PURPOSE: Buckwheat allergy is one of the most severe types of food allergy in some countries, especially among children. However, few studies have investigated this condition. The aim of this study was to report the clinical and laboratory findings in Korean children with buckwheat allergy. METHODS: Thirty-seven subjects, aged 1 to 14 years, were enrolled by retrospective medical record review from January 2000 through May 2015 at the Department of Pediatrics in Ajou University Hospital. The demographic profile, previous exposure to buckwheat pillows, clinical symptoms, and laboratory findings of each subject were recorded. RESULTS: Twenty-six of the 37 children had immediate-type allergic symptoms to buckwheat, while 11 subjects were tolerant to buckwheat. Seventeen out of 26 buckwheat allergic children (65.4%) had anaphylaxis. The median buckwheat specific IgE level in the buckwheat allergic group (7.71 kU(A)/L) was significantly higher (P<0.001) than in the buckwheat tolerant group (0.08 kU(A)/L) with an optimal cutoff value of 1.27 kU(A)/L (sensitivity 84.6%, specificity 100%). When adjusted for age, the difference between the 2 groups showed no statistical significance (P=0.063). In subjects who had anaphylaxis, buckwheat-specific IgE levels ranged from 0.37 to 100 kUA/L. CONCLUSION: Almost two-thirds of buckwheat-allergic children had anaphylaxis, and a wide-range of buckwheat specific IgE levels were observed in these children. Anaphylaxis occurred in a subject with a remarkably low IgE level (0.37 kU(A)/L).
Anaphylaxis ; Asian Continental Ancestry Group ; Child ; Fagopyrum* ; Food Hypersensitivity ; Humans ; Hypersensitivity* ; Immunoglobulin E ; Medical Records ; Pediatrics ; Retrospective Studies ; Sensitivity and Specificity ; Tertiary Care Centers*

PURPOSE: The aim of this study was to assess the clinical usefulness and added diagnostic value of specific IgE antibodies to wheat, gluten, and ω-5 gliadin in diagnosing wheat allergy and distinguishing wheat anaphylaxis. METHODS: This study included 196 children who visited Ajou University Hospital for suspicious food allergy. The subjects were divided into 2 groups: the wheat allergy (WA) and non-wheat allergy (non-WA) groups. Patients with wheat allergy were further divided into 2 subgroups according to their symptoms: the wheat allergy with anaphylaxis (WA(Ana)) and wheat allergy without anaphylaxis (WA(Non-Ana)) groups. Serum concentrations of total IgE and specific IgE antibodies to wheat, gluten and ω-5 gliadin were measured. RESULTS: The median values of specific IgE antibodies to wheat, gluten and ω-5 gliadin were significantly higher in the WA group than in the non-WA group, and the positive decision points (95% specificity) were at 3.12, 2.61, and 0.21 kUA/L, respectively. The combination of specific IgE antibodies to wheat and ω-5 gliadin resulted in the highest accuracy of 93.9% in diagnosing wheat allergy. In differentiating the WA(Ana) group from the WA(Non-Ana) group, only specific IgE antibody to ω-5 gliadin showed a significant difference at the optimal cutoff point of 1.56 kUA/L. CONCLUSION: Our results show that the individual levels of specific IgE antibodies to wheat, gluten or ω-5 gliadin may have a considerably high accuracy in diagnosing wheat allergy and that specific IgE antibody to ω-5 gliadin may be particularly useful in predicting wheat anaphylaxis.
Anaphylaxis ; Antibodies ; Child* ; Food Hypersensitivity ; Gliadin* ; Glutens* ; Humans ; Hypersensitivity ; Immunoglobulin E* ; Triticum* ; Wheat Hypersensitivity*

PURPOSE: The immunological characteristics of young Korean children with walnut (WN) allergy and the influence of different cooking methods on WN proteins have not been evaluated to date. This study aimed to evaluate the major WN allergens identified among Korean children, together with changes in WN antigenicity caused by common cooking methods. METHODS: We enrolled children under the age of 13 years with WN serum-specific immunoglobulin (Ig) E concentrations. The protein fractions of dry-fried and boiled WN extracts were compared with those of raw WNs using sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), 2-dimentional gel electrophoresis (2DE) and a proteomic analysis using electrospray ionization (liquid chromatography-mass spectrometry [LC-MS]). An immunoblotting analysis was conducted to examine IgE reactivity toward raw WNs using serum samples from 6 children with a clinical WN allergy. To determine the processed WN proteins with IgE-binding capacity, a 2D-immunoblotting analysis was performed using the pooled sera of 20 WN-sensitized children. RESULTS: Protein bands from raw WNs were identified at 9, 16, 28, 52, 58, and 64 kDa via SDS-PAGE. The 9- and 16-kDa protein bands were enhanced by boiling, whereas the 52- and 64-kDa bands were considerably diminished. On LC-MS analysis, of the 66 IgE-binding proteins present in raw WNs, 57 were found in dry-fried WNs, but only 4 in boiled WNs. The sera of 5 out of 6 participants reacted with the 52-kDa protein bands and those of 4 out of 6 participants reacted with the 16- and 28-kDa protein bands, respectively. Meanwhile, a 2D-immunoblotting result confirmed the presence of different binding patterns among children who consumed cooked WNs. CONCLUSIONS: The protein profile of boiled WNs is substantially different from that of raw WNs. However, 4 proteins including prolamins remained stable after dry-frying or boiling. Further studies are needed to evaluate the clinical relevance of these findings.
Allergens ; Child* ; Cooking ; Electrophoresis ; Electrophoresis, Polyacrylamide Gel ; Humans ; Hypersensitivity ; Immunoblotting ; Immunoglobulin E ; Immunoglobulins* ; Juglans* ; Prolamins ; Sodium Dodecyl Sulfate ; Spectrum Analysis

Background: The diagnosis of food allergies needs to be confirmed through an oral food challenge (OFC). However, specific immunoglobulin E (sIgE) concentrations analyzed by serological tests are also helpful in determining OFC items and predicting the presence of allergic reactions. Unfortunately, there is a limit to the number of antigens that can be simultaneously evaluated at one time. The purpose of this study was to analyze the possibility of detecting sIgE antibodies against food using clues in self-reported food allergy symptoms. Methods: Medical records of 377 patients aged 3 years or younger were collected for egg white-, cow’s milk-, walnut- and soybean-sIgE sensitization, and related clinical history. Each clinical history was classified into class 1: direct- isolated intake resulting in anaphylaxis or hives with consistent clincical history; class 2a: class 1 with inconsistency; class 2b: indirect-mixed intake resulting in anaphylaxis or hives regardless of consistency; class 2c: direct/indirect- isolated/mixed intake resulting in itching without hives, vomiting, or diarrhea with consistent clincical history; or class 3: class 2c with inconsistency or asymptomatic to direct, isolated exposure. Results: The area under the curve (AUC) of class 1 for cow’s milk was 0.790, and the accuracy was 78.0%. The AUC of class 1 and 2 for egg white was better than that of class 1 (0.750), and the accuracy rate was 77.6%. The AUCs of class 1 for walnut and soybean were 0.775 and 0.662, respectively. Conclusion In conclusion, sIgE sensitization to foods could be predicted by the combination of exposure and selfreported symptoms in children under 3 years of age.

Background: The diagnosis of food allergies needs to be confirmed through an oral food challenge (OFC). However, specific immunoglobulin E (sIgE) concentrations analyzed by serological tests are also helpful in determining OFC items and predicting the presence of allergic reactions. Unfortunately, there is a limit to the number of antigens that can be simultaneously evaluated at one time. The purpose of this study was to analyze the possibility of detecting sIgE antibodies against food using clues in self-reported food allergy symptoms. Methods: Medical records of 377 patients aged 3 years or younger were collected for egg white-, cow’s milk-, walnut- and soybean-sIgE sensitization, and related clinical history. Each clinical history was classified into class 1: direct- isolated intake resulting in anaphylaxis or hives with consistent clincical history; class 2a: class 1 with inconsistency; class 2b: indirect-mixed intake resulting in anaphylaxis or hives regardless of consistency; class 2c: direct/indirect- isolated/mixed intake resulting in itching without hives, vomiting, or diarrhea with consistent clincical history; or class 3: class 2c with inconsistency or asymptomatic to direct, isolated exposure. Results: The area under the curve (AUC) of class 1 for cow’s milk was 0.790, and the accuracy was 78.0%. The AUC of class 1 and 2 for egg white was better than that of class 1 (0.750), and the accuracy rate was 77.6%. The AUCs of class 1 for walnut and soybean were 0.775 and 0.662, respectively. Conclusion In conclusion, sIgE sensitization to foods could be predicted by the combination of exposure and selfreported symptoms in children under 3 years of age.