Mast cells, which are major effector cells in allergic reactions, are found in the perivascular spaces of most tissues and contain pro-inflammatory and vasoactive mediators. These mediators are released after IgE receptor cross-linking induced by allergens or other stimuli, including anaphylatoxins (C3a and C5a), aggregated IgG, certain drugs, venoms, and physical stimuli (pressure and temperature changes), as well as cytokines and neuropeptides. The excess release of these mediators can cause variable allergic symptoms and signs, such as bronchospasm, itching, flushing, nausea, vomiting, diarrhea, abdominal pain, vascular instability, and anaphylaxis. Furthermore, mast cell disorders may involve either excessive proliferation of mast cells or abnormal mast cell reactivity. Mast cell disorders can be broadly divided into 3 types: primary, secondary, and idiopathic. All of these disorders present with signs and symptoms of mast cell activation and differ in severity and involvement of various organ systems. The best characterized primary disorder is mastocytosis. Systemic and cutaneous forms of the disease are well described. Secondary disorders include typical allergic diseases and some types of urticarial diseases. In this article, the biochemical characteristics of mast cells and the role of mast cells in allergic inflammation, as well as the classification, diagnosis, and management of mast cell-related disorders, will be reviewed.
Abdominal Pain ; Allergens ; Allergy and Immunology ; Anaphylatoxins ; Anaphylaxis ; Bronchial Spasm ; Classification ; Cytokines ; Diagnosis ; Diarrhea ; Flushing ; Hypersensitivity ; Immunoglobulin E ; Immunoglobulin G ; Inflammation* ; Mast Cells* ; Mastocytosis ; Nausea ; Neuropeptides ; Pruritus ; Venoms ; Vomiting

Wheat dependent exercise-induced anaphylaxis (WDEIA) is a rare but potentially severe food allergy caused by the combination of wheat ingestion and physical exercise. The impact of WDEIA on quality of life (QOL) is unclear. This study characterized the clinical and laboratory features and investigated the QOL in WDEIA patients from Central China. Twenty-eight WDEIA patients were analyzed, and QOL was measured by validated Chinese version Food Allergy Quality of Life Questionnaire-Adult Form (FAQLQ-AF) and Food Allergy Independent Measure (FAIM) after obtaining the diagnosis. The results showed that half of the patients were females. The median onset age was 37 years old. The symptoms occurred within 1 h after wheat ingestion (26/28). Symptoms of anaphylaxis included cutaneous (26/28), respiratory (11/28), gastro-intestinal (5/28) and cardiovascular manifestations (27/28). Skin prick tests were positive to salt soluble (89.3%) and salt insoluble wheat allergen extracts (100%). Positive rate to wheat, gluten and omega-5 gliadin specific IgE was 64.3%, 92.9% and 92.9% respectively. Specific IgE to omega-5 gliadin with a cut-off value 0.83 KU/L offered highly efficient diagnostic criterion for WDEIA (sensitivity: 89.3%; and specificity: 88.9%). The mean scores of FAQLQ-AF and FAIM were 4.70 and 4.98 respectively and level of anti-omega-5 gliadin IgE had positive correlations with FAQLQ scores. Thereby, WDEIA is commonly found in mid-age adults. In most cases, multi-organs especially skin and cardiovascular systems are involved. Salt insoluble wheat allergen skin test and serum specific IgE to gluten and omega-5 gliadin help to diagnose WDEIA. QOL in WDEIA patients is severely impaired.
Adolescent ; Adult ; Aged ; Allergens ; administration & dosage ; chemistry ; immunology ; Anaphylaxis ; diagnosis ; immunology ; physiopathology ; psychology ; China ; Exercise ; Female ; Gastrointestinal Tract ; immunology ; physiopathology ; Gliadin ; administration & dosage ; chemistry ; immunology ; Heart ; physiopathology ; Humans ; Immunoglobulin E ; blood ; Lung ; immunology ; physiopathology ; Male ; Middle Aged ; Quality of Life ; Skin ; immunology ; physiopathology ; Skin Tests ; Surveys and Questionnaires ; Triticum ; chemistry ; immunology ; Wheat Hypersensitivity ; diagnosis ; immunology ; physiopathology ; psychology

Both immediate and delayed hypersensitivity reactions to iodinated contrast media (ICM) are relatively common. However, there are few data to determine the clinical utility of immunologic evaluation of ICM. To evaluate the utility of ICM skin testing in patients with ICM hypersensitivity, 23 patients (17 immediate and 6 delayed reactions) were enrolled from 3 university hospitals in Korea. With 6 commonly used ICM including iopromide, iohexol, ioversol, iomeprol, iopamidol and iodixanol, skin prick (SPT), intradermal (IDT) and patch tests were performed. Of 10 patients with anaphylaxis, 3 (30.0%) and 6 (60.0%) were positive respectively on SPTs and IDTs with the culprit ICM. Three of 6 patients with urticaria showed positive IDTs. In total, 11 (64.7%) had positive on either SPT or IDT. Three of 6 patients with delayed rashes had positive response to patch test and/or delayed IDT. Among 5 patients (3 anaphylaxis, 1 urticaria and 1 delayed rash) taken subsequent radiological examinations, 3 patients administered safe alternatives according to the results of skin testing had no adverse reaction. However, anaphylaxis developed in the other 2 patients administered the culprit ICM again. With 64.7% (11/17) and 50% (3/6) of the sensitivities of corresponding allergic skin tests with culprit ICM for immediate and delayed hypersensitivity reactions, the present study suggests that skin tests is useful for the diagnosis of ICM hypersensitivity and for selecting safe ICM and preventing a recurrence of anaphylaxis caused by the same ICM.
Anaphylaxis/chemically induced/diagnosis/immunology ; Contrast Media/*adverse effects ; Cross Reactions/immunology ; Dermatitis, Contact/*diagnosis/*immunology ; Drug Hypersensitivity/diagnosis ; Female ; Humans ; Iodides/*immunology ; Iohexol/analogs & derivatives ; Iopamidol/analogs & derivatives ; Male ; Middle Aged ; Republic of Korea ; Skin Tests/*methods ; Triiodobenzoic Acids ; Urticaria/diagnosis/immunology

BACKGROUNDAnaphylactic reactions during anesthesia and operation are common and life threatening. Follow-up investigation is necessary for avoiding potential re-exposure of the patients to the offending drugs. The purpose of this study was to assess cellular allergen stimulation test (CAST) as a diagnostic instrument in immunoglobulin E (IgE)- and non-IgE-mediated anaphylactic reactions.

METHODSThis study included 25 patients who developed perioperative anaphylactic reactions and 10 subjects that tolerated anesthetics and other drugs during perioperative period from September 2009 to October 2013 in Peking Union Medical College Hospital. We performed skin tests and flow cytometric analysis of basophil activation-based CAST in all subjects.

RESULTSOf the 25 patients, 17 had IgE-mediated anaphylactic reactions (causative agent identified by skin tests) and 8 had non-IgE-mediated anaphylactic reactions (negative skin tests). CAST showed a sensitivity of 42.9%, specificity of 90%, and negative predictive value of 80.6% for neuromuscular blocking agents.

CONCLUSIONSCAST may be useful for the diagnosis of anaphylactic reactions during perioperative period. Our findings call for further investigation to increase the sensitivity of the test.

Adult ; Allergens ; immunology ; Anaphylaxis ; diagnosis ; Drug Hypersensitivity ; Female ; Humans ; Male ; Middle Aged ; Perioperative Period ; Skin Tests ; methods ; Young Adult

PURPOSE: Cefaclor is widely prescribed for various infectious diseases. As its consumption increases, the number of hypersensitivity reactions to cefaclor has increased. This study aimed to evaluate the immunologic findings of immediate hypersensitivity to cefaclor. MATERIALS AND METHODS: We enrolled 47 patients with immediate hypersensitivity to cefaclor from Ajou University Hospital and Asan Medical Center. Serum specific IgE, IgG1, and IgG4 antibodies to cefaclor-human serum albumin (HSA) conjugate were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: The most common phenotype was anaphylaxis (Group I, 78.7%), followed by urticaria (Group II, 21.3%). The detection of specific IgE, IgG1, and IgG4 to cefaclor-HSA conjugate by ELISA tended to be higher in Group I (40.5%, 41.7%, 21.6%) than in Group II (20.0%, 20.0%, 0%) with no statistical significance. Significant associations were found between specific IgE and IgG1 or IgG4 (p<0.001, p=0.019). ELISA inhibition tests showed significant inhibitions by both free cefaclor and cefaclor-HSA conjugate. For basophil activation tests in patients having no specific IgE antibody, the CD63 expression level on basophils increased with incubations of free cefaclor. CONCLUSION: The most common manifestation of immediate hypersensitivity to cefaclor was anaphylaxis, most of which was mediated by IgE; however, a non-IgE mediated direct basophil activation mechanism was suggested in a subset of anaphylaxis patients.
Adolescent ; Adult ; Aged ; Anaphylaxis/*chemically induced/immunology ; Anti-Bacterial Agents/adverse effects/*immunology ; Antigens, CD63 ; Basophils/metabolism ; Cefaclor/*adverse effects/immunology ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Hypersensitivity, Immediate/chemically induced/diagnosis/*immunology ; Immunoglobulin E/*blood ; Immunoglobulin G/immunology ; Male ; Middle Aged ; Retrospective Studies ; Skin Tests ; Urticaria/chemically induced/diagnosis/immunology ; Young Adult

We experienced a case of immunoglobulin E (IgE) mediated anaphylaxis to levodropropizine. The patient was an 18-year old Korean woman. After taking the common cold medication including acetaminophen, domperidone, and levodropropizine, skin rash, angioedema and anaphylaxis were developed immediately. As she was tolerable to acetaminophen alone, we thought the culprit agent was maybe a levodropropizine tablet. To confirm the culprit, she underwent skin prick test and oral drug provocation test with the suspected one. Finally we detected levodropropizine specific IgE and confirmed the specificity by inhibition enzyme-linked immunosorbent assay (ELISA).
Adolescent ; Anaphylaxis/*chemically induced/*immunology ; Antitussive Agents/*adverse effects ; Bronchial Provocation Tests ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunoglobulin E/*immunology ; Propylene Glycols/*adverse effects ; Skin Tests

Specific IgE to gliadin was proposed as a marker for wheat dependent exercise induced anaphylaxis, while Tri a 14 was found to induce IgE response in baker's asthma. We evaluated whether these components could be used for discriminating phenotypes of wheat allergy. Twenty-nine patients who were wheat-induced anaphylaxis and/or urticaria (n=21, group I) and baker's asthma (n=8, group II) were enrolled. The prevalence of serum specific IgE to Tri a 14 was higher in group II (25%) than in group I (4.8%), while the serum specific IgE to gliadin was significantly higher in group I (70%) than in group II (12.5%). The cutoff value for predicting the baker's asthma using the ratio of serum specific IgE to Tri a 14 to gliadin was 742.8 optical densityx1,000/(kU/L) with high sensitivity and specificity. These findings suggest that Tri a 14/gliadin may be a potential marker for predicting baker's asthma.
Adult ; Anaphylaxis/immunology ; Antigens, Plant/*immunology ; Asthma/blood/diagnosis/immunology ; Biological Markers/blood ; Carrier Proteins/*immunology ; Female ; Gliadin/*immunology ; Humans ; Immunoglobulin E/*blood/immunology ; Male ; Phenotype ; Triticum/immunology ; Urticaria/immunology ; Wheat Hypersensitivity/*diagnosis/*immunology

Adult ; Anaphylaxis ; etiology ; Female ; Humans ; Male ; Semen ; immunology

BACKGROUNDWheat-dependent exercise-induced anaphylaxis (WDEIA) is a complex disease resulting from interaction of environmental and genetic factors. The aim of this study was to investigate the association of three single nucleotide polymorphisms (SNPs) (IL-4-C590T, IL-4RA A1727G and IL-10-A627C) with WDEIA.

METHODSSNP genotyping was conducted among the case subset composing 51 patients with WDEIA and four control subsets by sequencing DNA yielded from polymerase chain reaction (PCR). Statistical analysis of genotype/allele's frequencies between cases and controls were carried out through Fisher's exact test with the software of SPSS16.0.

RESULTSFor IL-4-C590T, there were statistically significant differences of genotype frequencies in case-control 1 (P = 0.03) and case-control 4 (P = 0.001) and statistically significant differences of allele frequencies in three case-control models (case-control 1: OR = 4.27 (95%CI = 1.40 - 13.07), P = 0.009; case-control 3: OR = 1.99 (95%CI = 1.13 - 3.50), P = 0.02; case-control 4: OR = 2.39 (95%CI = 1.49 - 3.84), P = 0.001). All other association studies showed no statistically significant (P > 0.05).

CONCLUSIONSIL-4-C590T may be related to the susceptibility of WDEIA, and the minor allele C might be a potential risk factor accounting for WDEIA. IL-4RA A1727G and IL-10-A627C might not be involved in the occurrence of WDEIA.

Adolescent ; Adult ; Aged ; Anaphylaxis ; genetics ; Asian Continental Ancestry Group ; genetics ; Child ; Child, Preschool ; Exercise ; physiology ; Female ; Gene Frequency ; genetics ; Genotype ; Gliadin ; immunology ; Glutens ; immunology ; Humans ; Immunoglobulin E ; Male ; Middle Aged ; Polymorphism, Single Nucleotide ; genetics ; Triticum ; immunology ; Young Adult

This study is to investigate the anti-allergic effect of anthocyanidin and to explore its possible mechanism. The experiments of passive cutaneous anaphylaxis reaction (PCA) and colorimetry were used to determine the effect of anthocyanidin on degranulation of mast cells in vivo. For in vitro study, various concentrations of anthocyanidin (100, 50 and 25 micromol x L(-1)) were added to the culture medium of mast cells cultured with 100 microg x L(-1) of dinitrophenyl (DNP) specific IgE overnight. The azelastine (100 micromol x L(-1)) was selected as the positive control. The antigen (DNP-human serum albumin, DNP-HAS)-induced release of degranulation was measured by enzymatic assay, histamine was determined by EIA, and interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) were measured by Western blotting, separately. In addition, the effects of anthocyanidin on phosphorylation of NF-kappaB, p38MAPK and Akt were observed by Western blotting. The results showed that treatments with anthocyanidin (100 and 50 mg x kg(-1)) were followed by a decrease in PCA of rats. Anthocyanidin (100 and 50 micromol x L(-1)) obviously suppressed the degranulation from mast cells, whereas results from anthocyanidin (100 and 50 micromol x L(-1)) group indicated significant inhibitory effect on histamine, the calcium uptake, TNF-alpha, IL-6, phosphorylation of NF-kappaB, p38MAPK and Akt of mast cells induced by antigen. Anthocyanidin may suppress the anaphylactic reaction by inhibiting the action of mast cells. NF-kappaB, p38MAPK and Akt at least in part contribute to this event.
Animals ; Anthocyanins ; pharmacology ; Anti-Allergic Agents ; pharmacology ; Calcium ; metabolism ; Cell Degranulation ; drug effects ; Histamine Release ; drug effects ; Immunoglobulin E ; immunology ; Interleukin-6 ; metabolism ; Male ; Mast Cells ; immunology ; metabolism ; physiology ; Passive Cutaneous Anaphylaxis ; drug effects ; Proto-Oncogene Proteins c-akt ; metabolism ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Signal Transduction ; Transcription Factor RelA ; metabolism ; Tumor Necrosis Factor-alpha ; metabolism ; p38 Mitogen-Activated Protein Kinases ; metabolism