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WHAT YOU SHOULD HAVE READ BUT….2010 ,[object Object],University of Verona, Italy Attilio Boner
Cefaclor anaphylaxis in children   Novembre  Allergy 2009:64:1233   5.1% In Children with Anaphylaxis 9 – 8 – 7 – 6 – 5 – 4 – 3 – 2 – 1 – 0 13/253 10 – ,[object Object],[object Object]
Cefaclor anaphylaxis in children   Novembre  Allergy 2009:64:1233   8 N° of Children with Anaphylaxis (N=13) 9 – 8 – 7 – 6 – 5 – 4 – 3 – 2 – 1 – 0 10 – 1 2 2 CEFACLOR  CEFTRIAXONE  AMOXICILLIN  BENZYL-  PENICILLIN  ,[object Object],[object Object]
Cefaclor anaphylaxis in children   Novembre  Allergy 2009:64:1233   8 N° of Children with Anaphylaxis (N=13) 9 – 8 – 7 – 6 – 5 – 4 – 3 – 2 – 1 – 0 10 – 1 2 2 CEFACLOR  CEFTRIAXONE  AMOXICILLIN  BENZYL-  PENICILLIN  ,[object Object],[object Object],The 8 children with cefaclor-induced anaphylaxis, all experienced symptoms within 30 min after cefaclor ingestion.
Cefaclor anaphylaxis in children   Novembre  Allergy 2009:64:1233   Amoxicillin  at concentrations of  2 and 20 mg/ml in normal saline for both prick and intradermal tests ,  cefaclor  at concentrations of  2 and 50 mg/ml in normal saline for prick testing , and 2 mg/ml for intradermal one. We prepared cefaclor sterile solutions no more than 2 h before testing, using the powder obtained from a capsule, as previously described.  (Romano A, Clin Exp Allergy 2005;35:1234–1242)   When prick tests were negative, 0.02 ml of the reagent solution was injected intradermally on volar forearm skin .  Readings were made 20 min after injections.  Results were considered positive when an increase larger than 3 mm in the initial wheal diameter accompanied by erythema was present.
7.6% (9/118) % of patient with a non-immediate reaction  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],10 – 5 – 0 Determining the negative predictive value of provocation tests with beta-lactams P. Demoly , Allergy 2010:65;327
7.6% (9/118) % of patient with a non-immediate reaction  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],10 – 5 – 0 Determining the negative predictive value of provocation tests with beta-lactams P. Demoly , Allergy 2010:65;327 Only 4  accepted a  re-challenge, negative in 2 cases and positive in the 2 others
7.6% (9/118) % of patient with a non-immediate reaction  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],10 – 5 – 0 Determining the negative predictive value of provocation tests with beta-lactams P. Demoly , Allergy 2010:65;327 The negative predictive value was 94.1% (111 out of 118 patients)
Resting basophils do not express CD63 (anchored in the basophilic granule) and weakly express CD203c. The cross-linking of two FcεRI (induced by an allergen or anti-IgE antibodies) provokes the histamine release (and as a consequence the  CD63 expression ) and the  upregulation of CD203c.   The rise in CD63 or CD203c expression (measured by fluorescence 2 / Phycoerythrin) before and after allergen challenge reflects thus the basophil activation / degranulation in response to an allergen.  basophil activation test by flow cytometry  * *
[object Object],[object Object],[object Object],[object Object],Usefulness of basophil activation test for the diagnosis of IgE-mediated allergy to quinolones B. Ben Said,  Allergy 2010;65;535
[object Object],[object Object],[object Object],Usefulness of basophil activation test for the diagnosis of IgE-mediated allergy to quinolones B. Ben Said,  Allergy 2010;65;535
[object Object],[object Object],[object Object],Usefulness of basophil activation test for the diagnosis of IgE-mediated allergy to quinolones B. Ben Said,  Allergy 2010;65;535
Immunogloblin E-mediated immediate allergic reactions to dipyrone: value of basophil activation test in the identification of patients.  Gómez C EA 2010;39:1217  ,[object Object],[object Object],[object Object]
Immunogloblin E-mediated immediate allergic reactions to dipyrone: value of basophil activation test in the identification of patients.  Gómez C EA 2010;39:1217  Background:  Pyrazolones are a major cause of immediate IgE-mediated reactions to drugs in many countries. Objective:  The aim of the study was to evaluate  a group of patients with this type of reaction by basophil activation test (BAT), focusing on the influence of the time since the reaction on the rate of positive results.
Immunogloblin E-mediated immediate allergic reactions to dipyrone: value of basophil activation test in the identification of patients.  Gómez C EA 2010;39:1217  ,[object Object],[object Object],85.7% % Patients with (+) SPTs 90 – 80 – 70 – 60 – 50 – 40 – 30 – 20 – 10 – 0 100 –
Immunogloblin E-mediated immediate allergic reactions to dipyrone: value of basophil activation test in the identification of patients.  Gómez C EA 2010;39:1217  ,[object Object],[object Object],Comparison of the basophil activation test with dipyrone at two concentrations in patients who were skin-test positive or negative to dipyrone.
Immunogloblin E-mediated immediate allergic reactions to dipyrone: value of basophil activation test in the identification of patients.  Gómez C EA 2010;39:1217  ,[object Object],[object Object],  Basophil activation test survival analysis over a 30-month period
Immunogloblin E-mediated immediate allergic reactions to dipyrone: value of basophil activation test in the identification of patients.  Gómez C EA 2010;39:1217  ,[object Object],[object Object],  Basophil activation test survival analysis over a 30-month period  Follow-up of the  BAT-positive patients showed a decrease over time, with 60% of these patients becoming negative after 6 months.
Immunogloblin E-mediated immediate allergic reactions to dipyrone: value of basophil activation test in the identification of patients.  Gómez C EA 2010;39:1217  ,[object Object],[object Object],  Basophil activation test survival analysis over a 30-month period  The time of performance of the test is critical to obtain a positive response.
[object Object],[object Object],[object Object],[object Object],Methylprednisolone-induced anaphylaxis: diagnosis by skin test and basophil activation test B. Ben Said,   Allergy 2010;65;531
[object Object],[object Object],[object Object],[object Object],Methylprednisolone-induced anaphylaxis: diagnosis by skin test and basophil activation test B. Ben Said,   Allergy 2010;65;531
[object Object],[object Object],[object Object],Take home

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Drug allergy

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  • 5. Cefaclor anaphylaxis in children Novembre Allergy 2009:64:1233 Amoxicillin at concentrations of 2 and 20 mg/ml in normal saline for both prick and intradermal tests , cefaclor at concentrations of 2 and 50 mg/ml in normal saline for prick testing , and 2 mg/ml for intradermal one. We prepared cefaclor sterile solutions no more than 2 h before testing, using the powder obtained from a capsule, as previously described. (Romano A, Clin Exp Allergy 2005;35:1234–1242) When prick tests were negative, 0.02 ml of the reagent solution was injected intradermally on volar forearm skin . Readings were made 20 min after injections. Results were considered positive when an increase larger than 3 mm in the initial wheal diameter accompanied by erythema was present.
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  • 9. Resting basophils do not express CD63 (anchored in the basophilic granule) and weakly express CD203c. The cross-linking of two FcεRI (induced by an allergen or anti-IgE antibodies) provokes the histamine release (and as a consequence the CD63 expression ) and the upregulation of CD203c. The rise in CD63 or CD203c expression (measured by fluorescence 2 / Phycoerythrin) before and after allergen challenge reflects thus the basophil activation / degranulation in response to an allergen. basophil activation test by flow cytometry * *
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  • 14. Immunogloblin E-mediated immediate allergic reactions to dipyrone: value of basophil activation test in the identification of patients. Gómez C EA 2010;39:1217 Background: Pyrazolones are a major cause of immediate IgE-mediated reactions to drugs in many countries. Objective: The aim of the study was to evaluate a group of patients with this type of reaction by basophil activation test (BAT), focusing on the influence of the time since the reaction on the rate of positive results.
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