Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food hypersensitivity usually due to cow's milk or soy. Recent researches show that fish is 1 of the most important triggers of FPIES in the Mediterranean countries. Due to the risk of multiple-food FPIES, avoiding foods in the same category or that often occur together may be reasonable. The aim of this study was to evaluate the evolution and follow-up of FPIES related to fish over a period of 20 years. We describe the clinical features of our population, discuss different approaches to oral food challenges, and analyze the possibility of introducing the culprit fish or other nonrelated fish to avoid unnecessary restricted diets.

Palabras clave: Heparinas no fraccionadas. Heparinas de bajo peso molecular. Test intradérmicos. Prueba de provocación simple ciego. Valor predictivo negativo.

RATIONALE: Allergic reactions to NSAIDs are amongst the most common causes of reactions to non-prescription medications. Ibuprofen is one of the most commonly used NSAIDs. Herein, we describe a cohort of patients who presented with allergy to ibuprofen. METHODS: Consecutive patients were identified with ibuprofen allergy between 2008-2015 by retrospective chart review. These patients were characterized with respect to demographics, clinical characteristics of their reactions, number of ibuprofen reactions and anaphylaxis severity scores. This study was approved by the institutional REB. RESULTS: 36 patients were identified with allergy to ibuprofen confirmed on history. Females were more commonly affected (25F:11M). The mean age at first reaction was 33 years (range: 5-65). Patients had a mean of 2.31 reactions (range: 1-8) prior to diagnosis. Mean time from to onset was 70.18 minutes (range: 2-540). The mean duration of symptoms was 174.09 minutes (range: 20-690). Most patients had cutaneous involvement (89%); whereas 42% had upper airway and 42% had lower airway involvement. Cardiovascular manifestations were documented in 36% of patients. Anaphylaxis severity scores were calculated. Reactions were mild (grade 1 in 17/36), moderate (grade 2 in 18/36) and severe (grade 3 in 1/36). Co-existent asthma was associated with moderate to severe anaphylaxis to ibuprofen. CONCLUSIONS: Allergic reactions to ibuprofen are one of the most common causes of drug allergy. Patients most commonly affected are young females. Cutaneous involvement is almost always present, but many patients also report cardiopulmonary involvement. Most patients present with mild to moderate reactions, but reactions may be severe, especially in those with co-existent asthma.

Background:Paracetamol is a Non-Steroidal Anti-Inflammatory Drug (NSAID) that can produce hypersensitive reactions mediated by specific immunological mechanisms (IgE or T cell-dependent) or by a non-immunological mechanism (inhibition of cyclooxygenase COX-1).Objective:An 80-year-old man with a history of allergy to pyrazolones, with good tolerance to other NSAIDs was referred to our allergy department because he presented a generalized urticaria after the administration of Intravenous (IV) paracetamol.Methods:We performed an Intradermal Test (IDT) with paracetamol (0.02mg/ml) and later a Single Blind Oral Challenge Test (SBOCT) with oral paracetamol.Results:IDT reading at 15min showed negative result so an SBOCT was performed with oral paraceta-mol. With an accumulative dose of 250mg, after 20min, he developed discomfort, nausea and dizziness, urticarial, hypotension (BP 80/40) as well as flare-up phenomenon was observed in the site of the IDT with paracetamol. Tryptase levels during the reaction and 2hrs later were increased.Conclusion:We present an anaphylactic shock due to sensitization to paracetamol because of a type I hypersensitivity mechanism, diagnosed by SBOCT and a positive IDT because of flare-up phenomenon, in a patient with previous pyrazolones allergy and with tolerance to other NSAIDs. Some relevant patents are also summarized in this paper.

Catal a Oncol ogic (2) Unitat Diagn ostic Al.l ergia Medicamentosa. UDAM. Barcelona. Spain (3) Brigham and Women's Hospital. Boston. USA RATIONALE: The Institut Catal a d'Oncologia, (ICO), publishes 4 per thousand of adverse reactions to chemotherapy, mediated or not by allergic mechanisms, and, in most cases, leaving the first therapeutic lines, for second one, safer, but less effective and undoubtedly higher direct costs. Our aim, to reverse that process, to get the opportunity to keep those patients with the best of possible medications. METHODS: 2 Part-time allergists, 1 nurse specialized in drug allergy, 1 Pharmaceutical, under the coordination of 1 Head of Unit First visit, skin tests, risk stratification and desensitization decision, place and number of steps The desensitization protocols used are from Brigham and Women's Hospital of Boston RESULTS: 285 patients, with different types and stages of cancer; 801 cycles of desensitization, mainly to Platins and taxanes; 98% of successes (reaching final dose prescribed by oncologist) 70% were 12-step cycles and 25% of 16; All in Day Hospital CONCLUSIONS: A Chemotherapy Drug Desensitization Unit, managed by allergists, increases the population's survival expectations with cancer, being able to maintain the first therapeutic line, recommended by the international guidelines, and that of another Form, they are confronted with second choices, safer perhaps, but clearly less effective