Gene/Protein Disease Symptom Drug Enzyme Compound
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Adverse food reaction in which no immunological mechanism is demonstrated should be termed nonallergic food hypersensitivity or food intolerance. We present the case of a 12-year-old girl with a clinical history of abdominal pain, nausea, and general malaise after tomato intake which completely remitted with antihistamines. The patient underwent a complete allergy evaluation: skin prick tests, serum specific IgE and IgG4 tests to tomato, and double-blind placebo-controlled food challenge. Skin prick tests and specific IgE to tomato were negative while the food challenge was positive. At the end of the workup, the patient underwent an oral rush desensitizing treatment. At the end of the treatment the patient could eat a maintenance dose of 100 g of tomato daily with no side effects at all. This successful result suggests that the oral desensitizing treatment can be used in patients with nonallergic food hypersensitivity.
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PMID:Oral rush desensitization with tomato: a case report. 1678 18

Chronic anisakiasis of the colon is rare and difficult to diagnose. We report a case of chronic anisakiasis associated with advanced colonic carcinoma. A 69-year-old man was admitted for abdominal pain, diarrhea, and urticaria. Right hemicolectomy was performed because of an obstruction of the ascending colon and a palpable tumor of the right lower abdomen. The lesion was thought to be located in the deeper layers of the ascending colon. Preoperative examinations failed to detect the coexistence of anisakiasis and carcinoma of the colon. The anisakis was identified morphologically in the intestinal wall of the resected specimen and by an elevated titer of an IgE antibody specific to the parasite. Seventy-five cases of colonic and rectal anisakiasis, including the present case, have been reported in Japan. This is the only reported case of anisakiasis to appear in association with colonic carcinoma.
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PMID:Chronic anisakiasis of the ascending colon associated with carcinoma. 1679 Sep 86

A 20-year-old woman was referred for evaluation after about 2 years of recurrent episodes of localized urticaria during handling of several kinds of raw fish in a sushi shop, where she had worked part-time for 2 years. She had also experienced allergic symptoms such as itching and swelling of her lips, generalized urticaria, laryngeal tightness, stridor and dyspnea immediately after ingestion of raw and cooked seafood, including sole, horse mackerel, sea eel and shellfish, over the previous 1 year before referral. Skin prick tests and blood test for specific IgE antibodies were positive for many kinds of seafood, including sole, horse mackerel, sea eel, eel, crab, and abalone, which belonged to different taxonomic phyla, including Chordata, Arthropoda, and Mollusca. A challenge with a piece of broiled sole induced swelling of the lips, obstruction of the larynx, difficulty with deglutition, and abdominal pain. In addition, serum-specific IgE antibodies to two major fish allergens, parvalbumin and collagen, were detected by ELISA, suggesting that allergic symptoms could be induced by many kinds of seafood in the present patient. She was therefore diagnosed with occupational contact urticaria and oral allergy syndrome due to seafood. At the time of this report, the present patient had been followed for one year and no reactions have occurred since she started to avoid the causative types of seafood.
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PMID:[A case of occupational contact urticaria and oral allergy syndrome due to seafood]. 1727 58

Cow's milk protein allergy is the most common food allergy in infants and young children. It is estimated that up to 50% of pediatric cow's milk allergy is non-IgE-mediated. Allergic proctocolitis is a benign disorder manifesting with blood-streaked stools in otherwise healthy-appearing infants who are breast- or formula-fed. Symptoms resolve within 48-72 h following elimination of dietary cow's milk protein. Most infants tolerate cow's milk by their first birthday. Food protein-induced enterocolitis syndrome presents in young formula-fed infants with chronic emesis, diarrhea, and failure to thrive. Reintroduction of cow's milk protein following a period of avoidance results in profuse, repetitive emesis within 2-3 h following ingestion; 20% of acute exposures may be associated with hypovolemic shock. Treatment of acute reactions is with vigorous hydration. Most children become tolerant with age; attempts of re-introduction of milk must be done under physician supervision and with secure i.v. access. Allergic eosinophilic gastroenteritis affects infants as well as older children and adolescents. Abdominal pain, emesis, diarrhea, failure to thrive, or weight loss are the most common symptoms. A subset of patients may develop protein-losing enteropathy. Fifty percent of affected children are atopic and have evidence of food-specific IgE antibody but skin prick tests and serum food-IgE levels correlate with response to elimination diet poorly. Elemental diet based on the amino-acid formula leads to resolutions of gastrointestinal eosinophilic inflammation typically within 6 wk.
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PMID:Educational clinical case series for pediatric allergy and immunology: allergic proctocolitis, food protein-induced enterocolitis syndrome and allergic eosinophilic gastroenteritis with protein-losing gastroenteropathy as manifestations of non-IgE-mediated cow's milk allergy. 1758 15

Tacrolimus-based immunosuppression in pediatric liver transplant recipients is known to be associated with EGID. Our goal was to determine the incidence, risk factors, and characteristics of EGID in our pediatric liver transplantation program. This study was a retrospective analysis of 38 pediatric liver transplant recipients. Rectal mucosal biopsy was performed to evaluate for gastrointestinal PTLD and eosinophilic colitis. There were 14 patients (37%) who were diagnosed with eosinophilic colitis. The mean age at transplantation was 10.8 +/- 1.8 months. Those with eosinophilic colitis had a higher incidence of peripheral eosinophilia (p = 0.003) during the first two months following transplantation and had a higher EBV infection rate. Symptoms, such as diarrhea, hematochezia, and abdominal pain, became apparent after an average of three months; diagnoses were made at 6.9 +/- 2.0 months after transplantation. There were eight patients (57%) with elevated food-specific IgE levels. With food restriction treatment, the symptoms of patients improved. EGID should be considered when clinical symptoms are present, because symptoms of this disorder are similar to those of gastrointestinal PTLD. It should also be considered when peripheral eosinophila is detected or when EBV seroconversion develops during the first two months following transplantation.
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PMID:The development of eosinophilic colitis after liver transplantation in children. 1763 Oct 20

We describe a 65-year-old man who had liver involvement with Churg-Strauss syndrome. He was admitted to the hospital because of fever, weight loss, dyspnea, abdominal pain, skin lesions and paraesthesias. His past medical history revealed a diagnosis of acalculous cholecystitis that had been made eight months earlier. Microscopic examination of a gall bladder biopsy specimen obtained at that time revealed an increase in extravascular eosinophils. There was evidence of a new bilateral pulmonary disease with bronchoconstriction and a transient infiltrated lesion in the right upper lung. The patient's white cell count was 14 620 per cubic millimetre, with 39% eosinophils (5800 per cubic millimetre) and 39% neutrophils. IgE was 503 g/L (normal range, 0 to 100 g/L). Liver function tests were mildly elevated. Fine needle liver biopsy showed active interface hepatitis. A diagnosis of Churg-Strauss syndrome was made. In this patient the syndrome occurred in a rare association with hepatitis, likely due to immunologic events in the liver. The patient was successfully treated with 60 mg/day of prednisolone monotherapy.
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PMID:Churg-Strauss syndrome associated with acalculous cholecystitis and liver involvement. 1919 81

We report two cases of anaphylactic reactions to peach with negative result of ImmunoCAP to peach. Case 1 is a 35-year-old man, who felt an itch in his oral cavity immediately after ingesting a whole fresh peach. He rapidly developed generalized urticaria, dyspnea, vomiting, and loss of consciousness. He recovered after treatment at a local hospital, thereafter he was referred to our hospital because ImmunoCAP conducted for screening allergens revealed a negative test result to peach and the cause of anaphylaxis remained unclear. He had a history of pollinosis. He reported that he previously felt an itch on his oral cavity after ingesting melon, watermelon, apple, and strawberry. Serum total IgE was 436 IU/ml. CAP-RAST revealed negative results to peach, strawberry and kiwi. Skin prick tests (SPTs) with raw peach pulp, canned peach pulp, strawberry and kiwi were positive. Case 2 is a 30-year-old woman who felt an itch on her oral cavity accompanied by blepharedema, rhinorrhea, generalized urticaria, nausea, abdominal pain and diarrhea after eating peach. She had a history of pollinosis. She reported that she previously developed urticaria after ingesting an apple. Serum total IgE was 85 IU/ml. ImmunoCAP revealed negative results to peach and apple. SPTs with canned yellow peach, strawberry and apple were positive. Consequently, the two patients were diagnosed with anaphylaxis due to peach, and allergic symptoms have never recurred since they avoided ingesting peach. Furthermore, in two patients ImmunoCAP to rPru p 1, rPru p 3, and rPru p 4 were negative. However, in IgE-immunoblotting of peach, serum IgE antibodies of two patients were bound to approximately 10 kDa proteins. Meanwhile, the cross-reactivity between Rosaceae fruits, such as peach, apple, apricot, and plum, has been reported. These results suggest that in patients, who are suspected of having peach anaphylaxis and show a negative ImmunoCAP result to peach, the additional testing, such as SPT with peach, should be performed for diagnosis.
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PMID:[Anaphylaxis due to peach with negative ImmunoCAP result to peach allergens, including rPru p 1, rPru p 3, AND rPru p 4: a report of two cases]. 1932 77

Anisakidae larvae can cause anisakiasis when ingested by humans. Although several groups have reported a gastrointestinal Anisakis allergy among people in Spain and Japan, our report is the first to summarize the clinical features of 10 Anisakis allergy cases in Korea. We enrolled 10 Korean patients (6 men and 4 women) who complained of aggravated allergic symptoms after ingesting raw fish or seafood. Sensitization to Anisakis was confirmed by detecting serum specific IgE to Anisakis simplex. The most common manifestation of anisakiasis was urticaria (100%), followed by abdominal pain (30%) and anaphylaxis (30%). All patients presenting with these symptoms also exhibited high serum specific IgE (0.45 to 100 kU/L) to A. simplex. Nine patients (90%) exhibited atopy and increased total serum IgE levels. The fish species suspected of carrying the Anisakis parasite were flatfish (40%), congers (40%), squid (30%), whelk (10%), and tuna (10%). Anisakis simplex should be considered as a possible causative food allergen in adult patients presenting with urticaria, angioedema, and anaphylaxis following the consumption of raw fish or seafood.
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PMID:The clinical characteristics of Anisakis allergy in Korea. 1954 98

Among proteins secreted from activated eosinophil granulocytes, eosinophil cationic protein (ECP) is the most useful tool for the follow-up of inflammatory diseases. Since ECP level reflects the eosinophil activation, it gives valuable information about disease activity. In this study, we aimed to investigate the possible relation between ECP levels and symptoms and laboratory findings of cystic echinococcosis (CE) and to evaluate the role of this protein in the diagnosis of CE. The study which was conducted at Clinical Microbiology Laboratory of Suleyman Demirel University Medical Faculty, Isparta, Turkey, included 58 patients with a pre-diagnosis of CE and 32 healthy individuals as control group. The diagnosis of CE was established serologically by modified enzyme-linked immunosorbent assay (ELISA) and indirect hemagglutination (IHA) test. The quantitative determination of ECP levels was done by fluoro-enzyme immunoassay (FEIA; Uni-CAP ECP, Pharmacia-Upjohn). The mean ECP level was 31.6 +/- 37 microg/ml in the patient group and 9.1 +/- 2.1 microg/ml in the control group, the difference being statistically significant (p = 0.001). Significant differences were also detected for erythrocyte sedimentation rate (ESR) (p = 0.001), total IgE level (p = 0.001), eosinophile count (p = 0.05) and CRP (p = 0.001) between the patient and the control groups. ECP was detected to be high in 35 (60%), IgE in 37 (63%), CRP in 29 (50%) and eosinophile count in 9 (15.5%) patients. While age, gender, ESR, IgE and CRP levels of patients with high ECP levels were not significantly different from levels of patients with normal ECP levels, significantly different eosinophil counts were detected among patients with high ECP values when compared to patients with normal ECP values. Furthermore, a correlation was detected between ECP levels and eosinophil rate, IgE and CRP levels of patients with CE (p = 0.01), while there was no correlation between ECP and ESR levels. Although high ECP level patients exhibited higher ALT and AST levels, no correlation was determined between liver enzyme levels and ECP levels (p > 0.05). The most common symtoms among CE patients were abdominal pain (41%), other gastrointestinal complaints (38%), shortness of breath (12%) and fever (10%). No statistically significant difference in terms of symptoms was detected between patients with high ECP levels and normal ECP levels. However, statistically significant difference was detected between ECP levels of patients with symptoms (except shortness of breath) and patients without symptoms (p < 0.05). In conclusion, ECP seems to be associated with the symptoms and signs of CE and it can be used as a valuable marker besides the other laboratory tests for the evaluation of patients with CE.
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PMID:[Evaluation of eosinophil cationic protein levels with clinical symptoms and laboratory findings of patients with cystic echinococcosis]. 1962 14

The relation between the duration of human fasciolosis and development of humoral immune response has not yet been clarified. This study was conducted to investigate the relation between different immunoglobulin isotypes and the period of disease in fasciolosis patients and also to evaluate the diagnostic value of immunoglobulin isotypes. The 50 patients (30 female, 20 male; age range: 18-70 years) included to the study were evaluated in 3 groups (3-6 months, 7-12 months and > 12 months) according to the duration of their signs and symptoms such as abdominal pain, fever, eosinophilia, detection of eggs in stool and radiological findings. An in-house enzyme-linked immunosorbent assay (ELISA) based on Fasciola hepatica excretory-secretory (ES) antigens was used for the determination of anti-F. hepatica specific IgG, IgM, IgA, IgE antibodies. The positivity rates were 100% for IgG, 50% for IgM, 62% for IgA and 42% for IgE. When the relation between disease period and immunoglobulin classes were evaluated, it was observed that in the 3-6 months period, patients IgM, IgA and IgE levels were; 90%, 72% and 54%, respectively; in the 7-12 months period patients IgM, IgA and IgE levels were 35%, 35% and 21%, respectively, in the > 12 months period patients IgA and IgE levels were 50% and 42%, respectively however, no positive IgM level were detected. In conclusion our data indicated that the specific IgM positivity rate was high (90%) in early stage in fasciolosis, gradually decreased (35%) and became negative in late stages of infection. However, IgA and IgE levels revealed no specific relation to the disease period. Specific IgM determination seems to be useful for the differentiation between acute and chronic period of fasciolosis. Further studies are necessary to prove the diagnostic value of specific IgA and IgE antibodies in setting of fasciolosis.
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PMID:[Investigation of immunoglobulin isotypes in patients with fasciolosis]. 1979 23


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