Bernad, A. (Amalia)
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- Unraveling the Diagnosis of Kiwifruit Allergy: Usefulness of Current Diagnostic Tests(Esmon Publicidad, 2022) Garrido-Arandía, (M.) María; Bernad, A. (Amalia); Goikoetxea-Lapresa, M.J. (María José); Gastaminza, G. (Gabriel); Díaz-Perales, A. (Araceli); Azofra, J. (Julián); Bueno-Díaz, C. (Cristina); Garrido-Fernández, S. (Sara); D'Amelio-Garofalo, C.M. (Carmen Mariana); Garcia, B.E. (Blanca Esther); Villalba, M. (Mayte); Ferrer-Cardona, M. (Marta)Objectives: To determine the usefulness of the in vitro and in vivo methods used in the diagnosis of kiwifruit allergy and to specifically assess the impact of seed proteins on sensitivity. Methods: We performed skin prick tests (SPTs) using various commercial extracts, homemade pulp, and seed extracts and prick-prick tests with kiwifruit on 36 allergic patients. The presence of specific IgE (sIgE) was assessed using the ImmunoCAP (kiwifruit extract), ELISA (Act d 1, Act d 2), ISAC, and FABER assays. Immunoblotting of seed extract was carried out, and a single-blind oral food challenge was performed with whole seeds in seed-sensitized individuals. Results: The prick prick test with kiwifruit demonstrated the highest diagnostic capacity (81.8% sensitivity and 94.1% specificity) among the in vivo tests. The sIgE levels measured using ImmunoCAP (kiwifruit extract) showed a similar sensitivity to that of global ISAC and FABER (63.9%, 59.5%, and 58.3%, respectively). Act d 1 was the major allergen. Sensitization to Act d 1 was associated with positive sIgE results to whole kiwifruit extract detected by ImmunoCAP (P<.000). A positive SPT result to kiwifruit seeds was associated with severe symptoms induced by kiwifruit (P=.019) as a marker of advanced disease, but not with clinically relevant sensitization. Challenge testing with kiwifruit seeds performed on 8 seed-sensitized patients yielded negative results. Conclusions: Sensitization to Act d 1 is associated with a positive result in conventional diagnostic techniques, whereas kiwifruit seed sensitization does not increase the sensitivity of the diagnostic techniques evaluated.
- Improvement of the Elevated Tryptase Criterion to Discriminate IgE- From Non–IgE-Mediated Allergic Reactions(International Anesthesia Research Society, 2018) Bernad, A. (Amalia); Goikoetxea-Lapresa, M.J. (María José); Gastaminza, G. (Gabriel); D'Amelio-Garofalo, C.M. (Carmen Mariana); Lafuente, A. (A.); Martinez-Molina, J.A. (Juan Ambrosio); Ferrer-Cardona, M. (Marta); Nuñez-Cordoba, J.M. (Jorge M.)BACKGROUND: Differentiating between immunoglobulin E (IgE)-dependent and IgE-independent hypersensitivity reactions may improve the etiologic orientation and clinical management of patients with allergic reactions in the anesthesia setting. Serum tryptase levels may be useful to discriminate the immune mechanism of allergic reactions, but the diagnostic accuracy and optimal cutpoint remain unclear. We aimed to compare the diagnostic accuracy of tryptase during reaction (TDR) alone and the TDR/basal tryptase (TDR/BT) ratio for discriminating IgE- from non–IgE-mediated allergic reac- tions, and to estimate the best cut point for these indicators. METHODS: We included 111 patients (45% men; aged 3–99 years) who had experienced an allergic reaction, even though the allergic reaction could be nonanaphylactic. Allergy tests were performed to classify the reaction as an IgE- or non–IgE-mediated one. The area under the curve (AUC) of the receiver operating characteristic analysis was performed to estimate the discrimi- native ability of TDR and TDR/BT ratio. RESULTS: An IgE-mediated reaction was diagnosed in 49.5% of patients, of whom 56% met ana- phylaxis criteria. The median (quartiles) TDR for the IgE-mediated reactions was 8.0 (4.9–19.6) and 5.1 (3.5–8.1) for the non–IgE-mediated (P = .022). The median (quartiles) TDR/BT ratio was 2.7 (1.7–4.5) in IgE-mediated and 1.1 (1.0–1.6) in non–IgE-mediated reactions (P < .001). The TDR/BT ratio showed the greatest ability to discriminate IgE- from non–IgE-mediated reac- tions compared to TDR (AUC TDR/BT = 0.79 [95% confidence interval (CI), 1.1–2.2] and AUC TDR = 0.66 [95% CI, 1.1–2.2]; P = .003). The optimal cut point for TDR/BT (maximization of the sum of the sensitivity and specificity) was 1.66 (95% CI, 1.1–2.2). CONCLUSIONS: The TDR/BT ratio showed a significantly better discriminative ability than TDR to discriminate IgE- from non–IgE-mediated allergic reactions. An optimal TDR/BT ratio thresh- old of approximately 1.66 may be useful in clinical practice to classify allergic reactions as IgE- or non–IgE-mediated. (Anesth Analg 2018;127:414–9)