracts
M o n o s p e c i f i c A l l e r g y to S w o r d f i s h . JM Kelso MD. RT Jones BS. JW Yunginger MD. San Diego, CA and Rochester, MN Fish is a relatively common food allergen and may cause fatal anaphylactic reactions. Fish allergic subjects usually demonstrate lgE antibody to several fish species, although clinical cross reactivity may be more limited. We report a patient clinically allergic to swordfish bat no other fish. This exclusive sensitivity was confirmed by in vivo and/n vitro testing and a unique swordfish allergen was identified. A 29 year old man reported that whenever he ate swordfish, about an hour later he had hives, nausea, vomiting and shortness of breath. He maintained that such reactions did not happen with any other fish. He was skin tested with ten different commercial fish extracts (catfish, cod, halibut, salmon, snapper, sole, trout, tuna, swordfish, and whitefish) and showed a reaction only to the swordfish. Immunoassay for IgE antibody was positive to fresh and cooked swordfish, but negative to other fish. Protein immunoblotting for IgE antibody was performed using serum from this patient. As a control, serum from another patient allergic to all fish species was also analyzed. The multiple fish-allergic patient demonstrated IgE antibody to a 13 kd protein in all fish species tested (probably the cod allergen Gad e 1 or its analogue in other species). The swordfish-allergic patient did not recognize the 13 kd band, but did have IgE antibody to a 25 kd band only in the swordfish. We thus report a patient who is clinically allergic exclusively to swordfish and who demonstrates lgE antibody solely to a unique swordfish allergen. This allergen is different than an allergen common to many fish species previously described in multiple fish-allergic patients. It is interesting to note that swordfish (Xyphias gladius) is the only member of the Xiphiidae fish family.
A s t h m a a f t e r c o n s u m p t i o n o f s n a i l s in h o u s e d u s t m i t e allergic patients: a ease of IgE crossreaetivity. R van Ree~ JH Akkerdaas~ GB Paino ~ L Corbetta F G Ferro~ M Zambito, MS Oarritani, F Bonifazi, R C Aalberse, L Antonicelli, Amsterdam, The Netherlands, Ancona/Messina/Palermo/Venczia, Italy A group of 28 patients from Italy was studied, that demonstrated asthmatic episodes after consumption of snail. Other symptoms observed were rhinitis, urticaria and anaphylaxis. All patients also had asthma and/or rhinitis caused by housedust mite. Sixteen patients were receiving mite immunotberapy (IT). RAST analysis confirmed the combined allergy to snail and mite. In a few sara IgE antibodies to other foods of invertebrate animal origin (mussel and shrimp) were detected. By means of P A S T inhibition it was shown that (most of the) IgE antibodies against snail were crossreactive with housedust mite. In contrast, the mite RAST was not inhibited by snail. This indicates that housedust mite was the sensitizing agent. Immunoblot analysis revealed multiple bands recognized by lgE in snail extract. In contrast to what has been described for crossreactivity between shrimp and mite, tropomyosin played no dominant role as a crossreactive allergen in these patients: only two patients recognized tropomyosin in snail. In conclusion: snail allergy can aggrevate asthmatic symptoms in house(lust mite allergic patients. The earlier observation that mite IT can induce IgE antibodies to snarl suggests that IT might be a risk factor for the development of food allergy. It is, therefore, worthwile to screen mite allergic asthma patients on IgE ant~odies against snarl and other foods of invertebrate animal origin, especially when they are receiving IT.
J ALLERGY CLIN IMMUNOL JANUARY 1996
607
Eggplant Anaphylaxis: Isolation of the Major Allergens and Demonstration of Cross-Reactivity With Other Solanaceae. R Muthiah PhD. A Zondlo. J Zondlo MD. $ Kaoen MD. Appleton, Wl The eggplant is a member of the Solanaceae, or nightshade family, which is a major source of foods and drugs worldwide. Related members of the eggplant include the white potato, red peppers and tomatoes. Here we present the isolation and characterization of the major allergen of the eggplant responsible for inducing anaphylaxis in our index patient. A 16 y female admitted to having symptoms of angioedema, asthma and pruritus immediately after eating at a restaurant. Being unable to identify the offending food, allergy skin testing to foods was performed. Food skin testing was positive for tomato, white potato, red pepper, dill seed, mustard and parsley. Inhalant reactions to grass, birch, ragweed, domestic mites, storage mites and epidermals of horse and dog origin. In vitro eggplant-specific IgE studies were positive, as was tomato. Immunoblotting revealed several IgE binding eggplant proteins. ELISA inhibition studies confirmed cross-reactivity with tomato and grass allergens. Eggplant must now be added to the list of grass cross-reactive foods.
608
PEACH ALLERGY WITH NO POLLEN SENSITIZATION IN CHILDREN M M o r a l s A l m e i d a . C S a n t a M a r t a . S Prates. J M Abrct, No~,ueira. JE R o s a d o Pinto~ I m m u n o a l l e r g y , D.Es~ef'ania Hospital, L i s b o n , P o r t u g a l Fruits are a heterogeneous group of foods responsible for allergic reactions, ranged from mild to severe symptoms. In most cases, fruit allergy is related with sensitization to pollen and other food allergens. In nothem and central Europe it was found a significant correlation between fruit allergy end pollinosis (namely birch-pollen allergy). In south Europe, erossreactivRy with grass, plantago end artemisia was found. The authors present 5 eases of children, aged between 5 and 13 years, 2 males and 3 females, without familial history of atopy, consecutively referred to our Unit (1994) with the following history of immediate allergic reactions to peach: anaphylatic shock (2), ttaiearia / angioedema (2) and oral allergy syndrome (1). These complaints were only related to peach ingestion. Skin prick tests (SPT) were performed with comercial extracts (negative or weak results) and with peach flesh and skin - all the patients had positive results with the fresh fruit (wheal areas> 20ram2). The SPT were negative to other fruits and pollemxs. A control population of 10 healthy children were tested with fresh peach - 100% negative results. Three patients show elevated levels of peach specific IgE antibodies. In two children, who accept to performe open food challenge, it was positive. We conclude that clinical history and SPT of children studied, fail to show any correlation between peach sensitization and any other inhalant or fruit. We didn't find significant differeaeies of potency of extracts prepared from peach skin or flesh, that could be related to different allergenic activity. Our results indicate that in children, peach allergy could be responsible for severe allergic syndromes and occur without predisposing factors.