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Suzuki, S., Nwaru, B. I., Ekerljung, L., Sjölander, S., Mincheva, R., Rönmark, E. P., . . . Lotvall, J. (2019). Characterization of sensitization to furry animal allergen components in an adult population. Clinical and Experimental Allergy, 49(4), 495-505
Open this publication in new window or tab >>Characterization of sensitization to furry animal allergen components in an adult population
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2019 (English)In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 49, no 4, p. 495-505Article in journal (Refereed) Published
Abstract [en]

Background: There are paucity of data on sensitization to furry animal allergen components in adults. Furry animals are major sensitizers and contributors to asthma burden in northern Europe and North America.

Objective: To characterize sensitization patterns to furry animal allergen components in Swedish adults.

Methods: Based on the West Sweden Asthma Study, a random population (n = 1103) and an asthma sample (n = 769) were tested for allergen sensitization using Phadiatop®. Those with IgE ≥ 0.35 kUA/L were tested for cat (Fel d 1, 2, and 4), dog (Can f 1, 2, 3, and 5), and horse (Equ c 1) allergen component sensitization. We defined allergen component poly‐sensitization patterns, identified data‐driven sensitization clusters, described component sensitization overlaps, and assessed determinants of sensitization patterns.

Results: The prevalence of allergen component sensitization ranged from 0.8% for Fel d 2 and Can f 3 to 8.9% for Fel d 1. The most common dog component was Can f 5 (3.6%); 2.1% were sensitized to Equ c 1. Those sensitized to Fel d 2 and Fel d 4 were commonly sensitized to Fel d 1. The most common dog component overlap was between Can f 1/Can f 2 and Can f 5. Mono‐sensitization was 5.6%, double sensitization 1.5% and poly‐sensitization 2.1%. Sensitization was always higher in the asthma than in the random sample. Three sensitization clusters were derived, namely non‐sensitized (90% in random vs 66% in asthma sample); Fel d 1‐driven sensitized (7% vs 19%); and multi‐sensitized (3% vs 15%). Key determinants of sensitization were gender, age, raised on a farm, family history of allergy or asthma, smoking, and occupational exposure to dust or fumes.

Conclusions & Clinical Relevance: Fel d 1 and Can f 5 are the most common cat and dog components sensitization in this adult Swedish population. Mono‐sensitization is more common than poly‐sensitization. This detailed characterization highlights the current distribution of furry animal allergen components in Swedish adults, and their impact on clinical outcomes of asthma will be further explored.

National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-382652 (URN)10.1111/cea.13355 (DOI)000463761700012 ()30697845 (PubMedID)
Funder
Swedish Research CouncilSwedish Heart Lung FoundationSwedish Asthma and Allergy AssociationRegion Västra Götaland
Available from: 2019-04-29 Created: 2019-04-29 Last updated: 2019-04-29Bibliographically approved
Reier-Nilsen, T., Michelsen, M. M., Carlsen, K. C. L., Carlsen, K.-H., Mowinckel, P., Nygaard, U. C., . . . Haland, G. (2019). Feasibility of desensitizing children highly allergic to peanut by high-dose oral immunotherapy. Allergy. European Journal of Allergy and Clinical Immunology, 74(2), 337-348
Open this publication in new window or tab >>Feasibility of desensitizing children highly allergic to peanut by high-dose oral immunotherapy
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2019 (English)In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 74, no 2, p. 337-348Article in journal (Refereed) Published
Abstract [en]

Background: There are limited data on the feasibility, efficacy and safety of high‐dose oral immunotherapy (OIT) in children highly allergic to peanuts.

Objective: In children highly allergic to peanut, we primarily aimed to determine the feasibility of reaching the maximum maintenance dose (MMD) of 5000 mg peanut protein or, alternatively, a lower individual maintenance dose (IMD), by OIT up‐dosing. Secondarily, we aimed to identify adverse events (AEs) and determine factors associated with reaching a maintenance dose.

Methods: The TAKE‐AWAY peanut OIT trial enrolled 77 children 5‐15 years old, with a positive oral peanut challenge. Fifty‐seven were randomized to OIT with biweekly dose step‐up until reaching MMD or IMD and 20 to observation only. Demographic and biological characteristics, AEs, medication and protocol deviations were explored for associations with reaching maintenance dose.

Results: All children had anaphylaxis defined by objective symptoms in minimum two organ systems during baseline challenge. The MMD was reached by 21.1%, while 54.4% reached an IMD of median (minimum, maximum) 2700 (250, 4000) mg peanut protein, whereas 24.5% discontinued OIT. During up‐dosing, 19.4% experienced anaphylaxis. Not reaching the MMD was caused by distaste for peanuts (66.7%), unacceptable AEs (26.7%) and social reasons (6.7%). Increased peanut s‐IgG4/s‐IgE ratio (OR [95% CI]: 1.02 [1.00, 1.04]) was associated with reaching MMD.

Conclusion: Although 75.5% of children with peanut anaphylaxis reached a maintenance dose of 0.25‐5 g, only 21.1% reached the MMD. Distaste for peanuts and AEs, including high risk of anaphylaxis, limited the feasibility of reaching MMD.

Place, publisher, year, edition, pages
WILEY, 2019
Keywords
adverse events, desensitization, feasibility, oral immunotherapy, peanut allergy
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-378729 (URN)10.1111/all.13604 (DOI)000458896800014 ()30225844 (PubMedID)
Available from: 2019-03-08 Created: 2019-03-08 Last updated: 2019-03-08Bibliographically approved
Mogensen, I., Alving, K., Dahlen, S.-E., James, A., Forsberg, B., Ono, J., . . . Malinovschi, A. (2019). Fixed airflow obstruction relates to eosinophil activation in asthmatics. Clinical and Experimental Allergy, 49(2), 155-162
Open this publication in new window or tab >>Fixed airflow obstruction relates to eosinophil activation in asthmatics
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2019 (English)In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 49, no 2, p. 155-162Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Some asthmatics develop irreversible chronic airflow obstruction, for example, fixed airflow obstruction (fixed-AO). This is probably a consequence of airway remodelling, but neither its relation to inflammation nor which asthma biomarkers can be clinically useful are elucidated. We hypothesized that the presence of type 2 inflammation relates to fixed-AO.

OBJECTIVES: To evaluate the presence of four markers for type 2 inflammation in fixed airflow obstruction among asthmatics.

METHODS: This was a cross-sectional study of 403 participants with asthma, aged 17-75 years, from three Swedish centres. Fixed airflow obstruction was defined as forced expiratory volume during the first second (FEV1 ) over forced vital capacity (FVC) being below the lower limit of normal (LLN). The following type 2 inflammation markers were assessed: exhaled nitric oxide (FeNO), serum periostin, serum eosinophil cationic protein (S-ECP), and urinary eosinophil-derived neurotoxin (U-EDN).

RESULTS: Elevated U-EDN (values in the highest tertile, ≥65.95 mg/mol creatinine) was more common in subjects with fixed-AO vs. subjects without fixed-AO: 55% vs. 29%, P < 0.001. Elevated U-EDN related to increased likelihood of having fixed-AO in both all subjects and never-smoking subjects, with adjusted (adjusted for sex, age group, use of inhaled corticosteroids last week, atopy, early-onset asthma, smoking history, and packyears) odds ratios (aOR) of 2.38 (1.28-4.41) and 2.51 (1.04-6.07), respectively. In a separate analysis, having both elevated S-ECP (>20 μg/L) and U-EDN was related to having the highest likelihood of fixed-AO (aOR (95% CI) 6.06 (2.32-15.75)). Elevated serum periostin or FeNO did not relate to fixed-AO.

CONCLUSIONS AND CLINICAL RELEVANCE: These findings support that type 2 inflammation, and in particular eosinophil inflammation, is found in asthma with fixed-AO. This could indicate a benefit from eosinophil-directed therapies. Further longitudinal studies are warranted to investigate causality and relation to lung function decline.

National Category
Medical and Health Sciences Immunology in the medical area
Research subject
Clinical Physiology
Identifiers
urn:nbn:se:uu:diva-372784 (URN)10.1111/cea.13302 (DOI)000457469600003 ()30365193 (PubMedID)
Funder
Swedish Heart Lung FoundationSwedish Research CouncilVårdal FoundationStockholm County CouncilSwedish Asthma and Allergy AssociationSwedish Foundation for Strategic Research
Available from: 2019-01-09 Created: 2019-01-09 Last updated: 2019-03-08Bibliographically approved
Nwaru, B. I., Suzuki, S., Ekerljung, L., Sjölander, S., Mincheva, R., Rönmark, E. P., . . . Lötvall, J. (2019). Furry Animal Allergen Component Sensitization and Clinical Outcomes in Adult Asthma and Rhinitis. Journal of Allergy and Clinical Immunology: In Practice, 7(4), 1230-1238
Open this publication in new window or tab >>Furry Animal Allergen Component Sensitization and Clinical Outcomes in Adult Asthma and Rhinitis
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2019 (English)In: Journal of Allergy and Clinical Immunology: In Practice, ISSN 2213-2198, E-ISSN 2213-2201, Vol. 7, no 4, p. 1230-1238Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Sensitization to allergen components has been linked to asthma in children, but studies in adults are lacking.

OBJECTIVE: To study the relation of sensitization to furry animal allergen components to risk of asthma, rhinitis, and markers of asthma severity in adults.

METHODS: From the West Sweden Asthma Study, a random population-representative sample of adults aged 16 to 75 years, 2006 participants were clinically examined; 1872 were analyzed for serum IgE level to a mix of aeroallergens. Those with an IgE level of more than 0.35 kU(A)/L to cat, dog, or horse allergen components were analyzed for specific cat (Felis domesticus [Fel d 1, Fel d 2, and Fel d 4]), dog (Canis familiaris [Can f 1, Can f 2, Can f 3, and Can f 5]), and horse (Equus caballus [Equ c 1]) allergen components. We defined monosensitization, double sensitization, and polysensitization (>2 components) patterns and applied cluster analysis to derive distinct sensitization clusters.

RESULTS: Sensitization to each allergen component, lipocalins, each sensitization pattern, and each sensitization cluster (nonsensitized, Fel d 1-driven sensitized, and multisensitized clusters) was associated with substantial increased risk of asthma, rhinitis, concomitant asthma and rhinitis, and Asthma Control Test-controlled asthma. Fel d 1, Can f 1, Can f 2, Can f 3, polysensitization, and multisensitized cluster were further associated with increased fractional exhaled nitric oxide and eosinophil levels, but with lower PD20 methacoline (provocative dose of methacholine causing a 20% drop in FEV1) values. There was no association with asthma exacerbations, FEV1 predicted values, emergency visits or regular oral steroid use, and neutrophil levels.

CONCLUSIONS: Sensitization to furry animal allergen components is an important predictor of asthma, rhinitis, and markers of asthma severity with increased blood eosinophils, fractional exhaled nitric oxide, and airway hyperreactivity.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE BV, 2019
Keywords
Asthma, Adults, Component-resolved diagnostics, Cat components, Dog components, Horse components, Cluster analysis, Furry animal, Severe asthma, Western Sweden
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-382392 (URN)10.1016/j.jaip.2018.12.018 (DOI)000463732500019 ()30594587 (PubMedID)
Funder
Swedish Research CouncilSwedish Heart Lung FoundationSwedish Asthma and Allergy Association
Available from: 2019-04-26 Created: 2019-04-26 Last updated: 2019-04-26Bibliographically approved
Frischmeyer-Guerrerio, P. A., Rasooly, M., Gu, W., Levin, S., Jhamnani, R. D., Milner, J. D., . . . Brittain, E. (2019). IgE testing can predict food allergy status in patients with moderate to severe atopic dermatitis. Annals of Allergy, Asthma & Immunology, 122(4), 393-400
Open this publication in new window or tab >>IgE testing can predict food allergy status in patients with moderate to severe atopic dermatitis
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2019 (English)In: Annals of Allergy, Asthma & Immunology, ISSN 1081-1206, E-ISSN 1534-4436, Vol. 122, no 4, p. 393-400Article in journal (Refereed) Published
Abstract [en]

Background: Diagnosing food allergy in patients with atopic dermatitis (AD) is complicated by their high rate of asymptomatic sensitization to foods, which can lead to misdiagnosis and unnecessary food avoidance.

Objective: We sought to determine whether food-specific (sIgE) or component immunoglobulin (Ig) E levels could predict allergic status in patients with moderate to severe AD and elevated total IgE.

Methods: Seventy-eight children (median age, 10.7 years) with moderate to severe AD were assessed for a history of clinical reactivity to milk, egg, peanut, wheat, and soy. The IgE levels for each food and its components were determined by ImmunoCAP. The level and pattern of IgE reactivity to each food and its components, and their ratio to total IgE, were compared between subjects who were allergic and tolerant to each food.

Results: Ninety-one percent of subjects were sensitized, and 51% reported allergic reactivity to at least 1 of the 5 most common food allergens. Allergy to milk, egg, and peanut were most common, and IgE levels to each of these foods were significantly higher in the allergic group. Component IgEs most associated with milk, egg, and peanut allergy were Bos d8, Gal d1, and Ara h2, respectively. The ratio of sIgE to total IgE offered no advantage to sIgE alone in predicting allergy.

Conclusion: Specific IgE levels and the pattern of IgE reactivity to food components can distinguish AD subjects allergic vs tolerant to the major food allergens and may therefore be helpful in guiding the clinical management of these patients. 

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2019
National Category
Respiratory Medicine and Allergy Immunology in the medical area
Identifiers
urn:nbn:se:uu:diva-382516 (URN)10.1016/j.anai.2019.01.001 (DOI)000463164500009 ()30639434 (PubMedID)
Available from: 2019-04-30 Created: 2019-04-30 Last updated: 2019-04-30Bibliographically approved
Guerrerio, P. A., Rasooly, M., Gu, W., Levin, S., Jhamnani, R., Milner, J. D., . . . Brittain, E. (2019). IgE Testing Can Predict Food Allergy Status in Patients with Moderate-Severe Atopic Dermatitis. Paper presented at Annual Meeting of the American-Academy-of-Allergy-Asthma-and-Immunology (AAAAI), FEB 22-25, 2019, San Francisco, CA. Journal of Allergy and Clinical Immunology, 143(2), AB130-AB130, Article ID 392.
Open this publication in new window or tab >>IgE Testing Can Predict Food Allergy Status in Patients with Moderate-Severe Atopic Dermatitis
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2019 (English)In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 143, no 2, p. AB130-AB130, article id 392Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
MOSBY-ELSEVIER, 2019
National Category
Respiratory Medicine and Allergy Immunology in the medical area
Identifiers
urn:nbn:se:uu:diva-377796 (URN)10.1016/j.jaci.2018.12.395 (DOI)000457771200388 ()
Conference
Annual Meeting of the American-Academy-of-Allergy-Asthma-and-Immunology (AAAAI), FEB 22-25, 2019, San Francisco, CA
Available from: 2019-02-28 Created: 2019-02-28 Last updated: 2019-02-28Bibliographically approved
Käck, U., Asarnoj, A., Grönlund, H., Borres, M. P., van Hage, M., Lilja, G. & Konradsen, J. R. (2019). Reply to: Can f 5 as a suitable marker of dog allergy: Assess male dog exposure before banning it [Letter to the editor]. Journal of Allergy and Clinical Immunology, 143(4), 1658-1659
Open this publication in new window or tab >>Reply to: Can f 5 as a suitable marker of dog allergy: Assess male dog exposure before banning it
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2019 (English)In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 143, no 4, p. 1658-1659Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
MOSBY-ELSEVIER, 2019
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-382771 (URN)10.1016/j.jaci.2018.12.1008 (DOI)000463348900051 ()30745149 (PubMedID)
Funder
Swedish Research CouncilSwedish Asthma and Allergy AssociationStockholm County CouncilSwedish Heart Lung FoundationCancer and Allergy Foundation
Available from: 2019-05-03 Created: 2019-05-03 Last updated: 2019-05-03Bibliographically approved
Mascialino, B., Yang, B. & Borres, M. P. (2019). Screening With Serology Testing Children With Asthma Could Contribute To Substantial Cost Savings To US Payors: A Population-Based Simulation Study. Paper presented at Annual Meeting of the American-Academy-of-Allergy-Asthma-and-Immunology (AAAAI), FEB 22-25, 2019, San Francisco, CA. Journal of Allergy and Clinical Immunology, 143(2), AB222-AB222, Article ID 675.
Open this publication in new window or tab >>Screening With Serology Testing Children With Asthma Could Contribute To Substantial Cost Savings To US Payors: A Population-Based Simulation Study
2019 (English)In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 143, no 2, p. AB222-AB222, article id 675Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
MOSBY-ELSEVIER, 2019
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-377797 (URN)10.1016/j.jaci.2018.12.679 (DOI)000457771200669 ()
Conference
Annual Meeting of the American-Academy-of-Allergy-Asthma-and-Immunology (AAAAI), FEB 22-25, 2019, San Francisco, CA
Available from: 2019-02-28 Created: 2019-02-28 Last updated: 2019-02-28Bibliographically approved
Valcour, A., Lidholm, J., Borres, M. P. & Hamilton, R. G. (2019). Sensitization profiles to hazelnut allergens across the United States. Annals of Allergy, Asthma & Immunology, 122(1), 111-116
Open this publication in new window or tab >>Sensitization profiles to hazelnut allergens across the United States
2019 (English)In: Annals of Allergy, Asthma & Immunology, ISSN 1081-1206, E-ISSN 1534-4436, Vol. 122, no 1, p. 111-116Article in journal (Refereed) Published
Abstract [en]

Background: Measurement of IgE antibody to hazelnut components can aid in the prediction of allergic responses to the food.

Objective: To investigate the association between patient demographics (age, location) and patterns of allergic sensitization to hazelnut components across the United States and to investigate the degree of correlation between hazelnut sensitization with sensitization to other tree nuts, peanuts, and their components.

Methods: Serum samples from 10,503 individuals with hazelnut extract specific IgE (sIgE) levels of 0.35 kU(A)/L or higher were analyzed for IgE antibodies to Cor a 1, 8, 9, and 14 by ImmunoCAP. A subset of these patients were analyzed for IgE antibodies to peanut, walnut, and cashew nut IgE along with associated components.

Results: Among hazelnut sensitized individuals, children (<3 years old) were predominantly sensitized to Cor a 9 and Cor a 14. Conversely, Cor a 1 sIgE sensitization was much higher in adults than children, especially in the Northeastern United States. Cor a 8 sensitization was relatively constant (near 10%) across all ages. Cosensitization of hazelnut with other tree nuts and peanuts was related to correlation of IgE concentrations of individual component families.

Conclusion: We conclude that sensitization to individual hazelnut components is highly dependent on age and/or geographic location. Component correlations suggest that cosensitization to hazelnut and walnut may be caused by their pathogenesis-related protein 10 allergens, nonspecific lipid transfer proteins, or seed storage proteins, whereas hazelnut and peanut cosensitization is more often caused by cross-reactivity of pathogenesis-related protein 10 (Cor a 1 and Ara h 8) and nonspecific lipid transfer proteins (Cor a 8 and Ara h 9). (c) 2018 American College of Allergy, Asthma & Immunology.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2019
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-372870 (URN)10.1016/j.anai.2018.09.466 (DOI)000453757300017 ()30292797 (PubMedID)
Available from: 2019-01-10 Created: 2019-01-10 Last updated: 2019-01-10Bibliographically approved
Valcour, A., Lidholm, J., Borres, M. P. & Hamilton, R. G. (2019). Sensitization Profiles to Hazelnut Allergens across the United States of America. Paper presented at Annual Meeting of the American-Academy-of-Allergy-Asthma-and-Immunology (AAAAI), FEB 22-25, 2019, San Francisco, CA. Journal of Allergy and Clinical Immunology, 143(2), AB238-AB238, Article ID 721.
Open this publication in new window or tab >>Sensitization Profiles to Hazelnut Allergens across the United States of America
2019 (English)In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 143, no 2, p. AB238-AB238, article id 721Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
MOSBY-ELSEVIER, 2019
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-377798 (URN)10.1016/j.jaci.2018.12.726 (DOI)000457771200715 ()
Conference
Annual Meeting of the American-Academy-of-Allergy-Asthma-and-Immunology (AAAAI), FEB 22-25, 2019, San Francisco, CA
Available from: 2019-02-28 Created: 2019-02-28 Last updated: 2019-02-28Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-9045-2304

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