Dupilumab to induce tolerance to SLIT-Melocotón®.

Summary: Introduction. Food allergy is an increasing problem for population and treatments inducing tolerance using sublingual immunotherapy is currently under study. Case presentation. Our aim as allergists is to achieve tolerance to sublingual allergen specific immunotherapy with sublingual immunotherapy (SLIT-peach). We present a case report consisting of a 40 year old woman with anaphylactic reactions after eating fruit and other plant-foods due to sensitization to nonspecific lipid transfer proteins (nsLTP). Her diagnose, LTP-syndrome. This protein is the main panallergen in our area and causes crossed reaction to multiple plant foods. The principal allergen in this syndrome is rPru p3, present in peach and most vegetables, fruits, nuts and grains. Serum specific IgE levels were performed using microarrays and positive for seven nsLTPs: rAra h9, rCor a8, nJug r3, rPru p3, rTri a 14, nArt v3 and rPla a3. Immediate reaction to SLIT in the fourth month of maintenance-dose led us to interrupt pru p3 immunotherapy. Immediate reaction to Omalizumab in the fourth dose in Hospital consisting in anaphylaxis prompted us to switch to Dupilumab. After four months with this monoclonal antibody we reintroduced sublingual immunotherapy with pru p3 SLIT-peach® achieving maintenance dose of four drops a day with no clinical reactions. SLIT-peach® in our patient is crucial for her due to her restricted diet, the severity of reactions and lack of quality of life measured by Europevall questionnaire. Conclusions in our case our aim is to achieve SLIT. We report a case of compassionate use with Dupilumab in a patient with multiple food allergy syndrome mediated by nsLTP. There are no cases reported for Dupilumab in this use.

[Diagnostic performance of eosinophil protein quantification. Review]. / Rentabilidad diagnóstica de la cuantificación de las proteínas del Eosinófilo. Revisión.

The role of eosinophils in the pathophysiology of atopic diseases, parasitic infestations, neoplasms, and immune deficiency, among other disorders, has been demonstrated in recent years. Among eosinophil constituents we find proteins associated with membranes, cytoplasm, and granules. When the cell is activated, it can release various products, notably the basic granular proteins which have a cytotoxic effect on bronchial epithelial cells, parasite larvae, and tumoral cells: principal basic protein, eosinophil cationic protein, protein X of the eosinophil/eosinophil-derived neurotoxin, and peroxidase derived from the eosinophil. Knowledge of the biological functions of these proteins and of their concentration in different tissues is important because it reflects the role of eosinophils in the production of the histologic and clinical findings of diverse disorders. Moreover, there are now sensitive radioimmunoassays that allow measurement of these substances in different body fluids, such as serum, bronchoalveolar lavage fluid, sputum, and nasal lavage fluid. In this sense, the protein most studied has been eosinophil cationic protein, although there also are many publications on the effects of principal basic protein on bronchial epithelium and its concentration in the sputum of asthmatic patients. As regards diagnostic performance, quantitation of the granular proteins can be useful for monitoring the activity of diseases such as bronchial asthma, and it helps to predict which patients may experience a delayed asthmatic reaction after bronchial provocation with and allergen. Finally, increased serum levels of principal basic protein in the last weeks of pregnancy seem to serve as a predictive index of term gestation.

Determination of eosinophil rate after nasal provocation test in allergic rhinitis diagnosis.

After nasal provocation test in patients with allergic rhinitis, using the allergen they were sensitized to, we have observed: 1) an increase in the percentage of nasal eosinophils after 2, 3, 24 and 48 hours; 2) sneezes, mainly in the first 30 minutes; 3) nasal obstruction in the first three hours; 4) absence of rhinorrhea, but not in all the patients; and 5) no predominance of nasal, auricular and/or palatine pruritus at any time. When patients without rhinitis, or with allergic rhinitis were stimulated using a pneumoallergen they were not sensitized to, no significative increase in the nasal eosinophils percentage was found. No symptoms were observed either. So, we can conclude that nasal secretion samples, for eosinophilia percentage determination, should be taken from 2 to 48 hours after nasal provocation, and that the most frequent symptoms, which are probably related to cellular changes, are nasal obstruction and sneezes.