To our knowledge, we present the first case report of allergic reaction from oyster mushroom ingestion, which was confirmed by an oral food challenge test. Trehalose phosphorylase was identified as a novel potential allergen by IgE immunoblotting and mass spectrometry.

Subcutaneous immunotherapy (SCIT), commonly known as \"allergy shots,\" aims to achieve a clinical tolerance for allergens that cause symptoms of allergic rhinoconjunctivitis, allergic asthma, or insect sting allergies. Systemic reactions to SCIT are classified in severity from one organ system (grade 1) to anaphylaxis that potentially may have a fatal outcome (grade 5). Uterine cramps fall under grade 2, and they are rarely reported during SCIT. In this study, we report four cases of uterine anaphylaxis following SCIT for environmental allergens with symptoms such as severe lower abdominal cramping resembling menstrual cramps. Patients also experienced urticaria, angioedema, diffuse erythema, and flushing. None of the patients experienced uterine bleeding. To the best of our knowledge, this is the largest case series reporting this reaction to SCIT. We accompany this finding with a review of the literature on this rare but interesting topic.

BACKGROUND: Allergen immunotherapy (AIT) is the only treatment that has modified the natural history of allergic diseases. However, since its overall effect on the immune system has not been elucidated, AIT is either absolutely or relatively contraindicated in patients with rheumatic autoimmune diseases (RADs). Therefore, there have been no long-term observations of patients with RADs receiving AIT; thus, the effectiveness and safety of AIT in these patients remain unclear.
METHODS: This was a single-center retrospective observational study. RAD patients receiving AIT for allergic rhinitis at our institution were selected. Changes in the activity of RAD patients were investigated for 2 years from baseline, including those who discontinued AIT. The effectiveness of AIT was also investigated using the Japan Allergic Rhinitis Standard Quality of Life Questionnaire.
RESULTS: Thirteen patients with RADs were enrolled in the study. All patients received sublingual immunotherapy, of which four discontinued AIT owing to adverse events. Among all patients, the symptoms of RADs in three patients worsened during the observation period; however, none of them were causally related to AIT. Most of the adverse events associated with AIT were mild, in which only one patient required drug intervention due to worsening rhinitis symptoms. In the nine patients who were able to continue AIT, their eye and nasal symptom scores showed a significant improvement from 1.67 (1.5-2.0) at baseline to 0.67 (0-1.17) in the 2nd year of treatment (p = 0.0141).
CONCLUSIONS: AIT is a safe and effective treatment modality for patients with allergic rhinitis complicated by RADs.

The identification of allergens is essential in the management of allergic rhinitis. Sugarcane produces anemophilic pollen. The purpose of our study is to assess the role of sugarcane pollen in the occurrence of allergic rhinitis. We conducted a case-control analytical study of patients living in a Malagasy rural commune in which sugarcane cultivation and processing are important sources of employment, from July 2017 to June 2018. We enrolled 182 patients (91 cases and 91 controls). Factors associated with the occurrence of symptoms of allergic rhinitis were: a distance of less than 500 meters between homes and sugarcane fields (OR = 1.50), being a sugarcane worker (OR=1.16) and having a family history of allergic rhinitis (OR=13.67). In addition, exposure to wind gusts (OR=0.84) and outdoor occupation (OR=0.92) were protective factors. Exposure of patients to sugarcane pollen is associated with clinical manifestations of allergic rhinitis and confirms the role of this allergen in the occurrence of the disease. Avoidance and hygiene measures are the basis of treatment.

This is a series of 4 cases (3 therapeutic failure and 1 early relapse) in adult patients treated with allergen immunotherapy (AIT) for allergic rhinitis (AR) in our immunotherapy clinic, which treats 110 new patients per year. AIT includes both subcutaneous and sublingual routes. The current national/international AIT recommendations and the literature have been searched to identify guidance for the optimal management of therapeutic failure of AIT in AR. There is scant information available to support clinicians when treatment failure and/or intolerable side effects occur. The importance is highlighted for developing the guidance and evidence base for the benefit of this patient subgroup. The potential strategies that clinicians have proposed are discussed in this article, though it is acknowledged that these are mostly not evidence-based.

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UNASSIGNED: This paper presents a peculiar first case of an allergy to Silybum marianum (milk thistle) and Eragrostis tef (teff). Both teff and milk thistle have been presented in the literature (both domestic and foreign) in a positive light, the former as a new part of gluten-free diet, and the latter as a treatment for a number of conditions, particularly those of the liver.
UNASSIGNED: A 29-year-old male presented at our clinic due to an episode of itching and burning in his mouth, swollen tongue, and difficulty swallowing following ingestion of teff flakes. He also reported sneezing, runny nose, watering and burning eyes, and wheezing following inhalation exposure to ground milk thistle. The patient\'s occupation is associated with exposure to these allergens. The patient underwent comprehensive allergy diagnostic assessments (including skin-prick testing, serum specific IgE levels, Faber test, spirometry, and acoustic rhinometry) and gastroenterological assessments. The diagnosis was established on skin tests with native allergens (milk thistle 16/35, teff flour 22/60, negative control 0/0, histamine 3/5) provided by the patient. There are no commercially available (standardized) tests for milk thistle or teff either in Poland or anywhere else in the world.
UNASSIGNED: Milk thistle is available in the form of dry, finely-ground preparations (which are used as additives to bread, soups, and yoghurts) and extracts (which are used as ingredients in over-the-counter herbal remedies). Teff is a gluten-free cereal whose grains are rich in methionine, calcium, iron, folic acid, and antioxidants. This case report presents milk thistle and teff as potentially new allergens. A literature review revealed no similar allergy cases in Poland or elsewhere in the world.

Two fish parvalbumin models were established to study relationships among matrix effect, extractability, and thermostability during in vitro immunodetection using two parvalbumin-specific monoclonal antibodies (3E1 and PARV19). Our results illustrated that matrix-induced thermal instability of parvalbumin was due mainly to physical (hydrophobic effect) and chemical (thiol-disulfide interchange) interactions. The addition of sodium dodecyl sulfate (SDS, surfactant), β-mercaptoethanol (reducing agent) or ethylenediaminetetraacetic acid (EDTA, metal chelator) during sample preparation could not only increase the extractability of parvalbumin but also enhanced its immunodetection. Our findings demonstrated excess EDTA completely chelated Ca2+ in parvalbumin and rendered it undetectable using PARV19 (a Ca2+-dependent antibody). Overall, our resulted showed that matrix effect on in vitro analyte quantification cannot be underestimated. Any false negative or positive results could lead to severe or life-threatening allergic reactions.