Anaphylaxis Research Articles

Recombinant Antibody Fragments for Neurological Disorders: An Update.

Recombinant antibody fragments are promising alternatives to full-length immunoglobulins, creating big opportunities for the pharmaceutical industry. Nowadays, antibody fragments such as antigen-binding fragments (Fab), single-chain fragment variable (scFv), single-domain antibodies (sdAbs), and bispecific antibodies (bsAbs) are being evaluated as diagnostics or therapeutics in preclinical models and in clinical trials. Immunotherapy approaches, including passive transfer of protective antibodies, have shown therapeutic efficacy in several animal models of Alzheimer's disease (AD), Parkinson's disease (PD), frontotemporal dementia (FTD), Huntington's disease (HD), transmissible spongiform encephalopathies (TSEs) and multiple sclerosis (MS). There are various antibodies approved by the Food and Drug Administration (FDA) for treating multiple sclerosis and two amyloid beta-specific humanized antibodies, Aducanumab and Lecanemab, for AD. Our previous review summarized data on recombinant antibodies evaluated in pre-clinical models for immunotherapy of neurodegenerative diseases. Here, we explore recent studies in this fascinating research field, give an update on new preventive and therapeutic applications of recombinant antibody fragments for neurological disorders and discuss the potential of antibody fragments for developing novel approaches for crossing the blood-brain barrier (BBB) and targeting cells and molecules of interest in the brain.

Epitope profiling of cow's milk allergen-specific antibodies with determining IgE content in epitopes-ALL, a 14-epitopes mixture

Allergen-specific antibodies (Abs), IgE, and IgG4 increase during the early phase of oral immunotherapy (OIT) of allergen food in patients; subsequently, IgE levels decrease and specific IgG4 levels increase after successful OIT treatment. The detailed profile of these Abs during OIT remains largely unclear. We developed a diagnostic tool to assess the OIT efficacy and extent of responsiveness based on a profiling method by identifying epitopes recognized by the Ab classes of IgE or IgG4.A peptide microarray followed by microplate analysis using synthetic peptides was used to identify 14 epitopes widely recognized by IgE and/or IgG4 in the serum samples of patients with OIT among the amino acid sequences of five major cow's milk allergens. The set of defined 14 epitopes clarified different epitope profiles of allergen-specific IgE and IgG4 in each patient's serum samples. Moreover, the total signal of Abs recognizing all 14 epitopes was equal to the sum of all individual epitope-specific Abs. It was further observed that the quantitative value of IgE concentrations of 14 epitopes-ALL correlated with the ImmunoCAP IgE value.These findings strongly imply that the quantity of IgE and IgG4 recognizing epitopes-ALL may easily be used to measure allergy severity. To investigate this potential, we developed an immunochromatographic method that can detect IgE and IgG4 levels in patient samples.This study clearly demonstrated the usefulness of the defined 14 epitopes and their mixture, “epitopes-ALL,” and that the simple and reliable methods of immunochromatography and microplate analyses demonstrating the epitope profile of allergen-specific Abs are applicable for diagnostic use at multiple disease stages and the OIT-treatment course in patients with cow's milk allergy.

A 3D-Printed Bionic Membrane with Autonomously Passive Unidirectional Liquid Transfer Capability for Water Condensation, Collection, and Purification.

Interfacial solar vapor generation is a promising technology for alleviating the current global water crisis, and the evaporation rate and efficiency have approached the theoretical limit. In a practical interfacial evaporation water purification system, the collection rate of purified water is typically lower than the evaporation rate. Passive collection devices based on gravity are susceptible to environmental influences and exhibit low collection efficiency, while active collection devices consuming external energy suffer from complex device systems and extra energy consumption. Given that both collection devices are nonselective and unable to distinguish contaminants mixed in the vapor, bionic membranes with autonomously passive and unidirectional water transfer capacity are developed through 3D printing for efficient water collection. More importantly, the bionic membranes are capable of high-speed water transportation without the need for external energy or gravity drive and liquid-selective transportation for separating oily pollutants from the collected products. The directional transport property facilitates the modular assembly of the bionic membrane, extending its application to practical large-scale solar-driven seawater desalination systems.

Effect of Blood Sampling Time After Colostrum Intake on the Concentration of Metabolites Indicative of the Passive Immunity Transfer in Newborn Dairy Calves.

Due to the synepitheliochorial placental structure, bovines show no maternal antibody flow from mother to fetus during pregnancy, resulting in an agammaglobulemic newborn [...].

Diagnostic Accuracy of Tryptase Levels for Pediatric Anaphylaxis: A Case-Control Study

Introduction: Anaphylaxis is a severe allergic reaction which can be difficult to diagnose. Two strategies evaluating changes in tryptase levels were proposed for diagnosing anaphylaxis. Strategy 1 established a threshold of tryptase levels during reaction exceeding 2 ng/mL + 1.2* (baseline tryptase levels) as a rule for detecting anaphylaxis, while strategy 2 established the ratio of tryptase levels during reaction versus baseline tryptase exceeding a threshold of 1.685. We aimed to compare the diagnostic test accuracy of the two strategies in pediatric anaphylaxis. Methods: We conducted a case-control study. Cases consisted of 89 patients with anaphylaxis who had reaction tryptase and subsequent baseline tryptase measured. Controls consisted of 25 patients with chronic urticaria who had two tryptase measurements. Sensitivity and specificity for each of the strategies were computed and compared using McNemar test. The area under the curve (AUC) between the two strategies was compared using the DeLong test. Results: The sensitivity and specificity for strategy 1 was 53.3% and 95.0%, respectively. For strategy 2, the sensitivity and specificity was 54.4% and 85.0%, respectively. There was no significant difference between both strategies’ sensitivity and specificity. The Delong test determined that the AUC was significantly (p < 0.05) higher for strategy 1 (0.69) than strategy 2 (0.64). Conclusion: The Delong test determined that strategy 1 was slightly better in validating anaphylaxis diagnosis than strategy 2. However, both strategies demonstrated a low sensitivity <55%.

A case of anaphylactic reaction to oxytocin in a parturient undergoing emergency caesarean section

Anaphylaxis to oxytocin is a rare but critical complication that can arise during labor and delivery [1], necessitating rapid recognition and management. We describe the case of a 20-year-old term primigravida with gestational hypertension who underwent an emergency lower segment caesarean section (LSCS) due to fetal distress. After successful spinal anesthesia with 0.5% bupivacaine, an infusion of 10 U oxytocin was initiated immediately following the delivery of the infant. Shortly thereafter, the patient developed acute respiratory distress, hypotension, and swelling of the lips and tongue, which progressed to bradycardia and a drop in oxygen saturation. Emergency intubation was performed due to significant airway edema, and resuscitation included intravenous adrenaline, atropine, hydrocortisone, pheniramine, and deriphylline. The surgical procedure concluded uneventfully, and the patient was transferred to the ICU for mechanical ventilation. She was extubated the following day and discharged five days later without complications. This case underscores the rare occurrence of anaphylaxis due to oxytocin administration. It highlights the need for vigilance and preparedness for allergic reactions in obstetric settings, as well as the importance of having alternative uterotonics available.

Eosinophil-Basophil/Lymphocyte (EB/LR) and Eosinophil-Basophil-Platelet/Lymphocyte (EBP/LR) Ratios Could Serve as Useful Additional Markers for Assessing the Severity of Wasp Allergic Reactions.

Wasp venom allergy can trigger severe allergic reactions, and predicting these acute responses remains challenging. This study evaluates the utility of immune system indexes, particularly the eosinophil-basophil/lymphocyte (EB/LR) and eosinophil-basophil-platelet/lymphocyte (EBP/LR) ratios, in assessing the severity of allergic reactions in patients with wasp venom allergy. A total of 61 patients with confirmed wasp venom allergy were categorized according to the Mueller scale, which classifies the severity of allergic reactions. Blood samples were analyzed for total and specific IgE levels alongside a range of hematological and biochemical parameters. This study found significant differences in the EB/LR and EBP/LR indexes between patients with mild (Mueller I-II) and severe (Mueller III-IV) allergic reactions, with higher values indicating more severe responses. However, no significant differences were observed in other immune indexes, such as the platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, and systemic inflammatory response index, as well as in additional blood parameters. These findings suggest that the EB/LR and EBP/LR ratios may serve as useful markers for predicting the severity of allergic reactions in patients with wasp venom allergy. This is the first study to establish such a link, although further research with larger cohorts is necessary to confirm these results and their potential application in clinical settings.

Pediatric Allergy Management at ULSNE: Insights into Public Health Implications

Abstract Introduction Pediatric allergies present a complex challenge to public health systems, affecting both policy-making and clinical management. This study explores the management trends and challenges of pediatric allergies at the Unidade Local de Saúde do Nordeste (ULSNE) in Portugal, emphasizing its implications for refining healthcare practices over a seven-year period. Methods A retrospective review of medical records was performed, from children aged 0 to 18 who presented with allergic reactions at ULSNE’s emergency services between 2017 and 2023. The analysis concentrated on demographics, allergen types, reaction severity, and the management strategies deployed. Results The analysis revealed a wide range of allergens, from food to insect stings, with medication being the most prevalent triggers. Significant findings include observing severe allergic reactions across all age groups, highlighting the need for acute emergency interventions. The data underscores a critical demand for early diagnosis and tailored-made management plans to efficiently handle the diverse severity of allergic reactions observed. Conclusions This study demonstrates the complexity of managing pediatric allergies within ULSNE’s public health framework. Standardized, evidence-based management methods should be adopted to strengthen emergency response capabilities, as shown by the frequency of severe responses and the prevalence of various allergens. As an outcome, our results support a comprehensive, interdisciplinary strategy that includes medical personnel, educational institutions, and family involvement to create a supportive community that is supportive of both immediate care and long-term preventive measures. Subsequent efforts should give precedence to educational programs designed to increase consciousness and encourage preventive measures in community environments. Key messages • A rapid response is essential for healthcare systems to have fast, effective strategies ready for children’s severe allergic reactions. • Emphasizes a collective approach involving healthcare workers, schools, and families to prevent and manage children’s allergies, enhancing safety and awareness.

Adverse Drug Reactions to β-Lactam Antibiotics: A Portuguese Pharmacovigilance Database Analysis

Abstract Background The β-lactam antibiotics are one of the most relevant drug classes globally. They accounted for the largest share of systemic antibiotics consumption in Portugal across both community and hospital settings. Due to their significance, continuous monitoring of adverse drug reactions (ADR) associated with β-lactams is fundamental. Aim To analyse and characterise cases related to β-lactam antibiotics received by the Portuguese National Pharmacovigilance System. Methods Retrospective analysis of cases containing at least one medicinal product classified as suspect under the Anatomical Therapeutic Chemical (ATC) code J01C or J01D, reported to the Portuguese Pharmacovigilance System between 2014 and 2023. Characterisation of cases considered patient demographics, reported suspected medicines, MedDRA Preferred Term (PT), seriousness and type of reporter. Results A total of 3557 cases were identified (54.0% females; median age = 42.0 years; interquartile range = 52.2), with 95.9% originating from spontaneous reporting and 93.5% being reported by healthcare professionals. The most frequently reported medicines were those belonging to ATC J01CR. Around 70% of cases were classified as serious, with 38.7% being related to situations of disability or other criteria of greater seriousness. Most frequently reported PTs were related to skin disorders. Anaphylactic reaction was the most reported Designated Medical Event term. The PTs “Drug ineffective” and “Off label use” were reported in 5.2% and 2.4% of the cases, respectively. Conclusions Despite the majority of cases are serious, most of the ADR identified are related to already known hypersensitivity reactions. To improve the knowledge regarding these medicines and to generate evidence to address emerging public health issues it is of paramount importance to strength the Portuguese Pharmacovigilance System. This can be achieved through enhancing spontaneous reporting and implementing active pharmacovigilance programs. Key messages • Monitoring the efficacy and safety profile of β-lactams in a real-world context is crucial to mitigate the impact in public health and associated economic burden. • Enhancing the surveillance systems improves data collection and evidence generation, supporting tailoring treatment approaches and implementation of public health policies.

"The medicine is not something that interests me at all." Beliefs, health-related behaviors, and medication adherence in patients with symptomatic peripheral arterial disease

Abstract Background Despite evidence-based guidelines recommending secondary prevention with antithrombotics and lipid-lowering therapies, adherence to optimal pharmacological therapies remains suboptimal in patients with symptomatic lower extremity peripheral arterial disease (PAD), potentially contributing to excess morbidity and mortality. However, the behavioral factors and health beliefs underlying this behavior are still poorly understood. Purpose To explore the health-related behaviors and beliefs of patients with symptomatic PAD regarding secondary preventive therapy. Methods Using a qualitative design, we conducted individual semi-structured interviews with patients diagnosed with symptomatic PAD. Participants were recruited from four departments of vascular surgery in Denmark from December 2022 to January 2024. Data analysis was performed using framework analysis based on the six domains of the Health Belief Models1 (HBM) as analytical framework: perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy. The HBM is widely used for conceptualizing individual’s attitudes and beliefs to explain and predict health behaviours. Results Sixteen patients participated in the study: seven adherent and nine non-adherent patients. Based on the HBM components, the following findings emerged (Figure 1). Patients expressed low perceived awareness of the severity of PAD and its potential consequences, not recognizing PAD as a systemic condition associated with broader cardiovascular risk. The perception of PAD centered around the experience of excruciating leg pain and its impact on everyday life. This focus on symptoms affected the perceived benefits of secondary preventive therapies. Patients lacked knowledge about the importance and goal of treatment and did not link the secondary preventive therapy to PAD, often associating it only with other cardiovascular diseases. Barriers included inadequate understanding of the chronic progressive nature of PAD and its severity, experience and fear of side-effects, prescription confusion, pill burden, financial constraints, and allergies. Fear of recurring pain, complications, and early death served as strong internal adherence triggers. Paradoxically, despite expressing fear, some patients were only adherent to antithrombotic therapy, not assigning the same importance to statins. Other cues to action included practical arrangements as well as establishing a trusting patient-provider relationship and receiving comprehensive and logical explanations. Conclusions This study provided new perspectives on the multifaceted challenges hindering adherence to secondary preventive therapy among patients with symptomatic PAD. Notably, the insufficient knowledge regarding the chronic progressive nature of PAD and its cardiovascular implications, underscores the need for enhanced patient education and tailored interventions to ensure optimal secondary preventive therapy.Figure 1

Combining low- and high-frequency microwave radiometer measurements from the MOSAiC expedition for enhanced water vapour products

Abstract. In the central Arctic, high-quality water vapour observations are sparse due to the low density of meteorological stations and uncertainties in satellite remote sensing. Different reanalyses also disagree on the amount of water vapour in the central Arctic. The Multidisciplinary drifting Observatory for the Study of the Arctic Climate (MOSAiC) expedition provides comprehensive observations that are suitable for evaluating satellite products and reanalyses. Radiosonde observations provide high-quality water vapour estimates with a high vertical but a low temporal resolution. Observations from the microwave radiometers (MWRs) on board the research vessel Polarstern complement these observations through high temporal resolution. In this study, we demonstrate the high accuracy of the combination of the two MWRs HATPRO (Humidity and Temperature Profiler) and MiRAC-P (Microwave Radiometer for Arctic Clouds – Passive). For this purpose, we developed new retrievals of integrated water vapour (IWV) and profiles of specific humidity and temperature using a neural network approach, including observations from both HATPRO and MiRAC-P to utilize their different water vapour sensitivity. The retrievals were trained with the European Centre for Medium-Range Weather Forecasts (ECMWF) reanalysis version 5 (ERA5) and synthetic MWR observations simulated with the Passive and Active Microwave radiative TRAnsfer tool (PAMTRA). We applied the retrievals to synthetic and real observations and evaluated them with ERA5 and radiosondes launched during MOSAiC, respectively. To assess the benefit of the combination of HATPRO and MiRAC-P compared to single MWR retrievals, we compared the errors with respect to MOSAiC radiosondes and computed the vertical information content of the specific humidity profiles. The root mean squared error (RMSE) of IWV was reduced by up to 15 %. Specific humidity biases and RMSE were reduced by up to 75 % and 50 %, respectively. The vertical information content of specific humidity could be increased from 1.7 to 2.4 degrees of freedom. We also computed relative humidity from the retrieved temperature and specific humidity profiles and found that RMSE was reduced from 45 % to 15 %. Finally, we show a case study demonstrating the enhanced humidity profiling capabilities compared to the standard HATPRO-based retrievals. The vertical resolution of the retrieved specific humidity profiles is still low compared to radiosondes, but the case study revealed the potential to resolve major humidity inversions. To what degree the MWR combination detects humidity inversions, also compared to satellites and reanalyses, will be part of future work.

Transcatheter patent foramen ovale closure in patients with and without documented nickel hypersensitivity

Abstract Background Transcatheter PFO closure has been established as a safe and feasible approach for secondary prevention in appropriately selected patients with previous cryptogenic stroke. The two FDA-approved devices, widely used, consist of a nitinol frame; a nickel-titanium alloy. Although nickel is recognized as the primary metal causing hypersensitivity reactions worldwide, the potential occurrence of nickel hypersensitivity following PFO closure remains a subject of debate. Purpose The aim of this study is to investigate whether patients with nickel hypersensitivity are more susceptible to experiencing adverse events after PFO closure and to explore the potential role of device selection. Methods We prospectively enrolled patients undergoing PFO closure at our tertiary hospital. Before the procedure, all patients underwent nickel skin patch tests, considered the gold standard for diagnosing nickel hypersensitivity. Subsequently, patients were randomized to receive one of the two FDA-approved devices. During a three-month follow-up period, we evaluated the primary endpoint, a composite outcome including patient-reported chest pain, palpitations, headaches, and rash. Blinding was maintained for the patients, the operator, and the assessor of endpoints regarding the results of the nickel skin patch tests. The chi-squared test was utilized to evaluate the primary endpoint. Results for continuous variables are expressed as mean ± standard deviation or, for non-normally distributed variables, as median (interquartile range). Results Between January 2021 and November 2023, a total of 63 patients were included in our analysis. The majority were men (n=33, 52.4%) with a mean age of 46.1 ± 10.1 years. The median RoPE score was 7 (6-8). Nickel hypersensitivity was documented in 30.8% of the patients. The primary endpoint was met in 37.7% (n=23) of the total sample, with a significantly higher incidence in patients with nickel hypersensitivity than in those without (61.1% versus 27.9%, p=0.015, OR: 4.060, 95% CI: 1.275 – 12.930). No significant difference was observed when analyzing the two devices separately (p=0.096 and p=0.078, respectively). No recurrent ischemic stroke, severe anaphylactic reaction, or requirement for device surgical removal was observed in any patient. Conclusions Our findings indicate that patients with documented nickel hypersensitivity are more likely to develop symptoms such as chest pain, palpitations, headaches, and rash following the procedure. However, these findings do not raise major safety concerns. The completion of our study is necessary to acquire more reliable and conclusive results.

Specific anti-toxic immunotherapy: use in medical practice and perspectives

The results of use of approaches and means of antitoxic immunotherapy in medical practice are summarized: passive transfer of various variants of antibodies specific to toxic compounds, vaccination – specific active immunization with vaccines carrying determinants of the immunochemical specificity of target toxic compounds. The practical effectiveness of the known approaches of passive transfer and vaccination is associated with the ability of specific antibodies, by binding target bioactive compounds with pronounced toxicity, to change the availability of corresponding structures in the body-targets and, in the presence of a sufficient number of specific antibodies with high binding ability to the target compounds, neutralize their toxicity. In medical practice, polyspecific heterologous antisera or the gamma globulin fraction of antisera (extremely rare monoclonal antibodies of narrow specificity) are widely used for passive transfer as antidotes in the treatment of victims in order to prevent deaths and extensive necrosis of soft tissues at the site of the bite of poisonous snakes and insects. Active immunization – vaccination with appropriate antigenic drugs should create in immunized individuals a state of humoral immunity with the corresponding characteristics of antibody formation specific to the target compound. When a target toxic compound enters an immunized organism, it is also possible to neutralize its toxicity. The most successful experience in using the principles of active immunization as a technology for specific antitoxic therapy is associated with the practice of using toxoids for toxinemic infections. Specific practical techniques used to achieve the effectiveness of possible approaches to specific antitoxic immunotherapy in the form of passive transfer of specific antibodies or their fragments are considered: to combat lethal infections in the pathogenesis of which the toxic effects of bacterial exotoxins are significant; when treating victims of snake and insect bites, exposure to poisons of marine organisms, algae and plant toxins; in the treatment of severe intoxication with certain low molecular weight toxic substances: digoxin, colchicine, tricyclic antidepressants. The most successful experiences of using the principles of active immunization as a technology for specific antitoxic therapy, based on the use of toxoids with specificity for diphtheria, tetanus, botulism, cholera, typhoid fever, dysentery, gas gangrene and other toxinemic infections, are also considered. The fairly high immunogenicity of toxoids with the possibility of activating both constitutional and adaptive immunity has become the basis for their use as macromolecular carriers of hapten analogues of narcotic substances – a promising direction in drug addiction, in the implementation of which a number of experimental molecular and combined vaccines of opiates, methamphetamine, cocaine, and nicotine. This variant of practical efforts in medicine can be regarded as a new direction of specific antitoxic immunotherapy – an option to combat drug addiction by vaccinating drug addicts.

Antibodies targeting the Crimean-Congo Hemorrhagic Fever Virus nucleoprotein protect via TRIM21

Crimean-Congo Hemorrhagic Fever Virus (CCHFV) is a negative-sense RNA virus spread by Hyalomma genus ticks across Europe, Asia, and Africa. CCHF disease begins as a non-specific febrile illness which may progress into a severe hemorrhagic disease with no widely approved or highly efficacious interventions currently available. Recently, we reported a self-replicating, alphavirus-based RNA vaccine that expresses the CCHFV nucleoprotein and is protective against lethal CCHFV disease in mice. This vaccine induces high titers of non-neutralizing anti-NP antibodies and we show here that protection does not require Fc-gamma receptors or complement. Instead, vaccinated mice deficient in the intracellular Fc-receptor TRIM21 were unable to control the infection despite mounting robust CCHFV-specific immunity. We also show that passive transfer of NP-immune sera confers significant TRIM21-dependent protection against lethal CCHFV challenge. Together our data identifies TRIM21-mediated mechanisms as the Fc effector function of protective antibodies against the CCHFV NP and provides mechanistic insight into how vaccines against the CCHFV NP confer protection.

School Teachers' Knowledge and Attitudes Related to Anaphylactic Reactions: A Cross-Sectional Study

School Teachers' Knowledge and Attitudes Related to Anaphylactic Reactions: A Cross-Sectional Study

When allergies have no name: is idiopathic anaphylaxis driven by co-factors?

Idiopathic anaphylaxis (IA) is a severe allergic reaction without identifiable external triggers, presenting significant challenges in diagnosis and management. However, growing evidence suggests that many cases classified as idiopathic may actually be driven by cofactors such as exercise, hormonal fluctuations, medications, or hidden allergens. This mini-review explores the evolving understanding of IA, highlighting the role of these cofactors in triggering or amplifying anaphylactic reactions. It emphasizes how advances in diagnostic tools, including component-resolved diagnostics, are helping to identify previously undetected allergens, leading to more accurate diagnoses and reducing the prevalence of true idiopathic cases. As our knowledge of anaphylaxis and its underlying mechanisms deepens, the need for comprehensive evaluations that account for cofactor involvement becomes increasingly clear. Continued research in this area is essential to improve patient outcomes and better manage this complex condition.

The Efficacy and Safety of Stepwise Oral Food Challenge in Children with Cow’s Milk Allergy

Plain Language SummaryStepwise oral food challenge (OFC) tests begin with low doses of allergens, progressing to full doses. This is one of the strategies used to avoid anaphylactic reactions to the reintroduction of allergens. We previously reported the safety and efficacy of hen egg OFC. In this study, we discuss it for cow’s milk (CM) allergy. We included 927 children (median age, 3.2 years) who underwent CM-OFC between 2017 and 2021. The target challenge dose was classified as low (<10 mL), middle (≥10 mL but <100 mL), or full. When the participants reacted to low doses, they underwent very low-dose OFC using baked milk or <1 mL of CM. Positive reactions developed in 210 cases (22.7%), including 69 anaphylactic reactions (7.4%). A lower target dose resulted in more positive OFC results and anaphylaxis. Multivariate analysis indicated that only in low-dose OFCs, higher CM-specific IgE (CM-sIgE) levels, younger age, and complete CM elimination were associated with positive OFC results. Food ladders, an approach to reintroduce allergens, are becoming increasingly popular. Although we believe that OFC is a safer strategy to reintroduce CM to children with CM allergy, our CM-OFCs appeared to develop more anaphylactic reactions than milk ladders. The stepwise OFC reintroduced small amounts of CM, even in cases with high CM-sIgE levels or a history of anaphylaxis. Performing CM-OFC at a younger age, preferably from infancy, with very low doses, similar to milk ladders, may facilitate the safe reintroduction of CM.

Difference in Allergenicity between β-Lactoglobulin in Bovine Milk and Caprine Milk is Related to Their Respective Digestive Stability.

The underlying cause of differences in sensitization between bovine and caprine milk β-lactoglobulin (β-LG) remains unclear. In this study, denatured forms of bovine and caprine milk β-LG were obtained through reductive alkylation and evaluated for allergenicity and digestibility in Balb/c mice. Results indicated weaker sensitization to nondenatured caprine milk β-LG compared to nondenatured bovine milk β-LG, with no significant difference in sensitization observed between denatured β-LG from both sources. The nondenatured β-LG of caprine milk and two types of denatured β-LG were degraded more rapidly than nondenatured bovine milk β-LG in the small intestine of mice. In terms of undenatured proteins, mouse intestinal tissues absorbed more bovine milk β-LG than caprine milk β-LG. Overall, structural disparities in β-LG between bovine and caprine milk resulted in varying digestion rates. Moreover, the slower-degraded bovine milk β-LG and its enzymatic fragments facilitated easier absorption by the intestine, disrupting the Th1/Th2 balance and increasing susceptibility to severe allergic reactions in mice.

Successful administration of cetuximab using dose escalation method: a case report

IntroductionCetuximab, used to treat head and neck squamous cell carcinoma and metastatic colorectal cancer, can cause severe infusion reactions.Case presentationWe report an 87-year-old East Asian woman with stage IV ileocecal signet ring cell carcinoma who experienced severe allergic reactions to cetuximab despite pre-treatment. A dose escalation method, involving weekly incremental doses with comprehensive pre-treatment and close monitoring, was employed, successfully reducing allergic reactions and allowing safe administration.ConclusionThis approach demonstrates a viable alternative for patients with hypersensitivity to cetuximab, warranting further research for personalized treatment optimization.

Anaphylatic Shock during Surgery for Hydatid Cyst of the Liver

Anaphylatic Shock during Surgery for Hydatid Cyst of the Liver