Cabrera-Freitag, P. (P.)

Ferrer, M. (Marta)

Javaloyes, G. (G.)

Martinez, R. (R.)

Sanz, M.L. (María Luisa)

Ferrer-Cardona, M. (Marta)

Universidad de Navarra

The basophil activation test as a promising diagnostic tool in hypersensitivity to chironomid larvae

Dadun, University of Navarra

Practitioner’s Corner J Investig Allergol Clin Immunol 2011; Vol. 21(2): 153-161© 2011 Esmon Publicidad158articles in the fi eld of infectious diseases. BMC Infect Dis. 2005;5(1):16.  8.  The Institute for Scientifi c Information: SCI: Science Citation Index Expanded-Journal Citation Reports, http://scientifi c.thomsonreuters.com/cgi-bin/jrnlst/jlresults.cgi?PC=D&SC=AQ (Accessed January 2010).   9.  National Library of Medicine, Index Medicus Database (PubMed), http://www.ncbi.nlm.nih.gov/entrez/query.fcgi (Accessed January 2010). 10. Seglen PO. Citations and journal impact factors: questionable indicators of research quality. Allergy. 1997 Nov;52(11):1050-6. ❚ Manuscript received April 16, 2010; accepted for publication September 24, 2010.Chrysanthi L Skevaki, MDAllergy Research Laboratories, Second Department of Pediatrics “P & A Kyriakou” Children’s Hospital, University of Athens41 Fidipidou str, 115 27 Athens, GreeceE-mail: cskevaki@allergy.gr The Basophil Activation Test as a Promising Diagnostic Tool in Hypersensitivity to Chironomid LarvaeP Cabrera-Freitag, M Ferrer, R Martínez, G Javaloyes, ML SanzDepartment of Allergology and Clinical Immunology, Clínica Universidad de Navarra, Pamplona, SpainKey words:  Anaphylaxis. Basophil activation test. Chironomus. Diagnosis. Fish food.Palabras clave: Anafilaxia. Test de activación de basófilos. Chironomus. Diagnóstico. Comida para peces.Chironomids are nonstinging insects belonging to the Nematocera suborder of the Diptera order. They are found in wetlands and are a frequent cause of environmental allergy in Sudan, Japan, Egypt, and the northern part of the United States [1]. However, in recent years, hypersensitivity to chironomids has been reported after occupational exposure in fi sh food handlers (fi sh food factories, fi shermen, pet shops.) [2] and in relation to hobbies in countries where Chironomus larvae (Chironomus thummi) are commercialized as fi sh food [3]. Hypersensitivity to these larvae has been reported to cause urticaria, rhinoconjunctivitis, asthma, angioedema, and even anaphylaxis [3,4].Conventional diagnosis is made using the skin prick test with chironomid extract and specifi c immunoglobulin (Ig) E against C thummi. However, the allergenic potential of Chironomus larvae carries a risk when the noncommercial extract is used in skin tests, and cases of anaphylaxis have been reported when these tests were performed [4].We report the case of a 33-year-old woman with an unremarkable clinical history. Immediately after feeding her fi sh with Chironomus larvae (Tetra Delica, Tetra, Spectrum Brands, USA) 10 days previously, the patient suffered from bouts of sneezing, itching in the nose and eyes, rhinorrhea, and epiphora followed a few minutes later by ocular angioedema and dizziness. This clinical picture persisted with diffi culty in breathing, wheezing, and dry cough for which she took terbutaline. Her symptoms improved slowly, although the rhinorrhea and nasal obstruction persisted. She had previously handled the same fi sh food with no problems. However, on the day of the reaction, she had rubbed the dry Chironomus larvae between her fi ngers to break them into smaller pieces before dropping them into the fi sh tank.Two weeks after her fi rst consultation and with all her symptoms having resolved, a skin prick test was performed with a battery of common inhalant and food allergens including pollens, dust mite, fish, shellfish, Anisakis, cockroach, and common mosquito (Aedes communis), all of which were negative. We performed a further skin prick test with an extract of freeze-dried Chironomus larvae (Tetra Delica 20% w/v in phosphate-buffered saline), which was positive (29  13 mm), and determined specifi c IgE to C thummi (41.70 kUA/L). Five skin prick tests were performed with Chironomus in control patients and the results were negative. A few minutes after the skin test, the patient began to report a sensation of nasal obstruction and pharyngeal foreign body, but not breathing diffi culties. Examination revealed no apparent edema of the uvula. She was administered 5 mg of levocetirizine and her clinical picture gradually resolved. A basophil activation test using CD63 as a marker for activated basophils (FACSCanto, BD Biosciences, San José, California, USA) was performed with C thummi extract (6 mg/mL) with a positive result at all the concentrations tested (29.8% at 3 mg/mL, 25.5% at 0.3 mg/mL, 20.6% at 0.03 mg/mL, 20.5% at 3 μg/mL; baseline activation, 2.3%; anti-IgE, 42.1%) (Figure). The test was carried out in parallel in 4 controls and the results were negative.We present a case of allergy to C thummi, with positive results in the skin prick test, specifi c IgE determination, and basophil activation test. To our knowledge, this is the fi rst report of an allergy to Chironomus in which the basophil activation test [5] was performed as part of the allergy workup. Given the risk not only of serious local reactions [6], but also of severe systemic reactions [4] when a prick-prick test with Chironomus is used, we believe that the basophil activation test is a highly useful tool in the diagnosis of allergy to C thummi.References  1. Suzuki M, Itoh H, Sugiyama K, Takagi I, Nishimura J, Kato K, Mamiya S, Baba S, Ahya Y, Itoh M, Ohta N. Causative allergens of allergic rhinitis in Japan with special reference to silkworm moth allergen. Allergy. 1995;50:23-7.J Investig Allergol Clin Immunol 2011; Vol. 21(2): 153-161 © 2011 Esmon PublicidadPractitioner’s Corner159Baseline Response Anti IgE (Positive Control) C thummi 3 mg/mLC thummi 0.3 mg/mL C thummi 0.03 mg/mL C thummi  3 μg/mL105104103102102 103 104 105CD 63 PE-A(– +) 2.3% (+ +)(– –) (+ –)A-IgE FITC-A105104103102102 103 104 105CD 63 PE-A(– +) 42.1% (+ +)(– –) (+ –)A-IgE FITC-A105104103102102 103 104 105CD 63 PE-A(– +) 29.8% (+ +)(– –) (+ –)A-IgE FITC-A105104103102102 103 104 105CD 63 PE-A(– +) 25.5% (+ +)(– –) (+ –)A-IgE FITC-A105104103102102 103 104 105CD 63 PE-A(– +) 20.6% (+ +)(– –) (+ –)A-IgE FITC-A105104103102102 103 104 105CD 63 PE-A(– +) 20.5% (+ +)(– –) (+ –)A-IgE FITC-AFigure. Basophil activation test with Chironomus thummi extract (6 mg/mL). Results of the different concentrations tested.  2. Liebers V, Hoernstein M, Baur X. Humoral immune response to the insect allergen Chi t 1 in aquarists and fi sh-food factory workers. Allergy. 1993;48:236-9.  3. Aldunate MT, Echechipía S, Gómez B, García BE, Olaguibel JM, Rodríguez A, Moneo I, Tabar AI. Chironomidae and other causes of allergy to fi sh food. Allergol Inmunol Clin. 1999;14:140-5.  4. Nguyen M, Paradis L, Des Roches A, Primeau MN, Paradis J. Adverse reactions resulting from skin testing in the diagnosis of red grubs (Chiromides) allergy. Allergy. 2007;62:1470-7.  5. Sanz ML, Maselli JP, Gamboa PM, Oehling A, Diéguez I, de Weck AL. Flow cytometric basophil activation test: a review. J Investig Allergol Clin Immunol. 2002;12(3):143-54.  6. Cabrerizo S, de Barrio M, Baeza ML, Rubio M. Allergy to chironomid larvae (red midge larvae) in non professional handlers of fi sh food. J Investig Allergol Clin Immunol. 2006;16:63-8.❚ Manuscript received September 17, 2010; accepted for publication October 8, 2010.Paula Cabrera-FreitagDepartment of Allergology and Clinical ImmunologyClínica Universidad de Navarra31008 Pamplona, SpainE-mail: pcabrera@unav.es    

The basophil activation test as a promising diagnostic tool in hypersensitivity to chironomid larvae

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