Oral allergy syndrome (OAS) is an IgE-mediated hypersensitivity. Patients with pollen allergy will experience oropharyngeal allergy after eating fresh fruits or vegetables containing homologous pathogenesis-related allergen, occasionally accompanied by systemic symptoms, it is a special type of food hypersensitivity in which respiratory allergens and food allergens are similar structurally and lead to the cross-reactivity. At present, there is little research and attention to it in China. To master the definition, epidemiological characteristics, pathological mechanism, diagnosis, prevention and treatment of OAS is very important to the prevention and control of OAS. This article reviews the research progress of OAS, providing reference and prevention basis for clinicians to improve the diagnosis and differential diagnosis of OAS.
Humans ; Pollen ; Food Hypersensitivity/diagnosis* ; Rhinitis, Allergic, Seasonal/therapy* ; Allergens ; Fruit ; Cross Reactions

Pollen food allergy syndrome (PFAS) is an IgE-mediated allergic reaction that occurs when some pollinosis patients ingest certain plant-derived food that contains cross-reactive allergenic components. PFAS is prevalent in both children and adult pollinosis patients. In most cases, PFAS symptoms are confined to the oropharynx and occur within several minutes after oral contact with food. Therefore, PFAS has been also referred as oral allergy syndrome (OAS). A small proportion of PFAS patients would experience systemic symptoms or anaphylaxis. Currently, the diagnosis of PFAS is mainly based on clinical history and allergic tests [skin prick tests and(or) serum specific IgE tests]. Oral provocation tests are used to verify atypical patients. Component-resolved diagnosis is essential for further precise diagnosis and treatment. Management options for PFAS include lifestyle adjustment, symptomatic medication, and immunotherapy. The efficacy and appropriate population for immunotherapy need further investigation. This article aims to update the knowledge on epidemiology, pathogenesis and clinical management of PFAS, thereby enhancing clinicians' understanding as well as treatment progress of this disease entity.
Adult ; Child ; Humans ; Rhinitis, Allergic, Seasonal/therapy* ; Syndrome ; Food Hypersensitivity/therapy* ; Pollen ; Fluorocarbons ; Immunoglobulin E

Pollen food allergy syndrome (PFAS) is an IgE-mediated allergic reaction that occurs when some pollinosis patients ingest certain plant-derived food that contains cross-reactive allergenic components. PFAS is prevalent in both children and adult pollinosis patients. In most cases, PFAS symptoms are confined to the oropharynx and occur within several minutes after oral contact with food. Therefore, PFAS has been also referred as oral allergy syndrome (OAS). A small proportion of PFAS patients would experience systemic symptoms or anaphylaxis. Currently, the diagnosis of PFAS is mainly based on clinical history and allergic tests [skin prick tests and(or) serum specific IgE tests]. Oral provocation tests are used to verify atypical patients. Component-resolved diagnosis is essential for further precise diagnosis and treatment. Management options for PFAS include lifestyle adjustment, symptomatic medication, and immunotherapy. The efficacy and appropriate population for immunotherapy need further investigation. This article aims to update the knowledge on epidemiology, pathogenesis and clinical management of PFAS, thereby enhancing clinicians' understanding as well as treatment progress of this disease entity.
Adult ; Child ; Humans ; Rhinitis, Allergic, Seasonal/therapy* ; Syndrome ; Food Hypersensitivity/therapy* ; Pollen ; Fluorocarbons ; Immunoglobulin E

BACKGROUND: In adult patients with chronic urticaria (CU), the prevalence of food allergy is low compared to childhood patients. However, there are many patients who report food-related aggravation of CU, and some of them may have histamine intolerance. OBJECTIVE: The aim of this study was to evaluate the role of ingested histamine and to investigate the effect of a histamine-free diet in adult patients with CU. METHODS: Twenty-two adult patients with CU were enrolled. Foods with high amounts of histamine were prohibited to all patients for four weeks. The degree of severity of the urticaria was evaluated using the urticaria severity score (USS) and urticaria activity score (UAS). Plasma histamine levels and diamine oxidase (DAO) activity were determined and compared before (baseline) and after the histamine-free diet. RESULTS: Twenty-two adult patients were recruited and completed four weeks of histamine-free diet. The USS and UAS scores each showed significant differences before and after the histamine-free diet (p=0.010, p=0.006). There was a significant reduction in plasma histamine level after the histamine free-diet, compared with baseline (p=0.010). However, DAO activity did not change after the histamine-free diet (p=0.165). CONCLUSION: Our study suggested that ingested histamine might be related to CU severity and that a histamine-free diet is helpful for treatment of adult patients with CU.
Adult* ; Amine Oxidase (Copper-Containing) ; Diet Therapy ; Diet* ; Food Hypersensitivity ; Histamine ; Humans ; Plasma ; Prevalence ; Urticaria*

OBJECTIVETo investigate the effects of adipose-derived stem cells (ADSC) and non-methylated CpG-oligodeoxynucleotides (CpG-ODN) on the expression of peripheral blood CD4CD25regulatory T (Treg) cells in young mice with food allergy, as well as their immune intervention effects.

METHODSA total of 40 female BALB/c mice were randomly divided into control group, allergic group, ADSC treatment group, and CpG-ODN treatment group, with 10 mice in each group. A mouse model of food allergy was established by intraperitoneal injection and intragastric administration of ovalbumin (OVA) for sensitization and challenge. The mice in the control group were treated with normal saline at the same dose; the mice in the ADSC treatment group were given intraperitoneal injection of ADSC (1×10cells for each mouse) before and after OVA challenge, and those in the CpG-ODN treatment group were given intraperitoneal injection of non-methylated CpG-ODN solution (40 μg for each mouse) at 1 hour before challenge by gavage. The allergic symptom scores were determined for each group after model establishment. ELISA was used to measure the serum level of OVA-IgE. Flow cytometry was used to measure the percentage of peripheral blood CD4CD25Treg cells. Hematoxylin and eosin staining was used for the pathological analysis of the jejunum.

RESULTSThe allergic group had significantly higher allergic symptom scores and serum level of OVA-IgE than the control group (P<0.05). There were no significant differences in the allergic symptom score and the serum level of OVA-IgE between the ADSC treatment group and the CpG-ODN treatment group (P>0.05), but these two groups had significantly lower allergic symptom scores and serum level of OVA-IgE than the allergic group and significantly higher allergic symptom scores and serum level of OVA-IgE than the control group (P<0.01). The allergic group had a significantly lower percentage of peripheral blood CD4CD25Treg cells than the control group (P<0.05). The ADSC treatment group and the CpG-ODN treatment group had a significantly higher percentage of peripheral blood CD4CD25Treg cells than the allergic group (P<0.05); there were no significant differences between these two groups or between them and the control group (P>0.05). Pathological results showed structural damage and edema in the jejunal villi, a large number of eosinophils, and lymphocyte infiltration in the allergic group, while the ADSC treatment group and the CpG-ODN treatment group had less structural damage and edema in the jejunal villi, a lower number of eosinophils, and less lymphocyte infiltration.

CONCLUSIONSADSC and non-methylated CpG-ODN have a certain effect in the treatment of food allergy and can increase the percentage of peripheral blood CD4CD25Treg cells and reduce the level of OVA-IgE. They may be associated with the induction of immune tolerance and these two treatment have comparable effects. Detailed mechanisms of action still need further investigation.

Adipose Tissue ; cytology ; Adjuvants, Immunologic ; pharmacology ; Animals ; Female ; Food Hypersensitivity ; immunology ; therapy ; Immunoglobulin E ; blood ; Mice ; Mice, Inbred BALB C ; Oligodeoxyribonucleotides ; pharmacology ; Ovalbumin ; immunology ; Stem Cell Transplantation ; T-Lymphocytes, Regulatory ; drug effects ; immunology

OBJECTIVETo investigate the immunoregulatory effect of adipose-derived stem cell (ADSC) transplantation by intraperitoneal injection in food-allergic young mice before and after ovalbumin (OVA) sensitization.

METHODSThirty-two 3-week-old female Balb/c mice were randomly divided into control, allergic model, ADSC treatment, and ADSC prevention groups (n=8 each). A young mouse model of food allergy was established by OVA sensitization via intraperitoneal injection. Each mouse from the prevention and treatment groups was transplanted with 1×10(6) ADSCs on days 1 and 15 post-sensitization, respectively. The allergic symptoms of all groups were observed and scored. The jejunal villi and inflammatory cell infiltration were observed by hematoxylin-eosin staining. Serum levels of allergy-related inflammatory cytokines were measured by Luminex.

RESULTSCompared with the allergic model group, the ADSC prevention and ADSC treatment groups had significantly reduced allergic symptom scores (P<0.05). The two groups also showed significantly alleviated allergic pathological damage of the jejunal mucosa. Serum levels of interleukin (IL)-4, IL-5, IL-6, IL-17A, IL-22 and IL-23 were significantly lower in the ADSC prevention and treatment groups than in the allergic model group (P<0.05). However, the ADSC treatment group had a significantly increased serum interferon-γ level and a significantly reduced serum monocyte chemotactic protein-1 level compared with the allergic model and ADSC prevention groups (P<0.05).

CONCLUSIONSADSC transplantation, performed before or after sensitization, has an immunoregulatory effect on food allergy in young Balb/c mice, but this effect is better if transplantation is performed after sensitization.

Adipose Tissue ; cytology ; Animals ; Cytokines ; blood ; Disease Models, Animal ; Female ; Food Hypersensitivity ; immunology ; therapy ; Male ; Mice ; Mice, Inbred BALB C ; Stem Cell Transplantation

: Anaphylaxis is a predominantly childhood disease. Most of the literature on anaphylaxis has emerged from Western countries. This study aimed to describe the incidence, triggers and clinical presentation of anaphylaxis among children in Singapore, look for predictors for anaphylaxis with severe outcomes, and study the incidence of biphasic reactions.: We retrospectively reviewed records of children presenting with anaphylaxis to our paediatric emergency department from 1 January 2007 to 31 December 2014.: We identified 485 cases of anaphylaxis in 445 patients. Cutaneous symptoms (urticarial/angio-oedema) were the most common across all age groups (481 cases, 99%), followed by respiratory (412, 85%), gastrointestinal (118, 24%) and cardiovascular (35, 7.2%) symptoms. Central nervous system symptoms (drowsiness/ irritability) were rare across all age groups (11, 2.2%). Food was identified as the most common trigger across all age groups (45% to 63%). Seafood was the most common food trigger (57, 25%). A total of 420 (86.6%) children were treated with adrenaline, 451 (93%) received steroids and 411 (85%) received antihistamines. Sixty-three (13%) children fulfilled the criteria of severe anaphylaxis. There was no statistically significant association between severe anaphylaxis and the type of trigger (= 0.851), nor an overall past history of atopy (= 0.428). The only independent predictor for severe anaphylaxis was a previous drug allergy (= 0.016). A very low prevalence of biphasic reactions (0.6% of study population) was noted in our study.: We described the presentation and management of anaphylaxis in the Singapore population. A history of drug allergy is associated with severe presentation. Biphasic reactions are rare in our population.
Adolescent ; Adrenal Cortex Hormones ; therapeutic use ; Anaphylaxis ; drug therapy ; epidemiology ; etiology ; physiopathology ; Angioedema ; epidemiology ; etiology ; physiopathology ; Child ; Child, Preschool ; Drug Hypersensitivity ; epidemiology ; Emergency Service, Hospital ; Epinephrine ; therapeutic use ; Female ; Food Hypersensitivity ; complications ; epidemiology ; Gastrointestinal Diseases ; epidemiology ; etiology ; physiopathology ; Histamine Antagonists ; therapeutic use ; Humans ; Hypotension ; etiology ; physiopathology ; Incidence ; Infant ; Male ; Pediatrics ; Prevalence ; Respiratory Tract Diseases ; epidemiology ; etiology ; physiopathology ; Retrospective Studies ; Risk Factors ; Seafood ; Severity of Illness Index ; Singapore ; epidemiology ; Sympathomimetics ; therapeutic use ; Tertiary Care Centers ; Urticaria ; epidemiology ; etiology ; physiopathology

INTRODUCTIONAtopic dermatitis is a common, chronic pruritic condition affecting both children and adults, which has a negative impact on the quality of life. These guidelines were developed by an expert workgroup appointed by the Dermatological Society of Singapore, to provide doctors with information to assist in the management of their patients with atopic dermatitis. The workgroup members are experienced dermatologists with interest and expertise in eczemas.

MATERIALS AND METHODSWorkgroup members arrived at a consensus on the topics to be included. Relevant studies from the literature were assessed for best evidence, supplemented by the collective experience of the workgroup.

RESULTSFor mild atopic dermatitis, emollients, mild potency topical steroids and topical calcineurin inhibitors are recommended. For moderate-to-severe atopic dermatitis, the use of emollients, moderate-to-potent topical steroids, topical calcineurin inhibitors, wet dressings, antimicrobials for secondary skin infection, phototherapy, and systemic therapy (e.g. prednisolone, cyclosporine, azathioprine or methotrexate) may be warranted. Patients with moderate-to-severe atopic dermatitis should be managed in conjunction with a dermatologist.

CONCLUSIONGood outcomes can be achieved with an individualised therapeutic approach combined with adequate patient and parental education.

Administration, Cutaneous ; Adrenal Cortex Hormones ; therapeutic use ; Anti-Bacterial Agents ; therapeutic use ; Azathioprine ; therapeutic use ; Calcineurin Inhibitors ; therapeutic use ; Coinfection ; complications ; drug therapy ; Cyclosporine ; therapeutic use ; Dermatitis, Atopic ; complications ; immunology ; therapy ; Dermatology ; Disease Management ; Emollients ; therapeutic use ; Food Hypersensitivity ; immunology ; Humans ; Immunosuppressive Agents ; therapeutic use ; Methotrexate ; therapeutic use ; Patient Education as Topic ; Phototherapy ; Practice Guidelines as Topic ; Referral and Consultation ; Severity of Illness Index ; Singapore

Administration, Cutaneous ; Adrenal Cortex Hormones ; therapeutic use ; Azathioprine ; therapeutic use ; Calcineurin Inhibitors ; therapeutic use ; Cyclosporine ; therapeutic use ; Dermatitis, Atopic ; immunology ; therapy ; Disease Management ; Food Hypersensitivity ; immunology ; Humans ; Immunosuppressive Agents ; therapeutic use ; Patient Education as Topic ; Phototherapy ; Practice Guidelines as Topic ; Severity of Illness Index ; Singapore

OBJECTIVETo explore the effect of non-methylated cytosine-phosphate-guanine oligodeoxynucleotides (CpG-ODN) on serum transforming growth factor (TGF)-β and immune regulation in ovalbumin (OVA)-sensitized young mice.

METHODSThirty female BALB/c mice (2-3 weeks old) were randomly divided into control, model, and CpG-ODN intervention groups. A young mouse model of food allergy was established by OVA sensitization. Normal saline of the same volume was used for replacement in the control group. The mice in the intervention group were intraperitoneally injected with CpG-ODN solution 1 hour before every OVA sensitization. Allergic symptoms were observed and scored for each group. The jejunal tissue was histopathologically examined with hematoxylin-eosin staining. Serum OVA-IgE level was measured using ELISA. Serum concentrations of interleukin (IL)-4, interferon (IFN)-γ, and TGF-β were determined by CBA.

RESULTSAllergic symptoms were observed in the model group and the jejunal tissue showed the pathological characteristics of type I allergic reaction. The allergic symptom scores in the model and CpG-ODN intervention groups were significantly higher than in the control group (P<0.01). The serum levels of OVA-IgE, IL-4, and TGF-β were significantly higher in the model group than in the control and CpG-ODN intervention groups (P<0.05). The CpG-ODN intervention group had significantly higher serum levels of OVA-IgE, IL-4, and TGF-β than the control group (P<0.05). Compared with the control and CpG-ODN intervention groups, the model group had a significantly reduced IFN-γ level (P<0.05).

CONCLUSIONSThe serum TGF-β level is increased in the young mouse model of OVA-sensitized food allergy and is involved in the allergy mechanism. Non-methylated CpG-ODN can reduce the serum TGF-β level in sensitized young mice and play an immunoregulatory role in food allergy.

Aging ; Animals ; DNA Methylation ; Female ; Food Hypersensitivity ; drug therapy ; immunology ; Immunoglobulin E ; blood ; Interleukin-4 ; blood ; Mice ; Mice, Inbred BALB C ; Oligodeoxyribonucleotides ; pharmacology ; Ovalbumin ; immunology ; Transforming Growth Factor beta ; blood