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Literature support Test chart for the use of ImmunoCAP ® Allergen components

Literature support Test chart for the use of ImmunoCAP ® Allergen components Suspicion of fruit allergy Risk for severe reactions?. Suspicion of fruit allergy. Is it allergy? Risk for severe reactions?. Test with ImmunoCAP ® Allergen. Fruit allergen + Pru p 3 (f420). Fruit: neg

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Literature support Test chart for the use of ImmunoCAP ® Allergen components

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  1. Literaturesupport Test chart for the use of ImmunoCAP® Allergen components • Suspicion of fruit allergy • Risk for severe reactions?

  2. Suspicion of fruit allergy Is it allergy? Risk for severe reactions? Test with ImmunoCAP® Allergen Fruit allergen + Pru p 3 (f420) Fruit: neg Pru p 3: neg Fruit: pos Pru p 3: neg Fruit: pos Pru p 3: pos Very low risk for severereactions to fruit Low risk for severereactions to fruit Risk for severereactions to fruit Recommendationsfor further testing Risk grading: Pru p 1 (f419)  Pru p 4 (f421)  CCD (Ro214) 

  3. Suspicion of fruit allergy Is it allergy? Risk for severe reactions? •   • Pru p 3 – ImmunoCAP® f420 rPru p 3 • Often associated with systemic and more severe reactions in addition to Oral Allergy Syndrome (OAS). • Stable to heat and digestion, risk for reactions also to cooked food. • A marker for sensitization to fruit LTP (Lipid Transfer Protein). • Pru p 1 – ImmunoCAP® f419 rPru p 1 • Often associated with local symptoms such as OAS. • A marker for birch-pollen related cross-reactions to fruit. • A heat labile protein, cooked food is often tolerated. • A marker for sensitization to fruit PR-10 proteins. • Pru p 4 – ImmunoCAP® f421 rPru p 4 • Seldom associated with clinical symptoms but may cause demonstrable or even severe reactions in a minority of patients. • Present in plants and plant derived foods, associated with a broad spectrum of cross-reactions. • A marker for sensitization to profilins. • CCD (MUXF3) – ImmunoCAP® Ro214 MUXF3 • Rarely associated with clinical symptoms. • A marker for sensitization to cross-reactive carbohydrate determinants (CCD). • Present in all plants. •    References: Asero R et al. J Allergy Clin Immunol 2003;112:427-32, Asero R, Int Arch Allergy Immunol 2005; 138:1-11, Sicherer S, J Allergy Clin Immunol 2001; 108:881-90

  4. References • Asero R. Review - Plant Food Allergies: A Suggested Approach to Allergen-Resolved Diagnosis in the Clinical Practice by Identifying Easily Available Sensitization MarkersInt Arch Allergy Immunol 2005;138:1-11 • Asero R et al. Detection of clinical markers in patients allergic to plant-derived foods J Allergy Clin Immunol 2003;112:427-32 • Sicherer S. Clinical implications of cross-reactive food allergensJ Allergy Clin Immunol 2001;108:881-90

  5. Asero R. Review - Plant Food Allergies: A Suggested Approach to Allergen-Resolved Diagnosis in the Clinical Practice by Identifying Easily Available Sensitization MarkersInt Arch Allergy Immunol 2005;138:1-11 • Systemic reactions (including anaphylaxis and asthma) following intake of Rosaceae fruits*are reported in LPT sensitized patients • These reports are from Spain and Italy • The geographical distribution pattern was confirmed in a study in NL, AT, ES and IT • Pollen allergic patients often report OAS after intake of apple and other fruits • A consequence of cross-reactivity to different Bet v 1 homologues in fruits, e.g. Pru p 1, and the birch allergen component Bet v 1 * Apple, pear, peach, apricot, plum, cherry

  6. Asero R et al.Detection of clinical markers in patients allergic to plant-derived foods J Allergy Clin Immunol 2003;112:427-32 • The risk of severe and potentially life-threatening reactions is relevant if the sensitizing allergen is pepsin resistant and heat stable - as are LTPs • Birch-pollen and fruit allergic patients sensitized to labile proteins, as Pru p 1, are at less risk of dramatic reactions after ingestion of the allergenic food • Symptoms usually limited to OAS. • Occasionally, severe reactions are induced after ingestion of foods in pollen-allergic patients. • Sensitization to profilin is likely in the presence of OAS to citrus fruits, melons, banana or tomato

  7. Sicherer S.Clinical implications of cross-reactive food allergens (A review) J Allergy Clin Immunol 2001;108:881-90 • Subjects: 1361 food and pollen allergic patients with OAS, and systemic reactions: • 8.7% systemic reactions outside the gastrointestinal tract • 3% sometimes systemic reaction without oral symptoms • 1.7% anaphylactic chock What distinguish those at risk of severe reactions? • Reactions involving specific IgE to LTPs are more likely to be severe! • Fruit allergy in absence of allergy to pollen is characterized by specific IgE antibodies detected to: • LTP • Profilin

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