Onset of Nut Allergy in a Pediatric Cohort: Clinical and Molecular Patterns in the AFRUSEN Study.

BACKGROUND AND OBJECTIVE: Nut allergy is a growing problem, yet little is known about its onset in children. Objective: To characterize the onset of nut allergy in children in southern Europe. METHODS: The study population comprised consecutive patients up to 14 years of age who visited allergy departments with an initial allergic reaction to peanut, tree nut, or seed. The allergy work-up included a clinical history, food challenge, skin prick testing, determination of whole-extract sIgE, and ImmunoCAP ISAC-112 assay. RESULTS: Of the 271 children included, 260 were first diagnosed with nut allergy at a mean age of 6.5 years and at a mean (SD) of 11.8 (21.2) months after the index reaction. The most common culprit nuts at onset were walnut (36.5%), peanut (28.5%), cashew (10.4%), hazelnut (8.5%), pistachio (5.4%), and almond (5%). Onset of peanut allergy was more frequent in children ≤6 years and walnut in those aged >6 years (P=.032). In 65% of cases, the allergic reaction occurred the first time the patient consumed the nut, and 35% of reactions were anaphylactic. Overall, polysensitization to nuts was detected by skin prick testing in 64.9% of patients, although this rate was lower among walnut-allergic children (54.7%) and peanut-allergic children (54.1%) (P<.0001). Sensitization to 2S albumins was predominant (75%), especially Jug r 1 (52.8%), whereas sensitization to lipid transfer proteins was less relevant (37%). CONCLUSION: In the population we assessed, the onset of nut allergy occurred around 6 years of age, slightly later than that reported in English-speaking countries. Walnut was the main trigger, followed by peanut. 2S albumin storage proteins, especially Jug r 1, were the most relevant allergens. This study will help guide management and may contribute to preventive strategies in pediatric nut allergy.

Food protein-induced enterocolitis syndrome by fish: Not necessarily a restricted diet.

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food hypersensitivity usually due to cow's milk or soy. Recent researches show that fish is 1 of the most important triggers of FPIES in the Mediterranean countries. Due to the risk of multiple-food FPIES, avoiding foods in the same category or that often occur together may be reasonable. The aim of this study was to evaluate the evolution and follow-up of FPIES related to fish over a period of 20 years. We describe the clinical features of our population, discuss different approaches to oral food challenges, and analyze the possibility of introducing the culprit fish or other nonrelated fish to avoid unnecessary restricted diets.

Social Media as a Tool for the Management of Food Allergy in Children.

BACKGROUND: Food allergy markedly impairs quality of life, and avoiding the offending food requires extensive patient education. Social media have been proven a useful source of information for other chronic conditions. Our aim was to describe how pediatric patients with food allergy and their families are using social media. METHODS: We performed a cross-sectional study in the pediatric allergy unit of a tertiary hospital. Patients with food allergy were questioned about their disease and their use of social media. The survey was completed by the patients themselves in the case of those aged over 13 years and by parents or guardians in the case of younger patients. RESULTS: We included 193 patients (162 guardians, 31 adolescents). Social media were used by 109 guardians (67.3%) and 29 adolescents (90.3%), of whom 30.3% and 6.9%, respectively, used them for food allergy-related purposes. The most popular websites were Facebook for guardians (52.2%) and YouTube for teenagers (80.6%). Having cow's milk and/or egg allergy was the only feature related to using social media for food allergy. Using social media for information on food allergy did not correlate with the frequency of recent reactions, self-scored knowledge about food allergy, or opinion on evidence-based or alternative therapies for the disease. CONCLUSIONS: Most patients and guardians of patients with food allergy used social media. However, only a small portion accessed used them to increase their knowledge of the disease.

Clinical-Hematological Changes and Predictors of Severity in Acute Food Protein-Induced Enterocolitis Syndrome Reactions at Oral Food Challenge: A Multicenter Observational Study.

BACKGROUND: Oral food challenge (OFC) is the criterion standard for diagnosis of acute food protein-induced enterocolitis syndrome (FPIES). No diagnostic/prognostic biomarkers are available, and OFC assessment criteria are not validated. OBJECTIVE: To assess clinical-hematological changes and predictors of severity of FPIES reactions at OFC. METHODS: This was an observational multicenter prospective study. Children aged 0 to 18 years diagnosed with acute FPIES were recruited at follow-up OFC in 12 tertiary centers in Spain and Italy. OFC outcomes (as positive/negative/inconclusive and mild/moderate/severe) were assessed on the basis of published "2017 FPIES Consensus" criteria. Clinical characteristics were recorded, and full blood cell count was done at baseline, reaction onset, and 4 hours later. Regression analysis was performed to assess predictors of severe reactions at OFC. RESULTS: A total of 81 children had positive OFC (mild in 11% [9 of 81], moderate in 61% [49 of 81], and severe in 28% [23 of 81]). Increase in neutrophils and reduction in eosinophils, basophils, and lymphocytes were observed (P < .05). OFC was inconclusive in 19 cases despite objective signs or neutrophilia. Regression analysis showed that a 2-day OFC protocol where only 25% of an age-appropriate portion is given on day 1 (not sex, age, culprit food, cumulative dose, and previous reaction severity) was associated with reduced odds of severe reaction compared with giving multiple doses in a single day. CONCLUSIONS: Distinct hematological changes may help support FPIES diagnosis. Current OFC assessment criteria may not capture the broad spectrum of acute FPIES presentations. This 2-day protocol may be associated with a reduced risk of severe reactions. Future work should aim to develop safer OFC and non-OFC diagnostics for FPIES.

Specific oral tolerance induction in paediatric patients with persistent egg allergy.

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.

Fluctuating periodic solutions and moment boundedness of a stochastic model for the bone remodeling process.

In this work, we model osteoclast-osteoblast population dynamics with random environmental fluctuations in order to understand the random variations of the bone remodeling process in real life. For this purpose, we construct a stochastic differential model for the interactions between the osteoclast and osteoblast cell populations using the parameter perturbation technique. We prove the existence of a globally attractive positive unique solution for the stochastically perturbed system. Also, the stochastic boundedness of the solution is demonstrated using its p-th order moments for p ≥ 1. Finally, we show that the introduction of noise in the deterministic model provides a fluctuating periodic solution. Numerical evidence supports our theoretical results and a discussion of the results is carried out.

In vitro and in silico characterization of open-cell structures of trabecular bone.

This work aimed to perform a detailed in vitro and in silico characterization of open-cell structures, which resemble trabecular bone, to elucidate osteoporosis failure mechanisms. Experimental and image-based computational methods were used to estimate Young's modulus and porosities of different open-cell structures (Sawbones; Malmö, Sweden). Three different open-cell structures with different porosities were characterized. Additionally, some open-cell structures were scanned using a microcomputed tomography system (µCT) to non-destructively predict specimen Young's modulus of the structures by developing voxel-based and tetrahedral finite element (FE) models. A 3D reconstruction and FE analyses were used. The experimental and computational results with different element types (linear and quadratic tetrahedrons and voxel-based meshes) were compared with Sawbones data (Sawbones; Malmö, Sweden) revealing important differences in Young's modulus and porosities. The specimens with high and low volume fractions were best represented by linear and quadratic tetrahedrons, respectively. These results could be used to develop new osteoporosis-prevention strategies.

Diagnosis and management of hypersensitivity reactions caused by oxaliplatin.

Hypersensitivity reactions to oxaliplatin have been increasing since its introduction at the end of the 1990s, but allergy tests with antineoplastic drugs are rarely used to aid diagnosis. We describe 5 cases in which hypersensitivity reactions to oxaliplatin after several courses of chemotherapy were managed by allergy testing and desensitization. Skin prick tests were negative at 1 mg/mL in all patients, positive at 10 mg/mL in 2 tested patients, and negative in 10 control subjects. Intradermal tests were positive and not irritant at 0.01 to 0.001 mg/mL concentrations. A desensitization protocol with increasing concentrations and flow rates was successfully completed in all patients. We conclude that prick and intradermal skin tests are useful in the diagnosis of hypersensitivity reactions to oxaliplatin and that the desensitization protocol performed avoided discontinuation of chemotherapy in all patients.

Recommendations for the use of propofol in egg-allergic patients

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Is self-injectable epinephrine being used by children with food allergy?

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Anaphylaxis related to passive second-hand exposure to cannabis sativa cigarette smoke in adolescents

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