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A family history of food allergy can cause anxiety in parents. This may prevent food introduction in their children. Current guidelines recommend skin testing only when there is a reaction to a food in that specific patient. When there is a family history of food allergy, parents frequently ask their physicians for food testing of their children prior to introduction of specific foods. We conducted this study to determine whether allergy skin testing reduces anxiety levels in parents thereby leading to food introduction. Methods The parents of 50 children with a family history of food allergy completed a Visual Analog Score (VAS) to estimate their anxiety to give their children the specific food of concern. Previously, the children had not eaten the food. The VAS scores were recorded pre- and post-skin testing on a scale from 0 to 10. The likelihood of food introduction pre- and post-skin testing was estimated. Results The mean age of the children was 3.6 years; the majority were males (62%). Approximately 58% of patients’ parents, 38% siblings and 4% other relatives had food allergy. Most children (78%) had family history of a single food allergen and 60% had a family history of allergy to peanuts. All children tested negative for the food allergen of concern. Mean VAS was statistically different pre- and post-skin testing (pre VAS mean= 7.83 vs post VAS mean = 2.15; p=

Background The complement system is a vital component of innate immunity. Deficiencies in any part of the complement pathway characteristically present with recurrent infections. C2 factor deficiency is the most common complement deficiency. The presentation can vary from being asymptomatic to developing recurrent infections. Thus empiric vaccinations have been recommended, despite the lack of substantial evidence to support this practice. Recently, Jonnson and colleagues revisited this controversial topic and demonstrated the importance of vaccinations in this patient population. They further established that C2 deficient patients can mount an immune response to vaccination, undergo class-switching and develop a ‘more efficient’ phagocytosis. C2 deficiency is inherited in an autosomal recessive pattern. Homozygotes generally present with increased severity of disease as compared to heterozygotes. Alper and colleagues state that 25% of C2-deficient homozygotes have increased susceptibility to severe bacterial infections. Furthermore, they found that these C2-deficient patients had significantly lower mean levels of IgG4 and IgA than those patients that did not demonstrate an increased susceptibility for recurrent infections.

We report a case of a 65-year-old female with an anaphylactic type reaction during a graded oral celecoxib challenge. She was previously using NSAIDS and Celebrex (celecoxib) for analgesia in 2005. However, due to the side effect profile of COX2 inhibitors, Celebrex was discontinued. The patient’s primary analgesic was ibuprofen. Upon reintroduction of Celebrex, the patient developed urticaria after the second dose and urticaria with angioedema after the third dose. When the patient presented to the allergy clinic, it was felt that the urticaria and angioedema were secondary to ibuprofen. Because she had a negative crude prick skin test to Celebrex, an oral challenge to Celebrex was done. One hour after the 200 mg cumulative challenge, the patient was asymptomatic and an additional 200 mg was given. Twenty minutes later the patient developed facial flushing, angioedema, respiratory distress and hypotension, with her blood pressure dropping to 78/53 mmHg from a baseline of 120/80 mmHg. The patient was treated with epinephrine 0.1 mg subcutaneously, without recovery. After 5 and 15 minutes additional 0.2 mg subcutaneous epinephrine injections were administered. She was also treated with Reactine 20mg and prednisone 50mg. The patient was stabilized within thirty minutes. The patient was able to tolerate ibuprofen and sulfonamide antibiotics without any side effects. She was also taking hydrochlorothiazide on a daily basis for hypertension. She does not have any previously documented allergies or adverse reactions to medications. Discussion