Sensitisation to Lep d 2- Lepidoglyphus destructor allergy in asthma and rhinitis.

Summary: Background. Mites are responsible for allergic diseases, such as asthma and rhinitis, in nearly 1.5% of the world population. It is known that nowadays, besides House Dust Mites (HDM), Storage Mites (SM) are important sensitisers in urban non-occupational dwellings, predominantly in the Mediterranean area. The main objective of our study was to analyse the clinical relevance of the most prevalent SM, Lepidoglyphus destructor, by assessing the relationship between sensitisation to the major molecular allergen Lep d 2 and allergic respiratory disease phenotype in an urban population monosensitised to this molecular allergen. Methods. Cross-sectional study which included consecutive patients evaluated in our Allergy Department between 2012 and 2018, from urban non-occupational setting, with rhinitis and/or asthma, perennial symptoms and proven sensitisation to SM Lep d 2, tested using ImmunoCAP Immuno Solid-phase Allergen Chip (ISAC) technology, which detects 112 allergens. Results. A total of 37 allergic patients were included (23 female), aged 20.1 ± 12.8, min-max 5-58 years-old. The molecular sensitisation profile showed 18.9% of L. destructor mite monosensitised patients, having only sIgE to Lep d 2. This subset of patients mainly had allergic rhinitis, with 28.6% also being asthmatic. Regarding severity, most patients showed a persistent moderate phenotype of respiratory disease. The mean value of Lep d 2 sIgE was 8.3 ± 9.8 ISU-E, lower than in mite polysensitised patients (21.7 ± 21.5, p = 0.049). Conclusions. Our proof-of-concept study focused on Lep d 2 monosensitisation, showed that SM may have clinical relevance in perennial allergic asthma and rhinitis, and should be taken into account when assessing and treating allergic respiratory disease. Conclusions. The present survey demonstrated that Italian primary care pediatricians accomplish ARIA guidelines and adapt treatment on the basis of the intensity of symptoms. Corticosteroids and antihistamines are the most common prescribed medications. Nasal lavages are also popular.

Primary care doctors' attitude towards drug allergy in Portugal: a questionnaire.

Summary: Background. The aim of the study was to learn about perception of drug allergy by general practitioners (GP) from continental Portugal, identify difficulties and educational needs for its management. Methods. A total of 372 answers were obtained. A questionnaire was addressed to GPs. Results. The most commonly identified drugs were antibiotics for 65.3% of the GPs and skin was the most commonly affected organ for 65.8%. Drug allergy was considered as very important in clinical practice by 73.7%, but difficulties in recognizing it were stated by 70.2%. Further education in this field wouldbe welcome by 97.8% of the doctors. The collaboration of Immunoallergology centers was considered non satisfactory by 39.8% of GPs and 45.7% of them stated that two-thirds of the suspected reactions were not investigated. Conclusions. These points deserve consideration in future health educational and organizational strategies.

Molecular Profile of Sensitization to Dermatophagoides pteronyssinus Dust Mite in Portugal.

BACKGROUND AND OBJECTIVES: To analyze component-resolved diagnosis of sensitization to Dermatophagoides pteronyssinus (Der p) in patients with respiratory allergy and the association between diagnostic findings and clinical severity in different geographical areas. METHODS: The study population comprised 217 patients (mean age, 25.85 [12.7] years; 51.16% female) selected from 13 centers in Portugal (5 from the North, n=65). All had allergic rhinitis with or without asthma and positive skin prick test results to at least 1 dust mite. Specific IgE (sIgE) to Der p, Dermatophagoides farinae, Lepidoglyphus destructor, Der p 1, Der p 2, Der p 10, and Der p 23 was determined using ImmunoCAP. The Mann-Whitney test was applied for the following comparisons: rhinitis vs rhinitis and asthma; mild vs moderate-to-severe rhinitis; North vs South. RESULTS: The prevalence of sensitization was 98.2% for Der p, and 72.4%, 89.4%, 9.7%, and 77% for Der p 1, Der p 2, Der p 10, and Der p 23, respectively. The corresponding median sIgE levels were 8.56, 17.7, 0.01, and 3.95 kUA/L. sIgE to all allergens was higher in patients with moderate-to-severe rhinitis and rhinitis with asthma (nonsignficant). Concentrations of sIgE to Der p 2 were significantly higher in the South than in the North (P=.0496). CONCLUSION: The most common sensitization in Portugal was to Der p. The highest prevalence and median sIgE level were observed for Der p 2. All sIgE values for molecular components were higher in more symptomatic patients (nonsignificant). Concentrations of sIgE to Der p 2 were higher in the South, probably because of the warmer temperature and/or the larger sample size.

Skin testing in patients with hypersensitivity reactions to iodinated contrast media - a European multicenter study.

BACKGROUND: Iodinated contrast media cause both immediate and nonimmediate hypersensitivity reactions. The aim of this prospective study was to determine the specificity and sensitivity of skin tests in patients who have experienced such reactions. METHODS: Skin prick, intradermal and patch tests with a series of contrast media were conducted in 220 patients with either immediate or nonimmediate reaction. Positive skin tests were defined according to internationally accepted guidelines. Seventy-one never-exposed subjects and 11 subjects who had tolerated contrast medium exposure, served as negative controls. RESULTS: Skin test specificity was 96-100%. For tests conducted within the time period from 2 to 6 months after the reaction, up to 50% of immediate reactors and up to 47% of nonimmediate reactors were skin test positive. For immediate reactors, the intradermal tests were the most sensitive, whereas delayed intradermal tests in combination with patch tests were needed for optimal sensitivity in nonimmediate reactors. Contrast medium cross-reactivity was more common in the nonimmediate than in the immediate group. Interestingly, 49% of immediate and 52% of nonimmediate symptoms occurred in previously unexposed patients. Many of these patients were skin test positive, indicating that they were already sensitized at the time of first contrast medium exposure. CONCLUSIONS: These data suggest that at least 50% of hypersensitivity reactions to contrast media are caused by an immunological mechanism. Skin testing appears to be a useful tool for diagnosis of contrast medium allergy and may play an important role in selection of a safe product in previous reactors.

Nasal provocation tests in the diagnosis of urticaria induced by acetylsalicylic acid.

Nasal provocation tests with lysine acetylsalicylic acid (ASA) have been used in the diagnosis of ASA-induced asthma and rhinitis. To establish its possible role in identifying aspirin sensitivity manifested by urticaria or angioedema, 18 patients suffering from chronic or acute recurring urticaria/angioedema (10 ASA-sensitive and 8 ASA-nonsensitive) were submitted to nasal provocation tests with freshly prepared solutions of lysine ASA. Clinical response and variation of nasal expiratory peak-flow were evaluated, classified according to previously defined scores, and compared. The results showed a significant difference between ASA-sensitive and ASA-nonsensitive patients, suggesting that this test can be an important diagnostic tool for ASA-induced urticaria/angioedema.