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[Background]: Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently avoided in mastocytosis, because of a potential increased risk for drug hypersensitivity reactions (DHRs) due to inhibition of cyclo-oxygenase (COX), subsequent depletion of prostaglandin E2 and release of leukotrienes. [Objectives]: Here, we aimed at determining the prevalence of mast cell (MC) mediator release symptoms triggered by NSAIDs in mastocytosis patients and the associated clinical and laboratory features of the disease. [Methods]: Medical records from 418 adults to 223 pediatric mastocytosis patients were retrospectively reviewed. Patients were classified according to tolerance patterns to NSAIDs and other COX inhibitors (COXi) and compared for epidemiological, clinical and laboratory findings. [Results]: Overall, 87% of adults and 91% of pediatric patients tolerated NSAIDs and other COXi. Among adult and pediatric patients presenting DHRs, 5% and 0% reacted to multiple NSAIDs, 4% and 0.7% were single reactors, and 3% and 8% were single reactors with known tolerance to paracetamol but unknown tolerance to other COXi, respectively. Among adults, hypersensitivity to ≥2 drugs was more frequent among females (p = 0.009), patients with prior history of anaphylaxis to triggers other than NSAIDs or other COXi and Hymenoptera venom (p = 0.009), presence of baseline flushing (p = 0.02), baseline serum tryptase ≥48 ng/ml (p = 0.005) and multilineage KIT mutation (p = 0.02). In contrast, tolerance to NSAIDs and other COXi was more frequent among males (p = 0.02), in patients with anaphylaxis caused by Hymenoptera venom (p = 0.02), among individuals who had skin lesions due to mastocytosis (p = 0.01), and in cases that had no baseline pruritus (p = 0.006). Based on these parameters, a score model was designed to stratify mastocytosis patients who have never received NSAIDs or other COXi apart from paracetamol, according to their risk of DHR. [Conclusions]: Our results suggest that despite the frequency of MC mediator related symptoms elicited by NSAIDs and other COXi apart from paracetamol is increased among mastocytosis patients versus the general population, it is lower than previously estimated and associated with unique disease features. Patients that tolerated NSAIDs and other COXi following disease onset should keep using them. In turn, adults with unknown tolerance to such drugs and a positive score should be challenged with a preferential/selective COX-2 inhibitor, while the remaining may be challenged with ibuprofen., This work was supported by grants from the Carlos III Health Institute co-financed by the European Regional Development Fund (PI19/01166) and CIBERONC CB16/12/00400, Ministerio de Ciencia e Innovación (Madrid, Spain), Asociación Española de Mastocitosis y Enfermedades Relacionadas (AEDM 2019), Fondos de Investigación para Enfermedades Raras del Ministerio de Sanidad, Servicios Sociales e Igualdad (Madrid, Spain).

Icing occurs when an unheated solid structure is exposed to liquid cloud droplets at temperatures below the freezing point. Supercooled liquid water (SLW) in the atmosphere can persist in a physically metastable state until coming into contact with a solid object “In-cloud icing” occurs when super cooled liquid droplets (SLD) like clouds collide with a structure or object and freezes.Atmospheric icing prediction has gain attention in the last years. Despite the progress made in meteorology, both weather forecasting modelling and atmospheric observations through advanced experimental technologies, there are still limitations in the accurate forecast and detection of icing conditions. The GFA‐ULE group has carried out some NWPs. In a previous work, we investigated the capability of the Weather Research and Forecasting model to detect regions containing supercooled cloud drops, proposing a multiphysics ensemble approach. Four microphysics and two planetary boundary layer schemes were used. Morrison and Goddard parameterizations with the YSU scheme, yielded superior results in evaluating the presence of liquid water content.Concerning the remote detection of icing conditions, some European research centres (i.e. DLR, CIRA, ONERA, INCAS) as well as University of Leon (GFA-ULE) already have nowcasting or forecasting activities for detection of clouds and icing conditions. In this work a multichannel, microwave radiometer (MMWR) was used to detect the appearance of SLW. Consequently, we present both comparison between indirect detection of SLW and the output obtained by WRF with the two combination of parametrizations selected.In our work we have taken into account:The comparison has been made at different levels, from the ground up to 5000 meters high We have taken different thresholds of the SLW: 0.05, 0.1, 0.15, 0.20, 0.25 and 0.30 g m-3 because of the flight campaigns carried out previously, which revealed that the presence of low concentrations of SLW could lead to the appearance of aircraft icing. The results show a good concordance between the number of events found by the MMWR and the result of the two numerical modeling performed. Therefore, everything seems to indicate that indirect detection by MMWR can be an accurate technology to detect the appearance of SLW and that the models can be qualitatively validated.Acknowledgments: Data support came from the Atmospheric Physics Group, IMA, University of León, Spain, and the National Institute of Aerospace Technology (INTA). This research was carried out in the framework of the SAFEFLIGHT project, financed by MINECO (CGL2016‐78702) and LE240P18 project (Junta de Castilla y León). We also thank R. Weigand for computer support.

Physical examination revealed hepatosplenomegaly and an erythematous, maculopapular, confluent rash on the trunk. What is the most likely diagnosis?

Coeliac disease (CD) is a permanent intolerance to gluten that provokes alterations in the mucosa of the small intestine. The disease can usually be controlled by excluding gluten from the diet. CD is immunologically-mediated, with a strong linkage to certain HLA alleles and a permanently altered intraepithelial lymphocytes (IEL) pattern. The development of a flow cytometric technique for the evaluation of IEL subsets has increased our understanding of these alterations and has prepared the ground for its clinical application. Our experience shows that this procedure has excellent sensitivity and specificity in the diagnosis of CD and that it is particularly useful in the evaluation of atypical presentations of the disease. The present article reviews our experience in the diagnosis of CD and discusses some of the hypotheses that have been put forward on the possible role of IEL in its pathogenesis.