Manifestations Of Hypersensitivity Research Articles

Practical Approach to Hypersensitivity to Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in Children.

We aimed to assess the real-life prevalence, patient profile, and clinical presentation of drug hypersensitivity to NSAIDs in children after an incidence of an adverse event during treatment, verified by a drug challenge test. We included 56 children, aged 4-18 years, referred to our allergy clinic due to the incidence of adverse reaction during treatment. Skin prick tests and a drug provocation test were performed in all patients. Diagnostics for persistent urticaria were performed. In 56 patients suspected of drug allergy, we proved NSAID hypersensitivity in 17 patients (30.1%). In 84.9% (n = 47) of patients, the clinical manifestations of hypersensitivity revealed angioedema and urticaria. The most common culprit drug among NSAIDs in children was ibuprofen. Thirty-one (55.4%) reactions were immediate, and 25 (44.6%) were delayed or late. Previous history of allergy was a risk factor for NSAID hypersensitivity (p = 0.001). Vitamin D deficiency in the blood serum was a risk factor for NASID hypersensitivity (OR = 5.76 (95% Cl: 1.42-23.41)). Hypersensitivity to NSAIDs is a difficult diagnostic problem in pediatric allergy. The most common manifestation of hypersensitivity to ibuprofen in children is acute urticaria and angioedema. Two important problems in the differential diagnosis are cofactors such as vitamin D levels and viral infections, which require further research.

Critical Windows: Exploring the Association Between Perinatal Trauma, Epigenetics, and Chronic Pain.

Chronic pain is highly prevalent and burdensome, affecting millions of people worldwide. Although it emerges at any point in life, it often manifests in adolescence. Given that adolescence is a unique developmental period, additional strains associated with persistent and often idiopathic pain lead to significant long-term consequences. While there is no singular cause for the chronification of pain, epigenetic modifications that lead to neural reorganization may underpin central sensitization and subsequent manifestation of pain hypersensitivity. Epigenetic processes are particularly active during the prenatal and early postnatal years. We demonstrate how exposure to various traumas, such as intimate partner violence while in utero or adverse childhood experiences, can significantly influence epigenetic regulation within the brain and in turn modify pain-related processes. We provide compelling evidence that the burden of chronic pain is likely initiated early in life, often being transmitted from mother to offspring. We also highlight two promising prophylactic strategies, oxytocin administration and probiotic use, that have the potential to attenuate the epigenetic consequences of early adversity. Overall, we advance understanding of the causal relationship between trauma and adolescent chronic pain by highlighting epigenetic mechanisms that underlie this transmission of risk, ultimately informing how to prevent this rising epidemic.

A Murine Model of Food Allergy by Epicutaneous Adjuvant-Free Allergen Sensitization Followed by Oral Allergen Challenge Combined with Aspirin for Enhanced Detection of Hypersensitivity Manifestations and Immunotherapy Monitoring.

Food allergy is one of the major existing health problems, but no effective treatment is available. In the current work, a murine model that closely mimics pathogenesis of human food allergy and its quantifiable diagnostic parameter design, even for mild hypersensitivity reactions, were established. BALB/c mice were epicutaneously sensitized with 1 mg chicken egg ovomucoid (OVM) or cow's milk casein, free of adjuvants, five times a week for two consecutive weeks. Eleven days later, allergen-specific IgG1 and IgE in serum were measured by ELISA. On day 25, 20 mg OVM or 12 mg α-casein was administered orally, and allergic reactions such as the fall in rectal temperature, symptom scores during 90-120 min, serum mast cell protease-1 and cytokine levels were monitored. The detection of mild allergic reactions due to adjuvant-free allergen sensitization and oral allergen challenge routes was amplified by the combination of oral allergen and aspirin administration simultaneously or aspirin administration within 15-30 min before an allergen challenge. Quantification of the maximum symptom score and the frequency of symptoms during the monitoring period improved evaluation accuracy of food allergy signals. Based on these results, efficacy of casein oral immunotherapy for cow's milk allergies, which are generally difficult to detect, was monitored adequately.

Effects of Benzene: Hematological and Hypersensitivity Manifestations in Resident Living in Oil Refinery Areas.

Literature is teeming with publications on industrial pollution. Over the decades, the main industrial pollutants and their effects on human health have been widely framed. Among the various compounds involved, benzene plays a leading role in the onset of specific diseases. Two systems are mainly affected by the adverse health effects of benzene exposure, both acute and chronic: the respiratory and hematopoietic systems. The most suitable population targets for a proper damage assessment on these systems are oil refinery workers and residents near refining plants. Our work fits into this area of interest with the aim of reviewing the most relevant cases published in the literature related to the impairment of the aforementioned systems following benzene exposure. We perform an initial debate between the two clinical branches that see a high epidemiological expression in this slice of the population examined: residents near petroleum refinery areas worldwide. In addition, the discussion expands on highlighting the main immunological implications of benzene exposure, finding a common pathophysiological denominator in inflammation, oxidative stress, and DNA damage, thus helping to set the basis for an increasingly detailed characterization aimed at identifying common molecular patterns between the two clinical fields discussed.

CASE REPORT ON THE DIAGNOSTIC CHALLENGE IN PEDIATRIC HEMODIALYSIS PATIENTS: HYPERSENSITIVITY REACTION TO SYNTHETIC MEMBRANES

<h3>Introduction</h3> Hypersensitivity reactions dependent not only on IgE during hemodialysis there are more reported and frequently in patients dialyzed with biocompatible polysulfone or polyethersulfone membranes in absence of other risk factors. Describing multiple pathogenic mechanisms. We present the diagnostic approach to a pediatric patient with clinical manifestations of hypersensitivity during hemodialysis. <h3>Case Description</h3> Nine-year-old male with history of myelomeningocele corrected at ten days of life. Currently with stage V chronic kidney disease, bilateral hydronephrosis and neurogenic bladder, requiring intermittent treatment with peritoneal dialysis. February 2022, started hemodialysis and during third session, presented urticaria, angioedema, pruritus, and dyspnea within 30 minutes. Session was suspended and antihistamine administered, without new or different medications to those used in previous sessions. Next session, was premedicated with antihistamine and intravenous steroid, which within 5 minutes of onset presented same symptoms, hemodialysis was stopped and symptoms decreased with the application of antihistamine, changing to cellulose triacetate membrane, allowing to continue hemodialysis in subsequent sessions without new events. <h3>Discussion</h3> The approach to the patient with symptoms of hypersensitivity during hemodialysis represents a diagnostic challenge due to polypharmacy and the difficulty of identifying the causal agent. Associated hypersensitivity reactions, anaphylactic associated or not with IgE, are related to equipment sterilized with ethylene oxide (EtO), polysulfone or cellulose membrane, and drugs. Reactions generally present as acute events with symptoms such as erythema, pruritus, angioedema, pain, and dyspnea. The importance of knowing these reactions helps to create diagnostic protocols and paraclinical tools to search for the causal agent.

S2710 Atypical Cutaneous Eruption to Mesalamine

Introduction: Mesalamine, 5-aminosalicylic acid (5-ASA), is an anti-inflammatory drug that is used in the treatment of ulcerative colitis (UC). Mesalamine use is associated with rare, but well-described hypersensitivity reactions with renal, cardiac, and pulmonary involvement. We present a case of an atypical cutaneous reaction in a patient with UC associated with mesalamine therapy. Case Description/Methods: An 85 year old male with hypertension, diabetes, and mucinous adenocarcinoma of the lung presented to inflammatory bowel disease (IBD) clinic to establish care. He was diagnosed with UC in the 1970s and had previously been treated with sulfasalazine. For lung cancer, patient was treated with pembrolizumab, which was discontinued 18 months prior. Upon presentation, he reported 1-2 bowel movements daily with intermittent blood per rectum and right lower quadrant pain. Colonoscopy done 2 years prior to presentation had demonstrated quiescent disease. The patient was started on mesalamine 4800mg daily. Two weeks after starting mesalamine, patient endorsed hypopigmented spots on scalp and torso, generalized pruritis, and bilateral foot pain. Mesalamine was stopped. Within 2 weeks, patient developed a new rash (Figure). He was urgently referred to Dermatology clinic and noted to have tense bullae and pruritic pink plaques on his torso. Punch biopsy was performed, and labs were sent including pemphigoid Ab panel that confirmed diagnosis of bullous pemphigoid (BP). Patient was started on prednisone 40mg daily for 2 weeks. At return visit in two weeks, skin lesions had resolved, and the patient was weaned from prednisone. Discussion: We presented a case of drug-associated bullous pemphigoid (DABP) associated with mesalamine therapy. There are multiple reports of mesalamine-induced Steven Johnson Syndrome, but BP has been rarely described. Although our patient was on a PD-1 inhibitor, his discontinuation 18 months prior makes the likelihood of it causing his cutaneous symptoms exceedingly unlikely. Mesalamine-DABP is a cutaneous manifestation of mesalamine hypersensitivity and can be recurrent upon re-introduction of mesalamine. Although a rare complication, mesalamine-DABP is an adverse event that gastroenterology providers should be aware of when starting patients on mesalamine.Figure 1.: Drug-associated bullous pemphigoid after mesalamine treatment.

HLA-B58.01 et vascularite rénale d’hypersensibilité à l’allopurinol chez un patient chinois

IntroductionAllopurinol, widely used in the treatment of hyperuricemia and gout, has been shown to cause severe cutaneous reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis, as well as systemic reactions such as DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms). The HLA-B*5801 allele is known to be a risk factor for severe cutaneous manifestations of hypersensitivity to allopurinol, mostly in Asian populations. ObservationWe report the observation of a 47-year-old Chinese patient, with no previous medical history, carrying the HLA-B*5801 allele, who developed an isolated allopurinol hypersensitivity necrotizing renal vasculitis without cutaneous manifestations. Discussion. The identification of this allele should be proposed before prescribing allopurinol in patients originating from certain regions of Asia, and the imputability of allopurinol should be evoked in case of necrotizing renal vasculitis, even without associated cutaneous involvement.

Applying lessons learned from nanomedicines to understand rare hypersensitivity reactions to mRNA-based SARS-CoV-2 vaccines.

After over a billion of vaccinations with messenger RNA-lipid nanoparticle (mRNA-LNP) based SARS-CoV-2 vaccines, anaphylaxis and other manifestations of hypersensitivity can be considered as very rare adverse events. Although current recommendations include avoiding a second dose in those with first-dose anaphylaxis, the underlying mechanisms are unknown; therefore, the risk of a future reaction cannot be predicted. Given how important new mRNA constructs will be to address the emergence of new viral variants and viruses, there is an urgent need for clinical approaches that would allow a safe repeated immunization of high-risk individuals and for reliable predictive tools of adverse reactions to mRNA vaccines. In many aspects, anaphylaxis symptoms experienced by the affected vaccine recipients resemble those of infusion reactions to nanomedicines. Here we share lessons learned over a decade of nanomedicine research and discuss the current knowledge about several factors that individually or collectively contribute to infusion reactions to nanomedicines. We aim to use this knowledge to inform the SARS-CoV-2 lipid-nanoparticle-based mRNA vaccine field.

DRESS/DIHS syndrome induced by sulfasalazine

Among the manifestations of drug hypersensitivity, DRESS/DIHS syndrome is of particular importance. The clinical manifestations include rash, enlarged lymph nodes, fever, hepatitis, leukocytosis with eosinophilia, as well as the involvement of other organs and systems. The most common causative agents include anticonvulsants, antidepressants, sulfanilamides, non-steroidal anti-inflammatory drugs, and allopurinol, but the list is constantly expanding. The exact pathogenesis of DRESS/DIHS syndrome is currently unclear. Timely diagnosis and adequate therapy can improve prognosis of this disease. In our clinical case, DRESS syndrome developed after the patient was administered sulfasalazine for erosive proctosigmoiditis. In order to ensure adequate prevention, early diagnosis, and proper management of DRESS syndrome, it is necessary to raise awareness of practitioners of different specialties about the possibility of developing this undesirable reaction to pharmacotherapy.

The Historical Burden of Sporotrichosis in Brazil: a Systematic Review of Cases Reported from 1907 to 2020.

Sporotrichosis is a cosmopolitan subcutaneous mycosis caused by Sporothrix species. Recently, this mycosis has gained notoriety due to the appearance of new endemic areas, recognition of new pathogenic species, changes in epidemiology, occurrence of outbreaks, and increasing numbers of cases. The purpose of this study is to analyze the peculiarities of sporotrichosis cases in Brazil since its first report in the country until 2020. In this work, ecological, epidemiological, clinical, and laboratorial characteristics were compiled. A systematic review of human sporotrichosis diagnosed in Brazil and published up to December 2020 was performed on PubMed/MEDLINE, SciELO, Web of Science, and LILACS databases. Furthermore, animal sporotrichosis and environmental isolation of Sporothrix spp. in Brazil were also evaluated. The study included 230 papers, resulting in 10,400 human patients. Their ages ranged from 5months to 92years old and 55.98% were female. The lymphocutaneous form was predominant (56.14%), but systemic involvement was also notably reported (14.34%), especially in the lungs. Besides, hypersensitivity manifestations (4.55%) were described. Most patients had the diagnosis confirmed by isolation of Sporothrix spp., mainly from skin samples. Sporothrix brasiliensis was the major agent identified. HIV infection, cardiovascular diseases, and diabetes were the most common comorbidities. Cure rate was 85.83%. Concerning animal sporotrichosis, 8538 cases were reported, mostly in cats (90.77%). Moreover, 13 Sporothrix spp. environmental strains were reported. This review highlights the burden of the emergent zoonotic sporotrichosis in Brazil, reinforcing the importance of "One Health" based actions to help controlling this disease.

Проект сучасної класифікації клінічних проявів харчової гіперчутливості у дітей

Актуальність. Харчова гіперчутливість (ХГ) залишається важливою проблемою дитячого віку, що має медичну та соціальну сторону. Протягом десятиріч класифікація шкірних проявів ХГ заснована на поєднанні нечітких патофізіологічних і клінічних ознак й обумовлена недостатнім використанням методу морфологічної детермінації елементів висипу та його порівнянням з анамнестичними даними. Мета. Запропонувати оновлені дефініції та проект класифікації клінічних проявів харчової гіперчутливості, що дозволить підвищити клінічну значимість, визначити цілі можливого терапевтичного впливу при різних патогенетичних механізмах ХГ, підвищити ефективність клінічної діагностики, виробити єдині підходи до інтерпретації даних. Матеріали та методи. Розширений огляд літературних джерел як на паперових носіях, так і в електронному вигляді (включаючи Medline та Cochrane Library, 2010–2016), а також результати власних досліджень слугували основою створеного проекту. Результати. Існуюча класифікація ХГ є неоднозначною та відображує недостатність розуміння природи даного захворювання, що може мати імунні та неімунні механізми. Проблеми при верифікації діагнозу також пов’язані з тим, що один і той самий симптом на шкірі може зустрічатися при різних патофізіологічних механізмах розвитку, і саме тому важливим є врахування анамнестичних і суб’єктивних симптомів, які різняться при окремих формах ХГ. У статті запропоновано проект класифікації клінічних проявів ХГ, базованих на останніх літературних даних і результатах власних спостережень. За основу взято орган-мішень і патогенетичний механізм, окремі морфологічні елементи. Висновки. Запропонований метод дозволить підвищити клінічну значущість і створити єдині підходи до інтерпретації даних.

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Cutaneous Adverse Drug Reactions in Hospitalized HIV/AIDS Patients

Background: Cutaneous adverse drug reaction (CADR) is the most common manifestation of drug hypersensitivity in humanimmunodeficiency virus (HIV), which presented as maculopapular rash. The incidence of CADR is found to be more commonin untreated HIV patients, and the frequency is higher in severe immunodeficiency status. Early diagnosis and appropriatetreatment give better outcomes. Purpose: To evaluate the incidence and management of CADR in HIV and acquired immunedeficiency syndrome (AIDS) patients. Methods: A retrospective descriptive study of HIV/AIDS patients with CADR whowere hospitalized at Intermediate Care and Infectious Disease Centre Dr. Soetomo General Academic Hospital. Result: Therewere more CADR cases in 2017, accounted 2.35% of the total Intermediate Care and Infectious Disease Centre RSUD Dr.Soetomo General Academic Teaching Hospital ward patients. There were more male patients (62.5%), with the mostcommonly found at the age of 25-44 years (64.3%), and which mostly (89.3%) originated from Surabaya. The most commondiagnosis was morbiliform eruption (60.7%), main complaint was red spots all over the body (45%), all of which are obscureerythematous macules. The most common causes were Duviral + Neviral antiretroviral (46%) and the most common treatmentwas dexamethasone injection. Conclusion: The incidence of CADR increased in 2017. The most frequent manifestation wasmorbilliform eruption due to Duviral+Neviral as the first line ARV treatment. Skin management varies widely in form oftopical, oral, and intravenous injection drugs, mostly using steroid class, dexamethasone intravenous injection in particular.

Ipersensibilità ai FANS: intolleranza o allergia?

Non-steroidal anti-inflammatory drugs (NSAIDs) are the main triggers of drug hypersensitivity reactions in children. According to the EAACI latest classification NSAIDs hypersensitivity reactions are differentiated into cross-reactive reactions, with non-immunological mechanisms (based on COX-1 inhibition), and selective reactions, with immunological mechanisms. Paediatric clinical manifestations of NSAID hypersensitivity are typically cutaneous, but sometimes, similarly to anaphylaxis, can involve other systems, especially the respiratory one. Differentiating between NSAID intolerance and NSAID allergy through drug provocation tests is crucial for the patient because the two clinical entities require different management.

Progress in research of allergen detection methods

Allergic diseases have continued to increase year by year causing serious physical and mental injury to patients, families and individuals. This increase has been driven by conventional environmental and nutritional changes but is also created by the continual introduction of food additives into the diet and novel interior decoration materials into the living space. The causes of allergic diseases are complex and diverse, and the medical laboratory often is not be able to identify the allergic trigger; this creates a difficult environment to identify the appropriate clinical treatment for disease prevention and control. Physicians must be able to identify these triggers to help patients avoid the underlying allergenic cause of their disease. This can only be done by actively knowing a patient's medical history, identifying the clinical manifestations of hypersensitivity and utilizing confirmatory testing as an important clinical tool in identifying the allergic source.

Association of HLA genotypes with Beta-lactam antibiotic hypersensitivity in children.

Beta-lactam (BL) antibiotics hypersensitivity is common in children. Clinical manifestation of BL hypersensitivity varies from mild to severe cutaneous adverse drug reactions (SCARs). To determine the association of HLA genotype and BL hypersensitivity and the prevalence of true drug allergy in patients with history of BL hypersensitivity. A case-control study was performed in 117 children with aged 1-18 years. Children with history of non-SCARs BL hypersensitivity were evaluated for true drug hypersensitivity including skin test and drug provocation test. Tolerant control patients were children who could tolerate BL for at least 7 days without hypersensitivity reaction. HLA genotype (HLA-A, HLA-B, HLA-C and HLA-DRB1) were performed in 24 cases and 93 tolerant controls using PCR-SSO (polymerase chain reaction - sequence specific oligonucleotide probes). There were association of HLA-C*04:06 (OR = 13.14, 95%CI: 1.3-137.71; p = 0.027), and HLA-C*08:01 (OR = 4.83, 95%CI: 1.93-16.70; p = 0.016) with BL hypersensitivity. HLA-B*48:01 was strongly associated with immediate reaction from BL hypersensitivity (OR = 37.4, 95%CI: 1.69-824.59; p = 0.016) while HLA-C*04:06, HLA-C*08:01 and HLA-DRB1*04:06 were associated with delayed reaction (p < 0.05). Among 71 cases who were newly evaluated for BL hypersensitivity, only 7 cases (9.8%) had true BL hypersensitivity. Less than 10% of children with suspected of BL hypersensitivity have true hypersensitivity. There might be a role of HLA-B, HLA-C and HLA-DRB1 genotype in predicting BL hypersensitivity in Thai children.

Basophils from Cancer Patients Respond to Immune Stimuli and Predict Clinical Outcome.

Basophils are involved in manifestations of hypersensitivity, however, the current understanding of their propensity for activation and their prognostic value in cancer patients remains unclear. As in healthy and atopic individuals, basophil populations were identified in blood from ovarian cancer patients (n = 53) with diverse tumor histologies and treatment histories. Ex vivo basophil activation was measured by CD63 expression using the basophil activation test (BAT). Irrespective of prior treatment, basophils could be activated by stimulation with IgE- (anti-FcεRI and anti-IgE) and non-IgE (fMLP) mediated triggers. Basophil activation was detected by ex vivo exposure to paclitaxel, but not to other anti-cancer therapies, in agreement with a clinical history of systemic hypersensitivity reactions to paclitaxel. Protein and gene expression analyses support the presence of basophils (CCR3, CD123, FcεRI) and activated basophils (CD63, CD203c, tryptase) in ovarian tumors. Greater numbers of circulating basophils, cells with greater capacity for ex vivo stimulation (n = 35), and gene signatures indicating the presence of activated basophils in tumors (n = 439) were each associated with improved survival in ovarian cancer. Circulating basophils in cancer patients respond to IgE- and non-IgE-mediated signals and could help identify hypersensitivity to therapeutic agents. Activated circulating and tumor-infiltrating basophils may be potential biomarkers in oncology.

Drug-Induced Acute Tubulointerstitial Nephritis

Abstract Nowadays, incidence of drug-induced acute tubulointerstitial nephritis is on the rise due to increased access of the patients to a variety of both prescribed and over-the-counter drugs. Acute kidney injury and hypersensitivity manifestations are the main features of acute tubulointerstitial nephritis. Classically considered reversible after prompt withdrawal of the offending medication, recent decades revealed potential for evolution to chronic kidney disease. This article presents the challenges in the diagnosis and treatment and also evolutive features of allergic acute tubulointerstitial nephritis induced by drugs.

Laboratory diagnosis of immuno-mediated reactions of hypersensitivity to drugs in patients with pulmonary tuberculosis

To date, there are no unified and standardized laboratory methods for diagnosis allergic reactions to anti-TB drugs.Objective — to optimize the methods of laboratory diagnostics of hypersensitivity reactions to anti-tuberculosis (TB) drugs in patients with pulmonary tuberculosis and to find out their immunological mechanisms.Materials and methods. Clinical and immunological examination was carried out in 39 patients with pulmonary tuberculosis, which were divided into two groups: 1st — with the presence of clinical manifestations of hypersensitivity to anti-TB drugs; 2rd — without visible clinical sings of hypersensitivity. The tests were performed to detect intolerance to first-line anti-TB drugs in vitro: activation of basophiles, determination of serum tryptase, total (IgE) and specific (IgEsp ) immunoglobulin E levels, and erythrocyte sedimentation rate (ESR).Results and discussion. Patients of the 1st group showed increase levels of tryptase, total IgE, specific IgEsp for rifampicin and ethambutol in the blood. Frequency of positive values of ESR for isoniazid was significantly higher in group 1. Correlation between ESR and number of activated basophils and its activated receptors, levels of tryptase and total IgE was observed.Conclusions. The most informative tests in vitro to determine the causative drug in TB patients with clinical manifestations of allergy are: the level of specific IgEsp for rifampicin and ethambutol; erythrocyte sedimentation reaction for isoniazid. The use of basophil activation test is limited in the diagnosis of immuno-mediated allergic reactions to first-line anti-TB drugs

Negative bias and reduced visual information processing of socio-emotional context in borderline Personality Disorder: A support for the hypersensitivity hypothesis

Background and objectivesCurrent studies on emotional dysregulation in BPD suggest that it might be manifested by altered appraisal and biased attentional mechanisms, rather than by hyperreactivity. The aim of this study was to acquire more evidence on this topic by testing the hypothesis that BPD patients are characterized by a negative evaluation bias and reduced visual exploration in response to socio-emotional content. Moreover, the association between the previous conceptualizations and typical dysfunctional processes in BPD were evaluated. MethodsFifty-four socio-emotional pictures were administered to 20 female BPD patients and 20 healthy controls (HCs) divided into three blocks characterized by different stimulus durations (500 ms, 3s, 18s). Self-reported and eye-tracking data were collected during the experiment. ResultsBPD patients showed lower valence ratings and reduced visual exploration of socio-emotional pictures compared to HCs. Visual exploration in BPD was affected by exposure time with reduced exploration in response to prolonged stimuli presentation. Dysfunctional features and pre-task negative affectivity level in BPD were correlated with self-reported evaluations and eye-tracking data. LimitationsPossible effects of gender on emotional responsivity could not be addressed given the female composition of our sample. Moreover, the role of psychiatric symptoms and medications should be addressed in future research. ConclusionsThis study presented evidence on dysfunctional mechanisms sustaining emotional dysregulation in BPD. This construct seemed supported by a well-established negative bias towards emotional stimuli together with a reduced processing of social information as manifestations of emotional hypersensitivity.