Exhaled breath temperature as a marker of airway remodelling in asthma: a preliminary study

(Sigma). Chemiluminescent staining was performed using Westernbreeze (PerBio Science, Aalst, Belgium). The intensity was photographed using a Chemidoc gel documentation system (BioRad Laboratories, Nazareth Eke, Belgium) and analysed with Quantity One software (BioRad). The patient showed an almost fivefold higher intensity for IgE compared with the highest control. IgE staining against S. cerevisiae was negative. Modern rHBV vaccines are manufactured by harvesting hepatitis B surface antigen (HbsAg) from cultures of recombinant strains of S. cerevisiae transfected with the HbsAg gene. HBvaxPRO contains HbsAg that is absorbed to amorphous aluminiumhydroxyphosphatesulphate. Excipients are sodium chloride, sodium borate and water. Although rHBV vaccines are considered effective and safe drugs (1), different rHBV-vaccine-related adverse events have been identified and published. The cutaneous adverse effects of rHBV comprise local and generalized reactions (2, 3). Local cutaneous events predominantly consist of transient inflammatory reactions resulting from nonspecific lymphoid or granulomatous reactions. Allergic reactions to the vaccine strain, adjuvants, conservatives or other excipients are less frequently involved in local cutaneous adverse reactions and remain anecdotal. Brightman et al. (4) described a comparable case clinic and presumed the reaction to result from an IgE-mediated S. cerevisiae allergy. We present a patient in whom the regional and temporal relationship between injection and symptoms is highly indicative of an rHBV-related adverse event. This presumption is endorsed by the positive basophil activation test (BAT) and IgE-blotting results for the vaccine and the absence of sensitization from alternative causes. The principals and diagnostic applications of the BAT are discussed elsewhere (5). It emerges that the BAT can also help diagnose allergy from rHBV. Although the BAT does not discriminate between IgE and non-IgE-mediated reactions, according to the blotting experiments, it appears that the reaction in our patient could be IgE-mediated. This finding that IgE to be involved in the pathomechanism of extensive large local reactions seems similar to the observation in Hymenoptera venom allergy (6). In our opinion, demonstration of an IgEmediated mechanism seems to preclude re-administration of rHBV in our patient. The authors would like to thank Ms Christel Mertens for her skilful technical assistance.