1. Markedly increased diamine oxidase during acute anaphylaxis is associated with an underlying clonal mast cell disorderMatija Rijavec, Žan Kogovšek, Jezerka Inkret, Peter Kopač, Peter Korošec, 2026, izvirni znanstveni članek Povzetek: Introduction Diamine oxidase (DAO) degrades histamine, the key mediator in anaphylaxis, yet its relationship with clonal mast cell disorder (CMD) in the context of anaphylaxis is unclear. We evaluated whether DAO during anaphylaxis differs by CMD status. Methods We enrolled 35 emergency-department patients with acute anaphylaxis to drugs (7 patients), food (2 patients), or Hymenoptera venom (26 patients). Tryptase, DAO, and histamine degradation were measured during anaphylaxis and convalescence. CMD was defined by detecting KIT p.D816V in peripheral blood leukocytes using highly sensitive qPCR. Post-mortem DAO and tryptase were also compared in two fatal Hymenoptera venom-triggered anaphylaxis (HVA) cases with CMD versus 13 non-anaphylaxis controls. Results KIT p.D816V was detected in 6 (17%); all had severe HVA and normal basal tryptase. During anaphylaxis, DAO increased markedly in CMD (median 1142%), but only modestly in KIT p.D816V-negative patients (median 20%; p < 0.0001), independent of trigger or severity. Acute DAO was ~5-fold higher in CMD (median 101 vs. 18 U/mL), while convalescent DAO was similar (both 14 U/mL). Despite markedly elevated DAO, we observed impaired histamine degradation in acute anaphylaxis plasma. Receiver-operating-characteristic analyses showed strong discrimination for CMD using acute DAO (AUC 0.92; cut-off 53 U/mL; sensitivity 83%; specificity 97%) and percentage increase from convalescence (AUC 0.97; cut-off 223%; sensitivity 83%; specificity 100%). Post-mortem DAO lacked specificity, whereas post-mortem tryptase supported the diagnosis of fatal anaphylaxis and CMD. Conclusion DAO concentrations rise markedly during anaphylaxis in CMD and may help identify individuals at the highest risk. Further studies should refine the diagnostic utility and elucidate the mechanisms by which DAO may amplify anaphylaxis in CMD. Ključne besede: anaphylaxis, clonal mast cell disorder, diamine oxidase, KIT p.D816V, tryptase Objavljeno v DiRROS: 06.05.2026; Ogledov: 46; Prenosov: 33
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2. Targeting of the IL-5 pathway in severe asthma reduces mast cell progenitorsAbigail P. Alvarado-Vazquez, Erika Mendez-Enriquez, Maya Salomonsson, Peter Kopač, Ana Koren, Urška Bidovec, Sabina Škrgat, Oscar E. Simonson, Valentyina Yasinska, Peter Korošec, 2025, izvirni znanstveni članek Ključne besede: asthma, benralizumab, IL-5, mepolizumab, mast cells, mast cell progenitors Objavljeno v DiRROS: 15.04.2026; Ogledov: 145; Prenosov: 88
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3. A three-dose mRNA COVID-19 vaccine regime produces both suitable immunogenicity and satisfactory efficacy in patients with solid cancersUrška Janžič, Urška Bidovec, Peter Korošec, Katja Mohorčič, Loredana Mrak, Marina Čakš, Maja Ravnik, Erik Škof, Matija Rijavec, 2023, izvirni znanstveni članek Povzetek: Background: The recommended booster third dose of vaccination against COVID-19 in cancer patients seems reasonable to protect them against a severe disease course. A prospective study was designed to assess the immunogenicity, efficacy, and safety of COVID-19 vaccination in this cohort. Methods: Patients with solid malignancies on active treatment were followed up after the primary course and booster third dose of vaccination to assess their anti-SARS-CoV-2 S1 IgG levels, efficacy in the case of SARS-CoV-2 infection, and safety. Results: Out of 125 patients receiving the primary course of vaccination, 66 patients received a booster third dose of mRNA vaccine, with a 20-fold increase in median anti-SARS-CoV-2 S1 IgG levels compared to Ab levels six months post-primary course of vaccination (p < 0.0001). After the booster third dose, anti-SARS-CoV-2 S1 IgG levels were comparable to healthy controls (p = 0.113). There was a decline in Ab levels 3 (p = 0.0003) and 6 months (p < 0.0001) post-third booster dose. No patients had either a severe disease course or a lethal outcome in the case of SARS-CoV-2 infection after the third booster dose. Conclusion: The third booster vaccination dose against COVID-19 in solid cancer patients triggers substantial immunogenicity and is safe and effective for preventing a severe COVID-19 disease course. Ključne besede: solid cancer, COVID-19 vaccination, booster third dose Objavljeno v DiRROS: 25.02.2026; Ogledov: 358; Prenosov: 181
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5. Cytokine profiles of bronchoalveolar lavage in patients with interstitial lung diseases and non-allergic asthmaDana Greif Lenarčič, Urška Bidovec, Pia Kristanc, Peter Kopač, Mateja Marc-Malovrh, Izidor Kern, Katarina Osolnik, 2025, izvirni znanstveni članek Povzetek: Diagnosing and prognosing immune-mediated airway diseases, like hypersensitivity pneumonitis (HP) and sarcoidosis, is complicated due to their overlapping symptoms and the lack of definitive biomarkers. Hence, we wanted to compare bronchoalveolar lavage (BAL) cytokine and chemokine profiles from 92 patients with different immune-mediated and inflammatory airway diseases, namely, HP, sarcoidosis, non-allergic asthma, amiodarone lung, and EGPA. We also compared pulmonary function parameters, BAL’s cellularity, and lymphocyte immunophenotypes. We found significant differences across all measured lung functions (VC, VC%, FEV1, FEV1%, and Tiff%) and in the number of macrophages, lymphocytes, neutrophils, and eosinophils. Furthermore, we showed significant differences in CD4, CD8, and CD4/8 across all included ILDs and OLDs; however, no significant differences were found in CD3, CD19, NK, or NKT. We identified nine biomarkers (IL-1β, IL-6, IL-8, IL-13, VEGF, angiogenin, C4a, RANTES, and MCP-1) that significantly differ in the BAL of patients with HP and sarcoidosis and showed that RANTES and IL-6 are associated with fibrotic outcome. We have demonstrated that interstitial and obstructive lung diseases differ in cytokine and cellular lung imprint, which may, in the future, enable the determination of the disease subtype and thus the identification of targets for the treatment of individuals or subgroups within diseases. Ključne besede: hypersensitivity pneumonitis, sarcoidosis, non-allergic asthma, amiodarone lung, EGPA, cytokines, bronchoalveolar lavage, chemokines, complement anaphylatoxins, angiogenesis-related factors Objavljeno v DiRROS: 05.08.2025; Ogledov: 777; Prenosov: 447
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6. Hereditary α − tryptasemia and peripheral blood KIT D816V mutation in patients with pediatric mastocytosisOlga Točkova, Tanja Planinšek Ručigaj, Simona Ivančan, Urška Bidovec, Matija Rijavec, Julij Šelb, 2025, izvirni znanstveni članek Povzetek: Hereditary α-tryptasemia (HαT)—a genetic trait caused by increased α-tryptase-encoding typtase alpha/beta-1 (TPSAB1) copy number—is associated with adult mastocytosis. The primary objective was to assess the association between α-tryptase and pediatric mastocytosis. We also want to evaluate whether the KIT p.D816V mutation in peripheral blood leukocytes (PBLs) reliably predicts systemic mastocytosis (SM) in children. A prospective cohort of 68 children from a referral center in Slovenia with cutaneous mastocytosis (CM) underwent tryptase genotyping by droplet digital PCR and examination for KIT p.D816V in PBL using a sensitive PCR test. A significant majority of patients (57 of 68; [83.8%]) had at least one α-tryptase-encoding gene; none had HαT. 7 of the 68 (10.3%) who were positive for KIT p.D816V in PBL, one fulfilled diagnostic criteria for indolent SM, and another was diagnosed with monoclonal mast cell activation syndrome. One of those individuals had an increased basal serum tryptase (BST) level (14.5 ng/mL). We found a high presence of germline α-tryptase in children with CM, but not HαT. By employing sensitive examination for KIT p.D816V in PBL, in combination with clinical data and other examinations, our study suggests that KIT p.D816V in PBL may indicate systemic disease in children with CM. Ključne besede: KIT D816V, hereditary α-tryptasemia, peripheral blood Objavljeno v DiRROS: 05.08.2025; Ogledov: 755; Prenosov: 500
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7. Basophil activation test predicts cetuximab anaphylaxis severity in alpha-gal IgE-positive patientsPeter Kopač, Ana Koren, Urška Bidovec, Mitja Košnik, Luka Dejanović, Tanja Mesti, Primož Strojan, Peter Korošec, Janja Ocvirk, 2024, izvirni znanstveni članek Povzetek: Upon first exposure to cetuximab, hypersensitivity reactions can occur. We aimed to assess the utility of the basophil activation test (BAT) to alpha-gal and cetuximab for predicting severe reactions. We prospectively recruited 38 patients and evaluated sIgE to alpha-gal in all patients before the first application of cetuximab. In all alpha-gal-sensitized patients, we evaluated skin tests to meat extracts, gelatine, and cetuximab and performed BAT with alpha-gal and cetuximab. In 24% (9/38) of patients, sIgE to alpha-gal was >0.10 kUA/L, and 8/9 reacted to the cetuximab. Basophil activation tests with alpha-gal were positive in all sensitized patients and were higher in those with severe reactions (18.3% in grade 4 [n = 4] vs. 1.8% in grade 2 [n = 3] or no reaction [n = 1] at 3.3 ng/mL of alpha-gal; p = 0.03). All patients with severe grade 4 reactions had a positive CD63 BAT response to cetuximab compared to patients with moderate or no reaction, who all had negative BAT (57.7% vs. 0.9% at 500 µg/mL, 63.2% vs. 4.1% at 100 µg/mL, 58.2% vs. 2.7% at 10 µg/mL, and 32.1% vs. 3.3% at 1 µg/mL of cetuximab, respectively; p ≤ 0.001). In summary, before initiating cetuximab treatment, sIgE to alpha-gal should be assessed in all patients. To predict the severity of the reaction and to assess the risk of cetuximab-induced anaphylaxis, we should perform BATs with alpha-gal or more discriminative BATs with cetuximab. Ključne besede: alpha-gal, baseline serum tryptase, basophil activation test, cetuximab, drug allergy Objavljeno v DiRROS: 22.07.2025; Ogledov: 1032; Prenosov: 516
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8. Priporočila za sistemsko onkološko in radioterapevtsko zdravljenje rakov biliarnega traktaErik Brecelj, Martina Reberšek, Ajra Šečerov Ermenc, Vesna Zadnik, Maja Ebert Moltara, Nežka Hribernik, Peter Korošec, Tanja Mesti, Janja Ocvirk, Franc Anderluh, Marko Boc, Marija Ignjatović, Ana Jeromen, Irena Oblak, Vaneja Velenik, Jelena Azarija, Neva Volk, Nena Golob, 2025, strokovni članek Povzetek: Raki biliarnega trakta so redka in heterogena skupina z naraščajočo incidenco in visoko umrljivostjo. Imajo slabo prognozo s celokupnim preživetjem manj od 1 leta. Nova dognanja o molekularno genetski heterogenosti rakov biliarnega trakta in novi terapevtskih pristopi omogočajo tem bolnikom daljša preživetja in boljšo kvaliteto življenja. V Priporočilih so predstavljena najnovejša priporočila za sistemsko onkološko zdravljenje in radioterapijo te skupine rakov, med katere po mednarodnih propročilih sedaj prištevamo karcinom žolčnika, intrahepatalne holangiokarcinome in ekstrahepatične holangiokarcinome, s perihilarnim holangiokarcinomom in karcinomom distalnega žolčevoda. Priporočila za sistemsko zdravljenje so povzeta in pripravljena na podlagi mednarodnih priporočil, ameriških, National Comprehensive Cancer Network (NCCN) in evropskih, Evropskega združenja za internistično onkologijo – European Society of Medical oncology (ESMO). Ključne besede: raki biliarnega trakta, sistemsko zdravljenje, priporočila Objavljeno v DiRROS: 18.07.2025; Ogledov: 784; Prenosov: 322
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9. Combination of experimental and bioinformatic approaches for identification of immunologically relevant protein–peptide InteractionsJerneja Debeljak, Peter Korošec, Julij Šelb, Matija Rijavec, Mitja Košnik, Mojca Lunder, 2023, izvirni znanstveni članek Povzetek: Protein–peptide interactions are an essential player in cellular processes and, thus, of great interest as potential therapeutic agents. However, identifying the protein’s interacting surface has been shown to be a challenging task. Here, we present a methodology for protein–peptide interaction identification, implementing phage panning, next-generation sequencing and bioinformatic analysis. One of the uses of this methodology is identification of allergen epitopes, especially suitable for globular inhaled and venom allergens, where their binding capability is determined by the allergen’s conformation, meaning their interaction cannot be properly studied when denatured. A Ph.D. commercial system based on the M13 phage vector was used for the panning process. Utilization of various bioinformatic tools, such as PuLSE, SAROTUP, MEME, Hammock and Pepitope, allowed us to evaluate a large amount of obtained data. Using the described methodology, we identified three peptide clusters representing potential epitopes on the major wasp venom allergen Ves v 5. Ključne besede: phage panning, next-generation sequencing, bioinformatic analysis, allergen Ves v 5, epitopes Objavljeno v DiRROS: 02.07.2025; Ogledov: 670; Prenosov: 569
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10. Hereditary α-tryptasemia is associated with anaphylaxis to antibiotics and monoclonal antibodiesPeter Korošec, Jonathan J. Lyons, Manca Svetina, Monika Koudová, Martina Bittóová, Mihaela Zidarn, Lenka Sedláčková, Matija Rijavec, Peter Kopač, 2025, izvirni znanstveni članek Povzetek: Background
Hereditary α-tryptasemia, a genetic trait caused by increased α-tryptase copy number, is associated with idiopathic and venom anaphylaxis.
Objective
We aimed to determine the impact of tryptase genotypes on drug-induced anaphylaxis.
Methods
A prospective discovery cohort of 99 patients from a referral center in Slovenia with acute anaphylaxis to drugs underwent tryptase genotyping by droplet digital PCR. For validation, we included a cohort of 26 patients from the Czech Republic. Associated inciting agents and the severity of the reactions were subsequently examined.
Results
Hereditary α-tryptasemia was associated with drug-induced anaphylaxis with a prevalence of 13% (n = 13 of 99) in the discovery cohort and 15% in the validation cohort (n = 4 of 26). Hereditary α-tryptasemia was identified in every individual with elevated basal serum tryptase levels (11.6-21.9 ng/mL; n = 14) within both cohorts of patients. Hereditary α-tryptasemia was more prevalent in individuals with antibiotic- or mAb-induced anaphylaxis in both the discovery and validation cohorts (n = 13 of 51; 26%) compared to those with anaphylaxis resulting from neuromuscular blocking agents, nonsteroidal anti-inflammatory drugs, contrast, chlorhexidine, or other drugs (n = 5 of 74; 7%; P = .02; odds ratio = 4.1; 95% CI, 1.3-11.1). Overall, we found fewer individuals with no ⍺-tryptase than in the general population, and there was a trend for subjects with more ⍺-tryptase copies to have more severe reactions. Thus, among subjects with three ⍺-tryptase copies, the prevalence of severe anaphylaxis was 73%, compared with 59% with one to two ⍺-tryptase copies and 58% for subjects without ⍺-tryptase.
Conclusions
Risk for anaphylaxis to antibiotics and biologics is associated with inherited differences in α-tryptase–encoding copies at Tryptase α/β1 . Ključne besede: immunology, drug allergy, anaphylaxis, antibiotics, monoclonal antibodies, α-tryptase, hereditary α-tryptasemia Objavljeno v DiRROS: 18.06.2025; Ogledov: 756; Prenosov: 442
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