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TRANSCRIPT
M Alcocer 2017
Food Allergy amp Intolerance
Marcos Alcocer
Associate ProfessorSchool of BiosciencesSutton Bonington campusUniversity of NottinghamUK
lsquoFood Waste Utilisation amp Alternative
Proteins Workshoprsquo 28112017
M Alcocer 2017
in our industrialised worldhellip
Not everything is exactly under our controlhellip
Quino
EFA
With the end of our own vegetable gardenshellip
You tube animation mp4 or media centre
M Alcocer 2017
M Alcocer 2017
Classification
M Alcocer 2017
Adverse Reactions to Food
Non toxic toxic
Based on 2000 COT report and Skypala et al food hypersensitivity
Immune mediated Non immune mediated UnknownAversion
(psychosomatic)
Enzymatic
PharmacologicalCaffeine acidsTyramine
Alkaloids Histamine
Monosodium glutamate
Salicylates Benzoates
Intolerance to lactose
Alcohol galactosemiaNon IgE mediated
IgE mediated
Proctocolitis
Enterocolitis
Coeliac disease
Eosinophilic esophagitis
Anaphylaxis
Oral allergy syndrome
Exercise induced anaphylaxis
Classification
M Alcocer 2017
Adverse Reactions to Food
Non toxic toxic
Immune mediated Non immune mediated Unknown
Non IgE mediated
IgE mediated
Enzymatic
Pharmacological
Based on 2000 COT report and Skypala et al food hypersensitivity
caffeine acidsTyramine
Alkaloids Histamine
Monosodium glutamate
Salicylates benzoates
Aversion
(psychosomatic)
Intolerance to lactose
Alcohol galactosemia
Proctocolitis
Enterocolitis
Coeliac disease
Eosinophilic esophagitis
Anaphylaxis
Oral allergy syndrome
Exercise induced anaphylaxis
Food hypersensitivity
Classification
M Alcocer 2017
Adverse Reactions to Food
Non toxic toxic
Immune mediated Non immune mediated Unknown
Non IgE mediated
IgE mediated
Enzymatic
Pharmacological
Based on 2000 COT report and Skypala et al food hypersensitivity
caffeine acidsTyramine
Alkaloids Histamine
Monosodium glutamate
Salicylates benzoates
Aversion
(psychosomatic)
Intolerance to lactose
Alcohol galactosemia
Proctocolitis
Enterocolitis
Coeliac disease
Eosinophilic esophagitis
Anaphylaxis
Oral allergy syndrome
Exercise induced anaphylaxis
Food allergy
Food hypersensitivity
Classification
M Alcocer 2017
What is Food allergy
It is ldquoImmunity Gone Wrongrdquo
mucosal barrier
The Gut is Bombarded by Foreign Antigens
bull Activation of mucosal mast cells
bull Release of inflammatory mediators
Transepithelial fluid loss
Smooth muscle contraction
Vomiting and diarrhoea
Anaphylaxis
bullEradicationbullContainment
bull ldquoDiseaserdquo
No Response
(Tolerance)
Response
(Immune Activation)
The Gut sampling system
Watch full Nature video in
youTube httpswwwyoutubecomwatchv=gnZEge78_78
An allergic (atopic) patient Video
M Alcocer 2017
It is not known why food in particular provoke different constellations of symptoms in different individuals
National Institute of Allergic diseases- Boyce et al 2010 J Allergy Clin Immunol
Symptoms
ldquohellipsymptoms of acute IgE responses
(sneezing coughing vomiting diarrhoea itch)
evolved as protection against helminthic
irritants toxins venoms hematophagus fluids
and phytochemicalsrdquo
Palmer et al Nature 2012484
M Alcocer 2017
Is food allergy a problem
httpswwwyoutubecomwatchv=AKVjKC3u9hk
M Alcocer 2017If your source is newspapers only
M Alcocer 2017
Urticaria
M Alcocer 2017
Eczema
M Alcocer 2017
Courtesy Dr Jane Lucas
Systemic Anaphylactic shock
M Alcocer 2017
Systemic Anaphylactic shock
A 10-Year-Old Child with Food-Induced Anaphylaxis
The endotracheal tube and angioedema of the lip are shown
Lack G (2008) New England J Med 3591250-60
M Alcocer 2017
64321680 1 2 4
Incid
en
ce
Age (years)
Asthma
Rhinitis
EczemaFood allergy
Atopic march
Redrawn from Durham SR amp Church MK Allergy 2nd edition 2001 Mosby
M Alcocer 2017
Could food allergy be fatal
Peoplehellipchildren dead by Foodhellip early reports
Baby death nursery fined A nursery where an allergic child died
after eating a milk product has been fined pound60000 and has been
ordered to pay pound19000 costs
Jigsaw Day Nurseries Ltd was sentenced at Aylesbury Crown Court
on Thursday
Thomas Egan who was five months old had been diagnosed with an
allergy to all dairy products
A nurse at the Jigsaw Day Nursery in Browns Wood Milton Keynes
fed Thomas a breakfast cereal not realising it contained milk
Fatal cases
M Alcocer 2017
Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
in our industrialised worldhellip
Not everything is exactly under our controlhellip
Quino
EFA
With the end of our own vegetable gardenshellip
You tube animation mp4 or media centre
M Alcocer 2017
M Alcocer 2017
Classification
M Alcocer 2017
Adverse Reactions to Food
Non toxic toxic
Based on 2000 COT report and Skypala et al food hypersensitivity
Immune mediated Non immune mediated UnknownAversion
(psychosomatic)
Enzymatic
PharmacologicalCaffeine acidsTyramine
Alkaloids Histamine
Monosodium glutamate
Salicylates Benzoates
Intolerance to lactose
Alcohol galactosemiaNon IgE mediated
IgE mediated
Proctocolitis
Enterocolitis
Coeliac disease
Eosinophilic esophagitis
Anaphylaxis
Oral allergy syndrome
Exercise induced anaphylaxis
Classification
M Alcocer 2017
Adverse Reactions to Food
Non toxic toxic
Immune mediated Non immune mediated Unknown
Non IgE mediated
IgE mediated
Enzymatic
Pharmacological
Based on 2000 COT report and Skypala et al food hypersensitivity
caffeine acidsTyramine
Alkaloids Histamine
Monosodium glutamate
Salicylates benzoates
Aversion
(psychosomatic)
Intolerance to lactose
Alcohol galactosemia
Proctocolitis
Enterocolitis
Coeliac disease
Eosinophilic esophagitis
Anaphylaxis
Oral allergy syndrome
Exercise induced anaphylaxis
Food hypersensitivity
Classification
M Alcocer 2017
Adverse Reactions to Food
Non toxic toxic
Immune mediated Non immune mediated Unknown
Non IgE mediated
IgE mediated
Enzymatic
Pharmacological
Based on 2000 COT report and Skypala et al food hypersensitivity
caffeine acidsTyramine
Alkaloids Histamine
Monosodium glutamate
Salicylates benzoates
Aversion
(psychosomatic)
Intolerance to lactose
Alcohol galactosemia
Proctocolitis
Enterocolitis
Coeliac disease
Eosinophilic esophagitis
Anaphylaxis
Oral allergy syndrome
Exercise induced anaphylaxis
Food allergy
Food hypersensitivity
Classification
M Alcocer 2017
What is Food allergy
It is ldquoImmunity Gone Wrongrdquo
mucosal barrier
The Gut is Bombarded by Foreign Antigens
bull Activation of mucosal mast cells
bull Release of inflammatory mediators
Transepithelial fluid loss
Smooth muscle contraction
Vomiting and diarrhoea
Anaphylaxis
bullEradicationbullContainment
bull ldquoDiseaserdquo
No Response
(Tolerance)
Response
(Immune Activation)
The Gut sampling system
Watch full Nature video in
youTube httpswwwyoutubecomwatchv=gnZEge78_78
An allergic (atopic) patient Video
M Alcocer 2017
It is not known why food in particular provoke different constellations of symptoms in different individuals
National Institute of Allergic diseases- Boyce et al 2010 J Allergy Clin Immunol
Symptoms
ldquohellipsymptoms of acute IgE responses
(sneezing coughing vomiting diarrhoea itch)
evolved as protection against helminthic
irritants toxins venoms hematophagus fluids
and phytochemicalsrdquo
Palmer et al Nature 2012484
M Alcocer 2017
Is food allergy a problem
httpswwwyoutubecomwatchv=AKVjKC3u9hk
M Alcocer 2017If your source is newspapers only
M Alcocer 2017
Urticaria
M Alcocer 2017
Eczema
M Alcocer 2017
Courtesy Dr Jane Lucas
Systemic Anaphylactic shock
M Alcocer 2017
Systemic Anaphylactic shock
A 10-Year-Old Child with Food-Induced Anaphylaxis
The endotracheal tube and angioedema of the lip are shown
Lack G (2008) New England J Med 3591250-60
M Alcocer 2017
64321680 1 2 4
Incid
en
ce
Age (years)
Asthma
Rhinitis
EczemaFood allergy
Atopic march
Redrawn from Durham SR amp Church MK Allergy 2nd edition 2001 Mosby
M Alcocer 2017
Could food allergy be fatal
Peoplehellipchildren dead by Foodhellip early reports
Baby death nursery fined A nursery where an allergic child died
after eating a milk product has been fined pound60000 and has been
ordered to pay pound19000 costs
Jigsaw Day Nurseries Ltd was sentenced at Aylesbury Crown Court
on Thursday
Thomas Egan who was five months old had been diagnosed with an
allergy to all dairy products
A nurse at the Jigsaw Day Nursery in Browns Wood Milton Keynes
fed Thomas a breakfast cereal not realising it contained milk
Fatal cases
M Alcocer 2017
Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
M Alcocer 2017
Classification
M Alcocer 2017
Adverse Reactions to Food
Non toxic toxic
Based on 2000 COT report and Skypala et al food hypersensitivity
Immune mediated Non immune mediated UnknownAversion
(psychosomatic)
Enzymatic
PharmacologicalCaffeine acidsTyramine
Alkaloids Histamine
Monosodium glutamate
Salicylates Benzoates
Intolerance to lactose
Alcohol galactosemiaNon IgE mediated
IgE mediated
Proctocolitis
Enterocolitis
Coeliac disease
Eosinophilic esophagitis
Anaphylaxis
Oral allergy syndrome
Exercise induced anaphylaxis
Classification
M Alcocer 2017
Adverse Reactions to Food
Non toxic toxic
Immune mediated Non immune mediated Unknown
Non IgE mediated
IgE mediated
Enzymatic
Pharmacological
Based on 2000 COT report and Skypala et al food hypersensitivity
caffeine acidsTyramine
Alkaloids Histamine
Monosodium glutamate
Salicylates benzoates
Aversion
(psychosomatic)
Intolerance to lactose
Alcohol galactosemia
Proctocolitis
Enterocolitis
Coeliac disease
Eosinophilic esophagitis
Anaphylaxis
Oral allergy syndrome
Exercise induced anaphylaxis
Food hypersensitivity
Classification
M Alcocer 2017
Adverse Reactions to Food
Non toxic toxic
Immune mediated Non immune mediated Unknown
Non IgE mediated
IgE mediated
Enzymatic
Pharmacological
Based on 2000 COT report and Skypala et al food hypersensitivity
caffeine acidsTyramine
Alkaloids Histamine
Monosodium glutamate
Salicylates benzoates
Aversion
(psychosomatic)
Intolerance to lactose
Alcohol galactosemia
Proctocolitis
Enterocolitis
Coeliac disease
Eosinophilic esophagitis
Anaphylaxis
Oral allergy syndrome
Exercise induced anaphylaxis
Food allergy
Food hypersensitivity
Classification
M Alcocer 2017
What is Food allergy
It is ldquoImmunity Gone Wrongrdquo
mucosal barrier
The Gut is Bombarded by Foreign Antigens
bull Activation of mucosal mast cells
bull Release of inflammatory mediators
Transepithelial fluid loss
Smooth muscle contraction
Vomiting and diarrhoea
Anaphylaxis
bullEradicationbullContainment
bull ldquoDiseaserdquo
No Response
(Tolerance)
Response
(Immune Activation)
The Gut sampling system
Watch full Nature video in
youTube httpswwwyoutubecomwatchv=gnZEge78_78
An allergic (atopic) patient Video
M Alcocer 2017
It is not known why food in particular provoke different constellations of symptoms in different individuals
National Institute of Allergic diseases- Boyce et al 2010 J Allergy Clin Immunol
Symptoms
ldquohellipsymptoms of acute IgE responses
(sneezing coughing vomiting diarrhoea itch)
evolved as protection against helminthic
irritants toxins venoms hematophagus fluids
and phytochemicalsrdquo
Palmer et al Nature 2012484
M Alcocer 2017
Is food allergy a problem
httpswwwyoutubecomwatchv=AKVjKC3u9hk
M Alcocer 2017If your source is newspapers only
M Alcocer 2017
Urticaria
M Alcocer 2017
Eczema
M Alcocer 2017
Courtesy Dr Jane Lucas
Systemic Anaphylactic shock
M Alcocer 2017
Systemic Anaphylactic shock
A 10-Year-Old Child with Food-Induced Anaphylaxis
The endotracheal tube and angioedema of the lip are shown
Lack G (2008) New England J Med 3591250-60
M Alcocer 2017
64321680 1 2 4
Incid
en
ce
Age (years)
Asthma
Rhinitis
EczemaFood allergy
Atopic march
Redrawn from Durham SR amp Church MK Allergy 2nd edition 2001 Mosby
M Alcocer 2017
Could food allergy be fatal
Peoplehellipchildren dead by Foodhellip early reports
Baby death nursery fined A nursery where an allergic child died
after eating a milk product has been fined pound60000 and has been
ordered to pay pound19000 costs
Jigsaw Day Nurseries Ltd was sentenced at Aylesbury Crown Court
on Thursday
Thomas Egan who was five months old had been diagnosed with an
allergy to all dairy products
A nurse at the Jigsaw Day Nursery in Browns Wood Milton Keynes
fed Thomas a breakfast cereal not realising it contained milk
Fatal cases
M Alcocer 2017
Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Classification
M Alcocer 2017
Adverse Reactions to Food
Non toxic toxic
Based on 2000 COT report and Skypala et al food hypersensitivity
Immune mediated Non immune mediated UnknownAversion
(psychosomatic)
Enzymatic
PharmacologicalCaffeine acidsTyramine
Alkaloids Histamine
Monosodium glutamate
Salicylates Benzoates
Intolerance to lactose
Alcohol galactosemiaNon IgE mediated
IgE mediated
Proctocolitis
Enterocolitis
Coeliac disease
Eosinophilic esophagitis
Anaphylaxis
Oral allergy syndrome
Exercise induced anaphylaxis
Classification
M Alcocer 2017
Adverse Reactions to Food
Non toxic toxic
Immune mediated Non immune mediated Unknown
Non IgE mediated
IgE mediated
Enzymatic
Pharmacological
Based on 2000 COT report and Skypala et al food hypersensitivity
caffeine acidsTyramine
Alkaloids Histamine
Monosodium glutamate
Salicylates benzoates
Aversion
(psychosomatic)
Intolerance to lactose
Alcohol galactosemia
Proctocolitis
Enterocolitis
Coeliac disease
Eosinophilic esophagitis
Anaphylaxis
Oral allergy syndrome
Exercise induced anaphylaxis
Food hypersensitivity
Classification
M Alcocer 2017
Adverse Reactions to Food
Non toxic toxic
Immune mediated Non immune mediated Unknown
Non IgE mediated
IgE mediated
Enzymatic
Pharmacological
Based on 2000 COT report and Skypala et al food hypersensitivity
caffeine acidsTyramine
Alkaloids Histamine
Monosodium glutamate
Salicylates benzoates
Aversion
(psychosomatic)
Intolerance to lactose
Alcohol galactosemia
Proctocolitis
Enterocolitis
Coeliac disease
Eosinophilic esophagitis
Anaphylaxis
Oral allergy syndrome
Exercise induced anaphylaxis
Food allergy
Food hypersensitivity
Classification
M Alcocer 2017
What is Food allergy
It is ldquoImmunity Gone Wrongrdquo
mucosal barrier
The Gut is Bombarded by Foreign Antigens
bull Activation of mucosal mast cells
bull Release of inflammatory mediators
Transepithelial fluid loss
Smooth muscle contraction
Vomiting and diarrhoea
Anaphylaxis
bullEradicationbullContainment
bull ldquoDiseaserdquo
No Response
(Tolerance)
Response
(Immune Activation)
The Gut sampling system
Watch full Nature video in
youTube httpswwwyoutubecomwatchv=gnZEge78_78
An allergic (atopic) patient Video
M Alcocer 2017
It is not known why food in particular provoke different constellations of symptoms in different individuals
National Institute of Allergic diseases- Boyce et al 2010 J Allergy Clin Immunol
Symptoms
ldquohellipsymptoms of acute IgE responses
(sneezing coughing vomiting diarrhoea itch)
evolved as protection against helminthic
irritants toxins venoms hematophagus fluids
and phytochemicalsrdquo
Palmer et al Nature 2012484
M Alcocer 2017
Is food allergy a problem
httpswwwyoutubecomwatchv=AKVjKC3u9hk
M Alcocer 2017If your source is newspapers only
M Alcocer 2017
Urticaria
M Alcocer 2017
Eczema
M Alcocer 2017
Courtesy Dr Jane Lucas
Systemic Anaphylactic shock
M Alcocer 2017
Systemic Anaphylactic shock
A 10-Year-Old Child with Food-Induced Anaphylaxis
The endotracheal tube and angioedema of the lip are shown
Lack G (2008) New England J Med 3591250-60
M Alcocer 2017
64321680 1 2 4
Incid
en
ce
Age (years)
Asthma
Rhinitis
EczemaFood allergy
Atopic march
Redrawn from Durham SR amp Church MK Allergy 2nd edition 2001 Mosby
M Alcocer 2017
Could food allergy be fatal
Peoplehellipchildren dead by Foodhellip early reports
Baby death nursery fined A nursery where an allergic child died
after eating a milk product has been fined pound60000 and has been
ordered to pay pound19000 costs
Jigsaw Day Nurseries Ltd was sentenced at Aylesbury Crown Court
on Thursday
Thomas Egan who was five months old had been diagnosed with an
allergy to all dairy products
A nurse at the Jigsaw Day Nursery in Browns Wood Milton Keynes
fed Thomas a breakfast cereal not realising it contained milk
Fatal cases
M Alcocer 2017
Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Adverse Reactions to Food
Non toxic toxic
Based on 2000 COT report and Skypala et al food hypersensitivity
Immune mediated Non immune mediated UnknownAversion
(psychosomatic)
Enzymatic
PharmacologicalCaffeine acidsTyramine
Alkaloids Histamine
Monosodium glutamate
Salicylates Benzoates
Intolerance to lactose
Alcohol galactosemiaNon IgE mediated
IgE mediated
Proctocolitis
Enterocolitis
Coeliac disease
Eosinophilic esophagitis
Anaphylaxis
Oral allergy syndrome
Exercise induced anaphylaxis
Classification
M Alcocer 2017
Adverse Reactions to Food
Non toxic toxic
Immune mediated Non immune mediated Unknown
Non IgE mediated
IgE mediated
Enzymatic
Pharmacological
Based on 2000 COT report and Skypala et al food hypersensitivity
caffeine acidsTyramine
Alkaloids Histamine
Monosodium glutamate
Salicylates benzoates
Aversion
(psychosomatic)
Intolerance to lactose
Alcohol galactosemia
Proctocolitis
Enterocolitis
Coeliac disease
Eosinophilic esophagitis
Anaphylaxis
Oral allergy syndrome
Exercise induced anaphylaxis
Food hypersensitivity
Classification
M Alcocer 2017
Adverse Reactions to Food
Non toxic toxic
Immune mediated Non immune mediated Unknown
Non IgE mediated
IgE mediated
Enzymatic
Pharmacological
Based on 2000 COT report and Skypala et al food hypersensitivity
caffeine acidsTyramine
Alkaloids Histamine
Monosodium glutamate
Salicylates benzoates
Aversion
(psychosomatic)
Intolerance to lactose
Alcohol galactosemia
Proctocolitis
Enterocolitis
Coeliac disease
Eosinophilic esophagitis
Anaphylaxis
Oral allergy syndrome
Exercise induced anaphylaxis
Food allergy
Food hypersensitivity
Classification
M Alcocer 2017
What is Food allergy
It is ldquoImmunity Gone Wrongrdquo
mucosal barrier
The Gut is Bombarded by Foreign Antigens
bull Activation of mucosal mast cells
bull Release of inflammatory mediators
Transepithelial fluid loss
Smooth muscle contraction
Vomiting and diarrhoea
Anaphylaxis
bullEradicationbullContainment
bull ldquoDiseaserdquo
No Response
(Tolerance)
Response
(Immune Activation)
The Gut sampling system
Watch full Nature video in
youTube httpswwwyoutubecomwatchv=gnZEge78_78
An allergic (atopic) patient Video
M Alcocer 2017
It is not known why food in particular provoke different constellations of symptoms in different individuals
National Institute of Allergic diseases- Boyce et al 2010 J Allergy Clin Immunol
Symptoms
ldquohellipsymptoms of acute IgE responses
(sneezing coughing vomiting diarrhoea itch)
evolved as protection against helminthic
irritants toxins venoms hematophagus fluids
and phytochemicalsrdquo
Palmer et al Nature 2012484
M Alcocer 2017
Is food allergy a problem
httpswwwyoutubecomwatchv=AKVjKC3u9hk
M Alcocer 2017If your source is newspapers only
M Alcocer 2017
Urticaria
M Alcocer 2017
Eczema
M Alcocer 2017
Courtesy Dr Jane Lucas
Systemic Anaphylactic shock
M Alcocer 2017
Systemic Anaphylactic shock
A 10-Year-Old Child with Food-Induced Anaphylaxis
The endotracheal tube and angioedema of the lip are shown
Lack G (2008) New England J Med 3591250-60
M Alcocer 2017
64321680 1 2 4
Incid
en
ce
Age (years)
Asthma
Rhinitis
EczemaFood allergy
Atopic march
Redrawn from Durham SR amp Church MK Allergy 2nd edition 2001 Mosby
M Alcocer 2017
Could food allergy be fatal
Peoplehellipchildren dead by Foodhellip early reports
Baby death nursery fined A nursery where an allergic child died
after eating a milk product has been fined pound60000 and has been
ordered to pay pound19000 costs
Jigsaw Day Nurseries Ltd was sentenced at Aylesbury Crown Court
on Thursday
Thomas Egan who was five months old had been diagnosed with an
allergy to all dairy products
A nurse at the Jigsaw Day Nursery in Browns Wood Milton Keynes
fed Thomas a breakfast cereal not realising it contained milk
Fatal cases
M Alcocer 2017
Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Adverse Reactions to Food
Non toxic toxic
Immune mediated Non immune mediated Unknown
Non IgE mediated
IgE mediated
Enzymatic
Pharmacological
Based on 2000 COT report and Skypala et al food hypersensitivity
caffeine acidsTyramine
Alkaloids Histamine
Monosodium glutamate
Salicylates benzoates
Aversion
(psychosomatic)
Intolerance to lactose
Alcohol galactosemia
Proctocolitis
Enterocolitis
Coeliac disease
Eosinophilic esophagitis
Anaphylaxis
Oral allergy syndrome
Exercise induced anaphylaxis
Food hypersensitivity
Classification
M Alcocer 2017
Adverse Reactions to Food
Non toxic toxic
Immune mediated Non immune mediated Unknown
Non IgE mediated
IgE mediated
Enzymatic
Pharmacological
Based on 2000 COT report and Skypala et al food hypersensitivity
caffeine acidsTyramine
Alkaloids Histamine
Monosodium glutamate
Salicylates benzoates
Aversion
(psychosomatic)
Intolerance to lactose
Alcohol galactosemia
Proctocolitis
Enterocolitis
Coeliac disease
Eosinophilic esophagitis
Anaphylaxis
Oral allergy syndrome
Exercise induced anaphylaxis
Food allergy
Food hypersensitivity
Classification
M Alcocer 2017
What is Food allergy
It is ldquoImmunity Gone Wrongrdquo
mucosal barrier
The Gut is Bombarded by Foreign Antigens
bull Activation of mucosal mast cells
bull Release of inflammatory mediators
Transepithelial fluid loss
Smooth muscle contraction
Vomiting and diarrhoea
Anaphylaxis
bullEradicationbullContainment
bull ldquoDiseaserdquo
No Response
(Tolerance)
Response
(Immune Activation)
The Gut sampling system
Watch full Nature video in
youTube httpswwwyoutubecomwatchv=gnZEge78_78
An allergic (atopic) patient Video
M Alcocer 2017
It is not known why food in particular provoke different constellations of symptoms in different individuals
National Institute of Allergic diseases- Boyce et al 2010 J Allergy Clin Immunol
Symptoms
ldquohellipsymptoms of acute IgE responses
(sneezing coughing vomiting diarrhoea itch)
evolved as protection against helminthic
irritants toxins venoms hematophagus fluids
and phytochemicalsrdquo
Palmer et al Nature 2012484
M Alcocer 2017
Is food allergy a problem
httpswwwyoutubecomwatchv=AKVjKC3u9hk
M Alcocer 2017If your source is newspapers only
M Alcocer 2017
Urticaria
M Alcocer 2017
Eczema
M Alcocer 2017
Courtesy Dr Jane Lucas
Systemic Anaphylactic shock
M Alcocer 2017
Systemic Anaphylactic shock
A 10-Year-Old Child with Food-Induced Anaphylaxis
The endotracheal tube and angioedema of the lip are shown
Lack G (2008) New England J Med 3591250-60
M Alcocer 2017
64321680 1 2 4
Incid
en
ce
Age (years)
Asthma
Rhinitis
EczemaFood allergy
Atopic march
Redrawn from Durham SR amp Church MK Allergy 2nd edition 2001 Mosby
M Alcocer 2017
Could food allergy be fatal
Peoplehellipchildren dead by Foodhellip early reports
Baby death nursery fined A nursery where an allergic child died
after eating a milk product has been fined pound60000 and has been
ordered to pay pound19000 costs
Jigsaw Day Nurseries Ltd was sentenced at Aylesbury Crown Court
on Thursday
Thomas Egan who was five months old had been diagnosed with an
allergy to all dairy products
A nurse at the Jigsaw Day Nursery in Browns Wood Milton Keynes
fed Thomas a breakfast cereal not realising it contained milk
Fatal cases
M Alcocer 2017
Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Adverse Reactions to Food
Non toxic toxic
Immune mediated Non immune mediated Unknown
Non IgE mediated
IgE mediated
Enzymatic
Pharmacological
Based on 2000 COT report and Skypala et al food hypersensitivity
caffeine acidsTyramine
Alkaloids Histamine
Monosodium glutamate
Salicylates benzoates
Aversion
(psychosomatic)
Intolerance to lactose
Alcohol galactosemia
Proctocolitis
Enterocolitis
Coeliac disease
Eosinophilic esophagitis
Anaphylaxis
Oral allergy syndrome
Exercise induced anaphylaxis
Food allergy
Food hypersensitivity
Classification
M Alcocer 2017
What is Food allergy
It is ldquoImmunity Gone Wrongrdquo
mucosal barrier
The Gut is Bombarded by Foreign Antigens
bull Activation of mucosal mast cells
bull Release of inflammatory mediators
Transepithelial fluid loss
Smooth muscle contraction
Vomiting and diarrhoea
Anaphylaxis
bullEradicationbullContainment
bull ldquoDiseaserdquo
No Response
(Tolerance)
Response
(Immune Activation)
The Gut sampling system
Watch full Nature video in
youTube httpswwwyoutubecomwatchv=gnZEge78_78
An allergic (atopic) patient Video
M Alcocer 2017
It is not known why food in particular provoke different constellations of symptoms in different individuals
National Institute of Allergic diseases- Boyce et al 2010 J Allergy Clin Immunol
Symptoms
ldquohellipsymptoms of acute IgE responses
(sneezing coughing vomiting diarrhoea itch)
evolved as protection against helminthic
irritants toxins venoms hematophagus fluids
and phytochemicalsrdquo
Palmer et al Nature 2012484
M Alcocer 2017
Is food allergy a problem
httpswwwyoutubecomwatchv=AKVjKC3u9hk
M Alcocer 2017If your source is newspapers only
M Alcocer 2017
Urticaria
M Alcocer 2017
Eczema
M Alcocer 2017
Courtesy Dr Jane Lucas
Systemic Anaphylactic shock
M Alcocer 2017
Systemic Anaphylactic shock
A 10-Year-Old Child with Food-Induced Anaphylaxis
The endotracheal tube and angioedema of the lip are shown
Lack G (2008) New England J Med 3591250-60
M Alcocer 2017
64321680 1 2 4
Incid
en
ce
Age (years)
Asthma
Rhinitis
EczemaFood allergy
Atopic march
Redrawn from Durham SR amp Church MK Allergy 2nd edition 2001 Mosby
M Alcocer 2017
Could food allergy be fatal
Peoplehellipchildren dead by Foodhellip early reports
Baby death nursery fined A nursery where an allergic child died
after eating a milk product has been fined pound60000 and has been
ordered to pay pound19000 costs
Jigsaw Day Nurseries Ltd was sentenced at Aylesbury Crown Court
on Thursday
Thomas Egan who was five months old had been diagnosed with an
allergy to all dairy products
A nurse at the Jigsaw Day Nursery in Browns Wood Milton Keynes
fed Thomas a breakfast cereal not realising it contained milk
Fatal cases
M Alcocer 2017
Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
What is Food allergy
It is ldquoImmunity Gone Wrongrdquo
mucosal barrier
The Gut is Bombarded by Foreign Antigens
bull Activation of mucosal mast cells
bull Release of inflammatory mediators
Transepithelial fluid loss
Smooth muscle contraction
Vomiting and diarrhoea
Anaphylaxis
bullEradicationbullContainment
bull ldquoDiseaserdquo
No Response
(Tolerance)
Response
(Immune Activation)
The Gut sampling system
Watch full Nature video in
youTube httpswwwyoutubecomwatchv=gnZEge78_78
An allergic (atopic) patient Video
M Alcocer 2017
It is not known why food in particular provoke different constellations of symptoms in different individuals
National Institute of Allergic diseases- Boyce et al 2010 J Allergy Clin Immunol
Symptoms
ldquohellipsymptoms of acute IgE responses
(sneezing coughing vomiting diarrhoea itch)
evolved as protection against helminthic
irritants toxins venoms hematophagus fluids
and phytochemicalsrdquo
Palmer et al Nature 2012484
M Alcocer 2017
Is food allergy a problem
httpswwwyoutubecomwatchv=AKVjKC3u9hk
M Alcocer 2017If your source is newspapers only
M Alcocer 2017
Urticaria
M Alcocer 2017
Eczema
M Alcocer 2017
Courtesy Dr Jane Lucas
Systemic Anaphylactic shock
M Alcocer 2017
Systemic Anaphylactic shock
A 10-Year-Old Child with Food-Induced Anaphylaxis
The endotracheal tube and angioedema of the lip are shown
Lack G (2008) New England J Med 3591250-60
M Alcocer 2017
64321680 1 2 4
Incid
en
ce
Age (years)
Asthma
Rhinitis
EczemaFood allergy
Atopic march
Redrawn from Durham SR amp Church MK Allergy 2nd edition 2001 Mosby
M Alcocer 2017
Could food allergy be fatal
Peoplehellipchildren dead by Foodhellip early reports
Baby death nursery fined A nursery where an allergic child died
after eating a milk product has been fined pound60000 and has been
ordered to pay pound19000 costs
Jigsaw Day Nurseries Ltd was sentenced at Aylesbury Crown Court
on Thursday
Thomas Egan who was five months old had been diagnosed with an
allergy to all dairy products
A nurse at the Jigsaw Day Nursery in Browns Wood Milton Keynes
fed Thomas a breakfast cereal not realising it contained milk
Fatal cases
M Alcocer 2017
Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
mucosal barrier
The Gut is Bombarded by Foreign Antigens
bull Activation of mucosal mast cells
bull Release of inflammatory mediators
Transepithelial fluid loss
Smooth muscle contraction
Vomiting and diarrhoea
Anaphylaxis
bullEradicationbullContainment
bull ldquoDiseaserdquo
No Response
(Tolerance)
Response
(Immune Activation)
The Gut sampling system
Watch full Nature video in
youTube httpswwwyoutubecomwatchv=gnZEge78_78
An allergic (atopic) patient Video
M Alcocer 2017
It is not known why food in particular provoke different constellations of symptoms in different individuals
National Institute of Allergic diseases- Boyce et al 2010 J Allergy Clin Immunol
Symptoms
ldquohellipsymptoms of acute IgE responses
(sneezing coughing vomiting diarrhoea itch)
evolved as protection against helminthic
irritants toxins venoms hematophagus fluids
and phytochemicalsrdquo
Palmer et al Nature 2012484
M Alcocer 2017
Is food allergy a problem
httpswwwyoutubecomwatchv=AKVjKC3u9hk
M Alcocer 2017If your source is newspapers only
M Alcocer 2017
Urticaria
M Alcocer 2017
Eczema
M Alcocer 2017
Courtesy Dr Jane Lucas
Systemic Anaphylactic shock
M Alcocer 2017
Systemic Anaphylactic shock
A 10-Year-Old Child with Food-Induced Anaphylaxis
The endotracheal tube and angioedema of the lip are shown
Lack G (2008) New England J Med 3591250-60
M Alcocer 2017
64321680 1 2 4
Incid
en
ce
Age (years)
Asthma
Rhinitis
EczemaFood allergy
Atopic march
Redrawn from Durham SR amp Church MK Allergy 2nd edition 2001 Mosby
M Alcocer 2017
Could food allergy be fatal
Peoplehellipchildren dead by Foodhellip early reports
Baby death nursery fined A nursery where an allergic child died
after eating a milk product has been fined pound60000 and has been
ordered to pay pound19000 costs
Jigsaw Day Nurseries Ltd was sentenced at Aylesbury Crown Court
on Thursday
Thomas Egan who was five months old had been diagnosed with an
allergy to all dairy products
A nurse at the Jigsaw Day Nursery in Browns Wood Milton Keynes
fed Thomas a breakfast cereal not realising it contained milk
Fatal cases
M Alcocer 2017
Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
The Gut sampling system
Watch full Nature video in
youTube httpswwwyoutubecomwatchv=gnZEge78_78
An allergic (atopic) patient Video
M Alcocer 2017
It is not known why food in particular provoke different constellations of symptoms in different individuals
National Institute of Allergic diseases- Boyce et al 2010 J Allergy Clin Immunol
Symptoms
ldquohellipsymptoms of acute IgE responses
(sneezing coughing vomiting diarrhoea itch)
evolved as protection against helminthic
irritants toxins venoms hematophagus fluids
and phytochemicalsrdquo
Palmer et al Nature 2012484
M Alcocer 2017
Is food allergy a problem
httpswwwyoutubecomwatchv=AKVjKC3u9hk
M Alcocer 2017If your source is newspapers only
M Alcocer 2017
Urticaria
M Alcocer 2017
Eczema
M Alcocer 2017
Courtesy Dr Jane Lucas
Systemic Anaphylactic shock
M Alcocer 2017
Systemic Anaphylactic shock
A 10-Year-Old Child with Food-Induced Anaphylaxis
The endotracheal tube and angioedema of the lip are shown
Lack G (2008) New England J Med 3591250-60
M Alcocer 2017
64321680 1 2 4
Incid
en
ce
Age (years)
Asthma
Rhinitis
EczemaFood allergy
Atopic march
Redrawn from Durham SR amp Church MK Allergy 2nd edition 2001 Mosby
M Alcocer 2017
Could food allergy be fatal
Peoplehellipchildren dead by Foodhellip early reports
Baby death nursery fined A nursery where an allergic child died
after eating a milk product has been fined pound60000 and has been
ordered to pay pound19000 costs
Jigsaw Day Nurseries Ltd was sentenced at Aylesbury Crown Court
on Thursday
Thomas Egan who was five months old had been diagnosed with an
allergy to all dairy products
A nurse at the Jigsaw Day Nursery in Browns Wood Milton Keynes
fed Thomas a breakfast cereal not realising it contained milk
Fatal cases
M Alcocer 2017
Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
An allergic (atopic) patient Video
M Alcocer 2017
It is not known why food in particular provoke different constellations of symptoms in different individuals
National Institute of Allergic diseases- Boyce et al 2010 J Allergy Clin Immunol
Symptoms
ldquohellipsymptoms of acute IgE responses
(sneezing coughing vomiting diarrhoea itch)
evolved as protection against helminthic
irritants toxins venoms hematophagus fluids
and phytochemicalsrdquo
Palmer et al Nature 2012484
M Alcocer 2017
Is food allergy a problem
httpswwwyoutubecomwatchv=AKVjKC3u9hk
M Alcocer 2017If your source is newspapers only
M Alcocer 2017
Urticaria
M Alcocer 2017
Eczema
M Alcocer 2017
Courtesy Dr Jane Lucas
Systemic Anaphylactic shock
M Alcocer 2017
Systemic Anaphylactic shock
A 10-Year-Old Child with Food-Induced Anaphylaxis
The endotracheal tube and angioedema of the lip are shown
Lack G (2008) New England J Med 3591250-60
M Alcocer 2017
64321680 1 2 4
Incid
en
ce
Age (years)
Asthma
Rhinitis
EczemaFood allergy
Atopic march
Redrawn from Durham SR amp Church MK Allergy 2nd edition 2001 Mosby
M Alcocer 2017
Could food allergy be fatal
Peoplehellipchildren dead by Foodhellip early reports
Baby death nursery fined A nursery where an allergic child died
after eating a milk product has been fined pound60000 and has been
ordered to pay pound19000 costs
Jigsaw Day Nurseries Ltd was sentenced at Aylesbury Crown Court
on Thursday
Thomas Egan who was five months old had been diagnosed with an
allergy to all dairy products
A nurse at the Jigsaw Day Nursery in Browns Wood Milton Keynes
fed Thomas a breakfast cereal not realising it contained milk
Fatal cases
M Alcocer 2017
Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
It is not known why food in particular provoke different constellations of symptoms in different individuals
National Institute of Allergic diseases- Boyce et al 2010 J Allergy Clin Immunol
Symptoms
ldquohellipsymptoms of acute IgE responses
(sneezing coughing vomiting diarrhoea itch)
evolved as protection against helminthic
irritants toxins venoms hematophagus fluids
and phytochemicalsrdquo
Palmer et al Nature 2012484
M Alcocer 2017
Is food allergy a problem
httpswwwyoutubecomwatchv=AKVjKC3u9hk
M Alcocer 2017If your source is newspapers only
M Alcocer 2017
Urticaria
M Alcocer 2017
Eczema
M Alcocer 2017
Courtesy Dr Jane Lucas
Systemic Anaphylactic shock
M Alcocer 2017
Systemic Anaphylactic shock
A 10-Year-Old Child with Food-Induced Anaphylaxis
The endotracheal tube and angioedema of the lip are shown
Lack G (2008) New England J Med 3591250-60
M Alcocer 2017
64321680 1 2 4
Incid
en
ce
Age (years)
Asthma
Rhinitis
EczemaFood allergy
Atopic march
Redrawn from Durham SR amp Church MK Allergy 2nd edition 2001 Mosby
M Alcocer 2017
Could food allergy be fatal
Peoplehellipchildren dead by Foodhellip early reports
Baby death nursery fined A nursery where an allergic child died
after eating a milk product has been fined pound60000 and has been
ordered to pay pound19000 costs
Jigsaw Day Nurseries Ltd was sentenced at Aylesbury Crown Court
on Thursday
Thomas Egan who was five months old had been diagnosed with an
allergy to all dairy products
A nurse at the Jigsaw Day Nursery in Browns Wood Milton Keynes
fed Thomas a breakfast cereal not realising it contained milk
Fatal cases
M Alcocer 2017
Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Is food allergy a problem
httpswwwyoutubecomwatchv=AKVjKC3u9hk
M Alcocer 2017If your source is newspapers only
M Alcocer 2017
Urticaria
M Alcocer 2017
Eczema
M Alcocer 2017
Courtesy Dr Jane Lucas
Systemic Anaphylactic shock
M Alcocer 2017
Systemic Anaphylactic shock
A 10-Year-Old Child with Food-Induced Anaphylaxis
The endotracheal tube and angioedema of the lip are shown
Lack G (2008) New England J Med 3591250-60
M Alcocer 2017
64321680 1 2 4
Incid
en
ce
Age (years)
Asthma
Rhinitis
EczemaFood allergy
Atopic march
Redrawn from Durham SR amp Church MK Allergy 2nd edition 2001 Mosby
M Alcocer 2017
Could food allergy be fatal
Peoplehellipchildren dead by Foodhellip early reports
Baby death nursery fined A nursery where an allergic child died
after eating a milk product has been fined pound60000 and has been
ordered to pay pound19000 costs
Jigsaw Day Nurseries Ltd was sentenced at Aylesbury Crown Court
on Thursday
Thomas Egan who was five months old had been diagnosed with an
allergy to all dairy products
A nurse at the Jigsaw Day Nursery in Browns Wood Milton Keynes
fed Thomas a breakfast cereal not realising it contained milk
Fatal cases
M Alcocer 2017
Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017If your source is newspapers only
M Alcocer 2017
Urticaria
M Alcocer 2017
Eczema
M Alcocer 2017
Courtesy Dr Jane Lucas
Systemic Anaphylactic shock
M Alcocer 2017
Systemic Anaphylactic shock
A 10-Year-Old Child with Food-Induced Anaphylaxis
The endotracheal tube and angioedema of the lip are shown
Lack G (2008) New England J Med 3591250-60
M Alcocer 2017
64321680 1 2 4
Incid
en
ce
Age (years)
Asthma
Rhinitis
EczemaFood allergy
Atopic march
Redrawn from Durham SR amp Church MK Allergy 2nd edition 2001 Mosby
M Alcocer 2017
Could food allergy be fatal
Peoplehellipchildren dead by Foodhellip early reports
Baby death nursery fined A nursery where an allergic child died
after eating a milk product has been fined pound60000 and has been
ordered to pay pound19000 costs
Jigsaw Day Nurseries Ltd was sentenced at Aylesbury Crown Court
on Thursday
Thomas Egan who was five months old had been diagnosed with an
allergy to all dairy products
A nurse at the Jigsaw Day Nursery in Browns Wood Milton Keynes
fed Thomas a breakfast cereal not realising it contained milk
Fatal cases
M Alcocer 2017
Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Urticaria
M Alcocer 2017
Eczema
M Alcocer 2017
Courtesy Dr Jane Lucas
Systemic Anaphylactic shock
M Alcocer 2017
Systemic Anaphylactic shock
A 10-Year-Old Child with Food-Induced Anaphylaxis
The endotracheal tube and angioedema of the lip are shown
Lack G (2008) New England J Med 3591250-60
M Alcocer 2017
64321680 1 2 4
Incid
en
ce
Age (years)
Asthma
Rhinitis
EczemaFood allergy
Atopic march
Redrawn from Durham SR amp Church MK Allergy 2nd edition 2001 Mosby
M Alcocer 2017
Could food allergy be fatal
Peoplehellipchildren dead by Foodhellip early reports
Baby death nursery fined A nursery where an allergic child died
after eating a milk product has been fined pound60000 and has been
ordered to pay pound19000 costs
Jigsaw Day Nurseries Ltd was sentenced at Aylesbury Crown Court
on Thursday
Thomas Egan who was five months old had been diagnosed with an
allergy to all dairy products
A nurse at the Jigsaw Day Nursery in Browns Wood Milton Keynes
fed Thomas a breakfast cereal not realising it contained milk
Fatal cases
M Alcocer 2017
Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Eczema
M Alcocer 2017
Courtesy Dr Jane Lucas
Systemic Anaphylactic shock
M Alcocer 2017
Systemic Anaphylactic shock
A 10-Year-Old Child with Food-Induced Anaphylaxis
The endotracheal tube and angioedema of the lip are shown
Lack G (2008) New England J Med 3591250-60
M Alcocer 2017
64321680 1 2 4
Incid
en
ce
Age (years)
Asthma
Rhinitis
EczemaFood allergy
Atopic march
Redrawn from Durham SR amp Church MK Allergy 2nd edition 2001 Mosby
M Alcocer 2017
Could food allergy be fatal
Peoplehellipchildren dead by Foodhellip early reports
Baby death nursery fined A nursery where an allergic child died
after eating a milk product has been fined pound60000 and has been
ordered to pay pound19000 costs
Jigsaw Day Nurseries Ltd was sentenced at Aylesbury Crown Court
on Thursday
Thomas Egan who was five months old had been diagnosed with an
allergy to all dairy products
A nurse at the Jigsaw Day Nursery in Browns Wood Milton Keynes
fed Thomas a breakfast cereal not realising it contained milk
Fatal cases
M Alcocer 2017
Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Courtesy Dr Jane Lucas
Systemic Anaphylactic shock
M Alcocer 2017
Systemic Anaphylactic shock
A 10-Year-Old Child with Food-Induced Anaphylaxis
The endotracheal tube and angioedema of the lip are shown
Lack G (2008) New England J Med 3591250-60
M Alcocer 2017
64321680 1 2 4
Incid
en
ce
Age (years)
Asthma
Rhinitis
EczemaFood allergy
Atopic march
Redrawn from Durham SR amp Church MK Allergy 2nd edition 2001 Mosby
M Alcocer 2017
Could food allergy be fatal
Peoplehellipchildren dead by Foodhellip early reports
Baby death nursery fined A nursery where an allergic child died
after eating a milk product has been fined pound60000 and has been
ordered to pay pound19000 costs
Jigsaw Day Nurseries Ltd was sentenced at Aylesbury Crown Court
on Thursday
Thomas Egan who was five months old had been diagnosed with an
allergy to all dairy products
A nurse at the Jigsaw Day Nursery in Browns Wood Milton Keynes
fed Thomas a breakfast cereal not realising it contained milk
Fatal cases
M Alcocer 2017
Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Systemic Anaphylactic shock
A 10-Year-Old Child with Food-Induced Anaphylaxis
The endotracheal tube and angioedema of the lip are shown
Lack G (2008) New England J Med 3591250-60
M Alcocer 2017
64321680 1 2 4
Incid
en
ce
Age (years)
Asthma
Rhinitis
EczemaFood allergy
Atopic march
Redrawn from Durham SR amp Church MK Allergy 2nd edition 2001 Mosby
M Alcocer 2017
Could food allergy be fatal
Peoplehellipchildren dead by Foodhellip early reports
Baby death nursery fined A nursery where an allergic child died
after eating a milk product has been fined pound60000 and has been
ordered to pay pound19000 costs
Jigsaw Day Nurseries Ltd was sentenced at Aylesbury Crown Court
on Thursday
Thomas Egan who was five months old had been diagnosed with an
allergy to all dairy products
A nurse at the Jigsaw Day Nursery in Browns Wood Milton Keynes
fed Thomas a breakfast cereal not realising it contained milk
Fatal cases
M Alcocer 2017
Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
64321680 1 2 4
Incid
en
ce
Age (years)
Asthma
Rhinitis
EczemaFood allergy
Atopic march
Redrawn from Durham SR amp Church MK Allergy 2nd edition 2001 Mosby
M Alcocer 2017
Could food allergy be fatal
Peoplehellipchildren dead by Foodhellip early reports
Baby death nursery fined A nursery where an allergic child died
after eating a milk product has been fined pound60000 and has been
ordered to pay pound19000 costs
Jigsaw Day Nurseries Ltd was sentenced at Aylesbury Crown Court
on Thursday
Thomas Egan who was five months old had been diagnosed with an
allergy to all dairy products
A nurse at the Jigsaw Day Nursery in Browns Wood Milton Keynes
fed Thomas a breakfast cereal not realising it contained milk
Fatal cases
M Alcocer 2017
Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Could food allergy be fatal
Peoplehellipchildren dead by Foodhellip early reports
Baby death nursery fined A nursery where an allergic child died
after eating a milk product has been fined pound60000 and has been
ordered to pay pound19000 costs
Jigsaw Day Nurseries Ltd was sentenced at Aylesbury Crown Court
on Thursday
Thomas Egan who was five months old had been diagnosed with an
allergy to all dairy products
A nurse at the Jigsaw Day Nursery in Browns Wood Milton Keynes
fed Thomas a breakfast cereal not realising it contained milk
Fatal cases
M Alcocer 2017
Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
Peoplehellipchildren dead by Foodhellip early reports
Baby death nursery fined A nursery where an allergic child died
after eating a milk product has been fined pound60000 and has been
ordered to pay pound19000 costs
Jigsaw Day Nurseries Ltd was sentenced at Aylesbury Crown Court
on Thursday
Thomas Egan who was five months old had been diagnosed with an
allergy to all dairy products
A nurse at the Jigsaw Day Nursery in Browns Wood Milton Keynes
fed Thomas a breakfast cereal not realising it contained milk
Fatal cases
M Alcocer 2017
Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
Baby death nursery fined A nursery where an allergic child died
after eating a milk product has been fined pound60000 and has been
ordered to pay pound19000 costs
Jigsaw Day Nurseries Ltd was sentenced at Aylesbury Crown Court
on Thursday
Thomas Egan who was five months old had been diagnosed with an
allergy to all dairy products
A nurse at the Jigsaw Day Nursery in Browns Wood Milton Keynes
fed Thomas a breakfast cereal not realising it contained milk
Fatal cases
M Alcocer 2017
Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Location Food allergy fatalities 1992-98 UK
Pumphrey Clin Exp Allergy 2000
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Patterns of sensitisation
Birch pollen
Apple pear Mald 1
Apple pear LTP
Problems with data acquisition
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Diagnosis
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
(2008) New England J Med 3591250-60
Diagnosis algorithm (egg Allergy)
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017Skin Prick Test
Method such as Skin Prick Test (SPT) despite its severe limitations is still widely used hellipbut
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Plant Vegetable
Seeds
Shellfish
Cerealsroots
Others
Inhaled AllergensDog
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
A45
14
A57
516
A77
53
A87
55
A97
57
E45
14
E57
516
E77
53
E87
55
E97
57
G45
14
G57
516
G77
53
G87
55
G97
57
M45
14
M57
516
M77
53
M87
55
M97
57
21 Plant Vegetable
Fruits
Herbs Spices
Seeds
Meat
Fish
Shellfish
Beans
Nuts
Cerealsroots
Dairy
Eggs
Others
Drink Sauce
Antibodies
Inhaled Allergens
Enterobacteria
Cat
Complex analysis ldquoImmune Profilingrdquo is now possible
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Complex analysis ldquoImmune Profilingrdquo is now possible
Wulfert et al (2012) J Immunol Meth
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Allergens
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Basophil (or mast cell)
Immunoglobulin EAllergens
Key players in Allergy
IgE
degranulationReceptorCross-linking Mediator release
bullHistamine bullLeukotrienesbullcytokines
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
gt90
Few food products are implicated in anaphylactic reactions
Very few protein families are actually allergenic
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Radauer amp Breiteneder 2007 J allergy Clin Immunol
Availability of sequences has revolutionised our understanding of the evolutionary biology of allergens
Currently protein expressionLarge databases roboticshellip
Extracts-gt Component Resolved Diagnostics
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
6 Soybeans and products thereof except
(a) fully refined soybean oil and fat (b) natural mixed tocopherols (E306) natural D-alpha
tocopherol natural D-alpha tocopherol acetate natural D-alpha tocopherol succinate
from soybean sources (c) vegetable oils derived phytosterols and phytosterol esters
from soybean sources (d) plant stanol ester produced from vegetable oil sterols from
soybean sources
1 Cereals containing gluten (ie wheat rye barley oats spelt kamut or their hybridised
strains) and products thereofexcept
(a) wheat-based glucose syrups including dextrose (b) wheat-based maltodextrins
(c) glucose syrups based on barley (d) cereals used for making distillates or ethyl
alcohol of agricultural origin for spirit drinks and other alcoholic beverages
2 Crustaceans and products thereof
3 Eggs and products thereof
4 Fish and products thereof except
(a) fish gelatine used as carrier for vitamin or carotenoid preparations (b) fish gelatine
or Isinglass used as fining agent in beer and wine
5 Peanuts and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
7 Milk and products thereof (including lactose) except
(a) whey used for making distillates or ethyl alcohol of agricultural origin for spirit
drinks and other alcoholic beverages (b) lactitol
8 Nuts ie almonds (Amygdalus communis L) hazelnuts (Corylus avellana) walnuts
(Juglans regia) cashews (Anacardium occidentale) pecan nuts (Carya illinoiesis
(Wangenh) K Koch) Brazil nuts (Bertholletia excelsa) pistachio nuts (Pistacia
vera) macadamia nuts and Queensland nuts (Macadamia ternifolia) and products
thereof except (a) nuts used for making distillates or ethyl alcohol of agricultural
origin for spirit drinks and other alcoholic beverages
9 Celery and products thereof
10 Mustard and products thereof
11 Sesame seeds and products thereof
12 Sulphur dioxide and sulphites at concentrations of more than 10 mgkg or 10 mglitre
expressed as SO2
13 Lupin and products thereof
14 Molluscs and products thereof
Legislation Commission Directive 200768EC
(EFSA) EC Regulation 11692011 (Dec 2014)
httpwwwfoodallergensinfoLegalCODEXhtml
httpwwwfoodallergensinfoManufacTop10html
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Quino
Change tactics
Be more selective on
Your suppliers
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Help guidance links Legislation
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of foof allergy in the United States J Allergy Clin
Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association (EFAAAEAACI)
American College of Allergy Asthma and Immunology (ACAACI)
httpwwwacaaiorgPagesdefaultaspx
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Bernstein IL Li JT Bernstein DI Hamilton R Spector SL Tan R et al Allergy
diagnostic testing an updated practice parameter Ann Allergy Asthma Immunol
2008100(3 Suppl 3)S1-148
American Academy of Allergy Asthma and Immunology (AAAAI)
Help guidance links
European Academy of AC Immunology Allergen standardization and skin tests
European Journal of Allergy and Clinical Immunology 19934848-82
European Academy of Allergy Clinical Immunology (EAACI)
National Institute of Allergy and Infections Disease (USA)
Chafen et al Prevalence natural history diagnosis and treatment of Food Allergy a systematic review of
evidences 2010 RAND Health
Boyce et al Guidelines for the diagnosis and management of food allergy in the United States J Allergy
Clin Immunol 2010 126(6)S5 httpswwwyoutubecomwatchv=AKVjKC3u9hk
European Federation of Asthma and Allergy Association
American College of Allergy Asthma and Immunology (ACAACI)httpwwwacaaiorgPagesdefaultaspx
Anaphylaxis Campaign (UK) httpwwwanaphylaxisorguk
Food Allergy and Anaphylaxis Anaphylaxis Network (USA) httpwwwfoodallergyorg
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Questions
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Adrenaline is the drug of choice in first line
treatment of anaphylaxis because it works quickly
to reverse the symptoms of an anaphylactic
reaction Adrenaline constricts blood vessels causing a rise in blood pressure relaxes smooth
muscle in the lungs to improve breathing stimulates the heart beat and reduces swelling around the
face and lips
httpwwwanaphylaxisorguk
Adrenaline injections
Slit immunotherapy
httpswwwyoutubecomwatchv=dpWomI4iPLY
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Adrenaline injections
httpwwwepipencouk
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Ragweed allergic patients may experience OAS following contact with various
fresh melons (eg watermelon cantaloupe honeydew) and bananas Birch pollen
allergic patients may develop symptoms following the ingestion of raw potatoes
carrots celery apples pears hazelnuts and kiwi
OAS is elicited by a variety of plant proteins especially pathogenesis-related
proteins cross-reacting with airborne allergens
Symptoms are provoked almost exclusively in the oropharynx and rarely involve
other target organs It is estimated that OAS affects up to 50 to 70 of adults
suffering from pollen allergy especially to birch ragweed
and mugwort pollens
Oral allergy syndrome (1)
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017ProteinFraction
Protein () MW (kD) Nomenclature
Cows Milk
Caseins 76-86 19-24
αs1-Casein 53-70 27 Bos d 8
α s2-Casein 45-50 23
β-Casein 25-35 24
κ-Casein 8-15 19
Whey 14-24
β-Lactoglobulin 7-12 36 Bos d 5
α-Lactalbumin 2-5 1444 Bos d 4
Serum albumin 07-13 69 Bos d 6
Chicken Egg White
Ovalbumin 54 45 Gal d 1
Ovomucoid 11 28 Gal d 2
Ovotransferrin 12-13 777 Gal d 3
Peanut
Vicilin - 635 Ara h 1
Conglutin - 1719 Ara h 2
Glycinin - 64 Ara h 3
Soybean
Glycinin G1 acidic chain
- 40
Profilin - 13 Gly m 3
Fish
Parvalbumin - 123 Gad c 1
Shrimp
Tropomyosin - 36 Pen a 1
Sensitization to food allergens may occur in
the gastrointestinal tract
considered traditional or class 1 food
allergens
Class 1 Food Allergens (1)
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy
M Alcocer 2017
Class 2 Food Allergens (Cross-reactive and Associated with Oral Allergy Syndrome) (1)
Protein Nomenclature Protein FractionMW (kD)
Latex-Fruit Cross-reactivity
Pathogen-related protein 2 group
LatexAvocadoBananaChestnutFigKiwi
Hev b 2 13 gluconase 3436
Pathogen-related protein 3 group
LatexAvocadoChestnut
Hev b 602Pers a 1
ChitinaseEndochitinase
532
Pathogen-related protein 5
Apple Mal d 2Thaumatin-homologue
31
Cherry Pru av 2 Thaumatin 233
Birch Bet v 1 Homologues (pathogen-related proteins 10)
Apple Mal d 1 Bet v 1 homologue
Cherry Pru av 1 Bet v 1 homologue
Apricot Pru ar 1 Bet v 1 homologue
Pear Pyr c 1 Bet v 1 homologue 18
Carrot Dau c 1 Bet v 1 homologue
Celery Api g 1 Bet v 1 homologue 16
Parsley pcPR 1 and 2 Bet v 1 homologue
Hazelnut Cor a 1 Bet v 1 homologue 17
Birch Bet v 2 Homologues (celery-mugwort-spice syndrome)
Latex Hev b 8 Profilin 14
Celery Api g 4 Profilin
Potato Profilin
Cherry Pru av 4 Profilin 15
Pear Pyr c 4 Profilin 14
Peanut Ara h 5 Profilin 15
Soybean Gly m 3 Profilin 14
hellipor as a consequence of an allergic
sensitization to inhalant allergens
considered class 2 food allergy