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COVID‐19‐related mortality in high‐risk individuals is substantial and current treatment options are limited. There is convincing evidence that the COVID‐19 vaccines reduce the severity of infection and prevent deaths. Three COVID‐19 vaccines are approved in the United Kingdom with many more in development. There are limited data on the triggers and mechanisms of anaphylaxis to these vaccines. We review the potential allergenic compounds in the COVID‐19 vaccines and describe an innovative allergy support model for the vaccination hubs that allows most patients with severe allergy be immunized. Finally, we propose a practical algorithm for the investigations of anaphylaxis to these vaccines.

The study compares the concentration of birch pollen indoors and outdoors in 2019. The investigations were carried out using the volumetricmethod (Hirst type pollen sampler). Seasonal Pollen Index (SPI) was estimated as the sum of daily average pollen concentrations in the givenseason. Pollen season was defined as the period in which 98% of the annual total catch occurred. The birch pollen season in 2019 started at thebeginning of April. The first pollen grains were recorded in internal samples on the April 4th, only one day after than in external air. In generally theperiod of occurrence of birch pollen in the outdoor and indoor air coincided (28/29 days). The maximum values of seasonal birch pollen countwere noted on April 18th (467 g/m3) and on April 20th (1971 g/m3) (indoor/outdoor). The annual pollen sum of birch noted outdoor reached 18 148, inside seminary room – 3141, which is 17% of total. Three peaks of high concentrations of birch pollen were noted outside, which was only partly reflected in the indoor air. This may be result of closing the windows for the night and on weekends. The threat of birch pollen allergens during the 2019 pollen season was high. For most of the season in outside air were noted values in which patients report severe allergy symptoms. Such concentrations were recorded for 9 days indoor with concentration above 90 grains/m3 (acute symptoms of allergy).

La campagne vaccinale contre la Covid-19 a été marquée par une grande appréhension vis-à-vis du risque allergique, en particulier vis-à-vis des excipients vaccinaux : polyéthylène glycol (PEG), polysorbate ou encore trométamol. Une allergie confirmée à ces derniers ou après la première dose de vaccin constitue une contre-indication vaccinale. Nous rapportons le cas d’un patient présentant une allergie avérée au PEG et une sensibilisation cutanée au vaccin COMIRNATY® (PEG dans sa composition). Il a pu bénéficier de ce vaccin dans le cadre d’un protocole d’induction de tolérance en 5 étapes. Conclusions : une prise en charge allergologique spécifique doit être proposée aux patients suspects d’hypersensibilité sévère au PEG ou à d’autres excipients vaccinaux. Nous proposons ici un protocole ayant permis, sur un cas d’allergie avérée au PEG, d’administrer le vaccin COMIRNATY® sans réaction secondaire.

Background Both oral immunotherapy (OIT) and epicutaneous immunotherapy (EPIT) are emerging potential treatments for peanut allergy. Caregiver goals and expectations of these therapies are poorly defined. Objective To determine caregiver goals and expectations of food allergy therapy. Methods Twenty-two detailed, semistructured interviews of OIT and EPIT caregivers were conducted, allowing caregivers to describe their motivations for and experiences with food allergy therapy and life with a peanut allergic child. Results In this sample, caregivers of peanut allergic children enrolled in OIT or EPIT phase 3 trials expressed a primary goal for their child to develop a buffer against an unintentional peanut exposure. The perception of the buffer varied, representing a decreased reaction severity on exposure, increased time to react to allow for assessment, or increased threshold of peanut exposure tolerated. Although caregivers expressed that a buffer may increase their confidence in travel and dining outside the home, they do not anticipate this buffer would lessen their overall level of pretherapy anxiety, allergen-associated vigilance, or avoidance practices. Most of the caregivers hope the buffer will increase their and their child's perceived sense of freedom for the child's actions and social interactions, translating to quality of life improvement, while still respecting the limitations of having a severe allergy that has been partially treated. No caregiver viewed these therapies as a cure, and most viewed treatment as a supplement to their current avoidance practices. Conclusion Caregivers of peanut allergic children strongly desire that OIT and EPIT result in a buffer against an unintentional reaction, although most admitted that this would not significantly change their anxiety and family's current lifestyle.

We posit that investor distraction can be exogenously triggered by allergy onset's degrading effects on local investors’ health and cognitive functioning. We document that allergy onset is related to lower trading activity. We use daily pollen counts to measure the severity of allergy onset at different locations and show that stocks of firms located in areas with severe allergy problems exhibit declines in trading volume and lower stock returns. Moreover, allergy onset is associated with both a decline in investor demand for firm information, as proxied by Google search volume, and stock underreaction to earnings news. Collectively our evidence supports the notion that the association of allergy onset and stock market outcomes may be emerging through a local investor distraction channel.

We present a case of a 27-year-old female with T2 DM who developed allergic reactions after commencement of insulin therapy. Trial with different types of insulin resulted in a series of allergic reactions ranging from urticarial rash to development of angioedema, bronchospasm and anaphylactic shock. She was successfully treated with a modified insulin desensitization protocol using rapid-acting insulin.

Mast cell activation (MCA) accompanies diverse physiologic and pathologic processes and is one of the more frequently encountered conditions in medicine. MCA-related symptoms are usually mild and often transient. In such cases, histamine receptor blockers and other mediator-targeting drugs can usually control MCA. In severe cases, an MCA syndrome (MCAS) may be diagnosed. However, overt MCAS is an unusual condition, and many patients referred because of suspected MCAS are diagnosed with other diseases (autoimmune, neoplastic, or infectious) unrelated to MCA or suffer from MCA-related (eg, allergic) disorders and/or comorbidities without fulfilling criteria of an overt MCAS. These considerations are important as more and more patients are informed that they may have MCA or even MCAS without completing a thorough medical evaluation. In fact, in several instances, symptoms are misinterpreted as MCA/MCAS, and other clinically relevant conditions are not thoroughly pursued. The number of such referrals is increasing. To avoid such unnecessary referrals and to prevent misdiagnoses, we here propose a diagnostic algorithm through which a clinically relevant (systemic) MCA can be suspected and MCAS can subsequently be documented or excluded. In addition, the algorithm proposed should help guide the investigating care providers to consider the 2 principal diagnoses that may underlie MCAS, namely, severe allergy and systemic mastocytosis accompanied by severe MCA. Although validation is required, we anticipate that this algorithm will facilitate the management of patients with suspected MCAS., This study was supported in part by the Austrian Science Fund (FWF), projects F4701-B20 and F4704-B20, and the Division of Intramural Research, National Institute of Allergy and Infectious Diseases.

There are no reports of coordinated action plans to combat all allergic conditions, including asthma, in a defined population. The Finnish Allergy Programme 2008–18 was based on new scientific data of immune development and changed avoidance strategy to tolerance strategy at population level. Medicalization and psychological tolerance were also considered. Severe allergy and asthma were in focus, and allergy health —good life even with allergies—was promoted. Implementation was carefully planned, organized and monitored to help health care adapt the new ideas and improve provision of care. Almost 21,000 health care professionals have taken part in more than 300 educational sessions. An information campaign targeted lay public and 2.3 million Finns were reached. The general messages of the programme were widely accepted and the midterm results indicated that the goals set at the beginning were pragmatic and obtainable. The successes and pitfalls of the Finnish initiative is a lesson to learn, to be adjusted, modified and improved according to local and national needs. Allergic conditions are a heterogenous group of common symptoms causing a lot of disability and costs. A systematic approach can significantly reduce the burden at population level.

Background During adolescence, the young person should gradually develop independence from his or her parents. However, having a chronic disease like a severe allergy may add stress and challenges beyond normal development and involves a struggle between adapting socially, feeling healthy, and managing the disease. Objective To describe experiences of living with a severe allergy from the perspective of adolescents and their parents. Method A qualitative study with six focus group interviews were performed, two with adolescents and four with their parents (10 adolescents, 10–16 years old and 21 parents). The transcribed data were analyzed using systematic text condensation. Result Four themes emerged: Feeling different (adolescents and parents), shift in responsibility (adolescents and parents), the importance of parents (only adolescents) and the importance of healthcare providers (only parents). The adolescents relied on their parents, while also taking responsibility for managing their disease. The parents expressed a need to protect their children; but they did not seem to be aware of the responsibility their children took. The parents highlighted the importance of support from healthcare providers but this was not mentioned by the adolescents. Conclusion This study showed that both the adolescents and their parents stated that they took responsibility for managing the disease, but in different ways. For healthcare providers, this needs to be taken into account in order to support both adolescents and parents for self-management and shift in responsibilities which begins during adolescents.

Background Discontinuation of E. coli l-asparaginase in patients with acute lymphoblastic leukemia (ALL) is unavoidable upon severe allergic reaction. We sought to examine outcomes following E. coli l-asparaginase discontinuation due to severe allergic reactions. Procedure We evaluated the outcome of children enrolled in Taiwan Pediatric Oncology Group-2002-ALL protocol between 2002 and 2012, who had E. coli l-asparaginase discontinued due to severe allergic reactions, and compared the outcomes of those who continued with Erwinia l-asparaginase (Erwinase) with those who did not. Results Among 700 patients enrolled in this study, 33 patients had E. coli l-asparaginase treatment discontinued due to severe allergic reactions. Five-year overall survival did not differ significantly among the 648 patients without discontinuation (81 ± 1.6%, mean ± SE), compared to 17 patients with allergic reactions and treated with Erwinase (88 ± 7.8%) and 16 patients with allergic reactions but not treated with Erwinase (87 ± 8.6%). Among 16 patients who did not receive Erwinase, all 10 who received ≥50% of the scheduled doses of E. coli l-asparaginase before discontinuation survived without events. Conclusions Erwinase treatment may not be needed for some ALL patients with severe allergy to E. coli l-asparaginase if ≥50% of prescribed doses were received and/or therapy is augmented with other agents.

In the management of allergic diseases, targeting IgE using biologicals is a current research focus. This proof of concept shows that plasma cell depletion using daratumumab results in decreased total and allergen-specific IgE levels.

The prevalence of immune-mediated diseases (allergies, autoimmune diseases, and autoinflammatory diseases) is rising world-wide and their management is difficult, since treatments usually are mainly symptomatic. Insight in the exact pathomechanisms is crucial for focused prevention or improvement of therapies.

International audience; Introduction: Vernal keratoconjunctivis (VKC) is a severe form of pediatric ocular allergy, characterized by acute and chronic corneoconjunctival inflammation that may lead to visual sequelae. Although topical immunosuppressive drugs such as cyclosporine are usually effective, some severe forms may be refractory and require prolonged steroid therapy. Very few papers report the use of omalizumab in VKC in the literature. In the present study, we describe our clinical experience with omalizumab in severe VKC children.Methods: We retrospectively reviewed the files of four boys treated with omalizumab because of severe VKC, defined as persistent corneal inflammation despite continuous topical 2% cyclosporine and steroid eye drops. We also performed a literature review.Results: Four boys, aged 7–13 years old, were treated. All children had asthma and one had severe lid eczema. Two patients had required intrapalpebral depot-steroid injections. Omalizumab was administered every 2 weeks by subcutaneous injections, at doses varying from 450 to 600 mg per injection. Three patients out of four responded to the treatment, with a decrease in global symptoms (median symptom rating decreasing from 89 to 29 on a 100-mm visual analog scale), frequency and in duration of the inflammatory flares, and also a decreased need for topical steroid. Their median clinical grade decreased from 4 to 3 (Bonini grading). However, the response was incomplete and they still had inflammatory corneoconjunctival flares despite continuous topical cyclosporine. On the other hand, asthma and lid eczema were completely controlled in these three patients. The fourth child did not respond to omalizumab and needed oral steroids for his VKC and his asthma. Noticeably, this latter patient did not have detectable sensitization to any allergen, contrary to the other cases. The treatment was stopped in this refractory case, but is still ongoing in all other cases, with a median duration of 33 months (range 16–42 months). In the literature (four cases), omalizumab may have a more complete efficacy in some cases, but the results are still variable.Conclusion: Omalizumab is an interesting treatment in severe refractory forms of VKC, but its efficacy is incomplete in these very severe cases.

One of the main goals of haemovigilance is to gather and analyze adverse events in recipients of blood products in order to improve blood safety. The French National Blood Service has a specific role in the management of immediate adverse events: to alert to quarantine the potentially dangerous blood products from the same donation(s), to provide blood testing for the etiologic assessment and to give transfusion advice to patients. The updating of the recipient's computer file allows a better monitoring for both immediate and delayed adverse events. Finally, the French National Blood Service's correspondent of haemovigilance is responsible for donor's inquiries, especially in cases of transfusion related to bacterial contamination, severe allergy, suspicion of transfusion acute related lung injury and viral seroconversion. The management effectiveness for adverse events requires a strong collaboration between all members of the haemovigilance network.

Introduction The management of patients with severe allergies and anaphylaxis often spans multiple specialties. A research survey among pediatricians was conducted as a means of obtaining peer input to identify priorities for managing challenging cases of allergies and anaphylaxis, as well as referral relationships among specialties and rationale for patient referral. Methods An online survey was conducted among a sample of 150 US community-based pediatricians who treat >12 patients/month with severe food allergies/anaphylaxis. The survey queried general pediatricians about their consultation and referral practices as well as their frequency and reasons for referrals when treating allergy/anaphylaxis patients. Results In this survey, 87% of community pediatricians (N=131) indicated that they frequently or occasionally refer patients with severe allergic reactions or anaphylaxis outside of their practice. A majority of pediatricians (72%) reported consulting with their peers about challenging cases on at least an occasional basis. Virtually all of these patient referrals (93%) were made to allergists. Most common reasons for referral were (1) complex cases requiring more specialization and (2) the availability of resources that pediatricians may lack, eg, intradermal/skin testing. Patients most likely to be referred to outside specialists were infants with anaphylaxis (87%), patients with comorbidities (78%), and patients with peanut allergies (62%). Conclusions Most community pediatricians will frequently or occasionally refer patients with severe allergies/anaphylaxis outside their practice, most often to allergists. A meaningful percentage report consulting with their peers on challenging cases, demonstrating their willingness to reach out or refer complex cases to their colleagues.

Background In 2002, a paediatric respiratory service in South Wales carried out a study to identify children in local schools who had a diagnosis of severe allergy, requiring them to carry an epipen. This investigation was carried out as a result of three schools seeking advice. Three children were identified as suffering from severe allergy; one child from each of the three schools. It was evident that sufficient education and support was not available for these children, their families and school staff regarding allergy management. This led to further investigation to see if there were others experiencing similar problems. Method To identify school-aged children with a diagnosis of severe allergy, a survey took place of the three schools mentioned above plus a further 111 schools. Sixteen additional children were noted to be carrying epipens in 16 separate schools. An audit pro forma was devised and used to collect relevant data to establish previous allergy management and current allergy status. The 16 children and their families were invited to an assessment clinic where they were interviewed by a respiratory nurse specialist. Results There were deficiencies in allergy management relating to: assessment, diagnosis, medication provision, education, support and ongoing follow up. These deficiencies highlighted the need for the development of a paediatric allergy service and a multi professional collaborative approach to care. Conclusion The findings from the five phases of this study have influenced the development of an allergy clinic. This has led to collaborative working between healthcare professionals, school staff, children, and their families. The findings have promoted practice in terms of conducting thorough nursing and medical assessment, appropriate diagnosis, education and ongoing support for children and their families.

Iodine-deficient goitre was common in some parts of the UK prior to the introduction of salt iodisation. Many contemporary salt preparations do not contain much iodine, and there are renewed concerns about the iodine status of the population. We present a boy with severe allergy who developed goitre and significant thyroid dysfunction in association with an iodine-deficient ‘food-restricted’ diet. The case highlights the importance of a comprehensive nutritional assessment in all children on multiple food restrictions.

There are 30-40% of people with allergies world wide in 2011, this is based on data from the Center for Disease Control and Prevention (CDC) more than tripled from 1993 to 2006. Parents play an important role in overcoming the recurrence of allergies in children in order of recurrence allergies and more severe recurrence. The goal of the study is to analyze association mothers’s role and knowledge in recurrence prevention of food allergy in children under five years-old. The study is an analytic observational research with cross sectional design. Method of sampling usedis simple random sampling. The samples were 39 mothers who have children under five years-old with food allergy in Rumah Sakit Islam Jemursari Surabaya. Analysis used chi-square test with α = 0.05 significance level.The results revealed the knowledge of mothers’ with allergy recurrance is 15 person (38,5%) have a good knowledge in prevention of food allergy in children under five years-old, while mothers’s role in recurrence prevention of food allergy in children under five years-old is 26 person (66,7%) have a role unfavorable. The statistical test by using chi-square revealed there were association between mothers’role (ρ=0,030) and mother’s of knowledge (ρ=0,00001)in recurrence prevention of food allergy for children under five years-old.The conclusions of the results this study is mothers’s role with unfavorable to have children under five years-old with an allergy recurrence of severe allergy, while mothers with good knowledge to have children under five years-old with an allergy reccurrance of mild allergy.Keywords: recurrence allergies, mother’s role, mother’s knowledge

Background. The transregional increase in pollen-associated allergies and their diversity have been scientifically proven. However, patchy pollen count measurement in many regions is a worldwide problem with few exceptions. Methods. This paper used data gathered from pollen count stations in Germany, Google queries using relevant allergological/biological keywords, and patient data from three German study centres collected in a prospective, double-blind, randomised, placebo-controlled, multicentre immunotherapy study to analyse a possible correlation between these data pools. Results. Overall, correlations between the patient-based, combined symptom medication score and Google data were stronger than those with the regionally measured pollen count data. The correlation of the Google data was especially strong in the groups of severe allergy sufferers. The results of the three-centre analyses show moderate to strong correlations with the Google keywords (up to >0.8 cross-correlation coefficient, P < 0.001) in 10 out of 11 groups (three averaged patient cohorts and eight subgroups of severe allergy sufferers: high IgE class, high combined symptom medication score, and asthma). Conclusion. For countries with a good Internet infrastructure but no dense network of pollen traps, this could represent an alternative for determining pollen levels and, forecasting the pollen count for the next day.

Halliday, Ayun. Peanut . Illus. Paul Hoppe. New York: Schwartz & Wade Books, 2012. Print. In the graphic novel Peanut, Ayun Halliday, a graduate of Northwestern University, and author and illustrator of the parenting zine East Village Inky, brings attention to the fact that some people live with life-threatening allergies to a common food item as she tells the story of a teenage girl trying to make her mark at school. When Sadie asks a girl about her “wicked cool” ID bracelet, she is introduced to the concept of severe food allergies. Sadie learns that the girl has a lethal allergy to peanuts and has to wear a medical bracelet. After moving to a new neighbourhood, Sadie is desperate to find a way to fit in at her new high school. She orders a medical bracelet and pretends to have a peanut allergy. This has the desired effect of gaining the attention of kids at school. Sadie builds friendships around the lie and finds it increasingly difficult and stressful to maintain the charade with her friends and with school staff, but cannot bring herself to tell the truth. Over the course of events, Sadie and other characters in the novel increase their awareness, to a limited degree only, about a severe peanut allergy and its potential consequences. It was a bit disappointing that Sadie’s character matured very little over the course of the story, both in her interactions with others as well as in her health knowledge. The story ends a little abruptly so the reader does not find out the longer term consequences of pretending to have a medical condition, co-opting the challenges of living with a severe allergy to gain popularity and eventually being found out, or whether or not these experiences change Sadie’s outlook. New York based illustrator and Visual Arts instructor Paul Hoppe uses colour sparingly in Peanut . Readers will be drawn to the book cover, with its rich blue monochromatic background featuring a lone peanut shell. Illustrations within the graphic novel are all in blue-black, white, and grey; the only exception is Sadie who stands out in her salmon-coloured top. Aerial views lend an interesting perspective to the scenes. Recommended: 3 out of 4 stars Reviewer: Maria Tan Maria is a library intern at the University of Alberta’s John W. Scott Health Sciences Library. She enjoys travelling and visiting unique and far-flung libraries. Maria firmly believes that children's literature is an essential component in the fountain of youth.

BackgroundThe transition to adulthood can be particularly challenging for young people with severe allergies, who must learn to balance personal safety with independent living. Information and support for young people and their families are crucial to successfully managing this transition. We sought to: gather insights into the impact of severe allergies on the lives of young people; explore where young people go for information about anaphylaxis and what information they want and need; identify areas where further support is needed.MethodsAn online questionnaire survey of young people aged 15–25 years with severe allergies in the United Kingdom (UK) was conducted on behalf of the Anaphylaxis Campaign, the main patient support organisation. Participants were recruited mainly from the Anaphylaxis Campaign membership database and also via allergy clinics and social media. The study was funded by the Anaphylaxis Campaign’s In Memoriam Fund.ResultsA total of 520 young people responded to the survey. The majority had lived with severe allergies since they were young children; 59% reported having attended Accident and Emergency units as a consequence of their allergies. Only 66% of respondents reported always carrying their epinephrine auto-injectors; only 23% had ever used these. Few were currently receiving specialist allergy care; younger respondents were more likely to be under specialist care (34%) than those 18 years and above (23%). Respondents wanted more information about eating out (56%), travelling (54%) and food labelling (43%). Almost a quarter of respondents (23%) reported needing more information on managing their allergies independently without parental help. Managing allergies in the context of social relationships was a concern for 22% of respondents.ConclusionsThis survey has identified the information and support needs and gaps in service provision for young people with severe allergies. Healthcare professionals and patient support organisations, with the support of the food industry, can help to meet these needs.

Background: Two atopic patients suffering from severe allergy difficult to handle by conventional medication were given Xolair despite an IgE level Methods: Increasing dosages were given and monitored by clinical evaluation and CD-sens to clinically relevant allergens. The patients’ IgE antibody fractions were 11–14%. Results: Xolair dosages extrapolated from a recommended dose for IgE of 30–75 kU/l were adapted to the patients’ IgE body pool but had very little effect. The double dose resulted in some clinical improvement and a decrease in CD-sens. However, not until the dose was doubled again did the patients become symptom free, although 1 patient needed some additional drugs but no oral steroids. CD-sens turned negative to 5 of the 7 tested allergens. Conclusions: Xolair is most useful also in atopics with an IgE level

*Objective: To evaluate the rate of allergy documentation during inpatient admissions and determine if discrepancies exist between ethnicities and English proficiency, genders, and by medication classes. Methods: Patients at an outpatient clinic with severe medication allergies documented in their electronic medical record were identified. Inpatient hospital admissions following the date this allergy was documented were reviewed and the presence or absence of this documentation in the inpatient electronic medical record was noted. An overall rate of successful documentation of allergies was calculated by dividing the number of admissions where the allergy was entered into by the total number of admissions where the opportunity to enter the allergy existed. Each patients ethnicity, gender, and the class of medication to which they were allergic to, was also recorded to determine if difference exist within each demographic. Results: Overall, allergy information was successfully entered in 84.6% of 246 hospital admissions. This rate was significantly lower (37.5%) among patients whose ethnicity groups, on average, have lower rates of English fluency. There was no significant difference between genders. Allergies to cephalosporins were less likely to be entered (44.4%). Conclusion: Patients who are not proficient in speaking English may be at an increased risk of experiencing an adverse drug reaction as their severe allergies are less likely to be documented during a hospital admission.

Food sensitivities are constantly increasing in "westernized" countries and may pose serious health risks to sensitized individuals. Severe allergy episodes have also been reported after the intake of probiotic products containing milk protein residues, especially in children. The need for safe and effective probiotic strains and food supplements, which contain them, is now emerging clearly. The present work describes the way of achieving this aim by the avoidance of any kind of raw materials at risk, both in probiotic strain industrial manufacturing and finished product formulation. Allergen-free probiotics represent, without any doubt, an innovative and safe tool for human health.

Background: Allergy to sharon fruit (persimmon) has been only rarely reported. Cross-reactivity with pollen (profilin and Bet v 6) appeared to be involved, but Bet v 1 has not been implicated previously. Objective: It is our aim to identify whether Bet v 1 sensitization is linked to sharon fruit allergy. Methods: Two patients with a reaction upon first exposure to sharon fruit were included in the study, as well as 7 patients with birch-pollen-related apple allergy. Sensitivity was assessed by skin prick testing (SPT), a radio-allergosorbent test (RAST) and immunoblotting. RAST analysis was performed for Bet v 1, Bet v 2 and Bet v 6. Cross-reactivity was evaluated by RAST and immunoblot inhibitions. Biological activity of IgE was measured by basophil histamine release. Sharon fruit allergy was evaluated by double-blind placebo-controlled food challenge (DBPCFC) or open challenge (OC). Results: Both sharon-fruit-allergic patients demonstrated positive reactions in the RAST (8.6 and 6.2 IU/ml, respectively) and SPT (wheal area 37 and 36 mm2). Sharon fruit allergy was confirmed by DBPCFC in 1 patient. The second patient refused a challenge because of the severe initial reaction. Sera from both patients were reactive to Bet v 1 and Bet v 6, which was cross-reactive with sharon fruit by inhibition assays. The patient with the severest reactions was reactive to profilin on immunoblotting. However, profilin did not induce significant histamine release, nor did Bet v 6. Bet v 1 induce approximately 60% histamine release. An OC with sharon fruit in 7 patients allergic to birch pollen and apple, who had not eaten sharon fruit previously, was positive in 6/7 cases. Conclusions: Birch-pollen-related allergy to sharon fruit is mediated by the known cross-reactive pollen allergens including Bet v 1 and may become more of a problem should sharon fruit consumption increase.

We read with interest the correspondence from Dr. Kluger and colleague to our image article [1]. The authors express similar views with regards the need for better understanding of medical alert tattoos within the medical community and also the need for a recognised symbol and site for these tattoos, so they can be readily seen and acted upon in an emergency. However, the authors do not agree that tattooing should be advocated in minors. Their reasons are this is a decision which many adults take a long time to consider and something that should be approached with caution, particularly in diabetic patients. We agree that this does not apply to all young people with a chronic condition or severe allergy, but instead that clinicians should be able to support young people on a case-by-case basis who have taken the time to decide to obtain a medical alert tattoo and are fully aware of the risks, benefits and permanency of the procedure. This is particularly pertinent for UK paediatricians and general practitioners as tattooing is illegal for minors under the age of 18 years in the UK. This article and correspondence highlight an important issue for clinicians, as young people (as well as adults) are increasingly choosing medical alert tattoos over more traditional alert jewellery. We would be interested in Dr. Kluger and colleague expanding on their reasons for not advocating this in minors as we feel the support of clinicians should be available for a competent young person, and their parents, who have made the informed decision to obtain a medical alert tattoo.

We report the success of oral cyclosporine therapy in a patient with severe vision-threatening vernal keratoconjunctivitis. A child presented with severe allergy which was not controlled with topical steroids, cyclosporine and mast cell stabilizers. Oral steroids were required repeatedly to suppress inflammation. Child showed a dramatic improvement and stabilization with oral cyclosporine therapy. Oral cyclosporine therapy can be tried in severe vision-threatening allergy refractory to conventional therapy.

Psoralens occur in many plant species from several families, and the risk of psoralen-containing food has been previously noted.v 6 Our patient had a severe allergy to 8-MOP, but this did not seem to disturb her life except for intolerance to diluted lime juice. The other reports on adverse reactions to 8-MOP have not included any comments on intolerance to naturally occurring psoralens. Therefore it is unlikely that systemic exposure to naturally occurring psoralens poses a serious problem. We observed that the patient recovered more quickly from the edema and flare during provocation than during PUYA treatment. Without irradiation 8-MOP forms a loose complex with DNA, and the concentration of 8-MOP in skin and serum deNiels Bech-Thomsen, MD, and Hans Christian Wulf, MD, DSc Copenhagen, Denmark

A 40-year-old male developed a constant hand and foot dermatitis in 1980 while using sorbolene cream as a barrier cream at work. He was forced to leave his trade as a motor mechanic because of his hand dermatitis. It was not until 16 years later that he was diagnosed as having an allergic contact dermatitis to chlorocresol secondary to an endogenous hand and foot dermatitis. Chlorocresol is the preservative used in sorbolene cream as well as many corticosteroid creams. Patch testing carried out in 1983 was negative but had omitted testing with chlorocresol or sorbolene cream.

Two women with allergy to human seminal plasma are described. Both patients had generalized and local allergic symptoms, i.e., hypotension, asthmatic dyspnea, urticaria, and vaginal swelling, beginning within a few minutes of intercourse. The antigen causing the reaction in these patients was common to all seminal plasmas examined. Most of the antigenic activity was shown to be present in one protein band detected by acrylamide gel electrophoresis. The seminal plasma reaction was mediated through an immunoglobulin E (IgE) antibody. Passive transfer of the hypersensitivity with the serum of both patients was successful, and the radioallergosorbent test showed that the serum of the first patient contained IgE specific to seminal plasma.

The use of iodinated contrast media is contraindicated in some patients due to serious life-threatening adverse events. In such cases, there are reports that gadolinium (gadobutrol), which is commonly employed in magnetic resonance imaging, may be used as contrast media for coronary angiography. We report two cases with a history of severe allergy to iodinated contrast agent who underwent coronary angiography with gadolinium. The procedures were well tolerated, the amount of contrast media did not exceed 0.3-0.4 ml/kg and the images obtained were of acceptable quality for diagnostic purposes.

1.1. A case of extreme allergy to green peas has been presented. 2.2. The failure to confirm the clinical history of sensitivity to beans has been discussed.