Search

Summary A questionnaire was addressed to general practitioners (GP) from continental Portugal aiming to learn about their perception of drug allergy and identify their difficulties and educational needs for its management and 372 answers were obtained. As main culprit drugs antibiotics were identified by 65.3% and skin is the most involved organ for 65.8% of GP. 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 would be welcome by 97.8% of the doctors. The collaboration of Immunoallergology centers was considered non satisfactory by 39.8% of GP and 45.7% of them state that two-thirds of the suspected reactions were not investigated.Those points deserve consideration in future health educational and organizational strategies.

Cholinergic urticaria is a relatively common condition defined by itching, redness and whealing induced by exercise and passive warming. In turn, acquired idiopathic generalized anhidrosis is a rare disorder of unknown pathogenesis, characterized by an impairment in total body sweating despite exposure to heat or exercise. We report two cases of this extremely rare association of cholinergic urticaria and acquired generalized hypohidrosis, and briefly review current knowledge with regard to classification, ethiopathogenesis and therapeutic options.

Objective: 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). Conclusions: 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.

The impact of air pollution on respiratory diseases, particularly in asthma, has been the subject of several studies. The impact of pollution on the daily symptoms of patients with asthma has been less studied. The aim of this study is to assess the association between the intensity of asthma symptoms and the variation of pollution levels.Patients with a diagnosis of asthma were instructed to record the intensity of their respiratory symptoms daily, expressed on a scale from 0 to 5, in the months of March and April 2018. The website of the Portuguese Environment Agency was consulted in order to obtain the daily levels of pollutants measured by the two local monitoring stations during the same period of time. Data was analyzed using a temporal causal model to study the association between pollutant levels - particulate matter, ozone, nitrogen dioxide and carbon monoxide - and the intensity of respiratory symptoms.From the 135 schedules delivered, 35 were correctly filled out and returned. The patient median age was 47.0 years, 18 being females. The best statistical model obtained identified ozone as the most relevant 'Granger cause' of asthma symptoms. Particulate matter, carbon monoxide and nitrogen also appeared as lower impact factors. The quality of the model was expressed by an R2 of 0.92. The correlation between ozone values and asthma symptoms was more significant after five days. For the other identified factors there was a lag of four to five days.Our results support the existence of a daily variation of asthma symptoms that is associated with the pollution levels, even if these are within acceptable limits according to national and international standards. Regretfully, the small number of participants was a limitation in term of the conclusions that could be drawn and did not allow the analysis of clinical or other factors that are potentially involved.In the place and period studied the air pollutants behaved as factors of variation in the intensity of asthma symptoms. The ozone level was the best predictive factor of symptom variation. Levels of particulate matter, carbon monoxide and nitrogen were identified as secondary markers. The time lag between the variables with the best correlation suggests there could be a delayed effect of pollutants on respiratory symptoms.Introdução: O impacto da poluição atmosférica nas doenças respiratórias, nomeadamente na asma, tem sido objeto de numerosos estudos. A repercussão da poluição na sintomatologia diária dos doentes asmáticos tem sido menos estudada. Pretendemos estudar a relação entre a intensidade dos sintomas diários de asma e a variação dos níveis de poluição. Material e Métodos: Foram selecionados doentes com diagnóstico de asma, sendo instruídos para anotar diariamente a intensidade dos seus sintomas respiratórios, expressa numa escala de 0 a 5, nos meses de março e abril de 2018. O website da Agência Portuguesa do Ambiente foi consultado e registaram-se os níveis diários de poluentes medidos pelas duas estações locais de monitorização durante o mesmo período. Os dados foram analisados utilizando um modelo causal temporal com a finalidade de relacionar os níveis de poluentes – partículas inaláveis com diâmetro menor que 10 μm, ozono, dióxido de nitrogénio e monóxido de carbono - com a intensidade dos sintomas de asma dos doentes. Resultados: Dos 135 calendários entregues, 35 foram corretamente preenchidos e devolvidos. A mediana de idades dos doentes foi de 47,0 anos, sendo 18 do sexo feminino. O melhor modelo estatístico obtido identificou o ozono como a ‘causa Granger’ mais relevante para os sintomas de asma. A qualidade do modelo traduziu-se por um R2 de 0,92. A correlação entre os valores de ozono e os valores dos sintomas de asma foi mais significativa após cinco dias. Para os outros fatores identificados verificou-se um desfasamento de quatro a cinco dias. Discussão: Os nossos resultados sugerem, de forma significativa, uma relação entre a variação dos sintomas de asma e os níveis de poluição, mesmo dentro dos limites considerados aceitáveis pelos padrões nacionais e internacionais. A reduzida dimensão da amostra foi, no entanto, um fator limitativo das conclusões e não permitiu a análise de outras varáveis potencialmente envolvidas. Conclusão: No período e local estudados, os poluentes atmosféricos comportaram-se como fatores de variação da intensidade dos sintomas de asma. O nível de ozono foi o melhor fator preditivo das variações da sintomatologia. Os níveis de partículas inaláveis, com diâmetro menor que 10 μm, de monóxido de carbono e de dióxido de nitrogénio foram identificados como marcadores secundários. O desfasamento temporal entre as variáveis com melhor correlação sugere um possível efeito retardado dos poluentes sobre os sintomas respiratórios.

Objective: To translate and perform a cross-cultural adaptation of the Asthma Questionnaire (SAQ) so that it can be used as a tool to measure the impact of asthma symptoms on quality of life as well as the impact of asthma treatments in severe asthmatic patients in Portugal. Methods: Based on the principles of good practice for the translation and cross-cultural adaptation of such instruments, the protocol included the following steps: acquisition of authorization from the authors of the original questionnaire; translation of the instrument to Portuguese, carried out by two health professionals; reconciliation; back-translation to English, carried out by two health professionals who are fluent in Portuguese; review of the back-translation; harmonization; review and approval of the questionnaire; focus groups involving 12 patients who completed and improved the wording of the questionnaire; analysis of the results; and review and preparation of the final version of the instrument approved by the original SAQ team. Results: The final version of the SAQ for use in Portugal included minor modifications suggested by the patients. The mean and standard deviations of the patients age was 50.08 ± 13.43 years and 50% were female. All had some level of education and the majority (58.3%) had a favourable economic background. Conclusions: The SAQ demonstrated to be comprehensible, clear, and appropriate. The original questionnaire and the translated version, cross-culturally adapted for use in Portugal, were reliably comparable. Consequently, it can become an extensively used tool for severe asthma patients. Objetivo: Traduzir e realizar uma adaptação transcultural do Questionário de Asma Grave (SAQ, do inglês Severe Asthma Questionnaire) para que possa ser usado como ferramenta para medir o impacto dos sintomas de asma na qualidade de vida e o impacto do tratamento da asma nos doentes com asma grave em Portugal. Métodos: Com base nos princípios de boas práticas para a tradução e adaptação transcultural de tais instrumentos, o protocolo incluiu as seguintes etapas: aquisição de autorização dos autores do questionário original, tradução do instrumento para português, realizada por dois profissionais de saúde, reconciliação, retrotradução para inglês, realizada por dois profissionais de saúde fluentes em português, revisão da retrotradução, harmonização, revisão e aprovação do questionário, grupos de discussão envolvendo 12 doentes que completaram e melhoraram a redação do questionário; análise dos resultados e revisão e preparação da versão final do instrumento aprovada pela equipa original do SAQ. Resultados: A versão final do SAQ para uso em Portugal incluiu pequenas modificações sugeridas pelos doentes. A média e desvio-padrão da idade dos doentes foi de 50,08 ± 13,43 anos e 50% eram do sexo feminino. Todos apresentavam algum nível de escolaridade e a maioria (58,3%) possuía um histórico económico favorável. Conclusões: O SAQ demonstrou ser compreensível, claro e apropriado. O questionário original e a versão traduzida, adaptada culturalmente para uso em Portugal, eram comparáveis de forma confiável. Consequentemente, pode representar uma ferramenta amplamente utilizada para doentes com asma grave.

A urticária crónica espontânea é uma doença complexa, de etiologia mal-esclarecida, de diagnóstico fácil mas de abordagem terapêutica por vezes difícil. Tem um impacto significativo na qualidade de vida do doente e resulta em elevados custos diretos e indiretos. O diagnóstico da urticária crónica espontânea é essencialmente clínico, sendo recomendado um número limitado de exames complementares para diagnóstico diferencial e/ou para a investigação/exclusão de possível causa para a urticária crónica espontânea. Além do hemograma e da proteína C reativa, e/ou velocidade de sedimentação, os exames adicionais devem ser selecionados de acordo com critérios clínicos. O objetivo da terapêutica é o controlo clínico total da urticária crónica espontânea. A evolução deve ser documentada através do registo semanal do score de sintomas – Weekly Urticaria Activity Score (UAS7) –, assim como da avaliação de qualidade de vida. A abordagem terapêutica é baseada nos anti- histamínicos H1 (anti-H1) de segunda geração administrados de forma contínua nas doses aprovadas (primeira linha) e, na ausência de resposta clínica, até quatro vezes a dose diária aprovada (segunda linha). Os anti-H1 de primeira geração não são recomendados. Cerca de 30% dos doentes não ficam controlados com a terapêutica de segunda linha, pelo que é recomendado adicionar uma terapêutica de terceira linha. Das duas opções, omalizumab e ciclosporina, o omalizumab é a única opção com autorização de introdução no mercado para a urticária crónica espontânea, e possui melhor perfil de segurança, sendo assim recomendado preferencialmente. Em Portugal não existem recomendações nacionais aplicáveis à prática clínica. A elaboração destas recomendações é justificada pela necessidade de uniformização tanto da abordagem diagnóstica como da abordagem terapêutica dos doentes com urticária crónica espontânea em Portugal, e para a referenciação a centros especializados, nos casos mais graves.

N/a.

Fundamentos: O teste de tansformação linfocitária (TTL) tem vindo a ser utilizado nas últimas décadas no estudo de reações alérgicas a fármacos. Baseia-se na deteção de uma resposta proliferativa das células T quando expostas ao fármaco suspeito e alguns grupos têm relatado uma sensibilidade e especificidade elevadas neste contexto. A sua validação necessita, contudo, de estudos mais alargados e melhor controlados. Objetivos: Avaliar o desempenho do TTL na identificação dos fármacos responsáveis por reações alérgicas e aferir os seus critérios de positividade, diferenciando os vários grupos farmacológicos e as reações observadas. Métodos: Foram avaliados os resultados de 95 testes de TTL, realizados em 73 doentes estudados por alergia medicamentosa e com um diagnóstico estabelecido com elevado grau de certeza pela clínica e testes cutâneos. Analisamos os resultados dos testes considerando os vários grupos de fármacos, as reações observadas e o tempo de demora entre a reação e a execução do TTL. Resultados: Os resultados analisados por grupos de fármacos evidenciaram sensibilidade / especificidade de 76,1 % / 57,1 % para os beta-lactamicos, de 83,3 % / 55,5 % para os anti-inflamatorios não esteroides, de 88,9% / 100% para os anticonvulsivantes e de 46,1 % / 66,7 % para os antibióticos não beta-lactamicos. Conclusões: A sensibilidade do TTL foi boa, exceto para os antibióticos não beta-lactamicos. Os resultados não foram tão bons para a especificidade, baixa para os anti-inflamatorios não esteroides, o que era expectável, mas foi abaixo da descrita por outros grupos para os antibióticos beta-lactamicos. Apesar disso, o TTL evidenciou um poder discriminativo de 70,6 % e permitiu confirmar a alergia a um fármaco em 36 casos, 58,1 % dos casos de alergia da amostra, cujos testes cutâneos eram negativos ou impossíveis de realizar. Justifica-se, assim, a sua utilização no estudo da alergia a fármacos, ainda que não permitindo dispensar uma cuidada análise da história clínica e a execução de testes cutâneos Background: The lymphocyte transformation test (LTT) has been used in the study of drug allergy for the last 3 decades. It bases on the detection of a proliferative T cell response in the presence of the drug to be tested and some groups present good results in identifying a culprit drug, sensitivity and specificity differing with the drug, the reaction and other factors. Validation of LTT depends, however, on larger and better controlled studies. Aims: To evaluate the LTT performance in identifying culprit drugs in allergic reactions and analyse positivity criteria regarding different pharmacological groups and observed reactions. Methods: We analysed the results of 95 LTT tests, performed in 73 patients submitted to a drug allergy evaluation who were diagnosed with a high level of certainty by clinic and skin tests. Drug classes, type of allergic reactions and time between those and test execution were taken into account. Results: Results by drug classes showed sensitivity/specificity of 76,1% / 57,1% for beta-lactams, 83,3% / 55,5% for non steroidal anti-inflammatory drugs, 88,9% / 100% for anticonvulsivants and 46,1% / 66,7% for non beta-lactam antibiotics. Conclusions: LTT sensitivity may be considered good, except for non beta-lactam antibiotics. As expected, specificity was low for non steroidal anti-inflammatory drugs, but was lower than generally described for beta-lactams. Nevertheless, LTT showed a discriminative power of 70,6% in this study and allowed to confirm a drug allergy diagnosis in 36 cases, 58,1% of allergy sample cases, where skin tests were negative or impossible to perform. So, its use in drug allergy is completely justified, although a careful clinical history and skin tests whenever possible must not be forgotten

N/a.

Cutaneous delayed reactions to antihypertensive drugs have been described in a limited number of case reports but the mechanisms remain mostly unknown. We report the case of a 60-year-old female patient with a 3-week history of an itchy erythematous maculopapular eruption. Although the patient was polymedicated, irbesartan was the most likely culprit. Patch tests and a lymphocyte transformation test to irbesartan were both positive, which was useful for diagnosis and suggested an immunological reaction. No new lesions appeared after irbesartan was stopped or after the introduction of candesartan. Despite its similar chemical structure, candesartan may be tried in patients allergic to irbesartan. LEARNING POINTS Irbesartan can induce immunological cell-mediated skin reactions. Allergy to irbesartan does not imply a class allergy. Patch tests and a lymphocyte transformation test were useful in the diagnosis of irbesartan allergy.

Introdução: Os anti-inflamatorios não esteroides (AINE) são a segunda causa de reações de hipersensibilidade medicamentosa. O largo espetro de sintomas observados, os diferentes mecanismos fisiopatológicos envolvidos e a exiguidade de métodos de diagnóstico eficazes tornam complexa a sua investigação. Objetivo: Classificar um grupo de doentes com hipersensibilidade a AINE de acordo com o novo sistema proposto pela EAACI Task Force on NSAIDs Hypersensitivity, caracterizar os grupos resultantes e avaliar os meios de diagnóstico clinicolaboratoriais de acordo com esta perspetiva. Material e métodos: Foram analisados os processos clínicos de 64 doentes estudados no período de 2010 a 2015 por hipersensibilidade a AINE em que o estudo tivesse incluído a realização do teste de ativação de basófilos (TAB) e foi aplicada ao grupo a classificação referida: Grupo 1 - Doença respiratória exacerbada por AINE; Grupo 2 - Doença cutânea exacerbada por AINE; Grupo 3 - urticária/angioedema induzido por AINE; Grupo 4 - Urticária/angioedema ou anafilaxia induzida por um AINE único. Foram registados e analisados dados demográficos, clínicos e resultados de testes cutâneos, provas de provocação e TAB. Resultados: Foi possível classificar 59 dos 64 doentes. A diferença da prevalência de atopia foi significativa entre os grupos 3 e 4, respetivamente de 50% e de 5% (p=0,027). Houve no total três provas de provocação positiva ao nimesulide e uma com o celecoxib. O metamizol foi responsável por 54% das reações do grupo 4 e por 56% das reações anafiláticas nos doentes estudados. A positividade dos testes cutâneos e do TAB, tomadas em conjunto, identificaram 11 (79%) dos doentes com hipersensibilidade isolada a este fármaco. Conclusões: A classificação usada foi aplicável à maioria dos doentes estudados.Salientamos a importância das provas de provocação para encontrar alternativas seguras e também a importância dos testes cutâneos e do TAB no diagnóstico da hipersensibilidade isolada ao metamizol Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) represent the second most common cause of drug hypersensivity (0.6-5.7% of general population). The wide spectrum of symptoms, the various mechanisms involved and the lack of efficient diagnosing methods turn it into a challenge to the allergist. Objective: The aim of this study was to classify a group of patients with a history of NSAID hypersensitivity according to the system proposed by the EAACI Task Force on NSAIDs Hypersensitivity, to characterize the resulting groups and to evaluate clinical and laboratory data accordingly. Material and methods: Medical records of 64 patients referred to our Centre between 2010 and 2015 and investigated for NSAID hypersensitivity with a basophil activation test (BAT) performed were investigated and classified: group 1- NSAIDs-exacerbated respiratory disease; group 2 - NSAIDs-exacerbated cutaneous disease NSAIDs; group 3 - induced urticaria/angioedema; group 4 - Single-NSAID-induced urticaria/angioedema or anaphylaxis. Demographic and clinical data as well as skin tests, challenge tests and BAT results were analysed. Results: We were able to classify 59 out of 64 patients. Atopy prevalence was significantly higher in group 3 (50%) than in group 4 (5%), p=0,027. The records showed 3 positive provocation tests to nimesulide and 1 to celecoxib. Metamizol was the culprit drug of 54% group 4 reactions and 56% of overall anaphylactic reactions. Skin tests and BAT positivity taken together could identify 11 (79%) of patients reacting to metamizol in group 4. Conclusions: Most of our study patients fitted into the proposed classification. We underline the role of provocation tests to find a safe alternative NSAID and also the efficiency of skin tests and BAT in the diagnosis of metamizol hypersensitivity as single NSAID offender

Anaphylaxis has a growing incidence, especially in children. It represents a medical emergency and its successful therapy depends on early and proper intervention. Intramuscular epinephrine, with dose adjustment according to weight and age, is the drug of choice for anaphylaxis treatment. After resolution of the acute reaction, the patient should be kept under clinical surveillance for 6 to 24 hours, due to possible biphasic reactions. Prescription of an epinephrine auto injectable device should be considered in all patients with diagnosed or suspected anaphylaxis; additionally these patients should always be referred to an Immunoallergy consultation, to perform adequate investigation and management in order to reduce future risk. All anaphylaxis episodes must be recorded in The Portuguese Catalogue of Allergies and other Adverse Reactions (Catálogo Português de Alergias e outras Reações Adversas, CPARA), which represents a fundamental tool to share clinical information within the Health System. The present manuscript intends to disclose the most recent Portuguese guidelines for the diagnosis and treatment of anaphylaxis, making its clinical approach more effective and homogeneous, and to promote the use of The Portuguese Catalogue of Allergies and other Adverse Reactions as an essential tool to register and share information on anaphylaxis in Portugal.A anafilaxia apresenta uma incidência crescente, particularmente em idade pediátrica. Constituindo uma emergência Médica, o sucesso terapêutico depende de uma intervenção precoce e adequada. A adrenalina por via intramuscular constitui o fármaco de eleição para o seu tratamento, devendo a dose ser ajustada ao peso e à idade. Resolvida a reação aguda, o doente deve ser mantido sob vigil'ncia Médica por um período de 6 a 24 horas, pelo risco de ocorrência de reações bifásicas. Deverá ser considerada a prescrição de um dispositivo de autoadministração de adrenalina em todos os doentes com diagnóstico ou suspeita de anafilaxia; adicionalmente estes doentes têm indicação formal para estudo em consulta de imunoalergologia, de modo a permitir uma adequada intervenção diagnóstica e terapêutica que reduzirá o risco futuro. Todos os episódios de anafilaxia devem ser registados no Catálogo Português de Alergias e outras Reações Adversas (CPARA), constituindo este um instrumento fundamental de partilha de informação clínica dentro do Sistema de Saúde. Este manuscrito pretende divulgar as orientações para o diagnóstico e tratamento da anafilaxia, tornando a sua abordagem clínica mais eficiente e consertada a nível nacional, e promover a adesão ao Catálogo Português de Alergias e outras Reações Adversas como um instrumento essencial de registo e partilha de informação dos episódios de anafilaxia ocorridos em Portugal.

A anafilaxia apresenta uma incidência crescente, particularmente em idade pediátrica. Constituindo uma emergência médica, o sucesso terapêutico depende de uma intervenção precoce e adequada. A adrenalina por via intramuscular constitui o fármaco de eleição para o seu tratamento, devendo a dose ser ajustada ao peso e à idade. Resolvida a reação aguda, o doente deve ser mantido sob vigilância médica por um período de 6 a 24 horas, pelo risco de ocorrência de reações bifásicas. Deverá ser considerada a prescrição de um dispositivo de autoadministração de adrenalina em todos os doentes com diagnóstico ou suspeita de anafilaxia; adicionalmente estes doentes têm indicação formal para estudo em consulta de imunoalergologia, de modo a permitir uma adequada intervenção diagnóstica e terapêutica que reduzirá o risco futuro. Todos os episódios de anafilaxia devem ser registados no Catálogo Português de Alergias e outras Reações Adversas (CPARA), constituindo este um instrumento fundamental de partilha de informação clínica dentro do Sistema de Saúde. Este manuscrito pretende divulgar as orientações para o diagnóstico e tratamento da anafilaxia, tornando a sua abordagem clínica mais eficiente e consertada a nível nacional, e promover a adesão ao Catálogo Português de Alergias e outras Reações Adversas como um instrumento essencial de registo e partilha de informação dos episódios de anafilaxia ocorridos em Portugal.

The aim of this study was to present two cases of severe anaphylaxis during sentinel lymph node biopsy (SLNB). Case 1: A 64-year-old-woman had two months earlier been diagnosed with breast ductal invasive carcinoma by first local excision. She was taken for further surgery with SLNB. At induction she received midazolam, fentanyl, propofol, atracurium, cefazolin and paracetamol. She was given a subcutaneous injection of the dye Patent Blue V (PBV) and shortly afterward she developed a blue rash over her abdomen and her blood pressure dropped precipitously. She was treated successfully with intravenous adrenaline and fluids. Six weeks later, a skin prick test (SPT) and intradermal test (ID) to all used drugs, latex and B-lactamics were performed. SPT and ID to PBV were positive with 3mm and 6.5m in weal diameter. ID test to cefazolin was also positive (6.5mm). All others were negative. Case 2: A 49-year-old woman required local excision of a breast lump with SLNB. She received midazolam, fentanyl, cefazolin and atracurium. PBV was then injected and 15 min later, she developed generalized erythema and severe hypotension and bradycardia. She required, intravenous adrenaline and amines infusion postanaesthetic. SPT and ID to all used drugs, latex and B-lactamics were performed. SPT to PBV diluition 1:100 and 1:10 were positive with 3mm and 8mm in weal diameter. The ID testing of atracurio in major concentration of 1:1000 revealed a 7 mm increase in the weal. All others were negative.

A anafilaxia é uma reação de hipersensibilidade sistémica, de início súbito, clínica e gravidade variáveis, cujo diagnóstico é clínico. Sendo uma emergência médica, é um desafio diagnóstico, particularmente em pediatria. Os autores realizaram um estudo retrospetivo com consulta dos processos clínicos das 38 978 crianças admitidas num serviço de urgência pediátrica hospitalar (SUPH) de 01/01/2010 e 31/12/2014, com o objetivo de calcular a incidência e caracterizar a população e as reações anafiláticas. Dos processos analisados identificaram-se 27 episódios de anafilaxia em 24 crianças: 54 % do sexo feminino; média de idade 5,5 anos. A incidência foi de 69,2/100 000, em 5 anos, tratando-se do primeiro episódio em 10 crianças. Clinicamente todas as crianças apresentaram envolvimento cutâneo e 74 % respiratório, 33 % gastrointestinal e 15 % cardiovascular. Em 63 % das reações os alimentos foram a causa identificada, em 11 % a picada de himenóptero e em 7 % a aplicação de produtos cutâneos. As opções terapêuticas foram: 93 % anti-histamínicos H1, 89 % corticoides, 70 % oxigénio suplementar, 59 % adrenalina, 44 % salbutamol inalado e 27 % soro fisiológico, em diferentes associações. Em dez episódios houve necessidade de internamento. Onze crianças (46 %) foram referenciadas à consulta de imunoalergologia. Não se verificaram óbitos. A anafilaxia é causa rara de recurso ao SU, sendo a alergia alimentar a causa mais comum no grupo analisado. Apenas em 59 % dos casos houve administração de adrenalina, sendo que as recomendações internacionais advogam o seu uso precoce em todos os casos. Menos de metade das crianças foram referenciadas à consulta de imunoalergologia, atitude que impossibilita a investigação para diagnóstico etiológico e o desenho de um plano de prevenção e terapêutica adequado Anaphylaxis is a systemic acute hypersensitivity reaction, showing a large variation in clinical presentation and severity. It is a medical emergency requiring an immediate recognition and represents a challenge mainly in younger population. The aim of our study was to evaluate the incidence of anaphylaxis and characterize it in children admitted to a pediatric emergency department during a 5-year period. Revision of 38.978 files of patient with less than 18 years admitted to the pediatric emergency department between 01/01/2010 and 31/12/2014 was performed. From the analyzed data 27 anaphylactic reactions were identified; 24 children-54 % females, mean age 5,5 years were involved. For 10 of them this was a first episode. The incidence was 69.2/100 000 in 5 years. All children had cutaneous manifestations and 74 % had respiratory, 33 % gastrointestinal and 15 % cardiovascular involvement. In 63% of the reactions food was the eliciting factor, in 11 % hymenoptera stings and in 7 % skin care products. The treatment options were in 93 % a first generation antihistaminic, in 89 % corticosteroid, in 70% supplementary oxygen, in 59 % adrenaline, in 44 % inhaled salbutamol and in 27 % normal saline solution, in different combinations. Hospitalization was required in 10 episodes. Eleven children (46 %) were referred to an allergy consultation. There was no mortality. Anaphylaxis is a rare reason for admission in the emergency department. Food related reactions were the most common cause in our study group. Only in 59% of the episodes adrenaline was used, in spite of the guidelines recommend it as first line of treatment, for every anaphylactic reaction. Less than 50% of the children were referred to a specialty consultation, lacking the majority the access to both, a correct diagnostic workup and a personalized emergency and therapeutic plan

Fundamento: A positividade do teste cutâneo prick (TCP) ao pólen de parietária é na maioria dos casos acompanhada de TCP positivos a outros pólenes. Por outro lado, uma percentagem significativa destes doentes não apresenta IgE específica para rPar j 2, considerado atualmente como marcador de alergia à parietária. Objetivo: Encontrar critérios preditivos de alergia ao pólen de parietária em doentes com TCP positivo a este pólen. Métodos: Foram recolhidos dados clínicos, resultados dos TCP e doseamentos de IgE específica para rPar j 2 de 64 doentes com TCP positivos à parietária - pápula com diâmetro médio (dm) igual ou maior que 3 mm. Foi construída uma árvore de classificação de alergia à parietária (tomando como referência de “verdadeira alergia” a positividade da IgErPar j 2), utilizando o algoritmo CHAID (qui-squared automatic interaction detection). Resultados: No grupo estudado, 36 doentes eram do sexo feminino e a média de idades de 25,0±15,0; 70,3 % apresentava TCP positivos para ácaros (do pó), 84,4 % para pólen de gramíneas, 78,1 % a oliveira e 62,5 % para “outros pólenes” (excluindo as gramíneas ou a oliveira). Os fatores preditivos do melhor modelo obtido foram a relação entre as dimensões da pápula do TCP à parietária e à histamina, o sexo e o resultadodos TCP a “outros pólenes”. Assim, os doentes com pápula do TCP à parietária superior à da histamina do sexo feminino tiveram IgErPar j 2 positiva em 100 % dos casos. Por outro lado, um dm de pápula igual ou inferior à histamina acompanhado de TCP positivos para “outros pólenes” associou-se a uma probabilidade de negatividade a este recombinante de 95,5 %. O modelo gerado pela árvore de decisão apresentou bom ajuste, tendo estimativa de risco de 0,16 (erro-padrao= 0,04), mostrando-se estável, considerando-se que o risco estimado pela validação cruzada foi próximo do modelo final (risco 0,19; ep=0,05). Conclusões: Foi possível, com base nos resultados de um estudo alergológico básico, criar um modelo preditivo de alergia ao pólen de parietária com classificação correta em 84 % dos casos e boa capacidade de generalização. Palavras-chave: Alergénio recombinante rParj 2, algoritmo, modelo preditivo, polinose a parietária Background: In most cases a positive prick test (PT) to parietaria goes along with positive PT to other pollens. On the other hand, a significant percentage of this patients don´t presenta rPar j2 specific IgE, which is currently considered as a marker to parietaria allergy. Objective: To define predictive criteria for allergy to parietaria pollen in patients with a positive PT to this pollen. Methods: We collected the medical records, PT results and rPar j 2 specific IgE levels of 64 patients with a positive PT to parietaria - wheal with mean diameter equal or larger then 3mm. Using the CHAID algorithm (Qui-squared Automatic Interaction Detection) we were able to create a classification tree of parietaria allergy (considering “true allergy” the positivity of specific IgE to rPar j 2). Results: In our study group, 36 were female and mean age was 25.0±15,0; 70.3% had a positive PT to dust mites, 84.4 % to grass pollen, 84.4% to olive tree pollen and 62.5% to “other pollens” (non grass nor olive tree pollen). Predictive factors identified by the best model were the ratio between mean diameters of histamine and parietaria PT wheals, the patient gender and the result of the PT to “other pollens”. Therefore, patients with a PT wheal to parietaria larger than histamine that were female hada rPar j 2 positive in 100% of the cases. In the other hand, a PTwheal to parietaria equal or smaller to histamine followed by a positive PT to “other pollens” were related to a 95.5% probability of negative rPar j 2IgE. The computed tree estimated risks were: re-substitution 0.16 (standard error 0.04) and cross-validation 0.19 (standard error 0.05). Conclusion: Basic allergological patient evaluation allowedto create a predictive model of parietaria pollen allergy with a reasonable performance

Fundamentos: A aplicação de questionários estandardizados e a avaliação funcional respiratória são fundamentais na avaliação do doente com sintomas de asma e/ou rinite. O CARATkids é o primeiro questionário padronizado e validado que avalia simultaneamente o controlo da asma e rinite alérgica (ARA) na criança. Objetivos: Avaliar o grau de controlo clínico da ARA em crianças utilizando os scores clínicos obtidos pela aplicação do CARATkids; Estudar a relação entre os referidos scores e os parâmetros espirométricos. Métodos: Estudo prospetivo incluindo 109 crianças entre os 6 e os 12 anos de idade, com ARA, seguidas em consulta de Imunoalergologia, que consistiu em preencher o questionário CARATkids aquando de uma avaliação funcional respiratória. Consideramos o score total obtido e, separadamente, as perguntas respondidas afirmativamente pelos pais (score adulto) e pelas crianças (score criança); dentro deste último, atribuímos uma classificação independente às perguntas relativas às vias aéreas superiores (score VAS) e inferiores (score VAI). O grau de controlo da ARA é inversamente proporcional aos valores dos scores obtidos. Consideramos duas faixas etárias (6-9 e 10-12 anos) e calculamos o grau de correlação entre os parâmetros espirométricos e os valores dos vários scores. Resultados: Encontramos uma elevada frequência de sintomatologia e de impacto da doença nas atividades de vida diária das crianças. Nas crianças mais novas verificamos correlações negativas significativas, embora modestas, entre os scores criança, adulto e total e a %FEV1, o que não aconteceu nas crianças na faixa etária 10-12 anos. Conclusões: Os resultados do CARATkids sugeriram um controlo insuficiente da ARA na maioria das crianças da nossa amostra, evidenciando a importância da utilização de um questionário padronizado na sua avaliação. A baixa correlação demonstrada, nas crianças mais novas, entre alguns dos scores considerados e os valores de %FEV1 sugerem que os dois métodos de estudo avaliam aspetos diferentes da asma, devendo ser utilizados de forma complementar Background: The use of standardised questionnaires and lung function measurements are essential in the assessment of patients with asthma and/or rhinitis symptoms. CARATkids is the first questionnaire to simultaneously assess the control of asthma and allergic rhinitis (AAR) in children. Objectives: To evaluate the degree of clinical control of AAR in children using the clinical scores obtained by applying CARATkids; To study the correlation between the clinical scores and the spirometric parameters. Methods: Prospective study including 109 children aged 6 to 12 years-old, with AAR, referred to our Hospital’s Immunoallergy Department, which consisted in filling out the CARATkids questionnaire during a lung function test. We considered the total score obtained and, separately, the questions answered positively by the parents (adult score) and by the children (child score); within the latter, we assigned a separate classification to the upper airway (VAS score) and lower airway (VAI score) questions. The level of AAR control is inversely proportional to the obtained scores. We considered two age groups (6-9 and 10-12 years) and calculated the degree of correlation between the spirometric parameters and the values of the several scores. Results: We found a high frequency of symptoms and and relevant impact of the disease on the children’s daily activities. We found in younger children a negative correlation between the child, adult and total scores with %FEV1, which did not happen in children aged 10-12 years. Conclusions: The CARATkids results suggest that AAR was insufficiently controlled in most of the children in our sample, highlighting the importance of using a standardized questionnaire in their evaluation. The low correlation demonstrated in younger children between some of the considered scores and %FEV1 values suggest that the two study methods assess different asthma aspects, and should be used in a complementary way

Table of contents ORAL ABSTRACTS Symposium 1: Biochemistry, structure and environment of the allergen: what makes a protein an allergen? O1 Two cell-membrane peptidases carrying galactose-alpha-1,3-galactose are implicated in delayed anaphylactic reactions upon pork kidney ingestion in patients with IgE-antibodies to alpha-Gal Christiane Hilger, Kyra Swiontek, Jörg Fischer, François Hentges, Christiane Lehners, Martine Morisset, Bernadette Eberlein, Tilo Biedermann, Markus Ollert O2 Structure solution of Pla l 1 suggests similar folding of Ole e 1-like family members but distinct immunological properties Sabrina Wildner, Teresa Stemeseder, Regina Freier, Peter Briza, Roland Lang, Eva Batanero, Mayte Villalba, Jonas Lidholm, Thomas Hawranek, Fatima Ferreira, Hans Brandstetter, Gabriele Gadermaier Symposium 2: New allergen molecules in the spotlight O3 Identification of the cysteine protease Amb a 11 as a novel major allergen from short ragweed (Ambrosia artemisiifolia) Philippe Moingeon, Rachel Groeme, Julien Bouley, Véronique Bordas, Maxime Le Mignon, Laetitia Bussières, Aurélie Lautrette, Laurent Mascarell, Vincent Lombardi, Véronique Baron-Bodo, Henri Chabre, Thierry Batard, Emmanuel Nony O4 Production and characterization of polybia paulista recombinant antigen 5: a valuable diagnostic tool Karine Marafigo De Amicis, Alexandra Sayuri Watanabe, Daniele Danella Figo, José Roberto Aparecido Dos Santos-Pinto, Mario Sergio Palma, Fabio Fernandes Morato Castro, Jorge Kalil, Therese Wohlschlager, Peter Briza, Sabrina Wildner, Fatima Ferreira-Briza, Gabriele Gadermaier, Keity Souza Santos Symposium 3: Progress in molecular and cellular diagnosis O5 Basophil activation test with recombinant Pru p 3; identifying genuine peach allergic patients Margaretha Faber, Athina Van Gasse, Vito Sabato, Margo M. Hagendorens, Chris H. Bridts, Luc S. De Clerck, Araceli Diaz Perales, Didier Ebo O6 Nanofluidic technology enables rapid, near-patient quantification of allergen-specific IgE Petra Zavadakova, Aurélie Buchwalder, Fabien Rebeaud, Iwan Märki Symposium 4: Relevance of molecular diagnostics for intervention and treatment O7 Longitudinal analysis of Bet v 1-specific epitope repertoires during birch pollen immunotherapy Barbara Gepp, Nina Lengger, Christian Möbs, Wolfgang Pfützner, Christian Radauer, Barbara Bohle O8 A natural CCD-free tool: is polistes sp. venom suitable for polybia paulista diagnosis and therapy? Karine Marafigo De Amicis, Alexandra Sayuri Watanabe, Clovis Eduardo Galvao, Daniele Danella Figo, Jose Roberto Aparecido Santos-Pinto, Mario Sergio Palma, Fabio Fernandes Morato Castro, Jorge Kalil, Fatima Ferreira, Gabriele Gadermaier, Keity Souza Santos Symposium 5: The advent of molecular allergology in epidemiology O9 Peanut oleosins: from identification to diagnostic testing Christian Schwager, Skadi Kull, Frauke Schocker, Jochen Behrends, Wolf-Meinhard Becker, Uta Jappe O10 Endotypes of oral allergy syndrome in childhood: a molecular diagnostic approach Carla Mastrorilli, Salvatore Tripodi, Carlo Caffarelli, Riccardo Asero, Arianna Dondi, Giampaolo Ricci, Carlotta Povesi Dascola, Elisabetta Calamelli, Andrea Di Rienzo Businco, Annamaria Bianchi, Tullio Frediani, Carmen Verga, Iride Dello Iacono, Diego Peroni, Giuseppe Pingitore, Roberto Bernardini, Paolo Maria Matricardi Symposium 6: Molecular AIT: which approaches will make it to market? O11 Mbc4: an innovative molecule to tackle birch pollen and concomitant food allergies Heidi Hofer, Claudia Asam, Michael Hauser, Peter Briza, Martin Himly, Christof Ebner, Fatima Ferreira O12 Challenges and solutions associated with the production of recombinant Bet v 1 allergen as a therapeutic protein Emmanuel Nony, Maxime Le Mignon, Pierrick Lemoine, Karine Jain, Kathy Abiteboul, Monica Arvidsson, Sabina Rak, Philippe Moingeon Clinical Cases: Breakthroughs and headaches from CRD: interactive session CC1 Anaphylaxis caused by lipid transfer proteins: a complex clinical pattern syndrome Inês Mota, Filipe Benito Garcia, Angela Gaspar, Cristina Arêde, Susana Piedade, Graça Sampaio, Graça Pires, Luís Miguel Borrego, Cristina Santa-Marta, Mário Morais-Almeida CC2 IgE sensitization profile in a patient with asteraceae pollen-exotic fruits association Florin-Dan Popescu, Mariana Vieru, Florin-Adrian Secureanu CC3 Food-dependent: exercise induced anaphylaxis. Which component to blame? Rosa Anita Rodrigues Fernandes, Isabel Carrapatoso, Raquel Gomes, Celso Pereira, Ana Todo-Bom CC4 Anaphylaxis to intravenous iron preparations in a patient that tolerates oral administration María Cecilia Martín Fernández De Basoa, Javier Barrios Regio, Juan De Castro Cordova, Antón Fernández Ferreiro CC5 IgE sensitization pattern in an adult patient with oral allergy syndrome to peanuts and pollinosis from southern Romania Florin-Dan Popescu, Mariana Vieru, Florin-Adrian Secureanu CC6 Evidence of specific IgE to plant-derived cross-reactive carbohydrate determinant in a patient with delayed anaphylaxis to red meat Mariana Vieru, Florin-Dan Popescu, Florin-Adrian Secureanu POSTER PRESENTATIONS Poster Session 1: Molecular allergology and epidemiology P1 Atopic children produce stronger and more frequent IgG responses than non-atopic children: longitudinal data from the German MAS birth cohort Olympia Tsilochristou, Serena Perna, Alina Schwarz, Alexander Rohrbach, Antonio Cappella, Laura Hatzler, Carl-Peter Bauer, Ute Hoffmann, Johannes Forster, Fred Zepp, Antje Schuster, Raffael D’amelio, Ulrich Wahn, Thomas Keil, Susanne Lau, Paolo Maria Matricardi P2 The IgG sensitization profiles against 112 allergenic components support the absence of a protective role of IgG in allergic individuals, outside of the context of SIT Pol André Apoil, Claire Mailhol, Anne Broué-Chabbert, Agnès Juchet, Alain Didier, Elodie Carrer, Thomas Lanot, Antoine Blancher P3 The immune response against the timothy grass pollen allergen Phl p 5 in non-allergic humans Almedina Kurtaj, Christoph Hillebrand, Gerda Fichtinger, Martin Danzer, Christian Gabriel, Theresa Thalhamer, Sandra Scheiblhofer, Josef Thalhamer, Richard Weiss P4 Analyzing the cross-reactivity profile of the major ragweed allergen Amb a 1 Martin Wolf, Michael Hauser, Ulrike Pichler, Teresa Twaroch, Gabriele Gadermaier, Christof Ebner, Hidenori Yokoi, Toshiro Takai, Alain Didierlaurent, Adriano Mari, Peter Briza, Heidrun Behrendt, Angela Neubauer, Frank Stolz, Fátima Ferreira, Michael Wallner P5 LTP (Pru p 3) sensitisation in skin prick test: which means in clinical practice? Sara Carvalho, Tatiana Lourenço, Joana Cosme, Fátima Cabral Duarte, Amélia Spínola Santos, Ana Célia Costa, Manuel Pereira Barbosa P6 IgE profiles, allergen exposure and lifestyle of 501 Austrian pupils: investigation of influences on the development of allergic sensitizations Teresa Stemeseder, Eva Klinglmayr, Bettina Schweidler, Lisa Lueftenegger, Stephanie Moser, Patrick Doppler, Roland Lang, Martin Himly, Gertie J. Oostingh, Arne Bathke, Joerg Zumbach, Thomas Hawranek, Gabriele Gadermaier P7 Molecular profiles of sensitization to perennial inhalant allergens in a middle European region Petr Panzner, Martina Vachova, Tomas Vlas, Marek Maly P8 Evolution of the IgE response to house dust mite allergen molecules in childhood Daniela Posa, Serena Perna, Stephanie Hofmaier, Laura Hatzler, Alexander Rohrbach, Carl-Peter Bauer, Ute Hoffmann, Johannes Forster, Fred Zepp, Antje Schuster, Philippe Stock, Ulrich Wahn, Linus Grabenhenrich, Thomas Keil, Susanne Lau, Kuan-Wei Chen, Yvonne Resch, Susanne Vrtala, Rudolf Valenta, Paolo Maria Matricardi P9 Tropomyosin (Pen a1): to include or not to include in skin prick testing? Joana Cosme, Sara Carvalho, Tatiana Lourenço, Amélia Spínola Santos, Manuel Pereira Barbosa Immunoallergy Department - Hospital de Santa Maria – Centro Hospitalar Lisboa Norte, Lisbon, Portugal, Lisbon, Portugal; Immunoallergy Department - Hospital de Santa Maria – Centro Hospitalar Lisboa Norte, Lisbon, Portugal; Faculdade de Medicina de Lisboa, Lisbon, Portugal P10 Component-resolved IgE profiles in Georgian patients Tamar Abramidze, Nino Lomidze, Maia Gotua P11 Cross reactivity between food and pollen allergens in Lithuania according to spIgE evaluation Austeja Dapkeviciute, Ruta Einikyte, Jolita Norkuniene, Laima Skrickiene, Asta Miskiniene, Violeta Kvedariene P12 Distribution of inhalant allergy in the population of Lithuania Ruta Einikyte, Austeja Dapkeviciute, Jolita Norkuniene, Laima Skrickiene, Asta Miskiniene, Violeta Kvedariene Poster Session 2: Allergen molecules: identification, characterization, structure and function P13 Interference of antigen 5-based cross-reactivity in the diagnosis of hymenoptera venom allergy Maximilian Schiener, Bernadette Eberlein, Carmen Moreno-Aguilar, Gunilla Pietsch, Mareike Mc Intyre, Lea Schwarze, Dennis Rußkamp, Tilo Biedermann, Edzard Spillner, Ulf Darsow, Carsten Schmidt-Weber, Markus Ollert, Simon Blank P14 IgE cross-reactivity between European Hymenoptera and Asian hornet (Vespa velutina) venom allergens Cyril Longé, Andrea Brazdova, Jean-Louis Brunet, Claire Schwartz, Bruno Girodet, François Lavaud, Joelle Birnbaum, Nhân Pham Thi, Magalie Duchateau, Julia Chamot-Rooke, Laurence Guilloux, Marie-Ange Selva, Rémy Couderc, Hélène Sénéchal, Jean-Pierre Sutra, Pascal Poncet P15 Carbohydrate composition of house dust mite extracts and major group 1 and group 2 allergens Steffen Augustin, Linda Pump, Martin Wald, Thomas Eichhorn, Frank Fischer, Christoph Willers P16 Specificity of monoclonal antibodies against cross-reactive carbohydrate determinants Michaela Miehe, Melanie Plum, Sara Wolf, Frederic Jabs, Tim Raiber, Frank Bantleon, Henning Seismann, Thilo Jakob, Edzard Spillner P17 Red meat allergic patients have a selective IgE response to the a-Gal glycan Danijela Apostolovic, Anh Thu Tran, Sara Sanchez-Vidaurre, Tanja Cirkovic Velickovic, Maria Starkhammar, Carl Hamsten, Marianne Van Hage P18 Specificity of non-specific lipid transfer proteins and influence of the ligands on their three-dimensional structure Pawel Dubiela, Piotr Humeniuk, Sabine Pfeifer, Merima Bublin, Tomasz Borowski, Karin Hoffmann-Sommergruber P19 Real-time PCR analysis of Pru av 1 and Pru av 3 allergens Martie C.M. Verschuren, Shanna Bastiaan-Net, Defien Depoortere, Kay Foetisch, Stephan Scheurer, Harry J Wichers, Theo Noij P20 Specificity of anti-Pru av 1 antibodies for the detection of Pru av 1 isoallergens Martie C.M. Verschuren, Shanna Bastiaan-Net, Nikki M.E. Van Uden, Karel Vandenberghe, Kay Foetisch, Stephan Scheurer, Harry J. Wichers H.J., Theo H.M. Noij P21 Enhancing recombinant production yield of Bet v 1 through codon usage harmonization Anargyros Roulias, Maria Alejandra Parigiani, Heidi Hofer, Claudia Asam, Christof Ebner, Fátima Ferreira P22 Structural and dynamic insights into the world of PR-10 allergens Linda Ahammer, Sarina Grutsch, Martin Tollinger Poster Session 3: Allergen molecules: identification, characterization, structure and function P23 Purification of polcalcin from different pollen allergenic sources by antibody-affinity chromatography Raquel Moya, Mª Angeles López-Matas, Raquel Reyes, Jerónimo Carnés P24 Variations of wheat allergens in cultivars measured through a targeted quantitative mass spectrometry approach Colette Larré, Hélène Rogniaux, Roberta Lupi, Sandra Denery-Papini P25 Art v 1, Amb a 4 and Par h 1 defensin-like proteins share similar structural features but distinct immunological and allergenic properties Isabel Maria Pablos, Stephanie Eichhorn, Yoan Machado, Peter Briza, Christof Ebner, Jung-Won Park, Alain Didierlaurent, Naveen Arora, Stefan Vieths, Gabriele Gadermaier, Fatima Ferreira P26 Homogeneity or diversity of IgE-binding proteins in wheat dependant exercise induced anaphylaxis? Sandra Denery-Papini, Charlene Tanaka, Florence Pineau, Roberta Lupi, Martine Drouet, Etienne Beaudouin, Martine Morisset, Susan Altenbach P27 Deciphering the role of disulfide bonds and of repetitive epitopes in immunoglobulin E binding to wheat gliadins Sandra Denery-Papini, Hamza Mameri, Chantal Brossard, Roberta Lupi, Florence Pineau, Jean Charles Gaudin, Denise Anne Moneret-Vautrin, Etienne Beaudouin, Evelyne Paty, Martine Drouet, Olivier Tranquet, Colette Larré P28 Assessment of the allergenicity of soluble fractions from bread and durum wheats genotypes Roberta Lupi, Stefania Masci, Olivier Tranquet, Denise-Anne Moneret-Vautrin, Sandra Denery-Papini, Colette Larré P29 Isolation and characterization of Ara h 12 and Ara h 13: defensins, a novel class of peanut allergens Skadi Kull, Arnd Petersen, Marisa Böttger, Sandra Rennert, Wolf-Meinhard Becker, Susanne Krause, Martin Ernst, Thomas Gutsmann, Johann Bauer, Buko Lindner, Uta Jappe P30 Allergenicity attributes of different peanut market types Stef Koppelman, Shyamali Jayasena, Dion Luykx, Erik Schepens, Danijela Apostolovic, Govardus De Jong, Tom Isleib, Julie Nordlee, Joe Baumert, Steve Taylor, Soheila Maleki P31 The impact of peanut lipids on Ara h 1-induced immune responses in monocytes-derived dendritic cells Chiara Palladino, Barbara Gepp, Sofía Sirvent, Alba Angelina, Merima Bublin, Christian Radauer, Nina Lengger, Thomas Eiwegger, Oscar Palomares, Heimo Breiteneder P32 Compared allergenicity of native and thermally aggregated ovalbumin as large agglomerated particles Mathilde Claude, Roberta Lupi, Grégory Bouchaud, Marie Bodinier, Chantal Brossard, Sandra Denery-Papini P33 Simulation of the gastrointestinal digestion of the hazelnut allergens Cor a 9 and Cor a 11 by an in-vitro model and characterisation of peptidic products including epitopes by HPLC-MS/MS Robin Korte, Julia Bräcker, Jens Brockmeyer P34 Analysis of distribution of rice allergens in brown rice grain and allergenicity of the products containing rice bran Rie Satoh, Reiko Teshima Poster Session 4: Molecular approaches in AIT P35 Production of a recombinant hypoallergenic variant of the major peanut allergen Ara h 2 for allergen-specific immunotherapy Angelika Tscheppe, Dieter Palmberger, Merima Bublin, Christian Radauer, Chiara Palladino, Barbara Gepp, Nina Lengger, Reingard Grabherr, Heimo Breiteneder P36 Mutagenesis of amino acids critical for calcium-binding leads to the generation of a hypoallergenic Phl p 7 variant Marianne Raith, Linda Sonnleitner, Doris Zach, Konrad Woroszylo, Margit Focke-Tejkl, Herbert Wank, Thorsten Graf, Annette Kuehn, Ines Swoboda P37 Are birch pollen allergen immunotherapy induced blocking antibodies protective for cross-reactive allergens? Claudia Asam, Sara Huber, Heidi Hofer, Roland Lang, Thomas Hawranek, Fátima Ferreira, Michael Wallner P38 High success of 58 subcutaneous immunotherapy for pets allergy in a polyallergic cohort of patients: a component resolved individually adapted treatment (CRIAT) Fabienne Gay-Crosier P39 Neutrophils are potential antigen presenting cells in IgE- mediated allergy Dominika Polak, Birgit Nagl, Claudia Kitzmüller, Barbara Bohle P40 Characterization of allergen-specific CD8+ T cells in type I allergy Nazanin Samadi, Claudia Kitzmüller, Rene Geyeregger, Barbara Bohle, Beatrice Jahn-Schmid Poster Session 5: Molecular and cellular diagnostic tests P41 Nanofluidic-based biosensors allow quantification of total circulating IgE from a drop of blood in 5 minutes Aurélie Buchwalder, Ariel Gomez, Fabien Rebeaud, Iwan Märki P42 Allergen microarray for the analysis of serum IgE binding profile and allergenic activity Jaana Haka, Liisa Hattara, Marika Heikkinen, Merja H Niemi, Juha Rouvinen, Petri Saviranta, Pekka Mattila, Kristiina Takkinen, Marja-Leena Laukkanen P43 Generation of a well-characterized panel of periplaneta americana allergens for component resolved diagnosis Stephanie Eichhorn, Isabel Pablos, Bianca Kastner, Bettina Schweidler, Sabrina Wildner, Peter Briza, Jung-Won Park, Naveen Arora, Stefan Vieths, Gabriele Gadermaier, Fatima Ferreira P44 Improved diagnostic sensitivity of recombinant Api m 1 and Ves v 5 in diagnosis of Hymenoptera venom allergy Mira Silar, Julij Selb, Rok Kogovsek, Mitja Kosnik, Peter Korosec P45 Added value of biomarkers of primary sensitization and cross-reactivity in patients with hymenoptera venom allergy Leticia Pestana, Alcinda Campos Melo, Ana Mendes, Maria Elisa Pedro, Manuel Pereira Barbosa, Maria Conceição Pereira Santos P46 Cosensitization to Alt a 1 and Act d 2: more than a fortuitous association? Françoise Bienvenu, Claire Goursaud, Lorna Garnier, Sandrine Jacquenet, Michaël Degaud, Sébastien Viel, Annick Barre, Pierre Rougé, Jacques Bienvenu, Joana Vitte P47 Molecular diagnosis for peanut allergy: ALFA method performs as well as established methods for Ara h 1, Ara h 2, Ara h 6, Ara h 9 and CCD Amel Bensalah, Isabelle Cleach, Laurent Mousseau, Chantal Agabriel, Valérie Liabeuf, Joëlle Birnbaum, Jean-Louis Mège, Joana Vitte P48 Evaluation of a food challenge service in relation to specific IgE to molecular components in children with suspected peanut allergy James Gardner, Minal Gandhi, Harsha Kariyawasam, Giuseppina Rotiroti P49 Component resolved diagnosis in cereal allergy Isabel Carrapatoso, Celso Pereira, Frederico Regateiro, Emília Faria, Ana Todo-Bom Poster Session 6: Molecular diagnosis in prevention and therapy P50 Pretreatment molecular sensitizations determine the sIgG4 induction during the updosing of SCIT and may be useful to identify clinically relevant additional sensitizations Johannes Martin Schmid, Ronald Dahl, Hans Juergen Hoffmann P51 Usefulness of recombinant latex allergens in immunotherapy’s decision and follow-up Inês Mota, Filipe Benito Garcia, Angela Gaspar, Mário Morais-Almeida P52 Omega-5-gliadin in the diagnosis of wheat-dependent anaphylaxis induced by ibuprofen but not by exercise Joana Cosme, Letícia Pestana, Amélia Spínola Santos, Manuel Pereira Barbosa P53 Food dependent exercise-induced anaphylaxis: a component-resolved and in vitro depletion approach to access IgE cross-reactivity Diana Silva, Teresa Vieira, Ana Maria Pereira, André Moreira, Luís Delgado P54 Olive pollen allergens: what are we missing? Sara Prates, Cátia Alves, Elena Finelli, Paula Leiria Pinto P55 Purified Alt a 1 extract in Alternaria alternata allergy diagnosis Bárbara Kong Cardoso, Cíntia Cruz, Filipa Semedo, Elza Tomaz, Filipe Inácio P56 Use of specific IgE Bos d8 (casein) to aid early introduction of dietary baked milk in children with cows’ milk allergy James Gardner, Santanu Maity, Giuseppina Rotiroti, Minal Gandhi P57 Molecular characterisation and immunoreactivity of a peanut ingredient for use in oral food challenges Ivona Baricevic-Jones, Justin T. Marsh, Phil E. Johnson, Anuradha Balasundaram, Anya-May Hope, Aafke Taekema, Angela Simpson, Aida Semic-Jusufagic, E.N. Clare Mills P58 Specific IgE to recombinant allergens of hazelnut and oral food challenge in children Gourdon Dubois Nelly, Sellam Laetitia, Pereira Bruno, Michaud Elodie, Messaoudi Khaled, Evrard Bertrand, Fauquert Jean-Luc Poster session 7/8: miscellaneous P59 What defines a protein as an allergen? A discussion of sources and sufficiency Richard E. Goodman P60 Cat allergy: relationship between clinical and molecular diagnostic María Cecilia Martín Fernández De Basoa, Antón Fernández Ferreiro, Elena Rodríguez Plata P61 Anaphylaxis to rabbit: the cat came in last Luis Amaral, Borja Bartolomé, Alice Coimbra, Jose L Placido P62 Dog allergy: relationship between clinical and molecular diagnostic María Cecilia Martín Fernández De Basoa, Antón Fernández Ferreiro, Elena Rodríguez Plata P63 Correlation of serum timothy grass-pollen specific IgE levels determined by two immunoblot test systems Mariana Vieru, Florin-Dan Popescu, Florin-Adrian Secureanu, Carmen Saviana Ganea P64 Development of oral food challenge formulations for diagnosis of fish allergy using powdered fish ingredients Carol Ann Costello, Ivona Baricevic-Jones, Martin Sorensen, Clare Mills, Adrian Rogers, Aage Otherhals P65 Fish and peanut allergens interact with plasma membranes of intestinal and bronchial epithelial cells and induce differential gene expression of cytokines and chemokines Tanja Kalic, Isabella Ellinger, Chiara Palladino, Barbara Gepp, Eva Waltl, Verena Niederberger-Leppin, Heimo Breiteneder P66 Interleukin 4 affects fat tissue metabolism and expression of pro-inflammatory factors in isolated rat adipocytes Dawid Szczepankiewicz, Ewa Pruszynska-Oszmalek, Marek Skrzypski, Krzysztof W. Nowak, Aleksandra Szczepankiewicz P67 Ozone induced airway hyperreactivity in PD-L2−/− mice model Gwang-Cheon Jang P68 Thymic stromal lymphopoietin (TSLP) and its receptor as targets for the development of anti-inflammatory inhibitory agents Iva Markovic, Andreas Borowski, Tina Vetter, Andreas Wohlmann, Michael Kuepper, Karlheinz Friedrich P69 The mononuclear phagocyte system in experimentally-induced allergic rhinitis Ibon Eguiluz Gracia, Anthony Bosco, Ralph Dollner, Guro Reinholt Melum, Anya C Jones, Maria Lexberg, Patrick G Holt, Espen Sønderaal Bækkevold, Frode Lars Jahnsen P70 Expression of histamine metabolizing enzymes is increased in allergic children Aleksandra Szczepankiewicz, Paulina Sobkowiak, Marta Rachel, Beata Narozna, Dorota Jenerowicz, Witold Swiatowy, Anna Breborowicz P71 Modifying the glycosylation of human IgE towards oligomannosidic structures does not affect its biological activity Melanie Plum, Sara Wolf, Frank Bantleon, Henning Seismann, Frederic Jabs, Michaela Miehe, Thilo Jakob, Edzard Spillner P72 Flying Labs: an educational initiative to transfer allergy research into high-school settings Michael Wallner, Heidi Hofer, Fatima Ferreira, Reinhard Nestelbacher P73 Clinical significance of antihistamines and Kujin, an anti-allergic Kampo medicine Hiroyuki Fukui

Table of contents Poster walk 11: miscellaneous drug hypersensitivity 2 (P92–P94, P96–P101) P92 16 years of experience with proton pump inhibitors (PPIs) Javier Dionicio Elera, Cosmin Boteanu, Maria Aranzazu Jimenez Blanco, Rosario Gonzalez-Mendiola, Irene Carrasco García, Antonio Alvarez, Jose Julio Laguna Martinez P93 Allergy evaluation of quinolone induced adverse reactions Jaume Martí Garrido, Carla Torán Barona, Carolina Perales Chorda, Ramón López Salgueiro, Miguel Díaz Palacios, Dolores Hernández Fernández De Rojas P94 Bupropion-induced acute urticaria and angioedema, a case report Emre Ali Acar, Ayse Aktas, Aylin Türel Ermertcan, Peyker Temiz P96 Delayed type hypersensitivity and study of cross-reactivity between proton-pump inhibitors Chien-Yio Lin, Chung-Yee Rosaline Hui, Ya-Ching Chang, Chih-Hsun Yang, Wen-Hung Chung P97 Diagnostic work-up in suspected hypersensitivity to proton-pump inhibitors: looking at cross-reactivity Fabrícia Carolino, Diana Silva, Eunice Dias De Castro, Josefina R. Cernadas P98 Management of infusion-related hypersensitivity reactions to enzyme replacement therapy for lysosomal diseases Luis Felipe Ensina, Carolina Aranda, Ines Camelo Nunes, Alex Lacerda, Ana Maria Martins, Ekaterini Goudouris, Marcia Ribeiro, José Francisco Da Silva Franco, Leandra Queiroz, Dirceu Solé P99 Management of insulin allergy with continuous subcutaneous insulin infusion Ceyda Tunakan Dalgiç, Aytül Zerrin Sin, Fatma Düsünür Günsen, Gökten Bulut, Fatma Ömür Ardeniz, Okan Gülbahar, Emine Nihal Mete Gökmen, Ali Kokuludag P100 Off-label use of icatibant for management of serious angioedema associated with angiotensin inhibitors Ana M. Montoro De Francisco, Talía Mª De Vicente Jiménez, Adriana M. Mendoza Parra, Angella M. Burgos Pimentel, Amelia García Luque P101 Thiocolchicoside anaphylaxis: an unusual suspect? Luis Amaral, Fabricia Carolino, Leonor Carneiro Leão, Eunice Castro, Josefina Cernadas Poster walk 12: betalactam hypersensitivity (P102–P111) P102 A curious delayed reading: a case report of a β-lactam allergy in a child Nicole Pinto, Joana Belo, João Marques, Pedro Carreiro-Martins, Paula Leiria-Pinto P103 Betalactam-induced hypersensitivity: a 10-years’ experience Amel Chaabane, Haifa Ben Romdhane, Nadia Ben Fredj, Zohra Chadly, Naceur A. Boughattas, Karim Aouam P104 Cefazolin hypersensitivity: towards optimized diagnosis Astrid P. Uyttebroek, Chris H. Bridts, Antonino Romano, Didier G. Ebo, Vito Sabato P105 Clavulanic acid allergy: two cases report Anabela Lopes, Joana Cosme, Rita Aguiar, Tatiana Lourenço, Maria-João Paes, Amélia Spínola-Santos, Manuel Pereira-Barbosa P106 Diagnosis of betalactam allergy in an allergy department Cíntia Rito Cruz, Rute Pereira Dos Reis, Elza Tomaz, Ana Paula Pires, Filipe Inácio P107 Diagnostic work-up of 410 patients with suspicion of betalactam antibiotic hypersensitivity Filipe Benito-Garcia, Inês Mota, Magna Correia, Ângela Gaspar, Marta Chambel, Susana Piedade, Mário Morais-Almeida P108 Immediate selective hypersensitivity reactions to clavulanic acid Alla Nakonechna, Yurij Antipkin, Tetiana Umanets, Fernando Pineda, Francisca Arribas, Volodymyr Lapshyn P109 Prevalence and incidence of penicillin hypersensitivity reactions in Colombia Pablo Andrés Miranda, Bautista De La Cruz Hoyos P110 Selective sensitization to amoxicilin and clavulanic acid Jose Julio Laguna Martinez, Aranzazu Jimenez Blanco, Javier Dionicio Elera, Cosmin Boteanu, Rosario Gonzalez-Mendiola, Marta Del Pozo P111 Infliximab-specific T cells are detectable also in treated patients who have not developed anti-drug antibodies Alessandra Vultaggio, Francesca Nencini, Sara Pratesi, Andrea Matucci, Enrico Maggi Poster walk 13: biologicals, local anesthetics, others (P112–P118) P112 A case report of allergic immediate systemic reaction to adalimumab and certolizumab Ceyda Tunakan Dalgiç, Fatma Düsünür Günsen, Gökten Bulut, Fatma Ömür Ardeniz, Okan Gülbahar, Emine Nihal Mete Gökmen, Aytül Zerrin Sin, Ali Kokuludag P113 Allergy to local anesthetics: negative predictive value of skin tests Ivana Cegec, Danica Juricic Nahal, Viktorija Erdeljic Turk, Matea Radacic Aumiler, Ksenija Makar Ausperger, Iva Kraljickovic, Iveta Simic P114 Cutaneous adverse reactions of molecular targeted agents: a retrospective analysis in 150 patients in our department Yukie Yamaguchi, Tomoya Watanabe, Megumi Satoh, Tomohiko Tanegashima, Kayoko Oda, Hidefumi Wada, Michiko Aihara P115 Generalized paralysis induced by local lidocaine injection Jaechun Jason Lee, Jay Chol Choi, Hwa Young Lee P116 Hypersensitivity to local anaesthetics: a 10 year review Rosa-Anita Rodrigues Fernandes, Emília Faria, Joana Pita, Nuno Sousa, Carmelita Ribeiro, Isabel Carrapatoso, Ana Todo Bom P117 Local anaesthetics: a rare culprit in hypersensitivity reactions Ana Rodolfo, Eunice Dias-Castro, Josefina Cernadas P118 Stevens–Johnson syndrome in clinical practice: a variant of clinical course Marina Voronova Poster walk 14: RCM (P119–P128) P119 13 cases of severe anaphylactic reactions due to radiocontrast media Jaume Martí Garrido, Ramon Lopez Salgueiro, Diana Kury Valle, Verónica Pacheco Coronel, Carolina Perales Chordá, Dolores Hernandez Fernandez De Rojas P120 Anaphylactic shock after administration of iodinated contrast medium during cardiac catheterization Roselle Catherine Yu Madamba, Marta Ferrer, Maria Jose Goikoetxea, Carmen D’Amelio, Amalia Bernad, Olga Vega, Gabriel Gastaminza P121 Anaphylactic shock and cardiac arrest induced by gadolinium-based contrast agents Beatriz Pola Bibián, Marina Lluncor Salazar, Gemma Vilà Nadal, Ana María Fiandor Roman, Javier Dominguez Ortega, Miguel Gonzalez Muñoz, Santiago Quirce Gancedo, Maria Rosario Cabañas Moreno P122 Anaphylaxis to gadobenate and cross-reactivity to other gadolinium-based contrast agents in two patients Kathrin Scherer Hofmeier P123 Anaphylaxis to glatiramer acetate in a patient with multiple sclerosis Fabrícia Carolino, Vladyslava Barzylovych, Josefina R. Cernadas P124 Delayed hypersensitivity reaction to radiocontrast media Fabrícia Carolino, Diana Silva, Leonor Leão, Josefina R. Cernadas P125 Drug reaction with eosinophilia and systemic symptoms induced by iodixanol Gemma Vilà-Nadal, Beatriz Pola, Marina Lluncor, Ana Fiandor, Teresa Bellón, Javier Domínguez, Santiago Quirce P126 Electronic consultation support system for radiocontrast media hypersensitivity changes clinician’s behavior Min-Suk Yang, Sun-Sin Kim, Sae-Hoon Kim, Hye-Ryun Kang, Heung-Woo Park, Sang-Heon Cho, Kyung-Up Min, Yoon-Seok Chang P127 Hypersensitivity reactions to iodinated contrast media: skin testing and follow-up Danica Juricic Nahal, Ivana Cegec, Viktorija Erdeljic Turk, Iva Kraljickovic, Matea Radacic Aumiler, Ksenija Makar Ausperger, Iveta Simic P128 Would iodine allergy exist? Clémence Delahaye, Jenny Flabbee, Julie Waton, Olivia Bauvin, Annick Barbaud Poster walk 15: MPE/type 4 (P129–P137) P129 Delayed hypersensitivity cutaneous reactions: a case/control study from a tunisian database Karim Aouam, Najah Ben Fadhel, Zohra Chadly, Nadia Ben Fredj, Naceur A. Boughattas, Amel Chaabane P130 Delayed hypersensitivity reactions to cephalosporins: a review of seven cases Joana Cosme, Anabela Lopes, Amélia Spínola-Santos, Manuel Pereira-Barbosa P131 Diclofenac induced allergic contact dermatitis: case series of four patients Sandra Jerkovic Gulin, Anca Chiriac P132 Late-onset maculopapular rash to irbesartan Bárbara Kong Cardoso, Elza Tomaz, Regina Viseu, Filipe Inácio P133 Nonimmediate hypersensitivity reactions to betalactams: a retrospective analysis Ana Moreira, Susana Cadinha, Ana Castro Neves, Patricia Barreira, Daniela Malheiro, J. P. Moreira Da Silva P134 Occupational airborne contact dermatitis to omeprazole Ružica Jurakic-Toncic, Suzana Ljubojevic, Petra Turcic P135 Ornidazole-induced fixed drug eruption confirmed by positive patch test on a residual pigmented lesion Liesbeth Gilissen, Sara Huygens, An Goossens P136 Repeated delayed reaction induced by amoxicillin and amoxicillin clavulanate Inmaculada Andreu, Ramon Lopez-Salgueiro, Alicia Martinez Romero, Pau Gomez Cabezas P137 Systemic photosensitivity from fenofibrate in a patient photo-sensitized to ketoprofen Liesbeth Gilissen, An Goossens Poster walk 16: HLA genetics (P138–P146) P138 A copy number variation in ALOX5 and PTGER1 is associated with nonsteroidal anti-inflammatory drugs induced urticaria and/or angioedema Pedro Ayuso Parejo, Maria Del Carmen Plaza-Serón, Inmaculada Doña, Natalia Blanca López, Carlos Flores, Luisa Galindo, Ana Molina, James Richard Perkins, Jose Antonio Cornejo-García, José Augusto García-Agúndez, Elena García-Martín, Paloma Campo, María Gabriela Canto, Miguel Blanca P139 Association of galectin-3 (LGALS3) single nucleotide polymorphisms with non-steroidal anti-inflammatory drugs-induced urticaria/angioedema José Antonio Cornejo-Garcia, Inmaculada Doña, Rosa María Guéant-Rodríguez, Natalia Blanca-López, María Carmen Plaza-Serón, Raquel Jurado-Escobar, Esther Barrionuevo, María Salas, María Luisa Galindo, Gabriela Canto, Miguel Blanca, Jean-Louis Guéant P140 Detection of T cell responses to ticlopidine using peripheral blood mononuclear cells from HLA-A*33:03+ healthy donors Toru Usui, Arun Tailor, Lee Faulkner, John Farrell, Ana Alfirevic, B. Kevin Park, Dean J. Naisbitt P141 Epistasis approaches to identify novel genes potentially involved in NSAIDs hypersensitivity James Richard Perkins, Jose Antonio Cornejo García, Oswaldo Trelles, Inmaculada Doña, Esther Barrionuevo, María Salas, María Auxiliadora Guerrero, Miguel Blanca, Alex Upton P142 Genetic predisposition of cold medicine related SJS/TEN with severe ocular complications Mayumi Ueta, Hiromi Sawai, Chie Sotozono, Katushi Tokunaga, Shigeru Kinoshita P143 HLA-B*13:01 and dapsone induced hypersensitivity in Thai population Chonlaphat Chonlaphat Sukasem, Patompong Satapornpong, Therdpong Tempark, Pawinee Rerknimitr, Kulprapat Pairayayutakul, Jettanong Klaewsongkram P144 HLA-B*15:02 alleles and lamotrigine-induced cutaneous adverse drug reactions in Thai Chonlaphat Sukasem, N. Koomdee, T. Jantararoungtong, S. Santon, A. Puangpetch, U. Intusoma, W. Tassaneeyakul, V. Theeramoke P145 HLA-B*38:01 and HLA-A*24:02 allele frequencies in Spanish patients with lamotrigine-induced SCARs Teresa Bellón, Elena Ramirez, Alberto Manuel Borobia, Hoi Tong, Jose Luis Castañer, Francisco José De Abajo P146 Overrepresentation of a class II HLA haplotype in severe hypersensitivity type I reactions to carboplatin Violeta Régnier Galvao, Rebecca Pavlos, Elizabeth Mckinnon, Kristina Williams, Alicia Beeghly-Fadiel, Alec Redwood, Elizabeth Phillips, Mariana Castells Poster walk 17: in vivo diagnosis + sIgE (P147–P154) P147 Absence of specific Ig-e against beta-lactams 9 months after an allergic reaction to amoxicillin-clavulanic acid Elisa Boni, Marina Russello, Marina Mauro P148 Drug provocation tests in suspected opioid allergy Kok Loong Ue, Krzysztof Rutkowski P149 Improvement to the specific IgE cut-off in the assess of β-lactamic allergy Victor Soriano Gomis, Jorge Frances Ferre, Angel Esteban Rodriguez, Vicente Cantó Reig, Javier Fernandez Sanchez P150 Initial false negative specific IgE to gelatin in a patient with gelatin-induced anaphylaxis Christine Breynaert, Erna Van Hoeyveld, Rik Schrijvers P151 Inmediate reactions to beta-lactam antibiotics: pattern of skin test response over the time Jose Julio Laguna Martinez, Rosario Gonzalez Mendiola, Javier Dionicio Elera, Cosmin Boteanu, Aranzazu Jimenez Blanco, Marta Del Pozo, Raquel Fuentes Irigoyen P152 New fluorescent dendrimeric antigens for the evaluation of dendritic cell maturation as a test to detect allergy reactions to amoxicillin Daniel Collado, Yolanda Vida, Francisco Najera, Ezequiel Perez-Inestrosa, Pablo Mesa-Antunez, Cristobalina Mayorga, María José Torres, Miguel Blanca P153 Positive skin test or positive specific IgE to penicillin does not predict penicillin allergy Line K. Tannert, Charlotte G. Mortz, Per Stahl Skov, Carsten Bindslev-Jensen P154 Significance of skin testing and in vitro-analysis of neuromuscular blocking agents in diagnosis of perioperative drug hypersensitivity: evaluation of a negative control population Wolfgang Pfützner, Hannah Dörnbach, Johanna Visse, Michele Rauber, Christian Möbs Poster walk 18: in vitro/ex vivo (P155–P158, P160–P164) P155 Diagnostic value of the lymphocyte toxicity assay (LTA) and the in vitro platelet toxicity assay (IPTA) for β-lactam allergy Abdelbaset A. Elzagallaai, Lindsey Chow, Awatif M. Abuzgaia, Michael J. Rieder P156 Enzyme linked immunospot assay used in the diagnosis of severe cutaneous adverse reactions to antimicrobials Alec Redwood, Jason Trubiano, Rebecca Pavlos, Emily Woolnough, Kaija Stautins, Christina Cheng, Elizabeth Phillips P157 Evaluation of in vitro diagnostic methods for identifying the culprit drugs in drug hypersensitivity Kenichi Kato, Hiroaki Azukizawa, Takaaki Hanafusa, Ichiro Katayama P158 Ex-vivo expanded skin-infiltrating T cells from severe drug eruptions are reactive with causative drugs: a possible novel method for determination of causative drugs Toshiharu Fujiyama, Hideo Hashizume, Takatsune Umayahara, Taisuke Ito, Yoshiki Tokura P160 In vitro release of IL-2, IL-5 and IL-13 in diagnosis of patients with delayed-type nickel hypersensitivity Mira Silar, Mihaela Zidarn, Helena Rupnik, Peter Korosec P161 Single cell analysis of drug responsive T cells; identification of candidate drug reactive T cell receptors in abacavir and carbamazepine hypersensitivity Alec James Redwood, Kaija Strautins, Katie White, Abha Chopra, Katherine Konvinse, Shay Leary, Rebecca Pavlos, Simon Mallal, Elizabeth Phillips P162 Specificity and sensitivity of LTT in DRESS: analysis of agreement with the Spanish pharmacovigilance system probability algorithm Rosario Cabañas, Elena Ramirez, Ana María Fiandor, Teresa Bellón P163 The role of interleukin-22 in β-lactam hypersensitivity Andrew Sullivan, Paul Whitaker, Daniel Peckham, B. Kevin Park, Dean J. Naisbitt P164 Vancomycin-specific T cell responses and teicoplanin cross-reactivity Wei Yann Haw, Marta E. Polak, Carolann Mcguire, Michael R. Ardern-Jones Poster walk 19: BAT and biomarkers (P165–P173) P165 A combination of early biomarkers useful for the prediction of severe ADRs Yumi Aoyama, Tetsuo Shiohara P166 Basophil activation test in the diagnostic approach of reactions during general anaesthesia Ana Moreira, Susana Cadinha, Patrícia Barreira, Ana Castro Neves, Daniela Malheiro, Sara Correia, J. P. Moreira Da Silva P167 IL-10 can be related to successful desensitization Asli Gelincik, Semra Demir, Fatma Sen, Hamza Ugur Bozbey, Muge Olgac, Derya Unal, Raif Coskun, Bahauddin Colakoglu, Suna Buyuozturk, Esin Çatin-Aktas, Gunnur Deniz P168 Immediate reactions to proton pump inhibitors: value of basophil activation test Maria Salas, Jose Julio Laguna, Esther Barrionuevo, J. Dionicio, Tahia Fernandez, R. Gonzalez-Mendiola, I. Olazabal, Maria Dolores Ruiz, Miguel Blanca, Cristobalina Mayorga, Maria José Torres P169 Improvement of the elevated tryptase criterion to discriminate IgE from non-IgE mediated allergic reactions Gabriel Gastaminza, Alberto Lafuente, Carmen D’Amelio, Amalia Bernad, Olga Vega, Roselle Catherine Madamba, M. Jose Goikoetxea, Marta Ferrer, Jorge Núñez P170 Low expression of Tim-3 could serve as a biomarker for control and diagnose maculopapular exanthema induced by drugs Tahia Diana Fernández, Inmaculada Doña, Francisca Palomares, Rubén Fernández, Maria Salas, Esther Barrionuevo, Maria Isabel Sanchez, Miguel Blanca, Maria José Torres, Cristobalina Mayorga P171 Role of basophil activation test using two different activation markers for the diagnosis of allergy to fluoroquinolones Esther Barrionuevo, Tahía Fernandez, Arturo Ruiz, Adriana Ariza, Maria Salas, Inmaculada Doña, Ana Molina, Miguel Blanca, Maria Jose Torres, Cristobalina Mayorga P172 The importance of basophil activation test in anaphylaxis due to celecoxib Amalia Bernad Alonso, Carmen D’Amelio Garófalo, Olga Vega Matute, Marta Ferrer Puga, María José Goikoetxea Lapresa, Roselle Catherine Yu Madamba, Gabriel Gastaminza Lasarte P173 The role of basophil activation test in the diagnosis of immediate type drug hypersensitivity to betalactam antibiotics Antonia Thinnes, Hans F. Merk, Jens Malte Baron, Martin Leverkus, Galina Balakirski Poster walk 20: TCR recognition, cellular (P174–P183) P174 Characterisation of the effect of co-inhibitory signalling on the activation of drug-derived antigen-specific T-cells Andrew Gibson, Monday Ogese, Lee Faulkner, B. Kevin Park, Dean J. Naisbitt P175 Characterization of drug hapten-specific T cell responses in piperacillin hypersensitive patients Zaid Al-Attar, Fiazia Yaseen, Xiaoli Meng, Rozalind Jenkins, Paul Whitaker, Daniel Peckham, Lee Faulkner, John Farrel, Kevin Park, Dean Naisbitt P176 Characterization of the response of T-cells to telaprevir and its metabolite in normal volunteers Zaid Al-Attar, Khetam Alhilali, Yanni Xue, John Farrell, Lee Faulkner, Kevin Park, Dean Naisbitt P177 Characterization of the T cell receptor signatures of drug-responsive T cells Patricia Illing, Nicole Mifsud, Heidi Fettke, Jeffrey Lai, Rebecca Ho, Patrick Kwan, Anthony Purcell P178 Defining the signals between hepatocytes and immune cells in idiosyncratic drug-induced liver injury (DILI) Monday O. Ogese, Lee Faulkner, B. Kevin Park, Catherine Betts, Dean J. Naisbitt P179 Development of novel chemicals that do not bind to HLA-B*57:01 or activate CD8 + T-cells through modification of the 6-amino cyclopropyl group of abacavir Paul Thomson, John Farrell, Mohammad Alhaidari, Neill Berry, Paul M. O’Neill, B. Kevin Park, Dean J. Naisbitt P180 Generation and characterization of dapsone- and nitroso-dapsone-specific T-cell clones using lymphocytes from healthy volunteers Abdulaziz Alzahrani, Monday O. Ogese, John Farrell, Lee Faulkner, Andrew Gibson, Arun Tailor, B. Kevin Park, Dean J. Naisbitt P181 Identification of benzylpenicillin-hapten peptides responsible for naïve T-cell activation and immunization of allergic patients to penicillin Marie Eliane Azoury, Lucia Fili, Rami Bechara, Noémie Scornet, Cathy Nhim, Richard Weaver, Nancy Claude, Delphine Joseph, Bernard Maillere, Paola Parronchi, Marc Pallardy P182 Massive expansion of clonotypic and polycytotoxic CD8+ T cells in toxic epidermal necrolysis Axel Patrice Villani, Aurore Rozières, Benoît Bensaïd, Mathilde Tardieu, Floriane Albert, Virginie Mutez, Tugba Baysal, Marc Pallardy, Janet Maryanski, Jean-François Nicolas, Osami Kanagawa, Marc Vocanson P183 Pharmaco-immunological synapse of HLA-drug-TCR in SCAR Shuen-Iu Hung Poster walk 21: new in vitro methods, haptens, etc. (P184–P194) P184 Amoxicillin-clavulanate forms distinct multiple haptenic structures on human serum albumin in patients Xiaoli Meng, Arun Tailor, Caroline J. Harrison, Rosalind E. Jenkins, Paul Whitaker, Neil S. French, Dean J. Naisbitt, B. Kevin Park P185 Dendrimeric antigens for studying the influence of penicillin determinants orientation on IgE recognition Maria Isabel Montañez, Cristobalina Mayorga, Francisco Najera, Adriana Ariza, Tahia D. Fernandez, Maria Salas, Angela Martin-Serrano, Miguel Blanca, Ezequiel Perez-Inestrosa, Maria Jose Torres P186 Dendrimeric antigens on solid supports: designed materials for IgE quantification Yolanda Vida, Maria Isabel Montañez, Noemi Molina, Daniel Collado, Francisco Najera, Adriana Ariza, Maria Jose Torres, Cristobalina Mayorga, Ezequiel Perez-Inestrosa P187 Development of a screening assay for drug hypersensitivity using naïve T cells from donors with seven different HLA class I risk alleles Lee Faulkner, Sally Wood, Ana Alfirevic, Munir Pirmohamed, Dean J. Naisbitt, B. Kevin Park P188 Different patterns of recognition of structures derived from amoxicillin by IgE antibodies from patients with immediate hypersensitivity reactions to betalactams Adriana Ariza, Cristobalina Mayorga, María Isabel Montañez, María Salas, Inmaculada Doña, Ángela Martín-Serrano, Ezequiel Pérez-Inestrosa, Dolores Pérez-Sala, Miguel Blanca, Antonio E. Guzmán, María José Torres P189 High-resolution typing of HLA polymorphism and T-cell receptor repertoire for severe adverse drug reactions based on the cost-effective next-generation sequencing approaches Tai-Ming Ko, Yuan-Tsong Chen, Jer-Yuarn Wu P190 Identification and fate of intracellular proteins haptenated by amoxicillin Francisco J. Sánchez-Gómez, Juan M. González-Morena, Yolanda Vida, Ezequiel Pérez-Inestrosa, Miguel Blanca, María J. Torres, Dolores Pérez-Sala P191 In vitro detection of terbinafine protein adducts Arun Tailor, Toru Usui, Yanni Xue, Xiaoli Meng, Dean J. Naisbitt, B. Kevin Park P192 MicroRNAs dysregulation in PBMCs from drug hypersensitivity patients during drug challenge in vitro Alejandra Monroy Arreola, Jesus Agustin Badillo Corona, Silvia Mendez Flores, Judith Dominguez Cherit, Dean J. Naisbitt, Noe Valentin Duran Figueroa, Jose Luis Castrejon Flores P193 NSAIDs-exacerbated cutaneous disease: high throughput gene expression profiling José Antonio Cornejo-García, James Perkins, Natalia Blanca-López, Diana Pérez-Alzate, Raquel Jurado-Escobar, Inmaculada Doña, Gador Bogas, María J. Torres, Gabriela Canto, Miguel Blanca P194 Utility of skin tests in non-immediate reactions to amoxicillin Luis Mario Tubella Marti, Fernando Pineda De La Losa, Francisca Arribas Poves, Jaime Tubella Lopez, Teodora Lopez Santiago