R Asero1, E Scala2, D Villalta3, V Pravettoni4, A Arena5, L Billeri6, G Colombo7, G Cortellini8, F Cucinelli9, M L De Cristofaro10, L Farioli11, E Iemoli12, F Lodi Rizzini13, R Longo14, L Losappio15, D Macchia16, G Maietta17, P Minale18, F Murzilli9, F Nebiolo19, E A Pastorello15, M T Ventura20, S Voltolini18, S Amato21, G Mistrello21. 1. Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano (MI), Italy. 2. Istituto Dermopatico dell´Immacolata - IRCCS, Roma, Italy. 3. SSD di Allergologia e Immunologia Clinica, Azienda Ospedaliera S. Maria degli Angeli, Pordenone, Italy. 4. UOC Clinical Allergy and Immunology, IRCCS Foundation Ca´ Granda Ospedale Maggiore Policlinico, Milan, Italy. 5. Ambulatorio Allergologia, Azienda Usl 5 di Messina, Messina, Italy. 6. Department of Laboratory Medicine, University Hospital, Padova, Italy. 7. Allergy and Clinical Immunology Unit, IRCCS San Raffaele Hospital, Milan, Italy. 8. UO di Medicina Interna e Reumatologia, Azienda Sanitaria della Romagna, Rimini, Italy. 9. UOSD di Allergologia, Ospedale SS Filippo e Nicola di Avezzano, Avezzano (AQ), Italy. 10. Ambulatorio di Allergologia, Ospedale San Timoteo, Termoli (CB), Italy. 11. Department of Laboratory Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. 12. Allergy and Clinical Immunology Unit, ASST Fatebenefratelli/Sacco, Milano, Italy. 13. SSVD Allergologia, AO Spedali Civili di Brescia, Brescia, Italy. 14. Ambulatorio Territoriale di Allergologia, ASP Vibo Valentia, Italy. 15. Department of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. 16. Allergologia Immunologia Clinica, PO S Giovanni di Dio, Firenze, Italy. 17. Ambulatorio di Allergologia Accreditato ASL, Lecce, Italy. 18. UOC Allergologia IRCCS San Martino-IST, Genova, Italy. 19. Ambulatorio di Allergologia e Immunologia, AO Ordine Mauriziano, Torino, Italy. 20. Dipartimento di Medicina Interna, Immunologia e Malattie Infettive, Università di Bari, Policlinico, Bari, Italy. 21. R & D, Lofarma, Milano, Italy.
Abstract
BACKGROUND AND OBJECTIVE: Skin prick testing (SPT) with commercial extracts is the first step in the diagnosis of shrimp allergy, although its clinical efficiency is unknown. Objective: To analyze the clinical usefulness of all commercial crustacean extracts available for SPT in Italy. METHODS: We performed a multicenter study of 157 shrimp-allergic patients who underwent SPT with 5 commercial crustacean extracts and with house dust mite (HDM) extract. Commercial extracts were analyzed using SDS-PAGE and compared with a freshly prepared in-house shrimp extract. IgE to Pen a 1/Pen m 1, Pen m 2, and Pen m 4 was determined, and immunoblot analysis was performed on a large number of sera. RESULTS: The skin reactions caused by commercial crustacean extracts were extremely heterogeneous, resulting in 32 clinical profiles, with marked differences in protein content and missing proteins at molecular weights corresponding to those of major shrimp allergens. Only strong Pen a 1/Pen m 1 reactors reacted to both HDM and all 5 commercial extracts in SPT. Most patients, including those who were tropomyosin-negative, reacted to HDM. Patients reacted to a large and variable array of proteins, and IgE reactivity was common at high molecular weights (>50 kDa). CONCLUSIONS: The in vivo diagnosis of shrimp allergy must continue to be based on SPT with fresh material. Shrimp-allergic patients frequently react to a number of ill-defined high-molecular-weight allergens, thus leaving currently available materials for component-resolved diagnosis largely insufficient. Mites and crustaceans probably share several allergens other than tropomyosin.
BACKGROUND AND OBJECTIVE: Skin prick testing (SPT) with commercial extracts is the first step in the diagnosis of shrimp allergy, although its clinical efficiency is unknown. Objective: To analyze the clinical usefulness of all commercial crustacean extracts available for SPT in Italy. METHODS: We performed a multicenter study of 157 shrimp-allergicpatients who underwent SPT with 5 commercial crustacean extracts and with house dust mite (HDM) extract. Commercial extracts were analyzed using SDS-PAGE and compared with a freshly prepared in-house shrimp extract. IgE to Pen a 1/Pen m 1, Pen m 2, and Pen m 4 was determined, and immunoblot analysis was performed on a large number of sera. RESULTS: The skin reactions caused by commercial crustacean extracts were extremely heterogeneous, resulting in 32 clinical profiles, with marked differences in protein content and missing proteins at molecular weights corresponding to those of major shrimp allergens. Only strong Pen a 1/Pen m 1 reactors reacted to both HDM and all 5 commercial extracts in SPT. Most patients, including those who were tropomyosin-negative, reacted to HDM. Patients reacted to a large and variable array of proteins, and IgE reactivity was common at high molecular weights (>50 kDa). CONCLUSIONS: The in vivo diagnosis of shrimp allergy must continue to be based on SPT with fresh material. Shrimp-allergicpatients frequently react to a number of ill-defined high-molecular-weight allergens, thus leaving currently available materials for component-resolved diagnosis largely insufficient. Mites and crustaceans probably share several allergens other than tropomyosin.
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