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| QUESTION [28 December 2001]
What is delayed food allergy, is this a type II? Is it very common? If there is such a condition how is it detected or tested for? Jim K. (Arvada, CO, USA) |
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| QUESTION [06 December 2001]
I have an allergy to peanuts and other nuts including walnuts, hazelnuts and cashews (although not almonds, sesame, or coconut). I am planning a three month trip to India next year, but have been told that groundnut oil is widely used in cooking. Can anyone give me any advice about travelling in this country with this allergy? As different areas of the country have very different cooking styles I think it may be possible to avoid areas using groundnut oil, but none of the guidebooks seem to carry this sort of information. Do anyone know how widely anaphylaxis is understood in India, for example, will waiters in restaurants understand my question if I ask them what oil food is cooked in? Any suggestions gratefully appreciated! Becky S. (London, UK) |
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| QUESTION [23 November 2001]
I may show my stupidity, but what is the difference between excema and generalized excema? Does generalized mean that the excema is focused in one particular area? B.S. |
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| ANSWER [25 November 2001]
It is just the other way round. Symptoms are called "generalized" when the whole body is affected and not one particular part. Matthias Besler, PhD
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| QUESTION [13 November 2001]
I recently took a 50 year old friend who has chronic excema to a hospital emergency dept. because of: inability to bend fingers or put pressure on feet after 50 days of extreme excema break out; severely swollen feet with purple vessels markings; elevated blood pressure l49/94; tingling feelings and anxiety; shaking. She had been prescribed an antibodic by a dermatologist (without doing blood work) that was causing projective vomiting. Topical cream was prescribed with a steroid and bathing in baby oil and water. No suggestion of follow up with an alergist or immunologist or family doctor re. feet swelling. Blood work showed no infection in body. Has family history of heart problems (mother, father and grandmother). Friend has been a heavy smoker ... Donna W (Canada) |
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| QUESTION [12 November 2001]
very single time I drink a glass of wine with my meal at supper time, the quantity does not matter, I always wake up in the middle of the night for about 3 to 4 hours. Sometimes, I cannot go back to sleep at all. Sometimes, it is accompanied with a headache. What is in the red wine that causes this effect. I also have this symptom with I drink certain herbal tea (decafinated). If I happen to drink the wine at lunch's time, I am not disburbed by it. Help me, as I am a red wine lover! Annette D. (Canada) |
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| QUESTION [30 October 2001]
I´m searching for an analysis method for peanut allergens (in food samples) (and if possible an wipe-quicktest also).Thanks! Sascha S. |
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| ANSWER [01 November 2001]
There are commercially available ELISA-test kits for the detection of peanut allergens in foods. For the performance of the ELISA-method (enzyme-linked immunosorbent assay) some laboratory equipment such as a microplate reader (or at least a photometer) is needed. The following companies provide peanut ELISA-test kits with sufficient
limits of detection:
Another test described in the literature is a dip-stick ELISA quicktest, which is to my knowledge not commercially available. Matthias Besler, PhD
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| QUESTION [17 August 2001]
My seven year old child was diagnosed with milk protein and soy allergy when he was 10 months old. After several periods of allergenic avoidance, during which he felt better, the allergy persists. The symptoms are not severe and his life is not at risk when he eats food with milk or soy, but he has severe stomachakes and gastrointestinal disturbances. As he becomes older it is more difficult for me to prevent him from eating food with any of this allergens and he almost always feels bad. What I realy want to know and physicians have not been able to answer is whether this condition may have any aditional long term complication. I have heard that some kinds of diabetes melitus may develop associated with some kinds of food allergy. Is this true? Ana Maria E. (Mexico) |
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| QUESTION [07 August 2001]
As a child I was able to eat just about anything with no ill effects. However, in the last 10 years or so (I am 27) I have found that shortly after eating many fruits (any melons, especially watermelon, mango, whole oranges (I can drink orange juice though), and strawberries) and a few vegetables (raw carrots (cooked are fine), non-iceburg lettuce, cabbage, and raw tomatoes), I get a strong (often irresistable) urge to vomit. I really enjoy many of these foods. Is there anything I can do to be able to eat them again? Marc S. (Illinois, USA) |
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| QUESTION [21 July 2001]
I seem to suffer burning and itching on and deep within the skin of my arms when i have been drinking wine, even in small amounts of say two glasses.It has been diagnosed as excema, but dr not sure what has caused it. does anyone know of a wine realted link to skin irritation? and what to do about it other than antihistamines and menthol creams? Tim |
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| QUESTION [10 July 2001]
My four year old has a peanut allergy, 4-5+ on skin testing, Equivocal, Level 1 on the RAST. He was given the RAST at age one. It is now time for hime to be retested. Dr. Hugh Sampson from Mt. Sinai says the UNI CAP or CAP RAST is best for determing which children will outgrow the allergy by measuring IgE per KU/L. This was not how his old RAST was measured, but if we get the UNI CAP or CAP RAST, how can we compare it to his old RAST or is there reason to? Which would be better to get? Also have you heard of the Chinese Herbal Remedy FA-1 being investigated by Mt. Sinai and John Hopkins? It was reversing peanut allergy in sensitized mice and stopping anp. shop symptoms. I'd love to know where they are on this. Ramona B. |
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| ANSWER [26 May 2001]
CAP RAST is more sensitive than RAST. There are about 15% more positive results with the CAP system. While RAST is a semiquantitative system CAP RAST is comparable to the WHO-reference standard of IgE giving quantative results. You can compare RAST and CAP RAST for qualitative results only. Matthias Besler, PhD
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| QUESTION [03 July 2001]
I think I have cold-induced uticaria. I am pretty much "text-book" from what I've read, but I'm waiting to see a second dermatologist to be diagnosed as my dermatologist was unfamiliar with it. I was wondering--(I'm 39 and have acquired this in the last 8-9 mos.) -- will it ever go away? Or am I stuck with this annoyance for the rest of my life? Is it possible that it could continue to get worse? I only get hives after being exposed to the cold air/water, but don't experience any of the other systemic symptoms I've read about. I don't react to cold food or beverage. Thanks for replying. Claudia |
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| QUESTION [25 May 2001]
I am 27 years old. Through a process of elimination, I found that I would have swollen lips the morning after comsuming strawberries or pineapple. This really angered me, I already deal with seasonal allergies and now I had a food allergy. Yesterday I made fresh squeezed lemonade. Today, I woke up with swollen lips similar to the reaction I get from strawberry and pineapple. Are these groups related and if so what else can I expect to grow an allergy to? Jessica C. |
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| QUESTION [20 May 2001]
I get a severe allergic reaction to certain foods / and combinations of certain foods. My first reaction was about 15 years ago to one bite of a pommegram , an immediate reaction. Since then I have had immediate reactions to mixture of honey and apple cider; Life Brand cough syrup. I have had delayed reactions ( 6 to 8 hours) to fruit salads; banana and cranberry juice; homemade spagetti with sauce; other fruit combinations. I have had two allergy tests but they did not give any results. Doreen P. |
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| ANSWER [24 May 2001]
A thorough diagnosis of food allergies is required. You should see a doctor who is an expert in the field of food allergies. The diagnosis of adverse reactions to foods is based on the patients' case history, skin testing, and in-vitro diagnostics eventually followed by conclusive oral provocation tests. Matthias Besler, PhD
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| QUESTION [08 May 2001]
I am a 26 year old caucasion female with OAS. I first started getting symtoms while eating apples, and then it progressed to peaches, plums, cherries and now kiwi. I get the typical moderate syptoms...itchy throat, my lips and tongue may swell, and my ears always itch inside. It drives me CRAZY!!! Especially since I love fruit and veggies. Is there anything I can take to stop this? I take normal allergy medication for my severe hayfever and pollen allergies. (Allegra). But it does not help with the OAS. And it is getting worse...slowly. I always thought I had this strange rare allergy no one else had to the skins of apples and other fruit, until I was properly diagnosed. I also wanted to know...how many people have this allergy? Rebecca S. |
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| ANSWER [10 May 2001]
Eventually a pollen immunotherapy can also improve your oral allergy syndrome. You should see a doctor specialized in (food) allergy. There are no data of the actual prevalence of oral allergy syndrome in the general population. According to a study in Switzerland about 30% of food allergic individuals suffer from isolated oral allergy syndrome. Matthias Besler, PhD
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| QUESTION [08 Apr 2001]
When I touch feathers I get instantly conjonctivitis and I have to blow my nose continuously, and when I eat eggs on their own I suffer from very strong nausea and headache. I have also had some bad rushs with shampoos containing egg parts. However, I never had any problems eating other aliments containing egg. Do you think I suffer from bird-egg allergy? If so why can't I eat eggs on their own but without problem in every other meal? Lea V. (Turin, Italy) |
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| QUESTION [21 Feb 2001]
Here's one for you. If I consume alcohol at the same time I consume any food prepared with cayenne or red chili powder, within minutes I have a moderate to severe reaction - tachycardia, dyspnea, anxiety and disorientation, and nausea. I have experienced this four times in my life, and I know of one other person who has had a similar reaction with the same combination. Vomiting helps lessen the severity. Diphedral is usually sufficient to subdue the attack, but the next day I experience muscle aches and a dull lower gastric upsetment. How common is this particular allergy? Christine P. (Reedley, CA, USA) |
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| QUESTION [25 Jan 2001]
Stay away from foods containing tartrazine - it's deadly for my husband. There are no skin tests for food additives, preservatives and colorings. Most of the colorings are derived from coal tar - yes coal tar. Mary B. (Winnipeg Manitoba, Canada) |
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| QUESTION [23 Jan 2001]
I believe that I recently had an allergic reaction to a banana. Racing heart, beet red face, nausea, etc... Is this possible from a banana? If so, are there other foods that I should avoid? Please help! anonymous |
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| ANSWER [25 Jan 2001]
The mentioned symptoms could be due to ingestion of food allergens. Banana is a latex-allergy associated fruit. The most frequently associated fruits are avocado, banana, chestnut, fig, kiwi, mango, melon, papaya, passion fruit, peach, pineapple, and tomato. Normally not all of these foods must be avoided. First an allergist should diagnose your suspected allergy to bananas. Matthias Besler, PhD
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| QUESTION [22 Jan 2001]
I am currently suffering from extreme excema. I have an allergy to Birch and recently read an artical that states that 'Birch related foods' could cause severe excema. The article does not state what foods these may be. Could anyone advise me on this subject please - what are Birch related food and what scientific evidence is there for this? Zoe J. (University of Plymouth, UK) |
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| ANSWER [25 Jan 2001]
Birch pollen associated food allergy is a well known phenomenon of cross-sensitization to birch allergens and food allergens. Foods most frequently associated to birch pollen allery are apples, hazelnuts, peaches, cherries, almonds, pears, carrots, and celery. However, most probably a birch sensitive individual is sensitized to only some of these food items. You should see an allergist for evaluation of your suspected food allergy. Matthias Besler, PhD
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| QUESTION [07 Jan 2001]
Twice after eating an Indian restaurant buffet, the end of my tongue became very irritated. Dark red swelling and pain (a cross between numb and burned) covered about 1" of the end of the tongue, and was accompanied by very dry mouth and thirst. The symptoms developed four hours after eating, were severe for 2-3 days, and didn't completely resolve for about a week. I have eaten there many previous times without problems. Are there any spices or other ingredients in Indian cooking that could cause this? I ate chicken, onions, green peppers, coriander, cardamom (whole pods), rice, lentils, eggplant, peas, yogurt, tomatoes, cucumber, and who knows what else. I am definitely allergic to Mangoes, but don't know of any other allergies. Pam R. |
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| ANSWER [08 Jan 2001]
Potentially every food and ingredient you mentioned may cause an allergic reaction. An allergist can verify wether you are allergic to the mentioned items or not. I would suspect, that you have eaten mango chutney, a classical sauce served in Indian restaurants. You may asked at the restaurant wether they serve it or not. Matthias Besler, PhD
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| QUESTION [03 Jan 2001]
We have a 2 yr old with multiple food allergies and eczema. He is allergic to milk, eggs, wheat, soy, peanuts, peas, garbanzo beans, rye, barley, banana, pineapple, coconut. My husband is German and we have not visited Germany with our child because we are not sure whether food products are reliably labeled and we do not know where to find allergen free food. Can you help us? Devyani G. (Jersey City, NJ, USA) |
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| ANSWER [08 Jan 2001]
Appropriate labelling of allergens on prepacked foods is definitely a problem. Currently there are no food law regulations on allergen labelling in Germany and Europe. An EU-directive is in preparation. Wheat and gluten containing cereals must be declared with respect to celiac disease. I would assume that production standards are similar in the USA and in Germany thus you should know the products which potentially contain the relevant allergens. Matthias Besler, PhD
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| QUESTION [14 Nov 2000]
Who knows the relevant allergens (kDa) of buckwheat? Jörg D. (Laboratory, Germany) |
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Please refer to the following most recent papers:
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| QUESTION [09 Nov 2000]
I have never really had an allergy to red wine. However earlier this week, drank a bottle of Spanish wine over 3 nights (2 glasses per night) and developed a skin irritation on upper body and face - red markings which have remained for a few days. Is it possible that the bottle being 13 years old and possibly not properly stored could have developed some unusual allergens? Nalin W. (Nth Turramurra NSW, Australia) |
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| ANSWER [09 Nov 2000]
Common compounds in red wine potentially inducing adverse reactions are histamine (biogenic amine), sulfite (preservative), and sometimes yeast proteins. I don't know of any allergen which developes during storage of wine. Matthias Besler, PhD
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| ANSWER [30 May 2001]
I experienced the same red marks on my face after eating anything with sulfites in the drink or food. Sulfites also react in a number of ways, and it is in almost everything, some drinks and food have a higher count of sulfites and the reactions could get worse.You should get tested. QUESTION: ANYTHING NEW ON SULFITES I would like to know if there is anything new on sulfites. All information would be very helpfull. I heard there was a I.E.G. shot to stop the allergy from starting ,any information on this? Stana B. [top]
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| QUESTION [25 Oct 2000]
Who knows sources of supply for pure lyophilisate latexprotein (suitable for allergy testing)? Jörg D. (Laboratory, Germany) |
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| QUESTION [07 Oct 2000]
My 8-yr. old daughter is allergic to soy. Upon ingesting soy, she has an immediate asthma attack. I have found that she does react to soy oil. I know that this is rare. I have read that in a small number of cases that the body reacts to haptens (molecules) rather than proteins to induce an immunological response. Any information about this possibly being responsible for a soy oil reaction? Also, my daughter is taking the bronchodilator, Serevent. To my horror, it was brought to my attention that lecithin is one of the ingredients. The allergist doesn't think this is a problem. Anyone beg to differ? My inclination is to discontinue it immediately since my daughter reacts to soy lecithin in foods. Help!!!!! Lynnae B. |
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| ANSWER [07 Oct 2000]
Allergic reactions to edible oils are most probably due to residual proteins. In general highly refined oils should not contain proteins although there is no guarantee. Allergic reactions to lecithins are known (see below). Therefore, you should be very cautious with lecithin containing foods and medication. You may ask for a substitute for this bronchodilator which doesn't contain lecithins. Matthias Besler, PhD
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| QUESTION [04 Oct 2000]
I developed moderate urticaria soon after starting medical school a year ago where we used latex gloves during dissection for about 7 hours per week. After consulting my GP I was diagnosed as having scabies(I had not made the connection with latex back then). After several months of treatment (and without having 'typical' signs of scabies) I asked to see a consultant dermatologist who agreed it definetly was not scabies but was an allergy of some variety. Since then I set about discovering the cause of the allergy. I had a hunch that the culprit was tomatoes as I had most severe itching the night and day after eating fresh tomato. After researching tomato allergies I found out about the latex-fruit syndrome. During the time I was using the latex gloves I can remember having hives on my hands, now I have stopped using gloves as we stopped dissection (i am a pre-clinical student) 9 months ago they seem mainly on my forearms and inner thighs. I stopped eating fresh tomatoes and products which obviously contained tomatoes a week ago, but I still have itching. I therefore consulted my GP with the aim of being tested for an allergy to tomatoes, as it is hard to completely cut out tomatoes as a lot of products contain it. He said that skin prick tests were too dangerous. I prompted him about blood tests and he said that eisonphil count was the only blood test he could do, but that only indicates whether I have any allergy. I thought there was a 'RAST' blood test which can test for specific allergies - is this expensive hence why he didnt do it (in the UK each practice has a budget). I am starting dissection again this week, hence I will be using latex gloves again. Can one get non-latex examination gloves? John G. (UK) |
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| ANSWER: Non-Latex
Gloves for Biohazard Work [03 July 2001]
There are non-latex gloves available. We tested 3 different types of nitrile gloves and chose the one that was most comfortable for long periods of wear. We chose the nitrile as we handle blood products and needed the equivalent in barrier protection to the latex gloves. I'm not sure whether they are available in the UK. The manufacturer's web address is www.shieldmaster.com, (catalog # 63102 med). The nitrile are more expensive than regular gloves, some of our techs find them harder to put on, and the "feel" is not the same, however, the staff member that had started to develop a latex related dermatitis can now work in safety, also, it reduces her overall exposure to latex and means that others can use powder-free latex gloves in her lab. Hope this helps. M. O'L. (USA) [top]
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| QUESTION [25 Sept 2000]
What ist the meaning of hull proteins in soybean. Are these the proteins in the hull seed? Jörg D. (Germany) |
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| ANSWER [25 Sept 2000]
There is a different allergen pattern in soybean seeds and in soybean hulls. The seeds are enclosed / surrounded by the hulls. Hull (husk) is the term used in pulses (legumes like peas, beans, and soybeans) while the term spelt (husk, grume) is used in cereals and grains. The hull proteins are frequently involved in inhalant episodes of soy allergy in e.g. harbour workers. Matthias Besler, PhD
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| QUESTION [22 Sept 2000]
I am a 30 year woman who has been experiencing something strange on and off for the last 1 1/2 years. I get little bumps on my lips 1st, that then get swollen, and the insides of my mouth get a little bit raw. It doesn't happen at the time I eat, but the next morning, which confuses me. I think it may be related to citrus (pineapple, grapefruit) or white wine. No other symptoms exist. Any ideas? Jaqui (anonymus) |
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| ANSWER [25 Sept 2000]
I am not a physician but a food chemist. Therefore I would recommend that you should see an allergist to verify your symptoms and to do some allergy testings. However, delayed type allergic reactions to foods can occur. You may find further patients' information on food allergy on the following websites: Information
for Patients by the American College of Allergy, Asthma & Immunology
Matthias Besler, PhD
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| QUESTION [23 Aug 2000]
My 13 year old son has a history of Oral Allergy Syndrome (OAS) after ingesting apples, specifically Granny Smith and Red Delicious, though not Rome or Macintosh. He also has had reactions with carrots, peaches and almonds. Although I had suspected an Oak pollen allergy, I was unaware of the Birch pollen relationship. What other foods might we suspect of causing him discomfort? Are there other apples unrelated to the Granny Smith family? Thank you for the information; I feel better able to educate him now. Barbara U. (USA) |
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| ANSWER [26 Aug 2000]
There are many fruits and vegetables frequently involved in Oral Allergy Syndrome: apple, peach, hazelnut, peanut, apricot, almond, pear, tomato, cherry, fennel, melon, orange, banana, carrot, potato, watermelon, chestnut, pea, plum, celery and grape (according to an Italian Study). Foods frequently associated to apple allergy include peach, pear, and cherry. Moreover, cross- reactivity has been observed to kiwi fruit and celery. Birch and mugwort pollens are associated in most cases. Golden Delicious and Granny Smith contained higher amounts of allergens than McIntosh and Red Delicious (Study USA). According to another study in Europe the allergen content of different apple varieties decreased in the following order: Golden Delicious, Granny Smith, Jona Gold, Idared, Gala, Jamba, and Gloster. Matthias Besler, PhD
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| ANSWER [29 Nov 2000]
In the UK, the Cox's and Braeburn varieties are also "allergy-safe". That's been my experience. In general, it seems that the more "leathery-skinned" types like those two cause no problems at all. Funny, though; I just came across this page: http://www.allergie-infodienst.de/nah/n0007.html which lists Braeburn and Cox Orange as being as high in the allergens as the Golden Delicious and Granny Smiths. Chuck R. (UK) [top]
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| QUESTION [22 Aug 2000]
I'm trying to identify what I'm allergic to, but I know it's not any of the common food allergens, (i.e. shellfish, peanuts, etc.). On occassion I have a severe reaction 4-5 hrs. after I've eaten, usually after I've been asleep two hrs. Symptoms are hives, explosive diarhea, sometimes vomiting, drop in blood pressure, severe sweating. I had a doctor tell me these reactions were unrelated ... The only food I can identify as having eaten each time is beef, but I can eat it most of the time with no problem. However I am wondering if there is a known problem with undercooked (this time it was rare steak) beef that would cause this type of reaction. Claire R. (Ozone, AR, USA) |
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| ANSWER [22 Aug 2000]
A case of adverse reactions to raw meat without sensitivity to cooked meat was first described in 1982 by Fisher. A patient experienced anaphylactic symptoms after eating rare-cooked beef, while well-cooked beef was tolerated. In another study 3 out of 11 children with beef allergy reacted exclusively to rare-cooked meat (red centrally and pink peripherally), while they tolerated well-cooked meat (Werfel et al. 1997). Reported adverse reactions were predominantly cutaneous symptoms, whereas severe systemic reactions were not observed. Heat treatment induces denaturation of meat proteins losing their state of water solubility. Thus the allergenic potency of heated meat may be less for some meat allergic individuals. Anyway you should see an expert to verify your allergy and to get advice for medication. Matthias Besler, PhD
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| QUESTION [18 Aug 2000]
I don't want to stop eating sushi, but two days ago I was hit by a severe food allergy reaction. Waking up a few hours after eating with extreme hives attack, swollen tongue, chest pains and fainting I was taken to the emergency room, was treated with steroids and epinephrine. All I consumed was miso soup and raw tuna with wasabi and soy sauce, and a fair amount of sake. Have you ever heard of this before? Do you have any suggestions? Sue S. |
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| ANSWER [21 Aug 2000]
Most food allergic reactions are immediate type and occur within 45 min. However, delayed reactions may occur after ingestion of food allergens. In your case the elucidating agent has not been identified. A toxicological adverse reaction can't be ruled out (raw tuna!) yet. You should see a doctor who is an expert in the field of allergy to identifiy your food allergies by thorough anamnesis and diagnostic testing. Matthias Besler, PhD
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| QUESTION [16 Aug 2000]
I just found out that the more I am in contact with latex I have a reaction. What other foods will triger this reaction? I read that bananas, something came up about tomatos is this true? Any help with food contribute to latex will be of much help. I do have other allergies: penicillium, candida, rhizopus, mucor, fusarium, phoma batae, microsporium. What I need is a list of foods that I need to stay away from. Can you help me? Thanks. Anna S. |
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| ANSWER [17 Aug 2000]
The most prominent foods associated to latex allergy are banana, avocado, chestnut, and kiwi. Other fruits may be involved too: fig, mango, melon, papaya, passion fruit, peach, pineapple, and tomato. But before avoiding all these foods you should see an allergist to evaluate your allergies. It is likely that you don't have to avoid all of these fruits. Matthias Besler, PhD
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| QUESTION [13 Aug 2000]
I have a 4 month old who has acid reflux. We've done everything to treat the reflux (zantac, reglan, donnatal, prilosec, tagamet, etc.) with no success. He has eczema and cradle cap. We think there may be a formula allergy. He started on milk and soy at 3 wks of age and had allergy symptoms. We started him on hydrosolate. He seemed better for a time but now worse. We also tried the whey formula and he seemed to tolerate that well, but the one on the market currently has lactose. We used drops to eliminate the lactose, which made him terrible constipated. We recently switched from one hydrosolate to another (corn based versus sucrose). His eczema worsened. He is currently back to the corn based hydrosolate and tagamet for the reflux. Rosemarie L. (USA) |
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Allergy Testing: Testing in the
Young Child
| QUESTION [11 Aug 2000]
My 16 month old daughter is allergic to lentils and peanuts (after direct oral ingestion challenge, she developed perioral urticaria/hives/erythema & the same plus a rash on her hands/arms.) The hives/erythema lasted about 45 minutes. The rash lasted about 24 hours). I think she also experiences unpleasant sensations in her mouth, as she eagerly took 1-2 bites, and then refused any more of the offending food. She also has eczema; we have not deciphered what causes it to flare. Is it reasonable to want her to undergo allergy testing at this point? What is considered accepted practice in a child of this age? Colleen L. (VA, USA) |
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| ANSWER [11 Aug 2000]
The reaction that was observed is consistent with an allergic reaction. For children with mild to moderate eczema (atopic dermatitis) about a third have food allergy. Even infants can be evaluated for allergies and certainly this child deserves a complete evaluation to determine the foods involved, to learn how to avoid them and how to treat reactions from accidental ingestions. Prof. Scott H. Sicherer, MD
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Cold Induced Urticaria: Special Precautions
During a Surgery?
| QUESTION [8 Aug 2000]
What is known of problems faced by patients with cold urticaria who have to undergo surgery? What precautions are necessary to protect the patient? Are there examples of extreme reactions to exposure to oxygen, saline, instruments? Peter D. |
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Mango Allergy: Allergens in Pulp
or Peel?
| QUESTION [29 May 2000]
Last summer some areas of my face got very red and puffy and were very itchy. Then my lips got very swollen and uncomfortable. My doctor and I finally figured out that it was probably the many mangoes I had eaten during vacation. A course of prednisone cleared it up after a few days. I love mangoes, and hate to give them up. I recently tried just a few bites and was ok, then a few days later ate about half a mango, with, so far, no ill effects. I peeled and cut it with a knife and fork, and never touched either the skin or the flesh. Is the allergen just in the skin, or is it in the pulp as well? Pam R. |
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Most recent investigations of the in-vitro allergenicity revealed similar allergenic potencies of mango pulp and peel (Dept. of Food Chemistry, University of Hamburg). However, different sensitization patterns to pulp and peel may occur in each mango allergic individual. Another explanation can be contact allergic reactions to mango compounds which are predominantly in the peel. Contact allergy is attributed to volatile oil substances like beta-pinen and limonen. Matthias Besler, PhD
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| ANSWER [3 November 2000]
At first I thought I was just allergic to skin, but i am now allergic to just eating it. I do not touch the skin. I only eat little pieces cut up. This is my third reaction in 10 years and I have boils and hives all over. anonymus [top]
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| QUESTION [25 May 2000]
Is it possible for a person with fish allergies to react to the odour of fish or do they have to ingest the fish? I have had this allergy most of my life and have been wondering this as of late. Anita (ON, Canada) |
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Allergic reactions to fish are caused predominantly by ingestion; however, inhalation of fish or seafood allergens has been implicated in adverse reactions, such as wheezing, asthma, urticaria, angioedema, and rhinitis. These reports most often involve occupational exposure during processing, handling, and cooking of fish. Some studies of fish aeroallergens have examined the allergenicity of vapors from boiling fish. IgE-binding proteins (allergens) have been identified in steam from boiling salmon and have been shown to be similar to both raw and boiled salmon. In Madrid, patients with IgE-mediated fish hypersensitivity have had reactions after exposure to fish odours in an open-air fish market. Most recently fish allergen was detectable in the air of an open-air fish market by using air sampling and an immunochemical analytic technique. (Reference: Taylor et al. (1999) J Allergy Clin Immunol 166-9.) Matthias Besler, PhD
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In response to your posting about the possiblity of inhalant-induced fish allergy, I can definitely answer that it is possible. Since the age of about 3-4, I have had anaphylatic shock reactions to fish, both by "smell" and ingestion. Raw, live, or even frozen fish poses much more of a threat when inhaled than does cooked fish. Carrie C. [top]
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Egg White Allergy:Severity,
Outgrowing, Desensitization
| QUESTION [1 May 2000]
Our 14 month old daughter's allergy tests have shown a strong positive reaction to egg white. The test was undertaken following an immediate reaction to a very small amount of egg white in the form of severe vomitting and a bright red rash over her mouth, neck, chest and back. The pediatrician who ordered the tests was very helpful, however, we have a few questions which have arisen since. What is the likelihood of her reaction being more severe (eg anaphylaxis) with subsequent exposures to egg white? Does quantity matter, would her reaction be worse with larger quantities of egg white? What are the chances of her growing out of the allergy and if so by what age? If she does not grow out of it can she be de-sensitized, and if so what is the recommended age for this? Graham & Alison M. (Australia) |
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(Dept of Allergology, Università Cattolica del Sacro, Cuore-Policlinico Gemelli, Rome, Italy) [top]
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The severity of allergic reactions depends on the individual susceptiblity and the potency of the allergen preparation. Your daughter may have more severe reactions after the first adverse reactions experienced lately. As regards the allergic potency all forms of egg white preparations are potentially allergenic. However, heated products may be less allergenic for individuals who are not sensitized to ovomucoid (Gal d 1) the major allergen from egg white. There is an individual threshold concentration for the elicitation of symptoms which could be quite low (several milligrams). The existence of a dose-response relationship has not been identified up to date. However, ingesting less quantities is less dangerous than ingesting larger quantities. The prognosis of outgrowing egg white allergy by the age of 3 years can be estimated to be approximately 80% and by the age of 6 years >90%. But egg white allergy can persist throughout life in some cases. Oral desensitization of food allergy has not been generally accepted yet. There are no accepted standardized protocols and no placebo-controlled studies which prove the effectiveness. However, some successful desensitizations of egg allergy have been reported. The individuals were >5 years of age. Matthias Besler, PhD
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Cases:Cold Induced Urticaria & Anaphylaxis
| QUESTION [14 Nov 1999]
Our daughter (5 years) is asthmatic, anaphylactic to peanuts (via RAST test) and very allergic to eggs & dustmite. Recently when swimming after about 15 mins she suffered urticaria followed by waves of loss of muscle tone, sleepiness and later, near collapse. She was taken to a doctor about 45 mins later by which time Aisha had recovered with no medication. We thought she reacted to some chemical in the pool (saltwater) - no scratch tests done yet. But yesterday we went swimming in the ocean and she had a similar but less severe reaction - localised urticeria (ankles, wrists & red ears) and sleepiness. She has swum in cold water since birth with no ill effects until incidents described here. Does anyone have any experience/knowledge of cold induced urticaria and possible links to anaphylaxis. Is this link likely or is something else going on? Stephanie & Mark K. (Perth, Australia) |
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There are two clinical sitituations I would consider. If indeed this is cold urticaria it should be possible to induce a local urticarial reaction by applying an ice cube to the patient's forearm initially 30 seconds then 1 minute, 2 minutes, 4 minutes and finally 5 minutes at intervals of 5 minutes. If an urticarial wheal develops it confirms that the patient has cold induced urticaria and further ice cube testing is not necessary, in fact may induce an anaphylactic reaction if continued ice cube application. The other entity I would consider is exercise induced anaphylaxis. These symptoms frequently occur when patients exercise shortly after eating. Such affected patients should not exercise for at least 4 hours after eating, stop when pruritus occurs (do not try to push through the reaction, it will progress to possibly a life-threatening reaction), and carry epinephrine for self administration in the event of a reaction and go immediately to the hospital for severe reactons. Albert L. Sheffer, M.D.
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First you should see a local allergist and/or dermatologist to do a thorough case history. The case seems to be similar to the phenomenon of so-called exercise-induced anaphylaxis (EIA). EIA is a unique physical allergy which is triggered by strenuous activities such as jogging or brisk walking. Anaphylactic symptoms, including hypotension or upper airway obstruction, urticaria, or angioedema are described. Patients could reduce their attacks by avoiding exercise during extremely hot or cold weather, avoiding ingestion of certain foods before exercise, and restricting exercise during their allergy season (Shadick NA et al. 1999: J Allergy Clin Immunol 104(1):123-7). Before doing any restrictions, especially dietetic restrictions, a clear diagnosis of triggering factors should be done. The coincidence of cold induced urticaria and anaphylactic reactions has been described in a study of 80 patients with cholinergic urticaria (which is also triggered by stressful conditions), exercise-induced anaphylaxis occurred in 8 patients of which 7 presented simultaneously cold urticaria (Mijailovic B et al. 1996: Vojnosanit Pregl 53(6):497-501). Matthias Besler, PhD
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Software: Patients'
Data Processing
| QUESTION [26 Sep
1999]
Does anybody has a well-suited software for food-allergic patients data processing: symptomes- diagnosis- therapy- monitoring- diets etc? We have quite a long list of selected patients but have not an effective software. Kristoif Nekam, MD, PhD, Assoc Prof and Head
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I have looked everywhere and cannot find software to do what is requested. The closest I could find was software that allows you to monitor immunotherapy/desensitization. Dr. Harris Steinman
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The only suitable software I know is the AllergieManager by Bencard (Munic, Germany, http://www.Bencard.de) in German language. Bencard contemplates to develop an internet version that will be most probably available in English too. Matthias Besler, PhD
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| QUESTION [19 Oct
1999]
Last month I asked a question about allergenicity of refined soybean oils. Thank you for your response referencing 2 studies which indicate that in general ingestion of highly refined soybean oils should not pose a risk to soybean- sensitive individuals. Can you tell me if soy lecithin is similarly processed so as not to pose a risk as an allergen. C.S. (Chico, CA, USA) |
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Recently Palm et al. (Allergy 1999 Oct 54(10):1116) reported two cases of lesions of atopic dermatitis caused by egg and soybean lecithins in allergic patients. Müller et al. (1998) demonstrated IgE- binding to proteins extracted from commercial soybean lecithins (see: Allergen Data Collection: Soybean / 10 Allergen Sources). Scince it is more difficult to purify lecithins than soybean oils from proteins, lecithins should be regarded as potential allergen sources for egg and soybean allergic individuals. Matthias Besler, PhD
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Soybean Allergy:Save
Ingestion of Soybean Oils ?
| QUESTION [07 Sep
1999]
I've read that soybean oils are highly refined, and therefore safe for consumption by individuals with soy allergies. Are there any recent studies to support this? C.S. (Chico, CA, USA) |
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Most recently Awazuhara et al. (Clin Exp Allergy 1998 Dec;28(12):1559-64) analyzed soybean oil samples from 3 different companies. Samples contained 1.4 to 4.0 mikro grams total protein per 100 gram. In in vitro tests (SDS-PAGE immunoblot) they observed no IgE or IgG4 binding from 4 soybean- sensitive patients to any protein in soybean oil. Bush et al. (J Allergy Clin Immunol 1985 Aug;76(2 Pt 1):242-5) performed challenge tests with 3 commercial soybean oil samples without any symptoms occuring in 7 soybean- sensitive patients. In general ingestion of highly refined soybean oils should not pose a risk to soybean- sensitive individuals. Matthias Besler, PhD
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Latex-Fruit-Syndrome:
Cucumber and Latex Allergy ?
| QUESTION [05 Sep
1999]
I too have a latex allergy. I couldn't find it anywhere in the search, but I was wondering if you've found out if cucumbers are a part of the latex allergy. Just yesterday Sept 4th, and a time previous, I have found out that when I work with or eat cucumbers, I start out as if I'm getting a cold. My eyes start out itchy, watery, and red, my sinuses plug up. This only lasts about an hour after I eat. I find it has so far been the cucumbers, amongst rubber, of which I'm careful with. If you can help me, I'd apreciate it. M.E. (Manitoba, Canada) |
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I know no previous reactions in patients with latex allergy. However: 1) cucumber has a protein reminding the MW (molecular weight) of profilins, 2) cucumber reacts with epitopes common to banana, a prominent fruit among the crossreactions latex-fruits and vegetables. Please refer to my recent paper: Cantani A. Latex allergy in children J Invest Allergol Clin Immunol 1999; 9: 14-20 Arnaldo Cantani, MD, PhD, Prof.
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This is the first case brought to my attention of a latex allergic patient who is simultaneously allergic to cucumber. Cucumber allergy has not been described as being associated with latex allergy. In general, IgE- mediated allergy to cucumber is rather rare. To confirm a cross- reactivity between two allergen sources appropriate tests would have to be performed (at least e.g. cross- inhibitions by RAST or immunoblot). But these information are of no practical benefit for the patient in question, since she already is informed about her allergy to latex and cucumber. Therefore, she is aware of which allergen sources she needs to avoid. Heimo Breiteneder, PhD., Assoc. Prof.
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To my knowlegde no direct association between cucumber and latex-allergy was described up to now. But a cross- reactivity between cucurbitaceae fruits / vegetables (e.g., watermelon, melon, cucumber) and banana has been reported. Scince banana is known as part of so-called "latex-fruit syndrome" (latex associated fruits: avocado, banana, chestnut, fig, kiwi, mango, melon, papaya, passion fruit, peach, pineapple, tomato), it is likely, that cucumber is also associated to latex in some individuals. Matthias Besler, PhD
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Allergen Extracts:
Skin Prick Testing
| QUESTION
I am very pleased to see the initiative on food allergens. I am looking for a company that specialises in producing food allergens for skin prick testing. If you know of any good quality sources, I would be very interested to have contact details. M.W. (UK) |
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Try ALK-Abello, 2 Tealgate, Hungerford, Berks RG17 0YT, UK Tel +44 1488 686016 Fax +44 1488 685423 Jonathan Hourihane
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| QUESTION
Most of the General allergists here in the USA test for IgE mediated hypersensitivity to food allergy. What about IgG, delayed hypersensitivity? These tend to cause more dermatologic reactions, i.e. excema etc. My Question ???? What is your approach to the patient with suspected food allergy? Do you skin test, RAST, Rast for IgE, IgG ?? F.B. (USA) |
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Adverse reactions to foods can be classified as either "Intolerance" or "Allergic." Allergic (hypersensitivity) reactions are mediated by immunologic mechanisms. Of these, Type I IgE-mediated reactions are the most common. (...) Reactions range from mild to life-threatening. Characteristically they begin within one hour of exposure. Reactions include perioral hives, oral pruritis, generalized hives, vomiting, diarrhea, cough, stridor, wheezing, laryngeal edema, hypotension, death. The extent of reaction is proportional to the magnitude of sensitization measured by the amount of food-specific IgE. Some previously allergic people (developed tolerance) continue to have lower levels of specific IgE. It is therefore necessary to challenge those suspected of having developed tolerance to determine whether or not they are still clinically sensitive. The presence of specific IgE can be determined by skin prick tests with fresh food or commercial food allergen extracts. An alternative, which is more quantitive is the IgE RAST. IgG RASTs are controversial. The vast majority of board certified allergists in the USA believe that IgG RASTS currently have no place in the diagnosis and management of food allergy. IgG food antibodies are regularly found in non-allergic people.They are related to dietary intake. In fact, their presence may indicate the absence of clinical allergy to foods. Type IV (contact) delayed hypersensitivity reactions to food do occur. As with Type I reactions, a detailed history is the most important aspect of diagnosis. For these reactions, patch tests are done and read at 24 and 48 hours after application. The rash is reproduced at the patch test site. In some individuals, the area needs to be exposed to sunlight also (phytophotodermatis). These additional factors need to be considered in demonstrating certain Type I reactions also. Food-dependent exercise-induced urticaria and/or anaphylaxis as seen with celery, carrots is an example where both food and exercise are required to produce a reaction. These reactions can be delayed in time, occurring at the time of exercise, 4 to 5 hours after ingesting the allergenic food. The oral allergy syndrome (OAS) is common. Ragweed-allergic people frequently complain of oral pruritis or angioedema while eating melons, birch-allergic individuals may do the same with apples. Here again, the history is most important. In all instances, currently the major principles of management are avoidance of the offending food allergen and preparedness to treat acute potentially life-threatening Type I reactions with self-administered epinephrine. Contact reactions are treated with antihistamines and topical glucocorticosteroids. Robert H. Schwartz, M.D.
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| QUESTION
Unfortunately I found not much about histamine hypersensitivity on the Web. Do you know some links or books ? I am interested in the right nutrition and support of the immune system in particular. J.S. (Austria) |
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