RESUMEN
OBJECTIVE: Strict avoidance of trigger food is the primary management of food protein-induced enterocolitis syndrome (FPIES). No published data are available on active induction of tolerance with oral desensitization (OD) in FPIES. CASE REPORT: We carried out an OD in a 9 and a half years old boy with persistent acute egg FPIES. OD was performed with increasing doses of raw egg every week, starting with an initial dose of 0.2 ml. The boy presented mild and transient gastrointestinal adverse reactions when the 4 ml dose was reached. He could tolerate a whole raw egg in less than 14 months. CONCLUSIONS: Even though randomized controlled clinical trials on patients including various phenotypes of FPIES are needed, our experience is encouraging about the possible efficacy and safety of OD in this food allergy.
Asunto(s)
Desensibilización Inmunológica/métodos , Ingestión de Alimentos/inmunología , Hipersensibilidad al Huevo/dietoterapia , Hipersensibilidad al Huevo/etiología , Huevos/efectos adversos , Enterocolitis/dietoterapia , Enterocolitis/etiología , Hipersensibilidad al Huevo/inmunología , Enterocolitis/inmunología , Humanos , Lactante , Masculino , Síndrome , Resultado del TratamientoRESUMEN
Effectiveness of retinoic acid (RA) in treating food allergy is not yet clear. Using an allergic mouse model, we examined the amelioration of the severity of food allergy by daily RA intake with allergen or without. Female Balb/c mice were systemically sensitized to egg white (EW) and alum by intraperitoneal injection. Sensitized mice were provided diets supplemented with 0% (non-treated group), 0.1% EW (allergen group), 0.0017% RA (RA group), or 0.1% EW plus 0.0017% RA (RA+allergen group) with 20% casein for 4 wk. Oral food challenge (OFC) and allergic biomarkers were quantified. The decrease in rectal temperature post-OFC was significantly suppressed in the RA and RA+allergen groups compared to those in the non-treated and allergen groups, respectivety. The plasma levels of ovalbumin-specific IgE, IgA and IgG1 at the study endpoint were higher in the allergen and RA+allergen groups than those in the non-treated and RA+allergen groups, respectivety. Plasma ovalbumin-specific IgG2a levels at the study endpoint were significantly higher in the RA+allergen group than those in the RA groups. The supernatant concentrations of interleukin-10 and interferon-γ in the cultured spleen lymphocytes were highest in the RA+allergen group compared to those in the other groups. Thus, continuous intake of RA under allergen exposure ameliorated the severity of food allergy in a mouse model with food allergy.
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Alérgenos , Suplementos Dietéticos , Hipersensibilidad a los Alimentos/dietoterapia , Tretinoina/administración & dosificación , Animales , Temperatura Corporal , Modelos Animales de Enfermedad , Hipersensibilidad al Huevo/dietoterapia , Clara de Huevo , Femenino , Inmunoglobulina A/sangre , Inmunoglobulina E/sangre , Inmunoglobulina G/sangre , Interferón gamma/metabolismo , Interleucina-10/metabolismo , Linfocitos/inmunología , Linfocitos/metabolismo , Ratones , Ratones Endogámicos BALB C , Ovalbúmina/inmunologíaRESUMEN
INTRODUCTION AND OBJECTIVES: Symptom-based score (SBS) quantifies the number and severity of suspected cow's milk-related symptoms. In this study, we aimed to evaluate the efficiency of SBS in patients diagnosed with cow's milk protein (CMPA) and hen's egg allergy (HEA). MATERIALS AND METHODS: A single-center study was conducted between June 2015 and August 2017. Infants who were diagnosed with CMPA and HEA or both were enrolled in the study. SBS was applied at baseline and at one month during an elimination diet. RESULTS: One hundred and twelve patients were enrolled in the study. Of these, 56 (50%) were female. Forty-nine (43.8%) patients were diagnosed with CMPA, 39 (34.8%) patients were diagnosed with HEA and 24 (21.4%) patients were diagnosed with cow's milk protein and hen's egg allergy (CMPHEA). In the analysis of SBS, median Bristol scale and initial total symptom-based scores were significantly lower in the HEA group than others (p=0.002; p=0.025). After the elimination diet, mean SBS decrease in the CMPHEA group (11.3±4.7) was found to be higher than CMPA (8.8±3.7) and HEA (8.0±4.0) groups (p=0.009). In 41 (83.7%) patients with CMPA, 33 (84.6%) patients with HEA and 21 (87.5%) patients with CMPHEA, a ≥50% decrease in SBS was observed after the elimination diet. CONCLUSION: We may conclude that the present study suggests that SBS can be useful in monitoring the response to elimination diet in infants diagnosed with cow's milk protein and hen's egg allergy.
Asunto(s)
Hipersensibilidad al Huevo/diagnóstico , Hipersensibilidad a la Leche/diagnóstico , Proyectos de Investigación , Alérgenos/inmunología , Animales , Brasil/epidemiología , Bovinos , Preescolar , Estudios Transversales , Hipersensibilidad al Huevo/dietoterapia , Hipersensibilidad al Huevo/epidemiología , Proteínas del Huevo/inmunología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Hipersensibilidad a la Leche/dietoterapia , Hipersensibilidad a la Leche/epidemiología , Proteínas de la Leche/inmunología , Prevalencia , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Few studies on the age of resolution of Food Protein Induced Enterocolitis Syndrome (FPIES) induced by solid foods are available. In particular, for FPIES induced by egg, the mean age of tolerance acquisition reported in the literature ranges from 42 to 63 months. OBJECTIVE: We have assessed whether the age of tolerance acquisition in acute egg FPIES varies depending on whether the egg is cooked or raw. METHODS: We conducted a retrospective and multicentric study of children with diagnosis of acute egg FPIES seen in 10 Italian allergy units between July 2003 and October 2017. The collected data regarded sex, presence of other allergic diseases, age of onset of symptoms, kind and severity of symptoms, cooking technique of the ingested egg, outcome of the allergy test, age of tolerance acquisition. RESULTS: Sixty-one children with acute egg FPIES were enrolled, 34 (56%) males and 27 (44%) females. Tolerance to cooked egg has been demonstrated by 47/61 (77%) children at a mean age of 30.2 months. For 32 of them, tolerance to raw egg has been demonstrated at a mean age of 43.9 months. No episodes of severe adverse reaction after baked egg ingestion have been recorded. CONCLUSIONS: It is possible to perform an OFC with baked egg, to verify the possible acquisition of tolerance, at about 30 months of life in children with acute egg FPIES.
Asunto(s)
Culinaria/estadística & datos numéricos , Hipersensibilidad al Huevo/dietoterapia , Enterocolitis/dietoterapia , Enfermedad Aguda , Alérgenos/inmunología , Niño , Preescolar , Hipersensibilidad al Huevo/epidemiología , Proteínas del Huevo/inmunología , Enterocolitis/epidemiología , Femenino , Humanos , Tolerancia Inmunológica , Italia/epidemiología , Masculino , Estudios Retrospectivos , SíndromeRESUMEN
BACKGROUND: Previous studies suggest inclusion of baked egg and milk in the diet of children with egg or cow's milk (CM) allergy might positively affect native tolerance. However, differences in native food reactivity based on historical baked tolerance are not fully understood. OBJECTIVE: To assess differences in native egg and CM oral food challenge (OFC) outcomes based on presenting history of tolerance and exposure to these foods in the baked form. METHODS: This study is a retrospective review of all egg and CM OFCs at the Children's Hospital of Philadelphia (Philadelphia, Pennsylvania) over 4 years (Nâ¯=â¯580). History of baked ingestion was compared with OFC pass rate, eliciting dose, epinephrine use, reaction classification, and recent skin test reaction or specific immunoglobulin E level. RESULTS: There were 115 egg- and 70 CM-positive challenge reactions, with most eliciting anaphylaxis. Children tolerating baked egg passed OFC more frequently (75%) compared with children who avoided baked egg (58%; Pâ¯=â¯.01) or never ingested egg (45%; P < .0001). For positive reactions, children tolerant of baked egg reacted at higher eliciting doses of native egg (median 3.0 g, range 0.125-15.75 g) compared with those avoiding baked egg (median 0.69 g, range 0.13-10.0 g; Pâ¯=â¯.03) and those with no egg exposure (median 0.88 g, range 0.13-13.88 g; Pâ¯=â¯.01). Further, epinephrine use was lower in children tolerating baked egg (10%) compared with children avoiding baked egg (22%; Pâ¯=â¯.02) and compared with children who never ingested egg (32%; Pâ¯=â¯.0001). These differences were not observed for CM challenges. CONCLUSION: Children who historically tolerated baked egg were less sensitive to native egg during OFC compared with children whose baked reactivity was largely unknown.
Asunto(s)
Culinaria/métodos , Dieta/métodos , Hipersensibilidad al Huevo/dietoterapia , Hipersensibilidad a la Leche/dietoterapia , Adolescente , Alérgenos/inmunología , Anafilaxia/etiología , Niño , Preescolar , Hipersensibilidad al Huevo/inmunología , Femenino , Humanos , Inmunoglobulina E/sangre , Lactante , Estimación de Kaplan-Meier , Masculino , Hipersensibilidad a la Leche/inmunología , Philadelphia , Estudios Retrospectivos , Pruebas CutáneasRESUMEN
BACKGORUND: Food allergy is a rare disorder among breastfeeding babies. OBJECTIVE: Our aim was to identify responsible allergens in human milk. METHODS: We studied babies developing allergic symptoms at the time they were breastfeeding. Skin prick tests (SPT) were performed with breast milk and food allergens. Specific IgE was assessed and IgE Immunoblotting experiments with breast milk were carried out to identify food allergens. Clinical evolution was evaluated after a maternal free diet. RESULTS: Five babies had confirmed breast milk allergy. Peanut, white egg and/or cow's milk were demonstrated as the hidden responsible allergens. No baby returned to develop symptoms once mother started a free diet. Three of these babies showed tolerance to other food allergens identified in human milk. CONCLUSION: A maternal free diet should be recommended only if food allergy is confirmed in breastfed babies.
Asunto(s)
Alérgenos/inmunología , Lactancia Materna/efectos adversos , Hipersensibilidad al Huevo/inmunología , Hipersensibilidad a la Leche/inmunología , Proteínas de la Leche/inmunología , Leche Humana/inmunología , Hipersensibilidad al Cacahuete/inmunología , Alérgenos/efectos adversos , Hipersensibilidad al Huevo/diagnóstico , Hipersensibilidad al Huevo/dietoterapia , Femenino , Humanos , Inmunoglobulina E/inmunología , Lactante , Pruebas Intradérmicas , Masculino , Hipersensibilidad a la Leche/diagnóstico , Hipersensibilidad a la Leche/dietoterapia , Proteínas de la Leche/efectos adversos , Hipersensibilidad al Cacahuete/diagnóstico , Hipersensibilidad al Cacahuete/dietoterapia , Valor Predictivo de las Pruebas , Factores de RiesgoRESUMEN
BACKGROUND: The gold standard test for confirming whether a child has clinical hypersensitivity reactions to foods is the oral food challenge. Therefore, there is increasing interest in simpler diagnostic markers of food allergy, especially in children, to avoid oral food challenge. The goal of this study was to assess the diagnostic accuracy of atopy patch test in comparison with oral food challenge. METHODS: We investigated 243 children (mean age, 51 months) referred for evaluation of suspected egg or cow's milk allergy. Skin prick test and atopy patch test were carried out, and after a 2 weeks elimination diet, oral food challenge was performed. RESULTS: Two hundred and forty-three children underwent OFC to the suspected food. We found clinically relevant food allergies in 40 (65%) children to egg and in 22 (35%) to cow's milk. The sensitivity of skin prick test for both milk and egg was 92%, specificity 91%, positive predictive value 35%, and negative predictive value of 93%. Sensitivity, specificity, positive predictive value, and negative predictive value of atopy patch test for both milk and egg were 21%, 73%, 20%, and 74%, respectively. CONCLUSION: Our study suggests that there is insufficient evidence for the routine use of atopy patch test for the evaluation of egg and cow's milk allergy. OFC remains gold standard for the diagnosis of egg and milk allergy even in the presence of high costs in terms of both time and risks during application.
Asunto(s)
Alérgenos/administración & dosificación , Dermatitis Atópica/diagnóstico , Hipersensibilidad al Huevo/diagnóstico , Pruebas Inmunológicas/métodos , Hipersensibilidad a la Leche/diagnóstico , Pruebas del Parche , Administración Cutánea , Administración Oral , Factores de Edad , Alérgenos/inmunología , Animales , Bovinos , Preescolar , Dermatitis Atópica/inmunología , Hipersensibilidad al Huevo/dietoterapia , Hipersensibilidad al Huevo/inmunología , Femenino , Humanos , Pruebas Intradérmicas , Masculino , Hipersensibilidad a la Leche/dietoterapia , Hipersensibilidad a la Leche/inmunología , Valor Predictivo de las Pruebas , Reproducibilidad de los ResultadosRESUMEN
Hen eggs are an important and inexpensive source of high-quality proteins in the human diet. Egg, either as a whole or its constituents (egg yolk and white), is a key ingredient in many food products by virtue of its nutritional value and unique functional properties, such as emulsifying, foaming, and gelling. Nevertheless, egg is also known because of its allergenic potential and, in fact, it is the second most frequent source of allergic reactions, particularly in children. This review deals with the structural or functional properties of egg proteins that make them strong allergens. Their ability to sensitize and/or elicit allergic reactions is linked to their resistance to gastroduodenal digestion, which ultimately allows them to interact with the intestinal mucosa where absorption occurs. The factors that affect protein digestibility, whether increasing it, decreasing it, or inducing a different proteolysis pattern, and their influence on their capacity to induce or trigger an allergic reaction are discussed. Special attention is paid to the effect of the food matrix and the processing practices on the capacity of egg proteins to modulate the immune response.
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Alérgenos/efectos adversos , Hipersensibilidad al Huevo/dietoterapia , Proteínas Dietéticas del Huevo/efectos adversos , Industria de Procesamiento de Alimentos/métodos , Alimentos Especializados/efectos adversos , Modelos Inmunológicos , Modelos Moleculares , Alérgenos/administración & dosificación , Alérgenos/química , Alérgenos/metabolismo , Animales , Pollos , Digestión , Hipersensibilidad al Huevo/inmunología , Hipersensibilidad al Huevo/metabolismo , Hipersensibilidad al Huevo/prevención & control , Proteínas Dietéticas del Huevo/administración & dosificación , Proteínas Dietéticas del Huevo/química , Proteínas Dietéticas del Huevo/metabolismo , Alimentos Especializados/análisis , Humanos , Valor Nutritivo , Fragmentos de Péptidos/efectos adversos , Fragmentos de Péptidos/química , Fragmentos de Péptidos/metabolismo , Conformación Proteica , ProteolisisRESUMEN
Cow's milk (CM) and hen's egg allergies are among the most common food allergies in children. With evidence of increasing food allergy prevalence and more persistent disease, it has become vital to improve the management of CM and egg allergies. The ability to tolerate baked milk or egg, such as in a cake or muffin, has been associated with an increased chance of tolerance development. Studies report that about 70% of CM- and egg-allergic children can tolerate baked milk or egg and that incorporating baked milk or egg into the diet is well tolerated. Being able to add baked milk or egg into the diet can also increase quality of life by expanding the diet, boosting nutrition, and promoting inclusion in social activities. There is some debate over how baked milk and egg should be introduced, at home or in a supervised setting. Anaphylaxis and treatment with epinephrine during baked milk or egg challenges have been reported. Study of potential biomarkers to predict tolerability of baked milk and egg, such as serum specific IgE levels and skin prick test wheal diameters, is ongoing. Many parents can reliably report that their CM- or egg-allergic child is already consuming baked goods without symptoms. However, for those who cannot report such tolerance, the most prudent approach is to perform a supervised oral food challenge to determine the tolerability of baked milk and egg. The purpose of this article was to review the pathophysiology, clinical data, and safety of baked milk and egg and provide a practical guide to managing CM allergy and/or egg allergy. Recipes for baked milk and egg challenges and guidance on how to add baked milk and egg if tolerated to the child's regular diet are provided.
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Culinaria/métodos , Dieta/métodos , Hipersensibilidad al Huevo/dietoterapia , Hipersensibilidad al Huevo/inmunología , Hipersensibilidad a la Leche/dietoterapia , Hipersensibilidad a la Leche/inmunología , Niño , Humanos , Pruebas CutáneasRESUMEN
INTRODUCTION: Desensitisation or specific oral tolerance induction (SOTI) to food is a new topical-therapeutic approach of food allergy for those children who have not achieved tolerance spontaneously. The objective of this study is to induce clinical tolerance in children with persistent allergy using an oral desensitisation protocol with powdered pasteurised egg. METHODS: Seventy-two patients with egg allergy confirmed by open oral challenge test were randomly assigned to SOTI or elimination diet as a control group. Forty children (5-15 years) underwent a SOTI beginning with 1mg and increasing the dosage weekly until a dose of 10g, equivalent to an egg. The control group included 32 patients (4-15 years). RESULTS: The procedure's average duration was 10 weeks (range 4-28 weeks). Three patients were withdrawn from the protocol for persistent gastrointestinal symptoms. During SOTI, 21 children (52.5%) presented symptoms. In eight the symptoms were mild and required no treatment. In the other 13 (61.90%), the reactions were more severe. Seventeen children finished the treatment over a year ago and 20 in the past 6-12 months. Thirty-seven patients (92.5%) in the active group achieved tolerance to egg, versus 21.8% in the control group. We only found statistically significant differences (p<0.05) for skin prick tests with powdered egg at various dilutions and IgG levels with egg white after SOTI. Specific IgE concentration did not change significantly. CONCLUSIONS: Our SOTI protocol is a safe, effective treatment for food allergy and of reasonable duration, confirming that tolerance can be induced in children who have not achieved it spontaneously.
Asunto(s)
Alérgenos/uso terapéutico , Desensibilización Inmunológica/métodos , Hipersensibilidad al Huevo/terapia , Huevos , Administración Oral , Adolescente , Alérgenos/administración & dosificación , Alérgenos/efectos adversos , Anafilaxia/tratamiento farmacológico , Anafilaxia/etiología , Asma/complicaciones , Niño , Preescolar , Dermatitis Atópica/complicaciones , Relación Dosis-Respuesta Inmunológica , Hipersensibilidad al Huevo/complicaciones , Hipersensibilidad al Huevo/dietoterapia , Huevos/efectos adversos , Esofagitis Eosinofílica/etiología , Epinefrina/uso terapéutico , Femenino , Estudios de Seguimiento , Manipulación de Alimentos/métodos , Alimentos en Conserva , Liofilización , Enfermedades Gastrointestinales/etiología , Humanos , Masculino , Pasteurización , Polvos , Pruebas CutáneasRESUMEN
PURPOSE: Lysozyme, obtained from egg white, is a potential food allergen used in the dairy industry to prevent late blowing of the loaf caused by the outgrowth of clostridial spores (Cl. butyricum and Cl. tyrobutyricum) during cheese aging. The aim of this study was to evaluate the possible correlation between egg protein allergy in pediatric age and sensitization to egg lysozyme, used for the preparation of Grana Padano cheese. METHODS: The tolerability of Grana Padano cheese has been evaluated in pediatric patients allergic to egg proteins through an oral provocation test with increasing amounts of cheese containing, or not, lysozyme at 12 and 24 months of aging. RESULTS: When lysozyme-sensitized children received 12-months aged and lysozyme-containing cheese, several immediate and late adverse reactions such as itching, abdominal pain, vomiting, nausea, dermatitis, rhinitis, bronchial asthma, urticaria, and angioedema were seen in 5 out of 21 subjects; only 1 out of 21 children showed an adverse reaction after challenge with 24-months-ripened lysozyme-containing cheese. CONCLUSIONS: There is a possible relationship between the severity of allergic reactions and the lysozyme-specific IgE level in blood. In particular vomiting, hypotension, and abdominal pain were present when IgE level was higher than 7 kU/L. A ripening time of 24 months may reduce allergy problems when lysozyme-containing cheese is given to sensitized subjects, probably due to the hydrolysis of antigenic epitopes during aging.
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Antígenos/efectos adversos , Queso/efectos adversos , Dieta/etnología , Hipersensibilidad al Huevo/inmunología , Manipulación de Alimentos , Muramidasa/efectos adversos , Adolescente , Antígenos/metabolismo , Queso/análisis , Queso/microbiología , Niño , Preescolar , Clostridium butyricum/crecimiento & desarrollo , Clostridium tyrobutyricum/crecimiento & desarrollo , Hipersensibilidad al Huevo/sangre , Hipersensibilidad al Huevo/dietoterapia , Hipersensibilidad al Huevo/fisiopatología , Femenino , Fermentación , Inspección de Alimentos , Humanos , Inmunoglobulina E/análisis , Italia , Masculino , Muramidasa/metabolismo , Índice de Severidad de la Enfermedad , Factores de TiempoRESUMEN
BACKGROUND: It is controversial whether egg-allergic children should strictly avoid all forms of egg, or if regular ingestion of baked egg will either delay or hasten the resolution of egg allergy. OBJECTIVE: This is the first study to examine the relationship between frequency of baked egg ingestion and rate of decline in egg skin prick test size in egg-allergic children. METHODOLOGY: This was a retrospective clinical cohort study. All children with challenge-proven egg allergy who attended the Royal Children's Hospital Allergy Department 1996-2005 and had at least two egg skin prick tests performed in this period were included (n = 125). Frequency of baked egg ingestion was assessed by telephone questionnaire as follows: (a) frequent (> once per week), (b) regular (> once every 3 months, up to ≤ once per week) or (c) strict avoidance (≤ once every 3 months). The relationship between frequency of baked egg ingestion and rate of decline in egg skin prick test size was examined by multiple linear regression, adjusting for potential confounders. RESULTS: Mean rate of decline in egg skin prick test size in all children was 0.7 mm/year (95% CI 0.5-1.0 mm/year). There was no evidence (P = 0.57) that the rate of decline in egg skin prick test size differed between children who undertook frequent ingestion (n = 21, mean 0.4 mm/year, 95% CI -0.3-1.2 mm/year), regular ingestion (n = 37, mean 0.9 mm/year, 95% CI 0.4-1.4 mm/year) or strict avoidance (n = 67, mean 0.7 mm/year, 95% CI 0.4-1.1 mm/year) of baked egg. CONCLUSIONS: Compared with strict dietary avoidance, frequent consumption of baked egg was not associated with a different rate of decline in egg skin prick test size in egg-allergic children. CLINICAL RELEVANCE: Given that dietary restrictions can adversely impact on the family, it is reasonable to consider liberalizing baked egg in the diet of egg-allergic children.
Asunto(s)
Culinaria , Dieta , Hipersensibilidad al Huevo/inmunología , Huevos/efectos adversos , Niño , Preescolar , Hipersensibilidad al Huevo/dietoterapia , Femenino , Humanos , Tolerancia Inmunológica , Masculino , Pruebas Cutáneas , Encuestas y CuestionariosAsunto(s)
Hipersensibilidad al Huevo , Conocimientos, Actitudes y Práctica en Salud , Hipersensibilidad a la Leche , Educación del Paciente como Asunto , Anafilaxia/tratamiento farmacológico , Anafilaxia/epidemiología , Anafilaxia/etiología , Cuidadores , Preescolar , Dieta , Hipersensibilidad al Huevo/complicaciones , Hipersensibilidad al Huevo/dietoterapia , Epinefrina/administración & dosificación , Familia , Conducta Alimentaria , Humanos , Hipersensibilidad a la Leche/complicaciones , Hipersensibilidad a la Leche/dietoterapia , PadresRESUMEN
BACKGROUND: Eosinophilic esophagitis (EoE) is of growing interest for pediatricians and allergists. There is no general agreement about diagnostic and clinical management procedures. The objective of this prospective, observational study was to evaluate the efficacy of a protocol for the etiologic diagnosis and accurate treatment of EoE in the pediatric population. PATIENTS AND METHODS: Starting in 2001, patients aged 0 to 14 years with a diagnosis of EoE were consecutively included in a protocol which included an allergy study. Depending on the results, an avoidance or elemental diet was established. Topical corticosteroids were prescribed to patients who rejected the diet. Clinical, endoscopic, and histological evaluation was performed to assess response. In the case of disease remission, challenge tests were performed to identify the offending food. RESULTS: Seventeen patients were included. Most of them were male (14/17) and a high percentage (88%) had a history of allergy as well as a history of atopy in parents. Fifteen patients were sensitized to 1 or more foods. With this protocol and the subsequent treatment, 9 out of 17 patients were cured (1 out of 4 with swallowed corticosteroids, 3 out of 3 with an elemental diet, and 5 out of 12 with an avoidance diet). The offending food was identified in 8117 patients. Milk and eggs were the most common foods implicated. CONCLUSIONS: The allergy study was a useful diagnostic tool but it was not sufficient to identify the offending food.An elemental diet should be attempted before food is excluded as the cause of the disease.
Asunto(s)
Esofagitis Eosinofílica/diagnóstico , Esofagitis Eosinofílica/terapia , Hipersensibilidad a los Alimentos/diagnóstico , Hipersensibilidad a los Alimentos/terapia , Administración Oral , Adolescente , Niño , Preescolar , Protocolos Clínicos , Hipersensibilidad al Huevo/diagnóstico , Hipersensibilidad al Huevo/dietoterapia , Hipersensibilidad al Huevo/terapia , Esofagitis Eosinofílica/dietoterapia , Femenino , Hipersensibilidad a los Alimentos/dietoterapia , Alimentos Formulados , Glucocorticoides/administración & dosificación , Glucocorticoides/uso terapéutico , Humanos , Masculino , Hipersensibilidad a la Leche/diagnóstico , Hipersensibilidad a la Leche/dietoterapia , Hipersensibilidad a la Leche/terapia , Resultado del TratamientoRESUMEN
IgE-mediated egg allergy is a common childhood food allergy affecting about 1-2% of 2-yr-old children. Egg avoidance is the mainstay of treatment for egg allergy; however, it is unclear what type of dietary advice parents of children with egg allergy receive and to what extent this dietary advice is adhered to. This study aimed to assess: (i) the type and source of dietary advice parents receive in a tertiary hospital setting, (ii) how closely parents adhere to advice given, (iii) what patient characteristics influenced adherence to diet and (iv) whether strict adherence to dietary advice was an identifiable factor in whether children outgrew their egg allergy. In 2006, a questionnaire was sent to 261 parents of children seen in a tertiary paediatric allergy clinic in 2003 and diagnosed with egg allergy which included 84 children who had undergone an in-hospital open oral egg challenge during this time period (2003-2006). Questions included demographic data, details of egg allergy, dietary avoidance and attainment of unrestricted egg ingestion. Of 199 questionnaires confirmed received, 167 were returned (84%). The mean age of the cohort was 6.6 yr with an average of 5.5 yr of follow-up since the first reaction. Sixty-eight percent of subjects reported avoidance of all food containing egg all the time. Forty-seven percent of the children had been accidentally exposed to egg. The severity of the initial reaction did not appear to influence adherence to an advised diet. Of the 84 children who underwent in-hospital open egg challenges, 57 children were able to ingest egg without clinical reaction and were classified as having outgrown their egg allergy. These children did not differ from those who were challenge positive to egg in terms of either the dietary advice they received or the degree to which they had undertaken strict avoidance of egg. In addition, children who had outgrown their egg allergy did not differ from those who remained egg-allergic on in-hospital challenge in terms of either the frequency of accidental ingestion or the severity of initial reaction. Strict avoidance of egg and accidental ingestion of egg did not appear to influence the acquisition of tolerance.
Asunto(s)
Dieta/normas , Hipersensibilidad al Huevo/dietoterapia , Hipersensibilidad al Huevo/inmunología , Tolerancia Inmunológica , Cooperación del Paciente , Administración Oral , Alérgenos/inmunología , Niño , Dieta/efectos adversos , Proteínas del Huevo/inmunología , Estudios de Seguimiento , Humanos , Pruebas Cutáneas , Encuestas y CuestionariosRESUMEN
BACKGROUND: Atopic eczema (AE) is a non-infective chronic inflammatory skin disease characterised by an itchy red rash. OBJECTIVES: To assess the effects of dietary exclusions for the treatment of established atopic eczema. SEARCH STRATEGY: We searched The Cochrane Skin Group Specialised Register (to March 2006), The Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 1, 2006), MEDLINE (2003 to March 2006), EMBASE (2003 to March 2006), LILACS (to March 2006), PsycINFO (1806 to March 2006), AMED (1985 to March 2006), ISI Web of Science (March 2006), www.controlled-trials.com, www.clinicaltrials.gov and www.nottingham.ac.uk/ongoingskintrials (March 2006). Pharmaceutical companies were contacted where appropriate for reviews or unpublished trials. SELECTION CRITERIA: People who have atopic eczema as diagnosed by a doctor. DATA COLLECTION AND ANALYSIS: Two independent authors carried out study selection and assessment of methodological quality. MAIN RESULTS: We found 9 RCTs involving a total of 421 participants of which 6 were studies of egg and milk exclusion (N=288), 1 was a study of few foods (N=85) and 2 were studies of an elemental diet (N=48). There appears to be no benefit of an egg and milk free diet in unselected participants with atopic eczema. There is also no evidence of benefit in the use of an elemental or few-foods diet in unselected cases of atopic eczema. There may be some benefit in using an egg-free diet in infants with suspected egg allergy who have positive specific IgE to eggs - one study found 51% of the children had a significant improvement in body surface area with the exclusion diet compared to normal diet (RR 1.51, 95% CI 1.07 to 2.11) and change in surface area and severity score was significantly improved in the exclusion diet compared to the normal diet at the end of 6 weeks (MD 5.50,95% CI 0.19 to 10.81) and end of treatment (MD 6.10, 95% CI 0.06 to12.14). Methodological difficulties have made it difficult to interpret these studies. Poor concealment of randomisation allocation, lack of blinding and high dropout rates without an intention-to-treat analysis indicates that these studies should be interpreted with great caution. AUTHORS' CONCLUSIONS: There may be some benefit in using an egg-free diet in infants with suspected egg allergy who have positive specific IgE to eggs. Little evidence supports the use of various exclusion diets in unselected people with atopic eczema, but that may be because they were not allergic to those substances in the first place. Lack of any benefit may also be because the studies were too small and poorly reported. Future studies should be appropriately powered focusing on participants with a proven food allergy. In addition a distinction should be made between young children whose food allergies improve with time and older children/adults.
Asunto(s)
Dermatitis Atópica/dietoterapia , Hipersensibilidad al Huevo/dietoterapia , Alimentos Formulados , Humanos , Hipersensibilidad a la Leche/dietoterapia , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: Specific oral tolerance induction (SOTI) seems to be a promising treatment of food allergy. Specific oral tolerance induction and elimination diet were compared with respect to efficacy rate and patterns of clinical reaction. METHODS: Children with challenge proven immunoglobulin E (IgE)-mediated cow's milk (CM) allergy or hen's egg (HE) allergy were randomly assigned to SOTI or elimination diet as a control group. Specific oral tolerance induction treatment was performed at home on a daily basis according to a study protocol with fresh CM or lyophilized HE protein. Re-evaluation of clinically relevant food allergy was performed by food challenge after a median of 21 months. Children in the SOTI group received a secondary elimination diet for 2 months prior to follow-up challenge to evaluate persistence of induced oral tolerance. RESULTS: At follow-up challenge, nine of 25 children (36%) showed permanent tolerance in the SOTI group, three of 25 (12%) were tolerant with regular intake and four of 25 (16%) were partial responders. In the control group, seven of 20 children (35%) were tolerant. Allergen-specific immunoglobulin E decreased significantly both in children who developed natural tolerance during the elimination diet (P < 0.05) and in those with SOTI (P < 0.001). CONCLUSIONS: Specific oral tolerance induction seems a valid treatment option for patients with persistent food allergy. Indications may be given if avoidance cannot be guaranteed or for those who are eager to eat the food in question. Advantages of SOTI are the increased threshold dose for allergic reactions and the substantially reduced risk of severe allergic reactions after inadvertent ingestion of the allergen. However, careful monitoring during SOTI is mandatory.
Asunto(s)
Alérgenos/administración & dosificación , Desensibilización Inmunológica , Hipersensibilidad al Huevo/terapia , Inmunoglobulina E/sangre , Hipersensibilidad a la Leche/terapia , Administración Oral , Adolescente , Alérgenos/inmunología , Niño , Preescolar , Desensibilización Inmunológica/efectos adversos , Hipersensibilidad al Huevo/dietoterapia , Hipersensibilidad al Huevo/inmunología , Femenino , Humanos , Tolerancia Inmunológica , Inmunoglobulina E/inmunología , Lactante , Masculino , Hipersensibilidad a la Leche/dietoterapia , Hipersensibilidad a la Leche/inmunologíaRESUMEN
About 2% of the general population and up to 6% of children suffer from food allergy. Cow's milk is charged with a important role in infancy after weaning, since conventional formula are based on its procession. IgE-mediated and Non-IgE- mediated allergic reactions, which are different in manifestation and pathogenesis, can be distinguished. A special role play the exacerbation of atopic dermatitis and the gastrointestinal-food-hypersensitivity-reactions. Skin-prick-test and determination of specific IgE are important diagnostic tools beside medical history. The golden standard of diagnosis is the double-blind-placebo-controlled-food- challenge. The clear result from food-challenge allows to verify suspected food allergies or, on the other hand, to avoid unnecessary diets. Extensively-hydrolysed-formula or Amino-acidformula are a high nutritional value alternative in case of proved cow's milk allergy in infancy.
Asunto(s)
Vías Clínicas , Hipersensibilidad a la Leche/diagnóstico , Animales , Bovinos , Niño , Preescolar , Comorbilidad , Dermatitis Atópica/diagnóstico , Dermatitis Atópica/dietoterapia , Dermatitis Atópica/inmunología , Hipersensibilidad al Huevo/diagnóstico , Hipersensibilidad al Huevo/dietoterapia , Hipersensibilidad al Huevo/inmunología , Hipersensibilidad a los Alimentos/diagnóstico , Hipersensibilidad a los Alimentos/dietoterapia , Hipersensibilidad a los Alimentos/inmunología , Humanos , Inmunoglobulina E/sangre , Lactante , Pruebas Intradérmicas , Hipersensibilidad a la Leche/dietoterapia , Hipersensibilidad a la Leche/inmunología , PronósticoRESUMEN
Issues on empirical dietary restriction or supplementation are important but inadequately studied in children with atopic eczema (AE). The dietary habits of children with AE followed at a paediatric dermatology clinic (n = 179) were compared with those without eczema (n = 78). The mothers of 53% of the patients with or without eczema did not breastfeed their children. Common food items avoided by parents whose children have moderate-to-severe AE included fish or seafood [64% vs. 32% of controls, odds ratio (OR) 3.84, 95% CI 2.12-6.95], beef (42% vs. 17%; OR = 3.57, 95% CI 1.79-7.11), eggs (34% vs. 14%; OR = 3.05, 95% CI 1.46-6.34) and cows' milk (18% vs. 4%; OR = 5.56, 95% CI 1.61-19.12); whereas their avoidance was less frequent in children with noneczematous diseases. The avoidance of these foods were often based on belief, but 66% of all AE patients who had avoided any of the above foods reported previous experience of eczema exacerbation by these items. Patients with moderate-to-severe AE were more likely to have consumed 'bird's nest' soup and traditional Chinese medicines. It is important to evaluate whether the AE patients are genuinely 'allergic' to some of these food items. Management is suboptimal if children with food allergy and severe disease continue to consume the culprit food. Conversely, avoidance of common foods in children without food allergy could result in food faddism or malnutrition.
Asunto(s)
Dermatitis Atópica/dietoterapia , Dieta/efectos adversos , Automedicación , Adolescente , Adulto , Lactancia Materna , Niño , Preescolar , Suplementos Dietéticos , Hipersensibilidad al Huevo/dietoterapia , Femenino , Hong Kong , Humanos , Lactante , Masculino , Carne/efectos adversos , Medicina Tradicional China , Hipersensibilidad a la Leche/dietoterapia , Alimentos Marinos/efectos adversosRESUMEN
The aim of this study was to assess the preventive effect of exclusive breast-feeding and early solid food avoidance on atopic dermatitis (AD) in infancy. This study is part of a dietary clinical trial in a prospective cohort of healthy term newborns at risk of atopy. It was recommended to breast-feed for at least 4 months and to avoid solid food in the same time-period. Eight hundred and sixty-five infants exclusively breast-fed, and 256 infants partially or exclusively formula-fed, were followed-up until the end of the first year following birth. AD and sensitization to milk and egg were considered as study end-points. The 1-year incidence of AD was compared between the two study groups. Adjusted odds ratios (OR) with 95% confidence intervals (CI) were calculated by multiple logistic regression. The incidence of AD was calculated in relation to age at introduction of solid food and amount of food given. In the breast-fed group, the adjusted OR for AD was 0.47 (95% CI 0.30-0.74). The strongest risk factor was the occurrence of AD in the subject's core family. The risk of infants with AD to be sensitized to milk was four times higher, and to egg eight times higher, than in infants without AD. Age at first introduction of solid food and diversity of solid food showed no effect on AD incidence. We conclude that in infants at atopic risk, exclusive breast-feeding for at least 4 months is effective in preventing AD in the first year of life.