SonoVue® (Bracco; Milan, Italy) is an ultrasound contrast medium which contains polyethylene glycol (PEG) or macrogol, an excipient responsible for severe allergic reactions, especially through the parenteral route, and widely used, especially in the health field. We present an adult patient who experienced an IgE-mediated anaphylactic shock due to macrogol contained in SonoVue®, as demonstrates the skin tests realized. The allergy study has been useful in our case because it has guided us in the preventive measures to advice to the patient, who has to avoid not only SonoVue® but also other products that contain macrogol. We consider this case of interest because it is an allergic adverse reaction to SonoVue® in which its excipient, macrogol, has acted like the allergen responsible. We have to add SonoVue® to the list of the products that contain macrogol in their composition and keep in mind the possible allergenic capacity of this excipient for suspecting its responsibility, especially in those patients with multiple drug allergy and/or reactions to products of different natures like ultrasound gels, topical products (e.g. toothpastes, antiseptics, sunscreens, etc.), plasma expanders and others.

Chronic spontaneous urticaria (CSU) is defined as the spontaneous appearance of wheals, angioedema, or both, for at least 6 weeks, due to known or unknown causes [1]. In some patients who present a CSU with daily or almost daily symptoms a type I allergy could be the underlying cause. We present one adult patient with chronic urticaria who was finally diagnosed as a non-occupational case of IgE-mediated wheat allergy manifested following exposure by 3 different routes: inhalation (rhinitis and bronchial asthma), dermal absorption (contact urticaria) and ingestion (systemic chronic urticaria). We were able to detect the culprit proteins by immunoblotting. Serum IgE binds mainly to alpha-amylase/trypsin inhibitors and, to a lesser extent, to other proteins associated with food allergy to grains (e.g. beta-glucanase, serpin, peroxidase). In our opinion, skin prick tests with a food standard battery could help in the etiological diagnosis of chronic urticaria. The identification of responsible allergens could be difficult because only a few complex in vitro techniques allow detecting the allergy to several proteins.

The seeds of Plantago ovata, called psyllium or ispaghula, have been used in the preparation of bulk laxatives. Nowadays, it is also used as an ingredient in bakery and breakfast cereals to increase dietary fiber and to give baking products fluffiness and viscosity. Mostly, there are described cases of occupational allergy that handle Plantago ovata seeds in powder laxatives and some cases of anaphylaxis after eating products containing psyllium. This case report is about a geriatric assistant who had an anaphylactic shock after eating a multigrain gluten-free piece of bread containing psyllium, who presented a positive skin test with psyllium in the allergy study. We recommended to the patient to avoid the ingestion and the inhalation at work of Plantago ovata seeds and to carry self-injectable adrenaline. With this case, we would like to highlight the growing uses of psyllium, especially in bakery products, and that it can behave like a hidden allergen.

Food allergy poses a major problem during childhood. Component-resolved diagnosis detects allergy to proteins isolated in food. This descriptive study analyzes the use of customized and standardized recommendations in a sample made up of 22 children aged 2 to 16 years old with plant food allergy and assesses sensitivity to four plant panallergens. According to component-resolved diagnosis results, therapy was personalized, guidelines on what foods or components to avoid were provided, and co-factors that may favor food allergic reactions were explained. No new reactions were referred by 20/22 cases. Oral allergy syndrome developed in 2/22 patients with allergy to profilin because they did not follow the recommendations. Component-resolved diagnosis was useful for the diagnosis and management of these children. Standardized recommendations, based on each patient's component-resolved diagnosis, prevented severe food allergic reactions.

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