435 Side-Effects of Ultra Rush Insect Venom Immunotherapy—Retrospective Study

A. C. Costa1, R. Alves1, S. L. Silva1, E. Pedro1, M. C. Santos2, M. A. P.Barbosa1; 1Immuno-allergology Unit, Santa Maria Hospital, Lisbon,PORTUGAL, 2Clinical Immunology Unit, Santa Maria Hospital, Lisbon,PORTUGAL.RATIONALE: Ultra rush immunotherapy (URI) protocol is regarded assafe, well tolerate and that give more rapid protection but fear of side-effects (SE) may prevent its use. Aim of this study was to analyze safetyand tolerance and to determine the risk factors for development SE inpatients treated with a 3.5 hours URI protocol (cumulative dose of101�g), divided in 6 applications.METHODS: 41 URI protocols of 40 patients (28M, 12F; 10-75 years,mean age: 44) with systemic reactions to insect stings (Mueller classifi-cation) were analyzed retrospectively. All patients had been treated withstandardized venom aqueous extracts (Dome Hollister Stier-DHS): bee(B=27), wasp (W=12), polistes (P=2), wasp and polistes (1) venom. Local(L) and systemic (S) reactions occurred during URI were evaluated.RESULTS: Sting reactions previous URI: Grade I-1(1W), Grade II-3(2B,1W), Grade III-19(13B, 5W, 1P), Grade IV-17 (12B, 4W, 1 W+P). Spe-cific IgE: Class I/II: B-9, W-7, P-2; Class III/IV: B-15, W-5; Class ≥V: B-3. During URI protocol we observed: LR (39%) in 16 and SR (29.2%) in12 patients: G I - 9 (22%) (B-7, W-2); G II - 1 (2.4%) (B); G III - 1 (2.4%)(B); G IV - 1 (2.4%) (W). Sex, age, severity to insect sting reactions, spe-cific IgE were not related with occurrence and severity of SR during URI.CONCLUSIONS: The frequency of SR (29.2%) was similar with thedata in the literature and the majority was Grade I. Bee venom allergy andatopic disease increased the risk, but not the severity, of SR during URI.

T. Carrillo1; 1Sección de Alergia, Hospital Dr. Negrín, Las Palmas de GC,SPAIN, 2Servicio de Inmunología, Hospital Dr. Negrín, Las Palmas deGC, SPAIN, 3Unidad de Investigación, Hospital Dr. Negrín, Las Palmasde GC, SPAIN.RATIONALE: The latex-fruit syndrome is a well-defined disorder,whose genetic background has not been elucidated.METHODS: In a case-control study, we have investigated a carefullyselected group of latex allergic patients, searching for association betweenlatex-fruit allergy and HLA class I and II genes, HLA-DR functionalgroups, and markers IL4-RI and FcεRI-�ca.RESULTS: Seventy eight latex allergic patients without spina bifida,33% of them also allergic to fruits, were included in our protocol. Skinprick test (SPT) results with both a commercial latex extract and purifiedhevein were significantly greater in latex-fruit than in latex not-fruit aller-gic patients. A cut-off point of > 7 mm for commercial latex SPT diag-nosed latex-fruit allergy with a sensitivity of 66.7% (95% CI, 41.0-86.6)and a specificity of 83.3% (95% CI, 68.6- 93.0). No significant differ-ences were found regarding HLA class I, IL4-RI or FcεRI-�ca allele dis-tributions. However, comparison of HLA class II allelic frequenciesbetween latex-fruit and latex not-fruit allergic patients showed significantassociations of latex-fruit allergy with DQB1*0201 (Pc=0.001, OR=7.3,with a 95% CI of 2.6-20.0), as well as with HLA-DR functional group “E”(Pc=0.028; OR=16.0, with a 95% CI of 1.9-134.1). When comparingallelic distribution among different subgroups of latex-allergic patients,additional significant associations of latex-fruit allergy with DRB1*0301and *0901, and of latex not-fruit allergy with DQB1*0202, DRB1*0701and *1101, were also demonstrated.CONCLUSIONS: Latex-fruit allergy is associated with HLA-DQB1*0201, DRB1*0301 and *0901, as well as with HLA-DR function-al group “E”, while latex not-fruit allergy is associated with DQB1*0202,DRB1*0701 and *1101 alleles.Funding: Instituto de Salud Carlos III

438 Concurrent Latex and Seminal Fluid Allergy

M. R. Rupp, G. D. Marshall, Jr., R. D. deShazo; Allergy and Immunolo-gy, University of Mississippi Medical Center, Jackson, MS.RATIONALE: To report a case of latex allergy in a patient with seminalfluid (SF) allergy.METHODS: A 23-year-old female complained of dyspareunia with post-coital vaginal soreness and swelling. She also reported sore throat and lipswelling after oral sex and had experienced abdominal urticaria after ejac-ulate exposure. She also reported labial pain and swelling after protectedsex with condoms. Following unprotected intercourse she experienced anepisode of angioedema, generalized urticaria, and dyspnea that requiredan emergency room visit for treatment with antihistamines, steroids, andepinephrine. Ejaculate from her sexual partner was prepared for skin pricktesting (SPT) on the patient and her partner (as a control) by filtration andcentrifugation. MEDLINE was searched for case reports of concurrentlatex and SF allergy.RESULTS: She was SPT positive to SF (1:1000) [6 mm wheal; histamine8mm; saline 0mm]. Her partner was similarly tested and was found to beSF negative [histamine 7mm]. Her latex RAST was positive. MEDLINEsearch revealed one report of associated latex and SF allergy.CONCLUSIONS: To our knowledge, this represents the second reportedcase of concurrent SF and latex allergy. This patient initially volunteeredinformation related to symptoms after exposure to ejaculate, but lateradmitted to similar symptoms when exposed to latex condoms. Such ahistory could lead away from SF sensitivity altogether or could lead todismissing a role for latex. This may be more frequent than is commonly

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436 Assessment of Current Practice in Concomitant Use of ACEInhibitor and Hymenoptera Venom Immunotherapy

P. Gogineni1, J. Baldwin2, E. Robinson1, N. T. Gunaratnam1; 1St. JosephMercy Health System, Ann Arbor, MI, 2Allergy and Immunology, Uni-versity of Michigan, Ann Arbor, MI.RATIONALE: Reports of anaphylactic reactions in patients onangiotensin converting enzyme inhibitors (ACEI) receiving immunother-apy are found in literature as early as 1990. In addition, one manufactur-er of hymenoptera vaccine, Hollister-Stier, has warned of possible inter-actions between this product and ACEI therapy. Therefore, it is importantto assess current practices in simultaneous ACEI and Hymenopteravenom immunotherapy administration.METHODS: A survey was sent to a subset of US members in the Amer-ican Academy of Allergy, Asthma, and Immunology whose e-mailaddresses were collated from the Academy’s 2002 directory. The subsetincludes all members for whom an e-mail address was valid (N= 1443).RESULTS: Of the 370 (26%) respondents to date, the mean age and yearsof allergy experience were 51 and 17 respectively. Ninety-one percent holdor discontinue beta-blockers, while only 14% hold or discontinue ACEIs.A significantly higher proportion of allergists stop beta-blockers than thosewho stop ACEI (p<.001). There was no allergist who held or stopped ACEIwho did not also hold or stop beta-blockers. Of the allergists who do holdor stop ACEI, there is no significant difference in the proportion using theHollister-Stier versus those who use ALK Laboratories vaccine.CONCLUSIONS: Only 14% of allergists currently hold or stop ACEIbefore immunotherapy, despite 49% of respondents using a vaccine thatcarries the concomitant warning. Until the relationship between ACEIsand Hymenoptera immunotherapy is studied further and a standard of careis established, it is important for allergists to be aware of the potentialincreased anaphylaxis risk associated with simultaneous use.Funding: St. Joseph Mercy Hospital

437 Genetic Basis of the Latex-Fruit Syndrome: Association WithHLA-Class II Alleles

C. Blanco1, F. Sánchez-García2, M. J. Torres-Galván3, A. G. Dumpier-rez1, L. Almeida1, J. Figueroa1, N. Ortega1, R. Castillo1, M. D. Gallego1,

appreciated. Thus, careful history and latex testing should be consideredfor patients reporting SF-induced symptoms.