Int Arch Allergy Immunol Research Articles

Prevelance of Common Aeroallergens in Allergic Rhinitis and its Correlation with Bronchial Asthma: A Study on 798 Patients by Skin Prick Test.

Allergic rhinitis affects 30% of the Indian population (Dey et al. in Int Arch Allergy Immunol 178:60-65, 2019). Patients can be sensitive to single or multiple allergens. Polysensitization is more common (Bousquet et al. in Ann Epidemiol 20:797-803, 2010; Arbes et al. in J Allergy Clin Immunol 116:377-383, 2005). Sensitization to multiple allergens may have a role in the severity and the association of Asthma in such patients. A total of 798 patients with allergic rhinitis (SFAR ≥ 7) were included. Disease severity and associated symptoms were evaluated using questionnaire. Each patient underwent a Skin prick test with an allergen panel of 35 allergens each (Annesi-Maesano et al. in Allergy 57:107-114, 2002) and the results were evaluated to study the association of asthma and severity of Allergic rhinitis. Data consisting of 389 (48.7%) males and 409 (51.3%) females were assessed. A total of 82.2% of the study population of symptomatic patients were sensitized to at least one of the allergens. Seventy patients (8.78%) had associated asthma. Forty-four patients were polysensitized and fifteen were mono sensitized. Among polysensitized patients, 36 patients had sensitization to at least 6 different allergens. Dermatophagoides pteronyssinus was the most common allergen among asthma patients. This study provides a thorough knowledge of locally prevalent aeroallergens which is essential for the prompt diagnosis and treatment of allergic patients. Skin prick test can be a non-invasive vital tool in analyzing patterns of allergen exposure, the prevalence of allergen, sensitizing potential of different allergens in that specific geographic area.

Effectiveness of the Air Purification Strategies for the Treatment of Allergic Asthma: A Meta-Analysis

FE van Boven, NW de Jong, GJ Braunstahl, LR Arends, R Gerth van Wijk. Int Arch Allergy Immunol . 2020;181(5):395–402 To update an existing systematic review by McDonald et al, which was conducted 20 years ago, by reviewing the clinical effectiveness of the air purification strategy for the treatment of allergic asthma. Participants included children and adults with physician-diagnosed bronchial allergic asthma with positive testing to house dust mite, dog, cat, or cockroach. A meta-analysis of trials evaluating the impact of housing or mobile ventilation systems, including HEPA filters but not vacuum cleaners, on allergic asthma. Studies were included only if they documented …

Fecal Microbiome and Food Allergy in Pediatric Atopic Dermatitis: A Cross-sectional Pilot Study

KB Fieten, JEE Totte, E Levin. Int Arch Allergy Immunol. 2018;175(1–2):77–84 To determine whether particular microbial species in the gut are associated with food allergy. Pediatric patients with atopic dermatitis (AD), with or without food allergy and partaking in a Western diet, were included in a cross-sectional observational pilot study. A total of 82 children with AD with a median age of 2.5 years, 20 of whom were diagnosed …

Association Between Caesarean Delivery and Isolated Doses of Formula Feeding in Cow Milk Allergy

F Gil, A Amezqueta, D Martinez. Int Arch Allergy Immunol. 2017;173(3):147–152 To identify perinatal factors that influence the development of cow’s milk (CM) sensitization and allergy. A total of 211 subjects were included in this study. Case subjects were children diagnosed with cow’s milk allergy (CMA) within their first year of life who attended an outpatient pediatric gastroenterology clinic. Control subjects had no history of allergy to CM, regularly tolerated CM, and had no other digestive medical problems. This retrospective case-control study was performed at a single site in Navarra, Spain. Subjects seen in the clinic from 1990 to 2013 were included as case subjects if they had a clinical history of allergic symptoms with the ingestion of CM, elevated serum immunoglobulin E (IgE) levels to CM proteins, and a positive food challenge (although food challenges were not performed if there was a history of anaphylaxis or IgE levels >2.5 killiunits per liter). …

Efficacy of Buffered Hypertonic Saline Nasal Irrigation for Nasal Symptoms in Children With Seasonal Allergic Rhinitis: A Randomized Controlled Trial

V Malizia, S Fasola, G Ferrante. Int Arch Allergy Immunol. 2017;174(2):97–103 In this randomized control trial, buffered hypertonic saline (BHS) nasal rinses were compared with normal saline (NSS) nasal rinses in improving nasal symptoms in pediatric patients with seasonal allergic rhinitis (SAR). From October 2015 to February 2016, 36 children (ages 6–13 years) diagnosed with SAR and having active symptoms per the Total 5 Symptom Score (T5SS) were recruited from a single allergy outpatient clinic in Palermo, Italy. During the screening visit, skin prick tests to grass mix and olive pollen were performed to confirm allergic sensitization to pollens. Children were randomly assigned to either receive daily NSS (0.9%) or BHS (3%). The study began in May 2016, during the pollen season, and subjects were trained to administer (unblinded) 5 mL of NSS or BHS with an …

Influence of Intrinsic and Lifestyle Factors on the Development of IgE Sensitization

T StemesederE KlinglmayrS Moser. Int Arch Allergy Immunol. 2017;173(2):99–104 To determine the intrinsic and external environmental factors that influence the development of immunoglobulin E (IgE) sensitization in a westernized population. A cohort of students ages 12 to 21 years was recruited from schools in Salzburg, Austria. Subjects were randomly selected and enrolled in the cross-sectional study from October 2013 to May 2014. Serum samples were obtained from the 501 Austrian adolescents participating in the study. ImmunoCAP assays were performed on the serum samples to identify specific IgE values to 112 different allergens (including pollens, mite allergens, animals, and food). Medical history, early and current lifestyle information, and exposures were gathered from subjects via a questionnaire and analyzed …

Disagreement Between Skin Prick Tests and Specific IgE in Early Childhood

A Chauveau, ML Dalphin, V Kaulek. Int Arch Allergy Immunol. 2016;170(2):69–74 To evaluate for agreement between the results of skin prick tests (SPTs) and serum-specific immunoglobulin E (SSIgE) testing for sensitivity to environmental aeroallergens and food allergens in children. The authors of this study also assessed the associations between SPTs with positive results and the presence of atopic dermatitis in children from ages 1 to 6 years. Test results were available for 204 children from rural areas in France, who were recruited through the Protection against Allergy: Study in Rural Environments (PASTURE) project, which included a cohort of European children managed from birth to 10 years of age to determine the effect of farm exposure on the occurrence of allergies. SPTs, atopic dermatitis evaluations using Scoring Atopic Dermatitis Severity Scores, and SSIgE levels were completed at the …

Diagnostic Value of Serum Baseline Tryptase Levels in Childhood Asthma and Its Correlation With Disease Severity

S Gao, J Fan, Z Wang. Int Arch Allergy Immunol. 2016;171(3–4):194–202 To determine if the measurement of serum baseline tryptase (sBT) levels can accurately diagnose pediatric asthma and predict asthma severity. The study included 114 asthmatic children between the ages of 5 and 12 years. Within the cohort, 36 children had mild intermittent asthma, 38 had mild persistent asthma, and 40 had moderate to severe persistent asthma. In addition, 34 age-matched healthy children were included as controls. Serum baseline tryptase …

Serum 25-Hydroxyvitamin D in Early Childhood Is Nonlinearly Associated With Allergy

EM Savilahti, O Makitie, AK Kukkonen. Int Arch Allergy Immunol. 2016;170(3):141–148 To assess for an association between serum 25-hydroxyvitamin D (25-OHD) levels at birth and at 2 years of age and the development of allergic sensitization and disorders in early childhood. Subjects were part of a randomized, double-blinded, placebo-controlled trial designed to evaluate the effect of probiotics on allergy development. Infants with family history of atopy (1 or both parents had doctor-diagnosed allergic disease) were managed from birth until 5 years of age ( n = 819). Subjects were examined at 3 months, 6 months, 2 years, and 5 years of age. The primary outcome was the cumulative incidence of any allergic …

Clinical Features of Food Allergy During the First Year of Life: The ADAPAR Birth Cohort Study

D Dogruel, G Bingol, DU Altintas, M Yilmaz, S Guneser Kendirli. Int Arch Allergy Immunol. 2016;169(3):171–180 To assess the incidence of food allergies and identify risk factors for the development of food allergies in infants. The study population was part of the Adana Pediatric Allergy and Risk Factor (ADAPAR) birth cohort study in Adana, Turkey. From February 2010 to February 2011, 1475 infants born at a single center were enrolled. Infants were followed from birth until 1 year of age. At birth, umbilical cord blood was collected, and infants were examined. The infants returned for study visits at 3, 6, and 12 months of age. The subjects’ mothers …

Mast Cell Regulatory Gene Variants Are Common in Mast Cell Activation Syndrome

Recently recognized but likely prevalent, mast cell (MC) activation syndrome (MCAS) presents as heterogeneous chronic multisystem polymorbidity of generally inflammatory ± allergic theme; severity can be disabling. MCAS features aberrant MC reactivity and constitutive MC activation with little MC accumulation [Afrin, Ann Med 48:190-201], distinct from mastocytosis (rare and notable for recurrent KIT codon 816 variants). Studies at Univ. of Bonn [Molderings, Scand J Gastroenterol 42:1045-53 and Immunogenetics 62:721-7] suggest most MCAS patients (pts) bear in peripheral blood (PB) MCs somatic, likely constitutively activating, non-codon-816 variants, and some splicing variants, in mRNA for KIT, the dominant MC regulatory gene (MCRG). Other studies show most mastocytosis, too, bears variants in many MCRGs beyond KIT [e.g., Soverini, Blood 126:4085], suggesting the same is likely in MCAS. Confirmation of MCRG variants in MCAS would spur new direction in research in MCAS and chronic inflammatory diseases (CIDs) possibly born of MCAS [Afrin, Transl Res 174:33-59]. We are studying (UMN IRB-approved protocol 2015NTLS023) mRNA for KIT and other MCRGs in PB MCs from MCAS pts and controls (ctls).Methods: We extracted (Miltenyi CD117 immunomagnetic bead method per Bonn) PB MCs from 20 pts aged 18-50 diagnosed at UMN Jul-Dec 2015 with MCAS per criteria [Molderings, J Hematol Oncol 4:10] which in our experience (>1000 pts) reflects MCAS behavior better than other criteria [Valent, Int Arch Allergy Immunol 157:215-25]. We plan the same for 20 demographically matched ctls meeting rigorous good health criteria to exclude illness possibly from undiagnosed MCAS (9 ctls accrued so far, sequencing pending). Immunohistochemical staining with anti-human-c-kit antibodies (Thermo Scientific RB-9038-R7) confirmed extracts were pure bright CD117/c-kit-positive cells. mRNA was isolated (Qiagen RNeasy) and sequenced (Agilent HiSeq). Variant analysis of reverse-transcribed sequences from 38 genes (selected [Molderings, Crit Rev Oncol Hematol 93:75-89 and other reports] as regulating MC activation (receptor activation, signal transduction, cytokine production/release)) was performed via well-established GATK-based bioinformatic pipelines [Onsongo, BMC Res Notes 7:314], plus kallisto [Bray, Biotechnology 34:525-7] for finding RNA splice variants.Results: Table 1 shows key pt characteristics (families similarly afflicted). Percentages of pts with elevations of various MC mediators tested in diagnosing MCAS were similar to prior report [Zenker, Blood 126:5174].Exonic RNAseq showed many variants across many MCRGs in all 20 pts (median 11,276 variants per pt across studied genes; median 3,277 per pt were novel) but no recurrent variant signatures. Table 2 shows high- and medium-impact variants (HMIVs, i.e., frameshifts and missenses) found with high confidence (≥20 reads aligned to the region of the variant in all 20 pts); 8 KIT variants found were low impact (3’ untranslated region). As ctls are not yet fully accrued, we show comparator allele frequencies from 3 reference datasets.Other HMIVs were found with less confidence (<20 reads aligned to variant region in ≥1 pt) in ASXL1, CBL, DNMT3B, ETV6, EZH2, HNMT, IDH1, IL13, JAK2, KIT, KMT2A, KRAS, MS4A2, NLRP3, RASGRP4, SETBP1, SF3B1, TBXA2R, TET2, and TP53 (analysis ongoing). No HMIVs were found in ADGRE2, DNMT3A, HRH4, IL4, IL33, KITLG, MRGPRX2, NRAS, PDGFRα/β, RUNX1, SRSF2, SWAP-70, TNF, U2AF1, or VEGFA. We confirmed far greater expression of potentially more activating del(510-513) KIT splice variant in all pts.Discussion: We did not find HMIVs in PB MC KIT mRNA in our pts (we soon will study another 20), but we found all bear many mRNA variants in many MCRGs, requiring further study for significance. Reference datasets may be inadequate comparators, skewed by unrecognized MCAS (suspected prevalence as high as 17% [Molderings, PLoS One 8(9):e76241]), so we are accruing rigorously healthy ctls for similar study. If our ctls are largely devoid of HMIVs in MCRG mRNA from PB MCs (as in [Immunogenetics, op. cit.]), a stronger case will be made that MCAS is primarily a clonal disease, if complicated, heterogeneous, and notwithstanding MC-targeted/activating autoimmunity. Further study of variants will include validation by direct DNA sequencing, characterization, and probing for recurrence in CID-specific MCAS subpopulations. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Characterization of Mast Cell Activation Syndrome

Mast cell (MC) activation syndrome (MCAS) is a recently recognized, heterogeneous disease of chronic multisystem inflammation (CMI) ± allergy. MCAS features aberrant MC reactivity and constitutive MC activation with little accumulation of MCs, distinct from mastocytosis [Afrin, Ann Med 48:190-201]. Whether clonality in MCAS is common is debated. Symptoms (sxs) range from mild to disabling, even life-threatening; prevalence may be as high as 17% [Molderings, PLoS One 8(9):e76241], underscoring the importance of studying MCAS. Notwithstanding case reports, small case series, and reviews to date, we report the first systematic characterization of a large MCAS cohort.Methods: Under IRB-approved (Pro00015852, Pro00015857), Mastocytosis Society-sponsored protocols at one center, charts of 298 MCAS pts accrued retrospectively ("retro," diagnosed Nov 2008 - Sep 2012), plus 115 accrued prospectively (diagnosed Apr 2012 - Oct 2013), were reviewed for demographics, comorbidities (probs), sxs, family histories (FHs), physical exam and lab findings. For purposes of follow-up (f/u), data cut-off was June 30, 2014. Data were abstracted by LBA from available records. All were diagnosed with MCAS per criteria [Molderings, J Hematol Oncol 4:10] which in our experience (>1,000 pts) reflects MCAS behavior better than other proposals [e.g., Valent, Int Arch Allergy Immunol 157:215-25]. Blood samples from prospective pts were examined by flow cytometry for clonal MC disease (co-expressing CD45 and CD117 plus CD25 and/or CD2) and tested (ELISA kits, RayBioTech (Norcross, GA)) for elevated (↑) serum levels of cytokines (monocyte colony stimulating factor (M-CSF), granulocyte-macrophage colony stimulating factor (GM-CSF), interleukin-3 (IL-3), and tumor necrosis factor alpha (TNF-α)) potentially driving the mild relative monocytosis often seen in MCAS [Afrin, Blood 122:5240]; samples for cytokine testing were kept chilled from collection through assay, including centrifugation.Results: Most of the 413 pts were female (69%) and Caucasian (75%). Median (med) ages at sx onset and diagnosis (dx) were 9 yrs (range 0-88) and 49 yrs (range 16-92). Med time from sx onset to dx was 30 years (range 1-85). Med number of probs was 11 (range 1-66). Med number of sxs was 20 (range 2-84). Med number of FH issues was 4 (range 0-33). Tables 1, 2, and 3 show pts' common clinical and lab characteristics and relative utility of various MC mediators in dx. Frequencies of clinical findings in our pts likely are underestimates due to retro assessment in 298/413 (72%). As reported before for the retro subset [Blood 122:5240], general laboratory abnormalities in these MCAS pts were common, modest, and persistent.Most of our pts (72%) appeared chronically ill at times but overall healthier than expected from their many complaints, contributing to prior dx of somatism in most. Many pts "learned to live with it," no longer reporting some sxs unless asked.In the prospective pts, flow cytometry failed to find the targeted signature of clonal MC disease. Serum M-CSF, GM-CSF, IL-3, and TNF-α levels were assessed and, despite correct negative and positive control results, were not found ↑ in any pt.As of f/u cut-off, 388 pts (94%) were alive, 1 was lost to f/u and 24 pts (6%) had died of many causes (most commonly (25%) cancer). Data were insufficient to calculate meaningful survival statistics from time of dx.Discussion: Long sx duration in MCAS - and cessation, of futility, in reporting sxs - show comprehensive history in pts with CMI is important. Routine lab abnormalities are seen long before dx but are modest and thus given short shrift by busy practitioners, but this study suggests they should spark thought of MCAS in pts with CMI and no unifying dx.Relative utilities of MC mediators for dx in our pts were similar to a recent report [Zenker, Blood 126:5174] and further suggest serum tryptase - while still a good screen for MC neoplasia - poorly reflects MC activation.Conclusions: MCAS is challenging to recognize, but its prevalence, morbidity, chronicity, and ability of most pts to identify helpful therapy merit attention to dx and treatment. Our data, characterizing MCAS more comprehensively than ever before, may facilitate its clinical recognition. More research is needed to identify etiologies (and linkages with chronic inflammatory diseases), facilitate dx, and guide therapy. [Display omitted] [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Predictive Factors for Clinical Response to Allergy Immunotherapy in Children With Asthma and Rhinitis

Q Li, M Li, W Yue, J Zhou, R Li, J Lin. Int Arch Allergy Immunol. 2014; 164(3): 210–217 This study sought to determine factors that could predict clinical response to allergen immunotherapy (AIT) in children. A total of 185 children aged 4 to 14 years with persistent mild asthma based on Global Initiative for Asthma (GINA) guidelines or a diagnosis of persistent allergic rhinitis based on Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines were included. The mean age was 8.0 years; 50% of patients were affected by rhinitis only. All patients were sensitized to house dust mite (HDM), and 89% were polysensitized. Charts of the 185 participants were retrospectively analyzed. Children were included …

Ondansetron for Food Protein–Induced Enterocolitis Syndrome

SM Sopo, A Battista, M Greco, S Monaco. Int Arch Allergy Immunol. 2014;64(2):137–139 Previous reports suggest that ondansetron can be beneficial to hasten resolution of acute food protein–induced enterocolitis syndrome (FPIES) reactions. This study describes additional cases of successful treatment of acute FPIES reactions with intramuscular ondansetron in pediatric patients. Five children aged 13 months to 4 years with a known diagnosis of …

Vitamin D Supplementation Modulates the Immune System and Improves Atopic Dermatitis in Children

P Di Filippo, A Scaparrota, D Rapino. Int Arch Allergy Immunol. 2015;166:91–96 Previous studies have identified an association between atopic dermatitis (AD) and vitamin D deficiency. The authors observed the changes in clinical symptoms as well as the Th1/Th2 balance after vitamin D oral supplementation in children with AD. Thirty-nine children (aged 4 ± 3.15 years) were recruited from an Italian pediatric allergy clinic. They all had a clinical diagnosis of AD, Tanner Stage I of development, no recent history of vitamin D supplementation, and no recent calcineurin inhibitor or systemic antiinflammatory therapy. This …

Increased Osteopontin Levels in Children Undergoing Venom Immunotherapy May Serve As a Marker of Clinical Efficacy

ST Yavuz, OU Soyer, BE Sekerel. Int Arch Allergy Immunol. 2014;165(3):206–213 The authors measured changes in plasma osteopontin (OPN) and serum basal tryptase (sBT) in children undergoing 1 year of bee or wasp venom immunotherapy (VIT). Children with a history of large local reactions ( n = 18) or systemic reactions ( n = 24) after wasp or bee stings were recruited for this Turkish study. They were matched to 16 controls who had a history of …

Eczema in Early Childhood, Sociodemographic Factors and Lifestyle Habits Are Associated With Food Allergy: A Nested Case-Control Study

M Ben-Shoshan, L Soller, DW Harrington. Int Arch Allergy Immunol. 2015;166(3):91–96 The authors sought to determine whether certain atopic features, sociodemographic characteristics, and lifestyle habits were associated with childhood food allergy. Through randomized telephone calls, study participants were asked to complete a questionnaire if they had a history of food allergy (cow’s milk, egg, peanut, tree nuts, fish, shellfish, wheat, soy, or sesame). Controls were age-matched, nonallergic individuals either living in the same household or randomly selected. This was a case-controlled study nested within the SPAACE study (Surveying Prevalence …

Safety of rush subcutaneous immunotherapy administered in real life using an infusion pump

Rush subcutaneous immunotherapy (SCIT) schedules offer rapid clinical response, improved adherence, and increased cost-effectiveness because of a lower number of visits and doses. However, this therapy is associated with an increased incidence of adverse reactions (ARs). 1 Pfaar O. Leitzbach S. Hörmann K. Klimek L. Cluster protocols in SCIT: enough evidence for practical use?. Curr Opin Allergy Clin Immunol. 2010; 10: 188-193 Crossref PubMed Scopus (17) Google Scholar , 2 Justicia J.L. Barasona M.J. Serrano P. Moreno C. Guerra F. Predicting patients at high-risk of systemic reactions to cluster allergen immunotherapy: a pilot prospective observational study. J Investig Allergol Clin Immunol. 2007; 17: 386-392 PubMed Google Scholar , 3 Tabar A.I. Fernández-Távora L. Alonso R. et al. Tolerance of a cluster schedule with a house dust mite extract quantified in mass units: multicentre study. J Investig Allergol Clin Immunol. 2004; 14: 193-197 PubMed Google Scholar , 4 Goldberg A. Yogev A. Confino-Cohen R. Three days rush venom immunotherapy in bee allergy: safe, inexpensive and instantaneously effective. Int Arch Allergy Immunol. 2011; 156: 90-98 Crossref PubMed Scopus (27) Google Scholar , 5 Calabria C.W. Accelerated immunotherapy schedules. Curr Allergy Asthma Rep. 2013; 13: 389-398 Crossref PubMed Scopus (28) Google Scholar , 6 Cox L. Advantages and disadvantages accelerated immunotherapy schedules. J Allergy Clin Immunol. 2008; 122: 432-434 Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar A few years ago, our group described the use of an infusion pump (IP) to administer SCIT according to a rush schedule. [7] Sastre J. Vallejo L. Fernandez-Nieto M. Hernandez E. Rico P. Rush allergen subcutaneous immunotherapy administered with infusion pump. Ann Allergy Asthma Immunol. 2011; 107: 459-460 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar The purpose of this study is to update our data on the safety of this therapy approach and to assess risk factors for ARs in real life using a similar rush schedule with an IP.

Different Phenotypes of Non-Steroidal Anti-Inflammatory Drug Hypersensitivity during Childhood

Background: Although non-steroidal anti-inflammatory drug hypersensitivity (NSAID-H) has been widely studied in adults, there is still a lack of data regarding the features and phenotypes of NSAID-H in children. Our aim was to define risk factors and different phenotypes according to clinical patterns. Methods: Patients with a history of reaction to any NSAIDs referred between January 2012 and October 2014 were included. After completing a European Network for Drug Allergy (ENDA) questionnaire, initial skin and/or oral provocation tests (OPTs) were performed for the offending drug. Additional OPTs were done with aspirin in case of NSAID-H to determine cross-reactivity. NSAID-hypersensitive patients were defined as being either a selective responder (SR) or cross-intolerant (CI) and further categorized according to either the ENDA/GA²LEN classification or an alternative scheme by Caimmi et al. [Int Arch Allergy Immunol 2012;159:306-312]. Results: Among 121 patients [58.7% male, average age 7.8 years (4.7-10.8)] with 161 NSAID-related reactions, 110 patients with 148 reactions were assessed. NSAID-H was diagnosed in 30 (27%) patients with 37 (25%) reactions. Multivariate regression analysis revealed that an immediate-type reaction and respiratory symptoms during the reaction increased the risk of a reproducible NSAID-related reaction (OR 3.508, 95% CI 1.42-8.7, p = 0.007; OR 3.951, 95% CI 1.33-11.77, p = 0.014, respectively). Additional OPTs revealed 13 SRs and 14 CIs. A family history of allergic disease was more frequent in CIs compared to SRs (57.1 vs. 15.4%, p = 0.031). Reactions belonging to CIs were more frequently characterized by angioedema compared to those of SRs (81.3 vs. 46.2%, p = 0.019). SRs and CIs were further classified as single NSAID-induced urticaria/angioedema and/or anaphylaxis (n = 13), NSAID-induced urticaria/angioedema (n = 7), NSAID-exacerbated cutaneous disease (n = 2) and NSAID-exacerbated respiratory disease (n = 1). Four CIs could not be categorized according to either classification system. One SR could not be categorized according to ENDA/GA²LEN. Conclusion: During childhood, NSAID-H exhibits different phenotypes and the majority of them can be categorized with current classification systems; however, classifications based on adult data may not exactly fit NSAID-H in paediatric patients.

Molecular, proteomic and immunological parameters of allergens provide inclusion criteria for new candidates within established grass and tree homologous groups

Background Our knowledge of allergen structure and function continues to rise and new scientific data on the homology and cross-reactivity of allergen sources should be considered to extend the work of Lorenz et al., 2009 (Int Arch Allergy Immunol. 148(1):1–1, 2009) and the concept of homologous groups. In addition to this, sophisticated techniques such as mass spectrometry (MS) are increasingly utilised to better characterise the complex mix and nature of allergen extracts.Methods Homology models were used of Fag s 1 (Beech) and Cyn d 1 (Bermuda grass) and compared with template crystal structures of Bet v 1 and Phl p 1 from the ‘exemplar’ species of Birch and Timothy grass, respectively. ELISA experiments were performed to assess cross-reactivity of Beech (tree) and Bermuda (grass) extracts to rabbit sera raised to either “3-Tree” (Birch, Alder and Hazel) extract or “Grass” (12-grass mix extract), respectively. The comparability of biochemical stability of different allergen sources was assessed through statistical methods for a range of tree and grass species.Results Allergen cross-reactivity and/or structural homology have been described providing justification for inclusion of Beech within the Birch homologous tree group. Data from Bermuda grass (Cyn d 1) provides further justification for the inclusion of this species into the homologous group of the sweet grasses. However, further characterisation of relevant allergens from Bermuda grass and, in particular, comparison of cross-reactive patterns between subjects specifically in areas with high abundance of both Pooideae and Chloridoideae is sought.Conclusion MS allows the possibility to identify individual proteins or allergens from complex mixes by mass and/or sequence, and this has been extensively applied to the allergen field. New data on the homology, cross-reactivity and biological parameters of allergen sources have been considered to extend the work of Lorenz et al., 2009 in the context of tree and grass species. The concept of homologous groups is certainly dynamic allowing the flexibility and potential in streamlining quality parameters, such as stability profiles, due to extrapolation of exemplar data to a wider range of allergens.