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Table 1 Patient characteristics

From: ALEX versus ISAC multiplex array in analyzing food allergy in atopic children

Patient

(Sex M/F; age yr)

Food allergies

(clinically relevant)

Inhalation allergies

(clinically relevant)

Asthma

Eczema

Unexplained anaphylaxis

in history

Possibly relevant extra results (negative and positive sensitizations) found by ALEX

not present in ISAC

Sensitizations found by ALEX with unknown clinical relevance

Dietary modifications or extra challenge tests performed based on ALEX results

1

(M; 16)

Egg, peanut, nuts, coconut, legumes, wheat, seeds, carrot, banana, kiwi

Mites, trees, multiple animals

Yes

Yes

No

Highly positive; all sorts of nuts, legumes (except green bean), cereals incl. buckwheat and seeds

Moderately positive: caraway, cricket, storage mite(Lep d 2)

Negative: banana extract

Cricket, mealworm (low), caraway, fenugreek,  poppy seeds, storage mites, lupin

No dietary modifications

Optional: challenge test banana or green bean in future

2

(M; 12)

Nuts

Trees, grass, multiple animals

No

No

Yes

Highly positive: all sorts nuts and seeds (except fenugreek)

Moderate- highly positive: LTP proteins Act d 10 (kiwi), Mal d 3 (apple), Vit v 1 (grapes), Api g 2 (celery), Zea m 14 (corn). Buckwheat, chickpea extract, storage mites (Gly d 2, Lep d 2)

Storage mites

Cor a 14 (hazelnut)

Fag e 2 (buckwheat) (both negative in ISAC)

No dietary modifications

Food challenge tests performed for poppy seeds and buckwheat: both negative

3 (M;12)

Cow’s milk, nuts, certain legumes (except brown and green beans)

Mites, trees, grass, dog

Yes

No

Yes

Moderately positive: all legumes (except green bean), sunflower and poppy seeds, mustard, beef and pork

Negative: extracts and components for pistachio- and macadamia nuts, components cashewnut (Ana o 2, Ana o 3)

Cricket, grasshopper, mealworm and buckwheat (low sensitizations), lupin, seeds incl. poppy seeds and fenugreek 

No dietary modifications

Optional: challenge test cashewnut / pistachio and macadamia nut in future

4

(M: 15)

Nuts, sesame, bean sprouts, legumes (except brown and green beans), kiwi

Mites

Yes

Yes

No

Highly positive; all sorts of nuts, seeds incl. sesame and poppy seeds, buckwheat

Moderately positive: caraway, anise, chickpeas

Negative/very low: peas, lentils and green bean

Caraway, anise, buckwheat, poppy seeds

No dietary modifications

Optional: challenge test peas or lentils in future

5

(M; 7)

Cow’s milk, nuts, kiwi, fish

Also avoids seafood

No clinical relevant

Yes

Yes

No

Highly positive; all sorts of nuts (except macadamia), all sorts of fish (parvalbumins), beef potato and mustard, storage mites (Aca s, Gly d 2, Lep d 2, Tyr p)

Moderately positive: chickpeas, lentils, peas, buckwheat, lupin, sunflower, poppy and sesame seeds, beef, pork and rabbit

Negative/very low: macadamia nut, all seafood species

Chickpeas, lentils, seeds incl. fenugreek, poppy seeds, mustard,  buckwheat, lupin, rabbit meat, storage mites

Jug r 1 (walnut; negative in ISAC)

Introducing seafood allowed

Optional: challenge test macadamia nut in future

6

(M; 13)

Peanut, nuts (except almond)

Mites, trees, grass, multiple animals

Yes

Yes

No

Highly positive; cashewnut, pistachio, pecan- and walnut

Moderately positive: pear, storage mites (Gly d 2, Lep d 2)

Negative: macadamia- and brazil nut and almond

Storage mites

No dietary modifications

Optional: challenge test brazil or macadamia nut in future

7

(F; 13)

Cow’s milk, egg, soy, hazelnut

Avoids all nuts and fish

Mites, trees, grass, multiple animals

Yes

Yes

No

Moderate positive; tuna, carper and sword fish (parvalbumins), north sea shrimp (Troponin C), oyster, cashewnut and brazil nut extract (components negative), caraway and anise, cricket, grasshopper, mealworm, storage mites (Aca s, Tyr p, Lep d 2)

Negative/very low: pecan- and walnut, macadamia and pistachio nut

North sea shrimp, fish, cricket, grasshopper, mealworm, storage mites, poppy seeds

No dietary modifications

Optional: challenge test for any nut in future

8

(M; 11)

Peanut, peas, white beans, bean sprouts, walnut and pecan nut, fish

Also avoids seafood and big amounts of lentils and peas

Mites, trees, grass, multiple animals

Yes

Yes

No

Highly positive: All nuts (except almond and macadamia), all legumes, all fishes, cricket, grasshopper mealworm, pork, lamb, all storage mites

Moderately positive: buckwheat, lupin, corn, figue, strawberry, celery, pumpkin seeds, poppy seeds and fenugreek

Negative or very low: seafood

Buckwheat, lupin, pork, cricket, grasshopper, mealworm, storage mites, fenugreek, poppy seeds

Introducing seafood allowed

Avoiding insects from diet

Already eating all nuts (except walnut and pecannut) without symptoms

9

(F; 11)

Cashew nut, pistachio nut, kiwi

Mites, trees, grass, cat

No

Yes

No

Highly positive: cashewnut and pistachio nut, north sea shrimp (Troponin C), storage mite (Gly d 2)

Moderately positive: cricket and grasshopper, storage mites (Tyr p; Lep d 2, Aca s)

Negative: all other nuts

Cricket, grasshopper, storage mites

No dietary modifications

10

(M; 8)

Peanut, nuts (except almond), sesame, kiwi

Mites, trees, grass, multiple animals

No

Yes

Yes

Highly positive: all nuts (incl almond), buckwheat, sunflowers seeds, poppy seeds, tuna fish and sword fish (parvalbumines) and chickpeas, storage mites (Lep d2)

Moderately positive: lentils, lupin

Chickpeas, lentils, buckwheat, lupin, sunflower and poppy seeds, fish, storage mites

No dietary modifications

Eating almonds without symptoms

  1. Extra food allergen components and whole allergen extracts in ALEX, not present in ISAC
  2. Egg, cow’s milk and peanut: whole allergen extract for egg yolk, egg white and cow’s milk; Gal d 4 (egg white; Lysozyme C) and Ara h 15 (peanut; Oleosine)
  3. Nuts: whole allergen extracts for cashew, brazil, pecan, macadamia and almond; Cor a 11 (hazelnut; 7/8S Globulin); Jug r 2 (walnut; 7/8S Globulin), Jug r 4 (walnut; 11S Globulin), Jug r 6 (walnut; 7/8S Globulin); Mac i 2S (macadamia nut; 2S Albumin); Pis v 1 (pistachio; 2S Albumin), Pis v 2 (pistachio; 11S Globulin subunit) and Pis v 3 (pistachio; 7/8S Globulin)
  4. Legumes: whole allergen extracts for peas, chick peas, lentils and green bean and Gly m 8 (soy; 2S Albumin)
  5. Cereals: oats, quinoa, buckwheat, barley, millet, lupine, rye, spelt, rice and corn extracts and Zea m 14 (corn; nsLTP)
  6. Fish and seafood: whole allergen extracts and components for eight fish species (codfish, carp, herring, mackerel, salmon, stingray, swordfish and tuna), three prawn species (north sea shrimp, pacific white shrimp and northern pink shrimp), crab and lobster and five mollusks species (clam, mussel, oyster, scallop and squid)
  7. Fruits: Whole allergen extracts for: papaya, orange, mango, banana, cherry, pear, blueberry. Act d 10 (kiwi; nsLTP), Cuc m 2 (melon; profillin), Fra a1 + 3 (strawberry; PR10 + nsLTP), Mal d 2 (apple; TLP), Mal d 3 (apple; nsLTP) and Vit v 1 (grape; nsLTP)
  8. Vegetables: whole allergen extracts for: onion, garlic, carrot, avocado, potato and tomato. Api g 2 and Api g 6 (celery; nsLTPs), Dau c 1 (carrot; PR-10), Sola l 6 (tomato; nsLTP)
  9. Seeds: whole allergen extracts for pumpkin seeds, sunflower seeds, poppy seeds, sesame seeds and fenugreek
  10. Spices: whole allergen extracts for paprika, caraway, oregano, parsley, anise and mustard and Sin a 1 (mustard; 2S Albumin)
  11. Meat: whole allergen extracts for beef, chicken, pork, turkey, rabbit, lamb, horse, cricket, grasshopper and mealworm and Sus d 1 (pork; Serumalbumin)
  12. Other animal products:: whole allergen extracts for goat’s milk, camel’s milk, horse’s milk, sheep’s milk
  13. Storage mites: whole allergen extract for Acarus siro (Aca s), Tyrophagus putrescentiae (Tyr p); Blo t 10 (Blomia tropicalis; Tropomyosin), Blo t 21 (Blomia tropicalis), Gly d 2 (Glycyphagus domesticus; NPC2 family), Lep d 2 (Lepidoglyphus destructor, NPC2 family), Tyr p 2 (Tyrophagus putrescentiae; NPC2 family)
  14. Extra food allergen components in ISAC not present in ALEX
  15. Cow’s milk: Bos d lactoferrin (cow’s milk; Transferrin)
  16. Fruit: Pru p 1 (peach; PR-10), Act d 8 (kiwi; PR-10)
  17. Meat: Alpha-Gal (Gal-alfa-1,3-gal)
  18. Different results between ALEX and ISAC for overlapping components are highlighted in bold italics