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Genetic basis of the latex-fruit syndrome: Association with HLA-Class II alleles
Side-Effects of Ultra Rush Insect Venom Immunotherapy— Retrospective Study A. C. Costa1, R. Alves1, S. L. Silva1, E. Pedro1, M. C. Santos2, M. A. P. Barbosa1; 1Immuno-allergology Unit, Santa Maria Hospital, Lisbon, PORTUGAL, 2Clinical Immunology Unit, Santa Maria Hospital, Lisbon, PORTUGAL. RATIONALE: Ultra rush immunotherapy (URI) protocol is regarded as safe, well tolerate and that give more rapid protection but fear of sideeffects (SE) may prevent its use. Aim of this study was to analyze safety and tolerance and to determine the risk factors for development SE in patients treated with a 3.5 hours URI protocol (cumulative dose of 101g), divided in 6 applications. METHODS: 41 URI protocols of 40 patients (28M, 12F; 10-75 years, mean age: 44) with systemic reactions to insect stings (Mueller classification) were analyzed retrospectively. All patients had been treated with standardized venom aqueous extracts (Dome Hollister Stier-DHS): bee (B=27), wasp (W=12), polistes (P=2), wasp and polistes (1) venom. Local (L) and systemic (S) reactions occurred during URI were evaluated. RESULTS: Sting reactions previous URI: Grade I-1(1W), Grade II-3(2B, 1W), Grade III-19(13B, 5W, 1P), Grade IV-17 (12B, 4W, 1 W+P). Specific IgE: Class I/II: B-9, W-7, P-2; Class III/IV: B-15, W-5; Class ≥V: B3. During URI protocol we observed: LR (39%) in 16 and SR (29.2%) in 12 patients: G I - 9 (22%) (B-7, W-2); G II - 1 (2.4%) (B); G III - 1 (2.4%) (B); G IV - 1 (2.4%) (W). Sex, age, severity to insect sting reactions, specific IgE were not related with occurrence and severity of SR during URI. CONCLUSIONS: The frequency of SR (29.2%) was similar with the data in the literature and the majority was Grade I. Bee venom allergy and atopic disease increased the risk, but not the severity, of SR during URI.
435
Assessment of Current Practice in Concomitant Use of ACE Inhibitor and Hymenoptera Venom Immunotherapy P. Gogineni1, J. Baldwin2, E. Robinson1, N. T. Gunaratnam1; 1St. Joseph Mercy Health System, Ann Arbor, MI, 2Allergy and Immunology, University of Michigan, Ann Arbor, MI. RATIONALE: Reports of anaphylactic reactions in patients on angiotensin converting enzyme inhibitors (ACEI) receiving immunotherapy are found in literature as early as 1990. In addition, one manufacturer of hymenoptera vaccine, Hollister-Stier, has warned of possible interactions between this product and ACEI therapy. Therefore, it is important to assess current practices in simultaneous ACEI and Hymenoptera venom immunotherapy administration. METHODS: A survey was sent to a subset of US members in the American Academy of Allergy, Asthma, and Immunology whose e-mail addresses were collated from the Academy’s 2002 directory. The subset includes all members for whom an e-mail address was valid (N= 1443). RESULTS: Of the 370 (26%) respondents to date, the mean age and years of allergy experience were 51 and 17 respectively. Ninety-one percent hold or discontinue beta-blockers, while only 14% hold or discontinue ACEIs. A significantly higher proportion of allergists stop beta-blockers than those who stop ACEI (p<.001). There was no allergist who held or stopped ACEI who did not also hold or stop beta-blockers. Of the allergists who do hold or stop ACEI, there is no significant difference in the proportion using the Hollister-Stier versus those who use ALK Laboratories vaccine. CONCLUSIONS: Only 14% of allergists currently hold or stop ACEI before immunotherapy, despite 49% of respondents using a vaccine that carries the concomitant warning. Until the relationship between ACEIs and Hymenoptera immunotherapy is studied further and a standard of care is established, it is important for allergists to be aware of the potential increased anaphylaxis risk associated with simultaneous use. Funding: St. Joseph Mercy Hospital
436
Genetic Basis of the Latex-Fruit Syndrome: Association With HLA-Class II Alleles C. Blanco1, F. Sánchez-García2, M. J. Torres-Galván3, A. G. Dumpierrez1, L. Almeida1, J. Figueroa1, N. Ortega1, R. Castillo1, M. D. Gallego1,
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T. Carrillo1; 1Sección de Alergia, Hospital Dr. Negrín, Las Palmas de GC, SPAIN, 2Servicio de Inmunología, Hospital Dr. Negrín, Las Palmas de GC, SPAIN, 3Unidad de Investigación, Hospital Dr. Negrín, Las Palmas de GC, SPAIN. RATIONALE: The latex-fruit syndrome is a well-defined disorder, whose genetic background has not been elucidated. METHODS: In a case-control study, we have investigated a carefully selected group of latex allergic patients, searching for association between latex-fruit allergy and HLA class I and II genes, HLA-DR functional groups, and markers IL4-RI and FcεRI-ca. RESULTS: Seventy eight latex allergic patients without spina bifida, 33% of them also allergic to fruits, were included in our protocol. Skin prick test (SPT) results with both a commercial latex extract and purified hevein were significantly greater in latex-fruit than in latex not-fruit allergic patients. A cut-off point of > 7 mm for commercial latex SPT diagnosed latex-fruit allergy with a sensitivity of 66.7% (95% CI, 41.0-86.6) and a specificity of 83.3% (95% CI, 68.6- 93.0). No significant differences were found regarding HLA class I, IL4-RI or FcεRI-ca allele distributions. However, comparison of HLA class II allelic frequencies between latex-fruit and latex not-fruit allergic patients showed significant associations of latex-fruit allergy with DQB1*0201 (Pc=0.001, OR=7.3, with a 95% CI of 2.6-20.0), as well as with HLA-DR functional group “E” (Pc=0.028; OR=16.0, with a 95% CI of 1.9-134.1). When comparing allelic distribution among different subgroups of latex-allergic patients, additional significant associations of latex-fruit allergy with DRB1*0301 and *0901, and of latex not-fruit allergy with DQB1*0202, DRB1*0701 and *1101, were also demonstrated. CONCLUSIONS: Latex-fruit allergy is associated with HLADQB1*0201, DRB1*0301 and *0901, as well as with HLA-DR functional group “E”, while latex not-fruit allergy is associated with DQB1*0202, DRB1*0701 and *1101 alleles. Funding: Instituto de Salud Carlos III
438
Concurrent Latex and Seminal Fluid Allergy
M. R. Rupp, G. D. Marshall, Jr., R. D. deShazo; Allergy and Immunology, University of Mississippi Medical Center, Jackson, MS. RATIONALE: To report a case of latex allergy in a patient with seminal fluid (SF) allergy. METHODS: A 23-year-old female complained of dyspareunia with postcoital vaginal soreness and swelling. She also reported sore throat and lip swelling after oral sex and had experienced abdominal urticaria after ejaculate exposure. She also reported labial pain and swelling after protected sex with condoms. Following unprotected intercourse she experienced an episode of angioedema, generalized urticaria, and dyspnea that required an emergency room visit for treatment with antihistamines, steroids, and epinephrine. Ejaculate from her sexual partner was prepared for skin prick testing (SPT) on the patient and her partner (as a control) by filtration and centrifugation. MEDLINE was searched for case reports of concurrent latex and SF allergy. RESULTS: She was SPT positive to SF (1:1000) [6 mm wheal; histamine 8mm; saline 0mm]. Her partner was similarly tested and was found to be SF negative [histamine 7mm]. Her latex RAST was positive. MEDLINE search revealed one report of associated latex and SF allergy. CONCLUSIONS: To our knowledge, this represents the second reported case of concurrent SF and latex allergy. This patient initially volunteered information related to symptoms after exposure to ejaculate, but later admitted to similar symptoms when exposed to latex condoms. Such a history could lead away from SF sensitivity altogether or could lead to dismissing a role for latex. This may be more frequent than is commonly appreciated. Thus, careful history and latex testing should be considered for patients reporting SF-induced symptoms.
SUNDAY
Abstracts S109
J ALLERGY CLIN IMMUNOL VOLUME 115, NUMBER 2
435
Assessment of Current Practice in Concomitant Use of ACE Inhibitor and Hymenoptera Venom Immunotherapy P. Gogineni1, J. Baldwin2, E. Robinson1, N. T. Gunaratnam1; 1St. Joseph Mercy Health System, Ann Arbor, MI, 2Allergy and Immunology, University of Michigan, Ann Arbor, MI. RATIONALE: Reports of anaphylactic reactions in patients on angiotensin converting enzyme inhibitors (ACEI) receiving immunotherapy are found in literature as early as 1990. In addition, one manufacturer of hymenoptera vaccine, Hollister-Stier, has warned of possible interactions between this product and ACEI therapy. Therefore, it is important to assess current practices in simultaneous ACEI and Hymenoptera venom immunotherapy administration. METHODS: A survey was sent to a subset of US members in the American Academy of Allergy, Asthma, and Immunology whose e-mail addresses were collated from the Academy’s 2002 directory. The subset includes all members for whom an e-mail address was valid (N= 1443). RESULTS: Of the 370 (26%) respondents to date, the mean age and years of allergy experience were 51 and 17 respectively. Ninety-one percent hold or discontinue beta-blockers, while only 14% hold or discontinue ACEIs. A significantly higher proportion of allergists stop beta-blockers than those who stop ACEI (p<.001). There was no allergist who held or stopped ACEI who did not also hold or stop beta-blockers. Of the allergists who do hold or stop ACEI, there is no significant difference in the proportion using the Hollister-Stier versus those who use ALK Laboratories vaccine. CONCLUSIONS: Only 14% of allergists currently hold or stop ACEI before immunotherapy, despite 49% of respondents using a vaccine that carries the concomitant warning. Until the relationship between ACEIs and Hymenoptera immunotherapy is studied further and a standard of care is established, it is important for allergists to be aware of the potential increased anaphylaxis risk associated with simultaneous use. Funding: St. Joseph Mercy Hospital
436
Genetic Basis of the Latex-Fruit Syndrome: Association With HLA-Class II Alleles C. Blanco1, F. Sánchez-García2, M. J. Torres-Galván3, A. G. Dumpierrez1, L. Almeida1, J. Figueroa1, N. Ortega1, R. Castillo1, M. D. Gallego1,
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T. Carrillo1; 1Sección de Alergia, Hospital Dr. Negrín, Las Palmas de GC, SPAIN, 2Servicio de Inmunología, Hospital Dr. Negrín, Las Palmas de GC, SPAIN, 3Unidad de Investigación, Hospital Dr. Negrín, Las Palmas de GC, SPAIN. RATIONALE: The latex-fruit syndrome is a well-defined disorder, whose genetic background has not been elucidated. METHODS: In a case-control study, we have investigated a carefully selected group of latex allergic patients, searching for association between latex-fruit allergy and HLA class I and II genes, HLA-DR functional groups, and markers IL4-RI and FcεRI-ca. RESULTS: Seventy eight latex allergic patients without spina bifida, 33% of them also allergic to fruits, were included in our protocol. Skin prick test (SPT) results with both a commercial latex extract and purified hevein were significantly greater in latex-fruit than in latex not-fruit allergic patients. A cut-off point of > 7 mm for commercial latex SPT diagnosed latex-fruit allergy with a sensitivity of 66.7% (95% CI, 41.0-86.6) and a specificity of 83.3% (95% CI, 68.6- 93.0). No significant differences were found regarding HLA class I, IL4-RI or FcεRI-ca allele distributions. However, comparison of HLA class II allelic frequencies between latex-fruit and latex not-fruit allergic patients showed significant associations of latex-fruit allergy with DQB1*0201 (Pc=0.001, OR=7.3, with a 95% CI of 2.6-20.0), as well as with HLA-DR functional group “E” (Pc=0.028; OR=16.0, with a 95% CI of 1.9-134.1). When comparing allelic distribution among different subgroups of latex-allergic patients, additional significant associations of latex-fruit allergy with DRB1*0301 and *0901, and of latex not-fruit allergy with DQB1*0202, DRB1*0701 and *1101, were also demonstrated. CONCLUSIONS: Latex-fruit allergy is associated with HLADQB1*0201, DRB1*0301 and *0901, as well as with HLA-DR functional group “E”, while latex not-fruit allergy is associated with DQB1*0202, DRB1*0701 and *1101 alleles. Funding: Instituto de Salud Carlos III
438
Concurrent Latex and Seminal Fluid Allergy
M. R. Rupp, G. D. Marshall, Jr., R. D. deShazo; Allergy and Immunology, University of Mississippi Medical Center, Jackson, MS. RATIONALE: To report a case of latex allergy in a patient with seminal fluid (SF) allergy. METHODS: A 23-year-old female complained of dyspareunia with postcoital vaginal soreness and swelling. She also reported sore throat and lip swelling after oral sex and had experienced abdominal urticaria after ejaculate exposure. She also reported labial pain and swelling after protected sex with condoms. Following unprotected intercourse she experienced an episode of angioedema, generalized urticaria, and dyspnea that required an emergency room visit for treatment with antihistamines, steroids, and epinephrine. Ejaculate from her sexual partner was prepared for skin prick testing (SPT) on the patient and her partner (as a control) by filtration and centrifugation. MEDLINE was searched for case reports of concurrent latex and SF allergy. RESULTS: She was SPT positive to SF (1:1000) [6 mm wheal; histamine 8mm; saline 0mm]. Her partner was similarly tested and was found to be SF negative [histamine 7mm]. Her latex RAST was positive. MEDLINE search revealed one report of associated latex and SF allergy. CONCLUSIONS: To our knowledge, this represents the second reported case of concurrent SF and latex allergy. This patient initially volunteered information related to symptoms after exposure to ejaculate, but later admitted to similar symptoms when exposed to latex condoms. Such a history could lead away from SF sensitivity altogether or could lead to dismissing a role for latex. This may be more frequent than is commonly appreciated. Thus, careful history and latex testing should be considered for patients reporting SF-induced symptoms.
SUNDAY
Abstracts S109
J ALLERGY CLIN IMMUNOL VOLUME 115, NUMBER 2