Position document: IgE-mediated cow's milk allergy.

The present document offers an update on the recommendations for managing patients with cow's milk allergy - a disorder that manifests in the first year of life, with an estimated prevalence of 1.6-3% in this paediatric age group. The main causal allergens are the caseins and proteins in lactoserum (beta-lactoglobulin, alpha-lactoalbumin), and the clinical manifestations are highly variable in terms of their presentation and severity. Most allergic reactions affect the skin, followed by the gastrointestinal and respiratory systems, and severe anaphylaxis may occur. The diagnosis of cow's milk allergy is based on the existence of a suggestive clinical history, a positive allergy study and the subsequent application of controlled exposure testing, which constitutes the gold standard for confirming the diagnosis. The most efficient treatment for cow's milk allergy is an elimination diet and the use of adequate substitution formulas. The elimination diet must include milk from other mammals (e.g., sheep, goat, etc.) due to the risk of cross-reactivity with the proteins of cow's milk. Most infants with IgE-mediated cow's milk allergy become tolerant in the first few years of life. In those cases where cow's milk allergy persists, novel treatment options may include oral immunotherapy, although most authors do not currently recommend this technique in routine clinical practice. Enough evidence is not there to confirm the efficacy of elimination diets in the mother and infant for preventing the appearance of cow's milk allergy. Likewise, no benefits have been observed with prebiotic and probiotic dietetic supplements in infants for preventing food allergy.

Recommendations for administering the triple viral vaccine and antiinfluenza vaccine in patients with egg allergy.

Actually, food allergy is an emerging pathology; and egg allergy is the most frequent in childhood. The recommendations for measles, mumps and rubella (MMR) and influenza vaccination are increasing each year. This implementation increases the exposure of patients with egg allergy to such vaccines. In Spain, since 2004 the only available vaccine for MMR is grown in cultures of fibroblast from chick embryos; previously, patients with egg allergy were vaccinated with an alternative vaccine cultivated in diploid human cells which is no longer commercialized. Influenza vaccines grow in chick egg and the final product contains egg proteins (large variation in egg protein content has been reported). As controversy exist, the Food Allergy Committee of Spanish Society of Clinical Immunology and Pediatric Allergy decided to report some recommendations for the safe administration of MMR and influenza vaccines in patients with egg allergy. In summary, MMR vaccine is safe for children with egg allergy, only in patients with severe anaphylactic reaction after egg ingestion is recommended the administration in his reference hospital. Influenza vaccine is contraindicated in patients with severe anaphylactic reaction after egg ingestion. The rest can receive influenza vaccine in a 2-dose protocol with a vaccine that contains no more than 1.2 mcg of egg protein for mL.

Position document: IgE-mediated cow's milk allergy

The present document offers an update on the recommendations for managing patients with cow's milk allergy - a disorder that manifests in the first year of life, with an estimated prevalence of 1.6-3% in this paediatric age group. The main causal allergens are the caseins and proteins in lactoserum (beta-lactoglobulin, alpha-lactoalbumin), and the clinical manifestations are highly variable in terms of their presentation and severity. Most allergic reactions affect the skin, followed by the gastrointestinal and respiratory systems, and severe anaphylaxis may occur. The diagnosis of cow's milk allergy is based on the existence of a suggestive clinical history, a positive allergy study and the subsequent application of controlled exposure testing, which constitutes the gold standard for confirming the diagnosis. The most efficient treatment for cow's milk allergy is an elimination diet and the use of adequate substitution formulas. The elimination diet must include milk from other mammals (e.g., sheep, goat, etc.) due to the risk of cross-reactivity with the proteins of cow's milk. Most infants with IgE-mediated cow's milk allergy become tolerant in the first few years of life. In those cases where cow's milk allergy persists, novel treatment options may include oral immunotherapy, although most authors do not currently recommend this technique in routine clinical practice. Enough evidence is not there to confirm the efficacy of elimination diets in the mother and infant for preventing the appearance of cow's milk allergy. Likewise, no benefits have been observed with prebiotic and probiotic dietetic supplements in infants for preventing food allergy

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[Meningitis caused by Haemophilus influenzae type B, resistant to ampicillin and chloramphenicol]. / Meningitis por Haemophilus influenzae tipo b, resistente a ampicilina y cloranfenicol.

Authors present three cases of ampicillin and chloramphenicol resistant Haemophilus influenzae type b meningitis, and one case with resistance to ampicillin and allergy to chloramphenicol. These multiresistant Haemophilus influenzae strains create very important therapeutic problems. They have used first (cefacetrile), second (cefamandole) and third (cefotaxime an moxalactam) generation cephalosporins, in order to their disponibility. There was an excellent evolution in every case. They conclude that third generation cephalosporins are useful in cases of ampicillin and chloramphenicol resistant Haemophilus influenzae type b meningitis.

Recommendations for administering the triple viral vaccine and antiinfluenza vaccine in patients with egg allergy / Recomendaciones para la administración de la vacuna triple vírica y la vacuna anti-influenza en pacientes con alergia al huevo

Actually, food allergy is an emerging pathology; and egg allergy is the most frequent in childhood. The recommendations for measles, mumps and rubella (MMR) and influenza vaccination are increasing each year. This implementation increases the exposure of patients with egg allergy to such vaccines. In Spain, since 2004 the only available vaccine for MMR is grown in cultures of fibroblast from chick embryos; previously, patients with egg allergy were vaccinated with an alternative vaccine cultivated in diploid human cells which is no longer commercialized. Influenza vaccines grow in chick egg and the final product contains egg proteins (large variation in egg protein content has been reported). As controversy exist, the Food Allergy Committee of Spanish Society of Clinical Immunology and Pediatric Allergy decided to report some recommendations for the safe administration of MMR and influenza vaccines in patients with egg allergy. In summary, MMR vaccine is safe for children with egg allergy, only in patients with severe anaphylactic reaction after egg ingestion is recommended the administration in his reference hospital. Influenza vaccine is contraindicated in patients with severe anaphylactic reaction after egg ingestion. The rest can receive influenza vaccine in a 2-dose protocol with a vaccine that contains no more than 1.2 mcg of egg protein for mL

En la actualidad, la alergia alimentaria constituye una patología emergente; siendo la alergia al huevo la más frecuente en la infancia. Las recomendaciones para la vacunación de sarampión, parotiditis y rubéola (vacuna triple vírica), así como para la vacuna antigripal, aumentan cada año. El cumplimiento de estas recomendaciones aumenta la exposición de pacientes alérgicos al huevo a dichas vacunas. En España, desde el año 2004 solo se dispone de vacuna triple vírica cultivada en fibroblastos de embrión de pollo; anteriormente, los pacientes alérgicos al huevo se inmunizaban con una vacuna alternativa cultivada en células diploides humanas que no se comercializa actualmente. La vacuna antigripal se cultiva en huevos de gallina y el producto final contiene proteína de huevo (la cantidad en proteína de huevo es muy variable). Dada la existente controversia, el Comité de Alergia Alimentaria de la Sociedad Española de Inmunología Clínica y Alergia Pediátrica ha decidido establecer una serie de recomendaciones para la administración segura de la vacuna triple vírica y la vacuna antigripal en pacientes alérgicos al huevo. En resumen, la vacuna triple vírica es segura para los niños alérgicos al huevo, sólo en los pacientes con reacción anafiláctica grave tras la ingesta de huevo se recomienda su administración en su hospital de referencia. La vacuna antigripal está contraindicada en pacientes con reacción anafiláctica grave tras la ingesta de huevo. El resto pueden vacunarse con una administración fraccionada en 2 dosis y con una vacuna que contenga igual o menos de 1.2 mcg de proteína de huevo por ml

Recomendaciones para la administración de la vacuna antigripal en pacientes alérgicos al huevo / Recommendations for administration of the influenza vaccine

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Seguridad de la vacunación triple vírica en pacientes con alergia al huevo / Safety of MMR immunization in egg-allergic children

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Alergía a las proteínas de huevo / Allergy to egg proteins

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La leche de cabra no es una alternativa válida en pacientes con alergia a las proteínas de la leche de vaca / Goat´s milk is not valid alternative in patients allergic to cow´s milk proteins

Further reflections on streptococcal pharyngitis (AU)