Krzysztof Gomułka

Contact urticaria syndrome caused by haptens

In the group of urticaria, contact urticaria syndrome is a particular variety. In these patients, appearance of typical skin lesions is preceded by contact of the skin and mucous membranes with various inhaled allergens, nutrients or contact details. Furthermore, symptoms connected with contact urticaria syndrome are characterized by gradual, stepwise waveform, which can be easily generalized – patients may develop systemic symptoms similar to those found in the angioedema, asthma or anaphylactic shock. It is an attribute of contact urticaria syndrome in the course of which potentially life-threatening symptoms may develop after contact of the skin with the allergen. The underlying mechanisms are poorly understood; both immunological and non-immunological mechanisms are taken into account, therefore contact urticaria syndrome can be classified into two categories – allergic and non-allergic. An intriguing phenomenon seems to be the immediate reaction after exposure to low molecular weight allergens – haptens, such as metals, which are usually the cause of delayed allergic reactions. Diagnosis is based on clinical presentation indicating a coincidence of the onset of allergy with contract with allergen, and helpful exposure tests. Treatment consists of supportive antihistamines and corticosteroids – locally and systemically. In the case of anaphylaxis, appropriate treatment intensification of the integration of pressor amines and hydration is necessary. It is also regarded that prevention is advisable, which consists of relevant information to avoid situations connected with contact with well-known factors. In this paper we describe a case of a 57-year-old female admitted to the Department of Internal Medicine, Geriatrics and Allergology, Medical University in Wroclaw to undergo diagnostic tests of chronic urticaria and angioedema. According to information obtained from the clinical presentation and after the diagnostic procedures, contact urticaria syndrome due to exposure to metals was diagnosed.

Food-dependent, exercise-induced anaphylaxis triggered by co-incidence of culprit food, physical effort and a very high dose of ibuprofen or menstruation: a case report

Address for correspondence: Krzysztof Gomułka MD, PhD, Department of Internal Diseases and Allergology, Medical University of Wroclaw, 66 Marii Curie-Skłodowskiej St, 50-369 Wroclaw, Poland, phone: +48 71 784 25 28, e-mail: kgomulka@wp.pl Received: 11.12.2015, accepted: 22.04.2016. Food-dependent, exercise-induced anaphylaxis triggered by co-incidence of culprit food, physical effort and a very high dose of ibuprofen or menstruation: a case report

The diagnostic usefulness of the basophil activation test (BAT)with annexin V in an allergy to Alternaria alternata

BACKGROUND The basophil activation test (BAT) is an effective diagnostic tool in mold allergy, which is still not sufficiently known. OBJECTIVES The aim of our study was to assess the degree of annexin V binding to the surface of the basophil cell membrane after stimulation with anti-immunoglobulin E (anti-IgE) and Alternaria alternata allergenic extract. MATERIAL AND METHODS Alternaria alternata allergic patients (n = 32) and healthy volunteers (n = 33) were evaluated using skin prick tests (SPT), quantification of specific IgE (sIgE) and the BAT. Basophil activation was detected as a percentage degree of annexin V binding to the surface of the basophil cell membrane. RESULTS Receiver operating characteristic (ROC) curve analysis yielded a threshold value of 4.95% of activated basophils when the tested group and control group were studied, with a sensitivity and specificity of 100% (area under curve [AUC] = 1; p = 0.00000) for 100 SBU/mL Alternaria alternata allergen extract. The threshold value was 10.28% with a sensitivity of 93.8% and specificity of 100% (AUC = 0.98958; p = 0.00000) for 10 SBU/mL mold extract, and 9.37% with a sensitivity of 90.3% and specificity of 100% (AUC = 0.96307; p = 0.00000) for 1 SBU/mL Alternaria alternata allergen extract. The method was least efficacious in antiIgE stimulation, where the threshold value was 5.48% with a sensitivity of 90.6% and specificity of 30.3% (AUC = 0.46780; p = 0.67039). CONCLUSIONS The BAT with annexin V and sIgE measurement against Alternaria alternata increase the capability of a diagnostic laboratory for detecting mold sensitization. Both methods may certainly replace SPT, which are currently routinely used in allergy diagnosis. Annexin V may be considered a new basophil activation marker with an efficacy comparable to that of CD63 or CD203c.

Systemic contact dermatitis caused by cobalt chloride and palladium in a 26-year-old woman with allergic type I reactions, non-steroidal anti-inflammatory drug hypersensitivity and autoimmune thyroiditis

Address for correspondence: Krzysztof Gomułka MD, PhD, Department of Internal Medicine and Allergology, Wroclaw Medical University, 66 Marii Curie-Skłodowskiej St, 50-369 Wroclaw, Poland, phone: +48 71 784 25 28, e-mail: kgomulka@wp.pl Received: 2.11.2015, accepted: 4.10.2016. Systemic contact dermatitis caused by cobalt chloride and palladium in a 26-year-old woman with allergic type I reactions, non-steroidal anti-inflammatory drug hypersensitivity and autoimmune thyroiditis