Development of component resolved diagnostics to predict the clinical relevance and time course of food allergy in childhood
Final Report Abstract
Food allergy is a common disease that can involve any organ system. Reactions often involve the skin, the gastrointestinal and respiratory system. Severe reactions that are life threatening might occur. A clear diagnosis is important, as food allergic patients have to keep a strict diet avoiding the allergenic foods. Moreover, many food allergic patients have to carry medications for self-treatment including epinephrine for self-injection in order to be able to treat allergic symptoms that might be life threatening after accidental ingestion. Although food allergy has in general a good prognosis and many patients especially with cow’s milk and hen’s egg allergy will become tolerant over time, prognostic parameters are still missing. However, the way from suspicion to a clear diagnosis is troublesome. Up to date there is no laboratory parameter that proofs the diagnosis of food allergy or the time course of the disease. Determination of elevated allergy (IgE) antibodies to food in blood does not proof clinically relevant food allergy. Therefore, it is still common that patients with suspected food allergy undergo oral food challenge under medical supervision on an in-patient basis. This is costly, troublesome for the patients and bears the risk of severe allergic reactions. Therefore, better ways for diagnosis are under investigation. One promising approach is the determination of allergy (IgE) antibodies to individual allergens in the food. For example, instead of measuring IgE to all proteins in peanut, IgE to a certain seed storage protein Ara h 2 could be measured or even further the IgE to an individual binding side for the IgE. Within our research project we determined whether this approach is helpful for the main allergenic foods in Germany, namely hen’s egg, cow’s milk, peanut, hazelnut and wheat. Whereas for hen’s egg, cow’s milk, peanut and hazelnut the main allergenic proteins and in part also the relevant IgE-binding sites are know, wheat allergens are less investigated. Therefore, we also tried to identify new allergenic proteins in wheat. Especially for peanut and hazelnut, this approach of component-resolved diagnostic appears to be better than the measurement of IgE to the whole food. We could confirm that the measurement to the individual allergen Ara h 2 in peanut and Cor a 14 in hazelnut is superior for diagnostic. However, a yes-no answer can still not been given and especially in young children different allergens might paly a role that in older patients. Therefore, we calculated for the first time probabilities for these individual allergens that could estimate for an individual patient the likelihood of a peanut or hazelnut allergy. In contrast for cow’s milk, hen’s egg and wheat the advantage of this component-resolved way for diagnosis and prognosis appears to be less clear. Especially for wheat no new allergens could be identified that would distinguish a wheat allergic patient from a clinical tolerant one. In order to measure IgE to many individual allergens and allergenic binding sites, systems have to be developed that allow simultaneous detection of many parameters. Current platforms are not very sensitive. Therefore, another platform using glass slides with a special coated surface has been investigated showing that a more sensitive measurement seems to be feasible. In summary, with the help of many national and international collaborators we were able to obtain new data that will improve food allergy diagnostic.
Publications
- Individual cow's milk allergens as prognostic markers for tolerance development? Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology, 2012; 42(11): 1630–1637
Ahrens B., Lopes de Oliveira L. C., Grabenhenrich L., Schulz G., Niggemann B., Wahn U. and Beyer K.
- The Value of Specific IgE to Peanut and Its Component Ara h 2 in the Diagnosis of Peanut Allergy. The Journal of Allergy and Clinical Immunology in Practice 2013;1(4): 394–398
Lopes de Oliveira L. C., Aderhold M., Brill M., Schulz G., Rolinck- Werninghaus C., Mills C. E. N., Niggemann N., Naspitz C.K., Wahn U. and Beyer K.
(See online at https://doi.org/10.1016/j.jaip.2013.05.010) - Molecular sIgE profiles in infants and young children with peanut sensitization and dermatitis. Allergo J Int 2014;23:152–7
Trendelenburg V., Rohrbach A., Schulz G., Schwarz V., Beyer K.
(See online at https://doi.org/10.1007/s40629-014-0018-0) - Predictive values of component-specific IgE for the outcome of peanut and hazelnut food challenges in children. Allergy, 2015 Jan;70(1):90-8
Beyer K., Grabenhenrich L., Beder A., Kalb B., Ziegert M., Finger A., Harandi N., Schlags R., Gappa M., Puzzo L., Röblitz H., Millner-Uhlemann M., Büsing S., Ott H., Lange L., Niggemann B.
(See online at https://doi.org/10.1111/all.12530) - Wheat protein recognition pattern in tolerant and allergic children. Pediatr Allergy Immunol. 2016 Mar;27(2):147-55
Sievers S., Rawel H.M., Ringel K.P., Niggemann B. and Beyer K.
(See online at https://doi.org/10.1111/pai.12502)
