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Skin lesions are caused due to multiple factors, like allergies, infections, exposition to the sun, etc. These skin diseases have become a challenge in medical diagnosis due to visual similarities, where image classification is an essential task to achieve an adequate diagnostic of different lesions. Melanoma is one of the best-known types of skin lesions due to the vast majority of skin cancer deaths. In this work, we propose an ensemble of improved convolutional neural networks combined with a test-time regularly spaced shifting technique for skin lesion classification. The shifting technique builds several versions of the test input image, which are shifted by displacement vectors that lie on a regular lattice in the plane of possible shifts. These shifted versions of the test image are subsequently passed on to each of the classifiers of an ensemble. Finally, all the outputs from the classifiers are combined to yield the final result. Experiment results show a significant improvement on the well-known HAM10000 dataset in terms of accuracy and F-score. In particular, it is demonstrated that our combination of ensembles with test-time regularly spaced shifting yields better performance than any of the two methods when applied alone. Yes

The high prevalence of allergy to β-lactam antibiotics is a worldwide issue. Accuracy of diagnostic methods is important to prove tolerance or allergy, with skin test considered the best validated in vivo method for diagnosing immediate reactions to β-lactams. Although drug provocation test is the reference standard, it cannot be performed in highly risk reactions or in those with positive skin tests. For skin tests, the inclusion of major and minor determinants of benzylpenicillin (BP) is recommended. Commercial skin test reagents have changed along time, including as minor determinants benzylpenicillin, benzylpenicilloate (BPO), and benzylpenilloate (PO). Major determinants consists of multivalent conjugates of benzylpenicilloyl coupled through amide bond to a carrier polymer, such as penicilloyl-polylysine (PPL) or benzylpenicilloyl-octalysine (BP-OL). The chemical stability of such reagents has influenced the evolution of the composition of the commercial kits, as this requirement is necessary for improving the quality and standardization of the product. In this work, we provide a detailed study of the chemical stability of BP determinants. We observed that those structures suffer from an epimerization process in C-5 at different rates. Butylamine-Benzylpenicilloyl conjugates (5R,6R)-Bu-BPO and (5S,6R)-Bu-BPO were selected as a simple model for mayor determinant to evaluate the role of the different epimers in the immunoreactivity with sera from penicillin-allergic patients. In vitro immunoassays indicate that any change in the chemical structure of the antigenic determinant of BP significantly affects IgE recognition. The inclusion of stereochemically pure compounds or mixtures may have important implications for both the reproducibility and sensitivity of in vivo and in vitro diagnostic tests.

Immunotoxins appear as promising therapeutic molecules, alternative to allergen-specific-immunotherapy. In this work, we achieved the development of a protein chimera able to promote specific cell death on effector cells involved in the allergic reaction. Der p 1 allergen was chosen as cell-targeting domain and the powerful ribotoxin α-sarcin as the toxic moiety. The resultant construction, named proDerp1αS, was produced and purified from the yeast Pichia pastoris. Der p 1-protease activity and α-sarcin ribonucleolytic action were effectively conserved in proDerp1αS. Immunotoxin impact was assayed by using effector cells sensitized with house dust mite-allergic sera. Cell degranulation and death, triggered by proDerp1αS, was exclusively observed on Der p 1 sera sensitized-humRBL-2H3 cells, but not when treated with non-allergic sera. Most notably, equivalent IgE-binding and degranulation were observed with both proDerp1αS construct and native Der p 1 when using purified basophils from sensitized patients. However, proDerp1αS did not cause any cytotoxic effect on these cells, apparently due to its lack of internalization after their surface IgE-binding, showing the complex in vivo panorama governing allergic reactions. In conclusion, herein we present proDerp1αS as a proof of concept for a potential and alternative new designs of therapeutic tools for allergies. Development of new, and more specific, second-generation of immunotoxins following proDerp1αS, is further discussed.

16 p.-7 fig.-2 tab.-1 graph. abst., Serum and cellular proteins are targets for the formation of adducts with the β-lactam antibiotic amoxicillin. This process could be important for the development of adverse, and in particular, allergic reactions to this antibiotic. In studies exploring protein haptenation by amoxicillin, we observed that reducing agents influenced the extent of amoxicillin-protein adducts formation. Consequently, we show that several thiol-containing compounds, including dithiothreitol, N-acetyl-L-cysteine, and glutathione, perform a nucleophilic attack on the amoxicillin molecule that is followed by an internal rearrangement leading to amoxicillin diketopiperazine, a known amoxicillin metabolite with residual activity. Increased diketopiperazine conversion is also observed with human serum albumin but not with L-cysteine, which mainly forms the amoxicilloyl amide. The effect of thiols is catalytic and can render complete amoxicillin conversion. Interestingly, this process is dependent on the presence of an amino group in the antibiotic lateral chain, as in amoxicillin and ampicillin. Furthermore, it does not occur for other β-lactam antibiotics, including cefaclor or benzylpenicillin. Biological consequences of thiol-mediated amoxicillin transformation are exemplified by a reduced bacteriostatic action and a lower capacity of thiol-treated amoxicillin to form protein adducts. Finally, modulation of the intracellular redox status through inhibition of glutathione synthesis influenced the extent of amoxicillin adduct formation with cellular proteins. These results open novel perspectives for the understanding of amoxicillin metabolism and actions, including the formation of adducts involved in allergic reactions., This work was supported by grant SAF2015-68590-R from MINECO/FEDER, RTI2018-097624-B-I00 and RETIC Aradyal from ISCIII/FEDER RD16/0006/0021 to DP-S; RD16/0006/0001 to MT, RD16/0006/0024 to MB; grants CP15/00103 and PI17/ 01237 from ISCIII/ERDF and PI-0179-2014 from Andalusian Regional Ministry Health to MM. AA holds a “Sara Borrell” research contract (CD17/0146) supported by ISCIII from MINECO [confounded by the European Social Fund (ESF)]. We acknowledge support of the publication fee by the CSIC Open Access Publication Support Initiative through its Unit of Information Resources for Research (URICI)

Non-steroidal anti-inflammatory drugs (NSAIDs), the most commonly prescribed and consumed medicines worldwide, are the main triggers of drug hypersensitivity reactions (DHRs). The underlying mechanisms of NSAID-DHRs may be related to COX-1 inhibition (cross-hypersensitivity reactions, CRs) or to immunological recognition (selective reactions, SRs), being the latter remarkably less studied. SRs include those usually appearing within the first hour after drug intake (single-NSAID-induced urticaria/angioedema or anaphylaxis, SNIUAA), and those usually occurring more than 24 h after (single-NSAID-induced delayed reactions, SNIDR). We have evaluated the largest series of patients with SRs, analyzing the number of episodes and drugs involved, the latency for reaction onset, the clinical entities, among other variables, as well as the value of available diagnostic methods. Globally, pyrazolones and arylpropionics were the most frequent culprits (39.3% and 37.3%, respectively). Pyrazolones were the most frequent triggers in SNIUAA and arylpropionics in SNIDR. Urticaria was the most common clinical entity in SNIUAA (42.4%) followed by anaphylaxis (33.3%); whereas SNIDR induced mostly fixed drug eruption (41.1%) and maculopapular exanthema (32.6%). The percentage of patients diagnosed by clinical history was higher in SNIUAA compared with SNIDR (62.7% versus 35.3%, p = 0.00015), whereas the percentage of those diagnosed by skin tests was higher in SNIDR than in SNIUAA (47.1% versus 22.8%, p = 0.00015). Drug provocation test with the culprit was performed in 67 SNIUAA (14.5%) and in 9 SNIDR (17.6%) patients. Our results may be of interest not only for allergologists but also for other clinicians dealing with these drugs, and can be useful for the correct identification of subjects experiencing DHRs to NSAIDs, and for avoiding mislabeling. Moreover, as NSAIDs are highly consumed worldwide, our results may be of interest for evaluating other populations exposed to these drugs. Yes

The main objective was to evaluate the cost-effectiveness of protocol use of palivizumab in premature established by consensus in our Hospital comparing it based on the recommendations of various Scientific Societies. As a secondary objective risk factors and severity of hospitalized patients attending the established protocol in our Hospital were analyzed.The study period was 4 seasons with the expanded protocol (retrospective data) versus 2 with restricted or agreed protocol (prospective data). The perspective of the study was the Health System, including the costs of hospitalization and palivizumab our center. The calculation of the effectiveness was determined with the admission rate of premature patients stratified by weeks of gestational agelt;29,lt;32; andlt;35. For the analysis of risk factors and severity in patients admitted seasons with the new protocol are collected prospectively clinical data and environmental and social factors.In the range of gestational agelt;29 years old and lt;32 greater effectiveness of the extended protocol was not demonstrated against the consensus. Only more effective for EGlt;35 in the accumulated data and comparing seasons 12/13 and 08/09 to 13/14 for individual data was observed. This range has an associated incremental cost effectiveness ratio of € 53 250,07 (range: € 14 793,39 to € 90 446,47 for singles data and € 50 525,53 (€ 28 688.22 to € 211 575,65) for accumulated. The establishment of this protocol in our center meant an average saving per season € 169 911,51. A cost-effectiveness of the extended protocol appropriate relationship is found if the cost of palivizumab per patient was less than € 1 206,67 (calculated for maximum use of the vial) and a higher rate of hospitalization of 9.21%. Children entering the season with the new protocol (season 12/13 and 13/14) are 63.4% in children under 3 months and 90% are term infants who do not belong to any population at risk, while many of them have associated risk factors you vary as have school-age siblings, rural residence, parental smoking, poor educational background of parents, lack of artificial feeding and family history of allergy.The consensus protocol has not been a significant increase in hospitalization rates in preterm infantslt;32 weeks gestational age patients. In thoselt;35 has been observed a higher rate of hospitalization, with a very unfavorable cost-effectiveness for all clinical scenarios valued relationship.Objetivo: El objetivo principal fue evaluar el coste-efectividad del protocolo de uso de palivizumab en prematuros instaurado por consenso en nuestro hospital comparándolo con el basado en las recomendaciones de diferentes sociedades científicas. Como objetivo secundario se analizaron los factores de riesgo y gravedad de los pacientes hospitalizados atendiendo al protocolo establecido en nuestro centro.Material y métodos: El periodo de estudio fue de cuatro temporadas con el protocolo ampliado (datos retrospectivos) frente a dos con el protocolo restringido o consensuado (datos prospectivos). La perspectiva del estudio fue la del sistema sanitario, incluyendo los costes de hospitalización y del palivizumab en nuestro centro. El cálculo de la efectividad se determinó con la tasa de ingresos de pacientes prematuros estratificados por semanas de edad gestacional:lt; de 29,lt;32 ylt;35. Para el análisis de los factores de riesgo y gravedad en pacientes ingresados en las temporadas con el nuevo protocolo se recogen, de forma prospectiva, datos clínicos y factores ambientales y sociales. Resultados: En los estratos de edad gestacionallt;29 ylt;32 no se demostró una mayor efectividad del protocolo ampliado frente al consensuado. Solamente se objetivó una mayor efectividad para EGlt;35 en los datos acumulados y al comparar las temporadas 08/09 con la 12/13 y 13/14 para datos individuales. Este estrato lleva asociado un cociente coste eficacia incremental de 53.250,07 € (rango: 14.793,39 € a 90.446,47 € para los datos individuales y 50.525,53 € (28.688,22 € a 211.575,65 €) para los acumulados. La instauración de este protocolo en nuestro centro supuso un ahorro medio por temporada de 169.911,51 €. Se constata una relación coste-efectividad adecuada del protocolo ampliado si el coste del palivizumab por paciente fuese menor de 1.206,67 € (calculados para el máximo aprovechamiento del vial) y para una tasa de hospitalización mayor de 9,21%. Los niños que ingresan en las temporadas con el nuevo protocolo (temporada 12/13 y 13/14) son en un 63,4% niños menores de 3 meses y el 90% son neonatos a término que no pertenecen a ninguna población de riesgo, mientras que muchos de ellos tienen asociados varías factores de riesgo como tener hermanos en edad escolar, residencia rural, padres fumadores, escasa formación académica de los progenitores, ausencia de lactancia artificial e historia familiar de alergia.Conclusiones: El protocolo consensuado no ha supuesto un aumento significativo en las tasas de hospitalización en los pacientes prematuroslt;32 semanas de EG. En aquelloslt;35 se ha observado una mayor tasa de hospitalización, con una relación coste-efectividad muy desfavorable para todos los escenarios clínicos valorados.

JOURNAL ARTICLE; INTRODUCTION Hymenoptera venom immunotherapy (VIT) is an effective treatment but not one devoid of risk as both local and systemic adverse reactions may occur especially in the initial stages of treatment. We compared the tolerance to three buildup protocols of VIT and analyzed risk factors associated with adverse reactions occurring in this phase. METHODS We enrolled 165 patients divided into three groups based on the buildup protocol used (3, 4, 9 weeks). Severity of systemic reactions was evaluated according to World Allergy Organization model. Results were analyzed using exploratory descriptive statistics and variables were compared using analysis of variance. RESULTS Fifty-three patients (32%) experienced some form of adverse reaction, 43 were local and 10 systemic. Local reactions were immediate in 27 patients (63%) and delayed in 16 (37%). Severity of local reaction was slight/moderate in 15 patients and severe in 13. Systemic reactions were grade 1-2. No significant association was found between the treatment modality and the appearance of local or systemic adverse reactions or the type of local reaction. We only found a statistically significant association of severity of the local reaction with female gender. As for the risk factors associated with systemic reactions at buildup phase, we found no significant differences in these values depending on protocol used or the insect responsible. CONCLUSIONS The buildup protocols compared proved to be safe and did not differ significantly from one another. In the population studied the 9-week schedule presented no systemic reactions, so it can be considered the safest protocol. Yes

Journal Article; Research Support, Non-U.S. Gov't; CD66b is a member of the carcinoembryonic antigen family, which mediates the adhesion between neutrophils and to endothelial cells. Allergen-specific immunotherapy is widely used to treat allergic diseases, and the molecular mechanisms underlying this therapy are poorly understood. The present work was undertaken to analyze A) the in vitro effect of allergens and immunotherapy on cell-surface CD66b expression of neutrophils from patients with allergic asthma and rhinitis and B) the in vivo effect of immunotherapy on cell-surface CD66b expression of neutrophils from nasal lavage fluid during the spring season. Myeloperoxidase expression and activity was also analyzed in nasal lavage fluid as a general marker of neutrophil activation. RESULTS CD66b cell-surface expression is upregulated in vitro in response to allergens, and significantly reduced by immunotherapy (p

The study of cross-reactivity in allergy is key to both understanding. the allergic response of many patients and providing them with a rational treatment In the present study, protein microarrays and a co-sensitization graph approach were used in conjunction with an allergen microarray immunoassay. This enabled us to include a wide number of proteins and a large number of patients, and to study sensitization profiles among members of the LTP family. Fourteen LTPs from the most frequent plant food-induced allergies in the geographical area studied were printed into a microarray specifically designed for this research. 212 patients with fruit allergy and 117 food-tolerant pollen allergic subjects were recruited from seven regions of Spain with different pollen profiles, and their sera were tested with allergen microarray. This approach has proven itself to be a good tool to study cross-reactivity between members of LTP family, and could become a useful strategy to analyze other families of allergens. Yes

Journal Article; Research Support, Non-U.S. Gov't; OBJECTIVE To investigate sensitization to third-stage Anisakis simplex larvae in a randomly selected population in northern Morocco. METHODS We studied sera obtained from clinical analysis laboratories in Tangier and Tetuouan and from fishermen at Tangier port. The age of the study population ranged from 6 to 83 years. ImmunoCAP and immunoblotting techniques were used to determine total and specific immunoglobulin (Ig) E values and the chi2 and Fisher exact tests were applied to analyze relationships between study variables. RESULTS A seroprevalence of 5.1% was found, with a higher percentage of positive sera in the 31-to-43-year age group. Sensitization was not significantly associated with the origin, sex, occupation, or age of the individuals studied. In sera positive by InmunoCAP, immunoblotting studies detected numerous bands of between 7 kDa and >209 kDa, with a predominance of bands in the approximately 20-kDa to 24-kDa range. CONCLUSIONS Although no cases of human anisakiasis have been reported in Morocco to date, part of a randomly selected population in Northern Morocco shows sensitization to A simplex proteins. Yes Objetivos: La finalidad de este estudio ha sido la de investigar la sensibilización frente a la larva L3 de Anisakis, de una población elegida al azar del norte de Marruecos.Métodos: Hemos analizado sueros de pacientes atendidos en laboratorios de análisis clínicos de Tánger y Tetuán, incluyendo una subpoblación de pescadores del puerto de Tánger. La edad de la población ha estado comprendida entre 6-83 años. Se han utilizado las técnicas de ImmunoCAP e Immunoblotting para determinar la IgE total e IgE específi ca y se ha aplicado el estadístico de 􀁲2 o el test de Fisher, para conocer el grado de signifi cación entre las distintas variables. Resultados: La seroprevalencia obtenida ha sido del 5.1%, detectándose el mayor nº de sueros positivos en el intervalo de edad de 31-43 años. La sensibilización no está asociada con la procedencia, sexo, ocupación y edad de los individuos estudiados. Entre los sueros positivos por InmunoCAP, se detectaron por inmunoblotting, numerosas bandas entre 7 kDa y >209 kDa, predominando las de ~20 kDa – 24 kDa. Conclusiones: Aunque la anisakiasis humana por ahora no ha sido denunciada en Marruecos, nosotros aportamos datos acerca de la sensibilización con proteínas de Anisakis, de una población elegida al azar en el norte de Marruecos

Jose Luis Justícia1, Eva Baró2, Victoria Cardona3, Pedro Guardia4, Pedro Ojeda5, José Maria Olaguíbel6, José Maria Vega7, Carmen Vidal81Medical Department, Stallergenes Ibérica, Barcelona, Spain; 2Health Outcomes Research Department, 3D Health Research, Barcelona, Spain; 3Hospital Vall d'Hebron, Barcelona, Spain; 4Hospital Virgen Macarena, Sevilla, Spain; 5Clínica de Asma y Alergia Dres. Ojeda, Madrid, Spain; 6Complejo Hospitalario de Navarra, Pamplona, Spain; 7Hospital Regional Universitario Carlos Haya Málaga, Spain; 8Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, SpainBackground: Allergen-specific immunotherapy (SIT) is a treatment capable of modifying the natural course of allergy, so ensuring good adherence to SIT is fundamental. Up until now there has not existed an instrument specifically developed to measure patient satisfaction with SIT, although its assessment could help us to comprehend better and improve treatment adherence and effectiveness. The aim of this study was to develop an instrument to measure adult patient satisfaction with SIT.Methods: Items were generated from a literature review, focus groups with allergic adult patients undergoing SIT, and a meeting with experts. Potential items were administered to allergic patients undergoing SIT in an observational, cross-sectional, multicenter study. Item reduction was based on quantitative and qualitative criteria. A preliminary assessment of feasibility, reliability, and validity of the retained items was performed.Results: An initial pool of 70 items was administered to 257 patients undergoing SIT. Fifty-four items were eliminated resulting in a provisional instrument with 16 items. Factor analysis yielded four factors that were identified as perceived efficacy, activities and environment, cost-benefit balance, and overall satisfaction, explaining 74.8% of variance. Ceiling and floor effects were negligible for overall score. Overall score was associated with the type and intensity of symptoms.Conclusion: This is the first attempt to develop a satisfaction with SIT measure from the perspective of the allergic patient, and evidence has been found in favor of its reliability and validity.Keywords: allergy, allergen-specific immunotherapy, questionnaire, scale, assessment, satisfaction

Journal Article; Research Support, Non-U.S. Gov't; An aeropalynological study was carried out in the atmosphere of Estepona, a very popular tourist resort situated in the "Costa del Sol", (southern Spain) based on the data obtained during a three year air-monitoring programme (March 1995 to March 1998) using a volumetric pollen trap. The 34 taxa that reached a 10-day mean air pollen concentration equal to or greater than 1 grain of pollen/m(3) of air are reflected in the calendar. The first 10 taxa, in order of abundance, were: Cupressaceae, Olea europaea, Quercus, Poaceae, Urticaceae, Plantago, Pinus, Chenopodiaceae-Amaranthaceae, Ericaceae and Castanea, the first 3 of which accounted for approximately 56 % of the annual total pollen count. The greatest diversity of pollen type occurred during spring, while the highest pollen concentrations were reached from February-June, when approximately more than 80 % of the annual total pollen was registered. The lowest concentrations were obtaining during January, August and September. The annual quantity of pollen collected, the intensity and the dates on which the maximum peaks were recorded differed for the 3 years studied, which can be explained by reference to various meteorological parameters, especially rainfall and temperature. The pollen calendar spectrum is typically Mediterranean and similar to those of nearby localities, in which many pollen types are represented and the long tails indicating long flowering periods. Yes

12 p.-9 fig.-2 tab., Allergic reactions towards b-lactam antibiotics pose an important clinical problem. The ability of small molecules, such as a b-lactams, to bind covalently to proteins, in a process known as haptenation, is considered necessary for induction of a specific immunological response. Identification of the proteins modified by b-lactams and elucidation of the relevance of this process in allergic reactions requires sensitive tools. Here we describe the preparation and characterization of a biotinylated amoxicillin analog (AX-B) as a tool for the study of protein haptenation by amoxicillin (AX). AX-B, obtained by the inclusion of a biotin moiety at the lateral chain of AX, showed a chemical reactivity identical to AX. Covalent modification of proteins by AX-B was reduced by excess AX and vice versa, suggesting competition for binding to the same targets. From an immunological point of view, AX and AX-B behaved similarly in RAST inhibition studies with sera of patients with non-selective allergy towards b-lactams, whereas, as expected, competition by AX-B was poorer with sera of AX-selective patients, which recognize AX lateral chain. Use of AX-B followed by biotin detection allowed the observation of human serum albumin (HSA) modification by concentrations 100-fold lower that when using AX followed by immunological detection. Incubation of human serum with AX-B led to the haptenation of all of the previously identified major AX targets.In addition, some new targets could be detected. Interestingly, AX-B allowed the detection of intracellular protein adducts, which showed a cell type-specific pattern. This opens the possibility of following the formation and fate of AX-B adducts in cells. Thus, AX-B may constitute a valuable tool for the identification of AX targets with high sensitivity as well as for the elucidation of the mechanisms involved in allergy towards b-lactams., This work was supported by grants SAF2012-36519 from MINECO and RETIC RD07/0064/0007 and RD12/0013/0008 to DPS, Junta de Andalucía CTS-6603 and ISCIII PS09/01768 and PI12/02529 to MJT, funding from the People Programme (Marie Curie Actions) of the European Union's Seventh Framework Programme (FP7/2007-2013) under REA grant agreement n° 300230, to MIM. The stay of A.A. at CIB-CSIC was funded in part by a fellowship from ISCIII.

Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't; Validation Studies; INTRODUCTION AND OBJECTIVES The first quality of life questionnaire for Vespula-allergic patients (Vespid Allergy Quality of Life Questionnaire [VQLQ) was developed in 2002. Our objective was to perform the cross-sectional validation of the Spanish version of this questionnaire. PATIENTS AND METHODS Using the original English-language version of the VQLQ as a starting point, the Spanish translation and cultural adaptation were performed and the first Spanish version was backtranslated into English and discussed with the authors of the original version. The result was the Spanish Health-related Quality of Life Questionnaire for Hymenoptera Venom-Allergic Patients (HRQLHA). Cross-sectional validation was carried out in a multicenter study using a test-retest design. Patients over the age of 14 diagnosed with systemic allergic reaction to venom from Apis, Vespula, or Polistes species were included. The test-retest reliability, external validity, and internal consistency of the questionnaire were measured. RESULTS The sample comprised 116 patients. The mean HRQLHA score was 3.48. Test-retest reliability showed an intraclass correlation coefficient of 0.85. HRQLHA showed a positive correlation (0.5) with an external questionnaire, thus demonstrating its external validity. Analysis of the internal consistency of the HRQLHA yielded a Cronbach α of 0.95, which can be considered to be excellent. CONCLUSIONS Statistical analysis revealed the high test-retest reliability, internal consistency, and external validity of the HRQLHA. The HRQLHA is the first validated questionnaire to include patients allergic to Polistes species, which is common in our area. Our findings show that the questionnaire is also valid for these patients. Yes Introducción: En 2002 se desarrolló el primer cuestionario de calidad de vida para alérgicos a veneno de Vespula (VQLQ). El objetivo de este trabajo es desarrollar y validar una versión en español de este cuestionario. Métodos y Pacientes: Partiendo del VQLQ en inglés se realizó la traducción al español y adaptación cultural del cuestionario con una posterior retraducción consensuada con los autores de la versión original. Así se desarrolló el cuestionario de calidad de vida en español para pacientes alérgicos a veneno de himenópteros (HRQLHA). La validación transversal se realizó mediante un estudio multicéntrico, con diseño test-retest en el que se incluyeron pacientes mayores de 14 años con reacción sistémica por alergia a veneno de Apis, Vespula o Polistes. Se analizó la fiabilidad test-retest, la validez externa y la consistencia interna del cuestionario. Resultados: Se incluyeron 116 pacientes alérgicos a venenos de Apis, Vespula o Polistes. La puntuación media del HRQLHA fue 3.48. El estudio de fiabilidad test-retest mostró un coeficiente de correlación intraclase de 0.85. El HRQLHA mostró una correlación positiva (0.5) con el cuestionario de referencia externa, confirmando su validez. En el análisis de la consistencia interna se encontró una Alpha de Cronbach de 0.95.