World Allergy Organization Journal 2015, Volume 8 Suppl 1 http://www.waojournal.org/supplements/8/S1

MEETING ABSTRACTS

Open Access

3rd WAO International Scientific Conference (WISC) 2014 Rio de Janeiro, Brazil. 6-9 December 2014 Published: 8 April 2015 These abstracts are available online at http://www.waojournal.org/supplements/8/S1

MEETING ABSTRACTS A1 Perception of allergy in cinematography Georgios Mavroleon1*, Georgios Koutalonis2 1 Private clinic, Sfakion 10-12, 73134, Chania, Crete, Greece; 2Private clinic, Tzanakaki 21, 73100, Chania, Crete, Greece World Allergy Organization Journal 2015, 8(Suppl 1):A1 Background: Allergic symptoms are presented in everyday life. Cinematography, as a form of art describing life, has many incidents regarding allergy and even mechanisms involved. Methods: Collect movies and TV series for the last 10 years, editing the few second parts, commenting on rightness or false of the screen play. Results: There are many referrals in allergic symptoms and patients, but not all the presentations are correct and this could lead to wrong perception in public of what allergy really is and how specialists could help. Conclusions: There is an increased interest in the presentation of allergic patients in movies and it is our duty to get involved and set the records staight.

A2 The role of patch testing in non-immediate drug hypersensitivity reactions Razvigor Darlenski*, Nikolai Tsankov Tokuda Hospital, Sofia, Bulgaria World Allergy Organization Journal 2015, 8(Suppl 1):A2 Background: Skin is the most commonly affected organ by adverse drug reactions in almost 30% of all cases. According to the international consensus on drug allergy, drug hypersensitivity reactions (DHRs) constitute 15% of all adverse drug reactions affecting more than 7% of the general population. Methods: Herein we present case series of various non-immediate DHRs (occurring at any time as from 1 hour after the initial drug administration) amongst which drug-related intertriginous and flexural exanthema (Baboon syndrome), DRESS syndrome, fixed drug eruption and contact dermatitis. In all cases we performed patch testing with standardized and allergens prepared at our laboratory with the suspected drugs. The timing of patch test procedure was in median 6 weeks after the resolution of skin changes. Results: Based on the patch test results, we comment on the sensitivity and specificity of patch test in non-immediate DHRs. Different variables influence patch testing in DHRs such as allergen preparation, vehicle, concentration, intake of certain medications and testing healthy controls with the suspected allergens. We emphasize on these and on the demand for control and interpretation of the results. The role of web drug allergen databases in preparation of proper drug concentration and vehicle for patch testing is reviewed.

Conclusions: This presentation reports the personal experience with in vivo skin patch testing in patients with non-immediate DHRs.

A3 Development and treatment of steroid resistant asthma model by adoptive transfer of murine helper t cell clones Akio Mori*, Satoshi Kouyama, Miyako Yamaguchi, Yo Iijima, Akemi Ohtomo, Takayuki Ohtomo, Jun Itoh, Kentaro Watarai, Chihiro Mitsui, Chiyako Oshikata, Yuma Fukutomi, Kiyoshi Sekiya, Hiroaki Hayashi, Takahiro Tsuburai, Yuji Maeda National Hospital Organization, Sagamihara National Hospital, Japan World Allergy Organization Journal 2015, 8(Suppl 1):A3 Background: To investigate the role of helper T (Th) cells in steroid resistant (SR) asthma, steroid sensitive (SS) and resistant (SR) Th clones were selected in vitro, and then adoptively transferred into unprimed mice. Effect of CTLA4-Ig was analyzed both in vitro and in vivo. Methods: For in vitro evaluation of steroid sensitivity, ovalbumin (OVA) reactive Th clones were cultured with antigen presenting cells and OVA in the presence of various concentrations of dexamethasone (DEX). Proliferative responses of Th clones were measured by 3 H-thymidine incorporation. For in vivo evaluation, unprimed BALB/c mice were transferred with Th clones, challenged with OVA, and administered with DEX subcutaneously. Bronchoalveolar lavage fluid (BALF) was obtained 48 hr after challenge, and the number of infiltrating cells was differentially counted. CTLA4-Ig was administered either intravenously or intranasally. Results: SS and SR clones were selected based on the suppressive effect of DEX on the proliferative responses of antigen-stimulated Th clones. Airway infiltration of eosinophils and lymphocytes of mice transferred with SS clones were effectively inhibited by the administration of DEX. In contrast, those of mice transferred with SR clones were not significantly inhibited. Administration of CTLA4-Ig significantly suppressed the proliferation of DEX-treated SR clones in vitro, and the eosinophil infiltration of mice transferred with SR clones in vivo. Conclusions: Steroid sensitivity of Th clones assessed in vitro was consistent with that of adoptively transferred asthma model assessed in vivo. Costimulatory signal mediated through CD28 is crucial for the induction of steroid resistance both in vitro and in vivo.

A4 Economic costs of asthma in Brazil: a one year real life study in outpatient setting Eduardo Costafsilva*, Rogerio Rufino, Mauricio Bregman, Denizar Vianna Araújo, Claudia Costa State University of Rio De Janeiro, Brazil World Allergy Organization Journal 2015, 8(Suppl 1):A4 Background: Asthma cost have been studied predominantly in severe asthma and inpatient care. It is still unknown in different levels of severity

© 2015 various authors, licensee BioMed Central Ltd. All articles published in this supplement are distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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and in different regions of the world. The aim was to estimate economic costs of asthma treatment in specialized outpatient care in a big city of Brazil. Methods: Persistent asthmatics ≥ 6 years old under GINA outpatient treatment were consecutively included in a real life design and a society perspective/bottom-up approach. They underwent routine clinical visits at 3- to 4-month intervals and 2 interviews with 6-month intervals using a structured instrument, made by researchers not involved in their clinical treatment. Data on asthma costs were collected directly from patients or parents, regarding prior 3 to 6 months . Collected data were valued in Brazilian Reais (R$) by using data banks from Brazillian Ministry of Health (for public resources), Brazillian Medical Association (for suplemmentary system resources) and values informed by patients for private resources expenditures. Exchange rate used was US$ 1.00 = R$ 1.89 (purchasing power parity in 2012/World Bank). Results: Of 117 subjects, 108 completed the study, with female predominance (n=79/73.8%). In initial evaluation, 16 (14.8%) had severe, 39 (36.2%) had moderate and 53 (49%) had mild asthma. Rhinitis was present in 83.3%, and 59.2% were overweighted or obese. The majority had elementary scholling (n=76/70.4%) and the mean monthly family income was US$ 1,202.90 (SD=880.37), the lowest stratum of medium economic class in Brazil. The estimated mean asthma cost was US$ 882.37 per patient-year (SD=717.97), corresponding to 7% of mean annual family income (MAFI) and to 6% of per capita gross domestic product (GDP). Estimated mean cost of asthma plus rhinitis and associated respiratory infections reached US$ 1,005.22 per patient-year (SD=724.07), which corresponds to 8.3% of MAFI and 7% of per capita GDP. The severe, not controlled, obese and overweight asthmatics had greater asthma costs when compared to mild, controlled and normal weight ones, (differences=449.5%, 142.7%, 51.7% and 35.6%, respectively). Conclusions: It is the first study describing data on associated costs of outpatient treatment of asthma in different severity levels in Brazil, which with think can be useful for public health policies. The annual estimated cost represents an important impact on family budgets and per capita GDP. Public health strategies offering wide access to treatment and stimulating weight reduction can contribute to better results, reducing costs of asthma in Brazil.

A5 A comparison between ARIA and visual analogic scale methods for classifying allergic rhinitis severity Eduardo Costafsilva1*, Tatiana Menezes Monteiro1, Anna Carolina Nogueira Arraes1, Gabriela Andrade C Dias1, Denise Lacerda Pedrazzi1, Guilherme Loureiro Werneck2, Maria Ines Perelló1 1 State University of Rio De Janeiro, Brazil; 2Federal University of Rio De Janeiro, Brazil World Allergy Organization Journal 2015, 8(Suppl 1):A5 Background: There are different classification systems for allergic rhinitis (AR) severity, whose are used to guide treatment. Clinical observation suggests that ARIA method, made by doctors, and visual analogic scale of symptoms (VASS), made by patients, do not obtain the same results in many occasions. The aim of this study was to compare the results of these methods applied at the same time in a cohort of adolescents and adults with AR under specialized outpatient care. Methods: Retrospective study of clinical records of patients with AR in treatment between March-2011 and August-2012 at an university hospital in Rio de Janeiro/Brazil, where both classifications have been used routinely since 2010. Four hundred clinical sheets were reviewed, we excluded patients under 12 years old, without at least one cutaneos test positive to aeroallergens and those with incorrect clinical data. Kappa coefficient (Stata 11) was used to measure agreement between them using 2 (mild and moderate/severe), 3 (mild, moderate and severe) and 6 categories (also considering intermittent and persistent grades), according to original and modified ARIA classifications. Results: We included clinical records of 124 patients: 88 were women (71%), the median age was 39 years (perc25-75=17-55) and 77 (62%) had associated asthma. Using ARIA modificated method (ARIAm - Valero at al. 2007), they were classified as mild=55 (44.3%), moderate=56 (45.1%) and severe=13 (10.4%). Using VASS, patients classified themselves as mild=35 (28.2%), moderate=68 (54.8%) and severe=21 (16.9%). Kappa analysis in the entire sample showed low agreement at 2, 3 or 6 comparison levels between

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the classifications (k=0.30, 0.39 and 0.37, respectively). The classifications were different in 51 (41.1%) patients when we compared 3 level of severity with lower agreements at 3 or 6 levels of comparison in females, in patients older than 18 years and in those with associated asthma. Better concordance was achieved in patients younger than 18 years (substantial), in patients without asthma (moderate) and in males (moderate). Conclusions: Our findings suggest that many patients have a different perception of severity of their disease using VASS when compared with results from ARIA classification, with a low to moderate concordance between the two methods. Presence of asthma, age and gender seems to influence these results. Large studies comparing the outcomes using both methods to guide treatment may help us to define the better one to make therapeutic decisions in clinical practice.

A6 Side effects of the leukotriene receptor antagonists in asthmatic children Demet Can*, Semiha Bahceci Erdem, Hikmet Tekin Nacaroglu, Canan Sule Unsal Karkiner, Ilker Gunay Behcet Uz Children Hospital, Turkey World Allergy Organization Journal 2015, 8(Suppl 1):A6 Background: Leukotriene receptor antagonists (LTRAs) are drugs which have been widely used more than ten years. As the use of LTRAs increases, our knowledge with respect to their side effects increases as well. Objective: Our study was aimed to evaluate the observed side effects of LTRAs used in patients with astma. Methods: 1024 patients who were only treated with LTRAs owing to astma or early wheezing were included in the study for a five-year period. The observed side effects of LTRAs in these patients were retrospectively investigated. The side effects were divided into two parts as psychiatric and non- psychiatric. Results: It was found out that 67.5% of 41 (4%) patients in whom side effects were observed was male and their average age was 6.5. The rate of patients with asthma was 63.41% and it was 36.58% for patients with early wheezing. It was determined that sex, age and diagnosis (early wheezing or asthma) of the patients were ineffective in the emergence of side effects. The average period for the emergence of side effects was the fisrt month. It was observed that hyperactivity was the most frequently seen psychiatric side effect and abdominal pain was the nonpsychiatric side effect. Conclusions: The side effects of LTRAs were common in children. Therefore, patients must be informed at the beginning of the treatment and they must be evaluated at certain intervals.

A7 Food allergen sensitization patterns in Korean adult food allergy patients Sungryeol Kim*, Kyung Hee Park, Jung-Won Park, Jae-Hyun Lee, Hye Jung Park, Beom Seok Koh, Il Joo Moon, Dong Woo Leem Yonsei University College of Medicine, South Korea World Allergy Organization Journal 2015, 8(Suppl 1):A7 Background: Identification of the causative food in food allergy patients is crucial. However, offending allergens can vary with a country’s food choices and preparation methods. In this study, we analyzed the sensitization rate to specific food allergens in Korean adult food allergy patients. Methods: This study enrolled 134 adult patients who visited the allergy clinic of Severance Hospital due to their allergic symptoms related to food ingestion. Patients underwent skin prick test (SPT) with 55 allergens. Our food SPT panel included hairtail, yellow corvina, common eel, skate, squid, mackerel, anchovy, saury, octopus, chrysalis, sunflower seed, and pollock allergens prepared at our Institute of Allergy and reflecting the daily eating habits of Korean people. Results: Of the 134 patients, 73 (54.5%) were sensitized to one or more food allergens. The sensitization rate of men (69.2%) was higher than that of women (45.1%) (p = 0.008).

World Allergy Organization Journal 2015, Volume 8 Suppl 1 http://www.waojournal.org/supplements/8/S1

Sensitization to chrysalis was detected most frequently at a rate of 25.4%. Sensitization rates to other food allergens prepared by us or that were relatively highly sensitized were as follows: maize grain (13.4%), shrimp (11.9%), almond (11.1%), sunflower seed (8.2%), mackerel (5.2%), pollack (5.2%), halibut (4.5%), anchovy (4.4%), squid (3.7%), saury (3.0%), common eel (3.0%), yellow corvina (3.0%), hairtail (2.2%), octopus (2.2%), and skate (0.7%). Conclusions: Food sensitization patterns in Korean food allergy patients are different from those in other countries. Chrysalis showed the highest sensitization rate in Korean patients (25.4%). Interestingly, mackerel, pollack, halibut, anchovy and yellow corvina which are popular food ingredients in Korea were also highly sensitized. Therefore skin prick test panel is need to reflect the preferred food choices of a region.

A8 Circulating apo 2L levels decreased in hepatitis C with the pegilated interferon-2 alpha treatment Ata Nevzat Yalcin1*, Arzu Didem Yalcin2, Betul Celik3, Sukran Kose4, Ayhan Cekin5, Derya Seyman6, Saadet Gumuslu7 1 Department of Infectious Diseases and Clinical Microbiology, Akdeniz University, 07070, Antalya, Turkey; 2Internal Medicine, Allergy and Clinical Immunology, Genomics Research Center, Academia Sinica,11529, Taipei, Taiwan; 3Department of Laboratory Medicine and Pathology, Mayo Clinic in Jacksonville, USA; 4Department of Infectious Diseases and Clinical Microbiology, Allergy and Clinical Immunology Unit, Tepecik Education and Research Hospital. Izmir, Turkey; 5Department of Gastroenterology, Antalya Training Hospital, Antalya, Turkey; 6Department of Infectious Diseases and Clinical Microbiology, Antalya Education and Research Hospital, Turkey; 7 Department of Medical Biochemistry, Faculty of Medicine, Akdeniz University, 07070, Antalya, Turkey World Allergy Organization Journal 2015, 8(Suppl 1):A8 Background: Chronic hepatitis C (HCV) infects approximately 170 million people and causes more than 350 000 deaths every year. Information regarding pathogenetic mechanism of acute hepatitis C infection is limited. Following innate immune activation, cellular immunity, including natural killer (NK) cell activation and antigen-specific CD8 cell proliferation occurs. CD8+ T lymphocytes directly kill infected cells via direct cell-cell contact, and release antiviral cytokines (e.g. IFN, TNF). Methods: Eleven HCV-treatment naive HCV infected patients were treated with weight-based ribavirin daily in addition to either weekly pegIFN alfa-2b at 1.5 ug/kg, weekly pegIFN alfa-2a, or albinterferon alfa2b at 900mcg every 2 weeks. All patients gave written informed consent approved by the Institutional Review Board prior to enrollment in the studies. Intensive serum monitoring was completed at study visits day 0 (pretreatment), weeks 4, 6 and 12. Results: In this present study, we aimed to investigate the relationship between IFN treatment response, HCV viral load and sApo 2L levels. Eleven HCV-treatment naive HCV infected patients were treated with pegIFN alfa-2a. Intensive serum circulating Apo 2L levels were monitered at study visits day 0 (pretreatment), weeks 4, 6 and 12.HCV-RNA and sApo 2L levels decreased gradually with PegIF-a 2 treatment and the differences were significant between day 0 and 4 th week (p=0.001, p