We have identifi~ the major antigens or IgE binding components from wheat tIour. Thirty-five sera from patients with baker's asthma were used to analyze the reaction with wheat salt-soluble proteins. We found a 15 kDa SDS-PAGE band which reacted with all sera tested. Purified members of the a-amylase inhibitor family, which are the main components of the 15 kDa band, were recognized by specific IgE when tested with a pool of reactive sera. Immunodetection after two-dimensional electrophoretic fractionation of crude inhibitor preparations from wheat endosperms also detected several inhibitor subunits as major low-mol~ular-wei~t allergens.

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SummaryThe study of the singular hypersensitivity reactions to Anisakis simplex ( A.s ) proteins, may help us to undestand many of the unknown immune interactions between helmiths infections and allergy. We have developed a murine model of allergy to A. simplex , that mimics human A. simplex allergy to study the specific aspects of anaphylaxis induced by parasites. Male C3H/HeJ mice were intraperitoneally sensitized to A. simplex . Mice were then intravenous or orally challenged with A. simplex . Antigen-specific immunoglobulins, polyclonal IgE, anaphylactic symptoms, plasma histamine levels and cytokine profiles were determined. Comparative IgE immunoblot analyses were also performed.

Immediate hypersensitivity reactions to betalactams are IgE mediated and constitute the most frequent allergic reactions mediated by specific immunological mechanisms. IgE responses to benzyl penicillin (BP), the first antibiotic producing the benzyl penicilloyl structure (BPO), are characterized by a quick release of inflammatory mediators, resulting in anaphylactic shock, urticaria and angioedema. With the progressive appearance of other structures, comprising cephalosporins, carbapenems, monobactams and clavulanic acid, IgE selective responses and cross-reactivity reactions were observed. The diagnosis of betalactam hypersensitivity, classically based on skin testing with major and minor determinants of benzyl penicillin or in vitro IgE antibodies to BP, has been modified by the inclusion of different determinants generated from these compounds, for which amoxicillin (AX) is the most relevant, followed by cephalosporins. Some subjects develop positive responses to several betalactams, mostly within the same family, but others develop a selective response. These are relevant for the appropriate selection of antimicrobial drugs in patients who have immediate hypersensitivity to betalactams.

The management of patients with pancreatic cancer has advanced over the last few years. We convey a multidisciplinary group of experts in an attempt to stablish practical guidelines for the diagnoses, staging and management of these patients. This paper summarizes the main conclusions of the working group. Patients with suspected pancreatic ductal adenocarcinoma should be rapidly evaluated and referred to high-volume centers. Multidisciplinary supervision is critical for proper diagnoses, staging and to frame a treatment plan. Surgical resection together with chemotherapy offers the highest chance for cure in early stage disease. Patients with advanced disease should be classified in treatment groups to guide systemic treatment. New chemotherapeutic regimens have resulted in improved survival. Symptomatic management is critical in this disease. Enrollment in a clinical trial is, in general, recommended.

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We report a case of anaphylaxis caused by cloxacillin in a 13-year-old patient. The basophil activation test, performed 25 days after the anaphylactic reaction, was positive to cloxacillin, amoxicillin, and penicillin G and negative to ibuprofen, tolerated by the patient. The analysis was performed 17 days after the reaction was not conclusive because 74% of the basophil population was activated in basal conditions. The abnormally high activation was similar to that found in an analysis before the reaction, exactly 4 days after finishing a well-tolerated treatment with amoxicillin. This first analysis was available because a patient's sample was taken from the emergency laboratory as a blind control for a study to assess the basophil activation test reliability in diagnosis of hypersensitivity to NSAIDs. The high number of activated basophils in basal conditions after treatment with amoxicillin and before the anaphylactic reaction to cloxacillin probably reflects the beginning of the sensitization. Until now, no cases of hypersensitivity to cloxacillin have been diagnosed by means of the basophil activation test.

Introduction: The goal of this non-randomized, retrospective, and observational study was to assess the efficacy of three different first-line chemotherapy regimens in the treatment of metastatic pancreatic cancer. Methods: Data were retrieved on 139 patients (pts) who were treated for metastatic pancreatic cancer in the University Hospital Centre Zagreb between January 1st, 2015 and March 1st, 2018. Pts were treated with nab-paclitaxel plus gemcitabine (Nab-Gem), gemcitabine plus cisplatin (Cis-Gem), or gemcitabine alone (Gem). Median age at the time of the beginning of therapy was 62 yrs in the Nab-Gem group (n ¼ 45), 64.4 yrs in the Cis-Gem group (n ¼ 19), and 70 yrs in the Gem group (n ¼ 75). Results: The median duration of treatment for Nab-Gem, Cis-Gem, and Gem regimens was 23.1, 24.7, and 12.9 weeks (w), respectively. Multivariate analyses tested influence of prognostic factors on treatment duration. In accordance with previous studies, for the pts treated with Nab-Gem the duration of treatment was negatively correlated with age (p < 0.05). The same age-dependent relationship was not observed in the Cis-Gem and Gem groups. Pts treated with Nab-Gem showed significant difference in terms of time to failure of treatment when analyzed for the two age groups separately, <65 and >65 yrs of age. The <65 group received chemotherapy for the median duration of 57.1 w compared to the >65 group which was treated with Nab-Gem for median of 21.5 w. No significant sex-dependent difference was found in regard to duration of treatment in any of the three treatment regimen groups. Conclusion: With regards to the above limitations of the study, we conclude that, for pts younger than 65 y, Nab-Gem is an effective chemotherapy regimen with significant clinical effect. Furthermore, for selected patients, a combined use of Cis-Gem is superior to Gem alone in the first-line treatment for metastatic pancreatic cancer.