Chieira, C

Faria, E

Geraldes, L

Loureiro, G

Santos, A

Sousa, N

Name not available

Suspected heparin hypersensitivity reaction: case report

Repositório Institucional dos Hospitais da Universidade de Coimbra

1222Diagnostic utility of nasal provocationtests in children with possible allergicrhinitis and allergic asthmaV Tsybulkina1, G Zainetdinova1, N Tsybulkin2, LDuBuske31Allergy and Immunology, Kazan State MedicalUniversity, Kazan, Russian Federation, 2Allergy andImmunology, Kazan State Medical Academy, Kazan,Russian Federation, 3Allergy and Immunology, IRINE,Gardner, MA, United StatesBackground: Inhalation provocative tests(IPT) represent a precise and sensitivediagnostic tool in patients with allergic dis-eases. Nasal provocative tests (NPT) may bea useful alternative approach in vulnerablepatient groups like children. Additionalcriteria of assessment in NPT can increasethe diagnostic value of the test. The level ofeosinophilia in nasal secretions may prove tobe a useful marker of the intensity of allergicinflammation.Methods: NPT were performed in 22 patients5–16 years old with persistent allergic asthmaand allergic rhinitis. All patients had docu-mented sensitivity to house dust mites. NPTwere performed during periods of asthmaremission (FEV1475% of normal value) withall inhaled and systemic treatment with-heldprior to the NPT. Nasal secretion eosino-philia was assessed before NPT and mon-itored for 48 h following NPT.Results: NPT induced substantial changeswithin 20min with both early and lateresponses noted. The relative number ofeosinophils in nasal secretions decreasedfrom 4.65–3.45% within 20min after NPT,reaching a nadir (0.65%, Po0.001) at 5 hpost-NPT and persisting at diminished levelsfor at least 24 h (2.4%). There was acorrelation between the baseline levels ofnasal secretion eosinophilia and the clinicalseverity of the disease.Conclusions: NPT may be a valuable alter-native to IPT in asthmatic children due topotential adverse consequences of IPT,especially in children having allergic asthma.Transient eosinopenia in nasal secretionsmay be a supplementary marker of positiveresponses during NPT.1223Correlation between skin prick tests andspecific IgE in allergic Estonian adultsA Raukas-Kivioja1, K Julge2, H Loit1, A Minossenko1,E Ro¨nmark3, B Lundba¨ck31Department of Chronic Disease Prevention, NationalInstitute for Health Development, Tallinn, Estonia,2Children’s Clinic, Tartu University, Tartu, Estonia, 3Lungand Allergy Research, Karolinska Institutet, IEM,Stockholm, SwedenBackground: Skin prick tests (SPT) andserum specific IgE antibody measurementare commonly used in evaluation of allergy.The earlier Estonian data give an assump-tion that in children, the transient sensitisa-tion in early childhood is followed by adown-regulation of skin reactivity whilethe prevalence of circulating IgE anti-bodies remain high. Can SPT and specificIgE be considered as complementary, orshould SPT-positivity be confirmed by spec-IgE tests in adults? The current studyassesses the correlation between results ofSPT and specific IgE tests in SPT-positiveadults.Method: Adult population-based cross-sec-tional study (FinEsS) in three areas ofEstonia with 1346 randomly selected parti-cipants in whom SPT to 15 aeroallergenswere performed. Serum specific IgE weremeasured in 242 SPT-positive subjectsdefined as at least one positive reaction witha weal of equal or more 3mm. Positiveresponse was defined as specific IgE equal ormore 0.35 kU/L; UniCAP. Tetrachoric cor-relation coefficient for binary characteristics(Tetra) and Spearmans rank order correla-tion test (Spearmans) were used for assess-ment of correlation.Result: SPT and specific IgE to assessallergic sensitisation to cat were highlycorrelated (Tetra: 0.826 and Spearmans:0.602). SPT and IgE to cockroach correlatedat high or medium level (Tetra: 0.817 andSpearmans: 0.552), to house dust mite, D.pteronyssinus, at a medium level (Tetra:0.671 and Spearmans 0.496), while corre-sponding coefficients for storage mites,A. siro and L. destructor were 0.580 and0.379, and 0.644 and 0.424, respectively.Conclusion: On adults, it is highly likely todiagnose existing allergic sensitisation to catusing one of the two tests. Suspected allergicsensitisation to cockroach and mites speciesought to be confirmed with both SPT andspec-IgE tests.1224Suspected heparin hypersensitivityreaction: case reportN Sousa, G Loureiro, L Geraldes, A Santos, E Faria,C ChieiraImmunoallergology Department, Coimbra UniversityHospital, Coimbra, PortugalBackground: Heparin and other anticoagu-lants are some of the most important andwidely used drugs in hospitalized patients.However, in clinical practice, the incidenceof hypersensivity reactions to these drugs islow. Heparin is the first line therapy in somediseases, which makes an adequate diagnosisessential.Patients and methods: We present the caseof a 31-year-old female, with a historyof surgically corrected pulmonary arterio-venous shunt in 1990 and heterozygousprotein S deficiency which led to twothrombotic events (Deep Vein Thrombosisin 1994 and 2003). The patient was medi-cated with warfarine since the last episode.In 2004 the patient exhibited an immediatereaction, with erythema and pruritus atthe injection site of heparin. She was sentto our Department with suspected heparinallergy. Skin prick tests (SPT) to latex andheparin were done in the first step, followedby patch, intradermal test (IDT – 1/10000,1/1000, 1/100) and subcutaneous provoca-tion tests to heparin. Total serum IgE andspecific IgE to latex determinations werecarried out.Results: SPT, patch and intradermal teststo heparin were negative. SPT to latexwas positive. Five minutes after the sub-cutaneous administration of heparin(0.1mL), the patient suffered an intenseerythematous pruritic reaction not at theinjection site, but at the site of the latex SPTperformed the previous day in the homo-lateral arm. The heparin vial had a rubberseal. The next day, in a latex-free environ-ment, no reaction was observed after thesubcutaneous injection of heparin. SpecificIgE to latex was 6.4 kU/L. Total serumIgE was below 19 kU/L. The diagnosis oflatex allergy was made and the patientrestarted subcutaneous heparin therapy,with no complications.Conclusion: The use of a natural rubberlatex sealed heparin vial appears to be thecause of the symptoms, in a patient withoutany other signs of latex allergy. This caseemphasizes the importance of consideringlatex allergy in the differential diagnosis ofparenteric drug hypersensitivity.1225T-cell marker CRTH2: a tool for basophilicidentification?S Campina Costa1, A Campos Melo2, J Caiado3, ASpı´nola3, M Pereira Barbosa3, M Trindade1, A Sousa2, RVictorino2, M Pereira Santos21Departamento de Pneumologia, Hospital PulidoValente/Unidade de Imunoalergologia, Lisboa, Portugal,2Instituto de Medicina Molecular/Faculdade de Medicinada Universidade de Lisboa, Unidade de ImunologiaClı´nica, Lisboa, Portugal, 3Servic-o de Imunoalergologia,Hospital Santa Maria, Lisboa, PortugalBackground: CRTH2 (chemoattractant re-ceptor-homologous molecule expressed onTh2 cells) was shown to be expressed in asubset of T cells and in basophils (BA) andeosinophils. This molecule has been pro-posed as a marker to identify BA in thebasophil activation test (BAT).Aim: In order to assess its utility weconducted a BAT study to compare CRTH2with two other BA markers: CD203c or IgEexpression. Two cohorts of patients withallergy to insect venom (n5 7) and to drugs(n5 7) based on clinical history, skin testsand specific IgE, were evaluated. CD63 andup-regulation of CD203c were used asreadouts of the BA activation.Poster Group 3 – Allergy Diagnosticsr 2007 The AuthorsJournal Compilation r 2007 Blackwell Munksgaard Allergy 62 (Suppl. 83): 167–551428

Suspected heparin hypersensitivity reaction: case report

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