In children with EE, the sensitization to inhalant allergens increases with age, particularly after 4 years. Also, specific enquiry about severe food reactions in patients presenting with EE is strongly recommended as it appears this patient group has a high incidence of anaphylaxis.

Introduction Pembrolizumab is a humanised monoclonal antibody targeting the receptor programmed cell death protein-1 (PD-1), with anti-tumour activity demonstrated for many malignancies. Such immune checkpoint inhibitors are associated with many immune-related adverse events including rash, colitis, hepatitis, pneumonitis, endocrinopathy and, rarely, haematological adverse events, including immune-related thrombocytopenia. Case report We report a 60-year-old female with metastatic non-small cell lung cancer treated with pembrolizumab every three weeks. Following her fifth cycle, she presented to our hospital with community-acquired pneumonia. Thrombocytopenia developed the next day and, after detailed investigations, thrombotic thrombocytopenic purpura was diagnosed. Management and outcome Pembrolizumab was immediately ceased and plasma exchange commenced along with IV methylprednisolone 250 mg daily for three days followed by oral prednisolone. After five days of plasma exchange, platelet counts normalised and haemolytic anaemia resolved. Discussion Acquired thrombotic thrombocytopenic purpura is an autoimmune disorder caused by an inhibitory autoantibody against ADAMTS-13. While most cases of acquired thrombotic thrombocytopenic purpura are idiopathic, certain conditions (e.g. bacterial infection, autoimmune disorders, malignancies) and medications are associated with thrombotic thrombocytopenic purpura. Other potential causes were eliminated in our patient. As acquired thrombotic thrombocytopenic purpura is an autoimmune disorder, pembrolizumab, given its unique mechanism of action and association with immune-related adverse events, is believed to be implicated in the development of thrombotic thrombocytopenic purpura. This case is one of only two linking anti-PD-1 therapy to thrombotic thrombocytopenic purpura development (the other occurring in a patient on nivolumab plus ipilimumab). Thrombotic thrombocytopenic purpura is life-threatening and clinicians are advised to be aware of its possible occurrence in immune checkpoint inhibitor-treated patients.

In this patient population 0.6% olopatadine appears to be efficacious in symptom reduction in VMR and protects from hyperosmolar challenge.

Background Multiple myeloma (MM) is a hematological malignancy characterized by the clonal expansion of malignant plasma cells. Though durable remissions are possible, MM is considered incurable, with relapse occurring in almost all patients. There has been limited data reported on the lipid metabolism changes in plasma cells during MM progression. Here, we evaluated the feasibility of concurrent lipidomics and proteomics analyses from patient plasma cells, and report these data on a limited number of patient samples, demonstrating the feasibility of the method, and establishing hypotheses to be evaluated in the future. Methods Plasma cells were purified from fresh bone marrow aspirates using CD138 microbeads. Proteins and lipids were extracted using a bi-phasic solvent system with methanol, methyl tertbutyl ether, and water. Untargeted proteomics, untargeted and targeted lipidomics were performed on 7 patient samples using liquid chromatography-mass spectrometry. Two comparisons were conducted: high versus low risk; relapse versus newly diagnosed. Proteins and pathways enriched in the relapsed group was compared to a public transcriptomic dataset from Multiple Myeloma Research Consortium reference collection (n = 222) at gene and pathways level.

17Background: Multiple myeloma (MM) is a hematological malignancy characterized by the 18 clonal expansion of malignant plasma cells. Though durable remissions are possible, MM is 19 considered incurable, with relapse occurring in almost all patients. There has been limited 20 data reported on the lipid metabolism changes in plasma cells during MM progression. Here, 21we evaluated the feasibility of concurrent lipidomics and proteomics analyses from patient 22 plasma cells, and report these data on a limited number of patient samples, demonstrating the 23 feasibility of the method, and establishing hypotheses to be evaluated in the future. 24Methods: Plasma cells were purified from fresh bone marrow aspirates using CD138 25 microbeads. Proteins and lipids were extracted using a bi-phasic solvent system with 26 methanol, methyl tert-butyl ether, and water. Untargeted proteomics, untargeted and targeted 27 lipidomics were performed on 7 patient samples using liquid chromatography-mass 28 spectrometry. Two comparisons were conducted: high versus low risk; relapse versus newly 29 diagnosed. Proteins and pathways enriched in the relapsed group was compared to a public 30 transcriptomic dataset from Multiple Myeloma Research Consortium reference collection 31 (n=222) at gene and pathways level. 32Results: From one million purified plasma cells, we were able to extract material and 33 complete untargeted (~6000 and ~3600 features in positive and negative mode respectively) 34 and targeted lipidomics (313 lipids), as well as untargeted proteomics analysis (~4100 35 reviewed proteins). Comparative analyses revealed limited differences between high and low 36 risk groups (according to the standard clinical criteria), hence we focused on drawing 37 comparisons between the relapsed and newly diagnosed patients. Untargeted and targeted 38 lipidomics indicated significant down-regulation of phosphatidylcholines (PCs) in relapsed 39 MM. Although there was limited overlap of the differential proteins/transcripts, 76 40 Page 3 of 29 significantly enriched pathways in relapsed MM were common between proteomics and 41 transcriptomics data. Further evaluation of transcriptomics data for lipid metabolism network 42 revealed enriched correlation of PC, ceramide, cardiolipin, arachidonic acid and cholesterol 43 metabolism pathways to be exclusively correlated among relapsed but not in newly-44 diagnosed patients. 45 Conclusions:This study establishes the feasibility and workflow to conduct integrated 46 lipidomics and proteomics analyses on patient-derived plasma cells. Potential lipid 47 metabolism changes associated with MM relapse warrant further investigation. 48

H1N1 influenza infection is associated with significant mortality in hematology patients. Universal prophylaxis with oseltamivir during a nosocomial outbreak appeared to be effective in controlling spread of the virus. We recommend early institution of infection control and universal prophylaxis in any nosocomial outbreak of influenza.

Novelty statement:1. What is the new aspect of your work?• Acquired haemophilia A (AHA) typically occurs in elderly patients with multiple comorbidities. Immunosuppression has demonstrated improved overall survival and remission rates; however, treatment-related complications in this cohort often occur. Efficacious but dose-reduced immunosuppression for this rare condition will hopefully reduce morbidity and is an important area for further research. What is the central finding of your work?• Universal immunosuppression in AHA patients improves overall survival, and 87.5% of patients achieved a complete remission in a median of 48 days. The use of upfront rituximab with corticosteroids is increasing and is associated with shorter times to complete remission. Low-dose rituximab (100 mg/m 2 weekly IV for 4 doses) is emerging as an alternative and appears non-inferior in this case series.

offered standardized guidance for dosing adjustments based on a percentage factor of the running dose in an attempt to standardize dosing strategies amongst prescribers of different disciplines. The reduction in titrations required to reach a therapeutic aPTT goal showed the superiority over an empiric, prescriber-based strategy.There were no significant differences in the safety endpoints; however, our study was not designed or powered for these outcomes. This is the first published protocol to compare DTI therapy following a guideline that allows prescribers to choose between three therapeutic aPTT goals vs. a historic control and demonstrate an improvement in achievement of therapeutic goal values.There are several limitations to our study. Our analysis was observational in nature and as such unable to account for all forms of bias that may have affected the results.Unlike previously published guidelines that have been nurse-managed, our dosing guideline requires diligence of the prescriber to follow-up and order each dose change and subsequent monitoring frequency. Dosing titrations were enforced by clinical pharmacy staff.The implementation of a direct thrombin inhibitor dosing and titration guideline was associated with an increase in patients who achieved therapeutic aPTT goal, as well as achieving therapeutic aPTT goal on initial dose when compared to a historic cohort of patients managed by the prescriber.These findings were presented in abstract form at the 43rd