disorder the inverse correlation between prolactin and DHEA-S concentrations was a recognized tendency (3, 6) we investigated correlations within CU subjects for the hormones. There are however some controversies concerning the effect of prolactin on modulation of DHEA-S secretion. No significant corre- lation between serum DHEA-S and pro- lactin concentration in our CU patients might indicate that lower DHEA-S serum concentration could not be accounted for by changes in prolactin secretion. In conclusion, it seems that hyper- prolactinemia does not accompany the immune-inflammatory processes associ- ated with CU, also in the presence of positive ASST result, which suggests the autoimmune origin of the disease. We did not find any causal relationship between the reduced serum DHEA-S concentration and basal prolactin secre- tion. The lack of abnormalities in peripherally detectable hormones does not exclude the possibility of prolactin exerting immunomodulatory effects upon the urticarial inflammation. Verification of such hypothesis requires however further studies to be performed. Chair and Clinical Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, Poland *Author first and second equally contributed to this work.   Alicja Kasperska-Zaja ˛ c Chair and Clinical Department of Internal Diseases Allergology and Clinical Immunology ul. 3-go Maja 13-15, 41-800 Zabrze Poland Accepted for publication 12 November 2006 Allergy 2007: 62:566–567 Ó 2007 The Authors Journal compilation Ó 2007 Blackwell Munksgaard DOI: 10.1111/j.1398-9995.2006.01296.x References 1. De Bellis A, Bizzarro A, Pivonello R, Lombardi G, Bellastella A. Prolactin and autoimmunity. Pituitary 2005;8:25–30. 2. Schwartz KE. Autoimmunity, dehydroepiandrosterone (DHEA), and stress. J Adoles Health 2002;30S:37–43. 3. Straub RH, Zeuner M, Lock G, Scholmerich J, Lang B. High prolactin and low dehydroepiandrosterone sulphate serum levels in patients with severe systemic sclerosis. Br J Rheumatol 1997;36:426–432. 4. Kasperska-Zajac A, Brzoza Z, Rogala B. Serum concentration of dehydroepiandrosterone sulphate in female patients with chronic idiopathic urticaria. J Dermatol Sci 2006;41:80–81. 5. Kasperska-Zajac A, Brzoza Z, Rogala B. Lower serum concentration of dehydroepiandrosterone sulphate in patients suffering from chronic idiopathic urticaria. Allergy 2006;61:1489–1490. 6. Glasow A, Breidert M, Haidan A, Anderegg U, Kelly PA, Bornstein SR. Functional aspects of the effect of prolactin (PRL) on adrenal steroidogenesis and distribution of the PRL receptor in the human adrenal gland. J Clin Endocrinol Metab 1996;81:3103–3111. Anaphylaxis to multiple pollen allergen sublingual immunotherapy A. O. Eifan*, S. Keles, N. N. Bahceciler, I. B. Barlan Key words: anaphylaxis; asthma; pollen; rhinitis; sublingual immunotherapy. As the traditional subcutaneous immu- notherapy (SCIT) route of administra- tion had a high risk of serious side-effects, the sublingual immunotherapy (SLIT) has been investigated and approved as a reliable desensi- tization method for clinical use in respiratory aller- gies (1). The efficacy of SLIT for allergic rhi- nitis has been confirmed re- cently by a meta- analysis and reporting a complete absence of systemic side-effects (2). The immunotherapy task force has released a common European standard for practical allergen-specific immunotherapy which provides gold standard treatment guidelines (3). Hereby we report the first case of SLIT anaphylaxis seen in Europe. An 11-year- old girl with a history of allergic rhinitis and asthma sensitized to House Dust Mite (HDM) and seasonal pollen aero- allergens (mixture grasses, Plantago, Artemisia, Parietaria offi, Zea mays and Secale cereale), was started on standard- ized extracts of HDM (Dermatophagoides farinae : Dermatophagoides pteronyssinus 50% : 50%; stalle´rgenes, Antony, France) and seasonal pollen mixture (five grasses : four cereals 50% : 50%; stall- e´rgenes, Antony, France) SLIT with a 1 : 300 dilution in addition to inhaler and intranasal corticosteroid treatment. Three years earlier, patient was skin test reactive to multiple seasonal pollen aeroallergens and received SLIT for sea- sonal pollen of a 1 : 100 dilution of mixed extracts containing mixture of five grasses and Secale cereale (50%/50%), but discontinued by the family with their own will after one and a half year of usage due to regression of her complains. She reappeared after a 2 years lost fol- low-up with her asthma and rhinitis symptoms recurring especially during spring season. Compared with the previous skin test reactivity, she was polysensitized to a number of aeroallergens mostly seasonal aeroallergens in addition to HDM. After the induction treatment, the maintenance dosing regimens were eight drops of 300 index of reactivity (IR) for HDM taken in the morning and a mixture of pollen allergens taken in the evening three times a week was initiated. One month after starting maintenance phase, one evening during a peak spring season, she felt swelling of her lower lip 3 min after self- administering pollen SLIT drops which bulged 10 times the normal size and was accompanied with high fever, chest pain, nausea and abdominal pain. The patient was rushed to the emergency department and immediately treated for anaphylaxis and hospitalized for observation. Two days after this episode, the patient was challenged with half the usual main- tenance dose of pollen allergen at the emergency department which was toler- ated without any symptoms and dose modification was performed. Thereafter, she still had complains of swelling/burn- ing sensation under the tongue after modification dose of pollen SLIT which Risk of anaphylaxis reaction with sublin- gual immunotherapy containing mixture of multiple allergen extract. 567 ALLERGY Net