Food-protein-induced enterocolitis syndrome caused by fish.

INTRODUCTION: Food protein-induced enterocolitis syndrome (FPIES) occurs in infants. Typical symptoms include profuse vomiting and/or diarrhea several hours after ingestion of a given food. The disorder is a non-IgE mediated food hypersensitivity. The most frequently involved foods are milk and soy, but some cases of FPIES induced by solid foods have been described. We report 14 patients with FPIES due to fish protein. MATERIAL AND METHODS: History and physical examination, skin prick test (SPT) with fish allergens and Anisakis simplex, prick-by-prick test with implicated fish and determination of specific IgE antibodies against fish were performed. In eight children atopy patch test (APT) were also performed. In nine patients an open oral food challenge with the implicated fish was carried out. RESULTS: There were six boys and eight girls, aged from 9 to 12 months at diagnosis, with between two and six reactions to the offending fish proteins before the diagnosis was established. Four patients had a previous history of atopy. Presenting symptoms included diarrhea in two patients, profuse vomiting in six patients, and recurrent vomiting and subsequent diarrhea in three patients. In addition to these symptoms, associated septic appearance, apathy and lethargy were present in the remaining three patients. Onset of symptoms occurred a few minutes after fish ingestion in two patients and from 60 minutes to 6 hours in the 12 remaining patients. SPT to fish were negative in all patients. Serum food-specific IgE antibodies were negative in all patients except one. APT was positive in three patients. Open oral challenge (OC) was performed in nine infants and was positive in all. The patients were followed-up for between 1 and 7 years after diagnosis, and follow-up OC tests were performed after fish had been eliminated from the patients' diet for 3-4 years. Four patients became clinically tolerant to the causal food. Three patients currently tolerate only one type of fish (swordfish). CONCLUSIONS: We report 14 patients with FPIES caused by fish protein. The symptoms suggest a form of cell-mediated, non-IgE mediated food hypersensitivity. The gold standard for diagnosis is OC, although caution should be exercised in infants with several reactions or a recent diagnosis. After a period of elimination of the causal food from the diet, tolerance can develop.

Non-occupational allergy caused by the pine processionary caterpillar (Thaumetopoea pityocampa).

UNLABELLED: Contact with the pine processionary caterpillar induces dermatitis, usually located in exposed areas, and, less frequently, ocular lesions through a toxic-irritative mechanism. Recently, the existence of an immediate hypersensitivity mechanism has been demonstrated, mainly in occupationally exposed patients. OBJECTIVE: To present four patients who experienced allergic reactions (urticaria-angioedema and rhinitis-asthma) after non-occupational exposure to pine processionary caterpillar. PATIENTS AND METHODS: The four patients underwent allergy testing through skin prick tests (SPT), specific IgE detection and SDS-PAGE immunoblotting. One patient also underwent a specific bronchial challenge test with the pine processionary antigen. RESULTS: In all patients, both SPT with the caterpillar extract and specific IgE were positive. Western blotting showed several IgE-binding bands with molecular mass values ranging from 18 to 107 kDa. A shift in the electrophoretic mobility of some of the relevant allergens occurred under the presence of a reductive agent (beta -mercaptoethanol). The specific bronchial challenge test with pine processionary antigen performed in one of the patients also produced positive results. CONCLUSIONS: The results of this study show an immunologic IgE-mediated immediate hypersensitivity mechanism in these reactions. The processionary caterpillar's airborne urticating hairs or spicules should be considered, at least in some locations, not only as contact and occupational allergens, but also as seasonal aeroallergens.

Asthma camp. Quality of life questionnaires.

Asthma is one of the most common chronic chilhood disease. Asthmatic children need a self-management educational program, besides the medical treatment and clinical control. Camps are the ideal place to complete the educational program, to get the right control of the disease and to build the child confidence. Madrid Castilla la Mancha Allergy Society organizes every year a summer camp in a town, near Madrid. Fifty-four children stay for one week with certified allergists, fellows-in-training, nurses and cheer-leaders.Fifty-four children from 8 to 14 years old, with moderate to severe asthma participate in the camp. The camp includes educational, athletic and social activities. Campers participate daily in instructive and didactic teaching sessions. We evaluate quality of life with a questionaire filled in the camp and two months later. Results are analysed into two age groups, one between 8-10 years old and the other from 11 to 14 years old. The first group get a good management and improve their vision of the disease, quite the contrary, adolescents face up to a chronic disease with daily treatment, feeling asthma as a restriction of their autonomy. Even so, they identify crisis and learn to control them in an special risky life period. Asthma camps is a good experience for both groups and also for sanitary equipment.

[Exercise-induced anaphylaxis after apple intake]. / Anafilaxia inducida por ejercicio tras ingesta de manzana.

Exercise-induced anaphylaxis frequently is related to food ingestion, so that it receives the name of "food-dependent exercise-induced anaphylaxis". The food identification is difficult in some patients. We report two patients with apple-dependent exercise-induced anaphylaxis. STUDY: hematimetries, biochemistries, VMA and 5-HIAA in urine. Complement levels, antinuclear antibodies and viruses serology. ALLERGOLOGIC STUDY: skin prick test with a common inhalant. Skin prick test and prick by prick with different foods. Total Ig E level and specific Ig E determination by the CAP-Pharmacia System. Oral challenge test with apple, exercise test and exercise challenge test after eating an apple. Prick by prick test with fresh apple was positive. Specific Ig E determination by the CAP-Pharmacia System revealed a positive result. We get to reproduce the episode with an exercise challenge test after eating an apple in the same conditions of usual exercise in both patients.

[Cold urticaria: review of 12 cases]. / Urticaria por frío: revisión de 12 casos.

BACKGROUND: Cold urticaria is caused after exposition to cold air, water and food. It is the third more frequent physical urticaria in pediatric population. METHODS AND RESULTS: We reviewed twelve patients, studied different characteristics and obtained following results: mean age is 12 years and 9 months and it is more frequent in female subjects, atopy is present in 67 % of patients, other physical urticaria are present in 25 % and there is not familial inheritance. 83 % of patients have localized and generalized symptoms. Cold stimulation test is positive in 92 %. Cryoglobulins and cold agglutinins are negative in 100 % of patients in which these tests were made. There is infectious disease in only two patients. Cetirizine was used in most of patients and it was successful in 70 %. Mean duration is 3 years and 6 months. Only patient with negative cold stimulation test remains without symptoms. CONCLUSIONS: Cold urticaria must be initially diagnosed by cold stimulation test and clinical history. Cetirizine is effective and cause less adverse effects than other antihistamines traditionally used.