Carrapatoso, I

Chieira, C

Faria, E

Ribeiro, F

Ribeiro, H

Rodrigues, F

Sousa, N

Repositório Institucional dos Hospitais da Universidade de Coimbra

a-s IgE ab levels against peanut, at 5 yearsof age.Conclusion: Early IgE sensitization to anyof the allergens measured increases the riskof developing a stronger IgE sensitizationlater in life. High a-s IgG and/or IgG4 lev-els against peanut do not seem to preventhigh levels of a-s IgE against peanut.602Food-dependent exercise-inducedanaphylaxisChivato, T; Mateos, J; Montoro, A; De Mateo, B;Hernandez, J; Nun˜ez, A; Presa, N; Fernandez, MHospital Central Defensa ‘Go´mez Ulla’, AllergyDepartment, Madrid, SpainCase record: A 18-year-old male patient,with allergic rhinitis since the age of 14,showed an anaphylatic reaction while hewas playing football just after eating anapple. Few minutes after the ingestion ofone apple and when he was playing foot-ball with this friends the patient showedgeneralized pruritus, dyfuse erythema,hives, facial edema, cough, hoarseness anddysphonia. He was carried to an emer-gency unit and was treated with 0.3 mlsubcutaneous epinephrine (1/1000), subcu-taneous dexclorfeniramine (5 mg) andintravenous methylprednisolone (40 mg).He was non smoker, he had no pets andhe lived in a dry and sunny flat in Madrid.In the previous hours the patient tookaspirin because a headache. He wasreferred by his family physician becausethe severe reaction showed above. He stud-ied nursery. He had a family history atopysince his father and one brother had aller-gic bronchial asthma. No allergic reactionsto drugs nor foods were referred previ-ously.Diagnostics test: Skin prick tests to inhal-ants were positive to grass pollen and neg-ative to the pollens, house dust mites,animal dander and moulds. Blood testswere within normal parameter. Skin pricktest to foods were positive to apple andnegative to other fruits, dry fruits andlatex. Total IgE: 240 U/ml. Specific IgE forLolium perenne 14 kU/l and apple 2.4 kU/l. A basal forced spirometry revealed anormal lung function. Exercise challengetest without previous ingestion of applewas performed at the office and well toler-ated. Aspirin challenge test (single blindplacebo controlled) was performed at theoffice and well tolerated.Diagnosis: A diagnosis of food-dependentexercise-induced anaphylaxis was made.Treatment and follow up: A diet avoid-ing apple was started. The patient was dis-charged with a prescription for anepinephrine injector, education on use andindications. He was advised to avoid eatingapple and other fruits for, at least, 6 hprior to exercise. Since the diagnosis thepatient is totally asymptomatic and he ispractising all types of physical activities,including football, without clinical manifes-tations. The patient is eating other fruitswith good tolerance. He is taking aspirinwith good tolerance.603Contribution of in vitro methods to thestudy of fruit allergy clinical patternsSousa, N1; Carrapatoso, I1; Faria, E1; Ribeiro, F1;Rodrigues, F2; Ribeiro, H2; Chieira, C11Coimbra University Hospitals, ImmunoallergologyDepartment, Coimbra, Portugal; 2Coimbra UniversityHospitals, Immunology Laboratory, Coimbra, PortugalBackground: Immunoblotting and immu-noblotting inhibition essays have been usedfor many years to investigate cross reactiv-ity in food allergic patients. The use ofcomponent resolved diagnostics, in theform of ImmunoCAP ISACR, has emergedas a new in vitro method to study thesepatients, allowing the simultaneous deter-mination of multiple allergenic componentsin a single step.Patients and methods: We reviewed theclinical files of patients observed in our Im-munoallergology consultation in the year2008. The patients that had undergone Im-munoCAP ISACR as well as immunoblot-ting and/or inhibition immunoblottingassays were selected. We then proceeded tocompare the results in a case-to-case basis.Results: Six patients were evaluated (5 F/1 M, mean age 37 years). Three patientspresented food allergy and pollinosis,three isolated food allergy and two werealso allergic to latex. The clinical manifes-tations ranged from isolated oral allergysyndrome (oas), urticaria (u) and angioe-dema (ag) to dyspnoea (dysp) and glottisoedema (go).Table 1. For abstract 603.Patients1 2 3 4 5 6Fruits Peach Apple, peach Peach Apple, peach Kiwi, peach,chestnutKiwi, banana,chestnutSymptoms u + ag + dysp oas + dysp u + ag + go u + rc u + ag + dysp + go uSPT Peach + Peach, apple + Peach + Peach and apple + Chestnut + Kiwi +Specific IgE 1.7 kU/l Apple 3.29 kU/l,peach 10.1 kU/lPeach 1.06 kU/l Peach 3.0,apple 0.79 kU/lLatex 49.0 kU/l Latex 2.0,kiwi<0.35 kU/lImmunoCAP ISACR Pru p 3 + Bet v 1 and Mal d 1 + Pru p 3 + Hev b 5.0101,Hev b 6.02,Hev b 11.0101 +Immunoblottingessays (molecularweight ofpredominantbinding bands)Poa pratensis – 14.42and 30.15–34.24 kDaBetula verrucosa –16.49 kDaPoa pratensis –15.9 and 30.3 kDaPeach –13.55 kDaLatex – 39.38,110.0 and82.77 kDaLatex – 26.07and 31.15 kDaPeach – 13.66 Peach – 19.33 kDa Peach – 15.5 kDa Apple –12.62 kDaChestnut – neg Kiwi – 24.34 kDaApple – neg.ImmunoblottinginhibitionNo inhibitionbetween Poaand peachnd Partial inhibitionof peach by Poand No inhibitionbetween chestnutand latexPartial inhibitionof latex by kiwiNo inhibitionof Poa by peachPartial inhibitionof kiwi by latexPoster Group 1 – Food Allergy: from Clinical Presentation to Molecular CharacterisationÓ 2009 The AuthorsJournal Compilation Ó 2009 Blackwell Publishing Ltd Allergy 64 (Suppl. 90): 179–538 245

Contribution of in vitro methods to the study of fruit allergy clinical patterns

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Contribution of in vitro methods to the study of fruit allergy clinical patterns

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