history of pollinosis and the patient had negative SPT to common inhalative allergens. Our patient was provided with an emergency kit (including adrenaline) and was recommended to avoid the relevant fruits. In summary, we report, for the first time, on a German patient with an IgE-mediated allergy against blueberries, which was most likely attrib- utable to sensitization to a 10-kDa LTP. Even though sensitization to LTPs is rare in Germany, our case shows that it may be a clinically relevant and potentially dangerous food allergen outside the Mediterranean area. The authors declare that they have no conflict of interest. We are indebted to Dr Jonas Lindholm (Phadia AB, Uppsala, Sweden) for providing the Immuno- CAPs for rPru av 3 and rPru p 3 and Dr Stephan Scheurer (Paul-Ehrlich- Institut, Abteilung Allergologie, Langen, Germany) for providing r Pru av 3 for immunoblotting. *Department of Dermatology, Venereology and Allergology Universita¨tsklinikum Leipzig A.o¨.R., Leipzig Philipp-Rosenthal-Str. 23-25 04103 Leipzig Germany Tel.: +49 341 9718363 Fax: +49 341 9718609 E-mail: carl.gebhardt@medizin.uni-leipzig.de Accepted for publication 7 September 2008 Allergy 2009: 64:498–499 Ó 2009 The Authors Journal compilation Ó 2009 Blackwell Munksgaard DOI: 10.1111/j.1398-9995.2008.01923.x References 1. Marzban G, Mansfeld A, Hemmer W, Stoyanova E, Katinger H, da Camara Machado ML. Fruit cross-reactive allergens: a theme of uprising interest for consumersÕ health. Biofactors 2005;23:235–241. 2. Scheurer S, Pastorello EA, Wangorsch A, Kastner M, Haustein D, Vieths S. Recombinant allergens Pru av 1 and Pru av 4 and a newly identified lipid transfer protein in the in vitro diagnosis of cherry allergy. J Allergy Clin Immunol 2001;107:724–731. 3. Pastorello EA, Farioli L, Pravettoni V, Ortolani C, Fortunato D, Giuffrida MG et al. Identification of grape and wine allergens as an endochitinase 4, a lipid-transfer protein, and a thaumatin. J Allergy Clin Immunol 2003;111:350–359. 4. Salcedo G, Sanchez-Monge R, Diaz-Perales A, Garcia-Casado G, Barber D. Plant non- specific lipid transfer proteins as food and pollen allergens. Clin Exp Allergy 2004;34:1336–1341. 5. Pastorello EA, Ortolani C, Farioli L, Pravettoni V, Ispano M, Borga A et al. Allergenic cross-reactivity among peach, apricot, plum, and cherry in patients with oral allergy syndrome: an in vivo and in vitro study. J Allergy Clin Immunol 1994;94:699–707. 6. Malandain H, Giroux F, Cano Y. The influence of carbohydrate structures present in common allergen sources on specific IgE results. Eur Ann Allergy Clin Immunol 2007;39:216–220. Delayed hypersensitivity to bosentan A. Romano*, A. Giovannetti, C. Caruso, E. Rosato, M. Pierdominici, F. Salsano Key words: bosentan; delayed hypersensitivity; drug rash (or reaction) with eosinophilia and systemic symptoms; lymphocyte transformation test. Bosentan is a competitive antagonist of endothelin (ET)- 1 at the ET-A and ET-B recep- tors and is indicated for the treatment of pulmonary hypertension. Bosentan is generally well tolerated; never- theless, a recent study concerning the European post-marketing surveillance of bosentan (1) has reported a 7.6% inci- dence of serum aminotransferase eleva- tion in 4623 patients under treatment. To our knowledge, however, only one case of severe liver dysfunction associated with bosentan therapy has been reported. It was characterized by a very high level of serum aminotransferase, which devel- oped in the initial 4 to 6 months of treatment, and was reversible without sequelae either during continued treatment with bosentan or upon the discontinuation of therapy (2). We studied a 44-year-old Hispanic woman who had experienced a general- ized maculopapular exanthema (MPE) on the 18th day of therapy with bosentan for pulmonary hypertension caused by her scleroderma. Her symptoms subsided after 10 days of therapy with betameth- asone orally (4 mg/day on the first 1 2 3 1 A C 12 M P M P kDa 14.4 - 20.1 - 30.0 - 45.0 - 66.0 - 97.0 - A B C D E kDa 14.4 - 20.1 - 30.0 - 45.0 - 66.0 - 97.0 - B Figure 1. (A) SDS-PAGE of blueberry extract (right lane, P); the left lane (M) represents low-molecular- weight marker proteins. (B) IgE-binding of the blueberry allergic patient (1), nonallergic controls (2 and 3). (C) IgE-binding of the blueberry allergic patient without (A) and with (B, serum with 10· rPru av 3; C, serum with 50· rPru av 3) preincubation of the serum. (D) SDS-PAGE of rPru av 3 (right lane, P), the left lane (M) represents low-molecular-weight marker proteins. (E) IgE-binding of the blueberry allergic patient (1), nonallergic control (2). This is the first case of a cell-mediated hypersensitivity to bosentan diagnosed on the basis of positive responses to the lym- phocyte transformation test and a challenge. However, the latter provoked a severe reaction (DRESS). ALLERGY Net Ó 2009 The Authors Journal compilation Ó 2009 Blackwell Munksgaard Allergy 2009: 64: 496–502 499