13^th International Conference on Allergy and Clinical Immunology December 13-14 , 2018 Abu Dhabi, UAE

The systemic manifestations induced by food hypersensitivity responses are due to the ability of localized exposure to foods in the gastrointestinal tract to result in symptoms in distal target organs. Cow’s milk protein, for example, may induce hives (urticaria), atopic dermatitis, isolated gastrointestinal symptoms or severe generalized anaphylaxis in different individuals or in the same person at different times. These diverse manifestations are the result of complex interactions among the causal food protein, gut, immune system and target organs. The dynamic state of these interactions is demonstrated by

the development of food tolerance in most subjects and by the ability to experience the development of new allergies in some subjects. This presentation explores the variety of clinical manifestations of food hypersensitivity disorders in the context of the question: What determines the local or systemic expression of food allergy in a given individual at a particular time? Evidence is provided for both systemic and local immune activation. The role of food-protein chemistry, absorption and processing of ingested allergen, immune responses (type, degree, and specificity) and target organ hyper reactivity are considered as determinants in the expression of food allergic disorders.

Merin Kuruvilla is an Assistant Professor of Allergy and Immunology at Emory University in Atlanta, GA. Her research interests include drug allergy and biologic therapies. She is also collaborating with translational researchers to elucidate disease mechanisms behind nasal polyps and provide insight into future therapies. She acts as Clinical Mentor for young investigators involved in clinical research. She is also interested in antimicrobial stewardship in the context of medication allergies and is actively contributing to the antimicrobial stewardship program at Emory.

Background: Ten percent (10%) of hospitalized patients report Penicillin Allergy (PA); however, studies indicate that ~98% patients are not truly allergic. Unconfirmed PA labels pose substantial public health risks and PA evaluation is recommended as part of effective antibiotic stewardship. While the most widely accepted protocol is Skin Testing (ST) followed by oral

amoxicillin challenge, time constraints and other limited resources may be a barrier to ST application. An accumulating body of evidence supports the safety and efficacy of using direct oral amoxicillin challenges in low-risk individuals with a history of PA.

Objectives: To evaluate the safety of direct oral graded challenges to amoxicillin.

Methodology: This is a retrospective review of adult patients treated at the outpatient allergy clinic at Emory University. For PA, we currently recommend direct oral amoxicillin challenge in patients with history of benign rash, benign somatic symptoms or unknown history associated with last penicillin exposure >12 months ago. If the index reaction occurred within the past 12 months, or with a history of anaphylaxis, we perform ST first and proceed to oral challenge only if the ST is negative. We do not evaluate PA further if there is a history of a penicillin-associated blistering rash, hemolytic anemia or organ involvement. Any delayed reactions after the oral challenge are reported by the patient.

Results: We describe outcomes of direct oral challenges in patients with PA labels. No acute positive reactions or delayed reactions were noted for the course of the study period. While subjective reactions were reported, these did not constitute a clinically significant challenge reaction.

Conclusion: Direct oral challenge without preceding ST is safe and sufficient to rule out PA in low risk patients. While a history of anaphylaxis or severe drug reactions warrants extreme caution, a simpler and more streamlined protocol might do for lower risk patients.

Objective: To assess adherence to asthma medications among pediatric population in Saudi Arabia, correlate poor adherence with the level of asthma control and investigate the factors that may influence the patient's adherence.

Methods: This cross-sectional study includes 319 pediatric participants. They are recruited from two pediatric Asthma Clinics at King Abdullah Medical City, KAMC and Maternity and Children Hospital, MCH in Makkah by using a valid Arabic translation of the 8-item Morisky Medication Adherence Scale (MMAS-8).

Results: Our study group consisted of total 319 patients, male 45.1% and female 54.9% with a mean age of 6.34±7.35 years, the adherence rate among children by MMAS-8 identified in 35.1% were low adherence rate, while medium adherence were 64.9%. The adherence rate significantly increased with the parent's educational level among mothers (P-Value≤0.001) while the

fathers is (P-Value=0.004). Moreover, the prevalence of parents concern about asthmatic medication side effects of long-term usage is 56.7% while 43.3% of parents are not.

Conclusion: The studies in Saudi Arabia showed high prevalence of asthma among children and a high rate of poor asthma control, yet no studies was conducted to assess the rate of pediatric adherence to asthma medication also the burden of the problem of non-adherence among asthmatic children in terms of medical complications, educational problems and healthcare cost, although the lack of studies in Saudi Arabia in particular and Middle East in general. Routine screening for bronchial asthma risk factors among children, promotes the education about risk factors of bronchial asthma as well as the morbidity

of poor adherence and the benefits of strict adherence to asthma medication, may improve the adherence rates to asthma medication as well as the severity of asthma.

Fuad Alrowaishdi is the consultant in Allergy and Immunology (Adult-Pediatrics) field of medicine. He is also the consultant Pediatric Pulmonology and Bronchoscopy. He is fellow member of American Academy of Asthma Allergy and Immunology. He serves as member of several organizations like European Academy of Allergy and Clinical Immunology, European Respiratory Society, French Allergy Pulmonology Society and World Allergy Organization.

This lecture intended for doctors involved in allergy of anesthesia consultations (eg anaesthetists, allergists, dermatologists, pediatricians and pulmonologists). The goal is to comply with the recommendations for clinical practice, update knowledge and practices in the prevention of anesthesia allergic risk.

The main themes addressed during the topic:

• The epidemiology of these reactions

• The anesthetic agents involved

• People at risk

• The clinical presentation of these reactions, their consequences

• Diagnostic methods: skin tests, biological tests

• The organization of an allergy of anesthesia consultation

• Preventive measures

The reality of allergic risk in anesthesia is confirmed by the publications in English and French of more cases of anaphylactoid reactions during the last 15 years, about 60% are IgE-dependent immunological origin .the anaphylactoid reaction represents 9 to 19% of the complications of anesthesia .The mortality is 5 to 7% .The incidence of the anaphylactic reaction was evaluated in

France, in 1996, at 1 / general and loco-regional anesthesia, all responsible substances combined. The incidence of anaphylaxis in the patients was 1/6 500 anesthesia with curare .The curare represents 62% of them, the latex 16.5%, the hypnotics 7.4%, the antibiotics 4.7%, the substitutes of the plasma 3.6%, the opioids 1.9%. Allergy to local anesthetics appears exceptional (0.7%).

No anaphylactic reactions have been published with halogenated anesthetics.The curares most involved were: rocuronium, suxamethonium, atracurium and vecuronium .The clinical manifestations are more serious in an immunological reaction than in a pharmacological reaction. The clinical signs are not always complete. In 17 to 30% of the cases of anaphylactic reactions to the curares, there was no preliminary contact with molecules. The situation is often aggravated by the existence of an underlying cardiac pathology or by the use of certain drugs such as beta-blockers. The treatment of allergic reactions during anesthesia should not be designed in a rigid pattern.

Naren Pandey is an allergist from Kolkata, West Bengal, India. He is the general secretary of Indian Primary Respiratory Care & Allergy Foundation. He serves as an international affiliate member at American College of Allergy Asthma & Clinical Immunology, life member at Indian Academy of Allergy and also member of European Academy of Allergy & Clinical Immunology; He is also the fellow of royal society of tropical medicine & hygiene and an associate member of International Primary Respiratory Care Group.

Introduction: Sub Lingual Immunotherapy (SLIT) Rush immunotherapy was tried on some patients to evolve some faster and affordable immunotherapy modality to make the patient achieve the maintenance plateau within a very short time. Conventional method of immunotherapy is administered with long durations, rush immunotherapy is super-fast methodology in attaining the maintenance/boosting module, which requires hospitalization and other precautionary methods and multiple allergen vaccines to be administered within short span of time. But in this method, it was found that within 15-20 days the relief of the immunotherapy was reached. Nasal ointment reduces allergic rhinitis symptoms.

Material & Method: 186 patients out of which 48 with urticaria allergy and 138 with allergic rhinitis & bronchial asthma were selected. The therapy consists of administration of four vials of mixed allergen extracts of Pollens HDM and insects, 1st vial: 1:25.00, 2nd vial 1:2.5, 3rd vial 1:25, and 4th vial 1:10 dil. The 1st & the 2nd concentrations were administered in daily 6

hourly schedules in a graphically rising manner. The patients had been given pre-medication. Blood examination and IgG & IgE level estimation were done before & after 8 weeks. The Allergen extracts were procured from All Cure Pharma Pvt.Ltd, Bahadurgarh,Harayana, of Allergens of Herbal base . All the patients gave informed written consent for inclusion.

Results & Conclusion: Some of the patients showed local skin reactions and few with lightheadedness /vasovagal type of symptoms which subsided without drugs and no systemic reaction was noted in addition 3rd generation anti histamines were added in the initial phase for 3 weeks. There was substantial decrease in IgE & increased IgG level, significant & marked

satisfactory relief was observed in the patients symptomatology, thus the procedure was graded as a very fast & affordable & SAFE with Mixed allergen extracts of Pollens HDM and insect’s immunotherapy.

Nuha Nuwayri Salti worked as a professor at the Department of Human Morphology at the American University of Beirut, Beirut, Lebanon. Currently she serves as research associate at the Chronic Care Centre, Hazmiyeh, Lebanon.

White blood cells (WBC) are the major cells that defend the body against aggression from the environment. Their function is to recognize and differentiate self from foreign tissues and agents. Most cases with immune deficiency are due to defective leucocyte function. This may be either intrinsic to the cells such as a very low production of WBC surface receptors to chemoattractants, or extrinsic to these cells such as abnormal production of chemo-attractants by the injured tissues. These and similar defects may be inborn or acquired. In addition, poor performance of WBC may be secondary to paralysis, or early destruction, of these cells by foreign material (inert or live) that may invade and hinder their proper function and/or shorten

their life span. In circulation, WBC exists in low numbers. From the marginating pool, all types of WBC leave the blood and lymphatic vessels to infiltrate organs policing their cells. The most important exception to this surveillance is the brain which has its own defense cell type (microglia). To obtain WBC pure and in high numbers we collect them on slides using “Skin

Window” (SW), which yields both groups, granulocytes and agranulocytes, each on a separate slide. On the slides these cells can be subjected to a large variety of manipulations.

Objective: This study reports a review of patients records for over thirty years. They were referred to our laboratory for confirmation and determination of the cause of suspected immune deficiency. We carried out advanced studies testing their immune cells morphology and function. Skin Window was the test most frequently used. It is practical, inexpensive and easy to apply. Very often SW revealed the diagnosis and the patients once treated were normal again. In this presentation we recommend its use especially that not only it is simple to perform, but also at a low cost and can be applied in field studies

distant from any laboratory.

Methods: Skin Window consists of collecting each of the granulocytes and agranulocytes on sterile slides or cover slips that overlay an abraded small area within the epidermis. The leucocytes migrate to the injured surface where they adhere to the slide/cover slip. Harvested, live and in action, the leukocytes are tested for the suspected defect in the patient. Using any of several histologic techniques, including immunochemical, and fluorescent dies, each of the different cell types are studied. Since live, the cells can be set up in cultures, especially when suspected to carry live organisms.

Results: In the majority of these patients, SW revealed the problem and the patient when accordingly treated, recovered totally. In a very small minority of patients the problem could only be resolved using molecular studies. The remaining (0.3%) were not diagnosed in our laboratory.

Conclusion: SW is a very simple technique to collect live pure leucocytes in high enough numbers to facilitate studying and testing their morphology and function. SW testing in most of our patients lead to specific diagnosis which when treated resulted in the patients regaining normal functioning of the immune system.

Zoe Williams is a parent of 2 children with different food allergies and intolerances. Her youngest daughter, now aged 4 and a half, was clinically diagnosed with 6 food allergies as a baby. She is an advocate for parents of children with food allergies and food allergy sufferers. She is a food allergy blogger at www.myallergykitchen.com where she shares allergy-friendly recipes, tips and advice to help others. She is in contact with other parents of children with food allergies and food allergy sufferers on a daily basis through her blog and social media accounts.

Food allergies in babies are underdiagnosed. The purpose of this video presentation is to describe my experience of seeking help as a parent of a baby with food allergies. My daughter had 6 food allergies, some of which were present from birth and some which were not evident until she started on solid foods. She was exclusively breastfed until 6 months and we identified that she had cow’s milk protein allergy at just 4 weeks old with the help of a breastfeeding peer supporter. It took until 14 months of age to get a formal diagnosis of all of her allergies. During this time, we saw several GPs and a pediatrician. None of them recognized the signs of food allergies in babies, despite the fact that she already had an existing food allergy. As a result, I had to undertake an exclusion diet without medical support in order to resolve her symptoms. It was only after doing this that she was referred to a pediatrician and dietician for proper diagnosis and support. This was a very stressful time for the whole family. We were caring for our sick baby whilst also looking after our older daughter. We had very little sleep as our baby frequently suffered with stomach pains in the night. This had an impact on our mental health. It was very demoralizing to ask for help from medical professionals and be turned away. We did not know why our baby was suffering. We had to focus

our efforts on managing her symptoms. If her allergies had been identified sooner, we could have eliminated her suffering immediately. Front line health professionals do not always recognize the signs of food allergies in babies. This makes it difficult for parents to access care and support.

Vasyl Y Velykyi is the Junior Researcher from Ukraine. He had made first steps in scientific from second year of study in Tars Shevchenko National University of

Ukraine. The global world problem as breast cancer had been interested him. Especially his attention concentrated on problem of diagnostic mechanisms on the early stages of disease and preventing measures for safety women health.

The risk of the development of breast cancer is a significant issue in modern medicine practice, especially in diagnostics and determination of the treatment strategy. More than 1.3 million patients suffer from cancer diseases, for instance, more than 508,000 women in the world have lost their lives due to breast cancer in 2011. The majority of issues regarding breast cancer treatment would be resolved using new immunological methods of diagnostics and immunotherapy. This study combined immunology and glycobiology to reveal new data that could be used for the construction of the novel test-system for the indication of the immune response upon the breast cancer progression. The purpose of this study was isolation, purification and characterization of lectins from albumen gland and mucus of H. pomatia, investigation their potential for the creation of an anticancer vaccine or a test system for monitoring or prognostication of the efficacy of the anticancer chemo and/or immunotherapy. For the isolation of the lectins from albumen gland homogenate and mucus we used salting out. ELISA was used for the detection of cross-reactivity of antibodies from serum of rats with transplanted Walker carcinosarcoma and also we used serum of patients with breast cancer of I-IV stages for the detection of antitumor antibodies with cross-reactivity with lectin. Western-blot with serum antibodies, which showed high cross-reactivity was used for the identification of the protein fraction which had demonstrated high cross-reactivity by ELISA results. The cross-reactive protein fraction was purified by chromatography and characterized by using MALDI-TOF. Lectins represent a huge group of proteins and glycoproteins which are able to selectively bind to glycans and glycan's determinants on biopolymers. Almost all groups of organisms contain lectins in different organs and tissues that represent a high potential for cancer diagnostics and for proper anticancer therapy construction. Malignization is known to promote the high level of cancer cells’ proteins glycosilation. This increases the amount of untypical glycans on the surface of tumor cells which facilitates intercellular interaction, migration and adhesion. Different types of lectins are used as markers for screening different tumor processes for development of new therapies for oncological pathologies treatment and for the construction of anticancer vaccines. For example, agglutinin (lectin) of Helix pomatia is used for the prediction of breast cancer metastasis. It was shown experimentally that high index of binding of lectins to the tumor cell glycocalix is associated with a high risk of metastasis and the unfavorable prognosis. We isolated and characterized protein from albumen gland and mucus of Helix pomatia which showed cross-reactivity with serum antibodies of experimental animals with transplanted Walker carcinosarcoma and also observed cross-reactivity of antibodies of patients with breast cancer of I-IV stages. The titer of antibodies from serum of experimental animals and patients, which showed cross-reactivity with isolated proteins, correlated with tumor stages and the reaction for antitumor therapy. Proteins of H.pomatia could be used for the development of perspective test system for monitoring or prognostication of the efficacy of anticancer chemoand/or immunotherapy.