Component-resolved diagnosis of baker's allergy based on specific IgE to recombinant wheat flour proteins

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:135

Article

Sander, Ingrid¹  Rihs, Hans-Peter¹  Doekes, Gert²  Quirce, Santiago^3,4  Krop, Esmeralda²  Rozynek, Peter¹  van Kampen, Vera¹  Merget, Rolf¹  Meurer, Ursula¹  Bruening, Thomas¹  Raulf, Monika¹ 

[1] Ruhr Univ Bochum IPA, Inst Prevent & Occupat Med, German Social Accid Insurance, Bochum, Germany

[2] Univ Utrecht, IRAS, NL-3508 TC Utrecht, Netherlands

[3] Hosp La Paz Inst Hlth Res IdiPAZ, Dept Allergy, Madrid, Spain

[4] CIBER Resp Dis CIBERES, Madrid, Spain

关键词: Baker's asthma;    Triticum aestivum;    recombinant allergens;    alpha-amylase inhibitor;    cross-reactivity;    grass pollen;    rye flour;    wheat allergy;    specific IgE;    component-resolved diagnosis;   

DOI  :  10.1016/j.jaci.2014.11.021

来源: Elsevier

【 摘 要 】

Background: Sensitization to wheat flour plays an important role in the development and diagnosis of baker's asthma. Objectives: We evaluated wheat allergen components as sensitizers for bakers with work-related complaints, with consideration of cross-reactivity to grass pollen. Methods: Nineteen recombinant wheat flour proteins and 2 cross-reactive carbohydrate determinants were tested by using CAP-FEIA in sera of 101 bakers with wheat flour allergy (40 German, 37 Dutch, and 24 Spanish) and 29 pollen-sensitized control subjects with wheat-specific IgE but without occupational exposure. IgE binding to the single components was inhibited with wheat flour, rye flour, and grass pollen. The diagnostic efficiencies of IgE tests with single allergens and combinations were evaluated by assessing their ability to discriminate between patients with baker's allergy and control subjects based on receiver operating characteristic analyses. Results: Eighty percent of bakers had specific IgE levels of 0.35 kU(A)/L or greater and 91% had specific IgE levels of 0.1 kU(A)/L or greater to at least one of the 21 allergens. The highest frequencies of IgE binding were found for thiol reductase (Tri a 27) and the wheat dimeric a-amylase inhibitor 0.19 (Tri a 28). Cross-reactivity to grass pollen was proved for 9 components, and cross-reactivity to rye flour was proved for 18 components. A combination of IgE tests to 5 components, Tri a 27, Tri a 28, tetrameric a-amylase inhibitor CM2 (Tri a 29.02), serine protease inhibitor like allergen (Tri a 39), and 1-cys-peroxiredoxin (Tri a 32), produced the maximal area under the curve (AUC = 0.84) in receiver operating characteristic analyses, but this was still lower than the AUC for wheat- or rye flour specific IgE (AUC = 0.89 or 0.88, respectively). Conclusions: Component-resolved diagnostics help to distinguish between sensitization caused by occupational flour exposure and wheat seropositivity based on cross-reactivity to grass pollen. For routine diagnosis of baker's allergy, however, allergen-specific IgE tests with whole wheat and rye flour extracts remain mandatory because of superior diagnostic sensitivity.

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