Emmanouil Manousakis

Cow’s milk allergy as a cause of anaphylaxis to systemic corticosteroids

unblinded manner. Six to ten hours after consumption of kiwi she reproducibly developed an itchy rash consisting of confluent 3–5 mm purpuric macules and papules on the legs, lower trunk and forearms with consecutive bleeding in the central part of the lesions. Oral provocations with apple, banana and pineapple were negative. Western Blot analysis of a kiwi fruit extract with the patient’s serum showed IgG-, but no IgE-reactivity, corresponding to themajor kiwi fruit antigen Act c 1 (Fig. 1C). HE staining of a fresh lesion, that was taken soon after appearance, showed neutrophilic infiltration in and around cutaneous vessels with leucocytoclasia consistent with leucocytoclastic (allergic) vasculitis (Fig. 1D/E). In the light of the patient’s history, diagnostic findings and the reproducible induction of symptoms by oral provocation with kiwi, we diagnosed ‘kiwiinduced allergic leucocytoclastic vasculitis’. Elimination diet with avoidance of the consumption of kiwi lead to slow resolution of the purpuric lesions and hyperpigmentations over time. No recurrences of vasculitis were observed over a period of 3 years. Using repeated oral food challenges we were able to identify kiwi fruits as a causal elicitor of allergic vasculitis. The presence of Act c 1-specific IgG strongly supports an antigen-specific process, but food-specific IgG antibodies are also frequent finding in healthy individuals (1). Foodstuff is rarely considered as a cause for allergic vasculitis in clinical practice and is reported only anecdotally in current literature (rye, carrot, cow’s milk, hen’s egg, cocoa products and additives) (2–4). Strikingly, in our patient mainly dependent body regions like legs and feet were affected by vasculitis and therefore, the formation of IgG immune complexes with kiwi antigen and their deposition in dermal postcapillary venules can be assumed as pathogenic process (5). The authors report no conflict of interest. J.G., S.K., and J.R. cared for the patient. J.G. and S.K. wrote the manuscript. M.O., M.M. and J.R. reviewed the manuscript. M.O. performed the western blot.

Omalizumab in pediatric cold contact urticaria: warm blanket for a cold bath?

1. McWilliam V, Koplin J, Lodge C, Tang M, Dharmage S, Allen K. The prevalence of tree nut allergy: a systematic review. Curr Allergy Asthma Rep 2015: 15: 1–3. 2. Cummings AJ, Knibb RC, King RM, Lucas JS. The psychosocial impact of food allergy and food hypersensitivity in children, adolescents and their families: a review. Allergy 2010: 65: 933–45. 3. Eller EU, Bindslev-Jensen C. Clinical value of component-resolved diagnostics in peanut-allergic patients. Allergy 2013: 68: 190–4. 4. Beyer K, Grabenhenrich L, H€artl M, et al. Predictive values of component-specific IgE for the outcome of peanut and hazelnut food challenges in children. Allergy 2015: 70: 90–8. 5. Savvatianos S, Konstantinopoulos AP, Borg a A, et al. Sensitization to cashew nut 2S albumin,Anao3, ishighlypredictiveofcashew and pistachio allergy in Greek children. J Allergy Clin Immunol 2015: 136: 192–4. 6. CiprandiG,PistorioA,SilvestriM,RossiGA, Tosca MA.Walnut anaphylaxis: the usefulness of molecular-based allergy diagnostics. Immunol Lett 2014: 161: 138–9. 7. Theofficial listofallergens.WHO/IUIS AllergenNomenclatureSub-Committee. http://www.allergen.org/AccessedJune2016. 8. Sordet C, Culerrier R, Granier C, et al. Expression of Jug r 1, the 2S albumin allergen from walnut (Juglans regia), as a correctly folded and functional recombinant protein. Peptides 2009: 30: 1213–21. 9. Scala E, Till SJ, Asero R, et al. Lipid transfer protein sensitization: reactivity profiles and clinical risk assessment in an Italian cohort. Allergy 2015: 70: 933–43. 10. Maloney JM, Rudengren M, Ahlstedt S, et al. The use of serum-specific IgE measurements for the diagnosis of peanut, tree nut, and seed allergy. J Allergy Clin Immunol 2008: 122: 145–51.

PD02 - Observational follow-up study with the Pan-European standard prick test to determine inhalant allergen sensitisation rates in a Greek population

Skin prick testing (SPT) is the standard method for diagnosing allergic sensitization. Correct diagnosis of inhalant allergies, requires knowledge of the most important inhalant allergen sensitizations. Few data are available regarding the prevalence of these sensitizations in Greece.

PD17 - Food allergy profile in late adolescence in a tertiary healthcare facility

Results Among 56 patients (46 male, age range 14-22,5 years, median 16,6 years) 55% had positive family history of atopy, 64% reported atopic dermatitis and 80% asthma and/or allergic rhinitis. 1/3 developed their first reaction to a food allergen during infancy, the main allergens being egg (11%), milk (9%) and fish (7%).32% first experienced FA as preschoolers, 27% between 6-12 years and only 11% in adolescence. In 21/56 patients the first reaction was anaphylaxis. All subjects became tolerant to milk and egg before adolescence. The most common allergens in late adolescence were nuts (including peanut) (55%), fruits (25%), fish (23%) and sesame seed (9%). Nut allergy appeared in 48,4% (15/31 patients) in preschool years, in 25,8% between 6-12 years and in 25,8% during adolescence. The rates for fish allergy apparition were 69,2%(9/13 patients), 23,1% and 7,7%, respectively. Fruit allergy emerged in most patients between 6 12 years old. Only 2 patients became tolerant to fish and 3 to nuts before/during adolescence. Over half of the patients experienced at least 1 anaphylactic reaction and 20% had 2 or more. An adrenaline auto-injector was prescribed to 80% of the patients. Nevertheless, only 18% reported carrying it at all circumstances and 20% occasionally.

PD19 - Co-recognition of lipid transfer protein in pollen and foods in a Greek pediatric population

PD19 Co-recognition of lipid transfer protein in pollen and foods in a Greek pediatric population Dimitrios Karantoumanis, Savvas Savvatianos, Anastasios P Konstantinopoulos, Dimitrios Koutsalitis, Anna Pananaki , Maria Psomiadou, Kassiani Tzeli, Marianna Tziotou, Dimitrios Mitsias, Eirini Roumpedaki, Stavroula Giavi, Paraskevi Xepapadaki, Nikolaos Douladiris, Emmanouil Manousakis, Nikolaos G Papadopoulos

P31 - Natural history of wheat allergy in Greek children

Methods We completed a retrospective medical record review of patients from the Allergy Clinic, 2nd Pediatric Clinic, University of Athens that were diagnosed as having wheat allergy. Patients were included in the study if they had a history of symptomatic reaction to wheat and or a positive wheat IgE test result. Clinical history, laboratory results, and final outcome were recorded for 70 patients. Resolution of wheat allergy was based on food challenge results. Total IgE, wheat IgE (f4), specific gluten IgE (f79) and the ratio f4/ lgE, (at presentation), were compared between children with active or resolved wheat allergy, 4 years after their first reaction, performing the non-parametric Mann-Whitney test.

PD23 - Decision points for boiled egg challenges in Greek children with sensitisation to egg proteins

Decision points based on food-specific IgE antibody concentrations have been proposed and are used in the clinic, in order to predict reactivity to foods and reduce the number of high risk food challenges. In the process of screening for eligibility in a study, we started carrying out open food challenges to boiled egg in children with sensitization to egg proteins, independent of their skin reactivity and specific IgE concentrations. In several occasions, the expected cut-off points were not confirmed. Furthermore, cut-off points have been evaluated in children with clinical indications of allergy and not in those who are only sensitized. Therefore, we hypothesized that decision points for this population may need to be reevaluated.

PD38 - Clinical features and natural history of cold contact urticaria in children

Cold contact urticaria (CCU) or Acquired cold urticaria is a common subtype of physical urticaria characterized by itchy wheals and/or angioedema after cold exposure. However, extensive cold contact of large skin areas may lead to systemic reactions.The prevalence and course of CCU is not well defined.

P28 - Wells’ syndrome (or Eosinophilic Cellulitis) – a case report.

Background Wells syndrome belongs in diseases with eosinophilic involvement in specific organs (eg, skin, lungs). Peripheral eosinophilia (mild or moderate-profound) is present in more than 50%. May be idiopathic, associated with drugs, or even associated with myeloproliferative, immunological or infectious diseases. Reported about 80 incidents worldwide. Has an excellent prognosis. It tends to resolve in weeks or months, usually without scarring. It occasionally recurs. In these recurrent cases, it can take years to ultimately resolve.

Cow’s milk allergens as an infrequent cause of anaphylaxis to systemic corticosteroids

Case 1 A 9-year-old boy with a history of severe persistent cow’s milk allergy (CMA) was seen at the Emergency Department due to a virus-induced asthma exacerbation presented with wheezing and moderate dyspnea. The boy was administered nebulized salbutamol and 40mg of MP intravenously. Wheezing deteriorated, so the boy was given another course of the same medication. Within a few minutes the patient acutely collapsed, with hypotension, cyanosis and respiratory arrest and had to be immediately transferred to the IC Unit, where he was injected epinephrine and was intubated.