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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The diagnostic algorithm for drug-allergy combines both <span class="elsevierStyleItalic">in vivo</span> &#40;prick test&#41; and <span class="elsevierStyleItalic">in vitro</span> &#40;specific IgE&#41; tests&#46; The basophil activation test &#40;BAT&#41; is a functional <span class="elsevierStyleItalic">in vitro</span> assay that could help in case of allergen-sensitization suspicion&#46; The indication of BAT could be addressed when specific-IgE test is not commercially available&#44; the allergic patient is at high risk of anaphylactic reaction after new exposition to allergen or due the low sensitivity of specific-IgE test in drug-sensitization cases&#46; In all cases the BAT could support the allergy diagnosis&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">An increase of total serum IgE levels could suggest an immediate IgE reaction but also another clinical overlap of food and inhalant allergy or parasite infection should be ruled out&#46; Furthermore&#44; total IgE is not especially increased in cases of drug hypersensitivity&#46; To our knowledge&#44; there is no omeprazole specific-IgE test in the reference system &#40;CAP&#44; Thermo Fisher&#41;&#44; so the BAT could be used as <span class="elsevierStyleItalic">in vitro</span> diagnostic tool to confirm sensitization&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The letter to editor comments about several points in order to improve the immunophenotypic assessment of basophils as CD45<span class="elsevierStyleSup">dim</span>CD123<span class="elsevierStyleSup">bright</span>HLA-DR<span class="elsevierStyleSup">neg</span> instead of FSC&#47;SSC dot plot&#46; The authors regret that the format of case report does not allow describe the methods in detail&#46; However&#44; the FSC&#47;SSC dot plot showed in Figure 1 &#40;Belmar et al&#46;&#41;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> represents the backgating&#44; there is neither gate in the plot nor mention in the figure legend about the gating strategy of basophils based on FSC&#47;SSC&#44; due to space constraints&#46; Moreover&#44; as suggested by the authors&#44; the use of CD203c could help in the identification of basophils&#46; After the performance of the omeprazol-BAT we include the CD203c marker in our routine flow cytometry panel and &#62;97&#37; CD123<span class="elsevierStyleSup">&#43;</span>HLA-DR<span class="elsevierStyleSup">neg</span> were CD203c<span class="elsevierStyleSup">&#43;</span>&#44; confirming the high concordance of basophils identification with both panels&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The authors are aware about the interpretation of the BAT is controversial&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> most of the studies use a single cut-off value&#44; stimulation index &#40;SI&#41; or &#37;CD63&#46; The study with 43 patients with omeprazole-allergy cited by the authors uses a single cut off above 2 SI&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> moreover the same research group in the context of quinolone-allergy used SI &#62;2 or CD63 &#62;5&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> In the case report both conditions SI and &#37;CD63 were fulfilled&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The formil-Metionin Leucin Prolin &#40;fMLP&#41; activate basophils in a IgE-independent way&#44; the authors assume that it is not the best positive control for basophil IgE-dependent degranulation and anti-IgE should be used instead&#46; Nonetheless&#44; the fMLP allows validate the BAT&#44; confirming the ability of basophils to degranulate&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">We could not exclude a possible immune-mediated reaction through the binding of the drug to H2 and H4 in basophils&#44; as indicated by the authors in their reply&#46; It could modulate the Th2 immune response by producing IgG that would induce the nephritis&#46; Despite the suggested inhibition by omeprazol on basophils that we could not discard&#44; we demonstrated an <span class="elsevierStyleItalic">in vitro</span> basophils degranulation after exposure to the drug&#46;</p></span>"
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Letter to the Editor
Author's reply
Réplica a la carta al Editor
Lara Belmar Vegaa,
Corresponding author
belmarvega@outlook.es

Corresponding author.
, David San Segundo Arribasb, Juan Irure Venturab, Marcos López Hoyosb, Gema Fernández Fresnedoa, Emilio Rodrigo Calabriaa, Juan Carlos Ruiz San Millána
a Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Spain
b Servicio de Inmunología, Hospital Universitario Marqués de Valdecilla, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The diagnostic algorithm for drug-allergy combines both <span class="elsevierStyleItalic">in vivo</span> &#40;prick test&#41; and <span class="elsevierStyleItalic">in vitro</span> &#40;specific IgE&#41; tests&#46; The basophil activation test &#40;BAT&#41; is a functional <span class="elsevierStyleItalic">in vitro</span> assay that could help in case of allergen-sensitization suspicion&#46; The indication of BAT could be addressed when specific-IgE test is not commercially available&#44; the allergic patient is at high risk of anaphylactic reaction after new exposition to allergen or due the low sensitivity of specific-IgE test in drug-sensitization cases&#46; In all cases the BAT could support the allergy diagnosis&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">An increase of total serum IgE levels could suggest an immediate IgE reaction but also another clinical overlap of food and inhalant allergy or parasite infection should be ruled out&#46; Furthermore&#44; total IgE is not especially increased in cases of drug hypersensitivity&#46; To our knowledge&#44; there is no omeprazole specific-IgE test in the reference system &#40;CAP&#44; Thermo Fisher&#41;&#44; so the BAT could be used as <span class="elsevierStyleItalic">in vitro</span> diagnostic tool to confirm sensitization&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The letter to editor comments about several points in order to improve the immunophenotypic assessment of basophils as CD45<span class="elsevierStyleSup">dim</span>CD123<span class="elsevierStyleSup">bright</span>HLA-DR<span class="elsevierStyleSup">neg</span> instead of FSC&#47;SSC dot plot&#46; The authors regret that the format of case report does not allow describe the methods in detail&#46; However&#44; the FSC&#47;SSC dot plot showed in Figure 1 &#40;Belmar et al&#46;&#41;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> represents the backgating&#44; there is neither gate in the plot nor mention in the figure legend about the gating strategy of basophils based on FSC&#47;SSC&#44; due to space constraints&#46; Moreover&#44; as suggested by the authors&#44; the use of CD203c could help in the identification of basophils&#46; After the performance of the omeprazol-BAT we include the CD203c marker in our routine flow cytometry panel and &#62;97&#37; CD123<span class="elsevierStyleSup">&#43;</span>HLA-DR<span class="elsevierStyleSup">neg</span> were CD203c<span class="elsevierStyleSup">&#43;</span>&#44; confirming the high concordance of basophils identification with both panels&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The authors are aware about the interpretation of the BAT is controversial&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> most of the studies use a single cut-off value&#44; stimulation index &#40;SI&#41; or &#37;CD63&#46; The study with 43 patients with omeprazole-allergy cited by the authors uses a single cut off above 2 SI&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> moreover the same research group in the context of quinolone-allergy used SI &#62;2 or CD63 &#62;5&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> In the case report both conditions SI and &#37;CD63 were fulfilled&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The formil-Metionin Leucin Prolin &#40;fMLP&#41; activate basophils in a IgE-independent way&#44; the authors assume that it is not the best positive control for basophil IgE-dependent degranulation and anti-IgE should be used instead&#46; Nonetheless&#44; the fMLP allows validate the BAT&#44; confirming the ability of basophils to degranulate&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">We could not exclude a possible immune-mediated reaction through the binding of the drug to H2 and H4 in basophils&#44; as indicated by the authors in their reply&#46; It could modulate the Th2 immune response by producing IgG that would induce the nephritis&#46; Despite the suggested inhibition by omeprazol on basophils that we could not discard&#44; we demonstrated an <span class="elsevierStyleItalic">in vitro</span> basophils degranulation after exposure to the drug&#46;</p></span>"
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Article information
ISSN: 20132514
Original language: English
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