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: 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: Perilla seed (PS) is the most common cause of seed-induced anaphylaxis in Korean children, but the reports on PS allergy, including phenotype and cross-reactivity, are rare. The aim of this study is to assess the clinical characteristics of PS allergy and investigate cross-reactivity with sesame seed (SS). Methods: Through a retrospective medical record review, patients with clinical PS allergy were identified in a single tertiary hospital. Clinical characteristics of allergic reaction upon exposure to PS and SS, results of skin prick test (SPT) to PS and SS, and the levels of serum SS-specific immunoglobulin E (SS-sIgE) were investigated. Cross-reactivity between PS and SS was studied using IgE enzymelinked immunosorbent assay (ELISA) inhibition. Results: The median age of 34 PS-allergic children was 41.5 months (range, 10 months to 12 years), and the proportion of anaphylaxis upon exposure to PS was 29.4% (n = 10). The PS SPT was positive in 94.1% (n = 32) with the median wheal size of 6.25 mm. Among PS-allergic children, the percentages of patients with positive symptoms, negative symptoms, and indeterminate symptoms upon exposure to SS were 8.8%, 41.2%, and 50%, respectively. Out of 14 PS-allergic children who were tolerant to SS, positive sensitization to SS was noticed in 78.6% by serum SS-sIgE, and 57.1% by SS SPT. Partial cross-reactivity between PS and SS was identified in IgE ELISA inhibition. Conclusion This study reported the clinical profiles and SPT results in a relatively large number of PS-allergic children and identified the partial cross-reactivity between PS and SS for the first time.

Purpose: In food allergy, significant component antigens can be assessed by using the microarray. The purpose of this study was to evaluate the diagnostic value of component resolved diagnosis (CRD) in young children with kiwifruit allergy. Methods: Through a retrospective review of medical records, we evaluated the clinical characteristics of 12 children who underwent measurement of serum immunoglobulin E concentrations to kiwifruit (kiwi-sigE) and were diagnosed as kiwifruit allergy. We applied ImmunoCAP ISAC-CRD 112 using the residual sera of patients at the initial visit. Results: The median age of kiwifruit allergic children was 33.5 months (range, 13 to 84 months), and the proportion of systemic reactions, including 2 anaphylaxis cases, was 66.7%. Four had localized reactions on the lips. A total of 11 (91.7%) were sensitized to Act d 1; among them, 8 were mono-sensitized to Act d 1 and 3 were sensitized to ≥ 2 kiwifruit components. There was no significant difference in CRD results between those with systemic reactions and those with local reactions. Conclusion Act d 1 is the major allergenic component in Korean young children with clinical kiwifruit allergy. The additional diagnostic value of the CRD in diagnosing and predicting the severity of kiwifruit allergy is expected to be low in young children.

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