Naslov
Polysensitization as a diagnostic problem in a clinical practice: a case report

Autori
Pevec, Branko ; Radulovic Pevec, Mira ; Stipic-Markovic, Asja ; Batista, Irena

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
Abstract book XXV Congress of the European Academy of Allergology and Clinical Immunology / - , 2006

Skup
XXV Congress of the European Academy of Allergology and Clinical Immunology

Mjesto i datum
Beč, Austrija, 10.06.2006. - 14.06.2006

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
polysensitization; cross-reactive; carbohydrate determinants

Sažetak
BACKGROUND Polysensitization is often caused by IgE antibodies to cross-reactive carbohydrate determinants (CCDs). They frequently originate from insect stings, but can also be induced by sensitization to pollen glycoproteins. Their clinical relevance is still controversial. We present a patient sensitized to a number of allergens, after several insect stings. METHODS SPTs were performed by standard and prick-by- prick methods. Specific IgE was measured by the CAP-System FEIA. Cross-reactivity of specific IgE was studied by FEIA inhibition, with a bee venom (100 µ ; ; ; g/ml and 800 µ ; ; ; g/ml) as the inhibitor. Nasal challenge was done using a pump-action spray method, and evaluated clinically and rhinomanometrically. Bronchial challenge was performed with increasing doses of the allergen, until a significant fall in FEV1. Oral challenge with different foodstuffs was done as an open procedure. CASE PICTURE A 71-year-old male Caucasian, previously diagnosed asthmatic, suffered a few severe systemic reactions following bee stings. Contrary, several wasp stings manifested with mild local reactions. SPTs were positive to a broad spectrum of allergens (house dust and storage mites, cockroach, bee and wasp venoms, tree, grass and weed pollens, different vegetable foodstuffs, and latex). Specific IgE antibodies were detected to each tested allergen (range: from 4.96 kU/L for peach to 12.80 kU/L for bee venom). Each sIgE, except anti-mite sIgE, could be significantly inhibited with a bee venom. The inhibition was greatest for anti-birch pollen sIgE (81% and 83% with 100 µ ; ; ; g/ml and 800 µ ; ; ; g/ml of bee venom, respectively), and lowest for anti-mugwort pollen sIgE (42% and 46% with 100 µ ; ; ; g/ml and 800 µ ; ; ; g/ml of bee venom, respectively). Nasal and bronchial challenges with mugwort pollen were positive. Two puffs of 20 mg/ml of allergen led to mild nasal secretion and irritation, without obstruction. Five inhalations of 4 mg/ml caused intensive cough and 37% fall in FEV1. Oral challenges were negative with corn, peanut, soy, bean, hazelnut, tomato, peach, olive, apple, melon, watermelon, citrus fruits, and banana. CONCLUSIONS Polysensitization in this patient is probably due to sensitization to CCDs caused by bee stings. Why are some cross-reactive allergens clinically relevant (mugwort pollen), and others, in spite of positive SPTs, are not (vegetable foodstuffs) remains unresolved. Further investigations are needed. Bee venom specific immunotherapy seems like a reasonable therapeutic option.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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