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Background: Plant food allergies associated with lipid transfer protein (LTP) have been widely described in the Mediterranean Basin. Objective: The aim of this work was to describe the clinical profile and pollen sensitization of plant food- allergic patients sensitized to LTP in a non-Mediterranean area. Methods: Patients with clear IgE-mediated symptoms associated with plant foods and a positive skin prick test (SPT) to Pru p 3 were included in a prospective study in the north of Spain. Reported symptoms were analyzed together with a battery of food and pollen SPTs and specific IgE components by ISAC microarray. Cross-inhibition studies were performed by ImmunoCAP with plane tree, mugwort and rPru p 3. Results: Among the 72 patients included, the most frequent food allergy reported was to peaches (69%) followed by nuts (walnuts 55%, peanuts 54% and hazelnuts 43%). Most patients suffered from symptoms with multiple plant foods (a median of 6 foods per patient). Regarding the patients' pollen sensitization, 36% were sensitized to mugwort pollen (72% showing sIgE to Art v 3), 33% to grass pollen and 24% to plane tree pollen (94% with sIgE to Pla a 3). Inhibition studies showed that specific IgEs against mugwort and plane tree pollen are inhibited by Pru p 3 in a strong manner, whereas Pru p 3 was less inhibited by pollen extracts. Conclusions: LTP syndrome occurs in a non-Mediterranean area and is related to multiple sensitizations to foods and pollens such as plane tree and mugwort. In these pollen sensitizations, Pru p 3 seems to be the primary sensitizer.

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Background: Allergy to mollusks has been the focus of fewer studies than allergy to crustaceans. Furthermore, allergy to mollusks is less well characterized. Objectives: To describe the clinical characteristics of mollusk-allergic patients, to identify the responsible allergens, and to assess crossreactivity. Methods: We performed a prospective multicenter study including 45 patients with mollusk allergy, which was diagnosed based on a suggestive clinical history and a positive skin test result with the agent involved. Fractions were identified using SDS-PAGE and immunoblotting. The proteins responsible were subsequently identified using mass spectrometry. ELISA inhibition studies were performed with mollusks, dust mites, and crustaceans. Results: We found that 25 patients (55%) were allergic to cephalopods, 14 (31%) to bivalves, and 11 (24%) to gastropods. Limpet was the third most frequent cause of allergy (15% of cases). In 31 patients (69%), the manifestation was systemic; 10 (22%) exhibited oral allergy syndrome, and 7 (15%) experienced contact urticaria. Most major allergens were found between 27 kDa and 47 kDa. ELISA inhibition assays revealed a high degree of inhibition of cephalopods and bivalves from all the groups of mollusks, mites, and crustaceans. Mass spectrometry identified tropomyosin, actin, and myosin as the major allergens. Conclusions: Cephalopods, especially squid, are the mollusks that most frequently trigger allergic symptoms. The very frequent occurrence of allergy to limpets is striking, given their low consumption in our area. It is worth highlighting the heterogeneity observed, exemplified by the gastropods. Tropomyosin appears to be responsible for the high cross-reactivity found between mollusks, mites, and crustaceans. Three new mollusk allergens were also identified, namely, actin, enolase, and a putative C1q domain-containing protein.

K E Y W O R D S : CAS no. 122-99-6, case report, contact urticaria, phenoxyethanol, ultrasound gel Phenoxyethanol is a preservative used extensively in cosmetics and pharmaceutical products because of its antibacterial and antifungal properties. Despite its widespread use, it is a rare cause of delayed and immediate contact reactions. We report a case of contact urticaria after use of an ultrasound gel containing phenoxyethanol. CASE REPORTAn 80-year-old woman was referred for evaluation of pruritic, erythematous and oedematous lesions at the site of contact of the ultrasound gel Eco Supergel (Ceracarta Laboratories, Forlì, Italy). The eruption started 10 minutes after contact with the gel at room temperature. The patient had noted previous episodes of swelling and pruritus a few minutes after the application of cosmetics such as moisturizers and wet wipes. An open test on the forearm with Eco Supergel (water, polymer, humectant, preservatives, and colorant) was positive at 10 minutes (Figure 1). As we were not able to obtain the components of the gel, we performed open application tests with some preservatives: at the 10-minute reading, phenoxyethanol (1% pet.) gave a positive result (Figure 2). Open application tests gave negative results with methyldibromo glutaronitrile, propylene glycol, polyethylene glycol, triethanolamine, imidazolidinyl urea, methylisothiazolinone, and Kathon CG (methylchloroisothiazolinone + methylisothiazolinone). The manufacturer confirmed that Eco Supergel contained phenoxyethanol.FIGURE 1 Photograph taken at 30 minutes of the site of application of the ultrasound gel Eco Supergel 132 ARANZABAL ET AL.