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Mónica Antón,1 Nieves Cabañes,2 Salvador Fernández-Meléndez,3 Mar Fernández-Nieto,4 Gloria Jiménez-Ferrera,5 Antonio Letrán,6 Paula Méndez-Brea,7 Javier Montoro,8,9 Francisco Moreno,6 Pilar Mur-Gimeno,10 Virginia Rodríguez-Vázquez,7 Ana Rosado,11 Inmaculada Sánchez-Guerrero,12 Jose Mª Vega-Chicote,3 Carmen Vidal7,13 1Allergy Department, Hospital Universitario San Juan de Alicante, Alicante, Spain; 2Allergy Department, Hospital Universitario de Toledo, Toledo, Spain; 3Allergy Department, Hospital Civil de Málaga, Malaga, Spain; 4Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; 5Allergy Department, Hospital Universitario de Badajoz, Badajoz, Spain; 6Allergy Unit, Centro médico Asisa Doctor Lobatón, Cádiz, Spain; 7Allergy Department, Complejo Hospitalario Clínico Universitario de Santiago, Santiago de Compostela, Spain; 8Allergy Department, Hospital de Llíria, Valencia, Spain; 9Department of Medicine, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain; 10Allergy Department, Hospital de Santa Bárbara, Puertollano, Ciudad Real, Spain; 11Allergy Department, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain; 12Allergy Department, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain; 13Department of Medicine, Universidad de Santiago de Compostela, Santiago de Compostela, SpainCorrespondence: Carmen Vidal, Allergy Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, 15706, Spain, Tel +34 981 951752, Email carmen.vidal.pan@sergas.esPurpose: The objective of this study was to develop and validate a questionnaire, through a Delphi consensus, to be used by allergists in their routine clinical practice to assess the preferences of patients starting allergen immunotherapy (AIT) treatment using an objective approach.Patients and Methods: A Delphi consensus-driven process was used. The scientific committee, composed of 15 allergists, led the study and participated in the preparation of the questionnaire. Two-hundred panelists from different Spanish regions were invited to complete a 16-item questionnaire on a nine-point Likert scale covering six topic blocks. Consensus was achieved if ≥ 66.6% of panelists reached agreement or disagreement.Results: Of the 200 experts invited to participate in the Delphi process, a total of 195 (97.5%) answered the questionnaire. The panel experts reached a consensus on “agreement” on a total of 12 of the 16 (75.0%) items, covering a total of six categories: (a) patient knowledge (2 questions), (b) barriers to patient adherence (3 questions), (c) patient behavior (4 questions), (d) future actions (3 questions), (e) treatment costs (2 questions), and (f) final patient preferences (2 questions).Conclusion: This Delphi consensus study validated a set of twelve recommended questions for patients objectively assessing their preferences and suitability for the most common AIT options available. The questionnaire intends to assist allergists in making an objective, unconditioned decision regarding the best AIT option for each patient, after informing them about the different routes.Keywords: allergen immunotherapy, Delphi consensus, shared decision-making, questionnaire

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 phases. We compared the tolerance to 3 VIT buildup protocols and analyzed risk factors associated with adverse reactions during this phase., Materials and Methods: We enrolled 165 patients divided into 3 groups based on the buildup protocol used (3, 4, and 9 weeks). The severity of systemic reactions was evaluated according to the World Allergy Organization model. Results were analyzed using exploratory descriptive statistics, and variables were compared using analysis of variance., Results: Adverse reactions were recorded in 53 patients (32%) (43 local and 10 systemic). Local reactions were immediate in 27 patients (63%) and delayed in 16 (37%). The severity of the 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 onset of local or systemic adverse reactions or the type of local reaction. We only found a statistically significant association between severity of the local reaction and female gender. As for the risk factors associated with systemic reactions during the buildup phase, we found no significant differences in values depending on the 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, patients undergoing the 9-week schedule presented no systemic reactions. Therefore, this protocol can be considered the safest approach.

A 27-year-old woman suffered from anaphylaxis after being stung by Solenopsis invicta ants while she was handling wood from South America. The patient reported no previous adverse reactions to stings by other hymenopteran species. Intradermal skin tests with hymenoptera venom (Vespula vulgaris, Polistes species, Apis melifera) were negative. Serum specific immunoglobulin (Ig) E yielded positive results for S invicta (5.28 kU/L) and negative results for A melifera, Ves v 5 and Pol a 5. Immunodetection assays showed the presence of serum IgE against the Sol i 2 allergen. The patient had probably been stung previously although inadvertently by red fire ants while she handled infested wood from South America, and precautionary measures are thus advisable when this material is to be handled. To our knowledge this is the first case of anaphylaxis from red fire ant stings reported in Europe.

Background: Aniseed is a spice frequently used in Mediterranean cooking and, as with other Umbelliferae, it has been involved in clinical allergy., Objective: This investigation was undertaken to study the allergens implicated in a case of occupational allergy to aniseed associated with rhinoconjunctivitis and gastrointestinal symptoms., Methods: Skin prick tests were performed to inhalant allergens, spices used in the patient's workplace (aniseed and cinnamon), and 12 other Umbelliferae spices, birch, and mugwort. A nasal challenge test to aniseed and cinnamon and a double-blind placebo-controlled oral food challenge test to aniseed were also performed. The molecular weights of the allergens were studied by sodium dodecyl sulfate-polyacrylamide gel electrophoresis immunoblotting and cross-reactivity among Umbelliferae species by enzyme immunoassay inhibition., Results: Skin prick tests showed a positive immediate response to aniseed, asparagus, caraway, coriander, cumin, dill, and fennel extracts, and an intense late response to aniseed. Skin prick tests to celery, carrot, birch pollen, and mugwort pollen extracts were negative. Results of a nasal challenge test were positive to aniseed and negative to cinnamon; an aniseed oral food challenge test yielded a positive response. The molecular weights of the main immunoglobulin (Ig)E-binding proteins in aniseed extracts were approximately 48, 42, 39, 37, 34, 33, and 20 kD. Caraway, fennel, cumin, and coriander extracts showed similar IgE-binding patterns. Enzyme immunoassay inhibition studies with the patient's serum revealed cross-reactivity among the IgE components from aniseed, caraway, coriander, fennel, and dill extracts., Conclusions: We demonstrate the presence of aniseed allergens in a case of occupational rhinoconjunctivitis and food allergy, with molecular weights for this spice that differed from those previously reported.