Role of Skin Tests in the Diagnosis of Immediate Hypersensitivity Reactions to Taxanes: Results of a Multicenter Study.

BACKGROUND: Immediate hypersensitivity reactions (HSRs) to taxanes have been increasing in recent years, but the importance of skin tests in allergological workup has not been established. OBJECTIVE: In our study we tried to evaluate the role of prick and intradermal tests in the diagnosis of HSRs to paclitaxel and docetaxel. METHODS: In this multicenter prospective study, we enrolled patients with immediate HSRs to the aforesaid agents. Skin tests were performed on these subjects and if results were negative, intradermal tests with the culprit drug were conducted. Patients with grade 1 reactions subsequently underwent graded challenge; in cases of grade 2 or 3 reactions and/or positive test results, the culprit drug was administered with a desensitization schedule. Skin tests were also performed in 30 control subjects exposed to the taxanes without HSRs. RESULTS: A total of 84 patients (63 with HSRs to paclitaxel and 21 to docetaxel) were recruited in the period July 2015 to July 2017 by 8 centers; 58 patients (69%) developed grade 2 or 3 reactions. Prick test results were negative in all the cases, whereas intradermal test results were positive in 14 patients (10 with paclitaxel [15.9%] and 4 with docetaxel [19%]). The positivity of skin tests significantly correlated with grade 3 reactions and cutaneous involvement during HSRs. Graded challenge was performed in 16 patients without problems and 58 subjects underwent desensitization, which was well tolerated in all but 2 cases. In the control group, skin test results were negative in all the patients. CONCLUSIONS: Skin tests for taxanes seem useful and can be performed in the allergological workup of subjects with HSRs to these agents, especially in cases of severe reactions with cutaneous involvement.

[Cereal-dependent exercise-induced anaphylaxis]. / Anafilaxia dependiente de cereales inducida por ejercicio.

Wheat-dependent exercise-induced anaphylaxis (WDEIA) is increasing. In vitro test such as omega-5-gliadin levels are useful in the diagnosis, while oral single blind challenge tests (OCT) with wheat plus exercise continuous being the gold standard diagnostic method. This paper reports the case of a 38-year-old woman, with several episodes of anaphylaxis after eating different foods and doing exercise after ingestion. An allergy study was performed with positive skin prick tests for wheat, barley and rye. Total IgE 238.0KU/L, positive specific IgE (>100KU/L) to wheat, barley and rye, and negative to rTri-a-19 omega-5 gliadin. OCT with bread and exercise was positive. In this case of wheat-dependent exerciseinduced anaphylaxis (WDEIA) with negative serum specific IgE to omega-5-gliadin, negative results with gamma, alpha, bheta y omega-gliadin doesn't exclude the diagnosis of WDEIA.

La anafilaxia inducida por ejercicio dependiente de trigo (WDEIA por sus siglas en inglés de wheat-dependent-exercise-induced-anaphylaxis) es una entidad cada vez más frecuente. La detección de IgE frente a omega-5-gliadina in vitro se usa como método diagnóstico, pero la provocación oral controlada simple ciego (POC) con el alimento, junto con la realización de ejercicio físico, es el método diagnóstico patrón de referencia. Se comunica el caso de una paciente de 38 años de edad, con antecedente de episodios de anafilaxia relacionados con la ingestión de alimentos y la realización de actividad física. Se realizó un estudio alergológico. Las pruebas cutáneas fueron positivas a harina de trigo, cebada y centeno. IgE total: 238.0 kU/L, IgE específica positiva (mayor de 100 kU/L) a trigo, cebada, centeno y negativa a rTri-a-19omega-5 gliadina. La provocación oral controlada con pan de trigo y ejercicio físico fue positiva. En este caso con anafilaxia inducida por ejercicio dependiente de trigo sin sensibilización omega-5 gliadina la ausencia de IgE frente gamma, alfa, beta yomega-gliadina no excluiría el diagnóstico de esta enfermedad.