CURRENT ALLERGY & CLINICAL IMMUNOLOGY JOURNAL OF THE ALLERGY SOCIETY OF SOUTH AFRICA
Vol 34, No 2 June 2021
- Unusual or emerging food allergies
- Adult-onset food allergies
- Veganism and food allergies
- IgE to meat, cat and ascaris in alpha-gal syndrome
- Lipid transfer protein syndrome
- Allergy to olive fruit
- Pet groomers’ occupational exposures
UNUSUAL OR EMERGING FOOD ALLERGIES
Authors: Claudia Gray
Abstract: The allergist in the 21st century is well versed with diagnosing and managing classical food allergies such as those to peanut, cow’s milk and egg. Some allergies, however, are somewhat unusual and unfamiliar, which can make diagnosis more difficult and often delayed. A case in point is the increased popularity of vegan diets: this has opened up a whole new avenue for unusual food allergies to emerge – especially to those allergens of plant origin. he advent of component-resolved diagnostics, however, has allowed several cross-reactivity syndromes – which can involve reactions to seemingly unrelated foods – to be recognised more accurately.
ADULT-ONSET FOOD ALLERGIES
Authors: Marinda McDonald and Claudia Gray
Abstract: While much attention is paid to food allergies in infancy and early childhood, some types of food allergy classically have their onset in later childhood and adulthood. Such allergies can lead to some confusion, especially if foods were previously tolerated. Adult-onset food allergies can be late-onset ‘primary’ food allergies such as those to seafood, peanut and tree nuts; or they can be secondary to sensitisation to specific proteins in seemingly ‘unrelated’ allergens such as the pollen food syndromes and lipid transfer protein syndrome. Alpha-gal allergies cause a characteristic allergy to non-primate mammalian red meats, usually in adulthood and typically delayed by 3–6 hours after allergen ingestion. In adulthood, co-factors such as exercise, alcohol, infections, hormonal fluctuations and the use of non-steroidal anti-inflammatory drugs may be necessary for certain food allergies to manifest. A knowledge of adult-type food allergies, including crosssensitivity patterns and co-factors, is essential to the correct diagnosis and management of adult-onset food allergies.
Keywords: adult-onset food allergies, lipid transfer protein syndrome, alpha-gal syndrome
IGE TESTING FOR MEAT, CAT & ASCARIS IN PATIENTS WITH AND WITHOUT ALPHA-GAL ALLERGY
Authors: Michael E Levin, Wisdom Basera, Maresa Botha, Heidi Facey Thomas, Tshegofatso Mabelane
Background: Severe meat allergy with anaphylaxis may be caused by sensitisation to alpha-gal. Although a wide range of variation in alpha-gal-specific IgE is found in both subjects with and without alpha-gal-induced meat anaphylaxis, the level of alpha-gal sensitisation correlates with the likelihood of meat allergy. Other laboratory tests have been implicated to be affected by alpha-gal sensitisation. Correlations between alpha-gal sensitisation and sensitisation to certain animals or parasites may provide further clues about potential sensitisers, apart from ticks, in alpha-gal allergy.
Methods: In this study we assessed 131 participants who reported adverse reactions to meat, and 26 control subjects, by means of questionnaires, IgE sensitisation to alpha-gal and oral food challenge to beef sausage. Specific IgE to alphagal, beef, pork, lamb, cat, cat serum albumin and ascaris in those participants with challenge-proven meat allergy were compared with control subjects from the same environment.
Results: 84 participants were diagnosed with alpha-gal allergy. Alpha-gal IgE ranged between 0.7 and 344.5 kU/L. Beef, pork and lamb IgE were strongly correlated with alpha-gal IgE in both cases and controls. Cat IgE was significantly associated with alpha-gal sIgE, with a strong correlation in cases but a moderate correlation in controls. There was no association between cat serum albumin and alpha-gal IgE. Ascaris sIgE was significantly associated with alpha-gal sIgE.
Conclusion: Cross-sensitisation between alpha-gal and beef, pork, lamb and cat can be explained by the presence of alpha-gal-containing epitopes on the ImmunoCAP reagents. The absence of cross-sensitisation to cat serum albumin is due to the pure nature of the reagent used. Cross-sensitisation between alpha-gal and ascaris could be explained by the resence of significant amounts of alpha-gal-containing epitopes within the helminth. However, the absence of binding to acaris IgE in some patients with significant levels of alpha-gal IgE argues against this being the sole or main factor, thus the possibility of a causative role in helminths causing sensitisation to alpha-gal.
Keywords: alpha-gal, galactose-alpha-1,3-galactose, anaphylaxis, food allergy, meat allergy, oral food challenge, red meat allergy, ascaris
LIPID TRANSFER PROTEIN SYNDROME – AN EMERGING ALLERGY IN NON-MEDITERRANEAN COUNTRIES?
Authors: Claudia L Gray
Abstract: The lipid transfer protein (LTP) is a pan-allergen found across a wide range of pollens and plant-based foods. The LTPs are highly resistant to heat treatment and proteolytic digestion, and have a propensity to cause severe food allergy reactions. A significant possibility of cross-sensitisation exists among LTP-containing foods. This can lead to a syndrome of allergies to multiple LTP-containing foods, most commonly the Rosaceae fruits and nuts, termed the ‘LTP syndrome.ʼ To date, LTP syndrome has been described commonly in Mediterranean Spain and less frequently in other areas of the world. This case report describes the case of a South African patient in his forties presenting with multiple new-onset food allergies, consistent with LTP syndrome.
Keywords: lipid transfer protein, LTP syndrome, pan-allergen, cross-reactivity syndromes
VEGANISM AND FOOD ALLERGIES – WHEN THE EXCLUSION OF ANIMAL PRODUCTS AND ALLERGENS COINCIDE
Authors: Lindsay Archibald-Durham
Abstract: Plant-based, vegetarian and vegan diets are becoming increasingly popular. With novel vegan protein sources such as pea, lupin, quinoa and hemp increasingly entering the marketplace, and the increased use of existing vegan protein sources (eg nuts, soya, pulses and wheat protein isolate), it is likely that the rates of allergic reactions to these protein sources may increase. Food allergy and vegan diets both impose dietary restrictions, in this way limiting the sources of important nutrients. Therefore an improved dietary variety is needed. Moreover, factors such as a reduced bioavailability of nutrients in alternative foods need to be taken into consideration. The combination of veganism and food allergy consequently warrants careful consideration and monitoring.
Keywords: veganism, food allergies, dietary restrictions, plant-based proteins
ALLERGY TO OLIVE FRUIT: LIPID TRANSFER PROTEIN SYNDROME
Authors: Felipe Santos Vicente, Margarita Latasa Eceizabarrena, Ángel Rodríguez Paredes, Lucía Jimeno Nogales
Abstract: A 40-year-old female was previously diagnosed with asthma and rhino-conjunctivitis due to pollen sensitisation and food allergy to several fruits and nuts. She had two episodes of itching and generalised urticaria after the ingestion of olive fruit, one as a natural edible food and the other after eating a pizza. We could see differences in a skin-prick test, and immunoblotting results, depending on the stage of ripeness of the fruit. The main allergen implicated was the non-specific lipid transfer protein, Ole e 7. The patient had also had many episodes with other lipid transfer protein fruits/nuts, so we can define it as a lipid transfer protein syndrome. We present a clinical case of olive fruit allergy in the context of a lipid transfer protein syndrome. We could demonstrate by in vivo and in vitro means that the main allergen responsible for the reactions was Ole e 7, a lipid transfer protein. A previous pollen sensitisation to Oleaceae family is not necessarily required. We could also observe differences in sensitisation according to the stage of ripeness of the fruit.
Keywords: olive fruit, lipid transfer protein, lipid transfer protein syndrome, Oleaceae, food allergy
ALLERGY IN THE WORKPLACE
PET GROOMERS’ OCCUPATIONAL EXPOSURES: AN UNDER-RESEARCHED GROUP OF WORKERS IN A GROWING PET-CARE INDUSTRY
Authors: Munyadziwa Muvhali, Tanusha Singh
Abstract: The increase in global pet ownership has led to the pet-care industry’s growth, making pet grooming an occupation that has seen considerable growth. Yet, little is known about their occupational environment, exposures and the associated health effects. Veterinary workers may be the most closely comparable group, owing to their similar occupational exposures. This review explores both the comparable biological, chemical and other hazards identified in veterinary practices and their impact on the health of veterinary workers; it also considers how research findings among these workers may help to determine the direction in which studies among pet groomers must focus. Studies reported on the following: veterinary workers have a high prevalence of sensitisation to animal allergens and latex, which lead to both respiratory and skin effects such as asthma and contact dermatitis. Zoonotic infections among veterinary workers are also common. Research on respirable dust and bioaerosol exposure among veterinary workers is still limited, but current evidence from veterinary and pet-grooming establishments shows the need for further investigation. Other physical, ergonomic and noise hazards need to be investigated further in pet-grooming settings. Inadequate training on health and safety aspects and poor personal protective equipment use was observed in veterinary workers and pet groomers. The need for more research among pet groomers is necessary, as there seems to be little to no information on a variety of occupational exposures and their health effects. Future studies need to focus on the environmental conditions, hazards and also on workers’ health and prevention strategies.
Keywords: pet groomers, pet allergy, biological hazards, infectious disease, allergens
TELEMEDICINE, ALLERGY AND THE COVID-19 PANDEMI
Authors: Sharon Kling
Abstract: The global COVID-19 pandemic has changed the world and healthcare practice. Telemedicine is important in reaching underserved and rural populations. But it has also become important in limiting the exposure of patients and healthcare professionals to infection, while at the same time still providing access to healthcare consultations for patients with acute and chronic conditions.
Keywords: telemedicine, allergy, COVID-19
A DAY IN THE LIFE OF AN ALLERGIST: THINKING OUT OF THE BOX
Authors: Claudia L Gray
Abstract: Allergology is so much more than ‘itchy noses’. It is a broad sub-specialty which encompasses immunological ‘mishaps’ in many organ systems. Part of the art of allergology is sorting out the ‘normal’ from the ‘allergic’ from the ‘alternative diagnoses’. The allergist needs to be able to see through common misperceptions, arrange appropriate tests for the patient in a targeted rather than a generic way, and recognise patterns of symptoms which can lead to the diagnosis. The allergist then needs to gently guide the patient into accepting the real diagnosis, and set out management plans for the long term as well as for acute exacerbations and emergencies. It is one of the few sub-specialties that deals with the whole patient rather than homing in on a specific organ system. The variety is stimulating and challenging, as demonstrated by a series of cases in the ‘day in the life of an allergist’.
AN UNUSUAL CASE OF ANAPHYLAXIS IN A CHILD WITH PULMONARY ECHINOCOCCOSIS
Authors: Francesca G Maraschin, Debbie A White
Abstract: Echinococcus is a tapeworm that causes hydatid disease. Cystic echinococcosis, caused by Echinococcus granulosus, is a condition endemic to South Africa, particularly in sheep-farming areas such as the Eastern Cape. Patients may present with a variety of symptoms and complications, including spontaneous cyst rupture and subsequent anaphylaxis which may prove to be fatal. Treatment methods may be medical or surgical. We report the case of an 11-year-old boy who was treated medically for pulmonary hydatid disease and subsequently presented with spontaneous cyst rupture and anaphylaxis, resulting in the need for surgical resection of the cyst.
Keywords: pulmonary echinococcosis, tapeworm, cystic echinococcosis