矢上 晶子

BACKGROUND: The relationship between the severity of peanut allergy and component-specific immunoglobulin E (IgE) remains partially analyzed. We aimed to explore this relationship using a proteomic analysis of pediatric patients with peanut allergy. METHODS: Immunoblotting and mass spectrometry were used to identify candidate peanut allergen components, which were confirmed via enzyme-linked immunosorbent assay using sera from pediatric patients with peanut allergy confirmed through a positive oral food challenge test (OFC). The association between each protein-specific IgE level and the severity of peanut allergy was compared. The severity of peanut allergy was quantified as TS/Pro, which is the total score (TS) of Anaphylaxis Scoring Aichi divided by the cumulative protein dose of peanuts at the OFC (Pro). RESULTS: This study comprised 52 patients with peanut allergy. In addition to the known peanut allergen components, we discovered seven allergens in more than five participants. Among the participants, 24 (46.2%) had Annexin Gh1-specific IgE. Ara h 2 (rs = 0.67, p < .001) and Ara h 6 (rs = 0.66, p < .001) specific IgEs and the sum of the absorbance of all seven candidates (rs = 0.64, p < .001) were strongly correlated with TS/Pro. Ara h 1 (rs = 0.30, p < .05), Ara h 3 (rs = 0.37, p < .01), Ara h 7 (rs = 0.34, p < .05), and the seed biotin-containing protein SBP65 (rs = 0.35, p < .05) specific IgEs were correlated with TS/Pro. CONCLUSION: Ara h 2- and 6-specific IgEs and sensitization diversity were the most significant factors that correlated with peanut allergy severity. We identified SBP65 (Ara h 20) as a potential novel allergen component related to peanut allergy severity.

Patients with peach allergy who experience severe symptoms, including anaphylaxis, reportedly have a higher positivity for peach gibberellin-regulated protein (GRP)-specific immunoglobulin (Ig) E than those with only oral symptoms. However, a study in Italy investigating apple allergy (another Rosaceae fruit) found no clear association between apple GRP-specific IgE levels and clinical disease types. This study aimed to evaluate the clinical utility of GRP-specific IgE measurement in Japanese patients with apple allergy. We collected sera from apple-allergic patients in Japan and measured their IgE levels specific to apple GRP. Apple-allergic patients (14 with oral reactions and 14 with systemic reactions) and seven non-allergic controls were examined. The specific IgE levels against apple, Mal d 1, Mal d 4, Japanese cedar, Japanese alder, Japanese white birch, Bet v 1, and Bet v 2 were also determined using 3gAllergy™. Positive results for apple-GRP-specific IgE by enzyme-linked immunosorbent assay were obtained in one patient with oral reactions and in seven cases of systemic reactions. Exercise as a cofactor was involved in cases with high apple GRP-specific IgE. GRP expression was considerably lower in apples than in peaches, as detected by reverse transcription-quantitative polymerase chain reaction testing. Thus, GRP-specific IgE may be an important marker for diagnosing systemic reactions triggered by exercise in fruits with low GRP expression, such as apples.

OBJECTIVE: Eosinophilic gastrointestinal disorders (EGIDs) are pathologically diagnosed by manually counting the eosinophils in biopsy tissue under microscopy. However, the skill of the individual examiner is considered to influence the accuracy of the resulting eosinophil count (EC). This study aimed to examine the effects of different examiners and histopathological staining types on the EC results of pathological tissues from patients with EGIDs. METHODS: Infiltrating eosinophils in lesion tissues from 10 eosinophilic esophagitis and 28 eosinophilic gastroenteritis cases were counted by three pathologists and one cytotechnologist. The intra- and inter-observer variabilities in ECs related to hematoxylin-eosin (HE), May-Grünwald Giemsa (MG), and direct fast scarlet (DFS) staining were investigated. The effects of examiner expertise and staining method on ECs were analyzed using a linear mixed effects model. The difference in color value (ΔE) for each staining method was obtained using the Commission International de l'Eclairage luminance-a-b model (L*a*b*). RESULTS: There was no significant intra-observer variability in eosinophil counting. Regarding inter-observer agreement, the examiner with the most EGIDs experience reported higher ECs than the other examiners for all three staining types (P<0.001). ECs were significantly higher with MG and DFS staining than with HE staining, regardless of the examiner (both P<0.001). Additionally, the ΔE values with DFS were higher than those with MG and HE. CONCLUSIONS: DFS staining offered the most selective visualization of eosinophils. ECs may vary depending on both the skill of the examiner and the staining method.

OBJECTIVES: This study was conducted to investigate factors involved in anaphylaxis related to diclofenac etalhyaluronate (DEH) [product name: Joyclu® (JCL)] (containing DEH and macrogol 400), which is used to treat patients with osteoarthritis. METHODS: Patients with osteoarthritis were divided into two groups that had (experienced patients) or had not experienced anaphylactic symptoms after JCL administration (nonexperienced patients). Five tests performed to assess factors related to anaphylaxis consisted of a skin prick test as the primary endpoint and the other tests including basophil activation test, allergen-specific IgE tests using enzyme-linked immunosorbent assay or immunochromatographic kits, and genetic study were secondary endpoints. RESULTS: The skin prick test showed 4 (wheal)/7 (erythema) of 15 experienced patients and 0/3 of 19 nonexperienced patients were positive for any of the test reagents containing DEH. The basophil activation test showed two experienced patients were positive for test reagents containing DEH. DEH- and diclofenac-allergen-specific IgE were detected in 3 and 1 of 12 experienced patients, respectively. No clear results were shown in the other tests. CONCLUSIONS: DEH may be the main factor involved in the development of anaphylaxis. The skin prick test was more sensitive than the basophil activation and allergen-specific IgE tests for identifying factors associated with anaphylaxis.

BACKGROUND: The skin-prick and intradermal tests are the main diagnostic methods used to identify the causative agent in patients with suspected perioperative anaphylaxis. Although the intradermal test is more sensitive than the skin-prick test, multiple intradermal injections can be painful for children. Here, we present the case of a child with autism and suspected perioperative anaphylaxis. The causative agent was successfully identified using the intradermal test under general anesthesia. CASE PRESENTATION: An 8-year-old boy with autism developed anaphylaxis during general anesthesia for the fourth cleft lip and palate surgery. An allergic workout was performed, but both the skin-prick and basophil activation tests for suspected causative agents yielded negative results. The patient was afraid of multiple injections, and an intradermal test was performed under general anesthesia by anesthesiologists and allergists. Piperacillin was confirmed as the causative agent, and subsequent surgery using the same anesthetic agents without piperacillin was uneventful. CONCLUSIONS: Concerted efforts should be made to identify the causative agent for diagnosing perioperative anaphylaxis.

OBJECTIVE: This study was conducted to investigate the mechanisms of anaphylaxis in patients with osteoarthritis of the knee and hip after diclofenac etalhyaluronate [product name: JOYCLU® (JCL)] intra-articular injection and to determine the utility of tests to investigate the mechanism involved. METHODS: In this observational study in Japan, patients aged ≥20 years with knee or hip osteoarthritis who received JCL intra-articular injection experienced anaphylactic symptoms considered related to JCL ('experienced patients') or did not experience allergic symptoms considered related to JCL ('non-experienced patients'). Basophil activation tests (BATs), specific immunoglobulin E (IgE) antibody testing by enzyme-linked immunosorbent assays (ELISAs) or immunochromatographic kit, and genome-wide association studies (GWASs) were conducted using patient blood and saliva. RESULTS: Thirteen experienced patients and 14 non-experienced patients were tested. Seven experienced patients tested positive by BAT using diclofenac etalhyaluronate-containing test substances. Diclofenac-specific IgE antibodies were detected in four of seven BAT-positive patients but not in the non-experienced patients. Specific IgE antibody testing by immunochromatographic kit and genome-wide association study showed no clear results. CONCLUSIONS: These findings suggest that anaphylaxis occurs after JCL administration via an IgE-mediated mechanism and that diclofenac etalhyaluronate may be involved in this mechanism. BAT and diclofenac -specific IgE enzyme-linked immunosorbent assay may be useful tests for investigating the mechanisms of anaphylactic reactions after JCL administration.

BACKGROUND: Chronic spontaneous urticaria (CSU) is a chronic inflammatory disease characterized by recurrent pruritic wheals (hives) and/or angioedema. Patients with CSU could remain symptomatic despite standard-of-care H1 antihistamines (H1-AH) or anti-IgE (omalizumab) treatment. Dupilumab blocks IL-4/IL-13 signaling and is approved for multiple type 2/atopic indications. OBJECTIVE: We conducted two phase 3, randomized, placebo-controlled, double-blind trials comparing dupilumab with placebo in patients with symptomatic CSU despite H1-AH. METHODS: In LIBERTY-CSU CUPID Study A, patients were omalizumab-naive (n = 138, aged ≥6 years). In Study B, patients were omalizumab-intolerant/incomplete responders (n = 108, aged ≥12 years). The primary end point was either change from baseline over 7 days in the Urticaria Activity Score (UAS7) or Itch Severity Score (ISS7) at week 24, with the other as a key secondary end point, depending on regional regulatory requirements. Studies were pooled for safety assessment. RESULTS: In Study A, UAS7 and ISS7 improved with dupilumab versus placebo (difference -8.5 [95% CI, -13.2 to -3.9; P = .0003] and -4.2 [95% CI, -6.6 to -1.8; P = .0005]). In Study B, tested at α = 0.043 after interim analysis, UAS7 improved (difference -5.8 [95% CI, -11.4 to -0.3; P = .0390]), with a numerical trend in ISS7 (difference -2.9 [95% CI, -5.7 to -0.07; nominal P = .0449, not significant]). Pooled safety data were consistent between dupilumab and placebo and with the known dupilumab safety profile. CONCLUSIONS: Dupilumab reduced urticaria activity by reducing itch and hives severity in omalizumab-naive patients with CSU uncontrolled with H1-AH. Although the primary end point for Study B was not met, dupilumab effects were small in patients who were omalizumab-intolerant/incomplete responders.

Henna is a plant-based dye obtained from the powdered leaf of the pigmented plant Lawsonia inermis, and has often been used for grey hair dyeing, treatment, and body painting. As a henna product, the leaves of Indigofera tinctoria and Cassia auriculata can be blended to produce different colour variations. Although allergy from henna products attributed to p-phenylenediamine, which is added to enhance the dye, is reported occasionally, raw material plants of henna products could also contribute to the allergy. In this study, we reported that raw material plants of commercial henna products distributed in Japan can be estimated by LC-high resolution MS (LC-HRMS) and multivariate analysis. Principal Component Analysis (PCA) score plot clearly separated 17 samples into three groups [I; henna, II; blended henna primarily comprising Indigofera tinctoria, III; Cassia auriculata]. This grouping was consistent with the ingredient lists of products except that one sample listed as henna was classified as Group III, indicating that its ingredient label may differ from the actual formulation. The ingredients characteristic to Groups I, II, and III by PCA were lawsone (1), indirubin (2), and rutin (3), respectively, which were reported to be contained in each plant as ingredients. Therefore, henna products can be considered to have been manufactured from these plants. This study is the first to estimate raw material plants used in commercial plant-based dye by LC-HRMS and multivariate analysis.

BACKGROUND: This study aimed to elucidate the current implementation status of medical practices for adult patients with food allergies (FA) in Japan. METHODS: A survey was conducted from October to December 2021 at the allergy specialist training facilities of the Japanese Society of Allergology, examining the status of medical practices for patients with food allergies in 2019. RESULTS: Of the 819 facilities, 273 (33%) treated childhood or adult patients with FA, 8% did not treat patients with FA, and 59% did not respond to the survey. Among the facilities, 24% treated adult patients with FA across various specialties: dermatology (45%), pediatrics (37%), otolaryngology (16%), internal medicine (14%), and ophthalmology (0%). The total number of adult patients with FA at the 273 facilities was 9260, with 37% having childhood-onset and 63% having adult-onset. Among childhood-onset cases, 99% were treated in pediatric departments. The oral food challenge (OFC) was available at 198 facilities (73%), including pediatrics (94%), dermatology (66%), internal medicine (30%), and otolaryngology facilities (0%). A total of 934 OFCs were conducted in adults, of which 63% were performed in pediatric departments. CONCLUSION: Medical practices for adult patients with FA in Japan remain insufficient, with inadequate transitional care for childhood-onset cases. Strengthening medical support, including OFC for adult patients with FA, and establishing seamless transitional care is necessary.

INTRODUCTION: Screening for ω-5 gliadin specific IgE antibody (sIgE) has high diagnostic utility in cases of suspected wheat-dependent exercise-induced anaphylaxis (WDEIA); however, negative cases may require confirmatory tests, such as the oral challenge test. Thus, newly identified allergens that can be used for the serological diagnosis of WDEIA are needed. This study aimed to identify additional sIgE biomarkers of WDEIA. METHODS: Forty-two patients with WDEIA (5 negative/37 positive for ω-5 gliadin sIgE) were enrolled. For comparison, 8 patients with immediate-type wheat allergy without WDEIA and 20 healthy controls without wheat allergy were also enrolled. Extracted wheat proteins were separated by 2D-PAGE. Proteins that reacted with serum IgE antibody in 2D Western blotting (2D-WB) were identified using mass spectrometry. Recombinant proteins were synthesized in Escherichia coli, and the antigenicity was tested using ELISA and the basophil activation test. RESULTS: In 2D-WB, nine proteins reacted with the serum IgE antibody from at least 60% of patients with WDEIA (n ≥ 25/42). ELISA revealed that alpha/beta gliadin MM1 exhibited the highest positive immunoreactivity in 23 of 26 patients who were positive for ω-5 gliadin sIgE (88%) and in 5 of 5 patients who were negative for ω-5 gliadin sIgE (100%). Alpha/beta gliadin MM1 exhibited significantly higher basophil activation in 14 patients with WDEIA when compared to 5 individuals without a wheat allergy. CONCLUSIONS: Alpha/beta gliadin MM1 sIgE exhibited the highest seropositivity, even among patients who were negative for ω-5 gliadin sIgE. The inclusion of alpha/beta gliadin MM1 in allergen-sIgE tests may improve the sensitivity for diagnosing WDEIA.

BACKGROUND: Immediate allergy caused by natto, a popular Japanese food prepared by fermenting soybeans with Bacillus subtilis var. natto, has been reported. Polygamma glutamic acid (PGA) in the sticky substance around natto beans has been reported to be a causative allergen of natto allergy. However, some of our patients with natto allergy were negative for PGA in the skin prick test (SPT). The sticky substance of natto beans contains a subtilisin family serine protease, nattokinase, along with PGA. In this study, we aimed to examine the antigenicity of nattokinase in natto allergy. METHODS: Eight patients, who developed symptoms after ingesting natto and positively reacted to natto (seven to the sticky substance in natto and one to the whole natto product) in their SPT, were enrolled in this study. To analyze IgE reactivity, we performed immunoblotting, ELISA, and SPT for natto (bean and sticky substance), and/or PGA, and/or nattokinase and/or cultured B. subtilis var. natto extract. RESULTS: In the SPT, four cases each were PGA-positive and PGA-negative. Immunoblotting of the sera from PGA-negative patients showed a protein band at 30 kDa, which was identified as nattokinase. Three PGA-negative cases, but not three PGA-positive cases, showed a positive reaction to nattokinase in the SPT and had a history of atopic dermatitis. The ELISA for nattokinase revealed a positive reaction of PGA-negative cases and negative reaction of PGA-positive cases in the SPT. CONCLUSIONS: We identified a subtilisin family serine protease, nattokinase, as a novel allergen in natto allergy patients unsensitized to PGA.

BACKGROUND: The Japanese baseline series (JBS), established in 1994, was updated in 2008 and 2015. The JBS 2015 is a modification of the thin-layer rapid-use epicutaneous (TRUE) test (SmartPractice Denmark, Hillerød, Denmark). No nationwide studies concerning the TRUE test have previously been reported. OBJECTIVES: To determine the prevalence of sensitizations to JBS 2015 allergens from 2015 to 2018. METHODS: We investigated JBS 2015 patch test results using the web-registered Skin Safety Care Information Network (SSCI-Net) from April 2015 to March 2019. RESULTS: Patch test results of 5865 patients were registered from 63 facilities. The five allergens with the highest positivity rates were gold sodium thiosulfate (GST; 25.7%), nickel sulfate (24.5%), urushiol (9.1%), p-phenylenediamine (PPD; 8.9%), and cobalt chloride (8.4%). The five allergens with the lowest positivity rates were mercaptobenzothiazole (0.8%), formaldehyde (0.9%), paraben mix (1.1%), mercapto mix (1.1%), and PPD black rubber mix (1.4%). CONCLUSIONS: Nickel sulfate and GST had the highest positivity rates. The JBS 2015, including a modified TRUE test, is suitable for baseline series patch testing.