Allergy Asthma Respir Dis AARD Allergy, Asthma & Respiratory Disease 2288-0402 2288-0410 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology 10.4168/aard.2017.5.6.331 Original Article Sensitization to component antigens in acute idiopathic urticaria in children Choi Young Jin 1 Yoon Jung Min 2 Chang Yeo Soon 2 https://orcid.org/0000-0003-2714-0065 Oh Jae-Won 1 2 Department of Pediatrics, Hanyang University Guri Hospital, Guri, Korea. Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea. Correspondence to: Jae-Won Oh. Department of Pediatrics, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 11923, Korea. Tel: +82-31-560-2254, Fax: +82-31-552-9493, jaewonoh@hanyang.ac.kr 11 2017 30 11 2017 5 6 331 335 03 05 2017 26 09 2017 27 09 2017 © 2017 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology 2017 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/). Purpose

The aim of this study was to evaluate hidden allergens of acute idiopathic urticaria (AIU) in childhood by using the component-resolved diagnostics (CRD).

 Methods

We applied CRD using pathogenesis-related protein family number 10 (PR-10) and nonspecific lipid transfer proteins (nsLTP).

 Results

Twenty-two of the 74 AIU children (29.7%) were found to be positive on CRD. Ten children were positive to nMal d 1 for apple (value range, 1.10–40.59), 6 to rConr a 1 for hazelnut (1.53–11.97), 4 to rPru p 1 for peach (1.32–11.83). 6 to rAra h 8 for peanut (1.20–8.12), 6 to nAct d 8 for kiwi (0.85–3.32), 4 to rBet v 1 for birch (2.49–54.28), and 3 to rAln g 1 for alder (2.32–5.74). Six children were positive to nPru p 3 for peach (1.45–18.77), 4 to rCor a 8 for hazelnut (2.56–9.19), 2 to nArt v 3 for mugwort (3.40–7.42), and 3 to rBet v2 to profilin of birch (2.56–17.46). Ten children with AIU were positive to multiple component proteins. For hazelnut, 5 children were positive to PR-10 (rConr a 1) and nsLTP (rConr a 1). For peach, 3 children were positive to PR-10 (rPru p 1) and nsLTP (nPru p 3).

 Conclusion

IgE sensitization to PR-10 or nsLTP may be allergen components for AIU in childhood.

 Urticaria Allergen Diagnosis Tuncel T Uysal P Arikan-Ayyildiz Z Firinci F Karaman O Uzuner N Pediatricians' approach to children with acute urticaria Minerva Pediatr 2016 68 96 102 Carr TF Saltoun CA Chapter 21: urticaria and angioedema Allergy Asthma Proc 2012 33 Suppl 1 S70 S72 Steele C Conlon N Edgar JD Diagnosis of immediate food allergy BMJ 2014 349 g3695 Valenta R Duchene M Vrtala S Birkner T Ebner C Hirschwehr R Recombinant allergens for immunoblot diagnosis of tree-pollen allergy J Allergy Clin Immunol 1991 88 889 894 Thomas WR Stewart GA Simpson RJ Chua KY Plozza TM Dilworth RJ Cloning and expression of DNA coding for the major house dust mite allergen Der p 1 in Escherichia coli Int Arch Allergy Appl Immunol 1988 85 127 129 Valenta R Vrtala S Ebner C Kraft D Scheiner O Diagnosis of grass pollen allergy with recombinant timothy grass (Phleum pratense) pollen allergens Int Arch Allergy Immunol 1992 97 287 294 Valenta R Kraft D Recombinant allergen molecules: tools to study effector cell activation Immunol Rev 2001 179 119 127 Canonica GW Ansotegui IJ Pawankar R Schmid-Grendelmeier P van Hage M Baena-Cagnani CE A WAO - ARIA - GA2LEN consensus document on molecular-based allergy diagnostics World Allergy Organ J 2013 6 17 Sastre J Molecular diagnosis in allergy Clin Exp Allergy 2010 40 1442 1460 Valenta R Lidholm J Niederberger V Hayek B Kraft D Grönlund H The recombinant allergen-based concept of component-resolved diagnostics and immunotherapy (CRD and CRIT) Clin Exp Allergy 1999 29 896 904 Wang J Lin J Bardina L Goldis M Nowak-Wegrzyn A Shreffler WG Correlation of IgE/IgG4 milk epitopes and affinity of milk-specific IgE antibodies with different phenotypes of clinical milk allergy J Allergy Clin Immunol 2010 125 695 702 702.e1 702.e6 Melioli G Compalati E Bonini S Canonica GW The added value of allergen microarray technique to the management of poly-sensitized allergic patients Curr Opin Allergy Clin Immunol 2012 12 434 439 Ruiz-García M García Del Potro M Fernández-Nieto M Barber D Jimeno-Nogales L Sastre J Profilin: a relevant aeroallergen? J Allergy Clin Immunol 2011 128 416 418 Hauser M Roulias A Ferreira F Egger M Panallergens and their impact on the allergic patient Allergy Asthma Clin Immunol 2010 6 1 Sastre J Landivar ME Ruiz-García M Andregnette-Rosigno MV Mahillo I How molecular diagnosis can change allergen-specific immunotherapy prescription in a complex pollen area Allergy 2012 67 709 711 Tripodi S Frediani T Lucarelli S Macrì F Pingitore G Di Rienzo Businco A Molecular profiles of IgE to Phleum pratense in children with grass pollen allergy: implications for specific immunotherapy J Allergy Clin Immunol 2012 129 834 839.e8 Nicolaou N Custovic A Molecular diagnosis of peanut and legume allergy Curr Opin Allergy Clin Immunol 2011 11 222 228 Shreffler WG Microarrayed recombinant allergens for diagnostic testing J Allergy Clin Immunol 2011 127 843 849 Borres MP Ebisawa M Eigenmann PA Use of allergen components begins a new era in pediatric allergology Pediatr Allergy Immunol 2011 22 454 461 Eigenmann PA Component-resolved diagnosis in food allergy, are micro-array assays helpful to the clinician? Allergy 2008 63 1519 1520 Mittermann I Zidarn M Silar M Markovic-Housley Z Aberer W Korosec P Recombinant allergen-based IgE testing to distinguish bee and wasp allergy J Allergy Clin Immunol 2010 125 1300 1307.e3 Müller U Schmid-Grendelmeier P Hausmann O Helbling A IgE to recombinant allergens Api m 1, Ves v 1, and Ves v 5 distinguish double sensitization from crossreaction in venom allergy Allergy 2012 67 1069 1073 Walsh J O'Flynn N Diagnosis and assessment of food allergy in children and young people in primary care and community settings: NICE clinical guideline Br J Gen Pract 2011 61 473 475 Vereda A van Hage M Ahlstedt S Ibañez MD Cuesta-Herranz J van Odijk J Peanut allergy: clinical and immunologic differences among patients from 3 different geographic regions J Allergy Clin Immunol 2011 127 603 607 Luengo O Cardona V Component resolved diagnosis: when should it be used? Clin Transl Allergy 2014 4 28 Valenta R Ferreira F Focke-Tejkl M Linhart B Niederberger V Swoboda I From allergen genes to allergy vaccines Annu Rev Immunol 2010 28 211 241 The results of 22 children with component-resolved diagnostics positive in 74 acute idiopathic urticarias
Subjects PR-10 nsLTP Profilins
Birch Alder Hazel nut Apple Peach Soybean Peanut Kiwi Peach Hazelnut Mugwort Birch
Sex Age (yr) rBet v 1 rAln g 1 rCor a 1.0401 rMal d 1 rPru p 1 rGly m 4 rAra h 8 nAct d 8 nPru p 3 rCor a 8 nArt v 3 rBet v 2
F 5 0.00 0.00 0.00 0.00 3.50 0.00 0.00 0.00 0.00 0.00 0.00 0.00
F 4 0.00 0.00 2.10 2.70 0.00 0.00 1.20 3.22 0.00 2.56 0.00 0.00
F 3 0.00 0.00 0.00 0.00 0.00 1.79 0.00 0.00 4.70 0.00 0.00 0.00
M 3 0.00 0.00 0.00 1.10 2.90 0.00 0.00 0.00 0.00 0.00 0.00 0.00
F 6 0.00 0.00 3.77 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
F 5 0.00 0.00 0.00 3.45 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
F 12 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2.45 0.00 0.00 0.00
M 13 0.00 0.00 0.00 0.00 0.00 4.26 0.00 0.00 0.00 0.00 0.00 0.00
M 10 6.83 0.00 0.00 3.34 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
M 7 0.00 0.00 1.53 0.00 0.00 0.00 0.00 0.00 18.77 9.19 7.42 17.46
F 9 0.00 0.00 0.00 0.00 0.00 0.00 2.78 1.56 4.60 0.00 0.00 0.00
F 7 0.00 4.23 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
F 2 0.00 0.00 0.00 4.83 0.00 0.00 0.00 3.32 0.00 0.00 0.00 0.00
M 11 0.00 0.00 0.00 0.00 11.83 1.05 0.76 0.85 1.45 0.00 0.00 0.00
M 13 0.00 0.00 0.00 3.32 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
M 10 2.49 0.00 3.23 0.00 0.00 0.00 0.00 1.26 0.00 3.23 0.00 0.00
F 8 0.00 0.00 0.00 8.67 4.34 0.00 0.00 0.00 3.55 0.00 0.00 0.00
F 7 4.82 2.32 5.20 0.00 0.00 0.00 0.00 3.26 0.00 0.00 3.40 10.29
M 13 0.00 0.00 0.00 40.59 8.89 0.00 8.12 0.00 0.00 0.00 0.00 0.00
M 6 0.00 0.00 0.00 12.34 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
M 14 54.28 5.74 11.97 2.20 1.32 0.00 0.00 0.00 2.27 3.44 0.00 2.56
F 2 0.00 0.00 0.00 0.00 0.00 2.56 0.00 0.00 0.00 0.00 0.00 0.00

PR-10, pathogenesis-related protein family number 10; nsLTP, nonspecific lipid transfer proteins.

 The positive results of PR-10 in children with acute idiopathic urticaria
Component No. of subject (%) Value range
rMal d 1 for apple 10 (45.5) 1.10–40.59
rCor a 1 for hazelnut 6 (27.3) 1.53–11.97
rAra h 8 for peanut 6 (27.3) 1.20–8.12
nAct d 8 for kiwi 6 (27.3) 0.85–3.32
rPru p 1 for peach 4 (18.2) 1.32–11.83
rGly m 4 for soybean 4 (18.2) 1.05–4.26
rBet v 1 for birch 4 (18.2) 2.49–54.28
rAln g 1 for alder 3 (13.6) 2.32–5.74

PR-10, pathogenesis-related protein family number 10.

 The positive results of nsLTP and profilin in children with acute idiopathic urticaria
Component No. of subject (%) Value range
nsLTP
 nPru p 3 for peach 7 (31.8) 1.45–18.77
 rCor a 8 for hazelnut 4 (18.2) 2.56–9.19
 nArt v 3 for mugwort 2 (9.1) 3.40–7.42
Profilin
 rBet v 2 for birch 3 (13.6) 2.56–17.46

nsLTP, nonspecific lipid transfer proteins.

 Multiple positive results of PR-10, profilin, and nsLTP in children with acute idiopathic urticaria
Source Component No. of subject (%)
Hazelnut PR-10 (rCor a 1) and nsLTP (rCor a 1) 4 (18.2)
Peach PR-10 (rPru p 1) and nsLTP (nPru p 3) 3 (13.6)
Birch PR-10 (rBet v 1) and profilin (rBet v 2) 2 (9.1)

PR-10, pathogenesis-related protein family number 10.