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The diagnosis of drug-induced anaphylaxis (DIA) is a serious health problem. The Basophil activation test (BAT) is considered a specific in vitro provocation, and compared to in vivo provocation, it is more convenient, cheaper, and safer for the patient. This study aimed to evaluate the usefulness of the BAT in the diagnosis of DIA. This study included 150 patients referred to a reference allergy clinic with suspected drug allergies. All patients underwent a detailed clinical evaluation supplemented with the BAT. Positive BAT results were obtained in two out of 21 patients who were to receive the COVID-19 vaccine. The sensitivity and specificity of the BAT were 40% and 75% for the COVID-19 vaccine, 67% and 58% for DMG PEG 2000, and 100% and 75% for PEG 4000, respectively. Nine out of 34 patients with suspected antibiotic allergies had positive BAT results with 14 different antibiotics. Positive BAT results were also obtained with NSAIDs in two patients and with local anesthetics in three patients. The confirmation of allergy by the BAT improves the safety profile of the diagnostic work-up as it may defer the need for drug provocation, preventing potential anaphylactic reactions. [ABSTRACT FROM AUTHOR]

Background: In patients who require venom immunotherapy (VIT), there is a need to identify underlying mast cell (MC) disorders since these may affect the risk and severity of future sting reactions and the long‐term effectiveness of VIT. Methods: 1319 individuals with Hymenoptera venom allergy (HVA) who needed VIT from referral centers in Slovenia, Austria, Croatia, and Poland underwent examination for KIT p.D816V in peripheral blood leukocytes (PBL) using a highly sensitive PCR test and tryptase genotyping by digital droplet PCR. We also included 183 control individuals with large local reactions (LLRs) to Hymenoptera stings and with asymptomatic sensitization to Hymenoptera venoms. Results: 285 of 1319 individuals recommended for VIT (21.6%) were positive for KIT p.D816V in PBL, preferably those who present with severe reaction (33.9% [n = 207 of 610] with Ring‐Messmer grade 3–4 vs. 11% [n = 78 of 709] with Grade 1–2; p <.0001), whereas only 1.3% (n = 2 of 152) of controls with LLR and none with asymptomatic sensitization (n = 31) had KIT p.D816V. KIT p.D816V allelic burden was higher in those with severe reaction (median 0.018% [n = 207] in Grade 3–4 vs. 0.001% [n = 78] in Grade 1–2; p <.0001), and the majority had normal baseline serum tryptase levels (69% [n = 196 of 285]). All KIT p.D816V‐positive individuals (n = 41) who underwent bone marrow (BM) biopsy were found to have underlying clonal diseases, principally BM mastocytosis. HαT was also associated with severe HVA and symptoms (p <.01), and remarkably, 31.0% (n = 31 of 100) were found to have concomitant KIT p.D816V. Concomitant HαT and KIT p.D816V showed an additive effect, and having both was associated with the highest risk for severe HVA, even higher than having either HαT or KIT p.D816V alone (OR = 3.8; p <.01). Conclusions: By employing prospective universal tryptase genotyping and examination for KIT p.D816V in PBL in large HVA populations, we have demonstrated a high burden of clonal MC disorders and HαT in patients who require VIT. [ABSTRACT FROM AUTHOR]

Introduction: Hereditary angioedema (HAE) is a rare inherited autosomal dominant disease caused by deficiency or dysfunction of C1 inhibitor (C1INH). Clinical symptoms include recurrent subcutaneous and submucosal angioedema of the internal organs. Abdominal attacks affect more than 90% of patients, are often misdiagnosed and result in unnecessary surgical procedures. Aim: To analyse the utility of imaging studies (USG, CT) in patients with C1INH-HAE during an abdominal attack and remission. Material and methods: We enrolled 40 patients with type I and II HAE (30 women, 10 men; mean age 39 years). The diagnosis of C1INH-HAE was based on patient and family history, significantly reduced values of C1INH serum level and activity. Abdominal and pelvic ultrasound were performed in patients within the first 6 h of the abdominal attack and repeated during remission. Moreover, 23 cases underwent abdominal or pelvic computed tomography during acute abdominal symptoms. The most common ultrasound and CT findings showed the transient presence of a significant amount of fluid in the free abdominal cavity and intestinal oedema during the symptom progression and spontaneously disappearing during the seizure in 90% and 50% of patients, respectively. CT revealed also an enlargement of the mesenteric lymph nodes as well as a fat stranding along the bowel wall thickening. Conclusions: Ultrasound or CT imaging facilitates the diagnosis of the patient suspected of having an abdominal attack due to C1INH-HAE. They allow to identify transitional presence of an abundant fluid in the free abdominal cavity and intestinal swelling which spontaneously disappear with a symptoms attack. [ABSTRACT FROM AUTHOR]

Introduction. Until recently, allerguc contact dermatitis (ACD) in childhood had been diagnosed too rarely. Aim of the study. To analyze the frequency of contact allergies among Polish children with symptoms of eczema. Material and methods. In 2007, during a prophylactic health programme in Krakow (Poland) schoolchildren wre questioned about the presence of allergy symptoms. Among those with dermatitis, 2008 underwent patch testing, including 96 pupils (42 boys and 54 girls) aged 7 and 112 (24 boys and 88 girls) aged 16. Patch tests were carried out with 10 haptens: Chloromethylisothiazolinone, Nickel sulfate, Mercury ammonium chloride, Themerosal, Cobalt chloride, Potassium dichromate, Wool alcohols, Fragrance mix, Balsam of Peru and Colophony, with a test reading after 48 and 75 h. Results. 101 of the 2008 tested children (48.5%) were found patch test positive. Among 96 children aged 7, 44% positive patch tests were recorded, most frequently for: nickel (30%), thimerosal (10%), cobalt (8%), fragrance mix (7%), Kathon CG (6%), chromium (6%), balsam of Peru (3%), mercury ammonium choride (2%), and colophony (1%). Among 112 teenagers, 53% positive patch test results were recorded, with sensitization to: nickel (26%), cobalt (12%), fragrance mix (7%), chromium (6%), mercury ammonium chloride (2%), Kathon CG and balsam of Peru (each 1%). The final diagonosis of ACD was confirmed in 36% of 7-years-olds and 28% 16-years-olds. Conculusions. The patch test is an indispensable element of eczema diagonosis in children. In future epidemiological studies of eczema in children, allergic contact dermatitis should be among the considered diagnosis. [ABSTRACT FROM AUTHOR]

INTRODUCTION    Allergic rhinitis (AR) is the most common atopic disease. Specific immunotherapy (SIT) is the only effective treatment method for AR. In uncertain diagnostic cases, before establishing eligibility for SIT, nasal provocation tests (NPTs) should be performed. However, there are numerous contraindications to performing NPTs, and there is ongoing search for an alternative in vitro method. OBJECTIVES    The aim of the study was to determine whether a specific in vitro provocation, that is, the basophil activation test (BAT), may replace a specific in vivo provocation, that is, the NPT, in establishing patient's eligibility for SIT. PATIENTS AND METHODS    The study included 30 patients with AR caused by allergy to house dust mite or birch pollen, referred for SIT. The assessment of basophil activation by measuring CD63 antigen expression was performed using the Flow2 CAST test. Basophils were stimulated with allergen preparation (concentrations of 5000, 500, and 50 standardized biological units) used in NPTs. BAT results were expressed as stimulation index (SI) and basophil reactivity (BR). RESULTS    Allergen concentrations of 500 and 50 SBU proved to be appropriate for basophil stimulation. Median SI and BR were higher for positive NPT results than for negative NPT results (P <0.001). Sensitivity for SI and BR was in the range from 83% to 100%; specificity, from 78% to 89%; positive predictive value, from 75% to 87%; and negative predictive value, from 89% to 100%. We observed a high correlation of the analyzed parameters for the allergen concentrations of 500 and 50 SBU (range, 0.58-0.74; P <0.05). CONCLUSIONS    If there are contraindications to performing the NPT, BAT may be regarded as an alternative in establishing patients' eligibility for SIT. The optimal concentrations of allergen preparations are 500 and 50 SBU. Both SI and BR are good indicators of basophil activation.

The severity of allergic symptoms in patients with atopic dermatitis (AD) intensifies when the number of colonies patient’s of Staphylococcus aureus on patents’ skin increases. The basic feature determining the quality of any diagnostic test for S. aureus is its credibility. Performing a test always carries the risk of obtaining false positive and/or false negative results. Furthermore, producing material for microbiological analysis of internal body cavities is sometimes difficult. Therefore, in our study, we compared the results of three tests to determine if their results were mutually compatible and if they confirmed whether S. aureus was present in patients with AD and what was its role in the development of the disease in those patients. Infection with S. aureus was tested in patients with AD and healthy volunteers using the API Staph system. The specific IgE antibodies for staphylococcal enterotoxin A (SEA) and B (SEB) were measured using the UniCAP system. The secretion of IFN-γ, IL-2, IL-13 by peripheral blood mononuclear cells (PBMCs) after stimulation with SEA and SEB were studied with Elispot assay. We found that only certain patients with AD and S. aureus produced antibodies against SEA and SEB in the acute phase of AD. The secretion of IFN-γ was low in patients with exacerbated AD and S. aureus. Testing for the presence of S. aureus in the mucous membrane of the nasal vestibule and skin lesions is not sufficient for complex diagnosis of the role of S. aureus in the pathomechanism of AD. Measuring the presence of antibodies against bacterial components in patients’ serum and the reactivity of patients’ immune cells against these bacterial components is required in order to accurately diagnose this role of S. aureus in a patient.

Honey bee venom (Apis mellifera) is a mixture of many components, both amines, peptides enzymes and toxins. Most of the enzymes are allergens with different allergenic potential. It may affect not only to the symptoms, it may also contribute to the success of immunotherapy. In some cases the problem of a bee venom allergy diagnosis is difficult due to the imperfection of the classical diagnostic methods. In the present work reports in the literature regarding the bee venom allergy diagnosis on the basis of identification of the venom allergen sIgE to components are summarized. The use of recombinant allergens has allowed for the study of sIgE against the allergenic components, and thus determination of the individual profile of allergy. Extending the test panel of bee venom components to rApi m10 and rApi m3 compared to rApi m1 increases the diagnostic sensitivity by identifying new allergens that are not always present in the available preparations used in immunotherapy.