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LATE BREAKING ABSTRACT SESSIONS POSTER SESSIONS Mechanisms of Allergy I 1441 IgE binding proteins from sunflowers seeds Tavares, B1; Lundberg, M2; Ribeiro, C3; Loureiro, G3; Pereira, C3; Rodrigues, F4; Chieira, C3 1 Coimbra University Hospitals, Immunoallergology Department, Praceta Mota Pinto, Coimbra, Portugal; 2 MIAB, Uppsala, Sweden; 3Coimbra University Hospitals, Immunoallergology Department, Coimbra, Portugal; 4Coimbra University Hospitals, Immunology Laboratory, Coimbra, Portugal

Background: Sunflower seeds and their products are extensively used in diet. They can cause allergic symptoms including severe anaphylactic reactions after ingestion or respiratory symptoms after occupational exposure to sunflower seed dust. Allergens remain until now to be fully recognized. The aim of the study was to identify the IgE binding proteins from sunflower seeds in allergic patients. Methods: Sera from three patients with anaphylaxis to sunflower seeds were evaluated. Specific IgE levels to sunflower seeds allergens and IgE to rBer e 1 (recombinant 2S albumin from Bertholletia excelsa) were quantified (ImmunoCAP, Phadia). Immunobloting analysis of sunflower seed extract was performed with sera from the three patients and with one in-house sample (MIAB). Results: IgE to sun flower seeds was 7.1 KU/l, 52.5 KU/l and 2.1 KU/l. All patients had IgE to rBer e 1 0.05). CD3+CD45RA+ (naive T cells) were found to be lower at the age of 4 weeks (0.003). Conclusion: Gamma-Delta T cells seemed to increase due to vaccine against tuberculosis. NK cells were also induced by BCG despite the fact that, these cells were found to be lower in healthy newborns. However, CD2+, CD3+, CD4+, CD8+ cells B cells demonstrated to be induced in 4 weeks which were normally expected in newborns. Further studies in order to elucidate the mechanism of action of the observed differences are warranted.

1461 The role of immunoglobulin E(IgE) in bronchial asthma Singh, D Kharkiv National Medical University, Medicine, Kharkiv, Ukraine

The central role of IgE antibodies in allergic bronchial asthma (ABA) is not disputed any longer. Immunological mechanisms other than IgE-mediated reactions in the pathogenesis of ABA have not yet been definitely demonstrated. There is controversy as to whether IgG STS antibodies, probably IgG4, play a role in the disease process. There is no evidence to support the involvement of immune complexes. Anti-beta-2-adrenergic receptor autoimmune responses cannot be considered as responsible for the development of the disease at the present time. In the last few years a great effort has been made to understand the immunological mechanisms underlying the enhanced and long-standing

 2009 The Authors Journal Compilation  2009 Blackwell Publishing Ltd Allergy 64 (Suppl. 90): 551–598

IgE antibody production in atopic diseases. The results obtained in different laboratories, including our own, are in favor of a high responder status to allergen epitopes in a large proportion of atopies and suggest that a preferential expression of IgE isotype in the antibody responses may occur through different mechanisms. Of great interest is the recent demonstration of IgE-binding factors with IgE-potentiating and suppressive activity and of other related regulatory molecules and receptors. Progress has been recently achieved in the characterization of mediators responsible for the different pathological changes of ABA. A linkage between immediate IgEmediated reactions, bronchial late-phase reactions (LPR) and chronic inflammation (CI) has been reported. It has been demonstrated that a cascade of mediators and cell interactions induce both LPR and CI. There is evidence of a close relationship between LPR-CI and nonspecific bronchial hyper reactivity. A better knowledge of pathogenetic mechanisms of ABA would open new perspectives in the therapy. A modulation of IgE antibody production can be attempted in different ways. At present a control of mediator release and of airway hyper reactivity can be achieved by several pharmacological interventions and by the avoidance of common and/or occupational allergens or pollutants.

1462 The Effect of Asian Sand Dust In Allergic Inflammation Of Allergic Mouse Jung, J1; Gang, I1; Kim, S2 Gachon Medical School, Department of Otolaryngology, Inchon city, Korea; 2Gachon University of Medicine and Science, Department of Otolaryngology, Inchon city, Korea

1

Background and objectives: Asian sand dust (ASD) was known to aggravate the respiratory symptoms in patients with bronchial asthma. However, the effect of ASD in allergic rhinitis was not known. The objective of this study was to investigate whether ASD can activate the allergic inflammation in allergic mouse model. Materials and methods: 40 female BALB/c mice were divided into 4 groups. Group 1 was nebulized with saline and group 2 with ASD. Group 3 was nebulized with OVA only and the group 4 with OVA plus ASD after intraperitoneal injection with OVA. The allergic symptom scores were checked. The mouse OVA specific IgE/IgG1, IL-4, IL-5 and IFN-c were measured by ELISA. The nasal mucosa was examined for the expression of IL-4, IL-5 by immunohistochemical stain. Results: The average symptom score was increased in group 4 compared to group 3 557

Late Breaking Poster Abstract Sessions – Mechanisms of Allergy II

(P < 0.05). The IgE was significantly increased in group 4 compared to group 3 (P < 0.01). The IL-4 level of nasal lavagefluid (NALF) was significantly increased in group 4 compared to group 3 (P < 0.05). The IL-5 level showed no significant difference between the group 3 and group 4 both in serum and NALF. The level of IFN-c was not changed in NALF. Immunohistochemical staining showed that the positive cells for IL-4 were expressed in epithelial layer and submucous gland and the positive cells were more increased in group 4 than group 3. Conclusion: In allergic mouse model, ASD has shown to activate the allergic inflammatory reaction by the stimuli of Th2 cytokine production.

1463 Relationship between basophil activation test results and clinical outcome of acetylsalicylic acid intolerance Korosec, P1; Nusa, M2; Nissera, B1; Mira, S1; Mitja, K1; Ales, M2 1 University Clinic of Respiratory and Allergic Diseases, Lab. for Clinical Immunology & Molecular Genetics, Golnik, Slovenia; 2University of Ljubljana, Faculty of pharmacy, Chair of Biopharmaceutics and Pharmacokinetics, Ljubljana, Slovenia

Background: Treatment with acetylsalicylic acid (ASA) is sometimes complicated with asthma exacerbation, urticaria and angioedema or anaphylactoid reaction. Systemic reactions are due to hypersensitivity to pharmacological actions of the drug. We wanted to evaluate basophil activation test (BAT) in the diagnostics of ASA intolerance. Methods: We performed a prospective single-blind study in 62 subjects to ascertain the relationship between the clinical results according to medical history and/or provocation testing and the CD63 BAT results. Results: We found 41 ASA tolerant and 21 ASA intolerant subjects. Both groups were comparable according to the manifestation of the rhinosinusitis, polyps and asthma. There was no difference in baseline basophil response or after fMLP or anti-FceRI stimulation. However, intolerant subjects showed significantly higher basophil response after stimulation with 0.25 mg/ml or 1 mg/ml ASA concentrations in comparison to tolerant subjects (P < 0.0001). Moreover, this response was cellular specific, as it was markedly higher at higher concentration (0.25 versus 1 mg/ml; P < 0.0001). If we calculate the ratio between responses at 1 mg/ml and the baseline response and put on the cut-off index at 3, then the clinical sensitivity of BAT test was 55% and the specificity was 83%. If we further excluded 5 patients with chronic urticaria the sensitivity rose to 65%.

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Conclusions: Our study confirmed that there are differences in in vitro basophil responsiveness to ASA between ASA intolerant and tolerant subjects. These results also suggest that these differences might be connected with different clinical manifestation of ASA intolerance. Finally, this study adds up a significant scientific base for further evaluation of ASA BAT for diagnostic and research purposes.

patients demonstrated a 3–7 fold reduction of allergenic activity of the transgenic carrots, with respect to the amount of carrot extract required to produce half-maximum level of mediator release. Conclusion: RNAi-mediated gene silencing can be used for allergen reduction in carrots. The beneficial effect of transgenic carrots for allergic patients needs to be investigated.

1464 RNAi-mediated allergen suppression in carrots

1464b Disseminated BCG in the Iranian children with severe combined immunodeficiency

Weigand, D1; Peters, S2; Fo¨tisch, K1; Lidholm, J3; Mahler, V4; Kogel, K2; Vieths, S1; Scheurer, S1; Imani, J2 1 Paul-Ehrlich-Institut, Allergology, Langen, Germany; 2 Justus-Liebig-Universita¨t, Phytopathology and Applied Zoology, Giessen, Germany; 3Phadia AB, Research and Development, Uppsala, Sweden; 4Hautklinik Universita¨tsklinikum Erlangen, Allergology, Erlangen, Germany

Background: Two allergens have been described in carrot (Daucus carota): the Bet v 1 homologue Dau c 1, represented by multiple isoforms and variants, showing a sensitization rate of 98% and the profilin Dau c 4 showing a sensitization rate of 21– 38%. Of these, Dau c 1 is by far the more important. Using carrot as model for posttranscriptional gene silencing of allergens, we hypothesize that knock down of Dau c 1 will result in carrots with reduced allergenicity. Methods: For constitutive over-expression of Dau c 1.01 and Dau c 1.02 RNAi we cloned the cDNA from each gene into the Gateway compatible binary vector under control of 35S promoter. For carrot (cv. Rodelika) transformation, RNAi vectors were introduced into Agrobacterium tumefaciens strain GV3101pMP90. Transformed plantlets were selected by kanamycin resistance and the presence of the siRNAinsert was confirmed by RT-PCR. Carrot leaves were screened for mRNA expression level by qRT PCR. Allergen suppression in carrot roots was analyzed by Dau c 1.0104 and Dau c 1.0201 specific ELISA, immunoblotting and in vitro histamine release. Results: Both Dau c 1 isoforms accumulate in roots of carrot wild type plants, with Dau c 1.01 being more abundant than Dau c 1.02. Screening data of 50 putative RNAi lines by qRT-PCR were in good agreement with the ELISA results. 25 of 27 Dau c 1.02_RNAi lines showed a Dau c 1.02 content reduced by up to >90% as compared to wild type plants while 12 of 17 Dau c 1.01_RNAi lines showed a suppression of Dau c 1.01 by up to 90%. Reduced allergen accumulation was confirmed by immunoblotting. In vitro histamine release tests with selected sera from carrot allergic

Sadeghi Shabestari, M1; Rezaei, N2 Children’s Hospital, Tabriz University (Medical Sciences), Division of Pediatrics’ Immunology Allergy, Tabriz, Islamic Republic of Iran; 2Medical Sciences/ University of Tehran, Immunology, Asthma and Allergy Research Institute, Tehran, Islamic Republic of Iran

1

Background: Bacille Calmette-Gue´rin (BCG) vaccine is a widely practiced vaccine, which is useful for prophylaxis against tuberculosis. Disseminated BCG infection (BCG-osis) is one of the most important complications of this vaccine, which could be sees in the patients with an underlying immunodeficiency. This study was performed to determine the underlying defects in the patients with BCG-osis. Methods: Immunological evaluation was performed in all children who were complicated with BCG-osis after vaccination in Tabriz, Iran. Results: BCG-osis was documented in 8 cases following vaccination. Axillary adenitis was detected in 7 cases and hepatosplenomegaly was found in 7 patients as well. Immunological studies revealed low serum IgG, IgM and IgA levels in all patients. Further investigations for enumeration of lymphocyte sub-population revealed SCID in all these patients. Three patients had T-B+NKSCID, 4 had T-B-NK+ SCID, and 1 had TB+NK+ SCID. Unfortunately, all these patients were died due to severe disseminated BCG infection. Conclusions: Inoculation of live vaccines such as BCG should be postponed in the suspected cases to PID for a few months till appropriate screening tests exclude such diagnosis, but it should definitely be performed later in the cases with intact immune system.

 2009 The Authors Journal Compilation  2009 Blackwell Publishing Ltd Allergy 64 (Suppl. 90): 551–598

Late Breaking Poster Abstract Session Bronchial Asthma 1465 Improved exercise capacity after Omalizumab treatment in severe allergic asthmatics Noga, O1; Probst, M2; Kru¨ll, M2; Gla¨ser, S3; Gla¨ser, S3 1 Charite´ Universta¨tsmedizin Berlin, Respiratory and Infectious Diseases, Berlin, Germany; 2Charite´ Universta¨tsmedizin Berlin, Respiratory and Infectious Diseases, Berlin, Germany; 3University Greifswald, Respiratory and Infectious Diseases, Berlin, Germany

Background: Omalizumab is a novel add on therapy for severe allergic asthma. Several changes including improved quality of life and a lower rate of exacerbations but also several changes in allergic inflammation after omalizumab treatment were described. Clinical response rates to omalizumab therapy of approximately 60% have been reported. The individual effectiveness is usually assessed by physician’s judgment based on a clinical evaluation since objective and technical examinations have not been shown any superiority. The evaluation of the exercise capacity might provide a further tool in the evaluation of the effectiveness of omalizumab therapy. The major hypothesis to be investigated in this study is to what extent cardiopulmonary exercise testing (CPET) can provide sufficient and reliable measures to assess a treatment success due to omalizumab. Methods: Ten patients with severe allergic asthma were treated with omalizumab. Pulmonary function testing (PFT) and CPET were performed before therapy and after 16 weeks of omalizumab treatment in comparison to 10 severe asthmatic patients as controls (without treatment). A symptom limited CPET was performed on a cycle ergometer with continuous increments in work load. Besides oxygen uptake at anaerobic threshold and peak exercise expiratory flow limitation was assessed by dynamic flow volume loops. Results: Omalizumab treatment resulted in an significantly increased exercise capacity (peak oxygen uptake; P < 0.05; oxygen uptake at anaerobic threshold; P < 0.05). In the control group no significant difference was observed. Improvement of exercise capacity was in some cases immense (170%) and correlated with IGETE. Conclusions: This study demonstrates that CPET can provide an additional and useful tool to assess the individual clinical response to omalizumab treatment.

1466 High sensitive CRP in mild asthma Aras, G1; Kadakal, F1; Uzu¨mcu¨, M2; Purisa, S3; Yy´lmaz, V1 1 Yedikule Chest Disease and Surgery Research Hospital, Chest Disease, Y´stanbul, Turkey; 2Taksim Research and Education Hospital, Microbiology, Y´stanbul, Turkey; 3Istanbul University, Medical Faculty of Cerrahpa·a, Biostatistics, Istanbul, Turkey

Background: Local inflammation, systemic inflammation is present in asthma depend on various cells, cytokines and mediators. High sensitive CRP could be a useful tool for detecting systemic inflammation in new diagnosed in asthma without heart disease and diabetes mellitus. Objective: The aim of our study to suggest whether there was any correlation increased levels of hs-CRP with deteriorations of respiratory functions and systemic inflammation in asthma. Beside, we assessed how ICS (inhaler corticosteroid) treatment could suppress hs-CRP levels. Methods: We included 15 new diagnosed untreated mild persistent asthma patients according to the criteria recommended by the GINA. Pulmonary function test, reversibility, prick test, IgE levels were evaluated in all patients. The sera of the patients were stored at -20C. Pretreatment and four weeks after ICS treatment high sensitive serum CRP levels were assessed by nephelometric methods (RADIM, Roma, Italia). The Mann-Whitney U-test was used to analyse differences between pre and post treatment levels of hs-CRP. Correlations between data were analysed using Spearman’s rank correlation test. Results: FEV1 and PEF values were significantly different between pre and post-treatment (respectively; P = 0.013, P = 0.05). After treatment, however hs-CRP levels did not suggest difference (P = 0.064). After treatment measurements of FEV1 (rs: -0.59, P = 0.021) and PEF (rs: -0.54, P = 0.035) negatively correlated with hs-CRP serum levels. There weren’t any correlation with positive prick test, IgE levels and hsCRP levels. Conclusion: Asthma patients have ongoing chronic inflammation. Hs-CRP serum levels increase in patients with deterioration of pulmonary function. ICS use may be insufficient to suppress systemic inflammation in asthma.

 2009 The Authors Journal Compilation  2009 Blackwell Publishing Ltd Allergy 64 (Suppl. 90): 551–598

1467 Respiratory Function Tests in Children Diagnosed of Extrinsic Bronchial Asthma Martin Mateos, M; Dı´az Ga´lvez, M; Sierra, J; Valero, A; Giner, M; Plaza, A; Piquer, M; Dominguez, O Hospital Sant Joan de Dios-Hospital Clinic.Universidad de Barcelona, Inmunologı´a y Alergia Pedia´trica, Barcelona, Spain

Hypothesis: Respiratory function tests can be used to detect early changes in the initial phases of disease when one-second forced expiratory volume (FEV1) and forced vital capacity (FVC) by spirometry may be normal and only increased lung volume is found. Objectives: To know the averages and standard deviation of forced spirometry and whole body plethysmography parameters in children diagnosed of extrinsic bronchial asthma. To correlate baseline and post-bronchodilation forced spirometry and static lung volume parameters. Methods: Descriptive epidemiologic study from 2007 to 2008 of 16 patients diagnosed of controlled extrinsic bronchial asthma, in which forced spirometry and whole body plethysmography techniques were used. A comparative analysis was made of the values obtained in respiratory function tests. Results: Average age was 12.9 years (range 6–17). Average (standard deviation) static lung volumes, in liters, were intrathoracic gas volume (ITGV): 2.92 l (0.99), total lung capacity (TLC): 5.13 l (1.36), and residual volume to total lung capacity ratio (RV/TLC): 24.26 l (9.23). Mean spirometric values, expressed in liters and percentages, were 2.86 l (82%) FVC, 2.54 l (88%) FEV1, and 2.89 l (84%) FEF 25–75. A significant correlation (P < 0.05) was found between forced vital capacity (FVC-spirometry) and total lung capacity (TLCplethysmography) that also was observed after the bronchodilatation test. Conclusions: The average values obtained in forced spirometry in children with controlled asthma were within normal limits. Static lung volumes (ITGV, TLC, RV/ TLC) were higher than reference values. A good correlation was demonstrated between forced spirometry and plethysmography in air flow obstruction with reduced FEV1 and increased ITGV.

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Late Breaking Poster Abstract Sessions – Bronchial Asthma

1468 FeNO in different asthma phenotypes Gemicioglu, B; Guven, K; Dogan, I Istanbul Un. Cerrahpasa Fac. of Medicine, Pulmonary Diseases, Istanbul, Turkey

Aim: The study aimed to identify fractioned nitric oxide (FeNO) levels in expiration air in different asthma phenotypes. Method: In 416 asthmatic patients (mean age: 41.8 ± 14 years) on combined therapy, followed at least 1 year in 3rd-line pulmonary diseases clinic, exhaled FeNO measurement (NIOX Mino, Aerocrine AB, Solna Sweden) were performed. Skin prick test results (ALK Abello Spain), emergency visits and hospitalizations during the past 1 year, pulmonary functions (ZAN 100 Flow Handy II, Germany), comorbidities and smoking habits were recorded; their correlations with FeNO were studied. Results: FeNO and FEV1% were not correlated. FeNO was not different in patients with and without smoking history (74.6% was non-smokers). Age and FeNO were negatively correlated (P = 0.009, r = -0.13). 70.7% of patients were female and their mean BMI were 27.4 ± 5.1. Male were higher FeNO than female (P < 0.005). FeNO values varied significantly in patients with and without emergency visit history (P < 0.001, P = 0.02). No difference was observed for FeNO in patients with and without hospitalization history (P < 0.001). FeNO was statistically different in patients with positive and negative skin prick test (P = 0.004). FeNO was statistically different in patients with and without allergic rhinitis (P = 0.008). FeNO was different in patients with and without allergic conjunctivitis (P = 0.02). Conclusion: As possible interactions between FeNO and various parameters have been shown, each patient should be individually assessed according to his/her best FeNO value.

1469 Severe asthma: incidence of intensive care unit admission in patients attending a public hospital emergency room de Barayazarra, S1; Raffaelli, A1; Corelli, S1; Teijeiro, A1; Baena-Cagnani, R1; Najo, M1; Baena-Cagnani, C2 1 San Roque Hospital, Allergy Department, Cordoba, Argentina; 2Universidad de Genova, Respiratory Medicine Department, Genova, Italy

Severe asthma is an increasing public health problem. Under diagnosis and under treatment are among the causal factors all around the world and particularly in middle/low income patients. In this study severe asthma was considered, according to the American Thoracic Society definition, as a serious asthma event from the beginning or

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one that gets worse progressively, not responding to the recommended therapeutic intervention. Over the last decades, an increment in the frequency of asthma has been recorded in most parts of the world. Asthma severity is associated to the underestimation of symptoms and under treatment by both patients and health care providers (HCP). The aim of this study was to evaluate the incidence of patients that attended to the San Roque Hospital emergency room (ER) due to severe asthma exacerbation and which required to be admitted into the Intensive Care Unit (ICU). The factors associated to these events were also evaluated. The analysis of the results showed that 3.55% of the 647 patients that came into the ER from January 1st 2003 to September 30th 2006 required to be admitted to the ICU. 43% of patients were intubated. Respiratory infections and undertreament were identified as the major causal factors; only 8.7% received controller medication before being admitted to the ER care in the hospital. The death rate was 4.35%. Conclusion: Under treatment and no-treatment at all is the major cause of severe asthma in low-income settings requesting ICU. The mortality rate is substantial. Educational intervention in both patients and HCP is urgently needed.

1470 Publication of a new genetic classification of atopy and a manual for a personalized medicine on bronchial asthma Kondo, N Gifu University, Pediatrics, Gifu, Japan

Introduction: Recently treatment / management guidelines on bronchial asthma have been published, and they are utilized in clinical practice. However, the clinical features of the patients and the causes of the diseases vary. Therefore, personalized medical care (tailor-made medicine) is necessary for the improvement of QOL. Here we present a new genetic classification of atopy (by Kondo N) and a manual for a tailor-made medicine on bronchial asthma. Methods: We publish a new genetic classification of atopy and a manual for a personalized medicine on bronchial asthma. Results: Based on recent reports and our study, we presented a new genetic classification of atopy (by Kondo N). There are four categories of genes that affect the expression of allergic disorders, which include (1) antigen recognition, (2) IgE production (downregulation = brake and upregulation), (3) mediators production and release and (4) events on target organs. Based on the genetic classification of atopy, the tailormade medicine will be developed. Now, we are newly developing a manual (guideline)

on the personalized medicine (tailor-made medicine) of bronchial asthma based on the detections for 1: various symptoms, 2: the various immune responses and 3: the various causative candidate genes mutations or polymorphisms. Here we shows parts of the Japanese edition of the manual. For example, as one of the markers of symptoms, for viral induced asthma, antileukotriene receptors are effective. For example, as one of the markers of labolatory findings, for the poor IFN-c production, Th2 cytokine controller is effective. For example, as one of the gene markers, for LTC4S-444 AA type, Th2 cytokine controller is effective and, for LTC4S-444 AC or CC type, antileukotriene receptor is effective. Discussion: In the near future, the guideline on the tailor-made medicine of bronchial asthma and allergic disorders will be available.

1471 Subcutaneous emphysema and pneumomediastinum: unusual complications in a asthmatic young woman with a neutrophilic phenotype Patella, V1; Florio, G1; Di Pace, L1; Iannelli, L2; Magliacane, D3 1 U.O. of Allergy and Clinical Immunology, ASL SALERNO, Department of Medicine, Agropoli, Salerno, Italy; 2U.O. of Radiology, ASL SALERNO, General Hospital of Agropoli, Salerno, Italy; 3Division of Allergy and Clinical Immunology and Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy

Last February, a 24-year-old woman presented to the emergency department per an acute attack of asthma. Two days prior to admission, she had fever (body temperature 38.3C) and mild dyspnoea. Then after 24 h she had an increase in the severity of her symptoms with the onset of substernal chest pain, malaise and fatigue. In the past she had some episodes of adverse drug reactions to steroids (metilprednisolone sodio succinato and betametasone disodio fosfato), which it was characterized by urticaria/angioedema. At the admission to the hospital she had cough, dyspnoea, an expiratory wheezes with rhonchi bilaterally. A subcutaneous emphysema on the right side of the chest anteriorly down over the neck was reported by palpating of this region, crepitations were plainly evident and they were confirmed by auscultation. Circumoral and nail bed cyanosis was present. Chest x ray showed radiographic signs suggestive of subcutaneous emphysema of soft tissues. A computed tomography of chest confirmed this observations and indicated a moderate mediastinal emphysema, but not pneumothorax. A white blood count revealed a leukocytosis of 12.000 with neutrophilia (92% of total white blood cells). She was successfully treated with nebulised

 2009 The Authors Journal Compilation  2009 Blackwell Publishing Ltd Allergy 64 (Suppl. 90): 551–598

Late Breaking Poster Abstract Sessions – Bronchial Asthma

salbutamol, steroids, antibiotics and high flow oxygen. She made a good recovery and was discharged after 7 days. The neutrophilia of white blood count (11 040 cells/mm3) that was initially referred by escalating of the dose of steroid, but successively a prominent neutrophilic inflammation in the sputum of subject, observed during asthma exacerbation, suggested the characteristic of a neutrophilic asthmatic phenotype. As like in this case reported, these particular phenotypes of asthmatics had experienced at least one severe exacerbation with an accelerated loss of lung function respect to asthmatic patients that have a classic pattern of eosinophilic phenotype. Eosinophilia with/without history of atopia is not sufficient to define a unique clinic patterns of patient with acute attack of asthma. While the environmental causes of asthma exacerbation are heterogeneous, common upper respiratory tract viruses, especially rhinoviruses, are the most common and important causes of asthma attack. This case highlights the need for a high index of suspicion of such complications in young peoples with neutrophilia presenting acute attack of asthma for the first time.

Table 1. For abstract 1473. Serum IgE level 1000

9 (12%)

14 (18, 7%)

4 (5.3%)

0

35 (46.7)

7 (9.3%)

1 (1.3%)

5 (6.7%)

patients were with bronchial asthma and 43 with COPD (33 men-37 women and mean age 61, 6’’b17, 5 years) . Serum IgE, CRP, C3 and C4 levels were estimated in all the patients by nephelometry (Beckman). Statistical analysis was possible by SPSS. Results: The mean value of IgE (NV < 165 mg/dl) in patients with bronchial asthma was 283.12 ‘‘b 214.68 and in patients with COPD 111.11 ‘‘b108.2l8 (P < 0.001). In 5 (6, 7%) cases of COPD serum IgE levels were above >1000 mg/dl. CRP, C3, C4 and fibrinogen were higher respectively to healthy controls. However, statistically significant difference was not observed among the patients with asthma and COPD. Conclusions: 1. Increased serum IgE levels were observed in the majority of patients with bronchial asthma. 2. Serum IgE levels were within normal values in most of the patients with COPD. Elevated levels could be explained by age, smoking, drug treatment or coexisting diseases. 3. As far as acute phase proteins were concerned, no statistically significant difference was observed among the patients with asthma and COPD.

1472 Serum IgE concentration and acute phase proteins in patients with bronchial asthma and chronic obstructive pulmonary disease Konstantina, P1; Ntrivala, M1; Laekkakou, A2; Zafeiriadou, O3; Papaefstathiou, E3; Fakiri, E1; Trakas, N1 1 Sismanogleio General Hospital Athens, Clinical Microbiology, Athens, Greece; 2Sismanogleio General Hospital Athens, 1st Pulmonary Department, Athens, Greece; 3Sismanogleio General Hospital Athens, Clinical Chemistry, Athens, Greece

1473 Serum IgE concentration in patients with bronchial asthma and chronic obstructive pulmonary disease

Introduction: IgE is an immunoglobin produced by B-lymphocytes which elevated levels are related with atopic diseases. Studies have demonstrated that it is influenced by several factors. Aim: To study the levels of IgE in comparison to CRP, fibrinogen, C3, C4 in patients of bronchial asthma and chronic obstructive pulmonary disease (COPD) who were admitted to our hospital due to lung infection. Material and methods: A total of 70 patients from Pulmonary Department of our hospital were examined. 27 of the

Pavlou, K1; Ntrivala, M1; Stamoulos, K1; Zafeiriadou, O2; Fakiri, E1; Trakas, N2 1 Sismanogleio General Hospital Athens, Clinical Microbiology, Athens, Greece; 2Sismanogleio General Hospital Athens, Clinical Chemistry, Athens, Greece

Introduction: IgE is an immunoglobin produced by B-lymphocytes which elevated levels are related with atopic diseases. Studies have demonstrated that it is influenced by several factors, such as age or smoking.

Table 1. For abstract 1472.

BRONCHIAL ASTHMA COPD

Serum IgE level

Serum IgE level

Serum IgE level

Serum IgE level

CRP

C3

C4

1000

NV95% of cases of anaphylaxis. Aim of the study was to establish how the new diagnostic criteria, proposed by the NIAID and FAAN could be combined with the previous definition of anaphylaxis. Methods: This multicentre prospective study enrolled all children with anaphylaxis consecutively attending 29 outpatient allergic clinics in Italy. Information regarding anaphylaxis was obtained by completing a standardised questionnaire. Results: Overall 191 children (68.1% males) (mean age 4.9 years) with food anaphylaxis were selected. Of these reactions, 29.3% were mild, 51.3% moderate and 19.4% severe. Of the 191 children, 85.3% met the new diagnostic criteria for anaphylaxis: 80.4% met Criteria 1, 19.6% Criteria 2. No children met Criteria 3. The new diagnostic criteria correctly defined 36/37 (97.2%) of severe anaphylaxis, 90/98 (91.8%) of moderate and 37/56 (66%) of mild anaphylaxis. Of the episodes, 3.7% was defined as exercise-dependent food anaphylaxis. Three children (1.6%) had a biphasic anaphylaxis. None of the remaining 28/191 (14.7%), fitting these three criteria and thus defined as suffering from ‘generalised food allergy’, had a biphasic reaction. Conclusion: In our study population, the new diagnostic criteria detect the large majority (85.3%) of children with a systemic allergic reaction, even if this percentage is lower then that expected by NIAIDFAAN. In particular, the new diagnostic criteria appear to show good sensitivity for severe anaphylaxis, as almost all (97.2%) episodes were included. Since our population included only children with a proven systemic allergic reaction, specificity of NIAID-FAAN criteria cannot be calculated.

1491 Allergy to cow’s milk and egg: the performance of a component-based allergen microarray in clinical practice Cavagni, G1; D’Urbano, L2; Donnanno, S1; Artesani, M1; Pellegrino, K1; Luciano, R3; Riccardi, C1; Tozzi, A4; Rava`, L4; Carloni, E4; De Benedetti, F2 1 UOC Allergologia Pediatrica, Italy; 2Laboratorio di Reumatologia, Italy; 3UO Laboratorio di Analisi, Italy; 4 IRCCS Ospedale Pediatrico Bambino Gesu`, UOC Epidemiologia, Roma, Italy

Background and aim: Currently, the diagnosis of food allergy is based on allergenspecific history, on the measurement of allergen-specific IgE (sIgE) using natural allergen extracts for in vivo and in vitro tests and on the food challenge test (FCT). The diagnostic specificity of sIgE is still discussed. Although cut-off values of sIgE levels measured with the ImmunoCap System have been proposed1, the food challenge test (FCT) still represents the diagnostic gold standard. The aim of this study was to compare the performance of the measurement of sIgE with a component-based allergen microarray (ISAC version CRD89) and that of the standard ImmunoCAP System in children with allergy to cow’s milk (CM) or hen’s egg (HE) proteins that underwent FCT. Patients and methods: We enrolled 104 children, with clinically suspected diagnosis of allergy to CM (58) and HE (46). In these patients we performed skin prick test (SPT, Lofarma), and sIgE measurement with the CAP and ISAC systems and open FCT. The performance of IgE reactivity to each component of microarray, of the ImmunoCap system and of the SPT was evaluated by ROC analysis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of SPT and of the two methods for sIgE measurement were evaluated as predictors of a positive diagnostic FCT performed in all patients. Results: FCT was positive in 32/58 (55%) patients with suspected CM allergy and in 22/46 (44%) with suspected HE allergy. IgE reactivities to Bos d 8 (27/58, 46.5%) and Bos d 4 (16/58, 27.6%) were more frequent, while very few patients showed sIgE to Bos d 7 (6/58, 10.3%) or lactoferrin (6/ 58, 10.3%). IgE reactivities to Gal d 1 (18/ 46, 39.1%), Gal d 2 (24/46, 52.1%) and Gal d 4 (17/46, 36.9%) were more frequent, while very few patients showed sIgE to Gal d 3 (6/46, 13.0%) or Gal d 5 (2/46, 4.3%). Comparisons among the results of the various tests did not show statistically significant differences. For CM, the highest AUC were observed when casein was used as the target allergen in the various tests. For HE, the highest AUC were observed with sIgE to Gal d 1 and the combination of Gal d 1 + Gal d 3. Based on ROC analysis and on

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the selection of a cut-off value with the highest possible PPV, sIgE to Bos d 8 > 0.61 had PPV = 96% and NPV = 78%; similarly, sIgE to Gal d 1 > 0.86 had PPV = 88% and NPV = 83% and sIgE to the combination of Gal d 1 + Gal d 3 > 0.64 had PPV = 87% and NPV = 80%. Conclusions: In patients with severe allergy to CM or to HE, the microarray allergen test appears to have a good clinical performance in predicting the outcome of the FCT. 1. Sampson HA. Food allergy – accurately identifying clinical reactivity. Allergy 2005;60 (s79):19–24.

1492 Glatiramer anaphylaxis: Antibodies and Basophil Activation Test to Glatiramer Soriano, V1; Marco, F2; Perez, A3; Gonzalez, P4 Universitary General Hospital, Allergy Service, Maestro Alonso, Alicante, Spain; 2Alicante University, Biotechnology Department, Alicante, Spain; 3Universitary General Hospital, Neurology Service, Alicante, Spain; 4 Universitary General Hospital, Allergy Service, Alicante, Spain

1

Introduction: Multiple Sclerosis is an inflammatory and degenerative disorder involving the central nervous system. Currently, immunomodulatory therapies represent first-line therapeutic options. Glatiramer acetate (GA) is a synthetic molecule composed of four amino acids (L-alanine, L-glutamine acid, L-Lysine, and L-tyrosine) with an average molecular mass of 4700–11 000 Da. It is usually injected subcutaneously once a day. GA may cause side effects. Material and methods: We present three patients with anaphylactic reaction to GA post-injection showed with skin tests, specific IgE and basophil activation test (BAT). Intradermal skin tests with GA were performed in saline solvent and at a dilution 1/100. Antibodies to GA were measured by indirect ELISA on microplates with 5 lg/well of antigen. Sera were analyzed at double dilutions from 1/2 for IgE and 1/100 for IgG antibodies. BAT was carried out with buffy coat samples obtained from blood treated with EDTA. Activated basophiles were identified by double staining with anti-IgE-FITC plus anti-CD63-PE. Patients with low IgE expression on basophiles were studied with anti-CD123-PE+anti-HLA DR-PerCP + anti-CD63-FITC. CD63 cut-off values were set at 15%. Results: Intradermal tests with GA were positive in all patients. Three healthy atopic controls were negative. ‘In vitro’ results of the patients were compared with 10 atopic and non-atopic controls. One patient showed positive IgE to GA at a high serum dilution (1/32) while other

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showed a level above the cut-off at 1/2 dilution. IgG antibodies were found in 3 patients ranging in title from 1/100 to 1/ 400. BAT gave positive results in two cases at 1000 lg/ml of GA and was always negative at 100, 10 and 1 lg/ml. One of these cases was studied with the CD123 mixture. One among 6 controls displayed IL-3 induced activation and was excluded. One control gave positive BAT results at 1000 lg/ml. This control was an atopic patient. Conclusions: In our experience the highest diagnostic sensitivity for GA anaphylaxis is achieved by skin tests. ‘In vitro tests’ support an IgE-mediated pathogenic mechanism in some cases, but they have less sensitivity than skin tests. Taken together ‘in vitro’ tests should be considered as a useful additional method for the diagnosis of GA anaphylaxis.

1493 IFN-c-induced Specific Oral Tolerance Induction (ISOTI) of Non-IgE-mediated Food Allergy with Late Eczematous Reactions Noh, G1; Lee, J2; Jin, H2; Noh, J3; Lee, W4; Lee, S2 Seoul Allergy Clinic, Allergy and Clinical Immunology, Seoul, Korea; 2Hanyang University, College of Human Ecology, Food and Nutrition, Seoul, Korea; 3Konkuk University, College of Animal Bioscience & Technology, Animal Biotechnology, Seoul, Korea; 4Eulji University, Food Science, Sungnam, Korea

1

Background: With the exception of avoidance, there is currently no specific therapeutic treatment for non-IgE-mediated food allergies (NFA). Interferon (IFN)-cinduced desensitization for house dust mites was successful in treating atopic dermatitis (AD). Non-IgE-mediated food allergies with late eczematous reactions for several foods as well as milk were attempted with treatment via IFN-cinduced specific oral tolerance induction (ISOTI). Method: A total of 74 subjects who had a food allergy with late eczematous reactions, negative skin prick test, and undetectable food-specific IgE levels were selected from a pool of AD patients. Thirty-two patients received ISOTI treatment, 14 received IFN-c therapy only, 13 received the offending food only, and 15 did not receive any treatment. Results: All patients treated with ISOTI achieved tolerance, whereas none of the subjects did in the other groups. Symptoms of non-IgE-mediated food allergies were measured by late eczematous reactions to challenge tests before and during treatment. Moreover, the percentage of eosinophils in blood decreased following IFN-c therapy and increased with continuous food challenges.

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Conclusions: Treatment with ISOTI is a safe and easy method for non-IgE-mediated food allergies with late eczematous reactions in AD patients. Administration of IFN-c was necessary for the induction, but not the maintenance of tolerance. Non-IgE-mediated food allergies with late eczematous reactions appear to be food allergies that occur in high-dose ranges.

1494 Severe allergic reactions to cooked green bean: the culprit protein is a lipid transfer protein Pravettoni, V1; Farioli, L2; Conti, A3; Scibilia, J2; Primavesi, L4; Piantanida, M4; Pastorello, E2 1 IRCCS Foundation Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Clinical Allergy and Immunology Unit, Milan, Italy; 2Niguarda Ca’ Granda Hospital, Allergology and Immunology Unit, Milan, Italy; 3ISPA, National Research Council, Turin, Italy; 4IRCCS Foundation Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Clinical Allergy and Immunology Unit, Milan, Italy

Background: Green bean (Phaseolus vulgaris) belongs to the Fabaceae family, which includes widely consumed species, such as bean, peanut and soybean. In literature few cases described allergic reactions upon the exposure to boiling green bean steam or ingestion. Here we describe the cases of 5 patients (4 female and 1 male, mean age 29.4) reporting documented severe adverse reactions upon the ingestion of cooked green beans. In particular, among the patients three reported Oral Allergy Syndrome + gastrointestinal involvement, one pt asthmatic attacks and one glottis oedema. All of them suffered from severe allergic symptoms to peach and four out of them experienced adverse reactions to other legumes. Methods: Fresh and cooked green beans were tested by prick + prick technique, according to EAACI recommendations. SDS-PAGE and IgE immunoblotting were performed as described by Pastorello et al. (1994) with boiled vegetable extract. This extract was prepared according to Bjo¨rksten from 15 min boiled green bean, since this legume is consumed after cooking. The N-terminal sequence was obtained by analysing the excised band by a Procise 492 protein sequencer. The immunoblotting inhibition of cooked green bean with inhouse purified peach LTP was performed by preincubating for 1h the pooled serum with 4 lg of peach LTP and then following the IgE immunoblotting protocol. Results: Prick + prick tests with raw and cooked green beans were positive for all the patients, without any significant difference. SDS-PAGE of cooked green bean revealed many protein bands, while the IgE Immunoblotting showed all the

patients reacting towards a unique IgEbinding protein at about 10 kDa. The obtained N-terminal sequence revealed the following aminoacids: Ala-Ile-Ser-X-GlyQln-Val-Thr-Ser-Ser-Leu-Ala, corresponding to an LTP. A complete inhibition of the IgE binding to this protein was obtained by preincubation with purified peach LTP, confirming IgE Immunoblotting results. Conclusion: In this study we report the cases of 5 patients with severe allergic reactions to cooked green beans and we identify a Lipid Transfer Protein as the responsible allergen, allowing to include green bean in LTP Syndrome causing foods.

1495 The clinical relevance of in vivo/in vitro tests for cereal and peanut sensitisation in grass pollen allergic patients Martens, M; Schnoor, H; Hans J, M; Poulsen, L Copenhagen University Hospital, Allergy Clinic, Copenhagen, Denmark

Background: The botanical relation between grasses and cereal grains may be important in regard to diagnosing food allergy to cereals. Our aim was to investigate the degree of cross-sensitisation to cereals and peanut in a group of grass pollen allergic subjects without clinical reactions to foods botanically related to grass. Materials and methods: 70 grass pollen allergic subjects (41 females; mean age 32 years) with no history of reactions to cereals or peanut and 20 healthy controls (13 females; 24 years) were tested by open food challenge (OFC) to 25 g of wheat, rye, barley, oat, maize, rice and peanut, skin prick test (SPT) and specific IgE both on IMMULITE (Siemens) and ImmunoCAP (Phadia) to grass and birch pollen, cereals, peanut and bromelain. Results: Five allergic subjects displayed a positive OFC with only mild, subjective symptoms and were excluded from further investigation. Of the 65 OFC-negative subjects 46% had positive SPT to one or more of the foods tested. As for specific IgE, 20% and 37% had positive results to one or more of the foods with IMMULITE and ImmunoCAP respectively. The mean SPT wheal size to cereals and peanut was 3 times smaller than to grass, and the levels of specific IgE to cereals and peanut were 20 times lower than to grass. All controls were negative in all tests. There was only partly correlation between IMMULITE and ImmunoCAP, the latter typically being more positive. The clinical non-relevant sensitisation could be

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divided into three groups with wheat, rye and barley representing the highest frequency (SPT 45%, IMMULITE 13%, ImmunoCAP 29%). In SPT and ImmunoCAP a subgroup further reacted to rice, maize or oat, whereas IMMULITE identified a subgroup of maize-sensitised individuals less dependent on other cereals. Cross-reactive carbohydrate determinants (CCD) as evidenced by reaction to bromelain could explain a minority of the measured IgE-sensitisations but not the majority, presumably being true protein cross-reactivity. Peanut reactions were independent of cereal and CCD reactions but related to birch pollen sensitisation. Conclusion: Grass pollen allergic patients with proven food tolerance may express significant sensitisation (albeit depending on the test system) to cereals and peanut, and to avoid frequent false-positive food allergy diagnoses it is important to use alternative ways of confirmation such as food challenges in routine clinical work and epidemiological studies.

1496 Occupational allergy to bell pepper pollen in greenhouses in the Netherlands, an 8-year follow-up study Patiwael, J1; De Jong, N1; Burdorf, A2; de Groot, H3; Gerth van Wijk, R1 1 Erasmus MC, section of Allergology, Rotterdam, The Netherlands; 2Erasmus MC, Department of Public Health, Rotterdam, The Netherlands; 3Reinier de Graaf Groep, Allergy Centre, Voorburg, The Netherlands

Background: Pollen from bell pepper plants cultivated in greenhouses are known to cause occupational disease. A cross-sectional study among 472 bell pepper employees in 1999 demonstrated sensitization to bell pepper pollen in 28% and work-related allergic symptoms in 54% of workers. In the current situation preliminary detection of workers at risk of developing occupational allergy in bell pepper horticulture is not yet possible. To identify employees at risk of developing sensitization and disease in this branch a follow-up study was started. Methods: Bell pepper employees who participated in a cross-sectional survey in 1999 were asked to take part in a follow-up study in 2007. Subjects that had left the job were traced and also asked to participate. Information on demographic characteristics, job characteristics and (workrelated) allergic symptoms was gathered by means of a questionnaire (on-site). Fur-

thermore, skin prick tests were performed with occupational allergens such as bell pepper pollen, Botrytis cinerea, Amblyseius cucumeris, Thyrophagus putrescentiae and with common inhalant allergens. Results: In total, 280 out of 472 employees were available for questionnaires and in 250 of these 280 employees allergy tests were performed as well. 9% of employees had developed a sensitization to bell pepper pollen. The incidence of work-related rhinitis symptoms during the 8-year followup was 19%. Atopy (odds ratio = 4.3), sensitization to one of the occupational allergens (odds ratio = 3.5) and smoking (odds ratio = 2.3) were significantly associated with the development of these rhinitis symptoms. The incidence of workrelated asthma symptoms was 8%. Again atopy (odds ratio = 2.8), sensitization to one of the occupational allergens (odds ratio = 3.6) and smoking (odds ratio = 8.6) were significant risk factors. Conclusion: Atopy, sensitization to one of the occupational allergens and smoking are risk factors for developing work-related rhinitis and asthma symptoms in bell pepper horticulture.

1497 Longitudinal validity and responsiveness of the Food Allergy Quality of Life Questionnaire — Parent Form (FAQLQ-PF) in children 0–12 years following positive and negative food challenges DunnGalvin, A1; Cullinane, C2; Flokstra-de Blok, B3; Dubois, A3; Hourihane, J2 1 Clinical Investigation Unit Cork University Hospital, Department of Paediatrics and Child Health, Clinical Investigation Unit Cork University Hosp., Cork, Ireland; 2 University College, Department of Paediatrics and Child Health, Cork, Ireland; 3University of Groningen, Department of Paediatrics, Division of Paediatric, Groningen, The Netherlands

Rationale: The incorporation of patientreported health related quality of life (HRQL) measures to more accurately assess clinical outcomes has been an important goal of evidenced based medicine. There are no published studies of longitudinal HRQL assessments of food allergic children using a disease-specific measure. This study assessed the responsiveness and longitudinal measurement properties of the Food Allergy Quality of Life Questionnaire — Parent Form (FAQLQ-PF) in a sample of children undergoing food challenge. Methods: Parents of children 0–12 years completed the FAQLQ-PF and the Food Allergy Independent Measure (FAIM),

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before the child underwent a clinically indicated food challenge, and at 2- and 6-month post food challenge. We assessed the statistical significance and relative magnitude of HRQL changes over the 3 time points for both positive and negative groups, using a repeated measures, 2 · 3 multivariate design. We evaluated longitudinal validity by computing correlation coefficients between change scores in the FAQLQ-PF and change scores on the FAIM. Reliability of the change score was computed as an intraclass correlation coefficient (ICC) of change. We determined the minimally important difference (MID) for subscales and total FAQLQ-PF scores using distributional criterion and effect size (ES) approaches. Finally, we developed a logistic regression model to profile those children who fall below the MID point. Results: A total of 82 children underwent challenge in total (42 positive; 40 negative). Domains and total score improved significantly at both time points for positive and negative groups after food challenge (all P < .05). Sensitivity was demonstrated by significant differences between positive and negative groups on all subscales and total score at 6 months [F (2.59) = 6.221, P < 0.003] and by differing improvement on relevant subscales (P < 0.05). The size of the MID was 0.45 on a 7-point response scale. The ICC of change was 0.89. Poor quality of life at baseline increases the odds by over 2.0 of no improvement in HRQL scores 6 month time point. General maternal health (OR 1.252; CI 1.245–4.626), number of foods avoided (OR 1.369; CI 1.693–4.963) and children >9 years (OR 1.173; CI 1.014–3.576) were also significant predictors. The model correctly predicted 84% of cases. Conclusion: The FAQLQ-PF is sensitive to change, and has excellent longitudinal reliability and validity in a food allergic patient population. The SEM value of 0.5 points as a threshold for meaningful change in domains of questionnaires with a 7-point response scale was confirmed in this study. These results enable the use of the FAQLQPF as a parent-administered outcome measure in clinical trials with children with food allergy from 0–12 years. In addition, we have shown that undergoing a food challenge has a significant positive impact on HRQL, irrespective of whether the challenge itself was positive or negative.

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Late Breaking Poster Abstract Session Immunodeficiency and Autoimmune Syndromes 1498 Impaired regulatory T-cell homeostasis due to Vitamin D deficiency in Undifferentiated Connective Tissue Disease 1

2

3

4

Zold, E ; Szodoray, P ; Kappelmayer, J ; Gaal, J ; Csathy, L3; Barath, S1; Gyimesi, E1; Zeher, M1; Szegedi, G1; Bodolay, E1 1 University of Debrecen Hungary, 3rd Department of Internal Medicine, Debrecen, Hungary; 2University of Oslo, Oslo, Immunobiological Laboratory, Oslo, Norway; 3University of Debrecen Hungary, Department of Clinical Biochemistry, Debrecen, Hungary; 4Kenezy Country Hospital, Department of Rheumatology, Debrecen, Hungary

Objectives: The aim of this study was to perform a quantitative and functional analysis of natural regulatory T cells (CD4+CD25highFoxp3+T cells; nTreg) and CD4+IL-17+ T cells, and to assess the plasma levels of proinflammatory cytokines in patients with UCTD before and after five weeks 0.5 lg/day vitamin D analogue (alfacalcidol) supplementation. Methods: Twenty-nine UCTD patients were enrolled in the study. Plasma levels of 25(OH)D were assessed by HPLC method. Flow cytometry was used for the quantification of nTreg and IL-17 expressing TH17 cells. The plasma concentrations of cytokines, interleukin (IL)-12, IFN-gamma, IL-23, IL-6 and IL-10 were measured by ELISA. Results: Plasma 25(OH)D levels were elevated after vitamin D analogue. Alfacalcidol treatment decreased both Th1 (IL-12 and IFN-gamma) and TH17 related (IL-23, IL6) cytokine levels in UCTD patients, while the soluble IL-10 level increased (IFNgamma:40.8 ± 13.0 pg/ml versus 20.2 ± 9.7, P < 0.001; IL-12:155.1 ± 74.2 pg/ml versus 87.0 ± 42.4 pg/ml, P < 0.001; IL23: 387 ± 82 pg/ml versus 211 ± 69 pg/ml, P < 0.001; IL-6: 40.3 ± 10.0 pg/ml versus 24.0 ± 7.2 pg/ml, P < 0.001, IL-10: 8.5 ± 3.2 pg/ml versus 20.1 ± 9.7 pg/ml, P < 0.001) Alfacalcidol improved the TH17/ nTreg imbalance, as it inhibited the IL-17 expression of TH17 cells, and increased the number of nTregs (TH17/nTreg: 0.81 ± 0.7 versus 0.25 ± 0.2, P < 0.005). The regulatory function of nTreg was similar to the healthy controls, however vitamin D analogue could increase the capacity of nTreg cells to suppress the proliferation of autologous CD4+CD25- cells. Conclusions: Our findings support the idea that the clinical application of vitamin D in patients with UCTD may influence and restore Th17/nTreg imbalance, therefore could be beneficial in the management of the disease. 570

1499 Mixed connective tissue disease (MCTD): phenotypes and immunological characteristics Hajas, A1; Szodoray, P2; Demeter, N3; Zold, E1; Dezso, B4; Csipo, I1; Tumpek, J1; Bodolay, E1 1 University of Debrecen Hungary, 3rd Department of Internal Medicine, Debrecen, Hungary; 2University of Oslo, Oslo, Immunobiological Laboratory, Oslo, Norway; 3University of Pe´cs, Department of Nuclear Medicine, Medicine Faculty, Pe´cs, Hungary; 4University of Debrecen Hungary, Department of Pathology, Debrecen, Hungary

Introduction: Mixed connective tissue disease (MCTD) is an inflammatory autoimmune disorder. Anti-U1RNP has a pathogenic role in the disease process. However, other antibodies, such as antiCCP and anti-endothelial cell antibodies (AECA) can have an effect on the phenotypes of MCTD as well. Patients with MCTD have been classified into three subgroups based on their clinical symptoms and different patomechanisms. Patients and methods: The studied population consists of 184 MCTD patients, who were regularly followed-up. The mean age of the 184 MCTD patients was 51.2 ± 9.5 years, while the disease duration was 13.8 ± 10.9 years. Anti-U1RNP, anti-CCP, and AECA were determined by ELISA. Von Willebrand Factor Antigen (vWFAg) was investigated by using immunoturbidimetrical method, while thrombomodulin measurements were carried out by ELISA. Results: In Group I (54 patients) the patients with MCTD had vascular complications, including pulmonary arterial hypertension (PAH), Raynaud’s phenomenon, sclerodactyly; in Group II (93 patients) interstitial lung disease and myositis were the dominant symptoms, while in Group III (37 patients) erosive arthritis occurred more frequently compared to the other groups. All patients’ sera contained high levels of anti-U1RNP. In Group I, AECA and the endothelial cell markers, TM and vWFAg were significantly elevated compared to Groups II and III (P < 0.001). In Group II via immune complex-driven mechanism, interstitial lung disease and myositis occurred more frequently. In Group III, anti-CCP autoantibodies showed a high association with erosive, destructive arthritis. Discussion: Patients with MCTD have been subcategorized based on their clinical and serological properties. Our findings suggest that anti-U1RNP and other autoantibodies, namely anti-CCP and AECA have the abil-

ity to alter the clinical phenotypes of MCTD. 1500 Simple urticaria as the initial manifestation of SLE: Why The(y) Wait ? Kutlu, A1; Ozturk, S2; Onem, Y3; Nalbant, S3; Kiralp, M4; Taskapan, O2 1 Gu¨lhane Military Medical Academy Haydarpa·a Training Hospital, Allergy Department, Gu¨lhane Military Medical Academy Haydarpa·a Traini, Istanbul, Turkey; 2 Gu¨lhane Military Medical Academy Haydarpa·a Training Hospital, Allergy Department, Istanbul, Turkey; 3 Gu¨lhane Military Medical Academy Haydarpa·a Training Hospital, Internal Medicine Department, Istanbul, Turkey; 4Gu¨lhane Military Medical Academy Haydarpa·a Training Hospital, Department of Physical Medicine, Istanbul, Turkey

A 36-year-old woman was seen for recurrent attacks of widespread urticaria (lasting 4–6 h without angioedema) for the last 1 month. Past medical history was unremarkable but thalassemia minor. Laboratory evaluations including complete blood count, liver/renal function tests, erythrocyte sedimentation rate, thyroid function tests, antinuclear antibody (ANA) and hepatitis markers were normal other than hypochromic microcytic anemia. She was given antihistaminics and the episodes partially improved. After 1 month of treatment, she started to suffer several angioedema attacks on the lips for which corticosteroid therapy was commenced. Thereafter, she started to experience fever, generalized arthralgias and arthritis in the ankle and the small joints of the hands along with exacerbated attacks of urticaria and angioedema. Laboratory tests revealed leukopenia, decreased hematocrit, negative ANA and rheumatoid factor; decreased C3 and increased C-reactive protein levels. Repeat laboratory evaluations 10 days after her persistent arthritic findings were as follows; C3: 0.7 g/l (0.79–1.52), C4: 0.13 g/l (0.16–0.38), rheumatoid factor: 55.2 IU/ml (0–20), ANA: positive, antidsDNA: positive, erythrocyte sedimentation rate: 27 mm/h. Eventually, the patient was diagnosed to have also systemic lupus erythematosus (SLE). Chronic urticaria and/or angioedema may ensue as one of the manifestations of a systemic disease including SLE, Sjogren syndrome and rheumatoid arthritis. In the relevant literature, a few cases have been described where urticarial vasculitis precede the diagnosis of SLE. Further, systemic symptoms like arthralgia, myalgia, abdominal or chest pain may accompany. In our patient, systemic findings and positive serology

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could only be detected during the follow up. Besides, the skin lesions were considered to be inconsistent with the aforementioned vasculitic features. Accordingly, presenting this interesting patient of ours, we call attention of physicians towards the fact that simple urticaria may also be an initial manifestation of SLE. Last but not least, despite the absence of specific serologic markers in the beginning of the disease course, care and vigilance should remain as the prerequisite during the follow up of such patients with regard to the possible emergence of connective tissue diseases.

1501 The effectiveness of antihistamines in up to four-times conventional doses on urticarial discomfort and quality of life in difficult-to-treat urticaria Church, D1; Baiardini, I2; Staevska, M3; Popov, T3; Kralimarkova, T3; Dimitrov, V3; Church, M4 1 University of Southampton, Allergy and Inflammation Research, Mail point 825, Southampton General Hospital, SO16 6YD, Southampton, United Kingdom; 2 University of Genoa, Allergy and Respiratory Diseases, Genoa, Italy; 3Medical University of Sofia, Clinical Centre of Allergology, Sofia, Bulgaria; 4Charite´Universita¨tsmedizin Berlin, Allergy and Dermatology, Berlin, Germany

Background: Increasing doses of non-sedating H1-antihistamines up to four-fold has been proposed for treatment of chronic urticaria patients unresponsive to standard doses. This study explored the effect of incremental doses of levocetirizine and desloratadine on patients’ perception of discomfort due to their urticarial symptoms (discomfort) and quality of life (QoL). Methods: In this double-blind study, 80 chronic urticaria patients were randomized to receive 5 mg of levocetirizine or desloratadine daily for one week. Patients without urticarial lesions and pruritus for the last 3 days of treatment were considered ‘symptom free’ and left the trial. Unresponsive patients received 10 and then 20 mg of drug daily during the second and third week respectively. Discomfort was assessed using a 100 mm visual analogue scale (VAS) and QoL with the specific CUQ2oL questionnaire. Results: Analysis of discomfort scores showed that patients may be divided into 3 groups: low-dose responders, the ~10% of patients in whom 5 mg of either drug caused >90% improvement; non-responders, the ~15% of patients with 50% discomfort improvement

were 52%, 65% and 74% with 5, 10 and 20 mg levocetirizine and 41%, 56% and 63% on similar doses of desloratadine. QoL improvement, which was significantly (P < 0.004) correlated with improvement of discomfort, showed similar results: ~10% low-dose responders with QoL improvement of >90% with 5 mg of either drug; ~15% of non-responders with 50% improvement in QoL of were 59%, 74% and 81% with 5, 10 and 20 mg levocetirizine and 24%, 45% and 55% on similar doses of desloratadine. Levocetirizine was significantly more effective than desloratadine in improving discomfort (P < 0.003) and QoL (P < 0.013) (Mann-Whitney Test). Conclusions: Increasing antihistamine doses up to four-fold is of benefit in relieving symptoms in ~75% of patients. However, ~10% of patients (low-dose responders) respond well to conventional doses of antihistamines while ~15% (non-responders) fail to improve even on high doses and probably need a different therapeutic approach.

1502 Recombinant C1 inhibitor for Acute Attacks of Hereditary Angioedema Reshef, A1; Leibovich, I2 1 Sheba Medical Center, Allergy & Immunology, TelHashomer, Israel; 2Sheba Medical Center, Angioedema Center, Tel Hashomer, Israel

Background: Hereditary angioedema (HAE) is a rare genetic disease, manifested by recurrent attacks of tissue swelling that cause severe dysfunction and may become fatal. A typical attack may last 24–72 h if left untreated. We present our recent experience with recombinant C1 inhibitor (rC1INH) extracted and purified from transgenic rabbit milk, for the treatment of acute attacks of HAE. Methods: We administered rC1INH (350– 1050 mg) intravenously to 8 adult HAE patients (age 16–54), on 20 separate occasions. Infusions were given within 4–5 h of the onset of an acute attack (peripheral, facial, abdominal or laryngeal). Visual analog-scale (VAS) of 0–100 mm was used to record and assess the intensity of each key symptom (i.e. edema, pain, nausea, discomfort). Symptom severity was recorded by the patients at predetermined time points, until symptoms fully resolved, or at least 48 h after every treatment. Laboratory data was collected during the attack, after 24 h, and 22 and 90-days post-treatment. It included antigenic and functional

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C1INH, C4, C1q, human and recombinant C1INH-specific antibodies, and anti-rabbit milk antibodies. Results: Acute attacks included 11 abdominal, 4 peripheral (hands, feet), 3 facial, 1 laryngeal and one mixed (abdomen/ feet). Mean symptom score (MSS) for edema or pain upon admission was 78.19 ± 15.2 mm (Range: 58–100), which increased to 86.24 ± 11.3 (Range: 65–100) when treatment was commenced. Mean reduction of 50% from maximal MSS was obtained within less than 2 h in 12 attacks. MSS was: 22.2 ± 24.2, 17.4 ± 25.1 and 5.7 ± 11.7 at 4 h, 8 h and 24 h, respectively. One patient had a second breakthrough attack. Plasma levels of C1INH increased within 15 min and were maintained up to 4 h. No increase in rC1INHspecific antibodies was observed up to 90days post-treatment. No significant early or late adverse reactions were observed, and no additional rescue medications were required during rC1INH treatments. Repeated infusions (up to 5 times in a single patient) were not associated with hyper-sensitivity reactions or tolerance. Conclusion: The present study supports the use of rC1INH for the treatment of acute HAE exacerbations involving various locations. We found it effective, safe and well tolerated.

1503 Plasma kallikrein activation in patients with hereditary angioedema due to C1 inhibitor deficiency Zanichelli, A; Maggioni, L; Cicardi, M University of Milan, Department of Medical Sciences, Milan, Italy

Background: Hereditary angioedema (HAE) is a rare genetic disorder due to C1 inhibitor (C1-INH) deficiency. It is characterized by recurrent attacks of edema affecting skin, gastrointestinal tract, and larynx. C1-INH has a broad spectrum of activities inhibiting complement, contact, coagulation and fibrinolytic systems. During HAE attacks unregulated active kallikrein cleaves highmolecular weight kininogen releasing bradykinin, the mediator of angioedema. The frequency of attacks is variable among HAE patients and in the same individual during life. This study is aimed to identify biochemical markers that could distinguish patients with a high frequency of attacks from those with sporadic symptoms. Such markers could be relevant to predict disease severity thus defining the need for prophylactic treatment. Methods: We measured complement parameters, plasma kallikrein inhibiting activity and plasma kallikrein spontaneous activity, in 47 HAE patients, 20 with high

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frequency of angioedema attacks (>12 attacks/year) and 27 with low frequency (12 attacks per year compared to those with A), possibly causing a new acceptorsplicing site before Exon 8, coding for the intracellular part of the IL7RA chain. FACS analysis showed no expression of IL7 receptor alpha-chain on the patient’s PBMCs. The patient received HSCT at age 24 months, developed mild GvHD at the skin and could be discharged at age 26 months. Although our patient had almost absent T-cell functions clinical symptoms occurred relatively late compared to previously published patients. In summary, IL7 receptor deficiency can present as delayed onset (T-B+NK+) (S)CID.

1508 Sjogren syndrome and yeast allergy 1507 Delayed onset of (T-B+NK+) (Severe) Combined Immunodeficiency (S) CID: Complete IL7 receptor deficiency in a 22-month year-old girl Rossberg, S1; von Bernuth, H1; Susanne, L1; Schwarz, K2; Ebell, W3; Wahn, V1 1 University Hospital Charite´ Berlin, Department of Pediatric Pneumology and Immunology, Berlin, Germany; 2 University of Ulm, Institute for Transfusion Medicine, Ulm, Germany; 3University Hospital Charite´ Berlin, Department of General Pediatrics, Berlin, Germany

IL7 receptor deficiency prevents early and late T cell differentiation and usually presents as classical (T-B+NK+) (S) CID within the first 6 months of life. All known IL7R-deficient patients received HSCT within the first year of life. We here present a girl with delayed manifestation. The patient was born to non-consanguineous German parents. First pneumonia, papularpustulous rash and failure to thrive developed at 8 months of age. Pneumonic chronic infiltration was diagnosed at 1 year of age nonresponsive to oral antibiotic treatments. On admission at age 22 months the girl’s body weight was above the 25th, HC at 50th and length under 3rd centile. She had a tachypnoe at 80/min. CBC revealed normal leukocytes with lymphopenia at 500/ll. X-Ray and ultrasound showed

Corrocher, G1; Martinelli, N2; Di Lorenzo, G3; Biasi, D2; Bambara, L2; Caramaschi, P2; Pacor, M2 1 University of Verona, Dipartimento di Scienze Morfologico-Biomediche Sez, Verona, Italy; 2University of Verona, Department of Clinical and Experimental Medicine, Verona, Italy; 3University of Palermo, Dipartimento di Medicina Clinica e delle Patologie, Palermo, Italy

Background: Allergic disorders have been described in a variety of connective tissue disorders. Although an association between allergy and primary Sjogren’s syndrome has been suggested, it has not been well documented. Methods: The purpose of this study was to analyze the prevalence of several yeast allergy in a cohort of 44 patients with primary Sjogren’s syndrome. The presence of an allergic disorder was evaluated by diet yeast free, challenge test with yeast, Skin Prick test and RAST test. Results: Fourteen patients (31.8%) with primary Sjogren’s syndrome presented also yeast allergy. All the 44 patients performed a trial with yeast free diet, but only the above mentioned subgroup of patients with documented yeast allergy had a symptom’s improvement after diet. Conclusions: Further studies are needed to evaluate the role of yeast allergy in patients with Sjogren’s syndrome.

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1509 The role of TGF-beta1 at the pathogenesis of Rheumatoid Arthritis Yatsyshyn, R; Neyko, Y; Yatsyshyn, N Medical University, Internal Medicine, Ivano-Frankivsk, Ukraine

Background: The role of TGF-beta1 in Rheumatiod Arthritis is considered protective, whereas that of IL-6 both protective and pro-inflammatory. Among a variety of actions, TGF-beta1 antagonizes the action of IL-1beta, inhibits the expression of collagenase-1 and stimulates the production of the metalloprotease inhibitor-1 (TIMP-1). IL-6, alone or in combination with its soluble receptor induces the TIMP-1 expression in human synoviocytes and chondrocytes and blocks IL-1-induced collagenolytic activity, but also it stimulates bone resorption and the production of MMP-13 by rat fibroblasts. Objectives: The purpose of our study was to investigate the role of TGF-beta1 and IL-6 in the human synovial fibroblasts and chondrocytes at the Rheumatiod Arthritis, since definitive data about these cells are not available. Methods: Fibroblasts were isolated from synovial membrane and articular cartilage obtained from 15 patients with Rheumatoid Arthritis undergoing joint arthroplasty. All experiments were performed with cells of 3rd to 5th passages. The IL-6 levels in cell culture conditioned media were determined by ELISA. Results: Fibroblasts were cultured in serum-free DMEM for 48 h in the presence or absence of TGF-beta1 (1 ng/ml). In the presence of TGF-beta1, the IL-6 levels in conditioned medium significantly increased, (2.5–4.5 times) and (3.5–5.0 times) for fibroblasts, respectively. The observed increase was dose (0.01–1 ng/ml) and time (12– 48 h) dependent. RT-PCR indicated that fibroblasts up-regulated IL-6 mRNA in response to TGF-beta1 (0.01–1.0 ng/ml) in a concentration-dependent manner. Using specific protein kinases inhibitors (H-89 and calphostin C against protein kinase A, tyrosin kinase and protein kinase C, respectively), it was found that only calphostin C significantly suppressed the TGF-beta1-induced IL-6 expression. When fibroblasts were incubated with 1 ng/ml TGF-beta1 for 24 or 48 h in the presence of indomethacin (1 mg/ml), a decrease of IL-6 concentration (21%) was observed. Conclusion: It was demonstrated that TGF-beta1 significantly enhances the production of IL-6 by human synovial fibroblasts. The IL-6 induction by TGF-beta1 is carried out by protein kinase C-dependent pathway. Therefore, the role of TGF-beta1 should not be considered purely protective

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since, under different circumstances, it may promote inflammatory or anti-inflammatory activities, via induction of IL-6. 1510 Potential role of interleukin-1 beta in the stimulation of nitric oxide production in patients with systemic sclerosis Yatsyshyn, R; Neyko, Y; Yatsyshyn, N Medical University, Internal Medicine, Ivano-Frankivsk, Ukraine

Backgrounds: One of the earliest and frequent features of system scleroderma are the disturbance of microcirculation. This pathology is represented as reaction of endotelium to the system autoimmune process. Nitric oxide (NO) is an important mediator of immune and inflammatory responses. The deficit of nitric oxide plays important role in the mechanism of vasoconstriction. We have put before ourselves the purpose to learn its value in originating and development of a lesion of internal organs in scleroderma. Objective: In this study, we have examined whether peripheral blood mononuclear cells from patients with systemic sclerosis (SSc) produce higher levels of NO spontaneously or in response to several stimulations in vitro. Methods: The production of NO by peripheral blood mononuclear cells was studied at the 25 patients with SSc and 10 normal donors. Release of NO after stimulation with interleukin-1 beta (IL-1beta), tumor necrosis factor alpha (TNF-alpha) and interferon gamma (IFN-gamma) was determined by ELISA. Results: Peripheral blood mononuclear cells from SSc patients exhibited a higher level of spontaneous release of NO than those from control subjects. Incubation of peripheral blood mononuclear cells for 24 h with stimulants caused an increase in NO production both in normal subjects and SSc patients. Stimulation with IL-1 beta induced a significantly increased NO production in SSc patients compared with normal subjects. Incubation with other stimulants showed no significant differences in NO production between SSc patients and normal subjects. Conclusion: These results suggest the abnormal regulation of NO production in peripheral blood mononuclear cells of SSc patients in response to IL-1 beta, which might contribute to the fibrotic process in SSc.

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1511 Up-regulation of CCL2 production in Chronic Idiopathic Urticaria patients

1512 Urticaria due intradermal test with articaine hydrochloride

Santos, J; Azor, M; Lourenc¸o, F; Futata, E; Damante, I; Prearo, E; Rivitti, E; Duarte, A; Sato, M University of Sao Paulo, Dermatology, Sa˜o Paulo, Brazil

Sa´nchez-Morillas, L; Da´vila Ferna´ndez, G; Rojas Perez-Ezquerra, P; Laguna Martinez, J; Santos, A; Gomez-Tembleque Ubeda, P; Blanco Moratiel, H Hospital Central de la Cruz Roja, Allergology Department, Madrid, Spain

Background: Chronic Idiopathic Urticaria (CIU) is characterized by the recurrence of transient and itching maculopapular skin lesions for more than six weeks. Approximately one third of patients with CIU have circulating autoantibodies against FceRI on basophils and mast cells, though 70–80% of patients with CIU remains unknown. Basophils and mast cells produce factors, like chemokines, that are very important to attract others cells to the lesions contributing to the disease severity. To investigate the pattern of chemokines in patients serum and peripheral blood mononuclear cell (PBMC) stimulated by mitogens. Methods: A total of 34 UCI patients (mean age 48.68 ± 11.79) were selected from the Dermatological Outpatient Clinic of the Hospital das Clinicas de Sao Paulo and 38 healthy donors (mean age 40.28 ± 9.83). PBMC were stimulated by phytohemagglutinin (PHA) or an endotoxin Staphylococcus aureus (SEA) for 24 h. Chemokines were analyzed by cytometric bead array or ELISA. Results: A significant increase of CXCL8/ IL-8, CXCL10/IP-10, CXCL9/MIG and CCL2/MCP-1 serum levels in UCI patients when compared with the control group. No difference was observed in CCL5/RANTES serum levels. Baseline chemokine production by PBMC a significant increase in CCL2 levels by UCI patients revealed. In addition, they also demonstrated increased CXCL8 and CCL5 levels upon PHA stimulation and CCL2 and CXCL8 production after stimulation by SEA compared to control group. The results showed an altered CCL2 and CXCL8 production, suggesting a role of these chemokines in T and mast cells responses. Since CXCL8 induces T cell chemotaxis, suppresses IL-4 and up-regulates CXCL8 production by CD4+ T cells and CCL2 recruits monocytes, memory T cells, and dendritic cells to sites of tissue injury, and importantly causes the degranulation of basophils and mast cells. Conclusion: The findings indicated that an altered chemokines production can influence T cell response and basophils and mast cells activation. More investigations regarding chemokines receptors expression will be important to analyse the participation of chemokines in the disease immunopathogenesis. Financial support: FAPESP and HC/ FMUSP

Background: Articaine hydrochloride belongs to the class of amide local anesthetics. Although adverse reactions to local anesthetics are frequent, allergy reactions are uncommon. Case report: A 26-year-old woman, with no history of atopy or allergy, was treated with a subcutaneous injection of Ultracain (articaine 4 mg and ephinefrine 0.005 mg) for a dental surgery. She developed 20 min after the injection, pruritus, generalized urticaria and dysphagia. Material and method: Prick test with latex and prick and intradermal tests with lidocaine 2%, mepivacaine 1%, bupivacaine 1% and articaine 4% were made. The patient was patch tested, as well, with lidocaine 2%, mepivacaine 1%, bupivacaine 1% and articaine 4% in saline solution. We performed single-blind subcutaneous challenges with lidocaine, mepivacaine, bupivacaine and ephinefrine. Results: Prick and intradermal tests with lidocaine, mepivacaine and bupivacaine and prick test with articaine and latex were negative. Intradermal test 1/10 dilution with articaine 4% was positive. Twenty minutes after the intradermal test, the patient developed urticarial lesions in chest and face. Patch tests with lidocaine, mepivacaine, bupivacaine and articaine in saline solution were negative. Single-blind subcutaneous challenges tests with lidocaine, mepivacaine, bupivacaine and ephinefrine were performed with negative result. Discussion: We report an Ig E-mediated reaction to articaine confirmed by a positive intradermal test. The patient developed a generalized urticaria after the skin test. She tolerated other amide local anesthetics.

1513 Prevalence of hypersensitivity reactions to nonsteroidal anti-inflamatory drugs in 212 patients with mastocytosis in Spain Sa´nchez-Matas, I1; Matito-Bernechea, A2; Gonzalez de Olano, D3; A´lvarez-Twose, I2; Sa´nchez-Mun˜oz, L2; de la Hoz Caballer, B4; Escribano, L2 1 Hospital Virgen del Valle, Mast Cell Unit, Ctra. Cobisa s/n, Toledo, Spain; 2Hospital Virgen del Valle, Mast Cell Unit, Toledo, Spain; 3Hospital de Fuenlabrada, Allergy Department, Madrid, Spain; 4Hospital Ramo´n y Cajal, Allergy Department, Madrid, Spain

Background: The frequency of adverse reactions to nonsteroidal antiinflamatory drugs (NSAIDs) in patients with mastocytosis is estimated as higher than in general

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Late Breaking Poster Abstract Sessions – Immunodeficiency and Autoimmune Syndromes

population, but there are not epidemiological studies to support this statement. A prospective study was carried out to establish the prevalence of adverse reactions to NSAIDs in patients with mastocytosis, and to characterize the clinical presentation of these adverse reactions. Methods: A total of 212 patients (116 adults/96 children) with mastocytosis were included. Adverse reactions to NSAIDs were recorded by a questionnaire, requesting for the kind of clinical manifestation and the responsible drug. Hypersensitivity was established through a detailed history of recurrent reactions to NSAIDs or an oral provocation test. Results: The overall frequency of reactions was of 14% in adults (17 patients, 5 of them presented two or more reactions). NSAIDs responsible in adults were ASA (n = 7), consecutively followed by pyrazolone (n = 6), diclofenac (n = 4), ibuprofen (n = 4) and naproxen (n = 2). Clinical manifestations were mainly anaphylaxis (48%, n = 11), followed by urticaria (31%, n = 7), asthma (13%, n = 3), flushing (4%, n = 1) and angioedema (4%, n = 1). In children, only 2 patients (2%) have an adverse event (urticaria) after taking NSAIDs, being responsible of them ibuprofen and metamizol. All our children tolerate paracetamol and 50% of them had taken ibuprofen without presenting reaction. Conclusion: In Spain the frequency of adverse reactions to NSAIDs is higher in adults with mastocytosis than in the general population. This event could be related to a non-specific activation of mast cells in patients with mastocytosis, although further studies are needed. Paracetamol is a safe alternative choice in those patients. These results can be useful to counsel patients, parents and physicians. 1514 Evolution of mast cells-mediator related symptoms in pregnant women with mastocytosis: a retrospective study in 23 pregnancies by the Spanish Network on Mastocytosis (REMA) Matito, A1; Sa´nchez-Matas, I1; Villasevil, E2; A´lvarez-Twose, I1; Sa´nchez-Munoz, L1; Gonza´lez de Olano, D3; Escribano, L1 1 Hospital Virgen del Valle, Mast Cell Unit, Red Espan˜ola de Mastocitosis, Toledo, Spain; 2Hospital Carlos III, Unidad de Calidad, Madrid, Spain; 3Hospital de Fuenlabrada, Allergy Department, Madrid, Spain

Background: Mastocytosis consists of a group of disorders characterized by a pathologic increase in mast cells (MC) in tissues with symptoms due to the sporadic or continuous MC-mediator release. Actually there is little information on how pregnancy might affect to patients with masto-

cytosis, the evolution of symptoms and the advisable treatment at that period. Method: We retrospectively reviewed our patient database (REMA) searching for women who had conceived after developing mastocytosis. A total of 15 women were included, 12 with indolent systemic mastocytosis and 3 with cutaneous mastocytosis. A specific questionnaire on MCmediator related symptoms and therapies received before, during, intrapartum and after pregnancy was filled by the physicians of the REMA during the patient’s visit. After giving informed consent, additional medical records about labour management and anaesthetic technique were received when available from hospitals where women delivered. Results: A total of 15 pregnant women, with 23 pregnancies and deliveries, were analyzed. Median age at delivery was of 32.3 ± 3.11 years. Time from the disease onset to delivery was of 12.09 ± 8.12 years. There was not change of severity of symptoms in 56.6% of pregnancies (13/23), increase and decrease were experienced in 21.7% (5/23) respectively. Pruritus worsened in 17.4% (4/23) and improved in 13% (3/23). Anti-mediator therapy was not used in 78.3% (18/23), 91.3% (21/23), 78.3% of women before, during and after pregnancy, respectively. The 9 pregnancies (39.1%) referred to REMA received ferrous sulphate in all cases, and dexchlorpheniramine when necessary in 8.7% (2/23). A total of 69.6% (16/23) vaginal deliveries and 30.4% (7/23) caesarean deliveries were carried out. Anti-mediator therapy previous to labour was used in 21.7% (5/23). Epidural and general anaesthesia was used in 87% (20/23) and 4.3% (1/23) respectively. The frequency of MC-mediator related symptoms intrapartum was 13% (2/23: generalized erythema and tachycardia, 1/23: pruritus). Conclusion: Non-aggressive categories of mastocytosis are not a contraindication for pregnancy, although the evolution of MCmediator related symptoms is variable in each pregnant woman. Epidural anaesthesia is a safe option in delivery management.

1515 Angioedema after ingestion of rifampicin Go´mez Gala´n, C; Ferre Ybarz, L; Torredemer Palau, A; Nevot Falco´, S Hospital Sant Joan de De´u, Althaia Manresa, Allergy Section, Pediatric Department, Manresa, Spain

Background: Rifampicin is a semisynthetic derivative of rifamycin, a complex macrocyclic antibiotic that inhibits ribonucleic acid synthesis in a broad range of microbial pathogens. It has bactericidal action and a potent sterilizing effect against tuber-

 2009 The Authors Journal Compilation  2009 Blackwell Publishing Ltd Allergy 64 (Suppl. 90): 551–598

cle bacilli in both cellular and extracellular locations. Since resistance readily develops, rifampicin must always be administered in combination with other effective antimycobacterial agents. Rifampicin is well tolerated by most patients at currently recommended doses, although gastrointestinal tolerance can be unacceptably severe. Other adverse effects (skin rashes, fever, influenza-like syndrome and thrombocytopenia) are more likely to occur with intermittent administration. Rifampicin rarely elicits immediate hypersensitivity symptoms. Material: We report the case of a 54-yearold woman, without any previously reaction with drugs. She was referred to allergy section describing angioedema after ingestion of isoniazid and rimpampicin treatment (chemoprofilaxis was offered to PPD+). On the 5th day, she developed a periorbital and lips angioedema minutes after the ingestion of these drugs. She hadn’t experienced difficulty in breathing or any other symptoms. Methods: Skin prick test (SPTs) were performed according to general considerations for drug allergy diagnosis. Skin-prick test (60 mg/ml) and intradermal test (0.6 mg/ ml) were negative to isoniazid. Prick tests (60 mg/ml) were positive to rifampicin, five healthy controls were negative. Simpleblind oral challenge test with isoniazid (300 mg) was well-tolerated. Conclusions: We present the case of a patient who developed angioedema during treatment with rifampicin. The results of skin tests and symptoms referred by the patient suggest an IgE-mediated hypersensitivity mechanism although an oral challenge double-blind placebo-controlled wasn’t performed.

1516 Ultrasound gel: an unusual cause of cold urticaria Perez-Calderon, R; Gonzalo-Garijo, M; Perez-Rangel, I; Sanchez-Vega, S Infanta Cristina University Hospital, Allergology, Badajoz, Spain

Background: Ultrasonography is a diagnostic imaging technique used to visualize deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Sonographers typically use a hand-held probe (transducer) that is placed directly on and moved over the patient. A waterbased gel is used to couple the ultrasound between the transducer and patient. Objective: To describe the case of a localized contact cold urticaria due to an ultrasound gel.

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Case report: A 23-year-old woman developed pruritic erythematous and edematous papules in the area restricted to the application of an ultrasound gel for an abdominal echography due to a gall bladder colic. The reaction began after few minutes of the gel contact and disappeared within 1 h after the parenteral administration of dexchlorpheniramine and methylprednisolone. The patient documented a history of cold-induced urticaria and cholinergic urticaria treated and well controlled with daily cetirizine, but she had stopped this drug due to the colic symptoms. The patient had not been

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exposed to ultrasound gel previously, and she had not history of adverse reactions to drugs. Methods and results: The ice-cube-challenge test proved positive at 4 min. Patch tests on the back with the ultrasound gel involved in the reaction and two more from different manufacturers were negative at 30 min, 48 and 96 h. Use tests with the three gels on the abdomen induced a positive reaction with erythema, edema and pruritus. The same tests using the gels previously heated were negative. An abdominal ultrasonography was performed some

days later under treatment with antihistamines and corticosteroids and using heated gel with no reaction. Conclusions: We report a case of cold urticaria induced by an ultrasound gel demonstrated by use test, an event no previously reported in the literature. We suggest to take into account this condition if these patients need treatment, surgery or explorations associated to a drop of the body temperature.

 2009 The Authors Journal Compilation  2009 Blackwell Publishing Ltd Allergy 64 (Suppl. 90): 551–598

Late Breaking Poster Abstract Session Allergen Immunotherapy and Hymenoptena Sting Allergy 1517 Comparison of Phlp5 content in sublingual preparations for immunotherapy in allergy Fahlbusch, B; Khachaturyan, L; Agsten, J; Mankowski, D; Markert, U Friedrich-Schiller-University Jena, Department of Obstetrics, Jena, Germany

Background: The efficacy of sublingual immunotherapy has been demonstrated in numerous studies and observations. For these investigations, different preparations and protocols from different manufacturers have been used. Most of them use distinct unit systems to determine the allergen contents. Therefore, we aimed to compare the Phl5p concentration in 8 sublingual preparations (maintenance doses) available in Germany. The preparations may contain other phleum allergens, which are not Phlp5 and which have not been analyzed. Methods: Phlp5 has been analyzed by using a commercial ELISA kit (Indoor Biotechnologies, UK). Tablets for sublingual application have been solubilized in 1 ml water. A bradford assay has been performed to analyze total protein concentration in the preparations. Results: The Phlp5 concentration varied from 0.77 lg/ml up to 290 lg/ml. This was between 1.1% and almost 100% of the total protein content in the different preparations. Conclusion: The Phlp5 concentration in different sublingual preparations varies by a factor of approximately 300.

1518 Desensitization to aspart insulin Dı´az Angulo, S1; Rodrı´guez Ferna´ndez, F1; Jime´nez Go´mez, I1; Anto´n Casas, M1; Duque Go´mez, S1; Martin-Gil Granados, D1; Perdomo Gutie´rrez, G1; Pello´n Ferna´ndez, L2; Alonso Juaristi, S2 1 Valdecilla¢s Universitary Hospital, Allergy Department, Santander, Spain; 2Sierrallana¢s Hospital, Allergy Department, Torrelavega, Spain

We describe a case of delayed hypersensibility that needed desensitization. Material and methods: A 66-year-old woman was studied in our service in 2002 to evaluate a possible insulin allergy. She started to be treated with Humaplus NPH (Lilly) insulin 6 months before presenting systemical symptoms that lasted for 1 h. She was changed her treatment to Novolet NPH (Novo Nordisk), a month later she presented similar longer and more intense systemical

symptoms that lasted 24 h. Treatment with insulin was stopped and change for oral antidiabetics. Cutaneous tests to different insulins were positive. She was controlled until 2008 with oral antidiabetics, when she had to be intervened so she needed insulin in case of decompensation. Cutaneous test to different insulins were negative. We decided to make her desensitization to aspart insulin. It was done under supervision in a setting equipped to manage allergic reactions and shock. She was administered each subcutaneous dose every 15 min using the next procedure: DOSE CONCENTRATION uu/ml VOLUME cc UNITS 1 0,01 0,1 0,001 2 0,01 0,5 0,005 3 0,1 0,1 0,01 4 0,1 0,5 0,05 5 1 0,1 0,1 6 1 0,2 0,2 7 1 0,5 0,5 8 10 0,1 1 9 10 0,2 2 10 10 0,4 4 11 10 0,8 8 12 100 0,1 10 TOTAL 26 Result: It took 3 h to make the desensitization. The patient was supervised 1 h more after it finished. She presented pruriginous rash in her right leg and a hipoglucemiant episode that needed treatment. The desensitization didn’t have to be stopped. Discussion: We describe a case of systemic allergic reaction to insulin. Diagnosis was based on clinical history and cutaneous tests that showed an immediate-type IgEmediated hipersensibility. Insulin was indispensable despite a previous allergic reaction 6 years before with positive cutaneous test. Skin test was negative this time probably because of such long time without having used this treatment. We made her a subcutaneous desensitization that was finished successfully, the patient got on well with therapeutical insulin doses and she still maintains treatment with aspart insulin everyday without any problems. 1519 Efficacy and safety of sublingual specific immunotherapy in children Verini, M1; Cingolani, A2; Rapino, D2; Consilvio, N2; Spaguolo, C2; Di Pillo, S2; Chiarelli, F3 1 University of Chieti, Paediatric Clinic, Clinical Hospital Colle dell’Ara, Chieti, Italy; 2Allergological Paediatric Service, Paediatric Clinic, University of Chieti, Italy; 3Paediatric Clinic, Clinical Hospital, University of Chieti, Italy

Background: Specific Immunotherapy is the only therapy able to influence the natural history of allergic diseases, particularly of asthma. The introduction of Sublingual route (SLIT) has increased the use even in children less than 5 years of age. The aim of our study is to evaluate the clinical efficacy and safety of SLIT in relation to age and the

 2009 The Authors Journal Compilation  2009 Blackwell Publishing Ltd Allergy 64 (Suppl. 90): 551–598

used allergen in 292 children (205 Male, 87Female; mean age 8.08 ± 3.13 years), affected by allergic bronchial asthma and/or rhinoconjunctivitis, that have received SLIT for a mean time of 2.68 years. Method: The efficacy was evaluated by a Score in reference to reduction of clinical symptoms: 0.05). There was no severe or near fatal side effect including severe bronchospasm or hypotension in all study subjects. Among 20 of 65 patients (30.8%) with AD who showed SR, 16 patients (80%) showed urticaria, angioedema, or pruritic skin rash and 4 patients (20%) showed mild bronchospasm. SR was developed within 5 h after administration of maximal allergen dose in 19 of 20 patients (95%) with AD. Conclusion: Accelerated schedules of allergen-immunotherapy could be a safe and useful tool in the treatment of AD.

1523 Clinical efficacy of accelerated schedules of allergen-immunotherapy in the treatment of severe atopic dermatitis Nahm, D1; Lee, H1; Sung, J1; Lee, J1; Choi, G1; Park, H1; Park, H1; Jeon, S2 1 Ajou University Hospital, Department of Allergy and Rheumatology, Suwon, Korea; 2Yonsei-Ajou Clinic, Department of Pediatrics, Gwang-Ju, Korea

Background: Clinical usefulness of allergen-immunotherapy in the treatment of 578

 2009 The Authors Journal Compilation  2009 Blackwell Publishing Ltd Allergy 64 (Suppl. 90): 551–598

Late Breaking Poster Abstract Sessions – Allergen Immunotherapy and Hymenoptena Sting Allergy

atopic dermatitis (AD) has been demonstrated. To improve convenience and clinical efficacy of allergen-immunotherapy in the treatment of AD, we analyzed the clinical efficacy of two kinds of accelerated schedules of allergen-immunotherapy in this study. Methods: Patients with severe AD (SCORAD value ‡40) and hypersensitivity to house dust mites (HDM) were studied. Patients were treated by subcutaneous injections of HDM extracts (Allergopharma, Germany) using either ultra-rush protocol (1-day) or cluster protocol (6-weeks) for initial build-up phase of allergen-immunotherapy in a prospective controlled study design. Histamine-immunoglobulin complex combined with HDM extracts was subcutaneous administered at 2-weeks interval during maintenance phase of allergenimmunotherapy. Clinical severity of AD was assessed using SCORAD index in 20 patients treated by ultra-rush protocol and in 41 patients treated by cluster protocol at baseline, 3 months and 6 months. Results: The mean percentage decrease in SCORAD values as compared with baseline was 49.6% ± 26.1% (S.D.) and 69.7% ± 12.3% at 3 months and 6 months in patients treated by ultra-rush protocol, and 43.6% ± 24.8% and 59.6% ± 20.6% at 3 months and 6 months in patients treated by cluster protocol (P < 0.05 at 6 months). A decrease of SCORAD value ‡50% compared with baseline was observed in 19 of 20 patients (95%) treated by ultra-rush protocol and 29 of 41 patients (71%) treated by cluster protocol after 6 months of allergenimmunotherapy (P < 0.05). Conclusion: Application of accelerated schedules can improve a clinical efficacy of allergen-immunotherapy in the treatment of AD.

1524 Immunotherapy with inhalant allergens in a cluster protocol Ca´rdenas, R; Beitia, J; Vega, A; Alonso, A H.U.Guadalajara, Allergy, Guadalajara, Spain

Background: The aim of this study was to evaluate the safety and tolerance of a cluster schedule of immunotherapy with depot extracts of inhalant allergens in an Immunotherapy Unit. Method: We have performed a retrospective observational study. Allergic patients with rhinoconjunctivitis and/or asthma diagnosis were included. A cluster immunotherapy protocol with 4 · 2 schedule (two doses per day with 30 min interval between doses) along four weeks to reach maintenance dose. All doses were administered in Immunotherapy Unit of our hospital.

Results: We evaluated 151 patients. 147 achieved maintenance dose. 4 patients abandoned the regimen due to different causes (2.64%). We administered 1175 doses of different depot extracts: 129 pollens (87%), 9 house dust mites (6.12%), 4 Alternaria (2.72%) and 5 danders (3.40%). Four patients had immediate local reaction (2.72%). It was 0.85% of all administered doses. Seven patients had some adverse reaction: in 3 cases it was unlikely relationship with immunotherapy and four patients suffered systemic reactions with a range of 30 min–2 h after the end dose (2.72% of patients and 0.34% of doses). Conclusion: Immunotherapy schedule 4 · 2 can considered a safe treatment, with an equal or even lower rate of reaction than conventional immunotherapy. No patient suffered an immediately systemic reaction.

1525 Anaphylactic sting reactions to Dolichovespula media (Retzius 1783) Kroth, J1; Mauss, V2; Przybilla, B1; Rueff, F1 1 Ludwig Maximilian University, Department of Dermatology and Allergology, Munich, Germany; 2 Centre for Wasp Sciences, Research, Consulting, Conservation, Michelfeld, Germany

Background: In Germany among vespid species especially Vespula vulgaris and Vespula germanica are known to cause anaphylactic sting reactions. At present it is thought that anaphylactic sting reactions caused by Dolichovespula wasps may be neglected. Methods: Sting challenges with living V. vulgaris or V. germanica were done in patients during maintenance therapy with vespid venom to monitor the treatment efficacy. The insects were entomologically assessed afterwards in order to exclude possible identification errors. Results: Between 2006 and 2008 among 366 classified wasps 13 insects were Dolichovespula media and 1 Dolichovespula saxonica. 2 out of 13 patients that were tested with Dolichovespula media developed a moderate anaphylactic reaction after sting challenge. A 41-year-old male patient (patient A) with indolent systemic mastocytosis and a 50-year-old female patient (patient B) with elevated basal serum tryptase (17.3 lg/l) without cutaneous mastocytosis were affected. Both patients had a medical history of asthma bronchiale and were treated adequately. After several anaphylactic reactions during maintenance therapy patient A was increased to a venom dose of 200 lg after premedication with omalizumab. Later treatment as well as sting challenge were conducted after discontinuation of omalizumab. Patient B received a venom dose of 100 lg as main-

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tenance dose and developed only subjective reactions during initiation treatment. Conclusion: Established preparations for treatment and diagnosis of wasp allergy contain venoms of Vespula species. Anaphylactic reactions upon sting challenge demonstrate that also Dolichovespula spp. can be the elicitor of anaphylactic sting reactions. To what extent this is the case is unknown because of lacking diagnostic possibilities. Obviously, available extracts do not protect against allergic reactions due to Dolichovespula stings.

1526 Acetylsalicylic acid (ASA) desensitization before coronary stenting in allergic patients, 3-years experience Cortellini, G1; Santarelli, A2; Santucci, A3; Piovaccari, G2; Corvetta, A3 1 Rimini Hospital, Internal Medicine, Rimini, Italy; 2 Rimini Hospital, Cardiology, Rimini, Italy; 3Rimini Hospital, Internal Medicine, Rimini, Italy

In clinical practice most cases of ASA intolerance must be resolved using alternative drugs, e.g. selective COX2 inhibitors. On the other side, Acetylsalicylic acid desensitization presents more risks and patients cannot stop this therapy. Nevertheless ASA desensitization is mandatory for patients with ischemic heart diseases needing coronary stenting. After coronary stenting, these patients should receive double anticoagulant therapy for 3–6 months, with ticlopidine or clopidogrel plus aspirin. The only one alternative treatment is the coronary surgery, but it is more hazardous and uncomfortable for the patients. Over the years 2006–2007–2008, we have undergone 22 patients to ASA desensitization. We used the following protocol: administration in increasing doses of acetylsalicylic acid dissolved in water until the final dose of 75 mg. The interval between administrations was 20 min. The protocol was effective in 19 patients. Three patients have shown delayed type skin rash. One of these patients was known to present urticaria angioedema and erythema fixed caused by Aspirin. For this patient a successive challenge with aspirin, administered in slow desensitization, was ineffective. 21 patients followed this protocol because they had to undergo to angioplasty intervention secondary to acute coronary syndrome. Only one patient has been following this protocol after primary coronary angioplasty with stent medicated. In the past, this patient had an allergic reaction to ASA taking 100 mg of aspirin as an anti-platelet dose. After primary angioplasty, she reached the tolerance of 300 mg of aspirin (after premedication with methylprednisolone and chlorpheniramine). The following

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day, after application of medicated stent, patient don’t tolerate challenge test with aspirin 100 mg, and she presented general erythema. Symptoms resolved spontaneously after a hour. So she began successive desensitization protocol for aspirin. Desensitization protocol was effective. Therefore we believe that our protocol of desensitization is useful, fast and secure for patients who have just performed a coronary stents after primary angioplasty, and for patients with urgent need for coronarography. 1527 Induction of oral tolerance to peanut: a safe and effective home-based regimen Ojeda, P1; Alfaya, T1; Pineda, F2; Ojeda, I1 Clinica de Asma y ALergia dres. Ojeda, Allergy, Madrid, Spain; 2Diater Pharmaceuticals, Research Department, Madrid, Spain

1

Background: Induction of oral tolerance (IOT) with whole food is becoming a relatively safe and effective alternative for managing food allergies. To date, only five cases of successful IOT to peanut have been described. We describe a home-based regimen for IOT in peanut allergy. Methods: A 7-year-old boy highly allergic to peanut (facial urticaria and lip angioedema when sucking a peanut, positive SPT, specific IgE 265 kU/l, positive oral challenge test with 62.5 mg of peanut; specific IgG4: 6.11 mg/l) was submitted to an IOT regimen with peanut. Three solutions (12.5; 250; and 500 mg/ml) of ground peanut mixed in water were used. Starting predicted dose: 0.625 mg; Max. predicited dose: 50 000 mg; predicted duration: 54 days. Concomitant cetirizine (5 mg/day) was administered. Results: Starting dose: 0.625 mg; Max. dose: 5000 mg (equivalent to 7 nuts); duration: 150 days. 43 doses (28% of total doses administered) produced reactions that where unspecific or mild (from headache to nausea and vomiting). No severe

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reactions requiring emergency treatment nor adrenaline or corticosteroids where described. All the doses, but three, were administered at home, and all the reactions were easily managed at the patient’s home. Upon completion of IOT: specific IgE was 457 kU/l, specific IgG4: 14.8 mg/l. Currently, the patient tolerates 7 peanuts without supportive medication. Conclusion: IOT to peanut has been successfully and safely performed in a highly sensitized patient with a home-based dosescalating induction regimen. The length has been almost three times longer than that initially expected. The tolerated dose (7 peanuts) achieved is enough for preventing allergic reactions with inadvertent or hidden contact with peanut.

1528 Identification of cockroach allergen using proteomic analysis Barbosa, M1; Santos, A1; Santos, L2; Palma, M2; Ferreira-Briza, F3; Briza, P3; Erler, A3; Pome´s, A4; Arruda, L1 1 School of Medicine of Ribeira˜o Preto - University of Sa˜o Paulo, Department of Medicine, Ribeira˜o Preto, Brazil; 2Biosciences Institute, State University of Sao Paulo, Social Insects Center, Rio Claro, Brazil; 3 University of Salzburg, Molecular Biology, Salzburg, Austria; 4Indoor Biotechnologies, Molecular Biology, Charlottesville, United States

Background: Cockroach allergy is a major cause of asthma. Approximately 50% of patients with asthma and/or rhinitis living in Brazil who present positive skin tests to commercial cockroach extracts show IgE sensitization to Periplaneta americana allergens Per a 7 (tropomyosin) (42%) and/or Per a 1 (5%). Proteomic analysis could lead to identification of novel P. americana allergens to be used for diagnosis and treatment of cockroach allergy. Methods: Proteins from a cockroach whole body extract, detected by 2-D electrophoresis, were visualized by Coomassie Brilliant Blue staining, and were transferred to

nitrocellulose membrane. Immunoblotting was performed using undiluted serum pool constructed with sera obtained from 27 patients with asthma and/or rhinitis allergic to P. americana and with negative skin tests and serum IgE to Per a 7 and Per a 1 allergens. The membrane was incubated with biotin-conjugated anti-human IgE (1 : 250), followed by Streptavidin Horseradish Peroxidase. Detection was carried out by Enhanced Chemiluminescence (ECL) with exposure of 30 min. The spots of interest were digested with trypsin and peptide sequencing was determined by mass spectrometry. Results: The proteomic analysis of P. americana extract revealed approximately 100 spots with pI ranging from 3 to 9, and molecular mass varying from 14 to 60 kDa. Of these proteins, 5 showed IgE reactivity using the cockroach-allergic serum pool. These IgE-binding proteins, with pI 3–5 and molecular mass of 45– 50 kDa, comprised peptides derived from the same protein, showing homology to hexamerins from the tropical cockroach Blaberus discoidalis (97% overall identity) and from P. americana (67% identity). Sequence alignments revealed that we have obtained approximately 10% of the sequence of the whole molecule. Hexamerin from P. americana had been previously identified as allergen Per a 3 among patients with asthma living in Taiwan, therefore our results suggest that the protein identified in the present study corresponds to an isoform of Per a 3 allergen. Conclusion: Proteomic analysis of P. americana extract can provide novel information on cockroach allergens and related isoforms, which could contribute to better diagnosis and treatment of cockroach allergy. Isoforms of cockroach allergens homologous to hexamerin may show significant variation in different areas of the world.

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Late Breaking Poster Abstract Session VARIA I 1529 Hypothesis of a classification of the parameters of an allergy-free hotel Casale, G; Serlenga, E Asl Bat, Allergology Unit, Bat, Italy

Background: Allergic diseases are increasing. The allergic patient needs to treat allergies and to make prevention. Sometimes the patient is away from home (for work or for vacation) and must follow the same rules of prevention: it is important that the hotels facilitate this task. Aim of the study: To identify some simple and easy to handle parameters to ensure allergic patient to stay comfortably and free of symptoms in a hotel. Methods: Surveys were conducted in 10 hotels to assess the type of furnishings, wall surfaces, effects of the bed, room structure and cooling. We highlighted the possible interventions to be made to make the room as possible allergy-free. In this respect, we considered respiratory allergies (rhinitis and asthma - mite, molds, pets and pollen), food allergy and contact dermatitis. We consulted the hoteliers for the assessment of the necessary changes and for the evaluation of the economic impact. Conclusion: We defined an hypothesis of a classification of the required parameters and optional parameters, adhering to which the hoteliers can reach the best solution for the allergic patient. Compliance with these requirements could lead to a marked improvement in quality of life of allergic patient who is away from home. 1530 Novel method of evaluating epidemiology of allergic diseases in children — will a progress come? Elazny, I; Nowicki, R Medical University, Dermatology, Venereology and Allergology, Gdan˜sk, Poland

Background: The prevalence of allergic diseases is increasing substantially, however exact data are difficult to estimate. The majority of cases of allergy begin in childhood, this is why we devised a new method of collecting data concerning the prevalence of allergic diseases in children. Method: Specially designed surveys are being fulfilled by parents or caregivers while regular check-ups in some regional outpatients clinics. The surveys are being fulfilled in chosen (by drawing) regional outpatient clinics. We started this study in region of

Pomerania (Pomorze) but afterwards, we plan to conduct similar study in all polish provinces. The survey is short and takes no more than 5 min to fulfill. To study general population we are distributing surveys in outpatient clinics of only healthy children, while regular checkout of 2, 4, 6, 10, 14 and 18-year-old patients. The survey contains questions about the presence of allergic reactions from nose, eyes, atopic dermatitis, about symptoms suggesting asthma and about diagnosing of asthma by the physician. Additionally the survey contains questions about the age, gender, dwelling place, material conditions and prevalence of allergies in other family members. Result: Until now we have only 216 surveys fulfilled, as the study lasts for 4 months and not every parent wants to take part in the study, but we plan to continue the study for more than 2 years. The surveys will be analyzed according to age, gender, dwelling place (amount of inhabitants, city/village)of children, material conditions, prevalence of allergies in the family. Additionally, data concerning the diagnosis of asthma will be analyzed and especially the correlation of asthma symptoms with its diagnosis by the physician. Conclusion: We are aware that the study is in its infancy, but we decided to present it during the Congress as we believe it is a pilot study and it may play a crucial role in future epidemiologic studies. 1531 Research of the lipid composition of red cells membranes in patients with atopy Djambekova, G; Sadykova, G; Sayfulmulyukova, N Specialized Therapy Centre, Allergy Department, Tashkent, Uzbekistan

Background: Atopic Dermatitis (AtD) is a disease associated with food allergy, asthma, allergic rhinitis. Oftentimes, when respiratory allergy (RA) is developed, the diagnosis is formulated as dermo-respiratory syndrome (DRS), which leads to belated diagnostics of bronchial asthma. The objective: Researching the lipid composition of red cell membranes in patients with skin and respiratory manifestations of allergy. Methods: A total of 32 patients with immunologically confirmed atopy (total and specific Ig E, RIDA AlergyScreen test) aged 15–20 have been examined; the control group was comprised of 14 healthy individuals.

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Results: In cases of AtD activity significant defects in lipid composition of red cell membranes have been identified. Reduction of the major phospholipid fractions (phosphatidylcholine and phosphatidylethanolamine) as well as increase of their toxic lisoforms have been marked which indicates increase of phospholipase activity. Imbalance of phospholipid fractions is associated with reduced expression of b2 adrenoreceptors, which maintains permanently high cutaneous sensibility, causes vegetative disorders of the skin and organism as a whole. In patients with active RA symptoms, the changes in the lipid composition of the membranes were identical, which confirms pathogenetic unity of the process. Complex therapy including vitamins and antioxidants did not lead to normalization of the lipid matrix. Significant improvements in indicators were achieved by the use of essential phospholipids (polyenylphosphatidilcholine 1800 mg/day). Conclusion: Research of red cell membranes can be recommended for early diagnostics of atopy, prognostication of relapses and severe forms of the disease. Further research of the membrane protection possibilities of essential phospholipids for atopic diseases is promising.

1532 Is their a connection between IgE sensitization to moulds and fungal evolution? ¨ nell, A1; Soeria-Atmadja, D2; Borga˚, A˚1 O Phadia AB, R&D, Uppsala, Sweden; 2Uppsala University/National Food Administration, Department Medical Sciences/Div.Toxicology, Uppsala, Sweden

1

Background: Mould allergy is a difficult area, partly due to the complexity of the fungal organisms, the variability in extract composition and allergenic potency. In addition, it has been difficult to systematically categorize fungal species. However, modern phylogenetics, i.e. studies of evolutionary relations among organisms using molecular sequencing data, has paved the way for a substantially improved fungal molecular systematics. Objective: To study the relationship between fungal molecular systematics based on modern phylogenetics and IgE sensitization patterns of moulds commonly used in allergy diagnosis. Methods: Serum IgE levels in mould-sensitized individuals were recorded to 17 mould allergens. Data were then computationally analyzed with multivariate clustering, 581

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wherein moulds were grouped into a hierarchical structure based on all-against-all pairwise similarity. The resulting structure was thereafter compared with modern fungal systematics. Results: Overall, similarities between allergenic moulds based on IgE sensitization patterns remarkably well reflected modern fungal systematics founded on phylogenetic studies. Conclusion: To our knowledge, this is the first study to thoroughly demonstrate a close relationship between molecular fungal systematics and IgE sensitization to moulds. The hierarchical structure of moulds based on IgE-sensitization should be valuable for identification of IgE cross-reactive components important within different mould subgroups. 1533 Latex hypersensitivity in professionally exposed population Dukic, M General Hospital Subotica, Allergy Department, Subotica, Serbia and Montenegro

Allergy to latex became an important health problem among persons professionally exposed to rubber products. Hypersensitivity to latex establishes in form of early type (to latex proteins) and late type (to latex additives). Aim of the work: 1. To assess prevalence of hypersensitivity (early and late type) to latex; 2. to assess prevalence of early type of hypersensitivity to latex; 3. To correlate atopic constitution an early type of hypersensitivity to latex; 4. To assess prevalence of early type of hypersensitivity to additives; 5. To determine the influence of chemical contact factors of the workplace to the late type hypersensitivity to additives; 6. To correlate anamnestical data on complaints about latex exposure and positive tests of early and late hypersensitivity. Methodology: This is a clinical study. The sample was built up on 40 persons grouped in medical staff, rubber industry workers, hairdresser school pupils and a control group. The subjects were assessed in the following manner: anamnesticals data were recorded, a clinical examination was made, in vitro, tests of total and latex specific IgE were made in vivo, skin tests of early (prick) hypersensitivity to latex proteins, and late (patch) hypersensitivity to latex additives were also made. The results were statistically processed and presented in tables and charts. Results: Prevalence of early type of hypersensitivity to latex among hairdresser school pupils was 5%, in the group of rubber industry workers 7.5%, and 10% in the group of medical staff. Prevalence of late type hypersensitivity to latex additives

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in named groups was 10, 15, and 17.5%. Total prevalence of hypersensitivity in groups was 15, 22.5, and 25%. Atopic constitution is in positive correlation with the establishment of early types of hypersensitivity to latex. Chemical contact factors statistically significantly influence the development of late types of hypersensitivity to additives. There is a positive correlation among anamnestical data on latex exposure and positive tests of early and late hypersensitivity. Conclusion: People professionally exposed to latex have higher prevalence of early and late type hypersensitivity to latex. There is a positive correlation between atopic constitution, exposure to chemical contact factors, anamnestical data on complaints, and establishment of a sensibilisation to latex.

1534 Allergic contact stomatitis caused by acrylates in superglue Dietrich, K; Rueff, F; Przybilla, B; Thomas, P Ludwig Maximilian University, Department of Dermatology and Allergology, Munich, Germany

Background: Allergic contact stomatitis to denture materials, in particular to acrylates, is a well known, but rather rare condition. The tolerance favouring characteristics of the oral environment may however be weakened, for example by strong irritation. Subsequently sensitisation may occur. Case report: A 51-year-old man presented in our department because he had developed a severely painful stomatitis including aphthae. He had worn his denture for years without any problems. 5 weeks before presentation his denture had loosened. In order to fix his denture the patient had used a common acrylate-based superglue. The next day he suffered from swollen lips and a painful red mouth. Since the denture was still loosened, the patient used some special adhesive he had bought in a dental laboratory. Within the next day he had developed more severely painful mucosal lesions. Clinical examination revealed erythema especially in the upper gingiva, palate and the thong with disseminated small ulcers. Further analysis including smear and PCR analysis showed no signs of pathogenous bacteria, candida or herpes simplex virus. Patch testing was started (standard series, dental screening series) and readings were performed after 48 and 72 h. Testing with the standard series was negative. The patient showed a positive patch test to 2-hydroxyethylmethacrylate which was included in the second glue the patient had used. Patch testing to various other acrylates was positive whereas testing

to methyl methacrylate which is considered as a marking substance for allergy to acrylates was negative. It is likely to assume that the patient became sensitised to acrylates when using superglue which had caused an irritant stomatitis and subsequently induced sensitisation. The material safety data sheet (MSDS) of the superglue stated that it contains ethyl-2-cyanacrylate. The adhesive from the dental laboratory included various acrylates. We treated the patient with topic corticosteroids as well as disinfectant and anaesthetic fluids. The patient reported a considerable improvement. Examination revealed a reduction of erythema and aphthae. Due to the sensitisation to various acrylates the patient was no longer able to wear his denture. It was necessary to perform special adaptations to his new denture in order to minimize the release of acrylic monomers. The patient is now symptom-free upon wearing a particularly polymerized new denture.

1535 Allergy to Technetium: Case Report of Exfoliating Dermatitis after Myocardial Perfusion Imaging Pravettoni, V; Piantanida, M; Primavesi, L IRCCS Foundation Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Clinical Allergy and Immunology Unit, Milan, Italy

Background: Several adverse reactions after injection of technetium are reported, in particular anaphylaxis or anaphylactoid reactions were associated to dextran-stabilized Tc-99m sulphur colloid. Here we describe a case of exfoliating dermatitis after myocardial scintigraphy with Tc-99m sestamibi. A 63-year-old man referred to our Allergology Unit for an exfoliating itching dermatitis in his whole body started 3 weeks before. In his history: heart chronic ischemic disease, right coronary stent in 2002, myocardial scintigraphy stress/rest with Tc-99m sestamibi in 2006, acute coronary syndromes with a second coronary stent in December 2008. He also suffered from Raynaud phenomenon, already investigated few years ago. One month after myocardial infarction he was submitted to the second myocardial scintigraphy stress/rest with Tc-99m sestamibi. The day after the end of test a widespread, itching, dermatitis onset. He referred to a dermatologist who diagnosed dermatitis of unknown origin and prescribed topical therapy and oral antihistamines; without prescribing skin biopsy or other tests. The dermatitis presented rapid course, became exfoliating and involved the whole body, so he referred to our Unit. At examination we noticed a remarkable dry skin exfoliating in the whole body: limbs were particularly

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Late Breaking Poster Abstract Sessions – VARIA I

interested and the patients complained severe itching. We required routine blood tests including titration of auto-antibodies (ANA, ENA), capillaroscopy, and SIDAPA Patch-Test. Results: At blood tests we interestingly found absolute hyper-eosinophilia (1602 cells/mm3), while auto-antibodies resulted negative. SIDAPA Patch-Test, including 40 standard haptens, resulted positive only for potassium dichromate. Capillaroscopy resulted negative, excluding autoimmune disease as cause of Raynaud phenomenon. The patient was quickly treated with antihistamines and high dose oral prednisone, topical steroid and moisturizing cream. After two weeks of treatment we observed an improvement in skin lesions, with complete remission in about 1 month and eosinophilia decrease and remains up to now in normal range. Conclusion: Here we describe a case of exfoliating dermatitis correlated to Tc-99m sestamibi. Because of the time between exposure to technetium and dermatitis onset, the hyper-eosinophilia, the lack of any other likely causes for the exfoliating dermatitis, and the improvement with prednisone, we concluded technetium was the causative agent.

1536 Atypical facial pain, neuroinflammation and intraoral metals Fracchiolla, N1; Guzzi, G2; Costa, A3; Pigatto, P4 Mangiagalli, Regina Elena IRCCS, Hematology-Bone Marrow Transplant Unit, Fondazione, Milan, Italy; 2 Italian Association for Metals and Biocompatibility Research, A.I.R.M.E.B., Milan, Italy; 3IRCCS Maggiore Hospital, Mangiagalli and R. Elena Foundation, University of Milan, Department of Diagnostic and Interventional Neuror, Milan, Italy; 4IRCCS Galeazzi Hospital, University of Milan, Department of Technology for Health, Dermatologica, Milan, Italy

1

Background: Persistent idiopathic facial pain (best known as atypical facial pain AFP) is characterized clinically by neuropathic orofacial pain. We report a successful treatment of AFP after removal of mercury dental amalgams and palladium-based alloy crowns. Methods: A 40-year-old woman presented with atypical orofacial pain. The pain became more severe and was unrelieved by drugs. She had 4 mercury amalgams – underneath her resin fillings – and 4 palladium-based crowns. A provisional diagnosis of AFP related to intraoral metals was made. We then proceeded with removal of crowns and amalgams, which were safely removed with ‘lift-on technique’ procedure. Results: We measured total mercury and palladium in chewing-gum-stimulated whole saliva. We detected oral galvanism between left upper premolar and left lower

molar (200 mV). Patch tests were negative for dental allergens. Before amalgam and palladium crowns removal, the concentrations of palladium and mercury in saliva were 16 and 2.29 mcg/l, respectively. After palladium crowns and amalgams removal, the levels in saliva samples were 2.18 and 0.27 mcg/l, respectively. Soon after the early amalgams removal, her neuropathic symptoms improved rapidly but temporarily. However, only after palladium-crowns were completely removed, her facial neuropathy was greatly ameliorated. She achieved a complete remission of her AFP within eight weeks after the removal of both amalgams and palladium crowns. At the time of the last follow-up 8 months later, she was symptom-free. Mercury amalgam, palladium, silver, and indium may all have a role in neuroinflammation of trigeminal nerves. Interpretation: Metals released from alloy dental restorations may trigger intraoral toxicity and act as immunotoxicants, affecting trigeminal nerves and/or peripheral nerves fibers by immuno-mediated injury. 1537 Laryngopharengeal Reflux Manifestations of our asthmatic patients with gastroesophageal reflux Aras, G1; Develioglu, O2; Yelken, K3; Kanmaz, D4; Purisa, s5; Kadakal, F4 1 Yedikule Chest disease and Surgery Research Hospital, Chest Disease, Yedikule Chest Disease Hospital telsiz,Zeytinburn, Istanbul, Turkey; 2Taksim Research and Education Hospital, Otolaryngology, Istanbul, Turkey; 3Gaziosmanpasa University Medicine, Otolaryngology, Tokat, Turkey; 4Yedikule Chest disease and Surgery Research Hospital, Chest Disease, Istanbul, Turkey; 5Istanbul University,Cerrahpasa Medicine Faculty, Bioistatistics, Istanbul, Turkey

Background: Human and animal studies in asthma and upper airway disorders using the microaspiration of acid into the larynx and trachea have shown similar pathophysiological findings to those found with EER(extraesophageal reflux). LPR symptoms can be assessed with the Reflux Symptom Index(RSI). Signs of LPR as determined with Reflux Finding Score (RFS), which includes assessment of site specific laryngeal inflammatory changes. Objectives: Our purpose was to asses LPR symptoms and laryngoscopic signs in asthma with GER. In addition, the value of RSI and RFS were evaluated in LPR examination of asthma patients with gastroesophageal reflux. Material and method: Thirty-seven patients with both asthma and reflux symptoms participated in the study at the pulmonary specialty outpatient clinic at the Yedikule Chest Disease and Surgery Research Hospital between January 2007 - 2008. Diagnosis of asthma was made according to GINA guidelines. All of the patients had gastro-

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esophageal symptom under the treatment of inhaler corticosteroids. RSI was questioned. LPR evaluation: Fiberoptic laryngoscopic (Xion Nasopharyngoscope, Endostrop DX.) examination was conducted by otorhinolaryngologist Findings of laryngoscopy were assessed according to reflux finding score (RFS). Statistics: All statistics were performed by using UNISTAT 5.1 statistics pack program. Results: There were 37 male (n = 15) and female (n = 22) asthma patients According to GINA classification, 7 of 37 had intermittent asthma, 20 had mild persistent 10 had moderate persistent and 7 had severe persistent asthma. The most common laryngopharyngeal reflux symptoms were sore throat (80.5 %), dysphagia (75%), chronic cough (71.4%) followed by globus sensation (50%) and dysphonia (41.9%) Laryngoscopic evaluation revealed posterior commissure hypertrophy to be the most common finding 66.6% (n = 18) in asthma patients with GER. There was only correlation between pseudosulcus and sore throat when we correlated LPR symptoms with laryngoscopic manifestations. Conclusion: Sore throat, dysphagia, chronic cough, globus and hoarseness have high frequency, respectively and posterior commissure hypertrophy was the most frequent laryngoscopic signs in asthmatic patients with GER. Globus was the most common symptom the patients with a RFS greater than 7. There appears to be poor correlation RFS between signs and symptoms.

1538 Alt a 1 and enolase are a must but not enough to build an allergen panel for the diagnosis of mould allergy Martı´nez, J1; Fernandez, J2; Gutie´rrez-Rodrı´guez, A1; Postigo, I1; Sun˜en, E1; Guisantes, J1 1 University of Basque Country, Immunology, Microbiology and Parasitology, Vitoria, Spain; 2University Miguel Herna´ndez, Department of Medicine, Alicante, Spain

Background: Along the last decades the genomic and proteomic have contributed in a decisive way to the current knowledge of the individualized allergenic components and their potential use in clinical diagnosis of IgE mediated allergies. Recent investigations have demonstrated that Alt a 1, the major allergen of Alternaria alternata, should be considered as a relevant allergen of Pleosporaceae group and the enolase as the main allergen involved in the cross-reactivity to fungi, but it remains unclear the dimension of these allergens as a tools for the diagnosis of the mold allergy in our country. Objective: The aim of this study was to demonstrate the current value of the current available fungal allergen panel and

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what are the coming needs to build an accurate mould allergen array to diagnose the most of the fungal allergy cases, discriminating polysensitization and crossreactivity phenomena. Methods: Component-Resolved Diagnostics with mould allergens by ImmunoCap System was performed in thirty allergic patients to Alternaria and in a hundred blood donors. Cross-reactivity studies were performed by FEIA-inhibition and linear regression. Individual and global reactivity profiles and also the comparison between reactivity to different allergens and extracts were analysed to define polysensitisation and cross-reactivity patterns. Results: The results revealed that the most of the allergic patients showed positive specific IgE levels to several moulds belonging to different taxonomical families. When recombinant allergen was used, only 8 out of 30 patients could be labelled as ‘polysensitised subjects’. Current available fungal allergen array was not sufficient to establish an accurate diagnosis end enolasa can not explain the cross-reactivity phenomenum in 7 out of 11 patients with specific IgE to this allergen. Unexpected correlations between Alt a 1 and Curvulaia or Cladosporium, also between Alternaria and Curvularia or Cladosporium could be the key to define a more accurate allergen array. Conclusions: Alt a 1 and fungal enolase should be considered the main tools for the diagnosis of mould allergy in Spain but more individualized fungal allergens are needed to discriminate between fungal polysensitization and cross-reactivity. Alt a 1 is the main marker to define the Allergy to Pleosporaceae not including Curvularia.

birth to 2 years including information on the children’s health, diseases and use of any medication in the past 6 months. Reports of paracetamol use and any lower airway infection (pneumonia, bronchitis or bronchiolitis) or upper airway infection (tonsillitis, otitis media, or laryngitis) until 6 months of age were used for the present analyses. The 10 years investigations included detailed parental structural interview on the children’s health, lung function, allergic and clinical examination. Main outcome measures at 10 years were a history of asthma and current asthma (symptoms and/or asthma medication in the last 12 months of children with asthma). Results: Paracetamol use (no/yes) until 6 months age was reported in 42 boys and 41 girls. Paracetamol intake was significantly associated with a history of asthma in girls (odds ratio (OR) (2.2 (1.1, 4.3) P = 0.02), but not in boys (OR (1.2 (0.6, 2.3) P = 0.65)). Although lower and upper airway infections (no/yes) before 6 months of age were associated with increased risk of a history of asthma in girls as well as in boys, (OR (7.2 (3.4, 15.6) P < 0.001) and (2.0 (1.1, 3.8) P = 0.03) respectively in girls and OR (2.9 (1.7, 5.9)P < 0.001) and 2.7 (1.5, 4.6) P < 0.001), respectively in boys), the adjusted odds ratio in girls and boys for history of asthma after paracetamol intake remained unchanged. Current asthma at 10 years was not associated with paracetamol intake at this age. Conclusion: Girls, but not boys receiving paracetamol in the first 6 months of life have increased risk of childhood asthma despite adjusting for early airways infections.

1539 Increased risk of childhood asthma in girls after intake of paracetamol before 6 months of age

1540 Chronic inflammation in airways of patients with chronic cough

Bakkeheim, E1; Mowinckel, P1; Carlsen, K2; Loedrup Carlsen, K1 1 Oslo University Hospital, Ullevaal, Pediatric Department and ORAACLE Group, Oslo, Norway; 2Oslo University Hospital, Rikshospitalet, Voksentoppen and ORAACLE Group, Oslo, Norway

Background: Recent studies suggest a causative role of paracetamol use in early childhood for asthma development, pointing to a possible imbalance of oxidative-antioxidative inflammatory mechanisms in the development of allergic diseases. We investigated if paracetamol intake until 6 months of age was associated with risk of asthma in school age in girls or boys. Methods: In the prospective Oslo birth cohort study, Environment and Childhood Asthma (ECA), 1016 children included at birth were re-investigated at 10 years. Halfyearly questionnaires were completed from

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Grabowski, M1; Dilissen, E2; Decraene, A3; Litwa, M1; Dupont, L3; Bullens, D4; Panaszek, B1 1 Wroclaw Medical University, Department of Internal Medicine and Allergology, Wroclaw, Poland; 2Katholiek Universiteit Leuven KULeuven, Clinical Immunology, Leuven, Belgium; 3Katholiek Universiteit Leuven KULeuven, Department of Pneumonology, Leuven, Belgium; 4Katholiek Universiteit Leuven KULeuven, Department of Woman and Child, Leuven, Belgium

Background: Chronic cough (CC) defined as cough which persists for more than 8 weeks of unknown origin is an important clinical problem. Epithelial damage might lead to a chronic inflammatory process in the airways in CC patients causing symptoms. Methods: A total of 39 chronic cough patients (M/F 23/31, mean age 44.5 ± 6.0 year, mean duration 3.3 ± 3.0 year) and 18 healthy non-allergic age- and sexmatched subjects were enrolled in the study. Patients had normal spirometry and did not use oral nor inhaled glucocorticoids. All

patients underwent gastroscopy and showed signs of GERD. 12 patients were on proton pomp inhibitors (PPI) at the moment of sputum induction. 27 patients started PPI treatment after sputum induction was performed. PPI-responsiveness was investigated in that group four weeks later. Airway cells were obtained by sputum induction. Sputum Interleukin(IL)-8, IL-17, CD3-g (reflecting lymphocytic inflammation) and Foxp3 mRNA expression was studied by RT-PCR, using b-actin as housekeeping gene. Results: We divided the study population in two groups based on score points from adjusted Leicaster Cough Questionnaire (LCQ) with 4.0 as the splitting point (26 high, 13 low). Differential cell count did not differ between the study and control group. The percentage of eosinophils in both groups did not exceed 1.5%. Both IL-8 and IL-17 mRNA levels were higher in the CC group compared to healthy controls reaching statistical significance for IL-8 (3.2 ± 3.0 versus 1.6 ± 1.2). Patients with high LCQ score tended to have higher IL-17 mRNA levels than patients with low LCQ score. Patients on PPI tended to have lower IL-8 (1.6 ± 2.0 versus 3.2 ± 4.0) and CD3g (20.0 ± 21.0 versus 13.3 ± 17.0) and higher Foxp3 mRNA levels (113.6 ± 228.2 versus 61.4 ± 89.0) than untreated patients. Later-on PPI-non-responders had longer history of coughing (4.0 ± 4.3 versus 2.2 ± 3.7 years, P = 0.06), higher IL-8 (4.1 ± 5.4 versus 2.0 ± 2.9) and CD3g (28.3 ± 26.0 versus 12.2 ± 11.0) mRNA levels and lower Foxp3/CD3-g ratio (4.6 ± 6.2 versus 11.6 ± 22.3) than later on PPIresponders. Conclusion: Higher IL-8 mRNA levels might reflect epithelial damage in CC patients. Taking PPI reduces airway inflammation in CC patients. Decreased expression of Foxp3 in the group of patients without PPI improvement suggests decreased number of T regulatory cells in their airways. 1541 Features of melatonin expression in nasal polyps in patients with aspirin triad Evsyukova, H; Okuneva, E Saint-Petersburg State University, Medical faculty, Saint-Petersburg, Russian Federation

Background: Patients with aspirin sensitive asthma (ASA) often have concomitant polypous rhinosinusitis (PR). PR in patients with ASA is the severe disease, which poorly responds to surgical and medical treatments. This requires elaboration of new principles for pathogenetic therapy of these diseases. It is known that patients with ASA have low production of

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Late Breaking Poster Abstract Sessions – VARIA I

melatonin (MT) in platelets and other APUD — system cells. We suppose that PR in patients with ASA is partially caused by the low production of MT. The aim of this research was to investigate possible relationships between melatonin expression in nasal polyp tissue and histologycal structure of nasal polyps (NP) in patients with ASA. Methods: We analyzed a histological structure of ablated NP and melatonin content in NP in 11 patients with ASA, in 8 patients with aspirin-tolerant bronchial asthma (ATA), in 13 patients with PR without concomitant bronchial asthma, and in 10 healthy subjects. Microscopic sections of NP for the histological studies were prepared on glass slides for staining with Giemsa stain and microscopic examination. MT content in the NP was studied in microscopic sections stained by indirect immunofluorescence with specific anti-melatonin serum and fluorescence rabbit antiimmunoglobulin antibody. Tissue samples for healthy subjects were taken in the back end of inferior nasal concha. Results: Melatonin expression was detected in nasal tunica mucosa of healthy subjects (the area of specific MT fluorescence is 11.61 ± 5.16%) and in higher quantity in NP, especially in NP of patients with ASA (28.26 ± 10.18%). There was increased quantity of eosinophils and decreased quantity of lymphocytes in NP of ASA patients, especially in comparison with patients with ATA (Eos 36.5 ± 2.0% versus 20.1 ± 4.2% (P 4.0, AUC = 0.86. ECNF’s median in AR with effective clinical response to antihistamines was 4.0 and 8.0 with ineffective response, the best cut-off value was ¡U¨ 5.0, AUC = 0.94. ECNF’s median in NAR with an effective clinical response to antihistamines was 1.0 and 2.0 with ineffective response, and the best cut-off value was ¡U¨ 3.0, AUC = 0.64. Conclusion: Our results suggest an interesting practical use of ECNF data as evaluator of the clinical severity both AR and NAR. As predictor of the clinical response to antihistamines, ECNF is accurate only in patients with AR. The ECNF’s performance was moderately accurate in distinguish patients with AR and NAR.

Objective: Allergic rhinitis (AR) often causes sleep disturbances and associated daytime somnolence, thus resulting in a poor quality of life. AR can also increases snoring and sleep apnea in OSAHS. Montelukast and Intranasal budesonide are main treating drug in AR. We investigate The role of montelukast and intranasal budesonide on OSAHS and Allergic rhinitis. Study design: A total of 625 OSAHS (RDI ‡ 5) patients from The center of diagnosis and treating of sleep apnea in zhongshan hospital in China, 89 patients of the 625 suffer from AR, 89 patients were enrolled in a double-blind placebo-controlled. 44 patients in treating group, 45 patients in placebo group, we use montelukast and intranasal budesonide to treat in treating group for 12 weeks. Collected subjective data included a daily diary recording nasal symptoms, sleep issues, and daytime fatigue, the Functional Outcomes of Sleep Questionnaire, the Epworth Sleepiness Scale, Juniper’s Rhinoconjunctivitis Quality of Life Questionnaire, the Rhinitis Severity Scale, the Calgary Sleep Apnea Quality of Life Index. Results: Subjects in treating group, compared with placebo group, showed a statistically significant improvement in all index (P £ 0.05). Conclusions: Montelukast and Intranasal budesonide, when compared with placebo, improved the symptoms of AR and OSAHS, and also improve sleep quality and reduce daytime somnolence with the disorder.

1557 Mometasone furoate nasal spray and oxymetazoline nasal spray administered concurrently in subjects with seasonal allergic rhinitis significantly reduced nasal congestion in as early as 15 min Meltzer, E Allergy and Asthma Medical Group & Research Center, San Diego, United States

Background: Nasal decongestants offer rapid congestion relief, but concerns about tachyphylaxis/rhinitis medicamentosa have limited them to short-term use. Guidelines  2009 The Authors Journal Compilation  2009 Blackwell Publishing Ltd Allergy 64 (Suppl. 90): 551–598

recommend intranasal corticosteroids (INS) as first-line therapy for allergic rhinitis (AR) where congestion is a major symptom. Concomitant INS/decongestant use may prevent reduced efficacy seen with intranasal decongestant monotherapy and may provide more rapid relief than expected with INS monotherapy. We evaluated concomitant therapy with mometasone furoate nasal spray (MFNS) 200 mcg once daily (QD) and oxymetazoline (OXY) QD versus either drug alone to relieve symptoms of seasonal AR (SAR). Methods: Phase II 15-day study randomized subjects, age ‡12 years with 2-years history of SAR and moderately severe symptom exacerbation, to 1 of 5 treatment arms: MFNS 200 mcg QD+OXY 0.05% 1 s/n QD (MFNS+OXY1), MFNS+OXY 3 s/n QD (MFNS+OXY3), MFNS 200 mcg QD (MFNS QD), OXY 2 s/n twice daily (OXY BID), or placebo (PL). Primary efficacy endpoints: change from baseline in AM/PM NOW (instantaneous) total nasal symptoms score (TNSS; sum of subject diary scores for congestion/rhinorrhea/itching/sneezing) over Days 1–15 (Endpoint), and area under the curve for change from baseline in congestion score 0–4 h (AUC [0–4 h]) post-dosing on Day 1 (congestion scores every 15 min for 1 h post-dosing/ every 30 min for 3 h). Results: Baseline AUC (0–4) and AM/PM NOW TNSS were similar across groups (Table). MFNS+OXY1 demonstrated significantly greater improvements in change from baseline in AUC (0–4) versus MFNS QD (P = 0.021) and OXY BID (P < 0.001) on Day 1. Significant improvements were seen with MFNS + OXY3 versus MFNS QD (P < 0.001). MFNS+OXY1, MFNS+OXY3, and OXY BID showed improvement versus PL (P £ 0.001) 15-min post-dosing. TNSS reductions from baseline were numerically greater for MFNS+OXY1 and MFNS+OXY3 versus MFNS QD, with statistically significant improvements seen versus OXY BID (P < 0.05 for both) over Days 1–15. Active treatment groups were superior to PL (P < 0.05 for all) except OXY BID (P = ns). Proportion of subjects reporting treatment-related adverse events similar across groups: MFNS+OXY1 (9.0%), MFNS+OXY3 (7.9%), MFNS QD (3.6%), OXY BID (6.4%), PL (5.6%). Conclusion: In subjects with SAR, both combinations of MFNS+OXY provided significantly faster nasal congestion relief

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Table 1. For abstract 1557. Standardized AUC(0–4 h) of Nasal Congestion Score

Treatment Arm 1. 2. 3. 4. 5.

MFNS+OXY1 MFNS+OXY3 MFNS QD OXY BID Placebo

LSM Baseline Score (n)

2.64 2.62 2.59 2.64 2.64

(145) (138) (139) (140) (140)

Standardized AUC(0–4 h) of Nasal Congestion Score

AM/PM NOW TNSS

LSM mean change from baseline on Day 1 (%)

LSM Baseline Score (n)

)0.80 )0.92 )0.63 )1.06 )0.57

9.68 9.70 9.61 9.78 9.89

than MFNS 200 mcg QD alone, with onset of action £15 min, and numerically greater reductions in TNSS than either treatment alone. Both combinations were well tolerated.

1558 Mometasone furoate nasal spray significantly reduces individual ocular symptoms in subjects with seasonal allergic rhinitis Bielory, MD, L1; Canonica, MD, G2 UMDNJ-New Jersey Medical School, Asthma and Allergy Research Center, Newark, United States; 2 University of Genoa, Department of Internal Medicine, Genoa, Italy

1

Background: Patients with allergic rhinitis (AR) may experience both nasal and ocular symptoms. Depending on mechanism of action of the treatment drug, positive effect on reducing symptom severity can vary. Results of a meta-analysis of randomized, double-blind, placebo-controlled trials of the intranasal corticosteroid mometasone furoate nasal spray (MFNS) for treatment of allergic rhinitis (AR) provide level Ia evidence of its efficacy in treating both nasal and non-nasal symptoms. MFNS also has been shown to reduce the ocular symptoms associated with seasonal AR (SAR). Ocular data from six randomized placebo-controlled trials of MFNS for treatment of SAR were meta-analyzed to determine impact of MFNS on ocular allergy symptoms. Methods: We performed a meta-analysis of ocular data from 6 double-blind, randomized, placebo-controlled studies of MFNS 200 mcg once daily (QD). In two studies, ocular data were assessed prospectively, and in four studies ocular data were retrospectively analyzed. Subjects were age ‡12 years with ‡2-year history of SAR. Twice daily (AM and PM), subjects recorded in diaries their ocular symptoms (tearing, itching, and redness) on a 4-point scale (0=none, 3=severe). Evaluations used the validated 7-item Clinical Relevance Instrument. Treatment effect was assessed based on AM/PM prior (reflective) scores from subject diaries, using RevMan5. Minimum 592

()29.6) ()34.1) ()23.4) ()38.8) ()20.7)

(145) (138) (139) (140) (140)

AM/PM NOW TNSS LSM mean change from baseline Days 1–15 (%) )3.29 )3.36 )2.97 )2.44 )1.90

()33.4) ()33.4) ()29.5) ()24.0) ()18.6)

ocular symptom score was not entry criteria in four of the six studies. Results: Subjects received MFNS 200 mcg QD or placebo over a 15-day treatment period in the two prospective studies (MFNS, n = 429; placebo, n = 421) and the four retrospectively analyzed studies (MFNS, n=492; placebo, n = 497). Mean baseline itching/redness/tearing scores for MFNS versus placebo were 2.48 versus 2.47; 2.23 versus 2.26; 2.33 versus 2.33 in the prospective studies and 1.68 versus 1.72; 1.35 versus 1.40; 1.39 versus 1.45 in the retrospectively analyzed studies. MFNS group demonstrated significant overall improvement versus placebo: itching (mean difference [95%CI]: -0.12 [-0.21, -0.02]), redness ()0.10 [-0.19, -0.01]), tearing -0.13 [-0.23, -0.04]) (all P < 0.00001). Conclusion: In this meta-analysis of prospective and retrospective data, over a 2week period MFNS 200 mcg QD demonstrated significant reductions in ocular symptoms associated with SAR in a large patient population age 12 and older.

1559 Evaluation of nasal eosinophilia in the diagnosis of allergic rhinitis Kianiamin, M1; Daneshi kohan, M2; Shahrokni, M3; Mohammadi, N4; Bagherabadi, F3 1 Qazvin Medical University, Immunology and Allergy Departement, Qods Children Hospital-Qods Square, Qazvin, Islamic Republic of Iran; 2Qazvin Medical University, Medical Laboratory Science, Qazvin, Islamic Republic of Iran; 3Qods Children Hospital, Pediatric, Qazvin, Islamic Republic of Iran; 4Qazvin University of Medical Sciences, Social Medicine, Qazvin, Islamic Republic of Iran

Background: Allergic rhinitis(AR) is a heterogenous disorder that despite of high prevalence is often undiagnosed. It is characterized by one or more symptoms including; sneezing, itching, nasal congestion, and rhinorrhea and confirmed by paraclinic tests such as skin prick test or Radioallergosorbent test,(RAST). On the other hand, the presence of eosinophils in the nasal secretion, is taken as evidence of allergic rhinitis. Objective: The aim of this study was to assess the usefulness of nasal smear eosino-

philia with a skin sensitivity test for the diagnosis of allergic rhinitis and to determine the degree of correlation between the tests. Material and methods: Fifty patients with clinical history suggestive of nasal allergy and forty seven controls were studied. A range of allergens were for the skin sensitivity test in both groups. Nasal smears were examined by light microscopy. Results: A positive skin test reaction was demonstrated in 93% of the study population and 8.5% of the controls, whereas 28% of the patients and 6.38% of the controls demonstrated significant nasal smear eosinophilia. There was a statistically significant relation between the two tests (P: 0.014), although the correlation coefficient was poor (r: 0.248). Conclusion: Both the skin prick test and nasal smear eosiniphilia are sensitive for the diagnosis of allergic rhinitis, however, the sensitivity of skin prick test 93% was high compared to that of nasal smear eosinophilia (28%). Owing to the specificity of nasal smear eosinophilia (93.6%), it can be a good substitute for the skin prick test in contraindicatory cases. 1560 Nasal tryptase in patients with systemic mastocytosis and rhinitis: evidence for a non-allergic, mastocytosis associated rhinitis (NAMAR) Dollner, R1; Taraldsrud, E2; Kristensen, B3; Pfrogner, E4; Kramer, M4 1 Oslo Universityhospital - Rikshospitalet, Otorhinolaryngology, Head and Neck Surgery, Oslo, Norway; 2 Oslo Universityhospital - Rikshospitalet, Institute of Immunology, Oslo, Norway; 3Phadia ApS, Phadia, Allerød, Denmark; 4Ludwig-Maximillians-University, Campus Grosshadern, Otorhinolaryngology, Head and Neck Surgery, Munich, Germany

Background: Systemic mastocytosis (SM) is a very rare disease based on the enhanced monoclonal development and accumulation of mast cells (MC) in one or more organs. The natural clinical course of SM is variable depending on age, organs involved, and other co-existing disorders (e.g. allergies). Since mediator-release from MC¢s determines most of the individual symptoms, IgE-mediated allergies might be clinically overestimated in these patients. To increase the understanding of rhinitis in patients with SM, the present report refers nasal tryptase levels and serologic findings to nasal complaints in this patient group. Methods: Nine patients with confirmed diagnosis of SM underwent a structured allergologic / ENT examination. CRS or nasal polyposis were excluded endoscopically. Samples of nasal secretions were collected and processed for determination of tryptase as described previously. The patients were asked to score the four major rhinitis symptoms (blocked nose, runny

 2009 The Authors Journal Compilation  2009 Blackwell Publishing Ltd Allergy 64 (Suppl. 90): 551–598

Late Breaking Poster Abstract Sessions – Allergy and Non-allergic Rhinitis

nose, sneezing, and itchy nose) on a scale from 1 (not troubled) to 6 (extremely troubled). Serum-tryptase, total IgE, allergy screening tests, and specific IgE were determined from serum samples; local tryptase from nasal secretions. Nasal provocations were performed if necessary. Results: Three out of nine patients scored one or more items >4. Two of these patients suffered from intermittent, and one from persistent rhinitis symptoms. However, total-IgE, allergy screening and nasal provocation ruled out an atopic condition. Highly elevated levels of nasal tryptase (165.6–182.8 lg/l) were striking. There was a significant correlation (P < 0.01; r = 0.85) between symptom scores and nasal tryptase. Elevated tryptase in these three patients was significantly higher (P < 0.001) compared to the six SM patients scoring symptom items 0.05). In the majority of patients with allergic rhinitis and controls, HcGP-39 staining was seen in subepithelial cells near the basement membrane. Positive correlation was found between the number of HcGP-3 positive cells and the thickness of basement membrane(r = 0.52), the number of macrophage(r = 0.41). Conclusion: We have shown that HcGP-39 was found in increased quantities in patients with allergic rhinitis, in whom the expression of HcGP-39 correlated positively with the thickness of the subepithelial basement membrane. Our data suggest that HcGP-39 may participates in the process of airway remodeling of allergic rhinitis.

1568 Novel solubilization of azelastine and budesonide with Captisol in a convenient combination nasal spray format provides faster and greater nasal symptom relief than either Captisol-enabled budesonide or Rhinocort Aqua alone: a meta-analysis of two environmental exposure chamber (EEC) studies Salapatek, A1; McCue, S1; D’Angelo, P2; Liu, J2; Zimmerer, R3; Pipkin, J3 1 Cetero Research, Research and Development, Mississauga, Canada; 2Cetero Research, Biostatistics, Mississauga, Canada; 3CyDex Pharmaceuticals Inc., Research and Development, Lenexa, United States

Background: Captisol increases solubilization and stabilization of pharmaceutical compounds. Two separate EEC studies were performed in allergic patients exposed to ragweed allergy. The first assessed the efficacy of Captisol-Enabled Budesonide (CE-BUD), a comparator, Rhinocort Aqua (RA), and placebo (2006). The second assessed the efficacy of Captisol Enabledbudesonide+Azelastine (CE-BUD+AZ), Astelin+Rhinocort Aqua (AS+RA) given sequentially, respectively and placebo (2007). Methods: Statistical analyses were performed to ensure that placebo arms between studies behaved similarly. An ANCOVA was performed on baseline adjusted AUC for Total Nasal Symptom Score (TNSS) and overall mean change from baseline in TNSS. The model included fixed terms for sequence, period and treatment and a random effect for subject nested within sequence. Baseline TNSS was a covariate in the model after verifying homogeneity of slopes. All comparisons were adjusted for multiple testing. Results: Meta analyses revealed no significant difference in placebo effect and that placebo effects were comparable

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(P = 0.64) in both studies, thus allowing data pooling and comparison between test products with CE and the comparators for both studies. Baseline adjusted AUC and overall mean change from baseline in TNSS showed similar trends for both studies. Change from baseline in AUC for TNSS revealed that when CE-BUD was compared to CE-BUD+AZ there was a significantly greater relief of nasal symptoms with the combination product than CE-BUD alone (P = 0.005) and when RA was compared with CE-BUD-AZ there was a significantly greater relief of nasal symptoms with the combination product than with RA alone (P = 0.009). RA was compared to AS+RA and there was no statistically significant difference after adjusted for multiple testing (P = 0.085) and this was also true when CE-BUD was compared with RA (P = 0.999). A comparison of CE-BUD+AZ with AS+RA indicated no statistically significant difference in nasal relief with the solubilized product compared with each product given individually and consecutively, however, TNSS was numerically lower for CEBUD+AZ. Conclusion: Meta analyses demonstrated that CE-BUD+AZ was significantly better than placebo and reduced TNSS when compared against CE-BUD or RA alone. CE-BUD+AZ administered in a convenient combination format provided comparable (with a trend to more) nasal symptom relief than either product (AS+RA) given separately and sequentially.

1569 Symptom improvement correlates with improvement in daily functioning in subjects with persistent allergic rhinitis treated with desloratadine 5 mg daily: results from the Aerius Control: Clinical and Evaluative Profile of Treatment-2 (ACCEPT2) trial in collaboration with Global Allergy and Asthma European Network Bousquet, MD, PhD, J1; Bindslev-Jensen, MD, PhD, C2; Sanquer, MD, PhD, F3; Zuberbier, MD, PhD, T4 1 Hoˆpital Arnaud de Villeneuve, Service des Maladies Respiratoires, Montpellier Cedex 5, France; 2Odense University Hospital, Department of Dermatology and Allergy Center, Odense, Denmark; 3Private Practice, Private Practice, Quimper, France; 4Charite´ Universita¨tsmedizin Berlin, Department of Dermatology and Allergy, Berlin, Germany

ity rather than time of occurrence. However, there is limited evidence on the effects of nonsedating second-generation antihistamines in patients with ARIA-defined persistent AR (PER; symptoms present for >4 days/week and >4 consecutive week/ year), and little is known about the relationship between symptom improvement and daily functioning. A post hoc analysis of the ACCEPT2 study evaluated this relationship in subjects with moderateto-severe PER treated with desloratadine (DL). Methods: In this multinational trial, subjects with moderate-to-severe PER (baseline score 9.5/15) were randomized to DL 5 mg or placebo QD for 12 week. The primary efficacy end point was mean change from baseline (MCB) in 12-h reflective (PRIOR) total 5-symptom score (T5SS; sum of nasal congestion, sneezing, rhinorrhea, and nasal and ocular pruritus scores averaged over Days 1–29). Symptoms were rated each morning and evening (AM/PM PRIOR T5SS) on a 4-point scale (0 = none; 3 = severe). Pearson correlation coefficients (r) were calculated for MCB in AM/PM PRIOR T5SS averaged over Days 1–29, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores at Day 29, Work Productivity and Activity Impairment (WPAI) questionnaire at Day 29, and interference with activities of daily living (ADL) averaged over Days 1–29 on a 0–3 scale (0 = none; 3 = severe). Results: DL-treated subjects (n = 355) included in this post hoc analysis were aged ‡12 years and had a history of PER ‡2 years. Significant (P £ 0.004) improvements were observed in AM/PM PRIOR T5SS (MCB-3.83), total RQLQ (MCB-1.33), WPAI activity score (MCB-19.74), and interference with ADL (MCB-0.64). Positive correlations were found between MCB in AM/PM PRIOR T5SS and MCB in total RQLQ (r = 0.53), in WPAI activity score (r = 0.46) and in interference with ADL (r = 0.67) (P < 0.0001 for all). Conclusions: Treatment with DL reduced the impact of AR symptoms on QoL in subjects with the greatest disease burden, as evidenced by the positive correlation of T5SS with improvement in daily functioning, including QoL, WPAI activity impairment, and interference with ADL scores.

Background: Allergic rhinitis (AR) impairs work, school, and social functioning; emerging evidence suggests that perennial AR is associated with greater quality of life (QoL) impairment than seasonal AR. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines recommend classifying AR based on symptom duration and sever 2009 The Authors Journal Compilation  2009 Blackwell Publishing Ltd Allergy 64 (Suppl. 90): 551–598

Late Breaking Poster Abstract Sessions – Allergy and Non-allergic Rhinitis

1570 Symptom and treatment patterns in Allergic Rhinitis and its Impact on Asthma–classified intermittent and persistent allergic rhinitis: a large observational study of subjects in general practice settings in France Demoly, MD, PhD, P1; Didier, MD, PhD, A2; Mesbah, MD, K3 1 Hoˆpital Arnaud de Villeneuve, Allergy DepartmentINSERM, Montpellier Cedex 5, France; 2Hopital Larrey, Clinique des Voies Respiratoires, Toulouse, France; 3 Schering-Plough France, Medical Director, Levallois-Perret, France

Introduction: Epidemiologic surveys show that a large proportion of allergic rhinitis (AR) patients are classified as having moderate/severe (m/s) AR, irrespective of duration category. The Caracteristiques et Evaluation des Symptoˆmes de la rhinite AlleRgique (CESAR) study sought to confirm these results by assessing the severity of symptoms in subjects with Allergic Rhinitis and its Impact on Asthma (ARIA)defined AR treated in general practice in France. Methods: Duration of AR and symptom severity rating were recorded by investigators on case report forms. Subjects were then categorized according to ARIA-defined classifications of mild intermittent AR (IAR), m/s IAR, mild persistent AR (PER), or m/s PER. Results: 195 investigators collected data from 1079 subjects (mean age 42 years; 53% women). Subjects were classified as having mild IAR (9.4%), m/s IAR (23.8%), mild PER (9.4%), or m/s PER (29.5%). An additional 17.8% of subjects were unclassified, and 10.2% had had no prior episode. The top 3 symptoms reported were rhinorrhea (94%), nasal obstruction (92%), and sneezing (92%). Intensity of rhinorrhea was rated as moderate or severe by 73.5% of subjects with m/s IAR; 72.6% and 70.4% reported moderate or severe intensity of nasal obstruction and sneezing, respectively. In subjects with m/s PER, intensity of rhinorrhea, nasal obstruction, and sneezing was rated as moderate or severe by 78.2%, 82.9%, and 68.6% of subjects, respectively. After diagnosis, oral AHs were the most prescribed medication (92.7% m/s IAR; 95.8% m/s PER), followed by topical corticosteroids (51.8% m/s IAR, 56.7% m/s PER) and intranasal AHs (27.9% m/s IAR, 28.0% m/s PER). Prior to study initiation,