Poster Session Group II – Red

TPS 29 – Allergy and asthma epidemiology

854

Development of asthma is associated

with the consumption of instant foods in

Korean adults as well as teenagers

Yang, MS1,2; Song, WJ2; Kim, SH2,3; Cho, SH2; Min,

KU2; Chang, YS2,3

1SMG-SNU Boramae Medical Center, Internal Medicine,

Seoul, Korea; 2College of Medicine, Internal Medicine,

Seoul National University, Seoul, Korea; 3Internal

Medicine, Seoul National University Bundang Hospital,

Seongnam, Korea

Background: The association between the

development of childhood allergic diseases

and consumption of certain foods had been

reported. However, the relationship between

adult-onset asthma and consumption of cer-

tain foods had never been assessed.

Method: This study was conducted using

two nationwide stratified random sampled

surveys; the eighth Korea Youth Risk

Behavior Web-based Survey (KYRBWS),

2012 and the fifth Korean National Health

and Nutrition Survey (KNHANES V),

2011. KYRBWS was a nationwide cross-

sectional survey of Korean middle- and

high-school students aged 13–18 years and

KNHANES V was a survey of Koreans of

all age. For balanced sampling, both of the

surveys adopted a complex sample design.

Having diagnosed with asthma within past

1 year was regarded as the development of

asthma. Consumption of instant foods was

defined as taking the food more than five

times a week for the adolescents and more

than once a week for the adults. Multivari-

able analyses were performed adjusting for

age, gender, region, body mass index,

smoking and physical activity. The devel-

opment of asthma after 30 years old was

defined as adult onset asthma.

Results: The estimated number of adoles-

cents who had ever diagnosed with asthma

was 350 000 (9.3%) and 25% of them diag-

nosed asthma within past 12 months

(recent diagnosis of asthma) according to

the KYRBWS data. The prevalence of phy-

sician diagnosed asthma was 3.6% in whole

Korean population and about 90 000 cases

were newly diagnosed within 12 months

according to the KHANES V data. Con-

sumption of instant foods was significantly

associated with the development of asthma

in Korean adolescent (OR 1.7, 95% CI

1.36–2.19) and also in Korean adult (OR

3.7, 95% CI 1.38–9.7) aged 30 years old or

more after multivariable analysis.

Conclusion: In nationwide surveys from

Korea, there was significant association

with consumption of instant foods and the

development of asthma in Korean adults

as well as adolescents.

855

Wider neck circumference may be related

with asthma severity in children

Yavuz, ST1; Hacihamdioglu, B2; Yesilkaya, E2; G€ulec�,M3; Gok, F4

1Department of Pediatric Allergy, Gulhane Military

School of Medicine, Ankara, Turkey; 2Department of

Pediatric Endocrinology, Gulhane Military School of

Medicine, Ankara, Turkey; 3Department of Adult Allergy

and Immunology, Gulhane Military School of Medicine,

Ankara, Turkey; 4Department of Pediatrics, Gulhane

Military School of Medicine, Ankara, Turkey

Background: Obesity is an established risk

factor for asthma in children. Measures of

central obesity are reported to be more

associated with the severity of asthma in

adults. The aim of the study is to investi-

gate the association between fat distribu-

tions that is determined by anthropometric

measures and asthma severity in children.

Method: Children with asthma who were

followed in our pediatric allergy unit were

consecutively recruited. Asthma severity

was graded according to GINA guidelines.

Patients were categorized into two groups;

children with intermittent and mild persis-

tent asthma formed Group 1 (mild asthma)

whereas children with moderate and severe

persistent asthma formed Group 2 (severe

asthma). Anthropometric measures includ-

ing height, weight, neck circumference

(NC), waist circumference (WC) and hip

circumference (HC) were obtained. Pulmo-

nary function tests and skin prick tests

were performed in all subjects.

Results: A total of 127 children (82 male,

64.6%) with a median age of 8.3 (6.4–11.3)years were included. Aeroallergen sensiti-

sation was present in 77 (60.6%) patients.

Ninety-one patients (71.6) were in the mild

asthma group. There were no significant

difference between two groups in terms of

age, gender, aeroallergen sensitisation,

obesity prevalence, body mass index, WC

and HC. NCs of children with severe

asthma were significantly wider than chil-

dren with mild asthma [29.0 cm (27.0–32.0)vs. 28.0 (26.0–30.0), P = 0.019]. The preva-

lence of children with NC higher than 90th

percentile was also more frequent in chil-

dren with severe asthma (41.7% vs.

23.1%). Result of multivariate logistic

regression analysis revealed that presence

of NC >90th percentile were associated

with severe asthma in children (OR; [95%

CI] (2.63 [1.10–6.28]; P = 0.029).

Conclusion: Neck circumference, which is

a simple tool of anthropometric measures,

is more associated with asthma severity in

children when compared with standard

methods.

857

Sleeping on animal skin in the first

3 months of life and development of

asthma and allergy in later childhood

Tischer, C1; Lehmann, I2; Schaaf, B3; von Berg, A4;

Heinrich, J1

1Helmholtz Zentrum M€unchen, Institute of

Epidemiology I, Neuherberg, Germany; 2Helmholtz

Zentrum for Environmental Research UFZ,

Environmental Immunology, Leipzig, Germany;3Pediatric Outpatient Department, Bad Honnef,

Germany; 4Marien-Hospital Wesel, Wesel, Germany

Background: Protective effects of microbial

compounds on asthma and allergy in child-

hood have been particularly observed in

farm environments with suggested higher

and more diverse microbial exposure as it

can be found in urban environments.

Method: The aim of the study was to

investigate the impact of sleeping on ani-

mal skin, mostly sheep skin, in the first

3 months of life on asthma and allergy

later in childhood in the German LISAplus

birth cohort. Exposure to animal skin at

3 months of life as well as risk factor and

health outcome information was obtained

periodically up to 10 years by parental

questionnaires.

Results: In total, 3095 children were

included in the analysis. Sleeping on ani-

mal skin was common and reported with

55%. In adjusted logistic regression analy-

ses, sleeping on animal skin showed signifi-

cant inverse associations with ever

wheezing [aOR (95%CI): 0.78 (0.63–0.96)],ever physician-diagnosed asthma [0.64

(0.42–0.99)] up to 10 years of age and with

physician-diagnosed eczema at 6 years:

0.66 (0.47–0.93). No significant association

has been observed for physician-diagnosed

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453326

hay fever and allergic sensitisation to mite

and aero-allergens at any ages.

Conclusion: The animal skin might serve

as a reservoir of numerous viable and non-

viable microbial compounds, probably

more diverse than what has been found in

settled dust from floor or mattresses, espe-

cially in urban environments.

858

Molecular identification of rhinovirus

subtypes in patients with HRV infection-

induced asthma exacerbation in the area

of Cracow, Poland

Hubalewska-Mazgaj, M; Sanak, M

II Department of Medicine, Jagiellonian University

Medical College, Krak�ow, Poland

Background: Forty to 85% of asthma

exacerbations are related to upper-respira-

tory-tract virus infection, of which 60%

are caused by HRV. It is not known, if

there are any specific subtypes or HRV

group, which are of higher prevalence in

causing URT-associated asthma exacerba-

tions.

The purpose of the study was to deter-

mine frequency of HRV detection in URT

in patients with asthma exacerbation and

molecular identification of detected sub-

types. If available, a few weeks after

asthma exacerbation, we performed addi-

tional test to check for the HRV presence

in URT.

Method: Fifty-five patients with asthma

exacerbations were enrolled to the study.

To detect and identify HRV, nasal aspirate

from each patients was taken. Total RNA

was extracted and RT combined with

nested PCR reaction was performed. PCR

products from HRV-positive samples were

cloned and sequenced. Obtained fragments

were compared and identified using

BLAST database. Sequences were aligned

and phylogenetic tree was constructed.

Twenty-four patients were enrolled in the

control study. Detection and HRV molecu-

lar identification procedures were per-

formed again.

Results: HRV were found in 27 of 55 cases

(49%). We classified 18 samples as HRV-

A, one sample as HRV-B and two samples

as HRV-C. One sample seemed to be co-

infected with HRV-A and HRV-C.

In the control study, 3 of 10 patients

who previously were HRV-positive, turned

out to harbor HRV in URT again. In one

of them the virus was identical to HRV

detected during exacerbation. Phylogenetic

analysis of all samples revealed the pres-

ence of HRV subtype circulating in the

population for over 2 years.

Conclusion: There is no evidence that any

specific HRV subtypes are more responsi-

ble for causing asthma exacerbations.

HRV are present in URT of some asth-

matic subjects without causing symptom-

atic infection, as well as during good

control of asthma. Some HRV subtypes

can circulate in the population over rela-

tively long time periods causing recurrent

infections with the same subtypes.

859

A novel measure of socioeconomic

status using individual housing data in

health disparities research for asthma in

adults

Juhn, Y1; Krusemark, E1; Rand-Weaver, J1; Beebe,

T2; Sloan, J2; Yawn, B3; Lahr, B4; Jacobson, D4;

St Sauver, J2

1Mayo Clinic, Pediatrics, Rochester, MN, United States;2Mayo Clinic, Health Sciences Research, Rochester,

MN, United States; 3Olmsted Medical Center, Research,

Rochester, MN, United States; 4Mayo Clinic, Statistics,

Rochester, MN, United States

Background: We recently developed

HOUSES, an individual housing-based

socioeconomic status (SES) measurement

to overcome the absence of SES measures

in commonly used datasets for research.

We assessed whether HOUSES was associ-

ated with the prevalence of asthma and

other chronic conditions in adults.

Method: A population-based retrospective

study was conducted among Olmsted

County residents in 2009. We assessed the

prevalence of asthma by ICD-9 codes,

which was reported to be one of the five

most burdensome diseases in the United

States by the Agency of Healthcare

Research and Quality. Using a z-score for

housing value, actual square footage, and

numbers of bedrooms and bathrooms,

HOUSES was formulated and categorized

into quartiles. The frequency of each con-

dition was tested for an association with

SES as measured by HOUSES using a

Cochran-Armitage test for trend.

Results: There were 88 563 individuals

available for this study of whom 93% were

white and 55% were female; the mean age

(�SD) was 45.6 � 18.1 years. The preva-

lence of asthma in the study subjects was

8.6%. The prevalence rates of asthma were

9.6%, 8.8%, 8.3%, and 7.7% for patients

in the first (the lowest SES), second, third,

and fourth quartiles of HOUSES, respec-

tively (P < 0.001). Overall, HOUSES was

inversely associated with the prevalence of

asthma and other chronic diseases.

Conclusion: There are significant health dis-

parities in asthma among individuals with

different SES as measured by HOUSES.

HOUSES may be useful for overcoming the

lack of conventional SES measures in com-

monly used datasets used for health dispari-

ties research concerning asthma.

860

Comparative pharmacoepidemiology of

bronchial asthma in the Repablic of

Belarus for a 10 year period

Davidovskaya, EI1; Baranovskaya, TV1; Kozhanova, IN2;

Gavrilenco, LN2; Sachek, MM3

1Belarussian Medical Academy of Post-Graduate

Education, Minsk, Belarus; 2Belarussian State Medical

University, Minsk, Belarus; 3Republican Scientific

Practical Center of Medical Information Technologies,

Management and Economics in Health Care, Minsk,

Belarus

Background: Therapy of bronchial asthma

(BA) in the Republic of Belarus are regu-

lated by the National agreement (2006)

and current clinical standards (2012),

developed on the basis of GINA recom-

mendations.

Method: For the evaluation of pharmaco-

epidemiology of BA were developed ques-

tionnaires for doctors and assessment

protocols of medical records of patients.

Using the program MicrosoftAccess pro-

cessed and analysed 1265 questionnaires

(database ‘BA – questioning doctors’) and

862 protocol data from medical records

of patients with asthma of varying degrees

of severity (database ‘BA – treatment of

patients’). When analyzing the structure was

estimated basic therapy and its compliance

with the established severity of the disease.

Note that the level of control of asthma in

this study was not determined by virtue of

the methods used, but could be indirectly

assessed by the number of SABA per patient

per year. The obtained data were compared

with the results of the 2003–2006 survey.Results: Eighty-six per cent of the sur-

veyed physicians on the first place in the

basic treatment BA put anti-inflammatory

drugs, with inhaled steroids (IS) accounted

for 72%, which significantly differs from

the results obtained from 2003 (24% and

16% respectively). Among IS in monother-

apy preferences are divided between beclo-

metasone and fluticasone. In 18% of cases

the different combinations inhaled IS and

LABA beta-agonist are chosen at start.

Another 22% received combination ther-

apy as an alternative to increasing the dose

IS on an insufficient level of asthma con-

trol (2.4% in 2006). In 6% of cases in

2013, with mild persistent allergic asthma

was carried out specific immunotherapy,

which corresponds to the level of 2006.

Leukotriene blockers were included in 2012

standards and were appointed by 6.2%

cases (montelukast). For situational ther-

apy used inhaled SABA. 5.6 inhaler SABA

/patient per year was used in 2013, com-

pared with 9.2 in 2003.

Conclusion: Thus, despite the positive

trend pursued by the basic therapy is still

impossible to achieve the expected level of

BA control.

Poster Session Group II – Red. TPS 29 – Allergy and asthma epidemiology

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 327

861

Health related quality of life among

adolescents with asthma

Jonsson, M1,2; Bergstr€om, A3; Egmar, A-C4,5; Wickman,

M3,6; Lind, T2,3; Kull, I3,6,7

1Department of Womans and Childrens Health,

Karolinska Institutet, Stockholm, Sweden; 2Centre of

Occupational and Environmental Medicine, Stockholm

County Counsil, Stockholm, Sweden; 3Karolinska

Institutet, Institute of Environmental Medicine,

Stockholm, Sweden; 4The Red Cross University

College, Stockholm, Sweden; 5Department of Learning,

Informatics, Management and Ethics, Medical

Management Centre, Karolinska Institutet, Stockholm,

Sweden; 6Sachs’ Children0s Hospital, S€odersjukhuset,

Stockholm, Sweden; 7Department of Clinical Science

and Education, Stockholm South General Hospital,

Karolinska Institutet, Stockholm, Sweden

Introduction: It is known that asthma can

be difficult to manage in adolescents, due to

poor symptom control and low adherence

to treatment. There is a lack of information

on impact of asthma on health related qual-

ity of life during this sensitive period in life.

Objective: To assess the impact of asthma

on health-related quality of life among

adolescents in the BAMSE cohort.

Method: This study was conducted within

the birth cohort BAMSE where children

were recruited from the general population

and followed up to 16 years of age. In the

16 year follow-up information about

asthma symptoms and lifestyle factors were

obtained (n = 2946). In addition, health

related quality of life (HRQoL) was self-

reported with by the visual analogue scale,

EQ VAS.

To fulfil the definition of asthma the ado-

lescents should have at least four episodes

of wheeze in the last 12 months or at least

one episode of wheeze in combination with

prescribed inhaled steroids occasionally or

regularly, reported from adolescents.

Results: Adolescent in the cohort had an

EQ VAS mean score of 85.41 and a median

of 90. Girls reported a lower median EQ

VAS than boys at the same age (87 vs. 90

P ≤ 0.001). In total 7.6% of the adolescents

fulfilled criteria’s for asthma (n = 223).

Adolescents with asthma had a lower med-

ian EQ VAS compared with adolescents

without asthma (85 vs. 90, P = 0.002) and

had the lowest median EQ VAS compare to

adolescent with rhinitis and eczema. Fre-

quent asthma symptoms were reported

more often from adolescents who had a

lower median EQ VAS (85 vs 90,

P = 0.011). There was no significance in

median EQ VAS between those who were

treated with inhaled corticosteroids com-

pared with those who were not treated with

inhaled corticosteroids (88 vs 85 P = 0.236).

Conclusion: In this prospective study ado-

lescents with asthma report an impairment

of HRQoL. Further studies are needed to

explore if asthma control and other factors

related to asthma care influence the

HRQoL in adolescents.

863

Physical therapy treatment of impaired

chest mobility and respiratory movement

in patients with airway environmental

sensitivity

Johansson, E-L1; Ternest�en Hasseus, E2; Fagevik Ols�en,

M1; Millqvist, E2

1Physiotherapy and Occupational Therapy, Sahlgrenska

Academy, University of Gothenburg, Gothenburg,

Sweden; 2Department of Internal Medicine/Respiratory

Medicine and Allergology, Sahlgrenska Academy,

University of Gothenburg, Gothenburg, Sweden

Background: In sensory hyperreactivity

(SHR) patients have airway symptoms

induced by environmental irritants and are

characterised by increased cough reaction

to inhaled capsaicin. Lung function tests

are normal and asthma medications have

no or little effect.

Aim: To evaluate if a physiotherapeutic

intervention can increase the chest mobility

in SHR, influence these patients’ symp-

toms, quality of life and reduce capsaicin

cough sensitivity.

Method: Forty-one patients with well-

defined SHR were recruited to the study. In

a 12-week controlled, randomised training

study, one group performed symptom regis-

tration and a training program while the

other group only registrated symptoms

(control group). After 12 weeks the groups

changed to training or just symptom regis-

tration respectively. Chest expansion was

measured with a measuring tape and tho-

racic and abdominal movement with light

sensors. Pain sensitivity was assessed using

pressure algometry and a standardised cap-

saicin inhalation threshold provocation

evaluated cough sensitivity. General health

related quality of life was measured with

The SF36 version2.

Results: Chest mobility and upper thoracic

respiratory movements improved

(P < 0.01), as did the feeling of chest pres-

sure and the capsaicin cough sensitivity

decreased (P < 0.01). Other symptoms and

quality of life remained unchanged. The

patients had significantly lowered pain

pressure thresholds measured with algome-

try (P < 0.001) that did not change.

Conclusion: The pronounced improvement

of chest mobility after tailored physiothera-

peutic intervention indicates that these

patients suffer from dysfunctional breath-

ing. The regular use of a training program

and structural breathing instructions can

be used to improve chest mobility, chest

symptoms and capsaicin cough sensitivity

in SHR patients with signs of dysfunc-

tional breathing.

864

Highlighting the need for and the

development of a resourced national

food allergy service – the ‘Irish Food

Allergy Network’ experience of a national

targeted educational roll out

Hourihane, JO1,2; Fitzsimons, J3,4; Charles, R1; IFAN

Executive Core Working Group1Irish Food Allergy Network, c/o Department of

Paediatrics & Child Health, Cork, Ireland; 2Paediatrics

and Child Health, University College Cork, Cork, Ireland;3Irish Food Allergy Network, Cork, Ireland; 4Paediatrics

and Child Health, HSE Our Lady of Lourdes Hospital,

Drogheda, Ireland

Background: The Health Service in Ireland

has not recognised allergic disease as a pri-

ority despite documented increases in these

conditions (food allergy, asthma, eczema

and hay fever) over the recent decades and

public demand for services. At this time

services for adults and children with food

allergies continue to be extremely under re-

sourced. Health care staff especially in the

community need to have much greater edu-

cation, training and support.

Method: The Irish Food Allergy Network

(IFAN) was founded in 2010, representing a

professional multidisciplinary network of

health care staff and patient advocates. A

core working group was formed which

devised a 2 phased project plan. Unrestricted

educational grant aid provided funding.

1 Phase 1 aimed to develop diagnostic

and management algorithms and food

specific care pathways.

2 Phase 2 aimed to disseminate phase 1

outcomes.

Results: Production of best practice evi-

denced based diagnostic and management

algorithms for Paediatric Food Allergy for

Primary & Secondary Care settings, and,

specific care pathways for Cow’s Milk,

Egg, Peanut & Tree nut. www.ifan.ie was

specifically produced to host these

resources which are adapted for the Irish

health care environment. A CME accred-

ited educational presentation was delivered

to over 600 multidisciplinary health care

staff across 14 venues nationwide. 95% of

attendees reported new learning and a

change in practice as a result. Full evalua-

tion and audit is now underway.

Conclusion: In Ireland the level of knowl-

edge where it exists is basic and largely

‘faulty’. The level of interest in and engage-

ment with IFAN0s resources is high, espe-

cially among front line staff further

demonstrating the need for an integrated

and timely management approach offering

diagnosis, management, guidance, advice

and support for children and families when

and where needed.

Poster Session Group II – Red. TPS 29 – Allergy and asthma epidemiology

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453328

Poster Session Group II – Red

TPS 30 – Allergy and environment

865

Allergy to grass pollen in the highlands

of Madagascar: Rhynchelytrum repens

(wild grass) and Zea mays (cultivated

grass) are high IgE sensitising inducers

Ramavovololona, P1; S�en�echal, H2; Ramamonjisoa, ZR1;

Andrianarisoa, AC3; Rakotoarimanana, VM1; Godfrin,

D4; Peltre, G2; Poncet, P2; Sutra, J-P2

1Science Faculty, Biology and Plant Ecology,

Antananarivo, Madagascar; 2Biochemistry and

Molecular Biology, Hospital Armand Trousseau, Paris,

France; 3Medical Faculty, Medicine and Medical

Specialities, Antananarivo, Madagascar; 4Scientific

Police Laboratory, Ecully, France

Background: Few studies have investigated

allergy to tropical grass pollen in the high-

lands of Madagascar where savanna and

grassland cover extensive areas. Maize and

rice are two cultivated grass and their

crops constitute the main food in this

region. The aim of this work was to study

the prevalence of allergy to pollen from six

wild and two cultivated grasses.

Method: Sixty five Malagasy allergic

patients, from the Antananarivo region

selected on the basis of their seasonal ato-

pic symptoms were clinically (skin-prick

test, SPT) investigated and their sera were

immunochemically (mono- and bi-dimen-

sional immunoblot) studied with regard to

grass pollen allergens.

Results: As expected wide IgE cross-reac-

tivities were observed between the various

wild grass pollen. Nonetheless, Rhynchely-

trum repens pollen was found to be the

most allergenic when studied in both SPT

(symptom relevance) and immunoblot

(IgE binding). An unexpected high pro-

portion of these patients were sensitised to

maize and/or rice pollen as revealed by

SPT (62 vs 59%) and IgE immunoblotting

(85 vs 40%). Some clinically relevant

allergens were recognised by Malagasy

patients’ serum IgE in maize (groups 1, 2,

3, 4, 12, 13 and 22 allergens) and in rice

pollen extract (groups 1, 2, 3, 7 and 23

allergens).

Conclusions: Cross-reactivities between

wild and cultivated grasses and also

between rice and maize pollen are involved

in allergy to grass pollen in Madagascar as

well as some specific maize pollen sensitisa-

tions. The high levels of maize pollen sensi-

tisation should be related, in this tropical

region, to a specific environmental expo-

sure including

1 A proximity of the population to the

allergenic source and

2 A putative exacerbating effect of a

highly polluted urban atmosphere on

pollen allergenicity.

The presence of dense urban and peri-

urban agriculture, in different African

regions and worldwide, could be a high

environmental risk factor for people sensi-

tive to maize pollen.

866

Impact of the fight campaigns against

ragweed on the quantities of these

pollens

Thibaudon, M1; Martinez, Q2; Sindt, C1; Oliver, G1;

Chauvel, B3

1RNSA, Brussieu, France; 2Observatoire des

Ambroisies, Dijon, France; 3Inra, Dijon, France

Background: Common ragweed pollen

(Ambrosia artemisiifolia) is known for its

allergenicity causing hay fever, rhinocon-

junctivitis and asthma to patients living in

infested areas.

The dispersion of ragweed plant is

anthropogenic, and because it’s an invasive

plant, a number of control procedures have

been implemented whose effectiveness was

measured, in position of proximity, by the

emission of ragweed pollens which was

compared between the different areas.

Method: In addition to Hirst volumetric

pollens traps of the RNSA network, it was

decided to use passive traps SLT (SIGMA2

Like Trap) positioned near a treated or

non-treated area. Measures are weekly dur-

ing the months of August and September.

Two areas with different levels of infes-

tation were selected:

1 Infested areas: 12 SLT traps were set up:

a 8 traps in the department of Is�ere,in the town of Estrablin with two

trapss in non-treated areas and 8 in

well treated areas.

b 4 trapss in the department of Drome,

in the metropolitan area of Valence

with one trap in non-treated area

and three in well treated areas.

2 A few infested area in the department

of Cote d0Or (France) with four traps

located in lightly infested areas with 1

in an area without ragweed plant and 3

in areas with presence of small amounts

of ragweed plants.

Results:

1 Ragweed pollen amounts collected

from treated areas and non-treated

areas are different, with a maximum of

a few hundred of pollen grains for trea-

ted areas against a few to tens of thou-

sands for the non-treated areas.

2 On the area not really infested, the

quantities of pollen are limited to low

tens of ragweed pollen grains.

3 Periods of heavy pollination of ragweed

pollens are the same for SLT traps and

for Hirst pollen traps.

Conclusion: Even if the amounts of pollen

collected from the treated areas infestations

are still high, they are significantly less

important than the amounts present on

non-treated areas. The set-up of manage-

ment practices enable to locally reduce the

pollen pressure but only a generalised fight

will actually enable to relieve people aware.

867

Seasonal distribution of airborne pollen

and spores in Tbilisi, Georgia

Abramidze, T1; Bragvadze, T2; Chikhelidze, N2; Akhalka-

tsi, M2; Gotua, M1; Gamkrelidze, A1

1Center of Allergy & Immunology, Allergy, Tbilisi,

Georgia; 2Ilia State University, Institute of Botany,

Tbilisi, Georgia

Background: Airborne pollen and mold

spores are major sources of inhalant aller-

gens. The seasonal distributions of these ae-

roallergens vary between different countries

and regions. Information on the seasonal

distribution of local aeroallergens is impor-

tant tool to aid allergists in making accurate

diagnosis. The composition and seasonal

distribution of airborne pollen in atmo-

sphere in Tbilisi, capital of Georgia, has

been studied between July 2012 and Novem-

ber 2013 using Burkard volumetric traps.

Method: Burkard 7-day sampler was

located in a height of 15 m above the

ground. Analysis of each 24-h period was

conducted by counting four transets at

9400 magnification. Pollen and spores

counts were expressed as a daily mean

value in number of pollen grains/spores

per m3 of air.

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 329

Results: In the study period 18 pollen

types (from the investigated list of poten-

tially allergenic thirty-three plants) domi-

nated in the atmosphere. About 65% of

these pollen grains belonged to trees, 24%

to grasses/weeds and 11% of other plants

not included in the investigated list. Two

peak pollen dispersal seasons were

observed per year. The first peak was

occurred from February to June (end of

winter and spring), accounting for 81% of

total annual pollen count and second peak

– from August to November. The highest

concentration of pollen of airborne pollen

was from Taxus/juniperus (31%), followed

by Platanus (16%), Artemiasia (7%),

Carpinus (5%), Pinus (5%), Ulmus (4%),

Cruciferae (4%), Ambrosia (4%), Grami-

neae (3%), Chenopodium (3%), Urtica/Pa-

rietara (2%) and Aesculus (2%).

Atmospheric mold spores were presented

throughout the year with two peaks of

highest concentrations (May–June and

September–November). The most abun-

dant (36%) was Cladosporium.

Conclusion: A seasonal incidence chart

(pollen/spores calendar) for Tbilisi based

on study period observation has been con-

structed, which can be useful for providing

an early warning to allergenic individuals.

868

Retrospective analysis of pollen

sensitivity and its changing pattern in

Bangalore city

Pandit, GS

Meenakshi ENT Speciality Centres, ENT and Allergy,

Bangalore, India

Background: Bangalore city does not have

any recent pollen calender. The study is

aimed to analyse the sensitivity pattern of

pollens in patients attending allergy clinic

and their changing patterns (2010–2013).Method: Patients presenting with running

nose, sneezing, itchy nose and eyes were

subjected to skin prick allergy test. Three

hundred patients were tested from January

2010 till December 2013.

Results: Sensitivity patterns for 14 pollens

were studied. 24.8% were sensitive to Che-

nopodium, 14.7% were sensitive to Parthe-

nium, 11% were sensitive to Ipomea and

8% each sensitivity was noted with Pelto-

phorum and Cynodon, 7% for Amaranthus

and rest of percentage by other pollens.

Conclusion: The last available pollen calen-

der for Bangaore was 1995 which showed

Parthenium, Holoptelea and Cassurina and

Amaranthus in order of highest to lowest

occurance. There is significant change in

sensitivity which is now more with Che-

nopodium, followed by Parthenium. Cassu-

rina sensitivity has reduced to <1%.

Ipomea though entamophillous is new

emerging pollen.

This demands continuous pollen monitor-

ing of pollens round the year with help of

aero biologist to know the new emerging

pollens. This will also help Clinician to

select allergens for testing and in treatment

aspect.

869

A 2-year pollen-count monitoring in

Guadalajara (Spain)

Mateo-Borrega, B1; Vega-Castro, A1; Beitia-Mazuecos,

JM1; Alonso-Llamazares, A1; Benito, J2

1Allergy, Guadalajara University Hospital, Guadalajara,

Spain; 2Otolaryngology, Guadalajara University

Hospital, Guadalajara, Spain

Background: Pollen allergy is a disease with

increasing prevalence that affects more than

24% adults and up to 40% children in Eur-

ope. The aim of this work was to investigate

the main pollen types and the time of year

of its presence in the air of Guadalajara, a

city located in the centre of Spain.

Method: A 7-day Burkard spore trap oper-

ating at 10 l per minute and situated at an

altitude of 15 m over ground level was

used during the period 2011–2012. Sam-

pling method, slide preparation and data

interpretation were performed according to

the methodology recommended both by

the Aerobiology Committee of the SEAIC

and the Spanish Aerobiology Network.

Study area: Guadalajara city is 675–710 m

over sea and has Mediterranean continen-

tal climatic conditions.

Results: High levels of Cupressaceae pol-

len were observed between January and

mid-March in 2011, whereas in 2012 the

most intense pollination occurred from

mid-February to mid-March. Quercus

obtained the highest concentrations of pol-

len from April until May in 2011 and from

May to mid-June in 2012. Poaceae and

Olea main pollination has been observed

between late May and June. Chenopodia-

ceae-Amaranthaceae species reached the

largest amounts of pollen from August

through September. Platanus has shown a

explosive pollination from late March-to

early April both years. Total annual pollen

count was higher in 2011 compared with

2012, with 50 971 pollen grains/m3 in 2011

and 29 686 in 2012. Cupressaceae was the

main pollen type in 2011 (34.13% over

total pollen grains) followed by Quercus

and Platanus (23.45% and 14.76% respec-

tively). Poaceae and Olea pollen occupied

the 4th and 5th place (5.90% and 4.62%

respectively). The most abundant pollen

type in 2012 was Quercus, accounting of

32.65% total annual pollen, followed by

Platanus (14.93%) and Cupressaceae

(14.03%). Chenopodiaceae-Amaranthaceae

species showed similar results during the 2-

year period evaluated regarding both the

proportional pollen load (9th place in 2011

and 8th place in 2012) and the total num-

ber of grains/m3 (783 grains/m3 in 2011 vs

784 grains/m3 in 2012).

Conclusion: Year-on-year variations have

been observed regarding both the total pol-

len load and the ratio at which different

types of pollen have been identified.

Fundings: This work has received a grant

from the Foundation of the SEAIC.

870

Relevance of ovalbumin-based animal

models in comparison to house dust

mite models in research of cough

hypersensitivity syndrome

Buday, T; Gavliakova, S; Hanuskova-Kovacova, E;

Plevkova, J

Department of Pathophysiology, Jessenius Faculty of

Medicine, Comenius University in Bratislava, Martin,

Slovakia

Epidemiological studies indicate that

chronic cough affects approximately 10%

of the population, and it is common in mid-

dle aged and postmenopausal female, espe-

cially in those where the diagnostic triad

(asthma, gastroesophageal reflux and upper

airway diseases) fail to confirm the reason

for coughing. Cough hypersensitivity syn-

drome may be the underlying condition

explaining high prevalence of ‘unexplained’

cough frequently misdiagnosed and mis-

treated as asthma and its phenotypes.

Majority of the data in the field of cough

reflex modulation were obtained from gui-

nea pig model, as the most convenient one,

in which the neurophysiology and neuro-

pharmacology of the cough reflex – which is

exclusively mediated by the vagus nerve –share close similarities with humans. Yet we

were not able to reproduce cough hypersen-

sitivity syndrome in ovalbumin – based ani-

mal models. Lack of the relevant data from

the animal models lead to the failure of

understanding its pathogenesis and also

development of the drugs which would be

successfully used to treat cough hyper-

sensitivity syndrome is hampered.

House dust mites (HDM) (Dermato-

phagoides pteronyssius and Dermatophago-

ides farinae) on the other hand represent one

of the most frequent human aeroallergens.

However, the HDMmodels are used consid-

erably less than ovalbumin models, possibly

due to its more time-consuming sensitisation

protocol. Here we address the relevance of

HDM models as more suitable to study

cough hypersensitivity with all the complex-

ity of the ongoing immune, inflammatory

and neurogenic processes in the airways.

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453330

Poster Session Group II – Red. TPS 30 – Allergy and environment

The primary objective of our work is to

develop and validate the model of HDM

induced hypersensitivity with higher ability

to translate the results obtained in animal

models to clinical use in field of respiratory

medicine.

871

Preliminary clinical evaluation of an

allergen challenge theatre

Yang, WH; Yang, J; Perrins, R; Gerwing, D; Kelly, S;

Karsh, J

Red Maple Trials Inc., Ottawa, ON, Canada

Background: Allergen challenge chambers

expose allergen-sensitive subjects to a pre-

determined concentration of allergen in a

closed, controlled environment and provide

a mechanism to induce clinical symptoms

and measure the effect of medication.

Method: We performed a preliminary eval-

uation of the capabilities of the newly con-

structed Red Maple Trials Allergen

Challenge Theatre. Health Canada and a

provincial Ethics Board approved the

study. After signing informed consent,

patients with a history of grass allergy, not

on allergy medications and with a positive

skin prick test to grass antigen (≥3 mm)

were exposed for 3 h to timothy grass pol-

len (Phleum pratense) in our allergen chal-

lenge theatre. Total nasal (TNSS), ocular

and respiratory symptom scores (TRSS)

were recorded at baseline and every 30 min

during the challenge.

Results: 32/50 patients evaluated demon-

strated a positive skin prick test and

were challenged. Baseline TNSS and TRSS

(Mean � SD) were 0.6 � 1.04 and

0.6 � 1.07 respectively. Symptom scores

reached a plateau at 30 min (TNSS

4.8 � 2.68; TRSS 5.8 � 3.69) and remained

steady for the 180-min exposure period

reaching final values of TNSS 3.7 � 2.16;

and TRSS 5.8 � 3.79. Because entry to a

therapeutic trial usually requires achieving a

TNSS � 5 during a priming exposure, we

calculated the results for the 17/32 patients

reaching this score at 30 min (TNSS

6.65 � 2.21; TRSS 8.35 � 3.18). Scores

held steady and at 180 min were: TNSS

4.71 � 1.69; TRSS 7.88 � 3.06. No unex-

pected adverse events were reported during

the challenge.

Conclusion: The Red Maple Trials allergen

exposure theatre demonstrated the capacity

to induce symptoms of appropriate inten-

sity upon allergen challenge. Our chamber

with a seating capacity of 99 places has the

ability to evaluate large test groups at a

time.

872

The effect of Der p 7 on dendritic cells

and its role in the T cell polarization

Tsai, J-J1; Liao, E-C2

1Department of Medicine, Taichung Veterans General

Hospital, Taichung, Taiwan; 2Department of Medical

Research, Taichung Veterans General Hospital,

Taichung, Taiwan

Background: The innate signaling pathway

for Th2 immunity activated by inhaled

allergens is not well defined. Dendritic cells

(DCs) can use their innate pattern-recogni-

tion Toll-like receptors (TLRs) and C-type

lectin receptor to generate innate immunity

and influence adaptive response.

Aims: The aim of this study was to investi-

gate the glycoform of Der p 7 and its

functional interaction with dendritic cell-

specific intercellular adhesion molecule-3-

Grabbing Non-integrin (DC-SIGN).

Method: Both bone marrow-derived den-

dritic cells (BMDCs) derived from mice

and (monocyte-derived DCs) MDDCs

derived from human peripheral blood

mononuclear cells (PBMCs) were used to

investigate Der p 7 functions. Dendritic

cells derived from THP1 were used to

investigate the glycol-form of Der p 7.

Results: The Der p 7 could be interacted

with DC-SIGN recognised by immunopre-

cipitation and glycoprotein staining and its

function was partially inhibited by degly-

cosylation. When BMDCs were cultured

with Der p 7, the secretion of IL-6 and

gene expressions of IL-6, OX40L and Jag-

ged-1 were increased. The IL4+/CD4+ T

cells could be induced by Der p 7, but

IFN-c+/CD4+ T cells were down-regu-

lated. The effects of Der p 7 on DCs were

down-regulated in the presence of

DC-SIGN or TLR4 antibodies and degly-

cosylation. The rDer p 7 enhanced DCs

differentiation of major histocompatibility

complex (MHC) class II, CD80 or CD86,

high expression. The effects of Der p 7

pulsed -DCs with PBMCs showed IL4+/

CD4+ and IFN-c+/CD4+ both signifi-

cantly increased after Der p 7 stimulation

and decreased by the DC-SIGN antibody

inhibition.

Conclusion: the BMDCs could be activated

by Der p 7 through TLR4 and DC-SIGN,

follow by the ligand expression of OX40L

and Jagged-1, the IL4+/CD4+ cells could

be enhanced. These findings identified a

previously unrecognised function of Der p

7 to establish a link between innate TLR4/

C-type lectin receptors and adaptive Th2

immunity.

873

A case with severe asthma attack with

subcutaneous emphysema and Horner

syndrome

Caglayan Sozmen, S; Isik, S; Polat, I; Hiz, S; Guleryuz,

H; Anal, O; Karaman, O; Uzuner, N

Dokuz Eylul University Faculty of Medicine, Izmir,

Turkey

Asthma is chronic inflammatory disease of

the lung characterised by cough, chest

tightness and dyspnea. Herein, we pre-

sented a rare complication of asthma.

An 11 years old boy who was diagnosed

as asthma and treated with inhaled steroid

and long lasting beta agonist and leukotri-

en receptor antogonist. He presented with

severe dyspnea, chest and back pain. Physi-

cal examination revealed cyanosis, bilateral

decreased breath sounds with rhoncus.

Crepitation in the neck and upper part of

the chest pointed subcutaneous emphy-

sema. Thorax computed tomography

revealed pneumomediastinum and subcuta-

neous emphysema of the neck. He treated

with oxygen, systemic steroid, salbutamol

and magnesium sulphate. At the second

day of theraphy he experienced partial pto-

sis and miosis of the right eye. Neck MRI

showed prominent subcutaneousand intra-

muscular emphysema of the neck and

symptoms emerged due to compression of

the right cervical chain. We want to

emphasize a rare clinical finding of severe

asthma attack with Horner syndrome.

Symptoms regressed after supportive thera-

phy.

874

Per a 10 enzymatic activity initiates

allergic inflammation at mucosal surfaces

by inhibiting elastase inhibitors and

increasing epithelial permeability

Kale, SL; Agrawal, K; Arora, N

Allergy and Immunology Section, CSIR-Institute of

Genomics and Integrative Biology, Delhi, India

Background: Proteases have been shown to

initiate and exacerbate allergic reactions.

Per a 10, a major allergen from Periplaneta

americana induces allergic airway inflam-

mation in mice and polarizes dendritic cell

mediated T-cell response towards Th2. The

aim of the present study was to elucidate

the role of serine protease activity of Per a

10, on epithelial barrier function and on

innate lung defenses.

Method: Calu-3 cells were grown in tight

monolayers. They were exposed to active

or inactive Per a 10 to assess the changes

in permeability. Disruption of tight junc-

tions was checked by immunocytochemical

staining of tight junction proteins. B cells

were purified by MACS from human

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 331

Poster Session Group II – Red. TPS 29 – Allergy and asthma epidemiology

PBMCs. Cleavage of CD23, a low affinity

IgE receptor on B-cells by Per a 10 was

analysed by flow cytometry. Human elas-

tase inhibitors A1Pi and SLPI were incu-

bated with Per a 10 for 3 h and analysed

for cleaved products by Western blotting.

Results: Permeability assay of Per a 10

treated Calu-3 monolayer revealed that

nPer a 10 increased the epithelial cell per-

meability in a time dependent manner.

Immunohistochemical analysis of ZO-1

and claudin proteins revealed uniform and

continuous distribution of tight junctions

in controls which was discontinuous with

breaks in Per a 10 treated epithelial mono-

layers. This suggests that Per a 10 might

increase epithelial permeability by ZO-1

and claudin cleavage. Proteolytically inac-

tive Per a 10 (DPer a 10 and rPer a 10)

had no effect on epithelial permeability

and tight junctions. B cells treated with

active Per a 10 have lowered expression of

CD23 as compared to inactive Per a 10

suggesting CD23 cleavage. Additional low

molecular band in lanes loaded with Per a

10 treated A1Pi and SLPI indicated Per a

10 might cleave human elastase inhibitors.

Conclusion: Serine protease activity of Per

a 10 enhances epithelial cell permeability

and down regulates innate lung defenses.

Inhibiting the protease activity may be of

therapeutic value for immunotherapy.

875

Neonatal monocolonisation with

Bifidobacterium longum induces

prophylaxis against birch pollen

sensitisation in mouse model

Kozakova, H1; Schwarzer, M1; Srutkova, D1;

Schabussova, I2; Hudcovic, T1; Wiedermann, U2

1Institute of Microbiology of the Academy of Sciences

of the Czech Republic, v.v.i., Laboratory of

Gnotobiology, Novy Hradek, Czech Republic; 2Medical

University of Vienna, Institute of Specific Prophylaxis

and Tropical Medicine, Vienna, Austria

Background: Early life events, such as

exposures to microbes, have a major influ-

ence on the development of balanced

immune responses and play the role in

allergic onset in sensitive individuals. The

aim of this study was to investigate the

prophylactic effect of neonatal mother-to-

offspring mono-colonisation with Bifido-

bacterium longum ssp. longum on subse-

quent allergic sensitisation.

Methods: Adult male and female germ-free

(GF) mice were mono-colonised with

B. longum, mated and their offspring, as

well as age-matched GF controls, were sen-

sitised with the major birch pollen allergen

Bet v 1. Furthermore, signaling pathways

involved in the recognition of B. longum

were investigated in vitro.

Results: Neonatal mono-colonisation of

GF mice with B. longum suppressed Bet v

1-specific IgE-dependent b-hexosaminidase

release as well as levels of total IgE and

allergen-specific IgG2a in serum compared

to sensitised GF controls. Accordingly, Bet

v 1-induced production of both Th1- and

Th2-associated cytokines in spleen cell cul-

tures was significantly reduced in these

mice. The general suppression of Bet v

1-specific immune responses in B. longum

colonised mice was associated with

increased levels of regulatory cytokines

IL-10 and TGF-beta in serum. In vitro,

B. longum induced low maturation status

of bone marrow-derived dendritic cells and

production of IL-10 in TLR2-, MyD88-,

and MAPK-dependent manner.

Conclusions: Our data demonstrate that

neonatal monocolonisation with B. longum

reduces allergic sensitisation, likely by acti-

vation of regulatory responses via TLR2,

MyD88, and MAPK signaling pathways.

Thus, B. longum might be a promising can-

didate for perinatal intervention strategies

against the onset of allergic diseases in

humans. Supported by grant CZ.3.22/

2.1.00/13.03892.

877

Clinical relevance of the domestic mite

Gohieria fusca sensitivity

Meijide Calderon, A1; Garcia Paz, V1; Rial Prado, M1;

Rico Diaz, MA1; Veleiro Perez, B1; Bartolome, B2

1Complejo Hospitalario a Coru~na, Alergolog�ıa, A

Coru~na, Spain; 2Bial-Ar�ıstegui Lab., Bilbao, Spain

Introduction: The mite specie Gohieria

Fusca is a minor mite of the Glicyphagoi-

dea family. It is widely spread in high

humidity regions such as Galicia or the

North of Extremadura, in Spain. It pre-

sents cross reactivity with other mites as

Lepidogliphus destructor. Although the

presence of positive skin test with Gohieria

Fusca there is no data about its clinical rel-

evance.

A 30 year-old male living in A Coru~na(Galicia, Spain), refers conjuntival pruritus

anda nasal symptoms (rhinorrea, nasal

itching, sneezing) throughout the year.

Method: We performed skin prick test

with commercial extracts, specific IgE

determination, Imnoblotting and Conjunc-

tival challenge with Gohieria Fusca.

Results: Skin prick test with common

inhalant allergens extracts (Bial-Aristegui�

Lab.): Dermatophagoydes pteronyssinus

4 mm, Lepidogliphus destructor 10 mm,

Tyrophagus putrescentiae, Gohieria Fusca

20 mm, Chortoglyphus arcuatus, Alterna-

ria alternata, Aspergillus fumigatus, Cupre-

sus arizonica, Platanus acerifolia, Betulla

alba, Olea europea, Phleum, Cynodon,

Plantago, Parietaria judaica, Profilin, LTP

peach, Blatella germanica, Prawn, Dog

ephitelum, Cat epithelium. HISTAMINE

6 mm.

Specific IgE (INMUNOCAP�): D. Pter-

onyssinus 0.023 U/ml, Lepidoglifus de-

structor 0.88 U/ml, Tyrophagus

putrescentiae 0.016 U/ml.

Inmunoblotting SDA-PAGE (Bial- Ar-

istegui� Lab.): Gohieria Fusca extract

showed several proteins with molecular

weights between 14.4 and 20.1 kDa; Lepi-

dogliphus destructor extract showed pro-

teins with molecular weights of 14.4 and

20.1 kDa too.

Conjunctival challenge test with a

full- gown culture of Gohieria Fusca (Bial-

Aristegui� Lab.) by Bonini method we

performed five consecutive dilutions up to

0.00005 mg/ml for skin prick test, which

was the end point. The conjuntival chal-

lenge test started at the end point and

resulted positive to 0.05 mg/ml, when the

patient developed conjunctival pruritus,

tearing and nasal bockage.

Conclusion: We can conclude that patient

is sensitised to Gohieria Fusca, Lepidogli-

phus destructor and Dermatophagoydes

pteronyssinus; we believe Gohieria Fusca is

the first sensitised. We have to take into

account the clinical relevance of the posi-

tive result in skin prisk test with Gohieria

Fusca.

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453332

Poster Session Group II – Red. TPS 30 – Allergy and environment

Poster Session Group II – Red

TPS 31 – Allergy diagnosis: new methods

878

Skin prick tests may be performed at any

age

Demir, E; Gokce, S; Tanac, R; Gulen, F; Cigerci

Gunaydin, N

Allergy-Immunulogy Department, Ege University

Faculty of Medicine, Children Hospital, Izmir, Turkey

Background: Skin prick test (SPT) and

allergen specific IgE are the most frequent

allergy tests performed in an allergy clinic.

The sensitivity and the specificity of these

are similar. The aim of this study is to learn

the relationship between allergen sp-IgE

and skin prick testing results at the diagno-

sis and the age related variations of these

results.

Methods: Serum total, sp-IgE and SPT

were performed to 1075 children who

admitted to Ege Universitiy Children Hos-

pital Allergy Clinic because of allergic dis-

ease. The statistic analise were performed

by SPSS after the patients were grouped

according to age.

Results: Patients were aged between 0 to

22 years old and %67 of the them were

male. Skin prick test’s positivity was 70.9%.

Aeoroallergen and food sensitivity by SPT

and sp-IgE are 77.5% versus 66.4% and

63% versus 50.2%, respectively. Aeroaller-

gen sp-IgE values were increasing with age

and becomes positive generally after

24 months old (0.15 � 12.2 ku/l in

0–24 months old and 4.7 � 43.5 ku/l in

25–60 month old, P: 0.00). The difference is

more significant after 5 years of age

(0.3 � 23.6 ku/l in <5 years, 8.5 � 45.4 ku/

l in >5 years, P: 0.00). Food sp-IgE positiv-

ity was 48.6% in 0–6 months old group,

11.1% in >5 years group (P: 0.00). Median

induration diameter was 8.14 � 1.9 mm in

sp-IgE positive group and 7.75 � 2.1 mm

in negative group (P: 0.008).

Aeroallergen sp-IgE positive and nega-

tive patient’s SPT was 82.3% and 32.6%

positive respectively (P: 0.00). The indura-

tion diameters were significantly larger in

aeroallergen and food sp-IgE positive

group (P: 0.00).

Compared with the SPT, the cut off

value of allergen sp-IgE >0.35 ku/l’s posi-

tive predictivity was 80% and negative pre-

dictivity was 78%.

Conclusion: Food sensitivity was higher in

younger patients and environmental aller-

gen sensitivity was higher in older patients.

Skin prick tests and sp-IgE values are com-

patible tests. Costs and time consuming

should be considered to choose the appro-

priate test.

879

An immunodiagnostic assay for

quantitation of specific IgE to the major

pollen allergen component, Pas n 1, of

the subtropical Bahia grass

Timbrell, V1; Riebelt, L2; Simmonds, C2; Butler, C2;

Upham, J1,3; Smith, P4; van Nunen, S5,6; Smith, W7;

McLean-Tooke, A8,9; Solley, G10; Kober, A11; Langguth,

D2; Davies, JM1

1School of Medicine, The University of Queensland,

Brisbane, Qld, Australia; 2Sullivan Nicolaides

Pathology, Immunopathology, Brisbane, Qld, Australia;3Princess Alexandra Hospital, Respiratory Medicine,

Brisbane, Qld, Australia; 4Queensland Allergy Service3,

Goldcoast, Australia; 5Royal North Shore Hospital,

Immunology, Sydney, NSW, Australia; 6Sydney

Medical School, University of Sydney, Sydney, NSW,

Australia; 7AllergySA, Adelaide, SA, Australia;8Immunology, Freemantle Hospital, Perth, Australia;9Immunology, Sir Charles Gairdner Hospital, Perth,

Australia; 10Watkins Medical Centre, Brisbane, Qld,

Australia; 11ImmunoDiagnostics, Thermo Fisher

Scientific, Uppsala, Sweden

Background: An immunodiagnostic IgE

assay for the major molecular allergenic

component, Pas n 1, of Bahia grass (Pasp-

alum notatum) pollen (BaGP) would have

utility to address unmet needs of patients

with allergy to subtropical grass pollens

that differ immunologically from temperate

grass pollens.

Methods: Pas n 1 was purified from BaGP

extract by ammonium sulfate precipitation,

hydrophobic interaction and size exclusion

chromatography. Biotinylated-Pas n 1 was

coated onto streptavidin-ImmunoCAPs.

316 subjects, recruited with ethical

approval, were assessed for their clinical

history of allergic rhinitis and skin prick

response to aeroallergens. Serum total,

BaGP- and Pas n 1-specific IgE were mea-

sured.

Results: Pas n 1 IgE concentrations were

highly correlated with BaGP skin prick

responses (r = 0.776, P < 0.0001) and

BaGP IgE (r = 0.902, P < 0.0001). At

0.098 kU/l Pas n 1 IgE, the diagnostic sen-

sitivity (96.3%) and specificity (98.7%) was

high with the area under the Receiver

Operator Characteristics curve of 0.978

(P < 0.0001). Median levels of Pas n 1 IgE

in sera of non-atopics (0.010 kU/l, n = 79)

and subjects with other allergies

(0.017 kU/l, n = 47) showed no significant

difference between groups, whilst BaGP-

allergic patients with allergic rhinitis

showed markedly elevated Pas n 1 IgE

(6.261 kU/l, n = 187; Kruskal–Wallis,

P < 0.0001). Control values; low and high

IgE curve controls; non-atopic, other

allergy and BaGP-allergic serum pools;

and no serum controls, did not differ sig-

nificantly between assays. The interassay

coefficient of variability for the BaGP-

allergic serum pool was 6.92%.

Conclusions: Pas n 1 IgE appears to

account for most of the BaGP-specific IgE

in BaGP-allergic patients with allergic rhi-

nitis. This molecular component immuno-

assay for Pas n 1 IgE has the potential to

improve the sensitivity and accuracy of

diagnosis of BaGP allergy for patients in

subtropical regions.

880

Sensitivity and specificity of three

standardised allergen extract solutions

for diagnosis of allergy by skin prick

testing

de Blay, F1; Didier, A2; Lavaud, F3; Radu, C1; Melac, M4;

Viatte, A4; Furrer, M-P4; Zeldin, RK4

1Chest Diseases Department, University Hospital of

Strasbourg, Strasbourg, France; 2Respiratory Diseases

Department, Rangueil-Larrey Hospital, Toulouse,

France; 3Respiratory Diseases Department, Maison

Blanche Hospital, Reims, France; 4Stallergenes S.A.,

Global Clinical Development, Antony, France

Background: Skin testing is commonly

used for the diagnosis of allergen-induced

rhinitis or rhinoconjunctivitis. Here we

report the sensitivity and specificity of

5-grass, birch, and D. pteronyssinus mite

allergen extract 100 IR/ml skin prick test

solutions assessed in a double-blind, con-

trolled study.

Method: Patients (5–60 years) with at least

a 2-year history of seasonal or perennial

rhinitis, conjunctivitis and/or stable asthma

due to grass, birch, or mite exposure were

eligible to participate. Their true allergy

status was defined by clinical history of

allergy to the considered allergen and spe-

cific serum IgE levels ≥0.35 kUA/l. A

wheal diameter >3 mm in response to skin

prick testing was considered positive. The

primary analysis sets were Per Protocol

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 333

Sets (PPSs) defined for each allergen. True

(TN) and false negatives (FN) and true

(TP) and false positives (FP) were defined

according to the patient’s medical history,

specific-IgE levels and skin testing. Sensi-

tivity and specificity were calculated as TP/

(TP+FN) and TN/(FP+TN), respectively.

Results: A total of 323 patients were

included. Respective numbers of allergic

and non-allergic patients in the PPSs were:

PPS5-grass 141 and 78, PPSbirch 103 and 130,

and PPSmites 120 and 81. Sensitivity was

96.5% (CI95% [91.9; 98.8]) for 5-grass,

95.1% (CI95% [89.0; 98.4]) for birch, and

95.0% (CI95% [89.4; 98.1]) for mites. Speci-

ficity was 88.5% (CI95% [79.2; 94.6]) for

5-grass, 91.5% (CI95% [85.4; 95.7]) for birch,

and 90.1% (CI95% [81.5; 95.6]) for mites. Of

the three adverse events reported, one, pruri-

tus at the application site, was considered

related to the investigational product.

Conclusion: The three 100 IR/ml skin

prick test solutions were sensitive and spe-

cific and are appropriate for the diagnosis

of grass, birch, and house dust mite

allergy. The solutions were well tolerated.

881

Stability of immunoassay analytes and

test kits used for monitoring

environmental allergen exposure

King, EM1; Smith, BR2; Block, DS2; Filep, SC2;

Chapman, MD2; Hindley, JP3

1Immunoassay Department, Indoor Biotechnologies Inc,

Charlottesville, VA, United States; 2Indoor

Biotechnologies Inc, Charlottesville, VA, United States;3Indoor Biotechnologies Ltd., Cardiff, United Kingdom

Background: Allergen exposure assess-

ments are routinely based on dust extracts

tested in immunoassays. The stability of

immunoassay test kits and allergens in dust

extracts has not been fully established.

Methods: Microtiter plates were coated

with an antibody specific for one of eight

common environmental allergens. Plates

were treated with stabilizing buffer, dried,

and packaged in foil pouches. The stability

of pre-coated plates and assay reagents

was evaluated after one, two, three, and

6 months. To measure the stability of aller-

gens in extracted dust samples, extracts

were prepared from four sieved dust sam-

ples. The extracts were aliquoted and

stored at five different temperatures. Aller-

gen levels were measured using MARIA 8-

plex (Der p 1, Der f 1, Mite Group 2, Fel

d 1, Can f 1, Bla g 2, Mus m 1, and Rat n

1) over a period of 9 months.

Results: Pre-coated immunoassay plates

and reagents remained stable for at least

6 months. Allergens in dust extracts

remained stable for 1–3 days at 30°C,3 days at RT, and 1–3 weeks at 4°C. Aller-

gens were most stable when dust extracts

were stored frozen at either �20°C or

�80°C.Conclusion: Dust extracts may be stored at

4°C for up to 1 week, but should be frozen

at or below �20°C for long-term storage

to maintain allergen stability. This finding

is particularly relevant for determining

sample shipping and handling conditions.

The results showed that pre-coated allergen

ELISA kits are stable for 6 months and

may be suitable for epidemiological studies

involving allergen exposure assessment.

882

The predictive value of microarray

assessed IgE-sensitisation for new-onset

rhinitis in adults

Patelis, A1; Gunnbjornsdottir, M1; Alving, K2; Borres,

MP2,3; Janson, C1; Malinovschi, A1

1Respiratory Medicine and Allergology, Uppsala

University, Uppsala, Sweden; 2Department of Women’s

and Children’s Health, Uppsala University, Uppsala,

Sweden; 3Immunodiagnostics, Thermo Fisher

Scientific, Uppsala, Sweden

Background: The prevalence of rhinitis in

adults continues to increase in western

world. The aim of the present study was to

determine the value of assessment of IgE

sensitisation by microarray technique for

predicting new-onset rhinitis in a popula-

tion-based study.

Methods: The study was based on 302

adults who participated in the European

Community Respiratory Health Survey

(ECRHS) II and III in Uppsala. IgE-sensi-

tisation at ECRHS II (1999–2000) was

assessed with microarray technique (Immu-

noCAP ISAC). Rhinitis symptoms were

questionnaire assessed both at ECRHS II

and ECRHS III. The interval between the

two surveys was approximately 12 years.

Results: A higher prevalence of asthma

(25.0% vs. 4.1%, P < 0.001), pollen sensiti-

sation (37.5% vs. 8.9%, P < 0.001), peren-

nial sensitisation (furry pets, mite and

mould) (34.4% vs. 3.3%, P < 0.001) and

other IgE sensitisation (latex, cockroach,

anisakis, mercury, bee, bromelin) (21.9%

vs. 1.6%, P < 0.001) was found in subjects

with new-onset rhinitis (n = 32) compared

to subjects without rhinitis at both surveys

(n = 123). Pollen (titre of IgE ≥ 0.3 ISU

for any pollen component) (OR = 3.8(1.1–13.2)), perennial (OR = 16.8(2.9- 98.3))

and other allergen sensitisation (OR = 14.1

(1.8–111)) were independent predictors of

new-onset rhinitis

Conclusion: Sensitisation to seasonal and

perennial allergens assessed by microarray

technique had a predictive value for new

onset rhinitis in a cohort of adults.

883

Use of intracutane skin test, total and

specific IgE as diagnostic preparation of

long term immunotherapy for asthmatic

subjects

Prnjavorac, B1,2; Deljki�c, A3; Mehmedovi�c, A4; Sinano-

vi�c, A5; Sejdinovi�c, R5; Juki�c, J6; Krajina, K7; Bego, T8;

Malenica, M8; Duji�c, T8; Adlija, �C8; Semiz, S8; �Saranovi�c,

L9; Mujari�c, E9; Mehi�c, J5; Fejzi�c, J5

1General Hospital Te�sanj, Pulmology – Immunology,

Te�sanj, Bosnia and Herzegovina; 2Pathophysiology,

University Sarajevo, Sarajevo, Bosnia and Herzegovina;3Internal Medicine – Immunology, General Hospital

Te�sanj, Te�sanj, Bosnia and Herzegovina; 4Clinical

Hospital for Internal Medicine, University Sarajevo,

Sarajevo, Bosnia and Herzegovina; 5Pulmology-

Immunology, General Hospital Te�sanj, Te�sanj, Bosnia

and Herzegovina; 6Intensive Care and Anestesiology,

General Hospital Te�s�sanj, Te�sanj, Bosnia and

Herzegovina; 7University Pittsburgh, Pittsburgh, PA,

United States; 8Clinical Biochemistry, University

Sarajevo, Sarajevo, Bosnia and Herzegovina; 9Internal

Medicine, Cantonal Hospital Zenica, Zenica, Bosnia and

Herzegovina

Background: Proper diagnostic research is

the cornerstone for success of specific

immunotherapy for allergic diseases. Pre-

cise diagnosis includes both: provocation

tests, performed as intracutaneous or prick

test, and measurement of total and specific

IgE in the blood, used as confirmation for

asthma, caused by patterns of type I

hypersensitivity, according to Gell and

Coombs classification. Other types of ‘asth-

matic syndrome’, like asthma caused by

acetyl salicylic acid, are not of interest for

this paper.

Method: Asthmatic patients, treated for

1 year in the Division of Allergology of

the Department of Pulmology, were evalu-

ated for this study. Measurement of total

IgE and specific IgE was performed using

the enzyme immunoassay sandwich

method, with which final fluorescent detec-

tion, known as ‘ELFA method’, combined

a two-step method. Skin provocation tests

were performed according to a method

described in the Manual of Clinical Labo-

ratory Immunology. Statistical analysis

was completed by using software package

Statistica for Windows, with multiple-

correlation test and descriptive statistics.

Results: During the 1 year, 64 patients

were treated, 35 of which were female and

29 male. Total IgE (average value 596 IU/

ml, SD 144, 1 IU = 3.2 ng) measurements

were performed on all 64 patients. Specific

IgE measurement were performed for: der-

matophagoides pteronissimus (38.57 IU/

ml, SD 57.62), dermatophagoides farinae

(39.52 SD 61.89), pollen of birch (38.54,

SD 60.2), timothy grass 26.5 (SD 15.56),

alder 24.27 (SD 12.7), oak 7.09 (6.2), and

mugwort 2.75 (SD 1.12). Intracutaneous

skin tests were administered for the same

allergens. The diameter of the weal, after

intracuneous injection of allergen, was

measured and multiple correlations were

Poster Session Group II – Red. TPS 31 – Allergy diagnosis: new methods

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453334

established. No significant correlation was

found between the Total and specific IgE

levels nor for Total IgE and skin test.

However, significant correlation was

revealed between specific IgE and related

allergen skin test.

Conclusion: Because subcutaneous specific

immunotherapy is a long-term treatment, it

is necessary to properly diagnose patients

with Asthma and Type I hypersensitivity

before treatment. Significant correlation

between specific IgE level and related aller-

gen skin test was found, while no signifi-

cant correlation was displayed between

total IgE and related allergen skin test.

Skin test was found to be most important

in deciding to perform SCIT.

884

Validation of the Phadia 100 for use in

analysis of IgG and IgG4 in rBet v1

reactive serum

Mwange, JD; Thomas, NG; Hutchings, JW; Hewings,

SJ; Skinner, MA

Allergy Therapeutics plc, Worthing, United Kingdom

Background: Phadia 100 is widely used in

molecular allergology diagnosis in the

clinical field. However, there has been an

increased use of molecular allergology in

the efficacy assessment of immunotherapy

products. To meet the current EMA/

INS/GCP/454280/2010 and MHRA

(GCP) guidelines, a validation of the Pha-

dia 100 was conducted as there is cur-

rently no commercial validation package

available.

Method: The Phadia 100 is a high binding

Fluoroenzyme immunoassay consisting of

a reaction chamber with a flexible hydro-

philic polymer to which the rBet v 1 aller-

gen covalently binds. Serum samples were

added resulting in a reaction between the

recombinant rBet v 1 allergen and the Bet

v 1 IgG/IgG4 antibodies in the serum.

Non-specific antibodies were removed by

washing prior to the addition of enzyme

labelled antibodies against IgG/IgG4. Any

unbound enzyme-anti-IgG/IgG4 was

removed by washing. The bound complex

was further incubated with the developing

solution resulting in the formation of a

fluorescent product. This reaction was

stopped using Sodium Carbonate. Phadia

100 measures the fluorescence of the eluate

where the higher the fluorescence, the more

IgG/IgG4 present in the sample tested. The

instrument interpolates the IgG/IgG4 con-

centrations from the calibration curve

reporting results in (mg/l). In accordance

with ICH Q2 (R1), as a content assay, the

following parameters were validated: Accu-

racy, Repeatability, Intermediate Precision,

Specificity, Linearity and Range.

Results: The design and execution for vali-

dation of both IgG/IgG4 assays will be

presented to demonstrate both methods

met the acceptance criteria for all valida-

tion parameters above.

Conclusion: The validation of the Phadia

100 was successful and has proven specificity

and precision in the quantitative assessment

of IgG/IgG4 following immunotherapy.

885

Identification of disease-causing

allergens by a single allergen

components diagnosis in allergic rhinitis

patients with positive skin prick tests to

birch and grass pollen

Christoff, G1,2; Nikolova, M2,3; Karova, E4

1Faculty of Public Health, Medical University Sofia,

Sofia, Bulgaria; 2Tokuda Hospital, Sofia, Bulgaria;3National Center of Infectious and Parasitic Diseases,

Sofia, Bulgaria; 4Faculty of Dental Medicine, Medical

University of Sofia, Sofia, Bulgaria

Background: The in vitro diagnosis of

allergies against pollen is generally per-

formed using raw pollen extracts. In recent

years, allergenic proteins from pollen are

used for detection of specific IgE. This

approach is very useful for the purpose of

precise diagnosis, prognosis and treatment.

Method: Twenty-five patients with positive

medical history for seasonal allergic rhinitis

who were referred to the outpatient depart-

ment of a major private hospital were skin

prick tested(SPT) for sensitisation to out-

and indoor allergens with commercial aller-

gen extracts(Alyostal Prick, Stallergenes,

France). In all patients SPT sensitivity to

birch and grass mixtures was at high and

practically identical level. The range of

patients0 pollen season was from March to

July and it was difficult to differentiate the

worst part of it. Patients’ serum samples

were tested for specific IgE levels by a com-

ponent-resolved, multiparameter immuno-

blot test system(SPAC pollen, Euroline

system, EUROIMMUN AG, Germany).

According to the detected IgE levels the fol-

lowing groups were defined: genuine birch

or grass sensitisation with/without cross-

reactivity, co-sensitisation to birch and

grass with/without cross-reactivity, cross-

reactivity sensitisation. SIT was chosen with

regard to the group to which patients were

included.

Results: 38.9% of the patients were with

genuine birch sensitisation; 5.6% – with

genuine grass sensitisation; co-sensitisation

was found in 38.9%. 5.6% were sensitised

to cross-reactive allergens. In 11.1% no

elevated IgE were detected. Cross-reactive

sensitisation parallel with that to birch and

grass was found in 33.3%. In 83.3% of the

cases it was due to profilins and in 16.7%

– to Ca-binding proteins.

Conclusion: These data show that often

skin prick testing with natural allergen

extracts can not differentiate between two

causal allergen sources. For better diagno-

sis, prognosis and treatment it is relevant

to use IgE tests for a single allergen com-

ponents diagnosis.

886

Allergen-specific IgE after anaphylaxis to

tick or mammalian/marsupial meat in

Australia

Baumgart, KW1; Mok, A1; Sivertsen, T1; Mullins, R2;

Van Nunen, S3

1Douglass Hanly Moir Pathology, Department of

Immunology, Macquarie Park, NSW, Australia; 2Medical

School, Australian National University, Canberra, ACT,

Australia; 3Department of Clinical Immunology and

Allergy, Royal North Shore Hospital, St Leonards,

Australia

Background: Increased rates of sensitisat-

ion to mammalian and marsupial meat

have been observed in tick endemic areas.

The Thermofisher Phadia ImmunoCAP for

‘Alpha-gal’ (U953) has allowed robust,

reproducible detection of allergen-specific

IgE in persons who may be sensitised to

ticks. In Sydney, Australia, a hyperendemic

area for Ixodes holocyclus ticks we have

observed a massive increase in tick bite fre-

quency. Our laboratory has offered testing

for Alpha-gal since August 2011.

Method: We reviewed the first 363 patients

referred for alpha-gal specific IgE compris-

ing 151 (42%) males and 212 (58%) females

between August 2011 and October 2013.

Associated tests requested on that and other

occasions were extracted from the labora-

tory information management system.

Results: Patients were referred for testing

if exposure to ticks or ingestion of meat

were possible elicitors of a serious allergic

reaction. Although bovine gelatin was

often requested prior to the availability of

alpha-gal, it was seldom requested after-

wards being infrequently positive. Com-

mon co-requested tests included tryptase

and specific IgE for beef, lamb and pork.

Twelve patients had serial tests typically

about 12 months apart, of whom 9 dis-

played significant reductions in alpha-gal,

beef and lamb specific IgE levels while 3

had rising levels. Tryptase levels were

co-requested on 139 patients with 10

elevated, remote from any allergic events.

Hundred and fifty-five patients had elevated

alpha-gal specific IgE levels, 29 had ‘low

level sensitisation’ (between 0.10 and

0.35 kU/l) and 178 were negative. Of the

group without detectable specific IgE to

alpha-gal, 3 were at least moderately reac-

tive (Class II or higher) to beef, 4 to lamb

and 1 to pork. However, for all persons with

moderate or greater reactivity to alpha-gal,

Poster Session Group II – Red. TPS 31 – Allergy diagnosis: new methods

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 335

equivalent or lower levels of sensitisation

to beef, lamb and pork were seen.

Conclusion: No evidence of meat or tick

sensitisation was seen in 57% of this

cohort referred after serious allergic reac-

tions. Sensitisation to alpha-gal appears to

account for almost all of the sensitisation

to mammalian meat in this cohort. Clinical

request patterns have evolved to include

concurrent requesting for alpha-gal, beef,

lamb and pork and periodic 12–18 month

serial testing. It will be of interest to deter-

mine whether declining alpha-gal and meat

specific IgE occurs more widely in this

cohort with allergen avoidance and

whether threshold levels can predict better

future tolerance of tick and meat exposure.

887

Basophil activation test: comparison of

different basophil identification markers

by multicolor flowcytometry

Eberlein, B1; Hann, R1; Eyerich, S2; Pennino, D2; Ring,

J1; Schmidt-Weber, CB2; Buters, J2

1Department of Dermatology and Allergy Biederstein,

Technische Universit€at M€unchen, M€unchen, Germany;2Technische Universit€at and Helmholtz Center Munich,

Center of Allergy and Environment, M€unchen, Germany

Introduction: Flowcytometric identification

of basophils is a prerequisite for measuring

activation of basophils with IgE-dependent

or IgE-independent stimuli. It was the aim

of this study to compare different marker

combinations in a simultaneous multicolor

flowcytometric measurement.

Methods: Ten patients with a grass pollen

allergy and three controls were included in

the study. Basophilic cells were gated by

using anti-CCR3-Alexa Fluor 647, anti-

IgE-FITC, anti-CRTH2-V450, anti-

CD203c-PE und anti-CD3-PerCP-Cy 5.5.

Cells were activated by a monoclonal anti-

FceRI antibody, N-formyl-methionyl-

leucyl-phenylalanine (fMLP) and the

allergen Phleum pratense. The activation

marker anti-CD63-PE-Cy 7 was used.

Results: The highest relative number of ba-

sophils was found with anti-CCR3+ cells,

anti-IgE+ and anti-IgE+/anti-CD203c+

cells, the lowest with CRTH2+/CD203c+/

CD3� cells. A very good and good concor-

dance of CCR3+ cells was seen with

CCR3+/CD3- cells and CRTH2+/

CD203c+/CD3- cells in all experiments. The

contamination of the CCR3+ population

with CD3+ cells and the contamination of

the IgE+-population with CCR3- cells and

CD203� cells were the lowest in all experi-

ments.

Conclusions: The highest relative number of

basophils was identified by Alexa-Fluor 647

anti-CD193 (CCR3) followed by the anti-

IgE-FITC and anti-IgE-FITC/antiCD203c-

PE positive population in most cases. The

basophil population with the highest purity

was identified by anti-IgE-FITC.

888

Predicting challenge outcomes in

children: role of histamine levels

De Amici, M; Leoni, MC; Cugno, M; Caimmi, S; Licari,

A; Marseglia, A; Castagnoli, R; Marseglia, GL

Department of Pediatrics, Universit�a degli Studi di

Pavia – Foundation IRCCS Policlinico San Matteo,

Pavia, Italy

Background: To our knowledge, the nor-

mal range for histamine has not yet been

identified for children. The aim of this

study was to assess if histamine levels (ng/

ml) measured pre- and post-oral provoca-

tion test (OPT) could be useful in predict-

ing the outcome of oral challenges in

children. This study was conducted also to

evaluate histamine serum baseline values in

different age groups including 1–4 years,

5–10 years and 11–16 years.

Method: A retrospective chart review of

OPTs conducted between January 2011

and January 2013 was performed: during

this period 95 children (mean age,

6.34 years) had a negative food or drug

challenge. Plasma histamine levels were

measured by Enzyme Immunoassay in all

patients at the beginning and within

10 min after the end of OPT. Any reaction

was observed during and for 1 h after the

completion of the challenge.

Results: The median values of histamine

were respectively 0.58 ng/ml and 1.48 ng/

ml before and immediately after OPT;

the increase (median 0.49 ng/ml (CI 0.30–0.72) resulted statistically significant

(P-value < 0.001). The children were

divided into groups according to their

age: the range of plasma histamine pre-

OPT was 0.1–10.08 ng/ml in the full

cohort, 0.1–20.61 ng/ml in the group

1–4 years, 0.1–10.44 ng/ml in the group

5–10 years, 0.1–5.8 ng/ml in the group

11–16 years. The p50 values of histamine

resulted 1.03 ng/ml in the group 1–4 years,

0.46 ng/ml in the group 5–10 years,

0.46 ng/ml in the group 11–16 years.

Conclusion: In the present study we

observed a significant increase in histamine

levels after negative OPTs, despite patients

did not react clinically to the challenge.

We suggest a non-specific histamine libera-

tion. We confirmed that a positive OPT is

the only way to diagnose true food or drug

allergy. We have also identified baseline

reference values for histamine into subsets

defined by age; however, further large-scale

cohort studies are required.

889

Native prick test in diagnosis of systemic

reaction to pigeon tick (Argas reflexus)

Przybyszewski, M1; Pałgan, K1; Ku�zmi�nski, A1; Graczyk,

M1; Zbikowska-Gotz, M1; Przybyszewska, J2; Bartuzi, Z1;

Szynkiewicz, E2

1Allergology, Clinical Immunology and Internal

Diseases, Nicolaus Copernicus University Collegium

Medicum in Bydgoszcz, Bydgoszcz, Poland; 2Nicolaus

Copernicus University Collegium Medicum in

Bydgoszcz, Bydgoszcz, Poland

Background: The pigeon tick Argas reflexus

feeds typically on pigeons, in special condi-

tions ticks attack humans. Argas reflexus

belongs to family Argasidae, found also in

Poland. It is this the very dangerous tick

which lives in nests of pigeons, jackdaws as

well as the home fowl. People living in the

vicinity of the birds0 nesting sites are fre-

quently bitten by A. reflexus. The bites can

provoke serious allergic and non-allergic

reactions, including fatal anaphylactic

shock.

Method: In the abstract, we present the

case report of the person who developed

serious allergic reaction after A. reflexus

bite. A 54-year-old male, previously

healthy, reports two systemic reaction,

including rash on his corpus and limbs,

itching, nausea, loss of consciousness and

tremor of the whole body forcing his fam-

ily to call the ambulance. The interview

revealed that the patient live in apartment

on the top floor over 28-years, there was a

dovecote in the loft above, which was

liquidated 3 years ago. Since 2010. after

the liquidation of the loft started to appear

in the apartment ticks, which periodically

summer in the night bite all household

members.

Results: A prick-by-prick test with the

pigeon tick excretion was made. The skin

test with native allergen was strongly posi-

tive (histamine 14 mm/6 mm, prick-by-

prick 40 mm/11 mm).

Conclusion: The prick-by-prick test was

useful in objective confirmation of the

source of symptoms.

890

Significance of ImmunoCAP® specific

immunoglobulin E test to cat or dog

dander sensitiser

Park, KH; Lee, JH; Park, JW

Department of Internal Medicine, Yonsei University

College of Medicine, Seoul, Korea

Background: Skin prick test (SPT) is an

important tool to diagnose immunoglobu-

lin (Ig) E mediated allergic diseases. It is

primarily used because it has many advan-

tages likelow cost, rapid results and

easy availability. Nevertheless, there are

several limitations. The weakness is false

Poster Session Group II – Red. TPS 31 – Allergy diagnosis: new methods

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453336

positivity, allergen standardisation, opera-

tor variability, interruption of allergy medi-

cations. Especially, false positivity and

false negativity become a troublesome

problem regarding pet ownership. Thus we

evaluated the significance of specific IgE

(sIgE) test in respect of cat or dog sensitis-

ers.

Method: We enrolled 109 allergic rhinitis

and asthma patients and classified into

three groups by pet ownership. Cat own-

ers, dog owners and both owners. We per-

formed skin prick tests and ImmunoCAP

sIgE tests including crude cat(e1), dog dan-

der(e5) and their major allergens Fel d 1,

Can f 1.

Results: In 9 both owners, SPT positivity

rate was 85.7% to cat SPT and 42.9% to

dog SPT. But positivity rate of e1, Fel d 1

was 100% and 66.7% to e5. Positive predic-

tive value of e1, Fel d 1 was higher than

SPT. But Can f 1 was positive only in

22.2% of both owner. In 60 dog owners,

dog SPT positivity was 57.8% compared to

85% positive rate to e5. But Can f 1 was

only 55% positive response. Nevertheless

they own just dogs, the IgE response to cat

was high. SPT to cat was 66.7%, e1 was

70%, Fel d 1 was 43.3%. Among 40 cat

owners showed 88.6% positive response to

cat SPT, 95% to e1 and 90% to Fel d 1.

Eventhough they don’t have dogs, but posi-

tive response was shown about 42.9% to

dog SPT, 62.5% to e5, 37.5% to Can f 1.

Conclusion: ImmunoCAP test of e1, Fel d

1 and e5 can detect pet sensitiser more pre-

cisely than SPT. Can f 1 have specificity

and lowest false positive rate. Crude cat

sIgE(e1) and major allergen(Fel d 1) have

high sensitivity ranging between 90 and

100%.

891

Mold allergy diagnosis: can recombinant

single mold allergens substitute crude

mold extracts?

Kespohl, S1; Maryska, S1; Rihs, H-P1; B€unger, J1;

Hagemeyer, O1; Jakob, T2; Joest, M3; Knecht, R4;

Koschel, D5; Kotschy-Lang, N6; Merget, R1; M€ulleneisen,

NK7; Rabe, U8; R€oseler, S9; Stollewerk, D10; Straube,

H11; Ulmer, H-M12; Walusiak-Skorupa, J13; Wiszniewska,

M13; Wurpts, G9; Br€uning, T1; Raulf, M1

1Institute for Prevention and Occupational Medicine of

the German Social Accident Insurance, Institute of the

Ruhr-University Bochum (IPA), Bochum, Germany;2Allergy Research Group, Medical Center, Department

of Dermatology, University of Freiburg, Freiburg,

Germany; 3Malteser Lung and Allergy Centre Bonn,

Bonn, Germany; 4Medical Practice for Pediatrics,

Bretten, Germany; 5Department of Pulmonary Diseases,

Fachkrankenhaus Coswig, Centre for Pulmonary

Diseases and Thoric Surgery, Coswig, Germany;6Berufsgenossenschaftliche Klinik f€ur Berufskrankheiten

Falkenstein, Falkenstein, Germany; 7Asthma Allergy

Centre, Leverkusen, Germany; 8Johanniter-Hospital,

Treuenbrietzen, Germany; 9Department of Dermatology

and Allergology, University Hospital RWTH Aachen,

Aachen, Germany; 10Medical Practice for Respiratory

Medicine, Allergology, K€oln, Germany; 11Pediatric

Pulmonology/Allergy, Children’s Hospital Princess

Margaret, Darmstadt, Germany; 12Pulmonary and

Allergy Practice, Lahr, Germany; 13Department of

Occupational Diseases, Nofer Institute of Occupational

Medicine, Lodz, Poland

Background: Due to missing standardisa-

tion of mold test extracts and/or low test

sensitivity, diagnosis of mold sensitisation

is often difficult. The aim of this study was

to verify, weather recombinant single mold

allergens can improve the in-vitro diagnosis

in patients reporting mold allergic symp-

toms and/or exposure.

Method: Specific (s) IgE against A. alter-

nata, A. fumigatus, P. chrysogenum, C. her-

barum and A. versicolor was measured by

ImmunoCAP (ThermoScientific) in 162

subjects with suspected mold sensitisation.

Sera displaying sIgE ≥0.35 kU/l to one or

more of the mold allergens were further

tested with an appropriate panel of single

recombinant allergens: rAlt a 1, rAsp f 1,

2, 3, 4, rAsp f 6 (ImmunoCAP) and rPen

ch MnSOD and rPen ch 35 coupled by

biotin-streptavidin-affinity to Immuno-

CAPs (IPA).

Results: In 41 A. alternata sensitised sub-

jects 88% had sIgE to Alt a 1 with signifi-

cant correlation between sIgE to

A. alternata-crude extract and rAlt a 1

(r(Pearson) = 0.943, P < 0.0001). From 19

sera with A. fumigatus sensitisation dis-

played 11 sera (58%) sIgE ≥0.35 kU/l to

one of the five rAsp f- allergens. rAsp f 1

and rAsp f 3 were the most frequently

recognised allergens (37% and 42%) fol-

lowed by rAsp f 4 (32%), rAsp f 2 (26%)

and rAsp f 6 (10%). Specific IgE-concen-

tration to A. fumigatus crude extract and

the sum of rAsp f single allergens was sig-

nificantly correlated (r(Pearson) = 0.662;

P = 0.002). From 19 sera with sIgE to

P. chrysogenum displayed only four sera

(21%) sIgE ≥0.35 kU/l to rPen ch MnSOD

and no serum recognised rPen ch 35.

Conclusion: A. alternata sensitisation pro-

file was reliably represented by sIgE mea-

surement of rAlt a 1. Concordance

between A. fumigatus crude extract and the

sum of single rAsp f allergens was about

60%, indicating that several sIgE-binding

components were missing. The diagnostic

relevance of tested P. chrysogenum single

allergens has to be evaluated. Further sin-

gle allergens are necessary to improve the

diagnosis of mold allergy.

892

Egg allergy: diagnosis and benefit of

basophilic activation test

De Amici, M1; Castagnoli, R1; Caimmi, S1; Licari, A1;

Marseglia, A1; De Silvestri, A2; Torre, C1; Leoni, MC1;

Marseglia, GL1

1Department of Pediatrics, Universit�a degli Studi di

Pavia – Foundation IRCCS Policlinico San Matteo,

Pavia, Italy; 2Biometry and Statistic Unit, Foundation

IRCCS Policlinico San Matteo, Pavia, Italy

Background: We aimed to evaluate the

application of Basophilic Activation Test

(BAT) in the analysis of egg-allergic

patients, considering the effects of eating a

trace amount of the offending food and

confirming clinical utility of standard tests.

Method: The study sample included 77

infants (mean age, 4.2 years) with history

suggestive of egg allergy and positive skin-

prick and/or serum testing who underwent

the complete food allergy work-up includ-

ing skin prick testing, measurements of

serum specific IgE and BAT.

Results: We did not observe a statistically

significant difference in Patient Back-

ground (PB) values between the subgroup

of infants under specific total eviction of

offending food (50 patients, 65%) and chil-

dren eating a trace amount of the offend-

ing food (27 patients, 35%). 25 patients

(32.5%) had an Oral Food Challenge

(OFC) and in 6 (24%) we had a positive

OFC result (reaction grade I). The BAT

had a Sensitivity (Se) of 100%, a Specific-

ity (Sp) of 100% and Positive (PPV) and

Negative (NPV) Predictive Values of 100%

and 100% if we considered a rate of acti-

vated basophils of 15% as the optimal pos-

itivity threshold for egg; the BAT had a Se

of 100% and a Sp of 89% if we reduced

the optimal positivity threshold for egg to

the rate of 10% of activated basophils.

Poster Session Group II – Red. TPS 31 – Allergy diagnosis: new methods

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 337

Wheal diameter after the skin prick test to

standardised egg white extract ranged from

3 to 7.5 mm (median diameter, 4 mm) and

had a Se of 83%, a Sp of 44% and NPV

of 87.5%; the same median wheal diameter

to egg white had a Se of 100%, a Sp of

33% and NPV of 100%.

In our patients egg white IgE levels

>0.35 kU/l had a Se of 83% and a Sp of

18%; we confirmed that levels of IgE anti-

body to egg white >7 kU/l are highly pre-

dictive of clinical reactivity to egg

(specificity of 94%).

Conclusion: Referring to a decisional algo-

rithm, combining BAT, specific IgE and

SPT allowed the correct identification of

100% of patients as allergic to eggs. The

diet does not influence the reliability of

BAT.

Poster Session Group II – Red. TPS 31 – Allergy diagnosis: new methods

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453338

Poster Session Group II – Red

TPS 32 – Allergy prevention and risk factors

893

Risk factors for anaphylaxis in Finland –allergybarometer study

Kauppi, P1; Peura, S2; Salim€aki, J2; J€arvenp€a€a, S3;

Haahtela, T1

1Skin and Allergy Hospital/Allergy Clinic, Helsinki

University Central Hospital, Helsinki, Finland;2Association of Finnish Pharmacies, Helsinki, Finland;3MedCare Ltd, €A€anekoski, Finland

Introduction: In the Finnish Allergy Pro-

gramme 2008–2018 we aim to allocate

resources to manage and to prevent severe

allergies such as anaphylaxis. In order to

prevent severe allergy, a better understand-

ing of risk factors and causes is needed. In

this study, we examined determinants asso-

ciated to anaphylaxis in those seeking for

allergy or asthma medication in Finnish

pharmacies in September 2010.

Methods: The Allergy Barometer Survey

was conducted in autumn 2010 in Finnish

pharmacies across the country. The cohort

includes 1114 from 5 to 75 year old patients

obtaining allergy and asthma medication.

Self-reported physician diagnosed anaphy-

laxis (N = 120) and use of medication were

assessed by standardised questionnaires.

Risk factors for anaphylaxis were estimated

by logistic regression analysis.

Results: Use of epinephrine autoinjector at

least once in the last 12 months was

reported by 4.2% (five respondents) and

twice or more often in the last 12 months

by 2.5% (three respondents) in the anaphy-

laxis group. Only every third of those with

self-reported anaphylaxis had received

guidance for severe allergic reactions.

In adults, older age (OR 1.03), atopic

eczema (OR 1.96) and food allergy (OR 4.90)

remained independent risk factors for ana-

phylaxis in multivariate analysis) (Table 1).

Conclusion: 6.7% of those with anaphy-

laxis reported of a reaction in the last

12 months. Only third of anaphylaxis

patients recalled having received guidance

for severe allergic reactions. Food allergies

remained the strongest predictive factor for

anaphylaxis both in adults (OR 4.90) and

in children (OR 8.92).

Table 1. Multivariate OR-values (95% CI)

for anaphylaxis (age ≥18 years).

Age 1.03 (1.01–1.05) (P < 0.001)

Atopic eczema 1.96 (1.23–3.11) (P = 0.0044)

Food allergy 4.90 (2.80–6.90) (P < 0.001)

894

Third generation study: maternal and

grand-maternal smoking in pregnancy

and wheeze in children

Patil, VK1,2; Holloway, JW2,3; Karmaus, W4; Zhang, H4;

Mitchell, F1; Ewart, S5; Arshad, SH1,2

1The David Hide Asthma & Allergy Research Centre,

Newport, United Kingdom; 2Clinical & Experimental

Sciences, University of Southampton, Southampton,

United Kingdom; 3Human Development and Health,

University of Southampton, Southampton, United

Kingdom; 4Biostatistics, & Environmental Health,

University of Memphis, Memphis, United States;5Department of Large Animal Clinical Sciences,

Michigan State University, East Lansing, MI, United

States

Background: Smoking in pregnancy is a

risk factor for wheeze/asthma in offspring.

There are only couple of studies reporting

on transgenerational effect of grand-mater-

nalsmoking in pregnancy on asthma in

children. In a prospective birth cohort

study we investigated the effect of smoking

in pregnancy of grandmother (F0) and

mother (F1) on wheeze in third generation

children (F2).

Method: The Isle of Wight birth cohort

(F1) is an unselected cohort of children

born in 1989/90 (N = 1456). Smoking in

pregnancy by mothers (F0) when pregnant

with F1 was collected prospectively. Chil-

dren of F1 were recruited in a third genera-

tion study (F2). The effect of smoking in

pregnancy by F0 and F1 on wheeze in F2

children was investigated using logistic

regression model.

Results: There were 129 ≥ 1 year old chil-

dren with data available for smoking in the

F1 and F0 generations. Wheeze was

reported in 48.8% (63/129) of F2 children;

in 21.7% (28/129) both F0 and F1 genera-

tions had smoked in pregnancy, 27.1%

(35/129) with only F1 and 20.2% (26/129)

with only F0 smoking in pregnancy. The

Odds ratio for wheeze in F2 was higher if

they had history of both F0 and F1 smok-

ing in pregnancy (Table 1).

Effect of grand-maternal (F0) and

maternal (F1) sm

Conclusion: This study identified a >2-foldincreased risk of wheeze in children if both

mother and grandmother smoked in preg-

nancy. In spite of growing knowledge of its

ill effects, smoking in pregnancy continues

to be prevalent. The effect on not only

children, but also grandchildren, should be

emphasised in public health campaigns to

reduce smoking during pregnancy.

895

Significant reduction in allergic features

in the offspring of mice supplemented

with specific non-digestible

oligosaccharides during lactation

Hogenkamp, A1; Thijssen, S1; Knippels, L1,2;

Garssen, J1,2

1Utrecht Institute for Pharmaceutical Sciences, Utrecht

University, Utrecht, the Netherlands; 2Nutricia

Research, Utrecht, the Netherlands

Background: Earlier it was shown that

maternal supplementation with non-digest-

ible carbohydrates during pregnancy led to

a significant reduction in the development

of several allergic asthma features in adult

offspring. In the current study, it was

investigated whether maternal supplemen-

tation during lactation only would have

similar effects.

Method: Mice were mated at 10 weeks of

age. Directly after birth of the offspring,

mice in the lactation group were

transferred to the AIN93 control diet sup-

plemented with short-chain galacto- and

long-chain fructo-oligosaccharides (scGOS/

lcFOS; ratio 9:1). Mice in the sham and

control groups were kept on control

AIN93. The male offspring were sensitised

Table 1: Effect of grand-maternal (F0) and maternal (F1) smoking in pregnancy on wheeze in

the F2 generation

Smoking during

pregnancy

Smoking during

pregnancy

Wheeze

% (n)

No Wheeze

% (n) OR (95%CI) P value

Grandmother (F0) Mother (F1)

No No 45.0 (18/40) 55.0 (22/40) Reference Reference

No Yes 42.9 (15/35) 57.1 (20/35) 0.9 (0.4–2.3) 0.852

Yes No 42.3 (11/26) 57.7 (15/26) 0.9 (0.3–2.4) 0.830

Yes Yes 57.7 (15/26) 32.1 (9/28) 2.6 (0.9–7.1) 0.065

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 339

to OVA at the age of 6 weeks, with the

exception of those in the sham group, and

the acute allergic skin response was mea-

sured at the age of 8 weeks. Airway hyp-

erreactivity to metacholine was measured

after 3 consecutive airway challenges with

OVA aerosol.

Results: Although the acute allergic skin

response and the airway hyperreactivity

did not differ between the control group

and the lactation group allergic inflamma-

tion was significantly down-regulated by

the dietary intervention during lactation.

Total cells numbers, and percentages of

eosinophils and lymphocytes in the bronc-

hoalveolar lavage fluid as markers for

allergic inflammation were significantly

decreased in the offspring of dams fed

scGOS/lcFOS during lactation. Analysis of

total and OVA specific immunoglobulin

levels showed that the specific diet did lead

to lower levels of OVA-specific and total

IgG1 levels. OVA-specific IgE levels did

not differ between the lactation and the

control group, although levels of total IgE

were significantly lower in the lactation

group.

Conclusion: Maternal supplementation

with scGOS/lcFOS during lactation did

down-regulate allergic inflammation in the

lungs. In addition immunoglobulin levels,

relevant for allergic disease, were down-

regulated as well. In contrast, allergic skin

reactions and lung functions were not

affected. These data are comparable to

studies performed earlier in which dietary

intervention with scGOS/lcFOS was per-

formed during pregnancy only although in

these animals skin reactions and lung func-

tion were affected as well. Altogether, our

data suggest that early life dietary interven-

tion with non-digestible carbohydrates may

be beneficial for the allergic outcome later

in life, which may also be highly relevant

for the development of atopic disease.

896

Inhibitory effect of unicellular green

algae (Chlorella vulgaris) water extract

on allergic immune response

Shon, D-H1; Shin, H-S1; Bae, M-J2; Han, J-G3

1Functionality Evaluation Research Group, Korea Food

Research Institute, Seongnam-si, Korea; 2School of

Biological Sciences, Seoul National University, Seoul,

Korea; 3Daesang Corp., Health Food R&D Division,

Icheon-si, Korea

Background: Chlorella is used as a func-

tional food in East Asia and has been

shown to enhance immune system

function. However, there has been no

direct evidence of the suppressive effect of

a hot water extract of Chlorella vulgaris

(CVE) on histamine-mediated allergic

responses.

Method: The antihistamine activity of

CVE was analysed using rat peritoneal

mast cells (RPMCs) stimulated by com-

pound 48/80. For in vivo verification, oval-

bumin (OVA)-immunised BALB/cmice

were treated with CVE orally. Serum

immunoglobulin E (IgE) levels and spleno-

cyte cytokine levels were determined by

enzyme-linked immunosorbent assay

(ELISA).

Results: CVE prevented histamine release

through degranulation ofmast cells by

blocking the uptake of extracellular Ca2+

into RPMCs. Moreover, CVE administra-

tion inhibited serum IgE overproduction

by OVA via induction of T helper 1 (Th1)

skewing that was dependent on interferon-

c (IFN-c) and interleukin 12 (IL-12) secre-

tion.

Conclusion: The results of this study

clearly demonstrate that CVE acts as an

antiallergic dietary agent by suppressing

histamine release via its enhancive effect

on Th1-related responses.

897

Allergen sensitisation in patients with

asthma and or allergic rhinitis

Barayazarra, S1; Jares, E2; Teijeiro, A3; Corelli, S1;

Cornaglia, S1; Zanacchi, A1; Sosa, S1; Herrera, E1;

Recuero, N1; Bainotti, N1

1Hospital San Roque, C�ordoba, Argentina; 2Fundaci�on

LIBRA, Buenos Aires, Argentina; 3Hospital Pedi�atrico,

C�ordoba, Argentina

Background: Allergen sensitisation is a

common feature of allergic rhinitis (AR)

and asthma. Mono and polysensitisation

may affect clinical symptoms. The present

work addresses AR and asthma patients’

sensitisation in different age groups.

Method: This observational cross-sectional

study included a group of AR and asthma

patients consecutively evaluated. Type and

number of sensitisations, were considered.

Skin prick tests (SPT) with commercial

extracts (Allergofarma Argentine) were

performed. Total IgE was measured (RIA).

Spirometries were performed with Vithalo-

graph Pneumotract spirometer.

Results: From 286 patients, 116 (40.5%)

presented AR and asthma, 120 (42%),

asthma, and 50 (17.5%) AR. Age: Three

to 6 years old: 49 patients (17.1%),

7–14 years old: 78 patients (27.3%),

15–49 years old: 111 patients, (38.8%) and

more than 50 years old: 48 patients

(16.8%). Forty percent of them were

female. IgE >100 UI/ml was found in 189

patients (66%): Fifty four point nine per-

cent were polysensitisated. (3–7 years old:

7%, (P < 0.0001; OR: 0.23), 8–14 years

old:31%, (P = ns), 15–49 years old: 42%,

(P = ns) and more than 50 years old: 20%,

P = ns). There was no significant difference

between mono or polysensitisation and sex,

IgE, and pulmonary function values.

Conclusion: Polysensitisation risk was less

in the age group of 3–7 years than other

groups. There were no differences in sensi-

tisation in patients with asthma, AR and

both diseases.

898

Maternal intake of natto, a Japan’s

traditional fermented soybean food,

during pregnancy and the risk of eczema

in Japanese babies

Yamamoto, T1; Ozawa, N1; Suzuki, Y2; Ochiai, S3;

Yamaide, F1; Nakano, T1,4; Morita, Y1; Inoue, Y1; Arima,

T1; Suzuki, S4; Kohno, Y1,5; Shimojo, N1

1Department of Pediatrics, Graduate School of

Medicine, Chiba University, Chiba, Japan; 2Department

of Public Health, Graduate School of Medicine, Chiba

University, Chiba, Japan; 3Department of

Bioenvironmental Medicine, Graduate School of

Medicine, Chiba University, Chiba, Japan; 4Department

of Pediatrics, National Simoshizu Hospital, Chiba,

Japan; 5Chiba Rosai Hospital, Chiba, Japan

Background: Several studies in European

countries suggest that the maternal diet

during pregnancy may affect development

of babies’ eczema. In contrast, there were

only a few studies on the maternal diet

during pregnancy and the babies’ eczema

in Asia. In this study, we investigated the

relationships between frequencies of the

maternal intake of some common foods

and natto, that is unique to Japan, during

pregnancy and the eczema in infancy.

Method: A birth cohort study of 882

mother-baby pairs was set up at two hospi-

tals in Chiba city. Just after delivery,

mothers were asked to report dietary hab-

its concerning fish, butter, margarine,

yogurt and natto during pregnancy and

their family’s history of allergic diseases.

The intake frequencies of these foods were

classified into four groups:

1 Daily,

2 2–3 times a week,

3 Once a week and

4 Once a month or less.

Diagnosis of eczema at 6 months of age

was made by the presence of an itchy rash

that persisted more than 2 months. Presence

or absence of eczema at 6 months of age was

obtained from mothers by questionnaire.

Results: Valid data on 650 mother-baby

pairs were obtained. One hundred and four-

teen babies had eczema at 6 months of age

(17.6%). No relationship between frequen-

cies of the maternal intake of fish, margarine

and yogurt during pregnancy and the inci-

dence of the babies’ eczema were observed.

For butter consumption, the incidence of

babies’ eczema was significantly higher in

the group with daily intake than in those

Poster Session Group II – Red. TPS 32 – Allergy prevention and risk factors

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453340

with an intake 2–3 times a week or less

(P = 0.044). For natto, the incidence of

babies’ eczema was significantly lower in the

group with everyday intake than those eat-

ing it 2–3 times a week or less (P = 0.020).

Conclusion: High frequency intake of natto

during pregnancy possibly reduces the inci-

dence of eczema in children at 6 months of

age.

899

Dog ownership in infancy had protective

effect on atopic eczema in later life

Ohya, Y1,2; Yang, L2; Narita, M1; Futamura, M1; Yamam-

oto, K1,2; Kitazawa, H1,2; Morita, K1; Saito, H2,3; T-CHILD-

Tokyo-Children’s Health, Illuness, Development Study

Group1Division of Allergy, National Center for Child Health

and Development, Tokyo, Japan; 2Medical Support

Center for Japan Environment and Children’s Study,

Tokyo, Japan; 3National Center for Child Health and

Development, Tokyo, Japan

Background: It is still controversial in

Japan whether pet ownership during early

stage of life has protective effect on child-

hood allergic diseases. The aim of this study

was to elucidate whether early life exposure

of furred pets would have protective effect

on childhood asthma and/or eczema or not.

Method: This study was carried out as a

part of T-CHILD (Tokyo-Children’s

Health, Illness and Development) study

which is a hospital based birth cohort

study. Pet ownership at 6–8 months of age

was examined by a questionnaire and,

asthma and eczema at 5 years old was

detected by using the ISAAC question-

naire. Multivariate analysis was applied to

these data by using logistic regression mod-

els in SPSS.

Results: Two hundreds and ninety five

children (21.6%) at the age of 6–8 months

experienced furred pet ownership and 1093

children (78.4%) didn’t keep any animals.

Dog keeping was experienced in 136

infants (9.7%) and cat keeping was in 84

infants (6.0%). Cumulative incidence and

prevalence of asthma at the age of five was

28.7% and 16.5%, respectively. Cumula-

tive incidence and prevalence of atopic

eczema at the age of five was 27.2% and

21.9% respectively. Dog keeping at 6–8 months of age had protective effect on

onset of asthma (wheezing episode) till the

age of five (OR: 0.474, 95%CI: 0.255-

0.879), but no significant effect on current

asthma at the age of five (OR: 0.486, 95%

CI: 0.217–1.085). Cat keeping had not pro-

tective effect on onset of asthma (OR:

0.895, 95%CI: 0.474 -1.689). The other pet

ownership had not protective effect on

asthma nor on atopic eczema. Dog keeping

at the age of 6–8 months had protective

effect on current atopic eczema and ever

eczema at the age of 5 years (OR: 0.276,

95%CI: 0.118–0.615, OR0.503, 95%CI:

0.273–0.928, respectively). The other pet

ownership including cat had not protective

effect on atopic eczema at 5 years old.

Conclusion: Only dog ownership during

infancy had protective effect on wheezing

episode and atopic eczema at the age of

5 years.

900

Furred pets modulate the composition

gut microbiota in infants with high risk

of allergic disease

Nermes, M1; Salminen, S2; Endo, A2; Isolauri, E1

1Department of Pediatrics, Turku University Hospital,

Turku, Finland; 2Department of Biochemistry and Food

Chemistry, Functional Foods Forum, University of

Turku, Turku, Finland

Background: The hygiene hypothesis sug-

gests that environmental changes in the

industrialized world have lead to reduced

microbial contact at an early age, the earli-

est and the most massive origination from

the gut microbiota. In addition, frequent

exposure to animals, and thereby to micro-

bial products, has been associated with the

protection against the development of

asthma and allergy. In order to provide a

unifying theory for environmental micro-

bial contacts via exposure and early gut

microbiota composition, we undertook to

determine whether perinatal exposure to

furred pets affects the gut microbiota, the

potential route of immunemodulation, in

infants with high risk of allergic disease.

Method: This study was a part of double-

blind, placebo- controlled trial involving

two different probiotic combinations (1.

Lactobacillus rhamnosus + Bifidobacterium

longum and 2. Lactobacillus paraca-

sei + Bifidobacterium longum) given to the

mother 2 months prior to and 2 months

after delivery. The amounts of Bifidobacte-

rium pseudolongum and Bifidobacterium

thermophilum, i.e. bifidobacteria of animal

origin, were determined by quantitative

PCR in faecal samples of the infants

(n = 58) of the families with a furred pet at

the age of 1 month. Infants (n = 68) from

families with no pet were selected as con-

trols in consecutive order of recruitment.

Results: The numbers of animal-specific

bifidobacteria B. pseudolongum were signifi-

cantly higher in the samples of pet-exposed

than non-exposed infants (0.0/3.9 vs. 0.0/

0.0, respectively, median/upper quartile,

log (DNA/g of feces)), P = 0.02.

Conclusion: Perinatal exposure to furred

pets impacts the gut microbiota composi-

tion at an early age, providing one expla-

nation for a decreased risk of later

emerging asthma and allergy.

901

Novel risk factors for allergic rhinitis in

Korean elementary school children

Han, DH1; Ahn, J-C1; Mun, SJ1,2; Kim, J-W1,3; Lee,

CH1,3; Rhee, C-S1,3

1Department of Otorhinolaryngology, Seoul National

University Hospital, Seoul, Korea; 2Pusan National

University Yangsan Hospital, Yangsan, Korea; 3Seoul

National University Bundang Hospital, Seongnam,

Korea

Background: Allergic rhinitis (AR) is a

multifactorial disease and their genetic and

environmental risk factors have been stud-

ied during decades. Many pediatric studies

pointed out familial history of allergy,

hygiene hypothesis, breast-feeding, pet

ownership and diets as risk factors of AR.

However, most of the factors are still in

debate. This study aimed to confirm the

known risk factors and find the novel risk

factors of AR in the Korean pediatric pop-

ulation.

Method: A bi-seasonal, winter and sum-

mer, study in two elementary schools

included whole elementary students whose

parents completed the questionnaire of

past medical history, previous infantile sta-

tus, current daily life status, smoking,

drinking and other drug and past medical

history of parents, and current living envi-

ronment and feeding status of the family.

Skin prick tests and endoscopic examina-

tion were conducted to all participants.

Results: Among total 1020 children, there

were 338 participants with AR. After

adjusting gender and age, the univariate

analysis were performed over 20 risk fac-

tors including other allergic disease history,

small family size, less playing time, fre-

quent indoor activities, less ventilation time

including opening window, parental aller-

gic history, fewer intakes of fruit and more

intakes of fatty meat and salty ingredients.

The multivariate analysis concluded seven

risk factors; male gender (OR, 1.6; 95%

CI, 1.08–2.49), allergic conjunctivitis his-

tory (14.1; 5.48–36.40), an hour decrease of

playing time (1.2; 1.06–1.46), <1 h ventila-

tion time (1.7; 1.13–2.63), parental historyof allergic rhinitis (3.0; 1.93–4.53), less thana fruit intake in a day (2.2; 1.18–4.05), andadding salty ingredient (2.3; 1.48–3.66).Conclusion: The playing time in childhood

is a newly found risk factor of AR in this

study with confirming the familial history

of AR, less ventilation time and fewer

intakes of fruits as the other risk factors.

Poster Session Group II – Red. TPS 32 – Allergy prevention and risk factors

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 341

902

Circulating allergy related chemokines in

children from a probiotic intervention

study

Andersson, JE1; Forsberg, A1; Abelius, M1; Bj€orkst�en,

B2; Abrahamsson, T3; Jenmalm, MC1

1Autoimmunity and Immune Regulation (AIR),

Department of Clinical and Experimental Medicine

(IKE), Faculty of Health Sciences, Link€oping University,

Link€oping, Sweden; 2Institute of Environmental

Medicine, Karolinska Institutet, Stockholm, Sweden;3Division of Pediatrics, Department of Clinical and

Experimental Medicine (IKE), Faculty of Health

Sciences, Link€oping University, Link€oping, Sweden

Background: The increasing allergy preva-

lence among children in affluent societies,

possibly deriving from reduced microbial

exposure, may be prevented by perinatal

probiotic supplementation. An allergic

immune system favors TH2 over TH1

responses, and chemokines recruit immune

cells from both arms to the site of an aller-

gic reaction. Difficulties detecting TH1 and

TH2 cytokines in the circulation suggest

chemokines may be important immune bi-

omarkers in allergy development. The aim

of the study is to investigate expression lev-

els of allergy related chemokines (TH1:

CXCL10/ CXCL11, TH2: CCL17/CCL22)

and the novel potential TH2 biomarker

CCL26, in children enrolled in a random-

ized, double blind, placebo controlled pro-

biotic trial, and relate these to allergy

development and sensitisation.

Method: ELISA and Luminex measure-

ments of chemokine levels in plasma sam-

ples from children at birth, 6, 12,

24 months and 7 years of age (73, 38, 54,

55 and 146 subjects, respectively) with or

without pre- and postnatal Lactobacillus

reuteri treatment.

Results: The TH1 and TH2 related chemo-

kines were strongly associated at all time

points (rho = 0.44–0.75, P < 0.001, and

rho = 0.34–0.59, P < 0.001–0.016). High

levels tended to correlate with absence or

presence of allergic symptoms and sensiti-

sation, respectively. CCL26 levels did not

associate with any other chemokine or

allergy at any time point, even after includ-

ing additional samples (allergic = 15, non-

allergic = 11, 6/12/24 months–7 years).

Furthermore, CCL26 levels were lowest in

cord blood and significantly higher at all

time points after birth, and probiotic treat-

ment did not affect CCL26 levels.

Conclusion: The CXCR3 ligands CXCL10/

CXCL11 and the CCR4 ligands CCL17/

CCL22 are pair wise interrelated and asso-

ciated with allergy. In contrast, the CCR3

ligand CCL26 does not correlate with the

other chemokines or allergy development,

nor is it affected by probiotic treatment.

903

Immunoallergology0s day care unit –5 years retrospective analysis

Pestana, M; Soares, J; Aguiar, R; Silva, P; Fernandes,

N; Duarte, F; Caiado, J; Lopes, A; Mendes, A; Costa,

AC; Alonso, E; Pedro, E; Pereira-Barbosa, M

Immunoallergology Department, Hospital de Santa

Maria, CHLN, E.P.E., Lisbon, Portugal

Background: In our Immunoallergology’s

Day Care Unit (IDCU) there are done

diagnostic and therapeutic procedures that

carry increased risk or that can’t be done

at home.

Method: We feature a retrospective analy-

sis of procedures between January 2009

and July 2013.

Results: There were registered 11398 pro-

cedures (1888 patients) with an average of

46+- years (min 3, max 92, median 45).

The most common procedure was the

administration of Immunoglobulin G intra-

venou s (2784 procedures in 409 patients),

followed by administration of omalizumab

(2395 sessions in 92 patients). Seven hun-

dred and fifty-one patients had provoca-

tion tests (PT) with drugs (51% to

analgesics/NSAIDs and 49% to antibiot-

ics). Hundred and eight patients had PT

with food (186 sessions) and 59 and PT

with additives (124 sessions). There were

done 1377 administrations of specific

immunotherapy: 1136 (83%) with hyme-

noptera and 241 (17%) to aeroallergens.

From the total of rush protocols executed,

84% were to aeroallergens and the remain-

der to hymenoptera. There were executed

the inductive phases for latex and peach

vaccination in 7 (30 sessions) and 18

patients (72 sessions), respectively. There

were also done 608 cutaneous tests (65%

to drugs, 13% to food, 10% to biologicals

and 12% to extracts of hymenoptera).

There were done 963 sessions of desensiti-

sation: 88% to drugs (70% to cytostatic)

and 12% to food. The C1 inhibitor was

delivered 453 times (80% of the sessions

corresponding to two patients contraindi-

cated to other medication) and icatibant

once. Other procedures included intrave-

nous drugs (342 sessions; 3%), administra-

tion of drugs under vigilance (105 sessions;

0.9%), analysis of epicutaneous tests (eight

sessions; 0.1%) and ophthalmological

provocation tests and spirometry with

equal prevalence (14 sessions; 0.12%).

Conclusion: The IDCU allows the realiza-

tion of certain therapeutic procedures with-

out hospitalisation, mainly in patients that

require frequent medication, like in pri-

mary immunodeficiencies. It also allows

the controlled, safe and supervised realiza-

tion of immunoallergology’s diagnostic

procedures.

904

Allergy to cow0s milk protein is a

multifactorial disease

Ibsaine, O1; Djenouhat, K2; Lamdjadani, N3; Abrouk, S4;

Berrah, H1

1CHU Hussein Dey, Algiers, Algeria; 2Institut Pasteur

d’Algerie, Algiers, Algeria; 3CHU Hussein Dey,

Epidemiology, Algiers, Algeria; 4CNMS, Algiers, Algeria

Background: Allergy to cow′s milk protein

(CMPA) is a multifactorial disease.

Genetic background, interaction mother-

fetus during pregnancy and birth, and peri-

natal environment could be the main risk

factors of this disease. Assess whether

caesarean section, having a supplement of

cow′s milk and other conditions are risk

factors to develop CMPA.

Method: Hundred and fifty CMPA cases

diagnosed over a period of 6 years (2004

-2010) and 300 controls matched for sex

were included in this prospective case-con-

trol study. Control population consists of

healthy infants who received cow0s milk or

its derivatives for at least 2 months. Were

collected, data, genetic, medical, preg-

nancy, mode of delivery, and the perinatal

environmen.

Results: The median age of our 150

patients was 102.7 � 5.31 days. We found

that 85 of them (57%) present IgE depen-

dant-CMPA versus 65 (43%) no IgE

dependant cases. Results of logistic regres-

sion analysis when comparing our data

with controls infants (119.92 days � 3 1)

showed that the risk of CMPA is doubled

when child is born by caesarean section (P:

0.024) and is fourfold increased if the child

has already received an additional artificial

milk in the first week of life before starting

breastfeeding (P < 0.001). When taking

both factors above-cited, the risk is multi-

plied by a factor of 9 (P < 0.0001). In

addition, factors increasing statistically the

risk of CMPA in our study are atopy

(P < 0.001), preeclampsia (P: 0.031) and

occurrence of neonatal disease (P: 0.006).

Conclusion: On the basis of results of

our work, we deduce that CPMA is a

multifactorial diseases where genetic, nutri-

tional, mode of delivry and perinatal con-

ditions are implicated. Preventive measures

are available, in addition to encouraging

exclusive breastfeeding, mainly oriented

maternity careers.

Poster Session Group II – Red. TPS 32 – Allergy prevention and risk factors

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453342

905

Influence of endothelial dysfunction and

perinatal factors on atopic disease in

preterm children

Kyslova, Y1; Yablon, O2; Mazulov, O2

1Pediatrics No.1, Vinnitsa National Pirogov Memorial

Medical University, Vinnitsa, Ukraine; 2Vinnitsa

National Pirogov Memorial Medical University,

Vinnitsa, Ukraine

Background: Atopic diseases accompanied

by inflammatory disorders, morphological

and functional alterations of microvessels,

especially in preterm baby. We established

clinical significance of endothelial dysfunc-

tion and perinatal factors in preterm

infants with atopic diseases.

Method: The main group 15 children, who

in adjusted age of 12 months was diag-

nosed atopic disease (atopic dermatitis,

food allergy). The average birth weight

1473.1 � 97.4 g, gestational age –29.9 � 0.6 weeks. In the comparison group

included 24 premature infants with birth

weight 1529.5 � 82.8 g and gestational age

30.6 � 0.6 weeks without atopic diseases.

Results: Found that children with atopic

diseases more often to have been born to

mothers who had a history of chronic uro-

genital infections 46.7% (Sp 72.4%, Se

70.0%), abortions, miscarriages 53.4% (Sp

73.0%, Se 61.5%). 35.7% children with

atopic diseases born by Caesarean section.

Children from the main group significantly

more often after birth need of mechanical

ventilation 73.4% (Sp 78.9%, PPV 73.4%)

vs. 37.5% (P < 0.05). In the neonatal per-

iod in 33.4% of children with atopic dis-

eases were diagnosed small to gestational

age (Sp 70.6%, Se 100.0%) and 20.0% of

children – patent ductus arteriosis (Sp

66.7%, Se 100.0%) (P < 0.05).

The obtained values of VEGF in serum

for 5–7 days of life in children of all stud-

ied groups did not significantly differ (main

group – 175.5 � 52.6 and 134.6 � 28.6 pg/

ml in the comparison group, P > 0.05). In

dynamics, at 28 days of life in children

with atopic diseases observed increase in

VEGF – 399.5 � 93.4 pg/ml (P < 0.05),

compared with 208.5 � 90.2 pg/ml in the

children without atopic diseases, P > 0.05.

VEGF level have a high degree of specific-

ity and sensitivity (>60%). Regression

analysis established the relationship

between values of serum VEGF at 5–7 day

of life and indicators of body weight

(r = 0.62, P < 0.05), duration of gestation

at birth (r = 0.64, P < 0.05) and duration

of mechanical ventilation (r = 0.89,

P < 0.05).

Conclusion: Several maternal characteris-

tics, perinatal factors, VEGF level are

associated with an elevated risk of atopic

diseases in the child in later life.

Poster Session Group II – Red. TPS 32 – Allergy prevention and risk factors

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 343

Poster Session Group II – Red

TPS 33 – Basic questions in allergy

906

Opposite effect on offspring FcγRIIb B

cells expression on dependency of

maternal immunisation with OVA or

Dermatophagoides pteronyssinus:

different mechanisms for different

allergens?

Lira, AADL; Oliveira, MGD; Oliveira, LMD; Duarte,

AJDS; Sato, MN; Victor, JR

Laboratory of Medical Investigation LIM 56, Division of

Clinical Dermatology, University of Sao Paulo – School

of Medicine, Sao Paulo, Brazil

Background: In the last decade, our group

has demonstrated that murine preconcep-

tion immunisation with allergens has a

protective effect on the development of

allergies in the offspring. The murine

model used in the present study represent

an comparative between allergy induction

by OVA and the dust mite Dermatophago-

ides pteronyssinus (Dp).

Method: C57BL/6 Female mice were im-

munised with OVA or Dp in Alum and

boosted after 10 and 20 days. Females

were mated after immunisation and pups

from immunised or non non-immune

mothers were immunised with the same

antigen of maternal immunisation at

3 days old (d.o.) with OVA or Dp in Alum

and boosted after 10 days with the same

antigen/dose in saline. Offspring experi-

mental analyses were performed at 20 d.o.

Results: Maternal immunisation with OVA

and Dp did not enhance IgE Ab levels, in

contrast to the increased levels of allergen-

specific IgG1 Abs compared to non-immune

mothers. Offspring sera analyses reveals

that maternal immunisation with OVA sup-

pressed IgE production only in offspring im-

munised with OVA. Both preconception

immunisation protocols are able to inhibit

cellular influx to the airways of immunised

offspring and up-regulate CD40 expression

on offspring B cells compared to control

groups. Similar frequency of offspring

IgM+ B cells were founded in OVA and Dp

immunised groups compared to their respec-

tive control group. Moreover, preconcep-

tion immunisation with OVA induces an

enhancement in the FccRIIb expression on

OVA-immunised offspring B cells. Contrari-

wise a decreased FccRIIb expression on

Dp-immunised offspring B cells were

observed when compared to Dp-immunised

offspring.

Conclusion: Together these results shows

that preconception OVA or Dp immunisa-

tion can inhibit allergy development

with opposite effects of on FccRIIb expres-

sion on offspring B cells, suggesting differ-

ent inhibition mechanisms between those

allergens.

907

Sequential allergen desensitisation of

basophils is nonspecific and may involve

p38 MAP kinase

Witting Christensen, SK; Krohn, IK; Skjold, T; Schmid,

J; Hoffmann, HJH

Department of Respiratory Diseases and Allergy,

Aarhus University Hospital, Aarhus C, Denmark

Background: Sequential allergen desensiti-

sation provides temporary tolerance for

allergic patients. We adapted a clinical pro-

tocol to desensitise human blood basophils

in vitro and investigated the mechanism

and allergen specificity.

Method: We included 28 adult, grass aller-

gic subjects. The optimal, activating aller-

gen concentration was determined by

measuring activated CD63+ CD193+SSLow

basophils in a basophil activation test

(BAT) with 8 log-dilutions of grass

allergen. Basophils in whole blood were

desensitised by 10-min incubation with

2–2.5- fold increasing allergen doses in 10

steps starting at 1/1000 of the optimal

dose. After desensitisation basophils were

challenged with the optimal allergen dose.

Involvement of the p38-kinase was assessed

after 3 min, compared to unchallenged

samples (n = 7). Allergen specificity was

investigated by desensitising cells from

multi allergic subjects with grass allergen

and challenging with optimal doses of

grass, birch, recombinant house dust mite

(rDer p2) or anti-IgE (n = 10).

Results: Desensitisation reduced the frac-

tion of blood basophils responding to chal-

lenge with an optimal allergen dose from a

median 81.0% (IQR 66.3–88.8) to 35.4%

(IQR 19.8–47.1, P < 0.0001). CD63 MFI

expression was reduced from 68248 (IQR

29336–92001) to 30496 (IQR 14046–46179,P < 0.0001). Basophils from multi allergic

subjects were desensitised with grass aller-

gen. Challenge with grass resulted in

39.6% activation (IQR 15.8–58.3). Chal-

lenge with an unrelated allergen (birch,

rDer p2 or anti-IgE) resulted in 53.4%

activation (IQR 30.8–66.8, P = 0.16). De-

sensitisation reduced p38 phosphorylation

from a median 48.1% (IQR 15.6–92.8) to

26.1% (IQR 7.4–71.2, P = 0.047). p38

phosphorylation was not completely inhib-

ited causing an increase from a median

8.9% (IQR 3.2–18.5) to 26.1% (IQR 7.4–71.2, P = 0.03) following allergen chal-

lenge.

Conclusion: Desensitisation attenuated

basophil response rapidly and nonspecifical-

ly, and p38 could be part of the mechanism.

909

Assessment of apoptosis of CD 123+

dendritic cells derived from human

peripheral blood monocytes after non-

specific stimulation of viral and bacterial

factors

Kubicka-Sierszeń, A; Michalak, A; Grzegorczyk, JŁ

Microbiology and Medical Laboratory Immunology,

Medical University of Lodz, Lodz, Poland

Background: Dendritic cells (DC) are anti-

gen-presenting cells that play key role in

linking innate and adaptive immunity

because they are the first which contact

with foreign antigens and then stimulate

other immune cells to response. Up to now

there is little knowledge about the influence

of bacterial and viruses on DC apotosis.

Method: DC CD123+ were isolated from

peripheral blood monocytes of eight

healthy donors by adherence method. The

cells were cultured for 7 days in the pres-

ence of IL-4 and GM-CSF in a humidified

incubator with 5% CO2 at 37°C. After

then they were incubated for 24, 48 and

72 h without (as control, SP) or with

recombinant fusion protein of human

parainfluenza virus (FP hPIV3; 10 ng/ml),

LPS (1 lg/ml) and tetanus toxin (TT;

25 ng/ml), respectively. The different stages

of CD123+ DC apoptosis was detected by

using the flow cytometry method (PE-

conjugated anti-CD123 monoclonal anti-

bodies and Annexin V-FITC and PI

apoptosis detection kit). The results were

presented as mean � SE and range (min–max). The statistical differences was esti-

mated using the Wilcoxon test (P < 0.05).

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453344

Results: After isolation the fraction of

CD123+ DC was 26.40 � 11.68%; 11–43%. In early apoptosis after 24, 48 and

72 h of experiment there were no signifi-

cant differences in the percentage of cells

under the influence of LPS, TT and FP

hPIV3 compared to SP. In late-apoptosis

the percentage of CD123+ DC significantly

increased only under the influence of LPS

after 24 h of experiment (67.69 � 4.00%;

47.03–80.94%) compared to SP

(57.36 � 6.57%; 37.53–77.27%).

Conclusion: The apoptosis of CD123+ DC

varies depending on the time of culture

and the infectious factors used in the

experiment.

910

Immunologic and enzymologic urinary

assessment of surgical efficacy in

children with decompensated obstructed

megaureter

Drannik, GN1; Kalinina, N1; Mygal, L1; Peterburgskiy, V1;

Savchenko, V1; Poroshina, T1; DuBuske, LM2,3

1National Medical University, Kiev, Ukraine;2Immunology Research Institute of New England,

Gardner, United States; 3The George Washington

University School of Medicine, Washington, United

States

Background: The role of cytokine s and

enzymes in development of decompensated

obstructed megaureter remains unclear.

This study assesses the impact of trans-

forming growth factor-b1 (TGF-b1), tumor

necrosis factor-a (TNF-a) and urinary

tubular enzymes (N-acetyl-b-D-glucosamini-

dase (NAG), b-galactosidase (b-GaL) in

the urine as new criteria for assessment of

surgical treatment of children with decom-

pensated obstructed megaureter (DOM).

Methods: Thirty-two children (48 ureters)

aged 3–36 month after having staged

DOM repairs were examined. The first

stage for urodynamic and renal function

improvement required ureter middle seg-

ment resection in 14 children (21 ureters);

and temporary uretero-cutaneostomy in 18

(27 ureters) patients. The uretra-vesical

segment final correction was done after

urodynamic and renal function improve-

ment. Ureteroneostomy was performed in

14 children. For vesico-dependent DOM

(13 ureters) the uretero-cutaneostomy

closure was sufficient for normal urine pas-

sage. Levels of TGF-b1, TNF- a and

urinary tubular enzymes NAG and b-GaL

in urine were assessed by ELISA.

Results: After 1 year fibroblastic activity

decreased in operated renal parenchyma in

8 (25%) patients with urinary TGF-b1 lev-

els (4.5 � 1.7 pg/ml, P < .001) being near

the reference group values. The urinary

TNF-a concentrations level (9.3 � 2.12 pg/

ml, P < 0.01) were decreased compared to

control group levels in 12 (37.5%) patients.

The NAG urine levels decreased compared

to the reference group values in 23 (71.8%)

children up to 51.7 � 6.35% and the

b-GaL urine levels in 18 (56.2%) children

up to 45.5 � 8.1%, respectively.

Conclusions: Staged surgical treatment for

patients with DOM improves ureteral func-

tion. TGF-b1, TNF-a and urinary tubular

enzymes remaining at high levels suggests

that ureteral surgical treatment does not

provide renal improvement in all cases.

These biomarkers are noninvasive and reli-

able criteria in staged surgical treatment of

patients with decompensated obstructed

megaureter.

911

Expression of leukotriene E4 receptor:

GPR80/99 in human nasal mucosa

Shirasaki, H; Kanaizumi, E; Seki, N; Himi, T

Otolaryngology, Sapporo Medical University, Sapporo,

Japan

Background: The cysteinyl leukotrienes

(CysLTs) are lipid mediators that have

been implicated in the pathogenesis of

allergic rhinitis. Pharmacological studies

using CysLTs indicate two classes of recep-

tors named CysLT1 and CysLT2 receptor

exist. The former is sensitive to the Cys-

LT1R antagonist currently used to treat

asthma and allergic rhinitis. Recent studies

have begun to uncover receptors selective

for LTE4:P2Y12, an adenosine diphos-

phate receptor, and the orphan receptor

GPR80 (also called GPR99). We have

previously reported the expression of Cys-

LT1R, CysLT2R and P2Y12, by using

immunohistochemistry and in situ hybrid-

ization (Shirasaki et al. Clin Exp Allergy

2002, Allergol Int 2013). To clarify the

expression of GPR80/99 in human nasal

mucosa, we investigated the expression and

the localisation of GPR80/99 protein in

human nasal mucosa by western blotting

and immunohistochemical analysis.

Method: Human turbinates were obtained

after turbinectomy from six patients with

nasal obstruction refractory to medical

therapy. The expressionof GPR80/99 pro-

tein was evaluated by western blotting. To

identify the cells expressing GPR80/99 pro-

tein, immunostaining was performed using

anti-human GPR80/99 antibody.

Results: Two bands of approximately

38 kDa and 76 kDa were detected in human

turbinates and primary cultured nasal epi-

thelial cells by western bol analysis using

anti-GPR80/99 antibodt. The immunohisto-

chemical studies revealed that anti-GPR80/

99 antibody mainly labeled epithelial cells,

submucosal glands and some inflammatory

leukocytes in nasal mucosa

Conclusion: The results suggest a primary

role for GPR80/99 as the LTE4 mediated-

secretory responses in upper respiratory

tract.

912

Anti-endotoxin immunity and levels of

C-reactive protein in Graves disease

associated with cardiovascular disease

Beloglazov, VA1; Kalugina, JJ1; DuBuske, LM2,3

1Crimea State Medical University, Simferopol, Ukraine;2Immunology Research Institute of New England,

Gardner, United States; 3The George Washington

University School of Medicine, Washington, United

States

Background: Cardiovascular diseases

(CVD) are major problems for Graves

Disease (GD) patients. Endotoxin (ET) can

induce systemic inflammation in GD. This

investigation assessed humoral and cellular

anti-endotoxin immunity and systemic

inflammation in GD patients with CVD.

Methods: Levels of anti-endotoxin anti-

bodies (serum anti-ET-IgM, anti-ET-IgA,

anti-ET-IgG and secretory anti-ET-IgA in

saliva) and C-reactive protein (CRP) were

assessed by ELISA. The levels of ET recep-

tors were assessed by laser double staining

flow cytometry. Monoclonal antibodies to

anti-CD14-RE (IOTest�O), to CD14 and to

lipopolysaccharides from E. coli K 235

conjugated with fluoresceinisothiocyonate

(ET-R) were assessed. All patients with

GD were divided into three groups. Group

1: 25 GD patients without CVD; Group 2:

46 GD patients with endocrine cardiomy-

opathy complicated by atrial fibrillation

and Group 3: 16 GD patients with ische-

mic heart disease (IHD). 30 healthy donors

served as controls.

Results: Patients in Groups 2 and 3 had a

greater percentages of men and greater lev-

els of thyroid hormones (T3, T4), TPO

and TSH receptor antibodies than patients

from Group 1. All three groups of GD

patients had decreased levels of anti-ET-

IgM (0.08 � 0.008; 0.1 � 0.03; and 0.2 �0.02 units of optical density (u.o.d.)) in

comparison with the group of control

(0.23 � 0.04 u.o.d., P < 0.05). GD patients

with CVD have decreased levels of anti-

ET-IgG (0.3 � 0.05; 0.3 � 0.06 u.o.d.) in

comparison with the control group (0.7 �0.1 u.o.d., P < 0.05). Levels of secretory

anti-ET-IgA levels in both groups of GD

patients with CVD (0.03 (0.02–0.04) u.o.d.;0.02 (0.01–0.03) u.o.d.) were significantly

less than the normal range (0.04 (0.02–0.05) u.o.d. (P < 0.05)). Levels of CRP

were high in all groups of patients but in

Group 3 was 1.3- fold more than in

Group1 (P < 0.05). Decreased levels of

anti-ET-IgM, normal serum anti-ET-IgA

levels and ET receptors on monocytes and

Poster Session Group II – Red. TPS 33 – Basic questions in allergy

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 345

granulocytes not having significant inter-

group differences were findings common to

all three GD groups.

Conclusion: Development of CVD in

patients with GD is associated with

impaired neutralization mechanisms of ET

by anti-ET antibodies in mucous mem-

branes with less secretory anti-ET-IgA and

impaired systemically in blood with less

anti-ET-IgG with greater levels of systemic

inflammation reflected by increased CRP.

These results suggest that anti-endotoxin

immunity participates in the pathogenesis

of GD and CVD.

913

Vitamin C suppress the electrolyte

secretion in mouse tracheal epithelium

through inhibition of the oxidative stress

Kim, WK1,2; Nam, YR2; Nam, JH2,3

1Internal Medicine, Dongguk University Ilsan Hospital,

Goyang, Korea; 2Dongguk University/Channelopathy

Research Center, Goyang, Korea; 3Dongguk University,

Physiology, Kyungju, Korea

Background: We investigated the changes

in electrolyte secretion of tracheal epithe-

lium in the mice chronically exposed to

normobaric hyperoxia (95% FiO2, 24 h).

Also, the effects of vitamin C and H2O2 on

the epithelium were tested.

Method: The short-circuit current (Isc) of

the epithelium was measured using a flow-

type Ussing chamber technique. Na+

absorption via epithelial Na+ channel was

evaluated by amiloride-sensitive Isc. Cystic

fibrosis transmembrane conductance regu-

lator-mediated, cAMP-dependent Cl�

secretion was evoked by forskolin and

isobutylmethylxanthine applied to the ba-

solateral side. Ca2+-dependent Cl� secre-

tion was evaluated from transient increase

in Isc by luminally applied ATP.

Results: In the mice exposed to 95% FiO2

for 24 h, the Isc values measured from the

above protocol were not affected. Also,

neither H2O2 (100 lM) nor vitamin C

(300 lM) directly affected the Isc of mouse

airway epithelium. Interestingly, in the

presence of vitamin C, the forskolin

induced Cl� secretion was inhibited.

Conclusion: Our results suggest that mouse

airway epithelium is relatively resistant to

hyperoxic stresses under ambient hyperoxia

or direct application of H2O2.

An excessive dose of vitamin C sup-

presses the cAMP dependent Cl- secretion

in mouse tracheal epithelium.

914

Differentiation of pDC and mDC from

cord blood derived stem cells to study

the effect of early nutritional intervention

on allergy in vitro

Nandanan, B1; Kumar, D1; Nauta, AJ2,3; Garssen, J2,3;

Sandalova, E1,3

1Division of Immunology, Danone Nutricia Research,

Singapore, Singapore; 2Department of Immunology,

Nutricia Research, Utrecht, the Netherlands;3Department of Pharmacology and Pathophysiology,

Utrecht Institute for Pharmaceutical Sciences, Utrecht

University, Utrecht, the Netherlands

Background: Accumulating evidence indi-

cates that commensal microbiota is one of

the key drivers of immune system develop-

ment. Nutritional modulation of the gut

microbiota has been identified as a novel

approach for the allergy prevention. The

ability of DCs to orchestrate allergic

immune responses makes them unique

targets for functional studies in allergy.

DCs may also play a role when probiotic

intervention is used to prevent or treat

allergic diseases. Recent literature suggests

both myeloid dendritic cells (mDCs) and

plasmacytoid dendritic cells (pDCs) also

play a role in allergic manifestations.

Method: As the number of DCs is quite

low in blood it become crucial to develop

an in vitro methodology to develop both

mDC and pDC from single donor blood,

to study the mechanism of allergic modula-

tion in individuals’ in vitro. In addition,

DCs derived from adult PBMCs might not

exactly reflect what is happening in an

infant, since the immune system in neo-

nates is still na€ıve. Here we describe a

method to differentiate pDC and mDC

from cord blood-derived stem cells.

CD34+ cells isolated from CBMC were

cultured in presence of Human SCF,

GM-CSF, IL-4, and Flt3L for mDC’s dif-

ferentiation and Human TPO, Flt3L, and

IL-3 for pDCs. Toll-like-Receptor agonists

(TLR) were added to the cells for activa-

tion and the cells were analysed for expres-

sion of activation markers and production

of cytokines

Results: We show that DCs obtained by

this method express DC markers and read-

ily respond to TLR stimulation. The yield

of mDC was 1.2E6 cells and of pDC,

9.75E6 from 1.5E6 CD34+ cells. Activated

cells showed high expression of cytokines

compared to immature cells.

Conclusion: Taken together, results of this

study indicated that both pDC and mDCs

can be derived from cord blood and

thereby provides a methodology to study

the development and maturation of na€ıvecells. This in vitro model can provide valu-

able insights into the influence of early

nutritional programming through modula-

tion of gut microbiota on DC development

and response.

915

The natural immune response against

the timothy grass pollen allergen Phl p 5

in non-atopic humans living in different

environments

Isakovic, A; Thalhamer, T; Scheiblhofer, S; Thalhamer,

J; Weiss, R

Molecular Biology, University of Salzburg, Salzburg,

Austria

Background: The ‘hygiene hypothesis’ pos-

tulates that a lack of exposure to infectious

components during early childhood results

in a higher risk to develop allergic diseases,

whereas a high diversity of microbes in the

first years of life could be important for

development of a healthy immune response

and protection against the development of

allergies. In this study, we assessed the

immune status of non-allergic people in

detail. On the one hand people living in a

farming envorinment, who are regularly

exposed to grass pollen allergens in the

context of a diverse microbial environment

(animal sheds, haylofts, harvesting activi-

ties) and on the other hand people living in

an urban environment, who lack such

microbial exposure.

Method: PBMCS from non-allergic volun-

teers are expanded antigen-specifically with

timothy grass pollen allergen Phl p 5.

Afterwards, T-cell function is determined

by multiple intracellular cytokine staining

and cytokine analysis of supernatants. Fur-

thermore, TH subsets are identified by

staining of subset-specific surface markers

and transcription factors. Moreover, IgE,

IgG1 and IgG4 antibody levels in human

plasma are measured by ELISA.

Results: IgG1, a TH1 associated subclass,

is elevated in non-allergic humans com-

pared to TH2 associated IgG4. Different

expression of surface markers and tran-

scription factors, as well as cytokine secre-

tion allows identification of TH1, TH2,

Treg and TH17 cells. We found a high

phenotypic diversity among non-allergic

individuals, indicating that multiple mecha-

nisms of naturally acquired protection

exist.

Conclusion: These established methods will

allow to statistically assess the distribution

of different T-cell subsets in the non-atopic

immune system, depending on different

environments and to find a potential link

between exposures to microbes and the

development of allergy.

Poster Session Group II – Red. TPS 33 – Basic questions in allergy

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453346

Poster Session Group II – Red

TPS 34 – Diagnosis of drug reactions in clinical practice

916

Hypersensitivity to proton pump

inhibitors – a rare case

Almeida, JP; Lopes, A; Barbosa, M

Department of Immunoallergology, Santa Maria

Hospital – CHLN, Lisbon, Portugal

Background: Hypersensitivity reactions to

proton pump inhibitors (PPI) are known

to be rare. The diagnosis is complex and

requires a high level of clinical suspicion.

Whereas there is no well-defined pattern,

possible cross-reactivity must be consid-

ered. Literature only reports case series

with few patients, reactions described being

mostly immediate. The authors report a

case of delayed hypersensitivity to all PPI

available in Portugal.

Case report: Thirty-nine year-old woman,

with a past history of mild persistent aller-

gic rhinitis, medicated daily with deslorata-

dine 5 mg/day. She was referred to our

Immunoallergy Department due to drug

allergy suspicion: (i) in 2007 she was given

intravenous aspirin and omeprazol and 3 h

later developed a generalised itchy ery-

thema and lips angioedema; (ii) in 2008, a

similar reaction was observed 6–8 h follow-

ing oral administration of ibuprofen and

omeprazol. The patient self diagnosed non-

steroidal anti-inflammatory drug hypersen-

sitivity and started withdrawal of all anal-

gesics except for paracetamol. In 2010, due

to indigestion/pyrosis complains she per-

formed an upper gastrointestinal endos-

copy which revealed reflux esophagitis, and

started on omeprazol 4 mg/day. About 6 h

after the first intake, a generalised itchy

erythema was noticed. Then, the sequential

self administration of other oral PPI (lans-

oprazol, pantoprazol and esomeprazol)

revealed the same reaction pattern. How-

ever, the intake of rabeprazol provoked a

vesicular-bulhous rash of the upper limbs.

Our immune-allergological investigation

revealed negative immediate prick tests but

delayed positive intradermal tests (10 h

later) for all 5 PPIs available. Avoidance

of PPIs was advised and the patient is cur-

rently on ranitidine, with good tolerance.

Conclusion: This is the first case in litera-

ture reporting delayed hypersensitivity to

all PPIs. We highlight the importance of a

good anamnesis and clinical suspicion for

correct diagnosis.

918

Anaphylaxis with hydrocortisone, a rare

case

Mascarenhas, MI1; Costa Silva, I1; Campos Melo, A2;

Pereira Santos, MC2; Rosado Pinto, J3

1Immunoallergology, Hospital Beatriz Angelo, Loures,

Portugal; 2Faculdade de Medicina da Universidade de

Lisboa/Instituto de Medicina Molecular, Lisbon,

Portugal; 3Immunoallergology, Hospital da Luz, Lisbon,

Portugal

Background: Corticosteroids are frequently

used as anti-inflammatory and immuno-

modulating therapy. Hypersensitivity reac-

tions are rare and mostly non-immediate.

Immediate hypersensitivity reactions are

rare and its’ physiopathology isn’t com-

pletely understood (IgE and non-IgE medi-

ated), nor the cross-reactivity between

structural groups.

Case report: We present a 66-year old

man, with partially controlled asthma, per-

sistent severe non-allergic rhinitis and nasal

polips, treated with ebastine, budeso-

nide + formoterol, nasal budesonide, tri-

amcinolone im. He was assisted in the ER

for asthma exacerbation and respiratory

infection. Immediately after administration

of hydrocortisone IV, he developed gener-

alised erythematous rash, wheezing, dysp-

nea, rhinoconjuntivitis and urinary

incontinence. He was treated with IM

adrenaline, clemastine, salbutamol and ip-

ratopium and monitored for 24 h. Then

topical corticosteroids were reintroduced,

without symptoms, maintaining daily treat-

ment, along with montelukast 10 mg and

azitromicine. An adrenaline kit was pre-

scribed and he was advised to avoid any

systemic corticosteroid. Basophile activa-

tion test (BAT) with hydrocortisone, me-

thilprednisolone and dexametasone was

performed being positive with the first two

drugs (IgE-mediated reaction suggestive

pattern). In spite of what was recom-

mended, he self-administered triamcinolone

injection, without reaction. Skin prick test

and oral provocation test with bethameta-

sone were negative.

Conclusion: Although rare, immediate

hypersensitivity reactions with corticoster-

oids can be severe and should be consid-

ered in patients with inflammatory or

immunologic conditions that require recur-

rent systemic corticosteroid therapy. In our

patient, the anaphylactic reaction and the

BAT results suggest an IgE-mediated

mechanism. We highlight, in this case, the

contribution of BAT to the diagnosis and

therapeutic decision.

919

Anaphylactic shock induced by

polysorbate 80

Luengo, O; Garriga-Companys, S; Lara-Ruiz, M; Delaval-

le, B; Moreno-P�erez, N; G�omez-Duque, M; Sala-Cunill,

A; Guilarte, M; Labrador-Horrillo, M; Cardona, V

Hospital Vall d’Hebron, Allergy Section, Barcelona,

Spain

Background: Emulsifiers are added to

products to help binding the ingredients

and to ensure a homogeneous distribution

and provide the same performance use

after use (e.g. fragrances).

Polysorbate 80 (also known as Tween 80

and polyoxyethylene-sorbitan-20-monool-

eate) is a solubilizing agent used in creams,

lotions, ointments, multiple medical prepa-

rations and as an additive in tablets.

Although rare, there have been reports of

severe IgE and non-IgE mediated reactions

induced by polysorbate 80.

Case report: A 18-year-old professional

basketball player presented generalised

pruriginous erythema with chest tightness,

dizziness and loss of consciousness 20 min

after receiving intramuscular treatment

with Inzitan� (cyanocobalamin, dexameth-

asone, lidocaine hydrochloride and thia-

mine hydrochloride) with a complete

recover after treatment with intramuscular

adrenaline.

Methods: A complete allergological study

was performed. Baseline serum tryptase

and IgE were determined. Skin tests (prick

1/1 and intradermal (IDR) 1/10) were per-

formed to: Inzitan�, lidocaine, methylpred-

nisolone 20 mg/ml, hydrocortisone

100 mg/ml, budesonide 0.5 mg/ml, dexa-

methasone 4 mg/ml, triamcinolone 10 mg/

ml (Trigon�) and fluticasone 1 mg/ml (Fli-

xonase�).

Results: Skin prick tests were only positive

to Inzitan�. IDR 1/10 were positive to:

Trigon� (triamcinolone) and Flixonase�

(fluticasone). As the only common excipi-

ent to Inzitan�, Trigon� and Flixonase�

was the polysorbate, prick tests to polysor-

bate 80 and 20 were performed and posi-

tive in both cases. Skin tests were negative

in three atopic controls. Serum tryptase

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 347

levels (2.22 mcg/l) and total IgE levels

(45 KU/l) were normal. The challenge test

to dexamethasone 4 mg, lidocaine and cya-

nocobalamin was negative.

Conclusions: Although IgE mediated reac-

tions to excipients (as polysorbate) are

rare, they should be ruled out when the

allergological study to the active com-

pound is negative.

920

Allergy work-up in a child undergoing

general anesthesia, with suspected latex

allergy

Caimmi, S1; Caimmi, D2; De Amici, M1; Artusio, L1;

Zavras, N1; Castagnoli, R1; Bosa, L1; Marseglia, GL1

1Fondazione IRCCS Policlinico San Matteo, S.C.

Pediatria, Pavia, Italy; 2CHRU Montpellier, Montpellier,

France

Background: Immediate hypersensitivity

reactions to latex or anesthetics represent

rare but not negligible complications dur-

ing surgery. Latex allergy is not common

in the pediatric population. We present the

case of a 10 years old boy that suffered

from a perioperative hypersensitivity reac-

tion and needed an allergy work-up before

another surgical procedure.

Method: A skin prick test for latex, per-

formed in another center, (Stallergenes,

Milan-100 IR) was negative, but he was

declared as allergic to latex, since he pre-

sented positive specific IgEs for this aller-

gen (k82, Immunocap�). When we

evaluated him, we decided to evaluate IgEs

for latex recombinants, which resulted

positive for the latex profilin Hev b 8

(36.4 ku/l) only. To reassure both the fam-

ily of the patient and the anesthesiologist,

we proceeded with a provocation test for

latex (both rubbing test and latex use test),

which were negative. The allergy work-up

continued with all those agents used during

the procedure at the time of the reaction.

Results: We identified Ibuprofen as the

only agent to which he was sensitised and

allergic.

Conclusion: The diagnosis of latex allergy

is based on a positive clinical history and

positive in vivo tests. We may now perform

IgE evaluation for specific latex allergens.

Hev b 1, Hev b 2, Hev b 5, Hev b 6, and

Hev b 13 are the major latex allergens and

therefore need to be included in the

extracts used for in vivo tests. These aller-

gens are responsible for latex allergic reac-

tions. Hev b 7, Hev b 8, Hev b 9, Hev b

10, Hev b 11, and Hev b 12 may be taken

into consideration as possibly responsible

for cross-reactivity reactions with other

allergens. Although being of minor clinical

relevance, they also must be present in the

extracts, in order to assess a possible cross-

reactivity. Nevertheless, they are usually

not related with clinical symptoms of latex

allergy. Provocation tests to latex are cur-

rently not included in the standard work-

up, but may be useful when diagnosis

appear controversial.

921

Angioedema induced by naproxen

without cross-reactivity with other

nonsteroidal anti-inflammatory drugs

(NSAIDs)

Figueroa, J; Mart�ınez, D; Caballero, E; Gallego, MD;

Garc�ıa, JA; S�anchez, A

Allergy Section, Hospital Universitario Insular de Gran

Canaria (CHUMI), Las Palmas de Gran Canaria, Spain

Background: Naproxen is an aryl propi-

onic NSAID (nonsteroidal anti-inflamma-

tory drug) used widely in Spain and have

been frequently involved in hypersensitivity

reactions like fixed drug eruption, asthma

or urticaria/angioedema. These reactions

are usually associated to reactions to other

NSAIDs (as nabumetona in fixed drug

eruption or other aryl propionic drugs or

aspirin in asthma or urticaria/angioedema).

Method: A 39 years old female referred

5 years before a reaction after naproxen

administration showing lips angioedema

and generalised pruritus that needed

urgently treatment. Symptoms resolved in

4 h after treatment. After this first reaction

the patient have taken paracetamole and

metamizole without any problem but 1 year

before she referred a reaction after the

administration of first tablet of a combina-

tion of esomeprazole 20 mg with naproxen

500 mg, showing at this time lip angioedem-

a and genital angioedema that resolved in

around 5 h after urgently treatment. We

performed single-blind placebo-controlled

(SBPC) challenge tests with esomeprazole

40 mg, naproxen 550 mg, ibuprofen

600 mg, nabumetona 1 g, metamizole

575 mg and aspirin 500 mg in different

days. Before the naproxen oral challenge

tests skin prick and intradermal tests (three

dilutions) with the drug were carried out.

Results: Skin prick and intradermal tests

with naproxen were negative, but the SBPC

challenge was positive observing after

40 min angioedema in both lips and refer-

ring genital pruritus. The symptoms

resolved after treatment without any other

complication. One month later we per-

formed SBPC challenge test in different

days with esomeprazole 40 mg, metamizole

575 mg, aspirin 500 mg, nabumetona 1 g

and ibuprofen 600 mg with a negative

result.

Conclusion: The pathogenetic mechanism

responsible of this reaction is unknown but

it seems to be specific since no cross-reac-

tivity was observed with other NSAIDs,

including other aryl propionic ones as ibu-

profen.

Further studies are needed to understand

mechanisms involved.

922

Cutaneous drug eruption induced by

antihistamines

Vi~nas, M; Castillo, M; Hern�andez, N; Ibero, M

Hospital de Terrassa, Terrassa, Spain

Introduction: Topical application of anti-

histamines commonly leads to sensitisation

for patients but systemic administration of

antihistamines rarely induces allergic

hypersensitivity. These are mainly linked to

phenothiazine and piperazine derived com-

pounds.

Case report: A 70-year-old Spanish

woman affected with lichen planus visited

because of a history of generalised morbili-

forme eruption and complete peeling of the

entire body for a treatment with predni-

sone and hydroxyzine. Later she took a ce-

tirizine for a cold and presented palmar

erythema and desquamation.

Materials and Methods: Skin tests (prick

tests and intradermal tests) were performed

with steroids and patch tests (read after 48

and 96 h) with steroids and antihistamines.

Controlled oral challenge tests were per-

formed with prednisone and with an alter-

native antihistamine (dexchlorpheniramine).

Results: Skin tests were negative for all cor-

ticosteroids. Patch tests were all negative for

steroids and for antihistamines were positive

for hydroxyzine and levocabastine. An oral

challenge with prednisone and dexchlorphe-

niramine were negative.

Conclusion: The patient was diagnosed of

cutaneous drug eruption from hydroxyzine

and cetirizine. We consider that is impor-

tant to study every patient whose skin con-

dition worsens after the treatment with

antihistamines, especially hydroxyzine

because it’s known that the relation

between systemic exposure and contact

dermatitis is probably misdiagnosed.

923

Tinea faciei-wrong diagnosis of fixed

drug eruption: case report

Chiriac, AE1; Pinteala, T1; Brzezinski, P2; Foia, L1;

Bujor, A3

1University of Medicine and Pharmacy Gr T Popa Iasi,

Iasi, Romania; 26th Military Support Unit, Ustka,

Poland; 3U.M.F. ‘Iuliu Hateganu’, Cluj, Romania

In August 2013 a Caucasian woman of

37 year-old, house working full time,

known for many years with migraine

and self-medication (nonsteroidal anti-

Poster Session Group II – Red. TPS 34 – Diagnosis of drug reactions in clinical practice

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453348

inflammatory drugs) developed an ery-

thematous, painful, intense pruritic, well

demarcated round plaque of 3 cm in diam-

eter on the left cheek.

The patient declared that she had

recently taken Ibuprofene orally for a

severe headache. The allergologist sus-

pected a fixed drug eruption, recommended

antihistamines twice daily and topical ste-

roids class II in cream for 10 days. A new

medical examination was asked a few days

later, due to the enlargement of the lesion,

intense pruritus and anxiety of the patient.

On the close view an intense erythema-

tous plaque of almost 5 cm was observed,

discrete desquamation, no lymphadenopa-

thy, no other symptoms or signs. Lab

investigations were within normal range,

patch test to Ibuprofene proved to be neg-

ative. She denied any other drug intake.

A dermatological consult was demanded.

Direct mycological examination from the

scraping was done and a positive result

raised the suspicion of Tinea faciei. A

treatment with Itraconazol orally was

started and topical antifungal cream. The

lesion disappeared completely in 3 weeks

with no scars, no erythema. No recurrence

was reported so far. Meanwhile the myco-

logical culture became positive.

924

Multiple drug hypersensitivity in a case

of DRESS syndrome

Sierra Salgado, OF; Moreno Rodilla, E; Moreno Mon-

toya, A; Gonz�alez Ruiz, A; Mu~noz Bellido, FJ; D�avila

Gonz�alez, I

Hospital Universitario de Salamanca, Allergy,

Salamanca, Spain

Background: The clinical expression of

non-immediate drug hypersensitivity reac-

tions is highly heterogeneous. DRESS syn-

drome is characterised by a variable

combination of cutaneous and multiorgan

involvement with lymphocyte activation

and eosinophilia.

Method: A 75-year-old male with meta-

static colorectal cancer was treated with sev-

eral cycles of oxaliplatin and capecitabine.

He underwent a CT scan with the contrast

agent iohexol, and 1 week after the exami-

nation he developed a exhantema on the

torso and limbs. The histopathologic analy-

sis revealed a perivascular lymphohistiocytic

and eosinophilic infiltration. The laboratory

tests revealed eosinophilia of 38.20% and an

alteration of the hepatic profile. Systemic

corticosteroids were prescribed and the lab-

oratory parameters returned to normal

values. One week after a new dose of

oxaliplatin the patient developed the same

clinical picture that disappears after

1 month. Four weeks later, skin tests, were

performed for the drugs suspected, accord-

ing to the ENDA recommendations.

Results: The patch tests with platinum-

based agents (oxaliplatin, carboplatin),

capecitabine and contrast agents (iohexol,

iodixanol, iobitridol, ioversol) were nega-

tive at 48 and 96 h. The Immediate and

delayed reading of the intradermal tests

with the drugs mentioned above were nega-

tive. However, 1 week after the intrader-

mal test with iohexol, iodixanol and

oxaliplatin, the patient developed local ery-

thema and induration that lasted several

days. A single-blind placebo-controlled

challenge test with iobitridol was negative.

Conclusion: We present a case of DRESS

induced by two antigenically and chemi-

cally different drugs oxaliplatin and ioh-

exol. The allergic reactions to platinum

salts are well described and they usually

are IgE-mediated reactions. However there

are few reported cases of delayed hypersen-

sitivity reactions. This is the first case of

DRESS syndrome in which these two sub-

stances are involved.

925

Fixed drug eruption caused by

moxifloxacin. Case study

Ahmida, T; J�ımenez Tim�on, S; Martin Maghfour, Y;

Garc�ıa Ponce, J; Alvarado Arenas, M; Porcel Carre~no, S;

Hern�andez Arbeiza, J

Hospital Virgen de la Monta~na, Allergy, C�aceres, Spain

Background: Fixed drug eruption (FDE) is

a distinctive type of cutaneous drug reac-

tion that characteristically recurs in the

same locations upon reexposure to the

offending drug. Acute FDE usually pre-

sents with a single or a small number of

dusky red or violaceous plaques that

resolve leaving post inflammatory hyper-

pigmentation. Rare severe atypical variants

of FDE, including multiple, nonpigment-

ing, and generalised bullous variants, share

clinical features with Stevens-Johnson syn-

drome/toxic epidermal necrolysis. Accord-

ing to literature, fixed drug eruption is

uncommon, and the most commonly

involved drugs are sulphonamides, anti-

biotics, NSAIDS, analgesics and hypnotic

drugs. With regard to quinolones few cases

of (FDE) were reported.

Method: Seventy-eight year old male with

a history of ASA Syndrome, colonic diver-

ticulitis, maxillary ethmoidectomy, polyp-

ectomy, chronic urticaria and hiatus

hernia. He presented an initial episode of

cutaneous macular eruption 30 min after

taking Moxifloxacin in the right forearm

and right leg, without additional systemic

symptoms. He was attended at the Emer-

gency Department with intramuscular

Urbason.

Results:

1 Blood count and chemistry panel: nor-

mal.

2 Standard prick skin tests for food,

pneumoallergens and anisakis: negative.

3 Basophil activation test using flow

cytometer: positive results for Moxi-

floxacin and negative for Ciprofloxin.

4 While under study, the patient acciden-

tally took the same drug again, pre-

scribed for a respiratory infection,

30 mins later he presented pruritus,

flushing and subsequent violaceous skin

lesions measuring 7–8 cm in diameter,

appearing in the same location as the

previous reaction. The lesions pro-

gressed to subsequent scaling, with no

residual pigmentation.

Conclusion: We report a case of multiple

fixed drug eruption caused by the ingestion

of moxifloxacin and diagnosed using baso-

phil activation test (BAT) and reexposure.

No FDE cases were reported due to qui-

nolones with positive (BAT).

928

Anaphylaxis to acetaminophen: a case

report

Loloci, G1; Hoxha, M2; Nikolla, E2; Marko (Plaku), O2;

Deliu (Shameti), A2; Gjata- Loshe, E3; Zogaj, D4

1Hospital Center, Service of Allergology and Clinical

Immunology, Tirana, Albania; 2Service of Allergology

and Clinical Immunology, University Hospital Center

‘Mother Theresa’, Tirana, Albania; 3Lushnja Hospital,

Service of Allergology, Lushnja, Albania; 4Kosovo

University Clinical Center, Alergology Department,

Prishtina, Albania

Background: Acetaminophen is a non-ste-

roidal, anti-inflammatory, analgesic, and

antipyretic. Anti-COX3 is a possible mech-

anism of action. Hypersensitivity to Acet-

aminophen are rare. Allergic-like reactions

to this drug, including urticaria, angioe-

dema, and anaphylactic reactions have

only rarely been reported.

Case report: A 23 year old men presented

in our clinic (Dec2013) and refered general-

ised urticaria, rash, pruritis, dyspnea, chest

tightness, hypotension (2008) 20 min after

receiving oral acetaminophen 500 mg. (Feb-

ruary 2009). He had generalised urticaria,

pruritis, rash, dyspnea, 15 min after inges-

tion of oral acetaminophen 500 mg, phenir-

amine maleate 25 mg, ascorbic acid 200 mg,

(gum arabic, citric acid, sodium saccharin,

sucrose) 11.5 mg. Blood pressure 80/

50 mmHg. He refered 4 other episodes

(2008, 2013, 2013, 2013) with face and neck

urticaria, rash, and pruritis after consuming

juice in cans, catch up and potato, hot dog

with catch up, salep with cinnamon. We per-

formed Prick by prick and labial challenge

with catch up and cinnamon. The results

Poster Session Group II – Red. TPS 34 – Diagnosis of drug reactions in clinical practice

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 349

were negative. After 2 weeks, we performed

an oral challenge with acetaminophen. He

was first given placebo orally, without any

reaction. This was followed by 50 mg of

acetaminophen orally, and 25 min later a

face, neck and around mammalian glands

rash, and after 2 min in all cutaneous sur-

face, numbness of lips, tingling, heat sensa-

tion in the face, palmar pruritis, diffuse

urticaria, and dyspnea developed. His blood

pressure decreased in 70/40 mmHg. The

symptoms resolved with administration of

1/3 epinephrine 1 mg/1 ml s/c, prednisolone

75 mg i/v and antiH1 180 mg p.o. After the

episode, the plasma tryptase level rose to

21 ng/ml.

Discussion: Acetaminophen minimally in-

hibite cyclooxygenase, it is usually consid-

ered safe for NSAID-sensitive patients.

Diagnosis can be confirmed with single-

blind oral challenge test. We present a case

of anaphylaxis to Acetaminophen with

positive oral challenge. The increase of the

serum tryptase level supports the diagnosis

of anaphylaxis. Remains to discuss: who is

the connection between consumed foods

and acetaminophen, are these episodes

dedicated to the active substance or addi-

tives.

Conclusion: Acetaminophen is usually con-

sidered a safe drug, but physicians must be

aware of the possibility of anaphylactic

shock. Studies shows that Skin tests in case

of anaphylaxis due to this drug are not

very effective, and the diagnosis is realised

with a suggestive clinical history or the

gold standard in allergy tests, the OCT

with high dose (650 mg).

929

Specificity of the immune response in

B-lactam allergy: not always so clear

Ruano, FJ; Blanca-L�opez, N; Garcimart�ın, MI; P�erez-

Alzate, D; Vazquez de la Torre, M; Dionicio, J; Somoza,

ML; Canto, G

Hospital Universitario Infanta Leonor, Allergy

Department, Madrid, Spain

Background: In immunoglobulin (Ig)

E-mediated responses to betalactams the

IgE response can be specific to the drug

inducing the reaction or cross-reactive to

the classical BPO determinant. We describe a

case in which during the evaluation of b-lac-tam allergy, seemed to be a selective respon-

der but after administration of the culprit

drug a change in sensitisation occurred and a

cross-reactivity was stablished.

Method: Case report.

Results: We present a case of a 29 year

old male suspected of having b-lactamallergy, evaluated according to the Euro-

pean Network for Drug Allergy (ENDA)

guidelines including skin tests, in vitro

measurements, and drug challenge (admin-

istered at increasing doses, with a 60-min

interval).

At age 28 years, he received oral amoxi-

cillin-clavulanic acid for acute bronquitis

treatment and had immediate symptoms of

rhinoconjunctivitis, dysphonia and dysp-

nea. He was treated with injectable metil-

prednisolone and rapidly recovered.

Diagnostic work-up: IgE antibodies to

penicillin G, V, amoxicillin and ampicillin

were negative.

Penicillin skin testing (prick and intra-

dermal with BPO, MDM and penicillin G)

resulted negative and the patient tolerated

a 1000 mg dose of penicillin V.

One week later, amoxicillin skin tests

(prick and intradermal) resulted negative

and the patient tolerated a 1000 mg dose

of amoxicillin.

One week later, clavulanic acid skin test

(prick and intradermal) resulted negative,

but 10 min after the oral administration of

5 mg of amoxicillin-clavulanic acid the

patient had a positive reaction (rhinocon-

junctivitis, dysphonia and localised hives

on back)

In order to confirm selective allergy to

clavulanic acid we repeated study with

amoxicillin, skin tests were negative but

after the administration of 5 mg of amoxi-

cillin the patient had a positive reaction

(rhinoconjunctivitis, dysphonia and facial

angioedema).

Finally, repeated study with penicillin

resulted in a positive reaction after intra-

dermal with penicillin G, (rhinoconjunctivi-

tis, dysphonia and facial angioedema) (skin

test negative to BPO and MDM beginning

with a hundred-fold dilutions).

Reactions were treated with injectable

adrenaline, metilprednisolone and

dexclorfeniramine and rapidly recovered.

Conclusion: A diagnostic work-up should

be made carefully, cross-reactivity might

appeared at the end, when the culprit drug

elicits a reaction and a boosting effect on

IgE antibodies against main structures of

b-lactams.

930

An unexpected allergic reaction with

Saccharomyces boulardii: a case report

Demirel, F1; Kartal, O1; Gulec, M1; Yesillik, S1; Baysan,

A1; Uyanık, M2; Musabak, U1; Sener, O1

1Division of Immunology and Allergic Diseases,

Gulhane Military Medical Academy and Medical

School, Ankara, Turkey; 2Department of Clinical

Chemistry, Gulhane Military Medical Academy and

Medical School, Ankara, Turkey

Background: Saccharomyces boulardii

(S. boulardii), known as a nonpathogenic

yeast probiotic shows it’s efficacy in

inflammatory and infectious diseases of the

gastrointestinal tract safely. This report

presents an allergic reaction and positive

skin test in a patient who takes S. boulardii

as an antidiarrheal therapy.

Case report: A 60-year old male patient

was admitted to the hospital with itchy

rash on both ankles within 1.5 h after

ingesting S. boulardii 250 mg capsule and

nifuroxazide 100 mg capsule. Hyperemic

macular lesions surrounding the ankles

were seen on physical examination. Oral

antihistamine, oral and topical steroid ther-

apies were initiated. Skin tests with sus-

pected drugs were performed a month

later. The prick and intradermal tests were

performed with S. boulardii and nifuroxaz-

ide. The intradermal test with S. boulardii

was detected positive at 1/10 W/vol con-

centration. However, skin tests were found

to be negative with nifuroxazide.

Conclusion: Although S. boulardii is

known a safe drug in the treatment of

some gastrointestinal disorders, it can not

be referred completely reliable on the basis

of allergic reactions. Previously, only one

allergic reaction was reported effecting gas-

trointesinal system. Our case is important

in clinical practice, because the first skin

manifestation of S. boulardii allergy was

presented and confirmed by skin test.

931

Bullous fixed drug eruption by etoricoxib

Corrales-Vargas, SI; P�erez-Calder�on, R; Gonzalo-Garijo,

M�A; Habernau, A; Mahecha, AC; Chiarella, GM

Allergology, Infanta Cristina University Hospital,

Badajoz, Spain

Introduction: Fixed drug eruption (FDE) is

a skin reaction characterised by one or

more macular or bullous lesions, associated

in most cases with medication. Nonsteroi-

dal antiinflammatory drugs (NSAIDs)

are the most frequent cause. Selective

cyclooxygenase-2 inhibitors (coxibs) have

also been described as triggers but more

exceptionally. There are two cases reported

of FDE by etoricoxib with good tolerance

to celecoxib (this may be explained because

etoricoxib is a bipyridine and celecoxib is a

sulfonamide, as parecoxib). Patch tests

have been useful for the diagnosis in some

cases, but the concentrations used have

been different. Studies of tolerance with

other bipyridines, as milrinone, have not

been performed.

Case report: A 29 year-old woman with a

history of chronic urticaria with intolerance

to NSAIDs presented 24 h after taking a

tablet of etoricoxib stinging in the palate

followed in 2–3 h of a bullous lesion at that

location and on the 4th finger of the

right hand. Lesions improved within a week

without treatment, persisting residual

Poster Session Group II – Red. TPS 34 – Diagnosis of drug reactions in clinical practice

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453350

hyperpigmentation on the finger for 3–4 weeks. A few weeks later, the patient took

etoricoxib again and 20 min later she had a

similar reaction. Since then she has avoided

coxibs.

Methods and results: Six weeks after the

second reaction we performed patch tests

with etoricoxib, milrinone, celecoxib and

parecoxib 10% pet on healthy skin on the

back, and with etoricoxib 10% pet on resid-

ual finger lesion. Only in the latter case the

test was positive at 48 and 96 h. The patient

was unable to attend on new appointment

to patch milrinone on finger lesion. Con-

trolled oral administration of meloxicam

and celecoxib was well tolerated.

Conclusions: We report a case of bullous

FDE by etoricoxib with positive patch tests

in previously affected skin using a drug

concentration of 10% pet. We have shown

good tolerance to other coxibs belonging

to sulfonamides, but we could not confirm

the tolerance to bipyridines.

932

Is there anything else than omeprazole

allergy?

Meijide Calderon, A; Garcia Paz, V; Rial Prado, M;

Rico Diaz, MA; Veleiro Perez, B

Complejo Hospitalario a Coru~na, Alergolog�ıa, A

Coru~na, Spain

Introduction: Omeprazole is a ben-

zimidazol derivate that works as a proton

pump inhibitor in the oxyntic gastric cells.

Domperidone is a benzimidazol derivate

that acts as a peripheral and central dopa-

minergic antagonist.

A 47 year-old woman took 10 ml of

Motilium� (Domperidone) orally, and a

few hours later she developed a prurigin-

ous eruthema in the neck and hands. She

was treated with Metilprednisolone i.v. and

Dexclorpheniramine i.m. in the Emergency

Department. The exantema resolved with

desquamation some days later.

Afterwards, she took Arcoxia� (Etoric-

oxib) and Omeprazole orally to treat a sci-

atica pain; after a few hours she presented

with facial erythema and burning sensa-

tion, that resolved without treatment.

At the moment the patient tolerates oral

Diclofenac. She hasn′t take Omeprazole or

Domperidone after that event

Method:

1 Prick (40 mg/ml) and intradermal (0.1–1 mg/ml) tests with Omeprazole: NEG-

ATIVE.

2 Oral challenge test with Omeprazole

20 mg: 30 min after administration

7 mg our patient developedmalar

erythema and burning sensation.

3 Oral challenge test with Etoricoxib:

GOOD TOLERANCE.

4 Oral challenge test with Domperidone:

10 min after administration 5 ml she

started with malar erythema and burn-

ing sensation.

Results: We have confirmed by oral chal-

lenge allergy to both drugs: Omeprazole

and Domperidone.

Conclusion: Omeprazole and Domperidone

have a common benzimidazole ring in their

molecular estructure. In our opinion, this

ring is responsible of the cross reactivity

between the two drugs. To confirm this, we

need the oral challenge, as the skin tests

were of low sensitivity.

933

Inmediate and noninmediate

hypersensitivity reactions to Iodinated

contrast media: diagnosis

Benito Martinez, P; Veza Perdomo, S; Saura Foix, P;

Blanco Carmona, JG; Juste Picon, S; Carretero

Anibarro, P; Garcia Gonzalez, F

Hospital Universitario Burgos, Alergolog�ıa, Burgos,

Spain

Background: More than 70 millions iodin-

ated contrast injections per year are admin-

istered worldwide to perform the diagnosis

and treatment or several diseases. Iodin-

ated contrast are generally well tolerated,

although hypersensitivity reactions has

been described. It may present inmediately

as anaphylaxis or delayed such as maculo-

papular exanthema.

Method: Daily, patientes with history of

reaction following administration of iodin-

ated contrast are coming to our services.

Skin test have been proposed as a useful

tool for diagnosis, although sometimes is

necessary to draw on drug provocation test

in order to confirm it.

Results: In our hospital, last half-year, we

have seen 50 patients with reactions follow-

ing administration of iodinated contrast.

There was 33 women and 17 men, aged

between 17 and 85 years. About risk fac-

tors, no one has history of previous reac-

tion, four patients was b-blocker drug

users and only one was asthmatic. Thirty-

one patient present inmediate reactions

and 19 present non-immediate reation.

20% of our patients has presented symp-

toms of anaphylaxis, 24% exanthema,

40% urticaria and/or angioedema, 16%

mild symptoms. Skin tests (prick, intrader-

mal and patch test) were negative in 45

patients. We test Iopamidol, Iodixanol,

Iomeprol, Amidotrizoato and Iopromida.

We obtained five positive tests. Four intra-

dermal test (3 in pacients with clinical

histoy of inmediate reaction, and one with

a noninmediate reaction) and one patch

test (non inmediate reaction). We recom-

mend premedication for patients with neg-

ative skin test. To positive skin test results

we assess to do a drug provocation test in

order to look for an alternative.

Conclusion: Iodinated contrast are widely

used and although generally they are well

tolerated, hypersensitivity reactions do

occur and it could be severe. When we

have to identify an alternative non-cross-

reactive iodinated contrast media, based on

skin test results, drug provocation test is

often needed to confirm the diagnosis.

935

Role of skin tests in the diagnosis of

hypersensitivity reactions to tocilizumab

Puxeddu, I; Rocchi, V; Del Corso, I; Migliorini, P

Pisa University, Clinical and Experimental Medicine,

Pisa, Italy

Background: Tocilizumab (TCZ) is a

humanized anti-human interleukin 6 receptor

(IL-6R) monoclonal antibody, recently intro-

duced for the treatment of immune-mediated

disorders. An increased therapeutic use of

this monoclonal antibody in Autoimmune

Diseases disclosed other side-effects, included

immediate hypersensitivity reactions. Thus, it

is important to define simple and reliable

diagnostic tests for these patients. The aims

of our study are to analyze the frequency of

hypersensitivity reactions in patients treated

with TCZ and to evaluate the role of skin

tests in the diagnosis.

Method: We performed in-vivo skin prick

tests and intradermal tests in 5 out of 72

patients treated with TCZ who experienced

hypersensitivity reactions, in three patients

who discontinued the treatment for ineffi-

cacy and in 10 healthy volunteers.

Results: Among the five patients with

hypersensitivity reactions, four patients

experienced anaphylaxis, and one pruritus.

All the reactions were classified as immedi-

ate (within 20 min from the infusion).

According to the grade, one of the reac-

tions was mild, one moderate and three

severe. Positive reactions to TCZ were

observed by intradermal tests in three out

of the four patients who developed ana-

phylaxis. On the contrary, the three

patients who discontinued the treatment

for inefficacy and 10 healthy subjects

resulted negative to the skin tests.

Conclusion: On the basis of our findings,

we suggest that skin tests to TCZ might be

a simple and sensitive tool for the diagno-

sis of IgE-mediated hypersensitivity reac-

tions to this biological agent.

Poster Session Group II – Red. TPS 34 – Diagnosis of drug reactions in clinical practice

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 351

Poster Session Group II – Red

TPS 35 – Drug allergy: desensitise or avoid

936

Tolerance to COX-2 in a population with

NSAID cross-intolerance

García Nuñez, I1; Algaba Marmol, MA2; Barasona

Villarejo, MJ3; Suarez Vergara, M4; Escalona Pena, M1;

Reina Ariza, EM1

1Allergy Department, Hospital Quiron Malaga, Malaga,

Spain; 2Environmental Council, Junta de Andalucia,

INFOCA Medical Department, Castro del Rio, Spain;3Allergy Department, Hospital Universitario Reina Sofia,

Cordoba, Spain; 4Allergy Department, Hospital Quiron

Campo de Gibraltar, Los Barrios, Spain

Background: NSAID cross-intolerance is a

very common diagnosis in patients refer-

ring problems after NSAID intake. We

have to give alternatives in order to use

them if they need them. Our aim was to

describe our patients with a diagnosis of

NSAID cross-intolerance, the protocol we

performed to diagnose them and to recom-

mend alternatives drugs.

Methods: All patients diagnosed as cross-

intolerance to NSAID during 2013 were

included. After a clinical report focusing

in their symptoms after NSAID intake

and the drugs implicated, we proposed a

Drug Provocation Test, after a signed

consent, with paracetamol 2 g (placebo-

500–500–1000 mg), meloxicam 30 mg

(placebo-15–15), celecoxib 400 mg (pla-

cebo-celecoxib-celecoxib) and etoricoxib

120 mg (placebo-30–30–60). All the

patients were controlled in the Day Hospi-

tal ward and the reactions were registered.

Results: Thirty-two patients (11 males and

21 females; mean age 40.81 years) were

included. The most implicated drugs in their

clinical episodes were propionic acid mem-

bers in 23 patients (71.87%), salicilates in

18 (56.25%) or pirazolones in 15 (46.87%).

Five patients (15.62%) presented only respi-

ratory symptoms, while 20 (62.5%) referred

cutaneous symptoms and 7 (21.87%) cuta-

neous and respiratory symptoms. After the

DPT, seven patients (21.87%) didn0t toler-ate paracetamol 2 g, 4 (12.5%) meloxicam

30 mg, 1 (3.12%) celecoxib 400 mg and 1

(3.12%) didn0t tolerate etoricoxib 120 mg.

Conclusions:

1 Our patients referred clinical symptoms

after propionic intake in a high percent-

age of episodes, being the cutaneous

symptoms the most frequently referred.

2 DPT with alternative COX-2 drugs has

to be performed in all patients, because

in a moderate percentage of patients,

the tolerance doesn0t exist, and we can-

not recommend drugs without a well-

known tolerance.

937

Negative predictive value of typing safe

antibiotics in patients with a history of

allergy to amoxicillin

Specjalski, K; Kita-Milczarska, K; Chełmi�nska, M;

Jassem, E

Department of Allergology, Medical University of

Gdansk, Gdansk, Poland

Background: Amoxicillin is a beta-lactam

widely used in the therapy of common bac-

terial infections. History of an adverse

reaction to this antibiotic, irrespective of

mechanism involved, significantly elevates

patients’ anxiety and affects therapeutic

decisions in the future leading to unneces-

sary avoidance. As a consequence it would

be useful to find a safe and reliable proto-

col of typing safe alternative antibiotics.

The aim of the study was to determine

negative predictive value of typing safe

antibiotic in patients with the history of

hypersensitivity reaction to amoxicillin.

Method: Seventy-one patients, aged 20–83,with the history of adverse reaction to amox-

icillin were retrospectively analyzed. On the

basis of a reaction type they were divided

into three groups: A – symptoms not typical

for hypersensitivity reactions, B – allergy

manifested by urticaria and/or angioedema,

C – anaphylaxis. In the group A amoxicillin

was tested (skin tests and oral challenge),

group B – cefuroxime (skin tests, oral chal-

lenge), group C – macrolide: azithromycin or

clarithromycin (oral challenge). Telephone

follow-up visits were performed 6–12 months

after clinical assessment to evaluate tolerance

of antibiotic typed as safe. On the basis of

follow-up results negative predictive value

(NPV) of the protocol was calculated.

Results: The full diagnostic protocol was

applied in 62 participants. Amoxicillin was

found safe in 22, cefuroxime – in 21 and

macrolide – in 19 patients. No anaphylac-

tic reactions were observed during the

tests. On the basis of telephone follow-up

negative predictive value of protocol

applied in the study was 96%.

Conclusion: Stepwise approach including

skin prick tests, intracutaneous tests and

provocations with amoxicillin/cefuroxime/

macrolide depending on patient’s history is

safe and allows typing safe antibiotic in a

vast majority of patients.

938

Hypersensitivity reactions to non

steroidal anti-inflammatory drugs

(NSAIDs) in a Portuguese population

Geraldes, L1; Abreu, C2; Almeida, E3; Faria, E3;

Chambel, M4; Gaspar, A4; Malheiro, D5; Cadinha, S5;

Pinto, PL6; Gomes, E2

1Centro Hospitalar do Alto Ave, Guimar~aes, Portugal;2Centro Hospitalar do Porto, Porto, Portugal; 3Centro

Hospitalar da Universidade de Coimbra, Coimbra,

Portugal; 4Hospital CUF Descobertas, Lisboa, Portugal;5Centro Hospitalar Vila Nova de Gaia/Espinho, Vila

Nova de Gaia, Portugal; 6Hospital Dona Estefania,

Lisboa, Portugal

Background: NSAID are becoming in

many countries the main cause of drug

hypersensitivity. In order to improve care

of these patients the classification, diagnos-

tic approach and management has been

recently reviewed.

The aim of this retrospective multicenter

study was to identify the most frequent

clinical manifestation and drugs involved

in NSAIDs hypersensitivity reactions in a

Portuguese population.

Method: A total of 332 patients with

NSAID HS attending the drug allergy out-

patient clinic of six Portuguese hospitals

were evaluated. Demographic data, past

personal history, drug reactions and diag-

nostic procedures were assessed.

Results: In this study 189 (57%) were

female, the mean age was 36 years-old and

105 (32%) were children; 136 (41%) were

atopic, 90 had asthma, 140 rhinitis and 27

chronic urticaria.

The most common drugs involved in the

reactions were: ibuprofen (36%), aspirin

(17%); paracetamol (7.8%); metamizol

magnesium (5.7%); diclofenac (4.5%) and

nimesulide (4%) and 97 patients presented

symptoms after intake of more than one

NSAID.

Most of the described reactions were

immediate (173–52%). The main symptoms

described at the first reaction were cutane-

ous in 202 patients, respiratory in 20 and

57 had anaphylaxis. 235 patients referred

that they could safely take at least one

alternative NSAID.

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453352

A drug provocation test (DPT) was per-

formed with the culprit drug in 174 patients

(34 positive) and with an alternative drug in

194 (17 positive). Hundred and twenty-four

patients refused or were found to have con-

traindications to perform it. From the stud-

ied population it was possible to exclude

NSAID HS in 145 cases (negative DPT with

culprit drug) and diagnose a DH in 54 (posi-

tive DPT with culprit or alternative drug or

pyrazolon skin test positive). These patients

presented NSAIDs-induced urticaria/ an-

gioedema (24), single NSAID-induced urti-

caria/ angioedema or anaphylaxis (17)

NSAIDs exacerbated respiratory disease

(9), NSAIDs exacerbated cutaneous disease

(3), and NSAIDs-induced delayed hypersen-

sitivity reactions (1). DPT also allowed iden-

tifying alternative NSAID treatments in 184

patients.

Conclusion: We could observe the different

phenotypes previously described. Although

immediate reactions with only cutaneous

manifestation were the most frequent pre-

sentation, in some cases anaphylaxis was

the first manifestation of DH. Drug provo-

cation tests are still an essential tool to

exclude or confirm suspected NSAID HS

and required to find safe alternative drugs.

940

Metronidazole desensitisation

Johnsen, CR1; Skov, PS1,2; Falkencrone, S1; Poulsen, LK1

1Copenhagen University Hospital Gentofte, Hellerup,

Denmark; 2RefLab, Copenhagen, Denmark

Background: Metronidazole (MNZ) is gen-

erally effective and well tolerated in treat-

ment of Trichomonas vaginalis infection.

This case represents a 47 year old woman

allergic to MNZ with persistent severe

symptoms of chronic vaginitis for

7 months due to treatment failure of alter-

native medication. In two occasions, she

had experienced intolerable severe univer-

sal pruritus within an hour after oral

intake of MNZ. Skin prick and intracutan-

eus test were negative but a titrated (using

12 3-fold dilutions D1-D12) Basophil

Histamine Release (BHR) test to MNZ

was positive.

Method: After pre-treatment with fexofen-

adine and prednisolone, desensitisation

with 14 incremental doses of MNZ was

successfully performed without symptoms

or signs of systemic reactions. MNZ was

initially given intravenously with doses

from 5 lg to 125 mg followed by oral

doses from 250 to 2000 mg during a 6 h

period in an intensive care setting. The

infection was successfully eradicated during

the following 6 days treatment with MNZ

500 mg three times daily.

Results: Serial measurements of tryptase

during desensitisation showed no signifi-

cant changes. Measurements of BHR to

metronidazole, Anti-IgE and determina-

tions of total histamine showed decreasing

values concomitant during up dosing with

MNZ (Table).

Conclusion: Desensitisation to MNZ was

successfully performed in a woman allergic

to the culprit drug. The abolished hista-

mine release response to MNZ during up-

dosing either indicates a desensitisation of

patient’s basophils or reduced number of

circulating basophil. The reduced cellular

histamine content during up dosing could

be due to either a sequential histamine

release or trapping of basophils in the

extravascular compartment. The close link

between basophil desensitisation and the

clinical tolerance points to the value of

basophil histamine release test in monitor-

ing drug desensitisation.

941

Safety of sulindac for desmoid tumor in

a patient with NSAID hypersensitivity

Martinez-Tadeo, JA; Perez-Rodriguez, E; Gonzalez-

Colino, C; Rodriguez-Plata, E; Garcia-Robaina, J

Hospital Universitario Ntra. Sra. de Candelaria, Allergy,

SC de Tenerife, Spain

Background: Sulindac is a non steroidal

anti-inflammatory drug (NSAID) agent

related to indometacin with cycloxigenase

(COX) 1 and 2 inhibitory activity. Its anti-

inflammatory activity has been compared

with ibuprofen or aspirin. Because of its

COX 1 inhibition activity it has been con-

traindicated in patients with aspirin

induced asthma or angioedema although

there are no studies about tolerance in this

population.

In the last years a number of in vitro

and in vivo studies have demonstrated that

sulindac has properties to inhibit the grow-

ing of certain tumors as desmoid abdomi-

nal tumors and familial adenomatous

polyposis.

Method: A 26 years old male with diagno-

sis of desmoid tumor was referred from the

surgery inpatient unit to evaluate tolerance

to sulindac. He had been previously stud-

ied in our unit at the age of fifteen refer-

ring at least five episodes of eyelid

swelling, cough, difficult to swallow and

wheezing after the intake of aspirin, ibu-

profen and other NSAID. A single blind

aspirin oral challenge was positive with

eyelid swelling and nasal symptoms 1 h

after 200 mg of cumulative dose. Oral

challenges with COX 2 inhibitors celecoxib

and rofecoxib and paracetamol were nega-

tive. When we re-evaluated the patient at

the age of 26, he had taken paracetamol

and COX 2 inhibitors without incidence.

He presented a last drug reaction 2 years

ago after taking ibuprofen wrongly. After

assesing the risks and potential benefits of

the treatment we decided to perform a

challenge with sulindac, and if positive, try

a desensitisation protocol.

After signed informed consent, doses of

25, 50, 100 and 125 mg of sulindac were

given at 1 h intervals to reach an accumu-

lative dose of 300 mg and he stayed in the

unit for 3 h after de last dose. Peak flow

and vital signs were recorded basally and

before each dose.

Date time

25-9-13

11:00

1-11-13

10:00

6-1-14

09:15

6-1-14

10:25

6-1-14

11:29

6-1-14

13:12

6-1-14

14:18

6-1-14

15:45

7-1-14

10:15

Comment

for MZN

desensitizationPre-test Baseline Desensitization

Next

day

Tryptase lg/l 3.56 <1.0 2.20 <1.0 1.87 1.75 2.03 2.72

Cumulative

histamine

release

(ng/ml) Blood)

19 21 8 4 19

Highest titer

with positive

reaction

D4 D4 D2 Neg D4

Cellular

histamine

content

(ng/ml)

88 73 46 43 93

Anti-IgE:

Cumulative

histamine

release

(ng/ml Blood)

8 6 0 0 11

Tryptase, Histamine Release, anti IgE.

Poster Session Group II – Red. TPS 35 – Drug allergy: desensitise or avoid

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 353

Results: Dose of 300 mg of sulindac was

reached without incidence. The patient

continued taking a dose of 300 mg daily

with good tolerance.

Conclusion: Dose of 300 mg of sulindac

seems to be safe in patients with NSAIDs

hypersensitivity.

942

A practical desensitisation protocol in

immediate hypersensitivity reactions due

to iron

Olgac, M1; Demir, S2; Unal, D2; Demirturk, M2; Gelincik,

A2; Colakoglu, B2; Buyukozturk, S2

1Internal Medicine Division of Allergy, Istanbul

University Faculty of Medicine, Istanbul, Turkey;2Istanbul University Faculty of Medicine, Istanbul,

Turkey

Hypersensitivity reactions to iron are sel-

dom. Here we report two patients who

experienced type 1 hypersensitivity reac-

tions due to oral iron preparations and

were successfully desensitised with oral

route.

Case 1: A 44 year-old patient who suf-

fered from angioedema in her uvula with

ferrous sulphate within 1 h was applied

prick and intradermal tests with ferrous

sulphate and the results were both nega-

tive. She didn’t give consent for oral prov-

ocation tests and due to her severe iron

deficiency anemia, a desensitisation proce-

dure was applied as will be explaned.

Case 2: A 69 year-old patient who experi-

enced angioedema on her face with ferrous

sulphate and ferric hidroxide polymaltose

in 15 min were applied prick tests with

both iron salts and the test results were

positive with both iron salts. The same de-

sensitisation procedure was also applied to

her.

Oral ferrous (II) glysine sulphate was

used for desensitisation procedure. Two

vials are prepared. Vial 1 is 1:10 dilution

of the original suspansion (0.4 mg Fe+2 in

1 ml), vial 2 is 1:10 dilution of vial 1

(0.04 mg Fe+2 in 1 ml).

On day1 cumulative dose of 60.52 mg

given as incremental 13 doses 20 min

apart. First three doses were given from

vial 2, with amounts of 0.1 ml, 0.2 ml,

0.25 ml; iron concentration of 0.04 mg,

0.08 mg, 0.01 mg consecutively. Following

five doses were given from vial 1, with

amounts of 0.25 ml, 0.5 ml, 1 ml, 2 ml,

2.5 ml; iron concentration of 0.1 mg,

0.2 mg, 0.4 mg, 0.8 mg, 1 mg consecu-

tively. The final five doses were given from

original suspansion, with amounts of 1 ml,

2 ml, 2.5 ml, 4 ml, 5 ml; iron concentra-

tion of 4 mg, 8 mg, 10 mg, 16 mg, 20 mg

consecutively.

On day 2 cumulative dose of 120 mg

were given as incremental three doses from

the original suspension. Amount of 5 ml,

10, 15 ml iron concentration of 20 mg,

40 mg, 60 mg were given consecutively

60 min apart.

On day 3 cumulative dose of 120 mg

were given as two equal doses of 15 ml

(60 mg) from the original suspension.

After successful desensitisation both

patients completed the 6 month iron treat-

ment without any reactions.

Conclusion: Although hypersensitvity reac-

tions due to iron are seldom, there is no

alternative treatment. So desensitisation

has to be the choice in these patients. For

tolerance induction this easy desensitisation

protocol seems to be a promising alterna-

tive to the previous long desensitisation

protocols.

943

Desensitisation allows drug-

readministration in patients with

vemurafenib-induced rashes

Klossowski, N; Kislat, A; Homey, B; Gerber, PA;

Meller, S

University Hospital D€usseldorf, Department of

Dermatology, D€usseldorf, Germany

The BRAF inhibitor vemurafenib has

recently been established in the treatment

of metastatic malignant melanoma in

patients with a mutation of the BRAF

gene. Under therapy with vemurafenib sev-

eral side effects were observed, including

skin rashes. We report the case of a patient

with a maculo-papular rash due to vemu-

rafenib application.

A 51-year-old woman was treated with

vemurafenib for metastasized malignant

melanoma. About 7 weeks after therapy

initiation the patient developed a pro-

nounced, pruritic exanthema with erythem-

atous macules and papules. Vemurafenib

was paused for approximately 2 weeks and

a treatment with prednisolone (100 mg/d)

was started.

Subsequently to complete resolution of

the rash after 2 weeks, vemurafenib was re-

initiated at a 50% dose under concomitant

administration of prednisolone (40 mg/

day), loratadine and clemastine. During

the following 3 weeks, prednisolone was

reduced while the dose of vemurafenib

increased. Within 2 weeks the vemurafe-

nib-dosage was escalated up to 100% and

at the persistent absence of further cutane-

ous reactions, prednisolone was fully

deposed. Vemurafenib therapy could be

continued at the full effective dose

(960 mg/day).

Our clinical observation of a successful

readministration shortly after resolution of

the rash suggests that vemurafenib-associ-

ated rashes are a consequence of pharma-

cological effects rather than drug-specific

allergic reactions. This hypothesis is fur-

therly supported by the results of a lym-

phocyte transformation test performed in

our patient, which failed to detect drug-

specific T cells.

Concluding, desensitisation protocols are

effective and enable the continuation of

anti-melanoma treatment in respective

patients. Nevertheless, further studies are

needed to analyse the molecular and celul-

lar mechanism of vemurfenib-associated

cutaneous toxicities.

945

Nonsteroidal anti-inflammatory drug

hypersensitivity management in children

Bakiri, A1; Xhixha, F2; Xhoxhi, G3; Hitaj, M3; Nikolla, J4;

Mingomataj, E5

1Hygeia Hospital, Tirana, Albania; 2Multidisciplinary

Tirana Policlinics No 3, Allergology and Clinical

Immunology, Tirana, Albania; 3Multidisciplinary Tirana

Policlinics No 1, Allergology and Clinical Immunology,

Tirana, Albania; 4Hygeia Hospital, Pneumology, Tirana,

Albania; 5‘Mother Theresa’ School of Medicine,

Allergology and Clinical Immunology, Tirana, Albania

Background: Hypersensitivity reactions to

nonsteroidal anti-inflamatory drugs

(NSAID) are usually seen in adults. But

sometimes they occur even in young chil-

dren. Although NSAID are not widely rec-

ommended in this population, ibuprofen is

used for treatment of pain and fever in

infants and toddlers. And as in all allergic

reaction the best treatment is to avoid the

culprit drug. Although the issue seems to

be easily solved when specific and drug

reaction occurs, several drugs like ibupro-

fen, acetaminophen, etc. induce hypersensi-

tivity reactions in children. In these

children cross-reactivity to acetaminophen

and ibuprofen was estimated to be between

4 and 25%.

Case report: A 6 year old boy was admit-

ted for allergological evaluation of general-

ised hives and itching. The medical history

revealed treatment with ibuprofen for sev-

eral days as antipyretic for viral infection.

Corticosteroids and antihistamines were

administered within the emergency unit

and he was also advised to use acetamino-

phen in the forthcoming episodes of infec-

tion and pain. Two months later the boy

was re-treated in the emergency depart-

ment for labial angioedema and dispnoea

after half an hour of acetaminophen oral

intake. All examinations were within nor-

mal range.

Discussion: As no other medication is

approved for the treatment of acute fever

or pain, and management consists in the

use of COX-2-specific medications, such as

celecoxib, perhaps we should take under

consideration the use of corticosteroids

Poster Session Group II – Red. TPS 35 – Drug allergy: desensitise or avoid

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and other drugs that causes hyperhidrosis

and sweating as an alternative for fever

treatment.

Conclusion: Avoidance of the NSAIDs is

recommended in the patient with hypersen-

sitivity reactions to these drugs. But further

investigations are needed to elucidate the

proper treatment in young children with

multiple NSAIDs hypersensitivity, even

though to acetaminophen.

946

Acetylsalicylic acid tolerance in a patient

with history of NSAIDs induced asthma

Vásquez Bautista, AA; P�erez Pimiento, A; Villal�on

Garc�ıa, AL; Rodr�ıguez Cabreros, M; L�opez San Mart�ın,

M; Rodr�ıguez Mosquera, M

Hospital Puerta de Hierro, Majadahonda, Spain

Background: Medical literature provides

series of patients with NSAIDs intolerance,

asthma due to mite allergy and anaphy-

laxis due to food contaminated with mites.

A single case of IgE-mediated allergy to

shellfish only manifested when ingested

NSAIDs has also been reported.

Aim: To describe a case of acetylsalicylic

acid tolerance in a patient with a history of

asthma and intolerance to NSAIDs.

Case report: A 38-year-old male diagnosed

from adolescence of asthma, rhinoconjunc-

tivitis and mite allergy, food allergy to

shellfish and kiwi fruit, and NSAIDs intol-

erance, referred several episodes of bron-

chospasm and facial angioedema confirmed

by means of two challenge tests with ace-

tylsalicylic acid. Coming from the Basque

Country, Spain, where it is described a

high prevalence of mite allergy, he received

several years of immunotherapy to Derma-

tophagoides without clinical improvement,

but most symptoms disappeared after

changing his residence to the city of

Madrid, Spain.

Material and method: Skin prick tests were

performed to mites, pollens, kiwi fruit,

prawn and shrimp. Laboratory test

included CBC and biochemistry with liver

and renal profile, C3, C4, immunoglobulins

(A, G and M), serum tryptase, serum IgE

and parasites in the stool. Challenge test to

oral acetylsalicylic acid was also carried

out.

Results: Skin prick tests were positive to

Dermatophagoides farinae and D. pter-

onyssinus, Platanus and Olea pollens, kiwi

fruit, prawn and shrimp. CBC, biochemis-

try, complement and immunoglobulins

were in normal range. Parasites in the stool

were negative. Serum tryptase and serum

IgE levels were 15.72 ng/ml and 48.1 U/

ml, respectively. Two controlled challenge

test to oral acetylsalicylic acid up to

800 mg confirmed tolerance of the drug,

without any symptoms of angioedema and/

or asthma, and no changes in spirometry.

Discussion: We describe a case of an asth-

matic patient with mite and shellfish

allergy who developed tolerance to acetyl-

salicylic acid, which previously induced

asthma exacerbations. It is possible that

such tolerance was related to lack of expo-

sure to mites in his current city, but it is

necessary further research for other associ-

ated factors.

947

Severe allergic reaction to topical

antimycotic therapy in an undiagnosed

diabetic patient

Ibranji, A1; Bakiri, A2; Ndreu, A1; Shametaj, AD1;

Xhixha, F3; Hitaj, M4; Mingomataj, E1,5

1’Mother Theresa’ School of Medicine, Tirane, Albania;2Hygeia Hospital Tirana, Tirane, Albania;3Multidisciplinary Tirana Policlinics No 3, Tirane,

Albania; 4Multidisciplinary Tirana Policlinics No 1,

Tirane, Albania; 5Faculty of Technical Medical Sciences,

Tirane, Albania

Background: Cotrimazol is a widely used

topical cream prescribed in fungal cutane-

ous infections. Here we report a clinical

case of severe allergic cutaneous reaction

to this drug in undiagnosed diabetic

patient.

Method: Here we report the clinical case

of a 45 years female subject in the emer-

gency unit with severe bullous erruptions.

The bullous elements filled with clear and

yellow liquid located symetrically on both

legs up to knee level, were very suggestive

for an allergic reaction and a superimposed

bacterial infection. An isolated lesion was

located on her right mid lateral thigh. We

found out from her history that she had a

chronic fungoid infection on both her toes

treated with cotrimazol cream for 10 days

until 1 day before the cutaneous eruptions

onset.

Results: We did not find any further find-

ing on her history for any other causative

agent for this severe bullous cutaneous

eruptions besides the topical anti fungoid

treatment and that the patient was diabetic

and never diagnosed for this disease. The

patient is recovered in the intensive care

unit at the moment, with gangrenous toes

and intensively assisted against the septic

shock.

Conclusion: Drug allergy could appear as

a severe cutaneous reaction in topical

applications and the disruption of the skin

integrity might amplify the risk for bacte-

rial infections.

948

Successful desensitisation protocol for

docetaxel in two breast cancer patients

Ibranji, A1; Bakiri, A2; Xhixha, F3; Mingomataj, E1,4

1Mother Theresa School of Medicine, Tirana, Albania;2Hygeia Hospital, Tirana, Albania; 3Multidisciplinary

Policlinic No 3, Tirana, Albania; 4Faculty of Technical

Medical Sciences, Tirana, Albania

Background: The recent biggest issue on

drug allergy implies cancer treatment and

the scarce or complete lack of alternative

drugs, in case of hypersensitivity to chemo-

therapy drugs. The underlying mechanism

may be related to other biological pro-

cesses such as the release of vasoactive

molecules or non-histamine/tryptase-medi-

ated allergy besides IgE-mediated hyper-

sensitivity. Despite the suspected

mechanisms, different desensitisation pro-

tocols have resulted to be very promising

in terms of desensitisation outcome.

Method: We report two clinical cases of

two women 56 years and 45 years of age,

both diagnosed with breast cancer. They

manifested allergic reactions such as hives,

dispnea, chest tightness, dysphagia and

facial angioedema during their first chemo-

therapy cycle with docetaxel. They both

had positive reaction to skin prick test with

docetaxel (0.4 mg/ml) and they both

underwent the same desensitisation proto-

col of five steps dilutions: 1/10 000, 1/

1000, 1/100, 1/10 and 1/1 with an infusion

interval of 15 min between each step

except the last stage. The individual desen-

sitisation dose calculated according to the

Body Surface Area was 364 mg and

263 mg respectively and the mean dose

applied for both patients was 100 mg/m2.

Both patients’ premedication therapy

implied 50 mg prednisolone i.v. at 13 h,

7 h, and 1 h prior to the procedure plus

180 mg fexofenadine at 7 h in advance.

Results: Both patients tolerated without

incidents the full entire desensitisation pro-

cedure and continued their ten stages con-

tinuous cycles of 1-h infusion over 3 weeks

without hypersensitivity symptoms onset.

Conclusion: Desensitisation to chemother-

apy agents could be very useful in cancer

treatment, considering that unlike other

diseases, the alternative drug is a luxury or

sometimes impossible.

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© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 355

949

Aspirin desensitisation as a treatment for

aspirin-sensitive chronic spontaneous

urticaria

Lee, J1; Lee, YW2

1Jeju National University School of Medicine, Internal

Medicine, Jeju, Korea; 2Kwandong University College

of Medicine, Internal Medicine, Jeju, Korea

Background: Nonsedating antihistamines

are the treatment of choice for chronic

spontaneous urticaria (CSU). However, in

some cases the symptoms are refractory

even to high dose antihistamines. Aspirin-

sensitive CSU is often recalcitrant to treat-

ment, even when exposure to aspirin is

completely avoided. Aspirin desensitisation

has been shown to be safe and clinically

effective in aspirin exacerbated respiratory

diseases, yet its use is debated for aspirin-

sensitive CSU.

Case report: We report the case of a 16-

year-old high school girl who suffered from

CSU that was successfully treated by aspi-

rin desensitisation. She had suffered from

itchy hives for 4 years, which had recently

become aggravated and refractory to high

dose antihistamines. Aspirin hypersensitiv-

ity was confirmed by provocation. Aspirin

desensitisation was performed for this aspi-

rin-sensitive CSU, which was effectively

controlled. A complete remission was

observed after 5 months of low dose aspi-

rin maintenance.

Conclusions: Compared with other treat-

ment options in antihistamine-resistant

CSU, successful aspirin desensitisation and

maintenance may be a cheaper, safer and

more effective treatment.

950

A case of heparin allergy with good

tolerability of fondaparinux during

pregnancy

Pascolini, L; Buonomo, A; Colagiovanni, A; Pecora, V;

Rizzi, A; Aruanno, A; Ricci, AG; Di Rienzo, A; Centrone,

M; Sikora, A; Nucera, E; Schiavino, D

Allergy Department, Universit�a Cattolica del Sacro

Cuore, Rome, Italy

Background: Fondaparinux sodium is a

synthetic pentasaccharide which strongly

binds to antithrombin and enhancesthe

inactivation of factor Xa without interac-

tion with factor II or platelets. Several

studies have shown the lack of cross-reac-

tivity of fondaparinux with unfractioned

heparins and low molecularweight hepa-

rins. For this reason fondaparinux is the

drug of choice in patients with heparin

allergy. We report the case of a 40 year-

old woman suffering from essential

thrombocytemia who had a clinical history

of intrauterine fetal death and recurrent

pulmonary embolism and developed urti-

caria and dysphagia during treatment with

calcium nadroparin.

Method: The patient underwent skin prick

test and intradermal test with sodium hep-

arin, calcium heparin, sodium enoxaparin,

calcium nadroparin, sodium reviparin,

sodium dalteparin and sodium fondapari-

nux. Since the patient needed anticoagulant

treatment because she planned a preg-

nancy, we decided to perform a challenge

test with an alternative compound on the

basis of allergy testing results.

Results: Skin test with both unfractioned

and low molecular weight heparins

showed a positive response while skin

tests with fondaparinux were negative.

These results were consistent an IgE-medi-

ated allergy to heparins and confirmed the

lack of cross-reactivity of fondaparinux

with other heparins. Then the patient well

tolerated tolerated a therapeutic dose of

2.5 mg of fondaparinux. When the patient

became pregnant treatment with sodium

fondaparinux was promptly started. No

adverse reactions were observed. At the

36th week, the patient underwent caesar-

ean delivery and a healthy female baby

was born.

Conclusion: Fondaparinux has shown to

be safe and effective in pregnant patients

but larger studies are needed to assess tol-

erability. We recommend to perform

allergy testing in case of type I or type IV

hypersensitivity reactions to exclude cross-

reactivity before any treatment with fonda-

parinux to avoid unexpected reactions.

951

Drug fever: a rare hypersensitivity

reaction due to isoniazid and rifampicin

K€oyc€u, G; Keren, M; €Oner Erkekol, F

Ataturk Chest Diseases and Thoracic Surgery, Training

and Research Hospital, Immunology and Allergy,

Ankara, Turkey

Although drug fever with isoniazid and rif-

ampicin has been reported, it is rare. Two

cases of drug fever with isoniazid and rif-

ampicin will be presented. Case 1: Twenty

9 years old male was consulted to our

clinic with fever, arthralgia, fatigue, anor-

exia, nausea and vomiting after consump-

tion of isoniazid, rifampicin, pyrazinamide,

ethambutol HRZE. Medication had been

started 1 months ago with suspicion of sili-

cotuberculosis. Since in the 15th day of the

treatment, symptoms mentioned above had

been occurred, the drugs had been given

one by one. However 7–8 h after rifampi-

cin and 2 h after isoniazid similar symp-

toms had been occurred. We decided to

give the drugs with a graded challenge pro-

tochol. Five hour after 75 mg isoniazid we

observed similar reactions. The reaction

was treated with paracetamol, metilpredn-

isolone and pheniramine successfully. The

patient0s primary physicians decided to

continue treatment after the confirmation

the diagnosis. After mediastinoscopy pro-

cedure he was diagnosed as silicosis and a

drug-free follow up was decided. Case 2:

Forty four years old male with relapsed

tuberculosis was consulted to our clinic

due to high fever, nausea and vomiting 1 h

after drug intake. The symptoms had been

started on the 2nd day of the HRZE-S

(streptomycin) therapy. We decided to give

the drugs with a graded challenge proto-

chol. All of the drugs except ripampicin

were successfully given with the ptotocol.

During the gradually increasing dose pro-

tocol, 1 h after the full dose rifampicin

short lasted tremor and 3 h later fever

occured. The reaction was treated with

paracetamol, metilprednisolone and phenir-

amine successfully.

952

Toxic epidermal necrolysis caused by

lamotrigine

Zande, M1; Sinaniotis, A1; Psarros, F2; Syrigou, E1

1Sotiria General Hospital, Allergy, Athens, Greece;2Athens Naval Hospital, Allergy, Athens, Greece

Background: Toxic epidermal necrolysis

(TEN) is a rare but severe disease affecting

mainly the skin and mucous membranes.

Drugs are the responsible factor in the

majority of cases (75%) whereas there are

some cases where either an infection is the

cause or it may remain unknown. We

report a case of TEN after the intake of

lamotrigine with a fortunate outcome for

the patient

Method: A 39-year- old female patient

came to the emergency department of our

hospital due to a persistent maculopapular

rash in addition to epigastric pain, nausea,

weakness and headache. The patient was

suffering from epilepsy (focal apheresis)

since the age of 12 for which she was trea-

ted with valproic acid. Four days before

the appearance of the rash, lamotrigine

50 mg s: 1 9 2 was added to her treat-

ment.

Results: Lamotrigine was stopped the sec-

ond day after rash eruption. Nevertheless

our examination revealed face erythema,

maculopapular rash of the trunk and

extremities posterior jugular lymphadenitis

without any involvement of the mucous

membranes. She was admitted for monitor-

ing and treatment with methylprednisolone

16 mg s: 2 9 3 and cetirizine 10 mg s:

1 9 1 p.os. Two days after admission the

rash became diffuse and coalescent with

blisters, the bucal mucosal was red with

Poster Session Group II – Red. TPS 35 – Drug allergy: desensitise or avoid

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453356

ulcers and she complained for a burning

sensation in her eyes whereas the examina-

tion revealed conjuctivitis. The above sett-

ed the suspicion of Stevens- Johnson

syndrome. Her treatment with methyl-

prednizolone was modified s: 80 mg 9 4

and IVIG s: 30 g/24 h 9 4 days was

added. Valproic acid was replaced with lev-

etiracatame 750 mg 9 2 iv. Unfortunately

despite early recognition and treatment,

she deteriorated and was transferred to a

burn unit where she stayed almost 3 weeks

and fortunately was dismissed with the

diagnosis of TEN due to lamotrigine.

Conclusion: TEN is a syndrome with high

mortality rate (25–35%) but also long term

sequelae for the survivors underlying the

importance of early diagnosis, treatment

and prompt follow-up.

Poster Session Group II – Red. TPS 35 – Drug allergy: desensitise or avoid

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 357

Poster Session Group II – Red

TPS 36 – Drug anaphylaxis

953

Drug-induced anaphylaxis: a 5 years

review in an outpatient allergy clinic

Bommarito, L; Mietta, S; Marengo, F; Cadario, G

A.O. Citt�a della Salute e della Scienza di Torino –

Presidio Molinette, S.C. Allergy and Clinical

Immunology, Turin, Italy

Background: Anaphylaxis is a potentially

fatal systemic allergic reaction. Our objec-

tive was to characterise a case series of

anaphylactic reactions due to drugs noti-

fied to Regional Observatory for severe

allergic reactions of Piedmont Region dur-

ing the past 5 years.

Method: Cases of drug-induced anaphy-

laxis, notified by Allergy Outpatient Clinic

of Citt�a della Salute e della Scienza (Moli-

nette Hospital, Turin, Italy), between 1

January 2009 and 31 December 2013 were

reviewed. Demographical and clinical char-

acteristics, causative drugs and approach

leading to diagnosis were analyzed.

Results: Eighty-four patients (55 women,

29 men) with at least one documented epi-

sode of drug-anaphylaxis were included,

with a total number of 93 episodes

described (seven patients reported two epi-

sodes and one patient three episodes).

Mean age at the time episode was

40.4 years (SD � 17.62 years); 54.9% of

patients were atopics, 9% reporting also

food allergy. Basal triptase levels (obtained

in 41/84 patients) were higher than

11.4 lg/l in two patients. Causative drugs

were antibiotics (64 betalactams and nine

quinolones) in 79% of cases, nonsteroidal

anti-inflammatory drugs in 17%, and other

drugs (local anesthetic, radiocontrast

media, vaccines) in 4% of cases. Amoxicil-

lin-clavulanate was the most involved drug

(33/93 of total episodes, 33/64 considering

only betalactam antibiotics). Diagnosis was

obtained in 18% of cases using serological

tests only, in 51% performing also cutane-

ous tests, in 5% of cases also by an oral

challenge.

Conclusion: In our experience betalactam

antibiotics, in particular amino-penicillins,

are the most involved causative drug in

anaphylaxis. The female gender was most

represented and almost all episodes (83%)

occurred between 14 and 65 years. Allergo-

logical work-up was helpful in final diag-

nosis in the majority of cases, probably

due to the type of drugs involved.

954

Drugs induced anaphylaxis: assessment

using WAO criteria

Blažienė, A; Buterlevi�ci�ut _e, N; Paltarackien _e, V; Linausk-

ien _e, K

Center of Pulmonology and Allergology, Vilnius

University, Vilnius, Lithuania

Background: Anaphylaxis is the most

severe IgE-mediated hypersensitivity reac-

tion. We analysed the incidence of anaphy-

laxis induced by drugs.

Method: Seventy patients with anaphylaxis

hospitalised from 2009 to 2012 in Vilnius

University Hospital were analysed: 38

women (54.3%) and 32 men (45.7%),

47.31 � 17.63 (range 20–83) years old. A

total of 26 patients with drugs induced

anaphylaxis were included in the study. We

analysed the causes, symptoms and diagno-

sis of anaphylaxis using WAO criteria.

Results: The main cause of drugs induced

anaphylaxis were NSAIDS (14.3%), antibi-

otics (11.4%), local anesthetics (1.4%) and

other drugs (10.0). Three cases fulfilled the

first WAO criteria for anaphylaxis diagno-

sis; 21 met the second criteria; and 1

met the third criteria. The majority of

patients (86.4%) have had cardiovascular

symptoms, 80.8% – skin symptoms, 50.0%

– respiratory symptoms and 23.1% – gas-

trointestinal symptoms. Epinephrine as an

initial treatment was administered only for

57.7% of patients. Nine patients (34.6%)

were treated in the intensive care unit.

Conclusion: The main reason of drugs

induced anaphylaxis was NSAIDS. The

cardiovascular system was the most fre-

quently affected, followed by the skin and

respiratory systems. The one third of

patients required admission to the intensive

care unit.

955

Anaphylactic drug reactions in childhood

Cavkaytar, O; Buyuktiryaki, B; Arik Yilmaz, E; Tuncer, A;

Sackesen, C; Sekerel, BE; Uysal Soyer, O

Department of Pediatric Allergy, Hacettepe University

Medical Faculty, Ankara, Turkey

Background: Objective of this study is to

gain insight into the epidemiologic charac-

teristics on drug related anaphylactic reac-

tions in childhood.

Method: The patients who had a history

of anaphylactic drug reaction were

inquired by ENDA questionnaire. Diag-

nostic epidermal and intradermal tests and/

or provocation tests were performed. Diag-

nostic tests were not performed if the

patient had the anaphylactic drug reaction

in our hospital and grouped as ‘physician

diagnosed anaphylaxis’ (PDA).

Results: Two hundred and thirty-two

patients and 345 reactions were assessed.

Forty-four patients (19%) with 49 anaphy-

lactic drug reactions (14%) were included

in the study. Twenty-six patients (60%) [28

reactions (57%)] were diagnosed as true

drug allergy [PDA (n = 14), skin tests

(n = 8), provocation tests (n = 4)]. The

drugs responsible for true drug allergy

were antibiotics (n = 10), chemotherapeu-

tics (n = 10), NSAIDs (n = 4), monoclonal

antibodies (n = 3), factor 9 (n = 1).

Chronic drug intake (50% vs. 11.1%,

P = 0.007) and concurrent allergic disease

(44% vs. 11.1%, P = 0.021) were more

common in true drug allergic patients com-

pared to nonallergic ones whereas age, gen-

der, total IgE and eosinophil levels were

similar. Gastrointestinal system involve-

ment during the reaction (46% vs. 19%,

P = 0.046) and anaphylaxis due to chemo-

therapeutics (35.7% vs. –, P = 0.002) were

more frequent in true allergic drug reac-

tions whereas existence of infection during

the reaction (36% vs. 67%, P = 0.032) and

anaphylaxis due to antibiotics (32% vs.

62%, P = 0.013) were less frequent. Con-

current allergic disease [(OR: 16.1, 95%

CI = 2.5–105.5, P = 0.004) and chronic

drug intake [(OR: 17.9, 95%CI = 2.8–115.9, P = 0.002)] increased the risk

whereas a history of antibiotic related ana-

phylaxis decreased the risk for the diagno-

sis of a true drug allergy [(OR:5, 95%

CI = 1.25–16.7, P = 0.016)].

Conclusion: ‘True drug allergy’ was diag-

nosed in 50% of the children with a his-

tory of an anaphylactic drug reaction.

Demographic characteristics of the patients

can warn the clinician in advance for true

drug allergy.

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453358

956

Anaphylaxis to immunoglobulins:

importance of anti-IgA-antibodies

Wagner, N1; Podda, M1; Staubach, P2

1Dermatology, Clinical Centre of Darmstadt GmbH,

Darmstadt, Germany; 2Dermatology, University Medical

Centre Mainz, Mainz, Germany

A 42 year-old patient, presenting in 2012,

planned a short-term trip to the Maledives

in 1992. Immunoglobulins, consisting of

160 mg/ml (95%) IgG and a maximum of

1.7 mg/ml IgA, were injected i.m. as protec-

tive immunisation, especially for hepatitis

A. 10 min. later she experienced nausea,

urine and stool loss, collapse and cardiac

arrest. She was resuscitated. Now, 20 years

later, anti-IgA antibodies could be detected,

explaining anaphylaxis. These auto-antibod-

ies occur in up to 40% in patients with IgA-

defiency and in 10–25% in common variable

immune deficiency (CVID)-patients, and are

known to induce anaphylactoid transfusion

reactions, but not in every patient. Incidence

of anaphylaxis in patients with IgA- defi-

ciency is about 1:100. In healthy subjects, as

our patient, prevalence of IgA-autoantibod-

ies is up to 5.6%. The initiating mechanism

is not fully understood, different possible

triggers are discussed. Anaphylactic reaction

seems to depend on serum concentration of

IgA-antibodies, specifity of the antibodies

and IgA content of the injected or infused

preparation.

Conclusion: Especially in patients receiving

immunoglobulins, either for immune defi-

ciencies, autoimmune diseases or inflamma-

tory diseases as Kawasaki′s syndrome, the

possibility of anaphylaxis to IgA should be

considered.

957

Macrogols as a cause of perioperative

anaphylaxis

Wenande, E; Mosbech, H; Krøigaard, M; Garvey, LH

Danish Anaesthesia Allergy Centre, Copenhagen

University Hospital Gentofte, Allergy Clinic, Hellerup,

Denmark

Introduction: Macrogols or polyethylene

glycols (PEGs) are polymers of varying

molecular weight, used widely for their

properties as solvents, dispersing agents,

vehicles and active ingredients. In the peri-

operative setting, they figure in eg. lubri-

cating gels, anaesthetic sprays, hydrogels

and haemostatic agents rarely suspected of

causing anaphylaxis and thus their use is

often undocumented.

We describe the case of a 69-year old

male with anaphylaxis (BP 60/40, urticaria)

during emergency craniotomy for subdural

hematoma and subsequent reactions on

exposure to disparate drugs at home.

Method: The patient underwent standar-

dised investigations with skin prick tests

(SPT), intradermal tests (IDT), specific

IgE, histamine release (HR) and provoca-

tion with drugs and substances adminis-

tered before the anaphylaxis. In DAAC, all

patients are tested for latex, chlorhexidine,

ethylene oxide, methylcellulose and macro-

gols, as exposure is almost certain in the

perioperative setting. Macrogols are tested

with SPT and HR only, as IDT and provo-

cation has been linked to systemic reac-

tions.

Results: Simultaneous SPT with macrogol

3000 and 6000 induced clearly positive

reactions (wheal 7–11 mm). Approximately

40 min later, the patient developed

systemic urticaria requiring antihistamine

treatment. Three weeks later, repeated SPT

with 20 min intervals again showed posi-

tive results for macrogol 3000 and 6000.

SPT for macrogol 300, HR tests for mac-

rogols and tests for other drugs and sub-

stances were negative.

Conclusions: Macrogols of high molecular

weight were concluded to have caused the

patient’s reactions. Upon avoidance, he

has had no further episodes. Importantly,

we report a systemic reaction after SPT,

possibly due to duplicate testing with sev-

eral macrogols simultaneously. Macrogols

are prevalent in the perioperative setting

but their allergenic potential is often over-

looked. We therefore suggest testing for

macrogols following perioperative anaphy-

laxis.

958

Anaphylaxis due to oxytocin

Mahecha-Garc�ıa, AC1; Garc�ıa-Menaya, JM1; Bobadilla-

Gonz�alez, P1; Corrales-Vargas, SI1; Chiarella-Privette,

GM1; Cordob�es-Duran, C2

1Allergy, Hospital Infanta Cristina, Badajoz, Spain;2Allergy, Hospital General de Merida, Merida, Spain

Background: Oxytocin is considered an

uncommon cause of severe allergic reaction

during induction, augmentation of labor

and delivery as well abortions. A few docu-

mented reports on anaphylactic reactions

as well as severe airway obstruction have

been reported.

Patient and methods: A 34-year-old female

patient without history of atopy or drug

allergy, suffered a cesarean after an unsuc-

cessful labor induction. Just before and

during the cesarean, she was treated with

lidocaine, bupivacaine, midazolam, ondan-

setron, ranitidine, amoxicillin-clavulanic

and intravenous infusion of oxytocin. In

the postsurgical room, she also received

dexketoprofen and again ondansetron and

oxytocin. One hour later after coming into

the postsurgical room she showed pruritic

hives of widespread distribution, eyelid and

lips angioedema, widespread warm sensa-

tion, mild dyspnea, tachycardia and hipo-

tension. Antihistamines and corticosteroids

were administered, oxytocin was immedi-

ately withdrawn and the reaction resolved

within 2 h. The anaesthesiologist attributed

the reaction to oxytocin. After obtaining

the patient‘s informed consent, we deter-

mined specific IgE to amoxicilin, ampicilin,

G and V penicillin, latex, suxamethonium,

formaldehyde and ethylene oxide and rea-

lised prick to latex and skin and challenge

test with the involved drugs.

Results: Specific IgE to amoxicilin, ampici-

lin, G and V penicilin, suxamethonium,

ethylene oxide, formaldehyde and latex

and prick test to latex were all negatives. A

positive intradermal diluted test (1:100)

was obtained with oxytocin. Negative

results were recorded for skin and chal-

lenge test with the rest of the implicated

drugs in this reaction.

Conclusions: We report a rare case of an

IgE-mediated anaphylactic reaction caused

by the use of oxytocin diagnosed by a posi-

tive intradermal test to oxytocin. We have

demonstrated tolerance to the rest of the

used drugs. We have not realised challenge

test with oxytocin due to ethical reasons.

960

A case of anaphylaxis caused by

Ambroxol

Lee, Y-S; Ban, G-Y; Kim, M-A; Yoo, H-S; Shin, Y-S; Ye,

Y-M; Nahm, D-H; Park, H-S

Allergy and Clinical Immunology, Ajou University

School of Medicine, Suwon, Korea

Background: Ambroxol is a widely pre-

scribed mucolytic agent in the treatment of

bronchopulmonary diseases. There have

been some reports of adverse drug reac-

tions to Ambroxol with involvements of

gastrointestinal tract, skin, and subcutane-

ous tissue. However, a certain case of ana-

phylaxis to Ambroxol has not been

reported worldwide. We experienced a case

of anaphylaxis to Ambroxol and here we

report the case with immunologic evalua-

tion.

Method and Results: A 39-year-old male

with allergic rhinitis visited the emergency

room because of repeated urticaria, angioe-

dema, dyspnea and gastric soreness after

ingestion of Ambroxol. We diagnosed him

as anaphylaxis to Ambroxol because he

showed acute cutaneous and mucosal

involvements, respiratory compromises,

and persistent gastrointestinal symptoms

after repeated ingestion of Ambroxol. Skin

prick test to common allergens showed

positive result for house dust mites. Skin

prick test with Ambroxol extracts showed

Poster Session Group II – Red. TPS 36 – Drug anaphylaxis

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 359

a negative result while intradermal test

showed a positive result. We performed

enzyme-linked immunosorbent assay using

Ambroxol-human serum albumin conju-

gate to detect serum specific IgE and spe-

cific IgG4 to Ambroxol extracts, but found

negative results.

Conclusion: In conclusion, we report a

case of anaphylaxis induced by Ambroxol

in which non-IgE-mediated mechanism was

suggested.

962

Are protom pumb inhibitors as safe as

we think?

Mur Gimeno, P1; Mart�ın Iglesias, A1; Parias Angel, N2;

Crespin Crespin, M3; Ceres Alabau, F4; Lombardero

Vega, M5; Sancho Calatrava, E6; Roa Llamazares, C7

1Hospital Santa B�arbara, Allergy Unit, Puertollano,

Spain; 2Hospital Santa B�arbara, Intensive Care Service,

Puertollano, Spain; 3Hospital Santa B�arbara, Cardiology

Unit, Puertollano, Spain; 4Hospital Santa B�arbara,

Internal Medicine Service, Puertollano, Spain; 5ALK-

Abell�o, I+D Department, Madrid, Spain; 6Surgery

Department, Hospital Santa B�arbara, Puertollano,

Spain; 7Endocrinology Unit, Hospital Santa B�arbara,

Puertollano, Spain

Background: Kounis syndrome refers to

the clinical spectrum of angina pectoris to

acute myocardial infarction after an aller-

gic reaction to food, drugs, insect stings

and so on. We describe a clinical case and

study alternative treatments.

Method: We report a 43 year-old man

with suspicion of intolerance to INSAIDS.

He attended to hospital Emergency by a

muscle contracture that was treated with

ketorolac + omeprazole + paracetamol +sulpiride + metoclopramide i.v. Minutes

later, he suffered an anaphylactic shock.

The electrocardiogram detected ischemia

in the underside with mirror changes in

the back side. He was treated with adren-

alin, corticosteroids and antihistamines

i.v. and he improved clinically with rever-

sion of the electric changes. Twenty

hours later, in the Intensive Care Unit,

they administered omeprazole i.v. and

immediately appeared the same clinical

symptoms with electrocardiograph altera-

tions that were reversed without using

adrenalin. Severe hypokaliemia (2.7 mM)

was discovered.

Results: Cardiac catheterization: absence

of atheromatous obstructive lesions.

Abdominal angio-CT scanning: left adrenal

incidentaloma of 2 cm. Serum tryptase:

164 mcg/l (during the shock) and 7.3 mcg/l

(basal). Prick test with common inhalants:

positive for olive and grass pollens. Oral

challenge with ketorolac, paracetamol,

metoclopramide and sulpirid: negatives.

Cutaneous test (prick and IDR) with

omeprazole, lansoprazole, pantoprazole,

rabeprazole and esomeprazole: negatives.

Oral challenges with lansoprazole, pantop-

razole, rabeprazole: negatives. Serum renin:

<0.2 ng/ml/h. Serum basal aldosterona:

402 pg/ml. Suppression of mineralocorti-

coid test: aldosterona 347 pg/ml.

Conclusion: We describe an anaphylactic

shock with coronary artery spasm (Kounis

Syndrome type I) caused by omeprazole,

without cross-reactivity to other protom

pumb inhibitors. This patient has a pro-

ductive aldosterone adenoma (Conn syn-

drome), not previously described

associated to Kounis syndrome.

964

Angioedema induced by ACE- inhibitors

Bregu, B1; Duda, H2; Mesonjesi, E2; Sinani, G2; Priftanji,

A2

1Department of Allergy and Clinical Immunology,

University Hospital Center ‘Mother Theresa’, Tirana,

Albania; 2University Hospital Center ‘Mother Theresa’,

Tirana, Albania

Background: Angioedema is an uncommon

side effect of using angiotensin-converting

enzyme (ACE) inhibitors. It is not an aller-

gic reaction, but probably related to the

increased levels of bradykinins which are

metabolized by ACE with a prevalence

estimated to be 0.1–0.2% reaching 0.68%

in some studies.

Case: A 67 years old man presented in the

emergency department at 12 p.m with

swollen lips, markedly swollen tongue pro-

truding from the mouth and difficulty

breathing. At the admission he was admin-

istered high doses of cortisone but the

edema proceeded associated with severe

dyspnoea. It was tried the intubation was

impossible to perform due to larynx

edema. Also tracheotomia was not useful.

Although paraenteral cortisone at very

high doses (500 mg methylpredsisolone)

was continued the edema was resistant. He

was transferred at the intensive care and

was maintained under O2 therapy until 3

p.m when the angioedema alleviated. He

had experienced some less severe episode

of tongue swelling 3 years ago, at the time

he started treatment with enalapril, which

resolved spontaneously. Also he reported

experiencing dry cough during these

3 years. That night before the actual epi-

sode he had taken 20 mg of enalapril and

10 mg atorvastatine. Routine examination

was normal.

Discussion: The most common side effect

of ACEI use is dry cough and angioedema

less frequent. First it was thought that

most cases of angioedema occur within the

first week of treatment with ACE inhibi-

tors, but recent reports indicate that late-

onset angioedema may be more common.

This cases often go underdiagnosed

because of the long time between the regu-

lar use of ACE inhibitors and the onset of

angioedema.

Conlusion: With this case we want to ou-

line that in any case presenting with face

or upper airways edema, a preceding epi-

sode which are not associated by urticaria,

in a patient taking ACEI even if the drug

is taken for a long time before, we should

consider ACEI associated angioedema. The

mainstay of therapy is discontinuation of

the culprit medication. Severe cases are

treated with epinephrine, antihistamines,

and steroids. The benefits of icatibant

administration (bradykinin receptor

blocker) during acute episodes needs to be

evaluated better.

965

Anaphylactic shock by topical antiseptics

Chiarella, GM1; P�erez-Calder�on, R1; Gonzalo-Garijo,

M�A1; C�amara, C2; Jim�enez-Ferrera, G1; Corrales-Vargas,

SI1; Mahecha, AC1

1Allergology, Infanta Cristina University Hospital,

Badajoz, Spain; 2Immunology, San Pedro Alc�antara

Hospital, C�aceres, Spain

Introduction: Polyhexanide is a chlorhexi-

dine polymer used as topical antiseptic.

Both drugs belong to biguanides (as met-

formin and proguanil). Anaphylactic reac-

tions to chlorhexidine are rare but are

being reported increasingly in association

with a variety of products. Polyhexanide

has occasionally been associated with

severe allergic reactions after topical appli-

cation.

Case report: A 77 year-old woman had a

sudden episode of malaise, generalised skin

itching, rash, dyspnea, peripheral cyanosis

and cardio-respiratory arrest after wound

care of an ulcer in the foot with Pronto-

san� (undecylenamidopropyl betaine, poly-

hexanide, glycerol, purified water, and

hydroxyethylcellulose), Askina� (modified

starch polymer, glycerol and water) and

Iruxol Mono� (clostridiopeptidases). She

needed cardiopulmonary resuscitation and

admission to ICU. Two-three days later

she again presented a similar episode with

the same follow-up, while the foot ulcer

was being treated with Prontosan� and

Iruxol Mono�. The patient had no known

history of allergy. She takes treatment

for underlying diseases (heart disease,

lower limb ischemia, hypothyroidism, and

diabetes) with good tolerance.

Methods and Results: Specific IgE to

chlorhexidine was negative and basal tryp-

tase was normal. Basophil activation test

proved positive with Prontosan�, negative

with amidopropylbetaine, hydroxyethylcel-

lulose, metformin and Askina�, and doubt-

ful with glycerol and Hibiscrub�

(chlorhexidine digluconate, PEG-7 glyceryl

cocoate, glycerol, poloxamer 237, lauryl

Poster Session Group II – Red. TPS 36 – Drug anaphylaxis

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453360

dimethylamine oxide, ponceau 4R, isopro-

pyl alcohol, herbacol, d-gluconalactone

and water). Skin prick tests were positive

with Hibiscrub� diluted 1/100 and Pronto-

san� 1/10000. Pricks with pure solutions of

both products were negative in five con-

trols. The use tests conducted in healthy

skin and ulcer with glycerol, Iruxol Mono�

and Askina� were negative in both the

open test and after 12-h occlusion.

Conclusions: We report a case of anaphy-

lactic shock due to hypersensitivity to poly-

hexanide (topical biguanide antiseptic) with

basophil activation test and skin tests posi-

tive. Our results of the in vivo and in vitro

tests suggest that there could be cross-reac-

tivity with chlorhexidine. Our patient toler-

ates oral biguanide drugs.

966

Anaphylaxis due to angiotensin receptor

blockers

Viegas, L1; Ferreira, MB1,2; Barbosa, MP1,2

1Hospital Santa Maria – CHLN, Immunoallergology

Department, Lisbon, Portugal; 2Faculdade de Medicina

da Universidade de Lisboa, Lisbon, Portugal

Background: Angiotensin receptor blockers

(ARB) are commonly used in high blood

pressure (HBP) treatment, as well as heart

and renal failure. Anaphylaxis due to ARB

is rare with only three cases reported. The

authors report a case of anaphylaxis

induced by two different ARB.

Case report: Fifty-four year old male with

history of HBP and moderate persistent

allergic rhinitis. He had no previous his-

tory of drug or food allergy. At the age of

51, losartan was introduced due to uncon-

trolled blood pressure (BP). One hour after

the first administration he started general-

ised shivering which resolved spontane-

ously. He denied other symptoms. The

drug was witdraw until 1 year later when

losartan was prescribed for the same rea-

son. One hour after the second administra-

tion he developed sudden dyspnoea and

lypothymy. In the Emmergency Depart-

ment (ED) hypoxemia and serious hypo-

tension were observed, prompting

admission to an Intensive Care Unit for

monitoring and amminergic support, with

no need for ventilation. He was discharged

48 h later on nifedipine 30 mg id. He

denied taking any other drugs or relation

with food or alcohol intake, or physical

exercise.

Three years later, he was prescribed can-

desartan/hidrochlorothiazide due to ensu-

ing HBP. Fifteen minutes after the first

administration he started vomiting and

diarrhea, oropharyngeal grasp, dysphonia

and dyspnoea. In the ED hypotension,

hypoxemia, global decrease of breath

sounds and pharyngo-laryngeal oedema

were observed. Anaphylactic shock was

diagnosed and IM adrenaline, EV corticos-

teroids and antihistamines were adminis-

tered with progressive improvement. He

was admitted to our Department and dis-

charged 24 h later, assymptomatic. His BP

is currently controlled with nifedipine

30 mg bid.

Conclusion: We present this case report

not only due to the rarity of ARB’s ana-

phylaxis, but also because of the immediate

reaction to two different ARB, which

prompts caution in the reintroduction of

any other drug of this class.

967

Macrogol hypersensitivity reactions

during cleansing preparation for colon

endoscopy

Pizzimenti, S1; Heffler, E1,2; Bussolino, C1; Gentilcore,

E3; Raie, A1; Fornero, M1; Nebiolo, F1; Rolla, G1

1Medical Sciences – Allergy and Clinical Immunology,

University of Torino – AO Ordine Mauriziano, Torino,

Italy; 2ASL-TO3 – ‘Edoardo Agnelli’ Hospital, Allergy

Outpatients’ Clinic, Torino, Italy; 3‘Edoardo Agnelli’

Hospital, Gastroenterology Unit – Internal Medicine,

Pinerolo, Italy

Background: Macrogols are polymers of

ethylene glycol widely used as laxatives or

excipients in pharmaceutical products. In

colon endoscopy macrogols are used as

osmotic laxatives, to minimise faecal con-

tamination.

Method: The case herein reported is about

a patient who experienced two consecutive

episodes of systemic hypersensitivity reac-

tions after intake of bowel preparation

containing macrogol.

Results: Skin prick tests confirmed macro-

gol allergy. The patient also referred about

a previous systemic reaction after intake of

nimesulide soft pill containing cetomacro-

gol.). In vivo oral tolerance test with ni-

mesulide formulation not containing

macrogol was well tolerated by the patient.

Conclusion: This is a case of anaphylaxis

due to allergy to macrogol taken for

cleansing colon endoscopy preparation. We

suggest that it would be desirable a closer

collaboration between gastrointestinal en-

doscopists and allergists to improve the

safety of endoscopic diagnostic procedure.

968

Drug-induced anaphilaxis in Latin

America

Jares, E1; S�anchez-Borges, M2; G�omez, M3; Ensina, LF4;

Serrano, C5; Arias-Cruz, A6; Baena-Cagnani, CE7; Mon-

sell, SJ1; Sole, D4; Gonzalez Diaz, S6; Macias Wein-

mann, A6; Cuello, MN8; Morfin-Maciel, B9; Diez-

Zuloaga, S10; Ram�ırez-Giraldo, RH10; Mimessi, G3; De

Falco, A11; Barayazarra, S12; Cherrez, I13; Toche Pinaud,

P14; Vinuessa, M15; Zanacchi, A12; Cardona Villa, R10

1LIBRA Fundation, Buenos Aires, Argentina; 2Centro

Medico-Docente La Trinidad, Caracas, Bolivarian

Republic of Venezuela; 3Hospital San Bernardo, Salta,

Argentina; 4Federal University of S~ao Paulo, S~ao Paulo,

Brazil; 5Fundaci�on Valle del Lili, Cali, Colombia;6Hospital ‘Dr. Jose Eleuterio Gonzalez’ Universidad

Aut�onoma de Nuevo Le�on, Monterrey, Mexico;7Catholic University of Cordoba, Cordoba, Argentina;8Consultorios San Juan, San Juan, Argentina; 9Hospital

San Angel, Mexico, Mexico; 10Universidad de Antiquia,

Medellin, Colombia; 11Universidad Nacional de La

Plata, La Plata, Argentina; 12Nuevo Hospital San Roque,

C�ordoba, Argentina; 13Respiralab – Hospital Kennedy,

Guayaquil, Ecuador; 14Cl�ınica Las Condes, Santiago,

Chile; 15Universidad de Rosario, Rosario, Argentina

Background: The information regarding

the clinical features and real life manage-

ment of anaphylaxis triggered by drugs in

Latin America is scarse. The present work

addresses on putative etiologic agents, and

treatment.

Method: A descriptive cross sectional

study using a modified ENDA question-

naire was implemented in 22 allergology

units from 11 Latin American countries.

We sought among patients reporting a sus-

pected hypersensitivity drug reaction.

Patients presenting anaphylaxis were

selected. Causal relationship was catego-

rized into certain, probable, possible,

unlikely, and conditional, according to

WHO-UMC Causality Categories.

Results: From 893 patients evaluated, 257

(28.8%) presented anaphylaxis. Sixty-seven

percent of them were female, and 56% had

an atopic background. Thirty-three percent

had a history of adverse reactions with

other drugs, and 16% presented previous

reactions with the same drug. Certain and

probable causal relationship were attrib-

uted to: NSAIDs (61%), beta-lactams

(13%), non-beta-lactam antibiotics (5%),

steroids (3%), local anesthetics(2%), gas-

troenterological drugs, neurological drugs

and allergen vaccines (1.6%), and radiolog-

ical contrast media (1.3%). Thirty-five per-

cent of the reactions were elicited by

parenteral administration of the drug.

Fifty-three percent of the reactions were

moderate and 47% severe. Eighty- three

percent were treated in the ED, 11% by an

allergist, and 2% by a general practitioner.

Epinephrine was used in 23% of patients.

Shock treatment was reported in 28% of

cases. Eighty-two percent of this group

received epinephrine, 36% plasma expand-

ers, and 12% oxygen. There was not report

of mortality in the group.

Poster Session Group II – Red. TPS 36 – Drug anaphylaxis

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 361

Conclusion: NSAIDs and antibiotics were

the drugs implicated in almost 80% of

patients. Most of the reactions were treated

in the ED, but epinephrine was adminis-

tered only in 23% of the patients, mostly

for anaphylactic shock. Medical education

of ED physicians in Latin America should

focus on this topic.

969

Refractory anaphylaxis in hypertensive

patients

De Vicente Jiménez, T1; Montoro, A1; Burgos, A2;

Fonseca, J2; Mateos, JM2; de Mateo, B2

1Allergy, Hospital Central de la Defensa G�omez Ulla,

Madrid, Spain; 2Hospital Central de la Defensa, G�omez-

Ulla, Madrid, Spain

Background: Anaphylaxis is a rapid-onset

severe allergic reaction that can be poten-

tially fatal, and can worsen by a series of

well-defined risk factors. The use of Angio-

tensin II Receptor Blockers (ARBs) pro-

duce a renin-angiotensin-aldosterone

system blockade inhibiting the action of

angiotensin II, the most powerful vasocon-

strictor in the body.

Method: Two hypertensive patients (68

and 65 years old) were treated with Irbe-

sartan 150 mg and Losartan / Hydrochlo-

rothiazide 100/12.5 mg, respectively. The

first patient attended the emergency

department with hives (urticaria)-angioe-

dema, nausea and abdominal pain, after

handling and eating raw whiting. After a

neurological deterioration the patient was

admitted to the ICU. The second patient

took Losartan after entering the operating

room for a mastectomy.

Results: The allergologic study in the first

case reveals sensitisation to Anisakis sim-

plex 40 ku/l ImmunoCAP. The second case

serum shows tryptase 45 ug/l and E

specific Ig Amoxicillin 58 ku/l.

Conclusion: Angiotensin II receptor antag-

onists (ARBs) represent a potential risk for

patients suffering an episode of anaphy-

laxis; blocking the angiotensin compensa-

tory response to the rapid loss of fluid into

the interstitial space. It should be consid-

ered that administration of ARBs prior to

surgery, represents an added risk of a

possible allergic reaction.

Poster Session Group II – Red. TPS 36 – Drug anaphylaxis

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453362

Poster Session Group II – Red

TPS 37 – Environmental risk factors for asthma and allergies

970

Google® knows when you will sneezing

König, V; M€osges, R

Medical Informatics, University of Cologne, Cologne,

Germany

Background: The transregional increase in

pollen-associated allergies and their diver-

sity have been scientifically proven. Patchy

pollen count measurement in many

regions, however, is a worldwide problem

with few exceptions. This paper used data

gathered from pollen count stations in

Germany, Google� queries using relevant

allergological/biological keywords, and

patient data from three German study cen-

ters participating in a prospective, double-

blind, randomized, placebo-controlled

multi-centre desensitisation study to ana-

lyze a possible correlation between these

data pools.

Method: The symptom and medication

values of the placebo group from the clini-

cal trial were added to obtain a combined

symptom medication score. These data

were then analyzed using cross-correlation

analyses for the pollen count data mea-

sured at the nearest pollen count stations

and for the search frequencies of identified

keywords from the search engine tool

Google� Insights for Search (Trends).

Results: Overall, correlations between

patient data and Google� data were stron-

ger than those between patient data and

regionally measured pollen count data. The

correlation of the Google� data was espe-

cially strong in the groups of severe allergy

sufferers. The results of the three center

analyses show moderate to strong correla-

tions to the Google� keywords (up to >0.8CCF, P < 0.001) in 10 of 11 groups (three

averaged patient cohorts and eight sub-

groups of severe allergy sufferers: high IgE

class, high combined symptom medication

score, asthma). Interestingly, the cross-cor-

relations with a lag of �1 in almost all

subgroup analyzes were highest. This

means that the strength of the pollen flight

was given by Google� 1 day before the

real strength of pollen flight.

Conclusion: For countries with a good in-

ternet infrastructure but no dense network

of pollen traps, this could represent an

alternative for determining pollen levels.

971

Do aeroallergens have any effect on the

biophysical properties of pulmonary

surfactant?

L�opez-Rodr�ıguez, JC; Cerrada, A; Echaide, M; Villalba,

M; Rodr�ıguez, R; P�erez-Gil, J; Barderas, R; Batanero, E

Complutense University of Madrid, Bioqu�ımica y

Biolog�ıa Molecular I, Madrid, Spain

The lungs are constantly exposed to air-

borne particles including allergens. Parti-

cles entering the lung will be in contact

with pulmonary surfactant (PS), a mem-

brane-based lipid-protein complex mixture

synthesized by alveolar type II epithelial

cells, which lines the entire alveolar respira-

tory surface. Its composition is approxi-

mately 90% lipids and 10% of proteins by

weight. Four specific proteins are specifi-

cally associated with PS so far: surfactant

protein (SP)-A, -B, -C and -D, accounting

for their assembly and biological function.

The main function of this airway com-

ponent is to reduce the surface tension of

the alveolus, thereby contributing signifi-

cantly to the maintenance of the normal

mechanics of breathing. However, PS is

involved in other processes such as innate

and adaptive immunity. In this sense, it

has been reported that SP-A and SP-D can

interact with glycosylated aeroallergens,

suggesting a role in the modulation and

development of allergic reaction.

The aim of this study is to analyze the

possible effect of olive pollen aeroallergens

in the activity and mechanical stability of

PS using a Captive Bubble Surfactometer

(CBS), emphasizing on the physiological

relevance. CBS is based on an air bubble

generation into a liquid chamber that

forms a film around the bubble upon puri-

fied native surfactant addition. CBS per-

mits to compress and expand the bubble

by varying the hydraulic pressure, mimick-

ing the alveolar respiration cycles. Olive

pollen allergens, such as Ole e 1, were cho-

sen as model to study the interaction since

olive pollen pollinosis is one of the most

important causes of allergy in the Mediter-

ranean area.

A better understanding of the PS func-

tion related to allergy is important to gain

insight into the pathogenesis of the disease,

and open new possibilities to design novel

therapeutic strategies.

973

Is there a diagnostic role of total IgE in

asthma?

Tayeb, MMS1; Koshak, E2; Qutub, M1; Bawakid, K3;

Alrabea, M1

1King Abdulaziz University, Makkah, Saudi Arabia;2Albaha University, Al Baha, Saudi Arabia; 3Ministry of

Health, Riyadh, Saudi Arabia

Background: The role of total IgE (TIGE)

in the diagnosis of allergic asthma is con-

troversial and frequently underestimated.

Methods: This is a cross-sectional study

over 1 year period starting from January

2011. Adult asthmatics from King Abdula-

ziz University Hospital (KAUH) were

selected. Then high TIGE (>100 kU/l) and

positive skin prick test (SPT) were used

to assess the sensitisation to common aero-

allergens. SPSS was used to analyze any

statistical correlation.

Results: Hundred and eighteen asthmatics

with a mean age of 34 � 14 years were

included, of which 63.6% being females.

High TIGE was found in 69 (71.1%) asth-

matics. SPT to aeroallergens was positive

in 81 (77.9%) asthmatics. High TIGE was

correlated significantly with positive sensiti-

sation to most indoor aeroallergens; and

their statistical values as follow:

Sensitivity Specificity

Positive

predictive

value

Negative predictive

value P value

Dermatophagoides

pteronyssinus

80.3 39.1 59.4 64.2 0.029

Dermatophagoides farina 83.7 38.9 52.1 75 0.012

Aspergillus 28.9 25.5 2.8 82.1 0.020

Cladosporium 25 24.7 2.8 78.5 0.007

Cockroach G 90 33.7 26 92.8 0.029

SPT 78.2 25 72 31.8 0.46

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 363

Conclusion: High sensitivity and low speci-

ficity of elevated TIGE in dust mites and

cockroach implicate that normal TIGE lev-

els doesn’t exclude sensitisation. Con-

versely, the high negative predictive value

of elevated TIGE in mold and cockroach

implicates that normal TIGE level can

almost exclude sensitisation. Despite TIGE

measurement is controversial; TIGE has a

potential role in asthmatics as a simple

crude screening tool towards optimal diag-

nosis of allergic asthma.

974

Sensitisation to novel aeroallergens for

children and adolescents diagnosed with

allergic asthma and rhinoconjunctivitis

Cavkaytar, O1; Buyuktiryaki, B1; Sag, E2; Uysal Soyer,

O1; Sekerel, BE1

1Hacettepe University Medical Faculty, Pediatric

Allergy, Ankara, Turkey; 2Hacettepe University Medical

Faculty, Pediatrics, Ankara, Turkey

Objective: To investigate the extent and

importance of sensitisation to novel aller-

gens in children and adolescents who are

sensitised to routinely used battery of aero-

allergens.

Method: Patients (6–18 years) with allergic

asthma/rhinoconjunctivitis (sensitised to at

least one of grass mix, weed mix, tree mix,

house dust mites, cat, dog, moulds) were epi-

dermally tested with novel aeroallergens

(Alnus glutinosa, Cupressus arizonica, Junipe-

rus communis, Tilia platyphyllos, Robinia

pseudoacacia, Acacia dealbata, Rumex aceto-

sa, Urtica dioica, Ambrosia artemisifolia,

smut mix, yeast mix, Blomia tropicalis, Lepi-

do destructor, Tyrophagus putrescentiae, Aca-

rus siro, mouse and budgerigar epithelia).

Results: Forty percent of 319 participants

[59.1% male, 11.5 (8.9–14.1) years] were

found to be sensitised to at least one of the

novel aeroallergens. The most frequent sen-

sitisations were B. tropicalis (11.3%),

R. pseudoacacia (9.7%) and L. destructor

(8.1%). 16.3% (n = 52) of the study group

were sensitised to storage mites whereas

41.7% (n = 35) of them were sensitised to

house dust mites. Novel tree and weed pol-

len sensitisations were 16.3% (n = 52) and

9.7% (n = 31), respectively, whereas 21.2%

and 35.5% of the sensitised ones respec-

tively were found to be also sensitised to

tree and weed pollens used in routine bat-

tery. Meanwhile 90% and 89% of novel

tree and weed polen sensitised patients

were found to be sensitised to grass pollens

used in routine battery. Only 15% of six

patients sensitised to smut mix were sensi-

tised to moulds (Alternaria or claudospori-

um) used in routine battery whereas 47%

of 17 patients sensitised to yeast mix were

sensitised to them.

Conclusion: Though sensitisation to novel

aeroallergens was quite common. A part of

the sensitisations are due to crossreactivity,

but others don’t. Health authorities tend to

restrict the extent of the battery of aller-

gens in order to decrease expenditures

resulting in decrease in quality of service

for allergic diseases.

975

Reasons for referral to an

immunoallergology department and

profile of allergen sensitisation in

pediatric age

Moreira, AS; Lopes, I; Moreira da Silva, J

Centro Hospitalar Vila Nova de Gaia/Espinho,

Immunoallergology, Vila Nova Gaia, Portugal

Background: Allergic disease is common in

pediatric age. Our aim was to characterise

the pediatric patients referred to our Imu-

noallergology deparment from primary

health care and to assess their profile of

allergen sensitisation.

Method: A cross-sectional study was con-

ducted. The following data were retrospec-

tively collected from the clinical files of

patients aged 18 or less referred in 2013:

gender, age, reasons for referral, time from

referral to first appointment, time from

symptoms onset until referral (TSR), diag-

nostic tests previously performed, atopy,

sensitisation profile for aeroallergens and

diagnosis.

Results: We studied 240 patients, 52% of

which were males. Median age was

11 years (1–18). The reasons for referral

were: nasal symptoms (62%), bronchial

symptoms (46%), ocular symptoms (16%)

and cutaneous symptoms (25%). Different

reasons for referral were found simulta-

neously in 38% of patients. The mean time

from referral to first appointment was

2.1 � 1.2 months and the mean TSR was

3.3 � 2.8 years. Diagnostic tests were pre-

viously performed in 51% of patients

(immunological study 40%, radiography

6%, spirometry 9%). The prevalence of

atopy was 65% and the most frequent

allergens found were Dermatophagoides

pteronyssinus(DP)(48%), Dermatophago-

ides farinae (43%), grasses (23%), Lepi-

doglyphus destructor (19%) and cat

epithelium (15%). The main diagnosis were

allergic rhinitis(56%), probable allergic

asthma (25%), nonallergic rhinitis (12%),

atopic dermatitis (8%) and prurigo stroph-

ulus (6%). Older ages were associated with

longer TSR (P < 0.05), more nasal symp-

toms (P < 0.05), greater number of diag-

nostic tests previously performed

(P = 0.01) and higher prevalences of atopy

(P < 0.05) and allergic rhinitis (P < 0.05).

Conclusion: As expected nasal and bron-

chial symptoms were the most prevalent.

TSR was high but the response time of our

department to requests for consultations

was adequate. Sensitisation to DP was the

most common in agreement with previous

studies.

976

Non-occupational airborne anaphylaxis

induced by Anisakis simplex

Barbarroja-Escudero, J; S�anchez-Gonz�alez, M-J;

Antol�ın-Am�erigo, D; �Alvarez-Mon, M; Rodr�ıguez-

Rodr�ıguez, M

Allergy Division, Hospital Universitario Pr�ıncipe de

Asturias, Alcal�a de Henares, Spain

Background: Anisakis simplex (AS) pro-

vokes allergic reactions including anaphy-

laxis. Airborne anaphylaxis is an unusual

clinical picture provoked by a few etiologi-

cal agents. Althouh AS has been described

as a cause of this type of anaphylaxis, it

was referred as an occupational disease.

Method: A 40-year old cleaning worker

woman without atopic history. Four years

ago she displayed urticaria and angioedem-

a after eating fresh anchovy, she avoided

seafood since then. Two years later, she

suffered from rhinoconjunctivitis followed

by generalised pruritus, tongue edema, dry

cough, dyspnea and dizziness, when she

was standing in the street, just in front of

a fish store entrance. This episode was

resolved spontaneously in about 60 min.

She was referred to our outpatient clinic

and a specific allergological work-up was

performed.

Results: Skin-prick-test (SPT) for AS was

positive. SPT for different fishes, crusta-

cean, and molluscs were negative. Prick-

prick-tests were positive to clam, tuna, and

anchovy. Serum total IgE was 7490 UI/ml.

Serum specific IgE for AS was >100 kU/l

in several determinations. Specific IgE for

the foods mentioned before were <0.10 kU/

l, except to clam (5.7 kU/l). Serum specific

IgE values for tropomyosines (rPen a 1 and

nDer p 10) were 0.01 kU/l. Serum baseline

tryptase values were 5.7 and 6.1 lg/l. Oral

challenge test with hake under anti-Anisa-

kis conditions showed good tolerance.

Conclusion: To our knowledge, this is the

first case reported of non-occupational

airborne anaphylaxis due to Anisakis

simplex.

Poster Session Group II – Red. TPS 37 – Environmental risk factors for asthma and allergies

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453364

977

Home-made airborne dermatitis due to

Colophonium

Veza, S; Carretero, P; Benito, P; Saura, P; Garc�ıa, F;

Juste, S

Hospital Universitario de Burgos, Burgos, Spain

Background: Colophony is a complex mix-

ture of over 100 compounds derived from

pine trees. It is has been reported as occu-

pational exposure (used in solder flux,

soaps, cutting fluids, milk cartons, . . .), aswell as in non-occupational exposure (rock

climbers or players of string instruments

use rosin on the bow hair). Colophony

allergy may also been seen in a medican

setting from reactions to adhesive in skin

sutures or dental prostheses. Cross-reac-

tions include balsam of Peru, turpentine,

wood tars, pine resins, and propolis.

Case report: A 34-years-old woman devel-

oped four itching outbreaks in exposed

areas, with papular rash and skin desqua-

mation on her face, ears, neck, forearms

and back of hands. She related the symp-

toms to have been changing the floorboard

at her countryside cottage, manipulating

pinewod, resins and floor polish.

Method and Results: Patch test were per-

formed with European Standard Series

(True Test�) and other occupational aller-

gens (including Resorcinol, P-Aminoazo-

benzene, Hydroquinone, Tetramthylthiuram

disulfide, diaminodiphenylmethane,

Hydrazide sulfate, Lindane, Phenol formal-

dehyde resin and Chlorpromazine chloride).

They showed positive reaction to nickel

sulphate (++) and colophonium (+++) at 48and 96 h.

Conclusion: Airborne contact dermatitis is

caused by substances that are first released

into the atmosphere and that then settle on

exposed skin (ie, face, ‘V area’ of the neck,

hands and forearms). The nature of air-

borne reactions can be irritant, allergic,

photoallergic, phototoxica and contact

urticarial.

In this kind of dermatitis, we must be

aware of daily life activities, work duties,

hobbies and other unsusual tasks devel-

oped by patients. Etiological diagnosis

plays an important role in this patient, in

other to avoid harsh surroundings where

colophony may be.

978

In utero cigarette smoke exposure affects

foetal pulmonary signalling networks in

a murine model

Dehmel, S1; Nathan, P1; Milger, K1; Prungnaud, R1;

Imker, R1; John, G1; Yildirim, A€O1; Irmler, M2; Beckers,

J2,3; Eickelberg, O1; Krauss-Etschmann, S1

1Helmholtz Zentrum Muenchen, Comprehensive

Pneumology Center, Member of the German Center for

Lung Research, Muenchen, Germany; 2Helmholtz

Zentrum Muenchen, Institute of Experimental Genetics,

Muenchen, Germany; 3Chair of Experimental Genetics,

Technische Universitaet Muenchen, Freising, Germany

Background: Maternal smoking during

pregnancy is a main risk factor for the off-

spring to develop asthma later in life.

However, the underlying mechanisms are

currently only insufficiently understood.

We therefore asked whether maternal

smoking affects

1. Pulmonary maternal immune

responses (which might affect in utero envi-

ronment and foetal development) and

2. Signalling networks in lungs of off-

spring in late foetal stage.

Method: Pregnant BALB/c mice were

exposed to filtered air (FA) or mainstream

cigarette smoke (MCS) daily from E2.5 to

E17.5. Foetal lungs were collected on

E18.5. Maternal blood carboxyhaemoglo-

bin (Hb-CO) was determined to assess

MCS exposure. RT-qPCR was used to

measure immunologically important tran-

scription factors (Tbx21, Gata3, Rorc, and

Foxp3) in maternal lung and spleen. Gene

expression profiling of foetal lung mRNAs

and microRNAs (n = 6/group) was per-

formed on Affymetrix GeneChips�. Net-

work analysis was done using Ingenuity�

software.

Results: Blood Hb-CO levels of MCS mice

were comparable to human smokers.

Maternal pulmonary Tbx21 and Gata3

mRNA expression decreased, while Rorc

mRNA increased in MCS vs. FA mice.

Foxp3 mRNA remained unchanged. In

spleen, only Tbx21 mRNA was signifi-

cantly increased by MCS exposure. Lung

and body weights were significantly

reduced in MCS vs. FA pups at E18.5.

Upstream regulator analysis of foetal pul-

monary gene expression indicates MCS-

induced deregulation of microRNAs (e.g.

miR-29b-3p, miR-30c-5p), transcription

factors (e.g. E2F7, CEBPA, SREBF1) and

several downstream genes involved in a sig-

nalling network important for function and

development of the respiratory system.

Conclusion: In utero MCS exposure affects

fetal pulmonary signaling networks on

multiple levels including changes in tran-

scription factor and microRNA expression.

These changes might affect lung develop-

ment and later disease susceptibility.

979

The correlation between environmental

tobacco smoke exposition (ETS) and

atopic constitution in children with

asthma

Radic, SD1; Milenkovic, BA2; Zivkovic, ZM1; Gvozdenov-

ic, BS3; Krivokapic, T4; Smiljanic, S4; Micic-Stanojevic,

M4; Calovic, O4; Vlahovic, O4

1Klinical Hospital Center Dr Dragisa Misovic Dedinje,

Children’s Hospital for Respiratory Diseases, Belgrade,

Serbia; 2Hospital for Pulmonary Diseases, University

Medical Centre LjubljanaSchool Belgrade, Belgrade,

Serbia; 3PPD, PPD Sebia, Belgrade, Serbia; 4Clinical

Hospital Center Dr Dragisa Misovic Dedinje, Children’s

Hospital for Respiratory Diseases, Belgrade, Serbia

Aim: To explore the correlation between

ETS exposure and 1) total serum IgE level

and 2) at least one positive skin-prick test

(SPT) on common aeroallergens in asth-

matic children.

Method: Five hundred and twenty-seven

children (6–16 years), with moderate to

severe asthma were recruited at a hospital

admission for acute asthma exacerbation. A

questionnaire was filled out by the physi-

cian concerning the history of asthma and

family smoking status. Based on the results,

children were divided into two groups: ETS

exposed (ETSE = 337) and ETS free chil-

dren (ETSF = 190). Total IgE serum level

was drawn and a SPT was performed on all

children. At least one positive SPT result

was considered as a positive result.

Results: 49.9% were boys and 50.1% were

girls, average age 10.8 � 2.8 years. There

were 63.9% ETSE children, with 39.5% liv-

ing with one and 24.5% with two smoking

parents, 43.3% with smoking mothers and

45.2% with smoking fathers. The mean

value of total IgE was 461.7 � 547.5 IU/

ml. The mean value of total serum IgE

serum was significantly higher in children

living with 1 or both smoking parents, com-

pared to ETSF children (P < 0.001). The

children of smoking mothers, fathers or

both smoking parents had significantly

higher mean values of total IgE compared

to the children of no smoking mothers,

fathers or ETSF children (P < 0.001). Mean

values of total IgE in children with solo

smoking mothers were highest (F = 12.6,

P < 0.001) compared to the children with

solo smoking fathers, both smoking parents

and ETSF children. There were 67.2% chil-

dren with at least one positive SPT. If par-

ents did not smoke, the percentage of

children with negative or positive SPT was

the same (49.2% vs. 50.8%). The percent-

age of children with positive SPT increased

positively three to four times with the

increased number of smokers in the family

(v2 = 38.1, P < 0.001).

Conclusion: ETSE children had higher val-

ues of total IgE and a higher percentage of

positive SPT. It is necessary to protect chil-

dren with asthma from ETS.

Poster Session Group II – Red. TPS 37 – Environmental risk factors for asthma and allergies

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 365

980

Effects on allergy and tolerance in

offspring after maternal exposure to

carbon nanotubes

Hansen, JS1; Johansson, HKL2; Vogel, U1; Larsen, ST1;

Hougaard, KS1

1National Research Center for the Working

Environment, Danish Nanosafety Center, Copenhagen,

Denmark; 2National Food Institute, Technical University

of Denmark, Lyngby, Denmark

Background: Prenatal particle exposure

has been shown to increase allergic

responses in offspring. Here, C57Bl/6J

female mice were exposed intratracheally

to 67 lg multiwalled carbon nanotubes

(CNTs, NM-400) the day before mating,

inducing pronounced lung inflammation.

Allergy and tolerance responses were then

investigated in offspring after weaning.

Methods and results: Low-dose sensitisat-

ion with ovalbumin (OVA) and OVA aero-

sol inhalation led to significantly lower

OVA-specific IgE and IgG1 production in

5-week-old offspring of CNT-exposed

dams (CNT offspring) relative to offspring

from sham-exposed dams (CTRL off-

spring). In contrast, a significantly higher

number of macrophages and epithelial cells

in the lungs were observed in CNT off-

spring after OVA inhalation. The lung

eosinophil influx was also marginally

increased (P = 0.055).

Another group of offspring were intra-

nasally exposed to 5 lg OVA once a week

for 5 weeks to induce airway mucosal tol-

erance. Subsequent OVA sensitisation and

aerosol inhalation led to a low OVA-spe-

cific IgE production and no inflammation

in the 11-week-old offspring. However,

male CNT offspring had lower IgE levels

than did male CTRL offspring.

Conclusion: These data are in line with

previous studies showing that maternal

particulate exposure perturbs the off-

spring’s immune function and increases

allergic airway responses. Whether mater-

nal lung inflammation mediates these

effects warrants further studies.

981

A nested case control study in MOCHE

cohort: indoor formaldehyde exposure

within 1st year of life infulencing chronic

cough at the age of 3

Kwon, JH1; Park, EA1; Hong, YC2; Lim, Y-H3; Park, H3;

Ha, M4; Kim, Y5; Kim, Y-J6; Ha, E-H3

1Department of Pediatrics, Ewha Womans University

School of Medicine, Seoul, Korea; 2Department of

Preventive Medicine, Seoul National University, College

of Medicine, Seoul, Korea; 3Department of Preventive

Medicine, Ewha Womans University School of

Medicine, Seoul, Korea; 4Department of Preventive

Medicine, Dankook University College of Medicine,

Cheonan, Korea; 5Department of Occupational and

Environmental Medicine, Ulsan University Hospital,

University of Ulsan College of Medicine, Ulsan, Korea;6Department of Obstetrics Medicine, Ewha Womans

University School of Medicine, Seoul, Korea

Background: Formadehyde(FA) is an irri-

tating agent to the airway and associated

with allergic diseases. The FA effect to

allergic disease in children is still uncertain.

Therefore, we investigate the relationships

of indoor FA exposure within first year of

life and allergic disease development in

Korean young children.

Method: From a birth cohort of MOCHE

study, FA in baby’s room were measured

between 6 and 12 month. Among them,

185 children were answered the question-

naire about allergic disease at 6 and

36 month. Concentrations of FA were

divided two groups by third quartile

(75th). Chi-square test and multiple logistic

regression were used to analysis of the rela-

tions between high FA exposure and aller-

gic disease. Eosinophil count, total

immunoglobuline(Ig) E and interleukin

(IL)-10 were measured from blood sam-

pling at 36 months.

Results: The average concentration of FA

was 116.5 � 77.2 ㎍/m3. We determined

high FA expose group more than 152.1

㎍/m3 (75 percentile). The incidence of ato-

pic dermatitis, upper respiratory illness

(URI) at 6 months and chronic cough at

36 months was high in high FA expose

group than lower expose group. There

were no relationships between FA concen-

trations and indoor materials. High expose

FA increase risk of chronic cough at

36 months using the calibration parameters

as parents allergy, sex and household

income (OR = 4.059; 95% Cl 1.022–16.117). High FA expose group increase

risk of URI at 6 months using the same

calibration parameters (OR = 4.618; 95%

Cl 1.529–13.951). Eosinophil count, IgE,

IL-10 were not significantly different

between high and low FA espose groups.

Conclusion: Our results show that expo-

sure to high concentrations of FA increase

the risk of URI at 6 months and chronic

cough at 36 months The data give concept

that exposure of FAs during infancy influ-

ence to early childhood respiratory tract

disease. In the future, it is needed that

longer follow up of developing asthma and

allergic rhinitis at school aged children.

982

Absence of effects of indoor endotoxin

and allergen levels on different

prevalence of asthma and allergy

between urban and rural children in

Guangdong, China

Feng, M; Yang, Z; Chen, Y; Pan, L; Jing, L

State Key Laboratory of Respiratory Disease, The First

Affiliated Hospital, Guangzhou Medical University,

Allergy and Clinical Immunology, Guangzhou, China

Background: We sought to assess whether

exposure to indoor endotoxin and major

allergens associated with prevalence of cur-

rent asthma in urban and neighboring

rural children in Guangdong, China.

Methods: The questionnaire survey was

performed in 6062 and 5841 children from

urban Guangzhou and rural Conghua,

respectively, in which 854 (188 children with

wheeze and 231 controls from Guangzhou,

129 with wheeze and 306 controls from

Conghua) were recruited for the further

case-control study. Lung function, hista-

mine bronchial provocation test, blood

eosinophil count and skin response to eight

common aeroallergens were examined.

House dust samples from 156 families (76

from Guangzhou and 80 from Conghua)

were obtained to analyze the concentrations

of endotoxin, house dust mite (HDM, Der p

1+Der f 1) and cockroach (Bla g 1+ Per a 1).

Results: The prevalence of doctor-diag-

nosed and recent asthma was significantly

higher in children from urban Guangzhou

(6.9%, 6.1%) than rural Conghua (3.4%,

1.5%). Rural children also had a reduced

risk of atopy (adjusted OR 0.16, 95%CI

0.11–0.23) when compared with their

urban counterparts. Indoor concentrations

and loads of endotoxin and cockroach

allergens in rural families were significantly

higher than the urban area, whereas level

of HDM was significantly lower. HDM

sensitisation correlated significantly with

current asthma. However, with logistic

regression analysis, no correlation between

indoor levels of endotoxin, HDM, cock-

roach and asthma/atopy was found.

Conclusions: Children in rural area had a

reduced prevalence of asthma and atopy.

Although indoor concentrations of endo-

toxin, HDM and cockroach were signifi-

cantly different between urban and rural

area, they do not contribute to the differ-

ent prevalence of asthma and allergy

between these two regions. Exposure to

rural environment might protect children

against asthma and allergy, however, the

real factors need to be further investigated.

Poster Session Group II – Red. TPS 37 – Environmental risk factors for asthma and allergies

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453366

983

Atopy and environmental factors in a

pediatric population with respiratory

disease

Moreira, AS; Lopes, I; Moreira da Silva, J

Immunoallergology, Centro Hospitalar Vila Nova de

Gaia/Espinho, Vila Nova Gaia, Portugal

Background: The prevalence of asthma

and rhinitis in pediatric age have been

increasing. The development of both dis-

eases depends on the interaction between

genetic and environmental factors. Our

aim was to evaluate the clinical and envi-

ronmental characterisation of a pediatric

group with respiratory disease. In addition

we investigated the factors associated with

the presence of atopy.

Method: Retrospective analysis of the clin-

ical files of patients aged 18 or less, with a

diagnoses of rhinitis and/or asthma, who

had their first appointment in our depart-

ment during 2013. The following data were

collected: gender, age, atopy, age at onset

of symptoms (AOS), environmental factors

(exposure to pets and tobacco smoke) and

family history of atopic disease (FHA).

Atopy was defined by the presence of posi-

tive prick skin test for at least one aeroal-

lergen.

Results: We studied 195 patients, 52%

(n = 101) of which were males. The median

age was 11 years (1–18). Skin prick tests

were performed in 91% (n = 177) of

patients and 81% (n = 143) of them were

atopic. The median AOS was 7 years (1–17). Approximately 50% (n = 97) of

patients were exposed to pets and 74%

(n = 72) of them were atopic. The preva-

lence of exposure to tobacco smoke was

22% (n = 43) (active smoking 3%, n = 6

and passive smoking 19%, n = 37) and

77% (n = 33) of them were atopic. A FHA

was found in 64% (n = 124) of patients.

AOS until 3 years were associated with

absence of atopy and ages between 8 and

17 years were associated with the presence

of atopy (P < 0.05). Neither environmental

factors, FHA or patients’ gender were

associated with the presence of atopy.

Conclusion: The prevalence of exposure to

tobacco smoke in our study was high. The

majority of patients exposed to pets and

tobacco smoke were atopic. Older ages at

onset of symptoms were associated with

atopy. Unlike the results found in previous

studies, environmental factors and FHA,

in our patients, did not correlate with the

presence of atopy.

984

Environmental determinants in recurrent

wheezing

Martins, M; Reis, R; Tomaz, E; In�acio, F

Imunoalergologia, Hospital S~ao Bernardo, Set�ubal,

Portugal

Background: Acute bronchiolitis in young

children is one of the most important

causes of hospitalisation during winter time

in Hospital S~ao Bernardo Set�ubal, Portu-

gal. Many infants with an episode of severe

bronchiolitis experience recurrent wheez-

ing. The factors influencing the recurrence

of bronchiolitis are probably multifactorial,

including the genetic background of the

infant as well as extrinsic characteristics

(like exposure to allergens, tobacco smoke

and endotoxin). The objective of this study

was to analyze the relationship of environ-

mental conditions like breastfeeding,

parental smoking, number of siblings and

indoor pets with the recurrence of wheez-

ing after a first episode of bronchiolitis

requiring hospitalisation in children under

6 months old.

Method: We evaluated the clinical pro-

cesses of 79 children (F = 45; M = 34) hos-

pitalised with the first episode of

bronchiolitis during winter seasons of 2011

and 2012, and followed these children for

12 months. The children were retrospec-

tively monitored for respiratory symptoms

through the analysis of the follow-up medi-

cal appointments, visits to the emergency

service, and by interviews to the parents.

We used a Multiple Regression Model to

analyze the association between variables

in study.

Results: There were no significant correla-

tions between breastfeeding, parental

smoking, number of siblings and indoor

pets with recurrence of wheezing during

the following 12 months after the first epi-

sode of bronchiolitis.

Conclusion: In our study there were no rel-

evant association between the extrinsic

variables analyzed and the recurrence of

bronchiolitis episodes.

Poster Session Group II – Red. TPS 37 – Environmental risk factors for asthma and allergies

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 367

Poster Session Group II – Red

TPS 38 – Epidemiology

985

Economic costs of asthma in Brazil: a

real life study

Costa, E1; Bregman, M1; Costa, C2; Rufino, R2; Araujo,

DV3

1Internal Medicine – Allergy and Immunology Section,

State University of Rio de Janeiro, Rio de Janeiro,

Brazil; 2Medical Specialities, State University of Rio de

Janeiro, Rio de Janeiro, Brazil; 3Internal Medicine, State

University of Rio de Janeiro, Rio de Janeiro, Brazil

Background: Asthma cost is predomi-

nantly studied in severe asthma and

unknown in different regions of the world.

The aim was to estimate economic costs of

asthma treatment in specialised ambulatory

care in a big city of Brazil.

Method: Persistent asthmatics ≥6 years old

were consecutively included in a real life

design. They made routine clinical visits at

3–4-month intervals and two interviews

with 6-month intervals, under GINA treat-

ment. Data on asthma costs were collected

directly from patients or parents, regarding

prior 12 months in a society perspective/

bottom-up approach. Exchange rate was

US$1.00 = R$2.05.

Results: Of 117 subjects, 108 completed

the study. In initial evaluation, 16 (14.8%)

had severe, 39 (36.2%) had moderate and

53 (49%) had mild asthma. Rhinitis was

present in 83.3%, and 59.2% were over-

weight or obese. Mean monthly family

income was US$ 795.80. The estimated

annual cost was US$ 919.54 per patient

(US$ 825.37 direct cost; US$ 94.17 indirect

cost). Obese and overweight patients,

severe and not controlled asthmatics had

greater asthma costs compared to non-

obese, mild and controlled ones (differ-

ences = 31.1%, 61.1% and 53.5%, respec-

tively). In a subgroup matched analysis,

asthma medication costs were smaller in

patients under immunotherapy (differ-

ence = 22.0%).

Conclusion: The study is the first adressing

information on associated costs of asthma

in different severity levels of asthma in a

medium to low socio-economic stratum in

Brazil. Public health strategies stimulating

weight reduction, better control of asthma

and, also, providing allergen immunother-

apy to selected allergic asthmatics could

contribute to better results with lower costs

in asthma programs in developing coun-

tries.

986

Clinical characteristics and symptom

prevalence of current asthma: data from

the west Sweden asthma study

Mincheva, R; Ekerljung, L; Bjerg, A; Lundb€ack, B;

L€otvall, J1Krefting Research Centre, Sahlgrenska Academy,

University of Gothenburg, Gothenburg, Sweden

Background: The aim of the study was to

describe the prevalence of asthma symp-

toms, use of asthma medications, health-

care utilisation and clinical characteristics

in subjects with current asthma.

Method: An extensive postal questionnaire

was sent to 30 000 randomly selected

adults from the West Sweden region. Clini-

cal examinations were performed in a sub-

set of subjects, 744 of which were defined

as current asthmatics – reported ever hav-

ing asthma or physician diagnosed asthma

and one of the following – use of asthma

medications, recurrent wheeze or attacks of

shortness of breath with or without wheeze

in the last 12 months. Comparisons were

made with a respiratory disease-free con-

trol group of 847 subjects, i.e. not report-

ing ever or physician diagnosed asthma or

asthma symptoms, COPD, chronic bron-

chitis, emphysema or TB.

Results: 87.5% of current asthmatics used

asthma medications, 40.6% had partly

controlled and 17.8% had uncontrolled

asthma as per GINA guidelines. Asthmatic

subjects reported significantly more symp-

toms in the last 12 months than the con-

trol group – wheezing (79.4 vs 9.2%),

shortness of breath (62.7 vs 31.8%), wheez-

ing with shortness of breath (58.7 vs

1.3%). Sufficient complaints were cough

with phlegm (36.1 vs 6.8%), longstanding

cough (33.5 vs 11.1%), morning cough

(42.5 vs 15.5%) which bothered half of the

uncontrolled and one third of partly con-

trolled subjects. Asthmatics had lower

FEV1, higher FENO, reacted to lower

doses of methacholine and were more fre-

quently sensitised to common allergens and

reported concurrent allergic rhinitis. Emer-

gency visits and hospitalisations did not

differ significantly between the two groups.

Conclusion: More than 50% of asthmatics

in this representative Swedish sample had

insufficiently controlled asthma and persis-

tent complaints, despite a high use of

asthma medications. These self-reported

symptoms were supported by clinical

examination data. This study provides an

up-to-date report of current asthma state

in Sweden – a useful tool for future explo-

ration.

987

Osteoporosis/osteopenia bone mineral

density and clinical features of elderly

asthmatic patients

Hur, GY1; Oh, JY2; Min, KH2; Shim, JJ2; Ye, Y-M3; Park,

H-S3; Kang, KH1

1Korea University College of Medicine, Internal

Medicine, Seoul, Korea; 2Korea University College of

Medicine, Seoul, Korea; 3Ajou University School of

Medicine, Suwon, Korea

Background: Asthma in elderly is increas-

ing but still underdiagnosed and under-

treated. Long term use of inhaled

corticosteroid (ICS) is the mainstay of

treatment, which may affect bone mineral

density. We aimed to investigate the preva-

lence of osteoporosis and relationship with

clinical parameters, comorbid conditions

and asthma control status in elderly

asthma patients.

Method: This is a retrospective, cross-sec-

tional study. Clinically diagnosed as bron-

chial asthma patients were enrolled over

60 years old. In total 107 subjects were

enrolled. Bone mineral density (BMD, g/

cm2) was measured using dual energy

X-ray absorptiometry (DXA) (Hologic

Discovery A, Hologic, Bedford, MA,

USA). Induced sputum analysis and lung

function tests were conducted, and asthma

control status was evaluated by asthma

control test (ACT) score.

Results: Mean age was 70.18 � 5.67. Sev-

enty-two patients were female (67.3%).

Mean asthma duration was 10.00 �10.13 years rangaed from 0.8 to 50 years.

Sixty one (57.0%) were in well control sta-

uts (ACT ≥ 20). Ninety two (86.0%) were

using ICS in which 21.6% were using high

dose ICS and 15.0% had a history of sys-

temic steroid (SS) use. Fifty patients

(46.7%) had osteoporosis (T score <�2.5),

and 89 patients (83.2%) had osteopenia (T

score <�1.0). Among the patients with

osteoporosis, female was predominant

(74.2% vs. 25.8%, P = 0.001). Moreover,

mean BMD was significantly lower in

female (P = 0.001). The patients with

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453368

osteoporosis had significantly higher com-

orbidities (P = 0.039) with a negative cor-

relation between number of comorbidities

and BMD level (P = 0.024). ICS and SS

use was not significantly associated with

the prevalence of osteoporosis or osteope-

nia and no significant differences were

noted in BMD level whether the patients

were using ICS or SS use. However, the

patients with early onset asthma had lower

BMD (P = 0.046). No significant associa-

tions were found between presence of oste-

oporosis/osteopenia and asthma control

status, FEV1 level and sputum inflamma-

tory cell profiles (P > 0.05, respectively).

Conclusion: Osteoporosis and osteopenia

are very prevalent comorbid condition in

elderly asthma, particularly in female

patients. We suggest that multiple comor-

bidies in elderly asthma is a risk for osteo-

porosis.

988

The associations between risk factors,

asthma control, and quality of life in

adult asthma

Hsiao, H-W1; Lin, M-C2; Wu, C-C2; Wang, C-C2;

Wang, T-N1

1Department of Public Health, Kaohsiung Medical

University, Kaohsiung, Taiwan; 2Division of Pulmonary

and Critical Care Medicine, Kaohsiung Chang Gung

Memorial Hospital, Kaohsiung, Taiwan

Background: The risk factors of asthma

include exposure to allergens, obesity,

smoke, and environment. Asthma causes

symptoms such as wheezing, breathless-

ness, chest tightness, and coughing that

further affect the quality of daily life. Pre-

vious studies reported that asthma control

is a strong predictor of quality of life.

Thus, the aim of this study is to explore

the relationships between risk factors, the

scores of Asthma Control Test TM (ACT)

and quality of life (QoL) in asthmatic

patients.

Methods: This cross-sectional study

included 359 asthmatic patients above

18 years old from a medical center in

southern Taiwan. The predictors and out-

come variables were collected by using a

questionnaire. ACT scores were used to

determine the level of disease control and

QoL was assessed with the Taiwanese ver-

sion of an asthma quality-of-life question-

naire (TAQLQ) which was revised from

Asthma Quality of Life (AQLQ). The data

were analyzed by multiple linear regression

and path analysis.

Results: We found that males had higher

quality of life than females. Patients with

more allergens, more frequency of wheez-

ing in the previous year and poor asthma

control decreased quality of life. Structural

equation model for predicting QoL

provided a well fit (v2(df) = 140.55(90);

RMSEA (90%CI) = 0.04(0.026–0.052)).Gender, obesity, immunoglobulin E (IgE),

healthcare utilisation, work environment,

work symptoms and home environments

are directly or indirectly associated with

asthma control and QoL. Smoke is associ-

ated with lung function, but not asthma

control and QoL. Path analysis revealed

that better asthma control related to higher

quality of life.

Conclusion: Our research has demon-

strated that the risk factors such as obesity,

high levels of IgE, work symptoms and

home environments impair life quality of

asthmatic adults. The ACT was highly

associated with QoL.

989

Characteristics of house dust mite

allergic asthmatic adults initiating

sublingual immunotherapy in a French

real life setting

Gayraud, J1; Refabert, L2; Leutenegger, E3; Chartier, A4

1Allergologist, Tarbes, France; 2Allergologist, Paris,

France; 3Gecem, Montrouge, France; 4ALK, Medical

Department, Courbevoie, France

Background: The ADARA survey* has

shown striking differences between children

and adults house dust mite (HDM) allergic

patients eligible for sublingual immuno-

therapy (SLIT). This subgroup analysis

describes and compares the characteristics

of HDM allergic asthmatic adults (AAA)

to non asthmatics.

Method: ADARA was an observational,

transversal, national multicentre study per-

formed from June to December 2012 with

1578 patients enrolled from 184 sites.

Results: Among the 876 adult patients

(≥16 years), 374 (43%) were asthmatics,

had an average age of 31.5 � 12.3 years.

The majority lived in urban environments

(66%), in plain (72%) or seaside areas

(25%), and most in one family houses

(52%). The majority were non-smokers

(70%). 59% were referred by their general

practitioner. Compared to non-asthmatic

adults patients, asthmatics were more often

polysensitised (64% vs 51%, P < 0.001);

mainly to grass pollen (60%), animal dan-

der (45%) and tree pollen (42%) and they

had a longer history of diagnosed rhinitis

(8 vs 6 years, P < 0.05). According to

ARIA, concomitant allergic rhinitis (AR)

was slightly less persistent in asthmatics

(87% vs 93%, P < 0.01) but no difference

was shown neither in AR severity (85% vs

88% moderate to severe) nor on its symp-

tomatic treatment (85% vs 81% for oral

antihistaminics and 59% vs 54% for nasal

corticosteroids). Asthmatic patients had a

controlled (59%) or partly controlled

asthma (35%) with 89% having a FEV1 ≥70%. 48% were classified in GINA step 1

and 25%, 21% and 6% in step 2, 3 and 4

respectively. Patients had on average

1.8 � 2.4 exacerbations of asthma in the

previous year of which 0.1 � 0.3 were

responsible of hospitalisations.

Conclusion: This sub analysis of the AD-

ARA cohort portrayed the HDM AAA

patient as observed in French specialist

practice. These data highlight the urgent

need of clinical data for SLIT in HDM

partly controlled AAA patients with con-

comitant AR.

*J.Gayraud et al./Revue Franc�aise d’aller-

gologie Vol. 53–5 (2013).

990

Outcomes of emergency room visits for

asthma and associated risk factors

Irani, C1,2; Nahas, O3; Sabbagh, C4; Zoghbi, A4;

Haddad, F3

1Internal Medicine/Allergy&Immunology, Hotel-Dieu

Hospital Saint Joseph University, Beirut, Lebanon;2University of Alberta, Pulmonary, Edmonton, Canada;3Hotel-Dieu Hospital Saint Joseph University, Internal

Medicine, Beirut, Lebanon; 4Hotel-Dieu Hospital Saint

Joseph University, Emergency Department, Beirut,

Lebanon

Background: Acute asthma attacks remain

a frequent cause of emergency room (ER)

visits and hospital admission. Multiple fac-

tors contribute to asthma severity: smok-

ing, presence of allergies to aeroallergens

and allergic rhinitis, non-compliance or

bad technique in using available devices,

poor access to a specialist. The aim of the

study is to evaluate the outcomes of

asthma exacerbation in the ER, by identi-

fying patients who are discharged home,

admitted to regular floor or to the inten-

sive care unit; and to recognise associated

risk factors.

Method: Prospective observational study,

where patients above 15 years of age are

recruited from the ER at Hotel Dieu de

France hospital university Medical Center

in Beirut for a period of 12 weeks. The

study is approved by the ethical committee

of the hospital. A consent is signed by the

patients. A questionnaire is filled by a phy-

sician to collect the following data: asthma

medications at home, previous visit to an

asthma specialist, presence of allergic rhini-

tis and smoking history. After data collec-

tion, a descriptive analysis is done.

Results: Of 3110 adult ER visits between

October and December 2013, 65 were for

asthma exacerbation; 46 (71%) were on

asthma medications at home(ICS/

LABA � LTRA), 80% had already visited

at least once an asthma specialist. A his-

tory of allergic rhinitis was observed in

85% of the patients and 63% had a

Poster Session Group II – Red. TPS 38 – Epidemiology

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 369

smoking history. 82% of all consultations

were discharged home; 15% needed a hos-

pital admission to the floor and 3% needed

to be admitted to the intensive care unit.

Conclusion: The prevalence of asthma

exacerbation in the ER is relatively low;

knowing that patients have easy access by

mobile phone to their physician in this

area of practice. The majority of patients

presenting to the ER were evaluated at

least once by a specialist and were under

asthma medications at home. The presence

of allergic rhinitis or a smoking history is

associated with more hospital admissions.

991

Effect of inhaled corticosteroids on

evolution of bronchial asthma in young

adults

Ivanov, A; Chernyak, B

Irkutsk State Medical Academy of Continuing

Education, Irkutsk, Russia

Background: Aim of the study was to ana-

lyze the effect of treatment with inhaled

corticosteroids (ICS) on the evolution of

bronchial asthma (BA) from childhood to

young adulthood.

Method: Comparative analysis of the

dynamics of the disease held in two groups

of patients aged 19–35 years old, suffering

from childhood. The first group (n = 41)

consisted of patients whose BA severity in

adulthood compared with childhood

decreased. The second group (n = 24) –patients whose disease severity over the age

of 18 years increased. Diagnosis of BA and

detection of BA severity were made

according to GINA guidelines (FEV1, PEF

variability, daytime and nighttime symp-

toms, therapy). Retrospective analysis of

childhood BA severity was based on anam-

nesis and data from medical archives.

Results: In the first group, where BA in

adults has become more mild than in child-

hood, regular and long term treatment

with ICS was performed in 26 persons

(63.5%), whereas in the second group,

which was characterised by increasing

severity of the disease, ICS were used

much less frequently – Only 6 of the 24

cases (25.0%). Using logistic regression

analysis showed that inadequate therapy in

childhood is a significant risk factor for the

rise of BA severity (OR = 5.2; CI

1.5 < OR <18.8; P = 0.006).

Conclusion: Retrospective analysis of the

dynamics of BA from childhood to young

adulthood showed that in the group of

persons receiving regular treatment in

childhood significantly more frequently

formed mild BA. In turn, the lack of ade-

quate management in children is a risk fac-

tor for more severe illness.

992

The possibility of early diagnosis of

asthma in a lack of specialised personnel

Nurpeissov, TT; Nurpeissov, TN; Berkinbayev, SF;

Abdushukurova, G; Nurpeissov, T

SRI of Cardiology and Internal Diseases, Republican

Allergological Center, Almaty, Kazakhstan

Background: According to GINA, in the

most developed countries the prevalence of

asthma exceeds 10%, whereas in the devel-

oping countries this measurement is far

lower. Reverse pattern is observed in mor-

tality rates, which is due to, firstly, the

high organization of early diagnosis and

detection of asthma, and, secondly, the

ability of organized healthcare to signifi-

cantly reduce the proportion of severe

cases and complications. In Kazakhstan,

the availability of an organized asthma

health care is insufficient even in the sub-

urbs of large cities, that requires the devel-

opment of alternative approaches.

Aim: To explore the possibilities of initial

detection of asthma at an early stage by

surveying and measuring of PEF without

specialised personnel assistance.

Method: During the cross-sectional study,

we examined 997 people from the subur-

ban village of Almaty (more than 40% of

the entire adult population of the settle-

ment). All of them have filed the question-

naires (n = 997). PEF measurement was

conducted in the case of any doubt about

the presence of respiratory pathology and

was performed in 811 persons (81.3%).

Age of the respondents ranged from 15 to

80 years, average – 49.8 � 3.0 years. Male/

female = 41.4%/58.6%, respectively. Social

status: unemployed – 26.5%, pensioners –14.8%. Level of education: secondary edu-

cation – 94.9%, including 38.2%, who had

a university of college degree.

Results: The presence of asthma during

questionnaire-based survey was admitted

by five women (0.86%) and one man

(0.24%), the presence of chronic obstruc-

tive lung disease – by 6.5% of men and

6.3% of women. Normal PEF values were

detected just in 20.7% of the subjects!31.3% of patients had 60–80% of pre-

dicted PEF values, 34.4–40–60%, 13.6% –below 40% of the expected rates, which

suggest insufficient compliance and the

lack of peakflowmetry technics.

Conclusion: Thus, the first phase of the

study showed that the application of the

common questionnaires, as well as con-

ducting peakflowmetry without involve-

ment of specialised personnel is not able to

provide the reliable data on the prevalence

of asthma, as well as provide a diagnosis

in the early stages. Additional training

activities of the peakflowmetry technique

for primary health care workers, as well as

the development of more accurate and effi-

cient algorithms, including questionnaires,

functional and laboratory methods of diag-

nosis and differential diagnosis, applicable

in the ‘field’ conditions, is required.

993

Assesment of some aspects of the

property of life of patients with bronchial

asthma

Yakovliev, PH1; Vulcheva, TU2; Komsijska, D3; Takovska,

ND4; Paskova, E5

1Allergology and Clinical Immunology, Tracian

University of Stara Zagora, Stara Zagora, Bulgaria;2Clinical Center of Allergology, Medical University of

Sofia, Sofia, Bulgaria; 3Psychiatry and Medical

Psychology, Tracian University of Stara Zagora, Stara

Zagora, Bulgaria; 4Consulting Room of Blagoevgrad,

Allergology and Clinical Immunology, Blagoevgrad,

Bulgaria; 5Consulting Room of Vidin, Allergology and

Clinical Immunology, Vidin, Bulgaria

Background: Fifty-three outpatients with

bronchial asthma in remission were investi-

gated in order to analyse the influence of

the suffering over social functioning as two

mutually connected axes determining the

property of life.

Method: Within research is used a ques-

tionnaire for propery of life of patients

with bronchial asthma, filled in by patinets.

The questionnaire for property of life

includes list of the activities, in which pati-

nets with asthma were restricted during the

last 2 weeks before the research.

Results: About 1/3 of the patients indi-

cated that during last 2 weeks they have

felt restricted mostly to doing activities at

work place, keeping the house, hurry,

climbing up and sleeping (questions from

group A). On accounting the results of the

answers of questions from group B there

was determined considerable differences

between groups, formed in dependence

with etiology of the ailment. The results

given make it clear that ills with nonatopic

bronchial asthma have much more subjec-

tive complaints and the property of their

life is changed from the illness in much

higher degree in comparison with atopics.

Patients with nonatopic bronchial asthma

have restricted themselves more to casual

duties, and have narrowed their social con-

tacts as well because of the necessity to

avoid surroundings, filled with tobacco

smoke, scents and pollution. More often

they experience anxiety, fear, disappoint-

ment and disturbances in their sleep in

connection with the illness. On accounting

the influence of age over property of life of

ills with bronchial asthma in remission, it

was determined that age has considerable

influence on the degree of its worsening.

Conclusion: Property of life of women ill

with nonatopic form of bronchial asthma,

at the age of 30–45 years, is obstructed at

Poster Session Group II – Red. TPS 38 – Epidemiology

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453370

highest degree. Using psychotherapeutical

procedures, especially group psychother-

apy, would bring about more successful

adaptation of patients.

994

Associations of mycoplasmosis and

chlamydiosis with different pathogenic

forms of bronchial asthma with account

ethnicity

Smirnova, S; Sharavii, A; Tereshchenko, S

Scientific Research Institute of Medical Problems of the

North, Krasnoyarsk, Russia

Background: High prevalence of such infec-

tious diseases as Mycoplasmosis and Chl-

amydiosis has no small part in the

development of bronchial asthma. Aim of

Research: to study the prevalence and clini-

cal peculiarities of Mycoplasmosis and Chl-

amydiosis in patients with different

pathogenic forms of bronchial asthma (BA)

taking into account ethnicity of a patient.

Method: The research covered 239 subjects

– both the Europeoids and the Mongoloids

in the city of Krasnoyarsk and the town of

Kyzyl, all of them being BA patients of

different stages, including acute stage and

practically healthy. We had determined

antigens Mycoplasma pneumoniae, Myco-

plasma hominis, Chlamydophila pneumo-

niae, Chlamydophila psittaci and

Chlamydia trachomatis in smears of

mucosa of pharynx and antibodies to these

antigens in peripheral blood serum.

Results: We found high frequency of My-

coplasmosis and Chlamydiosis in the

inhabitants of Eastern Siberia, BA patients

with different pathogenic forms as com-

pared to control group. We had deter-

mined ethnic peculiarities of specific

immune response: IgM to M. pneumoniae

was revealed in the Europoids more fre-

quently than in the Mongoloids, but IgM

to C. pneumoniae and to C. trachomatis,

C. trachomatis antigens had been revealed

more often in the Mongoloids than in the

Europoids. We accepted as clinical equiva-

lents of Mycoplasmosis and Chlamydiosis

diagnostics the following signs: tempera-

ture around 37°C (subfebrile temperature),

non-intensive but stable coughing with

scanty mucous and muco-purulent sputum,

dyspnea of mixed character.

Conclusion: Mycoplasma and Chlamydia

are meaningful etiologic factors of bronchial

asthma. We have found the peculiarities of

immune response depending on ethnicity of

a patient (ethnic belonging). Clinical mark-

ers of Mycoplasmosis and Chlamydiosis

should be taken into account in bronchial

asthma in order to provide diagnostics

timely as well as eradication of infection

agents. Because of insufficient knowledge of

problem of bronchial asthma related to con-

tamination with Mycoplasma and Chla-

mydia we put the goal to study the

frequency of Mycoplasmosis and Chlamydi-

osis occurrence in bronchial asthma patients

and determine the characteristics clinical

course of diseases. We defined antigens

Mycoplasma pneumoniae, Mycoplasma ho-

minis, Chlamydophila pneumoniae,

Chlamydophila psittaci, Chlamydia tracho-

matis in smears of oropharynx mucosa and

antibodies to them in blood serum.

995

Nasal symptoms are common in

asthmatic subjects sensitised to house

dust mites

Xhixha, F1; Bakiri, A2; Hitaj, M3; Ibranji, A4; Elezi, K1;

Valbona, D1; Mingomataj, E4,5

1Multidisciplinary Policlinic no 3, Tirana, Albania;2Hygeia Hospital Tirana, Tirana, Albania;3Multidisciplinary Tirana Policlinics No 1, Tirana,

Albania; 4Department of Allergology & Clinical

Immunology, Mother Theresa School of Medicine,

Tirana, Albania; 5Faculty of Technical Medical Sciences,

Tirana, Albania

Background: Allergic rhinitis (AR) is an

allergen-induced, upper-airway inflamma-

tory disease, highly coexistent in allergic

asthma patients, characterised by hyperac-

tive airway mucosa and episodes of chronic

symptoms with periods of acute exacerba-

tion, during exposure to highly allergen-

concentrated environments.

Methods: In our prospective study, we

report results on allergic rhinitis in 116 asth-

matic patients sensitised by house dust mites.

Multidisciplinary Tirana polyclinics 1 and 3

have provided the study data on patients

with asthma history of 2 years up to

20 years, all sensitised by house dust mites.

There have been enrolled 74 females and 42

males.

Results: We found persistent symptoms of

allergic rhinitis in 67 patients; intermittent

symptoms in 31, and 18 did not manifest

any symptoms at all. Within the subgroup

of patients with persistent rhinitis symp-

toms, almost 40% of the patients referred

to have a minimal persistent nasal obstruc-

tion only when asked by the specialist.

Within the group of 98 patients with

persistent and intermittent rhinitis symp-

toms, we found that 73 patients or 74%

reported rhinitis, cough and dyspoea symp-

toms when exposed to highly concentrated

environments with house dust mites such

as closed living and working places or air

conditioned and not properly ventilated

closed spaces.

Discussion: The purpose of this study is to

show the high incidence of allergic inter-

mittent or persistent rhinitis, in asthmatic

subjects sensitised by house dust mites, and

the importance of the environmental fac-

tors contributing to the severity and fre-

quency of symptoms onset.

996

Association of allergic rhinitis and

asthma with aeroallergenes

Qama, D1,2,3; Nano, A1; Shehu, E2; Hoxha, M3

1Regional Hospital of Berat, Internal Medicine, Berat,

Albania; 2Regional Hospital Durres, Durres, Albania;3Allergy Unit UHC Mother Teresa, Tirane, Albania

Background: The prevalence of allergic dis-

eases is growing all over the world. The

association of aeroallergen with allergic

diseases is changing too. We aimed to

investigate the prevalence of aeroallergens

and the correlation with Asthma and Rhi-

nitis to allergic patients in our clinic.

Method: This is a retrospective study. A

total number of 947 adult patients were

included, who were referred in our clinic

during the last 10 years. We examined all

the patients and performed the basic aller-

gic examinations as: spirometry with bron-

chodilator response, skin prick test and

methacholine challenge when was needed.

Results: From all the patients, 599 of them

were diagnosed with Bronchial Asthma.

From them 71% had allergen induced

asthma and 29% non allergic Asthma. In

the study 62% of them were women. From

the sensitised patients 32% of them have

both asthma and allergic Rhinitis, 27% have

only Bronchial Asthma and 41% have Rhi-

nitis as their only allergic disease. The per-

centage of patients sensitised only to house

dust mites, parietaria weed pollen, grasses

and others were respectively: 43%, 11%, 7%

and 3%. Polisensitised patients were 36%.

Conclusion: The present study revealed

that the prevalence of allergic rhinitis has

been increasing in number compare to pre-

vious studies. Although, the most common

sensitised allergen was house dust mites,

similar to other studies, however the per-

centage of polisensitised patients was found

significantly higher.

997

Asthma diagnosis revised: overdiagnosis

revealed by methacholine bronchial

challenge

Heffler, E; Pizzimenti, S; Bussolino, C; Raie, A; Nebiolo,

F; Rolla, G

University of Torino, Medical Sciences – Allergy and

Clinical Immulogy, Torino, Italy

Background: The incidence of adults

reporting a history of asthma is rising.

Some studies suggested that this may

depend on an overall increase in asthma

awareness resulting in overdiagnosis. One

Poster Session Group II – Red. TPS 38 – Epidemiology

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 371

of the peculiar feature of asthma is bron-

chial hyperresponsiveness, easily assessable

by methacholine bronchial challenge

(MBC). The aim of this study was to

describe the use of anti-asthmatic drugs in

patients with respiratory symptoms before

formal diagnosis of asthma by MBC.

Method: retrospective study analyzing all

MBCs performed by our Allergy Outpa-

tients Clinic in the last 3 years; all MBCs

were performed to confirm/exclude the diag-

nosis of asthma in patients referred by gen-

eral practitioners and complaining asthma-

like symptoms. Patients’ clinical records col-

lected since the date of MBC have been

revised in order to obtain information on

anti-asthmatic drugs taken by patients.

Results: A total of 226 patients’ clinical

records and MBCs have been revised: 99

(43.8%) resulted positive at MBC test and

37 (37.4%) of these patients, compared to 65

out of 127 (51.2%) of those with negative

MBC, were previously taking anti-asthmatic

drugs (P = 0.03). No differences in daily

dose of inhaled corticosteroids (563.8 vs

456.3 mcg BDP equivalents in patients with

positive and negative MBC respectively,

P > 0.05) or other anti-asthmatic drugs

(LABA, LTRA), as well in duration of treat-

ment before the assessment of bronchial hy-

perresponsiveness (25.3 vs 24.9 months in

patients with positive and negative MBC

respectively, P > 0.05) were found.

Conclusion: A sizeable percentage of sub-

jects reporting physician-diagnosed asthma

have a negative MBC. Nevertheless, a

greater proportion of negative MBC

patients were taking anti-asthmatic drugs

compared to those with confirmed asthma,

underlying that overdiagnosis of asthma

may lead to over- and mis-treatment of

respiratory symptoms.

998

Burden of doctor diagnosed asthma and

its association with smoking habits and

respiratory symptoms among adult

population in Barrackpore area in West

Bengal (INDIA)

Chakraborty, K1; Mitra, RN1,2; Mahapatra, T3; Musk,

AW4; Thompson, PL4

1Barrackpore Population Health Research Foundation,

Population Health, Kolkata, India; 2Population Health,

University of Western Australia, Perth, Australia;3Mission Arogya Health and Information Technology

Research Foundation, Public Health, Kolkata, India;4Western Australia Institute of Medical Research,

University of Western Australia, Population Health,

Perth, Australia

Background: Bronchial asthma is a com-

mon and important cause of morbidity

among adults. According to WHO esti-

mate, the number of people suffering from

asthma will cross 100 million by 2025. In

the absence of an unanimous definition,

two recent national level studies reported

the burden of 0self-reported0 and 0diag-nosed0 bronchial asthma to be 1.8% and

2.5% respectively among adult Indians.

The disease is characterised by episodes of

wheezing, breathlessness and cough while

smoking have got important roles as evi-

denced from hospital-based studies.

Method: To measure the burden of doc-

tor-diagnosed asthma and its correlates

among adults, a cross-sectional study was

conducted in six randomly chosen (from a

total 24) administrative divisions of Bar-

rackpore, an urban area in West Bengal

state of India in 2011, nested in a popula-

tion cohort which was being followed up

since 1999.

Results: Data collected from 9061 resident

adults (4287 male, 4774 female) were

included in the analyses. 3.1% males and

2.9% female were found to have diagnosed

bronchial asthma with an overall preva-

lence of 3.05%. While more than 46% of

the residents had some exposure to tobacco

smoking, current smoking was reported by

37.77% males, 0.82% females and 15.6%

asthmatics. Cough, breathlessness, phlegm,

wheezing and tightness in chest were com-

monly experienced symptoms, being pres-

ent in 15.6%, 26.8%, 75%, 16.7%, 38%

and 30.4% of the asthmatic subjects

respectively. Asthma was found to be

strongly associated with advancing age.

Conclusion: This study did provide impor-

tant information regarding the burden and

correlates of doctor-diagnosed asthma.

Burden of asthma, respiratory symptoms

and prevalence of smoking were alarmingly

high. Smoking and advancing age were

found to have significant association with

bronchial asthma. Intervention to improve

awareness regarding the hazards of

tobacco smoking seemed to be urgently

required to ensue measurable reduction of

the community prevalence of bronchial

asthma.

999

The relationship between environment

and the prevalence of asthma in pre-

school children in Guangzhou

Jiaying, L1; Baoqing, S1; Huimin, H1; Jiamin, H2; Peiyan,

Z1; Nili, W1

1State Key Laboratory of Respiratory Disease,

Guangzhou, China; 2Guangzhou Medical University,

Guangzhou, China

Background: In recent decades, the preva-

lence of asthma in many countries has

increased, particularly among children.

According to previous study, we know the

influential factors included individual char-

acteristics (allergic constitution), genetic fac-

tor, and environmental factor and so on.

Environmental pollution in china is getting

worse, we don’t know whether the preva-

lence of children’s asthma related to the

environment or not. To investigate the rela-

tionship about the prevalence of children’s

asthma and the environment (passive smok-

ing, long-term exposure to plush or bubble

toys, long-term exposure to pets and use car-

pet at home, etc) could serve as strong evi-

dence for prevention of asthma in children.

Method: The questionnaire was designed

based on the internationally accepted Inter-

national Study of Asthma and Allergies

in Childhood (ISAAC) questionnaire

with combination of the epidemiological

characteristics of local allergic disorder in

Guangzhou city. Kindergartens were

selected by a random, cluster-sampling

method. There are 13 kindergartens, includ-

ing 2500 children. Parents of kindergarten

children completed the questionnaire after

taught by teacher. Relevant investigators

confirmed the effectiveness of the question-

naire by phone call. The results were

analyzed by SPSS 17.0. Multivariable logis-

tic regression was used to analyze the

associations between parent-reported

asthma and environment factors that

yielded P-values < 0.1 in the univariate

analyses.

Results: Of 2500 questionnaires that had

been handed out, 2355 were valid and 145

invalid, giving a valid answer rate of 94.2%.

The prevalence of asthma in children in this

survey was 4.2%. Applied logistic regres-

sion analysis of environment factors in chil-

dren asthma, we can found that Home or

school near the road; long-term exposure to

plush or bubble toys; pet ownership; passive

smoking, the risk of children with asthma

increased (P < 0.05). Using cotton pillow or

quilt was one of the protection factors.

Conclusion: In Guangzhou city, Home or

school near the road; long-term exposure

to plush or bubble toys; pet ownership;

passive smoking can increase the risk of

asthma in children.

Poster Session Group II – Red. TPS 38 – Epidemiology

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453372

Poster Session Group II – Red

TPS 39 – Epidemiology and mechanisms of drug allergy

1000

Characteristics of serious adverse drug

reactions among spontaneously reported

adverse drug reactions in a tertiary

university hospital

Kim, CW1,2; Kim, SH2; Eom, MR2; Jeong, EH2; Lee, HK2

1Department of Internal Medicine, Inha University

Hospital, Incheon, Korea; 2Inha Regional

Pharmacovigilance Center, Inha University Hospital,

Incheon, Korea

Background: Adverse drug reactions

(ADRs) frequently occur in hospital set-

ting, and serious ADRs (SAEs) may threa-

ten the patient’s life and affect treatment

outcome negatively. Early detection and

urgent medical intervention is required to

prevent serious outcomes from SAEs. The

number of self-reported ADRs has been

rapidly increased in Korea. This study was

conducted to investigate the clinical char-

acteristics of SAEs in a single university

hospital.

Method: ADRs reported to hospital Phar-

macovigilance Center were collected from

January 2012 to December 2013, and cases

of SAEs were selected. Clinical information

was collected from electronic medical

records.

Results: A total of 203 SAEs among 5256

ADRs were identified through spontaneous

reporting system. Among them, 78 (38.4%)

were reported from male patients, and 125

(61.5%) were reported from patients aged

50 and over. SAEs were reported by doc-

tors (41.4%), nurses (11.3%), and pharma-

cists (47.3%). ADR related-hospitalisation

or prolongation of existing hospitalisation

was the most common cause of SAEs, and

other medically important event was the

second cause. Antineoplastic agents

(33.5%), anti-infectives (18.7%), and agents

for central nervous system (16.3%) were the

drug class commonly involved, and chemo-

therapeutic agents, cephalosporin antibiot-

ics and NSAIDs were the three leading

subclass. Skin and appendages disorders

were frequently involved, and white cell and

RES disorders were the next. Severe cutane-

ous adverse reaction such as Stevens-John-

son syndrome were noted in 21 cases.

Conclusion: Chemotherapeutic agents,

cephalosporin antibiotics and NSAIDs can

elicit SAEs most frequently. Hospitalisa-

tion or prolongation of existing hospitali-

sation was the most common cause of

SAEs, and might cause increased socioeco-

nomic costs for medical care. Comprehen-

sive prophylactic approaches will be

required to prevent development of pre-

dicted SAEs, and to reduce the chance of

unpredicted SAEs.

1001

The use of propofol in patients allergic to

egg, soy or peanut

Asserhøj, L; Krøigaard, M; Mosbech, H; Garvey, LH

Gentofte Hospital, Clinic of Allergy, Hellerup, Denmark

Background: Allergy to the anaesthetic

drug propofol is infrequent, but due to it’s

contents of egg lecithin and soybean oil it

is suggested to be able to cause allergic

reactions in patients allergic to egg, soy or

peanut. In some countries manufacturer’s

product leaflets contraindicate use of

propofol in egg, soy or peanut allergic

individuals.

In the literature only five cases linking

the two types of allergy were identified but

no evidence was found for egg lecithin and

soybean oil in propofol triggering allergic

reactions. The aims of this study were

1 To estimate the frequency of propofol

allergy and

2 To investigate if patients with specific

IgE to egg, soy or peanut tolerated

propofol.

Methods: Study A examined the frequency

of propofol allergy in 273 patients investi-

gated following a suspected perioperative

allergic reaction. Of these, 153 had been

exposed to propofol and were tested with

in-vitro tests, skin tests and intravenous

provocation with propofol. Study B retro-

spectively investigated 544 adult patients

with positive specific IgE for egg, soy or

peanut. Of these 152 had been anaesthe-

tized and propofol exposure was identified

through anaesthetic charts.

Results: In study A four of the 153 propo-

fol exposed patients (2.6%) were diagnosed

with propofol allergy. Of these, three were

positive on iv provocation only and none

had allergic symptoms when eating egg,

soy or peanut or detectable levels of posi-

tive specific IgE for egg or soy. In study B

we found no sign of allergic reactions

towards propofol in 171 retrieved anaes-

thetic charts from 99 patients with specific

IgE for egg, soy or peanut.

Conclusion: No evidence was found for a

connection between allergy towards propo-

fol and allergy to egg, soy or peanut. The

present practice in some centres of choos-

ing alternatives to propofol in patients with

this kind of food allergy is not evidence

based and should be reconsidered together

with recommendations in product leaflets.

1002

Paracetamol hypersensitivity according

data of Vilnius University Hospital

Santariskiu Klinikos

Didziokaite, G1; Gaidej, O1; Kvedariene, V1,2

1Vilnius University, Vilnius, Lithuania; 2Center of

Pulmonology and Allergology, Vilnius, Lithuania

Paracetamol hypersensitivity is rare, but

reactions induced by this drug can repre-

sent wide variety of symptoms, from mild

skin reactions to severe anaphylaxis.

Aims: To evaluate paracetamol hypersensi-

tivity in Lithuanian adult population.

Methods and materials: We followed 144

adult patients (172 cases of clinical histo-

ries) with suspected paracetamol hypersen-

sitivity. Research has been conducted in

the Pulmonology and Allergology Centre

of Vilnius University Hospital Santariskiu

Klinikos for a 5 years period. Median age

was 41.0 years old [30.0–52.0] with min 18

and max 86 years. Most of patients were

females 117 (81.25%). Eighteen kinds of

medication containing paracetamol were

declared. ENDA questionnaires were com-

pleted, patch and drug provocation tests

DTPs under ENDA protocol were per-

formed to confirm the diagnosis.

Results: Most of patients experienced an-

gioedema and skin reactions – 115 (65.7%)

cases, bronchospasm – 16 (9.3%) and ana-

phylaxis – 10 (5.81%). In our study imme-

diate and non immediate reactions were

equall distributed – 74 (43.0%) vs. 72

(41.9%) accordingly. Only 16 of patients

underwent further allergological work-up

with suspected causative agents. Only 5

(31.25%) of them were true paracetamol

hypersensitivity. For one patient the hyper-

sensitivity was demonstrate by patch test,

and for 4 by OPT. All of them was skin

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 373

reactions. Nobody with anaphylaxis in

their clinical history had true paracetamol

hypersensitivity.

Conclusions: True paracetamol hypersensi-

tivity is rare. Skin reactions were the most

frequent. True hypersensitivity to paraceta-

mol was confirmed only in one-third of

patients.

1003

Aeroallergen sensitisation in a

population with propionic acid allergy

Garc�ıa Nu~nez, I1; Barasona Villarejo, MJ2; Algaba

Marmol, MA3; Suarez Vergara, M4; Escalona Pena, M5;

Reina Ariza, EM1

1Allergy Department, Hospital Quiron Malaga, Malaga,

Spain; 2Allergy Department, Hospital Universitario Reina

Sofia, Cordoba, Spain; 3INFOCA Medical Department,

Environmental Council, Junta de Andalucia, Castro del

Rio, Spain; 4Allergy Department, Hospital Quiron

Campo de Gibraltar, Los Barrios, Spain; 5Malaga SAD,

Medical Department, Malaga, Spain

Background: Propionic allergy is diagnosed

every year in more patients than previous

one, caused perhaps by a high intake of

these drugs in our population. Our aim

was to describe these patients, focusing in

atopic symptoms and in aeroallergens sen-

sitisation, looking for differences between

clinical subgroups (anaphylactic and non-

anaphylactic) after propionic intake.

Methods: All patients with a diagnosis of

propionic allergy were selected from June

2012 to June 2013. We performed a clinical

history asking about other allergic prob-

lems with skin prick test with the most typ-

ical aeroallergens in our city (mites, pollen,

epithelia, moulds, Pho d 12, Ole e 3 and

Pru p 3), and we study this sensitisation

with total and specific IgE.

Results: Twenty-three patients (10 males

and 23 females: mean age 42.30 years) were

selected. Thirteen patients (56.52%)

referred allergic rhinitis and 5 (21.73%)

mild to moderate asthma. Ten patients

(43.47%) were sensitised to olea pollen, 7

(30.43%) to cat dander, 6 (26.08%) to D.

pteronyssinus or 5 (21.73%) to L. destruc-

tor. Two patients (8.69%) were sensitised to

Pru p 3 with good tolerance to fruits in one

of them (4.34%). Three patients (13.04%)

presented anafilactic symptoms after ome-

prazol intake too. Eighteen patients

(78.26%) presented urticaria-angioedema

after propionic intake, and 5 (21.73%) an-

afilactic symptoms, without differences in

sensitisation to aeroallergens.

Conclusions:

1 Aeroallergen sensitisation in propionic

allergic patients is very similar to

other populations without this allergy,

according to previously publications.

2 Olea pollen is the most frequent aeroal-

lergen causing sensitisation, more than

mites or epithelia.

3 There are no differences between ana-

phylactic and non-anaphylactic patients

in sensitisation profile.

1004

Structure of Stevens–Johnson syndrome

in children over the past 10 years in

Vinnitsa region (Ukraine)

Katilov, O; Dmytriiev, D; Koroleva, I; Poteeva, T;

Yankovska, L; Dmytriiev, K

Vinnitsa National Medical University, Pediatric No. 1,

Vinnitsa, Ukraine

Stevens-Johnson syndrome is related to

severe, common enough system allergic

delayed-type reactions, characterised with

expressed intoxication syndrome, skin and

mucous membranes lesions.

During last 10 years we observed 62

children with this disease. Children under

the age of 1 year – 17.74%, between 1–3 years – 46.77% and children older than

3 years – 35.48%. Boys have prevailed –59.67%. Burdened allergic anamnesis had

only 9 (14.52%) children. Etiological fac-

tors were: respiratory infection – 30.64%,

medicines – 50.01%, reason undefined –19.35%. Leading role among drugs

belonged to multivitamins – 54.84% (17

patients), other drugs – 35.48% (11),

whereas antibiotics amounted to only

9.67%. During the entire observation per-

iod drugs of penicillin group had never

caused the disease.

The basis therapy was infusion therapy;

volume and value for solutions were con-

ducted by Holiday-Segar method. In most

of the patients (42) antibiotic therapy were

not performed. System steroid therapy,

mainly prednisolone, were conducted in

70.96% (44) of cases. Hormonal therapy

were conducted in daily doses of 1–1.5 mg/

kg – 77.3% (34), 2–3 mg/kg – 13.6% (6) i

9.1% (4) were receiving 10 mg/kg. All

patients received a maximum dose of pred-

nisolone and continue to have most severe

complications (osteomyelitis, pneumonia

and keratitis). Over recent years nine

patients received intravenously drip normal

human immunoglobulin one time per day

at the rate of 0.5–1 g/kg body weight for

three to four consecutive days.

In the three patients with Stevens-John-

son syndrome within 1 year after recovery

emerged asthma, one at a time patient had

pneumonia, osteomyelitis and alopecia,

two patients had keratits with sustainable

decrease in vision. All complications

occurred in the period from 1 to 3 months

after discharge from hospital. None of the

nine patients who received immunoglobulin

were not observed any complications;

catamnesis of monitoring of these patients

was 1–2 years. Application of intravenous

immunoglobulin allows to stop progression

of lesions of skin and mucous membranes,

reduce the time of hospital stay by 1.7 and

prevent complications.

1005

Aeroallergen sensitisation in a

population with pyrazolone allergy

Garc�ıa Nu~nez, I1; Algaba Marmol, MA2; Barasona Villar-

ejo, MJ3; Suarez Vergara, M4; Escalona Pena, M5; Reina

Ariza, EM1

1Allergy Department, Hospital Quiron Malaga, Malaga,

Spain; 2Environmental Council; Junta de Andalucia,

INFOCA Medical Department, Castro del R�ıo, Spain;3Allergy Department, Hospital Universitario Reina Sofia,

Cordoba, Spain; 4Allergy Department, Hospital Quiron

Campo de Gibraltar, Los Barrios, Spain; 5Malaga SAD,

Medical Department, Malaga, Spain

Background: Pyrazolone allergy is a very

typical diagnose in our patients from

20 years ago to nowadays, although its

incidence is decreasing caused by a high

consume of other NSAIDs as ibuprofen.

Our aim was to describe these patients,

focusing in atopic symptoms and in aeroal-

lergens sensitisation, looking for differences

between clinical subgroups (anaphylactic

and non-anaphylactic) after pyrazolone

intake.

Methods: All patients with a diagnosis of

pyrazolone allergy were selected during

2013. We performed a clinical report ask-

ing about other allergic problems. Skin

prick test with the most typical aeroaller-

gens in our city (mites, pollen, epithelia,

moulds, Pho d 12, Ole e 3 and Pru p 3)

were performed. We study these sensitisa-

tions with total and specific IgE too.

Results: Twenty patients (eight males and

12 females: mean age 42.75 years) were

selected. Ten patients (50%) referred aller-

gic rhinitis and 6 (30%) mild to moderate

asthma. Five patients (25%) were sensi-

tised to D. pteronyssinus, 4 (20%) to L.

destructor, 4 (20%) to Lolium or 4 (20%)

to dog dander. No panallergens sensitisa-

tions were diagnosed. Medium total IgE

was 178.94, being the medium specific IgE

to D. pteronyssinus 16.35. Pyrazolone

intake produced in fifteen patients (75%)

urticaria and/or angioedema and in 5

(25%) anaphylactic symptoms, without dif-

ferences in sensitisation to aeroallergens.

Conclusions:

1 Aeroallergen sensitisation in pyrazolone

allergic patients shows more sensitisat-

ion to house dust mites than other own

series, which main sensitisation is to

Olea pollen.

2 There are no differences between ana-

phylactic and non-anaphylactic patients

in sensitisation profile, which could be

caused by a short database.

3 More studies are needed to confirm

these results.

Poster Session Group II – Red. TPS 39 – Epidemiology and mechanisms of drug allergy

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453374

1006

Selectivity of the response to

betalactams: role of amoxicillin and

clavulanic acid

Blanca-Lopez, N1; Ruano, FJ2; P�erez, D1; Garcimartin,

MI1; V�azquez de la Torre, MI1; Torres, MJ3; Blanca, M4;

Canto, MG1

1Infanta Leonor University Hospital, Madrid, Spain;2Infanta Leonor University Hospital, Allergy Unit,

Madrid, Spain; 3Carlos Haya Hospital, M�alaga, Spain;4Carlos Haya Hospital, Madrid, Spain

Background: Subjects with immediate

hypersensitivity reactions to Betalactams

(BLs) can respond to different penicillins

and eventually other BLs from the differ-

ent groups or be selective responders.

However no data are known of the consis-

tency of the selective response after subse-

quent exposures. Our aim was to study the

consistency of the specific response in cases

of subjects with selective response to amox-

icillin (AX) and clavulanic acid (CLAV)

and exclude the presence of coexistent

responses to both drugs.

Method: We selected a group of patients

with selective response to amoxicillin and

clavulanic acid after performing a well vali-

dated protocol. After establishing the diag-

nosis subjects were rechallenged with the

tolerant BLs in order to verify the consis-

tency of the response.

Results: A total of 51 cases were finally

included. The 78% were selective respond-

ers to AX and the 22% to CLAV. Most of

the subjects included had anaphylaxis. In

the amoxicillin selective group 72% were

skin test positive and 28% required a con-

trolled challenge. In the clavulanic selective

group the 63% were by skin tests positive

and the 27% by challenge. There were no

differences in both groups.

Conclusion: The selective response to

amoxicillin or clavulanic acid seems consis-

tent and only in a minority a subsequent

exposition may indicate positive to com-

mon penicillin determinants.

1007

Our experience in patients referring

allergy to non-steroidal antiinflammatory

drugs

Garcıa Nunez, I1; Algaba Marmol, MA2; Barasona

Villarejo, MJ3; Escalona Pena, M4; Reina Ariza, EM1;

Suarez Vergara, M5

1Hospital Quiron Malaga, Allergy Department, Malaga,

Spain; 2Environmental Council, Junta de Andalucia,

INFOCA Medical Department, Castro del Rio, Spain;3Allergy Department, Hospital Universitario Reina Sofia,

Cordoba, Spain; 4Malaga SAD, Medical Department,

Malaga, Spain; 5Hospital Quiron Campo de Gibraltar,

Allergy Department, Los Barrios, Spain

Background: Non-steroidal antiinflamma-

tory drugs (NSAID) hypersensitivity is a

very common problem in our Allergy

Department, being the most frequent refer-

ring drug allergy consultations. According

to these incidences, our aim was to describe

our patients referring NSAID hypersensitiv-

ity, the study we performed to classify them

as hypersensitivity or cross-intolerance.

Methods: We selected all patients that

came to our Allergy Department during

2012 referring clinical symptoms after

NSAID intake, needing to confirm a diag-

nose and looking for alternatives. After a

clinical report focusing in drug allergy and

other allergy problems, we classify the

patients as intolerant, cross-intolerant or

possibly non-allergic patients. We proposed

a drug provocation test (DPT) with AAS

1 g (placebo-placebo-250-250-500) or with

the culprit drug in order to confirm or dis-

card a NSAID allergy and to classify the

patient as intolerant or non-allergic patient.

Results: We selected 140 patients (56 males

and 84 females). Thirty-five patients (25%)

were classified as cross-intolerant patients,

72 (51.4%) as selective and 33 (23.6%) as

possibly non-allergic patients. In selective

subgroup, 15 patients (20.8%) presented

selective allergy to salicylates, 23 (31.9%)

to propionic acid, 9 (12.5%) to arilacetic, 2

(2.77%) to paracetamol and 23 (31.9%) to

pyrazolones, needing 16 patients (22.22%)

a DPT with AAS to confirm their NSAID

selective diagnose.

Conclusion:

1 Selective patients are more common

than cross-intolerant patients, not hav-

ing problems after an AAS intake in a

high dose.

2 A well performed clinical report is very

important to classify correctly our

patients, and to avoid unnecessary

DPT or NSAID well tolerated.

3 A DPT with the culprit drug can diag-

nose a patient as non-allergic. With a

good clinical report, the risk of these

provocations are very low.

1008

Clinical analysis of patients with multiple

drug hypersensitivity syndrome in our

allergy unit

Do~na, I; Torres, MJ; Campo, P; Gomez, F; Salas, M;

Herrero, L; Ruiz, MD; Guerrero, MA; Rondon, C; Blanca, M

Allergy Unit, Regional University Hospital of Malaga,

UMA, Malaga, Spain

Background: Multiple drug hypersensitivity

(MDH) has been defined as a hypersensi-

tivity to two or more chemically unrelated

drugs. This has been specially studied in

IgE-mediated hypersensitivity reactions to

antibiotics and more recently in T-cell-

mediated reactions. However, studies

focusing in MDH in large populations are

lacking. The aim of our study was to

describe a well-characterised group of

patients diagnosed of MDH.

Method: We analyzed retrospectively all

patients with a confirmed diagnosis of drug

hypersensitivity evaluated in our allergy

department between January 2005 and

December 2010.

Results: A MDH was diagnosed in 48

(2.41%) of the 1989 patients evaluated,

being 32 females, with a mean age of

50 � 14.43 years. A total of 137 episodes

were reported: 80 (58.39%) suggested an

IgE-mediated reaction, 37 (27%) a non-

immunologic mechanism (cross-reactive to

NSAIDs) and 20 (14.55%) a T-cell medi-

ated reaction. The percentage of MHD in

patients with IgE-mediated reactions

(9.78%) was higher compared to those with

T-cell mediated reactions (5.23%) and non-

immunologic reactions (1.91%)

(P < 0.0001). The drugs most frequently

involved were dypirone (13.6%), ciprofloxa-

cin (12.1%), amoxicillin-clavulanic acid

(11.4%), amoxicillin (10%), ASA (8.6%),

ibuprofen (7.1%) and moxifloxacin (5.7%).

Sensitivity to two chemically unrelated

drugs was diagnosed in 44 patients and to

three drugs in 4. The most frequent clinical

entities were anaphylaxis/shock (42.85%)

and urticaria (34.92%).

Conclusion: Patients with IgE-mediated

reactions have a higher risk for developing

MHD. More studies are needed to confirm

this finding.

1009

Potential adverse reaction from

complementary and alternative medicine

(CAM) containing pharmaceutical

products purchased locally and overseas

Wong, HCG

Department of Medicine, University of British

Columbia, Vanoucver, BC, Canada

Background: Complementary and alterna-

tive medicine (CAM) are readily available.

Many are considered without adverse reac-

tion.

Method: Visits were made to herbal shops

and pharmacies locally (Vancouver, Can-

ada), and overseas (Hong Kong, China

and Taipei, Taiwan). Some CAM were

found to contain pharmaceutical products.

Results: Three preparations, one from

Vancouver (1), one from Hong Kong (2),

and one from Taipei (3) were found to

contain pharmaceutical products.

(1) HO CHAI KUNG TJI THUNG SAN:

Indications-speedily relieves headache,

toothache, fever, influenza.

Dosage – adult 1 packet/package TID,

half dosage for children.

Caffeine dosage for children exceeding

Health Canada′s recommendation.

Poster Session Group II – Red. TPS 39 – Epidemiology and mechanisms of drug allergy

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 375

(2) KAM0S ANTIRHEUMATIC: Combi-

nation of three essential vitamins (B1, B6

and B12).

Ingredients (each capsule): Phenazone

150 mg, Vitamin B1 10 mg, Vitamin B6

2.5 mg and Vitamin B12 25 mcg.

Phenazone with known side effect of

agranulocytosis and hepatotoxicity.

(3) NEW ZENKOKU ICHOYAKU: Chi-

nese name: Japanese formulated gastroin-

testinal medication.

A herbal and pharmaceutical combination.

Ingredients listed for pharmaceutical

products only and in Japanese.

Pharmacist not able to translate into

Chinese or English and ingredients

unknown to purchasers.

Conclusion: There is potential adverse

reaction of CAM containing pharmaceuti-

cal products. Ingredients in CAM

unknown to purchasers (and physicians)

may have the potential of herb-drug and

drug-drug interaction, overdose and aller-

gic drug reaction.

There should be higher standard of regu-

lation.

1010

Anaphylactic and anaphylactoid reactions

caused bymedicines – clinicoepiemidologic

study

Radenkova-Saeva, J1; Petrunov, BN2

1Department of Toxicology, Emergency Hospital ‘

Pirogov’, Sofia, Bulgaria; 2Immunology and

Allergology, National Center of Infectious and Parasitic

Diseases, Sofia, Bulgaria

Background: Anaphylactic and anaphylac-

toid reactions are life-threatening events

that result from an overactive and misdi-

rected immune response to different drugs.

The present results are 1-year clinico-epi-

demiologic study of such reactions caused

by medicines in patients admitted to Toxi-

cology Clinic, Emergency Hospital ‘Piro-

gov’, Sofia, Bulgaria.

Method: The records of the all hospitalised

patients due to adverse drug reactions and

toxoallergic reactions with other etiology,

during 1 year period – 2012 were reviewed

retrospectively. The methods used include:

clinical observation and examination,

together with laboratory investigation. In

some of the patients were determined the

level of specific IgG and IgE antibodies to

the responsible antibiotics.

Results: The number of patients with

adverse drug reactions and toxoallergic

reactions with other etiology were 749 for

the studed period. The cases with Anaphy-

lactic and Anaphylactoid reactions were 29

(3.87%). There were 10 men (34.46) and 19

wemen (62.52%), median age 58 (range

29–87) years. The main group of drugs

induced these reactions were: antibiotics-

in 15 patients (51.7%), NSAIDs – in seven

patients (24.1%), analgesics – in three

patients (10.4%), other drugs – in four

patients (13.8%).

Conclusion: Our data show that the antibi-

otics are the most common cause of Ana-

phylactic and Anaphylactoid reactions in

adults. Affected patients should received

extensive training in order to guarantee an

adequate emergency managment.

1011

The prevalence of severe cutaneous

hypersensitivity reactions to non-

steroidal anti-inflammatory drugs and

sulfonamides

Vertieva, E1; Kolkhir, P2; Teplyuk, N2

1Dermatology and Venerology, I.M. Sechenov First

Moscow Medical University, Moscow, Russia; 2I.M.

Sechenov First Moscow Medical University, Moscow,

Russia

Background: According to recent studies

about 1–3% drug hypersensitivity reactions

(DHR) are accompanied by skin eruptions.

Among these the most severe ones are

toxic epidermal necrolysis (TEN), Stevens-

Johnson syndrome (SJS) and some cases of

urticaria/angioedema. The aim of this work

was to study the frequency of DHR to

non-steroidal anti-inflammatory drugs

(NSAIDs) and sulfonamides in patients

with severe chronic urticaria (CU), TEN

and SJS.

Method: We followed up 33 patients with

bullous dermatoses (BD) and 110 patients

with CU of different severity in dermatol-

ogy department of our hospital.

Results: Twenty-two patients with BD had

DHR and most of them were females older

than 70 years. Three of them had TEN and

seven suffered from SJS. The most common

causative drugs were sulfonamides (n = 5,

23%) and NSAIDs (n = 3, 14%). Sulfona-

mides caused 3 SJS (14%) and 1 TEN cases

(4.6%). NSAIDs provoked TEN in one

patient (4.6%). Depending on the presence

of reactions after NSAIDs intake CU

patients were divided into two subgroups:

positive (n = 25, 22.7%) and negative

(n = 85, 77.3%). The decline in the quality

of life was more sharp in the subgroup of

NSAID-positive patients than in NSAID-

negative group (mean�SD: 54.5 � 11 vs

62 � 11.6; P = 0.044). Most of NSAID-

positive CU patients had a severe disease

course (n = 17, 68%) and a poor response to

treatment with antihistamines (n = 13, 52%).

Conclusion: The results of our study indi-

cate that TEN and SJS may occur in about

45% patients with severe BD and the most

frequently implicated drugs are sulfona-

mides and NSAIDs. Reactions to NSAIDs

are observed in ¼ of CU patients and may

be associated with the low quality of life,

severe disease course and poor response to

antihistamine treatment. Due to the high

risk of mortality, management of patients

with severe BD, especially TEN and SJS, as

well as life-threatening angioedema,

requires rapid identification and interrup-

tion of the culprit drug, specialised support-

ive care and immunomodulatory therapy.

1012

Variability in mast cell activation genes

SYK, LAT1, PLCG1, PLA2G4A and

TNFRS11A in patients with NSAID-

induced urticaria and/or angioedema

(NIUA)

Plaza-Ser�on, MDC1; Ayuso Parejo, P1; Do~na, I2; Blanca-

L�opez, N1; Cornejo-Garcia, JA3; Torres, MJ2; Fernandez,

J4; Laguna, JJ5; Osorio, M3; Godineau, V3; Galindo, L2;

Mayorga, C3; Blanca, M2; Canto, MG1

1Infanta Leonor University Hospital, Allergy Service,

Madrid, Spain; 2Regional University Hospital of Malaga,

UMA, Allergy Unit, IBIMA, Malaga, Spain; 3Regional

University Hospital of Malaga, UMA, Research

Laboratory, IBIMA, Malaga, Spain; 4Elche Hospital,

Allergy Service, Elche, Spain; 5Cruz Roja Hospital,

Allergy Service, Madrid, Spain

Background: Non-steroid anti-inflamma-

tory drugs (NSAIDs) are the compounds

more frequently involved in hypersensitiv-

ity drugs reactions. NSAIDs-induced urti-

caria and/or angioedema in patients

without pre-existing chronic urticaria

(NIUA) are considered the most frequent

entities. These symptoms are induced by at

least two NSAIDs with different clinical

structure and the underlying mechanism

proposed is based on the pharmacological

properties of the NSAIDs. These reactions

occur as a result of mast cell activation

and subsequent degranulation and genera-

tion of lipid-derived mediators. These cells

can be activated by IgE-dependent and

IgE-independent mechanisms that share

common downstream signaling pathways.

In this work, we aimed to analyze the asso-

ciation between single nucleotide polymor-

phisms (SNPs) in key genes involved in

mast cell activation and NIUA patients.

Method: A total of 450 patients with

NIUA and 500 individuals who tolerated

NSAIDs were included. Nine SNPs in five

genes (rs290986 in SYK, rs7140 in LAT1,

rs2228246 and rs753381 in PLCG1,

rs2307198, rs12749354 and rs12746200 in

PLA2G4A; and rs35211496 and rs1805034

in TNFRSF11A genes) were carried out by

means of TaqMan� probes.

Results: NIUA patients were subdivided

according to the type of response and signifi-

cant differences were found between NIUA

patients who only developed urticaria and

the following SNPs: rs2228246, OR = 0.30

(95% CI = 0.11–0.82; P = 0.031) rs35211496,

OR = 2.67 (95%CI = 1.37–5.19;P = 0.0024)

Poster Session Group II – Red. TPS 39 – Epidemiology and mechanisms of drug allergy

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453376

and rs12746200, OR = 0.14 (95% CI = 0.03–0.59; P = 0.019). Nevertheless, statistically

significant differences were not found in

genotype frequencies of these SNPs between

NIUA and tolerant.

Conclusion: We found an association

between non synonymous polymorphisms

rs2228246 PLCG1 and rs35211496

TNFRSF11A and the non encoding SNP

rs12746200, which could be involved in

PLA2G4A regulation and urticaria induced

by multiple NSAIDs.

1014

A case of Telaprevir-associated severe

cutaneous adverse reaction: evidence of

immune-mediated mechanism

Aitella, E1; Abbondanza, C2; Federico, A2; Pezone, L2;

Savoia, A2; De Bartolomeis, F1; Sacerdoti, C1; Masotta,

T2; Di Sarno, S2; Astarita, C2

1University of Naples Federico II, Naples, Italy; 2Second

University of Naples, Naples, Italy

Background: Telaprevir (Tp), as part of tri-

ple combination therapy with peginterferon

and ribavirin, is known to increase signifi-

cantly severe cutaneous adverse reactions

(SCARs) caused by peginterferon/ribavirin

in the treatment of HCV infection. To our

knowledge, mechanisms of cutaneous/sys-

temic toxicity of Tp are unknown.

Method: In December 2013 a 50 years old

woman, affected by genotype 1b chronic

hepatitis C, was admitted to our Depart-

ment for a SCAR with systemic symptoms,

5 weeks after starting a triple therapy

including Tp. The patient presented a mildly

desquamating and itchy maculopapular

exanthema (>90% of body surface area)

with fever (<38°C) and eosinophilia

(1.090 eosinophils/ml). Tp was suspected as

the culprit drug and it was stopped. Because

maculopapular exanthema did not improve,

after a week all therapy was stopped. A

treatment with methylprednisolone 80 mg/

day and cetirizine 10 mg/day was started.

Exanthema resolved within 4 weeks. The

patient refused skin biopsy. T lymphocytes

activation test in vitro was performed: after

isolation from peripheral blood by density

gradient (Histopaque 1077), PBMC corre-

sponding to 0.5 ml of blood, were cultured

in triplicate in RPMI 1640 and inactivated

10% FCS for 38 h with 45 or 135 lg of Tp

dissolved in concentration of 45 mg/1 ml of

DMSO, or without the drug. After incuba-

tion with mix of fluorochrome-conjugated

MoAb versus CD3, CD45 and HLA-DR

(FITC, PerCP, PE),

T lymphocytes were counted by flow

cytometry (FACScan). One microgram of

superantigen TSST-1 was used as positive

control of T cells activation.

Results: Baseline HLA-DR+ T cells were

on average 6%. After stimulation with Tp,

we observed a 2.3-fold increase of HLA-

DR+ T cells. Otherwise, TSST-1 induced a

1.5-fold increase of activated T cells.

Conclusion: Results of specific T cell acti-

vation with Tp suggests that the increase

of prevalence of Tp-associated SCARs

compared with dual therapy is probably

due to an immune-mediated mechanism.

1015

Multiple drug hypersensitivity in

HIV-infected patient

Carolino, F1; Santos, N1; Ferraz, R2; Carvalho, AC2;

Sarmento, A2; Cernadas, J1

1CH S~ao Jo~ao, Immunoallergology Department,

Oporto, Portugal; 2CH S~ao Jo~ao, Infecciology

Department, Oporto, Portugal

Prevalence of drug hypersensitivity (DH) is

highly increased in HIV-infected patients.

Case report: We report the case of a 49-

year-old woman, recently diagnosed with

HIV-infection and AIDS, developing a dif-

fuse maculopapular exanthema (MPE),

fever and vomiting on the tenth day under

cotrimoxazole (CMX) prophylaxis. The

drug was suspended and alternative dap-

sone initiated, with a relapse of systemic

symptoms. Because she had also anorexia,

fatigue and night sweats for the past

3 months, hospitalisation was decided and

empirical antituberculosis therapy with a 4-

drug regimen initiated. After 10 days of

treatment, the patient developed a MPE,

severe liver dysfunction and drugs were

discontinued. Reintroduction of each drug

was done separately under a desensitisation

(DZT) protocol that identified rifampicin

as the culprit. Tuberculosis was not con-

firmed and the treatment stopped. By then,

CMV infection of the gastrointestinal tract

was established and treatment with intrave-

nous ganciclovir started, with development

of a generalised MPE following the second

dose administration. Skin biopsy revealed

an unspecific inflammatory response and

CMV was also isolated from the lesions.

Reintroduction of ganciclovir was success-

fully attempted in a stepwise approach and

switch to oral valganciclovir was well toler-

ated. Later, DZT to CMX was performed

and antiretroviral therapy (ART), which

was deferred during this period, was the

last to be initiated. On the sixth day of

ART, the patient developed a slight exan-

thema, controlled with a low dose oral cor-

ticosteroid, progressively reduced until

discontinuation. No new reactions

occurred and the patient was discharged

and is now complying with ART, oral val-

ganciclovir and prophylactic treatment

with cotrimoxazole.

The authors discuss the key factors for

multiple DH reactions in this case, as virus

can interfere with several mechanisms of

the immune response.

1016

In vitro evaluation of infliximab-specific

T cells and correlation with the

development of anti-infliximab

antibodies in treated patients

Petroni, G1; Pratesi, S1; Nencini, F1; Maggi, E1; Matucci,

A2; Vultaggio, A2

1Department of Experimental and Clinical Medicine,

Transfer and High Education DENOTHE, University of

Florence, Florence, Italy; 2EPE, Porto Unit, Careggi

Hospital, Immunoallergology Department, Centro

Hospitalar S~ao Jo~ao, Florence, Italy

Background: Infliximab (IFX), a chimeric

anti-TNFa monoclonal antibody, is an

established targeted therapy for immuno-

mediated inflammatory diseases. As other

biotherapeutics, it carries potential risk of

immunogenicity, with the expansion of spe-

cific T cells and the production of specific

anti-IFX antibodies (ATI), leading to

potential loss of response or acute infusion

reactions. This study was aimed to analyse

the correlation between the expansion of

IFX-specific T cells and the development

of ATI in IFX-treated patients.

Method: A panel of 53 patients suffering

from immunomediated diseases treated

with IFX were enrolled and categorized

into two groups: reactive and non reactive

patients. Non isotype-specific ATI were

measured by a double-capture Elisa kit

assay and titred through sera dilutions.

The presence of IFX-specific T cells was

evaluated in vitro by using a T cell prolifer-

ation assay: PBMCs obtained from

patients were stimulated with or without

different doses of IFX for 5 days.

Results: We showed a significant higher

incidence of ATI in the group of reactive

patients. When evaluated for T cell

responses, we observed that all patients

that resulted positive to the proliferation

assay, also displayed the production of

ATI. However about 50% of negative T

cell responses were showed for ATI-posi-

tive patients. ATI-positive patients that

showed positive T cell response, displayed

significant higher levels of serum ATI, than

ATI-positive T cell-negative patients. None

of ATI-negative patients displayed specific

T cell response. Moreover, we observed a

significant higher incidence of T cell

responses in the group of reactive patients.

Conclusion: Our study provide evidence of a

correlation between the cellular and the

humoral responses to IFX and contributes to

the understanding of pathogenic mechanisms

of immunogenicity of biological agents.

Poster Session Group II – Red. TPS 39 – Epidemiology and mechanisms of drug allergy

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 377

Poster Session Group II – Red

TPS 40 – Food allergy I

1017

A pediatric case of erythritol allergy

treated with oral immunotherapy

Shirao, K1,2; Nagao, M3; Tokuda, R3; Nishinaka, K3;

Okahata, H4; Fujisawa, T3

1Shirao Clinic of Pediatrics & Pediatric Allergy,

Hiroshima, Japan; 2Pediatrics, Hiroshima Nishi Medical

Center, Ohtake, Japan; 3Allergy Center and Institute for

Clinical Research, Mie National Hospital, Tsu, Japan;4JA Hiroshima General Hospital, Pediatrics, Hatsukaichi,

Japan

Background: Food allergens are usually

proteins and glycoproteins. However, as

prevalence of food allergy drastically

increases in recent years, allergic reactions,

especially anaphylaxis, to rare allergens

such as sugars have been reported. Erythri-

tol is a natural sugar alcohol made by fer-

menting glucose and contained in natural

food such as fruits and mushrooms. Here,

we report a case of 11 year-old boy who

had anaphylaxis by ingesting erythritol-

containing foods and was successfully trea-

ted with oral immunotherapy.

Method: We searched for the offending

allergen and identified erythritol by double-

blind placebo-controlled food challenge and

skin test. We also confirmed that erythritol

induced significant basophil activation

(CD203c expression) in the patient, not in

normal controls. Then, we instructed him

to start erythritol elimination diet, which

completely protected him from anaphylaxis.

However, erythritol is contained in a variety

of processed foods as sweetener and a possi-

ble risk of anaphylaxis after accidental ery-

thritol ingestion was a significant burden

for him. We then performed oral immuno-

therapy for him with erythritol. We started

oral administration of erythritol once daily

from 0.1 g and built up the dose by 0.1 g to

0.2 g in 2 week interval.

Results: Although he experienced mild

allergic symptoms such as oral pruritus or

local urticaria during the escalation phase,

he could safely eat 2.0 g of erythritol after

41 weeks of the treatment and basophil

activation turned negative accordingly.

Currently, he continues daily intake of

2.0 g of erythritol as maintenance without

any symptom.

Conclusion: Oral immunotherapy with ery-

thritol may be a treatment of choice for

erythritol allergy. Elimination-rechallenge

test is scheduled at the time of the abstract

submission.

1018

Sensitisation to Anisakis spp without

clinical manifestations

Almero, R1; Chivu, C2; Jimenez, I1; Gimeno, E1;

Colomer, N1; Giner, A1; Hernandez, D1

1Hospital La Fe, Allergy, Valencia, Spain; 2Human

Nutrition and Dietetics, University of Valencia, Valencia,

Spain

Background: The anisakiosis is a parasitic

disease that occurs in humans after con-

sumption of raw or undercooked fish,

infested with larvae of Anisakis spp. The

prevalence is increasingly high and may be

caused by a higher incidence of this para-

site in fish caught. Anisakis exposure may

cause allergic manifestations including

abdominal pain, nausea and vomiting, skin

rash, urticaria, angioedema and life-threat-

ening anaphylaxis.

Objectives: To describe the characteristics

of Anisakis-sensitised subjects referring no

symptoms related to the ingestion of fish

or seafood potentially infested by Anisakis.

Method: We selected 33 patients (21

women and 12 men) showing positive spe-

cific IgE for Anisakis, but not considered

as allergic to Anisakis by their attending

doctor. We reviewed the medical records

and collected information about allergic

complaints, skin-prick tests (SPT) and IgE.

A dietitian performed a telephone survey

in 26 patients, in order to evaluate the die-

tetic habits regarding fish and seafood

ingestion before and after diagnosis. The

study was performed from January 2012 to

June 2013.

Results: Urticaria with or without angioe-

dema, exanthema and pruritus were the

most common symptoms (25/33). Anisakis

spp SPT was positive in 12 patients and

negative in 18 patients (in three cases the

test was not performed). Total IgE levels

ranged 11.2–3.708 Ku/l (mean 189 Ku/l)

and Anisakis specific IgE 0.35 Ku/l to

17.9 Ku/l (mean 1.25 Ku/l). Four patients

were co-sensitised to fish and/or seafood.

Conclusion: Sensitisation to Anisakis spp,

is not always eliciting allergic symptom-

atology. Absolute avoidance of fish and/or

seafood is unnecessary in these cases.

1019

Oral allergy syndrome

Nagy, Z

Dermatology, Szabolcs-Szatm�ar-Bereg Megyei K�orh�azak�es Egyetemi Oktat�ok�orh�az, Ny�ıregyh�aza, Hungary

Prevalence of allergic rhinitis and food

allergies has increased. In the group of IgE

mediated food allergies there is a special

form, when the food allergy is associated

with pollen allergy, the oral allergy syn-

drome. It is typically triggered by raw

fruits and vegetables. The patient first

becomes sensitised to pollen/pollens. Symp-

toms are usually mild. The symptoms-in a

small percent of the patients-may progress

beyond the mouth and throat, anaphylaxis

is rare. The chance of such event might

increase during pollen season. Detailed

medical history is mandatory. Work-up

includes skin prick testing, measuring spe-

cific IgE levels and double-blind, oral food

provocation test. Treatment options are

limited. Avoidance of food, education of

patient/relatives are equally important part

of the prevention.

History: Childhood was eventless. His

symptoms started in his teens during the

summer. Nasal congestion, frequent sneez-

ing, runny nose and ithching of the eyes

and nose. Prick test revealed sensitisation

to pollens. He did well with the help of

antihistamine. A few years elapsed rela-

tively symptom-free or with mild symp-

toms. At the age of 22, during consumptio

n of raw celeriac salad, burning, itching of

the lips, mouth, tongue and throat, oc-

cured within a few minutes. Few years

later cooked celery was consumed, the

above listed reactions appeared again. The

reactions were accompanied this time with

intense skin itching, redness with tiny urti-

cas, conjunctival erythema. Celery (raw

and cooked) was avoided. But out of the

blue, while he was drinking black tea,

sweetened with acacia honey, the symp-

toms returned with abdominal cramps and

diarrhea. The work-up and therapy is

discussed.

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453378

1020

Common gastrointestinal disorders in

young infants do not necessitate an

allergy work-up

Bergmann, MM1; Caubet, J-C1; McLin, V2; Belli, DC2;

Sch€appi, MG3; Eigenmann, PA1

1Pediatric Allergy Unit – Department of Child and

Adolescent, University Hospitals of Geneva and

Medical School of the University of Geneva, Geneva,

Switzerland; 2Gastroenterology Unit – Department of

Child and Adolescent, University Hospitals of Geneva

and Medical School of the University of Geneva,

Geneva, Switzerland; 3Clinique des Grangettes, Geneva,

Switzerland

Background: Gastrointestinal disorders

such as colic, constipation and gastro-

esophageal reflux (GER) are frequent in

young infants, but usually rather mild and

transient. Nevertheless, cow0s milk (CM)

free diets are frequently prescribed, without

proper allergy investigation. In this study,

we aimed to evaluate the real incidence of

well diagnosed common gastro-intestinal

symptoms in the first 6 months of life, and

further apply an allergy diagnostic work-

up including a diet without CM in qualify-

ing infants.

Method: Infants between 0 and 6 months

of age presenting with colic, GER, or con-

stipation, partially or completely bottle-

fed, were prospectively screened in various

outpatient settings (university specialised,

and private primary care and specialised

clinics). Recruitment criteria were based on

well-defined diagnostic criteria based on

severity and persistence of symptoms in

order to avoid recruitment of infants with

short lasting, spontaneously resolving gas-

trointestinal symptoms due to other causes.

In qualifying infants, a placebo-controlled,

CM exclusion diet protocol with two

3 week cross-over phases was planed.

Results: A total of 6208 children (0–16 years of age) visited all sites during the

3 month recruitment period. We identified

34 0–6 month old infants who consulted

for colic, constipation or symptoms sugges-

tive of GER. Only eight infants met stan-

dard diagnostic criteria but all of them had

exclusion criteria (e.g. other causes or

exclusive breast-feeding). Therefore no

infant with persistent gastrointestinal

symptoms qualified for the diagnostic diet.

Conclusion: We found that the large

majority of young infants in large prospec-

tively cohort have short lasting, benign

symptoms. This group of patients did not

qualify for investigation of possible CM

allergy as the duration of a diagnostic

CM-free diet would have exceeded the

duration of the symptoms. We suggest that

a CM eviction diet is not necessary in most

young infants presenting with colic, consti-

pation or GER.

1021

Significance of 37–50 kDa allergens in the

moderate-to-severe clinical symptoms of

buckwheat allergy

Han, Y1; Cho, J2; Lee, J-OL1; Choi, J2; Do, J-R3; Kim, J2;

Ahn, K2

1Samsung Medical Center, Environmental Health

Center for Atopic Diseases, Seoul, Korea; 2Department

of Pediatrics, Samsung Medical Center, Seoul, Korea;3Korea Food Research Institute, Seongnam, Korea

Background: The purpose of this study

was to investigate components of buck-

wheat allergens related with moderate-to-

severe allergic reactions in patients with

buckwheat allergy.

Method: Fifteen patients with a history of

buckwheat ingestion and a buckwheat spe-

cific IgE level ≥0.35 kU/l were enrolled.

They were divided into two groups accord-

ing to clinical severity scores, with 0–1being mild and 2–4 being moderate-to-

severe group. Immunoblotting was per-

formed to investigate IgE reactivity toward

buckwheat allergens and intensity of each

component was measured using a reflective

densitometer.

Results: The proportions of positive band

to the 16 kDa (62.5% vs. 0%, P = 0.026)

and 37–50 kDa (87.5% vs. 28.6%,

P = 0.041) buckwheat allergens in the

moderate-to-severe group were higher than

those in mild group. The level of buck-

wheat specific IgE of moderate-to-severe

group was higher than that of mild group

(41.3 kU/l vs. 5.5 kU/l, P = 0.037). The

median optical densities (ODs) of IgE anti-

body binding to 37–50 kDa protein were

higher in the moderate-to-severe group,

compared with those in the mild group

(130% OD vs. 60.8% OD, P = 0.037).

Conclusion: The 37–50 kDa protein is

implicated as an important buckwheat

allergen to predict moderate-to-severe clini-

cal symptoms in Korean children.

1022

Crustacean allergy: a new allergen in the

cephalothorax

Phillips, E1,2; Guill�en, D1,2; Rivero, D1,2; Fiandor, A1,2;

Caballero, T1,2; Sanz, V3; Del Pozo, V3; Olalde, S1,2;

Quirce, S1,2

1Hospital Universitario de La Paz, Allergy, Madrid,

Spain; 2Health Research Institute IDIPAZ, Madrid,

Spain; 3Fundacion Jimenez Diaz, Madrid, Spain

Background: There has been an increase in

seafood consumption worldwide, together

with an increase in adverse reactions due

to its consumption and processing. How-

ever, there are some patients with allergy

symptoms related to crustacean consump-

tion who have negative results in the

allergy tests carried out with commercial

seafood extracts.

Method: We report on three patients with

anaphylaxis after shrimp intake and who

had negative skin-prick tests and allergen-

specific IgE (Phadia ImmunoCAP) to com-

mercial shrimp extract. Therefore, we per-

formed a new interrogation concluding

that our patients had in common the habit

of sucking the shrimp’s heads. A prick-

prick test was conducted with L. vanna-

mei’s cephalothorax, which was positive in

all three patients.

Results: Allergenic extracts were prepared

from different parts of L. vannamei (ceph-

alothorax, abdomen). SDS-PAGE showed

proteins with different MW in abdomen

and cephalothorax. Afterwards, SDS-

PAGE immunoblotting was performed

with serum from the three patients, observ-

ing that all detected a 70 KDa protein in

the cephalothorax extract, which was then

characterised as hemocyanin. The patients

sera did not detect any protein in the

abdomen extract.

Conclusion: These three patients, who had

experienced anaphylaxis, were sensitised to

a protein (hemocyanin) in the shrimp ceph-

alothorax. Allergic sensitisation to crusta-

cean could not be demonstrated with the

usual testing methods in these patients, as

they use abdomen extracts which do not

include this allergen.

1023

Characterisation of IgE cross-reactivity

between Australasian crustacean species

in shellfish-allergic patients

Abramovitch, J1,2; Kamath, S3; Varese, N1,2; Zubrinich,

C2; Lopata, A3; O’Hehir, R1,2; Rolland, J1,2

1Department of Immunology, Monash University,

Melbourne, Australia; 2Department of Allergy,

Immunology and Respiratory Medicine, Alfred Hospital

and Monash University, Melbourne, Vic, Australia;3School of Pharmacy and Molecular Science, James

Cook University, Townsville, Qld, Australia

Background: Shellfish are a major cause of

food-induced anaphylaxis and crustaceans,

especially crabs and prawns, are a common

cause of shellfish allergy world-wide. Cur-

rent diagnostic tests are limited by lack of

knowledge of clinically relevant crustacean,

in particular crab, allergens and there is no

specific immunotherapy. Clinical co-allergy

between crustacean species is often

observed but whether this is due to multi-

ple sensitivities or to IgE cross-reactivity is

unclear. Adding complexity, thermal pro-

cessing alters allergenicity of food proteins.

Tropomyosin is a well-documented shell-

fish allergen and can contribute to IgE

cross-reactivity between some crustaceans.

However, knowledge of the clinical impor-

tance of crab allergens and their cross-reac-

tivity is limited. This project examined the

allergenicity, with a focus on the effect of

Poster Session Group II – Red. TPS 40 – Food allergy I

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 379

thermal processing on IgE reactivity, of

allergens from four Australasian crusta-

cean species: blue swimmer crab, mud

crab, black tiger prawn and banana prawn.

Methods: Crustacean-allergic patients were

selected on the basis of positive shrimp Im-

munoCAP (specific IgE) and convincing

clinical history. IgE reactivity of raw and

cooked crustacean extracts was assessed

using IgE ELISA, immunoblot and basophil

activation. Blue swimmer crab tropomyosin

was cloned and sequenced. IgE cross-reac-

tivity between extracts was assessed by IgE

inhibition ELISA and immunoblot.

Results and conclusions: Differences were

apparent between the crustacean species

but cooked extracts consistently showed

greater IgE reactivity than raw. Basophil

activation tests confirmed clinical relevance

of IgE reactivity. There was strong cross-

reactivity between cooked extracts, particu-

larly due to tropomyosin, but also evidence

for crab-specific IgE reactivity. Blue swim-

mer crab tropomyosin, Por p 1, was identi-

fied as a novel allergen. These findings will

advance more reliable diagnosis and man-

agement of potentially severe food allergy

due to crustaceans.

1024

Lack of diagnostic value of skin tests and

IgE levels in sesame allergy

Dano, D1; Jacquenet, S2; Verdun, S2; Kanny, G1; Bihain,

B2; Ricahrd, C3; Astier, C1; Couturier, N2

1Universit�e de Lorraine, EA7299, Nancy, France;2Genclis SAS, Vandoeuvre-L�es-Nancy, France; 3Genclis

SAS, 54000, Vandoeuvre-L�es-Nancy, France

Background: The diagnosis of food aller-

gies is based on patient’s history, skin

prick tests, IgE levels and food challenge

test. Sesame allergy is a rare food allergy

with a prevalence of <1% of seeds allergy

(Zuidmeer et al, 2008) and causes anaphy-

lactic shocks in 30% of cases (Dalal et al,

2003). We sought to study the validity of

skin test and IgE test in the diagnosis of

sesame allergy.

Method: Forty-one patients who under-

went food challenge test for sesame were

studied. The challenge was negative when

the patient could eat more than 965 mg of

sesame without symptoms. We compared

Prick tests and IgE levels with food chal-

lenge test results. Statistical Fisher exact

test was used to validate the independence

between prick test, IgEs and food challenge

tests. A P value below 0.05 was considered

statistically significant. results of pric. . .Results: Out of the 41 patients, 13 patients

had positive food challenge tests. Of the 13

allergic patients, 8 had positive prick test

to sesame and 9 had specific IgEs to ses-

ame (>0.35 kU/l).

Of the 28 non-allergic patients, 24 had

positive prick tests and specific IgEs were

detected in 24 patients.

1025

Non-exercise-induced recurrent urticaria

due to gliadins

Zambrano Ibarra, GA1; Ameiro Mateos, B2; Pinto

Fern�andez, C1; Bartolom�e Zavala, B3; Tornero Molina,

P1; De Barrio Fern�andez, MJ1

1Gregorio Mara~non Hospital, Allergy Service, Madrid,

Spain; 2Hospital General Universitario Gregorio

Mara~non, Allergy Service, Madrid, Spain; 3Bial-

Ar�ıstegui, R&D Department, Bilbao, Spain

Background: Gliadin is a major protein of

gluten that has been implicated in IgE-

mediated allergy to wheat ingestion. The

x-5-gliadin is known to represent a major

allergen in exercise-induced wheat anaphy-

laxis, nevertheless very few cases of non-

dependent exercise-induced urticaria due to

this protein are reported.

Methods: A 29-year-old non-atopic

woman, with history of duodenitis, pre-

sented since 2009, generalised urticaria,

twice a month. That usually happened 45–120 min after food intake, unrelated to any

specific food and usually occurring after

ingestion of food in restaurants. The reac-

tions were not associated with physical

activity. The patient had dyspepsia after

eating cereals, so she was assessed by a

gastroenterologist who had ruled out celiac

disease. She often associated the urticaria

with intake of large amounts of cereals. It

was performed a complete study of recur-

rent urticaria, skin prick tests (SPT) and

specific IgE determination to food allergens

(milk, egg, fish, cereals, gluten, gliadin,

vegetables, legumes, nuts, peach, apple,

banana, garlic, mustard), Anisakis and

latex.

SDS-PAGE inmunoblotting with wheat

seeds (lyophilized and extract) and gluten

were performed.

Results: SPT was only positive against gli-

adin. The serum analytical test and total

IgE values were normal. Serum specific

IgE was positive (KU/l) to gluten: 1, x-5gliadin: 7.92, wheat: 0.65 and rye: 0.93.

SDS-PAGE Immunoblotting revealed IgE-

binding bands with gluten and lyophilized

wheat seed (47/50/55 kDa), whereas no

bands appeared in wheat seed extract.

Since June 2013, she is making a gluten-

free diet without urticaria symptoms.

Conclusions: We present a case of non-

exercise-induced recurrent urticaria, in a

non-celiac woman. The molecular mass of

the bands suggest they could be gliadins

(some of them x5-gliadin). In this case

allergy symptoms could be dose-dependent,

as happens with other food allergies, so it

would be suitable to perform a screening

of gluten allergy in patients with recurrent

urticaria.

1027

Egg allergy in adults – characterisation

and component resolved diagnostic tests

Makatsori, M; Mc Kenzie, R; Skypala, I

Royal Brompton and Harefield NHS Trust, Allergy,

London, United Kingdom

Background: Ovomucoid (Gal d 1) is the

immunodominant, heat stable protein in

egg white. Significant levels of specific IgE

antibodies to Gal d 1 indicate a risk for

clinical reactions to raw and cooked egg

while low or undetectable levels suggest

tolerance to extensively heated egg. In

cases of low levels to Gal d 1, sensitisation

to egg components Gal d 2 (ovalbumin)

and Gal d 3 (conalbumin) can cause clini-

cal reactions to raw and slightly heated

egg. Children with persistent egg allergy

have significantly higher Gal d 1 levels

than children who have outgrown their

allergy. Egg allergy is less well studied in

adult populations and the usefulness of egg

allergen components is not known.

Methods: Adults who had undergone test-

ing to egg allergen components (Gal d 1,

Gal d 2 and Gal d 3) in the last 2 years in

our Food Allergy clinic were identified. A

level of >0.35 iu/ml was considered posi-

tive. Review of the patient’s clinical his-

tory, co-morbidities and specific IgE results

was carried out in order to characterise

them and assess the relevance of egg aller-

gen components.

Results: Seventeen adults were identified.

Mean age was 31.9 years (range 18–69),52.9% were female. 64.7% had a history

of eczema and 47.1% also suffered with

cow’s milk allergy. All except one had a

history of egg allergy since childhood.

Symptoms included urticaria, gastro-intes-

tinal, respiratory and anaphylaxis (n = 3).

All patients had a positive sIgE test to egg

white, 76.5% were positive to Gal d 1 and

93.8% to Gal d 2. 84% also had positive

sIgE to egg yolk. Overall, individuals with

low levels to Gal d 1 tolerated cooked egg.

Allergic patients PT+ PT- Total Non-allergic patients PT+ PT- Total

IgE+ 7 2 9 IgE+ 21 3 24

IgE- 1 3 4 IgE- 3 1 4

Total 8 5 13 Total 24 4 28

Results of prick test and IgEs levels.

Poster Session Group II – Red. TPS 40 – Food allergy I

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453380

However, two individuals with a history of

anaphylaxis had low levels of Gal d 1 (0.4

and 0.7 iu/ml).

Conclusion: Egg allergen components can

help to identify whether individuals are

likely to react to raw or cooked egg. We

recommend that adults positive to Gal d 1

should undergo skin prick testing to raw

and cooked egg in order to assess if a chal-

lenge is indicated. Clinicians, should be

aware that in contrast to paediatric popu-

lations, in adults even the presence of low

levels of sIgE to Gal d 1 may be associated

with severe reactions including anaphy-

laxis. Food challenges are therefore the

gold standard for diagnosing egg allergy in

adults.

1028

No relationship between biochemical

measures of liver function and food

sensitisation in infancy

Boyle, R; T, W; Warner, JO; PATCH Study Investigators1Imperial College London, Paediatrics, London, United

Kingdom

Background: Biochemical measures of liver

function vary widely during infancy, and

the liver is important for oral tolerance.

Previous work found a possible relation-

ship between impaired infant liver function

and IgE food sensitisation.

Method: This study was undertaken on

PATCH trial participants (trial registration

number: ISRCTN65195597). Blood was

taken at 6 months for liver function tests,

specific and total IgE. Cumulative incidence

of atopic dermatitis (AD) and history of

suspected food allergy (FA) were assessed

at 12 months. We investigated whether

there was a relationship between biochemi-

cal measures of liver function, and food

sensitisation (specific IgE ≥0.35 kU/l) at

6 months, or AD or FA by 12 months.

Results: Blood samples were available

from 547 participants – 13% sensitised to

milk, egg or peanut, 33% with AD, 16%

with suspected FA. There was no evidence

of abnormal liver function in infants with

food sensitisation (median alanine amino-

transferase (ALT) 17.5 U/l [7.0, 38.3] sensi-

tised; 20.0 [8.0, 35.0] not sensitised

P = 0.40), with AD (ALT 18.0 [7.0, 34.0]

AD; 21.0 [8.0, 36.3] no AD P = 0.19), or

with FA (ALT 15.0 [7.0, 33.0]FA; 20.0

[8.0, 36.0] no FA P = 0.25). Analyses

adjusted for gender, birth weight, parental

allergy, mode of delivery, study centre, pet

ownership, maternal education and timing

of complementary feed introduction

showed no relationship between different

biochemical markers of liver function and

food sensitisation, AD or FA.

Conclusion: In one of the largest datasets

of infant liver function reported, we found

no evidence that abnormal liver function is

associated with food sensitisation or AD in

the first year.

1029

Co-factor enhanced anaphylaxis due to

citrus allergy

Jurgens, Y1; Depreux, N1; Padro, C1; Roger, A1;

Bartolom�e, B2; Basaga~na, M1

1Hospital Universitari Germans Trias i Pujol,

Alergologia, Badalona, Spain; 2Bial-Ar�ıstegui, Bilbao,

Spain

We report a case of 15-year-old woman

who experienced recurrent episodes of ana-

phylaxis immediately after eating sweet

oranges or mandarins, only if exercise was

co-exposed with the allergen. She tolerated

all types of citric fruits without exercise. As

a personal history of atopy she presented

mild-persistent rhinitis. Skin prick-test were

positive for mites (DPT and DF) and Olea

europea pollen and negative for fungi, cat

and dog epithelia, latex and pollen (Parie-

taria Judaica, Cupressus arizonica, Platanus

acerifolia, Graminae family, Artemisia vulga-

ris). SPTs were negative for food allergens

but orange, mandarin and lemon commer-

cial extracts show a 3*3 response compare

the negative control. A prick-test with profi-

lin from Graminae pollen and LTPs (Pru

p3) were also negative. Positive SPT were

obtained for the sweet orange, mandarin,

lemon and grapefruit pulp and peel extract.

Total serum IgE (UniCAP) was 263 KU/l

and specific IgE against sweet orange was

0.88 KU/l, lemon 0.18 KU/l, mandarin

0.18 KU/l, Pru p 3 0.28 KU7/l, omega-5-

gliadin 0.02 KU/l and tryptase 2.3. SDS-

PAGE immunoblotting was performed with

sweet orange pulp extract. IgE immuno-

blotting with the patient’s serum revealed,

under non-reducing conditions, an IgE

binding band of 12 KDa and a faint one of

25 KDa. We presented a case of Co-factor

enhanced anaphylaxis due to citrus allergy.

We demonstrated by means of immunoblot-

ting that the patient was sensitised to two

proteins of 12 and 25 KDa of the sweet

orange pulp extract that they could corre-

spond to Cit s3 and Cit s1 respectively

attending its molecular weigh. To conclude,

we believe that the clinical relevance aller-

gen in this case is Cit s3. The conclusion is

based on the LTPs have been linked regu-

larly to CEFA syndrome in the mediterra-

nean area and the clinical relevance of Cit

s1 should be studied more carefully. The

immunoblotting inhibition with Pru p 3 and

SDS-PAGE immunoblotting with orange

seed extract would be performed in the

future.

1030

Birth order and food allergy: first born

children are at greater risk for

sensitisation to foods than subsequently

born children

Bak, E; van Ginkel, CD; Kollen, BJ; van der Heide, S;

Flokstra-de Blok, BMJ; Dubois, AE

UMCG, Groningen, the Netherlands

Background: First born children have a

greater chance of developing allergic condi-

tions such as atopic eczema, asthma or

rhino conjunctivitis than their subsequently

born siblings. However, no studies have

been done on the birth order effect and

food allergies. We therefore studied the

effect of birth order on sensitisation and

clinical reactivity to foods in children sus-

pected of being food allergic.

Method: Data of 658 patients who under-

went double blind placebo controlled food

challenges (DBPCFCs) with cow’s milk,

hen’s egg, peanut, cashew or hazelnut was

analysed using logistic regression. The

objective was to test the association

between the number of siblings at the time

of the birth of the patient and food-specific

IgE levels and clinical reactivity as ascer-

tained by DBPCFC. Confounding of these

relationships was assessed for age, gender,

breastfeeding (yes/no), duration of breast-

feeding in months, atopic score of the par-

ents, population size of the current

residence, and co-existent rhino conjuncti-

vitis, asthma and eczema.

Results: An effect of birth order on sensiti-

sation to foods was found: children born

first had a greater chance on being sensi-

tised to foods than subsequently born chil-

dren (Odds Ratio = 0.35, 95%CI = 0.20–0.60, P = 0.00) after correction for the con-

founders age, atopic score of the parents,

and co-existent asthma and eczema. Birth

order showed no significant effect on clini-

cal reactivity (Odds Ratio = 0.95, 95%

CI = 0.72–1.24, P = 0.70).

Conclusion: These data show for the first

time that there is a birth order effect on

sensitisation to foods in children suspected

of being food allergic. This effect remained

significant after correction for factors con-

founding this association. There is no

effect of birth order on clinical reactivity

to foods. The birth order effect is thus rele-

vant for food allergy and seems to affect

sensitisation more than clinical reactivity.

Possible causes of this effect deserve fur-

ther investigation.

Poster Session Group II – Red. TPS 40 – Food allergy I

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 381

1031

Tolerance to boiled peanut in peanut-

allergic children: potential for oral

immunotherapy?

Turner, PJ1,2; Mehr, S3; Sayers, R4; Wong, M3; Shamji,

MH5; Campbell, DE2,3; Mills, ENC4

1Imperial College London, Section of Paediatrics,

London, United Kingdom; 2Division of Paediatrics and

Child Health, University of Sydney, Sydney, NSW,

Australia; 3Childrens Hospital at Westmead, Paediatric

Allergy & Immunology, Sydney, NSW, Australia;4Institute of Inflammation and Repair, University of

Manchester/Manchester Institute of Biotechnology,

Manchester, United Kingdom; 5Section of Allergy and

Clinical Immunology, Imperial College London,

National Heart and Lung Institute, London, United

Kingdom

Background: Asian cuisine often uses

boiled rather than roasted peanut, a cook-

ing practice that may be associated with a

lower incidence of peanut allergy. We pro-

vide evidence that tolerance to boiled pea-

nut is due to loss of Ara h 2, 6 and 7 from

the peanut seed during boiling.

Methods: Sera were obtained from four

peanut-allergic children, three of whom

were undergoing oral immunotherapy to

peanut using boiled peanut. Extracts to

raw and boiled peanut (prepared in-house)

and the cooking water used to boil peanuts

were analyzed by SDS-PAGE and key

allergenic proteins identified using pub-

lished values for molecular weight. IgE-

immunoblotting was then performed using

patient and non-atopic control sera.

Results: Boiling resulted in significant

leaching of proteins from peanut into the

cooking water, including Ara h 2, 6 and 7

(2S albumin fraction). All four children

demonstrated significant IgE binding to

proteins corresponding to Ara h 2, 6 and 7

present in extracts of raw peanut and the

cooking water. Binding to boiled peanut

seeds was limited to aggregated material.

Serum IgE from a child allergic to both raw

and boiled peanut (demonstrated at formal

food challenge) bound extensively to pro-

teins in raw and boiled peanut, a pattern not

seen in the boiled peanut-tolerant patients.

No IgE binding to the extracts was observed

with the non-atopic control serum.

Conclusion: Boiling resulted in the loss of

proteins, particularly Ara h 2/6, from the

peanut seed. Tolerance to boiled peanut in

otherwise peanut-allergic subjects may

relate to the reduced Ara h 2, 6 and 7 con-

tent. Boiled peanuts may present an alterna-

tive means by which desensitisation can be

induced in peanut-allergic individuals, with

potential for increased safety and decreased

breakthrough allergic symptoms. A con-

trolled trial of tolerance induction using

boiled peanut in peanut-allergic individuals

is required to investigate this further.

1032

Safety and clinical predictors of reacting

to extensively-heated cow’s milk

challenge in cow’s milk-allergic children:

a prospective cohort study

Turner, PJ1,2; Mehr, S3; Joshi, P3; Tan, J3; Wong, M3;

Kakakios, A1,3; Campbell, DE1,3

1Division of Paediatrics and Child Health, University of

Sydney, Sydney, NSW, Australia; 2Section of

Paediatrics, Imperial College London, London, United

Kingdom; 3Childrens Hospital at Westmead, Paediatric

Allergy & Immunology, Sydney, NSW, Australia

Background: Many children with IgE-med-

iated allergy to cow’s milk (CM) can toler-

ate CM in baked foods. The clinical

characteristics and severity of reactions of

children who react to baked CM at open

food challenge (OFC) are not well defined.

Methods: Children presenting to our ter-

tiary referral clinic with a diagnosis of CM

allergy and excluding all CM in their diet

were offered OFC to baked CM. Chal-

lenges were performed with incremental

dosages to a total of one baked muffin

containing 0.5 g CM protein following a

standardised protocol. Data was collected

prospectively from 2010 to 2013.

Results: OFC to baked CM were carried

out in 70 children, of whom 51 (73%)

passed and successfully incorporated baked

CM into their diet. Nineteen children

(27%) reacted to their challenge, of whom 4

(21%) experienced anaphylaxis (according

to WAO criteria) and required intramuscu-

lar adrenaline. Significant predictors of clin-

ical reactivity to baked CM were: asthma;

asthma requiring preventer therapy; IgE

mediated clinical reactions to more than

three food groups; and those with a past

history of CM anaphylaxis. Skin prick test-

ing to CM or prick-to-prick testing with a

slurry of the challenge muffin was not pre-

dictive of challenge outcome.

Summary: We believe these data provide

valuable additional information about risk

stratification for children where a baked

CM challenge is being considered. Based

upon our population, we recommend that

initial introduction of baked CM in CM

allergic children should occur under direct

medical supervision in an environment

where severe reactions can be managed

appropriately. Particular caution should be

exercised in those CM-allergic children

who have a combination of asthma, multi-

ple food allergies and past history of ana-

phylaxis to both CM and other foods.

1033

Geographical differences in infant food

allergy prevalence are partly explained by

regional variation in the prevalence of

risk factors across two regions of

Victoria

Koplin, JJ1,2; Allen, KJ1,3,4; Molloy, J1,5; Ponsonby,

A-L1,3; Vuillermin, PJ1,5,6; on behalf of the HealthNuts

and Barwon Infant Study Investigators1Murdoch Childrens Research Institute, Parkville,

Australia; 2Centre for Epidemiology and Biostatistics,

University of Melbourne, Parkville, Vic., Australia;3University of Melbourne, Paediatrics, Parkville, Vic.,

Australia; 4Royal Children’s Hospital, Allergy and

Immunology, Parkville, Vic., Australia; 5Deakin

University, School of Health Sciences, Geelong, Vic.,

Australia; 6Barwon Health, Child Health Research Unit,

Geelong, Vic., Australia

Background: There are large differences in

food allergy prevalence between studies

both between and within countries. The

relative contribution of differences in study

methodology and prevalence of environ-

mental factors to these findings are not

known. We assessed the contribution of

participant baseline characteristics to study

specific differences in food allergy preva-

lence in two large population-derived

cohort studies conducted in separate

regions of Victoria, Australia with standar-

dised measurement of allergic outcomes.

Method: The HealthNuts study is a cohort

from the Melbourne metropolitan region

recruited at age 12 months (n = 5276). The

Barwon Infant Study (BIS) is a birth cohort

from the Barwon region – a smaller regio-

nal centre located 100 km south west of

Melbourne (n = 1069; 622 have completed

12 month review). All infants underwent

skin prick test to egg and peanut at

12 months. Those sensitised had formal in-

hospital food challenges to determine their

allergy status using standardised protocols.

The contribution of differences in risk fac-

tors to prevalence rates was calculated by

comparing the odds ratio for the associa-

tion between study cohort and food allergy

before and after adjustment for each factor.

Results: Infants in Melbourne were more

likely to be allergic to egg (OR 2.2, 95%

CI 1.4–3.5) and peanut (OR 4.7, 95% CI

1.5–14.9). The largest contributors to the

difference in food allergy between studies

were parents’ country of birth and micro-

bial exposure factors (a pet dog, living on

a farm and having siblings). Collectively,

these factors explained 32% of the varia-

tion in egg allergy between the cohorts

(adjusted OR 1.5, 95% CI 0.9–2.4), and

30% of the variation in peanut allergy

(adjusted OR 3.3, 95% CI 1.0–10.6).Conclusion: A higher proportion of Aus-

tralian-born parents and higher prevalence

of microbial exposure factors contributed

to the lower prevalence of infant food

Poster Session Group II – Red. TPS 40 – Food allergy I

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453382

allergy in the Barwon region compared

with Melbourne.

1034

State of the art of food allergy in Mexico.

MexiPrevAAl study

Medina-Hern�andez, A1; Z�arate-Hern�andez, C2;

Huerta-Hern�andez, RE3; Mendoza-Hern�andez, DA4;

MexiPrevAAl Group1Medicine Faculty, University of Queretaro, Queretaro,

Mexico; 2Hospital Universitario, CRAIC, Monterrey,

Mexico; 3Private Practice, Pachuca, Mexico; 4National

Institute of Pediatrics, Allergy, M�exico, Mexico

Background: MexiPrevAAl is a cross-sec-

tional study carried out in M�exico in 1749

new patients prospectively recruited in out-

patients clinics. The aim of this nation-

wide study was to describe the profile of

the patients with suspicion of Food allergy

seen by Healthcare professionals (allergist

and non-allergist), the normal clinical prac-

tice followed by the physicians, the social

and healthcare repercussions of allergic dis-

eases in Mexico.

Method: An observational, descriptive,

cross-sectional study was carried out from

march 2013 to march 2014 using a conve-

nience sample of allergic patients who were

treated in the departments, both private

and public, of those physicians who seen

food allergy patients.

Results: Clinical, epidemiological, diagnos-

tic, therapeutic, social and general health-

care data were collected from 1749

suspicious food allergic patients presenting

for the first time in the departments of the

researchers involved in the study.

Conclusion: Food allergy suspicion is high

in Mexico. There are two important age

groups: preschools and young adults. Food

allergy is diagnosed of the patients seen in

clinics across Mexico, and has an impor-

tant impact on the quality of life of

patients. The foods involved in reactions

change with age. The clinical presentation

changes with the food, although the skin is

the most frequently affected organ. Even if

the suspicious is high, the use of diagnosis

resources must be improved.

1035

Predictive factors of adverse effects

during specific oral tolerance induction

(SOTI) with EGG

Sola Enrique, L; Garc�ıa Figueroa, BE; Pereira Gonz�alez,

JM; Vela Vizca�ıno, C; �Alvarez Puebla, MJ; Tabar Purroy,

AI

Allergy and Inmunology Department, Hospital Complex

of Pamplona, Pamplona, Spain

Background: To assess predictors of toler-

ance in SOTI with egg in patients with per-

sistent egg allergy.

Method: In 2013, SOTI with dehydrated

egg white (OVO-DES�) was carried out by

53 patients with positive oral provocation

test(OPT) and/or recent reaction

(<12 months) and/or specific (egg white or

its proteins) IgE >50 kU/l. Updosing was

performed weekly at hospital. All patients

received premedication (montelukast and

antihistamines) during the build-up period.

Three hen eggs per week were ingested

during maintenance period. Dependent

variables: allergic reactions requiring treat-

ment(ARRT). Independent variables: sex,

age, atopic dermatitis, rhinitis, asthma,

other food allergies, anaphylactic reaction

to egg or other foods, total IgE (tIgE), spe-

cific IgE (sIgE), rates IgE/tIgE, skin prick

test, OPT accumulated dose.

Results: Sixty percent males. Mean � sd

age 133 � 31 months. Eighty percent posi-

tive OPT. Previous history: 28.3% anaphy-

lactic reaction to egg; 13.2% to other

foods; 73.6% atopic dermatitis; 69.8%

other food allergy; 56.6% asthma.

During build-up period 313 doses

administered at hospital, median 6 (IQR

4–7) per patient and 2.209 doses at home,

median 37 (IQR 25–49) per patient.

Mean � sd follow-up maintenance period

110 � 85 days. Allergic reactions: 47%

some ARRT; 32.1% build-up and 50.9%

maintenance period. Two required adrena-

line at home. Dose 900 mg the worst toler-

ated. 80% of patients with ARRT in

build-up were asthmatics vs 47.7% without

ARRT (P < 0.05). Accumulated dose in

OPT was lower in patients with (median

74 mg; IQR 24–450) than without ARRT

(median 399 mg; IQR 342.7–1074)(P < 0.05); no differences in baseline sIgE

levels between patients with and without

ARRT in build-up or maintenance periods,

however sIgE/tIgE higher in ARRT

patients.

Conclusion: The SOTI with OVO-DES� is

an effective therapeutic option in children

with persistent egg allergy that causes fre-

quent but generally mild reactions.

It is worse tolerated by patients with

asthma and with lower threshold in oral

provocation test.

1036

Alt a 1, Alternaria major allergen,

interacts with Act d 2, kiwi major

allergen

Cubells Baeza, N1; G�omez-Casado, C1; Murua-Garcia,

A1; Garrido-Arandia, M1; Gonz�alez-Melendi, P1;

S�anchez-Monge, R1; Barber, D2; Pacios, L1; D�ıaz-Perales,

A1

1CBGP, Madrid, Spain; 2IMMA, Madrid, Spain

Alt a 1 is a protein found in Alternaria

alternata spores related to virulence and

pathogenicity and considered to be respon-

sible for chronic asthma in children. We

found that spores of Alternaria inoculated

on the outer surface of kiwifruits did not

develop hyphae. Nevertheless, the expres-

sion of Alt a 1 gene was upregulated, and

the protein was detected in the pulp where

it co-localised with kiwi PR5. Pull-down

assays demonstrated experimentally that

the two proteins interact in such a way

that Alt a 1 inhibits the enzymatic activity

of PR5. These results are relevant because

patients with chronic asthma could suffer

from an allergic reaction when they eat

fruit contaminated with Alternaria.

1037

Prevalence of IgE-mediated cow’s milk,

hen’s egg and peanut allergy in an Asian

population of young children

Lee, AJ1; Wong, LS-Y1; Labastida, CB1; Tang, W-E2;

Tung, Y-C2; Yeo, Y2; Tsou, K2; Lee, L-Y3; Wang, P1;

Chan, Y-H4; Goh, AE-N5; van Bever, HP1; Shek, LP-C1,6;

Lee, B-W6

1Department of Paediatrics, Khoo Teck Puat National

University Children’s Medical Institute, National

University Hospital, Singapore, Singapore; 2National

Healthcare Group of Polyclinics, Singapore, Singapore;3Department of Neonatology, National University

Hospital, Singapore, Singapore; 4Biostatistics Unit,

National University of Singapore, Singapore,

Singapore; 5Department of Paediatrics, KK Women’s

and Children’s Hospital, Singapore, Singapore;6Department of Paediatrics, National University of

Singapore, Singapore, Singapore

Background: Although common food

allergies in early childhood, there is paucity

of data on the prevalence and natural his-

tory of hen’s egg (HE), cow’s milk (CM)

and peanut allergy in many Asian coun-

tries. This study aimed to determine the

prevalence and associated risk factors of

IgE-mediated CM, HE and peanut allergy

in young Singaporean children.

Method: From November 2012 to January

2014, a cross-sectional population study

using a validated questionnaire assessing

demographics, lifestyle, dietary practices

and food allergy history was targeted at

well children aged 11–30 months attending

vaccination centers in Singapore. Those

demonstrating a convincing history of HE,

CM or peanut allergy were invited for skin

prick testing (SPT).

Results: Of 2737 children surveyed, a con-

vincing history of HE, CM and peanut

allergy was reported in 1.8% (n = 50),

0.5% (n = 14) and 0.3% (n = 8) respec-

tively. In consenting participants, skin

prick tests were positive (wheal ≥3 mm) in

8/12 for HE allergy, 0/1 for CM allergy,

and 0/2 for peanut allergy. Hence the

adjusted SPT-proven prevalence of HE

allergy is 0.30%. For HE allergy significant

risk factors were eczema using history

alone (adj OR 4.7, 95%CI 4.4–5.1), and

Poster Session Group II – Red. TPS 40 – Food allergy I

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 383

when SPT-proven (adj OR 11.2, 95% CI

10.4–12.0). Based on history alone, signifi-

cant risk factors were eczema for peanut

allergy (adj OR 4.9, 95% CI 4.1–5.6), andtaking more than four courses of antibiot-

ics (adj OR 2.8, 95% CI 2.3–3.3) for CM

allergy. No protective effect was observed

with exclusive or any breastfeeding for

6 months, introduction of any solids by

6 months, introducing egg products by

12 months or peanut products by

12 months.

Conclusion: Based on convincing history

alone, the prevalence of HE, CM and pea-

nut allergy in our population remains low

compared to other industrialized countries.

Significant risk factors were eczema for HE

and peanut allergy, and taking more than

four courses of antibiotics for CM allergy.

1038

Skin prick tests to ovomucoid may

predict clinical reactivity in children with

sensitisation to egg

Tziotou, M; Psomiadou, M; Pananaki, A; Konstantinopo-

ulos, AP; Koutsalitis, D; Karantoumanis, D; Tzeli, K;

Roumpedaki, E; Giavi, S; Manousakis, E; Douladiris, N;

Xepapadaki, P; Papadopoulos, NG

2nd Pediatric Clinic, University of Athens, Allergy Unit,

Athens, Greece

Background: Decision points based on skin

prick tests or serum specific IgE have been

proposed for safe food re-introduction in

children with various food allergies. How-

ever, such decision points may differ

between populations and may also be dif-

ferent in children sensitised but who have

never apparently eaten or reacted to the

reference food. Our purpose was to evalu-

ate whether any measure of IgE sensitisat-

ion could predict clinical reactivity in

children with sensitisation to egg, which

had never consumed egg in any form

before.

Method: We retrospectively studied data

from children who underwent open food

challenge to boiled egg from October 1st

2012 till February 28th 2014 and who had

sensitisation to egg proteins without previ-

ous consumption of egg. Challenges were

carried out in the process of screening for

eligibility in a study, independent of skin

reactivity and specific IgE concentrations.

Data from clinical history and laboratory

tests were statistically analyzed.

Results: Twenty-nine children (19 boys) of

mean age 19.36 � 8.86 months were stud-

ied. 79% of them suffered from atopic der-

matitis and 83% had another food allergy

as well. Three children had a positive chal-

lenge. G-means and the 1-sided 95% confi-

dence interval for G-means for egg white,

egg yolk and ovomucoid skin prick tests

for the children who did not react were

calculated. Only ovomucoid skin prick test

was statistically associated with clinical

reactivity to egg, as all three children who

reacted had values beyond the 95% confi-

dence interval ([-∞ to 2.07 mm],

P < 0.001). The values for egg white and

egg yolk were [-∞ to 5.74 mm] and [-∞ to

3.04 mm] respectively. Children with atopic

dermatitis had higher ovomucoid skin

prick tests than the others (P = 0.038). sI-

gEs for egg white and egg yolk were not

different between reactors and non-reactors

in our population.

Conclusion: Skin prick tests to ovomucoid

may be able to predict reactivity to egg in

children with sensitisation to egg proteins.

The study is ongoing.

1039

Cofactor-enhanced food allergy in the

west area in the Region of Murcia

(Spain)

Casas Saucedo, R; Victorio Puche, L; Pi~nera Mart�ınez,

AE; L�opez S�anchez, D; L�opez S�aez, P

Hospital Universitario Virgen de la Arrixaca, Allergy, El

Palmar, Spain

Background: The prevalence of food

allergy has doubled in the last decade. Fur-

thermore, the increase of food allergens

involved and the severity of the reactions

are causes of concern. In cofactor-

enhanced food allergy (CEFA), identifica-

tion of food allergens is not so obvious

because the reactions takes place only

when they are associated with a cofactor,

such as NSAIDs, alcohol, exercise or stress

among others. The aim of this study is to

determine the prevalence of CEFA in

adults referred to our allergy surgery, as

well as analyzing the symptoms, the impli-

cated food and cofactors.

Method: A total of 1370 patients who

came to Allergy Department for the first

time were recruited. Their food intake

symptoms and the possible involvement of

cofactors were investigated. Skin prick test

(SPT) with aeroallergens, food and pan-

allergens (LTP, profilin and polcalcin) and

serum levels of specific IgE (CAP) against

food were performed.

Results:

1 Food allergy and CEFA was found in

21.9% and 1.24% of the patients,

respectively. The involvement of a co-

factor occurred in 5.67% of food

allergy. -The average age of the patients

was 29 years.

2 Rosaceae fruits and nuts were the most

frequent food (47.06% each), being

peanut (53%), walnut (35.3%) and

peach (29.4%) the most common. Over

88% of patients showed a positive SPT

with LTP.

3 Exercise was the most involved cofactor

(65%), followed by the NSAID (47%).

Two patients were involved both cofac-

tors.

4 The most frequent symptoms were urti-

caria and/or angioedema (58.8%) while

41.2% had symptoms of anaphylaxis.

5 SPT to aeroallergens was positive in 82%

of the patients, all of them to pollens.

Conclusions:

1 A high percentage of food allergy in

patients referred to our allergy surgery

has been detected.

2 CEFA should be considered in the

diagnosis of allergic reactions that are

involved food and NSAID, physical

exercise or other cofactors.

3 In our population, most frequently

involved food was nuts and peach, food

high in LTP.

1040

Early immunotherapy with extensively

heated cow0s milk and egg proteins

(baked foods) is safe and may promote

tolerance in food allergic toddlers

Kidon, MI1,2,3; Ofek, M2; Deutch, M1; Forschmidt, R2;

Yaron, M3; Shapira, I2; Steinberg, S3; Efrati, O2; Chiang,

WC4; Reshef, A1

1Allergy and Clinical Immunology, Sheba Medical

Center, Ramat Gan, Israel; 2Pediatric Pulmonology and

National CF Center, Sheba Medical Center, Ramat Gan,

Israel; 3Clalit Health Services, Children’s Health Center,

Rishon Lezion, Israel; 4KK Women’s and Children’s

Hospital, Pediatric Allergy, Singapore, Singapore

Background: Cow0s milk (CM) and hen0segg (egg), are the most common food aller-

gens in infants and children. New data sug-

gest that natural acquisition of tolerance

may take more than 2 years in most chil-

dren. Previous reports suggested that in

school aged children with CM/Egg allergy,

tolerant to baked proteins, frequent con-

sumption of these proteins is associated

with earlier resolution of allergy. Data on

the safety and efficacy of early treatment

with baked foods in preschool children is

insufficient.

Method: Children, <36 months, presenting

with a clear history of an immediate aller-

gic reaction or a positive open challenge to

CM/egg proteins, and evidence of IgE-

mediated hypersensitivity, were offered an

open challenge with baked protein. If no

reaction developed after consumption of

2 g of CM/Egg protein as a cookie,

patients were instructed to continue daily

consumption of the same dose and prepa-

ration for 3 months (mo) at home.

Repeated observed open challenges with

modified (less heated) cookies, were per-

formed every 3 month until the patient tol-

erated non-processed whole milk or

scrambled eggs.

Poster Session Group II – Red. TPS 40 – Food allergy I

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453384

Results: Thirty-two patients underwent

intervention, 20 allergic to CM and 12 to

egg. The mean age at initial reaction was

6.5 month. Reactions included skin (70%),

respiratory (48%) and anaphylaxis (65%).

Mean age at the beginning of intervention

was 28 months (range 12–36). During an

average follow-up of 2 years, 24 children

were able to tolerate unprocessed allergenic

proteins ad-lib, 8 were still at different

stages of processed proteins consumption.

Two incidences of allergic reactions, lim-

ited to the skin were reported, but no ana-

phylactic reactions developed secondary to

this regimen at home.

Conclusion: Early intervention with exten-

sively heated CM/Egg proteins (baked

foods) in the subgroup of food-allergic

toddlers who demonstrated tolerance to

baked foods, is safe and may promote

early acquisition of tolerance.

1041

Shrimp allergic patients are at risk when

eating mealworm

Broekman, HC1; Knulst, AC1; den Hartog Jager, CF1;

Gaspari, M2; de Jong, GA3; Houben, GF3; Verhoeckx,

KC3

1Dermatology/Allergology, UMC Utrecht, Utrecht, the

Netherlands; 2Dipartimento di Medicina Sperimentale e

Clinica, Universit�a ‘Magna Græcia’ di Catanzaro,

Catanzano, Italy; 3TNO, Zeist, the Netherlands

Background: Strategies are being devel-

oped to change the current agricultural

practices by creating more sustainable and

new climate resistant crops to ensure an

adequate, safe sustainable and nutritious

food supply in the future. For this reason,

alternative and sustainable protein sources

like mealworms, are now being explored

for the production of food and feed. How-

ever, before novel products can be

launched on the market the assessment of

food safety is vital. One of the key aspects

of food safety is the possible risk to

develop food allergy.

Method: TNO together with the University

Medical Center Utrecht developed a risk

assessment strategy to assess the allergen-

icity of mealworm proteins (Tenebrio moli-

tor L.). Fifteen shrimp allergic patients,

were tested on their allergic reaction to

mealworm protein extracts using skin prick

tests (SPT), serology, immuno-blot and

basophil activation test (BAT).

Results: Shrimp allergy was based on his-

tory, SPT, specific IgE and specialist opin-

ion. The mean age was 37 years and 47%

was male. Symptoms to shrimp ranged

from oral allergy symptoms to anaphylac-

tic shock. At the time of inclusion 73% of

the patients had a House dust mite allergy

(HDM), 73% a seasonal inhalant allergy

to grass- or birch-pollens. All patients

avoided other crustaceans, 33% had a

positive history for shellfish, 13% for fish

and 60% had 1 or more other food aller-

gies. The mean diameter of SPT for raw

mealworm was 5.8 mm compared to 8.4

for HDM and 8.4 mm for Dutch shrimp.

Mean specific IgE, measured with Immu-

noCAP, for shrimp was 22.4 kU/l. Specific

IgE to mealworm was elevated in 73% of

the shrimp allergic patients. In the BAT, a

positive reaction was seen for shrimp as

well as for mealworm extract.

Conclusion: Shrimp allergic patients are at

risk for developing allergic reactions when

consuming mealworm. Double blind pla-

cebo controlled food challenge will have to

confirm this in the coming months.

1042

Breastfeeding lowers the risk of food

allergy

van Ginkel, CD1; van der Meulen, GN2; Bak, E1;

Flokstra-de Blok, BMJ3; Kollen, BJ3; Kukler, J1;

Koppelman, GH1; Dubois, AEJ1

1Department of Pediatric Pulmonology and Pediatric

Allergology, University of Groningen, University

Medical Center Groningen, Groningen, the Netherlands;2Department of Paediatric Allergy, Martini Hospital,

Groningen, the Netherlands; 3Department of General

Practice, University of Groningen, University Medical

Center Groningen, Groningen, the Netherlands

Background: Human breast milk is gener-

ally regarded as the ideal food for infants

for the first months of life. There is evi-

dence for health, psychosocial and develop-

mental benefits. Whether breastfeeding has

a protective effect on food allergy is still

unknown and the subject of this study.

Method: This study was conducted in chil-

dren suspected of being food allergic who

underwent a double-blind placebo con-

trolled food challenge (DBPCFC) as part

of routine care. Food allergy was defined

as having at least one positive DBPCFC to

at least one food. The association between

this outcome and breastfeeding in general

and breastfeeding in months was studied

by logistic regression analysis. If necessary,

this relationship was corrected for con-

founding. The number of atopic morbidi-

ties in the child and their parents (food

allergy, atopic eczema, asthma and rhino-

conjunctivitis), specific IgE levels (kU/l),

number of siblings at the moment of birth

of the child and population of the current

place of residence were tested for their

potential confounding effects.

Results: We identified 619 children of

whom 75.6% (n = 468) where breastfed

and 24.4% (n = 151) bottle fed. The preva-

lence of food allergy did not differ signifi-

cantly between breastfed and bottle fed

children (P = 0.31). However, in logistic

regression analysis of breastfed children,

breastfeeding lowered the risk for food

allergy by 7% per month (OR = 0.93, 95%

CI = 0.88–0.98, P = 0.01) after correction

for the confounding effect of sIgE. No

other confounders were identified in this

association, including parental atopy.

Conclusion: These results suggest that

breastfeeding lowers the risk for food

allergy. The effect size was considerable

and shows a dose-response. Reverse causal-

ity is not likely to be involved in this asso-

ciation since it is not confounded by, and

therefore independent of parental atopy.

1043

Validation of the basophil activation test

in the diagnosis of peanut allergy

Santos, AF1,2; Douiri, A3; Becares, N1; Wu, S-Y1;

Stephens, A1; Radulovic, S1,2; Chan, SMH1,2; Fox, AT1,2;

Du Toit, G1,2; Turcanu, V1; Lack, G1,2

1King’s College London, Pediatric Allergy, London,

United Kingdom; 2Guy’s and St. Thomas’ NHS

Foundation Trust, Paediatric Allergy, London, United

Kingdom; 3King’s College London, Department of

Public Health Science, London, United Kingdom

Background: The majority of peanut-sensi-

tised children do not have clinical peanut

allergy. In equivocal cases, oral food chal-

lenges (OFC) are required. However, OFC

are laborious and not without risk; thus, a

test that could accurately diagnose peanut

allergy and reduce the need for OFC is

desirable.

Objective: To validate the basophil activa-

tion test (BAT) as a diagnostic marker for

peanut allergy.

Methods: Peanut allergic (PA), peanut-sen-

sitised but tolerant (PS) and non-peanut-

sensitised non-allergic (NA) children

underwent skin prick test (SPT) and spe-

cific IgE (sIgE) to peanut and its compo-

nents. BAT was performed using flow

cytometry and its diagnostic performance

was evaluated in relation to allergy versus

tolerance to peanut (n = 104). Diagnostic

cut-offs for BAT were determined and vali-

dated in an independent population

recruited prospectively (n = 65).

Results: BAT in PA children showed a

peanut dose-dependent up-regulation of

CD63 and CD203c while there was no sig-

nificant response to peanut in PS

(P < 0.001) and NA children (P < 0.001).

BAT optimal diagnostic cut-offs showed

97% accuracy (95%CI: 93; 100), 95% PPV

(95%CI: 84; 99) and 98% NPV (95%CI:

89; 100). The area under the ROC curve

was larger for BAT [0.99 (95%CI: 0.97;

1.0)] than for the other tests. In the valida-

tion study, BAT retained high diagnostic

accuracy with 100% PPV (95%CI: 100;

100) and 90% NPV (95%CI: 83; 98) and

was still better than the other tests. BAT

allowed reducing the number of required

OFC by two-thirds. Using a 2-step

Poster Session Group II – Red. TPS 40 – Food allergy I

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 385

diagnostic approach where BAT was per-

formed only following equivocal SPT or

Arah2-sIgE, BAT had a major impact

(97% reduction) in the number of OFC

required.

Conclusion: BAT proved to have high

diagnostic accuracy in discriminating

between peanut allergy and tolerance, bet-

ter than other diagnostic tests, and reduced

the need for OFC.

1044

Soy anaphylaxis in an infant: a case

report

Carrusca, C; Albuquerque, C; Sousa, V; Mendes, C

Hospital Vila Franca de Xira, Pediatrics, Vila Franca de

Xira, Portugal

Soy allergy is less common than cow milk

protein allergy in infants but in some cases

there is cossentization.

We present a case of SA in a 9-months-

old infant, with familial atopy, atopic der-

matitis and multiple food sensitisation

(cow milk, egg, wheat) confirmed by skin

prick tests (SPT) and serum specific Immu-

noglobulin E (IgE) since 4 months old.

Specific IgE to soy was 0.77 KU/l (class 2),

although SPT to soy was negative. Family

was instructed to avoid these allergens and

an extensively hydrolyzed formula was rec-

ommended.

Despite recommendations, soy formula

was given twice. Few minutes after the sec-

ond intake he had an anaphylaxis episode:

vomiting, face and neck hives and dysfo-

nia. He received proper and rapid treat-

ment at hospital with good response and a

self-injectable epinephrine was prescribed

at discharge. Four months later specific

IgE to soy was negative. Prick-to-prick

skin tests with the soy formula ingested

were negative. After 1 year of follow up no

more anaphylaxis episodes occurred, SPT

repeated have been similar and the same

allergens are avoided.

We highlight this case because severe

reactions in soy allergy are very rare, espe-

cially in infants. This case illustrates how

performance of specific IgE levels for pre-

dicting clinical reactivity may be poor in

soy allergy.

1045

Lamb meat allergy in a patient with high

specific IgE to galactose alpha-1,3-

galactose

Brændholt Rasmussen, K; Johansen, KL

Holbæk Sygehus, Holbæk, Denmark

Background: About three percentage of the

Danes suffers from food allergy. Few are

diagnosed with red meat allergy which often

presents like a delayed anaphylactic reaction

hours after ingestion. This kind of allergy

has been related to high levels of specific

IgE to alpha-gal probably induced by the

bite of the tick Ixodes Ricinus in which

alpha-gal has been found in the intestine.

Method: We present a case of a 54 year

old male, who twice have had anaphylactic

reactions after eating a burger respectively

chili con carne. He was known for years

with birch induced rhinitis and a light oral

reaction to hazelnuts. Four months later

he had a life threatening anaphylactic reac-

tion 6 h after eating grilled lamb. After

recovering he was examined with skin

prick test and specific IgE to a wide spec-

trum of allergens. Afterwards he experi-

enced an urticarial reaction after eating

pork. He refused a food challenge.

Results: Skin prick test for inhaled aller-

gens was positive to birch and dog. Blood

samples showed a high total IgE

(1.269 kU/l), slightly elevated specific IgE

to birch, horse, dog, cat, cowmilk and

pork, while specific IgE to beef was highly

elevated (42 kU/l). Suspecting allergy to

alpha-gal he could tell about lots of tick

bites when walking in the nature of Gedser

(Falster). Subsequently specific IgE to

alpha-gal was extremely high (601 kU/l).

Specific IgE to chicken was negative, while

specific IgE to lamb was 17.8 kU/l.

Conclusion: Delayed onset of allergic symp-

toms after food ingestion constitutes a diag-

nostic challenge. We diagnosed a probable

type-1-allergy to alpha-gal in a patient suf-

fering from lots of tickbites, and several

cases of delayed anaphylactic reactions

after eating different types of mammalian

meat including lamb. This type of allergy

should be considered when there has been

no obvious allergen exposition prior to the

allergic reaction. A food challenge is recom-

mended but not always feasible.

1046

Papaya (Carica papaya) airbone allergens

as a novel cause of respiratory allergy by

inhalation

Gonzalez-Perez, R; Poza Guedes, P; Matheu Delgado, V;

Sanchez Machin, I

Hospital del T�orax, Allergy, Santa Cruz de Tenerife,

Spain

Background: Although the exact incidence

of allergic reactions to papaya (Carica

papaya) remains unestablished, compared

to other foods, reactions to papaya are

uncommon. Previous studies have also

described also that the papaya flower pol-

len can induce respiratory IgE-mediated

allergy.

Method: We present a 53 year-old female

working as a clinical assistant in a geriatric

institution, complaining with a 5-years clin-

ical history of immediate nasal and ocular

symptoms (i.e. ‘watery nose and itchy

eyes’) only when handling papaya tropical

fruit. No bronchial symptoms were appar-

ently associated, and she denied previous

papaya consumption.

Results: Diagnostic work-up showed a

markedly positive (25 9 20 mm) prick-

prick with fresh raw papaya fruit with a

total serum IgE of 324 UI/l and serum spe-

cific IgE (kU/l) to papaya: 60.0. A distinc-

tive serum molecular allergy diagnostic

profile was obtained. The patient gave her

written consent to undergo an open handle

challenge (including fruit peel) with the

raw papaya fruit that elicited immediate

nasal and conjunctival symptoms, objetive-

ly meassured by a clinical score. No

changes were observed in the lung funtion

test (forced bronchial spirometry). No pre-

treatment with systemic steroids and/or an-

tihistaminics were used. Clinical follow-up

was strictly observed during the whole

challenge. No late-phase adverse events or

reactions were present after treatment with

topical steroids and oral antihistamines.

Conclusion: To our knowledge this is the

first report to show that papaya-fruit air-

borne allergens can induce immediate IgE

mediated allergic respiratory symptoms by

inhalation.

Poster Session Group II – Red. TPS 40 – Food allergy I

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453386

Poster Session Group II – Red

TPS 41 – Food allergy II

1047

The odyssey of FPIES children

Fiocchi, A; Dahdah, L; Mazzina, O; Brindisi, G; Claps, A;

Mancini, S

Ospedale Pediatrico Bambino Ges�u, Rome, Holy See,

Vatican City State

Background: Food Protein-Induced

Enterocolitis Syndrome (FPIES) is a non

IgE-mediated food hypersensitivity occur-

ring mostly in young infants. Misdiagnosis

and delay in the correct presentation to an

allergist is common.

Objective: To evaluate their diagnostic

itinerary of FPIES children presenting to a

general Pediatric Hospital to before the

diagnosis.

Method: This is a retrospective evaluation

of clinical records of children diagnosed

with FPIES.

Results: Between August 2012 and April

2013 three patients (two males, one female,

median age 10 months, SE 4), were diag-

nosed with FPIES (from rice, apple and

fish) at our institution. They had been

admitted with acute symptoms including

vomiting, pallor, and asthenia. One had

dehydration and diarrhea, none had fever.

Two were admitted with a suspicion of

sepsis, treated with antibiotics, steroids,

and plasma. They had respectively 2, 3,

and four episodes before diagnosis. During

their hospital stay, diagnostic evaluations

included the following specialists: Special-

ists involved in diagnostic pathway.

Conclusion: In Italy, children show a delay

in the diagnosis of FPIES of 8 months.

During this time, they march through spe-

cialists, experience multiple episodes,

undergo many diagnostic procedures. Edu-

cational interventions on FPIES are needed

for hospital-based pediatricians to shorten

this time.

1049

Measurement and analysis of the

common food allergens specific IgE

Huang, H1; Sun, B1; Wei, N1; Luo, W2; Zheng, P1

1The First Affiliated Hospital of Guangzhou Medical

University, Guangzhou, China; 2Guangzhou Medical

University, Guangzhou, China

Background: To discuss the positive distri-

bution characteristics and analyse the cor-

relation of common food allergen-specific

immunoglobulin E (sIgE) with suspected

food allergy patients in the First Affiliated

Hospital of Guangzhou Medical Univer-

sity.

Method: Using fluorescence enzyme-linked

immunosorbent assay to detect the serum

sIgE antibody of 854 patients, including

sevn kinds of food allergens (milk, egg

white, egg yolk, shrimp, crab, peanut and

soybean) from July 2006 to January

2013.

Results: The positive rates of the seven

kinds of food allergen were 39.3% (283/

720), 36.3 (216 /595), 9.8% (28/285),

21.2% (36/170), 24.3% (17/70), 14.8% (9/

61) and 10.0% (5/50). Two hundred and

eighty-two patients were detected egg white

and egg yolk sIgE, the positive rate of egg

white sIgE 59.6% (168/282) was much

higher than the egg yolk sIgE 9.2% (26/

282). The positive rate of the milk and egg

white sIgE were different between the age

groups and decreased with the age (milk:

v2 = 792.88; egg white: v2 = 658.21,

P < 0.01). The degree in level 4 or above

of milk and egg white sIgE were 1.08% (2/

186) and 1.12% (2/178)in positive patients.

Five hundred and twenty-eight patients

were detected milk and egg white sIgE,

26.9% (142/528) were both positive, sIgE

levels in serum of them was moderately

correlated, (rs = 0.758, P < 0.01).

We detected serum sIgE of shrimp and

crab in 64 patients, 16 cases was positive

of the shrimp, 17 cases of the crab was

positive, both positive in 16 cases, sIgE lev-

els in serum of them were highly correlated

(rs = 0.973, P < 0.01). In the simultaneous

detection of 34 patients’ serum sIgE of

peanut and soybean, peanut was positive

in four cases, soybean was positive in three

cases, both positive in two cases, sIgE lev-

els in serum of them were highly correlated

(rs = 0.879, P < 0.01).

Conclusion: Egg white is the major aller-

gen of egg allergy. The correlations of

shrimp and crab, peanut and soybean are

extremely high, probably because of their

homology; egg white and milk are not

homologous food, but the levels of sIgE

between them display a moderately correla-

tion, indicating the existing phenomenon

of common sensitisation.

Specialist Suspect N. patients Specialist Suspect N. patients

Gastroenterologist Meckel’s diverticulum,

intussusception, congenital

microvillus atrophy,

pyloric stenosis

2/3 Anesthetist Hypotension, tachycardia,

arrhythmia, hyperpnea

2/3

Pediatric Surgeon Pyloric stenosis 2/3 Metabolic disease

specialist

Metabolic acidosis, Hereditary

Fructose Intolerance

2/3

Immunologist IPEX, primary

immunodeficiency

1/3 Endocrinologist Adrenal insufficiency 1/3

Cardiologist Congenital cardiopathy 1/3 Haematologist Anemia, methemoglobinemia 2/3

Neurologist Seizures, intracranial

hemorrhage

1/3 Dietician Enteral nutrition 1/3

Allergist Anaphylaxis 3/3 Infectious disease

specialist

Sepsis 3/3

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 387

1050

Development of an allergen-microarray

for the Spanish population

Aranda Guerrero, A1; Gomez, F2; Molina, A1; Macias,

L1; Diaz-Perales, A3; Mayorga, C1; Torres, MJ2; Blanca,

M2

1Research Laboratory, IBIMA, Regional University

Hospital of Malaga, UMA, Malaga, Spain; 2Allergy Unit,

IBIMA, Regional University Hospital of Malaga, UMA,

Malaga, Spain; 3Plant Biotechnology Institute (UPM-

INIA), Madrid, Spain

Background: Allergy diagnosis based on

purified allergen provides detailed informa-

tion regarding the individual sensitisation

profile of allergic patients. Allergen micro-

arrays is a novel assay that allow the

simultaneous detection of allergic patients0

antibody reactivity profiles towards each

allergen. At present, the commercial micro-

array platform does not include all the rel-

evant and most prevalent allergens in our

geographic area, but those in the Central

and North European population. We

aimed develop a microarray matrix with

the relevant allergens in the Spanish popu-

lation and study the prevalence of sensiti-

sation in this population.

Method: Sixty patients with confirmed

plant food allergy by clinical history and

positive skin prick test were included. Fif-

teen subjects with no food allergy and skin

prick test negative to commercial extract

were included as controls. Purified proteins

(Arah9, Cora8, Mald3, Prup3, Tria14,

Actd2, Mald2, Phod2, Mald4, Arah1,

Arah2, Arah3) at 0.25 and 0.125 mg/ml

were applied on epoxy-activated glass

slides using a MicroGrid II TAS arrayer.

Each array was blocked for 1 h and incu-

bated with undiluted serum overnight at

4°C. After, the slides were incubated with

anti-human IgE labelled with PE-DY 647.

Finally, the fluorescence intensity was mea-

sured by GenePix software.

Results: From all patients evaluated, 25

(41.6%) performed anaphylaxis, 24 (40%)

oral allergy syndrome and 11 (18.3%) urti-

carial and/or angioedema. The 70%

showed levels of specific IgE for LTPs pro-

teins (Arah9, Cora8, Mald3, Prup3,

Tria14), 23.5% for profilins (Phod2,

Mald4), 15% for TLPs (Actd2, Mald2)

and 3.3% for storage proteins (Arah1,

Arah2, Arah3). Levels of specific IgE to

profilins, TLP and storage proteins were

not detected in any controls. However,

21% of controls recognised the LTPs pro-

teins. Among the LTPs evaluated, Prup3,

Arah9 and Cora8 were the most recognised

with 80%, 80% and 76.6%, respectively,

followed by Mald3 and Tria14.

Conclusion: Although different families of

proteins are presents in our environment,

the LTPs are one of the main responsible

for the sensitisation to plant food in our

population. These data require more

detailed studies in order to evaluate the

sensitivity and specificity.

1051

Determination of specific IgE for alpha-

gal in patients with delayed anaphylaxis

after mammalian meat consumption, a

case series

Schrijvers, R; Kochuyt, A-M; Ceuppens, J

University Hospitals Leuven, Leuven, Belgium

Background: Recent observations sug-

gested a link between IgE directed against

the galactose-a(1,3)-galactose (a-gal) epi-

tope, a carbohydrate moiety on non-pri-

mate mammalian proteins, and allergy to

mammalian meat and/or dairy products.

Method: We determined specific IgE (sIgE,

ImmunoCAP, Phadia, Sweden) to a-gal ineight patients presenting between 2002 and

2013 with reactions after consumption of

mammalian products. Initial evaluation

included quantification of sIgE and/or skin

prick test (SPT) for mammalian meat,

milk, and/or cetuximab.

Results: Male/female ratio was 2/6 and

median age 57 years (range 27–71). Symp-

toms ranged from urticaria to anaphylaxis

(moderate in 5/8 to severe anaphylaxis in

3/8 patients, according to Brown’s classifi-

cation) and occurred 1–7 h after meat con-

sumption. Suspected products included

beef and/or pork; one patient had isolated

reactions to pork kidney; in two patients

beef and/or pork did not systematically

provoke symptoms. SPT for the suspected

product was positive in 2/5 and doubtful

in 2/5 patients. SPT for cetuximab, a

monoclonal antibody containing a-gal, waspositive in 3/3 patients. In all patients sIgE

was elevated for a-gal (median 13.6 UA/

ml, range 2.1 to >100 UA/ml), beef (f27,

median 6.1 UA/ml, range 0.6–41.8 UA/ml)

and pork (f26, median 3.6 UA/ml, range

0.3–29.8 UA/ml). In the patient with iso-

lated reactions to pork kidney, sIgE was

only modestly elevated for pork (0.3 UA/

ml) and beef (0.6 UA/ml) whilst positive

for a-gal (13.7 UA/ml). Basal tryptase was

normal in all subjects and significantly ele-

vated in 4/4 patients where tryptase was

measured early after the reaction. Treat-

ment included eviction of mammalian meat

and/or dairy products.

Conclusion: Mammalian meat consump-

tion can be a cause of delayed anaphylaxis.

Our case series underscores the usefulness

of a-gal sIgE determination, especially in

cases with doubtful SPT positivity and/or

modestly elevated sIgE for mammalian

products.

1052

Hypersensitivity reaction due to Atherina

boyeri ingestion

Corrales-Vargas, SI1; Gonzalo-Garijo, M�A1; Bartolom�e-

Zavala, B2; P�erez-Calder�on, R1; Jim�enez-Ferrera, G1;

Mahecha, AC1; Chiarella, GM1

1Allergology, Infanta Cristina University Hospital,

Badajoz, Spain; 2Dpto. I+D Bial-Aristegui, Bilbao, Spain

Introduction: Atherina boyeri is a species of

fish which belongs the Atherinidae family.

It is widespread along coasts, in lagoons

and estuaries, and in the downstreams of

rivers. It is a small fish usually eaten fried

and the whole body. We report a case of

hypersensitivity to Atherina boyeri inges-

tion with good tolerance to other fish.

Case report: A 33-year-old woman who

presented in three occasions pruritic rash

on arms and legs about 3 h after ingestion

of fish identified as Atherina boyeri. Only

on the first occasion she was treated with

methylprednisolone i.m. with improvement

in 3 h, on the next two events the patient

improved without treatment in a similar

period of time. Thereafter she has tolerated

other fish and seafood, but she has avoided

the ingestion of Atherina boyeri.

Methods and results: Prick tests were nega-

tive with extracts of Anisakis, food (includ-

ing oily and white fish and shellfish) and

inhalant allergens. Prick-prick tests proved

positive with raw Atherina boyeri (meat,

head and guts) and head and meat fried,

and negative with fried guts. Specific IgE

by EAST method (Enzyme AllergoSor-

bent) for raw and cooked Atherina boyeri

was negative. Pricks with extracts from

raw meat and a mix of head and guts were

positive, and negative with the same

extracts cooked. SDS-PAGE immunoblot-

ting under reducing conditions (with 2-

mercaptoethanol) showed intense IgE

binding bands in the extract prepared from

the mixture of raw heads and guts around

25, 29, 33 and 37 kDa; in the extract of

raw meat a very faint band of about

45 kDa was revealed.

Conclusions: We report a case of hypersen-

sitivity due to Atherina boyeri ingestion

with good tolerance to other fish, con-

firmed by skin tests and in vitro techniques.

In the literature review we found only

three cases of hypersensitivity to Atherina

boyeri presented in congresses (none pub-

lished). The authors identify IgE binding

proteins with different molecular mass to

those detected in this study. In our case,

none of the bands revealed seems to be

parvalbumin.

Poster Session Group II – Red. TPS 41 – Food allergy II

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453388

1053

Prediction of allergen specific IgE

sensitisation by detailed history taking in

young children with food allergy

Lee, J-M; Jeong, K; Seon, M-G; Jeon, S-A; Lee, S-Y

Pediatrics, Ajou University School of Medicine, Suwon,

Korea

Background: Diagnosis of food allergy is

based on detailed clinical history, labora-

tory findings, and confirmative challenge

test but to young children, blood sampling

and food challenge test can be demanding.

This study aims to predict allergen specific

IgE sensitisation by detailed history taking

in young children.

Method: From May 2011 to April 2013,

children under 3 years old with a history

of allergic diseases and exposure to aller-

gens (egg white, cow0s milk, walnut, soy-

bean) have been enrolled and detailed

clinical histories with specific IgE sensiti-

sation were reviewed by medical records.

Clinical histories were divided into three

classes. With direct-single-ingested food,

anaphylaxis or acute urticaria was classi-

fied into class 1 (highly likelihood of sensi-

tisation) and itchy, vomit, or diarrhea was

classified into class 2 (suspicious of sensiti-

sation). Other than direct-single-ingested

ways were regarded as indirect exposure

and adverse reactions with them were clas-

sified into class 2. Meanwhile, anaphylaxis

with single-skin exposure has been classi-

fied into class 1 and inconsistent histories

of class 1 were classified into class 2. Rest

of patients was classified into class 3 (sensi-

tisation unlikely). The prognostic capacity

to allergen specific IgE sensitisation was

estimated using the area under the receiver

operating characteristic curve (AUC).

Results: A total of 182 cow0s milk (CM),

116 egg white (EW), 22 soybean, and 17

walnut exposure histories with specific IgE

levels were evaluated. AUC of class 1 CM

was 0.790, class 1 + 2 CM was 0.697, class

1 EW was 0.717, and class 1 + 2 EW was

0.750. AUC of class 1 WN, and class 1 + 2

WN was 0.775 and 0.758, respectively.

AUC of soybean was low less informative.

Conclusion: Detailed clinical history taking

in young children with food allergy has a

moderately accurate value on prognosis of

IgE sensitisation to walnut, CM, and EW.

Additional study of clinical histories on

food challenge test is in process.

1054

Dietary omega-3 polyunsaturated fatty

acids prevent impaired social behaviour

and prefrontal dopamine metabolism in

food allergic mice

de Theije, CGM1; van den Elsen, LWJ1; Willemsen,

LEM1; Milosevic, V1; Lopes da Silva, S1,2; Olivier, B1;

Garssen, J1,2; Korte, SM1; Kraneveld, AD1

1Pharmacology, Utrecht University, Utrecht, the

Netherlands; 2Nutricia Research, Utrecht, the

Netherlands

Background: It is suggested that allergic

immune activation, combined with a

genetic predisposition, may contribute to

the expression of aberrant social behaviour

relevant to autism. We have previously

shown that a food allergic response

reduced social behaviour in mice, which

was associated with altered dopaminergic

activity in brain regions relevant for social

and emotional behaviour. Dietary fatty

acid composition has been shown to affect

both the immune system and neurological

processes and may therefore contribute to

the prevention of food allergy-induced

abnormalities in social behaviour.

Method: The aim of this study was to

assess whether dietary supplementation

with fish oil rich in long chain omega-3

polyunsaturated fatty acids (n-3 LCPUFA)

prevents food allergy-induced abnormali-

ties in social behaviour and associated defi-

cits of the dopaminergic system in the

prefrontal cortex of whey-sensitised mice.

Results: The n-3 LCPUFA-enriched fish

oil diet decreased the acute allergic skin

response and was able to prevent the dis-

turbance in social behaviour of whey-sensi-

tised mice. N-3 LCPUFA supplementation

increased docosahexaenoic acid (DHA)

incorporation in the brain and restored lev-

els of dopamine and its metabolites 3,4-di-

hydroxyphenylacetic acid (DOPAC), 3-

methoxytyramine (3-MT) and homovanillic

acid (HVA) in the prefrontal cortex of

allergic mice. Moreover, reduced levels of

5-HIAA, metabolite of serotonin, in intes-

tines of allergic mice was also restored by

the n-3 LCPUFA-enriched diet.

Conclusion: In addition to its effects on

the allergic skin response, n-3 LCPUFA

restored allergy-induced deficits in social

behaviour and in prefrontal dopamine and

metabolite levels. Therefore, n-3 LCPUFA

may exert its beneficial effect on behaviour

via modulation of the dopaminergic system

in the prefrontal cortex and may therefore

be an interesting target in the use of die-

tary interventions for immune-mediated

psychiatric disorders such as ASD.

1055

Are skin prick tests a reliable predictor of

oral food challenge outcomes?

Loprete, JN1,2; Katelaris, CH1,3

1School of Medicine, University of Western Sydney,

Penrith, Australia; 2Department of Medicine,

Campbelltown Hospital, Campbelltown, Australia;3Department of Immunology, Campbelltown Hospital,

Campbelltown, Australia

Background: Supervised food challenges

are a time consuming but necessary investi-

gation to determine when a child has

developed tolerance to a particular food.

We performed an audit of challenges with

common foods performed in our service in

recent years examining the positivity rate

and looking for correlations with skin test

size.

Method: Over the last 3 years at Camp-

belltown Hospital, 378 challenges were per-

formed with cow’s milk, egg and various

nuts. Characteristics of the 87 positive

challenges were analysed using SPSS. In

addition, all information on performance,

and outcomes of, tree nut challenges were

examined.

Results: Positive challenges were as fol-

lows: baked egg: 8/44 (18%); lightly

cooked egg:20/82 (24%); milk: 8/20 (40%);

peanut: 35/108 (32%); tree nuts:14/94

(15%); mixed tree nuts 2/30 (6%).There

were no statistically significant correlations

between skin test size and positive food

challenge with any of these foods. For six

of the patients with positive peanut chal-

lenge, skin tests had become negative at

the time of challenge.

Conclusion: In selected children, perfor-

mance of a mixed tree nut challenge

proved to be an efficient way of clearing

these nuts for consumption.

The lack of significant correlation

between SPT and oral food challenge out-

comes supports the necessity for perform-

ing supervised food challenges to

determine tolerance. In our population, the

risk of a positive challenge was greater

with peanut, lightly cooked egg and milk.

Performing a challenge of mixed tree nuts

rather than individual tree nuts in those

with positive skin tests to one or more tree

nuts appears to be an efficient mechanism

to reduce the number of food challenges in

those who have had a clinical reaction to

peanut but not to tree nuts.

Poster Session Group II – Red. TPS 41 – Food allergy II

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 389

1056

Feasibility of mixed nut challenges in

children with multiple sensitisation to

tree nuts

van Erp, FC1; Kok, IL2; van Velzen, MF1; Knulst, AC3;

van der Ent, CK1; Meijer, Y1

1Paediatric Pulmonology and Allergology, University

Medical Centre Utrecht, Utrecht, the Netherlands;2Department of Dietetics, Internal Medicine and

Dermatology, University Medical Centre Utrecht,

Utrecht, the Netherlands; 3Department of (Paediatric)

Dermatology and Allergology, University Medical

Centre Utrecht, Utrecht, the Netherlands

Background: In children without previous

ingestion of any tree nut before (due to

eczema) or with suspected allergy to one

specific tree nut, multiple sensitisation to

tree nuts is common. To minimize the risk

of accidental reactions due to contamina-

tion, those children are advised to exclude

all nuts from their diets. Multiple food

challenges are needed to determine the

presence of clinical relevant tree nut aller-

gies. A pilot study to determine the feasi-

bility of mixed nut challenges in children

with multiple sensitisation to tree nuts was

performed. The first data are presented in

this abstract.

Methods: Children with previous negative

hazelnut challenge and multiple tree nut

sensitisation underwent an open mixed nut

challenge containing five gram of a mini-

mum of four tree nuts followed by the

ingestion of whole nuts and when indicated

a reintroduction schedule at home. Feasi-

bility regarding safety, reactions during

challenge, tolerance of the challenge mate-

rial, satisfaction of the parents, reintroduc-

tion and dietary restrictions after challenge

were evaluated.

Results: Until now, 13 children with a

mean (SD) age of 9.6 (3) years sensitised

for more than two different tree nuts were

included for this study. Mixed nut chal-

lenges were well accepted and conclusive in

12/13 (92%) children and had a negative

outcome in 8/12 (67%) children. No life

treating reactions were observed, reactions

were classified up to Sampson grade 2.

Nine children (69%), including the child

with inconclusive outcome, managed to

reintroduce one or more tree nuts at home.

Three children (23%) could return to a diet

without any nut related restrictions. The

mixed nut challenge could prevent at least

two open single nut challenges in all but

one child.

Conclusion: Mixed nut challenges are well

accepted, safe and an efficient way to

exclude multiple nut allergies in children

with multiple sensitisations to tree nuts

and no previous reactions. Negative mixed

nut challenges do not always result in a

restriction free diet due to possible contam-

ination with other allergens or the absence

of nut specific labelling of products.

1057

Component resolved diagnosis in

eosinophilic esophagitis: special focus on

panallergens

Lluncor, M1; Cancelliere, N1; Pagola, MJ1; Fiandor, A1;

Quirce, S1; Caballero, T1

1Allergy Department, Hospital Universitario La Paz,

Madrid, Spain

Background: Eosinophilic esophagitis

(EoE) patients show variable sensitisation

patterns. Component resolved diagnosis

(CRD) could improve its diagnosis and

management. Imnuno-solid-phase allergen

chip (ISAC) allows simultaneous assess-

ment of specific IgE antibodies to different

allergens enabling to distinguish primary

sensitisation from sensitisation due to

cross-reactivity. The aim of this study was

to describe the allergen sensitisation profile

in EoE patients using CRD.

Methods: Forty-five patients with con-

firmed EoE were included (82% male). The

mean age was 36.4 years (range 15–72).Specific IgE antibodies against 103 and 112

different food and aeroallergen compo-

nents were measured by InmunoCAP

ISAC in 40 and five patients, respectively.

Results: Sensitisation to at least one of the

different components was found in 43 out

of 45 (96%) patients. Sensitisation to aero-

allergens was observed in 43 patients

(96%), being pollen (93%) the most com-

mon aeroallergen. Sensitisation to plant-

derived food allergen components was

found in 40 patients (89%). The most fre-

quent sensitisation was to trypsin inhibitors

(77%) (mainly to Ole e 1:64%), followed

by lipid transfer proteins (LTP) (51%),

being the most frequent Pru p 3 (49%),

profilins (49%) and pathogenesis-related

(PR) 10 proteins (22%). Less frequently

polcalcine (20%), cross-reactive carbohy-

drate determinants (16%), thaumatin-like

protein: Act d 2 (16%), 2S albumins

(11%), vicilins (6.7%), and legumins

(2.2%). Sensitisation to animal-derived

food allergens was less frequent: tropomyo-

sin (7%) and serum albumin (2%).

Conclusion: Most EoE patients were poli-

sensitised as described previously. Pollen

was the most common aeroallergen. The

most frequent sensitiser was trypsin inhibi-

tor, present in both aeroallergens and food

allergens. The next most frequent allergens

were LTP and profilins. This sensitisation

profile may have a pathogenic role in EoE,

which should be deeplier studied.

1058

The role of immunoblotting method in

diagnostic of cross-allergy

Napi�orkowska-Baran, A1; Kołodziejczyk, J2; Graczyk, M1;

Zacniewski, R1; Szynkiewicz, E1; Pałgan, K1; Bartuzi, Z1

1Department of Allergology and Clinical Immunology,

University Hospital No 2, Bydgoszcz, Poland;2University Hospital No 2, Bydgoszcz, Poland

Background: Patients with the birch pollen

allergy frequently develop hypersensitive

reactions to certain plant food. This prob-

lem can concern even 70% patients with

pollinosis. Mostly, it is caused by cross-

reactivity between these allergens. These

reactions result from the similarity of aller-

gen proteins structure, which are some-

times unbound phylogenetically. Diagnosis

of this allergy is very complicated and its

confirmation became possible due to apply-

ing methods, such as e.g. immunoblotting.

Method: Fifty eight patients at the age

above 16 were included in the study. The

clinical history, the positive result of the

skin prick test with the birch extract and

symptoms after consumption plant food

were the condition for qualifications. The

immunoblotting was performed for the

patients with the positive value of birch,

apple, celery and/or carrot specific IgE to

confirm the cross-reactivity.

Result: Sera of 13 patients (18 patients

were analyzed) revealed positive results in

the immunoblotting method. Sera of only

12 patients revealed the reaction against

the birch pollen protein with a molecular

weight 17–18 kDa corresponding to the

main birch allergen Bet v 1. Sera of only

two of these patients revealed the presence

of antibodies cross-reacting with the apple

protein with the same molecular weight,

which may indicate the main allergens of

these foods – Mal d 1. Serum of six patient

revealed the presence of antibodies cross-

reacting with apple and celery protein with

the same molecular weight, which may

indicate the main allergens of these foods –Mal d 1 and Api g 1. Serum of only one

patient revealed the presence of antibodies

cross-reacting with the apple, celery and

carrot protein with the same molecular

weight, which may correspond the main

allergens of these foods – Mal d 1, Api g 1

and Dau c 1. Additionally sera of six per-

sons demonstrated the presence of antibod-

ies reacting with apple protein with the

molecular weight 10 kDa which may corre-

spond the lipid transfer protein (LTP).

Among some of the patients, antibodies

which have not been identified so far,

reacted with birch, apple and celery pro-

teins, with the particle mass 30–31 kDa.

Conclusion: Although the immunoblotting

is an effective method confirming the exis-

tences of the cross-reactivity, it still

remains the method of verifying and

Poster Session Group II – Red. TPS 41 – Food allergy II

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453390

supplementing other diagnostic tests, and a

negative result doesn0t exclude the existence

of this kind of allergy.

1059

Usefulness of basophil activation test in

gluten sensitivity

Campochiaro, C1; Yacoub, M-R1; Corsetti, M2; Colombo,

G1

1Internal Medicine, Allergy and Clinical Immunology,

San Raffele Scientific Institute, San Raffaele Hospital,

Milan, Italy; 2Unit of Gastroenterology, San Raffele

Scientific Institute, San Raffaele Hospital, Milan, Italy

Background: Gluten sensitivity is a clinical

entity characterised by intestinal and extra-

intestinal symptoms that develop in

patients after eating wheat-made products.

The aim of our study is to investigate

the role of basophil activation test (BAT)

in this disease.

Method: Twenty patients with suspected

wheat allergy were evaluated in our Allergy

Unit. All patients complained of gastroin-

testinal symptoms such as abdominal

bloating, abdominal pain, constipation,

dyspepsia and heartburn after eating

wheat-made products. Mean age was

49 years (range 24–77 years), they were all

female. Patients underwent a complete

allergological evaluation with Skin Prick

Test (SPT) for food allergies and prick by

prick with flour and yeast. Celiac disease

investigations nad BAT for cereals were

performed in all patients. BAT was consid-

ered positive if CD63 was >5 and stimula-

tion index was >2. DBPCFC was then

obtained.

Results: SPT was negative in 18 patients

and were slightly positive for yeast and for

buckwheat in one patient each. Food-spe-

cific IgE were slightly positive for cereals in

three patients. Celiac disease was diagnosed

in two patients, three patients refused to

undergo gastroscopy. All patients with posi-

tive food-specific IgE or with a diagnose of

celiac disease were ruled out from our

cohort. A possible diagnosis of gluten sensi-

tivity was then formulated in 12 patients.

BAT for alpha-amylase was positive in 8

patients, for yeast in five patients, for corn

in five patients, for gliadin, oat, rye and soy

in five patient each. In 1 case BAT was neg-

ative. DBPCFC was then obtained in 12

patients, in three patients it was negative, in

10 patients it was positive. DBPCFC was

positive in eight out of 11 patients with a

positive BAT (70%), there was no case of

negative BAT with a positive DBPCFC.

Positive predictive value for BAT in our

cohort was 72%.

Conclusion: These preliminary data on the

usefulness of BAT in gluten sensitivity sug-

gest that this test can be used to predict

the results of DBPCFC.

1060

Mast cell activation syndrome. Is bone

marrow biopsy always required?

Leguisamo, S; Prados, M; Baynova, K; Cimbollek, S1Allergy, Virgen del Roc�ıo Universitary Hospital, Seville,

Spain

Background: Systemic mast cell activation

syndrome (MCAS) is characterised by

signs and symptoms of mast cell activation,

transient increase in an MC-derived media-

tor and response to agents that attenuate

the MC-derived mediators. We describe a

case of food-dependent-exercise-induced

anaphylaxis with high basal tryptase levels

and no findings of clonally in bone marrow

biopsy.

Method: A male, 32-years-old, with a past

history of seasonal rhinitis, allergic oral

syndrome to nuts and lupins, experienced

on two separate occasions, while jogging,

generalised wheals, lips and tongue angioe-

dema, dysphagia, dysnea, palm and sole

itching and malaise. In the first event he

breakfasted bread, tomato and ham.

In the next event he lunched tomato,

meat, chicken and macaroni. In both

events he required medical support and

administration of corticosteroids and anti-

histamines.

Allergologic work-up was performed

(skin test with inhalants, animal food, veg-

etables, and prick-prick with nuts, lupins,

tomato, and flours), microarrays with 112

antigens (ISAC), triptase levels and bone

marrow biopsy.

Results: Skin test were positive to O. euro-

pea, P. pratense, C. arizonica, P. acerifolia,

P. persica, A. vulgaris, S. kali, P. judaica,

cat, dog and horse dander. Vegetables bat-

tery food were positive to lentils. Prick-

prick to walnut, almond, tomato, lupins,

wheat flour and rice flour were positive.

Prick-test to animal battery food negative.

ISAC were positive to the lipid trans-

porter protein, pectin metil esterase, Group

5 of Olea, Group 1 of grasses, uteroglo-

bine, arginine esterase, 7S globuline storage

protein, poligalacturonase, pectato liase.

Basal serum tryptase level: 15.60 mcg/l and

14.70 mcg/l. In the bone marrow biopsy,

no multifocal dense infiltrates nor expres-

sion of CD2 and/or CD25 on mast cells

were described.

Conclusion: We present a patient with a

secondary MCAS with high basal tryptase

levels but without evidence of mast cell

monoclonal disorder.

1061

A novel ImmunoPCR based strategy to

detect serum concentrations of IgE

antibodies specific to the major shrimp

allergen tropomyosin in shrimp allergic

adults and children

Kamath, SD1,2,3; Johnston, EB2,4; Koplin, JJ3,5; Eckart,

J3; Rolland, JM6; O’Hehir, RE6; Schaeffer, PM2,4; Allen,

KJ3,5; Lopata, AL1,2

1Molecular Immunology Group, School of Pharmacy &

Molecular Sciences, James Cook University,

Townsville, Qld, Australia; 2Centre for Biodiscovery and

Molecular Development of Therapeutics, James Cook

University, Townsville, Australia; 3Centre for Food and

Allergy Research, Murdoch Childrens Research

Institute, Melbourne, Australia; 4Supramolecular &

Synthetic Biology Group, School of Pharmacy &

Molecular Sciences, James Cook University,

Townsville, Australia; 5University of Melbourne,

Melbourne, Australia; 6Department of Allergy,

Immunology and Respiratory Medicine, The Alfred

Hospital & Monash University, Melbourne, Australia

Background: Current in vitro diagnostics

for shrimp allergy quantify IgE antibodies

against whole shrimp extract, often with

low specificity and may result in false nega-

tive results. Allergen component testing

may offer not only improved sensitivity

over empirical methods but also enhance

the specificity of detecting shrimp allergen

specific IgE. The aim of this study was to

develop a highly sensitive and specific

method to quantify tropomyosin specific

IgE antibodies in a very small volume of

patient serum using an ImmunoPCR

approach.

Method: Shrimp allergic adults (n = 39)

and children (n = 66) were recruited with

negative or confirmed clinical history to

shrimp and/or skin prick data and shrimp

sIgE using ImmunoCAP. Serum IgE anti-

body binding to shrimp allergens were

analysed using IgE immunoblotting to

whole shrimp extract. Tropomyosin-specific

IgE was quantified using the novel tus-ter-

lock ImmunoPCR methodology.

Results: Sera IgE binding was demon-

strated to tropomyosin and other major

shrimp allergens using immunoblotting.

Tropomyosin-specific IgE were detected in

48% of adults and 44% of children. In

addition IgE to other prawn allergens were

detected in the majority of patients (66%

adults and 61% children). A very similar

prevalence of tropomyosin specific reactiv-

ity was established using the novel aller-

gen-specific ImmunoPCR, with an

efficiency of 80%.

Conclusion: We have developed a novel

method of allergen component diagnosis

for shellfish allergy using tropomyosin as a

model allergen with high efficiency. How-

ever, strong IgE binding was also observed

to other allergens by immunoblotting,

especially in children. In summary, in vitro

testing using ImmunoPCR offers the abil-

ity to quantitate specific IgE to specific

Poster Session Group II – Red. TPS 41 – Food allergy II

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 391

allergen components using very small vol-

umes of only five microliters of patient

serum. Future inclusion of other important

prawn allergens will offer an advantage in

designing adult-specific and children-spe-

cific allergy diagnostics for crustaceans.

1062

Clinical characteristics in patients with

eosinophilic esophagitis

Garcimartin Galicia, MI; Ruano Perez, FJ; Blanca Lopez,

N; Somoza Alvarez, ML; Perez Alzate, D; Vazquez de la

Torre Gaspar, M; Sanchez Millan, ML; Canto Diez, G

Allergy, Hospital Infanta Leonor, Madrid, Spain

Background: Eosinophilic esophagitis

(EEo) is a chronic inflammatory disorder

of the esophagus with esophageal dysfunc-

tion and eosinophilic infiltration, that in

genetically susceptible patients is often trig-

gered by food allergens.

The aim of this study was to detail ato-

pic characteristics, symptoms, sensitisation

profile to food allergens and response to

different treatments in patients with EEo.

Method: We included 17 patients, 13

adults and four children at the Allergy

Unit of Hospital Universitario Infanta

Leonor (Madrid). We evaluated cutaneous

response to aeroallergens by skin prick test

(SPT) (pollens, animal danders, molds and

house dust mites), food sensitisation profile

by SPT and/or specific IgE (meats, milk,

egg, nuts, legumes, wheat, fish and sea-

food), atopic diseases, symptoms and clini-

cal improvement after 6 month of

treatment with either single or combination

therapy with proton pump inhibitor (PPI),

topical steroids (TS) and elimination diet

(D).

Results: Seventy percent of patients were

male and 30% female. Allergic symptoms

were presented in 14 patients rhinitis and

asthma in eight patients, only rhinitis in

four and only asthma in two. Peripheral

eosinofilia was observed in 35% of patients

and an elevated total serum IgE value in

58%. Dysphagia (58%), food impactation

(29.4%) and abdominal pain (12.6%) were

the most frequently symptoms reported.

Most of patients had symptoms with more

than one food, being meat, legumes, wheat

and nuts the most frequently involved. The

88% of patients had positive SPT and/or

specific IgE with the culprit food. The

most common treatment regimen was

TS+D+PPI (47.1%), TS + D (35.3%) and

D (17.6%). After 6 months of treatment

with triple therapy patients had less symp-

toms than the D and the non PPI contain-

ing group.

Conclusion: Patients with EEo have a high

food sensitisation and atopy rates therefore

a full allergy study is required to establish

a correct treatment. Treatment with PPI

add to elimination diet and TS improves

the clinical response.

1063

Diagnostic value of basophil activation

test in children with a food allergy

Khaleva, E1; Novic, G1; Bychkova, N2

1Department of Pediatrics, Saint Petersburg State

Pediatric Medical University, Saint Petersburg, Russia;2Nikiforov Russian center of Emergency and Radiation

Medicine, EMERCOM of Russia, Laboratory of Cell and

Humoral Immunity, Saint Petersburg, Russia

Background: The basophil activation test

(BAT) is an in vitro test, which allows

identifying children with food allergy (FA)

at the sensitisation stage and clinical mani-

festations of atopic dermatitis (AD).

Although double-blind placebo-controlled

food challenges remain the gold standard

to confirm food allergy, the CD203c+-based BAT may supplement routine tests

for allergy diagnosis.

Method: We used the BAT by flow cytom-

etry (CD203C+), total and specific IgE,

reaction of mast cell degranulation in rats

(RMCD), prick skin test and open provo-

cation test. We investigated 89 children

from 3 months to 12 years with FA and

AD symptoms in varying severity.

Results: The level of spontaneous activa-

tion of basophils (sBAT) depended on the

severity of AD and period of the disease

(P < 0.05). The level of sBAT, allergen-

induced basophil activation (aBAT) was

significantly higher in children with polyva-

lent sensitisation (P < 0.05). We found cor-

relation between level of total lgE and

sBAT (r = 0.575, P < 0.01). The aBAT in

children with acute food allergic reactions

were extremely higher (more than 40%)

when levels of slgE and RMCD were low

and/or even negative. We found positive

basophil activation in 25% of specific IgE

negativity, in 30% of RMCD negativity.

Prescription of ED to children with posi-

tive BAT and negative results of specific

IgE and RMCD improved the clinical pic-

ture. The BAT was measured as an activa-

tion index and calculated as a specific

activation (%) / sBAT (%). We postulated

the presence of sensitisation if activation

index was more than 1.05.

Conclusion: BAT is a highly sensitive and

accurate method of diagnostics of sensiti-

sation in children with FA, which is mani-

fested in the form of AD. The BAT could

be used in the selection and duration of

ED, and the possibility of the product′sreintroduction. aBAT could be recom-

mended for diagnosis of acute food allergic

reactions, in case of different results of

slgE and prick skin test.

1064

Anaphylaxis to both garlic and onion

Vovolis, V1; Tsami, M1; Psomiadou, M2; Mikos, N1

1Allergology Department, Laiko General Hospital,

Athens, Greece; 22nd PediatricClinic, Allergology

Department, University of Athens, Athens, Greece

Background: Garlic (allium sativum) and

onion (allium cepa), both belong to the Al-

lioideae subfamily. There are few studies

investigating allergic reactions to onion

and garlic. However, anaphylaxis to both

garlic and onion has not been reported so

far.

Method: We report two cases, patient 1, a

38-year-old female and patient 2, a 44-

year-old man, who visited our department

reporting many anaphylactic episodes all

of which were associated with the con-

sumption of foods containing both onion

and garlic.To determine the contribution

of onion and garlic to the patients’ symp-

toms, PTP tests with three different parts

(peel, bulb and clove) of the raw vegetables

as well as with cooked onion and garlic

were performed. PTP tests with leek, a

member of Allioideae subfamily (raw and

cooked) were also performed. The same

extracts were tested on 20 control sub-

jects.Total serum IgE, specific IgE to onion

and garlic and serum tryptase levels were

measured. The atopy profile to both

patients was checked with aeroallergens of

the common screening panels.

Results: PTP tests were positive to both

raw and cooked vegetables (onion and gar-

lic) with all three parts of the plants. The

PTP tests with leek, raw and cooked, in

patient two were also positive. All subjects

of the control group were tested negative

to onion, garlic and leek. Laboratory

investigation for specific IgE was positive

to onion and garlic. Total serum IgE and

serum tryptase levels were normal.

Conclusion: Our patients were proved to

be sensitised to a heat-stable allergen exist-

ing in all parts of the vegetables (peel, bulb

and clove), which possibly belongs to LTP-

panallergen group .In the literature, there

are few studies of anaphylaxis to garlic

and fewer to onion. Most of them, in con-

trast to our study, have shown monosensi-

tisation to a thermolabile allergen.

Furthermore, our cases are the first pre-

senting allergy to both onion and garlic

demonstrating the cross-reactivity among

the different Allioideae vegetables.

Poster Session Group II – Red. TPS 41 – Food allergy II

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453392

1065

Fennel (Phoeniculum vulgare) allergy

Nico, A1; Vacca, M1; Bellotti, A2; Di Giacomo, M1;

Giliberti, L1; Lotti, A1; Caiaffa, MF2; Macchia, L1

1Allergology and Clinical Immunology, University of

Bari, Bari, Italy; 2Allergology and Clinical Immunology,

University of Foggia, Foggia, Italy

Background: Unlike celery (Apium graveo-

lens), fennel, a typical vegetable of the

Mediterranean Diet (often eaten row), has

not been regarded as a major food aller-

gen, so far.

Method: We analyzed a recent series of

189 well diagnosed cases of food allergy,

with the purpose of estimating the occur-

rence of fennel allergy, in a population

with a typically Mediterranean Diet, from

Apulia – Southern Italy. The patients were

diagnosed on the basis of a convincing

clinical history, demonstration of specific

mast cell-bond IgE, by skin prick tests per-

formed with commercial extracts or, in

selected cases, by prick-by-prick with fresh

food, and demonstration of specific serum

IgE, by CAP RAST (when needed).

As for fennel, the investigation was car-

ried out by:

1 Quantitative skin prick tests with a

commercial extract marketed by Lofar-

ma, Milano;

2 Quantitative prick by prick procedure

with the fresh vegetable;

3 CAP RAST for fennel.

Results: Allergy to fennel was clearly diag-

nosed in 57 patients (30% of all food

allergy patients), 11 (19%) of whom were

positive only for fennel. Many of these

patients exhibited also multiple sensitisa-

tions to food allergens of the Apiaceae

family. Thus 45 patients (79%) had posi-

tive skin tests for celery, 22 (39%) for pars-

ley (Petroselinum crispum), and 21 (37%)

for carrot (Daucus carota). Notably, all of

these patients had lip angioedema and oral

itching after fennel’s ingestion. However,

17 (30%) had also Quincke0s edema, 11

(19%) urticaria and finally, one patient

experienced severe anaphylaxis, after eating

row fennel.

Conclusion: In Southern Italy (and per-

haps in other countries where the Mediter-

ranean Diet is dominant), fennel allergy

accounts for a substantial proportion of all

food allergy cases, possibly, up to 30%.

We conclude that emphasis should be put

on development of appropriate fennel

extracts and these extracts should be used

in the routine food allergy diagnosis, in

those Countries where the Mediterranean

Diet prevails.

1066

Association of filaggrin gene

polymorphisms with food allergy and

atopic dermatitis

Vardar, N1; Gungordu, B1; Cavkaytar, O2; Yilmaz, EA2;

Buyuktiryaki, B2; Karaaslan, C1; Sackesen, C2

1Biology, Molecular Biology Section, Hacettepe

University, Ankara, Turkey; 2School of Medicine,

Pediatric Allergy and Asthma Unit, Hacettepe

University, Ankara, Turkey

Background: Filaggrin (FLG) protein is

involved in the formation of skin barrier

and play role in epidermal differentiation.

Studies have shown that FLG gene poly-

morphisms associated with allergen sensi-

tivity and allergic diseases such as

ichthyosis vulgaris, allergic rhinitis, atopic

dermatitis (AD), food allergy and asthma.

Atopic diseases are related to each other in

a process. Process representing natural

course of atopic evidence is called as an

‘atopic march’. In the atopic march, first

encountered atopic allergic disease is gener-

ally atopic dermatitis, and then the clinical

signs of food allergy occur. Studies from

European countries about patient with AD

have shown that 42% of these patients

have FLG mutations.

Aim: The aim of the study is to reveal the

frequency of changes in FLG gene within a

group of children with AD and food

allergy in Turkish population and also to

determine the role of filaggrin gene in ato-

pic march.

Methods: R501X and 2282del4 FLG

mutations were screened using PCR-RFLP

method in 458 patient and 128 control

groups. R501X and 2282del4 FLG gene

regions were amplified with repeat 1 spe-

cific primers. After the amplifications,

amplicons of R501X were cut with Hin1II

restriction endonuclease enzyme and ampli-

cons of 2282del4 were cut with AdeI

restriction endonuclease enzyme. Eventu-

ally results were controlled by DNA

sequence analysis in 50 patients for R501X

and 10 patients for 2282del4which were

chosen randomly.

Results: Frequency of R501X FLG muta-

tion was determined 0% in patients and

control groups; frequency of 2282del4

FLG mutation was determined 0.7% in

patient group, 0.8% in control group. No

significant result was observed in R501X

and 2282del4 FLG gene polymorphisms.

Conclusion: When compared to the studies

from European populations our results did

not show any significant association of

R501X and 2282del4 polymorphisms in

FLG gene with food allergy and atopic

dermatitis in the group of Turkish children

involved to the study.

1067

Predictors of health-related quality of life

of food-allergic patients in eight

European countries

Goossens, NJ1,2; Saleh-Langenberg, J1,2; Flokstra-de

Blok, BM2,3; van der Meulen, GN1,4; Le, TM5; Knulst,

AC5; Jedrzejczak-Czechowicz, M6; Kowalski, ML6;

Rokicka, E7; Starosta, P7; de la Hoz Caballer, B8;

Vazques-Cort�es, S9; Cerecedo, I8; Barreales, L10; Asero,

R11; Clausen, M12; Dunn Galvin, A13; O’B Hourihane,

J13; Purohit, A14; Papadopoulos, NG15,16;

Fernand�ez-Rivas, M9; Frewer, L17,18; Burney, P19;

Duiverman, EJ1,2; Dubois, AE1,2

1Department of Pediatric Pulmonology and Pediatric

Allergy, University of Groningen, University Medical

Centre Groningen, Groningen, the Netherlands; 2GRIAC

Research Institute, University of Groningen, University

Medical Centre Groningen, Groningen, the Netherlands;3Department of General Practice, University of

Groningen, University Medical Centre Groningen,

Groningen, the Netherlands; 4Department of Pediatric

Allergy, Martini Hospital, Groningen, the Netherlands;5Department of Dermatology/Allergology, University

Medical Center Utrecht, Utrecht, the Netherlands;6Department of Immunology, Rheumatology and

Allergy, Medical University of Lodz, Lodz, Poland;7Faculty of Economics and Sociology, Lodz University,

Lodz, Poland; 8Department of Allergy, University

Hospital Ram�on y Cajal, IRICYS, Madrid, Spain;9Department of Allergy, Hospital Clinico Universitario

San Carlos, IdISSC, Madrid, Spain; 10Department of

Preventive Medicine, Research Unit, Hospital Cl�ınico

San Carlos, IdISSC, Madrid, Spain; 11Clinica San Carlo,

Ambulatorio di Allergologia, Paderno Dugano, Italy;12Department of Allergy, Landspitali, University

Hospital, Reykjav�ık, Iceland; 13Department of Paediatrics

and Child Health, Clinical Investigation Unit, Cork

University Hospital, Cork, Ireland; 14Department of

Chest Diseases, Division of Allergy, University Hospital

of Strasbourg, Strasbourg, France; 15Allergy

Department, 2nd Pediatric Clinic, University of Athens,

Athens, Greece; 16Center for Pediatrics and Child

Health, University of Manchester/Institute of Human

Development, Manchester, Unites Kingdom; 17Food

Safety and Consumer Behaviour, Marketing and

Consumer Behaviour Group, Wageningen, the

Netherlands; 18Food and Society Group, School of

Agriculture, Food and Rural Development, Newcastle

University, Newcastle, Unites Kingdom; 19Imperial

College London, Department of Respiratory

Epidemiology and Public Health, National Heart and

Lung Institute, London, Unites Kingdom

Background: Although health-related qual-

ity of life (HRQL) is widely used as an

outcome measure for food allergy, little is

known about factors other than disease

severity which may contribute to HRQL.

Objective: To identify factors which could

predict HRQL of food-allergic adults and

children.

Methods: A total of 648 food-allergic

patients (404 adults, 244 children) from

eight European countries completed the

Food Allergy Quality of Life Questionnaire

(FAQLQ), the Food Allergy Independent

Measure (FAIM) and descriptive ques-

tions. Multiple linear regression analyses

were performed to develop models for pre-

dicting HRQL of these patients.

Results: For adults, the prediction model

accounted for 62% of the variance in

HRQL and included perceived disease

severity, type of most severe symptoms,

having a fish or milk allergy and gender.

Country of origin and having a wheat

Poster Session Group II – Red. TPS 41 – Food allergy II

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 393

allergy were only predictive for specific

HRQL domain scores.

For children, the prediction model

accounted for 28% of the variance in

HRQL and included perceived disease

severity, having a peanut or soy allergy,

and country of origin.

For both adults and children, neither

experiencing anaphylaxis nor being pre-

scribed an epinephrine auto-injector (EAI)

contributed to impairment of HRQL.

Conclusions: Food allergy-related HRQL

can be predicted to a greater extent in

adults than in children. Experiencing ana-

phylaxis or being prescribed an EAI has

no impact on HRQL in either adults or

children. Allergy to certain foods causes

greater HRQL impairment than others.

Country of origin may affect HRQL, espe-

cially in children.

1068

Allergy to the non Rosaceae family fruit

in children

Somoza, ML; P�erez-Alzate, D; Blanca-L�opez, N;

Garc�ıa-Blanca, A; Ruano, FJ; Garcimart�ın, M;

Dionicio, J; Canto, G

Allergy, Infanta Leonor – University Hospital, Madrid,

Spain

Background: Allergy to fruits is the most

frequent cause of allergy to food in chil-

dren older than 5 years old and its inci-

dence is increasing. Although fruits from

the rosacea family are still the most preva-

lent, fruits from non rosaceae family have

to be also taken into account in the Medi-

terranean as well as other areas.

Method: A group of 274 children who

attended the Allergy Unit referring allergy

to different vegetables were evaluated over

a period of 2 years. The range of age was

1.5–14 years old with a mean of 8 years.

Medical history, skin prick tests and detec-

tion of specific IgE levels to a set of most

common inhalant and food allergens in

our area were performed in all these

patients.

Results: In a total of 174 children (63%)

allergy to fruits was reported. From these,

66% to the non rosaceae family fruits, with

211 episodes, distributed as follows:From

all these patients, skin prick tests were

positive to:

-Melon 41.4%, Kiwi 22.4%, Banana

5.2%, Watermelon 4.6%, Avocado 2.9%,

Grape 2.3%, Citrus Fruits (Orange and

Tangerine) 1.15% and Pineapple 0.6%.

And the specific IgE levels were positive

to:

-Banana 30%, Kiwi 26.4%, Avocado

21.3%, Citrus fruits 20%, Melon 18.4%,

Grape 11.5%, Watermelon 6.3% and Pine-

apple 2.9%.

Conclusion: Based on the number of epi-

sodes, Kiwi is the most offender within the

non rosaceae family fruits in our popula-

tion, followed by Banana. The most fre-

quent clinical entity reported is the Oral

Allergy Syndrome, being Kiwi and Melon

responsible for most of the anaphylactic

reactions.

1069

Apple-dependent exercise-induced

anaphylaxis: a report of three cases in

children

Carrusca, C; S�a Ferreira, P; Mendes, C

Pediatrics, Hospital Vila Franca de Xira, Vila Franca de

Xira, Portugal

Background: Food-dependent exercise-

induced anaphylaxis (FDEIA) occurs dur-

ing exercise when it is preceded in the last

few hours by food intake, but separately

they are well tolerated. Apple-dependent

exercise-induced anaphylaxis (ADEIA) is

very rare and very few cases have been

reported in children. We present the largest

series on ADEIA cases in children.

Case 1: A 13-year-old boy with known

food allergy (orange, crab), allergic rhinitis

and asthma suffered three episodes of ana-

phylaxis during exercise after eating apple.

Apple was the common exposure in the

three episodes. Skin prick test (SPT) was

positive to kiwi and apple; specific Immu-

noglobulin E (IgE) was positive to grass

polen, olive tree and apple.

Case 2: A 15-year-old boy with allergic

rhinitis had no previous food reaction.

Two hours after eating an apple he prac-

ticed intense physical exercise and in few

minutes he suffered an anaphylaxis episode

(generalised urticaria, labial angioedema,

dyspnea). Specific IgE were positive to

apple, walnuts, peanuts and dust mites.

The reintroduction of apple was held at

hospital with no reaction.

Case 3: A 5-year-old boy had allergic rhi-

nitis and perioral rash after ingestion of

peach, without previous reactions to apple.

Two hours after eating an apple he prac-

ticed intense physical exercise and in few

minutes he developed palpebral edema,

urticarial rash in trunk and arms, abdomi-

nal pain, vomit and dyspnea. Specific IgE

revealed sensitisation to apple, peach (Pru

p3), grass polen, dust mites and cockroach.

Conclusion: In the three cases, apple and

exercise were well tolerated separately and

the other possible causes of anaphylaxis,

including the allergen sensitisation in SPT

and IgE, were excluded. All patients

received rapid treatment with epinephrine

and self-injection was prescribed. A four

hour period free from exercise was recom-

mended after eating apple, and none had

recurrence (mean follow up of

23 � 14 months).

1071

Ethnic differences in peanut sensitisation

and allergy patterns in South African

children with atopic dermatitis

Gray, CL1; Levin, M2; du Toit, G3

1Paediatric Allergy and Asthma, Red Cross Children’s

Hospital, Cape Town, South Africa; 2Cape Town, Red

Cross Children’s Hopsital, South Africa; 3Evelina

Children’s Hospital, London, Unites Kingdom

Background: Geographic and possible eth-

nic differences in peanut allergy prevalence

may exist. This study aims to compare pea-

nut sensitisation, component and allergy

patterns between South African children

with atopic dermatitis (AD) of Black

(Xhosa) vs mixed race origin.

Table I. Clinical Manifestations.

Oral Allergy

Syndrome (%)

Urticaria/

Angioedema (%)

Anaphilaxis

(%)

Contact

Urticaria (%)

Other

Symptoms

Kiwi

(52 episodes)

55.7 26.9 7.7 7.7 2% (Vomiting)

Banana

(51 episodes)

58.8 25.5 2 11.7 2%

Melon

(43 episodes)

62.8 23.2 7 4.7 2.3% (Rhinitis)

Pineapple

(16 episodes)

81.25 18.75

Watermelon

(14 episodes)

57.1 28.7 7.1 7.1% (Rhinitis)

Citrus Fruits

(16 episodes)

62.5 31.25 6.25% (Cough)

Grape

(9 episodes)

55.5 33.3 11.2

Avocado

(3 episodes)

66.6 33.3

Poster Session Group II – Red. TPS 41 – Food allergy II

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453394

Methods: One hundred children (6 months

to 10 years) with moderate to severe AD

were randomly selected from a dermatol-

ogy clicic at the Red Cross Children’s Hos-

pital in Cape Town. They underwent food

allergy screening by questionnaire, SPT

and ISAC test. Those who were sensitised

to peanut (SPT ≥3 mm or ISAC ≥ 0.3U,

n = 43) underwent ImmunoCAP tests for

rArah 1,2,3,8 and 9. All patients with any

uncertainty regarding peanut allergy status

(n = 25) underwent an incremental open

oral food challenge.

Results: Overall, 43% of patients were

peanut sensitised (53% mixed race and

37% Xhosa, P = 0.1). Peanut allergy rates

were high overall (24%), but significantly

lower in the Xhosas (15%) vs mixed race

(38%, P = 0.01), despite comparable base-

line characteristics. Traditional 95% PPV

for SPT (≥8 mm), peanut specific IgE

(≥14 kU/l) and rArah2 (≥0.35 kU/l) pro-

duced good PPVs of 88–93% in the mixed

race group, but poor PPVs 57–80% in

Xhosas.

Component tests followed similar trends

in both groups with Arah2 most strongly

associated with peanut allergy (92% of

peanut allergic vs 40% of tolerant children

were Arah2 positive, P < 0.01). However,

the likelihood of allergy if you had a posi-

tive Arah2 was significantly lower in Xhosa

vs mixed race patients (53% vs 93%,

P = 0.01). Arah 3.8 and nine were more

commonly positive in tolerant patients.

Conclusion: In Xhosa patients, sensitisat-

ion to peanut (including Arah2) is signifi-

cantly less likely to equate to true allergy

than in mixed race patients. Traditional

95% PPV for peanut allergy perform

poorly in Xhosa patients. The component

Arah2 is the most valuable for differentiat-

ing sensitisation from allergy in both ethnic

groups; Arah8 and 9 are associated with

tolerance.

1072

Do baked egg challenges (BEC) for

children improve the lives of patients

and parents/families?

Chalmers, R

Dietetics Department, Imperial College Healthcare NHS

Trust, London, Unites Kingdom

Background: Anecdotally healthcare pro-

fessionals and parents believe passing a

BEC will improve the lives of egg allergic

patients. Published data is scant. As it is

suggested, that consumption of baked egg

promotes acquisition of tolerance, more

children undergo BECs in our department.

We aimed to determine if passing a BEC

improves the daily lives of allergic patients

and their parents.

Method: Retrospective telephone survey to

assess the acceptability of BEC and impact

on daily life passing a BEC has on an egg

allergic individual/their parents. All BEC’s

performed between January 2009 to March

2014 reviewed. Parents of children who

passed the challenge were invited to com-

plete the telephone survey. A visual ana-

logue scale (1 = minimal improvement;

10 = life changing) was used to gauge ben-

efits on lifestyle.

Results: Thirtynine challenges performed,

20/39 (51%) passed hospital based part.

17/20 agreed to participate. There was no

significant age difference between children

who passed or failed the BEC: median age

5.5 years (range 1.2–16.5) vs median 9.3

(1.2–16.0). Children who passed the chal-

lenge had smaller wheal size diameter on

skin prick testing: passed BEC: SPT to

Whole Egg Extract (Stallergenes, SA,

France) median 6 mm (range 0–11) and to

Raw Egg median 9 mm (0–25 mm) vs

failed BEC: median 10 mm (5–22) and

15.5 mm (8–30) respectively (P = 0.003;

P = 0.019). Baked egg was successfully

introduced into the diet of 15/17 children

and consumed regularly (mostly as cakes

[93%]/biscuits [73%]. 2/17 (12%) reacted

on home-introduction of baked egg; one

child refuses food containing baked egg.

Visual analogue scales showed BEC

improved the daily lives of families, with a

mean VAS-score of 7.75: 0/15 Score <4; 2/15 Score 4–8 [1 refuses egg] and 13/15 par-

ents rated the impact as ‘life changing’

(VAS score >8).Conclusion: Baked egg challenges improve

the daily lives of egg allergic patients and

parents. The inclusion of baked egg in the

diet supports social inclusion.

1073

Epidemiologyc features in patients with

food allergy in an area population from

Madrid

Perez Alzate, D; Somoza, ML; Blanca-L�opez, N;

Garcia, A; Sanchez-Millan, ML; Garcimartin, M;

Ruano, F; Canto, G

Allergy, Infanta Leonor – University Hospital, Madrid,

Spain

Background: The prevalence of food hy-

persensitivities is higher than appreciated

in the past. Recent studies suggest that

nearly 4–5% of Americans and European

population are afflicted with food allergies.

The prevalence changes with age and

depend on the diet andcultural habits.

Methods: An observational retrospective

study was done, identifying 1.155 patients

(adults and infants) referred to the food

Allergy Unit of our Hospital from Febru-

ary 2011 to February 2014, Epidemiologic,

clinical data and prick test and serum spec-

ificIgEwere registered.

Results: A total of 1.155 patients who

referred clinical symptoms after consump-

tion of foods, enrolled the study. The 62%

were female and 37.6% male; the 73%

were adults (mean: 35 years old) and the

27% children (mean: 8 years old). In more

detail 16.4% of our patients came from

other countries: 68% Latin America, 13%

Africa, 12% Eastern Europe, 4.7% Asia

and 2.6% other European countries. Con-

comitants diseases In infants: atopic der-

matitis (AD), allergic rhinitis (AR),

bronchial asthma (BA), both (AR/BA),

latex allergy (LA), drug allergy and eosino-

philic esophagitis (EE) was: 64.5%,

22.5%, 26.5%, 1.6%, 0.96% and 0.6%

respectively. In adults was: 13.7% AD,

29% AR, BA 2%, AR/BA:46%, LA:1.3%,

drug allergy: 9% and EE: 2%. The total of

closed relatives (4.134) reported: food

allergy 6.7%, drug allergy 12%, allergy to

inhalants 25% and hymenoptera venom

allergy the 0.3. More than 13.200 episodes

were registered in adults as follows: fruit,

mix nuts. Only the 5% of patients referred

1 episode with food being the most com-

mon a fruit followed by seafood and mixed

nuts; and more than 790 episodes in chil-

dren, most frequents foods were fruits and

nuts.

Conclusions: We observed more frequency

of food allergy in female than in males as

reported in other studies. The most preva-

lent concomitant disease in infant was ato-

pic dermatitis and respiratory allergic

disease in adults. Is more prevalence the

food allergy than drug allergy.

Poster Session Group II – Red. TPS 41 – Food allergy II

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 395

Poster Session Group II – Red

TPS 42 – Hymenoptera venom allergy

1074

Molecular diagnosis of hymenoptera

venom allergy in Madrid and Manchester

Arochena, L1; Jara, P2; Hernandez-Garcia, E2; Marinho,

S1; Sastre, J2

1Allergy Service, University Hospital of South

Manchester NHS Foundation Trust, Manchester, Unites

Kingdom; 2Allergy Service, Fundacion Jimenez Diaz,

Madrid, Spain

Background: Hymenoptera venom allergy

is a common problem both in Spain and

Unites Kingdom. We aimed to determine

whether measurement of specific IgE (sIgE)

to recombinant hymenoptera allergens

(RHA) helped to clarify the diagnosis.

Methods: We evaluated 51 patients (26

female, 25 male, mean age

4704 + 1604 years) who reported local (13),

systemic (13) or anaphylactic (25) reactions

with hymenoptera stings at both clinics.

We measured baseline mast cell tryptase

(MCT), total IgE, sIgE to whole venoms

extracts (WVE) and to rApi m1, rVes v1

and rVes v5. Skin prick and intradermal

tests (ST) were performed with ALK Phar-

malgen� extracts (concentrations as per

EAACI guidelines, 100 lg/ml, 10 lg/ml,

1 lg/ml, 0.1 lg/ml, 0.01 lg/ml and

0.001 lg/ml).

Results: Baseline MCT was normal in all

patients (mean 5.01 + 2.78 SD) and mean

total IgE was 140.47 + 179.8 SD. Sixteen

patients had negative results to sIgE to

both bee and wasp WVE, 10 of which also

had negative sIgE to RHA and ST. Four

of them had positive results to sIgE to

RHA, which changed the diagnosis, and

two had negative sIgE to RHA but posi-

tive ST.

Five patients had positive sIgE to some

WVE (three bee, two wasp) but negative

results for the respective RHA.

Seven patients showed double sensitisat-

ion with positive sIgE to both WVE that

was confirmed by positive RHA in three of

them. One had positive results for sIgE to

rApi m1 but negative results for wasp rec-

ombinants, and three had positive results

for wasp recombinants only. Interestingly,

only three out of these seven patients had

positive sIgE to MUXF3 CCD.

Twenty-three patients were sensitised to

only one of the venoms according to sIgE

to both WVE and RHA (21 wasp, two

bee).

Conclusion: Molecular diagnosis with sIgE

to RHA modified the diagnosis and thera-

peutic attitude in eight patients out of 51

(15.6%). Four patients (two in each clinic)

would have been misdiagnosed as non-

allergic and four (One in Madrid and three

in Manchester) would have been misdiag-

nosed with double sensitisation. Moreover,

sIgE to WVE are also necessary for a cor-

rect diagnosis and indication of immuno-

therapy in these patients.

1075

Comparison of different in-vitro

diagnostic tests to dissect honeybee and

wasp allergy

Erzen, R1; Silar, M2; Korosec, P2

1University Clinic for Pulmonary Diseases and Allergy,

Golnik, Slovenia; 2Immunology Lab, University Clinic

for Pulmonary Diseases and Allergy, Golnik, Slovenia

Background: The accurate diagnosis of the

culprit insect in venom allergy could be

hampered by limitations of different diag-

nostic tests.

Method: Twenty-five patients with severe

anaphylactic reactions to Hymenoptera

sting and all candidates for venom immu-

notherapy were prospectively included in

2013. All subjects have specific IgE anti-

bodies to both honeybee and wasp venom,

and all were tested in routine clinical labo-

ratory setting for sIgE to rApi m 1, rVes v

5 and rVes v 1 and with BAT with up to

four concentrations of wasp and honeybee

venom.

Results: In 10 patients the culprit insect

was honeybee. Single IgE positivity to rApi

m 1 was seen in three patients, single posi-

tivity to rVes v 5 or 1 in three patients,

double recombinant positivity in three and

double negativity in two patients. BAT

was significantly higher for honeybee

venom in nine patients (up to median 7-

fold). One patient was BAT non-respon-

der. In 10 patients the culprit insect was

wasp or hornet. Single IgE positivity to

rVes v 5 or 1 was seen in nine patients and

double recombinant positivity in two

patients. BAT was significantly higher for

wasp venom in nine patients (up to median

5.4-fold). In nine patients with double posi-

tive culprit the recombinants and BAT

were equally double positive. Three

patients with unknown culprit showed sin-

gle positivity to rVes v 1. BAT was single

positive or much higher for wasp in two

patients, but similarly double positive in

one patient.

Conclusion: The recombinant serological

IgE dissection of the culprit insect was

good for wasp, but not for honeybee

allergy. The cellular BAT dissection of the

culprit insect was good for both venoms.

For accurate selection of honeybee culprit

venom in double-positive patients the com-

bination of serological and cellular tests is

obviously necessary.

1076

A study of the diagnostic usefulness of

recombinant venom allergens in a Greek

population of hymenoptera allergic

patients

Potika, M1; Scarlatou, G1; Guibas, G1; Koulias, C1;

Aggelidis, X1; Makris, M1; Chliva, C1

12nd Dpt of Dermatology and Venereology, Medical

School, University of Athens, University Hospital

‘Attikon’, Allergy Unit ‘D. Kalogeromitros’, Athens,

Greece

Background: Multiple venom sensitisation

is frequent in the Mediterranean area,

hampering hymenoptera allergy diagnosis.

Component-resolved analysis with recom-

binant species-specific major allergens

(rSSMA) may help choose the appropriate

venom for immunotherapy. We thus opted

to investigate whether rSSMA could be

used to distinguish true sensitisation from

cross-reactivity when the culprit insect

could not be defined from history and spe-

cific IgE (sIgE) to whole venom extracts.

Method: A total of 24 patients (Four

females; mean age 43 � 14 year) were

investigated. All had been diagnosed based

on history, skin testing, sIgE to venom

extracts (Honey Bee, Vespula vulgaris, Pol-

istes dominulus) and components (Api m 1,

Ves v 5, Pol d 5 and cross-reacting carbo-

hydrate determinants MUXF3). Serum

sIgE were determined by ImmunoCAP,

Thermo, Uppsala, Sweden.

Results: Out of eight patients who

reported reaction to bee sting and were

sensitised to bee venom, only four came

out positive for Api m 1. Eighteen patients

were sensitised to both Polistes and Vespu-

la venom and nine of them (50%) were

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453396

positive to both vespid rSSMAs. Detailed

data are shown in the table below.

Conclusion: Recombinant species-specific

major allergens analysis may occasionally

contribute to the diagnosis of hymenoptera

venom allergy. Its sensitivity appeared to

be low, especially for Api m 1, suggesting

that it is more appropriate as a comple-

mentary test.

1077

Predictors of severe systemic honeybee

field sting anaphylactic reactions

Celesnik Smodis, N; Ziberna, K; Silar, M; Zidarn, M;

Dezman, M; Erzen, R; Bajrovic, N; Kosnik, M;

Korosec, P

University Clinic of Respiratory and Allergic Diseases

Golnik, Golnik, Slovenia

Background: Honeybee venom-allergic

patients are at a greater risk of a systemic

reaction for subsequent insect sting than

those with Vespula venom allergy. Our aim

was to evaluate risk factors which could

contribute to the severity of honeybee field

sting anaphylactic reaction.

Method: We enrolled 93 untreated patients

with a history of a honeybee field sting, 13

of Grade I (14%), 48 of Grade II (52%)

and 32 of Grade III (34%) anaphylactic

reaction. Several variables including demo-

graphic (age, gender), clinical (sting reac-

tion latency, absence of cutaneous

symptoms, head or neck stings, cardiovas-

cular conditions and medications and other

allergies) and laboratory factors (sIgE,

tIgE, baseline serum tryptase, SPT and

CD63 basophil response) were evaluated in

relation to the severity of honeybee sting-

induced anaphylaxis.

Results: Higher values of baseline tryptase,

median 5.9 lg/l (IQR 4.0–7.8) were found

in Grade III vs Grade II 3.8 (3.1–5.5) or I

4.5 (3.2–5.4). Five patients (5.4%) had an

elevated level (≥11.4 lg/l), four of Grade

III and 1 of Grade II. None of CD63

basophil parameters (EC15, EC50, CD-

sens or AUC) were found to be associated

with increased severity risk, except for

moderate increase in response to 0.001 lg/ml of honeybee venom. Beside increased

baseline tryptase levels several other fac-

tors, such as male gender, senior age, con-

comitant cardiovascular disease, treatment

with ACE inhibitors, reaction latency of

<5 min, absence of cutaneous symptoms

and head or neck sting showed significant

correlation with severe field anaphylactic

reaction.

Conclusion: Clinical history with focus on

sting reaction details, concomitant diseases

and medications, demographic data

together with baseline serum tryptase

should be accurately evaluated to identify

patients at increased risk for severe sys-

temic anaphylaxis after a honeybee field

sting.

1078

Improvement of sensitivity of venom

specific IgE antibody test by spiking of

allergen component on venom extracts

in Japanese patients suspected venom

allergy

Yoshida, N1; Hirata, H1; Watanebe, M1; Tatewaki, M1;

Sugiyama, K1; Fukushima, Y2; Ishii, Y1

1Dokkyo Medical University, Tochigi, Japan; 2Dokkyo

Medical University, Saitama, Japan

Background: Using natural wasp venom

extracts, negative IgE test results have been

observed in a proportion of patients sus-

pected of having wasp venom allergy.

European reports have recently demon-

strated improved clinical sensitivity of Im-

munpCAP tests prepared with wasp and

paper wasp venoms spiked with antigen 5.

We compared sensitivity of these improved

ImmunoCAP tests to the existing Immuno-

CAP and Immulite in Japanese patients

with suspected venom allergy.

Method: Sixty-seven patients who experi-

enced systemic reactions after wasp (yellow

jacket: YJ) or paper wasp (PW) stings were

enrolled in this study. Diagnosis was done

according to history of wasp sting, based

on the patients’ own identification of the

culprit insect. Specific IgE antibodies to YJ

and PW were measured by the existing and

the improved ImmunoCAP and by Immu-

lite (Siemens).

Result: Of 64 patients, 15 (23.4%) tested

positive (≥0.35 KUA/l) with YJ and 26

(40.6%) with antigen 5-spiked YJ Immu-

noCAP. Of 58 patients, 14 (24.1%) tested

positive with PW and 25 (43.1%) with

antigen 5-spiked PW ImmunoCAP. All the

patients who turned to positive by antigen

5-spiked venoms were sensitised to antigen

5. The patients who were negative against

antigen 5 remained negative or lower posi-

tive against the antigen 5-spiked venoms.

Sensitivity of Immulite was 39.1% for YJ

and 56.9% for PW calculated by cutoff 0.1

IKUA/l. Sensitivity of antigen 5-spiked

venom ImmunoCAP was 71.9% for YJ

and 65.5% for PW when the cutoff

0.1UA/ml was used.

Conclusion: We confirmed in Japanese

patients with venom allergy that the sensi-

tivity of YJ and PW venoms of Immuno-

CAP were increased by spiking of antigen

5. The improved ImmunoCAP might be

useful to diagnose YJ and PW venoms

allergy in Japan. Improvement of sensitiv-

ity should be focused on quality of allergen

extract involving molecular allergen based

allergy diagnosis.

1079

The prevalence of Hymenoptera venom

allergy and sensitisation in an Irish birth

cohort

Stanley, EL1; Falsetto, T1; Hourihane, JOB2

1Paediatrics, University College Cork, Cork, Ireland;2Paediatrics, Cork University Hospital, Cork, Ireland

Background: Insect sting is the second

most common cause of anaphylaxis world-

wide. The Hymenoptera order of insects is

comprised of apidae (honey bees), vespidae

(wasps) and formicidae (ants). In Northern

Europe the most common cause of insect

stings are from bees and wasps. Hymeno-

ptera venom allergy has been studied exten-

sively in adults and children but, there is a

paucity of research regarding infant and

toddler allergy to bee and wasps.

Method: One thousand, two hundred and

nine subjects attending for their 24-month

assessment as part of the BASELINE

study were asked about previous sting his-

tory and had skin prick tests for bee and

wasp venom. The subjects who reported a

previous sting history were contacted at a

later date by phone and questioned in rela-

tion to the conditions surrounding the

sting event.

Patients with

a history of

reaction to

Hymenoptera

stings

Apis

sensitization

Vespula

sensitization

Polistes

sensitization

Api

m 1

sIgE+

Ves

v 5

sIgE+

Pol

d 5

sIgE+

MUXF3

sIgE+

Honey Bee 8 8/8 6/8 4/8 4/6 3/5 1/4 3/5

Wasps 4 3/4 4/4 4/4 0/2 4/4 3/3 1/1

Unidentified 7 4/7 7/7 6/7 2/4 4/7 3/6 1/2

Honey bee and

unidentified

2 2/2 1/2 1/2 0/1 1/2 0/2 0/2

Wasp and

unidentified

2 0/2 2/2 2/2 0/1 1/2 1/2 0/0

Honey Bee

and Wasp

1 1/1 1/1 1/1 0/1 1/1 1/1 0/1

Results of diagnostic tests

Poster Session Group II – Red. TPS 42 – Hymenoptera venom allergy

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 397

Results: Seventy seven subjects (6.8%)

reported a positive sting history, all of

which were limited to localised reactions

and consequently had negative skin prick

tests to bee and wasp venom. In the uns-

tung population subjects had a sensitisat-

ion rate of 0.7% was observed and there

was no reported previous sting.

Conclusion: Interestingly, in this cohort

sensitisation does not correlate with posi-

tive sting history and draws into question

the aetiology of Hymenoptera allergy and

sensitisation.

1080

Changes in basophil activation test after

venom immunotherapy

Alfaya, T1; De la Roca, F1; Urra Ardanaz, JM2; Cabrera,

C2; Feo Brito, F1

1Allergy, Ciudad Real Hospital, Ciudad Real, Spain;2Immunology, Ciudad Real Hospital, Ciudad Real, Spain

Background: Venom immunotherapy

(VIT) is highly effective in the treatment of

anaphylactic reactions to hymenoptera

stings but nowadays we don0t have a reli-

able test to predict the immunotherapy

outcome in a particular patient. In some

cases we can use the re-sting challenge test

although several risks have been related to

this technique. The aim of this work is to

analyze the changes in basophil activation

test (BAT) after 6 months of venom immu-

notherapy in order to identify new tools to

predict the VIT efficacy.

Method: We included seven patients trea-

ted with venom immunotherapy (6 Polistes

dominulus and 1 Vespula germanica). We

performed BAT, specific IgE and intrader-

mal tests before immunotherapy and after

6 months of treatment. We used BAT at 1

and 0.1 lg/ml of venom.

Results: We found a significant decrease in

BAT values at 1 (P = 0.018) and 0.1 lg/ml

(P = 0.018) after 6 months of VIT, greater

with 0.1 lg/ml (73.43 � 33.74%) than with

1 lg/ml (65.67 � 18.33%). We also found

a significant decrease in intradermal tests

mean diameter of 38.46% (P = 0.028). Spe-

cific IgE values didn0t show a significant

change.

Conclusion: BAT with hymenoptera

venom was the most sensitive test to show

changes after 6 months of immunotherapy

when compared to specific IgE and intra-

dermal tests. The 0.1 lg/ml concentration

showed the best results. According to our

results BAT could be better than specific

IgE and intradermal tests to monitor

venom immunotherapy.

1081

Strategy for reducing side effects of

immunotherapy with Apis mellifera: a

case report

Ruiz León, B; Moreno Mata, E; Gonz�alez S�anchez, LA;

Cand�on Morillo, R1; Burgos Montero, A

Allergology, La Mancha Centro Hospital, Alc�azar de

San Juan, Spain

Background: Although venom immuno-

therapy is effective in the majority of

patients, there are systemic side effects in

20–40% of treated individuals and the fail-

ure of treatment in 10–20% of patients

with honeybee venom allergy. We pre-

sented a girl who had a poor tolerance and

lack of efficacy to bee immunotherapy.

Method: A girl, 15 years old and Bee-

keeper0s daughter, when she was 6 year old

suffered wheezing, dyspnea, and angioe-

dema, after a bee sting. She had received

Immunotherapy Apis mellifera (Pharmal-

gen� ALK) for 2 years in her reference

hospital, but after 1 year, she began to suf-

fer acute dry cough, wheezing, itching after

dose of 100 lg. Sting challenge test was

positive. She was transferred to the Man-

cha Centro Hospital for assessment.

Results: We repeated the Allergy study:

Serial Intradermal Hymenoptera venom

was positive to Apis mellifera (0.001 mg/

ml) with Specific IgE (CAP) of 17.7 KU/l

and undetectable for Vespid. We extend

the study with Molecular study (Advia

Centaur) Api m1: 87.29, Api m2: 7.7 and

Api m4: 3.77. She was diagnosed of Ana-

phylaxis grade III with sensitisation to bee

venom and she started with immunother-

apy 100% Apis mellifera (Aquagen�

ALK). We used a cluster protocol (seven

doses and three visits) but before, she

received treatement with intramuscular cor-

ticoids and antihistamine. During the first

cluster she presented good tolerance, how-

ever during following clusters, she suffered

with first doses, an acute dry cough,

wheezing and itching which disappear with

treatment. She reached the maintenance

dose (200 lg once a month) but she always

presented side effect with the first doses.

After 2 year, we reduced the dosing inter-

val to 200 lg each 15 days. She began with

a perfect tolerance and we performed a

sting challenge test with result negative.

Conclusion: There are some strategies for

reducing venom immunotherapy0s side

effects like premedication and using the

different extract as purified and depot

extract can improve the tolerance. The

modification of the dosing interval, short-

ening the dose interval, could be a useful

strategy to improve safety and efficacy to

Immunotherapy with Apis mellifera.

1082

Pre-treatment with omalizumab allows

ultra-rush honey bee venom

immunotherapy in patients with mast

cell disease

da Silva, EN1,2; Randall, KL1,2

1Department of Immunology, Canberra Hospital,

Canberra, Australia; 2ANU Medical School, Australian

National University, Canberra, Australia

Background: Venom immunotherapy is

indicated for all individuals with a history

of venom-induced anaphylaxis and demon-

strable venom specific IgE. Elevated base-

line serum tryptase, such as in monoclonal

mast cell disorders, including mastocytosis,

confers an increased risk of anaphylaxis

during venom immunotherapy, thus making

both initiation and continuation of venom

immunotherapy difficult in these patients.

Method: We describe a successful protocol

that has been used in two patients requir-

ing bee venom desensitisation, one with

monoclonal mast cell activation syndrome

(MMAS) and one with systemic mastocy-

tosis.

Results: Patient 1 was a 52 year old man

referred to the Immunology Outpatient

clinic after an anaphylactic reaction to bee

sting. Investigations revealed a positive

honey bee venom-specific IgE (41.9 kU/l).

He commenced bee venom immunotherapy

by our standard protocol but he suffered

anaphylaxis within minutes after the first

dose (0.01 mcg). Further investigation

revealed an elevated baseline tryptase

(22 mcg/l, reference range (RR) < 15 mcg/

l) on two occasions, and analysis of bone

marrow aspirate and trephine confirmed

the presence of the C-KIT D816V muta-

tion without other criteria for systemic

mastocytosis. A diagnosis of MMAS with

honey bee venom allergy was made.

Patient 2 was a 32 year old man admit-

ted to an Intensive Care Unit after a car-

diac arrest following a bee sting. He was

found to have a positive honey bee venom-

specific IgE (13.7 kU/l) and a basal serum

tryptase of 12.1 mcg/l (RR < 11.4). Bone

marrow biopsy revealed increased numbers

of mast cells, some with spindle morphol-

ogy, a small population of cells expressing

CD117, CD25 and CD2 and the presence

of the C-KIT D816V mutation consistent

with a diagnosis of systemic mastocytosis.

Both patients received three doses of

omalizumab (10, 6, and 2 weeks prior to

commencement of ultra-rush immunother-

apy) and proceeded to tolerate the stan-

dard ultra-rush protocol to a maintenance

dose of 100 mcg of bee venom over 3 days.

For patient one we have been able to stop

the monthly omalizumab injections and he

has now had 12 months of venom immu-

notherapy without incident.

Poster Session Group II – Red. TPS 42 – Hymenoptera venom allergy

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453398

Conclusion: We describe a protocol to

allow ultra rush bee venom immunother-

apy to proceed in patients with mast cell

disease at high risk of adverse events.

1083

The take in charge of the hymenopteran

venoms in a specialised department in

Algiers

Rachid, A; Malki, G; Douagui, H

ALGER, Pneumo-Allergologie, Alger, Algeria

Background: The allergy to hymenopteran

venoms is an important cause for the (ana-

phylaxie).The prevalence of the systematic

reactions is from 0.7 to 8% for the general

population, 0.34 to 8% for children, 14–32% for the beekeepers. The risked popu-

lations are the beekeepers and their fami-

lies, the pastry cooks, the people working

outside.

Creation since December, 2006 of a

specialised center at the in the CHU

B�ENI-MESSOUS (ALGIERS) for the

diagnosis, the treatment (processing) and

the prevention of allergies of hymenopter-

ans venoms.

Method: It is about a national survey

which took place from December 2006 to

April 2013, on a sample of 393 patients

(237 male and 156 female) coming from 17

departments of Algeria.

It took place at the day hospital of the

Pneumo-Allergology department (CHU

B�eni Messous, Algiers).The average age of

the patients is 23 years old with extremes

from 06 to 62 years, the achieved examina-

tions are the cutaneous tests (bee and

wasp) and IgE (bee and wasp).

Results: The notion of atopy is found for

46% of the patients, an exhibitor profes-

sion for 25%. We note an ascendancy of

the stage III (44%) followed by the stage

IV (30%) according to the Muller classifi-

cation, the tests are positive almost exclu-

sively for the bee (45%), it is the same for

the dosage of the specific IgE.

One fifty seven patients have been put

under desensitisation with 154 for bee ven-

oms and 03 for wasp venom, 4�e according

to rush protocol and 115 according to

ultra rush protocol with a systematic sani-

tary education for the whole ills.

Conclusion: The allergic reactions after

hymenopteran venom stings are potentially

serious with a risqk of death by anaphylac-

tic shock.The desensitisation has an effi-

ciency superior to 90% .It is necessary to

increase the number of specialised centers

in the Maghreb region as well as the Afri-

can countries in order to improve the diag-

nosis, the treatment and the prevention

against hymenopteran venom allergy.

1084

Kounis symdrome associated with

hypersensibity to hymenotera stings

Ramos, T; Vega, F; Las Heras, P; Frutos, MC;

Jimenez, H; Blanco, C

Allergy, Hospital Universitario de la Princesa, Madrid,

Spain

Background: A 46-year old male, with a

history of aortic and mitral valvular pros-

thesis after rheumatic fever, was stung on

the right arm by a Poslistes wasp. He

developed local pain, dysphasia, obnubila-

cion and amnesia, but not loss of con-

sciousness, few minutes after the sting, and

he also presented chess pain. He was

immediately transferred to hospital. On

clinical evaluation, his blood pressure was

normal, an EKG revealed an atrial fibrilla-

tion. Blood samples were taken for cardiac

enzymes and troponin that resulted nor-

mal.Chess pain was maintained and a new

EKG revealed ST segment depression (V3-

V6). Blood samples show increased tropo-

nins and cardiac enzymes. Coronary arteri-

ography performed 20 h after sting was

normal. Apical necrosis was detected in

cardiac magnetic resonance 5 days after

sting. Cardiologic diagnosis was non-Q

wave myocardial infarction.After some

weeks, he presented situations of emotional

stress with reappearance of neurological

symptoms. An EEG showed a slow wave

cortical activity in symptomatic period,

turning normal when he was asymptom-

atic. The magnetic resonance showed cere-

bellar microinfarcts. Neurologic diagnosis

was partial epilepsy with secondary gener-

alised seizures.

Method: Skin prick and intradermal test

with Polistes and Vespula venom were per-

formed. Total IgE, venom-specific IgE to

both Polistes ssp.and Vespula, venom aller-

gen components, and serum tryptase levels

were determined.

Results: Skin prick and intradermal tests

with Vespula venom were negative. Mean-

while Polistes venom SPT was negative, a

positive intradermal reaction to 0.1 micro-

grams/ml was obtained. Total IgE was

24.5 kU/l, serum tryptase 4.2 lg/l, venom

specific IgE (Advia Centauro) to Ves v 1

0.19 kU/l, and to Pol d 1 0.21 kU/l.

Conclusion: We present an atypical case of

Kounis Syndrome type I due to Polistes

sting, associated with the debut of epilepsy.

Vasospasm producing the coronary

involvement could be responsible for the

epilepsy debut.

1085

To bee or not to bee: is omalizumab is

the answer? Successful pretreatment

with omalizumab in bee venom

immunotherapy

Pereira, AM1,2,3; Coimbra, A1; Reis Ferreira, A1; Fonseca,

JA1,2,3

1Centro Hospitalar S~ao Jo~ao, Servic�o de

Imunoalergologia, Porto, Portugal; 2Department of

Health Information and Decision Sciences, Faculty of

Medicine of the University of Porto, Porto, Portugal;3Instituto and Hospital CUF, Allergy Unit, Porto,

Portugal

Background: Immunotherapy is an estab-

lished treatment for venom anaphylaxis

however serious adverse effects may occur.

Method: We report two cases of pretreat-

ment with omalizumab in bee venom

immunotherapy (VIT).

Results: First case: 45 year old female

bank clerk, recreational beekeeper with a

history of two anaphylaxis episodes follow-

ing bee stings. Positive intradermal skin

tests (IDT; 0.1 lg/ml) and normal serum

tryptase. VIT with a conventional schedule

was initiated in 2003 but she experienced

recurrent systemic reactions at each

attempt to increase the dose above 10 lg.In 2011, she repeated IDT which were

positive (0.01 lg/ml) with an anaphylactic

reaction; specific bee IgE (sIgE) 2.90 KU/l.

VIT was restarted after pretreatment with

omalizumab (dose according to total IgE

and weight) that was administered 1 week

before VIT. An ultra.rush schedule (UR)

was uneventful and the 100 lg dose was

attained. Omalizumab pretreatment was

maintained 1 h before each VIT adminis-

tration every 4 weeks for 6 months. She

stopped omalizumab on December 2012.

Second case: 27 year old female social

worker with a history of near fatal anaphy-

laxis after 1 bee sting. Positive IDT

(0.001 lg/ml), sIgE level >100 kU/l and

normal tryptase. VIT with UR was suc-

cessful in August 2011 but she had recur-

rent systemic reactions with the following

doses, in spite of pretreatment with antihis-

tamine and montelukast. In March 2012,

pretreatment with omalizumab in a similar

schedule was started and VIT administra-

tion was successful.

Both are currently on VIT without any

adverse reactions.

Discussion: Both the BSACI and AAAAI

guidelines consider pretreatment with anti-

IgE in exceptional cases. However, the evi-

dence is scarce, approximately 20 published

cases with different regimens and doses.

The protocol we used was successful in

attaining the target dose of VIT without

any adverse reactions in two bee allergic

patients. Nonetheless, more studies are

necessary for stronger evidence basis.

Poster Session Group II – Red. TPS 42 – Hymenoptera venom allergy

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 399

1086

Bleeding disorders in the course of

anaphylaxis, after Hymenoptera sting, in

a patient with mastocytosis

Cortellini, G; Santucci, A; Corvetta, A

Internal Medicine, Rimini Hospital, Rimini, Italy

Background: Clinical case. Male 29 year

old. He had recently a severe anaphylaxis,

after Hymenoptera sting (vespa crabro),

grade 4 according with Mueller classifica-

tion: respiratory symptoms, cardiovascular

symptoms with loss of consciousness for a

long time. In Emergency he was treated

with adrenalin intramuscular 0.5 milliliter,

repeated after 100, anthystamines and corti-

costeroids. Blood exams routinely executed

show high partial activated tromboplastine

time: over 250.

Method: First Blood exam was few hours

after anaphylactic shock, but value

remained high for 2 days. Patient under-

goes in following days two serial tryptase

dose, both elevated, over 30 micrograms

/milliliter. Skin tests and RAST (immuno-

CAP) confirmed diagnosis of anaphylaxis

due to vespa crabro sting. Patient received

venom Immunotherapy. He was also stud-

ied for possible mastocitosys.

Results: Dermatological examination

excluded urticaria pigmentosa. Indolent

Systemic Mastocitosys, according with

Word Health Organization criteria was

confirmed after bone marrow exam. For

these reason after, patient received venom

Immunotheraphy at double dose

(200 micrograms) to reach a better thera-

peutic protection.

Conclusion: In our review of Literature we

don’t find disorders of partial activated

tromboplastine time after adrenalin ther-

apy. On the other hand coagulation disor-

ders are described after Hymenoptera sting

and also in association with Mastocitosys.

Particularly there are reports of intravascu-

lar systemic coagulation in both syn-

dromes, of plasminogen activation after

Hymentoptera sting and of Von Wille-

brand association with Mastocitosys. Last

we find a report of heparin release in Mas-

tocitosys. We suppose that the association

of Hymenoptera Venom anaphylaxis and

Mastocitosys caused this temporary coagu-

lation disorder. Factor 12°, Factor 11°,Factor 9° and Von Willebrand were also

dosed and resulted normal.

1087

A rare complication of wasp sting:

dystonia

Gungor, A1; Arslan, M2; Kaya, G1; Unay, B2; Yavuz, ST3;

Gok, F1

1Department of Pediatrics, Gulhane Military School of

Medicine, Ankara, Turkey; 2Department of Pediatric

Neurology, Gulhane Military School of Medicine,

Ankara, Turkey; 3Department of Pediatric Allergy,

Gulhane Military School of Medicine, Ankara, Turkey

Introduction: Wasp stings are very com-

mon forms of insect bites worldwide. Reac-

tions to wasp stings may vary from mild

local reactions to systemic reactions includ-

ing fatal anaphylaxis in sensitised patients.

Apart from these immune mediated reac-

tions, rare complications with delayed

onset including vasculitis, serum sickness,

neuritis and encephalitis may arise with

unknown mechanisms. Herein, we report a

child who developed dystonia, an unusual

complication of wasp sting.

Case report: A four-year-old boy was

admitted to our clinic with the complaints

of loss of strength in hands and feet,

spasms in all extremities and neck and gait

disorder. He was stung by a wasp on the

left ear 20 h before admission. The patient

had spasms on the lower and upper

extremities and neck dystonia, which were

not accompanied by loss of consciousness.

Reminder of the systemic and neurologic

examinations revealed no abnormality.

Routine biochemical analyses were within

normal limits, including complete blood

count, liver and kidney function tests,

serum electrolytes and thyroid hormones.

Cranial magnetic resonance imaging and

electroencephalography showed no abnor-

mality. He was managed conservatively

with fluid replacement and antihistamines

and the symptoms relieved totally within

8 h.

Conclusion: Neurological complications

due to wasp stings are extremely rare and

symptoms may start within several hours

or days in contrast to immediate immune-

mediated reactions and may be fatal in

cases particularly with central nervous sys-

tem lesions. Our patient did not have any

delayed deficit and recovered completely.

1088

The take in charge of the hymenopteran

venoms in a specialised department in

Algiers

Rachid, A; Malki, G; Douagui, H

ALGER, Pneumo-Allergologie, Alger, Algeria

Background: The allergy to hymenopteran

venoms is an important cause for the (ana-

phylaxie); it reaches 0.4–0.8% of children

between 4–16 years old.

Method: Assess (evaluate) the take in

charge of the hymenopteran venoms

allergy for child in Algiers.

A retrospective survey on children

affected by hymenopteran venoms allergy

has been carried out at the service of the

day hospital from December 2006 to

November 2013.

Results: During this period 74 (children)

have been take in charge, 24 girls and 50

boys with a sex-ratio of 2.08 and an aver-

age age of 08 years.

The clinical symptoms are dominated by

a generalised urticaria, the dyspnoea and

(dysphonie).

The cutaneous tests were positive for the

bee in 38 cases, for the wasp in three cases

and for the bee and wasp in four cases and

negative in 11 cases.

For the IGE dosage, 32 cases are posi-

tive for the bee and �e& (bee and wasp).

The desensitisation was made according

to the protocol rush and ultra rush, by tak-

ing into account 02 criteria: the age

(>5 years) and the M €ULLER classification

(stages III and IV).

The selection criteria for the desensitisa-

tion allowed retaining 30 children. 10 chil-

dren are desensitised according to rush

protocol and 20 according ultra rush pro-

tocol. 12 children have had secondary

effects to the desensitisation. Ten of rank

II and two of rank III according to the

classification of RING and MESSER;

these latter have been treated by oxygen,

Corticoids, antihistaminic and adrenalin

for two patients and a child presented a

shock state requiring the definitive stop-

ping of the desensitisation.

Conclusion: The allergic reactions after

stings by the hymenopteran venoms for the

child are easy diagnosis, confirmed by the

allergic cutaneous tests and the specific

IGE.

These reactions can be potentially seri-

ous. The introduction of the protocol ultra

rush in the service will allow taking in

charge of a high number of patients.

1089

High adherence to hymenoptera venom

subcutaneous immunotherapy: a real life

Italian experience

Kamberi, E1,2; Brianzoni, MF1; Garritani, MS1; Antonicel-

li, L1; Bonifazi, F1; Bil�o, MB1

1Allergy Unit, Department of Internal Medicine, Azienda

Ospedaliero-Universitaria Ospedali Riuniti di Ancona,

Ancona, Italy; 2Scuola di Specializzazione in

Allergologia e Immunologia Clinica, Universit�a

Politecnica delle Marche, Ancona, Italy

Background: Venom subcutaneous immu-

notherapy (VIT) is a highly effective treat-

ment, however, there is no data available

concerning the adherence.

Poster Session Group II – Red. TPS 42 – Hymenoptera venom allergy

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453400

Aim of the study: To evaluate, in retro-

spective manner, real-life adherence to con-

tinue VIT for a 5-year period (maintenance

phase) in an Italian population.

Methods: Subjects who had started VIT at

our University-Hospital from January 2000

to December 2006 were included. Adher-

ence to continuation was defined as still

receiving maintenance dose of VIT at regu-

lar intervals after one, three and 5 years.

Maintenance phase schedules were

extracted from our files and a question-

naire was administered from the healthcare

practitioners to follow-up patients, while a

phone interview was carried out for

patients lost to follow-up or referred to the

corresponding residence hospital.

Results: Five hundreden eight patients (M/

F = 3:1) with mean age 46 (from 9 to

84 years old) were included in the study.

The 26% of the subjects had received VIT

for two venoms. 99% of all the subjects

had regularly completed the one-year

maintenance VIT; 95% three-years and

84% five-years. The overall major reason

for discontinuation was inconvenience

(50%) and the second reason (12%) was

the appearance of a new disease not related

to venom allergy.

Conclusions: This is the first study that

evaluates adherence to VIT for a 5-year

follow-up period in real life. A high adher-

ence rate was observed at one, three and

even 5 years. We believe that these results

may be due to: peculiarity of this potential

life-threatening allergic disease, patient

motivation ensuing from pre-VIT incisive

counselling by allergist on its efficacy and

safety, and take care of patients through

regular follow-up.

1090

Kounis syndrome secondary to wasp

venom allergy

Pe~na Arellano, MI1; Flores Martin, IM1; Exposito

Barroso, F2; Miras Bruno, JA3

1Hospital Vega Baja, Alergolog�ıa, San Bartolom�e,

Spain; 2Servicio de Urgencias Extrahospitalarias 061,

Murcia, Spain; 3Hospital Los Arcos, San Javier, Spain

Background: After hymenoptera stings we

can find different reaction, from local to

systemic symptoms. Systemic reactions

cause a spectrum of manifestations ranging

from cutaneous signs to respiratory

involvement and cardiovascular compro-

mise. Occasionally these allergic reactions

may be associated with ischemic heart dis-

ease secondary to mediator release.This

clinical syndrome is called Kounis syn-

drome.

Method: We report a 33 year-old man

who suffered a wasp sting. After 5 min he

developed sweating, nausea, dizziness and

loss of consciousness with spontaneous

recovery. When the patient arrived at the

emergency room he was hypotensive

(blood pressure 90/40 mmHg) and electro-

cardiographic changes with an increase of

troponin levels were found. The patient

was diagnosed with acute coronary syn-

drome and he was admitted to the inten-

sive care unit where he recovered

completely. The patient had no history of

heart or cardiovascular disease. A compre-

hensive cardiac study was performed

before referral to the allergy unit to asses a

possible hymenoptera sting hypersensitiv-

ity.

Results:

1 EKG:elevation of the J point in V2-V3,

negative T in I-aVL

2 Troponin I level:1.8 (<0.2)

3 Ergometry,echocardiography:normal

4 Specific IgE levels:Polistes dominulus

4U/ml.

5 Intradermal test:P. dominulus positive

at a concentration of 0.01 lg/ml.

6 Tryptase basal level 11 ng/ml

Kounis syndrome secundary to wasp

allergy

Conclusion: Kounis syndrome was first

described in 1991 and it involves the coin-

cidental occurrence of acute coronary syn-

drome with anaphylaxis. Kounis syndrome

is caused by inflammatory mediators, and

multiple triggers have been associated with

this syndrome (including Hymenoptera

venoms or drugs). There are three types:

Type 1 in patients with normal coronary

arteries, type 2 in patients with a preexist-

ing atheromatous disease, and type 3 in

patients with stent thrombosis. We report

the case of a patient with type I variant of

Kounis syndrome secondary to wasp sting

hipersensitivity.

1091

Outcomes of Hymenoptera allergy in

polish children non-treated with venom

immunotherapy

Lange, J1; Cichocka-Jarosz, E2; Marczak, H1; Tarczo�n, I2;�Swiebocka, E3; Lis, G2; Kulus, M1

1Department of Pediatric Pulmonology and Allergology,

Medical University of Warsaw, Warsaw, Poland;2Medical College, Department of Pediatrics, Chair of

Pediatrics, Jagiellonian University, Cracow, Poland;3Department of Pediatrics, Children’s Gastroenterology

and Allergology, Medical University, Bialystok, Poland

Background: Data on natural history in

Hymenoptera allergy in children are rare.

We undertook a retrospective multicenter

study to examine the rate of sting recur-

rence and outcome of Hymenoptera venom

anaphylaxis in children who did not meet

criteria of venom immunotherapy (VIT).

Methods: We evaluated patients records

from databases of three pediatric depart-

ments in Poland and selected 219 patients

who were admitted into hospital after sting

reaction between 2003 and 2012. Of 219

children 180 (82%) didn’t meet criteria of

VIT due to local or mild systemic reactions

(SR) in Mueller’s classification, 18/219

(8%) presented non IgE-mediated SR. We

conducted phone and post survey of these

patients by using standardised question-

naire.

Results: Of 219 patients 130 responded

(59%) with a mean follow-up period of

5.5 years (�2) after diagnosis. There were

93 males (72%), mean age for the whole

group at the time of diagnosis equaled

11 years (�4). Of 130 children 44 (34%)

were re-stung 62 times by the insect they

were allergic to. Among those, 27 children

(43 re-sting episodes) experienced normal

local reaction, nine children (re-stung ten

times) suffered from large local reaction,

while eight patients (re-stung nine times,

six by wasp, two by honey bee, one

unidentified) developed SR. Six of them

had more severe SR after re-sting (three of

them subsequently were qualified for VIT),

one presented the same reaction and one

was stung by different insect.

There was some association (r = 0.35,

P = 0.059) between class of venom-specific

IgE at the time of initial evaluation and

grade of severity of subsequent insect sting

reaction.

Most patients (67%) avoided stings after

proper education and prescription of an

emergency kit for self-treatment.

Conclusion: A minority of children in our

sample was re-stung. Most observed reac-

tions were mild. Only three children were

qualified to VIT after subsequent sting

during long-term observation.

1092

Differences in clinical characteristics of

adults and children from Southern

Poland qualified for venom

immunotherapy (VIT)

Stobiecki, M1; Cichocka-Jarosz, E2; Brzyski, P3; Rogatko,

I4; Czarnobilska, E1; Lis, G2

1Clinical and Environmental Allergology, Jagiellonian

University Medical College, Krak�ow, Poland;2Department of Pulmonology, Allergy and

Dermatology, Jagiellonian University Medical College,

Karakow, Poland; 3Epidemiology and Preventive

Medicine, Jagiellonian University Medical College,

Krakow, Poland; 4Department of Biochemistry,

Jagiellonian University Medical College, Krakow,

Poland

Background: Clinical history of IgE-medi-

ated relevant systemic insect sting reaction,

both in children and adults is an indication

of VIT. Most of the studies concerning

venom allergy and VIT have been con-

ducted with adults.

Poster Session Group II – Red. TPS 42 – Hymenoptera venom allergy

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 401

Method: A cross-sectional study based on

medical records of adults and children

qualified for VIT from the region of South-

ern Poland was performed. The following

clinical and diagnostic information were

collected: Mueller’s grade of systemic reac-

tion, symptoms of mast cell disorders, up-

dosing intradermal skin tests (IDT), serum

specific IgE and tryptase.

Results: Study group comprised of 113

adults (mean age 41.3 year; SD 13.8; 53%

males) and 203 children (mean age

11.2 year; SD 3.7; 76% males). There was a

difference in type of sensitisation, with

prevalence of Vespula spp. (V.s). allergy in

adults (59%), while Apis m. (A.m) in chil-

dren (56%, P = 0.005). In the adult group

there was a predominance of grade IV of

Mueller0s reaction (58% vs 34% children),

while grade III was more frequent in chil-

dren (42% vs 36%, P = 0.000). Median

value of V.s. venom extract concentration

with positive result of IDT was lower in

adults (0.001 mcg/ml vs 0.055 mcg/ml,

P = 0.000), similar to a case of A.m. venom

extract IDT (0.0001 lg/ml vs 0.01 lg/ml,

P = 0.000). There was a difference between

groups in median level of both sIgE: to V.s.

venom in adults 2.6 kU/l vs 5.1 kU/l in

children (P = 0.007), and to A.m. venom in

adults 4.2 kU/l vs 23.7 kU/l, P = 0.000).

Baseline serum tryptase concentration

regardless of kind of venom differed

between the groups and was higher in

adults (3.88 lg/l vs 3.10 lg/l, P = 0.001).

Conclusion: In spite of the same region of

residence there are differences between

children and adults both in type of sensiti-

sation and clinically relevant manifestation

of venom allergy.There are also significant

dissimilarities in immunological character-

istics among groups. Conclusions based on

data concerning adults can not be extrapo-

lated directly to children.

1093

Personality and temperament patterns in

hymenoptera venom allergy populations

Nittner-Marszalska, M1; Bielous, A2; Babel, P3

1Department and Clinic of Internal Diseases, Geriatry

and Allergology, Medical University of Wrocław,

Wrocław, Poland; 2Department of Pathophysiology,

Medical University of Wrocław, Wrocław, Poland;3Institute of Psychology, Jagiellonian University,

Krak�ow, Poland

Background: The clinical diffrences

between bee and vasp venom allergy are

significant. The aim of the study was to

measure personality and temperament

traits in atopic subjects with Hymenoptera

venom allergy (HVA).

Method: One hundred and fifty patients

entered the study. Forty six patients have

bee venom allergy (mean age 36.28, SD

16.0; 18 women and 28 men) and one hun-

dred and four patients have vasp venom

allergy (mean age 41.24, SD 15.25; 58

women and 46 men). All subjects have

convincing history of a severe or a life-

threatening anaphylactic reaction of grade

II–IV according to Mueller after wasp or

honey bee sting. HVA was confirmed by

intracutaneous skin tests and venom-spe-

cific IgE concentration. All of the patients

filled in Eysenck Personality Question-

naire-Revised (EPQ-R) measuring Neuroti-

cism, Extraversion, Psychoticism and Lie.

The Formal Characteristics of Behaviour –Temperament Inventory (FCB-TI) measur-

ing Briskness, Perseverance, Sensory Sensi-

tivity, Emotional Reactivity, Endurance,

and Activity was also used.

Results: The subjects with bee venom

allergy obtained significantly lower scores

in Neuroticism (M = 9.52, SD = 5.25) than

vasp venom allergy subjects (M = 11.61,

SD = 5.77) (P = 0.05). Emotional Reactiv-

ity was also significantly lower in bee

venom allergy patients (M = 7.9;

SD = 4.81) than vasp venom allergy

patients (M = 9.67, SD = 4.45) (P < 0.05).

Bee venom allergy group have significantly

higher scores in Briskness (M = 16.65,

SD = 2.77) than vasp venom allergy group

(M = 14.97, SD = 3.28) (P < 0.001). The

level of slgE had no effect on the results

obtained.

Conclusion: Lower scores in Neuroticism

and Emotional Reactivity in bee venom

allergic patients are in line with higher

score in Briskness in this group. Our

results show more emotional stability in

bee venom allergic people compared to

vasp venom allergic people. It is difficult to

interpret, however it may be of importance

that all psychological traits measured in

the study have biological basis.

Poster Session Group II – Red. TPS 42 – Hymenoptera venom allergy

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453402

Poster Session Group II – Red

TPS 43 – Immunotherapy – AIT clinics I

1094

Subcutaneous allergen immunotherapy

with high-dose hypoallergenic pollen

preparations improves quality of life and

is effective and safe in real life

Egert-Schmidt, A-M1; Henrichs, T2; Fielenbach, T2;

Thum-Oltmer, S1

1Allergopharma GmbH & Co. KG, Reinbek, Germany;2Syneed Medidata GmbH, Konstanz, Germany

Background: Efficacy and safety of aller-

gen immunotherapy with high-dose hypo-

allergenic pollen preparations have been

demonstrated in clinical studies. Objective

of this observational study was to collect

data on the efficacy, tolerability and adher-

ence on these preparations in the daily rou-

tine of office-based physicians.

Method: This post marketing surveillance

study was conducted at 218 centres in Ger-

many. Study data of 753 patients (median

age: 32 years, range: 5–78 years) with IgE-

mediated allergic diseases (rhinitis, con-

junctivitis, asthma) was analyzed before

start of SCIT with registered high-dose

hypoallergenic pollen preparations and at

the end of the first and second pollen sea-

son via structured questionnaires. The effi-

cacy was evaluated based on symptoms

and antiallergic medication using different

treatment regimens over two treatment sea-

sons. Quality of life data was obtained by

a self-administered questionnaire (EQ-5D).

Results: The number of patients with mod-

erate and severe symptoms decreased dur-

ing study duration. The use of concomitant

anti-symptomatic medication decreased in

the total population from 86.3% previ-

ously to 53.4% at the final visit. The med-

ian EQ-5D VAS score increased from 70 at

the first to 90 at the last visit, indicating an

improvement in the current health state of

the patients. Patients’ overall compliance

was excellent or good (89.5%). Most

patients were very satisfied or satisfied with

the therapy benefit (89.0%) and the tolera-

bility of the therapy (91.9%). 246 AEs

were reported in 113 patients (15.0%,

10.8% locally, 4.5% mild systemic, 1.7%

severe systemic), none AE was classified as

serious.

Conclusion: SCIT with high-dose hypoal-

lergenic pollen preparations proved to be

effective and safe in real life as shown by

beneficial effects on the severity of allergy

symptoms, on the frequency of concomi-

tant medication use, and quality of life.

Acceptance and compliance by patients

was high.

1095

Responder analysis for intracutaneous

test (ICT) reactivity in a dose range

finding (DRF) trial investigating a timothy

grass (Phleum pratense) pollen allergoid

preparation

Hansen, S; Häfner, D; L€ubcke, P; Narkus, A

Allergopharma GmbH & Co. KG, Reinbek, Germany

Background: Outcome measures in clinical

trials should clearly separate clinically rele-

vant effects from unspecific effects.

Responder analyses provide an appropriate

tool to prove if the magnitude of an effect

reaches a well-defined threshold value to

confirm clinically relevant efficacy. With

this objective, we performed a responder

analysis on the ICT reactivity of patients.

Method: This was a double-blind, placebo

and actively controlled trial. Adult patients

(FAS n = 98) with allergic rhinoconjuncti-

vitis � bronchial asthma were randomised

to one of five groups. Three groups

received nine pre-seasonal injections of the

Phleum pratense allergoid in different

doses: standard dose (n = 18), 3-fold lower

(n = 20), and 3-fold higher than standard

dose (n = 18). The active comparator

group (n = 22) was treated with a standard

dose of a commercial allergoid from a 6-

grasses pollen mixture. Twenty patients

received placebo. Response was defined as

a reduction of 50% in the primary efficacy

endpoint: the change of swelling size (area

in mm2) 6 h after ICT injection pre and

post treatment.

Results: Patients treated with all doses of

the Phleum pratense pollen allergoid and

the active comparator showed clear and

statistically significant (pairwise chi2-test P-

value vs placebo) responses. Response rates

were 73.3% (P = 0.006) of patients in the

high dose group, 83.3% (standard dose

group, P = 0.001), 70.0% (low dose group,

P = 0.006), and 85.7% of patients in the

active comparator group (P < 0.001),

whereas a response was observed for only

26.3% of patients in the placebo group.

Conclusion: Using intracutaneous test reac-

tivity in a dose range finding trial on dif-

ferent doses of a Phleum pratense pollen

allergoid and a commercial 6-grasses pollen

allergoid a clear discrimination between

actively treated (response rates 70.0–85.7%) and placebo treated patients

(response rate 26.3%) was observed. This

proved clinically relevant efficacy for the

allergoid preparations at all doses investi-

gated.

1096

Efficacy of 300IR 5-grass pollen extract

sublingual tablet in patients with grass

pollen-associated allergic

rhinoconjunctivitis assessed by daily

combined score in a long term study

Didier, A1; Montagut, A2; Zeldin, RK2

1Respiratory Diseases Department, Rangueil-Larrey

Hospital, Toulouse, France; 2Global Clinical

Development, Stallergenes S.A., Antony, France

Background: The daily Combined Score

(CS) equally weights symptom and rescue

medication scores. Its use as a primary

outcome measure of clinical trials with

allergen specific immunotherapy for respi-

ratory allergy is consistent with the World

Allergy Organization’s recommendation.

Here, we present efficacy results of a long-

term study with 300IR 5-grass pollen

extract sublingual tablet using the daily

CS.

Method: Grass pollen allergic adults were

randomised 1:1:1 to receive placebo or

300IR tablet pre- and co-seasonally start-

ing either 4 months (4M) or 2 months

(2M) prior to the season. They were trea-

ted over three consecutive years and fol-

lowed for 2 years post-treatment. The daily

CS (range 0–3) was analysed post-hoc over

each of the five evaluation periods using a

linear mixed model with repeated measures

and ANCOVA. Results are presented for

the 4M group, i.e. the approved treatment

regimen.

Results: Six hundreden thirty three adults

were randomised and 457 completed the

three treatment years. In each of the first

three evaluation periods, differences from

placebo in daily CS least-squares (LS)

means in active group were significant

(P ≤ 0.0024). The relative differences vs

placebo were �16.4% in Year 1, �38.0%

in Year 2, and �38.3% in Year 3. 433

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 403

patients completed the subsequent, treat-

ment-free year. During Year 4, the differ-

ence in daily CS LS means from placebo

was significant (P = 0.0103) with a relative

difference of �25.3%. 372 patients com-

pleted treatment-free Year 5. The differ-

ence in daily CS LS means from placebo

was significant (P = 0.0478) with a relative

difference of �28.1%.

Conclusion: In grass pollen-allergic adults

treated discontinuously with 300IR 5-grass

pollen extract sublingual tablet in a long-

term study, efficacy was demonstrated over

3 treatment years vs placebo. A significant

improvement vs placebo was also shown in

the first and second years post-treatment.

1097

Randomised, controlled, multicenter,

phase IV study with house dust mites

subcutaneous immunotherapy. Twelve

months quality of life results in the

ALUMITES study

Sanchez, J1; Vidal, C2; Hern�andez, D3; Malek, T4; Pelaez,

A5; Garcia, MA6; Valero, A1

1Hospital Clinic Universitari Barcelona, Barcelona,

Spain; 2Complejo Hospitalario Universitario de

Santiago, Santiago de Compostela, Spain; 3Hospital

Universitario y Polit�ecnico La Fe, Valencia, Spain;4Hospital General de Castellon, Castellon, Spain;5Hospital Clinico Universitario de Valencia, Valencia,

Spain; 6Medical Department, Stallergenes Iberica, S.A.,

Barcelona, Spain

Background: ALUMITES study was

designed to assess the efficacy of house

dust mites (HDM: D. pteronyssi-

nus + D. farinae) 10 IR/ml subcutaneous

immunotherapy for the treatment of aller-

gic rhinitis patients throughout the year.

Here we report quality of life (QoL) score

after 12 months of treatment.

Method: In this controlled multicenter

phase IV study, HDM adult allergic

patients were randomized to receive SCIT

with a 10 IR/ml depot extract plus symp-

tomatic treatment (group A) or only symp-

tomatic treatment (group B) (2:1). Quality

of life (QoL) was recorded at basal visit

and after 6 and 12 months of treatment.

ESPRINT-15 questionnaire was used.

ESPRINT-15 consisting of 15 items on a

7-point Likert scale (lower score indicating

a better quality of life) is composed of four

domains: symptoms, daily activities, sleep

and psychological affectation.

Results: Forty eight of 57 patients com-

pleted the ESPRINT-15 questionnaire.

Active group experienced an improvement

in their QoL score being at basal visit

2.6 � 1.55 and twelve months of treatment

later 1.2 � 1.31 (P = 0.0001). Control

group did not experienced a significant

improvement since they scored 2.6 � 1.21

at basal visit and 1.9 � 1.67 (P = 0.0942)

twelve months later.

By domains, symptoms �1.6 (95% CI

[�2.1,�1.1], P < 0.0001), daily activities

�1.3 (95% CI:[�1.8,�0.8], P = 0.0001),

sleep�1.1 (95%CI:[�1.6,�0.6], P = 0.0001)

and psychological affectation �1.8 (95% CI:

[�2.3,�1.2], P < 0.0001) improve just in the

active group whereas none of them improved

significantly in the control group.

Conclusion: Patients report improvement

of their quality of life (ESPRINT-15)

already twelve months after beginning

SCIT with a 10 IR/ml depot HDM extract

in all domains demonstrating the clinical

meaningfulness of the efficacy of this treat-

ment.

1098

The role of subcutaneous

immunotherapy on asthma prevention in

children and teenagers sensitised to

house dust mites with allergic rhinitis

Hitaj, M1; Bakiri, A2; Xhixha, F3; Ibranji, A4; Mingomataj,

E4,5; Elezi, K6

1Multidisciplinary Tirana Policlinics No 1, Tirana,

Albania; 2Hygeia Hospital Tirana, Tirana, Albania;3Multidisciplinary Policlinic No 3, Tirana, Albania;4Mother Theresa School of Medicine, Allergy and

Clinical Immunology, Tirana, Albania; 5Faculty of

Technical Medical Sciences, Tirana, Albania; 6Policlinic

3, allergologji, Tirana, Albania

Background: Specific subcutaneous immu-

notherapy (SCIT) has been studied and

found to have the altering potential on the

natural course of allergic disease. Allergic

rhinitis or rhinoconjunctivitis often pre-

cedes asthma, and that is the moment

where the SCIT might be of a great help

on asthma prevention plan, especially in

pediatric and teenage population.

Method: We enrolled 26 patients, (15 male

and 11 female) diagnosed and followed up

by the specialists of two multidisciplinary

clinics of Tirana 1 and 3, suffering from

allergic rhinitis and intermittent coughing

symptoms. All patients included in this

study showed positive skin prick test and

specific IgE to house dust mites (HDM).

Patients’ age range was 6 years up to

17 years. We analyzed monthly objective

data such as FEV1 and MMEF 25–75 as

well as clinical evaluation of coughing

symptom onset during the night and/or on

minimal effort, and rhinitis symptoms such

as sneezing and/or nasal obstruction.

Results: We report the results of a

12 month follow up period upon the begin-

ning of SCIT. Eighty four per cent of 26

patients with coughing symptoms during

the night or during the effort resulted to be

symptom-free. We found normal reference

values regarding FEV1 19 out of 26

patients and nearly 59% of the subjects

normalised MMEF 25–75 values after

12 months house dust mite SCIT.

Conclusion: Allergy specific immunother-

apy can alleviate the symptoms of allergic

rhinitis and alters positively the immune

response toward normal pulmonary perfor-

mance on subjects sensitised to HDM pre-

venting thus asthma development.

1099

Impact of 5-year subcutaneous

immunotherapy (SCIT) on new

sensitisations in a Mediterranean adult

population

Skarlatou, G1; Gkavogiannakis, N1; Koulias, C1; Tsilo-

christou, O1; Aggelides, X1; Vatikiotis, D1; Makris, MP1

1Allergy Unit ‘D. Kalogeromitros’, National University

of Athens Medical School, University General Hospital

‘Attikon’, 2nd Dpt. of Dermatology and Venereology,

Athens, Greece

Introduction: SCIT is considered able to

reduce the chance of developing new sensi-

tisations mainly in children. However, data

on the impact of SCIT on new sensitisa-

tions in adults is still poor.

Objective: To evaluate the development of

new sensitisations in a well-selected popu-

lation of adult patients with respiratory

allergy that underwent SCIT.

Methods: A retrospective analysis of 31

individuals (15 ♀, mean age

33 � 13.17 years) who underwent specific

immunotherapy for 5 years was performed.

All suffered from allergic rhinitis � asthma

and SCIT treatment up to four inhalant

allergens was prescribed after diagnosis

with skin prick tests � specific IgE mea-

surements � nasal provocations. Among

them, 29% were sensitised in one allergen,

35.5% in two allergens and 35.5% in more

than two. All patients were evaluated with

skin prick tests (extended battery of 28 ae-

roallergens according to Greek flora

including the GA2LEN European standard

set) before starting and after 5 years of

SCIT. Statistical analysis was performed

using SPSS 20.0 software.

Results: New sensitisations were docu-

mented in 58.1% with mean number of 3.6

new positive reactions to inhalant allerg-

enes per patient. Among these, the preva-

lent new sensitisations were found to be:

cypress (11.3%), plantago (11.3%) and

artemisia (11.3%). In monosensitive

patients the prevalence of new sensitisa-

tions was 33.3%. The corresponding preva-

lence in patients with two sensitisations

and more than two sensitisations was

72.7% and 66.7% respectively. Although it

is obvious that new sensitisations were

more frequent among individuals with >1initial sensitisation, the observed difference

did not reach statistical significance

(P = 0.055).

Conclusion: Our data do not favor the

hypothesis that SCIT prevents the develop-

Poster Session Group II – Red. TPS 43 – Immunotherapy – AIT clinics I

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453404

ment of new sensitisations in adults. These

results must be interpreted bearing in mind

the specific aerobiological conditions of

Mediterranean area while the small study

sample cannot permit to reach confirmative

conclusions.

1100

Efficacy of subcutaneous immunotherapy

among allergic rhinitis patients in the

North-eastern Thailand

Sittisomwong, S1; Sittisomwong, S2

1Allergy Division, Khonkaen Ram Hospital, Khonkaen,

Thailand; 2Oral and Maxillofacial Surgery, Faculty of

Dentistry, Khonkaen University, Khonkaen, Thailand

Introduction: Subcutaneous specific immu-

notherapy (SCIT) is considered as a stan-

dard and effective treatment of respiratory

allergies. However, there have been no

data reported on clinical efficacy of SCIT

in the north-eastern of Thailand.

Aim: To evaluate the clinical efficacy of

SCIT (ALK-Abell�o) in respiratory allergic

patients visited Khonkaen Ram hospital.

Method: We performed a 3 years prospec-

tive descriptive study to evaluate the clini-

cal efficacy of SCIT (ALK-Abell�o) in

allergic rhinitis patients visited Khonkaen

Ram hospital. Twenty-two patients (14

male and eight female, age 64–625 months,

median age = 213 months) with AR due to

aeroallergens were enrolled in the study.

Main outcome of the study was the rhino-

conjunctivitis symptom score (RSS). RSS

was evaluated every year after SCIT in

relation with the pre-treatment period in

which patients suffered the highest symp-

tomatic levels.

Results: The majority of allergen sensitisa-

tions in our patients were mixed mite

(D. pteronissinus + D. farinae) and mixed

cockroach (American cockroach + German

cockroach). The RSS was 11 � 0.9

(mean � SD) in the pre-treatment period

and decreased to 2.1 � 1.4(mean � SD) in

3rd years follow up period (P < 0.0001).

Conclusion: This study revealed that our

SCIT regimen decreased the RSS in

patients with intermittent or persistent AR

indicating the effectiveness of the north-

eastern SCIT regimen of Khonkaen Ram

hospital.

1101

Efficacy and safety of immunotherapy in

patients with different clinical

characteristics

Nell, MJ1; Pfaar, O2; Boot, JD1; van Twuijver, E1; van

Osch, P1; Bachert, C3

1HAL Allergy BV, Leiden, the Netherlands; 2Center for

Rhinology and Allergology Wiesbaden, Department of

Otorhinolaryngology, Head and Neck Surgery,

University Hospital Mannheim, Wiesbaden, Germany;3UZ Gent, Ear-, Nose and Throat Department, Gent,

Belgium

Background: Allergen specific immunother-

apy (SIT) is indicated in patients with IgE

mediated moderate to severe intermittent

or persistent allergic rhinitis (AR). In

guidelines several patient characteristics are

listed as success factors for SIT treatment.

The efficacy of SIT for house dust mite

(HDM) and birch pollen induced AR was

recently examined. The aim of this addi-

tional analysis was to determine whether

SIT is effective in subgroups of patients

with different clinical characteristics.

Method: Adult patients with a positive

medical history for HDM or birch pollen-

induced AR, confirmed by a positive skin

prick test (SPT) and specific IgE levels par-

ticipated in two different multicentre phase

II efficacy studies with SIT. The primary

outcome of these studies was a titrated

nasal provocation test (TNPT). The fol-

lowing subgroups were examined: with or

without asthma, with or without perennial

co-sensitisation, high or low SPT diameter,

high or low IgE levels and age. The mean

improvement in the TNPT score after

treatment was compared between these

subgroups.

Results: SIT induced an improvement in

the TNPT compared to placebo in both

studies. In the HDM study we observed no

differences in efficacy between all investi-

gated subgroups. In the birch study the

improvement in the subgroup without

asthma was significantly higher (P = 0.03)

compared to the subgroup with asthma.

No differences were observed between the

other subgroups.

Conclusion: For HDM SIT the subgroups

showed similar efficacy profiles as in the

overall study population with no differ-

ences between the subgroups. For birch

SIT this was the same, with the exception

of patients without asthma. This finding

requires confirmation in larger clinical effi-

cacy studies. Overall, the results support

the use of SIT in IgE mediated moderate

to severe intermittent or persistent AR,

regardless of concomitant asthma, sensiti-

sation status, severity profile or age.

1102

Studio double blind placebo with Mites

therapeutic vaccines for the treatment of

bronchial asthma and allergic

rhinosinusitis

Celio Murillo, R1,2,3; Rodriguez Santos, O4; Cruz Suarez,

MA5; Laurrabaquio Miranda, AM6

1Alergologia e Inmunologia, Unidad de Medicina

Integral, Tehuacan, Mexico; 2Alergologia e

Inmunologia, Benemerita Universidad Autonoma de

Puebla, Tehuacan, Mexico; 3Colegio de Pediatria del

Estado de Puebla, Pediatria y Alergologia, Puebla,

Mexico; 4Policlinico Previsora Camag€uey Cuba,

Alergologia e Inmunologia, Camaguey, Cuba; 5Alergia

e Inmunolog�ıa, Centro M�edico de Especialidades s.a.

de c.v. de Cd. Ju�arez Chihuahua, Alergologia e

Inmunologia, Ciudad Juarez, Mexico; 6M�edico Pediatra,

Inmun�ologo Cl�ınico y Alerg�ologo, Maestro en Ciencia

de Salud P�ublica y Administraci�on de Hospitales,

Servicio de Alergia e Inmunolog�ıa Cl�ınica Hospital

Regional Lic. Adolfo L�opez Mateos, Alergologia e

Inmunologia, Mexico DF, Mexico

Background: To assess efficacy and safety

of subcutaneous immunotherapy (ITSC) in

the treatment of allergic rhinitis and bron-

chial asthma with extracts of mites pro-

duced in laboratories DIATER from

Argentina.

Method: The universe of individuals

related to Previsora allergy service, from

January 2010 to December 2013, we

selected a sample of 160 patients with

bronchial asthma and allergic rhinosinus-

itis, by random allocation of treatment and

placebo groups were formed. We included

patients mono or poly sensitised to Derma-

tophagoides pteronyssinus, Dermatophago-

ides farinae Dermatophagoides siboney,

Blomia tropicalis, siro mite, Lepidoglyphus

destructor, Tyrophagus putrescentiae, Gli-

cyphagus domesticus, Blomia kulagini and

Chortoglyphus arcuatus. Sensitisation by

skin Prick Test positive test was detected.

The ITSC was administered in a phase of

increase in weekly doses during 13 weeks

and a phase of maintenance with monthly

injections. Placebo injections of diluent

solution. All the samples are supplied con-

comitant treatment in the presence of man-

ifestations of rhinitis and asthma. We

evaluated the efficacy according to variable

quality of life, consumption of drugs, fre-

quency and severity of crises. The quality

of life for rhinoconjunctivitis (RQLQ)

questionnaires and questionnaire of quality

of life for asthma (AQLQ) were applied.

Security was measured according to local

and systemic adverse events.

Results: The study concluded 145 patients

(76 and 69 treatment with placebo). In both

groups there was increase of quality of life

questionnaires score even higher at ITSC

(P = 0.02). Drug consumption decreased in

rhinitis and asthma in the placebo without

significant differences between both the

study group (P = 0.08). The frequency and

severity of crises of rhinitis and asthma

decreased in the sample being higher in the

Poster Session Group II – Red. TPS 43 – Immunotherapy – AIT clinics I

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 405

treatment group (P = 0.018). Light local

and systemic reactions in ITSC not reported

in the placebo group.

Conclusion: The results of the study indi-

cate that Mites subcutaneous immunother-

apy is effective and safe in patients with

asthma and allergic rhinosinusitis.

Keywords: Rhinosinusitis, subcutaneous

immunotherapy, asthma, safety, efficiency

1103

A dose-range finding study according to

European Medicines Agency (EMA)

guidelines, with subcutaneous

immunotherapy (SCIT) from Phleum

pratense depot extract

Madariaga, B1; �Alvarez-Cuesta, E2; Ferreira, JA3;

Rodr�ıguez Mosquera, M4; Landeta, A5

1Bial Industrial Farmac�eutica, Medical Section. R&D

Department, Bilbao, Spain; 2Hospital Ram�on y Cajal,

Madrid, Spain; 3Centro Hospitalar Vila Nova de Gaia,

Servic�o de Imunoalergologia, Vila Nova de Gaia,

Portugal; 4Hospital Puerta de Hierro, Madrid, Spain;5Medical Section, R&D Department, Bial Industrial

Farmac�eutica, Bilbao, Spain

Background: According to EMA guideline,

a dose-response trial of SCIT with Phleum

pratense native extract in depot, was per-

formed in order to establish its optimal

dose.

Method: A dose-response, multicenter,

randomized, double blind, placebo-con-

trolled trial in parallel groups (Five active

and placebo) was performed in 10 (Five

Spanish and five Portuguese) sites. 151

adult patients 18–60 years with rhinocon-

junctivitis � asthma sensitised to Phleum

pratense were randomized. All patients

signed informed consent and met the inclu-

sion criteria and none of the exclusion,

which were defined according to ARIA

and EMA. Primary endpoint was the dif-

ference of the extract concentration needed

to produce a positive nasal provocation

test (NPT) from baseline to final visit. Sec-

ondary endpoint included specific IgE, IgG

and IgG4, dose response prick-test and

safety. Doses ranged from 0.25 to 4.0 Skin

Prick Test (SPT) units. Treatment duration

was 17 weeks, 5 for the induction phase

(weekly injections) and 12 for the mainte-

nance phase (monthly injections).

Results: In terms of safety, doses of 2 and

4 SPT presented severe adverse reaction

(SAR) of grade III or greater: 1 SAR for 2

SPT (0.5%) and 3 SARs for 4 SPT (1.5%),

but not with lower doses. Although only in

the higher groups an increase on the con-

centration needed to induce a positive

response on NPT was shown, without sig-

nificance due to sample size, a dose effect

was seen in surrogate markers, as IgE lev-

els decreased, IgG and IgG4 increased and

wheals on the prick decreased in all active

groups but not in the placebo.

Conclusion: Although the NPT was not

sensitive enough to quantify differences

between lower doses, a clearly dose-depen-

dence in the effect of SCIT has been dem-

onstrated by immunoglobulin profile and

cutaneous reactivity. According to the

safety results found in the trial and taking

into account the known risk of adverse

reactions with grasses, doses >1 SPT seem

to be inappropriate for efficacy confirma-

tory trials.

1104

Randomised, controlled, multicenter,

phase IV study with house dust Mites

subcutaneous immunotherapy. Twelve

months immunological changes in the

ALUMITES study

Sanchez, J1; Vidal, C2; Hern�andez, D3; Malek, T4; Pelaez,

A5; Garcia, MA6; Valero, A1

1Hospital Clinic Universitari Barcelona, Barcelona,

Spain; 2Complejo Hospitalario Universitario de

Santiago, Santiago de Compostela, Spain; 3Hospital

Universitario y Polit�ecnico La Fe, Valencia, Spain;4Hospital General de Castellon, Castellon, Spain;5Hospital Clinico Universitario de Valencia, Valencia,

Spain; 6Medical Department, Stallergenes Iberica, S.A.,

Barcelona, Spain

Background: ALUMITES study was

designed to assess the efficacy of house

dust mites (HDM: D. pteronyssi-

nus + D. farinae) 10 IR/ml subcutaneous

immunotherapy (SCIT) for the treatment

of allergic rhinitis patients throughout

1 year.

Method: In this controlled multicenter

phase IV study, HDM allergic adult

patients were randomised to receive SCIT

with a 10 IR/ml depot extract plus symp-

tomatic treatment (group A) or only symp-

tomatic treatment (group B) (2:1). Total

IgE and Der p 1 and Der p 2 specific IgG4

were measured at baseline, and after 6 and

12 months of treatment.

Results: Total IgE and IgG4 were col-

lected from 46 of the 57 patients enrolled

in the study. The difference between basal

and 12 months visit total IgE was

27.5 kU/l (95% CI: [�16.0; 71.0],

P = 0.1151) in active group and �55.4 kU/

l (95% CI: [�135.5; 22.7], P = 0.0398) in

control group.

The increase for Der p1 IgG4 was

0.4 kU/l (95% CI: [0.3; 0.5], P < 0.0001) in

active group and 0.1 kU/l (95% CI: [�0.1;

0.4], P = NS) in control group. Der p 2

IgG4 increased 0.7 kU/l (95% CI: [0.5;

1.0], P < 0.0001) in active group and

0.0 kU/l (95% CI: [�0.0, 0.0], P = NS) in

control group. Specific IgG4 values for Der

p 1 and Der p 2 increased significantly in

active group vs control group (P < 0.0002

year P = 0.0001 respectively).

Conclusion: Twelve months of treatment

with a 10 IR/ml depot HDM extract

showed an objective immunomodulatory

effect as demonstrated by the fact that

both specific IgG4 increased their levels in

patients receiving active treatment com-

pared to patients in control group.

1105

Randomised, controlled, multicenter,

phase IV study with house dust Mites

subcutaneous immunotherapy. Twelve

months symptoms and medication

scores results in the ALUMITES study

Sanchez, J1; Vidal, C2; Hern�andez, D3; Malek, T4; Pelaez,

A5; Garcia, MA6; Valero, A1

1Hospital Clinic Universitari Barcelona, Barcelona,

Spain; 2Complejo Hospitalario Universitario de

Santiago, Santiago de Compostela, Spain; 3Hospital

Universitario y Polit�ecnico La Fe, Valencia, Spain;4Hospital General de Castellon, Castellon, Spain;5Hospital Clinico Universitario de Valencia, Valencia,

Spain; 6Medical Department, Stallergenes Iberica, S.A.,

Barcelona, Spain

Background: ALUMITES study was

designed to assess the efficacy of house

dust mites (HDM: D. pteronyssi-

nus + D. farinae) 10 IR/ml subcutaneous

immunotherapy (SCIT) for the treatment

of allergic rhinitis patients throughout the

year. Here we present results of 12 months

symptoms and medications scores.

Method: In this controlled multicenter

phase IV study, HDM allergic adult

patients were randomized to receive 10 IR/

ml depot extract plus symptomatic treat-

ment (group A) or only symptomatic treat-

ment (group B) (2:1). Symptom scores

were collected at inclusion visit and once a

month till the end of the trial, using a 0–3scale for four nasal symptoms. Medication

consumption was collected at inclusion

visit and daily along the study, only symp-

tomatic medication included in the proto-

col was allowed. Medication score was

calculated as following: antihistaminic one

point, nasal decongestant two points and

nasal corticoids three points.

Results: Fourty eight of 57 patients com-

pleted the patient0s symptom and medica-

tion diary entirely. Total symptom score in

active group (A) at basal visit was

3.7 � 2.72 and 12 months later 2.1 � 2.25

(P < 0.0013). In control group (B) the

basal value was 3.5 � 2.30 and twelve

months later 3.0 � 3.19 (P = NS). Each

individual nasal symptoms score also

showed a similar evolution: nasal conges-

tion, sneezing, runny nose and nasal itch-

ing experienced a significant reduction in

active group but not in control group.

Medication consumption decreased from

1.0 � 0.93 to 0.3 � 0.67 (P < 0.0001) in

active control whereas in control group

this decrease was from 1.5 � 1.36 to

1.2 � 1.36 (P = NS)

Poster Session Group II – Red. TPS 43 – Immunotherapy – AIT clinics I

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453406

Conclusion: Efficacy is demonstrated with

twelve months treatment with a 10 IR/ml

depot HDM extract that resulted in a sig-

nificant improvement in nasal symptoms

and reduction of rescue medication intake.

This improvement was not achieved by the

control group.

1106

Is allergoid immunotherapy against grass

pollen before season effective in patients

with allergic rhinitis?

Corut, N; Ozmen, S; Bostanci, I; Sahin, S; Seymen, H

Pediatric Allergy and Immunology Department,

Dr. Sami Ulus Obstetrics, Gynecology and Pediatrics

Training and Research Hospital, Ankara, Turkey

Background: Allergen immunotherapy is

recommended in early phases of allergic

rhinitis and asthma and particularly in the

childhood due to the fact that it can alter

the course of allergic diseases and prevent

the development of new sensitisations. The

purpose of allergoid immunotherapy is to

decrease allergenicity while maintaining

immunogenicity, and therefore a reduction

in the number of injections and side effects

is expected. The study was planned to eval-

uate the effects of allergoid immunother-

apy on exhaled NO, and the changes in

respiratory function test and nasal airflow

in rhinomanometry and relation of these

changes to clinical allergic rhinitis symp-

tom scores and the scores in visual analog

scale in patients.

Method: A total of 48 patients age

between 5 and 15 years were included in

the study. Allergovit� administered for

7 weeks before the season contains a mix-

ture of extracts from six grassesand/or a

mixture of four cereals. Tests were admin-

istered to the patients before vaccination,

during and at the end of the peak period

of pollen season.

Results: Of the patients, 28 received aller-

goid immunotherapy and 20 did not

receive any therapy. Total symptoms score

was significantly higher in the immunother-

apy group at the end of the pollen season

.Exhaled NO did not significantly differ

between the groups at the beginning of the

immunotherapy, during and at the end of

the season. FEV1 and FEF 25–75 signifi-

cantly differ between immunotherapy and

non-immunotherapy groups in the pollen

season. At the end of the season, only

FEV1 was found to be lower in the non-

immunotherapy group. Nasal air flow val-

ues were not different two groups.

Conclusion: We before pollen season, a

significant improvement was detected in

evaluated first year clinical and laboratory

results in patients with allergic rhinitis and/

or asthma that underwent allergoid

immunotherapy before season. Although

no clinical improvement has been noted in

patients that underwent allergoid immuno-

therapy respiratory function tests.

1107

Assessment of the safety of a

depigmented polymerised mite extract in

paediatric and adult patients using a

rush schedule

S�anchez, C1; Hinojosa, B1; G�omez, MJ2; Orovigt, A1;

Maravi, A1; Rodriguez, M1

1CE Virgen de la Cinta, Hospital Juan Ramon Jim�enez,

Huelva, Spain; 2Laboratorios Leti, SLU, Tres Cantos,

Madrid, Spain

Background: Mite allergy has become a

global public health problem affecting mil-

lions of people worldwide. It has been

demonstrated that the efficacy of specific

immunotherapy (SIT) is related with

administered dose.

The objective of this systematic data col-

lection was to evaluate the safety of differ-

ent Depigoid� mite preparations using a

rush schedule, under routine medical con-

dition.

Method: Safety records were analysed ret-

rospectively in patients previously diag-

nosed with rhinitis/rhinoconjunctivitis with

or without controlled asthma due to sensi-

tivity to mites. The diagnosis was made by:

anamnesis, physical examination, positive

skin prick tests, and positive specific IgE

against these allergens.

All individuals received immunotherapy

with a Depigmented and polymerised mites

extract using a rush schedule of the vial at

maximum concentration (100 DPP/ml) of

0.2 ml and 0.3 ml after 30 min, reaching

the maximum dose (50 DPP) from the first

day.

Adverse reactions (AR) were recorded

according to EAACI 2006 following classi-

fication: Local moderate or severe AR and

systemic AR level 0, 1, 2 and 3. Mild local

reactions were not recorded systematically,

and not included in the analysis.

Results: Out of 506 patients, 374 were pae-

diatric (74%), with an average age of 9.1

(2–17.9), and 132 were adults (26%) with a

mean age of 30.2 (range from 18 to 61.8).

57% of patients were female and 43%

male.

In the analysed population, no reaction

was recorded, either local or systemic, with

any of the mite extracts administered on a

rush schedule.

Conclusion: SIT was well tolerated in pae-

diatrics and adults patients. The proposed

rush escalation schedule, reaching maxi-

mum dose from day 1 with a depigmented

polymerised mites extract, is safe.

1108

Adherence, compliance and safety with

subcutaneous high-dose hypoallergenic

house dust Mites preparations during

2 years treatment

Carrillo D�ıaz, T1; Cumplido Bonny, J�A1; Hern�andez-

Pe~na, J2; Rodr�ıguez Marco, A2

1Allergy Unit, Hospital Universitario de Gran Canaria

Doctor Negrin, Las Palmas de Gran Canaria, Spain;2Medical Department, Merck S.L., Madrid, Spain

Background: Efficacy and safety of the

high-dose hypoallergenic house dust mites

preparations have been documented in sev-

eral randomized trials previously.

In order to achieve the greatest possible

efficiency, both in the long and short term,

the patients′ proper adhesion to the treat-

ment is mandatory.

Our objective was to determine the level

of adherence, compliance by patients and

safety during the first 2 years of treatment

with these high-dose modified preparations

in daily practice.

Method: A retrospective observational

multicenter study with the participation of

42 researchers was carried out. From May

to December 2013; 460 patients with house

dust mites IgE mediated allergic rhinocon-

junctivitis and/or bronchial asthma, who

had started treatment with the high-dose

hypoallergenic house dust mites prepara-

tions during 2010 were included.

Once administered the first dose, adher-

ent was the patient who did not suspend

the treatment on its own initiative. Thera-

peutic compliance was defined by the

administration of at least 80% of the doses

provided during the evaluation period.

Results: Two hundreden twenty two

patients (48.3%) were male. The mean age

was 23.2 (12.9) years old.

The 52.6% of the preparations contained

100% D. Pteronissinus, 45% contained

50%D. Pteronissinus+ 50% D. Farinae

and 2.4% contained other mixtures of

house dust mites.

Five thousand hundreden fourty doses

were administered in the first year of treat-

ment (92.7% of the total planned doses),

being the adherence of the 98.7% (454

patients) with a therapeutic compliance of

88.3% (406 patients received at least 80%

of the planned doses). In the second year

3904 were administered doses (83.7% of

the planned dose) with adhesion of 324

(70.43%) patients received at least 80% of

the planned doses.

One hundreden sixteen adverse reactions

in 79 patients(17.2% of patients) were

reported: 79 local reactions and 34 sys-

temic reactions classified as grade I/II.

Conclusion: High adherence and compli-

ance where observed with these subcutane-

ous high-dose hypoallergenic house dust

Poster Session Group II – Red. TPS 43 – Immunotherapy – AIT clinics I

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 407

mites preparations after 2 years of treat-

ment (83.7% and 70.43% respectively).

High safety profile as well was observed.

1109

Adherence, compliance and safety with

subcutaneous high-dose hypoallergenic

pollen preparations during 2 years

treatment

Guti�errez Gonz�alez, ML1; Sola Mart�ınez, J2; Rodr�ıguez-

Marco, A3; Hernandez-Pena, J3

1Allergy Unit, Hospital Clinico Universitario San Carlos,

Madrid, Spain; 2Allergy Unit, Hospital Universitario

Ram�on y Cajal, Madrid, Spain; 3Medical Department,

Merck S.L., Madrid, Spain

Background: Efficacy and safety of the

high-dose hypoallergenic pollen prepara-

tions have been previously documented in

several randomized trials. In order to

achieve the greatest possible efficiency,

both in the long and short term, the

patients0 proper adhesion to the treatment

is mandatory.

Our objective was to determine the level

of adherence, compliance and safety during

the first 2 years of treatment with these

high-dose modified preparations in daily

practice.

Method: A retrospective observational

multicenter study with the participation of

21 researchers was carried out. From May

to December 2013; 230 patients with pol-

len IgE mediated allergic rhinoconjunctivi-

tis and/or bronchial asthma, who had

started treatment with the high-dose hypo-

allergenic pollen preparations during 2010

were included. Once administered the first

dose, adherent patient was who did not

suspend the treatment on its own initia-

tive. Therapeutic compliance was defined

by the administration of at least 80% of

the doses provided during the evaluation

period.

Results: One hundreden ten patients

(47.4%) were male. The mean age was 31.1

(SD 12.8) years old. 89.6% of the prepara-

tions contained grasses, 46.9% olive and

2.6% other allergens (trees, weeds).2798

doses were administered in the first year of

treatment (97.2% of the total planned

doses), being the adherence of the 99.1%

(230 patients) with a therapeutic compli-

ance of 96% (221 patients received at least

80% of the planned doses). In the second

year, 2494 doses were administered (89.2%

of the planned dose) with adhesion of 198

patients (89% compared to adherents in

the first year and 85.3% compared to the

total number of patients enrolled). 181

patients (81.4% compared to adherents in

the 2nd year and 78% with respect to the

total) properly fulfilled the treatment. 47

adverse reactions (0.9% of administered

doses) were reported: 37 (0.7%) local reac-

tions and 10 (0.2%) systemic reactions

classified as grade I/II.

Conclusion: After 2 years of treatment, we

demonstrate:

High adherence and compliance were

observed with these subcutaneous high-

dose hypoallergenic pollen preparations

after 2 years of treatment (85.3% and 78%

respectively).

High safety profile (0.9% of total admin-

istered doses).

1110

Perceived efficacy of high-dose

hypoallergenic house dust Mites

preparations in daily practice: 2 year

follow-up

Carrillo D�ıaz, T1; Poza Guedes, P2; Hern�andez-Pe~na, J3;

Rodrıguez Marco, A3

1Hospital Universitario de Gran Canaria Doctor Negrin,

Las Palmas de Gran Canaria, Spain; 2Hospital del

T�orax, Allergy Unit, Santa Cruz deTenerife, Spain;3Medical Department, Merck S.L., Madrid, Spain

Background: Efficacy and safety of the

subcutaneous high-dose hypoallergenic

house dust mites preparations have been

documented in several randomized trials.

The objective of this study was to deter-

mine the effectiveness of these subcutane-

ous high-dose modified house dust mites

preparations in daily practice.

Methods: A retrospective observational

multicenter study with the participation of

42 researchers was carried out. From May

to December 2013; 460 patients with house

dust mites IgE mediated allergic rhinocon-

junctivitis and/or bronchial asthma, who

had started treatment with the high-dose

hypoallergenic house dust mites prepara-

tions during 2010 were included.

Conjunctival, nasal and/or bronchial

symptoms experienced by patients were

classified as missing, infrequent (<2 days

per week), frequent (2–5 days per week) or

very frequent (more than 5 days per week)

before starting the treatment and in the

first and second year. Also the need for

symptomatic medication was recorded in

each one of the years.

Results: Two hundreden twenty two

patients (48.3%) were male. The mean age

was 23.2 (12.9) years old. 52.6% of the

preparations contained 100% D. Pteronis-

sinus, 45% contained 50% D. Pteronissi-

nus+ 50% D. Farinae and 2.4% contained

other mixtures of house dust mites.

Conjunctival symptoms: 28% and 58%

of asymptomatic patients in the first year

and second year respectively after the treat-

ment.

Nasal symptoms: clinical improvement

perceived of the 60% in the first year and

81% (P < 0.0001) after 2 years of treat-

ment.

Bronchial symptoms: 27% and 53% of

asymptomatic patients in the first and sec-

ond year respectively.

Medication use: 53% of patients didn’t

need ‘stable medication use’ during the 2nd

year. The intermittent use of rescue medi-

cation dropped from a statistically signifi-

cant (P < 0.0001) for steroids and

antihistamines topically and long/short act-

ing b-agonists.Conclusions: Subcutaneous immunother-

apy with high-dose modified house dust

mites preparations is effective in daily

practice.

Patient’s conditions improve remarkably

being this effect observed in the first year

and sustained during both years of treat-

ment.

1111

Perceived efficacy of high-dose

hypoallergenic pollen preparations in

daily practice: 2 years follow-up

Guti�errez Gonz�alez, ML1; Montoro de Francisco, A2;

Rodr�ıguez Marco, A3; Hernandez-Pena, J3

1Allergy Unit, Hospital Clinico Universitario San Carlos,

Madrid, Spain; 2Allergy Unit, Hospital Central de la

Defensa G�omez Ulla, Madrid, Spain; 3Medical

Department, Merck SL, Madrid, Spain

Background: Efficacy and safety of the

subcutaneous high-dose hypoallergenic

pollen preparations have been documented

in several randomized trials. The objective

of this study was to determine the effec-

tiveness of these subcutaneous high-dose

modified pollen preparations in daily

practice.

Method: A retrospective observational

multicenter study with the participation of

21 researchers was carried out. From May

to December 2013; 230 patients with pollen

IgE mediated allergic rhinoconjunctivitis

and/or bronchial asthma whose had started

treatment wtih the high-dose hypoaller-

genic pollen preparations during 2010 were

included.

Conjunctival, nasal and/or bronchial

symptoms suffered by patients were classi-

fied as missing, infrequent (<2 days per

week), frequent (2–5 days per week) or

very frequent (more than 5 days per week)

before starting the treatment and in the

first and second pollen season after it

starts. Also the need for symptomatic med-

ication was recorded in each one of the

pollen seasons.

Results: One hundreden twenty patients

(51.7%) were female. The mean age was

31.1 (12.8) years old. 89.6% of the prepa-

rations contained grasses, 46.9% olive and

2.6% other allergens (trees, weeds).

Conjunctival symptoms: 25% and 43.2%

of asymptomatic patients in the 1st and

2nd pollen season with a clinical

Poster Session Group II – Red. TPS 43 – Immunotherapy – AIT clinics I

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453408

improvement perceived from the 86.5% at

2 years (P < 0.0001).

Nasal symptoms: clinical improvement

perceived of the 85.6% (P < 0.0001) after

2 years of treatment with an improvement

sustained effect the 45.5% in the 2nd pol-

len season VS the first one.

Bronchial symptoms: 26% and 40% of

asymptomatic patients in the 1st and 2nd

pollen season respectively with a clinical

improvement perceived from the 85% at

2 years (P < 0.0001).

Medication use: 47.2% of patients don‘t

need ‘stable medication use’ during 2nd

pollen season. The intermittent use of res-

cue medication dropped from a statistically

significant (P < 0.0001) for steroids and

antihistamines topically and long/short act-

ing b-agonists.Conclusion: Subcutaneous immunotherapy

with high-dose hypoallergenic pollen prep-

arations is effective in daily practice.

Patients′ conditions improve remarkably

being this effect observed in the first pollen

season and sustained during both years of

treatment.

Poster Session Group II – Red. TPS 43 – Immunotherapy – AIT clinics I

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 409

Poster Session Group II – Red

TPS 44 – Immunotherapy - AIT clinics II

1112

Clinical and immunological evaluation of

sublingual specific immunotherapy with

Pru p 3 in 10 Portuguese patients, during

12 months

Costa, AC1; Melo, A2; Duarte, F1; Pedro, E1; Pereira-

Barbosa, M1; Pereira Santos, C2

1Immunoallergology Department, Hospital de Santa

Maria, CHLN, Lisbon, Portugal; 2Instituto de Medicina

Molecular, Faculdade de Medicina de Lisboa, Lisbon,

Portugal

Background: Peach allergy is prevalent,

persistent and potentially severe. LTPs

(Prup3) and profilins (Prup4) are the main

allergens involved in this allergy. The hid-

den presence of LTPs in foodstuffs can

trigger severe reactions, including anaphy-

laxis, being considered an important target

for specific immunotherapy (IT).

Aim: Evaluation of clinical and immuno-

logical parameters, during 12 months, to

demonstrate the efficacy and safety of

SLIT-Prup3 in pts with systemic reactions

(SR) associated with peach ingestion.

Material and methods: Ten pts (8F, 2M;

mean age-26.2; 19–41 years) with a history

of peach allergy, confirmed by Oral Food

Challenge, undergoing SLIT-Prup3 during

1 year, were evaluated. 100% of pts had

SR (80% anaphylaxis) associated with

peach ingestion (60% symptoms with other

foods containing LTPs). All patients

underwent aeroallergens skin prick tests

(SPT), peach extract peel and pulp, other

foods according to symptoms, Prup3 and

Prup4. SLIT-Prup3 had an induction phase

(4 days in Immunoallergology Depart-

ment), followed by outpatient maintenance

phase. We performed SPT and specific IgE

and IgG4 (sIgE, sIgG4) for peach and

Prup3 before (T0), 1(T1), 6(T6) and

12 months (T12) after SLIT initiation.

Basophil Activation Test (BAT) was per-

formed with Prup3 extract in three concen-

trations 0.05, 0.5, 5 lg/ml at the same time

points.

Results: There was a significant decrease of

the mean wheal diameter of SPT in T0-T12,

with peel and pulp peach (P = 0.0039) and

Pru p 3 (P = 0.0078). Quantification of sIgE

to peach and Pru p 3: significant decrease of

T0-T12 (P = 0.0046 and P = 0.0089 respec-

tively); sIgG4: significant increase of T0-T12

(P = 0.0020) for the same allergens; BAT:

significant decrease between all time points

and concentrations. Local reactions (itch-

ing) occurred only during the induction

phase in 60% of pts, without other reactions

along 1 year.

Conclusions: These data showed that SLIT

Prup 3 seems to be a promising and safe

therapeutic for patients with severe peach

allergy.

1113

Specific sublingual immunotherapy with

Pru p3 in cases of anaphylaxis to peach

in pediatric age - safe and effective?

Gomes, R; Cunha, L; Reis, A; Carmo, A; Falc~ao, H

Centro Hospitalar do Porto, Porto, Portugal

Background: Nowadays, treatment in food

allergy only considers avoidance of the spe-

cific food. However, cross-reactivity makes

this practice difficult to accomplish. Peach

allergy is a prevalent food allergy, with

high cross-reactivity among other foods

and with serious life-threatening reactions

such as anaphylaxis. The most frequently

allergens involved are LTPs (Pru p3) and

profilins (Pru p4). In this study we present

two patients undergoing with sublingual

immunotherapy to Pru p3 (ALK-Abell�o)and we intend to demonstrate tolerability,

safety and potential effectiveness of this

treatment. We report a case of a 9 years

old girl with history of severe anaphylactic

reaction to vapors, touch and intake of

peach and a 15-year-old adolescent with an

episode of anaphylaxis after ingestion of

peach, with no reaction with other foods

(P2) which are under immunotherapy with

Pru p 3 for 2 and 1 year respectively.

Methods: Skin Prick Test (SPT) to com-

mercial extracts from food allergens, serum

specific IgE (sIgE) and a respiratory pleth-

ysmography were carried out previously

immunotherapy and at the point of revalu-

ation.

Results: For P1 the initial SPT (results

shown in mm) were positive to histamine

(6.5), peach (7) and apple (5.5) and nega-

tive to profilin and saline solution. A total

IgE of 870 UI/ml and positive sIgE (kU/l)

to Pru p3 (6.85); peach (6.20) and apple

(4.9). After 2 years of treatment this

patient has not shown any reaction to

immunotherapy and she manages to stay

close to peach and and handling with slight

reaction. At reassessment, SPT - histamine

(6), peach (7.5) and apple (8); total IgE of

787UI/ml and sIgE to Pru p3 (10.5); peach

(10) and apple (8.47). For P2 the initial

SPT were positive to histamine (5), peach

(7.5) and apple (4.5), being negative to

profilin and saline solution; total IgE of

76UI/ml and positive sIgE to Pru p3

(1.48); peach (2.01) and apple (1.35). He

also had a great tolerance to immunother-

apy and he never ate peach again. At reas-

sessment SPT - histamine (5), peach (4.5)

and apple (6.5); total IgE of 121UI/ml;

sIgE (kU/l) to Pru p3 (1.94); peach (1.83)

and apple (1.21). Respiratory pletismogra-

phy was normal for both.

Conclusion: According to the results sub-

lingual immunotherapy with Pru p 3

appears to be safe and well tolerated in

cases of severe allergic reaction to peach

and in paediatric ages. Also highlighted the

clinical improvement in P1 after 2 years of

immunotherapy. Both patients remain

under this immunotherapy.

1114

Clinical efficacy of Grazax sublingual

immunotherapy in seasonal vs

continuous treatment regimens

Nakonechna, A1; Hills, J2; Moor, J1; Dore, P1; Abu-

zakouk, M1,2

1Immunology and Allergy Department, Hull and East

Yorkshire Hospitals NHS Trust, Cottingham, Unites

Kingdom; 2Hull-York Medical School, Hull, Unites

Kingdom

Background: Grazax sublingual immuno-

therapy is an effective but expensive treat-

ment for severe allergic rhinoconjunctivitis

(ARC), that patients take continuously on

daily basis for 3 years.

Objective: The aim of this audit was to

compare the clinical efficacy of seasonal vs

continuous Grazax treatment over 3 years

in patients with severe ARC.

Methods: Thirty nine adult patients with

severe ARC due to grass pollen received

daily Grazax tablets (ALK-Abello, Den-

mark) as either seasonal (nine patients) or

continuous (thirty patients) treatment regi-

mens. Outcome measurements including

Rhinoconjunctivitis Quality-of-Life Ques-

tionnaire (RQLQ), Visual Analogue Scale

(VAS) scores and medication usage were

performed and assessed initially before

starting treatment and subsequently after

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453410

each pollen season throughout therapy.

Statistical analysis between study groups at

each timepoint was performed by using an

independent-sample t-test with P < 0.05

considered significant.

Results: Grazax was an effective treatment

for patient with severe ARC. Patient

receiving seasonal and continuous Grazax

treatment demonstrated equal improve-

ment in symptom severity on the combined

RQLQ and VAS scores at each of the

timepoints (P < 0.05). Medication usage

was difficulty to assess accurately in both

treatment groups.

Conclusion: Our audit demonstrated that

seasonal Grazax treatment regimen could

improve cost-effectiveness without any sig-

nificant detriment to clinical efficacy. Fur-

thermore seasonal treatment may represent

a convenient option and improve compli-

ance in patients with severe grass pollen

allergy treated with Grazax.

Keywords: Efficacy, Grazax, RQLQ, VAS

1115

Safety of the subcutaneous and

sublingual immunoterapy with different

allergens in Camaguey Cuba

Rodriguez Santos, O1; Celio Murillo, R2,3,4; Laurrab-

aquio Miranda, AM5; Cruz Suarez, MA6

1Policlinico Previsora Camag€uey, Alergologia e

Inmunologia, Camaguey, Cuba; 2Alergologia e

Inmunologia y Pediatra, Unidad de Medicina Integral,

Tehuacan, Mexico; 3Inmunologia y Alergologia,

Benemerita Universidad Autonoma de Puebla,

Tehuacan, Mexico; 4Pediatria y Alergologia, Colegio de

Pediatria del Estado de Puebla, Puebla, Mexico;5Alergologia e Inmunologia, Hospital Adolfo Lopez

Mateos ISSSTE, Mexico DF, Mexico; 6Alergia e

Inmunolog�ıa, Centro M�edico de Especialidades s.a. de

c.v. de Cd. Ju�arez Chihuahua, Alergologia e

Inmunologia, Ciudad Juarez, Mexico

Background: To verify the safety of subcu-

taneous and sublingual immunotherapy

with allergy vaccines.

Method: The study group patients were

referred to the allergy service of Previsora

Camag€uey in the period of June 2011–October 2013. The sample consisted of 456

patients with respiratory allergies registered

in the service and those who had been

given subcutaneous immunotherapy (SCIT)

and sublingual immunotherapy (SLIT)

with extracts of mites Dto pteronyssinus

(Dp), Dto siboney (Ds) and Blomia tropi-

calis (Bt), Ragweed and pollen psilostachy-

a, Amaranthus leucocarpus, Helianthus an,

Rumex acetosella, Lolium p, Cupressus

lindley, and Cocos nucifera.

Results: A group of 148 patients were

applied SLIT and 308 were applied SCIT.

The employed regimen of SLIT was two

drops daily beginning with 200 UB/ML

and 100 UNP/ML for mites and pollens

respectively, reaching 20 000 UB/ML and

10 000 UB/ML respectively as maintenance

dose. The SCIT was started by 20 UB/ML

for mites and 10 UNP/ML in pollen and

reaching 10 000 UB/ML or 10 000 UNP/

ML respectively. A total of 36 720 injec-

tions and 124 320 sublingual doses were

applied. During the course of the treatment

local and systemic reactions were assessed

and scored according to severity and fre-

quency. A total of 8 (2.5%) mild events

occurred in SCIT with reaction on the site

of the injection consisting of: subcutaneous

nodule <8 cm, wheal <5 cm, erythema

<10 cm, and pruritus. In SLIT there

occurred 11 (7.4%) adverse events consist-

ing of: epigastric pain, nausea, lingual or

oral pruritus that disappeared in 30 min

following administration of the vaccine. In

both pathways 14 (3.0%) events occurred

consisting of: localised urticaria, rhinitis or

asthma that appeared after 30 min of

administration and was tolerated by the

patient not requiring medication. No mod-

erate or severe reactions occurred. Regard-

ing the number of adverse events in SCIT

there was a frequency of 0.02% and a fre-

quency of 0.008% in SLIT.

Conclusion: Subcutaneous and sublingual

immunotherapy with mites and pollens

show good safety indicators with the stated

guidelines.

Keywords: Subcutaneous and sublingual

immunotherapy, dust mites, pollen, safety

1116

Management of allergic rhinitis with

custom made SLIT tablets

Nagendra, K1; Kanni, P2; Leishangthem, A2; Acharya,

S2; Kanni, P1Allergy, Bengaluru Allergy Center, Bangalore, India;2Allergy Pharmacy, Bengaluru Allergy Center,

Bangalore, India

Background: In view of the fast progress-

ing SLIT, Personal medicine with focus on

custom made SLIT tablets is likely to be

effective and precise for better response

against fixed dose formulations. SLIT tab-

lets prepared on the basis of personal pre-

scription against clinical evaluation,

specific IgE and Skin Prick Test (SPT).

Custom made SLIT tablets were prepared

in the pharmacy taking care of all process

and product parameters following Good

Manufacturing Practices (GMP).

Method: Bengaluru Allergy Center (BAC)

selected 390 subjects who were suffering

from Rhinitis sensitive to House Dust

Mite. 173 subjects were Male and 217 sub-

jects were Female and age range from 2 to

74 years. Clinical confirmation of sensitiv-

ity by SPT and prescription was generated

and submitted to the pharmacy at BAC.

The SLIT tablets dispensed for 2 months

with one tablet once daily. The patients

instructed to keep the tablets under the

tongue for 5 min before the dinner. SLIT

tablets disintegrated with in 90 sec. The

patients were instructed to keep saliva for

three to five minutes below the tongue to

generate maximum tolerance and minimum

adverse effect. The SLIT tablets initiated

with maintenance dose from day one. The

SLIT tablets were dispensed once in two

moths after every follow-up visit monitor-

ing the symptoms.

Each SLIT tablet contains 2266 Biologi-

cal Units (BU) equivalent to 34 mcg w/v

standardised HDM. Depending upon the

sensitivity to HDM, the prescription was

prepared and volume of allergen dispensed

to generate 68000 BU per month.

Conclusion: The personalised SLIT tablet

initiated for 6 months with observing the

adverse effects, symptom score and medi-

cation score. It was observed that there

were no adverse effects with these subjects

and noticed good symptoms relief.

1117

First season with five grass pollen tablets

in allergic children/teenagers. A real-life

disease impact in terms of symptoms

and medication. SMILE study

Garcia, MA1; Antolin, D2; Valbuena, T3; Valls, A4;

Garrido, S5; Blanco, C4

1Medical Department, Stallergenes Iberica, S.A.,

Barcelona, Spain; 2Hospital Universitario Principe de

Asturias, Alcala de Henares, Spain; 3Hospital

Universitario Infanta Sofia, Madrid, Spain; 4Hospital

Universitario de la Princesa, Madrid, Spain; 5Complejo

Hospitalario de Navarra, Pamplona, Spain

Background: Clinical development of grass

immunotherapy tablets should be comple-

mented with data from real-life settings.

The aim of this study was to obtain clin-

ical information of patients (under

18 years) that had been treated following a

precoseasonal schedule.

Method: Cross-sectional, observational,

multicentric study. The information was

collected in just one visit after the 2012

pollen season.

The patientshad have a moderate/severe

(ARIA classification) allergic rhinoconjuc-

tivitis (RCA) uncontrolled with symptom-

atic medication to grass pollen before

initiating the treatment and received for

the first time SLIT tablets in a precosea-

sonal schedule.

Results: One hundren twenty one children

and teenagers were recruited (55% between

6–11 years; 63% males). The 66% of the

children had asthma (59% in teenagers)

and 66% were polysensitised (65% in teen-

agers). The mean RCA duration was

3.9 � 2.0 years (6.9 � 3.50 years in teen-

agers). All patients were treated with five

grasses extract tablets (300 IR) during

Poster Session Group II – Red. TPS 44 – Immunotherapy - AIT clinics II

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 411

5.2 � 1.0 months. Before receiving SLIT,

100% of the children and teenagers had a

moderate/severe RCA (inclusion criteria).

After SLIT tablets 55% of the children

and 60% of the teenagers improved to a

mild or absent rhinitis.In children, 97%

reported having annoying symptoms and

87% had performance disruption before

the treatment, being the 34% and the 21%

the ones who were respectively affected

after the first treatment season (similar val-

ues in teenagers). Before the treatment with

SLIT tablets 99% and 69% of the children

were treated with oral antihistamines and

nasal corticoids respectively (96% and

75% in teenagers), after the first season of

treatment, these values drops to 67% and

18% respectively (72% year 23% in teen-

agers). Among those that are still using

symptomatic treatment, >75% of the chil-

dren/teenagers declare to use less quantity

than the before. No severe reactions were

reported.

Conclusion: Precoseasonal treatment with

five grass pollen tablet (300 IR/day) has

demonstrated in real life that the patients

perceived it asan efficient treatment to

reduce symptoms and medication therefore

reducing the impact of the grass pollen

allergy.

1118

Quality of life of children and teenagers

after 5 months treatment with five

grasses tablet. SMILE a real-life study

Perez Bustamante, MS1; Vazquez, L1; Callejo, AM2; Vila,

C3; Villalon, AL4; Alonso, MD3; Garcia, MA5

1Hospital Madrid Sanchinarro, Madrid, Spain; 2Hospital

Virgen de la Concha, Zamora, Spain; 3Hospital

Universitario Fundaci�on Alcorcon, Alcorcon, Spain;4Hospital Puerta de Hierro, Majadahonda, Spain;5Medical Department, Stallergenes Iberica, S.A.,

Barcelona, Spain

Background: Quality of life improvement

has been demonstrated in clinical develop-

ment of grass pollen tablets for children

and teenagers. The aim of this study is to

confirm this finding in real-life setting in

patients treated with a precoseasonal

scheme for the 2012 pollen season.

Method: Observational, cross-sectional,

multicentre study. Specialist collected

information in just one visit at the end of

the 2012 pollen season.

Patients should had moderate/severe

(ARIA classification) and uncontrolled

allergic rhinoconjunctivitis (RCA) due to

grass pollen before initiating for the first

time the treatment with

Five grass tablet (SLIT) following a pre-

coseasonal schedule.

Children (6–11 years) completed the

PRQLQ questionnaire and teenagers (12–17 years) the AdolRQLQ, and also an ad

hoc questionnaire to evaluate the patients

beliefs and attitudes by a likert five points

scale (totally agree - totally disagree).

Results: Data from 53 children and 33

teenagers who completed the questionnaire

were presented (71% of the participants).

The PRQLQ questionnaire has a 0–6 rate

(the higher the score the more the rhinitis

affects). The children global score was

1.12 � 1.09. The questionnaire includes five

dimensions: activity limitation (0.82 � 1.15);

practical problems (1.33 � 1.22); nasal

symptoms (1.50 � 1.47); ocular symptoms

(0.99 � 1.33) and other symptoms

(1.02 � 1.03).

The AdolRQLQ questionnaire has the

same punctuation rate as PRQLQ, the global

score for teenagers was 1.05 � 0.81. The

questionnaire includes six dimensions: activ-

ity limitation (1.54 � 1.29); practical prob-

lems (1.25 � 1.18); nasals symptoms

(1.45 � 1.18); ocular symptoms (0.73 � 0.87)

and other symptoms (0.60 � 0.83).

The three statements in which both chil-

dren and teenagers were agree more with

were: is important to take the treatment

properly (precoseasonal) (95% children;

90% teenagers); there is no problem in

repeating the treatment to control the

symptoms (next year) (85% children; 89%

teenagers); I would recommend this treat-

ment (86% children; 87% teenagers).

Conclusion: The low scores in all the

dimensions in PQRQLQ and AdolPRQLQ

quality of life questionnaires confirm that

both children and teenagers perceive the

beneficial effects of the five grasses extract

tablets treatment in their first season of

treatment.

1119

Efficacy of LAIS� Birch-Alder tablets in

patients suffering from tree pollen-

induced allergic rhinoconjunctivitis: a

dose finding study

Eichel, A; D€uster, M; Astvatsatourov, A;

Shah-Hosseini, K; M€osges, R

Institute for Medical Informatics, University of Cologne,

Cologne, Germany

Background: In our dose finding study on

the efficacy of LAIS� Birch-Alder tablets

the optimal dose was evaluated in accor-

dance with the aim of high efficacy and

low side effects.

Method: In this pre-seasonal, prospective,

double-blind, randomised, four-armed,

multi-centre phase II study 159 patients,

aged between 18 and 75 years, with at least

2 years of birch or alder pollen induced

rhinoconjunctivitis were included. For each

treatment group the number of patients for

whom a higher allergen concentration was

necessary after a sublingual immunother-

apy (SLIT) of 3 months in order to induce

a positive conjunctival provocation test

was determined. Suitable patients were

assigned to one of four treatment groups

(300, 600, 1000, 2000 UA/day) ahead of

the tree pollen season 2013 by randomisa-

tion. In addition, the frequency, intensity

and duration of adverse events (AEs) and

its relation to the study medication was

recorded.

Results: In total, data sets of 154 patients

were obtained for the ITT analysis. In

comparison to the initiation, significant

improvements of the mean threshold could

be assessed in the reaction to the CPT in

all four comparison groups. A further eval-

uation shows a clear dose-dependency with

an increasing effect up to 1000 UA/day

and the following level/plateau, summaris-

ing the conjunctivial reactions in the three

steps of allergen concentrations. A differ-

ence on the 5% significance level was

secured in the individual comparison of the

two lowest doses. The most patients with-

out AE (74.4%) were those who received a

dose of 1000 UA/day.

Conclusion: After 3 months of treatment

with LAIS� Birch-Alder tablets a daily

dosage of 1000 UA was shown to be the

most preferable.

1120

Clinical and immunologic efficacy of

sublingual immunotherapy in patients

with respiratory allergy

Maslova, L1; Titov, LP2; DuBuske, L3

1Medical Academy of Postgraduate Education, Minsk,

Belarus; 2Republican Scientific and Practical Center for

Epidemiology and Microbiology, Minsk, Belarus;3Immunology Research Institute of New England,

Gardner, United States

Background: Sublingual immunotherapy

(SLIT) offers the potential for a safer and

more convenient alternative to Subcutane-

ous IT for allergy patients.

Method: Sixty adult patients were studied

with allergic rhinoconjunctivitis and with

or without asthma, from 19 to 46 years

old, sensitisation proven by positive skin

prick tests and IgE determination (at least

class three) who received SLIT (drop for-

mulation) for 2 years with standardised

allergen extracts (Sevapharma, Czech

republic). Patients were divided into two

groups. Group 1 included 30 patients with

respiratory allergy including allergic rhini-

tis with asthma (six patients) and without

asthma (24 patients), receiving monothera-

py with mixture of grasses I or Artemisia

mixtum. Group 2 included 30 patients with

respiratory allergy including allergic rhini-

tis with asthma (Nine patients) and with-

out asthma (21 patients), receiving

combination therapy of a mixture of

Poster Session Group II – Red. TPS 44 – Immunotherapy - AIT clinics II

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453412

grasses I or Artemisia mixtum and mixture

of house dust mites or a mixture of indoor

moulds. The control group included 30

healthy subjects. SLIT involved an up-dos-

ing phase and maintenance phase with a

maximum dose achieved (10000 JSK -

grass pollen extracts and mixture of house

dust mites; 1000 JSK - mixture of indoor

moulds). Specific IgE by immunoblot (R-

Biopharm, Germany) and IgG4 by ELISA

(Dr. Fooke, Germany) were assessed at

baseline and after 2 years of treatment.

Clinical efficacy was assessed using symp-

tom relief score analysis (0–3 where three

is maximum) and for asthma patients the

Asthma Control Test.

Results: SLIT reduced overall symptom

scores and rescue drug intake, with a

highly significant reduction as in patients

of Group 1 and in patients of Group 2

(P < 0.0001). After 2 years of SLIT specific

serum IgE to grasses pollens (P = 0.002)

and to Artemisia mixtum (P = 0.008) level

were significantly decreased in patients of

Group 1 as were allergen specific IgE to

grasses pollens (P = 0.0003), to dust mites

(P = 0.0006) and either to indoor moulds

(P = 0.0006) in Group 2. Levels of specific

IgG4 to grass pollens (P = 0.0003) and to

Artemisia (P = 0.008) increased in patients

of Group 1 and specific IgG4 to grass pol-

lens (P = 0.0002), to Artemisia (P = 0.001)

and to dust mites (P = 0.0006) were signifi-

cantly increased in Group 2. Adverse

effects were limited to a small number of

patients having mild local oral reactions.

Conclusion: SLIT showed efficacy over

2 years of continuous treatment modulat-

ing clinical and allergen specific IgG4 and

IgE responses.

1121

Treating grass pollen allergic patients

with severe allergic rhinoconjunctivitis

symptoms with 5-grass pollen tablets -

results from a 2-year real-life medical

practice study

Karagiannis, E1; Hadler, M1; Shah-Hosseini, K2;

Moesges, R2

1Stallergenes GmbH, Kamp-Lintfort, Germany; 2Institute

of Medical Statistics, Informatics and Epidemiology

IMSIE, Cologne, Germany

Background: The aim of this non-interven-

tional study was to document the impact

of a sublingual allergen immunotherapy

(AIT) with 5-grass pollen tablets (Stallerg-

enes, France) on symptom severity and use

of symptomatic medication as well as toler-

ability in patients with grass pollen-induced

allergic rhinoconjunctivitis (RC) over

2 years of real-life medical practice treat-

ment. Here we focus on patients with

severe RC symptoms during the season

before treatment.

Method: This prospective, open, non-con-

trolled, multicenter trial was conducted

from September 2010 to October 2012 in

Germany. Overall 1.482 patients (752 f,

722 m, mean age: 28 � 15 years) partici-

pated in the study. They were treated

according to a pre-/coseasonal treatment

regimen for two consecutive years.

Patients rated their symptoms (rhinitis,

conjunctivitis, asthma) as a combined

scores of severity [scale: 0 (none)–3(severe)] and frequency [scale: 0 (none)–4(very often)]. In the combined RC score,

the severity of rhinitis and conjunctivitis

were pooled (scale: 0–6).Patients with severe RC symptoms in the

season before treatment (sbRC) were

defined as patients with a RC score of high

degree of severity (either rhinitis or con-

junctivitis at least ‘severe’) during the grass

pollen season preceding AIT.

Results: During the grass pollen season

preceding AIT, 49.0% of the patients had

a severe RC score. This rate decreased to

5.5% in the first (Y1) and to 2.9% in the

second season (Y2) of AIT. Likewise the

RC score decreased in sbRC patients

(n = 711) from a mean value of

5.10 � 0.98 to 2.27 � 1.45 during Y1 and

to 1.61 � 1.18 during Y2. The asthma

score decreased in sbRC patients with

asthma from a mean value of 3.76 � 1.61

to 1.48 � 1.50 during Y1 and to

1.23 � 1.57 during Y2.

During the grass pollen season preceding

AIT, 89.5% of the sbRC patients had used

symptomatic medication. This rate

dropped to 57.0% during Y1 and to

47.8% during Y2.

AIT with 5-grass pollen tablets was well

tolerated in sbRC patients with an inci-

dence of adverse events of 17.7% during

the 2 years of treatment.

Conclusion: Grass pollen allergic patients

with severe symptoms treated in real-life

medical practice benefit from AIT with 5-

grass pollen tablets. All symptom scores as

well as the symptomatic medication use

dropped during the 2 years of treatment.

Furthermore AIT was well tolerated by

this subgroup of patients. Our real-life

medical practice results thus confirm

results obtained in clinical studies.

1122

Clinical efficacy of SLIT in pediatric

patients with allergic rhinitis and asthma

Djuric-Filipovic, I1,2; Filipovic, D3; Stojanovic, M4;

Zivkovic, Z5

1Faculty of Medical Scinece Kragujevac, Immunology,

Kragujevac, Serbia; 2Immunology, Kragujevac

University, Kragujevac, Serbia; 3Institute for Emergency

Medicine, Belgrade, Serbia; 4Clinical Centre of Serbia,

Belgrade, Serbia; 5Children Hospital for Respiratory

Diseases and TBC, Belgrade, Serbia

Background: Allergen specific immunother-

apy is the only treatment with immuno-

modulatory effect and capability to change

natural course of allergic diseases. In order

to promote ASIT GINA include ASIT in

the standard protocol for asthma treat-

ment. The main aim of ASIT is to slow

down further progression of asthma and

allergic rhinitis and to stop or slow down

irreversible changes and remodeling of

respiratory mucosa. The clinical trials also

showed positive effect of ASIT in reducing

symptoms and medications score.

Methods: Sixty four children with asthma

and allergic rhinitis treated in Children’s

Hospital for Lung Diseases and Tuberculo-

sis, Medical Center ‘Dr Dragisa Misovic’,

Belgrade, Serbia are included in our study.

34 children received SLIT according to

WHO position paper on allergen specific

immunotherapy whereas 30 subjects

received standard pharmacotherapy. Clini-

cal efficacy was measured during 3 years

using symptom score, medic mentation

score and laboratory testing. Laboratory

testing included in vivo and in vitro allergen

tests, spirometer and concentration of

exalted NO. The results were analyzed

using SPSS statistical package.

Results: Children in the experimental

group have fewer symptoms score comper-

ing with the children in control group.

According to medicamentation score our

study showed that SLIT can reduce the

usage of standard pharmacotherapy. Labo-

ratory testing especially in vivo skin prick

test showed that SLIT can have positive

effect on desensibilisation.

Discussion: Our results are in accordance

with the results from other studies. Beside

the fact that positive effect of SLIT can be

seen in the first 6 months of treatment,

3 years treatment is optimal duration of

treatment. SLIT is also very important for

preventing further asthma progression and

in the improvement the patient‘s quality of

life.

Conclusions: Although SLIT is well known

treatment for allergic diseases for more

than century it is still not used enough in

clinical practice. Clinical efficacy study is

very important for promoting SLIT as the

only immunomodulatory treatment for

allergic disease.

Poster Session Group II – Red. TPS 44 – Immunotherapy - AIT clinics II

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 413

1123

Predictive clinical parameters for adverse

events in the course of sublingual

immunotherapy

Allam, J-P; Christ, L; Novak, N

University Hospital Bonn, Bonn, Germany

Background: To date sublingual immuno-

therapy (SLIT) has been widely accepted

as a safe and effective alternative to subcu-

taneous immunotherapy in the treatment

of type-I mediated respiratory allergies. As

only local adverse events (AE) occur, its

importance for SLIT has been rather

neglected. However, daily clinical routine

and great studies show that patients react

differently to SLIT in terms of AE.

Aim of the study: To identify clinical oral

pathologies (OP) correlating with onset

and severity of local AE in response to

SLIT.

Method: Before initiation of SLIT,

patients (n = 25) where examined for OP

scored as follows: gum bleeding (1.5), peri-

odontitis (0.5), lip lickers dermatitis (0.5),

aphthous lesions (1) and geographic tongue

(1). AE were categorized in oral, pharyn-

geal and ear pruritus; all scored with 1

each. Scores for OP and AE were then cor-

related.

Results: The scores for AE and OP signifi-

cantly correlated to each other (r = 0.73;

P < 0.001). Irrespective of quality of OP,

the occurrence of at least two different OP

in patients appears to be a predictor for

severe local AE in SLIT.

Conclusion: This pilot study shows that

OP correlate with AE in SLIT. Further

studies are needed to evaluate whether the

presence or absence of OP in SLIT patients

influence therapy adherence and whether

OP represent a negative selection criteria

for SLIT.

1124

Oral specific immunotherapy in HIV

infected patients

Iemoli, E1; Borgonovo, L1; Fusi, A2; Rizzardini, G2; Pi-

coni, S2

1Allergy and Clinical Immunology Unit, Luigi Sacco

Hospital, Milano, Italy; 2Luigi Sacco Hospital, Milano,

Italy

Background: According to the WHO

guidelines, an immunodeficiency such as

HIV infection is a contraindication for

allergic immunotherapy. However highly

active antiretroviral therapy (HAART) has

improved immune function and life expec-

tancy in HIV infected patients. The inci-

dence of respiratory allergies in HIV

patients is similar to the general popula-

tion. The objective of this study was to

evaluate the efficacy and the safety of oral

specific immunotherapy (Oralair, Stallerg-

enes) in a group of grass-pollen allergic

HIV patients.

Method: Twenty three HIV patients with a

clinical history of grass-pollen sensitisation

were enrolled in the study. Thirteen

patients were treated with Oralair from

February to May 2013 and were then com-

pared with ten patients receiving symptom-

atic therapy alone. All HIV patients were

in efficacy immune-virological active anti-

retroviral therapy for at least 1 year. Both

HIV viral load and peripheral lymphocyte

CD4 counts were evaluated during the

study as well as clinical benefits of the

analysis of VAS symptoms, VAS drugs

and a QOL questionnaire.

Results: Clinical efficacy data showed a

significant improvement in Oralair treated

patients compared to controls (VAS symp-

toms: P = 0.003; VAS drugs: P < 0.05;

QOL: P = 0.03). During the study period

we did not observe a notable modification

of CD4 cell counts and of viral load in

both groups of patients.

Conclusion: Our preliminary data showed

that oral allergic immunotherapy with

Oralair in HAART controlled HIV infec-

tion is safe and well tolerated. Considering

the potential interaction between symptom-

atic allergic drugs and protease inhibitors,

together with the high incidence of allergy

respiratory diseases and chronic character-

istics of HIV infection, oral specific allergic

immunotherapy could be considered in the

management of HIV allergic patients.

Poster Session Group II – Red. TPS 44 – Immunotherapy - AIT clinics II

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453414

Poster Session Group II – Red

TPS 45 – Mechanisms of asthma: I

1125

Basophil sensitivity is a valuable tool to

monitor the effects of subcutaneous

immunotherapy

Schmid, JM1; W€urtzen, PA2; Dahl, R3; Hoffmann, HJ1

1Respiratory Medicine, Aarhus University Hospital,

Aarhus C, Denmark; 2Department of Immunology, ALK,

Hørsholm, Denmark; 3Department of Allergology,

Odense University Hospital, Odense, Denmark

Background: Allergen specific immunother-

apy is the only disease modifying treatment

of allergic diseases. It results in an inhibi-

tion of the specific type 1 allergic reaction.

Changes in basophil sensitivity reflect this

treatment effect.

Method: Twenty four adults suffering

from rhino-conjunctivitis due to grass pol-

len allergy were randomized to subcutane-

ous immunotherapy (n = 18) or to an open

control group (n = 6). Basophil sensitivity

was measured by flow cytometry as the

percent of CD63 on the surface of

CD193+ blood basophils activated by

eight log dilutions of grass pollen extract

(0.0000256–256 SQU/ml). Washed cells

were reconstituted with either plasma from

the present or baseline visit or with med-

ium, in order to explore overall changes

and to be able to distinguish between

changes mainly caused by humoral or cel-

lular components. We measured basophil

sensitivity every 3 months during 3 years

of SCIT.

Results: We found a rapid decrease in

basophil sensitivity during updosing, result-

ing in a 19-fold (P = 0.0003; 8.7; 1318)

increase of allergen concentration to cause

half-maximum basophil activation. M

maximum decrease occurred after 1 year of

treatment (135-fold, 14.1; 1318,

P = 0.0003), then slowly increasing again.

This overall effect was mostly owing to

humoral factors: we found a similar devel-

opment during the first year (12.0-fold,

7.9:23.4; P = 0.0005 and 30.2-fold increase,

6.5; 1660; P = 0.0004 after updosing and

1 year respectively, then slowly decreasing.

Measuring the cellular impact did not

reach a significant level. We found no sig-

nificant changes in the control group.

Conclusion: We found a significant

decrease of basophil sensitivity to allergen

during 3 years of SCIT. This decrease

developed rapidly after the start of treat-

ment and reached a maximum level after

1 year. These changes were mainly caused

by humoral changes, while we found only

minor cellular changes in this study. Mea-

surement of basophil sensitivity appears to

be a useful method for monitoring SCIT.

1126

Evolution of basophil reactivity during

sublingual immunotherapy with LTP

(pru p 3) in allergic patients sensitised to

food by LTPs

Gomez, F1; G�omez, E2; Torres, MJ1; Galindo, L1; Ruiz,

MD1; Bogas, G1; Campo, P1; Posadas, T1; Blanca, M1;

Jimeno, L3; Mayorga, C2

1Allergy Unit, IBIMA, Regional University Hospital of

Malaga, UMA, Malaga, Spain; 2Research Laboratory,

IBIMA, Regional University Hospital of Malaga, UMA,

Malaga, Spain; 3ALK-Abello Madrid, Madrid, Spain

Background: In Southern Europe Pru p3 is

the primary sensitiser of plants fruit and it

is responsible of severe reactions. Specific

immunotherapy (SIT) brings a new per-

spective to treat those patients. There is a

lack of knowledge regarding cellular

responses that include changes in the baso-

phil activation during the IT. We aim to

analyse early changes in the basophil

response to Pru p 3 and other related aller-

gen (Ara h 9) after the first month of sub-

lingual immunotherapy (SLIT).

Method: Forty-six peach allergic patients

confirmed by positive specific IgE deter-

mined by skin prick test or fresh peach

(prick-by-prick), ImmunoCAP IgE and/or

a double blind placebo control food chal-

lenge with peach. Basophil reactivity was

determined by the basophil activation test

(BAT) with Pru p 3 and Ara h 9 at three

concentrations, 1, 0.1 and 0.01 lg/ml,

before and after 1 month of SLIT.

Results: Twenty one patients evaluated

(45%) had anaphylaxis and 25 (55%) urti-

caria and/or angioedema. The 82.6%

showed sensitisation to other plant foods

proteins and 69.5% showed sensitisation to

pollens. After the first month of treatment,

28% patients showed an increase in the

basophil reactivity to Pru p 3, 36%

patients showed no changes in their reac-

tivity and 36% presented a decreased reac-

tivity to Pru p 3. Similar results were

obtained for Ara h 9 in those patients..

Conclusion: Preliminary results disclosed

that only after the first month of SLIT

patients showed a different behaviour in

the basophil reactivity with good correla-

tion in the response to Pru p3 and Ara h

9. There were not differences in the clinical

pattern in the groups studied after 1 month

of SLIT.

1127

Molecular diagnosis: is it helpful in the

choice of the specific immunotherapy

composition?

Rom�an India, C1; Munoz Archidona, C1; Moreira Jorge,

A1; Quevedo Teruel, SJ1; Bracamonte Berrmejo, T1;

Echeverr�ıa Zudaire, LA1

1Hospital Severo Ochoa, Pediatrics, Legan�es, Spain

Background: Determine the usefulness of

molecular diagnosis by recombinants for

the composition of specific immunotherapy

(SIT) and describe the pattern of sensitisat-

ion to Phleum (Ph) in our population.

Method: Descriptive study in 88 patients

sensitised to Grass (G) and Olea (O) in

which molecular diagnosis was performed.

Variables considered were age, presence of

rhinoconjunctivitis (RCJ), asthma, prick to

airborne allergens, profilin, polcalcin, total

IgE, specific IgE (SIE) to Olea, Phleum, and

recombinants (Phl p 1, 5, 7, 12 and Ole e 1).

Results: Mean age 10.28 years (4–15).86.4% of patients had asthma and 90.9%

RCJ. Other associated sensitisation: Cu-

pressus (59.8%), Platanus (58.1%) and

Weeds (67.4%), profilin (24.3%) and pol-

calcin (31.8%). The mean of total and SIE

and recombinants (kU/l): IgE 575; phleum

53.64; Phl p1 49.4; Phl p5 20.7; Phl p7

6.14; Phl p12 1.46; Olea 24.1; Ole e1 20.7.

SIE was positive in Phleum (95.4%), Olea

(96.6%), Phlp1 (90.7%), Phlp5 (44.3%),

Phlp7 (12.1%), phlp12 (23.1%) and Ole e1

(82.6%). If we consider a value of SIE to

Ph or O (in patients sensitised to both)

more than 10%, compared to the other

allergen to be significant, in 14 children

their SIT would vary (15.9% of prescrip-

tions). If we consider significant all values

over 0.35 kU/l to Phl p1, Phl p5 and Ole

e1, it would result in 18 children changing

their SIT to 100% O or 100% G (20.4%

change SIT). Taking into account only val-

ues >10% of Ole e1 compared to the other

(Phl p1 y 5), SIT would alter in 31.8% of

cases to 100% G or O.

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 415

Conclusion:

1 Profile of sensitisation to Phleum in

our population is mainly Phl p1.

2 Performing molecular study of recomb-

inants in polysensitised children, would

modify theoretical SIT in 20.4% of

patients.

3 If we only consider significant values of

SIE to Ole e1 higher than 10% of SIE

to Phl p1 or 5, would change SIT in

the 31.8%.

1128

Mixtures of depigmented and chemically

modified pollen extracts from different

homologous groups generate specific

IgG antibodies with IgE blocking capacity

against individual allergens

Iraola, V; Leonor JR; Morales, M; Moya, R;

Lopez-Matas, MA; Gallego, M; Carn�es, J

Laboratorios LETI, R&D, Tres Cantos, Spain

Background: Allergen immunotherapy

(AIT) with mixture of allergen extracts

from different homologous groups remains

controversial. Successful AIT has been

linked to a specific immune response and

the production of blocking antibodies. The

objectives of this study were to determine

the antibody response, and induction of

IgE-blocking antibodies against total

extract and purified allergen by depigment-

ed-polymerised (Dpg-Pol) vaccines com-

posed by a mixtures of grass and olive or

pellitory pollen.

Method: Sera from New Zealand rabbits

immunised with a mix (50%:50%) of Dpg-

Pol vaccine of grasses (5 species) with Olea

europaea or Parietaria judaica extracts were

obtained. Specific IgG (sIgG) against the

extracts (grasses, O. europaea and P. juda-

ica) and purified allergens (Phl p 5, Ole e 1

and Par j 1 / 2) was determined by ELISA,

immunoblot and immunoblot-inhibition.

The capacity of these induced antibodies to

block the human-IgE binding sites was

tested by ELISA and immunoblot-inhibi-

tion, comparing the binding of IgE from a

pool of human sera after the incubation of

extracts and purified allergens with rabbit’s

immunised sera and their corresponding

preimmune.

Results: Vaccines composed by mixtures of

grasses with O. europaea or P. judaica

induced high levels of sIgG antibodies to

the complete allergen extracts and to the

purified allergens. In both vaccines, the pro-

duced antibodies show the capacity to block

human-IgE binding sites of the extracts and

purified allergens with percentages of IgE-

inhibition higher than 70%.

Conclusion: Specific immunogenicity is

maintained after the mix of two depigment-

ed and polymerised extracts from different

homologous groups, corroborating the

immunological efficacy of the treatment.

1129

The application evaluation of Der

pteronyssinus components specific-IgE

and IgG4 in detecting with allergic

diseases

Zheng, P; Sun, B1Guangzhou Institute of Respiratory Diseases, First

Affiliated Hospital of Guangzhou Medical University,

Guangzhou Medical University, State Key Laboratory of

Respiratory Disease, Guangzhou, China

Background: Nowadays, More than 20

allergens have been described for Der pter-

onyssinus (Der p). Der p1 and Der p2 are

considered major allergens of Der p 2.

IgG4 antibody level is an important indica-

tor of the body’s immune system exposure

to the antigen. To investigate the dynamic

changes of specific IgE and IgG4 antibod-

ies specific to Der p, and its major aller-

gens (Der p1 and Der p2) in serum from

specific immunotherapy (SIT) patients, and

the clinical significance of detection sIgE

and sIgG4 to Der p1 and Der p2.

Method: A retrospective investigation was

carried out on 70 cases of rhinitis and/or

asthma patients who were given a full year

of standardised Der p-specific immunother-

apy in our hospital. A correlation analysis

was performed from serum Der p and its

component specific IgE and IgG4, as well

as 8 types of cytokines (IL-4, IL-5, IL-8,

IL-10, IL-13, IL-17, IFN-g, TNF-a) before

SIT and after SIT.

Results: Before SIT, 17 weeks and

52 weeks after SIT was given, the serum-

specific IgE Der p1 and Der p2 were both

lower than Der p (P < 0.05). 17 weeks

after SIT, serum-specific IgE Der p, Der

p1, and Der p2 were all significantly

decreased compared with that of before

SIT (P < 0.05). However, when SIT was

continued to 52 weeks, Der p1 and Der p2

sIgE were elevated again, which resulted in

unchanged Der p, Der p1 and Der p2 sIgE

compared with that of before SIT. After

SIT, Der p, Der p1, Der p2-specific IgG4

all demonstrated an increase (P < 0.05),

whereas 52 weeks after SIT the level of

IgG4 to Der p2 was lower than that of

Der p and Der p1 (P < 0.05). The 8 types

of cytokines did not show significant differ-

ences before SIT and after SIT. However,

a positive correlation was noted between

Der p2 IgG4 and IL-5 before SIT.

17 weeks after SIT, Der p1 and Der p2

IgG4 were both positively correlated with

IL-5 and IL-17 (P < 0.01), Der p and Der

p2-IgE were also positively correlated with

IFN-c (P < 0.05). 52 weeks after SIT, Der

p and Der p2-IgG4 shown a positive corre-

lation with IL-8 (P < 0.05), while a nega-

tive correlation with IL-13 (P < 0.05).

Conclusion: Diagnostic tests containing the

major mite allergens (Der p 1, Der p 2)

sIgE and sIgG4 may improve the diagnos-

tic selection of patients for immunotherapy

with Der p extracts. SIT is a dynamic

immune process, and Der P component-

specific IgE and IgG4 are objective indica-

tors of the immune status during the

immune process.

1130

Milk-EPIT protects milk-sensitised mice

against new sensitisations: the role of

epigenetic modifications

Mondoulet, L; Dioszeghy, V; Ligouis, M; Dhelft, V;

Puteaux, E1; Plaquet, C1; Dupont, C2; Benhamou, P-H1

DBV Technologies, Bagneux, France; 2Hopital

Necker - Universit�e Paris Descartes, Paris, France

Background: In milk-sensitised mice, milk-

specific epicutaneous immunotherapy

(milk-EPIT) reduces further sensitisations

to peanut, HDM or pollen (Mondoulet et

al. EAACI, abstract 224, 2013). This study

evaluated the mechanism of this immune

protection process and its maintenance.

Method: BALB/c mice were orally sensi-

tised to milk, then treated by EPIT before

being sensitised to peanut 2, 4 or 8 weeks

later. An oral provocation test with peanut

was then performed, with measurement of

esophageal mucosal eosinophilia. Epige-

netic modifications were measured in whole

spleen for transcription factors (GATA-3

and Tbet). In a second experiment,

CD4+CD25+regulatory T cells (Tregs)

were isolated from spleen of milk-sensitised

mice after EPIT or Sham, and transferred

into naive mice (recipient). Recipient mice

were sensitised to peanuts and exposed to

a peanut regimen.

Results: After sensitisation to peanut, only

the milk-EPIT group showed a significant

increase of peanut-sIgG2a and no signifi-

cant esophageal eosinophilic infiltration

after peanut oral exposure (3 vs 27 eosin-

ophils/mm2 in sham, P < 0.01). The effect

was maintained over 2 months after the

end of immunotherapy at both humoral

and esophageal levels (mucosal infiltration

7 vs 16 eosinophils/mm2 vs sham,

P < 0.05). In the spleen, the methylation of

GATA-3 promoter region increased signifi-

cantly after EPIT and persisted over

2 months, correlating with the decreased

expression of GATA-3 mRNA. Tbet DNA

and mRNA levels did not vary. Moreover,

Tregs transfered to naive recipient mice

protected them from sensitisation to pea-

nut and prevented from esophageal eosin-

ophils infiltration (16 vs 57eosinophils/mm2

in sham, P < 0.05).

Poster Session Group II – Red. TPS 45 – Mechanisms of asthma: I

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453416

Conclusion: In a model of successive sensi-

tisation mimicking the allergic march,

milk-EPIT prevented from new sensitisat-

ion via a Treg mechanism and induced epi-

genetic modifications.

1131

Identification of a specific molecular

signature of pro-allergic (type 2) human

dendritic cells: application to the follow-

up of allergen immunotherapy

Gueguen, C; Moussu, H; Bouley, J; Le Mignon, M;

Nony, E; Lombardi, V; Baron-Bodo, V; Mascarell, L;

Moingeon, P

Stallergenes, Research and Pharmaceutical

Development, Antony, France

Background: Dendritic cells (DCs) are key

players in the initial polarization or reorien-

tation of T cell responses. Specifically, C1Q

and Stabilin-1, two regulatory DC markers,

are overexpressed in peripheral blood

mononuclear cells (PBMCs) of grass pollen

allergic patients exhibiting clinical benefit

during allergen immunotherapy (AIT).

Herein, we sought to define new markers

specific for human monocyte-derived DCs

differentiated toward type 2 (i.e. pro-aller-

genic) DCs (DC2) to evaluate their poten-

tial as candidate allergy biomarkers.

Method: Immature DCs were treated with

either lipopolysaccharide (LPS) from

E. coli or a cocktail of pro-DC2 molecules

to induce DC1 or DC2 differentiation,

respectively. Cytokine production by DCs

or co-cultures of DCs with allogeneic

CD4+ T cells was analyzed by cytokine

quantification assay. Using cDNA micro-

arrays together with quantitative proteo-

mics (label-free mass spectrometry), we

compared mRNA and protein levels in

immature DCs, DC1 and DC2.

Results: After screening more than one

hundred biological and pharmaceutical

agents, we selected a cocktail of molecules

during the differentiation of DCs towards

DC2, supporting IL-5 and IL-13 secretion

by CD4+ T cells. While DC1 produce

IFN-c, IL-1b, IL-6, IL-8, IL-10, IL-12p70as well as TNF-a, DC2 secrete a distinct

panel of effector cytokines (IFN-c-, IL-1b-,IL-12p70-, TNF-a-, IL-10low, IL-6+, IL-8+

and IL-13+). Whole genome transcriptome

and proteome comparison of immature

DCs, DC1 and DC2 revealed extensive dif-

ferences between these DC subsets. Specifi-

cally, 121 and 32 genes/proteins were up-

and down-regulated, respectively, in DC2

when compared with immature DCs and

DC1.

Conclusion: We identified specific DC2

markers, discriminating pro-allergenic cells

from immature DCs and DC1. Studies are

ongoing to evaluate if these markers can

be used to characterise disease severity or

to follow-up AIT efficacy in a cohort of

grass pollen allergic patients exposed in a

challenge chamber.

1132

Impact of the sensitisation to the minor

birch pollen allergens Bet v 2 and Bet v 4

on the clinical efficacy of ASIT and

evolution of oral allergy syndrome

Kozulina, I; Pavlova, K; Kurbacheva, O1; Ilina, N

NSC - Institute of Immunology, Moscow, Russia

Background: Determination of the preva-

lence of the sensitisation to the major and

minor Betulaceae allergens (Bet v 1, Bet v

2, Bet v 4) among patients with respiratory

allergic diseases with hypersensitivity to

trees pollen allergens and study of the

impact of the sensitivity to minor allergens

Bet v 2 and Bet v 4 on the evaluation of

oral allergy syndrome (OAS) and progno-

sis of the clinical efficacy of ASIT.

Method: The study included 50 patients

with allergic rhinitis and conjunctivitis

(ARC), with/no asthma, with/no OAS,

with confirmed sensitisation to Betulaceae

allergens in SPT. All patients measured

specific IgE to Bet v 1, Bet v 2, Bet v 4 in

serum (before ASIT) IFA method (Phadia,

Sweden). All patients were conducted

ASIT (1 year) of mix natural extracts of

trees pollen allergens (Stallergenes, France)

followed by evaluation of the clinical effi-

cacy by means of questionnaire RQLQ and

authors questionnaire.

Results: Sensitisation to Bet v 1 was

detected in 100% cases (50 patients), sensi-

tisation to Bet v 2 was detected in 6%

cases (Three patients), to Bet v 4–0%cases. All patients reported about decrease

of ARC symptoms during trees pollen sea-

son after 1 year of ASIT. Average value of

the efficacy was 68 � 4.2%. Quality of life

of patients improved from 1.7 � 0.5 to

0.6 � 0.3, P = 0.00. The results of labora-

tory tests were compared with the clinical

efficacy of ASIT and the presence of OAS.

There was no correlation between the pres-

ence of OAS and sensitivity to Bet v 2 and

Bet v 4 (r = 0.565, P = 0.000). Also there

was no correlation between clinical efficacy

of ASIT and sensitisation to Bet v 2 and

Bet v 4 (r = 0.616, P = 0.004).

Conclusion: The prevalence of sensitisation

to Bet v 1 amount patients with ARC and

sensitivity to Betulaceae allergens is 100%,

to Bet v 2–6%, to Bet v 4–0%. There is no

correlation between the presence of the

sensitisation to Bet v 2 and Bet v 4 and

OAS. The presence of a minor allergen

sensitisation to Bet v 2 and Bet v 4 is not a

predictor of lack of clinical efficacy of

ASIT by natural extracts of Betulaceae

allergens.

1133

Adeno-associated viruses (AAV) coupled

with HER-2 mimotopes are safe and

effective anti-tumor vaccines in a

xenograft mouse model

Singer, J1,2; Manzano-Szalai, K2,3; Thell, K1,2; Lukschal,

A1; Fazekas, J1,3; Roth-Walter, F3; Weghofer, M4; Ritter,

M4; Jensen-Jarolim, E1,2,3

1Institute for Pathophysiology and Allergy Research,

Medical University of Vienna, Vienna, Austria;2Biomedical International R+D, Vienna, Austria;3Comparative Medicine Messerli Research Institute of

the University of Veterinary Medicine Vienna, Medical

University Vienna, and University Vienna, Vienna,

Austria; 4Medigene AG, Martinsried, Germany

Background: In contrast to passive immu-

notherapy with monoclonal antibodies,

which is well established in clinical oncol-

ogy, active immunotherapy with anti-can-

cer vaccines is far less advanced, due to the

phenomenon of tolerance in respect to the

self-origin of tumor-associated-antigens.

Mimotopes, small B-cell epitope-mimick-

ing peptides (6–38 amino acids), could

overcome this obstacle, because they do

not rely on consensus sequence with the

epitopes on tumor antigens, but rather

three-dimensional similarity to be specifi-

cally recognised by the immune system and

thus break tumor tolerance. Adeno-associ-

ated viruses (AAV) and their derived virus

like particles (AAVLP) could serve as

highly effective vectors to display mimo-

topes to the immune system.

Method: Mice were immunised 3 times

with AAV, displaying an epitope-mimic of

the clinically applied antibody trast-

uzumab. After each round of immunisa-

tion, antibody levels were determined and

finally mice were challenged with HER-2

overexpressing tumor grafts.

Results: AAV-vaccinations induced a

strong and lasting immune response in im-

munised mice, mainly via IgG1 antibodies,

and showed a good safety profile. Further,

the induced antibodies had anti-prolifera-

tive properties. Upon tumor graft, immun-

ised mice showed significantly delayed and

reduced tumor growth.

Conclusion: This study describes the gener-

ation and evaluation of an AAV-vaccine

inducing trastuzumab-like anti-HER-2

antibodies. Due to its good safety profile

and significant tumoristatic and tumorici-

dic effects, this vaccine could help to estab-

lish active immunotherapy for cancer

patients, which could be highly beneficial

in minimal residual and early stage disease.

Poster Session Group II – Red. TPS 45 – Mechanisms of asthma: I

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 417

Poster Session Group II – Red

TPS 46 – Molecular allergology III

1134

Biological functionality, epitope

conservation and taxonomic diversity of

clinically relevant allergens

Heath, MD; Swan, NJ; Hutchings, JW; Mwange, JD;

Collis, J; Skinner, MA

Allergy Therapeutics plc, Worthing, Unites Kingdom

Background: A large-scale proteomic char-

acterisation of major relevant allergens

within a vast range of products was recently

conducted; allowing the biological function-

ality, epitope conservation and taxonomic

diversity of clinically relevant allergens to

be assessed. Allergenic proteins must cross-

link specific IgE molecules, bound to the

surface of mast cells and basophils, to stim-

ulate an immune response. A better struc-

tural understanding of the allergen-IgE

interface is needed to better predict cross-

reactivity’s between allergens.

Method: To confirm their presence, mass

spectrometry of peptide fragments were

searched against well-established protein

databases through MASCOT, using protein

databases such as NCBI and Swissprot.

Using a combination of computational

approaches, allergens were computed and

sorted according to their likely biological

function. Epitope specificity was then com-

piled, mapped and compared and, where

possible, structural data was generated.

Results: Clinically relevant allergens were

assigned predicted biological functions,

where they had previously been unassigned

or miss-annotated. The taxonomic diversity

was widespread and epitope conservation

was described, including new structural

information of a number of relevant aller-

gen-IgE interfaces.

Conclusion: The methods and results

described herein provided further invalu-

able characterisation and verification of

clinically relevant allergens, leading to a

greater understanding of the characteristics

of allergenic proteins.

1135

Lipotripeptides for delivery of genetic

materials

Koloskova, O; Shilovskii, I; Andreev, S; Khaitov, M

NRC-Institute of Immunology FMBA of Russia, Lab.

Molecular Immunology, Moscow, Russia

Background: Cationic peptide-saturated

delivery vectors are promising transfection

agents and are rapidly developing in the

field of gene therapy. These compounds

are capable of effective packaging of DNA

molecules and are able to protect them

from nucleases. The natural properties of

their components ensure a successful entry

into the cell.

Method: Trends in the development of

new synthetic mediators of transfection

pay a lot of attention to cationic amphi-

philes with multivalent cationic group and

long hydrocarbon chain. Therefore, in this

study we synthesized a series of aliphatic

tripeptide derivatives with a different

amino acid sequences in a head group and

hydrocarbon chains with length of 16 car-

bon atoms. The structures of obtained

compounds were confirmed by mass spec-

tra. Liposomes based on synthesized com-

pounds were prepared by hydration of a

thin film. Particle sizes according to pho-

ton correlation spectroscopy did not exceed

100 nm. Transfection efficiency was

assessed on HEK 293 cells.

Results: We selected tripeptide sequences

LysLysLys, LysTrpLys, LysLysGlu in the

polar part as the most promising transfec-

tion agents among the series of synthesized

compounds, in their case percentage of

transfected cells was about 70%. For the

concentrations used we didn0t observe any

cytopathic effect. For selected delivery sys-

tems we have achieved reproducible trans-

fection for different formation of

liposomes.

Conclusion: We obtained an effective

genetic material delivery system that is

promising for further investigation as a

drug delivery agent in gene therapy.

1136

Fractional exhaled nitric oxide (FeNO) of

≥ 100 and implications for future asthma

research

Chipps, BE; Anderson, C; Harder, J

Capital Allergy & Respiratory Disease Center,

Sacramento, United States

Background: There is an association

between elevated FeNO levels and risk of

wheezing and asthma attacks.

Method: Chart review over 6 months (Jan-

uary 2013 to June 2013), capturing patients

both in and out of allergy season. In total,

we collected data on 40 patients with

FeNO ≥ 100. All 40 patients underwent a

standard evaluation.

Results: Through this small-scale observa-

tional study, we have perhaps identified a

previously uncharacterised group of patients

with apparently normal lung function

(FEV1 ≥ 90%) but very high FeNO values

of >100. As may be expected, these patients

were found to be taking lower ICS doses

than the patients with FEV1 values <90% of

predicted. In the FEV1 ≥ 90% group, 10 of

13 patients were steroid na€ıve, and the 3

patients using ICS were taking a low dose

(average 153 mcg of fluticasone propionate

(FP) or its equivalent, range 100–200 mcg).

The ACT score of the steroid-na€ıve patients(20) did not differ significantly from the rest

of the group (18.8). In the FEV1 < 90%

group, (avg 74, range 44–48) with average

ACT 15.5, 14 of the 27 patients were steroid

na€ıve, and the average dose for the 13

patients using ICS was 506 mcg of FP or its

equivalent (range 80–1040 mcg).

Conclusion: Epidemiologic studies have

shown that patients with FeNO levels >100are at risk of a more severe clinical course,

marked by increased asthma burden,

repeated asthma exacerbations and

increased utilisation of healthcare resources.

However, because of the apparent discon-

nect between the impairment domain

(FEV1, ACT score) and the risk domain (of

which FeNO is an indicator), these patients

may not get the treatment they need. A

well-designed prospective study is needed to

understand patients with a very high FeNo,

in terms of their underlying, potentially

unique pathophysiology and the treatment

modalities that will be most beneficial.

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453418

1137

Serum IgE analysis for determining

covariation of sensitisation to the

silkworm moth (Bombyx mori) and nine

inhalant allergens among allergy patients

Zheng, P; Sun, B; Zeng, G; Wei, N; Luo, W; Huang, H

Guangzhou Institute of Respiratory Diseases, First

Affiliated Hospital of Guangzhou Medical University,

Guangzhou Medical University, State Key Laboratory of

Respiratory Disease, Guangzhou, China

Background: The silkworm, Bombyx mori,

is an important insect in the textile indus-

try and its pupa are used in Chinese cui-

sine and traditional Chinese medicine.To

investigate the sensitisation profile of silk-

worm moth (Bombyx mori)-sensitised

patients against 9 common inhalant aller-

gens and sort out their statistical correla-

tions.

Method: A total of 175 patients with

asthma and/or rhinitis recruited from a

respiratory clinic were tested for serum

specific IgE against silkworm moth. The

co-sensitisation profile and correlation rate

between the silkworm moth and nine com-

mon inhalant allergens were compared and

analyzed.

Results: Of the 175 serum samples tested,

86 (49.14%) had silkworm moth-specific

IgE. When they were tested against

another nine common inhalant allergens,

high positive concordance was found with

Dermatophagoides pteronyssinus (94.34%),

Dermatophagoides farinae (86.57%), Blo-

mia tropicalis (93.33%), Blattella germa-

nica (96.08%), and Periplaneta americana

(79.41%), but not with cat dander

(19.05%), dog dander (26.19%), Aspergil-

lus fumigatus (16.13%), and Artemisia vul-

garis (11.11%). Among the five allergens

with higher positive concordance, the high-

est correlation of sIgE positive rate was

found between silkworm moth and Blattel-

la germanica (R = 0.777), followed by Blo-

mia tropicalis (R = 0.757), D. farinae

(R = 0.647), D. pteronyssinus (R = 0.524),

and Periplaneta americana (R = 0.396). In

addition to house dust mites, the study

confirmed a high prevalence of silkworm

moth-specific IgE among Chinese respira-

tory patients.

Conclusion: The serum specific IgE data

also showed silkworm moth sensitivity had

a high positive concordance with D. pter-

onyssinus, D. farina, Blomia tropicalis,

Blattella germanica, and Periplaneta ameri-

cana. It suggests a cross-reactive relation-

ship may present since all these arthropods

grow optimally under similar humidity

conditions in subtropical regions.

1138

Characterisation of recombinant Bet

v1.0101 produced in Chinese hamster

ovary cells

Warmenhoven, H; Vigil Garcia, M; van Schijndel, H1HAL Allergy BV, Leiden, the Netherlands

Background: Chinese Hamster Ovary

(CHO) cells are the most widely used

expression system for the production of

therapeutic proteins. CHO cells contain the

appropriate machinery, comparable to

human cells, for the production of properly

folded and post-translationally modified

proteins. In this study, we used CHO cells

as a production platform for the recombi-

nant Bet v1.0101 isoform, the immuno-

dominant major allergen from birch

pollen.

Method: CHO-S cells were cultured and

transfected with the commercial expression

vector pcDNA3.1 (Life Technologies) con-

taining the strong human CMV promoter,

the Bet v1.0101 gene and a G418 resistance

cassette. Individual clones from stably

transfected cell pools under selection pres-

sure with G418 were isolated by limiting

dilution, generating monoclonal cell lines.

Bet v1.0101 from the harvested medium

was purified using several chromatographic

techniques. Various immunological, bio-

chemical and physicochemical assays were

applied for characterisation and compari-

son of the newly produced rBet v1.0101 to

natural and other recombinant forms of

Bet v1.

Results: Stable CHO-S clones producing

rBet v1.0101 were isolated. The purified

rBet v1.0101 showed a high purity as deter-

mined by SDS-PAGE. The results from the

assays used for characterisation and com-

parison showed a high degree of similarity

between the different forms of Bet v1.

Conclusion: In this study, we have demon-

strated the possibility of producing, in CHO

cells, rBet v1.0101 with similar biochemical

and immunological characteristics com-

pared to other available forms of rBet v1.

This is, based on available literature data,

the first plant-derived recombinant allergen

expressed in a mammalian cell line.

1139

Not all urticaria is allergy. A case report

Garriga Baraut, T; Vil�a, B; Blasco, C; Delavalle, B;

Martens, J; Moreno-Gald�o, A

Allergy Department, Vall d0Hebron University Hospital,

Barcelona, Spain

Background: Neonatal-onset multisystem

inflammatory disease (NOMID)/ chronic

infantil, neurological, cutaneous and articu-

lar (CINCA) syndrome is a dominantly

inherited autoinflammatory disease associ-

ated to gain-of-function NLRP3 mutations

and included in the cryopyrin-associated

periodic syndromes (CAPS). It is considered

a rare disease. However, the true prevalence

of CAPS is likely higher than estimated, as

the disease is still not widely known and

therefore often not diagnosed correctly.

Methods: We report a 10-month-old girl,

diagnosed with DiGeorge syndrome, with

persistent and migratory generalised ery-

thematous and edematous papules compat-

ible with urticaria. She was derived to our

allergy department to evaluate a possible

allergy etiology. Urticaria was minimally

itchy and she had been suffering from

recurrent episodes of urticaria since birth.

The previous month the episodes of urti-

caria were followed by fever with musculo-

skeletal symptoms (arthralgia and arthritis)

in left left ankle and in the right wrist.

Results: Allergy study was negative. Labo-

ratory parameters were compatible with

inflammation (elevated erythrocyte sedi-

mentation rate and elevated C-reactive pro-

tein) and the blood count showed anemia

and leukocytosis. Perivascular polymorpho-

nuclear cell infiltration was observed in the

cutaneous biopsy, which was compatible

with autoinflammatory syndromes. Molecu-

lar genetic testing for mutations in the

NLRP3 gene confirmed the CINCA/NO-

MID diagnosis. Her father, who was

healthy, also has this mutation but without

association to any CAPS symptoms. Cur-

rently the patient is being treated with cana-

kinumab (a fully human immunoglobulin

IgG1j monoclonal antibody against IL-1b)with clinical improvement.

Conclusion: Urticaria is not always a syno-

nym of allergy. The association of chronic

inflammation with recurrent fever and neo-

natal onset urticaria is a common charac-

teristic of autoinflammatory diseases. If

joint symptoms and/or neurological affec-

tation are associated to these symptoms we

should suspect a NOMID/CINCA syn-

drome. Because the disease is rare and

some patients present initially only with

symptoms of urticaria, the diagnosis of

NOMID/CINCA is often delayed and

therefore has to be considered in the differ-

ential diagnosis of urticaria.

1140

MSE for the parallel identification and

quantification of allergens and non-

allergenic proteins in birch pollen

Spiric, J1; Engin, A1; Karas, M2; Vieths, S1; Reuter, A1

1Allergology, Paul-Ehrlich-Institut, Langen, Germany;2Pharmaceutical Chemistry, University of Frankfurt,

Frankfurt, Germany

Background: Allergen products are made

from natural sources that contain a wide

Poster Session Group II – Red. TPS 46 – Molecular allergology III

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 419

variety of allergenic and non-allergenic

proteins. Characterisation and standardisa-

tion of allergen products is a prerequisite

for the safety and efficacy of allergen prod-

ucts. Mass spectrometry is a superior pro-

teomic tool that offers precise information

on the variability of natural allergen

extracts. Therefore, the aim of this study

was to use a data-independent mass spec-

trometry (MSE) approach to identify and

quantify the entire birch pollen protein

profile including all known allergens, isoal-

lergens, and non-allergenic protein in a sin-

gle run.

Method: A liquid chromatography (LC)-

ESI-MSE method was applied for record-

ing protein profiles, and quantifying aller-

genic and non-allergenic proteins in birch

pollen.

Results: We recorded quantitative data for

all birch allergens. Additionally we

obtained conclusive quantitative values for

5 non-allergenic proteins. Moreover, we

acquired qualitative data for another 4

non-allergenic proteins. The coefficient of

variation (CV) varied between 3% and

30% for birch pollen allergens concerning

the technical, the digest, and the extraction

replicates. The CV for non-allergenic pro-

teins was in a range of 2%–50%.

Conclusion: This technique is suitable for

monitoring batch consistency of allergen

products including both allergenic and

non-allergenic protein content. Measure-

ment and reproducibility errors are smaller

than current regulatory demands. As we

quantified vast majority of total protein

content, this method may be used to

replace currently applied methods for aller-

gen product characterisation, such as

ELISA and SDS-PAGE.

1141

T-cell reactivity of natural and

recombinant group 1 and 2 allergens

with Der p 1 and Der p 2 specific T-cell

lines and clones

Kahlert, H; Nandy, A; Wald, M; Klysner, S

Allergopharma GmbH & Co. KG, Reinbek, Germany

Background: T-cell reactivity is regarded

as a basic requirement to molecules used

for allergen specific immunotherapy. To

gain further knowledge about the cross

reactivity on T-cell level, T-cell lines (TCL)

and clones (TCC) raised against Der p 1

and Der p 2 were investigated using

natural and recombinant group 1 and 2

allergens from D. pteronyssinus and D.

farinae. Together with serological and

structural data the results constitute the

basis for evaluating the potential composi-

tion of recombinant mite preparations for

SIT.

Method: Der p 1 and Der p 2 reactive

TCL and TCC were raised from peripheral

blood mononuclear cells of allergic patients

and used for stimulation experiments. T-

cell reactivity was measured by ³H-thymi-

dine incorporation after stimulation in vitro

with natural allergens or a recombinant

isoform. T-cell epitopes were identified

using synthetic 12mer peptides.

Results: A proportion of 39% natural and

53% recombinant Der p 1 and 35% vs

24% Der p 2 reactive TCL do not show

any reactivity with their respective counter-

parts from D. farinae. Considering TCC

reactivity, these differences could be attrib-

uted to differences in the amino acid

sequence. The selected recombinant iso-

forms showed no reactivity with about

33% of the group 1 allergen TCL and

about 50% of the group 2 allergen TCL. A

larger proportion of the recombinant than

the natural purified group 1 and 2 allergens

revealed species specific T-cell reactivity

with TCL and TCC.

Conclusion: Significant differences in TCL

and TCC reactivity were observed between

both species and allergen groups and most

pronounced for the group 2 allergens. It is

not possible to conclude from these results

whether the extent of cross reactivity

between the allergens of the two species

are sufficient to induce a protective

response using only allergens from one spe-

cies. Notably, the isoform specific differ-

ences observed on the T-cell level do not

reflect the cross reactivity seen on IgE-

level.

1142

Clonation and characterisation of the

Siberian hamster allergen (Phodopus

sungorus)

Torres, JA1; Carlos, PV2; Joaqu�ın, S1; Fernando, V2;

Aroa, SM2; De las Heras, M1

1Allergology, Fundacion Jimenez Diaz, Madrid, Spain;2Immunology, Fundacion Jimenez Diaz, Madrid, Spain

Background: Siberian Hamster (SH)

allergy is increasing in our environment;

however, the allergens of this frequent exo-

tic pet had not been identified.

Method: Twenty-one patients with SH

allergy were recruited. Skin prick tests

(SPT) were carried out to native epithe-

lium, saliva, and urine extracts obtained

from SH (Phodopus sungorus), Golden

(Mesocricetus auratus), European (Cricetus

cricetus), and Roborovski (Phodopus robo-

rovskii) hamster’s respectively. SDS-PAGE,

Immunoblotting, Immunoblotting-inhibi-

tion, and ELISA assay were performed.

The N-terminal of IgE-binding bands was

determined by mass spectrometry and

degenerate primers were designed for

cDNA amplification by RT-PCR. Aller-

genic properties of recombinant proteins

were assayed by immunoblotting, ELISA

and basophil activation test (BAT).

Results: SPT with SH extracts were posi-

tive in all patients. Five patients also were

positive to Roborovski hamster extracts.

Immunoblotting from patient’s sera

showed common IgE-binding bands of

about 18, 21, and 23-kDa either on the epi-

thelium, urine and saliva extract. Mass-

spectrometry from the three identified

bands revealed the same partial amino-acid

sequence. IgE-binding band proteins were

identified as lipocalin-like protein and the

cDNA was cloned. The recombinant SH

protein was recognised by patient’s sera.

Total inhibition between different SH

extracts was demonstrated meanwhile a

partial inhibition with Roborovski hamster

extracts. However, not cross-reactivity was

showed between SH and Golden and Euro-

pean hamsters. BAT showed in vivo activ-

ity of the recombinant SH protein extract

in patients.

Conclusion: An 18-kDa IgE-binding band

in SH extracts was identified while its aller-

genicity was confirmed. A partial cross-

reactivity between SH and Roborovski

hamster was demonstrated but not with

Golden and European hamster species. An

SH recombinant protein was sequenced

and first-time described as lipocalin-like

protein whose IgE activity is demonstrated

by BAT.

1143

Polymorphisms of BsmI, FokI, ApaI TaqI

VDR gene and serum levels of vitamin D

as a risk factors for Class IV lupus

nephritis in Colombian patients

Garavito de Egea, G1; Olier, D2; Fang, L3; Iglesia, A4;

Aroca, G5; Eegea, E6

1Department of Medicine, Universidad del Norte,

Barranquilla, Colombia; 2Medicina, Universidad Rafael

Nu~nez, Cartagena, Colombia; 3Odontology, Universidad

de Cartagena, Cartagena, Colombia; 4Medicina,

Universidad Nacional de Colombia, Bogtota, Colombia;5Medicina, Universidad Simon Bolivar, Barranquilla,

Colombia; 6Medicina, Universidad del Norte,

Barranquilla, Colombia

Background: Several studies have demon-

strated the role of vitamin D receptor

(VDR) polymorphisms and the deficient

serum level of VitD in the development of

systemic lupus erythematosus (SLE); how-

ever, these results are inconsistent between

different cohorts. Actually There is not suf-

ficient VDR genetics variants study in

Latin admixed ethnics groups and none in

Colombian Patients suffering from this

Cass IV LN.

Method: The aims of this work was to

study the prevalence of the VDR FokI

(rs2228570), BsmI (rs1544410), ApaI

Poster Session Group II – Red. TPS 46 – Molecular allergology III

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453420

(rs7975232) and TaqI (rs731236) geno-

types, alleles and haplotypes in Class IV

LP in a Colombian population. Patients

(n = 49) and healthy individuals (n = 97).

Statistical analyzes were performed using

SPSS v 20, IBM Arlequin 3.51.3., and Haplo-

view 4.2. softwares.

Results: We did not observe significant dif-

ferences for either the VDR BsmI, ApaI

and TaqI genotype and allele frequencies

in patients with SLE and healthy individu-

als. However, the frequency of the VDR

and genotypes of FokI was statistically dif-

ferent between patients with class IV LN

renal disease and patients without this

symptom OR = 3.228 (1.534–6.792,P = 0.0014). The VDR- FokI genotypes of

rs2228570, AA (Case �18.4% vs Controls

�12.4%) and AG (Case �59.2% vs Con-

trols �35.1%) were significantly associated

with the disease (P = 0.02 9), AA and

rs2228570 AG VDR_ FokI also behave as

risk markers for NFL -IV (OR: 3.59 [1.18

to 10.8], P = 0.024) and (OR 4 11 [1.78 to

9.51], P = 0.001) respectively.When assess-

ing this SNP using a dominant model (AA

genotype grouping vs GG + AG) of its

allele, a partnership with NFL -IV

(P = 0.01 77.6% vs 47.4%) was found.

The dominant model of the A allele

(AA + AG vs GG) also was associated

with insufficient levels of vitamin D,

[76.9% vs 23.1%, P = 0.23, OR: 2.9 (1.09–7.7)]. Y (10.8], P = 0.024) and (OR: 4.11

[1.78–9.51], P = 0.001) respectively. On the

other hand We did not found low blood

levels of vitamin D in between patients and

control (37.2 ng/mL vs 36.5 � 12.2 ng/

mL � 11.1, P = 0.82).

Conclusions: These results Taken together

it Seems that SNPs FokI rs2228570 poly-

morphisms may be Implicated in LN sus-

ceptibility In this Colombian patients.

Poster Session Group II – Red. TPS 46 – Molecular allergology III

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 421

Poster Session Group II – Red

TPS 47 – Occupational allergy

1144

Sensitisation to recombinant allergens of

Hevea brasiliensis in patients with

intraoperative latex anaphylaxis

Escobar Montalvo, JM; Alejo Alm�anzar, E; Enr�ıquez

Matas, A; Fern�andez Rodr�ıguez, C; Di�eguez Pastor, MC;

Vives Conesa, R

Allergolgy, Hospital Universitario 12 de Octubre,

Madrid, Spain

Background: Latex is the second cause of

intraoperative anaphylaxis. The study of

Hevea brasilensis0 recombinant allergens

increases the diagnostic accuracy in cases

of latex allergy.

Aim: describe the sensitisation profiles to

Hevea brasilensis0 recombinant allergens in

patients diagnosed with intraoperative

latex anaphylaxis (ILA) in the Service of

Allergology at Hospital Universitario 12 de

Octubre during 2012.

Method: A descriptive study of the sensiti-

sation profiles to latex recombinant aller-

gens in patients diagnosed with ILA was

performed. The analyzed variables were

age, sex, job, atopy, pollinosis, latex prick

test results (SPT-latex), levels of specific

immunoglobulin E for latex (IgE-latex)

and their recombinant allergens. Every

serum was evaluated for eight latex rec-

ombinants using Phadia-Immuno

CAP�250. The cutoff for value of latex-

specific IgE and their recombinant was

0.35 kU/l.

Results: During 2012, four cases of ILA

were diagnosed. The study of other possi-

ble anaphylaxis causes was performed with

negative results. SPT-latex was performed

in three patients with positive result in only

one case. IgE-latex assays were positive in

all the cases (X = 10, 65 � 11.5 kU/l). One

patient was sensitised to r Hev b 8; a sec-

ond one, to r Hev b 6.01 and r Hev b 6.02;

a third one, to r Hevb 8, r Hevb 6.01 and r

Hevb 6.02; and the fouth one, to r Hevb

6.01, r Hevb 6.02, and r Hev b 11. The

study of other recombinants was negative.

Conclusion: In this interoperative latex

anaphylaxis cases, sensitisation to r Hevb

6.01, and r Hevb 6.02 were the most fre-

quent.

In the fourth case, sensitisation to r Hev

b 11 could be explained by cross-reactivity

with r Hev 6.01 and r Hev b 6.02.

1145

A case of protracted intraoperative

anaphylaxis to latex

Nieto-Nieto, AM; Farias-Aquino, EG; Tob�on-Franco, JD;

Jim�enez-Ruiz, C; Pe~na-Acevedo, Y; Vila-Albelda, C;

Tejedor-Alonso, MA

Allergy Unit, Hospital Universitario Fundaci�on

Alcorcon, Alcorcon, Spain

Introduction: Prolonged anaphylaxis cases

are rare.This case report describes a pro-

tracted severe anaphylaxis maintained for

4 days.

Methods: A Male 62 years with bladder

urothelial carcinoma was scheduled for

surgical cystectomy. 20 min after the start

of surgery and immediately after manual

intra-abdominal manipulation, the patient

experienced increased pressure of airway

and hypotension.His blood pressure

dropped to 50/30 mmHg without response

to Dopamine and massive infusion of flu-

ids. Redness of the face and upper chest

was noted. Latex anaphylaxis was sus-

pected and treatment was initiated with

intravenous boluses of Adrenaline, Methyl-

prednisolone and Ranitidine with improve-

ment of blood pressure. All latex material

was removed and drugs (propofol, fenta-

nyl, rocuronium, bupivacaine) used previ-

ously were replaced. After completion of

the surgery the patient was admitted for

4 days in the Postanesthesia Care Unit by

prolonged hypotension with distributive

shock requiring continuous infusion of

Adrenaline and Dopamine due to the

worsening of hemodynamic markers if

drugs were retired. Infectious and other

causes of shock were discarded. After 96 h,

there was a hemodynamic improvement

allowing the withdrawal of inotropic drugs.

Results:

1 Serum tryptase levels during surgery

was 74.3 lg/l (0.0 to 11.6), after 6 h:

53.6 lg/l and 24 h later: 8.92 lg/l/ Spe-cific IgE to latex 3.04KU/l / Skin Prick

Test to latex:7x7 mm.

2 2-D echocardiogram showed no abnor-

malities.

3 Other allergic tests with the drugs

involved in the episode could not be

completed due to the death of patient

3 months after surgery.

Conclusion:

1 We report a case of intraoperative ana-

phylactic shock and prolonged course

for 4 days due to a probable hypersen-

sitivity to latex.

2 Despite the normalisation of serum

tryptase levels after 24 h of the onset of

anaphylaxis, functional alterations per-

sisted for 96 h without myocardial

damage that could explain the evolu-

tion of the hemodynamic indicators.

1146

Anaphylactic reaction to oxytocin in a

patient with previously undiagnosed

latex allergy

Dziadzio, M1; Rotiroti, G2; Kariyawasam, H2; Lukawska,

J3; Gardner, J4; Seneviratne, SL1; Chee, R1

1Department of Immunology, Royal Free Hospital,

London, Unites Kingdom; 2Department of Allergy and

Medical Rhinology, RNTNE and University College

London Hospitals, London, Unites Kingdom; 3King’s

College London, London, Unites Kingdom; 4Department

of Child Health, Royal Free Hospital, London, Unites

Kingdom

Background: Rare cases of anaphylactic

reactions during labour in women receiving

synthetic oxytocin (Synthocinon) have been

reported. Some authors suggested that

those reactions were due to latex allergy

rather than Synthocinon. There is some

epitope homology between oxytocin and

latex (its patatin antigens), which raises the

possibility of cross-reactivity. Hev b 7.01

and Hev b 7.02 have homology with six

oxytocin contiguous amino acids [1].

Methods: To report a case of type-1 hyper-

sensitivity to oxytocin in a patient with

undiagnosed latex allergy.

Results: After a vaginal delivery, a 32-

years old primigravida required surgical

removal of placenta performed under a

spinal block with lignocaine. After receiv-

ing Synthocinon in a ‘latex-free’ theatre,

she had anaphylaxis with laryngospasm

and hypotension and was resuscitated.

Subsequent allergy testing to lignocaine

was negative. She had a positive skin test

(wheal, erythema) after intradermal admin-

istration of 0.03 ml of Synthocinon 1:100

(considered a non-irritant concentration).

She also had a positive SPT to latex and

positive sIgE to latex (14.5 kU/l).

Although she denied any previous history

of allergies, she confirmed a history of

adverse reactions (local irritation) on expo-

sure to condoms. A diagnosis of an IgE-

mediated allergy to oxytocin and to latex

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453422

was made and she was advised to avoid

both.

Conclusions: Our case illustrates type-1

hypersensitivity to oxytocin confirmed by

positive skin test in a latex-allergic patient.

Potential cross-reactivity was suggested [1]

due to some aminoacid homology between

oxytocin and latex. This may be of concern

for patient safety during obstetric proce-

dures. Patients with a history of reactions

to oxytocin should be screened for latex

allergy. Where there is a likely history of

latex allergy, patients should be tested for

latex allergy and if found positive, they

should undergo skin testing with Synthoci-

non prior to delivery.

[1] PMID:17519267:

1147

False negative sIgE and ISAC microarray

chip in latex allergy

York, M; Egner, W; Sargur, R; Shrimpton, A

Sheffield Teaching Hospitals NHS Foundation Trust,

Clinical Immunology and Allergy Unit, Sheffield, Unites

Kingdom

Background and Methods: A 53-year-old

female community health care support

worker presented via occupational health

to a Unites Kingdom allergy clinic with a

very clear clinical history of Type 1 IgE

mediated allergy to latex but negative

blood tests to latex. Her symptoms

included immediate periorbital swelling,

urticaria, wheezing and dizziness after

exposure to latex gloves and balloons in

work and home environments.

Results: Testing confirmed a negative latex

sIgE however, skin testing to Alyostal and

ALK latex commercial skin test solutions

elicited positive responses. An Immuno-

CAP Solid-phase Allergen Chip (ISAC)

test containing latex component allergens;

rHev b 1, rHev b 3, rHev b5, rHev b 6.01

and latex profilin rHev b 8, was entirely

negative in the absence of any obvious

cross-reactive pollen allergens to explain

the skin tests. Basophil activation testing

was performed using Alyostal and ALK

latex skin test solutions with positive

responses (>10% basophil activation com-

pared to the control sample). Latex avoid-

ance was recommended and an adrenaline

auto-injector prescribed as her job may

lead to occasional low level allergen expo-

sure in the community.

Conclusion: This case demonstrates that

latex sIgE and ISAC microarray testing

alone, cannot exclude latex sensitisation in

patients with suspected NRL allergy. Cur-

rently, of the thirteen known latex aller-

gens, five are available as part of the

ImmunoCAP ISAC microarray. Three

additional component allergens are avail-

able as ImmunoCAP recombinant sIgE

tests; rHev b 6.02, rHev b 9 and rHev b

11. Development of a microarray chip con-

taining a wider panel of recombinant latex

components may be a useful tool in the

future diagnosis of latex allergy.

In summary, the investigation of sus-

pected latex allergy should include a com-

bination of latex sIgE, component resolved

diagnostics, skin testing and proper inter-

pretation by an allergy specialist. Relying

on skin testing or specific IgEs alone as

evidence of latex sensitisation could lead to

a misdiagnosis in a small number of

patients with latex allergy.

1148

Sensitisation to recombinant allergens of

Hevea brasiliensis in a patient with

intraoperative anaphylactic shock to

latex

Alejo Alm�anzar, E; Escobar Montalvo, J;

Ruiz Sancho, V; Barranco Jim�enez, R; Mielgo Ballester-

os, R; Vives Conesa, R

Allergology, Hospital Universitario 12 de Octubre,

Madrid, Spain

Background: The use of recombinant aller-

gens of latex enables the identification of

specific profiles of sensitisation. Sensitisat-

ion to r Hev b 11 is rare.

Method: A 63 year-old man with clinical

suspicion of lung cancer suffered just after

thoracic surgeon manipulated pulmonary

parenchyma with latex gloves during diag-

nostic thoracotomy presented with general-

ised erythema, hypoxemia, hypotension

and bronchospasm. He had a complete

response to adrenaline, antihistamines, cor-

ticosteroids and fluid therapy. Before the

surgical procedure was administered vanco-

mycin, bromazepam, and tiotropium bro-

mide. Anesthetic induction was performed

with midazolam, fentanyl and rocuronium.

After the anaphylactic shock, the patient

tolerated vancomycin, bromide tiotropium,

midazolam and fentanyl.

Results: Tryptase levels at 2, 6, and 24 h

after the anaphylactic shock were 20.9 lg/l, 19.6 lg/l and 7.74 lg/l respectively. Spe-cific IgE were positive to latex (28.9 kU/l),

r Hev b 6.01 (36.4 kU/l), r Hev b 6.02

(20.8 kU/l) and r Hev b 11 (6.12 kU/l).

Specific IgE to other recombinant latex

allergens measured (Hev r b: 1, 3, 5, 8 and

9) were negative. Skin testing to rocuroni-

um and bromazepam were negative. Oral

challenge to bromazepam was negative.

Conclusion: We report a case of intraoper-

ative anaphylactic shock due to latex, in

which, the use of molecular diagnostic

component has shown a pattern of unusual

sensitisation.

1149

Clinical case of a sanitary presenting a

‘full frame’ latex-fruit syndrome

Duda, H; Priftanji, A; Bregu, B; Mesonjesi, E; Sinani, G

Clinic of Allergology and Clinical Immunology,

Universitary Hospital Center Mother Theresa, Tirana,

Albania

Background: Latex fruit syndrome involves

an allergic reaction to fresh fruits and raw

vegetables manifested mainly in the oral

cavity, after sensibilization with latex aller-

gens. It is not a rare manifestation entity

among patients diagnosed with latex

allergy, in particular among health care

workers wich are highly exposed to latex

allergens.

Method: A 48 years old sanitary worker,

presented in our clinic with episodes of itch-

ing and skin irritation in the area of hands

and face, watery eyes, ocular and nasal itch-

ing, watery nasal secretions during shift

hours. She also reported lip and eye swell-

ing, hoarseness and itchy throat after con-

suming foods as: banana, kiwi, hazelnut,

walnut. After contact with latex gloves, her

symptoms aggravate. Skin Prick Test with

pneumoallergens resulted positive for Latex

allergen. SPT with trophoallergens resulted

positive for banana and hazelnut. Prick by

prick tests with raw banana, kiwi, chestnut,

hazelnut and a piece of latex glove resulted

positive. Based on the patient clinical his-

tory, profession and exposure to latex, also

the results of skin prick tests, we considered

the diagnosis of Latex Fuit Syndrome.We

recommended total avoidance of banana,

chestnut, hazelnut, kiwi and no exposure to

latex material and especially latex gloves.

We prescribed emollient for local adminis-

tration and 2 week therapy with antihista-

mine twice a day.

Discussion: Association between latex

allergy and plant derived food allergy is

described as 21–58%. The most frequently

involved foods in LFS are plant derived

foods which share cross reacting allergens

with latex as banana, chestnut, kiwi and

avocado etc. The molecular basis of cross

reactions in latex fruit syndrome is attrib-

uted to the homology of about 70% inden-

tity between latex hevein allergen (Hev b

6.02)and the terminal domain of the hevein

like allergen of plant derived foods, wich

belongs to chitinases class I.

Conclusion: Skin prick tests and prick by

prick tests were relevant to our case. Total

eviction of banana, kiwi and chestnut con-

sumption and lack of exposure to latex

gloves resulted in symptoms dissapearence.

Oral desensibilization with these fruits is

not an option given that primary sensitisat-

ion was to latex allergens. Specific immu-

notherapy with latex allergens would be

the probable treatment of choice in this

Poster Session Group II – Red. TPS 47 – Occupational allergy

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 423

case but there are not very supporting fea-

tures from studies involving this topic.

1150

When allergy plays the first

fiddle. . .occupational asthma due to

colophony in a violin player

Hanon, S1; Rong�e, R1; Potvin, M2; Schuermans, D1;

Vincken, W1

1Respiratory Division, UZ Brussel, Brussels, Belgium;2Pneumology, GZA Sint-Augustinus, Wilrijk, Belgium

The patient, a professional violin player

since 1993, first experienced asthma and

rhinitis symptoms in 2009.

Lung function was normal, except for

significant bronchial hyperresponsiveness

to histamine (PD20 = 1.22 mg). Skin prick

tests confirmed allergy to house dust mite,

grass pollen and tree pollen.

The patient was diagnosed with atopic

asthma and allergic rhinitis and treatment

with low dose ICS/LABA and montelukast

was initiated.

Despite the maintenance treatment the

patient remained symptomatic, especially

during violin playing. In 2010 a wrist frac-

ture forced her to stop playing the violin

temporarily and a prompt improvement of

her asthma symptoms occurred. This led to

the hypothesis of occupational asthma, due

to allergy to unheated colophony, the resin

used on violin bows.

A 3-day in-hospital diagnostic work-up

was scheduled after stopping all asthma

maintenance drugs.

The first day, routine lung function test-

ing proved normal and mild nonspecific

histamine bronchial hyperresponsiveness

was measured (PC20 FEV1 = 2.91). A

‘sham’ bronchoprovocation test with lac-

tose was negative.

On the second day a realistic specific

bronchoprovocation with colophony was

performed. This time a dramatic drop in

FEV1 (�30%) was measured after a cumu-

lative exposure time of 61 min. Also the

nonspecific bronchial hyperreactivity to

histamine at the end of day 2 (PC20

FEV1 = 0.436 mg/ml) was increased.

On day 3 the situation returned to nor-

mal, except for the persistence of increased

nonspecific bronchial hyperresponsiveness

to histamine (PC20 = 0.155 mg/ml)

This extensive testing procedure con-

firmed the diagnosis of occupational

asthma due to unheated colophony dust.

The patient quit violin playing and

started a college education in psychology,

without the asthma recurring.

Occupational asthma due to colophony is

common in workers in several industries,

but this is the first report in a string instru-

ment player.

1151

Managing the risk of occupational allergy

in the enzyme detergent industry

Basketter, D1; Kruszewski, FH2; Mathieu, S3; Kirchner,

DB4; Panepinto, A4; Fieldsend, M5; Siegert, V6; Barnes,

F7; Bookstaff, R4; Simonsen, M8; Concoby, B9

1DABMEB Consultancy Ltd, Sharnbrook, Unites

Kingdom; 2American Cleaning Institute, Washington,

United States; 3AISE, Brussels, Belgium; 4Procter &

Gamble, Cincinnati, United States; 5Unilever,

Sharnbrook, Unites Kingdom; 6Henkel AG & Co,

Duesseldorf, Germany; 7Robert McBride Ltd,

Manchester, Unites Kingdom; 8Novozymes A/G,

Bagsvaerd, Denmark; 9Duke University Medical

CenterPont, Palo Alto, United States

Background: Enzyme proteins have long

been recognised to have a potential to

cause occupational allergy. Consequently,

as users of enzymes in formulated prod-

ucts, the detergents manufacturers have

chosen to implement a number of control

measures to ensure that the hazard does

not translate into health effects in the

workforce. To that end, the trade associa-

tions, the American Cleaning Institute

(ACI) and the International Association

for Soaps, Detergents and Maintenance

Products (AISE), have developed best

practice risk management guidelines pro-

viding occupational hygiene and medical

monitoring as part of an effective exposure

control strategy. The need for businesses to

recognise the utility of the available guid-

ance is reinforced by reports where facto-

ries failure to following good industrial

hygiene practices can give rise to incidences

of occupational allergy.

Method: Both medical surveillance and air

monitoring practices associated with the

implementation of industry guidelines at

approximately 100 manufacturing facilities

were evaluated with respect to the preva-

lence of allergic antibody and occupational

respiratory allergy.

Results: The data show that using the

approaches described for the limitation of

exposure, for good occupational hygiene,

and for active health monitoring, the respi-

ratory allergenic hazard associated with

enzyme proteins can been successfully

managed to ensure the safety of the work-

force.

Conclusion: The results confirm that the

approaches described for the limitation of

exposure, for good occupational hygiene

and for active health monitoring, mean

that the respiratory allergenic risk associ-

ated with enzymes can be successfully man-

aged to ensure the safety of the workforce.

The results reinforce the view that current

occupational hygiene controls and health

monitoring strategies developed by ACI

and AISE represent an approach that

might be adopted by other industries con-

templating working with enzymes.

1152

Work-exacerbated rhinitis - a frequent

cause of work-related upper airway

symptoms

Wiszniewska, M; Lipi�nska-Ojrzanowska, A; Salski, W;

Walusiak-Skorupa, J

Department of Occupational Diseases, Nofer Institute of

Occupational Medicine, Lodz, Poland

Background: Work-exacerbated rhinitis

(WER) is pre-existing or concurrent rhini-

tis that is worsened by workplace expo-

sures, while the disease has not been

caused by the workplace sensitisers. It is

pointed out that WER should be consid-

ered only after careful exclusion of a spe-

cific sensitisation to a workplace agent

through proper diagnostic procedures. The

aim of the study was to evaluate the fre-

quency of WER in bakers reporting work-

related respiratory symptoms and the use-

fulness of diagnostic tests in differentiating

WER and occupational rhinitis.

Method: The study group included 393

bakers reporting work-related respiratory

symptoms. In all subjects questionnaire,

spirometry, skin prick tests (SPT), evalua-

tion of serum total and specific IgE (sIgE)

level were performed. Recognition of occu-

pational rhinitis (OR) was based on spe-

cific inhalative challenge test with

evaluation of nasal response.

Results: OR was found in 35.1% bakers

while WER was recognised in 29.5% sub-

jects. In patients with OR the latency per-

iod was 10.8 � 7.7, whereas in bakers with

WER 13.8 � 9.2 years. Sensitisation to

common and occupational allergens was

significantly more frequent in subjects with

OR than in those with WER. Nevertheless,

about 30% of subjects without recognised

occupational allergy were sensitised to

workplace allergens (occupational SPT

were positive in 33.6% subjects while sIgE

to flours were found in 24.1% bakers with

WER). Additionally, OR frequently coex-

isted with occupational asthma (68.1%

subjects) while among bakers with WER

asthma was found in 26.7% subjects.

Conclusions: WER can be diagnosed in

about 1/3 of bakers reporting allergic respi-

ratory symptoms. The assessment of sensi-

tisation (SPT to occupational allergens,

evaluation of sIgE) is not specific enough

to differentiate occupational and work-

exacerbated rhinitis. Thus, the specific

challenge test should be performed in bak-

ers with suspicion of work-related rhinitis.

Poster Session Group II – Red. TPS 47 – Occupational allergy

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453424

1153

Rhinoconjunctivitis and bronchial asthma

induced by a mix of seeds used to feed

birds

Lluch-Bernal, M1; Umpierrez, A1; Garcia-Alonso, M2;

Rodriguez-Perez, R2; Caballero, ML3

1Allergy, Hospital Carlos III, Madrid, Spain;2Immunology, FIB-Hospital Carlos III, Madrid, Spain;3Immunology, Hospital Carlos III, Madrid, Spain

Background: IgE-mediated reactions

caused by handling bird seeds have been

reported. However there are no cases

described of sensitisation to more than one

type of seed.

We report the case of a 24-year-old man

who developed rhinoconjunctivitis and

bronchial asthma once a week related with

the feeding and care of his birds. The food

included the following seeds: flax (Linum

usitatissimum), canary (Phalaris canarien-

sis), turnip (Brassica rapa), perilla (Perilla

ocymoides) and hemp (Cannabis sativa).

The patient was allergic to pollen (grass,

Cupressus arizonica, Olea europea, Plat-

anus L).

Our aim was to study the seeds and the

allergens involved in the patient’s clinical

reactions.

Method: The study was performed by

SDS-PAGE and IgE-Immunoblotting with

extracts prepared from the five types of

seeds used. The extracts were heated

(100°C/15 min) or digested with simulated

gastric fluid (37°C/30 min). Patient’s serum

was also tested with a peach peel extract

enriched in Pru p 3 (LTP) by IgE-Immuno-

blotting and with the peanut recombinant

Ara h 2 (2S albumin) by ImmunoCAP.

Results: Patient’s serum detected allergens

in four of the five extracts being negative

for the turnip seeds extract. Multiple IgE-

binding bands with an apparent molecular

weight ranging between 148 and 12 kDa

were detected both in the extracts of flax

and perilla seeds. The 12 kDa band was

also detected in canary and hemp seeds

extracts. This allergen is the unique

detected in the four positive extracts. Heat-

ing of the extracts did not affect the IgE

binding capacity of the12 kDa protein,

however it was abolish by simulated gastric

fluid. The patient’s serum did not recognise

neither Pru p 3 nor rAra h 2.

Conclusion: This is the first case described

of allergy to several bird seeds. The aller-

gen involved is around 12 kDa, heat stable

and was digested in simulated gastric fluid.

Given these characteristics and that the

patient is allergic to pollen this allergen

could be a profilin.

1154

Can data from daily exposure to

microbial enzymes in a small population

of employees and their sensitisation

status serve as a contributing

benchmark?

Simonsen, M1; Lykke, AMN2; Larsen, AI3

1Toxicology & Product Safety, Novozymes A/S,

Bagsvaerd, Denmark; 2Global OHS, Novozymes A/S,

Bagsvaerd, Denmark; 3Medical Centre, Novozymes A/S,

Bagsvaerd, Denmark

Background: Microbial enzymes may in

cases where exposure exceeds the TLV

(Threshold Limit Value) cause sensitisation

to individuals who are occupationally

exposed. However, data showing a link

between the level of enzyme exposure and

sensitisation status of exposed individuals

are very scarce. For technical reasons

exposure data are often given as weighted

averages of 1–4 h measurements. In this

study more precise exposure data repre-

senting both background and peak expo-

sure for a small homogeneous population

were generated and combined with data on

sensitisation status.

Method: Enzyme exposure mapping was

made in laboratories in Novozymes facili-

ties where ventilation had shown to be

insufficient. Subsequently the ventilation

issues were corrected. Gilian Aircon 2 sam-

plers were used, 25 l/min. equipped with

Teflon filters, which were analyzed by dou-

ble sandwich Elisa. Sampler nozzles were

placed in the breathing zone of the operat-

ing personnel. Background exposure was

measured in the morning for 60 min before

any activities took place in the laborato-

ries. Peak exposures were measured during

exaggerated activities in the laboratories

for up to 60 min.

Sensitisation status of the operating per-

sonnel was measured by custom made IgE-

ImmunoCAPS.

Results: Background enzyme exposures up

to 68 ng/m3 were observed, and peak expo-

sures up to 115 ng/m3 for the exaggerated

working conditions were recorded.

A total of 21 persons worked in the lab-

oratories and were exposed for up to 8 h

per day. The seniority of the population

was 4–25 years. The exposure took place

through a period of several years. None of

the persons became sensitised during the

period of exposure.

Conclusion: The data obtained in this

small study represents data where informa-

tion on daily exposure and peak exposures

can be linked to individuals including their

sensitisation status. Apparently a daily

exposure up to 68 ng/m3 for many years is

in this stable population tolerated without

leading to sensitisation when peak expo-

sures are moderate. Hence, a daily expo-

sure slightly higher than the TLV is

tolerated in this population.

It may be speculated that if similar case

investigations in other populations combin-

ing results from both exposure monitoring

and sensitisation status may show that the

established TLV can be slightly raised

without compromising the safety of the

exposed population.

1155

Hairdressers’ occupational rhinitis,

asthma and contact urticaria caused by

hydrolysed wheat protein

Airaksinen, L; Pallasaho, P; Voutilainen, R; Pesonen, M

Finnish Institute of Occupational Health, Helsinki,

Finland

Introduction: Hydrolysed wheat protein

(HWP) is a common ingredient in food

and cosmetic products. HWP in cosmetic

products has been shown to cause allergic

contact urticaria (CU) and even to induce

wheat-dependent exercise-induced anaphy-

laxis (WDEIA) in consumers.

Methods: We report two hairdressers, in

whom the use of HWP-containing hair-

dressing products at work led to the devel-

opment of HWP hypersensitivity,

occupational rhinitis (OR) and occupa-

tional CU. One of them also developed

occupational asthma (OA). In addition,

both hairdressers developed symptoms con-

sistent with WDEIA.

Results: Both patients had strong positive

SPT and urticarial reactions in open skin

application tests to hairdressing products

containing HWP. Of the products’ ingredi-

ents, the HWP, laurdimonium hydroxypro-

pyl hydrolysed wheat protein, gave a

strong positive SPT reaction in both

patients. In hairdresser 1, occupational rhi-

nitis and asthma was diagnosed based on a

specific inhalation challenge test with prod-

uct 1, which caused immediate marked

watery rhinorrhea and decline in FEV1 in

the first challenge and in PEF in a re-chal-

lenge the next day. In hairdresser 2, nasal

provocation with laurdimonium hydroxy-

propyl hydrolysed wheat protein caused

marked rhinorrhea with nasal congestion.

Control SPT and nasal provocation results

to healthy volunteers were negative.

Conclusion: Both of our patients were pre-

viously healthy hairdressers who used

HWP-containing hair conditioning and

styling products in their work, and devel-

oped occupational OR and CU, one of

them also OA, caused by HWP. Both

patients also developed symptoms consis-

tent with WDEIA.

Respiratory symptoms are frequent com-

plaints among hairdressers. Hydrolysed

wheat proteins are commonly used in cos-

Poster Session Group II – Red. TPS 47 – Occupational allergy

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 425

metics such as hairdressing products, and

should be considered as a possible cause of

hairdressers’ OR, CU and OA.

1156

Respiratory allergy to thaumatin in an

olive oil mill worker

Siraj, A1; Perez Senci�on, JO1; De la Osa Puebla, V1;

Hernandez Agujetas, R1; Tapia de Pedro, G1; Pineda, F2;

Senent Sanchez, C1

1Allergy Department, Virgen del Valle Hospital, Toledo,

Spain; 2Diater Laboratories, Madrid, Spain

Background: Olive fruit products are fre-

quently grown and used in the Mediterra-

nean diet making its industry one of the

most relevant in the agricultural sector in the

region nevertheless occupational allergy

related olive oil pressing is rare. A 58 year

old olive oil mill worker who resides in a

rural area in central Spain known for abun-

dance of olive tree plantations was referred

to our allergy department complaining of

progressive symptoms throughout the olive

oil pressing period including irritative cough,

chest tightness, dyspnoea and chest wheeze

remaining asymptomatic while not working

in the olive oil mill and in the olive tree poli-

nization season. The patient tolerates olive

oil consumption and does not suffer from

rhinoconjunctivitis in the polinization period

nor during the pressing activity.

Method: Prick test to common pneumoal-

lergens,total IgE and IgE to olive major

allergen were measured, baseline spirome-

try and metacholine challenge, prick test

and bronchial challenge with olive fruit

extract, metacholine challenge and peak

expiratory flow rate registering after the

bronchial provocation, western blott with

olive fruit extract and protein mass spec-

trometry to identify the culprit allergen

were performed.

Results: Baseline spirometry was normal,

Skin prick tests to common pneumoaller-

gens, baseline metacholine challenge and

IgE to nOle e 1 were negative however

prick test with olive extract were positive

and bronchial provocation resulted in a

progressive decrease in forced expiratory

volume and peak expiratory flow rate and

positivization of metacholine challenge

after bronchial provocation. Western blott

revealed IgE fixation to a protein of

approximately 24 kDa which was later on

identified to be Thaumatin by protein mass

spectrometry.

Conclusion: We present a case of occupa-

tional asthma without rhinoconjunctivitis

due to Thaumatin in an olive oil mill

worker.

1158

Allergic contact dermatitis to face masks

in dental clinic: case reports

Stroici, C1; Brzezinski, P2; Chiriac, A3,4; Bujor, A5

1Dental/Facial Estethic, University Apollonia, Iasi,

Romania; 2Dermatology, 6th Military Support Unit,

Ustka, Poland; 3Dermatology, University Apollonia, Iasi,

Romania; 4Nicolina Medical Center, Iasi, Romania;5U.M.F. ‘Iuliu Hateganu’, Cluj, Romania

Dental physicians wearing facial masks are

at risk of allergic contact dermatitis.

We present two cases of allergic contact

dermatitis occurred in dental physicians,

caused by wearing masks over their faces

during medical activity.

Case 1: A 45-year old female dentist was

seen in Emergency for a sudden onset of

an intense erythema localised on the per-

ioral area and anterior neck, well delin-

eated, associated with pruritus and slight

edema. All symptoms appeared after using

a mask for a few hours during labor (Fig-

ure 1). She was a healthy middle-age per-

son, with no current medical problems, no

drug intake, no history of allergies. The

incriminated mask was taken from a new

parcel delivered by a new pharmaceutical

company and has been used during last

week. The standard patch test was negative

as well as routine investigations.

Full recover was obtained in 10 days

using antihistamines and topical class II

steroids.

Case 2: A 28 year-old resident in Stoma-

tology, being on medical internship in a

dental clinic, was addressed to us for an

acute eczema of the lips and chin. She

described a burning sensation, edema and

erythema followed by vesicles, especially

on the lower lips, induced by a short (less

than half hour) contact with the protective

mask.(Figure 2).No other allergic reactions

were seen, no other medical concerns, no

drug intake, no allergic background. The

standard patch test was negative. Wonder-

ful results with a short course of oral anti-

histamines and topical steroids.

Facial contact dermatitis can be treated

by avoiding the cause, in these cases

replacing the paper /textile masks by plas-

tic ones after testing the persons.

1159

Guidelines for the safe handling of

enzymes in occupational settings

Simonsen, M1; Fieldsend, M2; Broekhuizen, K3; Rodri-

guez, C4; Mathieu, S5; Maurer, KH6; Holtkoetter, O7;

Barnes, F8; Dhir, S9

1Novozymes A/S, Toxicology and Product Safety,

Bagsvaerd, Denmark; 2Unilever, Port Sunlight, Unites

Kingdom; 3DuPont Industrial Biosciences, Leiden, the

Netherlands; 4Procter & Gamble, Brussels, Belgium;5A.I.S.E., Brussels, Belgium; 6AB Enzymes, Darmstadt,

Germany; 7Henkel, D€usseldorf, Germany; 8McBride,

Middleton, Unites Kingdom; 9Reckitt Benckiser, Slough,

Unites Kingdom

Introduction: Industrial enzymes may cause

occupational allergy if handled incorrectly.

Within the detergent industry and within

the enzyme producing industry this risk of

occupational allergy has been well man-

aged during the last 40 years. Currently,

the knowledge gained on industrial hygiene

issues during handling of enzyme products

is only known within these industries as

well as to a limited number of people

within both the scientific and the medical

world. However, this knowledge on best

practice might be of value to any enzyme-

handling industrial sector or other inter-

ested stakeholders.

Method: Knowledge, experience and best

practice has been collated from key stake-

holders, industrial hygiene and occupa-

tional health experts within the enzyme

producing industry and the detergent man-

ufacturing industry on how to control and

monitor the working environment during

enzyme handling and the manufacturing

and packing of enzyme products. Existing

peer reviewed articles and relevant regula-

tion within the area has been reviewed.

Results: Based on the information

obtained a guideline was developed on the

control of enzyme exposure in industrial

settings, monitoring of the working envi-

ronment, and on the health screening and

surveillance of employees who are handling

enzyme products. Implementation of the

principles in this guideline has led to a

reduced number of enzyme sensitisations

and enzyme allergies within the enzyme

and detergent handling industries.

Conclusion: A comprehensive guideline on

all key elements of how to ensure a safe

working environment when handling or

manufacturing enzymes has now become

publicly available. This guideline can be

used as a model by all sectors as an educa-

tional book on industrial hygiene for

enzyme handling. The guideline can be

downloaded from the A.I.S.E webpage

without cost.

Poster Session Group II – Red. TPS 47 – Occupational allergy

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453426

1160

Impaired nasal epithelial barrier in house

dust mite sensitised allergic rhinitis

patients

Steelant, B1; Van Gerven, L1,2; Farr�e, R3; Ceuppens, J1;

Boeckxstaens, G3; Akdis, C4; Hellings, PW1,2

1KULeuven, Laboratory of Clinical Immunology,

Leuven, Belgium; 2Research Group Experimental

Oto-Rhino-Laryngology, University Hospital Leuven,

Leuven, Belgium; 3KULeuven, Translational Research in

GastroIntestinal Disorders, Leuven, Belgium; 4The

Swiss Institute of Allergy and Asthma Research,

University of Zurich, Zurich, Switzerland

Background: The nasal epithelial barrier

forms a physical and immunological bar-

rier against inhaled allergens. Compro-

mised epithelial barrier function is

associated with many pathological condi-

tions like asthma, chronic rhinosinusitis,

atopic dermatitis and inflammatory bowel

disease. Nevertheless, the role of tight junc-

tions (TJs) has not been extensively investi-

gated in patients with allergic rhinitis

(AR).

Aim: To study the epithelial barrier integ-

rity and tight junction (TJ) expression in

AR patients.

Method: Human nasal epithelial cells were

isolated from the inferior turbinate of 6

healthy, non-allergic controls (HC) and 6

house dust mite AR patients by protease

treatment and two negative selection proce-

dures. Cells were grown in air-liquid inter-

face (ALI) on transwell inserts. After

21 days, epithelial integrity was evaluated

by transepithelial resistance (TER) mea-

surement and interepithelial passage of

FITC-dextran 4 kDa (FD4). mRNA

expression for claudin-1, occludin and

zonula occludens-1 was determined by

quantitative RT-PCR.

Results: The TER of ALI cultures of AR

patients was significantly lower compared

to HC (1015 � 143 Ω 9 cm² vs

1602 � 142 Ω 9 cm², P < 0.05). TER cor-

related with FD4 passage in AR

(r = �0.9481, P < 0.001), and showed a

trend towards a negative correlation in HC

(r = �0.7893, P = 0.062). Of the TJ gene

expression measured, Claudin-1 expression

was increased in AR epithelial cells com-

pared to HC (1.4 � 0.2 vs 0.7 � 0.1 rela-

tive expression vs b-actin) reaching levels

of borderline significance (P = 0.057). No

differences in occludin and zonula occlu-

dens-1 was found between AR patients

and controls.

Conclusion: Our preliminary data suggest

an impaired epithelial barrier in AR

patients with an increased expression of TJ

proteins claudin-1. This defect may facili-

tate the passage of allergens, leading to

immune activation and the symptoms of

AR.

Poster Session Group II – Red. TPS 47 – Occupational allergy

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 427

Poster Session Group II – Red

TPS 48 – Pediatric allergy I

1161

Is adenoid hypertrophy a comorbidity in

children with allergic rhinitis?

Eren, E1; Arslano�glu, S1; Bahc�eci Erdem, S2; Nacaroglu,

HT2; Unsal Karkiner, CS2; Can, D2; Onal, K1

1Department of Otolaryngology Head & Neck Surgery,

Izmir Katip Celebi University Atat€urk Research and

Education Hospital, Izmir, Turkey; 2Department of

Pediatric Allergy, Dr Behcet Uz Children Hospital, Izmir,

Turkey

Background: Several studies investigate the

possible relationship between adenoid hype-

trophy (AH) and allergy. There is no con-

sensus whether or not allergic rhinitis (AR)

is a possible cause of AH. The aim of the

study is to evaluate the role of allergy in

AH and explore the role of nasal endo-

scopic examination and history in diagnos-

ing allergic rhinitis empirically in children.

Method: This study was conducted between

January and September 2013 in _Izmir Behc�etUz Children Hospital. One hundred and

fifty-five consecutive childrens (109 male)

were included. A simplified visual analog

scale (sVAS) was used to evaluate the history

items. Nasal endoscopy was performed by a

physician blinded to patient0s history. AH

was graded according to Parikh0s classifica-

tion. All patients were tested with common

aeroallergens using standardised extracts of

Alk-Abello (Alk, Denmark).

Results: One hundred-one (65.2%)

patients had a positive skin prick test

(SPT). Multiple allergen sensitivity was

identified in 76 (75.2%) patients. History

items itching (P: 0.04, OR: 2.2), sneezing

(P: 0.002, OR: 4.9), coughing (P: 0.03, OR:

0.4) has a predictive value in diagnosing

AR empirically in children. Physical exami-

nation findings do not have statistically

significant predictive value. On the con-

trary characteristics of nasal secretions

(P < 0.001, OR: 6.3) do have a predictive

value. AH and allergen positivity have a

negative statistically significant correlation

(P: 0.009, r: �0.208). But no statistically

significant relationship between allergen

hypersensitivity and tonsil hypertrophy or

inferior turbinate hypertrophy.

Conclusion: Characteristic of nasal secre-

tions, itching, sneezing and coughing has

found to be predictor of AR in children.

AH has found to be inversely related aller-

gic rhinitis in this study. This a controver-

sial topic and studies with narrow age

groups are needed.

1162

Eosinophilic esophagitis: a possible long

term complication of immunotherapy for

cow’s milk allergy

Remedios, C1; Garc�ıa, C2; G�omez, E2; Garc�ıa, R2; De la

Roca, F2; Rodr�ıguez, J2; Feo, F2; Segade, J2; Galindo,

P2; Alfaya, T2; Mendez, Y2

1Allergy, Hospital General Universitario de Ciudad Real,

Ciudad Teal, Spain; 2Hospital General Universitario de

Ciudad Real, Ciudad Real, Spain

Background: In the last decades, several

authors have published their experience

with oral immunotherapy (OIT) in cow’s

milk (CM) allergic children; although aller-

gic reactions during the procedure are fre-

quent, few cases of late complications due

to these innovative therapeutic procedures

have been reported.

Method: We describe two patients (14 and

15 years old) who underwent an oral

immunotherapy protocol with cow0s milk

and developed symptoms of esophageal

dysfuntion (dysphagia and chocking) sev-

eral months after achieving partial toler-

ance.

Results: A first endoscopy was performed

in both patients after 2 months treatment

with proton-pump inhibitors (PPIs). More

than 30 eosinophils/hpf (high-power field)

were found in the proximal and distal

esophagus. This data fulfilled the criteria

for EoE and CM was excluded from the

diet. Both patients are asymptomatic since

the exclusion of CM from the diet, and

several months later biopsies showed a

normal esophageal mucosa with no eosin-

ophils in the biopsy samples. Furthermore

in one patient, tolerance to milk disap-

peared in a few weeks after excluding regu-

lar milk intake from the diet and he

developed anaphylaxis with the ingestion

of small amounts of milk hidden in other

foods.

Conclusion: We conclude that EoE is a

possible late complication in food allergic

patients treated with OTI protocols.

A strict elimination diet with the impli-

cated food should be prescribed for the

remission of the EoE and to avoid the risk

of severe reactions due to the possible dis-

appearance of tolerance after stopping reg-

ular intake of the food.

1163

Interleukin-33 and thymic stromal

lymphopoietin are elevated in sera of

children with eosinophilic gastroenteritis

Shoda, T1; Nomura, I1; Matsuda, A1; Morita, H1; Arai,

K2; Shimizu, H2; Yamada, Y3; Narita, M4; Ohya, Y4; Sai-

to, H1; Matsumoto, K1

1National Research Institute for Child Health &

Development, Tokyo, Japan; 2Division of

Gastroenterology, National Center for Child Health and

Development, Tokyo, Japan; 3Gunma Children’s

Medical Center, Gunma, Japan; 4Division of Allergy,

National Center for Child Health and Development,

Tokyo, Japan

Background: Eosinophilic gastroenteritis

(EGE) is a gastrointestinal inflammatory

disorder characterised by massive infiltra-

tion of eosinophils into the intestinal wall.

The pathogenesis of EGE remains largely

unsolved. To elucidate the pathogenesis of

EGE in children, we investigated the cyto-

kine secretion profiles in the sera of

patients with EGE and mRNA expression

in intestinal tissue specimens.

Method: Pediatric EGE patients and age-

matched controls were recruited after

obtaining informed consent from their

guardians. The cytokine profiles (30 pediat-

ric EGE patients and 25 age-matched con-

trols) were analyzed using a Milliplex assay

system. mRNA expression in the intestinal

biopsy specimens (Five EGE patients and

four age-matched controls) was examined

using a microarray system.

Results: The concentrations of IL-33 and

TSLP correlated with disease activity and

decreased when the symptoms were improved

by elimination of milk from the diet. In addi-

tion, a strong positive correlation (r = 0.7)

was seen between the concentrations of IL-33

and TSLP, whereas IL-33 showed no correla-

tion with either IL-13 or IL-5. TSLP mRNA

expression was markedly increased in the

intestinal specimens from patients with EGE,

whereas IL-33 mRNA expression was similar

in patients and controls.

Conclusion: TSLP is likely induced in the

intestine of patients with EGE, whereas

IL-33 is likely released by direct damage to

the intestinal wall. IL-33 and TSLP may

play critical roles in the pathogenesis of

EGE through inducing and/or amplifying

Th2-type inflammation. The roles of these

cytokines may provide novel therapeutic

targets and/or candidates for useful diag-

nostic tests for EGE.

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453428

1164

Eosinophilic esophagitis management -

experience in a Portuguese pediatric

hospital

Paiva, M1; Finelli, E1; Marques, J1; Rosa, S1; Prates, S1;

Santos, F2; Flores, H2; P�o, I2; Afonso, I2; Oliveira, L2; Ca-

bral, J2; Leiria-Pinto, P1

1Immunoallergy Department, Hospital Dona Estefania,

Lisbon, Portugal; 2Gastroenterology Unit, Hospital

Dona Estefania, Lisbon, Portugal

Background: Eosinophilic esophagitis is a

chronic, immune-mediated disease charac-

terised by symptoms of esophageal dys-

function. Food allergy seems to be

involved.

Aim: To characterise a pediatric popula-

tion with diagnosis of EoE and evaluate

efficacy of different treatment options.

Method: We included patients with diag-

nosis of EoE performed under 18 years

old. Diagnosis of EoE was made if symp-

toms of esophageal dysfunction associated

with esophageal eosinophilia in biopsy

(>15 eos/hpf) and exclusion of GERD by

pH monitoring or lack of clinical and his-

tology improvement after a 8 weeks trial

with PPI. Patients performed skin prick

tests (SPT) and specific IgE’s to common

food allergens. If sensitised to food, chil-

dren went on dietary restriction. Children

without food sensitisation initiated topical

fluticasone propionate 500 mcg bid. After

3–6 months of treatment, clinical and

endoscopic revaluation was performed.

Results: Sixty eight children were included

with male predominance (79%). About 2/3

of patients were atopic. There was a delay

between the beginning of symptoms

(6.5 � 4.4 years) and age of diagnosis

(9.1 � 4.6 years). GERD symptoms were

the usual presentation under 6 years old,

while older children complained of dyspha-

gia, food impaction or chest pain. Specific

IgE and SPT to at least 1 food was

detected in 71% and 46% patients, respec-

tively. Complete remission was achieved in

63/68 (92%) of children. 46 patients went

on dietary restriction guided by tests, of

whom 14 (30%) achieved clinical and his-

tological remission. Milk was the most

common food allergen. Topical fluticasone

was a very effective treatment (97% remis-

sion), but relapse was often observed after

discontinuation.

Conclusion: Food sensitisation is a com-

mon finding in patients with EoE but effi-

cacy of dietary restriction was low. Non-

adherence to diet and difficulties in identify

the culprit food by standard tests could

explain these data. Topical steroids are a

highly effective therapy.

1165

Food protein induced enterocolitis

syndrome (FPIES): a case series of

sixteen patients

Guibas, G1; Potika, M1; Tsilochristou, O1; Koulias, C1;

Aggelidis, X1; Makris, M1; Chliva, C1

12nd Dpt of Dermatology and Venereology, Medical

School, University of Athens, University Hospital

‘Attikon’, Allergy Unit ‘D. Kalogeromitros’, Athens,

Greece

Background: Food-Protein Induced

Enterocolitis Syndrome (FPIES) is a rare,

non-IgE-mediated food hypersensitivity

disorder that presents with severe GI

symptoms in its acute form and typically

appears before the age of 1 year. Main

offending foods are cow milk (CM) and

soy, but solid foods are also incriminated.

Diagnosis is set clinically as there are no

pathognomonic in vivo/in vitro markers:

Skin Prick Tests (SPTs) are of low useful-

ness and the value of Atopy Patch Tests

(ATPs) is contentious. Food challenges can

confirm the diagnosis and ascertain toler-

ance induction, commonly occurring by

the age of three. Here we present a series

of sixteen FPIES patients.

Results: Sixteen patients were referred to

our Unit and acute FPIES was diagnosed

clinically from their history. Seven were

male (44%) and nine female. Disease onset

was within the first year for thirteen

patients (81%) and within the second year

for three (19%); for two patients, non-

induction of tolerance was further con-

firmed by food challenges at the ages of 8

and 13, respectively. Offending foods were:

fish for 11 patients including the two

patients with intractable disease (69%),

chicken for two patients (12.5%) and CM,

veal and egg for one patient each (6%).

Reported acute symptoms were: vomiting

in all patients (100%), diarrhea in three

(19%), lethargy in three and marked

abdominal pain in two (12.5%). SPTs to

the offending foods were undertaken in

twelve patients and were all negative

(100%); ATPs to the offending foods were

conducted in thirteen patients and were

positive in nine (69%) and negative in the

remaining four (31%).

Conclusion: We present a series of sixteen

patients with a rare syndrome, including

recalcitrant disease at a protracted age, an

infrequent occurrence in the literature.

Interestingly, CM was an uncommon cul-

prit, with fish being incriminated in up to

two thirds of our patients. In our hands,

ATPs appeared to be a useful diagnostic

tool.

1166

Prospective study of pollen food

syndrome in children attending a

specialist allergy clinic

Ludman, SW1; Du Toit, G1

1St Thomas’ Hospital, Children’s Allergy Service,

London, Unites Kingdom

Introduction: There is limited information

regarding the onset and sensitisation pat-

terns of pollen food syndrome (PFS) in

children. We aimed to explore this within

children referred to a specialist allergy

clinic at a London Tertiary Hospital.

Methods: Fifty four patients with seasonal

allergic rhinitis (SAR) were enrolled

equally in three age groups; 0–5, 6–10, 11–15 years. Families completed a question-

naire on rhinitis, food symptoms and qual-

ity of life (QOL). Children underwent skin

prick testing (SPT) to fresh fruits, nuts and

a blood test for microarray analysis.

Results: Sixty one percent of patients were

male, average age per group: 4.5, 9 and

13.4 years (range 2.6–15.8 years). 65% had

other non-related food allergies, 61% ato-

pic dermatitis and 56% asthma. Clinical

diagnosis of PFS (PFS+) was made in 26

(48%), increasing with age [group 1: 3,

group 2: 9, group 3: 14 (P = 0.03)].

Patients scored equally poorly in QOL, but

PFS+ had significantly more anxiety

around meal preparation (P = 0.029). SPT

wheals to fresh fruits, carrot and hazelnut

were statistically larger in PFS+ but not

with melons, tomato or fresh peanut. 23

PFS+ patients were sensitised to the PR-10

family, 8 to profilins, 4 to TLP and three

each to nsLTP and CCD; with PR10 sensi-

tisation from 4.5 years and nsLTP only in

children from 11.4 years. PFS+ were more

highly sensitised to grass with a wider

spread of grass components. PFS- were

more likely to be sensitised to house dust

mites (54% vs 39%, P ≤ 0.001). Sensitisa-

tions to nuts and legumes were similar but,

PFS- were sensitised to a wider range of

these components.

Conclusions: We have demonstrated that

SAR occurs in children from 1.5 years and

PFS from 4.5 years with an age related

increasing prevalence. PFS+ have addi-

tional anxiety concerning meal preparation.

Microarray results to panallergen families

show progression from PR-10 to nsLTP in

an age related fashion. Whether interven-

tions (such as sub-lingual immunotherapy

to grass) may prevent or delay the onset of

PFS in children is an intriguing possibility.

Poster Session Group II – Red. TPS 48 – Pediatric allergy I

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 429

1167

Milk-specific immunoglobulin free light

chain secretion is increased in children

with eosinophilic esophagitis

Chehade, M1; Vos, AP2,3; Yershov, O1; Kleinjan, M3;

Garssen, J2,3; Redegeld, F3

1Mount Sinai School of Medicine, Center for

Eosinophilic Disorders, Jaffe Food Allergy Institute,

New York, United States; 2Nutricia Research, Utrecht,

the Netherlands; 3Institute for Pharmaceutical Sciences,

Utrecht University, Utrecht, the Netherlands

Introduction: Eosinophilic esophagitis

(EoE) is an esophageal inflammatory dis-

ease triggered by foods, milk being the

most common by far. Standard allergy

tests to milk are not predictive. Immuno-

globulin free light chains (IgfLC) were

shown to be elevated in allergic diseases in

an antigen-dependent manner and indepen-

dently from serum IgE levels. We sought

to investigate whether milk-specific IgfLC

secretion is increased in children with EoE.

Methods: Serum samples from 40 children

with EoE, 11 gastroesophageal reflux dis-

ease (GERD) and 11 controls were

retrieved. Age and atopic status were

recorded. Serum milk-IgfLC levels were

determined by ELISA where milk protein

concentrate was coated to a plate. Binding

of milk-IgfLC was detected by kappa (K)

or lambda (L) IgfLC-specific antibodies.

Optical density (OD) values for K and L

milk-IgfLC were compared among the 3

groups. Serum milk-IgE levels were mea-

sured in all subjects by fluoro-enzyme

immunoassay. P < 0.05 was considered sig-

nificant.

Results: Serum milk-IgfLC levels were sig-

nificantly more elevated in EoE than in

GERD or controls. For K: median OD

0.32 in EoE vs 0.17 in GERD (P = 0.01)

and 0.18 in controls (P = 0.01). For L:

median OD 0.26 in EoE vs 0.24 in GERD

(P = 0.01) and 0.20 in controls

(P = 0.005). OD values were comparable

between GERD and controls. Serum milk-

IgfLC levels did not correlate with age (K:

R = 0.20, P = NS; L: R = 0.23, P = NS),

serum milk-IgE (K: R = 0.23, P = NS; L:

R = 0.21, P = NS), or atopic status (K:

median OD 0.25 in atopic vs 0.30 in

non-atopic, P = NS; L: median OD 0.25 in

atopic vs 0.26 in non-atopic, P = NS).

Conclusion: Milk-specific IgfLC secretion

is increased in children with EoE, milk

being the most common food trigger. This

increase was independent of age, milk sen-

sitisation status or atopic status. These

results indicate that IgfLC may be impor-

tant in the pathogenesis of food-induced

EoE, and may potentially pave the way to

development of a diagnostic test for food

triggers in EoE.

1168

Comparison of exhaled nitric oxide with

spirometry and impulse oscillometry in

the evaluation of airway

hyperresponsiveness in preschool

children

Shim, JY1; Lee, J-W1; Standardization Group of Allergic

Disease in Children1Pediatrics, Sungkyunkwan University School of

Medicine/Kangbuk Samsung Hospital, Seoul, Korea

Background: The fractional concentration

of exhaled nitric oxide (FeNO) is used as a

biomarker of airway inflammation, and

impulse oscillometry (IOS) is a noninvasive

measurement to assess respiratory imped-

ance in young children. However, the rela-

tionship between FeNO level and IOS

parameters and spirometry has not been

reported in preschool children. In this

study, we assessed FeNO level and param-

eters of IOS and spirometry to evaluate the

association with AHR and atopy in pre-

school children.

Method: Children aged 4–6 years from the

general population were evaluated using

FeNO measurements, spirometry, methach-

oline bronchial provocation test, IOS, total

serum IgE, and a skin prick test. FeNO

levels, parameters of IOS and spirometry

were evaluated in children with and with-

out AHR or atopy. AHR was defined

when FEV1 decreased by more than 20%

after inhalation of methacholine in a dose

of ≤8 mg/ml.

Results: The overall prevalence of AHR

was 35.0% and the prevalence of atopy

was 20.6%. Mean FeNO levels were signif-

icantly higher in children with AHR than

in children without, and atopic children

also showed higher mean FeNO levels than

nonatopics. Mean FeNO levels were higher

in children with both atopy and AHR,

compared to children with either atopy or

AHR. However, IOS and spirometry

parameters as well as bronchodilator

responses by FEV1 or R5 Hz showed no

significant differences between children

with and without AHR or atopy. FeNO

was significantly associated with AHR,

while parameters of IOS and spirometry

showed no associations. Mean FeNO level

was positively correlated with a dose-

response slope for methacholine, serum

eosinophil counts and total IgE levels, but

not with IOS or spirometry parameters.

Conclusion: FeNO is a more sensitive mea-

surement of AHR than other lung function

tests and can be a good indicator for eval-

uating eosinophilic lung inflammation and

AHR in preschool children.

1169

Differential use of immunomodulators in

frequently ill children

Maleyka, K1; Aida, AJ2; Mammad, AK2

1Children Diseases II, Azerbaijan Medical University,

Baku, Azerbaijan; 2Pathological Physiology, Azerbaijan

Medical University, Baku, Azerbaijan

Background: Bronchopulmonary pathol-

ogy remains one of the most urgent prob-

lems of pediatrics. Viral infections of the

respiratory tract represent a major cause of

morbidity in childhood.

Method: The aim of our study was to

study on the clinical and laboratory level

performance immunomodulators Kipferon

(alpha2 -interferon) and Imunofan (heksa-

peptide) in frequently ill children (FIC)

with acute respiratory diseases. For this

purpose, we studied 87 FIC with acute

respiratory diseases. Measured levels of

cytokines IL-1beta, IL-2, IL-6, IL-8, TNF-

alpha, IFN-gamma in serum, level of sub-

stance P, the state of haemostasis, the

number of CD3, CD4, CD8, CD19 cells,

the concertration of serum immunoglobu-

lines A, M, G, E. Has been studied as the

state of intestinal microflora, microbioce-

nosis nasopharynx.

Results: Our results show that in the acute

period of the respiratory disease, reduced

the level of cellular immunity, marked

imbalance of humoral immunity reduction

of IgA and IgG, increase of IgM and IgE.

By the marked in cytokine status increase

proinflammatory cytokines IL-1beta, TNF-

alpha, IL-6, IL-8 and reducing IL-2 and

IFN-gamma. In acute period of the disease

is marked as raising the substance P and

blood clotting. Purposely immunocorrec-

tion, we used immunomodulators Kipfero-

nand Imunofan In cases where dysbiosis

upper respiratory tract and intestinal, dys-

immunoglobulinemia were more severe, we

applied Kipferon, and in those cases where

the decrease cellular immunity was more

pronounced, used Imunofan. Our results

revealed that children with frequent episo-

dies of acute respiratory diseases, the use

of immunomodulators Kipferon and Imu-

nofan leads to positive dynamic of immu-

nological parameters, cytokine status,

substance P, hemostasis, eliminated dysbio-

sis upper respiratory tract and intestinal,

prevent complications, recurrence, chronic

inflammation.

Conclusion: Saved changes in the clinical

remission in frequently ill children requires

adequate therapy.

Poster Session Group II – Red. TPS 48 – Pediatric allergy I

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453430

1170

The role of immunoallergology in

supporting other medical specialities in

the hospital

Aguiar, R; Soares, J; Pestana, L; Silva, P; Caiado, J;

Mendes, A; Costa, C; Branco Ferreira, M; Lopes, A;

Pereira-Barbosa, M

Immunoallergology Department, Hospital de Santa

Maria - Centro Hospitalar Lisboa Norte, Lisbon,

Portugal

Introduction: In our daily hospital activity,

we are faced with requests to observe

patients (pts) from other services. To opti-

mise this evaluation it was settled in the

Imunoallergology Department the support

to the Emergency service (ES) in 2004 and

to the inpatients services (IS) in 2008.

Objectives: To evaluate the causes for re-

feral and guidance the pts.

Methods: Review of patients files observed

and referenced by Central and Paediatric

ES (Jan 06–July 13) and IS (Jul 08–Decem-

ber 13).

Results: We identified 761 requests in 758

patients from ES and 133 requests from

IS.

Pts sent from ES were mostly referenced

by the Internal Medicine 724 (95.1%), and

the remaining by ENT’s 6 (0.78%), Der-

matology 24 (3.15%), Pediatrics 3 (0.39%),

Pulmonology 1 (0.13%) and 1 Stomatology

(0.13%).

The median age was 37 (7–92) years.

68.2% were women.

The reasons for these requests were urti-

caria (468, 61.8%), isolated angioedema

(AE) (181, 23.9%), unspecified dermatitis

(38, 5.02%), respiratory distress (30,

3.96%), anaphylaxis (17, 2.24%) and oth-

ers (24, 3.17%).

Drug allergy was a common etiology

suspected in AE alone (99 pts, 53.1%), this

suspicion was less frequent for pts with

urticaria.

In anaphylaxis, drug allergy was the

most common etiology (12; 5.9%), fol-

lowed by food allergy (1, 5.9%) and hyme-

noptera venom (1, 5.9%).

Six hundred and three pts (79.5%) were

discharged and referenced to IA consulta-

tion and 29 (3.8%) were admitted for sur-

veillance. The others were guided to a

different speciality.

The support to inpatient services was

mainly prompted by Cardiology 44 (33%)

and Internal Medicine 38 (28.6%). The

most common reasons were suspected drug

allergy to aspirin (69, 51.8%), isolated AE

(30, 22.5%) and urticaria (40, 30.0%). The

median age was 49 (2–84) years. 52.1%

men.

Thirteen pts (9.7%) underwent drug de-

sensitisation. One hundred and three pts

(77.4%) were referred to the general query

IA, 8 (6.01%) for Primary Immunodefi-

ciencies Consultation and the remaining

for other specialities.

Conclusions: Urticaria with or without AE

and suspected drug allergy were the most

frequent reasons for supporting the IA /

IS, respectively. The IA support to the

other specialties represents a growing pro-

portion of activity in hospital. The Immu-

noalergology has a unique role in the

guidance of patients with suspected immu-

noalergology disease in the hospital.

1171

The impact of allergic diseases on the

Emergency Room of the General Hospital

- University of Padova from 2008 to 2012

Cancian, M1; Vettore, G2; Frigo, AC2; Mormando, G1;

Baldo, D1; Senter, R1; Dako, S1; Fabris, F1

1Dept. of Medicine, General Hospital and University of

Padua, Padova, Italy; 2General Hospital and University

of Padua, Padova, Italy

Background: As very few studies have been

published about the epidemiology and the

management of allergy in adults at the

Emergency Department (ED), we assessed

the global impact of allergic diseases at the

ED of Padua University Hospital from

2008 to 2012.

Method: We recovered and read 6497 dis-

charge reports with nosological codes sug-

gestive of an allergic etiology. Data

obtained from 4040 cases of admissions

really related to an allergic disease were

compared with those from the total num-

bers of ED entries using the test of hypoth-

esis v2 and Fisher0s exact test Main.

Results: Allergy represented 0.9% of all

the causes of admission, mostly for urti-

caria/angioedema (57%), asthma (18%)

and isolated angioedema (13%). Although

anaphylaxis accounted only for 2.70%, the

prevalence of both yellow and red codes

showed to be higher in allergic than in

total admissions (37.55% vs 27.32%, and

5.35% vs 3. 55%, respectively; P < 0.001).

Allergic symptoms were treated with corti-

costeroids in 77.82% and antihistamines in

66.1% of cases, whilst epinephrine was

administered mainly in anaphylactic shock

(87.1%), anaphylaxis (31.03%) and more

sporadically in asthma and angioedema.

Short-term Intensive Observation protocol

was applied to 9.31% of allergies and

3.5%, of global accesses (P < 0.001), with

a lower percentage of hospitalisations due

to allergies (3.2% vs 18.18%; P < 0.001).

Only seven patients - five of those intubat-

ed on site by the rescue personnel or on

their arrival at the ED - were admitted to

the intensive care unit, where two died

(one for angioedema and one for asthma).

Conclusion: Our results demonstrate a sig-

nificant impact of allergic diseases on the

emergency department, both in terms of

epidemiology and clinical resources. The

few deaths observed and the low percent-

age of hospitalisations show as a well-orga-

nized ED may successfully approach all

the allergic diseases seeking for emergency

care.

Poster Session Group II – Red. TPS 48 – Pediatric allergy I

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 431

Poster Session Group II – Red

TPS 49 – Pollen

1174

A search for aeroallergens from

sunflower (Helianthus annuus L.) pollen:

a common sensitiser to rhinitis patients

Ghosh, N1; Pandey, N2; Gupta Bhattacharya, S1

1Division of Plant Biology, Bose Institution, Kolkata,

India; 2Mediland Diagnostic, Kolkata, India

Background: Helianthus annuus pollen

grains are present in large proportion in

the aerosol of Kolkata,a mega-city of India

and pose allergy in this area. Two aller-

genic proteins of 34 and 14.7 kDa were

previously reported by Jim�enez et al.

(1994) and Asturias et al. (1998). The aim

is to identify and characterise novel aero-

allergens from the pollen grains of Helian-

thus annuus using homology driven proteo-

mic approach.

Method: The allergenic potential of Helian-

thus pollen was investigated by skin prick

test and ELISA and further confirmed by

immunoblotting. Protein bands binding IgE

from allergic sera were excised from a 2D

electrophoresis gel and five major allergens

were identified by MALDI-TOF-TOF and

LC- ESI MS/MS. As the Helianthus genome

has not yet been sequenced, mass spectrom-

etry-based approach followed by MASCOT

searching against NCBInr database was

performed to identify if the peak lists

deduced from MS/MS spectra show any

sequence homology with known proteins

from phylogenetically related species. In

case of low confidence (P < 0.05) protein

identification, searching was done against

Helianthus EST database.

Results: One dimensional and 2D immu-

noblot using allergenic patient sera against

Helianthus pollen protein revealed the pres-

ence of five major allergens of which two

spots of 44 and 35 KDa were identified by

MALDI TOF TOF and three spots of 44,

49 and 29 KDa by LC-ESI MS/MS. The

44 kDa proteins showed sequence homol-

ogy with pollen allergen Amb a 1.2 and

Amb a 1.3 from Ambrosia artemisiifolia,

which were pectate lyase, and may be two

isoforms. 35, 49 and 29 KDa proteins were

subjected to similarity searches against the

Helianthus EST database using the

BLASTx algorithm and they were identi-

fied as a cystein protease, beta tubulin and

PR protein respectively.

Conclusion: The present study reports five

major areo-allergens from Helianthus pol-

len for the first time. Further studies of

these allergens will improve the component

resolved diagnosis.

1175

Mosquito allergy in the tropics:

involvement of tropomyosin and cross-

reactivity with other arthropods

Cantillo, J1,2; Lafosse-Marin, S3; Fern�andez-Caldas, E2;

Puerta, L4

1Complutense University of Madrid, Madrid, Spain;2Inmunotek S.L., Alcala de Henares, Spain; 3Cabinet de

Allergologie, Fort de France, Martinique, France;4Institute for Immunological Research, Cartagena de

Indias, Colombia

Background: Allergic reactions to mos-

quito may be induced by mosquito bites,

or inhalation of mosquito allergens. Sensi-

tisation to other arthropods seems to be a

predisposing factor for the onset of cutane-

ous and allergic respiratory responses to

mosquitoes. Cross-reactivity among mos-

quitoes and other arthropods has been sug-

gested. However the main responsible

allergens have not been identified. We

analysed the prevalence of sensitisation to

Aedes aegypti in a group of allergic indi-

viduals from Martinique, and evaluate

cross-reactivity with mites, cockroaches

and shrimps.

Methods: A. aegytpi whole body was used

to prepare an extract and to purify native

tropomyosin. Biologic characterisation of

tropomyosin was done by mass spectrome-

try, western blot and ELISA. Specific-IgE

to the extract was measured by ELISA

using sera from 115 allergic individuals

from Martinique with positive skin prick

tests to mites, or shrimp. Cross-reactivity

between A. aegypti and Dermatophagoides

pteronyssinus, Blomia tropicalis and Peri-

planeta americana was evaluated by ELISA

inhibition. Cross-reactivity of A. aegypti

tropomyosin was evaluated by immuno-

blotting and ELISA inhibitions using

tropomyosin derived from Penaeus mon-

odon (nPen m 1) and from Litopenaeus

vannamei (rLit v 1).

Results: Fourty percent of allergic individ-

uals from Martinique had specific IgE

against A. aegytpi. D. pteronyssinus pro-

duced >50% Inhibition when A. aegypti

was used in the solid phase. Adsoprtion

with the other extracts produced no

inhibition. Two tropomyosin isoallergens

(Uniprot code: Q17H75 and Q17H80) of

32 kDa were purified and reacted with

33% of the mosquito positive sera. nPen m

1 and rLit v 1 produced >90% inhibition

when mosquito tropomyosin IgE was used

in the solid phase.

Conclusion: There is a high frequency of

sensitisation to A. aegytpi in mite and

shrimp allergic individuals. A. aegypti con-

tains species specific as well as cross-reac-

tive allergens, such as tropomyosin,

involved in IgE sensitisation.

1176

The study of individuals sensitive to

Artemisia allergens: situation analysis in

Lithuania

Sauliene, I1; Greiciuviene, J1,2; Kainov, D1; Sukiene, L1

1Department of Environmental Reserach, Siauliai

University, Siauliai, Lithuania; 2Public Institution

Republican Siauliai Hospital, Siauliai, Lithuania

Background: Seventeen different Artemisia

family plant species grow and are being

cultivated in Lithuania: Its pollen is the

main cause for allergic reactions in late

summer and autumn. We evaluated the

amount of Artemisia airborne pollen and

to investigate the quality of life of patients

sensitive to Artemisia allergens.

Method: Airborne pollen was collected by

using Hirst spore traps in Siauliai (Lithua-

nia). 2004–2013 data was used for the

analysis. 42 people participated research in

2013 have never done this allergy test

before and constantly live in the aerobio-

logically defined environment. Skin prick

tests were performed with different aller-

gens. Questions about symptoms and life

quality were included in questionnaire,

which was used only to question the

patients with positive skin prick test.

Results: Average Artemisia pollen season

in Lithuania lasts from 20th July to 30th

August, seasonal pollen index being 1517

pollen grains/m3. In 2013 the main pollen

season was earlier in comparison with

long-range pollen data. After skin prick

test all individuals had positive reaction to

pollen allergens. 76% of pollen-allergic

participants (average age 34 years) had

positive reaction to Artemisia allergens and

all of them felt hay fever symptoms, as

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453432

much as 87% of tested had bronchitis,

while 28% asthma symptoms. 44% period-

ically suffer from short breath. In the ques-

tionnaire, Artemisia pollen sensitive people

have pointed out that when felling the

symptoms, most of them limit day-to-day

activities (91%) and have sleeping disorder

(78%). It was established that their quality

of life falls dramatically during Artemisia

pollen season (July–September).

Conclusion: A high prevalence of sensiti-

sation to Artemisia was found. Future

studies with larger number of individuals

are needed to evaluate the relation of sensi-

tisation with clinical symptoms and pollen

abundance.

This research was funded by a grant

(No. VP1-3.1-SMM-07-K-03-069) from the

Research Council of Lithuania.

1177

Ile-de-France: assessment of the

representativeness of the pollen traps

installed in the region

Thibaudon, M1; Sindt, C1; Bex, V2; Barral, S2

1RNSA, Brussieu, France; 2Laboratoire d’Hygi�ene de la

Ville de Paris, Paris, France

Background: In Ile-de-France region, the

biological particles monitoring of the air

(pollens and moulds) and their impact on

the health is carried out, in the remit of

the RNSA, only from one pollen trap

located in the 15th district on the roof of

the Pasteur Institute in Paris center. A

study from 2003 to 2007 confirmed that

this pollen trap allows a sufficient coverage

for Paris and a part of the closest areas.

The aim of the study is to check if the

information from Paris pollen trap allows

to cover all the Ile-de-France region, by

comparison with the results obtained from

three other pollen traps set up in the same

region: in the North in Gonesse, in the

South–East in Melun and in the South–West in Saint-Quentin-en-Yvelines.

Method: The monitoring of the pollen air

content was carried out on the four sites

during 26 to 33 weeks in 2012 and 34 to

39 weeks in 2013 (according the stations),

from samples obtained with Hirst-type

traps at a 10 l/min suction.

Results: The daily total pollen counts of

the four traps are closed for the 2 years of

study. Nevertheless, the comparison of the

daily all taxa concentrations for each of

the three stations around Paris with the

results of Paris pollen trap (Wilcoxon on

matched pairs test) shows that there is, for

the 2 years, a significant difference between

Paris and Saint-Quentin-en-Yvelines in one

hand (P = 4.7.10�6 in 2012 and

P = 4.7.10�4 in 2013) and in the other

hand between Melun and Paris

(P = 2.5.10�5 in 2012 and P = 3.0.10�3 in

2013). The main taxa in terms of quantity

are a little bit different from one pollen

trap to the other: Urticaceae, Cupressaceae

and Betula in Paris; Betula in Gonesse; Ur-

ticaceae, Quercus and Poaceae in Melun;

Urticaceae and Betula in Saint-Quentin-en-

Yvelines (for 2013 season).

Conclusion: The comparison of the results

obtained for the main taxa on 2012 and

2013 pollen seasons shows that, even if the

profile of daily concentrations are generally

close, there are significant differences

between the historical pollen trap in Paris

and the three other ones set up in Ile-de-

France. Moreover, significant differences

were observed between the seasons.

1178

Effects of airborne pollen levels on drug

consumption for seasonal allergic

rhinoconjunctivitis: a ten-year French

study

Caillaud, DM1; Martin, S2; Segala, C2; Vidal, P3; Lecadet,

J3; Rouzaire, P4; Tridon, A4; Dupuy, N5; Thibaudon, M5;

Evrard, B4

1Pulm Dpt, University Hospitals, Clermont-Ferrand,

France; 2Statistic Institute, Baud, France; 3Service

M�edical Auvergne, Clermont-Ferrand, France;4Immunology Dpt, University Hospitals, Clermont-

Ferrand, France; 5French Network of Aerobiological

Monitoring, Brussieu, France

Background: The aim of this study was to

analyze the short-term relationship between

pollen exposure and allergic rhinitis and

conjunctivitis (ARC) using drug deliveries

for 10 years in the urban area of Cler-

mont-Ferrand, France (260.000 inhabit-

ants).

Method: An ARC case was defined as the

association of an oral antihistamine and a

local antiallergic drug on the same pre-

scription. The relationship between changes

in pollen concentrations and daily changes

in the number of treated ARC cases were

analyzed using generalised additive models,

taking into account confounding factors

such as air pollution, meteorological data

and days of the week.

Results: Between 2003 and 2012, the total

yearly number and the median number per

day of treated ARC rose from 7.626 to

11.315 and from 26 to 42. Relative risk of

treated ARC [RR (95IC)] associated with

an interquartile increase in pollen concen-

tration increased significantly for Fraxinus

1.019 [1.004–1.003], Birch 1.030 [1.005–1.055], Hornbeam 1.039 [1.008–1.070],Platanus 1.044 [1.004–1.086], Poaceae 1.04

[1.038–1.050] and Urticaceae 1.022 [1.002–1.042]. The risk decreased significantly with

age for Poaceae.

Conclusion: The prevalence of ARC rose

around 50% in 10 years. While confirming

the significant increase in treated ARC

related to Fraxinus, Betula and Poaceae

pollens, this study shows new association

between treated ARC and Hornbeam, Plat-

anus, and Urticaceae pollens.

1179

Bi-hourly distribution and characteristics

of major airborne allergenic pollen in

Lithuania

Sukiene, L; Sauliene, I1Department of Environmental Reserach, Siauliai

University, Siauliai, Lithuania

Background: The distribution of airborne

allergenic pollen amount during the day is

very important for allergic people planning

their daily activities. In countries with per-

formed aerobiological studies are showed

that part of plants have regular pollen emis-

sion, while the release of majority pollen is

highly dependent on the local conditions.

Method: Airborne pollen was collected by

using Hirst spore traps in three cities of

Lithuania: Klaipeda, Siauliai and Vilnius.

The study was performed with the major

airborne allergenic pollen types in Lithua-

nia: Alnus, Corylus, Betula, Poaceae, Arte-

misia. For the research the pollen data

covering the period of 2005–2013 were used.

Main pollen season and seasonal pollen

index (SPI) was calculated with the 95%

range. For bi-hourly pollen distribution the

day was divided into 4 parts: morning

(04:00–10:00), daytime (10:00–16:00), even-ing (16:00–22:00), night (22:00–04:00).Results: In Lithuania the largest daily pol-

len concentrations were recorded during

the flowering of birch (11041 pollen grains/

m3), but varies from year to year. SPI were

ranged from 1122 to 46477 pollen grains/

m3. Corylus was distinguished with the

lowest SPI (varies between 39 and 839 pol-

len grains/m3) from the present pollen

types. Results of bi-hourly distribution are

determined by the important aspects:

1 Characteristics of marine (Klaipeda)

and continental (Vilnius) climate,

2 Weather conditions determining vegeta-

tion season in analysed years,

3 Long range transport, leading to atypi-

cal pollen amounts in the air (recorded

the largest amounts of non-local Betula

pollen).

Conclusion: We found that Betula pollen

season has never started earlier in Klaipeda

than in other locations. Visible pollen day

cycle is distinguished in Artemisia case

(38% recorded during the daytime in Klai-

peda, 47% - Siauliai and 43% - Vilnius).

This research was funded by a grant

(No. VP1-3.1-SMM-07-K-03-069) from the

Research Council of Lithuania.

Poster Session Group II – Red. TPS 49 – Pollen

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 433

1180

Relationship between cross-reactive

Fagales tree pollens and asthma

exacerbations

Krmpotic, D1; Luzar-Stiffler, V2; Hrga, I3; Zaninovic, K4

1Dept. for Asthma and Allergies, University Hospital

Centre Zagreb University of Zagreb, Zagreb, Croatia;2CAIR Research Center, University Computing Center

University of Zagreb, Zagreb, Croatia; 3Aerobiology

Laboratory, Institute of Public Health, Zagreb, Croatia;4Dept. for Climatological Research and Applied

Climatology, Meteorological and Hydrological Service,

Zagreb, Croatia

Background: Asthma exacerbations may

be triggered by airborne pollens but the

role of cross-reactive pollens is not com-

pletely elucidated. The aim of this study

was to investigate the relationship between

the cross-reactive tree pollens of the Fa-

gales order and asthma exacerbations

requiring hospital admissions.

Method: Daily Fagales tree pollen count

and emergency asthma admissions for

adults were recorded for 3 years in Zagreb,

Croatia. Their trend over the course of

time was investigated by using time-series

analysis. The associations between the tree

pollens and asthma admissions were ana-

lyzed by Pearson’s correlation coefficients.

Results: The distribution of tree pollens

showed a typical spring pollination pattern

with annual alterations. Adler and hazelnut

pollinated in February and March, birch in

March and April, hornbeam in April and

May, and oak in May and June. Birch was

highly correlated with hornbeam. No

cross-correlations between tree pollens and

weather variables were found. The correla-

tions of asthma admissions with birch

(r = 0.12) and hornbeam (r = 0.22) were

low but statistically significant (P < 0.001).

Conclusion: The Fagales trees pollinated

one after another thereby prolonging aller-

gen pollen exposure. The cross-reactive Fa-

gales tree pollens tended to exacerbate

asthma at the end of their pollination sea-

son indicating a priming phenomenon.

1181

Sensitisation to Ambrosia pollen and

other airborne allergens in the

population of the Western region of

Romania

Panaitescu, C1; Ianovici, N2; Marusciac, L1; Cernescu,

LD1; Tamas, PT1; Lazarovicz, R-A1

1Functional Sciences, University of Medicine and

Pharmacy Victor Babes Timisoara, Timisoara, Romania;2West University Timisoara, Timisoara, Romania

Introduction: The aim of this study was to

determine the impact of sensitisation to

Ambrosia pollen in patients from the Wes-

tern region of Romania in 2013, as well as

the sensitisation patterns to other inhaled

allergens in 2011 and 2012.

Methods: The subject group consisted of

patients who were allergologically evalu-

ated for hypersensitivity to inhaled aller-

gens in Timisoara, between 2009 and 2013.

Patient evaluation consisted of skin prick

test to a panel of 18 standard airborne

allergens (tree pollens, cereal pollens, grass

pollens, Artemisia pollen, Ambrosia pollen,

Dermatophagoides farinae, Dermato-

phagoides pteronyssinus, molds). For 2009

the air pollen concentration was correlated

with the clinical data.

Results: In 2012, only 41.97% (n = 437) of

the evaluated patients were found to be

sensitised to inhaled allergens, less than in

2011 (50.39%, n = 697). In 2012, 94

(52.51%) of all allergic patients were

monosensitised to outdoor allergens, 79

(44.14%) to indoor allergens, the remain-

der being polysensitised. In 2011, of all

allergic patients, 219 (31.42%) were hyper-

sensitive to outdoor allergens and 160

(22.95%) to indoor allergens, the remain-

der being polysensitised. Of the monosensi-

tised patients evaluated in 2011 and 2012,

90 (12.91%) and 61 (34.07%), respectively,

were monosensitised to Ambrosia pollen,

32 (4.59%) and 20 (3.80%), respectively to

poaceae pollen, 102 (14.63%) and 54

(30.16%), respectively, to house dust mites,

and 58 (8.32%) and 25 (13.96%) to mold

species. In 2013 there were 84 patients sen-

sitised to Ambrosia pollen, 64% of which

being polysensitised. Allergic rhinoconjunc-

tivitis affects mostly young, otherwise

healthy patients, the average age at presen-

tation being 32 years old, the vast majority

of patients (93%) exhibiting moderate-

severe symptoms. Ambrosia pollen is the

most abundant in the atmosphere, with a

concentration peak of 292 particles/cubic

m in August 2009. The peak of patients

allergic to Ambrosia pollen was 2 weeks

after the peak Ambrosia pollen concentra-

tion in the atmosphere.

Conclusion: The number and percentage of

patients allergic to inhaled allergens that

present in allergology departments in Ti-

misoara are somewhat decreasing in com-

parison with previous years. Ambrosia

pollen is the most allergenic pollen in the

Banat area, causing at least moderate aller-

gic reactions in a great number of allergic

patients, which are usually polysensitised.

1182

Threshold levels for symptom induction

due to tree and grass pollens in the

Vinnitsa region of central Ukraine

Rodinkova, VV1; Stremedlovsky, BA2; Gelman, EG3;

Motruk II1; Kremenska, LV1; Slobodianiuk, LV1;

Palamarchuk, OO4; DuBuske, LM5,6

1Vinnitsa National Pirogov Memorial Medical

University, Vinnitsa, Ukraine; 2Vinnitsa Regional Clinical

Hospital for Children, Vinnitsa, Ukraine; 3Medical

Department No 1, Vinnitsa National Pirogov Memorial

Medical University, Vinnitsa, Ukraine; 4Vinnitsa

National Medical University, Vinnitsa, Ukraine;5Immunology Research Institute of New England,

Gardner, United States; 6The George Washington

University School of Medicine, Washington, United

States

Background: Correspondence between

pollen counts and severity of seasonal

allergy symptoms allows relevance of

pollen forecasting. This study evaluates the

threshold pollen concentrations for symp-

tom induction for tree and grass pollen in

the Vinnitsa region of Ukraine

Methods: Pollen collection in 2010 used

volumetric methods employing a Burkard

trap placed at a height of 25 meters above

the ground on the roof of a Vinnitsa

National Medical University building.

There were 36 weekly samples taken from

March 1 until October 31. Seasonal allergic

patients’ symptoms assessed at university

allergy clinics including ocular, nasal and

lung symptoms in 2010 were correlated with

the timing of pollen counts in 37 patients

with tree pollen allergy and 12 patients with

a grass allergy. Most tree pollen allergy was

due to alder, birch, hornbeam and oak.

Results: Correlation between timing of

symptoms and pollen count fluctuations

showed allergy symptoms to Alnus, Quer-

cus, Carpinus pollen began at 22–30 pollen

grains grains/m3 and for Corylus pollen at

15–20 pollen grains/m3. Threshold concen-

tration for Betula pollen was difficult to

determine as counts exploded from few

grains to huge number rapidly. Symptoms

to oak pollen were observed transiently at

moderate and high concentrations in early

May. Grass pollen induced symptoms over

a longer period from May to July, the time

of pollination of Poaceae in Vinnitsa. Con-

centrations of grass pollen varied from sin-

gle to dozens of pollen grains within the

pollination season with symptoms begin-

ning at 13–15 pollen grains/m3.

Conclusions: The thresholds for tree pollen

allergy symptom induction are greater than

the threshold for grass pollen allergy symp-

toms in the central Ukrainian city of

Vinnitsa. Corylus threshold for symptom

induction was lower than for Alnus,

Quercus and Carpinus pollen. Knowledge

of the thresholds for symptom induction

by various pollens can greatly assist pollen

forecasting related to the likelihood of

allergic disease manifestations.

Poster Session Group II – Red. TPS 49 – Pollen

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453434

1183

Assessing Timothy grass pollen

sensitivity in South Texas utilising the

Biogenics Research Chamber

Jacobs, RL; Ramirez, DA; Rather, C; Andrews, CP

Biogenics Research Chamber, San Antonio, United

States

Background: Allergen challenge chambers

(ACC) are effective facilities to determine

reactivity to a specific aeroallergen irre-

spective of natural exposure.

Method: Twenty-six grass sensitive partici-

pants from South Texas, without ongoing

exposure to Timothy grass pollen (TGP),

underwent skin testing to a battery of grass

pollen extracts. Serum was collected for

measurement of specific IgE. Twenty-two

participants qualified for exposure; 13 had

always lived in South Texas without expo-

sure to TGP. Nasal and ocular symptom

scores were recorded at base line and every

30 min during 2 ACC exposures of 3 h

duration.

Results: Twenty-two participants, 12

males, 9 Hispanics, average age 40.1/year.

(21–69) completed the study. All tested

positive to both Timothy and Bermuda

pollen extracts. Twelve and 13 of 22 had

positive sIgE to Timothy and Bermuda,

respectively, with 11 having both positive.

Pollen counts were maintained in the ACC

at 4000 grains/m3 (�500) All participants

responded with a change from baseline

symptoms. There was a strong correlation

between sIgE, size of skin test, and higher

symptoms. There was little difference in

the severity of symptoms between those

who had lived their entire life in South

Texas and those who had lived elsewhere.

Conclusion: Participants in South Texas,

without previous or ongoing natural expo-

sure, react to TGP. Strongly positive skin

tests and sIgE are significant predictors of

high symptoms upon chamber exposure to

TGP. Utilising a chamber, South Texas

participants can be identified for TGP

studies.

1184

High Betula pollen counts occur during

even years in Ukraine

Rodinkova, V1; Slobodianiuk, L1; Motruk, I1; Mazur, O1;

Kremenska, L1; DuBuske, LM2,3; Gelman, EG4

1National Pirogov Memorial Medical University,

Vinnitsa, Ukraine; 2Immunology Research Institute of

New England, Gardner, United States; 3The George

Washington University School of Medicine,

Washington, United States; 4Medical Department No 1,

Vinnitsa National Pirogov Memorial Medical University,

Vinnitsa, Ukraine

Background: Betula is an important source

tree pollen in Northern and Central Eur-

ope. Birch allergy sufferers need to know

the seasonal onset, peak and end. Data

about biological rhythms of birch pollina-

tion is helpful for allergy symptom control.

Method: Pollen counts from 1999 to 2000

were obtained by gravimetric sampling.

Pollen collection from 2009 to 2013 used

volumetric methods employing a Burkard

trap placed at a height of 25 meters above

the ground on the roof of a Vinnitsa Medi-

cal University building. Samples were

taken from March 1 until October 31.

Results: The birch season was much more

severe in 2000 vs 1999 with 25.13- fold

more Betula pollen collected in 2000. Volu-

metric methods showed increased amounts

of pollen for every even year as well, with

2009, 2011 and 2013 characterised by low

pollination activity for birch. Birch pollen

collected in 2010 19.17- fold exceeded the

quantity of pollen for 2009. There was

7.32- fold more pollen collected in 2012 vs

2011 with less pollen collected in 2013. Pol-

len peaks recorded for the even years

included 1450 and 1681 pollen grains per

cubic meter for 2010 and 2012 correspond-

ingly. Interestingly, Betula seasonal maxi-

mum for the years 2009 through 2012 were

recorded on the same day, April 21. Peak

pollen of 386 pollen grains per cubic meter

in 2013 was noted 3 days earlier on April

18 due to unusually warm weather. Betula

peaks for 1999 and 2000 were both seen in

the second 10-day period of April.

Conclusion: Increased abundance of Betula

pollination is characterised by 2-year cycles

in the Vinnitsa region of Ukraine, which

corresponds with data from other European

authors. High Betula pollination activity

occurs during even years in Vinnitsa. These

findings may help allergy sufferers to pre-

dict years and weeks of maximal birch pol-

len exposure enhancing effective seasonal

allergy control in Vinnitsa, Ukraine.

1186

Which is currently the most important

month for pollinosis in Madrid?

Subiza, J1; Fernandez-Caldas, E2; Barjau, C1; Rodriguez,

V1; Gonzalez, P1; Kilimajer, J1

1Clinica Subiza, Madrid, Spain; 2Research and

Development, Inmunotek SL, Alcala de Henares, Spain

Background: Traditionally, May and June

are considered the most important months

for pollinosis in Madrid. However, climatic

changes and changes in vegetation

(increased planting of Cypress and Syca-

more trees), pollution (an increase in diesel

vehicles) and in the incidence of atopy, lead

us to question whether this is still true.

Method: Six hundred and forty-six patients

from an outpatient clinic, diagnosed with

pollinosis, and resident in Madrid, were

selected at random. Their pollinosis symp-

toms were monitored during four consecu-

tive years (from 1st January 2009 to 31st

December 2012), using an electronic diary

card to record daily symptoms, which we

developed to be used in their computers

and/or mobile devices connected to our

clinic monitoring system (Allercon).

Results: The study was completed by 96

patients and the rest were excluded due to

poor compliance and/or a change of resi-

dence away from the urban environment of

Madrid. The symptomatology can be seen

in the following table, and is expressed as

the mean of the percentage of monthly

reactivations of rhinoconjunctivitis. Symp-

toms were reported all year round, from

January to December. Although May con-

tinues to be the most important month,

globally speaking, March is higher than

June and February is higher than April.

Conclusion: These data indicate the grow-

ing importance of pollinosis during the

winter months and at the beginning of

Spring. These findings may have implica-

tions in the clinical diagnosis of allergic

patients and in the composition of immu-

notherapy treatments.

1187

Quercus pollen sensitisation; what is

happening in Madrid?

Kilimajer, J1; Fern�andez-Caldas, E2; Subiza, J1

1Allergy, Subiza Asthma and Allergy Centre, Madrid,

Spain; 2Immunotek SL, Madrid, Spain

Background: It is well known that in

Madrid, Spain, one of the highest levels of

airborne pollen are from the Quercus spe-

cies, especially Quercus rotundifolia, abun-

dant in May and June. Although its

airborne pollen is produced in considerable

quantities, it is not found to cause impor-

tant sensitisations or allergies (JACI 1995

96:15–23). However, both changes in the

quality of pollution in this city due to an

increase in diesel vehicles (from 10% in

1985 to 70% in 2013) and the expansion of

motorways around Madrid cutting through

areas where Quercus trees are abundant,

make us think that these factors could

affect the prevalence of sensitisation to

Quercus airborne pollen in our city.

Method: A 7 year pollen count (2007–2013) was performed in our clinic, in

Madrid, to determine the concentrations of

important airborne allergenic pollens (Cu-

pressaceae, Olea, Platanus, and grasses)

compared to Quercus. Pollen counts were

made with a Burkard 7-day spore trap.

The results were compared to the results of

skin prick tests using common inhalants

(Inmunotek Lab) carried out on 23 193

patients that came to our clinic with sus-

pected sensitisation to aeroallergens.

Poster Session Group II – Red. TPS 49 – Pollen

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 435

Results: The second highest airborne pres-

ence was for Quercus rotundifolia. The con-

centrations of this pollen during these

7 years didn0t vary significantly. The preva-

lence of positive prick test results had not

changed for the most important allergenic

pollens during these years. To the contrary

however, the number of patients sensitised

to Quercus rotundifolia increased signifi-

cantly. In 2007 (9%), 2008 (9%), 2009

(12%), 2010 (12%) 2011 (16%) 2012 and

18% in 2013.

Conclusion: We observed an important

increase in sensitisation to Quercus pollen

within pollinosis patients in Madrid during

this 7 year period, although the concentra-

tions of this airborne pollen during the

same time did not vary significantly.

1188

The Parietaria judaica Par j 1 allergen is a

LPS binding protein with

immuno-modulatory activity

Bonura, A1; Corinti, S2; Schiavi, E2; Giacomazza, D3;

Gianguzza, F4; Di Felice, G2; Colombo, P1

1Istituto di Biomedicina e di Immunologia Molecolare

del Consiglio Nazionale delle Ricerche, Palermo, Italy;2Istituto Superiore di Sanit�a, Roma, Italy; 3Istituto di

Biofisica del Consiglio Nazionale delle Ricerche, UOS

Palermo, Palermo, Italy; 4Dipartimento di Scienze e

Tecnologie Molecolari e Biomolecolari, Universit�a degli

Studi di Palermo, Palermo, Italy

Background: The Parietaria pollen con-

tains two major allergens belonging to the

family of the Lipid Transfer Proteins (Par j

1 and Par j 2). In particular, the family of

the Par j 1 allergens is composed of two

isoforms differing for the presence of a

COOH terminal region of 37 amino acid

(Par37). The main objective of this paper

was the analysis of the biological proper-

ties of the Par37 peptide.

Methods: In silico analysis, spectrofluori-

metric experiments and in vitro cell culture

assays were used to study the biological

properties of Par37. In addition, a mouse

model of sensitisation was used to study

the relevance of Par37 peptide in vivo.

Results: In silico analysis suggested that

Par37 displays biochemical features of a

host defence peptide. The biological activ-

ity of this region was studied using a syn-

thetic peptide. No direct antimicrobial

peptide activity per se was detected. Spec-

trofluorimetric analysis, Real Time PCR

and ELISA assays demonstrated that

Par37 peptide possesses a LPS-binding

activity. In addition, we observed that in

the RAW264.7 cell line, LPS-induced IL-6

and TNF-a transcription and translation

were inhibited after preincubation of LPS

with Par37. Consistent with these data,

inhibition of IFN-g secretion was observed

in spleen cells from na€ıve mice and in

human PBMC. Finally, mice immunised

with the two Par j 1 isoforms differing in

the presence or absence of the Par37 pep-

tide showed different immunological

behaviours in vivo.

Conclusions: This paper demonstrates that

the Par j 1.0101 allergen is a LPS binding

protein and that the Par37 region is also

capable of influencing cytokine and anti-

body responses in vitro and in vivo.

1189

Environmental changes could enhance

the biological effect of Hop J pollens on

human airway epithelial cells

Lee, SI1; Pham, DL1; Jin, HJ2; Shin, YS1; Suh, DH1;

Park, HS1

1Department of Allergy and Clinical Immunology, Ajou

University School of Medicine, Suwon, Korea;2Department of Internal Medicine, Yeungnam

University College of Medicine Daegu, Korea

Background: Hop J pollen is a major aller-

genic pollen in East Asia and its sensitisat-

ion has increased with environmental

changes in Korea. We investigated the bio-

logical effects of Hop J pollens on airway

epithelial cells (AECs) due to environmen-

tal changes.

Methods: We collected Hop J pollens in

1998 and 2009 in Suwon, Gyeonggi prov-

ince, South Korea and prepared two pollen

extracts (the 98 and 09 extracts). Human

AECs (Calu-3) were treated with the 98

and 09 extracts using an air interfaced cul-

ture method to analyze transepithelial per-

meability. The degradation of occludin (a

tight junction protein) and the expressions

of protease-activated receptor 2 (PAR2) as

well as thymic stromal lymphopoietin

(TSLP) were investigated using Western

blots and immunocytochemistry. Reactive

oxygen species (ROS) production induced

by Hop J pollen extracts and the effects of

N-acetylcystein (ROS-scavenger) were eval-

uated.

Results: Compared to the 98 extracts, the

09 extracts induced greater transepithelial

permeability and occludin degradation as

well as up-regulated expressions of PAR2

and TSLP in Calu-3 cells. Treating with

N-acetylcystein attenuated Hop J pollen-

induced occludin degradation and the

up-regulated expression of PAR2 as well as

TSLP in Calu-3 cells.

Conclusion: Environmental changes could

augment the biological effects of Hop J

pollen to enhance airway inflammation

through the degradation of occludin (a

tight junction protein) and the up-regu-

lated expressions of PAR2 as well as TSLP

via ROS production.

Poster Session Group II – Red. TPS 49 – Pollen

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453436

Poster Session Group II – Red

TPS 50 – Asthma and allergy: how to improve treatment and

patient education

1190

Pulmonary hemosiderosis secondary to

cow’s milk allergy (Heirner’s syndrome).

A case report

Lagos, M1,2; Quilodran, C3; Lezana, V1; R�ıos, G1,4

1Escuela de Medicina, Universidad de Valpara�ıso,

Valpara�ıso, Chile; 2Inmunolog�ıa, Hospital Gustavo

Fricke, Vi~na del Mar, Chile; 3Neumolog�ıa Pedi�atrica,

Hospital Gustavo Fricke, Vi~na del Mar, Chile; 4UCI

Pediatrica, Hospital Gustavo Fricke, Vi~na del Mar, Chile

Background: Pulmonary Hemosiderosis

(PH) is a rare cause of diffuse alveolar

hemorrhage in children. According to its

etiology is classified into primary (idio-

pathic) or secondary to a specific cause. A

particular type of PH associated to cow0smilk allergy (CMA) has been described for

the first time by Heiner, and only a few

reports have been published.

Method: Review of clinical record. Here

we describe a patient with Heiner’syn-

drome (HS) of severe course, that radically

improves with cow’s milk protein (CMP)

diet.

Results: One-year-old boy with a declining

growth rate and severe iron-deficiency ane-

mia, unresponsive to iron treatment, that

since the introduction of milk formula

refers bloating, reflux and projectile vomit-

ing. He presents with a history of non pro-

ductive cough and progressive dysnea.

Examination revealed diminished oxygen

saturation and chest RX with pulmonary

infiltrates, and was admitted with oxygen

therapy, inhaled B2 agonist, red blood cell

transfusion and antibiotic treatment. After

few days evolves with increasing oxygen

requirements, severe respiratory distress

and imaging appearance of bilateral alveo-

lar patchy infiltrates. He was admitted to

ICU, requiring mechanic ventilation. Due

to poor response to antibiotics and endove-

nous corticosteroids, high frequency

mechanic ventilation was needed. Lung

biopsy revealed numerous hemosiderin-

laden macrophages. CMP elimination

resulted in remarkable improvement, lead-

ing to ventilation weaning within days and

clearing of the pulmonary infiltrate within

weeks. High titters of precipitating anti-

bodies to CM proteins were demonstrated,

confirming the diagnosis, with no specific

IgE.

Conclusion: HS should be suspected in

young children with pulmonary hemoside-

rosis of obscure cause. The diagnosis is

supported with a positive milk precipitin

test and improvement on a trial of milk

elimination. Early diagnosis improves

prognosis and avoid long-term complica-

tions such as pulmonary fibrosis.

1191

Effect of Wogonin on allergic

inflammation in allergic mouse model

Kim, ST1; Jung, JH1; Gang, IG1; Lee, HJ2

1Gil Medical Center, Otolaryngology, Gachon

University, Incheon, Korea; 2Lee Gil Ya Cancer and

Diabetes Institute, School of Medicine, Gachon

University, Molecular Medicine, Incheon, Korea

Background: Flavonoids from plant origin

show anti-inflammatory activity, which

have been found to regulate the expression

of inflammation-associated proteins.

Among the several flavonoids, wogonin

(5,7-dihydroxy-8-methoxyflavone) was

known as the most potent derivative. How-

ever their effect on asthma and allergic rhi-

nitis has not been studied. The purpose of

this study was to examine the effect of

wogonin on the allergic inflammation of

nasal cavity and lung in allergic mouse

model.

Materials and methods: Forty BALB/c

female mice were divided into four experi-

mental groups according to the treatment

agents and allergic states (allergic rhinitis

and asthma each): Saline (G1), ovalbumin

(OVA) (G2), OVA+Wogonin (G3) and

OVA+dexamethasone (G4). After last stim-

uli, the mouse OVA specific IgE and IL-4

and IL-5 were measured in serum. IL-4,

IL-5, IL-10 were measured in nasal lavage

fluid (NALF) and bronchoalveolar lavage

fluid (BALF) by ELISA. Eotaxin and Ran-

tes were also measured in BALF. H&E

staining, PAS staining and immunohisto-

chemical staining for IL-4, IL-5, MUC5AC

was done in the nasal mucosa and lung.

Results: In allergic rhinitis model, the

serum IgE level was significantly decreased

in G3 and G4 compared to G2 (P < 0.01).

In the NALF, IL-4, IL-5 and IL-10 level

did not significantly decrease in G3 com-

pared to G2. In immunohistochemical

staining, the positive cells for IL-4, IL-5

and MUC5AC have decreased in G3 and

G4 compared to G2. In asthma model, IgE

was significantly decreased in G3 compared

to G2. However, the IL-10, IL-4, RAN-

TES and eotaxin in serum has showed var-

iable results.

Conclusion: The present study indicated

that wogonin has decreased the allergic

inflammatory reaction in allergic murine

model. However, we need to study repeat

experiment for confirm.

1192

Manual revision of automated lung

function grading results in an increase of

usable data

Krop, E1; Aalders, B2; Rosbach, J1; Jacobs, J1; Heederik,

D1

1Institute for Risk Assessment Sciences, Utrecht

University, Utrecht, the Netherlands; 2NKAL, Utrecht,

the Netherlands

Background: In large studies, lung function

measurements are often performed on loca-

tion, using partly automated devices. These

systems allow trained fieldworkers to simply

measure lung function. The systems per-

form automated quality controls on the

lung functions, allowing to only use techni-

cally correct lung functions in data analysis.

In this large study we performed a manual

control on the generated data by a specia-

lised lung function assistant to evaluate the

efficiency of the intergraded quality control.

Method: In total 4799 lung function mea-

surements were collected from the Euro-

pean HITEA study (n = 3625) and the

Dutch FRESH study (n = 1174). All mea-

surements were performed with the NDD

EasyOne, which uses an algorithm based

on between-manoeuvre acceptability crite-

ria from the ATS/ERS in an adapted grad-

ing system. A, B and C grades are

acceptable for data analysis while data

with grades D and F are rejected. All tests

were manually checked by a certified lung

function assistant using the same grading

system. All adjustments were recorded.

Results: The automatically generated

results showed 54% A grades while 22%

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 437

of the measurements had grades D or F.

Manually checking resulted in adjustments

in 1929 (40%) measurements. 447 (23%)

adjustments did not result in chances in

quality grade while 246 (13%) changes

resulted in a lower quality grade. 1237

(64%) changes resulted in a higher quality

grade. Changes from grades D or F to A,

B of C were recorded 615 (32%) times and

the reverse change 68 (4%) times.

Conclusion: Manual control of lung func-

tion data showed that an algorithm for

quality control in lung function measure-

ments makes debatable decisions in 40%

of the tests. Manual adjustment resulted in

rescuing 58% of the rejected measurements

for data analysis while 2% of the automat-

ically approved measurements were found

to be of too low quality for data analysis.

We advise to manually check automated

lung function grading before the data is

used in analyses.

1194

The effect of washing Futon (bedding) on

asthma control in children with house

dust mite allergy

Nambu, M1; Shirai, H2; Maeda, C3

1Pediatrics, Tenri Hospital, Tenri, Japan; 2Institute of

Tokyo Environmental Allergy, Tokyo, Japan; 3Research

and Development, Duskin Co., Ltd., Osaka, Japan

Background: House dust mites (HDMs)

are the most popular allergens in Japan

and beddings are suitable for HDMs to

grow. The Japanese usually use Futons as

beddings, which can be carried and

washed. By washing Futons, we can

decrease the levels of HDM allergens, and

if we can use hot water to wash Futons

and/or hot air to dry Futons, we may even

kill HDMs. Therefore, we studied the

effect of washing Futons on asthma con-

trols.

Method: We selected 10 asthma children

with HDM allergy. On March/April in

2013, their Futons were washed with warm

water and dried with hot air. We are fol-

lowing up their conditions of asthma, their

controller therapies and the levels of

HDMs in their futons. We are also collect-

ing the data of their treatments of Futons

(How frequently did they dry Futons out-

side? How frequently did they vacuum Fu-

tons? And so on.). We are comparing these

data with those of seven control children

with asthma whose Futons were not

washed.

Results: The first evaluation was done on

July/August in 2013. Out of 10 children,

the asthma controller treatment was

stepped down in six, and unchanged in

four. The levels of HDMs in their Futons

were decreased in five children, similar in

four, and increased in one. On the other

hand, in seven control children, the treat-

ment was stepped down in three,

unchanged in two, and stepped up in two.

The levels of HDMs in their Futons were

decreased in one child, and similar in six.

Conclusion: Washing Futons was somehow

effective. The second evaluation was made

in November/December, and the final one

will be in March/April in 2014. We are still

collecting the data in details.

1195

Forearm injection is less pain than upper

arm injection for subcutaneous specific

immunotherapy: a self-control study

Wang, H

Huazhong University of Science and Technology,

Wuhan, China

Background: WAO recommends the injec-

tion site of the specific immunotherapy

should be the outer side of the 1/3 far-end

of the upper arm and the dorsal part of

the 1/3 middle of the forearm, however, in

China, vaccines were commonly injected at

the margo inferior of the upper arm del-

toid. we sought to identify the differences

between the two subcutaneous injection

sites and provide nurses a clinical basis to

select the SIT injection sites which

accepted by patients readily.

Method: Ninety eight patients in the SIT

maintenance treatment period were ran-

domly divided into two groups. VAS was

used to evaluate the pain intention, and

local adverse reaction was recorded during

each injection.

Group A uses China’s commonly

injected site: the margo inferior of the

upper arm deltoid, and

Group B uses the commonly injected site

in the world: the outer side of the 1/3 far-

end of the upper arm.

After 30 weeks, Group A switched to

the injection side by WAO recommended

and Group B switched to the side by Chi-

nese nurse selected.

Results: Group A’s pain score changed

from 1.09 � 0.98 to 0.54 � 0.73 after

switching the injection site from the margo

inferior of the upper arm deltoid to the

outer side of the 1/3 far-end of the upper

arm, there were significant difference

(P < 0.05); Group B’s pain score changed

from 0.64 � 0.76 to 1.15 � 1.01 after

switching the injection site from the outer

side of the 1/3 far-end of the upper arm to

the margo inferior of the upper arm del-

toid (P < 0.05); There was significant dif-

ference between the two groups before and

after the switched injection site (P < 0.05).

The adverse reaction rate of the injection

site which select margo inferior of the

upper arm deltoid is 12.4%, while refer to

outer side of the 1/3 far-end of the upper

arm, the rate of adverse reaction is 11.9%,

there was no significant difference between

the 2 different injection site (P < 0.05).

Conclusion: The outer side of the 1/3 far-

end of the upper arm as the site of subcu-

taneous injection should be more readily

accepted by Chinese SIT patients.

1196

Severe mosquito allergy: a case report

Baysan, A; Yesillik, S; Demirel, F; Kartal, O; Gulec, M;

Musabak, U; Sener, O

Division of Immunology and Allergic Diseases, Gulhane

Military Medical Academy and Medical School, Ankara,

Turkey

Background: Reactions to mosquito bites

are characterised by local, large local and

systemic reactions. The reported anaphy-

lactic reactions due to mosquito bites are

extremely rare. We report a patient who

experienced anaphylactic reactions after

mosquito bites.

Case report: A 23-year-old male patient

was admitted to our clinic with the history

of systemic allergic reactions to mosquito

bites. While he had local reactions to mos-

quito bites before, he experienced pruritus

and urticaria on his arms about 24 h after

he was bitten from his neck in June 2013.

His complaints were resolved spontane-

ously after an hour. A few days later, he

was again bitten by mosquito and in

<5 min he had generalised pruritus,

urticaria, shortness of breath and loss of

consciousness. He was treated with antihis-

tamines and corticosteroids, his symptoms

resolved in 12 h. In August 2013, he was

again bitten while he was sleeping. He has

awakened with pruritus, urticaria, shortness

of breath and he lost his consciousness in

few minutes. His symptoms resolved com-

pletely with antihistamines and steroids in

24 h. Then he experienced generalised pru-

ritus and urticaria in every mosquito bite

despite prophylaxis with antihistamine and

steroid. There was nothing remarkable in

his past medical history and family history.

His physical examination, complete blood

count, routine blood chemistry, total IgE

were normal. Aedes communis mosquito-

specific IgE level was positive (0.13 kU/l).

Skin prick test was performed with Aedes

communis mosquito (Alyostal, Stallargenes,

France), on the volar surface of the fore-

arm. The result was read at 15 min and it

was negative, but nearly an hour later, urti-

carial plaques were occurred on the legs

and treated with antihistamines. The

patient was informed about the avoidance

measures and prescribed an adrenaline

autoinjector.

Poster Session Group II – Red. TPS 50 – Asthma and allergy: how to improve treatment and patient education

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453438

Conclusion: Although reported systemic

reactions to mosquito bites are very rare,

we should take into account the risk of

severe anaphylaxis due to mosquito bite.

Skin prick testing with mosquito may

cause systemic reactions.

1197

Neuropsychiatric disorders associated

with montelukast

Burgos Pimentel, ABP1; Montoro de Francisco, A1;

Tavakov, A2; Fonseca Avenda~no, J1; De Vicente

Jim�enez, T1; Chivato P�erez, T1; Mateos Galv�an, JM1

1Allergy, Hospital Central de la Defensa, G�omez Ulla,

Madrid, Spain; 2Clinical Farmacology, Hospital Central

de la Defensa, G�omez Ulla, Madrid, Spain

Background: Montelukast is a potent and

selective antagonist of the cysteinyl leuko-

triene (Cys-LT1) receptor. Indicated as an

adjunct treatment for the control of bron-

chial asthma; provides relief in allergic rhi-

nitis. Rash, diarrheal evacuations, and

neuropsychiatric disorders related to mont-

elukast use have been observed after its

commercialization, their incidence is low,

but is not specified in the summary of

product characteristics of this drug. These

side effects are clinically relevant and

might require psychiatric treatment or drug

withdrawal.

Method: We present 2 childs: a female,

9 years old, After 6 months using mont-

elukast presents nervousness, visual halluci-

nations (bugs), yielding gradually after

30 days of stopping the drug, and a male

3 years old, Starts montelukast 4 mg to

asthma control, after 3 days presents ner-

vousness, aggression, insomnia, nightmares,

hallucinations (speech alone), generalised

rash, diarrheal evacuations, after 15 days

therapy is discontinued and the picture

refers gradually in 1 week. Background of

loratadine and cetirizine nervousness. As

well a male, 49 years old who has trouble

sleeping and frequent nightmares, after a

week starting montelukast, the patient

removes the drug. Insomnia and nightmares

wear off gradually over the next 5 days. No

personal or family history of psychiatric dis-

orders any of the patients.

Results: In order to evaluate a possible

causal relationship between montelukast

and the neuropsychiatric disorders, and in

the second child generalised rash, diarrheal

evacuations and montelukast we used a

modified Karch-Lasagna algorithm. In all

cases, a causal relationship was qualified as

probable.

Conclusion: In literature, all cases of ner-

vousness, aggression, hallucinations and

abnormal dreams, have been observed in a

population-aged bellow 18.

A health professional should pay a

special attention to these side effects,

especially when it comes to a pediatric

population.

1198

The effects of levocetirizine (5 mg) and

hydroxyzine (50 mg) on cognitive and

psychomotor performance during

simulated diving

Kienhorst, EA1; van Ooij, P-J2; van Hulst, RA2;

Verster, JC1

1Division of Pharmacology, Utrecht University, Utrecht,

the Netherlands; 2Diving Medical Center, Royal Dutch

Navy, Den Helder, the Netherlands

Background: Research on the effects of

antihistamine drugs on cognitive function-

ing under hyperbaric conditions is limited.

However, these drugs are widely used by

divers. The purpose of this study was to

examine the effects of levocetirizine and

hydroxyzine on cognitive and psychomotor

performance during simulated diving.

Methods: Twenty-four healthy male divers

from the Royal Netherlands Navy partici-

pated in a double blind, crossover trial.

They received a single dose of levocetiri-

zine (5 mg), hydroxyzine (50 mg), or pla-

cebo. Six cognitive and psychomotor tests

measuring reaction time and number of

errors were conducted on mobile phones

and included arrow reaction time, number

pairs, arrow flankers, memory scanning,

paired associate learning, and serial sevens.

Measurements were conducted at baseline

(T1, before treatment administration, on

surface), during simulated diving at 4 Bar/

30 meters (T2, 60 min) and 2 Bar/10

meters (T3, 80 min), after returning to sur-

face (T4, 140 min), and after recovery (T5,

200 min, at surface).

Results: Levocetirizine did not significantly

impair cognitive and psychomotor perfor-

mance during simulated diving. After

recovery (T5), a significant increase in

reaction time on the memory scanning test

(P = 0.041) and serial sevens test

(P = 0.003) was found. No significant

effects were found for levocetirizine on num-

ber of errors. In contrast, hydroxyzine

significantly impaired performance in five

out of six tests (P < 0.05). Increased reac-

tion time and number of errors was most

pronounced at 2 bar and after the simulated

dive (T4-T5), reflecting Cmax of the drug

(2 h).

Conclusions: Hydroxyzine significantly

impaired cognitive and psychomotor func-

tioning during simulated diving and there-

after. Effects of levocetirizine were

inconsistent and seen only after recovery

from diving.

Funding: This study was funded by The

Royal Netherlands Navy, National Diving

Center (Delft), and Utrecht University.

1199

The factors affecting the proficiency in

the use of inhaler and the effect of

education on inhaler technique

Jo, E-J1; Lee, S-E2; Mok, J-H1; Kim, M-H1; Lee, K1; Kim,

K-U1; Lee, M-K1; Park, H-K1

1Department of Internal Medicine, Pusan National

University Hospital, Busan, Korea; 2Department of

Internal Medicine, Pusan National University Yangsan

Hospital, Yangsan, Korea

Background: The appropriate use of inha-

ler is important in treatment of asthma.

We assessed the proficiency in the use of

inhaler, and investigated the factors affect-

ing the inhaler technique.

Method: We evaluated the inhaler tech-

nique in outpatients with asthma using

inhalers for over 1 year, and analyzed the

relation between the technique and baseline

characteristics. The inhaler technique was

assessed from 6 criteria: for metered dose

inhaler (MDI), remove mouthpiece cover

and shake, breathe out gently, trigger at

the same time as breathing, breathe in

slowly and deeply until full, hold breath

for 10 s, and mouth rinsing if it contains

corticosteroid; for dry powder inhaler

(DPI), remove mouthpiece cover, prime

device, breathe out gently, breathe in

quickly and deeply until full, hold breath

for 10 s, and mouth rinsing if it contains

corticosteroid. The correct operation of

each item scored 1 point. Then, they were

taught how to use the inhaler. At the next

visit, the technique was assessed again, and

they were educated once more.

Results: A total of 119 patients

(61.98 � 11.97 years, female 56.3%) were

enrolled. All patients had learned how to

use the inhaler when they were prescribed

inhaler for the first time. The duration of

inhaler use was 4.82 � 4.18 years (1–20 years). They scored 3.25 � 1.72 in MDI

technique and 4.21 � 0.89 in DPI. Age

was correlated with MDI technique

(q = �0.389, P = 0.013), but not DPI. And

there was no relation between inhaler tech-

nique and gender, educational status, lung

function, and duration of inhaler use. After

the education on inhaler technique, the

score improved significantly (MDI,

5.23 � 1.56, P < 0.001; DPI, 5.54 � 0.80,

P < 0.001). After training twice, the tech-

nique was much improved. Furthermore,

MDI technique after education did not

show a correlation with age.

Conclusion: This study showed the inhaler

technique was poor despite long-term inha-

ler use and was not associated with dura-

tion of inhaler use. MDI technique was

correlated with age, but repetitive educa-

tion improved the technique of inhaler,

regardless of age.

Poster Session Group II – Red. TPS 50 – Asthma and allergy: how to improve treatment and patient education

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 439

1200

Regular and correct use of inhaler

devices and relation to asthma control

Capanoglu, M1; Dibek Misirlioglu, E1; Toyran, M1;

Civelek, E1; Kocabas, CN1

1Pediatric Allergy and Immunology, Ankara Pediatric &

Pediatrics Hematology Oncology Training Research

Hospital, Ankara, Turkey

Background: Regular and correct use of

inhaler devices are important in treatment

of asthma. In this study, our aim was to

adress the problems about correct or regu-

lar use of inhaler devices and to evaluate

the effects of these problems on control of

asthma.

Methods: Children who were followed

with a diagnosis of asthma in our clinic

were evaluated for the correct and regular

use of inhaler devices using a standard

questionnaire. Control levels of patients

were defined according to GINA criteria

and asthma control tests.

Results: For the study 171 patients and

their families were interviewed. The mean

age was 8.29 � 4.65 years (1–19) and

62.6% were male. The devices were used

correctly by 68.1% of patients using MDI

device and 34.6% of patients using dry

powder inhalers (DPI) (P < 0.001). The

most common improper step was ‘to keep

covering the mouth and nose for 10 sec

after inhalation’ for MDI devices (24.4%)

and ‘to empty the lungs before activating

the spray’ for DPI devices (51.9%). Fre-

quency of correct use was higher in

patients trained three times compared to

patients trained less (86.1 vs 37.4;

P < 0.001).

Asthma was controlled according to

GINA criteria in 52.5% of correct users

and 25% of incorrect users (P < 0.001).

Asthma control tests revealed controlled

asthma in 65.7% of correct and 47.2% of

incorrect users (P = 0.016).

In 22.8% of patients drugs were used

irregularly. The most frequent cause was

forgetting to take the drug (50%). Asthma

control according to GINA criteria was

more frequent among regular users (46.2%

vs 23.1%; P = 0.01).

Conclusion: Correct and regular use of

inhaler drugs for treatment of asthma is

important for disease control. Repetitive

training about correct use of devices may

help for better using practices.

1201

Improving self-efficacy of caregivers and

clinical outcomes of asthmatic children

by enhanced interactive asthma

education program

Yeh, K-W1; Chen, S-H2; Chen, L-C3; Huang, J-L4

1Pediatrics, Chang Gung Memorial Hospital, Kweshan,

Taiwan; 2Nursing, Chang Gung Memorial Hospital at

Keelung, Keelung, Taiwan; 3Chang Gung Memorial

Hospital, Taoyuan, Taiwan; 4Pediatrics, Chang Gung

Memorial Hospital, Taoyuan, Taiwan

Background: Continuing asthma education

is an integral part of asthma management.

Despite advances in medical treatment,

many children with asthma were not well

controlled. A well-constructed asthma edu-

cation program should be established for

better control of asthma.

Method: Sixty children with asthma were

randomized into two groups of receiving

enhanced interactive asthma education

program including periodic individualized

and group education and regular telephone

survey or given conventional care for

12 months period. Parents’ knowledge,

attitudes, and self-efficacy regarding self-

management were evaluated by question-

naire. Children’s lung function, numbers of

emergency department visits and hospital

admissions were recorded during 12-

months period.

Results: Regarding to parents’ asthma

knowledge, attitude, and self-efficacy of

asthma management showed significant

improvement in study group (P < 0.01).

The score of self-efficacy behaviors for

asthma management increased from

105.03 � 8.71 to 117.53 � 5.51 compared

to control group in helping their asthma

care of children (P < 0.01). Their attitude

became more positive towards the use of

asthma medication when asthma attacks.

The children of study group had signifi-

cantly improved in FEV1 from

78.30 � 15.40 to 87.50 � 8.83 predicted

value and 4-fold lower emergency room

visits

(P = 0.02) at the end of study.

Conclusion: The enhanced interactive

asthma education program improved asth-

matic children’s outcomes and self-efficacy

of their parents. A standardised asthma

education program is recommended to be

integrated into conventional asthma care

strategies.

1202

Selected determinants of quality of life in

asthma – physical domain

Szynkiewicz, E1; Graczyk, M2; Napi�orkowska-Baran, K2;

Popow, A3; Bartuzi, Z2; Cegła, B4; Flisi�nska, J2

1Chair and Clinic of Allergology, Clinical Immunology

and Internal Diseases University Hospital No.2,

Department of Nursing in Internal Diseases, Collegium

Medicum, Nicolaus Copernicus University, Bydgoszcz,

Poland; 2Chair and Clinic of Allergology, Clinical

Immunology and Internal Diseases University Hospital

No.2, Bydgoszcz, Poland; 3University Hospital No.2,

Bydgoszcz, Poland; 4Department of Nursing in Internal

Diseases, Collegium Medicum, Nicolaus Copernicus

University, Bydgoszcz, Poland

Background: Bronchial asthma is chronic

disease which affects people all over the

world. It is an illness with variable course

as well as a long-lasting and incurable con-

dition influencing patients’ quality of life

(qol) in different domains. The aim of this

study was to evaluate:

1. The influence of physical domain

(PD) on qol of patients with different

degrees of asthma severity.

2. Subjective assessment of qol based on

four questions concerning global quality of

life and perception of general health

(GQOLPGH).

Method: The study was conducted in years

2009–2010 in the Clinic of Allergology,

Clinical Immunology and Internal Diseases

in Dr J. Biziel University Hospital No. 2 in

Bydgoszcz.

Patients were divided into three groups.

The criterion of the division was the degree

of asthma control: (Gina 2006 definitions)

controlled (86), partially-controlled (50)

and uncontrolled (76). The research was

conducted by means of diagnostic survey

method with an interview technique.

To determine the qol, the Polish version

of WHOQOL-100 scale was used. It con-

tains 100 questions in six life domains and

24 subscales within these areas and four

general questions relating to the

GQOLPGH. PD contains three subscales,

consisting of four questions each, concern-

ing the prevalence of limitations caused by

the presence of pain, lack of vital energy

and disorders related to sleep difficulties

and during rest. The study used ANOVA

test and Tukey RIR test. The collected

material was analyzed statistically, verify-

ing the hypotheses at the significance level

P < 0.05.

Results: 1. Level of qol in the PD is signif-

icantly higher in patients with controlled

asthma than in other groups. Levels of qol

in the groups with partially controlled and

uncontrolled asthma do not differ from

each other (P < 0.0001).

2. Responses to 4 questions about

GQOLPGH can be seen as subjective since

they reflect individual feelings of the

respondents. Based on the conducted

Poster Session Group II – Red. TPS 50 – Asthma and allergy: how to improve treatment and patient education

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453440

research, it was found that there are signifi-

cant differences in GQOLPGH in patients,

depending on the degree of asthma control

(P < 0.002, P = 0.043, P < 0.0004,

P < 0.043).

Conclusion: 1. Physical domain affects the

assessment of qol in patients with bron-

chial asthma.

2. Along with the reduction of the

degree of asthma control, average scores of

GQOLPGH significantly decrease.

3. In order to improve qol, targeted edu-

cation should be implemented.

Keywords: Physical domain, qol, asthma,

degree of control

1203

Factors associated with Saudi asthmatic

children visits to the emergency

department for asthma therapy

Al-Muhsen, S1; Vazquez-Tello, A2; Al-Jahdali, H3;

Al Qufaidi, R2; Halwani, R1

1Pediatrics, King Saud University, Riyadh, Saudi Arabia;2Prince Naif Center for Immunology Research, King

Saud University, Riyadh, Saudi Arabia; 3King Saud

Health Sciences University, Riyadh, Saudi Arabia

Background: Asthma is the most frequent

chronic pulmonary disorder in children

from Saudi Arabia. Acute exacerbations of

bronchial asthma remain the major cause

of frequent Emergency Department (ED)

visits. However, psychosocial, behavioral

and educational factors are also reportedly

associated with repetitive ED visits by

asthmatic children. In Saudi Arabia, few

studies have investigated the nature, fre-

quency and impact of these factors on ED

frequency of visits.

Objective: To analyze potential risk factors

for their possible association with increased

frequency of visits to ED, to outpatient

clinics, and of hospital admissions by asth-

matic children.

Methods: Asthmatic children (n = 289)

aged 7–17 years old were interviewed at

the time of visiting an ED facility at two

major hospitals in a period of 1 year. Data

regarding education and awareness of

asthma disease, use of medications, therapy

devices, environmental factors, and reasons

for visiting an ED were collected by

dichotomy Yes/No and multiple-choice

questions. The effect of these factors on

the decision of asthmatic patients to visit

ED and outpatient clinics were then inves-

tigated.

Results: Recruited patients visited an ED

3.9 � 3.2 times per year on average, more

than the primary care facility (2.6 � 3.0).

Most patients had intermittent (63.5%) or

mild symptoms (27.6), and the majority

(73.5%) had their symptoms well con-

trolled. Several asthma education-related

factors significantly affected visits to ED

and the outpatient clinic, which included

instructions about asthma disease, medi-

cines and inhaler use, as well as ways to

prevent and treat symptoms. Environmen-

tal factors, asthma severity classification,

and other reasons for visiting the ED were

significantly associated with frequency of

hospital admissions, but not with ED vis-

its. Schooling levels and asthma control

scores had no significant effect.

Conclusion: Our study indicated that most

ED visits by asthmatic children were not

for the purpose of treatment against

asthma exacerbations. Patients with both

better education and awareness about

asthma disease visited more frequently the

ED and the outpatient clinic. It also

revealed that most of the patients were not

using medications properly, suggestive of

inefficient management of symptoms at

home. This indicates the necessity to

improve the education about the disease

and medication to both patients and their

parents/guardians leading to the proper

usage of medical facilities.

1204

Effect of asthma education programme

on asthma control in children with

uncontrolled asthma

Arikan Ayyildiz, Z1; Isik, S1; Caglayan-Sozmen, S1;

Anal, O1; Karaman, O1; Uzuner, N1

1Department of Pediatric Allergy, Dokuz Eylul

University Faculty of Medicine, Izmir, Turkey

Background: Previous studies show that

educational strategies are necessary to

increase asthma knowledge and skills to

improve patients0 self-management and

control. This study assessed the effect of

an asthma education programme on

asthma control in children with uncon-

trolled asthma.

Method: Children with uncontrolled

asthma were recruited from university hos-

pital located in Izmir, Turkey. Patients are

randomized to have a group education

programme or usual care. Primary out-

come was the mean change in asthma con-

trol test (ACT) scores between baseline

and months 1 and 3. Secondary outcome

measures were unplanned hospital visits,

exacerbations, emergency room visits, hos-

pitalisations and missed school days.

Results: Seventy eight children were ran-

domized to education (Group 1) and usual

care groups (Group 2). Thirty children

were excluded from the study because of

incomplete visits and failure to attend edu-

cation programme. Twenty-seven children

in Group 1 and twenty-one children in

Group 2 were included in the analysis.

Basal asthma control test scores were simi-

lar in two groups (mean: 15.59 � 3.17,

13.76 � 3.40, P: 0.06), while ACT scores

in first month were significantly higher in

the group having education programme

(mean: 19.33 � 3.49, 16.75 � 3.90, P:

0.02). Asthma control test scores were sim-

ilar in two groups at 3 months (mean:

20.62 � 3.28, 20 � 3.96, P > 0.05). ACT

scores improved within time in both

groups leading 61.8% uncontrolled asthma

in group 1 and 38.2% in group 2.

Unplanned hospital visits, exacerbations,

emergency room visits and hospitalisations

were similar in both groups while missed

school days were significantly lower in

group 1 at the end of the third month.

Conclusion: This study confirmed the

importance of education for children with

uncontrolled asthma. Repetetive education

methods may be needed to improve asthma

control and decrease unplanned hospital

and emergency care visits and hospitalisa-

tions.

1205

The use of spacer device (aerochamber)

in the treatment of asthma in children:

how could be taught better?

Akar, HH1; Dorterler, K1; Deniz, S1; Aydın, E1; Tahan, F1

1Department of Pediatric Allergy, Erciyes University

School of Medicine, Kayseri, Turkey

Background: Inhaled medications are the

mainstay of asthma therapy, but significant

deficiencies exist in the knowledge and

skills of patients regarding use of metered-

dose inhalers (MDI) and spacer devices

(aerochamber). The purpose of this study

is to teach the correct use of aerochamber,

and improve the control of asthma in chil-

dren.

Method: This study was performed at the

Pediatric Allergy and Asthma Unit of Erci-

yes University in Kayseri, Turkey. 128

patients with newly diagnosed asthma were

included in this study. The patients were

divided five groups,

Group 1 (just video watched),

Group 2 (just explained by technician),

Group 3 (video plus explained by tech-

nician),

Group 4 (firstly video was shown, later

parents explained to the technician

again), and

Group 5 (firstly explained by techni-

cian, later parents explained to the tech-

nician again).

After education, the learning percentage

of family was evaluated based on scoring

out of 100 by a nurse.

Results: The mean scores of groups were

79, 83, 83, 87, and 88 respectively. The

highest mean score was found 75 in group

Poster Session Group II – Red. TPS 50 – Asthma and allergy: how to improve treatment and patient education

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 441

5. There was an inverse correlation

between mean scores and mother’s ages

(P = �0.009, r = 0.922). Statistically signif-

icant difference was found in the mean

scores between the group 5 and group 1

(group 5:88, group 1:79, P = 0.031).

Conclusion: The highest mean score was

found in group 5. The method of ‘firstly

explained by technician, later parents

explained to the technician again’, as in

group 5, was found the best method for

teaching the correct use of aerochamber.

1206

General physician (GP) communication

strategies in Latin-American asthma

patients

Cherrez Ojeda, I1; Colombaro, D2; Calderon, J1;

Calero, E1; Cherrez, A3

1Respiralab – Hospital Kennedy, Guayaquil, Ecuador;2Hospital Argerich, Buenos Aires, Argentina;3Heidelberg Universit€at, Heidelberg, Germany

Background: A good patient-physician

communication is considered a relevant

tool for improving treatment adherence.

Quality of medical communication is

directly related to patient satisfaction,

improve adherence, treatment compliance,

decrease risk of malpractice and increase in

health care provider’s levels of satisfaction.

Evidence shows that recommendations

of international guidelines on education,

communication and development of a doc-

tor-patient partnership are still ignored. In

Latin-American, there isn’t information

about this topic.

Method: Observational, descriptive, cross-

sectional study.

We lead an anonymous survey among

GPs in this pilot study at Buenos Aires.

This survey was developed by an expert

panel of the Italian Society of Respiratory

Medicine composed by 24 items about

communicative strategies on a five-point

Likert’s scale, and four questions that

explore physicians’ experience regarding

asthma management.

Descriptive statistics were used for ques-

tions about physicians’ experiences and

demographic data. First 24 items were ana-

lyzed as a dichotomous variable. In order

to estimate the reliability of this survey, we

used Cronbach0s alpha.Results: Eighty seven physicians anwered

the survey, but only 62 (71.26%) filled

completely the survey. Mean of age was

44.94 year (SD: 10.29), 61.3% were

females, and 43.5% pediatrician. 24.2%

answered be more prone to supply sup-

porting educational material to patient,

and 53.2% about asking the patient to

repeat the prescriptions together and

involving the patient in the asthma man-

agement strategies. About drugs adminis-

tration, 75.8% simplify the therapeutical

regimen and 85.5% prefer drugs which

require mono-administration. Cronbach0salpha for these items was 0.762. 66.1%

were concerned about the fact of perma-

nent care and 51.6% about need of long

term therapy.

Conclusion: We found that some recom-

mendations about a development of a doc-

tor patient partnership are still ignored and

this would contribute to not well asthma

control.

Poster Session Group II – Red. TPS 50 – Asthma and allergy: how to improve treatment and patient education

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453442

Poster Session Group II – Red

TPS 51 – The diverse spectrum of urticaria

1207

Characterisation of urticarial vasculitis in

Western Ukraine

Lishchuk-Yakymovych, K1; Pukalyak, R1; DuBuske, LM2

1Danylo Halytsky Lviv National Medical University, Lviv,

Ukraine; 2Immunology Research Institute of New

England, Gardner, United States

Background: Urticarial vasculitis is a sub-

type of vasculitis characterised clinically by

urticarial lesions and histologically by nec-

rotizing vasculitis. This study examines the

association between hypocomplementemia,

HHV6, EBV, CMV and systemic disease.

Methods: The clinical and histologic fea-

tures of urticarial vasculitis were assessed

in patients seen in the Clinical Immunol-

ogy and Allergology Department of Lviv

National Medical University and Lviv

Regional Clinical and Diagnostic Center,

Lviv, Ukraine. A chart review of histologi-

cally confirmed cases of urticarial vasculitis

in the database of our department was

done evaluating all urticarial vasculitis

cases seen from 2002 to 2013.

Results: Sixteen patients (10 women and

six men; median age of 38 � 6.1 years)

were included. In 11 patients (68.8%), the

lesions persisted for more than 48 h; in 5

(31%) patients more than 24 h, and in six

cases (50%) the lesions resolved but left

hyperpigmentation. 12 (75%) patients had

moderate eosinophilia; 8 (50%) patients

had low complement levels and elevated

serum immune complexes; 14 (87.5%) had

extra-cutaneous symptoms; and 8 (50%)

had associated systemic disease, the most

common of which were drug-associated

vasculitis, ANCA-associated vasculitis and

systemic lupus erythematosus. 11 (68.8%)

patients including six (54.5%) with ANCA-

associated vasculitis had acute HHV6

infection while five (45.5%) had acute EBV

infection and chronic CMV infection. All 4

(25%) patients having urticarial vasculitis

associated with drug-induced (NSAID)

vasculitis had moderate eosinophilia and

elevated immune complexes. Urticarial vas-

culitis with systemic lupus erythematosus

was associated with persistent HHV6 infec-

tion and acute EBV infection.

Conclusions: Urticarial vasculitis may have

a variable response to treatment especially

when associated with acute EBV and

HHV6 infections. These urticarial vaculitis

patients often have hypocomplementemia,

increased immune complexes, moderate

eosinophilia and extracutaneous symptoms.

All such urticarial vaculitis patients need

to be analyzed for a potential viral influ-

ence on vasculitis development.

1208

ASST sensitivity and specificity in

detecting autoimmune urticaria

Bahrani, B; Gattey, N; Hull, P1University of Saskatchewan, Saskatoon, Canada

Background: Chronic spontaneous urticaria

(CSU) is defined as continuous spontaneous

wheals, with or without angioedema and

irrespective of the etiology, whether autoim-

mune, allergic, pseudoallergic, infection-

related or spontaneous. An autoimmune

basis is thought to be responsible for about

half of CSU cases. IgG anti-IgE receptor

and IgG anti-IgE autoantibodies are known

to be involved in 60% and 10% of patient

cases, respectively. The objective of this

study was to use an indirect immunofluores-

cence assay to identify the presence of anti-

mast cell IgG antibodies, and to use this as

a gold standard to measure the sensitivity

and specificity of the autologous serum skin

test (ASST).

Method: All patients with CSU seen in the

Division of Dermatology had an ASST test

performed. Patients receiving IVIG treat-

ment were excluded. Indirect immunofluo-

rescence detecting mast cell bound IgG

autoantibodies was performed on 55

patients using historical pathology sections

from a patient with severe bullous masto-

cytosis. Of these, 13 had a documented

positive ASST.

Results: Using mastocytosis sections, posi-

tive indirect immunofluorescence was

found in 35 (46.05%) of the patients.

There was positive indirect immunofluores-

cence in 17 (50%) patients who had a posi-

tive ASST. Using the indirect

immunofluorescence as the ‘gold standard’

the ASST has a sensitivity of 34.62% (95%

CI: 17.25% to 55.66%) and a specificity of

82.76% (95% CI: 64.21% to 94.09%).

Conclusion: In CSU, the ASST fails to

detect a large percentage of patients with

autoimmune urticaria as determined by

positive indirect immunofluorescence. The

ASST does have reasonable sensitivity.

1209

Usefulness of capillaroscopy as a

diagnostic tool in chronic urticaria

Biarnes Ribas, G1; Gaig Jan�e, P1; Porras Ledantes, JA2;

Dalmau Duch, G1; G�azquez Garc�ıa, V1

1Hospital Universitari de Tarragona Joan XXIII, IISPV,

Universitat Rovira i Virgili, Section of Allergology,

Tarragona, Spain; 2Hospital Universitari de Tarragona

Joan XXIII, IISPV, Universitat Rovira i Virgili, Internal

Medicine Service, Tarragona, Spain

Background: Over the last 20 years, a new

subset of chronic spontaneous urticaria is

being recognised internationally, based on

laboratory and clinical evidence, called

autoimmune chronic spontaneous urticaria.

To study some autoimmune diseases is

used the capillaroscopy, an in vivo, non-

invasive image tool to morphologically

study the nailfold microcirculation, used in

the differential diagnosis of Raynaud’s

phenomenon, present in different connec-

tive tissue diseases. The aim of this study is

to evaluate the presence of nailfold micro-

vascular damage in patients with chronic

urticaria.

Methods: We present 17 patients (Four

men and 13 women), mean age

59 � 10.7 years (range 28–73), all of them

with chronic urticaria. Of these, three

patients had cold urticaria, six patients had

chronic autoimmune thyroiditis, one

patient had delayed pressure urticaria and

two patients had urticarial vasculitis. Aver-

age time course of urticaria was

12.2 � 8.8 years (range 1–40). All patients

underwent a nailfold capillaroscopy of the

second to fifth fingers of both hands with a

209 to 2009 binocular optical microscpe,

after placing a drop of immersion oil. Cap-

illary nailfold morphology, density and dis-

tribution were evaluated, considering as

pathologic the presence of enlarged and

giant capillaries, microvascular dilatation,

loss of capillaries, microhaemorrhages, tor-

tuosities, ramified capillaries and/or angio-

genesis in two or more fingers.

Results: The capillaroscopy was normal in

94.1% of subjects. There was only one

patient, who suffered during 19 years of

chronic urticaria associated with autoim-

mune thyroiditis, with abnormal capillaro-

scopic pattern, observing mild loss of

capillaries, isolated complex ramifications

and pale background in several fingers.

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 443

Conclusion: Nailfold capillaroscopy is a

diagnostic tool of limited use in the study

of chronic urticaria.

1211

Association between suppression of skin

response to histamine by high doses

antihistamines and clinical outcomes in

patients with chronic urticaria

Valerieva, AD; Staevska, MT; Petkova, EG;

Kralimarkova, TZ; Dimitrov, VD; Popov, TA

Clinical Centre of Allergology, Medical University of

Sofia, Sofia, Bulgaria

Background: Inhibition of the histamine-

induced wheal (W) and flare (F) reaction

of the skin of healthy volunteers is com-

monly used to assess the comparative effi-

cacy of antihistamines (AHs). This

approach, however, may not reflect ade-

quately the clinical effectiveness of AHs in

different diseases states. We compared the

inhibitory effect of levocetirizine (LEV)

and desloratadine (DES) in up to four

times of the conventional doses on the his-

tamine-induced W&F in patients with diffi-

cult to treat chronic spontaneous urticaria

(CSU) and correlated it with the clinical

outcomes.

Methods: Eighty patients with difficult to

treat CSU took part in this double-blind

study and were randomized to receive

increasing daily doses of 5, 10 and 20 mg

LEV (40 patients) or DES (40 patients) at

1 week incremental treatment steps. We

did skin prick tests with 100 mg/ml hista-

mine on the volar surface of the forearm

of the patients at baseline visit (V1), and

after treatment with 5 mg (V2), 10 mg

(V3) and 20 mg (V4) with either LEV or

DES. Clinical effect of treatment was

assessed on the basis of urticarial symptom

scores.

Resuts: The mean diameters of the W&F

for the 2 drugs are shown in the table:

These results correlated with the clinical

outcomes with 22 of 40 patients on LEV

achieving complete therapeutic success vs

12 of 40 on DES (P < 0.04; Fisher exact

test).

Conclusion: LEV was superior to DES in

suppressing the histamine-induced W&F

skin reactions and in achieving complete

therapeutic effect in patients with difficult

to treat CSU. Our results provide evidence

that the suppression by AHs of the hista-

mine-induced W&F is a good predictor of

their clinical effectiveness.

1212

Improvement of disease-specific quality

of life in patients with chronic idiopathic/

spontaneous urticaria treated with

omalizumab: results of three

randomised, double-blind, placebo-

controlled studies

Maurer, M1; Raimundo, K2; Solari, PG2; Trzaskoma, B2;

Zazzali, JL2; Baiardini, I3

1Charit�e – Universit€atsmedizin, Berlin, Germany;2Genentech Inc., South San Francisco, United States;3IRCCS AOU San Martino-IST, Allergy & Respiratory

Diseases Clinic – DIMI – University of Genoa, Genoa,

Italy

Background: Omalizumab (anti-IgE) has

been shown to reduce disease activity in

patients with chronic idiopathic/spontane-

ous urticaria (CIU/CSU). Here, we have

assessed the changes in disease-specific

quality of life (QoL) in CIU/CSU patients

treated with omalizumab in three phase III

trials.

Method: ASTERIA I and ASTERIA II data

were pooled. Subjects (n = 640) were ran-

domized 1:1:1:1 to receive placebo or oma-

lizumab 75, 150 or 300 mg (PLB, OMA75,

OMA150, OMA 300) every 4 weeks for three

(ASTERIA II) or 6 doses (ASTERIA I). In

GLACIAL, subjects (n = 335) were random-

ized 1:3 to receive PLB or OMA300 mg

every 4 weeks for six doses. Disease-related

QoL, as assessed by the Chronic Urticaria

Quality-of-Life Questionnaire (CU-Q2oL;

overall score, range 0–100; higher scores indi-cate greater impairment in QoL; adminis-

tered only in countries where a translation of

CU-Q2oL to the local language was avail-

able), results are presented as change from

Baseline to Week 12.

Results: At Baseline, on average, patients

reported QoL impairment, as assessed by

the overall CU-Q2oL score [pooled ASTE-

RIA I and II, mean (SD), PLB: 42.31

(15.96); OMA75: 42.86 (18.59); OMA150:

43.92 (18.58); OMA300: 44.12 (17.55);

GLACIAL PLB: 42.22 (17.78); OMA300:

42.93 (16.72)]. On average, most treatment

arms improved from Baseline to Week 12;

however, the largest improvements were

seen in patients treated with OMA300. For

pooled ASTERIA I and II, the change in

overall CU-Q2oL score from Baseline to

Week 12 was significantly higher for

OMA150 and OMA300 arms compared to

PLB [PLB �18.56, OMA75 �19.99

(P = 0.50), OMA150 �25.29 (P = 0.009),

OMA300 �31.02 (P < 0.001)]. For GLA-

CIAL, the change in overall CU-Q2oL

from Baseline to Week 12 was also statisti-

cally significant for OMA300 compared to

PLB [PLB �16.28, OMA300 �29.28

(P < 0.001)].

Conclusion: Omalizumab 150 mg and

300 mg significantly reduce disease-related

quality of life impairment in patients with

chronic idiopathic/spontaneous urticaria as

measured by CU-Q2oL.

1213

Omalizumab phase III trials: medication

history and baseline characteristics of

patients with refractory chronic

idiopathic/spontaneous urticaria

Ros�en, K1; Bradley, MS1; Ashby, M1; Hsieh, H-J1;

Georgiou, P2; Casale, T3; Maurer, M4

1Genentech Inc., South San Francisco, United States;2Novartis Pharmaceuticals Unites Kingdom Limited,

Horsham, Unites Kingdom; 3University of South

Florida-Morsani College of Medicine, Tampa, United

States; 4Charit�e – Universit€atsmedizin, Berlin, Germany

Background: Patients with chronic idio-

pathic/spontaneous urticaria (CIU/CSU)

are a difficult to treat patient population,

often failing with standard and high-dose

antihistamines treatment.

Method: We describe the baseline charac-

teristics of patients from three multicenter,

randomized, double-blind, placebo-

controlled studies of omalizumab that

enrolled patients 12–75 years of age with

CIU/CSU ≥6 months who remained symp-

tomatic despite standard dose of H1-antihis-

tamine treatment (ASTERIA-I/II) or H1-

antihistamine treatment (≤4 times approved

dose) and an H2-antihistamine and/or leuko-

triene receptor antagonist (GLACIAL).

Results: A total of 975 patients (ASTE-

RIA-I: n = 318; ASTERIA-II: n = 322;

GLACIAL: n = 335) were randomized and

treated. Most patients were white (85.4%)

and female (73.4%); mean body mass

index was 29.6 (SD 7.3). Mean disease

duration was 6.9 (SD 9.1) years; median

was 3.6 years. A high degree of disease

activity was observed, as defined by high

weekly itch severity score (mean: 14.1 out

of 21.0) and urticaria activity score during

a 7-day period (UAS7, mean score: 30.9

out of 42.0). Angioedema was reported by

47.2% of patients. Patients reported a

mean of 5.0 (SD 2.8) previous medications

for CIU/CSU: On study day 1, 61.5%

V1 W V1 F V2 W V2 F V3 W V3 F V4 W V4 F

LEV [mm] 5.8 16.4 3.8 5.8 1.6 4.4 2.0 4.6

(mean � SD) 2.2 9.8 1.6 2.6 1.8 2.5 1.6 1.8

DES [mm] 4.8 13.3 2.3 11.1 3.6 8.3 3.8 8.9

(mean � SD) 2.6 9.6 2.1 7.8 1.6 6.3 2.2 7.2

P 0.05 0.15 0.004 0.002 0.02 0.015 0.048 0.048

LEV/DES W&F on V1, V2, V3 & V4

Poster Session Group II – Red. TPS 51 – The diverse spectrum of urticaria

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453444

were receiving H1-antihistamines only,

21.9% were receiving H1- and H2-antihista-

mines, the rest were receiving other combi-

nations of CIU medications. 45.7% of

patients had taken systemic steroids (pre-

dominantly prednisone) and 8.9% immu-

nosuppressants (predominantly

cyclosporine).

Conclusion: Patients enrolled in the oma-

lizumab Phase III trials had moderate to

severe CIU/CSU refractory to treatment.

The inadequacy of current therapies is

demonstrated by the degree of uncon-

trolled disease and the prevalent use of sys-

temic steroids and limited use of

immunosuppressants in this patient popu-

lation.

1214

Long term efficacy of fixed-dose

omalizumab for patients with severe

chronic urticaria

Havlucu, Y1; Yorgancioglu, A1; Yurtman Havlucu, D2;

Madak, B2; Kurhan, F1

1Pulmonology Department, Celal Bayar University

Faculty of Medicine, Manisa, Turkey; 2Dermatology,

Merkez Efendi State Hospital, Manisa, Turkey

Background: Treatment of chronic urti-

caria is challangeing because many patients

arerefractory to or experience adverse

effects with conventional therapy. Oma-

lizumab therapy is effective and safe in

chronic urticaria in placebo controllede tri-

als but real life data are scarce.

Method: In this clinical analysis, 13

patients with severe chronic urticaria at

our clinic recevied omalizumab, 150–300 mg every 2–4 weeks between 2010 and

2013. disease severitywas measured by urti-

caria activity scores before treatment, dur-

ing treatment, and at most recent follow-

up, ranging from 13–24 months. Duration

of therapy was determined individually for

each patient. In this retrospective analysis,

outcome measures include number of treat-

ments required to induce remisson and

long term remisson sustainability.

Results: Seven patients (53.8%) had remis-

son of urticaria after their first injection. 5

patients required 4–8 treatments to achive

remisson.1 patient discontinued treatment

after four injections. 12 patients who ini-

tially benefited (92.3%), 6 remain in remis-

sonmore than 12 monts after their last

treatments. Five patient patients continue

to achive remission with maintenance oma-

lizumab. One patients became refractory

and discontinued treatment. Urticaria

activity scores were improved in most of

the patients.

Conclusion: Omalizumab is ana effective

treatment for inducing and mantaining long

term remission for patients with severe

chronic urticaria. Onset of remission is

rapid. Large scale of randomized trials are

necessary to confirm our findings that sup-

port the long term efficacy of omalizumab

treatment for sever chronic urticara.

1215

Effect of omalizumab therapy in a group

of patients with spontaneous chronic

urticaria resistant to conventional

treatment

Iemoli, E1; Borgonovo, L2; Fusi, A1; Rivolta, L1;

Asero, R3; Piconi, S1

1Luigi Sacco Hospital, Milan, Italy; 2Allergy and Clinical

Immunology Unit, Luigi Sacco Hospital, Milan, Italy;3Clinica San Carlo, Paderno Dugnano, Italy

Background: Spontaneous chronic urti-

caria is a common heterogeneous group of

disorders that affects 1%–3% of people in

western countries. Non sedating H1-anti-

histamines (nsAH), leukotriene receptor

antagonists represent first and second line

therapies, whereas immunosuppressive

drugs should be reserved for severe resis-

tant diseases.

Currently more data show promising

results of Omalizumab treatment in the

management of spontaneous chronic urti-

caria.

Method: We present a group of patients

with chronic urticaria resistant to conven-

tional treatments (antihistamines, systemic

steroids, immunosuppressive drugs) treated

with Omalizumab. The starting dosage and

interval of administration of omalizumab

were initially chosen according to asthma

dosages but, after a second injection, they

were modified according to the clinical

response of each patient.

Results: Nine patients were enrolled in

the study (M = 3; F = 6; mean

age = 45.22 years, range 13–71 = years).

Before initiation of omalizumab the IgE

average level was 276.11 (range = 20–848),the average urticaria duration was

5.11 years (range 3–11 years). The initial

dosage of omalizumab was between

150 mg–300 mg every 4 weeks. After the

first injection seven patients (77%) showed

a complete resolution of urticaria, while

two patients showed a partial resolution

after first and third injection respectively.

In no patient were observed significant

adverse effects. Currently all patients,

except one, are still on treatment with

omalizumab even if with lower dosages

and more prolonged administration inter-

vals.

Conclusion: Our preliminary study showed

that the treatment of chronic spontaneous

urticaria resistant to conventional treat-

ment with omalizumab was effective, safe

and well tolerated.

1216

Anti-IgE therapy for chronic spontaneus

and delayed pressure urticaria

Yesillik, S; Baysan, A; Demirel, F; Kartal, O; Gulec, M;

Musabak, U; Sener, O

Division of Immunology and Allergic Diseases, GATA,

Ankara, Turkey

Background: Omalizumab is a recombi-

nant, humanized, monoclonal antibody

that may be an efficient alternative treat-

ment for chronic urticaria (CU) which do

not respond to conventional drugs such as

antihistamines (updosing), corticosteroids,

and other antiinflammatory and immuno-

suppressive agents.

Cases: In this case report, we describe a

35-year-old male patient with chronic

spontaneus (CSU) and delayed pressure

urticaria (DPU) who had a significant

reduction in quality of life due to unsuc-

cessful therapies with antihistamines, corti-

costeroids, antileukotrienes, cyclosporine,

colchicum and dapsone, since 2003. In

Februbary 2012, he underwent a full physi-

cal, laboratory examination and a chest X-

ray. Autologous serum skin test was nega-

tive. Total serum IgE level was 83.33 IU/

ml. Punch biopsy of lesional skin showed a

superficial, deep perivascular and intersti-

tial dermatitis without immune complex

deposits.

After initiation of 150 mg/month oma-

lizumab treatment, rapid and complete

response was seen in CSU with no signifi-

cant improvements in DPU. He still

receives omalizumab for nearly 2 years

without experiencing any adverse effects.

Conclusion: There are many CU patients

who were resistant to conventional drugs

that treated with omalizumab succesfully

and also few reports of omalizumab treat-

ment failure in some CU in the literature.

Some patients may show CSU and DPU

can patterns at the same time. Because of

underlying different pathological mecha-

nisms, the improvements in CU patients

may differ. Future large scale researches

will help us to distinguish which CU sub-

types that can be treated with omalizumab.

1217

Neutrophilic urticaria. Case report

Zande, M1; Andreou, G2; Vourlakou, C2; Sinaniotis, A1;

Syrigou, E1; Tziotou, M3

1Allergy, Sotiria General Hospital, Athens, Greece;2Pathology, Evaggelismos General Hospital, Athens,

Greece; 3Allergy Department, University of Athens, 2nd

Pediatric Clinic, Athens, Greece

Background: Neutrophilic urticaria is a

subtype of urticaria characterised histologi-

cally by diapedesis of neutrophils and a

predominantly neutrophilic dermal infil-

trate.The exact pathomechanisms of this

Poster Session Group II – Red. TPS 51 – The diverse spectrum of urticaria

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 445

entity are not yet clearly understood.We

report the case of a patient with neutro-

philic urticaria.

Method: A 24-year-old female patient was

refered to our allergy outpatient depart-

ment because of an urticarial rash and an

episode of angioedema of the upper lip

which started 2 months ago during an

exam period.The patient was first examined

to a hospital’s emergency department and

treated with prednisolone for 9 days with

gradual tapering and levocetirizine.It is

mentioned that she had the same rash

5 years ago which lasted 1 month.The rash

consisted of pruritic and burning wheals

mainly in the limbs and trunk which were

worse during the night.They were lasting

<24 h, disappearing without discoloration

and were resistant to treatment with anti-

histamines.She reported transient joint pain

in the wrists and ankles especially in the

morning.Her personal medical history

included Gitelman syndrome and gastritis.

Results: A punch biopsy(HS biopsy punch

5 mm) of an 8 mm diameter lesion located

in the middle-outer surface of the left calf

was performed and sent for histological

analysis.The results from the histological

evaluation were perivascular oedema of the

dermis as well as perivascular infiltration

consisting mainly of neutrophils and eosin-

ophils without vessel damage except from

vasodilation and endothelial cells swell-

ing.Leukocytoclasia was minimal.These

pathologic features were consistent with

neutrophilic urticaria.

Conclusion: Neutrophilic urticaria is prob-

ably underdiagnosed and an allergologist

should always include it in the differential

diagnosis of patients with chronic urticaria.

1218

Chronic urticaria, fever and monoclonal

gammopathy: think in Schnitzler’s

syndrome

Escobar Bola~nos, C; Egu�ıluz Gracia, I; Rubio P�erez, M;

Gonz�alez Guti�errez, ML; Robledo Echarren, T; Mart�ınez

C�ocera, C; Fern�andez Rivas, M

Allergy, Hospital Clinico San Carlos, Madrid, Spain

Background: We report the case of a

58 years old woman who was diagnosed of

Schnitzler’s Syndrome 12 months after the

onset of her symptoms despite she fulfilled

diagnostic criteria: recurrent fever, urti-

caria, IgM /IgG monoclonal gammopathy,

musculoskeletal pain, arthralgia and

lymphadenopathy.

Case report: Our patient begun in 2006

with outbreaks of nonpruritic dermatitis in

areas of pressure. After a stressful personal

event in 2009, the symptoms appeared to

change into itchy wheals, predominantly

nocturnal. In 2010 she started with inter-

mittent fever up to 37.9°C without focus,

mild leukocytosis and increased inflamma-

tion parameters (CRP and ESR); she was

diagnosed of probable vasculitis /mastocy-

tosis. An IgM kappa monoclonal gammop-

athy was found as the patient was

re-evaluated, the Hematology Department

performed a medullogram ruling out

malignancy. She also developed arthralgias

being treated with corticosteroids and

NSAIDs. In 2011 she was referred to our

Allergy Department for persistent urticaria

and we established the diagnosis of Schnit-

zler0s Syndrome, and prescribed subcutane-

ous anakinra 100 mg/day (an IL-1

antagonist receptor). The patient had a

favourable response within the first 48 h

with adequate control of symptoms and

inflammation parameters. After 2 years fol-

low- up the patient is well controlled and

she has not developed associated amyloido-

sis or lymphoproliferative disorders.

Conclusion: With this case report we want

to draw the attention of clinicians to this

rare disease, since it can be controlled with

IL-1 antagonists; its early recognition and

treatment prevents the development of

amyloidosis or lymphoproliferative disor-

ders.

1219

Is urticaria may be the first clinical

presentation of thyroid carsinoma?

Demirel, F1; Yesillik, S1; Kartal, O1; Baysan, A1;

Gulec, M1; Alag€oz, E2; Musabak, U1; Sener, O1

1Division of Immunology and Allergic Diseases,

Gulhane Military Medical Academy and Medical

School, Ankara, Turkey; 2Department of Nuclear

Medicine, Gulhane Military Medical Academy and

Medical School, Ankara, Turkey

Background: Chronic urticaria (CU) is a

common disease in which most cases were

considered to be idiopathic. This report

presents two patients with chronic urticaria

who diagnosed papillary thyroid carci-

noma.

Case Reports: The first case, a 50-year-old

woman, admitted to hospital with a one-

year history of urticaria. She was taking

medications because of allergic asthma.

Laboratory examination revealed no

abnormalities. Allergy tests resulted nega-

tive. On physical examination thyroid

gland was found hypertrophic. Ultrasound

examination revealed a heterogeneous solid

nodule on the left thyroid lobe and a

lymphadenopathy on the neck. Fine-needle

aspiration biopsies resulted with papillary

carcinoma of thyroid. She underwent total

thyroidectomy and completely recovered

from her urticarial lesions 3 days later.

The second case, a 38-year old woman,

presented with a 10-year history of CU.

She had not atopy. She had yielded no

improvement with different threapies. Four

years ago, thyroid malignancy had been

excluded with a thyroid biopsy. Labora-

tory tests were detected normal and allergy

tests resulted negative. A hypoechoic solid

nodule was found on the right thyroid lobe

with ultrasound examination. Fine-needle

aspiration biopsy result was also consistent

with papillary carcinoma of thyroid and

she underwent total thyroidectomy opera-

tion too. Her urticarial lesions disappeared

on the fourth day of postoperative period.

Conclusion: Several cases of thyroid malig-

nancies associated with urticaria have been

published in the literature. However, the

exact mechanisms cause to these disorders

concomitantly have not been known yet.

Based on the reports, urticaria symptoms’

improvement give rise to thought a pres-

ence of cause and effect relationship

between CU and thyroid malignancies.

These reports may highlite to evalution of

CU patients. Eventhough the laboratory

findings are normal, examination of thy-

roid gland must be done carefully.

1222

Treatment of mediator-related symptoms

in patients with mastocytosis

Parente, R1; Magliacane, D2; Pericoli, MA1; De Feo, G1;

Triggiani, M1

1Division of Allergy and Clinical Immunology,

University of Salerno, Salerno, Italy; 2Allergy and

Respiratory Disease, Hospital of Battipaglia, Salerno,

Italy

Background: The clinical picture of masto-

cytosis, either cutaneous or systemic, is

often dominated by symptoms due to the

release of mast cell-derived mediators.

Given the usually benign course of the dis-

ease, in the majority of patients with mast-

ocytosis the primary therapeutic aim is to

control mediator-related symptoms.

Method: We evaluated the requirement of

anti-mediator treatment in 91 patients with

mastocytosis (44 males and 47 females,

mean age 20 years, range 1–80). Anti-medi-

ator treatment included H1 antihistamines,

H2 receptor blockers, cromolyn sodium,

leukotriene receptor antagonists and oral

glucocorticoids. The drugs were adminis-

tered at standard dosage. Treatment was

considered as continuous when prolonged

for more than 3 months.

Results: One-third of patients with masto-

cytosis had no or minor symptoms and

never required treatment. About one-half

of patients (45/91) required only anti-H1

antihistamine either on-demand (41/45) or

as continuous treatment (4/45). More than

one medication, including the association

of two antihistamines or any other combi-

nation of the above mentioned drugs was

required in 11% of patients (10/91). Only

Poster Session Group II – Red. TPS 51 – The diverse spectrum of urticaria

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453446

three patients needed oral glucorticoids to

control their symptoms. No difference in

treatment requirement was detected

between patients with cutaneous and sys-

temic mastocytosis.

Conclusion: These data indicate that the

majority of patients with mastocytosis

require on-demand treatment of mast cell-

derived mediator symptoms. Antihista-

mines at the usual dosage are effective in

these patients. However a subset of

patients requires two or more antimediator

drugs to control their symptoms.

Poster Session Group II – Red. TPS 51 – The diverse spectrum of urticaria

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 447

Poster Session Group II – Red

TPS 52 – The expanding universe of drug allergy

1223

Flupirtine-induced hypersensitivity

reactions

Baran, AM; Homey, B; Meller, S1Department of Dermatology, University Hospital

D€usseldorf, D€usseldorf, Germany

Non-steroidal anti-inflammatory drugs

(NSAIDs) constitute a class of widely pre-

scribed drugs beneficial because of their

analgetic, antipyretic and anti-inflamma-

tory potency. However, hypersensitivity

reactions following the intake of NSAIDs

are observed frequently, presenting either

as immediate-type hypersensitivity reac-

tions, delayed-type hypersensitivity reac-

tions or – in most cases – as non-

immunological intolerances. In NSAIDs-

sensitive patients, COX-2-Inhibitors have

been proposed to represent an alternative

drug class since hypersensitivity reactions

have been reported less frequently. Never-

theless, their long-term use is limited due

to their cardiovascular effects, especially in

patients with a pre-existing heart disease or

increased risk factors for developing car-

diovascular events. In search of an appro-

priate alternative medication, flupirtine has

been suggested to be a potentially safe

drug, constituting a centrally acting non-

opioid analgesic which is especially used in

the treatment of orthopaedic indications

due to its muscle relaxing properties. In

view of this background, we would like to

present two cases of clinically proven

hypersensitivity to flupirtine. The first

patient reported of a 6-week-history of

recurrent erythematous skin lesions, emerg-

ing repeatedly in identical skin sites after

exposure to flupirtine. Clinical examination

revealed livid-erythematous plaques with

central bullae located on the dorsal side of

the hands and fingers. Skin tests including

patch test in loco were performed revealing

positive reactions for flupirtine. The second

case was a 58-year-old female patient pre-

senting with generalised urticarial exan-

thema following the administration of

several drugs including flupirtine. Here,

too, the patient underwent a patch test

showing a positive reaction for flupirtine.

In both cases, the diagnosis of a flupirtine-

induced drug eruption was made.

1224

Amiodarone hypersensitivity reaction

and basophil activation test

De Amici, M1; Vignini, A2; Caimmi, D3; Caimmi, S1;

Castagnoli, R1; Torre, C1; Marseglia, GL1

1S.C. Pediatria, Fondazione IRCCS Policlinico San

Matteo, Pavia, Italy; 2Dermatology, Fondazione IRCCS

Policlinico San Matteo, Pavia, Italy; 3CHRU Montpellier,

Montpellier, France

Background: Amiodarone is an antiar-

rhythmic drug with several known side

effects, including hypersensitivity reaction.

Toxidermic reactions may be very severe

and become a challenge for allergists.

Severe forms, in fact, are difficult to test

and, therefore, in most cases, drug avoid-

ance is indicated.

Method: We report the case of an 89 years

old man with retrosternal pain radiating to

the left shoulder, dyspnoea, productive

cough and fever, admitted to our hospital

and treated by an intravenous therapy with

Levofloxacine, Amiodarone and Ringer’s

lactate. Two days after admission, he

started to present a cutaneous reaction

suggestive for drug-induced erythema or

bullous disease at early stage. Trypstase

levels were above average reference. We

performed a Basophil Activation Test to

prove that the suspected drug was actually

the culprit one.

Results: Fourty three percent of CD63

positive basophils were observed upon in

vitro stimulation of patient blood samples

with amiodarone only. No other drug

could be considered as responsible for the

reaction. Two skin biopsies for IFD were

carried out with negative histological

results. Antibiotic therapy was continued

during the clinical course of skin lesions,

which resolved with fine desquamation in

about 2 weeks.

Conclusion: Basophil Activation Test may

be a good diagnostic tool for immediate

hypersensitivity drug reactions, especially

when skin biopsy is negative.

1225

Allergy to moxifloxacin eye wash

Sanchez Moreno, V1; Sola Martinez, FJ2; Farrarons

Lorente, L3; Antolin Am�erigo, D4; Alvarez-Cuesta, E2

1Allergy Division, Madrid, Spain; 2Ramon y Cajal

University Hospital, Madrid, Spain; 3Allergy Division,

Barcelona, Spain; 4Allergy Division Alcal�a De Henares

University Hospital, Madrid, Spain

Background: Quinolones form a family of

synthetic antibiotics which have been used

for more than 30 years. Because of their

broad antibacterial activity in the gram-

negative and gram-positive spectrum and

their enhanced potency, they are widely

used. Photosensitivity and phototoxicity

are the most common adverse reactions

with bullous eruption, photo-onycholysis,

petechia localised to sunlight-exposed

areas. Fluoroquinolones rarely cause ana-

phylactic or anaphylactoid reactions; they

can cause pruritus, urticaria, and angioe-

dema.

Method: We present the case of a 35 year-

old female diagnosed with acute purulent

conjunctivitis in right eye and showed a

sudden puritus, conjunctival hyperemia,

pain and erased vision after the first

administration of Moxifloxacin eye wash

(0.5%). The reaction was controlled in few

days after receiving topical corticosteroid

and the patient completed antibiotic treat-

ment with Gentamicin and cephalosporin

eye washes. Department of Oftalmology

contacts us for allergy study and the

patient signed an informed consent.

Results: Although prick test and intrader-

mal tests results are considered to be unre-

liable because they are often positive in

healthy controls (direct histamine release),

we performed recommended non-irritant

skin tests (intradermal test concentrations:

Moxifloxacin 0.5 mg/ml; Ciprofloxacin

0.004 mg/ml, 0.02 g/ml, 0.002/ml; Levo-

floxacin 0.025 g/ml; Ofloxacin 0.5 mg/ml).

Patch tests were negative to Moxifloxacin,

Ciprofloxacin, Norfloxacin, Levofloxacin

and Ofloxacin (10% pet.) with lecture at

24 and 48 h.

Oral controlled exposure to Moxifloxa-

cin (125 gr) was positive, showing immedi-

ate pruritus, erythema and angioedema in

the same eye. Oral provocation tests to

Levofloxacin and Ciprofloxacin were

negative.

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453448

Conclusion: The structural similarity of qui-

nolones, the clinical data on cross-reactions

and some in vitro analyses suggest frequent

cross-reactivity. Strict avoidance of all qui-

nolones is advisable, however in this case

the patient tolerated oral therapeutic dose

of Ciprofloxacin and Levofloxacin.

1226

Adverse reaction to recombinant factor

VII

Aguiar, R; Mendes, A; Fernandes, N; Pereira-Barbosa,

MA

Immunoallergology Department, Hospital de Santa

Maria-Centro Hospitalar Lisboa Norte, Lisbon, Portugal

Recombinant factor VII is very similar to

human factor VII and thus very few alergic

reactions are described. We present a case

of a woman, 51 years old, with diagnosis of

a Congenital Coagulopathy at the age of 47

after preoperative routine finding of ele-

vated TP and deficit factor VII = 8% (70–130%). She held the 1st Administration of

rFVIIa at the age of 48 prior to total colo-

noscopy without any adverse reactions.

Three years later she held the 2nd adminis-

tration of rFVIIa prior to elective laparo-

scopic colecystectomy and then again after

surgery. From day 1 to day 3 she did ther-

apy with recombinant FVII 8 mg 8/8 h ?12/12 h with no apparent reaction. On D3

and D4 morning she started feeling metallic

taste on the tongue 5–10 min after bolus of

factor VII and oropharyngeal pruritus,

oppression and high cervical dysphagia

accompanied by palpitations and pruritic

erythema located at the venous route local

infusion. In D5 it was requested the support

of Imunoallergology. Laboratory evalua-

tion TP 25.2/11.6 s, APTT 29.5/29.0 s, INR

2.11, Factor VI: C 10%, 295 mg/dl Fibrino-

gen, Factor VII Inhibitor negative. Skin

prick tests with rFact VII (vs six controls)

were negative. Intradermal tests were not

preformed due to lack of of reability. Skin

tests for aeroallergens including latex, ham-

ster and rabbit epithelium (in the event of

cross-allergy, since these animals are used in

the preparation of the factor) were also neg-

ative. She was proposed for administration

at Immunoalergology day-care Unit with

pre-medication with 40 mg methylpredniso-

lone, montelukast 10 mg, clemastine 2 mg,

ranitidine 50 mg and slow administration

(15 min) of 2 mg of recombinant rFact VII.

No adverse reactions ocurred after 150 min

surveillance. The patient was discharged

with the indication to continue the adminis-

tration according this scheme.She was able

to complete her treatment with no further

reactions.

1227

A non-immediate reaction to an

iodinated contrast medium

Aranzabal, MA1; Lizarza, S2; Lasa, EM2; Navarro, JA2;

Joral, A2; Echenagusia, MA3

1Allergy Unit, OSI Goierri-Alto Urola, Zumarraga,

Spain; 2Department of Allergology, Hospital

Universitario Donostia, San Sebasti�an, Spain; 3Allergy

Unit, OSI Bajo Deba, Mendaro, Spain

Background: Macular or maculopapular

exanthema is the predominant clinical pic-

ture of non-immediate radiocontrast media

(RCM) hypersensitivity and resemble to

other drug-induced eruptions. Patients with

previous delayed cutaneous reactions to

RCM are at risk for developing new erup-

tions upon re-exposure to the RCM and

another RCM should be chosen if repeated

exposures are required.

Case report: An 84-year-old woman was

referred after experiencing a symmetrical

erythematous and pruritic maculopapular

eruption that began on the trunk and pro-

gressed to the extremities. The patient was

taking celecoxib in the last 2 weeks due to a

lumbar pain and a myelography with iom-

eprol was performed 5 days before. After

withdrawal of celecoxib and starting treat-

ment with prednisone the skin lesions

resolved in 6 days. The allergy study was

carried out 4 weeks later. In 2005 after a

surgical intervention she suffered an exan-

thema suspicious of a drug-induced derma-

titis but the culprit drug wasn0t investigated.At that time a thoracic-abdominal scanner

was performed.

Results: Patch tests were positive to the

implicated iodinated contrast medium iom-

eprol and negative to celecoxib. She had

positive delayed intradermal tests with i-

omeprol and iohexol. Oral challenge test

with celecoxib was well tolerated. A month

later patch tests were positive to iobiditrol,

iodixanol, iopromide and ioxaglate and

negative to amidotrizoate. Intradermal test

was positive to amidotrizoate.

Conclusion: We report on a patient who

experienced a non-immediate hypersensitiv-

ity exanthema to iomeprol. The patch tests

and the intradermal test with iomeprol

have been useful tools in identifying the

causal agent. We have observed cross-

reactivity between different iodinated

contrast media as has been described.

1228

Multifocal fixed drug eruption due to

ornidazole

Demirel, F; Baysan, A; Yesillik, S; Kartal, O; Gulec, M;

Musabak, U; Sener, O1Division of Immunology and Allergic Diseases,

Gulhane Military Medical Academy and Medical

School, Ankara, Turkey

Background: Ornidazole, a synthetic nitro-

imidazole derivative, is widely used in clini-

cal practice. Ornidazol has low rate of side

effects, but sometimes may cause signifi-

cant allergic reactions such as fixed drug

eruption (FDE). We describe a case of

multifocal FDE caused by ornidazole.

Case report: A 40-year old woman applied

to the Immunology and Allergy clinic with

pruritic erythematous lesions over the lat-

eral sides of both arms and right hip

within 30 min after the ingestion of orniza-

dole 500 mg tablet. She reported that five

recurrent reactions emerged with the same

drug on the same locations previously, and

their severity was increased consecutively.

She was prescribed ornidazole for tricho-

monal vaginitis and she never warned phy-

sicians about the previous drug reactions.

In view of the personal history and physi-

cal examination a diagnosis of FDE due to

ornidazole was diagnosed. After a month

from the last reaction allergy tests includ-

ing prick, intradermal and patch tests were

performed with ornidazole and metranidaz-

ole. Skin tests with 1/100 W/vol and 1/

10 W/vol concentrations and undiluted

form of the two drugs were negative. The

patch tests consisted of the same drug con-

centrations were applied to the lesion site

on her left arm. Readings were done at

48 h later and positive results were

obtained with ornidazole but not with met-

ranidazole. A placebo controlled oral chal-

lenge was performed with metranidazole

and no reaction was observed. Following,

she contunied to receive metranidazole

without any problem.

Conclusion: The lesionel patch test is more

diagnostic than other allergy tests at

rec€urrent fixed drug reactions. The patch

test may be performed with the same drug

solutions as performed on skin prick and

intradermal tests without adding petrola-

tum. Although metronidazole and ornida-

zole are chemically related drugs, and

metranidazole is known more susceptible

to cause FDE, metranidazole may be an

alternative drug to ornidazole like our

case.

Poster Session Group II – Red. TPS 52 – The expanding universe of drug allergy

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 449

1229

Acute localised exanthematous

pustulosis by beta-lactam antibiotics

Mahecha, AC; P�erez-Calder�on, R; Gonzalo-Garijo, M�A;

Habernau, A; Corrales-Vargas, SI; Chiarella, GM

Allergology, Infanta Cristina University Hospital,

Badajoz, Spain

Introduction: Acute localised exanthema-

tous pustulosis (ALEP) is a localised vari-

ant of the generalised form (AGEP) which

presents with non-follicular pustules and is

triggered by drugs. We present a case of

ALEP due to beta-lactam antibiotics.

Case report: A 29 year-old woman pre-

sented two episodes of non-follicular pus-

tules (3–5 mm diameter) and surrounding

erythema on the perioral area after taking

amoxicillin-clavulanic acid for 5 days. The

first episode disappeared without treatment

within a week and the second in 4 days

after topical application of mupirocin and

mometasone. Both episodes resolved with-

out desquamation or residual lesions. The

patient had no fever, mucosal lesions, or

systemic manifestations. She has not had

previous or subsequent episodes without

taking drugs. Since then she has avoided

beta-lactam antibiotics but has tolerated

macrolides.

Methods and results: Total IgE, blood

count and biochemistry were normal.

Bacterial, viral and fungal cultures from

pustules were negative. No biopsy was

performed, given the location of lesions.

Patch tests with amoxicillin-clavulanic acid

20% in petrolatum applied on previously

affected skin and healthy skin on the back

proved negative at 48 and 96 h. IgE spe-

cific levels to penicillin, amoxicillin, ampi-

cillin and cefalosporin mixture were

negative. Prick and intradermal tests with

major and minor penicillin determinants,

amoxicillin, amoxicillin-clavulanic acid, ce-

furoxime and penicillin G were negative at

immediate and delayed reading. Controlled

oral administration of amoxicillin-clavul-

anic acid and cefuroxime was positive

after 3 days of treatment (the same lesions

reappeared around the mouth) and nega-

tive with cefditoren and cloxacillin (7-day

treatment) and ceftazidime (5-day treat-

ment).

Conclusions: We describe a case of ALEP

produced by amoxicillin-clavulanic acid

with good tolerance to other beta-lactams

(cefditoren, cloxacillin and ceftazidime) but

not to cefuroxime.

1230

Anaphylaxis to erythromycin diagnosed

by rechallenge

Ramos, T; Vega, F; Las Heras, P1; Valls, A; Daschner, A;

Blanco, C

Allergy, Hospital Universitario de la Princesa, Madrid,

Spain

Background: A 49-year old male, started

treatment with paracetamol, metamizol

and erythromycin, 15 min after intake he

started with genital, leg and groin itching,

followed shortly after by a macular rash,

labial angioedema and dizziness. On clini-

cal evaluation, hypotension was revealed

and he was treated with adrenalin. The

diagnosis was drug anaphylaxis.

When initially studied, drug oral chal-

lenge tests with paracetamol, nimesulide

and isonixine were negative. Subsequently,

he had tolerated codeine, tramadol, hyo-

scine methyl bromide and amoxicillin cla-

vulanic acid. After several years, he was

referred to our Allergy Department for

reevaluation.

Material and methods: Skin prick and

intradermal tests with erythromycin, clari-

thromycin, nystatin and spiramicin were

performed. Drug oral challenges with

metamizol and erythromycin were done.

Results: Skin and oral challenge tests with

metamizol were negative, as well as skin

tests with erythromycin. However, 60 min

after being oral challenged with erythromy-

cin 250 mg, he developed thoraxic ery-

thema and itching, which disappears

without treatment in some minutes. Then,

a new dosis of 250 mg of erythromycin

was administered and well tolerated. But

this challenge was considered unconclusive.

Some weeks later, a new drug challenge

with erythromycin was done. After 30 min,

he presented dizziness and sweating, but

not loss of consciousness. In spite of treat-

ment with methylprednisolone and dex-

chlorpheniramine, he began with palmar

pruritus, dyspnea, conjunctival erythema

and acute uticaria. Treatment with adrena-

lin was required, and he was discharged

asympthomatic.

After 1 month, skin prick tests were

repeated with different macrolide drugs

(erythromycin, clarithromycin, nystatin

and espiramicin), showing negative results.

Conclusions: We report a case of anaphy-

laxis to erythromycin, which was diagnosed

by rechallenge test.

We suggest to perform rechallenge tests

not only with beta-lactam antibiotics, but

also with other drugs, such as erythromy-

cin.

1231

Stevens–Johnson syndrome/Toxic

epidermal necrolysis overlap induced by

methotrexate: a case report

Calzada-Bustingorri, P1; Ure~na-Tavera, A1; Zamora-

Verduga, M1; Berges-Gimeno, P1; Sola-Martinez, J1;�Alvarez-Cuesta, E2

1Allergy Division, Hospital Ramon y Cajal, Madrid,

Spain; 2Head Allergy Division, Hospital Ramon y Cajal,

Madrid, Spain

Background: Methotrexate is one of the

most effective and commonly used medi-

cines in the treatment of several forms of

rheumatoid arthritis. It is known as a dis-

ease-modifying anti-rheumatic drug

(DMARD). In low doses methotrexate is a

generally safe and well tolerated drug.

There are few cases of delayed reaction

secondary to methotrexate.

Methods: A 35 years old man with non

erosive rheumatoid arthritis positive rheu-

matoid factor and anti-CCP, who was on

methotrexate and prednisone treatment,

followed irregularly. The patient came to

our hospital with a history of malaise, skin

lesion, and the day before fever and oral

mucosal ulceration.

During allergollogic history, the patient

referred to be under methotrexate (160 mg/

day) for the last 20 days due to a misun-

derstood of the prescription. Also, one day

before, he received his first leflunomide

dose. The patient denies recent viral infec-

tion. The methotrexate and leflunomide

were stopped.

Results: On physical examination revealed

targetlike lesions on palms and soles, sym-

metric purpuric plaques on both legs, con-

fluent macular rash on thorax, back and

proximal inner legs and multiple painful

oral ulcerations. No Nikolsky sign was

present.

A skin biopsy taken from his palm and

back showed a morphological finding com-

patible with exudative erythema multi-

forme /TEN/ Stevens-Johnson and during

his hospitalisation he developed pancytope-

nia and renal dysfunction. He was treated

with methylprednisolone, platelet transfu-

sion, folinic acid, filgrastim, cyclosporine,

and antibiotic prophylaxis. Having com-

plete resolution at 10th day of admition.

After discharge he received low doses of

methyprednisolone and tocilizumab, and

had no recurrence of Stevens-Johnson syn-

drome.

Conclusion: We present a case of Stevens-

Johnson syndrome/Toxic epidermal necrol-

ysis overlap induced by methotrexate.

This case demonstrated that even drugs

without high potential to develop severe

delayed skin reaction have to be taken

under consideration at the moment of the

evaluation of this disease.

Poster Session Group II – Red. TPS 52 – The expanding universe of drug allergy

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453450

1232

A case report of allergy to cephalosporin:

diagnosis and management

Perez-Rodriguez, E; Martinez-Tadeo, JA; Gonzalez-

Colino, C; Hernandez-Santana, G; Garcia-Robaina, JC

Service of Allergy, Hospital La Candelaria, Santa Cruz

de Tenerife, Spain

Background: In the last years, knowledge

about cross reactivity patterns between

beta-lactams drugs has increased. As a

consequence, it is usual to test cephalospo-

rin to patients with penicillin or amoxicillin

allergy. In cephalosporin allergy, antigens

are less known, although lateral chains are

though to play an important role. Cross

reactivity between cephalosporins with sim-

ilar lateral chains has been described.

Method: A 77 years old woman was

referred to our out-patient facility because

suspected drug allergy. She presented palm

and plant itching, difficult to breath, rash,

loss of conscience and hypotension imme-

diately after taking a tablet of cefuroxim.

She required adrenaline and vital support.

She previously has tolerated the drug.

Skin prick test and intradermal test were

programmed with major and minor penicil-

lin determinants (PPL and MDM), penicil-

lin, amoxicillin, imipenem, cefuroxime,

ceftriaxone and cefotaxime. For cefixime

and cefaclor only prick test was done using

an oral solution presentation.

Oral or intravenous graded challenges

were performed depending on the skin test

results.

Results: Skin prick test were positive for

cefuroxime, ceftriaxone and cefotaxime so

intradermal testing was not performed.

Prick test was negative to cefixime and

cefaclor.

Prick and intradermal test were negative

to PPL, MDM, penicillin, amoxicillin and

imipenem.

Despite of negative skin test for cefixime

and cefaclor the patient refused oral chal-

lenge with these cephalosporins.

Oral graded challenge to penicillin

allergy and intravenous challenge to imipe-

nem were performed, with excellent toler-

ance to both drugs.

Conclusion: We present a case report of

severe cephalosporin allergy with good tol-

erance to other beta-lactam drugs as amox-

icillin and imipenem.

Skin cross reactivity was found between

the culprit drug-cefuroxime- and other

cephalosporins with similar lateral chains

as cefotaxime and ceftriaxone.

The most probable sensitising antigen in

the case of this patient is the R1 lateral

chain.

1233

Severe systemic reaction to

trimethopim/sulfamethoxazole

Burgos Montero, AM1; Candon Morillo, R1; Gonzalez

Sanchez, LA1; Ruiz Le�on, B2; Moreno Mata, E1

1Allergy, Hospital, Alcazar de San Juan, Spain; 2Allergy,

Hospital La Mancha Centro, Alcazar de San Juan, Spain

Background: We report a 44 year old male

patient with known HIV infection since

1995 that is regularly followed by Internal

Medicine Department, and he had a good

adherence to antiretroviral treatment. He

had clinical criteria of chronic bronchitis

and rhinitis with an allergic history to

grass. He had received treatment with tri-

methoprim-sulfamethoxazole to prevent

Pneumocystis infection for five, 6 years but

he stopped treatment by himself 2 years

ago. Later, he was recommended to restart

the treatment by physician.

Method: We were required from Internal

Medicine ward to assess this admitted

patient from Emergency. He developed, in

indeterminate period of latency from the

new first intake to the symptoms onset, a

pruritic erythema involved palms and soles

that was extended progressively in a week.

Thus, he had fever (39°C) the early days

but not swollen lymphs. Skin lesions are

not papular or purpuric and he had bilat-

eral conjunctival erythema but not other

erosion mucous was evidenced.Total count

blood, biochemistry and coagulation were

performed 2 days before his admission to

the hospital and hospitalisation day. At

first, we observed eosinophilia (1200 eosin-

ophils/lL) and hypertransaminasemia with

normal coagulation and renal creatine. At

the second analysis we observed 900 eosin-

ophils and down transaminases. After

2 days of corticoids treatment analysis

became standard.

Results: We diagnosed a DRESS syn-

drome (drug reaction with eosinophilia and

systemic symptons) by trimethopim-sulfa-

metoxazole in a HIV patient. The possibil-

ity of desensitisation was assessed to this

patient. But, after reviewing clinical history

(bad adherence to treatment) and being in

mind involvement of internal organs,

trimethopim-sulfametoxazole substitution

to dapsone was decided.

Conclusion: DRESS is a severe immuned

mediated cutaneous reaction usually

induced by drugs. Besides, the incidence of

adverse reactions is three times higher in

immunocompromised patients such as

HIV. It is described some cases of desensi-

tisation, but it is with a high risk, since

internal involvement can compromise the

patient life.

1235

Allergy workup in 108 patients with

reported reactions to betalactam

antibiotic

P�erez-S�anchez, N1; Esponda-Ju�arez, K1; Escobar

Bola~nos, C1; Pescosolido, E1; Gonz�alez-Guti�errez, ML1;

Robledo Echarren, T1; Del Prado, N2; Fern�andez-Rivas,

M1

1Allergy Department, Hospital Clinico San Carlos,

IdISSC, Madrid, Spain; 2Preventive Medicine

Department, Hospital Clinico San Carlos, Epidemiology

Unit, IdISSC, Madrid, Spain

Background: Betalactam (BL) are the anti-

biotics most frequent involved in allergic

reactions. The allergy workup comprises

the performance of skin tests and serum

specific IgE (sIgE) determinations, and if

negative, drug provocation tests (DPT).

The aim of this study is to describe the

allergy workup in 108 adult patients

referred to our Allergy Dept. for adverse

reactions (AR) to BL.

Methods: Between July 2011 and Novem-

ber 2012, 108 adult patients with AR to

BL were studied in our Dept following the

EAACI/ENDA algorithm. Skin prick

(SPT) and intradermal (IDT) tests were

performed with PPL (penicilloyl-polyly-

sine), MDM (minor determinant mixture)

(Diater, Madrid, Spain), AMP (ampicillin,

20 mg/ml), PG (benzyl-penicillin, 1000 UI/

ml), AX (amoxicillin, 20 mg/ml). sIgE to

PG, PV (penicillin V), AMP and AX were

measured by means of ImmunoCAP (Ther-

mofisher Scientific Phadia), and considered

positive if ≥ 0.35 kUA/l. In those patients

with negative skin tests and sIgE, a DPT

was performed.

Results: The 108 subjects comprised 36

males and 72 females, mean age was 51.2 y

(range 18–83). Positive skin tests and sIgE

to at least one BL determinant were found

in 23 and 10 patients, respectively,

accounting for a confirmed BL allergy in

34/108 (31.5%). The remaining 74 patients

underwent a DPT with the culprit BL with

a positive outcome in 7 and negative in 67.

As a result BL allergy was confirmed in

41/108 (38%) patients, with AX involved

in 83% of reactions. Skin tests were not

performed in 4 patients due to previous

severe AR and positive sIgE. In the 37

patients skin tested three systemic reac-

tions, all grade 2, were observed during

IDT. The seven patients with confirmed

BL allergy in the DPT all experienced

immediate urticaria (grade 1–2). The 10

systemic reactions observed during IDT

and DPT resolved with oral or i.v. antihis-

tamines and corticosteroids, and only two

patients received i.m. adrenaline (1 in the

IDT and 1 in the DPT reactive groups).

Conclusion: In our experience BL allergy

has been diagnosed in 38% of patients

with reported reactions. The combination

Poster Session Group II – Red. TPS 52 – The expanding universe of drug allergy

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 451

of suggestive history and positive IgE

assessed by either skin tests or Immuno-

CAP, provided a positive diagnosis in 83%

of patients, and therefore DPT were only

required in 17%. Both IDT and DPT

induced mild to moderate systemic reac-

tions. Due to the intrinsic risk of the

allergy workup in BL allergy it should be

performed by experienced allergists in a

hospital setting.

1236

A case of amikacin-induced anaphylaxis

confirmed by in vivo and in vitro tests

Savoia, A1; Aitella, E2; De Bartolomeis, F2; Sacerdoti,

C2; Astarita, C1

1Second University of Naples, Napoli, Italy; 2University

of Naples Federico II, Napoli, Italy

Background: Amikacin has recently been

involved in a case of DRESS. We report

the first case of Amikacin-induced anaphy-

laxis as confirmed by skin tests and baso-

philes activation test (BAT)

Method/Results: In October 2013, we

evaluated a 51 years old man for a recent

episode of anaphylaxis. The patient suf-

fered from obesity, hypertension, and

chronic ulcerative phlebostasis of inferior

limbs with recurrent superinfections by

Amikacin sensitive bacteria. In January

and March 2013 the patient completed

two cycles with Amikacin at dosage of

500 mg/day for 10 days. In May 2013, ten

minutes after starting a new cycle of Ami-

kacin, he developed anaphylaxis that was

solved in A&E Department. Patient’s med-

ical history was negative for previous

allergic diseases. Nonirritating concentra-

tions of Amikacin were used for skin

prick test (max. 25 mg/ml) and for intra-

dermal test (max. 2.5 mg/ml). SPT was

negative at 25 mg/ml, but IDT was

slightly positive at 0.025 mg/ml and

strongly positive at 0.25 mg/ml. Skin tests

with maximum nonirritating concentra-

tions of Gentamicin (4 mg/ml) were nega-

tive. The baseline BAT was negative at

different doses (500 ng; 5 mg; 50 mg) of

pure drug/120 ml of blood peripheral cells

final suspension, probably because of the

haptenic nature of the drug. When BAT

was repeated after an overnight incubation

of the drug with patient0s serum, signifi-

cant basophiles activation values (>5%)

were achieved at dose of 50 mg/120 ml of

blood peripheral cells final suspension.

BAT was also positive after an overnight

incubation of Amikacin with human albu-

min. BAT with patient’s serum without

drug and BATs vs pure and pre-incubated

Amikacin in five healthy subjects were

negative.

Conclusion: To our knowledge, this is the

first report of immediate specific hypersen-

sitivity to Amikacin that has been con-

firmed in vivo by using nonirritanting

concentrations of the drug, and in vitro by

BAT performed with a hapten-carrier deri-

vate of Amikacin.

1237

Acute generalised exanthematous

pustulosis (AGEP) due to pantoprazole: a

case report

Ameiro Mateos, B1; Zambrano Ibarra, G1; Caralli Bonet,

ME1; Seoane Rodriguez, M1; Bell�on Heredia, T2;

De Barrio Fern�andez, M1

1Allergy, H.G.U. Gregorio Mara~n�on, Madrid, Spain;2Instituto de Investigaci�on Hospital Universitario La

Paz-IdiPAZ, Madrid, Spain

Background: AGEP is characterised by

several small sterile pustules over an ery-

thematous-edematous skin. Fever, neutro-

philic leukocytosis and eosinophilia may

also be associated. Although this entity is

considered a severe cutaneous adverse reac-

tion the prognosis is usually favourable,

especially in young adults.AGEP is usually

drug induced, principally with antibiotics.

The proton pump inhibitors (PPI) have

been implicated exceptionally (omeprazole

and lansoprazole).

Method: A 37-year-old man, with personal

history of polynosis and cholecystectomy

went to the Emergency Room because on

the fourth day of the administration of

amoxicillin-clavulanic acid and pantopraz-

ole presented exanthema on the back, pap-

ules and pustules on anterior thorax and

upper limbs, facial erythema and desqua-

mation. He had no fever. An analytical

blood was performed that showed neutro-

philic leukocytosis. He was diagnosed by

the dermatologist as AGEP and treated

with topical corticosteroid and antihista-

mine, resolved in 4 weeks with desquama-

tion.Skin tests, challenge tests and

lymphocyte transformation test (LTT) were

performed.

Results: ID was negative with amoxicillin-

clavulanic acid, PNG, PPL and MDM.

Patch test (PT) was negative with amoxicil-

lin-clavulanic acid and pantoprazole.

As we thought the most likely cause was

the antibiotic, we started a simple blind

controlled challenge test with pantoprazole,

being positive 72 h after (erythema, pap-

ules and sterile pustules appeared on lat-

eral trunk zone, armpits and arms). For

this reason afterwards we made a LTT that

was positive with pantoprazole and

omeprazole and negative with amoxicillin-

clavulanic acid.The challenge test with

amoxicillin-clavulanic acid was negative.

Conclusion: We present a case of AGEP

due to pantoprazole confirmed by chal-

lenge test.

In this case the LTT was useful for the

etiologic diagnosis but not the PT.

We have observed cross-reactivity with

other PPI (omeprazole).

1238

Cross-reactivity to acetaminophen and

NSAIDs: a case report

Loloci, G; Hoxha, M; Nikolla, E; Marko Plaku, O;

Deliu Shameti, A; Gjata Loshe, E

Service of Allergology and Clinical Immunology,

University Hospital Center ‘Mother Theresa’, Tirana,

Albania

Background: NSAIDs are responsible for

21–25% of reported adverse drug events

which include immunological and nonim-

munological hypersensitivity reactions.

Hypersensitivity to Acetaminophen (ACT)

are rare. Hypersensitivity to ACT cause

urticaria, angioedema, and anaphylactic

reactions. The mechanism of multiple

drug-induced reactions is not clear. Mecha-

nisms related to inhibition of COX-1, as in

case of cross-reactive types of NSAIDs

hypersensitivity, have been suggested.

Case report: A 10 years old boy with past

history of adverse drug reaction came in

our clinic (2013) to perform an oral chal-

lenge test with acetaminophen (2011). He

refered that due to a viral condiction, after

receiving ibuprophen 400 mg and acetami-

nophen 500 mg, he had periorbital angioe-

dema and erithema, dry cough, without G-

I, and respiratory manifestation. (2012) He

received ibuprofen 400 mg and acetamino-

phen 500 mg due to another viral condi-

tion, and he manifested the same

symptoms as the first episode. (July 2012)

The third episode happened after taking

acetaminophen 500 mg and acid mefenam-

ic 500 mg with all over mentioned symp-

toms and rhinorea. About a month ago he

presented to our clinic, after receiving acet-

aminophen 1500 mg and metamizole

400 mg with dry cough, severe dyspnea,

periorbital angioedema, erithema, and cili-

ary injection. He had also a 4 years histori

of rhinitis. Usually laboratory tests were

normal. SPT and specific IgE were positive

to D.Pter, D.Farinea, Altern, Cladosp. We

decided to perform oral challenge test with

acetaminophen, and the result was positive

in a dose of 650 mg, the clinical manifesta-

tion was periorbital angioedema and erit-

hema, dry cough, dyspnea, chest tightness,

hypotension. He was treated with 1/3 epi-

nephrine, prednisolone and antihistamine.

Discusion and Conclusion: Higher preva-

lence of atopic background was reported.

A stepwise approach to the diagnosis of

Poster Session Group II – Red. TPS 52 – The expanding universe of drug allergy

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453452

hypersensitivity to NSAIDs is proposed,

including clinical history, in vitro testing

and/or provocation oral test alternative

drug depending on the type of the reaction.

Aspirin sensitivity has not frequently been

described in younger age groups. This

patient also had several unusal features in

that he presented first with sensitivity to

acetaminophen that was then aspirin sensi-

tivity. He had angioedema and erithema,

dry cough, dyspnea with both NSAID and

acetaminophen. He had combined pulmo-

nary and cutaneous manifestations to both

acetaminophen and NSAID, which are

rarely described, and he had anaphylaxis

with high-dose acetaminophen.

Poster Session Group II – Red. TPS 52 – The expanding universe of drug allergy

© 2014 The Authors

Allergy © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, 69 (Suppl. 99), 326–453 453