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The study was supported by the Instituto de Salud Carlos III (Fondo de Investigaciones Sanitarias, Spanish Ministry of Health, PI19/01023) (Co-funded by the European Regional Development Fund ‘A way to make Europe’), and Fundación de la Sociedad Española de Alergología e Inmunología Clínica (SEAIC) SI

Objective: To define the sensitization pattern of patients with anaphylaxis to Vespa velutina nigrithorax (VVN). Methods: We studied 100 consecutive Spanish patients with anaphylaxis to Hymenoptera venom and systematically determined specific IgE (sIgE) to whole venoms (Vespula species, Polistes dominula, Apis mellifera, Vespa crabro, and Dolichovespula maculata) and their molecular components (rApi m 1, rApi m 5, rApi m 10, rVes v 1, rVes v 5, rPol d 5, and cross-reactive carbohydrates). Specific IgE to VVN venom and its antigen 5 (nVesp v 5) were measured in a subsample. Results: Seventy-seven patients had anaphylaxis to VVN. Of these, only 16 (20.8%) reported previous VVN stings, but were stung by other Hymenoptera. Positive sIgE (>0.35 kUA/L) to each of the whole venoms was detected in >70% of patients (Vespula species in 100%). The components showing >50% positivity were rApi m 5 (51.4%), rPol d 5 (80.0%), and rVes v 5 (98.7%). This pattern was similar to that of Vespula species anaphylaxis (n=11) but different from that of A mellifera anaphylaxis (n=10). Specific IgE to nVesp v 5 was positive in all patients (n=15) with VVN anaphylaxis and was correlated with sIgE to both rVes v 5 (R=0.931) and rPol d 5 (R=0.887). Conclusions: VVN has become the commonest cause of Hymenoptera anaphylaxis in our area. Most cases report no previous VVN stings. Their sensitization pattern is similar to that of patients with anaphylaxis to other Vespidae. Specific IgE to antigen-5 from VVN, Vespula species, and P dominula are strongly correlated in patients with VVN anaphylaxis.

This study investigated the sensitization pattern of crustacean-allergic patients according to tolerance to molluscs. Thirty-one patients with anaphylaxis to crustaceans (14 with mollusc allergy and 17 with mollusc tolerance) were studied using skin prick tests (SPTs), specific IgEs (sIgEs) and SDS-PAGE immunoblotting. IgE-reactive shrimp proteins were identified by proteomic analyses. Patients with mollusc allergy presented more frequently SPTs positive to molluscs and higher sIgE titres in response to both molluscs and crustaceans. Shrimp-sIgE and rPen a1-sIgE values of 1.57 kUA /l and 4.38 kUA /l, respectively, showed positive likelihood ratios of 4.3 and 10.9 for the identification of mollusc allergy. Patients with mollusc allergy reacted more frequently to tropomyosin in immunoblots than did patients without it (93% vs 35%, respectively, P = 0.004). Reactivity to proteins other than tropomyosin (n = 14) was not different between the two groups. Among patients with crustacean anaphylaxis, patients with mollusc allergy and mollusc tolerance show a different pattern of sensitization, something that may help identify them.

Background: Once the optimal dose is reached, subcutaneous immunotherapy [SCIT] with mite extract is capable of reducing symptoms and the need for rescue medication. Objective: To assess the capacity of a subcutaneous extract of mites [D. pteronyssinus] to bring about a reduction in concomitant medication as well as in vivo and in vitro changes in just 2-3 months of treatment in patients with allergic asthma. Methods: A total of 45 patients with persistent mildmoderate allergic asthma due to sensitisation to D. pteronyssinus were included in a multi-centre, double-blind, placebocontrolled trial. Length of treatment was 4 months. After a period for adjusting medication in order to classify asthma severity appropriately, patients were commenced on treatment of 400 or 800 μg/day of budesonide as concomitant medication. Results: After 4 months of treatment there were no significant changes in the budesonide dose between the active group and the placebo group. In the active group there was a significant difference between active and placebo group in sIgG4 [p=.0003], as well as a significant increase in the cutaneous tolerance index [2.81, CI 95%: 1.29 – 7.48, which was significant with a Confidence Interval of 95%]. These changes were not observed in the placebo group. Conclusion: After just 4 months of treatment, SCIT was capable of inducing in vivo and in vitro changes, but these changes were not reflected in improved clinical outcome within the first 4 months of therapy.

Desensitization protocols for chemotherapy agents (taxanes and platinum salts) have been extensively performed to safely administer these drugs to patients who have previously suffered a hypersensitivity reaction (HSR). Standardized protocols have been published using 12 or 16 steps to reach the cumulative dose in every patient. All these protocols were based on the preparation of 3 different solutions at 100-fold, 10-fold, and 1fold dilution of the final target concentration. However, from the pharmacological point of view, a reasonable doubt on the stability of diluted concentrations arises because there are no published data available. For example, concentrations higher than 0.2 and 0.1 mg/mL are known to be stable for paclitaxel and carboplatin, respectively, but no studies have been performed with lower concentrations. Docetaxel is the least stable drug. According to the Food and Drug Administration, a sodium chloride solution or 5% dextrose solution to produce a final docetaxel concentration of 0.3 to 0.74 mg/mL is stable for 4 hours under ambient room temperature and lighting conditions but there are no data for longer periods of time or lower concentrations. To address this potential problem of stability, a new protocol of desensitization with carboplatin and taxanes was developed. We present a proposed protocol that perfectly fits with the recommended published dosages for these chemotherapy agents but using the same solution during the whole procedure. Twelve patients with HSR to taxanes or platinum salts and for whom continued treatment with these drugs was considered advantageous were evaluated between July 2013 and April 2016. All patients were women with a median age of 50 years (range, 35-72 years) and had received antineoplastic treatment due to either ovarian and/or breast cancer. Eight of them had suffered at least 1 reaction with carboplatin and the remaining 4 with taxanes (2, paclitaxel and 2, docetaxel). Nine patients presented severe reactions involving the respiratory and/or the cardiovascular system. Most patients (11 of 12) presented with cutaneous symptoms (pruritus, flushing, or urticaria). During this period we have used different brands according to the availability at the hospital: docetaxel (Taxotere, Sanofi Aventis, Essex, United Kingdom; Docetaxel, Accord, Middlesex, United Kingdom; Docetaxel, Actavis, Devon, United Kingdom), carboplatin (Carboplatin, Pharmacia Nostrum, Madrid, Spain; Carboplatin, Accord, Middlesex, United Kingdom; Carboplatin, Kabi, Hampshire, United Kingdom), and paclitaxel (Taxol, Bristol Myers Squibb, Latina, Italy; Paclitaxel, Hospira, Madrid, Spain).

Background: Total and specific serum immunoglobulin E (IgE) are routinely used as diagnostic tools in allergy clinics. Several studies have demonstrated an increase of total serum IgE concentrations in alcoholics, but the possible influence of lower quantities of ethanol intake on serum IgE values has not been fully evaluated. This study was aimed at analyzing the influence of alcohol intake on both total and specific serum IgE concentrations in patients studied in an allergy clinic. Methods: A total of 460 patients were included in the study. According to skin-prick tests to common aeroallergens, 325 were classified as atopics and 135 as nonatopics. Most atopic patients (253; 78%) were allergic to mites. Alcohol consumption was recorded as the number of standard (10-g) drinking units regularly consumed per week. Two hundred subjects (43%) were abstainers, and 260 (57%) were regular consumers of a median of 30 g of alcohol per week. Total serum IgE was measured in all patients by latex-enhanced nephelometry. Serum-specific IgE was assayed by fluoroenzymeimmunoassay. Results: Total serum IgE increased along with ethanol consumption. On multivariate analysis, regular alcohol consumption greater than 70 g per week was associated with increased total serum IgE levels, even when adjusting for age, sex, atopy, and smoking. Among house-dust mite–allergic patients, specific serum IgE values against the house dust mite Dermatophagoides pteronyssinus were higher in regular alcohol consumers than in abstainers. This difference was not observed among patients allergic to grass pollen (Lolium perenne). Conclusions: Alcohol consumption, even in moderate quantities, is associated with increased total and specific IgE concentrations in subjects studied in an allergy clinic. Alcohol intake should be taken into account in epidemiological studies of total serum IgE levels.

Background IgE-mediated allergy to insects different from Hymenoptera species is seldom reported. Objective To describe and study the case of a previously nonatopic man with an anaphylactic reaction (grade III, Mueller) caused by a bite from a louse fly ( Hippobosca equina ). Methods In vivo (skin prick tests) and in vitro (enzyme-linked immunosorbent assay and sodium dodecyl sulfate-polyacrylamide gel electrophoresis immunoblotting) tests were used for diagnosis. Cross-reactivity between H equina and different insects was investigated. Results Results of skin prick tests and serum specific IgE were positive to H equina . Immunoblot inhibition studies identified common bands in H equina, Apis mellifera, and Musca domestica, but this cross-reactivity did not affect a band of 16 or 15 kDa. This molecular weight is similar to that of phospholipase A2 in A mellifera venom. Conclusion We describe a case of IgE-mediated allergy to H equina in which specific molecular band proteins seemed to be responsible for the reaction.

Background: Immunoglobulin E (IgE) to N-glycans from plant and invertebrate glycoproteins induces extensive in vitro cross-reactivity. This study investigates the prevalence and diagnostic relevance of IgE to these N-glycans [cross-reactive carbohydrate determinants (CCDs)] in patients with suspicion of respiratory allergy. Methods: A total of 1,025 adult subjects with symptoms of rhinitis and/or asthma from a reference allergy clinic were studied. Determinations included a structured questionnaire, skin prick tests (SPT), total IgE, a multiallergen IgE test and specific IgE (sIgE) to bromelain, MUXF (the bromelain-type N-glycan) and honeybee phospholipase-A2. Inhibition studies with CCDs were performed in selected cases. Results: The prevalence of CCD sensitization (MUXF sIgE and/or bromelain-sIgE ≧0.1 kUA/l) was 18.0%. Male sex and atopy (SPT positivity) were associated with CCD sensitization. Sensitization was more frequent in patients sensitized to pollens than in those sensitized to mites, the most common inhalant allergens in the area. A history of Hymenoptera stings was associated with CCD sensitization and multiallergen IgE test positivity. CCD sensitization was not significantly associated with age, rural residence, alcohol consumption or smoking. Only 58 patients (5.6%) showed CCD-sIgE levels ≧0.35 kUA/l. CCD-induced inhibition of pollen-sIgE or mite-sIgE in patients with respective positive SPT was minimal or absent in most cases. Conclusions: In this population of predominantly mite-allergic patients, CCD sensitization is relatively rare and CCD-sIgE levels are low. Thus, CCDs do not represent a major obstacle for the diagnosis of respiratory allergy in a specialized setting. Hymenoptera stings are associated with CCD sensitization.

La esofagitis eosinofílica, entidad caracterizada por la infiltración de la mucosa esofágica por más de 20 eosinófilos por campo de gran aumento, se suele presentar en forma de disfagia intermitente de larga evolución, pudiendo estar asociada a sensibilización alérgica a aeroalérgenos y/o alimentos. Presentamos el caso de un varón con clínica de disfagia intermitente coincidiendo con la toma de quesos curados de oveja y cabra que precisó asistencia urgente tras la impactación de un comprimido de ibuprofeno a 30 cm de la arcada dentaria. El estudio practicado demostró la existencia de estenosis en el esófago a ese nivel con infiltración eosinofílica difusa y sensibilización a proteínas de la leche de cabra, oveja y vaca, con especial relevancia para la IgG bovina, lactoferrina y albúmina sérica. Tras tratamiento con fluticasona deglutida y medidas de evitación se consiguió la resolución del cuadro clínico y la desaparición de los eosinófilos en la mucosa.

Background Sea urchins are increasingly used as culinary products in Japanese and Korean cuisine throughout the world. Objective To investigate a possible IgE-mediated allergy in a patient who experienced an anaphylactic reaction after eating sea urchin roe and mussels. Patient and Methods A 40-year-old man experienced generalized pruritus and urticaria, shortness of breath, and wheezing 10 minutes after eating steamed mussels and boiled sea urchin roe. Investigations included skin prick tests, serum specific IgE determinations, oral challenge tests, sodium dodecyl sulfate–polyacrylamide gel electrophoresis, and immunoblotting. Results Results of skin prick tests with common aeroallergens were negative. Positive prick test responses were obtained with boiled and raw sea urchin extracts, boiled and raw sea urchins themselves, and boiled sea urchin water. Results of an oral challenge test with steamed mussels were negative. Five minutes after the oral mucosa contacted the boiled sea urchin extract, lip pruritus was present. Specific IgE concentrations to boiled sea urchin water and boiled and raw sea urchins surpassed the criterion for a positive result (1.1, 0.6, and 0.4 kU/L, respectively). In boiled sea urchin extract, a 118-kDa band appeared as the unique relevant IgE-binding antigen. Conclusion In this patient with IgE-mediated food allergy to sea urchin roe, a 118-kDa protein seemed to be the antigen responsible for the reaction.

Background Anaphylaxis after the first exposure to a food allergen is uncommon unless a cross-reaction is present. Objective To investigate a possible relationship between the fruit Cyphomandra betacea Sendth (commonly known as tamarillo) and the wood of Triplochiton scleroxylon (obeche) in a patient with allergic occupational bronchial asthma due to obeche wood who began to experience anaphylaxis episodes after eating tamarillo. Methods A 33-year-old carpenter exposed to obeche wood in his occupation was initially seen with rhinitis and bronchial asthma. The causal relationship of these symptoms to obeche wood exposure was investigated by means of peak flow monitoring and bronchial inhalation testing. Furthermore, the patient had 2 acute episodes of anaphylaxis a few minutes after eating salad containing tamarillo. He had never tasted tamarillo before. The allergologic study included skin prick tests, serum specific IgE determinations, bronchial challenges, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and immunoblotting. Results Results of skin prick tests with common aeroallergens were negative. Strong skin prick test responses were obtained with obeche and tamarillo. Results of bronchial challenge testing with obeche extract were positive. In tamarillo extract, a 28-kDa band appeared as the most relevant IgE-binding antigen. A similar band of 28 kDa happens to be frequently detected in obeche-allergic patients. Conclusion To our knowledge, this is the first reported case of anaphylaxis to tamarillo presented in a patient allergic to obeche, which raises the question of a new cross-reactivity antigen.

Background The nonpigmenting fixed drug eruption is a distictive drug reaction characterized by large, tender and symmetric erythematous plaques that diappear with no residual pigmentation. Methods A case of a non-pigmenting fixed drug eruption due to pseudoephedrine is reported. Results The reappearance of typical lesions at the same sites after oral challenge with 60 mg pseudoephedrine together with the absence of pigmentation confirm the diagnosis. Conclusion A new case of proven nonpigmenting fixed drug eruption to pseudoephedrine is described.