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  1. Article ; Online: Tick-induced allergies: mammalian meat allergy and tick anaphylaxis.

    van Nunen, Sheryl A

    The Medical journal of Australia

    2018  Volume 208, Issue 7, Page(s) 316–321

    Abstract: Mammalian meat allergy after tick bites and tick anaphylaxis are the most serious tick-induced allergies. They are often severe, should be largely avoidable and offer fascinating insights into the development and prevention of allergies. Australian ... ...

    Abstract Mammalian meat allergy after tick bites and tick anaphylaxis are the most serious tick-induced allergies. They are often severe, should be largely avoidable and offer fascinating insights into the development and prevention of allergies. Australian clinicians reported the first cases of tick anaphylaxis and discovered the association between tick bites and the development of mammalian meat allergy. The subsequent finding of the allergen epitope within the meat responsible for the allergic reaction, α-gal (galactose-α-1,3-galactose), stimulated further interest in this emergent allergy. Reports of mammalian meat allergy associated with bites from several tick species have now come from every continent where humans are bitten by ticks. The number of diagnosed patients has continued to rise. Clinically, mammalian meat allergy and tick anaphylaxis present quite differently. The prominent role of cofactors in triggering episodes of mammalian meat allergy can make its diagnosis difficult. Management of mammalian meat allergy is complicated by the manifold potential therapeutic implications due to the widespread distribution of the mammalian meat allergen, α-gal. Exposures to α-gal-containing medications have proved lethal in a minority of people, and fatal tick anaphylaxis has been reported in Australia. Prevention of tick bites is prudent and practicable; killing the tick in situ is crucial to both primary and secondary prevention of allergic reactions. Mechanisms in the development of mammalian meat allergy constitute a paradigm for how allergies might arise.
    MeSH term(s) Anaphylaxis/immunology ; Anaphylaxis/parasitology ; Animals ; Food Hypersensitivity/immunology ; Food Hypersensitivity/parasitology ; Humans ; Mammals ; Meat ; Tick-Borne Diseases/immunology
    Language English
    Publishing date 2018-03-27
    Publishing country Australia
    Document type Journal Article ; Review
    ZDB-ID 186082-3
    ISSN 1326-5377 ; 0025-729X
    ISSN (online) 1326-5377
    ISSN 0025-729X
    DOI 10.5694/mja17.00591
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  2. Article ; Online: Intravenous immunoglobulin and the current risk of moderate and severe anaphylactic events, a cohort study.

    Martinez, Carlos / Wallenhorst, Christopher / van Nunen, Sheryl

    Clinical and experimental immunology

    2021  Volume 206, Issue 3, Page(s) 384–394

    Abstract: This large cohort study from the US Premier Healthcare Database evaluated the risk and predictors of anaphylaxis in association with intravenous immunoglobulin (IvIg) therapy in the inpatient and outpatient setting. Data were collected retrospectively ( ... ...

    Abstract This large cohort study from the US Premier Healthcare Database evaluated the risk and predictors of anaphylaxis in association with intravenous immunoglobulin (IvIg) therapy in the inpatient and outpatient setting. Data were collected retrospectively (January 2009-December 2018) from 24 919 patients administered IgPro10 IvIg, median age 54 years. Immunoglobulins of interest were IgPro10 and other IvIg given before or after IgPro10. Moderate and severe anaphylaxis was identified from same-day parenteral epinephrine and IvIg use and reviews of patient record summaries. Predictors for first anaphylactic reactions associated with IvIg administration were derived from adjusted incidence rate ratios (IRR) using Poisson regression. Moderate anaphylaxis in IvIg use was rare and severe anaphylaxis very rare based on a total of 124 moderate and four non-fatal severe first anaphylactic events, incidence rate of 7.11 and 0.23/10 000 IvIg administrations, respectively. Age under 18 years was an independent predictor of moderate or severe anaphylactic events [adjusted incidence rate ratio = 2.94, 0.95 confidence interval  = 1.91-4.52] compared with those aged 18 years and older. First IvIg administration was a strong predictor of anaphylaxis. The IRR in those with a subsequent IvIg administration in the preceding 42 days decreased to 0.27 (0.17-0.42) and in those effectively IvIg-naive (no IvIg for > 42 days) to 0.76 (0.44-1.32) compared with first IvIg use. The key conclusions from this study are that the risk of anaphylaxis has progressively reduced over the last decade, from 14.87 of 10 000 in 2009-10 to 4.39 of 10 000 IvIg administrations in 2017-18 and is rare overall, and that the risk of anaphylaxis is increased in those aged under 18 years.
    MeSH term(s) Adrenergic Agonists/therapeutic use ; Anaphylaxis/drug therapy ; Anaphylaxis/epidemiology ; Epinephrine/therapeutic use ; Female ; Humans ; Immunoglobulin G/adverse effects ; Immunoglobulin G/therapeutic use ; Immunoglobulins, Intravenous/adverse effects ; Immunoglobulins, Intravenous/therapeutic use ; Incidence ; Male ; Middle Aged ; Retrospective Studies ; Risk ; Urticaria/epidemiology
    Chemical Substances Adrenergic Agonists ; Immunoglobulin G ; Immunoglobulins, Intravenous ; Epinephrine (YKH834O4BH)
    Language English
    Publishing date 2021-10-17
    Publishing country England
    Document type Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 218531-3
    ISSN 1365-2249 ; 0009-9104 ; 0964-2536
    ISSN (online) 1365-2249
    ISSN 0009-9104 ; 0964-2536
    DOI 10.1111/cei.13665
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  3. Article ; Online: The Human Health Impacts of the Red Imported Fire Ant in the Western Pacific Region Context: A Narrative Review.

    Lopez, Diego J / Winkel, Kenneth D / Wanandy, Troy / van Nunen, Sheryl / Perrett, Kirsten P / Lowe, Adrian J

    Tropical medicine and infectious disease

    2024  Volume 9, Issue 4

    Abstract: Background: ...

    Abstract Background:
    Language English
    Publishing date 2024-03-26
    Publishing country Switzerland
    Document type Journal Article ; Review
    ISSN 2414-6366
    ISSN (online) 2414-6366
    DOI 10.3390/tropicalmed9040069
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  4. Article: Tick-induced allergies: mammalian meat allergy, tick anaphylaxis and their significance.

    van Nunen, Sheryl

    Asia Pacific allergy

    2015  Volume 5, Issue 1, Page(s) 3–16

    Abstract: Serious tick-induced allergies comprise mammalian meat allergy following tick bites and tick anaphylaxis. Mammalian meat allergy is an emergent allergy, increasingly prevalent in tick-endemic areas of Australia and the United States, occurring worldwide ... ...

    Abstract Serious tick-induced allergies comprise mammalian meat allergy following tick bites and tick anaphylaxis. Mammalian meat allergy is an emergent allergy, increasingly prevalent in tick-endemic areas of Australia and the United States, occurring worldwide where ticks are endemic. Sensitisation to galactose-α-1,3-galactose (α-Gal) has been shown to be the mechanism of allergic reaction in mammalian meat allergy following tick bite. Whilst other carbohydrate allergens have been identified, this allergen is unique amongst carbohydrate food allergens in provoking anaphylaxis. Treatment of mammalian meat anaphylaxis involves avoidance of mammalian meat and mammalian derived products in those who also react to gelatine and mammalian milks. Before initiating treatment with certain therapeutic agents (e.g., cetuximab, gelatine-containing substances), a careful assessment of the risk of anaphylaxis, including serological analysis for α-Gal specific-IgE, should be undertaken in any individual who works, lives, volunteers or recreates in a tick endemic area. Prevention of tick bites may ameliorate mammalian meat allergy. Tick anaphylaxis is rare in countries other than Australia. Tick anaphylaxis is secondarily preventable by prevention and appropriate management of tick bites. Analysis of tick removal techniques in tick anaphylaxis sufferers offers insights into primary prevention of both tick and mammalian meat anaphylaxis. Recognition of the association between mammalian meat allergy and tick bites has established a novel cause and effect relationship between an environmental exposure and subsequent development of a food allergy, directing us towards examining environmental exposures as provoking factors pivotal to the development of other food allergies and refocusing our attention upon causation of allergy in general.
    Language English
    Publishing date 2015-01-28
    Publishing country Korea (South)
    Document type Journal Article ; Review
    ZDB-ID 2614800-6
    ISSN 2233-8268 ; 2233-8276
    ISSN (online) 2233-8268
    ISSN 2233-8276
    DOI 10.5415/apallergy.2015.5.1.3
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  5. Article ; Online: Newly Recognized α-Gal Syndrome in the Upper Midwestern United States.

    Chacon Osorio, Gina R / Palraj, Raj / van Nunen, Sheryl / White, Michael J

    Mayo Clinic proceedings

    2022  Volume 97, Issue 9, Page(s) 1754–1755

    MeSH term(s) Food Hypersensitivity ; Humans ; Immunoglobulin E ; Midwestern United States/epidemiology
    Chemical Substances Immunoglobulin E (37341-29-0)
    Language English
    Publishing date 2022-06-23
    Publishing country England
    Document type Letter
    ZDB-ID 124027-4
    ISSN 1942-5546 ; 0025-6196
    ISSN (online) 1942-5546
    ISSN 0025-6196
    DOI 10.1016/j.mayocp.2022.07.003
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    Ua VI Zs.183: Show issues Location:
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  6. Article: A novel Australian tick

    Kwak, Mackenzie / Somerville, Colin / van Nunen, Sheryl

    Asia Pacific allergy

    2018  Volume 8, Issue 3, Page(s) e31

    Abstract: Tick-induced mammalian meat allergy has become an emergent allergy world-wide after van Nunen et al. first described the association between tick bites and the development of mammalian meat allergy in 2007. Cases of mammalian meat allergy have now been ... ...

    Abstract Tick-induced mammalian meat allergy has become an emergent allergy world-wide after van Nunen et al. first described the association between tick bites and the development of mammalian meat allergy in 2007. Cases of mammalian meat allergy have now been reported on all 6 continents where humans are bitten by ticks, in 17 countries - Australia, United States of America (USA), Europe (France, Spain, Germany, Belgium, Switzerland, Sweden, United Kingdom, Italy, and Norway), Asia (Korea and Japan), Central America (Panama), South America (Brazil), and Africa (South Africa and Ivory Coast). To date, in each of these countries, bites from only a single tick species have been linked to the development of mammalian meat allergy:
    Language English
    Publishing date 2018-07-26
    Publishing country Korea (South)
    Document type Case Reports
    ZDB-ID 2614800-6
    ISSN 2233-8268 ; 2233-8276
    ISSN (online) 2233-8268
    ISSN 2233-8276
    DOI 10.5415/apallergy.2018.8.e31
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  7. Article: Tick killing

    Taylor, Benjamin William Phillips / Ratchford, Andrew / van Nunen, Sheryl / Burns, Brian

    Asia Pacific allergy

    2019  Volume 9, Issue 2, Page(s) e15

    Abstract: Background: Tick anaphylaxis is a potentially fatal outcome of improper tick removal and management.: Objective: To investigate whether killing ticks in-situ with ether-containing sprays or permethrin cream, before careful removal by the mouthparts ... ...

    Abstract Background: Tick anaphylaxis is a potentially fatal outcome of improper tick removal and management.
    Objective: To investigate whether killing ticks in-situ with ether-containing sprays or permethrin cream, before careful removal by the mouthparts could reduce this risk.
    Methods: This was a prospective study at Mona Vale Hospital Emergency Department (ED) in Sydney, New South Wales, over a 6-month period during the peak tick season of 2016. Tick removal methods, allergic/anaphylactic reactions were recorded for patients presenting with ticks
    Results: One hundred twenty-one patients met study inclusion criteria. Sixty-one patients (28 known tick-hypersensitive) had ticks killed with Wart-Off Freeze or Lyclear Scabies Cream (5% w/w permethrin) before removal with fine-tipped forceps or Tick Twister. Three patients (2 known tick-hypersensitive) had allergic reactions (5%), none anaphylactic. The 2 known hypersensitive patients suffered reactions during the killing process and the third patient had a particularly embedded tick meaning it could not be removed solely by mouthparts. Fifty patients presented to the ED posttick removal by various methods, none using either fine-tipped forceps or Tick Twister, of which 43 (86%) experienced allergic reactions - 2 anaphylactic. Five patients suffered allergic reactions before presentation despite no attempt at kill or removal, but ticks had likely been disturbed by some other method. Five patients had live ticks removed in ED - 3 refused killing and had no reaction despite 1 having known hypersensitivity; 2 had ticks on eyelids contraindicating killing, 1 with known hypersensitivity but both had allergic reactions post removal.
    Conclusion: Results support killing ticks in-situ before careful removal by mouthparts to reduce allergic/anaphylactic reactions although further research is still required.
    Language English
    Publishing date 2019-04-18
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2614800-6
    ISSN 2233-8268 ; 2233-8276
    ISSN (online) 2233-8268
    ISSN 2233-8276
    DOI 10.5415/apallergy.2019.9.e15
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  8. Article: Developing pharmacogenetic screening methods for an emergent country: Vietnam.

    Nguyen, Dinh Van / Vidal, Christopher / Chu, Hieu Chi / van Nunen, Sheryl

    The World Allergy Organization journal

    2019  Volume 12, Issue 5, Page(s) 100037

    Abstract: Background: The finding of strong associations between certain human leukocyte antigen (HLA) genotypes and the development of severe cutaneous adverse drug reactions (SCARs), [for example, HLA-B*57:01 and abacavir (ABC), HLA-B*15:02 and carbamazepine ( ... ...

    Abstract Background: The finding of strong associations between certain human leukocyte antigen (HLA) genotypes and the development of severe cutaneous adverse drug reactions (SCARs), [for example, HLA-B*57:01 and abacavir (ABC), HLA-B*15:02 and carbamazepine (CBZ) and HLA-B*58:01 and allopurinol], has led to HLA screening being used to prevent SCARs. Screening has been shown to be of great benefit in a number of studies. Clinical translation from bench to bedside, however, depends upon the development of simple, rapid and cost-effective assays to detect these risk alleles. In highly populated developing countries such as Vietnam, where there is a high prevalence of HLA-B*15:02 and HLA-B*58:01 correlating with a high incidence of CBZ- and allopurinol-induced SCARs, the crucial factor in the implementation of comprehensive screening programs to detect these major risk HLA alleles is the availability of suitable assays.
    Body: We have summarized the role and economic benefits of HLA screening, reviewed published HLA screening methods used currently in pharmacogenetic screening and examined the advantages and disadvantages of assays developed specifically for use in screening for risk alleles in the prevention of HLA-associated SCARs in Vietnam.
    Conclusion: The optimal approach we propose may serve as a template for the development of screening programs in other emergent countries.
    Language English
    Publishing date 2019-06-06
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2581968-9
    ISSN 1939-4551
    ISSN 1939-4551
    DOI 10.1016/j.waojou.2019.100037
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  9. Article: Human leukocyte antigen-associated severe cutaneous adverse drug reactions: from bedside to bench and beyond.

    Nguyen, Dinh Van / Vidal, Christopher / Chu, Hieu Chi / van Nunen, Sheryl

    Asia Pacific allergy

    2019  Volume 9, Issue 3, Page(s) e20

    Abstract: Despite their being uncommon, severe cutaneous adverse drug reactions (SCARs) result in a very great burden of disease. These reactions not only carry with them a high mortality (10%-50%) and high morbidity (60%) with severe ocular complications, ... ...

    Abstract Despite their being uncommon, severe cutaneous adverse drug reactions (SCARs) result in a very great burden of disease. These reactions not only carry with them a high mortality (10%-50%) and high morbidity (60%) with severe ocular complications, alopecia, oral and dental complications and development of autoimmune diseases, but also create a substantial economic burden for patients' families and society. SCARs are, therefore, an important medical problem needing a solution in many countries, especially in Asia. The clinical spectrum of SCARs comprises Stevens-Johnson syndrome, toxic epidermal necrolysis, DRESS (drug rash with eosinophilia and systemic symptoms) (also known as drug hypersensitivity syndrome or drug-induced hypersensitivity syndrome) and acute generalised exanthematous pustulosis. Recent crucial advances in determining genetic susceptibility and understanding how T cells recognise certain medications or their metabolites via the major histocompatibility complex and the effects of cofactors, have led to the implementation of cost-effective screening programs enabling prevention in a number of countries, and to further understanding of the patho-mechanisms involved in SCARs and their significance. In this review, we document comprehensively the journey of SCARs from bedside to bench and outline future perspectives in SCARs research.
    Language English
    Publishing date 2019-05-31
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 2614800-6
    ISSN 2233-8268 ; 2233-8276
    ISSN (online) 2233-8268
    ISSN 2233-8276
    DOI 10.5415/apallergy.2019.9.e20
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  10. Article ; Online: Mammalian meat allergy - beyond urticaria?

    Schimmel, Joshua / Fawaz, Bilal / Renzi, Michael / Heymann, Warren R / van Nunen, Sheryl / Manders, Steven

    International journal of dermatology

    2020  Volume 59, Issue 8, Page(s) e312–e314

    MeSH term(s) Animals ; Food Hypersensitivity/complications ; Food Hypersensitivity/diagnosis ; Humans ; Meat ; Skin Tests ; Urticaria/etiology
    Language English
    Publishing date 2020-05-07
    Publishing country England
    Document type Letter
    ZDB-ID 412254-9
    ISSN 1365-4632 ; 0011-9059 ; 1461-1244
    ISSN (online) 1365-4632
    ISSN 0011-9059 ; 1461-1244
    DOI 10.1111/ijd.14897
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