Allergy - 2019 - Abstracts LB TPS

DOI: 10.1111/all.
13962
ABSTR ACTS
SUNDAY, 2 JUNE 2019

LB TPS 01
DRUG HYPERSENSITIVITY
LBTP1804 | Allergy to low molecular weight clinical entity was delayed-type hypersensitivity (DTH), followed
heparins by urticaria, anaphylaxis and vasculitis. We observed a high cross-

reactivity among LMWHs and Heparin. Challenge is considered the
Pérez-Alzate D; Blanca-López N; Ruano FJ; Somoza ML; gold standard for the diagnoses, being the clinical findings similar to
Vázquez De La Torre M; Canto G
previous reported.
Hospital Universitario Infanta Leonor, Madrid, Spain
Background: Considering the widespread use of heparins in daily

clinical practice, the incidence of hypersensitivity reactions to hep- LBTP1805 | Safety and effectiveness of
arins may be higher than previously thought. They are known to pro- rapid desensitization in the management of
voke all types of hypersensitivity reactions, especially delayed-type hypersensitivity reactions to chemotherapeutic
hypersensitivity (DTH), like so heparin-induced immune thrombo- agents
cytopenia (HIT), allergic vasculitis, hypereosinophilia or urticarial/
Sánchez-Morillas L1,2; Casado Herraez A3;
angioedema. Our aim was to characterize the patients of hypersen-
Cerecedo Carballo I1,2; Cimarra Alvarez-Lowell M1;
sitivity to Heparins in our clinical practice. Gonzalez Gutierrez ML1; Jaqueti Moreno P1,2;
Method: A retrospective study was performed in our Allergy Unit; Robledo Echarren T1; Vázquez Cortés S1,2; Fernández-Rivas M1,2
(January-2013 to December-2018) Clinical records were registered 1
Allergology Department, Hospital Clinico San Carlos, IdISSC, Madrid, Spain;
2
from all patients who performed heparins hypersensitivity. Each pa- ARADyAL (RD16/0006/), Madrid, Spain; 3Oncology Department, Hospital
Clinico San Carlos, IdISSC, Madrid, Spain
tient, including skin testing and challenge test with heparin involved
and others heparins.
Results: The study included 32 patients for drug allergy workout. Background: Hypersensitivity reactions (HSRs) to chemotherapy
(87 5% female, 12.5% males) mean ages: 61.23 years. In 23 (71.87%) have increased in the last 20 years, preventing the use of first-line
of 32 patients had finally diagnosis of allergy to at least one heparin. therapies, with a negative impact in patient's survival and quality of
The heparins most used were the LMWH, being enoxaparin followed life. Rapid drug desensitization (RDD) is a procedure that allows safe
by bemiparin, dalteparin and fondaparinux. re-administration of a drug to which a patient has become allergic.
78.2% had DHT; 13% patients: urticarial/rash, 4.4%: anaphylaxis 4.4%: Method: Between 2010 and 2018, we have performed 372 RDD
leukocytoclastic vasculitis. Patch test was performed with different (Brigham and Womenʹs Hospital Program with a standardized 12-
heparins in 10 of 23 patients. Skin testing was performed in all patients. 16 step protocol) in 82 oncologic patients. Seventy seven (93.9%)
It was positive three cases with the culprit drug; one of these cases was patients were women, most of them (87.8%) with a gynecological
positive intradermal test with two alternatives drugs. Subcutaneous cancer. Two patients had HSRs to 2 drugs and one patient to 3 drugs,
challenge test was performed with the culprit drug and alternatives bringing the total number of HSRs to 91. Patients reacted to car-
heparins. Results were Positive sc challenges with Enoxaparin: 65.2%, boplatin (n = 59), paclitaxel (n = 14), liposomal doxorubicin (n = 7),
Bemiparin: 34.7%, nadroparin: 21.7%, tinzaparin: 17.3% and heparin in cisplatin (n = 4), oxaliplatin (n = 4), docetaxel (n = 2) and etoposide
4.3%. Fondaparinux sodium was given subcutaneously in seven of 23 (n = 1). All RDD were performed in the hospital setting under the
patients and was well tolerated. Intravenous provocation with heparin close observation of an allergist. Acetyl Salicylic Acid (300 mg) and
was not performed because the anaphylaxis episodes (3) in the same montelukast (10 mg) were administered orally 48 hours, 24 hours
patient. In 9 patients in whom there was only one involved (heparin), and 30 minutes before the initiation the protocol and specific pre-
after the allergological study, other low molecular weight heparins medication dictated by oncology department.
were also positive (bemiparin, tinzaparin, nadroparin). Results: A total of 331 (8.9%) RDD were performed in 64 patients
Conclusion: In this study, the incidence of hypersensitivity reactions (78%) without reactions; 41 (11%) of RDD in 18 patients (22%) elic-
to heparins is low but increasing. In our experience most common ited a reaction. 11 (13.4%) patients presented a mild or moderate
reaction, and 7 (8.5%), a severe reaction. In 5 of the subjects with
854 | © 2019 EAACI and John Wiley and Sons A/S. wileyonlinelibrary.com/journal/all Allergy. 2019;74:854–915.
Published by John Wiley and Sons Ltd.
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ABSTRACTS | 855
severe anaphylactic reactions, the treatment was discontinued and other penicillins if skin tests to these are negative; 7 piperacillin al-
was switched to a second-line treatment, whereas 2 patients con- lergic patients in our cohort tolerated the aminopenicillin amoxi-
tinued the RDD with omalizumab premedication. As a result RDD cillin on subsequent challenge. This is especially important given
were performed in 77/82 patients accounting for an effectiveness of comorbidities. Only 1 patient was allergic to the beta-lactamase in-
93.9%. The majority of reactions (38/41 = (92.7%) appeared during hibitor. SPT is less sensitive than IDT in diagnosing immediate-type
the infusion of pure drug solution and only 3 of 41 (7.3%) during the piperacillin/tazobactam allergy: 2 patients presenting with anaphy-
infusion of a 1/10 dilution, being the latter all mild. 72.2% of reac- lactic reactions did not react to SPT testing, showing hypersensitiv-
tions developed at steps 11-14. ity only in IDT challenge. Although skin testing was generally safe, 1
Conclusion: In our experience RDD can elicit allergic reactions, but patient with cross-reactivity suffered a systemic reaction after SPT.
when performed by expert allergists in a hospital setting it is a safe
and effective procedure that allows 94% of patients to receive the
first line treatment. In patients experiencing severe anaphylaxis LBTP1807 | The utility of drug provocation
omalizumab may be added to the standard premedication to en- tests in iodinated contrast media hypersensitivity
hance safety.
Pires Alves M1; Ribeiro C1; Sousa N2; Pita J1;
Anita-Fernandes R1; Regateiro F1; Azevedo J1; Alen I1;
Ciobanu A1; Todo-Bom A1
LBTP1806 | Investigation of piperacillin/ 1
Allergy and Clinical Immunology Department, Coimbra University Hospital
Center, Coimbra, Portugal; 2Allergy and Clinical Immunology Consultation, Leiria
tazobactam allergy in 48 patients
Hospital Center, Leiria, Portugal
Casimir-Brown RS1; Kennard L2; Mirakian R 2; Wagner A 2
1
University of Cambridge, Cambridge, United Kingdom; 2Cambridge University Background: Iodinated contrast media (ICM) are increasingly used
Hospitals NHS Foundation Trust, Cambridge, United Kingdom
worldwide. Therefore, although hypersensitivity reactions (HSR) to
ICM are rare, they occur regularly and are often severe and even
Background: Piperacillin is a widely used and important ureido- life-threatening. The diagnosis of HSR to ICM includes clinical his-
penicillin antibiotic used in combination with tazobactam, a beta- tory, skin tests and drug provocation test (DPT). The aim was to de-
lactamase inhibitor. Various adverse drug reactions to piperacillin/ scribe the experience of our Allergy Departments with the diagnosis
tazobactam have been described. We report the results of a cohort of HSR to ICM.
of patients seen for suspected hypersensitivity reactions to pipera- Method: Retrospective review of all patients referred to our
cillin/tazobactam in allergy clinic over 6 years (2012-2018). Departments in 2018 with history of HSR to ICM. The panel of
Method: 48 patients (aged 6-81, med = 39). 30 female:18 male. The ICM included: iomeprol (Iomeron 400 mg/mL), iopromide (Ultravist
patient group had high levels of comorbidity; 14 participants includ- 370 mg/mL), iodixanol (Visipaque 270 mg/mL), ioxitalamate (Telebrix
ing 9/18 males had cystic fibrosis. We performed skin prick tests 300 mg/mL). Skin prick tests (SPT) with undiluted ICM and intra-
(SPT) and intradermal tests (IDT) to piperacillin/tazobactam, penicil- dermic tests (IDTs) were performed. In case of positive skin test it
lin PPL (major determinant) and MD (minor determinant), benzylpen- was performed a DPT with an alternative ICM. In patients with an
icillin, amoxicillin, co-amoxiclav and flucloxacillin. anaphylactic HSR and all the skin tests showed negative results, we
Results: Allergy was confirmed in 22/48 participants. 15/22 had performed a DPT with an alternative ICM. The DPT was performed
a delayed positive IDT (9 female:6 male). 5/15 showed cross- with increasing doses according to protocol: 5, 15, 30 and 50 cc with
reactivity to other penicillins. Of 10 patients who showed no 30-minute intervals.
cross-reactivity, 7 subsequently tolerated other penicillins [co- Results: A total of 13 patients (mean age 49 years; range 23-76), 8 fe-
amoxiclav (4) flucloxacillin (1) meropenem (1)] and ceftazidime (1). males and 5 males, were evaluated. All patients experienced an HSR
4 patients that tested negative in all SPT and IDT nevertheless had within the first hour after ICM administration [immediate reaction
a clinical presentation which strongly indicated a delayed pipera- (IR)]. The culprit ICM was known in 62% of all patients: iopromide
cillin/tazobactam hypersensitivity. 7/22 had immediate positive (Ultravist) was involved in 7/8 patients and ioxitalamate (Telebrix)
skin tests (7/7 female). 2/7 had a positive SPT. 5/7 had a positive in 1/8 patients. Four patients had been exposed to ICM in the past.
IDT. 2/7 had cross-reactivity to other penicillins on skin testing History of previous exposition to ICM was unknown in 9 patients.
[Benzylpenicillin (2), amoxicillin (1)]. 1 patient was allergic to the Anaphylaxis occurred in 8 patients, one with hypotension (anaphylac-
beta-lactamase inhibitor, showing cross-reactivity in vivo to co- tic shock). 7/13 patients had atopic history (n = 4 with history of HRS
amoxiclav, positive skin tests to clavulanic acid and negative skin to other drugs). The results of SPT, IDT and DPT are shown in Table 1.
tests to other penicillins. 1 patient who showed no cross-reactivity Conclusion: 62% of all HSR experienced anaphylactic reactions.
subsequently tolerated amoxicillin. The patient with DPT positive (iomeprol) had negative tests with
Conclusion: Delayed type hypersensitivity to piperacillin/tazobac- iomeprol, which corresponds to 1 false-negative. It is noteworthy
tam is more common than immediate type hypersensitivity (73% to observe the proportion of patients who tolerated in DPT the
: 27%). Piperacillin hypersensitive patients were likely tolerant to
856 | ABSTRACTS
TA B L E 1 . Results of SPT, IDT and DPT to ICM
SPT (n = 13) IDT (n = 13) DPT (n = 13) ICM of the DPT
Negative (n = 12) Negative (n = 5) Negative (n = 5) Iomeprol (n = 4)

(n = 5 with an alternative drug) Iopromide (n = 1)
Positive (n = 7) Negative (n = 6) Iomeprol (n = 3)
Iomeprol (n = 3) (n = 5 with an alternative drug) Iopromide (n = 3)
Iopromide (n = 3) (n = 1 with the culprit drug) Iomeprol (n = 1)
Iopromide and iodixanol (n = 1) Positive (n = 1)
(n = 1 with an alternative drug)
Positive (n = 1) Positive (n = 1) Negative (n = 1) Iomeprol (n = 1)
Ioxitalamate (culprit drug) Iopromide (n = 1) (n = 1 with an alternative drug)
alternative ICM (92%) which could be used in future radiologic in- Conclusion: We present three cases who experienced a severe reac-
terventions. Our workup allowed to identify a safe alternative drug. tion after a re-exposure to BLs and/or skin testing. We advise to con-
sider repeating skin testing in subjects with consistent past histories
in order to mislabel cases as no allergic.
LBTP1808 | Severe reaction after re-exposure

to BLs support to re-evaluate allergic patients
LBTP1809 | Allergic reactions to topical
with clear histories but negative allergological
lidocaine: Cases reports
studies
Sánchez Moreno V; Dávila Fernández G;
Blanca-López N1; Ruano-Zaragoza M2; Pérez-Alzate D1;
Chamorro Gómez M; Elices Apellániz A
Ruano FJ1; Canto G1; Blanca M1
1
Allergy Division-Hospital Universitario del Henares, Madrid, Spain
Hospital Universitario Infanta Leonor, Madrid, Spain; 2Hospital General
Universitario De Alicante, Alicante, Spain
Background: Local anesthetics are very often used in minor surgical
Background: Up to 10% of patients with a clear long past history procedures and dentist treatments, however amide compounds are
but negative allergological study of betalactams, develop a reaction associated with an incidence lower than 1% of reported cases.
after a subsequent administration. EAACI guidelines recommend a Method: We present two cases: A 55 year old male diagnosed with
re-exposure to exclude re-sensitisation. urinary infection showed local pruritus, erythema and angioedema
Method: We present three cases of subjects who after an initial after a few hours of applying lidocaine cream during bladder
negative evaluation developed a severe anaphylactic response in catheterization.
the re-exposure. A 38 year old female showed pruritus, blush and facial macular rash
Results: Case 1: a 31 year old M who reported in childhood ery- after few minutes applying lidocaine cream in aesthetic treatment.
thema after topical penicillin with no betalactams intake after. In Both reactions were controlled with a few days of oral corticoster-
August-2018 ceftriaxone was needed for treating an endocarditis. oids and antihistamine. Patients signed informed consent and allergy
An allergological study with penicillin and ceftriaxone was negative study was performed with skin and epicutaneous tests (standard
tolerating a therapeutic course. Upon request, skin test and toler- patch, lidocaine, mepivacaine, bupivacaine, articaine, 5-10% in pet.),
ance with penicillin was confirmed again. Three weeks after skin test subcutaneous controlled challenge test.
with ceftriaxone and challenge was negative. After administering the Results: CASE 1: Patch tests with lidocaine and mepivacaine (5-10%
last dose of 500 mg in a course of 7 days, the patient had dizziness, in pet.) were positive in lecture at 48 and 96 hours, negative to bupi-
malaise and vomiting with facial and upper limbs erythema, sweat- vacaine and articaine. Skin testing with articaine and bupivacaine
ing and mucocutaneous pallor. Blood pressure was 6/4 mmHg and were negative so we performed subcutaneous controlled tests with
gradually normalized after treatment. them confirming good tolerance.
Case 2: a 64 year old M reported immediate urticaria after AX CASE 2: Patch tests resulted negative in lecture at 48 and 96 hours.
25 years ago. The allergological study with benzyl penicillin Intradermal testing with lidocaine and mepivacaine (1/100) were
and AX was negative in the first evaluation with a positive skin positive in immediate lecture, and negative with bupivacaine and
test to PG followed by a severe systemic response in a second articaine. We performed subcutaneous controlled tests with bupiv-
evaluation. acaine and articaine assuring tolerance to both of them.
Case 3: A 39 year old F had two anaphylactic episodes with AX and Conclusion: A true immunologic reaction to amide anesthetics is
AX-Clavulanic each. The first allergological study was negative but very rare, however we presented two cases diagnosed with hyper-
in the second evaluation an anaphylactic reaction appeared in spite sensitivity to lidocaine, showing cross reactivity to mepivacaine.
of negative skin testing with PG.
ABSTRACTS | 857
Both patients were sensitized after applying topical anesthetic con- care. The aim of this pilot study was to determine the prevalence of
firming an immediate and a delayed allergic reactions. registered penicillin allergy in primary care.
Method: We performed a single-centre pilot study among 1014
patients at the Academic Primary Care Centre Groningen, the
Netherlands. Patients with a penicillin allergy label were identi-
LBTP1810 | Evaluation of NSAIDs tolerance
fied in the electronic health records of patients by International
following Omalizumab treatment for chronic
Classification for Primary Care codes: A12 (allergic reaction) includ-
spontaneous urticaria ing A12.01 (anaphylaxis), A12.02 (angioedema), A13 (worries about
Marcelino FC1; Guimarães VGT2; Valente CFC3; side effects drug), A85 (drug side effect) including A85.01 (drug al-
Raeder DFT1 lergy), S98 (urticaria) and S07 (general redness skin, erythema). The
1
HRAN, Brasília, Brazil; 2HMIB, Brasília, Brazil; 3HCB, Brasília, Brazil prevalence of reported penicillin allergy was measured by dividing
the number of participants with a registered penicillin allergy by the
Background: Multiple nonsteroidal anti-inflammatory drug (NSAID) total number of patients in the study population.
cutaneous reactors may have underlying chronic spontaneous urti- Results: Penicillin allergy was registered in 24 out of 1014 pa-
caria (CSU). The potentially beneficial effect of Omalizumab treat- tients (2.36% of patients). Participants were mainly women (75%).
ment on NSAID hypersensitivity associated to CSU has not been Amoxicillin allergy was reported in 18 of 24 patients (75%) and al-
well evaluated so far. lergy for other antibiotics (Flucloxacillin, Pheneticillin) was reported
Method: Clinical case description, based on medical file and oral in 6 of 24 patients (25%). We found that only skin symptoms were
drug provocation tests (DPT) in a Drug Allergy Unit of Brazil. reported in 9 patients (38%), anaphylaxis was reported in 1 patient
Results: MBS, a 53 year old female presenting CSU since 2002. She (4%), other symptoms were reported in 4 patients (16%) and no in-
also reported mild intermittent asthma and allergic rhinitis since formation about symptoms was reported 10 patients (42%).
childhood. In 2009 she started to present urticaria and angioedema Conclusion: Penicillin allergy was registered in 2.36% of patients.
exacerbations 10 minutes after intake of several NSAIDs, without In 42% of patients no additional information was registered in the
respiratory symptoms worsening. Patient underwent oral DPT with health record about the symptoms on which the label penicillin al-
paracetamol in increasing doses every 20 minutes achieving a cu- lergy was assigned. In order to verify these penicillin allergy labels
mulative dose of 500 mg. After 100 mg of paracetamol she devel- additional research is needed.
oped urticaria. In a different moment she was submitted to DPT
with Etoricoxib 60 mg with tolerance, being released for use only
selective COX2 inhibitors. With worsening of CSU, the therapy LBTP1812 | Audit of β-lactam drug challenges
with Omalizumab was indicated. After 4 months of treatment with in a Tertiary Children's Allergy Service and the
Omalizumab 300 mg/month, patient achieve urticaria control and
outcomes of subsequent courses of antibiotics
was submitted to DPT with Paracetamol 500 mg once more, but
now with tolerance. Pentland J; Vance G; Michaelis L; Mcdonnell A; Gardner J
Conclusion: Up to 30% of CSU are exacerbated by NSAIDs. The clin- Great North Children's Hospital, Newcastle, United Kingdom
ical case shows the importance of assessing the tolerance to NSAIDs

after disease control, with the purpose of increase NSAIDs options Background: A retrospective study of b-lactam drug allergy (BLDA)
and release the use of cheaper and safer drugs. challenges in children attending a tertiary allergy centre. Many chil-
dren are labelled as having ab-lactam drug allergy when they do not
have a true drug allergy. This leads to inappropriately prescribed,
second-line, broad spectrum antibiotics which are more toxic, ex-
LBTP1811 | Prevalence of registered penicillin
pensive and potentially exert a selection pressure for antimicrobial
allergy in primary care in the Netherlands resistance. While the gold standard for diagnosing b-lactam allergy
Van Der Velde JL; Schweigmann M; Oude Elberink JNG is a provocation challenge, initial skin prick testing to the major de-
University Medical Centre Groningen, Groningen, The Netherlands terminant benzylpenicilloyl (PPL) and the minor determinant mixture
(MDM) is routine in our clinic followed by oral challenges with peni-
Background: A registered penicillin allergy often cannot be verified cillin, amoxicillin or co-amoxiclav. The children were followed up to
by allergy testing in approximately 90% of cases. Incorrect penicillin see if subsequent courses were tolerated.
allergy labels may cause increased use of secondary choice antibiot- Method: To assess whether children labelled with a BLDA have a
ics, increased bacterial resistance against antibiotics and increased true drug allergy. If deemed non allergic, to remove the label of being
costs. Only few studies have been performed in primary care on this penicillin allergic from patient. A retrospective review of the case
topic. As the majority of penicillin is prescribed in primary care, it is notes of BLDA was reviewed between the years 2014-2018. After a
important to determine the magnitude of penicillin allergy in primary relevant history taken, the children were seen in the drug challenge
service where one dose or graded doses of triggering antibiotic
858 | ABSTRACTS
given, followed by an observation period of an hour with an addi- (P < 0.001). We found no association between HSR and asthma, car-
tional 5 day course of antibiotic on discharge to rule out a delayed diovascular disease, angiotensin converting enzyme inhibitors, an-
reaction. The children's GP were contacted to see if subsequent giotensin II antagonist or β-blockers, cancer, autoimmune or thyroid
courses were tolerated. disease.
Results: 158 patients were challenged to penicillin. 45 (62%) male;27 In LA group (n = 20 [80% female, mean age 46 ± 22 year]), iso-
(37%) female Age mean age 5 years 4 months. The presenting symp- lated skin reactions were the most frequent (42%). Suspected LA
tom (s) included a viral infection with fever 13 (35%), a viral rash25 agents were Articaine (n = 5), Lidocaine (n = 5) and unknown in 5
(34%), Erythema Morbilliform rash 21 (29%),urticarial rash 18 (25%), patients (26.3%). Only one patient showed positive ST results with
chest infection 11 (15%),ear infection 9 (12%); angioedema 9 (12%), Lidocaine.
tonsillitis 7 (10%), Erythema Multiforme rash 4 (5%), and Macular Conclusion: Antibiotic agents, mainly cefazolin, were the most com-
papular rash 4 (5%). The challenge outcomes showed 153 (96%) mon culprit drug in our patients. Younger age and Atopy were associ-
passed with no signs of a systemic or delayed allergic reaction and ated with HSR development. LA allergy is very rare. Close attention
5 (4%) failed with 2 (1.2%) presenting in hospital and 3 (1.8%) post should be paid even to mild HSR since this could be the first sign of
challenge with delayed symptoms. 72 (45%) patients had subsequent a life-threatening reaction.
courses of antibiotics with no reaction.
Conclusion: Viral infections are the commonest cause of rashes in
children under 5 years of age. Our study confirms that many children
LBTP1814 | Progesterone hypersensitivity
(96%) are falsely labelled as having a BLDA and can be challenged in
treated with a subcutaneous desensitization
the “one dose” clinic safely. Many children have gone on to have sub-
sequent courses with no issue and this has a impact on cost benefit
protocol
as well as improved patient outcomes. Elduque C1; Navarro B1; Botey E1; Morales M1; Claver Á1;
Sureda C2; Gil R 2; Cisteró-Bahíma A1
1
Allergy Department “Al.lèrgia-Dexeus”, Hospital Universitari Dexeus-GQS, UAB,
Barcelona, Spain; 2Farmacy Department, Hospital Universitari Dexeus-GQS,
LBTP1813 | Anaesthesia-associated UAB, Barcelona, Spain
hypersensitivity reactions
Background: Allergic reactions induced by high-dose exogenous
Mesquita M1; Cadinha S2; Garcia S3; Sousa MJ4; Barreira P4;
progesterone required for in vitro fertilization (IVF) can limit the
Cruz L1; Lopes I2; Malheiro D3
1 patient 's ability to achieve pregnancy. Patients with demonstrated
Allergy and Clinical Immunology department, Vila Nova De Gaia, Portugal;
2
Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova De Gaia, Portugal; progesterone hypersensitivity can be treated with desensitization
3
EPE, Vila Nova De Gaia, Portugal; 4Vila Nova de Gaia, Portugal protocols.
Method: A 40-year-old woman with personal history of allergy to
Background: Hypersensitivity reactions (HSR) during anesthesia are hymenoptera venom (Apis mellifera) treated with immunotherapy
an important cause of morbidity and mortality. These reactions are and infertility was referred to our Allergy department for evalua-
rare but often severe and difficult to manage due to the number of tion of local reactions after injection of exogenous progesterone
drugs involved. and local pruritus and generalized urticaria after administration of
Method: Retrospective analysis of patients referred to our depart- intravaginal progesterone ovules. Her obstetrician advised us that
ment who experienced HSR during general or local anesthesia be- high-dose of systemic progesterone (25 mg of Prolutex® twice a
tween 2009 and 2018, was performed. Allergy evaluation including day) was needed to achieve significant rise of progesterone levels
demographics, co-morbidities, HSR description, results of in vitro to successful IVF.
and in vivo tests were reviewed. Results: Skin test (both prick and intradermorreaction) with exoge-
Results: Eighty-five patients (77.6% female) were evaluated. Sixty- nous progesterone (dilutions 1/1000, 1/100, 1/10) were performed,
five patients (76.4%) experienced HSR with general anesthetics (GA) showing positive results in intradermorreaction to all of them.
and 20 (23.6%) with local anesthetics (LA). In the GA group (76.9% For our patient, intravaginal progesterone preparations were not
female, mean age 47 ± 18 year) isolated skin reactions were the most an option, as she had presented local reaction and generalized ur-
frequent (43.1%). Sixty-one reactions (93.8%) were considered im- ticaria when this treatment was performed, and progesterone lev-
mediate. Tryptase levels in acute phase were obtained in 19 patients els were not enough using this route. As an alternative, we adapted
and just 1 had an elevated higher value. Hypnotic agents were the previously described intramuscular progesterone desensitization
most common suspected drugs (n = 41 [48.8%]) and among them protocol, using a 2-day scheme and the subcutaneous route, with-
Propofol was the main one (n = 42 [72.9%]). Cefazolin was the most out premedication, resulting in good tolerance (final dose tolerated:
common culprit (n = 9). Mean age was significantly lower in patients 50 mg) and correct progesterone levels to initiate IVF programme.
with HSR when compared to patients without HSR (P < 0.01), and
atopic patients had more HSR in comparison to non-atopic patients
ABSTRACTS | 859
185 patients underwent a home challenge, and 173 patients un-

Dose no. Time Dose (mg) Dilution mL
derwent an in office challenge. The majority of home challenges
1 0.00 0.002 1:1000 0.1
were not completed with no follow-up communication of result
2 0.15 0.004 1:1000 0.2 (107/185, 58%), resulting in an incomplete diagnosis. Of the re-
3 0.30 0.020 1:100 0.1 mainder of completed home challenges, the majority were tolerant
4 0.45 0.040 1:100 0.2 (75/78, 96.15%) with 3/78 (4%) developing a delayed rash. In con-
5 1 0.200 1:10 0.1 trast, in-office challenges were safely completed and tolerant in
6 1.15 0.400 1:10 0.2 the majority of patients (171/173, 99%) with only 1% (2/173) de-
7 1.30 1.100 1:10 0.5 veloping in-office rash. Patients with serum sickness who tested
8 1.45 2.200 1:10 1 negative were not challenged (7/365).
9 2 4.500 1:1 0.2

Conclusion: Intradermal testing and immediate in-office amoxi-
cillin oral challenge proved to be safe and most effective in con-
10 2.15 7.800 1:1 0.35
firming penicillin tolerance and ruling out allergy. The majority
11 2.30 10.130 1:1 0.45
of home amoxicillin challenges in the same population remained
12 2nd day 25 1:1 1.112
undiagnosed, and an ineffective use of consulting resources,
demonstrating the benefit and efficiency for immediate in-office
Conclusion: We present a case of progesterone hypersensitivity
challenges.
successfully treated with a modified desensitization protocol, with
no premedication and using the subcutaneous route.
LBTP1816 | NSAID hypersensitivity:

LBTP1815 | Seizing the moment: Benefits of Experience from Vilnius University Hospital
immediate in-office penicillin oral challenge in Santaros Klinikos
the management of suspected penicillin allergy Dumciute M; Linauskiene K; Chomiciene A; Malinauskiene L;
Cerniauskas K; Vebriene R; Kvedariene V; Blaziene A
Wu V; Ohayon JA Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
McMaster University, Hamilton, Canada
Background: Nonsteroidal anti-inflammatory drugs (NSAID) are

Background: Ten percent of the population identify as penicillin al- among the most frequently used drugs and known to cause hyper-
lergic, however only 10% of this population is referred for allergy sensitivity reactions. Oral provocation tests are a gold standard
testing. Assessment of true penicillin allergy requires both allergy when hypersensitivity reactions to NSAID's are suspected.
testing and drug provocation for confirmation. Without assessment, Method: Patients with suspected NSAID hypersensitivity consulted
alternate expensive, broad spectrum antibiotics are unnecessarily in Vilnius University Hospital Santaros Klinikos Pulmonology and
prescribed. Allergology outpatient department in 2017 and 2018 were included
Method: A retrospective review of penicillin allergy testing in a com- in this study. The aim of this study was to find out the most com-
munity allergy clinic was conducted from June 2016 to February mon NSAID, causing hypersensitivity reactions; analyze if there is
2019. Presentations varied from generalized rash to anaphylaxis. a coherence between NSAID's hypersensitivity reactions and the
Patients underwent intradermal testing to Benzylpenicilloyl polyly- presence of atopy.
sine, minor determinant mixture (MDM), penicillin G and ampicillin Results: 77 patients were challenged with 90 suspected causative
as per standard protocol. Patients with positive intradermal test and alternative NSAID oral provocation (OP) tests. 57 of our patients
were diagnosed as penicillin allergic. Patients with negative intra- were women, 20-men. The age average was 47.1 years. The most
dermal test were challenged with amoxicillin at home or in office. common NSAID's, which caused hypersensitivity reactions were
Patients who underwent home challenge were asked to communi- acetylsalicylic acid—50% (10 positive tests of 20), diclofenac—27.27%
cate results of home challenge after 5 days. Patients who underwent (3 positive tests of 11), meloxicam 7.3% (3 positive tests of 41). We
in-office challenge were given 25 and 225 mg of amoxicillin with a found out that atopy had no impact on test positivity.
30 and 45-minute monitoring period after each dose respectively, Conclusion: The most common NSAID medication, related to drug
immediately after penicillin skin testing. hypersensitivity reactions was acetylsalicylic acid (50%). No rela-
Results: Of 396 patients (mean age 20.2), 31 (7.83%) and 365 tionship between atopy and hypersensitivity with NSAID was found.
(92.17%) patients had positive and negative intradermal tests, re-
spectively. Of the 365 patients with a negative intradermal test,
860 | ABSTRACTS
LBTP1817 | Cross reactivity to cephalosporins ACT protocol in these patients based on their specific clinical
profile.
and carbapenems in penicillin allergic patients
Method: Retrospective study of our ACT protocol in our depart-
Sánchez J; Segurola A; Seras Y; Gamboa PM; Martinez MD; ment from 2015 to 2018. Our protocols respect a delay of 1.5 hour
Irazabal MB; Jauregui I
between each dose. Performed in single blind, the dose progres-
HU. Cruces, Osakidetza, Baracaldo, Spain
sion is pragmatic, validating cumulative anti-aggregating, analgesic
or anti-inflammatory doses (165-400-1000 mg). Depending on the
Background: Penicillins are the antibiotics that most frequently
clinical profile of the patients, the protocol starts with lower doses
cause IgE-mediated allergic reactions. The allergy to these drugs
(10-25-50-90 or 10-75-90 mg).
causes the restriction, in many cases unnecessary, of the use of other
Results: 162 patients were included. ACT confirmed non-
beta-lactams. In order to study the cross-reactivity between penicil-
immunological IHS to the NSAISs in 46 patients. Among them, we
lins and other beta-lactams we tested the tolerance to Cefuroxime,
distinguished 3 groups according to their predisposing factors: bron-
Ceftriaxone and Imipenem in 134 patients with immediate allergy
chial or ENT (45% of the patients), urticarial (9%), the rest free of
to penicillins.
these risk factors. Respiratory history appears as a risk factor (63%
Method: In the 134, skin tests were performed with minor deter-
of the positive ACT). In 43% of these cases, the reaction was ob-
minant mixture (MDM), Penicilloyl polylysine (PPL), Amoxiciline,
served more than 60 minutes after the last dose. The initial reaction
Cefuroxime, Ceftriaxone plus the involved drug and in 40 patients
seems to be predictive of the results of ACT, which is positive in 45%
with Imipenem, following the recommendations of the ENDA. In 122
of cases if asthma was described by the patient in the initial reaction,
patients, specific IgE in vitro (sIgE) was performed with Penicillin G,
42% in case of involvement of at least two organs and 18% in case
Penicillin V, Ampicillin and Amoxicillin (ThermoFisher). Oral expo-
of isolated urticaria. Cumulative reactive dose is ≤165 mg for 76%
sure tests were performed with Cefuroxime (500 mg) and IV with
of the respiratory group, 75% of the urticarial group and 54% of the
Ceftriaxone (1 g) and Imipenem (1 g).
group without risk factors. 6 patients responded to the cumulative
Results: We studied 134 patients (81 women) (age 51 ± 14 years),
dose of 1.5 g. There was no serious adverse event. 20 patients had
who presented anaphylaxis (n = 45) or urticaria/angioedema
severe reactions to ACT: 70% were considered at risk and had a pro-
(n = 89) <1 hour after the administration of penicillins (123 pa-
tocol starting with doses lower than 165 mg; and indeed 60% had a
tients Amoxicillin or Amoxicillin-Clavulanic, 6 cases Penicillin G,
reactive dose of <165 mg.
2 Ampicillin, 2 unknown and 1 Amoxicillin and Cefuroxime). 129
Conclusion: ACT is indispensable for removing unnecessary evic-
patients had positive skin tests with beta-lactam antibiotics (1
tions from NSAIDs. The bronchial or ENT histories of patients are
Cefuroxime, 1 Ceftriaxone, 24 PPL, 8 MDM, 108 Amoxicillin). 36
predictive of positive ACT. Starting ACT with lower doses in at-
patients presented Positive sIgE (>0.35 KU/L) (26 Penicillin G, 26
risk patients allows to confirm IHS by limiting severe clinical reac-
Penicillin V, 22 Ampicillin, 29 Amoxicillin).
tions. The delay of 1.5 hour between two doses is a necessary to
5 patients with negative skin tests and specific IgE presented posi-
guarantee the safety of ACT and ensure the tolerance of an anti-
tive oral challenge test with Amoxicillin.
aggregating dose. ACT should be conducted up to the cumulative
Challenge test was performed in 133 patients with Cefuroxime, 123
dose of 1.5 g to ensure the absence of non-immunological hypersen-
patients with Ceftriaxone and 36 patients with Imipenem, all of them
sitivity to NSAIDs.
with negative skin tests with these drugs, with tolerance in all cases.
Conclusion: In patients with immediate allergy to penicillins and
negative skin tests with Cefuroxime, Ceftriaxone and Imipinem,
these drugs are a safe alternative and can probably be recommended
safely without the need to check their tolerance. LBTP1819 | Tolerance to Iopamidol in Iomeprol
allergic patients
Sánchez J; Segurola A; Seras Y; Martinez MD; Irazabal MB;
LBTP1818 | Immediate HyperSensitivity (IHS) Jauregui I; Gamboa PM
HU. Cruces, Osakidetza, Baracaldo, Spain
to NSAIDs: Which Aspirin Challenge Test (ACT)
for which patient?
Background: Adverse reactions to iodinated contrasts are frequent,
Srour Jilani S; Guénard Bilbaut L; Metz Favre C; De Blay F but in many cases it is not possible to demonstrate a specific hyper-
Nouvel Hôpital Civil, Strasbourg, France sensitivity mechanism. In patients with adverse reactions to these
contrasts, the alternative contrast to be used safely is not quite well
Background: ACT is proposed to patients suspected of IHS to defined. With the objective to determine the tolerance to other io-
NSAIDs. Several protocols have been published up to the EAACI dinated contrasts, we have studied 23 patients with demonstrated
recommendations in 2007. The aim of our work is to validate our allergy to Iomeprol.
ABSTRACTS | 861
Method: 23 patients with allergy to Iomeprol were included: 14 with benzylpenicillin, phenoxymethylpenicillin, ampicillin and amoxicillin,
immediate hypersensitivity (<1 hour after its administration) and 9 and since 2010 a research only test for IgE to “penicillin minor deter-
with late hypersensitivity (more than 1 hour after its administration). minants” (MD) has been included (ImmunoCAP, Phadia AB, Sweden).
In 23 cases, the elapsed time between reaction and diagnosis was There are no previous publications on the use of specific IgE to MD.
shorter than 6 months. The aims of this study were to calculate the proportion of patients
In these 23 patients, skin tests were performed with Iomeprol, who only tested positive for specific IgE to MD and to describe the
Iopamiro and Iopramide, according to Clinical Practice Guideline clinical characteristics of these patients.
for Diagnosis and Management of Hypersensitivity Reactions to Method: Specific IgE results from 2010 to 2017 were collected
Contrast Media from SEAIC, performing the readings after 20 min- retrospectively from the laboratory database, including data from
utes in patients with immediate reactions and after 48 hours in case 11 051 patients with suspected penicillin allergy. In 6537 patients
of patients with late reactions. Intravenous exposure test was per- all five analyses were performed. Clinical characteristics of patients
formed with 100 mL of alternative contrast used. only testing positive for IgE to MD during 2013-2017 (n = 66) were
Results: IMMEDIATE HYPERSENSITIVITY: 4 patients presented retrieved from the medical notes.
anaphylaxis and 10 presented urticaria/angioedema with Iomeprol. Results: There were 347 out of 6537 (5.3%) patients with positive
12 patients had skin tests positive to Iomeprol and negative to IgE tests in the five-analyses-group, vs 148 out of 4514 (3.3%) in
Iopamidol and Iopramide. Two patients had negative skin tests to the the group without MD IgE test (P < 0.0001). In 86 (25%) of the IgE
three iodinated contrast but positive challenge test with Iomeprol positive patients specific IgE MD was the only positive test. Culprit
(urticaria). All patients tolerated intravenous exposure to Iopamidol. drug was Dicloxacillin/flucloxacillin in 11 (17%) and phenoxymeth-
7 Computerized axial tomography scans performed to those patients ylpenicillin in 38 (58%) patients. Twenty-five (38%) had reactions
after the study conduct that received Iopamidol were well tolerated. <2 hours after drug intake; 56 (85%) had a rash incl. urticaria and
LATE HYPERSENSITIVITY: 9 patients developed widespread cuta- 17 (26%) had symptoms from airway and/or circulation. Six (9%)
neous exanthemas after administration to Iomeprol. 6 patients pre- patients received adrenaline treatment and 47 (71%) received
sented positive skin tests with Iomeprol and negative to Iopamidol antihistamines ± steroids.
and Iopramide. Two patients presented negative skin tests and posi- Conclusion: In a large cohort of patients with suspected penicillin
tive challenge test with Iomeprol. Of the 9 patients, 7 tolerated ex- allergy significantly more IgE positive patients were identified if spe-
posure IV with Iopamidol and two patients did not tolerate exposure cific IgE to MD was included in the testing. This test identifies 1 in 4
with Iopamidol, presenting cutaneous exanthema. Three CT scans of the total number of specific IgE positive patients, and this group
performed on these patients, after the allergological study in which includes a high proportion of cases with moderate to severe imme-
Iopamidol was used, were well tolerated. diate reactions. Future studies should compare the performance of
Conclusion: In patients with immediate and late allergy to Iomeprol, this new IgE test with existing skin tests for penicillin MD.
Iopamidol is a safe alternative being tolerated by 14 (100%) of pa-
tients with immediate allergy and 7 (78%) of patients with late
allergy.
LBTP1820 | The use of specific IgE, including

specific IgE to penicillin minor determinants, in
the diagnosis of penicillin allergy
Lendal V1; Fransson S1; Mosbech H1; Poulsen LK1,2; Garvey
LH1,2
1
Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University
Hospital Gentofte, Hellerup, Denmark; 2Department of Clinical Medicine,
University of Copenhagen, Copenhagen, Denmark
Background: In a Danish allergy clinic, testing for specific IgE is

used as first line investigation in the diagnosis of immediate type
allergy to penicillins. Detectable specific IgE to one or more penicil-
lins combined with a history suggestive of allergy is considered di-
agnostic. We use the commercially available tests for specific IgE to
862 | ABSTRACTS
SUNDAY, 2 JUNE 2019

LB TPS 02
IMMUNE MECHANISM IN IMMUNOLOGICAL DISEASES
LBTP1822 | Local skin infiltration of memory putatively ACD-relevant CD4+ T cell clones comprised 13 out of 67
T cell clones in acute allergic contact dermatitis Ni-specific CD4+ memory T cells clones identified in blood. A part of
the relevant clones was also present in healthy skin (30% of CD8+,
includes nickel-specific CD4+ T cells identified in
67% of CD4+ and 15% of Ni-specific clones) arguing for a contribu-
blood tion of both skin-resident and freshly migrating CD4+ and CD8+ T
Siewert K1; Molin S2,3; Bacher P4,5; Scheffold A5,6; cell clones to the inflammatory ACD reaction.
Timmermann B7; Krumbholz M8; Chudakov D9,10; Conclusion: Combining high throughput ab TCR sequencing and
Thierse H1; Luch A1
FACS analysis we identify a small fraction of CD4+ and CD8+ mem-
1
Department of Chemical and Product Safety, Federal Institute for Risk
ory T cell clones of the inflammatory T cell infiltrate that prolifer-
Assessment, Berlin, Germany; 2Department of Dermatology and Allergology,
Ludwig-Maximilians-University, Munich, Germany; 3Division of Dermatology, ates locally in ACD skin. It includes Ni-specific CD4+ memory T cells
Department of Medicine, Queen's University, Kingston, Canada; 4Institute of identified in blood arguing for the identification of skin-relevant Ni-
Clinical Molecular Biology (IKMB), Kiel University, Kiel, Germany; 5Department specific CD4+ T cell clones by blood-based assays.
of Cellular Immunology, Clinic for Rheumatology and Clinical Immunology,
Charité—University Medicine Berlin, Berlin, Germany; 6Institute of Immunology,
University Medical Center (UKSH), Kiel, Germany; 7Sequencing Core Facility,
Max Planck Institute for Molecular Genetics, Berlin, Germany; 8Department
of Neurology and Hertie Institute for Clinical Brain Research, Eberhard Karl
LBTP1823 | Direct quantification of nickel-
University, Tübingen, Germany; 9Central European Institute of Technology, specific naïve and memory Th cells in peripheral
Masaryk University, Brno, Czech Republic; 10Department of Genomics of
Adaptive Immunity, Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry,
blood of allergic and non-allergic donors
Moscow, Russia Aparicio Soto M1; Leddermann M1; Riedel F1; Bacher P2;
Scheffold A3; Heine G4; Thierse H1; Luch A1; Siewert K1
Background: Acute allergic contact dermatitis (ACD) to nickel (Ni) 1
Department of Chemical and Product Safety, German Federal Institute for
is characterized by massive T cell infiltration into the inflamed skin. Risk Assessment (BfR), Berlin, Germany; 2Institute of Clinical Molecular Biology
(IKMB), Kiel, Germany; 3Institut für Immunologie Universitätsklinikum Schleswig-
However, the proportion of individual antigen-reactive T cell clones
Holstein, Kiel, Germany; 4Klinik für Dermatologie, Venerologie und Allergologie
which are locally expanded in human skin remains unknown. To ad- Charité, Berlin, Germany
dress this question we compared the total and Ni2+-specific T cell
receptor (TCR) repertoires of skin and blood T cell populations from Background: Nickel (Ni) allergies may affect about 9% of the
a patient with acute ACD to Ni. European population which makes Ni a frequent common single
Method: RNA was isolated from healthy and ACD skin biopsies as cause of allergic contact dermatitis (ACD), the clinical manifestation
well as from 50 000 to 100 000 naïve (CCR7+ CD45RO-) or mem- of the allergic reaction. ACD is mediated by specific memory T cells
ory (not naive) CD4+ and CD8+ T cells from blood of a patch tested that have so far been semi-quantified by proliferation-based in vitro
patient (72 hours after patch test application, patch test ++). In ad- cultures or cytokine secretion assays which only detect subpopula-
dition, 272 Ni-reactive CD154+ CD4+ memory T cells were sorted tions of T cells. Our aim is to develop a more quantitative in vitro
after incubation of peripheral blood mononuclear cells (PBMCs) assay which represents an unmet need for the clinical and therapeu-
with 200 μmol/L NiSO4 for 7 hours. From all samples a- and b-chain tic management of ACD.
TCR mRNA was transcribed with gene-specific primers, a SMART Method: We adopted a recently developed method based on short-
adapter with unique molecular identifier was incorporated for im- term unbiased expression of CD154 (CD40L) by antigen-specific
proved error correction and count of transcribed cDNAs. TCR librar- naïve and memory Th cells to directly quantify Ni-specific Th cells
ies were Illumina sequenced after two rounds of PCR and sequences in peripheral blood mononuclear cells (PBMCs) from allergic and
analyzed with MiGEC, MiXCR, VDJtools and R. non-allergic donors by flow cytometry. Activated CD154+ Th cells
Results: For ACD skin we obtained 653 217 b-chain TCR sequences were further characterized for cytokine, activation, and migratory
representing 138 524 clones, results for the a-chain were similar. markers. Single CD154+ memory Th cells were sorted, expanded,
Of all b-chain sequences, 26% and 39% were assigned to blood and restimulated with different antigens.
CD8+ and CD4+ memory T cell clones, respectively. Of these, only Results: We stimulated PBMCs from non-allergic (n = 12), “long-
23 CD8+ (out of 6088) and 103 CD4+ (out of 20 876) clones had a term” (non-acute) allergic (n = 8), and acute Ni-allergic donors
4-fold higher frequency in ACD skin compared to blood and ACD (n = 11) with Ni (200 μmol/L NiSO 4) or control antigens. Non-
count numbers ≥100 indicating relevant local proliferation. Clones allergic and “long-term” allergic donors had similar frequencies of
that were not shared between skin and blood and naïve T cells had Ni-specific CD154+ Th cells in both the naïve (median 0.1%) and
only low individual sequence counts (<<100). The enriched and memory (median 0.1%) compartments. Interestingly, donors with
ABSTRACTS | 863
recent allergic reactions showed significantly increased memory long-term prophylaxis (LTP) with tranexamic acid (8%), danazol (8%),
frequencies (median 1.0%) indicating acute effector Th cell re- C1-Inhibitor (C1-INH) concentrate or C1-INH recombinant (16%) and
sponses These cells comprised an increased proportion of cutane- 55% of women with progestin. Since February 2019, 8 additional
ous lymphocyte-associated antigen (CLA) positive and Ki67+ cells french centers join the registry (Cloud-R HAE) and included 13 more
compared to cytomegalovirus pp65-specific memory Th cells and patients.
the total pools of memory Th cells, respectively. Cytokine secre- Conclusion: Angioedema registry gives the possibility to gather in-
tion seemed donor-associated with either more IL-17 or IL- 4 ex- formation to define natural history of angioedema and to evaluate
pressing cells among the Ni-specific CD154+ Th cells. Ni-specific treatment efficacy in real life. The possibility that data from single
T cell activation was inhibited by major histocompatibility complex countries merge into a global structure facilitates improvement
(MHC) blocking antibodies and individual in vitro expanded T cell and dissemination of the knowledge on this rare disease and its
clones were specifically restimulated with Ni which argues for T treatment.
cell receptor-mediated interactions.
Conclusion: Our results suggest that acute Ni-specific effector Th
cell responses may be quantified and characterized directly ex vivo
from peripheral blood by CD154 expression which might represent LBTP1825 | Potential immunomodulatory
in the future a new diagnostic tool to diagnose Ni and other metal
effect of the house dust mite microbiome
contact allergies.
Kim JY1; Yi M2; Lee J2; Lee I2; Yong T2
1
Department of Environmental Medical Biology, Institute of Tropical Medicine,
and Arthropods of Medical Importance Resource Bank, Brain Korea 21 PLUS
LBTP1824 | The French side of the Global Project for Medical Science, and Yonsei University College of Medicine, Seoul,
South Korea; 2Department of Environmental Medical Biology, Institute of
Angioedema Registry in 2019
Tropical Medicine, and Arthropods of Medical Importance Resource Bank, and
Boccon-Gibod I1; Awu M2; Di Maulo R 2; De Munari M2; Yonsei University College of Medicine, Seoul, South Korea
De Roberto L2; Pagnier A1; Kevorkian-Verguet C1; Mansard
C1; Deroux A1; Bocquet A1; Simon N1; Arnaud M1; Carrat N1; Background: The HDM microbiome might have an immunomodu-
Cicardi M2; Bouillet L1
latory role in allergic diseases owing to its ability to generate
1
Grenoble Alpes University Hospital, Grenoble, France; 2University of Milan Luigi
microbial-associated molecules, such as lipopolysaccharides and li-
Sacco Hospital, Milan, Italy
poteichoic acid. In this study, a 16S rRNA amplicon analysis using
high-throughput sequencing technology was performed to deter-
Background: Angioedema is a recurrent localized swelling of cutane-
mine the microbiome of Dermatophagoides farinae.
ous and mucosal tissues. Potentially life-threatening, creates tem-
Method: Mites were cultivated for 6 weeks with or without ampicillin
porary disability which deteriorates quality of life. Seven inherited
powder. 16S rRNA amplicon (V3_V4) analysis using high-throughput
or acquired forms of angioedema without wheals are yet classified,
sequencing technology was performed with Miseq (Illumina). 16S
included hereditary or acquired C1 inhibitor deficiency (C1-INH-
rRNA cloning, cultivation of mite homogenates, and several stains
HAE and C1-INH-AAE). Last year, the French angioedema refer-
were performed.
ence center network (CREAK) joined the registry of angioedema
Results: Over 99% of reads were assigned to Bartonella and
without wheals (Cloud-R HAE). Here we present the contribution
Enterococcus. this finding was supported by 16S rRNA cloning, culti-
of the Grenoble Alpes University Hospital (CHUGA) to this disease
vation of mite homogenates. Enterococcus faecalis were distributed
registry.
throughout the intestine of D. farinae and were densely gathered
Method: Study population is composed of C1-INH-HAE/AAE pa-
in the stool at the hindgut region. Bartonella spp. were detected in
tients with a proved diagnosis. The following items are collected:
the hemocoel. Antibiotics were applied to the mites to determine if
patients’ personal-demographic data, clinical/laboratory/genetic
the microbiome of them affects the allergy induction. The amount
characteristics, major comorbidities, treatments (prophylaxis/
of total bacteria and the endotoxin concentration in mites were re-
acute attacks). As from Cloud-R HAE structure, patients can di-
duced. However, allergen (Der f1) concentration was not changed
rectly provide information on angioedema attacks and their treat-
by antibiotics treatment. When the extract of antibiotics-treated
ment through a dedicated electronic app, web connection or paper
mites was administered to the human bronchial epithelial cell line
support, which is then transferred into the registry at CHUGA.
(BEAS-2B), the secretion of IL-6 and IL-8 was significantly lowered.
Results: Since February 2018, 23 C1-INH-HAE patients from
Conclusion: We found that Enterococcus and Bartonella are the core
Grenoble Alpes University Hospital (CHUGA) outpatient clinic
microbiome of D. farinae and that a change in the microbiome could
have been included (informed consent signed). Seventeen per cent
affect the ability of the mite to induce allergic disease.
of them provide prospective data on angioedema attacks. Within
C1-INH-HAE, median age is 44 years (range 12-72), sex-ratio: 6/17
(M/F). Due to the frequency of symptoms, 52% of them are on
864 | ABSTRACTS
LBTP1826 | Hereditary angioedema with LBTP1828 | Waldmann's disease—A case

normal C1 Inhibitor with plasminogen (PLG) report
mutation: Phenotype characteristics of an Herknerova M1; Wald M2; Gonsorcikova L2
additional five-generation affected family in the 1
Hospital Na Homolce, Prague, Czech Republic; 2Hospital Motol, Prague, Czech
Republic
French cohort
Boccon-Gibod I; Marlu R; Hardy G; Defendi F; Dumestre-
Background: Waldmann's disease is a rare disorder characterized by
Pérard C; Bouillet L
primary intestinal lymphangiectasia (PIL), dilated intestinal lacteals
Grenoble Alpes University Hospital, Grenoble, France
resulting in lymph leakage into the small bowel lumen and respon-
sible for protein-losing enteropathy (PLE) leading to lymphopenia,
Case report: In HAE with normal C1 Inhibitor level (nC1-INH-HAE)
hypoalbuminemia and hypogammaglobulinemia. The first main
some mutations have been described as F12 gene mutation (Bork et
symptom is predominantly limb edema.
al, Deroux et al) and more recently a missense variant in angiopoie-
Method: We present a 6-years old girl suffering from this disease.
tine-1 gene (ANGPT1, c.807G>1, p.Ala119Ser) (Bafunno et al) and a
She has congenital lymphedema (LE) of upper right limb which was
new mutation affected the plasminogen (PLG, NM_000301.3) gene
confirmed by indirect lymphoscintigraphy at her age of 4 months.
corresponded to the mutation c.988A>G in exon 9. This mutation
Genetical consultation at her age of 2 months regarded LE as an
has been identified by Bork et al in 60 nC1-INH-HAE patients be-
isolated characteristic, her karyotype is 46XX. Her first PLE oc-
longing to 13 different German families with a particular PLG-HAE
curred when she was 6 years old. She was thoroughly investigated
phenotype described in this cohort. Belbezier et al, reported also
by the surgeons and then referred to gastroenterologists and
in three additional PLG-HAE families a particular clinical phenotype
immunologists.
such angioedema attacks preferentially located on tongue, face and
Results: We present biochemical, immunological and imaginative
laryngeal area confirming the results observed in other studies since
parameters of our patient and compare these data with the current
then (Bork et al, Dewald et al). The penetrance is still not well known.
available literature sources about this rare syndrome. Immunological
Among the PLG-HAE French cohort we have identified an addi-
abnormalities involve both the B-cell and T-cell lineages. The B-
tional five-generation affected family at Grenoble Alpes University
cell defect is characterised by low immunoglobulin levels. The T
Hospital. For the 2 patients with PLG-HAE mutation, C1 Inh antigen
cell-defect and T-lymphopenia is also present. Furthermore, PILs’
and function are normal, and no FXII associated mutation found.
patients peripheral blood samples contain extremely low counts
Regarding the phenotype characteristics, PLG-HAE patients prefer-
of CD4+ T helper cells. This feature is also present in our patient.
entially developed face and tongue swelling. The probant patient is a
We discuss also differential diagnosis of Waldmann's syndrome and
90 years old woman who experienced angioedema since more than
management and treatment .
30 years. Angioedemas’ location is mainly tongue but also lips, face
Conclusion: Waldmann's disease occurring rarely might be a strange
and pharyngeal. The frequency varies from every 2 weeks to every
and hidden diagnosis. Although the patients present at first sight by
5-6 months without any identified trigger factors. Angiodemas’ du-
limb lymphedema and do have immunological abnormalities, their
ration varies also from few hours to 3 days. During her 2nd preg-
main problem is the PIL resulting in PLE. The management of these
nancy the symptoms worsened with more frequent tongue swelling
patients should be operated by gastroenterologists.
which means estrogen trigger is possible.
Five more family members among five generation present the same
clinical phenotype with recurrent tongue swelling but the PLG muta-
tion has not been tested for them yet: probant 's father, probant 's LBTP1829 | Innate immune interactions of
sister, niece, grand niece and probant 's grand grand daughter. We human rhinovirus-16 and grass pollen in grass
have no genetic data for probant 's father who is dead. Probant 's sis- pollen allergic adults
ter is not genetic tested yet but she experienced the same recurrent
Kailaivasan TH1,2; Nouri H3; Upham J3,4,5; Davies JM1,2
tongue swelling symptoms as her sister. 1
Institute of Health and Biomedical Innovation, Queensland University of
Plasminogen activity has been tested for the probant patient and Technology, Brisbane, Australia; 2Center for Children's Health research, South
a low value (65% of the reference value) has been found. PLG mu- Brisbane, Australia; 3The University of Queensland, Brisbane, Australia;
4
tation and activity need to be tested for other affected and non Translational Research Institute, Woolloongabba, Australia; 5Princess
Alexandra Hospital, Woolloongabba, Australia
affected patients in this family, C1 Inhibitor antigen and activity dos-
age checked, to obtain more data regarding the PLG-HAE phenotype
Background: Sensitization to aeroallergens such as grass pollens
characteristics and also the penetrance of the disease.
(GP) have shown to be associated with increased risk of develop-
ing respiratory virus-induced wheezing and asthma exacerbations
in children. Studies have revealed a counterregulatory effect on
the innate antiviral response following co-exposure of virus and
ABSTRACTS | 865
allergen, corroborated by results of our preliminary studies. We were obtained with MALDI-TOF/TOF mass spectrometer. The spec-
aim to further elucidate these innate immune interactions in adults tra, after processing in the R programming environment, were sub-
with human rhinovirus-16 (RV-16) and Paspalum notatum pollen mitted to statistical analysis in MetaboAnalyst software.
(Bahia grass; BaGP), a relevant grass pollen allergen source in Results: A significant increase of IgG4 level was measured in
Queensland. patients undergoing VIT, whereas, in the control group, no sta-
Method: Participants (GP-allergic, n = 23; non-atopic, n = 22) were tistically significant differences were observed in time. The
recruited with informed consent in Queensland. Clinical history and non-parametric statistical analysis of serum proteomic profiles
skin prick test (SPT) were evaluated. PBMC cultures were treated as obtained 1 day before starting VIT with those acquired on the 1st,
follows; no treatment, RV-16 only, RV-16 + BaGP, and BaGP only. RV- 11th and 90th day of treatment revealed changes within them.
16 was applied at a multiplicity of infection of 1 and BaGP aqueous Among the discriminative peptides, parts of complement C3, com-
extract was applied at 30 μg/mL. IP-10 and IL-6 induction was meas- plement C4A, mucin 3A and fibrinogen alpha chain were identi-
ured by ELISA in culture supernatants at 24 hour. Induction of IFN-β, fied. However, the comparison of the proteomic patterns obtained
MxA, OAS, IL-23 p19, IL-12 p35 and 40 transcription was measured from patients 1 day before VIT and on the 180th day showed no
by RT-PCR in 6 hour cell pellets. statistical differences. The differences between serum protein/
Results: IP-10 production was induced by RV-16 and significant peptide profiles of the control group obtained in two-time points
inhibition was observed following co-incubation of BaGP regard- were also negligible.
less of GP-allergy status. IL- 6 was induced strongly by BaGP but Conclusion: The results of this study revealed changes in serum
co-incubation with RV-16 had no effect on IL- 6 induction by BaGP. protein/peptide patterns during VIT detectable until the 90th day
MxA, OAS and IFN-β gene expression was induced by RV-16, but after starting the treatment. Lack of differences between profiles
only MxA gene expression was inhibited by co-exposure with derived from patients 1 day before starting VIT and on the 180th
BaGP in allergic subjects. IL-23 p19 gene expression induced by may result from the applied protocol of immunotherapy, in which
RV-16 was significantly lower for allergic subjects compared to from 90th day patients received only maintenance dose every
healthy subjects. 4 weeks.
Conclusion: The innate antiviral response induced by RV16 in PBMC Joanna Matysiak & Eliza Matuszewska contributed equally to this
cultures was inhibited by co-incubation with BaGP in GP-allergic work.
and non-allergic groups. This outcome indicates a role for grass
pollen allergen exposure in modulating respiratory virus induced
inflammation. LBTP1831 | Altered protein expression
patterns of Blattella germanica by antibiotics
show decreased IgE reactivity with allergic
LBTP1830 | Venom immunotherapy causes
patients
serum protein/peptide profiles changes
Lee S; Yi M; Kim JY; Lee J; Lee I; Yong T
Matysiak J1; Eliza Matuszewska E2; Derezinski P2; Department of Environmental Medical Biology and Arthropods of Medical
swiatly-Blaszkiewicz A 2; Kosinski SW3; Smorawska-Sabanty Importance Resource Bank, Institute of Tropical Medicine, Yonsei University
E3; Kokot ZJ2; Kowalski ML3; Matysiak J2 College of Medicine, Seoul, Korea
1
Medical Faculty, Higher Vocational State School, Kalisz, Poland; 2Department
of Inorganic and Analytical Chemistry, Poznan University of Medical Sciences,
Background: Cockroaches bodies produce allergens that bind to
Poznan, Poland; 3Department of Clinical Immunology and Allergy, Medical
University of Lodz, Lodz, Poland IgE antibodies and play roles in allergic diseases. Recent stud-
ies have shown that arthropods such as house dust mite by an-
Background: Venom immunotherapy (VIT) is the most potent way tibiotics reduce the allergic response. In this study, we aimed to
to reduce the risk of anaphylaxis following Hymenoptera sting. In demonstrate whether antibiotics can reduce allergens of Blattella
order to better understand the mechanism and impact of this treat- germanica.
ment on the human organism, serum proteomic patterns obtained Method: We reared Blattella germanica treated with ampicillin for
from Hymenoptera venom allergic patients undergoing VIT were 3 months. SDS-PAGE was performed to examine protein expression
studied and compared. For this purpose, an advanced analytical- patterns. The specific IgE level to cockroach extract was detected
bioinformatic method was proposed. using sera of cockroach allergic patients by ELISA.
Method: Serum samples were derived from 22 allergic patients Results: Our results showed that protein patterns of Blattella ger-
1 day before starting VIT and on the 1st day of treatment, then on manica were altered by ampicillin treatment. Most protein bands
the 11th, 90th and 180th day. Control group was constituted by pa- smaller than 43 kD were decreased and most proteins larger than
tients diagnosed with Hymenoptera venom allergy but not qualified 72 kD were increased by treatment of ampicillin. The specific IgE
to VIT. Samples from controls were collected twice, the second one levels to cockroach reared under ampicillin were significantly re-
90 days after the first collection. Serum protein/peptide profiles duced in certain patients (2 out of 14) when compared to the control.
866 | ABSTRACTS
Conclusion: We showed that antibiotics may alter protein patterns LBTP1834 | Genetics variants in the TLR3
in Blattella germanica. We need further study to identify the altered
locus are associated with eosinophilic esophagitis
proteins and their allergenicity.
in Spanish population
Ávila Castellano R1; Cimbollek S1; De Aramburu Mera T1;
García Lozano R1; Lucendo A 2; Qurialte J1
LBTP1833 | Genetics variants in the TLSP locus 1
Hospital Universitario Virgen del Rocío, Sevilla, Spain; 2Hospital General de
here associated with eosinophilic esophagitis in Tomelloso, Ciudad Real, Spain
Spanish population
Background: Eosinophilic esophagitis (EoE) is an antigen-driven dis-
Ávila Catellano R1; Cimbollek S1; De Aramburu T1;
Garcia Lozano R1; Lucendo A 2; Quiralte J1 ease mediated by an abnormal immune TH2 response. Disease risk
1 variants and an altered esophageal transcriptional profile underlie
Hospital Universitario Virgen del Rocío, Sevilla, Spain; 2Hospital de Tomelloso,
Ciudad Real, Spain the genetic background of EoE.
Objective: To investigate gene polymorphisms associated in regulat-
Background: Eosinophilic esophagitis (EoE) is an antigen-driven dis- ing immune responses leading to disease susceptibility.
ease mediated by an abnormal immune T helper 2 (TH2)-type re- Method: Twenty-one tag single nucleotide polymorphisms (tSNPs)
sponse. Thymic stromal lymphopoietin (TSLP) is a cytokine produced selected in four candidate genes (TLR3, TLR4, FOXP3 and FLG) were
by esophageal epithelial cells, which acts by driving dendritic cells genotyped in 218 EoE patients and 376 non-EoE controls (healthy
(DCs) towards a TH2 response. TSLP being identified as a major can- ethnically matched bone marrow donors, were selected). All patients
didate gene involved in the pathogenesis of the disease by genome- were recruited at two Spanish hospitals: Hospital Universitario Virgen
wide association studies. Objective: To replicate the association of del Rocío (Sevilla) and Hospital General de Tomelloso (Ciudad Real).
the TLSP gene with EoE in a Spanish population. Genomic DNA was extracted from blood leukocytes using QIAmp
Method: Six tag single nucleotide polymorphisms (tSNPs) selected DNA Mini Kit (Qiagen, Hilden, Germany) according to the manufac-
in candidate gene TSLP were genotyped in 218 EoE patients and turer's recommendations, and stored at −20°C. Allele frequency dis-
376 non-EoE controls (healthy ethnically matched bone marrow do- tributions were compared using the χ 2 test and a corrected P-value
nors, were selected). All patients were recruited at two Spanish hos- (pc) was calculated from 10 000 permutations (Haploview program).
pitals: Hospital Universitario Virgen del Rocío (Sevilla) and Hospital Skin prick-test (SPT) were carried out in EoE patients with a panel
General de Tomelloso (Ciudad Real). Genomic DNA was extracted of 17 common aeroallergens and 22 plant and animal-derived food.
from blood leukocytes using QIAmp DNA Mini Kit (Qiagen, Hilden, Results: SPT were performed in the overall group of 218 patients
Germany) according to the manufacturer's recommendations and with EoE revealed aeroallergen and food sensitization in 72.22% and
stored at −20°C. Allele frequency distributions were compared using 61.46% of them, respectively.
2
the χ test and a corrected P-value (pc) was calculated from 10 000 The successful rate of genotyping was >98% for all the SNPs in-
permutations (Haploview program). Skin prick-test was carried out in cluded, and the study population was found to be in Hardy-Weinberg
EoE patients with a panel of 17 common aeroallergens and 22 plant equilibrium for all the polymorphisms analyzed (P > 0.05). No statis-
and animal-derived food. tically significant differences were found between EoE patients and
Results: 218 adult patients with EoE (170 males and 48 females; control subjects in the distribution of the allelic frequencies of any of
mean age at diagnosis 35.4; range 9-74) and 376 healthy ethnically the SNPs of TLR4, FOXP3 and FLG loci. However, one tSNP located
matched bone marrow donors, were selected. Five tSNPs located in the TLR3 locus were significantly associated with EoE. TLR3 locus
in the TSLP locus were significantly associated with EoE. Since was found to be associated with aeroallergens sensitization and food
the prevalence of EoE in males is higher than in females, a gender- allergy in EoE patients: the rs11721827C allele was more frequently
stratified analysis of EoE patients and controls was carried out to found among EoE patients sensitized to aeroallergens (9.4% vs 1.1%,
determine whether TSLP variants contribute to this gender bias: OR = 9.67, pc = 0.025), and rs5743303T allele was found as a pro-
significant differences remained unchanged between patients and tective factor for food sensitization (17.5% vs 28.5%, OR = 0.53,
controls in the male group, with only rs2289276 polymorphism in pc = 0.048).
TSLP gene being not associated after p-correction (P = 0.013 and Conclusion: This study describes the TLR3 gene as a novel genetic
pc = 0.065). Regarding female patients, no significant differences in susceptibility locus for developing EoE for the first time.
the distribution of alleles were found, with a similar trend in the dis- The TLR3 gene was found to be associated with aeroallergens and
tribution to that observed in the male group; the TSLP gene polymor- food sensitization in EoE patients.
phism rs10062929 was found to be associated before p-correction
(P = 0.016). Finally, no association between TSLP and sensitization to
food or inhalant allergens was found.
Conclusion: We have replicated the association of the TSLP gene
with EoE. TSLP variants don' t contribute to gender bias.
ABSTRACTS | 867
LBTP1835 | Identification of the major LBTP1836 | The use of omalizumab for

allergenic proteins of Bombyx mori moth's wings dermatologic manifestations of Hyper-IgE
Araujo LML1; Zanchin NIT2; Souza C2; Rosario Filho NA1 Syndrome—Two case reports
Miranda J1; Gomes N2; Carneiro-Leão L1; Baudrier T2;
1
Federal University of Parana, Curitiba, Brazil; 2Carlos Chagas Institute, Curitiba,
Brazil Torres Costa J1
1
Immunoallergology, Centro Hospitalar Universitário de São João, Porto,
Background: Moths are a significant source of aeroallergens, which Portugal; 2Dermatology, Centro Hospitalar Universitário de São João, Porto,
might trigger symptoms of asthma and allergic rhinitis in predisposed Portugal
subjects, after home or occupational exposure. High prevalence of

sensitization to Bombyx mori extract was demonstrated in individu- Case report : We described two cases of Hyper-Immunoglobulin E
als with allergic respiratory diseases. There are no studies on these (IgE) Syndrome. The first concerns a 33 year old male diagnosed
moth species allergens involved in allergic respiratory reactions. The with STAT3 mutation, with a history of severe recalcitrant eczem-
aim of this study was to determine the major allergenic proteins of atous dermatitis, onychomycosis and multiple recurrent respira-
Bombyx mori moth's wings responsible for allergic sensitization of tory and cutaneous infections since childhood requiring repeated
individuals with rhinitis and/or asthma. courses of antistaphylococcal antibiotics and antifungals. At the
Method: We studied 36 patients submitted to skin prick tests using time of observation he held a poor control of his skin disease de-
Bombyx mori’s wings and other six aeroallergens standardized ex- spite a daily dose of 80 mg of prednisolone. In order to control cu-
tracts, as well as blood sample collection. They were divided into taneous symptoms, to diminish his high levels of IgE (11.802 kU/L)
three groups: group 1 consisted of 21 allergic subjects whose skin and his need for corticotherapy, omalizumab therapy was initiated
prick tests were positive to Bombyx mori extract, group 2 consisted on February 2018 with 375 mg every 2 weeks. Evaluation after
of 8 individuals whose skin prick tests were positive to mite extract 1 year of omalizumab treatment showed a significant improve-
and group 3 consisted of 7 non allergic subjects whose skin prick ment in skin lesions and pruritus, allowing a reduction to an inter-
tests were negative, as controls. We performed Western blot using mittent dose of corticosteroids.
anti-IgE antibodies with moth's wings extract, which was analysed The second describes a 38 year old male with a heterozygous vari-
by mass spectrometry as well. Written informed consent was ob- ant of the DOCK8 gene and IgE levels of 1435 kU/L. He presented
tained from all participants. a history of recalcitrant eczematous dermatitis with intense pruritus,
Results: Among the 21 subjects from group 1, 19 reacted to moth folliculitis, frequent skin abscess formation, psychomotor impairment,
extract by Western blot. All reacted to a protein at 80 kDa, five other intellectual disability and Hodgkin Lymphoma (14 years ago). At the
bands (66, 50, 45, 37 e 30 kDa) were identified in more than 50% of time of observation he retained shortness of breath and wheezing
individuals tested, considered major proteins. From 8 participants of without response to medication, severe recalcitrant eczematous der-
group 2, seven showed reactivity to moth extract by Western blot . matitis, intense pruritus and frequent cutaneous infections requir-
Sera samples from healthy individuals did not react to moth extract. ing daily corticotherapy and multiple courses of antibiotherapy. He
Based on research databank of molecular mass already described started therapy with omalizumab in April 2018 with 300 mg every
to Bombyx mori, it was possible to identify 5 from 6 major proteins 2 weeks. After 10 months of treatment, he maintained his skin lesions
reactive on immunoassays. The 80 kDa protein, seen in all reactive but showed a slight improvement of pruritus, achieving a small de-
participants from group 1 and in none of the patients from group 2, crease of his corticotherapy dosing. Both patients gave informed con-
is a potential specific allergen from moth's wings. More studies are sent for publication regarding all information approached in this work.
necessary to better characterize this protein. The 45 kDa protein, Conclusions: Different response to Omalizumab between two cases
visualised in 84.2% of the group 1 patients, was identified by mass of Hyper-IgE syndrome with distinctive types of mutations causes a
spectrometry as vitellogenin. deliberation on the use of this therapy on a case-by-case basis.
Conclusion: This was the first study to highlight the major allergenic
proteins of Bombyx mori moth's wings in individuals with allergic res-
piratory diseases. The ones at 80 and 45 kDa are specific allergenic LBTP1837 | Omalizumab treatment in children
proteins of this moth species that require more studies to better with chronic spontaneous urticaria: Efficacy and
understand its clinical importance on patients with asthma and/or
safety
rhinitis.
Kahveci M; Sahiner ÜM; Büyüktiryaki B; Sekerel BE;
Soyer O
Department of Pediatric Allergy, Hacettepe University Faculty of Medicine,
Ankara, Turkey
Background: Chronic spontaneous urticaria (CSU) is defined as

spontaneous occurrence of wheals and/or angioedema for ≥6 weeks.
868 | ABSTRACTS
Omalizumab is useful as add-on treatment in patients unresponsive chemokine (TECK/CCL25), periostin and zonulin levels in infants
to high doses of second generation antihistamines. The aim of this with AD.
study was to evaluate the efficacy and side effects of omalizumab Method: We examined 74 infants with AD and 63 healthy infants.
treatment in children with refractory CSU. Severity of AD was evaluated with the SCORing Atopic Dermatitis
Method: CSU patients aged 12-18 years-old with the diagnosis of (SCORAD) index. Serum MEC/CCL28, TECK/CCL25. periostin and
symptomatic CSU and unresponsive to the classical treatment were zonulin levels were measured.
included to the study. All patients had an urticaria-activity-score Results: Infants with atopic dermatitis [9.9 (4.6-16.4) ng/mL] had
(UAS7) of 16 or greater and they were treated with omalizumab higher median value of MEC/CCL28 than healthy infants [9.3 (4-
300 mg every 4 weeks. The UAS7 scores were recorded monthly. 16.4) ng/mL] (P < 0.01). Median value of zonulin were lower in in-
Complete response, partial response and no response was defined fants with atopic dermatitis [51.5 (14.3-71.8) ng/mL] compared to
as more than 90%, 30% to 89% and <30% reduction in symptoms healthy controls [58.3 (13.9-80.8) ng/mL] (P < 0.001). Duration of
respectively. The relapse was considered to be the re-appearance of atopic dermatitis and SCORAD index score did not show correlation
CSU symptoms after the end of treatment. with MEC/CCL28, TECK/CCL25, periostin and zonulin levels. Infants
Results: A total of 29 patients were evaluated. The patients were with MEC/CCL28 levels »8.35 ng/mL, have 3.8 times more risk of de-
predominantly females (n = 16;55%). The median age and symptom veloping atopic dermatitis than the infants with MEC/CCL28 levels
onset age of the patients were 15.2 (IQR,12.8-16.5) years and 14.0 <8.35 ng/mL. In addition, infants with zonulin levels ≤55.15 ng/mL
(IQR,11.8-15.9) years, respectively. The median duration of urticaria have 5.84 times more risk of developing atopic dermatitis than the
was 8 (IQR,4-24) months. Eleven (37.9%) patients had angioedema infants with zonulin levels >55.15 ng/mL.
and 10 (34.5%) patients had concomitant allergic diseases. Autolog Conclusion: Periostin and TECK/CCL25 do not seem to have roles in
serum skin testing was positive in 2/10 (20%) and SPT was positive atopic dermatitis. However, MEC/CCL28 and zonulin are candidates
in 5/10 (50%) of patients. The median age at the beginning of treat- to be investigated in infants with AD and might be used for deter-
ment with omalizumab was 15.4 (IQR;12.9-16.9) years. The median mining risk for AD.
symptom duration was 12 (IQR;6.5-27.5) months before the omali-
zumab treatment. Twenty-eight (96.5%) of the patients (89.6% com-
plete, 6.9% partial) achieved response with omalizumab however
LBTP1840 | Vascular endothelial growth
one patient was non-responder (3.5%). Adverse effect was observed
factor and interleukin-33 levels in children with
in one (3.4%) patient as angioedema after 3rd dose of omalizumab.
Twenty-three patients who completed the treatment were followed
recurrent wheeze
up for median 18 (IQR,13-27) months. Relapse was observed in 3 Aydin B1; Koksal B2; Tekindal MA3; Yilmaz Ozbek O2
1
(13%). The relapse time of 3 patients were 4, 6, 12 months after end Department of Pediatrics, Baskent University, Ankara, Turkey; 2Division
of omalizumab therapy. of Pediatric Allergy, Baskent University, Ankara, Turkey; 3Department of
Biostatistics, Selcuk University, Konya, Turkey
Conclusion: Omalizumab is considered as an effective and safe
treatment for CSU in children. Relapses mostly occur within the first
Background: Recurrent wheezing (RW) is frequent in preschool
year after the cessation of the treatment. Larger-scale studies in this
children. Wheezing phenotypes, asthma predictive index (API) and
population are warranted.
modified API (mAPI) have been described for clinical purposes. Our
aim was to examine Vascular Endothelial Growth Factor (VEGF) and
interleukin (IL)-33 which are involved in inflammation, angiogenesis
LBTP1839 | Mucosa-associated epithelial and remodelling, in children with RW.
chemokine, thymus expressed chemokine, Method: Ninety-four children who were under 4 years of age with
periostin and zonulin levels in infants with atopic the history of at least four episodes of wheezing during the last
dermatitis 12 months and age-matched healthy controls were included in the
study. Children with RW were classified according to wheezing phe-
Koksal B1; Zengin HY2; Yilmaz Ozbek O1
notypes as episodic viral wheeze (EVW) or multi-trigger wheeze
1
Division of Pediatric Allergy, Baskent University, Ankara, Turkey; 2Department
(MTW), and positive or negative mAPI. Blood for VEGF and IL-33
of Biostatistics, Baskent University, Ankara, Turkey
levels were drawn during wheezing episode free periods.
Results: Mean ages of children with RW and healthy children were
Background: Atopic dermatitis (AD) is a chronic inflammatory
2.6 ± 0.9 and 2.4 ± 1.02 years, respectively. Children with RW had
skin disease. Chronic inflammation exacerbates skin barrier im-
similar levels of serum VEGF and IL-33 levels with healthy chil-
pairment, and leads to the development and symptoms of AD.
dren. When we compared children according to wheezing pheno-
Chemokines and inflammatory markers are involved in patho-
types and mAPI, VEGF and IL-33 did not show difference between
genesis of allergic diseases. Our aim was to investigate mucosa-
groups. VEGF levels of girls with MTW (51.5 ± 25.1 pg/mL) were
associated epithelial chemokine (MEC/CCL28), thymus expressed
higher than girls with EVW (22.9 ± 18.3 pg/mL) and control group
ABSTRACTS | 869
(32.7 ± 32.2 pg/mL) (P < 0.01). 38 children with RW were using in- help in predicting asthma risk. However, serum VEGF levels in girls
haled steroid and/or montelukast treatment. with RW may help to predict asthma.
Conclusion: VEGF and IL-33 levels did not show difference between
healthy children and children with RW in wheezing episode free pe-
riods. These results show that VEGF and IL-33 levels seem not to
870 | ABSTRACTS
SUNDAY, 2 JUNE 2019

LB TPS 03
FOOD ALLERGY
LBTP1841 | Visual communication of allergens LBTP1842 | Identification of hypoallergenic

on food labels: A qualitative assessment peach and nectarine cultivars by quantification of
Fonseca I1; Silva M1; Vairinhos M1; Quental J1; Moreira A 2 Pru p 3 content in 102 core peach collections
Jin J1,2; Gao L2; Gao Z1,3; Li X4; Nie J2; Zhao L2; Xie H2;
1
University of Aveiro, Aveiro, Portugal; 2University of Porto, Porto, Portugal
Wu S1; Ye Z4; Luo J4; Cao K5; Ma R6; Chen M7; Arus P8;
Background: An effective food labelling system is very important Versteeg SA3; Wang H9; Jia H2; Van Ree R3
1
for health protection of allergic consumers. The last update on the Allergy Research Center, Zhejiang University, Hangzhou, China; 2College
of Agriculture and Biotechnology, Zhejiang University, Hangzhou, China;
European Food Information Regulations 2014 mandates the disclo- 3
Department of Experimental Immunology, Amsterdam UMC, University of
sure of any of the 14 listed allergens on food labels and establishes Amsterdam, Amsterdam, The Netherlands; 4Forest & Fruit Tree Institute,
guidelines for their presentation. Yet, many consumers still face Shanghai Academy of Agricultural Sciences, Shanghai, China; 5Zhenzhou
Fruit Research Institute, China Academy of Agricultural Sciences, Zhengzhou,
difficulties when shopping, particularly in the visibility and inter-
China; 6Horticultural Institute, Jiangsu Academy of Agricultural Sciences,
pretation of allergen information. Therefore, we aimed to evaluate Nanjing, China; 7Fenghua Honey Peach Institute, Xikou, Fenghua, Zhejiang
food allergens visibility and legibility properties considering the Province, Xikou, China; 8Centre de Recerca en Agrigenòmica CSIC-IRTA-UAB,
Regulation (EU) No 1169/2011 on the provision of food information Campus UAB—Edifici CRAG, Barcelona, Spain; 9Department of Allergy, the
Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou,
to consumers. China
Method: Twelve visual parameters concerning visibility and leg-
ibility were developed. These were validated in a pilot by eight Background: The lipid transfer protein Pru p 3 is the most impor-
graphic design specialists and PhD design students that employed tant fruit allergen. Pru p 3 content is variable in different cultivars
a 5-point Likert scale in the analysis of food labels (n = 8). Eleven which affects the severity of allergic reaction. Peach is originated in
of those parameters were considered to have enough internal con- China with rich genetic diversity. Selection of hypoallergenic variety
sistency (α > 0.7) and were used in the analysis of an intentional is beneficial for peach allergic patients.
sampling of food labels (n = 196) in a major supermarket store in Method: Pru p 3 content was quantified in peach fruits from 102
Portugal. core peach collection by double monoclonal antibodies ELISA in
Results: All the analysed food labels disclosed the presence of 2016-2018. Pru p 3 immunofluorescence was localized in four se-
allergens via typographic signal (mostly bold, capital letters or lected varieties.
underline) within the ingredients list. The majority of the labels Results: As whole fruit, there was up to 18-fold difference in Pru
(n = 193) identified the allergen in text by at least one instance p 3 content among the 102 core peach accessions. Most nectarine
of their common name. The mean x-height value of the text of cultivars had low Pru p 3 content ranged from 4.8 μg/g-FW to 31 μg/
the sample (M = 1.2; SD = 0.2) sits right over the minimum value g-FW (fresh weight), while a large variation was observed in peach
defined by EU standards of 1.2 mm, and 34 food labels (17%) were (with hairy skin): the lowest 3.5 μg/g-FW in a wild peach used as
found to have that value below the legal limit. The defined ty- rootstock, to the highest 64.4 μg/g-FW in ripening delicious yellow
pographic parameters found to have the lowest scores were the flesh peaches. Pru p 3 allergen levels were related to flesh color: low-
leading (M = 3.34; SD = 1.13), width-to-height ratio (M = 3.47; est in the red flesh cultivars, medium for white flesh and highest in
SD = 1.17) and tracking (M = 3.71; SD = 1.08), while conspicuity yellow flesh varieties. Lower Pru p 3 content varieties usually ripen
(M = 3.58; SD = 1.16) was the visibility parameter in greater need early, in both nectarine and peach cultivar group, with lower soluble
of improvement. solid content and aroma intensity. Immunofluorescence experiment
Conclusion: Our findings support the need to review regulation con- demonstrated Pru p 3 was localized predominantly in the peel, with
cerning the principles of visual communication of allergens. Solutions a major difference in both peel and pulp between the low and high
to be developed should respond to functional requirements such as allergenic cultivars.
legibility, but also facilitate perception, understanding and decision Conclusion: Pru p 3 contents are 18-fold variable depending on cul-
making, thus providing clear and accurate food allergen labelling for tivars, related to fruit type, flesh color and ripening date. We identify
consumers. several hypoallergenic peach and nectarine cultivars.
ABSTRACTS | 871
LBTP1843 | Sensitization to Ana o 3 in tree nut LBTP1845 | Crustacean characterization:

and peanut allergy Identifying the seafood allergic patient, co-
Brosseron L; Lopes J; Mesquita M; Franco-Leandro P; morbidities and associated atopic risk factors
Sousa MJ; Ferreira AR; Lopes I Moni T; Ohayon JA
Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Vila Nova De Gaia,
McMaster University, Hamilton, Canada
Portugal
Background: Shellfish allergy represents a common acquired food

Background: Ana o 3, a 2S albumin, is known as a major cashew al-
allergy in later childhood and adulthood. Questions often arise on
lergen and seems to be an important predictive of both cashew and
risk of cross reactivity to other food allergens (i.e. finned fish) and
pistachio allergy. Tree nuts (TN) are a common cause of anaphylaxis
risk of shellfish allergy development in patients presenting with
and their widely distribution in snacks and processed food raises
other forms of atopic disease. Characterization of the shellfish al-
important concerns. The aim of this study was to evaluate the rel-
lergic population would assist in identifying patterns of co-morbid
evance of Ana o 3 in TN allergy in our Food Allergy Department.
food allergy and atopic disease.
Method: A retrospective analysis was performed assessing clinical
Method: A retrospective chart review in a community allergy clinic
and demographic data of TN and peanut allergic patients, and those
® serving a population of 2 million in southwestern Ontario was per-
with positive specific IgE to Ana o 3 (ImmunoCAP-Thermofisher )
formed to review patient presentation of shellfish allergy. Data on other
were selected.
confirmed food allergies, inhalant allergies and atopic co-morbidities
Results: From 51 patients with TN allergy, 7 sensitized to Ana o
were captured to help identify trends in shellfish allergic population.
3 were included, 6 male, with a median age of 7 years [4-51]. Six
Results: Twenty-five patients were confirmed as shellfish allergic
were atopic, with other allergic co-morbidities found in 5. The me-
from Dec 2015 to Feb 2019. Clinical presentation ranged from oral
dian age of the first reaction was 4 years [2-35] and the median
pruritus to anaphylaxis. Mean age of diagnosis was 42 years and
age at diagnosis 6 years [2-50]. The suspected TN involved were
males accounted for majority (19/25, 76%). House dust mite sen-
cashew (n = 2), walnut (n = 1), Brazil nut (n = 1), cashew and pis-
sitization was the commonest aeroallergen (20/25, 80%) followed
tachio (n = 1), cashew and peanut (n = 1) and hazelnut, almond
by animal dander (16/25, 64%). Atopic dermatitis was found in half
and peanut (n = 1). Clinical manifestations were anaphylaxis (n = 5)
(12/25), Asthma in 8/25 (32%) and Allergic Rhinitis in 5/25 (20%).
and urticaria/angioedema (n = 2). One patient reported anaphy-
Finned fish allergy as a co-morbidity was identified in 28% of shell-
laxis with contact/inhalation and the remaining reactions resulted
fish allergic patients (7/25). Of these seven combined shellfish and
upon ingestion. All patients had positive skin prick tests (SPT) to
finned fish allergic patients, 6/7 (86%) had co-morbid food aller-
cashew and pistachio (exclusive in 3 patients), with the remaining
gens (tree nuts) and 5/7 (71%) had Atopic Dermatitis. The shellfish-
also positive to walnut (n = 3), soy (n = 2), hazelnut (n = 1) and pea-
only allergic population was identified with lower co-morbid food
nut (n = 1). All were sensitized to Ana o 3 [0.39-19.3 kUA/L]; 1 also
allergy (8/18, 44%) and co-morbid Atopic Dermatitis (7/18, 39%).
to Jug r 1 (3.6 ISU-E) and Jug r 2 (0.4 ISU-E); 1 to Jug r 1 (1.7 ISU-E)
There was no difference in rate of asthma in the shellfish-only al-
and Ara h 1 (0.4 ISU-E) and 1 to Pru p 3 (0.51 kUA/L). All patients
lergic group and the combined seafood allergic group.
avoid pistachio and cashew, but 5 patients referred tolerance to
Conclusion: In the shellfish allergic population, co-morbid finned
other TN; almond (n = 4), hazelnut (n = 3), walnut (n = 3), peanut
fish allergy is present in the minority of patients. The combined
(n = 2) and pine nuts (n = 1). Only one patient reported accidental
shellfish and finned fish allergic patient is often more atopic with co-
exposure, with facial local erythema after a kiss from his father
morbid food allergies and atopic dermatitis. Identifying these higher
who had eaten pistachios.
risk shellfish allergic patients for screening of finned fish allergy may
Conclusion: In our population prevalence of Ana o 3 sensitization
be warranted.
was 14%, it occurred in early life, and was associated with anaphy-
laxis (71%) and reactions occurring after contact/inhalation. The
best predictor of Ana o 3 allergy was positive SPT to cashew and
pistachio. As described in the literature, Ana o 3 was associated LBTP1847 | Study of the effects of Pru p 3
to cashew and pistachio allergy and the little cross-reactivity ob- sensitization in the MALT
served should alert us to the importance of seeking tolerance to
Tome Amat J; Pazos-Castro D; Martin-Murillo A;
other TN, avoiding unnecessary diets restrictions and improving Garrido-Arandia M; Romero-Sahagun A; Cuevas-Zuviria B;
quality of life. Pacios LF; Diaz-Perales A
Centre for Plant Biotechnology and Genomics (UPM-INIA), Universidad
Politécnica de Madrid, Madrid, Spain
Background: Within the study of alimentary allergy, previous re-

ports have shown different aspects of the micro and macromolecular
872 | ABSTRACTS
changes that happen in the mucosa associated lymphoid tissue a low specificity and thus high rate of false positives. Our aim was
(MALT). Even with the wide knowledge regarding the sensitization to isolate individual known and unknown IgE-binding proteins from
process, there are still several events that remain unclear, making it almond nuts and evaluate their clinical importance and involvement
impossible to achieve definitive treatments against the disease yet. in cross-reactivity with other tree nuts.
For that reason, we propose to deepen in these studies by analyzing Method: For the isolation of seed storage proteins, a combination
the effects of Pru p 3 (major allergen of peach) sensitization in dif- of precipitation and chromatographic techniques was used. MALDI-
ferent MALT systems. TOF and high accurate tandem mass spectrometry were applied in
Method: Both in vitro and in vivo approaches were developed for order to identify the mass and the amino acid sequences of the puri-
our studies, employing Pru p 3 and its lipid ligand as a model for fied proteins. Further, the immunological activity was evaluated by
food allergy sensitization. For the first case, a wide variety of cell IgE-ELISA using sera from 31 almond allergic patients.
lines from different tissue origin were used and multiple parameters, Results: Preliminary results showed that we purified three IgE bind-
including allergen transportation and cytokines production and re- ing almond proteins: putative almond vicilin, legumin (Pru du 6) and a
lease, were studied. For the in vivo analysis, mice were sensitized 13 kDa antimicrobial peptide. When tested in ELISA, 68% of almond
using different routes and several cellular and histological events allergic patients’ sera had sIgE to almond extract. Of those, 76% con-
were studied. tained IgE specific for Pru du 6. Initial testing showed that almond
Results: Pru p 3 administration in epithelial cell lines from skin, gut vicilin and 13 kDa antimicrobial peptide were recognized by majority
and lung showed differential transportation of the allergen, together of sera containing almond-specific IgE.
with a differential pattern in the cytokines expression. Similarly, the Conclusion: Identification of other IgE-binding almond proteins as
in vivo studies showed differential tissue remodeling and lympho- well as further biochemical and immunological characterization of
cyte infiltration, depending on which route was used for Pru p 3 sen- the purified proteins will be performed to evaluate the relevance of
sitization (nasal, gastrointestinal or epicutaneous). these proteins for diagnosis of almond allergy based on the concept
Conclusion: Allergy is a systemic disease in which very different of component-resolved diagnosis. We will include in the study an
factors take part, from external barriers to cellular signaling all over equal number of patients who are only sensitized but without symp-
the body. These results provide new insights in our understanding toms to almond to try to distinguish between allergens specific for
of the MALT. Although previous studies already reported changes clinical reactivity and those involved in cross-reactivity with aller-
occurring in this tissue in in vivo models of peach allergy, this is the gens from peanut or other tree nuts.
first report comparing different routes and analyzing them simulta-
neously, allowing us to understand sensitization effects happening
both near the sensitization pathway and through other tissues and
LBTP1850 | Sensitization to cow milk
systems away from it.
components in children with different
phenotypes and endotypes of food allergy
Prikhodchenko N; Shumatova T; Zernova E
LBTP1849 | Identification and characterization
Pacific State Medical University, Vladivostok, Russia
of almond allergens
Kabasser S1; Jensen AN2; Mothes-Luksch N2; Background: The variety of causes of the food allergy development,
Jensen-Jarolim E1,2,3; Hoffmann-Sommergruber K1;
complex pathogenesis, and the unequal response of patients to ther-
Breiteneder H1; Bublin M1
1
apy have led to the identification of phenotypes and endotypes of
Institute of Pathophysiology and Allergy Research, Center of Pathophysiology,
Infectiology and Immunology, Medical University of Vienna, Vienna, Austria;
allergic diseases. Studies on the study of food allergy phenotypes
2
AllergyCare—Allergy Diagnosis, Vienna, Austria; 3Comparative Medicine, and endotypes are rare.
The Interuniversity Messerli Research Institute of the University of Veterinary Method: 216 children with cow's milk allergy (CMA) were examined
Medicine Vienna, Medical University Vienna and University Vienna, Vienna,
to study the frequency of sIgE to cow's milk protein and its fractions.
Austria
sIgE was determined by the Immunocap method. IgE-mediated CMA
was confirmed in 68.5% of children (n = 148), non-IgE-mediated—
Background: Almond, a drupe of Prunus dulcis tree from the
in 31.5% of children (n = 68). It was revealed that in most children
Rosaceae family is one of the most commonly produced and con-
(n = 87, 58.8%) sensitization was determined to nBos d 8, in 45.9% of
sumed nuts all over the world. According to studies on the preva-
cases to nBos d 4 (n = 68).
lence of tree nut allergies, almond allergy usually ranks fourth. An
Results: The conducted clinical and laboratory analysis allowed us
accurate diagnosis in patients with suspected almond allergy is im-
to isolate the skin, gastrointestinal, and mixed phenotype CMA in
portant because almond is a source of nutrition and milk products
children. The skin phenotype (SPh, n = 72, 33.3%) was characterized
for children with other food allergies. Current diagnostic often made
by an isolated lesion of the skin. Ig E positive endotype prevailed and
on the basis of routine skin prick testing and/or almond specific-IgE
was determined in 54 children (75% among children with SPh), the
levels testing with whole almond protein extract is complicated by
ABSTRACTS | 873
average level of total Ig E was 27.16 + 3.68 kUA/L. No sIgE for cow's anti-gluten sIgE. We found a positive correlation between spe-
milk protein and its fractions (Ig E negative endotype) were detected cific sIgE to wheat and barley but not O5G and barley, suggesting
in 28 children with SPh. The gastrointestinal phenotype (GIPh, cross-reactivity between barley proteins and wheat proteins other
n = 46, 21.3%) was characterized by an isolated lesion of the gastro- than O5G.
intestinal tract. This phenotype was represented predominantly by Conclusion: Currently available tests confirm WDEIA patients sensi-
Ig E negative endotype (71.7% among children with GIPh). Ig E posi- tised to O5G can also be sensitised to proteins in rye and barley. Not
tive endotype was determined in 13 children with GIPh (28.26%), all of these patients tested positive for sIgE against wheat or gluten.
the average level of total Ig E was 34.71 + 5.92 kUA/L. Mixed pheno- This suggests that the sensitivity of these tests is lower and may be
type (MPh) prevailed in our study, n = 98 (45.4%) and was character- less specific. This may also be true for tests for barley and rye. If spe-
ized by a combination of skin and gastrointestinal manifestations, 7 cific IgE against secalins and hordeins could be measured the results
children have symptoms of skin, gastrointestinal tract lesions and might demonstrate a higher level of cross reactivity. Therefore, at
respiratory manifestations. Ig E positive endotype prevailed, it was present, WDEIA patients cannot be accurately told whether they are
determined in 81 children with MPh (82.7%), the average level of safe to eat rye and barley-containing products, even if specific IgE to
total Ig E was 21.58 + 5.24 kUA/L. The analysis showed that sensi- those grains is negative.
tization to nBos d 4 has the greatest value on the formation of the
GIPh. In the formation of skin manifestations in children with SPh
and MPh, the combined sensitization to nBos d 8 and nBos d 6, as LBTP1852 | Profile of children with persistent
well as the combination nBos d 8 and nBos d 5.
peanut allergy
Conclusion: Selection of individual phenotypes of CMA will allow
explaining the clinical, pathophysiological, functional features of Vázquez De La Torre Gaspar M; Prieto-Moreno A;
Torres-Rojas I; Somoza Alvarez ML; Pérez-Alzate D;
each specific patient and choosing personalized therapy.
Ruano Lopez FJ; Blanca-López N; Haroun Diaz E;
Canto Diez G
Infanta Leonor University Hospital, Madrid, Spain
LBTP1851 | Cross-reactivity in
wheat-dependent, exercise-induced allergy Background: Peanut allergy is increasing in prevalence, often severe
1 2 2 2 and typically life-long. Treatment requires food avoidance and ac-
Smith ME ; Wagner A ; Kennard L ; Mirakian R
1 cess to injectable epinephrine. The aim of our study was to describe
Cambridge University, Cambridge, United Kingdom; 2Addenbrooke's Hospital,
Cambridge, United Kingdom epidemiological and clinical features of children with persistent pea-
nut allergy.
Background: Omega-5-gliadin (O5G), a wheat protein, is the major Method: We conducted a retrospective descriptive study of
allergen in wheat-dependent, exercise-induced allergy (WDEIA) children with persistent peanut allergy, collected in 1 year
with high sensitivity and specificity. Anti- O5G IgE cross-reacts (2018) at Infanta Leonor University Hospital (Madrid, Spain).
with proteins present in rye and barley (secalins and hordeins, Epidemiological and clinical data were registered from clinical re-
respectively), due to structural homology. Therefore gluten-free cords: gender and age; type of reaction and age at initial reaction;
diets are currently recommended for WDEIA patients. This study other legumes and nuts tolerance; presence of rhinitis, asthma or
looked at the degree of cross-sensitisation between the grains and atopic dermatitis; and familiar history of atopy. Diagnostic studies
whether in vitro tests could inform advice on avoidance of rye and performed included skin prick tests and specific IgE (sIgE) to pea-
barley. nut. Persistent peanut allergy was identified in patients with any
Method: The study included 34 patients, 24 with WDEIA (of WDEIA symptom after peanut ingestion, skin prick test >8 mm and high
patients, 83.3% were male, age at diagnosis ranged from 21-72). levels of sIgE to peanut.
Specific IgE (sIgE) to O5G, gluten, wheat, rye and barley was measured. Results: A total of 28 children were enrolled in the study (17
The prevalence of patients simultaneously sensitised to wheat, gluten, males, 11 females). Age range: 3-15 year old (Mean 8.9 year old,
rye and barley was used to determine the extent of the cross-reactivity. median 9 year old). The mean age at the time of the first reaction
Results: Of the patients with WDEIA (sIgE to O5G = 9.57 ± 2.28), was 4 year old. All patients were diagnosed by skin prick tests,
75% were sensitised to rye (r = 0.68, significant) with sIgE of with a wheal mean size of 13.44 mm (range 8-21 mm) and positive
2.00 kua/L ± 0.59, whereas 29% were sensitised to barley (r = 0.33, sIgE to peanut, with a mean value of 76 kU/L (14 to >300 kU/L).
non-significant) with sIgE of 0.73 kua/L ± 0.39. This indicates that From the total, 46% were sensitized only to peanut and 56% also
there is significantly less cross-reactivity between barley and to other nuts: hazelnut 21%, cashew 15% and nut 13%. Most pa-
O5G than rye and O5G. Of the patients sensitised to wheat, 88% tients (89%) tolerated other legumes. Regarding clinical symp-
were sensitised to rye and 41% to barley (r = 0.70 and 0.50 re- toms, the skin (either urticaria or angioedema) was the organ most
spectively, both significant). 17/24 WDEIA patients tested positive frequently involved (46%). Anaphylaxis was present in 29% of chil-
for sIgE against wheat. 15/18 of the WDEIA patients tested had dren, OAS in 7% and gastrointestinal symptoms in 4%. Concerning
874 | ABSTRACTS
concomitants diseases in 61% of patients other allergic patholo- importance of the avoidance diet, thanks to which, it was not neces-
gies were present, being the most frequent atopic dermatitis, fol- sary to change the immunosuppressive treatment.
lowed by rhinoconjunctivitis and asthma. In addition 64% of cases Keywords: anaphylaxis; egg allergy; almond allergy; transplant-
referred family history of atopy. acquired food allergy (TAFA); intestinal transplantation.
Conclusion: Peanut allergy is responsible of severe reactions, with
29% of anaphylaxis in our study. In our population, as described,
the profile of persistent allergy to peanut in children is a male, with
LBTP1854 | First report of monosensitivity to
urticaria-angioedema as clinical manifestation, that tolerates other
the Atlantic wolffish ( Anarhichas lupus)
legumes, and with personal and family history of atopy.
Ganseman E1,2; Vanden Eycken C3; Coorevits L1;
de Jong NW4; Bullens DM1,5; Proost P2; Schrijvers R1,6;
Breynaert C1,6
LBTP1853 | Transplantation acquired egg 1
Department of Microbiology, Immunology and Transplantation, Research Group
and almond allergy in patient under tacrolimus Allergy and Clinical Immunology, KU Leuven, Leuven, Belgium; 2Department of
Microbiology, Immunology and Transplantation, Research Group Immunity and
immunosuppression Inflammation—Molecular Immunology, KU Leuven, Leuven, Belgium; 3Department
of Dermatology, University Hospitals Leuven, Leuven, Belgium; 4Department
Sánchez-Rodríguez A; Fernández-Crespo J;
of Allergology and Clinical Immunology, Erasmus Medical Center, Rotterdam,
Diéguez-Pastor MC
The Netherlands; 5Department of Pediatrics—Pediatric Allergology, University
Hospital 12 de Octubre, Madrid, Spain Hospitals Leuven, Leuven, Belgium; 6Department of General Internal Medicine—
Allergy and Clinical Immunology, University Hospitals Leuven, Leuven, Belgium
Case report:
Background: Transplantation Acquired Food Allergy (TAFA) is a Case report : The Atlantic wolffish ( Anarchichas lupus) is a fish
common phenomenon described after orthotopic solid organ trans- type belonging to the classification of the Perciformes, which also
plantation, especially after liver or kidney transplantation. This oc- comprises tuna and mackerel. The wolffish thrives in moderately
currence is mostly reported in childhood and the etiology of TAFA is deep and cold water and can be found mostly in the North Atlantic
still unclear. However, it is known that immunosuppression with cal- Ocean. Here, we report a case series of two patients with a unique
cineurin inhibitors (CNIs), especially tacrolimus, compared to other allergy only against wolffish, whereas they tolerate many other
CNIs, may play an important role in TAFA by inducing a shift towards types of fish. Patient 1, a 44-year old female, developed throat
T-helper 2 cells. swelling after consumption of wolffish. Specific IgE (sIgE) tests
Case report: A 53-year-old patient underwent intestinal transplanta- (ImmunoCAP, Phadia Thermofisher) were negative for all fish, includ-
tion due to a desmoid tumor associated with Familial adenomatous ing mackerel and parvalbumin. Skin prick tests (SPT) were positive
polyposis (FAP). Immunosuppressive treatment with tacrolimus was for wolffish, shrimp and house dust mite, and negative for oyster,
given. Five years after transplantation, the patient presented with salmon, codfish, tuna, flatfish and sole. SPT for mackerel, which
dysphagia, nausea, abdominal pain, vomiting, facial erythema and belongs to the Perciformes as well, was dubious. The patient toler-
diarrhea related to the immediate intake of raw or poorly cooked ated all these fishes, including crustacean and mollusca. Patient 2, a
egg. Six years later, the patient presented the same symptoms after 70-year old man, developed diffuse urticarial rash and hypotension
almond intake. Both foods were previously throughout his life. with an acute serum tryptase increase to 23.6 μg/L 2 hours after
Methods and results: Skin prick-test with egg commercial ex- ingestion of wolffish. Two years before, he already had an allergic
tracts, prick by prick with almond, general IgE and specific IgE reaction after eating wolffish and crustacean, however, at that time,
Immunoassay were performed. Skin prick testing was positive the crustaceans were thought to be the culprit as he had tolerated
for commercial extracts of egg white (EW) (7 mm), egg yolk (EY) all species of fish in between. SPT were positive for wolffish, scampi
(6 mm), ovoalbumin (OVA) (7 mm), ovomucoid (OVM) (14 mm). Prick and oyster, and negative for salmon, codfish, trout and shrimp. SPT
by prick was positive for almond (11 mm). The presence of Egg- were dubious for tuna, mackerel, tilapia and sole. sIgE was posi-
specific IgE antibodies with positive results for EW 3.14 kUA/L, tive for mackerel (1.18 kU/L) and negative for all other tested fish,
EY 0.91 kUA/L, OVA 1.67 kUA/L OVM 1.08 kUA/L and almond including parvalbumin. Additional basophil activation tests (BAT)
0.56 kUA/L confirmed the sensitization with no evidence of sensi- in both patients showed reactivity towards defatted wolffish and
tization to other nuts, profilin or LTP. untreated wolffish, but not to codfish and swordfish. An immuno-
Conclusion and clinical relevance: As displayed in this report, we blot using wolffish, codfish, swordfish and shrimp extracts and the
present a rare case of de novo egg and almond allergy, appearing in serum of both patients showed a strong binding to multiple protein
adulthood after intestinal transplantation. Given the limited experi- bands with a molecular weight between 37 and 50 kDa. Protein
ence in intestinal transplantation, increasing awareness of allergen bands with higher molecular weight showed reactivity as well, al-
sensitization following transplantation may help to prevent serious though less intense. On top of that, one of the patients reacted very
allergic reactions in transplant recipients. This case emphasizes the strong to a protein band around 30 kDa. No protein bands were
ABSTRACTS | 875
identified to codfish and swordfish. An oral provocation test with regions. Eight investigated proteins together (Gal_d1, Gal_d2 and
codfish and salmon in patient 2, was negative. Gal_d3; Bos_d4, Bos_d5, Bos_d6, Bos_d8 and lactoferrin) are suit-
To our knowledge, we hereby report the first case series of unique able for use as a sensitization markers equally as well as extracts in
sensitization to Atlantic wolffish or Anarhichas lupus, demonstrated in vitro molecular (serological) diagnostics. Developed method of
by SPT, BAT and immunoblotting. protein extraction from native sources will allow to investigate the
diversity of protein composition of different commercially available
food products that could be useful in correction of diet plans of al-
lergic persons.
LBTP1855 | Component-resolved study in
microarray format of cow milk and chicken egg
white major allergen proteins in allergic patients
LBTP1856 | Food allergy profiles observed
in Moscow region, Russia
within ethnic group populations in West
Stukolova O1,2; Dolgova A1; Tyumentseva M1;
Birmingham and Sandwell, UK
Andryushina T1; Sudina A1; Shipulin G3
1
Central Research Institute for Epidemiology, Federal Service on Consumers Ashton G
Rights Protection and Human Well-Being Surveillance, Moscow, Russia; 2Federal Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom
State Budgetary Scientific Institution Izmerov Research Institute of Occupational
Health, Moscow, Russia; 3Federal State Budgetary Institution Center for
Strategic Planning and Management of Medical and Biological Health Risks, Background: Studies in America have shown that there are differ-
Moscow, Russia ences in food allergy profiles seen in African American, Latino and
white populations but there is a paucity of data for the UK. The
Background: The cow milk and chicken eggs are well-known aller- population within the West Birmingham and Sandwell area in the
gen sources and ones of the main food products in Russia. However UK is ethnically diverse so data were collected to ascertain any dif-
there is still shortfalls of information about IgE reactivity to indi- ferences between the ethnic groups regarding allergenic foods.
vidual allergens from these sources in this region. Here we aimed Method: Data on the ethnicity of paediatric allergy patients and
to determine the profile of IgE reactivity to three major chicken egg their food allergies seen by a paediatric allergy dietitian at Sandwell
white allergens (Gal_d1, Gal_d2, Gal_d3) and five major cow's milk General and City Hospitals were collected for 6 months in 2018.
allergens (Bos_d4, Bos_d5, Bos_d6, Bos_d8, lactoferrin) in allergic Results: Data were collected on 221 patients and 13 ethnicities. Only
patients in Moscow region, Russia. milk was divided into IgE mediated and non IgE mediated (See table).
Method: The study was conducted using sera from 60 anonymous Nuts, milk and egg were the top three allergens in all ethnic groups.
subjects: 30 and 10 patients with ≥0.35 IU/mL serum levels of IgE to The most common nut allergy across all the groups was peanut, ex-
cow milk extract (f2, ImmunoCAP) and to chicken egg white extract cept for Black Afro-Caribbean where it was cashew. Egg was the
(f1, ImmunoCAP) respectively and 20 negative controls. Allergens commonest allergen in Black African and white European children.
were purified from chicken egg white, cow milk and blood serum The most common food allergy for white British children was non
using modified published methods. IgE levels were measured using IgE mediated cow's milk allergy whereas for Bangladeshi children it
specially developed microarray method. was jointly fish and peanut, for Black Afro Caribbean it was cashew
Results: Gal_d1 was found to bind IgE from 6/10, Gal_d 2 from and for Indian, Pakistani and Black Afro Caribbean it was egg.
9/10 and Gal_d 3 from 9/10 of the patients sera tested. Bos_d4, Milk allergy (IgE and non IgE) was common in all ethnicities, except
Bos_d5, Bos_d6, Bos_d8 and lactoferrin were found to bind IgE from white British, there was more IgE mediated than non-IgE mediated
21/30, 22/30, 20/30, 12/30 and l 3/30 of the patients sera tested milk allergy.
respectively. We found a moderate positive correlation between Conclusion: There were differences in the most common food al-
total IgE and specific IgE to all chicken egg white allergens and to lergens between ethnic groups. This may be a reflection of the types
Bos_d4, Bos_d5, Bos_d6 and Bos_d8. Only two samples classified by of foods eaten within these communities but may also reflect wean-
ImmunoCAP as negative showed positive signal to cow milk protein, ing and genetic differences. This would need to be explored further.
one of which was positive in ImmunoCAP f 27 (beef) test. About 95% A nut or milk allergy featured in the top 3 food allergies in the ma-
of the patients could be diagnosed as egg white or milk allergic using jority of the ethnic groups. Egg featured in the top 3 food allergies
the combination of these 8 allergens. for all groups. The ethnically diverse population means it would be
Conclusion: Sensitization to chicken egg white and cow milk indi- potentially be useful to develop more culturally appropriate dietetic
vidual allergens in Russia is comparable to previous studies in other resources, and in relevant languages.
876 | ABSTRACTS
Black Afro- Black White

White Indian Pakistani Bangladeshi Caribbean African European Other
(N = 80) (N = 36) (N = 33) (N = 15) (N = 14) (N = 14) (N = 9) (N = 20)
NUTS 32% 69% 58% 67% 36% 58% 12% 55%

Peanut 19% 42% 33% 33% 21% 50% 11% 90%
Cashew 5% 42% 30% 13% 30% 33% 11% 54%
Pistachio 5% 36% 18% 13% 14% 33% 11% 18%
Almond 1% 25% 3% 13% 7% 30% 0% 9%
Brazil 1% 3% 3% 7% 7% 33% 0% 9%
Walnut 3% 25% 6% 27% 7% 30% 0% 9%
Hazelnut 4% 22% 15% 20% 14% 33% 11% 18%
Egg 30% 53% 51% 27% 21% 67% 44% 80%
Milk Of 63% 33% 30% 47% 43% 50% 33% 50%
which
IgE 25% 30% 18% 27% 29% 50% 22% 40%
Non IgE 38% 3% 12% 20% 14% 0% 11% 10%
Wheat 4% 14% 9% 0% 0% 21% 0% 5%
Fish 4% 0% 9% 33% 21% 21% 0% 0%
Sesame 3% 6% 3% 0% 7% 7% 0% 5%
Soya 3% 14% 3% 0% 7% 0% 0% 0%
Lentil 1% 11% 9% 13% 0% 0% 0% 0%
The information from this survey would suggest that producing sup- their first years of life, but the allergy can be “outgrown” after some
portive literature about egg, milk and nut avoidance in a variety of years. The role of IgE vs IgG1 and IgG4 antibodies during the devel-
languages would be beneficial. It would also suggest that leaflets on opment of cowʹs milk allergy, or during re-establishment of tolerance
baked milk and egg introduction should contain more culturally ap- against cow milk on the other hand needs to be explored. We aimed
propriate foods. Further studies on weaning practices in these di- to generate IgE, IgG1 and IgG4 antibodies against the major milk al-
verse populations would need to be explored further. lergen beta-lactoglobulin (BLG) by Polymerase Incomplete Primer
Extension (PIPE) cloning.
Method: The antibodies, containing the variable region against BLG
(Jylhä et al. 2016), were assembled using the PIPE cloning method,
transformed into E. coli and finally transfected into Expi293F cells
LBTP1857 | PIPE cloning: Fast production of
for expression. After purification with affinity chromatography, cor-
human monoclonal IgG1, IgG4 and IgE antibodies
rect assembly of the antibodies was determined by SDS-PAGE, their
specific for the major milk allergen beta- specificity to BLG was investigated by dot blot, ELISA and ISAC 112
lactoglobulin allergen microarray. The functionality of the blocking capacity of
1 1 1 1 IgG4 was checked by inhibition immunoassays.
Pranger CL ; Singer JF ; Köhler VK ; Pali-Schöll I ;
Fiocchi A 2; Ilieva KM3; Karagiannis SN3; Jensen-Jarolim E1 Results: One transfection (30 mL) yielded 2.2 mg of IgE, 0.8 mg of
1
The Interuniversity Messerli Research Institute of the University of Veterinary IgG1 and 1.9 mg of IgG4 antibodies. Correct assembly of all anti-
Medicine Vienna, Medical University Vienna and University Vienna, Vienna, bodies was confirmed and their specific binding to BLG was double-
Austria; 2Pediatric Hospital Bambino Gesù, Rome, Vatican City, Italy; 3St. John's
checked in dot blot and in an allergen microarray with 112 allergens.
Institute of Dermatology, School of Basic & Medical Biosciences, King's College
London & NIHR Biomedical Research Centre at Guy's and St. Thomas’ Hospital In vitro, concentration-dependent specific binding of all antibodies
and King's College London, Guy's Hospital, King's College London, London, United to BLG was observed. Furthermore, IgG4 antibodies achieved a sig-
Kingdom
nificant inhibition of the binding of IgE to BLG in a concentration-
dependent manner in ELISA assays.
Background: Polymerase Incomplete Primer Extension (PIPE)
Conclusion: PIPE-cloning yielded high amounts of anti-BLG IgE, IgG1
cloning (Ilieva et al., 2017) is the newest technique to produce
and IgG4 antibodies with high specificity. They are ready to be ap-
allergen-specific monoclonal antibodies. Antibodies against beta-
plied in functional studies of milk allergy. They will also be suitable to
lactoglobulin could be useful tools in order to study the mechanisms
detect trace amounts of BLG in milk products to enhance patientsʹ
of cowʹs milk allergy and for the tracing of beta-lactoglobulin (BLG)
food safety.
in milk samples. Some infants suffer from cow milk allergy during
ABSTRACTS | 877
LBTP1858 | Changes in skin prick-tests and Conclusion: SPT and sIgE to CM, Casein, ALA and BLG significantly
decrease overtime following successful OIT to CM and support the
serum specific IgE in patients under Cowʹs Milk
immunomodulatory effect of OIT.
Oral Immunotherapy (OIT): A 48 months
follow-up evaluation
Freundt Serpa NP1; Gómez García I2; Serrano García I3; LBTP1859 | Clinical and serological
Fraga-Olvera A4; Flores-Cruz ML4; Jaqueti Moreno P1;
Uriarte Vega L1; Vázquez-Cortés S2; Cerecedo Carballo I2; characterization of a large cohort of red meat
Chaparro Briones P1; Cimarra Álvarez-Lovell M1; allergic patients from Sweden
Fuentes-Aparicio V5; González-Gutiérrez ML1;
Larco Rojas X1; Marchán Pinedo N1; Marco Martín G6; Kiewiet MBG; Apostolovic D; Grundström J;
Robledo Echarren T1; Rodríguez Álvarez M7; Starkhammar M; Hamsten C; Van Hage M
Sánchez-Morillas L2; Fernández-Rivas M2 Karolinska Institutet, Stockholm, Sweden
1
Allergy Department, Hospital Clínico San Carlos, IdISSC, Madrid, Spain;
2
Allergy Department, Hospital Clínico San Carlos, IdISSC, ARADyAL, Madrid, Background: Red meat allergy is a novel form of food allergy recog-
Spain; 3Hospital Clínico San Carlos, IdISSC, Madrid, Spain; 4Allergy and
nized worldwide. The patients experience severe allergic reactions
Immunology Department, Centro Médico Nacional ¨La Raza¨IMSS, Ciudad De
México, Mexico; 5Allergy Department, Hospital General Universitario Gregorio several hours after meat consumption and have IgE antibodies di-
Marañón, Madrid, Spain; 6Allergy Department, Hospital Universitario Infanta rected against the carbohydrate galactose-α1,3-galactose (α-Gal),
Sofía, ARADyAL, Madrid, Spain; 7Allergy Department, Hospital Universitario
which is present in mammalian meat. The onset of the disease is as-
Fundación Alcorcón, Madrid, Spain
sociated with tick bites. Here, we characterize a cohort of red meat
allergic patients from Sweden on a clinical and serological level.
Background: Cowʹs milk (CM) allergy is one of the most frequent
Method: A total of 137 patients were enrolled in the study by a
food allergies in children and the probability of acquiring natural
physician experienced in allergic disease, after they were diagnosed
tolerance is low after the age of 5. OIT to CM is an effective treat-
with red meat allergy. All had answered to a detailed questionnaire
ment to induce desensitization for these patients. We aimed to as-
regarding symptoms related to meat intake and tick exposure. The
sess the long-term effect up to 48 months follow-up (FU) of CM OIT
patient sera were analysed for IgE reactivity against protein extract
on serum specific IgE (sIgE) and skin prick-test (SPT) in patients who
from the European tick Ixodes ricinus (streptavidin ImmunoCAP)
were desensitized to 200 mL of CM.
and birch and timothy pollen using the ImmunoCAP System
Method: We carried out a retrospective analysis of 58 patients that
(Thermofisher Scientific, Uppsala, Sweden). The limit of detection
began cowʹs milk OIT protocol (Ethical approval nr. 05/345) between
was set at 0.1 kUA /L.
January 2006 and May 2013 and who were desensitized to 200 mL
Results: All patients were IgE positive to α-Gal and the median α-
of CM. SPT and sIgE (ImmunoCAP) to CM, Casein, alpha-lactalbumin
Gal IgE level of the cohort was 17.4 kUA /L (range 0.26-144 kUA /L).
(ALA) and beta-lactoglobulin (BLG) were measured at baseline, at the
Sensitization to pork and beef was observed in 98% and 98.5% of
end of desensitization (when 200 mL of CM were well tolerated on
the patients, respectively. They all suffered from the “classical” α-
a daily basis), at 6, 12, 24 and 48 month FU. During the FU period,
Gal-syndrome with delayed severe symptoms after mammalian meat
patients continued to have 200 mL of CM daily and/or free CM diet.
consumption. Nearly half (47%) reported anaphylaxis. The majority
IBM SPSS Statistics V. 21.0 and R V.3.2.2 were used for statistical
reported urticaria (91%) and gastrointestinal symptoms (75%) and
analysis including time dependent linear regression models.
more than half (60%) experienced angioedema. Neither the anti-α-
Results: The mean age of patients at baseline was 7.1 years (4-
Gal IgE/total IgE ratio nor the anti-α-Gal levels were associated with
15 years), 57% were boys, their first allergic reaction with CM had
symptom severity. The median age of the patients at time of inclu-
been on average at 4.8 months with the main presenting symptoms
sion was 49 years and men and women were in equal numbers. All
being urticaria, angioedema, erythema, vomiting and bronchospasm.
but three belonged to the B-negative blood groups (A/O). All pa-
Baseline SPT mean values in mm were: 8.47 for CM, 7.54 for Casein,
tients but one reported that they had been tick bitten and 77% were
9.40 for ALA and 8.40 for BLG. Baseline sIgE median values in
IgE positive to Ixodes ricinus. Also, 44% of the patients were clinically
kUA/L were 20.95 for CM, 15.00 for Casein, 5.48 for ALA and 2.33
diagnosed with airborne allergies, and sensitization to birch and tim-
for BLG. All patients had a persistent CM allergy confirmed by an
othy was observed in 72% and 63% of these subjects respectively.
entry CM oral challenge. The mean duration of the OIT was 96 days
Conclusion: The awareness of the α-Gal syndrome is increasing in
(range between 23 and 399 days). All SPT significantly diminished
Sweden. In this large cohort of patients almost half experienced
overtime with respect to baseline values: CM (P < 0.0001), Casein
anaphylactic shock pointing to the severity of the disease. All but
(P < 0.0001), ALA (P = 0.001) and BLG (P = 0.005). The same pattern
one patient had been tick bitten underlining the strong relationship
was observed in the sIgE for CM (P = 0.0007), Casein (P = 0.0003),
with tick bites. Pollen sensitization and the traditional atopic phe-
ALA (P = 0.01) and BLG (P = 0.07).
notype with airborne allergy was found to be common among these
patients.
878 | ABSTRACTS
MONDAY, 3 JUNE 2019

LB TPS 04
AIR POLLUTION AND ENVIRONMENTAL ALLERGIES
LBTP1860 | In-depth quantitative profiling of pollen extract was substantially lower in the 18 patients studied, as
post-translational modifications of Timothy grass measured by quantitative ELISA.

Conclusion: Quantitative, unrestricted, and detailed PTM searches
pollen allergome in relation to environmental
using an enrichment-free approach pointed to modifications of
pollution and oxidative stress Timothy pollen allergens and suggested that heavy metals are pri-
Smiljanic K1; Prodic I2; Apostolovic D3; Cvetkovic A4; marily responsible for oxidative stress effects observed as oxidative
Veljovic D5; Mutic J1; van Hage M3; Burazer L6; post-translational modifications of pollen proteins.
Cirkovic Velickovic T1,7,8
1
Centre of Excellence for Molecular Food Sciences, University of Belgrade-
Faculty of Chemistry, Belgrade, Serbia; 2Innovation Center Ltd, University of
Belgrade-Faculty of Chemistry, Belgrade, Serbia; 3Department of Medicine,
Karolinska Institute, Solna, Stockholm, Sweden; 4Institute of Public Health
LBTP1861 | Association between sensitization
of Belgrade, Belgrade, Serbia; 5University of Belgrade-Faculty of Technology
and Metallurgy, Belgrade, Serbia; 6Institute of Immunology, Virology and Sera to grasses and molds as cause of exacerbation
Production, Torlak Institut, Belgrade, Serbia; 7Ghent University, Faculty of
asthma in autumn
Bioscience Engineering, Ghent, Belgium; 8Serbian Academy of Sciences and
Arts, Belgrade, Serbia Hernández-Ramírez G; Pazos-Castro D; Garrido-Arandia M;
Tomé-Amat J; Pazos LF; Díaz-Perales A
Background: An association between pollution (e.g. from traffic Centre for Plant Biotechnology and Genomics (UPM-INIA), Universidad
emissions) and the increased prevalence of respiratory allergies has Politécnica de Madrid, Madrid, Spain
been observed. Field-realistic exposure studies provide the most

relevant assessment of the effects of the intensity and diversity of Background: Mold airborne and grass pollen are important aeroal-
urban and industrial contamination on pollen structure and aller- lergen sources with different seasonal behaviour: whereas pollen
genicity. The significance of in-depth post-translational modification levels have a marked seasonality (high levels in late spring and early
(PTM) studies of pollen proteomes, when compared with studies on summer), fungal spores are an ever component of the environment,
other aspects of pollution and altered pollen allergenicity, has not reaching highest levels in late spring and early autumn. In Central
yet been determined; hence, little progress has been made within Spain, clinical evidences about patients with grass pollen allergy
this field. who suffer from asthma attacks in September-October have been
Method: We undertook a comprehensive comparative analysis of reported, when pollen is not longer present but grass straw is.
multiple polluted and environmentally preserved Phleum pratense Method: In the current study, several assays have been performed
(Timothy grass) pollen samples using scanning electron microscopy, in order to prove a possible co-sensitization phenomenon between
in-depth PTM profiling, determination of organic and inorganic pol- grasses and associated-fungi. After identifying fungal species pre-
lutants, analysis of the release of sub-pollen particles and phenols/ sent in grass straw harvested in autumn, IgE immunodetection as-
proteins, and analysis of proteome expression using high resolu- says were performed to detect sensitization to both grass straw
tion tandem mass spectrometry. In addition, we used quantitative proteins and associated-mold proteins in a group of grass pollen
enzyme-linked immunosorbent assays (ELISA) and immunoglobulin sensitized-patients.
E (IgE) immunoblotting. Results: After having identified five fungal isolates from grasses
Results: An increased phenolic content and release of sub-pollen which have long been associated with allergy, immunodetection
particles was found in pollen samples from the polluted area, in- assay revealed that a high percentage of grass pollen sensitized-
cluding a significantly higher content of mercury, cadmium, and patients have sIgE against fungal proteins, having these patients IgE
manganese, with irregular long spines on pollen grain surface struc- against grass straw proteins too. Moreover, results suggest that al-
tures. Antioxidative defense-related enzymes were significantly lergens present in pollen could be conserved in grass straw.
upregulated and seven oxidative PTMs were significantly increased Conclusion: With the present study, we observed that grasses har-
(methionine, histidine, lysine, and proline oxidation; tyrosine gly- vested in September-October could be infected with mold spores
cosylation, lysine 4-hydroxy-2-nonenal adduct, and lysine carba- from species that play an important role in respiratory allergy.
mylation) in pollen exposed to the chemical plant and road traffic Patients with grass pollen sensitization showed a positive recogni-
pollution sources. Oxidative modifications affected several Timothy tion to mold and grass straw proteins. But also, allergic grass pol-
pollen allergens; Phl p 6, in particular, exhibited several different len proteins interact with fungal spores, acting spores like vehicle
oxidative modifications. The expression of Phl p 6, 12, and 13 al- of transmission of straw allergens. In summary, co-sensitization
lergens were downregulated in polluted pollen, and IgE binding to

ABSTRACTS | 879
process between both aeroallergen sources could be happening, LBTP1863 | Prevalence of asthma and obesity
being the base of asthma attacks observed in autumn.
and the role of environmental factors
Sepiashvili R1; Gamkrelidze S2; Chikhladze M2,3;
Khachapuridze D2,3
1
Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia;
LBTP1862 | Sensitisation and respiratory 2
National Institute of Allergology, Asthma and Clinical Immunology of Georgian
Academy of Sciences, Tskaltubo, Georgia; 3Faculty of Medicine, Akaki Tsereteli
symptoms induced by a new allergen from Peach State University, Kutaisi, Georgia
tree pollen in children and adolescents
Somoza ML1; Victorio Puche L2; Blanca-Lopez N1; Background: Air pollution and environmental factors is a well-known
Haroun Diaz E1; Garrido Arandia M3; López Sánchez JD2; risk for lung diseases, including asthma. Growing evidences suggest-
Diaz-Perales A3; Canto G1; Blanca M1 ing Air pollution and environmental factors as a novel risk factor for
1
Allergy Service, Infanta Leonor University Hospital, Madrid, Spain; 2Allergy the development of obesity. Several Epidemiological studies have
Service, Virgen de la Arrixaca University Hospital, Murcia, Spain; 3Center of
ascertained an association between various ambient and indoor air
Plant Biotechnology and Genomic, Universidad Politécnica de Madrid, Madrid,
Spain pollutants and obesity by medium of endocrine disruptive chemicals
that can disrupt the normal development and homeostatic controls
Background: Peach tree pollen (PTP) is relevant in sensitisation in over adipogenesis and energy balance and induce obesity. Several
children and adolescents in areas of peach cultivars and can induce obesity-induced mechanisms have been proposed that increases this
several clinical entities involving airways. We studied the frequency vulnerability of obese individuals to harmful effects of air pollution
of sensitisation to peach tree pollen as well as Pru p 9, a new allergen rendering them more susceptible to developing Air pollution and en-
identified by our group. vironmental factors driven incident asthma or worsening of already
Method: We carried out a population-based study in Blanca (Murcia existing asthma.
region, South-East Spain). We evaluated subjects who referred sea- Method: Asthmatic and control subjects were divided into 2
sonal respiratory symptoms. Their parents signed a written informed groups: obese and non-obese. The asthma group consisted of 24
consent and the subjects answered an adapted questionnaire super- women (10 obese and 14 non-obese). Among the 22 women in the
vised by their caregivers. We did skin prick tests (SPTs) to prevalent control group, 14 were of normal weight, while 8 were obese. Mean
pollens, PTP and Pru p 9 as well as Nasal provocation test (NPT) with age of the obese asthma patients (n = 40) was 35.4 ± 10.5 year,
PTP and Pru p 9 in 11 randomly selected children and adolescents whereas mean age of the nonobese asthma patients (n = 33) was
with positive SPT. The response was measured by symptoms score 30.8 ± 6 year. The control group consisted of 14 women of normal
and acoustic rhinometry. weight (mean age: 30 ± 7.5 year) and 8 obese women (mean age:
Results: We included 615 subjects aged between 3 and 19 year 32 ± 9.5 year).
old. No differences were found in gender. The 34% of them were CD4+, CD8+ T cells, leptin, interleukin-6 (IL-6) and Vitamin D were
sensitised to pollens: O. europaea 33%, P. pratense 26%; S. kali 19%, compared between obese, asthmatics and control subjects of nor-
C. arizonica 17%, P. Judaica 13%, P. acerifolia 10% and A. vulgaris mal weight. Respiratory function tests and allergy skin tests were
9%. also performed in the patients with asthma.
The 20% of them had positive SPT to PTP (median age 12 years Results: Interleukin-6 (IL-6), and leptin levels in obese asthma pa-
old, 61% male, 89% atopic). These subjects referred Rhinitis (67%), tients were higher than in the healthy controls (P < 0.01). IL-6 and
Conjunctivitis (57%) and Asthma (18%). In a randomly selected sub- leptin levels were higher in obese asthma patients than in non-obese
group of subjects sensitised to PT pollen, the 30% were SPT+ to Pru asthma patients (P < 0.01). No association was found between CD4+,
p 9. Nine out of 11 NPT with PTP were positive. In those who had a CD8+ T cells, Vitamin D,allergy test results and obesity (P > 0.05).
positive challenge with PTP we performed NPT with Pru p 9, being Conclusion: It is well documented that increased exposure to indoor
positive in four subjects. allergens and selected outdoor allergens (grass pollen and molds) are
Conclusion: In exposed children and adolescents, PTP is the third important risk factors for development of asthma and allergic sen-
most prevalent in sensitisation after olive and grass pollen and in- sitization. We identified, inflammation markers were at their high-
duced symptoms after specific nasal challenge. The new allergen est levels in obese asthma patients. Leptin levels were considerably
from PTP, Pru p 9, can elicit respiratory symptoms in sensitised chil- higher in obese patients than in normal weight controls. Like obe-
dren and adolescents. Other allergens in addition to Pru p 9 seem to sity, leptin is suggested to play a role in the pathogenesis of asthma.
be also implicated. The publication has been prepared with the support of the «RUDN
University Program 5-100».
880 | ABSTRACTS
LBTP1864 | Atmospheric pollutants NO2 LBTP1865 | Performance of the personalized

and O3 enhance allergenic potential of Dactylis allergy symptoms forecasting system
glomerata pollen Ritenberga O1; Sauliene I2; Sukiene L2; Berger U3;
Rodrigues Costa A1,2; Galveias A1,2; Arriegas R1,2; Abreu I3,4; Palamarchuk Y4; Sofiev M4
Helena R3,4; Antunes CM1,2
1
University of Latvia, Riga, Latvia; 2Siauliai University, Siauliai, Lithuania;
3
1 Medical University of Vienna, Vienna, Austria; 4Finnish Meteorological
Departamento de Química, Escola de Ciências e Tecnologia, Universidade
Institute, Helsinki, Finland
de Évora, Évora, Portugal; 2Instituto de Ciências da Terra, Évora, Portugal;
3
Departamento de Biologia, Faculdade de Ciências, Universidade do Porto, Porto,
Portugal; 4Instituto de Ciências da Terra, Porto, Portugal Background: The current study presents the performance of the
symptom forecasting model of Personalized Pollen Allergy Symptoms
Background: Airborne pollen during its transport become in contact Forecasting System that has been run over the pollen season of 2018
with a variety of atmospheric chemicals, including the common air in Europe in a format of a web-page (www.pasyfo.lt) and free-of-
pollutants O3 and NO2. Nevertheless, the effect of these pollutants, charge mobile application developed in Medical University of Vienna.
alone or in combination, is not fully elucidated. With a strong oxidiz- The software is available in nine languages, including four languages
ing potential, ozone may affect pollen redox balance and contribute (Lithuanian, Latvian, Russian and English) for Latvia and Lithuania.
to change the ratio of ROS scavenging enzymes and in the presence Method: The system consists of numerous segments, and several
of NO2, may also contribute to the nitration of proteins, including forecasting models developed using statistical methods as well as
allergens, affecting pollen allergenicity. Traffic-related pollution may the reference persistence-forecasting approach. The system pro-
as such contribute to an increased prevalence of pollen driven aller- vides instrumentation for combining the symptom entries with air
gic diseases in urban areas. quality and pollen concentrations predictions of the Copernicus
The goal of this research was to study the effects of O3, NO2 and Atmospheric Monitoring Service downscaled using computations of
the mixture of both pollutants on IgE-reactivity patterns to Dactylis SILAM model (FMI) for Northern Europe.
glomerata pollen, as well as on the levels of Dac g 5 and profilin by Results: Users of the system in case of Latvia and Lithuania in 2018
immunoblot. are mostly (70%) women, with the age range 25-43 years. The cur-
Method: D. glomerata pollen was treated in an environmental cham- rent evaluation refers to the statistical model, which projects the
ber during 6 hours. Protein extracts from unexposed (Control) or environmental parameters to the user entries (i.e. symptoms). The
exposed to air pollutants (O3, NO2 or O3+NO2) pollen samples were result of the performance varies from user to user. Statistical analysis
prepared in phosphate buffered saline (PBS) and frozen until analy- of the performance shows correlation coefficients fluctuation from
sis. SDS-page separated proteins were blotted and used to obtain very low to high (>0.85). The first preliminary results suggest that
IgE-reactivity patterns with pooled sera (from four D. glomerata over 50% of the patients were predicted with >0.5 correlation coef-
EAST-positive sera) and with antibodies against grasses group 5 al- ficient, better scores obtained for nose and eye, worse—for lungs.
lergens and profilin. Conclusion: The evaluation corroborates with the results of the
Results: IgE-reactivity have shown bands with MW of 15, 29, 33, 37, PASYFO feasibility study and the main hypothesis behind the sys-
46, 52, 57, 60, 69 and 142 kDa (intensity >4%). Bands with 15, 57 tem: symptoms can be successfully forecasted for a substantial frac-
and 60 kDa were intensified by NO2 exposure compared to control. tion of the allergy sufferers.
Pollen exposure to O3 induced an amplification of IgE-reactivity in “The study was partly covered by the project of EC ERDF and PostDoc
40% of the detected bands (29, 33, 60, 66, 69, 74 and 80 kDa). Pollen Latvia No 1.1.1.2/VIAA/2/18/283 ‘Development of Pollen data fusion
exposed to O3+NO2 showed augmented IgE-reactivity in bands with and assimilation: Real-time MonItoring and Modelling for public health’”.
14, 15, 18, 57, 66 and 80 kDa. Some of the bands identified to be
affected by the pollen exposure to air pollutants of MW 29, 33 and
60 kDa, have correspondence to known allergens, respectively, Dac LBTP1866 | Temporal changes in molecular
g 5, Dac g 1, Dac g 4. Additionally, immunoblot performed with IgG aerobiome diversity by applying DNA
anti-Dac g 5 and anti-profilin confirmed overexpressed bands with,
metabarcode sequencing across the pollen season
respectively, ~30 kDa and ~13 kDa, in O3 treated pollen.
Conclusion: D. glomerata pollen exposure to O3 and NO2 showed Campbell B1; Al Kouba J2; Noor M3; Timbrell V1; Gilding E4;
Angel N4; Kemish B4; Massel K4; Hugenholz P4; Godwin I4;
enhanced IgE recognition of several proteins, some of which are de-
Davies JM1,5
scribed allergens. These results suggest that common air pollutants 1
Queensland University of Technology, Brisbane, Australia; 2Macquarie
contribute to an increased pollen allergenicity and directly correlat-
University, Sydney, Australia; 3Fatima Jinnah Women University, Rawalpindi,
ing with the higher incidence of respiratory allergic diseases in urban Pakistan; 4University of Queensland, Brisbane, Australia; 5Metro North Hospital
areas. and Health Service, Brisbane, Australia
Background: The importance of grass pollen to the global burden

of allergic respiratory disease is well established but difference in
ABSTRACTS | 881
exposure to subtropical and temperate Poaceae pollens is difficult to of respiratory diseases, including hypersensitivity pneumonitis (HP),
discern. Current monitoring of airborne pollen relies on light micros- which is one of the most frequent reasons for this phenomenon. As
copy limiting for most pollen identification of taxa to family level. the main mechanism of pulmonary fibrosis is a pathology of repair of
We aimed to apply DNA metabarcoding to identify specific taxa con- wounded pulmonary epithelium, we assumed that improvement of
tributing to the aerobiome of environmental air samples and assess its regeneration by application the natural enhancer of this process—
temporal variation of Poaceae pollen across the season. cathelicidin (CRAMP; antimicrobial peptides, a key component of in-
Method: Airborne pollen concentrations were determined by nate immunity) could prevent or slow down the disease development.
light microscopy over two pollen seasons in the subtropical city of Method: The studies were performed in mice model of HP, wherein
Brisbane (27°S, 152°E), Australia. Daily pollen samples, collected pulmonary fibrosis is induced in mice strain C57BL/6J by chronic ex-
simultaneously with a standard continuous flow volumetric pollen posure to saline extract of Pantoea agglomerans (SE-PA). Cathelicidin
and spore trap, one every 7 days over 30 weeks, were subjected was administering in a form of aerosol during and after HP devel-
to high throughput DNA sequencing of the plastid rbcL amplicons. opment. CRAMP was used in dose needed to obtain in mice lung
Frequency of amplicon reads for identified taxa, principal compo- tissue concentration two times higher than the physiological. The
nent and redundancy analysis of aerobiome community diversity influence of CRAMP chronic exposure on lung tissue was also inves-
and median-joining network analysis of taxa were performed. tigated. Changes in the expression of genes involved in epithelial-
Results: Amplicons from a pilot study of 12 samples collected mesenchymal transition (EMT) were examined in lung tissue
during summer corresponded to plants observed in the local homogenates by the Real Time PCR.
biogeographical region and airborne pollen observed by micros- Results: Performed studies revealed that cathelicidin decreases
copy. During the following pollen season, 3238 different opera- the elevated level of myofibroblasts markers ( Vim, Acta2, Fn1,
tional taxonomic units (OTU) were detected in 30 environmental Cdh2) as well as increase the lowered level of epithelial markers
air samples. The aerobiome sequencing data identified pollen to (Cdh1, Ocln) in mice model of HP. Cathelicidin also reduced the
genus and species levels. Redundancy analysis of the OTUs and expression of Snail1, Snail2, Zeb1, Zeb2 (transcription factors re-
sequencing read counts indicated significant quantitative differ- sponsible for EMT process) up-regulated by SE-PA exposure.
ences in aerobiome diversity between the months and seasons. Cathelicidin also inhibited the expression of key representatives
Multiple peaks of Chloridoideae and Panicoideae grass pollen of signaling pathways leading to mesenchymal differentiation
were evident over the season confirming these subtropical grasses ( Tgfb1, Nfkb1, Ctnnd1, Wnt1, Wnt2, Wnt3a, Wnt5a, Notch1, Notch3)
as the dominant Poaceae pollen sources in this subtropical region accelerated by SE-PA treatment. The beneficial impact of CRAMP
in spring as well as summer. on the expression of mentioned genes was observed both during
Conclusion: DNA metabarcode sequencing of airborne pollen ap- and after HP development. Nevertheless, cathelicidin was not able
plied to routinely collected environmental air samples offers signifi- to completely neutralize the negative changes induced by SE-PA.
cant utility to track temporal changes in aerobiome diversity with Furthermore, it has to be noted that mice chronic exposure to
potential to monitor short- and long-term shifts in pollen exposure. cathelicidin did not cause any side-changes in the expression of
Precise identification of the composition and temporal distributions investigated genes.
of airborne pollen is important for tracking biodiversity and for man- Conclusion: Our results suggested the possibility of cathelicidin
agement of allergic respiratory disease. using in the prevention and treatment of pulmonary fibrosis.
This work was funded by National Science Centre, Poland: grant
number 2015/19/D/NZ7/02952.
LBTP1867 | Cathelicidin treatment reduces

negative changes in the expression of genes
involved in pulmonary fibrosis in mice model of LBTP1868 | Important of aeropolinologic study
hypersensitivity pneumonitis in children with risk of respiratory allergies
Lemieszek MK1; Golec M2; Dutkiewicz J3; Zwolinski J3; Sepiashvili R1; Chikhladze M2; Gamkrelidze S2;
Milanowski J2 Khachapuridze D2
1
1 People's Friendship University of Russia (RUDN University), Moscow, Russia;
Department of Medical Biology, Institute of Rural Health, Lublin, Poland; 2
2 National Institute of Allergology, Asthma and Clinical Immunology Georgian
Department of Pneumonology, Oncology and Allergology, Medical University
Academy of Sciences, Tskaltubo, Georgia
of Lublin, Lublin, Poland; 3Department of Biological Health Hazards and
Parasitology, Institute of Rural Health, Lublin, Poland
Background: Aeropolinologic study and monitoring in modern clini-
Background: Pulmonary fibrosis is more and more frequent pa- cal medicine acquired particular importance, as far as it is known
thology in aging global population. Unfortunately, this disorder is that among the etiologic risk factors of respiratory allergies .
characterized by a bad prognosis: no treatment is known and the Method: The goal of the study was to determine frequency and
survival is dramatically low. Pulmonary fibrosis occurs in a number character of dysfunction of bronchi in the children (n = 500, 275
882 | ABSTRACTS
boys and 225 girls) of the early school age (7-12 yy.) by the peak flow the users of the Family and Community Health Unit (USFC) about
meter method and computer spirometry. the harmful effects of smoke in children's health.
Results: It was found that 19.6% of the practically healthy chil- Method: Through a questionnaire, the knowledge of the population
dren of the early school age had decreased peak expiration rate. about smoking and the health risks of children derived from smoke
Decreased peak expiration rate under the physiological conditions in its different forms were evaluated: in the same environment, in a
was revealed in 61.2%, dysfunction of external respiration with different environment or in the external environment of the house
positive provocation test of the misty distilled water in 27.5%, the where the child lives. It was questioned the relation of these types of
obstruction of bronchi with physical tension only in 11.3% of the smoke with asthma, low growth, obesity, frequent colds, pneumonia,
sample. It was designated correlation between decrease peak flow otitis, hearing loss, tonsillitis and snoring.
rate and pulmonary function indices such as: (FVC) r = 0.4; (FEV1) Results: The results showed that, among the responses, there was
r = 0.6; (FEV1/VC) r = 0.2; (PEF) r = 0.3; (MEF 50%) r = 0.5; (MEF a greater relationship between smoking and respiratory diseases,
25%) r = 0.4. Thus the peak flow meter method and spirometry with percentages up to 96.4% in asthma in children in the same
permits to reveal among the children of the early school age the environment, up to 45.8% (P < 0.005) in outdoor settings. Besides
patients with dysfunction of bronchi and to unite them into the that, the population does not believe that the other diseases, not
risk group of respiratory allergies. The data of aeropolinometer directly connected to the respiratory system, are related to any
“Burkard Trap” were defined in accordance with the calendar for type of smoke. As an example, hearing loss had a connection with
distribution of aeroallergens reflecting concentrations of blos- smoking habits in the same environment for only 38.9% of the in-
soming tree-plants and atmospheric aerosols in the air. Permanent terviewed people, when smoking in external places could be con-
monitoring of the aeropolinometer “Burkard Trap” data proved that nected with this disorder in 16.5% (P < 0.005) of the answers. Also,
in west Georgia the beginning of aeroallergens’ increasing concen- the present study revealed no significant relation between school
trations is in March and the ending—in October, respectively, the degree, smoking habits or the presence of children cohabitating
peak is in May, when atmospheric concentrations of approximately the house and the knowledge of the harms of passive and third-
21 plants are increasing in the air simultaneously. Ambrosia, plan- hand smoke.
tain, common hazel, birch tree, alder, ryegrass, flowering period of Conclusion: The knowledge of the population about the topic
which is given in the calendar, are widely spread and characterized showed itself to be unsatisfying; the majority of the people only as-
with high allergenicity. Every above-mentioned diagnostic mark- sociated the health problems in children due to cigarette smoking in
ers have high degree correlation with each other and correlation the same environment and leading to respiratory diseases.
coefficient was r = 0.6, on average.
Conclusion: Calendar for distribution of aeroallergens in West
Georgia, and updated information about the concentration of aer-
LBTP1870 | The impact of environmental
oallergens are constantly given to the children who are from high
conditions on the expression of the major fungal
risk group of respiratory allergy. High degree correlation between
the above-mentioned markers proves its clinical importance/value
allergens Alt a 1 and Ulo c 1—A comparative
with respect to respiratory allergy. The publication has been pre- study on an indoor and outdoor fungal allergen
pared with the support of the «RUDN University Program 5-100». source
Pfeiffer S1; Sandler P1; Sterflinger K 2; Swoboda I1
1
Molecular Biotechnology Section, University of Applied Sciences, Campus
LBTP1869 | Second and third-hand smoke: Vienna Biocenter, Vienna, Austria; 2Department of Biotechnology, University of
Natural Resources and Life Sciences, Vienna, Austria
Public perceptions of the risks for children's
health Background: Fungi, ubiquitous organisms, are among the most im-
Bernhardt CDSD; Souza PDS; Zorzan AR; Bastos BS; portant inducers of respiratory allergy. Alternaria alternata, a fungus
Bernhardt TD; Wiese B; Bernhardt PD omnipresent in the outdoor environment, is one of the best stud-
Univali-Universidade do Vale do Itajaí, Itajaí, Brazil ied fungal allergen sources. The clinical significance of the species’
major allergen, Alt a 1, has been well documented. In contrast, much
Background: Passive smoking is a form of secondary exposure to less is known about the allergenic potential of the closely related
the components of cigarette smoke by nonsmoking individuals in the fungus Ulocladium chartarum, a typical indoor-species. We recently
same environment as an active smoker. Third-hand smoking is the identified Ulo c 1, an Alt a 1-homologous allergen, as the major U.
contamination of tobacco products that persists in the environment chartarum allergen. The aim of the present study was to compare the
after the cigarette has been put off. Both are harmful to health, and effect of different growth conditions on the expression of Alt a 1 in
it is believed that many diseases and conditions can be developed in the outdoor fungus A. alternata and Ulo c 1 in the indoor species U.
children under its influence. This study evaluates the perception of chartarum.
ABSTRACTS | 883
Method: Strains of A. alternata and U. chartarum were cultivated at LBTP1872 | Effect of living environment on IgE
different temperatures (4°C, 37°C, room temperature), under dif-
sensitization to the non-biting midge (Chironomus
ferent conditions of light exposure (darkness, constant light, natu-
flaviplumus, Chironomus kiiensis and Cricotopus
ral light cycle) and on different carbon sources (glucose, cellulose,
methylcellulose). Proteins were extracted from the fungal mycelium
bicinctus)
and spores and the expression of Alt a 1 and Ulo c 1 was investigated Yi M; Kim JY; Ree H; Yong T
in Western blots using an anti-Alt a 1 antiserum. Department of Environmental Medical Biology, Institute of Tropical Medicine,
Results: We observed that even though the carbon source had an influ- Arthropods of Medical Importance Resource Bank, and Yonsei University College
of Medicine, Seoul, South Korea
ence on the growth of both fungi, it did not affect the production of Alt
a 1 and Ulo c 1. In contrast, light exposure as well as the growth tem-
Background: Chironomids (non-biting midges) are widely and abun-
perature had an impact not only on the fungal growth, but also on the
dantly distributed near ponds, rivers, and artificially dammed pools
production of both major allergens. While Alt a 1 was predominantly
used for irrigation. Chironomids contain allergens and cause airway
produced at room temperature, Ulo c 1 was also highly expressed at a
allergic diseases in humans. In this study, we aimed to examine the al-
temperature of 37°C. Furthermore, it was interesting to see that light
lergenic potential of chironomids in inhabitants living near artificially
increased the expression of the major allergens of both species.
dammed pools.
Conclusion: In conclusion, we saw that the carbon source, the growth
Method: We examined the IgE reactivity to chironomid extract in
temperature as well as the conditions of light exposure influence the
the sera of residents living around installed dams and assessed the
growth of both A. alternata and U. chartarum. Furthermore, we ob-
correlations of IgE responses between chironomids (Chironomus fla-
served that the exposure to light and the growth temperature also af-
viplumus, Chironomus kiiensis, Cricotopus bicinctus) and house dust
fected the expression of the major allergens Alt a 1 and Ulo c 1. The
mites (Dermatophagoides farinae). Specific IgE antibodies in sera col-
obtained information will help to optimize the culture conditions for the
lected from the participants against the extracts were tested using
two allergen sources to allow high allergen expression for the produc-
enzyme-linked immunosorbent assay (ELISA).
tion of improved diagnostic and therapeutic fungal allergen extracts.
Results: The averages IgE-positive rates were 10.4%, 8.1%, 8.2% and
This study was funded by project H-279048/2018 of the
14.3% in C. bicinctus, C. flaviplumus, C. kiiensis and D. farinae, respec-
“Hochschuljubiläumsstiftung” of the City of Vienna and by project
tively. Interestingly, people living around installed dams were found
856337 of the FFG (Austrian Research Promotion Agency).
to have higher IgE responses to C. bicinctus than those living in other
places (P = 0.013). In addition, the results showed that there was
a positive association between HDM-specific IgE reactivity and C.
LBTP1871 | Prophylaxis of allergic rhinitis in bicinctus-specific IgE (P < 0.0001).
the light of own research Conclusion: Our data showed that people living around installed
Strózek JB; Krzych-Falta E; Lisiecka-Bielanowicz M; dams were more sensitized by C. bicinctus than those living in other
Furmanczyk K; Staron K; Samolinski B places. Further studies are needed to investigate there is a unique
Medical University of Warsaw, Warsaw, Poland allergens in C. bicinctus.
Background: Allergic diseases are an important problem in environmen-

tal medicine and public health. Undoubtedly, allergic rhinitis absorbs to LBTP1873 | Respiratory symptoms induced by
a large extent due to a number of factors costs, which can undoubtedly
two new Peach tree pollen allergens: Pru p 9 and
be minimized based on ready-made patterns of preventive measures.
Ole e 6-like
The purpose of this study was to assess the use of selected forms of
secondary prevention by patients diagnosed with perennial allergic. Somoza ML1; Victorio Puche L2; López Sánchez JD2;
Method: The study population comprised 18 617 respondents, 4783
Garrido Arandia M3; Romero Sahagún A3; Diaz-Perales A3;
Villalba M4; Canto G1; Blanca M1
of whom were qualified to undergo a medical examination. The
1
Allergy Service, Infanta Leonor University Hospital, Madrid, Spain; 2Allergy
study used ECRHS and ISAAC questionnaires adapted for Europe.
Service, Virgen de la Arrixaca University Hospital, Murcia, Spain; 3Center of
Results: Nearly 20% of patients diagnosed with chronic allergic rhinitis Plant Biotechnology and Genomic, Universidad Politécnica de Madrid, Madrid,
used preventive measures against house dust mites; this is in contrast Spain; 4Departamento de Bioquimica y Biologia Molecular, Facultad de
Quimicas, Universidad Complutense de Madrid, Madrid, Spain
with 13% of the control group (P = 1.358e−07). The secondary preven-
tive measures used most commonly in the study group were, in de-
Case report: Peach tree (PT) pollen is entomophilous, not trans-
scending order of frequency, mattress protectors and anti-dust-mite
ported by air, and can elicit allergy symptoms in farm workers after
spray. Undertaking preventive measures was most common among
occupational exposure. They are considered not relevant in non-
study participants with a higher education and residents of large cities.
exposed people. However in previous studies from our group PT
Conclusion: The proportion of patients diagnosed with a dust-mite
pollen was the third most prevalent in sensitisation after olive and
allergy who undertook preventive measures against perennial aller-
grass. These are data from a population-based study carried out in
gic rhinitis was relatively low.
884 | ABSTRACTS
Blanca (Murcia region, South-East of Spain) where there are high Continent (Vila Real, Porto, Coimbra, Castelo Branco, Lisboa, Évora
extensions of peach orchards. We have identified several allergens and Portimão) and 2 in islands (Funchal and Ponta Delgada, Madeira
from PT pollen. These data were also confirmed in children and ado- and Azores islands, respectively) were used. For airborne pollen
lescents of the same region. monitoring a Burkard Seven Day Volumetric Spore-trap® and the
We report a case of 12 year old girl living in an area of PT cultivars associate methodology suggested and recommended by European
who in the past 4 years developed symptoms from late February to Aerobiology Society—EAS were used. The influence of the mete-
early June consisting of nasal obstruction, rhinorrhea and sneezing orological factors on the atmospheric levels of Platanus pollen was
often accompanied with wheezing treated with B2 inhalers for con- analysed with Spearman's correlation.
trol. Symptoms appeared at visits or stays in the family farm in the Results: There were qualitative, quantitative and aerobiological dif-
period of Peach tree (PT) flowering and required to avoid exposure ferences among the regions. Platanus pollen presented, on average,
by leaving the place. Skin prick test (SPT) were positive to olive, the following representation in the pollen spectrum of the regions;
grass and PT pollen and negative to peach fruit as well as Pru p 6% Porto, 9% Coimbra, 6% Lisbon, 8% Évora, 2% Vila Real, Castelo
3. SDS-PAGE immunoblotting showed two allergenic bands recog- Branco, Funchal and Ponta Delgada and <1% in Portimão. In all local-
nized by IgE antibodies. These were isolated, purified, sequenced ities, the pollination season was very short and occurred during the
and named: Pru p 9 and Ole e 6-like proteins. The SPTs were posi- months of March and April. Concentrations of this pollen in the air
tive to both allergens. Nasal challenges with PT pollen and Pru p outside this period were minimal. The highest daily levels and levels
9 were positive as well as with Olive tree pollen and Ole e 6-like. of pollen were recorded in Coimbra and particularly in Évora. There
Because sensitisation to Peach tree pollen is highly prevalent in re- were significant correlations between their levels and the meteoro-
gions of peach cultivars, children directly or indirectly exposed to logical parameters.
PT pollen with symptoms in the flowering period must be evaluated. Conclusion: Considering the allergenic potential of Platanus pollen
Pru p 9 and Ole e 6-like are peach tree pollen allergens that can be and its prevalence in several Portuguese regions, this study provides
involved in the elicitation of symptoms. useful and relevant information to health professionals and general
population. As such, complains and pollinosis symptoms related with
the aerobiology of this pollen type will be better correlated and ac-
curately evaluated.
LBTP1874 | Aerobiology of plane tree pollen
(Platanus hispânica Miller ex Münchh) in Portugal
Caeiro E1,2; Nunes C1,3; Câmara-Camacho I1,4;
Morais-Almeida M1,5; Carreiro-Martins P1,6,7;
Rodrigues-Alves R1,8; Pedro E1,5,9
1
Sociedade Portuguesa de Alergologia e Imunologia Clínica—SPAIC, Lisboa,
Portugal; 2Instituto de Ciências Agrárias e Ambientais Mediterrânicas-ICAAM,
Universidade de Évora, Évora, Portugal; 3Centro de Imunoalergologia do Algarve,
Portimão, Portugal; 4Faculdade das Ciências da Vida, Universidade da Madeira,
Funchal, Portugal; 5Centro de Alergia, Hospitais CUF-Descobertas e CUF Infante
Santo, Lisboa, Portugal; 6Centro Hospitalar de Lisboa Central—CH, Lisboa,
Portugal; 7Nova Medical School, Lisboa, Portugal; 8Hospital do Divino Espírito
Santo, Ponta Delgada, Portugal; 9Centro Hospitalar Universitário Lisboa Norte-
CHLN, Lisboa, Portugal
Background: The plane tree is widely used as an ornamental in urban

environments and its pollen is considered an important cause of pol-
linosis in Europe. The aim of this study is to analyse the prevalence
and aerobiological behavior of Platanus pollen in Portugal.
Method: In this study, the daily data of Platanuspollen monitoring
and meteorological data, between 2002 and 2017, of 9 monitoring
centers of the Portuguese Aerobiology Network—RPA: 7 centers in
ABSTRACTS | 885
MONDAY, 3 JUNE 2019

LB TPS 05
AIRBORNE ALLERGENS AND UPPER AIRWAYS
LBTP1876 | Horse sensitization and allergy and coughing, with pulmonary wheezing and crackles, and dyspnea.
to mold, pollen, dust and storage mites, and Intradermal results were as follows (table):
Conclusion: No correlation was found between i) IDT response to
culicoides in a horse population from southern
molds, mites, pollens or culicoides and ii) predominant outdoor or
Portugal indoor living and sensitization to molds, pollens or mites. Except for
Leocádio JG1; Galhós A 2; Damásio L2; Leal CR 2; Fino T2; the majority of culicoides-sensitized, where a seasonal worsening
Martins LM3 was found, allergy signs appeared perennial due to a possible con-
1
Departamento de Medicina Veterinária, Escola de Ciências e Tecnologia, tinuous prevalence of different molds, pollens and dust or storage
Universidade de Évora, Évora, Portugal; 2Equimuralha, Lda., Évora, Portugal;
3 mites in horse housing or to a possible food allergy.
Departamento de Medicina Veterinária, ICAAM-Instituto de Ciências Agrárias
e Ambientais Mediterrânicas, Escola de Ciências e Tecnologia, Universidade de
Évora, Évora, Portugal
LBTP1877 | Expression of estrogen receptor

Background: Allergy in horses may present different forms like re-
(ER)-α in nasal polyps and the effects of
current airway obstruction with cough and dyspnea or pruritic hives
and eczema, with scaly and crusty alopecia. Those signs may resem-
dexamethasone on ER-α expression and
ble human, cat or dog atopy, but some horses may also present food apoptosis in RPMI 2650 cells
hypersensitivity, mostly to oat, wheat and corn. Identification of Baek BJ; Ban WW; Jeong JY
the most implicated allergen sources in each region is then useful Cheonan Hospital, Soonchunhyang University, Cheonan, South Korea
for an effective allergy control. Clinical inquiry should be done in
the presence of compatible clinical signs, followed by intradermal Background: Nasa polyps (NPs) are inflammatory outgrowths
testing (IDT) for environmental sources and exclusion diets if food of sinonasal epithelium, with the most commonly observed as-
allergy is suspected. When environmental or culicoides allergy is sociation being chronic rhinosinusitis. Glucocorticoids are drug
suspected, diagnosis should proceed by specific IgE determination, of choice for clinical treatment of NP. There is evidence that the
especially if allergen-specific immunotherapy is equated. This study nasal mucosa is affected by estrogen influence. Estrogen receptor
aimed to identify the main allergen sources for horses living in the (ER)- α, one of estrogen receptors, is known to be related to anti-
region of Alentejo, Portugal, allowing better avoidance strategies or inflammatory action and also to cell survival in certain tissues. In
immunotherapy. this study, we examined the presence or absence of ER-α in NP
Method: Twenty one horses (16 males and 5 mares; 13 cross-breed, and healthy inferior turbinate mucosa. And we also investigated
5 lusitanic and 3 arabian cross) presenting with compatible clinical the effects of dexamethasone on ER-α expression, cell viability,
signs were selected from a consultation population. Each horse was and apoptosis in RPMI 2650 cells.
submitted to clinical inquiry followed by IDT with a battery of 18 Method: Immunohistochemical staining and Western blot analy-
commercial allergen extracts from molds, pollens, dust and storage sis were performed to determine the expression of ER-α in NP
mites, and culicoides. IDT was performed on a left neck trichoto- and healthy inferior turbinate mucosa. After treating RPMI 2650
mized area, by administering 0.05 mL of each extract and positive cells with dexamethasone, expression of ER-α was analyzed using
and negative controls. Results were read upon 15 minutes for wheal Western blot analysis, cell viability was determined using MTT assay,
and flare reactions and scored from 0 to 4. and Western blot analysis and Annexin V-phycoerythrin (PE) stain-
Results: Patients aged 3-29 years old (mean = 13.5 year; SD = 6.645). ing were used to examine apoptotic cell death.
Twenty individuals presented largely with head and neck, flank, Results: Western blot analysis showed that ER-α expression was
croup and dock pruritic-derived alopecia, and one with sneezing up-regulated in NP tissues. Immunohistochemical staining for ER-α
Aerogenous Wild
molds Alt a Asp f grasses Art v Que i Dac g Phl p Lol Fes r Par j Der p Der f Lep d Aca s Tyr p Eur m Culicoides
Positivity No. 5 9 5 2 2 0 0 2 10 1 4 3 7 6 5 7 8 14
(0- 4; Range 1-3 1-2 1-2 1 1 0 0 1-2 1-2 0 1-3 1-2 1-3 1-3 1-2 1-3 1- 4 1- 4
n = 21)
Mean 1.75 1.44 1.2 1 1 0 0 1.5 1.3 0 1.75 1.33 1.71 1.33 1.8 1.71 2 2.3
SD 1 0.53 0.45 0 0 0 0 0.71 0.5 0 0.96 0.57 0.95 0.81 0.45 0.76 1.06 0.9
886 | ABSTRACTS
confirmed the results of the Western blot analysis. When RPMI essential considering changes of society and environment for ac-
2650 cells were treated with dexamethasone, ER-α expression was ceptable diagnosis and treatment.
suppressed, and cell viability was decreased. Furthermore, treat-
ment of RPMI 2650 cells with dexamethasone increased apoptotic
cell death, as signified by the increased level of BAX and cleaved
caspase-3, the decreased level of Bcl-2, and increased percentage of
LBTP1879 | Differentiating eosinophil and
cells with positive Annexin V-PE staining.
neutrophil inflammation in chronic rhinosinusitis
Conclusion: ER-α expression was higher in nasal polyps than in
healthy inferior turbinate mucosa. When RPMI 2650 cells were
with and without nasal polyps
treated with dexamethasone, ER-α expression was downregulated, Delemarre T1; Holtappels G1; De Ruyck N1; Bachert C1,2;
apoptosis increased, and cell viability decreased. The decrease in cell Gevaert E1
1
viability may be related, at least in part, to decreased levels of estro- Ghent University, Ghent, Belgium; 2Karolinska Institute, Stockholm, Sweden
gen receptor α protein, which likely contributed to the induction of

cell death in RPMI 2650 cells. Background: Chronic rhinosinusitis (CRS) patients are traditionally
classified as CRS with nasal polyps (CRSwNP) and CRS without nasal
polyps (CRSsNP). CRSwNP is typically characterized by a Th2-biased
eosinophilic inflammation, associated with asthma comorbidity,
LBTP1878 | The changes of the prevalence of
while CRSsNP is often related to a Th1-biased neutrophilic inflam-
skin prick test in Juju Island based on a Korean
mation pattern. In asthma, Th17 is linked to neutrophilic inflamma-
multi-center study tion and the presentation of a mixed Th2/Th17, associated with a
Park CS1; Cho JH2 mixed eosinophilic/neutrophilic inflammation, is associated with a
1
Department of ORL-HNS, St. Vincent 's Hospital, The Catholic University of more severe and harder to control phenotype. In CRS there is no
Korea, College of Medicine, Suwon, South Korea; 2The Catholic University of direct link between Th17 and disease severity, while the most severe
Korea, Seoul, South Korea
CRSwNP patient groups have increased concentrations of neutro-
philic cytokines as MPO, IL6 and IL8. In CRSwNP, eosinophils have
Background: Allergy is a very common condition. Allergic disease been shown to form EETs. Our aim is to further characterize and
is highly affected by environmental changes like temperature or compare eosinophilic and neutrophilic inflammation in CRSwNP and
exposure to other people. Conditions to increase the prevalence CRSsNP.
of Allergic disease have changed dramatically in Republic of Korea Method: Neutrophils and eosinophils were quantified in nasal polyp
(ROK). samples (n = 15) and sinonasal mucosae of CRSsNP (n = 17) using
Method: A total of 20 hospitals were selected based on population IHC staining. Neutrophilic and eosinophilic extracellular traps (NETs
distribution in ROK. A skin prick test (SPT) panel comprising 55 aer- and EETs) were visualized and quantified using IF staining. Tissue
oallergens was distributed to 18 hospitals for a prospective study. levels of IL17, IgE, ECP, GM-CSF, and Th2 cytokine levels were meas-
Results from SPTs done in 2006, 2010, 2014 and 2015 were col- ured (Luminex) and correlated to the degree of neutrophilia and eo-
lected and analyzed retrospectively from 20 hospitals. sinophilia and presence of NETs and EETs.
Results: We compared allergen-positive rates among seasons. Results: Both CRSwNP and CRSsNP show cases with explicit eosin-
Overall, Positive test rates for D. farina, D. pteronyssinus, cat and ophilic, a mixed eosinophilic-neutrophilic, or a profound neutrophilic
dogs were increased over time. And the rates for Cult rye pollen inflammation. In CRSsNP sinonasal mucosa and low Th2-inflamed
was decreased over time. Although positive rate to pollens varied tissues, neutrophil counts and neutrophil/eosinophil ratios were sig-
significantly according to temperature, precipitation, and humid- nificantly increased in tissues with high IL17 levels. This was not the
ity, the positive rates to house dust mite (HDM) were less sus- case in nasal polyps and highly Th2 inflamed tissues. Neutrophils in-
ceptible to the changes to environment. But the positive rates to filtrate to subepithelial regions in CRS mucosa, and migrate through
HDMs in Jeju island were higher than other are (Df P = 0.03, Dp the epithelium towards mucus in CRSwNP. In CRSsNP patients,
P = 0.0195). NETs were observed and significantly correlated with levels of GM-
Conclusion: Traditionally the bed and indoor environments are re- CSF, indicating a potential role for GM-CSF in local NET formation.
garded as the main sites of HDM exposure. But our results showed EETs were observed in both nasal polyps and CRSsNP sinonasal mu-
personal exposures to other people, social activity, transportation cosae and correlated significantly with tissue levels of IgE, ECP and
might be considered as the causes of the increasing positivity of IL5 in both groups.
house dust mites because the number of original residents was in- Conclusion: Variation in eosinophilic and neutrophilic inflammation
creased by 20% from 1987 to 2013 but the number of travelers in and differences in EET and NET formation is observed between
Jeju island was increased in 2012 by more than 200% since 2000. CRSsNP and CRSwNP. While neutrophilic inflammation and neutro-
Therefore, regular follow-up and re-evaluation of allergic test are phil/eosinophil ratios correlated with tissue levels of IL17 in patients
ABSTRACTS | 887
with low Th2 inflammation, neutrophilia appeared independent awareness in both patients and healthcare providers resulting from
from IL17 in a severe Th2 context. the media attention for our previous study.
LBTP1880 | Rhinitis medication use in patients LBTP1882 | Allergic factors affect outcomes
with persistent rhinitis: Belgian cross-sectional after endoscopic sinus surgery in patients with
study with historical control chronic rhinosinusitis
Scheire S1; Germonpré S1; Mehuys E1; Christiaens T2; Meng C; Sha J; An L; Zhu D
De Sutter A3; Van Tongelen I1; Demarche S 4; Van Hees T4; China-Japan Union Hospital of Jilin University, Changchun, China
Lahousse L1; Gevaert P5; Boussery K1
1
Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent
Background: Chronic rhinosinusitis (CRS) is a common health condi-
University, Ghent, Belgium; 2Clinical Pharmacology Research Unit, Heymans
Institute of Pharmacology, Ghent University, Ghent, Belgium; 3Department of tion in the world. Patient symptoms and objective testing procedures
Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium; play important roles in identifying appropriate surgical candidates,
4
Clinical Pharmacy Unit, University of Liege, Liege, Belgium; 5Department of but discordance between objective testing and quality of life (QOL)
Otorhinolaryngology, Faculty of Medicine and Health Sciences, Ghent University,
Ghent, Belgium
has been observed by us and others. To investigate whether the al-
lergic factors impact the severity of chronic rhinosinusitis (CRS), and
Background: In 2012, we performed a cross-sectional observational to explore the correlation of allergy and outcomes after endoscopic
study demonstrating a high level of nasal decongestant (over) use sinus surgery (ESS) in patients with CRS.
compared to nasal corticosteroid use in adults with persistent rhi- Method: 145 cases were arranged to detect allergic serum rela-
nitis. The results of this study received substantial media attention. tive index: the concentration of serum total IgE, specific IgE semi-
In 2017, a comparable study was conducted. The aim of the current quantitative test and the concentration of serum ECP; to survey
evaluation was to compare rhinitis medication use between the QOL status with VAS, SNOT-20, and SF-36; as well as inquire medi-
2012 and 2017 study. cal record, Lund-Mackay CT system scoring, clinical classification of
Method: In both studies, patients with persistent rhinitis were re- chronic rhinosinusitis. After FESS (>1 year), 82 cases were followed
cruited from community pharmacies. Participants completed a up.
questionnaire collecting data on sociodemographics, clinical char- Results: The improvements of VAS scores of the cases with in-
acteristics and medication use. We compared rhinitis medication creased serum total IgE were significantly lower than those without
use and long-term use of nasal decongestants (defined as: at least increased serum total IgE (P < 0.05). The objective outcomes of the
1 year chronic use) between the 2012 and 2017 study via Pearson cases with positive allergen (≥3) were significantly worse than those
Chi-Square tests. with the positive allergen (<3) (P < 0.05). The objective outcomes of
Results: Participants in the 2017 study (n = 1523) had a median age the cases with strong positive allergen were significantly worse than
of 50 years (IQR 26 years) and 62% were female. In comparison, par- those without strong positive allergen (P < 0.05). VAS scores and
ticipants in the 2012 study (n = 895) had a median age of 46 years SNOT-20 scores after endoscopic sinus surgery of the cases with
(IQR 22 years) and 58% were female. Most frequently reported strong positive allergen were significantly worse than those without
physician diagnoses were allergic rhinitis (48.1% of participants in strong positive allergen (P < 0.05). The concentration of serum ECP
2017 vs 40.6% in 2012) and rhinosinusitis (41.6% in 2017 vs 34.0% in of the invalid cases was significantly higher than ineffective cases
2012). In the 2017 study, we identified a lower number of nasal de- (P < 0.05). The concentration of serum ECP was positively correlated
congestant users (37.2% of participants vs 69.6% in 2012, P < 0.001) with Lund-Kennedy endoscopic scores (r = 0.529, P < 0.05). The ob-
and nasal saline irrigation users (33.4% vs 39.8% in 2012, P = 0.002). jective outcomes of the cases with increased serum ECP were sig-
By contrast, nasal corticosteroid use was significantly higher (63.7% nificantly worse than those without increased serum ECP (P < 0.05),
of participants vs 30.3% in 2012, P < 0.001) compared to our histori- VAS scores and SNOT-20 scores after endoscopic sinus surgery of
cal control group. No significant difference could be observed in the the cases with increased serum ECP were significantly worse than
use of oral antihistamines (21.6% of participants in 2017 vs 19.4% those without increased serum ECP (P < 0.05), the improvements of
in 2012, P = 0.206). The number of patients with long-term use of VAS scores of the cases with increased serum ECP were significantly
nasal decongestants was significantly lower (26.4% of participants lower than those without increased serum ECP (P < 0.05).
vs 42.1% in 2012, P < 0.001) compared to the 2012 study group. Conclusion: Those allergic serum relative indexes make some nega-
Conclusion: We noted a clear shift to more users of nasal steroids tive effect on subjective and objective outcomes. The results might
and less (long-term) users of nasal decongestants in patients with help to choose immunotherapy to combine with endoscopic sinus
persistent rhinitis. This shift might be caused by increased public surgery for those selected patients to improve the outcomes of CRS.
888 | ABSTRACTS
LBTP1883 | Acceptability and short term Conclusion: This small service evaluation suggests nasal photother-
apy is an effective and acceptable treatment from the child and nurs-
efficacy of nasal phototherapy in a small
ing perspective. The results warrant further investigation on a larger
paediatric population, a patient and nursing
cohort and follow-up to monitor long term efficacy.
perspective
Mathias FD
Sandwell and West Birmingham NHS Hospital Trust, Birmingham, United
Kingdom
LBTP1884 | Cytological monitoring of the

Background: The reported incidence of allergic rhinitis in the U.K. nasal mucosa in patients with non-allergic
paediatric population is high, and can impact significantly on the
vasomotor rhinitis treated with a new nasal spray
child's and family's quality of life (QOL). Despite standard medication
some children continue to experience symptoms resulting in poor
formulation
school attendance, reduced academic performance, restrictions on Masieri S1; Cavaliere C2; Luperto P3; Compalati E4; Strada P4;
social activities, and difficult to manage asthma. This service evalu- Frati F4
1
ation reports on findings from the first U.K. NHS Paediatric Allergy Department of Sense Organs, Sapienza University, Rome, Italy; 2Department
of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy; 3ASL BR1,
Unit to provide nasal phototherapy.
Brindisi, Italy; 4Lofarma Medical-Scientific Department, Milano, Italy
Purpose: Explore the acceptability and short term efficacy of nasal
phototherapy in a small paediatric population, from the patient and
Background: Non-allergic rhinitis (NAR) are about 23% of chronic
nursing perspective.
rhinitis, reaching 57% of patients affected by rhinitis in the case
Method: Nasal phototherapy was administered to 13, 8-17 year olds
of mixed rhinitis in which there is both an allergic and non-allergic
from a diverse ethnic and socio-economic background who, despite
component. Recently, on the basis of cytological findings, NAR are
compliance with standard medical treatment, were all still experienc-
classified in NARES (non-allergic with eosinophils rhinitis), NARNE
ing rhinitis symptoms impacting on their QOL. 8 Treatments were
(non-allergic with neutrophils rhinitis), (NARMA non-allergic with
provided for perennial symptoms and 6 treatments for seasonal
mast cells rhinitis) and NARESMA (non-allergic with eosinophils
symptoms. Treatment was delivered as shown in the methods table.
and mast cells rhinitis). Treatment NAR has always been very con-
Prior to commencing nasal phototherapy, a diagnosis of allergic rhi-
troversial, requiring the use of systemic and topical medications.
nitis was made by a paediatric consultant. All children were either
In this study, we wanted to evaluate the use of an innovative nasal
Skin Prick Test, sIgE or component test positive to at least one of
spray containing ribes nigrum, perilla ocymoides, and hyaluronic
house dust mite, tree pollen or grass pollen. All children were asked
acid. This nasal spray is designed for the hygiene of the nasal cav-
to complete a Total Nasal Symptom Score Sheet (TNSS) prior to com-
ity, thanks to the presence of ribes nigrum and perilla oil extracts
mencing each treatment.
that exert a soothing and decongestant action in case of a con-
Results: All 13 children completed their treatment programme. All
gested nose. Hyaluronic Acid helps soften and heal the mucous
patients reported improved TNSS and improved at the end of the
membrane.
treatment. Treatment was well tolerated. The reported side effects
Method: We used this innovative spray in eight patients aged 26-74
were mild, consisting of nasal dryness and mild epistaxis. Children
with NAR and we performed a cytological sampling before starting
reported that the treatment was fast, effective and pain free. From
treatment (T0) and after 30 days of treatment (T1). We also gave
the nursing perspective the treatment was well tolerated, simple and
patients the patient-reported outcomes (PROs) and Sino-nasal out-
quick to administer, with few, mild side effects.
come test (SNOT-22) questionnaires at T0 and T1.
Results: Six of eight patients treated had improved clinical scores
(PROs and SNOT-22) and nasal cytology compared to the start of
TA B L E 1 . Treatment Protocol
treatment. No patient discontinued treatment.
Per nostril Per nostril Conclusion: These preliminary data show how the nasal spray con-
Seasonal mins:secs Perennial mins:secs
taining ribes nigrum, perilla ocymoides, and hyaluronic acid is ef-
WEEK 1 1 2:00 WEEK 1 1 2:00 fective in reducing nasal inflammation, expressed as eosinophilic,
2 2:15 2 2:15 mastocyte and neutrophil infiltrate, in patients with NAR. Further
3 2:30 3 2:30 studies will be necessary to confirm these data.
WEEK 2 4 2:45 WEEK 2 2:45
5 3:00 WEEK 3 3:00
6 3:00 WEEK 4 3:00
WEEK 5 3:00
WEEK 6 3:00
ABSTRACTS | 889
LBTP1885 | Allergy and cystic fibrosis—Risk LBTP1886 | NAPPREB study protocol:

factors for chronic rhinosinusitis at child A pivotal clinical trial to investigate clinical
Murgu A; Ioniuc I; Popovici P; Azoicai A; Luca E; Vornices I; efficacy and potential response biomarkers to
Criscov I Benralizumab treatment in chronic rhinosinusitis
Emergency Children Hospital “St Mary”, Iasi, Romania with nasal polyps
Heffler E1; Puggioni F1; Mauri P2; Riccio AM3; Racca F1;
Background: Chronic sinusitis defined as a chronic inflammation
Malvezzi L1; Spriano G1; Paoletti G1; De Luca F1;
>3 months of the nasal mucosa and paranasal sinuses, is a rare pa- Canonica GW1
thology in the childhood but with a major impact on morbidity and 1
Humanitas University, Milano, Italy; 2C.N.R., Milano, Italy; 3University of
the quality of life through the complications that it generates. Clinical Genova, Genova, Italy
manifestations are related to the anatomical and immune particulari-
ties associated with childhood age and some predisposing/aggravat- Background: chronic rhinosinusitis with nasal polyps (CRSwNP) is a
ing factors, such as nasal allergy (AR) and cystic fibrosis (CF). severe upper-airway inflammatory disease, with a high rate of re-
Objective: To identify the incidence and risk conditions associated currence after surgery, a significant impact on the Quality of Life of
with cystic fibrosis and nasal allergy for the chronic rhinosinusitis patients, and high disease-related costs. Most of the patients with
of the child. CRSwNP have important eosinophilic inflammation in both upper
Method: is a retrospective study on the 43 children diagnosed with and lower airways. Benralizumab is a monoclonal antibody against
chronic rhinosinusitis in the period 2014-2018 in the Department of IL5-receptor alpha-chain and it is approved for the treatment of se-
Immunoallergology in Children's Emergency Hospital “St. Mary “Iasi. vere eosinophilic asthma.
Results: AR 17/43 (39.53%); CF 6/43 (13.95%); <6 years: AR 6/17 Method: The aim is to describe the protocol for a clinical trial to in-
(35.29%), CF 2/6 (33.33%); localization: maxillary sinusitis—AR vestigate the efficacy of Benralizumab on CRSwNP and to explore,
9/17 (47.36%), CF 4/6 (66.66%); fronto-maxillary sinusitis—AR 8/17 in an unbiased manner, potential response biomarkers.
(47.05%), CF 2/6 (33.33%); AR persistent severe 6/17 (35.29%), Results: the “NAsal Polyps inflammatory & molecular Phenotyping
moderate 11/17 (64.7%); AR comorbidities: chronic adenoiditis of Responders to Benralizumab” (NAPPREB) study is a single-center,
9/17 (52.94%), atopic dermatitis 4/17 (23.52%), bronchial asthma double-blind, placebo-controlled randomized trial on 20 patients
7/17 (41.17%), upper respiratory infections 6/17 (35.29%) allergic with severe CRSwNP (requiring at least 1 g oral prednisone over
polysensibilization: AR 15/17 (88.23%), CF 3/6 (50%); pollen mono the previous 12 months to control symptoms and with a nasal endo-
allergic sensitization AR 2/17 (11.76%); aspergillus spp/alternaria scopic score, NPS ≥5). Patients will be randomly assigned to treat-
spp mono allergic sensitization : AR 2/17 (11.76%), CF 3/6 (50%); ment (Benralizumab 30 mg s.c. every 4 weeks for the first 3 doses,
IgA-immune deficit AR 8/17 (47.05%), CF 4/6 (66.66%); clinical mani- and then every 8 weeks) or placebo in a 1:1 ratio. Treatment duration
festations: chronic headache/facial pain—AR 11/17 (64.7%), CF 6/6 will be 16 weeks, followed by a 36 weeks post-treatment follow-up.
(100%); chronic cough—AR 14/17 (82.35%), CF 6/6 (100%); chronic Primary outcome: significant reduction of NPS≥1.5 at week 24; sec-
rhinorrhea—AR 15/17 (88.23%), CF 3/6 (50%); orbital cellulitis-AR ondary outcome: unbiased correlations between clinical response
3/17 (17.64%), CF 2/6 (33.33%); sleep disorders AR 9/17 (52.94%), and biomarkers, including: blood eosinophils and tissue biomarkers
CF 5/6 (83.33%); halitosis—AR 4/17 (23.52%), CF 2/6 (33.33%); spe- (detected by proteomic analysis).
cific imaging (CT-SCAN/Rx) opacification of the sinuses—all cases; Conclusion: the NAPPREB study is a clinical trial investigating simul-
sinus hypoplasia: CF 4/6 (66.66%). taneously clinical efficacy and potential response biomarkers in pa-
Conclusion: Chronic rhinosinusitis in children is heterogeneously tients with severe CRSwNP.
clinical in relation to the particularities of immunogenic and anatomi- Study funded by AstraZeneca
cal responses reported in child's age. Multidisciplinary team collabo-
ration can quickly diagnose the involvement of aggravating factors
such as allergic rhinitis and cystic fibrosis.
LBTP1887 | Glucocorticoid inhalation

combined with olfactory training in the treatment
of chronic sinusitis olfactory dysfunction
Xiu Q; Lang JQ; Li GJ; Zhu DD
China Japan Union Hospital of Jilin University, Changchun, China
Background: Olfactory dysfunction caused by chronic sinusitis was

common; however the effective treatment is still under discussion.
890 | ABSTRACTS
Method: A total of 39 chronic sinusitis (CRS) patients with olfactory caused by diseases of the blood system, surgery, trauma and nasal
dysfunction (post chronic sinusitis) in China-Japan union hospital tumor. Survey contents include: 1. General items: gender, age;
during Jan 2017 to June 2018 were recruited in this prospective 2. Personal history: smoking and drinking habits; 3.Concomitant
study. EPOS 2017 was used for CRS diagnosis. Patients with malig- diseases;
nant tumor, diabetes history, hypertension history, hyperlipidemia Results: The four common parts of nasal hemorrhage were: Little's
history, asthma and other chronic respiratory diseases were ex- area, olfactory cleft, fornix of inferior nasal concha and middle
cluded from this research. The clinical data including age, gender, meatus. The age of patients had a certain relationship with the
and duration of disease, smoking history, and alcohol history were bleeding site, and Little's area was the most common bleeding site,
collected and analyzed. All patients underwent Sniffin’ sticks olfac- which can occur at any age. in addition, fornix of inferior nasal
tory test twice (before and after treatment), which was evaluated concha was the common site of bleeding of patients under the age
by composite threshold-discrimination-identification score (TDI), of 50 patients while olfactory cleft of the elderly. There had no
sinonasal computer tomography scanning, as well as magnetic reso- significant relationship between middle meatus bleeding and age.
nance scanning of the olfactory pathway. Nebulizing glucocorticoid Patients under the age of 50 male were significantly more than
(Budesonide) was inhaled once daily at the starting dose of 2 mg ta- female while there had fewer gender differences in patients over
pered to 1 mg after 2 weeks combined with olfactory training for 50 years old. Hypertension, diabetes and cardiovascular disease
28 days. SPSS 13.0 software, paired t test were used to analyze the are the most common accompanied disease associated with nasal
data. bleeding.
Results: Thirty five patients received treatment, with a mean age Conclusion: The age of patients had a certain relationship with the
of 49 (range from 31 to 67 years old), a mean olfactory dysfunction bleeding site. Gender, age, history of tobacco and alcohol, accom-
duration of 5 months (2.5-10 months). Around the patients, 10 were panied with hypertension, diabetes and cardiovascular disease are
anosmia, 29 were hyposmia. After olfactory training and nebulizing important factors of epistaxis.
glucocorticoid inhalation, the total scores of TDI increased with sta-
tistically significant (20.6 ± 6.2 vs 13.2 ± 5.5). The overall efficacy
was 48.5% (17/35), complete recovery were achieved in 3 patients LBTP1890 | The analysis and study on the
(8.5%), obvious improvement in 7 (20.0%), improvement in 5 (14.3%),
classification and clinical features of eosinophilic
no improvement in 2 (5.7%).
chronic rhinosinusitis
Conclusion: The outcomes suggest the efficiency and safety of glu-
cocorticoid combined with olfactory training in the treatment of ol- Meng C; Cui N; Zhao C; Sha J; Zhu D; An L
factory dysfunction caused by chronic sinusitis. China-Japan Union Hospital of Jilin University, Changchun, China
Background: Chronic rhinosinusitis is a heterogeneous disease. In

Europe and the United States, it has recently been divided into two
LBTP1888 | Multivariate regression analysis of
subgroups: chronic rhinosinusitis with nasal polyps (CRSwNP) and
epistaxis to predisposing site and treatment
chronic rhinosinusitis without nasal polyps (CRSsNP). The majority
Meng C; Sha J; Cui N; Zhao C; Zhu D of CRSwNP cases have a strong tendency to recur after surgery and
China-Japan Union Hospital of Jilin University, Changchun, China show eosinophil-dominant inflammation.
Method: According to postoperative histopathological examination
Background: Epistaxis remains the most frequent otolaryngologic and percentage of nasal tissue eosinophils, ECRS was determined as
emergency and the second most common reason for referral to an the percentage of eosinophil was 15% or more and NECRS as the
otolaryngologist. Over the years, many studies have sought to de- percentage was <15%. Evaluated all patients’ clinical features by
velop algorithms for treatment and prevention. Despite this, man- recording symptom scores and duration, testing peripheral blood
agement of epistaxis remains a controversial and evolving topic. As EOS% level, doing nasal endoscopy and sinus CT to assess the se-
a clinician, it is very important to find the bleeding point quickly and verity of nasal cavity, comparing symptom scores before and after
stop the bleeding in time. In order to explore the preexisting sites surgery.
of nasal bleeding and the relationship between relevant factors af- Results: There were no significant differences in the sex and age
fecting nasal bleeding, we conducted a retrospective analysis on the between the three groups of CRS cases with different histopatho-
data of 152 patients with nasal bleeding who visited our department logical type (P > 0.05). But the difference of three groups accord-
from September 2016 to August 2017. ing to the degree of eosinophil infiltration in the tissue was obvious
Method: 152 cases of nosebleed patients admitted to our de- (P = 0.000409).
partment from September 2016 to August 2017 were selected as There was no regular trend in ECRS composition or percentage of
research objects. Inclusion criteria :1. There were clear bleeding nasal tissue eosinophils in the past 12 years.
points in nasal endoscopic examination; 2. 2. Rare bleeding points There was no significant difference in sex and age between ECRS
were excluded after analysis and summary; 3. Exclude nosebleed group and NECRS group (P > 0.05).
ABSTRACTS | 891
The duration of ECRS was 12.00 [5.50; 30.00] months, and the Results: Nose and eye symptoms of patients who received im-
NECRS group was 9.00 [2.50; 36.00] months, the difference was not munotherapy were improved significantly (P < 0.01). The quality
statistically significant (P > 0.05). of life of patients with allergic rhinitis who received medication
The peripheral blood eosinophil percent in the ECRS group was 5.10 supervision was greatly improved compared with it before the
[3.00; 7.60], which was significantly higher than that of the NECRS treatment (P < 0.05). The quality of life of patients who accepted
group (1.90 [1.20; 3.55]), and the difference was statistically signifi- medication supervision was improved significantly compared with
cant (P = 6.14×10-10). The tissue eosinophil percent was associated it of the patients who didn' t accept the medication supervision
with peripheral blood eosinophil percent in ECRS (r = 0.49). When (P < 0.05). Nose symptoms were significantly improved in patients
peripheral blood EOS% ≥4.15%, the sensitivity of diagnosis of ECRS of both the IT group and the UIT group who accepted medication
was 64%, and the specificity was 81.8%. supervision.
Conclusion: CRS in the northeastern region of China can be classi- Conclusion: The quality of life of patients with allergic rhinitis was
fied according to the degree of eosinophil infiltration in the tissue. In improved significantly, no matter the ones accepted immunotherapy
the past 12 years, the trend of ECRS composition ratio has no signifi- or medication supervision.
cant characteristics. Compared with NECRS, ECRS had heavier sinus
lesion range and extent, in which the ethmoid sinus was the most
serious and the posterior ethmoid sinus and maxillary sinus were LBTP1892 | Quality of life assessment before
most vulnerable, and ECRS is more susceptible to the pansinusitis.
and after long-term treatment of allergic rhinitis
Increased percentage of peripheral blood eosinophils can be used as
a reference index for preoperative CRS typing.
in adults—10 years
Meng C; Sha J; Zhu D; Zhao C; Cui N
China-Japan Union Hospital of Jilin University, Changchun, China
LBTP1891 | Immunotherapy and medication

Background: Allergic rhinitis is a common disorder that is strongly
supervision improved quality of life in adult with
linked to asthma and conjunctivitis. It is usually a long-standing con-
allergic rhinitis, a longitudinal study
dition that often goes undetected in the primary-care setting. The
Xiu Q; Liu Yl; Zheng J; Zhu DD classic symptoms of the disorder are nasal congestion, nasal itch,
China Japan Union Hospital of Jilin University, Changchun, China rhinorrhea, and sneezing. A thorough history, physical examination,
and allergen skin testing are important for establishing the diagno-
Background: Immunotherapy is widely used in the treatment of al- sis of allergic rhinitis. Using the quality of life questionnaire (RQLQ)
lergic rhinitis recently. However whether the quality of life in adult related to nasal conjunctivitis, the effects of adult allergic rhinitis
patients who underwent immunotherapy and medication supervi- patients on quality of life before and after treatment were evaluated,
sion was improved or not is still under discussion. and the theoretical basis was provided for improving the quality of
Method: Permission for this longitudinal clinical study was ob- treatment and treatment compliance.
tained from the Research Ethics Committee of China Japan union Method: The patients who were diagnosed and treated by aller-
hospital of Jilin University (Changchun, China). Informed consent gic rhinitis in the nasal clinic of the hospital between 2007.03 and
was obtained from the study patients. All statistical analyses were 2008.08 were selected. The patients were followed by telephone
performed using SPSS statistics (Version 17.0, IBM, NY, USA). The and used the RQLQ. 142 patients were selected. Among them, 37
a-priori sample size estimation was performed at the 5% level of patients received specific immunotherapy. As a SIT group; The re-
significance (α = 0.05). One hundred and forty-two patients visit- maining 105 patients were divided into A1 and B1 groups, and the
ing our out-patient department, from March 2009 to August 2018, classification criteria were whether they had received guidance on
who were diagnosed as allergic rhinitis according to ARIA 2016 were drug application; Divided into A2 and B2 groups, the classification
collected. The patients were underwent immunotherapy or medi- criteria are whether they have been supervised by drug applica-
cal intervention during the study. The Rhinoconjunctivitis Quality of tions. The research data are analyzed and processed using SPSS 17.0
Life Questionnaire (RQLQ) was used for evaluating the treatment software.
effect. Both the telephone interview and face-to-face questionnaire Results: The improvement of the quality of life after treatment was
survey were used to fulfill the RQLQ. All the patients were dived into more obvious and statistically significant in AR patients receiving
two groups by using immunotherapy or not: 37 cases underwent im- drug guidance and drug supervision than before treatment (P < 0.05).
munotherapy (defined as IT group), 105 cases didn' t accept immuno- The improvement of nasal symptoms and eye symptoms after immu-
therapy (defined as UIT group) but underwent medical intervention notherapy is more obvious than before treatment, and it has statisti-
which following the guideline ARIA2016. The UIT group were dived cal significance (P < 0.01). Post-treatment drug guidance and drug
into two subgroup by whether the patients accepted medication su- supervision are significantly less effective in improving the quality
pervision or not. of life than in the absence of drug guidance, which is statistically
892 | ABSTRACTS
significant (P < 0.05). The improvement of immune therapy in nasal LBTP1894 | Evaluation of olfactory function
symptoms is more obvious than drug guidance and has statistical
as a potential biomarker in patients with
significance (P < 0.05). In addition, there is no correlation between
Mastocytosis
the influence of education on daily life and the influence of gender
on emotion. Deidda M1; Masala C2; Piras R 2; Firinu D1; Barca MP1;
Conclusion: The quality of life of AR patients can be improved after
Del Giacco S1
1
Department of Medical Sciences and Public Health, University of Cagliari,
receiving treatment. Strengthening the guidance and education of
Monserrato Campus, Cagliari, Italy; 2Department of Biomedical Sciences,
AR patients can improve the quality of life of AR patients. Section of Physiology, University of Cagliari, Cagliari, Italy
Background: Mastocytosis is a clonal disease characterized by an

LBTP1893 | The analysis and study of allergen accumulation of mast cells in various organs, such as skin, bones,
features in chronic rhinosinusitis with or without lymph nodes, liver, spleen, peripheral and central nervous system,
gastrointestinal and nose-pharyngeal tract. The serum tryptase, an
polyps
enzyme produced almost exclusively by mast cells is considered as
Meng C; Zhao C; An L; Sha J; Cui N; Zhu D a biomarker. The serum concentration of tryptase can therefore be
China-Japan Union Hospital of Jilin University, Changchun, China
considered a quantitative sign and an indicator of activity of the or-
ganism's mast cells. The aim of the study was first to investigate odor
Background: Allergen features were compared in the two subtypes threshold (OT), odor discrimination (OD) and odor identification (OI)
of CRS: chronic rhinosinusitis with nasal polyps (CRSwNP) and in mastocytosis patients (MP) compared to age matches healthy con-
chronic rhinosinusitis without nasal polyps (CRSsNP). To study the trols (HC), then to correlate olfactory function with, serum tryptase.
distribution features and clinical significance of allergens in patients Method: Eighty subjects were enrolled in this study (40 patients
with chronic rhinosinusitis (CRS) and chronic rhinosinusitis with pol- with mastocytosis, 18 women and 22 men, mean age 47.9, SD 14.4
yps (CRSwNP). and 40 healthy controls, 16 women and 24 men 47.9, SD 14.7). OT,
Method: A retrospective analysis was performed in 187 cases of OD, OI and their sum TDI score were evaluated using the psycho-
CRS and CRSwNP. Differences of allergens features of CRS were physical Sniffin’ Sticks. The Montreal Cognitive Assessment (MoCA)
analyzed, and they were compared to the allergens of 65 patients was used to assess cognitive ability. One way between groups
with allergic rhinitis (AR). Multivariate analyses of variance (MANOVA) was carried out to as-
Results: The total allergen positive rate in CRS was 49.8%. The sess the impact of olfactory function on the mastocytosis.
allergen positive rate, distribution proportion of inhaled and food Results: Among MP group, 10 (25%) reported normosmia, one pa-
allergens, distribution proportion of allergens subsets, distribution tient functional anosmia and the remaining showed hyposmia. Our
proportion of single and multiple allergens between two subtypes results indicated a statistical significant differences between the
of CRS had no significant difference (P > 0.05). The major allergens two groups (MP and HC) for the olfactory function and the MoCA
of CRS were single inhaled allergens (72.3%). Some CRS patients [F(5,74) = 504.7, P < 0.0005, Wilks’ Lambda = 0.03, partial η2 = 0.972].
were allergic to food allergen (8.6%). The minority allergens of CRS The analyses of each individual dependent variable, using Bonferroni
were a mixture of inhaled and food allergens (7.2%). Compared adjusted alpha level showed significant differences between two
to AR, the distribution proportion of inhaled and food allergens groups for OT [F(1,78) = 866.6, P < 0.0005, partial η2 = 0.917], OD
(χ 2 = 17.81, P < 0.001), the distribution proportion of allergens [F(1,78) = 76.6, P < 0.005, partial η2 = 0.495], for TDI [F(1,78) = 379.6,
2
subsets (χ = 15.51, P < 0.001), and the distribution proportion of P < 0.005, partial η2 = 0.830] and for MoCA [F(1,78) = 146.3, P < 0.005,
single and multiple allergens (χ 2 = 9.727, P < 0.001) had a signifi- partial η2 = 0.652]. Instead, no statistical significant difference was
cant difference. found for OI [F(1,78) = 0.62, P > 0.05, partial η2 = 0.008]. Significant
Conclusion: The allergen positive rate of CRS is much higher than the negative correlation was observed between the TDI vs serum
prevalence of allergic diseases in the general population, suggesting tryptase (r = −0.398, P < 0.05).
that allergic factors may be closely correlated to the pathogenesis of Conclusion: Our data suggest that olfactory dysfunction could rep-
CRS. The clinical features of allergens are similar in the two subtypes resent a potential biomarker to be more extensively evaluated for an
of CRS, while there are significant differences in allergen distribution early diagnosis of Mastocytosis.
between CRS and AR patients. The detection of allergens may be
helpful in the prevention and treatment of CRS.
ABSTRACTS | 893
LBTP1895 | Study of aero-allergens and mites diameter) followed by Dermatophagoides farinae (25 cases, 6.12 mm
diameter), Ageratum conyzoides (19 cases, 3.36 mm diameter),
in rural part of Eastern India by skin prick testing
Cannabis sativa (17 cases, 3.52 mm diameter) and Cassia occiden-
Sharma M1; Khaitan T2; Raman S3; Jain R4 talis (17 cases, 3.58 mm diameter). When the sensitivity was being
1
ICARE Institute of Medical Sciences and Research, Haldia, India; 2Dental
compared between the most common allergens, statistical signifi-
Institute, Rajendra Institute of Medical Sciences, Ranchi, India; 3MGM Medical
College and LSK Hospital, Kishanganj, India; 4Centre for Development Studies, cance was obtained for Ageratum conyzoides and Cannabis sativa
Trivandrum, India with Dermatophagoides farinae (P value −0.0001).
Conclusion: This study was an attempt to evaluate the pattern of
Background: Skin prick testing (SPT) is one of the most extensively allergenicity of aero-allergens and mites in the rural part of Eastern
used screening and diagnostic tool in contemporary allergy practice India using SPT. It is a reliable, minimally invasive procedure with im-
and considered the cornerstone of allergy diagnosis. It plays a vital mediate results useful in detection of tissue bound IgE and an atopic
role in diagnosis of type 1 hypersensitivity reaction in patients with state in patients with type 1 allergy.
rhinoconjunctivitis, asthma, urticaria, anaphylaxis, atopic eczema
and suspected food and drug allergy. It can be used to incite an
immediate hypersensitivity response in the skin when the stratum
corneum is punctured resulting in exposure of the epidermis to an
allergen solution.
Method: A total of 50 subjects (25 males and 25 females) were se-
lected for the present study. Complete history and clinical symptoms
were recorded according to ARIA guidelines. All the patients were
subjected to SPT using 35 allergens. Informed consent was taken
regarding the same. Positive sensitization was recorded in terms of
frequency, measured in terms of wheal diameter and subjected to
statistical analysis using STATA 14 software.
Results: The most common allergens observed were Gynandropsis
gynandra (positive sensitization in 33 cases with wheal of 4.18 mm
894 | ABSTRACTS
MONDAY, 3 JUNE 2019

LB TPS 06
RISK FACTORS, DIAGNOSIS AND QUALITY OF LIFE IN PEDIATRICS
LBTP1896 | The value of autonomic status for LBTP1897 | Thyroid status at children with
the control of bronchial asthma at children bronchial asthma (BA)
Tush E1; Eliseeva T1; Bulgakova V2; Khaletskaya O1; Prakhov Eliseeva T1; Tush E1; Bolshova E1; Prachov A1; Polyakova V1;
A1; Balabolkin I2 Balabolkin I2; Bulgakova V2
1
Privolzhsky Research Medical University, Nizhny Novgorod, Russia; 2National 1
Privolzhsky Research Medical University, Nizhny Novgorod, Russia; 2National
Medical Research Center of Children's Health, Moscow, Russia Medical Research Center of Children's Health, Moscow, Russia
Background: Violation of vegetative regulation (VR) is a compo- Background: Despite numerous studies, there was no consensus
nent of the pathogenesis of bronchial asthma (BA). Assessment of about the effect of thyroid hormones on asthma. Purpose: To assess
autonomic function in the management of patients with asthma in the relationship between the patient 's thyroid status and the level
routine clinical practice is not provided. However, the state of VR of BA control.
in patients with asthma continues to be of interest to researchers, Method: 51 children with BA were examined, of them 15 girls aged
especially in the aspect of the relationship of VR parameters with the 105.1 ± 35.3 and 36 boys aged 114.2 ± 14.1 months. All children
parameters of control of asthma. Purpose: Determine the relation- underwent general clinical examination, spirometry, ACQ5 assess-
ship of VR parameters with the parameters of asthma control level in ment, determination of thyroid-stimulating hormone (THS) levels,
children using methods available in a wide clinical practice. free thyroxine (free T4) test, and levels of antibodies to thyroperoxi-
Method: 88 patients (54 boys and 34 girls) aged 5-17 years with dase (anti-TPO) by ELISA.
atopic bronchial asthma were examined. Quantitative assessment Results: Elevated TSH levels occurred in 12 (23%) patients, while all
of bronchial asthma control was carried out using questionnaires of them had no clinical symptoms characteristic of hypothyroidism,
Asthma Control Questionnaire-5 (ACQ-5), Childhood Asthma con- and the maximum TSH rise was 8.45 mIU/L, which made it possible
trol test (ACT- C) in children under 12 years old, and Asthma con- to treat this condition as subclinical hypothyroidism (cGT). None of
trol test (ACT) in children and adolescents aged 12 years and older. the patients had an increase in the level of anti-TPO. Another 15
All children underwent a standard examination with determination people had a TSH level in the range of 1.16-1.97 mIU/L, the remain-
of blood pressure, pulse, respiratory rate, with the calculation of ing 24 had 2.01-3.74. 18—had an excess of T4 free, but it was insig-
Kerdo and Hildebrandt indices, characterizing vegetative regula- nificant—a maximum of 23.1 pmol/L at the upper limit of the norm of
tion. Taking into account the age-dependent changes in heart rate, 22 pmol/L, and was not accompanied by symptoms of thyrotoxicosis.
we used for the first time a relative heart rate index equal to the We did not obtain a clear correlation between the level of TSH and
ratio of the patient 's heart rate to the median heart rate for this free T4, R = 0.49, P = 0.4852. A weak negative correlation was found
age group. between the TSH level and the ACQ-5 score, R = −0.29, P = 0.033.
Results: Correlation with ACQ-5 was obtained for the Hildebrandt Most often (in 33% of cases) subclinical hypothyroidism occurred
index (r = 0.45 P = 0.0003), the respiratory rate (r = −0.27, in patients with complete control of BA (28, TSH 3.39 ± 1.96), and
P = 0.032) and the relative pulse index (r = 0.40, P = 0.0012). The was completely absent in patients with uncontrolled disease pro-
association of Kerdo index with ACT- C test values (r = −0.32, gression (5, TSH 1.87 ± 0.73). In patients with partial BA control,
P = 0.045) was established. In the group of patients with no BA TSH levels of 2.0-4.1 IU/L (18, TSH of 2.93 ± 1.5) prevailed, which
control the Hildebrandt index was statistically significantly higher may indirectly indicate iodine deficiency. These differences do not
than in patients with control of the disease. In children with un- reach the level of statistical significance (F = 1.74, P = 0.1858). Free
controlled asthma it was 5.23 ± 0.25 units that exceeds normal T4 levels were comparable in all groups (16.57 ± 1.93, 16.67 ± 3.04,
values and may reflect a mismatch in the work of cardiovascular 15.82 ± 4.93, respectively). Despite this, a negative correlation was
and respiratory systems. noted between the level of free T4 and FEV1 (mL/s), R = −0.42,
Conclusion: The interrelation of changes of vegetative regulation P = 0.01. Normal levels of TSH in the group of patients with poor
and the level of control of bronchial asthma in children is established, BA control may not be associated with the best thyroid function in
as well as the mismatch of the functioning of the cardiovascular and this group of patients, but with an inhibitory effect on the TSH syn-
respiratory systems in children with uncontrolled asthma. thesis of corticoid hormones (both exogenous glucocorticoids and
endogenous—produced by the body on stress—exacerbation of BA).
Conclusion: Patients with achieved BA control have a rather high
incidence of subclinical hypothyroidism (23%).
ABSTRACTS | 895
LBTP1898 | MMR immunisation practices in LBTP1899 | Risk factors in IgE mediated allergy
children with a history of egg allergy in infants—Cases study
Baris E1; Boran P1; Kiykim A 2; Safa B3; Ahmet O3; Alexoae MM; Rugina A; Murgu AM; Azoicai AN; Criscov IG;
Karakoc-Aydiner E3 Popovici P; Stana BA; Hogas MM; Ioniuc IK
1
Pediatrics, Marmara University, Istanbul, Turkey; 2Pediatric Allergy and Sf Maria Hospital, Iasi, Romania
Immunology, Cerrahpasa University, Istanbul, Turkey; 3Pediatric Allergy and
Immunology, Marmara University, Istanbul, Turkey
Background: The skin, respiratory and gastrointestinal allergy mani-
festations can evolves alternatively or concomitant in the first years
Background: Immunization is the most important primary care
of life; food sensitization is the common etiology. There are some
health measure for the prevention of certain infectious diseases. In
risk factors there are common to major of country and other specific
the presence of food allergies, especially egg allergies, primary care
for some regions.
providers in Turkey avoid vaccine administration and refer the chil-
Method: The objective of this study is the assessment of IgE-
dren to the tertiary health care centers. In this study, we retrospec-
mediated food allergy regarding clinical manifestations and their
tively evaluated the characteristics of children, who had allergies or
correlation with risk factors, the dietary and drug therapy impact
suspected allergies and referred to our well child clinic in a university
during a 22 months monitoring. We performed a retro-prospective
hospital for the administration of their vaccines.
study on 116 infants and young children diagnosed with IgE medi-
Method: Charts of all children, who were referred to our outpatient
ated food allergy, admitted in II Pediatric Clinic, Sf Maria Hospital
clinic due to concerns for allergies in the last 2 years were retro-
Iasi, Romania—4 years surveillance.
spectively reviewed. Data regarding age, sex, allergy history, delay
Results: The onset food allergy manifestations (mean age
in the administration of vaccine, laboratory test results, referral of
5-11 months) involve skin (66 cases), respiratory (55 cases) and/or
which vaccine, opinions of allergists before immunization and reac-
gastrointestinal tract (5 cases). We evidenced respiratory aeroal-
tions after immunization were extracted from the charts. The study
lergens sensitization (bronchial asthma and/or allergic rhinitis) in 50
was approved by the local ethics committee.
percent of cases. 43 children achieved oral tolerance for one or more
Results: A total of 122 children with or without an allergist made
foods, most commonly in milk and egg white allergy. The artificial
diagnosis of allergies were referred by their primary health care
feeding in the first hours of life, urban environment, the simultane-
providers. According to families’ statement and notes from family
ous exposure air pollutants, early food diversification, familial atopy,
physicians, 47 children (40.9%) had reactions with egg, 40 (34.8%)
C section birth were the risk factors with an individual share over
with multiple foods, 9 (7.8%) with milk, 8 (7.0%) with a previous vac-
40%. Early and repeated administration of antibiotics has been en-
cination,1 (0.8%) with medicine and in the remaining children the of-
tered with a frequency of 29.3% of the total cases.
fending agent was either unknown or the data were unavailable in
Conclusion: Inappropriate dietary practices during infancy, including
the charts. The most common reported reaction was rash (n = 84,
the delayed introduction of complementary feeding and exclusive
68.8%). Only 9 children had a history of anaphylaxis. Egg white al-
breastfeeding <3 months, and more frequent use of antibiotics dur-
lergy was positive in 51 (54.3%) children and 24 (19.7%) children had
ing the first year of life, were associated with food allergy develop-
positive testing for egg yolk. Median delay in the administration of
ment. Cow's milk and eggs, were the most common allergens among
MMR vaccine was 20.0 days (Interquartile range 8.7-41.2). Twelve
children with food allergy and were associated with atopic diseases
children were undergone skin prick testing with the vaccine (8 with
such as asthma and atopic dermatitis. Some of this risk factors can
MMR). In 6 children (4 with MMR and 2 with 4th month vaccina-
be avoid by promoting the breastfeeding and natural birth or by less
tions), vaccines were administered in increasing amounts according
antibiotic use in our country.
to allergists suggestions. No allergic reaction was observed after
vaccine administration except for one child reporting a slight rash
several hours after MMR vaccination.
Conclusion: Food allergies, especially egg allergy, are the most LBTP1900 | Extrahepatic manifestations with
common barrier of vaccine administration in children referred from immune mechanism in children with chronic
family physicians to our outpatient clinic. Given the absence of any hepatitis
reactions, our practice supports the administration of MMR vaccine
Azoicai AN; Ioniuc IK; Popovici P; Monica AM; Criscov IG;
in primary care centers even in egg allergic children to prevent de- Murgu AM; Hogas MM; Hanganu E; Stana BA
lays in national vaccine schedule. Sf Maria Hospital, Iasi, Romania
Background: Besides hepatic manifestations and within the whole di-

gestive system, there is a spectrum of extrahepatic manifestations in
all chronic hepatitis, regardless of etiology but closely related to it and
pathogenic ways of interrelation with the host organism. Formation
896 | ABSTRACTS
and storage of circulating immune complexes in tissues and organs

Min-Max Mean ± SD
represent the main action of these events. In children, they have a
Age of mothers (years) 18-54 29.87 ± 5.65
particular character and they can influence the long-term prognosis
for the patient, so that should be evaluated and treated early. Education N %
Method: We have investigated a total of 239 patients followed
Primary School 13 10.4
during 2005-2011, with chronic hepatitis of various etiologies and
Junior High School 27 21.6
extrahepatic manifestations, using the database for measuring and
High School 38 30.4
extracting data used in statistical processing. Extrahepatic manifes-
University 47 37.6
tations were quantified, explored and correlated with parameters of
evolution and prognosis. Min-Max Mean ± SD
Results: In patients with chronic HBV, the prevalence of extrahepatic
Age of children 2-120 21.62 ± 21.56
manifestations was 21.28%, in children with chronic HCV 15.43%, (months)
and 35.55% in those with hepatitis B and D. The most common
extrahepatic manifestations are hematological (8.78%), including N %
lupus-related phenomena, dermatological (6.76%), rheumatic events Sex of children

(5.56%). There were also patients with autoimmune myopathy, cryo- Male 71 56.8
globulinemia and glomerulonephritis. We reported also two patients Female 54 43.2
with Overlap syndrome (autoimmune and chronic viral hepatitis).
Diagnosis of children
Also, behavioral disorders and depression were determined in some
Atopic Dermatitis 64 51.2
patients included in the study group. The most common subjective
Urticaria 30 24.0
complaints involved arthralgia, myalgia, and asthenia. The most
Anaphylaxis 10 8.0
common extrahepatic manifestations related to clinical examination
Non-IgE food allergy 32 25.6
were adenopathies (41%), urticarial manifestations and respiratory
Culprit food
pathology being rather rare. Extrahepatic manifestations-related co-
morbidities were represented primarily by acrocyanosis and bruis- Cow’s milk 31 24.8
ing, followed by obesity and dermatologic disorders. Hen’s egg 35 28

Conclusion: Immune-induced extrahepatic manifestations were Cow’s milk and hen’s egg 42 33.6
found in pediatric patients, regardless of the type of chronic hepatitis. Multiple food 15 12
In some cases, interferon triggered or worsened some extrahepatic Others 2 1.6
autoimmune manifestations (mainly cutaneous manifestations), re-
quiring evaluation of the therapeutic options. Specific guidelines are
needed for particular situations in order to minimize the side effects to investigate the effects of the social media on mothers of food al-
and to maximize the pathogenic disease-modifying therapy results. lergic children who admitted to our clinic.
Method: Mothers of food allergic children were asked to fill in a
questionnaire including questions about socio-demographic data
and usage of social media. Non-volunteers, non-native Turkish
LBTP1901 | What does mothers of children
speakers and illiterate mothers were excluded from the study.
with food allergy searching on social media? Results: There were 125 mothers who fulfilled the questionnaire,
Yucel E1; Ozceker D2; Sipahi Cimen S1; Ozdemir C1,3; and 100 (96%) of them reported that they were using social media to
Tamay Z1 gather information about food allergy. More than half of them (62%)
1
Division of Pediatric Allergy and Immunology, Department of Pediatrics, were searching for an advice on management including allergen free
Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; 2Department
recipes and physician name. One third (36%) of them were seeking
of Pediatric Allergy and Immunology, Okmeydani Research and Training Hospital,
SBU, Istanbul, Turkey; 3Department of Pediatric Basic Sciences, Institute of Child for dietary advices. Of the responders, 16. 9% claimed that there
Health, Istanbul University, Istanbul, Turkey was a discordancy about the content of diet between their physi-
cian's advice and the advice that they found online. Although 66%
Background: The widespread use and the ease of accessing informa- of the participants did not trust the information found from internet,
tion through the internet has been a source of many knowledge for 55% of them applied these advices to their children (Tables 1, 2).
parents of children with food allergy. Not only professional medical Conclusion: Mothers of food allergic children frequently use social
web sites but also non-qualified social media bloggers are constantly media. Professional websites of allergy associations, medical units
sharing their experiences and knowledge on food allergy. While this and allergists should be easily accessible and must contain compre-
may help the family to cope with the idea of living with food allergy, hensible knowledge to overcome misleading information on differ-
the reliability of these information should be met with suspicion, ent websites and help food allergic children's parents to cope with
since they can sometimes be misleading. The aim of this study was the idea of living with food allergy.
ABSTRACTS | 897
LBTP1903 | The influence of atopic risk factors characteristics, sports habits of the patients and the attitude of fam-
ilies and teachers were questioned.
on evolution of subglottic laryngitis in children
Results: The study was a cross-sectional observation study and 130
Popovici P1; Popovici RM2; Ioniuc IK1; Alexoae MM1; patients were examined. 51.5% of the patients were male. According
Criscov IG1; Azoicai AN1; Stana BA1; Murgu A1
to the sports habits, 24.4% had sports license and took part in a
1
Sf Maria Hospital, Iasi, Romania; 2Cuza Voda Hospital, Iasi, Romania
sports team and 39.8% were regularly involved in sports.
Conclusion: n our study, we identify that negative thoughts of the
Background: Subglottic laryngitis is a common respiratory tract in-
families, low education level, severe attacks, insufficient support
fection among children between 6 months and 6 years of age. The
of teachers and the physician insufficient information transfer to
first aim of this study is to evaluate the effects of some sociode-
the patient are involved with sports behavior which is negatively
mographic parameters in the evolution of subglottic laryngitis and
affected in children with asthma. Therefore, it has been seen that
to compare the influence of this parameters on the incidence and
parents, physical education teachers and sports trainers should be
evolution of subglottic laryngitis in a group with atopic risk factors.
informed in more detail about this issue.
Method: This retrospective study enrolled 304 children aged 0-6 years
hospitalized in Emergency Hospital for Children “St. Mary” Iasi with
subglottic laryngitis during a period of 3 years. The anamnesis regard-
ing sociodemographic parameters was a key point in data collection. LBTP1905 | Investigation of factors triggering
Results: Age distribution, male sex, lower parental education, paren- asthma attack in childhood
tal history of atopy, prematurity, neonatal respiratory diseases, pre- Avunc N1; Kulhas Celik I2; Dibek Misirlioglu E2; Civelek E2;
vious hospitalization for a respiratory disease, living in a house, small Toyran M2
home size, residence in green areas, smokers at home and absence of 1
Division of Pediatrics, Ankara Child Health and Diseases Hematology Oncology
an air conditioning system at home were significantly more frequent Training and Research Hospital, University of Health Sciences, Ankara, Turkey;
2
Division of Pediatric Immunology and Allergy, Ankara Child Health and Diseases
in the atopic group than in the other lot.
Hematology Oncology Training and Research Hospital, University of Health
Conclusion: There is a significant association between environmen- Sciences, Ankara, Turkey
tal allergens and the severity of the evolution of subglottic laryngitis.
The main risk parameter factor was smoke and the presence of aller- Background: Acute asthma exacerbations are one of the most
gen factors in the atopic pediatric group. Recognition and avoiding common causes of hospital admissions and hospitalization in
these nocive factors can lead to a better evolution of the subglottic childhood. There are limited studies about the triggering fac-
laryngitis in pediatric population, respectively 0-6 years of age, es- tors in children with asthma exacerbations. The aim of this study
pecially in the presence of atopy. was to investigate the factors triggering asthma exacerbations in
childhood.
Method: The patients who were admitted to the emergency and al-
LBTP1904 | Evaluation of sports habits of lergy outpatient clinics with an acute asthma exacerbation between
children with asthma and factors effecting these the ages of 2 and 18 years were examined. Sociodemographic char-
acteristics of the patients, home conditions, pre-attack conditions
habits
and treatment-follow-up compliance were questioned. The severity
Bayraktar P1; Kulhas Celik I2; Dibek Misirlioglu E2; of the attack, laboratory data and vital signs were recorded.
Karaatmaca B2; Civelek E2; Toyran M2
Results: A total of 211 patients were evaluated. 132 (62.6%) of the
1
patients were male. Of the patients, 149 (70.6%) had respiratory
Training and Research Hospital, University of Health Sciences, Ankara, Turkey;
2
Division of Pediatric Allergy and Immunology, Ankara Child Health and Diseases tract infection as a possible triggering factor and the most common
Hematology Oncology Training and Research Hospital, University of Health factor in all groups according to age, season and sex. When the other
Sciences, Ankara, Turkey
triggers were examined, 55 of the patients were exposed to an ir-
ritant (26%), 142 to smoking (67.2%), 50 (23.6%) to inhalant allergens
Background: There are limited number of studies on sports habits and 30 (14.2%) to stressful events before the exacerbation and de-
and factors that affecting these habits in children. Therefore, in our fined these factors as possible triggers. In our study, it was observed
study we planned to evaluate the sports habits of the patients with that the frequency of respiratory tract infection as a possible trigger
asthma, the approaches of their families about their sports habits was higher in moderate/severe attacks (P: 0.030) and allergen ex-
and the positive/negative factors affecting these habits. posure as possible trigger was more frequent in mild exacerbations
Method: Pediatric patients aged between 7 and 18 years who were (P: 0.041). Allergen exposure as possible trigger was reported to be
followed up with the diagnosis of asthma at the Allergy clinic of more frequent in patients who did not regularly use asthma medica-
our hospital were evaluated. Sociodemographic characteristics, tions (P: 0.030) and in patients attending school (P: 0.021).
disease control status and treatment follow-up compliance, family
898 | ABSTRACTS
Conclusion: Children with asthma must be closely followed and LBTP1907 | Quality of life in children aged
every effort should be taken to prevent triggering factors, especially
8-18 with a diagnosis of confirmed drug
infections.
hypersensitivity reaction
Tanidir M1; Guvenir H2; Kulhas Celik I2; Uneri OS3;
Bavbek S 4; Toyran M2; Civelek E2; Dibek Misirlioglu E2
LBTP1906 | Allergic and non-allergic 1
comorbidities in pediatric atopic dermatitis Training and Research Hospital, University of Health Sciences, Ankara, Turkey;
2
Division of Pediatric Immunulogy and Allergy, Ankara Child Health and Diseases
Ioniuc IK; Murgu AM; Rugina A; Azoicai AN; Criscov IG; Hematology Oncology Training and Research Hospital, University of Health
Popovici P; Stana BA; Hogas MM; Alexoae MM Sciences, Ankara, Turkey; 3Division of Child and Adolescent Psychiatry, Ankara
Sf Maria Hospital, Iasi, Romania Child Health and Diseases Hematology Oncology Training and Research Hospital,
University of Health Sciences, Ankara, Turkey; 4Division of Immunology and
Allergy, Department of Chest Diseases, School of Medicine, Ankara University,
Background: Atopic dermatitis, chronic or recurrent inflammatory Ankara, Turkey
skin disease, has increased over the past half century. The etiopatho-
genesis of AD is complex and multifactorial, with genetic predis- Background: A significant increasing tendency has been observed
position, skin barrier dysfunction, altered immune responses, and in the incidence of drug hypersensitivity reactions in children. These
environmental and lifestyle factors, being suspected as the underly- reactions may affect the quality of life (QOL) of the patients. Studies
ing and aggravating factors. Disease onset predominately occurs in investigating the effects of drug hypersensitivity reactions on QOL
childhood and it is well known the relationships between atopic der- in children are limited. In our study, we aimed to evaluate the QOL
matitis and atopic disorders such as food allergies, allergic asthma, and the factors affecting quality of life in children with a diagnosis of
and non-atopic comorbidities. confirmed drug hypersensitivity. We also investigated the applica-
Method: The objective of this study was to underline the frequency bility of validated Turkish version of the drug-specific quality-of-life
and the impact of allergic and nonallergic comorbidities on the out- scale for adults for the children.
come and on the evolution of the disease, as well as those related Method: Our study is conducted among the children aged between
complications may affect the quality of life in early age. We per- 8 and 18 who had confirmed drug hypersensitivity and healthy
formed a retrospective study on 102 infants admitted in II Pediatric control group. Sociodemographic characteristics of patients and
Clinic, between January 2017 and December 2017 with diagnosis of families, drug(s) causing the reaction, characteristics of reaction
atopic dermatitis. and diagnostic tests used to confirm drug hypersensitivity reaction
Results: The average age of studied patients was 3 years. The im- were recorded. The Child Quality of Life Scale (PedsQL) parent and
munogram carried out shows the association of the immune deficit self-report forms, Drug Hypersensitivity Specific Quality of Life
(primary or transitory) in 38% cases. The associated comorbidities Questionnaire (DrHy-Q) patient form was used for quality of life
was represented by infections (35 cases), gastrointestinal distur- evaluations.
bances (15 cases), allergic disease (bronchial asthma and allergic The PedsQL findings of the patient group were compared with those
rhinosinusitis—10 cases) and 1 case with neurologic impairment. In of the healthy age group.
the relationship with atopic dermatitis, some of these comorbidities Results: The study is conducted on 46 patients (%63, 29 female).
have led to the aggravation of symptomatology (associated with fail- The mean age was 157.07 ± 33.87 months (min. 96, max. 216).
ure to comply with the doctor's recommendation treatment and in Twenty-two (47.8%) patients had reaction with antibiotics, 21
avoiding the risk factors), and others have been a side effect of the (45.7%) with nonsteroidal anti-inflammatory drugs. The reactions
dermatitis itself or of the treatment (respiratory, metabolic or diges- were as follows: angioedema in 16 (34.8%) patients, maculopapular
tive dysfunctions). rash in 8 patients (17.4%), severe cutaneous drug reaction in 6 (13%)
Conclusion: The atopic dermatitis associated comorbidities empha- patients and anaphylaxis in 5 (10.9%) patients. There was no statis-
size the burden of this disease in pediatric patients. Even the mecha- tically significant difference between the patients and the control
nisms of associated comorbidity are not yet fully understood, both group's PedsQL scores that was filled by themselves and their par-
atopic dermatitis itself as well as the treatment and the lifestyle fac- ents (P > 0.05). There was a negative correlation between PedsQL
tors may contribute to their genesis and outcome. and DrHy-Q (r = −0, 54 P = 0.00) thus we concluded that Turkish
version of DrHy-Q that was validated for adults can be used for chil-
dren aged 8-18 years.
Conclusion: There were no differences in regard of QOL between
patients and control group. It was shown that the DrHy-Q developed
for adults can be used in children.
ABSTRACTS | 899
LBTP1908 | Evaluation of underlying are established. Unfortunately information on mechanisms involved

in immune health in early life is scattered across thousands of scien-
etiological factors in children with high serum
tific papers. We used INDRA (Integrated Network and Dynamical
immunoglobulin E levels
Reasoning Assembler), an automated software infrastructure that
Esenboga S1; Sahiner UM1; Çetinkaya PG1; Cebeci K 2; uses text mining and machine learning tools, to extract and structure
Demir OO2; Buyuktiryaki B1; Sekerel BE1; Soyer O1 information on causal mechanisms to generate early life immune-
1
Division of Pediatric Allergy and Asthma, Hacettepe University Medical School,
networks that help to identify sensitive periods for early immune
Ankara, Turkey; 2Division of General Paediatrics, Hacettepe University Medical
School, Ankara, Turkey priming for life.
Method: First an inventory of available literature (till July 2018) re-
Background: Immunoglobulin E (IgE) is an antibody that plays an im- garding 6 immune developmental periods (1st/2nd/3rd trimester of
portant role in allergy and immunological defense against parasitic gestation, birth, newborn (0-28 days), infant (1-24 months)) in human
infections. Serum IgE level is mostly used in predicting both allergic and experimental animals was made using Scopus and PubMed.
and some immunological diseases. Articles were screened on title, abstract and full text to select rele-
Method: The aim of the study was to evaluate the etiological fac- vant articles which were subsequently classified into the appropriate
tors leading high serum IgE levels in children and to determine the early life time-periods. Next the INDRA text mining platform ren-
optimal cut-off values for serum IgE levels in different etiologic fac- dered the full texts computationally accessible, identified relevant
tors. Children with serum IgE levels above 95th percentile that were entities (e.g. genes/proteins/metabolites/processes/diseases) and
followed-up between 2015 and 2016 were enrolled in the study. extracted relationships between these entities. Next INDRA assem-
Data of the patients, including clinical characteristics, laboratory bled all relationships into causal early life-immune networks each
parameters, atopy, and diagnosis, were collected and analyzed. covering a different early life period.
Results: A total of 337 children (M/F: 222/115) with a median age Results: In total 2966 articles were selected using the literature da-
of 8.2 (3.8-11.6) years was included in the study. Allergic diseases tabases of which 829 articles (451 original manuscripts, 378 reviews)
consisted of asthma, allergic rhinitis, atopic dermatitis, food and were considered relevant after screening. This resulted in 249, 296,
venom allergy occurred in 90.7% of the study population. Out of 344, 252, 287, and 215 articles classified into resp. the 1st, 2nd, 3rd
337 patients, 4.8% had primary immunodeficiencies (PID), 2.7% trimester, birth, newborn and infant period (some articles covered
had chronic lung diseases, and 1.8% had rheumatological diseases. multiple periods). From these full text articles, INDRA extracted
Remarkably, serum IgE levels of the patients with PID [IQR: 793 resp. 2101, 3234, 3654, 1568, 2917 and 1487 unique relationships
(256-9892)] were significantly higher than the patients with the di- between entities, resulting in 6 large causal early-life immune net-
agnosis of other disorders as well as allergic diseases [IQR: 441 (281- works each covering a different early life period.
931)] (P = 0.041). Total serum IgE level >2500 IU/L was the optimal Conclusion: For the first time, we extracted and structured rel-
cutoff value [area under the curve (AUC) of 0.651 (P = 0.041)] in evant information from thousands of early-life papers to un-
predicting PID with a sensitivity of 43.8% and a specificity of 94.1% derstand causal relationships of between genes, proteins and
(negative predictive value 97.1% positive predictive value 26.9%). processes on immune health in different early-life periods by
Conclusion: Allergic diseases constitute a large proportion of the combining the text mining/machine learning tool INDRA with our
children presenting with high serum IgE levels. Moreover, IgE levels immune domain knowledge. The resulting early-life immune net-
below 2500 IU/L considerably excludes the diagnosis of PID. works generate knowledge on the dynamics of early life immune
health development which opens opportunities for interventions
to improve early life immune health.
LBTP1909 | Seeking early-life windows of

opportunity to shape lifelong immune health
LBTP1910 | A mixed methods investigation
through text mining
into a new Clinical Psychology service in
Van Bilsen J1; Van Stee M1; Dulos R1; Meima M1;
Children's Allergy
Rouhani Rankouhi T1; Neergaard Jacobsen L2;
Staudt Kvistgaard A 2; Garthoff J3; Knippels L4; Knipping K4; James P1; Mcgurk C2; Ridgley J2
Houben G1; Verschuren L1; Meijerink M1; Krishnan S1 1
Guys and St Thomas’ NHS, London, United Kingdom; 2Kings College London,
1 2 London, United Kingdom
TNO, Zeist, The Netherlands; Arla Foods Ingredients, Aarhus, Denmark;
3
Danone Food Safety Center, Utrecht, The Netherlands; 4Danone Nutricia
Research, Utrecht, The Netherlands
Background: The Children's Allergy Clinical Psychology service at
The Evelina London Children's Hospital provides services to chil-
Background: The first 1000 days of life is a period of growth and de-
dren, young people and their families. This study investigates the im-
velopment in which the foundations of lifelong immune homeostasis
pact of the psychology service and explores how parents experience
900 | ABSTRACTS
Average post
Patient Pre therapy goal ratings Post therapy goal ratings Average pre therapy rating therapy rating
1 5, 5, 5 10, 10, 10 5.0 10.0

2 4, 3, 1 9, 10, 9 2.7 9.3
3 4, 5, 4 6, 6, 5 4.3 5.6
4 5, 3, 3 9, 8, 8 3.7 8.3
5 5, 5, 4 10, 10, 10 4.7 10.0
6 2, 0, 5 10, 8, 10 2.3 9.3
7 5, 5, 5 10, 9, 9 5.0 9.3
8 5, 5, 5 10, 10, 10 5.0 10.0
9 4, 5, 1 10, 10, 10 3.3 10.0
10 4, 5, 4 6, 6, 5 4.3 5.6
the stepped care allergy psychology service, so as to inform future LBTP1911 | Seasonal variations in adverse
service development.
reactions during pollen subcutaneous
Method: A two phase mixed method quantitative and qualitative
immunotherapy in children
study. Phase 1: Quantitative sociodemographic and service data
were collected from the establishment of the service in 2016 until Gür Çetinkaya P; Kahveci M; Esenboga S; Karaatmaca B;
2018. Phase 2: A semi structured questionnaire was designed to
Buyuktiryaki B; Soyer O; Tuncer A; Sekerel BE; Sahiner U
Hacettepe University Medical School Division of Pediatric Allergy and Asthma,
gather parents’ perspectives of the stepped care allergy psychol-
Ankara, Turkey
ogy service. The questionnaire included open and closed questions
about the different types of psychological intervention from referral
Background: Allergen immunotherapy induces immune tolerance
to discharge.
by the usage of increased doses of responsible allergen and is an
Results: Phase 1: 254 patients were referred to the service from
effective treatment strategy for allergic rhinitis. However, adverse
2016-2018. These children ranged between 1 and 18 years, with
reactions are important problems in subcutaneous immunotherapy
the mean age 9.1 years. Of those who took up the service, patients
(SCIT).
were contacted within an average of 78.5 days. The mode of initial
Method: We aimed to evaluate the risk factors for the reactions de-
contact varied between phone, face to face and workshop. Average
veloping during pollen SCIT in a pediatric population. The data ob-
confidence ratings for subjective therapy goals before and after in-
tained from medical files of the children who had taken pollen SCIT
dividual therapy and workshop interventions were both statistically
between 2000 and 2018, retrospectively. Patients with local (LR),
significant at P > 0.005 level.
large local (LLR), systemic reactions (SR), and without any reactions
Phase 2: 36 parents were contacted by phone. The main reasons
were compared with respect to clinical and laboratory parameters.
for psychology intervention were reported by parents to be for
In addition, patients were analyzed for the predictors of large local
child anxiety and feeding difficulties. The majority parents reported
and systemic reactions during pollen IT.
that both therapies relieved anxiety and improved quality of life. All
Results: A total of 261 patients (M/F:177/84) with a mean age of 12.0
parents asked had a positive opinion of psychology in paediatric al-
(±3.0) years old were included in the study. Concomitant asthma and
lergy with it being described as “important”, “useful” and “essential”.
family history of atopy were present in 132 (50.1%) and 67 (25.7%)
Negative aspects of the experience reflected the realities of service
of the patients. Of 261 patients, LR, LLR, and SR occurred in 41.8%,
driven constraints including long waiting times, lack of provision for
11.5%, and 13.4% of the cases, respectively. Although total num-
older children transitioning to adult services and availability of dif-
ber of injections resulting in LR were more frequent in the build-up
ferent appointment times.
phase (5.6% vs 2.0%, P < 0.001), the difference was not significant
Conclusion: Service user feedback is imperative to providing a high
for LLR and SR. Moreover, injections resulting in LR and SR were
standard of care. This study highlighted positive experiences of a
significantly observed in pollen season (P < 0.001 and P = 0.003,
stepped care service and indicated areas for future improvement
respectively). Patients experiencing LLR and/or SR were frequently
that we are attempting to address. Waiting times decreased and
initiated SCIT in pollen season (P = 0.016) and had much more LR
number of clinics increased with continued growth of the service
during SCIT (P < 0.001) compared to the children without LLR and/
showing increased provision of psychology helps to address nega-
or SR. Risk analysis for the presence of LLR and/or SR during SCIT
tive aspects of parental reported experiences.
revealed the initiation of pollen SCIT in pollen season [OR:7.351,
95%CI:1.532-35.279, P = 0.013] and the presence of LR during
ABSTRACTS | 901
pollen SCIT [OR:4.214, 95%CI:2.159-8.224, P < 0.001] as independ- guidelines on both, wheezing and asthma, with appraisal of their
ent risk factors. quality.
Conclusion: Children underwent pollen SCIT experienced SR fre- Method: The Cochrane Library, MEDLINE, and EMBASE databases
quently both in pollen season and during build up period. Initiation were searched systematically in April 2017 in order to identify
of pollen SCIT in pollen season was found to be an independent risk guidelines for diagnosis and management of wheezing and asthma
factor for LLR/SR during SCIT. Choosing to start pollen SCIT out of in children. The methodological rigor, quality, and transparency of
the pollen season can reduce serious adverse reactions observed relevant guidelines were assessed by at least four independent re-
during SCIT. searchers, with the use of the Appraisal of Guidelines for Research
and Evaluation (AGREE II) tool.
Results: Of 24 included guidelines 5 achieved the highest scores
(>90%), and 3 of which were developed by recognized scientific
organizations. Further eight guidelines, were considered to be of
LBTP1912 | Preschool wheezing and asthma
high quality (i.e. overall quality scores >60%). The quality scores for
in children: Systematic review of guidelines and
each domain varied. Of all domains, clarity and presentation had the
quality appraisal with the Agree II Instrument highest mean score, and applicability and stakeholder involvement
Ruszczynski M1; Drag D2; Adamiec A 2; Matysiak K3; had the lowest mean score. The scores (mean ± SD) for individual
Elenius V4; Bircan O5; Maggina P6; Makrinioti H7; domains were as follows: domain 1 (score and purpose) 80 ± 17%;
Papadopoulos N8; Jartti T4; Feleszko W3
domain 2 (stakeholder involvement) 52 ± 24%; domain 3 (rigor of
1
Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland;
2
development) 55 ± 26%; domain 4 (clarity of presentation) 81 ± 17%;
Medical University of Warsaw, Warsaw, Poland; 3Department of Pediatric
Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland; domain 5 (applicability) 52 ± 29%; and domain 6 (editorial independ-
4
Department of Pediatrics, Turku University Hospital and University of Turku, ence) 59 ± 28%. Maximum possible overall score was 97%.
Turku, Finland; 5Department of Pediatric Allergy, Istanbul Medeniyet University Conclusion: A number of guidelines on wheezing and asthma man-
Göztepe Training and Research Hospital, Istanbul, Turkey; 6Allergy Department,
agement in children are available; however, their quality varies vastly.
2nd Pediatric Clinic, University of Athens, Athens, Greece; 7Imperial College
Healthcare NHS Trust, London, United Kingdom; 8Division of Infection, Immunity Overall, the guidelines developed by recognized professional/scien-
& Respiratory Medicine, Manchester, United Kingdom tific organizations were of the highest quality and these guidelines
should be recommended for use. It is important that future guide-
Background: Wheezing, especially in preschool children, is a com- lines for wheezy preschoolers aim to identify individuals who suffer
mon time and resources consuming problem, that also poses a di- from asthma, since its management is appropriately guided.
agnostic challenge. In order to address this issue, an EAACI Task
Force on Clinical Practice Recommendations on preschool wheeze
was established. As a first step in developing guidelines for pre-
school wheeze, we aimed to perform a systematic review of existing
902 | ABSTRACTS
TUESDAY, 4 JUNE 2019

LB TPS 07
MANAGEMENT OF RESPIRATORY DISEASE
LBTP1917 | Forced oscillation technique despite the reduction in PBE compared to BL, did not show changes
as useful method to monitor the efficacy of in WBI during treatment.

Conclusion: FOT could become a valuable tool to monitor the ef-
mepolizumab in treating severe eosinophilic
ficacy of MPZ treatment in SEA patients, whose changes showed to
asthma correlate with both ACT scores and PBE.
Tontini C1; Marchionni A 2; Gobbi A3; Gallifuoco M1;
Lucchetti B4; Garritani MS1; Bilò MB2; Antonicelli L1 Subjects
1
Allergy Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, (n = 18)
Italy; 2Allergy Unit, Dipartimento di Scienze Cliniche e Molecolari, Università
Demographic data Sex
Politecnica delle Marche, Ancona, Italy; 3Restech SRL, Milan, Italy; 4Allergy Unit,
Università Politecnica delle Marche, Ancona, Italy Female 11 (61.1%)
Male 9 (38.9%)
Background: Severe eosinophilic asthma (SEA) patients with recur- Age 54.5 (9.1)
rent exacerbations, despite maximal ICS/LABA dose, are eligible for BMI 24.9 (4.1)
treatment with the anti-Interleukin (IL)-5 monoclonal antibody me- Clinical history and use of Former smoker 10 (55.6%)
polizumab (MPZ) (1). During MPZ treatment, while symptoms and medications at baseline Duration of asthma 19.1 (9.5)
peripheral blood eosinophil counts (PBE) tend to reduce, changes Current use of OCS 13 (72.2%)
in lung function parameters (LFP) assessed by spirometry are mini-
Equivalent PDN use 5.0 (5.7)
mal (2). The forced oscillation technique (FOT) is a non-invasive test (mg/day)
that measures within-breath impedance (WBI) of peripheral airways OCS use
using sound waves at selected frequencies during tidal breathing.
Chronic 8 (44.4%)
FOT was useful in monitoring severe asthma patients and, in one
On-demand 10 (55.6%)
case, documented the efficacy of omalizumab in reducing peripheral
Current ICS use 18 (100%)
airways impedance (3-5). The aim of our study was to assess whether
Current LABA use 18 (100%)
FOT is able to monitor the changes in peripheral lung mechanics in-
Current LAMA use 4 (22.2%)
duced by MPZ (6), and if such changes correlate with clinical, labora-
tory and lung function tests results. Current LRA use 6 (33.3%)
Method: We conducted a prospective study on 18 patients with se- Previous treatment 6 (33.3%)
with OMZ
vere eosinophilic asthma, scheduled to receive MPZ (Table 1). The
Previous treatment 2 (11.1%)
following parameters were assessed at baseline (BL) and then at 1, 3
with TP
and 6 months of treatment: asthma control test (ACT); PBE (/mmc-
Clinical features at baseline ACT 16.3 (3.7)
%); LFP parameters FEV1, FVC (L-%), and FEV1/FVC (%) assessed
™ Eosinophils (/mmc) 659.4
by spirometry (Vmax , Carefusion); WBI parameters expiratory 5 Hz
(300.9)
resistance (R5exp), reactance (X5exp) and full-breath % of predicted
Eosinophils (%) 7.9 (4.5)
(R5%, X5%) [7] assessed by FOT (Resmon PRO Full, Restech SRL).
FVC (L) 3.29 (0.9)
Results: Significant improvement of ACT scores (P < 0.001), FEV1-
FEV1% (P = 0.004), FVC-FVC% (P = 0.012) and significant reduction % of predicted FVC 89.2 (15.3)
of PBE (P < 0.005) were observed from month 1 of MPZ therapy. FEV1 (L) 1.9 (0.6)
While ACT scores improved over time, LFP and PBE parameters % of predicted FEV1 70.2 (20.1)
showed no further improvement at month 3 and 6. Statistically sig- FEV1/FVC 58.8 (12.1)
nificant changes were observed in WBI parameters: X5% (P = 0.02) R5exp (cmH2O/L/s) 5.0 (1.7)
reduced from month 1, and X5exp (P = 0.04), R5exp (P = 0.02) % of predicted R5 159.8 (53.4)
and R5% (P = 0.003) from month 3. Changes in ACT scores corre- X5exp (cmH2O/L/s) -2.4 (1.6)
lated with changes in X5exp (r = .660, P = 0.007), FVC% (r = .600, % of predicted X5 174.1 (92.4)
P = 0.030), but not R5exp (P = 0.054), FVC, nor FEV1-FEV1%
(P > 0.05). Changes in PBE correlated with changes in X5exp, R5exp Data expressed as mean (SD) or n (%).
(r = .700, P = 0.036), FEV1 (r = .762, P = 0.028) and FEV1% (r = .738, Abbreviations: ACT, asthma control test; BMI, body mass index;
P = 0.037), respectively. The few non-responders to MPZ (3/18), FEV1, forced expiratory volume in 1 second; FVC, forced vital
capacity; ICS, inhaled corticosteroids; LABA, long-acting beta-2
ABSTRACTS | 903
agonist; LAMA, long-acting muscarinic agonist; LRA, leukotriene More serious arrhythmias were infrequent but were observed and
receptor antagonist; OCS, oral corticosteroids; OMZ, omalizumab; noted.
PDN, prednisone; R5exp, expiratory resistance at 5 Hz; TP, thermo-
plasty; X5exp, expiratory reactance at 5 Hz.
LBTP1921 | Salbutamol and ipratropium

bromide are risk factors for arrhythmias in
LBTP1920 | Salbutamol and ipratropium patients with CVS diseases
bromide are high risk factors for atrial
Sethi R; Zakharyan H
arrhythmias in patients with COPD and CVS Yerevan State Medical University, Yerevan, Armenia
diseases
Sethi R; Zakharyan H Background: A finding was noted that patients who were admitted
Yerevan State Medical University, Yerevan, Armenia with diagnosis of COPD and were known case of any CVS pathol-
ogy treated with salbutamol and ipratropium bromide are at risk of
Background: Salbutamol being a beta-adrenergic stimulator may developing arrhythmias. The patient who has COPD with a heart ail-
increase heart rate and the potential for cardiac arrhythmias in al- ment has CVS which is already compromised with a disease and a
ready compromised circulatory system of a CVS ailment patient. respiratory component is also present in addition to it, worsening the
Ipratropium bromide, on other hand is non-selective muscarinic an- scenario. Despite of the best modalities of diagnosis and treatment
tagonist, which means the acetylcholine (ACh) released by these fib- available, a treatment trend is followed as treating an exacerbation
ers binds to muscarinic receptors in the cardiac muscle, especially at of COPD patient with or without CVS pathology with salbutamol
the SA and AV nodes that have a large amount of vagal innervation and ipratropium bromide.
and ACh released by vagus nerve binds to M2 muscarinic receptors, a Method: The design was a case control study in 40 adult patients
subclass of cholinergic receptors which produces negative chronot- who presented with exacerbation of COPD out of which 20 were
ropy and dromotropy in the heart, as well as negative inotropy and males and 20 were females of mean age group of 55 years. Out of
lusitropy in the atria (the negative inotropic and lusitropic effects them 10 male and 10 female patients were known cases of different
of vagal stimulation are relatively weak in the ventricles) now will CVS ailments and others were not. Patients in Group A was num-
behave the other way because of antagonist effects of ipratropium bered from 1 to 20 and Group B was numbered from 21 to 40. Letter
bromide. “m” was used for male patients and letter “f” was used for female pa-
Method: The effect of above mentioned drugs was evaluated in patients. Patients were taking the SABA, Ipratropium bromide and ICS
tients with COPD and CVS ailments in 2 groups of same age and equal on, on and off basis for past 3-4 years as their treatment for COPD.
sex distribution. Age bar of being 65-70 years. In this study, ECGs And history was taken for any arrhythmias or ECG changes. This is
were evaluated before and after the usage of salbutamol and iprat- how case and control were taken and ODD's ratio was calculated.
ropium bromide. Patients were evaluated before and after 4 weeks Results: The positive ODD's Ratio of 10.23, and considering the vi-
of treatment with above mentioned drugs: 1) salbutamol, 90 mcg (1 tals monitored during the treatment as well, it simply explains the
puff) every 4 hours 2) Ipratropium Bromide, 34 mcg (2 puffs) every fact that salbutamol and ipratropium bromide has the potential to
6 hours. The series of ECGs were performed pre-treatment and at aggravate and cause arrhythmias in patients with CVS ailments.
Week 4th. We were able to find various arrhythmias such as atrial Conclusion: The patients with COPD forehand are prone to arrhyth-
tachycardia, atrial fibrillation and ventricular tachycardia. There mias because of electropathy hypothesis and underline autonomic
were 60 ECGs recordings in 30 treated patients (M = F). In total, Out neuropathy as the most possible mechanism of arrhythmias in hy-
of 30 patients, we could see ECG changes in 28 patients. The most poxemic, non-respiratory failure, and COPD patients. Hence, in adult
common met ECG was with Atrial Tachycardia in 20 patients out of patients with CVS pathologies, Beta 2-adrenergic receptors agonist
which 12 were females (60%) and 8 were males (40%). The least seen and anticholinergic drug cause significant arrhythmias. Treating pa-
was atrial fibrillation in only one male patient. The ventricular tachy- tients with Beta 2-adrenergic receptors agonist and anticholinergic
cardia was seen in 6 males and 1 female patient. drug can be pharmacologically aggravating the risk of development
Results: The percentage of patients with atrial tachycardia, post arrhythmias in already CVS and respiratory compromised patients
usage of the drugs mentioned was significantly higher with 71.4%, and should be avoided or given with lots of caution and under strict
which is way higher than other types of arrhythmias occurred monitoring.
3.57%(AF), 25%(VT) respectively. All treatment groups consistent
monitoring and were under supervision.
Conclusion: In conclusion, in this study of COPD and CVS ailment
patients with no other comorbidities, a high percentage of patients
were observed to have atrial tachycardia before after the treatment.
904 | ABSTRACTS
LBTP1922 | Occupational asthma in patients Background: Formaldehyde is a low molecular weight chemical that
combined with a human protein is able to produce a sensitizing neo-
exposed to Persulfate Salts. A 3 years experience
antigen. Formalin is a formaldehyde solution in water from 37% to
(2016-2018) in an allergy department
50% by volume. Cosmetics and personal care products that may
Baptista-Serna L; Ortega-Martín L; Sastre J; contain formaldehyde include nail polishes, makeup, body washes,
Fernández-Nieto M; Gómez-Cardeñosa A deodorants, shampoos or hair straightening products (also known as
Fundación Jiménez Díaz, Madrid, Spain
hair relaxers). It is also use as a sterilizing in the health care industry.
The aim of our study is to describe five patients in which formalde-
Background: According to the European Community Respiratory hyde induced nasal or bronchial response.
Health Survey, 10-25 percent of adult onset asthma is due to Method: Case series of rhinitis and/or occupational asthma due to ex-
Occupational asthma (OA). Persulfate salts (PS) are low-molecular- posure to formaldehyde at Fundación Jiménez Díaz University Hospital,
weight chemicals, and the most important OA agents in hairdressers. from 2005 to 2019, were evaluated. We perform the following tests:
Our aim is to study the basal conditions and the characteristics of the Patch tests with formaldehyde, FeNO, spirometry, methacholine chal-
patients diagnosed with asthma induced by PS in our department. lenge testing, specific bronchial challenge (SIC) with formaldehyde,
Method: We established a descriptive study about the asthma charac- monitored by spirometry and/or acoustic rhinometry (ARM).
teristics in all patients referred to our service between January 2016 and Results: A total of 207 SICs were performed in our department
December 2018, selecting those cases in which PS was the cause of their between 2005 and 2019. 131 SICs had a positive result for asthma.
disease. 6 SICs corresponded to exposure to formaldehyde. The patients
Results: 10 female hairdressers (mean age, 39 years; range, 26- were four women and two men. The mean age was 48 years (34-
52 years) were included. 5 were ex-smokers, 2 were active smokers, 58 years) There was only one case with positive formaldehyde
2 were non-smokers. 3 patients had a previous diagnosis of asthma patch tests.
and rhinitis. Regarding the previous aeroallergen sensitizations: 50% After SIC, FEV1 showed a fall of 20% or more and in three cases.
of patients were sensitized to common inhalants. The mean occupa- Only one patient had a positive nasal provocation test assessed by
tional exposure was 221.3 months and 59.13 months for symptoms using ARM. A significant change in pc20 methacholine value was ob-
until they were sent to our department. Regarding the characteris- served in the other two patients. No changes were observed in post
tics of the disease: 8 patients showed rhinitis, 8 dyspnea, 7 cough challenge FeNO values.
and 4 wheezing. The mean FeNO was 29.5 ppb. In 9 patients, the Conclusion: To our knowledge this is one of the few reports of oc-
methacholine bronchial provocation test was positive (mean PC20 cupational asthma due to formaldehyde and the first case of occu-
3.07 mg/mL). Bronchial provocation specific with PS was positive in pational rhinitis assessed by ARM. This results enforce the idea of
the 10 patients, with a mean decrease of 19.28% in FEV1. The aver- suspecting formaldehyde as a compound able to cause occupational
age time of sick leave during the study was 5.7 months. respiratory diseases.
Conclusion: We found a high prevalence of smokers (7/10 patients)
and sensitization to aeroallergens; in the future, this possible associa-
tion with PS OA should be studied. In addition, we find that is a great
LBTP1924 | Atopic status and exercise-induced
cause of concern the long period of exposure to PS and the onset of
asthma symptoms before they are referred to a specialist. In our opin- bronchoconstriction in high-school elite athletes
ion, hairdressers should be studied in an allergy department before Goossens J1; Jonckheere A1; Seys S1; Dilissen E1;
starting their jobs in order to check their basal pulmonary function Goossens C1; Schelpe A1; Van Der Eycken S1; Corthout S1;
and if they develop asthma symptoms or worsening in established Verhalle T1; Troosters T2; Peers K3; Dupont L4,5; Bullens D1,6
1
ones the diagnosis and treatment could be established earlier. Research Group Allergy and Clinical Immunology, Department of Microbiology
and Immunology, KU Leuven, Leuven, Belgium; 2Department of Rehabilitation
Sciences, KU Leuven, Leuven, Belgium; 3Sport Medical Advice Centre, UZ
Leuven, Leuven, Belgium; 4Laboratory of Pneumology, Department of Chronic
Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium; 5Clinical
LBTP1923 | Occupational asthma and rhinitis Division of Respiratory Medicine, UZ Leuven, Leuven, Belgium; 6Clinical Division
due to formaldehyde of Paediatrics, UZ Leuven, Leuven, Belgium
Berho Fuenzalida JM1; Extremera Ortega AM2;

Sastre-Domínguez J3; García Del Potro M3; Background: Physical exercise, though absolutely beneficial for
Fernández-Nieto M3 human well-being, is a well-known trigger to induce bronchocon-
1
Immunology Department, Clinical Hospital University of Chile, Santiago De striction. Exercise-induced bronchoconstriction (EIB) is defined as
Chile, Chile; 2Allergy Department, General University Hospital of Ciudad Real, transient, reversible airway narrowing occurring during or after ex-
Ciudad Real, Spain; 3Allergy Department, Fundación Jiménez Díaz University
ercise and is common among elite athletes. Atopy is considered to be
Hospital, Madrid, Spain
a risk factor for EIB. The purpose of this study is to investigate the
atopic status of young elite athletes.
ABSTRACTS | 905
Method: High-school selected elite football players (12-18 years) were recruited. We evaluated Skin Prick Tests (SPT) for the most
(n = 66) performing at least 12 hours of sport per week (me- common airborne, flours and storage mites allergens, spirometry,
dian = 15 hours) were recruited. Atopy was defined by a skin prick FeNO and Peak Nasal Inspiratory Flow (PNIF). A self-report symp-
test (SPT) against 9 common allergens. Subjects were considered to tom evaluation questionnaire (Sinonasal Outcome Test 22, SNOT-
be atopic if they had at least one positive SPT result. The eucapnic 22) and a VAS for nasal symptoms were also administered. In select
voluntary hyperventilation (EVH) test was performed according to cases were collected personal samples of flour dust during the work-
ATS guidelines and adapted for this young age group (n = 57). The ing hours and analysed with a gravimetric determination. The flour
fractional exhaled NO (FeNO) levels were measured at baseline in a dust cumulative exposure was also calculated.
subgroup of elite football players (14-18 years, n = 18). Results: We sampled 142 workers (99 men and 43 women, age
Results: A total of 23 football players were atopic (35%) of which 8 40 ± 13 years, length of service 14 ± 12 year), 60 (42%) of whom
were poly-sensitized. The most common observed positive allergens were active smokers; fourteen subjects (10%) reported upper res-
in these football players were house dust mite (n = 16), followed by piratory symptoms, whilst 10 (7%) had lower respiratory symptoms.
grass pollen (n = 11). FeNO levels were significantly higher in atopic Atopy was present in 78 workers (56%); furthermore 59 of them
athletes (median: 21.5 ppb, P25-P75: 18.3-37.8 ppb, n = 6) compared (42%) were skin positive to at least one occupational allergen.
to non-atopic athletes (median: 10.5 ppb, P25-P75: 5.3-14.5 ppb, Abnormal findings were detected in 14% of spirometry and 24.5% of
n = 12) (P = 0.0291). Moreover, athletes with FeNO levels higher FeNO. The range of flour exposures was 0.097-14.005 mg/m3.
than 18 ppb have a significantly higher risk to be atopic, with a sensi- At univariate logistic analysis, length of service was associated to
tivity of 83.3% and specificity of 83.3% (P = 0.0312). Seven athletes a higher grade of sensitization to flours (OR = 4.50; 95%CI: 1.08;
were considered to be EIB positive (12%), including 3 atopic athletes. 18.69). Following the literature, a multiple regression model has
In contrast, football players self-reported shortness of breath (35%, been fitted on the square root of PNIF values with a forward step-
n = 23) and/or wheezing (18%, n = 12) during exercise. wise selection of the variables (multiple R2 = 30%). Given the positive
Conclusion: 35% of the young elite athletes demonstrates atopy, effects of male sex, VAS for obstruction and hyposmia, and the neg-
which is slightly higher than in the general population in Europe (15- ative effects of FeNO, VAS for headache and odour identification,
20%). Atopic elite athletes have higher FeNO levels compared to we observed a significant negative effect of the prick test (regres-
non-atopic elite athletes. Accordingly, FeNO levels may be a useful sion coefficient = −0.88, P = 0.009) and an almost significant positive
indicator of atopic phenotypes among young elite athletes, using a effect of rye and soy sensitization (regression coefficient = 0.83 and
cut-off value of 18 ppb. Despite atopy is a risk factor for the devel- 1.14 respectively, P = 0.09).
opment of EIB in athletes, we could not find a correlation between Conclusion: Although many workers reported low prevalence of res-
atopy and the occurrence of EIB due to the low number of EIB posi- piratory symptoms, we frequently found signs of upper and lower
tive elite athletes. Consequently, also young elite athletes of other airways inflammation. It was also shown that occupational factors
sport disciplines need to be included. such as flour sensitization may affect nasal patency, considered as
forced inspiratory flows. Further studies and on a bigger population
are needed to confirm and better unfold these results.
LBTP1925 | Diagnosis of occupational

respiratory allergic diseases in bakers and their
exposition to flour powders LBTP1927 | Using an electronic nose to
monitor airway dysfunction in elite swimmers: A
Crivellaro MA1; Maculan P1; Guarnieri G2; Andriulo CM2;
Carrieri M3; Scarpa B4; Ottaviano G5; Maestrelli P2 pilot study
Cavaleiro Rufo J1; Farraia M1; Castro Mendes F2;
1
Allergy Unit, Occupational Health, Department of Cardiologic, Thoracic and
Vascular Sciences, University of Padova, Padova, Italy; 2Occupational Health, Paciência I2; Delgado L2; Moreira A1,2
Department of Cardiologic, Thoracic and Vascular Sciences, University of 1
Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal;
Padova, Padova, Italy; 3Industrial Hygiene, Department of Cardiologic, Thoracic 2
Faculdade de Medicina da Universidade do Porto, Porto, Portugal
and Vascular Sciences, University of Padova, Padova, Italy; 4Department of
Statistical Sciences, University of Padova, Padova, Italy; 5Otolaryngology Unit,
Department of Neurosciences, University of Padova, Padova, Italy Background: Endurance swimming exercises coupled to disinfection
by-products exposure has been associated with increased airways
Background: Exposure to flour powders and sensitization to mites dysfunction in swimmers, which is often referred as a precursor
play an important role in the development of bakers’ respiratory change leading to “swimmers’ asthma”. However, without continu-
disorders. The aim of this study was to evaluate the correlation be- ously monitoring lung function parameters, it is challenging to un-
tween occupational exposure to flours and prevalence of respiratory derstand the extent of the airway dysfunction associated with
signs, symptoms and inflammation biomarkers among bakers. swimming practice. The electronic nose technology has been shown
Method: A surveillance program was performed in 26 industrial and capable of identifying asthma-associated volatile organic com-
artisan bakeries in North-Eastern Italy, and 142 volunteer workers pounds (VOC) in the exhaled breath. Therefore, this study aimed to
906 | ABSTRACTS
investigate if an electronic nose system is able to identify the airway LBTP1929 | “Blockers” can benefit from
dysfunction traces associated with swimming practice.
300IR house dust mite tablet—results of a large
Method: A total of 10 elite swimmers (13-15 years old) and 15 elite
multicentre clinical trial in house dust mite
football players (15-17 years old) participated in this pilot cross-
sectional study. An asthma diagnosis was ruled out by a special-
induced allergic rhinitis patients
ist, according to standardized guidelines. Participants performed Demoly P1,2; Creticos P3; De Blay F4; Gevaert P5;
spirometry with bronchodilation and exhaled nitric oxide measure- Kowal K6; Le Gall M7; Nenasheva N8; Passalacqua G9;
ments. Exhaled breath was collected through a 1 L Tedlar bag. The
Pfaar O10; Tortajada-Girbés M11; Vidal C12; Casale T13;
Corren J14
exhaled breath VOC were then measured through an electronic nose
1
Department of Pulmonology and Addictology, Arnaud de Villeneuve Hospital,
system with 32 nanocomposite sensors. Mann-Whitney tests were
Montpellier University, Montpellier, France; 2Sorbonne Universités, UPMC
used to compare continuous variables between groups, and principal Paris 06, UMR-S 1136 INSERM, IPLESP, Equipe EPAR, Paris, France; 3Creticos
component analysis was performed to create discriminant factors Research Group, LLC in association with Charleston Allergy & Asthma,
Charleston, United States; 4Allergy Division, Chest Diseases Department,
from the measured VOC profiles. Finally, generalized linear models
Strasbourg University Hospital, SC, France; 5Upper Airways Research
were performed to estimate how the VOC factors were associated Laboratory, Strasbourg, Belgium; 6Department of Experimental Allergology and
with FEV1 reversibility after bronchodilation. Immunology, Medical University of Bialystok, Ghent, Poland; 7Stallergenes Greer,
Global Clinical Development, Bialystok, France; 8Russian Medical Academy
Results: As expected, FEV1 reversibility in swimmers was signifi-
of Continuous Professional Education of the Ministry of Health of the Russian
cantly higher than in football players (P = 0.007, Table 1). The facto- Federation, Antony, Russia; 9Allergy and Respiratory Disease, University of
rial analysis of the participants’ exhaled VOC was able to correctly Genoa, Moscow, Italy; 10Department of Otorhinolaryngology, Head and Neck
discriminate 100% of the swimmers and 87% of the football players Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Genoa,
Germany; 11Pediatric Pulmonology and Allergy Unit, Dr. Peset University
using a single factor (P < 0.001). Through linear modelling, the par-
Hospital, Marburg, Spain; 12Allergy Department, Complejo Hospitalario
ticipants’ FEV1 reversibility was shown to influence the aforemen- Universitario de Santiago, University of Santiago de Compostela, Valencia, Spain;
13
tioned component with a β value of 0.018 (CI 95% = 0.004 : 0.032, Division of Allergy and Immunology, University of South Florida, Santiago De
Compostela, United States; 14Departments of Medicine and Pediatrics, David
P < 0.013), even when adjusted for age, sex, body mass index, atopy
Geffen School of Medicine at the University of California, Tampa, United States
and the type of sport. The whole model was significant at a P value
<0.001.
Background: Nasal congestion (or blocked nose) is one of the most
Conclusion: These results show that, not only elite swimmers airways
prominent and troublesome symptoms for patients with house dust
are more sensitive to β-agonists, but they also exhale configurations
mite (HDM) allergic rhinitis (AR) and is strongly associated with a
of VOC that are more associated with bronchodilator response than
deteriorated quality of life, with negative impact on daytime func-
those from football players. A longitudinal study would be needed to
tioning, sleep, and a significant decrease in daytime productivity.
further confirm and validate these results.
Therefore, in a large European and North American clinical trial, we
aimed to evaluate how 300 index of reactivity (IR) HDM sublingual
Football tablet relieves nasal congestion.
Swimmers players P
Method: In this Phase III study, adults and adolescents (aged 12-
n (males) 10 (2) 15 (15) <0.001 65 years) with HDM AR were randomly assigned to 12 months of daily
Age (years) 14 (13 : 15) 16 (15 : 17) 0.008 treatment with either 300IR HDM sublingual tablet (Stallergenes
BMI 20.6 (19.0 : 20.8 (20.0 : 0.657 Greer, Antony, France) or placebo. Patients were provided with an e-
22.2) 22.0) diary and instructed to score their four allergic rhinitis symptoms (i.e.
FeNO (ppb) 14.0 (11.7 : 21.0 (12.3 : 0.165 itchy nose, sneezing, runny nose, blocked nose) on a scale ranging
19.0) 29.3)
from 0 (absent) to 3 (severe) and were allowed to take rescue medi-
Baseline FEV1 (L) 4.16 (3.06 : 4.15 (1.85 : 0.760 cation as required. As a secondary outcome evaluation, an ANCOVA
4.56) 4.34)
was performed on the full analysis set to assess differences in the
Chg from pred. 134.0 (128.2 138.2 (124.4 : 0.723
individual symptom scores between the 300IR and placebo groups
FEV1 (%) : 155.7) 146.3)
during the primary evaluation period. Chi-Square test was used to
Post BD FEV1 (L) 4.47 (3.27 : 4.26 (3.81 : 0.934
4.76) 4.52)
compare use of rescue medication between the two groups during
the same period.
Baseline FVC (L) 4.76 (3.75 : 4.57 (4.22: 0.967
5.13) 4.91) Results: A total of 1262 patients (300IR n = 586; Placebo n = 676)
PEF (L/min) 7.47 (6.51 : 7.24 (3.28 : 0.890 completed their rhinitis symptom scores during the primary evalu-
8.99) 8.18) ation period. More patients used rescue medication in the placebo
FEV1 reversibility (L) 0.24 (0.21 : 0.16 (- 0.10 : 0.008 group (62.4% vs 55.8%; P = 0.0169). The Least Square (LS) mean for
0.26) 0.22) the blocked nose symptom score was significantly lower in the 300IR
FEV1 reversibility 6.65 (5.33 : 3.49 (-2.62 : 0.007 group vs placebo (300IR: 0.85; Placebo: 1.04; Least square mean
(%) 7.85) 5.71) difference = −0.19; P < 0.0001). This corresponded to a relative LS
ABSTRACTS | 907
Mean difference of −18.3% in favour of the 300IR group. LS means functioning, sleep, and a significant decrease in daytime productiv-
for the other 3 nasal symptom scores were also significantly lower in ity. Therefore, in a large European and North American clinical trial,
the 300IR group vs placebo (P ≤ 0.0004), indicating a better overall we aimed to evaluate how 300 index of reactivity (IR) HDM sublin-
nasal symptom improvement in the 300 IR group than in the placebo gual tablet relieves nasal congestion.
group. Method: In this Phase III study, adults and adolescents (aged 12-
Conclusion: AIT with 300IR HDM sublingual tablet among adults 65 years) with HDM AR were randomly assigned to 12 months of daily
and adolescents with HDM AR significantly improved nasal symp- treatment with either 300IR HDM sublingual tablet (Stallergenes
toms compared to patients receiving placebo despite a higher con- Greer, Antony, France) or placebo. Patients were provided with an e-
sumption of rescue medication in the latter group. This treatment diary and instructed to score their four allergic rhinitis symptoms (i.e.
was particularly efficient at relieving blocked nose which is a trou- itchy nose, sneezing, runny nose, blocked nose) on a scale ranging
blesome symptom with a significant socioeconomic burden. from 0 (absent) to 3 (severe) and were allowed to take rescue medi-
cation as required. As a secondary outcome evaluation, an ANCOVA
was performed on the full analysis set to assess differences in the
individual symptom scores between the 300IR and placebo groups
LBTP1929 | “Blockers” can benefit from
during the primary evaluation period. Chi-Square test was used to
300IR house dust mite tablet—results of a large
compare use of rescue medication between the two groups during
multicentre clinical trial in house dust mite the same period.
induced allergic rhinitis patients Results: A total of 1262 patients (300IR n = 586; Placebo n = 676)
Demoly P1,2; Creticos P3; De Blay F4; Gevaert P5; Kowal completed their rhinitis symptom scores during the primary evalu-
K6; Le Gall M7; Nenasheva N8; Passalacqua G9; Pfaar O10; ation period. More patients used rescue medication in the placebo
Tortajada-Girbés M11; Vidal C12; Casale T13; Corren J14 group (62.4% vs 55.8%; P = 0.0169). The Least Square (LS) mean
1
Department of Pulmonology and Addictology, Arnaud de Villeneuve for the blocked nose symptom score was significantly lower in the
Hospital, Montpellier University, Montpellier, France; 2Sorbonne Universités,
300IR group vs placebo (300IR: 0.85; Placebo: 1.04; Least square
UPMC Paris 06, UMR-S 1136 INSERM, IPLESP, Equipe EPAR, Paris, France;
3
Creticos Research Group, LLC in association with Charleston Allergy & mean difference = −0.19; P < 0.0001). This corresponded to a rela-
Asthma, Charleston, United States; 4Allergy Division, Chest Diseases tive LS Mean difference of −18.3% in favour of the 300IR group. LS
Department, Strasbourg University Hospital, Sc, France; 5Upper Airways
means for the other 3 nasal symptom scores were also significantly
Research Laboratory, Strasbourg, Belgium; 6Department of Experimental
Allergology and Immunology, Medical University of Bialystok, Ghent, lower in the 300IR group vs placebo (P ≤0.0004), indicating a better
Poland; 7Stallergenes Greer, Global Clinical Development, Bialystok, France; overall nasal symptom improvement in the 300 IR group than in the
8
Russian Medical Academy of Continuous Professional Education of the placebo group.
Ministry of Health of the Russian Federation, Antony, Russia; 9Allergy and
Conclusion: AIT with 300IR HDM sublingual tablet among adults
Respiratory Disease, University of Genoa, Moscow, Italy ; 10Department
of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and adolescents with HDM AR significantly improved nasal symp-
and Allergy, University Hospital Marburg, Genoa, Germany ; 11Pediatric toms compared to patients receiving placebo despite a higher con-
Pulmonology and Allergy Unit, Dr. Peset University Hospital, Marburg, Spain;
12 sumption of rescue medication in the latter group. This treatment
Allergy Department, Complejo Hospitalario Universitario de Santiago,
University of Santiago de Compostela, Valencia, Spain; 13Division of Allergy was particularly efficient at relieving blocked nose which is a trou-
and Immunology, University of South Florida, Santiago De Compostela, United blesome symptom with a significant socioeconomic burden.
States; 14Departments of Medicine and Pediatrics, David Geffen School of
Medicine at the University of California, Tampa, United States
Background: Nasal congestion (or blocked nose) is one of the most

prominent and troublesome symptoms for patients with house
dust mite (HDM) allergic rhinitis (AR) and is strongly associated
with a deteriorated quality of life, with negative impact on daytime
908 | ABSTRACTS
TUESDAY, 4 JUNE 2019

LB TPS 08
ANAPHYLAXIS
LBTP1930 | School board policies on the effect of a single, 6-hour exposure to cold weather in real-life
prevention and management of anaphylaxis in setting on the epinephrine autoinjector (EAI) mechanism.
Method: We purchased 4 0.3 mg EpiPen Senior® EAIs (Meda
Istanbul: Where do we stand?
Pharma GmbH & Co. KG, Bad Homburg, Germany) from a local certi-
Ozen A1; Boran P2; Torlak F3; Bilgic Eltan S1; Baris S1; fied pharmaceutical wholesaler and brought them to a skiing resort
Karavus M3; Karakoc Aydiner E1
in Trysil, Norway, while ensuring no extreme temperature excursions
1
Department of Pediatric Allergy and Immunology, Marmara University Pendik
on the way. On the day of experiment, we left one EAI in an air-
Training and Research Hospital, Istanbul, Turkey; 2Department of Social
Pediatrics, Marmara University Pendik Training and Research Hospital, Istanbul, conditioned room with a constant temperature of 20°C. We brought
Turkey; 3Department of Public Health, Marmara University Pendik Training and the other 3 to a day of skiing-keeping one of the EAIs in the jacket
Research Hospital, Istanbul, Turkey breast pocket, one in the pants side pocket and one in a backpack.
After spending 6 hours outside (from 9:00 AM to 3:00 PM), we took
Background: Allergic diseases with a potential for anaphylaxis pose the EpiPens out, inspected them visually, injected the contents of
a critical public health issue in schools. each EAI into a test tube and measured its volume.
Method: Cross-sectional study. Schools were randomly selected Results: During the experiment, the ambient temperature ranged
from 11 different regions of Istanbul. A questionnaire was filled out from −22.1°C to −16.5°C, according to the data from the closest
by 2596 teachers/school principals from 232 public schools. weather station. On visual inspection of EAI no discoloration, cloudi-
Results: A school safety committee was absent in 80% of elemen- ness, or visible particles were seen. We observed no malfunction
tary schools (ES) and 60.8% of preschools (PS). Although some form of delivery mechanism when injecting contents of EAIs carried in
of health recording system was available in many schools, no such pants and jacket pockets, as well as control, obtaining equal volumes
system was available in 24.5% of ESs and 10% of PSs. A specific in- of 0.3 mL from each. The injector carried in the backpack fired the
quiry for detecting children with food allergies was a routine prac- needle correctly, but the solution was not expelled into the test tube.
tice in only 4% of ES and 10% of PS. Approximately 27% of teachers Conclusion: While patients at risk of anaphylaxis should always carry
stated that monitoring children in school places was not possible their adrenaline autoinjectors with them, exposing EAIs to extreme
at all times. Eighty four percent stated that no written anaphylaxis cold can potentially result in critical underdosing of epinephrine.
treatment protocol was available in their school and only around Concerningly, our study showed that the backpack, which for many
2.3% in ES and 3.1% in PS stated that they would perform an epi- would be the first choice place to carry their medication, was the
nephrine injection in the event of anaphylaxis. only location in which the solution froze and was not expelled, de-
Conclusion: Our survey demonstrated critical gaps in the organiza- spite the needle being fired thus mimicking correct function. Epipens
tion of schools for the management of children at risk of anaphy- kept in coat and pants pockets remained functional. We hypothesize
laxis. Data derived from this study would provide the initiative for that the body heat could play a role in keeping the EAI temperature
legislators to review the current situation of school health policies high enough to prevent freezing, therefore carrying autoinjectors as
along with the relevant authorities to establish school anaphylaxis close to the body as possible appears advisable.
guidelines.
LBTP1932 | Parenteral knowledge of

LBTP1931 | When adrenaline freezes over: anaphylaxis and their performance in epinephrine
Safety of epinephrine autoinjectors in the cold auto-injector use: A survey in Turkish patients
weather—A real-life pilot study
Serbes M1; Sasihüseyinoglu AS2; Karagöz D1; Yilmaz M1;
Lacwik P; Bialas AJ; Kupczyk M; Gorski P; Kuna P Altintas DU1
1
Medical University of Lodz, Lodz, Poland Çukurova University Faculty of Medicine, Adana, Turkey; 2Sanliurfa Child
Disease Hospital, Sanliurfa, Turkey
Background: According to prescribing information, epinephrine au-

toinjectors should be stored at 20-25°C, with excursions permitted Background: Anaphylaxis is an increasingly common life-threatening
to 15-30°C. However, those recommendations appear in conflict allergic reaction and immediate recognition of signs and symptoms
with the idea of ensuring prompt accessibility to epinephrine in out- and quick initiation of therapy with Epinephrine Auto-Injector (EAI)
of-hospital setting, where strict adherence to storage conditions is critical for recovery. Not only parenteral knowledge about ana-
may not always be possible. The aim of this pilot study was to assess phylaxis but also the correct use of EAI plays a crucial role in the
ABSTRACTS | 909
management of anaphylaxis. This study aimed to assess the knowl- only 12 parents (11.3%) were able to show all five steps of the cor-
edge and perception of patients’ parents who were prescribed EAI rect use of the device (Table 2).
for potential anaphylaxis. The study also examined their practical Conclusion: These data clearly indicate that parents’ knowledge and
performance in administering EAI and identify possible misuse of practical performance regarding diagnosis and management of ana-
the device. phylaxis in children are still inadequate.
Method: 106 families caring for children at risk of anaphylaxis were
included in the study. All parents completed a questionnaire and the
correct use was verified by the physician using a trainer with a five- LBTP1934 | Epinephrine prescription in
step examination. emergency department
Results: Anaphylaxis was described as a life-threatening reaction Extremera Ortega AM; Moreno Lozano L;
by 93 parents (87.7%) and 84 parents (79.2%) stated that they González Jiménez ÓM; Gómez Torrijos E;
can easily recognize anaphylactic reaction. However, when par- Borja Segade J; Alfaya Arias T
ents were asked to describe the symptoms of anaphylaxis, only 50 Allergy Section General University Hospital of Ciudad Real, Ciudad Real, Spain
parents (47.2%) were able to describe anaphylactic shock symp-
toms requiring EIA use correctly. In case of a recurrence, only 64 Background: Anaphylaxis is an acute severe life-threatening sys-
parents (60.4%) stated that they would promptly use an adrenalin temic hypersensitivity reaction which requires rapid recognition and
auto-injector. Regarding the measures to prevent anaphylaxis, 76 treatment. Epinephrine is the first line of treatment for anaphylaxis,
parents (71.7%) stated that they pay attention for elimination for and its prompt administration reduces the mortality of this disease.
prophylaxis, 18 parents (17%) said that they informed the other Epinephrine autoinjectors (EAI) are recommended in patients at risk
caregivers of children about anaphylaxis. Only 11 parents (10.4%) of anaphylaxis. The objective of our study was to determine the rate
had an anaphylaxis action plan and only 1 parents’ child had a of epinephrine administration in patients with anaphylaxis attended
warning necklace/wristband. Overall, only 49 parents (46.2%) car- in the emergency department (ED) of General University Hospital of
ried EAI device with them consistently in daily life and only 12.1% Ciudad Real. We also reviewed the rate of prescription of EAI when
of the parents used epinephrine IM when anaphylaxis recurred. the patient was discharged from the ED.
The main reasons for not using EAI reported by parents were that Method: We performed a retrospective study, reviewing the clinical
there was no EAI with them (41.2%), they were afraid and did not history of patients attended in the ED during the year 2017. Patients
feel sufficiently qualified (39.3%) (Table 1). 39 parents (36.8%) re- with clinical criteria for anaphylaxis were included in the study. Data
sponded that they believed they knew the correct use of EAI, but about age, gender, etiology, severity and prescription of epinephrine
and EAI were collected.
TA B L E 1 . Knowledge of parents regarding the use of the EAI Results: 95.552 patients were attended in the ED in 2017, 115 of
(Penepin) prescribed for 106 children them showed clinical criteria for anaphylaxis (0.12%). 61.7% of
the patients were men, with a mean age of 33.78 (range from 1 to
Number (% of
Indications for use of the EAI 106 parents) 94 years). 71% of the patients were adults and 29% children. Food
allergy was the main cause of anaphylaxis (51%) followed by drugs
Cutaneous symptoms (angioedema, urticaria) 30 (28.3%)
(28%). 17.39% were severe anaphylaxis (Brown). Only 32.17% of the
Respiratory symptoms (breathing difficulties) 23 (21.7%)
anaphylaxis were treated with Epinephrine in the ED. Treatment
Collapse or feeling of faintness 3 (2.8%)
with Epinephrine was significantly higher in severe anaphylaxis.
Anaphylactic shock 50 (47.2%) Excluding anaphylaxis caused by drugs (no indication for EAI), the
EAI availability rate of EAI prescription was 26.9% (vs 74% prescribed by allergist
At daily life 49 (46.2%) after study.
At school 8 (7.5%) Conclusion: The rate of Epinephrine treatment and EAI prescription
During sport activities 7 (6.6%) was very low in our ED. These data enforce the need to train ED staff
During outdoor activities 29 (27.4%) in prevention and treatment of anaphylaxis.
In restaurants 31 (29.2%)
Anaphylactic shock recurrence 33 (31.1%)
EAI use when anaphylactic shock recurred (% of 4 (12.1%)
33 cases)
Reasons for not using EAI (% of 33 cases)
Not carrying device consistently 14 (41.2%)
Being afraid and feeling not qualified 13 (39.3%)
Waiting until the attack resolves spontaneously 3 (9%)
Prefer to attend nearest hospital 3 (9%)
910 | ABSTRACTS
LBTP1935 | Underdiagnosis of anaphylaxis in researching and elaboration protocols for adequate immunization of
egg allergic patients becomes essential.
the County Emergency Clinical Hospital of Targu
Method: Longitudinal study was performed with patients referred
Mures: Misdiagnosed or miscoded?
to drug allergy unit with egg anaphylaxis diagnosis documented by
Bódi B1; Varo T1; Cantir M1; Gorbatovschi A1; Cojanu C1; clinical history and skin prick test (SPT) and/or ImmunoCap serum
Ureche C2 IgE (sIgE). They were submitted to SPT with undiluted YFV and/or
1
County Emergency Clinical Hospital of Targu Mures, Targu Mures, Romania;
2
intradermal test (ID) with YFV at 1:100 dilution. All patients received
University of Medicine, Pharmacy, Sciences and Technology of Targu Mures,
Targu Mures, Romania YFV in different protocols, according to the results of the tests.
Results: Ten patients aged 10 months-16 years were diagnosed
Background: Anaphylaxis has been defined as a severe, life- with egg anaphylaxis. Common symptoms related were urticaria
threatening generalized or systemic hypersensitivity reaction which (90%), angioedema (60%), vomiting (80%), dyspnea (20%), sleepi-
is characterized by being rapid in onset with life-threatening airway, ness (20%) and hypotonia (10%). Of the 8 patients submitted to SPT
breathing or circulatory problems; it is usually, but not always, as- with egg, 100% presented positive test; of the 8 patients submitted
sociated with skin and mucosal changes. Anaphylaxis is a clinical to sIgE, 75% had positive test (sIgE >3.5 kUA/L). All study patients
emergency and all healthcare professionals should be familiar with comproved egg sensibility. Only 1 patient had positive SPT and 3
its acute and ongoing management, clinical findings vary markedly patients had positive ID with YFV. Subsequently, 5 patients were
from patient to patient, sometimes the diagnosis is difficult. submitted to YFV administration in 4-steps according to the ASBAI
Method: Of patients admitted to the ED of County Emergency protocol (Table 1), 2 patients in 2-steps (50% + 50% of the YFV) and
Clinical Hospital of Targu Mures (nearly 70 000 per year) those with 3 patients in single dose. All patients were observed for 60 minutes.
possible allergic diseases between 1 January 2013 and 31 December Anyone had serious adverse events.
2018 were included in this study (6300 allergic presentation in Conclusion: YFV has been shown to be safe even in patients with
6 years). history of egg anaphylaxis. We suggest review the current protocols
Results: The International Classification of Diseases-10 codes were and make possible short-term YFV vaccination of patients with his-
used to search computer records and 25 patient were identified tory of egg anaphylaxis in 2-steps or even single-dose not staggered.
with hospitalization for anaphylaxis. Due to the fact to the non-

specific nature of anaphylactic symptoms, the diagnosis can easily
be overlooked. Time (minutes) Dose (mL)
Conclusion: For all these reasons under-diagnosis and under- 0 0.05 (1:10)
reporting are likely to be common and as a result epidemiologi- 30 0.05 (1:1)
cal measures are likely to underestimate the true disease burden. 60 0.15 (1:1)
Emergency physicians should become more aware of the definition 90 0.30 (1:1)
of anaphylaxis to avoid them being misdiagnosed as an allergic reac-
Yellow fever vaccine produced by Bio-manguinhos/Fiocruz—lyophi-
tion only.
lized multidose with 5 doses.
LBTP1936 | Evaluation of the safety of

LBTP1937 | Safety and efficacy data of AK002,
administration of yellow fever vaccine in patients
an anti-siglec-8 monoclonal antibody, in patients
with history of egg anaphylaxis
with indolent systemic mastocytosis (ISM):
Valente CFC; Bomfim LM; Ribeiro LG; Teixeira MB;
Results from a first-in-human, open-label phase 1
Da Silva MDAA; Macêdo ACT
Hospital da Criança de Brasília José Alencar, Brasília, Brazil
study
Siebenhaar F1; Bonnekoh H1; Hawro T1; Hawro MO1;
Background: Yellow Fever (YF) is responsible for 200 000 cases and Michaelis EG1; Rasmussen HS2; Singh B2; Kantor AM2;
Chang AT2; Maurer M1
30 000 annual deaths with 20-50% of fatality rate. Endemic disease
1
Charité-Universitätsmedizin Berlin, Berlin, Germany; 2Allakos, Inc., Redwood
in Africa and South America has an effective protection form, the
City, United States
vaccine. Yellow fever vaccine (YFV) is derived from strain 17D, com-
posed of live attenuated amaryl virus vaccine, grown in hens’ egg,
Background: ISM is a rare disease characterized by clonal prolifera-
with effectiveness of 95%. Anaphylaxis rate for YFV ranges from 0.8
tion of and excessive mediator release from activated mast cells
to 1.8/100 000 doses related to egg allergy or other constituents,
(MCs). ISM patients (pts) experience debilitating heterogeneous
such as gelatin. Egg allergy in children has prevalence of 0.5-2.5%.
symptoms and substantial quality of life (QoL) impairments. There
In Brazil where YF is an endemic disease, the role of the allergist in
are no approved therapies for ISM. AK002 is an antibody to Siglec-8,
ABSTRACTS | 911
MSQ (0-10 Scale) (n = 8)* MAS (0- 4 Scale) (n = 11)*
% Improvement at Week % Improvement

Symptom Baseline Score 21-22 Baseline Score at Week 21-22
Itching 3.7 56% 1.8 53%

Hives 4.2 38% 1.6 59%
Flushing 4.1 46% 1.7 57%
Abdominal pain 3.4 60% 1.4 84%
Diarrhea 2.9 49% 1.0 72%
Headache 3.7 50% 1.5 57%
Fatigue 5.1 47% 2.2 22%
Difficulty concentrating 3.9 59% 1.6 30%
Muscle pain 3.6 27% 2.0** 22%**
Joint pain 3.4 26% (2.0**) (22%**)
*3 pts were enrolled before MSQ PRO was available; one drop-out due to protocol deviation.
**In MAS PRO, bone, joint, and muscle pain were combined.
an inhibitory receptor selectively expressed on MCs and eosinophils LBTP1938 | Anaphylaxis due to occupational
(eos). Studies have shown that AK002 inhibits MCs, depletes eos,
allergy to Locusta migratoria and Schistocerca
and improves symptoms in pts with MC- and eos-driven diseases.
gregaria
This study evaluated single ascending doses and multiple doses (MD)
of AK002 in ISM. Here we present results from the MD arm of the Ganseman E1,2; Coorevits L1; Schrijvers R1,3; Bullens DM1,4;
study.
Proost P2; Breynaert C1,3
1
Department of Microbiology, Immunology and Transplantation, Research
Method: Eligible pts were diagnosed with ISM per WHO criteria
Group Allergy and Clinical Immunology, KU Leuven, Leuven, Belgium;
and had active symptoms despite treatment with antihistamines 2
Department of Microbiology, Immunology and Transplantation, Research
and other antimediator therapies. All pts provided informed con- Group Immunity and Inflammation—Molecular Immunology, KU Leuven,
sent. MD pts received 6 monthly doses: initial dose of 1 mg/kg and Leuven, Belgium; 3Department of General Internal Medicine—Allergy
and Clinical Immunology, University Hospitals Leuven, Leuven, Belgium;
subsequent doses at 1, 3, 6, or 10 mg/kg. Primary endpoint was 4
Department of Pediatrics—Pediatric Allergology, University Hospitals Leuven,
safety/tolerability. Pt-reported outcomes (PRO) were measured by Leuven, Belgium
Mastocytosis Symptom Questionnaire (MSQ), Mastocytosis Activity
Score (MAS), and Mastocytosis-QoL (MC-QoL). Case report: Locusta migratoria (migratory locust) and Schistocerca gre-
Results: 12 pts enrolled in the MD arm of the study. AK002 was garia (desert locust) are two types of acridid grasshoppers belonging
well-tolerated and only mild/moderate treatment-related adverse to the order of Orthoptera. Swarms of locusts are known to be accom-
events (AE) occurred. The most common AE was infusion-related panied by outburst of asthma. Moreover, allergies have been reported
reactions (flushing, feeling hot, headache, erythema, fatigue, or diz- in laboratory workers, zookeepers or pet keepers of reptiles fed with
ziness), which occurred mostly during the first infusion. MSQ and locusts. The European Union recently allowed human consumption of
MAS scores improved from baseline (BL) to Week 21-22 across all Locusta migratoria, what will likely result in an increase of locust breed-
measures (Table). MC-QoL scores improved from BL to Day 145 in all ing. Here, we present the case of a 29-year old male PhD student with
domains: skin (44%), symptoms (39%), social life/functioning (42%), underlying house dust mite allergy. He was seen at the outpatient clinic
and emotions (57%). due to gradually worsening of severe asthmatic attacks and even sys-
Conclusion: AK002 was well-tolerated and showed consistent and temic symptoms (including skin rash) upon entering the building where
significant improvements in symptoms and QoL. These results sup- both locusts were bred. Skin prick tests (SPT) were strongly positive
port further evaluation of AK002 as a new therapy for ISM. for both locusts, including the faeces. Basophil activation tests (BAT)
using raw extracts of different isolated parts of both types of locusts
confirmed the reactivity. By means of a control, two of his colleagues
were tested using SPT and BAT. One colleague with symptoms had
positive SPTs, whereas an asymptomatic colleague had negative SPT
results. However, BAT showed a strong positive result for the colleague
who reported symptoms, but surprisingly, the asymptomatic colleague
showed reactivity to all Schistocerca gregaria extracts as well. An im-
munoblot using the patient's serum showed strong binding to protein
bands with a molecular mass between 50-70 kDa in the whole body
912 | ABSTRACTS
extract of both Locusta migratoria and Schistocerca gregaria, and the Method: Case 1: A 10-year-old girl with history of vulvar lichen scle-
faeces of the latter. The symptomatic control reacts to proteins of the rosus, eczema, asthma, outgrown egg allergy and persistent allergy
whole body extracts in the same range, although less strongly. to all nuts, lightly cooked chestnut and buckwheat presented a grade
In conclusion, we report the case of a patient with occupational 2 anaphylaxis with urticaria, facial edema, rhino-conjunctivitis and
anaphylaxis to locusts, endorsing the allergenicity of Schistocerca breathing.
gregaria and Locusta migratoria. Together with a presumed increased Case 2: A 12-year-old boy with history of eczema, asthma, out-
exposure of laboratory workers and farmers and increased con- grown IgE-mediated food allergies to milk and egg, persistent food
sumption in future, we warrant for sufficient safety measures to re- allergy to nuts, fish and kiwi, and asymptomatic sensitization to
duce the sensitization in exposed employees or researchers. wheat and buckwheat declared two episodes of grade 2 exercise-
induced anaphylaxis with malaise urticaria, dyspnea and abdomi-
nal pain.
LBTP1939 | Idiopathic Anaphylaxis or Allergic Case 3: A 64-year-old horticulturist without any history of allergy
reactions to Carmine (E120)? had a grade 3 anaphylaxis with deep faintness, urticaria, chest pain
and trembling after eating a bulgur quinoa tuna salad.
Benito Martinez P; Fernandez Parra B
Results: Prick tests and specific IgE to quinoa were positive in the 3
Hospital El Bierzo, Ponferrada (leon), Spain
cases. Immunoblotting analysis identified a highly IgE-reactive band of
51 kDa with all 3 patient sera in crude quinoa extract, as well as a band
Background: Nowadays there are a lot of additives used in the food in-
of 63 kDa with sera of patient 1 and 2 and further highly reactive bands
dustry. Fortunately only a few have been implicated in adverse reactions.
of 11, 49, 85 and 100 kDa with serum of patient 1.
Method: We have to think about food additives in Allergic reactions
Conclusion: Chenopodium quinoa is a drought and frost resistant
(Urticaria, Angioedema, Anaphylaxis…). Cochineal extract ir Carmine (E
gluten-free plant, rich in calcium and iron, in omega 3 and 6 polyun-
120) is a red food dye used in many foodstuffs. We can find it in jam,
saturated fatty acids and high quality protein, providing all essential
butter, cookies, yogurt, different meats. We present 2 patients with ini-
amino acids with values close to those set by the FAO for ideal pro-
tially Idiopathic Anaphylaxis diagnosis. They refer reactions with differ-
tein equilibrium and similar to milk casein. 11S globulins (chenopo-
ent foods: pizza, sausage, jam sandwich, ice cream. In the evaluation of
din) and 2S albumins are its principal storage proteins.
these patients we make screening with multiple foods skin prick test.
Native chenopodin is composed of six 55-62 kDa heterodimers of A
We also make blood test with Ig E immunoassays for some food addi-
and B subunits, of 30-40 kDa and 20-25 kDa respectively, joined by
tives. Even we look for a purified preparation of the additive we suspect.
disulfide bonds. Chenopodin A was found to be implicated in one of
Oral challenge is the best process to confirm food additives reactions.
the 2 cases of quinoa allergy reported in the literature. The 51 kDa
Results: Multiple screening foods skin prick test was negative in
band we identified could correspond to the class of 7S globulins.
both patients.
Cross reactivity has been described between 11S and 7S globulins
Carmine Ig E was positive in both patients (6.04, 4.17 KU/L). Purified
of quinoa and buckwheat. Because of its potential therapeutic ef-
preparation of the additive Skin Prick by prick with Cochineal extract
fects in the prevention of cardiovascular disease, cancer and aging
(E 120) was positive in both patients. We made 4 negative controls.
Both patients refused Oral challenge procedure. We recommended
to avoid commercially prepared foods that contain Cochineal extract. TA B L E 1 . Immunoblot analysis with the 3 patient sera in crude
Patients keep asymptomatic since they avoid cochineal extract. quinoa extract
Conclusion: Specific food additives like Cochineal extract or Carmin
Quinoa proteins
(E 120) could be implicated in true Allergic reactions (Ig E mediated). (kDa) Patient 1 Patient 2 Patient 3
We have to think about it and excluding food additives as a cause of
200 +
reactions.
150 +
100 ++ +
LBTP1940 | Food anaphylaxis to quinoa seed 85 ++

63 ++ ++
Chatain C1,2; Jacquenet S3; Pernollet M4; Leccia MT1
1
51 ++ ++ ++
Department of Dermatology, Allergology and Photobiology, University Hospital
of Grenoble, Grenoble, France; 2Department of Pediatrics, University Hospital 49 ++
of Grenoble, Grenoble, France; 3Genclis SA, Vandoeuvre-Lès-Nancy, France; 39 +
4
Institute of Biology and Pathology, Laboratory of Immunology, University
36 + +
Hospital of Grenoble, Grenoble, France
30 +
Background: Anaphylaxis to quinoa is rare but could gain in fre- 24 + + +
quency due to changing diet habits. We report 3 cases of food ana- 11 ++

phylaxis to quinoa.
ABSTRACTS | 913
process and as substitute for wheat, milk and animal proteins, quinoa LBTP1942 | Recurrent acute urticaria as
is increasingly included in modern diets. Quinoa allergy may there- precursor of wheat dependent exercise-induced
fore be expected to increase in the future. It should be assessed by anaphylaxis
carefully taking the patient 's medical history and by including it in
Posadas-Miranda T; García-Campos J; Requena-Quesada G;
food allergy testing panels.
Muñoz Daga OA; Palao P; De La Higuera Artesero R;
Perez Padilla C; Campos Suarez G
Hospital Vithas Xanit Internacional, Benalmádena, Spain
LBTP1941 | Manioc anaphylaxis & Hevamine
A: A new latex protein involved in latex-fruit
Background: IgE-mediated allergy to the wheat protein omega-5-
syndrome cross-reactivity gliadin is associated with wheat-dependent exercise-induced ana-
Lopez San Martín M1; Blázquez Fernández M1; phylaxis (WDEIA), where exercise acts as a cofactor, although other
Pineda De La Losa F2; Castillo Fernández M2; cofactors could trigger the symptoms. We present 4 cases of Tri a 19
Delgado Gonzalez A1; Villalón García LA1 allergy, all of them WDEIA but initiated as recurrent acute urticaria.
1
Department Allergy, Puerta de Hierro-Majadahonda University Hospital, Method: Skin prick test with aeroallergens as well as with food aller-
Madrid, Spain; 2Application Lab, DIATER Laboratories, Madrid, Spain
gen (Leti Laboratory, Madrid, Spain), blood test for study of urticaria,
tryptase, total IgE as well as specific IgE to wheat and Tri a 19 were
Background: Manioc or cassava is one of the foods involved in the
performed in the four patients.
latex-fruit syndrome. Up to now, all the manioc allergic patients pub-
Results: The average age of patients was 45 years old. They started
lished had skin-related symptoms or anaphylaxis to manioc and also
with reactions between 3 and 7 years before being diagnosed. All
to latex. Hev b 5 latex allergen has been implicated in clinically rel-
of them presented recurrent acute urticaria before the episodes of
evant cross-reactivity with manioc.
anaphylaxis, and at least 2 episodes induced by exercise, although
Method: We present a 47 years old woman suffering from anaphy-
NSAIDs and stress were implicated in some episodes as other cofac-
laxis with elevated serum tryptase, after manioc intake. She has
tors. Skin prick test with aeroallergens were positive to D. pteronys-
never had either previous symptoms to latex nor to fruits. 4 months
sinus in 3 patients and grass and olive pollen just in one. Skin prick
later, she complained about possible cutaneous symptoms due to
test to wheat was positive in 50% patients, and negative the rest of
contact with domestic rubber gloves, to a sip of an almond drink
food tested.
and also to a chestnut intake. Normal baseline tryptase and positive
Blood test with blood count, ESR, coagulation, liver, kidney, thyroid
dermographism was documented.
function tests, autoimmunity and complement was within normal
Results: In vivo study yield positive results for manioc prick-prick
parameters. Total IgE was high in ¾ patients. Serum tryptase was
(5 × 4) and latex prick test (5 × 5). A prick test battery with most rele-
normal in all patients.
vant latex related fruits including almond and chestnut was negative.
Wheat IgE was positive in 2/4 patients and Tri a19 positive in all
Glove use test with sterile sanitary latex gloves, contact exposure to
of them. The four patients tolerate cereals being at rest and toler-
rubber gloves implicated in anamnesis and controlled provocation
ate exercise if avoid cereals 3 hours before. Challenges with culprit
with the same almond drink, were also negative.
NSAIDs were performed with good tolerance at rest.
In vitro study showed a specific IgE by ImmunoCAP (Phadia) to
Conclusion: Specific IgE to Tri a 19 it must be considered in the di-
manioc 3.89 kUA/L, rHev b 5 4.62 kUA/L and negative to rHev b
agnosis of patient with recurrent acute urticaria or idiopathic ana-
1, rHev b 3 and rHev b 6.02. The patient 's serum revealed through
phylaxis. Exhaustive clinical history looking for cofactors is very
Immunoblot with latex, avocado, chestnut and banana extract the
important for diagnosing these profile of patients.
recognition of a 26 kDa protein in all extracts and a 14 kDa protein
just in manioc and latex. An immunoblot inhibition with latex was
carried out with manioc, avocado, chestnut and banana extract and
just one protein of 26 kDa was inhibited in all extracts. The 26 kDa LBTP1943 | Case of anaphylactic shock to beer
protein was identified according to mass spectrometry analysis as Morales Gavilán M1; Claver Monzón A1; Navarro Gracia B1;
Hevamine A. Elduque Mora C1; Botey Faraudo E1; Pineda De La Losa F2;
Conclusion: Manioc allergy without clinical symptoms to latex nor Castillo Fernández M2; Cisteró-Bahíma A1
1
to latex-fruit syndrome food, has never been reported before, al- Allergy Department “Al.lèrgia-Dexeus”, Hospital Universitari Dexeus-GQS, UAB,
Barcelona, Spain; 2Application Department, Laboratories Diater, Madrid, Spain
though manioc and latex co-sensitization through Hev b 5 is well
documented. We have identified Hevamine A as a new latex protein
Background: Beer is one of the alcoholic beverages with more con-
involved in the latex-fruit síndrome.
sumption over the world but despite this allergy reactions are unu-
sual. We present a case report of an 18-year-old male with personal
914 | ABSTRACTS
history of mild intermittent asthma, who presented a severe ana- work-up included in vivo (skin tests) and in vitro (specific IgEs by
phylactic shock (dyspnea, hypotension and unconsciousness with ImmunoCAP, Immunoblot, and direct ELISA) testing with all the in-
cardiorespiratory arrest) shortly after beer ingestion (Chimay Blue®). gredients of the snack; moreover, ELISA inhibition experiments were
Method: Skin Prick Test (SPT); Serum-specific IgE determinations performed to investigate if such event could be the result of a cross-
(ImmunoCAP®); SDS-PAGE and Western Blot. reaction with food or airborne allergens.
Results: SPT to aeroallergens: Positive to dust mites, molds, dog Results: Out of all the tested ingredients, only the baobab fruit re-
dander and pollen (grass mix, Chenopodium, olive). sulted positive, and potential cross-reactions were ruled out. Any
SPT to commercial foods and cereals: Mild positive to rice (correct other possible cause of anaphylaxis was excluded. The SDS-PAGE
tolerance). Negative the rest, including non-specific lipid transfer profile of baobab fruit showed different protein components, and
proteins (nsLTPs). the IgE-immunoblot analysis detected two IgE-binding regions at
SPT with beers (Steinburg Dark®, Bock-Damm®, Leffe Brune®, about 40 and 60 kDa, in the patient 's serum. She was discharged
Duvel®): All positive. with the indication of strict avoidance of all kind of baobab-based
Serum-specific IgE determinations (ImmunoCAP®) to Cladosporium products and provided with self-injectable adrenaline.
(3.1 kU/L), Alternaria (8.63 kU/L), wheat (0.05 kU/L) and hops Conclusion: This is the first case of food allergy to baobab fruit,
(0.28 kU/L). that occurred with anaphylaxis, apparently at the first exposition to
SDS-PAGE and Western Blot with different beers, Chimay Blue® baobab. After ruling out possible cross-reactions, the episode could
(1), Chimay Red® (2), Estrella Damm® (3), Estrella Galicia® (4), Daura be explained by an overlooked previous sensitization to baobab,
® ®
Damm (5), Leffe (6), showed IgE-binding proteins between 35 and through alimentary (i.e. as an hidden ingredient in vegan foods) or
75 kDa for the extracts number 1, 2, 5 and 6 and one IgE-binding percutaneous pathways (“natural” cosmetics). Baobab fruit may be
protein of 18 kDa for the extracts number 1 and 2. an important allergen, able to trigger anaphylaxis due to food al-
Conclusion: We present a case of anaphylactic shock in a patient lergy. Taking into account the spreading fashion for natural products,
with mild intermittent asthma and predominant sensitization to special attention should be paid on new emerging “natural healthy”
molds and grass. The immunological study (SPT and in vitro study) products (e.g. food and cosmetics), like the baobab. Prick-to-Prick
suggest that our patient is sensitized to a different allergen from proved to be a reliable diagnostic test to identify baobab fruit allergy.
those previously described (those related to cereals or nsLTPs,
typical in our area). The several ingredients and methods used in
beer elaboration launch a challenge in the identification of culprit
allergens. LBTP1945 | Glutaraldehyde modified allergen
extract immunotherapy are able to cause
anaphylaxis as an adverse reaction?
LBTP1944 | The healthy food paradox:
Kilimajer J1; García F2; Córdoba P2; Barjau C2;
Anaphylaxis to baobab Casanovas M1; Subiza J2
Martini M1; Mistrello G2; Amato S2; Bilo’ MB1; Agolini S1; 1
Inmunotek S.L., Madrid, Spain; 2Clínica Subiza, Madrid, Spain
Corsi A1; Tontini C1; Antonicelli L1
1
Allergy Unit, Department of Internal Medicine, Azienda Ospedaliero- Background: Several studies have demonstrated that subcutaneous
Universitaria Ospedali Riuniti, Ancona, Italy; 2R&D Dept, Lofarma SpA, Milano,
allergen immunotherapy is an efficacious and safe approach to treat
Italy
allergic diseases. Glutaraldehyde-modified allergen extracts offer
several benefits compare to native allergen extract vaccines. The
Case report:
principal objective was to evaluate the safety of immunotherapy, in
Background: Baobabs (Adansonia digitata) are plants characteris-
an Allergy Clinic in Madrid (Spain) in the last 18 years using therapeu-
tic of Sub-Saharan Africa, Madagascar, and North-West Australia,
tic vaccines comparing modified and unmodified allergen extracts.
whose fruits have been largely used by the local populations as
Method: The period analyzed was from 01/01/2000 to 28/02/2019.
food and medications. Recently, the cosmetic, wellness, and food
All injections were administered in the immunotherapy unit of the
industries have promoted the baobab-based products, in the de-
Clinic and recorded using specific software (Inmunowin®). Patients
veloped countries, to address the growing interest in natural/or-
were in their majority allergic to pollens and received therapeutic
ganic products (e.g. vegan lifestyle). However, not all the natural
modified and unmodified vaccines. Safety was assessed by record-
products are totally safe, regardless of their healthy properties.
ing all side reactions related to immunotherapy.
We report the first case of anaphylaxis due to baobab fruit food
Results: The total number of injections administered during this
allergy.
period was 236 259. From these, 132 769 (56.2%) correspond to
Method: A 31-year-old Caucasian woman presented at the
unmodified allergen preparations and 103 490 (43.8%) to modi-
Emergency Room for anaphylaxis few minutes after ingesting, for
fied. In the last 8 years this proportion had change (79 366 injec-
the first time, a particular vegan snack. The allergologic diagnostic
tions), observing 68 368 (86.1%) for modified and 10 998 (13.9%)
ABSTRACTS | 915
for unmodified vaccines. The total immediate systemic reactions in LBTP1948 | Latex immunotherapy: An
19 years was 338 (total), 136 (40.2%) for modified and 202 (59.8%)
exceptional improvement in quality of life
for unmodified (P = 0.189). However, we detected 2 severe adverse
reactions (anaphylaxis: 1/70 000 injections) related with unmodified
Alen Coutinho I; Carvalho J; Alves M; Azevedo J; Loureiro C;
Todo Bom A
immunotherapy. On the contrary within 103 490 modified injections
Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
we didnʹt observed any anaphylaxis.
Conclusion: Anaphylaxis was detected only with unmodified immu-
Case report: Latex allergy is an emerging problem whose prevalence
notherapy but not with modified immunotherapy.
has increased in recent decades. It is important to highlight its pres-
ence in a number of products in our every day's life, making this
disease dramatic for some patients, especially among certain pro-
fessional categories. Specific immunotherapy has been suggested as
LBTP1947 | A complete honeybee “venome”. the only therapeutic capable of influencing the natural history and
Improving diagnostic and therapeutic tools inducing specific desensitization.
Castillo M; Martínez-Gomariz M; Gallergo R; Rodriguez D; The authors describe a case of latex allergy in a 36-year-old woman,
Pineda De La Losa F who worked as cultural animator. At the age of 26 she began to ex-
Diater Laboratories, Madrid, Spain perience many episodes of palpebral angioedema and rhinitis symp-
toms, minutes after banana, kiwi and other tropical fruits ingestion.
Background: The knowledge of the composition of the In one of these episodes, after eating banana, she presented at the
Hymenoptera venom and the structure of the allergens that emergency room with gradually worsening symptoms of facial angi-
compose it is a prerequisite to carry out more accurate diagnosis oedema, dyspnea and severe rhinitis symptoms. During the follow-
and treatment. The composition of the honeybee venom (HBV) up in Allergy and Clinical Immunology consultation she initiated
is a mixture of proteins with proteolytic activity in its majority. symptoms of dyspnea and wheezing, often 3-4 times per week that
After application of the most recent proteomic models it has been were related to exposure to rubber balloons in the workplace. She
revealed that there are more than 100 components, of which 12 even presented with palpebral angioedema, nasal obstruction and
have been described as allergens nowadays. The presence and the dyspnea after injection of Amoxicillin. Diagnostic workup started
amount of these allergens in therapeutic and diagnostic extracts, by skin prick tests (SPT), which was positive to latex, passion fruit,
might be easily affected by natural variations of the source mate- banana and negative to chestnut allergens. Blood-specific IgE (sIgE)
rial, different work-up strategies or even by degradation of par- were positive to Havea braziliensis, Hev b 5 and Hev b 6, with re-
ticular components. spectively values: 25.5 KU/L, 3.49 KU/L and 5.46 KU/L. Prick-to-
Method: Our aim has been to compare an autochthonal Spanish prick tests (PTP) and sIgE for banana, chestnut and passion fruit
crude HBV with a referenced commercially available crude HBV ex- allergens were negative. Skin tests to betalactams were negative
tract (Latoxan, France) by using proteomic tools for demonstrate the and also oral challenge test with Amoxicillin. She started rush sublin-
total representation of the allergens so far described for Apis mellif- gual immunotherapy (SLIT) with latex at 27 years old and complied
era venom. The electrophoretic profile of both HBV was carried out 3 years. During the SLIT she presented a significant improvement in
by mono and bidimensional SDS PAGE at reduced conditions. The respiratory symptoms, presenting only clinical exacerbations once a
allergenic properties of both extracts were performed by Western month, under adjuvant therapy with inhaled budesonide and formo-
blot using a pool of patients’ sera with different profiles of sensitiza- terol (160/4.5 mcg) twice daily. During immunotherapy, the patient
tion to HBV. The biological potency and the enzymatic activity of Api got pregnant and did not present clinical worsening. Under this pe-
m 1 were also determined. riod the inhaled therapy was adjusted to low dose of inhaled corti-
Results: The electrophoretic profiles of both HBV were similar, re- costeroid. At this moment, she tolerates banana and passion fruit
vealing compatible bands with the component-resolved allergens ingestion and she presents only an oral allergy syndrome with expo-
described (Api m 1, Api m 2, Api m 3, Api m 4, Api m 5 and Api m sure to kiwi and chestnut.
10), showing some differences possibly due to the natural variations Finally, she changed her job by choice and is currently working as
of each extract. The allergenic profile, biological potency and enzy- a Radiology Technician, tolerating exposure to a latex environment
matic activity of Api m 1 did not present significant differences for and using, as an alternative, vinyl gloves on direct contact.
both extracts.
Conclusion: Our data demonstrate similarities about the quality and
characteristics of crude HBV extracts in terms of antigenic and al-
lergenic content. This fact highlights the autochthonal Spanish crude
HBV is a good candidate to be used in diagnosis and treatment of
Apis mellifera allergy.

Allergy - 2019 - Abstracts LB TPS

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DOI: 10.1111/all.

SUNDAY, 2 JUNE 2019

heparins by urticaria, anaphylaxis and vasculitis. We observed a high cross-

Background: Considering the widespread use of heparins in daily

TA B L E 1 . Results of SPT, IDT and DPT to ICM

SPT (n = 13) IDT (n = 13) DPT (n = 13) ICM of the DPT

Negative (n = 12) Negative (n = 5) Negative (n = 5) Iomeprol (n = 4)

LBTP1808 | Severe reaction after re-exposure

ical case shows the importance of assessing the tolerance to NSAIDs

185 patients underwent a home challenge, and 173 patients un-

9 2 4.500 1:1 0.2

LBTP1816 | NSAID hypersensitivity:

Background: Nonsteroidal anti-inflammatory drugs (NSAID) are

LBTP1820 | The use of specific IgE, including

Background: In a Danish allergy clinic, testing for specific IgE is

SUNDAY, 2 JUNE 2019

LBTP1826 | Hereditary angioedema with LBTP1828 | Waldmann's disease—A case

LBTP1835 | Identification of the major LBTP1836 | The use of omalizumab for

subjects, after home or occupational exposure. High prevalence of

spectrometry as vitellogenin. deliberation on the use of this therapy on a case-by-case basis.

Background: Chronic spontaneous urticaria (CSU) is defined as

SUNDAY, 2 JUNE 2019

LBTP1841 | Visual communication of allergens LBTP1842 | Identification of hypoallergenic

LBTP1843 | Sensitization to Ana o 3 in tree nut LBTP1845 | Crustacean characterization:

Background: Shellfish allergy represents a common acquired food

Background: Within the study of alimentary allergy, previous re-

Black Afro- Black White

NUTS 32% 69% 58% 67% 36% 58% 12% 55%

MONDAY, 3 JUNE 2019

post-translational modifications of Timothy grass measured by quantitative ELISA.

been observed. Field-realistic exposure studies provide the most

enzyme-linked immunosorbent assays (ELISA) and immunoglobulin sensitized-patients.

lergens were downregulated in polluted pollen, and IgE binding to

LBTP1864 | Atmospheric pollutants NO2 LBTP1865 | Performance of the personalized

Background: The importance of grass pollen to the global burden

LBTP1867 | Cathelicidin treatment reduces

Background: Allergic diseases are an important problem in environmen-

Background: The plane tree is widely used as an ornamental in urban

MONDAY, 3 JUNE 2019

LBTP1877 | Expression of estrogen receptor

gen receptor α protein, which likely contributed to the induction of

cruited from community pharmacies. Participants completed a up.

LBTP1884 | Cytological monitoring of the

LBTP1885 | Allergy and cystic fibrosis—Risk LBTP1886 | NAPPREB study protocol:

LBTP1887 | Glucocorticoid inhalation

Background: Olfactory dysfunction caused by chronic sinusitis was

Background: Chronic rhinosinusitis is a heterogeneous disease. In

LBTP1891 | Immunotherapy and medication

Background: Mastocytosis is a clonal disease characterized by an

MONDAY, 3 JUNE 2019

Background: Besides hepatic manifestations and within the whole di-

and storage of circulating immune complexes in tissues and organs

lupus-related phenomena, dermatological (6.76%), rheumatic events Sex of children

ing, followed by obesity and dermatologic disorders. Hen’s egg 35 28

LBTP1908 | Evaluation of underlying are established. Unfortunately information on mechanisms involved

LBTP1909 | Seeking early-life windows of

1 5, 5, 5 10, 10, 10 5.0 10.0

TUESDAY, 4 JUNE 2019

as useful method to monitor the efficacy of in WBI during treatment.