Negative SPT Research Articles

Evaluation of Eosinophil-Derived Neurotoxin Level and Asthma Severity in Isolated Asthma in Comparison to Asthma with Allergic Comorbidity

Abstract Background Asthma and associated type 2 inflammation are observed in 50–70% of patients with asthma and eosinophilic inflammation is a common feature in many asthma patients, and is associated with a higher risk of a more severe disease. Esinophilic Derived Neurotoxin (EDN) it’s useful as a clinical biomarker for the diagnosis and monitoring of asthma. High levels of EDN have been observed in patients with asthma, with higher levels measured during asthma exacerbations than in those with stable asthma. Objective To compare the association of the level of Esinophilic Derived Neurotoxin and burden of asthma in patients with asthma with Allergic comorbidities such as rhinitis and / or eczema compared to patients with asthma alone. Methods A cross sectional study included 100 adult patients, 50 patients diagnosed as asthma according to GINA guidelines and 50 patients diagnosed as asthma with allergic comorbidity such as Allergic rhinitis and/or eczema were selected from those who presented to the Allergy and clinical immunology clinics at Ain Shams University Hospitals during the period between January to July 2022. Results 50% of the studied population had bronchial asthma alone while the remaining had asthma with allergic comorbidities with most of them had asthma with allergic rhinitis and Most of the patients with allergic rhinitis had mod/severe persistent AR. 77% of total patients had positive SPT and 23% had negative SPT. Most of the patients had positive result for dust mites (Dermatophagoides farina 35% and Dermatophagoides pteronyssinus 30%) followed by pollens (mugwort 27%, rye grass 26% and tobacco 13%) and Animal dander (horse hair 15%, sheep wool 14%, cat hair 13% and dog hair 12%). The Median (IQR) of absolute eosinophil count and total IgE were higher in patients with asthma with Allergic comorbidities [0.68 (0.58 – 0.83) cells/mm3 and 155 (120 – 350) IU/ml respectively] while patients with asthma alone were 0.25 (0.12 – 0.45) cells/mm3 and 68.5 (29 – 123) IU/ml respectively. Our study showed the Median (IQR) of Serum EDN level was higher in patients with asthma with Allergic comorbidities [34 (28 – 40) ng/ml] compared to the patients with asthma alone [15(11 – 18) ng/m]. The quality of life and asthma control test was poor in asthmatic patients with allergic comorbidities compared to patients with asthma alone. Conclusion Serum EDN, Absolute Eosinophilis and total IgE can be used as a marker of T2 inflammation of air ways as their levels were higher in asthma with Allergic comorbidities. Asthma with comorbidities has more symptom burden with poorer quality of life and lower asthma control test than asthma alone; with more concern to be taken for those patients with asthma comorbidities as they have more severe asthma and poorer quality of life

Clinical Characteristics of Patients with Dental Malocclusion: An Otolaryngologic Perspective.

Purpose: Allergic rhinitis (AR), which is a major cause of upper airway obstruction, may affect the development of the dental malocclusion. This retrospective study was aimed to investigate association between AR and dental malocclusion in otolaryngologic perspectives. Methods: Patients (n = 217) referred to the otolaryngology department before initiating orthodontic treatment were recruited. The frequency and severity of AR symptoms, sinonasal outcome test (SNOT-22) scores, physical examination findings, acoustic rhinometry results, and treatment modalities were retrospectively assessed. Patients with positive skin prick test findings (SPT) (n = 173; orthodontic group) were compared with age- and sex-matched patients being treated for AR (AR group). Results: We found that 76.5% of the enrolled patients had subjective nasal symptoms, and 93.1% patients showed abnormal physical examination findings such as inferior turbinate hypertrophy (82.0%), adenotonsillar hypertrophy (31.8%), or deviated nasal septum (7.4%). The 173 (79.7%) patients with positive SPT results exhibited a significantly higher incidence of rhinorrhoea, sneezing, and inferior turbinate hypertrophy compared to those with negative SPT results. The proportion of patients who underwent pharmacological or surgical treatments was significantly higher among patients with nasal obstruction (92.0%) than among patients without nasal obstruction (36.9%). The frequency and mean visual analogue symptom scores for nasal obstruction, rhinorrhoea, and sneezing, as well as all SNOT-22 domain scores, were significantly higher in the AR group than in the orthodontic group. The minimal cross-sectional area measured with acoustic rhinometry showed no significant difference between groups. Conclusion: Patients with dental malocclusion had a high SPT (+) rate and a high prevalence of structural abnormalities of the upper airway. The early detection and treatment of subclinical AR, other rhinological problems, and structural abnormalities of the upper airway in patients with malocclusion may help us manage malocclusion from an otolaryngologic perspective.

M010 DIAGNOSTIC CHALLENGE IN EVALUATING THE RISK AND MANAGEMENT OF ALLERGIC REACTION(S) TO SARS-COV-2 VACCINES

The frequency of immediate hypersensitivity reactions following immunization with either the Pfizer-BioNTech (BNT162b2) or Moderna (mRNA-1273) mRNA vaccines poses a clinical challenge for the allergist-immunologist. Anaphylaxis to the mRNA COVID-19 vaccines is currently estimated to occur in 2.5 to 11.1 cases per 1 million doses. Although excipients [polyethylene glycol (PEG), and polysorbate] and specific mRNA and Ad26.COV2.S components in COVID-19 vaccines have been cited as potential causative allergens, PEG is considered the likely culprit in mRNA vaccines. However, several skin testing published protocols using PEG have yielded conflicting results. We present a patient who developed anaphylaxis after the first dose of BNT 162b2 who was evaluated by PEG, polysorbate, and COVID-19 vaccine skin testing. A 49-year-old female, with a known atopic history, was evaluated for an anaphylactic reaction to BNT 162B2 vaccine occurring within 30 minutes after the first dose. Pruritic symptoms, facial urticaria, tongue swelling, and wheezing progressed to full body hives and difficulty breathing. Following treatment with epinephrine, IV diphenhydramine, and IV steroids, her symptoms improved. SPT and ID skin testing to PEG, polysorbate 80, and the BNT 162B2 and JNJ-78436735 (Johnson and Johnson) were negative except for positive ID testing to polysorbate 80. Negative SPT and ID skin testing with both excipients and vaccine specific components argues against an IgE-mediated mechanism and suggests a non-IgE mechanism. IgE skin testing may have no value as a predictive biomarker of susceptibility to allergic reactions of the mRNA COVID-19 vaccines and will require more research focused on non-IgE mechanisms.

Retrospective analysis of 222 oral food challenges with a single dose in acute food protein-induced enterocolitis syndrome.

The method of performing oral food challenge (OFC) in acute food protein-induced enterocolitis syndrome (FPIES) has not been systematically studied. Therefore, there is a certain variability in the choice of the various centers. Since 2011, we have been performing OFC for acute FPIES with a single dose of culprit food, a full serving size for age. In case of atypical FPIES (skin prick test, SPT, positive), we applied this protocol only if the description of previous adverse reactions was compatible with that of a classic acute FPIES, if other IgE-mediated food allergies were absent, and if the mean diameter of the wheal evoked by the SPT with the challenged food was ≤5mm. We have retrospectively analyzed 222 OFCs from 2011 to 2020. The grading of reactions was carried out according to the International Consensus Guidelines on FPIES of 2017. Forty-eight of 222 OFC (21.6%) failed. The mild reactions were 22 of 48 (45.8%), the moderate ones 22 of 48 (45.8%), and the severe ones 4 of 48 (8.4%) failed OFCs. The tested food processing (in the case of cow milk and chicken egg) did affect neither probability nor severity of the reaction. Patients with positive SPT for the tested food presented four times more severe reactions (2 of 9 failed OFC, 22.2%) than patients with negative SPT (2 of 39 failed OFC, 5.1%) (P=.316). The administration of a single dose in a full serving size for age appears to be a sufficiently safe method for OFC for acute FPIES, with the benefit of saving time. In patients with positive SPT for the tested food, it may be prudent to start with a smaller dose carrying on, in the absence of adverse reactions, with the administration of the full dose after a 4-hour observation.

Pericoronary adipose tissue inflammation on coronary computed tomography in patients with vasospastic angina

Abstract Background A recent study has demonstrated that coronary spasm is associated with inflammation of peri-coronary adipose tissue (PAT) by using the combination of 18F-fluorodeoxyglucose positron emission tomography and computed tomography (CT). PAT attenuation (FAI) on CT angiography (CTA) has been reported to reflect PAT inflammation. We sought to investigate if FAI on CTA was associated with coronary vasospasm in patients with suspected vasospastic angina (VSA). Methods A total of 88 patients who underwent CTA and acetylcholine provocation test (SPT) for suspected VSA were retrospectively investigated. FAI was assessed by the crude analysis of the mean CT attenuation value of 3 major coronary arteries on CTA. FAI was evaluated for the proximal reference diameter (FAI-Ref) and inner 2mm adipose tissue layer (FAI-2mm) from the vessel wall. Diagnosis of VSA (VSA group) was made by SPT and the subjects with negative SPT without organic coronary lesions served as non-VSA group. Association between VSA diagnosis and FAI was assessed and the predictors of VSA was explored by univariable and multivariable analyses. Results In 45 patients (51.1%), VSA was diagnosed (VSA group). There were no significant differences in baseline characteristics between the VSA and non-VSA groups. RCA-FAI was significantly higher in patients of VSA group than in non-VSA group. RCA-FAI-2mm provided significantly better diagnostic performance for VSA than RCA-FAI-Ref and LCA-derived FAI values. Furthermore, RCA-FAI-2mm showed a significant relationship with the severity of spasm evaluated by most stenotic segment diameter during SPT. (r=−0.28, p<0.001) Multivariable logistic regression analysis revealed that RCA-FAI-2mm was an independent predictor of predicting VSA (P<0.001). Conclusion Coronary spasm may be linked with PAT inflammation detected by CTA-derived RCA-FAI, particularly by inner PAT assessment close to the vessel wall. Representative cases for FAI analyses Funding Acknowledgement Type of funding source: None

Oral Wheat Immunotherapy in a Patient with Anaphylaxis Despite Negative Sensitization Tests

Introduction: Wheat allergy can develop at any stage of life. The aim of this report was to demonstrate that skin testing and specific IgE have poor specificities and sensitivities for wheat allergy. Case Presentation: A 37-year-old female presented symptoms that were initiated immediately after consumption of bread and biscuits. She was well until two months prior to her recent admission. Her skin prick test, RIDA assay, and patch test for wheat showed negative results despite a history of two episodes of anaphylaxis. She underwent an oral food challenge, which confirmed wheat allergy. A desensitization procedure was recommended for her. At the end of the immunotherapy process, she had normal intake of wheat without any symptoms. Conclusions: Negative sIgE and SPT results do not rule out clinical food allergy. Oral food challenges are still the cornerstone of diagnosis of food allergy.

THE ROLE OF TARGET ORGAN DIAGNOSTIC APPROACH IN SEASONAL ALLERGIC RHINITIS: NASAL SMEAR EOSINOPHILS.

Background:Allergic rhinitis (AR) related to local weeds pollen sensitization (Chenopodiaceous family) is the most common cause of respiratory allergy in Kuwait. Local nasal accumulation of different cells typical of allergic inflammation is responsible for clinical symptoms of AR. Although nasal smear for Eosinophils (NSE) is one of the earliest included valuable test in diagnosis of AR, with time is underestimated.Aim:Explore possible correlation of natural pollen allergen stimulation with appearance and quantity of Eosinophils in nasal smear.Methods:A group of randomly selected patients with clinical history suggestive for seasonal AR (SAR), who came to Al Rashed Allergy Center in period from October 2014 to October 2015, obtain Nasal Smear for Eosinophils as a screening test before further diagnostic evaluation. Nasal samples were collected by passing a sterile swab, from each nasal cavity, along the medial surface of the inferior turbinate 2 to 3 times and the specimen smeared on a clear glass slide. Nasal smears were examined by light microscopy after staining with hematoxylin and eosin stain. Skin prick test is performed in all symptomatic patients with a battery of inhalant allergens that include local pollens. The control group was recruited, with their voluntary consent, from the medical stuff with a negative history of any allergic nasal symptoms. In this group we performed only nasal smear for Eosinophils. Air Biology Laboratory Kuwait provided us with daily pollen count.Results:From total 158 study participants, 132 had SAR symptoms and are divided in four groups. Fifth, control, group is non symptomatic. For 38.6% of symptomatic patients NSE were positive, while 45% of these patients have negative SPT. From 62.1% NSE negative patients, 37.8% have negative SPT. Our results showed expected positive correlation of NSE positive patients with pollen season in Kuwait, in SPT positive group. However, presence of Eosinophils in nasal smear was moderate to high also in patients with negative SPT during the highest peak of season, in contrast to control group.Conclusion:NES showed moderate sensitivity, relatively high specificity and importance as screening test in SPT negative patients. Evaluation of AR demand wide and improved diagnostic approach due to significant number of SPT negative patients with positive NSE based on natural allergen stimulation. Our results emphasize locale allergic response of nasal mucosa and importance of target organ diagnostic approach.

The Safety of the Oral Food Challenge Test with the Small Amount of Wheat for the High Risk Patients

T U E S D A Y 810 Is the Allergen-Specific Basophil Activation Test (BAT) Predictive of Oral Food Challenge (OFC) Outcomes? Vijaya Knight, MD, PhD; National Jewish Health, Denver, CO. RATIONALE: Although specific IgE (sIgE) is the primary laboratory test for diagnosis of food allergy, some patients with elevated sIgEmay only be sensitized. The OFC carries many risks and challenges. This study was undertaken to determine whether an allergen induced BAT is more predictive of food allergy than sIgE/SPTand a potential surrogate for OFC. METHODS: BAT was performed on heparinized blood from patients undergoing OFC. Allergens included egg, milk, peanut, soy, wheat, almond, cashew, hazelnut, Brazil nut, walnut and pistachio. Allergenspecific upregulation of the basophil-specific ectoenzyme E-NPP3 (CD203c) was measured by flow cytometry. The extent of basophil activation, (fold increase of CD203c expression over baseline), was correlated with sIgE, SPT and OFC outcomes. RESULTS: 9 children underwent testing; 1 was excluded for inadequate response to positive control (anti-IgE). 57% demonstrated basophil reactivity to peanut; 43% egg; 40% pistachio, pecan, hazelnut, Brazil nut, cashew, and almond; 33% walnut; 29% milk and soy. Children with negative SPT or sIgE were not BAT positive, indicating good correlation for negative results. Two sensitized patients with negative BAT passed OFCs. CONCLUSIONS: This preliminary data demonstrates the utility of BAT in diagnosing food allergy. In this small cohort, specificity of the BAT appears equal, if not superior to sIgE and SPT in identification of patients with food allergy. The two patients with negative BAT passing OFC suggest that BAT could be used to guide the need for OFC. Recruitment to this study is ongoing. Further studies will focus on the BAT in select patient groups (e.g.; atopic dermatitis, high IgE).

P93 ‐ The role of allergy evaluation in children with eosinophilic esophagitis

Aim Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus immune/antigens mediated. It is clinically characterised by symptoms related to esophageal dysfunction and associated with eosinophil-predominant esophageal inflammation. The role of atopy has been clearly demonstrated both in epidemiological and experimental studies and has important implications for diagnosis and therapy.The aim of this study was to assess the relationship between food allergy and eosinophilic esophagitis in the pediatric population, as well as the effect of dietary modifications in patients’ clinical symptoms. Methods Thirty-six children aged 7 months to 12 years (median age 80 months), with EoE (esophageal symptoms, biopsy with >15 eosinophils/HPF after the patients have been treated with aP PI for at least 4– 8w eeks and other causes have been excluded) were included to group I. Twenty age and sex matched, apparently healthy, infants and children were studied as control group(group II).Serum specific IgEs to cow milk, egg, wheat, rice, corn, soy, chicken, potato, beef, peanut and pork were measured with the CAP-FEIA. Skin prick tests and atopy patch tests (using fresh foods) were performed for the same allergens. Results All children in control group had negative CAP, SPT and APT to all food allergens. In group I 30/36 children (83%) had positive APT. Of these, 12/30 (40%) had also positive SPT and 16/30 (53%) had also positive CAP. Of the 30 positive children 4 (4/30, 13%) had positive APT to one food allergen, 3/30 (10%) had positive APT to two food allergens and 23/30 (77%) to 3 or more food allergens. In the APT-positive children, in group I, withdrawing the suspected food allergens for an 8 week period resulted in the improvement of symptoms. Conclusion Food allergens seem to be a significant etiologic factor for eosinophilic esophagitis in infants and young children. Skin tests are able to identify, in most of the cases, the responsible food allergens leading to dietary modifications and symptom remission.

Local Allergic Rhinitis is Highly Prevalent in a Population Attended for the Evaluation of Rhinitis

Evidence demonstrates the existence of local allergic rhinitis (LAR) in an important group of non-atopic patients. In this study we evaluated the prevalence and clinical characteristics of LAR in Málaga, Spain. A group of 388 adult rhinitis patients attended in our allergy service last year was randomly selected. Clinical questionnaire, SPT, spirometry, serum total and specific IgE (sIgE) were evaluated. Nasal allergen provocation test with multiple aeroallergens (NAPT-M) including D. pteronyssinus, pollens, and alternaria were performed in patients with negative SPT and serum sIgE. A total of 364 patients were studied, 24 were excluded because of nasal hyperreactivity. The prevalence of LAR was 23%, systemic allergic rhinitis (SAR) 65%, and non-allergic rhinitis (NAR) 12%. LAR and SAR patients had a similar clinical profile: a non-smoker woman with severe-persistent perennial rhinitis with 6 years of evolution, frequently associated to conjunctivitis (68.1% vs 67.6%, p>0.05) and asthma (41.2% vs 44.1%, p>0.05). NAPT-M detected aeroallergens polysensitization in 40.4% of LAR patients. D. pteronyssinus was the main sensitizing aeroallergen in LAR (75.6% vs 55.9%, p=0.071), and pollens in SAR (82.4% vs 62.5%, p=0.059). NAR diagnosis was achieved in 88 visits by NAPT-M instead of 352 visits that would be required by NAPT with a single aeroallergen. This study shows a high prevalence of LAR in rhinitis patients, with a clinical history of persistent and severe nasal symptoms frequently associated to conjunctivitis and asthma, and an important proportion of cases with aeroallergens polysensitization. NAPT-M is useful diagnostic test for screening of LAR.

Camel milk is a safer choice than goat milk for feeding children with cow milk allergy.

Background. Various sources of mammalian milk have been tried in CMA. Objectives. To determine whether camel milk is safer than goat milk in CMA. Methods. Prospective study conducted at Hamad Medical Corporation between April 2007 and April 2010, on children with CMA. Each child had medical examination, CBC, total IgE, cow milk-specific IgE and SPT. CMA children were tested against fresh camel and goat milks. Results. Of 38 children (median age 21.5 months), 21 (55.3%) presented with urticaria, 17 (39.5%) atopic dermatitis, 10 (26.3%) anaphylaxis. WBC was 10, 039 ± 4, 735 cells/μL, eosinophil 1, 143 ± 2, 213 cells/μL, IgE 694 ± 921 IU/mL, cow's milk-specific-IgE 23.5 ± 35.6 KU/L. Only 7 children (18.4%) tested positive to camel milk and 24 (63.2%) to goat milk. 6 (15.8%) were positive to camel, goat, and cow milks. Patients with negative SPT tolerated well camel and goat milks. Conclusions. In CMA, SPT indicates low cross-reactivity between camel milk and cow milk, and camel milk is a safer alternative than goat milk.

Utility of inhaled allergen challenge in clinical diagnosis and management of asthma: What never? Well, hardly ever!

Cite this as: D. S. Robinson, Clinical & Experimental Allergy, 2011 (41) 606–608.

Food Allergy Related Pediatric Constipation: Appropriate Time Of Tolerance

RATIONALE: The aim of this study was to assess the relation between food allergy and pediatric constipation and to determine the timing of achieving tolerance in these patients. METHODS: Fifty-four children (median age 25 months) with chronic constipation, not responding to 3 months laxative therapy, were included (group I). As controls were used twenty healthy children (group II). Serum specific IgEs to cow milk, egg, wheat, rice, corn, and soy were measured with the CAP-FEIA. Skin prick and atopy patch tests were performed for the same allergens. RESULTS: All children in the control group had negative CAP, SPT and APT to all food allergens. In group I 26/54 children (48%) had positive APT. Of these, 10/26 (38%) were APT and CAP positive, while 8/26 (30%) were APT and SPT positive. Of the 26 APT positive children 8 (8/26, 30%) had positive APT to one food allergen, 10/26 (38%) had positive APT to two food allergens and 8/26 (30%) to 3 or more food allergens. Positive APT to egg was found in 17/26, to wheat in 16/26, to soy in 9/26, to cow milk in 8/26, to rice in 4/26 and to corn in 3/26. The cumulative percentage of patients achieving tolerance was 19% at 6 months, 78% at 12 months and 100% at 24 months of elimination CONCLUSIONS: Food allergy seems to be a significant etiologic factor for constipation in infants and young children. Based on this study, approximately 3 out of 4 patients achieved tolerance within the first 12 months of strict food allergens elimination

Safety of measles-mumps-rubella vaccine (MMR) in patients allergic to eggs

Introduction Since the measles and mumps components used in MMR vaccine are grown in cultures of fibroblast from chick embryos, for a long time there have been concerns about the presence of egg protein in the vaccine and the recommendations given to egg allergic patients. We include in this paper our clinical experience vaccinating egg allergic patients with a regular triple viral vaccine, as well as an immunological study of each vaccine available in Spain. The aim of this study was to evaluate the clinical safety of a conventional MMR vaccine in a population of egg allergic patients and to determine the presence of egg allergens in a conventional MMR vaccine and if IgE antibodies from egg allergic can recognize egg allergens in this vaccine Materials and methods Children 15 months old with a confirmed diagnosed of egg allergy were included. In all patients, a skin prick test with non diluted MMR vaccine (Priorix, GSK) was made. If negative, each patient received a single dose of measles, mumps, rubella (MMR) vaccine. If positive, a fractionated injection of the vaccine was made following SEICAP recommendations (2004). SDS-PAGE immunoblotting was performed with Priorix vaccine. Results A cumulative total of 26 patients with egg allergy have safely received MMR vaccine in a single-dose (after a negative SPT in all cases) at our department without any reaction. 5 sera of vaccinated patients and 6 control sera of egg allergic patients (positive oral challenge) were used to immunolabel the membranes. No positive bands corresponding to egg proteins were found in any of the patients. Conclusion Negative results found in SPT support the absence of clinical reaction against the components and Immunological studies point that there is no detectable amount of egg protein in this vaccine to produce an IgE mediated reaction. We can conclude that MMR can be safely administrated in children allergic to egg.

Influenza vaccine in 55 patients with egg allergy

RATIONALE: Egg allergy prevents many patients from receiving influenza vaccine. Clinical predictors of vaccine reaction might help in determining safety of administration.METHODS: 55 patients diagnosed with egg allergy confirmed by positive SPT and/or egg specific IgE underwent skin testing for flu vaccine. Patients with negative SPT received vaccine; those with positive SPT had vaccine administration deferred in most cases. Clinical and laboratory profiles were obtained to include asthma history, presence of other food allergy, and level of egg specific IgE. ELISA was conducted on selected vaccine lots to determine ovalbumin concentration.RESULTS: Clinical history of egg allergy ranged from eczema to wheezing. 45/55 patients had asthma and 52/55 had other food allergy. 32/55(58%) had negative SPT and 23/55(42%) had positive SPT. All 32 patients who were SPT negative to vaccine were immunized with 4 patients developing mild localized cutaneous reactions and 1 patient developing mild wheezing. Of the 23 patients who were SPT positive to vaccine 5 were immunized and none developed reactions. Detected ovalbumin concentration in three vaccine lots ranged from 4.9 ug/mL to 14.6 ug/mL.CONCLUSIONS: In our study patients with egg allergy were safely immunized with influenza vaccine. Current recommendations for influenza vaccine and egg allergy remain the safest and most reliable approach to administration (Zeiger RS. Current issues with influenza vaccination in egg allergy. JACI 2002;110:830-40). RATIONALE: Egg allergy prevents many patients from receiving influenza vaccine. Clinical predictors of vaccine reaction might help in determining safety of administration. METHODS: 55 patients diagnosed with egg allergy confirmed by positive SPT and/or egg specific IgE underwent skin testing for flu vaccine. Patients with negative SPT received vaccine; those with positive SPT had vaccine administration deferred in most cases. Clinical and laboratory profiles were obtained to include asthma history, presence of other food allergy, and level of egg specific IgE. ELISA was conducted on selected vaccine lots to determine ovalbumin concentration. RESULTS: Clinical history of egg allergy ranged from eczema to wheezing. 45/55 patients had asthma and 52/55 had other food allergy. 32/55(58%) had negative SPT and 23/55(42%) had positive SPT. All 32 patients who were SPT negative to vaccine were immunized with 4 patients developing mild localized cutaneous reactions and 1 patient developing mild wheezing. Of the 23 patients who were SPT positive to vaccine 5 were immunized and none developed reactions. Detected ovalbumin concentration in three vaccine lots ranged from 4.9 ug/mL to 14.6 ug/mL. CONCLUSIONS: In our study patients with egg allergy were safely immunized with influenza vaccine. Current recommendations for influenza vaccine and egg allergy remain the safest and most reliable approach to administration (Zeiger RS. Current issues with influenza vaccination in egg allergy. JACI 2002;110:830-40).

How long does the effect of birch pollen injection SIT on apple allergy last?

Recent studies showed that injection specific immunotherapy (SIT) with birch pollen extract greatly reduces or cures the associated apple allergy in a large proportion of birch pollen-allergic patients. However, the long-term efficacy of SIT for apple allergy has not been assessed. To evaluate the duration of the effect of injection SIT with birch pollen extract on apple allergy in birch pollen-allergic patients. Thirty birch pollen-allergic patients showing both the clinical disappearance of apple allergy and a negative SPT with fresh apple at the end of their injection SIT course were followed-up at 12-month intervals from 6 months after SIT was stopped. Apple tolerance as well as SPT was assessed on all occasions. Fifty-seven birch pollen-allergic subjects without apple allergy and not submitted to SIT regularly followed-up for the onset of oral allergy syndrome (OAS) were used as controls. The overall prevalence of OAS after 30 months of follow-up did not differ between patients and controls. Although most patients became re-sensitized to apple by SPT over time, >50% of them were still able to tolerate eating the fruit at the 30-month follow-up visit. Although most patients show a 'natural', gradual propensity to apple re-sensitization (a consequence of prolonged and repeated inhalation of birch pollen responsible for primary sensitization?), the clinical effects of injection SIT on food allergy seem rather long lasting.

Serum specific-IgE antibodies to peptides detected in a casein hydrolysate formula.

Up to 2.5% of infants are affected by cow milk hypersensitivity in the first two years of life, although most of these children will "outgrow" their reactivity within 2-3 years. Extensively hydrolyzed ("hypoallergenic") cow milk-based formulae are often recommended as a substitute formula and are generally well tolerated. However, a small minority of cow milk-allergic children experience allergic reactions to the hypoallergenic formulae as well. Utilizing inhibition-ELISAs and sera from patients with IgE-mediated cow milk allergy, we have identified residual protein fractions less than 20 kD in several of the extensively hydrolyzed cow milk-based formulae. Although many of the cow milk allergic children had positive skin prick tests [SPT] to one of the hydrolysate formulae (Nutramigen), the positive skin test result generally did not correlate with clinical reactivity, although the negative predictive value of the negative SPT was excellent. Children with IgE-mediated cow milk allergy and a positive skin prick test to the hypoallergenic formula should probably receive their first dose of the formula in a medical setting so that appropriate therapy can be administered in the unlikely event of an allergic reaction.