As alergias podem ser desencadeadas por substancias químicas, medicamentos, proteínas de origem vegetal e animal como, por exemplo, ácaros, alimentos, fungos e venenos. Reações alérgicas desenvolvidas em resposta a venenos de animais marinhos vêm sendo pouco estudadas. Este é o primeiro estudo que descreve a indução de reação anafilática em camundongos pelo veneno de um peixe brasileiro, acompanhado da caracterização detalhada dos mediadores solúveis e celulares envolvidos no processo. Nossos resultados mostram que o veneno do peixe T. nattereri possui proteínas alergênicas capazes de desencadear um processo alérgico, caracterizado por anafilaxia mediada por IgE e IgG1 e inflamação eosinofílica de fase tardia dependente de citocinas Th2. Ainda demonstramos a regulação da resposta pela positiva pela citocina IL-4 e participação da IL-12 e IFN-<font face=\"Symbol\">g na resposta. / Allergies are a significant and widespread public health problem. Anaphylaxis reactions are inducing by foods, medications and venoms and are IgE mediated. In mice, allergy can be caused also by IgG1. The results presented here describe for the first time anaphylaxis induced by Brazilian fish venom, accompanied by detailed characterization of soluble and cellular mediators involved in the process. Together our results demonstrated that the venom of T. natereri has allergenic proteins that can trigger allergic process, a phenomenon IgE-IgG1 dependent, IL-4 mediated and regulated by IFN-<font face=\"Symbol\">g. Furthermore, we observed a positive participation of the cytokines IL-12 and IFN-<font face=\"Symbol\">g in the exacerbation of the late phase reaction.

Asma é uma doença inflamatória pulmonar crônica usualmente associada com imunidade do tipo 2, eosinofilia pulmonar, hiperreatividade brônquica (AHR), hiper-produção de muco e altos níveis de IgE. Indíviduos asmáticos podem responder aos alérgenos por duas distintas fases: uma fase imediata (EPR) e uma fase tardia (LPR), ambas não reproduzidas na maioria dos modelos murinos de asma. No presente trabalho utilizamos camundongos AIRmax e AIRmin. Verificamos que camundongos AIRmin respondem com uma AHR intrínseca a metacolina. Esta resposta intensa correlacionou-se com uma menor expressão de receptores muscarínicos do tipo 2. Camundongos AIRmax sensibilizados e desafiados com OVA, ao contrário dos AIRmin, desenvolveram LPR e AHR a MCh. Os AIRmax apresentam um denso infiltrado inflamatório com predominância de eosinófilos, uma elevada produção de muco, citocinas (IL-5 e IL-13) e anticorpos anafiláticos IgE e IgG1. De forma surpreendente animais AIRmax desenvolvem quadro alérgico pulmonar crônico que cursa com AHR a MCh e uma inflamação pulmonar com infiltrado de eosinófilos com deposição de colágeno no tecido pulmonar além de uma produção elevada de anticorpos anafiláticos. Em conclusão desenvolvemos um novo modelo murino de asma. / Asthma is a chronic inflammatory lung disease usually associated to Type 2 T helper cells, lung eosinophilia, airway hyper-reactivity (AHR), mucus hyper-secretion and increased titers of IgE. Asthmatic individuals may react to allergens by two distinct phases: an immediate phase (EPR) and a late phase (LPR) both phases were not reproduced in classical murine models of asthma. In the present study we use AIRmax AIRmin mice. We found that AIRmin mice exposed to methacholine presented intense intrinsic AHR. This intense reaction was related to a lower expression of muscarinic type 2 receptors. AIRmax mice sensitized and challenged with OVA, unlike AIRmin developed LPR and AHR to MCh. The AIRmax also developed a dense inflammatory infiltrate containing predominantly eosinophils, hyper-secretion of mucus, cytokines (IL-5 and IL-13) and anaphylactic antibodies (IgE and IgG1). Surprisingly AIRmax mice develop chronic pulmonary allergic framework that leads to AHR to MCh and lung inflammation with eosinophilic infiltration with collagen deposition in lung tissue and a high production of anaphylactic antibodies. In conclusion, we developed a new murine model of asthma.

O desenvolvimento da alergia pode ter início precoce, durante os primeiros meses de vida ou ainda durante a gestação. Em camundongos, é descrita uma predisposição ao desenvolvimento de resposta Th2 no período neonatal, contribuindo para o desenvolvimento da resposta alérgica. A maturação das funções relacionadas à resposta Th1 pelo uso de adjuvantes imunológicos no período pós-natal pode contribuir na profilaxia da asma e outras doenças alérgicas. Neste trabalho, investigamos o efeito dos oligodeoxinucleotídeos CpG na imunização com ovalbumina (OVA) e extrato do ácaro Blomia tropicalis (Bt) em camundongos nos períodos neonatal e adulto. Os resultados obtidos mostram que o ODN-CpG é capaz de diminuir a produção de anticorpos IgE, um isótipo dependente de citocinas Th2, e aumentar os níveis de anticorpos IgG2a nas imunização com OVA e Bt, inclusive na imunização com os dois alérgenos associados. Além disso, a associação do ODN-CpG na imunização neonatal com OVA promove um aumento da produção in vitro de IFN-<font face=\"symbol\">g e diminuiu a produção de IL-10. Ao compararmos a eficiência modulatória do CpG nas imunizações com OVA em camundongos adultos e neonatos, observamos um maior efeito modulatório na produção de anticorpos em adultos. Os resultados mostraram que linfócitos B de camundongos jovens não aumentam a expressão do TLR-9 mesmo após 72 horas de estímulo com CpG, enquanto nos linfócitos de adultos já é possível observar um aumento em 48 horas. Além da menor ativação dos linfócitos B, evidenciamos uma produção de IL-10 e MCP-1 significantemente aumentada na cultura de células de neonatos após estímulo in vitro com CpG. Ao avaliarmos a influência do CpG na ativação antígeno específica dos linfócitos T CD4+, mostramos que linfócitos T CD4+ de neonatos expressam mais intensamente moléculas B7 do que células de adultos após estímulo antigênico in vitro, o que sugere uma característica supressora nestas células. Esse aumento foi inibido pela adição de CpG na cultura. A indução de células Treg (CD4+CD25+Foxp3+) in vitro também foi suprimida pela adição de CpG. Nossos resultados mostram um potencial modulatório do CpG no período neonatal e adulto nas respostas a OVA e Bt. Evidenciamos, também, diferenças qualitativas e quantitativas no efeito do CpG em relação às imunizações neonatal e adulta. Considerando a suscetibilidade dos neonatos às infecções e ao desenvolvimento de alergia, torna-se importante estabelecer estratégias imunomodulatórias que potencializem as respostas inata e adaptativa e possam ser profiláticas no desenvolvimento de doenças alérgicas. / The allergy development may occur in the early life, during the pregnancy or postnatally at the first months of life. In mice, it is described a predisposition to Th2 biased response in the neonatal period, favoring the development of allergic response. The maturation of functions related to Th1 response by the use of immune adjuvants may be beneficial to the allergy prophylaxis. In this work, we evaluated the effect of CpGcontaining oligodeoxynucleotides (CpG-ODN) in the neonatal and adult immunization with ovalbumin (OVA) or the extract of house dust mite Blomia tropicalis (Bt). The results show CpG-ODN is able to decrease IgE antibody production, an isotype related to Th2 response, and increase IgG2a antibody levels in OVA or Bt immunization of A/Sn mice, even when mice were co-immunized with both allergens. Moreover, CpG-ODN association in neonate immunization with OVA increases in vitro IFN-<font face=\"symbol\">g production and decreases IL-10. Comparing the modulatory efficiency of CpG in OVA immunization of neonate and adult mice, we observed a stronger effect on antibody production in adults. Results show that B cells from young mice do not increase the TLR-9 expression upon CpG stimulation for 72 hours whereas the increase of TLR-9 in adult B cells occurs within 48 hours. Besides the lower B cell activation, we found a significant increase of IL-10 and MCP-1 secretion levels by the neonatal cells stimulated by CpG. When we evaluated the influence of CpG on CD4+ T cell activation upon antigenic stimulation, we verified an upregulation of B7 molecules expression on neonate cells than adult cells. This high expression was inhibited by the addition of CpG in the culture. The induction of regulatory T cells (CD4+CD25+Foxp3+) in vitro was also suppressed by CpG. Our results show a modulatory potential of CpG in the immune response to OVA and Bt in both neonatal and adult periods. We also evidenced qualitative and quantitative differences in the CpG effect between neonates and adults. Considering the susceptibility to infections and allergy development in newborns, it becomes important to establish immunomodulatory strategies that enhance innate and adaptive responses and are prophylactic to the development of allergic disorders.

Abstract Beta-lactoglobulin (β-lg) is the main whey protein in bovine milk. It belongs to the lipocalin protein family, and it is one of the main milk allergens. Resistance to hydrolysis is a particular feature of β-lg making it possible that β-lg reaches the small intestine in its native form. Heat treatments during milk processing may change the native structure of bovine β-lg and change its intestinal transport properties. Heat induced conformational alterations may also expose new antigenic sites. However, there have been no previous studies on the effects of heat treatment on the transport of β-lg or on its sensitizing properties. Cow's milk allergy is one of the most important food allergies affecting about 2.4% of infants. Milk proteins, including β-lg, in breast milk substitute formulas are often the earliest foreign antigens in the diet of newborns. According to the hygiene hypothesis, natural infections and vaccinations may modify the immunological balance and decrease the risk of allergy. Isoelectric precipitations followed by anion exchange and gel filtration were used to purify bovine milk β-lg in its native form. Transport of native and heat-denatured β-lg was compared in two in vitro cell models, Caco-2 and M-cells. Sensitization properties of native and heat-denatured β-lg were studied with an animal model using Hooded-Lister rats. Effects of BCG vaccination in combination with the native β-lg were also studied. Effects of different sensitizations were assessed by antibody levels in serum and inflammation locally in the gastrointestinal tract. Heat denaturation of β-lg made its transport slower in both enterocytes and M-cells. M-cells were more effective transporters of both native and heat-denatured β-lg than caco-2 cells. Animals generated higher levels of IgE when sensitized with native β-lg, but heat-denatured β-lg induced a more intense inflammatory cell reaction in the gastrointestinal tract. Vaccination with BCG decreased serum IgE concentration and modified the predominant site of the inflammatory cell response in intestine. The results indicate that, heat denaturation of β-lg and BCG vaccination, change both the systemic and the mucosal response to bovine milk β-lg. The reasons for this remain speculative. The effect of BCG vaccination is consistent with the hygiene hypothesis. The observed alteration of transport properties could be one mechanism by which heat denaturation modifies the allergenic properties of this protein, but additional studies are necessary to assess whether other mechanisms, such as exposure of new antigenic determinants are also relevant.

Abstract Respiratory syncytial virus (RSV) infection may be associated with the development of asthma and atopy. The aim of the present study was to investigate this association and the related immunological mechanisms. Seventy-six children admitted to Oulu University Hospital in 1991–1994 for an RSV infection at an age of less than 12 months and healthy controls were called for a visit at the age of 6–10 years. Twenty subjects (26%) had asthma compared with 12 controls (16%) (difference 11%, 95% confidence interval (CI) –3% to 24%). Asthma had been diagnosed significantly earlier in the subjects. Eight per cent of the subjects had at least one positive skin prick test as compared with 43% of the controls (difference –35%, 95% CI –50% to –19%). Serum concentrations of interferon-γ and soluble intercellular adhesion molecule -1 were significantly higher among the subjects than among the controls and among the subjects with asthma or current wheezing than among the corresponding controls. All children born in Finland in 1986–1995 were arranged in birth cohorts by month and year of birth and grouped by exposure to an RSV epidemic at age 0–6 months, resulting in 97 exposed and 23 unexposed cohorts. The proportions of children taking asthma medication or receiving special reimbursement for asthma medication in 1995–2002 were similar in the unexposed and exposed cohorts. Altogether 47 children born between August and November 2001 with a cord blood sample taken were admitted to hospital (n = 26) or seen in an outpatient department (n = 21) for RSV infection before the age of six months. Twenty-eight children had some other respiratory viral infection and 84 children formed a group of healthy controls. High scores on a factor combining the cord blood interleukin-6 and interleukin-8 responses (as derived by factor analysis) were shown in logistic regression analysis to predict hospitalization for RSV infection by comparison with the healthy controls (odds ratio 2.29, 95% CI 1.21 to 4.33). We suggest that RSV does not induce asthma but inborn features of immunity affect the severity of RSV infection and the postinfectious development of asthma.

Les pneumopathies d'hypersensibilité sont des maladies respiratoires liées à l'inhalation répétée de substances antigéniques. Le diagnostic nécessite la présence d'un ensemble d'arguments cliniques, radiologiques, fonctionnels et immunologiques car les symptômes sont peu spécifiques. La mise en évidence d'immunoglobulines G (IgG) spécifiques des agents étiologiques est un élément essentiel dans la prise en charge diagnostique et thérapeutique. L'objectif de ce travail de thèse était d'identifier des protéines bactériennes et fongiques reconnues par les IgG des patients atteints de la maladie du poumon de fermier (PDF) et du poumon de mécanicien (FDM), et de produire ces protéines de façon recombinante afin de développer des tests sérologiques standardisés de type ELISA. Deux micro-organismes impliqués dans le PDF (Saccharopolyspora rectivirgula et Eurotium amstelodami, un Aspergillus), et un micro-organisme impliqué dans le PDM (Mycobacterium immunogenum) ont été étudiés. L'approche immunoprotéomique développée a permis de sélectionner les protéines d'intérêt, puis de produire les antigènes recombinants correspondants par génie génétique. Des sérums de patients PDF, PDM et de témoins exposés ont été recueillis dans le cadre de protocoles cliniques multicentriques. Les performances (sensibilité, spécificité, aire sous la courbe) des tests ELISA-IgG utilisant les antigènes recombinants produits ont été évaluées par l'analyse en courbe ROV (Receiver operating characteristics). A partir des trois micro-organismes étudiés, 71 protéines immuno-réactives ont été identifiées et 28 protéines recombinantes ont été produites et testées en ELISA. Pour le diagnostic du PDM, deux antigènes recombinants, la dihydrolipoyl déshydrogénase and Facyl-CoA déshydrogénase, étaient particulièrement performants avec une sensibilité de 90% lorsqu'ils étaient utilisés en combinaison. Pour le diagnostic du PDF, deux antigènes recombinants à'Aspergillus, la Glu/Leu/Phe/Val déshydrogénase et la glucose-6-phosphate isomérase, ont permis d'obtenir une sensibilité de 89% et une spécificité de 84%. L'utilisation de trois antigènes recombinants de S. rectivirgula,SRl¥A (protéine de fonction inconnue), SRI? (catalase) et SR22 (kétol acide réducto-isomérase), ont permis d'obtenir une sensibilité et spécificité optimales de 83% et 77%. Les protéines identifiées étaient majoritairement des protéines enzymatiques, dont certaines ont été mis en évidence comme facteurs de virulence dans d'autres pathologies. Des études complémentaires, sur des modèles animaux et sur des modèles cellulaires, devront être mennées pour explorer l'implication de ces protéines dans l'induction de la maladie. Ce travail a permis d'améliorer les connaissances sur les protéines bactériennes et fongiques reconnues par les anticorps des patients atteints de PDF et de PDM, de développer des antigènes recombinants, et de mettre au point des tests sérologiques standardisés et performants. Ces tests pourront faire l'objet d'une valorisation vers l'industrie. En effet, les sérologies pour le diagnostic des PHS sont des demandes courantes dans les laboratoires d'analyse médicale. / The hypersensitivity pneumonitis is a pulmonary disease caused by repetitive inhalation of antigens. The diagnosis requires clinical, radiological, functional and immunological features because of unspecific symptoms. The identification of specifie antibodies to causative antigens is an essential way for the diagnosis and therapeutic management.The aims of this thesis work were to identify bacterial and fungal immunogenic proteins specifie to patient with farmer's lung (FL) and machine operator's lung (MOL) diseases, to synthesize specifie recombinant antigens for the development of a standardized ELISA. Two microorganisms involved in FL (Saccharopolyspora rectivirgula and Eurotium amstelodami (Aspergillus sp)), and one involved in MOL had been srudied. The immunoproteomics approach has permit to select interesting proteins and to synthesize recombinant antigens by genomics techniques. The sera from FL patients (n=52), MOL patients (n=16) and sera from exposed control subjects were recruited. ELISA-IgG using recombinant antigens efficacies were evaluated by Receiver operating characteristics analysis (sensitivity, specifïcity, area under the curve).From the three srudied microorganisms, 71 immunogenic proteins were identified and 28 recombinant antigens were produced and tested by ELISA. For the MOL diagnosis, the recombinants dihydrolipoyl dehydrogenase and acyl-CoA dehydrogenase were useful with a sensitivity of 90% when used in combination. For the FL diagnosis, two recombinant proteins from Aspergillus, Glu/Leu/Phe/Val dehydrogenase and glucose-6-phosphate isomerase had a sensitivity of 89% and a specifïcity of 84%. A combination of the three recombinant antigens from S. rectivirgula, SRI FA (unknown function), SRI 7 (catalase) and SR22 (ketol acid reductoisomerase) allowed to obtain a sensitivity of 83% and a specificity of 77%. The immunogenic proteins were mainly enzymes, and some of these have been implicated in important functions for survival or the virulence of others pathogens. Further studies are required to determine the role of these proteins in immunological or virulence processes by animal and cellular model application. This present work has improved our knowledge about bacterial and fungal proteins recognized by FL and MOL patient's antibodies, and to develop useful standardized serological tests with new recombinant antigens. These tests could be exported to the health management in industry. Indeed, hypersensitivity pneumonitis serodiagnosis tests are common requests in medical analysis laboratories

Les cellules NK sont classiquement décrites comme des lymphocytes effecteurs du système immunitaire inné, dotées d’un jeu limité de récepteurs permettant la reconnaissance de cellules tumorales ou infectées par des pathogènes, et dépourvues de capacités de mémoire immunitaire. Des travaux récents montrent cependant que les cellules NK semblent douées de diverses propriétés « adaptatives » proches de celles des lymphocytes T (LT). L’étude princeps de ce nouvel aspect de la biologie des cellules NK a été réalisée dans un modèle murin d’hypersensibilité retardée (HSR) aux haptènes, et démontre qu’en l’absence des effecteurs classiques de ces réactions (LT), les cellules NK sont capablesd’induire des réactions d’HSR. La première partie de ce travail de thèse a consisté à étudier la contribution des cellules NK dans l’initiation et le développement des réactions d’HSR en présence des effecteurs classiques (LT). Nous montrons ainsi que bien que des cellules NK « mémoires » spécifiques de l’haptène soient retrouvées dans le foie des souris de type sauvage sensibilisées, leur contribution à la réaction d’HSR est mineure. Par contre, si ces cellules NK mémoires sont transférées à une souris receveuse dépourvues de LT nonsensibilisée, elles sont capables d’induire des réactions d’HSR lors d’un nouveau contact avec l’haptène. Dans la deuxième partie, nous avons comparé les réactions d’HSR induites par les cellules NK et les lymphocytes T mémoires dans ce système de transfert. Nous mettons en évidence que les réactions développées par les cellules NK sont d’une durée limitée et qu’elles impliquent un oedème avec peud’infiltration par les cellules immunitaires, au contraire des réactions induites par les cellules T mémoires. Enfin, dans la troisième partie de ce travail, nous avons analysé le compartiment cellulaire NK circulant chez des patients souffrant de pathologies inflammatoires cutanées dans lesquelles les LT ont un rôle clairement identifié à ce jour. Nous rapportons des modifications qualitatives et quantitatives de ces cellules, suggérant leur implication potentielle dans la physiopathologie de ces maladies. L’ensemble de ces données confirme donc l’existence de cellules NK « mémoires », dont le rôle physiologique en présence des effecteurs adaptatifs classiques reste encore aujourd’hui à démontrer. / NK cells are classically defined as lymphocytes of the innate immune system, equipped with a limited set of receptors involved in the recognition of tumoral or infected cells, and devoid of immune memory. However, recent studies showed that NK cells seem endowed with various "adaptive" properties similar to those of T lymphocytes (TL). The original description of this new aspect of NK cell biology was made in a murine model of delayed-type hypersensitivity (DTH) to haptens. In this model, NK cells were found to be able to induce DTH reactions in the absence of classical DTH effectors (TL). The aim of the first part of this PhD thesis was to study the contribution of NK cells in the initiation and development of HSR reactions in the presence of classical effectors (TL). We show that although hapten-specific "memory" NK cells are generated in the liver of hapten-sensitized wild type mice, their contribution to HSR reactions is minor. By contrast, if "memory" NK cells are transferred to unsensitized recipient mice lacking T cells, they can induce DTH reactions upon a new contact with the hapten. In the second part, we compared the DTH reactions induced by NK cells and memory T lymphocytes in thistransfer system. We showed that hapten-induced skin reactions mediated by NK cells are of limited duration and associated with a weak cellular infiltrate, in contrast to memory T cell-mediated reactions. Finally, in the third part of this work, we analyzed the circulating NK cell compartment in patients suffering from inflammatory skin diseases thought to be induced by T cells. We report qualitative and quantitative changes of NK cells in patients in comparison with healthy controls, suggesting the potential involvement of NK cells in the pathophysiology of these diseases. Altogether, our data confirm the existence of "memory" NK cells, whose physiological role in the presence of conventional adaptive effectors still remains to be assessed.

In this research, beta-lactoglobulin was chemically modified by attaching different levels of stearic acid to the protein. The effect of this modification on hydrophobic!ty, emulsifying and foam properties, digestibility and allergenicity of the protein was investigated. It was found that the effect of fatty acid attachment or lipophilization depended on the amount of fatty acids attached to the protein. Incorporation of the hydrophobic ligands led to increased hydrophobic interactions, resulting in a decreasing solubility with extent of incorporation. Furthermore, the surface hydrophobicity measurements showed that the two fluorescence probes 8-anilinonaphthalene-l-sulfonate (ANS) and cis-parinaric acid (CPA) used for the surface hydrophobicity measurements were not equivalent This may support the. observation by earlier workers that ANS measures aromatic hydrophobicity and CPA aliphatic hydrophobicity. The studies on surface functional properties i.e. emulsifying and foaming properties, indicated that there was some improvement in these functional properties at low and medium levels of incorporation which decreased as the extent of fatty acid attachment further increased. The improvement, of these functional properties could be attributed to improved amphiphilicity of the proteins at these levels of incorporation. This research also showed that both high solubility and high ANS surface hydrophobicity is needed for the best emulsifying properties. In vitro digestibility studies showed a decrease in digestibility of the modified proteins with increased lipophilization. From the passive cutaneous anaphylaxis experiments, it was found that the level of fatty acid attachment to the protein had a significant effect on its ability to elicit IgE antibodies. Increased ability to elicit IgE antibodies was observed at a low level of fatty acid. When a medium level of fatty acid was attached the ability to elicit antibodies was reduced and almost completely destroyed when a higher level of fatty acid was incorporated. The above observations could be explained by the fact that the low level incorporation of fatty acid led to changes in the protein structure which exposed more allergenic sites. The almost complete destruction of the allergenicity could be attributed to denaturation of the protein which reduced or destroyed available allergenic sites. The antigenicity or binding of the modified proteins to the IgG antibodies raised against the native protein was studied by both direct and competitive enzyme linked immunosorbent assay. It was found that at low and medium levels of incorporation, the proteins demonstrated increased binding ability compared to the native protein. This was attributed to the increased exposure of antigenic sites on the protein with fatty acid incorporation. However, the protein with high level of incorporated fatty acid showed decreased binding ability. / Land and Food Systems, Faculty of / Graduate

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23105号 / 医博第4732号 / 新制||医||1050(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 竹内 理, 教授 上野 英樹, 教授 椛島 健治 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

IntroductionApproximately 5-10% of the general population report an antibiotic allergy. It has been reported that labeling of medical records with antibiotic hypersensitivity are often incorrect. As a result, antibiotic treatment choice will be increasingly difficult resulting in prolonged hospital visit, increased use of broad-spectrum antibiotics, increased frequency of side effects and the development of antibiotic resistance.AimThe primary aim was to investigate to what extent medical records were labelled with antibiotic allergy and whether these labels were adequately documented. The secondary aim was to investigate the difference in the impact of the label on the doctors’ choice of antibiotics depending on whether the doctor worked at a clinic of infectious diseases or not.MethodsA retrospective cohort study based on medical records labeled with antibiotic allergy in patients admitted to the Clinic of Infectious Diseases and the Emergency Ward at the Clinic of Medicine between 1st of January to 30th of June 2018.ResultsOf the total 1720 patients there were 132 (7,7%) patients marked with antibiotic allergy. Of these, only 21 patients (15.8%) were correctly labelled. There was no significant difference in the impact of the label on the choice of prescription between the two wards.ConclusionA substantial number of medical journals have a label for antibiotic allergy and the quality of the label is often poor with only 21 (15.8%) correct documented labels. We argue the need of education on antibiotic allergy and how to label and medical records.