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Allergy To Sheep Milk With Or Without Allergy To Cow Milk
Abstracts AB199
J ALLERGY CLIN IMMUNOL VOLUME 133, NUMBER 2
Oral Allergy Syndrome - a Spectrum Of Presentations Dr. Parwinder Gill1, Dr. Gordon L. Sussman, FAAAAI2, Jiayi Bian1, Ms. Carly Barron3; 1University of Toronto, Toronto, ON, Canada, 2 University of Toronto, Faculty of Medicine, Toronto, ON, Canada, 3Gordon Sussman Clinical Research Inc., Toronto, ON, Canada. RATIONALE: We report a case series of patients presenting with features of oral allergy syndrome (OAS) with clinical symptoms ranging from gastrointestinal upset to anaphylaxis. This highlights the possibility that OAS may present not only as local irritation of the oropharynx, but can also manifest as more serious symptoms such as gastrointestinal upset, and even anaphylaxis. METHODS: Our report consists of six individuals who presented with gastrointestinal symptoms alone, and four individuals who presented with severe allergic reactions, who underwent allergy testing for investigation. RESULTS: In all ten cases, clinical history in addition to the results of the allergy testing was consistent with oral allergy syndrome presenting as gastrointestinal upset or anaphylaxis in response to their triggers. CONCLUSIONS: OAS is an IgE-mediated allergic reaction resulting from cross-reactivity of pollens, mainly birch and ragweed with certain nuts, fruits and vegetables. This is generally recognised as a benign syndrome presenting as local itching of the mouth occurring after contact with these foods. However, oral allergy syndrome can manifest as gastrointestinal symptoms and even anaphylactic allergy. We report these cases to alert the possibility that oral allergy syndrome can present as a spectrum of symptoms and can result in serious systemic reactions.
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Allergy To Sheep Milk With Or Without Allergy To Cow Milk Dr. Fouseena Pazheri1, Dr. Alton Lee Melton, Jr, MD2, Dr. Earl Poptic1, Dr. Belinda Willard1; 1Cleveland CLinic, Cleveland, OH, 2Cleveland Clinic, Cleveland, OH. RATIONALE: Cow milk protein represents a common food allergen in children. These children often look to other mammalian milks as nutritional alternatives, including goat milk and sheep milk. Previous reports suggest significant cross- allergenicity among the caseins of different mammalian milks. Isolated allergy to sheep milk protein is unusual, with only a few reported cases. We report the analysis of two cases of sheep milk allergy, one with concomitant cow milk allergy and the other without. METHODS: Clinical and laboratory characteristics of two children with allergy to milk proteins evaluated at a pediatric allergy clinic were reviewed. Two-dimensional SDS PAGE and immunoblotting will be performed using extracts made from sheep milk and cow milk and serum from the two patients and appropriate controls. RESULTS: Subject 1 is a 10-year-old boy who experienced anaphylactic reactions to two sheep milk cheeses ( Romano cheese and ricotta cheese). He tolerates cow milk products. IgE ELISA for cow milk was undetectable (<0.35 Ku/L) and positive for sheep milk (29.2 Ku/L). Subject 2 is a 15year-old boy with a long history of severe allergy to cow milk, who had IgE ELISA performed for several other mammalian milks. IgE ELISA was significantly elevated for both cow milk (34.1 Ku/L) and sheep milk (48.9 Ku/L). CONCLUSIONS: A high degree of cross-allergenicity exists between proteins from milks of different mammals, and this often limits dietary choices for children with clinical cow milk allergy. However, individual patients may display unique sensitization to a particular milk. These cases illustrate both these scenarios.
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Genome-Wide Study Of Interaction Between Season Of Birth and Peanut Allergy Identifies a Region On Chromosome 3 As a Genetic Risk Factor Corinne Keet, MD, MS1, Xiumei Hong, PhD2, Dr. Ingo Ruczinski, PhD2, Dr. Terri H. Beaty, PhD2, Dr. Jacqueline Pongracic, MD, FAAAAI3, Dr. Xiaobin Wang, MD, MPH ScD4; 1Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 2Johns Hopkins University School of Public Health, Baltimore, MD, 3Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 4Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. RATIONALE: Fall season of birth has been identified as a risk factor for food allergy, but underlying mechanisms remain unknown. We hypothesized that at least one common single nucleotide polymorphism (SNP) would show evidence of gene-environment interaction (GxEI) with season of birth and food allergy. METHODS: 312 case-parent trios were included in a genome wide association study of peanut allergy using the Illumina HumanOmni1-Quad BeadChip. Analysis of GxEI between season of birth and individual SNPs was done using the package TRIO in R, which rapidly fits a conditional logistic regression model while testing for interaction. The 1 degree of freedom test comparing the dominant model with and without GxEI is reported. Season of birth was defined as fall (September, October and November) versus all other months combined. Peanut allergy was defined as history of an immediate onset of typical allergy symptoms to peanut with confirmatory positive specific IgE or skin testing. RESULTS: Two SNPs near the genes PBRM1 & GNL3 on chr.3p21 yielded genome-wide significance in this test for GxEI (rs2590838 and rs1108842, p59.5x10-9 and 1.2x10-8, respectively). Forty-nine SNPS in this region approached genome-wide significance (10-7
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J ALLERGY CLIN IMMUNOL VOLUME 133, NUMBER 2
Oral Allergy Syndrome - a Spectrum Of Presentations Dr. Parwinder Gill1, Dr. Gordon L. Sussman, FAAAAI2, Jiayi Bian1, Ms. Carly Barron3; 1University of Toronto, Toronto, ON, Canada, 2 University of Toronto, Faculty of Medicine, Toronto, ON, Canada, 3Gordon Sussman Clinical Research Inc., Toronto, ON, Canada. RATIONALE: We report a case series of patients presenting with features of oral allergy syndrome (OAS) with clinical symptoms ranging from gastrointestinal upset to anaphylaxis. This highlights the possibility that OAS may present not only as local irritation of the oropharynx, but can also manifest as more serious symptoms such as gastrointestinal upset, and even anaphylaxis. METHODS: Our report consists of six individuals who presented with gastrointestinal symptoms alone, and four individuals who presented with severe allergic reactions, who underwent allergy testing for investigation. RESULTS: In all ten cases, clinical history in addition to the results of the allergy testing was consistent with oral allergy syndrome presenting as gastrointestinal upset or anaphylaxis in response to their triggers. CONCLUSIONS: OAS is an IgE-mediated allergic reaction resulting from cross-reactivity of pollens, mainly birch and ragweed with certain nuts, fruits and vegetables. This is generally recognised as a benign syndrome presenting as local itching of the mouth occurring after contact with these foods. However, oral allergy syndrome can manifest as gastrointestinal symptoms and even anaphylactic allergy. We report these cases to alert the possibility that oral allergy syndrome can present as a spectrum of symptoms and can result in serious systemic reactions.
690
Allergy To Sheep Milk With Or Without Allergy To Cow Milk Dr. Fouseena Pazheri1, Dr. Alton Lee Melton, Jr, MD2, Dr. Earl Poptic1, Dr. Belinda Willard1; 1Cleveland CLinic, Cleveland, OH, 2Cleveland Clinic, Cleveland, OH. RATIONALE: Cow milk protein represents a common food allergen in children. These children often look to other mammalian milks as nutritional alternatives, including goat milk and sheep milk. Previous reports suggest significant cross- allergenicity among the caseins of different mammalian milks. Isolated allergy to sheep milk protein is unusual, with only a few reported cases. We report the analysis of two cases of sheep milk allergy, one with concomitant cow milk allergy and the other without. METHODS: Clinical and laboratory characteristics of two children with allergy to milk proteins evaluated at a pediatric allergy clinic were reviewed. Two-dimensional SDS PAGE and immunoblotting will be performed using extracts made from sheep milk and cow milk and serum from the two patients and appropriate controls. RESULTS: Subject 1 is a 10-year-old boy who experienced anaphylactic reactions to two sheep milk cheeses ( Romano cheese and ricotta cheese). He tolerates cow milk products. IgE ELISA for cow milk was undetectable (<0.35 Ku/L) and positive for sheep milk (29.2 Ku/L). Subject 2 is a 15year-old boy with a long history of severe allergy to cow milk, who had IgE ELISA performed for several other mammalian milks. IgE ELISA was significantly elevated for both cow milk (34.1 Ku/L) and sheep milk (48.9 Ku/L). CONCLUSIONS: A high degree of cross-allergenicity exists between proteins from milks of different mammals, and this often limits dietary choices for children with clinical cow milk allergy. However, individual patients may display unique sensitization to a particular milk. These cases illustrate both these scenarios.
691
Genome-Wide Study Of Interaction Between Season Of Birth and Peanut Allergy Identifies a Region On Chromosome 3 As a Genetic Risk Factor Corinne Keet, MD, MS1, Xiumei Hong, PhD2, Dr. Ingo Ruczinski, PhD2, Dr. Terri H. Beaty, PhD2, Dr. Jacqueline Pongracic, MD, FAAAAI3, Dr. Xiaobin Wang, MD, MPH ScD4; 1Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 2Johns Hopkins University School of Public Health, Baltimore, MD, 3Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 4Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. RATIONALE: Fall season of birth has been identified as a risk factor for food allergy, but underlying mechanisms remain unknown. We hypothesized that at least one common single nucleotide polymorphism (SNP) would show evidence of gene-environment interaction (GxEI) with season of birth and food allergy. METHODS: 312 case-parent trios were included in a genome wide association study of peanut allergy using the Illumina HumanOmni1-Quad BeadChip. Analysis of GxEI between season of birth and individual SNPs was done using the package TRIO in R, which rapidly fits a conditional logistic regression model while testing for interaction. The 1 degree of freedom test comparing the dominant model with and without GxEI is reported. Season of birth was defined as fall (September, October and November) versus all other months combined. Peanut allergy was defined as history of an immediate onset of typical allergy symptoms to peanut with confirmatory positive specific IgE or skin testing. RESULTS: Two SNPs near the genes PBRM1 & GNL3 on chr.3p21 yielded genome-wide significance in this test for GxEI (rs2590838 and rs1108842, p59.5x10-9 and 1.2x10-8, respectively). Forty-nine SNPS in this region approached genome-wide significance (10-7
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