Hypersensitivity Reactions to Cancer Chemotherapy: Practical Recommendations of ARADyAL for Diagnosis and Desensitization.

Rapid drug desensitization has enabled first-line therapies in patients with drug hypersensitivity reactions to chemotherapeutic drugs including monoclonal antibodies. Desensitization is a safe and highly effective procedure, not only for IgE-mediated reactions, but also for those mediated by non-IgE mechanisms. The likelihood of breakthrough reactions during desensitization is low, and most are mild; in fact, moderate-to-severe reactions are infrequent. In this document, 16 allergy departments belonging to the Spanish research network ARADyAL present a review of the available scientific evidence and provide general guidelines for the diagnosis and management of drug hypersensitivity reactions to chemotherapeutic drugs and monoclonal antibodies. Emphasis is placed on the desensitization procedure.

Analysis of the effectiveness of training school personnel in the management of food allergy and anaphylaxis.

BACKGROUND: Food allergy is a very frequent and increasingly common disease in children and adolescents. It affects quality of life and can even be life-threatening. Given that 10-18% of allergic/anaphylactic food reactions take place in schools, it is essential to provide school personnel with training on the management of reactions. METHODS: The Allergy Unit of Hospital Universitario de Fuenlabrada, Spain, organized a conference entitled "Management of Food Allergy in Children and Adolescents in School Centers" during which teachers, cooks, cafeteria monitors, and summer-camp leaders underwent a training course. Attendees filled out a questionnaire with eight questions before and after the course to assess their self-efficacy in management of food allergy and anaphylaxis. The results were compared. RESULTS: A total of 191 people participated (51% dining-room monitors, 24% teachers, 13% cooks, and 12% other professions). The areas in which the attendees presented the lowest confidence before receiving the course were recognition of symptoms and treatment of the reactions/anaphylaxis. The mean score for each of the eight concepts evaluated improved after the training course. This improvement was significant in the management of anaphylaxis. CONCLUSIONS: Our study demonstrates the usefulness of a self-efficacy scale in school personnel as a tool to assess the ability to manage food allergy and anaphylaxis. It can help to identify problem areas in which more specific training programs can be implemented.

Molecular characterization of contact urticaria in patients with melon allergy.

BACKGROUND: The relevance of contact allergy to plant-related food has recently emerged. Oral allergy syndrome is one of the most characteristic symptoms of fruit allergy, although it also causes systemic reactions. Plant-food allergy is increasing at the same time as pollen allergy, and fruit-induced allergic contact urticaria could be rising as well. OBJECTIVES: The present study was carried out in order to investigate whether one particular primary melon-peel allergen is responsible for contact urticaria. METHODS: Fourteen patients presenting with contact urticaria after touching melon peel were evaluated. A melon-peel extract was prepared and analysed by immunoblotting using the patients' sera. Molecular characterization of IgE-binding bands was performed using mass spectrometry. Melon-peel lipid transfer protein (LTP) was purified. Inhibition studies and contact challenge with the protein were performed to confirm IgE reactivity to the purified allergen. RESULTS: An IgE-binding band of ~8-9 kDa was observed in an immunoblotting assay with all the patients' sera and was identified as an LTP. The melon-peel LTP was purified in two chromatography steps. Inhibition studies confirmed LTP as a major allergen in patients with melon-peel contact urticaria. Contact challenge with melon-peel LTP was performed in five patients, all of whom had positive results, exhibiting itchy erythema and hives in the area of contact. CONCLUSIONS: This study confirmed our previous findings that melon-peel LTP is a major allergen and is responsible for contact allergy. This knowledge may be used to improve both diagnosis and treatment of patients allergic to melon.

Delayed allergic skin reactions due to intralesional meglumine antimoniate therapy for cutaneous leishmaniasis.

BACKGROUND: The pentavalent antimonials are considered the first-choice drugs for treatment of leishmaniasis. Intralesional therapy is used to minimize the systemic effects of the drug. METHODS: Seventy patients were treated with weekly intralesional infiltrations of Glucantime(®) (meglumine antimoniate) for cutaneous leishmaniasis. Nine of them had infiltrated itchy erythematous and vesiculous plaques at the injection sites. Cutaneous tests were undertaken in eight patients. RESULTS: Prick tests were negative and seven of the eight patients showed positive intradermal tests with Glucantime(®) dilutions reading at D2 and D4. Only one patient had positive patch test to Glucantime a.i. Local reactions at the site of injection have been briefly mentioned in some reported series of leishmaniasis treated with intralesional or intramuscular meglumine antimoniate but the mechanism has never been explained before. CONCLUSIONS: We report the first series of patients with local reactions at the injection sites of meglumine antimoniate in whom type IV hypersensitivity could be involved.

Prevalence of sensitization to lipid transfer proteins and profilins in a population of 430 patients in the south of Madrid.

BACKGROUND: Lipid transfer proteins (LTPs) and profilins are the most important panallergens in the management of patients who are allergic to pollen and plant food in our area. LTPs are highly stable proteins that can induce systemic symptoms after ingestion. Profilins are labile proteins that are present in pollens and vegetables. Considered markers of several types of pollen sensitization, they are responsible for cross-reactivity between pollens and vegetables. The objective of this study was to assess the frequency of sensitization to LTP and profilin using skin prick tests (SPTs) in patients referred to our allergy unit for any complaint (not only pollen and plant food allergy). METHODS: The study sample comprised 430 consecutive patients who were evaluated using their medical history and SPTs with pollen, date palm profilin, and peach extract enriched in Pru p 3 (30 g/mL) as an LTP marker. RESULTS: We found that 52 (12.1%) patients were sensitized to profilin and 53 (12.3%) to LTP. Pollen allergy was diagnosed in 53% and plant food allergy in 11%. In the LTP-sensitized group and the profilin-sensitized group, 37.7% and 34.6% of the patients had plant food allergy, respectively. Thirty-three patients (62.3%) were sensitized to LTP but had no symptoms after eating vegetables. CONCLUSIONS: To the best of our knowledge, this is the first study to analyze the real rate of sensitization to profilin and LTP in a population sensitized to allergens other than pollens and plant foods. Twelve percent of patients were sensitized to both profilin and LTP. A large proportion of LTP-sensitized patients had no symptoms at the time of the study.

Hypersensitivity Reactions to Cancer Chemotherapy: Practical Recommendations of ARADyAL for Diagnosis and Desensitization

Rapid drug desensitization has enabled first-line therapies in patients with drug hypersensitivity reactions to chemotherapeutic drugs including monoclonal antibodies. Desensitization is a safe and highly effective procedure, not only for IgE-mediated reactions, but also for those mediated by non-IgE mechanisms. The likelihood of breakthrough reactions during desensitization is low, and most are mild; in fact, moderate-to-severe reactions are infrequent. In this document, 16 allergy departments belonging to the Spanish research network ARADyAL present a review of the available scientific evidence and provide general guidelines for the diagnosis and management of drug hypersensitivity reactions to chemotherapeutic drugs and monoclonal antibodies. Emphasis is placed on the desensitization procedure (AU)

La desensibilización a medicamentos ha permitido la administración de fármacos de primera línea en pacientes con reacciones dehipersensibilidad (RH) a quimioterápicos (QT), incluyendo los anticuerpos monoclonales (AcM). La desensibilización es un procedimientoseguro y altamente efectivo, no únicamente para las reacciones mediadas por IgE sino también para aquellas relacionadas con un mecanismoindependiente de IgE. El riesgo de reacciones durante la desensibilización es bajo y frecuentemente las reacciones observadas son leves,considerándose infrecuentes las reacciones moderadas o graves.En este documento, dieciséis Servicios de Alergia pertenecientes a la red española de investigación ARADyAL presentan una revisiónde la evidencia científica disponible y sugieren unas pautas de actuación generales para el diagnóstico y manejo de las RH a QT y AcM,centrándose en el proceso de desensibilización (AU)

Vulvovaginitis and dog allergy / Vulvovaginitis y alergia al perro

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