Flow-based basophil activation test in immediate drug hypersensitivity. An EAACI task force position paper

Diagnosing immediate drug hypersensitivity reactions (IDHRs) can pose a significant challenge and there is an urgent need for safe and reliable tests. Evidence has emerged that the basophil activation test (BAT), an in vitro assay that mirrors the in vivo response, can be a complementary test for many drugs. In this position paper, members of Task Force (TF) “Basophil activation test in the evaluation of Drug Hypersensitivity Reactions” from the European Academy of Allergy and Clinical Immunology (EAACI) present the data from a survey about the use and utility of BAT in IDHRs in Europe. The survey results indicate that there is a great interest for using BAT especially for diagnosing IDHRs. However, there are still main needs, mainly in the standardization of the protocols. Subsequently consensus-based recommendations were formulated for: (i) Technical aspects of BAT in IDHRs including type of sample, management of drugs, flow cytometry protocols, interpretation of the results; and (ii) Drug-specific aspects that should be taken into account when performing BAT in relation to betalactams, neuromuscular blocking agents, fluoroquinolones, chlorhexidine, opioids, radio contrast media, chemotherapeutics, biological agents, nonsteroidal anti-inflammatory drugs, COVID vaccine, and excipients. Moreover, aspects in the evaluation of pediatric population have also been considered. All this indicates that BAT offers the clinician and laboratory a complementary tool for a safe diagnostic for IDHRs, although its place in the diagnostic algorithm depends on the drug class and patient population (phenotype, geography, and age). The standardization of BAT is important for generalizing this method beyond the individual laboratory.Funding for open access charge: Universidad de Málaga/CBUA. The authors would like to thank EAACI for their financial support in the development of this Task Force Position Paper

7th Drug hypersensitivity meeting: part two

No abstract availabl

Supplementary Material for: Cor a 14: Missing Link in the Molecular Diagnosis of Hazelnut Allergy?

<b><i>Background:</i></b> Hazelnut allergy shows distinct clinical patterns that can be predicted through component-resolved diagnosis. However, identification of sensitization profiles remains incomplete. <b><i>Methods:</i></b> Sera of 75 patients allergic to hazelnuts, 14 infants with atopic dermatitis (AD) sensitized to hazelnuts, 15 hazelnut-tolerant individuals with specific IgE (sIgE) to hazelnuts and 15 healthy control individuals were tested for sIgE reactivity to rCor a 1.04, rCor a 8, nCor a 9, nCor a 11, rCor a 14, rBet v 1, rBet v 2 and cross-reactive carbohydrate determinants (CCDs). <b><i>Results:</i></b> Sensitization to Cor a 14 was observed in 18 out of 20 preschool children, 8 out of 10 school-aged children and 2 out of 7 adults with generalized reactions and in 3 out of 14 infants with AD. Only 2 out of 38 patients with an oral allergy syndrome (OAS) were sensitized to Cor a 14. No sensitization to Cor a 14 was observed in the group of hazelnut-tolerant and healthy control individuals. Sensitization to Cor a 1.04 was seen in 36 out of 38 OAS patients and in 14 out of 37 patients with generalized reactions. However, only 3 patients with generalized reactions were monosensitized to Cor a 1.04. Sensitization to Cor a 9 was observed in 26 out of 37 patients with generalized reactions and in 4 out of 14 infants with AD. Sensitization to Cor a 11, Cor a 8, rBet v 2 and CCDs was rare. <b><i>Conclusions:</i></b> Sensitization to Cor a 14 can have early onset and shows age-related variations. Together with Cor a 9, Cor a 14 enables us to correctly identify almost 90% of children with generalized reactions to hazelnut

Standard methods for <em>Apis mellifera</em> venom research.

Honey bees have a sting which allows them to inject venomous substances into the body of an opponent or attacker. As the sting originates from a modified ovipositor, it only occurs in the female insect, and this is a defining feature of the bee species that belong to a subclade of the Hymenoptera called Aculeata. There is considerable interest in bee venom research, primarily because of an important subset of the human population who will develop a sometimes life threatening allergic response after a bee sting. However, the use of honey bee venom goes much further, with alleged healing properties in ancient therapies and recent research. The present paper aims to standardize selected methods for honey bee venom research. It covers different methods of venom collection, characterization and storage. Much attention was also addressed to the determination of the biological activity of the venom and its use in the context of biomedical research, more specifically venom allergy. Finally, the procedure for the assignment of new venom allergens has been presented. Las abejas meliferas tienen un aguijon que les permite inyectar sustancias venenosas en el cuerpo de un oponente o atacante. El aguijon es un ovipositor modificado que solo se manifiesta en el insecto hembra, siendo este una caracteristica que define a las especies de abejas que pertenecen al subclado de himenopteros llamada Aculeata. Hay un interes considerable en la investigacion del veneno de abeja, principalmente debido a que un porcentaje importante de la poblacion humana desarrollara una respuesta alergica - a veces mortal - a la picadura de abeja. Sin embargo, el uso del veneno de la abeja melifera abarca mucho mas, con presuntas propiedades curativas en terapias antiguas e investigaciones recientes. El presente trabajo tiene como objetivo estandarizar metodos seleccionados para la investigacion del veneno de las abejas meliferas. Cubre diferentes metodos de recoleccion, caracterizacion y almacenamiento de veneno. Tambien se presto mucha atencion a la determinacion de la actividad biologica del veneno y su uso en el contexto de la investigacion biomedica, mas especificamente la alergia al veneno. Finalmente, se ha presentado el procedimiento para la asignacion de nuevos alergenos de veneno

The diagnosis and management of allergic reactions in patients sensitized to non-specific lipid transfer proteins

Sensitization to one or more non-specific lipid transfer proteins (nsLTPs), initially thought to exist mainly in southern Europe, is becoming accepted as a cause of allergic reactions to plant foods across Europe and beyond. The peach nsLTP allergen Pru p 3 is a dominant sensitizing allergen and peaches a common food trigger, although multiple foods can be involved. A frequent feature of reactions is the requirement for a cofactor (exercise, alcohol, non-steroidal anti-inflammatory drugs, Cannabis sativa) to be present for a food to elicit a reaction. The variability in the food and cofactor triggers makes it essential to include an allergy-focused diet and clinical history in the diagnostic workup. Testing on suspected food triggers should also establish whether sensitization to nsLTP is present, using purified or recombinant nsLTP allergens such as Pru p 3. The avoidance of known trigger foods and advice on cofactors is currently the main management for this condition. Studies on immunotherapy are promising, but it is unknown whether such treatments will be useful in populations where Pru p 3 is not the primary sensitizing allergen. Future research should focus on the mechanisms of cofactors, improving diagnostic accuracy and establishing the efficacy of immunotherapy. © 2021 European Academy of Allergy and Clinical Immunology and John Wiley &amp; Sons Ltd