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To the Editor, The COVID-19 pandemic led to rapid changes to our clinical and educational activities, showing that most of care of allergic diseases could be delayed with no significant serious effects or managed with telemedicine. Treating venom allergy during COVID-19 pandemic Regardless of the presence or absence of CMD, VIT should be started as soon as possible in patients with a systemic reaction to venom, as this is a life-threatening condition and VIT is a live-saving therapy. [Extracted from the article]

The article discusses the role of diagnostic tests in food hypersensitivity. For the diagnosis of food hypersensitivity, several in vivo and in vitro methods are available, among which are food challenges, skin test and radioallergosorbent test (RAST), histamine release and the study of changes in intestinal permeability. Skin tests and RAST, that demonstrate the presence of specific IgE for food items often cause confusion. On the basis of the study presented, it can be concluded that double-blind placebo-controlled food challenges, if carried out by a correct method and reaching sufficiently high doses, is the sole valid method for the diagnosis of food allergy.

Background: Heat-and-pepsin-sensitive plant food allergens (PR-10 and profilin) sometimes cause systemic reaction., Objective: To detect the risk factors for systemic reactions induced by labile food allergens., Methods: A retrospective multicenter study was performed on patients with a documented history of systemic allergic reaction to labile plant food allergens and on age-matched controls with a history of oral allergy syndrome (OAS) induced by the same foods. Offending foods, their amount, and state (solid or liquid), and potential cofactors (nonsteroidal anti-inflammatory drugs, protonic pump inhibitors, exercise, alcohol, and fasting) were considered., Results: We studied 89 patients and 81 controls. Sensitization to PR-10 or profilin, IgE to Bet v 1 and/or Bet v 2, and foods causing OAS were similar in the two groups. Twenty patients experienced >1 systemic allergic reaction. Tree nuts, Rosaceae, Apiaceae, and soymilk were the main offending foods. Seventeen (19%) patients were taking a PPI when the systemic reaction occurred (vs 5% in controls; P < .025). The ingestion of the offending food in liquid form (soymilk) was frequent among patients (15%) but unusual among controls (2%; P < .025). Soy milk-induced systemic reactions were independent of PPI treatment. Fasting and excess of allergen, but not NSAID and exercise, were other relevant cofactors for systemic reactions. Systemic reactions occurred without any identifiable cofactor in 39 (44%) cases., Conclusion: PR-10- and profilin-induced systemic reactions are facilitated by PPI, ingestion of large amounts of unprocessed foods, and fasting. Soybean beverages represent a risk for PR-10 hypersensitive patients and should be avoided., (© 2020 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.)